The evolutionary environment we create with our collective actions, which determines natural selection of covid19 mutations, also matters -- potentially a lot. As Isabelle Eckerle, the Co-Head of the Centre for Emerging Viral Diseases at the Geneva University Hospitals and the University of Geneva, posted on Twitter earlier today:
> Is it just me or does uncontrolled, high level community transmission with circulation of several new #SARSCoV2 #COVID19 variants while starting vaccination with modified schemes, leading to partial immunity in a large proportion, sounds like a bad idea? #evolution #thirdwave
Unless I'm misinterpreting the tweet, she suggests that a partial vaccination campaign will somehow lead to a higher rate of mutations?
As a non-biologist, it's not immediately obvious why that would be the case. What's the mechanism that increases the chance of mutations in vaccinated hosts?
Vaccination will create pressures selecting for variants that escape vaccine-generated antibodies.
The vaccine is ~95% effective. This means you're going to have a lot of people get infected still with the vaccine's antibodies present; any mutation that happens that causes escape from these antibodies will prolong disease and increase transmission, even if that mutation renders the virus a bit less fit in a non-vaccinated host.
> The vaccine is ~95% effective. This means you're going to have a lot of people get infected still with the vaccine's antibodies present; any mutation that happens that causes escape from these antibodies will prolong disease and increase transmission, even if that mutation renders the virus a bit less fit in a non-vaccinated host.
Is that an accurate summation of those who caught it after receiving the vaccine?
Seems like if 5% of virus strains circulating aren't affected by the vaccine, we're fucked anyway. That 5% will become 100% of what's circulating in the next year and will be ubiquitous?
If it's something like "5% of people don't respond to the vaccine to build antibodies at all," on the other hand, it's much rosier...
It's more like 5% of people don't build as many or as effective of antibodies to the vaccine spike protein, and then when infected are petri dishes providing selective pressure for variants to mutate that escape these antibodies and become dominant within their bodies (and, in turn, are more readily transmitted to vaccinated people around them).
Some of the 5% may just be unlucky people who got bigger doses of the virus/higher initial infectious dose, but the same logic applies.
It may be more than 5%, even; the vaccine likely does more to prevent symptomatic illness than infection.
It's hard to estimate what the probability of this happening is. It's certainly more likely when there's more illness circulating around-- e.g. if 1 million people with the vaccine become infected it's worse than if it's 10,000.
> It's more like 5% of people don't build as many or as effective of antibodies to the vaccine spike protein, and then are petri dishes providing selective pressure for viruses that escape these antibodies.
This seems very circular to me. If they don't build very effective antibodies, they shouldn't be putting much selective pressure on the virus, because if they did, they'd be more effective in the first place.
I suppose it depends on how exactly "effective" plays out here, as well as how easy it is for the virus to mutate significantly but stay as contagious as it is, but if we get unlucky it seems like just a question of time for it to get bad. Given Jan-Mar 2019, I have little faith that the US would ever be in a position to fully eradicate even a small remaining bit, and it would instead fester and mutate in this scenario until exploding again.
> This seems very circular to me. If they don't build very effective antibodies, they shouldn't be putting much selective pressure on the virus, because if they did, they'd be more effective in the first place.
If a normal person generates a dozen types of antibodies to the vaccine's spike protein, and a couple types are strongly sterilizing...
And you happen to have an immune response where you generate 8/12 of these, and only one of the strongly sterilizing variant, and you are more prone to become infected as a result...
Then, once infected, the virus will be under selective pressure during your illness to escape some of those 8 antibodies. In turn, whomever you spread it to will have a harder time.
> Maybe multiple vaccines mitigates this a bit...
Maybe. But the portion of the spike protein they're expressing and the resulting antibody profiles look very similar.
> Given Jan-Mar 2019, I have little faith that the US would ever be in a position to fully eradicate even a small remaining bit, and it would instead fester and mutate in this scenario until exploding again.
Yes, but one silver lining is that there would still be some immunity / cross-reactivity / t cell mediated immunity, etc. People would still be less likely to have severe illness, I believe.
It's a lot more complex than that. Immune responses are a lot more complex than antibodies. People can actually get rid of an infection before they have a lot of antibodies.
The virus in this case would have to evolve in your body to escape not just 4-6 of the 12 antibodies, but most of them, otherwise it still won't be able to cause productive infections before it starts getting neutralized and the immune system detecting neutralized viruses mounts a stronger response.
Yes. I know immunology is way more complicated than I understand, and that I'm oversimplifying even from my level of understanding. There's all kinds of immune responses we're interested in here.
However, sterilizing antibodies are most interesting because they are the strongest factor in preventing transmission.
People with weak immune responses of various kinds can be expected to have more infections and to be infected for longer times, and they provide selective pressure to evade the remaining mechanisms.
> This seems very circular to me. If they don't build very effective antibodies, they shouldn't be putting much selective pressure on the virus, because if they did, they'd be more effective in the first place.
Just to follow up / argue from another angle. It's believed to be likely that the "new" UK variant likely emerged in an immunocompromised individual. This results in A) -some- immune response, and B) prolonged infection where the virus is under evolutionary pressure to escape that immune response / original antibodies.
Someone who doesn't mount a strong response to the vaccine is a very similar case.
Not really, because they can still mount a strong response from the infection. The immune system is a lot more than just antibodies.
Even a weak response to the vaccine can activate bound antibody responses during challenge, which means the immune system is activated much faster and even though there is still infection it is much shorter, leaving less of a chance for the virus to mutate.
Even a partial response from a vaccine suppresses the virus and (usually) reduces the risk of transmission. At the same time, it creates a window where the virus is under selective pressure to escape some of the immune response from the vaccine's effects. Individuals who have smaller/partial responses to the vaccine are more likely to have this happen.
That is all I'm saying, and I don't think it's really that controversial. I'm not trying to make a robust immunological argument. I don't think it's inevitable, but it's another reason to reduce transmission. We already have the UK variant, which many have suggested is better at immune escape due to perhaps evolving during a long infection in an immunocompromised individual.
Selective responses against the vaccine are only selected for if those pressures persist during replication. It's not enough to have that pressure at the very beginning, it needs to persist all the way. This isn't really the case for a vaccine.
In other words, by the time the virus is replicating inside of you, it doesn't really have much pressure to evolve to evade those other facets of vaccine immunity, because doing so would probably hurt it.
The UK variant isn't better at evading the immune system from what we know. It's simply more infectious in general.
> Selective responses against the vaccine are only selected for if those pressures persist during replication. It's not enough to have that pressure at the very beginning, it needs to persist all the way. This isn't really the case for a vaccine.
I disagree. You have the weak vaccine response the entire duration of infection applying selective pressure. What you say seems to disagree with the consensus of the literature, e.g.
> The UK variant isn't better at evading the immune system from what we know. It's simply more infectious in general.
The mutations have been broadly described as "immune escape mutations" and are thought to have emerged from pressure to escape low numbers of existing sterilizing antibodies within the host, e.g.
"The unusually high number of spike protein mutations, other genomic properties of the variant, and the high
sequencing coverage in the UK suggest that the variant has not emerged through gradual accumulation of mutations
in the UK. It is also unlikely that the variant could have arisen through selection pressure from ongoing vaccination
programmes as the observed increase does not match the timing of such activities.
One possible explanation for the emergence of the variant is prolonged SARS-CoV-2 infection in a single patient,
potentially with reduced immunocompetence, similar to what has previously been described [17,18]. Such prolonged
infection can lead to accumulation of immune escape mutations at an elevated rate"
The article you linked first assumes only one or two antibodies.
As I said before, there is some pressure for antibodies, but the immune system is way more than that, and people can clear infections very effectively without any antibodies at all.
As for your other link, it's important to know that this a preliminary article that, on those subjects, gives ideas without data. Further research has shown that this variant does not seem to increase disease severity, and instead is just more infectious, as the spike protein evolved for higher binding affinity.
> The article you linked first assumes only one or two antibodies.
Assumes only a couple of neutralizing antibodies, which is fair for the vaccine candidates-- immune assays of Moderna's vaccine show two typical antibody binding sites against the RBD that are strongly neutralizing. I haven't seen the ELISA data for Pfizer's vaccine.
Given that we've got several papers describing how immune escape variants of other viruses have emerged in the past... I'm curious why you don't think it's much of a risk here?
> As I said before, there is some pressure for antibodies, but the immune system is way more than that, and people can clear infections very effectively without any antibodies at all.
Of course. I'm not speculating that there's going to be some nasty variant that completely eludes our immune response. I'm saying that it is likely-- and the consensus opinion-- that there is a real risk that the virus mutates to render the vaccine less effective.
> Further research has shown that this variant does not seem to increase disease severity, and instead is just more infectious, as the spike protein evolved for higher binding affinity.
Some of the mutations slightly increase binding affinity. Other deletions look like their primary fitness advantage is immune escape. A missing stop-codon also increases mutation rates for a portion of the RBD, which implies we can expect quicker emergence of subvariants.
It's like you're having an argument I never was having: I have never said that this is likely to cause more severe disease. I am just saying that the virus will be under selective pressure to evade the vaccine-induced immune responses-- which is something I think everyone agrees. This is less likely to happen if there's less infection around and people get vaccinated quicker.
Even in the worst case, where such a variant evolves quickly-- I don't think we're that bad off. As you mention, there's other immune responses. Strong T cell mediated immunity will almost certainly be cross-reactive and strongly reduce the risk of severe illness. We'll have more time to adjust vaccines without mortality accruing as quickly. It is still something we'd prefer to avoid at all costs.
The point of the argument here, from my point of view, is this. In the one to three months between full vaccination of vulnerable individuals and drastically reduced R due to general vaccination, is a variant of the virus going to appear that will be able to effectively infect vaccinated people and spread enough for the pandemic to continue?
The answer to this is very probably no. There is a huge difference between the virus making the vaccine less effective eventually, the virus making the vaccine less effective within one to three months, and the virus making the vaccine sufficiently less effective that it can sustain an epidemic among vaccinated individuals. The second is not very likely at all, because for it to happen a variant of the virus would have to mutate, and outcompete the dominant variant, that has a spike protein sufficiently different that it can keep R>1 among vaccinated individuals.
For this, the virus would not only have to evade antibody response sufficiently for there to not be sterilizing immunity, but it would have to do evade the much swifter and effective non-serological immune response enough to stay infectious.
All of this would have to happen in a subset of the population that has a 20x lower chance of being infected and even when that happens, the infection would be much shorter with most of it with completely different evolutionary pressures.
In one to three months.
It would also have to compete effectively against other variants in the non-vaccinated population while it is doing so, because non-vaccinated people are by very far the dominant infection vector. So it would have to evolve this not only in vaccinated, but also non-vaccinated patients, unless you believe that these extensive mutations will happen in one, vaccinated, patient, which is pretty much impossible.
> The point of the argument here, from my point of view, is this. In the one to three months between full vaccination of vulnerable individuals and drastically reduced R due to general vaccination,
Not a given. It's very likely, but we don't know how effective the vaccines will be in preventing transmission. Certainly there is past precedent for the opposite.
Also, there's likely to be pockets of population with poor vaccine penetration, so even if it confers sterilizing protection, we're likely to see endemic spread in these subpopulations continually challenging the vaccinated population.
> is a variant of the virus going to appear that will be able to effectively infect vaccinated people and spread enough for the pandemic to continue?
We see a hepatitis B vaccine escape variant every year or two, despite a much lower community disease burden. I don't think anyone can know how likely this is.
> All of this would have to happen in a subset of the population that has a 20x lower chance of being infected and even when that happens,
It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
> It would also have to compete effectively against other variants in the non-vaccinated population while it is doing so
Already the currently circulating variants are not equally neutralized by the vaccine. There's going to be immediate pressure making the variants that are least impeded more prevalent.
> unless you believe that these extensive mutations will happen in one, vaccinated, patient, which is pretty much impossible.
Again, the most likely scenario for the emergence for the UK variant is prolonged infection in one person with a low immune response. People like this are well represented in the groups we're immunizing first, too.
These things aren't mutually exclusive, though: you start off by favoring the current variants that the vaccine is least effective against. Then, you have ongoing evolution in vaccinated individuals with lower responses. Then the favored variants become endemic, circulating mostly in subpopulations with lower vaccine coverage and occasionally finding vaccinated people who are more susceptible.
How quickly it all happens depends upon total disease burden. I agree we will probably not get a worst-case escape variant in the first few months of the vaccination campaign, but I think we'll probably see some adaptation towards escape and lowered efficacy. Indeed, you don't even need mutation for that: just preferential selection for existing variants with lower vaccine efficacy.
No one's done the assays on the UK variant yet, but I will not be surprised if the current vaccines are somewhat less effective against it.
If the disease remains endemic with relatively high levels of circulation, variants that escape the current vaccines will be all but certain in the long term.
>We see a hepatitis B vaccine escape variant every year or two, despite a much lower community disease burden. I don't think anyone can know how likely this is.
Hepatitis B is a disease that lasts much, much longer than COVID-19, which exponentially increases the likelihood of such an event. Moreso, Hepatitis B immunity from vaccines is often very weak due to a lot of people not getting booster shots in adulthood.
>It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
Vaccines have been trialled using not symptomatic illness, but actually PCR tests for immunity, and found over 90% immunity with symptoms||viralRNA as a standard. So no, it's actually around 10-20x less likely to have infection, too. For things like severe ilness, it's more like 99-100%.
