The line I've heard repeatedly is we're waiting for "total" herd immunity, as in ensuring almost all of a population is potentially protected from the virus. Frequently quoting fall / end of 2021, potentially into 2022.
Shouldn't the only benchmark be those with medium-to-high risk of hospitalization? (Determination of risk however you'd like to do it.)
Put another way, you wouldn't shut the world down if a bunch of people got sick for a few days. You may, and indeed we have, shut it down if a large part of the population were at risk of hospitalization or death. In many developed countries, that population is looking at full inoculation (for those who want it) sometime this spring.
Should that not be the "end" of it?
Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?
Hospitalizations are weeks delayed from COVID# or %Positive spikes. Its a slow moving disease: taking 5 to 14 days before people feel sick, and then a week or two AFTER that before people decide to go to the hospital.
As such, if you see a spike of hospitalization, you're already 3-weeks late to the results (ie: hospital spikes are associated with infections that occurred 3+ weeks ago).
In contrast, watching COVID# or %Positive numbers gets you much closer to the ~5-14 day period where symptoms appear (and thanks to contact tracing, some people may test themselves before symptoms arrive: gaining a few precious days in the information war). Hospitalizations and Deaths are strongly correlated (with a few weeks delay). So you're effectively gaining a week-or-two worth of information.
Its better to be only 1-2 weeks behind (watching COVID#), rather than being 3-4 weeks behind (watching Hospitalization#).
Because it is not given and - if given - is not reassuringly close to 1. Correlation is positive, alright. But if you calculate hospitalization as percentage of cases, even adjusting for a lag, it is far from constant. Eg in Canada this ratio was 6x time higher in the first wave than in the second. It strongly depends on testing policies and hospital admission criteria.
* A peak of cases around Apr 11, followed by a peak of hospitalizations on Apr 22, with a peak of deaths also around Apr 22.
* A peak of cases around Jul 22, followed by a peak of hospitalizations around July 26, followed by a peak of deaths around August 4.
If I were going to do a more detailed analysis, I would want to try breaking out individual states/counties (subject to some reasonable population minimum), such that multiple distinct trends nationally don't interfere with each other in the data.
I really wish that stochastic testing were discussed more seriously.
As we vaccinate the people at the highest risk of hospitalization, the correlation will change: Numbers may stay very similar, but hospitalizations should go way down.
I would look at either hospitalizations or deaths once vaccinations reach a large percentage of the population.
Then we'll know in 2 weeks to change the policy and account for it.
Note that vaccinations will *also* cause the %positive and case# to decline. USA is approaching 15% vaccinated at over 95% efficacy means that you'll have 15% fewer cases (as well as 15% fewer hospitalizations later on). I'm not convinced that cases will become desynchronized with hospitalizations: my expectation is that vaccination will cause a decline in both case# and hospitalization#, roughly in proportion.
But if case# and hospitalization# become less correlated, then it won't take long (~2 weeks to see the first effects, maybe 4-weeks to be sure of the effects) to see such a split in the time-delayed correlation.
EDIT: Why the downvotes? Today, there's a new study being pre-pub'd that shows that Pfizer's mRNA vaccine is ~90% effective at stopping the spread of the virus (https://thehill.com/policy/healthcare/539783-pfizer-vaccine-...).
When you have a vaccine that's both 90% effective at stopping the spread and 95% effective at stopping hospitalizations, then the spread and hospitalization numbers will both go down severely (that is: #cases and #hospitalizations reported both go down).
This assumption that #cases and #hospitalizations will become "desynchronized" isn't necessarily written in stone. Its possible both numbers drop down dramatically in the coming weeks as vaccines are distributed... indeed, its highly likely IMO.
Concretely, that means hospitalization rates should decline a LOT faster than community spread. This is going to be less visible in countries that have their shit together and are able to vaccinate very fast / have already moved on to genpop, but in most of the EU (sigh), we've just finished vaccinating care homes and 75+. So now, a couple of weeks from now, we should see hospitalization numbers sharply decline because that share of the population represents the most hospitalizations, and will now be mostly immune.
So despite being at like, 5% total vaccinated, we should see a decline in hospitalizations of up to 75%.
Furthermore, given that most of the spread happens outside the most-at-risk in the first place (since those most at risk were those with the most protective measures before vaccines), 5% vaccinations should not mean 5% less cases total.
Once this "Priority 1A" group was vaccinated, then age 75+ individuals were vaccinated in Priority 1B. Even then, Postal Office employees and Grocery Store workers (other "high impact" workers) are in the 1B and 1C prioritization queues.
With efforts being to reopen schools, 1B also includes school-teachers (stop-the-spread focus). So a 21-year-old healthy school teacher is prioritized over a 67-year old obese person (despite the 67-year old's higher risk factors).
So at least in the USA: there's a significant effort being placed on high-impact "stop the spread" kind of vaccination effort. There is an element of "save lives", but stopping the spread also saves lives. So its a difficult calculus. (USA has some risk-factor prioritizations... 1B with 75+ age, and 1C with 65+ age + comorbidities like obesity. But again, Grocery Store workers are in 1C as well).
I realize other countries have different priorities. But hey, I live in the USA so my understanding of things will have a USA-slant. These 1B / 1C things are also CDC recommended. Different states (like Texas) are more aggressively stop-the-spread than CDC guidelines (while other states may lean more towards risk-factor based "save lives / prevent hospitalizations"). 50-different states, 50+ different policies. Welcome to America.
Michigan reports having given at least 1 shot to about 40% of over 75. Eligibility overlaps quite a lot rather than dictating the precise order.
