Comment by tchalla | Hacker News Reader

Comment by tchalla | Hacker News Reader

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> If the vaccine doesn't significantly stop the spread of the disease

Multiple studies show that vaccinated people have significantly lower transmission than unvaccinated.

> In studies conducted before the emergence of the Delta variant, data from multiple studies in different countries suggested that people vaccinated with mRNA COVID-19 vaccines who develop COVID-19 generally have a lower viral load than unvaccinated people.(157, 165-169) This observation may indicate reduced transmissibility, as viral load has been identified as a key driver of transmission.(170) Studies from multiple countries found significantly reduced likelihood of transmission to household contacts from people infected with SARS-CoV-2 who were previously vaccinated for COVID-19.(171-176) For the Delta variant, early data indicate vaccinated and unvaccinated persons infected with Delta have similar levels of viral RNA and culturable virus detected, indicating that some vaccinated people infected with the Delta variant of SARS-CoV-2 may be able to transmit the virus to others.(163, 164, 177-180) However, other studies have shown a more rapid decline in viral RNA and culturable virus in fully vaccinated people (96, 177, 180-182). One study observed that Delta infection in fully vaccinated persons was associated with significantly less transmission to contacts than persons who were unvaccinated or partially vaccinated.(181) Together, these studies suggest that vaccinated people who become infected with Delta have potential to be less infectious than infected unvaccinated people.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-br...

That's true but the government data from the UK also showed that the vaccinated (age group above 30 years old) got infected more often than unvaccinated.

The reasons are unclear, maybe it is the testing issue or that vaccinated are less careful with socialization and pay less attention to their symptoms and can even spread covid even more. Even if the data is suspect, it is a strong indicator that the difference between vaccinated and unvaccinated with regards to spreading of infection is not strong.

As with all studies, they are not always able to predict actual effects in the community. It very much depends when the study is done, what variants are currently circulating, behavioural changes which are very hard to control etc.

The theory that vaccinated people are less careful with socialization and pay less attention to symptoms is the exact same argument being made about masks. This makes agreeing or disagreeing with the theory a bit socially complex.

If we agree that protections like vaccinations and masks do effect people to behave more risky, then the benefit of masks need to be balanced towards that negative effect.

If we disagree that protections like vaccinations and masks do effect people to behave more risky, then the benefit of vaccinations need to be questioned.

Either way we are questioning the effectiveness of masks and vaccinations, two topics which is quite controversial to question.

Wow, that "people wearing masks will party like it's 2019" hypothesis is an interesting specimen: to me, almost two years into the pandemic it seems almost absurd, because when I put on a mask I'm immediately "pandemic me", with all the routine precautionary behavior patterns. I can only switch that off without a mask. But back in early 2020, those connections were not set up yet, it would have been quite likely that wearing a mask would have got the precaution box checked, leaving everything else "2019". At what point has it changed? Has it changed for everyone?

To me, putting on a mask is acknowledging of a high risk environment, like using a mass transportation during a pandemic. Airborne virus spread fast in crowded environment with limited ventilation, and if one has to be in such environment then doing anything to limit spread is good. The problem is when people started to use masks in order to allow themselves to be in an high risk environments.

For my perspective here in Sweden, not much has changed from last time during the holidays and this year. People still seem to want something to allow them go into high risk environment, like Christmas parties, weddings, mass transportation travel, and shopping during rush hours. To me it the same people who went to those last year with masks that goes to those things this year with vaccines. Thankfully vaccines is at least more effective and thus the outcome seem less worse this year for the health care system.

that is probably because the first to be vaccinated are the old, weak or diseased people and the unvaccinated are children with strong immune systems.

It's a rubbish assumption though. According to the UK data (which is age stratified), unvaccinated children get infected much more often. You could say that children have strong immune systems therefore they don't get sick but only infected. Maybe vaccination for children further improves their immunity that they don't get infected either (will see if it works for omicron though). As for other people, even vaccinated easily get infected but the severity of illness is reduced.

There's a lot of 'indicates' and 'suggests' and 'potential' there rather than clinical outcomes. Given how the unvaccinated are mostly locked out of things at present, current case trajectories and hospitalisations 'suggest' the overall vaccine outcome is not one that solves the problem in any meaningful way.

Last time I checked, invaccinated patients were vastly over repredented in hospitalization and ICU occupation. No indication, but hard facts.

If vaccines prevent serious cases and hospitalization for a large percentage of people, and they do, we would be all good if vaccination rates reach sufficient levels. Until they do, the very limited ICU capacity will be taken up overpropertionally unvaccinated. And we will continue to have problems.

