[HN Gopher] Covid vaccination linked to 'substantial reduction' ...
___________________________________________________________________
Covid vaccination linked to 'substantial reduction' in hospital
admissions
Author : BellLabradors
Score : 237 points
Date : 2021-02-22 13:55 UTC (9 hours ago)
(HTM) web link (www.heraldscotland.com)
(TXT) w3m dump (www.heraldscotland.com)
| [deleted]
| kuu wrote:
| If I'm not wrong, UK is only giving the first dose for now. I
| feel glad and relieve that with only one dose it is working.
|
| There seems to be a light at the end of this tunnel :)
| simonbarker87 wrote:
| I think you are wrong, all my relatives who have had theres
| have had two or know when their next one is I belive
| [deleted]
| Zariel wrote:
| Check the data yourself,
| https://coronavirus.data.gov.uk/details/vaccinations
|
| Most people I know who have a vaccine have had 2 doses
| Balero wrote:
| OP is correct, the link you've posted shows that around
| 600,000 have had 2 doses, and over 15 million have had 1.
|
| The UK is pushing to get all 'at risk' people one dose
| (around 49% of people getting the vaccine) as a priority,
| with the second dose following within 12 weeks.
| ceejayoz wrote:
| That's 600,000 times OP is _in_ correct.
| advanced-DnD wrote:
| Or OP is 3.5% incorrect.
| kuu wrote:
| OP here, I was partially incorrect, see:
| https://news.ycombinator.com/item?id=26226801
| ageitgey wrote:
| The UK is giving both doses. It's just that they are spacing
| them out at 12 weeks instead of 3-4 weeks. The idea is that
| this gives more at-risk people substantial protection more
| quickly.
| dragonwriter wrote:
| > The UK is giving both doses. It's just that they are
| spacing them out at 12 weeks instead of 3-4 weeks.
|
| Are they doing that for all vaccines, or just the
| Oxford/AstraZeneca one? Because that appears to be the
| recommended and most effective interval for the Oxford
| vaccine, but not for the others. (Note that the mix of
| vaccines approved for use differs considerably from country
| to country; Oxford/AstraZeneca is not in use on the US, only
| Moderna and Pfizer/BioNTech.
| dan-robertson wrote:
| There's not really much data on what the most effective
| interval is, though I think some data might come out of
| Israel and the NHS will probably try to conduct some
| randomised controlled trials. The choices made in the phase
| 3 clinical trials were driven by trying to pick a
| sufficiently large dose that the trial would succeed and as
| short an interval as reasonable to make the trials take
| less time. For other vaccines, larger intervals have been
| more effective. Given how unwilling politicians were to
| speed up rollout, I think aiming for maximum efficacy with
| minimum trial latency was the best decision the drug
| companies could have made.
| nicoburns wrote:
| They're doing it for both Oxford/AstraZeneca and Pfizer,
| which are the two approved vaccines in the UK at the
| moment.
| mprovost wrote:
| Moderna is also approved, although there doesn't seem to
| be much supply. Novavax should also be approved within
| the next few weeks.
| loveistheanswer wrote:
| Until we have challenge trials, how do we know whether or not
| other variables, such as natural herd immunity and seasonality
| are not also significant contributing factors to the 'substantial
| reduction'?
| rozab wrote:
| At the very least it would be easy to measure the vaccines
| effect on severity by comparing the rate of hospitalisations to
| the rate of infection
| Guest19023892 wrote:
| The numbers from Israel seem to show the 60+ age group that has
| been vaccinated with two doses is seeing a sharp drop in
| hospital admissions compared to the under 60 group that is
| still mostly unvaccinated. This should rule out the herd
| immunity and seasonality arguments.
|
| https://i.imgur.com/Tu3ckZN.jpg
|
| https://i.imgur.com/1eP5sbi.jpg
| pipeoperator wrote:
| This appears to be similar to what's being seen in Scotland:
| deaths in the over 85 age group dropping sharply compared to
| younger age groups.
|
| BBC Scotland article has some more data on the progress of
| the vaccine rollout and the impact it's having on outcomes:
| https://www.bbc.co.uk/news/uk-scotland-56097899
| paganel wrote:
| I would have expected even lower hospital admission numbers
| for the 60+ population, I mean taking into consideration that
| almost 80% of them have already been vaccinated.
| Lewton wrote:
| Older people with COVID bad enough that they end up in the
| hospital usually stay there for 3-6 weeks
| dboreham wrote:
| Data from personal friends contradicts this. 2-8 days in
| my sample.
| iso1631 wrote:
| That's called an annectdote.
|
| https://www.kpcnews.com/covid-19/article_8ab408ad-8fb0-5f
| 74-...
|
| Overall, the average hospital stay for COVID-19 for all
| ages is 22.4 days, just over three weeks. The length of
| stay is slightly longer, 23.5 days, for regular hospital
| admissions and shorter for ICU patients at 16 days,
| likely because ICU patients go on to die in the hospital.
|
| That's based over thousands of patients.
|
| > Patients in their 50s, who make up the third largest
| group of hospitalizations at 17.8% of all admissions,
| have, to date, had the longest average hospital stays at
| 27.5 days on average.
|
| > Older patients have slightly lower average stays than
| middle-aged Hoosiers -- again, likely because they are
| more prone to die in care than younger patients
|
| > The average stays for patients in their 30s is 16.4
| days
| dboreham wrote:
| > That's called an annectdote.
|
| Oh look: this data matches my annecdote(sic):
|
| https://bmcmedicine.biomedcentral.com/articles/10.1186/s1
| 291...
| iso1631 wrote:
| That study specifically says
|
| "There were too few studies to conduct any comparison by
| age or disease severity. "
|
| It also dates back from a year ago, under very different
| circumstances to today
| learc83 wrote:
| You have a control group of unvaccinated people.
| ssully wrote:
| These people are starting to get vaccinated now though[1],
| which actually causes issues with the study.
|
| [1]:https://www.npr.org/sections/health-
| shots/2021/02/19/9691430...
| ceejayoz wrote:
| That's the clinical trials, but it should be reasonably
| straightforward to do observational studies on COVID
| hospitalizations cross-referenced with vaccine status.
|
| There are plenty of millions of people who haven't yet (or
| won't ever) get vaccinated to serve as a control.
| woeirua wrote:
| Because you look at similar cohorts at the same time. So if
| group A has received the vaccine, but group B has not, _and_
| they 're being observed during the same time/geographical area,
| _and_ the groups are sufficiently randomized otherwise, then
| you would expect to capture the effect of any other confounding
| variables.
|
| Given the large number of people vaccinated so far, and the
| magnitude of the effect it's pretty safe to say that the
| vaccine is causing a significant reduction in hospitalizations
| independent from the broader background trend towards lower
| prevalence of the disease overall.
| foolmeonce wrote:
| Sounds like cherry picking to me. Doctors know if you have
| been vaccinated when making this decision. I.e. perhaps 90%
| of people with 1 dose who are admitted are serious enough to
| need intensive care vs a small percentage of non-vaccinated
| patients admitted more often as a precaution.
|
| I guess everyone here thinks double blind trials are for
| fools?
| woeirua wrote:
| I think the clinical guidance is still the same, that is
| you get admitted when you are showing certain symptoms
| regardless of vaccination status.
| DanBC wrote:
| https://www.gov.uk/government/publications/phe-monitoring-of...
| hannob wrote:
| We don't, but a challenge trial wouldn't change that.
|
| Best you could do with a challenge trial is to get faster to
| the results we already have. These vaccines work. We know that.
| This is just observational data supporting that what works in
| trials also works in the real world (which is not particularly
| surprising).
| nickthemagicman wrote:
| Give up trying to have any reason or rationality about this.
|
| The world wants this mass hysteria. I'm starting to think it's
| not even about Corona virus anymore. Everyone has an agenda.
| From the remote workers to the politicians to the news media to
| the people getting unemployment.
|
| You just have to let the madness pass as it looks like it's
| making progress towards being behind us.
| swayvil wrote:
| Or maybe they just lied about the numbers and the whole story
| is pure fabrication from the start.
|
| I wouldn't believe any of those guys.
| malandrew wrote:
| Isn't there also a confounding factor that the vaccinations
| were largely introduced following the thanksgiving and
| christmas infection events. Even without a vaccine, I would
| have expected hospitalizations to fall approximately 1 to 1.5
| months after the Christmas holiday.
|
| Basically, we had many clusters of fresh unburnt tinder (the
| household covid pod) and the Thanksgiving and Christmas holiday
| was a perfect event for many people to "just this one time"
| break quarantine protocol, leading to the many infections we
| saw. That's a 2-3 week increase in direct hospitalizations from
| those events, and then you have another 2-3 weeks of indirect
| hospitalizations impacting the remaining members of each covid
| pod. Anecdotally, I've personally witnessed this happen as I
| know fare more people that acquired immunity from becoming
| infected during the holidays than for most of last year.
| bluGill wrote:
| Depends on where you live, in the Midwest the peak was more
| around Halloween in October. You can hardly find Thanksgiving
| in any data (and then you probably have to squint and ignore
| proper statistics) By Chirstmas/new year things were clearly
| in decline. Other areas of course have different results.
| malandrew wrote:
| In those areas, has the rate of decline just been
| consistently downward? Has vaccine introduction had any
| measurable impact?
| unanswered wrote:
| The government will tell us of course! Are you one of those
| lolbertarians who thinks covid is a myth and doesn't trust
| government?
| asabjorn wrote:
| This WSJ article mention herd immunity. Covid spread really
| fast, so herd immunity through a combination of the large
| amount of people that already had covid and vaccination of the
| vulnerable should make a big difference.
|
| https://www.wsj.com/articles/well-have-herd-immunity-by-apri...
| bawolff wrote:
| Because its still winter and herd immunity from natural
| infections is a gradual process not a steep cliff? At the very
| least it seems like those factors could be accounted for.
| AndrewBissell wrote:
| Seasonal viruses often peak before the official end of
| winter. The key date may be the winter solstice in late
| December when sun exposure reaches its minimum.
| [deleted]
| aqme28 wrote:
| You don't need a challenge trial if you have large enough
| control and experimental groups.
|
| A challenge trial just reduces the time and number of people it
| takes--not everything needs a challenge trial.
| hinkley wrote:
| Why would seasonality be coming up now when we're a year into
| this thing?
|
| Do you think we got a break at the beginning that we didn't
| identify in the numbers?
| taeric wrote:
| I think it has been shown that standard corona seasonality
| shows the same shape of all case loads we have seen?
|
| That is, most of the recovery we saw last year going into
| summer could potentially be explained by regular cycles of
| similar viruses in the areas. The impression being that that
| could also explain or current recovery.
|
| It is not an argument against vaccination. And I haven't seen
| people pushing we have heard immunity, yet. But the stark
| drops we are seeing do seen surprisingly sharp.
| mikepurvis wrote:
| "the stark drops we are seeing do seen surprisingly sharp"
|
| Surely that suggests an unnatural cause, such as millions
| of vaccine doses being rolled out, specifically targeting
| the most vulnerable (LTC residents) and those most likely
| to catch/spread the virus (medical profession, first
| responders, front line workers)?
