11 ms·

CDC Internal Delta Variant Presentation

105 points by zckao 5y ago

perihelions 5y ago
Anyone else notice that failed redaction attempt on slides 1 and 24?
- chocolatkey 5y ago
  Or just get the version that's not redacted: https://www.washingtonpost.com/context/cdc-breakthrough-infections/11fc6a11-20d7-466e-a654-c6bc8426f688/ https://www.washingtonpost.com/context/cdc-breakthrough-infe...
- underseacables 5y ago
  Perhaps they don’t want you to contact or question the federal employee that wrote the document.
  - jonas21 5y ago
    Where "contact" is a euphemism for "send death threats to"?
    - underseacables 5y ago
      I wasn’t thinking that, but I see your point. That is a very real possibility these days.
- tomjen3 5y ago
  At this point I always check, just because. Such a common failure mode.
- bpye 5y ago
  First thing I noticed, cursor over the redacted region and it turned into a text selection cursor. Sigh.
jpster 5y ago
They did a prospective study of vaccine effectiveness vs infection and transmission among vaxxed healthcare and frontline workers. Seems biased from the start. Won’t it be confounded by their tendency to wear (better) PPE? Edited to add: I suppose it depends on their methodology. Quick glance at Thompson’s study, seems they compared vaxxed HCWs to unvaxxed HCWs. I don’t know if we would expect to see material PPE-wearing differences between those groups.
- Jtsummers 5y ago
  If you know the effectiveness of PPE vs no-PPE, and the effectiveness of PPE w/ Vaccine vs PPE w/o Vaccine, you can estimate the effectiveness of the Vaccine alone, even if you don't have statistics for it by itself.
seriousquestion 5y ago
"Acknowledge the war has changed" Maybe it has? For example, DC has reported 11 homicides since its last reported COVID death.
- rsa25519 5y ago
  This is an unfair comparison because covid death reporting lags far behind other data
  - deleted 5y ago
    [deleted]
  - seriousquestion 5y ago
    That excuse stopped working a long time ago. It has been said as a defense every time there is a scare. Remember when Texas removed the mask mandate? Mass death predicted. We waited 2 weeks. Deaths dropped. Remember the beach photos, complete with an interview with the grim reaper? The hospitals are going to overflow? How many times have we heard this? Yet we still continue to make the same apocalyptic predications, as though it's the first time. The hospitals are fine and the deaths are low. We flattened the curve long ago. Look at the stats for yourself. 1 Covid death in the past 2 weeks in DC. Where they are now they are requiring masks even for the vaccinated and signaling lockdown. What about all the homicides? What about all the other causes of death? What about the rapidly accelerating income inequality as a result of lockdowns and mandates? What about the kids, who are extremely low risk, falling behind in school? https://www.nytimes.com/interactive/2021/us/washington-district-of-columbia-covid-cases.html https://www.nytimes.com/interactive/2021/us/washington-distr...
- lefrenchy 5y ago
  Well it’s a good thing homicides aren’t a contagious disease then right? If not it might be under the jurisdiction of the Center For Disease Control.
  - AdrianB1 5y ago
    Google for 'gun violence epidemic' and you will find lots of high profile results pretending it is.
vsnf 5y ago
Slide 21 >Given higher transmissibility and current vaccine coverage, universal masking is essential to reduce transmission of the Delta variant Well that's very sad, if not entirely unexpected. How long will we be living in a masked world?
- caetris1 5y ago
  This virus will be here for eternity. It's a plot point in our story.
- dylan604 5y ago
  I know I'm tired now. When I read your "masked world", I heard it to the tune of REM's "Mad World"
  - mnd999 5y ago
    Tears for Fears surely.
- tomjen3 5y ago
  Forever, or not another day. Depends on how we want to fight this.
- arpa 5y ago
  what's wrong with masked world? it helps stop the spread of other airborne diseases as well, it filters out (to some extent) the smog, facial recognition software has more trouble, so we regain at least some privacy...
