Most Covid-19 hospitalizations due to four conditions | Hacker News Reader

Most Covid-19 hospitalizations due to four conditions

nih.gov

69 pointsfortran77156 comments

They seem to have overlooked hypovitaminosis D as a condition. Research indicates that it's a serious risk factor for hospitalization.

https://vitamin-d-covid.shotwell.ca/

Didn't find it in the link, what symptoms would one notice if this was a problem?

Severe hypovitaminosis D can cause brittle bones, muscle weakness, fatigue, and depression. However, there may be no obvious symptoms at all. If in doubt it's a good idea to get tested. It ought to be standard clinical practice to order a vitamin D blood test for anyone diagnosed with SARS-CoV-2 infection since that can indicate a patient is at higher risk for hospitalization.

Obesity is also correlated with vitamin D deficiency.

Vitamin D deficiency is also caused by obesity, for example and is a symptom of bad metabolic health in general.

Well the other three conditions they listed (diabetes, hypertension, and heart failure) are also frequently caused by obesity.

Maybe it’s all just obesity?

Except most obese people don't have issues with COVID. This is the thing that is most confounding about COVID. Most comorbidities only increase the risk factor by a little. The biggest and most reliable risk factor is age. We know there is almost no risk below the age of 5, and 15% chance of death over 75.

Severe obesity increases the risk by more than a little.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e4.htm

https://www.acpjournals.org/doi/10.7326/M20-3742

Yes, it's a little. A 20% increase over a small number is still a small number. I'm not talking relative risk, I'm talking overall risk. Most overweight people still have mild symptoms or were asymptomatic. The single factor that had the highest predictive factor for complications was age.

No. Although obesity is a risk factor for the other three, it is not necessary for any.

Heart failure is a loss of function, the other three aren't per se.

> caused by obesity

IANADr but I think type 2 diabetes is caused by too much sugar in the diet, and so is obesity.

"Almost 3 in 4 U.S. adults is overweight or obese."

Curious, Why is that ?

Laziness?

Cheap calories are less nutritious. You know how many servings of ramen noodles you have to eat to get a reasonable amount of vitamin A?

Generally, food isn't designed for nutrition. It's made to be maximally salty or crunchy or cheesy or whatever. This is true even for mid-range packaged items and not just the cheapest ones.

>Cheap calories are less nutritious.

What difference does that make on the whole? You don't overeat on these foods because you didn't get enough vitamin A. You overeat them because it's delicious or because the portions are wrong or your body doesn't send the signal to stop or because you're depressed or...

I found that I was a lot less likely to overeat when I ate few carbs. Instead, I ate foods mostly rich in protein and fats. But once I went back onto a general carbohydrate-heavy diet, as is common in the modern world, it was very easy to eat too much. (Most of our popular foods seem to contain flour in copious amounts.)

This isn't a silver bullet though. It might've worked for me while I was doing it, but might not work for others.

> your body doesn't send the signal to stop

This can be because your body is still missing some nutrition.

> I found that I was a lot less likely to overeat when I ate few carbs.

I think that while high protein and fats is fine, a lot can be said about the type of carb you eat as well. Chips and candy is a lot worse than bread and pasta, which is a lot worse than fibrous and filling carbs like vegetables.

Remember that until fairly recently in human history, meat was very expensive, and so it wasn't necessarily a thing you had for every meal.

>Remember that until fairly recently in human history, meat was very expensive, and so it wasn't necessarily a thing you had for every meal.

Sure, but plentiful grains are also a fairly new thing. Before agriculture it would've been not that easy to overeat on carbs for every meal.

> I found that I was a lot less likely to overeat when I ate few carbs.

I’ve been doing Keto (very-low carb, high fat) for 8 years now. For me, it simply helped that I was far more conscious about what I was eating.

But I still overeat when making any kind of Keto-"Pizza"

Not really. I grew up in a third world country and despite poverty, one can eat healthy.

Ok yeah that's a whole different issue. https://en.wikipedia.org/wiki/Food_desert#Urban_food_deserts

This fact became really obvious to me as soon as I moved from USA to Japan - I realized that what's considered "delicious" in the USA is really an arms race for how to inject the maximal amount of sugar and fat into all foods, and when I visited the USA again after being here a couple years, eating out at restaurants and tasting that kind of cuisine made me feel grossed out.

You just reminded me of something that surprised me when I visited the US - sweet foods seem much sweeter than in Europe. One would say that chocolate cake is sweet anywhere, but the american chocolate cake was on another level. It felt so sweet that I could not finish it, after four or five bites I felt so full that I had to stop eating - not full like full stomach but the other kind, when it starts to feel kind of gross instead of delicious. On the other hand, I still remember and miss "Entenman's crumb coffee cake" - store-bought delicacies are usually kind of dry where I live now but that american one was really like something my grandmother would have made. I guess that the perception of sweetness is one of those things that you get used to and need more to get the same level of stimulation. The US might be just further down that road.

I'm a proficient home cook and baker, on occasion I bring baked goods to work. Invariably, people tell me this thing that I've brought is Delicious! Because it's not TOO sweet! There's a weird disconnect between the commercial manufacturer and the consumer, there's no signalling mechanism; since all manufacturers ratchet up the sugar in everything, consumers don't have a valid choice for something less sweet. The "reduced" label -- I frequently see "reduced salt" or "30% less sodium" on things like bacon, canned beans. The "reduced sugar" I typically see on Weight Watcher or "diet" products. The normal stuff is tooth-achingly sweet, and covered with additional sugar drizzle or sprinkles. People (and even sadder, little kids) are now conditioned to respond to these ridiculous excess with delight, as if it were a special reward.

A while ago I went one month without any added sugar, I cut out dried fruits and reduced fruit intake. On the weekends I allowed myself one tablespoon of fruit jam. After the first week, the jam tasted incredibly sweet, but delicious. When I went back to normal eating, everything tasted incredibly sweet to me, and I thought two tablespoons of jam was unnecessary, and that was just one month!

We just celebrated Halloween here in the US. I think it was more special when cane sugar was more scarce and candy was really a special non-daily treat. No kid needs a tenth of the candy haul I see them carry around, and my office is in a glut of candies that were bought by the adults but not given away.

Diet & car culture would be my first two guesses, but they are only guesses. I'm guessing it's very unevenly distributed.

Car culture can play in to diet as well. When I was driving to and from work each day, the most tempting options by far were McDonalds and KFC because they had drive thrus which saved time on my way home when my brain was feeling fried.

Then I moved to the middle of the city and I have no commute and many options for food available which are healthier. Since I no longer use a car, these fast food places are less temping.

There was car culture in the 70's when everyone wasn't fat. The change is cable television and other inside diversions that weren't available 40 years ago.

Car centric development just got started then and it takes time for humans to grow up.

Most of Europe also has cable television and other inside diversion. However car dependence and obesity is lower.

I find this video here quite enlightening: https://www.youtube.com/watch?v=IUzuRL0uJnw

Because the definition of "overweight" is based on BMI, which is essentially pseudoscience.

And BTW includes most of the EU as well.

Countries like the US includes the EU too, at a lower level but still over 50% are supposedly overweight. [1]

[1] https://ec.europa.eu/eurostat/web/products-eurostat-news/-/d...

