angelzen

The argument is that herd immunity for covid cannot be attained via vaccines. Not even 100% vaccination.

The comparison with measles, another contagious airborne disease, is instructive. The threshold for herd immunity is estimated at 94%. This is possible because the vaccine effectiveness against infection is also 93-97%. Unfortunately covid vaccines have waning effectiveness against infection, estimated at about 50% after 6 months, and possibly waning even further.

"Five reasons why COVID herd immunity is probably impossible"

https://www.nature.com/articles/d41586-021-00728-2

"For example, the measles is a highly contagious illness. It's estimated that 94% of the population must be immune to interrupt the chain of transmission."

https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

"One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps."

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

"Effectiveness against infections declined from 88% (95% CI 86–89) during the first month after full vaccination to 47% (43–51) after 5 months."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

A paper, while not specifically addressing vaccination in immunocompromised patients, documents pretty clearly the phenomenon of runaway mutation chains in such patients.

https://www.nejm.org/doi/full/10.1056/NEJMsb2104756

Edit: Another piece, specifically addressing immunocompromised + covid + vaccines:

"Studies have shown that immunocompromised people are more vulnerable to being hospitalized or dying from COVID and less likely to develop strong protection from vaccination. But there are also some hopeful signs: additional doses of some COVID vaccines, strategic timing of immunosuppressive treatments and prophylactic COVID treatments may boost protection among some immunocompromised individuals—and restore at least some of the freedoms they have lost."

https://www.scientificamerican.com/article/how-immunocomprom...

The OA story is a great illustration why we should never put aside common decency. Break down indecent behavior dampening barriers at the risk of fickle mobs looking for the next target to shame. No one is safe. Even the most self-interested person has plenty to gain from a society that highly values common decency.

* Meet other people? The settled science is that you are putting others at risk of infectious disease.

* Drive a car? The settled science is that you are putting others at risk of blunt force trauma.

* Have a barbecue party? The settled science is that you are putting others at risk of food poisoning.

I see. If authorities claim that they are vaguely concerned about a risk you might pose to others, then they can arrest and confine you with no due process for an indeterminate time period.

Speed limit 20.

While Earth is technically a SPOF, it is also a very large place with a very long track record for successfully supporting complex life forms. We can even say that life forms as we know them are attractors (local minima) in the chemo-energetical ecological landscape provided by Earth. None of this holds for Mars. Even if we are successful in establishing a handful of outposts, they are likely to be short-lived because the ecological balance works against them.

I see. Perhaps you consider "forcing senior health officials to defer some planned deliveries" and "South Africa Asks J&J, Pfizer to Stop Sending Vaccines" are both accurately describing the same fact.

I suppose we should also excuse the prominent biased subtitle, because technically they are just quoting political figures from SA, not making the charge themselves.

The fact under contention is very specific, not just general vaccine hesitancy. The article appears to fail to mention it, unless there is some other quote that can be shared beyond the paywall. More interestingly, here's an approximate heatchart of the probability that a given paragraph in an article will be read by the average reader, by the position in the article the paragraph appears:

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There is a huge difference in attention between (free) headline & subtitle, and a (paywalled) paragraph squirreled somewhere near the end, which I am willing to bet is the case for the nyt article.

The very subtitle of the NYT article, which can be read without a subscription, apparently has changed and now reads: "With countries trying to close their doors to the new coronavirus variant, southern African officials note that the West’s hoarding of vaccines helped create their struggle in the first place." South Africa is the largest southern African country by a large margin (60M of 68M south Africans live in South Africa) [1]. Furthermore, that vaccine demand is so low that South Africa stopped asking for the vaccine is relevant to an article that is quick to prominently blame "the West" for their vaccine troubles.

[1] https://worldpopulationreview.com/continents/southern-africa...

Do you happen to have 2 months old predictions of the models you find non-trivial? My sense is that this is weather vs. climate prediction. They may be able to do a somewhat reasonable job a few days ahead, but beyond that it's all about common sense, i.e. similar to the historical record, as limited as it may be. They probably constantly retrofit the models with current data, which makes it look like the models where accurate all along.

Common sense can also work in the short term. E.g. Austria (and Netherlands) seem to have crested the cases wave [1], which I predicted a 3 days ago by looking at the death rates plateauing, and noticing that the same pattern happened in US southern states and BG/RO [2]. I wonder what said models were saying 3 days ago, if such models exist for AT/NL and if they happen to publish their historical predictions.

[1] https://news.ycombinator.com/item?id=29334288

[2] https://ourworldindata.org/explorers/coronavirus-data-explor...

Make that zero. To their credit, the authors of the Bangladesh mask study released the raw data. "The difference between the two groups was small: only 20 cases out of over 340,000 individuals over a span of 8 weeks." Drawing any conclusions from such small amount of data is deeply unserious.

http://www.argmin.net/2021/11/23/mask-rct-revisited

It's been obvious that covid is seasonal for a long time now. The winter season is here, the covid wave is here. No need for complex math models. BTW, funny how those models usually ignore seasonality, natural immunity or quarantine on symptoms, i.e. basic respiratory infectious disease common sense.

