The problem is being 99.9% effective just isn't good enough. One person slips through and it's all over. It isn't realistically possible to keep covid out of areas.
It is understood that it's not 100% effective, we enforce these restrictions upon ourselves in part so that we just slow it down and spread it out over time, so that medical centers are not overwhelmed and unable to provide care to those who really it, so that we have time to create better and better therapeutics.
I always thought the whole prevention thing is because we want to “flatten the curve”, remember? Not to prevent every single infection, which is impossible.
As another fun example, the doctor (and only the doctor) overwintering in Antartica needs to have had their appendix out.
Medical evacuations are tricky, especially in the winter, and the logic is that the (single) doctor could remove someone else's appendix, but it would much harder for them to remove their own. Leonid Rogozov did remove his own in the 1960s, but I think most stations would prefer to avoid a repeat of that.
In the US there are literally thousands of different public health agencies headed by health officers with strategies ranging from herd immunity by any means necessary to attempting COVID 0. Vague gripes about public health tag lines in such a fractured environment is unproductive.
That’s really not true though. 99.9% effective might not be good enough for an Antarctic research base, but that’s a pretty unusual circumstance. We’d be thrilled if our current countermeasures against Covid were 99.9% effective; we would’ve ended this in 2020 if that were the case.
If I understand correctly, you can mathematically model how effective countermeasures have to be in order to suppress a virus with a given R0. Given that the measles vaccine is 93% effective and sufficient to suppress one of the most infectious diseases we’ve ever seen (R0 of 12-18), I think 99.9% would be in the overkill category.
Can you give a source for that 93% efficiency of measles vaccine? Accuracy for 2 digits is very suspicious. Measles symptoms depend strongly on nutrition deficiencies with insufficient vitamin C being especially bad. If that is not the case, one can be asymptomatic and then we never know about infection.
> The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.
Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013 Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) at https://www.jstor.org/stable/24832555
> One dose of measles-containing vaccine administered at age ≥12 months was approximately 94% effective in preventing measles (range: 39%–98%) in studies conducted in the WHO Region of the Americas (141,142). Measles outbreaks among populations that have received 2 doses of measles-containing vaccine are uncommon. The effectiveness of 2 doses of measles-containing vaccine was ≥99% in two studies conducted in the United States and 67%, 85%–≥94%, and 100% in three studies in Canada (142–146). The range in 2-dose vaccine effectiveness in the Canadian studies can be attributed to extremely small numbers (i.e., in the study with a 2-dose vaccine effectiveness of 67%, one 2-dose vaccinated person with measles and one unvaccinated person with measles were reported [145]). This range of effectiveness also can be attributed to age at vaccination (i.e., the 85% vaccine effectiveness represented children vaccinated at age 12 months, whereas the ≥94% vaccine effectiveness represented children vaccinated at age ≥15 months [146]). Furthermore, two studies found the incremental effectiveness of 2 doses was 89% and 94%, compared with 1 dose of measles-containing vaccine (145,147). Similar estimates of vaccine effectiveness have been reported from Australia and Europe (Table 1) (141).
No mention of vitamin C. Given that "After exposure, up to 90% of susceptible persons develop measles", it seems very unlikely that differences in vitamin C play an important role.
You write "depend strongly on nutrition deficiencies", which my cited article describes as "In low to middle income countries where malnutrition is common, measles is often more severe and the case-fatality ratio can be as high as 25%".
That's calorie deficient, but not specifically vitamin deficient.
Thanks for the links. “About 93%” is much more sensible then 93%. As for vitamins there was an old study [1] :
Child mortality due to measles is 200 to 400 times greater in malnourished children in less developed countries than those in developed ones. In addition, measles brings about consumption of nutrients in marginally nourished children, so they will also do worse if not supplemented during infection.
I strongly disagree - ashtonkem's description is quite sensible. I don't expect HN comments to be more precise than medical professionals.
That is, it's easy to find scholarly papers published by doctors which don't add the "about" like:
"Measles vaccine is highly effective, with 1 dose being 93% effective and 2 doses being 97% effective at preventing measles." from "Measles Outbreak — Minnesota April–May 2017" by authors from the Minnesota Department of Health, at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687591/
"Based on the Centers for Disease Control and Prevention data, one dose of MMR vaccine is 93% effective against MeV, 78% effective against mumps virus (MuV), and 97% effective against rubella." by authors from The Ohio State University at https://www.pnas.org/content/pnas/118/12/e2026153118.full.pd... .
Yes, I already mentioned malnutrition as a known factor.
I asked for substantiation of your statement "insufficient vitamin C being especially bad."
You cited reference doesn't even mention vitamin C.
Delivery of the two doses of vaccine needed to achieve >90% immunity is accomplished by routine immunization of infants at 9–15 months of age followed by a second dose delivered before school entry or by periodic mass vaccination campaigns. B
I am extremely skeptical about precise numbers in medicine. The biology just does not work in that way. And it does no matter if the number comes from HN comments or peer-reviewed journal article. It signals that with very high probability that at best those who gave the number do not understand what they are talking about. At worst in can be just an arbitrary number where the extra precision was used to give a sense of legitimacy.
And note how much better the claim from the original article sounds: the efficiency of at least 90%. Which tells that even if one follow a reasonable lifestyle that minimizes chances of getting the infection (or at least feed infants in a reasonable way as we are talking about <2 years old), then still the vaccine reduces the chance of infection by a factor of 10.
And yes, it was stupid for me to rely on the memory when claiming about particular vitamin.
> And it does no matter if the number comes from HN comments or peer-reviewed journal article.
I’m sorry, that’s absurd. You will always be picking pedantic fights with people if you expect everyone everywhere to meet the standards of peer reviewed medicine.
From the outside picking a fight over the difference between “93%” and “about 93%” on a technology board is pedantic to the point of being suspicious.
Seeing people very critical of vaccine studies of a successfully eradicated disease that has had a long time since to evaluate that success aside a really generous benefit of the doubt given to vague claims about vitamin supplements makes me sad.
We can be observant and suspicious about the healthcare industry while also admitting that there is science being done. They manufacture vitamin C supplements, too. They make money whether you buy the regulated stuff or the unregulated stuff.