What's a sufficient level then? It was once 70%, then 80, then 90. Now we have places pushing 95 and that's still not enough? Perhaps we should be paying a bit closer attention to what the vaccines aren't doing.

NZ has 95% rate and just got first omicron cases few days in strict quarantine. Will see how it will go.

What a sufficient level is also depends on the goal: Eradicting Covid would require higher rates then just turning into a less serious endemic virus. Personally I think eradication is impossible by now.

Singapore hit 90%+ vaccination (eligible) a month ago and just got over a raging wave of Delta infections.

No idea what a sufficient level is, Delta, Omicron and all that considered. Also, I am not into pandemic modelling. Since I don't necessarily care where the level right now is, peiple can always look up the latest papers and studies in that topic.

100% would be ideal. It seems to impossible to achieve herd immunity against COVID (whether by vaccination or by immunity due to infection), so everyone will get it eventually. The more are vaccinated, the lower the load on the healthcare system will be.

100% is only an ideal if we don't really believe anything less will work...

Don't we want some sort of control group to remain for these vaccines that don't formally conclude their trials for a couple of years yet? Or is everyone just 100% convinced that nothing could possibly go wrong at this point? That would be proper scientific diligence.

This is about a medical intervention, not about a scientific study. Vaccine adverse events are usually evaluated by comparing with background rates from previous studies. Control groups are used in randomized control trials and are probably mostly worthless without randomization.

Except the trials are still underway, so yes, it is about scientific study. And proper diligence and reporting is critical for such a significant experiment, wouldn't you think?

> Or is everyone just 100% convinced that nothing could possibly go wrong at this point

What would be an example of something going wrong? Are you thinking that a sub-optimal outcome might occur ("the pandemic lasted 4 months longer than it had to") or that 80% of the people vaccinated drop dead in 2025?

The first case would be an unfortunate case of the best attempt of a decision made on uncertain data turning out to be incorrect in retrospect.

In the latter case, civilization is still protected as many people chose not to get vaccinated.

We don't know do we. That's the fact. And how would we know if the control group is just removed (as Pfizer did in their phase 3 trials anyway...)?

I guess hopefully we don't find out, because the only way it'll ever be clearly distinguished is if it goes very badly across the board. Anything less can quite simply be explained away. Isn't it nice for Pfizer/Moderna to be able to run the long-term study with immunity in a manner that is very hard to understand clinical outcomes (except the huge side-effect profile readily dismissed as 'acceptable' because some deaths are more important than others).

Not sure if this is the kind of reply you're hoping for, but I've been super encouraged by the defensive stance that Scandinavian authorities took with regards to the AstraZeneca and J&J vaccines once observations of rare side effects became available.

These decisions were mired in a whole lot of suspicious and unnecessary controversy. Rare and specific blood clots on the order of 1 per 20,000 vaccinations turned the ethical consideration of the vaccines from "obviously good" to "obviously bad" overnight, and they were removed from the program immediately. A single-digit number of unnecessary deaths were caused, but the buck stopped there.

I'm not as encouraged by the international response to this research and operative decision. It could be argued at the time that the Scandinavian decisions were made in the light of populations that had sufficiently low mortality from covid that the ethical consideration was different than in Europe at large.

But to my eyes, the European decision to keep using the AZ and J&J vaccines had an air of "let's not look too closely, or maybe we'll see something bad". Norwegian case studies indicated that the rare blood clots were pretty frickin' hard to distinguish from conditions caused by common lifestyle diseases. Two cases were specifically diagnosed only because they happened in doctors who ran themselves through a battery of expensive tests few normal patients would have qualified for. My qualified guess: There are rare but deadly and persistent side effects with these vaccines, that won't be discovered in healthcare environments that aren't finely tuned.

I suppose my point is that if there (God forbid) happen to exist bad but rare and non-obvious side effects of the new RNA vaccines, the truth can be uncovered. I'm not sure that a deliberate control group would be any good regardless; the AZ/J&J side effects were rare enough not to be seen in the control group. But they were still bad enough to disqualify the vaccines.

The whole thing is a super interesting subject, and it's obviously so political and subject to propaganda that you'd need a very critical eye to navigate it. Unless again, heaven forbid, the effect is so bad that it's obvious. Different health authorities do have different degrees of honesty and principled handling of these questions. There are control groups available; the large population of people who decide skip vaccination.

You will never hit 100% vaccinated. A big part of public health is “compliance”. Compliance rates with cancer are low 90% and these are people that die without treatment.

Hitting mid-80% is actually pretty impressive.

Delta and Omicron are just so much "faster" than what we encountered before. Thankfully the general working principle of the brakes (vaccines) seems to be mostly unaffected by them, but we have to press them harder.