These stats were made before the EU's most obese country left the union ;)

If you look at obesity level per country, the most populous country in the EU is on rank 79 of 191, not far from the middle of the table, while the US is on rank 12, with mostly micro nations above it: https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...

Obesity is increasing in most EU countries. Give them a few years and they'll eventually catch up to the US and UK.

It's easy to criticize BMI as a metric, and it's certainly not perfect, but for research and public health purposes it's good enough.

The real COVID-19 risk isn't from BMI or even obesity in general, but specifically from excess visceral fat.

https://www.metabolismjournal.com/article/S0026-0495(20)3030...

However measuring visceral fat is slow and expensive since it requires something like a DXA scan. We don't have enough equipment to scan everyone. So we usually rely on BMI as a proxy.

You can call it pseudoscience but that doesn't do anything for the fact that far too many Americans are fat by more scientific scales as well.

Then we can use the more scientific scales.

The number of weightlifters who compute their BMI and then think, "Oh, no, it turns out I'm obese" must be approximately zero.

The number of people who are going to get a caliper test done or a water displacement test, outside of elite athletes, is again approximately zero.

The number of people who are overweight or obese and don't realize and could discover it using just two pieces of easily available information is more than I could count in my lifetime, working 24/7.

It works well enough for the general population. People don’t like being told they’re overweight though, so there’s a lot of surface level commentary about it.

The biggest issue from what I can see is the lack of time / skill / willingness for most people / families to do their own food preparation from base ingredients. So what you end up with is prepackaged or restaurant-served foods, often in serving sizes or nutrition profiles that have excess calories.

When meal preparation is done manually from base ingredients, the calorie count is typically lower for a given level of "fullness" you feel from the food. And since it takes time and effort, the meals are prepared (and consumed) on a set schedule (breakfast, lunch, dinner). Now contrast that to ready made meals and restaurant meals. These typically have more calories than what is required for a serving (or they consists of excess servings), so over-consumption tends to happen due to easy access. And they are made to taste excessively good (because that sells better). Home cooked meals using traditional ingredients taste ok, but aren't the flavor profiles that keep you wanting to consume excess servings.

>The biggest issue from what I can see is the lack of time / skill / willingness for most people / families to do their own food preparation from base ingredients.

You forget one important piece of that puzzle, I think: access to (affordable) base ingredients. From my outsider perspective, having read some articles and seen some activists talk about this, there seems to be a thing in the US they call "food deserts"[0] where in many, mostly not very affluent neighborhoods there simply are no stores left that do sell fresh base ingredients, only "dollar stores" that sell highly processed cheap "food".

[0] https://en.wikipedia.org/wiki/Food_desert

Even in affluent locales, quality base ingredients are noticeably expensive.

Portion size / spoilage / price per unit are also a huge issue for those who are single. I'd have to eat almost the same thing every day to properly use up most highly perishable (good for me) foods before they spoil.

I am single, and I generally do not have much of an issue with that here in Germany. "Loose" fruit and vegetables[0] and "single-sized" packaged stuff[1] is widely available without much of a price difference. I rarely have to throw anything out because it spoiled, and I don't have to eat the same stuff for days on end, either.

Is that really such an issue where you live? Interesting.

[0] "Loose" stuff is usually sold by weight, there are scales in the supermarket where you weigh whatever you intent to buy, so buying small quantities has no surcharge at all.

[1] Smaller packages usually are a little bit more expensive than "family size" ones. But I hardly buy anything perishable in such packages anyway. It's mostly things like noodles or cereal, which if stored correctly, can last for months if need be, so buying a cheaper family-size pack as a single is not an issue for me.

Part of this is true, part of this is not.

Stores carry what is demanded of their customers, and they don’t carry what they can’t sell before it goes bad. The food isn’t there because it’s not consumed, and because you can’t buy it, it’s not consumed. Fresh food is expensive and goes bad, it’s too much risk as a small business to carry if you don’t think you can sell it. That’s the issue you often see.

My second point would be the huge number of ethnic markets in low income areas with a tone of fresh fruits and veggies. When consumed, they are carried.

There is a culture of convenience that pushes people to shelf stable meals. Those are quick, and generally unhealthy.

In addition, the total lack of cheap but healthy prepared foods. In the USA, "healthy" = "salad" = "$15 at Sweetgreen" or something. But living here in Japan, despite the cost of groceries being consistently higher than it is in the USA, there's an huge variety of healthy $5-10 meals, as well as healthy, low-calorie/high-protein snacks easily available at any convenience store (that are actually delicious - dried seafood and pickled veggies are a favorite), that simply doesn't exist in most of the USA.

For instance, I just had a grilled fish lunch set meal (teishoku) similar to this one [1] with miso soup (full of veggies), pickles, eggplant and small bowl of rice for $6 today, which based on similar meals at chain stores that publish calorie counts, probably amounts to maybe 600-750 calories with around 30-40 grams of protein. If you're hungry maybe choose a pork cutlet instead for the same price, or add a side dish for $1, or switch to a larger serving of rice for free.

That said, even if those options were available, convincing Americans that "tasty" is not equivalent to "supersaturated with butter and corn syrup" is a difficult proposition...

[1] https://upload.wikimedia.org/wikipedia/commons/c/ca/%E3%82%B...

A lifestyle built around availability and expectation of the use of personal vehicles as the sole means of transportation.

Every advertising influence pushes you to buy more, eat more, and then address the repercussions with strategies (Ab-Roller style gym equipment) that won't work as well as just not eating so much in the first place.

Small servings get ridiculed.

I'm going to buck the trend of most responses and say that we don't fully know. Some good obvious guesses, but a very hard field to study, all told.

I say this as someone that was gaining weight while biking twenty miles a day. Easy to chalk it up to previous years over eating. But I don't do most fast food that we love to demonize.

This is not a well researched opinion, but I would think that diet makes a bigger difference than exercise. Looking at the amount of energy contained in the average food and drink and the amount burned while exercising. A long and difficult exercise session ends up using far less energy than you burned simply living.

One thing that often gets overlooked is that muscles consume much more calories just for maintenance. So if you build a substantial amount of muscle, your base calorie consumption goes up and even if you don't love a lot on a particular day you burn more calories and gain less weight.

Is the effect really that significant? A cursory Google search suggests not. [1] Either way I don't see most Americans getting jacked any time soon.

[1] https://www.latimes.com/health/la-xpm-2011-may-16-la-he-fitn...

> even if you don't love a lot

That's a good typo there :)

Yeah, I'm going to guess it doesn't make a huge difference.

Though, I am sympathetic to the idea that some foods encourage you to be more active. At least, some do the opposite. Eating a full pizza will almost certainly not be followed by anything active.

Oddly, following anything active with eating a pizza seems better.

Absolutely.

When working from home, i managed to lose on the order of 5-6 kg by eating less and skipping the occasional meal.

Now that the office is open again, the weight is slowly creeping upwards. This is due to the rather large plate served in the canteen at work.

To balance that out, my estimate is that the 45 km of biking a week i do, will have to be supplemented with gym visits 2-3 times a week.