| hinkley wrote:
| Where are we at in mapping genotypes of the most affected
| and the superspreaders?
|
| Perhaps exposure has reached saturation among certain
| populations.
| taeric wrote:
| The argument is, if that were the case, it would be
| sharper than the natural charts of corona viruses
| otherwise.
|
| To be clear, I first saw this pushed by some epis on
| Twitter as caution to get to hopeful that we are seeing
| the vaccines as a resounding success so early in their
| rollout. It is expected that the vaccines are needed, but
| the dramatic drop was pushed as likely unrelated.
|
| I will try and dig up the tweets. Could be they have
| changed their minds with more data.
|
| Also, my first sentence was a question as I am not sure
| that is what the opening post meant.
|
| Edit: https://twitter.com/jbarro/status/13638661440299499
| 52?s=19 had a recent discussion where this came up.
| (Looking for epis in this one, but not finding them.:( )
|
| Edit: https://twitter.com/EricTopol/status/13635519120212
| 21377?s=1... is a look at a drop without vaccines
| hinkley wrote:
| Could it be that there's a strain that results in largely
| asymptomatic cases and there is not enough data on those
| people? That could result in a decline now due to
| competition, or the slope of the line is historically
| wrong due to invisible statistics.
|
| I know there has been some trouble identifying antibodies
| in people who were exposed months ago. So if you aren't
| really sick, you only get counted (maybe) if someone in
| your circle gets really sick.
| taeric wrote:
| For myself? I have no idea. I think this would fall under
| a general data quality concern.
|
| I can say I have not seen this brought up too much on
| Twitter. With the caveat that I am not following
| everyone. :)
| hinkley wrote:
| I do know that sometimes graphs with weird dog-legs are
| caused by either graphing the wrong derivative[1], or
| because there are more populations and someone is either
| being devious or is unaware.
|
| [1] Developers are by and large flummoxed by S-curves for
| progress. An S curve for distance maps to a bell curve
| for velocity. If the sums don't make sense, look at the
| rates, or the rate of change. Don't keep staring at the S
| trying to fit trend lines.
| malandrew wrote:
| Thanksgiving and Christmas holiday were both events where
| many people that were diligent about quarantine protocol for
| the past year decided to break protocol "just this once"
| because it involved the two primary holidays for gathering
| with loved ones.
| drummer wrote:
| > Roll-out of the first vaccine dose now needs to be accelerated
| globally to help overcome this terrible disease.
|
| In a publication in the International Journal of Antimicrobial
| Agents titled "SARS-CoV-2: fear versus data" (March 19th 2020),
| the researchers indicate that "there does not seem to be a
| significant difference between the mortality rate of SARS-CoV-2
| in OECD countries and that of common coronaviruses". Furthermore,
| according to their analysis, "SARS-CoV-2 infection cannot be
| described as being statistically more severe than infection with
| other coronaviruses in common circulation. [...] Finally, in OECD
| countries, SARS-CoV-2 does not seem to be deadlier than other
| circulating viruses."
| DenisM wrote:
| Well, that's a year old now, isn't it?
|
| And the negative impact of the virus consists of both mortality
| and virality.
| drummer wrote:
| Data still shows the same. IFR is comparable to mild flu. 98%
| of people show no to mild symptoms. Virus is overhyped.
| ashtonbaker wrote:
| Again, both IFR and transmissibility matter when we're
| discussing the severity of a disease. You're only talking
| about IFR.
| robertofmoria wrote:
| This just in! Covid19 not serious. Treatment already exists and
| was known. Reaction to covid19 worse than the disease.
| mchusma wrote:
| The UKs adoption of First Dose First is amazing and inspiring in
| a time when governments worldwide seem unable to operate
| effectively.
|
| There are 2 things every country can do to save lives that have
| effectively zero cost and zero negative externalities:
|
| - lifting lingering vaccine bans (the US's ban of AZ is most
| glaring)
|
| - first dose first - the evidence is overwhelming at this point.
|
| These two things, which could be done almost certainly by Biden
| alone (in the US), would allow possibly everyone who wants a
| vaccine to get one by the end of March, instead of July with the
| current projections. And this decision is effectively zero risk.
| bpodgursky wrote:
| The other almost-certain win would be half-doses of the mRNA
| vaccines (ie, double supply) given the antibody responses we
| saw with lower doses, but that's probably asking for too
| much...
| matwood wrote:
| Or even a hybrid. Age 65+ stays on the 2 dose schedule 3 weeks
| apart, and under 65 follows FDF.
| prox wrote:
| What is first dose first?
| dan-robertson wrote:
| See, for example, https://marginalrevolution.com/marginalrevo
| lution/2020/12/fi...
| jedberg wrote:
| The UK's policy of making sure everyone gets their first dose
| of the two dose vaccines before most everyone gets their
| second, setting the second dose at 3 months instead of 3-4
| weeks.
| ytwySXpMbS wrote:
| This isn't quite right. The UK has delayed second doses to
| 3 months after the first dose to enable more people to get
| their first dose quicker. The plan is all adults vaccinated
| by September, and they certainly aren't delaying second
| doses until then.
| timthorn wrote:
| That's been brought in - all adults are now expected to
| be offered their first dose by 21 July.
| djrogers wrote:
| While those 2 things would help, I haven't seen any projections
| that could possibly put supply _or_ distribution availability
| at ~400M doses in the next 5 weeks.
| alistairSH wrote:
| We'd need about 278 million doses (in the US). We're
| approaching 15% vaccinated, out of a population of 328
| million.
| sib wrote:
| Probably fewer, since much of the population (at least
| those under 16) isn't eligible.
| jedberg wrote:
| > the US's ban of AZ is most glaring
|
| People said the same thing about the US's ban on thalidomide
| until it turned out they were right.
|
| In this case I'm ok with a little conservatism on the part of
| the FDA. The US is already in 4th place on vaccinations per
| capita, just barely behind the UK, without either of those
| policies.
|
| Copying from my comment below, a bunch of other examples of
| times when the FDA was right and European regulators were
| wrong:
|
| https://en.wikipedia.org/wiki/Lumiracoxib -- Approved in
| Europe, not the USA. Withdrawn from sales due to side effects.
|
| https://en.wikipedia.org/wiki/Zimelidine -- Same.
|
| https://en.wikipedia.org/wiki/Tolrestat -- Approved in Europe,
| failed stage 3 clinical in the USA
|
| https://en.wikipedia.org/wiki/Rimonabant -- Approved in Europe,
| failed in the USA, withdrawn _worldwide_ because the side
| effects were so bad.
|
| Thalidomide is just the most famous because it was the most
| disastrous, but there are plenty of others.
|
| The FDA has a strong many decades track record.
| BurningFrog wrote:
| This is a very dangerous argument.
|
| Decisions to approve or ban medications are difficult because
| they're about probabilities, and whichever decision you make,
| there is an expected body count attached to it.
|
| The "but Thalidomide!" argument only considers one side: If
| you approve a medication that ends up hurting/killing people.
| That is bad, and everybody understands that.
|
| The other side is that if you delay the approval of a life
| saving drug, that _also_ kills a lot of people who die while
| you wait. That is bad, and very few understand that.
|
| The same people who died before, keep dying today. This does
| not make news, no one has to resign, and as a result
| regulators become very prone to err on the side on delaying
| approvals.
|
| How many Americans have died from this bias since Thalidomide
| is unknowable, but it's definitely in 6 figures, maybe more.
| nickpp wrote:
| It's been over 50 years since the thalidomide tragedy. Do you
| still let plane crashes of last century direct your choice of
| transportation?
| wpietri wrote:
| Plane crashes of the last century deeply inform regulation
| of planes this century. It's why we have so few plane
| crashes despite massive increases in passenger-miles flown.
| nickpp wrote:
| I strongly doubt the planes of today present the
| vulnerabilities of last century. Those lessons were leant
| and applied. Today's airplanes have different issues and
| policy should better be about the current issues (and
| crashes) otherwise it would be outdated and obsolete.
|
| But my analogy was about recommending flying or not
| flying: you should base that recommendation on the safety
| of today's airplanes, not on the crashes of the past
| (even if those crashes enabled the current safety level).
| jedberg wrote:
| The point is the USA was right when everyone else was wrong
| and didn't bow to public pressure, and so I trust them a
| bit more when they are conservative with approvals.
| nickpp wrote:
| Yes it was right _in that case_ , but blindly letting a
| single tragedy direct policy without taking into
| consideration current factors is extremely dangerous.
|
| People are dying of COVID right now. If fear of another
| thalidomide incident delays a saving vaccine we may end
| up losing more lives than potentially saving.
| jedberg wrote:
| It's not blindly letting a single tragedy set policy.
| It's one example of many that the FDA has used to build
| up trust in their process over the last eight decades.
|
| And it's not like the AZ vax is the only option out
| there. The lives will still be saved with the other
| vaccines.
| nickpp wrote:
| I don't know any of the other "many examples", the only
| one I keep hearing about is the thalidomide incident.
|
| Kind of like when people opposing nuclear power keep
| bringing up Chernobyl and Fukushima while ignoring their
| relative tiny victim count compared to the millions of
| people killed by our fossil energy production.
| jedberg wrote:
| https://en.wikipedia.org/wiki/Lumiracoxib -- Approved in
| Europe, not the USA. Withdrawn from sales due to side
| effects.
|
| https://en.wikipedia.org/wiki/Zimelidine -- Same.
|
| https://en.wikipedia.org/wiki/Tolrestat -- Approved in
| Europe, failed stage 3 clinical in the USA
|
| https://en.wikipedia.org/wiki/Rimonabant -- Approved in
| Europe, failed in the USA, withdrawn _worldwide_ because
| the side effects were so bad.
|
| Thalidomide is just the most famous because it was the
| most disastrous, but there are plenty of others. Like I
| said, the FDA has a strong many decades track record.
|
| This is nothing like opposing nuclear plants.
| nickpp wrote:
| OK, but if any of those was actually saving lives I'd
| argue it should've been approved, side effects be damned.
|
| Last time I looked, thousands of people were dying every
| day of Covid. Ignoring those just in case a vaccine is
| harmful is, IMHO, a bad tradeoff and I don't trust the
| people making it in my name. I prefer, in life-or-death
| situations, making my own (informed) decisions.
| jedberg wrote:
| If the AZ drug were the only COVID vax available, I might
| agree with you. But there are already two others and a
| third on a the way, all of which are more effective than
| the AZ drug. And the USA has already negotiated to get
| more of the approved ones than the UK is getting on a per
| capita basis.
|
| Allowing a drug you know doesn't work well is a great way
| to break the public trust, especially when there are
| plenty of alternatives.
| nickpp wrote:
| You'd be quite right if we had plenty of mRNA vaccines
| available, but, if I'm not mistaken, we are supply
| constrained and we'll be for at least a couple more
| months. Months in which people are dying, people who
| could be saved by the AZ vaccine, of course at some risk
| - but which is very much preferable to death, I'd say.
