Comment by timr | Hacker News Reader

Comment by timr | Hacker News Reader

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> However, we have a 30/70 split in number of covid hospitalizations, with 30 being vaccinated people, in countries where the split in the normal population is 90/10. This means that despite some unvaccinated people having had prior infection the vaccine reduces hospitalizations by 20x. Given this data the most effective strategy is to just vaccinate everyone without what is effectively a pointless distinction

No. This is wrong. As the parent noted, the CDC's own data shows that prior infection provides robust protection against severe disease. Both without vaccination:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm#F1_down

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm

As well as a substantial additional benefit after vaccination:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a4.htm

> Previous COVID-19 illness was associated with reduced odds of severe outcomes (aOR = 0.27; 95% CI = 0.09–0.84).

Moreover, the CDC estimates that over 150M people in the US (out of a country of 330M) have had Covid:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

That's 45% of the US population (before Omicron). There's no rational way to characterize this as insignificant.

I did not say that prior infection does not reduce severe outcome. It does but _it does not change the fact_ that the severe outcomes are much more rare among vaccinated people. This means that there are still too few people with prior infection, for this to be an important factor in policy making. It will be once the proportion of unvaccinated people in hospitals starts to resemble the proportion in the general population.

You said:

> Given this data the most effective strategy is to just vaccinate everyone without what is effectively a pointless distinction

The data clearly shows that protection from natural infection is at least as substantial as from vaccination, and that ~half (if not more) of the US population has had it. This fairly obviously impacts the most effective strategy. Mandating vaccines (and now boosters) in young, healthy people who were already at small risk, including those who have already had the virus, is so absurd that I can't even characterize it as science. It is simply punitive behavior.

Most countries recognize prior infection. We're in a small, small club of scientifically illiterate nations here, and it's rather embarrassing.

> It will be once the proportion of unvaccinated people in hospitals starts to resemble the proportion in the general population.

If the total number of hospitalizations is a manageable number, the percentage that are vaccinated is irrelevant. It's a metric of punishment, not a realistic policy goal. I have no idea what the future will bring with regard to the ratio of unvaccinated hospitalizations, but I know that hospitalizations in general will fall as the population achieves broad immunity -- and natural infection certainly counts toward that goal.

> Mandating vaccines (and now boosters) in young, healthy people who were already at small risk, including those who have already had the virus, is so absurd that I can't even characterize it as science. It is simply punitive behavior.

The idea that a vaccine is a punishment is disturbing. I'm glad to have been able to get it.

I said the mandate is punitive, not the vaccine.

If you feel more comfortable getting an unnecessary vaccination, nobody is stopping you. Other people should not be coerced into doing the same against their will.

College kids are currently being expelled for refusing boosters. Children are being refused classroom education. Prior infection is not taken into account, and risk/benefit is not a factor. There's no other way to frame this than as coercive behavior.

College kids were already required to get multiple vaccines to attend and I remember being lined up to take the swine flu nasal spray with no say in the matter if I was going to continue education.

> There's no other way to frame this than as coercive behavior

We coerce people constantly when they have bad behavior that affects society and others. I don’t know why people keep trotting out mandates as having aspects of coercion/authoritarianism is a mic drop moment explaining why they are bad. How is this worse than all the other health based coercion we’ve had?

I think their point is that the data shows that previous infection provides good protection. If the goal is protection, then this should count for something, and should be factored in to the risk-benefit ratio. The risk-benefit ratio is not negligible for young, which is why the vaccine still hasn't been approved for the very young (and there's certainly not a step function in the risk-benefit ratio, by age). But, the risk-benefit ratio calculations being used don't seem to be including previous infection. This is not necessarily scientific.

For the other-than-COVID vaccines that are required for enrollment, there isn't existing protection in the majority of the population. Nobody has natural, effective, protection against measles.

I think the practical problem/reason is that there's infrastructure set up to track and share vaccination/booster status. There's no infrastructure set up to track, or even test, immunity status, which is the real metric of risk. So, for practical reasons, proof of vaccination status will always be favored and, almost certainly, held above the true, yet difficult to measure, immunity status, to drive policies. This is an easy out, that might cause harm, relative to an "ideal" policies that were based on immunity.

> College kids were already required to get multiple vaccines to attend and I remember being lined up to take the swine flu nasal spray with no say in the matter if I was going to continue education.

Saying it's happened in the past isn't an argument that it should continue in the future. I doubt your swine flu nasal spray had as intense of negative side effects as the COVID second shot and booster tend to in the young and healthy. Now that we're in booster territory and Delta is being phased out the shots are almost certainly more painful than the disease for some portion of the population.

