13 ms·

Nothing matters but reproduction rate R

54 points by jseliger 6y ago

cs702 6y ago
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 https://twitter.com/EckerleIsabella/status/1345024694643208195 https://twitter.com/EckerleIsabella/status/13450246946432081...
- firebacon 6y ago
  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?
  - mlyle 6y ago
    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.
    - majormajor 6y ago
      > 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...
      - mlyle 6y ago
        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.
        majormajor 6y ago
        > 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. Maybe multiple vaccines mitigates this a bit...
        mlyle 6y ago
        > 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.
    - firebacon 6y ago
      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?
      - mlyle 6y ago
        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.
YokoZar 6y ago
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.
- xwdv 6y ago
  If everyone gets the vaccine, it doesn’t matter if it doesn’t provide sterilizing immunity.
  - geofft 6y ago
    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.)
    - mlyle 6y ago
      I think the current tradeoff is decent: 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.
causality0 6y ago
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."
amluto 6y ago
> 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.)
- maxerickson 6y ago
  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.
Igelau 6y ago
> 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.
- flukus 6y ago
  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).
- mlyle 6y ago
  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.
  - okaram 6y ago
    And also, it assumes we can identify all/most of the partiers ... and that vaccinating them won't create more parties with unvaccinated people.
cy_hauser 6y ago
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.
- geofft 6y ago
  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.
  - maxerickson 6y ago
    There's a pretty short shelf life, so lots of incentive to avoid holding it. A PS5 ages very well by comparison. 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).
    - Dylan16807 6y ago
      Six months is a pretty long time. Whether vaccine or PS5, six months is more than long enough to enable you to sell at peak price.
maxerickson 6y ago
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.
- mike_d 6y ago
  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.
  - sudosysgen 6y ago
    They are still going to get them faster than with a free market solution. This is also a non-representative sample, there are many facilities that have fully vaccinated medical workers.
  - maxerickson 6y ago
    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.
ridaj 6y ago
I'm not a fan of the current strategy or execution either, but > There is a lot of private incentive to combat an externality! No
Shorel 6y ago
I found the twice linked article: "How Perfectionism Has Made the Pandemic Worse", far more interesting and to the point. https://blog.supplysideliberal.com/post/2020/12/31/how-perfectionism-has-made-the-pandemic-worse https://blog.supplysideliberal.com/post/2020/12/31/how-perfe...
- ridaj 6y ago
  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
  - dereg 6y ago
    What was the evidence pointing to hcq being harmful?
    - ridaj 6y ago
      Re what exactly, hcq?
croes 6y ago
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.
- sudosysgen 6y ago
  Which is objectively worse for reducing deaths and long term side effects. It is a really bad idea.
aabhay 6y ago
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.
systemvoltage 6y ago
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 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.
- Nursie 6y ago
  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). Is it possible they were just wrong?
  - systemvoltage 6y ago
    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.
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coliveira 6y ago
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.
ggm 6y ago
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.
pokot0 6y ago
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.
sudosysgen 6y ago
This is a really bad idea on every level. 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.
reese_john 6y ago
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)" https://twitter.com/nntaleb/status/1344258592422158338 https://twitter.com/nntaleb/status/1344258592422158338
- marmshallow 6y ago
  I bet a small part of the problem is that the folks who are superspreading are also the anti-vaxer types.
  - rightbyte 6y ago
    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).
contravariant 6y ago
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.
deleted 6y ago
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bo1024 6y ago
There is modeling research that doesn't align with claims made here (disclaimer: I know an author): https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v2 https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v... > 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.
AntiImperialis4 6y ago
>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.
jussij 6y ago
> 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).
deelowe 6y ago
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?
- maxerickson 6y ago
  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.
  - deelowe 6y ago
    Yes, I'm aware, but what about vaccinating restaurant, grocery, pharmacy, and meat packing workers?
    - Exmoor 6y ago
      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.
      - deelowe 6y ago
        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.
- dependsontheq 6y ago
  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.
ball_of_lint 6y ago
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.
andy_ppp 6y ago
I heard the new variant adds something like 0.4-0.7 to the R value. Presumably we are completely screwed in the UK if this is true?
zyxzevn 6y ago
That is a huge oversimplification. According the Chinese study there is no asymptomatic transmission. So most of the numbers do not even make sense. Transmission within a masked & lockdown population is still large. Does not even seem to change... Because there is no asymptomatic transmission. We need quarantine instead of sick people. Masks have health side-effects, because 99% of people do not follow the OSHO safety standards. The transmission within a household between partners has an average of 27%. Another extremely weird number. Did the tests give false positives? Is the disease misidentified? Or did the others already have T-cell herd-immunity? So the real question is: What is causing transmission? And note the R does not show that at all, and focusing on that gives us the wrong solutions. There may be other factors that create a high transmission. Some doctors listed an extreme long survival time of the virus (up to 16 days under good conditions). So maybe it transmits mainly via surfaces and not via the air. That might explain why it can spread within a population under a military lockdown. But that latter might also be explained with the false positives from a PCR test (or similar test). Or the natural immunity of most people creating partial herd-immunity within the population.
- pmiller2 6y ago
  I don't think so. Here's a study looking at Beijing that estimates about 15% of cases were transmitted presymptomatically: https://jech.bmj.com/content/75/1/84.full https://jech.bmj.com/content/75/1/84.full
Exmoor 6y ago
Interesting to me that TFA completely ignores the two biggest things the government could do to expedite the vaccination process in the US: Approve the Oxford/AstraZeneca vaccine and extend the time in between doses of the mRNA vaccines. Studies in the UK and Brazil showed it to be safe and effective and it's been approved for use in the UK and, as of today, India. Apparently the FDA doesn't like studies from other countries, so they're waiting on a 3rd trial's data to come in, which may not happen for several months. The manufacturing technique and storage requirements for this vaccine mean that supply constraints should be much less significant than the currently approved vaccines. Doing this could easily save thousands, likely tens of thousands of lives by spring. So far the vaccines all ran with trials with the minimum time between doses that was likely to incur maximum immunity. It was absolutely the right call, given that they didn't know for sure how wildly effective the two mRNA vaccines would be in practice and wanted to expedite the trial timeline. However, now that we know the both vaccines provide roughly 80% immunity after 12 days, which likely last several months at least it would be smart to delay people second dose another 4-8 weeks to allow the maximum number of people to get some immunity quickly. The UK did both the above this week and I think we'll look back and realize it was absolutely the right move.
rich_sasha 6y ago
In the UK, the logic behind vaccinating old people first is that they are the most likely to put pressure in health care. If we could make everyone over 50 immune, say, the virus is a lot less deadly for the rest, and so a much smaller problem for the society. I’m oversimplifying but hopefully the idea is clear.

