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Comment by woofie11 | Hacker News Reader

Spirited and informed debate:

Virtually everything I see suggests that the effect is bimodal:

1. Everyone gets vaccinated at the same time, and the disease goes away. Not a lot of disease means not a lot of mutations.

2. No one gets vaccinated, and there is no such effect.

If immune escape is an issue, it seems like the solution would be 100% MANDATORY vaccinations, and to perform vaccinations all at once, region by region, so there are no populations which mix vaccinated and unvaccinated individuals.

I can't see how making vaccinations non-compulsory will do anything good. Where I live, 2/3 are vaccinated, and 1/3 are not. Virus is spiking, and there are a lot of opportunities for escape from the unvaccinated to the vaccinated. After a few months of similar effect, vaccine effectiveness fell from 95% to around 50%.

I think you gave a very strong argument FOR compulsory vaccination.

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> Everyone gets vaccinated at the same time [...] region by region, so there are no populations which mix vaccinated and unvaccinated individuals

This is logistically impossible and completely unrealistic. If you can find any literature or any experts suggesting that this is feasible, please share.

> and the disease goes away

Even if we did manage do achieve what you suggested, the current vaccines do not guarantee sterilizing immunity. This means that even vaccinated individuals can be infected and transmit the virus, which still gives plenty of opportunity for the virus to mutate and eventually evolve to escape the immune response in the theoretical 100% vaccinated population.

> I can't see how making vaccinations non-compulsory will do anything good

There are many viral elimination strategies that complement vaccination - for example multi-drug treatment using widely available and existing medicines [1][2][3][4][5]. The key is that using a diverse set of strategies helps reduce the possibility and risk of vaccine resistance.

> I think you gave a very strong argument FOR compulsory vaccination.

I appreciate the spirited discussion but your comment does not seem particularly well informed - it completely disregards the concerns and arguments put forth by experts in the field, which I've outlined in my previous comments.

[1] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a...

[2] Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection https://rcm.imrpress.com/EN/article/downloadArticleFile.do?a...

[3] Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents https://www.sciencedirect.com/science/article/abs/pii/S03069...

[4] Multidrug treatment for COVID-19 https://www.jstage.jst.go.jp/article/ddt/advpub/0/advpub_202...

[5] Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial https://pubmed.ncbi.nlm.nih.gov/33983065/

As a recommendation to individuals, the suggestion to seek early treatment -- indeed, to apply certain treatments immediately to oneself -- is, I believe, sound, and I second it.

But the situation as regards public health policy and messaging is more complicated. Denial is among the most human of emotional patterns; many people do not want to face the possibility that they've contracted a dread disease, and will procrastinate seeking treatment until they are quite ill. Altering that behavior on a large scale strikes me as a very heavy lift; but that is what we would have to do to pursue a public health strategy that leans heavily on early treatment. If you think it's doable anyway, why has no other country done it?

That said, the risk of vaccine escape seems to be real. Perhaps that's why the CDC is telling us to expect boosters.

Well put, and I agree that people have a tendency to procrastinate which can be detrimental to early treatment strategies.

> why has no other country done it?

Since early in the pandemic many front-line doctors have been successfully reducing hospitalization and death through early treatment with a multi-drug approach. Those are the doctors and researchers that authored the publications I cited in my previous comment, especially [1]. Those doctors had to treat patients early in the pandemic with a very little scientific literature and clinical trials to guide them, hence the world wide collaboration in putting together reasonable guidance based on existing medicine with established efficacy and safety profiles.

They continue to use these techniques - which are being further investigated for efficacy and safety in ongoing clinical trials - but with scarce media coverage compared to the vaccines.

So in many ways countries around the world have been doing it to some degree, but it hasn't been the primary strategy, as you point out. Why hasn't it been the primary strategy? Well that's a good question and tough to answer with any certainty. To speculate, I'd say that vaccines had a tremendous amount of funding and media attention poured into them, more so than any multi-drug therapy regime.

Sure, these early treatments have happened on a small scale; I've seen some of the papers. And don't get me wrong here; clearly we have to start with informal experiments and progress to small studies, to find promising treatments, before we expand their use. But there's still a world of difference between one doctor in one hospital cherry-picking the patients who happen to come in early and treating them successfully, versus basing one's entire public health strategy on early treatments. For one thing, if you do somehow convince people to come in early, you're going to have a lot more patients to treat. Not only do you have to make sure you have enough of the drugs and other supplies, but you have to have enough trained staff to administer them.

All that said, I would actually like to see someone try it. There are plenty of countries that have little expectation of receiving much vaccine supply this year anyway; they have little to lose. But it's no slam dunk; they face a daunting public education problem first, and then if they somehow solve that puzzle, they'll have to deal with the logistical difficulties.

Against all that, I think vaccines have more than just a marketing advantage. As long as they're reasonably safe and effective, they're a much more practical solution. Of course, what counts as "reasonably safe and effective" is debatable.

> This is logistically impossible and completely unrealistic. If you can find any literature or any experts suggesting that this is feasible, please share.

This doesn't need to be 100%. Large swaths of the world rely on help for vaccines. Instead of distributing aid evenly by country, it could go country-by-country. "At the same time" also doesn't mean everyone gets a shot on the same day, just not spread out over years as we're doing now.

> Even if we did manage do achieve what you suggested, the current vaccines do not guarantee sterilizing immunity.

They're about 50% effective for delta 6 months after vaccination, and about 95% effective for the original at vaccination. That's a big difference. We don't need sterilizing immunity; just for R0<1. Yes, the odd person will catch COVID19 from a deer, but if 7 billion people catch it, versus 1 million, that's a 7 million times difference in number of mutations.

> The key is that using a diverse set of strategies helps reduce the possibility and risk of vaccine resistance.

I agree 100%. This is the key. What amazing to me is the effectiveness of proper PPE. I don't understand why anyone uses cloth masks anymore. Proper masks are cheap, available, and help far more than vaccines or drug regiments. My opinion is that we should have vaccines, modest social distancing, N95-equivalent masks, universal HEPA filters, move what we can outside, etc. I think if we do all the cheap things consistently, we'll eliminate the need to do big, expensive things.

> I appreciate the spirited discussion but your comment does not seem particularly well informed - it completely disregards the concerns and arguments put forth by experts in the field, which I've outlined in my previous comments.

I'm not sure what you're referring to.

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