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Comment by zaroth | Hacker News Reader

This is another really great reason why the herd immunity threshold is lower than it has naively been claimed. If the effect is as large as TFA says then the threshold is actually much lower than the ~60% level.

This has a big impact on the estimated death rate for achieving herd immunity. The other factor in that estimate is the CFR which is also plummeting over the summer, although there’s reason to believe CFR could go back up somewhat in the winter depending on how much the gain was environment versus how much is due to better treatment protocols and therapeutics.

For example, if the immunity threshold goes from 60% -> 20% and the CFR goes from 5% -> 1% the estimate death toll is reduced to 1/15th (6.6%) of the original estimates.

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> This is another really great reason why the herd immunity threshold is lower than it has naively been claimed.

It sounds like you're starting from the happy assumption - herd immunity is much easier to achieve than we believe - and working backward to find data which justify your hope. To get good predictions, we have to be dispassionate and not assume the happy case.

A realistic assessment would probably assign some sort of a probability range to different thresholds - a model might suggest there's a 60% chance the threshold is 60%, a 5% chance it is 40%, a 20% chance it is 80%, a 10% chance it is 90%.

And any model has to take into account that any piece of data might be wrong, including this data about T-cell immunity.

In my area, as in Sweden, cases have been declining for many weeks now. Lockdown didn't become stricter. People didn't become more compliant; rather the opposite. Why aren't cases skyrocketing the way they were a couple of months ago? What explanation is there other than the herd immunity thresholds being wrong?

Mask compliance is reducing spread?

Sweden has recommended against wearing masks. So mask "compliance" would mean not wearing one, which should have led to an explosion of cases, no?

I’d say there has just not been a recommendation or mandate to wear them. There hasn’t been a recommendation against them. It could still happen they say, at least regionally e.g in public transport in one region for example.

A recent survey found only 6% mask compliance in Sweden so that's probably not a significant factor. There must be something else going on.

https://www.telegraph.co.uk/travel/destinations/europe/swede...

Did they open schools there as well? Those increases seem to be around early September, around when in many countries with those enormous increases have opened their schools. Could it be this a significant factor?

Yes, and schools were never fully closed.

I don't think our mask compliance has increased since the earlier spike; I would say the opposite. I don't have any hard data of course, so it's possible. I hope someone is collecting this data.

If masks are truly effective enough to alone cause the dramatic change we're seeing, then the initial advice that they weren't necessary was utterly disastrous.

I see one mask maybe every other day (major city in Sweden). I would guess mask usage is close to zero.

For my data point I’d say around 1-5 of 100 in large grocery stores (Stockholm). Outside almost no one.

It is tempting to see masks as a solution, but I doubt they are. We had quite strict mask requirements (bordering absurd, like wear the mask in the woods, being alone), and they are again required in indoor public places. Our neighbours in Latvia never required masks and hardly anyone wears them. They have just a fraction of new cases we have.

Data so far seems to suggest the opposite. Countries with harder enforcement of face masks seems to have had larger outbreaks later.

There has been earlier WHO studies that suggests improper use of masks may be detrimental, but it might just as well be confounding effects of something else.

Really? Germany, Taiwan and Korea disagree.

Counterpoint is Madrid, Spain, which had one of the worst outbreaks in the spring (antibody tests showed prevalence of 11%[0], higher than Stockholm[1]) and now is having a severe outbreak again[2]. What explanation is there other than herd immunity not having been reached?

As for Sweden, there's a lot of variety in human behavior and a lot we don't understand about the virus, and there are many possible explanations for the lack of major spread in any particular area. Sweden has continued to post a steady low level of cases over the last two months, not a continuing bell-curve decline, suggesting the virus is still consistently finding new hosts, just at a low and steady pace.

[0] https://www.reuters.com/article/us-health-coronavirus-spain-...

[1] https://www.theguardian.com/world/2020/may/21/just-7-per-cen...

[2] https://medicalxpress.com/news/2020-09-doctors-hard-hit-madr...

The number you're citing for Stockholm is from April, well before the outbreak became severe in Sweden. Cases in Sweden continued to grow after that, and didn't peak until late June, when daily case counts were 3x higher than in April. (Although it's important to point out differences in testing - the positivity rate peaked April 20th - 26th).

That's a different experience than Madrid, where the virus hit much earlier. By the end of April, daily case counts were 1/5th of their peak in Madrid.

