Nothing matters but reproduction rate R
johnhcochrane.blogspot.com
johnhcochrane.blogspot.com
I went on Twitter expressing that the US surgeon general and a bunch of CDC folks shouldn't be lying to the public about the following: Masks were initially in intense shortage. What did the leaders do? They lied to the public about how ineffective masks are to make sure there is enough stock for healthcare workers. I tried to expose this and everyone shunned me down by saying that this is a harmful thing to say. Since when is transparency harmful? You could be truthful and say "While masks are effective, please dont horde them as they are needed by the hospitals". Even if we didn't know the exact effectiveness of masks, they're not harmful to wear. They can only help. Leaders should have told the public about how to make them at home, which did happen, thanks to a bunch of Youtubers.
Here is the deleted tweet (google cache) from the US Surgeon General:
> "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! http://bit.ly/37Ay6Cm"
There were so many things like this. Ventilators, testing ratio, death rate, etc. Coronavirus pandemic was horribly handled by the entire world, particularly us as Americans. Shame really that this is the best we could do.
Edit: Added the official wording of the US Surgeon General Tweet on Feb 29, 2020.
Is it possible they were just wrong?
And potentially poor mask handling and discipline could have made transmission worse. We more or less know this isn't the case now, but didn't then.
So yes, it actually could make things worse.
Saying that the material has an enormous impact on effectiveness doesn't invalidate anything. I mean, that's why N95 masks are so complicated and different from surgical masks, because material matters so much.
They appear to have turned out to be effective (FYI: I've warn masks every time I've been outside since 2020/3/16 so I'm certainly on the side of masks)
Will you downvote this because it shows a logical flaw, not a judgement, but it you probably disagree with it?
Anyone with a brain cell in their head could see that the government's messaging on masks made no sense. This reduced public trust in the government's other public health announcements.
As it happens, people have since done studies. (Not double blind, though)
The fact that they said untruthful information about masks was awful, and it certainly deserves a proper postmortem-in-the-court-of-public-opinion, but I don't think it was deliberate lying.
At the onset, hospitals needed PPE, which includes masks. I remember there being messaging encouraging ordinary citizens not to stockpile N95 masks because hospitals needed the supply instead. If anybody in this same camp was telling the public that N95 masks aren’t effective then that’s an obvious contradiction, a lie.
Anyway, lies and inconsistent messaging both degrade trust, which is a big problem at this moment.
It's not so much now but that actual infectious disease specialists aren't being completely drowned out by people who should have known to keep their mouth shut. Seriously John Cochrane has an excuse, he's from the grifter school of economics and a dummy. Doctors, biologists, etc without specific training in infectious disease should have known better.
The effectiveness of other masks was not so much "not proven" but to the extent that the lack of any standard allows you to say anything about them they just aren't anywhere near as good. In my mind their effectiveness in combating the pandemic is still well within 'not-proven' territory, but since this is somehow a partisan issue in the U.S. I'll limit myself to just saying that they shouldn't be considered a replacement for social distancing.
Sure they were. At some points we weren't even sure if n95 masks did much.
Of course n95 masks only prevent entry through the mouth and nose, and particularly at the time we had reason to think those were other points of entry. So, saying that they were "proven" to work against SARS-CoV-2 at the time was simply false.
"Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
There are logical ways in which it can be true that they are useful for health workers but not for the public.
We know they aren't correct now, of course, as there is now evidence.
This is capitalism.
If masks are in short supply and hospitals needs them - we obviously buy them all up and sell to those in need for an exuberant markup
What do you think the US is, buddy
How are the mask manufacturers going to get more money if they can't charge an exorbitant markup? They need to buy new plant/ materials and hire new people. Is the plan that the mask manufacturers have to go deeply in to debt to create enough masks? That is the best I can think of without sharp price rises, and it is a terrible plan for encouraging people to produce more masks.
I don't have one, or actually care about specific numbers. There is some magic price where I'll start learning how to make masks but I doubt we're going to see that reached in my lifetime.
> If you add an extra dollar to the price, that's enough to get a lot of expansion of manufacturing.
In 18-24 months, sure. We're 12 months in so far though. If they need the money now it is a different story. The higher the price, the more immediate and desperate actions become justified to increase supply. That is one of the core parts of market economics. Let the price rise to some silly amount and people will move heaven and earth to increase supply.
To get extraordinary things done an extraordinary amount of money will be needed. That can come from extraordinary prices. Or it can not happen and shortages can persist longer than required.
Masks went up in price in April because supply was limited, by late May they were at clearance prices as supply out stripped demand.
I don't blame him. Human nature is to wield power. The more power the person has, in whatever form it is, the more inventive ways he will come up with to use it for his goals, be they selfish or otherwise.
JR would shut his mouth if his audience chided him to being conspiratorial.
The society has lost the ability to think critically. And the focus on individuality has exacerbated the problem. I don't mind individuality in matters such as personal growth, morality, religion, etc, but there are some aspects of social life where collective expert decisions must hold higher weight than individual opinions, such as in public health, defense, etc.
They don't really exist. At least not in any significant number. This is just a straw man to attack Joe Rogan.
I'm sorry but your comment shows that you did not read my comment. Please read:
> deviating even just slightly from what the government has chosen to do
> nuanced approach to re-openings is simply too difficult to get right and therefore untenable
What part of "deviating just slightly" and "nuanced approach" implies a complete inverse approach? I think you are straw-manning me, sorry. I never said that the solution was to not have lockdown at all. You can re-read my comment again if it helps. I implied that a nuanced approach and a slightly less restrictive approach would be better. It seems that my comment regarding people unwilling to have a nuanced conversation proves true again.
> other solutions should be tried because the current one clearly has disastrous consequences
Given the context of my other comments, you seem to have reached the wrong interpretation, and are still unwilling to entertain a conversation about what a milder lockdown looks like.
I’m not a politician nor I defend most of them in general but do you expect that people would not hoard them when everyone was (back then) panicking at a new extreme deadly virus?
