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Comment by stolenmerch | Hacker News Reader

If I'm reading this correctly, this is "protection against severe disease" and has little to do with transmission. The National Airport Data from Israel seems to suggest "the absolute number of infected individuals in the Vaccinated (boosted) group is likely to be at least as high as in the Unvaccinated" [0]

So it seems to me that as long as we all remain obsessed with case numbers and not actual hospitalizations and death, this isn't going away, at least not anytime soon. I personally find this beyond depressing.

[0] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3963606

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In many countries where vaccination rates are very high (think of Spain, Portugal...) the infection cases have been increasing yet people in the hospital or deaths caused by/with the virus have been rather low. Attribute it to vaccines, natural immunity, a potentially weaker variant - or everything at the same time but my point is: I agree with you, at least when it comes to these highly-vaccinated countries.

I wish we would just stop looking at infection rates as it's never going to change as long as the virus exists (and continues to mutate) and/or a sterilizing vaccine of sorts shows up and people take it.

> all remain obsessed with case numbers and not actual hospitalizations and death

It's a balance. E.g. Germanys current trouble is a direct consequence of official policy that had a core of "we only care about hospitalizations now", but ignored "... and based on case numbers and other statistics, what will future hospitalizations look like if we don't change anything about our approach" - not helped by election campaigns and politicians publicly admitting they haven't understood this whole "exponential" malarky yet. You really need to consider more than just one number.

As someone who has quite some experience in running operations based on data, numbers and metrics the German approach to COVID on that front alone really puzzled me from the beginning. First the incidence of 50 that they pulled out of their ass for contact tracing, which was ignored basically the next day. Then the fact that resources weren't really increased to improve contract traceability. Then the decision to use a backward looking KPI, ICU occupation, to tackle a highly dynamic situation. Which also meant to ignore the incidence, the only real predictive metric we have. And it is good at predicting ICU occupation and severe cases when combined with vaccination levels.

That's simply amateurish, and means all measures, not all of which are bad, are usually a couple of weeks late. Even better, the 7-day average incidence is based on the daily numbers. Those numbers are, what a surprise, limited to the testing capacities of laboratories, so the incidence is reported based on the day the test was analyzed, not when the sample was taken. This flattens the 7-day average curve. Well, until the new numbers are reported once labs git through their backlog. Thing is, the 7-day average is not changed once published. Again just amateurish.

It tells you a lot of the level of expertise in a country, if a physicist like Viola Priesemann previously not involved in any kind of disease modelling is able to be a significant voice in the national conversation. The 'experts' that are listened to are either numerically illiterate like Drosten or non-experts in disease control like Priesemann. Moreover the actual tools and quality of code that is used to model the situation are so far away from what would be ideal it is laughable.

You really think Drosten and Priesemann decide measures? That's politicians, the government decided on it. If I remember well, scientists were worried when hospitalization was declared the only truth.

And the RKI predicted the forth basically down to a T, they were a couple of weeks of so. Doesn't matter because they predicted, along with Drosten, already during summer.

I think there is an expert vacuum that was filled by opportunists and enabled politicians to decide non-sensical measures. Compare that to the situation in Taiwan, where the vice-prime Minister is an epidemiologist.

Yes, it's been really frustrating to see RKI predict this for weeks and just ... nothing happening. And then you still get headlines of "incidence fell slightly!" - from 392,4 to 392,2 (or sth like that), when testing labs are hitting capacity. We somehow lucked into a relatively good first wave and ever since then... so much unnecessary mess.

The drop in incidence is the same BS when reporting in DAX or S&P moving by 0.2 % day-to-day. That's noice, no signal.

EDIT: That's also noise for HF traders, because day-to-day numbers are pointless when you worry about milliseconds.

Also the "honor system" for quarantine. Also the closure of museums (airy, 25% capacity, everyone masked) but not department stores (crowded, many ignoring mask rules). Also the fact that my art-supply store in Berlin had to cordon off the half of its inventory that wasn't on the "essential" list, so some paint yes, some paint no. Also the refusal to confront the anti-vaxxers (police complicity, etc). Also the very public promises they knew they probably couldn't keep (Christmas is big in Germany).

