5 ms·

I still don't buy the evidence you've given. Sure, there's not hard clinical evidence that I can point to that demonstrates that there is zero viral shedding fr

I still don't buy the evidence you've given. Sure, there's not hard clinical evidence that I can point to that demonstrates that there is zero viral shedding from vaccinated individuals. But I don't claim that. I claim that it is highly likely that it knocks down viral shedding significantly. My reading of the monkey paper you cited earlier demonstrates to me a clear mechanism for reduction in viral shedding through the lower airway, thus reducing viral transmission through respiratory droplets during vocalization! I don't think you're drawing a distinction between pathologically immunocompromised individuals, and individuals who may not have as robust an immune response as others, but who can receive a vaccine. In someone who is pathologically immunocompromised, you should 100% be wearing a mask around them normally. They are not safe if you do not because they are vulnerable to a wide number of pathogens. If they are simply elderly or at-risk, let's get them vaccinated! My mom is elderly and very vulnerable, but she is not pathologically immunocompromised. She has a reaction to flu vaccines. I will most definitely be recommending to her that she receive either the Pfizer or the Moderna vaccine. There may be an adverse reaction, but she'll be a hell of a lot safer than if she didn't receive the vaccine and catches COVID. At some point people will stop wearing masks in the community (Neither you nor I have any control over this), and she will have to decide for herself if she chooses to enter the community unmasked, or if she will wear an N95 for the rest of her life. And, as I mentioned earlier, at the end of the day, what will happen will happen. Do you think the United States will go into a full China-style lockdown at some point to protect people who are unvaccinated after the vaccine has reached wide distribution? It's not gonna happen! It doesn't matter how either of us feels about this. It's just not gonna happen. The best plan we have for moving forward is to get as many people as we possibly can vaccinated. Based on my understanding of immunological mechanisms I believe that it is highly likely this will reduce community-transmission (you haven't convinced me to let go of my suspicion based on the evidence presented, and I think the monkey paper in fact strengthens my argument). For those that refuse to be vaccinated, or that are pathologically immunocompromised, their best bet will be increased access to N95 masks to actually filter incoming air, and the fact that they will once again have increased access to the healthcare system that they do not now have. What is your alternate proposal? Do you think the US will lock-down and mandate masks for the next 10 years, even after widespread vaccine distribution? Remember, we are not talking about science here, we are talking about policy. And despite Dr. Rifkin's faith in the angels of our better nature, and that "Our non-rational sides should inspire and inform reality, not dictate our perception of it," again, I invite you both to visit an Oklahoma WalMart and confront the fact that policy does not follow these humanitarian ideals. To quote from Ben Rhodes' memoir, "We take the world as it is, not as we wish it to be."