| jedberg wrote:
| The AZ vaccine still needs to be produced, it isn't
| sitting in a warehouse somewhere. The amount of time it
| would take to make AZ vaccine is the same as making the
| other Pfizer/Moderna vaccines. It's unlikely it would
| increase supply at all.
| nickpp wrote:
| I disagree, 3 vaccine sources should be better than 2.
|
| Now, if the US _hasn 't contracted_ any AZ vaccine, then
| you're right and the whole discussion is moot.
| ahmedshaikh wrote:
| What about those things Michael Yeadon & Dr Sucharit Bhakdi said
| about the vaccines being useless. Are they just dumbfuck chodes ?
| EliRivers wrote:
| Tough break here for Betteridge's law :/
| swayvil wrote:
| He got censored.
|
| What do you call censorship when you don't trust the censor?
| Entropy? Noise?
| InitialLastName wrote:
| Definitely censorship, and not moderating someone making
| unfounded, uncited, and crudely insulting allegations.
| swayvil wrote:
| Seeing as how he got censored, we don't know that.
| InitialLastName wrote:
| They got flagged by users. We can still see what they
| wrote, see that it effectively willfully provided
| negative value to the conversation, and move on without
| it having to be a global conspiracy.
| guilhas wrote:
| Cases are going down worldwide, numbers of vaccinated are too low
| to be relevant and second dose even lower.
|
| Also when vaccination started, we can clearly see a spike in
| deaths. Are those "linked"?
|
| https://www.dailymail.co.uk/news/article-9273943/Why-Covid-r...
| kop316 wrote:
| "By the fourth week after receiving the initial dose, the Pfizer
| and Oxford-AstraZeneca vaccines were shown to reduce the risk of
| hospitalisation from Covid-19 by up to 85 per cent and 94 per
| cent, respectively.
|
| Among those aged 80 years and over - one of the highest risk
| groups - vaccination was associated with an 81 per cent reduction
| in hospitalisation risk in the fourth week, when the results for
| both vaccines were combined."
|
| I wanted to highlight this part for folks reading. My brothers
| Mother in Law is now hospitalized due to COVID, and there is a
| high likelyhood that she will not survive COVID due to lung
| scarring. She got her first COVID vaccination about a week before
| she got COVID.
|
| You are not out of the woods just because you got your first dose
| COVID vaccine! It will take time for it to take affect.
| tonyedgecombe wrote:
| I think the figures from Israel show you are at increased risk
| of infection for the first week after the vaccine is
| administered. Presumably because people are already starting to
| change their behaviour.
| cnlevy wrote:
| It could also be because people got contaminated IN
| vaccination centers when coming for their first vaccine dose.
| Told from a doctor working in Israel.
| ashtonbaker wrote:
| I've worked several full days at a vaccination center in
| Michigan. It's quite crowded, something like a grocery
| store. It wouldn't surprise me if there was some spread
| there.
| merpnderp wrote:
| The vaccination locations are the largest group of people
| anyone I know how been around in a year. Dozens of people
| coming in and out of a room every 15 minutes, plus having
| to sit next to strangers for 15 minutes to make sure you
| don't have an adverse reaction is a larger risk than most
| take ever.
| mancerayder wrote:
| Is it possible the immune response initially from the virus
| causes strain on the body and temporarily and paradoxically
| makes it more susceptible ?
|
| The immune system can be weakened from a bunch of things,
| including lack of sleep and stress and other infections.
| StavrosK wrote:
| The AZ vaccine is more effective than the BioNTech one? That's
| extremely interesting.
| Exmoor wrote:
| Edit: I'm an idiot who was trying to do too many things at
| once and misread. Removing my incorrect commentary on 95% CI
| numbers. I'll leave the excerpt from the study since that's
| useful info.
|
| >Findings: The first dose of the BNT162b2 vaccine was
| associated with a vaccine effect of 85% (95% confidence
| interval [CI] 76 to 91) for COVID-19 related hospitalisation
| at 28-34 days post-vaccination. Vaccine effect at the same
| time interval for the ChAdOx1 vaccine was 94% (95% CI 73 to
| 99). Results of combined vaccine effect for prevention of
| COVID-19 related hospitalisation were comparable when
| restricting the analysis to those aged >=80 years (81%; 95%
| CI 65 to 90 at 28-34 days post-vaccination).`
|
| [0] https://www.ed.ac.uk/files/atoms/files/scotland_firstvacc
| ine...
| mcguire wrote:
| " _85% (95% confidence interval [CI] 76 to 91) ... 94% (95%
| CI 73 to 99)_ "
|
| Those aren't overlapping?
| Exmoor wrote:
| :facepalm: Wow. Trying to do too many things at once this
| morning and totally misread the numbers. Edited my
| original post. Thanks for catching.
| solarkraft wrote:
| With my very little biology knowledge I could imagine it
| being linked to the much stronger reaction many people seem
| to have to the AZ vs. the BioNTech one, resulting in more
| solid immunity.
| ageitgey wrote:
| I wouldn't read too much into that small difference. This
| study wasn't really designed to show which one works better.
| The bigger takeaway is that both show significant protection
| even with just one dose (which presumably rises after the
| second dose).
| sgt101 wrote:
| Agree. I can't find the right information but I suspect
| that the headline figures from the different vaccine trials
| may be generated by somewhat different counting
| methodologies. I think that some of the trials counted from
| day 1 of the vaccination, and some of them from day 15 -
| but I am hoping that someone has the actual information!
| turbonaut wrote:
| The vaccines have also been delivered in slightly
| different contexts that may relate to risk of
| hospitalisation.
|
| Pfizer, for example, often administered in hospitals due
| to the freezer requirement.
|
| You could imagine the risk of hospitalisation of an 80
| year old who frequents hospitals and one who doesn't is
| different.
| sgt101 wrote:
| That's an excellent observation - very challenging to
| fish that out of the numbers.
| zeku wrote:
| I could be wrong, but I think that's after just one dose. The
| pfizer vax requires 2 doses for it's full effect.
| checker659 wrote:
| AZ had 100% efficacy against severe disease in their 3rd
| phase interim readout. 0 hospitalization in vaccinated arm, 8
| hospitalizations 1 severe and 1 death in the control arm.
|
| In contrast, with pfizer, there were 0 covid deaths in the
| entire trial (vaccinated or unvaccinated).
| ageitgey wrote:
| I sorry to hear about your brother's Mother-in-Law.
|
| I just wanted to concur for anyone who is not yet aware: all
| the data so far (from multiple studies) shows that there is
| zero or near zero protection for the first two weeks after the
| first dose. It's not until the third/fourth weeks after the
| dose that you start to see substantial protection, with higher
| protection the fourth week.
| kop316 wrote:
| Thanks. Sadly we just heard she will not make it and is being
| moved to Hospice.
| lordnacho wrote:
| So sorry to hear this. My mother also died of covid, and I
| also feel there's a warning in her story for everyone.
|
| She'd been sad for several months from my father dying, so
| during the summer she went to visit her sister abroad.
| Until then she'd been shielding at home. They both knew
| about the virus but thought it wouldn't happen to them,
| arranging group meals with old friends.
|
| Three of them went to ICU, and everyone tested positive.
|
| It's of course up to people themselves what risk they want
| to take, but with this disease in particular the numbers
| are deceiving. The general figures seem so low but are
| actually a heck of a lot higher than flu. They're also
| markedly higher if you're in a risk group.
|
| It's also terrible because as family you think the odds are
| okay, most people at every stage (cough, hospital, icu)
| survive, until the doctor calls you and says it's tonight.
| iso1631 wrote:
| Must be awful - to lose someone from covid over the last 12
| months would be bad, but to be so close to the finish
| line....
| kop316 wrote:
| Yeah....I can only imagine what they are going through.
| That was why I posted that comment, I can't do anything
| for her, but I can hope that others will see that and
| take heed.
| xur17 wrote:
| Do you remember what studies this data was from? I'd be
| curious to look at it.
|
| The fda filing [0] for Moderna seemed to indicate a decent
| uptick in protection > 14 days after dose 1 (which seems to
| mirror the studies you are referencing). I see a "Vaccine
| Efficacy" of 92.1% for > 14 days after dose 1, which seems to
| be fairly close to the ~95% efficacy I've seen described for
| 14 days after dose 2.
|
| [0] https://www.fda.gov/media/144434/download (page 28)
| jhayward wrote:
| We should note that the >14-day efficacy is presumed to
| decay fairly rapidly, thus the need for the 2nd dose to
| cement the response long-term, as well as eke out the last
| few percent of efficacy.
| selimthegrim wrote:
| Then why is the delay in second doses being encouraged?
| xur17 wrote:
| I imagine "fairly rapidly" means a few months rather than
| a few weeks, in which case delaying the second dose from
| 4 weeks to 8 weeks won't cause any dramatic dips (this is
| all conjecture though).
| iso1631 wrote:
| The idea behind the second dose being delayed in the UK
| was it was better to give 24 million and 80% coverage to
| the most vulnerable people with 1 dose over 12 weeks
| (assuming 2 million per week), then to give 2 doses to 9
| million and 1 dose to 3 million over 12 weeks
|
| .8 * 24 = 19.2m covered in scenario 1
|
| .95 _9 + .8_ 3 = 10.95m covered in scenario 2
|
| Even if it were 60% with 1 dose and 95% with 2 it would
| be
|
| .6 * 24 = 14.4m covered in scenario 1
|
| .95 _9 + .8_ 3 = 10.35m covered in scenario 2
| garmaine wrote:
| Presumed by whom? AFAICT there is no reason to presume
| the protection decays rapidly or even at all (on short
| timescales). There isn't a biomechanism that would cause
| that. It's a conservative operating assumption just in
| case, but actually not likely.
| xur17 wrote:
| But that does seem to imply that 2 weeks post the first
| shot (assuming the second shot will be given soon after),
| folks are pretty much at maximum immunity.
| JCM9 wrote:
| Data is very encouraging.
|
| Presently this battle is essentially a race between the current
| vaccines (which data indicates are very effective against current
| strains) and eventual variants that will make the current
| vaccines less effective (or in the worst case ineffective).
|
| The mutations aren't really a question of if just when. Vaccine
| data on some new strains is concerning and potentially an early
| warning of things to come.
|
| If we can get shots in everyone's arms and maintain masks etc
| before any vaccine-resistant strains can develop then we stand a
| good chance of getting back to normalcy. If the virus mutates
| faster or people let their guard down too soon (including
| vaccinated individuals) then we could have a big setback. It's
| important that even vaccinated people follow protocols for now
| since if a vaccine-resistant variant does get out there we need
| to make sure it doesn't spread.
|
| Get vaccinated (when it's your turn) and wear those masks!
| fpgaminer wrote:
| Concurring with you, and here's some entertaining food for
| thought. It seems to me that every virus must have a minimum
| host population that it needs to persist.
|
| The way I think about it is like a tabletop game. You, the
| player, are a virus. You draw a strain card and roll a stat
| sheet. Then you pick a human to infect. They draw an immunity
| card. After that you roll a set of dice that determine if you
| get to "evolve". If you evolve you get to draw a new strain
| card, replacing your old strain card, roll new stats, and all
| players discard their immunity cards. Whether you evolve or
| not, you start a new round by picking a new human to infect and
| repeat. The big caveat: you can't pick a human with an immunity
| card.
