> The Covid vaccines are remarkably effective at preventing serious illness. If you’re vaccinated, your chances of getting severely sick are extremely low. Even among people 65 and older, the combination of the vaccines’ effectiveness and the Omicron variant’s relative mildness means that Covid now appears to present less danger than a normal flu.
> For the unvaccinated, however, Covid is worse than any other common virus. It has killed more than 865,000 Americans, the vast majority unvaccinated. In the weeks before vaccines became widely available, Covid was the country’s No. 1 cause of death, above even cancer and heart disease.
At this point if an adult in the US is unvaccinated it is (1) almost certainly by choice (there are some people who cannot get it for medical reasons but they make up only a very tiny fraction of the unvaccinated), and (2) it is very unlikely that any evidence or logical arguments will chance their minds.
With COVID becoming endemic everyone is going to get antibodies, with the only choice being whether you get your first antibodies by vaccination or by getting COVID.
The only question really then is how fast do we want the unvaccinated to do the getting antibodies by getting COVID thing. The faster they get it, the faster we can be as done with COVID as we are ever going to be.
I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
Apologies in advance for getting on my soapbox, but this has been on my mind for a while.
The way in which the media has gotten everyone to say "the unvaccinated" is a 'disease' against basic science (not even getting into the divisive nature of this). I would go as far as saying if you read any paper, study, or other that refers to the "unvaccinated" as a single cohort, you are reading vaccine propaganda, not science, or certainly not good science.
This must stop. Prior infection immunity is basic science that we've known for eons, and ignoring it is so blatantly glaring an omission, it should make the most staunch pro-vaccine person pause and say: "why are they so adamant to vaccinate those with prior infection?". One would expect prior infection to be robust, and multiple studies, including even the CDC's most recent shows it to be easily as good if not better and longer lasting than the vaccine. This should not come as a surprise to anyone.
If you think any of the above is "anti-vax" then I would suggest the media has won and science is dead. I'm not suggesting the vaccine doesn't work. I'm not suggesting it doesn't provide protection against severe disease and death. I'm not suggesting anyone go out and intentionally try to get COVID, but a HUGE # of people have already had it and ignoring them is downright unscientific. If you are a rational person who wants to see good science and are unemotional and detached from outcomes, then you will want to see proper study cohorts, and combining prior infection in with the "unvaccinated" cohort, is just bad science. This bad science fuels the anti-vaxx movement even more, and honestly, it is hard blame them.
> why are they so adamant to vaccinate those with prior infection
Because the data shows they don't matter.
This is the same thing as deaths due to covid vs. deaths while positive to covid. Sure some people might have been miscounted as covid deaths but actually died due to cancer/car accident/whatever. Despite this the excess deaths over the past two years is much higher than the number of covid deaths; thus showing that miscounts must be a small minority which, in any case, is absolutely dwarfed by excess deaths not counted as covid deaths. It might even grow a little as testing improves but it still remains mostly irrelevant.
Likewise it may be that some people do not need a vaccination. However, we have a 30/70 split in number of covid hospitalizations, with 30 being vaccinated people, in countries where the split in the normal population is 90/10. This means that despite some unvaccinated people having had prior infection the vaccine reduces hospitalizations by 20x. Given this data the most effective strategy is to just vaccinate everyone without what is effectively a pointless distinction.
As the number of unvaccinated but protected people will grow (through a combination of more infections, more vaccinations and more deaths), the proportion above will revert to 90/10 and unvaccinated people will not be an issue anymore. For now however analyzing the proportion of naturally immune people among the unvaccinated is, again, mostly irrelevant.
I've also noticed this. I have covid right now. I'm double vaccinated. I was planning to get my booster shot, but now that I've had covid what's the point. It's not likely to increase my immunity and it comes with risks.
At some point the government will probably change the definition of fully vaccinated to three shots and then I'll be in that unvaccinated group I usually make fun of.
Somebody I know lost their job because they wouldn't get vaccinated (but they'd already had confirmed covid). That seems very unfair.
I'm very angry at the dumbasses who haven't been infected and refuse to get vaccinated, including family of mine who died because of that. But no distinction is being made of those who have natural immunity. Which, as you say, is unscientific.
I feel like partly that's because many people think they had it, but didn't, and partly because it's easier for the government to just tell everyone to get vaccinated.
Not disagreeing with this (although my understanding is that there have been studies that show vaccination has been more effective), but how would you seperate the unvaccinated / previously-infected-and-recovered cohorts?
Even by reconciling PCR testing data (which I imagine is incredibly patchy at best), you still would only know historically how many people tested positive (ignoring what is in all likelihood a majority of the cases that never got tested) and be able to reconcile it against numbers of vaccinated, which tells you nothing useful without being able to intersect the two sets (which you can’t do without uniquely identifying every PCR test and matching it to an individual universally).
i.e. the better data you would need doesn’t exist.
Yes, this is a prime example of bad data being worse than no data.
In the UK, for months now, the rate of infection has been higher among the vaccinated cohort than among the unvaccinated cohort, for most age groups. [1]
The antivaxxers are of course pointing to this data and claiming it's evidence that the vaccines make you more likely to get infected, and therefore the tinfoil hats were right all along.
But what's actually happening is that the unvaccinated cohort contains a lot of people with natural immunity, who are dragging the numbers down, while the vaccinated cohort doesn't have as many people in it who have had a prior infection.
I strongly suspect that if you were you properly separate people by vaccination status and prior infection, you would see that the group of unvaccinated+no prior have a much higher case ratio than any other group. But since we don't have this good data, the antivaxxers are running hog wild with the bad data, drawing the wrong conclusions.
It's also sociopathic. We've stopped caring about the people around us and created a group to hate that we refer to in a dehumanizing way. You may not agree with their choices, but they are still people and it should be beneath us to dehumanize "them" - actually our neighbors. It's actually horrifying from a human perspective
> If you are a rational person who wants to see good science and are unemotional and detached from outcomes, then you will want to see proper study cohorts, and combining prior infection in with the "unvaccinated" cohort, is just bad science.
Not sure what you mean. Science detached from outcomes is bad science. Science is trying to suss out cause and effect, not to avoid reality.
> This bad science fuels the anti-vaxx movement even more, and honestly, it is hard blame them.
Ah. There it is. Nope. It's still easy to blame them. It's not a sufficient criticism to cede moral superiority. "You didn't adjust your tone to distinguish 'unvaccinated' from 'immune-because-infected' from 'vaccinated'." does not suggest that antivaxxers are any less morally bankrupt for promoting the course of action which results in serious illness and death.
Isn’t it just simpler to vaccinate everyone and be done with it? Instead of tracking who already had an infection etc. Just like we do for all the other vaccines we get.
I don’t understand why it’s so controversial. The upside is huge and there is literally no downside.
Unvaccinated people have caused other people to suffer worse health outcomes because unvaccinated people are disproportionately filling hospital and ICU beds (and wearing out doctors and nurses).
Developing antibodies the old fashioned way is great! Doing it with vaccines saves other people's lives. That is the problem with people who refuse the vaccine and why they deserve to be vilified.
> but a HUGE # of people have already had it and ignoring them is downright unscientific.
Unless they went to the hospital or had a positive test, then they just think they had it right?
We get data like this:
All we know are things like:
Unvaccinated 12-34 year-olds in Washington are
• 2 times more likely to get COVID-19 compared with fully vaccinated 12-34 year-olds.
• 5 times more likely to be hospitalized with COVID-19 compared with fully vaccinated 12-34 yearolds.
Unvaccinated 35-64 year-olds are
• 3 times more likely to get COVID-19 compared with fully vaccinated 35-64 year-olds.
• 7 times more likely to be hospitalized with COVID-19 compared with fully vaccinated 35-64 yearolds.
Unvaccinated 65+ year-olds are
• 4 times more likely to get COVID-19 compared with fully vaccinated 65+ year-olds.
• 7 times more likely to be hospitalized with COVID-19 compared with fully vaccinated 65+ year-olds.
• 11 times more likely to die of COVID-19 compared with fully vaccinated 65+ year-olds.
But it unfortunately doesn't break down things like "had a confirmed prior infection" or "thought they might have had a prior infection". It would be interesting to see how the data works, but right now unvaccinated people are on average in a very bad spot. For all we know, the unvaccinated are just more likely to have comorbidities (e.g. obesity) that lead to their higher fatality rates. But for now, getting vaccinated is so easy, I wouldn't take the risk.
> One would expect prior infection to be robust, and multiple studies, including even the CDC's most recent shows it to be easily as good if not better and longer lasting than the vaccine.
I got COVID back in March of 2020. I got two vaccines and a booster, and then in late December I caught COVID again (probably Omicron based upon symptoms and the prevalence).
I'd like to make sure I understand your underlying position before proceeding.
I think what you're trying to say is that you believe there is an adequate enough case for people who had prior infection to avoid what they believe is an unnecessary medical procedure which may have some risk. And, scientifically, you believe it's absolutely certain that in this specific situation, prior infection immunity provides very good protection, enough to override any benefits we might see that happen at very high vaccination rates.
Hope that's a good summary....
Are you a scientist?
You made a number of statements about what is good and bad science, but some of the reasoning you make doesn't completely add up. In science nobody has epistemic certainty, but scientists and public health people act as if they do.
In reality public health decisions are made using imperfect information and balance utilitarian and emotional concerns, as well as prior knowledge of patient compliance. Sometimes it may be necessary to not change a message, even if it's somewhat wrong, too quickly.
The calculus is very simple at this point. I believe CDC and others are saying that the additional risk from taking the vaccine is very very small, and the marginal benefit of having even people with prior infection get vaccinated presents a greater (overall) health outcome (presumably in the form of people who had infection immunity but still were re-infected, and then infected others).
Beyond that I don't think anybody has enough scientific data that is certain enough to say that you're right in your statements, and I think it's pretty poor taste to just keep attacking people who disagree with you as doing "bad science". Science is a subtle art, and anyway, public health is an entirely different field that has to concern itself with effective communication and people-emotions and ethics, so sometimes what CDC announcements may not be identical to what the state of the art of science is saying.
I think making a simpler and weaker point would work better. I'd criticize the media for unnecessarily creating additional fear, uncertainty, and doubt, around COVID (there was a lot of early reporting about how omicron was going to destroy the world, that was entirely baseless speculation). And too many people, both media and generally, are quick to criticize people who don't "follow the CDC to the letter", especially around vaccines. I think that kind of cropped up politically in the US after the unnecessary autism/vaccine scare and ended up representing a dividing line.
BTW, I'm an ex-scientist, worked in medical biology for decades, and I don't think many vaccines (flu, covid) are nearly as effective as the medical establishment suggests (look at the numbers of people who died of flu even in years with very high vaccination rates). And people do have significant side effects from getting vaccinated, but very rarely are the side effects more dangerous than the value of being vaccinated (in cases of flu and covid), which is why I support them. Finally, I think that herd immunity doesn't actually work in diseases like flu or covid. So I have some sympathy to your message but ultimately, just get vaccinated and boosted unless you can truly articulate some huge risk to your personal biology.
>If you think any of the above is "anti-vax" then I would suggest the media has won and science is dead.
[edited to remove antagonistic comment] - I think your comment about science being dead is less-than-useful hyperbole.
Why focus on the "get vaccinated" message? Because the vaccine is free. It's widely available. There is absolutely low, low risk to taking it - less risk by far than getting COVID or long COVID. Because prior to Omicron, the goal wasn't "let everyone get sick and be done with it", it was "prevent anyone from getting sick". I just thought of one as I type this: To say "we accept natural immunity as a viable strategy" could have encouraged thousands upon thousands of ignorant or otherwise actively anti-authority citizens to get sick on purpose to stick it to the man, then end up in the hospital.
I don't want lies to win, and I don't want to ignore the science. Natural immunity should be acknowledged for its benefits. I think a government could do that, and still say "tough shit, get vaxxed" just to make sure people don't commit bio-warfare on communities by trying to get ill.
Zeynep Turfekci talks about this in this thread, and about why she thinks prior infection offers less protection than the vaccines, to the point that she supports vaccinations for those who have already caught COVID.
simple numbers show that unvaccinated get covid at higher rates and the number of hospitalizations is higher which puts strain on the hospitals. If something happens to me I dont want an unvaccinated taking a spot I need.
In a prior probability sense, that makes sense, right? The adaptive immune system has to be working or the vaccines wouldn't work, and adapting against the actual threat has to be effective or you'd never have fought it off in the first place.
Of course, the general problem here is one of measurability and working in an adverse environment. So in a medical sense, prior infection determines response. But in a public health sense, if you believe that prior infection claims are easier to fake than vaccine records, and if you believe the spread risk is worse, then it makes sense to proxy spread risk with vaccine records. Personally, I get what you mean, and perhaps I'm not fighting too hard for the truth here because I don't really care that much.
But I just wanted to say I'm with you on the facts since every other response is operating (in my opinion) in the fallacious "there's a paper that says" mode. It's just not Bayesian.
Ignoring those who are unvaccinated but had a prior infection seems like it can only make the data look better for the unvaccinated than it actually is, no? Because the "true" death rate among the unvaccinated-and-not-yet-infected will be higher than among the unvaccinated-and-previously-recovered group that already has that immunity you talk about.
So if anything, breaking that out just makes not getting vaccinated for those without prior infection look even stupider.
I'd have no problem with treating proof of immune response as similar to vaccinated, but I also haven't seen most of the outraged argue for that - versus just arguing for "freedom" - so... don't wait for me to make that case for them.
