Why I’m for Covid vaccines, but against vaccine mandates
peterattiamd.com
peterattiamd.com
> In people who are previously infected vaccines offer zero additional benefit with respect to hospitalization
is so fatally flawed. The reason that previously infected people have lower hospitalization rates is that some percentage of people who were previously infected and at risk of hospitalization _died_. You're literally clearing out the population that is most likely to skew these numbers.
Second, this argument:
> vaccinated and unvaccinated persons with detectable infection have the same viral loads, despite the reduction in disease severity for the former group.
is similarly flawed, in that it goes right to transmission after successful infection, without touching on infection rates themselves. Sure, yes, when you have a breakthrough case, and are infected, you're probably similarly likely to infect household members. It's common sense.
But the raw infection rates for fully vaccinated people are much lower, even with omicron. The data from NYC is very clear:
https://datawrapper.dwcdn.net/fQBNe/16/
So vaccination is important because it reduces spread, and reduces infections. The medications he cites as justification for reduced need for vaccination are not widely available, and in the case of fluvoxamine, not widely prescribed. Over and over the author simply manipulates data to support their argument.
I watched in December a community that is over 99% vaccinated have an omicron spike which led to 10% of the population test positive in a week. This started a spike which then spread to the outlying areas, and was likely only even discovered because of surveillance testing. If 10% of a fully vaccinated population could become infected within a week, then clearly the vaccines were not reducing spread or infections.
This is just a fallacy. Even measles vaccines have a breakthrough rate—cases are so low because there is not widespread community transmission.
Just because it's not reducing transmission to your taste doesn't mean it's not reducing transmission.
Also where are you that's 99% vaccinated?
Someplace where children are forbidden, I guess.
The combination of comments raises enough doubt about the claims of high vax rates not protecting people that we can simply ignore it.
Folks: please stop claiming your data proves something if the observation is better explained by biased samples. In this case, we're talking about a tiny nation that has significant through-traffic, so it's entirely inapplicable to more or less any large nation.
"However, data show fully vaccinated persons are less likely than unvaccinated persons to acquire SARS-CoV-2, and infections with the Delta variant in fully vaccinated persons are associated with less severe clinical outcomes."
I interpret that as saying, indirectly, that vaccination protects against infection, but not fully, and leads to better health outcomes in case of infection. I doubt you can explain that with differing behavior ("fully vaxxed people are more likely to self isolate ... less likely to be tested, while still being contagious")
I interpret this probabilistically and from what I can see, CDC is saying their data analsysi agrees with that.
As far as effectiveness against infection, the data is crystal clear:
https://twitter.com/EricTopol/status/1488255436671176704
There is not actually any evidence supporting your position from any of the research or even any of the major health authorities. All agree that vaccination reduces infection and hence transmission. So it's hard to argue that mandatory vaccination doesn't improve the overall trajectory of the pandemic.
(I'm talking about "You're spreading misinformation now," which is a swipe that no one here should be resorting to, regardless of how right they are or feel they are.)
The deaths are obviously a tragedy, but given that they've already happened, what is their relevance here? Having survived a past infection predicts better outcomes. If that's because all of those that would have succumbed already did, it doesn't change that the surviving convalescent crowd is not high risk.
If the discussion is about not vaccinating and promoting natural immunity as the solution to end the pandemic then I must note that this has been tried and it failed.
We got delta, gamma and lambda from it and now omicron. Natural immunity did not end pandemic, it has prolonged it greatly.
Parent said that this argument is so fatally flawed... because people died? I couldn't quite follow.
The article is "why I'm for vaccines but against vaccine mandates", so that's what the discussion is about.
We've done something like 10B doses worldwide. A massive proportion of the population has had exposure via vaccine and/or infection. Mandates are an odious, blunt instrument, especially when there are so few remaining naive hosts.
I think its arguments are really flawed and not grounded in reality but like I said, I do not think that convalescents should vaccinate but I think they should be highly encouraged to have a booster shot because it about halves the change to become reinfected.
I think that this discussion if previously infected should or should not be vaccinated has generated just too much distraction.
Even in EU, where one, who had PCR test confirmed infection, can get COVID-19 certificate for 6 months (compared to 12 months for double vaccinated, now 9 months), it has given the anti-vaxxers too large platform.
They would not have gained it without this mistake in politics.
At some point, people started losing the plot. The win condition here is not "every single human vaccinated with the current batch of vaccines, and anyone in the way labeled and punished".
