Covid: the shape of things to come

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big_adventure

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There certainly is a movement in this country to villainize people who have not gotten vaxed - for whatever reason. Deny employment, attendance, participation, etc simply to drive the vax numbers up is not only folly but will have unintended but predictable consequences.

Because Barmoley got off to a good start, I just want to capture and "tweak" his thesis.

From the public policy stand point it is simpler to just say vax all, so this is what is being done. Simple has a great attraction to politicians who prefer to "do something" and then conflate it with "accomplish something". I just wish that there were more studies on natural immunity, as a bonus we might stop villainizing people if they don't get vaxed for whatever reason they choose.

Pro choice is not anti-vaccine.
OK, just no: denying privileges to bad actors or enforcing social contracts isn't "villainization."

You can't drive a car without a driver's licence. Is that "villainizing" people without licences? Of course not.

You can't go to work naked, generally. "Villains?" Nah.

You can't go to school or work in a lot of public sectors without a whole truckload of vaccinations already. Is that "villainization?" Obviously not.

You can't walk into the corner store and take a poop on the counter. Still not "villainization."

You can't run red lights and park in disabled spaces and drive 130 through the center of town, nobody calls that "villainization."

Putting rules in place to protect the public and enforcing them is literally the main purpose of government. We now see a deadly disease that doesn't have to be this deadly - the US started the vax effort well but, predictably, one of the two predominant political sides decided to politicize it. It stalled. They also politicized other mitigation efforts. Now the US is doing vastly worse than nearly every other developed western nation except for our friends waaaaaaay out there in the Pacific, who had a viable-ish lockdown strategy they could and did use. And, shockingly, this has translated into MUCH higher case numbers and MASSIVELY higher death numbers.

Arguing "we don't know 100% of the difference between vax+recovery and just vax" is in extremely bad faith, when we know, through real-world observation, empirically, beyond a shadow of a doubt that "vax is better than non-vax in every normal situation."

Vax / vax-adjacent mandates work. France was behind the States in vaccinations and doing worse in cases and deaths over a period of time until the administration here sacked up and put in the mandates. Vaccination rate shot up, and, shortly after, our case load started falling. With a population of around 1/5th the US, and much more densely populated (thus, generally better for virus transmission), the case rate here is about 1/20th the US rate (8K/day to 165K/day), and the death rate is slightly lower still at 1/23rd (81 versus 1888). Note, this is really easy to correlate, because a month ago, French rates were around 1/5th the US in both.
 

Matus

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Just to touch on immunity that stems from having recovered from Covid. Especially when one looks at different waves that when through different countries or regions (in particular several locations in south America or India that got hit badly last year are a good example) it becomes pretty clear, that once recovered one has certain level of immunity against the given type of virus, but as soon as new mutations shows, it all starts all over again. On the other hand the vaccines have (so far) been quite successful protecting from different mutations of the virus. That does not mean that it will be the case of the next one that may be just around the corner, but so far we got pretty lucky in this regard.
 

MarcelNL

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I wonder how all this became so policital, is there anyone listening to what the experts have to say? It;s not as if they cannot be heard, they have been all over TV every day and the whole day at that?

Same as with that article, the article is the source, if you listen to the translation of it by CDC propaganda office or someone recalling what they think the conclusions were it is all too easy to miss the whole point. Always go to the source, I hear master Yoda calling...
 

Luftmensch

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There certainly is a movement in this country to villainize people who have not gotten vaxed - for whatever reason. Deny employment, attendance, participation, etc simply to drive the vax numbers up is not only folly but will have unintended but predictable consequences.

Because Barmoley got off to a good start, I just want to capture and "tweak" his thesis.

From the public policy stand point it is simpler to just say vax all, so this is what is being done. Simple has a great attraction to politicians who prefer to "do something" and then conflate it with "accomplish something". I just wish that there were more studies on natural immunity, as a bonus we might stop villainizing people if they don't get vaxed for whatever reason they choose.

Pro choice is not anti-vaccine.
If someone holds a libertarian view, I will accept that as their world view. We can agree to disagree. I commend them if they are open about it. However, if a person holds a libertarian stance, I think it is profoundly wrong to muddy the medical consensus by throwing around red herrings.

In the countries we are talking about it is not illegal to be unvaccinated. Nobody has to be vaccinated. That said, it is becoming increasingly costly to exercise that choice. As you note, employment and attendance to certain venues may be limited for those who choose to remain unvaccinated. From a public health perspective, I do not have a problem with this. I do acknowledge this causes a dilemma for those who are inclined not to get vaccinated... but life is full of trade-offs.


.... on a side note... I am not entirely sure what the "unintended but predictable consequences" are...
 

Barmoley

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Just to touch on immunity that stems from having recovered from Covid. Especially when one looks at different waves that when through different countries or regions (in particular several locations in south America or India that got hit badly last year are a good example) it becomes pretty clear, that once recovered one has certain level of immunity against the given type of virus, but as soon as new mutations shows, it all starts all over again. On the other hand the vaccines have (so far) been quite successful protecting from different mutations of the virus. That does not mean that it will be the case of the next one that may be just around the corner, but so far we got pretty lucky in this regard.
I was referring to this study. Unfortunately, as I’ve acknowledged before it hasn’t been peer reviewed, so it is unknown if the conclusions are valid. This is why I want more studies, but in the US there is no political will to do so.

