> Similar reductions in COVID-19-related hospitalization or death were observed in patients treated within five days of symptom onset; 1.0% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (6/607 hospitalized, with no deaths), compared to 6.7% of patients who received a placebo (41/612 hospitalized with 10 subsequent deaths), with high statistical significance (p<0.0001). In the overall study population through Day 28, no deaths were reported in patients who received PAXLOVID™ as compared to 10 (1.6%) deaths in patients who received placebo.
Those extra two days (three versus five) could make a huge difference.
That said, this does work better it seems if taken early, before the anti-vax sentiment may have worn off. Hard to say.
What it does signal is really the "end of the pandemic". We have both a vaccine (now approved for kids) and a cure. That sounds like it to me.
40 000 people forced to work by their employers, who then spread it to colleagues and customers, because they had a respiratory disease but ‘it isn’t COVID’.
COVID is particularly bad, but employees should also be allowed to stay home and rest, to not spread the cold and flu.
Lack of approval + length of use as medicine. There's a narrative that drug X has been used for 50 years (despite what it's used for) and therefore the pharma industry is uninterested in its success because they can't get rich off of it.
The latter is a common thread, along the lines of "what THEY don't want you to know."
So why are THEY for these but against ivermectin?
Of course the whole idea of THEY is nutty. The idea that there is this level of coordination / cooperation among pharma companies is ridiculous enough to be the punchline of a joke.
Many people sick with COVID are not getting this "standard of care" you suggest exists. Just tylenol and good luck. So those other drugs are not very far from ivermectin in terms of accessibility. All effective drugs are controlled and access is not given to the broad public, only to doctors and pharmacists, and many of these gatekeepers keep them from the sick people. You have to be lucky and have a good doctor who cares about you, not just about following what government agencies tell him to do. Then he may give both "unproblematic" stuff like heparines and also more "controversial" stuff like ivermectin.
The FDA regulates the marketing of drugs, not the practice of medicine. Physicians can prescribe whatever they want. Treatment guidelines are determined entirely by practicing physicians.
Uptodate is a good resource to check out if you want to see for yourself what clinical guidelines look like, and the type of evidence they are supported by.
https://www.uptodate.com/contents/covid-19-management-in-hos...
However, that means something like this is still very useful because of that 5–8%, especially for the elderly and the immunosuppressed, etc.
(I share your skepticism anti vaxxers would be interested in an effective treatment.)
That's simply not correct.
"fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts." [1]
[1] https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
Vaccinated people are less likely to be infected, hence "breakthrough case." Your quote is like saying that "people thrown out of windows in car crashes have the same rate of injury, despite whether the person was wearing a seatbelt or not." That may be true, but wearing a seatbelt definitely reduces the chance of getting thrown out of a window.
If none of these seem to suggest a clear winner then you should just think that this is still undecided. You can also ask an expert. Choosing one and believing is basically just going with your suspicion.
a) choose the later study
b) look at what happens in the real world (e.g. https://news.ycombinator.com/item?id=29124652 )
And, If there is uncertainty (and there always is some small amount of it) then this does not support the parent commenter's strong and confident assertion that "do not, and never have" ... produced an effect.
b) in the real world, we had our biggest outbreak after vaccines were mainstream
Is that supposed to be relevant? When "we had our biggest outbreak" there were/are still sufficient unvaccinated people to transmit an outbreak.
You're clearly defending a fixed point of view here. If you want detailed responses to learn from, stop asking for people to do them yet again and look for what already exists upthread. If you're having trouble finding it, start here: https://news.ycombinator.com/item?id=29124446
Based on this study, vaccinated had a 25% chance vs 38% for unvaccinated to become infected if someone in their household had Covid. So a helpful reduction, but not night and day.
Once infected, from what I’ve read vaccinated folks are just as likely to spread it.
Please don't create accounts to break HN's guidelines with.
Go look at Singapore. 80%+ vaccination rate (Pfizer or Moderna), with regular mass testing.
About 65% of new cases are in fully vaccinated but the new cases are still stacking up. So yes it reduces the risk, but not by 7x. This is backed up by the recent Lancet paper which showed about a ~30% decrease in risk of infection.