Do we apply this same thinking to the flu? If I have had the flu before I shouldn’t be encouraged to get a flu shot? Seems easier for everyone to just get the flu shot than figure out if I have had the flu before and then maybe get a flu shot. What am I missing?
Because the vaccine protects so much better than just a previous infection. We've been over this, over, and over. But you just won't accept the numbers now will you?
I agree - I am worried about taking hospital capacity claims at face value though.
From what I've seen, it was common for hospitals to report being overwhelmed even during flu seasons pre-covid. I wouldn't classify that level of 'overwhelmed' worthy of mandates upon society.
I don't doubt that during these periods of time hospital resources are strained in some way, but there's a difference between this routine level of being overwhelmed and a level where freedoms should be restricted from the general public.
I don't have a good model for where the line should be drawn, but I lean towards not imposing restrictions unless massive benefit can be shown beyond a reasonable doubt.
Dude go to a hospital in a populated area during this surge. My wife sat in the waiting room for 3 hours with SEVERE abdominal pain, DURING A PREGNANCY and was unable to be seen. We went home. If she’d had an ectopic pregnancy, she would probably not be here anymore.
The thing they don't always mention is that hospital capacity is always close to being overwhelmed, by design, because otherwise you're sitting around with a large amount of extraordinarily expensive idle hospital capacity. A small change is enough to go from "almost full" to "over capacity."
The seemingly obvious thing to do would be to build some temporary capacity specifically for COVID patients. We've had quite a long time to do this now so I'm not sure what's preventing it. Maybe it's caught up in that thing where captured regulators are gatekeeping medical certifications to maintain labor scarcity or some such thing?
This pandemic has been extremely hard on many healthcare providers. But hospitals in many areas were routinely overwhelmed during winter respiratory virus season in previous years. They dealt with it as best they could, and we didn't impose mandates or restrictions on the rest of society.
There are operations research PhD's who use decades of aggregate demand data in dynamic pricing algorithms for the purpose of revenue and queue management in perishable services, e.g. software for pricing of airline seats, rental cars and hotel rooms.
In countries with universal healthcare, price cannot be used for queue management, but the US isn't one of those countries. Did any hospital use queue management software to adjust pricing as a mechanism for demand throttling, due to limited capacity in 2020-2021?
In any case, if supply-vs-demand is both a policy driver and metric of intervention performance, we need public, detailed hospital capacity data for analysis and optimization of net societal costs vs benefits. Utilization of space and skills is eminently quantifiable and software already exists for demand mgmt.
A few of my friends are doctors. When it hits, it's hell. Here in Poland 300h of work during the month the infections are at their peak is not unheard of.
> I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
Having anyone's freedoms dependent on available hospital capacity is a terrible way to run a society. Note that these freedoms were debated and won in an era where medicine was terrible.
I’d like to know that if I have a heart attack or get hit by a bus then I’ll have access to top quality healthcare —- not burnt out understaffed hospitals.
Sharing limited resources is a major role of the government, and managing hospital capacity seems to fall under “promote general welfare” to me.
Having anyone's freedoms dependent on available hospital capacity is a terrible way to run a society.
You should note that government regulations are designed to keep hospitals running nearer capacity. See "certificates of need", which are (in most places) required to get authorization to build a new hospital. You've got to prove to the gov't that a new hospital really is necessary. And thanks to regulatory capture, the tendency is for existing providers to try to sink such applications.
> Note that these freedoms were debated and won in an era where medicine was terrible.
That was also an era when the US was subject to numerous epidemics and pandemics of diseases such as cholera, typhus, yellow fever, bubonic plague, smallpox, and influenza, and it was debated and found that placing restrictions to try to limit the harm from those epidemics was a legitimate exercise of the state's police power and not an infringement of civil rights.
I hate this casting of the issue as "freedom". It's absurd.
My "freedom" to live because I have a medical issue but cannot get treatment will be severely impacted if hospitals are overrun with patients and worn out workers.
Having anyone's freedoms dependent on available hospital capacity is a terrible way to run a society.
So is letting people die from otherwise treatable injuries and infections so someone else can enjoy their "freedom" to ... you know what I'm driving at.
Freedoms aren’t considered in isolation. Maintaining freedom for some means removing freedom for others some times. In this case the “freedom” to get timely treatment for those that need it.
I recommend you do some basic research on the history of quarantine and the united states as well as colonial america. You'll quickly see your assertion stands on shaky ground. https://www.ushistory.org/laz/history/index.htm
The vaxxed and unvaxxed populations both rely on the same medical infrastructure. So when the unvaxxed fill hospitals to recover or die, they are consuming scarce resources that are required by the population at large for other things like birth, cancer, surgery, etc. Sadly, we don't have an ethical way to let all the unvaxxed get covid without impacting the medical system negatively for the rest of us.
Cigarette use kills 480000 people every year in the US alone. 300 billion dollars estimated to be spent per year with treatment of smoking-related illness.
I don't want even to look at the numbers of the more critical epidemic on the US: obesity and metabolic diseases.
By arguing that "the unvaxxed" are a burden and that they deserve discrimination, you are opening the gates for those arguing that smokers should be forced to stop smoking, or that obese people need to be forced to stricter diets.
I wanted to comment a little on the "choice" thing. I'm not sure that every person who is unvaccinated chose that. I had to try very hard to get my three doses. For the first series, I had to go to a faraway FEMA-run site. For the booster, I scheduled three appointments with CVS; the first two times, they canceled my appointment on the walk over (I made the first like 3 weeks in advance, and they canceled with 10 minutes notice -- "sorry, we ran out".) I did eventually get that third dose; but each signup took me about 15 minutes of typing in all of my medical information (`insert into form_responses (email, json_blob_that_is_passed_to_the_final_appointment_making_system) ...`?). I imagine some people just gave up after their first appointment was canceled.
I never saw anyone talking about this; the government websites are like "go to CVS, you can just walk in!" but in reality no CVS locations were accepting walk-ins if you asked. And even appointments were tenuous.
I feel like it's fair to place 90% of the blame on individuals, but I also think big companies are misrepresenting themselves to the government, or the government isn't asking if they actually have vaccines or not.
Access is also a larger issue in under-served populations. I'm fortunate enough, as probably are many on this site, to be able to just swing by CVS during some downtime while WFH. A person who is paid hourly for an in-person job and reliant on public transportation will have a much harder time.
I wish there were stats on "want to vaccinate, but haven't been able to."
How long ago was that? I have to think the situation today is quite different from when the major vaccines were approved months ago, but I could be wrong.
I've never heard a convincing argument about why the COVID restrictions weren't literal violations of human rights. Often I got a variant of "I'm scared we're just going to do it". Most (all?) of the arguments for it turned out to be wrong - eg, vaccination has not slowed the spread, even marginally, according to the experience in Australia where COVID tore through a highly vaccinated population. In my state (~95% adults 12+ vaccinated) we have had more than a million cases (population 8 million) in 1.5 months. And the testing systems collapsed, probably quite a bit more in reality.
This is now taking it one step further - this argument is as an assumption - suggesting people have to give up their freedoms because people paying for their own hospital capacity is unacceptable to you. I say that because the sort of person who is pro-freedom to the point of not wanting a vaccine might well overlap with the population of people pro-freedom enough that they want individuals to pay for their own healthcare.
This is not a sustainable position against 2019 business-as-usual. I agree with the headline.
I’m Australian. Vaccination and restrictions were why we never saw refrigerated containers of dead people on street corners, like NYC did in the first wave. Many people would have died or needed to be hospitalized.
It looks like that's more Americans than have been killed in combat in all of the wars of the 20th century combined [1]
Granted it's less than the UK lost in WW1 alone, so it's perhaps more a testament to how few the US managed to loose in the world wars (compared to Europe), but it's still wild to realize.
I know this is going to sound conspiratorial but I think you’d have to be pretty naive to accept the reported deaths in the US due to Covid to be that accurate. Hospitals(which in the US are for profit mind you) were quite literally given more money for reporting a death as a Covid death for a period of time. https://www.usatoday.com/story/news/factcheck/2020/04/24/fac...
Actually you could say it’s difficult to trust the numbers coming from any country for a variety of reasons, whether it be under or overreported.
These numbers can be further separated by "with Covid" and "from Covid" causality, as well as co-morbidities and expected lifetime. E.g. if someone was soon to die from illness A, but died 3 months earlier from complications induced by Covid, and the hospital received a financial payment for classifying this as Covid-related treatment, that should be broken out into a separate reporting category. Such deaths would not much change all-cause mortality for the year.
> It looks like that's more Americans than have been killed in combat in all of the wars of the 20th century combined [1]
Like all deaths tragic, but let's not pretend young men, effectively kids, dying in war is the same as elderly & chronically sick populations dying of disease.
I saw that email. David Leonhart I believe, who is one of my preferred NYT journalists.
Something that was conspicuously absent from the paragraph regarding the unvaccinated vs. the vaccinated paragraph preceding it:
Risk stratification by age. When talking about the vaccinated, he calls out the "even in people over age 65".
There is zero question that vaccines reduce the relative risk for people under 65, however, it should be noted that the absolute risk for healthy people in this category is orders of magnitude lower purely by virtue of their age. Unhealthy people in this category should be vaccinated, of course.
Just an example of narrative bias creeping in, even from the relatively top-flight Leonhart.
Anyway, not disagreeing with you, just calling out a specific example of why the journalism on COVID has been, primarily unintentionally, misleading.
Mandates work up to a point. Eventually you will be left with a portion of the population that cannot be convinced and will not obey mandates.
Once you've reached that point, what purpose does the mandate serve? Nobody else is going to get the vaccines, so there is no public health justification for keeping the mandate around. However, what remains is the continual need to provide your vaccine status to your employer and in various other aspects of your daily life, which is a burden for vaccinated people too.
The United States has probably already reached that point, or will soon.
>” At this point if an adult in the US is unvaccinated it is (1) almost certainly by choice (there are some people who cannot get it for medical reasons but they make up only a very tiny fraction of the unvaccinated), and (2) it is very unlikely that any evidence or logical arguments will chance their minds.”
This typical line of thought ignores a huge issue. Vaccine mandates don’t help per se, but it’s an issue that is pretty bad to just gloss over.
Articles like this really need to describe some sort of policy or plan for the 7 million or so immunocompromised people in America.
Like at least mention them and advocate something. Don’t just gloss over 7 million people. Propose something like Priority access to the new Pfizer pills and additional assistance with other things to avoid high risk activities.
> Articles like this really need to describe some sort of policy or plan for the 7 million or so immunocompromised people in America.
Wear good masks, social distance, etc. Basically do everything that's recommended to prevent the spread of covid, besides getting a vaccine. As a bonus, doing these things will help keep them safe from a large number of other airborne illnesses that put them at risk.
Plus, there has been an increased awareness about preventing the spread of airborne diseases in general. Lots of stores and businesses have installed filtration systems that help keep everyone safer. Contactless delivery / checkout is much more mainstream, and it's now socially acceptable & legal to wear a mask, which is something certain people are going to continue to do. So while it has certainly been a nightmare for immunocompromised people, some positive changes have also resulted.
There always have been, and always will be, vulnerable immunocompromised people. We didn't reorganize society around that fact before the pandemic, and we shouldn't do so now.
Sorry if that sounds harsh, but we can't keep using things that will never change as reasons to persist with a state of emergency -- otherwise that state of emergency will never end.
> If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
This is basically the reasoning used in Ireland; the hospitals weren't overwhelmed as Omicron peaked in the first week or so of January, so overnight we went from really quite restricted to all restrictions except mask requirements gone. Over 95% of Irish adults are vaccinated, so this isn't a trick that will work everywhere, but... for now it seems to be going okay.
My sense is the government has silently taken this stance and that hospitals aren't at risk of collapse like they were a year or more ago. I also get the feeling the vaccinated have given up on the unvaccinated too just based on how rarely I now see posts on social media. It's like a tacit acceptance that if people are going to choose to die, so be it.
I actually wonder if this not caring is what will actually defuse this particular anti-vaxx movement. Or it'll just be the next vaccine and the Covid vaccine issues will be completely forgotten. I mean when was the last time you heard about vaccines causing autism?
what's interesting here is the underlying psychology that makes people susceptible to manipulation by thinking they're in the know on some Big Lie. This seems to be nothing new however and I can't help but think of this quote from Goebbels of all people [1]:
> “If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”
What? I thought it has been pretty clear that even with Omicron, the vaccine dramatically reduces risk. In WA, the unvaccinated are 2-4x more likely to get covid and 5-11x more likely to be hospitalized.
> I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
You forget the second order effect here: the more unvaccinated people hospitals have to treat, the more likely their nurses and doctors are to quit, even if "the hospital is not overloaded". The more likely they are to quit, the more likely people are to die of other preventable causes in the future (because once they're burned and quit, they're not coming back).
The exact operation of this effect isn't clear, I think.
If we could wave a magic wand and make it all immediately end, that would be preferable. But that's not going to happen.
That leaves us with two choices. We can let it drag on and on, or we can tear off the bandaid quicker. It's not clear to me which of those two is worse for the healthcare professionals you're talking about.
> The faster they get it, the faster we can be as done with COVID as we are ever going to be.
This reminds me of the arguments that unvaccinated were the cause of COVID-19 and were endangering those who are vaccinated. Vaccinated people get and spread COVID still. In fact, recent studies show natural immunity or vaxxed plus COVID causes much more antibodies than simply getting vaccinated, especially with a vaccine that targets an old mutation that has proven much less effective against Omicron and the likes. The vaccinated people will prob continue to get vaccinated a few times a year until they get a less dangerous variant.