> How is this worse than all the other health based coercion we’ve had?

I can't recall any other health based requirement for attending an event or restaurant. I also don't understand why people continue to harp on how a personal COVID vaccination decision "affects society and others" at this point. The vaccine only marginally prevents infection at this stage, and the primary benefit of reduced severity should stop everyone who's vaccinated from worrying about what others around them may be doing. I get the flu shot so I don't get the flu, and I'm not sitting around telling others who haven't that they're putting me in danger.

When I worked in DoD intel in the past, I had to travel to multiple nations with extremely high rates of dangerous tropical disease. I took multiple vaccines for this purpose. At no point do I ever recall worrying about whether the local populations I was dealing with were vaccinated at all. Because that's how vaccines work. They make it so you don't have to worry about others not being vaccinated or giving you the disease. With diseases that are highly dangerous to children, this is a different case, because you can't vaccinate children when they're extremely young and therefore a person not being vaccinated can transmit the virus to them. With COVID it is the absolute opposite. Small children are at minuscule risk and are actually far more at risk from influenza due to the dynamics of the virus. This risk age gradient is actually unprecedented and a unique feature of COVID.

What's really happening here is people who have considered themselves progressive and tolerant their entire lives have decided that they want to impose policies that are tyrannical, but they have to desperately backfill this logic to make it feel okay. They aren't willing to let any form of data disrupt this because if they did, they would have to admit to themselves that they had a tyrannical impulse in the first place.

Notice how when he got the swine flu nasal spray he wasn't demanding that everyone else in every public place he went to also get it. Nothing about this makes sense unless you view it as people trying to psychologically justify tyrannical impulses.

> When I worked in DoD intel in the past, I had to travel to multiple nations with extremely high rates of dangerous tropical disease. I took multiple vaccines for this purpose. At no point do I ever recall worrying about whether the local populations I was dealing with were vaccinated at all.

Yeah the tropical diseases are an interesting parallel for me too. In a place where malaria or dengue are prevalent I don’t blame others for being vectors of the disease, I assess my own risk and behave accordingly. And the mere fact that they’re spread via mosquitoes instead of air/surfaces doesn’t change the necessity of congregating people to spread. But these diseases are not universally dangerous, so people should not be universally pressured to take any measure to avoid them.

I’m not sure I fully agree with the tyrannical impulse premise, but I’d subscribe more readily to a tribal “badge of honor” premise, which in this (and indeed most cases) happens to be tyrannical. I think generally the masses don’t intend tyranny, rather they virtue signal to coerce and thus become tyrannical as a result.

Marginal reduction in transmission can mean the difference in ending a pandemic or dragging it out for another year or two. There is a big difference in an R value of R1 and R0.9

And you probably don't remember ever being required to show vaccination status to get into a stadium or restaurant in your lifetime because you hadn't previously lived through a pandemic.

> Marginal reduction in transmission can mean the difference in ending a pandemic or dragging it out for another year or two.

Sure, it’s great that we have the vaccines to do so. We should be focusing on making them available to everyone on earth rather than forcing them down the throats of those who don’t want them to get to the fastest “end.”

> And you probably don't remember ever being required to show vaccination status to get into a stadium or restaurant in your lifetime because you hadn't previously lived through a pandemic.

Fair enough. My reply was in response to a status quo argument, but indeed this pandemic hasn’t been just that. In which case I think you have to assess the dangers to those who have been vaccinated, which is not much. Indeed with omicron the risk isn’t very high for a large portion of the population vaccinated or not. And the vaccines are available to anyone who wants to reduce their risk, thus the mandates make little sense.

There is a pre—existing vaccination mandate for enrollment at colleges in the US.

All the vaccines mandated by colleges have been around for decades. It’s not “just another vaccine” to add to the list; there is a difference.

Which brings it all back to a lack of trust in the vaccine/science. The current science is that the vaccines are safe and provide a greater degree of protection than prior infection alone. Outside of some very rare conditions that would make someone unfit for a vaccine, there's no reason not to get vaccinated. Refusing to get one only increases your chances of ending up in a hospital and for what? There's no advantage to giving yourself a disadvantage no matter how small you think the benefit a free vaccine would give you over the protection a natural infection has already given you.

Your logic here is flawed. Even if you've already had covid, the vaccine will give you more protection. That's good. We can't do the reverse (give deliberate natural immunity to those who are already infected), but that's no reason to say that natural immunity is "good enough." That goes for the individual as well as society. Would you decline airbags because seatbelts as effective?

I think you're hitting a strawman here.

Are any number of vaccine shots "good enough"? Or, should we be getting one every month to get as much protection as possible?