acqq 6y ago
You write: “Remember, we are not talking about science here, we are talking about policy” but, sorry, no, in many messages you just kept claiming the opposite of what is scientifically known at this very moment, and I’ve pointed to that false claim and gave you the quotes and the original vaccine tests protocols. Now the whole country is warned as explicitly as possible, most probably even with legal consequences to those who act against: https://news.yahoo.com/exclusive-vaccine-wont-free-self-165612950.html https://news.yahoo.com/exclusive-vaccine-wont-free-self-1656... As you ask what my proposal is: 1) You should apologize for spreading the beliefs that can put people in danger and stop doing that. 2) Understand what's currently scientifically known, and avoid spreading misinformation. 3) Regarding what the policy should be: allow the science to do its work instead promoting measures or beliefs that can put people in danger. The world had enough of that for months. Vaccines are good and should be used, but not believing what you promoted -- not behaving as the immunity provided by the vaccine was higher than what's known at the moment.
- phobosanomaly 6y ago
  1) Don't worry. Nobody else is reading this thread at this point. It's you, me, and svrb. You can relax. I'm not a clinician or an epidemiologist, and based on your arguments I don't think you are either, so the stakes are low. We're just having fun debating on the internet. I'll put in a disclaimer if it will help you sleep better at night: "At no point in this obscure thread in the dark corners of HackerNews does phobosanomaly advocate that within 10 months of receiving a SARS-CoV-2 vaccine should you be coughing on your elderly and comorbid friends and family who have not received a vaccine. Instead, you should bug them to get vaccinated as soon as possible!" Having a scientific hypothesis isn't a license to do stupid shit. I assumed I didn't have to spell that out. With regards to this: "Now the whole country is warned as explicitly as possible." I guess you're in the UK. I live in the USA, and it's a whole different ballgame over here. I don't think you quite understand my Oklahoma WalMart comment. There are people in Oklahoma WalMarts who refuse to wear a mask, and who open-carry handguns in case anyone tries to force them to. That is perfectly legal in this country, and very common depending on where you are. I think we're arguing from a totally different frame of reference when considering matters of policy. The United States is in complete free-fall, and there are places here where you can get shot for requiring someone to wear a mask. I am more concerned with triage, than the fine details of what happens once a significant percentage of the population is vaccinated. You must understand just how bad it is here. That's why I was astonished about how passionate you are about the fine details of this. We do not have a vaccine here. 3,000 people are dying every day. We have lost 276,000 people already. ICUs are at capacity. There are entire swaths of the population who do not believe the virus is real. We have no NHS. There is no vaccine distribution network. There is no plan. There is no-one in charge. Our president is currently occupied with trying to overturn our last presidential election. Mask compliance in massive parts of this country is a pipedream, so to be concerned about whether there will be mask compliance after widespread vaccine distribution seems utterly absurd. We're hoping we can actually get a vaccine distributed in the first place, and still trying to get people to wear masks to begin with. I need you to understand that in the entire state of Oklahoma, there is no requirement to wear masks at all, and the governor has instead proposed that the state have a day of prayer as a solution. Shift your frame of reference. I am not the enemy. You haven't the foggiest clue of the degree to which I am not the enemy. 2) I get what is currently known. There is no definitive randomized clinical trial that clearly demonstrates that a person vaccinated with the Moderna or Pfizer vaccine can in no conceivable situation spread virus to others. The public health officials you quote are saying just that. I don't dispute that at all. However, the absence of a specific randomized control trial does not mean that I cannot strongly suspect that, as I put it, "it is highly likely that it [the vaccine] knocks down viral shedding significantly." There's a clear mechanism for that, and papers you cited pointed that out. In those monkeys, the vaccine significantly knocked down viral shedding in the lower airway. It seems pretty darn plausible to me. Are you familiar with the famous parachute study? "Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for nonparticipants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001)." https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf Dunno about you, but despite the absence of clear RCT-based clinical evidence for the efficacy of parachutes, I'm not jumping out of a plane without one! There may not be completely airtight RCT-based evidence for something, but if you understand the underlying mechanisms (Parachutes reduce speed of fall; T and B cells reduce titers of a known viral pathogen when primed by a vaccine), it's not exactly an act of alchemy to draw reasonable conclusions in the absence of definitive answers. Show me an RCT that definitively proves that masks reduce transmission of SARS-CoV-2 in a community setting within the socioeconomic milieu of the United States? I've never seen a convincing one. I still wear my mask in a community setting, even when nobody explicitly tells me to. 3) Remember that long thing I posted about how public health is about multi-faceted approaches: There is no ultimate public health solution ever in any situation! Of course our response will be a multi-faceted approach! Look at how many businesses are now installing UV-lights in ventilation systems, allowing people to work from home, and how the wearing of masks has become normalized and accepted in many parts of the country! People will no longer hesitate to throw on a mask if they feel ill, unlike before when we used to wander into Target sneezing and coughing all over everything! Think of how awesome that is for immunocompromised people! The vaccine will be a critical link in a long chain that will hopefully save thousands, and thousands of lives. Whether it 100% eliminates the shedding of any measurable viral particles, knocks it down by 10%, 20%, 30%, 50% or whatever, it's a huge win. Right now we have zero way to even think about reducing viral shedding in real-world populations. We're relying 100% on social distancing and masks. Get excited! We're gonna kick this thing!

acqq 6y ago

You write: “Remember, we are not talking about science here, we are talking about policy” but, sorry, no, in many messages you just kept claiming the opposite of what is scientifically known at this very moment, and I’ve pointed to that false claim and gave you the quotes and the original vaccine tests protocols. Now the whole country is warned as explicitly as possible, most probably even with legal consequences to those who act against: https://news.yahoo.com/exclusive-vaccine-wont-free-self-165612950.html https://news.yahoo.com/exclusive-vaccine-wont-free-self-1656... As you ask what my proposal is: 1) You should apologize for spreading the beliefs that can put people in danger and stop doing that. 2) Understand what's currently scientifically known, and avoid spreading misinformation. 3) Regarding what the policy should be: allow the science to do its work instead promoting measures or beliefs that can put people in danger. The world had enough of that for months. Vaccines are good and should be used, but not believing what you promoted -- not behaving as the immunity provided by the vaccine was higher than what's known at the moment.

