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.

Source? Because the CDC says otherwise.

> In the first full week of October, vaccinated New Yorkers with a prior Covid-19 case were 19.8 times less likely to catch the virus than their unvaccinated and uninfected peers, whereas people who were unvaccinated but previously infected were 14.7 times less likely, and vaccinated but uninfected New Yorkers were just 4.5 times less likely.

In other words, natural immunity alone can be up to 5X more protective than the vaccine alone, according to the CDC.

https://www.forbes.com/sites/joewalsh/2022/01/19/cdc-prior-c...

That being said, your comment still doesn't make any sense. The people who would be substituting prior infection for a vaxpass would not be the dead ones, because dead people are not known for going to comedy shows, bars, or restaurants.

Ie, the claim is that "conditioned on being infected [and alive], a vaccine is superfluous". The [and alive] that you clarified is about as helpful as "and non-fictional"

Importantly it doesn’t account for the effect of boosters and looks at pre-omicron data.

That noted the best protection seems to be had by a combination of vaccination and prior infection, which is perhaps unsurprising.

Also other CDC studies suggest that natural immunity declines quicker than vaccine induced immunity (https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm?s_cid=mm...).

Given these results it would seem like generally a good idea to get vaccinated, even if you have had prior infection.

Don't just read the summary. Look at figure 1:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm#F1_down

There are unvaccinated, uninfected people...and then there is everyone else. Once you have been infected or vaccinated, the difference between is so small as to be academic. And as the authors note, the importance of natural infection increased over time, as the virus escaped the vaccines:

"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."

To your other claim:

> other CDC studies suggest that natural immunity declines quicker than vaccine induced immunity

No. That's not what that study said. First, it followed symptomatic infection, not severe illness. As we're seeing now, Omicron pretty handily bypasses vaccine-induced immunity to cause minor illness.

Also, methodologically, the study you're citing was bad. It only gave credit for natural immunity to those people with confirmed infections, which was/is an underestimate, and made vaccines look more effective than they are. A substantial fraction of the "only vaccinated" group almost certainly had undiagnosed covid infection.

This is shifting the goal. The disclaimers I cited come directly from the study and are highly relevant when comparing the effect of natural immunity vs vaccination.

> No. That's not what that study said. First, it followed symptomatic infection, not severe illness.

This doesn’t contradict what I said. The study gives evidence that natural immunity (to symptomatic infection) declines more quickly than vaccine induced immunity.

> Also, methodologically, the study you're citing was bad. It only gave credit for natural immunity to those people with confirmed infections, which was/is an underestimate, and made vaccines look more effective than they are.

One, the same effect would also have been present in the natural immunity group, as people may have been reinfected since their initial confirmed infection.

Two, this is largely irrelevant to the point I was making.

The statistical evidence suggests that even if you have had a previous confirmed infection, you’re still better off getting vaccinated.

Sure. And you'll continue to be better protected every time you get a booster, every 6 months, for the rest of your life. But all of us are going to stop getting boosters at some point. We're going to decide we're "immune enough", and go on with our lives, even though there will be some minute chance of getting Covid, from whichever variant is then around.

Many people with prior infection may feel they are "immune enough", and you can argue over the significance of the remaining risk, but ultimately that's a decision they make for themselves, just as all of us do in every facet of our lives every day.

No, it isn't. It's clarifying that there's a great big forest here, lest we get lost in the details of the spots on the bark beetles in one particular tree. The immunity granted by prior infection is at least on par with that of vaccination.

Moreover, I quoted directly from the study to explain why short-term squiggles in the lines at the bottom of the graph aren't worth dwelling upon: the vaccines are getting worse over time (against symptomatic infection), and the effect of natural immunity is gaining importance. This is exactly as you would expect for a virus that has evolved to partially escape the vaccine.

Regardless, these are minor differences. You can't reasonably argue that vaccination has a definitive advantage over natural infection. We should be counting both.

https://www.wsj.com/articles/the-high-cost-of-disparaging-na...

"Yet the CDC spun the report to fit its narrative, bannering the conclusion “vaccination remains the safest strategy.” It based this conclusion on the finding that hybrid immunity—the combination of prior infection and vaccination—was associated with a slightly lower risk of testing positive for Covid. But those with hybrid immunity had a similar low rate of hospitalization (3 per 10,000) to those with natural immunity alone. In other words, vaccinating people who had already had Covid didn’t significantly reduce the risk of hospitalization."

"Similarly, the National Institutes of Health repeatedly has dismissed natural immunity by arguing that its duration is unknown—then failing to conduct studies to answer the question. Because of the NIH’s inaction, my Johns Hopkins colleagues and I conducted the study. We found that among 295 unvaccinated people who previously had Covid, antibodies were present in 99% of them up to nearly two years after infection. We also found that natural immunity developed from prior variants reduced the risk of infection with the Omicron variant."

Classic NIH: Say there isn't enough data when challenged on a policy, then deliberately not study it. They did this for DECADES with cannabis.

https://www.imperial.ac.uk/news/232698/omicron-largely-evade... estimates that prior infection offered 85% protection against Delta but only 19% against Omicron.

Definitely not saying vaccines aren't important - they keep you out of hospital! But they don't prevent infection post Delta.

Look at this chart: https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-s...

If you read to the bottom of the previous study I posted they addressed vaccine effectiveness too based on UK data. They work! Just make sure to get your booster.

In other words, it's 70-80% effective, which is pretty poor performance for a vaccine. So, can we please get an update that encodes the Omicron spike instead of trying to boost antibodies for a virus that's now extinct?

It’s a far cry from the apparently very popular myth that the vaccines no longer work at all.

The original target effectiveness was set low because anything to nudge the R value down was better than nothing.

We now know that we can do much better.

Preferably including Omicron data as well.

A) Once in every.. I dunno, 200 times (0.5%) it kicks you so hard that, without protection you're 100% going to die

B) Once every 10 times (10%) it kicks you so hard you're sent to the hospital

C) Just to spitball, let's say 3 out of 10 times it will kick you hard enough that you're out of commission for a couple days but able to recover without hospitalization

D) 3 out of 10 times it will lightly kick you where you hurt a bit but it's just a minor inconvenience

E) The rest of the time it will let you leave without being kicked.

Ok, so you're strapped into this machine. Now, before I turn it on, I offer you a cup (protection). 70%-80% of the time this cup will offer you complete protection against whatever the machine throws at you. But remember that it's still 100% effective when the machine does nothing, so we only need to look at the 70.5% of the time the machine will actually kick you.

So with 70%-80% protection call it 75% effective, we drop our percentages for each scenario:

A) 0.5% -> 0.125% B) 10% -> 2.5% C) 30% -> 7.5% D) 30% -> 7.5%

This is just doing the simple math. The vaccines drastically lower the chance of severe COVID compared to no vaccine at a higher rate than their overall effectiveness.

So again, you going in there wearing the cup or no? Because that's the choice you have when it comes to getting vaccinated.

There is also the "what will happen to the previous batches" question as no one will be willing to get the old vaccine.

There are also interventions other than vaccines, e.g. early treatment, https://c19early.com

Natural immunity as a personal choice should have been possible. But that has not been an option, for someone who wants to be part of society.

Is that because people who have caught it are more likely to take precautions against catching it again?

Those who were vaccinated but previously uninfected may have had a “it can’t happen to me and if it does, I’m vaccinated” attitude.

I’d expect unvaccinated people to be in the bucket with covid deniers and anti-maskers, which would have the highest base rate of COVID.

Anecdotally, my sister is one of those people who “catches everything” so I can’t say I’m surprised, but clearly there is no such thing as absolute sterilizing immunity (natural or vaccine-induced) for this particular coronavirus.

This article explains why it's so hard to make a vaccine for coronaviruses:

https://www.abc.net.au/news/health/2020-04-17/coronavirus-va...

Of course, this was written a few weeks before "Project Warp Speed" when everyone and their dog announced that had found a vaccine for this brand new coronavirus.

The effect exists but the data shows it does not matter.

You may have been right at a time where almost nobody had a previous infection. However, estimates by reputable sources https://covidestim.org/us show that a large percentage of people have been infected by covid at least once. The data are by state, I see ~75% for MA, 80% for CA and NY, and you can pick your favorite state.

At this point it is more correct to say that the vaccine does not matter, and immunity by prior infection is the dominant effect. Either that, or the Yale school of public health, the Harvard school of public health, and the Stanford Medicine institutes who run the covidestim.org site are full of shit.

Not age adjusting the vaccinated and unvaccinated cohort is disingenuous. Not breaking out ‘unknown’ vaccine status — which only becomes relevant for the stats after death - is disingenuous.

You are reading propaganda, and reading it uncritically.

Similarly, there is a selection problem for the elderly who choose to remain unvaccinated. You're saying that they think vaccines are ineffective -- and this is definitely a cohort of people! But there is a separate cohort of people, who are more likely to be hospitalized, who know they have severe existing health problems.

I got COVID before there were vaccines and I've received all three shots. While all of my friends caught Omicron, I have not - and I'm the only one among them who got sick beforehand. On the other hand, I have an unvaccinated coworker who has now gotten Delta and Omicron. I know that doesn't prove anything, but it also doesn't make these studies I see any more illuminating either.

As an aside, I'm not even sure I want things to go back to "normal" other than lifted travel restrictions and the anger/frustration/callout culture to go away. Restaurants taking over the streets, working from home, less cars, etc have all been a boon for the way I live my life.

No. This is wrong. As the parent noted, the CDC's own data shows that prior infection provides robust protection against severe disease. Both without vaccination:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm#F1_down

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm

As well as a substantial additional benefit after vaccination:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a4.htm

> Previous COVID-19 illness was associated with reduced odds of severe outcomes (aOR = 0.27; 95% CI = 0.09–0.84).

Moreover, the CDC estimates that over 150M people in the US (out of a country of 330M) have had Covid:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

That's 45% of the US population (before Omicron). There's no rational way to characterize this as insignificant.

> Given this data the most effective strategy is to just vaccinate everyone without what is effectively a pointless distinction

The data clearly shows that protection from natural infection is at least as substantial as from vaccination, and that ~half (if not more) of the US population has had it. This fairly obviously impacts the most effective strategy. Mandating vaccines (and now boosters) in young, healthy people who were already at small risk, including those who have already had the virus, is so absurd that I can't even characterize it as science. It is simply punitive behavior.

Most countries recognize prior infection. We're in a small, small club of scientifically illiterate nations here, and it's rather embarrassing.

> It will be once the proportion of unvaccinated people in hospitals starts to resemble the proportion in the general population.

If the total number of hospitalizations is a manageable number, the percentage that are vaccinated is irrelevant. It's a metric of punishment, not a realistic policy goal. I have no idea what the future will bring with regard to the ratio of unvaccinated hospitalizations, but I know that hospitalizations in general will fall as the population achieves broad immunity -- and natural infection certainly counts toward that goal.

The idea that a vaccine is a punishment is disturbing. I'm glad to have been able to get it.

If you feel more comfortable getting an unnecessary vaccination, nobody is stopping you. Other people should not be coerced into doing the same against their will.

College kids are currently being expelled for refusing boosters. Children are being refused classroom education. Prior infection is not taken into account, and risk/benefit is not a factor. There's no other way to frame this than as coercive behavior.

> There's no other way to frame this than as coercive behavior

We coerce people constantly when they have bad behavior that affects society and others. I don’t know why people keep trotting out mandates as having aspects of coercion/authoritarianism is a mic drop moment explaining why they are bad. How is this worse than all the other health based coercion we’ve had?

For the other-than-COVID vaccines that are required for enrollment, there isn't existing protection in the majority of the population. Nobody has natural, effective, protection against measles.

I think the practical problem/reason is that there's infrastructure set up to track and share vaccination/booster status. There's no infrastructure set up to track, or even test, immunity status, which is the real metric of risk. So, for practical reasons, proof of vaccination status will always be favored and, almost certainly, held above the true, yet difficult to measure, immunity status, to drive policies. This is an easy out, that might cause harm, relative to an "ideal" policies that were based on immunity.

Saying it's happened in the past isn't an argument that it should continue in the future. I doubt your swine flu nasal spray had as intense of negative side effects as the COVID second shot and booster tend to in the young and healthy. Now that we're in booster territory and Delta is being phased out the shots are almost certainly more painful than the disease for some portion of the population.

> How is this worse than all the other health based coercion we’ve had?

I can't recall any other health based requirement for attending an event or restaurant. I also don't understand why people continue to harp on how a personal COVID vaccination decision "affects society and others" at this point. The vaccine only marginally prevents infection at this stage, and the primary benefit of reduced severity should stop everyone who's vaccinated from worrying about what others around them may be doing. I get the flu shot so I don't get the flu, and I'm not sitting around telling others who haven't that they're putting me in danger.

