Purely anecdotal but I'm double vaccinated (Astra Zeneca) and I caught Covid recently. It was probably Delta as 99% of cases in UK are. I know of quite a few vaccinated friends who've caught it recently too. Mainly AZ I think but one was Pfizer (single jabbed).
Anyway, none of us had severe illness although I felt pretty rough for a few days like I had a really bad cold and smell went for a week completely. I was basically fine though and everyone else I know is too who got it recently. The point is that it does seem like this Delta variant breaks through regularly and it does seem (again, purely anecdotal) like it's v infectious. Of course the thing to emphasise is that, whilst it might break through, the vaccine still stops serious illness to a high degree. It does highlight however the need to not be complacent. Vaccines don't seem to be stopping the spread right now as much as you might think, and the high number of cases combined with high vaccination rates is an obvious selection pressure. More variants are inevitably coming and it does seem like this virus is bucking the trend and not necessarily becoming less potent despite increased tranmissability in some variants
My conclusion is that, whilst I welcome the UK being sort of "back to normal", let's keep up the mask wearing, hygiene standards and so on. It's a balance but I sense things are getting a bit too lax. I'm not overly anxious but let's stick to the precautionary principle a bit more.
There’s a question of preferences that too often gets buried in this debate. If Covid becomes endemic at around its current severity, what level of pandemic restrictions are you willing to accept forever?
For me personally, Covid would have to be at least 100 times worse before I’d support masking forever. But I get the sense that some people barely see any downside to it. I think these cross-views drive so much if the underlying debate. But because we’re not talking about the hard long-term questions we’re getting bogged down in largely short term spats about case spikes, vaccine boosters, etc.
I hope I am mistaken here, but... are you saying that it would need to kill 1/6th of the population every year (instead of 1/600) before you will consider putting a piece of cloth over your face?
You're misdirecting and missing the point entirely.
While I'm not quite anti mask like the parent comment, it is an important question to consider, it is always a trade off. What severity warrant what measures? If there's still covid like now in 10 years, will we all have to wear masks at work until we retire? Is this feasible? If not, then when do we stop? Will the people advocating it ever tell us to stop? If not, do we stop without their blessing? All very important considerations that everyone should be thinking about for themselves.
> will we all have to wear masks at work until we retire
It's really funny to watch all the push back against masks considering how many uncomfortable things people put on themselves every single day, and usually just because someone told them it's cool thing to do. High heels, bras, neckties, etc. and not to forget things that we do to our bodies like implants and piercings and tattoos - most of that is way less useful and a lot more uncomfortable and even more dangerous to our bodies than wearing masks, and yet we not just accept them, we love having it.
Acceptance of masks as a regular part of clothing is just a matter of making it a cool thing to do.
The difference is that those are worn by choice, and in very specific social situations. A more comparable thing would be to shoes, or shirts, since we are talking about everyone wearing them. It's not just a matter of making it cool, hats are cool and not everyone wears a hat. Facial expression is a very important part of human interaction and I think that will always outweigh any amount of cool that can be pumped into masks.
Waitresses do not wear high heels by choice and there are some jurisdictions that have banned employers from mandating that waitresses must wear heels.
Additionally I doubt that many would chose to wear an uncomfortable necktie to work if they weren't mandated to by their employers.
Oh please enough with this "choice" argument. There's a feral organism out there trying to survive by eating us alive and you're whining about "choice"?
Let me break out the crayons and draw a simple analogy that I hope will drive the point home:
it's like complaining about curfew and how ugly blackout curtains look in your living-room, while the Nazis are trying to bomb your country back to the stone-age. Does that sound monumentally egotistic and ultimately eligible for a Darwin Award?
> Acceptance of masks as a regular part of clothing is just a matter of making it a cool thing to do.
I'm completely shocked to hear someone say this with a straight face. Humanity wearing masks over their face forever as if its a tattoo or a ring. And that's what you actually think is a good thing.
I can't express my complete disgust in that opinion.
I am surprised you didn't discuss how masks affect the most fundamental aspect of social interaction - loss of facial expressions. Our faces are so pivotal to social interaction, it is impossible to overstate.
With work from home you don't need a facial expression at all. Just close your Jira tickets quick enough, and surveillance software will ensure you are not doing anything funny in your working hours.
I guess it depends from a person to person. I actually find it relaxing, as being an Eastern European + an introvert I never really got used to American habit of smiling to everyone as a social norm. With mask I look less grumpy. :)
And also I think social interactions are constantly evolving process so, if needed, people would simply adapt to a new situation. Who knows, perhaps we'd start using our hands instead of facial expressions, just like the Belters did in The Expanse novels/series because they were limited by wearing space suits all the time.
Exactly! I think we can all disagree about preferences and risk-tolerance and that's fine. Society is about learning to live with compromise. But what I don't like is how nobody will pre-commit ahead of time about what the acceptable tradeoffs are.
What are the targets? How long do we expect restrictions to stay in place for? If we miss those targets, where do we go from there? Can we just all be clear about this up front, pre-commit and stick to the plan. I'm not even saying that unexpected conditions may necessitate calling an audible. But the burden should be on those who are asking for it to explain why they screwed up.
Right now it just feels like policymakers are making it up as they along, and virtually nobody feels like its leadership in any sense of the word.
I'd say the policy makers are making political decisions because it's a political problem in their eyes. If more people are pro mask they are going to enforce masks. If people get scared they are increasing restri tions. If people get annoyed the loosen restrictions. All they are focused on are the next elections
I don't think that's the case. It's about time to say goodbye to the illusion that we're ever going to extinguish this fire. It's seems to me the COVID is about to be become endemic, this is the new normal. It's not a far off scenario any more, so it does make sense to have this discussion, right now.
Been mulling over what I really wanted to say …
This is the par for the course on hacker news to have this kind intellectual conversations, exploring potential spaces.
However, what I was trying to convey is … it’s about being friends to each other right now, as in one big human family. And doing the right thing - which means coming together to have a conversation about how to extinguish this fire. I mean, we eliminated small pox. What happened to that human spirit of cooperation?
And to me, talking about what-ifs at this level doesn’t really address the underlying issue which is … people don’t want to figure out how to help each other - this is what we need right now otherwise it’s just another layer of drama that distracts us from what’s in front of us.
Edit : we already have a solution, which is basically - vax and mask up - we literally have people dying by the hundreds if not the thousands daily - but it’s always the government that’s the problem - and thinking about mask mandates 10 years down the road is like if “sir, our neighborhoos is on fire … can you please grab that bucket and help out” was met with “but What if it goes on for another week? Should we all be beholden to keep on filling and carrying the buckets? My house over there is fine why should I worry about that? I don’t really need to help out right now? I’m just worried that i will be forced to lug buckets forever”
> It's about time to say goodbye to the illusion that we're ever going to extinguish this fire.
That's a mischaracterisation of the above. Endemic at low levels is not the same as raging pandemic. Yes, the raging fire does actually have to be damped down to low levels before we can adjust and implement next steps after that.
But measures that are necessary during a pandemic are not the same as those necessary when a disease is endemic.
Masks are a new hygiene standard. Do you think the enlightened gentlemen doctors of the age actually set a bar of how many women should die before they began to wash their hands?
They smeared, they waffled, and now they serve as the warning to all of the the terrible, prideful (and filthy) fools who robbed families of their wives, daughters, and mothers over something people today balk at the idea of not doing- washing their hands.
Tacit defense of non-consensual disease transfer costs the arguer nothing to make and hurts others. It's far simpler to enjoy the same benefits of covering your mouth and nose that medical providers have for decades: knowing they are protecting others, whether or not they understand, appreciate, or ask for it.
Jesus Christ we aren't talking about backyard c-sections with gritty fingernails here. We are talking about breathing the air and smiling at others. Get a grip.
Sorry, I spent this morning figuring out the words to share at a friend's memorial. I've been emotional.
He was vaccinated, he wore a mask, he was careful. He did his part and hurt nobody.
I hope whoever gave it to him never finds out what it cost so they could smile at others and breathe the air. I'd trade their life for his in an instant.
Maybe he got it from a small child or someone fully vaccinated or someone who can't get the vaccine for medical reasons. Yes, fully vaccinated people can get the virus and transmit it.
Would you still trade his life for theirs in an instant ?
The Covid death rate among vaccinated people is under 0.01%[1]. One hundred times worse than the current situation would make Covid not significantly worse than seasonal influenza for the vaccinated.
Sure, one hundred times worse among those who refuse to vaccinate would be significantly worse. But if a significant proportion of the population voluntarily refuses to vaccinate, I see no reason why the rest of society should bend over backwards to protect them from their own choices.
I know it may all look like small potatoes, but this is HN and you are two orders of magnitude off.
0.01% is pretty close to annual death rate from flu in pre-COVID years [1] so the situation that "one hundred times worse than the current situation" will make it 100 hundred times worse (i.e. significantly worse) than seasonal influenza.
Okay, fair enough. But a major difference is that flu deaths are much more heavily burdened on the the young, whereas Covid is on the very elderly. The death of a 6 month old from flu results in approximately 20 times more QALY loss than an 85 year old.
Let me approach it from another angle. Pre-vaccine, it appears that Covid roughly doubled everyone's all-cause mortality.[1] Like it killed 30 year olds at a much lower rate than 90 year olds, but 30 year olds have a much lower baseline mortality to begin with. This isn't an exact relationship, but approximately about double mortality across the board. (Even interestingly enough men's excess Covid death rate is about in line with their general mortality vis-a-vis women.)
The vaccine appears to reduce the mortality risk of circulating Covid by about a factor of 100X. There's very little reason to believe that it substantially shifts the relative mortality burden between groups. So, post-vaccine Covid increases all-cause mortality broadly by about 1%. That translates into less than 1 month of lost life expectancy.[2]
>Let me approach it from another angle. Pre-vaccine, it appears that Covid roughly doubled everyone's all-cause mortality.[1] Like it killed 30 year olds at a much lower rate than 90 year olds, but 30 year olds have a much lower baseline mortality to begin with. This isn't an exact relationship, but approximately about double mortality across the board. (Even interestingly enough men's excess Covid death rate is about in line with their general mortality vis-a-vis women.)
I don't get why almost everyone compares death and disease rates of something with basically unrestricted spread(flu) with something that has had heavy precautions taken around it, i.e lockdowns, isolation, social distancing masking (Covid).
Covid would have way higher stats if it was allowed to spread unrestricted.
>Covid would have way higher stats if it was allowed to spread unrestricted.
This is scientifically false; there's no correlation between lockdown severity and covid fatality rates. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...: " Lastly, government actions such as border closures, full lockdowns, and a high rate of COVID-19 testing were not associated with statistically significant reductions in the number of critical cases or overall mortality"
> The government policy of full lockdowns (vs. partial or curfews only) was strongly associated with recovery rates (RR=2.47; 95%CI: 1.08–5.64). Similarly, the number of days to any border closure was associated with the number of cases per million (RR=1.04; 95%CI: 1.01–1.08). This suggests that full lockdowns and early border closures may lessen the peak of transmission, and thus prevent health system overcapacity, which would facilitate increased recovery rates.
No idea where you are getting the idea that the flu predominantly kills the young? It is one of the major causes of death for the old. You generally seem to just be wrong with almost all of your points?
I seriously hope it is true, i.e. COVID-19 with vaccination settles into roughly flu territory. With all-cause mortality percentages - it is important to remember that doubling all cause mortality happened during the introduction of public health measures. Has it not happened it would be much worse.
Relying on QALY results in some very strange decisions, unless you allow for negative QALY. E.g., to maximize total QALY you'd want a very large population.
What about people who can't be vaccinated? My sister in law is chronically ill and, according to her doctors, not well enough to be vaccinated. It means she is still having to isolate as much as possible.
Are you saying we should give up on protecting people like her (sacrifice her?) for the convenience of others?
People with peanut allergies stay out of Five Guys, and people with compromised immune systems will have to take their own precautions as they always have before COVID. You can still elect to wear an N95 and whatever else as long as you want, but you can't expect the whole world around you to stop for you.
Please don't forget about children who don't have a vaccine, or individuals that can't vaccinate.
Last I heard maybe next year children under 12 (?, mine is under 5) will have a vaccine. But with talk of a third shot, and possible issues with Moderna, we'll see.
Healthy children are at approximately one-in-a-million risk of dying from covid-19 if they get infected. It's more dangerous for you to drive someplace with your kid than for your kid to remain unvaccinated.
Children in risk groups should of course get vaccinated.
But we're much better off making sure the limited supply of vaccines go to older people in other parts of the world than to healthy kids in the developed world that don't need them.
Note that I said healthy children. Pretty much all of the children and teenagers who have died in the US, and elsewhere, have been in a risk group. Diabetes, usually.
If your child is in a risk group, you should be worried, and you should want that child to get vaccinated as soon as possible.
If not, it's extremely irrational to worry about your kid dying of covid because that's in lightning-strike territory.
About 400 American children have died with the majority having existing comorbidities. 50% of children have "recovered" from Covid and would already possess some immunity. Certainly its questionable whether 99.9% most kids stand to benefit much from the vaccine anyway.
Can all the people advocating for an IMO completely dystopic society where everywhere our faces are covered, point me to some peer reviewed, legit studies about masks actually working? Especially cloth masks that 80% of people use?
The only legit study ive seen is the danish one that shows masks basically do nothing to stop the spread of aerosol transmission, which COVID is.
You won't find any. Masks reduces the spread by the person who has covid, and it only reduces the spread if he wears it at all time, which is going to be the case in a study but is never going to be the case in reality.
Covid doesn't seem to be only aerosol BTW.
The only things that works at an individual level to reduce the risk to catch covid is to talk to less people. Which again is easy to do if it is chosen by the person but not going to happen if this is compulsory.
Mask works in theory but don't works when compulsory, social distancing works in theory but don't work when compulsory. Thus the probability that a legit study prove that mask mandate works exists is 0.
It does note that non-medical (e.g. cloth) masks may be less effective, but whether those are used a lot seems to depend on environment (nobody seems to use them here).
These studies do not support any claims regarding how covid spreads.
I suspect the main reason covid spread doesn't correlate with mask wearing is due to the size of the particles/aerosols, so few are wearing filtering masks (what you would wear in a painting booth), and so few masks are sealed around the face. And then mask discipline.
What I have observed is that masks are used a social queue; people wear them outside in public to signal "don't talk to me", and remove them in private when with friends. This behaviour is opposite of what would be effective, given that the right sort of masks are used, which is almost never the case.
I’m sceptical. This study measures aerosols going into a funnel centimeters away. It is also done with 10 people. This is a highly artificial situation. They even admit that they didn’t measure aerosol escapes at the top and side of masks.
What happens when you spend 15 minutes in a small room with a COVID infected person with a mask? When all side escaped aerosols spread in the room? Or in a shopping center with 10 COVID infected people? That’s the real life situation. And in that situation I’ve not seen any studies done.
To me this is basic physics. Aerosols float in the air. Any particles escaping the direct surface of the mask will float into the air. Just like dust. Except viruses are even smaller and float more. Any closed environment is likely to be saturated with virus fairly quickly, and if they aren’t filtered by a kn95 mask you will breath them in.
Edit: and I think with the new variants we are in a worse and worse situation. The initial variant needed 15 minutes of exposure to infect you apparently. I’m pretty sure delta is much much less. A few minutes or under a minute in a saturated room, mask or no mask, is prob enough
I agree with you, and think it’s kind of obvious, which is why nobody is testing for that I think.
If you spend long enough in a small room, even with someone wearing a mask the mask is not going to do much to prevent transmission.
I think that’s why the first rule of COVID is to not stay together in small rooms.
The important part is if you’ll be instantly infected by someone talking with you over the counter for a minute, and for that scenario masks are (apparently) pretty great.
The only way would be to wear N95+ masks yourself.
> The only way would be to wear N95+ masks yourself.
And properly. Almost no one wears one properly, because it requires training, correct sizing and e.g. to be shaved. Mandating that everyone wears masks without training people is lunacy. When they inevitably don't work people lose faith is science because they were told there was scientific evidence that they will help, when in fact scientific studies were made only in specific, limited conditions.
Not OP but my 2 cents is that we'll look back at this (and the time before covid) and wonder why we never mandated masks in places like doctor's offices and hospitals long before this. With Covid in the equation, maybe you extend that to places like grocery stores as well.
I think the thought process around this greatly changes if you look at the problem on a societal or individual level. For example (with fake numbers) if a cloth mask protects is 50% effective, it's worth it on a societal level (prevents 50% of infections which makes a huge impact on hospital load) but not on an individual level (you only need 1 infection to catch the disease and die).
However my problems with masks long-term on an individual level are:
- Where's it's theatrical such as outdoors; why do i need to wear a mask when running outside by myself, or when playing soccer outdoors. My city required this for a while and many people still choose to do this even while walking their dogs by themselves. Bars/restaurants; Maybe I'm wrong but it doesn't seem very helpful to wear mask for 30 seconds while you walk to your table then sit there talking/yelling for hours while eating and drinking without the mask on. Or (something i know much less about) if simple cloth masks are really less effective (on an individual vs pandemic/societal level) then N95 masks, then why is the mandate just to wear cloth masks.
- The philosophical problem of shifting the burden of protecting immune-compromised people onto all of society rather then finding a solution that is centered on them directly. Why should everyone at a concert be forced to wear a mask when a) it's a dangerous environment to be in if you don't have a health immune system. it was before the pandemic and it will be afterwards as well. b) why don't you just create an immune-compromised "vip" section instead (maybe with whatever technologies required to ensure the virus doesn't cross the boundary. c) If (again not sure on this) wearing something like an N95 mask "100%" protects the immune-compromised, why do the rest of us need to take action as well. Relying on 99% of people to protect 1% seems like it should be the last resort solution in a long-term endemic sense.
I don't think it's worth debating the details of this today because the answer will require lots of nuance and data that doesn't and cannot exist today. What variant(s) become endemic? How much of the population is considered vulnerable to those variants? What technologies are available to protect people at an individual level? How prevalent is testing 5 years from now? How effective are the vaccines over long periods of time? ect...
I agree with you that 1/6 would be unacceptable, if that's what the post you replied to intended.
On the other hand, 1/600 means between 16 and 17 dead for every 10000 people infected.
Of those 16 to 17 people, the vast majority have one or more comorbidities, mostly caused by lifestyle choices, and probably have little time left anyway.
I have nothing against wearing a mask. I quite enjoyed the anonymity ;)
I do not think cloth masks are very effective against a respiratory virus (it even says so on the box of the ones most people wore in Denmark).
I do think lockdowns are very damaging and we are going to have to live with the virus.
Their efficiency at stopping the spread is extremely small, and the whole debate takes energy away from things that actually work that we should be doing instead.
Masks are virtue-signaling talismans at best, just look at how people are actually using them.
If masks are used at a distance outdoors in the context of essential services during a lockdown with no shared indoor spaces they are ~extremely~ effective at preventing viral spread.
I agree though they are contributing arguably more harm than good now by encouraging people to feel safe making unnecessary contact.
For you personally, with Covid being 100 times as bad as it has already been, wearing or not wearing a mask would most likely no longer make any difference.
I feel like masking is such an inconsequential restriction in the grand scheme of things. If anything, we probably should just be wearing masks in enclosed spaces all the time anyway.
I for one am perfectly happy to have a mask in between myself and people's nasty sneeze air on the subway, or exhaust from the millions of vehicles on the road (I have masks with replaceable PM2.5 filter inserts), and now I'm grateful that nobody thinks I'm weird for wanting this.
Socializing is extremely high friction in a mask. Pre-mask, I'd make small talk with store clerks or waiters all the time. After masking, I can count on one hand the number of times that happened.
You struggle to understand people's muffled words, they struggle to understand yours. Facial expressions, the most important component of non-verbal communication, are half-hidden. Conveying a smile, the universal way to express warmth, is completely not possible.
Happiness psychology research has confirmed again and again that pleasant interactions with other humans is one of the primary sources of joy in our lives. Seeing each other faces is a critical component of that. People who lose their legs or arms will recover to baseline happiness in a year or so. People who's faces are disfigured never recover. The face is the core of human interaction.
If masking persists and it becomes a long-term norm, communication will evolve around the constraints. I'm reminded of a story of a Somali prisoner who was nearly suicidal in solitary confinement until a prisoner in another cell taught him something like morse code, eventually even reading him Anna Karenina, tap by tap.[0] Humans will overcome any constraints to communicate.
Inspiring but must be considered alongside all the people who struggle in prison with isolation to the deterioration of their mental and physical health, plus those who are not imprisoned who nevertheless struggle due to speech impediments, deformities and other issues that impede face-to-face interaction. We greatly benefit from normalizing a certain ease of socialization.
I wear glasses and masks are basically untenable. I have yet to wear a mask and not fog up my glasses. Maybe I'm just an idiot, I don't know, but being able to see properly is far more valuable to me than not getting COVID (in it's current state and threat level to me).
With some work it's possible to find and fit masks that don't fog glasses. Fwiw in order to work effectively as an "outbound" filter , the mask must not duct exhaled air around it's seal with the face. So fogging means it isn't working.
Then most masks, by your logic (and not necessarily arguing your logic) aren’t working.
The only way to completely seal off your mouth and nose is to wear a more fitted mask. The masks most (probably 99%+) people are wearing are ducting air on either side of the nose.
And yes, most masks have the metal piece to help with this, but it doesn’t work. No matter how I adjust the metal piece, air makes its way out.
So if what you’re saying is true, these cloth/disposable masks are not working, and the CDC should be telling everyone to stop wearing them, and switch to ones that properly seal your nose/mouth.