>It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
During this window if the individual is vaccinated before antibodies show up there is very little pressure to evolve resistance against them.
>Again, the most likely scenario for the emergence for the UK variant is prolonged infection in one person with a low immune response. People like this are well represented in the groups we're immunizing first, too.
Given the fact that we have seen zero severe illness in even very old people with many vaccines, this is even less likely than for a non-vaccinated but immunocompromised person, for which this scale of mutation didn't even happen yet, 1 year in. And by the way, the hypothesis - which is as of yet unconfirmed and whose certainty became lower after similar mutations were found in South Africa - is that this process happened in an unvaccinated immunocompromised individual during a month+ infection period. If the same individual was vaccinated, this would have been impossible, and we haven't seen this kind of illness in any vaccinated individuals.
>These things aren't mutually exclusive, though: you start off by favoring the current variants that the vaccine is least effective against. Then, you have ongoing evolution in vaccinated individuals with lower responses. Then the favored variants become endemic, circulating mostly in subpopulations with lower vaccine coverage and occasionally finding vaccinated people who are more susceptible.
Even for those, the vaccine is still incredibly efficacious. The differences IIRC are barely statistically significant. If you have a source for more significant variations I'd love to see it.
Crucially though, in the scenario you are suggesting where the virus is spreading in non-vaccinated populations, that the actual strain to acquire enough changes to become effective against vaccinated individuals absolutely needs to outcompete other strains, which isn't likely. This is because even if the virus were to infect one of the few vaccinated but less protected individuals, which would in this case probably be under 1% of infections, those mutations need not be a hindrance in the 99% of infections which won't be of less protected individuals that have more than benign infections in populations with low vaccination rates.
It's possible that this happens, eventually - think years. Not in the 1-3 months period we're talking about. The result is that it doesn't make sense to vaccinate 20-40 year olds in priority or to sell the vaccine on the free market, at all.
> Vaccines have been trialled using not symptomatic illness, but actually PCR tests for immunity, and found over 90% immunity with symptoms||viralRNA as a standard. So no, it's actually around 10-20x less likely to have infection, too. For things like severe ilness, it's more like 99-100%.
The only vaccine I'm aware of that had weekly PCR surveillance was the Oxford/AstraZeneca vaccine, which showed an efficacy of 57% against a positive swab (95% CI -- 41% to 66%; 95% CI efficacy against asymptomatic illness -17.2% to 54.9%). If you know another one that showed 90%+, please cite! Both the Moderna and Pfizer trials relied upon symptomatic illness (symptoms + PCR confirmation) as an outcome measure.
> During this window if the individual is vaccinated before antibodies show up there is very little pressure to evolve resistance against them.
No, but you can get a infection that shows up as antibody response is ramping. Neither infection and vaccine response are nice clean instantaneous, atomic events.
> Given the fact that we have seen zero severe illness in even very old people with many vaccines
You have to consider the statistical power of the study. In the very old people (75+), you're talking about 0 vs. 5 cases (symptomatic) in the Moderna study, for instance, with unknown impact on any symptomatic infections. You seem to be concluding an awful lot based on 0 vs 5 symptomatic cases in a short study period for what the outcome will be across a population of 18 million people in the US.
> If the same individual was vaccinated, this would have been impossible
Why? We've seen it happen in the wild with COVID (long illness times and failed immune clearance), and we've seen it with existing vaccines in other illnesses. "Impossible" is a very stronk word.
> Even for those, the vaccine is still incredibly efficacious. The differences IIRC are barely statistically significant. If you have a source for more significant variations I'd love to see it.
We don't know the efficacy for subvariants. We have nowhere near enough n. We do know that even during the phase 2 trial, there are serum neutralization titers for variants that the error bars do not overlap for, and the MLEs are an order of magnitude apart.
> It's possible that this happens, eventually - think years. Not in the 1-3 months period we're talking about.
First, it's more like a 6 month period, and longer when we consider the entire world.
> The result is that it doesn't make sense to vaccinate 20-40 year olds in priority or to sell the vaccine on the free market, at all.
Which, I understand, are things the original article advocated for, but I never did-- indeed I mocked it in other comments e.g. here https://news.ycombinator.com/item?id=25609607https://news.ycombinator.com/item?id=25609600 and in a comment on the original article. So really, come on. Argue with what I'm saying, not the make-believe argument you'd like to have.
The epidemiological and immunological communities consider it a risk, and I've shared papers. Here's what widely-followed Derek Lowe has to say:
"The good news continues to be that none of the mutations studied so far in the general population seem to be able to evade the antibodies raised by the current vaccines. That doesn’t mean that it can’t happen – and as we start putting selection pressure on the virus by vaccinating people we’ll have to keep a close eye out for anything like that developing. But then we have to consider transmission. If an antibody-evading form of the virus also becomes harder to catch, well, it’s going to be less of a worry. But if we were to start doing a better job at not spreading the virus in general, that would be sort of nice, beca...
Does the chance of seeing a vaccine-defeating mutation increase after injecting parts of the population with a less-effective vaccine (compared to the baseline scenario of no vaccinations at all)? What mechanism is responsible for that?
The answer is only obvious to me if both the original virus variant and the mutation compete for some kind of shared resource. But that shouldn't be the case here, right?
The original virus and the mutation compete for survival in a host body with a partially effective vaccination.
If you generate only a subset of the typical complement of antibodies that a vaccinated individual does, and are less protected and become infected as a result... then any virus variants that emerge within your body that escape any of your antibodies will have a fitness advantage. In turn, that virus will have an advantage spreading to other vaccinated individuals, too.
It is a low probability event in each individual, but if you generate enough individuals like this and infect them all, it's sure to happen eventually. We can't really estimate what the probability of this happening is, but it's certainly less likely if the efficacy is high and there's less disease circulating.
This entire article assumes that the vaccine provides sterilizing immunity (where you can't spread it) rather than just disease protection (where you get and spread the virus but aren't as symptomatic).
But even now no one knows if these vaccines provide sterilizing immunity, as they were only testing for disease protection in the trials. Some even theorize some vaccinated individuals might be _more_ contagious, as they are less likely to socially distance and could be more likely to be asymptomatic carriers.
Indeed the article itself is evidence of this risk, as the author seems to advocate giving the vaccine to people who are willing to pay a lot so they can go party.
That said, if sterilizing immunity is provided by the vaccine, then a lot of the arguments are more plausible. But I don't think it's valid to just assume that, and it's not fair to health officials who don't assume that either.
While that statement is true, it's not relevant to the author's claim - that if you have a limited dose of the vaccine, you should allocate it as quickly as possible (and the free market is a good way to do so) and to people who risk infecting other people. We don't have enough doses for everyone to get the vaccine, so whether it provides sterilizing immunity very much does matter to the question of who to allocate it to and how.
(If we did have enough doses ready to go for everyone, the government solution of "have the government buy it and distribute it to everyone" and the free market solution of "everyone and their insurance is very willing to buy one dose but values a second dose at $0" would basically collapse to the same thing, and so the author's argument would be moot.)
1B) frontline workers (high unavoidable exposure rate, and may be crucial transmission links) & the very old (high mortality rate). If the vaccine lowers transmission, we'll see a big effect from the frontline worker portion, which I suspect factored into the decision somewhat even if it is not acknowledged in the documents.
1C) This category is too big-- all essential workers and anyone with a health condition increasing risk or over age 65. This phase is actually bigger than 2. It needs to be split up some to prevent a mad rush for doses, and certainly we can benefit from further prioritization. Hopefully this is addressed, but it's tomorrow's problem.
2) The remaining group is smaller and probably the least interest in getting vaccinated, so I assume when we get to phase 2 we'll be facing different logistical concerns.
The really stupid thing we're doing, IMO, is reserving 55% of doses to ensure everyone gets dose 2. It should be a much smaller reserve (~25%): it's unlikely that Pfizer's production will stall entirely and even in that worst case scenario, most people would get a second dose, AND the data looks like 1 dose is likely effective.
This reserve is preventing many areas from having enough doses to enter phase 1B, and portions of phase 1B are parallel infrastructure (e.g. mass-vaccination clinics). So, allocating those additional doses could be expected to significantly increase throughput by activating other channels through which the vaccine is distributed.
This is scientific poor communication + regulatory inhibition.
No, the drug companies did not study sterilizing immunity. No, they make no claims. However, ask any expert and they would say they expect there will probably be some sterilizing immunity and reduction in spread for those who do get it.
Some moderna data showed a 2/3 reduction in asymptomatic cases. It would be astonishing if vaccines cause no decrease in spread.
This meme is the new “masks protect others, they don’t protect you”. They do, in fact, protect the wearer to some extent. How could they not?
> They do, in fact, protect the wearer to some extent.
That may be the case with N95 masks, but there is absolutely no way that a surgical mask protects the wearer to any measurable extent. At best, it helps prevent the wearer from spewing more viral particles into the air (and even that is far from proven).
I was an early advocate for masks (check my HN history) back in February, but it's bizarre how they've become a kind of magic talisman for half the population. Some of my "mask-skeptical" HN critics at that time were worried masks would make wearers overconfident, and go into high-risk situations, and they were right.
I thought that the effect would be like 80-90% or something. But given what was established practice in january last year I should not be too suprised with the results ...
The CDC says masks protect the wearer. Not nearly as much as an n95 surely, but how could a mask not protect the wearer to some extent? Virus in aerosols moves on very tiny water droplets, and a porous barrier will stop more than no barrier at all.
Obviously it’s way safer to simply not be in a risky situation. You’re reading stuff into my comment that I didn’t say.
It's a good point I hadn't really considered until now and is sure to make the author quite unpopular. However, in the words of Eliezer Yudkowsky, "Shut up and multiply."
> When I suggested free market vaccine allocation on top of government distribution, critics lambasted me.
I think this misses the point a bit. I think the CDC’s allocation is just fine — the main problem is that it’s being implemented slowly. Just about any carefully planned allocation will be slow. Sell to the highest bidder? Slow. Sell for $20? Faster, but still slow. Compare the way most vaccines are given in an office to the way that mass flu vaccines are done.
If I were running the show, I would choose categories. The categories don’t matter that much — suppose, for the sake of argument, that it’s (1) patient-facing medical personnel, (2) people over 75, (3) people at high risk, self-certified, etc.
Now, in each region, you open up vaccinations by group. Medical centers can run walk-through or drive-through vaccinations, and people in the relevant group line up and get the vaccine. Someone scans ID and types in name and (if available) DOB for people without ID and hands out the info flyer. A handful of technicians give the vaccines.
As soon as vaccine lines aren’t getting filled by one group, you open it to the next group.
Money is basically irrelevant here. The available production is spoken for and paid for. Trying to allocate carefully is nice, but it’s far more important to give someone the vaccine than to give the right person the vaccine.
(Stanford Hospital would have avoided a lot of flak if they did something like this. Randomize the last initials of residents into groups, and give residents the shots by last initial. Then do other groups. Or forget about distinguishing residents from other people — it’s not worth the logistical complications.)
Money is a big issue because there isn't any to staff the actual vaccinations. Spending money on it shouldn't even be a consideration, but here we are.
And then we don't have anything like a plan to treat administration of doses like an emergency. It's bonkers.
> if that same vaccine were given to a front line health care worker, or to a young partier who just can't seem to help themselves from giving it to 25 other people, including 3 grandparents, we solve the disease, we address the externality, and we protect old people, much more effectively
I was just thinking this the other day and wondering if I was some horrible monster. People looked at me like I was crazy. There's some comfort in knowing that whichever side of history this viewpoint lands on, there is a sense in which it was right by correctness if not by popularity.
That's assuming there aren't other ways to stop the young partier, like restricting their partying options and police enforcement for anyone breaking the rules.
Healthcare workers come into contact with many people, many of those people are at risk and the contact is essential (2019 definition).
It's only right to the extent that the vaccine reduces transmission, and this is something we suspect but don't know. We know for sure if we give the vaccine to LTCFs, we'll be saving lives immediately. We don't know the same at all for the partier.
The fact that the current government did a crap job isn't reason to jump on a free market solution. The free market does optimize, just not to anything fair, equitable, or even the most efficient in protecting the population. The solution is to have a government plan that optimizes for the proper variables and the means to apply that plan.
Also, the free market is extremely slow! Remember the whole PS5 hoarding saga from like a week ago - if you let the free market figure out the vaccine, someone will decide they can buy thousands of doses and resell them for profit in a couple of weeks once supply becomes smaller, and in the meantime, as the author worries, exponential spread will continue.
Even if you apply rationing (you could say that every dose purchased must be associated with a natural person who is going to get the vaccine as soon as it's shipped), the vaccine maker is now in the same position - why sell the vaccine for $100/dose to Hospital A today if they suspect that the bigger, richer, more bureaucratic Hospital B will get around to making an offer for $110/dose tomorrow?
So the "free market" solution here involves compelling the vaccine makers to accept any price offered immediately as well as preventing a secondary market, i.e., killing every mechanism for price discovery, which is the core mechanism of free markets. You can't really call it a market at that point, and all your intuitions about market efficiency go out the window.
The free market is the second fastest organisational method we have, beaten only by the military which can achieve specific operational goals extremely quickly. The free market is by far the fastest and most efficient force at sustained logistics.
As I recall it first group to have good Coronavirus testing
was the Koreans who let private industry do its thing [0]. The free market with government as another equal client would be faster than the government at distribution a vaccine.
> This is a pretty specific operational goal so why haven't we used our military?