See the coverage metrics tab for age group coverage in MI: https://www.michigan.gov/coronavirus/0,9753,7-406-98178_1032...
To take directly from the CDC , "Other essential workers, such as people who work in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health."
Doesn't that cover pretty much everyone on HN ?
 - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommend...
Second, shouldn't the focus be #1 - stop deaths; #2 - stop hospitalizations; #3 Stop the disease (which is what "spreading" actually is)
No, it's not. It's “essential workers”, which isn't everyone in the listed sectors but people in the listed sectors whose work cannot effectively be done remotely; approximately, the people that were exempted and allowed to work on site during the strongest lockdowns, where they occurred at all.
> Doesn't that cover pretty much everyone on HN ?
Probably not; lots of people on HN are probably in jobs that can be and are being done remotely. Even if it did, “everyone on HN” and “everyone” aren't the same thing.
Outside of big corporate tech, I also know a bunch of people working 100% remote but already got vaccinated because they are an employee of pharmaceutical/medical company and qualify as health care workers.
We can be pedantic on how a 1C essential worker isn't everyone but it is a huge percentage. Maybe my sample of people I know in the Bay Area is too small but at least half of my friends can classify as 1C.
Edit: I found some slides from the CDC which totals the 1C estimate as 129M people. So my small local observation isn't that far off from what the CDC expects.
Now people are going to game this stuff, but the distribution is wide enough that it’s not really that import to be completely precise.
Not to be impolite, but _I am absolutely correct_.
See here  for the detail, on which I quote, "in Phase 1c, persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions, and essential workers not recommended for vaccination in Phase 1b should be offered vaccine."
Further, if you read the double asterisks note at the bottom of that page, you'll see this, "On December 20, 2020, ACIP voted 13 to 1 in favor of the Phase 1b and 1c allocation recommendations."
Finally, if you look at the chart on the lower half of the page, you will see that _group 1c includes 199 million people_ (32 + 110 + 57 ), which is, after the 75 million people in groups 1a & 1b, darn near everyone.
So if you think I'm wrong, offer proof, not an interpretation. With proof, I'll gladly admit error, but the facts are very clear.
 - https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e2.htm?s_cid=...
Because stopping the disease implicitly stops the deaths and hospitalizations, its not very clear that a focus on deaths-only or hospitalizations-only is optimal.
Especially when you consider that the disease will continue to mutate as it exists (possibly making our vaccines less effective or even obsolete). So stopping the disease first-and-foremost might be the most effective way to stop deaths/hospitalizations (especially when mutations are considered).
Turning the R-value from 1.5 to 1.3 means a 14% decline COMPOUNDED PER GENERATION. After one generation, its 14% fewer cases (and 14% fewer hospitalizations and 14% fewer deaths). After two generations, that's 25% fewer cases (and 25% fewer hospitalizations and 25% fewer deaths). After three generations, its 35% fewer cases (and 35% fewer hospitalizations and 35% fewer deaths). Etc. etc.
As such, "stopping the spread" has a benefit that grows exponentially every week or two (the generational period of this virus). Exponentially growing its results and efficacy.
Keeping our eye on the bigger picture, it seems like stopping the spread is the best way forward to stop deaths and hospitalizations. I realize this is a bit "splitting hairs" (compared to people who would rather "save lives" and focus on hospitalizations and/or deaths). But... it seems like the superior strategy in my opinion.
That’s not how it works, you’re missing a variable (prevalence).
However, we could speculate that perhaps we should in fact put more priority on the groups that have most infections, not highest risk? Because the restrictions impact their lives (of young people) most.
However, I'm quite sure that the priorisation of old people will continue, except possibly in places where priorisation is done by money (the rich purchasing vaccinations).
If you were running a business and there was a relatively low incidence of an utterly catastrophic outcome, you’d buy insurance for the eventuality.
If you were running another business with a high occurrence of a mild outcome, you’d price it into the cost of doing business.
Insurance = vaccine. Cost of business = stimulus cheques.
From a control theory perspective, it's one of the worst measures because it's delayed. Much more efficient to measure cases - then you don't need restricted social life as long.
Sure they are. They're less precise, but they're more useful, because they're more likely to let you combat the spike before it gets out of control.
It's like a smoke alarm. Maybe it's going off because it's over-sensitive and someone just took a shower... but it's a better early warning system than waiting for active flames to appear.
Until then, getting out in front of a spike remains necessary.
But once enough people are vaccinated, the pattern may change. For example, you may still catch quite a lot of cases through PCR testing which is very sensitive, but the share of asymptomatic cases will be much higher and the share of people who are going to suffer a severe case much smaller.
The entire societal signature of the disease will change depending on vaccination levels and maybe even particular vaccines used.
From very early on in the pandemic, it seemed to me like our goal for optimal balance between caution/risk was to try and maintain the highest level of hospital occupancy that is sustainable. If every single person quarantines perfectly, then our hospitals are empty, but so is every business. If no one quarantines, our businesses are full, but so are hospitals and everyone's viral load; i.e. maximum mortality.
With the vaccines now available, it seems like our goal should still be be to maintain the highest level of sustainable medical system occupancy.
I just object with the parent's following statement:
> With the vaccines now available, it seems like our goal should still be be to maintain the highest level of sustainable medical system occupancy.
