Why doesn’t natural immunity count in the US? | Hacker News Reader

Why doesn’t natural immunity count in the US?

bmj.com

463 pointspeteradio1,568 comments

Because it's a terrible policy prescription. If natural immunity is acceptable, what proportion of the unvaccinated-uninfected population will just take the risk? Half? More?

Millions of people will just (continue to) take the risk, get sick, go to hospital, and die (in decreasing proportions), incurring substantial personal and social costs along the way.

Accepting only vaccination as evidence of protection reduces the size of that risk-taking population, and the concomitant social costs.

Should there be a third policy option - accepting test-verified infection and recovery as of _now_ as evidence of protection, but discounting future recoveries? Based on the observational studies cited all over this thread , probably yes. Seems like associated costs would be higher though, and the only benefit would be less gnashing of teeth here and elsewhere, so its understandable the CDC isn't rushing to implement it.

Should those people just be allowed to assume the risk? Not while the costs are predominantly social. Insurance (or tax-payers) pay the financial costs, healthcare workers bear the burden of treating a preventable illness, and we all assume the risk that healthcare resources will be stretched to the point of unavailability. While risk-takers do pay into the same system, their premiums don't yet reflect the increased expected costs of their personal choice. While ICUs often run close to or at capacity in one hospital, rarely do they run close at every hospital in a region, as is happening in the south and will happen elsewhere. While it would be nice if there were more doctors, nurses and facilities able to treat patients, we're at war with the army we've got.

To reply as the devils advocate to this comment, what is the tolerance to social costs that society is willing to bear? Also why would one segment of society have to do something that it doesn't want e.g. not bear risk if they want to?

Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

What about drinking and smoking? Maybe we should also ban these because these people will probably go on government health insurance when they come down with chronic health issues from too much alcohol or tobacco.

I guess I don't see where your argument about societal costs doesn't become a slippery slope.

Also full disclosure I'm 100% vaccinated and will get the booster in Dec.

>Should we tell people to get their BMI under 25 too? >What about drinking and smoking?

There's a lot of investment in trying to fix these problems already, or at least offset the costs. For example, there are "sin taxes" for things like cigarettes and alcohol, which means smokers and drinkers are paying disproportionately more taxes than those that don't.

You could argue that overweight folks are also paying disproportionately more simply by buying more food than someone who weighs 20% less.

All that aside though- forcing fat people to get skinny isn't a valid comparison to forcing people to take a vaccine. One takes a couple minutes and the other is something requiring an hour or more of dedicated time per day for potentially years (or a whole lifetime!).

Let's say, hypothetically, there existed a free shot which would immediately make its recipient a perfectly lean 20 BMI and grants all the benefits of health and exercise without the work. How many people would choose not to take it, and how would society view those that decided to walk around weighing 400lbs? That's really the apples to apples comparison here, and I think you'd find there would be very few folks walking around at 400lbs in that scenario.

>> All that aside though- forcing fat people to get skinny isn't a valid comparison to forcing people to take a vaccine. One takes a couple minutes and the other is something requiring an hour or more of dedicated time per day for potentially years

Well we could just tell the fat people they aren't allowed to eat in restaurants and can't keep their jobs. That way they won't be able afford or get the food that keeps them fat! </sarcasm>

> Let's say, hypothetically, there existed a free shot which would immediately make its recipient a perfectly lean 20 BMI and grants all the benefits of health and exercise without the work

I would be very skeptical and wonder what the downside is

Are you suggesting then that the US should adopt something like Japan's "metabo law"? It appears to be at least somewhat effective in coercing people into losing weight.

https://www.jacksonville.com/reason/fact-check/2016-09-16/st...

> You could argue that overweight folks are also paying disproportionately more simply by buying more food than someone who weighs 20% less.

Overweight people pay their tax in a significant decrease in their quality of life. Eating unhealthy is way way cheaper. I can confirm both after 170lbs of weight loss. My food budget quadrupled. Rice, pasta, and white bread are cheap. Meat and veggies, not so much.

Except the food you eat to get fat is often much cheaper than the food to stay healthy. Produce is expensive per calorie, lean meat is expensive per calorie, cooking takes time and effort, and a gym membership is expensive. This is one of the reasons why obesity is so prevalent, it's much easier than staying healthy. It's not just 20% more of what healthy people eat.

> One takes a couple minutes and the other is something requiring an hour or more of dedicated time per day

1. No it doesn't. It only requires eating less.

2. One of these is invasive, the other is not.

> There's a lot of investment in trying to fix these problems already

Not really. We have culturally embraced "health at any size", we don't clamp down on unhealthy food advertisers, we install vending machines in schools. We are now FIRING people for noncompliance with vaccine mandates, but shrugging impotently when childhood obesity rises 9% in 18 months of pandemic lockdowns.

Further, the obesity issue isn't just a baseline problem: it's also the #2 comorbidity of COVID itself. If these tinpot tyrant vaccine mandate people were even remotely serious about actual harm reduction from the pandemic, we've had approximately 72 weeks since we knew of the obesity-COVID severity link to include weight loss as a preventative protocol along with masks and vaccines.

The fact that we've heard no significant public messaging on this front during a period of time that high-risk obese populations have had the chance to dramatically reduce their risk profile tells you everything you need to know about how serious "public health officials" are about actually reducing deaths. Hint: they're not.

>One takes a couple minutes and the other is something requiring an hour or more of dedicated time per day for potentially years (or a whole lifetime!

Nope. You don't have to dedicate time to exercising to lose weight, you can just eat less.

>You could argue that overweight folks are also paying disproportionately more simply by buying more food than someone who weighs 20% less.

No one ever likes my proposed tax on slower metabolism

> You could argue that overweight folks are also paying disproportionately more simply by buying more food than someone who weighs 20% less.

You have a real incorrect view of obesity. Being obese does not mean excessive eating. There’s a whole slew of digestive and hormone issues that someone can have and be obese while eating less than 2000 calories a day.

> All that aside though- forcing fat people to get skinny isn't a valid comparison to forcing people to take a vaccine. One takes a couple minutes and the other is something requiring an hour or more of dedicated time per day for potentially years

The issue with being overweight is not so much the extra weight itself, but the fact that it is correlated with metabolic dysfunction. "TOFI" (thin-outside fat-inside) are just as unhealthy.

Metabolic dysfunction can be resolved in a matter of days to weeks by abstaining from high glycemic index foods and in general fixing modern-day malnutrition. This is with a more aggressive regimen often described as a "ketogenic" diet, although the term is abused by people who don't understand that ketosis is more of a side-effect of a species-appropriate diet that allows for healthy fat burning, and not simply hitting macros.

Again I stress that if public health officials had a clue the pandemic would have never happened, it was evident early on that this disease disproportionately affects the malnourished, people with poor blood glucose control, sedentary, and immune compromised. These all go together, although oftentimes the immune dysfunction is deliberately induced by pharmaceutical treatments to mitigate autoimmune disease.

See also:

[Only 12 percent of american adults are metabolically healthy](https://www.unc.edu/posts/2018/11/28/only-12-percent-of-amer...)

Covid is contagious, obesity is not.

Actually no, we don’t even need a shot to lose weight you just eat less.

Also the government is actively promoting obesity by subsidizing cheap unhealthy food via agriculture subsidies like hfcs and soybeans.

So while there are some who have actually spoken out against obesity like Michelle Obama, most are silent as the issue is kinda politically inconvenient for both parties on a macro scale.

It’s disgusting and why I don’t support either major political party in this country.

Aside from DUI risk and passive smoking, most of these risks are specific to the person. I can't catch obesity from being in the same room as a obese person, and while public health costs go up from drinkers/smokers/heavy people, I haven't heard of ambulances being gridlocked outside a hospital due to a spike of lifestyle diseases.

This pandemic would be a blip if everyone was in shape.

>CFR (case fatality ratio) in the large cohort in China was elevated for patients with comorbidities, with 10.5% of those with underlying cardiovascular disease, 7.3% of those with diabetes, 6.3% of those with chronic respiratory disease, and 5.6% of those with cancer dying of COVID-related illness. [1]

That looks like a clean 17% reduction for cardiovascular disease and diabetes. So yes, hospitals are getting gridlocked during this pandemic because of lifestyle diseases.

>The NCHS statement broke down the death certificates mentioning COVID-19. For 94% of people who had COVID-19 also had other conditions listed. COVID-19 alone was cause of death for 6%.

>Dr. Maja Artandi ( here ), medical director of the Stanford CROWN Clinic for COVID-19 patients ( here ), told Reuters via email that the CDC’s numbers “are really not a big surprise,” as “patients who have a comorbidity such as diabetes, hypertension or obesity have a higher risk of getting seriously ill and dying from COVID-19.” [2]

Without COVID they would still be alive, but no doubt lifestyle disease has been a serious contributing factor to deaths during this pandemic.

1. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guida... 2.https://www.reuters.com/article/uk-factcheck-94-percent-covi...

But doesn't a population's overall poor health contribute to the potential gridlock of the healthcare system? I mean, what is the percentage of non-accident emergencies in the system and has it increased with the overall decline in society's fitness? (assuming it has declined I suppose, I don't have any numbers as I am not in that field)

Children can “catch” obesity from their parents. Once you’re sufficiently overweight, it’s hard to turn back, even when you leave your parents house.

> Aside from DUI risk and passive smoking, most of these risks are specific to the person. I can't catch obesity from being in the same room as...

That's not entirely accurate. Human behavior is effectively viral (per any of the Jonah Berger books among others). What we see becomes the norm, a behavioral norm.

Smoking has decreased because it has become "less fashionable." And so on. So while you might not catch obesity in the strict virus sense, if you're exposed enough, that exposure can and often does influence your behavior.

Generally medical gridlock hasn’t been a problem, but this is a unique case in that ICU beds are filling up in some regions leading to _entirely preventable_ illness and death that is unrelated to covid.

Once that stops happening, I will care significantly less. But if I have the risk of not having an ICU bed if I get into a car crash because people aren’t getting vaccinated, that’s an unacceptable social outcome to me.

My personal take is that insurance should progressively cover less of covid treatment of unvaccinated (by choice- minors and immunocompromised being excluded from this policy) patients until it is having a minimal impact on our healthcare system. If people don’t want to get the vax, that’s fine, but I’m not pooling for your medical bills.

Sure, it could be played into a “forever war” by reducing hospital/ICU capacity, but I don’t really see a benefit to doing that.

One of the issues with that argument is: If Biden's workplace vaccine mandate goes through, many of the remaining people who decide not to get vaccinated simply won't have insurance, given they'll also be out of a job.

Instead of paying more into the system, they'll be paying less. They'll still end up in the hospital. Defaulting on the hospital bill doesn't seem unlikely for many in this situation.

This is the biggest reason why this move by Biden is an idiotic gambit, relying on the hope that most of the holdouts are simply on the fence and need a manipulative push. He may be right, but the cost of being wrong could quite literally be large swaths of the US Healthcare System.

What's more, we're seeing concerning numbers of healthcare workers leave the industry. ICUs are not, generally, overfilled because they're out of physical beds; they're overfilled because they're out of people. No one in power is talking about this. Hospitals lose nurses making $70k, then turn around and pay $8000/week for travel nurses. Those nurses that left? You guessed it: many are trying out travel nursing. The rest are burnt-out.

The crisis really is not in the unvaccinated; its in our healthcare system, and it was growing long before the pandemic. A fractionally small part of me actually believes what some in the really, really fringe-right are saying right now: the administration wants the healthcare system to fail, because its another crisis which can be pivoted into single-payer or even nationalized healthcare. Well, its their fear, but its conversely my hope, because at least that would mean the people in charge have a medium term strategy for what seems to be inevitable at this point.

A very large component of the "anti-vaxxer" crowd are medical staff who are now quitting in large numbers thanks to the mandate. Your beds are now going to be lowered.

https://www.theguardian.com/us-news/2021/sep/13/new-york-hos...

>what is the tolerance to social costs that society is willing to bear? Also why would one segment of society have to do something that it doesn't want e.g. not bear risk if they want to?

Vaccines are already required to attend schools, daycare, college, to immigrate to the US, for many existing federal jobs, to join the military, most jobs in the medical field. These requirements have existed for 20+ years, society has tolerated these costs and benefited greatly.

