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Comment by vizzah | Hacker News Reader

Okay, but why demand boosters from those younger than 40?? Considering new myocarditis studies and how low the risk is for someone already vaccinated and how negligible it is with Omicron (even for non-vaccinated)? This blind boosterization is only demonstrating how the governments are still shitless scared of their medical system collapses with vulnerable groups, so that they want to boost anyone in sight, just to be on a safer side.

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Because if protection from symptomatic infection increases at a population level, then overall transmission becomes less likely.

Look, the risks are pretty low for younger people, but from a population level every extra bit of immunity helps to reduce the likelihood of health care system collapse (which has been the goal throughout the pandemic).

Then all you need is bullet-proof evidence that transmission is significantly impacted by the vaccines. It ain't a guessing game, do the measurement. Do it all over the world and compare and contrast.

This seems to suggest viral loads are the same for everybody - vaxxed, unvaxxed, symptomatic or asymptotic.

https://www.ucdavis.edu/health/covid-19/news/viral-loads-sim...

Vaccinated individuals hit the same peak mRNA loads for the same symptom severity on average. Their time to recover is faster though, and at peak you recover less viable virus indicating they are producing more viral debris.

And that's after fewer people who are vaccinated catch the virus, and there's more aborted infections and asymptomatic infections after vaccination.

All of those studies use PCR Ct values as proxies for viruses and compare vaccinated and unvaccinated individuals with similar symptom severity, and it turns out that correlates at peak because symptoms are on average due to antigen loading. Those studies aren't very good at showing how effective vaccination is at preventing transmission. They just show that its nonzero.

None of those old studies apply now that omicron is around. Omicron spread all throughout the world at record breaking pace via vaccinated people, so it doesn't seem like vaccines are doing much at all to prevent spread of omicron.

You may be correct, but it's too early to tell.

As I have stated elsewhere in this thread, the rate of vaccine escape has gone up by about 5x, (from 6% to 30%), but that's still much better than one would get from no vaccination.

But it spreads so fast that it doesn't seem like that matters. It spreads basically as fast as people are interacting, if it gets into the student body then everyone will be infected in a matter of days even if they are all vaccinated.

I can't see how it could spread any faster than it already does through vaccinated people. A few people there being unvaccinated wont make a difference.

> And that's after fewer people who are vaccinated catch the virus, and there's more aborted infections and asymptomatic infections after vaccination.

This is the big one. Conditional on symptoms the viral load may be similar betwee vax/no vax, but if the vax have much less probability of getting symptoms then all is good.

Shouldn’t we be distinguishing between unvaxxed who had Covid, and unvaxxed who didn’t?

I haven't read the full paper, and it's pretty small data (maybe n=120 in total) but this would seem to suggest that there's about a 40% reduction in transmission associated with vaccination: https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

I honestly don't understand how there wouldn't be protection from the vaccine. It's not a sterilising vaccine, but it does offer protection.

"SAR among household contacts exposed to fully vaccinated index cases was similar to household contacts exposed to unvaccinated index cases (25% [95% CI 15–35] for vaccinated vs 23% [15–31] for unvaccinated)."

In other words, once infected, there is no reduction. How effective are these boosters against Omikron infection, weeks and months down the line?

Maybe if the health care system had lots of staff, meaning lots of doctors, not just the trickle that comes from the tiny amount of medical schools, the system wouldn't collapse?

Has America tried addressing COVID that way, increasing the number of doctors?

Has America considered doubling the number of doctors, nurses, hospitals, and all other medical support, building and bootstrapping many more medical schools, and graduating an enormous cadre of recruits from a seven year program, all at a cost probably over a trillion dollars a year, so that we can care for a massive influx of Covid patients in preference to advocating booster shots?

That's not the real cost. They could double the number of doctors by cutting the amount of education required by half, and get better results. And they wouldn't need to expand medical school capacity at all.

The amount of education doctors get is harmful. It actually makes them worse at their job. It's effectively a form of hazing by AMA.

There's a combinatorial explosion of effects and side effects in the human body. It's important to learn and memorize, and memorization is undervalued, but not to that extent. It's like memorizing optimal solutions to traveling salesman instances. Other times it's like memorizing a times table of the three-digit numbers. That is a waste of time and will make you a much worse mathematician.