To the gentlemen who pointed out that me not getting the vaccine will not make this vaccine available somewhere else, thank you, but I acknowledged this at the end of this. I fully realize that this is not how vaccine distribution works and that individual decisions don’t matter here. Given that US already donated millions of vaccine doses to other countries on the federal level vaccines can be sent to other countries. We could save a lot of doses if it was determined that for example just one booster dose instead of two is enough for recovered.

Also, I don’t understand why a few of you are trying to make my arguments into antivax for people who didn’t recover. I think people who haven’t been sick should vaccinate and I’ve stated this multiple times. I am simply questioning why there are very few studies about natural immunity. I am interested to know if there is a need to vaccinate recovered and if so what should the protocol be. I want science to guide us not politics and in the US at the moment it seems to be politics.

Saying, “what’s a big deal just get a vaccine“ is missing the point, that these vaccine shots can potentially be more effective somewhere else. This is a global problem and if we have extras they should be donated abroad and this is possible on federal level as has already been done.
 

Luftmensch

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I am simply questioning why there are very few studies about natural immunity. I am interested to know if there is a need to vaccinate recovered and if so what should the protocol be. I want science to guide us not politics and in the US at the moment it seems to be politics.
Why is "natural immunity" of so much interest to you? Literally the first sentence of that CDC paper you guys were discussing addresses this:

Although laboratory evidence suggests that antibody responses following COVID-19 vaccination provide better neutralization of some circulating variants than does natural infection (1,2), few real-world epidemiologic studies exist to support the benefit of vaccination for previously infected persons.
You can look up those citations if you choose. A google search will reveal other publications on the natural immune response to COVID. The research is there. But you are glossing over points on why relying on a natural immune response is bad:
  • Exposure is risky
  • A low dose exposure does not necessarily confer a robust immune response
  • Exposure during the first wave does not necessarily confer a robust immune response to more recent variants
  • Identifying the degree to which a person has gained immunity from COVID is expensive and slow - a.k.a infeasible to effectively monitor from a public health perspective

Remember the vaccines are new. We are still trying to optimise their efficacy (e.g. time between doses). It may turn out that these are three dose vaccines (like hepatitis B or human papilloma virus). Maybe we do have to keep getting seasonal boosters like the Flu-shot.


Saying, “what’s a big deal just get a vaccine“ is missing the point, that these vaccine shots can potentially be more effective somewhere else. This is a global problem and if we have extras they should be donated abroad and this is possible on federal level as has already been done.
Okay... I agree with you if we are talking about a significant surplus. And as you noted somewhere, rich countries are donating surplus to poorer countries. So there is no problem?

But this is also what I mean about contradictory statements? An American who recovers from covid does not create a surplus - so the vaccine is not being taken away from anybody. The data suggests they would benefit from taking it. I dont see the problem? Or are you advocating the government plan to acquire and distribute less vaccines than the total population?

It is also worth pointing out that we can walk and chew gum. Why not try to get doses to poor countries whilst planning for gold-standard treatment in our own countries? If you believe a person in poor countries deserves the same access to medicine as the rich countries... then they will potentially need a third dose or boosters... and they will want to potentially advise their population to get a vaccine even if they have contracted covid.
 

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Barmoley

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Why is "natural immunity" of so much interest to you? Literally the first sentence of that CDC paper you guys were discussing addresses this:



You can look up those citations if you choose. A google search will reveal other publications on the natural immune response to COVID. The research is there. But you are glossing over points on why relying on a natural immune response is bad:
  • Exposure is risky
  • A low dose exposure does not necessarily confer a robust immune response
  • Exposure during the first wave does not necessarily confer a robust immune response to more recent variants
  • Identifying the degree to which a person has gained immunity from COVID is expensive and slow - a.k.a infeasible to effectively monitor from a public health perspective
I am not advocating exposure in lieu of vaccine. Once again, no exposure get the full vaccine. Your next 2 points is why we need more studies this study seems to contradict your points, claiming that previous exposure provides better immunity to Delta variant than 2 dose of Pfyzer.

From the study

Conclusions This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant.

The recovered were not recovered from delta variant, but instead recovered from other variants since Delta was not present at the time of exposure in Israel to any wide extent. If true it puts under suspicion your conclusion that natural immunity doesn't protect against variants. I also didn't notice them selecting for severity of infection in the recovered, unless I missed it, this puts under question the common belief that recovering after mild disease does not provide adequate protection.

So more studies are needed.


Remember the vaccines are new. We are still trying to optimise their efficacy (e.g. time between doses). It may turn out that these are three dose vaccines (like hepatitis B or human papilloma virus). Maybe we do have to keep getting seasonal boosters like the Flu-shot.



Okay... I agree with you if we are talking about a significant surplus. And as you noted somewhere, rich countries are donating surplus to poorer countries. So there is no problem?