I'm not aware of a more recent study.

The simplest explanation for Madrid is that it locked down too early, and herd immunity (which seems to occur at about 20-25%, based on Antibody testing of New York and Sweden) was never reached.

Lockdown also seems to increase the threshold for herd immunity and increase deaths, by dramatically changing the demographics of who is infected. Without lockdown, the youngest and most mobile people are likely to be infected - with minimal/zero deaths since COVID mortality is incredibly age dependent.

Under lockdown, those people are at home and intermingling with family. The only 'social' activity is shopping for food, leading to an unnatural mingling of old and young.

I live in Ukraine which has masks and little else against COVID. In shopping centers particularly in the evenings there are essentially zero old people - they fear for their lives, as they should.

The most effective policy we could have adopted was 6AM-10AM public transport and shopping for the aged only, and everyone else from then on. Segregate the elderly population into the mornings and let the masses in in the afternoon. This might have required shifting school and work to later hours in the day for three months, which seems a minor inconvenience.

Nobody credible believes 20-25% is a likely threshold for herd immunity. You cannot Realistically in America isolate the old from the young and if the young spread it like wildfire the old get sick.

Literally everything in your post is as poorly considered. It's important not to spread misinformation.

It's 20%-25% of currently detectable antibodies, coupled with another 20%-50% from prior coronaviruses or other cross-immunity. That's the important distinction. The sum approaches the 50%-70% needed for herd resistance based on 1-1/R0. That's the point of this article.

A couple people suppose is not the same as proof

See: https://www.news-medical.net/news/20200731/Research-suggests...

In addition to immunity based on T cells, the HIT depends on how individuals are networked. The original 60-70% estimates were based on 100% of people being vulnerable and also a random distribution of individuals interacting. In reality a small fraction of the population will have many interactions and once they become immune those transmission vectors away and the average R number drops. So based on the latest research plus observations of the worst hit places, 20-25% seems plausible.

Why are you assuming young people don't live with old people? It's extremely common.

It's rather uncommon in most European countries:

https://ec.europa.eu/eurostat/documents/3433488/5579620/KS-S...

Looking at this data for the US, it could be a factor for COVID mortality being higher in minorities:

https://www.pewsocialtrends.org/2010/03/18/the-return-of-the...

Your data actually says the opposite for Europe - it's highly dependent of the country of course, but if you look at page 6, in Southern countries - Spain, Italy, you have >30% of old people living with larger family (columns 'living with partners plus others' and 'no partner, not living alone'). That comes out at <10% for Nordic countries (Finland, Sweden etc)

Three-generation house-holds or households where adult children live with their older parents are very uncommon in most, but not all, EU countries.

The numbers you cite are explained by old people living in retirement facilities or coliving arrangements, but that doesn't imply cohabitation with young people. Under these circumstances, special precautions can and must be taken.

Please, please, stop reading and sharing hysterical news reports and go right to the data.

Here's daily deaths in Spain:

https://i.imgur.com/G84d20p.png

All numbers about total reported cases from the spring are going to be way, way off. There simply wasn't enough testing.

Deaths do not lie, which is why we should focus on those numbers. And by those numbers, this is in no way a repeat of Spring for Spain.

It's not a repeat of the spring...yet.

The daily number of cases in Spain appears to still be on the rise, and the death curve is usually 3-4 weeks lagging the cases. So deaths is likely still on the rise.

All that said, it may not reach the same proportions as the spring. But it is too early to wave it off either.

I'm afraid I don't follow.

Sweden didn't lock down because they wanted to achieve herd immunity quickly, while still taking measures to protect the most vulnerable. Spain locked down, actively attempting to minimize the spread of the virus.

How is the failure of Spain to achieve herd immunity (while actively attempting to achieve the opposite) a counterpoint to the Swedish example?

> Sweden didn't lock down because they wanted to achieve herd immunity quickly

This is a popular myth. There are no such statements (no not even from internal communication and similar). It was never a “strategy”

"In August, emails between the two men from as early as March show how they discussed herd immunity to limit the spread of the virus in Sweden." - Newsweek: Sweden's 'Herd Immunity' Mastermind Gets Promoted by WHO

https://www.newsweek.com/sweden-herd-immunity-mastermind-who...

One email thread out of thousands released where they brainstorm theories and predictions. Doesn't mean it's the official strategy and Giesecke is not even employed by FHM but retired.

