Children develop robust and sustained cross-reactive immunity after Covid | Hacker News Reader

Children develop robust and sustained cross-reactive immunity after Covid

nature.com

164 pointsmalchow266 comments

Finally some glimmers of hope in moving past Covid.. if Omicron continues on its current track of highly infectious but less serious —- and infection confers reactive immunity to a variety of strains, we could be closer to the endemic but manageable end game. Good vaccines + mild severity illness are basically the best case.

What a stroke of luck that we are here vs a more infectious strain of Delta or some other nightmare that would keep this rolling.

Indeed! I really hope governments will start recognising this and give us back our freedom. Media messages and restrictions are still pretty negative, despite the lack of severity. I don't know how can they talk about another lockdown.

Delta also had lower mortality than the first wave: this was confirmed by some fact-checkers and not by others (depending on how alarmist the fact-checker is) but looking at numbers, it does seem to be case.

It seems to be an evolutionary trend where the virus mutations that are successful became more transmissible and less deadly (probably because a dead host doesn't spread as much as an alive one).

> It seems to be an evolutionary trend where the virus mutations that are successful became more transmissible and less deadly (probably because a dead host doesn't spread as much as an alive one).

Covid spreads while still being non-symptomatic so that explanation doesn't stand that much. Flu is not getting milder.

Also, how many times more do you think you can get hit in the face by Manny Pacquiao instead of Mike Tyson and survive because his punches are milder ?

How many times can we keep catching mild covid and escape long term damages (edit: and death and everything in between) ?

A lockdown is probably impractical at this point, but we are stuck with a disease that will be a health burden on humanity that will be difficult to eliminate.

For example, if a disease kills 40,000 people per year. That's 400,000 people in a decade. A drop in the bucket of humanity for sure, but that's about a city size population. That's not counting the collectively lost days in term of feeling terrible.

> For example, if a disease kills 40,000 people per year. That's 400,000 people in a decade. A drop in the bucket of humanity for sure, but that's about a city size population. That's not counting the collectively lost days in term of feeling terrible.

Heart disease kills 659,000 people a year in the US alone (https://www.cdc.gov/heartdisease/facts.htm), but for some reason we're not having COVID-level panic about it.

I'm struggling to find annual statistics for COVID, but I did find an article written September '21 stating there had been over 630,000 COVID deaths in the US since the start of 2020, so that's over a year and a half-ish, so a bit less than heart disease.

Of course, heart disease isn't contagious (at least not in the traditional sense - genetics and lifestyle factors could be considered contagious if you're flexible with the term), but it's also a cause of death we've grown disconcertingly accustomed to for how prevalent it is. I expect once this outbreak has run its course, we'll probably see annual COVID deaths settle at a much lower number thanks to vaccinations/immunity. I'm not sure when we'll come to accept it as just another risk of life, though.

> Heart disease kills 659,000 people a year in the US alone (https://www.cdc.gov/heartdisease/facts.htm), but for some reason we're not having COVID-level panic about it.

I think you answered this yourself:

> Of course, heart disease isn't contagious

If heart disease were contagious and could be effectively curtailed by wearing masks and getting a vaccine, I think you'd see a similar reaction to it that you're seeing to covid.

Heart disease is not collapsing the health system. Why are we bothering to compare them.

Healthcare system capacity is somewhat fungible. If we reduced heart disease then there would be more resources available to deal with other conditions such as COVID-19. The majority of heart disease cases could be prevented, or at least delayed, by making better lifestyle choices.

The difficult thing about measuring causes of death is that we take it as axiomatic (and, to be clear, I think we're right to do so) that the goal is not for humans to live forever, that everyone should die of something. Heart disease mostly affects people who are at the age that people tend to die of "old age." In other words, eliminating heart disease entirely would largely only cause those people to die of something else. There are, I don't know, maybe 100-200K "premature" deaths from heart disease which ought to be the focus of public health interventions, but addressing the rest of them won't meaningfully save lives.

Or put another way: 22% of all deaths in the US happen in nursing homes. But we don't say we should get rid of nursing homes. If 22% of all deaths in a city happened in their college dormitories, there would be an immediate outcry to shut down the dormitories.

Now, the harder question is that covid also disproportionately affects people near the end of their natural life (and probably so does almost every medical cause of death besides, like, SIDS and pregnancy).

So the question is then, how many people does covid kill "before their time," so to speak, and how does that compare to heart disease? One of the common arguments is that it does kill lots of people before their time - even thought it skews towards the older, it nonetheless kills a good chunk of older folks who would have otherwise lived happy and healthy lives for several more years.

One way to measure this is by looking at excess deaths. How many people are dying of any cause compared to the year before covid was around? If covid was, say, killing people who were about to be killed by heart disease, we'd kind of expect a drop in heart disease death statistics. If we're not seeing that, then that implies that covid shouldn't be bucketed as an "old age" cause of death, that there's a reason to be more concerned about the 630,000 covid deaths over the past almost two years than the 659,000 heart disease deaths in 2019. And in fact it looks like the number of heart disease deaths didn't drop in 2020 (and grew, in fact) even as covid killed 350,000 people.

(You can get these numbers out of http://wonder.cdc.gov/ucd-icd10.html - which I found linked from the site you linked, thanks! - and break them down further by age etc.)

A lot of arguments that we should specifically care about covid (which is the camp I'm in) are predicated on the assumption that this is true; a lot of arguments that we should just treat it like we treat the flu are predicated on the assumption that it is not. I think this is a question of fact (though one that requires the statistics to actually be available) and not just a difference of opinion or worldview.

Beyond squabbling on numbers (COVID was actively fought in most developed countries, otherwise it would have killed many more), the difference is control.

Heart disease is well-understood, and largely avoidable with education; hence, it's not a problem as far as the ruling classes are concerned.

COVID and other infectious diseases, on the other hand, can hit literally anybody with a social life. They are fundamentally uncontrollable at the individual level, and have the potential to upset the social order if the numbers get out of control (as they did, shortly, last year). Until that continues to be the case, COVID will continue to be addressed as a significant problem.

I don't understand this argument at all. Are you saying that if heart disease went from killing 650 thousand people a year to 1.3 million people a year, that wouldn't cause a massive freakout?

Delta had equal or higher severity per infection than alpha which in turn had higher severity than the original variant. It just had lower mortality than the first wave because people had higher preexisting immunity, treatment had improved, and some of the most vulnerable had already been culled from the herd.

You have to compare between two variants at the same time, not against previous waves. Omicron is the first major variant to actually be less severe on this metric.

Freedom is seldom given. It usually has to be taken.

The question ever since it became clear that this coronavirus was endemic has been what a "manageable end game" is: that is, what level of risk and mortality are we prepared to accept, given that deaths from Covid will never be zero.

This is, in my opinion, the primary underlying disagreement. Some people think that no amount of deaths from Covid is acceptable. Some people believe that even the peak pandemic mortality is acceptable. And others fall somewhere in between, by, for example, focusing on hospital capacity. I don't think there is any long-term solution to Covid as a social issue, something we talk about and can't move past, until some kind of consensus is reached on this.

And from my point of view as someone in the field, arguments on either side are almost always based on an intuitive gut feeling about morality.

Very few people actually try to wrangle with putting numbers on the cost (in dollars) of a human life, or the economic burden of disease. There are no right or wrong numbers, but only if you begin there can you say you're rationally considering the economic or political tradeoffs.

Edit: and deaths could absolutely reach zero. If we threw everything and the kitchen sink at the problem, we would eradicate it in absolutely no time. The underlying question is the same here, namely whether the cost of eradicating the disease would be larger or smaller than what we would gain from doing it.

I think you overestimate our ability to “eradicate it in absolutely no time”. Eliminating it from both human and animal reservoirs (and permanently quarantining any immunocompromised carriers) worldwide would be a long and arduous process.

You make a great point about animal reservoirs, but the transmission bandwidth between humans and animals is afaik much lower than between humans. If you accept this assumption, and if we also assume that we really wanted to eradicate this thing, we could limit human transmission such as to reduce Rt well below 1 by implementing well-coordinated and strict policies.

Then you're left with the "leaky bucket" of transmission between humans and animals... But this is a known vulnerable point which could be monitored effectively and very cheaply.

This is completely unrealistic. Effective continuous monitoring for animal to human transmission would never be cheap. In much of the developing world it's not even remotely feasible. Have you ever been to places like rural Mexico?

The virus is here to stay. Eradication is a total fantasy, just a distraction and waste of time.

Here in Canada, we've been trying to eradicate rabies from the wild for half a century or so now. There are orally-active rabies vaccines we litter the landscape with in edible treat format. We cull rabid animals and quarantine or cull their known animal contacts. It's common knowledge that exposure to possible vectors means you need to go to the hospital. Tens of thousands of people are treated preventatively each year.

Despite all this, human cases of rabies still happen. Fortunately it's rather hard to spread rabies between humans and it's symptomatic by the time it becomes infectious. In the case of an easily airborne virus even with such measures available like vaccination and prophylaxis for possible exposure, it seems daunting to the point of impossible even in a very wealthy country. In the developing world it would be certainly hopeless.

Yeah, eradication of a disease in the wild is a whole other matter. But so rabies also is another matter. Cases are relatively rare here (hello, fellow Canadian!), and surveillance is relatively good for the little burden of disease it brings.

https://www.canada.ca/en/public-health/services/diseases/rab...