> With some work it's possible to find and fit masks that don't fog glasses.
I’m not convinced this is true, or maybe my face just won’t work with the typical mask. But most (all?) people I know that have glasses fog them up, with any amount of adjustment of the metal piece/mask.
EDIT: I see a downvote already, so curious how this is a flawed extrapolation. My logic is simply assuming the parent’s logic is true, and extrapolating from that. I’m not explicitly agreeing or disagreeing with it. A downvote means you either feel my extrapolation is flawed (please explain), or you think the parent’s logic is flawed (in which case you shouldn’t be downvoting my extrapolation).
I think cloth masks are at the crossroads of wishful thinking and public health theater.
They absolutely have legitimate medical uses, and can prevent droplet borne disease transmission and thus there is a plausible mechanism by which they reduce spread. But I don’t think there’s any serious evidence that they are anything more than marginal with respect to the spread of COVID.
That's not true. There have been plenty of studies showing cloth masks help significantly over nothing, and especially if it's a double layer mask. The cotton ones that are breathable are worse.
I am in the same boat with glasses. In the winter, I use some decent quality medical tape across the top of the mask to prevent fogging. The 3M medical paper tape works really well and is not too sticky and doesnt irritate my skin.
30 years ago I switched to daily contact lenses to be able to play rugby. This was one of the best switches of my life and of course today I have no problem with masks. If you can, I really advise this.
Another option would be to wear a more efficient mask, a less leaking one. I find FFP2 to be quite convenient past the first few seconds when you're surprised by the difference of air flow. Those masks have the advantage of not moving, you don't typically have to adjust them and there's no fog on glasses.
The only masks I have found that dont fog glasses are ones that have a metal wire bridge. It can be pinched to form fit the profile of your face. Now if I could just get my beard to stop pulling the mask down when I talk I would be happy.
Eating, drinking, smiling, frowning, grimacing, talking, kissing, recognizing our friends are all social activities that are impeded by masks. Humans are social animals.
People tend to take their masks off while eating, drinking and kissing. It's easy to tell when someone is smiling or frowning even if they're wearing a mask (unless their expressions are extremely subtle), and recognizing people when they're wearing a mask is no more difficult than with a mask off.
I suppose everyone's situation is different but I haven't noticed any change in the way people interact around me socially with or without a mask.
You may find this sentiment to sour in our near future in which it will be mandatory to show your face in public for facial recognition tech to keep track of you...
I agree with that. I've never felt better about walking around in public. If I trip over myself and look like a fool and someone posts it to Instagram, nobody will know it's me! It's great!
(No I've never tripped over myself and had it posted to Instagram. But I do worry about it!)
Your video claims that masks don’t work because they’ll leak vape smoke. However, masks aren’t meant to be airtight, but rather a barrier against droplets (like the kind expelled when you cough or sneeze). Droplets are what primarily carry the virus across long distances.
This says that the virus can be an aerosol and that this is what causes infection after long time periods after a spreader was in the area.
Can someone confirm if vape is an appropriate analog to aerosol virus in our breath? If so, the video is very convincing that masks are ineffective at preventing infection.
Aerosol covid viral particles are much, much smaller than the spaces between the fibers of a cloth mask, or an N95 mask, and anyways, you can see the vape going out the sides.
Right. After having Covid in April 2020 I developed what appears to be a hypersensitivity to Covid, where I get an allergic reaction when exposed within about 20-30 minutes. It's not pleasant, but I guess you could say I'm a human detector similar to what dogs have been trained for. I can assert that surgical, N-95, and KN95 are not completely effective in my experiences. P-100 masks however have been basically full proof so far. They have been a goto despite being expensive. They can be covered with cloth If you think they look dorky. Another antictode is that there are a lot of weak viral shedders with little or no symptoms out there. During some of the bad months I've inferred it must be around 1/5 to 1/10 people.
> But because we’re not talking about the hard long-term questions we’re getting bogged down in largely short term spats about case spikes, vaccine boosters, etc.
Masking is not a hard long-term question though. Masking is easy and doesn't require much.
Restrictions in liberties implemented through a mandatory covid pass to enter a restaurant, a concert hall, cross a border or travel too far, mandatory vaccinations for certain working categories of people, etc. are way harder.
Well in a year or two, barring extra bad mutations, well have reached a Covid steady state of sorts. Right now we’re still very much in the initial phase.
Are you saying you want mask restrictions to end now or are you saying you support them until we’re out of the initial phases in a year or so?
There’s “not going away” and then there’s “are enough vaccinated? Are the vulnerable vaccinated? Do we have hospital bed and nurse +doctor capacity?”
Here in Singapore, we’re ensuring that those above 60 get vaccinated where feasible before we fully open up. Meanwhile, with an increasing percentage of the population getting vaccinated, there are gradual lifting of controls. The Ministerial Task Force have said a few months ago that Singapore will have to prepare for the possibility that COVID 19 will be endemic.
I suggest that rather than take potshots at Faucci, it’d be wise to understand whether your hospital systems are ready for an upsurge in those who need to be hospitalised.
I think you’re probably right that lockdown measures should track, inter alia, projected hospital utilization. However, the message we’re still receiving is that the lockdown remains necessary because if we can just maintain it a bit longer, COVID will go away. It seems a bit disingenuous, sorta like “free beer…tomorrow.”
If you look at past graphs, the US could have been fully vaccinated by mid-June or perhaps July. The current problems faced by the hospital system in some areas of the US were probably avoidable, so what is true for Singapore’s policies is not the same in the US.
But it is likely quite hard to predict hospital utilization, since it changes many weeks after we needed to change behaviors to maybe avoid it.
I get that Fauci in particular is a controversial figure for some reason, but he’s for a long time been realistic that this virus has a high probability of becoming endemic [0]. I’m not sure why anyone would single him out as opposed to political leaders who sort of have a habit of addressing (or not) issues obliquely.
I think at this point, most of the vaccinated would no longer care if it weren't for the fact that procedures for things like cancer treatments and major surgeries are being outright canceled, for months, so that all resources can be spent treating all of the unvaxxed who are now scared enough about their "little cough" that they need to go to the doctor for it.
And kids under 12 not having access to vaccine. Once that is in place I personally think it’s time to go UK and figure out what this looks like long term.
I wonder if insurance companies will have different rates for people who choose to forgo essential vaccinations in the future.
>"... Of course the thing to emphasise is that, whilst it might break through, the vaccine still stops serious illness to a high degree...."
Important to note, vaccines do not protect you, its the
immune response they trigger and the level of antibodies that will protect you.
What really should be happening should be a mass vaccination program and a mass antibodies level testing program at the same time. Except for a few clinical studies, whose results are only now starting to come out I do not think any country is doing that. Frankly it puzzles me a little bit.
There is not enough data yet to see how these antibodies levels reduce with time, but there is already plenty of information to show they drop dramatically after 6 months, hence the talk now of the third shot.
Hence I think its better to say vaccines will produce level of antibodies that will protect...for now.
It's not just antibodies though. Vaccines also trigger you to get memory cells, which have a longer life span. So even if your antibody levels go down after ~6 months, and you might get infected again, your immune system will have a faster and more precise reaction, preventing a more severe course of covid.
This is what a lot of people do not understand. Antibodies are basically the front line soldiers fighting the virus, but there's no point keeping them deployed even after the war is over.
Memory cells circulate in the blood stream for much longer - sometimes decades for other pathogens - and if they identify their target antigen, will quickly trigger an immune response and produce new antibodies.
Having a high number of antibodies correlates with a strong immune response and lower rates of incidence, but that doesn't mean having a high number of antibodies is needed for that. It's really too early to say exactly how long term immune response works with this virus, as the only studies that have been completed so far are small samples sets or short time frames.
I'm curious to know how much the reaction to the second or subsequent jabs correlates to antibody/immunity level. I had no reaction to the first jab and a 12-hour flu-like reaction to the second jab the next day (both Moderna).
NOT having a similar reaction to a third booster would be concerning, but I wonder how much the reaction actually correlates with protection for shots beyond the first.
Good question. I think the consensus is that the two things are not related. That is the reason I argued for vaccination and testing for immunity as a single combined action for each individual.
"No, vaccine side effects don’t tell you how well your immune system will protect you from COVID-19"
for what its worth, I had AZ as my first shot and it was pretty rough for 36 hours and then I was fine. My second shot of pfizer 8 weeks later barely left a sore spot on my arm. Not sure what if anything it means, but curious what will happen if I get a 3rd.
I had 2 shots of AZ but the same experience. Rough initial period, but the second one was fine. I don't plan to get a third one until they make an updated vaccine for the newer variants like delta. What's the point if it's the old vaccine?
> Compulsory mass vaccination using the current vaccines poses a serious public health risk [1][2][3]
None of your references say this or anything remotely implying this. Backing up a provocative claim with a snowblind of irrelevant references is a shameful misinformation tactic and you should stop doing it immediately. Doing it in a public health context is particularly dangerous and frankly disgusting.
Definitely a stretch but the linked studies are worth a read anyway.
I've only (cursorily) read [1] but it suggests combining different approaches for targeting immune response rather than the same approach across the populous. The risk would be assuming high levels of protection given how likely the virus is of escaping a single target through evolution. I guess that does pose a risk if people treat the current vaccines as a means to return to normal. My guess is variations on "the vaccines aren't very effective" are the biggest and most credible concerns people have though not a good reason to not receive them.
The cited papers are definitely legitimate and interesting, even though they do not support the point the commenter wished to make. It's too bad that HN flagging means the OC can't be seen at all. Most content which deserves harsh criticism does not necessarily deserve full censorship, which can easily backfire.
We do need diversified defenses, but we shouldn't forget that our natural immunity is ultimately the line of defense that actually fights the virus. Vaccines just help it develop some particular tools against the spike protein. As of yet, I don't know any reason to believe that this prevents the immune system from forming more comprehensive and diverse defenses. On the contrary, the immune response is so complex and multifaceted that the vaccine-induced antibodies can only play a small role, albeit critical in the early stages of infection.
I didn't read it as a stretch because first generation vaccines used in the campaigns all have shared targeting, and medical treatment is being discounted.
> Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions
This was from [1]
> Backing up a provocative claim with a snowblind of irrelevant references is a shameful misinformation tactic and you should stop doing it immediately. Doing it in a public health context is particularly dangerous and frankly disgusting.
Please, be kind.
The references were applicable but not written for the everyday consumer.
It's not valid to go from "vaccine escape may occur" to "mass vaccination is a public health risk". You can't claim B, which doesn't follow from A, and follow B up with a bunch of citations that only support A. That's misinformation about a high-stakes public issue, it's irresponsible, and it warrants harsh criticism.
You're disregarding the nuances and evidence put forth in the cited literature - either intentionally or out of ignorance.
A much more fair representation is: "vaccine escape is exceedingly likely to occur under the conditions of mass vaccination combined with a vaccine that does not necessarily prevent infection and transmission, and which induces an immune response highly targeted toward the spike protein RBD"
In that case B absolutely follows from A. To argue otherwise is a non-sequiter.
Even if vaccine escape eventually occurs, it doesn't follow that mass vaccination itself is a bad policy. You have to weigh the consequences of the escape against the consequences of not mass vaccinating.
The consequences of not mass vaccinating are "a lot of people die that wouldn't have with the vaccine", so the consequences of escape need to be pretty dire to outweigh that. Does escape make the virus significantly more dangerous than it would have been if the vaccine were not used on such a large scale? It's unclear.
To answer that, one critical question would be whether the vaccine somehow hinders the immune system from developing a more complex and robust response to the virus. I have not seen anything that speaks to that question yet.
Antibiotic resistance don't make us regret the use of antibiotics. We just avoid using them without evidence that they are needed, and we use them in combination with other measures. Mass vaccination and a more targeted campaign are both consistent with both of those principles, and nuanced evidence and reasoning would be needed to favor one over the other.
> You have to weigh the consequences of the escape against the consequences of not mass vaccinating
Yes, agreed.
At this point we're talking in circles. It's obvious you believe that the benefits of compulsory mass vaccination outweigh the potential consequences of vaccine induced immune escape, even though you admit that "it's unclear" whether compulsory mass vaccination will make the virus even more lethal and potentially lead to even more suffering and death.
I won't continue on with the debate because no further evidence is being provided, and frankly we're in agreement that the calculus is intractable right now, and only in disagreement on whether it's acceptable to call compulsory mass vaccination a public health risk, so it's just semantics at this point.
> one critical question would be whether the vaccine somehow hinders the immune system from developing a more complex and robust response to the virus
Here is some literature that provides preliminary answers [1][2]. The summary is that natural infection induces an immune response which includes nucleocapsid protein antibodies, whereas vaccination using the current mRNA formulations does not. Compared to natural infection, vaccination induces an immune response that is more highly targeted toward the spike protein RBD. In terms of individual health outcomes, neither of these papers address whether natural infection offers better or worse immune protection compared to vaccination.
[2] Antibodies elicited by mRNA-1273 vaccination bind more broadly to the receptor binding domain than do those from SARS-CoV-2 infection
https://pubmed.ncbi.nlm.nih.gov/34103407/
Not talking in circles I think - I'm happy with where we landed. Sorry I started off harsh. You sounded too close to an antivaxxer trying to pass your opinions off as authoritative, and semantics really do matter there. I'm glad to see your ideas are much more nuanced and I think we largely agree at this point. To get any clearer we probably need input from proper vaccinologists. And hopefully they are informing policy, although that's no guarantee in this bungled response we've had.
My emphasis is on compulsory, but perhaps I should've been more clear. Obviously I've triggered some people here.
Vaccines are powerful tools that help save lives and we should use them. But if they are used indiscriminately they can actually further endanger public health. You might be familiar with antibiotic resistance - vaccines are subject to the same potential for unexpected consequences.
All of the sources I cited support this fact - it is not misinformation. Did you read any of them?
Here are some excerpts for you:
Excerpts from [1]:
> "The spike protein receptor-binding domain (RBD) of SARS-CoV-2 is the molecular target for many vaccines and antibody-based prophylactics aimed at bringing COVID-19 under control."
> "Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions. With the emergence of new strains of SARS-CoV-2 with altered transmissibility and immune evasion potential, a critical question is this: how easily can the virus escape neutralizing antibodies (nAbs) targeting the spike RBD?"
> "Our modeling suggests that SARS-CoV-2 mutants with one or two mildly deleterious mutations are expected to exist in high numbers due to neutral genetic variation, and consequently resistance to vaccines or other prophylactics that rely on one or two antibodies for protection can develop quickly -and repeatedly- under positive selection."
> "The speed at which nAb resistance develops in the population increases substantially as the number of infected individuals increases, suggesting that complementary strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) or that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification) are key to reducing the risk of immune escape"
> "Strategies for viral elimination should therefore be diversified across molecular targets and therapeutic modalities"
Excerpts from [2]:
> As vaccines against SARS-CoV-2 are deployed across populations, it is possible to create a selection pressure for variants that can escape the vaccine-acquired immune response. Over the past few months, several variants have emerged which show a reduced susceptibility to vaccine-acquired immunity, though none appears to escape entirely. These variants largely emerged before vaccination was widespread, thus selection pressure from vaccines is unlikely to have made a significant contribution to their emergence. However, as vaccines become more widespread, the transmission advantage gained by a virus that can evade vaccine-acquired immunity will increase.
> There is no historic precedent for the mass administration of antiviral medication in the community as prophylaxis, apart from the use of anti influenza Neuraminidase Inhibitors, which were used to a limited extent in this way in the early phases of Influenza Pandemic of 2009 in the UK. The safety and efficacy profile must be extremely well established for a mass administration strategy to work and poor compliance will likely rapidly lead to the selection of drug resistant variants, rendering such a strategy short lived.
I could go on, but that fact is your comment is not a charitable or informed response to the statements I made.
I stand by my post. None of this says anything remotely implying what you claimed, that the mass vaccination programs pose a serious public health risk. That is purely your speculation, vaguely inspired by the content of the papers.
Your contention that it matters whether the campaign is compulsory or not only takes you further from your supposed evidence base. It's not even in the same universe as what the papers are talking about, and is purely your own invention.
I understand that you're worried about vaccine escape, but to go from that to "compulsory mass vaccination is a serious public health risk" is a completely unwarranted leap. Your authors advocate for diversifying our defenses, not eliminating the only one we currently have.
I disagree. I think it is a serious public health risk, at a certain probability, and you've provided no sources or math to explain what the probability is. Can you enlighten us as to what the probability of vaccine escape is?
Is the risk of vaccine escape 50%? 5%? .5%? .00005%? I have no idea what the OOM of possibilities is (I am attempting to model it). I appreciate all literature that explores that.
Clearly we've seen a significant drop in VE. I think that's pretty good evidence that the possibility of full vaccine escape needs to at least be considered. And certainly if the probability is ascertained to be above a threshold, then it is a serious public health risk.
I think vaccines should be Bayesian (very good bet if over 30 and never had COVID). But there is zero precedent for mass vaccination in the midst of a pandemic, and some people think things could go wrong. I am very very curious what people who model it think the probability of that happening is.
I appreciate the links and position put forward by the commenter, and sad to see that flagged.
I'd prefer to see links to models/code/data that offers arguments to support that odds of vaccine escape are low.
To repeat what I've said several times now (how can I be more clear?), the risk of vaccine escape does not imply a particular public health policy. There is no procedure that tells us what policy we should choose based on vaccine escape risk, because it isn't the only consideration. It is irresponsible to make authoritative pronouncements on a complex public health policy issue when you're completely fixated on one particular risk. Unless you're willing to describe EVERY possible action as a public health risk, in which case you should be honest and upfront about the obscure, misleading choice of language.
> the risk of vaccine escape does not imply a particular public health policy
It does have major ramifications for public health policy - you're disagreeing with many experts in the field when you make these claims.
> There is no procedure that tells us what policy we should choose based on vaccine escape risk, because it isn't the only consideration
Of course it isn't the only consideration - no one claimed that it was. This is a straw man.
> It is irresponsible to make authoritative pronouncements on a complex public health policy issue when you're completely fixated on one particular risk.
We are in agreement on this in general, and I admit my comment could have been worded less strongly.
But again, these ideas are being espoused by experts publishing peer-reviewed literature. They are not "fixated on one particular risk", and if you take the time to read the cited literature you'll find rich discussion of many subtle nuances and tradeoffs. That is as authoritative as it gets. There is nothing irresponsible about sharing the knowledge and opinions put forth by world class researchers.
I agree that vaccine escape risk has real implications. I meant to say it doesn't determine whether mass vaccination is prudent. I explained what is missing to make that determination in another comment. Do we agree on that?
FWIW, there is precedent both in 1918 (when the Supreme Court ruled it was constitutional), and during the revolutionary war (when George Washington made history by vaccinating his troops with a new experiment technique called a vaccine)
When discussing vaccine escape (unlike antibacterial mutation pressure) I seem to usually see it described as an issue for diseases which already have many strains:
https://en.m.wikipedia.org/wiki/Antigenic_escape. Which wouldn’t yet apply to COVID. And is not a problem for the mRNA technique (which can simply change the target sequence and give a new/booster shot).
Great retort BTW. I will be using the "... not eliminating the only one we currently have" line in future. Im worried that any concerns people have result in them being lumped in with conspiracy theorists/misinformants (?) but it seems irrational and dangerous to deter people from receiving some protection if the risks are more effectiveness and longevity rather than side-effects. My most lingering concern is simply that such a large number of people receiving the same few new vaccines seems like a gamble that we will all be forced to participate in. That's life though..freedom isn't always a given.
It's possible that mandatory vaccination is not the optimal strategy. But authoritatively branding it a public health risk is not something anyone is in a position to do with the info available.
These concerns and warnings are coming from the scientific literature - from experts at top institutions in the world. Your dismissal of them is completely unsupported.
I am not dismissing them. On the contrary, every post I have made takes pains to distinguish between the legitimate analysis and claims in the scientific papers you have cited (e.g. that vaccine escape is worthy of concern) and your unwarranted, irresponsible inferences from them (i.e. that mandatory vaccination is a public health risk - especially stated with such a definitive air of authority, followed by a flurry of citations that simply don't say that).
At best we can say that vaccination programs are not without risks. But this is true of many, many legitimate public health measures, and it is deeply misleading to single out one of them as a "public health risk" on this basis. If we apply such a lax standard of labeling consistently, then not doing a compulsory mass vaccination program is also a public health risk, for reasons that are now extremely obvious if they weren't already.
You have misattributed too many strawman positions to me at this point. You are either unable or unwilling to engage in good faith and this may have to be the end of my interactions with you.
It doesn't make sense to me how you can admit that "vaccine escape is worthy of concern" (which is an understatement at best), but then say it's "deeply misleading" to call it a public health risk. Yes you're right that none of the citations literally say "this is a public health risk" - but is it really an "inference" to say that viral resistance driven by mass vaccination poses a risk?
We clearly disagree so we needn't go on longer - but FWIW I can't help but feel as though you've been downplaying the significance of these risks with very little supporting evidence, other than your own logical reasoning and accusation of misinformation. I do appreciate you conveying your opinions in a respectable manner.
Thank you. I appreciate you bringing these legitimate concerns to light and I hope there is open debate about all costs and benefits of mass vaccination. The lack of public discourse from a position of humility and curiosity has led to many bad decisions during this pandemic, IMO.
That said, public health requires the analysis of all costs and benefits using a consistent, logical methodology. We need to be very clear about the inferences supported and not supported by our evidence.
Saying that mass vaccination carries the risk of vaccine escape is very different from saying that mass vaccination is a public health risk.