So the easiest solution (not necessarily the best) was to do politics which is to deceive. If a country says that the masks are very effective yet only selected people will get them, even if it makes sense factually speaking, riots will ensue because that’s how masses work (in most big countries anyway). If you deceive, you gain time and everyone will eventually get their own masks, which is how it played out.
Hopefully I don’t get shunned by this. I’m just trying to illustrate that plain transparency at extreme situations may just not be an easy option as you put it.
Edit: wording
And I agree with your last point of course.
At what cost? How many people have died because mask wearing was discouraged during the early part of the pandemic? We will probably never know, but I would not be surprised if that advice caused a lot of deaths by allowing the virus to spread more easily.
Again I don’t defend these actions, I’m just trying to reason why they decided to go that way and not the most instintive one “let’s be fully transparent” (at least for HN anyway).
Face coverings were ordered in many states starting in April.
A competent administration would have bought up enough of (or all of) the PPE inventory as soon as they understood what was coming. At that point, there would have been no need to lie, because there would have been nothing left for the public to hoard.
I'm not blaming the CDC, or the SG. I'm blaming the political decision makers above them
> So the easiest solution was to do politics which is to deceive
I disagree. politics is not to deceive. Politics is to guide and educate. The longer we accept the rationale that politics is inherently an immoral game, the more our minds accept the status quo.
Those politicians who lied must be held accountable. Those who pushed for the truth but took actions to prioritize health workers should be rewarded.
Politics is IMHO all or a majority about deception unfortunately and once you accept this these actions just make more sense and you stop playing their silly game. I decided to move to a smaller and more healthy democracy because I knew degeneration of politics back in my (somewhat big) country was only going to get much worse and in some cases that can mean literal death to me and I could do nothing to change it. Well, all this is way too off-topic so let’s leave it for another time as it’s an interesting one :)
Just take a look at Fauci as an individual. He's never said masks don't work. He did say "there's no reason to be walking around with a mask," back in March, but, back in March, that was likely true. And, it's not like he hasn't reversed himself when new data comes in. That's precisely why he still has credibility: because what he says is always in line with the best available data.
Also I IMHO doubt that Fauci didn’t know about mask effectiveness - sure, maybe he didn’t know the very specifics but it was kind of obvious back then it wasn’t going to harm and one could infer that it’d probably help somewhat (nowadays it’s clear). IMHO all authorities just agreed to transmit a similar message around the world so they could in the meantime arrange more mask orders and sort out the distribution as production speeded up while avoiding massive riots and/or poor masks made at home that could’ve been worse than nothing.
We do have such mechanisms. In the olden days, opinions were expressed through slow moving mediums such as news papers and press conferences. Those who wanted to criticize them had channels such as letters to newspaper editors, radio calls, etc, to express disagreement or point out flaws. This was good and bad. Good because you had to invest a finite amount of time and resources to express counter opinion. Bad because it has the effect of amplifying the voices of fanatics.
However, with today's friction free methods to express opinion and social media echo chambers that amplify everything, there is just too much noise.
I just hate Twitter and Facebook. Their ultimate contribution to society is sum negative.
And we're expressing opinions without people being too belittled/shunned ...
The public is smarter than the technocrats give them credit for, and will bristle at attempts to influence their behavior through lying - or even just fibbing, as in this case.
Good luck gaining back their trust after a round or two of that. In that respect, they may resemble petulant children - but can you blame them?
Except they didn't. What they said that the odds of you getting infected were not substantially changed by you wearing a mask in general, but they were substantially changed for people in high risk situations, like healthcare workers.
That became less and less true as more and more people became infected, so the basal chances of you getting exposed, and therefore the impact of wearing a mask, changed.
^ US Surgeon General official tweet which was then deleted. Source, Google cached version, google "US Surgeon General tweet masks".
I added quote marks to clarify this. The original tweet has been deleted. The bitly link was part of the original tweet.
It will lower risk, particularly of you giving the disease to other people.
There was a genuine concern that people would not only consume the supply of mask product, but also that they'd think they were safe because they had a mask on, and then proceed to ignore other safety guidelines, thinking they were safe.
This in fact happens every day right now, but you know... it's just pedantry.
Again, if you look at the CDC statements, they are consistent with this. They said it could reduce the risk of spreading or contracting the disease (and the specifics of how that might work were not as well understood at the time), but that it would NOT prevent either of those scenarios.
If you think about it, communicating that "they don't work at all" but "we have to keep a stockpile of them for the people at highest risk" doesn't make any sense. It's not what happened.
Asking people not to hoard masks would have been no more effective than it was for toilet paper - I would guess less effective, in fact.
"if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
This is a statement of confidence in the masks he's talking about, N95/adjacent PPE. Saying they provide any substantial margin of personal protective safety for healthcare providers is saying they work.
Now some people read "STOP BUYING MASKS! They are NOT effective" and stopped thinking right there. Some of the fault lies in anyone who did that. Some of the fault lies with the SG for poor communication. But the fact is, the SG's statement did not stop there.
It continues into a statement skeptical not of the effectiveness of PPE masks as a personally protective measure, but as a measure that can protect the general public. There might by any number of reasons for that. He might believe the general public can't wear them effectively and conscientiously (I didn't believe that in March, but after watching people wear cloth masks, I absolutely do). He might believe there just weren't enough to protect the public (absolutely true then). He might believe they might engender a false sense of confidence preventing more effective measures (credible). Some of those reasons were actually stated and yet not perceived, which speaks to the trouble of "just telling the truth." There may have been others.
Additionally, I'm astonished that many people continue to read his statement and fail to distinguish between PPE masks and cloth masks primarily about preventing source transmission (ie, wearer infecting others, with some fractional protection from being infected by others). In fact, I'm astonished at how many people still don't understand what cloth masks can do and talk about themselves or those wearing them in terms of protecting themselves.
It's unfortunate that he didn't communicate better. Failing on that front might even be reason enough to have someone else doing that job.
But honestly 10 months out I don't know that it's all on him.