Genetic surveillance is just around the corner, and will soon be / is now within reach even of developing countries, with solutions like Oxford Nanopore's ultra-portable sequencers.

https://www.youtube.com/watch?v=6RRSxWtJPUw

Depending upon the specific agency, agencies in the USA value a statistical life at anywhere from $7-$10 million.

As a Canadian, I usually use the US DoT numbers (in the same ballpark as what you said) for my mental maths. A couple extra things to consider:

- what’s the date on these figures?

- can we extrapolate this to other countries?

- are these figures generally accepted, or are they controversial?

- how do you account for age, sex (differences in life expectancy, child bearing capacity, etc), education level or professional skill, etc?

Ironically enough, I think the data set comes from lawsuits that determine all of those conditions. A surgeon for example with all of their future surgeon income ruined by a bad car accident + medical care can be around $30 million, while someone who is relatively old with no chances of future income + medical care would typically get less AFAIK. It probably averages out to that $7-10 million figure.

I disagree.

I think the endgame is clear in the US. Most states have dropped all restrictions and those that haven’t will suffer economically and politically until they drop their restrictions. The only question is how much economic and political suffering individual cities and states will tolerate.

Virginia voters threw out their entire Democrat government and governor and will likely join the list of states banning restrictions.

In the end I don’t think it will be about Covid at all. One by one we’ll move on because the people will demand an end to restrictions.

You've been downvoted, but you're not wrong. Witness the number of people who have left California.

I’m not making a values argument either way. It just seems apparent that people are tired of restrictions, and those people seem more likely to vote. The result in Virginia was shocking and should have been a wake up call to Democrats.

I wonder if people would be OK with less restrictions, no vaccine mandates but perma n95 in public indoor and outdoor spaces ?

Because whether we like it or not the virus is still going to be around and kill people and saturate hospitals.

So, to me, the question seems to be:

  will living with the virus means "we don't treat covid patients anymore, if you get covid, tough luck, you are free to choose to wear a mask if you want, beyond that don't expect anything from public authorities"

>I wonder if people would be OK with less restrictions, no vaccine mandates but perma n95 in public indoor and outdoor spaces ?

The second and third most populous states in the nation have banned Covid restrictions. I think the answer to your question is… absolutely not.

I think you wanted to say the answer to my question is `yes`.

> Because whether we like it or not the virus is still going to be around and kill people and saturate hospitals.

Still be around and kill people? Sure, but that's true of the seasonal flu, and even the common cold in rare cases. Saturate hospitals? No.

> Still be around and kill people? Sure, but that's true of the seasonal flu,

I wish people would stop comparing it to the flu, it's highly misleading.

1. With restrictions in place covid killed more.

2. One in ten people still experience illness 12 weeks after the infection. Covid gets into the nervous system by crossing the neural-mucosal interface. Way more people that wouldn't have ended up in hospitals with a flu do ended up in hospitals with Covid. Even with vaccines. Long covid is no joke. Etc.

> and even the common cold in rare cases. Saturate hospitals? No.

Hopium and wishful thinking.

According to a UC study last summer, there hasn't been an abnormal number of people leaving California. https://www.universityofcalifornia.edu/press-room/uc-studies...

"Despite California losing a congressional seat for the first time in history due to slow population growth and some high-profile technology companies and billionaires leaving the state, there is no evidence of an abnormal increase in residents planning to move out of the state"

Recently released (days ago) US census data disagrees. Only New York had higher outmigration in absolute numbers than California.

California would be expected to have the largest outmigration given that it has the largest population.

"Better than New York" is damning with faint praise.

It’s an outlier even on a percentage change basis. One of only a handful of states losing over 0.5% of residents since the pandemic started.

The “bottom five” for percentage change is, in order… DC, NY, Illinois, Hawaii, California.

> what level of risk and mortality are we prepared to accept

IMO, the rational answer to this question is 'the same risk and mortality that we have already accepted from influenza.' There is a lot of variability there, of course, but it is way above zero in any case.

That would seem to make sense if covid displaced flu entirely. But flu + equivalently harmful covid is twice as bad as historical flu.

Influenza B is thought to have been made extinct recently due to the pressures introduced by SARS-CoV-2

https://www.webmd.com/lung/news/20211025/covid-pandemic-may-...

Wow, webmd made it really hard to find the primary source for that.

To be clear, they are attributing this drop off of this flu strain to be likely due to pandemic mitigation efforts, as well as maybe lucky timing and some specifics of how this strain spreads

Since it doesn’t seem plausible to repeat the wide scale pandemic mitigation controls any time soon, I doubt we can keep wiping out flu strains, but we could certainly reduce the damage the flu does if we want to

https://www.nature.com/articles/s41579-021-00642-4

Double the normal flu rate would be just 20% of what we're seeing this year from covid.

I don't think this is quite right. The risk from COVID is in addition to the risk from influenza, and much of the mitigation affects both. Changes like common mask wearing may not have been considered 'worth it' for only lessening mortality and the economic costs of influenza, but the economic benefits alone of reduced productivity due to influenza and COVID combined may mean it is the obvious choice now for governments and businesses to push mask wearing everywhere they can. Similar for vaccination when your yearly flu jab becomes a yearly flu + COVID jab.

There's more to life than economic benefits. I'm certainly not willing to spend the rest of my life wearing a mask, regardless of what governments say.

I am not convinced. Influenza has a pretty wide range, typically 12-52K a year (in the US). Doubling that top number would put it about 20% of the covid deaths we are seeing in 2021. Both diseases disproportionately punish people who are the least productive members of society (based on age alone); I don't think businesses are going to be volunteering to enforce mask mandates themselves. And the government is already showing considerably less enthusiasm than a year ago. Citizens are tiring of the masks, as evidenced by the waning compliance rate.

Vaccines, on the other hand, seem promising. Though the effective mutation rate seems quite a lot lower than influenza and there are good reasons to believe that the covid boosters will be considerably more durable than the original shots. If it really did come down to getting a booster every year, though, I think a lot of people would be okay with that if it meant no more attempts at lockdowns and mask mandates.

The primary concern form day one has been the capacity of our healthcare systems. "Peak pandemic mortality" includes scores of people dying from unrelated illness due to lack of care. Does anyone truly think its acceptable to let people die in ambulances outside of hospitals because a highly contagious disease filled all the hospital beds and medical staff is too fatigued to work? Maybe people with a political axe to grind pretend to think that.

I think the real problem is that in most countries the healthcare system was "optimized" to such extent that even seasonal flu was almost clogging it every year. And now SURPRISE, any disease, even a tad bit more deadly and contagious than the seasonal flu would make it collapse. TOTALLY UNEXPECTED.

As always, the standard gimmick of neoliberalism is to pin the blame for the collateral damage of its policies on the relatively powerless people who refuse its self-serving "solutions."

Which non-“neoliberal” (whatever that means) country had plenty excess hospital capacity to handle peak Covid case counts?

Cuba?

We've banned this account for using HN primarily for ideological battle. It also appears to be a single-purpose account, which goes against the intended spirit the site (curiosity), and therefore is not allowed here.

Would you please not create accounts to break HN's rules with? If you don't want to be banned on HN, you can email us at hn@ycombinator.com and give us reason to believe that you'll use the site as intended in the future.

https://news.ycombinator.com/newsguidelines.html

No, lots of people do actually think that, but we believe that three main methods can be employed to mitigate this:

1. aggressive triage based on chances and QALY remaining

2. increased healthcare funding

3. voluntary isolation of individuals who see lockdown as being preferable to their personal coronavirus risk

Will it result in more deaths than February 2020? Sure. But we don't have that choice because sars2 exists now.

We think it's better to ration healthcare and therefore doom an unlucky minority, versus rationing life itself for everyone (via lockdowns and restrictions) and slow killing everyone.

As far as I can tell, most of the lockdown debate centres around an erroneous idea that we can just do X, Y, Z, and then immunosuppressed Harriet can rejoin the world and avoid contracting coronavirus.

But she just can't. Even the original strain would have eventually infected her with high probability unless we continued to cycle lockdowns or she voluntarily isolated.

> Does anyone truly think its acceptable to let people die in ambulances outside of hospitals because a highly contagious disease filled all the hospital beds and medical staff is too fatigued to work? Maybe people with a political axe to grind pretend to think that.

Given widespread availability of vaccines, I think it is acceptable to turn away any non vaccinated people without medical exemptions to preserve hospital capacity.

Will it be you turning these people away?

Always puzzles me to see people suggesting all these “just let them die” silver bullet algorithms.

It wouldn't be explicit turning away, but if your in a triage situation, most doctors and medical systems will focus on the most time serious and the people they are most able to save if they have limited capacity. And if your not vaccinated, the ability to save you will be less than the vaccinated and the people with other acute medical issues that are not COVID. That is what will happen in practice in such a regime.

> And if your not vaccinated, the ability to save you will be less than the vaccinated

Is there any evidence that this is true at the point of presenting with equal acute symptoms? Sure, your symptoms are likely to be less acute if you are vaccinated, but that's not the issue, the issue is response to treatment given similar symptoms.