I had a pretty high opinion of German government competence, Berlin-specific dramas notwithstanding, before the pandemic. I now have a very, very low one.

Yes an authoritarian police state enforcing quarantine in Germany sounds like a great idea. I'm sure there are historical examples they can follow.

Or, you could be honest with the public and call it voluntary.

In many countries, compulsory quarantine was enforced. In Germany it never was, but they still presented it as compulsory and held out the possibility that it might be enforced.

I don’t wish they had enforced it, I wish they had been honest about the arrangement.

Well, this is the issue you have with a lot of these lockdown, mask laws. Are they enforceable? No, unless you have a compliant population and in that case no law is probably necessary.

Almost all western governments did a piss poor job of preventing facts which why we're in the situation we are now. They appear untrustworthy because they've presented partial truths or completely changed their stance throughout.

German government staff is as un-digital as you can get. They have no idea how a small modeling group would have helped. Maybe the incoming government will do better, but I am not holding my breath.

Access to modeling isn't even the issue, given RKI, Charité, ... Asking those resources the right questions and turning their results into policy and communicating it is the problem, which is even more fundamental "that's what a government is for" skills...

Being digital doesn't necessarily improve decision make. All the necessary data was there. RKI the German equivalent to the CDC in the US predicted the current wave rather accurately in summer, but politicians ignored it, because they wanted to win the election.

It's not modelling, just having a basic understanding of your metrics and the ability to choose the right ones. German officials showed none of that. Well, I'm not holding my breath on that neither.

The superseded government (by way of Jens Spahn) admitted that it held back on acting w.r.t. COVID in 2021 to avoid negative impact on their campaign. General inaction or adverse action in other areas (e.g. ICU staffing, leerdenker) did not help, either.

The reason why people are obsessed with case numbers and not deaths is that case numbers control the case numbers in the insufficiently immunized which predicts death toll 3 weeks ahead of time.

Why would you want to control a system with 2-3 weeks of additional lag in your input data when case numbers (a thing that is somewhat easy to measure) correlates so well future deaths?

Ideally politician would have some family of models the equivalent of the CDC runs 3 weeks into the future which accounts for seasonality, social events so we could model predictive control on the death numbers but my impression is that is not done (transparently), due to mistrust in experts.

> Why would you want to control a system with 2-3 weeks of additional lag in your input data when case numbers (a thing that is somewhat easy to measure) correlates so well future deaths?

Because case numbers are actually not easy to measure.

I'm basing this of my personal experience working in a German healthcare company, we took up testing during the pandemic; All the tests we do are on unvaccinated people.

That's because unvaccinated people are the only ones who need mandatory, and up to date, tests for pretty much everything from the barber to eating at a restaurant. Recently, it's become so strict that unvaccinated people even need a test to use public transport.

Vaccinated people do not need these mandatory tests, I have no clue who tests them and at what intervals, it certainly ain't the public testing stations, as those are now literally swarmed by the unvaccinated and nobody would go there if they didn't have to.

Which means that in practice we have a massive sampling bias going on; Somebody who's unvaccinated will be very likely to get flagged as positive very quickly, while somebody who's vaccinated would need to decide on their own to do a test.

The obvious solution to this problem is to do actual random sampling: pick members of the public in as close to a random fashion as possible, test them for Covid regardless of vaccination status or symptoms, and you should be able to get a reasonably unbiased estimate of actual infection levels in the community. The UK has been doing this since about spring 2020, but weirdly no-one else seems to even though it's obviously useful.

Just doing random sampling on a small group to estimate the error ratio should also work. Also as long as everyone who has symptoms can get a test the error ratio is bounded by the ratio of people with symptoms making it irrelevant for this control problem.

Sure, there is selection bias. Given the overall effectivness of vaccines, the number of positive, yet untested, vaccinated people should be rather small. Plus, those vaccinated without symptoms most likely are not the problem as they are not really infectious. Once you develop symptoms you are tested.

On tip of that, a lot of states are now on 2G+, recovered or vaccinated and tested (anti-gen), for things like cinemas (requiring official tests in e.g. Bavaria) or self tests on site (fitness studios for example). Kids are regularly tested in school (my son three times, my daughter twice). Sure, some of those tests, those at fitness studios, are not counted. If those are positive, I think the number of people not getting a proper PCR test is rather small.