"How Perfectionism Has Made the Pandemic Worse", far more interesting and to the point.
https://blog.supplysideliberal.com/post/2020/12/31/how-perfe...
That said yes speed does matter and seems not to be valued as much as it could have
Even if you apply rationing (you could say that every dose purchased must be associated with a natural person who is going to get the vaccine as soon as it's shipped), the vaccine maker is now in the same position - why sell the vaccine for $100/dose to Hospital A today if they suspect that the bigger, richer, more bureaucratic Hospital B will get around to making an offer for $110/dose tomorrow?
So the "free market" solution here involves compelling the vaccine makers to accept any price offered immediately as well as preventing a secondary market, i.e., killing every mechanism for price discovery, which is the core mechanism of free markets. You can't really call it a market at that point, and all your intuitions about market efficiency go out the window.
Which isn't to say that I think a market allocation would be working any better (there'd be plenty of stupid buyers and so on).
Also, the 6 months is for deep freeze storage, the next level of storage, the shippers+dry ice, is 30 days.
The free market is the second fastest organisational method we have, beaten only by the military which can achieve specific operational goals extremely quickly. The free market is by far the fastest and most efficient force at sustained logistics.
As I recall it first group to have good Coronavirus testing was the Koreans who let private industry do its thing [0]. The free market with government as another equal client would be faster than the government at distribution a vaccine.
[0] https://edition.cnn.com/2020/03/12/asia/coronavirus-south-ko...
WTF are we spending so much money on them for if not for combating something that's caused hundreds of thousands of deaths?
As in "fly over to Pakistan and assassinate bin Laden" sort of goals. Stuff that burns unreasonable amounts of resources to do something very specific very quickly. If something takes months to execute the market will be faster.
"Get a vaccine to everyone who can afford it" is something that the market will be fastest at. It would be prudent to leave it alone to solve that problem. Government can go solve a different problem.
The market SUCKS at strategic goals. It's basically the opposite: you're giving up on strategic goals because you're in a situation where you don't think central planning can be as effective as competition. But military history shows us that central planning can be very effective for this sort of campaign, complete with elaborate supply chains and logistical accomplishments.
Markets are generally smart enough not to think killing large numbers of people and overthrowing governments is a good idea. If the US government was somehow replaced with a market the Middle East would likely be a more peaceful place. Markets generally find better ways of doing things - like financial incentives - than military intervention.
I'm more than happy to admit defeat if you want to argue that markets are ineffective at subjugating exotic new lands. In terms of defence, I havn't looked in to it at all. I expect market based economies to beat command and control economies at war because they can better sustain an effort.
The Swiss have their bank accounts, yes. You could convincingly argue that people who are happy to accept low gains as a tradeoff for low risk are interested in avoiding war. But the world's largest markets are in the US. And before they were in the US, they were in the capital of the British Empire.
Markets are very good at solving the sort of problems they solve. But be careful about extrapolating that into "Markets are very good."
(Also, don't forget about the British East India Company.)
Think back to the toilet paper shortage, or the mask shortage, or the hand sanitizer shortage, and how long it took the market to respond to those events. Maybe the market is the "second fastest' method we have, in relative terms. My point is it's still very slow, and if you're saying that days matter, the market is not the tool we want.
(That said, throwing the military at this problem seems fine to me, honestly. It is a special case of throwing the government at the problem; it's the branch of the government that specializes in logistics and quick decision-making in life-or-death scenarios, as you point out, and they are used to dealing with situations that arise exactly once in the history of the world.)
Not long? Toilet paper distribution recovered quickly, little old ladies are now knitting masks and I hear distilleries have started converting into hand sanitiser plants. There was a month of confusion then in my experience everything started snapping back to normal. I've never seen so much hand sanitiser as is now available.
> My point is it's still very slow, and if you're saying that days matter, the market is not the tool we want.
Yet if we don't go with the market I bet a worse alternative will be chosen. Back in March-February people would have argued in February that the US CDC was there to overrule greedy companies rushing out coronavirus tests and make sure that there are high quality standards. Then the CDC shipped a test that didn't work and scuppered the US's opportunity to nip the pandemic in the bud. That instance alone is a damning indictment of a government-first response to a healthcare emergency.
People can keep making a big song and dance about how this time the market can't possibly work because it is different to all the other times the market worked really well. Then the government will implement something slower than just letting people buy vaccines like everything else. In time the complete screw-up of the response will be used as evidence that there is no way a free market could have handled something so complicated.
Pretty much every time a free market has been used to solve a problem, the problem gets resolved as fast as possible with minimum fuss. The only exception is problems that poor people have. Coronavirus is not a poor-person-problem. Leaving it to the market will get great results.
> That said, throwing the military at this problem seems fine to me, honestly.
It'll be slower than letting people buy a vaccine off the shelf. The military has no special advantage here. There are great reasons that the military isn't left in charge of running a countries logistics networks - they are competent but not the best at it.
Anyway, I'm happy to concede that the market will take about a month to figure out vaccine distribution. In fact, I said "a couple of weeks" in my original comment that said the market is "extremely slow." So I suspect we have the same actual time span in mind, it's just that you think that the description of that time is "quick" and I think it's "slow".
In particular, it sounds like you think it's quick by comparison to potential alternatives. But I'm saying it's slow by comparison to the author's argument - that additional days or weeks of delay cause serious exponential growth.
So we should at least ask what could be faster, before being satisfied with one month. I know of absolutely no way to make the market faster. I do know of ways to make the government more competent and faster, even if our current government agencies are not competent or fast.
For instance - do you think the military would take more than a month to do this?
(Also, the current government-run distribution regime is actually vaccinating healthcare workers, as we argue about this, and it's taken much less than a month from approval to getting real people vaccinated.)
That doesn't make a lot of sense. Why would you unable to implement your ideas if given money & resources in proportion to the value you are creating? Why do you need a politically charged environment with an opposition who disagrees with every aspect of your decision making process to implement your ideas?