But this is also what I mean about contradictory statements? An American who recovers from covid does not create a surplus - so the vaccine is not being taken away from anybody. The data suggests they would benefit from taking it. I dont see the problem? Or are you advocating the government plan to acquire and distribute less vaccines than the total population?

It is also worth pointing out that we can walk and chew gum. Why not try to get doses to poor countries whilst planning for gold-standard treatment in our own countries? If you believe a person in poor countries deserves the same access to medicine as the rich countries... then they will potentially need a third dose or boosters... and they will want to potentially advise their population to get a vaccine even if they have contracted covid.
Do you really not understand that if most recovered only need 1 shot instead of 2 or 2 + booster then we would have a lot more surplus? I am not suggesting that vaccine rich countries should give up their vaccines that are needed for local populations. I am suggesting that maybe we should figure out how many vaccines we actually need instead of just blindly administering more shots to people that might not need them.

This is why I am interested in natural immunity which requires more studies.
 

tcmx3

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There certainly is a movement in this country to villainize people who have not gotten vaxed - for whatever reason. Deny employment, attendance, participation, etc simply to drive the vax numbers up is not only folly but will have unintended but predictable consequences.

Because Barmoley got off to a good start, I just want to capture and "tweak" his thesis.

From the public policy stand point it is simpler to just say vax all, so this is what is being done. Simple has a great attraction to politicians who prefer to "do something" and then conflate it with "accomplish something". I just wish that there were more studies on natural immunity, as a bonus we might stop villainizing people if they don't get vaxed for whatever reason they choose.

Pro choice is not anti-vaccine.
your mistake is thinking that if you can safely get vaccinated and you dont that you arent a villain.

you are, unequivocally.
 

ian

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this study seems to contradict your points, claiming that previous exposure provides better immunity to Delta variant than 2 dose of Pfyzer.
Hey, that's cool. Wasn't aware of that! Yea, more studies = good.

I guess there are still merits to a universal 2 shot vaccination approach even if other studies have similar conclusions. E.g. it's harder to verify natural immunity, you don't want to encourage people to avoid vaccination by getting covid, and having a simple directive rather than one with a lot of exceptions will make everything smoother. I do admit I have a knee-jerk reaction to "let's see how we can get out of vaccination", since there are so many unreasonable objections to them in the air right now, which makes it harder to appreciate reasonable discussion. We probably all have this problem at the moment.
 
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daveb

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your mistake is thinking that if you can safely get vaccinated and you dont that you arent a villain.

you are, unequivocally.
Thanks (I guess) for your opinion. I don't share it.

While I chose to get the Vax, I have no judgement of those that don't.
 

Barmoley

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Hey, that's cool. Wasn't aware of that! Yea, more studies = good.

I guess there are still merits to a universal 2 shot vaccination approach even if other studies have similar conclusions. E.g. it's harder to verify natural immunity, you don't want to encourage people to avoid vaccination by getting covid, and having a simple directive rather than one with a lot of exceptions will make everything smoother. Sending more vaccines where they're needed sounds good, although I don't know how much supply is a problem. Like, is it going to be enough of a problem to actually factor into the question of what to do in the US? I do admit I have a knee-jerk reaction to "let's see how we can get out of vaccination", since there are so many unreasonable objections to them in the air right now, which makes it harder to appreciate reasonable discussion. We probably all have this problem at the moment.
There are merits to simple blanket statements, such as let's just vaccinate all. These have nothing to do with science, so let's not pretend they do. I am absolutely against governments lying to people for people's own good. As in let's not study or publish things that might encourage some idiots to get covid instead of vaccinate. I realize we live in the real world and people in government omit information to the public all the time, I just don't think we need to protect people who would actually choose to get sick. I suspect and hope there are very few of such individuals and that this is an imagined problem.

I absolutely agree with you Ian that having a reasonable discussion on the subject is virtually impossible at the moment. For some just questioning the need for the vaccine for some groups makes one evil and hatter of humans others think that vaccines that have been proven to be safe will somehow turn them into zombies.

<dumb rant follows>
I want more studies, so we can actually follow science when deciding on boosters and vaccine regiments. I want surplus to be sent where needed since as far as I read there are still shortages in the world. I want to be able to discuss science and medicine without people attaching me to groups I don't belong to. I can be pro vaccine in general and still question if boosters are needed or who needs them. I can be pro flipping on BST and decide not to do it myself. I can even appreciate simple carbon kitchen knives and also realize they are not the best tool for the job in most situations. These are not contradictions just the realities of the world not being black and white.
</end of rant>
 

MarcelNL

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I fully agree on more studies (heck I am in that business 😁 ), there are NUMEROUS studies ongoing. Not sure if anyone of you know clinicaltrials.gov (there are equivalent databases for EMA etc) , that site is trackin studies and if you hope to publish it needs to be listed there....4000plus ongoing studies,so read your heart out on protocol design and results when they come...

Disclaimer; the usual cycle between concept, approval (if patient consent is needed) to publication of results takes longer than you probably expect.
 

MarcelNL

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in addition; Government is not directing what gets studied or published in journals, you can also see the funding.
 