If we are still trying to maintain the highest level of sustainable medical system occupancy while the percentage of population that has been vaccinated is slowly increasing, it would actually mean we are doing a horrible job in trying to limit preventable deaths when a fully vaccinated populace + herd immunity is not too far away. Maybe when a much larger percentage of the population is vaccinated, the spread and rate of deaths will be low enough that this may change, but we are still nowhere near that stage.
Up to 3 weeks ago, California, the Southeast were in field hospital territory.
Anecdotally, Alabama hospitals have been in overflow since July.
Georgia re-established a field hospital in January at their conference center  hospitalizations only stopped dropping beginning at the end of January
And that article is from December.
You can see ER status by hospital here: https://georgiarcc.org . Flip through the counties where most people live and you'll see a lot of full ERs.
You should choose another region to support your argument, it's not going so well here in Georgia right now.
But if your base is zero then double that is still zero. That's why they've pursued elimination and why it has worked.
This was predictable in advance, and with hindsight I still would prefer 0 cases.
And normal only in the sense that many people don't care that much if very few people are allowed to enter the country.
For several days Auckland residents couldn't go to the pub.
Normally of course they can go to the pub. Or a night club. Or a packed stadium to watch sports.
But it's true that for several days last week in Auckland they weren't allowed to do that. And the same back in... September maybe? And according to you that isn't "mostly back to normal" so we can assume you believe it isn't "mostly back to normal" anywhere and never will be. That's just not a very useful benchmark.
Still, I think you're right when you say perhaps unnecessary: some countries have successfully suppressed COVID without eliminating it. That said, it's some but not many countries.
I'm a bit ambivalent. Regardless, it certainly wasn't necessary for NZ to close their border to asylum seekers.
Ouch, that article links to one from May 2020. It said the Avatar film crews were allowed to fly in, whilst families were separated.
1. Trend in 14-day rate of new COVID-19 cases per 100,000 population, shown as Trend in case rate;
2. Trend in 14-day rate of new COVID-19 hospital admissions per 100,000 population, shown as Trend in hospital admission rate;
3. Average 7-day percent occupancy of ICU staffed beds, shown as Percent ICU occupancy;
4. 7-day percent positive of COVID-19 tests, shown as Percent positivity.
And there are phased reopening plans, where restrictions are slowly lifted based on different tresholds for the above. So if the above 4 metrics meet some treshold we might go into phase 2 where now indoor dining at half capacity is permitted for example. If the numbers than stay under the treshold and eventually keep going down, we'd go to phase 3, etc. If the numbers get worse after moving to phase 2 we'd go back to phase 1 with more restrictions.
Seems pretty reasonable to me. They're always kind of revising the tresholds to some extent as well, so it's not set in stone. But it makes sense for me to take a staged approach to reopening and just make sure we're truly over Covid before going all back to normal (so it doesn't come back).
It depends which line you are considering; if wearing masks yes.
If "reopening and returning to normal" that remark is most resembles a hyperbole.
In the United States, on April 16th 2020, the Coronavirus task force outlined a 3 phase plan dependent on 3 criteria based on 2 week averages
1) Hospital Vacancy,
2) New cases decreasing (from where they were), and
3) Percent positive testing rate under 10% (that suggests that the tests numbers are close to accurate and not in community spread)(5% is the standard that Europe uses as a liberal goal, 2.5% is the recommended)
For an answer on those 3 in the US (today)
1) Hospitals are just now where they were on April 16
2) New cases is about 3x where they were April 16
3) We've been under 10% since 1/21 (now at a 7 day average of 5%)
So the goal posts haven't gotten harder. They did get easier; restaurants shouldn't have been open for socially distanced dining based on the plan until 1/21.
I wouldn't really call 1% of the population "a large part" of it. It's just, our healthcare capacity relative to the size of the overall population is miniscule. So even a disease that threatens .1% of the population with death and 1% with hospitalization is enough to overwhelm the healthcare system. And apparently policy makers aren't willing to let people die due to overwhelmed hospitals - they would rather shut down the entire economy than let that happen.
History will tell if that was the right decision. Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year, but everyone notices and remembers economic depressions that last a decade.
The IFR for COVID is likely ten times that, at least in societies with decent numbers of older people.
> Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year
This isn't a bad flu season in a 5 year cycle. The excess deaths caused by COVID last year are not just 'abnormally high'. They're more like once in a lifetime abnormally high.
Right I purposely picked a disease less deadly than covid that could still overwhelm the healthcare system
> This isn't a bad flu season in a 5 year cycle. The excess deaths caused by COVID last year are not just 'abnormally high'. They're more like once in a lifetime abnormally high.
Right, and I still maintain that those excess deaths will be largely forgotten within the next few years or so by the majority of the populace. 500k excess deaths in 2020 followed by several years with fewer than normal deaths (since an abnormal amount of old people that otherwise would have died weren't around to die). Great Depression 2.0 on the other hand is something that wouldn't be forgotten for a lifetime for the people that live through it.
Should we be pragmatic in public policy? Of course. You can’t prevent all the deaths, and we’ve got to keep individuals and businesses afloat as well as we can. But we need to go into these discussions with clear eyes about the real cost that each of those lost lives represent, both in a compassionate sense and in a practical sense (a not insignificant proportion of those dying were still working, still contributing to society, were young with many productive years ahead of them, etc.).
I really don’t think we’ll look back on this and think, “Eh, a half a million people died, oh well,” particularly not with a more historical lens, but I could definitely be mistaken.