They provide daily updates but have been changing the detail level and categorization to get away from pure case numbers.
Go back to late August to see the breakdown of cases across fully, partially and unvaccinated individuals. The vaccines clearly work prevent serious illness, but don’t seem to be slowing the spread that much.
The MOH used to also breakdown daily deaths into vaccinated and unvaccinated, but recently stopped. I suspect (and they confirmed a few cases) where the deaths are often fully vaccinated.
Of course they don’t want to provide data for the vaccine hesitant to call out, but they have been changing their narrative so often it’s starting to be a problem.
So on one hand we have detailed data from UK and Singapore with breakdown by age/date/vax status and limited VE agains infection, on the other hand opaque charts (US...) with only aggregate numbers, showing 6-10x odds in favor of vax. The lack of detailed epi USA data conspicuously continues.
I did sanity check one UK aggregate chart touted in a sibling thread claiming, absolute numbers, unvax infections >> vax infections in UK. There were egregious Simpson's issues, all age groups >18yo had (significantly) more vax infections than unvax infections. The <18yo case load was a huge outlier, dominating the aggregate numbers. Fireable offense for a data analyst.
https://www.moh.gov.sg/news-highlights/details/update-on-loc...
The Singapore one isn’t perfect since those at higher risk of exposure (medical workers) tend to be vaccinated so that isn’t corrected for. But that would also disappear as you start to get most of the population vaccinated.
IDK why anyone would deny this observable reality.
UK publishes the vax/unvax numbers broken down by age groups. See Table 2 in https://assets.publishing.service.gov.uk/government/uploads/.... Raw numbers:
cases between week 40 and week 43 2021
unvax vax 1dose
under 18 336893 818 36000
18-29 24097 33649 9500
30-39 25832 71492 7800
40-49 15717 130686 4500
50-59 6701 99722 2000
60-69 2484 56779 800
70-79 917 34305 300
≥80 471 12339 200
2. Under 18 has a large case number, which dominates the totals. Some issues:
2.1. Schools have strict testing and tracing policies. The large case numbers may simply an effect of higher testing rates for the respective population.
2.2. Related to 2.1., there are two ways to count cases: PCR cases and symptomatic cases. In case of large case numbers outliers, the difference between the two measures can explain a large difference, though it is impossible to independently verify that a consistent measure was applied for all age groups.
2.3. Vaccination in 12-17 was only recently introduced. VE decreases over time. Studies disagrees by how much. At six months time, for Pfizer I've seen 55%-75%, from a high of 90%. Closer to the vaccination event VE is higher, thus the number of vax cases is temporarily lower. A more realistic assessment assessment ought to a. break down under 18 in to 0-5, 5-11, 12-17, and wait 6 months post vaccination campaign. Note that VE is also a somewhat misleading metric, 90% means 9/10 case reduction, 50% merely 1/2; a small percentage drop in VE at the high values mean a large increase in cases.
3. In some age categories, e.g. 50-59, unvax share of the cases is as small as 6%. Not sure (*) what the unvax rate in UK is for that age group, the reports says somewhere in the low teens, that number has been contested. But 6% is low enough by itself. If that doesn't make you wonder about the official line "unvaccinated people were 6.8 times more likely to get COVID-19 than fully vaccinated people.", then nothing will ever do.
Can't speak about US data because US is, for some reason, very tight lipped when it comes to publishing basic epi data with breakdown by date, age and vax status. If you have a link to the equivalent of the UK PHE vaccine surveillance report for any US state, please share.
(*) Apparently UK is not sure about the vax rates either, because apparently UK doesn't know how many people of a given age live in the country. That is a story for another time.
This is of course exactly what you did above.
It also says "We have published a blog to accompany this section of the vaccine surveillance report" https://ukhsa.blog.gov.uk/2021/11/02/transparency-and-data-u...
You should not expect ZOE study data to match UK Govt data exactly, they use different methods and check different symptoms. This is that theme that Prof. Spector talks about often.