What's really happening here is people who have considered themselves progressive and tolerant their entire lives have decided that they want to impose policies that are tyrannical, but they have to desperately backfill this logic to make it feel okay. They aren't willing to let any form of data disrupt this because if they did, they would have to admit to themselves that they had a tyrannical impulse in the first place.

Notice how when he got the swine flu nasal spray he wasn't demanding that everyone else in every public place he went to also get it. Nothing about this makes sense unless you view it as people trying to psychologically justify tyrannical impulses.

Yeah the tropical diseases are an interesting parallel for me too. In a place where malaria or dengue are prevalent I don’t blame others for being vectors of the disease, I assess my own risk and behave accordingly. And the mere fact that they’re spread via mosquitoes instead of air/surfaces doesn’t change the necessity of congregating people to spread. But these diseases are not universally dangerous, so people should not be universally pressured to take any measure to avoid them.

I’m not sure I fully agree with the tyrannical impulse premise, but I’d subscribe more readily to a tribal “badge of honor” premise, which in this (and indeed most cases) happens to be tyrannical. I think generally the masses don’t intend tyranny, rather they virtue signal to coerce and thus become tyrannical as a result.

And you probably don't remember ever being required to show vaccination status to get into a stadium or restaurant in your lifetime because you hadn't previously lived through a pandemic.

Sure, it’s great that we have the vaccines to do so. We should be focusing on making them available to everyone on earth rather than forcing them down the throats of those who don’t want them to get to the fastest “end.”

> And you probably don't remember ever being required to show vaccination status to get into a stadium or restaurant in your lifetime because you hadn't previously lived through a pandemic.

Fair enough. My reply was in response to a status quo argument, but indeed this pandemic hasn’t been just that. In which case I think you have to assess the dangers to those who have been vaccinated, which is not much. Indeed with omicron the risk isn’t very high for a large portion of the population vaccinated or not. And the vaccines are available to anyone who wants to reduce their risk, thus the mandates make little sense.

Are any number of vaccine shots "good enough"? Or, should we be getting one every month to get as much protection as possible?

There's a line to be drawn somewhere, and I think what's argued here is that natural immunity should count for something, instead of being lumped into the same group as those "unvaccinated and no prior infection".

And more risk. Which is greater?

(This makes your case stronger, of course.)

I suggest you look up seroprevalence surveys. The bulk of COVID infections (barring mandatory and regular testing being extant in a given locality) go undetected, due to the mild symptoms in the vast majority of the population. The seroprevalence surveys have shown this since May 2020.

While not directly comparable, an official report from the UK [1, Figure 3] estimated that effectively 100% of blood donors were either vaccinated, previously infected, or both. This was in September. Blood donors are not a representative sample of the population, but it's not hard to believe that by now effectively everybody (in the UK) has some kind of immunity.

[1] https://assets.publishing.service.gov.uk/government/uploads/...

The end result is the same: higher proportion of severe illness among the unvaccinated, which is most easily fixed by vaccinating them.

No, among the unvaccinated and uninfected, which, as the data others have been giving shows, is nowhere near even a majority of the unvaccinated any more, let alone enough of a majority to treat it as if it represented all unvaccinated people. So your claim that the unvaccinated but infected are too few to matter and should not affect vaccine recommendations, let alone vaccine mandates, is egregiously wrong.

You are failing to differentiate between the two subgroups of unvaccinated people, the previously infected/unvaccinated, and the purely unvaccinated. Additionally, you are not doing any further subdivision on these two groups by age. The blanket "one size fits all" strategy you are advocating is assuming that all of these groups are at zero risk for adverse events from the vaccine. Young, healthy males have a statistically zero risk of severe COVID complications, and a statistically small but non-zero risk of myocarditis. The risk of myocarditis from the vaccine falls to practically zero as you progress upwards up the age distribution, which is the exact group of people who have the highest benefit from the vaccine. You are talking about a gradient which impacts both the cost and the benefit, with a diminishing cost and an increasing benefit going up in age. Not taking this into account is so illogical, that in my opinion, people who hold this view are clearly blinded by bias.

If I'm going to get smeared as an "anti-vaxxer", I'm going to go ahead and use a label to describe humans who hold the rigid, data-resistant view that you possess:

Immunity deniers

Now imagine having a healthy 7-year old son, and having an excruciatingly difficult conversation with your spouse about why he shouldn’t get vaccinated. Or having to cut off ties with your mother-in-law, preventing your children from seeing their grandmother, because she thinks you are actively harming your own young children by not getting vaccinated despite having natural immunity.

These people are destroying the very bonds of society.

Here's a new editorial from a prof at Johns Hopkins:

https://www.wsj.com/articles/the-high-cost-of-disparaging-na...

Might be useful in those conversations on previous infection. And I agree regarding the social fabric being destroyed by these bureaucrats. They are going to slowly try to find a way to ease out of this in a manner that minimizes the damage to their reputations. That's what political elites have always done when their narratives crumble after they have dug in. See the utter absence of contrition or self reflection after the Iraq wmd fiasco for an example. Or Vietnam. They don't care how much damage they do in the process.

The rationale for vaccinating kids was to prevent them from spreading it. The vaccine did that effectively before Delta. With omicron, it's worthless for preventing spread. Kids are the one age group at higher risk from flu than covid.

My two kids (8 and 15) aren't vaxxed. They caught omicron, and now they are in the ICU... Oh wait,no they are fine, had almost zero symptoms, and were playing outside the day they tested positive. Which is, statistically, a virtual certainty. They aren't morbidly obese or immunocompromised, so they shrugged it off.

Nobody is dying on a hill. We're just better at statistics and aren't gullible enough to believe these panicked fools.

Put an experimental product from Big Pharma in your kid for no reason. That's your call. But ask yourself why you suddenly trust the FDA, an organization that labeled oxycontin non addictive, approved Vioxx, approved remdesivir for covid despite it being useless, and that's just the past 15 years. Fear is the mind killer indeed.

We have lots of data on both. Said data shows that 7 year olds are much more likely to have serious affects from COVID than from the vaccine. That's not to say serious outcomes from covid are at all likely. Just that the relative risk is lower with the vaccine.

To reiterate, the absolute risk is tiny, so it's really not a big deal. But if you truly understand statistics, then you will also see that everyone will be exposed to COVID and you are better off with the vaccine than without no matter the age cohort.

And the vaccine reduces transmission (less so than we had hoped, but a reduction, nonetheless), no one ever said it would 100% stop transmission.

I suppose taking an experimental vaccine seems unnecessary if you consider a wild virus to be natural, maybe even artisinal, and you ignore the fact that while the vaccine is quality controlled and the same as what billions of people have now received, and the virus is constantly mutating, well then I guess the virus sounds safer.

Let's not do this. When this mess is over we'll all want to work and break bread together again, and that's much more important than whatever any of us happened to believe or say in the fog of war.

I'm just at a breaking point now, after 2 years of having the most anxiety and risk-averse among us gleefully demonize, censor, and shame those of us with heterodox opinions. When you add to that the enthusiastic endorsement of forcing people like me to get a shot despite already having immunity solely to appease their paranoia, the bitterness has put me over the edge. Considering that it's the same crowd who has spent decades chanting "my body, my choice" and insisting that the government "never come between a person and their doctor", the hypocrisy adds to the outrage. I've been called a conspiracy theorist for pointing out the highly improbable chain of coincidences that made me doubt the narrative around the virus' origins, then had to watch as they all change their minds without an ounce of self-reflection or a single apology. On top of this, the national media has been completely, un-flinchingly on board with all of it, which is a distinguishing characteristic from the harassment and government intrusion upon LGBT folks championed by the political far right until the 2010s. They gave these anxiety driven tyrants full moral authority to violate my rights. I hope you can understand my bitterness.

The last thing I want to do is dehumanize others. For the crime of not wanting to get NEEDLESSLY injected with a rushed, experimental genetic technology whose trials were entirely run by pharmaceutical companies who have a long history of overstating benefits and hiding risks for their products, I've been ostracized, condemned, and coerced by the same people who insist on not eating GMO produce.

Just finished a few trips to Latin America. Kissed the ground when I got back here to Florida, where kids goto school, don't wear masks, and don't have to be vaccinated. Here, we respect individual liberties. We respect the right to go out and earn a living and put food on the table and if we lock everything down, at least uncle sam sends out checks to hold us over for a while.

People are starving and dying in places like Venezuela, Cuba, and other countries in LA. Small business has been devastated by the un-ending lock downs.

Unemployment is rampant. People cannot put food on the table. Its crazy. The lack of empathy that local governments have in LA for a persons right to earn a living is unconscionable. Maybe its because the virus has hit hard the wealthy elite ruling class since they tend to be rich, fat, white, and old. I dunno. But they are all wanting to break in to America and would if they could.

Dividing groups of people up without going deep enough into categorization creates contradictory conclusions.

https://en.m.wikipedia.org/wiki/Simpson%27s_paradox

Roughly speaking this is the difference between your risk of driving with no seat belt and no air bags (unvaccinated), no seat belt and no air bags but with a bicycle helmet (prior infection), seatbelt (vaccinated), and seatbelt and airbags (vaccinated and boosted).

It's absolutely not the same delta there. Not even close. The relative risk and absolute risk are completely different in magnitude, and unvaccinated cohorts are concentrated in younger, healthier populations with a minimal level of risk.

The most distinguishing characteristic of COVID is it's age-risk gradient. There is LITERALLY a 1000X delta in IFR between the youngest and oldest demographics. The fact that the vaccine policies don't take this into account has resulted in the greatest erosion in trust of public health authorities in history. Your analogy doesn't even take this into account, which further demonstrates the shallow aspect of it.

This is the point that I can’t seem to express eloquently enough to overcome the nonstop torrent of poorly calibrated advice from the authorities. I don’t have time to pore over the data, but last time I checked the annualized death totals for children (17 and under) were approximately equal to the 2019 deaths from influenza for that age group. When the marginal benefit of vaccination gets that low, you do have to start asking whether the side effects are worth it—trading a 0.01% risk of myocarditis for a 2% risk of death is clearly worth it, but can you say the same when the risk of death is on the same order of magnitude as the side effects?

(edit: numbers are hand-wavy, not trying to make an authoritative point)

Myocarditis in particular is 8x more likely to occur with COVID vs the vaccine.

So, while an argument could be made that the risk of adverse reaction or death from COVID is too small to matter one way or the other in young people, it is not correct to say that the vaccine is more risky.

There is one exception I have seen in some data that myocarditis risk was roughly equal or slightly higher for young men of a specific age group who received the second dose of the moderna vaccine. But one could of course avoid that particular vaccine and still be better of vaccinated because that of course is only for myocarditis and the absolute risk is very tiny.

https://ravarora.substack.com/p/the-truth-about-vaccine-indu...

Also, if his data is to be believed, then the protection offered by having had COVID in the past has been far overstated.

The WHO definition of a covid death means that they can only be counted as covid deaths if there's a clinical link between cause of death and covid.

Ergo, cancer and car accident victims with covid wouldn't be counted.

I suppose it depends on how your country defines it and if it follows WHO guidelines

There are popular theories about thousands of such miscounts happening to get more money from the government, but it makes no sense for them to be more than a small minority of mistakes.

Show me profit motive, and I'll show you an audit worth doing. If you've not parsed and checked that data, I'd recommend not passing judgement on it. The market can stay irrational longer than you can remain solvent.

https://www.nbcbayarea.com/news/local/santa-clara-countys-co...

Is that vaccinated? Fully-vaccinated? Or "up to date" (i.e., whatever round of boosters are being pushed)?

The point is, the narrative has pushed the importance of "the science". Yet so much is actually not consistent with science / scientific method at all. Ffs, they can't even get the definitions and language right.

These aren't occasional lapses. They're non-stop. I hear what you're saying. However, it still doesn't address the negligence. After two yrs it's not incompotence, is it? Still?

". Given this data the most effective strategy is to just vaccinate everyone without what is effectively a pointless distinction."

So...we don't need science. Just everyone bend over and do what the authorities say, when they say, and how they say it? That's it? Kids? New borns? And everyone else on the low side of risk? Just because?

You can't have your science and dismiss it too.

In London this number has been as high as 40%, so it's highly relevant to present accurate numbers.

But the only place science has won is in producing a good vaccine, the rest has been a shit show of crazy decisions and a hunt for those who didn't want to get vaccinated right away.

I sincerely hope sanity returns.

Multiply by tens of thousands, and you can project the effects on hospitalization stats, which aren't necessarily tied to the degree of illness.

It seems like you don't have any actual knowledge of how healthcare works in the real world and are just making things up.

Early data from France suggests omicron patients leave hospital far more quickly - including 43 per cent in less than a day

https://www.telegraph.co.uk/global-health/science-and-diseas...

(at Kaiser Permanente Southern California) Among 154 Omicron variant-infected patients who completed hospitalization by January 1, 2022, 129 (83.8%) were discharged in ≤2 days

https://www.medrxiv.org/content/10.1101/2022.01.11.22269045v...

