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Comment by WalterBright | Hacker News Reader

For all the calling for "follow the science", I don't see much scientific behavior in how the crisis is handled. I see lots of politics instead.

For example, Dr Fauci says we won't achieve herd immunity before fall. But he also says vaccinated people should keep wearing masks, because they could still get infected and be infections.

But that would mean herd immunity is impossible. Herd immunity totally relies on vaccinated people not being infectious.

For another, Congressmen are outraged that some rich people are buying vaccines at $10,000 a dose. But Congressmen moved to the front of the line in December to get vaccinated, including the young & healthy ones.

Politics.

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> But he also says vaccinated people should keep wearing masks, because they could still get infected and be infections.

I wonder if, like when he "pushed" the numbers for the herd immunity threshold higher to push people to vaccinate he's deliberately omitting the data coming from Israel, which says that a full vaccination reduces the transmission of the virus and even prevents infection.

This is what irks me of the current public health policies worldwide. Every "good" news must be buried under a pile of terrorizing, negative news, because those in charge foolishly believe that hope for an improved situation might lower compliance with non pharmaceutical interventions.

In the end, they're either covering up for their failures (botched EU vaccine rollout) or just going to increase vaccine hesitancy (why bother, when everything stays the same?).

We need people to keep wearing masks until there is herd immunity for the simple facts that a) you can't tell who is vaccinated or not by sight, and b) social pressure to wear them in public will collapse if X% of people stop wearing them.

That argument is political, not scientific. Exactly my point :-)

I don’t think behavioral psychology counts as politics.

It doesn't really count as science either.

Politics is behavioral psychology.

Coronavirus policy has really helped me understand David Hume's point that you cannot derive and "ought" from an "is".

You can't follow the science on something as complex as pandemics and lockdowns. There are too many tradeoffs that people will weigh differently.

What they forgot is that pressure to get the vaccine has collapsed because the average person thinks there is no point. Public policy has to be smart.

> pressure to get the vaccine has collapsed

Uh, no it hasn't. We don't have vaccines laying around going bad with nobody who wants them, but we do have plenty of people who want the vaccine who can't get it.

Look at the surveys. Is that percentage high enough to achieve herd immunity?

As long as we are constrained by vaccine supplies, it is rational to prioritize mask compliance rather than vaccine uptake.

I would rather have policy push for interventions that have a better impact on transmission. While the latest ECDC report[1] says "use them, can't hurt", it acknowledges the lack of evidence of masks (and thus effectiveness) in preventing transmission in a community settings.

[1] https://www.ecdc.europa.eu/sites/default/files/documents/cov...

It's likely a matter of weeks at this point, the messaging on masking shouldn't be undermining messaging on vaccination when that is the case. Maybe 60 million doses shipping in March vs a total of 75 million from the start through today.

(Pfizer believes production rate will about double over the next couple of weeks, Moderna has been steadily increasing, J&J likely to get approved).

60 million doses is only enough to vaccinate 10% of the American population. Vaccines likely won’t be available for every adult who wants one until well into May.

Sure, I was pointing to the velocity increasing there more than thinking it was enough for everybody. Is the idea that if we have a couple months until wide availability we should have mask focused messaging for half the period regardless of how it impacts vaccination? Because in my mind, shots in arms are a lot more valuable than marginal mask behavior (which is already not that good because people have decided it's a serious infringement on their freedom).

>> 'Herd immunity totally relies on vaccinated people not being infectious.'

That's not accurate. Herd immunity only requires a vaccine reduce transmission rate sufficiently that R0 < 1. It doesn't require that R0 = 0.

If the R0 for a vaccinated person = X, such that 0 < X < 1, wearing a mask likely puts it < X. Which is a desirable characteristic.

Not knowing the transmission rate means one can not make any predictions of herd immunity.

To be clear, it requires R < 1, not R0 (which is the initial rate of spread). More importantly though, we don’t really need herd immunity - once everyone has had a chance to get vaccinated, the virus ceases to be an issue, as contracting covid is no different from contracting the cold or at worst the flu.

>For example, Dr Fauci says we won't achieve herd immunity before fall. But he also says vaccinated people should keep wearing masks, because they could still get infected and be infections.

An effective vaccine can mean 1, 2 or 3 different things. The first is that you don't get infected, the second is that if you do get infected that your disease course is mild, the 3rd is that you don't transmit it if you are infected.

If the vaccine just protects you and doesn't keep you from infecting others, then why are perfectly healthy 23-year-old healthcare workers getting it while there's still so many people over 65 waiting for it? And if it does keep you from infecting others, then why do you need to keep following the mask and social distancing rules even after you get it?

The answer is that we don't know. We think it works but we don't know for sure, only time will tell.

We need to get to this point:

(number of people vaccinated) * (vaccine effectiveness) > (herd immunity threshold)

At this point, the R0 drops below 1 and the pandemic dies out by itself.

However, if everyone keeps wearing masks, it looks more like this:

(number of people vaccinated) * (vaccine effectiveness) + (mask effectiveness) * (number of people vaccinated) * (1 - vaccine effectiveness) > 1

This makes it easier to get R0 below 1 with fewer societal restrictions. Given that it's trivial for most people to wear masks, this seems like an obvious choice.

Why isn’t the answer just “those who are afraid of the virus can stay inside indefinitely” and no one else has to wear masks if they don’t want to? I don’t think it is “trivial” to wear masks - it makes breathing harder, it affects mental health (by not seeing people’s emotions), it makes communication harder for those with certain disabilities, and it makes every activity less enjoyable. After all if we really think there is no negative impact from wearing masks why not permanently require it all the time including at home?

So then this comes down to a fuzzy tradeoff, which seems more like a values or politics based determination than a mathematical or scientific one.

Most vaccines are less than 100% effective at preventing infections. Vaccinate 10,000 people and intentionally expose them to the thing vaccinated against and you will get some infections.

When there are significant numbers of infected people in the population, adding other measures to the protection provided by vaccines decreases the spread of the infection.

I think the problem Fauci has is that he is confident that it is better to provide an answer than to hedge. It would be pretty reasonable for him to say something about getting vaccinations done as quickly as possible and evaluating what other measures are necessary once a larger percentage of the population is vaccinated.

We self-isolated just as hard as anyone from March - May. I was looking at my Amazon orders and I'm coming up next week on the 1 year anniversary of when I bought a pair of pulse oximeters as a diagnostic early warning measure.

In the summer, we started slowly going out more and doing things with people more. At this point, I think the country just needs to get on with life.

Everyone around here knows a dozen or two people who have had it, and a handful of elderly people who died from it. It's a tragedy, but so is their treatment this past year. My Grandma is 98 and has gone downhill so significantly this past year from lack of interaction. At least now she's allowed to talk with the other residents of the nursing home. She spent six months locked in her room. And they all caught coronavirus anyway last fall.

It's been clear since late Spring of last year that politics was driving the lockdowns far more than any real hard science.

It was obvious when Cuomo was doing a victory lap book tour during the summer declaring that masks work and he figured out how to fix things, only for infections to pick up again when the season changed.

I expect it'll be obvious in retrospect that human interventions had much less effect than thought, and the largest factors were a mix of demographics like obesity and nutrition, as well as geography (which influences sun exposure, humidity, etc.).

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