If you read beyond the title you'll find that [3] outlines the conditions for vaccine escape and gives many broad examples of antibiotic and antiviral resistance. [1][2] also discuss vaccine escape in detail, but you won't find that out from the title.
1) A population of virus or biotics has genetic diversity and mutations through generations when reproducing.
2) Some pressure is put on its survival (antibiotics, vaccines).
3) Those in the population that survive better (with the new pressure introduced) proliferate more than those in the population that didn't survive or thrive as much.
4) You end up with a population more resistant or immune to the chosen selective pressure initially used on it.
Note that it appears that it is still unknown how likely breakthrough infections are to result in long Covid. The very limited data that does exist indicates that the likelyhood is rather high (~20%).
Long Covid has the same symptoms as stress, anxiety and depression, which are to be expected after contracting a pandemic level virus and being forced to isolate. Is there any proof yet that it is any more than that?
I've had heart problems to the point that I can't do any exercise more vigorous than walking without getting heart pain severe enough to make me stop immediately, and often suffering from extreme fatigue in the days afterwards. I was previously a reasonably fit 28 year old who regularly danced, occasionally went to the gym etc.
It's nothing like depression. The symptoms are very much physical.
What are the stats on that, especially vs. other severe respiratory diseases?
Asking because I've had "long covid" since long before there was a COVID, so either everyone's making a bigger deal out of it than necessary, or I'm actually much worse off relative to normal than I thought and I should really be questioning my doctors.
> Asking because I've had "long covid" since long before there was a COVID
Well that isn’t “Long Covid” then. Symptoms can come from a variety of causes, and just because you suffered some of the same symptoms unrelated to a Covid infection doesn’t mean that others won’t experience similar symptoms after Covid.
So what are the percentages of people who will have long-term symptoms from Covid, how does that compare in severity and frequency to other respiratory diseases, and if it wasn't something people cared about before Covid, why do they care now?
> how does that compare in severity and frequency to other respiratory diseases
I’m not sure and that’s a very wide question, but the main difference is we have never had such a large amount of the population get a respiratory disease so quickly because of the transmissability.
> if it wasn't something people cared about before Covid, why do they care now?
Some people cared about it before Covid, and now more people care about it because it’s becoming more prevalent with the spread of Covid.
I mean to ask the same question - why didn’t people really care about respiratory viruses until about 2 years ago?
^ It's worth underscoring here that nocebo symptoms are absolutely real symptoms, they just aren't caused by the thing you think they're caused by!
It's not unreasonable to suspect that the nocebo effect is responsible for at least a very large portion of "long COVID" cases, particularly as many associated symptoms, such as brain fog, are very hard to test for!
The social isolation, stress, lack of sun and exercise, bad diets, and other side effects of the hypochondriac society we now live in are largely responsible for what is called long-covid.
I think lung damage found in some cases is likely fairly typical post-covid, but my theory is that this is common after any harsh illness involving the respiratory system whether it’s cold/flu/covid, we just weren’t looking for it nearly as often before.
Isn't long Covid caused by damage from the spike proteins? In that case, repeatedly giving people the vaccine might do damage as well since it gets you to produce those spike proteins right?
Long COVID isn't a distinct disease, it's just a vague label for a set of non specific symptoms. There is evidence that some cases are caused by re-activation of dormant Epstein-Barr virus infections.
If proven correct that wouldn't be at all surprising. We already know that major stresses can sometimes reactivate EBV. It might be a good idea to also test all COVID-19 patients for EBV.
To be clear mRNA vaccination introduces a small finite amount of mRNA that the body turns into spike proteins whereas infection with covid results in the body being used as a factory to manufacture virus which manufacturers more virus and so on.
This source suggests that a single person may be at peak infection host to between 1 billion to 100 billion virions.This is peak load at one time not an account of the total virions produces over course of infection.
Vaccination involves a vastly smaller number of proteins that are not damaging in the same fashion.
> That’s because the SARS-CoV-2 spike protein is a shape-shifter. To fuse its viral membrane with the host cell membrane it substantially changes its shape from an unstable pre-fusion state to a stable post-fusion state. While previously working on a vaccine for MERS, a disease caused by another coronavirus, McLellan and others discovered that by adding two proline molecules to the spike protein, they could lock it into its pre-fusion state, triggering a more effective immune response and preventing cell entry. The same harmless mutation, called 2P, as in two proline molecules, is used in the SARS-CoV-2 vaccines.
The spike proteins allow Covid to enter your cell where its actual RNA coopts the cellular machinery of the cell to reproduce. After enough copies of the virus are assembled the RNA coopted cell is made to kill itself by self-lysis releasing the new viruses.
I think it kind of is because it's got a similar binding affinity to heparin. Heparin is a first responder chemical in the immune system. Coopting a low level part of the immune system like that is rather more dangerous than if it were getting entry via some other mechanism. On the other hand I could be wrong about this.
Hundreds of millions of people have received vaccines that (either directly or indirectly) expose them to the spike protein in question, so clearly it can’t be dangerous.
OP is probably making some kind of reference to this: https://www.bmj.com/content/373/bmj.n954 I think they’ve got things a bit mixed up re the spike protein being the crucial element, though.
We now know beyond doubt that the risk of blood clots associated with any of the major vaccines is tiny, and very probably zero. Despite a lot of scare stories in the media, there has never really been any good evidence of a link at all.
To suggest at this point that any of the vaccines used in the West is “kind of dangerous” is just to say something obviously untrue. If the vaccines were dangerous we’d be seeing their harmful effects on a massive scale by now.
>> If the vaccines were dangerous we’d be seeing their harmful effects on a massive scale by now.
That's a bit all-or-nothing. There have been cases of bad reactions to them (small scale). That's not my point though, and to be clear I'm not anti-vax, just wondering if the spike proteins actually cause damage, possibly cumulative. I don't recall where I got the idea that they are responsible for damage though.
The viral infections don't make the perfect amount of spike protein for every complete viral particle that comes from the cellular infection, when the cell bursts open plenty of spike proteins and other partially assembled viral components are put into the blood stream.
I'd think that if the spike protein was causing the reactions you mentioned we would have seen the spike protein is dangerous. An active infection is going to make more free floating spike protein in your body than the RNA vaccine ever did.
It’s not all or nothing. It’s the only sensible conclusion that can be drawn after hundreds of millions of vaccinations. We know that the associated risks are tiny. There is always a non-zero risk from being injected with anything at all, but there is no reasonable sense in which COVID vaccines are “dangerous”.
> and to be clear I'm not anti-vax, just wondering if the spike proteins actually cause damage, possibly cumulative. I don't recall where I got the idea that they are responsible for damage though.
If you can’t even remember the source, it’s maybe not such a great idea to spread these sorts of unfounded rumors in the middle of a public health crisis.
Same. My breakthrough infection lasted over a week. Nothing serious, but definitely very infectious, so I self quarantined. I’ve had minimal social contact and just about avoided COVID the original, so it was surprising how quickly I caught Delta after it became dominant.
Since more people are vaccinated, they don’t always know that they carry. It adds a lot to the contagiousness. They may also be less careful, due to the insurance paradox (insured people have more accidents).
> it does seem like this virus is bucking the trend and not necessarily becoming less potent despite increased tranmissability in some variants
I would think causing more severe symptoms is a disadvantage for a Covid strain in terms of selection, because people affected by such an illness are more likely to go into quarantine or a hospital, reducing transmission.
From what I understand: Not if symptoms appear many days after the infection. Covid easily transmits when it's still in the upper parts of the body. Once it gets into the chest/pulmonary system and you start manifesting symptoms and it start inflicting long lasting damages it has already contaminated others. What happens then and after that doesn't apply pressure to the virus to be less virulent or lethal.
when reproduction[X] occurs before a selective factor[y] is in play, the selective factor has no first order influence on reproductive success.
the theory of inverse relationship between severity of symptoms and transmissibility, is based on the idea that sick individuals spend more time laying in convolesence than interacting with other individuals.
this mechanism goes out the window when the infection is transmissible before symptoms appear.
this is the case with covid, i wish it was other than wishfull hoping but it isnt.
causing illness in the host after transmission allows more contact between infected and putative hosts thus conspecific differential of reproductive success.
prospecific differential reproductive success occurs when variations are able to generate progeny that themlelves are capabe of reproducing. i.e. delta variant sars2
evolution occurs when the properties leading to these phenomenon are genetically based and transmitted through populations at varied frequencies subject to differential natural selection i.e. the fittest as in most apt to survive to reproductive modality.
> The point is that it does seem like this Delta variant breaks through regularly and it does seem (again, purely anecdotal) like it's v infectious. Of course the thing to emphasise is that, whilst it might break through, the vaccine still stops serious illness to a high degree.
If numbers from IHU Méditerranée are to be believed, the Indian variant is about 6 times less dangerous than the English one. Way more infectious and less dangerous, the latter part helped mutating it to the former. And that's the numbers without taking vaccination into account.
I wish medias would relay the information fully instead of spreading fear by only telling about the more infectious part. If indeed less dangerous this is a very good news that this strain is spreading more.
Assuming that all of Florida has the delta variant, right now 53% of all adult ICU patients is with COVID-19, and the total people in hospitals with COVID is about 79 per 100K. So I don’t understand why anyone thinks this variant is less dangerous. https://www.fha.org/covid-19.html
Less dangerous on an average individual level, more dangerous since its so contagious and can infect every last unvaccinated person who doesn't have antibodies (and a few who do).
I haven’t seen any credible evidence yet that delta is less dangerous at the individual level than alpha or than the original virus. We know that if a person is vaccinated, then exposure to the original variant is less dangerous than exposure to delta (based on limited controlled studies).
COVID and it's variants now have a growing reserve in the mammal animal populations of the world.
If we decide to continue this fight we must go in eyes wide open that this is an unwinnable war that will go on forever with ever new versions of vaccine immune COVID.
The problem is people believeing it will be over. And using that belief to justify opinions and action against others who believe the opposite... which is... since it's not going away we just have to live with it. We can not stop society for this. Society will collapse before this is eradicated to levels some members of public hope for.
You must consider the mutability of a virus along with is other attributes and respond accordingly.
Perhaps next we work on preventing earthquakes and volcanoes.
There is nothing untrue in this statement, shameful that you are getting downvoted.
People just can’t accept that COVID zero is impossible. The only way it could happen is if we find a prophylactic drug, and we all take it together, but this seems like a dream too.
> Fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period.
It appears that vaccinated people have the same viral load to spread when they're initially infected, but it is significantly diminished shortly thereafter.
A nearby county is one of the few in the state that is honestly reporting the share of vaccinated cases being hospitalized. Only 2/3rds if the hospitals are reporting, and about half of the patients in those 2/3rds of hospitals are vaccinated. Of course without knowing the age of the patients and the vaccination rate for that age bracket it’s hard to make much sense of the numbers. That is intentional. The data are available and could be reported but they are not, intentionally.
That most counties are withholding this information— the share of hospitalized cases that are vaccinated— is unconscionable to me. Is that not misinformation? They have the data and could report it, they’re reporting all sorts of other information about hospitalizations. It’s quite clear that they are withholding this information to help market the vaccines to the unvaccinated. If they reported the share of severe cases that were fully vaccinated it might give justification to the hesitant.
The problem is, by withholding the data to shade the truth and provide “nudges” as Fauci likes to say, they are instilling a false sense of safety in many vaccinated high risk people.
I’ve had arguments with elderly high risk family members when I tried to alert them to the Israel data and the fact that the vaccines were losing efficacy. They thought I’d fallen prey to anti-vaxx conspiracy theories. They we’re “trusting the science” that was being quoted by their favorite politicians and news outlets. I was paying attention to the international scientific literature.
Ironically, similar arguments played out at the outset of the pandemic when I tried to warn them that despite the WHO repeatedly saying there was no evidence of a pandemic, there indeed was a pandemic rapidly approaching. One went to Chinese New Year party in San Francisco, encouraged specifically by Nancy Palosi.
Similarly, at the outset of the pandemic I tried to tell them to wear masks, but our vaunted experts told them not to.
Up until a few days ago, they thought their vaccines rendered them invincible. Thankfully the sourced they trust are now talking about boosters, so they are being more cautious.
I’m sick of dangerous misinformation but it’s mostly come from the media and politicians. The scientific literature with a few notable examples has been solid. Sadly most posters in this thread won’t read it. Instead they’ll “trust the science” that the news muppets tell them to.
No idea, this is a deeply complex question that I'm not qualified to answer. I'm merely wondering out loud as a member of the public if we have our policy around this calibrated quite right.
Mask wearing was common in some Asian countries at certain times of the year even before this so it doesn't necessarily need to end at all. It all comes down to what level of hygeine you want to pursue.
No lockdowns are going to happen, but I expect to be masking up for at least another 6 months. Not a big deal, definitely better than it was last August, that’s for sure.
I see in New York's case that there's been a big rise in cases but barely a blip in deaths, as opposed to both rising in step in Texas, I'm guessing largely due to vaccination rate. So I expect this winter will be a lot better.
In some countries at least it might become normalized the same way it has in say Japan or Singapore with a history of respiratory disease, the UK does not have the same aversion to public health measures as the US.
A bit more until the virus decides to go away? Or a bit more until they invent a non-leaky vaccine? Or a bit more like when the cows come home? Because that's what you are talking about. A bit more forever.
Lets start with "Lets be precautious until hospitals stop triage of care". Maybe we should be precautious until hospitalization levels return to something looking like normal.
> Man shot 6 times waits more than a week for surgery after hospital is overwhelmed by covid
---------
When our hospitals are full, we should be cautious. When our hospitals empty out, we can open up a bit more. This obviously is location-dependent (and higher-vaccinated areas can afford to open up more).
But the absolute goal in every location is to keep hospitals functioning, and the relative stress levels of doctors / nurses at a reasonable level. I know in my state, we've been having to employ student nurses before they've graduated, so that there's enough staff around.
As long as hospitals feel the need for emergency measures, we need to be precautious and doing what we can to clamp down on the sickness.
Keeping hospitals functioning should be a minimum goal.
(like, you wouldn't reduce vaccination effort just because the load on hospitals eased up, high levels of vaccination is a reasonable goal unto itself)
Blaming Covid specifically for hospital overflow is a fallacy. It's just the straw that broke the camel's back.
Obesity/poor diet require an incredible amount of healthcare resources. Government subsidies of corn play no small factor. Ending subsidies for unhealthy foods is completely within our control unlike infections from new diseases. If we wanted to free up hospital resources we could have done that a year ago with a simple sugar/high fructose syrup tax.
A bit more until, by combination of the virus mutating to less dangerous forms and everyone's immune system being primed against it, it settles somewhere between common cold and the flu.
Yes someone thing like this. Exactly where we draw the line now is the hard question. I don't think we're massively off the mark but I feel we could be proceeding a bit more slowly is all. I'm not advocating the reverse gear or massively changing course. We're not quite out of the woods is the point.
a bit more until the virus runs out of variants, or in a very rare case becomes able to duck the immune system.
a bit more until there are no more infectable hosts, and a variant spills over from our species of succeptability to another of succeptability that will allow greater transmission, wash rinse repeat. this or very similar has happened 6 or perhaps 7 times as evidenced by the endemic corona virus we all experience on a regular basis
Do you have awareness that your anecdotal data, even if it were more than anecdotal, still would not prove that the shots you've taken reduced the symptoms, as many cases are asymptomatic / mild symptoms anyways?
The point in my sharing this as 'anecdotal' is that this is my subjective view, and that from where I sit, these conclusions might follow but the correlation might be coincidental too. I.e maybe I avoided serious illness for some other reason; maybe I have no antibodies and the vaccine didn't trigger a response in me but I'm one of many who had it mildly. There are any number of other possible explanations. I'm not making any scientific logically bullet proof statements here, I'm speaking as an armchair pundit thinking "hmm, seems like a lot of vaccinated people I know have the virus all of a sudden. Seems like vaccines might be helping with the severity of the illness, maybe I was one of them. However, I wonder if all this means we should exercise just a bit more caution until we're sure this high infection rate isn't a problem in the overall fight we're engaged in".
The actual hard logic and policy I'll leave to the scientists and policy makers but, in the UK, at least the latter have a chequered history.
You invoke "you people" and then draw an unfounded and non-sequitur conclusion about your interlocutor's motivation while asking them to think with a logical framework???
Current breakthrough rate in the US is .004%, including Delta. In fact, vaccines are generally working as well or better than expected against all known variants.
I am not an apologist for vaccine utopianism and don't agree with the other commenter but your particular example suffers the same unfortunate fate of a point I made in the past. The scientific explanation is that Google infographics suck. They are sourced from wikipedia data and have huge gaps and sometimes even absurd duplicates.
If you look at a consistent data source[0] you will see that the 7-day average case rate in Palestine has gone from 131 on August 11th to 699 August 20th, a doubling time of 1.42 days. This would be extremely rapid transmission.
Thank you! I didn't know about this resource, it's quite helpful! The site makes it possible to compare any two countries on the same graph. That's what I did, but the qualitative effect looks as sharp as in google's graphs. Please take a look
https://ourworldindata.org/coronavirus/country/palestine?cou...
Have you even thought about the kind of future you are promoting here? A society where people wear masks and continually force vaccinates their bodies?
This used to be dystopian science fiction just a few years ago. Now I see people like you acting like that's where we should be heading. So extreamly weird!
It's like you don't understand how unnatural it is for humans to wear masks and inject chemical substances into their blood streams. Do you think about what you are saying? What kind of world it creates for humanity?
> A society where people wear masks and continually force vaccinates their bodies? This used to be dystopian science fiction just a few years ago.
Hi, 57-day-old account. People have been wearing masks in Japan for many years. I have gotten flu vaccinations for decades. Where have you lived all your life that flu vaccinations are considered science fiction? Mississippi?
> ...the vaccine still stops serious illness to a high degree.
Anecdotally, you don't know that, you don't know what caused you to have a mild case, if this had happened a year ago you wouldn't be giving credit to a vaccine.
> it does seem like this virus is bucking the trend and not necessarily becoming less potent
Don't you think it's possible your very mild case might be evidence against this claim? Anecdotal, of course. I haven't seen the data for infection vs hospitalization/fatality rate for the Delta variant against previous ones, but it just seems to me that someone having caught it and had a very mild case wouldn't logically jump to "it isn't less deadly."
OK, that's good, but the claim I was responding to was that the new variant is not less deadly than the old one. I was asking about infection v hospital rates for the old and new variants. Also with all these different variants going around, if the newer one is less deadly it would skew that number unless the different variant cases, deaths and vaccination statuses are all accounted for.
A variant can be more dangerous even if it’s not technically more deadly simply because it’s more contagious.If a virus is 10x as transmissible, and a lot more people get infected than would otherwise, a 1% mortality rate would result in a lot more dead bodies
Sure I have no idea why the case was mild. This is just me saying "I seem to know a lot of vaccinated people who had mild cases".
"it just seems to me that someone having caught it and had a very mild case wouldn't logically jump to "it isn't less deadly."
I wasn't basing that on my own experience, just on random reports of studies I've picked up on. In two different studies from Canada and Scotland for example, patients infected with the Delta variant were more likely to be hospitalized than patients infected with Alpha or the original virus strains. So it does a least seem possible that it's both more infectious and more deadly to hospitalized individuals than other strains. It does seem like an unusual mutation therefore in that its both more deadly in theory, and more infectious. This is all I'm saying here.
"Selective pressure". I find this phrase really confusing, because I think people use it differently. I'm still trying to nail down my own knowledge about this, but here's the gist I have so far.
Viruses are not like bacteria. Bacteria can mutate in direct response to antibiotics. Viruses cannot mutate in direct response to vaccines. Some people use "selection pressure" to describe what happens with bacteria and antibiotics. Others use it in a looser sense.
Viruses mutate purely randomly. Now, if a virus happens to mutate in a way that escapes vaccines, and if vaccinated people are more likely to party because they are vaccinated, then yes, you could argue the mutation has an advantage against other variants the vaccine has protected against, in a social sense. Some people use "selection pressure" in this sense, which I think causes confusion.
So the more relevant question is, if a virus mutates in an unvaccinated person, and that mutation happens to have the ability to escape all current vaccines, then, can the virus spread faster in a 50% vaccinated community than a 0% vaccinated community?
Answers as far as I can tell:
- Arguably yes, if the 0% vaccinated community is so sick from other variants that they aren't out and about to get exposed to the new variant. But I think this answer is cheating and doesn't get to the heart of the question. So, control for population activity and assume that both the 0% and 50% populations have the same chance of being exposed.
- If the 0% vaccinated community is infected with variants that can "crowd out" the newer mutation, then it could grow faster in the 50% vaccinated community. But I don't know if this is actually possible - I do know it's possible to catch multiple variants at one time, and I'd expect that usually a mutation that is more fit in terms of escapability might also have fitness advantages with transmissibility.
- If the mutation responded to the vaccine, in a direct biological sense, then it would clearly grow faster in the 50% population since it wouldn't have existed otherwise. But this is the scenario that not possible as I understand it, since it is based on a misunderstanding of how viruses work.
I welcome any corrections from those who are more familiar with this.
Bacteria do not mutate directly, in fact, no living creature we know of mutates directly in response to anything. All evolution is random mutation in offspring randomly providing fitness to itself and it's progeny above its predecessors and peers. That is what Darwinian evolution is.
That makes sense. You could say that the "lack of vaccination" yields mutations, much in the same way that the "lack of antibiotic" (like people refusing to finish their prescription) can yield antibiotic-resistant bacteria. But in neither case does it "cause" the mutation.