I could see OSHA having a vaccine mandate that covers TDAP, MMR, polio and Hep B similar to the proposed covid mandate for large employers. But all of these are required to attend school and in other situations, so it isn't needed.

>What about drinking and smoking?

Drunk driving is a crime. Society doesn't tolerate it. We generally limit second hand smoke, banning smoking in restaurants and many other indoor buildings. Requiring vaccination to prevent the spread of infectious disease is analogous.

> Requiring vaccination to prevent the spread of infectious disease is analogous.

No, it isn't. Requiring someone to submit to a medical procedure that injects something into their body is very different from restricting the circumstances in which they can do things like smoke or drink.

Also, past vaccination campaigns (such as smallpox, polio, measles) have all been based on the expectation that mass vaccination would eradicate the disease (and that expectation has been realized with several of those diseases). There is no such expectation with the COVID vaccines we currently have; they are not going to eradicate COVID.

>Drunk driving is a crime

In someplace like Texas drunk driving is only a crime in limited circumstances, like driving in public. You could go to somewhere private, like an employer's private gated parking lot that is accessible to 100 employees but not the public, and you could not get a DUI. By the same token that it would be tyrannical for drunk driving to be a crime on private area of private property, it is quite tyrannical to enforce covid vaccines on facilities with 100 employees voluntarily engaging in employment on private property.

It's not a binary.

Sure, you should be able to take the risk (if an adult and mentally competent, and maybe also fully informed). It's a free country (or so they claim).

But when your choices rack up huge medical bills that the rest of us have to pay, then your freedom to do what you want collides with our freedom to not have to pay for it. If you're free to spend my money, then I'm less free.

But that isn't absolute, either. We let people drive, and emit carbon dioxide, and play loud music, all of which impose negative externalities on others. We even let people be obese and smoke, which impose financial costs on the rest of us. (And yet, there's been a massive anti-smoking campaign over the last 10 or so years...)

Societal costs is a slippery slope, or something like it. As a society, we're trying to find a place to stand on it that isn't "no healthcare for you because you make stupid choices", and also isn't "here's the public's checkbook for you to make full use of to try to undo the consequences of your bad choices". There are no simple answers. (And it's not just Covid.)

You are assuming that getting vaccinated is a burden, and then comparing it to challenges that many people take years, or longer, to overcome. That makes absolutely no sense.

Getting vaccinated takes just a few minutes, and has no long term consequences for virtually everyone, and does not require ongoing effort of any kind.

In no way is getting vaccinated comparable to struggling with obesity, quitting cigarettes, or alcoholism. Sorry, but your comparisons are, frankly, bizarre.

Wasn’t that the whole point of Michelle Obama’s healthy school lunch drive? And the conservatives who are largely against mandated vaccines today also declared that initiative as government going too far. People living in conservative states are also far more obese than liberal ones (California vs Texas, for example). Conservatives, at least, are being consistent.

The social costs of forgoing the vaccine are unique in that they arrive all at once. Smoking, drinking, obesity, etc. increase lifetime healthcare costs, but realize those costs over a long period of time. Hospitals are sized appropriately, more can be built if projections indicate more need, doctors can be trained, etc.

A policy that accepts infection-recovery as equivalent to vaccination unconditionally and removes most/all other restrictions could result in lots of those social costs over a very short period of time, much shorter than the timescale on which resources can adjust. So much so that resources become exhausted, and the costs compound from merely high to truly awful. Personal choice resulting in an impaired standard of care for unrelated people in need for unrelated reasons should probably be discouraged or proscribed.

Once the risk of resource exhaustion is eliminated, a policy that's less than a full-court press for vaccination might be reasonable. But that risk is primarily determined by the size of the covid-naive population, which can only be reduced by vaccination or infection...

> To reply as the devils advocate to this comment, what is the tolerance to social costs that society is willing to bear? Also why would one segment of society have to do something that it doesn't want e.g. not bear risk if they want to?

It has been debated to death and one of the thing we can't negotiate with is time so at some points some actions have to been taken, some things conceded. We can keep on debating the benefits of smoking and individual freedom but we as a society (our institutions) have decided that smoking or not wearing shoes inside restaurants is not allowed.

At some points our society decided that it wants everyone (let's put aside the special immunodeficient, babies, etc. cases) to be vaccinated.

Now why should I be obliged to risk my health by going to restaurants, social events or work where I am taking the risk to get covid because other people are fine with the risk (or are not fine but refuse to get the vaccines on the ground that it's not a health matter but a compliance to law matter for them. I know one) ? It's like smoking, don't blow it in my direction. Vaccines/pass/etc. are a necessity for the vast majority to enjoy life as it was, to get some freedom back.

People willing to participate in society without following the rules that society put in place to participate safely should not be allowed to join in without restrictions. It's my opinion, not a logical conclusion to any reasoning about our laws and how we behave as as specie/culture.

It's fine if they don't get the vaccines but it's not fine to put others at risk.

We can debate the fairness aspect of this decision or the framework in which freedom and liberties are defined and understood but at some points reality force us to take a stance.

There'll never be a perfect solution that reconcile everyone's visions of freedom.

With all that being said I strongly believe that keeping on debating publicly these aspects of the situation 24/7 is harming our recovery or transition to a better situation. These `debates` are just maintaining the illusion that options are still on the table, that we have the luxury to debate them, that somehow the longer we beat the same old dead horse maybe covid problems will magically disappear, that debating and coming to the same set of possible conclusions is somehow useful.

It's a resource vs demand at this point.

Socialized healthcare systems already deal with this. For example being obese or a smoker will put you at the bottom of the list for organ transplant.

Given how unvaccinated covid cases are filling up some ICUs, why shouldn't we prioritize ICU access against eligible unvaccinated people?

From risk management perspective obesity and pandemics have completely different risk characteristics. Pandemics are contagious and deaths can grow exponentially, leading to catastrophic outcomes. Obesity is constraint to individuals.

On the other hand. A vaccine that is not as rigorously tested as normal and is used on 80% of the population can also lead to catastrophic results. No one really knows the long term effects for sure. So I understand the paranoia on two sides.

You actually want to use as many different vaccines as possible so no single vaccine can exterminate your population. That’s why I belief natural immunity should be counted as a valid ‘vaccine’, if the science shows it offers similar protection.

When I drink or smoke or I’m overweight, that doesn’t affect the health of my neighbor. It also doesn’t overcrowd hospitals causing innocent people to die because they can’t find treatment[1].

There also isn’t a vaccine for being overweight.

(We should probably mandate seasonal flu vaccines too.)

1. https://www.washingtonpost.com/health/2021/09/12/alabama-ray...

> Should we tell people to get their BMI under 25 too?

Japan does this and has a 3.6% obesity rate compared to our 42%. Doesn’t seem that terrible of a slope to slip down.

https://www.nytimes.com/2008/06/13/world/asia/13fat.html

It is a slippery slope fallacy. You only have to look back through the history of vaccines and see. We have had vaccine mandates before and guess what? No dictatorship installed. It's easy to point at democracies all over the world. Mandated vaccinations never led to "okay now do this ______ to improve your health or else" . Also no one says bring in the police, just make it so that if you want a job then get the vax or bring in a reason from your doctor that says you can't take it because of some medical condition. Simple.

> Should we tell people to get their BMI under 25 too?

Overweight people can't transmit their overweightness to me through a virus or bacterium that they breathe into the air.

If they could, then yeah, we'd probably have some kind of legal mandate on it. Just like we have a bunch of restrictions on smoking now, because indeed, that's something that you push into the air.

The general rule is that your rights stop where others begin. Most issues of health are purely personal, but infectious diseases are not. Because they're infectious.

Overweight people already have their costs internalized: that's what your insurance rates are.

This is also actually tremendously fair, because if you're fat but don't suffer any lifestyle illnesses, then your insurance rates are low - you are actually able to support your mass. But once those conditions start ticking up, so do your insurance rates.

The US basically leads the way on addressing the social externalities of obesity as they relate to the healthcare system.

it's not clear that people who smoke, eat, and/or overeat actually consume more healthcare over a lifetime. most people incur the majority of their healthcare expenses as they slowly die over the last several years of their life. the last few years just come sooner for unhealthy people.

Obesity tends to kill people before they get old enough to incur real costs in medical care. It's like cigarette smoking, it actually saves the healthcare system money and resources because smoking tends to kill people before they get very old.

Also, I can't catch obesity by simply sharing the same room with someone who is obese like I can with COVID.

Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

No matter how obese someone is, I'm not going to catch their obesity by breathing the same air as them.

Your drinking is regulated. When you step into a car drunk, you are putting others at risk and it stops being your problem and starts being society's problem.

The same is true here. You are stepping into society on a state of health that presents risks to everyone around you.

> Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

You are the one making this claim. Back it up with some evidence.

> I guess I don't see where your argument about societal costs doesn't become a slippery slope.

Your admitting this, why even bring up your points if you know they dont matter? There's no reason to argue this point

> Should we tell people to get their BMI under 25 too?

That policy hurts farmers, so it's not viable for a different reason.

If hospital beds become filled to >50% capacity because of the obese then maybe we can start making this comparison.

Because of unvaccinated people many of us face significantly worse hospital care right now.

> What about drinking and smoking?

Literally Whataboutism. Don’t take the irrelevant bait.

The line seems to be drawn at socializing the risks of full hospital ICUs in a region

Edit: why the downvote to near-dead? I thought that's what the author emphasized :\

He isn't serious about this. Guarantee he has a tweet or liked a tweet from 2020 raging about Cheeto Mussolini's White Supremacy Vax. It's just politics, and has been, since early 2020.

Let us put the gays to the camps, they impose external costs to the healthcare system too (but we won't, because they are a holy symbol for these people).

The thing that makes COVID dangerous is it's contagion not so much it's direct effects.

If COVID were not highly transmissible, then the relatively low risk of death would make it spooky, but it's not likely we'd even see it on the news.

It spreads to others quickly, and many people get very sick even if they don't die, hospitals fill up and it makes it very difficult to operate a healthcare facility.

Consider the 'no policy' effect: if we did nothing in response to COVID, it would spread like a fire, and without 'flattening the curve' - which we mostly have done, it would badly degrade our ability to function. People not able to tend for the older population because they themselves are sick, hospital staff going down, people in hospitals with other ailments going down etc..

So because of that it's a community problem.

If you want to think about it from an 'individual choice' perspective, consider what it would mean if you didn't take proper precautions while doing an activity, and ended up killing someone even by accident, that's manslaughter.

Given a rational population with some reasonable, conscientious objectors, we should be at about 95% vaccination, which is plenty. There's room for the serious objectors, the problem is there's way too much arbitrary and misinformed skepticism.

So it's not like wearing a seatbelt or eating too much carbs, which is mostly a personal issue.

COVID is inherently a systematic problem.

* The risk isn't just on that segment. The vaccine is not 100% effective without herd immunity to back it up.

* The unvaccinated will be the source of new variants, so a substantial of social resources will need to be continually invested in developing and trialing new vaccines.

> Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

I believe the jury is still out on whether or not obesity is contagious.

> What about drinking and smoking? Maybe we should also ban these because these people will probably go on government health insurance when they come down with chronic health issues from too much alcohol or tobacco.

Most countries ban smoking in confined spaces where it can impact the health of non-smokers. I suppose you'd support repealing such laws.

> I guess I don't see where your argument about societal costs doesn't become a slippery slope.

Slippery slope to what exactly?

>Because it's a terrible policy prescription. If natural immunity is acceptable, what proportion of the unvaccinated-uninfected population will just take the risk?

You're making a calculation not regarding health, but regarding public reaction. The problem is that the public health community sucks as far as making these calculations go; I don't think I need to list all the missteps here. IMHO, they know a lot about epidemiology, nothing about the public. So it's best to just make the right policy and not to try 4D chess with the public, that tends to backfire.

Just about anyone who has remained unvaccinated so far is already taking the risk you pointed out*. No point in spending resources chasing recovering patients we don't really have to vaccinate right now.

Now I don't agree with using antibody test results (these kits aren't standardized, so the relation between immunity and the results isn't clear), but an actual record of recovery should do. As the article notes, that's what many other countries in the world do.

* Excluding the very few people who actually have a good reason to not vaccinate due to certain extremely rare immune system ailments.