And your ideas won't speed the government up, people keep putting good ideas up to improve government all the time then they get shot down in the political process. Congress is deeply unpopular for a reason, and it isn't that people are struggling to see where improvements could be made. The CDC isn't underfunded because the pandemic was unforeseeable, there have been warning signs that something like this could happen since SARS v1 in the early 2000s. It is underfunded because the political process is not an effective method of getting stuff done. As will probably be showcased again if there are any free market vs government rollout vaccine case studies of this next phase.
As plans go it could be boiled down to wanting Congress & the Trump administration put in charge. That isn't a very fleshed out plan, and the fleshy bits to it could reasonably be described as dodgy and unreliable.
> For instance - do you think the military would take more than a month to do this?
Yes. It is a big job.
> (Also, the current government-run distribution regime is actually vaccinating healthcare workers, as we argue about this, and it's taken much less than a month from approval to getting real people vaccinated.)
The healthcare workers have been dealing with the virus for 9 months now, they either have protections worked out or have already caught it. The most important thing, as the article notes, is ramping up production and mass deployments. I'm glad that they're vaccinated, but the most important thing at the moment is safety and raw numbers of people vaccinated, and not so much the targetting. I'd bet most of the healthcare workers who catch Covid catch it outside of work.
The fastest way to get mass vaccinations is to let companies sell vaccine shots to people who will pay them. The government can try to help by ordering a bunch of shots for people who can't otherwise pay.
That's just wrong. The Corona virus is hitting poor and minority populations much harder than wealthy white communities. This is what the free market is optimized to do. It's what Trump and most Republicans in congress truly believe is what's supposed to happen! This very issue is one of the fundamental differences between Republicans and Democrats.
The point that the author is making, is that in the absence of any such plan, market mechanisms would have allowed many of the people with regards to whom it is a collective benefit for us all if they have received the vaccine -- first responders, people who have jobs that require them to travel or be in public, and people who want to party -- to actually be able to get it. The free market doesn't always optimize to what is best, but the author makes a reasonable argument that in this case it would. You don't seem to disagree with their analysis, just markets in general -- and that's a politicized, unhelpful approach.
Why is no one discussing this? Giving a significant allocation to retirees instead of essential staff is the more compassionate thing, but is it the best?
Part of the reason is that it's easier to get healthcare workers near the freezers required to store the Pfizer vaccine, because many of those freezers are in hospitals.
[0]https://covid19-projections.com/infections/map_county_total_...
> There is a lot of private incentive to combat an externality!
No
> A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old.
Public health should never be left in the hands of the private sector.
On top of the poor response by government, I think the disaster now unfolding in the USA, and to a similar extent in the UK, are examples of governments trying to hinder/eliminate their public health institutions (i.e. the CDC and the NHS respectfully).
> Is it just me or does uncontrolled, high level community transmission with circulation of several new #SARSCoV2 #COVID19 variants while starting vaccination with modified schemes, leading to partial immunity in a large proportion, sounds like a bad idea? #evolution #thirdwave
https://twitter.com/EckerleIsabella/status/13450246946432081...
As a non-biologist, it's not immediately obvious why that would be the case. What's the mechanism that increases the chance of mutations in vaccinated hosts?
The vaccine is ~95% effective. This means you're going to have a lot of people get infected still with the vaccine's antibodies present; any mutation that happens that causes escape from these antibodies will prolong disease and increase transmission, even if that mutation renders the virus a bit less fit in a non-vaccinated host.
Is that an accurate summation of those who caught it after receiving the vaccine?
Seems like if 5% of virus strains circulating aren't affected by the vaccine, we're fucked anyway. That 5% will become 100% of what's circulating in the next year and will be ubiquitous?
If it's something like "5% of people don't respond to the vaccine to build antibodies at all," on the other hand, it's much rosier...
Some of the 5% may just be unlucky people who got bigger doses of the virus/higher initial infectious dose, but the same logic applies.
It may be more than 5%, even; the vaccine likely does more to prevent symptomatic illness than infection.
It's hard to estimate what the probability of this happening is. It's certainly more likely when there's more illness circulating around-- e.g. if 1 million people with the vaccine become infected it's worse than if it's 10,000.
This seems very circular to me. If they don't build very effective antibodies, they shouldn't be putting much selective pressure on the virus, because if they did, they'd be more effective in the first place.
I suppose it depends on how exactly "effective" plays out here, as well as how easy it is for the virus to mutate significantly but stay as contagious as it is, but if we get unlucky it seems like just a question of time for it to get bad. Given Jan-Mar 2019, I have little faith that the US would ever be in a position to fully eradicate even a small remaining bit, and it would instead fester and mutate in this scenario until exploding again.
Maybe multiple vaccines mitigates this a bit...
If a normal person generates a dozen types of antibodies to the vaccine's spike protein, and a couple types are strongly sterilizing...
And you happen to have an immune response where you generate 8/12 of these, and only one of the strongly sterilizing variant, and you are more prone to become infected as a result...
Then, once infected, the virus will be under selective pressure during your illness to escape some of those 8 antibodies. In turn, whomever you spread it to will have a harder time.
> Maybe multiple vaccines mitigates this a bit...
Maybe. But the portion of the spike protein they're expressing and the resulting antibody profiles look very similar.
> Given Jan-Mar 2019, I have little faith that the US would ever be in a position to fully eradicate even a small remaining bit, and it would instead fester and mutate in this scenario until exploding again.
Yes, but one silver lining is that there would still be some immunity / cross-reactivity / t cell mediated immunity, etc. People would still be less likely to have severe illness, I believe.
The virus in this case would have to evolve in your body to escape not just 4-6 of the 12 antibodies, but most of them, otherwise it still won't be able to cause productive infections before it starts getting neutralized and the immune system detecting neutralized viruses mounts a stronger response.
However, sterilizing antibodies are most interesting because they are the strongest factor in preventing transmission.
People with weak immune responses of various kinds can be expected to have more infections and to be infected for longer times, and they provide selective pressure to evade the remaining mechanisms.