In the US, hospitals aren't legally allowed to turn away non vaccinated people due to EMTALA. Also note that there is no 100% reliable way for hospitals to determine a particular patient's vaccination status.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMT...

Regardless of the legality of turning people away the commenter you’re responding to sounds pretty heartless.

Yep. We really need to stop this "us versus them" mentality. This looks like a war between the vaccinated and the unvaccinated, while the "people above" are doing their own greedy thing and laughing at us fighting each other.

I wish I could tell people that:

The vaccine does not prevent transmission as much as you think it does.

You do not spread as easily as you think you do, and you can personally attempt to reduce it even further.

You are vaccinated, and if it is indeed effective and you believe in it, you should not be worried much.

The unvaccinated are people too who probably do not have any malicious intent, and most likely pose little, or no risk to you.

Merry Christmas!

When you say "unvaccinated" here are you using the currently-accepted official definition which includes people that have received a COVID-19 EUA vaccination/booster within the last 14 days? Do you think that this would be likely to make people that were were concerned about side-effects from the vaccines more or less likely to get vaccinated?

Would you also be of the opinion that, due to the widespread availability of healthy food options and Richard Simmons exercise videos it's acceptable to turn away the overweight to preserve hospital capacity?

> Given widespread availability of vaccines, I think it is acceptable to turn away any non vaccinated people without medical exemptions to preserve hospital capacity.

Person A is "fully vaccinated", last dose five months ago, hasn't taken a Covid test since.

Person B is unvaccinated, but had a PCR test yesterday and is negative for Covid19.

Let's say you're clinically vulnerable, which of A or B would you rather sit next to during a meal?

That's not how healthcare works, besides that it puts the rest of the population at risk. This isn't the best comment in this thread by a long shot.

From examining Swedish death spike data, you can see that viruses like COVID occur about once a decade, the last being Swine Flu in 2009:

https://swprs.org/wp-content/uploads/2020/10/sweden-monthly-...

Its just that, using Swedish data again, Western societies are significantly more aged: eg. there 120,000 80-84 year old men (prime COVID death territory) in 2020, vs only 101,000 in 2009. Its similar in many other Western countries: about 20% more elderly people, in absolute numbers.

As such, the 'same' types of respiratory viruses will simply kill more people.

The decisions is thus a social and political one: do we lockdown and force 6-monthly vaccinations on everyone, based on elderly deaths that will occur anyway simply due to the baby boomer cohort entering their twilight years?

I think we need to just get more efficient at end-of-life care, focusing on simpler treatments and comfort, as well as euthanasia-on-demand for anyone over age 75.

I think taking a shot every six month is totally worth it if that will let your grandma live two years longer.

IMO casual masking (stores, airplanes, etc) and a shot every 6 months isn't the annoying part about covid, it's the economic damage of lockdowns, school closures, social gatherings missed, extreme isolation of the vulnerable, travel not happening and the supply chain logjams it has been creating everywhere as a result. You can't go to an office consistently and have face to face lunches coworkers with as a result.

I agree. However, the currently existing vaccines don’t seem to do anything at all to stop the spread, so your biannual vaccination does not help grandma much.

How are you estimating what the spread would have been in the absence of vaccination to draw that conclusion?

"Our vaccines are working exceptionally well. They continue to work well for Delta with regard to severe illness and death - they prevent it, but what they can't do anymore is prevent transmission."

CDC Director Rochelle Walensky

It would seem fairly important to actually ask the grandmas what they think about this, rather than decide on their behalf.

The four elderly members of our immediate family are all fairly adamant that the young have suffered enough, and "hell, yes" they want to see their grandkids, and no, they aren't asking about vaccinations and negative tests.

I'm minded to respect their opinions.

Yes, and we don't ask them either if they'd feel better if we took them, we just do it for them, it's understood.

Capacity of healthcare systems shouldn’t be the primary concern, preventative immune defense and avoiding hospitalization in the first place should be.

> The primary concern from day one has been the capacity of our healthcare systems.

This is clearly not the case for the vast swaths of our public health institutions who have supported and eagerly carried out mass terminations of healthcare workers who refuse the Covid vaccines.

I agree that in most countries this is the underlying disagreement. I wonder if we thought this through at a global community though.

Imagine if China didn’t or couldn’t pursue a zero covid policy. What happens when the world’s manufacturer closes? We’ve already seen huge supply chain issues.

It's not the case that they would need to close.

Across the Western world the vast majority of the economic and social issues have been caused by legalities rather than pandemic reality.

For example, for better or worse, if the 10 day isolation and testing regime did not exist in the UK then staff shortages would not either. People aren't actually getting ill en masse - we've just recalibrated what ill means.

> staff shortages would not either

That's just hilarious.

There are so many reasons for staff shortages in the UK right now. Covid isn't even the main one.

>What a stroke of luck that we are here vs a more infectious strain of Delta or some other nightmare that would keep this rolling.

How do we know we won't end up with that? Omicron evolved from Beta, which had pretty well disappeared when Omicron sprung up.

The better omicron is at spreading the more people it will confer natural / hybrid immunity to, reducing the dangers of a future variant.

Hopefully... the history of diseases before vaccines (polio, measles, smallpox, black plague, etc) doesn't exactly fill me with a lot of hope for it just becoming less deadly naturally, even if there are examples (Spanish flu) where they have.

What are the histories of the other coronaviruses? And would those histories be more relevant than histories of non coronaviruses?

Another coronavirus probably caused a worldwide pandemic starting in 1889. It killed a lot of people, but the survivors gained natural immunity which gave them significant protection against symptomatic reinfections. The same virus HCoV-OC43 is still endemic today. This seems relevant to the current pandemic.

https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/175...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252012/

I understand this is a reoccurring theme throughout history that lead to most of the endemic coronaviruses today. Omicron is truly fantastic; for example look at Ontario’s case count vs ICU count. Omicron has completely decoupled those graphs.

It's not really clear whether that is because it is less severe or if it is because there are lots more breakthrough infections.

(but a larger number of mild breakthrough infections is not itself terrible news either as the mildness indicates a population becoming more resilient against the virus)

It’s perfectly clear, across the world vaccinated or unvaccinated hospitalizations and severities are reduced. South Africa on one extreme and New South Wales on the other. Ontario a textbook example of a first world society’s expectation vis a vis vaccination, age curves, and severity.

'The evidence 1889-1890 outbreak was caused by a coronavirus has been referred to as "weak" and "conjectural" in an analysis of the literature'

Seems this theory has only gained traction in the last 2 years.

Looking into it further, case fatality rate of during the 1889-90 outbreak seemed to be 0.1-0.28, much lower than Covid-19 has been.

Our data on the 1889-90 pandemic is pretty thin. We don't have any reliable records on deaths in poorer countries so the error bars are quite wide.

A lower infection fatality rate in that previous pandemic is not at all surprising. Back in 1889 elderly people made up a much lower fraction of the population. And there was a lower rate of co-morbid conditions such as obesity, diabetes, and hypertension.

Sure, there have been a lot of Flu pandemics with lower case fatality rates as well. Prior to this pandemic, they had actually narrowed down the flu subtype:

"the reanalysis of seroarcheological data suggested Influenza A subtype H3 (possibly the H3N8 subtype) as a more likely cause for the 1889–1890 pandemic"

There was no thoughts that it was Coronavirus related before this pandemic.

edit: Interestingly though, the 1889-90 pandemic was thought to have originated in Bukhara, part of the Russian empire at the time, which has been historically a cattle raising area. H3N8 is Equine influenza virus, where as HCoV-OC43 was a Bovine coronavirus.

Common cold has a variety of coronaviruses

Do you have sources for that? Because isn’t that exactly what has not happened with all the existing variants?

> a more infectious strain of Delta

What? Omicron is a more infectious version of Delta.

Omicron causes the same number of deaths and hospitalisations and long covid as delta. It just also infects a lot more people more easily, and those people are at low risk and push the CFR down.

As the data becomes more available from South Africa, the UK, and Denmark, it’s starting to look like Omicron is a more infectious version of the wild type, maybe 40% less virulent than Delta, at least in terms of putting people in the hospital.

There’s still not enough data to conclude about mortality.

The good news is that prior immunity seems to confer a large degree of protection from severe illness still

https://www.lesswrong.com/posts/YBB9yZNJuz5j8hLdP/omicron-po...

https://twitter.com/dgurdasani1/status/1475061938010865665?s...

> Your risk of getting hospitalised with SARS-CoV-2 (any variant) depends on two things? 1. how likely are you to get infected? 2. what is your chance of getting hospitalised once infected

> In simple terms, because omicron can escape immunity from past infections and vaccines, your protection against infection against omicron is vastly lower than with delta. This means risk of 1. is vastly increased- as you're less protected & also v. high background transmission.

Omicron isn't a version of Delta.

There's no moving past covid until an exit plan is announced. If there isn't one, the only hope of moving past covid is resistance. If people stopped rushing for the latest vaccine, stopped getting tested regularly, even without symptoms, we would be past covid already.

You’re going to have to lay down the logic behind this one for me. I am not getting it.

The gist OP is getting at, though not put so eloquently, is that covid is endemic and there will continue to be deaths, even in a world with 100% vaccinated and boosted people.

So covid being "over" is really a state of mind/choice of when to accept that it's endemic and drop the hysterics/restrictions.