With the above it will be possible to get within 4-5 kg of the ideal weight:

https://en.m.wikipedia.org/wiki/Human_body_weight

So maintaining a healthy weight is not easy without reducing servings and the ideal weight is even harder to achieve.

One of the problems is we tend to offset exercise with reduced activity elsewhere. It seems the body/mind is really good at balancing these things out. So you might find your extra gym visits don't have the effect you want (although they will have other benefits).

I'm jealous. I bike that much every two days when active, and was still gaining weight. I don't eat sugar foods, as it messes with me. I just eat lots of food.

I tried switching to smaller plates. Doesn't seem to help too much.

I was finding that salads help. Not sure how much, though. I was basically in a starvation diet when it was working well.

That said, counting calories definitely helps better than I want it to.

Most people dont want to eat healthy, or hit the gym. Plus fast food is cheap there.

Gym culture is very American.

Really, the issue is that routine exercise of the most basic kind is totally absent in most Americans' lives. In most of the world you can reasonably walk to school, to work, to do some quick shopping, to meet with friends, and if you're not walking directly there you can walk to a bus or a train that will get you in that general direction. In most American suburbia, these types of walking journeys are at best indirect and at worst downright dangerous with a lack of safe sidewalks or crosswalks.

In 1969, half of American schoolkids walked or biked to school. In 2012, that figure declined to 19%. https://www.wnyc.org/story/284604-why-so-few-walk-or-bike-to...

I moved from a major, transit oriented US city to a suburb, and my daily steps walked declined by like 75%. The suburbs are designed around doing as little physical movement as possible.

Culturally, I think choosing to embrace being overweight rather than perceive it as a problem to solve by eating food higher in quality and lower in quantity is a large contributor. People who develop unhealthy food habits and are unwilling to view those habits as unhealthy are going to become increasingly overweight.

Fake. Everything is fake. The polite term is "substitute", there are entire shelves of respectable economic literature on how to deliver fake goods and services to consumers so they don't notice.

* The food supply is fake. Anecdote. Back in the '80s the Eastern Block went through a deep crisis, including a low grade famine. After the communism fell, the food supply improved. One item stood apart: the American frozen chicken. Three times the size of a domestic one, tasting like moist cardboard. Most people would not touch it, unless positively starving. These days, everything is tasteless fake: bread, chicken, milk, eggs, veggies. For somewhat better quality, the prices are at least 2x, possibly quite some more. Good quality produce is nearly impossible to find, the fakes have pushed real farmers into bankruptcy long ago. Even the meager subsistence farmers markets of the Eastern Block of old had noticeably higher quality offerings (caveat: in season).

* Americans don't prepare food at home. The American woman was pushed into the workforce and doesn't have time, energy, will or knowhow of basic homecooking. What, you reminisce of (grand)mother's comfort food? What kind of barbaric misogynist are you? No, men didn't step up to take on the traditional feminine role. Realistically, they will never do. No amount of nagging NYT editorials will change that. The food industry happily filled the void with processed fakes.

* The mass restaurant network delivers fake food. The staples are ground meat & fried potatoes, fake chicken & rice or pasta. Sometimes industrial tofu or shrimp. If you are really "health conscious", there is "gluten free" for you. Sure, there is a dazzling variety of sauces and presentations, but the basis is pauper. You have to search hard for ethnic restaurants to even find a veggie basis, and even then the most popular offering is American Indian, with dubious thick sauces.

* Americans eat way too much sugar. The food industry drops ridiculous amounts of sugar in everything, including savory foods if they get a chance. Anecdote. Coming from a different culture, American sweets literally make me sick. Making sweets at home, using about 1/4 - 1/3 of the American recipe sugar recommendation is about right.

* Americans don't walk. Old World cities are (were?) built in such a way that doing basic life functions require walking. Buying groceries, going to school, going to church, going to see friends, going to work (walk + public transport). Americans drive everywhere, because everything is too far away for walking. With Amazon and Amazon Fresh, even the meager shopping trips are vanishing, which will lead to an extra bump in obesity. Removing the reward for walking mostly removed walking itself. Shaming people for not hitting the gym often enough doesn't work, we are built to pick the path of least resistance.

* American kids don't roam the streets. Something happened and kids simply don't just go out to play with their friends for hours on end. At the minimum the parents must setup activities, playdates & transportation. In practice, this leads to sedentary overweight depressed kids. Let's buy them the latest networked gaming console instead, that will keep them socialized, active, and healthy.

* American culture is increasingly adverse to generating signals for distinguishing healthy and unhealthy. In the name of "inclusivity" we are implicitly promoting deeply unhealthy lifestyles. We are good people and wouldn't want to hurt feelings, right? Right, except that we are depriving our kids of the ability to identify and model healthy behaviors.

Cooking increased overall from 2003 to 2016. The percent of college-educated men cooking increased from 37.9% in 2003 to 51.9% in 2016, but men with less than high school education who cook did not change (33.2% in 2016) (p < 0.05). College-educated women who cook increased from 64.7% in 2003 to 68.7% in 2016, while women with less than high school education had no change (72.3% in 2016) (p < 0.05).

So maybe there is hope and evidently educated people care less about sexual identity stereotypes than you think.

https://nutritionj.biomedcentral.com/articles/10.1186/s12937...

Even a minimal familiarity with the American cooking landscape should easily disabuse anyone of the notion that Americans of either gender cook at home. No, "pasta salad", microwaved mac & cheese and the occasional barbecued hamburger is not home cooking.

I grew up in a poor country, with an objectively deprived food supply chain. There were multiple home cooked dishes in the fridge at all times, though, if memory serves right, '88/'89 were rough. Every single social gathering had more 10x tastier and more varied home cooked food than I ever saw in decades of American life. I met exactly one American family that took cooking seriously and placed a noticeable degree of effort in home cooking dinner from raw ingredients, though their results were rather on the high end, not sure they were engaging in the process on a regular basis.

Consider using 1900ish as the comparison point... https://collections.musee-mccord.qc.ca/scripts/explore.php

I have zero real-life exposure with the American cooking landscape, you seem to have some personal familiarity with it; both isn't a great basis for these kinds of societal judgements.

The linked study claims: While the mean per capita time spent cooking increased over time for both men and women, women cooked for a much greater amount of time than did men (50 min/capita/day vs. 20 min/capita/day). Even 20 minutes is a long time for microwaved mac & cheese.

From what you've been observing, it's very different here in Europe, I know a lot of people now who take cooking quite seriously, and I knew a lot of people back in the 90s for whom it was perfunctory. And in fact: The increase in men’s cooking found here mirrors trends in Europe, where research from four Nordic countries found increases from 1997 to 2012 in the percent of men cooking, particularly those from the working and upper classes [28]. Even in 2016, however, US males’ cooking levels were still lower than in the United Kingdom a decade earlier, when a 2005 time use survey showed 60% of men (and 85% of women) in the United Kingdom cooked over one 24-h period [29].

Unfortunately, I don't get a response for the URL you posted, maybe I'm geo-blocked or something.

Ah, the Nordics. What we are seeing is the result of the collapse of the family. First the village church, then the extended family, lately the nuclear family. Of course once people are completely and utterly atomized all gender roles are lost and people pick up some cooking out of necessity. No, it's not healthy.