What the vaccines are not doing: make it 2019 again.

This will eventually blow over. People getting infected with a variant that the vaccine does not prevent infection against, will still develop their immune reaction for that variant. At some point in the future there will once again be a balance between the collective immune response and the transmissability of the virus. The vaccines available right now are still obviously the best measure we have to make getting to that point less painful, as they reduce hospitalizations dramatically.

It's pretty obvious that e.g. if a 50% vaccination rate leaves the ICU at 10x capacity during an unmitigated outbreak, a 90% vaccination rate would be preferable even if it doesn't prevent the need for quarantine measures. This means that contact-reducing measures don't have to be as severe while the outbreak is happening.

> the overall vaccine outcome is not one that solves the problem in any meaningful way.

Only if you think that "people not dying" isn't meaningful, anyway.

But people are still dying. It's not that the vaccines haven't prevented death, it's that we seem to be past the peak of what they can solve and yet keep putting all our eggs in that basket. Recent to Omicron, there were more cases and hospitalisations than the same time last year when vaccination was low and Delta was the main variant still.

The message is constantly that it's the unvaccinated causing it, but why is that so when they form such a small proportion of the population, there's been plenty of prior exposure and seasonality seems to show a greater effect than the vaccines? Not to mention the risk to under 40's has been extremely low throughout. How do the unvaccinated keep 'filling up' hospitals if vaccines reduce spread and there's 80-90%+ double-dose coverage?

> it's that we seem to be past the peak of what they can solve

There's no peak to preventing a fixed percentage of deaths. It's fixed.

> and yet keep putting all our eggs in that basket.

As far as I'm aware, we haven't stopped all other research, so that would be false.

> How do the unvaccinated keep 'filling up' hospitals if vaccines reduce spread and there's 80-90%+ double-dose coverage?

Because 2% of 10% of an entire country is still a big number.

But that 2% of 10% are not standing in a line all holding hands. It's clear the vaccinated are readily spreading the disease around and yet the reward is greater freedom for them to spread it? Why do we not still care for the unvaccinated regardless of their reasons or situations for being so?

The vaccine is clearly not protecting that group (the original reason for mandates), and 'preventing deaths' vs the unknowns around long term vaccine outcomes (we're all just assuming nothing serious at present) and the increases in stresses and illnesses driven from lockdown, restrictions and mandates are creating a toll that we seem happy to assume is always less than the direct covid toll and therefore acceptable.

> It's clear the vaccinated are readily spreading the disease around and yet the reward is greater freedom for them to spread it? Why do we not still care for the unvaccinated regardless of their reasons or situations for being so?

Because they chose not to be vaccinated. Why should I limit myself when I have a very small risk after vaccination to protect someone who chose not to be vaccinated, for whatever reason?

> The vaccine is clearly not protecting that group

And that is their choice. What more is there to discuss?

Because they're human and you shouldn't pretend to assume you know their motives or circumstances.

Should I decide all those in religious minorities deserve whatever comes to them because they choose not to follow the major religion?

Should I decide obese people deserve no support or care because they 'choose' an unhealthy diet?

Let's not turn into horrible human beings just because we feel righteous. Righteousness has a habit of causing horrendous suffering.

> Should I decide all those in religious minorities deserve whatever comes to them because they choose not to follow the major religion?

In what way is this related to "other people shouldn't be inconvenienced to protect you from the choices you have made"?

> Should I decide obese people deserve no support or care because they 'choose' an unhealthy diet?

All these examples are so irrelevant that it feels like you're doing it in bad faith. We're not talking about what unvaccinated people should do. We're talking about what vaccinated people should do, and vaccinated people are under no obligation to limit themselves to protect unvaccinated people.

If you want to be unvaccinated, fine. I'm not going to go into lockdown so you don't die, though. Risking it is your choice.

> In what way is this related to "other people shouldn't be inconvenienced to protect you from the choices you have made"?

Who is inconvenienced? And should I feel 'inconvenienced' by those going to hospital because of vaccine adverse events? For instance, just for Pfizer in the EU, there are 640K events reported as of now [1], with ~70K of those for Blood & lymphatic system or cardiac disorders. Now these may not all be specific to Covid and not all hospitalisations, but there's certainly some 'inconvenience' to others here, no? Or is there some lower limit of 'inconvenience?'

You might also observe that a large number of adverse events are occurring in the 18-64 group, one that is of much lower risk of covid hospitalisation/death in the first place.

But wouldn't want to inconvenience you with lockdowns now would we! How frustrating! Better let you out so you can go give some unvaccinated people covid instead hmm? Sorry for the snark but what a selfish attitude.