I don't see how we could ask that of either people or publications - the data simply doesn't exist. Only a tiny fraction of Covid cases get genetically sequenced.
> The only question really then is how fast do we want the unvaccinated to do the getting antibodies by getting COVID thing.
I think the question that so many people forget is how fast the unvaccinated themselves want to get antibodies, not how fast someone else wants to get them antibodies.
> I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
Im my country, Germany, that currently is debating mandatory vaccinations for everyone, the maximum average share of Covid patients was 5% at the top of the most deadly Covid wave. 95% of patients were in for other reasons.
> Gemessen an der vorhandenen Bettenkapazität ergibt sich eine durchschnittliche Belegungsquote von 1,3% durch COVID-19. Die höchsten tagesbezogenen Belegungsquoten gab es in der zweiten Dezemberhälfte mit knapp 5% aller Betten.
I don't want to have to undergo medical procedures, just for optimizing a statistic by a very small percentage (for two weeks in a year) that could have been optimized in other ways. Some pointless covid intervations at national level have burned so much money that nations could have built thousands of new hospitals instead.
“ It has killed more than 865,000 Americans, the vast majority unvaccinated.”
Could someone please put a number on “vast majority”? I keep hearing this adage but a majority is 51% and there’s a big range between 51 and 100% that a word like “vast” doesn’t precisely capture..
You'd have to adjust for the period of time where vaccination wasn't available but currently the difference is best characterized as vast — the weekly rate is 10 per 100k versus 0.71 for fully vaccinated without a booster and 0.10 for boosted individuals:
I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
I don't think you're breaking any new ground here. In the two regions where I've lived since the outbreak, hospital capacity was already a factor in what precautions were mandated.
But the spread of disease is a lot more complicated than sick/not sick. It has an affect on society much farther and wider than hospital capacity, and that should not be the sold yardstick by which we measure our reaction.
You're not going to get COVID antibodies via the vaccines. You would with other vaccines (e.g., polio, measles, etc.), where they inject the actual disease into your body in order to trigger your body's natural immune response, but the mRNA vaccines don't work that way. The only way to get COVID-19 antibodies currently is to get the disease.
I'm not vaccinated and it is by choice because I've already had COVID. Getting a vaccine for a disease you've already had is like wearing two pairs of pants. Sure, you can do it, but why?
> With COVID becoming endemic everyone is going to get antibodies, with the only choice being whether you get your first antibodies by vaccination or by getting COVID.
My guess is you don't have children under 5 who can't be vaccinated right now. Yes, there is a low chance of complications, but it's still the most deadly infectious disease for that age group [1] and I'd rather have my kids obtain antibodies through vaccination than disease.
Except, the hospital capacity per 1000 population has been steadily declining in the West for ages [0] and is at half the capacity in China for comparison. So rather than blaming the unvaccinated, we should maybe review the policies that lead to it.
"By the week beginning October 3, compared with COVID-19 cases rates among unvaccinated persons without a previous COVID-19 diagnosis, case rates among vaccinated persons without a previous COVID-19 diagnosis were 6.2-fold (California) and 4.5-fold (New York) lower; rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19. During the same period, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates in California followed a similar pattern. These results demonstrate that vaccination protects against COVID-19 and related hospitalization, and that surviving a previous infection protects against a reinfection and related hospitalization. Importantly, infection-derived protection was higher after the Delta variant became predominant, a time when vaccine-induced immunity for many persons declined because of immune evasion and immunologic waning (2,5,6)."
TL;DR only vaccine did not provide better protection than only previous infection
Ethically I think it’s the people who cannot get vaccinated through no choice of their own that need to guide policy. If we can protect these people, and there was a fair amount of hospital capacity, I’d be all in on letting the anti-vaxxers just get it. I live in a country with health care. So I’d even be in favour of charging the anti-vaxxers the cost of care. Give the nurses the extra money.
This seems to be the near consensus opinion of reasonable people I know. People are really downplaying how effective the vaccines have been. My one unvaccinated friend has stated several times that they would rather sign a waver denying themselves access to an ICU bed than get vaccinated. I don't know what we are waiting on as a society to reopen other than enough people to get it.
Nice fairytale but you should see more television. People who decided to not get the jab have been hunted like animals. And people that got the jab got really sick or died and infected others.
Also there were effective medications for covid but people were misled to believe that they did not work, people died and were terrorized to get vaccinated.
> (2) it is very unlikely that any evidence or logical arguments will chance their minds.
While this is true, we've seen that employer mandates actually do change their minds. Yes, something like 1-2% of people don't get vaccinated even in that case, but that's far less than the 20% that claim they will lose their jobs to not get vaccinated.
This totally discounts reinfections and long covid. A lot of people are going to die and get disabled.
Antibodies seem to not last very long at levels that prevent infection. This is a very severe crisis that doesn't end because people get tired. It's like being tired of a war and laying down your weapons and then getting surprised when you get overrun.
New variants are now emerging every 30 days. Good luck with that plan. Why is the concept that life finds a way so hard to accept? We're getting our asses kicked by this thing.
But I would agree with you if the variants would just stop creating themselves. But it doesn't seem like any immunity really lasts. So this leads to repeatedly infecting yourself with variants as they emerge (1 in 6 chance of a bad outcome of long covid or worse), become a bit of a test rat for the latest vaccine, or some combination therein.
I'm hoping we eventually get a vaccine that transcends the evolutionary range of this thing. And then we could do exactly what you're suggesting. But that's a science project and you never know how those will go.
The main concern I have is will we be a nation crippled with PTSD and long-term healthcare concerns when this is finally over with?
I think the hospital capacity is a key argument indeed. But there is another aspect to consider. Each viral replication is a potential event where a new variant can arise, thus the fewer viral replications the better since each new variant has unknown risks. An unvaccinated person will on average be host to many more viral replications after exposure to the virus than a vaccinated person after exposure. Thus, if a large part of the population remains unvaccinated, the virus has more room room to evolve than necessary given we have easy access to effective and safe vaccines. Therefore, this should also factor into a debate around vaccination policies and personal choice vs societal risk.
> Thus, if a large part of the population remains unvaccinated, the virus has more room room to evolve than necessary given we have easy access to effective and safe vaccines.
Word was that Omicron diverged from an earlier version of covid in mice, over the course of about a year, then jumped into humans [0].
I think this detracts quite a bit from the point you were trying to make above, since we are not vaccinating mice, nor all the other animals that harbor covid such as bats, cats, dogs, primates, and deer [1].
Since we can't vaccinate or destroy all of the non-human hosts for this coronavirus, and the virus already has evolved in animals and made the jump to humans a couple of times, I don't agree that the point you made above is relevant.
I encourage everyone eligible to protect themselves by getting vaccinated but this is unlikely to prevent new variants from evolving. The current thinking is that new variants are most likely to evolve in immunocompromised patients who experience prolonged infections. Vaccines are less effective for them.
> The only question really then is how fast do we want the unvaccinated to do the getting antibodies by getting COVID thing. The faster they get it, the faster we can be as done with COVID as we are ever going to be.
No, there's one other question - how much of our limited health resources do we want to allocate to people still refusing to get vaccinated.
In all fairness, I think they should be allocated proportionately. If 20% of a region's population is unvaccinated, and there's a bed shortage, they should get ~20% of hospital beds.
It is so amazing to me how many people don't seem to recognize this.
My (somewhat baseless) speculation on this is that a lot of the people in forums like HN are early adopter types who mostly work from home, and so were able to avoid exposure and got the vaccine relatively early. From this standpoint, I could see it being harder to empathize with folks who were exposed in everyday life (it's just a simple jab, I did it, why can't everyone else? Or maybe even those folks must be bad/lesser people if they didn't stop themselves from being infected).
Combine that with the constant onslaught of media time that pointedly ignores the categories that you breakdown above, and maybe it's no wonder that people have the opinions on this that they do.
Encouraging natural immunity is asking for hospitals to get filled up by people giving themselves covid on purpose. This affects non covid patients too.
These days you have to add ‘eligible for booster and chose not to get it’, ‘got booster shot’ and ‘not eligible yet for booster shot’.
In the Netherlands we started the booster campaign on November 18, but we get graphs claiming ‘hardly any people with boosters in hospital!’ with the data including hospitalizations from November 19 onwards.
there are so many different standpoints you could take from the HN population.
- "HN focuses on tech; novel tech tends to be anti-regulation => HN must be anti-mandate."
- "HN focuses on engineering; engineering is often an optimization game that involves balancing tradeoffs => HN must believe COVID response relative to all the other risks we face is an over-reaction."
- and of course the one you presented.
my theory is that opinions within any group are just more divergent than people realize. some groups do a better job than others in (a) understanding that and (b) working with that. it's almost all cultural: do people in your culture publicly voice their non-conforming views, and to what degree do people in your culture update their beliefs when they hear new information?
The other thing that needs bringing into the discussion is vulnerability.
The average of death with Covid in the US is 80.
If every healthy 30 year old and under in the US declined the vaccine, this would barely move the needle. They personally are not vulnerable and are not likely to end up in hospital.
Reading this discussion, you would think that vaccinated = safe, unvaccinated = certain doom. Age is a much stronger predicter than vaccine status.
Age and also just health status in general, people with diabetes or heart issues are vulnerable; but to your point most of those vulnerable are now vaccinated.
You may even split up (1) into omicron-recovered and other-variants-recovered, since recovering from omicron strain seems to give a stronger resistance against reinfection for both omicron and delta, whereas recovering from delta offers little reinfection resistance to omicron[1].
This, along with a large number of other trends related to COVID (including vaccine effectiveness), can be simply explained by immunity just not being very long lasting (4-6 months?). The Delta wave predates Omicron by around that much time.
I think when all the dust settles around COVID, we're going to learn that both vaccines and "natural immunity" last 3-6 months, and that explains almost all of the noise and confusion about what "works" and what doesn't. And that also suggests that "herd immunity" was never a realistic goal, whether by vaccines or infection. Maybe some future vaccine can be developed which targets a different signal and can last longer.
Good breakdown. I'd propose further breaking out of each category based on whether the person is immunosuppressed (for example from medication given to organ transplant recipients) or otherwise immunocompromised.
“In theory, every citizen makes up his mind on public questions and matters of private conduct. In practice, if all men had to study for themselves the abstruse economic, political, and ethical data involved in every question, they would find it impossible to come to a conclusion about anything. We have voluntarily agreed to let an invisible government sift the data and high-spot the outstanding issues so that our field of choice shall be narrowed to practical proportions.”
I feel that you need to include the people for masks and those against it. Unlike vaccines, masks do not lose efficacy over time or due to new variants. Both anti-vax and pro-vaccine supporters can fall into the anti-mask category. I don’t understand why people in the West are so anti-mask. It's been two years since I've gotten sick with anything.
1. Covid-recovered and Vaccinated + pro-mask
2. Covid-recovered and Partly-vaccinated + pro-mask
3. Covid-recovered + pro-mask
4. Vaccinated + pro-mask
5. Partly-vaccinated (< 14 days after 2nd shot) + pro-mask
6. Covid-recovered and Vaccinated + anti-mask
7. Covid-recovered and Partly-vaccinated + anti-mask
8. Covid-recovered + anti-mask
9. Vaccinated + anti-mask
10. Partly-vaccinated (< 14 days after 2nd shot) + anti-mask
> I don’t understand why people in the West are so anti-mask.
"anti-mask" has an implicit spin where it sounds like you're claiming a person is against the idea of anyone wearing a mask, but then often apply the label to a person who is perfectly fine with masks so long as the person wearing the mask is doing so of their own volition.
so i say split that category, and then the major categories might be more like "pro-universal-masking", "anti-universal-masking" (i.e. "individual choice"), and "anti-mask-wearing-in-public" (not only doesn't want to wear a mask, but doesn't want the people around them to be wearing a mask).
> in the West are so anti-mask. It's been two years since I've gotten sick with anything.
For one data point, I'm vaccinated, had Omicron, and am now "anti-mask", as in, I think they are more harmful to me than not wearing a mask. The vaccines/boosters only target one protein, of 28. I want periodic exposure to all the proteins, to keep my immunity up and minimize my risk for now and future variants.
Of course, I wear a mask as a courtesy for others. But, if nobody around me has a mask, I will remove mine.
There's also a further separation that is veeery relevant: age groups. There are sometimes graphs that split them out if you go digging far enough, but the graphs that make headlines are usually along the lines of "death rate, fully vaccinated versus unvaccinated" (which as you point out has its own issues). Not splitting it out into age groups gives casual readers the impression that mortality is evenly distributed along all age groups, which it most definitely is not.
To the contrary, #3 includes everyone receiving a booster, because immune system suppression/DoS immediately after a vaccine makes it the period of highest risk for both infection (from Covid or anything else) and vaccine injury. If we don't have separate reporting for #3, those negative effects will be attributed to #4. How many people know they should minimize physical exertion and crowds for 14 days post-vax?
I'm vaccinated and boostered by my own choice. My problem with mandates is where does it end? Why this mandate and not other mandates? Who gets to decide that?
Great! The problem is that vaccines don't protect society unless a critical-mass of people are vaccinated. The estimate for COVID-19 is that roughly 70% to 85% of the population will need to be vaccinated to reach the herd immunity threshold. USA is at about 63% fully vaccinated (76% had at least one dose).
where does it end?
It ends when the the threat subsides.
Why this mandate and not other mandates?
