Vox: "We have to accept some risk of Covid-19"

[ThatRobGuy]

We have to accept some risk of Covid-19

There’s a growing consensus among health experts: Covid-19 may never go away. We’ll likely always have some coronavirus out there, infecting people and, hopefully only in rare cases, getting them seriously ill. The realistic goal is to defang the virus — make it less deadly — not eliminate it entirely.

If you go back to the earlier days of the pandemic, the original hope with vaccines was more modest. Previously, the Food and Drug Administration set the standard for an acceptable Covid-19 vaccine at 50 percent efficacy. The expectation was that the vaccine wouldn’t stop all cases of Covid-19, but would at least reduce the severity of the disease. As Baylor College’s Peter Hotez put it at the time, “Even if it’s not the best vaccine, it still could prevent me from going to the hospital or worse.”

Yet somewhere along the way — perhaps with the news the vaccines were far more effective than expected — that message has been lost. And now anything short of perfection is perceived as a failure.

But if you dig into the details of the [Provincetown] outbreak, they revealed some very good news for vaccinated people. Among the more than 1,000 cases so far linked to Provincetown, there have only been seven reported hospitalizations (some unvaccinated) and no deaths.

If this was 2020, given overall hospitalization and death rates, the outbreak would have likely produced roughly 100 hospitalizations and 10 deaths.

The Provincetown outbreak, then, showed that the vaccines had worked to defang the coronavirus — to make it more like the flu.

“We should cheer,” Amesh Adalja at the Johns Hopkins Center for Health Security told me. “The Provincetown outbreak, contrary to what the press reported, was evidence not of the vaccines’ failure but of their smashing success.”

In short: Pay attention to hospitalizations and deaths, not just cases.

 

[Norbert L]

I'm still trying to figure out the general logistics?

Person A is vaccinated and protected from death.
Person B is not vaccinated and isn't protected from death.

At what percentage point does a virus become a threat to the collapse of society?

 

[ThatRobGuy]

I'm still trying to figure out the general logistics?

Person A is vaccinated and protected from death.
Person B is not vaccinated and isn't protected from death.

At what percentage point does a virus become a threat to the collapse of society?

While "collapse of all society as we know it" may be a bit of a hyperbolic way to describe it, in terms of major societal impact that could constitute a partial collapse of certain institutions within society, I would say there could be a few different markers that could quantify that.

1) If hospitals/medical systems are overwhelmed
2) If enough people (in a mission critical field or vocation) come down with it simultaneously and cannot perform the tasks
3) If it killed off a substantial portion of people in a very necessary field


So, if hospital ICU units filled up to the degree where they couldn't provide care and had to turn people away would be an example of #1

For #2, if...say... 30% of the nation's farmers all came down with it simultaneously and couldn't work, that could put a major hurting on the supply chains for food

For #3, if half of the nation's doctors/police officers/fireman (insert any mission critical societal function) all died from something, we'd have major issues.


With Covid, I don't think we were ever in jeopardy of #2 or #3 happening (not to diminish the impacts of the Covid...I'm a strong proponent of getting vaccinated and taking it seriously)...it would have to be something like a virus with the lethality of Ebola, but with the transmissibility of Covid in order to cause one of those two scenarios.

However, scenario #1 was/is a possibility with Covid, and would've been doubly true had we gotten hit with the delta variant before the vaccine was widely available.

 

[MyOwnSockPuppet]

At what percentage point does a virus become a threat to the collapse of society?

The notable case of a virus causing societal collapse was the Antonine Plague, although there's debate over whether the plague wiping out a quarter to a third of the population or the sheer number of less-than-competent emperors who died violent deaths and the political instability that came with it that resulted in the decline and eventual collapse of the Roman Empire in the west.

If you widen it to any pathogen then Y. Pestis has twice caused serious depopulation in Europe, wiping out 1/4 to 3/5 of the population in the 6th and 14th centuries.