These were exactly the emails I mean. Anyone who reads them can clearly see there is not even a slight suggestion that reaching herd immunity is somehow a possible “strategy”.

> Counterpoint is Madrid, Spain, which had one of the worst outbreaks in the spring (antibody tests showed prevalence of 11%[0], higher than Stockholm[1]) and now is having a severe outbreak again[2]. What explanation is there other than herd immunity not having been reached?

The outbreak in Spain isn't as severe as you might think, there's a lot more positive tests, yet a lot less illness.

Herd immunity just means that R=1 without precautions. I would agree that Spain hasn't quite achieved herd immunity, but spread right now isn't anything like earlier this year.

One could speculate that because Spain went into such a strict lockdown, herd immunity could not be achieved, or that herd immunity was achieved, it just didn't last because COVID immunity doesn't last.

Antibody testing is getting tricky now, because antibodies are starting to fade, so unfortunately seroprevalence numbers will become underestimates with time.

That being said, in one hard-hit area of Stockholm, seroprevalence was 19% (https://www.folkhalsomyndigheten.se/publicerat-material/publ...). Stockholm as a whole has about 11% seroprevalence in their most recent numbers, but again, I believe antibodies are starting to fade now (https://www.folkhalsomyndigheten.se/publicerat-material/publ...).

more effective contact tracing.

There's no official national contact tracing in Sweden. Every region does it differently and some not at all.

That's not evidence of herd immunity thresholds being wrong though, that just opens up questions that need answers. Plus, the % positive rate doesn't seem to show a trend over the last 2 months, so I don't think your initial premise of "cases have been declining" is true.

https://ourworldindata.org/coronavirus/country/sweden?countr...

Because social distancing is only one part of equation.

Sweden has managed to address some of its other issues related to spread & fatalities. Notable among these are nursing homes, which had been a key source of spread. Once proper precautions were taken, they have stopped being as much of an issue.

That said, Sweden isn't out of the woods: The current trends are flat at best, and perhaps have a slight upward cast to them for new infections over the past few weeks.

> Notable among these are nursing homes, which had been a key source of spread.

Because so many different people visit those? Nursing homes have been key source of death, but not of spread.

Key source of spread are e.g. Prostitutes. Prostitution is (used to be) legal in e.g. Germany (afaik, in Sweden they intent to curb Prostitution by fining the client), but has been (temporarily) banned during the epidemic. That, of course, doesn't stop the custom, just moves it underground where the health of the providers cannot be monitored. Alleviating the financial problems of the providers might help curb the custom (as has been attempted in Germany afaik), as well as scaring the clients (as the state and media are doing their darnedest of).

Yes, nursing homes. Just look at the rates of health care workers in them getting sick. It spreads.

Besides, I gave that as one single example that helps explain Sweden's infection trends. I wasn't trying to comprehensively enumerate the many steps Sweden has taken to address COVID-19 without strict shutdown. I gave an existence proof of the possibility that your claim of herd immunity isn't the only possible explanation.

This is especially true given that other countries have not all had experiences in keeping with herd immunity.

The fact is that we still know too little about this puzzle. But every time a new piece comes out, everyone rushed to jam that piece into their own pre-conceived ideas.

> I gave an existence proof of the possibility that your claim of herd immunity isn't the only possible explanation.

My what? What else did you read into my text which I didn't write?

> Because so many different people visit those?

Yes, you can have temp workers that work in 5 facilities in a week, especially when staff starts falling ill and even more temp staff is nedded. The staff situation in Swedish elderly care was already a mess, and the pandemic just exposed some of the flaws.

> Lockdown didn't become stricter. People didn't become more compliant; rather the opposite.

> What explanation is there other than the herd immunity thresholds being wrong?

Let's start with sources on those first items before we get to an explanation.

My general understanding is that Sweden recommended certain things but never technically enforced anything, so I'm not sure what "compliance" means.

https://www.google.com/covid19/mobility/ says lockdown compliance has not changed much in my area and is trending slightly down if anything. I'm not aware of data on mask usage in my area, but a lack of confirmed scientific data shouldn't paralyze us; that results in problems like failing to recommend mask usage.

> but a lack of confirmed scientific data shouldn't paralyze us

Huh? That was not the point in contention. You said "the only conclusion is that the herd immunity numbers must be wrong" but have shown no evidence whatsoever to back that up.

