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Comment by cm2187 | Hacker News Reader

That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK. There isn't really a next step after having vaccinated the population, it is "steady state". So do they want us to have these restrictions (countries you can't travel to, endless testing, mask requirements) forever?

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Since no one under 16 has been vaccinated yet, about 70% of the population is vaccinated (44M out of 67M). That might be barely enough for herd immunity for some diseases, but the case numbers in the UK are still very high and trending back upward, showing that this isn't enough for herd immunity for Covid.

Hospitalization rates are also back up to significantly higher than they were this time last year.

And that's with the restrictions you're referring to. So, no, I don't think that it would make sense for the UK to just go right back to normal just yet, at least until the vaccinations rates are high enough that you see the case rate go back down and stay down.

What restrictions are there in the UK? As far as I know in England and Wales where the vast majority live there are none except for those around international travel or imposed by private enterprise.

They're pretty much gone, there are still some mask requirements on, e.g., London underground, but 50% compliance? There is some talk of introducing a vaccine passport for nightclubs, football grounds in a month or two.

For me, the mood in London is "we've had enough, it's endemic, let's live with it".

These herd immunity thresholds assumed that vaccinated people do not transmit the virus, but it appears that they do. Vaccines seem to be very efficient at preventing complications, which is great and good enough to neutralise this virus. But they don't seem to have made a dent into this summer's cases numbers. It doesn't look like vaccines will prevent the virus from circulating.

Hospitalisation rates have been pretty much flat vs previous waves (there was no wave last summer).

"It doesn't look like vaccines will prevent the virus from circulating."

Do you have some numbers?

As far as I know, it indeed supresses the virus from circulating, it just doesn't stop it completely.

Here in my area, which started early with broad vaccinations - the numbers are way down.

The size of the peak cases in countries that have high vaccination rate, vs previous peaks before vaccination.

UK for instance: https://coronavirus.data.gov.uk/details/cases

You are comparing different variants as if they are equal. That makes no sense. If you look at the data so far available it does seem to reduce incidence of infection.

we know the new variants are more contagious than what we had last year, if the vaccines didn't limit growth we should see a steeper curve, I believe.

How do you account for prior immunity as well as the "pool" of people that would show up as a case going down as well?

Both those factors would result in a softer curve without any vaccination.

Has the UK peaked?

Israel also started early with broad vaccinations. Now compare latest waves in USA/GB/Israel:

https://ourworldindata.org/explorers/coronavirus-data-explor...

For fun, add India, which has comparatively low vaccinations, where Delta began:

https://ourworldindata.org/explorers/coronavirus-data-explor...

Do you know about the quality of the data? I would suspect they match the big picture by now.

But while I was looking into that, last at the beginning of the year - the quality was horrible. Even here in developed germany, it was hard to get meaningful numbers from different districts. I mean, there were lots and lots of data flying around, but most of it not solid or directly comparable in my understanding.

And here india looks interesting, if true. That would speak for a sort of herd immunity?

I really don't know what to think about India. I add it only because its so weird how quickly Delta seemed to fizzle out there, and then everyone stopped talking about it. Lots of very strange cases like that in the data.

I think most data is not really comparable across countries, only across time (and even then: discard data early on), because of different levels of data collection. So best only to compare the same country vs its own prev spikes. But this is esp true with India vs smaller countries, you may be able to compare Euro nations to each other more accurately, but would caution against interpreting small differences as meaningful.

> As far as I know, it indeed supresses the virus from circulating, it just doesn't stop it completely.

Nope, it does not. Check your facts again with the Delta variant.

I'm almost sure 100% vaccination rate with the vaccines currently available won't change much. I hope I'm wrong. But there already are cases apparently confirming this.

IMHO we should just return to normal, consider this a new kind of flu and deal with the fact it's more deadly. I always knew there is a chance a flu can kill me one day. I'm Ok with the fact the chance is higher now.

My personal (apparently risky, I don't recommend it to others) strategy is living an active social life to be in regular contact with the virus (while testing every now and then to make sure I don't spread it) so my immune system keeps on producing the natural antibodies (I also test for every couple of months).

Returning to normal is a terrible idea when COVID patients are overwhelming hospitals across the world. How can things be normal if our healthcare systems are nearing collapse?

You might be willing to accept the risk of getting sick on your behalf, but by advocating a return to 'normal' before we have the capabilities to deal with this virus, you are advocating for putting even more stress on healthcare systems across the globe already on the verge of failure. There are patients in heavily-impacted areas who cannot access healthcare for other life-or-death concerns because hospitals are crumbling under the workload of COVID cases.

The article even states this; COVID is likely to reach endemic status eventually, but we are still nowhere near that. Ignoring it will have enormous costs on vulnerable populations -- even more than it already has.

Politicians say this all the time. I doubt anything we can do can change this. Just build more hospitals. We have resolved the masks shortage, we will resolve the shortage of ventilators and hospitals also. We can even soften the shortage of medical personnel by directing the unemployed to paid full-time medical boot camps.

I understand this is much easier said than done but we hardly have a choice if we actually want to do something useful.

Building more hospitals is a long-term process. Training medical personnel is a long-term process. Emergency measures intended to bridge the gap are untenable politically, and people are dying because of it. Thousands of them per day.

The answer to this is not to say 'we can't fix the underlying issues right now, so we're not going to do anything'. The answer is to take measures that we _can_ implement until those longer-term solutions can come into play.

What measures we can implement doesn't matter if these measures don't work.

Vaccines work. Vaccinated people are far less likely to contract COVID, and when they do they are far less likely to require healthcare resources beyond the standard treatments for someone who has the flu (stay home, rest, treat symptoms as needed).

Social distancing and masking work. They reduce the possibilities for spread between people -- not perfectly, but enough to reduce it to a manageable level for our current healthcare resources.

Saying that our current measures to combat the virus don't work is disingenuous at best, and a blatant disregard for everything we've learned from the past year and a half at worst.

> Vaccines work.

I have always been a vaccine enthusiast but now I see infection surging even in the most vaccinated areas.

> masking work

I have always been saying this, even when officials denied. Yes, mandatory masks in public transport and grocery stores are the only of all the deployed measures I recognize as actually working.

> blatant disregard for everything we've learned from the past year and a half at worst.

I actually don't think we have learnt much.

The vaccines are not failing. They are incredibly effective at preventing infections _and_ reducing severity of breakthrough infections. The Delta variant is more easily transmitted and more likely to cause breakthrough infections, but that does not account for the majority of the surge [0]. It's largely a surge amongst unvaccinated populations, buoyed by a smaller proportion of breakthrough infections. The ease with which Delta spreads, combined with relaxed restrictions on gatherings and masking, accounts for the surge in infections.

Despite the decline in vaccine effectiveness (I've seen conflicting studies of how much this has changed), they're still incredibly effective compared to any other protection we have at the moment.

None of this changes the fact that people are going to continue to die until a higher proportion of the population receives a COVID vaccine -- and that we _can_ mitigate this through other measures. None of these things lead me to the conclusion that we should return to normal and accept an increased healthcare system burden and death rate.

[0] https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e1.htm?s_cid=mm...

> I have always been a vaccine enthusiast but now I see infection surging even in the most vaccinated areas.

https://www.kff.org/policy-watch/covid-19-vaccine-breakthrou...

    The reported share of COVID-19 cases among those not fully vaccinated ranged from 94.1% in Arizona to 99.85% Connecticut.


    The share of hospitalizations among those with COVID-19 who are not fully vaccinated ranged from in 95.02% in Alaska to 99.93% in New Jersey. (Note: Hospitalization may or may not have been due to COVID-19.)


    The share of deaths among people with COVID-19 who are not fully vaccinated ranged from to 96.91% in Montana to 99.91% in New Jersey. (Note: Deaths may or may not have been due to COVID-19.)

*may or may not have been due to COVID-19

How is this data useful what so ever? I don't particularly care if someone in a car accident was or was not vaccinated unless Pfizer has came up with an MRNA based seat belt recently. If anything this data just muddies up the waters further.

> (Note: Hospitalization may or may not have been due to COVID-19.)

My company had out local health official come to our town hall meeting at talk. About covid.

Over 94% of patients are unvaccinated... It's pretty clear in my mind what's happening here.

> Building more hospitals is a long-term process. Training medical personnel is a long-term process. Emergency measures intended to bridge the gap are untenable politically, and people are dying because of it. Thousands of them per day.

It's like the whole chip shortage thing. Most people ask why aren't we building more chip-building plants? The answer is we are doing that, but it takes billions of dollars and a lot of trained manpower to set up such a factory, and all of that takes a lot of time.

These are what are called in economics as highly inelastic supplies, which it seems is unknown to many commentators, who BTW have a habit of quoting Econ 101 in every discussion.

Lol homeless people with scalpels what could go wrong?

Besides hardcore homeless drunkards there is a sufficient population of totally reasonable people who have just lost their jobs because of the crisis and can totally do nurse/paramedic job if taught for free and supported financially. I would steadily go for this if I had lost my job.

If medical boot camps are as effective as Javascript boot camps... you may want to wait a while before exposing yourself to other people's germs.

> If medical boot camps are as effective as Javascript boot camps... you may want to wait a while before exposing yourself to other people's germs.

This line made me both laugh and cry a little.

So, the initial job will get done, but please don’t look under the covers, and please do not attack it with anything infectious?

Might be better than having nothing, in the case of ICUs being overwhelmed and overcapacitied.

This is an incredibly bad faith argument. There is a whole lot of room between a 6 week bootcamp and a 12 year medical program. I'm pretty confident someone would learn to treat Covid patients in 2 years.

edit: your comment did make me laugh though. So perhaps you were just going for humor, in which case you succeeded and I apologize for being a wet blanket.

There was never a real ventilator shortage. Doctors figured out quickly that mechanical ventilation does more harm than good for the vast majority of COVID-19 patients. It's only used on a few percent of hospitalized patients now.

https://www.cdc.gov/nchs/covid19/nhcs/intubation-ventilator-...

It seems one option is to increase hospital capacity. There should be ways to do this without needing more RNs and MDs.

I agree! But the issue is that where these processes exist they are not designed for the scale of the current pandemic, are too inconsistent when implemented, and rely on spare personnel that do not currently exist.

That's not an option. Hospitals in many were already understaffed before the pandemic. And the pandemic has caused such a severe worker shortage that traveling RNs are getting paid upwards of $200/hr in remote parts of the USA.

The only way to deal with this pandemic is to vaccinate as many people as possible. It's the best way that we know of to reduce spread of, and the effects of catching covid-19.

> Hospitals in many were already understaffed before the pandemic. And the pandemic has caused such a severe worker shortage that traveling RNs are getting paid upwards of $200/hr in remote parts of the USA.

This has always been a systemic problem of how hard medical education and license are to get. I'm pretty sure medical personnel can be trained to reasonable (mediocre but better than nothing) skill level much faster and for much cheaper than it normally is.

Yeah, if the problem is lack of staff in COVID wards, just start COVID-specific training programs and hire COVID-specific personnel, who are only allowed to work with COVID patients. That should reduce training time a lot.

This approach might sound like some completely out of the box, untested and extreme approach, yet it’s completely standard in industries that are not as heavily regulated as medicine is. Alas, healthcare has its Rules and Procedures and Best Practices, and as a result, everyone else must adjust and implement novel approaches, so that the healthcare industrial and regulatory complex doesn’t have to.

And knowing they are going to get laid off when COVID dies down, do you expect people to be stampeding to be hired to a job with no transferable skills? Have you seen the Medicaid nursing home labor pool?