I don't disagree with any of that, but I would argue that public is _necessarily_ the intersection of individual health and public opinion. Policy makers can't just ignore public reception of/reaction to their prescriptions, since their goal is improvement the aggregation of outcomes across the entire population. Ignoring those second order effects is just as much a policy choice as trying to account for them, and not IMO a priori more likely to result in a better outcome. Might've in this case? We might've also got COVID parties.

> Accepting only vaccination as evidence of protection reduces the size of that risk-taking population, and the concomitant social costs.

That is effectively coercing people to undertake a medical procedure for their own or for society’s good. The ethics of doing that should be concerning, considering the social and ethnic makeup of the vaccine hesitant, and the checkered history of coercive medical intervention.

I’d much rather see the carrot used than the stick.

This is absurd. Vaccine efficacy is measured against natural antibodies resulting from a recovery.

I cannot get the vaccine and I’m effectively a second class citizen. I was sick and recovered - my immune system is working as designed.

what is stopping you from getting the vaccine?

If hospitals didn’t overflow and society didn’t crumble for most of 2020 (when there was 0% vaccination), it’s odd to argue that it will now that there is 65% vaccination.

It never took that large of a percentage of the population to get sick at once to overwhelm hospital capacity. Some tenths of a percent could probably it. 35% of the population vulnerable means there's plenty of room for that.

Enough people do OK w/o interventions that "social collapse" probably wasn't ever going to be the outcome (short of more virulent variants), it's just whether more or fewer of the people for whom treatment makes a difference between life and death (or other morbid outcomes) can get the treatment.

Also, there's probably an overlap between those who've received the vaccine and those who were taking other (ie distance-focused) related precautions pre-vaccine. And the possibility of burning out medical workers.

And in any case, things in some locations are worse now than they've been thus far:

     "In Florida, a record number of people are dying from COVID-19—a seven-day average of 338 deaths, higher than at any other point in the pandemic."

https://www.nationalgeographic.com/science/graphics/graphic-...

Either the vaccine works or it doesn't. So why are the numbers going up if it's working?

they did, and they are now. Society didn't crumble because of extreme monetary policy measures.

No they didn't, and not they aren't.

https://www.theatlantic.com/health/archive/2021/09/covid-hos...

In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease.

What prevented the societal breakdown in countries that didn't do nearly as much QE yet had their hospitals hit equally or worse?

Arguably society is in the process of crumbling now. Jan 6th was part of that, as were the BLM protests, the anti-vax protests, the contentious school-board meetings, the constant tug-of-war between Federal/state/local/individual authorities, high inflation, supply shortages, people refusing to go back to work, etc.

"If hospitals didn’t overflow and society didn’t crumble for most of 2020 (when there was 0% vaccination), it’s odd to argue that it will now that there is 65% vaccination."

2020 was the worst economic catastrophe in a century.

The US Fed printed money in terms it has never before, it's balance sheet has been massively inflated.

Government debt exploded to WW2 levels.

10's of millions were unemployed.

Most Healthcare systems had to adjust to delay and defer elective procedures.

Millions of restaurants and other businesses closed, never to re-open.

All of these measures were taken precisely because there were 0% vaccinated.

The US/World basically couldn't handle another year of those restrictions, it would probably break the economy and cause a lot of harm.

It's not going to be possible to fully re-open until COVID subsides (esp. Delta), vaccinates will be a primary driver of that.

A bunch of hospitals are more strained now than they ever were. Covid's more infectious now and some staff have quit.

There have been chronic nursing staff shortages for years. We were treating patients in tents during the 208 flu epidemic: https://time.com/5107984/hospitals-handling-burden-flu-patie...

The much larger problem is that our medical system isn't designed to handle any kind of case surge at all, because, for cost efficiency reasons, it purposely wants to operate at 80-90% capacity. Instead of us focusing on how we can improve our hospital systems for future pandemics, we vilify the unvaccinated for political points.

People should be skeptical that hospitals almost never provide thorough or accurate information about their true capacity, constraints, and current cases broken down by primary causes. But at the end of the day, one's views on the situation seem to primarily depend on political identity and whether one blindly trusts the chronically dishonest mainstream media.

How much is "a bunch" of hospitals? How are you measuring "more strained" "than they ever were?" Because the evidence I found suggests the situation was overblown:

https://www.theatlantic.com/health/archive/2021/09/covid-hos...

And we have staff quitting over the mandates. Which is causing service shortages in NYC now.

https://www.nbcnews.com/news/us-news/new-york-hospital-pause...

An upstate New York hospital system said it will be forced to "pause" maternity services this month because some employees' refusal to get vaccinated against Covid-19 has caused staffing shortages.

It seems like a policy of forcing people with natural immunity to be vaccinated could have negative externalities if there are other countries in the world that don't have enough vaccines.

Not to mention that there are some 25 million teenage boys who are at higher risk from covid vaccination than simply catching covid.

https://www.theguardian.com/world/2021/sep/10/boys-more-at-r...

And it's also unethical to force it onto someone who has natural immunity, since their natural immunity is already on par or better than vaccination. So what's the point?

https://www.science.org/content/article/having-sars-cov-2-on...

So? If lots of people independently choose to take the risk and they're not harming anyone else, why shouldn't they be allowed to?

The impact on the hospital system could be blunted simply by saying "This wing is for COVID patients, when it fills up further COVID patients will be turned away" and leaving the other wings for normal hospital patients. They have to do this for quarantine reasons anyway. Now that COVID is essentially preventable, it's a huge misallocation of resources to let all the hospital fill up with people who chose not to prevent it while leaving other ER patients to their fate.

> If lots of people independently choose to take the risk and they're not harming anyone else, why shouldn't they be allowed to?

There just isn't a way to ensure the "not harming anyone else" with a highly transmissible virus like this, even if we were to somehow convince hospitals to assume the legal and ethical risks of denying treatment to COVID patients when they have room to preserve hospital capacity, and even if that solution didn't expose healthcare workers to unnecessary risks, you would still be exposing other populations to risk who cannot get the vaccine or for whom the vaccine wasn't effective.

If you're at risk of covid, you can get vaccinated and are protected from covid. That's all the defense you need in order to not worry about anyone else being infected.

If you're in an at-risk category where you feel the vaccine isn't enough of a defense, you can wear n95 masks, get a third booster shot, or do whatever other extra mitigation measures you feel you need.

The reality is that covid isn't dangerous enough, given the tools people have at their disposal, to warrant authoritarian government or societal overreach. That unfortunately hasn't stopped the government, or it's political allies, from trying anyways. I firmly believe this overreach will backfire on the US democrat party and they will feel the backlash in the midterm elections of 2022.

Okay, now factor in that breakthrough infections are more common in the elderly, can still kill (though rarely), and are more likely to happen the more COVID is circulating in the community, which is then a function of the vaccination rate. My vaccinated grandmother is being put at risk by unvaccinated folks in her town. There's no "independent" risk.

Alternately: any of us could be this guy: https://www.npr.org/sections/coronavirus-live-updates/2021/0...

Unrelated, but one thing I've been curious about for a while is: what useful treatments are actually available when you're hospitalized for COVID-19? Is there anything besides intravenous fluids/vitamins and oxygen that is regularly provided? From what I've read, it seems that most people that reach the critical level of needing a ventilator don't recover anyway. Does being hospitalized improve outcomes by a substantial margin? Could people just use oxygen at home?

> Could people just use oxygen at home?

At that point, you need constant supervision and monitoring from the critical care team. You may be on other forms of life support (IV medications for blood pressure, etc). Your condition could rapidly deteriorate to the point where intubation is called for. It’s not like having a chronic illness where the patient has a home oxygen concentrator.

The various therapeutic treatments (monoclonal antibodies, convalescent plasma, remdesivir, etc.) are helpful, and need to be administered in a hospital setting (IVs, complications, etc.)

> and they're not harming anyone else

It's hard to isolate the personal risks (illness, long-term complication, death, cost) from the social risks (healthcare resource exhaustion, healthcare worker burden, socialized costs, increased transmission).

But assuming we could, how many people that choose to take the risk are _really_ prepared to accept the downside costs if their number comes up? How many would accept a reduced standard of care (or no care at all) as a risk they assumed? Or would there be much anger, regret, and gnashing of teeth?

Assuming the risk requires a degree of rationality that, while perhaps more common on this site, probably does not characterize the population that would choose to assume the risk...

It’s needs to be a step further though. This wing is for COVID patients who couldn’t be vaccinated for legitimate health risks or for the vaccinated who still get COVID. Anyone who willingly skips the vaccination should not be eligible for COVID ER beds.

Wow, we sure took a hard turn from "Heath care is a human right." Scribbled below that on the barn wall is, "...as long as you do what you're told."

We can test for natural immunity. That then counts as fully vaccinated.

It should count. But why test for it and why expect proof? If someone is concerned, get vaccinated if you don't have antibodies already. And wear a mask when cases go above N in your area. Problem solved.

What use is there to build systems of control that will turn into more surveillance and eventual enslavement?

>What use is there to build systems of control that will turn into more surveillance and eventual enslavement?

After the seatbelt laws came in, I didn't wear my seat belt. Before I new it, I was arrested. They sent me to a prison work camp. I had to work 14 hours a day. I nearly died of starvation. (The food was crap, I couldn't keep it down.) Fortunately, a guard took pity on me, and I managed to escape. I'm safe now, with a new ID, good internet access, etc, which is how I'm able to share my story.

If only we hadn't put up with those darn seatbelt laws, maybe things wouldn't have turned out so badly.

That's a little over the top.

Kids get vaccinated to go to schools. We aren't in chains.

> We can test for natural immunity. That then counts as fully vaccinated

According to who? It's not in the US or Canada, as examples. That's the point of the topic you're replying to.

https://tribune.com.pk/story/2313728/canada-refuses-entry-to...

s/counts/should count/

I would imagine there's a trial process that would have to go through, just as we had with vaccinations.

Why? There are already tests for antibodies. And we already know over 100 million Americans had covid already.

https://www.publichealth.columbia.edu/public-health-now/news...

A new study published in the journal Nature estimates that 103 million Americans, or 31 percent of the U.S. population, had been infected with SARS-CoV-2 by the end of 2020.

And we know that those antibodies from past covid are excellent, I call them superior.

https://www.science.org/content/article/having-sars-cov-2-on...

The natural immune protection that develops after a SARS-CoV-2 infection offers considerably more of a shield against the Delta variant of the pandemic coronavirus than two doses of the Pfizer-BioNTech vaccine, according to a large Israeli study that some scientists wish came with a “Don’t try this at home” label.

https://www.bloomberg.com/news/articles/2021-08-27/previous-...

If natural immunity is acceptable, what proportion of the unvaccinated-uninfected population will just take the risk? Half? More?

That's on them. It's not your job to police their choices, and especially not to impose "papers please" on everyone else. No thanks.

Millions of people will just (continue to) take the risk, get sick, go to hospital, and die (in decreasing proportions), incurring substantial personal and social costs along the way.

https://www.theatlantic.com/health/archive/2021/09/covid-hos...

Quote from article: "In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease."

So we have a situation where media-induced fear is causing people to panic until they rush to the hospital. It's certainly possible given that half of the hospitalizations are...not even meaningfully hospitalizations if they were mild or asymptomatic. What does this do to your narrative then, about how dangerous this is and how many millions will "continue to" take the risk?

Accepting only vaccination as evidence of protection reduces the size of that risk-taking population, and the concomitant social costs.

Nonsense. Over 100 million Americans had covid already.[0] We now know that antibodies from past infection are superior to vaccination.[1] [2] So why would you make this arbitrary demand for vaccination as the proof, when the antibodies are what count?

[0] - https://www.publichealth.columbia.edu/public-health-now/news...

"A new study published in the journal Nature estimates that 103 million Americans, or 31 percent of the U.S. population, had been infected with SARS-CoV-2 by the end of 2020."

[1] - https://www.science.org/content/article/having-sars-cov-2-on...

"The natural immune protection that develops after a SARS-CoV-2 infection offers considerably more of a shield against the Delta variant of the pandemic coronavirus than two doses of the Pfizer-BioNTech vaccine, according to a large Israeli study that some scientists wish came with a “Don’t try this at home” label. "

[2] - https://www.bloomberg.com/news/articles/2021-08-27/previous-...