Omicron should be cheered as an effectively natural vaccine that looks to quickly end the worst of covid, yet media continues to fear monger about case counts, by and large. I am seeing some articles speaking to it as beneficial though.

The fear a lot of people have over covid is totally out of proportion with the actual data, and media by and large continues to stoke these fears.

That was elegant and much more insightful.

> Omicron should be cheered as an effectively natural vaccine that looks to quickly end the worst of covid

In the medium term yes; in the short term, with millions of unvaccinated people and a very fast exponential growth, it still has potential to overflow healthcare.

I dunno, people working in the health care system are getting burned out and quitting in droves. I'd kind of like there to be doctors and nurses there to take care of me if I need to go to the hospital for whatever reason. Your state of mind seems irrelevant to this.

Well, it seems hospital systems are more than happy to fire their staff if they aren't vaccinated, so there must not be much of a shortage.

And the point is Omicron is largely benign, which is reflected in data at this point.

There's no need for 95%+ of people who catch it to go to the hospital. Look at the South African data... Hospitalizations are order of magnitude below cases with omicron, vs Delta.

But single variable policy proponents, like you appear to be, don't care about the facts or the science, just number of cases.

Personally I'd rather advocate for policy that looks at the actual data in regards to health outcomes, as well as other variables that take into account second order effects of any policy. That's called following the science.

Covid extremists are the religious ones at this point. I'm glad society is finally rejecting their failed views and authoritarian virtue signaling. Of which has made 0 difference state by state in the US, by and large. Check FL or TX vs CA or NY (e.g. the data, the science).

We're living in a bizarro world where these people think they have the scientific high ground, but are actually following mass group think/bubble mentality and ignoring anything beyond case counts.

I don’t know where you are, or what policies they are following. Where I live, the stated policy is to keep hospitals from being overwhelmed, which seems reasonable. I really can’t comment on the rest of your post.

If infection grants more generalized immunity, doesn’t that mean a tailored vaccine would do the same?

Possibly yes.

https://www.defenseone.com/technology/2021/12/us-army-create...

> Good vaccines + mild severity illness are basically the best case.

If it was a common cold or a flu ? Maybe.

> “Although COVID-19 has been described as a respiratory syndrome, evidence supports the involvement of multiple organ systems, with fibrosis, and inflammation in the lung, heart, kidneys, central nervous system (CNS), liver, adrenal glands, bone marrow, lymph nodes, and gastrointestinal tract. SARS-CoV-2 infection has also been associated with serious thrombotic complications, including strokes, pulmonary embolism, and cardiac injury.”

https://www.wsws.org/en/articles/2021/11/10/leon-n10.htm

Endemic we want ? Then we want yearly (or 6months it seems) vaccines. And masks. And ventilation.

Reinfections will get more severe with age once vaccine or infection elicited sera wanes.

> What a stroke of luck that we are here vs a more infectious strain of Delta or some other nightmare that would keep this rolling.

Omicron being the new kid on the block doesn't mean another more dangerous variant isn't building itself up in a body somewhere.

Maybe two years into the pandemic is not enough to let the reality sink in that we will never come back to before. Maybe we need ten years but by then we'll all be used to the new normal anyway. “Learn to live with the virus”, they said. Indeed.

I'm not sure why we wouldn't be able to go back to normal, and taking a stance that we never will strikes me as somewhat defeatist.

I'm more of an optimist. Having a small percentage of the population that's at greater risk of serious implications from infection (respiratory or otherwise) is something we've learned to live with before (see: the flu) without masks, mandates, or dramatically rearranging the way we live.

> I'm not sure why we wouldn't be able to go back to normal,

There are no path back to normal unless the virus disappears. We have vaccines that work for a limited time, we'll soon have pills@home. It will still not be `back to normal`.

> and taking a stance that we never will strikes me as somewhat defeatist.

We'll also never have FTL spaceships or teleportation star trek style.

> I'm more of an optimist. Having a small percentage of the population that's at greater risk of serious implications from infection (respiratory or otherwise) is something we've learned to live with before (see: the flu) without masks, mandates, or dramatically rearranging the way we live.

Covid is not the flu. Hoping it'll magically turn into a flu or that we can manage it like a flu is ignoring the reality currently unfolding.

40 years later and we still need condoms. We are not back to sex as it was in the 70's. Generations of teenagers have had their first time with a condom. This is what is normal now.

> We have vaccines that work for a limited time

This is flat out FALSE.

There are two different possible endpoints for vaccine efficacy. One is efficacy against infection, one is efficacy against severe disease and death.

Efficacy against infection is very difficult because it is mediated by circulating neutralizing antibodies. It is just difficult to get sterilizing immunity against a muscosally invading respiratory virus in the first place. And then neutralizing antibodies wane over time.

Efficacy against severe disease is almost certainly going to be more durable because it is mediated by memory T-cell and B-cells having been already formed due to prior exposure to a related antigen.

Unfortunately the result of the phase 3 trails on the mRNA vaccines were way too good on VE against infection and it was sold as being 90% effective and as that waned people declared them to be ineffective. That should never have been the yardstick though. And in fact before those results were announced Fauci was trying to condition the population to expecting a 50% VE against infection number as being good enough. The 90% efficacy results just blew that all away though.

What gets lost is that they're still >90% effective against severe disease/death and nothing has changed there. And you can see it in the headlines with Omicron. It is almost still certainly as intrinsically virulent as D614G, if not actually more intrinsically virulent than Delta itself, but hospitalization rates and death rates are plummeting. That is the human humoral immune system working.

I'd argue everyone should probably get boosted because of the maturation in immune response which is measured against Omicron. Once we're done with that though I fully expect that people can stop getting any future vaccines and they'll just get a cold next time they catch SARS-CoV-2 until they wind up being over 65 or a cancer patient or something -- just like every other ILI-causing virus.

(Or you know keep getting boosters like you get flu shots -- I'm honestly not sure what I'll do about it, but its going to look a whole lot more like yearly flu shots than the world-record mass immunization campaign we've seen up until now).

The mutation rate and the number of infected people is what is driving this, as long as we have this many people infected at the same time mutations will be hitting us to the tune of a new one every four to five months or so.

The vaccines are quite effective against a variant that is no longer in play and hasn't been for quite a while.

The vaccines are quite effective against severe disease and death from Omicron due to somatic hypermutation.

The people who are vaccinated against original Wuhan-Hu-1 make memory B-cells against Omicron as well. Even after boosting with Wuhan-Hu-1 spike antigen the neutralization titers against Omicron in the blood are high, even after all the spike mutations.

And again, there are around a thousand T-cell epitopes to spike and around 80% of them are conserved with Omicron, and there is very, very good reason to think that number doesn't ever get close to zero.

Your naive model of how the immune system works like a key and lock where if you change one of the pins then the vaccine stops working entirely is deeply flawed.

The human immune system is the end product of a hundreds of millions of years arms race between organisms and pathogens, and this isn't its first trip around the block with a pandemic virus that mutates. The whole way the humoral/memory immune system works is designed to deal with mutations.

> Your naive model of how the immune system works like a key and lock where if you change one of the pins then the vaccine stops working entirely is deeply flawed.

That isn't fair on your part.

The bit that you picked out is factually correct. It is also correct that the vaccines + previous immunity will give an improved chance at a positive outcome.

But it's not the same as it was for the first wave, the vaccines were very specifically developed and tested in that setting and every future mutation had a worse response, due to attenuation due to time and mismatch with the target. This is not a 'lock that doesn't fit the key', it is a vaccine that simply works less well on things that it wasn't very specifically designed for, and that is totally expected. The degree to which the difference materializes changes with time and further mutations, with each of those contributing some element to the final efficacy calculation. How much is impossible to tell ahead of time.

> But it's not the same as it was for the first wave, the vaccines were very specifically developed and tested in that setting and every future mutation had a worse response, due to attenuation due to time and mismatch with the target.

Again this is just wrong.

If you've been vaccinated then you have B-cells that match Omicron, even though you weren't vaccinated with Omicron's spike.

Maybe my analogy didn't work, but you have a flawed understanding of the immune system.

As a concrete and well-studied example, the H1N1 strain of influenza stopped spreading in the human race in 1957. Nobody after that was exposed to it, everyone born before that was exposed going back to 1918. It was displaced by the H2N2 pandemic in 1957. It mutated in pigs for 50 years. Then it underwent triple recombination in 2009 and jumped back to humans -- with an H1 gene that was derived from the human strain and an avian N1 gene that hadn't ever been seen before.

The impact of that 2009 pandemic was considerably blunted by human cross reactive T-cell immunity in the older population who had seen the long-lost relative of H1 protein back before 1957. That 50 year old "pre-vaccination" did not wane and was cross reactive after 50 years of mutation and adaptation in pigs, and was still effective enough to protect against severe disease and death.

Nobody had immunity against infection of course, but that cross reactive immunity to H1N1 in all the older people helped to dramatically blunt the impact of the 2009 pandemic to the point where the human impact was lower than normal human influenza.

Cross-reactive B-cells and T-cells to future variants to SARS-CoV-2 are going to work the same way. Most of the epitopes will still be conserved and the T-cell reaction will be able to clear the disease and protect against severe disease and death.