The vast majority of COVID patients aren't just "COVID patients". They're people with comorbidities that put them in a more serious position than a regular (otherwise healthy) individual with a respiratory illness. To "specialize" in COVID you likely need to have training on diabetes, neuro, renal, cardiac and other systems. To a certain point, you just need a fully trained nurse because you can't specialize too deeply on "COVID" without needing training on the comorbidties that come along with an ICU patient.

I guess I'm bias because my spouse is an ICU RN, but the ignorance of HN comments boggles my mind. Do all the hackers try to solve domain problems they have absolutely 0 experience in? I don't pretend to have solutions for the healthcare system because I don't work in the healthcare domain. I can assure you, the red tape that exists is there for very good reasons, because we've tried "unregulated" systems and they were a disaster. We've learned from our mistakes, and that means rigor that can't be replaced by some keyboard jockey writing webdev or embedded systems for unrelated fields.

> That's not an option. Hospitals in many were already understaffed before the pandemic. And the pandemic has caused such a severe worker shortage that traveling RNs are getting paid upwards of $200/hr in remote parts of the USA.

How did this understaffing happen?

> More than 260 hospitals and health systems furloughed workers in the last year, and many others implemented layoffs.

[0]: https://www.beckershospitalreview.com/finance/20-hospitals-l...

As someone whose partner is a med-surg nurse, and whose extended friend circle contains a lot of current and (mostly)former nurses, that post is not really the case. That's like saying that the shortage of software engineers is down to InfoSys having a bunch of IT layoffs.

The big issues are: the job sucks, the patients suck, the insurance companies suck, the hospital administration sucks. It's a hard, thankless job, where you get shit on all day by everyone, figuratively and literally, and for not much pay. Pre-COVID, pay was maybe $30-35/hr for most floor jobs. Or you could get an hospital office job, making more than that working a basic 9-5, no shit, no working holidays, no lawsuits (due to bone-headed coworkers fucking up), no feeling like a waiter, or being groped by patients.

Nursing is a terrible career anymore.

Hmm, who provides care at a hospital? Wow, RNs and MDs. Do you expect a janitor to intubate you? Increasing hospital capacity is hard, expensive and takes time.

Intubation procedures are often performed by respiratory therapists.

You go first! We'll give you 6 weeks training, and then you can go work in intensive care around infectious patients.

You seem to be ignorant about health care. Respiratory therapists have at least 2 years of training.

There's never been a better reason to start building capacity.

I don't need a person with a doctorate degree to treat me. I just need a person who has a reasonable understanding of how does a human body work and a reasonable skill of doing particular medical procedures.

Doctors generally don't have doctorate degrees. That's a Ph.D which is a doctor of philosophy degree. A physician becomes a doctor by earning degrees as an M.D., doctor of medicine, or D.O., doctor of osteopathic medicine.

What you're describing is either an MD, a NP, or a traditional nurse/specialist.

This is a pretty ignorant suggestion. It's like saying that my company should dramatically increase its software output without hiring software engineers. These are people, not robots. You must hire more skilled labor if you wish to expand the capacity which requires that labor.

If you're saying we should fill that labor requirement with low-skill medical technicians, you're misunderstanding the needs of the hospital. If you are ending up in the ER or ICU with covid, or any other cause, you are beyond the help of an at-home med tech, which is why you're at the hospital in the first place.

We get more efficiency out of nearly every sector of the economy. We grow more food despite an ever decreasing number of farmers.

The problem is that the incentives aren't aligned with health care primarily due to third party payer system and onerous regulations.

You ever wonder why there is a line of people outside of urgent care every day to get tested for covid? Presumably, there are cheap tests that be administered at home without having to see a nurse or doctor. Or if you really can't do that you can train someone how to administer tests in a few hours and have that as a service. But in the US at least, it's nearly impossible to do these things. It took until April 2021 for the FDA to approve at home covid tests, and they're still not popular or available (at least I haven't seen them)

https://www.npr.org/sections/coronavirus-live-updates/2021/0...

COVID testing is not the same thing. You don't need ER or ICU experience to administer one.

Medicine is a field notorious for its gatekeeping.

But a lot can be done. In Italy during the height of the pandemic, they "emergency graduated" 5th (or maybe 6th ... near the end) year medical students. I really wonder if there's any data whether they provided worse care after some on-the-job training than "fully educated" practitioners.

It's not gatekeeping when you're talking about life or death emergency medical care. Taking students out of school isn't a solution, it's an act of desperation.

If I have a private pilots license and the pilot of my commercial aircraft is incapacitated, sure I'm technically more qualified than the others on the aircraft to try to perform an emergency landing. But that doesn't mean American Airlines should be expanding their routes because I could land a plane.

Do you believe that expensive cures are preferable to cheap preventions?

Spend a bit of time on the /r/nursing subreddit and weep.

ICU nurses have been worked to the bone for 18 months now, and often already at higher patient/nurse ratios that customary.

The coming problem won’t be one one of insufficient beds but insufficient people to care for them.

duuuuuuuuude do you have any idea how labor intensive care for ICU patients is? ICU patients can't move. Requires staff to turn them so they don't get bed sores and to prone them stomach down for lung function.

If the ICU patient can't breathe on a vent and are able to secure ECMO, the ECMO specialist ratio is ideally 1:1. Under a crush of patients maybe 1:2 patients. A 1:3 ratio is risking all the patients under that specialist's care because the patients are all too tenuous. Let me reiterate and restate: 3 ECMO patients are too much for a single ES to support.

The ECMO specialist isn't the only person caring for the patient. There is the ICU nursing staff, the pulmonary therapist, plus the actual pulmonary doctors, the renal doctors, plus plus plus. You are talking decades if not a hundred+ years of study just to take care of a single ICU patient.

Labor and not beds is the bottleneck.

Are they really overwhelming hospitals?

This keeps being repeated but most hospitals operate at about 80% capacity as-is. Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%. [0]

If we look at Israel, which has a very high vaccination rate, we see that they're supposedly running out of hospital space. [1] But the article linked doesn't say _anything about their actual numbers atm_ and points to a fiscal problem rather than a manpower problem.

There was a recent Science Magazine article that states that 13% of the hospitalized-and-vaccinated group are under 60. That amounts to 39 people in a country of 9 million. [2]

I've asked this before both here and elsewhere: If these vaccines aren't "good enough," what is? At what point does this become "zero COVID" in that "nobody can ever die from this disease again?"

[0]: this may have changed -- things are changing quickly -- so I'd be curious if you have any recent (<1 week old) information on this.

[1]: https://www.haaretz.com/israel-news/israel-s-public-hospital...

[2]: https://www.sciencemag.org/news/2021/08/grim-warning-israel-... -- and I took this from Louis Rossmann's video https://www.youtube.com/watch?v=mYtfT7HsJq0

> Are they really overwhelming hospitals?

Yes.

> This keeps being repeated but most hospitals operate at about 80% capacity as-is.

They aren't overwhelming total hospital capacity, they are overwhelming specialized resource capacity, particularly ICU capacity.

> Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%

In Florida and numerous other states (not Tennessee), there are significant areas over 95% ICU capacity. [0]

[0] https://www.nytimes.com/interactive/2021/08/17/us/covid-delt...

> there are significant areas over 95% ICU capacity

It's not like there is any large ICU capacity anywhere anyway.

Those patients simply go somewhere else and cause more strain. We on hacker knews should known the pain of cascade failures more than other platforms.

Is every hospital getting overwhelmed though? I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I'm getting fake news?

I'll throw in a anecdote: my family in nearby hospitals are *not* being mandated to get vaccinated.

This is precisely because there is high demand for registered nurses and other medical staff at the moment.

> This is precisely because there is high demand

Ok. At least somebody can exercise reason when necessary.

By the way (I believe that's is nonsensical but I also believe I am probably wrong - I am far from an expert), what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it. And I don't know about any evidence of vaccinated people being less contagious than those naturally immune.

> what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay?

I don't know but, fwiw, Europe is considering prior infection proven by an antibody test as equivalent to being vaccinated.

Not all Europe. Some countries governments are stubbornly against this and only accept a positive PCR test taken during the actual sickness.

> To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it.

This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.

A vaccine is nothing more than exposing the immune system to the antigens. If their immune systems are already geared up to fight Covid, they will simply respond to the vaccine as another Covid infection and fight it accordingly.

As for whether there is any benefit, there absolutely is. Multiple exposure events greatly increase the storage of the antibodies in the memory cells of the immune system. This is why most vaccines require at least two shots, and why the CDC is now recommending a third booster shot for some people.

Plenty of studies show that the immunity of people who are vaccinated is stronger than those who were infected naturally (e.g. [1]), and that the immunity of people who have had Covid is significantly more robust after subsequent vaccination (e.g. [2], [3]).

1. https://www.biorxiv.org/content/10.1101/2021.04.15.440089v2....

2. https://apnews.com/article/science-health-coronavirus-pandem... ("The survivors who never got vaccinated had a significantly higher risk of reinfection than those who were fully vaccinated, even though most had their first bout of COVID-19 just six to nine months ago.")

3. https://www.medrxiv.org/content/10.1101/2021.04.25.21256049v...

Yet data from Israel suggests that the vaccinated are six times more likely to get delta than people with natural immunity: https://www.israelnationalnews.com/News/News.aspx/309762.

>This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.

There's nothing unscientific about it; it's been known for a while now that some vaccines like the flu vaccine are inferior to natural immunity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870374/

> Yet data from Israel suggests that the vaccinated are six times more likely to get delta than people with natural immunity:

In Israel, as almost everywhere else (other than early in the pandemic with nursing homes in many places), implementation of and compliance with vaccination and other COVID countermeasures had been strongest among the elderly and immunocompromised; at the same time, COVID infection has been more likely to lead to death in the elderly. So, the population most likely to be infected if exposed has a higher baseline vaccination rate and a smaller rate of prior COVID infection, both due to countermeasures and inverse survivorship effects. Without controlling for that, which bare population numbers like this don’t do, you have no idea what the relative immunity effect of prior infection vs. vaccination is.

> Yet data from Israel suggests that the vaccinated are six times more likely to get delta

Ok, well I've cited two studies that say the opposite, and one of those studies looked at antibody responses over time from matched individuals. The "on the ground" results in Israel are completely confounded by who is an isn't vaccinated, with at risk people (including healthcare workers) being significantly more likely to be vaccinated.

> it's been known for a while now that ...

Oh my. Did you read that study? It shows nothing of the sort. It is a mathematical Markov simulation of what happens assuming natural infection is stronger than vaccines.

The kicker is in the discussion:

> Under the plausible assumption that protection against influenza infection lasts longer after naturally acquired infection than after vaccination, we show that ...

This is literally begging the question. The authors make the assumption that naturally-acquired immunity is stronger. Then they write a model that repeatedly exposes people given that assumption. Then they "show" that, surprise surprise..... people with naturally-acquired immunity catch the flu less frequently.

> Is every hospital getting overwhelmed though?

In the country? No. In large areas? Yes.

> I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I’m getting fake news?

There are vaccine requirements being adopted some places, and there are departures related to it. But if you are seeing news suggesting that that is the major source of capacity strain (or even the major source of COVID-related causes of people departing healthcare jobs), it is, at least, distorted news.

Do you have a non-paywall link to that article or a link to the actual data? The article should list sources.

Have you tried Google?

There are NO ICU beds in Tennessee.

https://www.tennessean.com/story/news/health/2021/08/19/tenn...