Here's yours truly, cautioning that 'the coming winter risks being brutal', 58 days ago: https://news.ycombinator.com/item?id=28700532

The null hypothesis is the natural state of humanity, without medical intervention.

The insistent downplaying of natural immunity reminds me of an old soviet scifi novel, https://en.wikipedia.org/wiki/The_Air_Seller, if one can get past the on-the-nose soviet motives.

We don't know. They can change the mRNA code for the new spike protein, but they can't force the immune system to respond to the new code. For all we know, the immune system may mistakenly generate a response for the spike it was first imprinted against. This is a well known and documented phenomenon called "original antigenic sin". It sucks.

https://www.jstor.org/stable/985534

https://pubmed.ncbi.nlm.nih.gov/28479213

In masks + covid context it feels like "unethical" is used as a thought terminating cliche.

* The pandemic is affecting 8,000,000,000 people all around the world. A large size RCT enrolls X0,000 participants. For example, the Pfizer covid mRNA vaccine clinical trial had 21,728 placebo participants. For every RCT participant, the RCT results are going to inform the course of action for hundreds of thousands of people. This is to say that such RCTs are extremely valuable given the high infectiousness of the virus.

* The risk to the participants is at worst a moderate increase in the chance of being infected with covid. The covid fatality risk to a healthy adult is small. In the US there have been about 50,000 deaths with covid in <50yo age group. An RCT with 20,000 <50yo people on the placebo arm may see about 3 covid deaths assuming all the placebo participants are going to be infected. Realistically, only a fraction of participants are going to actually be infected with covid, thus there is a good chance every single one of the RCT participants will continue their lives just fine, especially if the study designers are careful to not include people with serious comorbidities.

* Vaccines are available to reduce the death risk by another order of magnitude if deemed necessary. Alas, while the vaccines have strong effects in preventing serious covid, they only have a middling effect on preventing infections [edit: after a few months]. The mask/no mask infection effect remains measurable.

* Covid is endemic. Everyone is at risk to to be infected with covid sooner or later. Wearing a mask may decrease the daily risk by a moderate margin, unfortunately integrated over many days the infection probability approaches 1. The RCT is merely speeding the risk by a moderate margin for the placebo arm participants.

* There is a large pool of potential volunteers that don't (want to) wear masks anyways. Adults have the right to volunteer for risky activities, including activities that may result in death.

> I was also surprised [...] to realize that our sanitary pass allow(ed) vaccinated people to attend mass events or restaurants or places where that pass is mandatory even if they have covid symptoms or are under quarantine.

Unfortunately the bureaucratic apparatus has chosen to overplay the vaccines hand and build up a convenient scapegoat for when the vaccines prove to be less effective than originally claimed. The correct and ethical course of action is for everyone to undergo the same level of social protection measures.

Delta has petered out in SA. This is perhaps the beginning of a new wave. Hopefully not. https://twitter.com/jburnmurdoch/status/1463956690743742470

Common wisdom is that immunocompromised individuals, which are unable to battle off the virus and suffer the infection for long periods of time, are fertile grounds for variants evolution.

"Rapid viral evolution has been described in immunosuppressed patients with persistent SARS-CoV-2 infection. Choi et al. described an immunosuppressed patient with antiphospholipid syndrome who was hospitalized in August 2020 and treated with anticoagulants, glucocorticoids, cyclophosphamide, intermittent rituximab, and eculizumab.2 During 152 days of persistent SARS-CoV-2 infection in this patient, the investigators identified 31 substitutions and three deletions in genome sequences. Twelve spike mutations were found, including seven in a segment of the receptor-binding domain consisting of 24 amino acids, some at sites linked to immune evasion (478, 484, and 493).6,7 The patient eventually died of severe Covid-19–related pneumonia. "

https://www.nejm.org/doi/full/10.1056/NEJMsb2104756

# observed infections = # of infections * probability of testing * probability of authority trustworthiness. Alas, in the developing world test penetration is low and authorities are not particularly trustworthy.

From 1998 https://www.tandfonline.com/doi/pdf/10.1080/0307945980841929..., page S50, Figure 4: BIVAL vv (late 70s) then RISPENS vv+ (early 90s). The text:

"The three major pathotype shifts are:

(1) from m MDV to v MDV strains in the late 1950s;

(2) from v MDV to vv MDV in the late 1970s;

(3) the appearance of the putative vv + pathotype in the early 1990s (Figure 4).