I don't know what that is. Put a bacteria and an antibiotic in a petri dish, and the bacteria can evolve in a way that has greater antibiotic resistance. Put a vaccine in a petri dish with a virus, and nothing happens. Bacteria are living organisms. Viruses are not.
Viruses are subject to selection, mutation, and heredity. These are the three necessary ingredients for Darwinian evolution.
Whether they're defined as "life" or not isn't really relevant.
(Personally, I have a pet definition of "life" that just equates it to being subject to Darwinian evolution. Viruses not being defined as life never sat well with me)
Vaccines can't do their thing in a petri dish, they need an immune system to work via. That's just a petri dish not being an adequate simulation of the environment viruses are normally in, and doesn't imply anything about whether viruses are subject to Darwinian forces.
"The creation of a vaccine for any new virus could also cause additional mutations.
“Let’s explain this concept a little further. Any virus will keep trying to change, so it can continue to spread. With all vaccines, the more quickly people get vaccinated the better. The slower vaccination happens, the higher the chance of having mutations in the virus and the appearance of more variants. And, as we are seeing with the delta variant, the more the virus can spread in the community.""
Isn't that just completely wrong? Saying that the vaccine "caused" that mutation when it was actually the lack of the vaccine that caused it?
Here's another one, a friggin NPR article (https://www.npr.org/2021/02/09/965703047/vaccines-could-driv...). It says "At the same time, vaccines can contribute to virus mutations" while the article itself is really only describing that it's the lack of vaccines that yield more time/opportunity for the virus to mutate. Why do people keep saying the virus causes the mutations? It's completely irresponsible.
First, the "virus" in this sentence means "all the trillions of individual virions currently in our environment, including the trillions currently in living cells. This does not mean that individual virions are changing in response to any stimulus or lack thereof. What they are saying is that as those trillions beget many trillions more, there will be many random mutations. Most of those mutations will result in failure. Some will end up as successful as their antecedent. A tiny few will end up with mutations that make them more successful in the current environment. So the mutations happen regardless of anything we do or don't do.
But as we take more countermeasures, it becomes harder for the baseline virions to be successful (because the vaccines work, distancing works, etc.). Any mutations that are only as successful as baseline are going to have trouble spreading. So by default what we will see is more of the mutations that result in things like easier transmission. Because they are better suited to the current environment where people are taking countermeasures. And because baseline is not as successful, the proportion of the new variants will increase over time.
Putting this together, if there's no selection pressure, mutations don't confer any advantage and they will tend to disappear from the population. So through that lens, the new variants wouldn't necessarily have gained a foothold if people weren't using countermeasures. That's not specifically the vaccines, though. Delta is apparently more transmissible generally, and that could also be a response (via random mutation) to social distancing & masking measures.
So the vaccine didn't cause the mutation, but the presence of the vaccine and other human countermeasures shaped the evolution of the vaccine.
> Why do people keep saying the virus causes the mutations? It's completely irresponsible.
The truly amazing thing is that they cite the Delta variant as an example for why vaccines cause dangerous mutations, without noting that Delta arose in December 2020, in India.
Not a lot of folks were vaccinated there around that time.
Think of viral particles as analogous to bacterial spores or plant seeds. A bacterial spore also wouldn't necessarily evolve in a petri dish with antibiotics, it needs a certain set of conditions to exit dormancy, for example a petri dish isn't implied to have agar in it nor do all bacteria thrive on agar.
The actual "life" of a virus starts once the viral load has co-opted the cellular machinery of the infected cell.
Viral infections can definitely evolve when a selective pressure is put on them.
My understanding of selection pressure in relation to viruses is something like viruses that escape the body's defences where those defences are strengthened. Eg if lots of people have antibodies triggered by a vaccine then it favours those viruses that avoid that immune response and infect the host.
Covid is going to be endemic like the flu and cold. It's not going to be eradicated, unfortunately, and I don't think we've come to terms with this yet.
Now what's our plan exactly? Get vaccinated every 6 - 12 months indefinitely and always wear masks? What's our goal and what's our new normal?
Yeah, as long as COVID-19 fills up hospitals we should do this. Not having hospitals seriously compromises quality of life.
I had untreated kidney stones for about a week at the peak of the pandemic. When I was in the middle of an attack I could not work, the pain was too severe. I was missing several hours of work everyday just dealing with pain.
I finally got to the emergency room which did basic imaging and gave me painkillers and muscle relaxers.
I didn’t get the actual stones removed until 6 months later!
So yes, I’d rather vaccinate and mask up then be denied healthcare.
> Not having hospitals seriously compromises quality of life.
A non-trivial percentage of healthcare workers were infected in 2020 and recovered with natural immunity to Covid. Some of those feel strongly enough about vaccine mandates that they are prepared to move jurisdictions or retire, which would exacerbate existing staffing shortages in some hospitals. If we don't want more hospital shortages, we should reconsider unnecessary vaccine mandates for those with hard-earned natural immunity, which includes nasal/mucosal immunity, unlike intramuscular vaccines that were developed for symptom reduction, https://www.statnews.com/2021/08/10/covid-intranasal-vaccine...
> Vaccines that are injected into the arm have done a spectacular job at preventing severe disease and death. But they do not generate the kind of protection in the nasal passages that would be needed to block all infection. That’s called “sterilizing immunity.” The fact that the vaccines don’t block all infections and don’t prevent vaccinated people from transmitting isn’t a big surprise, said Kathryn Edwards, a vaccine expert at Vanderbilt School of Medicine.
> Whilst we feel that current vaccines are excellent for reducing the risk of hospital admission and disease, we propose that research be focused on vaccines that also induce high and durable levels of mucosal immunity in order to reduce infection of and transmission from vaccinated individuals. This could also reduce the possibility of variant selection in vaccinated individuals.
A recent study showed having had COVID before offers less protection from reinfection than the vaccine [0].
"The study of hundreds of Kentucky residents with previous infections through June 2021 found that those who were unvaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated. The findings suggest that among people who have had COVID-19 previously, getting fully vaccinated provides additional protection against reinfection."
The CDC's report is a fantastic example as to why the CDC don't deserve our trust. They are dishonest. They cherry pick data to fit their narrative. They are unburdened by the constraints of peer review. They admit in their own study that it can't apply causation and yet they remain silent as the media run wild and report the study as causative fact.
> it looks like recovered people — people who had tested positive for the coronavirus in a past PCR test — are massively under-represented. Recovered people are around 9% of Israel’s population, but they’re less than 1% of current cases.
> That has led to speculation that recovery from past Covid is more protective against infection from the Delta Variant than vaccination. Known recovered people in Israel are mostly not vaccinated, though some chose to get a single booster dose ... From data I was passed last week, recovered people were testing at only 0.1% positivity, compared to more than 1% for vaccinated people.
> I wouldn’t be surprised if natural infection turned out to be more protective against variants than spike protein vaccination. It makes sense that the body’s immune system would find more ways to attack the whole pathogen and would recognise different parts of it compared to the changing spike in variants.
In the case of vaccine efficacy vs. severe disease, it is
the fact that both vaccination status and risk of severe
disease are systematically higher in the older age group
that makes overall efficacy numbers if estimated without
stratifying by age misleading, producing a paradoxical
result that the overall efficacy (67.5%) is much lower
than the efficacy for either of the age groups (91.8% and
85.2%).
Thanks for sharing this analysis. I scanned through it and it seems reasonable to me. I don't think anyone actually thinks natural immunity is 7 times as effective as vaccine immunity, as the numbers suggest might suggest without deeper or more thorough analysis.
As far as I can tell, the analysis you link also continues to support the notion that natural immunity works wonderfully well, on par with or better than vaccine immunity as far as we can tell.
> Also what should be obvious is this study doesn’t really look at the relative strengths of naturally acquired immunity vs vaccination acquired immunity, it is looking at whether vaccination can add further to the robust protection elicited by covid infection.
First off, I'm sorry you had to suffer like that - and I don't want anyone to be denied healthcare.
> I’d rather vaccinate and mask up then be denied healthcare
You've presented a false dichotomy here - mass vaccination and masking will not necessarily prevent overwhelmed hospitals.
Israel is a prime example - with one of the highest vaccination rates in the world - their hospitals are being overwhelmed right now due to the variants. The CDC is reporting similar data from the U.S. [1][2][3]. There's no doubt that vaccination is saving some lives, but it also may be partly to blame for the increasing dominance of variants of concern. [4][5]
And counterintuitively, compulsory masking is likely setting us up for a very bad winter in terms of endemic illnesses such as influenza and RSV - which poses an increased risk of overwhelming medical facilities even further.
I only raise these counterpoints to help inform others and bring much needed nuance to these discussions.
Only 66% of Israelis are fully vaccinated: there's a good 3 million hard-core religious orthodox who won't let science interfere with their deity's will.
3 million of blissfully and deliberately ignorant individuals who won't adapt their social behavior to avoid viral spread is more than enough to overrun any health system.
It's closer to 1 million than 3 million. There are about 6 million vaccinated out of a nation of 9 million, but that's also including kids 0-12. The number I know is about 1 million eligible who refuse the shot.
It's not the ultra orthodox who really stand out. There's about 30% in the general 20-29 groups who haven't taken their shots (going down to about 20% in 30-39 and down to 10% in the 60+ group), and many Arabs who are reluctant to do so too.
I would be cautious about interpreting those numbers without a bit of nuance.
The original spring 2020 outbreak in the UK was huge, affecting a sizable percentage of the population. However at that time PCR testing was nowhere near scaled up to the point that all of these cases could be tested.
Therefore if you were infected in the first wave, recovered, and are now reinfected 16 months later you probably aren't going to be one of those 137 because it's quite unlikely you were PCR tested the first time around.
That's not to say reinfection is super-common either, but it's probably at least an order of magnitude (or possibly even two) more common than that raw percentage would suggest. In other words, you've produced a statistic with zero significant figures of accuracy.
I was infected 3 times in last 9 months, according to my IgG level. First time I was one day away of hospitalization, 20% lungs damaged. Second time it was 37.1C temperature for 3 days (for those from imperial system, norm in 36.9) and no other symptoms. Third time I didn't notice at all.
Isreal also pretty strictly contolled things early on so had less natural immunity than others going into this wave (but Iceland did that too). And they struck a deal to get the vaccine early, so may have wanin immunity (lots of debate on this and whether this actually just behavior change due to presumption of immunity).
They did. Australia publishes data on this and the effect is profound. Australia has had about 400 flu cases in 2021, compared to a 5-year average of about 50000. None of those cases in 2021 have been hospitalised or led to death, when in the average year there’d be about 150. 2020 also yielded a similarly precipitous drop in cases.
It could have disappeared from Europe because the new version did not arrive from South-East Asia, where it normally originates. The anti-covid measures there might have prevented the world outbreak.
The previous flu version is not as potent due to vaccination and people having had it, thus the herd immunity is achieved.
> You've presented a false dichotomy here - mass vaccination and masking will not necessarily prevent overwhelmed hospitals.
That’s a very disingenuous way of presenting things: we can’t extinguish the house fire so we might as well leave the kids upstairs. It’s used far too much by people keen to profit from a cultural war that has nothing to do with health policies. It’s a sad news that a simple solution isn’t enough, but in no way it should called “a counter-point”. It’s not. “Vaccines alone are not enough” isn’t a counter point to saying that they are a necessary aspect of getting the pandemic to acceptable levels. It’s just saying they are insufficient.
Vaccines are incredibly effective; if hospitals are overwhelmed there would be far more deaths without the vaccines and you cannot in good conscience argue against widespread vaccination by claiming they are not enough on their own. There are many more things that can be done, and put all together last year, they have helped delay infection, spread the wave of hospitalisation to manageable levels. If we need more efforts now, let’s not throw the most effective tool we have because it’s not a cure-all.
Hospitals are always full. Like any business, they mean to run at close to capacity. Capacity here has more to do with staffing than actual rooms, beds, or equipment.
Same as with what probably happened with HCoV-OC43, another betacoronavirus very similar to SARS-CoV-2. Evidence indicates that it caused a worldwide pandemic that killed a lot of people starting in 1889. Now it's endemic. Most of us catch it when we're young and healthy which gives us partial immunity later.
> Fortunately the vaccines are very effective at preventing death
Yes individuals who have been vaccinated or recovered from natural infection will have durable immunity and significantly lower risk of severe outcomes like hospitalization and death. [5][6]
The real question: is mass vaccination effective at preventing the spread and increasing trasmission/virulence of variants of concern? A growing body of the scientific literature and evidence suggests not. [1][2][3][4]
This doesn't mean we shouldn't be using vaccines, rather we should use them in a highly targeted way, and supplemented by other therapeutic modalities.
[2] states:
> The UK should continue to proactively support a strategy of worldwide effective vaccination in order to drive down global viral load reducing the likelihood of dangerous variants emerging in other parts of the world.
In any case, even if vaccines lead to stronger variants (as some of the research you cited states is possible), a game theoretical situation is created where enough people are vaccinated that those who are not are just leaving themselves in greater danger. And in the case of a mutation breaking out of the vaccine, [2] suggests just to immediately start making a new one with the same technology.
> immediately start making a new one with the same technology
Take a look at what happened with Marek's disease virus in chickens to get a taste for why this could be a very bad idea [1][2].
> a situation is created where enough people are vaccinated that those who are not are just leaving themselves in greater danger
Yes this is exactly what happens, and is corroborated by the citations I provided in this comment.
Do you want to live in a world where you literally cannot survive without vaccination, because multiple generations of vaccines have been undermined by viral evolution? What you're suggesting is exactly how that can happen.
Because mass vaccination combined with a vaccine that does not necessarily prevent infection and transmission creates selective pressure that is likely to further enhance the fitness of the virus and will lead to variants that escape the immune response in both vaccinated and naturally infected individuals.
Excerpts from [1]:
- "The spike protein receptor-binding domain (RBD) of SARS-CoV-2 is the molecular target for many vaccines and antibody-based prophylactics aimed at bringing COVID-19 under control."
- "Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions. With the emergence of new strains of SARS-CoV-2 with altered transmissibility and immune evasion potential, a critical question is this: how easily can the virus escape neutralizing antibodies (nAbs) targeting the spike RBD?"
- "Our modeling suggests that SARS-CoV-2 mutants with one or two mildly deleterious mutations are expected to exist in high numbers due to neutral genetic variation, and consequently resistance to vaccines or other prophylactics that rely on one or two antibodies for protection can develop quickly -and repeatedly- under positive selection."
- "The speed at which nAb resistance develops in the population increases substantially as the number of infected individuals increases, suggesting that complementary strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) or that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification) are key to reducing the risk of immune escape"
- "Strategies for viral elimination should therefore be diversified across molecular targets and therapeutic modalities"
> Because mass vaccination combined with a vaccine that does not necessarily prevent infection and transmission creates selective pressure that is likely to further enhance the fitness of the virus and will lead to variants that escape the immune response in both vaccinated and naturally infected individuals.
And yet, the Delta variant evolved in an 100% unvaccinated population - and is quite happily punching through some of the protections afforded by vaccines, despite not having any evolutionary pressure to do so.
> "The speed at which nAb resistance develops in the population increases substantially as the number of infected individuals increases, suggesting that complementary strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) or that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification) are key to reducing the risk of immune escape"
Doesn't this mean that the problem is in having a large number of infected individuals? Which is exactly what happens when a virus sweeps through the unvaccinated population - see, delta.
Also, since Covid and its variants seems to happily re-infect people who have already had it, the same evolutionary pressures will still be present, as long as there's a large reservoir of sick people, regardless of whether they are rubbing shoulders with vaccinated individuals, or 'caught it eight months ago' individuals.
We have two broad options for reducing the number of dangerous COVID mutations.
1. Harsh lockdowns, Australia/NZ/China style, to bring cases down. It works, but everyone hates it.
2. Mass vaccination, that gets us to herd immunity against the most prevalent strains of COVID, so that we no longer have millions of active cases. We're not there with 50% of the population vaccinated. We might be there if we were at 85%.
Since you seem to think that #2 is not the solution, what is your plan for stopping the evolution of the virus? #1?
Simple answer is many people incorrectly self diagnose as recovered, and it's faster and easier to vaccinate than test for actual prior infection. And it provides even more robust immunity.
Vaccination has shown better health outcomes even in already infected persons[1] - getting both is the best protection and there is no rational reason to refuse the vaccine.
It is still very early in vaccine trials. There are anecdotal reports of an increase in non-Covid health problems (e.g. reactivation of dormant infections that had previously been suppressed by the immune system) in those who had already recovered from Covid, then got vaccinated. That's separate from the tens of thousands of reports in VAERS and non-public (HMO) adverse event reporting systems for all Covid-vaccinated people, whether or not they were previously recovered.
VAERS suffers from some serious data quality problems. It isn't a representative random sample. No one really validates reports to determine if adverse events were actually caused by vaccination. I suspect that some anti-vaxxers just straight up submit false reports to push their political viewpoint. At most VAERS provides some clues about where to focus real research.
Yes, hence the reference to private HMO databases. CDC VSD (Vaccine Safety Datalink) is not public, sometimes we get data snapshots when CDC is investigating specific adverse events, like blood clots, https://news.ycombinator.com/item?id=27464528. There are people with access to both VAERS and VSD for trend signals, including doctors with private data from seeing patients.
i.e., the questionable number is orders of magnitude larger than the reliable number.
> as antibody levels in survivors drop
Recovered survivors have multiple mechanisms of defense, including antibodies against components of SARS-CoV-2 (not just spike protein) and T-cells, which have been proven effective against SARS1 after 17 years. They also have both nasal/mucous and blood/serum antibodies, unlike the vaccinated which have primarily blood/serum antibodies against one spike protein variant for symptom reduction.
Survivors don't need boosters. Those who take non-sterilizing intramuscular vaccines may need boosters.
>
Where "in a particular way" is highly accurate genomic sequencing rather than a PCR test with a long list of known problems,
The particular way requires both the original diagnosis of the first infection AND the diagnosis of the second infection to be done the same way.
Most infections never get diagnosed that way in the first place, which is why such a comparison is impossible for the vast majority of cases.
What exactly is your theory? That those 35,000 people never had COVID in the first place, or that what they got the second time around isn't COVID? Or that we can disregard every other word in that report, because the only word that matters in it is '137'?
> , which have been proven effective against SARS1 after 17 years.
Unfortunately for those people, we're not dealing with a SARS1 outbreak.
How many years have they been proven effective against SARS2?
> Survivors don't need boosters. Those who take non-sterilizing intramuscular vaccines may need boosters.
> We have two broad options for reducing the number of dangerous COVID mutations
This is a false dichotomy, we have way more than two options. Below you'll find that I have supported my claim with exceptionally well cited publications and results from recent high quality clinical trials showing promising results.
A) strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) [1][2][3][4][5][6]
B) strategies that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification)
C) Vaccines are absolutely part of the answer here. However, compulsory mass vaccination alone is exceedingly unlikely to be a solution - for all the reasons and evidence put forth in the citations of my previous comment - and because data from all over the world is showing that high vaccination rates alone are not preventing the dominance of VOCs [7][8].
Glad to see you're not getting downvoted for this. This line of thought and information will be dismissed as a conspiracy theory and will follow the same arc as the lab leak hypothesis. Meaning there will be attempts to discredit it with no more than appeals to authority until the truth becomes impossible to ignore.
That’s an argument for alternative measures than vaccines (isolation, disinfection) but not against population-wide vaccination. If you can’t identify all cases, you want as many people as possible vaccinated to limit the overall spread.
Intramuscular vaccine delivery did not confer high levels of mucosal immunity. However, subsequent infection of the vaccinated may provide excellent systemic protection while allowing mucosal immunity to naturally develop as a consequence of infection.
If high levels of mucosal immunity develop as a result of breakthrough infection, that may go a long way towards reducing r0.
Further, nasal delivery covid vaccines are underdevelopment. These may also provide mucosal immunity.
So there is still a very plausible way out of the pandemic that includes the near eradication of the disease.
Slightly off-topic: shouldn't the 'new normal' be to wear N95/N99 masks?
We know they're far more effective, and there's been plenty of time to ramp up production. I don't see why the 'normal' option is to wear a non-medical mask.
It's also surprising that societies are entirely incapable of doing a hard lockdown for 3 weeks with mandatory testing at the end. I imagine that would be enough to reduce the case count to near zero, but it seems this cannot be done at a national scale even with time to prepare.
It's just hygiene theater to make people feel better. 95% of time when I see masks in a situation that isn't particularly risky (outdoors), it's not an N95. People do it because it makes them feel safer and to virtue signal.
What's bizarre is that it's rare for public health officials to care, either. It makes me think they're actually very effective (which I doubt with delta), they want to people to feel safe to keep the economy running, or they're worried about how much more contagious it could get facing a real obstacle.
As for the hard lockdown, I think we're past the point of that being a theoretical option. Looking to Australia, it's still spreading. There's a level of contagiousness where the minimum amount of interaction is still to much to stop the spread. We'll see what happens in New Zealand.
You're right about the national scale for everywhere other than Singapore. There are just too many people too spread out to actually enforce it. Borders are too porous, and enough people are onboard with letting it spread that this option isn't practically or politically viable.
> It's just hygiene theater to make people feel better.
With the disclaimer that I'm not an expert: this is wrong. Cloth masks are moderately effective in preventing the wearer from infecting others. N95/N99 masks do this job much better, as well as significantly protecting the wearer, unlike cloth masks. We've known this for some time.
As far as I know there's no reason to believe the new variants have changed things, other than making it even more beneficial to switch to N95/N99.
You argument is in bad faith: because something is effective but not perfect doesn’t mean we should get rid of it. If people are not wearing a mask properly, we should explain why it matters and how to do it — not throw out a good idea.