|
| Now, if the number of players in this game is low enough and
| the likelihood of you rolling an evolve action is low enough,
| then it's easy to see that in all probability you'll lose the
| game. Every human will get an immunity card before you roll an
| evolve.
|
| So there are two variables: host population and likelihood of
| evolution.
|
| Our goal with vaccination is to decrease the former as much as
| possible. If we get it low enough, the virus will lose the
| "game". Every other non-vaccinated human will gain herd
| immunity naturally before it has the chance to evolve. It will
| die out, and never be given a chance again.
|
| Now, I'm not addressing herd immunity. That's about whether a
| virus can spread in a given population. This tabletop game
| doesn't incorporate a virulence mechanic. This is about whether
| a virus can mutate before the _globe_ achieves herd immunity.
| The point I'm addressing is this idea lurking in the back of
| people's minds: third world countries. Won't the virus just
| "fester" in countries with low vaccination rates until it
| mutants enough that it can become a new pandemic?
|
| My suggestion is that it's not a given that that's the case, as
| long as whatever remaining non-immune population is small
| enough.
|
| What is low enough? An actual virologist could probably
| guesstimate for some given probability threshold.
|
| But the good news is that SARS-CoV-2 has really bad evolution
| stats. Many viruses have a "checksum" protein in their genome,
| just like most other organisms do, that actually work to
| prevent mutations. Some viruses have this protein "tuned" lower
| so that they mutate faster, but it's a trade off because that
| often results in more production of impotent viral particles.
| SARS-CoV-2, from what I've read in studies, has its "checksum"
| protein tweaked higher, so it just doesn't evolve as quickly as
| something like the common cold strains.
|
| In other words, I completely agree with your point. Get
| vaccinated as quickly as possible and keep up masks and social
| distance for now. That will give us the highest possibility of
| winning this "game".
| SpicyLemonZest wrote:
| Respectfully, I think the message you're presenting here is an
| endlessly shifting target that's going to seriously compromise
| vaccine takeup. The vaccine is highly effective and vaccinated
| people can safely resume normal life, although masks in public
| places will (and should) continue until anyone who wants a
| vaccine can get an appointment. Mutation risk is a legitimate
| concern, but not an overwhelming one that really needs to
| impact most people's personal decisions; Covid-19 mutating to
| escape vaccines is the same category of problem as the flu
| mutating to become more deadly.
|
| If you wait to resume normal life until experts say Covid-19
| isn't a problem at all, you're gonna be waiting somewhere
| between decades and forever, and you're gonna end up left
| behind by most of the world.
| JCM9 wrote:
| I think we're mostly saying the same thing.
|
| The end objective is to get the levels of COVID-19 down to as
| low as practical as quickly as practical with a population
| that has a high degree of immunity against current variants.
| If people are immune they won't get infected and if they
| don't get infected they won't give the virus a chance to
| mutate via replication.
| bdamm wrote:
| The mutations are far more likely if you give Regeneron to
| cancer patients and other immuno-compromised people. What an
| ethical problem... give a therapy knowing that the therapy will
| kill off the virus identified by the therapy but with a higher
| chance that mutations in the patient become free to propagate,
| or don't administer the immuno-therapy to the most vulnerable
| people in an attempt to stem early mutation? Since only the
| rich are getting Regeneron, it really is a case of class
| warfare.
| iso1631 wrote:
| In a world where we pump antibiotics into cattle, ethics
| don't really apply
| rcpt wrote:
| there's no race. If this virus can mutate into something that
| renders the vaccine ineffective it will. Brazil and Mexico and
| the rest of the developing world will give it ample opportunity
| no matter how quickly we roll out the current drugs. It took
| decades to hunt down smallpox.
| jjcon wrote:
| Isn't it almost certainly the case that the 'unstoppable'
| thing it turns in to will basically be more akin to a general
| cold though? The thing that makes this virus deadly is also
| the thing we are coding against in the vaccine.
| ufo wrote:
| Not necessarily. For example, some of the more recent SARS-
| CoV-2 variants spread more easily because the virus causes
| a more severe infection, which is transmissable for a
| longer period of time. It's also not a guarantee that the
| virus will evolve into something weaker. There are serious
| diseases like measles and smallpox that have circulated for
| thousands of years while remaining as deadly as they ever
| were. Sometimes, the disease not being as deadly after a
| while can be a result of natural selection selecting for
| more resistant individuals (after many deaths), not of
| natural selection selecting for less deadly pathogens.
| djrogers wrote:
| > For example, some of the more recent SARS-CoV-2
| variants spread more easily because the virus causes a
| more severe infection, which is transmissable for a
| longer period of time.
|
| That's purely speculation at this point, while
| epidemiology shows us that viruses which are more fatal
| tend to be less transmissible and vice-versa.
| ufo wrote:
| It can be more complicated than that, because in some
| circumstances increased virulence might also provide an
| evolutionary advantage for the pathogen. This article
| from snopes.com has a nice summary of the competing
| views: https://www.snopes.com/news/2021/02/01/will-
| coronavirus-real...
|
| """The trade-off model recognises that pathogen virulence
| will not necessarily limit the ease by which a pathogen
| can transmit from one host to another. It might even
| enhance it. Without the assumed evolutionary cost to
| virulence, there is no reason to believe that disease
| severity will decrease over time. Instead, May and
| Anderson proposed that the optimal level of virulence for
| any given pathogen will be determined by a range of
| factors, such as the availability of susceptible hosts,
| and the length of time between infection and symptom
| onset.
|
| There is little or no direct evidence that virulence
| decreases over time. While newly emerged pathogens, such
| as HIV and Mers, are often highly virulent, the converse
| is not true. There are plenty of ancient diseases, such
| as tuberculosis and gonorrhoea, that are probably just as
| virulent today as they ever were."""
| binaryorganic wrote:
| What your saying is a likely long-term outcome. But the
| reason we see milder viruses circulating as an "end-game"
| is just because we don't tend to deal with non-threats.
| There is no rule that mild strains are a given outcome of
| mutation. You just won't see super-deadly variants last
| long-term because it quickly turns into an us or them
| battle that we have so far been able to win.
| ufo wrote:
| There is a race because the more people that are infected
| with the current strains, the more chances that the virus
| will have to evolve into newer strains.
|
| It is also believed that new strains are more likely to
| appear in places where the pandemic is out of control, with a
| large number of people currently infected and also a large
| number of people that already have some immunity to previous
| versions of the disease. This provides the selective pressure
| that can lead to new variants arising. Therefore, getting the
| pandemic under control using vaccinations and other measures
| is key to reducing the number of new variants that pop up.
| LeCow wrote:
| that just means it might evolve slightly slower, not that
| it won't ever happen. it 100% will evolve and 100% will
| evade the vaccine. we've understood about evolution for a
| very long time, but everyone's in denial atm.
|
| even wearing masks did fuck all because it just evolved
| anyway. it ain't gonna matter when you aren't wearing them.
| binaryorganic wrote:
| There certainly is a race. The slower we go the more spread.
| The more spread, the more variation. The more variation, the
| more likelihood of a vaccine-resistant strain taking hold.
|
| Even if it's a long-term certainty, much better to be well-
| equipped to respond to it, which we simply are not at the
| moment.
| rcpt wrote:
| My point is that this virus spreads unbelievably fast and
| even with the most optimistic vaccine scenarios it has
| literally billions of hosts in the developing world to
| infect who have 0 zero chance of getting a shot anytime in
| the next few years.
|
| Of course the vaccines might be good enough to ward off
| infection from all future variants but that's just luck.
| 11thEarlOfMar wrote:
| How many lives were saved by delivering the vaccine in 1 year vs.
| 2?
| [deleted]
| chrisjs95 wrote:
| I'm really worried that will be "locked down" indefinite even
| when hospitalizations go down. I'm also worried that when an
| actually deadly virus hits our shores we'll be more hesitate to
| do lockdowns. So basically governments used their once in a 50
| year lockdown on this. It mainly killed people that were fat (why
| the US had a higher mortality) and old. Except no one every said
| lose weight, exercise and get fresh air. What happens when Ebola
| hits us.
| ImaCake wrote:
| When something with ~30-50% mortality starts doing a COVID
| there won't be room for anti-vaxxers and anti-lockdown people.
| With COVID you can get sick and live. With something like ebola
| you get sick and die, or you go through the most traumatic
| event of your life. It doesn't leave a middle ground of
| disbelief. So I think there would be the political will for a
| second lockdown if our next global pandemic looks like ebola. A
| second COVID probably might not be scary enough though.
| erfgh wrote:
| Ebola does not spread as easily as COVID so a lockdown would
| not be needed.
| ptaipale wrote:
| Ebola has spread quite quickly, and there have been
| lockdowns to stop it.
| tus89 wrote:
| More interesting to know does it lead to a significant drop in
| transmission?
| roywiggins wrote:
| Probably.
|
| https://www.reuters.com/article/health-coronavirus-israel-va...
| carbocation wrote:
| I don't mean to imply that this is your intention at all, but
| it's a false choice. Both questions are interesting; no need to
| set them up as if they were in tension with one another.
| tengbretson wrote:
| It actually can put them in tension. If the vaccine only
| stops symptoms it can remove the selective pressure to be
| less deadly and can actually cause the virus to evolve to be
| more deadly overall.
|
| If this is the situation we are in, then it would make the
| most sense to only vaccinate the most vulnerable, and not
| vaccinate the bulk of the population in order to keep the
| virus selected for survival + transmissibility.
| standardUser wrote:
| "...can actually cause the virus to evolve to be more
| deadly overall"
|
| That is wildly speculative. Pathogens do not evolve
| inevitably towards maximum lethality.
| tengbretson wrote:
| > That is wildly speculative.
|
| I'm not sure what more you should be asking for in a
| discussion about "what could happen"
|
| Of course it is speculation. And it is based on what we
| know about other viruses at large and the our current
| best information about covid.
| tus89 wrote:
| I meant less interesting as in all the studies/trials have
| already confirmed that the vaccines significantly reduce
| severe symptoms...the effect on transmission is still an open
| question from what I understand.
| [deleted]
| djrogers wrote:
| Preliminary results look good
|
| https://www.reuters.com/article/health-coronavirus-israel-
| va...
| carbocation wrote:
| Yes, I'm also personally most interested in that question.
| (But will accept more data on any of these questions, since
| they're so societally important.)
| NovaJehovah wrote:
| Why is that more interesting? Reducing severity is just as
| important as reducing transmission, if not _more_ important.
|
| If we could sufficiently reduce (or eliminate) severe cases and
| deaths, it wouldn't matter how contagious it was. Common colds
| are highly transmissible, but no one worries about them much
| since they very rarely cause severe illness.
| jimbokun wrote:
| It's very important until universal vaccination is achieved.
