1) I’m not aware of any research that shows near-zero reduction in transmission rate. As far as I’m aware, research shows that vaccination rate reductions in transmissiveness that are less than previous strains, but dramatically better than nothing.

https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v...

> For households with the Omicron VOC, the corresponding OR for infection for unvaccinated individuals was 1.04 (CI: 0.87-1.24) and 0.54 (CI: 0.40-0.71) for booster-vaccinated individuals.

2) Keeping hospitals from being overwhelmed and keeping people from dying is a legitimate goal of vaccination, even in the absence of any reduction in transmission. The vaccine remains effective at this. Hospitalization rates for the unvaccinated are leagues higher than the vaccinated.

> As far as I’m aware, research shows that a two-dose vaccination rate provides disappointing reductions in transmissiveness - but far, far better than nothing.

The paper you quote shows two-dose vaccination (or previous infection) increasing the secondary attack rate from 29% (unvaccinated) to 32%, i.e. worse than nothing. Only a booster reduces it back to 25%.

My guess is that the increase is not due to direct biochemical effects of vaccination/prior infection, but due to people assuming that they're protected and taking fewer precautions. Demographic differences might also play a role.

Nope, nope nope, not at all.

> After adjustment for confounders, we found that in households with the Delta VOC, the OR of infection was 2.31 (95% confidence interval (CI) 2.09-2.55) for unvaccinated individuals and 0.38 (CI: 0.32-0.46) for booster-vaccinated individuals when compared to fully vaccinated potential secondary cases. For households with the Omicron VOC, the corresponding OR for infection for unvaccinated individuals was 1.04 (CI: 0.87-1.24) and 0.54 (CI: 0.40-0.71) for booster-vaccinated individuals.

For delta, two dose vaccination helps. For Omicron, there is no statistically significant effect of two dose vaccination.

In no case is there an increase from two dose vaccination of attack rates.

Vaccination continues to reduce transmission (less for Omicron than before, but it was known never to be be 100%) but it also significantly reduces the number of people with serious cases (still quite successful even with Omicron).

That means there’s a big side effect from people not getting vaccinated: the healthcare system has finite capacity and when it’s full of people who wouldn’t be there if they’d been vaccinated, that means space isn’t available for anyone who has some other problem and the healthcare system is losing a lot of expensively trained people due to stress. It is extra hard on them to watch people die for avoidable reasons and many nurses, doctors, etc. have left at least temporarily due to burnout.

Not sure where the early downvotes are coming from but this is correct: my state has 95% 2 dose vaccination of adults and currently 150 ventilated patients- half of those are unvaccinated.

So 5% of the population represents 50% of ICU ventilator capacity.

While I'm sure the unvaccinated represent more, it's also true that many reporting stats considered double vaccinated to be in the unvaccinated category if they are eligible for a booster and haven't had them.

I don't know which sites you're seeing but the ones I use tend to break that out as “partially vaccinated” or “fully vaccinated” vs “fully vaccinated with booster” — which is good since the evidence has shown that there's a big difference between the waning protection against infection (i.e. neutralizing antibodies) versus protection against severe cases (i.e. T cells) even for partial vaccination.

https://ourworldindata.org/covid-vaccinations https://www.washingtonpost.com/graphics/2020/health/covid-va... https://www.nytimes.com/interactive/2021/world/covid-vaccina...

https://covidactnow.org/ uses “at least one dose” for the national map but breaks out their state-level displays as “1+” and “fully vaccinated”.

Yup. I’ve seen similar gaming. Of the people who died in Singapore, 5/8th weren’t “fully vaccinated”, so they lump in the ones with one dose and those who haven’t met some predefined period of time post-2nd dose.

This is not the case where I live, work and practice medicine

How much does it reduce transmission? Do you have links or know the studies to look for? (It's difficult for me to wade through everything out there and know what the "good" studies and data are)

It's still early but here's an example of what it's looking like:

https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v...

> Our results show that the Omicron VOC is generally 2.7-3.7 times more infectious than the Delta VOC among vaccinated individuals (Table 3). This observation is in line with data from (18), which estimated that 19% of Omicron VOC primary cases in households in the UK resulted in at least one other infection within the household, compared to only 8.3% of those associated with the Delta VOC. Furthermore, we show that fully vaccinated and booster-vaccinated individuals are generally less susceptible to infection compared to unvaccinated individuals (Table 2). We also show that booster-vaccinated individuals generally had a reduced transmissibility (OR: 0.72, CI: 0.56-0.92), and that unvaccinated individuals had a higher transmissibility (OR: 1.41, CI: 1.27-1.57), compared to fully vaccinated individuals.