Exactly. Neither should aggregate numbers that various US states and Prof. Spector use to spread fear, acrimony and stigma should be used to estimate VE, or mislead the audiences to estimate VE by themselves. Notice how the ZOE video you linked lacks the intellectual honesty to display the same disclaimer. His own website says "Incidence estimates were updated on 21 July 2021.". He's basically fabricating numbers, for all we know just as accurate as Prof. Ferguson. This is no better than the "antivax garbage" some people are so keen on summarily calling out.
Here are some longish term studies and preprints for Pfizer's VE against infection.
UK, 3 months VEaI = 75%. https://www.nature.com/articles/s41591-021-01548-7
Qatar, 3 months VEaI = 70%, 6 months VEaI = 12.8%, https://www.nejm.org/doi/full/10.1056/NEJMoa2114114
Sweden, <50yo, 2-4 months VEaI = 83%, 4-6 months VEaI = 50%, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3949410
US, veterans, 3 months VEaI = 78%, 6 months VEaI = 50%, https://www.medrxiv.org/content/10.1101/2021.04.20.21254636v...
Two notes:
* VE against infection drops over time. Sadly, I am not aware of any reliable literature for VE after 9 or 12 months. Unfortunately Pfizer killed their own critical trials, which had a solid headstart, by vaccinating the control arm after 6 months. But the trend is clear, and worrisome.
* 80% VE => 1:5 infection odds. 75% VE => 1:4 infection odds. 50% VE => 1:2 infection odds. 12% VE, it's a wash. Numbers like 1:6.8 infection odds this long after the vaccination campaign are fantasy.
This is a very bold partisan claim, in fact it is insult. It comes across as another Paranoid fantasy out of US politics, irrelevant to the UK. I'm no longer interested in anything that you have to say. Good day.
They literally changed their formula because the trends in the unvaccinated population didn't to conform to their prior biases. Though the formula details are still a mystery.
"Last week, we reported a plateau in new COVID cases based on our methods at the time, which relied on a small number of unvaccinated people in our dataset compared with the wider UK population. The number of daily new cases in the unvaccinated group appeared to be dropping which in turn resulted in our overall numbers trending down. This meant the figures were accurate to our dataset but didn’t represent the full picture in the UK."
https://covid.joinzoe.com/post/covid-estimates-updated-vacci...
I'll grant that UK has no vaccine mandates (including for kids!) and none of the craziness. Have a great one!
Sorry you had a severe issue with your vaccine.
I had a hardened blood clot surgically removed off my scalp the other day. Was in a vein right by my temple. When the report comes back confirming I'm hoping it'll get me a proper scan.
Does that mean that there is no evidence that it doesn't work either? :)
The well run trials to this point don't show a significant difference between the groups. The ivermectin advocates say that the trials have not been run correctly for various reasons like dosage, timing, etc. More trials can be run to try to address these concerns. This can be repeated any number of times but at some point people will give up trying if no effect is found.
You left a lot out in regards to the mechanisms of action: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203399/
[1] https://pubpeer.com/publications/EDF9109EE29DF2340379B562365...
I'm not anti-vax, btw. I have a medical condition that requires me to receive regular vaccination against several diseases, and I'm strict about doing that on time.
I've made a calculated decision in the case of this specific vaccine based on that fact that I've now had Covid twice (first time was a bit nasty, second time was very mild) and have acquired fairly robust natural immunity.
According to almost all of the research I've read, natural immunity is at least as effective as the vaccine, which makes sense to me. Our bodies (if healthy) tend to be pretty good at this stuff.
The vaccine carries risk, all medical treatments do. When I calculate my baseline risk - very healthy, fit, no cormobidities, etc..., couple it with my acquired natural immunity, my chances of a negative outcome from Covid asymptotically approach zero. This appears to me to be less risk than the vaccine introduces.
I say all this to describe my mindset, I think a lot of people share it. Lumping everyone that choses based on a risk calculation to not receive the vaccine as "anti-vaxxer" is a common thing that people do (though I believe it is wrong).
All that being said, my primary point is that if I got Covid again, I'd absolutely be receptive to a therapeutic like this.
