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Comment by greatpatton | Hacker News Reader

Seems from this case in Norway (https://www.eurosurveillance.org/content/10.2807/1560-7917.E...) that Moderna is a tad bit better at preventing infection from Omicron, but when you see the overall number of cases among fully vaccinated people I'm not very optimistic that vaccine with do something at limiting the spread of infection, however I'm optimistic that they will still be efficient to prevent severe disease.

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> When asked to grade the severity of symptoms on a scale from 1 (no symptoms) to 5 (significant symptoms), 42% (33/79) reported level 3 symptoms, whereas 11% (9/79) reported level 4 symptoms. None of the cases required hospitalisation up to 13 December 2021.

I am extremely optimistic.

in terms of covid hospitalisations overwhelming our hospitals: i‘m optimistic as well that this might not happen at scale.

but in terms of a large part of society getting sick (level 3 still makes you stick in bed) at the same time - this will lead to worker shortage - i’m kind of neutral-pessimistic.

in terms of longterm long covid effect on our demographic - i’m fearful.

in terms of society getting their act together to avert anything of this: absolutely pessimistic.

> in terms of covid hospitalisations overwhelming our hospitals: i‘m optimistic as well that this might not happen at scale.

I see no reason for this optimism. Every hospital that I know of in SE Michigan has been over capacity for several weeks. We have gotten regular emails from both hospital systems in Ann Arbor begging everyone to get vaccinated.

This is inaccurate https://www.michigan.gov/coronavirus/0,9753,7-406-98159-5236...

Most people don’t realize that hospitals typically run at 98%+ capacity in the winter in a pre-COVID environment. This maximizes their profitability and allows them to operate relatively at a loss for the rest of the year.

This varies greatly between countries. In many countries hospitals don't have profits - they operate like courts or army with yearly budgets assigned by the government.

Michigan has certificates of need for hospital beds. Capacity is centrally planned (no doubt the incumbents are good friends with their regulators).

That's in addition to the games CMS plays with Medicare certification and funding.

Pre-covid, if you picked a random hospital at a random point in time in the U.S. there was a 16% chance it would be at max capacity and something like a 30% chance it would be over 80% capacity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840149/

It amazes me that hospitals are shutting down, healthcare worker numbers have barely recovered to 2018 numbers, bed capacity is shrinking in many areas and even still people think we have a healthcare crisis.

We've created 80% of all dollars ever created in the past two years. We have the money. It seems obvious (to me, anyways) our healthcare spending would explode in that sector and solve simple issues like capacity and worker shortage, if in fact that was an issue to begin with.

Healthcare workers take many years to train. When they die of COVID, go on long term disability because of long COVID, or burn out because they can't mentally handle watching another willfully unvaccinated person die, that person is irreplaceable in the short term.

HCW aren't on the decline because of any of those things (at least not primarily). This is made abundantly clear by looking at the steep dropoff in march of 2020 https://fred.stlouisfed.org/series/PAYEMS

HCWs are below where they would otherwise be because of policy.

Aside from that, long covid is psychosomatic. https://jamanetwork.com/journals/jamainternalmedicine/fullar... which means the root cause of long covid is likely misinformation about long covid to begin with (thanks "The Atlantic", for scaring everyone into being sick)

Above 75% is roughly considered to be high occupancy. Efficiency drops at that point for various reasons, such as the difficulty in moving patients between units due to a lack of beds. These numbers are also comprised of large regions of the state with multiple facilities, but the facilities still operate independently.

For adults, those regions of Michigan have the following ICU utilizations:

Region 1: 90%

Region 2N: 82%

Region 2S: 89%

Region 3: 94%

Region 5: 85%

Region 6: 87%

Region 7: 94%

Region 8: 72%

The NYT compiles per-hospital stats at [1], although the data is incomplete.

If Detroit were to not have beds available for patients, one option might be to transport patients as far away as Cleveland. There's a recent article discussing the situation at the Cleveland Clinic's 64 bed MICU [2].

[1] https://www.nytimes.com/interactive/2020/us/covid-hospitals-...

[2] https://fox59.com/news/national-world/not-gonna-make-it-out-...

I can't stress enough how dangerous it is to pretend society can end a virus that is not only incredibly contagious between humans but also has many animal carriers.

There is nothing more dangerous than society with no trust and this completely fabricated idea that people's behavior is to blame for the continued existence of covid serves no purpose other than to erode trust.

How did humanity ever survive this long without modern medicine?

Well, a lot of people died, mostly.

By letting people die. If covid came around in the 1200s, then everyone would have gotten it and ~3% of the world population would have died. Definitely suboptimal but nowhere near an extinction event.

Given COVID’s risk/age relationship and already lower life spans in that time period plus higher vitamin D exposure rates it’s quite likely rate of death would have been lower in that population.

The infection fatality rate was never as high as 3%. The CDC estimated it at 0.6% back when almost no one was vaccinated.

Nobody said it was?

The question was about a world without modern medicine. It's totally reasonable to speculate there would be a higher fatality rate without medical intervention keeping people from dying.