This mandate related to COVID-19 which has killed (at least) 870,837 people in America, and 5,614,744 people worldwide.
Who gets to decide that?
The people you elect to represent you (for those of us with a democracy-like government)
>Great! The problem is that vaccines don't protect society unless a critical-mass of people are vaccinated.
They don't protect society at all. The herd immunity goal flew out the window with Delta and left the galaxy with Omicron. We will not ever eradicate Covid-19 with vaccination.
>It ends when the the threat subsides.
It should end right now, then. The threat has subsided. We have vaccines and other treatment programs.
> The people you elect to represent you (for those of us with a democracy-like government)
The problem is that so many elected officials don't abide by the rules that they push. Joe Biden, Gavin Newsom, Nancy Pelosi, London Breed, etc. When the powerful can ignore their own rules, they're more likely to enact sweeping mandates.
>> The problem is that vaccines don't protect society unless a critical-mass of people are vaccinated.
I'm having a harder and harder time believing this (that herd immunity is actually possible) considering that the vaccine does nothing to stop it from spreading.
You just skipped past their entire point, after helping build it (mandates to protect "society" indeed). Society will never be completely safe. Government has a tendency to hang on forever to powers gained during emergencies.
> The estimate for COVID-19 is that roughly 70% to 85% of the population will need to be vaccinated to reach the herd immunity threshold.
That used to be the estimate, however with current vaccines' limited effect on new variants and the extreme infectivity of omicron it seems likely to me that herd immunity is unachievable. At the very least 85% vaccination isn't enough.
Vaccines and booster vaccines seem to be very effective against reducing the severity of an infection though. It's not ideal but it's the best we can do for now. Well, I say 'can' but perhaps it's more accurate to say 'could'.
> The people you elect to represent you (for those of us with a democracy-like government)
The answers are not as simple as you have suggested. Problem is that there are unelected officials and scientists that are deciding these things, many of which have perverse relationships and incentives that may bias their decisions. I guess these things aren't obvious if you have blind trust in the politicians and media in power.
> The estimate for COVID-19 is that roughly 70% to 85% of the population will need to be vaccinated to reach the herd immunity threshold. USA is at about 63% fully vaccinated (76% had at least one dose).
In Australia we're over 93% double dosed. We're also in our worst outbreak with the most deaths. What is this "heard immunity threshold" meant to do?
> The estimate for COVID-19 is that roughly 70% to 85% of the population will need to be vaccinated to reach the herd immunity threshold.
The vaccines aren't completely effective against transmission, so those numbers were already underestimated for the original virus. With the low efficacy against the omicron (and higher transmission rates), I don't believe any amount of vaccination alone would be enough to stop it (but AFAIK, nobody actually knows it yet).
Still, any amount of vaccination will reduce the transmission rate. What is not clear if it's enough to get it lower than 1.
The US is where it is because we have individuals willing to fight for individual rights. If casualty of individuals is the cost to keep individuality in this country then I say let it be.
The vaccinated are protected and therefore you are safe (assuming you are vaccinated). So why do you need to proselytize your doctrine on those around you? You're allowed your own opinions, chant your religious beliefs, but don't turn it into law.
You might believe a mandate might be the logical solution, and maybe by some computer models it will save the greatest number of people, but its still a breach of individual rights.
I personally believe what makes the US great isn't the number of people but the quality of people. And I'd rather give up the quantity than the quality. Sure we may end up having a higher proportion of herd people if we dont mandate and many of the individuals end up dying, but we won't have a government that can control those individuals as easily, and that's what matters most.
I don't understand why people keep asking this like some kind of magic bullet.
Obviously there is a governmental body that has the authority to do this wherever you are from. And in a democracy that governmental body will be acting based on the will of the people. Even if you disagree that the executive has that authority, the courts have the authority to interpret if they do. And the legislature ultimately has the authority to override it.
In the United States if we all voted for it we could have mandates for every single vaccine ever created. But there is barely enough political will for this one. And that's only because COVID is much more of a threat than anything else at the moment.
Is it that hard to understand that many people are uncomfortable or unclear where the the line is drawn between civil liberties and state powers/majority rule. You might say that covid mandates are clearly inside the lines, but that isn't a declaration of where the line is.
I'm not so sure about this. Call me a cynic, or even a Libertarian (gasp!) but it is generally not in the nature of government to wind down an apparatus that they paid so much for once "the threat" has passed. Now that governments have the infrastructure for requiring and/or showing proof of vaccination, it really isn't a stretch to think they will want to keep that system and have it be readily available for the next pandemic, whatever it may be.
It would be more democratic if the people were making the decision themselves by directly voting the laws. With the elective system we delegate decision making to people we choose from a very limited pool of candidates which aren't selected democratically. In a way "elect democratically" is a bit of an oxymoron.
Answered how? Each one of those were debated and we have agreed on some of these rules. I don’t think the debate for vaccine mandates has been settled though, much as some would like to see any discussion of it quelled.
Respectfully, would you mind explaining how getting vaccinated against Covid helps fellow citizens? If it is only to reduce hospital loads then can't the same responsibility be applied to those who choose to engage in unhealthy behaviors?
> I rather think of vaccination as a responsibility toward your fellow citizens
We also have data and prudence and we are long past the point where framing this in that manner is highly morally questionable to put it mildly.
Your idea of responsibility to society is mandating that young healthy people take an injection(s) ostensibly to protect them from a disease they are at no great risk from, negative side effects of the injection be damned?
Do it for grandma? It actually does nothing for grandma, that’s always been a lie, the original study could make no claims about transmission. And now, just look around.
Even if it did something for grandma and grandpa, mandating young healthy people undertake a medical intervention having value trade-off for their own health which is murky, for the supposed benefit of the superannuated or people who have eaten into a state of morbid obesity and premature aging is a horrendous inversion of social order and what is good.
> I rather think of vaccination as a responsibility toward your fellow citizens, rather than a "choice".
I don't understand this argument. Maybe I'm being ignorant or childish but since when do we live in a world that as a person you have to be responsible for "fellow citizens".
Don't get me wrong I don't mean we shouldn't be nice or care about other people but no one owe me anything and I don't owe anybody anything. Don't we all learn that in life at some point?
I get the COVID is dangerous and vaccines help but don't put me responsible for you.
The vaccine mandates are also getting a bit awkward because the justification was always that they protect others, but with omicron, that's a lot less true.
What's aggravating is all the "feel good" policies that fly in the face of the current state of the pandemic. We have gotten to the point where numerous officials have said something along the lines of "vaccines won't protect you against getting Omicron, masks don't really do anything either".
So you think. Ok, we have gotten to the point where these measures are ineffective, so lets do away with the measures. And that is precisely where you bump up against these "feel good" policies.
We know masks don't really work, but lets keep mandating them because they give us the sense of security that they are doing something. We know vaccines don't prevent you from getting or spreading Covid but we feel like it does something, so mandate it anyways.
I'm afraid that we are moving from "we need mandates to keep people safe" to "we need mandates to keep people feeling safe". In 20 years we're all still going to be wearing masks at the airport because "it makes people feel safer".
Vaccines and masks absolutely work to reduce your chance of getting infected with covid. Further, if you do get breakthrough covid, vaccines greatly reduce the chances you will end up hospitalized or dead.
Any more details on the "masks don't work thing"? It's news to me, and i don't see how that could have changed - masks, even cloth ones, but even more so for surgical and N95 types, drastically limit how much virus you spread when you're contagious; and especially N95 also offer some protection against catching it. Especially for crowded places, masks seem like a no brainer.
Well we just had a once in a century global pandemic that killed one million Americans and vaccines that work extremely well and there is no mandate - so I think the better question is what would it take for there to be a mandate?
This sort of vague "slippery slope" argument can be applied to argue against almost anything.
It is common and logical to regulate activities that could harm those around you. What cars are allowed on the road and who's allowed to drive them is carefully regulated because cars can kill or injure people. You can drive around your property with an unsafe vehicle but if you want to bring it on a public road, it needs to have working brakes and so on. Vaccine are similar because unvaccinated people are more likely to injure those around them.
Who decides? My city recently created a vaccine mandate to dine indoors at a restaurant. It was decided by the city council and the mayor, same as any other law. I think most citizens support it, but if they didn't they have all the usual ways to make that known or overturn it.
"I'm not swinging my battleaxe around in crowded places by my own choice. My problem with prohibiting people from swinging battleaxes around in crowded places is, where does it end?"
i don't know about the US, but where i live there are actual vaccination mandates for diseases like polio and measles. you cannot go to school if you don't have the mandatory vaccines.
covid vaccines are just another one that you need to take.
You are already under hundreds of health regulations or "mandates". Pasteurized milk, refrigerated meat, measles vaccine required at admision get to school is standard in a lot of places.
I feel like given that vaccines do an acceptable job at reducing risk of hospitalization and death, there is only really a few things worth discussing, in relevant order:
- Are hospitals actually being overloaded by covid cases to the point of being an issue (according to many, yes. but according to [1] Johns Hopkins, no, or only in some cases?).
- Are the unvaccinated actually the majority of the covid related cases (as far as I'm aware, yes).
- Is this localized (state or city specific), or is this a federal issue.
- Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
- Finally, what actions, if any, should be taken to correct the hospital load? (nothing, vaccine mandates, accelerated hospital expansion, turning people away, etc)
- If the answer to the previous is nothing, then what are we even doing?
The focus on just asking "vaccine mandate, yes or no" feels like it's missing most of the discussion.
Remember when the US invaded Iraq to "find weapons of mass destruction"? Then a year or two later that shifted to "fighting the terrorist there so we don't have to fight them here", then "winning hearts and minds" or something.
Once you get a mandate for a large-scale, politically charged activity it will never stop; the goal posts will be moved again and again, as many times as it takes and as often as necessary to put the "other side" on the defensive.
We're many weeks past "three weeks to flatten the curve", every week we hear more excuses. My friends pick them up and start parroting them in near perfect unison. I don't actually have any Republican friends, but if I did I'm sure I'd hear something similar from them too. This is no longer about fighting a disease, if it ever was (I also remember the response to AIDS being somewhat less dramatic than to COVID), this is about securing access to resources and power for one group over another. If it means thousands of your followers are discouraged from taking potentially life saving vaccinations (that you yourself have taken) and die as a result, so be it. If it means subjecting billions of people to years of unnecessary and demonstrably ineffective pandemic theater, crushing the financial future of the next generations, and destroying vast swaths of small businesses people have spent their lives building while realizing unprecedented returns on your own portfolio, so be it. The people running this do not care about any of this in the slightest, it's just an excuse to enrich themselves, and for a certain segment of the upper middle class to feel morally superior to others while they take Zoom calls from home and order dinners from Seamless. I guess this is getting boring for them now, so we're starting to be allowed to hear a trickle of stories like this.
These restrictions are so classist and so harmful to the underprivileged and working class it amazes me that the party that is championing them is the one who claims to represent said classes. Almost all of what I thought was true about my political allegiance fell completely apart over the last two years.
> Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
I mean, clearly, yes. Those, in themselves, never (or at least virtually never) cause sudden exhaustion of hospital capacity. Now, many covid cases, particularly unvaccinated cases, have some sort of lifestyle problem as a comorbidity, but that's not really the point.
As an example, lets say hospitals have a capacity of 100, 40 of the capacity is generally taken up by non-lifestyle factors, 40 is taken up by various lifestyle factors (things that could have reasonably been avoided from a better diet, exercise, or otherwise), and the remainder is left as buffer. Now, lets say covid takes up 25 capacity, which now overflows hospitals by demanding 105 capacity. Why is this new lifestyle factor (not getting a vaccine) obviously worse than the previously accepted and accounted for lifestyle factors?
Is it the ease of avoidance? 3 jabs and you're done? If so, what about the injuries we accept that could be avoided entirely through inaction (sports, motorcycles, whatever)?
Is it the magnitude? Looking at covid as a single factor, it could be argued that it has far greater impact than any other individual lifestyle factor. but that information sure hasn't come up in any discussion I've seen. It's always left as an exercise for the reader.
Is it the suddenness? Covid sure has been a shock to the system that it was unprepared for, but that's only true through the lens of comparing pre-pandemic to current moment. Looking at the current state, it's no longer sudden. The existence of covid is now known, and so is hospitalization needs. Now it's just a question of capacity, not suddenness.
I'm not saying the point can't be argued, but it's certainly not obvious to me. And if every discussion is left as "it's obvious, why can't you see it", the discussion won't go anywhere.
> - Are the unvaccinated actually the majority of the covid related cases (as far as I'm aware, yes).
They needn't be a majority. The mandate acts to reduce strain on the hospital, so ask whether it achieves that (I think the answer is yes)
> - Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
It is harder to fix these than getting a jab.
> - Finally, what actions, if any, should be taken to correct the hospital load? (nothing, vaccine mandates, accelerated hospital expansion, turning people away, etc)
An alternative would be to charge unvaccinated people a premium on hospital costs, as I'm sure health insurance providers would be keen to do.
> > - Are the unvaccinated actually the majority of the covid related cases (as far as I'm aware, yes).
> They needn't be a majority. The mandate acts to reduce strain on the hospital, so ask whether it achieves that (I think the answer is yes)
Majority is very important here. If vaccinated and non-vaccinated people were hospitalized at equal rate (or even at a rate where more vaccinated were hospitalized) a vaccine mandate isn't exactly going to do anything.
But I now realize that I gave "vaccine works" as a prerequisite, so this bullet point is redundant.
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> > - Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
> It is harder to fix these than getting a jab.