You're putting words in my mouth; I did not say that at all. I asked "what explanation is there". I think a good discussion has resulted with some good points being made and some good data being shared.

One possibility is that better air circulation in closed rooms due to open windows, higher vitamin D levels, and people meeting others outdoors rather than indoors more often have been contributing factors. These ameliorating factors would play less of a role in Southern countries like Spain or Italy, since they were already present in spring in those regions and so all infections took place in spite of them.

Covid could be "lightly seasonal", so-to-say, though by far too infectious to be as seasonal as influenza. This is speculation, of course, unless it's backed up with studies.

By the way, maybe I'm mistaken about this, but it seems to me that any increase of the number of immunized people will statistically decrease the R-value even long before herd-immunity is reached. Together with the measures and heightened awareness this might also explain the data.

Even taking this seriously: Sweden has seen 570 deaths per million so far. If that toll represents the transition to effective herd immunity, then we'd expect another 3-4 million people to die worldwide before this burns itself out. And... you think that's a good thing? Sweden's response has been a disaster any way you cut it.

No.

The age-stratified IFR is magnitudes different between people under 40 and people above 70. You can still achieve herd immunity without infecting the vulnerable.

We have become better at treating patients with time as well, we now know that putting people on ventilators is a phenomenally bad idea, oxygen, steroids, and blood thinners is the way to go.

Also, the death rate in the US is higher than in Sweden, so how are those lockdowns working out for you?

The US population is unhealthy with bad health care on average. 42% are obese. It's not Lockdown leading to greater mortality.

The US? I'm not aware of any place here that's under lockdown.

Oahu in Hawaii is currently under lockdown until September 23rd.

Huh, you're right. Apparently there is limited hospital bed capacity on the Hawaiian islands.

As long as schools are closed you have at least a partial lockdown. Schools are still mostly closed in California, no?

yes, california is in arbitrary lockdown, closing many businesses and amenities that basically don't contribute to spread, rather than tackling the much harder but much more effective challenge of restricting (large) private social gatherings (where social norms actively discourage preventative measures like distancing) that are driving the spread (outside of hospitals and care facilities). our state "leaders" don't want to take the political hit of actually doing the effective rather than the performative.

If you count excess mortality then California has 60% more deaths than registered covid deaths, as can be seen here.

https://www.nytimes.com/interactive/2020/05/05/us/coronaviru...

If we take that into account then California actually has more deaths per capita than Sweden, and people are still dying in California so it will only get worse. So I agree their strategy was not all that good.

yes, as a resident, i can't tell you how frustrated i am with the inanity of it all. so much talk and bluster, so much performance, so much (lower- and middle-class) socioeconomic damage, yet so little effectiveness.

> Also, the death rate in the US is higher than in Sweden

Is Sweden comparable to the US? The population is more like a US state. Let's take Oregon as an example. About half the population of Sweden, and less than 10% of the covid deaths. We're not exactly locked down, either.

We're doing individual states? Cool, let's look at the northeast.

Massachusetts, Connecticut, and Rhode Island all have a total covid-19 death rate that's more than 2x that of Sweden.

Currently, the average daily cases is 5x higher in Rhode Island than in Sweden, 3x higher in Connecticut than in Sweden, and 2x higher in Massachusetts than in Sweden. The current daily covid-19 death rate in both Massachusetts and Rhode Island is higher than in Sweden.

> We're doing individual states? Cool, let's look at the northeast.

great, but what's the point? That Sweden is doing better than about a third of the United States?

The original point being made is that it's apples to oranges to compare the U.S. as a country to another country that it dwarfs in every population metric if you're looking at how to shape public policy.

In other words : There doesn't seem to be a one-size-fits-all solution for nation-wide policy making regarding a pandemic that fits every culture in the world.

I don't think that this surprises anyone.

Oregon does have a mask mandate. Wildfires are forcing most sane people indoors. Schools are digital at the moment. Lots of people working from home. There are definitely mitigation measures being taken in Oregon.

>What explanation is there other than the herd immunity thresholds being wrong?

Just to give two possible alternative reasons:

- outdoor life over the summer, leading to higher vitamin D levels;

- older people are more likely to still be living in their summer cottages.

Have you noticed that the death rate is possibly creeping upwards again? It’s simply too early to say.

When I arrived back in Stockholm (from the countryside) three weeks ago, the town was very empty: our family was alone eating lunch in a central Italian restaurant on a Sunday. Now the streets are full again, but covid takes 3-4 weeks to take hold again.