Better is the worst enemy of good. Please suggest a different metric then. One that can be measured easily and will do about as well as the biased infected numbers or one which will do better than the biased infected numbers at a similar effort.

There is little control theoretic relevance of the Dunkelziffer smoothly varying between 2 and 6 as long as that doesn't make the controller overlook a wave (it doesn't). The sign of the policy should still be the same and if measures don't work, harder measures are imposed means we basically got a PI(D) controller and can achieve stationary solutions even if the Dunkelziffer changes smoothly.

I'm sure you're right regarding sampling bias, but the vaccinated people I know have not turned off their phone contact tracing alerts, and get tested if they receive a tracing notice.

People get tracing alerts? I've had the apps of three different countries now for some 1.5 years running now and never received even a single blip.

All of that plus "What kills people from COVID now?" To which the answer is "Lack of access to ICU-capable health facilities."

And what causes lack of access? Total number of people hospitalized. And how does that number grow? Exponentially.

So every public health department in the world is optimizing for "How do we prevent our limited number of ICU-capable health facilities from being overwhelmed."

And that comes down to predicting the future hospitalization rate, which can be predicted by the current case count as you said.

I agree completely, with the addition that this has been the case pretty much from the start. Evolution of therapies has been minimal, the killer factor has always been the level of pressure on health services - which doesn't just mean ventilators as initially thought, but the entire care process over several days. And this is why vaccines are a game changer: they remove the need for hospitalization.

Also, obligatory: staff. Which is to say the health care system is sized for employing enough highly-trained trauma / ICU staff to support normal operations, with some small (very small) amount of surge capacity. And people under-estimate the specialization & experience required for high-level ICU and respiratory care. You can't just take a floor nurse and transfer them over to do the new work.

And the amount of complex hospitalizations due to COVID can very quickly become a couple orders of magnitude above "normal operations."

' "What kills people from COVID now?" To which the answer is '

Matching with observed reality a better answer may be: 18 months of enhancing the comorbidities of being overweight and in poor physical condition. Sitting on couch while snacking on carbohydrates and fear has been detrimental to many people.

That’s not necessarily true. If you suddenly start testing low risk people you weren’t testing before, then you can get an increase in cases without necessarily an increase in death.

For example, if you implement a travel rule that every traveler needs to get tested a day before they leave and a day after they arrive, then you’re going to see an increase in cases (both real and false positives).

Yeah, but in practice that hasn’t been relevant.

It’s important to be cautious, but it’s also important to not be a know-it-all who just because they can think of a limitation of a data collection / statistical method they can suddenly cast doubt on the whole thing, even though people who know much more about it already probably did exactly the same thing.

Finden a limitation of some data is extremely easy. Extremely easy. It will literally always be possible whenever people are working with data about people because this shit is hard. That doesn’t mean you get to name that limitation, cast doubt on something and piss off. That’s unproductive and irresponsible.

These are the facts: incidence is a great leading indicator if some care is taken with it and it’s regularly put into the larger context (i.e. given more vaccinations a higher incidence is possible until things turn to shit). And you can shout data limitations at that central fact until you are blue in the face but it’s still gonna be there and true.

For a successful technology(/medical intervention), reality must take precedence over public relations, for nature cannot be fooled

"Remain obsessed" with transmission of a highly contagious virus that has shown significant ability to mutate at scale? That sure seems worth being obsessed about. When it mutates to spread past all current defenses then consistently kill because we failed to stop current spread it will indeed be "depressing".

"a highly contagious virus that has shown significant ability to mutate at scale"

That doesn't uniquely describe COVID. It describes pretty much every virus you have heard of.

The gradient for viruses trends strongly towards trading severity for contagiousness. They do not generally "mutate past all defenses and kill", the generally "mutate past defenses and give slight to non-existent symptoms", for several reasons, the two most important of which is that killing means they can't spread anymore, and at the Pareto frontier (which viruses live on all the time), contagiousness and severity are in active conflict with each other; energy put into one comes right out of the budget for the other. And viruses have no particular interests in making you ill... they want to spread.