Likely, but hard to say definitively without data, and I know I don't have such data on hand. I talk about it a bit more in another reply better, but many things are even easier than getting 3 jabs. They only require inaction.
My ultimate question on this point is, why do we accept certain lifestyle injuries but not this? Ease of avoidance is a good reason, but I would like to see it compared to other lifestyle injuries.
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> > - Finally, what actions, if any, should be taken to correct the hospital load? (nothing, vaccine mandates, accelerated hospital expansion, turning people away, etc)
> An alternative would be to charge unvaccinated people a premium on hospital costs, as I'm sure health insurance providers would be keen to do.
I'm not against such an idea at all if it would solve the problem. The high-level issue is that the unvaccinated are costing the system more money / capacity than the vaccinated, so they should pay for it.
However, there is a lack of capacity, not necessarily a lack of funding. If the unvaccinated are charged more, will they actually have a lesser impact on capacity, or will capacity still be reached just with them paying more money? Which then circles back to needing more capacity. Who pays for the extra capacity is almost a separate discussion in itself.
I think so too, but do you know? I mean, only a few per cent of infectees require much medicine, and Pfizer's market share won't be 100% of that. It's not obvious that x>y.
Anyway, he may also well be thinking that the best policy is to have a history of assessments that turn out to be correct in hindsight. "Drop restrictions when the number of infections declines" is at least plausible.
Paxlovid is interesting in that it is only really effective if you take it as soon as you show any symptoms. Once production is scaled up, hundreds of millions of courses of treatment will be sold. Each around 100x more expensive than a vaccine dose.
It will soon be Pfizer's financial benefit to have as many infections as possible.
I doubt that. Consider no one was vaccinated and 1% of humans would need medication because of a "serious" case. Then the medicine would need to be 100x more expensive than the vaccine considering the alternative is everyone was vaccinated. Now consider many people got 3 or even 4 shots. It's 300x-400x now.
Also you can give the medicine to already vaccinated people that also have serious cases. So you still can sell it in a lower capacity. Also you can sell both vaccines and medicine to states in large batches which is great.
It's a big golden goose for the pharma industry.. let's never forget that.
Fortunately we can trust that they aren't using any of those billions they have made to manipulate public opinion on the issue, because that would be immoral and therefore off limits.
> Then the medicine would need to be 100x [300x-400x] more expensive than the vaccine
I'm not suggesting this is true, but it would need to be 100x-400x more profitable, and that includes cost to make and store as well as the price is charged.
Maybe making mRNA vaccines costs much more than a simpler molecule like Paxlovid [0], and hospitals generally seem to charge much more than the over the counter price for everything. You've seen horror stories about $25 aspirin [1] which is easily 400x more expensive than the penny per pill cost of 500 tablets in a $5 bottle [2].
I cannot recall another example in my lifetime of a global populous all agreeing to purchase a pharmaceutical company's medical product - not just once, but 2-3x per person - in under two years' time.
The implications of this phenomenon on Pfizer's business model are enormous. Pfizer & others would be foolish to not pay close attention to this and figure out a way to exploit it for further gains.
On the flip side, we're also going to witness a very large portion of the population that rejects most all pharmaceutical treatments due to lack of trust. Anyone that has had any vaccine injury, even if minor. Reproductive issues are in a weird classification as being "minor" in that they aren't life threatening, but they certainly are major for young women that are planning on having children. Another group that will have their trust shattered are the people that got vaxxed and boosted, and still caught covid in a very bad way. And finally, the group that has been turned off by the haphazard communication (at best) and downright creepy coercion to get vaccinated.
My trust in the system has been thoroughly shattered, I've gone from looking down at anti-vaxxers with disdain from before the pandemic- to now being labelled as part of that crowd because I am anti mandates. The whole timing of that terminology in and of itself is interesting as well- but that's probably going too deep down the rabbit hole.
Pfizer probably got an extra $50 for you this particular year, in addition to the hundreds or thousands of dollars it gets from you every year. If you want to attack drug pricing, drug patents and pharma profits, the time to do that is every year, not just special ones.
The big question for this vaccine is why we rewarded this fully taxpayer-funded development and testing with a patent monopoly.
> I cannot recall another example in my lifetime of a global populous all agreeing to purchase a pharmaceutical company's medical product - not just once, but 2-3x per person - in under two years' time.
Well this is the first major global pandemic in a century, so that would stand to reason, no? Most of the world received the polio vaccine within a few years of its discovery btw
> Pfizer is going to be making a lot more money from their COVID treatments than from the vaccine
If you're saying it's false you should please post a source or at least some kind of napkin calculation. It's not intuitive at all. Otherwise it just sounds like you're beating the already dead "pharma companies sole motivation is money" horse.
That is a trivial conclusion. Much has been written about it. Pfizer themselves have written they estimate 67 billion dollars in revenue each year from Paxlovid, which is way more than their vaccine revenues and it's not even close. If you want my back-of-the-napkin calculation, here it is.
The cost of a generic Paxlovid course of treatment is around 40$. The cost of treatment, negotiated down by the government (and thus higher for other parties) is around 600$. So the marginal profit from a course of treatment of Paxlovid is around 540$.
On the other hand, a vaccine dose costs 20$, and it is very difficult to manufacture. A reasonable estimate of profit is 10$ per dose. This is an overestimate, because Pfizer has to share a sizeable portion of the Profit with BioNTech and other companies.
Paxlovid is indicated to be taken as early as possible - and priced so that it makes financial sense for insurance companies to pay for it to avoid the cost of hospitalization. Therefore we can expect a sizeable proportion of people with COVID symptoms to take it.
Paxlovid reduces the symptomatic illness period, so there is also a very strong incentive for individuals to take it as it allows them to be less sick. For the less fortunate, it also means less sick days to take, which may be crucial to make ends meet.
If we're expecting everyone to take a vaccine dose every six months (which we all know will never happen), that's 20$/person.year from the vaccine.
If we expect everyone to have COVID symptoms every year (which is almost certainly an underestimate), at 540$/person.year, we only need to have a 3.7% take rate for Paxlovid in order for it to generate more profit than everyone taking two doses every year (which, again, will never even come close to happening).
So as long as 3.7% of the population takes one Paxlovid course of treatment every year, Pfizer will make more profit from Paxlovid than the vaccine.
So it is trivially true that widespread COVID infection (and low vaccination numbers) is going to be Pfizer's financial incentive.
They don't have enough supply yet for this incentive to be in effect. Once they reach the tipping point, look forward to them changing their tune. The good news is that it might actually align with the public's best interest.
Pfizer is going to be making 5.7 billion dollars in revenue from Paxlovid at the bare minimum in the next 6 months, in the US. That's around as much revenue as 300 million vaccine doses. We are already past the tipping point, as of around 20 days ago.
> “The only way to get compliance from people and get accommodation [is] if we demonstrate the ability to withdraw these [mandates] in the same manner in which we put them in,” Gottlieb added.
Nope. That line was crossed a long time ago. I can't imagine people suddenly regaining trust in pharma companies and health care agencies now because they backed off at this point.
They made tens of billions of dollars with zero liability and a rubber stamp from the fda...these are still the same toxic companies that have been sued for billions of dollars and benefitted from decades of lobbying and regulatory capture. They have an army of lawyers on standby on the off chance that someone does find a loophole through which to sue them over adverse effects if they prove to be substantial. Meanwhile the pandemic rages on a year after introducing these vaccines, which have gradually been proven less and less effective than these faceless megacorps repeatedly claimed.
Why on earth would you suddenly trust them "more than ever"?
> It's really the most divisive issue I've ever seen in my life.
I've been yelled at and called very awful things by people I know in real life. Biggest clue that this is 90% hysteria and 10% real.... What ever happened to keep calm and carry on.
Or there are financial incentives, which may justify paid interventions online to create the appearance of divisiveness. There are PR agencies which specialize in "grassroots PR".
Users can email hn@ycombinator.com to ask for human review of flagged articles. If the article still remains flagged, only then is the flag sanctioned by HN moderators. Otherwise, flags could be anywhere on the spectrum between organic users, troll botnets and paid interventions.
Is there an API to HN data which could report granular data on article flags, e.g. timestamps or user IDs doing the flagging?
Readit News
> The Covid vaccines are remarkably effective at preventing serious illness. If you’re vaccinated, your chances of getting severely sick are extremely low. Even among people 65 and older, the combination of the vaccines’ effectiveness and the Omicron variant’s relative mildness means that Covid now appears to present less danger than a normal flu.
> For the unvaccinated, however, Covid is worse than any other common virus. It has killed more than 865,000 Americans, the vast majority unvaccinated. In the weeks before vaccines became widely available, Covid was the country’s No. 1 cause of death, above even cancer and heart disease.
At this point if an adult in the US is unvaccinated it is (1) almost certainly by choice (there are some people who cannot get it for medical reasons but they make up only a very tiny fraction of the unvaccinated), and (2) it is very unlikely that any evidence or logical arguments will chance their minds.
With COVID becoming endemic everyone is going to get antibodies, with the only choice being whether you get your first antibodies by vaccination or by getting COVID.
The only question really then is how fast do we want the unvaccinated to do the getting antibodies by getting COVID thing. The faster they get it, the faster we can be as done with COVID as we are ever going to be.
I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
The way in which the media has gotten everyone to say "the unvaccinated" is a 'disease' against basic science (not even getting into the divisive nature of this). I would go as far as saying if you read any paper, study, or other that refers to the "unvaccinated" as a single cohort, you are reading vaccine propaganda, not science, or certainly not good science.
This must stop. Prior infection immunity is basic science that we've known for eons, and ignoring it is so blatantly glaring an omission, it should make the most staunch pro-vaccine person pause and say: "why are they so adamant to vaccinate those with prior infection?". One would expect prior infection to be robust, and multiple studies, including even the CDC's most recent shows it to be easily as good if not better and longer lasting than the vaccine. This should not come as a surprise to anyone.
If you think any of the above is "anti-vax" then I would suggest the media has won and science is dead. I'm not suggesting the vaccine doesn't work. I'm not suggesting it doesn't provide protection against severe disease and death. I'm not suggesting anyone go out and intentionally try to get COVID, but a HUGE # of people have already had it and ignoring them is downright unscientific. If you are a rational person who wants to see good science and are unemotional and detached from outcomes, then you will want to see proper study cohorts, and combining prior infection in with the "unvaccinated" cohort, is just bad science. This bad science fuels the anti-vaxx movement even more, and honestly, it is hard blame them.
Because the data shows they don't matter.
This is the same thing as deaths due to covid vs. deaths while positive to covid. Sure some people might have been miscounted as covid deaths but actually died due to cancer/car accident/whatever. Despite this the excess deaths over the past two years is much higher than the number of covid deaths; thus showing that miscounts must be a small minority which, in any case, is absolutely dwarfed by excess deaths not counted as covid deaths. It might even grow a little as testing improves but it still remains mostly irrelevant.
Likewise it may be that some people do not need a vaccination. However, we have a 30/70 split in number of covid hospitalizations, with 30 being vaccinated people, in countries where the split in the normal population is 90/10. This means that despite some unvaccinated people having had prior infection the vaccine reduces hospitalizations by 20x. Given this data the most effective strategy is to just vaccinate everyone without what is effectively a pointless distinction.
As the number of unvaccinated but protected people will grow (through a combination of more infections, more vaccinations and more deaths), the proportion above will revert to 90/10 and unvaccinated people will not be an issue anymore. For now however analyzing the proportion of naturally immune people among the unvaccinated is, again, mostly irrelevant.
At some point the government will probably change the definition of fully vaccinated to three shots and then I'll be in that unvaccinated group I usually make fun of.
Somebody I know lost their job because they wouldn't get vaccinated (but they'd already had confirmed covid). That seems very unfair.
I'm very angry at the dumbasses who haven't been infected and refuse to get vaccinated, including family of mine who died because of that. But no distinction is being made of those who have natural immunity. Which, as you say, is unscientific.
I feel like partly that's because many people think they had it, but didn't, and partly because it's easier for the government to just tell everyone to get vaccinated.
Even by reconciling PCR testing data (which I imagine is incredibly patchy at best), you still would only know historically how many people tested positive (ignoring what is in all likelihood a majority of the cases that never got tested) and be able to reconcile it against numbers of vaccinated, which tells you nothing useful without being able to intersect the two sets (which you can’t do without uniquely identifying every PCR test and matching it to an individual universally).
i.e. the better data you would need doesn’t exist.
In the UK, for months now, the rate of infection has been higher among the vaccinated cohort than among the unvaccinated cohort, for most age groups. [1]
The antivaxxers are of course pointing to this data and claiming it's evidence that the vaccines make you more likely to get infected, and therefore the tinfoil hats were right all along.
But what's actually happening is that the unvaccinated cohort contains a lot of people with natural immunity, who are dragging the numbers down, while the vaccinated cohort doesn't have as many people in it who have had a prior infection.
I strongly suspect that if you were you properly separate people by vaccination status and prior infection, you would see that the group of unvaccinated+no prior have a much higher case ratio than any other group. But since we don't have this good data, the antivaxxers are running hog wild with the bad data, drawing the wrong conclusions.
[1] https://public.tableau.com/app/profile/t.coddington/viz/UKRe...
Not sure what you mean. Science detached from outcomes is bad science. Science is trying to suss out cause and effect, not to avoid reality.
> This bad science fuels the anti-vaxx movement even more, and honestly, it is hard blame them.