Total bed usage is a very poor metric for this.

The bottlenecks here aren't total capacity, they are (in order of importance) 1. the number of vents, 2. the number of nurses with ICU level training, and 3. the number of ICU beds. The total number of hospital beds doesn't even factor in.

Source: I am a physician.

Yes. Unquestionably.

Here are a few different articles from around the gulf coast states that speak to this:

https://www.khou.com/article/news/health/coronavirus/houston...

https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-...

Something that may be a little confusing as well is what does "full" mean. Both morally and legally, it is very difficult for a hospital to turn someone away. Rather than turn someone away, the hospital will have new people wait, attempt to make more room, and provide less care to more people. This leads to the question: Is a hospital full if they're stashing patients in hallways and providing hallway care? Within an ICU, typical care is either one nurse to two patients or one to one depending on the reason for the ICU stay. At the moment, the ratios are 3-4 to 1, which is not the standard of care, but the best they can do. Does this count as a hospital being full?

On a more personal note, my wife is an ICU physician. At the moment, I'm writing this from a hotel room because I started traveling with her to help alleviate the stress from her work. On this trip, she will do seven days of twelve hour shifts in a row. The hospital has asked us to stay for longer, but we're exhausted and have work elsewhere. This sort of thing does not happen during flu season, so I will assert strongly that we are still not close to the realm of normal.

In a direct answer to your manpower question, this hospital does not have enough staff. They don't have enough physicians and they don't have enough nurses. Recently, this particular hospital acquired multiple new ECMO units, which do absolutely help with care. They can't use them. They don't have the nurses.

As one more anecdote, a friend of my wife who is also an ICU physician called the other day with a story from her unit. She just admitted a patient who spent six days waiting in the ER with COVID. They had no available, staffed beds until then.

Now, to be sure, I am just another voice on the internet. You can choose to believe me or not and that's fine. I will say that getting news from what actually occurs in the hospital is difficult. Reporters are people too and they're not necessarily trained to understand the nuance of hospital reality. That doesn't mean what they report isn't useful, but it may be frustratingly incomplete.

Some questions that may help with any personal investigation:

1. What are the number of staffed bed available in the hospital? Beds are different than staffed beds, but they are sometimes used synonymously. Right now, with the lack of staff, it may not be.

2. Are the ICUs in the Level 1, 2, or 3 trauma centers full? Trauma center designation gives information about the number and type of staff that a hospital is required to keep available 24-hours a day. Generally speaking, the large trauma centers have better staff and better equipment. Even if there is an ICU bed available in a regional medical center, it doesn't mean it can provide the care required. Simply, they may not have the equipment or specialists required for care. As long as the large hospitals in the cities are full then transfer is not possible and overall medical care in that region is reduced.

From what you are hearing, are staffing levels the same as pre-covid, and how much is reduced staff vs increased COVID patients contributing?

> More than 260 hospitals and health systems furloughed workers in the last year, and many others implemented layoffs.

[0]: https://www.beckershospitalreview.com/finance/20-hospitals-l...

That, I don't know. Since we've been together, prior to COVID, I never recall her mentioning they had trouble getting nurses. If there was a particularly busy night, the nurse manager had a number of nurses on-call who would then come in to staff beds. Now, that's impossible. They're not there. On top of that, the nursing staff calls out sick far more often now than before.

Are these difficulties because there are fewer nurses on the market, the existing staff are burned out, there are better opportunities to work locums, or some other factor? Not sure. Mostly, it's to say that there was never a conversation between us on the lack of nurses prior to COVID.

As far as physicians, also not sure. I will say that demand was consistent prior to COVID, but now demand for both temporary and permanent positions is extremely high. They won't stop calling. Something to understand here is that the supply of new critical care physicians takes a very long time to ramp up, four years of medical school, four years of residency, and two years of fellowship. They're not easy to replace.

As a final side note, whether they do or not, they would all like to quit. They're burned out. This has gone on too long. The families dealing with end of life care are often abusive. Virtually all of their patients are unvaccinated, which means that this is preventable. They're frustrated that their professional opinion has very little impact on the public discussion of COVID, especially when they deal with the issue so intimately and they spent a good portion of their life dedicated to understanding and treating the issues behind illness.

Those articles never define what “covid hospitalization” means. Is it people in the hospital because of covid or is it people that test positive for covid and are there for something else? There is a big difference between the two. Covid positive test results probably invoke a lot of extra overhead even if the patient has no symptoms and this could be a self made problem.

If someone is COVID positive, then they are likely contagious even if they have no symptoms. This means that they must be isolated from the other patients that do not have COVID or else there is a high risk of infection spreading to other patients. In places like the ICU, where all of the patients are critically ill, any additional infection will likely kill them.

Isolation from other patients means that they need other rooms and other nurses. It is not safe to have a nurse go from a clean room to a COVID room repeatedly if they don't have enough PPE to fully gown between rooms. Otherwise, there is cross contamination. Currently, there is not enough PPE. If a hospital has the staff, they will also isolate the physicians to either COVID or non-COVID wards to prevent cross contamination. Often, they do not have the physicians, so there is a time cost to constantly changing PPE. Time spent changing PPE means time not taking care of patients.

When a patient dies in a COVID room, the room must be cleaned. This takes time and staff. Failure to do so can also lead to increased infections.

To be clear, infections that spread in the hospital are very well studied. It's the reason why hospitals have very strict rules about things like hand hygiene. It's one of those inspections that can cost a hospital a lot of money.

That's a long way to say, it's not a self made problem. A patient that comes in for something like a heart stent who is also COVID positive is far more work than one who does not have COVID. I do not know if these news articles are referring to these cases as COVID hospitalizations. In some sense, it doesn't impact the broader issue: In a good number of states, hospitals are effectively full. The reason behind this issue is unvaccinated people catching COVID.

It is a self made problem. Imagine if we tested people for every infectious disease and put them into crazy protocol-land even if they don’t have symptoms. Nothing would ever get done!

We need to accept that vaccines exist and work. It shouldn’t matter if the dude in the hospital has a positive covid test because everybody in that room can be vaccinated if they want to.

This mass testing created a bunch more problems than it solved.

No. It is not.

The difference between COVID and something like cancer is that cancer is not highly contagious. COVID is. Further, it's contagious and deadly. That's why it requires special care. COVID is also not the only disease where these kind of precautions are taken. Another one is TB. Now, there are other diseases that are contagious, but not right now. For example, syphilis is both contagious and deadly. However, you're not going to catch syphilis when you're sitting next to someone who is positive. With COVID, you potentially will. That's why they have to test for it in the hospital.

Now, I will agree that vaccines exist and work. In the sense that there are people who choose to refuse vaccination, I will also agree it is a self made problem. However, this affects everyone to a high degree and not just the vaccinated.

Case in point, my wife and I are vaccinated. If she gets COVID, she most assuredly won't die, but she can't work in the ICU. She would risk getting her patients infected even though she is vaccinated. That means the hospital loses a physician in short supply. They're going to test you in the hospital because they can't afford you getting their staff sick.

This also affects you. You're vaccinated. However, say you're appendix bursts, you may or may not be able to get into the ER before you become septic. Yes, the ER will triage based on need. However, if there's no beds there's no beds and you will not be seen.

However, to reiterate, the hospital will always test you for diseases that they believe will affect their staff. You come in with respiratory symptoms. You're getting a COVID test. Having surgery? They'll test you for HIV. It's a protection issue. COVID is a pain because airborne infections are hard to contain.

Stop counting cases. We already know covid is endemic and isn’t going away. Why continue to test every patient for it? What purpose does it serve? Anybody that wants to be protected can be with a simple vaccine.

Here ya go in Texas:

https://www.texastribune.org/2021/08/10/coronavirus-texas-ho...

As the pandemic started, ~70% of ICU bed use was normal, since then its been around 80~90% and now approaching 100%.

https://covid-texas.csullender.com/

So yes it is overwhelming hospitals. Even if you're vaccinated, this should scare you.

So, the anecdotal evidence would be to visit /r/medicine and /r/nursing on reddit.

It may not be universal, but it certainly appears to be the case that many hospitals are being pushed over the limit due to covid patients.

Part of the issue, though, appears to be the fact that hospital admins are unwilling to raise salaries on essential employees like nurses.

I know many nurses and doctors who work at hospitals in and around the NYC tristate area -- they all say capacity is well under the normal rates for them.

Note: last April (2020), they said it had exploded due to COVID-19.

Yeah, the main difference appears to be states that have high vaccine participation and states that don't.

So what is there to say about Israel or Gibraltar?

Both have very high hospitalization rates. Both also have very high vaccination rates.

IDK, hard to say what's going on there.

In the worst case, it may just been that the vaccine effectiveness wanes over time.

This is just your bias showing, nothing more. COVID has been shown to be seasonal and to hit different parts of the world at different times of the year. Southern states appear to get hardest hit in the summer, while the colder Northern states are harder-hit in the winter.

Florida has the second-oldest population in the U.S., but it's death rate per 100,000 is average among the states. NYC and NJ are two states with the highest death rate per 100,000.

What is a covid patient? One that tested positive and is in the hospital for something else? Or one that is actually sick from covid? Because absolutely none of these articles I read clarify that tidbit and it is very important.

Positive covid tests require a hell of a lot more hospital overhead to deal with, even if they don’t have symptoms and are in for something else. It could very well be the case that this is a self made problem. We very well could be artificially overloading hospitals because we dictate that every positive test, regardless of symptoms, invokes massive overhead.

And again, every article I read never clarifies this. In fact many conflate “people with covid but there for something else” and “people sick with covid”.

I am fully inclined to believe that this hospital shortage is a self inflicted problem. If this was literally a hospital full of people choking on their own ooze, the media would be all over it like moths to a flame.

> What is a covid patient? One that tested positive and is in the hospital for something else? Or one that is actually sick from covid? Because absolutely none of these articles I read clarify that tidbit and it is very important.

The stories on the reddits I suggested are all pretty much the same. Patient comes in struggling to breath, tests positive for covid, ends up with blood clots or pneumonia which pushes them into the ICU.

Here's just one of many stories of burnout [1]

[1] https://www.reddit.com/r/nursing/comments/p9ps06/the_burn_ou...

Those are anecdotes not data.

Clearly.

> So, the anecdotal evidence would be...

I'm not trying to represent it as anything other than that.

India: yes.

The UK: in local areas, patients had to be diverted sometimes hundreds of miles to a hospital with space. all non emergency hospital care was stopped, and some emergency routine care was delayed.

Belgium was overwhelmed.

The issue is this, we can't just not admit the over 60s. even if we did, that would only free up 50% capacity (ie you could go one more cycle of exponential growth, doubling every n weeks/days)[source https://coronavirus.data.gov.uk/details/healthcare?areaType=...]

filling hospitals means that the resources used to treat both sudden hospitalizations and long term are diverted. so car accident/drinking/heavy sports/DIY injuries have worse outcomes, and cancer outcomes drop off a cliff.

if the UK manages to keep the total number of patients in hospital with covid to less than 7-10k that would be a brilliant outcome for winter. we are currently at ~6k, and its still summer.

The issue is there are not enough trained doctors and nurses. They take at least 8 years to train. that's the main constraint. Suitable beds can be made up in a number of weeks (see china and the "nightinggale hospitals") but if there is no staff, they are pointless

> you could go one more cycle of exponential growth, doubling every n weeks/days

I'm not sure a big percent- of people is prone to hard covid. I tend to believe the majority of people has already went through it asymptomatically/easily and so will the majority of those who still hasn't.

Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.

> Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.

Correct!

but when in the growth phase we can't know when it will stop. We have a fixed[1] upper bound on the number of people we can deal with at one go. so when we see we are getting close, we have to take drastic action.

We know that testing in the uk is a proxy for actual infection, it tends to favour symptomatic as its "self selecting". The ONS survey is more accurate but has a significant lag.

I really hope that you are correct about asymptomatic. but we can't be sure, yet.

Here is the Tennessee reporting. NO ICU beds.

https://www.tennessean.com/story/news/health/2021/08/19/tenn...

> At what point does this become "zero COVID"

In New Zealand, it already has. Every time there is a single case or two, the entire locale (Auckland in this case) fully locks down. This is the 5th time it locked down. https://www.nytimes.com/2021/08/17/world/australia/new-zeala...

It's ironic that Covid has been arguably more disruptive in NZ than in US, which has a ton of cases.

Definitely not more disruptive in New Zealand over the entire course of the pandemic and also we have suffered 600,000 fatalities as a result of the virus.

I'm virtually certain that the pandemic disrupted everyday life in NZ more than it did in Florida. Now more people died, but Florida demonstrates that even at the height of the pre-vaccine pandemic it's perfectly possible to live a lockdown free life post-Covid without society collapsing.

This is untrue. In New Zealand we locked down a reasonable amount for the information we have on the case. With the current lockdown, there was a single case with no known link to the border which had traveled around the country while infectious. Knowing just this and that every case in managed isolation (iirc) was is the Delta variant, we went into lockdown. Also, '5 lockdown' is misrepresentive. We can see on this page https://covid19.govt.nz/alert-levels-and-updates/history-of-... that while some lockdowns were very restrictive, country wide, and long (2.5 months), most were short and regional (with other regions maybe going to lvl 2 alert)

How is that untrue. There were three Alert Level 3 and two Alert Level 4 instances.

> short and regional

Downplay it all you want. Auckland is a pretty big place. Alert Level 4 means that 1/3 of New Zealand population is locked down.

Anecdotal, but an acquaintance here in Florida had to wait over 14 hours to get an emergency appendectomy (and over 12 hours to get from check-in to a bed in the ER) recently, due to both COVID protocols as well as COVID workload.

Vaccinated Covid patients are NOT overwhelming hospitals. LA county isn't that extraordinarily highly vaccinated. It's a county much denser and with a greater population than a lot of countries in Europe. There's been <4000 fully vaccinated people in 8 months admitted to the hospital. Only 36 have died. Not a lot more have needed ventilators.

This is a blip in the ocean of hospitalizations in LA county.

> COVID patients are overwhelming hospitals across the world

Extraordinary claims…

It does sound like they are on the verge of collapse...

"Tallia says his hospital is 'managing, but just barely,' at keeping up with the increased number of sick patients in the last three weeks. The hospital’s urgent-care centers have also been inundated, and its outpatient clinics have no appointments available.”

"Dr. Bernard Camins, associate professor of infectious diseases at the University of Alabama at Birmingham, says that UAB Hospital cancelled elective surgeries scheduled for Thursday and Friday of last week to make more beds available"

“We had to treat patients in places where we normally wouldn’t, like in recovery rooms,” says Camins. “The emergency room was very crowded, both with sick patients who needed to be admitted”

"In CA… several hospitals have set up large 'surge tents' outside their emergency departments to accommodate and treat … patients. Even then, the LA Times reported this week, emergency departments had standing-room only, and some patients had to be treated in hallways.”

“Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones for fear they’ll spread… Others are canceling surgeries and erecting tents in their parking lots to triage the hordes of… patients.”

“We’ve never had so many patients,” said Adrian Cotton, chief of medical operations at Loma Linda University Health in San Bernardino County.”

...but then again, maybe not. These are all quotes from 2018, flu season.

https://twitter.com/justin_hart/status/1422243808536715265

> How can things be normal if our healthcare systems are nearing collapse?

Why are healthcare systems unable to scale (horizontally or vertically) to meet demand unlike every other industry in the world? That should be a red flag that you don't have a robust system when it is unable to scale. We've had nearly 2 years since the start of covid to make healthcare systems more robust. Why haven't we? Maybe we should focus on that instead of telling people to mask up from cradle to grave.

Imagine if the computer industry were the same and we asked people to limit their internet time for 2+ years because the servers and routers that make up the internet were always on the brink of collapse? Like... wouldn't we just build more servers and routers until demand could be met?

> My personal (apparently risky, I don't recommend it to others) strategy

This seems to be the fundamental disagreement between the ‘anti’ side (anti-mask, anti-vaxx etc) and the ‘pro’ side. The reality is that different people can have vastly different risk tolerances. Some people are ok knowing they could die from a circulating respiratory illness and some simply are not. Some people believe vaccines are risky, others do not.

The challenge is it’s very hard (maybe impossible) to change someone’s personal risk tolerance. Imagine trying to convince someone with a fear of heights to go skydiving. You can state the facts, cite safety figures for parachutes etc but you are still unlikely to get them on a plane.

A lot of people are ok with risks, until they’re bitten by them.

There are many articles (I’ve seen two just in passing) where nurses talk about COVID patients going on a ventilator, and begging for the vaccine, only to be told it’s too late.

I feel that most people that are taking risks with COVID (e.g. healthy people not getting vaccinated) either don’t have enough foresight to realize they actually don’t want to be hospitalized/die from this, or they don’t believe the risks are real.

Risk assessment is something many aren’t great at — that is striking a reasonable balance between no fear and too much fear. This is made worse by conflicting opinions and studies, and not being able to discern truth from fiction/sensationalism.

> going on a ventilator, and begging

You read about it, I have heard from the witnesses. Some beg, some show fatalist. In fact,

> until they’re bitten

some do not quite realize that it is death involving slow asphyxia we are talking about... Days of drowning, not minutes.

> Risk assessment [...] is made worse by conflicting opinions and studies, and not being able to discern truth from fiction/sensationalism

Which is one of the biggest mess behind e.g. vaccine hesitancy, not to mention not convincing narratives about correct behaviour to prevent spreading.

Anyway, the communicational mess is a disaster, while this reference "fiction" is more problematic. It is not, at this level, something you discriminate easily. When Derek Lowe writes some find him credible, when Robert Malone speaks some find him credible - keys for discrimination are not easily at hand.

It's also a function of being practical. Spending a lot of time thinking and worrying about what might go wrong in various scenarios would take enjoyment out of life. This is where people differ. Some are happy-go-lucky's, some are neurotic, most are somewhere in between. Worry about Covid shines a spotlight on these differences.

> Some are happy-go-lucky's, some are neurotic, most are somewhere in between.

That is your opinion. One person’s neurotic is another person’s normal. It’s very hard, maybe impossible, to force-change someone’s perception of risk. Both sides will remain at loggerheads until they accept this.

> I'm almost sure 100% vaccination rate with the vaccines currently available won't change much.

How can you be almost sure ? Are you an immunologist or a contagious disease expert ? Do you have data to back this up ?

The information up to now was a mess, but one of the early "educated opinions" was that one is more contagious in the days just before the explosion of the symptoms. So, if that holds, and if you lived an active social life and tested from time to time, you risked being a spreader.

Second, about "getting antibodies the natural way": what about a 7 points IQ drop as a risk? What about a first-level-paretian-20-per-cent risk of long consequences, "the fifth wins four fifths of the jackpot"? A few made that reasoning and could tell you it was not a good idea, some still feel damaged. I invite you: do not focus on death as a risk.

Based on the error bars I've seen, you should be closer to 40% sure. Or less.

Maybe on the next mutation I'll have cause to agree with you. For now, herd immunity is still an endgame worth pursuing.

> Since no one under 16 has been vaccinated yet, about 70% of the population is vaccinated (44M out of 67M).

This fact really bothers me. I feel like once adults got vaccinated we all spiked the football and said "F--k the kids, I got mine".

The kids aren't in danger.

The kids weren't in danger, that appears to be changing very quickly with the new variant. Let's not be like George W. Bush standing on the aircraft carrier saying "mission accomplished", when we're still in the middle of this thing.

Show me data.

This "show me data" line works well in debates, but not in the real world. You often don't have the time or ability to wait for data to roll in, do a study, have it peer reviewed, and then make a decision. In real life you constantly have to make decisions under uncertain conditions with limited information of unknown quality. And that's the situation we're in right now.

We can send the kids back to school with no vaccines, no masks, no precautions, and say "We don't have any data that this thing is dangerous for children". The obvious problem there is that we don't have a ton of data in general with this variant. So, if we're wrong about the danger, we risk harming a lot of children while we dutifully wait for the data to roll in.

This is the same reason that most women (and many men for that matter) will cross the street late at night if they are on an empty street and see a large man approaching them. They have zero evidence suggesting that the person is a threat, but the cost of being wrong in such cases is very high. So, having limited data, they tend to take a very cautious and conservative approach and cross the street. In our case, just change, "Cross the street" to "Wear a mask".

This comparison is far from perfect, but you get the idea.

We are in a debate though - seems like a good time to show data.

No arguing on Hacker News is going to change the policy response anyway.

If you don’t have time to do those things, then the most reasonable thing to do is to assume that the results of those things still hold true.

In other words, whoever makes a claim that things have changed better provide a reason why it is reasonable to think things have changed. Typically that comes in data.

> The kids weren't in danger, that appears to be changing very quickly with the new variant

Death rate for kids with new variant please?

There is more than death. We still don't know enough about Long Covid - depending on who you believe it is anything from normal things blamed on Covid to additional life long complications. Until science figures this out (I expect it to take years) I don't know if it is safe to risk my kids or not.

And we still don’t know the long term effects of kids breathing god knows what substances these cheap Chinese masks contain. We also have no clue what it will do to their language and social development. Yet people cheer on forcing them to wear one for an entire school day 5 days a week.

Like what? This is the first I've heard such a thing. It isn't hard to do a chemical analysis, so if there was any grounding in it I'd expect to have seen a better source then a random comment.

That said, my kids are wearing made in the USA masks.

Right now kids are in danger because they are getting covid and RSV at the same time. RSV is surging in many areas of the USA.

"Dangerous" and "fatal" are not the same word. The Delta variant is more contagious, meaning more children are being hospitalized. Even if the Delta variant isn't "more dangerous" per case the same level of danger is more prevalent because of the contagion.

https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19...

also keep in mind that any "children" statistic refers to people anywhere in the range of 0-18

There is no data to this effect. There are some anecdotes from hospital staff saying they're seeing more kids now, but you might expect that given that adults are vaccinated.

Until there is data that shows conclusively that Delta affects kids more than previous variants, you should not parrot lines like "that appears to be changing quickly". Substantiate your claim with data or at least say it's anecdotal. Alternatively, if you have data, please share it.

I can see 2035’s viral video already. Targeting people who were too young to get jabbed, some of which still living with the effects of long COVID. Others blaming long COVID for other issues. The narrator turning them against us, endless b-roll of both anti-maskers and politicians reopening cities. How selfish of us, reopening before they were protected.

Actually the old have been fucking over the young to protect themselves since March 2020.

Speak for yourself, I have been parasitizing the young ever since before I was born.

We can test your model of reality. When X amount of youngsters get vaccinated, will we go back to normal? Ye or ne? My mental model says ne.

> That might be barely enough for herd immunity for some diseases

Also remember that herd immunity works best when those who are antibodies are evenly distributed. Schools will become major places where it's spread because of how many people without immunity are in one place.