Each occurrence has been associated with greater disease losses which have persisted until introduction of the next generation of vaccine. The reason for the shifts remain speculative. Shifts in the 1970s and 1990s may have been in response to certain MD vaccines. Kreager (1996) has suggested vaccines may have only a 10-year useful life before new strains evolve. The shift in the 1950s occurred prior to vaccine use, but may have been related to changes in poultry husbandry, especially the move towards larger houses and the increasing density of poultry operations in certain geographic regions"

m = mild, v = virulent, vv = very virulent, vv+ = very virulent plus, as explained on page S46, Table 1.

To be very clear, Marek is not covid. I am drawing no equivalence. I just point out that Andrew Read's 2021 articlet is built around a weak argument.

That is a rather hopeful chart. Even the very virulent Delta, in a country 25% vaccinated, has receded to almost negligible levels after ~4 months of flaring up.

Similar cases have happened for decades. Perhaps the frequency has changed, but the phenomenon is rare enough that is hard to tell. Linked an article from 2012.

https://www.cnn.com/2012/03/19/sport/health-muamba-heart-pro...

The core argument is that Marek kills in 10 days or less, which is too soon for viral spread to happen. MDV vaccines keep chickens from dying, thus spread of hot variants can occur. Since covid doesn't kill that much, Marek phenomenon can't happen. The obvious issue with the argument is that the hot lethal variants are observed post vaccine availability. Earlier strains were "mild" or "virulent", but not "very virulent plus". "Death was relatively rare".

From an 1998 article on Marek, there appear to have been at least 3 jumps in Marek virulence, one in the late '50s pre vaccines (mild => virulent) and two post vaccine availability (virulent => very virulent, very virulent => very virulent plus), see chart on page S50.

https://www.tandfonline.com/doi/pdf/10.1080/0307945980841929...

From Andrew Read's own 2015 article:

"MDV became increasingly virulent over the second half of the 20th century [19,21–24]. Until the 1950s, strains of MDV circulating on poultry farms caused a mildly paralytic disease, with lesions largely restricted to peripheral nervous tissue. Death was relatively rare. Today, hyperpathogenic strains are present worldwide. These strains induce lymphomas in a wide range of organs and mortality rates of up to 100% in unvaccinated birds."

https://journals.plos.org/plosbiology/article?id=10.1371/jou...

The conclusion of the rebuttal article you linked to is rather terrifying. If there ever was a "the road to [chicken] Hell is paved with good intentions", this is it.

"In the history of human and animal vaccines, there have not been many cases of vaccine-driven evolution. But in every one of them, individuals and populations have always been better off when vaccinated. At every point in the 50-year history of vaccination against Marek’s disease, an individual chicken exposed to the virus was healthier if it was vaccinated."

Nov 24, 2021 "Health minister suggests fourth vaccine dose amid rising fears of fifth COVID wave"

https://www.timesofisrael.com/health-minister-suggests-fourt...

Vaccines definitely have a positive effect. However, at this point most of it has been already accounted for by vaccinating the elderly populations at risk. Most Western world has elderly vaccination rates over 90-95%, including supposedly anti-vax regions, e.g. Florida [1]. The marginal effect of vaccinating young healthy populations with marginal covid risk is likely to be marginal. Realistically speaking, there aren't that many effective levers the authorities can wield. My hope is that the pattern we've seen in US southern states and BG/RO, i.e. steep short delta waves, will replicate elsewhere.

To keep things in perspective, covid mortality in Germany was 1.2/k since the beginning of the pandemic, compared to 10/k annual death rate from all causes. Hopefully the vaccines will help keeping this number even lower. Further confounding the issue, the death certificate cause of death for infectious diseases often times masks other systemic issues, for instance people with cancer are more susceptible to die of influenza or pneumonia [2]. What I suspect is happening is that covid replaced influenza and pneumonia as the Grim Reaper of choice. Remember that flu "paused" last year [3].

[1] https://www.mayoclinic.org/coronavirus-covid-19/vaccine-trac...

[2] https://pubmed.ncbi.nlm.nih.gov/33107375

[3] https://www.washingtonpost.com/health/2021/10/08/flu-season-...

It is called a "covid wave". Cases go up, then go down. Some people, mostly with frail systems, will sadly falter, not dissimilar to how flu operates. It's pretty clear that we are going to have at least one of these waves every year, no matter what the authorities do or not do. What it is not clear yet is whether it's going to be one wave, or several. I hope one. We'll know by May.

Article in arstechnica.com

CDC deleted the expression "to produce immunity to a specific disease" from the vaccine definition, but still defines:

"Immunity: Protection from an infectious disease. If you are immune to a disease, you can be exposed to it without becoming infected."

https://www.cdc.gov/vaccines/vac-gen/imz-basics.htm

That is a rather superficial "narrative" article that ignores the major impact of industrialization on culture. It is not Western vs. Eastern cultures, it is pre-industrial vs. industrial cultures. Obviously, within those two big clusters there are differences, the point is that those differences are dwarfed by the industrialization variable.