And we know based on the current evidence those antibodies will last for decades. [3]

[3] - https://www.nature.com/articles/d41586-021-01442-9

The answer is not "probably yes." The answer is a resounding yes, but the answer is also that no proof should be needed unless you work in a hospital where vaccination requirements already existed. We don't need a "papers please" society. If you're concerned for your health, get vaccinated if you don't have antibodies already. Wear a mask when cases go above N in your area. That's how simple this is. There's no need for building systems of control that will turn into systems of enslavement.

Meanwhile, you have a situation where healthcare resources are being intentionally fired or are quitting because of the idiotic mandates. [4]

[4] - https://www.nbcnews.com/news/us-news/new-york-hospital-pause...

"An upstate New York hospital system said it will be forced to "pause" maternity services this month because some employees' refusal to get vaccinated against Covid-19 has caused staffing shortages."

This is entirely a manufactured problem.

While risk-takers do pay into the same system, their premiums don't yet reflect the increased expected costs of their personal choice.

We've been hearing for YEARS about how bad insurance companies are. How they make record profits each and every year and still pass on higher premiums, higher deductibles, and shittier service to their customers. So why are people feigning concern for health insurance corporation bottom lines already? Wake up.

While ICUs often run close to or at capacity in one hospital, rarely do they run close at every hospital in a region, as is happening in the south and will happen elsewhere. While it would be nice if there were more doctors, nurses and facilities able to treat patients, we're at war with the army we've got.

https://www.theatlantic.com/health/archive/2021/09/covid-hos...

"In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease."

The media induced panic that causes people to flood the hospitals when they get a sniffle, because of fear. The situation with hospitalizations appears to have been exaggerated.

I believe your prediction of behavior to be wrong and careless and it also may highlight why public healthcare never got too far in the US.

It's not only not a terrible policy position, natural immunity will turn out in the end to be the ONLY effective thing which gets us to to herd immunity.

At this point I don't understand why this isn't obvious.

You make a targeted vaccine, in this case it will be evaded. We see it right now. That will continue. Natural immunity will cast a wider net and be proven much more effective.

> natural immunity will turn out in the end to be the ONLY effective thing which gets us to to herd immunity.

There are many illnesses for which humanity never reached natural herd immunity. Smallpox was consistently deadly for millennia, for example. Malaria's still going strong. HIV is kept in check by treatments, not immunity.

The COVID delta strain has an R of at least 5. Using naive models, this would mean that we'd need at least 80% immunity. But even if we achieved 100% vaccination, it's not clear that current vaccines (or natural infection) can provide 80% immunity over the longer term.

So realistically, I suspect that COVID will simply become one of the risks of life. I fully expect that I will catch it multiple times in the decades to come. But I get an annual flu shot, and I'm willing to get an annual COVID booster if necessary.

And there's no guarantee that this will all blow over soon. The worst case historical coronavirus appears to have jumped to humans around 20,000 years ago, and it looks like it exerted heavy selective pressure over many generations. See https://www.nytimes.com/2021/06/24/science/ancient-coronavir....

That's a really good point and I agree completely.

"Herd Immunity" as not the correct term to use because yes, it is with us for the foreseeable future.

Some weaker form of "herd immunity" where most people have had exposure and it ceases to become a large scale social threat would have been more correct, but I'm at loss for an exact term.

- The vaccine hasn't been evaded. The efficacy has been slightly reduced.

- Not all vaccines need be quite so targeted.

- Naturally acquired immunity can also be evaded.

If a person is infected, it has been evaded. Period.

WXYZ-TV posted the following question on facebook a few days ago and received 155k responses.

"After the vaccines were available to everyone, did you lose an unvaccinated loved one to COVID-19? "

https://www.facebook.com/80221381134/posts/10158207967261135...

The responses are not what you would expect. Certainly not what the media narrative is.

Cannot access to the comments without an account.

Regardless of what it is said, why should we trust those unverifiable comments, full of anecdotes instead of peer-review scientifics works?

Is there anywhere you could actually access any data that you can completely trust? I too have a relative who regrets taking a vaccine, as she's been having suspicious long term symptoms until now - she took the vaccine in Spring. Nothing in the 43k Pfizer study would indicate that such symptoms could appear, and maybe it is a coincidence that those symptoms started appearing after the vaccine. And of course it is anecdotal, but still it makes me vary at least about the Pfizer study. Symptoms seem to be related to blood flow issues in the legs, and getting this tingling sensation. Since it has happened to a relative I trust and who's otherwise pro vax, I'm slightly inclined to also believe other anecdotal stories, but obviously I can't use that as an evidence.

>>Should those people just be allowed to assume the risk? Not while the costs are predominantly social.

Then eliminate socialized healthcare. Your imposition of socialized healthcare is now being used to rationalize imposition of forced injections. Government can have a healthcare system that is entirely opt-in, for both taxation, and coverage.

Or how about just deprioritize unvaccinated individuals with COVID when there is a shortage of ICU beds.

Additionally, the only plausible way to do it would be to test for seroconversion. That's a blood draw, so it doesn't save anyone from a needle, and overall it's probably more work and more expensive than vaccination.

Given how simple the vaccine is there really should be a zero tolerance policy (barring a real medical reason). I think the president had the right idea with his mandate. To be a part of society those people can take one tiny shot (or two) .

>Because it's a terrible policy prescription.

And the government is ignoring the same science they are asking us to follow. It’s no wonder people are revolting. Although I am vaccinated I did take a antibody test before I did so and wouldn’t have if I had the natural antibodies. It’s almost the same lie they tell when they call this a vaccine- it’s really not. I really understand why people are pissed and I will fully support them in any way I can.

I feel like the entire comment thread after yours has gotten lost in hypothetical discussions about some ethical question about interventions that haven’t been shown to work. Not quite the usual dialog I expected here.

What the CDC recently said is that vaccination also reduces your chance of reinfection significantly, at near zero risk. So universal vaccination is a strictly dominant strategy for personal health, with or without any other interventions (diet, exercise, etc). Why wouldn’t a non-political organization recommend universal vaccination therefore (above age 12)? It makes for simple, cheap, and effective messaging.

If they said not to take a care of your health in some other equally proven way, then it would likely seem to be politically motivated and damage their trustworthiness. That probably has happened too (such as saying to mask outside, until they got more data), but we aren’t blindly trusting them in this, or anything.

The answer is pretty simple - the moment authorities start saying "well, natural immunity is probably just as good as vaccination, we'll accept that as equal to vaccination for passport purposes", a huge segment of the population who's on the fence about getting the vaccine might just opt to wait until they're infected naturally, or, even worse, get infected purposefully (EG, chicken pox parties). Which leads to more deaths and outbreaks.

In a perfect world, everyone would understand that getting the vaccine is the appropriate choice of action and we could accept natural immunity from people who were infected before vaccines were available - but unfortunately we're forced into playing these weird games where authorities have to try to incentivize people who aren't behaving rationally - which in turn leads to further distrust from people on the fence.

While not wrong in itself, your comment epitomizes everything that has been wrong with our public health response. Trying to manipulate populations into a desired behavior by lying to them is, as you point out, counterproductive in the long run.

Past covid gives antibodies that are superior to two shots of Pfizer.

https://www.science.org/content/article/having-sars-cov-2-on...

So yes, it IS just as good as the vaccination and should be treated as such. Vaccinating people for the sake of vaccinating them is illogical here.

And don't even get me started on vaccine passports, which are completely unnecessary. If a place of employment absolutely needs proof of vaccination, like the NICU at the hospital or a nursing home or a college dorm, that information can be relayed via existing protocols. We don't need a "papers please" society where paper shufflers and bureaucrats can arbitrarily gate access to society this way.

Europe (or Germany at least) accepts natural immunity in lieu of vaccination. As far as I've heard, no one has been getting covid on purpose as a result.

Crying wolf repeatedly to cajole and coerce people is not a good long run strategy.

From the article’s conclusion:

‘For Memoli, this reflects a bygone paternalism. “I always think it’s much better to be very clear and honest about what we do and don’t know, what the risks and benefits are, and allow people to make decisions for themselves.”’

hasn't it blown up in their face everytime the authorities tried to be strategic with their messaging (a nice way to say play silly games)?

> a huge segment of the population [might just] get infected purposefully

This made sense as a fear before vaccines were available. If immunity passports existed, and the only way to get one was to be infected - sure some people would do they.

Howver now it would be much easier to get vaccinated than finding an infection and get it registered. The policy would save a bunch of people from a couple of vaccine induced sick days without any reasonable downsides. Seems like an easy decision to make.

Natural immunity isn’t a singular binary consistent thing: it varies greatly in duration and effectiveness. You have some natural immunity for some amount of time after you get COVID, but that is nowhere consistent as can a vaccine will give (and its much easier to track vaccine effectiveness, adjust as needed, then each individual’s natural immunity response). And vaccine are still beneficial to those who have natural immunity.

Authorities aren’t trying to “trick people”, they are manage an epidemic with more of a sure thing (vaccines) rather than something that is much less reliable.

Your first paragraph is correct, but you seem to think it's a problem that people might choose to be naturally infected. That's a valid choice people can make. I believe most people who aren't vaccinated are doing so on purpose. Delta has actually been helpful towards getting herd immunity because is it so contagious but far less lethal than the earlier strains.

We can reach herd immunity with a combination of vaccines and natural immunity. You will not be able to vaccinate everyone.

Deliberate infection (or deliberate infection risk-taking) can be a valid concern, but I believe that validity depends a lot on the spreading characteristics of the virus in question. For SARS-COV-2 ca June 2020 I'd fully support the argument (the virus that was so bad at spreading from human to human that we thought that washing hands would make a meaningful difference). But with "chicken pox fast" delta, I doubt that it would make much difference. Anti-vaxxers will go through their first contact infection pretty soon wether they try or not. Just like the vaccinated. Or rather: in a very different way, rarely but still too often.

How can getting the vaccine be the appropriate course of action when 4,000 people have died from it, according to the CDC themselves?

I am talking specifically about people who already have been infected with the virus and have survived.

It seems like the best solution, if you're a healthy adult, is to get vaccinated then expose yourself to a variant better tolerated by the vaccines.

I think this is mostly correct but the distrust was partly earned and vaccine mandates don't really help here.

We can test whether someone has natural immunity.

As we saw when mask mandates were dropped for the vaccinated, the unvaccinated just lied and said they were. Same here - everyone who has neither been vaccinated nor infected will just claim they’ve had Covid. That is, unless we start testing everyone for antibodies.

> Which leads to more deaths and outbreaks.

Worse, it leads to

1. new COVID variants, some of which will be worse than what we have,

2. more deaths from people who had some other health emergency while unvaccinated idiots are slowly dying in the hospitals taking valuable beds, and

3. to more burned out, dead and PTSD suffering healthcare personal.

I would recommend everyone to browse [1] and [2]. Not being vaccinated if you can, is truly disgusting, selfish and stupid choice.

[1]: https://old.reddit.com/r/HermanCainAward/ [2]: https://old.reddit.com/r/nursing/

A recent study from Israel said that natural immunity is an order of magnitude better than vaccine-induced immunity against delta variant. I don't know who to believe, but if that's the case, then the narrative of "well they should get vaccinated anyway" is really freaking suspicious. We need deeper research on this, and the fact that they haven't researched this is truly scary.

I think the biggest issue is that a lot of people think they had covid previously but didn't get tested so they don't really know.

I thought I had covid early in the pandemic. Took a serology test and found out that I had not had it. I suspect a lot of people that think they had it are the same.

13 times actually

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

I think this will be more relevant to vaccinating kids: If this result holds for kids as well, and considering that Covid is not dangerous for kids, maybe kids are better off getting covid

Same study came to the result that getting a shot after surviving an infection (unvaccinated) gives even better protection. The real interesting comparison would be immunity after getting a breakthrough infection compared to other kinds of acquired immunity. I'm sure we'll get that study eventually.

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

I mean for someone with natural immunity to get the vaccine is not going to reduce their immunity, and might boost it (or might not). So with fairly little downside, it makes sense to vaccinate them surely?

There's no evidence that having the vaccine stops you from developing natural immunity if you have a breakthrough.

If the vaccine fails you then you will get covid (like you would have in the same situation without vaccine) and will develop natural immunity then.