> According to People in the EU, a new publication from Eurostat, the EU’s statistical office, Denmark boasts by far the highest proportion of single-person households of any country in the European Union, at 45%. Finland, the country with the next highest share, has only 40.8%. In the UK it is 30.6%. In Spain, 23.2%.

> According to figures from Statistics Denmark, the phenomenon of alene-kultur, as the Danes call it, has been on the march for decades, with the proportion of Danes living alone rising by 42% since 1986.

https://www.theguardian.com/world/2015/dec/20/city-of-borgen...

> Around 47% of households have just one occupant – typically a child-free, single adult.

https://www.flashpack.com/us/relationships/sweden-solo-livin...

PS. We might have inadvertently HN-effect the prior link, it was simply a reasonably looking description of the 1850-1930 household lifestyle.

So seemingly we're in agreement that Americans as well as people in Europe do, in fact, prepare food at home, since now you're bemoaning all the men (like me!) spending time in the kitchen, doing a woman's job.

No, we are absolutely not. You are measuring time spent, I am measuring results. The results, aka homecooked food, are not even barely passable in an American context. As I already said, pasta salad, microwaved mac and cheese and occasional weekend burgers are not homecooking. Just open the fridge of the average American household, it is a barren wasteland. Somehow I doubt modern Europe is doing much better, though possibly some pockets, especially in the Latin world, are holding by a thread.

I am aghast at the misogynistic downplay of the skills, hard work, love and dedication our foremothers poured in keeping the household happily humming along. But to each its own, at this point some of these words are probably just some empty strange anachronisms. Enjoy the Nordic lifelong solitude, probably happier to simply not know what has been lost.

The thing is, you're not measuring anything, just making vague extrapolations about the American household, based on -- I don't know what exactly.

I am aghast at the misogynistic downplay of the skills...

I'm sure you are. What specifically are you talking about?

Having moved internationally fairly recently, I would bet on (culturally-influenced) portion size. It's the dumbest possible explanation, but even so.

Yes. Crazy to think a lot of places won’t even let you order a small size combo anymore. Their smallest is what I remember a large to be years ago and often I’m upsized and charged for a large unless I opt out and tell them I want a medium. They don’t even ask usually. McDonald’s is the one I’m thinking of though they’re not alone.

Edit also this type of restaurant portion sizes bleeds into me preparing food at home for myself or my family.

Portions are enormous! Example: Chipotle, a super popular fast food restaurant, average food is like 1300kcal. It's huge and enough food for at least 3 average sized meals in Tokyo. And that's not including the giant soda most people buy.

Go into any supermarket in the USA and you'll see collections of giant cookies. They are easily 4x larger than cookies from the 1950s (or for that matter 2x/3x larger than cookies in many other countries) and they come in packs of 20+, each cookie is at least 400 kcals and people easily eat half the box at a time.

Chips come in giant bags. The average bag of chips in Japan is ~65g. The average bag of chips in the USA is 280g!!!

Cold Stone Creamery (an Ice Cream chain), you can see how big a single portion is in their front page image

https://www.coldstonecreamery.com/assets/webp/slides/2021/ba...

It's also at least 3x the portion I'd get in many parts of the world.

Those types portions have been arounds so long that now pretty much all of the USA takes them for granted. Anything smaller is considered a rip off. The culture is high volume, low price = best.

It's crazy to see all the giant obese people all over the place. Except maybe in SF/NYC, restaurants that served smaller portions would quickly go out of business.

This is because labor is much more expensive than food. So the cost of a $15 meal is maybe $5 food. If you make the meal 20% larger and charge 10% more for it, you do it, since then your costs go up by $1 but your revenue goes by $1.50. That process ends up in huge portions as people think they are getting a 20% more value for 20% more food (which they are) and so you may even sell more of the 20% bigger $16.50 meal.

As with anything else, to get smaller meals the food/wage price ratio needs to be larger. Food in America is absurdly cheap compared to most other nations.

Upvoted.

A friend of mine likes a local deli. The third or fourth time I joined him there, I remarked that the portions seemed sized for people doing hard physical labor all day--digging ditches or working on a loading dock--but that the clientele didn't seem to be laborers. He remarked that with comfort food, the ingredients are the least part of the cost.

Those four conditions increase hospitalization rate for other illnesses too. The question is if the correlation is stronger with COVID.

> A study estimated that nearly two-thirds of COVID-19 hospitalizations in the U.S. could be attributed to obesity, diabetes, hypertension, and heart failure.

> This research further highlights the burden of heart and metabolic diseases in the U.S. Almost 3 in 4 U.S. adults is overweight or obese. Nearly half of people have prediabetes or diabetes.

> “Medical providers should educate patients who may be at risk for severe COVID-19 and consider promoting preventive lifestyle measures, such as improved dietary quality and physical activity, to improve overall cardiometabolic health,” says O’Hearn.

I'm sure I'll get downvoted for saying this but I find it interesting how we can go so far as to terminate large numbers of people from their jobs if they refuse to get vaccinated, even if they have natural immunity, but it's basically blasphemy to talk about how fat and metabolically and cardiovascularly unhealthy large numbers of people in countries like the US are[1].

Incidentally, it's becoming more and more evident that the people who are more likely to have bad outcomes in breakthrough cases are...the same people who are more likely to have bad outcomes when unvaccinated[2]. And there's even some evidence that men with high BMIs have poorer immune responses to the vaccines to begin with[3]. Which isn't surprising either.

[1] https://www.cnbc.com/2021/09/01/sweetgreen-ceos-linkedin-pos...

[2] https://www.cnn.com/2021/09/08/health/severe-breakthrough-ca...

[3] https://www.news-medical.net/news/20210907/COVID-19-vaccine-...

> but it's basically blasphemy to talk about how fat and metabolically and cardiovascularly unhealthy large numbers of people in countries like the US are

Not really that interesting. People don’t like to feel bad.

Tell someone they have an unhealthy lifestyle and may die sooner (fat shaming), and they’ll feel bad.

And if people feel bad, they won’t vote for you in the next election, or worse, they won’t buy your company’s product.

and we know the virus is fat shaming the whole population from day one, everyone knows now

there is no use worrying about how blasphemous it is to point that out because its already working - “at risk people” (of obvious risk we shall not name) are sheltering in place as if it was March 2020 - at least in my part of the US

you can just talk to people online and tell there is a wide gulf of what reality is. there are people that have no idea that the worlds been opened up for most of the year and that gigantic hundred thousand+ music festivals are occurring

have you been to a big event? its all lean young people

it doesnt have to be said, its working on its own as people always had a choice to shelter without government instruction, government has helped lessened the consequence of that choice with subsidies

at this point there is only a marginal utility in public policy adjusting to say “yeah only fat people and diabetics and hypertensioned should or should have followed these lockdown procedures while the rest of society never needed to”. Theres no point now. There would have been some theoretically optimal way for the economy to not disrupt but thats a moot point now. No official is ever going to say “oh whoops”, there is just maybe going to be some obscure paper modeling an optimal mitigation measure that never was.