As in "fly over to Pakistan and assassinate bin Laden" sort of goals. Stuff that burns unreasonable amounts of resources to do something very specific very quickly. If something takes months to execute the market will be faster.
"Get a vaccine to everyone who can afford it" is something that the market will be fastest at. It would be prudent to leave it alone to solve that problem. Government can go solve a different problem.
I disagree on the effectiveness of market solutions for fighting a year-long military campaign. No, it's not a single "assassinate bin Laden" mission, but it maps pretty well to a war where you have both tactical goals to achieve with logistical challenges AND overarching strategic goals.
The market SUCKS at strategic goals. It's basically the opposite: you're giving up on strategic goals because you're in a situation where you don't think central planning can be as effective as competition. But military history shows us that central planning can be very effective for this sort of campaign, complete with elaborate supply chains and logistical accomplishments.
> I disagree on the effectiveness of market solutions for fighting a year-long military campaign.
Markets are generally smart enough not to think killing large numbers of people and overthrowing governments is a good idea. If the US government was somehow replaced with a market the Middle East would likely be a more peaceful place. Markets generally find better ways of doing things - like financial incentives - than military intervention.
I'm more than happy to admit defeat if you want to argue that markets are ineffective at subjugating exotic new lands. In terms of defence, I havn't looked in to it at all. I expect market based economies to beat command and control economies at war because they can better sustain an effort.
Er, the US government is basically funded by (and lobbied by) market participants. The market has realized that killing large numbers of foreign people and overthrowing foreign governments is good for domestic economic growth, and therefore happily operates in the US. The US defense budget is huge, and in turn it's a huge portion of taxes on market participants, and they'd figure out a way to make it stop if they weren't getting their money's worth, precisely because markets are good at solving problems and not wasting money.
The Swiss have their bank accounts, yes. You could convincingly argue that people who are happy to accept low gains as a tradeoff for low risk are interested in avoiding war. But the world's largest markets are in the US. And before they were in the US, they were in the capital of the British Empire.
Markets are very good at solving the sort of problems they solve. But be careful about extrapolating that into "Markets are very good."
(Also, don't forget about the British East India Company.)
The problem here isn't sustained logistics. The problem here is dealing with an entirely novel transient: vaccines for a novel virus exist (or were approved) when they didn't before, and people need them now, and then they're done with it. The market works great once it has had time to deal with transients and do price discovery, but this particular problem is entirely about transients and price discovery.
Think back to the toilet paper shortage, or the mask shortage, or the hand sanitizer shortage, and how long it took the market to respond to those events. Maybe the market is the "second fastest' method we have, in relative terms. My point is it's still very slow, and if you're saying that days matter, the market is not the tool we want.
(That said, throwing the military at this problem seems fine to me, honestly. It is a special case of throwing the government at the problem; it's the branch of the government that specializes in logistics and quick decision-making in life-or-death scenarios, as you point out, and they are used to dealing with situations that arise exactly once in the history of the world.)
> Think back to the toilet paper shortage, or the mask shortage, or the hand sanitizer shortage, and how long it took the market to respond to those events.
Not long? Toilet paper distribution recovered quickly, little old ladies are now knitting masks and I hear distilleries have started converting into hand sanitiser plants. There was a month of confusion then in my experience everything started snapping back to normal. I've never seen so much hand sanitiser as is now available.
> My point is it's still very slow, and if you're saying that days matter, the market is not the tool we want.
Yet if we don't go with the market I bet a worse alternative will be chosen. Back in March-February people would have argued in February that the US CDC was there to overrule greedy companies rushing out coronavirus tests and make sure that there are high quality standards. Then the CDC shipped a test that didn't work and scuppered the US's opportunity to nip the pandemic in the bud. That instance alone is a damning indictment of a government-first response to a healthcare emergency.
People can keep making a big song and dance about how this time the market can't possibly work because it is different to all the other times the market worked really well. Then the government will implement something slower than just letting people buy vaccines like everything else. In time the complete screw-up of the response will be used as evidence that there is no way a free market could have handled something so complicated.
Pretty much every time a free market has been used to solve a problem, the problem gets resolved as fast as possible with minimum fuss. The only exception is problems that poor people have. Coronavirus is not a poor-person-problem. Leaving it to the market will get great results.
> That said, throwing the military at this problem seems fine to me, honestly.
It'll be slower than letting people buy a vaccine off the shelf. The military has no special advantage here. There are great reasons that the military isn't left in charge of running a countries logistics networks - they are competent but not the best at it.
The CDC was also underfunded and the US's pandemic response budget had been slashed. The events of March are a damning indictment of letting small government do a big government's job, but not more than that.
Anyway, I'm happy to concede that the market will take about a month to figure out vaccine distribution. In fact, I said "a couple of weeks" in my original comment that said the market is "extremely slow." So I suspect we have the same actual time span in mind, it's just that you think that the description of that time is "quick" and I think it's "slow".
In particular, it sounds like you think it's quick by comparison to potential alternatives. But I'm saying it's slow by comparison to the author's argument - that additional days or weeks of delay cause serious exponential growth.
So we should at least ask what could be faster, before being satisfied with one month. I know of absolutely no way to make the market faster. I do know of ways to make the government more competent and faster, even if our current government agencies are not competent or fast.
For instance - do you think the military would take more than a month to do this?
(Also, the current government-run distribution regime is actually vaccinating healthcare workers, as we argue about this, and it's taken much less than a month from approval to getting real people vaccinated.)
> So we should at least ask what could be faster, before being satisfied with one month. I know of absolutely no way to make the market faster. I do know of ways to make the government more competent and faster, even if our current government agencies are not competent or fast.
That doesn't make a lot of sense. Why would you unable to implement your ideas if given money & resources in proportion to the value you are creating? Why do you need a politically charged environment with an opposition who disagrees with every aspect of your decision making process to implement your ideas?
And your ideas won't speed the government up, people keep putting good ideas up to improve government all the time then they get shot down in the political process. Congress is deeply unpopular for a reason, and it isn't that people are struggling to see where improvements could be made. The CDC isn't underfunded because the pandemic was unforeseeable, there have been warning signs that something like this could happen since SARS v1 in the early 2000s. It is underfunded because the political process is not an effective method of getting stuff done. As will probably be showcased again if there are any free market vs government rollout vaccine case studies of this next phase.
As plans go it could be boiled down to wanting Congress & the Trump administration put in charge. That isn't a very fleshed out plan, and the fleshy bits to it could reasonably be described as dodgy and unreliable.
> For instance - do you think the military would take more than a month to do this?
Yes. It is a big job.
> (Also, the current government-run distribution regime is actually vaccinating healthcare workers, as we argue about this, and it's taken much less than a month from approval to getting real people vaccinated.)
The healthcare workers have been dealing with the virus for 9 months now, they either have protections worked out or have already caught it. The most important thing, as the article notes, is ramping up production and mass deployments. I'm glad that they're vaccinated, but the most important thing at the moment is safety and raw numbers of people vaccinated, and not so much the targetting. I'd bet most of the healthcare workers who catch Covid catch it outside of work.
The fastest way to get mass vaccinations is to let companies sell vaccine shots to people who will pay them. The government can try to help by ordering a bunch of shots for people who can't otherwise pay.
That's just wrong. The Corona virus is hitting poor and minority populations much harder than wealthy white communities. This is what the free market is optimized to do. It's what Trump and most Republicans in congress truly believe is what's supposed to happen! This very issue is one of the fundamental differences between Republicans and Democrats.
The point that the author is making, is that in the absence of any such plan, market mechanisms would have allowed many of the people with regards to whom it is a collective benefit for us all if they have received the vaccine -- first responders, people who have jobs that require them to travel or be in public, and people who want to party -- to actually be able to get it. The free market doesn't always optimize to what is best, but the author makes a reasonable argument that in this case it would. You don't seem to disagree with their analysis, just markets in general -- and that's a politicized, unhelpful approach.
Health care workers are in the first group receiving the vaccine, so it's sort of confusing that the article goes on about them being prevented from getting it.
But they aren't getting them. Look at the Stanford situation for example. They allocated all the initial vaccines to tenured hospital staff and administrators. When called out on it they shrugged and said "well a computer algorithm decided" and continued with the plan.
Sure, the actual administration is a shit show, but from the top level, those people are getting the allocation because they are health care workers, not because they are vulnerable elderly or some other reason.
And also saved lives? Perfectionism is also perhaps what's stood in the way of generalized hcq treatment which has since been shown to be harmful, and every other well-intentioned quackery out there... It's hard not to see this as a hindsight 20/20 argument...
That said yes speed does matter and seems not to be valued as much as it could have
Free market vaccine, however, would not increase the amount of vaccine but only change the distribution. The wealthy companies would have faster access to the vaccine, which is not the same as the right companies having access.
Apple employees would probably be vaccinated sooner than nursing home employees.
Look at the rollout of the playstation 5 to examine how society in 2020 uses the free market to float a fixed supply resource. You'll find some interesting insights:
* Electronic technology makes it impossible to guarantee equal access. Hackers in other countries could easily disrupt the supply chain
* A "temporary socialism" emerged to disparage the scalpers and middlemen -- the public at large was incredibly unhappy
* Existing middlemen (retail stores) were completely overwhelmed, as there was a gigantic information asymmetry between production, distribution, retail, and consumption
* A completely totalitarian rollout (e.g. Sony sells on its own without middlemen) seems feasible, and might have actually been more efficient, even if delayed by a month. More people would have a PS5 now if the solution was totally vertically integrated.
I think one of the most disappointing things about this pandemic is being able discuss difficult topics without being shunned by the masses/mobrule. Anything you say that is slightly controversial will get slammed on Twitter/Media. We need better mechanisms to express disagreements than the status quo without being belittled, insulted, shunned, disrespected and ousted. If you're a respected scientist, you can get your career slashed in half. Everyone is human, forgiveness, and being able to discuss politely is only may be on HN.
I went on Twitter expressing that the US surgeon general and a bunch of CDC folks shouldn't be lying to the public about the following: Masks were initially in intense shortage. What did the leaders do? They lied to the public about how ineffective masks are to make sure there is enough stock for healthcare workers. I tried to expose this and everyone shunned me down by saying that this is a harmful thing to say. Since when is transparency harmful? You could be truthful and say "While masks are effective, please dont horde them as they are needed by the hospitals". Even if we didn't know the exact effectiveness of masks, they're not harmful to wear. They can only help. Leaders should have told the public about how to make them at home, which did happen, thanks to a bunch of Youtubers.
Here is the deleted tweet (google cache) from the US Surgeon General:
> "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! http://bit.ly/37Ay6Cm"
There were so many things like this. Ventilators, testing ratio, death rate, etc. Coronavirus pandemic was horribly handled by the entire world, particularly us as Americans. Shame really that this is the best we could do.
Edit: Added the official wording of the US Surgeon General Tweet on Feb 29, 2020.
AFAICT at the beginning of the pandemic, we were very much in "not proven" territory with masks. There was a lively debate ablut whether they provided much protection (and there still is, we mostly wear them to protect others from us, not for ourselves, again AFAICT).
Masks can ONLY help. They're not going to make it more likely to catch COVID even if there was no proven effectiveness. Basic logic and years of masks development (used in hospitals for over 100 years) should tell us that they do something. They're not useless.
This was never expressed by the authorities, they should explain. It is a pretty iffy claim and with such a claim, you gotta have some data that invalidates decades of mask usage in hospitals.
Saying that the material has an enormous impact on effectiveness doesn't invalidate anything. I mean, that's why N95 masks are so complicated and different from surgical masks, because material matters so much.
If they were ineffective but people thought they were effective they'd act like they were effective and go do things that would get them infected, falsely believing the mask would protect them.
They appear to have turned out to be effective (FYI: I've warn masks every time I've been outside since 2020/3/16 so I'm certainly on the side of masks)
Will you downvote this because it shows a logical flaw, not a judgement, but it you probably disagree with it?
The fact that hospital workers were desperate for masks, to the extent that they were making their own out of household materials when they couldn't get real ones, tells you all you need to know.
Anyone with a brain cell in their head could see that the government's messaging on masks made no sense. This reduced public trust in the government's other public health announcements.
"Not proven" in the same sense that parachutes are not proven to protect people jumping out of planes, in that it's pretty obvious that they do but no one's done a double blind study.
As it happens, people have since done studies. (Not double blind, though)
That's my memory too - at least in terms of public messaging, there was a lot of "wash your hands for 20 seconds" and "it takes two weeks for the virus to die on surfaces" and so forth, which is largely irrelevant given what we know now about transmission. We also had a significant shortage of hand sanitizer and soap, and e.g. New York's slave laborers were put to work making hand sanitizer, but there was no "hand sanitizer doesn't work" PSA, even though hospitals needed it badly too.
The fact that they said untruthful information about masks was awful, and it certainly deserves a proper postmortem-in-the-court-of-public-opinion, but I don't think it was deliberate lying.
At the onset, hospitals needed PPE, which includes masks. I remember there being messaging encouraging ordinary citizens not to stockpile N95 masks because hospitals needed the supply instead. If anybody in this same camp was telling the public that N95 masks aren’t effective then that’s an obvious contradiction, a lie.
Anyway, lies and inconsistent messaging both degrade trust, which is a big problem at this moment.
> That's my memory too - at least in terms of public messaging, there was a lot of "wash your hands for 20 seconds" and "it takes two weeks for the virus to die on surfaces" and so forth, which is largely irrelevant given what we know now about transmission.
