8 ms·

The strong and healthy are also dropping dead and we don’t know what the chronic, long term effects will be

rpiguy 6y ago
Doesn’t matter - a good portion of the US will never accept contract tracing, a prolonged shut down, mandatory antibody testing, or forced vaccination. It is illegal for states to prevent persons from neighboring, more constrictive states from traveling in and out. Given the Supreme Court make up it is unlikely any of the above would be upheld as constitutional. Therefore the US is heading toward a herd immunity strategy regardless of what technocrats think the end game will be. I laugh when I hear people talking about a vaccine. We can’t get people to vaccinate for diseases like measles that spread faster, are deadlier, and kill kids.
- maxerickson 6y ago
  MMR (measles is one of the M) vaccination rates are plenty high enough to get us to herd immunity for SAR-CoV-2 (we need something like 70% of the population being immune). Even in states with the worst coverage. It's closer to 90% in most of the country: https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxview/data-reports/mmr/trend/index.html https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxv... So what are you laughing at?
  - rpiguy 6y ago
    The idea that a vaccine could be mandatory. But thank you for agreeing we are heading toward herd immunity.
    - maxerickson 6y ago
      A 70% vaccination rate is one way to get to herd immunity. There's not much question about getting there eventually. The path we take is the question. You are apparently laughing that 10% of people will refuse a working vaccine and expose themselves to future risk? Fun.
- jshevek 6y ago
  I think you make excellent points in the first paragraph. As for the second: >I laugh when I hear people talking about a vaccine. We can’t get people to vaccinate for diseases like measles that spread faster, are deadlier, and kill kids. The relationship between immunity rate and effectiveness is not linear. It's be nice if we could vaccinate the anti-vax folks, but we don't actually need them to get massive gains from vaccinating part of the population. Rates as low as 70% would be incredibly helpful.
- joubert 6y ago
  I've also wondered about the end game and so far concluded that most societies (including the US) would go the vaccine route (which confers herd immunity) as opposed to natural immunity (what I think you mean by "herd immunity"), but I would love to hear what you think. The reason why I doubt the end game is herd immunity via natural infection is: * millions would die * health systems would get crushed * the virus is unlikely to disappear entirely, so would simmer around the world, triggering epidemics every few years or so. What do you think?
  - mlyle 6y ago
    We may not have a choice, in that we're not guaranteed to have a useful vaccine in massive doses anytime soon. But rebutting your individual points: > millions would die Unlikely. Improved estimates (thanks to serological data) for infection fatality rate range from 0.3% to 0.5%. If we can protect the most vulnerable populations, we can have a lower death rate than this-- e.g. in the under-30 crowd, the risk of hospitalization is 1 in 500 and the risk of death a tiny fraction of this (1 in 5000 or less). Further, any variance of susceptibility or contact density means you don't need to reach 60% for herd immunity. Some estimates say that the real threshold may likely be 25% or less: e.g. https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1?fbclid=IwAR3bdC5xcn6BuYkbwp13zCrRmCMa4i91WqJXszD6LgDDO9t2V0sowr02ZOI https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v... Further, lighter weight social distancing measures can further reduce Rt and attain herd immunity at a lower percentage. If you assume we need 40%, and 0.25% IFR from protecting the most vulnerable-- you come up with 328k deaths. This is bad, but less bad than many alternatives. Note that the shorter lived the controls protecting the elderly and other vulnerable people, the more effectively we can protect them, too. > health systems would get crushed We'd not want to do what New York did, but let's look at it as an example. New York's health care system (barely) sustained the load. Now they're very possibly most of the way to herd immunity in NYC. Yes, we'd like to flatten the curve a bit from this and be better prepared. > the virus is unlikely to disappear entirely, so would simmer around the world, triggering epidemics every few years or so. The long term immunity question is interesting. Of course, vaccines could help improve this picture even if one ends up with disease-spread based herd immunity. My personal belief is that A) total antibody-based immunity will last a few years, based on our experience with SARS-CoV-1; B) partial antibody-based immunity will likely last longer than that; C) memory B cell / T cell based immunity is likely lifelong and makes any subsequent course of disease less severe. That is, I think it's likely that the current human coronaviruses that cause the common cold might very well cause a high death rate and be very transmissable if exposed to an immunologically naive population. Of course, your third point holds even more true when it comes to interim suppression and containment efforts while we isolate and wait for a vaccine. It's an even more intractable issue to try and maintain suppression when the vast majority of the population is still susceptible.
steveeq1 6y ago
Availability bias. The infection fatality rate of someone in there 20's or even a teenager is basically a rounding error. The strong and healthy dying are the exception, not the rule.
- whatshisface 6y ago
  Did we ever get any good information on the rates of permanent lung damage or hospitalization for young people? I feel like over-focusing on fatality could cause us to overlook the more pragmatic risks.
  - nyhc99 6y ago
    On the Diamond Princess Cruise, they found lung damage in 54% of asymptomatic cases. I would call that a cause for concern. https://pubs.rsna.org/doi/10.1148/ryct.2020200110 https://pubs.rsna.org/doi/10.1148/ryct.2020200110
    - irishcoffee 6y ago
      Everyone is going to catch this. A vaccine will not exist for another year. The world can’t be shut down for another year. When everyone eventually catches this, some will have permanent lung damage. That sucks. Pretending this isn’t going to happen is foolish.
      - whatshisface 6y ago
        If we get the case count low enough we can open up and do contact tracing until the vaccine arrives or it's eliminated... if we open up before it's that low, everyone gets it.
    - steveeq1 6y ago
      Meh, the lung damage was "mild" in the bulk of the cases.
      - 6y ago