 

[wing2000]

Yet somewhere along the way — perhaps with the news the vaccines were far more effective than expected — that message has been lost. And now anything short of perfection is perceived as a failure.

Most of the anti-vaccine messaging I see is based on the false premise of vaccination perfection and demonstrating a remarkable inability to evaluate risks based on data.

 

[Norbert L]

While "collapse of all society as we know it" may be a bit of a hyperbolic way to describe it, in terms of major societal impact that could constitute a partial collapse of certain institutions within society, I would say there could be a few different markers that could quantify that.

1) If hospitals/medical systems are overwhelmed
2) If enough people (in a mission critical field or vocation) come down with it simultaneously and cannot perform the tasks
3) If it killed off a substantial portion of people in a very necessary field


So, if hospital ICU units filled up to the degree where they couldn't provide care and had to turn people away would be an example of #1

For #2, if...say... 30% of the nation's farmers all came down with it simultaneously and couldn't work, that could put a major hurting on the supply chains for food

For #3, if half of the nation's doctors/police officers/fireman (insert any mission critical societal function) all died from something, we'd have major issues.


With Covid, I don't think we were ever in jeopardy of #2 or #3 happening (not to diminish the impacts of the Covid...I'm a strong proponent of getting vaccinated and taking it seriously)...it would have to be something like a virus with the lethality of Ebola, but with the transmissibility of Covid in order to cause one of those two scenarios.

However, scenario #1 was/is a possibility with Covid, and would've been doubly true had we gotten hit with the delta variant before the vaccine was widely available.

The notable case of a virus causing societal collapse was the Antonine Plague, although there's debate over whether the plague wiping out a quarter to a third of the population or the sheer number of less-than-competent emperors who died violent deaths and the political instability that came with it that resulted in the decline and eventual collapse of the Roman Empire in the west.

If you widen it to any pathogen then Y. Pestis has twice caused serious depopulation in Europe, wiping out 1/4 to 3/5 of the population in the 6th and 14th centuries.

I tried to minimize the hyperbolic thoughts that could come in response to my comment. Seeing that you responded to my comment of "collapse of society" with "collapse of all society as we know it", would be a failure on my part on trying to avoid this.

I agree number 1 is more relevant to day to day life we all share, the collapse of a health care system in having the resources necessary to treat patients does take my comparison from individual to group. Being vaccinated wouldn't stop Rome from burning, which is a hyperbolic way of expressing its' gradual decline over time.

In my view the USA and its' Republic will eventually make for a good historical comparison as to what is more harmful to the well being of the individual and group. Those States that impose harsher legislation in regards to vaccination, compared to the States that are more tolerant.

 

[ThatRobGuy]

Most of the anti-vaccine messaging I see is based on the false premise of vaccination perfection and demonstrating a remarkable inability to evaluate risks based on data.

The talking point seems to be coming from both sides (with regards to vaccine efficacy), just with different angles and different impetuses behind the talking points.

So on one hand, you have many on the right saying
"See, the vaccine isn't perfect, so why bother?" (appeal to futility fallacy)

On the other hand, you have many on the left suggesting that because they're not perfect, that's reason for going back to universal masking and partial lockdowns. (a bit of the "nirvana fallacy" or unrealistic expectations)

Even some of the public health experts have lost sight of the original goals they had. Early on, they basically said if they could get a vaccine with the same efficacy rate as the flu shot with regards to preventing serious illness, and could convince 70% of the population to get it, they'd be happy with that and consider it a win.

We're there... we have close to 70% of people who've had their shots, and the Covid vaccines (even amid the delta variant) are still outperforming our yearly flu shots in terms of preventing hospitalizations and serious illness.

It seems like the goalposts have shifted. It comes across now as if "unless we can get 90% of the population vaccinated, and unless that vaccine is >90% effective and stopping any and all transmission, then it's too risky to open up"

 

[Pommer]

The talking point seems to be coming from both sides (with regards to vaccine efficacy), just with different angles and different impetuses behind the talking points.