[1] https://dap.ema.europa.eu/analytics/saw.dll?PortalPages

> Who is inconvenienced?

Vaccinated people. I feel like you aren't following the debate.

> And should I feel 'inconvenienced' by those going to hospital because of vaccine adverse events?

No, why would you?

> Wouldn't want to inconvenience you with lockdowns now would we! How frustrating! Better let you out so you can go give some unvaccinated people covid instead hmm? Sorry for the snark but what a selfish attitude.

Yeah if you think "you better stay inside so I don't get COVID because I don't want to get vaccinated" is a reasonable stance, this won't go anywhere.

I even completely fail to fathom how "you should limit your own liberty to protect me from my choices" is remotely acceptable, let alone thinking that somebody not doing that is selfish.

You can either get vaccinated and go out, or not get vaccinated and stay in. How is it at all reasonable to tell me what to do because you don't want to get vaccinated? You're basically saying "everybody else needs to stop driving because I like walking in the street instead of the sidewalk, how selfish of you to still want to drive!".

> Vaccinated people. I feel like you aren't following the debate.

So what exactly is this inconvenience, caused specifically by unvaccinated people and not government policy?

> No, why would you?

Depends on your answer for the above.

> Yeah if you think "you better stay inside so I don't get COVID because I don't want to get vaccinated" is a reasonable stance, this won't go anywhere.

So who exactly are you protecting with vaccination then? Other vaxxed people who are also protected? And as I mentioned in another comment, why pretend to understand the motives of the unvaccinated to make them the 'enemy?'

> I even completely fail to fathom how "you should limit your own liberty to protect me from my choices" is remotely acceptable

But it's ok to limit the liberties of the unvaxed because 'risk?' Everyone has rights or no one has rights. This is fundamental. Are you ok to be called unvaccinated if they decide boosters should be monthly even if a newer variant is evading those vaccines again?

> You can either get vaccinated and go out, or not get vaccinated and stay in. How is it at all reasonable to tell me what to do because you don't want to get vaccinated? You're basically saying "everybody else needs to stop driving because I like walking in the street instead of the sidewalk, how selfish of you to still want to drive!".

But being vaccinated doesn't stop it spreading while you're out, which highlights the selfish motives for getting it. You don't care about not making people sick, you care that your freedoms aren't restricted. There's a lot of vaccinated people in hospital still, are they an inconvenience?

> So what exactly is this inconvenience

You said this:

> Why do we not still care for the unvaccinated regardless of their reasons or situations for being so?

The inconvenience si "caring for the unvaccinated", at least that's how I interpreted your comment. If you meant something different please let me know.

> caused specifically by unvaccinated people and not government policy?

Government policy to protect unvaccinated people.

> So who exactly are you protecting with vaccination then?

Myself, obviously.

> why pretend to understand the motives of the unvaccinated to make them the 'enemy?'

I didn't make them "the enemy". They can do whatever I want, I just don't want any limitation on myself to protect them from their choices.

> But it's ok to limit the liberties of the unvaxed because 'risk?' Everyone has rights or no one has rights.

"But it's ok to limit the liberties of the drunk because 'risk?' Everyone can drive or no one can drive."

> But being vaccinated doesn't stop it spreading while you're out

This argument would make sense if curtailing the spread was the ultimate goal, but it's not. Preventing hospitalizations/deaths is the ultimate goal. If I go into a room with vaccinated people and give them all COVID but nobody is hospitalized, then that's fine. I don't think this is so hard to understand.

> You don't care about not making people sick, you care that your freedoms aren't restricted.

Everything is a tradeoff. If you're vaccinated, you're less of a risk than if you aren't. At some point, life has to go on. Or should we have been in perpetual lockdown for centuries so people didn't die of the flu as well?

No I mean having empathy and being considerate, not physically caring. And if I did mean physical caring, again how does those with adverse events not then qualify for being an 'inconvenience' to those who have to care for them. Though I believe you are only referring to government/business actions that impact you rather than the inconvenience of personal care?

> Government policy to protect unvaccinated people.

Government policy !== health. Protecting them by punishing them so you can be 'free?' Odd. Do you not see at all how the vaccine is not in this case forming a health solution (otherwise considering the vaccine still spreads covid there'd be continued lockdowns for all anyway to protect everyone...) but controls for their own sake?

> Myself, obviously

So why do you care what decision others make about it? Direct your frustration at those making policy calls, not those used as justification.

> "But it's ok to limit the liberties of the drunk because 'risk?' Everyone can drive or no one can drive."