Law of large numbers. The widespread plagues of the past were never 100% lethal, or we wouldn't be here - a sizable fraction of the population survived, and over several rounds of infection/reinfection gained something we'd think of sterilising immunity.

In the meanwhile, the plagues and their knock-on effects may have eliminated approximately HALF of the entire population of their times.[0]

0: https://en.wikipedia.org/wiki/Black_Death ("is estimated to have killed 30 percent to 60 percent of the European population")

The thing with the worker shortage is it'll be brief. SA's already peaked. We'll have maybe a month of worker shortage I guess.

All this talk about "mild" cases with Omicron are failing to grasp the whole situation at two very important corners:

- countries affected so far have excellent immunization rates, i.e. if I take these populations as a reference, I'm just checking how immunized people are affected. Not every country has had either a lot of cases or large/successful immunization programs

- if the transmission rate in South Afrika and GB is any indication (reminder, both have quite good immunization rates), there will still be enough severe cases, because there will be just an unbelievable amount of overall cases in a very short timeframe and even with Omicron and a well immunized population, some remaining x% will land in the hospital.

I would argue that at the rate Omicron currently growing in GB, NL, DK, NO, etc. this thing will go on a rampage all over Europe. The amount of spread virus is so much not comparable to Delta getting to populations that were so far better protected, i.e. child care, elderly care, etc.

Countries like Germany and Austria are seriously in for a ride. Yes, I'm quite pessimistic here and I really hope I am wrong.

0 out of 79 cases requiring hospitalization? If we assumed a _generous_ vaccination rate of, say, 80% for SA or GB, then we could say that 16 of these cases are with unvaccinated individuals. So, 0 out of 16 is still pretty good for no hospitalizations.

Or am I figuring this wrong?

Infection also leads to immunization.

Both GB and SA had considerably higher incidence numbers over the last 12 months than most of the EU, with GB running a very successful vaccination program.

Particularly in SA researches estimate that almost anyone has had one or more infections in the last 24 months.

96% of the participants were fully vaccinated.

Hospitalizations [0], and perhaps even cases [1,2], appear to have peaked in South Africa.

[0] https://www.bloomberg.com/news/articles/2021-12-17/s-africa-...

[1] https://twitter.com/pieterstreicher/status/14718990936853954...

[2] https://nymag.com/intelligencer/amp/2021/12/the-south-africa...

And this means... ?

It means that if (big ifs!) (a) the South African peak is truly a peak and (b) vaccine-acquired immunity staves off severe illness to the same extent that infection-acquired immunity does[*], Europe is not in for “quite a ride.” As in South Africa, cases will briefly peak at a very high level, but without a corresponding high level of hospitalizations or deaths.

[*] while only ~30% of SA’s population has been vaccinated, some estimate an additional 40% of the population have been infected, for an overall immunity rate of ~70%, which is comparable to the vaccination rate in the US/Europe.

The likely higher transmissibility in combination with a generally more elderly population and vaccination gaps among older individuals in some European countries (e.g. Germany) could still spell trouble.

And experts are pretty sure by now that it will.

Also NL, DK and the London area are already putting drastic measures up. They are not doing this just for fun.

Yeah, Omicron is is still potentially a huge threat to countries which both have low vaccine uptake amongst the most at risk and avoided people being infected by previous variants. I think that might only apply to Germany, Austria and China at this point though - almost everywhere on the planet had widespread infection in past waves, and the exceptions generally have high vaccination rates by now.

No country on earth has vaccinated children under 5.

SA allegedly has had a huge amount of hospitalized children under 10 in the past weeks.

This alone can cause havoc. And suffering for the affected (incl. health workers and parents).

South Africa has extremely low vaccination rates, correct?

Edit: Yes, your premise seems to be quite wrong. South Africa has only 26% vaccination rate.

But South Africa has a lot of previously infected people with some degeree of natural immunization.

Sure, but so does America and the UK and so on.

Incidence in UK over the last 12 months is not comparable to large parts of Europe.

Quite astonishing how you just "confirmed" how my premise is wrong without reading what I wrote in the first place

> well immunized population, some remaining x% will land in the hospital.

Compare that to that 8% fatality rate for the common cold amongst the vulnerables. Here we have 1.4% so far. It's a a ride, yes, but this ride looks good. We have such rides every single year.

It is already 2 weeks for "Omicron" hogging the news. If it is as deadly as Delta, by now you should have heard a lot of death and not "number of infected". Even if there is a delay in death due to better care, hospitals in SA should have full of patients in ICU rooms with pictures showing rows and rows of patients on ventilations. Even if you use the arguments lots of them are vaccinated, there are stil many not vaccinated especially outside of 1st world categories. SA isn't exactly at western EU level. I think this isn't as severe as most healthcare professional have expected. I would speculate this would be nature's way to confer us with some immunity.

Even if Omicron infected patients have half the rate of hospitalization as delta infected patients, that means the wave crushes the hospitals one doubling period later. Currently, the incidents numbers for omicron double every 2 to 4 days. So having less severe cases means the meteor will hit us a few days later. That is not a big improvement. For the individual risk of hospitalization, it is quite significant.

In practice it's worked out ok https://mobile.twitter.com/ScottGottliebMD/status/1472664060...

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