Ah. There it is. Nope. It's still easy to blame them. It's not a sufficient criticism to cede moral superiority. "You didn't adjust your tone to distinguish 'unvaccinated' from 'immune-because-infected' from 'vaccinated'." does not suggest that antivaxxers are any less morally bankrupt for promoting the course of action which results in serious illness and death.
I don’t understand why it’s so controversial. The upside is huge and there is literally no downside.
Developing antibodies the old fashioned way is great! Doing it with vaccines saves other people's lives. That is the problem with people who refuse the vaccine and why they deserve to be vilified.
Unless they went to the hospital or had a positive test, then they just think they had it right?
We get data like this:
All we know are things like:
(from https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/..., so local to where I live).But it unfortunately doesn't break down things like "had a confirmed prior infection" or "thought they might have had a prior infection". It would be interesting to see how the data works, but right now unvaccinated people are on average in a very bad spot. For all we know, the unvaccinated are just more likely to have comorbidities (e.g. obesity) that lead to their higher fatality rates. But for now, getting vaccinated is so easy, I wouldn't take the risk.
I got COVID back in March of 2020. I got two vaccines and a booster, and then in late December I caught COVID again (probably Omicron based upon symptoms and the prevalence).
I think what you're trying to say is that you believe there is an adequate enough case for people who had prior infection to avoid what they believe is an unnecessary medical procedure which may have some risk. And, scientifically, you believe it's absolutely certain that in this specific situation, prior infection immunity provides very good protection, enough to override any benefits we might see that happen at very high vaccination rates.
Hope that's a good summary....
Are you a scientist?
You made a number of statements about what is good and bad science, but some of the reasoning you make doesn't completely add up. In science nobody has epistemic certainty, but scientists and public health people act as if they do. In reality public health decisions are made using imperfect information and balance utilitarian and emotional concerns, as well as prior knowledge of patient compliance. Sometimes it may be necessary to not change a message, even if it's somewhat wrong, too quickly.
The calculus is very simple at this point. I believe CDC and others are saying that the additional risk from taking the vaccine is very very small, and the marginal benefit of having even people with prior infection get vaccinated presents a greater (overall) health outcome (presumably in the form of people who had infection immunity but still were re-infected, and then infected others).
Beyond that I don't think anybody has enough scientific data that is certain enough to say that you're right in your statements, and I think it's pretty poor taste to just keep attacking people who disagree with you as doing "bad science". Science is a subtle art, and anyway, public health is an entirely different field that has to concern itself with effective communication and people-emotions and ethics, so sometimes what CDC announcements may not be identical to what the state of the art of science is saying.
I think making a simpler and weaker point would work better. I'd criticize the media for unnecessarily creating additional fear, uncertainty, and doubt, around COVID (there was a lot of early reporting about how omicron was going to destroy the world, that was entirely baseless speculation). And too many people, both media and generally, are quick to criticize people who don't "follow the CDC to the letter", especially around vaccines. I think that kind of cropped up politically in the US after the unnecessary autism/vaccine scare and ended up representing a dividing line.
BTW, I'm an ex-scientist, worked in medical biology for decades, and I don't think many vaccines (flu, covid) are nearly as effective as the medical establishment suggests (look at the numbers of people who died of flu even in years with very high vaccination rates). And people do have significant side effects from getting vaccinated, but very rarely are the side effects more dangerous than the value of being vaccinated (in cases of flu and covid), which is why I support them. Finally, I think that herd immunity doesn't actually work in diseases like flu or covid. So I have some sympathy to your message but ultimately, just get vaccinated and boosted unless you can truly articulate some huge risk to your personal biology.
[edited to remove antagonistic comment] - I think your comment about science being dead is less-than-useful hyperbole.
Why focus on the "get vaccinated" message? Because the vaccine is free. It's widely available. There is absolutely low, low risk to taking it - less risk by far than getting COVID or long COVID. Because prior to Omicron, the goal wasn't "let everyone get sick and be done with it", it was "prevent anyone from getting sick". I just thought of one as I type this: To say "we accept natural immunity as a viable strategy" could have encouraged thousands upon thousands of ignorant or otherwise actively anti-authority citizens to get sick on purpose to stick it to the man, then end up in the hospital.
I don't want lies to win, and I don't want to ignore the science. Natural immunity should be acknowledged for its benefits. I think a government could do that, and still say "tough shit, get vaxxed" just to make sure people don't commit bio-warfare on communities by trying to get ill.
https://twitter.com/zeynep/status/1484930583214100481?t=UDTW...
Of course, the general problem here is one of measurability and working in an adverse environment. So in a medical sense, prior infection determines response. But in a public health sense, if you believe that prior infection claims are easier to fake than vaccine records, and if you believe the spread risk is worse, then it makes sense to proxy spread risk with vaccine records. Personally, I get what you mean, and perhaps I'm not fighting too hard for the truth here because I don't really care that much.
But I just wanted to say I'm with you on the facts since every other response is operating (in my opinion) in the fallacious "there's a paper that says" mode. It's just not Bayesian.
So if anything, breaking that out just makes not getting vaccinated for those without prior infection look even stupider.
I'd have no problem with treating proof of immune response as similar to vaccinated, but I also haven't seen most of the outraged argue for that - versus just arguing for "freedom" - so... don't wait for me to make that case for them.
And then immunity is not a binary or linear response. Vaccination can still boost immunity in the case that someone has recovered from infection.
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I know someone who could not get vaccinated for medical reasons (legitimately), and caught it, and died.
It just really sucks to know that the person I know would more likely be alive if not for the choices of others.
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From what I've seen, it was common for hospitals to report being overwhelmed even during flu seasons pre-covid. I wouldn't classify that level of 'overwhelmed' worthy of mandates upon society.
I don't doubt that during these periods of time hospital resources are strained in some way, but there's a difference between this routine level of being overwhelmed and a level where freedoms should be restricted from the general public.
I don't have a good model for where the line should be drawn, but I lean towards not imposing restrictions unless massive benefit can be shown beyond a reasonable doubt.
The seemingly obvious thing to do would be to build some temporary capacity specifically for COVID patients. We've had quite a long time to do this now so I'm not sure what's preventing it. Maybe it's caught up in that thing where captured regulators are gatekeeping medical certifications to maintain labor scarcity or some such thing?
https://time.com/5107984/hospitals-handling-burden-flu-patie...
This pandemic has been extremely hard on many healthcare providers. But hospitals in many areas were routinely overwhelmed during winter respiratory virus season in previous years. They dealt with it as best they could, and we didn't impose mandates or restrictions on the rest of society.
https://peterattiamd.com/covid-19-current-state-omicron/
In countries with universal healthcare, price cannot be used for queue management, but the US isn't one of those countries. Did any hospital use queue management software to adjust pricing as a mechanism for demand throttling, due to limited capacity in 2020-2021?
In any case, if supply-vs-demand is both a policy driver and metric of intervention performance, we need public, detailed hospital capacity data for analysis and optimization of net societal costs vs benefits. Utilization of space and skills is eminently quantifiable and software already exists for demand mgmt.
Normal flu seasons don't leave them with 1000 yard stares.
Having anyone's freedoms dependent on available hospital capacity is a terrible way to run a society. Note that these freedoms were debated and won in an era where medicine was terrible.
Sharing limited resources is a major role of the government, and managing hospital capacity seems to fall under “promote general welfare” to me.
My $0.02
You should note that government regulations are designed to keep hospitals running nearer capacity. See "certificates of need", which are (in most places) required to get authorization to build a new hospital. You've got to prove to the gov't that a new hospital really is necessary. And thanks to regulatory capture, the tendency is for existing providers to try to sink such applications.
That was also an era when the US was subject to numerous epidemics and pandemics of diseases such as cholera, typhus, yellow fever, bubonic plague, smallpox, and influenza, and it was debated and found that placing restrictions to try to limit the harm from those epidemics was a legitimate exercise of the state's police power and not an infringement of civil rights.
My "freedom" to live because I have a medical issue but cannot get treatment will be severely impacted if hospitals are overrun with patients and worn out workers.
See, we can both play the "freedom" game.
So is letting people die from otherwise treatable injuries and infections so someone else can enjoy their "freedom" to ... you know what I'm driving at.
I don't want even to look at the numbers of the more critical epidemic on the US: obesity and metabolic diseases.
By arguing that "the unvaxxed" are a burden and that they deserve discrimination, you are opening the gates for those arguing that smokers should be forced to stop smoking, or that obese people need to be forced to stricter diets.
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I never saw anyone talking about this; the government websites are like "go to CVS, you can just walk in!" but in reality no CVS locations were accepting walk-ins if you asked. And even appointments were tenuous.
I feel like it's fair to place 90% of the blame on individuals, but I also think big companies are misrepresenting themselves to the government, or the government isn't asking if they actually have vaccines or not.
I wish there were stats on "want to vaccinate, but haven't been able to."
This is now taking it one step further - this argument is as an assumption - suggesting people have to give up their freedoms because people paying for their own hospital capacity is unacceptable to you. I say that because the sort of person who is pro-freedom to the point of not wanting a vaccine might well overlap with the population of people pro-freedom enough that they want individuals to pay for their own healthcare.
This is not a sustainable position against 2019 business-as-usual. I agree with the headline.
It looks like that's more Americans than have been killed in combat in all of the wars of the 20th century combined [1]
Granted it's less than the UK lost in WW1 alone, so it's perhaps more a testament to how few the US managed to loose in the world wars (compared to Europe), but it's still wild to realize.
[1] https://www.statista.com/statistics/1009819/total-us-militar...
Actually you could say it’s difficult to trust the numbers coming from any country for a variety of reasons, whether it be under or overreported.
> It looks like that's more Americans than have been killed in combat in all of the wars of the 20th century combined [1]
Like all deaths tragic, but let's not pretend young men, effectively kids, dying in war is the same as elderly & chronically sick populations dying of disease.
Something that was conspicuously absent from the paragraph regarding the unvaccinated vs. the vaccinated paragraph preceding it:
Risk stratification by age. When talking about the vaccinated, he calls out the "even in people over age 65".
There is zero question that vaccines reduce the relative risk for people under 65, however, it should be noted that the absolute risk for healthy people in this category is orders of magnitude lower purely by virtue of their age. Unhealthy people in this category should be vaccinated, of course.
Just an example of narrative bias creeping in, even from the relatively top-flight Leonhart.
Anyway, not disagreeing with you, just calling out a specific example of why the journalism on COVID has been, primarily unintentionally, misleading.
https://www.economist.com/graphic-detail/2022/01/22/do-vacci... (https://archive.fo/g2vHF)
Once you've reached that point, what purpose does the mandate serve? Nobody else is going to get the vaccines, so there is no public health justification for keeping the mandate around. However, what remains is the continual need to provide your vaccine status to your employer and in various other aspects of your daily life, which is a burden for vaccinated people too.
The United States has probably already reached that point, or will soon.
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This typical line of thought ignores a huge issue. Vaccine mandates don’t help per se, but it’s an issue that is pretty bad to just gloss over.
Articles like this really need to describe some sort of policy or plan for the 7 million or so immunocompromised people in America.
Like at least mention them and advocate something. Don’t just gloss over 7 million people. Propose something like Priority access to the new Pfizer pills and additional assistance with other things to avoid high risk activities.
Wear good masks, social distance, etc. Basically do everything that's recommended to prevent the spread of covid, besides getting a vaccine. As a bonus, doing these things will help keep them safe from a large number of other airborne illnesses that put them at risk.
Plus, there has been an increased awareness about preventing the spread of airborne diseases in general. Lots of stores and businesses have installed filtration systems that help keep everyone safer. Contactless delivery / checkout is much more mainstream, and it's now socially acceptable & legal to wear a mask, which is something certain people are going to continue to do. So while it has certainly been a nightmare for immunocompromised people, some positive changes have also resulted.
Sorry if that sounds harsh, but we can't keep using things that will never change as reasons to persist with a state of emergency -- otherwise that state of emergency will never end.
This is basically the reasoning used in Ireland; the hospitals weren't overwhelmed as Omicron peaked in the first week or so of January, so overnight we went from really quite restricted to all restrictions except mask requirements gone. Over 95% of Irish adults are vaccinated, so this isn't a trick that will work everywhere, but... for now it seems to be going okay.
My sense is the government has silently taken this stance and that hospitals aren't at risk of collapse like they were a year or more ago. I also get the feeling the vaccinated have given up on the unvaccinated too just based on how rarely I now see posts on social media. It's like a tacit acceptance that if people are going to choose to die, so be it.
I actually wonder if this not caring is what will actually defuse this particular anti-vaxx movement. Or it'll just be the next vaccine and the Covid vaccine issues will be completely forgotten. I mean when was the last time you heard about vaccines causing autism?
what's interesting here is the underlying psychology that makes people susceptible to manipulation by thinking they're in the know on some Big Lie. This seems to be nothing new however and I can't help but think of this quote from Goebbels of all people [1]:
> “If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”
[1]: https://www.jewishvirtuallibrary.org/joseph-goebbels-on-the-...
https://www.wcax.com/2021/12/22/covid-positive-vermonters-wi...
I'm sure there's plenty of actual sick people too. But we need a serious change to our messaging.
Are you aware that vaccines are failing spectacularly with regards to Omicron infection?
Hospitalizations are another story, but this notion of the vaccines ending Covid is just not holding up with new variants.
https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/...
You forget the second order effect here: the more unvaccinated people hospitals have to treat, the more likely their nurses and doctors are to quit, even if "the hospital is not overloaded". The more likely they are to quit, the more likely people are to die of other preventable causes in the future (because once they're burned and quit, they're not coming back).