I got vaxxed as soon as I reasonably could and I never want to get COVID, but if that's true it really does seem insulting to require vaccination for people who can prove they already had COVID. It's like they did get vaccinated but picked a much more difficult/risky and much more effective way to do so -- if that were their intention (and they avoided spreading it once they got it), one could say it was a heroic choice...

At the same time though, I can imagine it would be really difficult/expensive to verify the proof of previous infection vs. verifying vaccination, and there could be the appearance of incentivizing anti-vaxxers to go infect themselves with COVID.

I suspect the marginal utility is better in having a larger % vaccinated. If those on the fence about it hear that there are circumstances where it’s better to only take one dose, or none, many won’t vaccinate at all because it seems less important.

It's deeply unfortunate but not really surprising, these kinds of large scale experiments on humans are rather difficult to organize (for good reason) and outside of a naturally occurring disaster may not have happened at all.

It probably is, however that enhanced immunity can come at the cost of damaged organs.

Please provide a credible source (preferably a peer reviewed publication) for such a bold claim.

The entire administration has set vaccination percentage as their OKR; they're not going to risk that number just because of the facts.

And natural immunity + 2 doses of vaccine is likely even better.

Do take an antibody test and decide for yourself. How can one make decisions without any metric?

Follow the money. Lots of money to be made with each round of shots the population is encouraged to get

>the fact that they haven't researched this is truly scary

Can you clarify who you mean by "they"? I don't suspect you mean Israel in that context.

There is finally a relevant flu analogy for those people to use, but they completely miss it in favor of some other non sequitur:

Exposure to this years seasonal flu will give better immunity to this year’s seasonal flu, than the vaccine for last year’s seasonal flu will give to this year’s seasonal fly. One day we’ll be able to say “Duh” in response to annual COVID flavors.

There will be vaccines specifically made for the delta variant and others.

The answers aren't medical, they're pragmatic.

- COVID-19 Antibody Tests cost more than the vaccine (roughly $40 Vs. $16/dose).

- We lack the quantity of Antibody Tests we'd need.

- We'd need to set up additional systems and processes to accommodate the testing and proof (which, again, is a cost).

The implicit assumption that often go along with these natural immunity proponents is that the vaccine is unsafe. Since if the vaccine was safe, the logistical and cost arguments win the day, the only way to make the argument otherwise is to start with the assumption that the vaccine is unsafe and work backwards.

Therefore, I propose that the argument between natural immunity Vs. vaccine is largely a distraction that people who believe the vaccine to unsafe use to obfuscate their goals. Since the data on vaccine safety is a settled issue, you're really just discussing if the US should waste money on multiple redundant workflows so that vaccine hesitant people can feel better.

Safety is not a binary condition. The vaccines have a good safety profile as confirmed through large-scale clinical trials, and have met stringent FDA criteria. However the risk isn't zero. The CDC has acknowledged a small risk of myocarditis for the mRNA vaccines.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/my...

This isn't generally a reason to avoid vaccination for most of the population, however the risk / benefit ratio may be different for some sub-populations. In particular there has been a higher than expected rate of adverse cardiac events for adolescent males.

https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v...

So particularly for those adolescents who have already recovered from infection and have no other risk factors we should have a scientific discussion about whether vaccination makes sense from an evidence-based medicine perspective. Unfortunately the issue has been so politicized that any suggestion of caution often gets misinterpreted as being anti-vaccination.

This is precisely correct, especially wrt the cost/benefit. The antibody tests won't tell you when you were infected, with which variant, or how much viral dose, on top of their imperfect accuracy. And if you're going to bother going to a hospital to get your blood drawn, why not just... get the shot and remove all doubt?

Does the calculus change in the countries where vaccines are basically nonexistant? Yes, of course. But vaccines in the US are as nearly easy to get as Gatorade now, and have been for several months. We spent many billions making it that way - we don't need to turn around and start spending even more money on pox party incentives.

On top of that, early on when the vaccine supply was constrained we didn't have enough data to know whether natural immunity was as effective as vaccination, and now vaccine supply in the US is in surplus[1], so there is no reason to be selective in who receives it.

So natural immunity didn't make sense to consider in the vaccination plan. It might make sense to consider in the booster plan though - if you've had a positive Covid test before or after being vaccinated, consider the later of those two actions to be a booster, and don't get another one. That would free up more doses for the rest of the world.

[1]We have a large amount of vaccine that has/is expiring shortly but there isn't enough time before the expiration date to redirect them overseas.

> COVID-19 Antibody Tests cost more than the vaccine (roughly $40 Vs. $16/dose).

That's not a valid reason at all.

> We lack the quantity of Antibody Tests we'd need.

We also lacked vaccine quantity, and many people still do.

> We'd need to set up additional systems and processes to accommodate the testing and proof (which, again, is a cost).

Meh, that's a very weak reason considering it's a small incremental cost to vaccine passports and covid testing.

> The implicit assumption that often go along with these natural immunity proponents is that the vaccine is unsafe.

That's just your 'implicit assumption'.

> Since if the vaccine was safe, the logistical and cost arguments win the day, the only way to make the argument otherwise is to start with the assumption that the vaccine is unsafe and work backwards.

Except vaccine efficacy is much lower than natural immunity and vaccine efficacy wears off over time. We literally have ZERO data on the long-term effects of the mrna vaccines. Plenty of drugs have been found to cause harm 5, 10, 15 years after being approved.

> Therefore, I propose that the argument between natural immunity Vs. vaccine is largely a distraction that people who believe the vaccine to unsafe use to obfuscate their goals.

Your comment here is a distraction. You literally haven't brought up a single fact or data point on vaccine vs natural immunity efficacy.

> Since the data on vaccine safety is a settled issue

How is it a settled issue when there is literally zero data on long-term effects?

> you're really just discussing if the US should waste money on multiple redundant workflows so that vaccine hesitant people can feel better.

Cool story bud.

> COVID-19 Antibody Tests cost more than the vaccine (roughly $40 Vs. $16/dose).

So a marginal cost of $24. Folks with natural immunity will have a stronger reaction to the vaccine, but let’s be conservative. Let’s say 12 hours of symptoms - headache, fatigue, light fever. Very standard with a shot. At around the minimum wage of $8/hour that’s a cost of $96. How much do you value your time?

Full disclosure: happily vaccinated. The vaccine is safe, but it’s dammed inconvenient.

I generally agree with this analysis, but people who are looking for some sort of 'smoking gun' that our government is colluding with pharma to help them make money by forcing unnecessary vaccinations, are more interested in hearing sexy, exciting narratives about how Fauci is working for the devil.

At least let people pay to get the Antibody Test, and if positive then they get a one year vaccine holiday.

There is little point getting knickers twisted over small percentage wins when a large population (children) are unvaccinated.

In Slovenia antigen test (which is acceptable across EU for 48 hours) priced at 10 EUR in a walk-in center and 12 EUR in drive-in lab. I don't know about the first, but the second is definetely a commercial venture with people employed and a place rented and software written and supported, so it should be even less in wholesale.

A lot of people will pay for the antibody tests.

How about start with anyone who had a positive test in the past gets a vaccinated card.

> Therefore, I propose that the argument between natural immunity Vs. vaccine is largely a distraction that people who believe the vaccine to unsafe use to obfuscate their goals. Since the data on vaccine safety is a settled issue, you're really just discussing if the US should waste money on multiple redundant workflows so that vaccine hesitant people can feel better.

I don't think this is a distraction, it's a difference in threat models.

Suppose a government official said that everyone should install a particular app on their phones. It's safe, they say. They ran it through antivirus checks and it came up clean. They measured performance of the phone and didn't see any regressions. All the old apps work normally. Major government security agencies are recommending everyone to install the app. Wouldn't it be normal to be suspicious? I mean, that app could do anything.

There are theories about the vaccine that are ridiculous. No, it doesn't have microchips. And so on. But on the other hand, the vaccine has been politicized by Republicans and Democrats alike. Democrats have a lot vested in the vaccine's success; if it turned out it had some serious flaw that was papered over because the benefits were perceived to be greater than the risks, it'd make them looks bad. In the same way that the operators of Fukushima Daiichi looked bad when their reactor failed, or BP looked bad when the blowout preventer didn't work. These are things where the experts said it was fine, but it wasn't. If you believe that government officials will cover up inconvenient facts for political reasons and your main source on the safety of the vaccines is government officials, then a rational choice is not to trust the vaccine.

If microchips aren't a realistic threat, what sort of realistic flaws might the vaccine have? Maybe it elevates risk of cancer or dementia twenty years down the line. Maybe it affects fertility in ways we haven't tested. And so on. Really we have no idea what the long term risks could be, we just know that the short and long term risks of Covid are pretty bad.

All that said, I got my two doses of the vaccine as soon as it was available, and I hope everyone else does the same. I'm just saying that given that some random person has no capacity to evaluate the safety of a vaccine on their own and supposing they have reasons to doubt that the people presented to them as experts regarding the safety of the vaccine would tell them the truth if there were real safety concerns with the vaccine, I can understand why they wouldn't want to get it. And I don't know what argument I could give that would change their minds. For the ones who've already gotten Covid and presumably have at least some reasonable amount of immunity, maybe there isn't really anything to be gained by trying to convince them.

I don't believe the science is settled no matter how much the already vaccinated wish to turn the page. What do you have to say that studies of vaccine efficacy and risk conducted by drug companies exclude those with prior immunity. How could the science be settled for a cohort purposefully excluded?

DR. GUPTA: "I get calls all the time, people say, 'I've already had COVID, I'm protected.' And now the study says maybe even more protected than the vaccine alone. Should they also get the vaccine?"

DR. FAUCI: "I don't have a really firm answer for you on that."

https://twitter.com/Breaking911/status/1436417459314171904

I think the full response better convey's his position:

"You know, that's a really good point, Sanjay. I don't have a really firm answer for you on that. That's something that we're going to have to discuss regarding the durability of the response.

The one thing that paper from Israel didn't tell you is whether or not as high as the protection is with natural infection, what's the durability compared to the durability of a vaccine? So it is conceivable that you got infected, you're protected, but you may not be protected for an indefinite period of time.

So, I think that is something that we need to sit down and discuss seriously, because you very appropriately pointed out, it is an issue, and there could be an argument for saying what you said."

Given the political discussions about “booster shots”, I find this quote pretty interesting:

> Other studies suggest that a two dose regimen may be counterproductive. One found that in people with past infections, the first dose boosted T cells and antibodies but that the second dose seemed to indicate an “exhaustion,” and in some cases even a deletion, of T cells.34 “I’m not here to say that it’s harmful,” says Bertoletti, who coauthored the study, “but at the moment all the data are telling us that it doesn’t make any sense to give a second vaccination dose in the very short term to someone who was already infected. Their immune response is already very high.”

i really don't understand why booster shots are a "political discussion"

i have normal flu booster shots ever year -- and that's fine. why not for covid?

That sounds more like an argument for the Canadian model where we went several months between shots (on the assumption that a high percentage of the populace partially-protected was more useful than a small percentage fully protected). I'm assuming semiannual or quarterly shots will be where we land until Covid is no longer a major threat.

It's very concerning that the president is saying things like "your refusal has cost all of us" and "our patience is wearing this" when talking to people with natural immunity who have not received the vaccine.

As president, he should be looking for every reason to not alienate his own citizens. It seems like he's doing the opposite. I'm not really sure why. My best guess is politics has become all about polarization lately.

>As president, he should be looking for every reason to not alienate his own citizens.

Through the pandemic, there have been ~40,000,000 COVID cases[0] in the US, and ~120,000,000 people are completely unvaccinated[1].

As such, there are more (perhaps much more) than twice as many folks who have not had COVID who are unvaccinated than there are those who have had COVID.

Given that huge disparity, it's not surprising that the relevant public health authorities (which are mostly state and local, with support from the Federal government) are pushing vaccinations very hard.

I'd also point out that there are actual studies of the efficacy of COVID vaccines, while the data for "natural" immunity is much spottier.

As such, we know much more about how well vaccinations protect people than we do about how well the immune systems of those who have recovered from COVID will protect from reinfection.

What's more, it's not the President's job to be everyone's friend. It's their job (among other things) to promote the general welfare of the population. Getting as many people as possible vaccinated is definitely within that purview.

Your statement seems to be along the lines of "Biden won't give me a pony! He's alienating me!"