> I really don’t think we’ll look back on this and think, “Eh, a half a million people died, oh well,”
Well, we look back on the past 2 decades (2000-2020) and think "eh, 700k+ people (mainly the elderly) have died from influenza, oh well." But actually most people don't even think that. Most people just... don't even keep track of how many people die of the flu because they don't care. Why would covid be any different 20 years from now? To be honest most people probably wouldn't even care how many people were dying of covid if the media wasn't shoving the statistic in everyone's face 24/7. Just like most people don't care to know how many people die in the USA per year in general (~3 million) and what the breakdown of those deaths are in terms of causes.
675k Americans died in the 1918 Flu, and we’re still talking about that one. We may very well surpass that in raw numbers (although not in percent of population) with COVID.
And lots of people care about the 3 million people that die every year! We’re constantly trying to make driving safer, investing in new therapies for heart disease and cancer, etc. I’ve seen many articles about the increase in suicide in the US over the past decade, written with the hope of stirring action and driving change. There’s no reason to accept potentially preventable deaths as a matter of course.
But it kills consistently year after year, decade after decade. Influenza has been consistently killing for how many years in a row before covid showed up? So really, the "current death toll" of the flu is in the many millions by now. Unless you reset the count after every year in which case covid's death count doesn't get to keep ticking up forever either and needs to reset to 0 at some year boundary.
> 675k Americans died in the 1918 Flu, and we’re still talking about that one.
And in 1918 America had less than one third the current population. 675k out of 100M is way deadlier than 500k out of 350M. Also we weren't really "talking about it" until very recently. Prior to 2020 almost nobody talked about it except people who study public health.
Hmm, but I would argue there's a difference between young healthy people dying en masse (war) and mainly the sickly and elderly dying (pandemic). It feels awfully utilitarian to distill it down to this, but I'm sorry, a healthy 18 year old dying from a bullet is way worse than a 70 year old dying of a disease, especially from a "years of life lost" perspective.
In my view, with covid, it's mostly the elderly that got a few years cut short, but most of them would have died within the next decade anyway of something else (including "age") and I predict we will see "negative excess deaths" in the coming years for that very reason.
Agreed, it's horribly callous.
After an acute terrorism threat ends, it's hard to get power back from the military and the police.
In this case, it will be hard to take back power and the narrative from the public health establishment.
While they perform a crucial role in our society, they will tend to value safety over freedom and quality of life to an extent that would be crippling if we let them continue to set the agenda after the acute phase of the crisis has passed.
Is this a joke considering the vast majority of Western countries have basically ignored their “public health establishments” for almost all of the past year? Ironically (or not) the only country that has really followed their “public health establishment” until recently was Sweden. Which isn’t surprising because theirs was the only one not asking the government to make tough choices.
Sitting in California where county sheriffs basically comprehensively vetoed the public health establishment throughout the crisis, I don't see that likely to be a real problem.
But regardless, the narrative is just as important. After some threshold of vaccine distribution, people need to be convinced that it's ok to return to normal life, and that they don't need to cower in fear in their homes or wear masks for years and years just because we haven't completely eliminated covid. There's a cost to all of this.
No one has suggested people should cower in fear, and people seem pretty happy going about without masks, or with masks worn in an openly defiant manner (under the chin, off of one ear, etc.) in public places with prominent mask mandate signage today, so, again, I don't think the issue you are alluding to is even remotely serious. As a society, whatever the formal provisions of law say, we haven't given public health authorities the power in practice that you argue we will have problems with when we need to take it away.
The implication is that everyone should be terrified, stay home as much as possible, and wear masks as long as there's any chance of catching covid. Even after being vaccinated.
Sure, people flout the restrictions, and they are met with social disapproval for doing so.
The worst thing is the hugely negative psychological effect this is all having on children. It shouldn't be taken lightly.
Apparently there is insufficient data to back up that the vaccine reduces transmission. That much is mostly true. It doesn't seem like they're trying particularly hard to find out.
Why are we not studying unvaccinated household members of vaccinated individuals and comparing with household members of the unvaccinated. Could be as simple as adding a data collection step after receiving a test result, given that it's pretty much a given you will infect people you live with we should notice a large difference very quickly.
That's not true. Studies are showing large fractions, say 10-25% of COVID patients are suffering symptoms after a month.
COVID infections have demonstrably damaged pretty much every organ in the body.
That's very different from the initial assumption, whence all policy, that COVID is like the flu, and passes in two weeks if it doesn't kill you.
> Even after being vaccinated.
However, these vaccines are stupidly effective. Once enough people are vaccinated, COVID will die out in the community, just like measles. You're right that we can't fear COVID forever.
> During the Sheffield, England influenza epi-
demic from 1972 to 1973, the cases of 50 consecutive
patients who were initially diagnosed as mild cases
and were treated on an outpatient basis were followed.
Transient electrocardiogram (ECG) changes were seen
in 18 patients, and long-lasting changes were seen
in 5 patients.
It could be that the flu is worse than covid in this regard, the few studies I looked at were surprising/sobering. They were talking for years about "long-flu" after the 1918 pandemic.
Until we have numbers to back it up I would not make the assumption that covid is any worse or different in this regard. Conventional wisdom is that every virus that attacks the body leaves some people with long term lung, heart, and or brain damage.
But this is being spun to imply that it's a serious threat to people who are otherwise in extremely low risk categories for severe covid. There's no solid evidence for that.
It's a numbers game.
When hundreds of millions of people are infected, you're still going to get a lot of hard hit people in 'low risk' categories, aren't you?
The lie here is that it's anything other an extremely minor risk for the large majority of people.
Now, with the vacinations, things change a bit. As soon we can show a significant reduction in hospitalisation, of course this needs to taken into respect. But with the vacinations, I would also expect the infection count to drop, as there are good indications that the vacinations reduce the infection count to drop.