You don't need reimmunization every time the virus mutates slightly, that would be poor design. The humoral immune system works closer to a Bayesian spam filter (arguably better).

That helps, thank you for taking the time to explain this.

Do you believe that there will be vaccine 'updates' (which especially for Moderna they were talking about from very early on), or is it that this mechanism is strong enough that until there is a real immune breakout we won't need them?

> The impact of that 2009 pandemic was considerably blunted by human cross reactive T-cell immunity in the older population who had seen the long-lost relative of H1 protein back before 1957. That 50 year old "pre-vaccination" did not wane and was cross reactive after 50 years of mutation and adaptation in pigs, and was still effective enough to protect against severe disease and death.

Wait, didn't the 57's H1N1 strain reappeared unchanged in the 70's and didn't a vaccination campaign happen then ? (I seem to remember it's mostly likely an unintentional lab leak, which would explain it didn't change in 25 years).

> > We have vaccines that work for a limited time

> This is flat out FALSE.

Allow me to rephrase: We have vaccines that protect us from severe diseases and hospitalizations (what you wrote after and which I mostly agree with) but its efficacy for milder symptoms wane after some months. And mild symptoms that translates into perma brain fog and other conditions is not something I want to take my chance with.

Most likely, if the best case scenario happens, I'd still take they yearly covid shot.

> but hospitalization rates and death rates are plummeting. That is the human humoral immune system working.

Not what's happening in countries around me. UK (17%), France (175%), Germany, Finland are seeing hospitalizations rise up again.

It remains to be seen if this is the last wave and you are right or if it's now the new normal.

Whatever the cause, considering the damages a mild covid can have, this is not a virus you want to wreak havoc on your system too many times in your life. Killer t-cells are fun but you don't want your immune system in perpetual immune response mode.

edit: regarding protection against severe form (we should be talking of consequences rather than form): vaccines had a ~95-97% efficacy. With Omicron, even tough it stays high, it doesn't stay that high. What worries me is that we are talking yearly flu shots but covid will likely require 6 months booster shots if you want to keep riding the vaccine for protection against all form/consequences.

Reasonable people can disagree here, and I'm not convinced by the case you've put up. I remain a realistic optimist that this will become endemic and we'll put up with the risk as we have when the flu became endemic.

Of course the vaccine will help tremendously (relative to, e.g., retroviral STDs), as will the constant pressure for people to return to their normal lives.

The virus will never disappear. We can go back to normal as soon as people decide to accept the risk. In fact that has already happened in several states.

I think we'll go back to normal when the risk that hospitals will get overwhelmed wanes.

I do believe that too because it seems to be the only and main factor that motivates public authorities decision and plans against covid.

And it frightens me a bit because it shows they do not care about our well-being, public hospitals saturated policy has the nice side effect of not killing us but that's it.

We clearly do not have a choice about endemicity. It will be endemic given that it very clearly evolves antigenically to achieve escape from waning neutralizing antibodies and it has animal reservoirs all over the place, including white tailed deer. It was pretty easy to see eradication was off the table in summer of 2020. At this point is kind of fucking stupid to talk about it. Even if you could snap your fingers and make it go away in humans it would just spill back from animal reservoirs. You'd have to eradicate all the deer, mink and every species you don't know about that has been infected with it. At this point it isn't humanly possible.

We won't be taking precautions forever though. Reinfection and vaccine breaktrhoughs will be mild. T-cells and B-cells don't wane the same way Nabs does and protection against severe disease and hospitalization will be durable.

There will be loss of protection as you age, but we already have that with all the ILI illnesses and viruses that lead to pneumonia and death in old people.

There won't be some worse virus that somehow punches through T-cells, that's getting into the realm of science fiction. While there's about 20 epitopes on spike that need to change for the virus to escape Nabs there's a few thousand T-cell epitopes that would need to change and many of those will be concentrated in conserved regions of the genome that can't mutate or the virus stops working.

And once you have a mature B-cell response your body can quickly respond with NAbs to prevent the viremia that leads to multiorgan infection. In fact with vaccine boosters it seems we may already have this level of protection, even against Omicron, and the jury is of course still out as to how durable that is and it may be more durable than initial shots were.

Once the virus completes the vaccination campaign the hard way then the pandemic is over and the human race has a new cold/flu virus, and we should treat it like a cold/flu virus. It is also unlikely that we'll continue boosting with vaccines. We're unlikely to get enough people boosting with vaccines every year to make a dent in spread and boosting will mostly be confined to people over 65 and those who are immune compromised. We won't ever boost our way to zero virus.

The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right. That doesn't fit neatly into the way that we carve up our society into Team Blue / Team Red though so its difficult for a lot of people to understand.

> The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right.

This is quite infuriating. We had a pretty good window when we could have done something about this and we totally squandered it.

> You'd have to eradicate all the deer, mink and every species you don't know about that has been infected with it

How much transfer is there in animal populations? Do we have any idea of the size of the populations affected? How does this translate to the original spillover event? After all, there must have been an animal reservoir prior to someone in Wuhan becoming the index patient.

We do similar things for various other animal borne plagues with varying degrees of success but there is more than one example of a successful eradication.

> This is quite infuriating. We had a pretty good window when we could have done something about this and we totally squandered it.

I honestly doubt it. We could have blunted the impact but it was out of Wuhan and in Italy before any doctors in Wuhan even knew about it or suspected. We were never going to lock down the entire world the way that China locked down. Even if the Western world did, then what would your plan be for Africa? What about the slums of Bangladesh and other areas in SE Asia?

We fucked it all up and a lot of people died who didn't need to, but I doubt the virus was ever stoppable starting from the first day it was even suspected.

> How much transfer is there in animal populations? Do we have any idea of the size of the populations affected?

Estimates are that around 1/3rd of the white tailed deer are infected and it readily transmits from deer to deer. According to the CDC:

> Recent experimental research shows that many mammals, including cats, dogs, bank voles, ferrets, fruit bats, hamsters, mink, pigs, rabbits, racoon dogs, tree shrews, and white-tailed deer can be infected with the virus. Cats, ferrets, fruit bats, hamsters, racoon dogs, and white-tailed deer can also spread the infection to other animals of the same species in laboratory settings.

Deer so far are the only known species where it is spreading epidemically in them in the wild, but there's likely to be others. We probably don't even know exhaustively all the species in the world that it might infect through having similar enough ACE-2 receptors, and you can't miss one.

And we've never eradicated a virus that has an animal reservoir. Successful eradication is only something you can really attempt if you don't have an animal reservoir (or you need to do something about the reservoir like wiping out the mosquitoes that feed on humans).

> I honestly doubt it. We could have blunted the impact but it was out of Wuhan and in Italy before any doctors in Wuhan even knew about it or suspected. We were never going to lock down the entire world the way that China locked down.

Ok, I accept that.

The problem with COVID-19 as far as I understand it compared to SARS-CoV is that with COVID-19 you first become contagious and then you start showing symptoms. That tiny little difference, first the danger, then the warning instead of the other way around is why it is going to be impossible to eradicate it, and in fact why this was likely impossible from the beginning.

But we could have massively slowed down the initial transmission (at severe economic cost but probably not nearly as bad as what we have to contend with now), buying time to get those vaccines developed and out there resulting in a much smaller first wave and subsequently fewer lives lost and people severely ill.

> Even if the Western world did, then what would your plan be for Africa? What about the slums of Bangladesh and other areas in SE Asia?

Yes, this was a global problem from day #1. But that is something that we don't seem to universally recognize even today.

> Deer so far are the only known species where it is spreading epidemically in them in the wild, but there's likely to be others.

> We probably don't even know exhaustively all the species in the world that it might infect through having similar enough ACE-2 receptors, and you can't miss one.

The parallels with computer security are interesting here. Indeed, a single species missed and it would be matter of time before the whole circus would start over again. But at this point in time I do not believe there is a viable path to controlling the virus in the human population.

> And we've never eradicated a virus that has an animal reservoir.

Ok.

> The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right. That doesn't fit neatly into the way that we carve up our society into Team Blue / Team Red though so its difficult for a lot of people to understand.

While I do agree (of course) with what you say about how the immune system cope with covid I still do disagree that those people will be right. Covid is still not a flu and unless the next variant loses its ability to wreak havoc on multiple organs it won't ever be like the flu.

I was not much into team blue/team red but last time I said to an antivax in my family that I was still wearing a mask in public transport despite being vaccinated and she told me she wished for me to get covid so I would stop be scared of it so much I decided to drop my empathy level a bit.

Omicron's lower hospitalization rate is likely just due to vaccination and recovery from infection with Delta. Delta was transmissible enough to complete the vaccination program.

Given that Omicron has higher viral loads, shorter serial interval and shorter incubation period than Delta, it is much more likely that Omicron is more intrinsically virulent as well and would be worse if you dropped it on a totally naive population in the summer of 2019. The current population, however, is longer immunologically naive, and I think that researchers are underestimating the existing seroprevalence.

At the same time if there's still pockets of entirely unexposed/unvaccinated people out there in rural areas or something, Omicron will likely find them since it seems to largely ignore unboosted Nabs to prior infection or vaccination. Kids in colleges will be taking Omicron home for Christmas to rural families right about now and a few weeks from now we should find out how many seronegative people are left.