That's one of the dumbest things I heard in a long time

We need to do that anyway, but then the doctors that make those decisions wouldn’t get paid nearly as much. There is absolutely an artificial scarcity of MDs in the medical field that needs to be discussed.

You're getting a massive influx even if the booster shots have 100% uptake, so let's just stop restricting the number of residencies and let the doctors we already train... work as doctors!

> Because if protection from symptomatic infection increases at a population level, then overall transmission becomes less likely.

Protection from Omikron quickly wanes. At what point does that "extra bit of immunity" justify heart injury? We're talking about roughly 1 in 10000 doses administered causing Myocarditis in a young male. We don't know if the risk increases after each dose, but preliminary data suggests that it may:

https://www.medrxiv.org/content/10.1101/2021.12.23.21268276v...

We're talking about ~1:10000 odds for one specific vaccine when vaccinating young males, which is why many countries are no longer using that vaccine for this demographic. Other vaccines are closer to 1:100000, which isn't far from the myocarditis risk of an infection with COVID-19.

The study also shows that there was practically no increase in risk for the third shot (though with a fairly wide CI), so it's possible the risk may just depend on whether someone is immunonaive or not.

> Other vaccines are closer to 1:100000, which isn't far from the myocarditis risk of an infection with COVID-19

The risk is given by the FDA as up to 1:14285 (males aged 12-17) for the second dose:

https://www.fda.gov/media/154869/download

However, a study from Hong Kong found an incidence of up to 1:2700 in the second dose (males aged 12-17):

https://pubmed.ncbi.nlm.nih.gov/34849657/

What we don't know is whether a vaccination would actually prevent Myocarditis in a breakthrough infection. These risks may well not be mutually exclusive. In any case, the risks are not directly comparable unless you assume 100% PCR-confirmed infection risk over six months, which is of course unrealistic.

1:100000 was in reference to the "males < 40" age bucket in the UK study linked by OP. The myocarditis risk from infection for the 12-17 age group appears to be significantly higher according to this study[1] (1:1141), which gets us quite close to the Hong Kong study incidence if we assume two shots after the first dose.

> In any case, the risks are not directly comparable unless you assume 100% PCR-confirmed infection risk over six months, which is of course unrealistic.

I do wonder how unrealistic it is with Omicron, but maybe we'll get lucky and Omicron's less likely to cause myocarditis.

[1]: https://www.medrxiv.org/content/10.1101/2021.07.23.21260998v...

"every extra bit of immunity helps" - Agree. But this shouldn't be mandated. Rewarded, yes. But not mandated.

All the above applies for the flu as well, so why do we insist on inventing a new set of rules for Corona ?

With vaccine and booster shots, both require a similar amount of hospital resources.

The current way is simply not sustainable.

> those younger than 40

I think your concern is based on the heightened risk of myocarditis, right?

My understanding (mostly from [0], made by a UK cardiologist) is that the danger of myocarditis from the vaccine is higher than the danger of myocarditis from COVID only for males under the age of 30 who receive a Moderna shot. For every other case, the vaccine is an improvement (so males under 30 should get Pfizer/BioNTech, which is the government recommendation at the moment in my country).

[0]: https://youtu.be/5iABaxRWGxk

I think you missed the point, people under 40 are not very likely to be hospitalized so why should they get the boosters.

People should be free to choose booster shots, those who are worried can continue to get booster shots.

In essence the same system we have with the flu is what we should have with Corona.

And then we can focus on some of the bigger problems such as Global Warming.

> I think you missed the point, people under 40 are not very likely to be hospitalized so why should they get the boosters.

I don't see the point written anywhere so I suppose I did.

In my opinion, people should get the vaccine as long as the harm of not having it is greater than the harm of having it. Adverse reactions are very uncommon and unvaccinated people are at heightened risk of hospitalisation (even under 40s) so the balance tips in favour of the vaccine. The booster seems like a good idea due to Omicron.

> People should be free to choose booster shots, those who are worried can continue to get booster shots.

I do agree that people should have a choice to take it or not.

However just as I believe the right to free speech doesn't mean I'm obliged to listen, I believe the right to choose not to be vaccinated (or receive a booster) doesn't mean I'm obliged to be around you. That is, I think it's fine for participation to be refused to people based on their vaccination status (though I support say testing as an alternative).