I know somebody who's had this. Despite never being hospitalized, after getting sick they had to take a long medical leave from work in hopes of getting their strength back. That's worlds away from "sick for a few days".
Then, if one starts digging into more serious discussion – even your link above – one finds that "long term" in medical parlance may mean a series of months but not necessarily years, and similar months-long impacts are known from diseases that we have generally tolerated among society. It also isn’t clear that these lingering symptoms affect enough people to impact the economy if measures are lifted once hospitalizations fall.
Hundreds of thousands of people. Average age mid 40s and sliced by hospitalized or not. Controlled against people who had the flu during lockdown.
Double digit percentages have issues 6 months on. Unsurprisingly not very different from SARS 1 and those people are still sick since 2003.
Intracranial haemorrhage is 3-4x more likely in hospitalized patients; ~5x higher in those with encephalopathy. For stroke, 2-3x for both. For first mood disorder, 1.5x/2x more likely.
They don't break down the cross-tabs by age (as they should), but given the patterns here, I would expect to see a strong correlation.
The sicker you are, the sicker you are.
Figure 3 has risk ratios sliced by age+sex
There's far too much to get into in a single comment, but the TL;DR is that they bury a lot of important information in the supplemental materials  that make a strong argument that what they're observing are spurious correlations with a third factor. At the very least, this kind of statistical fishing expedition has a high risk of bias, because the researchers know the outcomes ahead of time.
Consider supplementary tables 10 & 11: these show that a large number of the "psychiatric sequelae" are correlated with the control conditions, and the effect of Covid is not significantly different (even where they are, the authors have clearly gone on a fishing expedition, which should make you skeptical).
Figures 16-21 show that the risk of a patient developing Covid is 1.5x greater if they've had a recent psychological illness. This is on par with the risk ratios discussed in the text of the paper, and indicates that the association is not necessarily causative (i.e. it's not clear if Covid causes psychiatric problems or vice-versa).
Figure 22 shows a particularly interesting series of plots, where the diagnosis rates of the control illnesses (broken bones, etc.) are plotted over time. Without exception, everything drops but Covid. It is almost inevitable that if you look at this dataset, you will find an increase in diagnosis of X after Covid...because Covid patients are being seen at much higher rates!
Overall, my interpretation of the supplementary figures is that there was an intense focus on "Covid patients" in 2020, and all other groups stayed out of the doctor's office. Covid patients were showing up in the clinic, so covid patients were the ones being diagnosed with other illnesses.
Your thymus is very likely to be useless after 40 due to something called thymus involution.
This issue seems to be important to you personally and to others whose concerns may or may not be reasonable, but I don’t believe it will be important to most of society as vaccinations roll out and the Northern Hemisphere spring and summer are upon us.
This is the claim I'm disputing. I don't see evidence that this is so rare. In fact everything I can find suggests otherwise.
To be clear, I hate this.
Worth keeping in mind it was impossible to get a COVID test for a large fraction of the first wave.
Do you have a citation for this claim?
I was obviously not referring to actual scientific studies of long-term COVID effects, but as I said, those studies don’t say quite what the more sensationalistic mass-media coverage is saying.
Your insistence on denying distinctions like this makes you look like a person arguing a case, not somebody trying to jointly get at the truth. Which from my perspective, makes you much worse at arguing your case.
It isn't like that with disease.
The worse I've had is the complete inability to stand long enough to make a simple dinner, for example, and this was after napping and sitting most of the day. I'm lucky: Mine passed. Some people live with this day after day after day, and this is more similar to what folks with disease-related fatigue.
Sometimes people have strokes from sneezing.
See I can make generalizing statements about bullshit too.
And what percentage of people that get covid are hospitalized? Let's estimate and say 3% of people that get covid end up hospitalized. 3-8% of 3% is, frankly, a small percentage of people.
You can make any percentage seem large and scary with the right framing (https://xkcd.com/1252/)
> More than one in 10 Covid patients died within five months of being discharged from hospital, while almost a third of those who survived the virus had to be readmitted, new research has warned.
> Papers released by the governments Scientific Advisory Group for Emergencies (Sage) also revealed half of patients in hospital with the virus suffered complications, with one in four struggling when they got back home.
> Younger patients under the age of 50 were more likely to suffer complications.
ICNARC gives us some age data: https://www.icnarc.org/Reporting
What are the numbers?
They're reporting hazard ratios after propensity score matching with people who had the flu during the same time period.
You can't compare these supposed 1 in a million events to something like doing perf testing on a 64 node raspberry pi kubernetes cluster.
Doesn't mean you go on forever waiting for 0 infections, you just wait a bit longer than the minimum number of vaccinations to go back to activities with highest risks of transmission.
No way could the EU or USA get to zero in 6 weeks. It took Victoria Australia about 6 weeks to get from 500 cases to 20. America and Europe have a 100X more than 500 cases.
And the longer you need to lockdown, the less restrictive the lockdowns can be.
You'd be hard pushed to find a single person who would trade our state's response with pretty much any other countries response.
-- Lefty Gomez
Anyone who wants to hole up until they get the vaccine should be able to.
But I'll take the low risk.
This potentially means that people with other illness / disease can’t / don’t see a doctor in time, and others in a society take the brunt.
Yes, let’s open up; but let’s not throw caution to the wind either.
But they haven’t. The prevailing opinion I’m seeing on HN recently is that the US didn’t do a “real” lockdown which is why there are still so many cases. They opine that Americans largely didn’t “comply” with the government orders rendering any potential positive effects from lockdowns moot.
