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Comment by fouc | Hacker News Reader

Already 61% of the US have gotten their first jab, and it is only natural that the pace will slow down a bit. Distribution is always a bit of a long-tail. Especially when the last 13% are going to be the least interested.

edit: misread article re: 200 million doses

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After my second jab I honestly don’t care. Time to get on with life.

We have someone in our family that can’t be vaccinated for medical reasons and they feel the same way. The risk goes down significantly when the whole family is vaccinated.

It’s time to put covid in the “managed risk” section of our life and get on with things.

Yep. I'll feel bad for the people who can't get a jab due to lack of herd immunity and I'll worry about the anti-vaxxers leading to escape.

But even with that I know I won't be able to help but have a "screw 'em" stance pretty quick with the people who are choosing to not get vaccinated.

Given that it seems that you can be transmitting the virus without developing symptoms, would it really be that much safer for an unvaccinated person?

Depends on your vaccine. NEJM had a RWE study on Pfizer from Israel's data [1] that showed the 2nd shot had 92% efficacy against asymptomatic infection. Symptomatic infection was 94%.

[1]: https://www.nejm.org/doi/full/10.1056/NEJMoa2101765

That's fantastic, thank you.

You should care because your vaccine doesn't necessarily prevent you from catching a mutated variant . Given a long enough timeline and enough hosts such a strain will evolve, it's only a matter of time.

Is there any science supporting your statement?

You want a source for what? That viruses are subject to evolutionary pressures and will mutate to better adapt to their environments like literally everything else as advantageous random mutations are found?

You seem to be overstating the likelihood of covid-19 mutating into another strain, like the flu does. It's a coronavirus and those are known to be different in this regard. I haven't seen a source saying that we should expect immunity-evading strains. Do you have anything decent?

They literally already exist!

>You should care because your vaccine doesn't necessarily prevent you from catching a mutated variant . Given a long enough timeline and enough hosts such a strain will evolve, it's only a matter of time.

Yes, I know there are variants. But I've seen no science saying that it is likely or expected that the vaccine won't work against covid-19 variants. Have you?

> They literally already exist!

Ok, I googled and found this: "Variant or strain? Experts explain what's happened to the coronavirus" [0]

From the article: "However, Soucy noted that all currently known variants of COVID-19 belong to the SARS-CoV-2 strain and have not mutated enough to either be classified as their own strain or be ineffective against current and prospective COVID-19 vaccines."

Another quote from the article: "Infectious disease expert Dr. Lisa Barrett told CTV News Channel on Sunday that viruses often mutate, but some viruses do it more than others. She noted that while the genetic code of coronaviruses does typically change over time, she says the mutations aren’t normally a cause for concern."

Here's another article, with references to multiple studies: "We now have the best evidence yet that everyone develops long-term coronavirus immunity after infection — and it's not just about antibodies" [1]

From that article: "Many people who've never gotten COVID-19 seem to have memory T cells that can recognize the new coronavirus." ... "In this case, experts think these cross-reactive T cells likely come from previous exposure to other coronaviruses — those that cause common colds."

That's the kind of stuff I find when I dig into this. What are you seeing?

[0] https://www.ctvnews.ca/health/coronavirus/variant-or-strain-...

[1] https://www.businessinsider.com/long-term-coronavirus-immuni...

>Yes, I know there are variants. But I've seen no science saying that it is likely or expected that the vaccine won't work against covid-19 variants.

Absolutely it is the case that even in the extremely limited time that Covid has existed it's already built tolerance to some vaccine mechanisims - for example the Novavax vaccine is something like 89% effective normally, but drops to 50% effective against variant B.1.351. [1] Any vaccine that relies on the covid-19 spike protein (all of them) is best case less effective and worst case useless if a small change to that spike protein is made. In a long enough timeline such a random mutation will happen. Most of them will not result in viable viruses but eventually one of them will. It's just a matter of statistics.

>"Infectious disease expert Dr. Lisa Barrett told CTV News Channel on Sunday that viruses often mutate, but some viruses do it more than others.