Not that I expect to see the levels of sickness from April again. But there’s a long winter still ahead of us.

I got another data point that (potentially) supports your claim. Peru here. Highest death per million habitants in the world (not the numbers reported by the Ministry of Health that is artificially reducing the numbers).

In Perú we are (sadly) keeping track of the pandemic by comparing the daily death count from previous years with the one for this years. You can safely assume: - there is no contact tracing - adherence to mask usage is good - social interactions are generally avoided with the usual folks that don't pay attention and an increase in those interactions every week.

These are the "death curves" of every region:

https://imgur.com/a/CWiUPiC

This is what happens when your government does not do anything and pretty much every one gets infected and your healthcare system collapses. You get a high spike in daily deaths and then a sharp drop (Lima is a special case for many reasons - size and geography).

Heard Immunity in every region (except Lima - yet). Seroprevalence studies are on their way...

Maybe people in Sweden have less physical contact (hugs, etc) than in other countries?

The joke says "Now that covid is less prevalent, scandinavians do not need to follow the 2m constraint .... and go back to their usual 5m"

MY assumption would be that it's a combination of nice summer weather which makes social distancing easier, and all the super spreading idiots that don't comply are getting sick, recovering, and no longer able to (for the time being) continue to infect others.

Without any details about "your area" it's impossible to say. We'd need the raw data, not your anecdotal "things are better".

He's talking about Sweden as a whole. There's nothing anecdotal about it and the raw data is one Google search away. Sweden currently has one of the lowest death rates in Europe.

In the Netherlands cases have been skyrocketing for weeks though.

The COVID "new cases" data for New York state seem to show something like herd immunity, despite numbers that should be well below herd immunity.

I suppose it could be something else, like New York residents being more diligent about masks, social distance, etc. Anecdotally, though, that doesn't seem to be the case.

NYC still seems like a ghost town to me.

Could be something like people with behaviors consistent with a higher risk of catching/spreading it being already immune by now.

That is a factor in herd immunity though.

Almost no one is wearing a mask in Sweden, and the current daily numbers look a lot like NY and NJ.

Partly NYC is relatively empty and relatively cautious since it was present and real, but partly it’s likely many times more folks have had it in NYC than has been widely reported, possibly one or two orders of magnitude more, leaving fewer candidates now.

If, back in the spring, you worked backwards from NYC deaths using mortality rates within the lowest ranges in US studies, then it seemed likely that before summer infections may have already approached most of the population.

Mortality rates of 0.5% would have a far higher number of infected, as noted in this April suggestion of much wider prevalence, which if the case ”the real number of infected people in LA County would be 28 to 55 times higher” — https://www.webmd.com/lung/news/20200424/more-data-bolsters-...

Aside from that math, a variety of sources suggest perhaps 25% of New Yorkers infected in April, such as:

A claim in June of ”roughly 25% by June” — https://www.cnbc.com/2020/06/30/roughly-25percent-of-new-yor...

A July claim (opinion piece, not an epidemiologist) of an even earlier peak, Feb and March: ”With a city population estimated by the Census Bureau at 8,336,817, the 22.7% prevalence from the late-April state survey would mean that nearly 1.9 million New Yorkers had already contracted the disease as of early April.” — https://www.bloomberg.com/opinion/articles/2020-07-23/new-yo...

A July claim that ”over 60% of residents in some boroughs tested positive for the virus.”: https://abcnews.go.com/Health/nyc-neighborhoods-obtained-her...

Underappreciated, and insightful comment. I appreciate the insight and references, and did read all of them. Thank you.

There’s a naive equation for herd immunity which takes the unmitigated transmission rate or R0 of ~3 and calculates 1 - 1/R0 = .66.

This is the upper limit on the threshold (what I call the “naive herd immunity rate”) assuming there are no unaccounted for effects which would otherwise reduce R0.

Improved personal hygiene, social distancing, PPE, contact tracing, are all various behavioral ways that we have reduced the transmission rate below 2, which reduces the herd immunity needed to get transmission below 1 as long as those measures persist. Another way to say this is that if social measures get us to 1.3 then the infection still spreads until ~25% are infected.

The natural immunity discussed in the article is effectively a free boost to your current herd immunity rate. If serological studies show 20% had been infected, but then you can add another 30% on top of that, you are effectively already at 50% herd immunity.