If it Omicron fizzles though it is going to just be that Delta didn't leave anyone immune naive in its wake.

Another factor (though I'm not sure how large that factor is) is that a chunk of the susceptible population isn't around any more.

Literal survivorship bias.

There may also be a hard-to-infect/hard-to-seroconvert portion of the population left that could practically walk unmasked through a COVID ward in a hospital and not get infected. If they exist then the seronegative proportion of the population will start to be composed mostly of them over time through "purifying selection".

This is also why I'm somewhat skeptical about all the vaccine efficacy numbers that studies are throwing around. I don't think an adequate control group exists any more.

That's a good point: having a control group is pretty much a must to be able to get reliable numbers on efficacy and any future vaccine or medicine is going to have to some extent work with corrupted data from day #1.

It was shown in vitro to be 10x less effective at infecting lung cells vs epithelial cells (mucosal membranes). There’s more than prior immunity at play here. https://wap.business-standard.com/article-amp/current-affair...

A bunch of kids are ending up in the hospitals at a higher rate than before so you may be right.

It will be Omicron for a short period of time. Then it would split into different variants. So, don't keep your hopes up!

We're going to look back on our treatment of children these past 2 years as one of the greatest blunders in the history of public health policy.

We sacrificed the mental health of the young for the physical health of the old.

But hey, grandma gets to live another year now.

Who cares if the poor family never recovers after financial crisis.

Now inverse that statement and see where it takes you, and what it tells about you as a human being.

Downvoters: you want your elders (and not just them) to die and countless others to suffer long-term consequences of a disease not yet fully understood just to earn some money right now and keep the endless rat race going as it is; you make me sick.

You present a false choice. No disease will ever be fully understood; there is always more to learn. We can't keep restrictions in place indefinitely while waiting for more information.

And you make me sick with your ignorant, shortsighted vision of the problem.

Reducing economic crisis to "just to earn some money right now" is borderline idiotic.

I'm waiting for a time when we'll start investigating economic and mental impact on different layers of society.

Don't we accept that our children will die and countless others will suffer long-term consequences every time we take a car instead of walking? As long as the suffering is sufficiently vague and indirect (such as with air pollution and global warming) people choose to sacrifice themselves and others all the time. Covid is new, but this dilemma is old as time.

Whether you like it or not, participating in the endless rat race is how some people are able to (sometimes barely) afford to feed their children, or pay for medical treatment. Do poor people make you sick? How about those who would choose quality of life over a little life expectancy?

Some elders would rather see and hug their (grand-)children more often than live another two years in social isolation. Do you find such elders disgusting as well?

I would suffer financially greatly if it brought back my grandmother, she passed from COVID December of last year. I wish she had another year. She would have had a chance to meet her great grandson. But sure, complain about the numbers in your bank account some more.

Edit after being downvoted: Sure, downvote me and don’t respond over my dead grandmother, coward.

I am sure anyone can recover from financial troubles. It is possible.. The other one? Not so much...

Yep! Anyone can pull themselves by their bootstraps.

Yes.

That sounds like a good reason to re-think ouf current medical and insurance industry, not a good reason to throw grandma to the wolves.

Otherwise, the inevitable end of this logic is folks committing plausibly deniable suicide to get an insurance payout.

Pandemics aren't easy

My kids' mental health would be pretty heavily impacted by the death of their grandparents.

A pretty large number of kids are raised by "the old", too. https://www.prb.org/resources/more-u-s-children-raised-by-gr...

Let's not forget that 40% of adults in the US are obese and some immuno-compromised. As a parent who falls into one of those groups I hope we can find a path forward that balances personal liberty and our health.

And here's the impact of how we've treated children during the pandemic:

>The pandemic then brought on physical isolation, ongoing uncertainty, fear and grief. Centers for Disease Control and Prevention researchers quantified that toll in several reports. They found between March and October 2020, emergency department visits for mental health emergencies rose by 24% for children ages 5-11 years and 31% for children ages 12-17 years. In addition, emergency department visits for suspected suicide attempts increased nearly 51% among girls ages 12-17 years in early 2021 compared to the same period in 2019.[0]

>A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n = 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents.[1]

>Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.[1]

Experts think this is just the tip of the iceberg for issues that will affect us for decades.

0. https://publications.aap.org/aapnews/news/17718/AAP-AACAP-CH... 1. https://www.sciencedirect.com/science/article/pii/S089085672...

Zero of those mental health emergencies were due to the death of a loved one, right? It's all because of masks in schools and whatnot?

It seems like you're skimming the content because you have a pre-conceived notion of what you want to be true. Both links explicitly mention social isolation and loneliness as being driving forces in the negative mental health impacts.

your kids mental health might also be impacted by seeing a horror movie… that does not compare to being locked inside and unable to socialize for 2 years

Are you comparing seeing a horror movie to people’s close relatives dying… ?

Strawman fallacy.

appeal to incredulity. bravo!

> that does not compare to being locked inside and unable to socialize for 2 years

Good thing my kids haven't been subjected to that, despite being in a blue area of a blue state (New York).

Being angry about imaginary restrictions is silly. There's nowhere in the world kids have been "locked inside" for two years.

The effects of the pandemic on children has definitely been variable. Higher income kids going to private schools are back in school by 6 months, while lower income kid's public schools cannot even get zoom classes organized or access to such classes (laptops, etc) for over a year in some places. Average that out and the overall net effect has probably not been great.

Demand for mental health care during the pandemic has boomed, and the isolation of lockdown and all the other stresses are directly correlated to that.

I had great-grandparents and grandparents die as a kid. It's probably happened to most people.

> My kids' mental health would be pretty heavily impacted by the death of their grandparents.

Hopefully that's not something you could spare them with.

Learning to over come loss is something people have always had to deal with. Forced isolation is not.

Any culture with nasty winters has dealt with months worth of "forced isolation" for millennia. No FaceTime calls, either.

They also dealt with death from infection, commonplace wife beating, lack of running water, all sorts of other things that people these days don't just bend over and take without protest.

You can't just plop people down in a situation that's analogous to something in the past and say "just deal, your ancestors did". Well you can but they'll probable just deal with you.

I live in a Calgary, which has some of the worst winters on Earth. People always gathered during winter. Yea, they didn't do it daily but they did it as often as possible. Precisely because social isolation is literally the worst possible punishment for humans.

Why do you think northern countries all celebrate Christmas?

> My kids' mental health would be pretty heavily impacted by the death of their grandparents.

Yes, because without covid their grandparents will live forever.

You are conflating the emotion of grief with mental disorders.

It's pretty common nowadays, I find it quite strange.

My grandfather died when I was younger and it sucked. I still miss him.

But I could go to his funeral and hang out with my friends in the bar, go on holiday, study hard at University, etc, employ all of the normal time tested coping mechanisms.

Coronavirus restrictions deliberately took and removed almost everything it means to be human from people.

Sitting inside and only interacting with the world through a screen is obviously hilariously unhealthy.

> Coronavirus restrictions deliberately took and removed almost everything it means to be human from people.

Can you clarify which restriction regime you're referring to?

I've got relatives in Australia, and I live in New York state; both are on the heavier restrictions side, and the idea of describing our lives as having "removed almost everything it means to be human" is baffling to me.

We had a consecutive six months of it being literally illegal to visit family in the UK.

My job was banned by the Government and hasn't recovered.

I have _still_ not been able to practice many of my hobbies because the legal framework has made it impossible to plan forward more than a week or so.

Is it a gulag? No. Is it worth it? Worth what? Coronavirus is a 1% IFR disease, lower with vaccines. Boring.

Extraordinary claims require extraordinary evidence. Where's the evidence that any public health measure adversely affecting children worked any benefit to the old?

Can you clarify more?

I'm not saying we're doing well, but the bar for "greatest blunder in the history of public health policy" is pretty low, unfortunately:

https://www.ibtimes.com/scarred-life-canadas-uprooted-indige...

> one of the greatest blunders in the history of public health policy

Is it a blunder when malice is involved?

Greed and lust for power. Doesn't need to be malice.

I always said they should've just let all kids, college kids, etc just get it super quick. Isolate the colleges, let them party etc. Massive herd immunity after 4-6 weeks and then that huge part of society is fine.

I couldn't agree more. Children trying to eat lunch outside in the cold in NYC. Children in California barred from classrooms for a year+, and soon children forced to receive one or more medicines they simply do not need.

You may want to read this:

https://www.washingtonpost.com/health/2021/12/24/omicron-chi...

Biochemist opinion: somewhat speculative, but what I take from this is that immunity in children makes them less likely than adults to shift from 'removed' to 'susceptible', in the SIR model. [1]

[1] https://en.wikipedia.org/wiki/Compartmental_models_in_epidem...