That was a potential strategy for achieving the actual win condition of keeping society running. For a variety of reasons, we seem to have wrung the majority of the benefit we can out of that strategy. Now we have to go to the next phase, and it'd be nice to start undoing this bullshit division that's been created among us.
I touched this topic only because the author tries to convince us that he is not one.
Why is it important? Because their beliefs distract them to view this issue objectively.
For example if two doses of vaccine do not work against new variant, they conclude that vaccines are bad and should be abandoned instead of asking and testing if three doses might work.
I am seeing the same again with omicron. Vaccines do not work, should be abandoned. I am seeing that they still work fairly well, at least against serious illness that requires hospitalization and actually after boosting also against infection but just the virus is everywhere and changes to get it are enormous and this makes it hard to avoid even when vaccinated by three doses (efficacy is around 60% with 3 doses that is about the same as was 2 doses with delta but delta was just much much slower virus (even though I thought that it was fast back then)).
Maybe this doctor really is not one but people who are, are going to use this opinion piece to confuse other people and gain support against vaccination even when it really is the best option that they got at the moment.
This is why I find this aspect also important.
He tries to argue that vaccine mandates are bad because natural immunity after infection is superior.
Honestly, this is ridiculous conclusion. If natural immunity gives about the same or better or not too much worse outcome than vaccines, we should treat it equally. Period.
If somebody gets unlucky and gets infected. Let it be. If they want to have one additional shot, encourage them. If they are afraid to get one, calm them with correct information. But let them decide.
Of course then somebody would claim that we would encourage then people to get infected.
Yes, there would be some people who are stupid enough to try to get intentionally infected. I know that they exists through media and my personal contacts. But this very limited number of bad actors should not affect well behaving majority.
If we made convalescence passports equal to vaccine passports, we could have avoided a lot of unnecessary discussion and divide.
A more accurate way to frame that would be, "If you don't die from covid because you are unvaccinated, you are less likely to end up in the hospital the second time you have it, compared to people who never had it and didn't die but did get a shot" - and we would then compare the absolute mortality rate for unvaccinated individuals and vaccinated and see the obvious numbers that vaccinated people are less likely to die. It invalidates the argument in the article.
> The argument that is being made by the article is "natural immunity is better than vaccine acquired immunity because unvaccinated and previously infected people get hospitalized when they are reinfected less often, so vaccine mandates are bad"
I don't think that's the author's argument though. Their goal doesn't seem to be to pit the two types of immunity against each other and declare one a winner (just look at the title, and quotes like these: Can the case be any clearer, simultaneously, for both the efficacy of vaccines and natural immunity?)
The point is that in large part, a mandate would be imposed on people who already were infected, and these people won't benefit (much anyway), and neither will the vaccinated as a result.
If this was published early pandemic and the article was saying "no mandates, everyone should just get infected", I think your point would stand. But at this stage, there just wouldn't be that much benefit gained by forcing a largely convalescent population to get the shots, and you'd be incurring a heavy cost politically and ethically.
Still breakthrough infections can infect somebody, especially somebody without previous immunity and nobody should rely on somebodies else immunity for their own security.
But currently there are countries that mandate vaccination for people who did survive a previous infection without dying. Isn't that flawed?
In a nutshell:
- Vaccines help - Natural Immunity is best - Mandates don't need to be here now.
Thanks for posting this, very helpful
In principle it is smart to prime your immune system with a vaccine. Then if you get still sick, you will mostly gain benefits from natural immunity.
There are still risks involved because instead of single protein in fixed configuration you will get 29 of them in bioactive forms but at least you have greatly reduced your risk.
Why is existing natural immunity treated like an inferior sibling of being vaccinated (or even ignored completely), even when it provides the most up-to-date protection?
But how severe were these reinfections in terms of symptomatic disease? Protection against infection through vaccination is not great either.
Most civil liberties experts have been very consistently against vaccine mandates, on the basis that they are divisive, dangerous, and quite likely to be counter-productive.
Exceptions, such as the ACLU's recent pro-mandate stance, are based entirely on the scientism which this article takes down so well.
ARR requires that background risk is taken into account. Please note that small remark "Data collected from the Veterans Affairs system between December 2020 and March 2021." under the table.
Has prevalence of the disease changed after this period? Sure, greatly, there was delta wave and there is now omicron wave that has made the virus a lot more prevalent than it was during the winter/spring 2021.
This means that to address the risk, you should take into account future prevalence because it will affect your risk assessment.
Does he do this? No, of course not.
He just tries to look smart and is quite good at it by fooling great amount of people.
Is he really smart? I do not think so.
But I get it. People do not like to be told what to do. Especially when people who tell it are not really smart.
