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Comment by JPKab | Hacker News Reader

Less virulent, less dangerous than delta by far, according to the South African medical authorities who first identified and reported it. It's been a long established medical fact that viruses evolve to become less severe over time, due to selective pressures of being able to spread easier if you don't incapacitate your host. Micheal Crichton's Andromeda Strain featured this as a key plot point, written in the 70s.

For some reason, the international community treated South African scientists like third-world know-nothings, and overreacted, ignoring the fact that it's less severe.

https://www.washingtonpost.com/world/2021/12/14/south-africa...

Most everyone is vaxxed that is high-risk. Let the rest deal with their consequences. We have a few treatments that are highly effective, including monoclonal AB and the new Pfizer pill that has been shown in clinical trials to be absurdly effective: https://www.cnn.com/2021/12/14/health/pfizer-paxlovid-pills-...

Let's move on from this fear and get back to living instead of just existing.

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100% agree with you. If it turns out that it’s so much less deadly than the other strains, we should definitely be positive about it and stop the fear mongering. But all you can hear these days, is that how so much contagious Omicron is, without mentioning the chance of being a lot less harmful. This biased representation in the news turns me into being a skeptic of all the media outlets, regardless of their political agenda.

On the good side, even the inventor of mRna vaccines, Karikó Katalin says that Omicron could end the pandemic if it proves to be less harmful.[1]

1. https://hungarytoday.hu/kariko-omicron-pfizer-coronavirus/

> But all you can hear these days, is that how so much contagious Omicron is, without mentioning the chance of being a lot less harmful.

We _know_ that it's spreading very quickly (there is some legitimate question over how much of this is inherent spreading ability vs immunity evasion). The idea that it's "a lot less harmful" is largely speculative; there just isn't the data to say that right now. Now, it may emerge that it is, and that would be great, but it would be extremely dangerous to assume it at the moment.

Judging by the response of the authorities, the new strain is highly dangerous. There's a lot of panicking going on.

The authorities don't have any special secret knowledge here; they're responding to the (reasonably likely) possibility that it's as dangerous as Delta but will spread much more easily.

Honestly, given the rate of spread, even if it had half the hospitalization risk of Delta it's _still_ terrifying.

What's the hospitalization rate of delta in the vaccinated? It's pretty low.

At this point, the vast majority of the unvaxxed are younger, lower risk people. The high risk people who aren't vaxxed (fucking idiots) are now highly treatable. We've got at least two, but a third coming soon, potent treatment options that radically reduce hospitalization. The new Pfizer pill is a true game changer, and we already have the monoclonal ABs.

It doesn't appear that the public health authorities or the media are updating their policies based on these new realities. 90% of the people most at risk are vaxxed, and for those who are hospitalized (vaxxed or not) we now have treatments shown in clinical trials to further reduce hospitalization rates by roughly 88-90%. Translation: the hospitals aren't going to get overwhelmed anymore.

Science won, even with a sizable chunk of the populace not wanting the vaccine. People can debate the moral hazard of treating unvaxxed with these new therapeutics, but that's a moral argument, not a practical one. Give them the pill or the infusion, keep them out of an ICU bed, and wag your finger at them later. This pandemic is over, and the fear needs to go with it.

The pills won't be available in large quantities for a couple of months.

In countries with high vaccination rates, most ICU beds are now occupied by youngish, largely unvaccinated people. In Ireland, for instance, 60% of covid patients in ICU over the last 5 months have been under 65, and this is _growing_. They have a decent survival rate, but they're still taking up ICU beds, and the pandemic isn't over until they stop doing that.

The pills _may_, if they work as advertised, be the point where we can just stop caring about unvaccinated people. But there are another couple of months to go, even assuming they work as well as expected.