It's not so much now but that actual infectious disease specialists aren't being completely drowned out by people who should have known to keep their mouth shut. Seriously John Cochrane has an excuse, he's from the grifter school of economics and a dummy. Doctors, biologists, etc without specific training in infectious disease should have known better.
Surgical masks weren't in "not proven" territory at any point. Okay there might be some error bars left, but they are generally considered helpful. To the best of my knowledge no government has even attempted to deny this (which would be silly since half the airtime was people in surgical masks running around in Covid wards). These however were in limited supply.
The effectiveness of other masks was not so much "not proven" but to the extent that the lack of any standard allows you to say anything about them they just aren't anywhere near as good. In my mind their effectiveness in combating the pandemic is still well within 'not-proven' territory, but since this is somehow a partisan issue in the U.S. I'll limit myself to just saying that they shouldn't be considered a replacement for social distancing.
Right... just as N95 masks were proven against other non-coronaviruses.
Of course n95 masks only prevent entry through the mouth and nose, and particularly at the time we had reason to think those were other points of entry. So, saying that they were "proven" to work against SARS-CoV-2 at the time was simply false.
Not really, the CDC tweet said that they are ineffective at preventing covid in the general public but necessary for health workers in literally the same sentence:
"Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
There was, as far as I can tell, little evidence at the time that the general public wearing them was effective at stopping transmission, and there were worries that poorly fitted masks and poor mask discipline could actually make things worse.
There are logical ways in which it can be true that they are useful for health workers but not for the public.
We know they aren't correct now, of course, as there is now evidence.
That's not what the tweet said though. It said that they are not effective, with a capitalised "NOT". It's as clear as day that they were deliberately misleading the public.
The fact that you're able to share this opinion on HN without being downvoted, super-downoted (i.e. flagged), and super-duper-downvoted (i.e. moderated), shows that you're in the privileged minority here. That raises serious questions about whether your opinion about being "bullied", etc., is even relevant, because you objectively aren't. This only serves to itself belittle, shun, and disrespect those who are not allowed to share their opinion in these undiverse spaces.
The sensible approach when masks are in short supply is to direct more money to the mask manufacturers. It is overwhelmingly likely that they will use the money to produce more masks.
How are the mask manufacturers going to get more money if they can't charge an exorbitant markup? They need to buy new plant/ materials and hire new people. Is the plan that the mask manufacturers have to go deeply in to debt to create enough masks? That is the best I can think of without sharp price rises, and it is a terrible plan for encouraging people to produce more masks.
What's your threshold for "exorbitant"? If you add an extra dollar to the price, that's enough to get a lot of expansion of manufacturing. Beyond that, I would say that long-term purchasing contracts, or government funding to pay for new machinery, are both much better options to boost capacity than huge price hikes.
I don't have one, or actually care about specific numbers. There is some magic price where I'll start learning how to make masks but I doubt we're going to see that reached in my lifetime.
> If you add an extra dollar to the price, that's enough to get a lot of expansion of manufacturing.
In 18-24 months, sure. We're 12 months in so far though. If they need the money now it is a different story. The higher the price, the more immediate and desperate actions become justified to increase supply. That is one of the core parts of market economics. Let the price rise to some silly amount and people will move heaven and earth to increase supply.
To get extraordinary things done an extraordinary amount of money will be needed. That can come from extraordinary prices. Or it can not happen and shortages can persist longer than required.
Yeah what's also a bit frustrating is that people like Joe Rogan are openly discussing the controversial stuff people don't wanna hear and are getting SLAMMED on Reddit for deviating even just slightly from what the government has chosen to do along with the medical leaders. Most of the smart people I know think that widespread lockdowns are an extremely heavy-handed solution that will lead to more harm than good. History is proving this day by day... It seems a nuanced approach to re-openings is simply too difficult to get right and therefore untenable, which is extremely sad.
The problem is not JR, it's the people who listen to him and take his every word as some sort of ultimate truth.
I don't blame him. Human nature is to wield power. The more power the person has, in whatever form it is, the more inventive ways he will come up with to use it for his goals, be they selfish or otherwise.
JR would shut his mouth if his audience chided him to being conspiratorial.
The society has lost the ability to think critically. And the focus on individuality has exacerbated the problem. I don't mind individuality in matters such as personal growth, morality, religion, etc, but there are some aspects of social life where collective expert decisions must hold higher weight than individual opinions, such as in public health, defense, etc.
See this is my point. "You have no idea what would have happened" is an opt-out of a conversation. You can't deny the negative effects of lockdown. The point is that other solutions should be tried because the current one clearly has disastrous consequences. For example, an alternate solution could be tried in a small microcosm as a sort of A/B test, but no one is really entertaining that possibility, and anyone who does is hit with contentless comments such as yours. Thinking is hard, but it's time for everyone to start.
no it is not an opt-out of conversation. It's a point that you made a massive oversimplification and yourself opted out of thinking. You just basically said, lockdown = bad consequences, non-lockdown = good consequences. non-lockdown could have had 2x, 4x, 10x, 100x, 1x, 0.5x the infections. We don't know which. You ignored all those possibilities and their repercussions and just stated lockdown has been disastrous implying that non-lockdown would have been less disastrous. you don't know that. I for one believe non-lockdown would have been more disastrous. Hospitals would be more full, more people would be dying, people would be even more desperate than they are, the result would be an even worse economy and more suffering
> You just basically said, lockdown = bad consequences, non-lockdown = good consequences
I'm sorry but your comment shows that you did not read my comment. Please read:
> deviating even just slightly from what the government has chosen to do
> nuanced approach to re-openings is simply too difficult to get right and therefore untenable
What part of "deviating just slightly" and "nuanced approach" implies a complete inverse approach? I think you are straw-manning me, sorry. I never said that the solution was to not have lockdown at all. You can re-read my comment again if it helps. I implied that a nuanced approach and a slightly less restrictive approach would be better. It seems that my comment regarding people unwilling to have a nuanced conversation proves true again.
You seem to continue putting words in my mouth. What's up with that? Here's what I said:
> other solutions should be tried because the current one clearly has disastrous consequences
Given the context of my other comments, you seem to have reached the wrong interpretation, and are still unwilling to entertain a conversation about what a milder lockdown looks like.
> You could be truthful and say "While masks are effective, please dont horde them as they are needed by the hospitals".
I’m not a politician nor I defend most of them in general but do you expect that people would not hoard them when everyone was (back then) panicking at a new extreme deadly virus?
So the easiest solution (not necessarily the best) was to do politics which is to deceive. If a country says that the masks are very effective yet only selected people will get them, even if it makes sense factually speaking, riots will ensue because that’s how masses work (in most big countries anyway). If you deceive, you gain time and everyone will eventually get their own masks, which is how it played out.
Hopefully I don’t get shunned by this. I’m just trying to illustrate that plain transparency at extreme situations may just not be an easy option as you put it.
We can’t know for sure but I bet many people didn’t hoard or didn’t even bother to buy any in the beginning because of this announcement. At big scale (e.g. USA) this means millions of saved masks.
> At big scale (e.g. USA) this means millions of saved masks.
At what cost? How many people have died because mask wearing was discouraged during the early part of the pandemic? We will probably never know, but I would not be surprised if that advice caused a lot of deaths by allowing the virus to spread more easily.
The benefit was to save masks so health workers would get them (at least most of them) and the goal was more or less met. Cost? Probably too high. Alternatives?
Again I don’t defend these actions, I’m just trying to reason why they decided to go that way and not the most instintive one “let’s be fully transparent” (at least for HN anyway).
The many public figures dismissing masks after things really got going in July killed more people than the communication mistakes in February. Then they kept dismissing them in August and September and October and November and December, and many are still doing it now.
Face coverings were ordered in many states starting in April.
A competent administration would have bought up enough of (or all of) the PPE inventory as soon as they understood what was coming. At that point, there would have been no need to lie, because there would have been nothing left for the public to hoard.
I'm not blaming the CDC, or the SG. I'm blaming the political decision makers above them
Ideally, they could decree companies to prioritize shipments to hospitals and health workers and set-up a task force to route all purchase decisions through the govt. until mask shortage is solved.
> So the easiest solution was to do politics which is to deceive
I disagree. politics is not to deceive. Politics is to guide and educate. The longer we accept the rationale that politics is inherently an immoral game, the more our minds accept the status quo.
Those politicians who lied must be held accountable. Those who pushed for the truth but took actions to prioritize health workers should be rewarded.
Yeah there are better solutions but they’re not the easiest nor the fastest. Lying ticked those boxes and so they did it that way in many places.
Politics is IMHO all or a majority about deception unfortunately and once you accept this these actions just make more sense and you stop playing their silly game. I decided to move to a smaller and more healthy democracy because I knew degeneration of politics back in my (somewhat big) country was only going to get much worse and in some cases that can mean literal death to me and I could do nothing to change it. Well, all this is way too off-topic so let’s leave it for another time as it’s an interesting one :)
When you are an institution like the CDC you need to be trusted to be effective. So, yes, the most expedient solution to the mask problem is to lie, but it's not worth the long term damage to credibility when they are inevitably caught in that lie.
It’s a pick your poison situation. Reputation may have been damaged (who knows really, masses seem to forget rather quickly nowadays) but the alternative might just have caused a lot more trouble.
No, when you're the CDC, you disseminate the facts as they are known at the time. You don't lie to supposedly keep masks from being hoarded. Considering that's exactly what happened, I fail to see how it could have turned out much worse.
Just take a look at Fauci as an individual. He's never said masks don't work. He did say "there's no reason to be walking around with a mask," back in March, but, back in March, that was likely true. And, it's not like he hasn't reversed himself when new data comes in. That's precisely why he still has credibility: because what he says is always in line with the best available data.
I can’t talk specifics about CDC as I’m european but this way of acting was present in most of the countries around the world and I think it’s somewhat safe to think that it decreased masks demand to a certain point (1%? 20%? 30%?). Even in solid democracies with high trust like Finland they lied so that people wouldn’t hoard that much.
Also I IMHO doubt that Fauci didn’t know about mask effectiveness - sure, maybe he didn’t know the very specifics but it was kind of obvious back then it wasn’t going to harm and one could infer that it’d probably help somewhat (nowadays it’s clear). IMHO all authorities just agreed to transmit a similar message around the world so they could in the meantime arrange more mask orders and sort out the distribution as production speeded up while avoiding massive riots and/or poor masks made at home that could’ve been worse than nothing.
He didn't say they weren't effective. He said it wasn't worthwhile to be walking around wearing one at that time. The virus wasn't anywhere near as prevalent then as it is now, and, people had no real sense of how quickly this thing could spread.
So today these same people say that the vaccines are safe for anyone and everyone to take (including people not at risk from the virus, people who have already been infected, people with autoimmune issues, pregnant people, breastfeeding people, etc. etc.); but how long will it take before we look back and say "oh well that was likely true then but now we know better, teehee!"?
> We need better mechanisms to express disagrements than the status quo without being belittled, insulted, shunned, disrespected and ousted
We do have such mechanisms. In the olden days, opinions were expressed through slow moving mediums such as news papers and press conferences. Those who wanted to criticize them had channels such as letters to newspaper editors, radio calls, etc, to express disagreement or point out flaws. This was good and bad. Good because you had to invest a finite amount of time and resources to express counter opinion. Bad because it has the effect of amplifying the voices of fanatics.
However, with today's friction free methods to express opinion and social media echo chambers that amplify everything, there is just too much noise.
I just hate Twitter and Facebook. Their ultimate contribution to society is sum negative.
You're absolutely spot on. We need to come up with better etiquettes for debates of difficult situations on the internet than this Twitter/FB nonsense and in a more formal forum. There should be rules of engagement with freedom to express disagreements backed by logic, reasoning and data.
There was no explanation. The shadow-ban must have happened shortly after I posted an unpopular comment which received a lot of downvotes, which is why I assumed that it had to be some sort of automatic action.
Do I need to comment on the irony of a killed/flagged comment replying to yours stating that unpopular opinions are killed or flagged here immediately?
Agree. No one remembers that conservatives were also trying desperately to locate masks for purchase back in March.
The public is smarter than the technocrats give them credit for, and will bristle at attempts to influence their behavior through lying - or even just fibbing, as in this case.
Good luck gaining back their trust after a round or two of that. In that respect, they may resemble petulant children - but can you blame them?
> They lied to the public about how ineffective masks are to make sure there is enough stock for healthcare workers.
Except they didn't. What they said that the odds of you getting infected were not substantially changed by you wearing a mask in general, but they were substantially changed for people in high risk situations, like healthcare workers.
That became less and less true as more and more people became infected, so the basal chances of you getting exposed, and therefore the impact of wearing a mask, changed.
> "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! http://bit.ly/37Ay6Cm"
^ US Surgeon General official tweet which was then deleted. Source, Google cached version, google "US Surgeon General tweet masks".
Useless pedantry, and wrong, to boot. Given a low enough baseline exposure to the virus, which would otherwise cause disease, it certainly is possible that wearing a medical grade mask could lower one's exposure sufficiently to not get the disease. One may still be exposed to the virus, but, given the reduced viral load, one may not experience symptoms.
Not useless pedantry, particularly given the context and what was observed to have happened. These are technical terms and they have specific meanings, and the context was provided in the communications.
There was a genuine concern that people would not only consume the supply of mask product, but also that they'd think they were safe because they had a mask on, and then proceed to ignore other safety guidelines, thinking they were safe.
This in fact happens every day right now, but you know... it's just pedantry.
