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Comment by mchusma | Hacker News Reader

I hope they learned some lessons here and seek to accelerate lifting the ban on the Johnson & Johnson and Astrazeneca vaccines. Work they can do to get those approved in the next few weeks are what can end the pandemic in Q1.

In the US, given by Feb, there will have been about 100M infected, It really only takes about 100M vaccines to hit herd immunity. Between Pfizer, Moderna, J&J and Astrazeneca it's reasonable to expect/demand 100M out by Feb.

The FDA's approach of "moving slow to give confidence" cost lives and does not actually build confidence. Allowing this vaccine to be taken by the willing was among the easiest decisions ever made, and their pretending otherwise was absurd. It would have built more confidence if they said within 24 hours of the EUA filing "hey public, this was an easy call. We already looked at all this data over months, cut no corners. This isn't a borderline approval, this looks amazing."

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How are you arriving at 100M infected by February? The current case count is at around ~15M with ~250,000 cases being reported yesterday. To reach 100M by February you would need close to ~2M cases a day for every day between today (Dec 11th) and February 1st.

https://www.npr.org/sections/coronavirus-live-updates/2020/1...

> The actual number of coronavirus infections in the U.S. reached nearly 53 million at the end of September and could be approaching 100 million now, according to a model developed by government researchers.

> The model, created by scientists at the Centers for Disease Control and Prevention, calculated that the true number of infections is about eight times the reported number, which includes only the cases confirmed by a laboratory test.

Infection count is a lot higher than case count. If you divide the number of deaths by an IFR of 1% you get 30 million infected so far, while with an IFR of 0.5% you get 60 million. There are probably half a million infections every day right now, so 100 million by February doesn't seem that far fetched.

Though I see no reason to complain about the FDA dragging its feet, given that the bottleneck to vaccinating the populace is manufacturing, not authorization.

I’m not sure how many people fall into “high risk”, but after everyone who needs the vaccine gets one we can all breathe a huge sigh of relief.

For vast amount of people living in the United States the virus isn’t going to be dangerous. But for certain groups it’s extremely dangerous.

When did the FDA ban Johnson&Johnson and AstraZeneca vaccines? Why?

Enrollment of people into the studies had been paused after some people in the respective studies had suffered health issues that needed to be investigated to determine whether they were adverse reactions or not.

As I understand it, both pauses ended over a month ago, and there hasn't been any "ban".

As someone who just received a J&J vaccine or a placebo, I can definitively say that at least the one is not banned currently.

Both studies were paused, as is customary, due to medical complications from someone in the study. Upon investigation it was deemed in both cases to likely have not come from the vaccine, and the trials were resumed.

Your and likely most people's interpretation when they hear "ban" is that the FDA took some active step to specifically ban the J&J and AstraZeneca vaccines.

The other interpretation is that all pharmaceutical drugs are banned by default and that approving a drug is actually removing that ban. I suspect the original commenter was using "ban" in this context.

I'm very weary of this approval. This is the first messenger RNA .. thing (this isn't a vaccine; not like any attenuated or inactivated virus vaccines that have come before it. This is something very different in the way it works). There are no Longitudinal studies. This will be a significant increased risk for people under 40.

We shouldn't see to fast track any drug, vaccine or treatment outside of the normal process. I wish the inhaled steroid controlled studies had completed because I was curious of that would have been a useful treatment (a lot of doctors are using them off label) and we wouldn't need something this untested.

Fast tracking medications is how mistakes are made. Let's be critical of how these emergency powers are used.

No mRNA vaccine has been approved before, but from clinical trials of mRNA vaccines dating back to 2008 [1] there’s evidence of short-term side effects but no reason to suspect long-term safety concerns. mRNA vaccines don’t present the risk that attenuated vaccines pose to immunocompromised individuals or pregnant women, and they don’t stay in the body long enough to be a long-term threat. We can’t guarantee 100% because our bodies are complex, but I wouldn’t characterize it as “significant increased risk” for people under (or over) 40.

[1]: https://www.nature.com/articles/nrd.2017.243/tables/2

> It really only takes about 100M vaccines to hit herd immunity.