Herd immunity cannot be measured by an arbitrary percentage. Maybe it is 70% or 80%, but only if that's a random sample of the population. Social networks determine the relevance. If you have a single homogenous group of individuals that interact with each other that is unvaccinated then there's still plenty of threats. And that generally includes children as a big intermingling block.

The vaccine isn't a vaccine, it's a treatment. Cases are a poor indicator. It's time to go back to normal.

What's delta like for under 16?

In the US through May 2021, so it might not be a good representation for delta, here were the infections, hospitalizations, and deaths per 100k for various age groups:

    Age Inf Hosp Deaths
   0-17 37k  287    0.5
  18-49 44k 1100   25
  50-64 32k 2600   85
  65+   22k 5200 1140

Unless the numbers for delta are way higher, that suggests that for under 17 getting your immunity by actually getting COVID is fine. The main reason then you want to prevent kids from getting COVID is not so much for its danger to them but rather for the danger to the adults that the kids will spread it to. Kid gives it to a grandparent, and that grandparent is 20x as likely to be hospitalized and 2000x as likely to die as the kid. If the kid gives it to their parents, the parents are 4x as likely to be hospitalized and 50x as likely to die.

If the numbers for delta are at all similar for kids, then there is a good chance that there is not much difference between a population where everybody gets vaccinated and population where all the adults get vaccinated but the kids do not, suggesting vaccinating adults should be the priority.

The long term endgame is probably a population where it is endemic, everyone gets it as a child when they are young enough that it doesn't cause serious illness, and then keeps getting it every year or so for the rest of their lives. Those subsequent cases don't cause serious illness because they still have protection from the last time.

That's what happened with the four other coronaviruses that are in wide circulations in humans. They are thought to have caused terrible pandemics when they first got to humans which were deadly in adults but not bad in children. Nowadays they are still around, everyone gets them frequently, and we don't even bother to have a separate name for the illness they cause. We just lump it in with the illnesses from a bunch of other viruses and call it the common cold. Around 20% of common colds are from those coronaviruses.

How do you get half a death?!

.5 deaths per 100K is 1 death per 200K.

for comparison, all cause mortality[0] in infants (<1yr) is ~500/100K, and for 1-19 year olds, ~100/100K. for kids, covid is not even a blip on the mortality chart, being 2-3 orders of magnitude smaller.

[0]: https://www.childtrends.org/indicators/infant-child-and-teen...

Even with your numbers it puts a kid's chances of ending up hospitalized with covid at 1 in 128. Granted we're probably way under counting infections in that age group, but I'll still feel much better when my kid is vaccinated.

The positive case count is not the denominator. The chances of your kid ending up hospitalized with Covid are 287 / 100K, or .29%.

There's about 50 million kids under 12 in the US, so while that percentage looks small that's still ~150,000 kids going to the hospital. I believe the real percentage is probably a bit lower due to underreported infections, but it's worth remembering that even small percentages can have huge effects in a country with hundreds of millions of people.

Yes, given a large denominator rare events will happen. So what?

The relevant argument with kids and Delta is not about whether it happens to some people, it's whether the risk rates high enough to mobilize large scale, disruptive countermeasures.

I can only find data on deaths, not hospitalizations [1], but assuming the numbers are roughly proportional here are things that are more dangerous to kids than Delta:

  - Drug ODs
  - Car accidents
  - Cancer
  - Heart disease
  - Drowning
  - Suffocation

Caveat of course is that the data might be out of date, at least with respect to pockets with high rates of infection

[1] https://www.nejm.org/doi/full/10.1056/nejmsr1804754

Can you help me understand why the case count isn't the denominator?

The posted numbers seem to imply that if 37k out of 100k kids had covid, 287 of them end up in the hospital. Does it not follow that if 100k out of 100k had covid that 775 kids would have been hospitalized?

It's in your parent comment:

> Granted we're probably way under counting infections in that age group

People get tested when they feel sick enough to be worried, there are many very minor and/or asymptomatic cases for which we won't have data. By using the positive case counts as the denominator you are using the most serious slice of cases to argue that coronavirus infections are serious.

I'm not sure that follows. That would imply that every kid has already had/been exposed to COVID and that's resulted in those per 100k numbers.

It's definitely not exact to use the infection as the denominator, but I'd argue it's much closer than using the 100k as the denominator. I think I stand by my original post.

Not to mention risks of long term effects.

Like you, I can't wait until the vaccines are approved for under 12 children.

> That's what happened with the four other coronaviruses that are in wide circulations in humans. They are thought to have caused terrible pandemics when they first got to humans which were deadly in adults but not bad in children.

Yes, this is now thought to be the case for the 1889-1890 pandemic.

>That might be barely enough for herd immunity for some diseases

How can herd immunity be achieved with a leaky vaccine?

The UK seems to have a 62% full vaccination rate with 71% having at least one dose[0]. That sounds really low to me. "Close to full vaccination" to me would imply close to 100% or, reading "full" as "reaching herd immunity" I'd think 70-80% fully vaccinated - still a very long way to go.

I hear you that we will eventually reach a point where we've hit the new normal. It's just going to be whether that point is reached because we've given up (due to people refusing to vaccinate) or because we've managed to vaccinate enough. I think many people aren't ready to give up. Personally, the restrictions are quite meaningless to me in the US, but I can imagine that that's just because I get to work from home and all that.

[0] https://www.nytimes.com/interactive/2021/world/united-kingdo...

> That sounds really low to me.

Low compared to what? Do you know the vaccinations rates for all other diseases for which we have vaccines for?

Low compared to my third fucking sentence jesus christ.

92% of Brits have COVID antibodies, either through exposure or immunity:

https://news.sky.com/story/covid-19-around-nine-in-10-adults...

92% of the Brits eligible for vaccination.

That feels a little selective.

> Latest estimates from the Office for National Statistics (ONS) show 89.8% of adults in England are likely to have the antibodies, with the highest percentage of adults testing positive for them estimated to be the age groups 60 to 64, 70 to 74 and 75 to 79 (all 96.8%).

> The lowest percentage was for 16 to 24-year-olds at around 59.7%.

The 92% (91.8% cited) is presumably from this sentence?

> In Wales, 91.8% of adults are estimated to have antibodies in their system

The UK has only just started vaccinating under-18s, who make up a significant chunk of the population, and they are not vaccinating anyone under 16 yet. This is going to skew the numbers a bit. Among older age groups the numbers get up into the 80s and 90s.

We are also lagging among BAME groups and in certain economically deprived areas. If you are a white 75 year-old in Wimbledon the odds that you are vaccinated are around 95%, while if you are a 30 year-old Pakistani immigrant in Bradford then I would put the odds closer to 50%. Still a long way to go, but constantly improving.

>a 30 year-old Pakistani immigrant in Bradford

Are there reasons for hesitancy expressed among the population?

Due to the vaccine not being approved for children yet, the numbers will be low. Here in Canada it appears to lag by about 10% of the eligible population, so until that happens, 80% is probably the maximum limit I would expect.

However, with the high R0 of Delta taking its toll, it looks like places are starting to take the approach of making people's lives more limited if they aren't fully vaccinated without quite going to the level of mandating vaccination.

Spread of sars-cov-2 in human populations can be stopped. It first requires intramuscular vaccination to provide IgG antibodies in the body proper to prevent serious disease and then just as importantly, an intranasal vaccination to provide resident B and T cells in the surface mucosa tissues of the upper respiratory tract where the B cells will make local IgA antibodies and provide sterilizing immunity and prevent spread from person to person.

Intranasal boosters are the one obvious thing we could do top-down to end the pandemic and only have to deal with epidemics.

ref: https://science.sciencemag.org/content/373/6553/397

ref: https://www.gov.uk/government/publications/long-term-evoluti... page 5, #8. "Whilst we feel that current vaccines are excellent for reducing the risk of hospital admission and disease, we propose that research be focused on vaccines that also induce high and durable levels of mucosal immunity in order to reduce infection of and transmission from vaccinated individuals. This could also reduce the possibility of variant selection in vaccinated individuals."

ref: https://www.nature.com/articles/s41577-021-00550-x

Israel has close to full vaccination, yet cases are going up because immunity is falling again and there are new variants. It's understandable why the restrictions are back again.

But what's the end goal? Do we keep lockdown restrictions forever? The case fatality rate for a vaccinated population is really low. There must be an acceptable level - after all we don't lock down for other endemic viruses which also have non-zero CFRs. What is it? Have we reached it?

We'll have to have some restrictions in place for the highest-risk activities. I really wouldn't want to give introductory lectures in a room that seats 250 people and has been in use all day and then find out, like the Reverend Jackson, that the vaccine protection has worn off.

>I really wouldn't want to give introductory lectures in a room that seats 250 people and has been in use all day and then find out, like the Reverend Jackson, that the vaccine protection has worn off.

Ok then don't? No one is forcing you to go out.

Let everyone else make their own decisions. I'm kinda tired of the hypochondriacs forcing everyone else to do what they want. Everyone has access to the vaccine, they can stay in and mask all they want, they do not have to go near people. There's absolutely no reason to be locking down the rest of society. The only argument to keep these restrictions in place is if the hospitals get over capacity and that's not happening.

> if the hospitals get over capacity and that's not happening

It’s happening in quite a few places.

Some of these people appear to live in a completely different reality.

Data for hospitals that are over capacity in the US please. Should be easy to find since I'm apparently living in alternate reality.

https://protect-public.hhs.gov/pages/hospital-utilization

Additionally you need to provide a strategy that would stop this. Since apparently mass vaccination and locking down for nearly 2 years didn't help. Or you can keep supporting the same thing and hoping for different results.

Show me the data for the US please.

https://protect-public.hhs.gov/pages/hospital-utilization

Everyone can make their own decisions, but can everyone give an introductory lecture? Perhaps the 250 attendees can decide if they want to be there in person or remotely, why would you remove that choice from the person giving the lecture?

And we are not talking about locking down the rest of society. That was the extreme end of the spectrum when we were trying to get it under control. The only place still with national lockdowns are NZ and Australia because they were able to contain and control the virus earlier on.

Sounds like you are equating your experience with everyone. Not everyone has access to the vaccine, not everyone is able to work remotely, some people have to interact with the public as part of their job. Perhaps try looking at things from the perspective of people who are less fortunate than yourself.

There is an underlying current of selfishness behind everything you say.

> Perhaps the 250 attendees can decide if they want to be there in person or remotely, why would you remove that choice from the person giving the lecture?

If the lecturer is remote, then the 250 attendees don't have the choice to be there in person.

Big screen in a lecture hall is one option.

>Everyone can make their own decisions, but can everyone give an introductory lecture? Perhaps the 250 attendees can decide if they want to be there in person or remotely, why would you remove that choice from the person giving the lecture?

How am I removing that choice? Did I say anywhere they were not allowed to host it virtually if they chose to do so? The only one removing choices is the individual that decides they don't want anyone in person.

>Sounds like you are equating your experience with everyone. Not everyone has access to the vaccine, not everyone is able to work remotely, some people have to interact with the public as part of their job. Perhaps try looking at things from the perspective of people who are less fortunate than yourself.

Every reason you listed here only supports NOT locking down. Everyone in the US does have access to the vaccine. I am looking at it correctly, you're the one that wants people not to work by locking down everything. What's your solution? Wait until everyone gets it, which will never happen?

The irony in calling me the selfish one. I'm not making anyone do anything here. Exactly how is telling everyone they must do something not selfish? Anyone supporting more lockdowns/masking at this point is only doing it for themselves and no one else.