27% of hospitalizations are not vaccinated.

~50% of ICU cases are not vaccinated.

The conclusion is that people are bad at understanding statistics.

8% are not vaccinated at all.

27% are not vaccinated, partially vaccinated or unknown status

50% of the ICU cases are not vaccinated, partially vaccinated or unknown status.

It is good to understand that 1/2 of the people who come into the ICU are reported as unknown vaccine status by default because they can't speak or fill out paperwork.

I use to produce these reports for this government and the ones before for years . Presenting facts a certain way is what happens and reports get rescoped when the data doesn't agree with the intended outcome.

> I use to produce these reports for this government and the ones before for years . Presenting facts a certain way is what happens and reports get rescoped when the data doesn't agree with the intended outcome.

Are you saying the numbers presented in this report are not accurate or were fudged in some way?

I could go on about hospital visits for non covid reasons being lumped with covid hospital visits.

I have issues with how data is collected in the field. I have issues with the reclassifications that go back and claim covid killed this patients after dying of other reasons.

I have issues with what they decide to collect and what information they ignore.

Probably the most misleading stat of them all.

If somebody comes in the ICU without non-COVID symptoms, they aren't in the statistic, in other words you need to make the probability of "unknown status" conditional on being in the ICU for COVID.

What is the age breakdown of these excess deaths? If the distribution doesn't mirror the age distribution of known COVID deaths, that's an immediate indicator that it's factoring in multiple sources.

Drug overdoses, attempted suicides and actual suicides are way up, for example. Drug abuse is way up. Child abuse is way up.

I'm not saying you are wrong. I'm simply saying that you can't know that you are right without a careful analysis of the data. It should be noted that the "excess deaths are way up" is also used as a tool of people claiming that the vaccines are killing people as well.

Again, I want to emphasize, I don't know the detailed data behind the excess deaths. COVID is certainly one factor, but what percentage does it constitute? I'm not claiming I know, but you are. That's the difference.

You are also ignoring the studies out of Israel (sample size of 2.5 million people), Qatar (sample size of 400K people), the recent CDC study in other replies to your comment, etc. It's a long list of studies that show that prior infection is a superior, more durable form of immunity to Delta than vaccine-only populations.

Additionally, it's rather absurd to use hospitalizations as a metric for the general population. I'm sure you are extremely aware that the bulk of unvaccinated people getting hospitalized are not young or healthy. "Some unvaccinated people" is also a statement ignoring the shocking prevalence of prior infection in seroprevalence studies, which isn't really shocking when considering a respiratory virus that has an R0 that has been at minimum 3 in the beginning with the original variant, and is now 6-7 with omicron.

The data has changed, but many people's opinions have remained fixed. I don't understand what motivates this, but it's become tiresome as it continues to drive policies that are intuitively foolish and violate centuries of immunological knowledge.

I find it a great resource to cross-check the misinformation of the mainstream media. For example, I challenge anybody to look at the 0-14 and 14-44 graphs and tell me when covid actually occurred.

Note that excess is not defined as a deviation from a typical year, but as a deviation from a typical year when no diseases are circulating. The goal of the euromomo website is to detect things like flu outbreaks, so the number of excess deaths is usually greater than 0, capturing the flu, heat waves, and presumably other disasters.

> Note that excess is not defined as a deviation from a typical year, but as a deviation from a typical year when no diseases are circulating.

Data is deseasonalized, which does not mean what you wrote.

You are correct that I oversimplified a complex situation. https://euromomo.eu/how-it-works/methods/ describes their method, especially section "Hypothesis".

Their model includes a sinusoidal seasonal component, as you noted. However, what I said is also true. From the Hypothesis section, third bullet:

"Parts of Spring and Autumn are less likely to be influenced by additional processes leading to excess deaths and the main pattern of mortality can therefore be modelling using only those periods, resulting in a baseline being the number of deaths expected when no particular process increases mortality."

As is clear from the bullet that precedes the text that I quoted, "processes leading to excess deaths" means winter infections and summer heat waves. So my description, while incomplete, is hopefully not too misleading. For completeness, I should mention that they also adjust for population growth. (You can't just do 2020-avg(2015-2019) because the total population is different.)

Stepping back from the details for a minute: this is a 15-year long joint effort of public health authorities in Europe, with the explicit goal "to design a routine public health mortality monitoring system aimed at detecting and measuring, on a real-time basis, excess number of deaths related to influenza and other possible public health threats across participating European Countries." In terms of data analysis, their model is very simple, comprising a constant, a linear trend term for population growth, and a sine-wave term for non-flu seasonality. Do you really think that they would be so incompetent as to use a model that explicitly removes the flu, which is the very effect that they are trying to capture? Give them some credit, they know what they are doing.

Just to be clear, you're saying that the reason we've seen hundreds of thousands of excess deaths last year is because of drugs, suicides, and child abuse.

If people want to explore some "crude" (CDC's word) data by age group. Cherry-picking some data, there were 10-15 times more drug overdoses then covid deaths in 2020 (Q2-3) for 25-34. Similar ratios for 15-24. And I'm sure it'll be the exact opposite for higher age groups or if you focused on people with comorbidities. Yet these demographics are grouped together without any nuance when it comes to mandates. Note this is pre-vaccine and pre-delta so not really representative of current state of things.

In other words, excess death counts would account for overdose deaths because they are expected. They wouldn't be considered "excess" deaths.

The numbers I have seen for excess deaths pretty closely match COVID death numbers as counted from death certificates. So you have two unconnected sources matching up pretty closely. I'd say there is a good chance the near million COVID deaths number we are looking at is pretty close.

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.

You can't compare studies looking at the population average with someone's specific social circle. Young people have a near-zero chance of getting severe disease anyway.

"substantial protection against severe disease with omicron" is irrelevant when the chance of severe disease is so low.

Do you make no allocation in your mind for the potential that the government is corrupted and the motivations have nothing really to do with public health?

I mean, governments want to ensure their income stream (tax payers) are alive to pay taxes, but that's hardly "corrupt" and is still to do, indirectly, with public health

Yes, it's quite a possibility. Please read into the growing concentration of world power via corporations and un-elected organization like the WEF and WHO. Further, please read into puplic-private partnerships.

Our world is a global one these days and nearly every government is corrupted by a form of corporatism.

I think it's a stretch to suggest all the countries are in on this together as some sort of 'control' method.

Public/Private partnerships are a modern necessity in countries that choose to keep their citizens happy through low-tax policies. There's room for corruption there sure, but that doesn't lend itself to all countries agreeing to go with this wild covid idea as an exercise in exerting greater control over their populaces

So communist Cuba is corrupted by a form of corporatism? Big pharma got to the ayatollahs in Iran? Maduro in Venezuela is goose stepping to the beat of the pharmaceutical conspiracy?

https://www.who.int/news-room/feature-stories/detail/cuba-he...

> Authorities of the Ministry of Public Health (MINSAP) and the Biotechnological and Pharmaceutical Industries of Cuba (BioCubaFarma) met with representatives of European embassies, Cuban-based partner agencies and PAHO/WHO country office to continue promoting collaboration in the health sector.

https://www.farsnews.ir/en/news/13990121000392/Ayallah-Khame...

> The World Health Organization has considered priorities in combating coronavirus and Islamic Republic of Iran obeys and follows up priorities as defined by WHO.

Admittedly Iran banned US made vaccines, but then just put out their own in cooperation with the WHO, COVAX and Gavi.

https://www.hrw.org/news/2021/01/12/iran-khameneis-reckless-...

> Iran has said that the country is participating in the COVAX Facility, which is an effort by the World Health Organization, Gavi (the Vaccine Alliance), and the Coalition for Epidemic Preparedness Innovations (CEPI) to help low- and middle-income countries get access to vaccines. Iran started the first phase of the human trial for a domestically produced vaccine in December 2020.

See https://www.weforum.org/agenda/2020/04/who-funds-world-healt... for who the WHO is funded by. At the point when the US pulled funding, the largest donor was the Bill and Melinda Gates Foundation and the third was Gavi. Bill Gates owns a lot of pharma stock. The foundation is a way to garner influence in a tax free and humanitarian looking way.

Who funds Gavi?

It's a rabbit hole, but the world is complicated and conflicts of interest (corruption) abound. Please do follow a few of these research threads and try to be open minded to those suspicious of wealthy people claiming to operate in our interest.

You're not even proposing anything specific. This is Glenn Beck level 'just asking questions'.

The government, for the most part, is not an evil cabal of deep state cultists (in most countries that describe themselves as liberal today). People like you or me can join a party, and then get elected within a year or two.

What I absolutely do believe is that people elected, through what is essentially a harmless popularity contest in peace time, are the worst type of people you want to have taking decisions in a crisis. People worried about their next re-election are _not_ going to make the right decisions, apart from the fact that in peace time the electorate optimizes for populism and extremism, and the candidates are sometimes more like actors than leaders. In short: they are incompetent, heavy handed and not even remotely equipped to deal withe massive leverage attached to the levers they control.

A small town mayor has none of the power a member of congress would.

In democracy the larger the seat, the larger the infrastructure required to get there.

The funding of this infrastructure brings the necessity of corruption.

Assuming the mayor is in an executive mayor system (not a council-manager) system, they often have far more practical power than a member of Congress over any issue, but their power is over smaller issues. Even in a council-manager system, the mayor (who is a primus inter pares council member) is more likely than member of Congress to have decisive power over any issue within their ambit.

(Also, being a small town mayor, or similar local officer, is not an uncommon way to build the infrastructure for becoming, say a state legislator. And that's a way to build the infrastructure for Congress, and that for Senate/Governorship, and that for the Presidency.)

Also what's the end game here. Why would a corrupt government gain by mandating masks and encouraging vaccination. Even the potential motive is lacking.

Can you explain what risks you're referring to here?

That said, the risk of dying unvaccinated from COVID is much greater than the risks of vaccine. And it’s unclear if side effects from the shot are correlated to worse outcomes from COVID (e.g. It’s unknown if these people who were paralyzed definitely would have died when they contracted covid, so paralysis is a potentially better outcome).

[1] https://www.wpxi.com/news/top-stories/every-day-that-i-work-...

[2] https://www.wkrn.com/news/nashville-woman-partially-paralyze...

The math may still work out for your preferred choice, but i wanted to point out that it’s fallacious to dismiss the (rare) risks from reinfection, especially when focusing on the (rare) risks from the vaccine.

You may have said this and I just missed it, but both those risks are small and honestly boils down to a preference IMO. I may just have missed in your comment where you made the right comparison, in which case I’m being a bit pedantic without cause and I apologize.

While the vaccine risks are very small, they're also highest for those who have had the actual infection. There will be little bits of virus lingering in my body for a long time. If I get that vaccine, my immune system is going to go ape attacking them, and maybe do some collateral damage in the process.

To be clear, I still think the risk is small, but so is is the benefit. I don't think it's worth it.

Thanks for writing a detailed comment of your thinking, I think we both are evaluating it the same way, I just wasn't very clear with my initial wording.

The evidence disagrees with your opinion.

right now we know that even the booster provides little ability to stop you from getting omicron. likely by the next mandated booster the variant of the time will also easily surpass the booster.

This is true, but the data is showing that being boosted means that catching Omicron when boosted means you are much, much more likely to have a very minor illness. Refusing future boosters comes at the risk of your own health, as well as the health of the people around you.

And some scientists think that repeated boosters will backfire and lead to waning immunity or at least immunity better centered around the exact strain the vaccine is made (so could be mitigated by different boosters). Plus downsides of repeatedly have to make time to get boosters, taking doses from people who haven't even had the opportunity to get a single dose. Differences in risk between a healthy under 30 and an unhealthy over 65.

It's possible that your statement is correct for some demographics and incorrect for others. But that nuance is not in the current discussion or the current mandates; and that nuance could save lives in less-developed countries.

* citation needed *

> or at least immunity better centered around the exact strain the vaccine is made

Given how mRNA vaccines work, there's nothing stopping the producers from putting as many different "instructions" as they wish in a single dose. But anyways, again * citation needed *

> Plus downsides of repeatedly have to make time to get boosters

Boo frickin' hoo. Even if we have to get quarterly boosters, that's four times a year. You're on Hacker News, you obviously have spare time on your hands.

> taking doses from people who haven't even had the opportunity to get a single dose

At this point, in the developed world, there's no one left who hasn't had "the opportunity to get a single dose." In fact, we have vaccines going bad due to anti-vaxers refusing to get vaccinated. And realize that a vial of vaccine sitting in the WalMart or CVS down the street isn't going to magically get repositioned to Africa due to Americans refusing it.

> Differences in risk between a healthy under 30 and an unhealthy over 65.

You know what drastically lowers the risks of COVID infection, both in terms of getting infected in the first place and the chance of bad outcomes if you do contract it? GETTING VACCINATED.