AT5760

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I just don't think we need to protect people who would actually choose to get sick.
In principle, I agree with this statement. In practice, I don't agree at all. Protecting people that would choose to get sick has real, tangible benefits. Those that choose to get sick may get very sick and choose to seek medical attention. Those people choosing to get sick would be consuming scarce resources (time, medicine, hospital beds, etc.) that could be used by those who did not choose to get sick. Moreover, those that choose to get sick are imposing substantial monetary costs on the rest of society unless they are paying for all medical costs completely out-of-pocket. Second, those that choose to get sick can infect others - thus leading to a greater loss of life and greater consumption of resources.

Motor vehicles are a great example of where society requires people to take actions that on the surface protect only the individual being regulated - seat belt laws and motorcycle helmet laws. Those laws also limit the costs that those individuals' decisions place on other citizens and public resources (medical treatment, emergency responders' time).

I'm not a huge fan of regulating individual conduct. But, unless we are going to hold people wholly accountable for the results of their conduct, then in rare circumstances this type of regulation may be a viable option.

Regarding your other point, I agree that additional studies on the effectiveness of vaccines on people previously infected with COVID is a good idea.
 

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I don't think many will choose to get sick on purpose instead of getting vaccinated just because there might be a chance of natural immunity being stronger. There are very serious risks to getting sick. There might be a few such individuals, but we shouldn't make policies based on a few individuals acting irrationally. This reason gets brought up all the time in discussions of natural immunity, and it is suggested that we shouldn't even discuss it because of this. I think this is wrong and only a theoretical problem.

The example of motor vehicle laws I am not sure about. I don't know anything about reasoning or history of motorcycle helmet laws, so don't know. On the surface it seems like in a serious motorcycle crash medical treatment, emergency responders' time, etc would still be needed helmet or not. It would be interesting to see statistics of how much public money helmets save. Again, on the surface motorcyclists not wearing helmets would make great organ donors, so helmet laws might be net negative to the society. So maybe instead of helmet laws we should have being a donor a prerequisite to getting a motorcycle license. Same for seatbelts, they clearly save lives and lower injuries, but should they actually be a law? I don't have an opinion on the subject. A lot more people drive cars in the US, so seatbelts probably save a lot more costs to the US society than motorcycle helmets. I like that my kids are forced to use seatbelts and I can't really see the negatives of seatbelts or helmets. to that point, why don't we require car drivers to wear helmets? Surely there is improvement to safety with a helmet.
 

big_adventure

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I don't think many will choose to get sick on purpose instead of getting vaccinated just because there might be a chance of natural immunity being stronger. There are very serious risks to getting sick. There might be a few such individuals, but we shouldn't make policies based on a few individuals acting irrationally. This reason gets brought up all the time in discussions of natural immunity, and it is suggested that we shouldn't even discuss it because of this. I think this is wrong and only a theoretical problem.

The example of motor vehicle laws I am not sure about. I don't know anything about reasoning or history of motorcycle helmet laws, so don't know. On the surface it seems like in a serious motorcycle crash medical treatment, emergency responders' time, etc would still be needed helmet or not. It would be interesting to see statistics of how much public money helmets save. Again, on the surface motorcyclists not wearing helmets would make great organ donors, so helmet laws might be net negative to the society. So maybe instead of helmet laws we should have being a donor a prerequisite to getting a motorcycle license. Same for seatbelts, they clearly save lives and lower injuries, but should they actually be a law? I don't have an opinion on the subject. A lot more people drive cars in the US, so seatbelts probably save a lot more costs to the US society than motorcycle helmets. I like that my kids are forced to use seatbelts and I can't really see the negatives of seatbelts or helmets. to that point, why don't we require car drivers to wear helmets? Surely there is improvement to safety with a helmet.
You keep making these arguments as if it's a zero sum game. You seem to be saying either we go 100% or we don't bother going. That's simply not reality.

Helmets vastly decrease the need for emergency response and certainly for serious treatment. An otherwise harmless slip or whatever turns drastic if you hit your head, and a helmet stops a large amount of that risk.

The issue with vaccinations and such is that you have to draw the line somewhere. There is solid evidence (peer reviewed and everything) that one dose of Pfizer or Moderna + recovery from most covid infections is better protection than 2 doses of Pfizer or Moderna. In fact, that's the requirement in France to qualify as "fully vaccinated": 2 doses, or one dose plus recovery. It's what I had - I had Covid back in February, and got jabbed in May, as soon as I could.

People saying "I don't want to do anything at all because FREEEEEEDDDDOOOOOOM" are, yes, the villains. Period. And if the requirements for doing whatever we want include having a shot, or two shots, or three shots, damnit, sack the hell up and take a little owie for the team.

Continuing studies are a fantastic idea, I'm in full support, but then, so is everyone with the slightest scientific bent. But while we're waiting for that, get ****ing vaccinated. Get a booster as well. It won't hurt anyone if you do. (I'm using the non-specific "you" here). Studies take a long-ass time. Covid kills people much more quickly than that. Vax mandates work to protect people's lives. Period. If the scientific consensus becomes "get a booster" then get a freaking booster. Getting a shot of vaccine on top of covid recovery definitely won't kill you or anyone else, but covid might. Get it. This just isn't complicated.
 