This language is a little bit weasley in that it implies that COVID-19 varies at a relatively slow rate. This is a widespread but incorrect assumption. Covid-19 mutates at a rate of ~10^-3 nucleotide substitutions per site per year, which is comparable to ebola or other RNA viruses [0]

>We now have the best evidence yet that everyone develops long-term coronavirus immunity after infection — and it's not just about antibodies"

This is saying that after you get the virus and your antibodies fade you have some residual resistance in the form of T-cells that stay in your immune system. Those T-cells are virus-specific. T-cells have all kinds of different mechanisms to detect infected cells in your body but, for example, it can detect viral peptides emitted by the cell. Where do viral peptides come from? The virus protein spike! The same thing that, when mutated, reduces or eliminates vaccine effectiveness.

As far as whether this is current happening and what it means- researchers have modified other viruses to use the COVID-19 protein spike and then gave the virus suitable conditions to replicate and mutate. The result was a covid-19 spike protein that had resistance to both monoclonal antibodies and antibodies taken from patients[2].This isn't some academic exercise, this is something that is literally happening in the real world right now.

Even worse on further inspection those same researchers realized these spike protein modifications were *already present* in the wild, they just weren't present in large numbers yet.

[0] https://www.bmj.com/content/372/bmj.n771#xref-ref-8-1

[1] https://www.advisory.com/en/daily-briefing/2021/04/16/varian...

[2] https://www.nature.com/articles/d41586-020-02544-6

Thanks for the links! I made a first pass through them, and will look at them more. I appreciate the extra data. There's a lot of details to mull over, some of it seemingly conflicting.

For example, your linked article [0] mentions "Currently available vaccines will likely offer protection against prevailing variants of SARS-CoV-2", but also says "The risk of immune escape is hard to predict long term"

You linked article [1] says "it takes about eight times as many of the antibodies produced by the Moderna vaccine to neutralize the B.1.351 variant" but also says "so there is enough antibody still to neutralize the virus."

And your linked article [2] says "coronaviruses change more slowly than most other RNA viruses" and "other genome data have emphasized this stability" and "sluggish mutation rate" and "if a mutation did help the virus to spread faster, it probably happened earlier, when the virus first jumped into humans" and "no signs of natural selection for any of the variants" and “probably the virus binds to ACE2 about as well as it needs to right now" and "these strains remain constant, more or less".

At one point in [2] it is mentioned "I wouldn’t be surprised if this virus is maintained as a more common, cold-causing coronavirus". I've heard that mentioned as a likely outcome in other places [3].

The above article wrapped up with "Worrisome mutations could also become more common if antibody therapies aren’t used wisely", "Vaccines arouse less concern on this score because, like the body’s natural immune response, they tend to elicit a range of antibodies."

This reminded me of this doctor [4], who was warning about the dangers of the covid vaccination campaign setting us up for a much worse disaster by pressuring the widely circulating virus to evolve into something much more dangerous. The statement above near the end of article [2] seems to indicate that vaccines are not as likely to cause this as are antibody therapies.

I'm not sure what you were trying to get at with t-cells. I keep reading things that say t-cells from prior coronaviruses infections confer some protection against covid-19, even from other coronaviruses. Here's another link [5]. Are you saying that is not so?

When it comes to the fear of immunity-evading coronavirus mutations I seem to keep hearing scientists say it is possible, but not likely. I think that is an important distinction to make.

[0] https://www.bmj.com/content/372/bmj.n771#xref-ref-8-1

[1] https://www.advisory.com/en/daily-briefing/2021/04/16/varian...

[2] https://www.nature.com/articles/d41586-020-02544-6

[3] https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...

[4] https://www.deblauwetijger.com/wp-content/uploads/2021/03/Ge...

[5] https://www.sciencemag.org/news/2020/05/t-cells-found-covid-...

38.5% has at least one shot (as the title of the article says), not 61%. 61% is the result of a survey.

edit: misread article

You arent reading the article. From the first paragraph: "Over 127 million adults—38.5 percent of the US population—have received at least one shot. Over 80 million adults—24 percent of the US population—are now fully vaccinated."

Isn't herd immunity at 70%? This, along with those that have natural resistance to it should get us there, right?

Does the distribution matter here? I wonder if there'll be pockets of unvaccinated people in areas of higher vaccination hesitancy and what that means for herd immunity.

There always will be, but the nature of "herd" immunity means that such outbreaks will not be able to jump to the broader population, because on average outbreaks in a herd-immune community shrink and don't grow.