Just to follow up / argue from another angle. It's believed to be likely that the "new" UK variant likely emerged in an immunocompromised individual. This results in A) -some- immune response, and B) prolonged infection where the virus is under evolutionary pressure to escape that immune response / original antibodies.
Someone who doesn't mount a strong response to the vaccine is a very similar case.
Even a weak response to the vaccine can activate bound antibody responses during challenge, which means the immune system is activated much faster and even though there is still infection it is much shorter, leaving less of a chance for the virus to mutate.
Even a partial response from a vaccine suppresses the virus and (usually) reduces the risk of transmission. At the same time, it creates a window where the virus is under selective pressure to escape some of the immune response from the vaccine's effects. Individuals who have smaller/partial responses to the vaccine are more likely to have this happen.
That is all I'm saying, and I don't think it's really that controversial. I'm not trying to make a robust immunological argument. I don't think it's inevitable, but it's another reason to reduce transmission. We already have the UK variant, which many have suggested is better at immune escape due to perhaps evolving during a long infection in an immunocompromised individual.
In other words, by the time the virus is replicating inside of you, it doesn't really have much pressure to evolve to evade those other facets of vaccine immunity, because doing so would probably hurt it.
The UK variant isn't better at evading the immune system from what we know. It's simply more infectious in general.
I disagree. You have the weak vaccine response the entire duration of infection applying selective pressure. What you say seems to disagree with the consensus of the literature, e.g.
https://www.medrxiv.org/content/10.1101/2020.11.17.20233726v...
> The UK variant isn't better at evading the immune system from what we know. It's simply more infectious in general.
The mutations have been broadly described as "immune escape mutations" and are thought to have emerged from pressure to escape low numbers of existing sterilizing antibodies within the host, e.g.
"The unusually high number of spike protein mutations, other genomic properties of the variant, and the high sequencing coverage in the UK suggest that the variant has not emerged through gradual accumulation of mutations in the UK. It is also unlikely that the variant could have arisen through selection pressure from ongoing vaccination programmes as the observed increase does not match the timing of such activities. One possible explanation for the emergence of the variant is prolonged SARS-CoV-2 infection in a single patient, potentially with reduced immunocompetence, similar to what has previously been described [17,18]. Such prolonged infection can lead to accumulation of immune escape mutations at an elevated rate"
https://www.ecdc.europa.eu/sites/default/files/documents/SAR...
As I said before, there is some pressure for antibodies, but the immune system is way more than that, and people can clear infections very effectively without any antibodies at all.
As for your other link, it's important to know that this a preliminary article that, on those subjects, gives ideas without data. Further research has shown that this variant does not seem to increase disease severity, and instead is just more infectious, as the spike protein evolved for higher binding affinity.
Assumes only a couple of neutralizing antibodies, which is fair for the vaccine candidates-- immune assays of Moderna's vaccine show two typical antibody binding sites against the RBD that are strongly neutralizing. I haven't seen the ELISA data for Pfizer's vaccine.
Given that we've got several papers describing how immune escape variants of other viruses have emerged in the past... I'm curious why you don't think it's much of a risk here?
e.g. https://pubmed.ncbi.nlm.nih.gov/11410701/
> As I said before, there is some pressure for antibodies, but the immune system is way more than that, and people can clear infections very effectively without any antibodies at all.
Of course. I'm not speculating that there's going to be some nasty variant that completely eludes our immune response. I'm saying that it is likely-- and the consensus opinion-- that there is a real risk that the virus mutates to render the vaccine less effective.
> Further research has shown that this variant does not seem to increase disease severity, and instead is just more infectious, as the spike protein evolved for higher binding affinity.
Some of the mutations slightly increase binding affinity. Other deletions look like their primary fitness advantage is immune escape. A missing stop-codon also increases mutation rates for a portion of the RBD, which implies we can expect quicker emergence of subvariants.
It's like you're having an argument I never was having: I have never said that this is likely to cause more severe disease. I am just saying that the virus will be under selective pressure to evade the vaccine-induced immune responses-- which is something I think everyone agrees. This is less likely to happen if there's less infection around and people get vaccinated quicker.
Even in the worst case, where such a variant evolves quickly-- I don't think we're that bad off. As you mention, there's other immune responses. Strong T cell mediated immunity will almost certainly be cross-reactive and strongly reduce the risk of severe illness. We'll have more time to adjust vaccines without mortality accruing as quickly. It is still something we'd prefer to avoid at all costs.
The answer to this is very probably no. There is a huge difference between the virus making the vaccine less effective eventually, the virus making the vaccine less effective within one to three months, and the virus making the vaccine sufficiently less effective that it can sustain an epidemic among vaccinated individuals. The second is not very likely at all, because for it to happen a variant of the virus would have to mutate, and outcompete the dominant variant, that has a spike protein sufficiently different that it can keep R>1 among vaccinated individuals.
For this, the virus would not only have to evade antibody response sufficiently for there to not be sterilizing immunity, but it would have to do evade the much swifter and effective non-serological immune response enough to stay infectious.
All of this would have to happen in a subset of the population that has a 20x lower chance of being infected and even when that happens, the infection would be much shorter with most of it with completely different evolutionary pressures.
In one to three months.
It would also have to compete effectively against other variants in the non-vaccinated population while it is doing so, because non-vaccinated people are by very far the dominant infection vector. So it would have to evolve this not only in vaccinated, but also non-vaccinated patients, unless you believe that these extensive mutations will happen in one, vaccinated, patient, which is pretty much impossible.
Not a given. It's very likely, but we don't know how effective the vaccines will be in preventing transmission. Certainly there is past precedent for the opposite.
Also, there's likely to be pockets of population with poor vaccine penetration, so even if it confers sterilizing protection, we're likely to see endemic spread in these subpopulations continually challenging the vaccinated population.
> is a variant of the virus going to appear that will be able to effectively infect vaccinated people and spread enough for the pandemic to continue?
We see a hepatitis B vaccine escape variant every year or two, despite a much lower community disease burden. I don't think anyone can know how likely this is.