There's a line to be drawn somewhere, and I think what's argued here is that natural immunity should count for something, instead of being lumped into the same group as those "unvaccinated and no prior infection".

> Even if you've already had covid, the vaccine will give you more protection.

And more risk. Which is greater?

Your ~half estimate is more like 70-80% these days. See https://covidestim.org/us

(This makes your case stronger, of course.)

Absolutely. I'm being intentionally conservative here.

The severe outcomes are even more rare amongst prior-infected, unvaccinated people.

I suggest you look up seroprevalence surveys. The bulk of COVID infections (barring mandatory and regular testing being extant in a given locality) go undetected, due to the mild symptoms in the vast majority of the population. The seroprevalence surveys have shown this since May 2020.

And again I do not debate that. But they are too few to have an impact on the overall statistics of unvaccinated people. It they were not such a small minority, you would not be seeing so many more severe outcomes among the unvaccinated.

See https://covidestim.org/us for an update to your "too few" statement. The number of previously infected people is at least 70% in all US states I have looked at (80% in NY and CA).

While not directly comparable, an official report from the UK [1, Figure 3] estimated that effectively 100% of blood donors were either vaccinated, previously infected, or both. This was in September. Blood donors are not a representative sample of the population, but it's not hard to believe that by now effectively everybody (in the UK) has some kind of immunity.

[1] https://assets.publishing.service.gov.uk/government/uploads/...

It 70-80% has been infected, then most of the vaccinated population will be vaccinated and infected, which provides still stronger protection than just infections.

The end result is the same: higher proportion of severe illness among the unvaccinated, which is most easily fixed by vaccinating them.

> higher proportion of severe illness among the unvaccinated

No, among the unvaccinated and uninfected, which, as the data others have been giving shows, is nowhere near even a majority of the unvaccinated any more, let alone enough of a majority to treat it as if it represented all unvaccinated people. So your claim that the unvaccinated but infected are too few to matter and should not affect vaccine recommendations, let alone vaccine mandates, is egregiously wrong.

Again, a category error:

You are failing to differentiate between the two subgroups of unvaccinated people, the previously infected/unvaccinated, and the purely unvaccinated. Additionally, you are not doing any further subdivision on these two groups by age. The blanket "one size fits all" strategy you are advocating is assuming that all of these groups are at zero risk for adverse events from the vaccine. Young, healthy males have a statistically zero risk of severe COVID complications, and a statistically small but non-zero risk of myocarditis. The risk of myocarditis from the vaccine falls to practically zero as you progress upwards up the age distribution, which is the exact group of people who have the highest benefit from the vaccine. You are talking about a gradient which impacts both the cost and the benefit, with a diminishing cost and an increasing benefit going up in age. Not taking this into account is so illogical, that in my opinion, people who hold this view are clearly blinded by bias.

If I'm going to get smeared as an "anti-vaxxer", I'm going to go ahead and use a label to describe humans who hold the rigid, data-resistant view that you possess:

Immunity deniers

> Young, healthy males have a statistically zero risk of severe COVID complications, and a statistically small but non-zero risk of myocarditis.

Now imagine having a healthy 7-year old son, and having an excruciatingly difficult conversation with your spouse about why he shouldn’t get vaccinated. Or having to cut off ties with your mother-in-law, preventing your children from seeing their grandmother, because she thinks you are actively harming your own young children by not getting vaccinated despite having natural immunity.

These people are destroying the very bonds of society.

My wife is from a family of fiercely independent Filipino immigrants. She's always been super levelheaded. I lucked out with her. Her late father was a chemist, and her uncles are all practicing physicians. They were all universally shocked when the push to vaccinate kids started. They know it's not dangerous to kids. They can't even talk about it without lapsing into angry rapid Tagalog. She was right there with them.

Here's a new editorial from a prof at Johns Hopkins:

https://www.wsj.com/articles/the-high-cost-of-disparaging-na...

Might be useful in those conversations on previous infection. And I agree regarding the social fabric being destroyed by these bureaucrats. They are going to slowly try to find a way to ease out of this in a manner that minimizes the damage to their reputations. That's what political elites have always done when their narratives crumble after they have dug in. See the utter absence of contrition or self reflection after the Iraq wmd fiasco for an example. Or Vietnam. They don't care how much damage they do in the process.

Regardless of how small the absolute risk, the risks of COVID are far higher than the risks of the vaccine, even for 7 year olds. So why are you choosing to die on that hill?

Regarding 7 year olds, you are grossly misinformed, but that's not your fault. The US Federal government is continuing in it's grand tradition of doubling down on bad science to save face of bureaucrats who made bad policy decisions. For previous examples, see the thousands of studies by NIH to justify cannabis prohibition, USDA food pyramid, dragging feet on leaded gasoline for decades, etc.