So one of the main conclusions is that SARS-CoV-2 in children produces antibody responses to all the other human coronaviruses (this happens in adults too, but the effect is stronger in children)

In the discussion section they speculate that maybe recent infection with these other coronaviruses could give some level of protection against SARS-CoV-2, and that this could possibly explain some of the unusual-ness of the age-severity relationship, I.e. that very young children are not hit as hard by SARS-CoV-2 as by other diseases like the flu (relatively). That would be really interesting to see investigated carefully

So it's the same as other coronaviruses like HCoV-OC43. There's no vaccine available for those other ones so most of us get infected as youths, and the resulting immunity protects us as we age. But they can still be dangerous to immunologically naive older patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252012/

it's been obvious since march of last year that this was the inevitable outcome of covid, yet we've spent nearly two years hand-wringing and fearmongering over it. it's the novelty of the virus combined with the general unpreparedness of our immune systems (obesity, sickness of all sorts, and age correlate with lowered immune preparedness) that's created this wave of initial severity as the virus works it's way to a steady-state similar to other coronaviruses.

most people had, and still have, very little idea about how these things work, yet grandstand and moralize on about ineffective but distruptive remediations like masks and lockdowns that they hear about via propagandized media. even vaccines need only be seriously considered by the aforementioned immune-deficient (obese, elderly, etc.), not everyone (this article providing that evidence for children specifically).

I think it has been pretty clear for a very long time that covid is something we will all get, and that it might even become something bot unlike the seasonal flu.

The message has to my ears been "less contact = less infection = better access to healthcare for those who really need it".

What would you suggest instead? I am all for discussing the losses contra gains of lockdowns, but I dont think any options have sounded much better.

frankly, there wasn't a whole lot we could do to alter the trajectory we were on. even a month(s)-long, wuhan-style lockdown could only temporarily arrest infection rates, unless the whole world literally did it together. even then, reintroduction via animal reservoirs would be a significant threat. that's what we should have come to grips with early on, accepting that we are not the masters of even our own little earth out of the vast universe.

regarding "= better access to healthcare for those who really need it", that was entirely a political and economic choice to focus primarily on profit over critical care services and availability (not just the past 2 years, but decades). even so, hospitals aren't overflowing, as we keep hearing on the news, except in short-lived, isolated cases. 'exponential growth' was mediopolitical fearmongering, not mathematically sound modeling. if anything, that our limited hospital capacity has weathered the storm gives more hope, not less.

the biggest mistake we (that is, our various levels of government) made was not hyperfocusing on the immune deficient, and only the immune deficient (obese, chronically ill, elderly, etc.). for instance, we should have locked down care facilities immediately (along with care staff, perhaps 2 weeks on, 1 week off, 1 week quarantine, with generous benefits/pay). we should have enouraged physical fitness nine ways to sunday (more bikes, less cars!).

beyond that, give people timely and accurate information (as in, if it's uncertain, tell people how uncertain), encourage (don't mandate) pro-social (not self-righteous) behavior, and then ride it out. people already modulate their behavior (e.g., distancing, socializing) based on prevailing local conditions, so mask mandates and (theatrical) lockdowns really have had very marginal (and possibly no) effect on infections, hospitalizations, and death.

certainly don't shut down gyms, parks, restaurants, small businesses, offices, and the like. perhaps consider limiting venues that encourage hypersocial behavior (i.e., partying), like bars and clubs. again, we already modulate our behavior, so shutdowns likely had no or marginally small effect.

once vaccines were emergency-approved, encourage the immune deficient to take them, and allow the risk-averse to take them as well. don't mandate them for anyone, since they're non-sterilizing (and mRNA tech is new).

with that, we'd probably be right around where we are now, but without all the stress, fear, anger, and divisiveness.

Serious question: should we let this more infectious but less dangerous run its course to achieve natural immunity? What are the arguments for and against this strategy?

I know that if it is 5 times less likely to put people in hospitals but 10 times more transmissible then there will be 2 times more people in hospitals, but are there more arguments?

Yes. We should do that. We won't.

Pro: everyone is fine, the hospitals aren't overwhelmed, the anti-vaxxers will be fine along with everyone else.

Con: can't speak with disgust and disdain anymore to those who disagree with your medical opinions, or have concerns with how quickly you're forcing your experimental medications on the entire planet.

Not going to happen. I've already seen the usual suspects talking about how we need bigger, better, stronger vaccines for Omicron.

We're pretty excited by this RNA vaccine tech, and we're going to use it, no matter what happens.

There's too much money and too much political power on the pro-vax anti-immune-system side of things.

> everyone is fine

Except the people who aren't.

> the hospitals aren't overwhelmed

Except the ones that are.

> forcing your experimental medications on the entire planet

No more experimental than any other vaccine; due to how quickly COVID spread, we were able to do the same level of testing on the vaccine as for any other medication. It's as safe as anything else you take.

“No more experimental than any other vaccine”

you are creating more vaccine hesitancy by saying this

vaccine trials usually last 2 years alone from a quick glance

Because most vaccines are for diseases that aren't as prevalent in the population as COVID has been; we've had significantly more people to run the trials on!

To your first two points, you could say that before covid.

Do you have a time machine or something? You can't study long term effects just by having a bigger study.

Who's "we" and what makes you think they have any control over the matter?

Well, many governments reinstating restrictions, for one.

These work to slow the spread, which given the innocuous nature of Omicron, seem more damaging than helpful. Not that any government ever considered second order effects of these policies to begin with...

Many of these restrictions were put in place because the effects of Omicron were uncertain when they were decided. If these early results bear out, I'm sure we'll start seeing the easing of some restrictions again very quickly.

The restrictions largely don't have any effect anyway, if you compare different US state policies with health outcomes.

Especially something like a travel/flight ban, as if that can stop an exponentially spreading virus.

A travel/flight ban changes the exponent, which changes the shape and peak of the healthcare curve, buys time for gathering data, and in Omicron's case, more time to roll out an mRNA booster dose which significantly improves protection against severe symptoms compared with the 2-dose schedule.

It definitely has an effect, even if the virus is not "stopped".

If it is already widespread domestically, a travel ban isn't going to do anything.

In the US there's an important legal document that begins with "We the People".

> I know that if it is 5 times less likely to put people in hospitals but 10 times more transmissible then there will be 2 times more people in hospitals, but are there more arguments?

If it is more transmissible, people will be put into hospitals faster, and its not linear. Something that has an R of 1.1 will very slowly burn through part of the population then eventually die out as immunity reduces R just below 1.

Something that has R=11 will infect almost everyone, and very quickly, even if we halve transmission with drastic measures limiting contact etc.

Fantastic news. Actual science.

Thanks to these folk and gals, so much.

So the long Covid we’ve been afraid of for our children this whole time has actually been long term immunity? How ironic that our own push to vaccinate and save our children could put them in a worse position immunity-wise. Like rain on your wedding day.

Biochemist here: your claim that vaccination puts children in a worse position is neither supported by this paper, nor substantiated by any other data point to the best of my knowledge.

I think his point is that the immune response from the vaccine is lower than from just getting covid and the risks from getting covid for children are really low.

Still, I don't think it makes much of a difference either way, especially for kids who don't have much to fear from covid.

"immune response from the vaccine is lower than from just getting covid"

My point is that this is unsubstantiated.

And it does make a big difference, because this reduces the likelihood of children going through multiple periods of infectivity: the fewer times children are infectious to others, on average, the more herd immunity we have, collectively, against SARS-CoV-2.

I would agree with the other sibling reply that asking for citation for natural immunity vs vaccine protection is a bit like asking for a citation for claiming that frozen water floats. Sure, you could prove it but it's a well accepted understanding in epidemiology and virology. It's only lately been.... Politicized.

This is pretty close to my area of expertise, and I don't think this is a well established principle at all.

I was reading this article recently about natural vs vaccine immunity (mostly in adults I think). Didn't seem to reach any strong conclusions either way.

> “It appears from the literature that natural infection provides immunity, but that immunity is seemingly not as strong and may not be as long lasting as that provided by the vaccine...

> But not everyone agrees with this interpretation. “The data we have right now suggests that there probably isn’t a whole lot of difference” in terms of immunity to the spike protein

> Memoli highlights real world data such as the Cleveland Clinic study18 and points out that while “vaccines are focused on only that tiny portion of immunity that can be induced” by the spike, someone who has had covid-19 was exposed to the whole virus, “which would likely offer a broader based immunity” that would be more protective against variants. The laboratory study offered by the FDA22 “only has to do with very specific antibodies to a very specific region of the virus [the spike],” says Memoli. “Claiming this as data supporting that vaccines are better than natural immunity is shortsighted and demonstrates a lack of understanding of the complexity of immunity to respiratory viruses.”

https://www.bmj.com/content/374/bmj.n2101

Look into Measles vs MMR or pertussis and the pertussis vaccine

The paper itself asks the question I’ve suggested if you read between the lines: “COVID-19 vaccines are now being administered widely to adult populations and are also being delivered to children in some countries. Therefore, it is imperative to understand the profile of SARS-CoV-2-specific immune responses in children after natural infection to inform vaccination strategy.”

You can "read between the lines" many different things, none of which are said explicitly. Scientists love to be explicit whenever they can.

I don't see this as being indicative of any particular policy, but I see it as a data point which could inform decisions such as:

- whether boosters should be given to children, or whether they should be given them last in line

- whether we should allocate limited supplies to children, or to other vulnerable populations (eg.: vaccine inequity around the world)

- whether we need the same schedule for children and adults

- ...

Again, I don't think this paper pushes too hard either way on any of these types of questions, it's a data point in a sea of data.

The policy question this answers is whether to vaccinate children who have previously been infected, not whether to vaccinate children who have never been infected. The best decision for the latter group remains vaccination.

