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Comment by blendergeek | Hacker News Reader

> Only asymptomatic, more infectious people will be allowed in.

I don't see anything in the study that would indicate that people with the vaccine are more infectious than those without. Rather, the study says they are infectious.

The variable in this study was alpha vs delta variant and the result is that while the vaccine prevented the transmission of alpha variant it does not prevent the transmission of the delta variant.

This study does not address the question of whether those with the vaccine are more or less likely to spread the delta variant than those without the vaccine.

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Well it seems like simple logic no? If the vaccine decreases symptoms but not viral load, vaccinated are more likely to transmit it. Right? Maybe I’m being dumb again. Happens. :)

I'm not following the logic. Why would decreased symptoms mean you're more likely to spread? You're thinking that asymptomatic people are more likely to not wear masks/be in more populous places whereas symptomatic people are more likely to quarantine/wear a mask? I could see that line of reasoning, although, as a counterpoint, I understood that the main virality of COVID stems from the long lag between being infectious & symptoms. In other words, basically everyone is asymptomatic for the first 7-10 days that they're infectious anyway.

If the vaccine confers a reduction in symptoms, that's still valuable. The danger of COVID is the sudden spike needed in hospital resources & deaths. Sounds like the vaccine still decreases both, even for delta. Not getting infected at all is a secondary benefit that's a nice to have & important for eradicating the virus totally. I suspect that's a pipe dream at this point & the question is how quickly we can transition it to an endemic disease like the flu.

The paper does not make conclusions about whether the vaccinated are more likely to be asymptomatic - but in case you are interested the results are presented in Table 1.

Of The 69 cases infected, 47 developed symptoms (median 4 days post diagnosis), which is 68% of cases. Viral loads for symptomatic cases was higher (page 11).

Key points: there is not enough information here to draw conclusions about the infectiousness of vaccinated vs. unvaccinated individuals, or about whether vaccinated individuals are more likely to be asymptomatic. This paper does not even try to draw such conclusions.

> vaccinated are more likely to transmit it. Right?

The vaccinated are also less likely to have it in the first place, so no, not right.

There are "similar viral loads in vaccinated and unvaccinated patients" _who have symptoms_ - that's a huge selection bias right there. You can still assume that there are very different rates at which vaccinated and unvaccinated are prone to getting infected in the first place, then developing symptoms.

This conclusion is also wrong: "My vaccine doesn’t protect you and vice versa." - yet more simplistic, all or nothing, black or white thinking. Delta means that my vaccination doesn't protect you _as much as it did_ but it is incorrect to leap to "it doesn't protect you at all"

It's clear that at present, vaccination alone is not the answer, but it would be very wrong to disparage vaccination, e.g. to say that "vaccination is not the answer" - vaccination is part of the answer, likely the largest part.

I agree overall and think total vaccination would end the crisis given that it reduces mutations. But at least one health agency has put the protection of the mRNA vaccines for delta as low as ~40% and if the first 10 days everyone is infectious while the second 10 days the unvaccinated are in bed/quarantine then it sounds like the transmission rate could be about the same for both groups.

> But at least one health agency has put the protection of the mRNA vaccines for delta as low as ~40%

> then it sounds like the transmission rate could be about the same for both groups.

Assuming those numbers, then transmission would be 40% lower in the vaccinated group? The 40% who get protected, do not then transmit. That's not "about the same".

And the other ~60% have behavior changes like twice the time not in quarantine, so no real difference.

I think delta is probably at this reproductive optimum and that makes it very hard for a variant that isn't successful in both vaccinated and unvaccinated to survive in a place where vaccination is ~50% that adapts behaviors based on monitoring delta.

> And the other ~60% have behavior changes like twice the time not in quarantine,

I do not think that this has actually been quantified.

This study implies R>1 for consistent transmission of specific strain in vaccinated staff in Vietnam. The Massachusetts study is consistent with the in vivo R being similar between vaccinated and unvaccinated, so nothing supports drawing the conclusion that lower risk of infection dominates the results AFA safety for other people.

It is perfectly rational for vaccinated people to take more risks around infection since the infection is less likely and lower risk to the vaccinated. I think we shouldn't pretend there is adequate evidence that we provide any form of herd immunity to the unvaccinated as far as we know they are just as unsafe among us as among themselves.

That could be a valid concern, same way as evolutionary pressure pushes viruses to minimize symptoms (symptoms that are not it's spreading mechanism).

But the special party trick of Sars-Cov-2 has always been spreading before symptoms even appear (it just wasn't very good at spreading, before delta) which amongst other things ruins that evolutionary pressure effect.

The simplest explanation, and one that no data I've seen yet clearly contradicts, is that vaccines (most vaccines?) work just as well against delta than against its cousins. Even before delta, we knew that vaccinated could become infected. It just happened to be quite unlikely that they pass it on. Delta greatly increases the odds that you catch it when breathing air that contains a given viral load (earlier variants were so bad at making landfall that aerial spread was ruled out for months, based on the observed spread speed that was much lower than you'd expect for aerial) and now apparently you can have spread even in vaccinated communities. But their immune systems know how to deal with it, they'll clean it out faster than toddlers. Just not fast enough for spread to be completely ruled out.

Yes, this means herd immunity is off the table (that has been obvious for months). The unvaccinated will immunize the other way (or die trying). We likely won't need regular booster shots, the virus takes care of reminding our immune systems of it's existence. Yes, many dice will be rolled for creating an immune escape variant. We should definitely have mRNA vaccine manufacturing capacities on standby, it might become an arms race treadmill.

To clarify, I didn't assume anything. The article says that breakthrough case were a given, but we were led to believe otherwise.

My point is, the jabbed can carry and spread the virus. Less effectively perhaps, but none the less a carrier with no symptoms is to some extent more dangerous as they are unaware of their status and can likely think they're safe to in contact with more ppl.

The idea that the unjabbed are only getting infected from the unjabbed simply isn't accurate. But that's the gist of the article - and the ongoing rub of many - there's simply too many mixed signals and otherwise lazy reporting and "leadership". People are not responding for a reason, actually plenty of good reasons. To ignore that is text book insanity.

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