So on one hand, you have many on the right saying
"See, the vaccine isn't perfect, so why bother?" (appeal to futility fallacy)

On the other hand, you have many on the left suggesting that because they're not perfect, that's reason for going back to universal masking and partial lockdowns. (a bit of the "nirvana fallacy" or unrealistic expectations)

Even some of the public health experts have lost sight of the original goals they had. Early on, they basically said if they could get a vaccine with the same efficacy rate as the flu shot with regards to preventing serious illness, and could convince 70% of the population to get it, they'd be happy with that and consider it a win.

We're there... we have close to 70% of people who've had their shots, and the Covid vaccines (even amid the delta variant) are still outperforming our yearly flu shots in terms of preventing hospitalizations and serious illness.

It seems like the goalposts have shifted. It comes across now as if "unless we can get 90% of the population vaccinated, and unless that vaccine is >90% effective and stopping any and all transmission, then it's too risky to open up"

Given that only a fraction over 11% of Americans have been infected, there’s still a ways to go before we are going to be done with this all.

 

[ThatRobGuy]

Given that only a fraction over 11% of Americans have been infected, there’s still a ways to go before we are going to be done with this all.

Are you talking confirmed cases, or what the health agencies are reporting as estimates?

Obviously, there are only 36 million confirmed cases.

However, CDC estimates that 1/3 have actually been infected at this point.

Cases, Data, and Surveillance

The point being, that not everyone who was infected got a test to confirm it, and a lot of people probably didn't even know they had it and just assumed it was allergies or something (particularly, young people who tend to have much more mild cases), or asymptomatic.

And those estimates were pre-delta, so it's likely much higher than that at this point.

Maybe it's just the optimistic side of me...but I think we're actually much closer to herd immunity than some people think we are. The transmissibility and higher viral load of Delta is just burning through the remainder of the population that hasn't been vaccinated, or hasn't been exposed to the virus yet.

I lean toward the Dr. Scott Gottlieb prediction...which is that the Delta wave is going to be the last major wave we see here in the US.

There are several of us who have "double immunity"...where we've had Covid, and also been vaccinated on top of that. I had a positive antibody test (even prior to the vaccines being available), but still got vaccinated anyway back in April. I feel pretty good about ditching my mask at this point. Even in the rare instance that I could be a "unknowing carrier" after having the virus itself, and having the vaccine... vaccinations are widely available and they can't even give them away in some places. I don't feel any obligation at this point to inconvenience myself for the benefit of people who want to continue to indulge in virus-denial and pseudoscience.

I still wore my mask and kept distance in the month or so following my vaccination (as a courtesy to some folks who may have not been able to get it yet at that point). But we're at the point now where every pharmacy in town is offering walk-in vaccines (and many will even hook you up with a free gift card). If you get a serious case of covid at this point, it's due to poor decision making (with the exception of the less than a fraction of the population that has a legitimate immunocompromised state)

 

[whatbogsends]

The talking point seems to be coming from both sides (with regards to vaccine efficacy), just with different angles and different impetuses behind the talking points.

So on one hand, you have many on the right saying
"See, the vaccine isn't perfect, so why bother?" (appeal to futility fallacy)

On the other hand, you have many on the left suggesting that because they're not perfect, that's reason for going back to universal masking and partial lockdowns. (a bit of the "nirvana fallacy" or unrealistic expectations)

Even some of the public health experts have lost sight of the original goals they had. Early on, they basically said if they could get a vaccine with the same efficacy rate as the flu shot with regards to preventing serious illness, and could convince 70% of the population to get it, they'd be happy with that and consider it a win.

We're there... we have close to 70% of people who've had their shots, and the Covid vaccines (even amid the delta variant) are still outperforming our yearly flu shots in terms of preventing hospitalizations and serious illness.