Same thing for lockdown: it works. It might not be enough, or there are too many edge cases in Australia, but dismissing distancing because the first attempt wasn’t enough, or perfect is the opposite of what Hacker News stands for.
That's actually what Dr Fauci initially talked about with regard to the general public. With how masks are worn and used in practice, he was probably right.
Fauci: There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is. And, often, there are unintended consequences — people keep fiddling with the mask and they keep touching their face.
LaPook: And can you get some schmutz, sort of staying inside there?
Fauci: Of course, of course. But, when you think masks, you should think of health care providers needing them and people who are ill.
> "Well, the reason for [not telling people to wear masks in March, 2020] is that we were concerned the public health community, and many people were saying this, were concerned that it was at a time when personal protective equipment, including the N95 masks and the surgical masks, were in very short supply. And we wanted to make sure that the people namely, the health care workers, who were brave enough to put themselves in a harm way, to take care of people who you know were infected with the coronavirus and the danger of them getting infected."
Laudable as his intentions may be, and while I doubt he makes it a habit, he lied.
I've been asking those questions for about 16 months now and hardly anyone of those in charge is willing to even consider an answer. They just botch and bumble their way through from one lockdown to the next.
The COVID-19 vaccines are a boon and a vital component for ending this crisis. However, they're not the panacea those in charge made them out to be. Make no mistake, those vaccines, particularly those of the mRNA variety are more successful and have been available much more quickly than one could've reasonably hoped them to be.
Still, it should have been clear right from the start that virus variants against which vaccines are not as effective anymore are a distinct possibility.
Hence, my suggestions for a "new normal" (though I dislike that term because it implies both that the world in general is static and that on the other hand we have to accept the current situation as the new default indefinitely) for the time being (that is until COVID-19 has become endemic and most of the population has built up at least some level of immunity - through vaccines or by "natural" means) are these:
1. getting vaccinated, if possible
2. getting booster shots and / or updated vaccines regularly, in case that's proven to be useful (the jury still being out on both counts)
3. wearing masks in certain settings, e.g., on public transport
4. the most important one: having everyone - vaccinated or not - tested for indoor gatherings or large-scale events (rather than prohibiting those outright)
Other than that, life has to continue as normal: No further lockdowns, no social distancing, no civil rights restrictions.
Unfortunately, and totally incomprehensibly, #4 seems to be highly controversial, with some countries now even shutting down their previous - if perhaps not exemplary then at least adequate - testing schemes or implementing truly asinine measures such as mandating people to pay for tests and only requiring those not vaccinated to be tested at all.
Yeah, right. What could possibly go wrong? I suppose the rationale behind that one is: "No tests. No problem."
My impression is that the tests are not yet fast, accurate, and noninvasive enough for #4. I'm skeptical that we can vaccinate our way out of this mess completely, and I don't think we can test our way out yet either.
If we can improve the tests sufficiently, though, then I think your plan makes a lot of sense. I think of COVID as fire. Keep the fuel damp (#1, #2, natural immunity), don't pile up too much in one place (#3, low cost forms of social distancing), and watch for flare ups so you can douse them quickly (#4, sorta). Don't worry about putting the fire out, just keep it from burning down the forest.
There are saliva tests, which is probably as non-invasive as it gets. They're currently not quite as accurate (about 95%) as nasal swab tests (99%, if applied correctly) but still good enough to catch most infections. The biggest problem with these tests probably is getting a proper sample.
Still, that's at least by orders of magnitude better than simply doing nothing. Besides, an accuracy >= 95% with results in less than 15 minutes isn't that bad at all already.
#2 because if the virus gets an update it might make sense to give the immune system an update, too (the same way we do with the flu, by the way).
#3 because it further reduces the risk to get even mildly sick at little to no cost. I'll continue to wear a mask on public transport even after this pandemic is over. I don't need to catch the flu or even the common cold either, if I can avoid it.
#4 because it enormously helps with keeping new infections at a minimum. Hence, further lockdowns neither required nor justifiable anymore.
On public transport? Where people are getting on and off the train or bus every few minutes and you don't have a closed system?
I don't know about the specifics of UV air filters but I'm not sure they'd be an alternative in this particular scenario. They seem to be more useful in situations where the same people are in the same room for a prolonged period of time.
I'm all in favour of small, incremental improvements. Those can be a huge contributing factor, so we don't have to wield the blunt instrument that is lockdowns anymore.
Using air filters probably is more of such an additional improvement, rather than a complete solution in its own right.
Getting tested - have you? - is not neutral on your body. The nasal swab is sterilized by a carcinogen gas which exposure should be limited and you can’t avoid wrong gesture by a nurse physically damaging your nose. It’s fine time to time but not everyday.
That an object has been exposed to a compound during that object's lifetime doesn't necessarily mean that you'll be exposed to that compound upon touching the object.
> Get vaccinated every 6 - 12 months indefinitely and always wear masks
An annual Flu and COVID shot seems perfectly reasonable. Wearing masks in public is already normal (or at least not uncommon) in many places, and I don't have a problem with where I live being one of those places.
What if I have a problem with where I live being one of those places?
Or another question in a similar vein, what if I don't have a problem wearing a mask but my neighbor does?
Also I'd point out, seasonal flu vaccines are not mandatory and in most places have a low vaccination rate. Would you be fine with a non mandatory covid vaccine?
> What if I have a problem with where I live being one of those places?
> Or another question in a similar vein, what if I don't have a problem wearing a mask but my neighbor does?
I think that if seasonal flu vaccines start being combined with seasonable COVID vaccines that the rate would go up. And unfortunately I think mandatory vaccines would be unacceptable to too many people to think it's a viable option.
I don't have an answer to masks, though I think they'll get more and more normalized as time goes on. Even if COVID were to be basically suppressed, I'd probably still keep wearing them on public transit.
Sample size isn't the problem you think it is. The difference in statistical confidence between sample sizes of a hundred million (COVID vaccine doses) and a billion (flu vaccines) is basically zero.
Perhaps you could try to make a case that we need more time to evaluate the long-term effects of the vaccines. Historically speaking, we know that side effects for any vaccine are incredibly rare after more than a few months. mRNA vaccine technology has been researched for decades and there are no indicators that there are long-term complications resulting from their use. Other vaccine technologies show similar long-term safety.
Why get the flu vaccine anymore? If you believe official reports, it’s basically been eliminated by virtue of simple mask mandates that everyone swears no one is following.
Because it's safe and easy. I have immuno-compromised friends and elderly family members. Vaccines are almost literally the least I can do to help keep them safe. I have kids and taking care of sick kids is awful. Also I really really really hate having the flu personally. Bleh.
> If you believe official reports, it’s basically been eliminated by virtue of simple mask mandates that everyone swears no one is following.
I have not seen official reports that determined the drop in flu was due to masks. I would assume the drop in flu was due to many factors combined: schools and businesses going remote, other physical distancing, more people getting the flu vaccine to avoid getting sick and potentially straining our strained healthcare system, masking, and who knows what else...
...at any rate I expect the flu will return as kids go back to school, workers return to offices, etc. I'll keep getting vaccinated for the flu as long as my doctor recommends it for my reasons stated above.
I'm not surprised flu rates are crashing with the current social distancing, mask wearing, and higher skittishness around people with respiratory symptoms. Even if most people do them poorly, and others don't do them out of protest.
The takeaway isn't that official reports are baseless propaganda. It's that we were really bad about handling the flu before 2020. How many times did one of your coworkers show up with a persistent cough, running nose, or sneezing fits? How often did you see people with symptoms in grocery stores or buffets? I'm not surprised even a modicum of care greatly outperforms our previous habits.
I got covid last march, and got it again one month ago. I was very sick for three weeks on my second covid infection. I think we are about to face the harsh reality that covid is never going away, and immunity and is never going to happen. The virus will mutate and find new ways to infect
I feel like this is what most experts were saying from near the beginning: this is not a few months problem. This is an ongoing problem that will require us to adapt just as it adapts. I remember many articles in 2020 projecting what the virus might look like 5 or 8 years out.
Lockdowns and other extreme measures were about flattening infection curves to keep from overwhelming health systems, not about eradicating the virus outright.
Masks and distancing are about getting the virus to a manageable infection rate to minimize impact on our new normal lives.
Vaccines are the only way out without high mortality and extreme pressure on our health systems. Whether it requires vaccines like polio (one or two and safe forever) or flu (annual) is yet to be determined AFAIK. It seems like somewhere in the middle is most likely at least for many years to come.
I agree that it was never a few months problem - but I think we had a window to stamp it out and low vaccination production and adoption rates have killed that window dead. I don't believe it's impossible that we beat this - but I would not be surprised if mutation rates simply outrun vaccination adaptation.
What do you base that on? That seems highly unlikely to me. Even as the virus tapers down in one country, it or a variant surges back in five others and then it spreads to others. I haven't seen any chance of stamping that out.
I mainly have a view into how Canada responded to the virus - and we did things okay-ish but weren't at emergency levels. Canada provided a lot of pre-orders for doses to try and spur private research into the vaccine (provide a monetary incentive) but it really lagged on any serious investment into nationalized production facilities with the main assumed acquisition method being purchasing them abroad. In March 2020 we all knew that there would eventually be a strong need to produce a vaccine (or like... we'd all die - it was one of those two options) and Canada is a relatively economically advanced nation with the capability (and public will - unlike the US) to build large non-private vaccination production facilities. This likely would drive long term employment as well as helping to fight against the pandemic.
The world could have seen this pandemic and gone all war-industry on it - convert factories and gear up production as if the nazis were days away from invading our shores - we simply didn't.
I just dont see how getting a shot every year or six months for eternity is a viable solution. Not only that, vaccinated individuals can encourage new mutations (this is controversial, but I believe over time it will be realized)
Yes, but flu shots are entirely voluntary. Meanwhile, there's legislation being considered in the U.S. to put people on Do Not Fly lists for not showing proof of being "fully" vaccinated. And who knows how far the goalposts can move when it comes to what "fully" vaccinated means. Next year, that might mean having had 4 shots, or more.
In the 1970s the US required MMR shots for attendance in public schools and the disease quickly tapered off - we've done this before and, so long as the vaccinations aren't inducing a financial burden on individuals that are unable to afford it - I see no issue with requiring vaccination if you want to share a close space with others. A lot of potential partners will reject you if you're unable to provide negative STD results - this isn't all that different.
Oh also - a small pedantic correction. There is a formal thing in the US called the No Fly List and I've heard absolutely nothing about putting people onto it for not getting vaccinated - there has been discussion to restrict your ability to fly if you're unvaccinated though which... would be easy to fix (unlike getting off the No Fly List) by simply getting the shot.
First, public schools are government institutions, airlines are not. Sure, flight is heavily regulated, but do you want to live in a world where private companies form a cartel and all agree to require a medical treatment, effectively blocking you from long distance travel?
Second, their are religious exemptions to mandatory vaccinations. We can argue whether there should be, whether they're abused and all that, but as long as they're going to exist, shouldn't they apply across the board?
To the first point - yes because it's being done for a completely valid medical reason. There isn't a slippery slope argument available here because people consider this reasonable because the cause is reasonable.
To the second point - I think religion does a lot of harm to modern society so I'd rather those all went away - yes even for the amish as inoffensive as they are.
I too had a similar series of events and my second infection was both worse and better than the first. My first bout was longer but consisted of just a mild cough with a tolerable shortness of breath but 9 months of long haul hell. My second was rife with congestion, headaches, and muscle pains but it came and went in the span of a week, no long covid this time around (so far).
I am becoming more skeptical of that outcome unless we can kill it dead globally. It seems probable to me that this is going to go on in perpetuity like a much more deadly seasonal flu.
These variants have their most severe symptoms blocked by the same vaccine with very similar effectiveness. Influenza viruses, on the other hand, undergo recombination in such a way that the vaccine has to be engineered every year based on guesses of what the prevalent strain is going to be.
Not only that, but I’m afraid this is the endgame new normal for a densely populated world. How do we avoid continuous new disease pandemics when we are tightly packed in like sardines?
As part Native American, I am reminded of what happened when Europeans from a densely populated area came here. Estimates vary but maybe 90% died from the “new” diseases to them. The fact that Europeans weren’t decimated by native diseases makes me think that one of the prerequisites for societies free of disease is lots of empty space between people and limited travel. This will continually decrease with time in the anthropocene.
I certainly hope it isn't leading to a society where papers are checked and masks are always required. Although I am vaccinated, I feel vaccine mandates constitute a breach of bodily autonomy and medical privacy. As for masks - I find them stifling in more ways than one - it is hard to breathe, it fogs up glasses, it causes me to feel overheated, and it really diminishes human connection and exchange of emotions. I think the impact of masks on developing children who need natural socialization will be drastic and dangerous.
So my take is that at some point, we just need to deal with it as a background event and move on. The infection fatality rate for COVID is incredibly low, particularly for those under 50. It is irrational to worry about it to the extent we are, since we don't typically worry about such rare possibilities. I am also betting that phenomenon like "long COVID" will either be found to be other conflating factors, or found to be a phenomenon associated with any illness. It's just that we're so focused on COVID as an entire species, that we're spotting all the little things we would normally ignore.
>The infection fatality rate for COVID is incredibly low, particularly for those under 50.
The infection fatality rate is relatively low when hospitals aren't overwhelmed and when we have oxygen available, and let's not forget all the mask and vaccine measures you disparage.
That rate isn't going to remain low with the 'I've got mine, %$#@! you' attitude some people have, when even the lowest cost intervention (like wearing a mask) is unacceptable. With no interventions, infections spike and the death rate will be higher.
Ultimately, restrictions will remain until enough people have been vaccinated, either via the vaccine and/or in the 'natural' way. The attitude of some just means we'll all suffer for a bit longer.
Why indefinitely? If that was the case we would need shots for the other cold viruses as well, which we don't. As you say, Sars-2 will turn into an endemic virus and thus we will get used to it over time, death rates will drop and it will turn into a cold. There is absolutely no historic precedent to think it will turn out differently.
Yes, you are right. At the same time, flu viruses are very different from coronaviruses. We didn't get any shots against OC43 and the three other already endemic coronaviruses.
Also, note that older people and immune-deficient people (who are most likely those needing a shot every year) have been dying from ordinary cases of flu before, too.
The only reason we don’t “need” vaccines for other cold viruses is that they’re very rarely severe, right? I’d certainly take the shot if they existed.
Yes exactly. But how was it when they first appeared in the human population? We can't know for sure, but most likely they caused a heavy pandemic in the first years and then over time became "harmless".
Just think about how bacteria/viruses which were not really dangerous for Europeans wiped out entire populations in Middle and South America.
We don't have vaccines for the 200+ viruses that cause "the common cold". The flu, which is usually a more serious disease, has a vaccine that is updated and offered yearly.
80% of US medical personnel already take the yearly flu shot.
I would say 3-5 years without vaccines. See for example the 1889 pandemic [1], which might have also been induced by a coronavirus. It's hard to say with a vaccine since there is no real precedent. If I had to guess I'd say 1-3 years?
Vaccinate all people greater than 40 years old, preferably anyone and resume a normal life.
Even though the vaccine doesn't prevent to catch covid to high degree, it still prevent deaths and hospitalizations to more than 90% (whether Delta or not, and whether Aztrazaneca or Pfizer or Moderna)
Long Covid seems to exists, but it is about 2-3% of cases so nothing to really worry about more than any other disease.
Maybe at some point the vaccine won't protect from a new variant and things will change. But so far so good. And even at this point, Lockdowns and masks mania doesn't seem to be give a better output than asking citizen to be careful and try to limit meeting too many people (Sweden)
Disappointing that nobody can provide a real answer. A third shot 6-8 months later seems to provide robust immunity. Same with measles or any other shot regime, which is administered over a course of several months, but not continuously and forever.
Our plan is to take easy precautions like masks until we stop having massive waves whenever they’re relaxed that fill up icus like in Alabama. Probably in a year we’ll be able to relax them without that happening. What do you propose? Are you against the current mask mandates?
We are better of if we vaccinate every 6-12 months. We are better of if we keep some social distance measures. So we should keep doing this as long as it is the better option. The goal is continue with our lives with the least damage from the virus.
I'm not sure if this is technically feasible, but maybe a yearly covid shot just gets added to the flu shot routine. Either through the same shot, or two shots in one visit.
There's a social-acceptability phenomenon where people say one thing (e.g. in surveys) and do another (e.g. what they buy).
Relatively early in 2020, some grocery and pharmacy shelves were completely emptied of Vit C/D/Zinc/Quercetin. When they were restocked, they would sell out again, even with per-customer quotas. This took place even with a complete news blackout on early treatments. As with HCQ/Ivermectin, we have decades of data showing very low risk of adverse effects from these early treatments. So the worst case is that people waste money on placebos. But there are studies showing that early treatment helps some (not all) patients to recover more quickly.
Just as we don't know why some people are injured by vaccines, we don't know why some people are not helped by early intervention with supplements. More studies are need for both, including funding for autopsies of those who die and retroactive genomic sequencing of virus/vaccine/supplement samples collected from the most severely affected cases.
India (origin of Delta) provides comparative data because some areas have rejected Ivermectin while other areas have embraced it. This is a ZH (sorry) article, but it uses data from Johns Hopkins, https://www.zerohedge.com/covid-19/indias-ivermectin-blackou...
> This data shows how Ivermectin knocked their COVID-19 cases and deaths - which we know were Delta Variant - down to almost zero within weeks. A population comparable to the US went from about 35,000 cases and 350 deaths per day to nearly ZERO within weeks of adding Ivermectin to their protocol.
> Let us look at the August 5 numbers from Uttar Pradesh with 2/3 of our population. Uttar Pradesh, using Ivermectin, had a total of 26 new cases and exactly THREE deaths. The US without Ivermectin has precisely 4889 times as many daily cases and 191 times as many deaths as Uttar Pradesh with Ivermectin.
At present, there are billions of dollars of economic incentives for suppression of early treatment, because vaccines are still under EUA that could be questioned by the availability of therapeutics with decades of safety data. If the FDA fully approves one or more vaccines in September 2021, perhaps there will be more economic incentives to perform research and studies of therapeutics.
Merck (original holder of the Ivermectin patent) is developing a new patented therapeutic for early treatment of Covid. Time will tell whether this is a genuinely new treatment or an "evergreen" variant of Ivermectin to obtain patent revenue. Either way, it would mean that at least one Big Pharma company has an economic incentive to promote early therapeutics for Covid, which could provide some balance to the currently polarized treatment landscape.
How would an in-hospital treatment of Ivermectin reduce the number of cases? It's only being used when people are already in the hospital with symptoms, which really should have almost zero impact on the spread of disease.
> there are billions of dollars of economic incentives for suppression of early treatment, because vaccines are still under EUA that could be questioned by the availability of therapeutics with decades of safety data
Conspiracy theory. Rather old and naive, I should add.
Zero Hedge is a cesspool of pseudo-science when it comes to COVID. The best data source can be twisted into complete nonsense when folks have political agendas - so namedropping JHU in that context is just empty rhetoric.
Well, maybe it's not "empty" rhetoric, since clearly some naive folks are persuaded by it.
What you're doing is called a character attack. I agree with you about zero hedge, but that doesn't change what you're doing. A character attack is usually used when one doesn't have a counterpoint against the point being countered.
"There are financial incentives to sell vaccines" might be a conspiracy theory, but anyone not considering this reality a factor is delusional. I don't think they're selling us snake oil and scaring us into getting it, but there is definitely a motive beyond (but probably including) public health and that is to recoup the cost of development of the vaccine, at the very least.
If you don't make it clear that bullshit is bullshit, if you pretend like it belongs to the realm of sanity, then the debate becomes a farce - some kind of Monty Python absurd comedy.
Sure, but "there are financial incentives to push vaccines" is not bullshit. It is very real, and probably a non negligible factor in how the PR around them is being handled. Not to say public health is not a factor, probably the largest factor, but profit is always a factor as well and in this case would be a very real perverse incentive.
Is there a better analysis of cross-region variations in Delta cases and deaths in India, which identifies non-Ivermectin factors for the difference in outcomes?
It's sad that this comment (and probably mine) downvoted despite being a reasonable long-term response to this virus.
Instead of mandating this vaccine worldwide, why don't we focus on collectively building a better / stronger health that would prevent the large majority of severe cases?
I haven't seen an evidence that supplements would prevent the majority of severe cases, or the neurological damage done (in even mild cases). Is this something backed up by data?
Anyything that makes your immune system work properly will help, the reason Covid is even a subject is that there is a silent epidemic of immunocompromised people, a large number of which are unaware that they are - the kind of people who routinely get sick in the winter, for instance. It's very strange that we are pretending that healthiness doesn't exist or can't be improved. It can, and rather easily and cheaply (yes, Vitamin D is one, but also, especially for Covid, anything that improves vascular function, as the etiology of Covid is closely linked to vascular health... which is where Niacin (vitamin B3), vitamin C, and reducing /eliminating sugar come in).
If you look up "covid vascular" you'll find plenty of references. Seeing how it affects most people with chronic conditions associated with such problems (hypertension, diabetes), I'm convinced it's a correct assessment.
Is neurological damage in mild cases backed up by data? The only study I saw was based on self reporting and an Internet based IQ test.
Also considering perhaps 30% of the world has had covid now (anyone have the exact figure?) that would be an unbelievable amount of brain damage. I’d think we’d be aware of that if one in three people had recent brain damage.
I'm neither a researcher or doctor, but I've seen numerous articles that describe this. Anecdotally, I've had multiple people (acquaintances and family) suffer from neurological effects.