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You keep making these arguments as if it's a zero sum game. You seem to be saying either we go 100% or we don't bother going. That's simply not reality.
I say no such thing please don't read your bias in what I actually say.

Helmets vastly decrease the need for emergency response and certainly for serious treatment. An otherwise harmless slip or whatever turns drastic if you hit your head, and a helmet stops a large amount of that risk.
As I said I don't know. This is most likely true, but you'd have to provide proof of your statements. Just because it seems that this is true does not actually make it so without statistical data which I hope was used when helmets became law. I really don't care just not sure helmets are a good parallel to vaccines, I don't know anything about helmets or why they are law.

The issue with vaccinations and such is that you have to draw the line somewhere. There is solid evidence (peer reviewed and everything) that one dose of Pfizer or Moderna + recovery from most covid infections is better protection than 2 doses of Pfizer or Moderna. In fact, that's the requirement in France to qualify as "fully vaccinated": 2 doses, or one dose plus recovery. It's what I had - I had Covid back in February, and got jabbed in May, as soon as I could.
This is what I want and keep on writing about yet it is lost in the desire of some to just blindly vaccinate all.

In the US recovery + 1 dose is not considered being fully vaccinated. Even though as you say

There is solid evidence (peer reviewed and everything) that one dose of Pfizer or Moderna + recovery from most covid infections is better protection than 2 doses of Pfizer or Moderna.
In the US only 2 shots of Pfizer or Moderna or one shot of J&J is considered fully vaccinated. Regardless of the evidance that only one shot is needed for recovered. Even though it is totally irrelevant to this discussion I too had covid in February and received 2 doses of pfizer in May. It made sense to me due to my lifestyle and what was known at the time. I didn't need 2 doses from what we know now, but in the US getting just one I would not be considered fully vaccinated.

People saying "I don't want to do anything at all because FREEEEEEDDDDOOOOOOM" are, yes, the villains. Period. And if the requirements for doing whatever we want include having a shot, or two shots, or three shots, damnit, sack the hell up and take a little owie for the team.

Continuing studies are a fantastic idea, I'm in full support, but then, so is everyone with the slightest scientific bent. But while we're waiting for that, get ****ing vaccinated. Get a booster as well. It won't hurt anyone if you do. (I'm using the non-specific "you" here). Studies take a long-ass time. Covid kills people much more quickly than that. Vax mandates work to protect people's lives. Period. If the scientific consensus becomes "get a booster" then get a freaking booster. Getting a shot of vaccine on top of covid recovery definitely won't kill you or anyone else, but covid might. Get it. This just isn't complicated.
It is complicated and scientific consensus has to be based on science, in the US it doesn't seem to be when suggesting that we should vaccinate everyone with 2 shots and possibly additional booster soon. Since as you point out there is well researched evidence that one shot is enough.

You are lucky to live in a country where vaccine shots can be wasted to boost you beyond need while the rest of the world suffers not having vaccines. It's nice to get on a soap box and scream and yell get as many shots as you want even though protection is exceedingly marginal while some don't have any. How about just getting as much as makes you very safe and donating the rest to countries that need them? We as individuals can't do it, but our governments can. So they need to be held accountable for their policies.
 
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tcmx3

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You are lucky to live in a country where vaccine shots can be wasted to boost you beyond need while the rest of the world suffers not having vaccines. It's nice to get on a soap box and scream and yell get as many shots as you want even though protection is exceedingly marginal while some don't have any. How about just getting as much as makes you very safe and donating the rest to countries that need them? We as individuals can't do it, but our governments can. So they need to be held accountable for their policies.
that is a terribly bad faith argument.

most of what you're saying is reasonable even if I dont agree but this is not kosher IMO. the status of vaccine availability in his country is irrelevant to the validity of his point.
 

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that is a terribly bad faith argument.

most of what you're saying is reasonable even if I dont agree but this is not kosher IMO. the status of vaccine availability in his country is irrelevant to the validity of his point.
Which of his points are you referring to? That we should continue boosting on top of boosting even if the effect is exceedingly small because it doesn’t hurt anyone while COVID might.

Do you really think that he would say the same if vaccines were very limited in his country. Be honest with yourself, would he not instead encourage all to take just enough to be very safe and share the rest. So yes availability of vaccines in his country is very relevant. Please don’t bring up the, “well him not taking the shot won’t help anyone in Ukraine”.
 

tcmx3

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Which of his points are you referring to? That we should continue boosting on top of boosting even if the effect is exceedingly small because it doesn’t hurt anyone while COVID might.