| NovaJehovah wrote:
| Well obviously it would be great if they significantly
| reduce transmission as well. But even if they don't,
| vaccines could still effectively end the pandemic if they
| reduce severity enough.
|
| It's stupid to imply that drastically reducing severity
| isn't a big win.
| tus89 wrote:
| Only in that the effect on severe illness (reduction) has
| already been demonstrated through the studies/trials, this is
| not really news. Transmission effect is still being
| understood.
| NovaJehovah wrote:
| Fair enough when you put it that way :)
| matthewmacleod wrote:
| _Reducing severity is just as important as reducing
| transmission._
|
| I know what you're driving at and it's all pretty interesting
| - but counterintuitively I think it's way more effective
| overall to reduce transmission than it is to reduce severity.
|
| If you make the disease half as deadly, then pretty simply
| half as many people die. But if you make the disease half as
| transmissible, then the compound impact means that _far_
| fewer than half as many people die.
| NovaJehovah wrote:
| True. But if you make the disease not deadly at all, then
| no one dies, regardless of how transmissible it is.
| xyzzy_plugh wrote:
| Not everyone can be vaccinated for a plethora of reasons.
| This would do nothing for that cohort.
| munk-a wrote:
| That is not the case - it is for that specific variant of
| the disease but diseases spread through the entire
| population have a huge area to mutate in and one of those
| mutations could be quite deadly.
|
| One of the reason there's a lot of gas behind rolling
| this vaccine out quickly is that we want to avoid
| allowing the virus enough time to mutate up some
| different strains that this vaccine isn't effective in
| preparing us for since that makes the vaccine far less
| effective overall.
| srean wrote:
| Untill you visit a place with a significant un-vaccinated
| population.
|
| This has happened with other diseases.
| sgeisenh wrote:
| The problem is that if the vaccinated population carries
| the virus, then the risk of being infected increases for
| the unvaccinated population. It doesn't matter if the
| vaccine reduces the severity of the virus if you haven't
| received the vaccine.
|
| On the other hand, if the vaccine reduces the
| transmissibility of the virus, then everybody
| collectively benefits from each additional vaccination.
| rajin444 wrote:
| Isn' that how you end up with a leaky vaccine?
| https://en.wikipedia.org/wiki/Marek%27s_disease
|
| While it seems rare, it also seems like a much deadlier
| outcome.
| hinkley wrote:
| > If you make the disease half as deadly,
|
| I think you undercut your own point for no reason.
|
| Less deadly diseases get less reverence, leading to more
| risk taking. The percentage of people who die goes down,
| but the number of cases goes way up, resulting in
| potentially greater loss of life overall. Look at how
| cavalier we are about influenza, and then we set policy
| based on whether things are worse than the flu.
| [deleted]
| aantix wrote:
| Yes, the preliminary numbers out of Israel appear to confirm
| this.
|
| https://www.reuters.com/article/health-coronavirus-israel-va...
| blackbear_ wrote:
| Why is this more interesting exactly? If vaccines remove severe
| consequences of getting sick then why does it matter if the
| virus is still around?
| [deleted]
| [deleted]
| LeCow wrote:
| man I hate Scotland and the witch so much.
| wcfields wrote:
| I may get downvoted for this, but genuinely curious if there's
| vaccine tourism (not that I'm in a position to get on a jet to
| get a shot).
|
| Eg, if the wait time is long for my group in the US/UK/Wherever,
| can I book a flight to UAE or Cuba to get a vaccine at the
| airport?
| esalman wrote:
| Yes! I am from the Indian Subcontinent, I know people who went
| back to the country to get the Oxford vaccine, because the
| rollout is great and it is "open season" over there already.
| Converse is also true- rich people who were doubtful about a
| vaccine manufactured in India booked came to US to get both
| Moderna and Pfizer shots.
| Dumblydorr wrote:
| It's already the case, look at all the exceptions for the
| wealthy and powerful getting vaccines early, be that
| politicians, celebrities, athletes, connected individuals, and
| the numerous cases we each may know of. I won't say more but I
| do know a few personally who got the vaccine too early.
| sjf wrote:
| Sure, you think the 0.1% are just waiting for their phase to
| rollout?
| unix_fan wrote:
| Definitely. A few famous people in Latin America were flying to
| Miami to get vaccinated, despite not living in Florida.
| cogman10 wrote:
| I don't think so. There's simply not excess vaccines to go
| around at this point. I imagine this might happen more in the
| future when a larger percentage of some nations are vaccinated.
| ceejayoz wrote:
| > There's simply not excess vaccines to go around at this
| point.
|
| I'm sure there are creative people out there who'll, say, put
| you on the staff list at a dentist's office so you're
| technically a "first responder". For a price, of course.
| [deleted]
| aclimatt wrote:
| Since we're on the topic, shouldn't this (hospital admissions) be
| the almost singular criterion to influence public policy /
| restrictive measures?
|
| The line I've heard repeatedly is we're waiting for "total" herd
| immunity, as in ensuring almost all of a population is
| potentially protected from the virus. Frequently quoting fall /
| end of 2021, potentially into 2022.
|
| Shouldn't the only benchmark be those with medium-to-high risk of
| hospitalization? (Determination of risk however you'd like to do
| it.)
|
| Put another way, you wouldn't shut the world down if a bunch of
| people got sick for a few days. You may, and indeed we have, shut
| it down if a large part of the population were at risk of
| hospitalization or death. In many developed countries, that
| population is looking at full inoculation (for those who want it)
| sometime this spring.
|
| Should that not be the "end" of it?
| wpietri wrote:
| I take it you haven't been following what's going on with "Long
| Covid". But even among people who aren't hospitalized, there's
| lasting harm:
| https://www.medpagetoday.com/infectiousdisease/covid19/91270
|
| I know somebody who's had this. Despite never being
| hospitalized, after getting sick they had to take a long
| medical leave from work in hopes of getting their strength
| back. That's worlds away from "sick for a few days".
| metalliqaz wrote:
| I have been "fatigued" for 3+ years due to having children.
| Life goes on.
| ben_ wrote:
| Don't be so crass, people are suffering because of this
| that didn't chose to
| colecut wrote:
| That is a not insignificant percentage of parents
| psnatch wrote:
| Amusing - me too. Obviously you raise the false
| equivalency, though.
| Broken_Hippo wrote:
| "fatigued" from not getting enough sleep or being
| physically active is not the same thing as folks get from
| diseases. When you are fatigued from children, you can
| sleep and take care of it. It is solvable.
|
| It isn't like that with disease.
|
| The worse I've had is the complete inability to stand long
| enough to make a simple dinner, for example, and this was
| after napping and sitting most of the day. I'm lucky: Mine
| passed. Some people live with this day after day after day,
| and this is more similar to what folks with disease-related
| fatigue.
| Mediterraneo10 wrote:
| I have been following "long COVID" reports. Firstly, much of
| the mass media coverage is misleading, often intentionally so
| in pursuit of clicks and advertising revenue. A lot of the
| people claiming to have debilitating "long COVID" were never
| actually tested positive for COVID in the first place. They
| are the broadly the same demographic that, before COVID, were
| claiming to have "chronic Lyme" or whatever. Certainly mainly
| of them do have symptoms and distress, but it is questionable
| what relationship they have to COVID.
|
| Then, if one starts digging into more serious discussion -
| even your link above - one finds that "long term" in medical
| parlance may mean a series of months but not necessarily
| years, and similar months-long impacts are known from
| diseases that we have generally tolerated among society. It
| also isn't clear that these lingering symptoms affect enough
| people to impact the economy if measures are lifted once
| hospitalizations fall.
| NortySpock wrote:
| > A lot of the people claiming to have debilitating "long
| COVID" were never actually tested positive for COVID in the
| first place.
|
| Do you have a citation for this claim?
| Mediterraneo10 wrote:
| I was talking about the innumerable "long COVID" media
| coverage where some ordinary person is invited to tell
| the whole story of how they got ill, felt terrible, and
| still feel terrible, but nowhere did they actually go to
| the doctor and get a formal positive COVID test. They are
| just guessing that they had this disease that was going
| around. And now dedicated Facebook groups etc. are
| popping up whose membership has complaints and claims
| that are extremely similar to the "chronic Lyme" groups
| that flourished just before COVID.
|
| I was obviously not referring to actual scientific
| studies of long-term COVID effects, but as I said, those
| studies don't say quite what the more sensationalistic
| mass-media coverage is saying.
| rcpt wrote:
| Here: https://www.medrxiv.org/content/10.1101/2021.01.16.21
| 249950v...
|
| Hundreds of thousands of people. Average age mid 40s and
| sliced by hospitalized or not. Controlled against people
| who had the flu during lockdown.
|
| Double digit percentages have issues 6 months on.
| Unsurprisingly not very different from SARS 1 and those
| people are still sick since 2003.
| Mediterraneo10 wrote:
| Yes, indeed, the various studies (and yours is a typical
| example) show mainly an older demographic reporting
| symptoms stretching into months, and include the
| observation that it was mainly (even if not exclusively)
| a severe course of the disease that preceded lingering
| symptoms. But a lot of the attitudes that restrictions
| must be kept in place to prevent "long COVID" are held by
| younger people who are very afraid of coming down with
| the phenomenon, yet they are not significantly at risk of
| it according to these studies.
| rcpt wrote:
| I struggle to see how you reached that interpretation of
| the paper.
| timr wrote:
| Table 3 and Figure 2 make it clear that the hazard ratios
| for patients with hospitalization and/or encephalopathy
| are multiples higher for those without hospitalization
| and/or encephalopathy.
|
| Intracranial haemorrhage is 3-4x more likely in
| hospitalized patients; ~5x higher in those with
| encephalopathy. For stroke, 2-3x for both. For first mood
| disorder, 1.5x/2x more likely.
|
| They don't break down the cross-tabs by age (as they
| should), but given the patterns here, I would expect to
| see a strong correlation.
|
| The sicker you are, the sicker you are.
| Mediterraneo10 wrote:
| Average age 40, as you said yourself. And then as the
| authors of this paper find, "Risks were greatest in, but
| not limited to, those who had severe COVID-19."
| rcpt wrote:
| the "but not limited to" is the important part
| Mediterraneo10 wrote:
| It doesn't matter if these longer-term symptoms affect
| some number of people outside that older, frailer risk
| group. There are always statistical outliers. If the
| amount of younger, stronger people affected by these
| symptoms is small, then that weakens the case for
| maintaining restrictions after vaccination of the most
| at-risk groups.
|
| This issue seems to be important to you personally and to
| others whose concerns may or may not be reasonable, but I
| don't believe it will be important to most of society as
| vaccinations roll out and the Northern Hemisphere spring
| and summer are upon us.
| rcpt wrote:
| > statistical outliers
|
| This is the claim I'm disputing. I don't see evidence
| that this is so rare. In fact everything I can find
| suggests otherwise.
|
| To be clear, I hate this.
| bluGill wrote:
| Nobody has figured out what "long covid" is, or how long it
| lasts. The anecdotes I've heard about the effects to the
| relatively young mean I'd just assume not open up.