Vaccine mandates are an useful tool to reduce burden on health care system and reduce total amount of deaths. It has population level effect.
But it is being sold as solution for personal level problems. It just does not make sense and every claim about its benefits feels like total bullshit because it mostly is.
Of course vaccines have great personal benefits too. You will reduce your changes of severe illness and death. If there was a vaccine against death in car accidents, I would take it. The others in the accident who die? Well, bad luck for them - should have taken the vaccine too.
The vaccine will also reduce prevalence of the disease but so far the effect on personal level has stayed on coin flip level. Definitely better than nothing but still not great. But this on the population level is a huge difference. If you can reduce the amount of people being infected by half, it would be tens of millions (in US).
But lets get back to the ARR "theory". What if I told you that your child has 0.01% to die when infected. If I have the remedy that will reduce it to 0.009% and it is free but there is 0.001% risk that your child will develop heart condition that has 20% change being long lasting then will you take it? What if your child also has 0.1% of change to develop the same condition when infected but it has 50% change of being long lasting?
Now of course you will ask what is the change that your child will get infected, because you are a smart person. Why take the risk of the remedy when there is no real threat.
What this person is doing, is to confuse you to not ask this question. He claims that because the risk of infection was low in the past, you should not vaccinate your child. He decorates this claim in cleaver terms but the essence of it is exactly this.
Is he stupid or evil, I do not know.
What was the reality with delta wave? In some countries I checked, change of getting infected was about 10% in first weeks in unvaccinated children population. Omicron has been even faster. I would claim that there is near 100% change that your child will get it in coming years.
ARR does not tell us anything about this. This is just a tool used by anti-vaxxers to confuse people. Is this doctor an anti-vaxxer? Maybe not, but he for sure sound like one.
That ones new to me. It almost sounds like a strawman. But I think its just the phrasing. Obviously, vaccinated people are already "protected" from the virus, especially against severe illness and hospitalization, but less so for transmission. So vaccinated people can't really be protected any further, other than by lowering the probability that the person next to them has the virus (which I suppose would be the definition of "protecting vaccinated people" above, or protection from transmission).
This protects everyone, not just vaccinated people. It's what people called "herd immunity," before that started to mean a stealth uncontrolled eugenics project.
Trying to force the last diverse 20% to take something they chose not to is also a clear violation of the Nuremberg code. There's two rules in the code which I believe is relevant for denying participation in vaccinations and their imposed restrictions.
"The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion"
"The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment."
The second point is mostly related to vaccinating younger people "for the benefit of the populace" If you claim something benefits the group, you still have the responsibility of proving that it benefits the group. which for very young people, natural infection might similarly benefit the group just as much as taking the vaccination.
Whether or not the Nuremberg code has any standing in todays courts is debatable but as this experiment has no defined solution it is clear that someone should be able to deny participation.
The point is that the inability to predict the future does not necessarily imply that some action is "experimental," despite your insinuation that it does.
Or we take data we already have and make the conclusion already today - vaccines we currently have save more people from severe illness and death than they possibly put into risk.
I have tried to understand people who are against vaccination and have read great deal of this material and it will eventually, rather sooner than later, end up with complete delusional non-sense.
The study it points to shows that vaccination reduces spread by 40%. It’s a small study with n’s of <40 people, but 40% is a significant reduction in transmission.
Beyond that it tries to somehow ignore the massive benefits in reducing the risk of hospitalization (therefore ignores the fact that even when the vaccinated spread the virus, they are likely to in lower intensity), by claiming that a bad flu year has 50-70k hospitalized Americans. Which is true, and just goes to show how much worse the impact of COVID is on hospitalization when the hospitalization winter peaks have been 140k and 160k, more than double the worst flu season in the US. And no, 12% of the staff not being available (largely because they are burnt out because of COVID) is not even a part of the reason that hospitalization is so much of a problem when hospitalization is 100% greater than the worst flu year.
2) The article does not provide strong studies showing the benefits of reinfections. Other than a letter to the editor, the data ends pre-Omicron, but more importantly, covers a period which is well within the 6-9 month period of the last 2 surges where immunity from both vaccines and infection is considered strong. There is research showing that immunity due to infection does, in fact, reduce dramatically after 6-9 months. It may take some time for the effects of Omicron to be isolated, but either way, at best it shows that variants are able to evade immunity by infection.
3) Finally, they don’t actually provide any downsides to the vaccine mandates. And there are no novel civil liberty based defenses one can hide behind because vaccine mandates already exist for many vaccines. At least in the US, courts have ruled in favor of mandatory vaccinations even over religious objections.