Again, if you look at the CDC statements, they are consistent with this. They said it could reduce the risk of spreading or contracting the disease (and the specifics of how that might work were not as well understood at the time), but that it would NOT prevent either of those scenarios.
If you think about it, communicating that "they don't work at all" but "we have to keep a stockpile of them for the people at highest risk" doesn't make any sense. It's not what happened.
Hoarding masks would have been the sort of response that the author is railing against (a hoarded mask isn't doing anything to get R down), except that, being a free-market response, it would not have served the author's purpose as a parable extolling the wisdom of markets.
Asking people not to hoard masks would have been no more effective than it was for toilet paper - I would guess less effective, in fact.
There's any number of terrible things about the US response that could/should have been better. But the US Surgeon General did not lie to the public with that tweet. His communication wasn't adequate for someone holding his office, because it takes effort to parse, and crucial communications like his need to be better, but he didn't lie. Look carefully at what he said:
"if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
This is a statement of confidence in the masks he's talking about, N95/adjacent PPE. Saying they provide any substantial margin of personal protective safety for healthcare providers is saying they work.
Now some people read "STOP BUYING MASKS! They are NOT effective" and stopped thinking right there. Some of the fault lies in anyone who did that. Some of the fault lies with the SG for poor communication. But the fact is, the SG's statement did not stop there.
It continues into a statement skeptical not of the effectiveness of PPE masks as a personally protective measure, but as a measure that can protect the general public. There might by any number of reasons for that. He might believe the general public can't wear them effectively and conscientiously (I didn't believe that in March, but after watching people wear cloth masks, I absolutely do). He might believe there just weren't enough to protect the public (absolutely true then). He might believe they might engender a false sense of confidence preventing more effective measures (credible). Some of those reasons were actually stated and yet not perceived, which speaks to the trouble of "just telling the truth." There may have been others.
Additionally, I'm astonished that many people continue to read his statement and fail to distinguish between PPE masks and cloth masks primarily about preventing source transmission (ie, wearer infecting others, with some fractional protection from being infected by others). In fact, I'm astonished at how many people still don't understand what cloth masks can do and talk about themselves or those wearing them in terms of protecting themselves.
It's unfortunate that he didn't communicate better. Failing on that front might even be reason enough to have someone else doing that job.
But honestly 10 months out I don't know that it's all on him.
I agree with several points in the article, but suggesting market allocation is completely insane. We have a severely short supply of vaccines. If we use market allocation, who do you think will end up with all existing supply? The highest bidder! Rich people and institutions will buy this supply for months, to use it on people who are already well protected due to their economic status. First responders, especially in poor neighborhoods, will be lacking access and dying for several months. Moreover, if there is no government mandate for mass production and distribution, price-points may end up in a place where the poorest will never be able to afford the vaccine.
The implied false dichotomy by not actually discussing what a properly directed deployment under some non financial minmax. Much of the failure in public health here is caused by price centric thinking, and so this guy thinks to the limit in a price centric way, rather than actually discuss the alternatives.
While I agree with the author's arguments, I feel he is totally missing the point.
We are not going to fix society in time to stop this pandemic.
Problems that will not be solved:
- our politicians will not become competent. Our selection process for politicians is driven by how good they are at attracting votes, not how good they are at handling problems. Politicians are aware of this and just exploit it constantly.
- our people will not become reasonable. A sizable percentage of the population don't believe covid19 is different from flu, another does not want to take vaccines.
- corporations want to get the most out of it. A full blown pandemic is in their best interest. All those covid tests and vaccines pile up. Even better if they can convince us the vaccine only lasts one season!
So the bottom line for me is: if I am convinced the vaccine is safe and effective, just be careful and dodge the disease as long as I can get a vaccine.
There is not much more to it, and I focus my energies somewhere else.
Of course if everyone was like me, the pandemic would be over by now. But that's not the case and hoping in something that will not happen, like the author does in this piece, is fruitless.
First, targeting spread instead of severity. This is not good. The amount of people that would fit the profile from any available variables of a spreader are probably around 100 million in the US. If you're going to vaccinate most of them, you're going to need so many doses that you can vaccinate literally everyone that has over 0.2% fatality risk, and a month or two later you can reach herd immunity. There is clearly very little advantage there.
And for selling them on the free market, it's insane to expect that vaccine sellers with limited capacity will sell the vaccine for anywhere near an affordable price. You don't have nearly enough demand elasticity to justify the manufacturers - two of them, by the way, to drop their prices at all, because even if they sold them for 5000$ they would sell every dose they could produce for months. By the time they would be affordable for the average person, we could again have vaccinated all vulnerable people and a few months later essentially everyone.
In the two or three months between full vaccination of privileged classes and herd immunities, there will not be new mutations that will be able to spread despite full vaccination.
Nassim Taleb was arguing for something similar just the other day. The vaccine should be given to "superspreaders" first
"Most effective is to focus on 1) superspreaders (when they can be identified), 2) integral of exposure over time (hospital workers) & 3) vulnerability (older etc.), but (2) overlap with (1). Current focus is on (2)& (3), less optimal.
(1)>>>(2)+(3)"
Are superspreader a "personality type"? I thought it was some body property, like biological. Bigger nostrils or whatever (a joke but you get the point).
People can't even be convinced to buy toilet paper rationally, not sure if I trust them to buy a vaccine in a way that is even remotely rational.
And the argument that people more likely to spread the disease would be willing to pay more is a bit weak. Sure the chance you get infected correlates with the chance you infect someone, but for some people infection carries more risk than others. And presumably the author also wants companies to be able to require people to be vaccinated, because otherwise vaccines are of limited use to companies.
Finally I'm not too sure if combatting 'R' is the end goal. In the end you want to minimize total harm, this is subjective but among other things involves minimizing total deaths. It's conceivable that vaccinating the group that's overwhelmingly at risk first is an effective strategy to achieve that.
> A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old.
>Give it fast to the people most likely to get it and to spread it to others.
If you want to make sense of the world, don't look at what people say, look at what they do... and then infer the truths from that.
Why would people who are smart enough to make vaccines so clueless that they usually take it to the third world for large scale initial distribution or testing? It would make sense to do it to the local community, wouldn't it? It happened during t
COVID too.
There's a reason why the current vaccines are being prioritized for old people. We can't afford to lose first line workers.
> So what good has been achieved by banning a private market on top of government allocation?
Public health should never be left in the hands of the private sector.
On top of the poor response by government, I think the disaster now unfolding in the USA, and to a similar extent in the UK, are examples of governments trying to hinder/eliminate their public health institutions (i.e. the CDC and the NHS respectfully).
Did everyone miss the main premise of the article, which is that the distribution should be focused on reducing the r0? Yes, there was some stuff about free markets and such, but I think the main premise still has merit whether you're a socialist or a capitalist.
Why is no one discussing this? Giving a significant allocation to retirees instead of essential staff is the more compassionate thing, but is it the best?
That's not what we are doing! Healthcare workers are in the initial allocation in most states. There's been all sorts of news featuring doctors and nurses getting shots.
Part of the reason is that it's easier to get healthcare workers near the freezers required to store the Pfizer vaccine, because many of those freezers are in hospitals.
Depending on the state, essential workers are near the front of the list as well. Those would likely include a subset of your list, but probably not restaurant workers.
There are anecdotes, sure, but I haven't seen any plan that in anyway appears to be in the same tone as the author's premise here. That is, ideally the objective statement would start with something around lowering the r0.
There is no possible way to target superspreaders, a lot of spreading happens in work or private situations we can’t know in advance who will spread it there. And the possible age groups are too large so we will see no effect immediately with the limited supply of vaccine. Starting with the eldest and those who are most likely to die from COVID should bring mortality down in the next 16 weeks. And afterwards we can work on reaching herd immunity.
To be frank, the people most likely to be super spreaders have mostly become infected by now and achieved natural immunity. 30+% of people in large portion of the country have likely been infected [0]. There are certainly some regions with much lower than average numbers that could theoretically still benefit from this strategy, but I agree that targeting would be very difficult and controversial.
It's incorrect. The point of the response isn't to minimize R, it's to minimize harm. If that means minimizing R, then it means minimizing R. Here it doesn't - modeling shows that harm is minimized by vaccinating vulnerable populations even if they spread the virus less.
Putting vaccines on the free market would mean that they are purchased by individuals with the most buying power first, which are coincidentally the same people most able to isolate and avoid the disease entirely. To me, that seems counterproductive.
The current allocation might not be the maximally effective one but a free market solution that beats it is a pipe dream.
175 comments
[ 2.0 ms ] story [ 262 ms ] thread> Is it just me or does uncontrolled, high level community transmission with circulation of several new #SARSCoV2 #COVID19 variants while starting vaccination with modified schemes, leading to partial immunity in a large proportion, sounds like a bad idea? #evolution #thirdwave
https://twitter.com/EckerleIsabella/status/13450246946432081...
As a non-biologist, it's not immediately obvious why that would be the case. What's the mechanism that increases the chance of mutations in vaccinated hosts?
The vaccine is ~95% effective. This means you're going to have a lot of people get infected still with the vaccine's antibodies present; any mutation that happens that causes escape from these antibodies will prolong disease and increase transmission, even if that mutation renders the virus a bit less fit in a non-vaccinated host.
Is that an accurate summation of those who caught it after receiving the vaccine?
Seems like if 5% of virus strains circulating aren't affected by the vaccine, we're fucked anyway. That 5% will become 100% of what's circulating in the next year and will be ubiquitous?
If it's something like "5% of people don't respond to the vaccine to build antibodies at all," on the other hand, it's much rosier...
Some of the 5% may just be unlucky people who got bigger doses of the virus/higher initial infectious dose, but the same logic applies.
It may be more than 5%, even; the vaccine likely does more to prevent symptomatic illness than infection.
It's hard to estimate what the probability of this happening is. It's certainly more likely when there's more illness circulating around-- e.g. if 1 million people with the vaccine become infected it's worse than if it's 10,000.
This seems very circular to me. If they don't build very effective antibodies, they shouldn't be putting much selective pressure on the virus, because if they did, they'd be more effective in the first place.
I suppose it depends on how exactly "effective" plays out here, as well as how easy it is for the virus to mutate significantly but stay as contagious as it is, but if we get unlucky it seems like just a question of time for it to get bad. Given Jan-Mar 2019, I have little faith that the US would ever be in a position to fully eradicate even a small remaining bit, and it would instead fester and mutate in this scenario until exploding again.
Maybe multiple vaccines mitigates this a bit...
If a normal person generates a dozen types of antibodies to the vaccine's spike protein, and a couple types are strongly sterilizing...
And you happen to have an immune response where you generate 8/12 of these, and only one of the strongly sterilizing variant, and you are more prone to become infected as a result...
Then, once infected, the virus will be under selective pressure during your illness to escape some of those 8 antibodies. In turn, whomever you spread it to will have a harder time.
> Maybe multiple vaccines mitigates this a bit...
Maybe. But the portion of the spike protein they're expressing and the resulting antibody profiles look very similar.
> Given Jan-Mar 2019, I have little faith that the US would ever be in a position to fully eradicate even a small remaining bit, and it would instead fester and mutate in this scenario until exploding again.
Yes, but one silver lining is that there would still be some immunity / cross-reactivity / t cell mediated immunity, etc. People would still be less likely to have severe illness, I believe.
The virus in this case would have to evolve in your body to escape not just 4-6 of the 12 antibodies, but most of them, otherwise it still won't be able to cause productive infections before it starts getting neutralized and the immune system detecting neutralized viruses mounts a stronger response.
However, sterilizing antibodies are most interesting because they are the strongest factor in preventing transmission.
People with weak immune responses of various kinds can be expected to have more infections and to be infected for longer times, and they provide selective pressure to evade the remaining mechanisms.
Just to follow up / argue from another angle. It's believed to be likely that the "new" UK variant likely emerged in an immunocompromised individual. This results in A) -some- immune response, and B) prolonged infection where the virus is under evolutionary pressure to escape that immune response / original antibodies.
Someone who doesn't mount a strong response to the vaccine is a very similar case.
Even a weak response to the vaccine can activate bound antibody responses during challenge, which means the immune system is activated much faster and even though there is still infection it is much shorter, leaving less of a chance for the virus to mutate.
Even a partial response from a vaccine suppresses the virus and (usually) reduces the risk of transmission. At the same time, it creates a window where the virus is under selective pressure to escape some of the immune response from the vaccine's effects. Individuals who have smaller/partial responses to the vaccine are more likely to have this happen.
That is all I'm saying, and I don't think it's really that controversial. I'm not trying to make a robust immunological argument. I don't think it's inevitable, but it's another reason to reduce transmission. We already have the UK variant, which many have suggested is better at immune escape due to perhaps evolving during a long infection in an immunocompromised individual.
In other words, by the time the virus is replicating inside of you, it doesn't really have much pressure to evolve to evade those other facets of vaccine immunity, because doing so would probably hurt it.
The UK variant isn't better at evading the immune system from what we know. It's simply more infectious in general.
I disagree. You have the weak vaccine response the entire duration of infection applying selective pressure. What you say seems to disagree with the consensus of the literature, e.g.
https://www.medrxiv.org/content/10.1101/2020.11.17.20233726v...
> The UK variant isn't better at evading the immune system from what we know. It's simply more infectious in general.
The mutations have been broadly described as "immune escape mutations" and are thought to have emerged from pressure to escape low numbers of existing sterilizing antibodies within the host, e.g.