If you take that at face value, then shouldn’t we have had an overwhelmed medical system by now?
The Denver convention center was turned into a makeshift hospital for almost a year. They never had a single patient. My relatives lost their low-paying jobs and are still jobless today.
Remember the military hospital ships that were sent to NY and LA? They never saw a single COVID patient?
At this point I just don’t see any evidence that our healthcare system overwhelmed in any meaningful way. It’s FUD.
Don’t try and post an article about how some random ICU was at 80% capacity. ICUs are designed to be near operating capacity because it’s a waste of resources to over supply.
We did, in many cases, had overwhelmed medical systems at the local peaks, which were not nationally synchronized.
> Remember the military hospital ships that were sent to NY and LA? They never saw a single COVID patient?
You mean the ones that the military explicitly restricted to not taking COVID patients?
Yeah, I remember that. Funny how they never saw any COVID patients.
“ By the time of Comfort’s departure, the approximately 1,200-person crew and 1,000-bed hospital had treated just 182 patients, of which approximately 70 percent had COVID-19”
So I guess we were both wrong.
Mercy treated 77 patients and was not reconfigured for COVID, Comfort treated more after being converted to COVID just before local cases dropped from their peak for the wave the ship was present for.
It completed reconfiguration to take COVID patients on April 7, just before new cases in both NYC and NYS started rapidly dropping. It almost entirely missed the time it was needed.
I think they are both evidence that both the response and the systems for utilizing new resources wet optimized for the real needs, but neither shows that healthcare systems weren't overwhelmed.
Er, how was I wrong, again?
Yet 70% of the 182 patients had COVID.
Hospitals cancelled and delayed medical procedures around the world due to this: Italy, Spain, the UK, etc.
While the worst case scenarios of healthcare systems on their knees have not panned out, it’s disingenuous to suggest that the impact is imaginary or FUD.
My comment was geared towards America because I’m an American talking on a forum operated by an American company.
Italy can lock down to their heart’s content- that’s their prerogative.
But practically speaking most nations are taking this approach and have been reducing social distancing measures when hospitalization rates go down. (Often with negative results.)
Yes 100%. As soon as the "vulnerable" have received their vaccine we should remove all restrictions even if the vaccine doesn't 100% prevent the "old fat cigarette smoking weak people" from dying from this cough virus because after the vaccination there is nothing more we can do.
Vaccines are the single most effective way to prevent disease after clean water. It is the cherry on top of a cake in terms of what humans can achieve medically. A vaccine is literally the dream to achieve for any illness which could affect us. As a result, as soon as we have deployed our best and most effective weapon against this virus we must open up again. If the vaccine doesn't prevent fat people from dying then nothing will and we just have to accept that fat people will die due to their own wrong doings. After all that's how the world is designed to work.
No. This is the "flatten the curve" logic which was a horrible misjudgment. Having the disease in circulation in the community is not only doing tremendous damage to many, many people (even if the hospitals aren't full), but is also allowing the virus to mutate and potentially escape immunity protections or become more deadly. If you re-open as soon as the hospitals start to free up again, you just start moving the pendulum back in the direction of crisis.
Countries like Australia and New Zealand have shown that if you keep up lockdown measures for just a month or two after the hospitals free up (AND if you institute and keep real travel quarantine restrictions), you can get the virus to effectively ZERO community spread and keep it there. We can achieve this, and we ought to be aiming for it.
It's too late for that anywhere that isn't super remote like AU/NZ. Even South Korea and Japan, isolated as they are and with very strict measures, controls on lockdown, and a population that strictly follows them, cannot get / is not getting to zero community spread: It's doing regular, short, strict lockdowns instead.
This is the model that the west should adopt but instead a lot of countries are faffing around. Belgium has been in a five-months-long semi-lockdown that is leaving everyone severely depressed, is hugely damaging to the economy, and has plateau'd the spread to very non-zero numbers so the disease is still very much present. Worst of both worlds.
As an Australian citizen I often wonder how much this super distant story has to do with it.
Australia is hardly isolated. Tons of flights in and out every day, and a vital part of the world economy. Really, any country can be "isolated" if they just close the borders to non-quarantined (REAL quarantine) travel, which is much more important than lockdowns.
With vaccines and a decent uptake, the difficulty level to achieve zero spread should go down significantly.
That said, I totally agree that short but strict lockdowns would be much better than permanent half-assed measures.
To play devil's advocate, clearly the world can handle a certain amount of locking-down, the social distancing, the mask wearing, etc., so it seems it is better if we just accept these restrictions indefinitely because we can save more people. Maybe we're fine not having mass gatherings, not eating indoors, and not leaving the house without a mask if it means saving the vulnerable. After all, it could be that COVID stays in the body like herpes and creates a different set of problems years later. Until we know for sure, the safest course of action for the public is for them to remain quarantined.
After all, how bad is your life, really? If your life is tolerable, that means the restrictions are tolerable as well.
EDIT: It's like nobody knows what playing "devil's advocate" means anymore. I think it's valid to ask that, if all the measures we are taking are objectively good, whether we should take them from now on.
Furthermore, can the world really handle the restrictions in place indefinitely? We've been locked down for a year, and it's certainly starting to feel like the wheels are coming off for many. The economic devastation alone has been staggering.
Epidemiologically speaking, sure, doing this forever would save the most amount of people from COVID. But we can't just look at this from that point of view.