Arguably the likes of Jenny McCarthy, who have been anti vaxxers well before COVID-19 existed can take a principled stance against vaccine mandates, but it’s very difficult for others to do so considering they’ve been accepting them for so long with nary a word against them.
Consequently, an argument against a strong vaccine mandate must test on a cost benefit analysis, and it’s hard to argue against the mandate on a cost benefit analysis, and I don’t see how pointing out a bunch of benefits, without showing any costs (to those who don’t have medical exemptions, who presumably would be exempt from any version of a vaccine mandate) leads to a conclusion against mandates.
I've concluded mandates are useless because they got weaponized- the harder you try to push for vaccines, the harder the people who associated with antivax will push.
I'm curious what outcomes would have been different if we'd reached, say, 99.99% vax in the US.
Gibraltar: - vaccination: two doses >99%, boosted: 85% - cases: 145 (7 day avg)
Gibraltar population is 33k. This is pretty good example that vaccines can't stop the spread. With examples from other highly vaccinated countries (e.g. Portugal, Australia), it doesn't look it's a path to end covid.
You should get vaccinated to improve your own chances, but taking it to protect others doesn't really work.
> the harder the people who associated with antivax will push.
Does your definition of antivax include people who are vaccinated but oppose mandates? Because I would fit that definition and don't consider myself antivax since I do recommend vaccination to people who didn't get it yet. With small difference that I don't want to force them.
And one last question for those who propose mandates. When will mandates end? What happens after 6 months when you're no longer considered vaccinated? Do you subscribe to mandatory vaccination indefinitely?
There are 119 new positive cases in Gibraltar today. 71 are vaccinated and 48 are unvaccinated.
If vaccines didn't prevent transmission, one would expect that second number to be 10 or less given the base rate of vaccination.
All I sad that vaccines can't stop the spread and it still looks like that. I didn't say they don't reduce it or that they're not beneficial otherwise.
Personal anecdote time: I got covid from person who was fully vaccinated 2 months before and didn't have any symptoms. Btw. since this was second time for me, plus with vaccines in the mean time, it was like a very mild cold, one day of temperature and some coughing afterwards.
Hm, numbers I'm googling for Gibraltar don't really add up - population 2021: 35.120, fully vaccinated: 40.722. One explanation would be that there are non-rezidents who are working there and got vaxed, while not counted as population.
Re: your other point, no vaccine is 100% effective at "stopping" spread. Absolutely no vaccine is 100% effective. There is no qualitative difference between prevention and reduction. If it reduces spread, then by definition some nonzero number of potential infections were prevented.
Ok, next bigger countries on vacc list:
- UAE: population 9.3m, 94% fully, 2400 cases 7-day avg
- Portugal: population 10.3m, 89% fully, 55k cases 7-day avg
Especially Portugal's cases don't support that 90% vacc stops spread in any meaningful way.
You're free to present different numbers, but please don't cite anything pre-Omicron since it's not relevant any more.
Once more, my case is that current vaccines are not a way to stop spread and therefore vaccinating low-risk population like kids won't protect the elders. I fully support vaccination for self benefits. As I did for myself.
It looks like the mainstream health authorities have shared up to date information on the protection against infection by omicron by vaccines. If that's the case, doesn't it mean that vaccinating kids would protect elders?
In this way, a reader can deduce what they believe is the closest truth available rather than it be shouted down at them. The fact that grujicd did not interpret Gibraltar data accurately is, I believe in this case, not a mark against them but a testament to how well they formulated their argument that flaws can be evaluated easily.
public health authorities on the other hand will begrudgingly hand over data after months of outcry, as well as change testing criteria and engage in many other methods of purposeful/accidental obfuscation, making their arguments hard to decipher.
I can't really help you if your opinion is that public health authorities are working in bad faith.
I'm not sure what the detailed semantics of "is pro-vax but anti-mandate an anti-vax" position. There's a distinct difference from "anybody should be able to get the vax to protect themselves" and "we should impose mandates because vaccines are most effective when 95+% of the population takes them." If the latter were an extremely strong scientific position (IE, if there was a guarantee of herd immunity at 95% rate) then I think it would be a slam dunk.
I believe the mandates would be done when their effectivity is over. It's not like the people who want to impose these things are doing it because they enjoy exerting power over people. Anyway, there weren't any real large scale mandates forcing people to get vaccinated, so it's kind of moot?
It seems like one can argue for the former without arguing for the latter, but in the current crisis both sides of this debate are conflating the two.