Do you really think that he would say the same if vaccines were very limited in his country. Be honest with yourself, would he not instead encourage all to take just enough to be very safe and share the rest. So yes availability of vaccines in his country is very relevant. Please don’t bring up the, “well him not taking the shot won’t help anyone in Ukraine”.
hypothetical and completely irrelevant.

if you dont want to engage him on the point directly then dont. and dont try and turn it on me I know the shtick and am uninterested in engaging with you if you plan to do so, again, in bad faith.
 

ian

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I don’t understand what all the screaming is about anymore. It seems like @Barmoley is mostly questioning whether there should be a change in US policy where we don’t buy as many vaccines, or ship more overseas, and whether in the recent Biden order having had covid previously could count in lieu of at least one vaccine shot. Idk, these seem like reasonable questions. I’m not if sure I agree about the second one, since I do see potential benefits to the current approach, and the data seems to be still coming in, but on the other hand maybe it’d be worth it just to make everything slightly less polarized.

Maybe @Barmoley’s argument will seem less distressing if you just think about it as a question about future policy regarding vaccine allotment rather than about whether to yourself get vaccinated if there are shots available near you. Regarding this other question, my answer is well put in the article posted by @chefwp.
 

chefwp

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In principle, I agree with this statement. In practice, I don't agree at all. Protecting people that would choose to get sick has real, tangible benefits. Those that choose to get sick may get very sick and choose to seek medical attention. Those people choosing to get sick would be consuming scarce resources (time, medicine, hospital beds, etc.) that could be used by those who did not choose to get sick. Moreover, those that choose to get sick are imposing substantial monetary costs on the rest of society unless they are paying for all medical costs completely out-of-pocket. Second, those that choose to get sick can infect others - thus leading to a greater loss of life and greater consumption of resources.

Motor vehicles are a great example of where society requires people to take actions that on the surface protect only the individual being regulated - seat belt laws and motorcycle helmet laws. Those laws also limit the costs that those individuals' decisions place on other citizens and public resources (medical treatment, emergency responders' time).
Slightly off topic but I live in one of the few US states that does not require cyclists to wear helmets. I am heartened to say that I see a large percentage actually have the good sense to wear a helmet anyway while enjoying their motorcycle (my observations are anecdotal, I don't know the actual percentage). The others I've coined a special word for, I call them "donorcyclists."
 

big_adventure

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I say no such thing please don't read your bias in what I actually say.



As I said I don't know. This is most likely true, but you'd have to provide proof of your statements. Just because it seems that this is true does not actually make it so without statistical data which I hope was used when helmets became law. I really don't care just not sure helmets are a good parallel to vaccines, I don't know anything about helmets or why they are law.



This is what I want and keep on writing about yet it is lost in the desire of some to just blindly vaccinate all.

In the US recovery + 1 dose is not considered being fully vaccinated. Even though as you say



In the US only 2 shots of Pfizer or Moderna or one shot of J&J is considered fully vaccinated. Regardless of the evidance that only one shot is needed for recovered. Even though it is totally irrelevant to this discussion I too had covid in February and received 2 doses of pfizer in May. It made sense to me due to my lifestyle and what was known at the time. I didn't need 2 doses from what we know now, but in the US getting just one I would not be considered fully vaccinated.



It is complicated and scientific consensus has to be based on science, in the US it doesn't seem to be when suggesting that we should vaccinate everyone with 2 shots and possibly additional booster soon. Since as you point out there is well researched evidence that one shot is enough.

You are lucky to live in a country where vaccine shots can be wasted to boost you beyond need while the rest of the world suffers not having vaccines. It's nice to get on a soap box and scream and yell get as many shots as you want even though protection is exceedingly marginal while some don't have any. How about just getting as much as makes you very safe and donating the rest to countries that need them? We as individuals can't do it, but our governments can. So they need to be held accountable for their policies.
First: most countries don't accept the "recovered and one-shot" plan. Even France only does if the recovery is between, I believe, 3 and 12 months or something.

Second, the same studies that show that one shot + recovery is good (and probably somewhat better than "just" vaccinated) also clearly show that two shots plus recovery is better by a tangible degree. France simply made the decision, back when vaccines were rarer and it seemed like people would, you know, actually want the vaccines without being forced to take them, to reduce the load on the system for that small but tangible gain.

Third, we are in a changing, turbulent world here: because some asshats, a significant number of them, don't want to be vaccinated, roll-out stalled somewhat in many countries. This means more formation and distribution of variants. Up until now, some of the existing vaccines at their existing doses do pretty well against these variants, especially for preventing serious infections. But the larger the pool of the infect-able people, the larger the chance of variants forming that evade existing vaccines. Therefore, even a marginal improvement in protection for those willing to not endanger their fellow man is extremely justified, because those improvements are real and proven.

Fourth, you keep presenting this as a zero sum game simply because you are denigrating the entire system because it has some small flaws. You point these small flaws out as reasons to trash the larger, empirically effective part of it.

Fifth, you keep harping on worldwide distribution issues as a reason not to give plenty and more to Americans, from Americans themselves. Given the long term global problems in malnutrition (literally BILLIONS of people on this planet live in some state of malnutrition) while Americans consume and throw away much more than they need annually, I am led to assume that you don't do that, subsisting on minimal rice, grain and soybeans, never ever leaving anything uneaten, while yelling your lungs out about over-consumption back home. Given the massive amounts of poverty in the world, I have to assume that you are living an acetic, minimalist life, with nothing unnecessary at all and no flagrant over-consumption, and that you send half of what you earn to the impoverished in developing nations while proselytizing about that rampant over-consumption back home. No? I didn't think so.