You've been amped up to a level of fear so severe for viruses that if your fear was accurate, there would be no multicellular life on Earth, because highly contagious and severe viruses would kill anything that provided such a big target. So, good news! Your fear is not accurate. You can verify yourself by checking your environment for multicellular organisms that have not been killed by viruses.

This theory of "killing means they can't spread anymore" doesn't really work out with diseases like sars-cov2. It might have worked in a medieval world where people travel by foot, horseback or sailboat, and with a disease where the carrier stays contagious forever.

But we are in a modern world where travel around the globe happens in 24 hours. Covid is contagious for some time before the patient has any symptoms, and for most people, it stops being contagious by the time some of the carriers are so sick they might die.

So, when a patient starts having symptoms in 5 days, (s)he may have had time to infect other people on more than two continents.

A virus that kills the patient will still infect less people than one that doesn't.

The fact that viruses in general can spread more widely and more qiuckly doesn't change this.

> And viruses have no particular interests in making you ill... they want to spread.

To restate this without the teleological angle: virus will not become widespread unless they are easily transmitted, and they are not easily transmitted if they make the subject excessively ill. Ergo, the most common viruses are better at being transmitted than making people really ill.

If you ignore the context and the multifaceted consequences of lockdowns etc., then yes, you are correct and we should be obsessed with the transmission rates. However, we don't have the same level of obsessions about other viruses present in humans (say, HSV-1 which unlike SARS-CoV-2 will live inside you until you die), and even other coronaviruses. Why? Because what matters most is how dangerous the virus is.

Fortunately, as of today, Omicron deaths are still at zero, and this fills me with moderate optimism. [0]

[0] https://www.cityam.com/anxiously-optimistic-south-africa-hol...

> Omicron deaths are still at zero

Omicron hasn't been around long enough to expect many deaths yet. Even the optimists need to wait a few more weeks.

Plenty of evidence that Omicron has been around for a substantial period of time. I believe the lower bound is at least a month in the US and Europe at this point, presumably longer at the point of origin.

technically you are right. However delta is dominate and we don't sequence most tests so we don't really have any data to work with.

sewage treatment testing happens behind the scenes, involves essentially the entire population, and is incredibly valuable. it confirms omicron's "long term" presence in the US.

I seriously question whether we're at a level technologically that "control" was ever an option here.

With things like covid and the flu, vaccines will always be playing catch up with variants. Its not like the measles which doesn't mutate. Infection and hospitalization rates for vaccinated with covid are already significantly higher than the flu as far as baselines go .. it's reasonable to say we can't expect vaccines to snuff out this kind of disease.

Therefore, the only realistic way to stop the spread is with ruthless targeted testing, tracking, and quarantining. But the problem with that method is by the time we're aware of a problematic strain, its already spread too much for quarantining to be effective.

Nature is inevitable. Once we've done all we can, all that's left is to learn to live with it.

There is absolutely no way to stop the spread forever. Just suggesting it is crazy. It is an option you have to forget about.

Stalling the spread is useless as well - we have already had two major mutations in less than two years.

> There is absolutely no way to stop the spread forever.

There's a significant difference between COVID-19/SARS-COV-2 become endemic, and it continuing as a pandemic that threatens public health systems due to caseload density. Yes, we're unlikely to get beyond it being endemic, which means that like influenza, it will continue to be an issue, but we can certainly get a point where it is "just endemic", which would be a huge improvement over the current situation.

>we have already had two major mutations in less than two years.

How frequently do equivalent Flu mutations occur?

Every. Single. Year.

> There is absolutely no way to stop the spread forever.

Well, there is, we just don't want to pay for it: vaccinating poor countries, where effectively the mutations are being created by high infection rates.

Don't forget to vaccinate the wild deer and other animals that catch and spread COVID.

I don't understand: every single study out there says that vaccinated people do still catch the virus and can still spread it.

Why would the current crop of vaccines be able to stop the virus, even if applied worldwide, seen that they don't prevent infection?

If the vaccine brings R0 down to below 1.0 for vaccinated people, then the vaccine offers a way to get the virus to an endemic situation rather than a pandemic.

The evidence is still not solid on whether or not it does this, as far as I am aware.

The vaccine hasn't stopped spread in rich countries, why would it do so in poor countries?