"The unusually high number of spike protein mutations, other genomic properties of the variant, and the high sequencing coverage in the UK suggest that the variant has not emerged through gradual accumulation of mutations in the UK. It is also unlikely that the variant could have arisen through selection pressure from ongoing vaccination programmes as the observed increase does not match the timing of such activities. One possible explanation for the emergence of the variant is prolonged SARS-CoV-2 infection in a single patient, potentially with reduced immunocompetence, similar to what has previously been described [17,18]. Such prolonged infection can lead to accumulation of immune escape mutations at an elevated rate"
https://www.ecdc.europa.eu/sites/default/files/documents/SAR...
As I said before, there is some pressure for antibodies, but the immune system is way more than that, and people can clear infections very effectively without any antibodies at all.
As for your other link, it's important to know that this a preliminary article that, on those subjects, gives ideas without data. Further research has shown that this variant does not seem to increase disease severity, and instead is just more infectious, as the spike protein evolved for higher binding affinity.
Assumes only a couple of neutralizing antibodies, which is fair for the vaccine candidates-- immune assays of Moderna's vaccine show two typical antibody binding sites against the RBD that are strongly neutralizing. I haven't seen the ELISA data for Pfizer's vaccine.
Given that we've got several papers describing how immune escape variants of other viruses have emerged in the past... I'm curious why you don't think it's much of a risk here?
e.g. https://pubmed.ncbi.nlm.nih.gov/11410701/
> As I said before, there is some pressure for antibodies, but the immune system is way more than that, and people can clear infections very effectively without any antibodies at all.
Of course. I'm not speculating that there's going to be some nasty variant that completely eludes our immune response. I'm saying that it is likely-- and the consensus opinion-- that there is a real risk that the virus mutates to render the vaccine less effective.
> Further research has shown that this variant does not seem to increase disease severity, and instead is just more infectious, as the spike protein evolved for higher binding affinity.
Some of the mutations slightly increase binding affinity. Other deletions look like their primary fitness advantage is immune escape. A missing stop-codon also increases mutation rates for a portion of the RBD, which implies we can expect quicker emergence of subvariants.
It's like you're having an argument I never was having: I have never said that this is likely to cause more severe disease. I am just saying that the virus will be under selective pressure to evade the vaccine-induced immune responses-- which is something I think everyone agrees. This is less likely to happen if there's less infection around and people get vaccinated quicker.
Even in the worst case, where such a variant evolves quickly-- I don't think we're that bad off. As you mention, there's other immune responses. Strong T cell mediated immunity will almost certainly be cross-reactive and strongly reduce the risk of severe illness. We'll have more time to adjust vaccines without mortality accruing as quickly. It is still something we'd prefer to avoid at all costs.
The answer to this is very probably no. There is a huge difference between the virus making the vaccine less effective eventually, the virus making the vaccine less effective within one to three months, and the virus making the vaccine sufficiently less effective that it can sustain an epidemic among vaccinated individuals. The second is not very likely at all, because for it to happen a variant of the virus would have to mutate, and outcompete the dominant variant, that has a spike protein sufficiently different that it can keep R>1 among vaccinated individuals.
For this, the virus would not only have to evade antibody response sufficiently for there to not be sterilizing immunity, but it would have to do evade the much swifter and effective non-serological immune response enough to stay infectious.
All of this would have to happen in a subset of the population that has a 20x lower chance of being infected and even when that happens, the infection would be much shorter with most of it with completely different evolutionary pressures.
In one to three months.
It would also have to compete effectively against other variants in the non-vaccinated population while it is doing so, because non-vaccinated people are by very far the dominant infection vector. So it would have to evolve this not only in vaccinated, but also non-vaccinated patients, unless you believe that these extensive mutations will happen in one, vaccinated, patient, which is pretty much impossible.
Not a given. It's very likely, but we don't know how effective the vaccines will be in preventing transmission. Certainly there is past precedent for the opposite.
Also, there's likely to be pockets of population with poor vaccine penetration, so even if it confers sterilizing protection, we're likely to see endemic spread in these subpopulations continually challenging the vaccinated population.
> is a variant of the virus going to appear that will be able to effectively infect vaccinated people and spread enough for the pandemic to continue?
We see a hepatitis B vaccine escape variant every year or two, despite a much lower community disease burden. I don't think anyone can know how likely this is.
> All of this would have to happen in a subset of the population that has a 20x lower chance of being infected and even when that happens,
It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
> It would also have to compete effectively against other variants in the non-vaccinated population while it is doing so
Already the currently circulating variants are not equally neutralized by the vaccine. There's going to be immediate pressure making the variants that are least impeded more prevalent.
> unless you believe that these extensive mutations will happen in one, vaccinated, patient, which is pretty much impossible.
Again, the most likely scenario for the emergence for the UK variant is prolonged infection in one person with a low immune response. People like this are well represented in the groups we're immunizing first, too.
These things aren't mutually exclusive, though: you start off by favoring the current variants that the vaccine is least effective against. Then, you have ongoing evolution in vaccinated individuals with lower responses. Then the favored variants become endemic, circulating mostly in subpopulations with lower vaccine coverage and occasionally finding vaccinated people who are more susceptible.
How quickly it all happens depends upon total disease burden. I agree we will probably not get a worst-case escape variant in the first few months of the vaccination campaign, but I think we'll probably see some adaptation towards escape and lowered efficacy. Indeed, you don't even need mutation for that: just preferential selection for existing variants with lower vaccine efficacy.
No one's done the assays on the UK variant yet, but I will not be surprised if the current vaccines are somewhat less effective against it.
If the disease remains endemic with relatively high levels of circulation, variants that escape the current vaccines will be all but certain in the long term.
Hepatitis B is a disease that lasts much, much longer than COVID-19, which exponentially increases the likelihood of such an event. Moreso, Hepatitis B immunity from vaccines is often very weak due to a lot of people not getting booster shots in adulthood.
>It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
Vaccines have been trialled using not symptomatic illness, but actually PCR tests for immunity, and found over 90% immunity with symptoms||viralRNA as a standard. So no, it's actually around 10-20x less likely to have infection, too. For things like severe ilness, it's more like 99-100%.
>It's not very likely that the population has a 20x lower chance of being infected; the vaccine almost certainly does more to prevent symptomatic illness than any infection. They've shown a 20x lower chance of symptomatic illness. You're also leaving out the critical window before the first dose where protection (against symptomatic illness) slowly climbs over weeks to 70-80%.
During this window if the individual is vaccinated before antibodies show up there is very little pressure to evolve resistance against them.
>Again, the most likely scenario for the emergence for the UK variant is prolonged infection in one person with a low immune response. People like this are well represented in the groups we're immunizing first, too.
Given the fact that we have seen zero severe illness in even very old people with many vaccines, this is even less likely than for a non-vaccinated but immunocompromised person, for which this scale of mutation didn't even happen yet, 1 year in. And by the way, the hypothesis - which is as of yet unconfirmed and whose certainty became lower after similar mutations were found in South Africa - is that this process happened in an unvaccinated immunocompromised individual during a month+ infection period. If the same individual was vaccinated, this would have been impossible, and we haven't seen this kind of illness in any vaccinated individuals.
>These things aren't mutually exclusive, though: you start off by favoring the current variants that the vaccine is least effective against. Then, you have ongoing evolution in vaccinated individuals with lower responses. Then the favored variants become endemic, circulating mostly in subpopulations with lower vaccine coverage and occasionally finding vaccinated people who are more susceptible.
Even for those, the vaccine is still incredibly efficacious. The differences IIRC are barely statistically significant. If you have a source for more significant variations I'd love to see it.
Crucially though, in the scenario you are suggesting where the virus is spreading in non-vaccinated populations, that the actual strain to acquire enough changes to become effective against vaccinated individuals absolutely needs to outcompete other strains, which isn't likely. This is because even if the virus were to infect one of the few vaccinated but less protected individuals, which would in this case probably be under 1% of infections, those mutations need not be a hindrance in the 99% of infections which won't be of less protected individuals that have more than benign infections in populations with low vaccination rates.
It's possible that this happens, eventually - think years. Not in the 1-3 months period we're talking about. The result is that it doesn't make sense to vaccinate 20-40 year olds in priority or to sell the vaccine on the free market, at all.
The only vaccine I'm aware of that had weekly PCR surveillance was the Oxford/AstraZeneca vaccine, which showed an efficacy of 57% against a positive swab (95% CI -- 41% to 66%; 95% CI efficacy against asymptomatic illness -17.2% to 54.9%). If you know another one that showed 90%+, please cite! Both the Moderna and Pfizer trials relied upon symptomatic illness (symptoms + PCR confirmation) as an outcome measure.
> During this window if the individual is vaccinated before antibodies show up there is very little pressure to evolve resistance against them.
No, but you can get a infection that shows up as antibody response is ramping. Neither infection and vaccine response are nice clean instantaneous, atomic events.
> Given the fact that we have seen zero severe illness in even very old people with many vaccines
You have to consider the statistical power of the study. In the very old people (75+), you're talking about 0 vs. 5 cases (symptomatic) in the Moderna study, for instance, with unknown impact on any symptomatic infections. You seem to be concluding an awful lot based on 0 vs 5 symptomatic cases in a short study period for what the outcome will be across a population of 18 million people in the US.
> If the same individual was vaccinated, this would have been impossible
Why? We've seen it happen in the wild with COVID (long illness times and failed immune clearance), and we've seen it with existing vaccines in other illnesses. "Impossible" is a very stronk word.
> Even for those, the vaccine is still incredibly efficacious. The differences IIRC are barely statistically significant. If you have a source for more significant variations I'd love to see it.
We don't know the efficacy for subvariants. We have nowhere near enough n. We do know that even during the phase 2 trial, there are serum neutralization titers for variants that the error bars do not overlap for, and the MLEs are an order of magnitude apart.
> It's possible that this happens, eventually - think years. Not in the 1-3 months period we're talking about.
First, it's more like a 6 month period, and longer when we consider the entire world.
> The result is that it doesn't make sense to vaccinate 20-40 year olds in priority or to sell the vaccine on the free market, at all.
Which, I understand, are things the original article advocated for, but I never did-- indeed I mocked it in other comments e.g. here https://news.ycombinator.com/item?id=25609607 https://news.ycombinator.com/item?id=25609600 and in a comment on the original article. So really, come on. Argue with what I'm saying, not the make-believe argument you'd like to have.
The epidemiological and immunological communities consider it a risk, and I've shared papers. Here's what widely-followed Derek Lowe has to say:
"The good news continues to be that none of the mutations studied so far in the general population seem to be able to evade the antibodies raised by the current vaccines. That doesn’t mean that it can’t happen – and as we start putting selection pressure on the virus by vaccinating people we’ll have to keep a close eye out for anything like that developing. But then we have to consider transmission. If an antibody-evading form of the virus also becomes harder to catch, well, it’s going to be less of a worry. But if we were to start doing a better job at not spreading the virus in general, that would be sort of nice, beca...
The answer is only obvious to me if both the original virus variant and the mutation compete for some kind of shared resource. But that shouldn't be the case here, right?
If you generate only a subset of the typical complement of antibodies that a vaccinated individual does, and are less protected and become infected as a result... then any virus variants that emerge within your body that escape any of your antibodies will have a fitness advantage. In turn, that virus will have an advantage spreading to other vaccinated individuals, too.
It is a low probability event in each individual, but if you generate enough individuals like this and infect them all, it's sure to happen eventually. We can't really estimate what the probability of this happening is, but it's certainly less likely if the efficacy is high and there's less disease circulating.
But even now no one knows if these vaccines provide sterilizing immunity, as they were only testing for disease protection in the trials. Some even theorize some vaccinated individuals might be _more_ contagious, as they are less likely to socially distance and could be more likely to be asymptomatic carriers.
Indeed the article itself is evidence of this risk, as the author seems to advocate giving the vaccine to people who are willing to pay a lot so they can go party.
That said, if sterilizing immunity is provided by the vaccine, then a lot of the arguments are more plausible. But I don't think it's valid to just assume that, and it's not fair to health officials who don't assume that either.
(If we did have enough doses ready to go for everyone, the government solution of "have the government buy it and distribute it to everyone" and the free market solution of "everyone and their insurance is very willing to buy one dose but values a second dose at $0" would basically collapse to the same thing, and so the author's argument would be moot.)
1A) healthcare workers (highest unavoidable exposure rate) & LTCF (highest mortality rate)
1B) frontline workers (high unavoidable exposure rate, and may be crucial transmission links) & the very old (high mortality rate). If the vaccine lowers transmission, we'll see a big effect from the frontline worker portion, which I suspect factored into the decision somewhat even if it is not acknowledged in the documents.
1C) This category is too big-- all essential workers and anyone with a health condition increasing risk or over age 65. This phase is actually bigger than 2. It needs to be split up some to prevent a mad rush for doses, and certainly we can benefit from further prioritization. Hopefully this is addressed, but it's tomorrow's problem.
2) The remaining group is smaller and probably the least interest in getting vaccinated, so I assume when we get to phase 2 we'll be facing different logistical concerns.
The really stupid thing we're doing, IMO, is reserving 55% of doses to ensure everyone gets dose 2. It should be a much smaller reserve (~25%): it's unlikely that Pfizer's production will stall entirely and even in that worst case scenario, most people would get a second dose, AND the data looks like 1 dose is likely effective.
This reserve is preventing many areas from having enough doses to enter phase 1B, and portions of phase 1B are parallel infrastructure (e.g. mass-vaccination clinics). So, allocating those additional doses could be expected to significantly increase throughput by activating other channels through which the vaccine is distributed.