Sixth, the US has been making choices about the vaccines based on science since the beginning. That doesn't meant that there aren't other factors. As I stated before but you glossed over, the US's prime responsibility is to ensure adequate protection for all Americans, before ensuring the same for the rest of the world. This means distributing fragile vaccines in sufficient quantities to places reachable relatively easily by everyone in the country, no matter where they live. A vaccine shortage in the US is infinitely worse for the US, its residents and for the elected and career officials who manage this stuff. The US absolutely should error on the side of providing more, not fewer, vaccines for it's citizens than are strictly and completely necessary. Every country should do this, if possible.

Seventh, the issues facing vaccine distribution and supply in certain parts of the world are overwhelmingly not caused by consumption of available doses elsewhere. Early on, sure, but not at this time. Some places are politically challenged on the issue. Some, financially. It's a problem, and not a small one. But that being a problem elsewhere doesn't mean that the US shouldn't protect, and even overprotect, its own residents. And they definitely shouldn't decide to "wait for perfection" in the middle of a global pandemic. Peer-reviewed scientific studies take time, and getting multiple different studies run, reviewed, compared and published takes more time still, and frankly, we don't have that much time here. It would be different if people would just get the freaking vaccine, but the US has shown us that some people value invective over injections.

Eight, you know effectively nothing about me at all, please refrain from making personal judgments on what I believe and why that are outside of the context of what I've actually said.

Anyway, I can keep making points that you are going to continue to not listen to, but I think I've already hit my tl;dr for the day.
 

Barmoley

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First: most countries don't accept the "recovered and one-shot" plan. Even France only does if the recovery is between, I believe, 3 and 12 months or something.

Second, the same studies that show that one shot + recovery is good (and probably somewhat better than "just" vaccinated) also clearly show that two shots plus recovery is better by a tangible degree. France simply made the decision, back when vaccines were rarer and it seemed like people would, you know, actually want the vaccines without being forced to take them, to reduce the load on the system for that small but tangible gain.

Third, we are in a changing, turbulent world here: because some asshats, a significant number of them, don't want to be vaccinated, roll-out stalled somewhat in many countries. This means more formation and distribution of variants. Up until now, some of the existing vaccines at their existing doses do pretty well against these variants, especially for preventing serious infections. But the larger the pool of the infect-able people, the larger the chance of variants forming that evade existing vaccines. Therefore, even a marginal improvement in protection for those willing to not endanger their fellow man is extremely justified, because those improvements are real and proven.

Fourth, you keep presenting this as a zero sum game simply because you are denigrating the entire system because it has some small flaws. You point these small flaws out as reasons to trash the larger, empirically effective part of it.

Fifth, you keep harping on worldwide distribution issues as a reason not to give plenty and more to Americans, from Americans themselves. Given the long term global problems in malnutrition (literally BILLIONS of people on this planet live in some state of malnutrition) while Americans consume and throw away much more than they need annually, I am led to assume that you don't do that, subsisting on minimal rice, grain and soybeans, never ever leaving anything uneaten, while yelling your lungs out about over-consumption back home. Given the massive amounts of poverty in the world, I have to assume that you are living an acetic, minimalist life, with nothing unnecessary at all and no flagrant over-consumption, and that you send half of what you earn to the impoverished in developing nations while proselytizing about that rampant over-consumption back home. No? I didn't think so.

Sixth, the US has been making choices about the vaccines based on science since the beginning. That doesn't meant that there aren't other factors. As I stated before but you glossed over, the US's prime responsibility is to ensure adequate protection for all Americans, before ensuring the same for the rest of the world. This means distributing fragile vaccines in sufficient quantities to places reachable relatively easily by everyone in the country, no matter where they live. A vaccine shortage in the US is infinitely worse for the US, its residents and for the elected and career officials who manage this stuff. The US absolutely should error on the side of providing more, not fewer, vaccines for it's citizens than are strictly and completely necessary. Every country should do this, if possible.

Seventh, the issues facing vaccine distribution and supply in certain parts of the world are overwhelmingly not caused by consumption of available doses elsewhere. Early on, sure, but not at this time. Some places are politically challenged on the issue. Some, financially. It's a problem, and not a small one. But that being a problem elsewhere doesn't mean that the US shouldn't protect, and even overprotect, its own residents. And they definitely shouldn't decide to "wait for perfection" in the middle of a global pandemic. Peer-reviewed scientific studies take time, and getting multiple different studies run, reviewed, compared and published takes more time still, and frankly, we don't have that much time here. It would be different if people would just get the freaking vaccine, but the US has shown us that some people value invective over injections.

Eight, you know effectively nothing about me at all, please refrain from making personal judgments on what I believe and why that are outside of the context of what I've actually said.

Anyway, I can keep making points that you are going to continue to not listen to, but I think I've already hit my tl;dr for the day.
@ian gets what I am saying maybe he can explain it better. I keep on talking about one thing and you keep on bringing up everything else and accusing me of exactly what you are doing.
 