> throw_nbvc1234 1 hour ago | parent | context | flag | on: Pfizer board member suggests end to mask, vaccine ...

> Refusing future boosters comes at the risk of your own health, as well as the health of the people around you. And some scientists think that repeated boosters will backfire and lead to waning immunity or at least immunity better centered around the exact strain the vaccine is made (so could be mitigated by different boosters). Plus downsides of repeatedly have to make time to get boosters, taking doses from people who haven't even had the opportunity to get a single dose. Differences in risk between a healthy under 30 and an unhealthy over 65.

It's possible that your statement is correct for some demographics and incorrect for others. But that nuance is not in the current discussion or the current mandates; and that nuance could save lives in less-developed countries.

Based on your comment history, you're American, so you're not helping anyone in "less-developed" countries by refusing a vaccine. You're just exposing yourself and your community to a higher level of risk.

'the science' says you are wrong. the vaccines do not prevent spread. that is very very very clear in the data now, so stop spreading that nonsense

that assumption relied on at least 3 things being true: #1 ) having lower symptoms from the vaccine would not encourage those shedding the virus but not being observably sick to go out and spread the disease (*hint this is probably a pretty bad assumption) #2 ) the vaccine would reduce viral load #3 ) a reduction of viral load would prevent you from spreading it to others

It turns out the vaccine does not lower viral load. and even though this has been shown to be medically true, you can see that in places like Isreal and Germany where the virus spreads pretty easily. hell, even in the US, you dont get nearly 1m cases a day without vaccinated people spreading it.

I have MS, and I'm not sure that frequently boosting my immune system when I have an autoimmune disease is the best idea. In addition, I'm in a single-income WFH household and we easily isolated when we got omicron. My sister and I literally caught Omicron together and just quarantined for 14 days. We had our mother drop off stuff on the doorstep so we didn't have to go out/expose anyone. It was boring, but I'm damn sure we didn't infect anyone.

Plus to be completely blunt, "not likely to trigger an MS relapse or have any impact on long-term disease progression" isn't language to inspire confidence. To be fair, I think we understand the vaccines pretty damn well, it's MS that I think we might not understand well enough here.

Also, did you end up in the hospital? Did you die?

Because by being vaxxed and boosted you greatly increased your chances of having the chance to post ill-informed comments on Hacker News post-recovery.

No I was not unlucky. get your head out of the sand, omicron breaks through the vaccine easily.

<pajama caste playbook> Because by being vaxxed and boosted you greatly increased your chances of having the chance to post ill-informed comments on Hacker News post-recovery.

hinting at censorship already are you, boy, you just follow the playbook dont you?

<pajama caste playbook> we need to mandate vaccinations and masks to stop the spread of covid

<data> that's not working

<understanding of how the vaccines work> this is not how the vaccines work

<non pajama caste> you are violating my cival rights

<pajama caste playbook> well it prevents severe disease. you need to be censored for misinformation. you need to be prevented from going outside so I can feel safe because vaccination prevents the spread of covid.

<pajama caste playbook> you hate science, science works by censoring those who disagree with the proposed opinion. I worship science so I am the superior caste. I am science, I am good

Listen, if you're hell bent on willfully increasing your risk of death/hospitalization, that's on you. The simple fact is being vaccinated drastically reduces the risk of that.

Does the current vaccine work as well against Omicron as it did against prior variants? No. But does it work better than literally doing nothing? Yes.

And yes, you were unlucky. The vaccines are still 70+% effective at preventing breakthrough infections based on the data we currently have.

The vaccine is not ineffective. And it reduces the severity of the infection even in the case of a breakthrough.

And as far as OP is concerned, there is a high likelihood that their boosted status did protect them from infection.

Every time I have to show my vaccination card to be in public.

> Listen, if you're hell bent on willfully increasing your risk of death/hospitalization, that's on you.

I am vaccinated and boosted. I MAY not want to get boosted AGAIN because it was extremely painful and made me sick for more than a day. I MAY not want to go through that again while taking into account what is happening in the FUTURE with the variants. but I may not have the right to make my own decision due to mandate fanatics

> And yes, you were unlucky. The vaccines are still 70+% effective at preventing breakthrough infections based on the data we currently have.

do you even know what that means? what does it mean to be '70% effective'? How long does this effectiveness last? effective against what (covid19, delta, omicron)? Are you talking about vaccinated 1, 2, or booster? I know personally 20 people who have gotten it. 15 vaccinated 5 Unvaccinated. We have been having more than 600k cases per day since the beginning of January. I'm guessing there is A LOT of break through cases in that.

> And as far as OP is concerned, there is a high likelihood that their boosted status did protect them from infection.

If they were sitting across from me when I was feverish from omi, they would have gotten it. keep in mind, I was infected by someone who was vaccinated.

'the science' says you are wrong. the vaccines do not prevent spread. that is very very very clear in the data now, so stop spreading that nonsense

You thought the vaccines were risk free?

It's the same argument that people use to justify not wearing a seat belt. "There's types of wrecks where being unbelted is actually safer!" Well, sure, but those are an extremely tiny portion of wrecks, and you're vastly safer in the vast, vast majority of wrecks wearing a seat belt.

Get the damned vaccine. If you experience side effects, then that sucks, you lost the lottery. The CDC reports:

* Anaphylaxis happens to 5 people per million vaccinated. (0.0005% rate)

* Thrombosis with TTS after J&J vaccine. 57 confirmed in more than 18 million doses (0.0003% rate)

* GBS after J&J vaccine. 302 cases in more than 18 million doses (0.0017% rate)

* Myocarditis. 1233 reports in total.

* Death. 11,657 deaths among vaccinated. Note that this is death for any reason. A vaccinated person mauled to death by a bear is counted here. (0.0022% rate)

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/ad...

* edit for formatting

"Males between 16 and 29 years of age have an increased risk of developing heart problems after receiving a second dose of coronavirus vaccines made by Pfizer-BioNtech or Moderna, according to a large new analysis published on Wednesday in the New England Journal of Medicine.

The study, conducted in Israel, estimated that nearly 11 of every 100,000 males in that age group developed myocarditis, inflammation of the heart, a few days after having been fully vaccinated."

Why don't we just quote the part you conveniently left out: "For every million vaccinated boys ages 12 to 17, the shots might cause a maximum of 70 myocarditis cases, but would prevent 5,700 infections, 215 hospitalizations and two deaths, the agency has estimated... One of the new studies looked at data from 2.5 million vaccinated members of Israel’s largest health care network who were aged 16 years or above. The researchers identified 54 cases of myocarditis, and deemed 41 of them to be mild."

So 54 cases out of 2.5 million people vaccinated. And it likely prevented over 10,000 infections, 500 hospitalizations, and 5 deaths. It really, really sucks for those folks. But the benefits VASTLY (orders of magnitude) outweigh the risks.

The risk isn't "underappreciated." The risk is statistically insignificant compared to the protection offered by vaccination.

It's gamble, the next booster might be the one that gets you. And you'll need a booster because it only lasts a few months anyhow.

You use your dead relative as proof for your case in the same breath as calling them a dumbass.

This goes to prove a point. Does it matter if everyone is vaccinated & "safe", at the expense of our dignity and respect as a species?

I know name calling is pretty low, but I stand by it. The data is so good right now, there are so many people who have been vaccinated, so many who've had covid with and without being vaccinated, that yes, you're a dumbass if you think it's smart not to get the vaccine. You've listened to the wrong information and built a bad argument in your mind.

My family member who died was a lovely person, but always bad at critical thinking and always fell for conspiracy theories. Mostly it was harmless. Sometimes it just cost him a lot of money. This time it cost him his life.

Because the booster increases future immunity and decreases the chance that you'll pass future infection to others.

> It's not likely to increase my immunity

Yes it is. I don't know why people are so certain it won't.

https://www.latimes.com/science/story/2021-11-27/protection-... for instance.

I don't think it makes sense to extrapolate this to a hypothetical new shot which is developed for the new virus.

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.

https://www.forbes.com/sites/joewalsh/2022/01/19/cdc-prior-c...

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...

If you are right, most of them have natural immunity and the data proves that this is already better than the vaccine, so what's the point? They are already doing ok, and vaccination would then move them to the vaccinated column and count their immunity as a success for the vaccine, which is unscientific and dishonest.

Many places around the world have vaccine passes that don't care about natural immunity, which is incredibly unscientific and dishonest. If the case rate is higher among the vaccinated, you're statistically less protected at a venue that checks the vaccine pass. It's counterproductive and ought to be abolished immediately.

Vaccine mandates that ignore natural immunity are equally wrong. Many hospitals in the US fired un-vaccinated healthcare personnel without regarding natural immunity, which led to staff shortages, which combined with this Omicron surge means hospitals are so desperate for staff, that many are allowing people to work with an active corona infection, as long as they are vaccinated. We're preferring actually infected people over un-infected, but un-vaccinated people. In a healthcare setting.

And the people responsible for this is claiming to "follow science".

It's absurd.

The only measurement that should matter is your immunity level, regardless of how you acquired it.

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.

And there are zero mandatory vaccines that require 6-month boosters for life.

And zero mandatory vaccines that have efficacy rates under 90+% (probably more like 99%).

I think it's ok to acknowledge we're in totally novel territory with covid.

A woman has a right to say my body my choice. You think removing that choice is without controversy?

Choosing to terminate a pregnancy is not comparable to choosing to spread a highly contagious disease.

Let's say America's birthrate is too low because of the vaccine, the government could use that reasoning to suspend the right to choose.

Adverse reactions to vaccinations exist. Some are severe / fatal.

Ignoring this feeds into vaccine skepticism.

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:

   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.

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.

The best protection based on my knowledge of biochemistry would be natural immunity to the current variant in circulation.

The clear public health trend seems to be that we're going to see 2-3 revs of the vaccine booster per year, not that we're going to depend on natural immunity. I think it is almost certain that most COVID deaths were front-loaded and this will look almost exactly like flu vaccines in 3 years.

I also think you've set up a straw man to knockdown when you equate being skeptical to "question[ing] the medical establishment without data". There's no shortage of data out there on and around this topic. You can search on PubMed and literally read for weeks.

As to searching on pubmed and reading for weeks: that's the problem! The vast majority of people are not qualified to read the scientific literature. You need extensive training to learn how to read literature and evaluate it properly. This is especially true for medical/biology research. Learning to be proficient in that world (medical biology/public health literature) is the price of entry for being effective at changing policies. The Skeptics don't always win.

Agree to disagree but I’m all for people reading and researching on their own. Nobody understands the literature the first go, that happens with time.

I suppose it's a loaded term has a wide range of connotations, perhaps the point about not giving more fuel to "anti-science" groups like flat-earthers and hard line antivaxxers is justified.

But then I couldn't shake the feeling that the criticism of "bad science" is justified -- what you described is basically scientists making political and policy decisions, and dispensing not-exactly-true statements to the public. That may not be "bad science" for the reason that it's not science at all -- the scientist is tasked with being a politician, and we all know what politicians do.

The problem is that to outsiders (like me), there's really no way we can tell which hat the "Scientist" is wearing. I personally think that scientists trying to pretend to be politicians is going to backfire badly in the long run, no amount of policing against non-scientists bad mouthing "science" is going to fix that.

The fundamental problem is, without a full-blown censorship system to silence skeptics (whether justified or not), there's really no a good way to prop up the authority of the scientific establishment unless they stop telling white lies and establish authority based on a track record of speaking objective truths.

Adding on, immunity declines over time, so to maintain it would either mean reinfection or booster…

https://peterattiamd.com/covid-part2/

It was worth reading.

[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...

It's so ridiculous now they're requiring vaccination for the vaccinated too.

It is things with not wide but tall PDFs that cause problems with hospital capacity because it generally takes a fairly long time to increase hospital capacity.

Things with very wide but not tall PDFs are much easier to deal with because you've got years to build up capacity for them and that increased capacity will be needed for decades. The latter is important because it means a young person can look at that increased long term need and choose a career in healthcare knowing that the demand will still be there 10-14 years later when they've finished school and residency and will still be their long enough to see them through their entire career.

Second, it does prove my point in that the poster referred to the "unvaccinated" as a single group, a position that I'm suggesting results in a very inaccurate set of conclusions (which other responders have commented on) because of skewed cohorts.

Third, I most definitely do NOT have it all figured out - I'm as confused as anybody else on most of this stuff, which is why my post was on a single focused point, and not on issues where I have an opinion, but much less research and data supporting my position.

Lastly, I've read all the replies and thought it was good discussion. I didn't see anything to suggest I hadn't thought it through or disprove my position, just disagreements on how useful it would or wouldn't be, which is fair.

And to make it concrete: where I live we're into emergency (as in, stretching the system past its limits) ICU capacity and elective procedures (which, please note, does not mean optional) have been cancelled or delayed en masse for a couple months now as we've been going through our 4th and 5th waves.