Your proposal is to fire fat people from their jobs because they pose a risk to.... others?

In seriousness, the whole point of vaccination is public health, which means you're not doing it just for yourself but also for the person who's working next to you. That's why people are getting terminated.

I encourage everyone to get vaccinated if they can, but over the long run it does very little to protect the person who's working next to you.

https://www.nature.com/articles/d41586-021-02689-y

https://www.businessinsider.com/delta-variant-made-herd-immu...

Great link. I read it. The body of work is not conclusive. Yes we need boosters, according to the CDC so I guess that makes sense.

But, have you heard of herd immunity?

The research is quite conclusive. You might want to read it again.

I have heard of herd immunity. Unfortunately because the vaccines aren't really sterilizing and the Delta variant is so contagious there will be no significant herd immunity effect to protect those who lack immunity. Over the long run we'll all be exposed to the virus multiple times no matter what we do. That's why I recommend that everyone eligible get vaccinated to protect themselves against severe symptoms.

The paper was conclusive but the BODY of work does not in the majority agree, given the link. There is no consensus, yet. Also, "The study has not yet been peer reviewed" so maybe take it with a grain of salt.

Is your latter conclusion re herd immunity being impossible supported by the literature, or at least a mathematical model? If R0 goes below zero the community is protected. The vaccinated fraction might have to be large in order for this to happen, but that's also the case for the measles. You're stating that it doesn't matter what this fraction is, even if one person isn't vaccinated they're eventually going to get infected.

> There is no consensus, yet

There is no reasonable hypothesis for how humeral vaccines could induce antibodies in the mucosae, therefore stop viral replication there, and therefore reduce shedding and hence infection of others. Nasal vaccines perhaps, which are an exciting development and may be what actually ends the outbreak, but not the current lot.

To be able to claim the current vaccines reduce spread you either have to propose how humeral vaccines delivered to the blood could induce T cells in the mucous membranes of the nose and throat, or suggest another mechanism by which the virus can spread.

So you're saying case rates are only dropping because of masks?

I didn't mention masks nor the effect or lack of effect of the current vaccines on case rates, I only added a supporting statement to the previous comment that they are doing very little to stop spread.

> In seriousness, the whole point of vaccination is public health, which means you're not doing it just for yourself but the person who's working next to you.

9/23/2021: 99.7% of Waterford adults fully vaccinated against Covid-19 https://www.irishexaminer.com/news/arid-40704104.html

10/11/2021: Waterford Now Has Highest Incidence of Covid in Ireland https://waterford-news.ie/2021/10/11/waterford-now-has-highe...

Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States https://link.springer.com/article/10.1007/s10654-021-00808-7

Covid cases hit records in South Korea and Singapore despite widespread vaccinations https://www.nytimes.com/2021/10/01/world/covid-cases-hit-rec...

Chile sees Covid surge despite vaccination success https://www.bbc.com/news/world-latin-america-56731801

World's Most Vaccinated Nation Is Spooked by Covid Spike https://www.nytimes.com/2021/05/12/business/economy/covid-se...

Vermont sees the biggest surge in COVID cases despite having the country's highest vaccination rate https://fortune.com/2021/08/12/vermont-covid-cases-vaccinati...

Iceland has been a vaccination success. Why is it seeing a coronavirus surge? https://www.washingtonpost.com/world/europe/iceland-covid-su...

Nearly 60% of hospitalized COVID-19 patients in Israel fully vaccinated, data shows https://www.beckershospitalreview.com/public-health/nearly-6...

Virus surge hits New England despite high vaccination rates https://apnews.com/article/coronavirus-pandemic-health-pande...

A few more:

Vaccinated and unvaccinated individuals have similar viral loads in communities with a high prevalence of the SARS-CoV-2 delta variant https://www.medrxiv.org/content/10.1101/2021.07.31.21261387v...

Covid-19: Fully vaccinated people can carry as much delta virus as unvaccinated people, data indicate https://www.bmj.com/content/374/bmj.n2074

No Significant Difference in Viral Load Between Vaccinated and Unvaccinated, Asymptomatic and Symptomatic Groups Infected with SARS-CoV-2 Delta Variant https://www.medrxiv.org/content/10.1101/2021.09.28.21264262v...

It’s very interesting seeing doctors around me start to adopt the opinion that vaccines are effectively useless. I’ve talked to numerous doctors working in hospitals here who say that media publicity about the unvaccinated prevalence in their icus is bullshit.

It's hard to imagine doctors around you adopting the opinion that vaccines are useless. Because they're not.

Sadly, it's a moving target. After a number of months VE against infection falls off a cliff. VE against severe infection has decreased some 10%, but has not fell off a cliff. I don't know what the future will bring, I'm keeping a nervous eye on the situation. That Israel and FDA/CDC are clearly pushing for boosters is definitely not helping increase the confidence. They are in a much better position to glimpse at the future, and have decided for reasons they are not candidly sharing with the public that the vaccines as-is are not sufficient.

Vaccines and COVID prevalence are statistically uncorrelated. Does that seem like the mark of an effective vaccine?

High vaccination rate (meeting state targets) leads to revoking mask mandates and reopening schools and social venues. This increased social contact leads to a spike is cases. Nothing surprising here once you think about it.

Your list of articles fails to illustrate a point once you read beyond the click-bait headlines. Most articles say that even though there are spikes the cases are mild due to vaccine (Iceland, for example, has not hospitalized a single Covid case during their “surge”)

> High vaccination rate (meeting state targets) leads to revoking mask mandates and reopening schools and social venues. This increased social contact leads to a spike is cases. Nothing surprising here once you think about it.

What then was lockdown and mass vaccination for, if not to reduce spread? That's certainly what we were told where I live. If spread spikes when vaccinated people are again in close contact then wasn't the whole thing just a giant waste of time and money given the motivation?

>What then was lockdown and mass vaccination for, if not to reduce spread?

To reduce death and serious illness.

...in which case, restrictions should never have been mandated, and those who looked at their personal risk and decided that going about their lives as normal was acceptable should have been allowed to do so.

And besides, in the UK the continuing lockdowns were very much sold on the hypothesis that they prevent transmission.

And before anyone replies that mandates stop hospitals being overwhelmed, read the other comments here on the load obesity, smoking, alcoholism etc. places on the health services - mandates for COVID-19 are inconsistent with our past behaviours regarding causes of hospitalisation.

>in which case, restrictions should never have been mandated

Which would have resulted in more death and serious illness.

You either didn't read or understand my comment, or you're intentionally choosing not to address my points, so I won't reply to you any more.

I did read and understand your comment. I just chose to pick on the most obvious falsehood at the start.

>Nearly 60% of hospitalized COVID-19 patients in Israel fully vaccinated, data shows https://www.beckershospitalreview.com/public-health/nearly-6...

But almost everyone in Israel fully vaccinated, so a per capita number would be needed instead, and would tell a very different story. This is a pretty miss-leading title.

I haven't read the rest of the articles you posted, and likely won't given you included this one.

The title is not misleading. It's a statement of fact inferred from data presented in the first paragraph. Calculating per capita hospitalisation would be a measurement of a different metric and require a different title too.