Thanks for finding some papers but I’m not sure they support OP’s claim.
I’ll admit I don’t understand the first one. Somehow they’re claiming covid causes Parkinson’s and Alzheimer’s? How can we know that after less than two years?
The second one is clear to mention “ Most people infected with SARS-CoV-2 virus will have no or mild to moderate symptoms associated with the brain or nervous system. However, most individuals hospitalized due to the virus do have symptoms related to the brain or nervous system, most commonly including muscle aches, headaches, dizziness, and altered taste and smell.”
So They are claiming an effect but not for mild cases like OP said and not really claiming brain damage anyway.
What's mysterious about the flu disappearing? The precautions taken to reduce COVID were extremely effective against influenza. Given that it was much more broadly circulating, and therefore a large percentage of the population had antibodies to dominant strains (more than COVID even now), one would expect masks and isolation to basically destroy it's spread no?
It's also possible that viral disease dynamics are just like that, with one virus dominating at a time (amongst this class of highly contagious respiratory viruses).
At least in the case of vitamin D it's hardly pseudoscience. Multiple clinical studies have found that hypovitaminosis D is a serious risk factor for COVID-19.
Are you claiming that you read all the studies linked above and none of them show actual causal determination? We can't really prove anything 100% in biology but the totality of evidence is very strong here.
This is not a study, but it does discuss the biochemistry of vitamin D and the role it plays in the immune system. It is left to the viewer to draw their own conclusions.
COVID-19 and Vitamin D | Association Between Vitamin D Deficiency and COVID-19
Not everyone cooperated with lockdowns, rendering them less effective.
> - Masks should have stopped covid.
Not everyone wore masks, rendering them less effective.
> - Vaccines should have stopped covid.
Not everyone is getting vaccinated, rendering it less effective.
I see a pattern here with an obvious solution, and it's not doubting the "true" science and declaring ourselves epidemiologists, virologists, and public health experts.
If your solution requires every person on earth to obey you it's not much of a solution, and "everyone didn't obey" is an excuse to why your non solution predictably did not work.
Each of these scenarios was predictable and in fact, predicted by many. Yet here we are, still pretending to be shocked at the intensity of human autonomy.
If your plan requires everyone on earth to cooperate, it’s not a good plan.
You realize that the way other diseases were eradicated required the cooperation of everyone on earth? Or at least in most countries. The reason we don't get polio in virtually any country on earth is because of global cooperation in the face of a disease with a known mitigation. Barely 500 known cases world-wide in 2019. Thanks to global cooperation. Too bad propaganda and social media probably ruined our chances of repeating such a feat...
> The reason we don't get polio in virtually any country on earth is because of global cooperation in the face of a disease with a known mitigation.
The polio vaccine being a sterilizing one is certainly a _major_ reason for its success. The Covid vaccine, by contrast, does not confer sterilizing immunity. Polio also spreads through contaminated food and water, not the exhaled breath of the infected. So other than those minor things, great comparison.
I'd say another major reason for the polio vaccine's success is the whole world took it. Substitute mumps, measles, rubella, smallpox, whatever you'd like. Anyway you totally missed the point about global cooperation. We know masks, social distancing, and vaccination with enough cooperation could end the pandemic, but no, people just won't cooperate.
And now that there are new variants in the wild because of people not doing all of those things, the vaccines, lockdowns, and masks still keep ICU beds from overflowing. But you have to actually do them.
- Has one of the least vaccinated population in Europe (around 40% afaik)
- Has had 0 covid deaths in the last couple weeks.
- Has not had it worse than countries with stricter mandates.
Are we also forgetting about Iceland / Israel which are among the most vaccinated countries in the world (on top of having stringent mandates) and are basically experiencing their largest spike in cases since the beginning of this pandemic?
At the end of the day, it's also good to realise so called experts do not seem to have all the answers even though it's "backed by science". Going back to common sense and taking a step back is what will get us all out of this.
Have you been actually following how things have gone? Sweden has 1708% more deaths to covid vs Norway, but only 84% higher population. That doesn't sound that great to me.
This comparison between two datapoints is not too useful.
The graphs at https://euromomo.eu/graphs-and-maps/ provide a more nuanced picture, with the caveat that those are graphs of excess mortality and not necessarily covid-specific.
Useful or not, I think it's more representative within that region than you let on and matches basically the activity causing this moment in the timeline from your link: https://imgur.com/a/G3D7AZ2
> - Has had 0 covid deaths in the last couple weeks.
Deaths per week are a function of previous deaths and population distribution. If more people die at the beginning, then fewer are left to die later. That's how dying works. Sweden's weekly per capita deaths peaked much higher than in the US or EU overall, and they've lost more people per capita than their neighbors.
A person who cares about numbers should be looking cumulatively, not just within some specific narrow window.
> Are we also forgetting about Iceland / Israel which are among the most vaccinated countries in the world
Israel isn't even in the top 30 and their vaccinations flatlined back in February, they prematurely declared victory, and people went back to licking doorknobs. But let's ignore all of that for now.
Congratulations, people faffed around fighting against restrictions and vaccination for so long that now we have successfully developed a mutation that achieves viral escape. Go team! Yay! Mission accomplished!
Vaccines and lockdowns and mask mandates still appear to prevent deaths and hospital overflow. How do we know? Because deaths and ICU bed percentages go down during lockdowns and go up when lockdowns end and because a tiny fraction of the people dying are vaccinated.
Keep in mind also that Iceland still has one of the lowest total per capita COVID death rates of any place in the world. It's also a weird little volcanic island with everyone living in only a few places with a major international transit hub between Europe and North America. The few places in the world doing better than Iceland are places which also lock down quickly.
> Going back to common sense
Except that your "common sense" tells you that Sweden has done great and that Israel and Iceland are doing poorly when compared to other countries the opposite is true. How then should we assess the accuracy of your common sense?
My common sense says that people who refuse the vaccine should just be refused access to hospital resources if they get sick. It would neatly address a lot of issues.
You're acting in bad faith and you know it. You can't just say "lockdowns/masks/vaccines should have stopped covid, but they didn't", when you know that a lot of people out there refused to mask up, refused to quarantine and refused to get the vaccine.
People with your thinking are the reason we're still in this pandemic.
Attacking another user like this will get you banned here, regardless of how wrong they are or you feel they are. Please review the rules and stick to them when posting to HN: https://news.ycombinator.com/newsguidelines.html.
I realize emotions have been running high on this topic for a long time now, but that's a reason to be more mindful of the rules. As they say:
"Comments should get more thoughtful and substantive, not less, as a topic gets more divisive."
I said this above, but if your solution requires every living person to obey you it is not a serious suggestion for a solution. Everyone in the world was never going to mask up and lock themselves away, this was actually an argument made by people as part of why these measures wouldn't work. Is the current state of things proof they were right? I'm surprised to see this excuse for failure of these measures so often touted in a forum largely comprised of computer scientists.
So you're aware it was noncompliance that reduced the effectiveness of those measures, and you think... those measures shouldn't have been taken at all? I'm not clear on what the alternative was, apart from that.
There's a difference between what's reasonable and being perfect. I think they were absolutely reasonable solutions, since I haven't heard a peep about any better ones available, and even with noncompliance they are helpful.
Everything I've heard about how viruses evolve says that they get milder within the host population. The host's resistance keeps increasing as the virus mutates and the population is exposed to the new mutations, and over time this allows the virus to diverge from other populations... where the virus isn't spreading.
E.g. diseases can evolve in Europe then spread to Native American populations. Evolve in bats, or apes, then spread to humans.
Now that this virus has shown that humanity has become one population... and it will spread everywhere if we let it... we should let it.
If we do strict testing, vaccination, etc. and prevent international travel, and otherwise fiercely prevent the virus from spreading across populations, then we'll have just created a situation where the virus could mutate to become harmful.
It's absolutely horrific to bring up Native American populations considering the estimates on population loss range from 25% to 90% with most folks erring toward the 90% end of the range. As terrible as COVID has been we're no where near the level where - as a middle aged person with kids and parents[1] - it's expected that you'll be the only one to survive out of your extended family.
Estimates about the fatality of COVID put it way below the small pox epidemic in North America but that's an absolutely terrible example to draw on.
1. Assume your parents had two children - you both married and had two kids - that's ten people so choose one to survive (obviously epidemics don't actually work this way, but I've found it's the clearest way to demonstrate proportional mortality rates.
I see the sentiment here expressed, that Covid is far from over. To be honest, I stopped following news since being fully vaccinated some time ago, so I am kind of ignorant here.
Is the main problem, the unvaccinated, or that the Delta (and co.) variants are still, too dangerous for vaccinated people? Or is it the fear, that they will get more dangerous?
10.25/100k among people who are unvaccinated.
6.5/100k among people who are partially vaccinated.
1.0/100k among people who are fully vaccinated.
For hospitalization:
2.04/100k for unvaccinated,
1.11/100k for partially,
0.21/100k for vaccinated.
For current ICU status:
1.6/100k for unvaccinated,
0.7/100k for partially,
0.05/100k for vaccinated.
So basically the vaccines are really good, even against Delta. The disease is spreading primarily among the unvaccinated. And even those who get it who are vaccinated are on the whole not getting very sick.
EDIT: For those wondering about natural immunity: only 3.67% of the Ontario population is counted as having had COVID, so I doubt it's a significant influence on those statistics. Granted, the first wave had poor testing, so I'm sure the number is a little higher, but I doubt it's more than 5%.
EDIT: disregard the below comment about 10% ending up ICU; is incorrect because I was comparing the incremental new case count against current ICU status. I'll try to fix the # in a bit.
But what's kind of crazy is seeing that those numbers seem to be saying that among the unvaccinated who get it that almost 10% of them are ending up in ICU. And when you consider that those are probably overwhelmingly young people (here 92% of seniors are fully vaccinated and 95% at least one dose) that's scary.
That should be a clue that something is wrong with your numbers. 10% of unvaccinated people getting COVID are absolutely not ending up in the ICU. It's not even remotely close.
I'm counting ICU admissions among the unvaccinated separately, not against the population as a whole. When you consider that the majority of the population (65% total, 80% eligible) is vaccinated, then you have to separate the two groups because the outcomes are totally different.
But I did spot something wrong with the way I'm counting, so yes the 10% is probably wrong. The reason is that the daily new case count given by the province is incremental, while the ICU count is current # of cases, not new admissions. So it's not possible to do the comparison in this way. I'd have to take a look at the current active case count by vaccination status, which is something I don't think the province is reporting.
Whereas the spreadsheet from your page says 426. It's not even clear to me that the 650 number is accurate because not everyone may necessarily be reporting they have COVID. I know when my whole family got COVID we didn't report it to the government. I've seen estimates in the U.S. that actual case count is more than double reported case count: https://www.cidrap.umn.edu/news-perspective/2021/07/us-covid...
Secondly, ICU case counts are based on people who are in the ICU and happen to have COVID, not people who are in the ICU primarily because of COVID. So for yesterday the delta in ICU COVID case count was 15, but we don't know how many of those net new 15 are actually in the ICU for COVID symptoms primarily.
So taking the raw numbers for yesterday's delta, that's 15 / 650 as a rough estimate (dividing the deltas isn't really what we want but it's the best I can come up with), and that lands us at 2.3%. I also believe that number is far too high for the other reasons outlined above.
Not sure which spreadsheet you're talking about, the page I linked to has a series of feeds, and if you download today's CSV and sum all 4 case count columns it adds up to 650. 426 is the unvaccinated count. 650 is the count of all cases.
Date covid19_cases_unvac covid19_cases_partial_vac covid19_cases_full_vac covid19_cases_vac_unknown
2021-08-20 426 64 103 57
BTW, it's not "my page"; it's the official gov't of Ontario COVID data API. It's where the other link you pasted gets its data. There's another feed that provides just testing numbers, but doesn't break down by vaccination status. It also reports yesterday as 650. So the two accord.
But please, go on. "Your biggest problem" is that you don't read. Just like the 90% in Israel stuff.
You're right. We both made an analytical mistake, although yours was much bigger. If that means I don't read, then you must not read well either. Congrats on devolving to personal insults about my character though. I guess that means you ran out of data-based arguments.
If we adjust for my mistake and make 426 the denominator, the odds go up to 3.5%. If we take into account that at least half of cases go unreported, the odds drop to 1.75% or lower. If we take into account that 25% or more ICU COVID cases aren't really COVID-related, (hard to find data on that but it was what was reported that way for Florida last week), the odds go down to 1.3%.
I apparently read well enough to instantly spot that 10% ICU conversion of infected unvaccinated is a bogus number. And my Israel data mistake didn't affect my conclusions at all. Maybe you should work on your reading?
But i think you got them wrong
> 10.25/100k among people who are unvaccinated
that should be 10.25k - so your statement at the end about 10% ICU admissions does not hold.
> The disease is spreading primarily among the unvaccinated.
What is the evidence for this? Vaccinated people are capable of spreading the disease just as easily as those who aren't. And since they're much more likely to be asymptomatic, may be more likely to spread the disease unknowingly.
Those without the vaccination are more likely to end up in hospital, but that says nothing about how the disease is actually being transmitted.
I never said "spreading from the unvaccinated" I said "spreading among the unvaccinated" which is borne out by the fact that the unvaccinated (and partially vaccinated) here are only 35% of the population (25% of the eligible population) but are 75% of the daily new case count (and perhaps higher because there's a % with unknown vaccination status)
How are case counts determined? Why would someone who has no symptoms go for testing? Case counts among the vaccinated are surely being under reported because they're asymptomatic.
That would show up in the test positivity rate, as it would mess with the denominator. In my area it's pretty low (2.5%) still, despite case counts rising which shows that lots of people are testing negative.
Also your claim about people with the vaccine still being infected/infectious is a pretty bold claim. That's not settled science, and it's quite likely (and consistent with other viruses and vaccines) that the immune system fights off a COVID infection before it becomes communicable in most immunized people. There are definitely breakthrough cases but it's not clear that the majority of cases behave this way.
Of course we'll likely never know for sure because of the stubborn 30-50% who refuse to get vaccinated.
> That would show up in the test positivity rate, as it would mess with the denominator. In my area it's pretty low (2.5%) still, despite case counts rising.
I don't understand this. My conjecture is that people who are infected but asymptomatic due to vaccination would have no reason to show up in the case counts either way, since they would not seek out being tested at all.
As for being a bold claim, it's established science that vaccination can not prevent infection. The virus can still enter your system. I agree that it is a debatable question as to how many and to what extent those vaccinated people are infectious to others.
I'm not describing exposure, i'm talking about infection where the virus enters the bloodstream, regardless of test results (which aren't perfect and may not even be taken if the person is asymptomatic).
I'm curious to know, how does the delay between the first and second shot, and mixing of vaccines that was done in Canada affect thr current infection rate there and the overall efficacy of such vaccines.
Thanks for the link! Lots of interesting details in there. I'll attempt a TL;DR of points most relevant for non-Americans (but please check the article for context, particularly on numbers, and link to sources):
- Delta variant has ridiculously high R₀ - estimated to be between 5 and 9, where initial COVID-19 variants had it around 2 to 3.
- Viruses spread nonuniformly. Old COVID-19 (R₀ = 2-3) tended to spread through super-spreading events (few people infecting a lot more at a time). R₀ of 5-9 implies Delta variant doesn't need super-spreading events.
- This R₀ value also means it's not possible to eradicate the virus through vaccination or herd immunity - it's going to become endemic (which was always seen as a likely outcome anyway).
- Current vaccines have proven to be effective against the Delta variant, by significantly reducing infections (0.01% to 0.29% chance of breakthrough disease), such infections showing symptoms (~88% percent effective) and severity of those symptoms if they show up, as well as preventing hospitalization (~96% effective against Delta; >95% of all COVID patients in US hospitals are unvaccinated).
- There is evidence that vaccinated people can still transmit Delta, even if themselves they don't show symptoms. As expected, the virus seems to live shorter in the airways of vaccinated people.
- Above and high R₀ mean Delta can spread even through highly-vaccinated communities.
- Individually, for those who can get a shot, it's the best thing to do. Community-wise, we still need other precautions - like mask, widespread testing, hygiene, improvements in ventilation, to protect the vulnerable and slow the spread.
- Vulnerable groups now include children under 12 - they're not eligible for vaccination, and there's a growing (though still small) amount of children suffering from long-COVID and MIS-C.
- The end goal is still to slow the spread, to keep schools open and hospitals running, prevent healthcare personnel burnout, give time to develop better countermeasures and therapies, and let the economy slowly recover (instead of repeating 2020). Slowing the spread down also gives the virus less chances of mutating into a more problematic variant.
One clarification - between 0.01% and 0.29% (actually 0.54% now) of fully vaccinated people are affected by breakthrough infection, while 88% effective means in a situation where an unvaccinated person would become infected, the vaccinated person would have an 88% chance of not being infected. So the difference between the two is exposure, which is a function of prevalence.
What is the delta variant R₀ in fully vaccinated communities though? Certainly it's not in the range of 5 to 9. If it's something like 2, then sure, a mask mandate makes sense for everyone. But if it's much lower than 1, then is it fair to force the vaccinated to wear masks? Is this sort of information hidden from the public because officials are too cowardly to force vaccine passports? There are so many information gaps like these that leave room for doubters.
You can figure it with math. Given a starting R0, a vaccination level, and an efficacy, you can figure effective Rt:
Rt = R0 * (1 - (vacRate * effRate))
So if Delta R0 is 6, a community is 65% vaccinated, and a vaccine is 80% effective against transmission, then effective Rt would be:
Rt = 6 * ( 1 - (.65 * .8)) = 2.88
Real effective Rt includes impact of mitigation levels and natural immunity. So for instance, in Portland OR, Rt is about 1.4. We didn't get hit as hard as surrounding states in the first few rounds, so we don't have as much natural immunity. In contrast, Seattle got hit harder early on; their effective Rt is a little lower - and Silicon Valley is actually pretty close to 1 right now.
You are assuming that R0 for vaccinated that contract the virus is the same as those who are unvaccinated that contract the virus, which does not appear to be the case.
That was my question - how much less do those who are vaccinated and contract the virus infect other people than those who are unvaccinated and contract the virus. That can't be calculated from a single R0 number.
If you restrict it to the vaccinated population and the unvaccinated population, then you can consider the vaccinated population fully populated, and the unvaccinated population entirely unvaccinated.
Vaccinated group:
Rt = 6 * ( 1 - (1 * .8)) = 1.2
Unvaccinated group:
Rt = 6 * ( 1 - (0 * .8)) = 6
The question of "how much less" is hard to parse, but the point is that even among the vaccinated group (in this scenario), the virus is still spreading and growing exponentially.
I suppose if Rt was clearly below 1 for the vaccinated group, that might mean something, but if the groups intermingle, that advantage would be lost pretty quickly.
I think you are still missing my point. You are using a circular definition of R0. Where did you get that number 6? Is that for a fully unvaccinated population? Are partially vaccinated population? If so, what percentage? Your calculation makes absolutely no sense, it's circular. You can't calculate R0 using R0.
No, R0=6 is a given. I'm not calculating R0. R0 for Delta is estimated between 5 and 9.5. I picked 6, just for illustration. Given a starting R0 and a vaccination rate and a vaccine effectiveness, that is how you can calculate effective Rt. There's nothing circular about that.
There's no such thing as "R0 within a vaccinated community" - R0 is the starting reproductive number. Effective reproductive number - given various mitigation measures like vaccination, masks, natural immunity, etc - is Rt.
You can try the calculations using any other starting R0, from 5 to 9.5 if you stay consistent with estimates of Delta transmissibility.
The point is that it's possible that a group of vaccinated people would never have an Rt below 1 from vaccination alone, simply because of the limited vaccine effectiveness against transmission.
If one population spreads a disease more than another, it makes absolutely no sense that R0 is a constant across all populations, by definition. Perhaps you should look up the meaning of R0.
> Is the main problem, the unvaccinated, or that the Delta (and co.) variants are still, too dangerous for vaccinated people? Or is it the fear, that they will get more dangerous?
Lots of problems.
- The virus causes serious sequela; people who have been infected may have life-long damage, and some of that damage looks really bad. There's little correlation between severity of the initial infection and severity of the damage, so we don't know if vaccines help either.
- Not all people can be vaccinated. Young children can't be (their immune systems don't work the same way), people with some other underlying diseases can't be, etc. It's by no means just anti-vaxxers who are at risk.
- People aren't dying enough. Historically, this sort of pandemic only ended once the people who were genetically at risk had all died, and we're not letting that happen. Now, to be very clear: I'm not saying we should!
- Having a vaccinated population intermingling with an infections population means there's immense pressure on the virus to evade those vaccines. Many of the means by which it might do so will make it far more deadly to anyone who isn't vaccinated; Delta, for example, has adopted 'human wave tactics' to overwhelm the antibodies.
However, this does mean that history is a poor guide to what might happen.
Viruses don't generally have any reason to want their hosts dead, but there's also little evolutionary pressure for having that not happen.
We're helpfully adding pressure that's well suited to make it more deadly. Yay.
(1) vaccinated people who get infected can infect others (this wasn't common before Delta)
(2) Kids aren't being vaccinated, and masks have become political despite being the cheapest non-pharmaceutical intervention when most or all are masked (versus costs of shutting down, increasing ventilation, etc.). Some others also cannot be vaccinated due to health issues or availability (not in the US, it's widely available)
(3) most, but not all, hospitalizations are among the unvaccinated.
Kind of a combination of Delta and unvaccinated. Delta is more infectious than previous variants., which means that we need more vaccinated people to reach herd immunity.
> I stopped following news since being fully vaccinated some time ago
You're mostly fine, but you should not get disconnected completely from the news.