People are absolutely regularly having diminished quality of health care due to unvaccinated people catching, as well as spreading, covid.

Severe outcomes stretch the system more, and unvaccinated people have more severe outcomes.

At any rate, if those nurses weren't vaccinated it's likely more than 30% would be out and a significant portion of them would be dead, so if you want to go down the "vaccines make people sick/more likely to be sick" path then you've just fallen off the rails. The path you have in mind would be a mass death event our medical systems are completely unequipped to handle.

https://www.latimes.com/california/story/2022-01-20/hospital...

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.

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.

Which of these two people are more likely to spread COVID:

1. An unvaccinated person who rarely leaves their house and avoids contact with people as much as possible.

2. A vaccinated individual with an asymptomatic infection who regularly engages in social activity, confident that their triple-boosted immunity will protect them from serious illness.

So yes, the choices of others have an impact, but I don't think it's clear that getting a vaccine is the thing that universally improves the outcome for others. It's individual behaviors more than vaccination status that impact the health of others. The choice to get vaccinated (or not) has little impact on one's chance of shedding the virus. But the change in behavior thanks to vaccine-induced confidence leading to more risky behavior could actually have a negative impact on the health of others.

> Vaccination does not prevent one from being contagious.

I never said it did, that's not even a counterpoint. Seat belts do not prevent car accident injuries, helmets do not prevent concussions. But they all are effective in reducing the probability.

> On the contrary,

Note the common form of the straw man.

> Vaccination could lead to more risky behavior.

"could", an imagining of some sort of scenario that works for whatever reality you're trying to believe in

> Which of these two people are more likely to spread COVID:

Apparently you think those two options are exhaustive?? Eliding right past the public behavior of the non-immunocompromised unvaccinated? Ignoring the point that if more unvaccinated people were vaccinated and boosted, it would be less likely that vaccinated people engaged in social activity would spread COVID? So, no thank you, I will not ignore a reality that hit me viscerally in favor of your theories of what "could" be true.

Intramuscular/serum vaccines cannot stop respiratory infections, by definition. They are non-sterilizing. Only a nasal/mucosal vaccine or nasal infection can provide sterilizing immunity against a respiratory virus.

This is the technological limits of what vaccines are capable of. Vaccination limits the damage, ensuring a much lower likelihood of catching a 1 to 3 day cold affecting only my upper respiratory tracts rather than risking the lungs and the rest of my body on a potentially multi-week infection.

The longer the infection, the more likely pneumonia or another co-infection will injure or kill you.

https://www.cdc.gov/flu/prevent/flushot.htm

So does the Mayo Clinic:

https://www.cdc.gov/flu/prevent/flushot.htm

I won't go on, but by definition, a medicine that you take that's intended to build up your immune response to a disease is a vaccine. I saw someone upstream write "Intramuscular/serum vaccines cannot stop respiratory infections, by definition," and as far as I can tell this is just point-blank wrong. Whooping Cough -- pertussis -- is a respiratory bacterial infection we've been vaccinating against with intramuscular shots since the 1940s.

Does measles count as a respiratory infection? It causes coughing, is airborne, and infection happens via nasal passages. The intramuscular measles vaccine seems to work pretty well.

Is it super important that they are technically wrong on something, anyway? Like, do you think Fauci is going to be cancelled because he said something wrong? I doubt that's going to occur based on his prior messaging.

"If you're vaccinated, you won't get COVID" - Joe Biden

From the beginning, there has not been a COVID-19 vaccine that purported to be 100% effective. There are vanishingly few vaccines that provide 100% immunity, if for no other reason than the immune system is not perfect.

In human history, we have only completely removed 1 virus from humanity: smallpox. That is literally the only 100% effective vaccine ever produced. And even then, it is only 100% effective after the fact.

The mRNA vaccines give a broader immunization that covers more. That's not even up for debate, you're only pretending it is.

I hope your comment is sarcasm.

Either way I find it weird that the study clearly shows vaccination + infection provides the best protection yet people are using this to argue that they don't need a vaccination at all.

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.

I came in with absolutely no wait..ambulance directly to a trauma bay, no waiting, no clothing, no nothing.

After about six hours they figure out I was not going to die and was relatively okay. Okay here means two broken legs not “walking around”. Half of the patients at this hospital had covid and I have a five month old at home who isn’t vaccinated (obviously).

Once I got admitted to the trauma floor for a couples days it was like I didn’t exist. The staff seemed totally overwhelmed and it took hours to get some simple things like water. Without visitors, a bag of belongings got delivered by being isolated in a chair well out of my limited reach. Took me eight hours to get my laptop from that bag. I was okay with that because I wanted to interact with as few potential covid vectors as possible but wow.

I think, from my experience there are a couple of things happening:

1) staff are overwhelmed to day with the ratio of patients to staff. I can’t comment why but the nurses I saw weren’t sitting they were constantly moving.

2) staff are demoralized and frustrated. You could hear it in their voices and tone and body language. They were trying but grumpy.

3) shit rolls down hill. Drs. (Save one angel who talked with me for 30 minutes about life) where in and out for brief profunctory conversations that had no communicative value about what was

They need more nurses. And like everywhere else it seems no one is willing to pay them more or treat them better. We can pay execs millions with no qualms and no evidence it works. But as a patient having the worst day of my fucking life, I interact with front line staff and they are out there getting run into the ground and being treated like shit for it.

I’m so sorry for your wife, I was so lucky I had a different experience. But the shared thing, I think, is that the American medical system is going through a full and complete collapse and no one with the power to change things is willing to do anything.

I’m terrified.

They fucked around with these people for so long that when they need them, actually need them, they aren’t there. They rolled the dice in an assumption that they held sufficient economic power to control them. Now they are left exposing patients to covid as a necessity to prevent their operations from completely ceasing.

That is failure by any other name.

In the interest of profits we have wrung every ounce of every part of the system that runs healthcare. And at the end of all of those elements are human beings. Such systems are unstable. They work but are not fault tolerant at scale because no one ever really looks at the whole system they just look at a part of the system they control. I’m okay if healthcare is more like an a320 as opposed to an F22 because the F22 needs 50 man hours of maintenance to fly and the a320 does it’s thing in a much more germane fashion. Jwst can have 184 single point of failure actuators because it’s the bleeding edge, healthcare needs to have -184.

The problem is we see humans as humans. A machine breaks, it is not perceived as having agency, autonomy, or humanity we don’t blame it. When people die waiting in an er or healthcare personnel are short with patients or quit in droves there is a person whose actions and motives we can question and blame. We understand that experience slightly more and can find ways to question it.

It isolates the problems from view. When no one’s looking at the whole system (and being listened to) no one can shift course. It was not efficient to build capacity for truly abnormal events, so it didn’t make financial sense For anyone to do so. And now nurses are testing and isolating…and. Not just. And.

A explanation why people are frustrated, who work hard and intense, take all the risk - but only get low pay?

And people wonder why nurses are pissed off?

Stress is why I made the firefighters put in safety glasses and got angry at them that I couldn’t find my glasses. Both while trapped under a literal oak tree

But if you came pre-covid during say weekend night and you were not clearly about to die, 10+h waiting time in emergency was not unheard of (wife was serving there for some time as doctor, those folks deserve some proper respect). Simply overwhelmed, not enough staff comprised mostly by junior doctors. Now they are properly good in diagnosing whether your excruciating pain is life-threatening or not, but it must suck big time to be on patient's side.

This is by far the biggest emergency in whole canton. Any private clinic or smaller medical centre will send serious cases straight there.

Its not something discussed frequently but that's just how things are, in one of the richest and well-organized countries in whole world. Don't expect much better experience if you have bad luck with timing.

That means, I had to wait only a short time once, but that was after a dog bite to my face and it just looked horrible with blood all over it.

But the next time, with an deep open wound in my leg, which was actually way more dangerous, I had to wait quite some time, before they even checked.

Last week, my son had COVID (tested positive) but mild symptoms. At some point he says "I have a blue tongue, I don't remember having that before". Doctor and wife want to rush him to the ER and I say no. My daughter and I debugged it a day later (he had just taken a blue gummy pill, and somehow didn't think to mention that). What would have happened if we went to the ER? Shrugs from the doctor after sitting around the ER at midnight-5AM ("yeah I guess it's not cyanosis and it's gone now"), my wife and I have increased exposure to COVID in the ER, and a $3K bill for looking at a tongue.

1. Many hospitals are under staffed. Schools that produce nurses have stayed steady state while demand has increased. This was before the pandemic. During the pandemic many nurses left due to mandates, being treated poorly (by hospital mgmt and people in the hospital), being overworked during shortages, and more. This has all made staffing a huge problem.

When hospitals don't have the staff they close beds down and can't operate at full capacity.

Hospitals that used to only hire RNs with bachelor degrees and wouldn't consider an associates (it's the same amount of schooling in the nursing portion) are now trying to hire LPNs.

2. Some emergency rooms are seeing a crazy number of people. More than usual. This is for a variety of reasons. COVID is one but also people putting off having things treated so they are now emergencies is another. Couple this with the staffing shortage and it's even worse.

Do you know that it would have been a shorter wait time during a period where the hospital wasn't overwhelmed? If so, how much shorter? Perhaps the medical staff were able to tell the signs of ectopic pregnancy in a way that allowed them put your wife lower on the triage priority list than you thought she should have been.

Does your area have any sort of restrictions? If not, how would the amount of time you had to wait be changed in a world where your area did have restrictions?

Even if you can show some benefit from the restrictions, are the benefits great enough to be worthwhile given the costs?

Vaccines are entirely different story. They seem to have little effect on transmission (maybe enough to be useful after three doses but maybe not), but they seem to substantially reduce the number of people who end up hospitalized. So more vaccines would lower the curve, not flatten it.

(Take this with a grain of salt. Great data on vaccine efficacy in the US is a bit hard to come by, and I haven’t run the numbers.)

Actually I had to go to the hospital (not covid) and it was almost deserted with reception coming to check the desk they were supposed to be attending half an hour after we were supposed to be there. People generally went less to the hospital because of the pandemic (which causes other problems).

The time I had to wait 2 hours in SF, with a kidney stone was not pleasant, but it was at 3 AM at a hospital that does charity for the homeless, so that was a bit exceptional.

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?

If that was true, it would not be okay. There needs to be enough capacity to handle unpredictable spikes in load. This can be described using the same sort of queueing theory that anyone legitimately operating at scale needs to worry about: you don't just track average latency, but also track tail latency.

Luckily, emergency hospital buildings are not "always close to be overwhelmed." Their staff is always close to being overwhelmed, but the buildings are not. Instead, they maintain a reserve capacity of temp nurses, who get called during brushfire season and New Year's Midnight to handle the unusually high load. They are paid well by the hourly wage, but don't get any benefits, and either have a second job or a retirement plan to carry them over the rest of the year.

Only this time, they were never sent home. And, since some of them are being forced to quit their jobs, they're demanding the benefits package, which is getting expensive.

Edit: and, of course, this all goes to crap once a brushfire happens on top of the pandemic

Many states did exactly that back in march of 2020. Most of these temporary facilities were closed virtually unused.

It takes time to to train doctors and nurses, they don't grow on trees. Opening immigration for these professions could be a short term solution but getting a US license is complicated too (maybe rightfully so).

And while you can just build another hospital if you have the cash - you cannot just build another doctor, if you need one.

So take your pool of existing NPs and give them a temporary promotion.

I really don't understand why people are completely incapable of using their imagination to solve "hospitals over capacity". The only thing I can think of is perhaps hospitals have never actually been overwhelmed because if they were... we'd have fixed the problem already.

Would you prefer a student, or a seasoned doctor to decide on you - if you are in a critical condition in the hospital?

But sure, I would take any advanced med student over being ignored while in need of care. And since this is not rocket science, here in germany all the retired doctors, trained military medic, ... have been registered and contacted in the beginning - to be ready if needed, but as far as I know, it was not made use of (much?).

And YES. It should have been invested massivly in healthcare in the beginning of the crisis and it was. But mainly just in infrastructure it seems. Or high level corruption.

Because today there are de facto fewer hospital beds avaiable, than in the beginning - because apparently it was not invested enough in the people. The ordinary health workers. They are leaving burned out.

For a short amount of time, you can enlist lots of reserve stuff so to say. But not for years.

Find ways to make it work. Fire the naysayers. Figure it out.

Or alternately accept there never was a problem with healthcare capacity because if there was, we’d have demanded it to be fixed already. Because any reasonable person can state it can and should be fixable. Problem is too many people lost their mind and forgot what it meant to be reasonable.

Strange, that I head many demands of fixing the broken healthcare system way before covid, though.

When it would have been working right - it would have been possible to scale it up to the needed size.

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/

And though I really hope it's the case, I've heard no news yet that Omicron will be the last significant variant.