| [deleted]
| dev1n wrote:
| No. People (extraordinarily healthy people) are suffering
| pulmonary embolisms (and thus hospitalized) weeks after they
| have been cleared from the virus. There is a very, very, very
| long tail to this disease outside of the initial 2 - 4 weeks of
| being sick.
| aantix wrote:
| >People (extraordinarily healthy people) are suffering
| pulmonary embolism
|
| What are the numbers?
| rcpt wrote:
| I've posted elsewhere but
|
| Here: https://www.medrxiv.org/content/10.1101/2021.01.16.21
| 249950v...
| aantix wrote:
| Where in that study does it show the the numbers for the
| pre-COVID healthy cohort?
| rcpt wrote:
| I believe what you're asking about is covered in table 1
| and figure 2.
|
| They're reporting hazard ratios after propensity score
| matching with people who had the flu during the same time
| period.
| standardUser wrote:
| Small percentages of people suffer complications from many
| different types of illnesses. At a certain point, human
| beings simply have to live with a small chance of a bad
| outcome from ailments that are normally mild.
| vmchale wrote:
| > hospital admissions) be the almost singular criterion to
| influence public policy / restrictive measures?
|
| From a control theory perspective, it's one of the worst
| measures because it's delayed. Much more efficient to measure
| cases - then you don't need restricted social life as long.
| teawrecks wrote:
| The point isn't that we use hospital admissions as a metric
| to infer cases or some other metric, it IS the metric that
| matters. The problem over the last year wasn't that _there
| exists_ a person who is at risk, it 's that _there didn 't
| exist_ any healthcare system capacity to treat them.
|
| From very early on in the pandemic, it seemed to me like our
| goal for optimal balance between caution/risk was to try and
| maintain the highest level of hospital occupancy that is
| sustainable. If every single person quarantines perfectly,
| then our hospitals are empty, but so is every business. If no
| one quarantines, our businesses are full, but so are
| hospitals and everyone's viral load; i.e. maximum mortality.
|
| With the vaccines now available, it seems like our goal
| should still be be to maintain the highest level of
| sustainable medical system occupancy.
| _coveredInBees wrote:
| Call me a renegade, but I think the only goal should be to
| minimize the total number of deaths from Covid. Trying to
| maximize sustainable medical system occupancy is almost
| certainly not aligned with the former goal.
| arrosenberg wrote:
| No perfect solutions there. If there was perfect
| quarantine, we would still lose additional lives from
| suicide, domestic violence, etc. from the increased
| stress. There is definitely a balance to be struck, and
| making sure we have capacity to treat all of the sick
| seems to be as good as any.
| _coveredInBees wrote:
| Yeah, making sure we have capacity to treat anyone sick
| is certainly one of the highest priorities (and the
| reason there was such a scramble trying to contain the
| virus from wreaking havoc if we went past that). And I
| get that there are other "costs" to the virus and
| lockdown and a holistic, balanced view is useful. Heck, I
| have two young children who have been remote schooling
| for almost a year now while both parents work full-time.
|
| I just object with the parent's following statement:
|
| > With the vaccines now available, it seems like our goal
| should still be be to maintain the highest level of
| sustainable medical system occupancy.
|
| If we are still trying to maintain the highest level of
| sustainable medical system occupancy while the percentage
| of population that has been vaccinated is slowly
| increasing, it would actually mean we are doing a
| horrible job in trying to limit preventable deaths when a
| fully vaccinated populace + herd immunity is not too far
| away. Maybe when a much larger percentage of the
| population is vaccinated, the spread and rate of deaths
| will be low enough that this may change, but we are still
| nowhere near that stage.
| standardUser wrote:
| It's an important metric because earlier indicators aren't as
| useful. The rate of new cases is tricky because we don't
| really care if someone gets COVID-19 anymore than we care if
| they get the common cold, assuming they have only mild
| symptoms and fully recover. Hospitalizations are the first
| unambiguous metric we have to know there is a serious problem
| that may require a dramatic response.
| ceejayoz wrote:
| > It's an important metric because earlier indicators
| aren't as useful.
|
| Sure they are. They're less _precise_ , but they're more
| _useful_ , because they're more likely to let you combat
| the spike _before_ it gets out of control.
|
| It's like a smoke alarm. Maybe it's going off because it's
| over-sensitive and someone just took a shower... but it's a
| better early warning system than waiting for active flames
| to appear.
| standardUser wrote:
| I agree, but once vaccinations are widespread and we are
| confident that severe illness will be very rare, it would
| be hard to take drastic measures based only on the rate
| of new cases. There could be a huge surge of cases but we
| would expect a low hospitalization rate, so we would
| likely want to wait.
| ceejayoz wrote:
| Once vaccinations are widespread, yes.
|
| Until then, getting out in front of a spike remains
| necessary.
| km3r wrote:
| Immunity through vaccination + natural immunity is
| getting closer to 'widespread' now (in the US). We are
| likely near 30%, and of that 30%, a growing proportion is
| the most vulnerable sections of the population. A spike
| in cases now would be increasing less connected to a
| future rise in hospitalizations. I think its fair to say,
| that if we do not see a spike within the next 3-4 weeks,
| we are in the clear for future spikes. By April 1st, we
| should be nearing 40%, with the difference primarily
| being now vaccinated old and immune compromised people.
| inglor_cz wrote:
| In the wild phase of the pandemic, yes.
|
| But once enough people are vaccinated, the pattern may
| change. For example, you may still catch quite a lot of cases
| through PCR testing which is very sensitive, but the share of
| asymptomatic cases will be much higher and the share of
| people who are going to suffer a severe case much smaller.
|
| The entire societal signature of the disease will change
| depending on vaccination levels and maybe even particular
| vaccines used.
| [deleted]
| didibus wrote:
| I don't know about all states as they have different rules, but
| in Washington they track:
|
| 1. Trend in 14-day rate of new COVID-19 cases per 100,000
| population, shown as Trend in case rate;
|
| 2. Trend in 14-day rate of new COVID-19 hospital admissions per
| 100,000 population, shown as Trend in hospital admission rate;
|
| 3. Average 7-day percent occupancy of ICU staffed beds, shown
| as Percent ICU occupancy;
|
| 4. 7-day percent positive of COVID-19 tests, shown as Percent
| positivity.
|
| And there are phased reopening plans, where restrictions are
| slowly lifted based on different tresholds for the above. So if
| the above 4 metrics meet some treshold we might go into phase 2
| where now indoor dining at half capacity is permitted for
| example. If the numbers than stay under the treshold and
| eventually keep going down, we'd go to phase 3, etc. If the
| numbers get worse after moving to phase 2 we'd go back to phase
| 1 with more restrictions.
|
| Seems pretty reasonable to me. They're always kind of revising
| the tresholds to some extent as well, so it's not set in stone.
| But it makes sense for me to take a staged approach to
| reopening and just make sure we're truly over Covid before
| going all back to normal (so it doesn't come back).
| NovaJehovah wrote:
| It's generally a political challenge for a free society to get
| the power and the megaphones back from the people who they were
| given to during a crisis.
|
| After an acute terrorism threat ends, it's hard to get power
| back from the military and the police.
|
| In this case, it will be hard to take back power and the
| narrative from the public health establishment.
|
| While they perform a crucial role in our society, they will
| tend to value safety over freedom and quality of life to an
| extent that would be crippling if we let them continue to set
| the agenda after the acute phase of the crisis has passed.
| dragonwriter wrote:
| > In this case, it will be hard to take back power and the
| narrative from the public health establishment.
|
| Sitting in California where county sheriffs basically
| comprehensively vetoed the public health establishment
| throughout the crisis, I don't see that likely to be a real
| problem.
| NovaJehovah wrote:
| That didn't stop thousands of businesses from being closed.
|
| But regardless, the narrative is just as important. After
| some threshold of vaccine distribution, people need to be
| convinced that it's ok to return to normal life, and that
| they don't need to cower in fear in their homes or wear
| masks for years and years. There is a cost to all of this.
| umvi wrote:
| > You may, and indeed we have, shut it down if a large part of
| the population were at risk of hospitalization or death
|
| I wouldn't really call 1% of the population "a large part" of
| it. It's just, our healthcare capacity relative to the size of
| the overall population is miniscule. So even a disease that
| threatens .1% of the population with death and 1% with
| hospitalization is enough to overwhelm the healthcare system.
| And apparently policy makers aren't willing to let people die
| due to overwhelmed hospitals - they would rather shut down the
| entire economy than let that happen.
|
| History will tell if that was the right decision. Almost nobody
| notices or remembers blips of abnormally high "excess deaths"
| for a particular year, but everyone notices and remembers
| economic depressions that last a decade.
| rhino369 wrote:
| Yes, absolutely that should be the "end" of it. Especially
| since we are already giving the vaccine to front line works who
| aren't old or in danger.
|
| Anyone who wants to hole up until they get the vaccine should
| be able to.
|
| But I'll take the low risk.
| pipeoperator wrote:
| Everyone can empathise with wanting life to get back to
| normal. However the problem with folk wanting to take the
| individual risk is that the "low" percentage of people
| needing medical help can still overburden health care
| systems.
|
| This potentially means that people with other illness /
| disease can't / don't see a doctor in time, and others in a
| society take the brunt.
|
| Yes, let's open up; but let's not throw caution to the wind
| either.
| leesalminen wrote:
| > can still overburden health care systems
|
| But they haven't. The prevailing opinion I'm seeing on HN
| recently is that the US didn't do a "real" lockdown which
| is why there are still so many cases. They opine that
| Americans largely didn't "comply" with the government
| orders rendering any potential positive effects from
| lockdowns moot.
|
| If you take that at face value, then shouldn't we have had
| an overwhelmed medical system by now?
|
| The Denver convention center was turned into a makeshift
| hospital for almost a year. They never had a single
| patient. My relatives lost their low-paying jobs and are
| still jobless today.
|
| Remember the military hospital ships that were sent to NY
| and LA? They never saw a single COVID patient?
|
| At this point I just don't see any evidence that our
| healthcare system overwhelmed in any meaningful way. It's
| FUD.
|
| Don't try and post an article about how some random ICU was
| at 80% capacity. ICUs are designed to be near operating
| capacity because it's a waste of resources to over supply.
| pipeoperator wrote:
| This is a worldwide pandemic, not restricted to the
| borders of the US. People in countries around the world
| complied with quarantine, but their healthcare systems
| were still under real pressure. If they were not
| overwhelmed, it was a close run thing only prevented by
| social distancing.
|
| Hospitals cancelled and delayed medical procedures around
| the world due to this: Italy, Spain, the UK, etc.
|
| While the worst case scenarios of healthcare systems on
| their knees have not panned out, it's disingenuous to
| suggest that the impact is imaginary or FUD.
| leesalminen wrote:
| It's not clear to me how illustrating the flaws in one
| country's healthcare system should affect the decision of
| another's who hasn't experienced the same flaws even with
| greater per-capita cases of the virus.
|
| My comment was geared towards America because I'm an
| American talking on a forum operated by an American
| company.
|
| Italy can lock down to their heart's content- that's
| their prerogative.