If we could wave a magic wand and make it all immediately end, that would be preferable. But that's not going to happen.
That leaves us with two choices. We can let it drag on and on, or we can tear off the bandaid quicker. It's not clear to me which of those two is worse for the healthcare professionals you're talking about.
This reminds me of the arguments that unvaccinated were the cause of COVID-19 and were endangering those who are vaccinated. Vaccinated people get and spread COVID still. In fact, recent studies show natural immunity or vaxxed plus COVID causes much more antibodies than simply getting vaccinated, especially with a vaccine that targets an old mutation that has proven much less effective against Omicron and the likes. The vaccinated people will prob continue to get vaccinated a few times a year until they get a less dangerous variant.
Can we start holding people and publications to differentiating for past variant vs. Omicron, etc? It deserves and necessitates such nuance.
I think the question that so many people forget is how fast the unvaccinated themselves want to get antibodies, not how fast someone else wants to get them antibodies.
> I'd say the answer to that should be determined by the hospital capacity. If a region has sufficient hospital capacity that it would not be overwhelmed by the increase in COVID cases among the unvaccinated go ahead and lift most restrictions.
Im my country, Germany, that currently is debating mandatory vaccinations for everyone, the maximum average share of Covid patients was 5% at the top of the most deadly Covid wave. 95% of patients were in for other reasons.
https://www.bundesgesundheitsministerium.de/fileadmin/Dateie...
> Gemessen an der vorhandenen Bettenkapazität ergibt sich eine durchschnittliche Belegungsquote von 1,3% durch COVID-19. Die höchsten tagesbezogenen Belegungsquoten gab es in der zweiten Dezemberhälfte mit knapp 5% aller Betten.
I don't want to have to undergo medical procedures, just for optimizing a statistic by a very small percentage (for two weeks in a year) that could have been optimized in other ways. Some pointless covid intervations at national level have burned so much money that nations could have built thousands of new hospitals instead.
Could someone please put a number on “vast majority”? I keep hearing this adage but a majority is 51% and there’s a big range between 51 and 100% that a word like “vast” doesn’t precisely capture..
https://ourworldindata.org/grapher/united-states-rates-of-co...
Table 1 on page 3 has unvaccinated covid deaths at ~20% of the total.
https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7104e2-h.pdf
I don't think you're breaking any new ground here. In the two regions where I've lived since the outbreak, hospital capacity was already a factor in what precautions were mandated.
But the spread of disease is a lot more complicated than sick/not sick. It has an affect on society much farther and wider than hospital capacity, and that should not be the sold yardstick by which we measure our reaction.
I'm not vaccinated and it is by choice because I've already had COVID. Getting a vaccine for a disease you've already had is like wearing two pairs of pants. Sure, you can do it, but why?
That's not what endemic means.
[1] https://twitter.com/GYamey/status/1455708642297188354
[0] https://data.worldbank.org/indicator/SH.MED.BEDS.ZS?location...
Vaccines provide better protection than infection, just to be clear. It's not true that you're safe because of a previous infection.
See: https://www.cdc.gov/media/releases/2021/s0806-vaccination-pr...
"By the week beginning October 3, compared with COVID-19 cases rates among unvaccinated persons without a previous COVID-19 diagnosis, case rates among vaccinated persons without a previous COVID-19 diagnosis were 6.2-fold (California) and 4.5-fold (New York) lower; rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19. During the same period, compared with hospitalization rates among unvaccinated persons without a previous COVID-19 diagnosis, hospitalization rates in California followed a similar pattern. These results demonstrate that vaccination protects against COVID-19 and related hospitalization, and that surviving a previous infection protects against a reinfection and related hospitalization. Importantly, infection-derived protection was higher after the Delta variant became predominant, a time when vaccine-induced immunity for many persons declined because of immune evasion and immunologic waning (2,5,6)."
TL;DR only vaccine did not provide better protection than only previous infection
Also there were effective medications for covid but people were misled to believe that they did not work, people died and were terrorized to get vaccinated.
This is a crime. Unless you enjoy it.
While this is true, we've seen that employer mandates actually do change their minds. Yes, something like 1-2% of people don't get vaccinated even in that case, but that's far less than the 20% that claim they will lose their jobs to not get vaccinated.
Antibodies seem to not last very long at levels that prevent infection. This is a very severe crisis that doesn't end because people get tired. It's like being tired of a war and laying down your weapons and then getting surprised when you get overrun.
https://peterattiamd.com/covid-part2/
Disagree. Anecdotally a relative dying of Covid traumatizes some (not all) just enough to start questioning their beliefs and get the jab.
But I would agree with you if the variants would just stop creating themselves. But it doesn't seem like any immunity really lasts. So this leads to repeatedly infecting yourself with variants as they emerge (1 in 6 chance of a bad outcome of long covid or worse), become a bit of a test rat for the latest vaccine, or some combination therein.
I'm hoping we eventually get a vaccine that transcends the evolutionary range of this thing. And then we could do exactly what you're suggesting. But that's a science project and you never know how those will go.
The main concern I have is will we be a nation crippled with PTSD and long-term healthcare concerns when this is finally over with?
Dead Comment
Word was that Omicron diverged from an earlier version of covid in mice, over the course of about a year, then jumped into humans [0].
I think this detracts quite a bit from the point you were trying to make above, since we are not vaccinating mice, nor all the other animals that harbor covid such as bats, cats, dogs, primates, and deer [1].
Since we can't vaccinate or destroy all of the non-human hosts for this coronavirus, and the virus already has evolved in animals and made the jump to humans a couple of times, I don't agree that the point you made above is relevant.
[0] https://www.medicalnewstoday.com/articles/covid-19-did-omicr...
[1] https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/...
https://www.scientificamerican.com/article/covid-variants-ma...
No, there's one other question - how much of our limited health resources do we want to allocate to people still refusing to get vaccinated.
In all fairness, I think they should be allocated proportionately. If 20% of a region's population is unvaccinated, and there's a bed shortage, they should get ~20% of hospital beds.
#1 was already a high percentage in 2021 and is now higher due to Omicron.
Edit: CDC estimated pre-Omicron #1 as 146 million people (as of Oct 2021), https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
My (somewhat baseless) speculation on this is that a lot of the people in forums like HN are early adopter types who mostly work from home, and so were able to avoid exposure and got the vaccine relatively early. From this standpoint, I could see it being harder to empathize with folks who were exposed in everyday life (it's just a simple jab, I did it, why can't everyone else? Or maybe even those folks must be bad/lesser people if they didn't stop themselves from being infected).
Combine that with the constant onslaught of media time that pointedly ignores the categories that you breakdown above, and maybe it's no wonder that people have the opinions on this that they do.
I suspect that's why the media doesn't do it.
In the Netherlands we started the booster campaign on November 18, but we get graphs claiming ‘hardly any people with boosters in hospital!’ with the data including hospitalizations from November 19 onwards.
there are so many different standpoints you could take from the HN population.
- "HN focuses on tech; novel tech tends to be anti-regulation => HN must be anti-mandate."
- "HN focuses on engineering; engineering is often an optimization game that involves balancing tradeoffs => HN must believe COVID response relative to all the other risks we face is an over-reaction."
- and of course the one you presented.
my theory is that opinions within any group are just more divergent than people realize. some groups do a better job than others in (a) understanding that and (b) working with that. it's almost all cultural: do people in your culture publicly voice their non-conforming views, and to what degree do people in your culture update their beliefs when they hear new information?
It's almost like there's a narrative here.
The average of death with Covid in the US is 80.
If every healthy 30 year old and under in the US declined the vaccine, this would barely move the needle. They personally are not vulnerable and are not likely to end up in hospital.
Reading this discussion, you would think that vaccinated = safe, unvaccinated = certain doom. Age is a much stronger predicter than vaccine status.
[1] https://www.nytimes.com/2021/12/28/health/covid-omicron-anti...
I think when all the dust settles around COVID, we're going to learn that both vaccines and "natural immunity" last 3-6 months, and that explains almost all of the noise and confusion about what "works" and what doesn't. And that also suggests that "herd immunity" was never a realistic goal, whether by vaccines or infection. Maybe some future vaccine can be developed which targets a different signal and can last longer.
- Edward Bernays, “Propaganda”
1. Covid-recovered and Vaccinated + pro-mask
2. Covid-recovered and Partly-vaccinated + pro-mask
3. Covid-recovered + pro-mask
4. Vaccinated + pro-mask
5. Partly-vaccinated (< 14 days after 2nd shot) + pro-mask
6. Covid-recovered and Vaccinated + anti-mask
7. Covid-recovered and Partly-vaccinated + anti-mask
8. Covid-recovered + anti-mask
9. Vaccinated + anti-mask
10. Partly-vaccinated (< 14 days after 2nd shot) + anti-mask
11. Covid-naive + Unvaccinated + anti-mask
"anti-mask" has an implicit spin where it sounds like you're claiming a person is against the idea of anyone wearing a mask, but then often apply the label to a person who is perfectly fine with masks so long as the person wearing the mask is doing so of their own volition.
so i say split that category, and then the major categories might be more like "pro-universal-masking", "anti-universal-masking" (i.e. "individual choice"), and "anti-mask-wearing-in-public" (not only doesn't want to wear a mask, but doesn't want the people around them to be wearing a mask).
For one data point, I'm vaccinated, had Omicron, and am now "anti-mask", as in, I think they are more harmful to me than not wearing a mask. The vaccines/boosters only target one protein, of 28. I want periodic exposure to all the proteins, to keep my immunity up and minimize my risk for now and future variants.
Of course, I wear a mask as a courtesy for others. But, if nobody around me has a mask, I will remove mine.
> 1. Covid-recovered
> 2. Vaccinated
> 3. Partly-vaccinated (< 14 days after 2nd shot)
> 4. Covid-naive + Unvaccinated
And my group:
I consider this as the gold standard of SARS-CoV-2 immunization.Sources:
https://health.clevelandclinic.org/how-much-of-the-populatio...
https://www.nytimes.com/interactive/2021/us/covid-cases.html
They don't protect society at all. The herd immunity goal flew out the window with Delta and left the galaxy with Omicron. We will not ever eradicate Covid-19 with vaccination.
>It ends when the the threat subsides.
It should end right now, then. The threat has subsided. We have vaccines and other treatment programs.
The problem is that so many elected officials don't abide by the rules that they push. Joe Biden, Gavin Newsom, Nancy Pelosi, London Breed, etc. When the powerful can ignore their own rules, they're more likely to enact sweeping mandates.
I'm having a harder and harder time believing this (that herd immunity is actually possible) considering that the vaccine does nothing to stop it from spreading.
(Am vaxed and caught it, fwiw)
You just skipped past their entire point, after helping build it (mandates to protect "society" indeed). Society will never be completely safe. Government has a tendency to hang on forever to powers gained during emergencies.
That used to be the estimate, however with current vaccines' limited effect on new variants and the extreme infectivity of omicron it seems likely to me that herd immunity is unachievable. At the very least 85% vaccination isn't enough.
Vaccines and booster vaccines seem to be very effective against reducing the severity of an infection though. It's not ideal but it's the best we can do for now. Well, I say 'can' but perhaps it's more accurate to say 'could'.
> The people you elect to represent you (for those of us with a democracy-like government)
The answers are not as simple as you have suggested. Problem is that there are unelected officials and scientists that are deciding these things, many of which have perverse relationships and incentives that may bias their decisions. I guess these things aren't obvious if you have blind trust in the politicians and media in power.
In Australia we're over 93% double dosed. We're also in our worst outbreak with the most deaths. What is this "heard immunity threshold" meant to do?
The vaccines aren't completely effective against transmission, so those numbers were already underestimated for the original virus. With the low efficacy against the omicron (and higher transmission rates), I don't believe any amount of vaccination alone would be enough to stop it (but AFAIK, nobody actually knows it yet).
Still, any amount of vaccination will reduce the transmission rate. What is not clear if it's enough to get it lower than 1.
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The US is where it is because we have individuals willing to fight for individual rights. If casualty of individuals is the cost to keep individuality in this country then I say let it be.
The vaccinated are protected and therefore you are safe (assuming you are vaccinated). So why do you need to proselytize your doctrine on those around you? You're allowed your own opinions, chant your religious beliefs, but don't turn it into law.
You might believe a mandate might be the logical solution, and maybe by some computer models it will save the greatest number of people, but its still a breach of individual rights.
I personally believe what makes the US great isn't the number of people but the quality of people. And I'd rather give up the quantity than the quality. Sure we may end up having a higher proportion of herd people if we dont mandate and many of the individuals end up dying, but we won't have a government that can control those individuals as easily, and that's what matters most.
Obviously there is a governmental body that has the authority to do this wherever you are from. And in a democracy that governmental body will be acting based on the will of the people. Even if you disagree that the executive has that authority, the courts have the authority to interpret if they do. And the legislature ultimately has the authority to override it.
In the United States if we all voted for it we could have mandates for every single vaccine ever created. But there is barely enough political will for this one. And that's only because COVID is much more of a threat than anything else at the moment.
The politicians we elect democratically makes the decisions.
"Why seatbelts? Where does it end?"
"Why can't I shoot someone? Where does it end?"
etc etc
This belief might be to blame for many of society's crises. https://trendguardian.medium.com/free-will-a-rich-fairy-tale...
We also have data and prudence and we are long past the point where framing this in that manner is highly morally questionable to put it mildly.