It's not that it's not true, it's that it that you can't make the conclusion that vaccines are ineffective at stopping the spread of covid from it. And if you don't understand that, you are either (a) deliberately trying to misrepresent the evidence or (b) just exercising confirmation bias. Given your response to the parent post, it seems more like the former.

Overweight people put a huge strain on the healthcare system, maybe 30% of the entire health expenditure in the USA can be attributed to obesity. Which creates shortages and drives up costs for others who need it.

So yes, overweight people should be banned from civil society (and certainly restaurants) because the risk of them catching covid and causing even more strain on the healthcare system would be very bad even if they are vaccinated. Not until they get low risk and effective gastric bypass surgery at least. It's for the greater good.

That is to say, I don't believe such a horrific, dystopian, nasty, bullying attitude as this, but I can see how people who believe the unvaccinated should be given the same treatment for the alleged greater good would also think this about overweight people if they were to be logically consistent in their positions.

Unless there's an obesity spike that takes up all the ICU beds in a region (doughnut sale or something) your argument makes no sense.

It makes perfect sense. That is not required for my argument to make sense, 30% of healthcare costs is staggering, and absolutely could result in higher costs or worse outcomes for others.

And a spike from one particular cause does not necessarily lead to a shortage. If a few extra patients start getting covid and then there is a bed shortage, then fewer overweight people in there might also have prevented the shortage.

Look, it's for the greater good. No use arguing against it unless you hate grandma and Science™.

His point is that being fat and being unvaccinated both increase the risk society bears that you will a) give someone else covid and/or b) use hospital resources.

I understand TP's point. It's nonsensical because he's comparing twinkies to eclairs. They're superficially similar but are in reality vastly different things.

Yes, obese people are vastly worse for society than the unvaccinated in terms of financial costs. The solution is even simpler than getting a vaccine because they don't have to go anywhere. They simply have to eat less.

Cost of obesity was $1.4T in 2014, covid costs in excess of $16T. Just googling. I can't comment on methodology, etc. Obesity is ongoing, pandemic will eventually subside, etc. Thoughts?

For argument's sake let's say those numbers are right.

Then what is the argument for the covid response that could not also justify a similarly harsh response to obesity? Is it the exact amount of money that's at issue? The exact number of people who might die or suffer or be squeezed out of adequate healthcare due to load on the system caused by obesity?

I've never seen it. None of the experts or legislators or corporate news talking heads have ever explained it. If we got the cost of covid below $10T would that be sufficient to lift mandates and restrictions and other measures?

Or deaths? Deaths attributable to obesity is what, about 300,000 per year in the US? If covid deaths per year were brought down just a little bit and dipped under the 300k mark would that end the need for those measures?

You just don't get it. People aren't trying to optimize cost of healthcare at the system level, they are optimizing for themselves not dying and not getting sick. The perception (which I think it true, but you don't) is that the unvaccinated are putting them at risk. I want mandates to protect myself. I don't want to be in office with someone who is unvaccinated, or refuses to wear a mask. It's all about me, me, me.

No I do get it. People are trying to optimize the cost of healthcare system at the system level, and they absolutely cut it down as much as they can and people go without treatment for it.

You have vaccines to protect yourself, and if you're an anti vaxer or are still irrationally terrified of the virus you always have the option to shut yourself in your home.

If I'm understanding you, you don't personally believe in "banning overweight people from civil society" but you want to propose it to make a point about how much of a "horrific, dystopian, nasty, bullying attitude" you think the belief in vaccine mandates are, and how if one believes the anti-vaccinated should be restricted then it's effectively equivalent? Seems like an reductio ad absurdum fallacy to me, if so, since you're trying to characterize the belief in vaccine mandates as inevitably leading such a ridiculous, absurd conclusion. In this case banning overweight people.

> If I'm understanding you, you don't personally believe in "banning overweight people from civil society"

Correct.

> but you want to propose it to make a point about how much of a "horrific, dystopian, nasty, bullying attitude" you think the belief in vaccine mandates are, and how if one believes the anti-vaccinated should be restricted then it's effectively equivalent?

Much the same arguments made for bullying and coercing people to getting unwanted medical procedures can be used for either, yes.

> Seems like an reductio ad absurdum fallacy to me,

Why? What is any more absurd about it? 30% of health expenditure is a staggering cost to society. This is not just meh no big deal like the common cold, it's a real cost borne by everyone. And as we see, when they do get covid they get much more complications from it, which makes covid spikes more problematic too. Why can obesity be so easily brushed aside but not people who choose not to be vaccinated from covid?

Because that's just how I understand reductio ad adsurdum to mean, there's a valid chain of reasoning that leads from the initial premise to an unacceptable conclusion. In this case you believe that being "banned from civil society" (your characterization) for being unvaccinated is ok, you must accept the same for being overweight.

"Reductio ad absurdum is a mode of argumentation that seeks to establish a contention by deriving an absurdity from its denial, thus arguing that a thesis must be accepted because its rejection would be untenable"

You said _fallacy_ though. Because reductio ad absurdum can be a fallacy, and just taking any old "logical extreme" doesn't necessarily give you a sound argument.

I am not taking anything to extremes as far as I can see. The situations are not 100% identical to be sure, but as I said, most of the arguments I have heard about unvaccinated could also be applied to the overweight.

And as a disclaimer I'm sorry to have to use overweight as my example, if there was another equally good one I would use that instead because I worry it would cause pain to people even though I hope it's clear that I don't actually feel this way. But similarly I know people who don't want the vaccination and especially don't want to vaccinate their young boys, and they feel horribly bullied and coerced by it so I speak out.

You felt compelled to speak out in their defense, but your choice of comparisons and rhetoric is precisely why I felt compelled to clarify as well and what made me raise an eyebrow on the logic in it. That is to say I think you chose your example, and to make it in a intentionally hyperbolic way with things like "banned from civil society" and "horrific, dystopian, nasty, bullying" because you saw that it would make the most emotional impact to compare to your acquaintances' situation, but that's precisely where I felt it was becoming absurd.

Having just now re-confirmed that levels of nasal virus drop faster in vaccinated people to make sure I'm not being illogical, the creation of laws that allow businesses, schools, and others to legally stop you from entering isn't "horrific, dystopian, nasty, bullying" the way you characterize it at all, like banning obese people due to their burden on healthcare costs would be.

To me, it really does come off as a trying to point out the issues with mandates by drawing it to the absurd conclusion of excluding overweight people from society. So hopefully that clears up why I saw it that way, but maybe I'm incorrect definitionally.

There are always going to be mandates or policies that conflict with what parents, or people in general want to do. To me that doesn't make it nasty or bullying, though they may feel horribly bullied if it affects them. If anything I'd say those feelings (and most examples of nasty bullying I've seen) extend from the acts of anti-science politicization of masks and vaccines, which in my opinion is a great disservice to the public. We now people who now feel like nasty bullies are creating new mandates in a nasty dystopian nightmare world, which I think is extremely unfortunate.

I don't believe it does, and I think it's a fine analogy. I don't see why confirming levels of nasal virus dropping faster in vaccinated people would have anything to do with it. The actual question is the wide scale, end to end cost benefit analysis of all this and whether it justifies medical coercion.