Citation please? Dr. Fauchi says we need 70% innoculations to achieve herd immunity. https://news.yahoo.com/fauci-america-reach-herd-immunity-004...

From the numbers I've been able to gather, you need 200M vaccinated people to achieve herd immunity, which is 400M doses.

Sources:

Wikipedia gives the US population as 308,401,808. Seventy percent of that is 215,881,266.

Latest COVID-19 infection totals come to about 16 million. https://www.nytimes.com/interactive/2020/us/coronavirus-us-c...

Unclear why I'm being downvoted.

He's saying that if 100M already have natural immunity, then 100M with a vaccine brings us closet to that 70%.

100M doses brings us closer to 17%. We need 400M doses to innoculate 200M people, which is what we need to achieve 70%, counting the 16M people that have been diagnosed with the disease.

Except we don't know who those 100M people are so we can't exclude them from the vaccination pool.

I believe the author meant 100M infected by February (and assumed immune) + 100M more vaccinated is about 66% of the current US population of 328M.

They can't be added up like that though, since some of the previously infected will still be vaccinated. So it'll be more like 170 million total with 100 million vaccinated.

70% is the kind of "default" number. It's based on 1-1/R0. If R0 is 3, then you need 66.7% to no longer be susceptible before cases start to decay. If the vaccine is 95% effective, then you need about 70% vaccinated to get 66.7% no longer susceptible.

But: 1-1/R0 assumes universal, uniform susceptibility and uniform contact graph, which aren't true-- so it's pessimistic. And some people have caught the virus already and are no longer susceptible through that means.

Many computational models put it at about `25% of people infected will result in herd immunity with normal behavior, and the US is presently at about 16%. Unfortunately, getting the "right" additional 9% of people will require vaccinating much more than 9% of the population (we're not as good at selecting the most susceptible and most involved in spreading as the virus itself), but substantially less than 70%.

Further, R0 is based on baseline behavior. I suspect a decent chunk of us will be much more careful for some time, which effectively changes the required decrease in susceptibility to cause a case count decay.

> Latest COVID-19 infection totals come to about 16 million. https://www.nytimes.com/interactive/2020/us/coronavirus-us-c...

Current COVID-19 infection total estimate per CDC is about 53 million infections so far. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

Sure, there may be 53M infections, but how many of those untested positives will go on to get a vaccine? This will actually hinder herd immunity, wasting limited vaccines.

> Sure, there may be 53M infections, but how many of those untested positives will go on to get a vaccine? This will actually hinder herd immunity, wasting limited vaccines.

Oh, ideally you wouldn't vaccinate people who are already immune, but saying it hinders herd immunity is a bit silly.

I find it's always helpful to do thought experiments at the limit.

Do you think reaching herd immunity requires more doses A) in a population that is 99% of the way to herd immunity, but that 25% of doses will be wasted because they'll be given to people who are already immune, or B) in a population that is 1% of the way to herd immunity, but only 4% of doses will be wasted in this way?

> Oh, ideally you wouldn't vaccinate people who are already immune, but saying it hinders herd immunity is a bit silly.

If you only have 100M doses and you waste half on undetected positives, that definitely hinders achieving herd immunity. Unless you are saying uncontrolled spread helps develop herd immunity. It does, but it isn't a desirable method.

> but it isn't a desirable method.

Nobody said it was a desirable method. But I did assert that past infections does reduce the doses you need to give to reach herd immunity, which is a point you seemed to argue with.

We'll likely be at >70M natural infections before vaccination efforts hit full steam in mid-January. This is pretty close to the lower end of where models predict herd immunity effects (not ~60% because of non-uniform contact graphs and susceptibility). You don't need a whole lot of vaccination tacked on top of this to start to tamp things down, even though A) some of the vaccinations will be wasted, and B) the vaccinations will not be as "on-target" to break important links in the graph as infection itself is.

> But I did assert that past infections does reduce the doses you need to give to reach herd immunity, which is a point you seemed to argue with.

Sorry for the misunderstanding. I wasn't arguing that past infections change the needed doses, I was arguing that undiagnosed positives waste limited doses. Hope that's clarified.

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