54 points by jseliger 6y ago

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 https://twitter.com/EckerleIsabella/status/1345024694643208195 https://twitter.com/EckerleIsabella/status/13450246946432081...

firebacon 6y ago
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?
- mlyle 6y ago
  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.
  - majormajor 6y ago
    > 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...
    - mlyle 6y ago
      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.
      - majormajor 6y ago
        > 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. Maybe multiple vaccines mitigates this a bit...
        mlyle 6y ago
        > 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.
  - firebacon 6y ago
    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?
    - mlyle 6y ago
      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.

YokoZar 6y ago

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.

xwdv 6y ago
If everyone gets the vaccine, it doesn’t matter if it doesn’t provide sterilizing immunity.
- geofft 6y ago
  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.)
  - mlyle 6y ago
    I think the current tradeoff is decent: 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.

causality0 6y ago

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."

amluto 6y ago

> 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.)

maxerickson 6y ago
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.

Igelau 6y ago

> 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.

flukus 6y ago
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).
mlyle 6y ago
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.
- okaram 6y ago
  And also, it assumes we can identify all/most of the partiers ... and that vaccinating them won't create more parties with unvaccinated people.

cy_hauser 6y ago

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.

geofft 6y ago
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.
- maxerickson 6y ago
  There's a pretty short shelf life, so lots of incentive to avoid holding it. A PS5 ages very well by comparison. 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).
  - Dylan16807 6y ago
    Six months is a pretty long time. Whether vaccine or PS5, six months is more than long enough to enable you to sell at peak price.

maxerickson 6y ago

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.

mike_d 6y ago
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.
- sudosysgen 6y ago
  They are still going to get them faster than with a free market solution. This is also a non-representative sample, there are many facilities that have fully vaccinated medical workers.
- maxerickson 6y ago
  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.

ridaj 6y ago

I'm not a fan of the current strategy or execution either, but > There is a lot of private incentive to combat an externality! No

Shorel 6y ago

I found the twice linked article: "How Perfectionism Has Made the Pandemic Worse", far more interesting and to the point. https://blog.supplysideliberal.com/post/2020/12/31/how-perfectionism-has-made-the-pandemic-worse https://blog.supplysideliberal.com/post/2020/12/31/how-perfe...

ridaj 6y ago
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
- dereg 6y ago
  What was the evidence pointing to hcq being harmful?
  - ridaj 6y ago
    Re what exactly, hcq?

croes 6y ago

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.

sudosysgen 6y ago
Which is objectively worse for reducing deaths and long term side effects. It is a really bad idea.

aabhay 6y ago

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.

systemvoltage 6y ago

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 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.