I've never seen anywhere that case has been made, certainly not made in a comprehensive and compelling way that you couldn't reasonably disagree with.

I imagine the case would be different for different interests, but "a few hundred to a few thousand people die of covid every day" would be my go to if I were the one making it.

Compared with what? What exact measures would you propose, what benefit will they have and to whom, and what will they cost?

Is coercing people into getting vaccinated by preventing them from travel, jobs, etc. going to save thousands of the willingly vaccinated who otherwise would have died? Where are the numbers? Do you understand the gravity of coercing people to get unwanted medical treatments, or at least if you don't think it's a big deal at least accept that many people actually do extremely strongly believe notions like the government staying out of their bodies and medical issues?

And then can you logically make all these arguments and numbers in a way that they can not with similar arguments be applied to automobiles and related deaths, obesity and related issues and medical system load, etc etc?

None of this has been thoroughly examined, litigated, justified and sold to the public on its merits as far as I can see. Still. It still has not been. There has been propaganda relentlessly pushed out there in the form of fear and urgency and appeals to authority rather than facts or evidence. There has been no room to question things or present different opinions -- people who dared to do have been attacked, bullied, fired, deplatformed, and censored.

> Compared with what?

I really don't get what is the glitch here? You seem fixated on finding logical parallels to an ongoing response to a global pandemic, which is honestly getting quite repetitive to discuss.

It's compared with the current level of deaths to vaccination rate given it's not going away.. The logical conclusion of unsurprising policies as a response to the novel coronavirus, or any highly transmissible zoonotic virus.

Are we even on the same page here that less deaths is better from the perspective of public policy?

Honestly your rhetoric, message after message gets so tiresome to engage with, by virtue of hyperbolic it is. "Relentless propaganda", "daring to have different opinions gets you attacked bullied fired etc etc".

It's a national healthcare apparatus' response to a virus, nothing more or less.

After reading it all, repeating it every which way, it's just not compelling to me. This doesn't need to be some hyper-emotional, hyper-politicized topic, where parents of young boys need to fearfully victimize themselves as patriot-martyr enemies of the fascist state. I'm getting to the point of having a kind of second-hand embarrassment at the characterization.

> I really don't get what is the glitch here?

The glitch? The glitch is getting you to complete your ideas and form a coherent response.

> You seem fixated on finding logical parallels to an ongoing response to a global pandemic, which is honestly getting quite repetitive to discuss.

I'm fixated because I posted some questions in a covid thread that doesn't mindlessly toe the line, and that's exhausting you? I rather think you would be less upset in the end if you just conceded you don't have good answers. Sometimes it's okay to admit you don't know everything.

This flustered incoherent rambling is what's embarrassing and exposes you as incapable of addressing what I wrote just as surely as a simple admission would have. With the additional benefit of the latter being retaining some dignity. The entire thread is here plain as day for anybody to read, and the point is still floating around happily well above your head:

> Are we even on the same page here that less deaths is better from the perspective of public policy?

So what to do about the overweight person question. I know you're getting flustered and angry because you can't answer it, so you're just pretending it's not relevant or it's somehow "absurd", without actually being able to articulate why.

Why not just stop participating in the conversation if it's upsetting you so much? You're clearly not getting any benefit from considering different perspectives.

I'm not sure why my replies got deleted, pretty wack

It would make more sense at least then saying people who have had covid and had no issues overcoming it are an unacceptable amount of risk to allow at offices and in restaurants, but those who haven’t had covid but have gotten the vaccine are an acceptable amount of risk.

I personally don’t think we should ban, overweight people, people who have had covid or haven’t had covid, who have been vaccinated or haven’t been vaccinated like we did before covid. But since our risk tolerance has gone down as a society at least be logical about it. Getting on a plane, covid test regardless of the fact you don’t appear sick at all, ok fair enough you’re crammed in a tin can. For restaurants, and offices, I think “have no symptoms of covid” is an acceptable amount of risk.

Those saying vaccinated but never got covid are acceptable, but unvaccinated recovered from covid unacceptable, would be more logical to say fat people are banned.

That is the frustration with it. It is just one group trying to say to another group, submit to us, we are your masters, or else we will punish you.

I wonder what people who have endured that kind of attitude in their history think of that attitude?

> Your proposal is to fire fat people from their jobs because they pose a risk to.... others?

Responses like this are sadly typical. What is your aim? To shoot down a legitimate discussion of risk factors like obesity and poor cardiovascular health, which are disturbingly common in the US?

Calling into question the sanity of firing large numbers of unvaccinated people, many of whom will have natural immunity, is not a proposal to fire fat people. What is your purpose for trying to suggest that it is?

> In seriousness, the whole point of vaccination is public health, which means you're not doing it just for yourself but also for the person who's working next to you.

I recognize the value of vaccines and traveled halfway around the world to get vaccinated thank you very much.

But the COVID vaccines are not sterilizing. The data shows that they can reduce transmission of the virus, which is great, but this effect has very real limits that it is dishonest to overlook given what we know today.

Case in point: a new UK study found that, per the BBC, "individuals who have had two vaccine doses can be just as infectious as those who have not been jabbed"[1]. In the study, a vaccinated index case transmitted the virus to unvaccinated household members 38% of the time to vaccinated household members 25% of the time.

That's a meaningful reduction but not anywhere near enough reduction to pretend that vaccination is a panacea for stopping transmission.

Finally, your comment totally ignores the part of my comment that mentioned natural immunity, which the science increasingly says is robust, strong and lasting[2].

[1] https://www.bbc.com/news/health-59077036

[2] https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...

My aim is to point out the absurdity of comparing obesity vaccination and viral transmission.

Herd immunity? One of my responders says that's impossible and the only way to be safe is get vaccinated. You are essentially saying "hey just let it happen no vaccination needed".

What is a HN reader to make of these contrasting viewpoints?

How about this given current public health guidelines? Get vaccinated, or stop complaining when us vaccinated want to deny you entry. Wear a mask, or also be denied access. The difference between obesity and a deadly virus is that the deadly virus is directly and immediately affecting me by your choices. I can pay higher health insurance premiums, but I don't want to die.

> You are essentially saying "hey just let it happen no vaccination needed".

I neither stated nor implied this. Please don't lie about or distort what other people have posted.

This post is about a study which found most COVID hospitalizations are in people with four specific comorbidities that are major public health issues that are often pooh-poohed when raised.

> Get vaccinated, or stop complaining when us vaccinated want to deny you entry.

Thanks for your preaching. I don't know if you're making demands of me specifically or speaking generally, but as I mentioned, I traveled halfway around the world to get vaccinated.

The vaccines do not provide sterilizing immunity and the science is increasingly clear that the vaccines do not stop transmission to the extent everyone had hoped for. If you are in a high-risk group to begin with, you are still at higher risk of a bad outcome if you get a breakthrough infection.

Finally, once again, your "get vaccinated or else!" comment totally ignores the fact that authorities are trying to compel people who have natural immunity to get vaccinated, even when the science is already fairly clear that their immunity is robust, strong and lasting.

> Wear a mask, or also be denied access

Messaging has been a constant problem throughout the pandemic. A lot of people got vaccinated primarily because they were told vaccines offered the only and quickest path back to normalcy.