They make several good points about policy moving forward and vaccinating children, but they were disregarding Omicron before we even knew much about it. Their general position aged like milk, now that there are more people in the hospital with Covid than at any point in the pandemic. They complain about Fauci holding rigid positions, while my science-illiterate family complain that the rules keep changing/are confusing. None of this addresses the fact that masks and vaccines are consistent with past policy in America and have been more effective than nothing, at least as far as people complied, or that comparisons to the flu are a bit of a stretch.

https://peterattiamd.com/covid-part2/

https://profiles.ucsf.edu/monica.gandhi

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.

No one shops for healthcare in the US based on price, for three reasons. First, prices are unknowable in advance. Second, if you have insurance the insurance will fulfill their end of the bargain if you need to be admitted (i.e. they will pay as agreed upon in the insurance contract). Third, emergency rooms in the US are required by law to stabilize any emergent patient that walks in the door, which means anyone can go to any ER anywhere and get treatment.

I was recently in the hospital for abdominal issues. How would I know what drugs they would give me? How would I know if they were going to give me some kind of scan? If they were going to give me a scan, are they going to use a portable machine or use a stationary machine? Are they going to need to use some kind of endoscopic scope? Will I need other things to assist with those scans (sedatives, contrast materials, etc)? Which blood work tests is the doctor going to order? Which urine tests is the doctor going to order? Are they going to order stool samples? How many samples are they going to need, how many times are they going to need to re-run tests? What if I get there and determine I need surgery? How should I have known I needed that ahead of time? What kind of surgery is it going to be? What drugs are involved in that?

Its not like you can walk up and see a board that says "INTESTIONAL DISTRESS -- $175"

Considering that hospitals seem (anecdotal evidence only) to fuck up their own billing codes like 20% of the time, I'm not even sure that's enough.

It's an incredibly parasitic industry, I've never seen anything quite like it. It's a pretty stark contrast to the largely altruistic motives of many of the healthcare professionals themselves.

Private companies have coopted the power over our government during this pandemic, and we have gladly given it to them in fear.

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

If the pandemic could be fixed by the government managing individual behavior we’d be done with it by now.

Instead the government should be focused on expanding highly covid specific care capacity. That is by far a better way to spend the covid relief money than distributing it to sustain a nebulous lockdown.

As far as I understand from talking with doctors, at no time within the last year have hospitals been at maximum emergency covid capacity, as in hospital beds in the hall ways, cafeteria, etc. This tells me that we are close to the amount of beds we need, and it would be feasible to build out additional capacity quickly, relieve the strain, and get back to normal.

This is not something the government can do. It's not something anyone can do. What you're asking for (though you may not know it) is for their to suddenly be more nurses and medical practitioners. That's not a thing that can just suddenly happen, or even happen with 2-3 years of prep. You need a decade to actually functionally increase the supply of nurses and specialists.

Now there are lots of short term fixes the government has done, such as activating the national guard in locations (to reduce non-medical load on nurses) and hospitals can pause elective services to free up space and time, but that has huge downsides since it means people get life saving nonemergency surgeries like cancer removal.

How long would it take to train someone from a nursing adjacent field to treat 95% of what they are likely to see when treating a covid patient? Is anyone even asking that question? If not, why not?

It seems like we’re willing to take drastic action when it comes to mandate public behavior, but not when it comes to reforming bureaucracies, processes, and regulations.

I would love to see stats on that. From what I can tell, the actual percentage of medical practitioners quitting due to vaccine mandates is very small. My family work in the medical field in a red state and the set of people actually quitting over the vaccine requirement (as opposed to making a lot of noise and then deciding unemployment is unattractive) is tiny, but this may not be representative.

Similar things were said for the vaccine.

There is so much gatekeeping in the medical community that is not totally necessary. A doctor or nurse that immigrates to the US from a different country which has better health care than we do cannot practice were without jumping through tons of hoops. That is a pretty straightforward way the government – in a state of national emergency mind you! – could instantly and functionally increase the supply of nurses and specialists.

To give a couple examples. If a nurse moves to the US and learns he can't practice without going back to medical school, he may opt instead to work a different job and defer his medical career. If a doctor moves to the US and is in the same position, she may choose to remain a stay-at-home mom and let her husband be the primary breadwinner.

There's also the arbitrage aspect here: globally we may have a healthcare worker shortage, but it may be more severe in one place than another. Reducing the friction involved in moving the workforce could allow workers that are in relative over-supply to move to an area with relative under-supply, improving the overall efficiency of the system.

New York and New Jersey did this. In early 2020 (so two years ago). Despite this, they ran into extreme shortages. So now that we've done that, what next?

> If a doctor moves to the US and is in the same position, she may choose to remain a stay-at-home mom and let her husband be the primary breadwinner.

And is she just going to suddenly start working if the licensure requirement goes away? Some might, but a lot won't because they are already parenting. This is what I mean by these policies require years to have an impact.

But yes. Yes, I'm advocating that people be just a little bit more open minded and flexible about this issue and, ideally, the so many others like it. Sometimes it's quite depressing to consider the giant gap between how society functions today and how it could function if it operated by different rules.

Punishing the public with these awful mandates because “it’s too hard” is a huge failure of our government.

Sure. It's a pretty delicate balance between individual liberties and preventing bad collective outcomes, though.

If you lock down 340 million people for a week-- maybe the net effect is stealing 3.5 days of life's "enjoyment" or "quality" from each. That's 3.3 million years of quality life taken.

You need to save 20 years of quality life for 165,000 people to break even. In the first wave we probably exceeded that benefit, but it's highly doubtful any subsequent time passes that bar.

And, IMO, if there's ever anything close to a "tie", you need to favor individual liberty.

Maybe making people mask "costs" 0.2 days per week-- much smaller cost, but also a smaller effect. I think it's still justified, but only barely... It won't be soon.

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.

The doctors and nurses you're asking treatment from are people who deserve freedom and work-life balance, too. Many have been fed up and are quitting. Would you support the government forcing them to continue working? Would you force young people to be doctors and nurses?

In Texas, I can get hammered, drive a car drunk without a license behind a fence 10 feet next to the highway (property-side). And there's not a damn thing you can legally do about it, despite any fears I may plow through that fence. The suggested (stricken) OSHA mandates were basically forcing non-consensual penetration, or lose your job.

---------

>That's not totally true. This Texas-based DWI defense attorney says:

You conveniently skipped the top of the page where it explicitly says DWI in Texas must occur in public (a fenced in private property is almost never considered public). Sure a cop can probably find a reason to arrest you no matter what you're doing, if they want to.

>Obviously you should be able to be unvaccinated only on private property then...

Most businesses are on private property. Given that the fourth amendment protects us from handing over documents except on subpeona/court order or probable cause of crime (a few states do compel revealing your identity, although you don't have to reveal your age if the crime is age-related such as alcohol violation), and you can't tell by looking at someone if they're vaccinated, it would essentially be meaningless to make it a crime to be unvaccinated while walking to work for instance. Controlling vaccination is far easier on private property, where you have no freedom to travel and can thus be stopped and checked before entering.

> The police can arrest you if they have probable cause to do so for driving under the influence. Even if you are operating your motor vehicle on what you believe is your own property, the police still may have probable cause to believe your conduct is a threat to yourself or others. Therefore, you should not assume that you are completely safe from arrest or conviction if you are driving drunk on your own property. - http://jackpettit.com/blog/dwis-and-drunk-driving-on-private...

  - Infants/Toddlers (mask): linguistic development health risk
  - Adults (vaccine): risk of anaphylaxis, TTS, GBS, Myocarditis, Pericarditis

Also the driving thing was somebody else, I just responded to it. If you didn't like it, it would have made more sense to have told them it was a bad example instead of me. It wasn't my example.

Texas Penal Code 6.03(c): "A person acts recklessly, or is reckless, with respect to circumstances surrounding his conduct or the result of his conduct when he is aware of but consciously disregards a substantial and unjustifiable risk that the circumstances exist or the result will occur. The risk must be of such a nature and degree that its disregard constitutes a gross deviation from the standard of care that an ordinary person would exercise under all the circumstances as viewed from the actor's standpoint."

And what does the now-void sodomy law have to do with anything?

You're also mixing up indictment with conviction.

At any rate, you don't have to have a fact pattern that precisely matches a previously-recorded case to think "gee, maybe this is a bad idea and puts me at risk of violating some law." Most cases involve fact patterns that are at least somewhat different from previous case law. A prosecutor's job is to make their case based on the facts, the law, and the ability to draw parallels from other cases.

I know what the difference is between indictment and conviction, stop trying to act like this holier than thou. The 'fact pattern' of drunk driving on private property isn't a rare pattern, it shouldn't be difficult to dig up a conviction under that statute if it has been succesful.

>Reckless endangerment does not require you actually hit anyone. Where did you get that from?

No shit. I got it from my example, where the driver didn't hit anyone. That's what we were both talking about, a drunk driver on their own private property behind a fence. When did I ever say they hit someone? In my example they didn't, which is why I asked for a case where they didn't.

The sodomy law is an example of how overzealous prosecutors can prosecute "a ham sandwich" on whatever they want but it means jack in terms of whether they can actually convict someone, even if the exact letter of the law suggests they can.

>A prosecutor's job is to make their case based on the facts, the law, and the ability to draw parallels from other cases.

Sadly many prosecutors care more about convictions (or just dragging someone through the system, conviction or not) than any of those. And some care more about convictions than even justice, to the point they will imprison people for victimless crimes. A bad prosecutor is one of the most dangerous and despised members of society.

As for the sodomy law, before it was ruled unconstitutional (and therefore void), it was enforceable and people were convicted of it. See, e.g., https://www.glapn.org/sodomylaws/sensibilities/texas.htm

The fact that it has been voided since is something every prosecutor knows, and so they won’t even try to indict anyone for it. Getting the law off the books is a formality at this point.

Except I never said that no one had ever been convicted. I'm saying even though the law still is on paper, it doesn't mean someone can be successfully convicted of performing a 'fact pattern' that looks like it might violate the letter of the law. For someone formally trained in law you have a shockingly poor attention to detail or even accurately recalling facts.

> or you risk being removed from HN.

Is this some kind of threat? You have a power play fetish too eh? What would I _ever_ do without non-practicing lawyers arguing with me about the risk of me going to jail for some Texas penal code offense they can't even find a conviction for under one of the most common socially frowned upon 'fact patterns' known to man (Texan drunk at the wheel on his fenced-in property). But hey man, however you keep your razor sharp I guess.

--------------------

Other snips from Otterley's attacks on my character:

'Worse, you are a hypocrite: You gladly take full advantage of the protections the law affords you, while expressing disdain for the protections and fairness-guiding that the law affords others.'

'I think we've reached the end of this conversation with a clear understanding of the type of person you are. This is a garden-variety description of egotistical selfishness'

'Good for you. I bet you have a Black friend, too.'

Mr. Otterley: YOU are the hypocrite.

---------------------

Oh and another one for my friend Otterley from our old conversation, in case we don't meet each other under this username again:

'But I really thank you for the laughs. Maybe the next time I spark up a blunt, I'll stop and think to myself "lawless egotistical selfishness" and think back about dear Otterley'

My understanding is masks mandates were only banned in places like public schools, where the owner is the public thus the individual public student has the decision to wear a mask or not. I would certainly disagree with this sort of control on private school, although I might add it could be a public health risk to mandate masks in school as it could harm the linguistic health of some young children developing language skills.

Employers were banned from vaccine mandates (even on their private property).

Court rulings were that these were abuse of the state government on smaller local governments and private entities.

Is that really so different? If you need to drive for your job and try to do so without a licence you'll lose your job too. Conversely, if you're in your own home then nobody is going to make you wear a mask (well certainly not the government anyway).

The freedom to roam is freedom. I understand the point you're trying to make, but the parent comment is correct in the usage of the world freedom, whether you like it or not.

This is not always the case, even with hospitals in the US. Few markets are 100% laissez-faire in the US, and definitely not regulated industries like healthcare.

For example, if you are a hospital in the US that participates in Medicare, you must provide basic treatment to stabilize a patient with an emergency medical condition, or transfer the patient to another facility that can.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMT...

nor do mask or vax mandates limit this concept of 'roaming' in any way.

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.

Freedom is literally worth sacrificing lives for. This is a fundamental founding idea of the US.

So we sacrifice other lives (young children) so our own adult lives can perhaps be saved.

The lives of their grandparents (and of older folks not related to us), you mean. You know, the ones actually the most vulnerable to this epidemic.

I agree that the choices are difficult, no matter what we do. But there's no need to distort the basic equation, and make this particular choice appear to be something plainly selfish (young and mid-life adults snubbing the kids to cover their own asses) when it plainly is not.

If the health system becomes incapacitated, and we have to push people out of ICUs to make way for the "freedom fighter" who won't vaccinate (which is already happening in some areas), then everyone suffers -- not just "mid 30s adults".