(Also, I think there's at least a decent risk that many anti-vaxers will just refuse to take the pill anyway)

You are judging a response that is motivated by "abundance of caution" with zero limiting principle. They don't trust the South African data (in my opinion this is old fashioned bigotry by rich governments towards government agencies they view as being inferior in poorer countries) even though everything the South Africans has said for weeks has turned out be correct.

Bureaucrats aren't incentivized to do anything but minimize their own risk, with no regard to other factors like creating a panic.

It was blatantly obvious to those of us who give a shit about India (not the myopic, inward focused US media) in February that the delta variant was horribly dangerous based on what the doctors in India were saying. But in South Africa, we're ignoring their doctors and pretending like we're superior, and are the only ones capable of collecting and analyzing data in Excel.

My prediction:

Omicron will turn out to not increase hospitalizations (only cases, which don't really matter anymore with 90% of senior citizens being vaccinated), the media will focus on the cases, and the percentage of people who think the authorities/media are untrustworthy will go up even more than it already has. This is really really bad. I live in a county in Colorado with a mask mandate. It's a suburban, blue county. Heavily blue. And the mask mandate is universally ignored. That wasn't happening earlier in 2021. It is now, and it's very noticeable. They don't trust the authorities anymore, and this will make that worse.

There isn't really a choice for such a fast spreading virus. If you wait until you are certain it is dangerous the response will be too late.

I stopped trusting the media's reporting on covid when it became blatantly obvious that they were completely ignoring and obfuscating the risk stratification by age. It was clear to me that they were motivated to do this by elevating the desire to influence the behavior of the public over the duty to inform them with the actual facts.

They cynically assumed, just like the public health authorities did, that if the average Joe didn't personally feel at risk, they wouldn't change their behavior and would cause high-risk/elderly people to die out of negligence. Academics, I've noticed in my career working with them, are far more prone to view the public in this way. I'm sure a few of that variety will respond to this and tell me that yes, they can't be trusted.

> It's been a long established medical fact that viruses evolve to become less severe over time,

Is it? The evolutionary pressure is only that reproductive success, succeeds. A virus that spreads better, well, spreads more.

There is no real reason why COVID-19 would have to get less severe to be more successful, as most transmission is pre-symptomatic or asymptomatic already. If the host is more likely or less likely to die later on in the disease, is irrelevant to the virus' fitness.

https://twitter.com/zeynep/status/1468225625764814859

https://twitter.com/Devilstower/status/1465332043005501448

Could you please cite a source that says most transmission is pre-symptomatic or asymptomatic? Is that new with the delta variant? The studies I've seen have more recently concluded that asymptomatic transmission is far lower than previously thought. Although it probably doesn't matter, since the plurality of symptomatic people below the age of 55 are going to have symptoms hard to distinguish from a cold.

Regardless, you make a fair point, but for a virus to kill you, it's going to be more severe in earlier phases, and less likely to be transmitted by a person in a bed than one walking around. Sure, they might have spread while they were walking around, but the proportion of time they are infected and mobile (higher spread) is lower than if the virus is milder.

Covid hawks seem to have only one answer for all news items: be more afraid, lock down more. It's tiring, and reminds me of the right-wing equivalent after 9/11: Everything was terror, or potential terror, and you need to be afraid, and if you aren't afraid, it's because you are unpatriotic, stupid, or both.

> Could you please cite a source that says most transmission is pre-symptomatic or asymptomatic?

Both links above say as much. Please don't waste our time with "cite a source" when the sources are right there. No it is not new with Covid-Delta.

Neither of the links above said anything about asymptomatic transmission.

Neck beard of doom indeed.

Further down thread in both cases, but not very far. If you can't understand what you're reading, I can't help you.

As I understand it, the SA population is quite young and we are waiting for more data to come in on the effects of omicron (says so in the link you provided as well)... let's not forget we dismissed the whole virus as "just a common cold" at the beginning of the whole story as well.

The problem with letting others deal with their consequences is that they are overworking the medical staff, and are disregarding the population that cannot be vaxxed due to medical reasons.