phobosanomaly 6y ago
1) Don't worry. Nobody else is reading this thread at this point. It's you, me, and svrb. You can relax. I'm not a clinician or an epidemiologist, and based on your arguments I don't think you are either, so the stakes are low. We're just having fun debating on the internet. I'll put in a disclaimer if it will help you sleep better at night: "At no point in this obscure thread in the dark corners of HackerNews does phobosanomaly advocate that within 10 months of receiving a SARS-CoV-2 vaccine should you be coughing on your elderly and comorbid friends and family who have not received a vaccine. Instead, you should bug them to get vaccinated as soon as possible!" Having a scientific hypothesis isn't a license to do stupid shit. I assumed I didn't have to spell that out. With regards to this: "Now the whole country is warned as explicitly as possible." I guess you're in the UK. I live in the USA, and it's a whole different ballgame over here. I don't think you quite understand my Oklahoma WalMart comment. There are people in Oklahoma WalMarts who refuse to wear a mask, and who open-carry handguns in case anyone tries to force them to. That is perfectly legal in this country, and very common depending on where you are. I think we're arguing from a totally different frame of reference when considering matters of policy. The United States is in complete free-fall, and there are places here where you can get shot for requiring someone to wear a mask. I am more concerned with triage, than the fine details of what happens once a significant percentage of the population is vaccinated. You must understand just how bad it is here. That's why I was astonished about how passionate you are about the fine details of this. We do not have a vaccine here. 3,000 people are dying every day. We have lost 276,000 people already. ICUs are at capacity. There are entire swaths of the population who do not believe the virus is real. We have no NHS. There is no vaccine distribution network. There is no plan. There is no-one in charge. Our president is currently occupied with trying to overturn our last presidential election. Mask compliance in massive parts of this country is a pipedream, so to be concerned about whether there will be mask compliance after widespread vaccine distribution seems utterly absurd. We're hoping we can actually get a vaccine distributed in the first place, and still trying to get people to wear masks to begin with. I need you to understand that in the entire state of Oklahoma, there is no requirement to wear masks at all, and the governor has instead proposed that the state have a day of prayer as a solution. Shift your frame of reference. I am not the enemy. You haven't the foggiest clue of the degree to which I am not the enemy. 2) I get what is currently known. There is no definitive randomized clinical trial that clearly demonstrates that a person vaccinated with the Moderna or Pfizer vaccine can in no conceivable situation spread virus to others. The public health officials you quote are saying just that. I don't dispute that at all. However, the absence of a specific randomized control trial does not mean that I cannot strongly suspect that, as I put it, "it is highly likely that it [the vaccine] knocks down viral shedding significantly." There's a clear mechanism for that, and papers you cited pointed that out. In those monkeys, the vaccine significantly knocked down viral shedding in the lower airway. It seems pretty darn plausible to me. Are you familiar with the famous parachute study? "Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for nonparticipants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001)." https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf https://www.bmj.com/content/bmj/363/bmj.k5094.full.pdf Dunno about you, but despite the absence of clear RCT-based clinical evidence for the efficacy of parachutes, I'm not jumping out of a plane without one! There may not be completely airtight RCT-based evidence for something, but if you understand the underlying mechanisms (Parachutes reduce speed of fall; T and B cells reduce titers of a known viral pathogen when primed by a vaccine), it's not exactly an act of alchemy to draw reasonable conclusions in the absence of definitive answers. Show me an RCT that definitively proves that masks reduce transmission of SARS-CoV-2 in a community setting within the socioeconomic milieu of the United States? I've never seen a convincing one. I still wear my mask in a community setting, even when nobody explicitly tells me to. 3) Remember that long thing I posted about how public health is about multi-faceted approaches: There is no ultimate public health solution ever in any situation! Of course our response will be a multi-faceted approach! Look at how many businesses are now installing UV-lights in ventilation systems, allowing people to work from home, and how the wearing of masks has become normalized and accepted in many parts of the country! People will no longer hesitate to throw on a mask if they feel ill, unlike before when we used to wander into Target sneezing and coughing all over everything! Think of how awesome that is for immunocompromised people! The vaccine will be a critical link in a long chain that will hopefully save thousands, and thousands of lives. Whether it 100% eliminates the shedding of any measurable viral particles, knocks it down by 10%, 20%, 30%, 50% or whatever, it's a huge win. Right now we have zero way to even think about reducing viral shedding in real-world populations. We're relying 100% on social distancing and masks. Get excited! We're gonna kick this thing!