My decision against getting the vaccine was entirely risk based. At the point where I've contracted the illness again, however unlikely, the risk has been realized and I would 100% be receptive to taking this therapeutic if my doctor recommended it.
You say that, but you ended up catching COVID twice. Was the second time post the availability of vaccines?
In my opinion, if you're nice and wear a mask in crowded conditions, don't go around hanging especially indoors in big groups, your position is kind of ok.
Though I'd still look at the numbers to check if vaccines reduce infection rates and rate of spread. Because if that's true, it might be worth getting vaccinated to protect others a bit more.
Vaccinated people? Much less so than the unvaccinated.
Double vaccinated people are 60-75% less likely to catch even asymptomatic COVID. If infected, they are 50% less likely to transmit it onwards to others. These are Delta figures.
https://www.bbc.com/news/health-59077036
(Article contains link to the Lancet study)
From the Lancet study linked in the article:
> The SAR in household contacts exposed to the delta variant was 25% (95% CI 18–33) for fully vaccinated individuals compared with 38% (24–53) in unvaccinated individuals.
Vaccinated people will spread without even knowing, this is already the main way of spread in many areas with very high vaccination rates.
Me > Though I'd still look at the numbers to check if vaccines reduce infection rates and rate of spread.
Thankfully I said that already.
> Also vaccinated people spread delta, so everyone is getting it on some time scale.
That's not guaranteed, though. Just like not everyone on the planet will ever get all the strands of flu or cold or whatever. Through natural immunity + vaccinations at some point the disease can just die down and through a simple rotation you could avoid it (i.e. everyone else gets it at a time when you're not around so you're spared).
Plus the time scale is important. In November 2019 we didn't have any vaccines, now we have 4 that are approved on a wide scale (Pfizer, Moderna, J&J, AZ) plus a bunch of others with widespread usage but a less stellar reputation (Sputnik, the Chinese ones) plus another bunch coming soon <<and>> this very topic is about a drug for curing it. And another slightly less effective drug has also been approved recently, from Merck. That's... 24 months after the initial outbreak. Who knows what 24 more months will bring?
I personally didn’t mind the side effects, but mainly got it because I thought: What if I get Covid and give it to someone and something happens to them? And then I thought that it still worths the risk.
Of course no one should blame you if you want to care for yourself but I’m interested to know your feelings on this.
Your mindset should be: everyone is going to get this, probably multiple times in your life, vaccines reduce the symptoms, but not as effectively as having survived covid.
There are some inactivated virus vaccines which would be best for people who want to avoid new vaccine types, but AFAIK they haven't even been tested in the US.
I think there's also some "it won't happen to me" mentality that quickly disappears once it does (which is far too late for a vaccine)
Or that big pharma wasn't making enough money off ivermectin, so they invented a new pseudo-drug or something.
When you believe that core institutions are worse than inept and actively work against you, you can justify anything. I'd call it a coin toss whether they're for or against.
So no matter what, you'll get the viral mRNA in your body. Either through infection or through the vaccine. The vaccine just contains a small fragment and it does not proliferate. Unlike the virus.
But 99% of people don't know that water can kill you. I'm not talking about drowning.
https://en.wikipedia.org/wiki/Water_intoxication
If the most benign substance on the surface on the planet can kill you, anything can.
Anti-Vaxx people seem to absolutely love non-vax treatments.
I don't know if the rationalization is sound, but I'm not sure it's really that.
The anti-vaxx stigma pre-COVID I think has had it's toll.
The notion of 'government pushing you to take something' as well.
Whereas, 'you get sick, you take a pill' is an easy concept.
My fear is that a lot of people won't bother with a vax if they think there's a 'cure'.
Interesting. Indeed, should people bother with a vax if there's a highly effective cure? Is it worth all the teeth-gnashing and hair pulling on the part of the medical establishment, political establishment and media about people who would rather get COVID than get the vaccine? IMO this cure (once it starts rolling out ofc) is a reason to start rolling back vaccine and mask mandates rather than impose more mandates.
[Disclaimer: Fully vaxxed, will take a booster, etc]
Yes. COVID danger is it's virality, not it's lethality.