Luftmensch

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@Barmoley

Perhaps you and I share more views in common than might be obvious. :)

Like you noted earlier, the Israeli study has not passed peer review. Until then it is merely 'interesting'. Drawing strong conclusions based off the study is premature. The study is also not advocating for any particular health management position. It is simply presenting and analysis.

If we start from the position that the study is valid, it could also be used to support my point of view. Isnt one of the conclusions: previously infected & vaccinated individuals have the best immune response?

In fact you and I would probably agree that:

unvaccinated < vaccinated < previously infected & vaccinated

I don't think this is controversial? From my laughably limited understanding of immunology, this result is to be expected. The controversy in this discussion, such that there is one, is where the category 'previously infected & unvaccinated' should be placed. And how this category should be managed.

Again, my preference is to defer to large bodies. They know better than me. Australia is adopting the EU coding system for vaccine passports. As @big_adventure points out, the EU recognises recovery + one vaccine dose as fully vaccinated. However, this is not natural immunity. Recognising recovery + one vaccine dose as 'fully vaccinated' is not inconsistent with the findings of the Israeli study. It is not inconsistent with my position. And, it is not inconsistent with your position (one dose is saved). You will be pleased to know the EU is effectively treating recovered people as vaccinated for 180 days - so long as they hold valid certificates (as far as I can tell).

Given Australia is using this technology, it remains to be seen whether we layer a higher standard for vaccination on top of the system. I can imagine we might initially do this. In time we are likely to relax our position to align with our trading partners. At this stage... who knows? I don't.

Getting back to my preference for referring to more knowledgeable sources, I guess it is a "choose your own adventure". The Israeli study counters observations made in this study (published two months ago). I am sorry to say, it is a more impenetrable read! The press-release is more digestible. If quotes are an accepted medium for summarising an article, this is what a co-author says in the press-release:

What this work has shown us is that current observations about vaccines show they offer a much broader protection against COVID-19 and its variants than the body’s natural immune response following infection, which is usually only protective against the variant of the virus that the person was infected with. We, therefore, should not rely on the body’s natural immune response to control this pandemic, but rather the broadly protective vaccines that are available.
Make what you will of this information in the context of the unpublished Israeli study. I don't mean to trash the Israeli study. It just needs to be treated with caution until it has passed/failed review. In either case, I will note that they both point towards the position that previously infected & vaccinated is better than previously infected & unvaccinated.

But then, I think you would acknowledge this as well? :) In which case, perhaps our biggest difference is just about resource management? Here I will note; science does not tell us how to manage a scenario. It is a process used to explain phenomena and help answer some questions. Simply appealing for more data and analysis will not necessarily tell us exactly how to manage complex trade-offs. Hopefully it will lower the uncertainty of some of our decisions and add precision to our processes.

If this discussion is a resource management issue, I am not yet convinced of the benefits you imply might follow from naturally immunity. And I certainly dont think they stack up against the cost. As discussed, the added complexity to public health management does not look like it would result in a useful amount of benefit *to me*. This is particularly true given these individuals would benefit from the vaccine. And particularly true given the cohort is a minority.

America has approximately 42M documented cases of COVID... and a population of 333M. If all those people did not want to be vaccinated... that is a large minority of 12% with natural immunity. It represents a potential saving of 12% of the vaccine supply (6% if you consider it a one dose saving). I am not convinced this potential 'excess' saving would have a material effect on global supply.

In Australia, 80,400 people have had documented cases of COVID. Our population is 25.7M. If all those people did not want to be vaccinated... that is a tiny minority of 0.3% of the vaccine supply. Clearly Australia's potential 'excess' is just noise in the data - it doesnt even feature in the discussion.

Here I am just looking at the potential to save vaccines by relying on natural immunity. I don't see these savings as significant. Of course, it ignores all the potential benefits of vaccinating that cohort. Similarly, it ignores added complexity to public health management and distribution issues that we have already discussed!

I am willing to meet you in the middle and settle for previously infected & one dose-vaccinated as a policy. But at this stage I remain unconvinced that previously infected & unvaccinated is good for the individual or the pack. And I am prepared to be wrong... but I would be surprised if public health officials adopt previously infected & unvaccinated as a durable policy. If they do, I will reverse my position.
 
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natto

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I don’t understand what all the screaming is about anymore
Me too. It's a while since covid was researched enough to show the options we got. Research proceeds, but the basics got clear. Thet leaves the question open. how to balance different interests.

Germany got a government of two partys. One caring for people, the other for economy. This way lost income got some compensation. Of course restaurants and bars got compensations too. As this is germany, how to protect econymy was part of every equation, often unsaid. One result are alltime highs at the stock.

And we will elect a new government on 26th. It looks like we will need at least three partys to build a majority. This might become one of the elections where some change is possible.

To care for covid took a lot of money. What about fridays for future with all the money gone? A reduction of resource consumption that matters will be expensive. Only rich countries can afford this. Germanys idea is to develope and sell tecnologie and become richer, no cost in sight. Remind you, elections upcoming... ...tldr, back on topic
 
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