  - carnitas 5y ago
    Oh I don’t know, crushing depression, psychological atmosphere of fear, no biggy
    - arpa 5y ago
      If you think masks are depressing and fearful, just wait for the climate wars...
ramraj07 5y ago
Will anyone hold the CDC accountable for its screwups? Even misinformation by Fox News pales in comparison to the travesty that was CDCs recommendation to remove mask mandates for vaccinated people. If purported expert agencies can’t suppress their politics and idiocy and be cautious why can we ever expect the public to be careful?
- jimbob45 5y ago
  Did comparable agencies around the world make different or similar decisions in similar situations? Just because they were wrong doesn’t mean that they didn’t make the best decision possible with the available information and given circumstances.
  - qbasic_forever 5y ago
    Yes, Israel reinstated its mask mandate immediately after they saw cases rise a month ago and their own studies indicated the delta variant was impacting vaccine efficacy or even transmitting from vaccinated persons: https://www.timesofisrael.com/israel-to-reinstate-indoor-mask-mandate-next-week-as-covid-19-cases-keep-rising/ https://www.timesofisrael.com/israel-to-reinstate-indoor-mas... Much of the data in this CDC slide deck is actually from these Israeli studies. I will also note Israel has already approved a third dose of mRNA booster shots for 60+ year old people based on the data they have seen with waning efficacy. The CDC as of now currently says boosters are not necessary for Americans "at this time"...
  - ramraj07 5y ago
    Even assuming they were making the correct decisions in the beginning of the pandemic (which they were not), the decision recently to tell anyone vaccinated is fully safe is outrageous. There’s not a single expert who agreed that that was a good idea, and now thousands of people are dying because of it. The only reason to make that announcement was political and that’s exactly what I’m talking about. A scientific agency that puts politics before science. This and the fda authorization of the biogen drug have sealed the deal for me on how corrupted the US has become. It’s been coasting thanks to the good decisions made decades past, and finally it’s just fumes and the time couldn’t be more perfect.
gok 5y ago
So the entire delta-has-same-transmissibility-regardless-of-vaccination panic is from 145 cases in Massachusetts, on a bullet point that confuses mean and median.
notabee 5y ago
Stumbled upon some truly cursed knowledge (if it's true, though I fervently hope not). Imagine a followup pandemic not of more Covid but of neurodegenerative disease from this. Not just in the most severe cases. 1. https://twitter.com/fitterhappierAJ/status/1417435633212182552 https://twitter.com/fitterhappierAJ/status/14174356332121825... 2. https://www.sciencedirect.com/science/article/pii/S0969996116302947 https://www.sciencedirect.com/science/article/pii/S096999611...
- anonuser123456 5y ago
  I think you are conflating two separate issues.
  - notabee 5y ago
    Am I? Level of olfaction impairment and cognitive impairment have tracked together according to some other sources. Again, I'll be glad if this isn't true. He was most struck by three findings: One, he said, was the frequency with which people who had been exposed to the coronavirus had subsequent problems with memory. About 60 per cent had cognitive impairment, and for 1 in 3, the symptoms were severe. Second, his findings indicate that the severity of a COVID-19 patient’s illness does not predict cognitive problems. “What puts you at risk of having the cognitive problems is just having been infected, regardless of how badly ill you were,” he said. “You may have had very mild COVID, but if you were infected and you are older, you are at risk of having these issues.” And, third, losing the ability to smell, which has been commonly reported among COVID-19 patients, is correlated with cognitive troubles. “They track together quite well,” de Erausquin said. “The more severe your lack of smell, the more severe your cognitive impairment.” https://www.smh.com.au/world/north-america/covid-19-could-lead-to-cognitive-decline-new-research-suggests-20210730-p58ea1.html https://www.smh.com.au/world/north-america/covid-19-could-le...