100% vaccinated population even at only 85% effectiveness means R0 is well below 1 and COVID cannot spread.
100% of COVID patients treated at 85% effectiveness of antiviral therapy means probably well over 1/2 the population still gets COVID, that's devastating.
If this were about a non-communicable disease, then probably the vaccine would be a slightly better idea, but due to virality there's no doubt vaxxes are better.
The best is to have both.
Finally, the vaxx is $20, antiviral is $700, which is material.
That said, if the 'cure' were 100% perfect, no side effects, cost $1 and could be given at any time after infection and prevents any further adverse effects, then we could probably just settle on that if we had to.
I don't suspect we're going to hear a lot about this in the press, because the 'narrative' still needs to be 'get vaccinated'. What will happen is the CFR will come down to to this and other measures behind the scenes so to speak.
Unless this thing comes down to $50 and is something any doctor can prescribe willy-nilly easy-peasy in which case I think there would be a big media campaign to 'inform us'.
There is also the worry of the effects of long covid. Just yesterday I was reading a thread on here of people complaining about experiences of their loved ones with long term covid after effects not being able to find relief from doctors because, well, we still don't even know what causes it. Better to avoid an infection that let a virus ravage through your body hoping medication can reverse all the effects on the body
I agree we should get vaccinated to reduce spread but, good news, this is wrong. UK clinical guidelines[1] state the immunocompromised and the immunosuppressed should get vaccinated.
In fact, they basically recommend everybody be vaccinated. Pregnant? Yes. Mild allergies? Yes. History of anaphylaxis caused by a specific ingredient in the vaccine? Speak to a a specialist who should offer (where possible) an alternative vaccine.
Moreover we know two doses of the vaccines produce an antibody response in the immunosuppressed.
That said, three doses is a good idea[2] to boost that response to a more typical level.
[1] https://www.gov.uk/government/publications/covid-19-the-gree...
[2] https://twitter.com/sailorrooscout/status/138026987700974387... and preceding thread
So 1 * P(bad vax) vs P(getting covid) * P(bad covid case).
While most of other proposed treatments are after you already got it.
So P(bad side effects) vs 1 * P(bad covid case).
Depending on your priors and health, those balance very differently.
Also, if the new pill ends up as effective as they say it is, there is no reason to push for 100% vax uptake anymore -- it would turn covid into a slightly more dangerous cold.
1) There really is no such thing as 'Vaccine Risk' in the material sense, any more than we would us language such as 'Flying Risk'. Esp. in the US where thee is no AZ vaccine, the risk is negligible.
'The Vaccine Risk' in the minds of many people isn't consistent with the reality, and it's a major communications problem.
Anti-vaxxers are internalizing and propagandizing a degree of risk that just isn't real, leading to bad health outcomes.
Sure, technically, it's a risk, but so is anything else.
2) 'No push for 100% Vaccine' - maybe not for '100%' but we really need to push hard on vaccines.
COVID is not scary because it's excessively deadly. It's scary because it's excessively viral, meaning, it's a community disease, less so an individual disease.
Stopping COVID means stoping the spread, not trying to cure people when they get it.
With 95% vaccination, R0 drops below 1 and so hospitalization rates are low, we can focus on the hard cases.
With 0% vaccination and a 85% effective drug, well, 'everyone' will get COVID, and a scary number of them will die.
The 'Best Answer' by far in a world where vaccines are very safe, very cheap, and very effective - is to get 'as many as we can' vaccinated. And then use the expensive drugs on the hard cases.
If you were at risk, you can get vaccinated, why force a healthy person? (The answer is mostly for the folks who can't vaccinate, but those folks are screwed any way you look at this pandemic if we are honest).
Overwhelmingly, the numbers of people in Hospitals are unvaxxed.
In BC, the last report I saw for a region had almost 100% of people below 50 in intensive care unvaxxed, almost the same numbers for seniors.
Rates of spread are actually coming down even while business activity expands, vaccines are a potent part of this. Not perfect, but a major component.
So again: COVID is a community problem, less so an individual one. 'Stopping the Dominos' from dropping is much better than trying to lift all the dominos up after they fell with drugs.