> All of this would have to happen in a subset of the population that has a 20x lower chance of being infected and even when that happens,
It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
> It would also have to compete effectively against other variants in the non-vaccinated population while it is doing so
Already the currently circulating variants are not equally neutralized by the vaccine. There's going to be immediate pressure making the variants that are least impeded more prevalent.
> unless you believe that these extensive mutations will happen in one, vaccinated, patient, which is pretty much impossible.
Again, the most likely scenario for the emergence for the UK variant is prolonged infection in one person with a low immune response. People like this are well represented in the groups we're immunizing first, too.
These things aren't mutually exclusive, though: you start off by favoring the current variants that the vaccine is least effective against. Then, you have ongoing evolution in vaccinated individuals with lower responses. Then the favored variants become endemic, circulating mostly in subpopulations with lower vaccine coverage and occasionally finding vaccinated people who are more susceptible.
How quickly it all happens depends upon total disease burden. I agree we will probably not get a worst-case escape variant in the first few months of the vaccination campaign, but I think we'll probably see some adaptation towards escape and lowered efficacy. Indeed, you don't even need mutation for that: just preferential selection for existing variants with lower vaccine efficacy.
No one's done the assays on the UK variant yet, but I will not be surprised if the current vaccines are somewhat less effective against it.
If the disease remains endemic with relatively high levels of circulation, variants that escape the current vaccines will be all but certain in the long term.
Hepatitis B is a disease that lasts much, much longer than COVID-19, which exponentially increases the likelihood of such an event. Moreso, Hepatitis B immunity from vaccines is often very weak due to a lot of people not getting booster shots in adulthood.
>It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
Vaccines have been trialled using not symptomatic illness, but actually PCR tests for immunity, and found over 90% immunity with symptoms||viralRNA as a standard. So no, it's actually around 10-20x less likely to have infection, too. For things like severe ilness, it's more like 99-100%.
>It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
During this window if the individual is vaccinated before antibodies show up there is very little pressure to evolve resistance against them.
>Again, the most likely scenario for the emergence for the UK variant is prolonged infection in one person with a low immune response. People like this are well represented in the groups we're immunizing first, too.
Given the fact that we have seen zero severe illness in even very old people with many vaccines, this is even less likely than for a non-vaccinated but immunocompromised person, for which this scale of mutation didn't even happen yet, 1 year in. And by the way, the hypothesis - which is as of yet unconfirmed and whose certainty became lower after similar mutations were found in South Africa - is that this process happened in an unvaccinated immunocompromised individual during a month+ infection period. If the same individual was vaccinated, this would have been impossible, and we haven't seen this kind of illness in any vaccinated individuals.
>These things aren't mutually exclusive, though: you start off by favoring the current variants that the vaccine is least effective against. Then, you have ongoing evolution in vaccinated individuals with lower responses. Then the favored variants become endemic, circulating mostly in subpopulations with lower vaccine coverage and occasionally finding vaccinated people who are more susceptible.
Even for those, the vaccine is still incredibly efficacious. The differences IIRC are barely statistically significant. If you have a source for more significant variations I'd love to see it.
Crucially though, in the scenario you are suggesting where the virus is spreading in non-vaccinated populations, that the actual strain to acquire enough changes to become effective against vaccinated individuals absolutely needs to outcompete other strains, which isn't likely. This is because even if the virus were to infect one of the few vaccinated but less protected individuals, which would in this case probably be under 1% of infections, those mutations need not be a hindrance in the 99% of infections which won't be of less protected individuals that have more than benign infections in populations with low vaccination rates.
It's possible that this happens, eventually - think years. Not in the 1-3 months period we're talking about. The result is that it doesn't make sense to vaccinate 20-40 year olds in priority or to sell the vaccine on the free market, at all.
The only vaccine I'm aware of that had weekly PCR surveillance was the Oxford/AstraZeneca vaccine, which showed an efficacy of 57% against a positive swab (95% CI -- 41% to 66%; 95% CI efficacy against asymptomatic illness -17.2% to 54.9%). If you know another one that showed 90%+, please cite! Both the Moderna and Pfizer trials relied upon symptomatic illness (symptoms + PCR confirmation) as an outcome measure.
> During this window if the individual is vaccinated before antibodies show up there is very little pressure to evolve resistance against them.
No, but you can get a infection that shows up as antibody response is ramping. Neither infection and vaccine response are nice clean instantaneous, atomic events.
> Given the fact that we have seen zero severe illness in even very old people with many vaccines
You have to consider the statistical power of the study. In the very old people (75+), you're talking about 0 vs. 5 cases (symptomatic) in the Moderna study, for instance, with unknown impact on any symptomatic infections. You seem to be concluding an awful lot based on 0 vs 5 symptomatic cases in a short study period for what the outcome will be across a population of 18 million people in the US.
> If the same individual was vaccinated, this would have been impossible
Why? We've seen it happen in the wild with COVID (long illness times and failed immune clearance), and we've seen it with existing vaccines in other illnesses. "Impossible" is a very stronk word.
> Even for those, the vaccine is still incredibly efficacious. The differences IIRC are barely statistically significant. If you have a source for more significant variations I'd love to see it.
We don't know the efficacy for subvariants. We have nowhere near enough n. We do know that even during the phase 2 trial, there are serum neutralization titers for variants that the error bars do not overlap for, and the MLEs are an order of magnitude apart.
> It's possible that this happens, eventually - think years. Not in the 1-3 months period we're talking about.
First, it's more like a 6 month period, and longer when we consider the entire world.
> The result is that it doesn't make sense to vaccinate 20-40 year olds in priority or to sell the vaccine on the free market, at all.
Which, I understand, are things the original article advocated for, but I never did-- indeed I mocked it in other comments e.g. here https://news.ycombinator.com/item?id=25609607 https://news.ycombinator.com/item?id=25609600 and in a comment on the original article. So really, come on. Argue with what I'm saying, not the make-believe argument you'd like to have.