Except for the horrific acceleration of radical politics, rioting in the streets (and Capitol), effective abandonment of the education of the children of the bottom 50% percentile earners, rise in suicides and substance abuse, etc. Locked down masses are going to be increasingly difficult to pacify.
People certainly didn't permanently hide out before there were vaccinations against diseases like cholera.
For the record, I'm not in support of the prevailing COVID containment strategies. Believe me, I'd love to see politicians face some actual backlash over what's been happening.
Absent vaccines it would have been more complicated. But, at some point, countries say that they've done what they can and things are as they are.
I want my kids to go to a harvest festival again with a live band and tons of people like the one they did in fall 2019. No, this is not something worth giving up simply to preserve a few years of life for some nonzero number of society's most vulnerable and aged. And no, I'm not any more willing to wait five years to see whether there's some lurking complications from the disease, any more than people have been willing to do that with the vaccines which are being distributed.
Society really needs to use either the term correlation or causation more often so we can always have the "correlation does not imply causation" discussion and hammer that home until it's common knowledge and common sense.
The word "link" to me is a weasel word meant to plant the thought "causation" when only correlation is merited.
Among those aged 80 years and over - one of the highest risk groups - vaccination was associated with an 81 per cent reduction in hospitalisation risk in the fourth week, when the results for both vaccines were combined."
I wanted to highlight this part for folks reading. My brothers Mother in Law is now hospitalized due to COVID, and there is a high likelyhood that she will not survive COVID due to lung scarring. She got her first COVID vaccination about a week before she got COVID.
You are not out of the woods just because you got your first dose COVID vaccine! It will take time for it to take affect.
I just wanted to concur for anyone who is not yet aware: all the data so far (from multiple studies) shows that there is zero or near zero protection for the first two weeks after the first dose. It's not until the third/fourth weeks after the dose that you start to see substantial protection, with higher protection the fourth week.
She'd been sad for several months from my father dying, so during the summer she went to visit her sister abroad. Until then she'd been shielding at home. They both knew about the virus but thought it wouldn't happen to them, arranging group meals with old friends.
Three of them went to ICU, and everyone tested positive.
It's of course up to people themselves what risk they want to take, but with this disease in particular the numbers are deceiving. The general figures seem so low but are actually a heck of a lot higher than flu. They're also markedly higher if you're in a risk group.
It's also terrible because as family you think the odds are okay, most people at every stage (cough, hospital, icu) survive, until the doctor calls you and says it's tonight.
The fda filing  for Moderna seemed to indicate a decent uptick in protection > 14 days after dose 1 (which seems to mirror the studies you are referencing). I see a "Vaccine Efficacy" of 92.1% for > 14 days after dose 1, which seems to be fairly close to the ~95% efficacy I've seen described for 14 days after dose 2.
 https://www.fda.gov/media/144434/download (page 28)
.8 * 24 = 19.2m covered in scenario 1
.959 + .83 = 10.95m covered in scenario 2
Even if it were 60% with 1 dose and 95% with 2 it would be
.6 * 24 = 14.4m covered in scenario 1
.959 + .83 = 10.35m covered in scenario 2
Pfizer, for example, often administered in hospitals due to the freezer requirement.
You could imagine the risk of hospitalisation of an 80 year old who frequents hospitals and one who doesn’t is different.
>Findings: The first dose of the BNT162b2 vaccine was associated with a vaccine effect of 85% (95% confidence interval [CI] 76 to 91) for COVID-19 related hospitalisation at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 94% (95% CI 73 to 99). Results of combined vaccine effect for prevention of COVID-19 related hospitalisation were comparable when restricting the analysis to those aged ≥80 years (81%; 95% CI 65 to 90 at 28-34 days post-vaccination).`
Those aren't overlapping?
In contrast, with pfizer, there were 0 covid deaths in the entire trial (vaccinated or unvaccinated).
The immune system can be weakened from a bunch of things, including lack of sleep and stress and other infections.
With the rapid spread of some of the variants, it would be foolish to assume that what we are dealing with now is the same thing as what we are dealing with before, and we really don't know enough about the new variants. Maybe they are spreading, but not making people sick enough, increasing herd immunity.
It's difficult to account for these things because the same time these new variants started exploding is the exact same time we shifted resources from random testing to mass vaccination.
Do you think we got a break at the beginning that we didn't identify in the numbers?
That is, most of the recovery we saw last year going into summer could potentially be explained by regular cycles of similar viruses in the areas. The impression being that that could also explain or current recovery.
It is not an argument against vaccination. And I haven't seen people pushing we have heard immunity, yet. But the stark drops we are seeing do seen surprisingly sharp.
Surely that suggests an unnatural cause, such as millions of vaccine doses being rolled out, specifically targeting the most vulnerable (LTC residents) and those most likely to catch/spread the virus (medical profession, first responders, front line workers)?
To be clear, I first saw this pushed by some epis on Twitter as caution to get to hopeful that we are seeing the vaccines as a resounding success so early in their rollout. It is expected that the vaccines are needed, but the dramatic drop was pushed as likely unrelated.
I will try and dig up the tweets. Could be they have changed their minds with more data.
Also, my first sentence was a question as I am not sure that is what the opening post meant.
Edit: https://twitter.com/jbarro/status/1363866144029949952?s=19 had a recent discussion where this came up. (Looking for epis in this one, but not finding them.:( )
Edit: https://twitter.com/EricTopol/status/1363551912021221377?s=1... is a look at a drop without vaccines
I know there has been some trouble identifying antibodies in people who were exposed months ago. So if you aren't really sick, you only get counted (maybe) if someone in your circle gets really sick.