Your idea of responsibility to society is mandating that young healthy people take an injection(s) ostensibly to protect them from a disease they are at no great risk from, negative side effects of the injection be damned?
Do it for grandma? It actually does nothing for grandma, that’s always been a lie, the original study could make no claims about transmission. And now, just look around.
Even if it did something for grandma and grandpa, mandating young healthy people undertake a medical intervention having value trade-off for their own health which is murky, for the supposed benefit of the superannuated or people who have eaten into a state of morbid obesity and premature aging is a horrendous inversion of social order and what is good.
The young sacrificing for the old? What??
I don't understand this argument. Maybe I'm being ignorant or childish but since when do we live in a world that as a person you have to be responsible for "fellow citizens".
Don't get me wrong I don't mean we shouldn't be nice or care about other people but no one owe me anything and I don't owe anybody anything. Don't we all learn that in life at some point?
I get the COVID is dangerous and vaccines help but don't put me responsible for you.
We make decisions every day of our lives that impact our fellow citizens negatively. Your point is what?
So you think. Ok, we have gotten to the point where these measures are ineffective, so lets do away with the measures. And that is precisely where you bump up against these "feel good" policies.
We know masks don't really work, but lets keep mandating them because they give us the sense of security that they are doing something. We know vaccines don't prevent you from getting or spreading Covid but we feel like it does something, so mandate it anyways.
I'm afraid that we are moving from "we need mandates to keep people safe" to "we need mandates to keep people feeling safe". In 20 years we're all still going to be wearing masks at the airport because "it makes people feel safer".
No they haven't. There's a pervasive anti-vax myth that Fauci "admitted" the vaccines don't work. Not true and didn't happen.
The data are very clear that vaccines reduce your chances of getting infected (not just seriously ill or dying, but getting infected in the first place). https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effective...
Masks are also effective at preventing infection. Even "bad" masks are measurably better than nothing: https://www.pnas.org/content/118/4/e2014564118
Vaccines and masks absolutely work to reduce your chance of getting infected with covid. Further, if you do get breakthrough covid, vaccines greatly reduce the chances you will end up hospitalized or dead.
"Don't really work" - they do work, just with varying degrees of effectiveness.
> We know vaccines don't prevent you from getting or spreading Covid
Again, it looks like the vaccinations with booster do still provide some, limited protection against infection and may also reduce viral load reducing infection risks https://jamanetwork.com/journals/jama/fullarticle/2788105
It is common and logical to regulate activities that could harm those around you. What cars are allowed on the road and who's allowed to drive them is carefully regulated because cars can kill or injure people. You can drive around your property with an unsafe vehicle but if you want to bring it on a public road, it needs to have working brakes and so on. Vaccine are similar because unvaccinated people are more likely to injure those around them.
Who decides? My city recently created a vaccine mandate to dine indoors at a restaurant. It was decided by the city council and the mayor, same as any other law. I think most citizens support it, but if they didn't they have all the usual ways to make that known or overturn it.
i don't know about the US, but where i live there are actual vaccination mandates for diseases like polio and measles. you cannot go to school if you don't have the mandatory vaccines.
covid vaccines are just another one that you need to take.
Covid vaccine mandate -> good.
You can end the thought there. No need to come up with a slippery slope doomsday scenario.
I feel like given that vaccines do an acceptable job at reducing risk of hospitalization and death, there is only really a few things worth discussing, in relevant order:
- Are hospitals actually being overloaded by covid cases to the point of being an issue (according to many, yes. but according to [1] Johns Hopkins, no, or only in some cases?).
- Are the unvaccinated actually the majority of the covid related cases (as far as I'm aware, yes).
- Is this localized (state or city specific), or is this a federal issue.
- Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
- Finally, what actions, if any, should be taken to correct the hospital load? (nothing, vaccine mandates, accelerated hospital expansion, turning people away, etc)
- If the answer to the previous is nothing, then what are we even doing?
The focus on just asking "vaccine mandate, yes or no" feels like it's missing most of the discussion.
[1] https://coronavirus.jhu.edu/data/hospitalization-7-day-trend
Once you get a mandate for a large-scale, politically charged activity it will never stop; the goal posts will be moved again and again, as many times as it takes and as often as necessary to put the "other side" on the defensive.
We're many weeks past "three weeks to flatten the curve", every week we hear more excuses. My friends pick them up and start parroting them in near perfect unison. I don't actually have any Republican friends, but if I did I'm sure I'd hear something similar from them too. This is no longer about fighting a disease, if it ever was (I also remember the response to AIDS being somewhat less dramatic than to COVID), this is about securing access to resources and power for one group over another. If it means thousands of your followers are discouraged from taking potentially life saving vaccinations (that you yourself have taken) and die as a result, so be it. If it means subjecting billions of people to years of unnecessary and demonstrably ineffective pandemic theater, crushing the financial future of the next generations, and destroying vast swaths of small businesses people have spent their lives building while realizing unprecedented returns on your own portfolio, so be it. The people running this do not care about any of this in the slightest, it's just an excuse to enrich themselves, and for a certain segment of the upper middle class to feel morally superior to others while they take Zoom calls from home and order dinners from Seamless. I guess this is getting boring for them now, so we're starting to be allowed to hear a trickle of stories like this.
yeah it's all a big conspiracy to put the bars and restaurants out of business for sinister reasons that are beyond imagination.
I mean, clearly, yes. Those, in themselves, never (or at least virtually never) cause sudden exhaustion of hospital capacity. Now, many covid cases, particularly unvaccinated cases, have some sort of lifestyle problem as a comorbidity, but that's not really the point.
As an example, lets say hospitals have a capacity of 100, 40 of the capacity is generally taken up by non-lifestyle factors, 40 is taken up by various lifestyle factors (things that could have reasonably been avoided from a better diet, exercise, or otherwise), and the remainder is left as buffer. Now, lets say covid takes up 25 capacity, which now overflows hospitals by demanding 105 capacity. Why is this new lifestyle factor (not getting a vaccine) obviously worse than the previously accepted and accounted for lifestyle factors?
Is it the ease of avoidance? 3 jabs and you're done? If so, what about the injuries we accept that could be avoided entirely through inaction (sports, motorcycles, whatever)?
Is it the magnitude? Looking at covid as a single factor, it could be argued that it has far greater impact than any other individual lifestyle factor. but that information sure hasn't come up in any discussion I've seen. It's always left as an exercise for the reader.
Is it the suddenness? Covid sure has been a shock to the system that it was unprepared for, but that's only true through the lens of comparing pre-pandemic to current moment. Looking at the current state, it's no longer sudden. The existence of covid is now known, and so is hospitalization needs. Now it's just a question of capacity, not suddenness.
I'm not saying the point can't be argued, but it's certainly not obvious to me. And if every discussion is left as "it's obvious, why can't you see it", the discussion won't go anywhere.
They needn't be a majority. The mandate acts to reduce strain on the hospital, so ask whether it achieves that (I think the answer is yes)
> - Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
It is harder to fix these than getting a jab.
> - Finally, what actions, if any, should be taken to correct the hospital load? (nothing, vaccine mandates, accelerated hospital expansion, turning people away, etc)
An alternative would be to charge unvaccinated people a premium on hospital costs, as I'm sure health insurance providers would be keen to do.
> They needn't be a majority. The mandate acts to reduce strain on the hospital, so ask whether it achieves that (I think the answer is yes)
Majority is very important here. If vaccinated and non-vaccinated people were hospitalized at equal rate (or even at a rate where more vaccinated were hospitalized) a vaccine mandate isn't exactly going to do anything.
But I now realize that I gave "vaccine works" as a prerequisite, so this bullet point is redundant.
---
> > - Are unvaccinated hospitalizations significantly worse compared to other personal decisions (diet, exercise, risky hobbies).
> It is harder to fix these than getting a jab.
Likely, but hard to say definitively without data, and I know I don't have such data on hand. I talk about it a bit more in another reply better, but many things are even easier than getting 3 jabs. They only require inaction.
My ultimate question on this point is, why do we accept certain lifestyle injuries but not this? Ease of avoidance is a good reason, but I would like to see it compared to other lifestyle injuries.
---
> > - Finally, what actions, if any, should be taken to correct the hospital load? (nothing, vaccine mandates, accelerated hospital expansion, turning people away, etc)
> An alternative would be to charge unvaccinated people a premium on hospital costs, as I'm sure health insurance providers would be keen to do.
I'm not against such an idea at all if it would solve the problem. The high-level issue is that the unvaccinated are costing the system more money / capacity than the vaccinated, so they should pay for it.
However, there is a lack of capacity, not necessarily a lack of funding. If the unvaccinated are charged more, will they actually have a lesser impact on capacity, or will capacity still be reached just with them paying more money? Which then circles back to needing more capacity. Who pays for the extra capacity is almost a separate discussion in itself.
That is not true. Pfizer is going to be making a lot more money from their COVID treatments than from the vaccine.
Anyway, he may also well be thinking that the best policy is to have a history of assessments that turn out to be correct in hindsight. "Drop restrictions when the number of infections declines" is at least plausible.
It will soon be Pfizer's financial benefit to have as many infections as possible.
Also you can give the medicine to already vaccinated people that also have serious cases. So you still can sell it in a lower capacity. Also you can sell both vaccines and medicine to states in large batches which is great.
It's a big golden goose for the pharma industry.. let's never forget that.
Right now this isn't the case because there aren't enough to go around, but this is the premise of the trials, so this is how they will be sold.
People also get COVID more than once.
I'm not suggesting this is true, but it would need to be 100x-400x more profitable, and that includes cost to make and store as well as the price is charged.
Maybe making mRNA vaccines costs much more than a simpler molecule like Paxlovid [0], and hospitals generally seem to charge much more than the over the counter price for everything. You've seen horror stories about $25 aspirin [1] which is easily 400x more expensive than the penny per pill cost of 500 tablets in a $5 bottle [2].
[0] https://en.wikipedia.org/wiki/Nirmatrelvir
[1] https://www.healthcarefinancenews.com/blog/why-aspirin-taken...
[2] https://amazon.com/Basic-Care-Aspirin-Regular-Strength/dp/B0...
The implications of this phenomenon on Pfizer's business model are enormous. Pfizer & others would be foolish to not pay close attention to this and figure out a way to exploit it for further gains.
My trust in the system has been thoroughly shattered, I've gone from looking down at anti-vaxxers with disdain from before the pandemic- to now being labelled as part of that crowd because I am anti mandates. The whole timing of that terminology in and of itself is interesting as well- but that's probably going too deep down the rabbit hole.
The big question for this vaccine is why we rewarded this fully taxpayer-funded development and testing with a patent monopoly.
Well this is the first major global pandemic in a century, so that would stand to reason, no? Most of the world received the polio vaccine within a few years of its discovery btw
If you're saying it's false you should please post a source or at least some kind of napkin calculation. It's not intuitive at all. Otherwise it just sounds like you're beating the already dead "pharma companies sole motivation is money" horse.
The cost of a generic Paxlovid course of treatment is around 40$. The cost of treatment, negotiated down by the government (and thus higher for other parties) is around 600$. So the marginal profit from a course of treatment of Paxlovid is around 540$.
On the other hand, a vaccine dose costs 20$, and it is very difficult to manufacture. A reasonable estimate of profit is 10$ per dose. This is an overestimate, because Pfizer has to share a sizeable portion of the Profit with BioNTech and other companies.
Paxlovid is indicated to be taken as early as possible - and priced so that it makes financial sense for insurance companies to pay for it to avoid the cost of hospitalization. Therefore we can expect a sizeable proportion of people with COVID symptoms to take it.
Paxlovid reduces the symptomatic illness period, so there is also a very strong incentive for individuals to take it as it allows them to be less sick. For the less fortunate, it also means less sick days to take, which may be crucial to make ends meet.
If we're expecting everyone to take a vaccine dose every six months (which we all know will never happen), that's 20$/person.year from the vaccine.
If we expect everyone to have COVID symptoms every year (which is almost certainly an underestimate), at 540$/person.year, we only need to have a 3.7% take rate for Paxlovid in order for it to generate more profit than everyone taking two doses every year (which, again, will never even come close to happening).
So as long as 3.7% of the population takes one Paxlovid course of treatment every year, Pfizer will make more profit from Paxlovid than the vaccine.
So it is trivially true that widespread COVID infection (and low vaccination numbers) is going to be Pfizer's financial incentive.
Not if the vaccines don't work!
Nope. That line was crossed a long time ago. I can't imagine people suddenly regaining trust in pharma companies and health care agencies now because they backed off at this point.
On the other hand, I do trust the politicians much less.
Why on earth would you suddenly trust them "more than ever"?
An unending series of shots, mandates, and other restrictions is “a way out”? What are you smoking?
Dead Comment
It's really the most divisive issue I've ever seen in my life.
In all fairness, it doesn't get much less credible than the Epoch Times.
I've been yelled at and called very awful things by people I know in real life. Biggest clue that this is 90% hysteria and 10% real.... What ever happened to keep calm and carry on.
Users can email hn@ycombinator.com to ask for human review of flagged articles. If the article still remains flagged, only then is the flag sanctioned by HN moderators. Otherwise, flags could be anywhere on the spectrum between organic users, troll botnets and paid interventions.
Is there an API to HN data which could report granular data on article flags, e.g. timestamps or user IDs doing the flagging?
Dead Comment
"Cures are nice, but the money is in chronic conditions."
[1] https://www.cnbc.com/2021/12/22/fda-authorizes-pfizers-covid...
Language Warning.
https://www.youtube.com/watch?v=RRN3d5S_MTk
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