It seems like the goalposts have shifted. It comes across now as if "unless we can get 90% of the population vaccinated, and unless that vaccine is >90% effective and stopping any and all transmission, then it's too risky to open up"

I was never optimistic about achieving herd immunity on a virus with a high mutation rate. This was written recently by Northeastern research team:

With a highly contagious COVID-19 variant spreading rapidly across the U.S., herd immunity—once heralded to be the way out of the pandemic—may no longer be a possibility, several Northeastern experts say.

The concept of herd immunity has been offered up by health experts as a largely theoretical but important turning point in the COVID-19 pandemic. But hopes that the U.S. can achieve that critical mass of protection, whether by vaccination or natural infection, has started to wane, largely due to the Delta variant, says Mansoor Amiji, Northeastern University Distinguished Professor in the departments of pharmaceutical sciences and chemical engineering.

“In my opinion, the concept of herd immunity no longer exists,” Amiji says.

Early estimates in 2020 of what percentage of the population would need to be immune from infection to achieve herd immunity hovered between 70 and 80%. But that threshold has since risen, as more infectious variants began circulating.

Now that cases are rising across the country again because of the high transmissibility of the Delta variant, even with more than half of the U.S. population fully vaccinated, it’s time that health authorities rethink the pandemic “endgame,” says Neil Maniar, professor of the practice and director of the Master of Public Health in Urban Health program at Northeastern.

And that means throwing out herd immunity—which has helped inform the vaccine goal posts for cities and towns across the country—as a measure of progress, Maniar says.

“I don’t think herd immunity should be our focus anymore,” Maniar says. “We’re seeing now that even in a largely vaccinated population, you can still have spread, and that challenges one of the key goals of herd immunity.”

The goal now, Maniar says, should be to continue efforts to control infection rates. That means masking and urging that people continue to get the vaccine, which Maniar says “offers a higher degree of protection than natural immunity.”
...
It also is important that U.S. health authorities continue to expand their thinking about infection control policies beyond the nation’s borders, where several of the highly contagious variants first emerged, Amiji says.

“We really need to be more globally-minded,” Amiji says. “Even if we are very successful in our vaccination program, variants can come from elsewhere and upend that progress.”

And they have. The virus is now “constantly changing,” so much so that it’s making herd immunity an unattainable goal, Amiji says.

It could be too late to stop the Delta variant–and to achieve ‘herd immunity’ from COVID-19. - News @ Northeastern

 

[DaisyDay]

One reason COVID-19 is probably here to stay is that it is found in so many species besides humans, so even if a decent number of people got vaccinated, it will still fester in other populations and recur from time to time.

One hope is that like other corona viruses it will eventually evolve into a non lethal, widespread variety that doesn’t kill or cripple but confers immunity to the worse ones.

 

[ThatRobGuy]

I was never optimistic about achieving herd immunity on a virus with a high mutation rate. This was written recently by Northeastern research team:


It could be too late to stop the Delta variant–and to achieve ‘herd immunity’ from COVID-19. - News @ Northeastern

Maybe a better expression we should start using (with regards to public risk levels) is "herd protection" instead of "herd immunity"

...as one doesn't have to be absolutely impervious to the virus in order to get back to something resembling normalcy.

If we could get it to the point where the majority of people would be in a position where exposure/infection would likely be a worse-case-scenario of a mild-moderate respiratory infection that lasts a week, and we're blocking 40-60% of the transmission, I think that's adequate.

(which was the original hope & goal for the vaccines, and they're accomplishing that)

The reality is, a person is sorely mistaken if they think there was the chance that they could go through the rest of their life without every catching anything again.

While I'm vaccinated against covid, and still get my flu shot every year, I'm under no delusions about the fact that I'll get a cough, a fever, and sinus congestion at some point again in my life. I'm 37, I got another ~40-45 years left on the planet (if we're going with the averages), I'll get sick again at some point in my life.

"Let's all live like Howie Mandell" can't be the long-term approach to how we all live our lives.