Vaccine efficacy seems to wane slowly (faster for old people). Probably before the 1 year mark you should get a booster shot.
The Delta variant is skewing some of the initial estimates, for the worse.
The odds that you will catch the virus but have no symptoms or repercussions are still rather substantial, but definitely less than 50% (estimates vary). So there is a chance that you can still transmit it. Please wear a mask indoors in public places.
Before Delta, it was reasonable to resume almost all activities after being fully vaccinated.
I don't believe that is true any longer. There are too many breakthrough cases, presumably driven by a much higher viral load that can overwhelm defenses. (The figures I have seen are 1000x in the upper respiratory tract of infected people; I haven't been following well enough to know what the increase is in actually expressed viruses. But it's going to be a lot, and viral load has proven to be a very significant factor for transmission.)
Vaccinated people are still mostly fine, even with Delta. You just don't get the close to 100% protection against severe disease, it's a little lower than that. It's still pretty good protection against severe cases (talking about mRNA vaccines).
What's clearly disappointing is that the vaccines are not very good at preventing Delta from spreading. I have not seen good estimates, but the numbers floating around seem to indicate the vaccines (again, mRNA) are still at least 50% effective against spread, but nowhere near 100%. That's the biggest gap right now.
It is true that viral loads are orders of magnitude higher with Delta. That is still compatible with all the statements above.
Sorry, I was only disagreeing with the summary "You're mostly fine [because you are fully vaccinated]". I agree with everything else you said. My only disagreement is that I read "you're mostly fine" implying that it's still ok to resume (or in this case continue) regular activities. In my opinion, that is definitely no longer true if you live in or near an area with overburdened hospitals, and at the very least changes your calculations in other areas because it's again important to reduce transmission.
Before Delta, I felt like reducing transmission was good but not that important compared to the disadvantages of isolation. Delta shifted the tradeoff back in the other direction. How much is debatable, but personally I feel that quite a few activities that were ok, aren't anymore. I'm definitely still doing more than pre-vaccination, though.
For most people I know, other than mask requirements when going out certain places and the constant fear mongering on TV, COVID-19 is completely over and their lives are back to normal, complete with in person graduation parties this summer, going to ball games, family gatherings like it doesn't exist, etc. Other than both my parents last year (who recovered, didn't need hospitalization but were very ill for 2 weeks) I don't know anyone who has gotten seriously ill from it since.
For a balanced perspective and as a parent of ineligible children about to enter a new school year, Covid is far from over! We have no idea how long our school will be open or if we'll need to split attention between work and quarantined children at home. Similar to the evaporation of empathy for unvaxxed people who are admitted to the hospital, I'm concerned about a similar fatigue of tolerating working parents who are still partying like it's 2020, except we have no choice in the matter.
I have a friend that is an ER nurse that works at Cedars and she's ready to quit because of the attitude that "covid is over". She loves her job and helping people but the shitty attitudes of patients and people in general over this issue have caused her to rethink her life choices.
The main problem is that the U.S. federal government in particular has been pretending for a while that we can get to zero COVID, then blaming the unvaccinated when it doesn't happen. First, they said we need 50% vaccination to achieve, herd immunity. Then 60%. Then 70%. Then 80%. When things don't work out, they vilify and blame the unvaccinated.
In reality, unvaccinated with natural immunity are likely more protected against the virus than the vaccinated. Israel's vaccination rates are among the highest in the world, and they've suffered the same delta outbreak as everyone else. Further, Israel has the most accurate and comprehensive data to date, and their numbers clearly show the naturally-immunized outperforming the vaccinated during their delta wave. They've since resorted to giving 3rd booster shots to the most vulnerable to compensate.
The real issue is that COVID is likely going to become endemic, and at some point the world needs to face this and move on. Unfortunately, our politicians have been lying to us and using COVID as a tool to gain political power for so long, that they are unwilling to admit they were wrong and to steer us in the right direction. The best we can do is elect these people out.
You were (legitimately) attacking my numbers elsewhere but here you are posting completely inaccurate information. Israel is nowhere close to "90%" vaccinated. Haaretz from 4 days ago reports them at 78%: https://www.haaretz.com/israel-news/israel-vaccine-data-how-...
I misremembered. It was 90% of people over 50 that were vaccinated. It's in the article I linked. But I don't think that discredits my main point, that increased vaccination rates aren't going to eliminate the virus entirely and that natural immunity is actually doing better.
Here in Canada "natural immunity" would only cover maybe 4-5% of the population. Official testing numbers of total cases in Ontario since the pandemic began put it at 3.7% here (though it's likely a bit higher because of bad testing during first wave.)
Maybe in some US states where the disease was horribly mismanaged that number is much higher, but it's a) not reliably counted b) badly researched. Knowing whether someone is "naturally immune" is a big roll of the dice, whereas we know for sure when someone is vaccinated.
And to get to a high "natural" immunity rate requires unnecessary death and suffering.
But yes, half of the 18-29 year olds here seem to be rolling the dice and playing this "natural immunity" game; which is why they are now the vast majority of hospital admissions for this disease.
What's wrong with your 18-29 year-olds making that choice? Freedom means freedom to make sub-ideal choices or even bad choices, including choices that affect others negatively. Really almost every choice we make affects others in some capacity, for good or bad. Do you want to outlaw all choices you deem bad?
The state of COVID is such that if you are an adult you can get vaccinated and you are safe enough, no matter what decisions others make. If you are not an adult then the risks to you are so low that you are safe anyways. The 2009 swine flu killed 3 times as many children in 9 months as COVID has killed in 18 months: https://www.cidrap.umn.edu/news-perspective/2009/12/cdc-shar....
Yet This flu did not require masking, lockdowns, forced vaccinations, or any shutting down of schools.
If you are immunocompromised, or otherwise vulnerable even with the vaccine, then it is up to you to take extra precautions, like wearing an N95 in public or avoiding crowded areas.
COVID simply isn't deadly enough to warrant the curbing of freedom that is being done or the vilification of those not making choices we think they should. Get vaccinated if you want to and move on with your life. Stop forcing people to get vaccinated, especially those who've already been infected. And finally, get the government out of the business of mandates of any kind. They aren't needed. People have the tools already to protect themselves how they see fit.
That first paragraph really isn't fair because R0 has changed. So of course scientific opinion has changed. That's not same thing as pretending and then vilifying.
Your second paragraph is eliding a lousy "therefore" - obviously, the cost of shooting for natural immunity versus vaccination is that you have to experience the actual disease and all its risks. Survivorship bias.
Scientists are allowed and should be allowed to say "the data changed, so our recommendation changed". Politicians and health leaders have a responsibility to interpret the data and develop communications and policies that build trust and inform the public. It's a failure on the part of the latter when they make promises to the public that they know are not guaranteed.
They have made definitive statements that are wrong too many times in the past year and a half. That is a massive failure. The average joe has nowhere near the time nor expertise required to interpret the scientific data out there, so trust is everything for them. At some point, you run out of the good will required to say "ok, I'll trust you again". Maintaining trust is a leader's most important job.
Please share some scientific citations showing natural immunity gives better protection than vaccines. This runs counter to what I'm hearing from my virologist sources.
There is no scientific consensus that naturally acquired immunity gives better protection than vaccines.
Two facts that are trending toward consensus in the scientific literature:
A) Naturally infected individuals who recover will acquire robust and durable immunity [1][2]
B) Natural infection induces an immune response that is mostly similar but slightly different than the immune response induced by vaccination. The primary differences can be summarized as: naturally infected individuals have nucleocapsid protein antibodies whereas vaccinated individuals do not, and vaccinated individuals have an immune response highly targeted toward the spike protein RBD. [3][4][5]
In summary many people hypothesize that natural infection is better because it induces a broader and more balance antibody response, but the literature has not established consensus that this is necessarily "better" in terms of health outcomes for individuals.
[5] Antibodies elicited by mRNA-1273 vaccination bind more broadly to the receptor binding domain than do those from SARS-CoV-2 infection
https://pubmed.ncbi.nlm.nih.gov/34103407/
> In summary many people hypothesize that natural infection is better because it induces a broader and more balance antibody response, but the literature has not established consensus that this is necessarily "better" in terms of health outcomes for individuals.
Great summary - I have seen no evidence that natural immunity is better. The opposite could be true. A nucelocapsid-specific immune response cannot be used to kill live virus (the nucleocapsid is not accessible for binding on the surface of a live virus). This means natural immunity will result in an intense off-target immune response (in addition to an intense on-target one for the spike). That off-target response elevates the chances of collateral tissue damage (cytokine storm).
There appears to be two camps, one that believes that science can defeat this disease, and in the other camp people that believe we need to learn to adjust to our new reality.
I don't understand how a man made vaccine can provide better protection to the virus better than my body after recovering, but I'm not specialist.
Aren't the pharmaceutical companies financially incentivized to provide minimal protection, and annual booster shots? Why would they make something better?
As long as fear navigates our course, we won't see an end to this.
It really depends on the virus. For some viruses, the vaccines are far more effective and less risky and have helped eliminate or mostly eliminate the virus entirely. For other viruses, vaccines are far less effective.
The Israel data is clearly showing natural immunity doing better for COVID, and every other peer-reviewed study I have seen shows natural immunity doing "at least" as well as vaccinated immunity.
>There appears to be two camps, one that believes that science can defeat this disease, and in the other camp people that believe we need to learn to adjust to our new reality.
Vaccines are part of our adjustment. There's one camp which tries to adjust, and another which places hands in their ears.
>I don't understand how a man made vaccine can provide better protection to the virus better than my body after recovering, but I'm not specialist.
The same way an antibiotic could cure certain diseases much better than your own body. Besides, you're much more likely to survive the vaccine than the disease.
>Aren't the pharmaceutical companies financially incentivized to provide minimal protection, and annual booster shots? Why would they make something better?
Efficiency isn't something pharmaceutical companies could just decide in advance. If they try to make something inefficient, there's a good chance it won't be effective at all, and they'll lose all the money invested in R&D.
And ultimately, less effective vaccines will be crowded out of the market, we already see this in some countries with AZ and J&J.
Your numbers are wrong (see other responses for why.)
The herd immunity figure (1) legitimately changed with the variants, and (2) is always going to be a shot in the dark so personally I don't find much point in paying attention to government figures anyway. Government is providing figures to achieve an outcome; it's fundamentally a policy tool. If you want the science, listen to scientists.
The delta variant is currently overwhelming a large number of hospitals, and it wouldn't have done so with higher vaccination rates. Whether or not you view that statement as vilifying unvaccinated people is beside the point.
If it is going to become endemic, and there are very good arguments that it will, then I agree that we'll need to move on. But "moving on" != "ignoring". Flushing the existing vaccines down the toilet and letting the cards fall as they may is not a winning strategy, yet that's exactly what 40% of the US population is presently choosing.
"Moving on" means treating it like chickenpox or at least the flu. Not like meteor strikes.
> it wouldn't have done so with higher vaccination rates
That is the rhetoric that Fauci and others have been pushing, but the scientific literature is accumulating mounting evidence that counters the claim. Not to mention the data out of Israel - which has one of the highest vaccination rates in the world - is also strong evidence against your claim. Israel is struggling with overwhelmed hospitals due to variants reducing the efficacy of vaccination and also naturally acquired immunity.
FWIW I'm keeping an open mind, please cite primary sources to support your claim and I will happily consider them.
I misremembered the numbers but if you click to the linked analysis the numbers are correct there.
As to the delta variant overwhelming hospitals, that's partially because hospitals are firing nurses that won't get vaccinated. The lack of beds is primarily a staffing problem and hospitals are shooting themselves in the foot. I've also heard they have been underpaying nurses and some are just quitting or switching to better-paying contract work.
There's a whole section there debunking the claims, for instance, that hospitals in Florida are overwhelmed.
I don't think anyone thinks that "moving on" means forgetting, but I do think it does entail having the government get out of the business of mandating lockdowns, masks, or vaccines. The problem lies in the fact that the media were too successful in scaring people to death about COVID. It makes handling the virus in a sane way impossible without negative political fallout.
I know some doctors in affected areas. The hospitals were overwhelmed before any unvaccinated firings happened. The staff are incredibly exhausted, angry, and demoralized. Many went through this before with the first big wave, and not only are they back to insane hours and filling body bags, but now they have to deal with the awareness that it's unnecessary and avoidable.
If you'd like to confirm, dig up some medical staff on Twitter. "MedTwitter" is a thing. (But don't search based on keywords like "vaccine", because you will find what you seek. It'll be massively biased in a pro-vaccine direction. Find the medical professionals first, then see what they're saying.)
I think the question of whether to allow unvaccinated staff is a tricky one. I don't think it should be decided because some people are pissed off at vaccine resisters, and I haven't seen any strong evidence that it is. (I haven't looked, either.) Unvaccinated staff put their patients and coworkers at risk if they work, or if they don't work. Someone has to do the math.
Similarly for government intervention. It really bothers me when the government mandates anything. But I think of it like this:
Let's say I'm in a community that is fond of keeping tigers as pets. 5% of the population dies every year from wild tiger attacks. Many community members insist on letting their tigers be off-leash, calling it a fundamental part of their identity as tiger owners. Off-leash tigers kill 50% of the (remaining) human population each year.
I don't like leashing my tiger. But over half the people I know are dead. I would gather the community together and say, sorry guys, but we're going to have to agree to keep our kitties on leashes, no matter how friendly we think they are. And we're going to have to back up that agreement with expulsion, imprisonment, or taking tigers away. It sucks, but the risk is too high.
55% annual death rate is insanely high, but it makes the point that there is a number at which community (aka government) mandates are the right thing to do. We can argue at where the number ought to be, but not whether or not there is a number.
Right now, there are a lot of people dying, and a lot of "dry wood" that the virus is burning through. I think it's time to wet some of that fuel, whether it wants to get wet or not. (And even though we know some of that wet wood is still gonna burn.)
Your tiger analogy is a bit ridiculous unless you give people the ability to carry around a force field and laser defense system for free that gives them practical immunity to death or dismemberment by tiger.
At this point we have the tools we need to be safe against COVID. Any adult that wants to get can vaccinated. Kids are under such low risk that they don't need to be vaccinated. The 2009 H1N1 flu killed 3 times as many children as COVID so far, and in half the time! Yet we didn't lock down, shut down schools, or torture our little children with masks during that pandemic. https://www.cidrap.umn.edu/news-perspective/2009/12/making-s...
If you're immunocompromised or otherwise vulnerable even with the vaccine, then it is up to you to take extra precautions because COVID will be around forever.
COVID is not the equivalent of a population of tigers running rampant through our community. It's time for the fearmongering to stop and for us to get back to normal. And hospitals may need to adapt. Even during the height of the delta surge, data I've seen suggests that 80% or more of ICU beds are filled by non-COVID patients. Our hospitals are so designed for efficiency and cost reduction that we are incapable of handling surges of any kind, including ones that increase our ICU utilization by at most 25%. I see that more as a failure of our hospital systems than anything else.
Personally I think the real problem with COVID is that it is a disease which kills many people and harms many more, not that some people supposedly vilify unvaccinated people.
Is there any information on what the upper bound might be on the infectivity of SARS-CoV-2? I think a lot of people just assume one big jump consumes most of the range, but we've seen at least three big jumps so far ("Doug", "Alpha", and "Delta").
> And you can imagine, it was quite a mouthful. So, we started to call this D to G mutation ‘Doug’, and then any of the other virus sequences that didn’t have this mutation … we called ‘Douglas’, so it was sort of a bit of a private joke within the lab,” she said. “As more mutations came about, we’d come up with a person’s name for them.”
This is getting at “saying the quiet part out loud.”
For a variety of reasons media and influential organizations have avoided considering the upper bound on virility and mortality (? Not sure the right term) of covid.
But to think delta is it would be some kind of miracle. It would mean we are going through the worst of it, and that after we handle delta globally, people can worry about other things.
But it doesn’t stand to reason that we are done here with covid. There are too many hotspots and I believe delta is older than most of the big ones right now.
How likely is a nasty new variant not pop out of Iran or India, or Texas?
What about variants created by non-human beings like rats? [1] Are we going to skate by on those? That would be great!
I suspect the public is not ready to fully address the breadth and depth of covid’s impact. I also speculate that the “booster” shot suddenly being prescribed is intended to help ward off future variants as much or more so than delta alone.
You probably mean "virulence", not "virility". The latter word denotes the masculine ability to procreate.
The confusion arises because the Latin word "vir" means "man" (specifically of male sex, as opposed to human), and the similar word "virus" means poison.
SARS-CoV-2 has multiple animal reservoirs, and that's one reason why it will be impossible to eradicate. But generally variants that evolve in animals will select for fitness in those different species. So those will probably have less impact on humans.
This is one piece of circumstantial evidence why some virologists suspect the virus was produced in a lab doing gain of function research using transgenic mice with human like respiratory systems. When the virus first appeared in Wuhan it was already really good at infecting humans. That would be unlikely if it had evolved in wild bats or pangolins and then jumped straight to humans. But we don't know for sure, maybe it was just natural bad luck with no lab involved.
> When the virus first appeared in Wuhan it was already really good at infecting humans. That would be unlikely if it had evolved in wild bats or pangolins and then jumped straight to humans. But we don't know for sure.
Just curious about this point - wouldn't this always be the case, since before it was good at infecting humans it would only be in a few if any of them? IE. My thinking is that even if it had existed for a while before that point, we'd be unlikely to know since it wasn't at that point good at infecting humans and thus not many had it.
SARS-CoV-2 is a generalist that can infect many animals. I doubt it a "lab leak". Studies of genetic sequences from around the Wuhan fish market showed that it had been circulating and mutated a bit for some time before it was detected.
Here is a fantastic resource from the UK government that answers your question in great detail [1].
> As eradication of SARS-CoV-2 will be unlikely, we have high confidence in stating that there
will always be variants.
> We describe hypothetical scenarios by which SARS-CoV-2 could further evolve and acquire,
through mutation, phenotypes of concern, which we assess according to possibility.
> Scenario One: A variant that causes severe disease in a greater proportion of the population than has occurred to date. For example, with similar morbidity/mortality to other zoonotic coronaviruses such as SARS-CoV (~10% case fatality) or MERS-CoV (~35% case fatality). [...] Likelihood: Realistic possibility. Impact: High.
> Scenario Two: A variant that evades current vaccines. [...] Likelihood: Realistic possibility. Impact: High.
> Scenario Three: Emergence of a drug resistant variant after anti-viral strategies. [...] Likelihood: Likely - unless the drugs are used correctly. Impact: medium.
> Scenario Four: SARS-CoV-2 follows an evolutionary trajectory with decreased virulence. [...] Likelihood: Unlikely in the short term, realistic possibility in the long term.
And here is one very relevant quote:
> There is no historic precedent for the mass administration of antiviral medication in the community as prophylaxis, apart from the use of anti influenza Neuraminidase Inhibitors, which were used to a limited extent in this way in the early phases of Influenza Pandemic of 2009 in the UK. The safety and efficacy profile must be extremely well established for a mass administration strategy to work and poor compliance will likely rapidly lead to the selection of drug resistant variants, rendering such a strategy short lived.
[1] Can we predict the limits of SARS-CoV-2 variants and their phenotypic consequences?
> It may already be getting harder for SARS-CoV-2 to make big gains in infectiousness. “There are some fundamental limits to exactly how good a virus can get at transmitting and at some point SARS-CoV-2 will hit that plateau,” says Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center. “I think it’s very hard to say if this is already where we are, or is it still going to happen.” Evolutionary virologist Kristian Andersen of Scripps Research guesses the virus still has space to evolve greater transmissibility. “The known limit in the viral universe is measles, which is about three times more transmissible than what we have now with Delta,” he says.
Measles is estimated to be about 300% more infectious than the delta variant, so if it surpassed measles it would be the most contagious viral disease known to man. It's already pretty close to what is assumed to be the "ceiling".
I'm not sure "only twice as bad" paints an accurate picture.
- Herd immunity is much harder. Calculated as 1 - 1/r0 where r0 is defined in relation to transmissibility. So if r0 = 3 that's ~66% need to be immune to stop the virus. If r0 = 6 that's 83% needed, much higher threshold.
- The virus is only getting more deadly. A preprint study found delta has "120% greater risk of hospitalization, 287% greater risk of ICU admission and 137% greater risk of death"[1]
Also 225% more transmissible is 3x more unless I'm doing my math wrong?[2]
Right, and that's where vaccine efficacy comes into play. If r0 is 6 and HIT is 83.3%, but efficacy is only 90%, then you actually need about 93% vaccinated.
And for herd immunity, what matters is transmission, and the vaccine efficacies for asymptomatic infection are pretty low; 50-60%. So mathematically impossible without severe lockdowns and/or improved vaccines that are better at preventing transmission.
But I've been operating under the assumption that while vaccination won't prevent you from infection, it is still highly effective (90%+) at reducing symptoms, even with Delta. I'm certainly open to learning if this is false, however. I've just seen statistics that over 95% of people hospitalized are unvaccinated.
There are many efficacy numbers. mRNA does help against infection but efficacy is apparently low, like 50-60%. Makes sense because they weren't really developed with that in mind.
Efficacy goes to 60-80% for symptomatic, over 80% for serious/hospitalization, and mid 90% for death. I think.
Herd immunity happens long before we are all infected. Less than 40% of the US population is completely unvaccinated, which means we can open up more without overwhelming hospitals. That does put the unvaccinated at increased risks, but the general public is seemingly unwilling to continue lockdowns to protect people choosing not to be vaccinated.