Doesn’t matter - a good portion of the US will never accept contract tracing, a prolonged shut down, mandatory antibody testing, or forced vaccination. It is illegal for states to prevent persons from neighboring, more constrictive states from traveling in and out. Given the Supreme Court make up it is unlikely any of the above would be upheld as constitutional. Therefore the US is heading toward a herd immunity strategy regardless of what technocrats think the end game will be. I laugh when I hear people talking about a vaccine. We can’t get people to vaccinate for diseases like measles that spread faster, are deadlier, and kill kids.

maxerickson 6y ago
MMR (measles is one of the M) vaccination rates are plenty high enough to get us to herd immunity for SAR-CoV-2 (we need something like 70% of the population being immune). Even in states with the worst coverage. It's closer to 90% in most of the country: https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxview/data-reports/mmr/trend/index.html https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxv... So what are you laughing at?
- rpiguy 6y ago
  The idea that a vaccine could be mandatory. But thank you for agreeing we are heading toward herd immunity.
  - maxerickson 6y ago
    A 70% vaccination rate is one way to get to herd immunity. There's not much question about getting there eventually. The path we take is the question. You are apparently laughing that 10% of people will refuse a working vaccine and expose themselves to future risk? Fun.
jshevek 6y ago
I think you make excellent points in the first paragraph. As for the second: >I laugh when I hear people talking about a vaccine. We can’t get people to vaccinate for diseases like measles that spread faster, are deadlier, and kill kids. The relationship between immunity rate and effectiveness is not linear. It's be nice if we could vaccinate the anti-vax folks, but we don't actually need them to get massive gains from vaccinating part of the population. Rates as low as 70% would be incredibly helpful.
joubert 6y ago
I've also wondered about the end game and so far concluded that most societies (including the US) would go the vaccine route (which confers herd immunity) as opposed to natural immunity (what I think you mean by "herd immunity"), but I would love to hear what you think. The reason why I doubt the end game is herd immunity via natural infection is: * millions would die * health systems would get crushed * the virus is unlikely to disappear entirely, so would simmer around the world, triggering epidemics every few years or so. What do you think?
- mlyle 6y ago
  We may not have a choice, in that we're not guaranteed to have a useful vaccine in massive doses anytime soon. But rebutting your individual points: > millions would die Unlikely. Improved estimates (thanks to serological data) for infection fatality rate range from 0.3% to 0.5%. If we can protect the most vulnerable populations, we can have a lower death rate than this-- e.g. in the under-30 crowd, the risk of hospitalization is 1 in 500 and the risk of death a tiny fraction of this (1 in 5000 or less). Further, any variance of susceptibility or contact density means you don't need to reach 60% for herd immunity. Some estimates say that the real threshold may likely be 25% or less: e.g. https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1?fbclid=IwAR3bdC5xcn6BuYkbwp13zCrRmCMa4i91WqJXszD6LgDDO9t2V0sowr02ZOI https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v... Further, lighter weight social distancing measures can further reduce Rt and attain herd immunity at a lower percentage. If you assume we need 40%, and 0.25% IFR from protecting the most vulnerable-- you come up with 328k deaths. This is bad, but less bad than many alternatives. Note that the shorter lived the controls protecting the elderly and other vulnerable people, the more effectively we can protect them, too. > health systems would get crushed We'd not want to do what New York did, but let's look at it as an example. New York's health care system (barely) sustained the load. Now they're very possibly most of the way to herd immunity in NYC. Yes, we'd like to flatten the curve a bit from this and be better prepared. > the virus is unlikely to disappear entirely, so would simmer around the world, triggering epidemics every few years or so. The long term immunity question is interesting. Of course, vaccines could help improve this picture even if one ends up with disease-spread based herd immunity. My personal belief is that A) total antibody-based immunity will last a few years, based on our experience with SARS-CoV-1; B) partial antibody-based immunity will likely last longer than that; C) memory B cell / T cell based immunity is likely lifelong and makes any subsequent course of disease less severe. That is, I think it's likely that the current human coronaviruses that cause the common cold might very well cause a high death rate and be very transmissable if exposed to an immunologically naive population. Of course, your third point holds even more true when it comes to interim suppression and containment efforts while we isolate and wait for a vaccine. It's an even more intractable issue to try and maintain suppression when the vast majority of the population is still susceptible.

steveeq1 6y ago

Availability bias. The infection fatality rate of someone in there 20's or even a teenager is basically a rounding error. The strong and healthy dying are the exception, not the rule.

whatshisface 6y ago
Did we ever get any good information on the rates of permanent lung damage or hospitalization for young people? I feel like over-focusing on fatality could cause us to overlook the more pragmatic risks.
- nyhc99 6y ago
  On the Diamond Princess Cruise, they found lung damage in 54% of asymptomatic cases. I would call that a cause for concern. https://pubs.rsna.org/doi/10.1148/ryct.2020200110 https://pubs.rsna.org/doi/10.1148/ryct.2020200110
  - irishcoffee 6y ago
    Everyone is going to catch this. A vaccine will not exist for another year. The world can’t be shut down for another year. When everyone eventually catches this, some will have permanent lung damage. That sucks. Pretending this isn’t going to happen is foolish.
    - whatshisface 6y ago
      If we get the case count low enough we can open up and do contact tracing until the vaccine arrives or it's eliminated... if we open up before it's that low, everyone gets it.
  - steveeq1 6y ago
    Meh, the lung damage was "mild" in the bulk of the cases.
    - 6y ago