The rationale for vaccinating kids was to prevent them from spreading it. The vaccine did that effectively before Delta. With omicron, it's worthless for preventing spread. Kids are the one age group at higher risk from flu than covid.

My two kids (8 and 15) aren't vaxxed. They caught omicron, and now they are in the ICU... Oh wait,no they are fine, had almost zero symptoms, and were playing outside the day they tested positive. Which is, statistically, a virtual certainty. They aren't morbidly obese or immunocompromised, so they shrugged it off.

Nobody is dying on a hill. We're just better at statistics and aren't gullible enough to believe these panicked fools.

Put an experimental product from Big Pharma in your kid for no reason. That's your call. But ask yourself why you suddenly trust the FDA, an organization that labeled oxycontin non addictive, approved Vioxx, approved remdesivir for covid despite it being useless, and that's just the past 15 years. Fear is the mind killer indeed.

At this point, the vaccine is as experimental as getting COVID.

We have lots of data on both. Said data shows that 7 year olds are much more likely to have serious affects from COVID than from the vaccine. That's not to say serious outcomes from covid are at all likely. Just that the relative risk is lower with the vaccine.

To reiterate, the absolute risk is tiny, so it's really not a big deal. But if you truly understand statistics, then you will also see that everyone will be exposed to COVID and you are better off with the vaccine than without no matter the age cohort.

And the vaccine reduces transmission (less so than we had hoped, but a reduction, nonetheless), no one ever said it would 100% stop transmission.

I suppose taking an experimental vaccine seems unnecessary if you consider a wild virus to be natural, maybe even artisinal, and you ignore the fact that while the vaccine is quality controlled and the same as what billions of people have now received, and the virus is constantly mutating, well then I guess the virus sounds safer.

> Immunity deniers

Let's not do this. When this mess is over we'll all want to work and break bread together again, and that's much more important than whatever any of us happened to believe or say in the fog of war.

You're right, labeling people is a terrible thing to do.

I'm just at a breaking point now, after 2 years of having the most anxiety and risk-averse among us gleefully demonize, censor, and shame those of us with heterodox opinions. When you add to that the enthusiastic endorsement of forcing people like me to get a shot despite already having immunity solely to appease their paranoia, the bitterness has put me over the edge. Considering that it's the same crowd who has spent decades chanting "my body, my choice" and insisting that the government "never come between a person and their doctor", the hypocrisy adds to the outrage. I've been called a conspiracy theorist for pointing out the highly improbable chain of coincidences that made me doubt the narrative around the virus' origins, then had to watch as they all change their minds without an ounce of self-reflection or a single apology. On top of this, the national media has been completely, un-flinchingly on board with all of it, which is a distinguishing characteristic from the harassment and government intrusion upon LGBT folks championed by the political far right until the 2010s. They gave these anxiety driven tyrants full moral authority to violate my rights. I hope you can understand my bitterness.

The last thing I want to do is dehumanize others. For the crime of not wanting to get NEEDLESSLY injected with a rushed, experimental genetic technology whose trials were entirely run by pharmaceutical companies who have a long history of overstating benefits and hiding risks for their products, I've been ostracized, condemned, and coerced by the same people who insist on not eating GMO produce.

Enjoyed your posts and keep it coming.

Just finished a few trips to Latin America. Kissed the ground when I got back here to Florida, where kids goto school, don't wear masks, and don't have to be vaccinated. Here, we respect individual liberties. We respect the right to go out and earn a living and put food on the table and if we lock everything down, at least uncle sam sends out checks to hold us over for a while.

People are starving and dying in places like Venezuela, Cuba, and other countries in LA. Small business has been devastated by the un-ending lock downs.

Unemployment is rampant. People cannot put food on the table. Its crazy. The lack of empathy that local governments have in LA for a persons right to earn a living is unconscionable. Maybe its because the virus has hit hard the wealthy elite ruling class since they tend to be rich, fat, white, and old. I dunno. But they are all wanting to break in to America and would if they could.

That's really awful to hear regarding Latin America. How is Columbia doing? Do you have any insights there?

Lots of columbians here in miami trying to make ends meat. I've met one famous soap actress who cleans houses here ( in Fl) and also a successful psycologist who is waiting on tables because of the economic malaise caused by forced business closures.

Politics is a contact sport.

I completely agree with your comment and to help summarize why you are having to explain all of these things to these people, I suggest everyone on this thread read the following link to understand their error.

Dividing groups of people up without going deep enough into categorization creates contradictory conclusions.

https://en.m.wikipedia.org/wiki/Simpson%27s_paradox

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