It’s not clear. US health officials say it’s higher (https://www.google.com/amp/s/www.nytimes.com/2020/12/24/heal...), although Fauci’s credibility in this interview is kinda compromised by the statement that he wasn’t previously telling people what he really thought.

That was estimated for the original Wuhan sequence and the early single mutation D614G variant. Current variants with the 501.Y change have almost twice the virulence (they infect people more easily). And the 501Y.V2 and V3 have the E484K mutation (sequenced first in South Africa and Brazil) that makes them escape immune responses to the original Wuman and D614G variants. This also applies to a lesser degree to L452R sequenced first in California, USA but it does not share the increased virulence of the 501Y variants of concern.

Herd immunity might have been 70% in March 2020 but much more than that is required now. This is especially true as various ignorant populations have decided that no particular protectective behaviors are needed raising the R number even higher.

Please be careful with your terminology. Virulence refers to damage caused to the host, not how quickly the virus spreads or how quickly it infects the host.

Thanks for your concern but it's not quite that clear cut and you may have misunderstood my phrasing. Virulence refers to the ability to infect and multiply. Pathogenicity refers to the damage to the host.

Since the 501Y variants do not survive the environment any better than original sequence virus it is assumed their increased observed spread is due to their virulence. This makes sense given that the 501Y change is on the ACE2 contact residues of the spike and probably gives greater binding affinity.

[0]: https://covariants.org/variants/S.N501 [1]: https://www.biologyonline.com/dictionary/virulence

>The virulence of a pathogen is often correlated with the so-called virulence factors. A virulence factor is defined as the factor that enables an organism to invade a host and cause disease. It also determines the extent of damage to the host. These factors may be secretory, membrane-associated, or cytosolic in nature. An example of a virulence factor is the ability of microbes to multiply within their host cells.

It is, in fact, clear cut. Virulence refers only to the degree of damage done. [0]

There are several interrelated terms, which you conflated in your previous comment. It's important for all of us to have the right mental model about how these fit together, so I'm going to press on this point.

  - Transmissibility: how easily a pathogen travels from one organism (vector or host) to another
  - Infectivity: how easily a pathogen can establish infection in a host
  - Pathogenicity: degree of ability to cause disease in host
  - Virulence: degree of damage done to host
  - Virulence factors: factors that, in aggregate, can affect virulence

Virulence is affected by virulence factors, but these are not equivalent to virulence, and increasing a virulence factor does not necessarily mean that virulence will go up. (Another way of saying this: Taken individually, virulence factors are necessary but not sufficient for the definition or measurement of virulence.)

So of course, if a pathogen has higher transmissibility or infectivity, it has a greater potential for virulence. At the same time, that does not mean it is actually more virulent.

So taken in the context of your comment, the clearest word to use is almost certainly transmissibility or infectivity, depending on the data you're referring to.

[0]: https://www.biologyonline.com/dictionary/virulence

Give the above I think we can agree then it is not clear cut. But I do agree that infectivity would be a better choice.

It’s complex, I’ll give you that :)

Even if it was a uniform distribution, herd immunity is just enough to slow down the spread. The distribution isn't uniform, however. The people who are refusing the vaccines are doing so on ideological lines. The ideological lines are in turn largely driven by geography. So the result is that we have social clusters of people with much lower vaccination rates where the virus can spread.

Not yet, per this link we're at 39%. Maybe you're looking at data for total doses given? Lots of the vaccination in the US has been (IMHO, inappropriately) focused on completing the course, so while we might have had enough doses to put one in 60% of the population, we actually put two in most of those people.

The UK did the opposite, where slightly more total vaccine led to only 13% of people being completely vaccinated but 49% having at least one dose. And clearly their outbreak curve looks much better.

Though it's worth pointing out that the UK curve seems to be levelling off at an asymptote of about 50% vaccination, which is too low and broadly confirms the contention in the linked article.

Get your shots, folks.

https://91-divoc.com/pages/covid-visualization/?chart=countr...

The UK “leveling off” is likely a result of vaccine availability, especially as the number of second doses are ramping up (they have decided to use a longer gap between the first and second dose). I believe 95% of over 50s are vaccinated and the program just opened up eligibility for non at-risk people aged 45-50 a few days ago.

Now with potential fear around blood clots, future uptake is yet to be seen, I think it’s too early to say that vaccinations are leveling off.

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