Nursie 6y ago
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). Is it possible they were just wrong?
- systemvoltage 6y ago
  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.

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coliveira 6y ago

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.

ggm 6y ago

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.

pokot0 6y ago

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.

sudosysgen 6y ago

This is a really bad idea on every level. 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.

reese_john 6y ago

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)" https://twitter.com/nntaleb/status/1344258592422158338 https://twitter.com/nntaleb/status/1344258592422158338

marmshallow 6y ago
I bet a small part of the problem is that the folks who are superspreading are also the anti-vaxer types.
- rightbyte 6y ago
  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).

contravariant 6y ago

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.

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bo1024 6y ago

There is modeling research that doesn't align with claims made here (disclaimer: I know an author): https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v2 https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v... > 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.

AntiImperialis4 6y ago

>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.

jussij 6y ago

> 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).

deelowe 6y ago

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?

maxerickson 6y ago
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.
- deelowe 6y ago
  Yes, I'm aware, but what about vaccinating restaurant, grocery, pharmacy, and meat packing workers?
  - Exmoor 6y ago
    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.
    - deelowe 6y ago
      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.
dependsontheq 6y ago
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.

ball_of_lint 6y ago

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.

andy_ppp 6y ago

I heard the new variant adds something like 0.4-0.7 to the R value. Presumably we are completely screwed in the UK if this is true?

zyxzevn 6y ago

That is a huge oversimplification. According the Chinese study there is no asymptomatic transmission. So most of the numbers do not even make sense. Transmission within a masked & lockdown population is still large. Does not even seem to change... Because there is no asymptomatic transmission. We need quarantine instead of sick people. Masks have health side-effects, because 99% of people do not follow the OSHO safety standards. The transmission within a household between partners has an average of 27%. Another extremely weird number. Did the tests give false positives? Is the disease misidentified? Or did the others already have T-cell herd-immunity? So the real question is: What is causing transmission? And note the R does not show that at all, and focusing on that gives us the wrong solutions. There may be other factors that create a high transmission. Some doctors listed an extreme long survival time of the virus (up to 16 days under good conditions). So maybe it transmits mainly via surfaces and not via the air. That might explain why it can spread within a population under a military lockdown. But that latter might also be explained with the false positives from a PCR test (or similar test). Or the natural immunity of most people creating partial herd-immunity within the population.

pmiller2 6y ago
I don't think so. Here's a study looking at Beijing that estimates about 15% of cases were transmitted presymptomatically: https://jech.bmj.com/content/75/1/84.full https://jech.bmj.com/content/75/1/84.full

Exmoor 6y ago

Interesting to me that TFA completely ignores the two biggest things the government could do to expedite the vaccination process in the US: Approve the Oxford/AstraZeneca vaccine and extend the time in between doses of the mRNA vaccines. Studies in the UK and Brazil showed it to be safe and effective and it's been approved for use in the UK and, as of today, India. Apparently the FDA doesn't like studies from other countries, so they're waiting on a 3rd trial's data to come in, which may not happen for several months. The manufacturing technique and storage requirements for this vaccine mean that supply constraints should be much less significant than the currently approved vaccines. Doing this could easily save thousands, likely tens of thousands of lives by spring. So far the vaccines all ran with trials with the minimum time between doses that was likely to incur maximum immunity. It was absolutely the right call, given that they didn't know for sure how wildly effective the two mRNA vaccines would be in practice and wanted to expedite the trial timeline. However, now that we know the both vaccines provide roughly 80% immunity after 12 days, which likely last several months at least it would be smart to delay people second dose another 4-8 weeks to allow the maximum number of people to get some immunity quickly. The UK did both the above this week and I think we'll look back and realize it was absolutely the right move.

rich_sasha 6y ago

In the UK, the logic behind vaccinating old people first is that they are the most likely to put pressure in health care. If we could make everyone over 50 immune, say, the virus is a lot less deadly for the rest, and so a much smaller problem for the society. I’m oversimplifying but hopefully the idea is clear.