I can say I have not seen this brought up too much on Twitter. With the caveat that I am not following everyone. :)
 Developers are by and large flummoxed by S-curves for progress. An S curve for distance maps to a bell curve for velocity. If the sums don't make sense, look at the rates, or the rate of change. Don't keep staring at the S trying to fit trend lines.
Perhaps exposure has reached saturation among certain populations.
A challenge trial just reduces the time and number of people it takes--not everything needs a challenge trial.
BBC Scotland article has some more data on the progress of the vaccine rollout and the impact it’s having on outcomes: https://www.bbc.co.uk/news/uk-scotland-56097899
Overall, the average hospital stay for COVID-19 for all ages is 22.4 days, just over three weeks. The length of stay is slightly longer, 23.5 days, for regular hospital admissions and shorter for ICU patients at 16 days, likely because ICU patients go on to die in the hospital.
That's based over thousands of patients.
> Patients in their 50s, who make up the third largest group of hospitalizations at 17.8% of all admissions, have, to date, had the longest average hospital stays at 27.5 days on average.
> Older patients have slightly lower average stays than middle-aged Hoosiers — again, likely because they are more prone to die in care than younger patients
> The average stays for patients in their 30s is 16.4 days
Oh look: this data matches my annecdote(sic):
"There were too few studies to conduct any comparison by age or disease severity. "
It also dates back from a year ago, under very different circumstances to today
Given the large number of people vaccinated so far, and the magnitude of the effect it's pretty safe to say that the vaccine is causing a significant reduction in hospitalizations independent from the broader background trend towards lower prevalence of the disease overall.
I guess everyone here thinks double blind trials are for fools?
cases:mortality would be a weebit less influenced by placebo and it would be hard to reach numbers like 80%..
IMO, there's no way a significant number of discussions between doctor and patient are not going to reach different conclusions about whether to go to check in to a hospital or wait a few more days based on a significant fact like a jab 3 weeks ago.
So I'd have to say this is cherry picking..
Basically, we had many clusters of fresh unburnt tinder (the household covid pod) and the Thanksgiving and Christmas holiday was a perfect event for many people to "just this one time" break quarantine protocol, leading to the many infections we saw. That's a 2-3 week increase in direct hospitalizations from those events, and then you have another 2-3 weeks of indirect hospitalizations impacting the remaining members of each covid pod. Anecdotally, I've personally witnessed this happen as I know fare more people that acquired immunity from becoming infected during the holidays than for most of last year.
The vaccines seem to have an impact, but it is hard to be sure. There are a lot less old (>65) in the new infected list, which used to dominate the list. The younger groups seems to be be about even by age group. However there are many potential confounding factors, and I haven't done a proper statistical analysis so I don't want to claim something.
Best you could do with a challenge trial is to get faster to the results we already have. These vaccines work. We know that. This is just observational data supporting that what works in trials also works in the real world (which is not particularly surprising).
There are plenty of millions of people who haven't yet (or won't ever) get vaccinated to serve as a control.
I wouldn't believe any of those guys.
The world wants this mass hysteria. I'm starting to think it's not even about Corona virus anymore. Everyone has an agenda. From the remote workers to the politicians to the news media to the people getting unemployment.
You just have to let the madness pass as it looks like it's making progress towards being behind us.
There seems to be a light at the end of this tunnel :)
Are they doing that for all vaccines, or just the Oxford/AstraZeneca one? Because that appears to be the recommended and most effective interval for the Oxford vaccine, but not for the others. (Note that the mix of vaccines approved for use differs considerably from country to country; Oxford/AstraZeneca is not in use on the US, only Moderna and Pfizer/BioNTech.
Most people I know who have a vaccine have had 2 doses
The UK is pushing to get all 'at risk' people one dose (around 49% of people getting the vaccine) as a priority, with the second dose following within 12 weeks.
If this is the situation we are in, then it would make the most sense to only vaccinate the most vulnerable, and not vaccinate the bulk of the population in order to keep the virus selected for survival + transmissibility.
That is wildly speculative. Pathogens do not evolve inevitably towards maximum lethality.
I'm not sure what more you should be asking for in a discussion about "what could happen"
Of course it is speculation. And it is based on what we know about other viruses at large and the our current best information about covid.
If we could sufficiently reduce (or eliminate) severe cases and deaths, it wouldn't matter how contagious it was. Common colds are highly transmissible, but no one worries about them much since they very rarely cause severe illness.
I know what you're driving at and it's all pretty interesting - but counterintuitively I think it's way more effective overall to reduce transmission than it is to reduce severity.
If you make the disease half as deadly, then pretty simply half as many people die. But if you make the disease half as transmissible, then the compound impact means that far fewer than half as many people die.
I think you undercut your own point for no reason.
Less deadly diseases get less reverence, leading to more risk taking. The percentage of people who die goes down, but the number of cases goes way up, resulting in potentially greater loss of life overall. Look at how cavalier we are about influenza, and then we set policy based on whether things are worse than the flu.
While it seems rare, it also seems like a much deadlier outcome.
One of the reason there's a lot of gas behind rolling this vaccine out quickly is that we want to avoid allowing the virus enough time to mutate up some different strains that this vaccine isn't effective in preparing us for since that makes the vaccine far less effective overall.
On the other hand, if the vaccine reduces the transmissibility of the virus, then everybody collectively benefits from each additional vaccination.
This has happened with other diseases.
It's stupid to imply that drastically reducing severity isn't a big win.