I have not proposed a lockdown in any of my comments. I think you are looking for an argument with someone who wants another lockdown. I have not seen anyone proposing a new lockdown and think that the majority of people in the UK would neither support another lockdown or even think it is necessary.

Literally the only country that should be considering a lockdown at this stage is New Zealand due to them being a great way to prevent spread if there are very few cases in the general population and the majority of people are unvaccinated. For everyone else the only realistic solution.is vaccination for as much of the population as possible.

>The only place still with national lockdowns are NZ and Australia because they were able to contain and control the virus earlier on.

You literally supported lockdown measure with this comment. I'm not sure why you're backtracking now.

You might wanna backtrack on the whole AUS NZ thing since they've essentially become authoritarian police states over the COVID cases everyone told them they would get hit with. Turns out it had nothing to do with their measures and everything to do with the fact they're giant islands that can stop anyone coming into their country.

Oh I supported lockdown measures when they were first introduced. Because I am not an idiot. But now that we have vaccinations available they are a better option when the virus is so widespread. The UK is also an island and we could have cut ourselves off from travel and kept the virus out bit an incompetent government meant that never happened. So the best solution now is vaccination for as much of the population as possible.

Australia has gone a bit nuts but it's hardly a police state and NZ has fared very well and is very definitely not an authoritarian police state.

Of everywhere NZ has had the best handling of the situation. Of course it had everything to do with their measures, stopping international travel was one of those measures, lockdowns were another.

The only people who are being selfish are the people who insist the entire human population change their behavior in an extremely negative way for more than 1.6 years for a virus that we now have remarkably effective vaccines for that anybody at risk can take for free.

Sorry. It is selfish to ask people to continue to cower away in order to assuage peoples fear.

I'm tired of prudes telling me I can't drink and drive. Let everyone make their own decisions. Everyone else can stay home or drive sober if they want, but we shouldn't prevent the rest of society from having fun!

A better analogy than driving drunk would be driving at all.

I think the analogy is that there is a small percentage of our population that cannot drive a vehicle without dying and so everyone has to stay home and not drive in order to get rid of the .06% of of the population that will die driving on the road.

I wasn't aware that you could pass drunkenness through the air with no symptoms. That's new to me.

Are you suggesting we should all be responsible for stopping other people from drunk driving and also stopping anyone from getting into a car with a drunk driver? Are you also attempting to suggest that everyone else get should have their drivers' license revoked for the few that are caught drunk driving? That's essentially what masking, forced vaccination, mandated passports is.

Might wanna find a new metaphor. I'm sure you think that was an intelligent comparison but it absolutely sucks. You're comparing something that would take a deliberate act to something that might or might not be happening passively to you.

I agree it's not a great metaphor, but my point is that "let everyone make their own decisions" isn't some end-all argument. All rules and laws in society are about not letting people do whatever they want for the benefit of society at large.

Also you're trying to appeal to emotion by framing mask wearing as some sort of punishment ("revoking" people's drivers licenses) vs a precaution (like wearing a seatbelt... or not driving drunk). Furthermore, people caught drunk driving DO get their licenses taken away.

>Also you're trying to appeal to emotion by framing mask wearing as some sort of punishment

That's because I do view it as a punishment. Maybe you like wearing a mask, I do not. I got vaccinated and stayed away from big events, masked etc. for 2 years. I did my part, I'm done.

Enough with this kindergarten level discipline. It's like punishing the entire class for the one kid that can't keep quiet. Yeah the noisy kid is an ass and should be quiet but the teacher is the one you should really be mad at.

For how long? Certainly you can't mean forever.

Yes, forever, like gay men won't have orgies without condom any more.

The acceptable level is pretty much defined by when the hospitals aren't falling over again.

If everyone would just get vaccinated, we'd be there.

Instead people are for whatever reason ignoring the risks of the virus, and if the rate of hospitalization in their age category is only 1 in 50, enough of them making that choice mean that 2% of them guessing wrong is knocking the hospital system over again.

Maybe without a vaccination card or other pass that you're ineligible for the vaccine you get triaged right back out the door. That would help the hospital capacity, encourage vaccination, etc but it will probably need to get a bit more morgue capacity ramped up. Easier to train for.

The hippocratic oath prevents that fantasy.

That's why I called it triage. You can give steroids and O2 for home consumption? I guess it depends on the seriousness, on average, of the other people who are unable to use the hospital's services because it's overloaded and what their mortality rate is vs the unvaccinated who show up and are given some reasonable treatment to try, but not a bed. Not an easy decision or calculation to come up with.

The acheivable goal of lockdowns outside of effictively island countries is to keep hospitals open with sufficient capacity. When hospitals don't have enough capacity, any reason to go to the hospital has a worse outcome. Physical beds are one thing, but staffing is a bigger issue.

The problem is it's a tricky system to manage. We can measure hospital utilization, but that lags infections. We can mandate lockdowns, but compliance varies and too many changes risks more non-compliance.

Also, there are existing reasons leading to too many people in hospitals that reduces capacity. And systemic issues that make staffing a challenge.

Public acceptance of perpetual lockdowns, or at least at-will lockdowns, probably is the goal. People get more tolerant of authoritarian governments when there's a high prevalence of infectious disease. Governments seeking re-election pushing a narrative that the danger from infectious diseases is high while also being seen to be 'doing something' is likely a self-reinforcing dynamic.

To be honest, until two weeks ago the official narrative has been that we'll all go back to normal once everyone has taken the vaccine. Unfortunately, the virus has thrown a spanner into the works. This wasn't planned.

Maybe you remember way back at the very beginning that it was "two weeks to slow the spread"?

The narrative has always been we‘ll be back to normal in X weeks if we are all good little boys and girls and do what we‘re told. Unless of course some other really good reason to lockdown arises, like that single case in NZ.

By single case I assume you're referring the outbreak that has spread to 100+ cases in the last week (from transmission before the lockdown and associated households). If you use a country as an example, then please represent the situation there accurately.

"New Zealand To Begin a Three-Day Lockdown after a Single Case is Reported." Headline from The New York Times 5 days ago.

I'm willing to believe this is fake news from the NYT, or that the situation has changed, but others are reporting it as well.

Covid is like roaches, there's never just one. One case turns up, but meanwhile that individual infected dozens others who are not symptomatic yet. But with a lockdown the contagion spreads less quickly, and you can do contact tracing and isolate the affected people. Indeed, the headline from two days ago is "Delta outbreak spreading rapidly as cases jump"

Meanwhile at my regional institution the students are beginning to grumble. Let's go back online, they say, too many instructors cancel lecture because they are sick with covid and too many students can't attend class because they in bed with covid. That's what excess freedom looks like.

Israel is at 68%. I wouldn't call that close to full. Portugal is at 82%, and I wouldn't even call that full.

Portugal is at 66%

Portugal: 66.5% double jab, 75.8% at-least-single-jab. (22 Aug 2021)

(I was right in front of ourworldindata.org)

It is not because of the new variants and antibody escape. Prior variants before delta, gamma specifically, actually escape antibody neutralization far more than delta does.

No, what the world is seeing is that intramuscular vaccination for respiratory diseases does not provide long lasting IgG antibodies to the upper respiratory mucosa tissues. They seep into the lower lungs and provide protection there though. This has been known since the 1960s when the first intranasal flu vaccinations were introduced to combat the problem.

It wouldn't matter what variant is going around, it just happens to be delta now. The problem is the lack of persistent IgG antibodies in the surface mucosal tissues. To get long term protection from infection of these you need intranasal vaccination to recruit resident B and T cells to the mucosa to make IgA antibodies. Intramuscular does not prevent spread, it only prevents hospitalization and death. This is also true for intramuscular flu vaccination.

Yeah it's sad to see death rate spiking back up as well. https://www.worldometers.info/coronavirus/country/israel/

It's better than before, but it's too dangerous.

Maybe the only out of this is wait for more mutations with lower fatality.

If COVID is here to stay and previous lockdowns still did not stop the spread, even with vaccine rates at almost everyone, how is another lockdown going to stop it? This isn't just ignorant "muh freedoms" talking here but irrational governments playing god too much as if they could even possibly do that that without complete fascistic control.

Yet deaths aren't.

The UK dropped all restrictions with the exception of some travel related restrictions (to prevent the import of variants that could breakthrough the vaccine).

Any restrictions you see in the UK are implemented by businesses/local government (e.g. masks on the tube, or in some shops).

That is fake news, sorry

The law to imprison yourself (isolate) still is very much a law.

What restrictions do you mean? I am in the UK and facing no restrictions in daily life.

No restriction? You will have a nasty surprise if you return from a red list country. Plus mandatory covid tests before and after returning to the UK. Plus mandatory face masks in public transports. Plus mandatory self-quarantine if you are pinged by the NHS app. Many companies have not returned to the office. We are not back to normal.

> Many companies have not returned to the office. We are not back to normal.

This is the new normal (thankfully). Government regulations or not, management will not be able to force people back in the office. Office culture was a quirk of the 20th century. A halfway house between the assembly line and the internet. Covid just forced its inevitable collapse.

Yeah my team will meet in the office for an hour once a week otherwise WFH.

I suspect once the bean counters discover that the office is only used for an hour once a week also after corona there will be pressure to remove a lot of the seats.

The only one really resisting at my company is the "office manager" for some reason ;)

> Plus mandatory face masks in public transports.

I really hope this will stay forever, or at least until people don't learn to stay home when they get a cold

"or at least until people don't learn to stay home when they get a cold "

Not everyone can afford that, with a fear of losing their jobs.

Then we need better labor laws.

Possible, but it is hard to implement in a failsave way.

How can the new employee proof he was fired, because he was sick too often?

last time i tried to stay home [from a public facing food service position] due to the flu i was fired over Christmas. until you change the culture around working through illness and the punitive nature of sick days, especially for those with children, people are not gonna stay home if they think they can tough it out.

We're better than normal. My employer already decided to allow up to 60% time remote, no questions asked, forever. You can still come 100% of the time to the office if you want. Some restrictions are still in place, but the future seems brighter for the workplace.

Enforcement is a total joke though.

Well in the UK we've had three separate scandals where major government officials (including the fucking HEALTH SECRETARY) were caught flagrantly violating their own rules with minimal consequence, so you can hardly blame the public for taking things no more seriously than our leadership does.

> Plus mandatory self-quarantine if you are pinged by the NHS app.

I think you're poorly informed - it has never been mandatory to self-quarantine if pinged by the app.

And government mandated face masks on public transport went away on the 19th of July - but people are still encouraged and I think required by some individual institutions not by Her Majesty's Government.

And I don't think jet-setting around is 'daily life' so that's disingenuous.

self quarantine through the app couldn't be mandatory seeing as the app isn't mandatory

The only thing OP has a point on is travel abroad, which yeh as you say isn't really daily life for the majority of people and probably isn't too big a pill to swallow temporarily, and continued working from home, which to my knowledge is the choice of companies, not the government (though either way, I'm not complaining)

> Plus mandatory face masks in public transports.

Not true. There is no national requirement to wear a mask on public transport. London Underground and the Manchester Metro have used mayoral powers to require mask wearing - with variable compliance. Elsewhere its down to individual choice.

> Plus mandatory self-quarantine if you are pinged by the NHS app.

Not true. The app gives a recommendation. Only the NHS test and trace service can legally require you to self isolate. And for that you need to test positive (pcr) and not be fully vaccinated.