Also there haven't been enough variants as to determine that most variants are coming from poor countries. Speaking of delta, India has more population than the entirety of Europe. Mathematically it makes sense than a variant could come from there regardless of whether the vaccine does anything.

> The vaccine hasn't stopped spread in rich countries, why would it do so in poor countries?

It has greatly slowed the spread. The highest vaccinated countries have almost stopped it. There is every reason to believe that high vaccination across the world would stop covid, and anything less will ensure continued spread (and mutations).

People demanding an all or nothing from a vaccine are missing the big picture.

The highest vaccinated countries have almost stopped it? Israel had among the highest vaccination rates in the world prior to its most recent peak, which has now declined. Other countries are going through the same thing. There is only a very rough/weak correlation between vaccination rate and positive cases.

Isreal hasn't been among the highest vaccinated countries in quite a while. They got over 50% early, but stalled out. https://ourworldindata.org/covid-vaccinations (Isreal isn't selected by default) Check out countries like Portugal if you want to see what high vaccination does.

It is depressing how people pretend that it is the same virus every time.

Israel has faced waves of 3 different viruses - original, Alpha and Delta what have required different level of immunization and Israel has managed to vaccinate itself out of 2 of these waves.

Looks quite impressive to me.

I also fail to understand why people pretend that 2 doses should be expected to stop Delta that has higher viral load - it does not make any sense.

It is a probabilistic game - antibodies are not smart - they are like mines - you need to have high enough concentration to stop viral particles to move around. If the viral particles can overload this concentration - they are going to win. There obviously must be some threshold of antibody concentration below what you can't avoid infection - when 2 dose regimen reaches it too quickly, well, game over. 3rd dose regimen is known to boost antibody concentration and keep it high for longer time. There is no surprise here and yet even people in position (like WHO) that should know better have intentionally ignored it.

That’s a weird way to phrase your second paragraph, considering hospitals have been close to full very recently in parts of the us.

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

Hospital beds were "maxed out" before the pandemic. [0] at around 64%. They are sitting at around 78% on average now, with hard hit areas at around 80-85% according to your link. These are almost all at-risk and unvaccinated people. That's my point. If mandates and lockdowns are based on case counts instead of actual dire outcomes, then I fear we're going to continue seeing strange policies and laws for people at little to no risk, namely children and the vaccinated.

[0] https://www.webmd.com/lung/news/20200326/us-hospital-beds-we...

Apparently there was a flu epidemic during 2017-2018 and hospitals were being overwhelmed by flu patients [1].

[1] https://time.com/5107984/hospitals-handling-burden-flu-patie...

2017-2018 was an unusually deadly flu season:

> More than 80,000 Americans died of the flu in the winter of 2017-2018, the highest number in over a decade, federal health officials said last week. Although 90 percent of those deaths were in people over age 65, the flu also killed 180 young children and teenagers, more than in any other year since the Centers for Disease Control and Prevention began using its current surveillance methods.

https://www.nytimes.com/2018/10/01/health/flu-deaths-vaccine...

Other contemporaneous reporting:

https://www.nytimes.com/2018/01/26/health/flu-rates-deaths.h...

https://www.nytimes.com/2018/02/02/health/flu-symptoms-virus...

Meanwhile:

> Overall, more than 771,000 COVID-19 deaths have been reported in the U.S. during the pandemic. About 385,000 were reported in 2020, according to CDC data, and more than 386,000 have been reported this year.

https://www.webmd.com/lung/news/20211122/us-covid-deaths-202...

So 2021 alone has nearly 5x the Covid19 deaths as the 2017-2018 flu season. Also:

> As of last Monday, nine hospitals in Michigan were 100 percent full (https://www.michigan.gov/coronavirus/0,9753,7-406-98159-5236...), and at least 20 others were at or above 90 percent capacity. Statewide, nearly one in four hospital patients (https://www.bridgemi.com/michigan-health-watch/michigan-hosp...) has a confirmed or suspected case of Covid-19. In the last few weeks, my hospital has been consistently at or near capacity and nearly every day the vast majority of those patients are sick with Covid-19. Nearly all have been unvaccinated.