The epidemiological and immunological communities consider it a risk, and I've shared papers. Here's what widely-followed Derek Lowe has to say:
"The good news continues to be that none of the mutations studied so far in the general population seem to be able to evade the antibodies raised by the current vaccines. That doesn’t mean that it can’t happen – and as we start putting selection pressure on the virus by vaccinating people we’ll have to keep a close eye out for anything like that developing. But then we have to consider transmission. If an antibody-evading form of the virus also becomes harder to catch, well, it’s going to be less of a worry. But if we were to start doing a better job at not spreading the virus in general, that would be sort of nice, because that would reduce the chance that any nasty mutated forms get any kind of traction in general. If some sort of supervirus mutation occurs in a single patient who doesn’t then get close enough to other people for it to spread, then it’s a tree falling in a forest that doesn’t make much of a sound."
"It’s all a race between several different factors. But here in the US we have so many people infected (and so much transmission going on) that frankly we’re making ourselves vulnerable to any more dangerous mutations that might crop up. In fact, if something like that were to emerge, the odds are better that it would do so here, from what I can see. We’re giving the virus every opportunity to reproduce and for the subsequent viral variations to then go out and try their luck infecting lots of other people. Vaccinating enough people quickly enough would interrupt these processes, and so would doing the sorts of public health measures that we’ve all been hearing about for months. But the first is going to depend on vaccine supplies, logistics, and public acceptance, and the second, well, look around you, si monumentum requiris."
https://blogs.sciencemag.org/pipeline/archives/2020/12/10/th...
Which is broadly in agreement with what I'm saying.
The answer is only obvious to me if both the original virus variant and the mutation compete for some kind of shared resource. But that shouldn't be the case here, right?
If you generate only a subset of the typical complement of antibodies that a vaccinated individual does, and are less protected and become infected as a result... then any virus variants that emerge within your body that escape any of your antibodies will have a fitness advantage. In turn, that virus will have an advantage spreading to other vaccinated individuals, too.
It is a low probability event in each individual, but if you generate enough individuals like this and infect them all, it's sure to happen eventually. We can't really estimate what the probability of this happening is, but it's certainly less likely if the efficacy is high and there's less disease circulating.
I think this misses the point a bit. I think the CDC’s allocation is just fine — the main problem is that it’s being implemented slowly. Just about any carefully planned allocation will be slow. Sell to the highest bidder? Slow. Sell for $20? Faster, but still slow. Compare the way most vaccines are given in an office to the way that mass flu vaccines are done.
If I were running the show, I would choose categories. The categories don’t matter that much — suppose, for the sake of argument, that it’s (1) patient-facing medical personnel, (2) people over 75, (3) people at high risk, self-certified, etc.
Now, in each region, you open up vaccinations by group. Medical centers can run walk-through or drive-through vaccinations, and people in the relevant group line up and get the vaccine. Someone scans ID and types in name and (if available) DOB for people without ID and hands out the info flyer. A handful of technicians give the vaccines.
As soon as vaccine lines aren’t getting filled by one group, you open it to the next group.
Money is basically irrelevant here. The available production is spoken for and paid for. Trying to allocate carefully is nice, but it’s far more important to give someone the vaccine than to give the right person the vaccine.
(Stanford Hospital would have avoided a lot of flak if they did something like this. Randomize the last initials of residents into groups, and give residents the shots by last initial. Then do other groups. Or forget about distinguishing residents from other people — it’s not worth the logistical complications.)
And then we don't have anything like a plan to treat administration of doses like an emergency. It's bonkers.
Studies in the UK and Brazil showed it to be safe and effective and it's been approved for use in the UK and, as of today, India. Apparently the FDA doesn't like studies from other countries, so they're waiting on a 3rd trial's data to come in, which may not happen for several months. The manufacturing technique and storage requirements for this vaccine mean that supply constraints should be much less significant than the currently approved vaccines. Doing this could easily save thousands, likely tens of thousands of lives by spring.
So far the vaccines all ran with trials with the minimum time between doses that was likely to incur maximum immunity. It was absolutely the right call, given that they didn't know for sure how wildly effective the two mRNA vaccines would be in practice and wanted to expedite the trial timeline. However, now that we know the both vaccines provide roughly 80% immunity after 12 days, which likely last several months at least it would be smart to delay people second dose another 4-8 weeks to allow the maximum number of people to get some immunity quickly.
The UK did both the above this week and I think we'll look back and realize it was absolutely the right move.
First, targeting spread instead of severity. This is not good. The amount of people that would fit the profile from any available variables of a spreader are probably around 100 million in the US. If you're going to vaccinate most of them, you're going to need so many doses that you can vaccinate literally everyone that has over 0.2% fatality risk, and a month or two later you can reach herd immunity. There is clearly very little advantage there.
And for selling them on the free market, it's insane to expect that vaccine sellers with limited capacity will sell the vaccine for anywhere near an affordable price. You don't have nearly enough demand elasticity to justify the manufacturers - two of them, by the way, to drop their prices at all, because even if they sold them for 5000$ they would sell every dose they could produce for months. By the time they would be affordable for the average person, we could again have vaccinated all vulnerable people and a few months later essentially everyone.
In the two or three months between full vaccination of privileged classes and herd immunities, there will not be new mutations that will be able to spread despite full vaccination.
This is also a non-representative sample, there are many facilities that have fully vaccinated medical workers.
The current allocation might not be the maximally effective one but a free market solution that beats it is a pipe dream.
I’m oversimplifying but hopefully the idea is clear.
And the argument that people more likely to spread the disease would be willing to pay more is a bit weak. Sure the chance you get infected correlates with the chance you infect someone, but for some people infection carries more risk than others. And presumably the author also wants companies to be able to require people to be vaccinated, because otherwise vaccines are of limited use to companies.
Finally I'm not too sure if combatting 'R' is the end goal. In the end you want to minimize total harm, this is subjective but among other things involves minimizing total deaths. It's conceivable that vaccinating the group that's overwhelmingly at risk first is an effective strategy to achieve that.