> with variable compliance

Anecdotally, it seems to me that around 70-80% of people on the London Underground are still wearing masks. Which is to say that the "mandate" is a joke (like so many of our restrictions have been) and clearly isn't being enforced.

The percentage of people wearing masks on the tube, where masks are "compulsory", doesn't seem much higher than the percentage of people who are voluntarily wearing masks in other public places which have no mandate, so the fact that most people are still wearing masks on the Tube is probably less because of the mandate and more because of people's general sense of precaution/paranoia. I suspect if the mask mandate were lifted then most people would continue to wear masks voluntarily anyway, just as they're still doing at the supermarket.

No mandatory face masks on public transport, and only advisory quarantine if you are pinged by the app. I don't want to go back to the office.

Sure it may differ If I travel but that's one restriction not a multitude as you suggest.

Same for Denmark. We are at 85% first dose and 78% second dose for the 5.1m people a vaccine was offered, so we are at 75% of the population with at least one dose [1]. Everything is open, there is a suggestion to wear masks in metro, no idea about buses or trains.

[1] https://www.sst.dk/en/english/corona-eng/status-of-the-epide...

Aren't the vaccines still not available for those under 12? And they're emergency use only in many of those countries? Not sure how you can say any country, even Israel, is "close to full vaccination". 28% of their population is 14 and under.

https://en.wikipedia.org/wiki/Demographics_of_Israel#Age_str...

1 year ago the hive mind was buzzing about protecting the "elderly/infirm" with the warp drive wunder drugs. So it shouldn't be surprising that "full vaccination" might be calculated with "elderly/infirm" pop in the denominator.

There are studies ongoing and Singapore is planning to vaccinate kids below 12 as early as next year. https://www.asiaone.com/singapore/3rd-shot-covid-19-vaccine-...

The vaccination rate in the UK is 67%. A year ago the estimate was that we need about a 75% vaccination rate to reach herd immunity, and I doubt that the new mutations have pushed that number down.

Yes, with the Delta variant herd immunity seems out of reach according to experts, as vaccines can't completely stop transmission:

https://www.theguardian.com/world/2021/aug/10/delta-variant-...

https://www.theatlantic.com/health/archive/2021/02/herd-immu...

That's not strictly settled science. The truth is herd immunity / lack thereof is well within the error bars of the vaccine efficacy / R0 estimates. We don't actually know, but it looks like the delta curve is peaking in some areas so my bet is in favor of herd immunity.

> That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK

I cracked some ribs three weeks ago and coughing / sneezing are really painful. I am keeping my mask on because I really don't want even a mild cough, for whatever reason.

More generally, the vaccines are not 100% effective, the virus can still be transmitted and spread. For lots of people, getting COVID is still life threatening, even if the average case is not as bad as it used to be.

So you want country wide restrictions solely for your own comfort? Sounds incredibly selfish.

You really don't see the irony in this statement, do you.

That is exactly what people are asking for and it is super selfish. Asking everybody to hunker down to assuage people who continue to be afraid.

Sorry. Life is short. I’ve sacrificed 1.6 years of it for something I’ve never been afraid of. I’ve played by all the rules, but enough is enough. It is super selfish to insist we continue to live this way. We aren’t living, we are being kept alive… life was meant to be lived.

I don't care about myself but the social isolation of kids was pretty bad. I hope we can get back to where they can fully interact with each other again.

We could do it today if we wanted to. The only thing stoping it is tribalism and irrational fear.

Well, it's been profitable so far, so of course it's going to get milked for as long as possible.

https://inequality.org/great-divide/updates-billionaire-pand...

> That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK.

There are almost no UK legal restrictions relating to covid. There are some rules about people returning from certain high risk countries. And unvaccinated people who test positive still have to self isolate. And that's about it.

Many people (like myself) still wear masks in busy indoor locations. And many are choosing to forego foreign holidays this summer.

Life here in the UK doesn't feel entirely normal, but it's much much nearer to pre-pandemic conditions than this time last year.

> many are choosing to forego foreign holidays this summer

"Choosing" is a strange way to put it when COVID testing and quarantine requirements have added hundreds (and in some cases thousands) of pounds to the cost of most foreign holidays and the rules are changing so frequently and suddenly that it's a big financial risk to book anything more than a few days in advance.

> That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK.

Until the number needed for herd immunity is achieved, the 30% (or whatever) of your population that is not vaccinated can suffer devastating spikes in cases. Mostly having herd immunity is not a thing.

The UK already went ahead and reponed prematurely with a huge influx of new cases following

Don’t know about the UK but in other EU countries with near full vaccination rates it does seem like they want a perpetual semi lockdown yes. Directive 10-289.

once you have power its hard to give it up

Yes

Yes, yes they do. And they're even starting to be honest about it, look at the press coming out of NZ and Scotland. Many of us called this the second the lockdowns started and we were right. Coronavirus is real, but it's nothing more than another SARS, H1N1, Hong Kong flu, etc. The only difference between now and then is now governments were prepped for a full on power grab.

> Coronavirus is real, but it's nothing more than another SARS, H1N1, Hong Kong flu, etc.

SARS in 2002-2004 killed 811 people. H1N1 killed 18,500 in 2009. Neither of those had the sort of mass lock-downs mitigating their spread that we are experiencing now. I don't know about you, but I can see a big difference.

To slow the spread so that hospitals are not overwhelmed. You can be up for letting it spread through everyone, but not think that letting everyone catch it at once is sensible.

Maybe "mask requirements" are a sign of society advancing? There was a time in human history when we didn't bathe regularly, or brush our teeth, or have sewage removal systems in cities, etc. Maybe the next step is "you know, breathing in particles that came from the other 600 people in this railcar is not so great".

I certainly don't see a reason to go maskless on public transportation in the future. And, as supply chain problems work themselves out, someone will probably make masks that actually filter out virus-size particles and fit more people's faces. (I feel like every mask I've bought so far during the pandemic has either been completely ineffective, or has been designed to fit someone that is 1/3 my size.)

You're saying society should keep wearing masks everywhere literally forever? That's so insane I can't tell whether you're even serious.

Is there a particular reason you think that people shouldn't keep wearing masks everywhere literally forever, or is it just that it hurts your feelings?

Barely a century ago, it wasn't common for doctors to wash their hands, because it hurt doctors' feelings. Dr. Charles Meigs, an obstetrician, said, "Doctors are gentlemen and a gentleman's hands are clean."

But, of course, factually they weren't clean, factually they were full of germs, and factually Dr. Meigs was killing several of the people he operated on through his unclean hands. There was factual data that infant mortality dropped significantly in clinics where doctors were washing their hands.

But the response to hand-washing was much like yours. "You're saying society should keep washing hands everywhere literally forever? That's so insane I can't tell whether you're even serious." And in fact they sent the doctor who suggested hand-washing to an insane asylum, where he died.

https://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz...

Doctors washing their hands saves way more lives than masks do, and hand washing doesn't have negative side effects like masks do (e.g., constantly fogging up glasses, and keeping people who are hard of hearing from reading lips).

It is very important for young children to be able to see one's entire face. Facial expressions such as smiles help them understand context when communicating.

Who in the world is downvoting a statement like this?

I think you should pretty much ignore voting in contentious political threads. People have it in their heads that the "side" with the most upvotes "wins", so people are reading comments to determine sides and then to vote appropriately.

All I can say is that people are going to be super upset when they go to cash in their HN karma and find that it isn't honored as legal tender ;)

I'm just happy HN is such a fringe community not representative of the general population. It's pretty sad when you reach a point where you make medical decisions to "own" the "other team".

Your example is incorrect, actually.

This scenario [1] is a specific instance of using chlorinated lime to clean your hands after dealing with cadavers, which is a totally different scenario. In fact, he apparently references this as an alternative to "normal hand washing". The mid-19th century is not the middle ages, we knew about washing hands.

> Semmelweis's key claim was that physicians contaminated their hands with "cadaveric particles" in the morgue while conducting autopsies. He pointed out that ordinary washings with soap did not remove these particles, because the hands could retain a stench for several days in spite of such washings.

[1] https://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz...

Ahh, I too remember when escalators instead of stairs were seen as so insane that the public couldn't tell whether the mall owners were serious...

Interesting. Were you required to strap an escalator to your face?

Is it insane that everyone should keep wearing clothes everywhere literally forever?

If I found being nude to be significantly more comfortable/freeing than being clothed, I would still be expected to wear clothing in public spaces for both politeness and sanitary (e.g. sitting on subway seats) reasons.

Well by that logic, why stop at masks? Let's make everyone wear rubber gloves whenever they leave the house. Let's legally mandate that everyone carry antibacterial handgel on them at all times and wash their hands after touching any surface. Let's ban handshaking - hell, why don't we just permanently ban everybody from ever leaving their homes? That'll be sure to stop the spread of respiratory viruses and thus totally worth it, amirite?

And why stop at respiratory viruses? Sexual infections cause all kinds of harm too - the obvious response is to ban sex. When people want to reproduce they can just use IVF - thank God we live in the modern era.

And by the way, do you have any idea how many people are killed every year in road accidents? I propose we ban cars. Let's also ban walking in case anybody trips over. And let's ban eating so that no-one ever chokes on their food.

Am I doing this right?

Yeah. I basically agree with the article:

> The experience may also prompt people to take all respiratory viruses more seriously, leading to lasting changes in mask wearing and ventilation.

I don't think that mask mandates will continue, but I do think that many more people will choose to wear masks in situations that warrant them. In Asia, it was already pretty common before COVID-19 and even before SARS. Walk around Tokyo on any given day and you'll see people wearing masks (mostly to protect others). I think the West now has some idea why that might be a good thing.

The world has irreversibly changed. There is no getting around that.

Curious what kind of design workarounds we'll see for really hot and/or humid regions -- where I live, it's pretty comfortable to wear a mask 90% of the time. But where my parents live, it's a very different story: hot, humidity 90%+ a lot of the time, often rainy, few places have A/C. Wearing a mask is a lot less pleasant there and I suspect that's part of why mask mandates have seen resistance there.

> That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK

If you get it after being vaccinated, you still have a ~20% chance of becoming disabled.

That's a really extraordinary claim with no evidence whatsoever.

How does this not count as evidence?:

https://www.nytimes.com/2021/08/16/well/live/vaccine-long-co...

It literally says: "While most of the breakthrough cases were mild or asymptomatic, seven out of 36 workers tracked at six weeks (19 percent) still had persistent symptoms. These long Covid symptoms included a mix of prolonged loss of smell, persistent cough, fatigue, weakness, labored breathing or muscle pain."

It's certainly not great data, but it's still the best information we have as of right now.

I don't think very many reasonable people would count a "persistent cough" as "becoming disabled".

When you have a persistent cough due to lung damage then your chances of death the next time you catch a minor illness go through the roof. It's why so many of the people who survived SARS initially are no longer alive.

calling that "disabled" is incredibly misleading to the point of being disingenuous.

I mean if you're basically paralyzed, how does that not count as being disabled? What do you think muscle weakness and fatigue actually means in this context?

Nobody reasonable would say "muscle weakness and fatigue" means "you're basically paralyzed".

Muscle weakness and fatigue is in no way shape or form like paralysis.

I'm starting to think you've never encountered someone with a disability in your life.

> Muscle weakness and fatigue is in no way shape or form like paralysis.

Having muscle weakness in your arms mean that you can't do things like raising your hands to chest level and squeezing someone's hand. In practice it means you can't do everyday things like opening doors, or else can only do them with great difficulty.