[0] https://coronavirus.jhu.edu

[1] https://usafacts.org/visualizations/covid-vaccine-tracker-st...

I'm not against the vaccine, but I already had Covid, have been exposed and tested negative since having it, and haven't gotten the shot. I'm also a little bit of an adversarial person, and this move by Biden has made me seriously lean away from ever getting the jab.

I'm probably one of the more well-to-do people he's trying to target here, and if my first instinct is "Fuck you", this doesn't bode well for getting anyone else on-board.

You are correct. This is the largest overreach I have ever seen: if you work for any company we can control by sniffing around government agencies to find a regulation we can leverage, we will make sure you can't even have a job unless you take a particular vaccine. When you overreach in this way, you would at least want to carve out every reasonable exception you could, to not unnecessarily hurt lives, right? For instance

- If you have a positive antibody test, you're exempt. - If you work from home, you're exempt. etc.

But they don't. I won't make your conclusions for you, but they are obvious.

At times of national ... tragedy ... we sometimes hear about rallying behind the flag. The government's rhetoric seems like a ham-fisted effort at that.

Unfortunately, national US politics have devolved in some respects to a food fight of attacks on political opponents. Some viewed Trump's tax policies in this light, disfavoring residents of so-called 'Blue' states. It would, unfortunately, be very easy to recharacterize Biden's work-based vaccination requirement as an effort to get his staunchest political opponents fired, nationwide. I personally hope both sides can find a path to a more conciliatory approach to policy.

The article clearly states that one of the reasons for shrugging natural immunity is politics, there are prominent GOP figures supporting natural immunity in lieu of vaccines. So being against natural immunity becomes not only a public health policy but a political attack on one’s opponents and applauded by the base. This is what Biden is doing.

Unification in the eyes of many is "Do what we say, we gave you a choice, you choose wrong so now we have have to use force"

That is not unification or pluralism. They (including democrats and republicans but today right now mainly democrats) want a political mono-culture and are willing to use force to get it.

Yesterday in England, they published statistics that showed (among other things) the rate of non-covid deaths among vaccinated people greatly increased from March to August. By a factor that dwarfs the improvement in covid-related deaths. For some reason they didn't feel it was necessary to comment on or explain this surprising pattern. I can think of a number of explanations, but it makes me wonder if they are really on the ball, and would really make sound judgements on other matters such as natural immunity.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

There are lots of experts who regularly interpret this data.

Your comment is pretty vague, so I looked at the excel sheet myself - I assume you’re referring to table 5, “Second dose”? The highest death rate in that table is 14.6 per 100k on 2-Jul-21. Meanwhile, looking at the unvaccinated population in that same table, the death rate per 100k starts out at 22 per 100k, goes as high as 66 per 100k in February, and then comes back down and is in the 30s and 20s per 100k.

A naive interpretation of this data would suggest that being vaccinated is protecting people from murder and other non-COVID causes of death. Obviously this isn’t right (I’m not immediately sure why though), but I’d suggest that your suggestion that the NHS and other experts are unaware of patterns in the data may just be the result of you being unaware of how patterns in this type of mortality data typically work.

Do you know how the rate compares to 2019?

Articles like this is exactly why I can't take the US covid response seriously.

- "You're protected if you get antibodies... except if from natural infection" - "Masks don't help... oops they actually they do... nah they don't... hmmm they might" - "Can't fly into the country.... unless you come through the southern border" - "Covid is scary for kids... even though the flu kills an order of magnitude more kids"

So much cognitive dissonance I don't think I'll ever be able to trust public health ever again... they're either dishonest or completely incompetent at this point.

Perhaps both?

I'm in favor of vaccine mandates but if there was a better way of quantifying immunity I'd be all in favor of letting people with natural immunity get a waiver.

As everything with COVID, the lack of hard data and the poor communication of federal and state agencies has enabled politicians, con men and sectarians to exploit the confusion to their benefit.

There is, actually, antibody test. They are quite costly however.

Im my country, getting infected count as the 1rst dose (yes, i know, natural immunity is better with "real" infections, but rememeber that Covid sometime start an auto-immune disease, it's hard to test for this, so its less costly to just vaccinate people (the jab cost 12E)).

No scientific response. This is mostly pragmatic, and probably politic too. Its easier to just jab everyone you can while you can.

I know it's a bit hearthless, and i can't ask doctors to start triaging, but i'd really like that once everyone have had the possibility to get the double dose, we just stop everything covid related (maybe not the reduced maximum capacity and mask in public transport for the adults during peak hours: those restrictions should have been implemented way before covid).

My mother-in-law works in Healthcare as N auxiliary nurse and caught COVID-19 at the beginning of the pandemic. She was officially recorded as positive by the govt (through a periodic PCR test at work, and received a quarantine order). She received one dose since. But even though they're saying an infection is protecting as much as one vaccine dose, they aren't acknowledging it in the vaccine passport as "adequately protected".

She'll get the second dose, but she was under the impression she was already covered, it's a bit frustrating.

EU recognizes natural immunity for travel to/in EU and national health pass checks.

>even though they're saying an infection is protecting as much as one vaccine dose

That's not the same thing as saying it can replace one vaccine dose, though.

I wish I could get a third dose. She in effect has had a booster.

Why do we still not have data on the number of cases, hospitalizations, and deaths from COVID breaking all three down by groups that are unvaccinated, partially vaccinated, fully vaccinated, and previously infected?

It seems like we have some data — hospitalizations and deaths of vaccinated — but even that isn’t clearly and consistently reported anywhere that I’ve seen (e.g. try finding a chart in [1]).

We need to do better at tracking and reporting on this data, so that we can finally have answers to a lot of questions around effectiveness of vaccines and natural immunity from prior infection.

[1] https://www.google.com/search?q=covid+hospitalizations+and+d...

Because it is pretty simple to account for who got the vaccine and who did not.

And running entire population through antibody test just to find, in most cases, that you still need to administer the vaccine is just wasteful.

> running entire population through antibody test just to find

A red herring if I have ever seen one. Assuming for a moment the premise that one must be forced to establish their immunity to a particular disease before being allowed to leave their homes, all that would be required would be to allow individuals who believe they've had COVID-19 and do not wish to get the vaccine to be able use their test results as proof instead of having to show a vaccine card.

Note, this does NOT require some authority forcing the entire population take specific tests.

But, the point of these vax passes is for all the authoritarian OCD afflicted Munchausen-by-proxy patients to demonstrate that they can force their preferences on everyone else just like it was the case with masks, distancing, no school, lockdown, etc.

> Because it is pretty simple to account for who got the vaccine and who did not.

So it's about tracking people so the government can more easily keep the public safe. Let's give them all the power in the world to keep us safer!

We should be demanding OPTIONS. Even from a pragmatic standpoint, this would convince more people. When they mandate only one thing, it's as if they are pushing towards a dictatorship just for our own safety. How convenient.

I'm sorry, but people are a bit too eager to go there just because of fear. We were in this situation with the Patriot Act and the non-existent weapons of mass destruction. Governments have a track record of doing this!

I'm not sure any countries are actually using antibody tests for vaccine passport type purposes. They usually want a past positive PCR test.

i don’t see how it’d be wasteful to know how many people have natural immunity. seems quite useful actually even if we determine they should still get vaccine

Just zero the entire block of memory instead of checking the state of each bit.

If only these blocks cooperated!

I can guarantee there was more waste in the form of billions of money lost and human productivity and lives lost from locking down the world than if we just told scared people to stay at home at the beginning of the pandemic.

and more so, its extremely hard to track peoples blood test. Adobe Acrobat can easily change anyones name on a piece of paper with a blood test result, there wouldn't be a way to confirm this person has antibodies

In Israel a high antibody blood test gives you a "vaccine passport" for 6 months.

...to get that, you sign up for the blood test using your government ID # (SSN for the US), the government gets your results before you do, and the government issues you an encrypted barcode that can only be decrypted by a government built mobile app that restaurants or stadiums have. They scan it and compare to your own ID

Now, does anyone think the US can pull off getting peoples SSN , connect it to a blood test, send the SSN+result to the federal government and have them issue you a federal "antibody ID" which is directly connected to your SSN in a government database?

We could only wish

Americans are just really bad at these kinds of things. This is why we can't have nice things etc. etc. etc.

Are these people asleep? The vaccines are demonstrably better at producing immunity against strains other than the one you were infected with, particularly against Delta for people who were infected with vanilla or Alpha.

That seems completely untrue from the recent Israeli data.

1) Doesn't grant political power 2) Doesn't enable transfer of wealth

It is definitely considered [0]. However, natural immunity has a lot of unknowns -- length of time, etc.

[0]https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0288

The one thing missing from the article is the thing the vaccines needed to have prior to approval: rigorous controlled double-blinded studies on infection rates. My guess would be that, to people interested in data-driven epidemiological decisions, this is considered pretty important. What the article provides instead is direct measurement of biological indicators of immune response, which while useful is not remotely the same thing.

This is, however, slightly unfair. You can't ethically have a rigorous controlled double-blinded study on infection rates of people who have already had SARS-CoV-2. This would require infecting some people with SARS-CoV-2, making others incorrectly think they had been infected, and then letting all of them go about their lives post-"recovery". The ethical problems are obvious.

That said, I'd frankly be fine with letting people with (state-)government-verified past COVID cases act as though they have been vaccinated for a period after recovery (not sure what the period should be). It would be one way to get the next best kind of data (an observational study of vaccinated and recovered patients). It would also incentivize people to get tested (so they get that government-verified past case). I'm not sure it's worth building that bureaucracy, but if that compromise were proposed I'd happily accept.

Of course natural immunity doesn’t count, that would mean the mandates are about health, and they are not.

>> In public health, “the primary objective is to protect as many people as you can,” he says. “It’s called collective insurance, and I think it’s irresponsible from a public health perspective to let people pick and choose what they want to do.”

If it were really about maximizing defenses against the virus, we would also be told to maintain vitamin D sufficiency among other things that can help. So clearly the goal isnt that. It seems the goal is simply to vaccinate as many people as possible.

The way I understand the science is that we can say with some certainty that…

- we know vaccines work and they’re safe

- we know natural immunity works

- we have a good estimate on how well/long the vaccines work over time (probably 9-12 months with potential boosters) given a plethora of studies

- we don’t know how long natural immunity lasts, but we can (safely) assume it’s going to be 6+ months? Maybe 12, maybe 18, who knows. Does it matter?

- everyone wants to be safe, but the goal cannot be 100% safety/certainty, but severely reducing the spread and impact of covid without giving up our freedom, liberties as well as our economy

Rather than calling it a vaccine passport, call it something else that is less controversial, such as a covid protection status

- if you have been vaccinated/ bolstered using authorized vaccines in the last x months, you’re protected

- if you have an authorized lab based positive results in the last y months, you’re protected

- if you have neither, but can show antibodies from an authorized lab, you’re protected for z months

Let’s set best guesstimates on x, y and z and then call it a day? E.g. Make it 12 months for x and y, 3 or 6 months for z.

I feel like 90% of people could work within this framework. The other 10% is probably too far gone…

Or, hear me out, just get the vaccine.

Personally I think it should be perfectly acceptable to provide a serology test that shows you had Covid in lieu of a vaccination.

That is a statement about the past: "I am immune and here's proof. (either by vaccination or serology test)"

What we do about the future to contain the pandemic is separate question. If you're not a immune you should get a vaccine now.

That is the statement about the future: "I will get vaccinated, because I am not yet immune."

In an ideal world we'd be done here. Together these two statements make perfect sense to me.

Unfortunately there is some inexplicable (again, to me) resistance to getting the vaccine in some people. And hence it is not wise to end here.

Easier just to get the vaccine.

I'd assume that a lot of it is the existing polarization over the issue. It's easier to lie and say you already had COVID, and there's a bunch of people who'd probably do so. (Plus a lot of people who don't even know they've already had COVID, because of asymptomatic cases.)

The state of medical records in the USA is... not great, so it's easier to show evidence of the vaccination that can at least theoretically be verified.

EDIT: man, the rapid-downvoting is even worse here than in the Apple CSAM threads. :D

> because it's easier to lie and say you already had COVID, and there's a bunch of people who'd probably do so.

It's not actually. They're equivalent. The vaccine proof is PAPER which can be forged. And while evidence of a COVID19 test can be paper too, mine was digital.