As it has become clear that the vaccines don't stop people from catching and transmitting SARS-CoV-2, inconsistent guidance around masking, and flip-flops on masking rules, have only caused people to lose trust in public health authorities.

It doesn't help that the people now telling everyone they need to mask up even when vaccinated are frequently caught breaking their own rules.

> The difference between obesity and a deadly virus is that the deadly virus is directly and immediately affecting me by your choices.

If you are in not in a high-risk group, your odds of dying from COVID are minimal. If you are vaccinated and not in a high-risk group, your odds of dying are miniscule.

Once again, the vaccines do not provide sterilizing immunity and do not prevent you from getting and transmitting the virus.

People with comorbidities frequently associated with poor lifestyle choices affect everyone as they make up the majority of the people being hospitalized. Overwhelmed hospitals have resulted in individuals being unable to access non-emergency healthcare and they are one of the primary reasons we're told we can't just "live with the virus" even in places where vaccination rates are high.

> I can pay higher health insurance premiums, but I don't want to die.

Huh? Under the ACA, individuals cannot be denied coverage or charged higher premiums for being obese, diabetic, etc. And once again, if you're not in a high-risk group, your odds of dying in a car accident are probably higher than your odds of dying from COVID.

Don't tell me my odds when you don't know anything about me, my lifestyle, my age, etc. https://link.springer.com/article/10.1007/s10654-020-00698-1...

Yes, I pay higher premiums because the risk pool is large and includes high risk high cost individuals even though I'm low risk. I can afford it. Me. I can't afford dying (got dependents?), or long covid, which IMO worse than death in severe cases. The messaging for vaccination has been straightforward enough for me: I get it to protect me, you get it to protect me if only for herd immunity. Yes vaccine effectiveness fades over time, but you can get a booster. And, I think in places where the vaccination rate fraction is over 90% (arbitrary high threshold) things will get back to normal.

> I can't afford dying (got dependents?), or long covid, which IMO worse than death in severe cases.

Good news. There's early evidence that the vaccines don't provide nearly as much protection against long COVID:

https://www.medrxiv.org/content/10.1101/2021.10.26.21265508v...

> On the other hand, previous vaccination does not appear to be protective against several previously documented outcomes of COVID-19 such as long-COVID features, arrhythmia, joint pain, type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders. The narrow confidence intervals (related to the high incidence of these outcomes post-COVID) rules out the possibility that these negative findings are merely a result of lack of statistical power. The inclusion of death in a composite endpoint with these outcomes rules out survivorship bias as an explanation.

With all due respect, your comments suggest that you really don't understand the limitations of the vaccines. It seems you think they provide a lot more protection than they do and your mention of herd immunity is especially ill-informed. Discussion of herd immunity has all but died because the vaccines are non-sterilizing and do not prevent transmission of the virus. SARS-CoV-2 is well on its way to becoming an endemic virus.

> And, I think in places where the vaccination rate fraction is over 90% (arbitrary high threshold) things will get back to normal.

You should consider moving then because this certainly isn't going to happen in the US. And every 3-6 months when VE wanes in large numbers of vaccinated cohorts, you'll see spikes in breakthrough infections (where testing is being done to even catch them) and pushes for people to keep getting boosted. Most likely, the number of people willing to boost indefinitely will decrease as time goes on.

Things are going to get back to normal in places where people accept living with the virus.

You keep citing unreviewed papers. This last one was done by a psychiatrist, apparently. I'm not convinced that herd immunity is not going to happen given the evidence you've presented.

Getting vaccinated and wearing masks every 6 months and wearing masks indoors in public is living with the virus.

I don't know what their proposal was, but replace "fat" with "unvaccinated" in your response and you'll see what they (likely) were getting at. The logic of "you must get vaccinated to protect the vaccinated" eludes me, since I thought the vaccinated are already protected from severe disease (though crucially not from infection or transmission) irrespective of anyone else's vaccination status.

Full disclosure: I'm overweight. 14kg down from where I was a year ago, with another 10kg or so to go. I'm baffled that NIH/CDC said literally nothing about this issue as it relates to COVID since the beginning of the pandemic. One would think 18+ months is a sufficient amount of time to lose at least some weight, and thereby reduce the risk.

I think you're confused about why some unvaccinated people are being fired. It's not to be mean to them, it's to get them away from customers and employees so they don't pass it on and cause another shutdown. We've had fat people in the US for hundreds of years, and they still haven't caused a national shutdown.

> I think you're confused about why some unvaccinated people are being fired. It's not to be mean to them, it's to get them away from customers and employees so they don't pass it on and cause another shutdown.

The greatest confusion here is found in comments like yours, which imply that the vaccines provide sterilizing immunity and stop transmission of the virus, which they do not.

The latest on this: https://www.bbc.com/news/health-59077036

As for "shutdowns", the rationale du jour in places where vaccination rates are high but restrictions are still in place, and where people are often unable to access non-emergency healthcare services, is that the hospitals are overwhelmed.

The issue of obesity, diabetes, etc. is very pertinent to that, as the majority of the people being hospitalized have four comorbidities frequently associated with poor lifestyle choices.

As for deaths, https://www.bmj.com/content/372/bmj.n623 paints a very stark picture:

> Taking data from over 160 countries, the report found linear correlations between a country’s covid-19 mortality and the proportion of adults that are overweight. There is not a single example of a country with less than 40% of the population overweight that has high death rates (over 10 per 100 000), the report said. Similarly, no country with a death rate over 100 per 100 000 had less than 50% of their population overweight.

So maybe you should consider that "fat people" (as you call them) are a bigger pandemic problem than you argue. If "fat people" weren't clogging up the ICUs and dying, maybe it would be easier to start "living with the virus".

> The greatest confusion here is found in comments like yours, which imply that the vaccines provide sterilizing immunity and stop transmission of the virus, which they do not.

My comment does not imply that. It implies that a vaccinated person is less likely to spread it than an unvaccinated person, which is obviously true, given that the vaccine significantly lessens the chances of having it (if you don't have it, you won't spread it), and even for those who do get sick, it lessens the severity of the symptoms (a person coughing mucus and spit everywhere is more likely to spread it than someone who just has a fever).

Wouldn't the BIGGEST reason right now for COVID hospitalisation be not being vaccinated?

No.

The harsh truth is that in Victoria (Australia), over 90% of hospitalisations are unvaccinated

Correct.

https://www.thelancet.com/journals/lanam/article/PIIS2667-19...

Highlights:

"The need for emergency care/hospitalization due to breakthrough COVID-19 is an exceedingly rare event in fully vaccinated patients."

"Accounting for the SARS-CoV-2 vaccination population groups in Michigan, the ED encounters/hospitalizations rate relevant to COVID-19 was 96% lower in FV versus UV..."

("Fully-vaccinated" versus "un-vaccinated".)

Most people choose one sacrifice over another. Some you could say chose the wrong sacrifice and it was not for their own or others good.

There are a few who have had no choice at all. To them should we use our strength to protect.

Or as Jordan Peterson might say it “choose your damn sacrifice, or it will be chosen for you”

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