> On some shifts, the stress in the air is palpable. My colleagues and I know the patients are piling up, but there just are not enough nurses to properly triage everyone. A patient experiencing heart failure waits in an emergency room because inpatient rooms upstairs are all occupied. Patients who need surgery can’t be transferred because nearly every hospital within a two-hour drive is near or at capacity, too.

https://www.nytimes.com/2021/12/08/opinion/covid-michigan-su...

Hospitals are not designed to be empty, though. So you can’t just point to 80% full ICU beds and say a hospital is overwhelmed. Is there any data showing ICU beds filled above carrying capacity? Or number of patients transferred to a different hospital due to bed shortage?

Even in countries with fairly good covid situation (I'm in Finland) we are going to see excess mortality over the coming years, because right now as we speak, elective operations for heart surgeries and cancer operations are being postponed in order to make room for covid patients.

ICU wards are designed for normal operations at near-full capacity. Maintaining a large-scale vacant ICU capacity is both uneconomical and operationally very difficult (because ICU treatment skills are highly specific and learning, maintaining and updating them requires one to be working on the area).

This will show up as excess mortality of "preventable deaths".

But those stats will be overshadowed by 2 larger factors:

1. the pendulum will swing back as covid goes to zero .. fewer unhealthy and elderly members of the population will result in overall lower mortality rates in the short term (2-3 years).

2. baby boomers are coming of age .. a baby boom is eventually followed by a death boom. This will drive up the mortality rate long term (5-10 years).

This is the reported situation here in Minnesota as of yesterday: “Statewide, nearly 98% of adult ICU beds and 95% of overflow, observation, and active surge/expansion beds for adults were occupied, according to the state Department of Health.”

Likewise, hospital are routinely denying transfers. I’m also not sure what “above carrying capacity” would mean here. They’re not sticking two to a bed.

In Germany wr have evacuatiom flights from Bavaria to Hamburg for example. We had that early in the pandemic from France and Italy to Germany. So yes, there are numbers for sure somewhere.

Sure, but I'm willing to bet most of the hospitalised are not vaccinated, or at least a disproportionate amount of them aren't vaccinated

How much are you willing to bet? Keep in mind that if the population is 90% vaccinated, you expect something approaching 90% of ICU beds to be vaccinated (well, with an effective and sterilizing vaccine you wouldn’t expect this, but that’s not where we are).

In England last month, 79% of Covid deaths were vaccinated. Currently about 36% of hospitalizations are unvaccinated.

The raw data is here, good luck parsing anything useful out of it: https://assets.publishing.service.gov.uk/government/uploads/...

Not really. With population vaccination rate nearly 90 % we have something approaching 30-40 % of hospital and ICU bed users vaccinated.

The risk of ending up on ICU is about 30 x higher here, when comparing similar demographics. Risk of needing to go to hospital is 19 x higher currently.

The UK is interesting in that only about 70% of the population is fully vaccinated, which seems to be less than the proportion of Covid-releated deaths that were fully vaccinated. This isn't because the Covid vaccines are ineffective at preventing death - it's just that age has a much bigger effect than vaccination on someone's risk of dying from Covid, and the high-risk age groups are almost 100% vaccinated whereas the lowest risk are largely unvaccinated.

Yes, and generally the age risk is so high that proper assessments must be done comparing age cohorts, not the entire population vax/unvax rates.

I've been trying to get a clear answer to this for some time, because at least in Switzerland, and apparently in other countries as well, vaccination status of hospitalizations and deaths is well published, while vaccination status of ICU occupants is reported only anecdotally.

As you say, a sizable percentage of deaths (~50% in the 60+ age group) are vaccinated — because those tend to skew elderly (85 in Switzerland) and highly vaccinated (>90%).

Likewise, a sizable percentage of hospitalizations (~40% in 60+) are vaccinated — those are a bit younger (66 in Switzerland) because many of the very elderly patients never make it to a hospital.

All the ICU administrators I've seen interviewed, however, say that their ICU occupants are ~90% unvaccinated. One explanation for this might be that the ICU median age is considerably younger than the above ages, about 55 in Switzerland, and younger population groups are less vaccinated.

But IF this is in fact the case, I wish the statistics were public.