>If the health system becomes incapacitated

If the health care system isn't working, then we need to look at expanding healthcare; perhaps by eliminating a lot of the regulations that drag it down. You don't have the right to force someone to make sure there are beds at a hospital. I don't think the answer is compelling non-consensual activity in private business such as masks.

------------------

>It's not that they "seek healthcare". But that they expect to have critical resources like ICU beds available to them (and therefore, denied to others) so they can enjoy their "freedom" (to ignore common sense) -- that folks take issue with.

You're seriously complaining that when someone seeks healthcare they are using a bed? You know how many people using beds are there for non-essential activities (motorcycling, roofing a non-essential shed, snake bite because they went hiking, whatever). Should we outlaw any non-essential activity that could send you to the ED?

It's 'common sense' to me that my (almost) 2 year old's speech development will be harmed if she can't see me speak (and at least one initial study suggests that is correct), so I don't wear a mask anywhere when she's with me nor do I enter establishments that require me to. Maybe that makes me a 'freedom fighter' for my kid's development.

Would you agree with this analogy:

"Going out into crowded public spaces unmasked and unvaccinated ... is not unlike riding a motorcycle without a helmet. And with a busted taillight and bad brakes too, because you're also putting other people at risk."

Being vaccinated is a strong tail light (having already had COVID before may be a strong tail light too). Being unvaccinated but never caught COVID is a legal but moderate tail light. Being deathly ill but sneezing on the produce is no tail light.

https://peterattiamd.com/covid-part2/

https://profiles.ucsf.edu/monica.gandhi

Also, the discussion in that podcast is a bit strange (for a bunch of reasons). For one thing, it seems to reduce the "mask question" to one of individual (or close family) risk -- "If I'm comfortable with the risk level (as affects me and my family), I should be able to decide whether to wear a mask or not (paraphrasing)" -- and completely sidesteps the community risk issue (especially in crowded public settings). Which is very different, and is of course what mask mandates (whether you agree with them or not) are designed to address.

For another, it dwells a lot on the "shame" and (what they think of) as quasi-religious aspects of mask wearing - this idea that people expect others to wear masks because those who do not are "unclean". Which may be what some people think, but to suggest that this is what most people think or that this should be part of the policy debate is just ... werid.

I did, and it's rather obnoxious of you to suggest otherwise.

I just think your own reading of what she said is off, for reasons I'll let you figure out (or not) on your own.

https://news.ycombinator.com/newsguidelines.html

I'm not going to ban you right now, but if you'd please review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it.

Please also stop posting flamewar comments to HN generally. It's not what this site is for, and it destroys what it is for.

No, not when they "seek healthcare". But when they go out and inevitably get themselves covid because they think they're making bold, individualist statement (as many of these people apparently do think) by not masking and not getting vaccinated.

Not happening in the short term.

complaining that people seek healthcare when they are ill.

It's not that they "seek healthcare". But that they expect to have critical resources like ICU beds available to them (and therefore, denied to others) so they can enjoy their "freedom" (to ignore common sense) -- that folks take issue with.

Why not? It's an emergency. It's completely possible to fix this short term in a way that lets us move on without all these socially toxic and corrosive restrictions. Probably would cost an order of magnitude less, even.

That's not what people in healthcare say. But hey, you can say whatever you want.

If hospital capacity was an issue caused by covid surges, we'd have fixed it already.

This is supposed to be an emergency, right? Give me a break. Covid specific healthcare capacity can easily be scaled up with the amount of resources we are pouring in this dumpster fire. Figure it out.

So I find that a very, very weird implication for you to make.

I interpreted you were holding them accountable to answer the question of expanding/fixing health care in the short term. Clearly their answers are going to be in the context of their limited power to change the whole system without the cooperation of others. They need the cooperation of both the capital holders / owners of the health care industry as well as regulators and legislators. I think when you answering this question, they are answering it within the context of working within their current constraints, which can be quite tight.

To say they are the one to answer the question, in my opinion, is to shift the onus on them to answer it. In fact we need the feedback of these workers, and they're critical in us solving current problems. They need our cooperation. But I think framing the question as something they're supposed to answer, as you have done, narrows the focus on people not to be blamed for the constraints that hold them back and thus force an otherwise unreasonable answer.

Along with the second most critical resource that we expect them to have for us: empathy. Especially for those who won't vax.

If somebody says it isn’t possible, fire them and find somebody who can figure it out. It’s a fucking emergency, remember? It’s completely possible. Saying otherwise is an excuse. Figure it the fuck out.

Zero excuses.

(Or the more simple answer is there actually isn’t a problem with hospital capacity because otherwise we’d have fixed it. You know… because it is something that could be fixed… with money alone)

Is it a person's right to fly on an airplane without wearing a mask? I'd don't think so

Is it a person's right to decide what medicines they take? I'd say yes, definitely

You can take away freedoms in the interest of others, but not rights, in my opinion. The policies I've seen are pretty fuzzy on this distinction

Note that the mandates in question (those in Quebec) don't force you to get the vaccine.

They just say that if you don't, you no longer have an inalienable "right" to shop at Walmart.

All that an unregulated free market would change is how we decide who gets treated when there isn't enough capacity to treat everyone.

That's not freedom. Freedom is not putting up barriers.

Edit: to be clear on where I stand. I think you can do whatever you want, as long as it doesn't affect me. If it affects me, maybe you should still be able to do it, but then we need some thought and discussion and isn't an automatic right because "freedom".

So why not build more capacity instead of forcing the public to adhere to a bunch of toxic and socially corrosive mandates?

That's not freedom, that's an entitlement.

With Heroin, I'm not sure criminalization really had much affect at all on the percentage of heroin addicts. And I'd bet that it had less effect than the rate of prescriptions for synthetic opiates did.

what about laws banning second-hand smoke indoors?

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.

We also charge smokers more for health care due to the burden they put on the system, yet another form of discrimination.

You're also making the naive mistake of relating a stable system (smokers with health issues) with an unstable system (covid patients). These two types of systems have VERY different impacts on the medical infrastructure.

QED: no one is opening any flood gates. we've had this shit in place for over a century. we use to let you just die at home when you caught the plague.

I’m assuming it’s a bad idea for reasons that I haven’t thought through; I’d love to hear them from anyone who has spent time on the issue.

Based on seriousness of the case, not really on whether it was preventable in the first place. For extremely limited resources like organs there is consideration of future risks, but that isn't really the same thing.

>We also charge smokers more for health care due to the burden they put on the system, yet another form of discrimination.

So let insurance adjusters charge different rates for vax/unvac'd people covered by insurance like they do for smokers.

incorrect its based on likely hood of survival. no point in wasting resources on a soon to be dead individual when you can save someone who actually has a chance.

So in that sense, the response to COVID is similar - though on an accelerated time scale, because the epidemic is much worse.

Tobacco still causes 480K+ deaths a year in the US so saying covid is worse is a very strong claim.

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

I think the epidemic is worse in a few particular ways (though obviously not as bad in other ways as smoking, since I doubt COVID will keep causing 480k deaths a year). Ways in which it is worse:

1. It causes a spike of hospitalizations - this causes much less healthcare to be available in general. Smoking is already (regretably) factored in, I imagine, and doesn't cause sudden spikes.

2. COVID is generally not something you can protect yourself from - unlike smoking, which is to a much greater extent a personal choice.

3. Efforts to contain COVID are having a drastic effect on the economy in a way that smoking doesn't (both government-mandated and personal actions.)

2, Whole heartedly disagree with. Covid has specific health risk factors (Obesity, Diabetes etc) that long term people have a similar level of control over as smoking. People also have direct control over how much risk they want to take; there are vaccines, there are therapies, there are N95 Masks & no one is forcing you to go to a bar/club/sporting-event.

3. I'm not going to attribute to Covid the panic and over-reaction because of its novelty. Just like we don't attribute to the 9/11 terrorists the destabilization of the middle east and hundreds of thousands of deaths.

But people don't always control having diabetes. People don't control having cancer. People don't control other forms of immunocompromisation. People don't control being older.

3. I don't think it's an overreaction. You said in 2 that there are vaccines, therapies, masks. These things took a year to get to. If not for the actions in the first year, there'd be many more dead.

Honestly, then good, we should open that can of worms.

> 300 billion dollars estimated to be spent per year with treatment of smoking-related illness.

AFAIK this treatment doesn't include "clogging an ICU because these people are on ventilators". I could be wrong though.

1. Should smoking be banned? (by smoker status)

2. Should obese people be forced by the government to restrict calories? (by obesity status)

I honestly have no idea how it would go. Most people are more coy about those opinions.

Obese people is a more complicated issue and I would argue that (at a societal level) it is an indicator of a larger social problem that is then causing the issue downstream just like other issues of addiction. I think we would be better off targeting that issue upstream.

That being said I do really like that in some countries (Japan, from what I hear) your general doctor can prescribe you basic things like "exercise". It must be painfully obvious to so many doctors out there that the best solution to some problems is to get the person actually moving more but instead they have to beat around the bush with after the fact duct tape type medical fixes.

I'm not sure I understand. You mean like banning certain foods?

We have some hypotheses that children are the flu reservoir and that if we required them to get an annual shot it would tamp down flu seasons.

The primary difference is that the flu vaccine is predictive and can miss. It's kind of hard to demand that people take something that may not work.

If we got something genuinely terrible like Spanish Flu, yes, everybody would be demanding that people get a flu shot.

I am also saying that if problem of the health system is lack of personnel, then firing healthcare workers who refuse the vaccine (even after being infected) is counter-productive and can only be seen as a bone-headed political move.

But most of all what I am saying is that we should not accept the policy theater. Making this about vaxxed vs unvaxxed is just yet-another way for governments (worldwide) to hide their ineptitude.

It's been two years already. Countries in Europe with comparable levels of vaccination to the US are already treating Covid as "just a endemic, seasonal respiratory disease". Yet the US still wants to pretend that things just don't get solved because of rednecks and "problematic people" that need to submit to the will of the elite.

It is not the vaccination, per se[*]. It is the political maneuvering and using the unvaxxed as a cover for their failures, this perpetual "if only they did what we are asking of them", etc. The will of the elite is that we accept this perpetual terror until we give them carte blanche for them to do whatever "Big Reset" they want.

In Germany we are testing our kids twice a week at a minimum, and everyday when/if a positive test is found in the school. Case numbers are high, measures are in place, but people are mostly living their lives without waiting for Mary from Bumfuck Alabama to get her shot. Why is it so hard for the US to drop the empty pointless rhetoric and get their shit together?

[*]If it helps you, I am not against the vaccines. I got mine, boosters and all. What I am against is the policy theater. What I am against is schools being closed and causing a lot more long-term harm to kids than the potential risks of them getting covid. What I am against is firing health care workers for political reasons while claiming that the system will collapse unless everyone complies.

Granted, a very cynical view of the educational system is most Western countries is that it is a glorified time-waster for kids to be busy while parents work. But even that was lost during the pandemic. Most schools basically have given up on getting students to learn anything this past year. Lockdowns have acted as prolonged stunt on children's socialization opportunities. Anxiety levels for teenagers are through the roof.

The effects of these two years on younger kids will be profound and long-lasting. They are paying a lot more than their share of risk. And saying "they are not dying" is not a consolation because - unlike with the Plague - kids are basically zero-risk compared with other age groups.

> At least they had internet and other niceties

Are you serious? The last thing you should want for kids is for them to become dependent on something like the Internet. Such a comment is almost offensive to a parent that does not want to see their kids turning into mindless, socially-inept drones like the average HN-commenter.

As much as I support vaccination, it feels like gaps in vaccination are also used as an excuse to blow off repairing an extremely fragile public health system. We've had two years at this point.

I do agree that this is something governments ought to be looking into over the long term though.

Training people to assist Covid cases, run PCR tests, should be a matter of weeks, not years. Germany did it, I have 4 (four!) test centers on within a block of distance, all of them are filled with students and otherwise-unemployed people who got some minimal training.

If we're to treat this like an emergency, why aren't we treating it like an emergency?

Because in truth it probably never was. We assembled fully staffed field hospitals that went completely unused.

Also, assuming their obesity is a life style choice instead of type 1 diabetes, I suspect many obese people would be willing to take a easy vaccine if it exists considering how big the lose-weight-quick industry is

That's why I think vaccination schemes that offered free food were undermining the "following the science" bit.

As was the banning of the popular "Parkrun" in the UK, which is a collective outdoor exercise event, during the lockdown.

So many policies have undermined the "follow the science" bit in my mind.

> one run and one meal is not gonna make or break someones weight

On the contrary, we have had two years of this pandemic. Government messaging could have been a lot stronger on the benefits of exercise. That's 2 years for people to become healthier.

And "one vaccine" has turned into one vaccine plus boosters. Everyone is going to get Covid at some point. General fitness will remain one of the best long term ways of combating the virus.