"So taking preventative measures because it is forced down their throats seems hostile."
It's not hostile to the 80-90% of people in most advanced nations who have basic civil maturity. It's a mild distraction with obvious individual and group benefits, to the point where I have a hard time understanding lack of participation (yes, it's very easy to understand hesitancy and hostility to being required to do something, but not to the level where people actually would avoid doing something obviously beneficial).
I remember when smoking was banned indoors, I get that people were a begrudged, but I think in reality most people 'got it'.
Not to mention, everyone I know knows at least one person who had a stroke within weeks of getting one of the "vaccines", I know three. Previous to this past year I've known one person in my entire life that had a stroke, and it was my wife's uncle who was in his 90s.
Vaccine side effect tracking is done pretty thoroughly, so if what you see would be a real and generic phenomenon, it would have been noticed by now.
None of the 3 I personally know were (suppose that's just anecdotal also). The one received the second dose 3 days before a major stroke, and massive blood clots. I'm sure it was tOtAlLy UnReLaTeD.
> The official estimate by the CDC is that 1 in 40 vaccine injuries is reported.
Source?
But what about 75% vaccination (lots of countries are there already or very close) and 85% effective drug? How much effort much be spent on hunting down every last antivaxxer and how many side effects of that are acceptable? (like destroying public support for vaccine mandates in general, creating nice shiny tools for the next wannabe authoritarian, etc)
As for endemic, yes, a problem, but of a different kind.
Thankfully that risk is tiny.
> Also, if the new pill ends up as effective as they say it is, there is no reason to push for 100% vax uptake anymore -- it would turn covid into a slightly more dangerous cold.
No, vaccination remains far cheaper. Mass vaccination also reduces the risk of mutation, and of infection others.
If everybody gets vaccinated AND this anti viral is widely available for those infected, COVID will be well and truly deranged.
Only if the vaccine is effective enough. With these moderately effective vaccines, there is a danger that breakthrough cases will generate new variants.
Second, COVID just doesn't mutate that much considering how prevalent it is, in part due to RNA proofreading.
Moreover, no, emperical evidence shows the neutralizing antibody effect of vaccines decreases the spread of variants.
The world started vaccinating in January - 10 months ago. You won't even begin to know the true effectiveness of the vaccine and its outcomes until at least one more year goes by ey? Then you can begin to compare year over year health outcomes in highly vaccinated groups, vs unvaccinated, in the same region (same viral seasonality profile), across age groups. I can't wait to see regional all cause mortality with accurately age (and other vars) adjusted data between the vaxxed and unvaxxed.
One thing to keep in mind is that P(getting covid) is about 1. But for sure greater than 50%, especially if people don't vaccinate in large numbers (I mean others, of course) and if we do away with masks and restrictions.
When doing this kind of comparison, vaccines are tricky, because if you vaccinate close to 100%, then you'll have very few cases, so P(getting covid) will be rather small and then it will seem that the vaccines may not be worth it. But if you don't, then it will be high and that's what you should base your decision on. BTW, this is why antivaxxery could become such a phenomenon lately (even before covid): too few children died or got paralyzed in the past quite a few decades so the usual diseases somehow started to seem not such a big deal. Because people just didn't experience the other side of the equation anymore.
Also, on a side note, I'd expect that an antiviral will have more side effects than a vaccine.
Wealthy people.
If this drug is safe and can be made sufficiently cheap, it could be a great treatment for most kinds of common cold.
Why suffer for weeks with cold symptoms if you can simply spray this up your nose and feel better?
It could (potentially) be used similarly to Tamiflu.
The majority of the common cold cases is caused by rhinoviruses. But yes, like 20% (ballpark) are caused by coronaviruses.
This drug is fantastically effective at preventing hospitalisation and death, if administered within three days of symptom onset.
That gives quite a long time! But we still need to make it easy to take. Do pharmacies give it out? ER rooms? We don't want to wait until people are hospitalised; we are trying to avoid that.
So when you test positive, does the government send you out a pill with the "sorry, you have to isolate" SMS?