A majority of deaths in the winter months will be elderly people with underlying health conditions that might have died from a flue or cold virus if covid was not circulating. It's more interesting to see excess deaths for this winter. I have a hunch excess death rates will be similar to 2019.

I don't think so, but we can quite well follow it up here, for most developed and semi-developed countries.

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

(As OWID relies on official data sources, they may be skewed or manipulated for undeveloped or autocratic countries)

> the absolute number of infected individuals in the Vaccinated (boosted) group is likely to be at least as high as in the Unvaccinated

But if the vaccinated represent a much larger share of the population, the same absolute number represents a much smaller proportion who become infected.

This is a good point. Hospitalization and death are really all that matter. People will be getting sick (to lesser degrees, likely, but it will still happen) from this for generations to come. What really matters is whether or not you are sick in bed at home and missing a few days of work vs sick in the hospital, occupying emergency health resources and facing potential death.

And case numbers are the best metric we have to predict deaths and hospitalization. Together with vaccination rates, age and so on. But overall, if cases go up, hospitalization will go up a couple of weeks later. Why would we not use that to enable to us act instead of reacting once it's too late?

Because as new variants with lower virulence emerge, and we see more breakthrough and reinfection cases, that direct link will become less direct.

We don't lock down for the flu because the virulence of the flu is lower than covid and we consider it acceptable. At some point, we'll pass those acceptability thresholds for COVID as well.

For some people, and regions, they already have passed those thresholds, as both severity and people's acceptance of different outcomes vary.

I'm not into modelling, I would imagine that, depending on how good the vaccines work against variants, even that could be modelled quite well.

For me, the threshold when Covid becomes an acceptable fact of life is when hospitals can work normally without any measures in place. We seem to be quite far from that.

In my state, we have ~10k hospital beds. There are currently ~450 covid patients that are hospitalized and that's actually significantly higher than last week. I think a lot of places are pretty close to that situation now.

Of course, total hospital bed utilization is still over 80%, but overwhelmingly its non covid.

Exactly. Case numbers are not meaningless. They are a leading indicator. People unexpectedly showing up to hospitals is a lagging indicator of disease prevalence.

This is neither about transmission nor severe disease. The study itself is a lab test to see how the new virus holds up against the vaccines, their suggestions about protection are still conjecture

Yes, as far as I understand it's somewhat of an indicator for infection risk, but can't capture overall consequences, and I think right now any strong statement for "it's going to be this bad/not bad" should be taken with a large grain of salt - we just don't know yet and are watching datapoints coming in day by day.

I watch This Week in Virology occasionally. A discussion among virology professors. Vincent Racaniello who kind of seems to run TWiV has been skeptical about boosters. His argument is that they're not needed (unless you got the J&J) because your first 2 vaccinations will protect you from serious illness. You might something akin to a nasty cold but you'll be protected from hospitalization or worse. His argument is also that we need to get the rest of the world fully vaccinated before we start looking at boosters here in the US.

Also, Pfizer is only looking at antibody responses here, not T-Cell & memory B cell responses and other parts of the immune system that were primed by vaccination.

Focus on case numbers by means of PCR tests is problematic because a PCR test only measures virus RNA, not the cause of sickness or contagiousness.

If a thousand healthy people come in contact with the virus it is possible they all will have a positive PCR test while not being contagious at the same time.

As for breakthroughs a common problem with analyzing vaccinated with unvaccinated is that among the unvaccinated there will be disproportionally higher percentage of naturally immune (recovered), who are if not equal, better protected from reinfection than naive vaccinees.

We need to be able to predict the hospitalization rate to be prepared for surges, so tracking transmission is absolutely necessary. Perhaps after a long period of low hospitalizations (6 months, a year?) the general public can stop paying attention... but we're definitely not there yet.

It's looking like high double and triple vaccination rates can do it (like 80%+), but that's starting to look impossible in some countries.

Covid is endemic and will be with us forever. The terror threat indicator on news networks lasted many years and I suspect the attention to covid will follow a similar attention cycle unless something else major happens and dominates the news cycle. You'll need biannual boosters until then

I agree with you about the focus on cases instead of hospitalizations. However, even in places with high levels of vaccination, so far cases does translate into stressing hospitals to the edge, followed by lockdown and other restrictions. See Alberta, Canada in September, or Austria two weeks ago and Germany now.