No, the drug companies did not study sterilizing immunity. No, they make no claims. However, ask any expert and they would say they expect there will probably be some sterilizing immunity and reduction in spread for those who do get it.
Some moderna data showed a 2/3 reduction in asymptomatic cases. It would be astonishing if vaccines cause no decrease in spread.
This meme is the new “masks protect others, they don’t protect you”. They do, in fact, protect the wearer to some extent. How could they not?
That may be the case with N95 masks, but there is absolutely no way that a surgical mask protects the wearer to any measurable extent. At best, it helps prevent the wearer from spewing more viral particles into the air (and even that is far from proven).
I was an early advocate for masks (check my HN history) back in February, but it's bizarre how they've become a kind of magic talisman for half the population. Some of my "mask-skeptical" HN critics at that time were worried masks would make wearers overconfident, and go into high-risk situations, and they were right.
I thought that the effect would be like 80-90% or something. But given what was established practice in january last year I should not be too suprised with the results ...
Obviously it’s way safer to simply not be in a risky situation. You’re reading stuff into my comment that I didn’t say.
https://www.cdc.gov/coronavirus/2019-ncov/more/masking-scien...
I think this misses the point a bit. I think the CDC’s allocation is just fine — the main problem is that it’s being implemented slowly. Just about any carefully planned allocation will be slow. Sell to the highest bidder? Slow. Sell for $20? Faster, but still slow. Compare the way most vaccines are given in an office to the way that mass flu vaccines are done.
If I were running the show, I would choose categories. The categories don’t matter that much — suppose, for the sake of argument, that it’s (1) patient-facing medical personnel, (2) people over 75, (3) people at high risk, self-certified, etc.
Now, in each region, you open up vaccinations by group. Medical centers can run walk-through or drive-through vaccinations, and people in the relevant group line up and get the vaccine. Someone scans ID and types in name and (if available) DOB for people without ID and hands out the info flyer. A handful of technicians give the vaccines.
As soon as vaccine lines aren’t getting filled by one group, you open it to the next group.
Money is basically irrelevant here. The available production is spoken for and paid for. Trying to allocate carefully is nice, but it’s far more important to give someone the vaccine than to give the right person the vaccine.
(Stanford Hospital would have avoided a lot of flak if they did something like this. Randomize the last initials of residents into groups, and give residents the shots by last initial. Then do other groups. Or forget about distinguishing residents from other people — it’s not worth the logistical complications.)
And then we don't have anything like a plan to treat administration of doses like an emergency. It's bonkers.
I was just thinking this the other day and wondering if I was some horrible monster. People looked at me like I was crazy. There's some comfort in knowing that whichever side of history this viewpoint lands on, there is a sense in which it was right by correctness if not by popularity.
Healthcare workers come into contact with many people, many of those people are at risk and the contact is essential (2019 definition).
Even if you apply rationing (you could say that every dose purchased must be associated with a natural person who is going to get the vaccine as soon as it's shipped), the vaccine maker is now in the same position - why sell the vaccine for $100/dose to Hospital A today if they suspect that the bigger, richer, more bureaucratic Hospital B will get around to making an offer for $110/dose tomorrow?
So the "free market" solution here involves compelling the vaccine makers to accept any price offered immediately as well as preventing a secondary market, i.e., killing every mechanism for price discovery, which is the core mechanism of free markets. You can't really call it a market at that point, and all your intuitions about market efficiency go out the window.
Which isn't to say that I think a market allocation would be working any better (there'd be plenty of stupid buyers and so on).
Also, the 6 months is for deep freeze storage, the next level of storage, the shippers+dry ice, is 30 days.
The free market is the second fastest organisational method we have, beaten only by the military which can achieve specific operational goals extremely quickly. The free market is by far the fastest and most efficient force at sustained logistics.
As I recall it first group to have good Coronavirus testing was the Koreans who let private industry do its thing [0]. The free market with government as another equal client would be faster than the government at distribution a vaccine.
[0] https://edition.cnn.com/2020/03/12/asia/coronavirus-south-ko...
WTF are we spending so much money on them for if not for combating something that's caused hundreds of thousands of deaths?
As in "fly over to Pakistan and assassinate bin Laden" sort of goals. Stuff that burns unreasonable amounts of resources to do something very specific very quickly. If something takes months to execute the market will be faster.
"Get a vaccine to everyone who can afford it" is something that the market will be fastest at. It would be prudent to leave it alone to solve that problem. Government can go solve a different problem.
The market SUCKS at strategic goals. It's basically the opposite: you're giving up on strategic goals because you're in a situation where you don't think central planning can be as effective as competition. But military history shows us that central planning can be very effective for this sort of campaign, complete with elaborate supply chains and logistical accomplishments.
Markets are generally smart enough not to think killing large numbers of people and overthrowing governments is a good idea. If the US government was somehow replaced with a market the Middle East would likely be a more peaceful place. Markets generally find better ways of doing things - like financial incentives - than military intervention.
I'm more than happy to admit defeat if you want to argue that markets are ineffective at subjugating exotic new lands. In terms of defence, I havn't looked in to it at all. I expect market based economies to beat command and control economies at war because they can better sustain an effort.
The Swiss have their bank accounts, yes. You could convincingly argue that people who are happy to accept low gains as a tradeoff for low risk are interested in avoiding war. But the world's largest markets are in the US. And before they were in the US, they were in the capital of the British Empire.
Markets are very good at solving the sort of problems they solve. But be careful about extrapolating that into "Markets are very good."
(Also, don't forget about the British East India Company.)
Think back to the toilet paper shortage, or the mask shortage, or the hand sanitizer shortage, and how long it took the market to respond to those events. Maybe the market is the "second fastest' method we have, in relative terms. My point is it's still very slow, and if you're saying that days matter, the market is not the tool we want.
(That said, throwing the military at this problem seems fine to me, honestly. It is a special case of throwing the government at the problem; it's the branch of the government that specializes in logistics and quick decision-making in life-or-death scenarios, as you point out, and they are used to dealing with situations that arise exactly once in the history of the world.)
Not long? Toilet paper distribution recovered quickly, little old ladies are now knitting masks and I hear distilleries have started converting into hand sanitiser plants. There was a month of confusion then in my experience everything started snapping back to normal. I've never seen so much hand sanitiser as is now available.
> My point is it's still very slow, and if you're saying that days matter, the market is not the tool we want.
Yet if we don't go with the market I bet a worse alternative will be chosen. Back in March-February people would have argued in February that the US CDC was there to overrule greedy companies rushing out coronavirus tests and make sure that there are high quality standards. Then the CDC shipped a test that didn't work and scuppered the US's opportunity to nip the pandemic in the bud. That instance alone is a damning indictment of a government-first response to a healthcare emergency.
People can keep making a big song and dance about how this time the market can't possibly work because it is different to all the other times the market worked really well. Then the government will implement something slower than just letting people buy vaccines like everything else. In time the complete screw-up of the response will be used as evidence that there is no way a free market could have handled something so complicated.
Pretty much every time a free market has been used to solve a problem, the problem gets resolved as fast as possible with minimum fuss. The only exception is problems that poor people have. Coronavirus is not a poor-person-problem. Leaving it to the market will get great results.
> That said, throwing the military at this problem seems fine to me, honestly.
It'll be slower than letting people buy a vaccine off the shelf. The military has no special advantage here. There are great reasons that the military isn't left in charge of running a countries logistics networks - they are competent but not the best at it.
Anyway, I'm happy to concede that the market will take about a month to figure out vaccine distribution. In fact, I said "a couple of weeks" in my original comment that said the market is "extremely slow." So I suspect we have the same actual time span in mind, it's just that you think that the description of that time is "quick" and I think it's "slow".
In particular, it sounds like you think it's quick by comparison to potential alternatives. But I'm saying it's slow by comparison to the author's argument - that additional days or weeks of delay cause serious exponential growth.
So we should at least ask what could be faster, before being satisfied with one month. I know of absolutely no way to make the market faster. I do know of ways to make the government more competent and faster, even if our current government agencies are not competent or fast.
For instance - do you think the military would take more than a month to do this?
(Also, the current government-run distribution regime is actually vaccinating healthcare workers, as we argue about this, and it's taken much less than a month from approval to getting real people vaccinated.)
That doesn't make a lot of sense. Why would you unable to implement your ideas if given money & resources in proportion to the value you are creating? Why do you need a politically charged environment with an opposition who disagrees with every aspect of your decision making process to implement your ideas?
And your ideas won't speed the government up, people keep putting good ideas up to improve government all the time then they get shot down in the political process. Congress is deeply unpopular for a reason, and it isn't that people are struggling to see where improvements could be made. The CDC isn't underfunded because the pandemic was unforeseeable, there have been warning signs that something like this could happen since SARS v1 in the early 2000s. It is underfunded because the political process is not an effective method of getting stuff done. As will probably be showcased again if there are any free market vs government rollout vaccine case studies of this next phase.
As plans go it could be boiled down to wanting Congress & the Trump administration put in charge. That isn't a very fleshed out plan, and the fleshy bits to it could reasonably be described as dodgy and unreliable.
> For instance - do you think the military would take more than a month to do this?
Yes. It is a big job.
> (Also, the current government-run distribution regime is actually vaccinating healthcare workers, as we argue about this, and it's taken much less than a month from approval to getting real people vaccinated.)
The healthcare workers have been dealing with the virus for 9 months now, they either have protections worked out or have already caught it. The most important thing, as the article notes, is ramping up production and mass deployments. I'm glad that they're vaccinated, but the most important thing at the moment is safety and raw numbers of people vaccinated, and not so much the targetting. I'd bet most of the healthcare workers who catch Covid catch it outside of work.
The fastest way to get mass vaccinations is to let companies sell vaccine shots to people who will pay them. The government can try to help by ordering a bunch of shots for people who can't otherwise pay.
That's just wrong. The Corona virus is hitting poor and minority populations much harder than wealthy white communities. This is what the free market is optimized to do. It's what Trump and most Republicans in congress truly believe is what's supposed to happen! This very issue is one of the fundamental differences between Republicans and Democrats.
The point that the author is making, is that in the absence of any such plan, market mechanisms would have allowed many of the people with regards to whom it is a collective benefit for us all if they have received the vaccine -- first responders, people who have jobs that require them to travel or be in public, and people who want to party -- to actually be able to get it. The free market doesn't always optimize to what is best, but the author makes a reasonable argument that in this case it would. You don't seem to disagree with their analysis, just markets in general -- and that's a politicized, unhelpful approach.
This is also a non-representative sample, there are many facilities that have fully vaccinated medical workers.
> There is a lot of private incentive to combat an externality!
No
"How Perfectionism Has Made the Pandemic Worse", far more interesting and to the point.
https://blog.supplysideliberal.com/post/2020/12/31/how-perfe...
That said yes speed does matter and seems not to be valued as much as it could have
* Electronic technology makes it impossible to guarantee equal access. Hackers in other countries could easily disrupt the supply chain
* A "temporary socialism" emerged to disparage the scalpers and middlemen -- the public at large was incredibly unhappy
* Existing middlemen (retail stores) were completely overwhelmed, as there was a gigantic information asymmetry between production, distribution, retail, and consumption
* A completely totalitarian rollout (e.g. Sony sells on its own without middlemen) seems feasible, and might have actually been more efficient, even if delayed by a month. More people would have a PS5 now if the solution was totally vertically integrated.
I went on Twitter expressing that the US surgeon general and a bunch of CDC folks shouldn't be lying to the public about the following: Masks were initially in intense shortage. What did the leaders do? They lied to the public about how ineffective masks are to make sure there is enough stock for healthcare workers. I tried to expose this and everyone shunned me down by saying that this is a harmful thing to say. Since when is transparency harmful? You could be truthful and say "While masks are effective, please dont horde them as they are needed by the hospitals". Even if we didn't know the exact effectiveness of masks, they're not harmful to wear. They can only help. Leaders should have told the public about how to make them at home, which did happen, thanks to a bunch of Youtubers.
Here is the deleted tweet (google cache) from the US Surgeon General:
> "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk! http://bit.ly/37Ay6Cm"
There were so many things like this. Ventilators, testing ratio, death rate, etc. Coronavirus pandemic was horribly handled by the entire world, particularly us as Americans. Shame really that this is the best we could do.
Edit: Added the official wording of the US Surgeon General Tweet on Feb 29, 2020.
Is it possible they were just wrong?
And potentially poor mask handling and discipline could have made transmission worse. We more or less know this isn't the case now, but didn't then.
So yes, it actually could make things worse.
Saying that the material has an enormous impact on effectiveness doesn't invalidate anything. I mean, that's why N95 masks are so complicated and different from surgical masks, because material matters so much.
They appear to have turned out to be effective (FYI: I've warn masks every time I've been outside since 2020/3/16 so I'm certainly on the side of masks)
Will you downvote this because it shows a logical flaw, not a judgement, but it you probably disagree with it?
Anyone with a brain cell in their head could see that the government's messaging on masks made no sense. This reduced public trust in the government's other public health announcements.
As it happens, people have since done studies. (Not double blind, though)
The fact that they said untruthful information about masks was awful, and it certainly deserves a proper postmortem-in-the-court-of-public-opinion, but I don't think it was deliberate lying.