Having muscle weakness in the legs means that if you're lying on your back, you don't have the ability to raise your legs off the ground. In practice, it means that you can't do everyday things like walking, or else can only do them with great difficulty and probably some form of assistance.

It's obviously not exactly the same as being paralyzed, but it's not that far off either. On the spectrum from "I'm not setting new deadlift PRs lately" to "I'm likely going to hospice soon", it's a lot closer to the latter than the former. There's a good chance that it means using a wheelchair, possibly indefinitely. I think you're doing people an extreme disservice by underplaying how serious this is.

With paralysis, the cause is usually traumatic spinal cord injury. Whereas with muscle weakness, the cause is usually something more like an autoimmune disease attacking the tissue around your spinal cord. But in both cases the end result is nerve signals not getting properly transmitted, and the impact on everyday life is pretty similar.

COVID doesn't cause what you just described as "muscle weakness" in anywhere near 20% of people. The thing it causes that other people describe as "muscle weakness" is much closer to "I'm not setting new deadlift PRs lately".

Muscle weakness is a standardized medical diagnosis. When you see the term being used in a medical paper, it always means the same thing. C.f.: https://www.aafp.org/afp/2005/0401/p1327.html

This is basically the same argument that gets trotted out whenever someone points out Telsa's deceptive advertising wrt "autopilot".

"Real pilots know that autopilot means you still have to pay attention - nevermind that 99.9% of society thinks that idiom means they can sleep behind the wheel while it's turned on"

This is worse than that. With that, the argument sticks with that one definition throughout. Here, one meaning of "muscle weakness" is being used to make it sound scary, and another meaning is used to say COVID causes it. It's the equivocation fallacy.

So you're arguing that the New England Journal of Medicine article is using the word "weakness" in a colloquial sense, rather than in the medical sense, in the same sentence that the words "dyspnea" and "myalgia" appear?:

https://www.nejm.org/doi/full/10.1056/NEJMoa2109072

In the case of the U.K., it's the population (not the government) that is holding things back. My impression is that Boris Johnson is opening things up as fast as he thinks he can get away with, without an enormous backlash that gets him removed from office. Unlike, say, France where the positions of government and popular backlash are reversed.

Boris isn't in danger. He got what he always wanted - to be a wartime PM

> That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK

Because it s not about the pandemic. It s about asserting control over population and making them obey whatever govts, ongs, big pharma or big corps come up with. A kind of a mass scale social engineering project.

Edit: this btw doesn t need to be some sort of a secret group project. It can rise naturally and decentralized among many connected decision groups(govts, academia, big corps, etc) which already happened.

A pandemic seems like an awfully long and expensive way of doing that, especially considering they already did so before the pandemic through so many means (many of which actually make them money rather than cost them, I assume you pay taxes?)

The only group who can be said to have really profited off this is pharma. Maybe they have orchestrated the whole thing, but I'd like to see some evidence first.

The pandemic doesn't need to have been deliberately engineered; it only needed to provide an opportunity for nefarious actors to exploit.

Unless you think we're living through the only crisis in history which powerful people haven't exploited to further their existing agendas.

Well again that's not particularly new, even outside a crisis, that's part of every day life. Your hardly a nefarious actor if you're not exploiting anything.

Why is this different from other instances of governments instituting laws or regulations for the sake of public safety, of which there are already many?

Are seatbelt laws a mass experiment in social control?

Are laws mandating wearing underwear in public "about asserting control over population and making them obey"?

> Are seatbelt laws a mass experiment in social control?

For this, or other instances you might come up with, you had a large consensus between the rulers and the ruled. No one questioned the motif behind seatbelt wearing or other public safety measures.

Do you have such a consensus for vaccine mandates, lockdowns, mask wearing or covid passports? It seems not. The only consensus you have is at the top between those who hold the power, resources and influence.

When you have skeptic voices and vaccine hesitant people among medical personnel we can t really talk about a consensus. If you can't even persuade some doctor or nurse to agree with your medical decisions without using coercion what should the average joe do? What does that tell us about the motifs of those that hold the decision power?

>That's why I don't really understand why there are still covid restrictions in countries that are close to full vaccination, like the UK. There isn't really a next step after having vaccinated the population, it is "steady state". So do they want us to have these restrictions (countries you can't travel to, endless testing, mask requirements) forever?

Our government loves to pat themselves on the back having 80% vaccination. Which is more than double the usual flu shot rates. Yet here we are with a 4th wave, talk about complete lockdown.

At what point do you say that our approach is no different than the usual flu season? In my opinion that was long ago.

So why? Technically don't know the answer. You can look at it from liberties point of view. That the reason these restrictions haven't lifted has nothing to do with covid.

Another theory which seems legit. Vaccine doesnt work. If you follow texas gov abbot. TONS of articles slamming him for getting covid. https://www.cnbc.com/2021/08/17/texas-gov-abbott-who-banned-...

Texas Gov. Abbott, who banned mask and vaccine mandates, tests positive for Covid

But wait... Abbott is fully vaccinated. That's a huge issue. You can't slam him banning masks and all that. Vaccination is vaccination.

Article title should be "Texas Gov. Abbott, who is fully vaccinated, tests positive for Covid"

But that's where the politics of the situation come in. It's very evident covid-19 is completely influenced by politics. Which brings you right back to liberties point of view.

Greg Abbot even received a booster shot prior to infection.

https://www.nbcnews.com/politics/politics-news/texas-gov-gre...

> But wait... Abbott is fully vaccinated. That's a huge issue.

No, its not. While the rates are somewhat higher with Delta, breakthrough infections were always expected. The accines reduce the probability of getting COVID with similar exposure, they don't 100% prevent it.

> You can't slam him banning masks and all that.

Yes, you can. Even if schools weren't full of unvaccinated people, which they are, the existence of breakthrough infections would underline why banning mask mandates is a culpablr error.

>No, its not. While the rates are somewhat higher with Delta, breakthrough infections were always expected. The accines reduce the probability of getting COVID with similar exposure, they don't 100% prevent it.

That's not my understanding, I'm in IT and not a biologist or whatever. So perhaps you can explain to me.

A vaccine is something that boosts/helps the immune system develop protection against the disease.

Measles vaccine means nobody got measles until antivaxers started spreading measles.

Yes there can be a portion of society which does not have an immune system for the vaccine to help or boost and therefore the vaccines aren't useful and doesn't work. Percentages will change per country/society. However, someone fully vaccinated in my mind is someone who is never going to be infectious. Therefore prevents it.

>Yes, you can. Even if schools weren't full of unvaccinated people, which they are, the existence of breakthrough infections would underline why banning mask mandates is a culpablr error.

The problem with covid is that it clearly divides directly down political lines. Perhaps Texas guy is politically motivated and making bad decisions. The problem is the opposite as well. CNBC is clearly attacking when it's clearly unreasonable to do so.

I have no pity at all for anti-vaxxers who get covid. I'm not in the USA, nor do I care about Texas.

Also not a biologist, but on the point of vaccines and whether they prevent the disease full-stop or just reduce the risk of serious illness, that's covered in the article.

My synopsis of that was that it was not expected (by the developers of the vaccines) that it would prevent people getting the illness, but that it would considerably reduce the risk of serious infection.

Some early trial results raised hopes that it would prevent people getting it, but with Delta that's not been borne out.

That said, in addition to reducing the risk of serious cases, it does also help reduce transmission as vaccinated people who get it, generally have less serious cases, which mean they are infectious for a smaller amount of time.

> breakthrough infections were always expected

That isn’t the way it was portrayed. The way that it was initially portrayed by the media is that these would be 99% effective and that after getting the vaccine you could go back to normal.

I mean, that's definitely not the impression I had after getting the vaccine (first shot March 24, well before anyone came up with the "Delta" name for B.1.617.2). I stayed home and wore masks just as much as I did before the vaccine. I knew the vaccine would make things safer when I did need to interact with other people, but also that it was hardly a reason to "go back to normal."

Maybe your problem is you listen too much to the mainstream media instead of doing research for yourself? The corporate interests are trying to get you to consume more and so they wanted to entice you with the prospect of "going back to normal" and consuming things you don't need.

You could and lots of people have. The visibility of masks (literally in your face!) tends to distract people from this, but the vast, vast majority of Covid restrictions were revoked after vaccinations became widely available, including anything in the vein of "stay home" or "social distancing". In all of the US and I think a substantial chunk of Europe, it's considered safe as a matter of policy for vaccinated people to go wherever they'd like and do whatever they want.

> Vaccine doesnt work.

80% vaccine efficacy. We were hoping for 50% so that's actually pretty good.

This is on par with "we had a snowstorm so climate change isn't real" levels of logic.

Abbott has a mild case and isn't sucking on ventilator.

>80% vaccine efficacy. We were hoping for 50% so that's actually pretty good.

CDC says 94% efficacy. https://www.cdc.gov/mmwr/volumes/70/wr/mm7018e1.htm

Immunocompromise is 6%. https://coronavirus.jhu.edu/vaccines/blog/immunocompromised-... - Estimates are that about 6.2 percent of adults ages 18-64 in the U.S. are living with weakened immune function,

The vaccine is 100% effective for healthy fully vax people. That 6% is concerning and will differ amount countries im sure.

>This is on par with "we had a snowstorm so climate change isn't real" levels of logic.

I find your analogy to be very telling. You have moved to another political issue that is quite divided along the same political lines.

>Abbott has a mild case and isn't sucking on ventilator.

Does abbott have a compromised immune system? Shrug?

Should we even discuss the possibility that covid testing has high false positive testing? That Abbott never had covid and his more recent tests only days later he tested negative.

> CDC says 94% efficacy.

Published in May, using data from Jan-Mar.

Delta didn't exist.

> I find your analogy to be very telling. You have moved to another political issue that is quite divided along the same political lines.

I mean, yes. Science has become politicized and one side of the debate keeps making poor arguments.

> Abbott never had covid and his more recent tests only days later he tested negative.

He's vaccinated. Ct loads of viral mRNA drop more sharply if you've been vaccinated. Having it clear fast is expected.

https://www.medrxiv.org/content/10.1101/2021.07.28.21261295v...

The article's answer to this question is "the eventuality of endemic COVID-19 does not mean we should drop all precautions. The more we can flatten the curve now, the less hospitals will become overwhelmed". There are currently ~6000 COVID patients in hospital, which is a little less than 1/6 of the Jan 2021 peak and over 1/4 of the April 2020 peak. Which is to say, manageable right now but probably not something you want to let burn much hotter than that.

Long-term mask-wearing seem like an entirely reasonable social change.

It's like any other clothing: you're protecting a vulnerable part of your body and also displaying respect for others. And it's mostly enforced by social norms: though in many places it is in fact illegal to go without clothing, people wear clothes regardless of the law. (I was in San Francisco at the time the public nudity ban, or shall we call it the "clothing requirement," was passed, and I can assure you that people were generally clothed in San Francisco even before then.)

As another comment pointed out the other day (https://news.ycombinator.com/item?id=28255121), it's not just going to be SARS-nCoV-2. There's going to be a lot more easily communicable diseases in the future in dense locations. And there was the first SARS, of course, and countries hit hard by the first SARS already adopted a norm of mask-wearing in crowded locations like public transit, which helps them with other diseases that are "here forever" like the seasonal flu.

I think mask-wearing in public is going to become a sign of basic respect and decency and hygiene. We're already comfortable with "No shoes, no shirt, no service."

Hard no to that.

People love downvoting 'round here, but the comment is sensible.

Don't shoot the messenger, even if we all hate the news they bring.

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