I agree we should move from this fear, but I understand how for some the fear is still too real.

> the SA population is quite young

Quite young, and quite highly likely to already have had COVID-19: over 3/4 of the population has had it.

https://www.bloomberg.com/news/articles/2021-08-18/deaths-da...

Isn't this the case in the US, but in a slightly different manner? We're talking about a majority of adults being vaccinated, and then according to seroprevalence tracking over time, it's estimated that a large percentage of the population (both vaxxed and unvaxxed) have already recovered from an infection as well. But there is one delta on top of the age difference: We have a high rate of obesity, and the latest research shows that adipose tissue contributes to bad outcomes due to the virus infecting it and the cells then being a potent source of cytokines that dramatically and dangerously increase inflammation.

The great irony is that as much as we focus (rightly) on unvaxxed clogging the healthcare system, the obese who have been increasingly clogging it over the last few decades are the ones clogging the ICUs when they catch covid. All for a chronic condition that, for most, can be alleviated with voluntary lifestyle changes.

Mutating to lower virulence isn't a law of nature. https://medium.com/a-microbiome-scientist-at-large/do-viruse... Crichton wrote interesting books but not all his science was robust.

> It's been a long established medical fact that viruses evolve to become less severe over time

HIV, Smallpox and Rabies would like a word.

Sorry by “long established medical fact” I think what he meant was “pop science heuristic that is maybe true at t = infinity.”

> We have a few treatments that are highly effective, including monoclonal AB and the new Pfizer pill

Monoclonal antibodies are not highly effective and Paxlovid is not FDA approved yet (oe EUA”d).

> Let the rest deal with their consequences

Let me fix this for you: let all of us deal with their consequences.

Where did you get the idea that monoclonal antibodies aren't highly effective? Do you have any data to back this up? They are an FDA approved, clinically proven first-line treatment for anyone with symptoms showing them at risk of hospitalization.

Your statement is misinformation, scientifically inaccurate, and irresponsible. You are painting a scientifically proven and life-saving therapuetic as "not highly effective" when the data shows it absolutely is.

Here's a quote from a peer reviewed study in a little blog called the New England Journal of Medicine. Maybe you've heard of it?

"A total of 3 of 291 patients in the sotrovimab group (1%), as compared with 21 of 292 patients in the placebo group (7%), had disease progression leading to hospitalization (for >24 hours) for any cause or death (relative risk reduction, 85%; 97.24% confidence interval [CI], 44 to 96; P=0.002) (Table 2). The primary reasons for the 24 hospitalizations were consistent with progressive Covid-19 (Table 3), with one probable exception: 1 patient in the sotrovimab group who had a notable medical history of small-intestinal obstruction presented 22 days after infusion with a small-intestinal obstruction."

https://www.nejm.org/doi/full/10.1056/NEJMoa2107934?query=fe...

Hope you will stop spreading misinformation. It's not acceptable when people shit on the vaccines due to their right wing partisan echo chamber induced ignorance, and it's not helpful when people shit on effective treatments due to their left wing partisan echo chamber induced ignorance.

> according to the South African medical authorities who first identified and reported it

Well, according to the doctor who did. Other South African medical authorities have been a lot more cautious.

> Most everyone is vaxxed that is high-risk. Let the rest deal with their consequences.

The trouble is, the consequences for the rest involve filling up hospitals, ICUs (and ultimately morgues, though this is less disruptive). That impacts everyone. People are dying unnecessarily because their routine medical care is canceled or because they can't get an ICU bed due to pressure on hospital systems created primarily by unvaccinated patients.

Unvaccinated people under the age of 60 certainly do not put any significant pressure on ICUs. Saying otherwise is a blatant lie and demonizes people. Doing so and searching blame in others is a symptom of severe inferiority complex which is dangerous to other people, so take care what you say.