As far as I can tell, natural immunity relates to the variant. If you had Alpha, and then you encounter Delta, your natural immunity may help you a little, but possibly not enough to prevent hospitalization, since Delta is 2.5x more likely to cause a serious hospitalization. So natural immunity counts, but maybe not against powerful variants. And we should be doing whatever we can to prevent people from becoming infectious and spreading it further.

Not so - the recent Israeli data is mostly about people catching covid classic and being protected against delta. Natural seems to cope with variants better, probably because it exposed you to the whole virus, not just the spike protein.

Flip side: why does vaccination automatically count even though there are conditions and medications that can prevent the body from mounting a sufficient immune response? It's a rare case, but if the goal is to prove immunity then test for immunity (i.e. antibody levels) regardless of cause.

Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now.

Because its the strongest immunity you can get, in all measurable dimensions.

Administrative overhead.

Take this as anecdotal because I am not aware of a study being done, but many people with long COVID report the vaccination improving their symptoms. This seems to argue that there is additional defense in getting vaccinated.

Because its too expensive to measure it (B-cell test)

Because we don't have enough data.

it does matter, but your chances of getting it without taking more damage than you started with is a hell of a lot lower than getting it via vaccination.

Gov's are not good at granular management. they have to make broad sweeping rules that everyone needs to fit into or they get nothing done.

Sometimes on Hacker News, you won't get a right answer because it isn't in the Overton window.

dang

Why? Probably because everyone and their uncle self-diagnosed a bad cold as COVID-19 and plenty more would lie about having natural immunity.

Still I don't understand the current approach to COVID in the US. Vaccines are safe and available yet we only just approved the use in children under 12. I have heard second hand many doctors are downplaying the importance of the vaccine for people under 18.

On the other hand places with good vaccination rates are reimposing lockdowns and mask mandates. Quite a few public events are getting canceled or rescheduled.

By any metric the COVID response of lockdowns, etc. was at best breakeven in terms of cost effectiveness. Since the risk of COVID is lower now both due to the vaccine and also just our knowledge of treatment, any lockdown/mandate response will have a lower cost effectiveness.

IMO it would make a lot more sense to just keep vaccines available for everyone older than 2 including boosters every 6 months (just in case) and end all other restrictions. Sure there is a small population that would get vaccinated but genuinely can not due to a medical issue but that scenario is no different than the seasonal flu and other viruses.

It would be better to just do a vaccine/verified immunity passport like program but that is practically impossible in the US. Too many people won't like/use the governments app including both the normal conspiracy nuts but also the privacy-minded HN crowd. It also does not help that there are half a dozen passport like apps from insurance companies and various government agencies.

> Why? Probably because everyone and their uncle self-diagnosed a bad cold as COVID-19 and plenty more would lie about having natural immunity.

Serology is a thing, as are records of positive test results. Also, in many cases, "proof of vaccination" includes a cell phone photo of the piece of paper they handed out when you got a vaccine, so as it stands, lying is pretty easy.

> Vaccines are safe and available yet we only just approved the use in children under 12.

We don't know they are safe for children under 12. Pediatrics is a profession precisely because "children are not just small adults". Something that is safe for adults isn't automatically safe for children.

>I have heard second hand many doctors are downplaying the importance of the vaccine for people under 18

The vaccine is not important for people under 18.

Only 412 people age 17 or younger in the US have died from covid. [0]

Teenage boys are six times more likely to suffer from heart problems from the vaccine than be hospitalised from Covid-19. [1]

[0] https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-by-Sex...

[1] https://www.telegraph.co.uk/news/2021/09/09/teenage-boys-ris...

I've got a child under 12, and while everyone in my household over 12 is vaccinated, I'm not sure if the vaccine has any point for him. If you look at CDC stats, today there are only 412 reported covid19 deaths in the 0-17 age group, 138 in the 0-4 group, meaning 274 in the 4-17 group out of 670,000. Furthermore, kids rarely need treatment, so most infections go undiagnosed.

While I have no objection to a vaccine, and I don't question the efficacy of these, the trivial chance of my son's covid19 complications versus forcing him to a doctor's office over his fear of needles, which will cause him a lot of angst, makes me question whether to do it. These decisions aren't always entirely about death percentages.

> Still I don't understand the current approach to COVID in the US. Vaccines are safe and available yet we only just approved the use in children under 12. I have heard second hand many doctors are downplaying the importance of the vaccine for people under 18.

> IMO it would make a lot more sense to just keep vaccines available for everyone older than 2 including boosters every 6 months (just in case)

That's a terrible idea. Children are not small adults, and you can't use the same medicine for children as for adults. There are Pediatricians who work specifically with children. Giving drugs to children is unlike the scenario where a heavy car takes twice the gasoline a ligher care takes.

"Therefore, the risk of cardiac adverse events following the second dose of the mRNA vaccine could be around 3.7 times more likely than hospitalization due to COVID-19 in healthy 12-15-year-old boys during periods when the pandemic is better under control 2.1 times in 16-17-year-olds. The group found that this trend remains even when SARS-CoV-2 transmission rates are high, with vaccination being riskier than hospitalization from COVID-19. The long-term health effect of the mRNA vaccines on teenage boys is unknown. Few clinical trials have been conducted due to the early observation of adverse events." [1]

[1] https://www.news-medical.net/news/20210913/The-rate-of-vacci...

> Probably because everyone and their uncle self-diagnosed a bad cold as COVID-19 and plenty more would lie about having natural immunity.

This ignores the existence of antibody tests, and there's no reason that lying about a positive antibody test would be easier to get away with than lying about being vaccinated.

I am 28. A programmer with a sedentary lifestyle.

I was covid positive last October and kicked it fine (verified with a test).

I was tested 2 weeks ago for antibodies, my results were a “76” (I assume percentage?).

Why should I get vaccinated?

"Vaccines are safe and available yet we only just approved the use in children under 12"

From what I understand, different ages of people tend to have different sorts of immune responses. While vaccines are safe and effective, it takes some time to get the dosages right for children because of the way their immune system responds to things - at least, with a new vaccine. I'm not an expert, though, and I got this information while looking up variances in side effects (older folks get less than younger folks, and folks with two x chromosomes - mostly females - tend to get more as well).

Slight correction: vaccines are still not available to children under 12.

> Still I don't understand the current approach to COVID in the US. Vaccines are safe and available yet we only just approved the use in children under 12

The main issue here is that covid is less of a problem for people who are younger.

That means rarer issues can start to outweigh benefits. It's easily possible for vaccines to be beneficial over a certain age and detrimental under.

Also - while the vaccines lower transmission they do not stop it entirely so again it comes to weighing benefits.

The other issue is about testing how well the vaccines work in different groups. Just because it works well in a 65y grandfather doesn't mean it'll work well in a 2mo baby, or help with dosing decisions.

clinical trials are ongoing for <12 year olds. The biggest change is that the dosages will have to be lower. If you give a young child the current adult dose they will have a higher chance of side effects.

> I have heard second hand many doctors are downplaying the importance of the vaccine for people under 18.

Maybe because there's concerns.

https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v...

> "for boys 16-17 without medical comorbidities, the rate of CAE is currently 2.1 to 3.5 times higher than their 120-day Covid-19 hospitalization risk, and 1.5 to 2.5 times higher at times of high weekly Covid-19 hospitalization,"

>Sure there is a small population that would get vaccinated but genuinely can not due to a medical issue but that scenario is no different than the seasonal flu and other viruses.

There is a difference. Covid is 10 times more lethal than the average flu. It's not always that they can't either, it's also that their body won't develop enough antibodies.

Main reason for lockdown is so that your hospitals can keep functioning, or in the case of New Zealand, so that you can go back to complete normal life except for travel outside the country.

> COVID response of lockdowns, etc. was at best breakeven in terms of cost effectiveness

Can you share some of those any metrics? Legitimately asking.

Comment section here proving once again that high IQ nerds are, when it comes to the stuff that actually matters, overtly authoritarian. You might be all for giving children hormone blockers and championing the right to vote without ID, but it turns out the liberalism was just a LARP all along. I am fortunate to be in a position where my livelihood is not being threatened, and I will never get an unnecessary medical procedure to satisfy either contemptible neurotics, pharma shareholders, or the government. Freedom is the freedom to say "fuck you", and I don't need to justify why, though with the facts as they currently stand, it's about the easiest thing in the world. Seethe and cope, because at the end of the day you are a slave, and I will never be.

> at the end of the day you are a slave, and I will never be

I prefer the term "open source project maintainer."

A lot of people will never understand you, so don't waste your time. You should instead try with a red light, say I'm not a slave, and drive through. The light won't understand you either, but maybe you finally will.

I completely agree, although I don't really see too many "high IQ" comments here.

That's fine, just stay away from our towns and businesses where you can endanger people who care about each other. Your livelihood may not be threatened, mine isn't either - but you're probably threatening someone else's.

> Seethe and cope, because at the end of the day you are a slave, and I will never be.

See, I'm not that petty, and I mostly content myself with living in a country where hospitalization rates are at a record low thanks to vaccine mandates. I don't need to seethe or think about it that much.

But if I were that petty, I think my seething and coping would be abated by the knowledge a lot of you people are dying these days, unless they can afford top-of-the-line fetus-based therapy.

Or some of us might be aware of the paradox of tolerance and correctly conclude that unlimited tolerance of intolerance is not the only alternative to authoritarianism.

> I will never get an unnecessary medical procedure to satisfy either contemptible neurotics, pharma shareholders, or the government.

One man's freedom ends where another man's begins. By not getting vaccinated against coronavirus, you are endangering yourself (which, while fine from a personal freedom point of view, still leaves society in form of either the taxpayer or your health insurance on the hook for the treatment cost should you die from it) and you are endangering others who are legitimately unable to get vaccinated (children < 12 years of age, immunosuppressed people, non-responders) with a deadly disease.

And the more people get infected, the more overwhelmed hospitals get with COVID cases (especially given that the delta mutant is both more infections and more likely to cause severe, ICU-requiring distress)... which means the collective freedom of you and other people to not get vaccinated is likely to directly impact the freedom of others who are in need of an ICU bed. And then there is the immense mental and physical load that the unvaccinated severe cases of COVID put on the individual healthcare workers who are obligated by their professional ethics to treat you, no matter what.

So much loss of life, of wealth, of happiness only to satisfy the radical libertarianism of the few. You know, if it were like with seatbelts where the only one you're endangering by not wearing it is yourself then I'd say go for it, see you in wherever we end up after our death - but by not vaccinating, you are part of a direct threat against everyone else.

Because if everyone is vaccinated there is no control group.

I think we can safely say that counting natural immunity would harm too many $$$ dollars and prevent politicians from maximizing the tragedy of C19 for political, power, and financial gain.

From this article: “When the vaccine was rolled out the goal should have been to focus on people at risk, and that should still be the focus,” says Memoli. Such risk stratification may have complicated logistics, but it would also require more nuanced messaging. “A lot of public health people have this notion that if the public is told that there’s even the slightest bit of uncertainty about a vaccine, then they won’t get it,” he says. For Memoli, this reflects a bygone paternalism. “I always think it’s much better to be very clear and honest about what we do and don’t know, what the risks and benefits are, and allow people to make decisions for themselves.”

The authors here agree (I’d really like professionals to discuss this for it’s highly disturbing; but obvious why it wasn’t communicated to subjects)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645850/

THE RISK OF ADE IN COVID‐19 VACCINES IS NON‐THEORETICAL AND COMPELLING

https://www.science.org/content/blog-post/new-antibody-depen...

That article was published on 4th December, 2020. Have the concerns expressed therein borne out in the 10 month interim?

But it was rolled out to those at highest risk first no? It wasn't until many months later my wife (who wasn't employed in healthcare at the time and is relatively young) was able to get scheduled. By that point it had become clear the at risk population hadn't had an opposite effect than intended.

There's actually some limited evidence of ADE for delta: https://pubmed.ncbi.nlm.nih.gov/34384810/

This article also has long form responses. I'd love to see a reasoned contrary response.

The contrary argument is reasonably well-stated within the article, it seems to be mostly a matter of what you assess to be the greatest risks going forward as to which argument you think is more valid.

After glancing at the endnotes, it seems that the bulk of the scientific references examining natural immunity date from before the delta variant established itself.