This doesn't end until nearly everyone is vaccinated, recovered, or dead. To paraphrase the German health minister.

Alberta delayed a few surgeries, nobody was triaged out of ICU care. Bringing on enough staff to up ICU by 50 more beds is the right goal for them.

They had to backtrack and place severe restrictions on what activities were allowed and also restrict activities of the unvaccinated. There were hospitals transfering patients out of province, as well as surgeries cancelled - which is a big harm. The hospitals likely would have reached breaking point had no action been taken.

Maybe, maybe not. It is clear, even to someone with zero background in vaccines, that the COVID vaccines are no resulting in sterilizing immunity. Everyone said as much since the first trials.

What does this mean? IMHO it means that once we reached sufficient levels of vaccinations (no idea what that would be, definitely above 70%) COVID will be nothing more than a severe flue / cold for most of the population, if they get it at all. It would also, I would assume, push mutations down the more infections and less severe route in order to overcome the limited spread among the vaccinated (they are still overall less infectious then unvaccinted people) and the vaccines themselves. Both are good news.

And that drives me so crazy with the anti-vaxxers (among a lot of things with them). They don't want the shots because a) COVID is just a flew (and simultaniously a deadly bio weapon the Chinese spread in order to win a global economic war...) and b) vaccinated people are also infectious and can get it. Well, they kind of have it backwards there, don't they? it actually will be like a cold because people are vaccinated, not before. At which point the fact that vaccinated people can also transmit COVID is not really important anymore.

We're already at 70% or above for all the age groups that matter

https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-and-C...

It was already on the scale of a cold approximately for some 90%+ of people. This virus is mild or asymptomatic in the vast majority of cases and that has been apparent for a long time. The only possible justification for vaccines at this point is to minimize overloading of hospitals because of the contagious nature of the virus, the overall complication rate is still very low.

>anti-vaxxers (among a lot of things with them). They don't want the shots because a) COVID is just a flew (and simultaniously a deadly bio weapon the Chinese spread in order to win a global economic war...)

Maybe the problem is that people who are against covid vaccines are being a) slandered as anti-vaxxers and b) lumped in with all sorts of other conspiracists.

I am not aware of a common cold that resulted in hospitals being overloaded to the point planned surgery needed to be postponed. Severe cases maybe a rather small percentage, yet in absolute numbers they are big enough to be real problem.

Well, if I were an anti-vaxxer, why would being called one be a slander? Either I am one or not. And yes, they are conspiracy theorists, even worse they are of becoming even more radical every day.

But thanks for showing again the main problem I have with them: pure egoism. Covid wont be an issue for me (singing in the dark, lalala), so screw everyone else.

>I am not aware of a common cold that resulted in hospitals being overloaded to the point planned surgery needed to be postponed. Severe cases maybe a rather small percentage, yet in absolute numbers they are big enough to be real problem.

Which is exactly what I wrote. The problem with covid is its rate of spread, the actual complication rate per infection is very low. That's why I explicitly said the only possible justification for vaccines now is to prevent hospital overload.

>Well, if I were an anti-vaxxer, why would being called one be a slander? Either I am one or not

No, this isn't binary. Not all vaccines are created equal, and it is perfectly rational to be in support of vaccination in general but against covid vaccines. To blindly group such people with antivaxxers is disingenuous.

Governments and public policy makers are being excessively cautious and slow to react to changes. Governments are beholden to public opinion*, and public opinion is slow to change.

I'm not trying to justify the actions of govts, I'm merely stating that slow reaction times are considered by many to be a feature not a bug.

The Netherlands assess the "risk level" based on hospital admissions and ICU admissions: https://coronadashboard.government.nl/over-risiconiveaus

Yeah I stopped looking at case numbers a long time ago. They're completely irrelevant, with the amount of hysteria going around. Hospitalization is the only thing that matters at this point (and in fact has been since the beginning).

I find it encouraging. A virus that’s endemic and doesn’t kill people who are vaccinated is not a big deal. Like yeah it would be great if we eradicated it, but this is really fine.

Omicron is so infectious it may infect everyone available and die off quite rapidly.

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