> Unvaccinated people under the age of 60 certainly do not put any significant pressure on ICUs

However:

"Ohio Gov. Mike DeWine a day earlier warned of a “startling” rise in Covid hospitalizations among young people."

https://www.cnbc.com/2021/09/22/unvaccinated-covid-patients-...

"I’m treating more and more young, unvaccinated people in ICU"

https://metro.co.uk/2021/11/10/most-covid-patients-i-treat-i...

"We're seeing younger people, unvaccinated, who take up around 75 percent of the intensive care beds and that's not just here, that's nationally."

https://www.bbc.co.uk/news/uk-england-gloucestershire-594054...

"90% were not fully vaccinated, with most tending to be on average six years younger than patients admitted to ICU who are fully vaccinated"

https://www.bartshealth.nhs.uk/news/almost-90-of-patients-ad...

"Young people in ICU with Covid almost exclusively unvaccinated and some are dying"

https://www.independent.ie/irish-news/news/young-people-in-i...

Why do you call this "a blatant lie and demonizes people" ? - that's strong language, and would need some justification.

"blatant" means "very obvious", so what is very obvious about it?

What I'm very obviously seeing, is not what you claim to be very obviously seeing.

Those are not statistics related to ICU occupancy, except for this line:

"We're seeing younger people, unvaccinated, who take up around 75 percent of the intensive care beds and that's not just here, that's nationally."

How do you read that? 75% of ICU bed are being taken up by young unvaccinated covid patients? I'd bet all my money that is not true.

These sentences are being put together to drive the cattle not inform.

> 75% of ICU bed are being taken up by young unvaccinated covid patients?

FWIW, I think this roughly represents my experience WRT our 4-bed ICU on the Navajo Nation. Extremely high vaccination rate, with the exception of young people who didn't think they would get very sick, and they've ended up representing most of our ICU players.

They're not just "betting all their money" but also their lives on it not being true. because they really want it to be true.

And the majority win that bet, for them. But a minority losing it is still enough to fill the ICUs.

Wanna back up that 75% young people clogging up ICUs with covid? Is that what you really want to be true?

What I "really want to be true" is irrelevant, we have to engage with the world as it is, not as we wish it to be. Plans are better if they are based on reality, not on our "bet".

Ok, so to be clear you believe that young people with their covid are clogging up ICUs at a rate of 75% occupancy, and that is based on an off-the-cuff riff from a single person and not validated statistics? Personally I think its clear that they are saying 75% people of all ages are unvaccinated in the ICU, some unmentioned percentage being "younger" i.e 60 rather than 90. That is, not 75% are young and unvaccinated. The poor precision of the sentence lends itself to be understood incorrectly and its unfortunate that un-discerning people pass along their misunderstanding.

The Navajo Nation has a sky-high obesity rate. As a physician there you know this. And you also know that obesity is a primary driver of hospitalization in younger people. Fry bread is poison.

It's not representative of the whole. As unhealthy as most of the US population is, it's far worse on the rez.

There's absolutely nothing remotely statistically significant about a four bed ICU. You can't draw conclusions about broader trends based on that.

Here's the data on Ireland, and your suspicions are correct. It's not anchored in any fact. We're in a world where Rolling Stone and CNN will parrot a completely false story about a mass of gunshot victims in rural Oklahoma (because that makes sense....?????? How many shootings do you think happen in rural OK) being blocked from ICUs by an initial mass of ivermectin victims.....

The fear-mongering in the Irish press was clearly intended to drive behavior, rather than inform with real facts.

https://covid19ireland-geohive.hub.arcgis.com/pages/hospital...

None of these articles have any sources and are known for fear mongering by now. It is not reflected by numbers.

https://www.frontiersin.org/articles/10.3389/fmed.2020.56068...

or specifically:

https://www.frontiersin.org/files/Articles/560685/fmed-07-56...

And even they have a questionable method by aggregating people of age 40-69. If you would split it further 40-59, the middle aged group would look just as the young one.

