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Comment by funnym0nk3y | Hacker News Reader

However I think it is important for children to get sick. Humans need pathogens to train their immune system.

The hygiene hypothesis is tenuous at best and dangerous (especially for immunocompromised peers!) at worst: https://publichealth.jhu.edu/2022/is-the-hygiene-hypothesis-...

Hardly anyone even thinks about peanut allergies in a nation of 1.4 billion people (India) and kids don't drop dead like flies here.

But sure, let's just call the hygiene hypothesis tenuous.

That's not at all the same thing.

Peanut allergy prevalence in India seems to be 0.3%, while in the western countries it's 1.5-3%.

Or even seasonal allergies to like pollen too, right? There’s just much more pressing breathing related issues to be concerned with (AQI etc)

A: different genes, B: Different reporting standards, C: different access to healthcare for it to be reported

I thought the recommendation was to introduce some peanuts at an early age in order to reduce the risk of getting peanut allergies?

Could it be that people in India have different genetic makeup than people in other countries?

I mean, many populations have more/less risk of many physiological things. That's just how it goes.

Black men are at much higher risk of prostate cancer. White people of melanoma. As a man, I pretty much don't have to worry about autoimmune disorders because my risk is 1/10th that of a woman's. But, my risk of heart disease is much higher - even at the same weight!

Like your article states, there’s some evidence for exposure to benign microbes reducing allergies, but that is completely different than pathogens strengthening the immune system. Unfortunately some people seem to have remembered the hygiene hypothesis as meaning that microbes of all kinds are actually good.

There’s also a concept of immunity debt, although that’s more of an explanation for certain diseases being especially bad the year following COVID restrictions than an argument for exposure.

From the linked article:

"Almost no virus is protective against allergic disease or other immune diseases. In fact, infections with viruses mostly either contribute to the development of those diseases or worsen them.

The opposite is true of bacteria. There are good bacteria and there are bad bacteria. The good bacteria we call commensals. Our bodies actually have more bacterial cells than human cells. What we’ve learned over the years is that the association with family life and the environment probably has more to do with the microbiome. So one thing I would say is sanitizing every surface in your home to an extreme is probably not a good thing. Our research team showed in animals that sterile environments don’t allow the immune system to develop at all. We don’t want that."

Commensal bacteria are generally not airborne, whilst viruses that harm the immune system often are. So surface hygiene can be overdone, but air hygiene is a good idea.

I've had COVID multiple times and each time my immune system takes a bigger and bigger battering, leading to many other issues.

Are the benefits of this theory meant to start appearing any time soon...?

How often and how sick? The more the better?

It’s a good question. Obviously infinite sick is not desirable. If it were possible to induce antibodies via e.g. broad spectrum vaccinations would we see less sick kids in total?

After all the merits are supposedly eventual conferred immunity, not physically being ill. No reason to think you need to be sick to benefit.

This oversimplifies the original idea behind what you're trying to recall. Being sick in and of itself is not the beneficial part, it's exposure that can be beneficial in certain cases. If you can get the exposure without actually falling ill it's all the better, it's a win-win. Note that not all exposure is good, for example you never want to be exposed to the bubonic plague if at all possible.

Immune system won't help against air pollution from traffic and factories and forest fires.

That sounds plausible, but do you think it's better to be more sick than less?

Or do you just think that having a few sick days per year is better than marching into work no matter what state you're in? A very different proposition.

I suspect it's probably better to shift the sick days earlier in life. We probably can't significantly reduce the total. There are hundreds of endemic upper respiratory viruses and we all eventually get infected with most of them. It's just a matter of time. Our immune systems generally degrade as we age, so over the long run it's probably better to get infected when we're younger so that we can build immunity that protects us when we're older.

> We probably can't significantly reduce the total

That's ridiculous. During the crisis times of covid, the incidences of other communicable disease dropped significantly. Plus, to be frank, this is just an idiotic suggestion with zero reasons to think there's some set number of days people are sick. Before having kids in daycare I was rarely sick. I had a child not in daycare and was never sick. Now we're sick all the time, which wouldn't happen if my wife could stay home with them or we didn't have kids.

That's ridiculous. The interventions put in place during the crisis times of COVID were obviously unsustainable. When restrictions were lifted, the incidence of all other types of respiratory viruses spiked up.

I've had kids in daycare as well. Occasionally you get the sniffles. So what.

The story describes something that cut the average number of sick days by around 30%. Is 30% significant, in your opinion?

"Other" meaning "flu", which only dropped because they stopped tracking it to give resources to SARS-CoV-2. There was a note on the CDC website that very few people actually noticed, and almost all claims of reduced transmission used the CDC's FluView as their evidence.

> We probably can't significantly reduce the total

We can and we have. Through things such as the measles vaccine.

People forget that child mortality used to be a thing.

Sure, childhood immunization is great but we're not discussing measles here. Measles is a single, relatively stable virus that's easy to vaccinate against. But children in daycare facilities mostly get infected with upper respiratory viruses. There are literally hundreds of such endemic viruses, especially rhinoviruses but also coronaviruses and others. We aren't likely to have effective vaccines against those any time soon. If children aren't exposed to them in daycare then they'll be exposed somewhere else. Those viruses aren't going away and will continue circulating through the population no matter what we do.

> We probably can't significantly reduce the total

Considering it used to be commonplace to have 10 children and then maybe 2/3 make it to adulthood, I would say we absolutely can and have reduced the total number of sick days. We've also reduced the severity of sickness.

Don't worry, there will still be plenty of sickness. The article says 1/3 reduction. If you have kids, you'll know that the resulting number of sick days is still huge.

They're still getting sick.

While I personally agree with this sentiment, the last few years have made it amply clear that the population prefers padded rooms to icky playground sandlots.

Nuance: They're still getting exposed and thus gaining immunity with the environmental filtering, just not so much viral load as to be out of school [as often].

It's a win-win from that perspective and dismissing that serves no one in the end.

This tiny but significant factor is also why masks, even surgical masks, are so helpful. They don't need to prevent 100% transmission, just reduce the viral load received or passed on.

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