> Surprisingly, we observed no significant difference between the SAR of Omicron versus Delta among unvaccinated individuals (Table 3). This indicates that the increased trans-missibility of the Omicron VOC primarily can be ascribed to immune evasion rather than an inherent increase in the basic transmissibility.

That last part is why the boosters matter: neutralizing antibodies (which your body stops producing over time after the infection) can prevent someone from getting sick at all, whereas the longer-lasting T cell response helps your immune system fight it off more effectively. If the entire population is boosted, that would have been plenty to fight off Delta but with Omicron we still need a combination of other measures (masks, air filtering/exchange, etc.) and eventually updated boosters to put an end ot it. That doesn't mean that being vaccinated isn't worthwhile, of course: you're still far more likely to have a better outcome if you get it and the window where you're contagious is smaller.

I encourage everyone eligible to protect themselves by getting vaccinated but we're really chasing our tails by focusing on antibody levels. In the long run cellular immunity is more important. We can't give everyone boosters every few months just to keep antibody levels up.

https://youtu.be/GklHGYY8vN8

We can't put an end to this virus. It will be around at some level forever.

That's why the different between the neutralizing antibodies and T cells is so important: when the pandemic is raging, your odds of exposure are high and so public health people are concerned about the ability of vaccinated individuals to slow the spread impacting the entire healthcare system. The medical system is under levels of stress which haven't been seen in a century so they're understandably focused on trying all of the tools available to calm things down.

Once it's spreading at a lower level, your risk of personal exposure is much lower and the long-lasting T cell response becomes more of a focus because that reduces risk to the person and you're less worried about the crunch of many thousands of people showing up at the hospital at the same time because for someone vaccinated it's more like something like influenza where most people have a bad week or two but don't urgently need medical treatment.

> If vaccination does not meaningfully prevent transmission, as increasingly seems to be case with Omicron, faking vaccination harms only the fake recipient.

keyword being if and meaningfully.

Anyway that fake recipient may still need top notch expensive care to stay alive if he doesn't get mild covid. Are you suggesting that he should pay in full for those care since you state it only harms the fake recipient ?

Also, it increasingly seems that a third dose significantly increases protection against omicron.

Yes, I think that would be an excellent idea, and quite a few countries are in fact moving in that direction.

Early evidence is that the protection against transmission from the booster appears to be quite fleeting (weeks, not months), so the main reason to vaccinate is really to protect yourself.

The unvaccinated haven't done nearly the damage policy has to hospitals. The US has like 6-7% fewer staffed beds than before the pandemic and has stupidly decided to fire unvaccinated healthcare workers that have almost assuredly developed their immunity naturally.

People seem to forget much of the world still has no access to vaccines. Every person being vaccinated with natural immunity is someone without immunity missing that vaccine.

Yup. California is now changing the rules to allow Covid positive healthcare works to come back without any quarantine.

https://www.kcra.com/article/nurses-react-covid-19-protocols...

So is France and Canada.

What does natural immunity mean with new variants and when it lasts from 90 days to six months? Are these people going to pay to get their antibody titers checked every week? If they incubate a new variant themselves are they willing to be held personally liable?

>What does natural immunity mean with new variants and when it lasts from 90 days to six months?

I'm not sure what you're asking. Are you saying that antibodies last 90 days to 6 months? Firstly that's incorrect as antibodies seem to be detectable even after 8 months in the study I'm remembering, but more importantly your immune system is made up of many parts and antibodies are not the primary response to coronaviruses since the antibodies do fade rather quickly.

Instead the many other parts of our immune system are extremely long lived with other coronaviruses and there's no reason to expect they won't be extremely long lived with covid.

In fact the reason you see so many asymptomatic cases with covid is because of preexisting natural immunity to similar coronaviruses.

> If they incubate a new variant themselves are they willing to be held personally liable?

Are you suggesting if we had the tech (we don't) to trace down the exact host where a virus mutates into a recognizably different strain that host should be liable? I think you should really reflect on exactly that would mean and exactly how harmful that would be for society. You do realize every single person in the entire world will either die in the next couple of years or without a doubt be attacked by covid, right? That means you'd basically be putting up a lottery system to see who gets to lose for being "ground zero" for a new variant mutation. This would be completely pointless and would serve only to hurt people with zero chance of helping anyone.