It certainly does not affect you negatively if someone under 50 is unvaccinated because ICU usage would still be very low and the indictment warrants a direct response because the poster was accusing innocents.

If you're going to dismiss a wide range of mainstream media "unsourced, known for fear mongering" then I'm going to stop listening, it's not a worthwhile conversation.

Again, what is so "very obvious" about something that a wide range of sources contradict?

Part of the mainstream media does not have any credibility if they do not provide hard facts. Neither today nor historically do they have a clean record, this is why you need to check their statements. Either for access or financial incentives they like to write such articles, but that is irrelevant.

As I said, these articles aren't sourced credibly. You can believe me or not, that does not change the facts and that is specifically that young people are not clogging up ICUs, no matter if they are vaccinated or not. If the press states otherwise, then they are wrong. Perhaps the data is wrong too, but that is more unlikely.

It is a propaganda tactic to assert that the truth is "blatantly wrong" without justifying that, and then when asked, to rant about "bias", "credibility" " fear mongering" and "facts" in response.

If you do have a point, then your presentation entirely undermines it.

Your failure to answer what is so "very obvious" about something that a wide range of sources contradict, underscores it.

Let us just disagree here what we think is correct or false information. But if you or the original poster want to blame others for their life risk, expect headwind.

> Let us just disagree here what we think is correct or false information

Are you saying now that it's not obvious? So ... not blatant?

> But if you want to blame others for their life risk,

That's not the issue. But people's life risk doesn't exist in a vacuum, it impacts people around them. If their life risk impact me (which it does) then it's an issue. In order to deny that, you have to also deny e.g. that they end up filling the ICUs.

You have to live with that and the risk does not warrant blaming others. Because if they are under a certain age and therefore not in a risk group, the risk to you is marginal, completely independent from anyones vaccination status. You can reduce your risk by getting vaccinated yourself or by isolating.

> You have to live with that and the risk does not warrant blaming others

You could say that about any risk, e.g. "you have to live with the risk of drunk drivers, and the risk does not warrant blaming others, we just have to live with drunk driving."

it's certainly an opinion that you have there, but societies in general have not chosen to treat serious risks that way, so the "have to" part isn't correct, no: we can and often do choose better than that.

I see that you're no longer trying to defend your "blatant lie" comment. Good, it's indefensible.

The media sites you linked to are not "broad" at all. They are all very much left-of-center and toe a very ideologically consistent line of standard left of center COVID Hawkishness. The kind of people that told us we definitely needed to mask up outdoors last year and never apologized when it was quietly acknowledged that masking outdoors was utter nonsense and never backed by science.

This cabal of ideologues in media have done nothing but back "abundance of caution" policies with zero limiting principle of analysis of costs. Rather than critique and hold the public health officials accountable, they have simply licked their boots the entire pandemic.

I'm a lifelong Democratic voter, and it's become utterly transparent and obvious that the western media is filled with quantitatively/statistically illiterate activists masquerading as journalists.

The CDC numbers on the risk of young people with covid speak for themselves.

https://covid.cdc.gov/covid-data-tracker/#demographics

All age groups under the age of 30 COMBINED make up LESS THAN 1% OF DEATHS.

For all age groups under the age of 50, the total is less than 6% of deaths.

If you're going to complain about "worthwhile conversation", I would suggest understanding statistics before you get into conversations where you are clearly out of your depth.

> They are all very much left-of-center and toe a very ideologically consistent line of standard left of center COVID Hawkishness.

BBC, "leftist" after being pro-UK-government (right of centre) for a long time? I do not recognise your characterisation as grounded in reality at all. It looks like you just use that as a slur-word to dismiss what you don't like.

Where are you getting this from? I bet they have taken at least 50% capacity on average of our 4 bed ICU over the last few months.

That would make sense then. In that case I am firmly for throwing these two rascals in prison.

Please don't demonise them.

Not sure I understand this comment.