| dragonwriter wrote:
| > If you take that at face value, then shouldn't we have
| had an overwhelmed medical system by now?
|
| We did, in many cases, had overwhelmed medical systems at
| the local peaks, which were not nationally synchronized.
|
| > Remember the military hospital ships that were sent to
| NY and LA? They never saw a single COVID patient?
|
| You mean the ones that the military _explicitly
| restricted to not taking COVID patients_?
|
| Yeah, I remember that. Funny how they never saw any COVID
| patients.
| leesalminen wrote:
| The US Navy reports that the Hospital Ship Mercy treated
| fewer than 200 patients in total.
|
| " By the time of Comfort's departure, the approximately
| 1,200-person crew and 1,000-bed hospital had treated just
| 182 patients, of which approximately 70 percent had
| COVID-19"
|
| So I guess we were both wrong.
|
| https://www.navytimes.com/news/your-
| navy/2020/04/30/hospital...
| dragonwriter wrote:
| > The US Navy reports that the Hospital Ship Mercy
| treated fewer than 200 patients in total.
|
| Mercy treated 77 patients and was not reconfigured for
| COVID, Comfort treated more after being converted to
| COVID just before local cases dropped from their peak for
| the wave the ship was present for.
|
| It completed reconfiguration to take COVID patients on
| April 7, just before new cases in both NYC and NYS
| started rapidly dropping. It almost entirely missed the
| time it was needed.
|
| I think they are both evidence that both the response and
| the systems for utilizing new resources wet optimized for
| the real needs, but neither shows that healthcare systems
| weren't overwhelmed.
| dragonwriter wrote:
| > So I guess we were both wrong.
|
| Er, how was I wrong, again?
| leesalminen wrote:
| > You mean the ones that the military explicitly
| restricted to not taking COVID patients?
|
| Yet 70% of the 182 patients had COVID.
| dragonwriter wrote:
| Sorry, I realized and would have deleted that if you
| hadn't been so quick.
| leesalminen wrote:
| No worries :). Hope you have an enjoyable rest of your
| day!
| qndreoi wrote:
| In US State Ohio recently, the benchmark for restrictions was
| changed to the number of people hospitalized for COVID in the
| state. When it fell below a threshold, bars and restaurants
| were allowed to stay open later.
| rcpt wrote:
| As long as one believes that chronic covid does not exist or
| alter one's life expectancy and the comfort of the elderly is
| our top priority then yes. Once the olds are safe the virus
| shall run wild through the young.
| choward wrote:
| I agree completely. The only reason they used for shutting
| everything down at first was so hospitals don't get overrun.
| That's clearly not happening right now in most places. Also,
| it's not uncommon for the flu to cause hospitals to exceed
| capacity and we don't shut down for that.
| Solvitieg wrote:
| This is what I found bizarre about NZ's approach. Their goals
| was 0 _cases_ in the entire country. It's a great
| accomplishment but perhaps unnecessary.
| laurencerowe wrote:
| The big advantage of getting to zero is that after the
| initial severe lockdown life gets mostly back to normal.
| ghaff wrote:
| Almost zero.
|
| And normal only in the sense that many people don't care
| that much if very few people are allowed to enter the
| country.
| smileysteve wrote:
| > That's clearly not happening right now in most places
|
| Citation needed.
|
| Up to 3 weeks ago, California, the Southeast were in field
| hospital territory.
|
| Anecdotally, Alabama hospitals have been in overflow since
| July.
| hristov wrote:
| The problem with that sort of thinking is if you let the virus
| circulate and multiply you are risking mutations that are
| resistant to the vaccines. There already are two mutations that
| are already somewhat resistant to the vaccines according to
| initial anecdotal evidence.
|
| But practically speaking most nations are taking this approach
| and have been reducing social distancing measures when
| hospitalization rates go down. (Often with negative results.)
| ravenstine wrote:
| Should we have an "end"?
|
| To play devil's advocate, clearly the world can handle a
| certain amount of locking-down, the social distancing, the mask
| wearing, etc., so it seems it is better if we just accept these
| restrictions indefinitely because we can save more people.
| Maybe we're fine not having mass gatherings, not eating
| indoors, and not leaving the house without a mask if it means
| saving the vulnerable. After all, it could be that COVID stays
| in the body like herpes and creates a different set of problems
| years later. Until we know for sure, the safest course of
| action for the public is for them to remain quarantined.
|
| After all, how bad is your life, really? If your life is
| tolerable, that means the restrictions are tolerable as well.
|
| EDIT: It's like nobody knows what playing "devil's advocate"
| means anymore. I think it's valid to ask that, if all the
| measures we are taking are objectively good, whether we should
| take them from now on.
| AndrewBissell wrote:
| Have you actually looked into the numbers regarding what
| lockdowns have done to mental health, not to mention the
| economic impacts which are going to feed back into people's
| well being in all sorts of ways? Just because your subjective
| experience of being a shut-in for nearly a year has been a
| tolerable one does not mean that has been the case for large
| numbers of people.
|
| I want my kids to go to a harvest festival again with a live
| band and tons of people like the one they did in fall 2019.
| No, this is not something worth giving up simply to preserve
| a few years of life for some nonzero number of society's most
| vulnerable and aged. And no, I'm not any more willing to wait
| five years to see whether there's some lurking complications
| from the disease, any more than people have been willing to
| do that with the vaccines which are being distributed.
| leesalminen wrote:
| That sounds pretty close to fighting words to me.
| samr71 wrote:
| Assuming this is not sarcasm, this can be taken to any
| logical extreme of "tolerable". I'm sure there are many other
| new restrictions we can put in place that would make people's
| lives (more) miserable, that are nevertheless "tolerable".
|
| Furthermore, can the world _really_ handle the restrictions
| in place indefinitely? We 've been locked down for a year,
| and it's certainly starting to feel like the wheels are
| coming off for many. The economic devastation alone has been
| staggering.
|
| Epidemiologically speaking, sure, doing this forever would
| save the most amount of people from COVID. But we can't just
| look at this from that point of view.
| ghaff wrote:
| The vast majority of people are not fine with any of those
| things for an extended period. In fact, in the US, once late
| spring/summer roll around people are going to be out and
| about.
| ravenstine wrote:
| Really? That's what people said back when it was proposed
| that we shut everything down for a few weeks to "flatten
| the curve". Now look how long we've gone. I'd say Americans
| have very well tolerated this new way of life and could do
| so in perpetuity. I wouldn't count the protests and riots
| last summer since they were politically motivated.
| maxerickson wrote:
| It's preferable to have very low infection numbers, to reduce
| the likelihood of mutations taking hold.
|
| Doesn't mean you go on forever waiting for 0 infections, you
| just wait a bit longer than the minimum number of vaccinations
| to go back to activities with highest risks of transmission.
| garmaine wrote:
| With both travel restrictions and lockdown, It takes about 6
| weeks to get to (effectively) zero new cases. Not forever.
| jgalt212 wrote:
| Yes, but you're still stuck with a population who remains
| very susceptible to the diseases. Lockdowns, as I'm sure
| Australia will discover, are not a complete solution to the
| problem.
| rhino369 wrote:
| That depends on how many cases you started with and how low
| you can get the transmission rate.
|
| No way could the EU or USA get to zero in 6 weeks. It took
| Victoria Australia about 6 weeks to get from 500 cases to
| 20. America and Europe have a 100X more than 500 cases.
|
| And the longer you need to lockdown, the less restrictive
| the lockdowns can be.
| dragontamer wrote:
| > Since we're on the topic, shouldn't this (hospital
| admissions) be the almost singular criterion to influence
| public policy / restrictive measures?
|
| Given the high correlation between COVID# cases (or %Positive)
| and hospitalizations, why not just use COVID# and "gain" 2
| weeks of information?
|
| Hospitalizations are weeks delayed from COVID# or %Positive
| spikes. Its a slow moving disease: taking 5 to 14 days before
| people feel sick, and then a week or two AFTER that before
| people decide to go to the hospital.
|
| As such, if you see a spike of hospitalization, you're already
| 3-weeks late to the results (ie: hospital spikes are associated
| with infections that occurred 3+ weeks ago).
|
| In contrast, watching COVID# or %Positive numbers gets you much
| closer to the ~5-14 day period where symptoms appear (and
| thanks to contact tracing, some people may test themselves
| before symptoms arrive: gaining a few precious days in the
| information war). Hospitalizations and Deaths are strongly
| correlated (with a few weeks delay). So you're effectively
| gaining a week-or-two worth of information.
|
| Its better to be only 1-2 weeks behind (watching COVID#),
| rather than being 3-4 weeks behind (watching Hospitalization#).
| psychlops wrote:
| I'm curious about your data set. The correlation of cases to
| deaths using data from covidtracking.com for the US over the
| past year is 0.28-0.3 when I ran it. I slid it by two, three
| and four weeks.
| rflrob wrote:
| I'm not sure that a simple sliding correlation really
| captures how treatments, protocols, and behaviors have
| changed over time. Leaving aside the winter holidays case
| peak (which is much more multi-modal than the others), I
| see two peaks:
|
| * A peak of cases around Apr 11, followed by a peak of
| hospitalizations on Apr 22, with a peak of deaths also
| around Apr 22.
|
| * A peak of cases around Jul 22, followed by a peak of
| hospitalizations around July 26, followed by a peak of
| deaths around August 4.
|
| If I were going to do a more detailed analysis, I would
| want to try breaking out individual states/counties
| (subject to some reasonable population minimum), such that
| multiple distinct trends nationally don't interfere with
| each other in the data.
| scrollaway wrote:
| > _Given the high correlation between COVID# cases (or
| %Positive) and hospitalizations, why not just use COVID# and
| "gain" 2 weeks of information?_
|
| As we vaccinate the people at the highest risk of
| hospitalization, the correlation will change: Numbers may
| stay very similar, but hospitalizations should go way down.
| dragontamer wrote:
| > As we vaccinate the people at the highest risk of
| hospitalization, the correlation will change: Numbers may
| stay very similar, but hospitalizations should go way down.
|
| Then we'll know in 2 weeks to change the policy and account
| for it.
|
| Note that vaccinations will *also* cause the %positive and
| case# to decline. USA is approaching 15% vaccinated at over
| 95% efficacy means that you'll have 15% fewer cases (as
| well as 15% fewer hospitalizations later on). I'm not
| convinced that cases will become desynchronized with
| hospitalizations: my expectation is that vaccination will
| cause a decline in both case# and hospitalization#, roughly
| in proportion.
|
| But if case# and hospitalization# become less correlated,
| then it won't take long (~2 weeks to see the first effects,
| maybe 4-weeks to be sure of the effects) to see such a
| split in the time-delayed correlation.
|
| -------
|
| EDIT: Why the downvotes? Today, there's a new study being
| pre-pub'd that shows that Pfizer's mRNA vaccine is ~90%
| effective at stopping the spread of the virus
| (https://thehill.com/policy/healthcare/539783-pfizer-
| vaccine-...).
|
| When you have a vaccine that's both 90% effective at
| stopping the spread and 95% effective at stopping
| hospitalizations, then the spread and hospitalization
| numbers will both go down severely (that is: #cases and
| #hospitalizations reported both go down).