At the onset, hospitals needed PPE, which includes masks. I remember there being messaging encouraging ordinary citizens not to stockpile N95 masks because hospitals needed the supply instead. If anybody in this same camp was telling the public that N95 masks aren’t effective then that’s an obvious contradiction, a lie.
Anyway, lies and inconsistent messaging both degrade trust, which is a big problem at this moment.
It's not so much now but that actual infectious disease specialists aren't being completely drowned out by people who should have known to keep their mouth shut. Seriously John Cochrane has an excuse, he's from the grifter school of economics and a dummy. Doctors, biologists, etc without specific training in infectious disease should have known better.
The effectiveness of other masks was not so much "not proven" but to the extent that the lack of any standard allows you to say anything about them they just aren't anywhere near as good. In my mind their effectiveness in combating the pandemic is still well within 'not-proven' territory, but since this is somehow a partisan issue in the U.S. I'll limit myself to just saying that they shouldn't be considered a replacement for social distancing.
Sure they were. At some points we weren't even sure if n95 masks did much.
Of course n95 masks only prevent entry through the mouth and nose, and particularly at the time we had reason to think those were other points of entry. So, saying that they were "proven" to work against SARS-CoV-2 at the time was simply false.
"Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
There are logical ways in which it can be true that they are useful for health workers but not for the public.
We know they aren't correct now, of course, as there is now evidence.
This is capitalism.
If masks are in short supply and hospitals needs them - we obviously buy them all up and sell to those in need for an exuberant markup
What do you think the US is, buddy
How are the mask manufacturers going to get more money if they can't charge an exorbitant markup? They need to buy new plant/ materials and hire new people. Is the plan that the mask manufacturers have to go deeply in to debt to create enough masks? That is the best I can think of without sharp price rises, and it is a terrible plan for encouraging people to produce more masks.
I don't have one, or actually care about specific numbers. There is some magic price where I'll start learning how to make masks but I doubt we're going to see that reached in my lifetime.
> If you add an extra dollar to the price, that's enough to get a lot of expansion of manufacturing.
In 18-24 months, sure. We're 12 months in so far though. If they need the money now it is a different story. The higher the price, the more immediate and desperate actions become justified to increase supply. That is one of the core parts of market economics. Let the price rise to some silly amount and people will move heaven and earth to increase supply.
To get extraordinary things done an extraordinary amount of money will be needed. That can come from extraordinary prices. Or it can not happen and shortages can persist longer than required.
Masks went up in price in April because supply was limited, by late May they were at clearance prices as supply out stripped demand.
I don't blame him. Human nature is to wield power. The more power the person has, in whatever form it is, the more inventive ways he will come up with to use it for his goals, be they selfish or otherwise.
JR would shut his mouth if his audience chided him to being conspiratorial.
The society has lost the ability to think critically. And the focus on individuality has exacerbated the problem. I don't mind individuality in matters such as personal growth, morality, religion, etc, but there are some aspects of social life where collective expert decisions must hold higher weight than individual opinions, such as in public health, defense, etc.
They don't really exist. At least not in any significant number. This is just a straw man to attack Joe Rogan.
I'm sorry but your comment shows that you did not read my comment. Please read:
> deviating even just slightly from what the government has chosen to do
> nuanced approach to re-openings is simply too difficult to get right and therefore untenable
What part of "deviating just slightly" and "nuanced approach" implies a complete inverse approach? I think you are straw-manning me, sorry. I never said that the solution was to not have lockdown at all. You can re-read my comment again if it helps. I implied that a nuanced approach and a slightly less restrictive approach would be better. It seems that my comment regarding people unwilling to have a nuanced conversation proves true again.
> other solutions should be tried because the current one clearly has disastrous consequences
Given the context of my other comments, you seem to have reached the wrong interpretation, and are still unwilling to entertain a conversation about what a milder lockdown looks like.
I’m not a politician nor I defend most of them in general but do you expect that people would not hoard them when everyone was (back then) panicking at a new extreme deadly virus?
So the easiest solution (not necessarily the best) was to do politics which is to deceive. If a country says that the masks are very effective yet only selected people will get them, even if it makes sense factually speaking, riots will ensue because that’s how masses work (in most big countries anyway). If you deceive, you gain time and everyone will eventually get their own masks, which is how it played out.
Hopefully I don’t get shunned by this. I’m just trying to illustrate that plain transparency at extreme situations may just not be an easy option as you put it.
Edit: wording
And I agree with your last point of course.
At what cost? How many people have died because mask wearing was discouraged during the early part of the pandemic? We will probably never know, but I would not be surprised if that advice caused a lot of deaths by allowing the virus to spread more easily.
Again I don’t defend these actions, I’m just trying to reason why they decided to go that way and not the most instintive one “let’s be fully transparent” (at least for HN anyway).
Face coverings were ordered in many states starting in April.
A competent administration would have bought up enough of (or all of) the PPE inventory as soon as they understood what was coming. At that point, there would have been no need to lie, because there would have been nothing left for the public to hoard.
I'm not blaming the CDC, or the SG. I'm blaming the political decision makers above them
> So the easiest solution was to do politics which is to deceive
I disagree. politics is not to deceive. Politics is to guide and educate. The longer we accept the rationale that politics is inherently an immoral game, the more our minds accept the status quo.
Those politicians who lied must be held accountable. Those who pushed for the truth but took actions to prioritize health workers should be rewarded.
Politics is IMHO all or a majority about deception unfortunately and once you accept this these actions just make more sense and you stop playing their silly game. I decided to move to a smaller and more healthy democracy because I knew degeneration of politics back in my (somewhat big) country was only going to get much worse and in some cases that can mean literal death to me and I could do nothing to change it. Well, all this is way too off-topic so let’s leave it for another time as it’s an interesting one :)
Just take a look at Fauci as an individual. He's never said masks don't work. He did say "there's no reason to be walking around with a mask," back in March, but, back in March, that was likely true. And, it's not like he hasn't reversed himself when new data comes in. That's precisely why he still has credibility: because what he says is always in line with the best available data.
Also I IMHO doubt that Fauci didn’t know about mask effectiveness - sure, maybe he didn’t know the very specifics but it was kind of obvious back then it wasn’t going to harm and one could infer that it’d probably help somewhat (nowadays it’s clear). IMHO all authorities just agreed to transmit a similar message around the world so they could in the meantime arrange more mask orders and sort out the distribution as production speeded up while avoiding massive riots and/or poor masks made at home that could’ve been worse than nothing.
What he actually said:
> They are NOT effective
Please stop lying.
So today these same people say that the vaccines are safe for anyone and everyone to take (including people not at risk from the virus, people who have already been infected, people with autoimmune issues, pregnant people, breastfeeding people, etc. etc.); but how long will it take before we look back and say "oh well that was likely true then but now we know better, teehee!"?
We do have such mechanisms. In the olden days, opinions were expressed through slow moving mediums such as news papers and press conferences. Those who wanted to criticize them had channels such as letters to newspaper editors, radio calls, etc, to express disagreement or point out flaws. This was good and bad. Good because you had to invest a finite amount of time and resources to express counter opinion. Bad because it has the effect of amplifying the voices of fanatics.
However, with today's friction free methods to express opinion and social media echo chambers that amplify everything, there is just too much noise.
I just hate Twitter and Facebook. Their ultimate contribution to society is sum negative.
And we're expressing opinions without people being too belittled/shunned ...
No. Unpopular opinions get flagged and shadow-banned instantly here.
https://news.ycombinator.com/newsguidelines.html
There was no explanation. The shadow-ban must have happened shortly after I posted an unpopular comment which received a lot of downvotes, which is why I assumed that it had to be some sort of automatic action.
The public is smarter than the technocrats give them credit for, and will bristle at attempts to influence their behavior through lying - or even just fibbing, as in this case.
Good luck gaining back their trust after a round or two of that. In that respect, they may resemble petulant children - but can you blame them?
Except they didn't. What they said that the odds of you getting infected were not substantially changed by you wearing a mask in general, but they were substantially changed for people in high risk situations, like healthcare workers.
That became less and less true as more and more people became infected, so the basal chances of you getting exposed, and therefore the impact of wearing a mask, changed.
^ US Surgeon General official tweet which was then deleted. Source, Google cached version, google "US Surgeon General tweet masks".
I added quote marks to clarify this. The original tweet has been deleted. The bitly link was part of the original tweet.
It will lower risk, particularly of you giving the disease to other people.
There was a genuine concern that people would not only consume the supply of mask product, but also that they'd think they were safe because they had a mask on, and then proceed to ignore other safety guidelines, thinking they were safe.
This in fact happens every day right now, but you know... it's just pedantry.
Again, if you look at the CDC statements, they are consistent with this. They said it could reduce the risk of spreading or contracting the disease (and the specifics of how that might work were not as well understood at the time), but that it would NOT prevent either of those scenarios.
If you think about it, communicating that "they don't work at all" but "we have to keep a stockpile of them for the people at highest risk" doesn't make any sense. It's not what happened.
Asking people not to hoard masks would have been no more effective than it was for toilet paper - I would guess less effective, in fact.
"if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
This is a statement of confidence in the masks he's talking about, N95/adjacent PPE. Saying they provide any substantial margin of personal protective safety for healthcare providers is saying they work.
Now some people read "STOP BUYING MASKS! They are NOT effective" and stopped thinking right there. Some of the fault lies in anyone who did that. Some of the fault lies with the SG for poor communication. But the fact is, the SG's statement did not stop there.
It continues into a statement skeptical not of the effectiveness of PPE masks as a personally protective measure, but as a measure that can protect the general public. There might by any number of reasons for that. He might believe the general public can't wear them effectively and conscientiously (I didn't believe that in March, but after watching people wear cloth masks, I absolutely do). He might believe there just weren't enough to protect the public (absolutely true then). He might believe they might engender a false sense of confidence preventing more effective measures (credible). Some of those reasons were actually stated and yet not perceived, which speaks to the trouble of "just telling the truth." There may have been others.
Additionally, I'm astonished that many people continue to read his statement and fail to distinguish between PPE masks and cloth masks primarily about preventing source transmission (ie, wearer infecting others, with some fractional protection from being infected by others). In fact, I'm astonished at how many people still don't understand what cloth masks can do and talk about themselves or those wearing them in terms of protecting themselves.
It's unfortunate that he didn't communicate better. Failing on that front might even be reason enough to have someone else doing that job.
But honestly 10 months out I don't know that it's all on him.
We are not going to fix society in time to stop this pandemic.
Problems that will not be solved: - our politicians will not become competent. Our selection process for politicians is driven by how good they are at attracting votes, not how good they are at handling problems. Politicians are aware of this and just exploit it constantly.
- our people will not become reasonable. A sizable percentage of the population don't believe covid19 is different from flu, another does not want to take vaccines.
- corporations want to get the most out of it. A full blown pandemic is in their best interest. All those covid tests and vaccines pile up. Even better if they can convince us the vaccine only lasts one season!
So the bottom line for me is: if I am convinced the vaccine is safe and effective, just be careful and dodge the disease as long as I can get a vaccine.
There is not much more to it, and I focus my energies somewhere else.
Of course if everyone was like me, the pandemic would be over by now. But that's not the case and hoping in something that will not happen, like the author does in this piece, is fruitless.
First, targeting spread instead of severity. This is not good. The amount of people that would fit the profile from any available variables of a spreader are probably around 100 million in the US. If you're going to vaccinate most of them, you're going to need so many doses that you can vaccinate literally everyone that has over 0.2% fatality risk, and a month or two later you can reach herd immunity. There is clearly very little advantage there.
And for selling them on the free market, it's insane to expect that vaccine sellers with limited capacity will sell the vaccine for anywhere near an affordable price. You don't have nearly enough demand elasticity to justify the manufacturers - two of them, by the way, to drop their prices at all, because even if they sold them for 5000$ they would sell every dose they could produce for months. By the time they would be affordable for the average person, we could again have vaccinated all vulnerable people and a few months later essentially everyone.
In the two or three months between full vaccination of privileged classes and herd immunities, there will not be new mutations that will be able to spread despite full vaccination.
And the argument that people more likely to spread the disease would be willing to pay more is a bit weak. Sure the chance you get infected correlates with the chance you infect someone, but for some people infection carries more risk than others. And presumably the author also wants companies to be able to require people to be vaccinated, because otherwise vaccines are of limited use to companies.
Finally I'm not too sure if combatting 'R' is the end goal. In the end you want to minimize total harm, this is subjective but among other things involves minimizing total deaths. It's conceivable that vaccinating the group that's overwhelmingly at risk first is an effective strategy to achieve that.
> A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old.
If you want to make sense of the world, don't look at what people say, look at what they do... and then infer the truths from that.
Why would people who are smart enough to make vaccines so clueless that they usually take it to the third world for large scale initial distribution or testing? It would make sense to do it to the local community, wouldn't it? It happened during t COVID too.
There's a reason why the current vaccines are being prioritized for old people. We can't afford to lose first line workers.
Public health should never be left in the hands of the private sector.
On top of the poor response by government, I think the disaster now unfolding in the USA, and to a similar extent in the UK, are examples of governments trying to hinder/eliminate their public health institutions (i.e. the CDC and the NHS respectfully).
Why is no one discussing this? Giving a significant allocation to retirees instead of essential staff is the more compassionate thing, but is it the best?
Part of the reason is that it's easier to get healthcare workers near the freezers required to store the Pfizer vaccine, because many of those freezers are in hospitals.
[0]https://covid19-projections.com/infections/map_county_total_...
The current allocation might not be the maximally effective one but a free market solution that beats it is a pipe dream.