Unfortunately each of these cases often occupies an ICU bed for weeks. As a result we transfer dozens of other patients hundreds of miles away, and often after >24 hours boarding in the emergency department, because every other ICU bed is full as well (in addition to mandatory down time for the flight crews, which are also working overtime). With help from my ~5 person ED staff, I've called as many as 50 hospitals in a night (spanning 6 of the largest states) trying to find an open ICU bed.

Some relevant conversation on a thread I started in r/medicine: <https://www.reddit.com/r/medicine/comments/r6bl1u/not_accept...>

> Unvaccinated people under the age of 60 certainly do not put any significant pressure on ICUs.

In countries with near-universal vaccination of over-60s, they actually do. In Ireland, over the past 5 months, 60% of ICU admissions have been under 65. Only 10% have been over 75 (in Ireland, vaccination rates for over 75s are virtually 100%). 10% are aged 25-35: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronav...

The younger people do have a much better survival rate (94% of 15-44s survive, and 73% of 45-54s), but they are taking up space and causing delays of routine hospital work.

And Ireland has a relatively high rate of vaccination of young people; it's just that we have virtually universal vaccination of over 75s (and did by June when this data starts). Incidentally, this report encompasses a lot of data from a period when many 60-75s wouldn't have had their second dose (for various reasons, they were the only age group in Ireland allowed to be given AZ for most of the period, which has a delayed second dose). A similar report for the last three months would likely show an even starker age distribution.

Beyond that, unvaccinated people act as more of a transmission vector than vaccinated people (while at peak there's not much evidence that vaccinated people who have covid are less infectious than unvaccinated people, vaccinated people are less likely to get it in the first place and don't stay infectious for as long).

> Doing so and searching blame in others is a symptom of severe inferiority complex which is dangerous to other people, so take care what you say.

Eh?

You stated the percentage of COVID patients in the ICU who are under 65. What you didn't state is:

1) Are ICUs in Ireland being pushed to capacity or not? 2) What percentage of ICU beds are occupied by the totality of covid patients?

These two details are crucial to understanding whether the small percentage of covid CASES that become HOSPITALIZATIONS is significant enough in number to impact the ICUs. Based on every piece of data I've seen regarding the percentage of young people without comorbidities who get hospitalized after infection, it's probably overblown.

Based on this dashboard, there are a TOTAL of 108 people currently in Irish ICUs for covid. This is out of a total population of just over 5 million people.

https://covid19ireland-geohive.hub.arcgis.com/pages/hospital...

At the peak of delta, there were 218 people in the ICUs in Ireland for COViD. Ireland doesn't have enough ICU beds is what I would infer if this is "overwhelming the hospital system" there. I live in Colorado, and these numbers are nothing compared to the hospitalizations we had, and we have a similar population.

AZ has some reasonably accessible data: <https://azdhs.gov/covid19/data/index.php#hospital-bed-usage>

It looks like ~40% of all ICU beds taken by COVID patients recently. Doesn't break down by age, so doesn't inform this question completely, but it can speak against the 75% number quoted elsewhere in this conversation (and my anecdotal experience as well).

In AZ at least, certainly 75% of all ICU beds can't be taken by young unvaccinated COVID patients if only 40% of ICU beds were taken by COVID patients.

EDIT: UT also around ~40% <https://coronavirus-dashboard.utah.gov/hosp.html>

Duration of admission is something to consider as well though. Nobody likes to let young people die, and the odds of keeping someone with a very grim prognosis on the vent for weeks or months is higher if they are young and otherwise healthy as opposed to old or unhealthy; one young ventilated COVID patient could occupy an ICU bed for quite some time while the neighboring bed is turned over dozens of times and while dozens of other patients may expire or be flown hundreds of miles away (to the tune of tens of thousands of dollars for the flight alone) for lack of an ICU bed.

Difficult to answer (for me at least) ethical considerations on all sides.

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