If ~85% is needed for herd immunity then we could be rapidly approaching that point. Though specific locations would likely have outbreaks even if it was less of a concern nationally.
With an R0 of about 6 for the Delta variant, herd immunity won't provide a meaningful level of protection for most people. Herd immunity works with less contagious diseases because susceptible individuals can go their whole lives without exposure. But with SARS-CoV-2 now being endemic worldwide we'll all eventually get exposed, it's just a question of when. So the smart move is for everyone to protect themselves by getting vaccinated and actively treating co-morbid conditions like obesity, diabetes, hypertension, and hypovitaminosis D.
Any further lockdowns at this point cause far more harm than benefit.
They can prevent hospitals from being overwhelmed. Opening or not opening schools are one case where local communities are going to adjust based on the rates of hospitalization.
There's math you can do to roughly judge impact of partial vaccination. If R0 is six, and you're looking at hospitalization, estimate vaccine efficacy for Delta at around 90% (I've seen estimates above and below that).
Taking your estimate of a 60% vaccination rate:
6 * (1 - (.6 * .9)) = 2.76
2.76 is the effective Rt, which is far above 1, so no, that is not enough to open up more without eventually overwhelming hospitals.
Natural immunity from catching COVID, and other (inherently temporary) mitigation measures like masks/distancing/lockdowns would bring that Rt down further. But clearly what is best is more vaccination.
2.76 assumes normal conditions, social distancing literally changes the equation.
Mask use for example pushes that down. It’s easier to get below 1 with a 50% vaccination rate than a 0% rate. Meaning we can open up more without overwhelming hospitals.
That's pretty much what I said in my last line. The problem is, "opening up more" generally tends to mean things like less masking and less social distancing. So to the extent that Rt is pushed down by mitigation measures, Rt gets pushed back up when those mitigation measures end.
The advantage in my mind is you can avoid the most costly mitigation strategies.
Unfortunately, vaccination rates are age dependent so opening schools is a very high risk activity. Children are at low risk for COVID but they would be a major vector for transmission as everyone under 12 is unvaccinated.
That’s quite regional. Nationwide there is still plenty of ICU beds available, and presumably if it gets bad enough hot spots will respond appropriately.
By moving people with covid to other states, or importing medical personnel and equipment. Do so aggressively enough and you can keep capacity available.
And then you'll eventually realize: having thousands of people getting intensive care at the same time until everyone either had it or died from it is moraly not acceptable. Why do you come up with the idea that it's better to increase capacity rather than using large scale vaccination efforts?
I think there's am R0 for initial strain and then ranges for the other variants. I thought it was in Wikipedia but either it's been edited out or I saw it elsewhere.
What I recall (so huge grain of salt here) was R0 at 2.3 for initial strain then around 2x for Alpha and another 2-3x for Delta. Not. Great.
"Furthermore, measles's reproductive number estimates vary beyond the frequently cited range of 12 to 18.[15] The NIH quote this 2017 paper saying: "[a] review in 2017 identified feasible measles R0 values of 3.7–203.3"
Do absolute R0 numbers have meaning without a specified environment?
As in, shouldn't there be various values for R0 within a fully vaccinated community, R0 within an age group, R0 relative to the prevalence of active infection in a community, etc.?
I'm just wondering what complexity is concealed within an R0 figure. After all, if every infected person really infected 6 other people every 2 weeks or so, it would infect every person on Earth in about a year and a half.
Which is probably why R0 is distinguished from R1. Since otherwise R1 would be R0**2, and I highly doubt it is. It could be higher if viral load was a large factor (you have x% chance of picking it up when around a single carrier, but >x% if surrounded by multiple). Far more likely, it would be lower as it burned out tightly-connected groups.
Anyway, just thoughts triggered by seeing absolute R0 values.
Consider R0 a rough estimate of how many people each cade infects. It's an imperfect instrument but helps communicate the idea clearly that answers "how infectious is this virus?"
the next big mutations may not be more infectious because they can survive outside the body longer, but because they get around existing immunity or theres a longer asympomatic-but-still-transmissible phase. theres a lot of different paths this could take to mass infection.
This is a really great question. Technically speaking, any single mutation defines a new strain. But that's not how we tend to talk about it either to the general public or amongst clinicians. Rather we use a more informal notion of a significant functional change. We do this because there is, somewhat surprisingly, no real term that reflects the category of "new strain with significant or interesting functional effects."
The theory is that they will create a better early response in the cells where the virus makes first contact making it more likely to stop replication early.
If it works it would seem this could be a more effective way to vaccine for respiratory viruses.
Really interesting article. By the end, they admit that what makes Delta worse is the sum of the parts, and not just a single mutation in the spike protein.
This is a general property of biology: it's almost always the sum of the parts.
It reminds me the trajectory of computer sciences, where a lot of our (conventional) systems are carefully coordinated part orchestras. I.e., an engineer knows all the classes/functions/modules and how they interact. Compare with our recent multi-layer neural networks, where nobody can say what the coefficient at index [22, 2, 432, 91, 42] does exactly. I wonder if, similarly, bio-research will be able to move more towards automatic discovery of desirable systems.
》I wonder if, similarly, bio-research will be able to move more towards automatic discovery of desirable systems.
Bio research already does that, SARS-CoV-2 was created this way. It uses natural selection over multiple generations to select desired behaviour, the same way as neural networks are created. This process is automated to large extend.
Is it implausible to think that continued transmission and mutation at this rate will cause a catastrophic worsening of the pandemic to an extent several orders of magnitude above what it is now? Vaccination is effective in the current state of the pandemic, but what's to prevent the built-up immune response of humankind being wiped out if the virus adapts enough?
No, it is not implausible in the sense that "it could never happen". However, neither was it implausible for this to have happened with the myriad of other viruses which have jumped into our species across our natural history—and yet here we are.
Remember there is no motivation behind the virus to adapt, nor such thing as "wiping out" the immune response. At most, there are random mutations which, if they are more successful than the previous ones, will become more widespread than their alternatives.
Are mutations that are less sensitive to current populations' immune responses more likely to succeed? Yes, of course! But there is a practical limitation to how much a virus can accumulate mutations which evade immunity to previous variants: it must not break its ability to infect (human) cells. Eventually an equilibrium is reached, as it has thousands of times previously.
Both the worst-case and the best-case scenario are on the table. Only time will tell what happens. As you seem to be focusing on the worst-case scenario I will talk about the best-case scenario. The best-case scenario is that the human immune system is getting used to corona with even vaccinated people spreading the delta variant with little chance of getting very ill. This will turn covid-19 into something like the common cold or possibly the flu. Who knows what will actually happen? Both my best-case scenario and your worst-case scenario can happen. I think, though, that one should not only focus on the adaptability of the virus. The immune system also has been doing defense against various pathogens for many millions of years.
The likely scenario is that it turns into cold/flu.
Everyone either gets the vaccine or the virus and we are all mostly immune. It mutates a little and once it mutates just enough to spread substantially everyone who gets it gets immune. Only a fraction of the population will get any particular mutation.
I remember having the debate that herd immunity has never happened without a vaccine. Which is just BS. Every disease throughout history has eventually reached equilibrium with humans which is essentially herd immunity.
Most mutations are point mutations. Once enough point mutations accumulate that give the virus superior ability to spread, it will. It is unlikely that any point mutation will suddenly make the virus orders of magnitude more deadly.
> Every disease throughout history has eventually reached equilibrium with humans which is essentially herd immunity.
Not a biologist here but can you elaborate on this? Do you consider all circulating diseases such as HIV, yellow fever, malaria, hepatitis etc. having reached "equilibrium"?
Well, humanity still exists, therefore no disease wiped out all humans. That's a form of equilibrium, and it's a lot better than some other species.
And now we have decent medicine, we can properly turn the tables on diseases. mRNA vaccines are literally sci-fi stuff, and now they're here! Antibiotics weren't even in sci-fi, and we've got them (though they're no longer panaceas).
You don't understand what "herd immunity" means. Herd immunity means eliminating a disease within a community ("herd"). It does not mean endemic case incidence with socially tolerable outcomes, or whatever loosey-goosey idea you mean by "equilibrium."
Herd immunity means the contagion is eliminated. It has never happened worldwide without a vaccine, and I'm unaware of any virus where it has been sustained within a community without a vaccine. How could it? The only paths to immunity are vaccine or exposure, and exposure depends on the virus actually circulating.
At some point this is just arguing semantics, but my understanding is that the herd immunity threshold is defined when Reff < 1. You could have Reff=0.99999999, which counts as herd immunity being reached, but it would take a very long time for the virus to actually disappear. Even if we do momentarily hit Reff < 1 for the delta variant, there could be mutations/waning immunity that causes it to stay around 1 becoming endemic.
No, it is impossible to reach herd immunity if Reff >= 1, but Reff < 1 is not sufficient for herd immunity. Herd immunity also means low enough incidence that a nonimmune person is not at significantly greater risk than an immune person.
Herd immunity would usually be defined as: if a contagion is introduced to a community will it spread uncontrolled or will it die off. Reff < 1 implies it will die off, Reff > 1 implies it will spread. Herd immunity does not mean that the contagion is not present within the community or anything about the relative risk between immune/non-immune community members.
Not implausible at all. Mutation rate is proportional to the number of infected. Third world countries have barely even started vaccinating. There's a lot of room for nightmare scenarios.
Which is why I think it was a bone-headed move to not suspend patent protection on the vaccines. Thanks Bill Gates!
This. The Astra zenca vaccine, originally designed by the Oxford University, was supposed to be open licenced. But the gates foundation convinced them otherwise. The top priority should have been to get as many vaccine factories open as soon as possible but even functioning factories had trouble starting talks with bigshots like pfizer
It's gotten ~2x more contagious and slightly more virulent in the past 18 months. If training ML models taught me anything, in the near term, it will continue in the same direction, but the gains will be much smaller.
SARS-CoV-2 has four antigens. The existing vaccines stimulate the production of antibodies against only one of them, the spike protein.
The existing vaccines are proving ineffective against Delta because it has mutated significantly enough that its spike protein does not cause a neutralizing immune response. They may even be causing ADE, as evidenced by the most recent data comparing Israel and Palestine.
Do you have a source for the recent data on ADE? I searched and didn’t find anything suggesting this. The only thing I see are studies that more vaccinated people are dying in Israel, but that is to be expected because the older people are, the more likely they are to be vaccinated and they have less immune response to the vaccine.
See my reply to a sibling comment. The most damning evidence comes from the comparison between highly-vaccinated Israel, where there are many third-wave deaths, and mostly-unvaccinated Palestine, where there isn't a third-wave death spike at all. Having mostly-unvaccinated Palestine as a control group is showing us that we don't know what we thought we knew.
The graphs you've mentioned in your sibling comment does not separate deaths based on vaccination. Here is another source that takes this into account. Vaccination does reduce chances of severe infections even in delta, though it's not as good as before:
> The good news is that among Israel's serious infections on Thursday of this week, according to Health Ministry data, there were nine times more serious cases among unvaccinated people over age 60 (178.7 per 100,000) than among fully vaccinated people of the same age category, and a little more than double the number of serious infections among unvaccinated people in the under-60 crowd (3.2 per 100,000) than among the vaccinated in that age bracket.
Also do note that official numbers from Palestine could be undercounted because of the situation there
Novavax is a protein subunit vaccine, with the spike protein only. The Chinese CoronaVac and Indian Covaxin are traditional inactivated virus vaccines.
That seems very unlikely. If a variant evolves that has significant evasion of the vaccines, then we should be able to retool the mRNA vaccines quickly. And T-cell response is more robust to antigenic drift than the antibody response, though not as well studied. See [1] for a very detailed investigation into antigenic drift and vaccine evasion.
Not only is that article not a study but rather a letter to the editor, but also in their last paragraph they explicitly state that ADE in SARS-CoV-2 has never been demonstrated in vivo. Here is the relevant quote from the letter:
>[...] Although this potential risk has been cleverly anticipated before the massive use of Covid-19 vaccines6, the ability of SARS-CoV-2 antibodies to mediate infection enhancement in vivo has never been formally demonstrated. [...]
A couple things though - the median age of Israel is higher than that of Palestine by a pretty large margin. Secondly, how can we be sure both places are testing at the same rate? For instance, the percentage of cases reported in Palestine VS Israel is smaller when adjusted for population size.
People believe what's comfortable/convenient, not what's true.
In very early 2020, when I was following the news of the virus development in Wuhan, China, I felt like a conspiracy theorist pointing out to friends and coworkers that a bad epidemic spreading in one of the most crowded parts of the world. They thought it was ridiculous to say that hospitals were getting overwhelmed, people were being quarantined etc. Don't even think about suggesting it'll spread outside of China, or that the virus may have come from the lab that just so happened to also be in the origin of the epidemic, a lab which specialized in highly infectious diseases.
Not even 2 years later and where are we now? The entire world got sick and pretty much every country has done lockdowns/quarantines/shutdowns. Not to mention the lab theory of the virus origin still can't be ruled out.
Even after the pandemic started, people still had no problem sticking their head in the sand. It's not a big deal; it's 2020, we have technology and medicine and we'll just make a vaccine and get back to normal. Well now it's almost 2022 and somehow things just keep getting worse.
We can reasonably say the Black Death killed 30% of Europe's population. We can't reasonably say covid won't do the same. All optimistic projections so far have been proven wrong, so all we can say for sure is that humans are terrible at predicting the future.
> We can reasonably say the Black Death killed 30% of Europe's population. We can't reasonably say covid won't do the same
I was going along, nodding my head in agreement until this. Do you realize how bad medical care was during that era? Hygiene? Knowledge of how to slow transmission in a community (we Americans have not yet even BEGUN to really take COVID seriously)? Do you realize how vastly more deadly than Black Death that COVID will have to become to cause a 30% death rate among the general population? It's absurd.
It's one thing to say something is unlikely; to completely dismiss it out of hand without acknowledging there could be a chance is exactly what I was talking about originally.
That's just fear mongering nonsense, like claiming that we can't reasonably say that aliens won't invade the Earth tomorrow. I mean I can't prove it's impossible but come on. There's no scientific evidence that a coronavirus can be both highly contagious and have a 30% fatality rate. CDC data clearly shows that the fatality rate in the US has been 0.6%, largely because we have a lot of vulnerable elderly people with serious co-morbid conditions. The fatality rate in countries with younger, healthier populations is far lower. And for vaccinated people of all ages the death rate is close to 0.
Yes I'm aware of what today is like, now tell me what tomorrow will bring, because not many people have been able to do that so far. Instead, as I said, optimism is proven wrong as things just keep getting worse. But I'm sure you're right, all the other mis-steps to this point were flukes, this time you know for sure what the future holds.
>We can reasonably say the Black Death killed 30% of Europe's population. We can't reasonably say covid won't do the same. All optimistic projections so far have been proven wrong, so all we can say for sure is that humans are terrible at predicting the future.
I think Black Death had quite a bit higher mortality than any version of covid we will see
Delta-infected patients seem to be 1.8 times more likely to be hospitalised, compared to Alpha-infected patients [1]. Since the covid virus takes two weeks plus to kill its host and also spreads while the host is asymptomatic, there really isn't much selective pressure to make it less deadly. So far infectiousness and severity of disease has gone hand in hand with this virus.
> Early data from Scotland indicated that delta-infected Covid patients were 1.8 times more likely to be hospitalized than those with an alpha infection. Other U.K. data support the increased risk of hospitalization but do not provide clear evidence that delta patients experience more severe illness once in the hospital.
How do hospitals identify individual patients infected by Alpha, Delta or other variant?
Do they perform genetic sequencing of a virus sample from each patient, to determine what mutations are present? If they are doing statistical sampling, what percentage of patients are being sampled for variant identification?
It would helpful to have variant-specific numbers of cases and deaths added to national data, so that accurate graphs can be drawn for each variant. More granular data would support data analytics of local, variant-specific, policy interventions, to evaluate cause-effect on local health metrics.
Last I checked the US was sequencing about 1% of patients. In the Houston Methodist hospital system, they sequenced the viral genomes of 56% of patients, which they estimate is about 4% of Covid cases in the Houston metropolitan area: https://www.sciencedirect.com/science/article/pii/S000294402...
Of course, there is a sampling bias there for variants that result in hospitalizations.
Generally hospitals don't test for specific variants. Instead they forward a sample subset of patient specimens to regional or national infectious disease centers which then perform genetic sequencing. That way we can monitor the spread and evolution of variants.
Not every nation does this, mostly only the ones with socialized medicine are.
For nations like the US, we are measuring the variant by looking at sewage. It doesn't tell us anything about who ends up hospitalized, but it does give us a good indication of what the is the common variant in a community (and inferences are drawn from there).
The UK has been doing probably the most covid genome sequencing of any nation.
Thanks, good to know. Would be interesting if the UK also measured variants via sewage, as a methodological comparison against their more expensive individual sequencing.
"Since the deadliest virus mutations kill their hosts, weaker virus mutations can spread (without killing their hosts) more quickly."
The problem with the SARS-COV2 virus is that infected individuals are infected before they're symptomatic, let alone dead. Thus there is no evolutionary pressure that would make this virus less lethal, as is the case for viruses that kill their hosts early in the course of infection.
What are some good references on asymptomatic transmission?
Early 2020 reports of asymptomatic transmission from South Korea were later retracted. There was a contact tracing study of 10 million people in Wuhan which found no asymptomatic transmission.
Unfortunately I think the media has really mixed up the words "presymptomatic" and "asymptomatic". You're right there is little evidence that people who never develop symptoms can spread COVID. But it seems likely that COVID can be spread up to 48 hours before symptoms develop, which still presents roughly the same problem.
I also anecdotally know a few different people who caught COVID from someone who felt fine at the time they interacted, so I'm quite confident it is possible, although I'm not sure I'd make a strong statement about the prevalence.
I believe that "asymptomatic" refers to an infected individual who will never get symptoms. "Presymptomatic" means the individual has no symptoms, but will develop them later.
As far as presymptomatic transmission, this is a good case study from Germany: https://wwwnc.cdc.gov/eid/article/27/4/20-4576_article. A 59 case cluster in which little/no asymptomatic transmission was observed, but 75% of transmission was presymptomatic.
Another interesting paper, also out of Germany covering 400k individuals, 25k infections: https://science.sciencemag.org/content/373/6551/eabi5273. I can't write a summary better than the one in the paper:
The role that individuals with asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus 2 have in transmission of the virus is not well understood. Jones et al. investigated viral load in patients, comparing those showing few, if any, symptoms with hospitalized cases. Approximately 400,000 individuals, mostly from Berlin, were tested from February 2020 to March 2021 and about 6% tested positive. Of the 25,381 positive subjects, about 8% showed very high viral loads. People became infectious within 2 days of infection, and in hospitalized individuals, about 4 days elapsed from the start of virus shedding to the time of peak viral load, which occurred 1 to 3 days before the onset of symptoms. Overall, viral load was highly variable, but was about 10-fold higher in persons infected with the B.1.1.7 variant. Children had slightly lower viral loads than adults, although this difference may not be clinically significant.
The second paper is a bit dense, but there is a great discussion at https://www.youtube.com/watch?v=p4AR7qPxz_Q, with discussion of this paper beginning maybe 47:00. 1:14:08 beings a discussion about how a large number of cases might be caused by a small number of individuals. Interestingly, these individuals are not necessarily the same as those who go on to be seriously ill, hospitalized, or die.
In practice, the difference between presymptomatic and asymptomatic makes little difference. The key is that we have ample evidence that an infected person can infect others while they do not have symptoms.
There are some confounding factors to that though, I think? Infectivity post mortem (as seen with plague) and time lag between infectivity and symptoms appearing allowing for longer periods of asymptomatic transmission. Both variables that mean the spread of a mutation and it's lethality need not be linked.
Mass distribution of non-sterilizing vaccines which reduce symptoms (via blood/serum antibodies) but don't prevent infection and transmission (lack of nasal/mucous antibodies) can increase spread of variants that would otherwise cause symptoms and self-isolation of the infected person.
Vaccination reduces the infection rate. Among vaccinated individuals who suffer breakthrough infection the time at peak viral load is significantly reduced.
> Even if they’re not showing symptoms, fully vaccinated people should “get tested 3-5 days after exposure to someone with suspected or confirmed COVID-19 and wear a mask in public indoor settings for 14 days after exposure or until they receive a negative test result,” ... “Our updated guidance recommends vaccinated people get tested upon exposure regardless of symptoms,” CDC Director Rochelle Walensky, MD, told The New York Times
It's still lower than the peak of 3300 (7-day average) during the winter season, and that's when we had 250k cases daily. We're almost at 150k daily cases, but with only 1k daily deaths. At least based purely on numbers, the CFR is lower. The CFR is lower because most of the infections are happening in younger people.
Anyway, none of us had severe illness although I felt pretty rough for a few days like I had a really bad cold and smell went for a week completely. I was basically fine though and everyone else I know is too who got it recently. The point is that it does seem like this Delta variant breaks through regularly and it does seem (again, purely anecdotal) like it's v infectious. Of course the thing to emphasise is that, whilst it might break through, the vaccine still stops serious illness to a high degree. It does highlight however the need to not be complacent. Vaccines don't seem to be stopping the spread right now as much as you might think, and the high number of cases combined with high vaccination rates is an obvious selection pressure. More variants are inevitably coming and it does seem like this virus is bucking the trend and not necessarily becoming less potent despite increased tranmissability in some variants
My conclusion is that, whilst I welcome the UK being sort of "back to normal", let's keep up the mask wearing, hygiene standards and so on. It's a balance but I sense things are getting a bit too lax. I'm not overly anxious but let's stick to the precautionary principle a bit more.