There already is one response from 2 MDs and one MPH with citations. Glad you pointed out the long-form response section as it was a good read.

The reasoned answer is politics. One side of the aisle committed to a message before they had all the data. The other side did this too. Now it's too politically costly to change any of those positions, no matter how much anyone claims to "follow the science".

Why is this post flagged? And why is the vouch button unavailable?

It was flagged because users flagged it. This is in the FAQ: https://news.ycombinator.com/newsfaq.html.

The mods are surprisingly responsive on this site, so I say this without a hint of sarcasm - try emailing them about it. I recently had a thread unflagged within an hour.

I think the vouch button is only available once the post is dead. (Same for comments.)

The often-repeated phrase is "The vaccine is safe".

We (as in the world) do not yet have data to say that "The vaccine" is safe.

Nor is there one vaccine, there are many.

That all work equally well and have the same side effects and outcomes is unlikely.

We are living in a gigantic experiment at the moment.

Should we not be treated that way?

15 % get vaccine A 15 % get vaccine B .. . 20% get no vaccine.

Then we watch and learn.

The specific number are not important since much smarter brains than mine would have to work it out.

If one vaccine turns out to be terrible for whatever reason we have mitigated the risk.

There is a couple of datapoints now that one vaccine -may- cause a reduction in fertility for men. I am not saying it does, but -if- it should turn out to be true having it impact a controlled portion of the population would be prudent.

We are also continuously learning more about Covid and how it impacts those who do get. As it evolves and mutates, we may find better way of targeting treatment and vaccinations.

I mean what are the odds that the first "alpha" vaccine gets it all right?

If people start getting boosters or re-vaccinated with a better vaccine in a year, the possible outcomes of mixing vaccines within a singel person will also be interesterting and unpredictable.

In my opinion we will have enough data in 10 - 20 years. Or maybe longer.

I am a pessimist and I spend too much time writing code to handle all edge cases (which I never manage to).

So far the roll out, of all the vaccines that are presently in circulation appears to have been a huge success.

How can that be?

Billions of people. Not well tested vaccines.

Each person with different immune systems, different medical histories, different medication, different genetic makeups, some fat, some skinny, some anorexic, diabetes, there are a staggering number of different permutations that you will hit in. population of 3 billion people.

I would have expected more people to die and more people to have severe reactions.

We seem to have been incredibly lucky or just insanely great at creating safe and effective vaccines. More people have adverse reactions to sleeping pills, suntan lotions, ibuprofen etc

I am fully vaccinated, to shots of Pfizer myself

The argument seems fine to me. Let people with natural immunity have the same privileges as vaccinated people assuming they have a piece of paper from a federal entity to prove it.

The only argument I can think of against it is: Certain vaccine skeptic people might be incentivized to catch the virus on purpose.

> The only argument I can think of against it is: Certain vaccine skeptic people might be incentivized to catch the virus on purpose.

I think that's a pretty important argument against allowing natural immunity in lieu of vaccination. A lot of people will go and deliberately infect themselves. Some of them will die. They will spread it to others. Many will tie up ICU beds, doctors, nurses and other hospital resources, causing tons of first- and second-order harm.

To what extent has the efficacy of natural immunity been characterized? There should be some minimum bar of understanding that must be met before something becomes a policy even in extreme cases such as these.

Seeking infection may cure their skepticism faster than any amount of scolding!

Even if you've already had covid, the vaccine is still a safe and effective way to even further reduce your odds of transmitting it in the future

... yeah, this is not going to be a productive comment thread. Sadly, COVID has been so politicized that I tend to say "sit down, shut up, and let the public health people drive". Even if they're wrong, they're close-enough to right to satisfy me and that's better than opening public health up to debate.

I think everyone should get the vaccine, but this is the kind of comment that births brand new skeptics.

> Even if they're wrong

well that's very loaded, as in, if they're wrong to the point of having long term damage to your body, then probably..don't just get it...right? albeit, we've seen no proof that this is the case at all thus far.

Productive or not, the debate must go on. It is the foundation of our republics.

I agree that these discussions aren't very productive, but I take a different approach: let people decide for themselves.

The vaccines are cheap (government paid about $20 per dose to buy them in mass quantities), safe, and effective, and in plentiful supply (at least in developed countries). Even if natural immunity provides some protection, better to just get everyone vaccinated to maximize the protection, because it would cost more to determine that someone has effective antibodies than to just give them the shot. The only reason people are resisting this is because there has been an antivax propaganda campaign.

Phase 3 trials won’t be complete for years. There is a revolving door between the leadership at the FDA and Pfizer. Countries with high vaccination rates have not reported the expected reduction in cases or deaths. The non-pharmaceutical interventions adopted by some states appear to have no impact on outcomes when compared to states without them. FDA approval of Comirnaty, which nobody got, is a pretty transparent rhetorical stratagem. The guarantees of safety are testimonials from people who either provided material support in the creation of this virus or inflicted Microsoft on the world (I’m not sure which is worse).

You may not find these (non-exhaustive) reasons compelling, but I don’t think hesitancy is the result of some unnamed cabal of villains casting aspersions on the pure intentions of the American politburo and pharmaceutical industry.

It's a waste of resources to figure out whether someone has natural immunity (its quite hard to do logistically). Much easier to just give them the vaccine, then your bases are covered. These are public health decisions -- they don't occur in a vacuum with unlimited resources.

We could make individuals pay for it. Heck, we could tax it, make them pay through the nose for it, and reinvest it back into vaccinations. Up the costs even more if they want to be retested. Since it's not medically necessary, their insurance shouldn't have to cover it, meaning the costs won't have to be borne by everyone else.

So my medical decisions will be made for me because its too hard to do a proper test? How much fucking money has been spent due to this pandemic, amazing vaccine development, government backstops all over the place, but somehow a routine blood draw and test is seen as too absurd an idea?

Pros vs cons of taking natural immunity into account:

Pros:

- An extremely small number of people who would get side effects now wouldn’t

Cons:

- Logistics: you now need to perform a blood test on every single person in the country, process the results, send out vaccine invites based on the results, and set up some system where people can prove their blood test results. None of the aforementioned components currently exist. You also need to come up with some arbitrary threshold for “enough” antibodies.

- Cost: the blood test costs 4x as much as the vaccine, from what I see in other comments

- Incentives: you risk incentivising vaccine skeptics to deliberately contract COVID

Some notes:

>Pros:

>- An extremely small number of people who would get side effects now wouldn’t

What is an 'extremely small' number? The CDC[0] states that [Headache..., Fever, Nausea] are "common." Sadly 'common' is not defined, but with >100,000,000 folks with natural immunity it's hard to imagine a definition of 'common' that squares with any reasonable definition of 'extremely small'.

>Cons:

>- Logistics: you now need to perform a blood test on every single person in the country,

For a large chunk of the population you have past positive test results. For the rest, you just need to offer the option of taking a blood test. Furthermore, the majority of the US is already vaccinated. So in just a few steps you go from "every single person" to, if you allow me to guesstimate, somewhere in the single digit percentages.

Also a missing pro:

You have a government whose vaccine policies are grounded in proper science and medical ethics, reducing the number of vaccine hesitant individuals.

[0]https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/af...

We've already don't plenty of covid tests on people throughout the past year or so. Why not start with giving anyone who has a previous positive test a card saying they have the best possible protection.

It seems much harder to quantify the level of immunity conferred by natural infection. It depends entirely on an individual immune system detects and combats a particular infection.

Anecdotally, I know someone who has been infected twice. Refuses to get vaccinated now because "why bother? I have great immunity now." With no sense of irony, given that he's already been infected twice...

> It depends entirely on an individual immune system detects and combats a particular infection.

How is that different from a vaccine?

>Anecdotally, I know someone who has been infected twice

How does he know he was infected twice?

Saying that a PCR test returned positive values two times isn't a great answer - since by its nature PCR is only counting the existence (above the programmed threshold post amplification).

Serology is the only way to know for certain you were/are infected.

This highlights one of the bigger issues we have: PCR test are a very cheap and a useful way for getting estimates but their failure rate is high enough to make it pretty poor basis for doing large scale data analysis.

Why is it "harder"? I assume you mean harder to quantify than vaccination immunity and I don't believe that's the case, but I'm curious why you believe that is the case.

edit: surprising downvotes so I probably didn't communicate my point well.

I can't imagine a reason why natural immunity would be harder to quantify than vaccine induced immunity. It would seem to me the methodology to quantify both would be very similar.

>It depends entirely on an individual immune system detects and combats a particular infection.

Pardon my ignorance, but does this mean by contrast that vaccines are designed to induce a uniform response across immune systems?

EDIT: A reply (deleted before I could respond) mentioned that immune systems will combat the infection by some "pattern" of it's own design, but a vaccine will encourage the immune system to respond in a predetermined way, (increasing likelihood of uniformity, answering my question).

Is this accurate?

The question in the title is very very easy to answer.

The political reason that natural immunity “doesn’t count” indeed is not directly about medical reality.

To say things are political is almost an insult these days—I don’t mean it that way at all. But policy has medical implications, and so politics is part of it. This policy-decision is being made because there have been political movements since early on to do variations on “Let 'er rip,” that is, to allow COVID-19 to run rampant until a herd immunity develops, while maybe implementing decontamination procedures in nursing homes instead or so. The most notable statement to this effect was the Great Barrington Declaration but of course there have been smaller ones that hit wider spread.

Policy needs to factor in things like the huge early oppositions to shutdowns, the huge oppositions to masking despite it being absurdly effective for how cheap it is... there remain very strong political forces in this divided country which overlook the significance of younger people with COVID flooding the emergency rooms and overtaxing our limited health workers (NYT today reports that in the US South, they are at this level right now), and the death that can come from this, simply because the danger for young people is usually considerably smaller when those hospitals are operating normally. (See India for a cautionary tale, there.)

Given this political reality, ‘vaccinate everyone’ is a political countermeasure meant to create a potential-energy-barrier to lying. It’s not medical advice, it’s public policy. Lying to say ‘Yeah I was COVID-exposed but it wasn’t bad enough to go to the hospital’ is very very cheap. Forging a CDC vaccination card takes a couple hours of time right now and opens you up to some fraud risks—it’s not a huge cost but if it’s higher than the cost of just going and getting vaccinated, there is a hope that vaccination will win out.

I like to put numbers to things. People give up freedoms when there is a chance they or many other people die. Look at 9/11, not only did we give up multiple freedoms, but subsequently killed many Americans and other civilians in the Middle East as additional fallout.

9/11 killed: 2,977 people (only during the attack, many more likely received cancer or long-term illness and side-effects)

COVID19 has killed (in the US): 664,000 people

Even if you make the argument that 90% of COVID deaths are people who were well past their life expectancy, or obese, or had other health conditions, then that leaves 10% who were otherwise perfectly healthy people who died directly because of COVID, and that is about 66,000 people.

So, by this extremely conservative estimate, COVID has killed ~22x the amount of people 9/11 did.

With that number in mind, do I personally feel like mandating the vaccine ("government tyranny"), or putting innocent people at risk ("dozens of deaths in young women due from clotting, ~1,000 confirmed cases of myocarditis in young people") makes logical sense?

I actually think, yes, it does, 66,000 is a lot of people, it's too many, the death rate of this virus is just too high. If the virus was less transmissible, killed less people, or showed signs of quickly fading away, I would disagree, but it seems like the vaccine is actually a fairly logical tradeoff in reducing needless loss of human life.

How does this tie to the original post? The reason the vaccine is mandated, is because it simplifies public signaling and policy decisions, otherwise too many would assume "natural immunity" is okay and forego the vaccine, even if they did not themselves have COVID, leading to more needless deaths.

This is good solid math that I encourage everyone to think hard about, and that death rate is only going to go up.

In US culture this seems like it would potentially set up some perverse incentives among anti-vaxxers, leading to things like the "measles parties" that fueled the the 2019 NYC measles outbreak: https://www.sciencedaily.com/releases/2020/05/200527181329.h...

We are well past that. It's not that hard to say:

1) If you have natural immunity already, great! Provide evidence of your positive test

2) If you don't have evidence that you've been SARS-COV-19 positive, go get a shot so you don't have a severe hospitalization.

3) No, we don't suggest getting infected on purpose over the shot. Go read #2

Instead, the US federal government is being purposefully ignorant of how effective natural immunity is.

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