I’m not sure what you mean by starting from a happy assumption. The real world data shows us that there is irrefutably something working to either reduce R0 or effectively boost the herd immunity level which isn’t showing up in the serological studies. TFA refers to several studies which show scientific evidence of a biological process that can explain what’s happening in the real world.

We can accurately estimate the Rt by just looking at positivity rates, test count, and positive case count. Either R0 is much lower than initially calculated, or effective immunity level is higher than serology tests have shown. I suppose you can pick one, but Sweden at least is a strong datapoint that it’s a function of immunity not social suppression measures.

If you look at Atlanta cases are way down and everything is open. People go out to bars, nightclubs, strip clubs, etc. There is not much social distancing and only place I see people wear masks at is the grocery store. I feel like a lot of people that get it and are younger don't get tested and just stay home and ride it out. So the actual cases vs reported cases are a lot higher.

"The original estimates"

Look at this range of epidemiologists' 2020 death toll estimates (second chart below), gathered by 538 on April 2nd. Comparing to the current death total of 200k in the US, It's actually pretty decent, the majority of experts' ranges include 250k, which may be around where we end up in 2.5 months' time.

https://fivethirtyeight.com/features/best-case-and-worst-cas...

I would take any cruise-ship analysis from early on with a grain of salt. It's very hard to test a pandemic extremely early on, there are less valid and reliable testing instruments.

Not really, "immune" people can still contract and transmit the virus.

So the effect of T-Cell immunity is already accounted for in R0 and IFR estimates.

> the estimate death toll is reduced to 1/15th (6.6%) of the original estimates

A million people are dead of this virus already. Which "original estimates" are you citing that predicted 15M people dead? Those line up with the absolute worst case scenarios, not actual predictions.

Well,... for example, the National Institute for Health Research University College London predicted ~580k excess 1-year mortality in a "do nothing" scenario in their "high" relative-risk (RR) assessment. That's ~0.9% of the population in 1 year, or 70 million people if extrapolated worldwide.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Oh, and just for fun, this is MSNBC yesterday;

“ Math on Trump Covid strategy has millions dying before it works”

“2.97% fatality rate * 215,000,000 = 6,385,500 dead”

https://www.msnbc.com/rachel-maddow/watch/math-on-trump-covi...

And then factor in that about 1/2 of all Covid deaths (in the US) are in people over the age of 75 (a population of just 22m).

A focus on vaccinating that demographic will quickly, dramatically reduce the mortality rate of Covid.

Out of the 104 million people under the age of 25 in the US, only ~400 people have died from Covid.

Out of 220 million people under the age of 55, there have only been ~15,000 deaths.

We have a very blatant demographic target that we can focus on to rapidly knock down the mortality rate.

The main challenge for vaccines is currently the R+D, not manufacturing enough doses.

The mRNA vaccines being tested may need down to -70°C cold storage during transport and immediately before use, so quite a logistical challenge. Prioritizing those most at risk will be critical to knocking down the CFR dramatically.

> to -70°C cold storage during transport and immediately before use, so quite a logistical challenge.

Liquid N2. The same is done, e.g. for bull sperma. This isn't an insurmountable challenge.

Liquid N2 is common in industry. There are national and local companies with branches scattered all over the US that can supply liquid N2 to anyone equipped to handle it. Since doctors use N2 (to freeze warts) they know how to deliver medial grade N2 (if there is such a thing). Those suppliers will work with their normal customers to ensure medical use gets what they need (if arranged in advance they can produce less in exchange for a vaccine for their employees which ultimately means better profits)

That is N2 isn't a supply problem. However there are other logistical problems. Most industry uses of N2 are in very large quantities and so the ability to fill a millions of vial sized containers of N2 might not exist even though more than enough N2 exists.

Dry ice is -78°C so perhaps that could work?

We do not know that. The are several promising vaccines in stage 3 - that means R&D is over for them and has been for a while. If in the future we learn they work then the problem today is scaling manufacturing/delivery not R&D. Of course if it turns out they don't work then R&D remains the problem. We don't know which future we are in today.

The Oxford vaccine is being manufactured now, they aren't waiting for R&D to finish before they start.

Not in enough quantities to vaccinate the world. This quantity is a hard problem.

I think they are planning 2 billion doses, I’m not sure how long that will take though.

How does one focus on vaccinating the elderly without a vaccine? I mean, you're not wrong in principle, you just skipped an important step.

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