You're free to choose not to drink or to drink. To correct the analogy, how about we restrict those that like a drink from being able to drive at all because risk?

> This argument would make sense if curtailing the spread was the ultimate goal, but it's not

Funny, it was earlier this year. Amazing how the narrative changes over time and people just follow it along, with the usual 'oh but they're learning about it all the time and making the best decisions they can.' Which obviously highlights they're making bad decisions, but not now?

https://twitter.com/Sentinel2NO/status/1471886835152560130?s...

> Everything is a tradeoff. If you're vaccinated, you're less of a risk than if you aren't

a) you're not near 0 risk though and b) Not if you're under 40 years old with no comorbidities. Especially for those under 20, the vaccine risk (by nature of risk of being impacted == 1.0 by getting jabbed vs risk of actually contracting covid, let along having a serious reaction or spreading it) is not clearly behind the covid risk. Now we head into the logic gymnastics where we are vaccinating the young to protect others, who have been vaccinated and protected, leaving only the unvaccinated for the young to protect, except we don't care about them because 'they made their choice.' So why again are we vaccinating the young, considering vaccination doesn't prevent spread and the young are the lowest risk group by a large distance? Also remembering that earlier in the year the young already didn't readily catch or spread covid, so why now?

Please stop abusing the EMA data to spread misinformation. The website very clearly states:

The information on this website relates to suspected side effects, i.e. medical events that have been observed following the administration of the COVID-19 vaccines, but which are not necessarily related to or caused by the vaccine.

Without knowledge of the expected background rate of such events, the data is impossible to interpret. In no way does it show that the vaccines are unsafe.

I noted that my reply, but sure, let's not take the cautious approach with vaccines and yet take the extremely cautious approach with covid (dying within 30 days of catching covid is counted as covid death in many countries).

Covids deaths are not acceptable, but deaths in younger demographics are acceptable because they're less?

> But people are still dying

By that measure we might give up on food as well, what's it good for of people still eventually die?

> How do the unvaccinated keep 'filling up' hospitals if vaccines reduce spread and there's 80-90%+ double-dose coverage?

By getting infected and requiring medical assistance, that's how they do it.

It's an awful situation and there is absolutely no way it could be less awful without vaccines.

Really? Ask Africa, which keeps 'confusing' the experts.

Are there many experts who are easily confused by age structure?

https://abcnews.go.com/Health/wireStory/scientists-mystified...

I'm reading between the lines here but the index case seems to have been vaccinated given that everyone else at the party. They infected everyone^.

How much worse would this have been if an unvaccinated person had attended the venue? Realistically, if one person can infect 80, the vaccine is doing nothing to delay the spread.

^ Where today "everyone" is 70% of the partygoers.

But it did prevent the index patient from becoming seriously ill (i.e. hospitalised). It most likely reduced the initial dose of all that got infected by patient-0 [0]. And it most likely prevent _any_ of the invected to become hospitalised either.

Now you can make the argument (or at least attempt to make this argument), that it would have been _better_ for patient-0 not to be vaccinated, because then, maybe, patient-0 would already have been sick and not at that party. Unfortunately this is the main problem of Covid in the first place: A significant portion of the downstream infections are generated before the onset of symptoms.

So yes, the vaccine didn't prevent much of the spread [1], but it still reduces the amount of strain put on the health care system. Somewhere upthread there was the question: "How do the few unvaccinated overwhelm the hospital system?" The answer is: We can't deal with 1% of society being in the hospital. So getting 5% of all unvaccinated there and having 20% unvaccinated is already too much!

Last year we managed, because we radically cut down on all interactions and delayed the spread that way. We _can_ do that again. But then this Christmas party just wouldn't have happened at all!

[0] Note this is still somewhat a conjecture, as actually getting clean data for this is nigh impossible. [1] I'd still take the 30% reduction, but it's an upper bound and can still decrease. So yeah, let's call this "doesn't help slow down the spread"

> ... but it still reduces the amount of strain put on the health care system

Sure, but the case for a vaccine mandate pretty much collapses at that point. I have some anti-vaxxers living across the road from me who earn a lot of money. They'd be paying an above-average amount of taxes.

So the mandate argument to them is essentially "well, we're going to force you to do something, otherwise you'd be more likely than average to consume services that you pay for". Now that is a good argument for getting vaccinated, no doubt. But it is a terrible argument for banning people from public life as a vaccine mandate requires if it is going to be implemented.

It is also a bit questionable to be reaching out and forcing medical procedures on people based on being unwilling to expand the hospital system. If the unvaccinated were given an option to just pay for the extra capacity required (some form of insurance, dare I say) then they can get what they want and stay vulnerable at no cost to others.

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