"Most effective is to focus on 1) superspreaders (when they can be identified), 2) integral of exposure over time (hospital workers) & 3) vulnerability (older etc.), but (2) overlap with (1). Current focus is on (2)& (3), less optimal.
(1)>>>(2)+(3)"
I was just thinking this the other day and wondering if I was some horrible monster. People looked at me like I was crazy. There's some comfort in knowing that whichever side of history this viewpoint lands on, there is a sense in which it was right by correctness if not by popularity.
Healthcare workers come into contact with many people, many of those people are at risk and the contact is essential (2019 definition).
* Electronic technology makes it impossible to guarantee equal access. Hackers in other countries could easily disrupt the supply chain
* A "temporary socialism" emerged to disparage the scalpers and middlemen -- the public at large was incredibly unhappy
* Existing middlemen (retail stores) were completely overwhelmed, as there was a gigantic information asymmetry between production, distribution, retail, and consumption
* A completely totalitarian rollout (e.g. Sony sells on its own without middlemen) seems feasible, and might have actually been more efficient, even if delayed by a month. More people would have a PS5 now if the solution was totally vertically integrated.
We are not going to fix society in time to stop this pandemic.
Problems that will not be solved: - our politicians will not become competent. Our selection process for politicians is driven by how good they are at attracting votes, not how good they are at handling problems. Politicians are aware of this and just exploit it constantly.
- our people will not become reasonable. A sizable percentage of the population don't believe covid19 is different from flu, another does not want to take vaccines.
- corporations want to get the most out of it. A full blown pandemic is in their best interest. All those covid tests and vaccines pile up. Even better if they can convince us the vaccine only lasts one season!
So the bottom line for me is: if I am convinced the vaccine is safe and effective, just be careful and dodge the disease as long as I can get a vaccine.
There is not much more to it, and I focus my energies somewhere else.
Of course if everyone was like me, the pandemic would be over by now. But that's not the case and hoping in something that will not happen, like the author does in this piece, is fruitless.
But even now no one knows if these vaccines provide sterilizing immunity, as they were only testing for disease protection in the trials. Some even theorize some vaccinated individuals might be _more_ contagious, as they are less likely to socially distance and could be more likely to be asymptomatic carriers.
Indeed the article itself is evidence of this risk, as the author seems to advocate giving the vaccine to people who are willing to pay a lot so they can go party.
That said, if sterilizing immunity is provided by the vaccine, then a lot of the arguments are more plausible. But I don't think it's valid to just assume that, and it's not fair to health officials who don't assume that either.
(If we did have enough doses ready to go for everyone, the government solution of "have the government buy it and distribute it to everyone" and the free market solution of "everyone and their insurance is very willing to buy one dose but values a second dose at $0" would basically collapse to the same thing, and so the author's argument would be moot.)
1A) healthcare workers (highest unavoidable exposure rate) & LTCF (highest mortality rate)
1B) frontline workers (high unavoidable exposure rate, and may be crucial transmission links) & the very old (high mortality rate). If the vaccine lowers transmission, we'll see a big effect from the frontline worker portion, which I suspect factored into the decision somewhat even if it is not acknowledged in the documents.
1C) This category is too big-- all essential workers and anyone with a health condition increasing risk or over age 65. This phase is actually bigger than 2. It needs to be split up some to prevent a mad rush for doses, and certainly we can benefit from further prioritization. Hopefully this is addressed, but it's tomorrow's problem.
2) The remaining group is smaller and probably the least interest in getting vaccinated, so I assume when we get to phase 2 we'll be facing different logistical concerns.
The really stupid thing we're doing, IMO, is reserving 55% of doses to ensure everyone gets dose 2. It should be a much smaller reserve (~25%): it's unlikely that Pfizer's production will stall entirely and even in that worst case scenario, most people would get a second dose, AND the data looks like 1 dose is likely effective.
This reserve is preventing many areas from having enough doses to enter phase 1B, and portions of phase 1B are parallel infrastructure (e.g. mass-vaccination clinics). So, allocating those additional doses could be expected to significantly increase throughput by activating other channels through which the vaccine is distributed.
No, the drug companies did not study sterilizing immunity. No, they make no claims. However, ask any expert and they would say they expect there will probably be some sterilizing immunity and reduction in spread for those who do get it.
Some moderna data showed a 2/3 reduction in asymptomatic cases. It would be astonishing if vaccines cause no decrease in spread.
This meme is the new “masks protect others, they don’t protect you”. They do, in fact, protect the wearer to some extent. How could they not?
That may be the case with N95 masks, but there is absolutely no way that a surgical mask protects the wearer to any measurable extent. At best, it helps prevent the wearer from spewing more viral particles into the air (and even that is far from proven).
I was an early advocate for masks (check my HN history) back in February, but it's bizarre how they've become a kind of magic talisman for half the population. Some of my "mask-skeptical" HN critics at that time were worried masks would make wearers overconfident, and go into high-risk situations, and they were right.
I thought that the effect would be like 80-90% or something. But given what was established practice in january last year I should not be too suprised with the results ...
Obviously it’s way safer to simply not be in a risky situation. You’re reading stuff into my comment that I didn’t say.
https://www.cdc.gov/coronavirus/2019-ncov/more/masking-scien...
Transmission within a masked & lockdown population is still large. Does not even seem to change... Because there is no asymptomatic transmission. We need quarantine instead of sick people. Masks have health side-effects, because 99% of people do not follow the OSHO safety standards.
The transmission within a household between partners has an average of 27%. Another extremely weird number. Did the tests give false positives? Is the disease misidentified? Or did the others already have T-cell herd-immunity?
So the real question is: What is causing transmission?
And note the R does not show that at all, and focusing on that gives us the wrong solutions.
There may be other factors that create a high transmission. Some doctors listed an extreme long survival time of the virus (up to 16 days under good conditions). So maybe it transmits mainly via surfaces and not via the air.
That might explain why it can spread within a population under a military lockdown. But that latter might also be explained with the false positives from a PCR test (or similar test). Or the natural immunity of most people creating partial herd-immunity within the population.