Children have nearly no risk of complications with covid vs. quite a large risk with the vaccine.

This is unequivocally incorrect.

https://stevekirsch.substack.com/p/weve-now-killed-close-to-...

That is a substantial misinterpretation of the data.

Who wants to win a million dollars? The author has a $1 million dollar offer to debate him and prove him wrong.

Let's see the escrow first. Seriously though, VAERS is not meant to be used in this way.

Let me try to describe how I understand the mechanism, I'm sure there are people on HN that would be more than happy to correct me if anything is out of whack:

- VAERS allows for the reporting of suspected side effects

- this information is then made available again to ensure transparency

- the suspicion of a side effect is not the same as an actual side effect

- an example: you get vaccinated. The next day you die of a heart attack. An entry into VAERS is made. There is now a job lined up to figure out of you actually died of a heart attack due to your vaccination or if you were going to have that heart attack anyway, in so far as this is possible.

- if it is determined that you were at substantially elevated risk of a heart attack then it is likely that there will be no further action

- If a strong link is found between the vaccination and the heart attack the case is flagged for a much more thorough review. Possibly an autopsy will be ordered or any number of other investigations to get to the bottom of it, assuming that the case is out of the ordinary enough

- finally a determination is made: either there is a link, or there isn't, and if there is then the various risk factors are adjusted.

- If a similar link is established in other cases reported through VAERS or even through similar mechanisms in other countries then this can result in a warning, a change in administration (dose, frequency, certain groups within the population) or in an extreme case the vaccine can be taken off the market altogether if the risk to the population is deemed to be too high to continue the vaccinations. This translates into: the net effect of continued administration of this vaccine is worse than the alternatives (or possibly even worse than the disease)

Within that context the debate is pointless: VAERS is not intended to settle arguments, it is intended to gather possibly useful data.

> Within that context the debate is pointless: VAERS is not intended to settle arguments, it is intended to gather possibly useful data.

Sounds like you've got this one in the bag, then!

I will bow out here, if you don't mind.

No, I don't mind at all.

Enjoy the silo you’ve dropped yourself in

Thank you, it's quite nice here.

Without a reputable source for these claims you're just spreading misinformation.

I'm pretty baffled by this reply. It used to be (last year?) common knowledge that children were largely unaffected by covid. I guess the vaccine rollout has changed people's minds, but it hasn't changed the data.

https://stevekirsch.substack.com/p/weve-now-killed-close-to-...

> children were largely unaffected by covid

The issue is not with that, it's with your second claim re: large risk with the vaccine. That's the claim that needs to be substantiated.

It's substantiated in the link...

Among all infectious diseases children are facing Covid is one of the most severe.

The worst side effect of the vaccine (myocarditis in young males) has been eliminated with better dosing protocols.

https://stevekirsch.substack.com/p/weve-now-killed-close-to-...

There was an excellent refutation of using Adverse Events Reports for anything but safety signalling.

The author of the linked substack could have uploaded the death reports himself. And he didn't even think about comparing his numbers to expected numbers.

So, no: children don't die from the vaccine.

The author has a $1 million dollar offer to debate him and prove him wrong.

Sounds like he is part of the anti-vax bullshit industry.

Question is why you are regurgitating it? Do you believe any of it?

...industry?

Oh wow, never mind it’s settled truth then /s

I am not Steve Kirsch

Boys at least appear to be more in danger from the vaccine than the virus.

https://www.theguardian.com/world/2021/sep/10/boys-more-at-r...

I think there’s a bit more nuance to it than that

The paper in question found that in this age group risk of hospitalization for cardiac adverse events (CAE) is a few times higher than risk of hospitalization with Covid.

It’s unclear (to me at least) how to quantify the level of danger in terms of acute and long term health effects from just this data.

> Further research into the severity and long-term sequelae of post-vaccination CAE is warranted. Quantification of the benefits of the second vaccination dose and vaccination in addition to natural immunity in this demographic may be indicated to minimize harm.

https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v...

No they don't. The study that article references is hot garbage.

https://sciencebasedmedicine.org/dumpster-diving-in-vaers-do...

85% of VAERS reports are made by physicians. 100% are validated by the CDC.

What’s important is to disqualify the best information available so you just have to accept vague assertions from authority.

VAERS is not the best information available by any means, but it is indeed a valid source of information. The issue with the paper is that it misuses the information and draws conclusions that aren't actually indicated.

What other dataset are you using to inform yourself about vaccine related harm in the public?

Your question would seem to imply you've used VAERS to inform yourself, but I would contend you've relied on someone else's interpretation of it.

Is it the best dataset or do you have a better one?

"Garbage"?

> In an FDA analysis of the Optum healthcare claims database, the estimated excess risk of myocarditis/pericarditis approached 200 cases per million fully vaccinated males 16-17 years of age and 180 cases per million fully vaccinated males 12-15 years of age. [1]

This rate is close to the findings of the Høeg study (even higher, actually). [2]

On the one side we have the FDA and multiple scholarly publications largely in alignment. On the other side, we have an internet blog article with hyperbolic language and a generally unprofessional tone.

[1] https://www.fda.gov/media/153447/download

[2] https://twitter.com/TracyBethHoeg/status/1435796382841860099

Different data sets. The sentence preceding your quote from the FDA estimates rates of 71.5 and 42.6 per million using VAERS, vs. the garbage paper's 164 and 92 per million. i.e. less than half the incidence.

Regarding that other data set, see page 24 of this report: https://www.fda.gov/media/151733/download

Importantly, in relies on unconfirmed cases of myo/pericarditis, and concludes vaccine benefits outweigh risks even in a hypothetical worst case scenario anyway.

Hyperbolic language doesn't discredit any of the blogger's criticisms, but here's another more calmly worded one if you'd like: https://sciencebasedmedicine.org/peer-review-of-a-vaers-dump...

The Hoeg findings are off by 2X from the VAERS-based numbers cited by the FDA, but Hoeg examines "probable" vs. "medical chart-confirmed" cases. A factor of 2 is small in the scheme of things considering (a) the apple-to-oranges nature of the comparison, (b) the confidence intervals, and (c) the unacknowledged uncertainties that stem from our lack of understanding of reporting rates.

This new blog article you cite points out problems with 7 of the 257 cases included by the Hoeg study -- intermixed with a healthy dose of stay-in-your-lane-bro rhetoric. It also makes unfounded criticisms, such as "The claim from the study authors is that they replicate the [ACIP analysis] and found a much higher incidence than previously reported." In fact, the paper is clear that they follow a different method, and it claims "using these broader [emphasis mine] search and inclusion criteria, we found post-vaccination rates ... that exceed the rates previously reported."

This looks like someone is nit-picking when, in the big picture, considering the general concurrence with results from other studies, including other data sets, the findings are not misleading.

One recent publication: 370 / 1,000,000 rate of acute myocarditis/pericarditis following 2nd dose of Comirnaty in male adolescents between June and September of 2021. https://academic.oup.com/cid/advance-article-abstract/doi/10...

It's not apples-to-oranges, it's apples-to-less-carefully-selected-apples. The Hoeg paper mentions a broader case-finding method, but "We otherwise maintained the specificity of our analysis by requiring the same objective findings of cardiac injury used by the CDC to identify probable cases (Supplement 1) and excluded cases without sufficient objective evidence of cardiac-specific injury." The 7 cases in the blog are highlighted to demonstrate that this is clearly not true; they have not excluded cases without sufficient evidence of cardiac-specific injury in line with the CDC. So no, that criticism is not unfounded.

You've dismissed as apples-to-oranges the 2x difference in numbers between the two publications using VAERS data, then linked a third paper using different data (which isn't available in full; who knows what their inclusion criteria were) that shows another 2x discrepancy as evidence that the findings are in general concurrence? Would you have me believe that's not actually an apples-to-oranges comparison? Why not this paper[1] out of Canada the gives a rate of 97/million for the group most closely matching your 370/million number? Or this one[2] out of Israel with 137/million.

[1]https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v... [2]https://www.nejm.org/doi/full/10.1056/NEJMoa2109730

This article is pretty much garbage. You need to compare getting myocarditis from vaxx vs covid. And chances of getting it from covid is ~11x higher.

Myocarditis didn't become a concern until the jabs were rolling out

From vaccination no, but from COVID it has been a concern right from day #1.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm

Is there any reason to assume that initial infection with Covid can't cause both immunity against subsequent infection AND long Covid symptoms?

Think about how chicken pox works. You get infected, you deal with (usually but not always) mild symptoms, and then you don't get chicken pox again. But you are susceptible to shingles later in life.

Chicken pox is caused by varicella, a herpes virus which remains permanently in most infected people. It is in no way comparable to COVID-19.

I'm not suggesting that Covid and chicken pox are related as viruses. I'm merely pointing out one example of how long-term symptoms are not incompatible with immunity. We know that Covid causes long-term symptoms in some people. So it would be interesting to see whether the differential between natural immunity and vaccinated immunity (if there is one) is outweighed by the acute and long-term symptoms of active infection.

Having gotten chicken pox intentionally then again as a teen, only to learn it significantly increases my risk for shingles later in life, I don't recommend natural infection when there is a vaccine. The second infection was particularly painful.

Please vaccinate your kids.

You couldn’t have lost the plot any more with this one

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