> That is, I think it's fine for participation to be refused to people based on their vaccination status

This doesn’t make sense either. You are already free not to participate. You can’t demand non-participation. Especially as it is not proven that vaccination prevents transmission.

> And then we can focus on some of the bigger problems such as Global Warming

Funny how that got dropped from the spotlight, I didn’t even notice.

Myocarditis is not the same as death. Boosters are required because the efficacy of the vaccine has been observed to wane with time.

Too bad the health systems couldn't come up with one tiny sugar pill that would confer 100% protection against all variants for the next 100 years. The are asking us to take 3 shots, the horror!

> This blind boosterization is only demonstrating how the governments are still shitless scared of their medical system collapses with vulnerable groups, so that they want to boost anyone in sight, just to be on a safer side.

I mean yes, that's still sort of the point.

There's still probably about 10% of the population which is unvaccinated and unexposed. If they all wind up catching Omicron in the next 2-3 months (due to its ability to reinfect and ignore neutralizing antibodies to travel through the population to find those still-vulnerable hosts) then the fraction of them winding up in the hospital will be sufficient to knock over the hospital system again. We didn't have any excess capacity in our medical system when this started, and we have less now.

The population's tolerance for any sort of behavioral changes is low, and the unvaccinated aren't listening to anyone, so the real only remaining lever to pull is recommending boosters to try to provide some level of protection against disease and transmission over the next couple of months in order to flatten the curve yet again.

The modelling estimates that I've read though are that we're at about 90% of the population being exposed (depends somewhat widely on vaccination status and how hard the area was hit by Delta though), so we're just about done with the pandemic. Omicron should mostly finish the job that Delta started of finding all the holdouts and burning through all the dry wood in the population. In the meantime though that last 10% is enough to put the medical system under too much stress again.

When 100% of the population was dry tinder hospitals were under strain X.

Now we have 1/10th that by your estimate. Why wouldn't we be under significantly less strain?

Current variants are significantly more infectious (R0 used to be around 2.5-3.0 for the ancestral strain, Delta was 5+, Omicron estimates go up to 10). Vaccine efficacy is also reduced for these variants. We've also scaled back non-pharmaceutical interventions in many places.

You've neglected to account for the substantial difference in average hospital stay period between Delta and Omicron.

Do we know how large this effect is for the unvaccinated? I'm still not sure if the numbers we're seeing from countries with relatively high seroprevalence through either vaccination, infection, or both can easily be applied to other countries.

This UK report[1] does show a corrected Hazard Ratio of 0.76 relative to Delta, but more than half of this group seems to have had a previous infection. Not sure what it would look like if you exclude them.

[1]: https://www.imperial.ac.uk/media/imperial-college/medicine/m...

Because it has never taken more than a small fraction of the immune-naive population getting coronavirus to have the severe cases overload the hospitals and Delta made that worse.

And Omicron is able to reinfect through the recovered/vaccinated population and we're not taking any precautions at all now so the rate of infections is through the roof.

The Omicron curve in South Africa looks like a Bell curve and is in the process of dropping as fast as it rose. Without vaccines or boosters.

Sir John Bell, regius professor of medicine at Oxford University:

https://www.theguardian.com/world/2021/dec/28/omicron-is-not...

"Omicron is “not the same disease we were seeing a year ago” and high Covid death rates in the UK are “now history”, a leading immunologist has said."

There should be special scalable government covid wards to handle overflow at this point. This is no longer a collective problem, considering that the remaining unvaccinated are mostly by choice. The externalities are far worse than the disease now.

There aren’t any excess medical professionals to staff a scalable COVID ward.

Are we really that unimaginative as a society so as to walk the decision tree all the way down to "not enough doctors and nurses" as the intractable problem behind all this suffering and strife? I used the word "scalable" with intention. There has been more than enough time to design a protocol and train less experienced staff that could be utilized in most cases. Highly trained medical professionals would be reserved for unique situations, which surely are not the bulk of covid hospitalizations. Hundreds of billions could have been invested into a scalable protocol that doesn't require drafting of existing medical professionals, and the cost would have still just been a drop in a bucket compared to how much has been spent on relief and how much has been lost by society as a whole. Other than R&D in pills and shots, the response to covid has been lethargic and hopeless. They didn't use this excuse of lack of medical professionals during the polio epidemic - for those that got left behind by the vaccine, they used ingenuity and created the iron lung.

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