The Parkrun is a weekly occurrence, and is popular even for those who do not have an interest in exercise as a hobby, as it is informal. As such, it acts as an important gateway to a healthier lifestyle.

I'm by no means alone in seeing banning it as counterproductive, and not "following the science".

https://www.bbc.co.uk/news/uk-wales-59816344

If the government wants to serverely curtail individual liberties, then I expect good reasons for doing so. It's not good to encourage blind adherance to illogical policies.

Obviously, yes, medical conditions do place burdens on health systems. That's why we tax cigarettes highly. However, in spite of considerable public health initiatives, the obesity rate continues to rise...

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."

Most people are not that lucky, and unfortunately have to choose to roll the dice on COVID to avoid the certainty of being fired for missing work.

I would love it if there was data on "want a vaccine but couldn't get it". The vaccine finder website could have you indicate "I'm interested" and then email you every month and ask you to confirm that you got a vaccine or that you gave up or that you're still looking. I fear that people don't ask questions they don't want to know the answer to; "300 million people are looking for a vaccine but only 200 million got it" would not look good. Sigh!!

For my third dose, that was last month. I think I signed up for my ultimately-canceled appointment early December targeting a date before Christmas. I ended up getting the shot in the first week of January.

I felt like I had to devote a lot of mental energy to getting the vaccine much later than everyone else, looking at statistics. I totally believe that other people said "I like the vaccine, but fuck this shit" and that's why they're not vaccinated.

The situation is not great. I have no idea how a poor person would navigate this system.

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.

Start here: https://91-divoc.com/pages/covid-visualization/

Showing new deaths per day with 1 week averaging normalized by population, the US is about 2-3x Australia right now.

As for new confirmed cases per day normalized by population, everybody is about the same because Omicron is so infectious. I suspect the US number is a bit undercounted because the number of cases spiked so fast that confirmed cases simply couldn't keep up.

In the last 7 days the US has had 46 deaths per million population. Australia has had 17.

See for yourself: https://www.worldometers.info/coronavirus/

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.

This would include the things like firing healthcare workers, leading to other problems being undiagnosed, and worsening instead of being treated. I would also include lockdowns and mask mandates as being responsible for increased amounts of depression, which has a known poor impact on survival over time, and that's not just counting suicide.

if your going to make shit up at least make up believable bullshit.

And it doesn't have to be widespread - given the thin staffing margins that hospitals already run on, losing a small amount of people in a large facility can have outsized effects.

I'd thank you to engage with the argument in good faith per the site guidelines, or don't bother responding.

once you actually have a position that can be discussed. show me evidence of your position and I'll stop calling it a bat shit insane conspiracy theory.

right now all you've done is assert complete bullshit. I can link to articles with hospitals stating how many of their staff they've fired due to anti-vax behaviors. I doubt you can find a single instance of a hospital shortage due directly to the few thousand works in the entire country who were fired for their anti-vax beliefs.

even if you did find a hospital in that position, the issue certainly isn't wide spread enough to even merit a footnote when it comes to health policy.

Some doctors are reporting adverse/fatal effects associated with the use of Remdesivir (which hospitals are using to treat COVID patients). These issues include acute kidney injury, bradycardia, and death. The CDC has counted these deaths as COVID deaths as well.

There are also other aspects of COVID that seem difficult to suss out. For example, how many people have died from the vaccines? VAERS is reporting 22,193 vaccine-related deaths and over 1 million adverse reactions. There are also deaths and suicides caused by our response to COVID; e.g., the lockdowns, depression, job loss, fear of going to the doctor/hospital due to COVID, etc. Those aren't being counted as COVID-related deaths by the CDC, but perhaps they should be.

Even if you removed all the politicization/propaganda of both COVID and the vaccines, it still seems like we've made a lot of mistakes during the past two years that would make producing an accurate death count virtually impossible.

This must be a golden age for those doing a dissertation on media studies. So many quant-driven narratives, so little time. Hopefully cross-country data and narratives are being archived and aggregated into an open-data academic repository that can be studied in coming years.

https://www.reuters.com/business/healthcare-pharmaceuticals/...

> recent study from Israel showed that while a fourth dose of an mRNA vaccine boosted antibodies, the level was not high enough to prevent infection by the Omicron variant ... the debate appears to have shifted with the European Medicines Agency (EMA) saying on Friday that international regulators now preferred clinical studies to be carried out before approval of a new vaccine ... it may not be possible to realise a current plan to launch an Omicron-targeting vaccine by the end of March ... Inclusion of clinical trial data in the regulatory filings may have an impact on the delivery of initial batches.

It's like arguing about the raw data of the Wright brothers flight, when millions of people are flying around the world on 747s. Was it relevant in the past? Yes. Is it relevant today? No.

You want to know about vaccine safety? Look at excess mortality, hospital admissions, and long-term health problems of the vaccinated and unvaccinated populations, today. Ten billion COVID vaccines have been administered around the world in the past year. Any of the data we've gathered from that is about a thousand times more relevant to literally anything we could be doing, than raw study data on a few thousand people.

Most ethical and legal systems around the world, in fact, would use that evidence to both convict the criminal, and then independently recommend separate sanctions for breaking procedures.

But we're not even talking about ethics or legality, here. We are talking about knowledge. People claim that we don't know about the safety of vaccines because we don't have data on trials conducted on thousands of people.

... Yet we have data about vaccines administered to billions of people. Why don't those critics look at that data, instead?

It's because knowledge and fact-finding isn't the point of that complaint. The people asking about this don't actually care about having a data-driven argument about the safety or efficacy of vaccines, they just found a procedural problem, that they can play a political game with. The politics is the entire point.

Heart disease, unintentional injuries, Alzheimer disease, and diabetes all jumped more than the expected trend.

2021 numbers I don't think will be finalized for another month or so.

As for excess deaths, it presumably depends on how well the country can endure the self-inflicted downsides (such as a recession) that comes with it. Countries where it causes severe problems probably are the very ones who didn't have the political will to maintain the lockdowns, leading to some biased conclusions. We also have lots of other issues caused by covid response such as shortages and spiking prices all over. Being outright dodged by pointing blame at some indermediate actor like "corporate supply chains" or "hoarders" or whatever.

The point is there are arguments that can be made on all sides. No need to insult and dismiss people.

Here is a summary of over 400 studies demonstrating lockdowns are ineffective or harmful:

https://brownstone.org/articles/more-than-400-studies-on-the...

Prepare a sufficiently convincing argument against each and every one of them, and against the credentials of each and every author, before using the term "denialist" in application to anyone other than yourself.

It's at about the same level as the counter argument regarding Sweden (which is one reason I made it).

Have a look through the studies I linked, you'll find several that perform rigorous analysis on a large number of countries, including in some cases specifically regarding excess mortality.

For example, have a look at Figures 2A and 2B from the following study. 38 countries compared by length of initial lockdown measures, versus per capita excess mortality for the period, and then the same measure compared across all states of the US:

https://www.nber.org/system/files/working_papers/w28930/w289...

This doesn't support the hypothesis that lockdowns reduce excess deaths.

Lockdowns working/not-working and/or causing collateral damage potentially eliminating other gains is not even remotely on par with astrology.

Lockdowns used in this manner are entirely unprecedented, and the long-term results cannot be known by anyone, only guessed at.

Your rigid adherence to them as beacons of purity only demonstrates your religious-like faith in them, which strikes me as having far more in common with astrology than well-evidenced arguments by well-credentialed individuals that they might not work or be counterproductive.

What I object to is your demand that anyone disagreeing with you first go through 400 studies, individually, and find the flaws in them, and destruct the credentials of the authors.

> Here is a summary of over 400 studies demonstrating lockdowns are ineffective or harmful:

You're welcome to present studies demonstrating the opposite, but even if you can find 400 of them (and I doubt you can), the best we'd have arrived at would be equal uncertainty either way.

The longterm results of anything for which a long term has not yet elapsed can indeed only be guessed at. The fact I need to point this out to many people is striking in its resemblance to some kind of mass delusion on their part.

> Lockdowns used in this manner are entirely unprecedented, and the long-term results cannot be known by anyone, only guessed at.

So which one is it? Are your studies useful, or can the results only be guessed at, and so what's the point of your 400 studies?

> The longterm results of anything for which a long term has not yet elapsed can indeed only be guessed at. The fact I need to point this out to many people is striking in its resemblance to some kind of mass delusion on their part.

It's amazing that you tell other people this yet don't seem to understand it yourself.

Can you explain this more? Surely a hospital doesn't just get money for simply classifying it. How does a hospital benefit from classifying someone's treatment as Covid related other than being paid for the necessary treatment?

> U.S. Centers for Disease Control and Prevention Director Robert Redfield agreed that some hospitals have a monetary incentive to overcount coronavirus deaths as they do deaths for other diseases. “I think you’re correct in that we’ve seen this in other disease processes, too. Really, in the HIV epidemic, somebody may have a heart attack but also have HIV — the hospital would prefer the [classification] for HIV because there’s greater reimbursement,” Redfield said during a House panel hearing Friday when asked by Rep. Blaine Luetkemeyer about potential “perverse incentives.”

For families, Covid classification for a death enabled up to $9000 for funeral expenses, https://www.cnet.com/personal-finance/covid-funeral-reimburs...

The 2nd point offers a financial incentive for families to agree with hospital (mis)classification, i.e. it aligns the financial incentives of family and hospital towards Covid attribution.

https://www.usatoday.com/story/news/factcheck/2020/04/24/fac...

> 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.

Where elderly means > 40 and chronically sick includes "has a bit of high blood pressure".

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precaut...

Fortunately the vaccines and other treatments are still very effective in preventing deaths among the elderly population.

The CDC says > 40% of US adults are obese (> 100 Million people!) and 13% of US adults have diabetes. If that's not a chronically sick population I don't know what is.

[1] https://www.cdc.gov/obesity/data/adult.html [2] https://www.cdc.gov/diabetes/pdfs/data/statistics/national-d...

My big problem with the initial lockdowns was not really about the larger lockdown at all - we just (obviously in hindsight) went too far with locking down larger, wide open places where people exercise.

Spring break in Miami with people crammed onto a beach? Probably a bad idea. A few surfers going in the water a hundred feet from one another and some other people doing a morning run? Likely a net benefit to Covid outcomes.

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.

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?

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/...

1) Assuming animals were a major source of variants, it quantitatively but not qualitatively changes the problem. Until we know the quantities, I do not see how you can assert relevance.

2) The references you provide say Omicron came most likely from a human with prolonged infection. The paper proposing a intermediate variant in mice is interesting, but considered unlikely (your reference: "Evolutionary biologist Mike Worobey, Ph.D., of the University of Arizona in Tucson, said the most plausible theory remained that Omicron evolved in an immune-compromised patient with a protracted [SARS-CoV-2] infection.")

Viral replications are the only scenario where variants can emerge naturally. Duration of disease and severity of disease are correlated with load and total viral replications. Vaccination reduces both at the population level. A vaccinated person therefore will on average be a less likely source of a variant. How much this weighs against other factors when deciding on policy is impossible for me say, but I would insist it is not irrelevant based upon current knowledge.

I was probably thinking that the other factors (personal protection, hospital capacity, and the political question of mandates) seem so much more significant to me. There's lots of lesser factors (side effects, the immuno-compromised, social cohesion, etc).

I guess I kind of looked at variants as a wash, given they are so much out of our control and there are many unknowns. It's in the realm of possibility that the current vaccines could leave us more susceptible to future variants (a la original antigenetic sin). Hard to make a decision on less significant unknowns.

https://www.scientificamerican.com/article/covid-variants-ma...

The paper you cite supports this: in a case study of a single immunocompromised patient who---because of that---had a prolonged infection, many replications of the virus were observed. This patient represents a "hot spot" of variant emergence in this furthermore antibody treated patients. From the article "the remaining samples [sic: most] are consistent with arising from a consistent viral population".

What I take from this is: we ought to prevent prolonged infections where it is possible. Again, from the article "The effects of convalescent plasma on virus evolution found here are unlikely to apply in immunocompetent hosts in whom viral diversity is likely to be lower owing to better immune control." And a vaccinated individual will on average have the best immune control.

https://www.sciencedirect.com/science/article/pii/S026240792...

e.g. https://www.channelnewsasia.com/commentary/covid-omicron-var...

>Do the unvaccinated populations fuel the emergence of SARS-CoV-2 variants?

> The consensus among the scientific community is yes, they likely do. Unvaccinated people have less protection from the SARS-CoV-2 virus and thus would allow more of the virus to multiply within them.

> The higher rate of virus multiplication in the unvaccinated is likely to result in more possible mutations of the virus, resulting in the emergence of a larger number of variants in unvaccinated than vaccinated people.

I think at this point there is not much more to say here, at least from my end. Have a great day.

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.