|
| This assumption that #cases and #hospitalizations will
| become "desynchronized" isn't necessarily written in stone.
| Its possible both numbers drop down dramatically in the
| coming weeks as vaccines are distributed... indeed, its
| highly likely IMO.
| scrollaway wrote:
| Pretty much all countries are distributing vaccine to the
| elderly / at-risk population first. We're doing that for
| the obvious reason that the most-at-risk population is
| most-at-risk, and thus most at risk of hospitalization.
|
| Concretely, that means hospitalization rates should
| decline a LOT faster than community spread. This is going
| to be less visible in countries that have their shit
| together and are able to vaccinate very fast / have
| already moved on to genpop, but in most of the EU (sigh),
| we've just finished vaccinating care homes and 75+. So
| now, a couple of weeks from now, we should see
| hospitalization numbers sharply decline because that
| share of the population represents the most
| hospitalizations, and will now be mostly immune.
|
| So despite being at like, 5% total vaccinated, we should
| see a decline in hospitalizations of up to 75%.
|
| Furthermore, given that most of the spread happens
| outside the most-at-risk in the first place (since those
| most at risk were those with the most protective measures
| before vaccines), 5% vaccinations should not mean 5% less
| cases total.
| dragontamer wrote:
| The #1 group in the USA was not "at-risk" population, but
| doctors, nurses, and other front-line staff. The idea is
| that these groups are seeing many, many COVID19 patients
| and therefore have a big risk at spreading the virus
| around.
|
| Once this "Priority 1A" group was vaccinated, then age
| 75+ individuals were vaccinated in Priority 1B. Even
| then, Postal Office employees and Grocery Store workers
| (other "high impact" workers) are in the 1B and 1C
| prioritization queues.
|
| With efforts being to reopen schools, 1B also includes
| school-teachers (stop-the-spread focus). So a 21-year-old
| healthy school teacher is prioritized over a 67-year old
| obese person (despite the 67-year old's higher risk
| factors).
|
| ---------
|
| So at least in the USA: there's a significant effort
| being placed on high-impact "stop the spread" kind of
| vaccination effort. There is an element of "save lives",
| but stopping the spread also saves lives. So its a
| difficult calculus. (USA has some risk-factor
| prioritizations... 1B with 75+ age, and 1C with 65+ age +
| comorbidities like obesity. But again, Grocery Store
| workers are in 1C as well).
|
| I realize other countries have different priorities. But
| hey, I live in the USA so my understanding of things will
| have a USA-slant. These 1B / 1C things are also CDC
| recommended. Different states (like Texas) are more
| aggressively stop-the-spread than CDC guidelines (while
| other states may lean more towards risk-factor based
| "save lives / prevent hospitalizations"). 50-different
| states, 50+ different policies. Welcome to America.
| MR4D wrote:
| Group 1C is pretty much "everyone".
|
| To take directly from the CDC [0], "Other essential
| workers, such as people who work in transportation and
| logistics, food service, housing construction and
| finance, information technology, communications, energy,
| law, media, public safety, and public health."
|
| Doesn't that cover pretty much everyone on HN ?
|
| [0] - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/
| recommend...
|
| ------
|
| Second, shouldn't the focus be #1 - stop deaths; #2 -
| stop hospitalizations; #3 Stop the disease (which is what
| "spreading" actually is)
| dragonwriter wrote:
| > Group 1C is pretty much "everyone".
|
| No, it's not. It's "essential workers", which isn't
| everyone in the listed sectors but people in the listed
| sectors whose work cannot effectively be done remotely;
| approximately, the people that were exempted and allowed
| to work on site during the strongest lockdowns, where
| they occurred at all.
|
| > Doesn't that cover pretty much everyone on HN ?
|
| Probably not; lots of people on HN are probably in jobs
| that can be and are being done remotely. Even if it did,
| "everyone on HN" and "everyone" aren't the same thing.
| dragontamer wrote:
| > Second, shouldn't the focus be #1 - stop deaths; #2 -
| stop hospitalizations; #3 Stop the disease (which is what
| "spreading" actually is)
|
| Because stopping the disease implicitly stops the deaths
| and hospitalizations, its not very clear that a focus on
| deaths-only or hospitalizations-only is optimal.
|
| Especially when you consider that the disease will
| continue to mutate as it exists (possibly making our
| vaccines less effective or even obsolete). So stopping
| the disease first-and-foremost might be the most
| effective way to stop deaths/hospitalizations (especially
| when mutations are considered).
|
| --------
|
| Turning the R-value from 1.5 to 1.3 means a 14% decline
| COMPOUNDED PER GENERATION. After one generation, its 14%
| fewer cases (and 14% fewer hospitalizations and 14% fewer
| deaths). After two generations, that's 25% fewer cases
| (and 25% fewer hospitalizations and 25% fewer deaths).
| After three generations, its 35% fewer cases (and 35%
| fewer hospitalizations and 35% fewer deaths). Etc. etc.
|
| As such, "stopping the spread" has a benefit that grows
| exponentially every week or two (the generational period
| of this virus). Exponentially growing its results and
| efficacy.
|
| Keeping our eye on the bigger picture, it seems like
| stopping the spread is the best way forward to stop
| deaths and hospitalizations. I realize this is a bit
| "splitting hairs" (compared to people who would rather
| "save lives" and focus on hospitalizations and/or
| deaths). But... it seems like the superior strategy in my
| opinion.
| CraigJPerry wrote:
| >> approaching 15% vaccinated at over 95% efficacy means
| that you'll have 15% fewer cases
|
| That's not how it works, you're missing a variable
| (prevalence).
| ptaipale wrote:
| ...meaning that to reduce the number of cases evenly,
| we'd have to choose people to vaccinate by random, but
| we're not doing that; we're choosing by risk, and those
| at higher risk of severe disease are less likely to
| contract an infection because they move around less and
| meet fewer people.
|
| However, we could speculate that perhaps we should in
| fact put more priority on the groups that have most
| infections, not highest risk? Because the restrictions
| impact their lives (of young people) most.
|
| However, I'm quite sure that the priorisation of old
| people will continue, except possibly in places where
| priorisation is done by money (the rich purchasing
| vaccinations).
| CraigJPerry wrote:
| >> those at higher risk of severe disease are less likely
| to contract an infection
|
| If you were running a business and there was a relatively
| low incidence of an utterly catastrophic outcome, you'd
| buy insurance for the eventuality.
|
| If you were running another business with a high
| occurrence of a mild outcome, you'd price it into the
| cost of doing business.
|
| Insurance = vaccine. Cost of business = stimulus cheques.
| hntrader wrote:
| This, and also hospitalizations are a less exploitable
| metric. Self-selection bias isn't much of a problem, and
| the number of tests being done doesn't influence the
| results.
|
| I would look at either hospitalizations or deaths once
| vaccinations reach a large percentage of the population.
| smileysteve wrote:
| > The line I've heard repeatedly is we're waiting for "total"
| herd immunity
|
| It depends which line you are considering; if wearing masks
| yes.
|
| If "reopening and returning to normal" that remark is most
| resembles a hyperbole.
|
| In the United States, on April 16th 2020, the Coronavirus task
| force outlined a 3 phase plan dependent on 3 criteria based on
| 2 week averages
|
| 1) Hospital Vacancy,
|
| 2) New cases decreasing (from where they were), and
|
| 3) Percent positive testing rate under 10% (that suggests that
| the tests numbers are close to accurate and not in community
| spread)(5% is the standard that Europe uses as a liberal goal,
| 2.5% is the recommended)
|
| For an answer on those 3 in the US (today)
|
| 1) Hospitals are just now where they were on April 16
|
| 2) New cases is about 3x where they were April 16
|
| 3) We've been under 10% since 1/21 (now at a 7 day average of
| 5%)
|
| So the goal posts haven't gotten harder. They did get easier;
| restaurants shouldn't have been open for socially distanced
| dining based on the plan until 1/21.
| garmaine wrote:
| > Since we're on the topic, shouldn't this (hospital
| admissions) be the almost singular criterion to influence
| public policy / restrictive measures?
|
| No. This is the "flatten the curve" logic which was a horrible
| misjudgment. Having the disease in circulation in the community
| is not only doing tremendous damage to many, many people (even
| if the hospitals aren't full), but is also allowing the virus
| to mutate and potentially escape immunity protections or become
| more deadly. If you re-open as soon as the hospitals start to
| free up again, you just start moving the pendulum back in the
| direction of crisis.
|
| Countries like Australia and New Zealand have shown that if you
| keep up lockdown measures for just a month or two after the
| hospitals free up (AND if you institute and keep real travel
| quarantine restrictions), you can get the virus to effectively
| ZERO community spread and keep it there. We can achieve this,
| and we ought to be aiming for it.
| scrollaway wrote:
| > _Countries like Australia and New Zealand have shown that
| if you keep up lockdown measures for just a month or two
| after the hospitals free up (AND if you institute and keep
| real travel quarantine restrictions), you can get the virus
| to effectively ZERO community spread and keep it there._
|
| It's too late for that anywhere that isn't super remote like
| AU/NZ. Even South Korea and Japan, isolated as they are and
| with very strict measures, controls on lockdown, and a
| population that strictly follows them, cannot get / is not
| getting to zero community spread: It's doing regular, short,
| strict lockdowns instead.
|
| This is the model that the west should adopt but instead a
| lot of countries are faffing around. Belgium has been in a
| five-months-long semi-lockdown that is leaving everyone
| severely depressed, is hugely damaging to the economy, and
| has plateau'd the spread to very non-zero numbers so the
| disease is still very much present. Worst of both worlds.
| garmaine wrote:
| Japan does NOT have strict lockdowns in place. I know, I
| work for a Japanese company. Heck they've been giving out
| travel vouchers for free travel around the country. Not a
| model for pandemic response at all.
|
| Australia is hardly isolated. Tons of flights in and out
| every day, and a vital part of the world economy. Really,
| any country can be "isolated" if they just close the
| borders to non-quarantined ( _REAL_ quarantine) travel,
| which is much more important than lockdowns.
| ggm wrote:
| _It 's too late for that anywhere that isn't super remote
| like AU/NZ._
|
| As an Australian citizen I often wonder how much this super
| distant story has to do with it.
| malandrew wrote:
| Thinking more about headlines like this, I wish we could just
| replace the word "linked" with the words "correlates with"
|
| Society really needs to use either the term correlation or
| causation more often so we can always have the "correlation does
| not imply causation" discussion and hammer that home until it's
| common knowledge and common sense.
|
| The word "link" to me is a weasel word meant to plant the thought
| "causation" when only correlation is merited.
| jorgeleo wrote:
| <sarcasm> In other news, it turns out that the earth IS round
| (mostly) </sarcasm>
| wayanon wrote:
| We are so lucky we had 2020 science to deal with this rather than
| in previous decades. I wonder how our current efforts will seem
| to scientists from decades in the future!
| goldforever wrote:
| Yes, because most died before they could even be admitted.
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(page generated 2021-02-22 23:01 UTC)