- lamontcg 5y ago
  > cursed can we please stop using this stupid word? calling things "cursed" is the opposite of bringing any clarity to the world.
mjevans 5y ago
Page 3 is the chart they need to have on display for anyone that doesn't trust the vaccines.
- aaccount 5y ago
  Those values are for a 100,000 people, If you do the calculation for the people not affected 99.9785% of vaccinated are not infected 99.8714% of un-vaccinated are not infected 99.9999% of vaccinated are not hospitalized 99.9975% of un-vaccinated are not hospitalized 99.99996% of vaccinated are not dead 99.99904% of un-vaccinated are not dead This is such a small difference.
  - mikenew 5y ago
    My odds of getting in a car wreck today are tiny. If I wear a seatbelt today it will almost certainly not matter. My odds of getting in a car wreck over the course of years are not so tiny, and wearing a seatbelt makes a big difference.
    - pixxel 5y ago
      Stop with this seatbelt analogy. At least until the government demands you start ingesting them.
  - adrianN 5y ago
    If you write it in permille the differences appear even smaller. But if you look at the actual number of people who will die if we keep the pandemic going and don't get the vaccination rates up, the difference is suddenly in the millions of people.
  - zamfi 5y ago
    …in just one given week, though. And that week was not so bad; in January we had case rates many multiples higher. But maybe if you count infections per second, instead of per week, you can get a number so close to 100% not dead that it’s a rounding error: pandemic solved!
throwawaysea 5y ago
A couple questions for those who might know: 1. Slide 16 mentions India but the details aren't clear. Is this study's focus on breakthrough cases and spreading of Delta based off data in India? I know India was where Delta originated and that it blindsided them because COVID measures that worked well for previous variants did not work anymore - so does that simply mean that the most data on Delta happens to be in India due to the larger cumulative number of Delta cases there? And if so how applicable is that data to the US, given that the type of vaccine administered is different and may have different (reduced) efficacy compared to Pfizer or Moderna, and since other factors (population size, density, healthcare quality, etc) may also be different and influence the data? 2. The graphs on Slides 20-21 are unclear to me. My interpretation is that they have four different scenarios and are using the bottom-left one, which assumes a higher R0 representing the Delta variant, and a lower assumption of natural immunity of 5% - basically the more conservative outlook. The graph itself seems to be indicating a probability of increase in cases, and we presumably want to be below 0.5. The legend shows three colors for universal masking, masking of the unvaccinated, and no masking. But the graph itself has five color bands - are the other color bands just hybrids? So the color between beige and lilac represents some vaccinated people masking and all unvaccinated people masking? And no masking is not an option per this graph even at 100% vaccination, because the probability of cases increasing would be around 80% still? If the natural immunity is higher (the bottom-right graph), then there is no need for universal masking in nearly all levels of vaccination? Am I interpreting all that correctly?
- _Microft 5y ago
  The colored bands seem to be semi-transparent, so all can be shown in the same graph instead of having to show an own one for each of them (i.e. it is purely a display problem where the bands overlap).
X6S1x6Okd1st 5y ago
page 18 seems to be indicating that Delta is ~2x more likely to have all of the bad outcomes relative to ancestral strain. That combined with how much more infectious this is makes it truly worrying. One interpretation of the fact that Israel has such different numbers on vaccine effectiveness is that effectiveness starts dropping ~6 months in. We'll need to start doing 3rd shots for lots of people ~now.
- koheripbal 5y ago
  2x the extremely low rate for vaccinated people is still very low - hence the extra efforts needed to vaccinate people.
  - X6S1x6Okd1st 5y ago
    Yes, it's important, in the US we are largely demand constrained, however globally we are supply constrained. IMO the world just got a lot darker.
sbierwagen 5y ago
Slide 20: >Given increased transmissibility, lower VE, and current vaccine coverage, NPIs needed to reduce transmission of Delta variant >Masking: >• Source control 40-60% effective >• Personal protection 20-30% effective >NO ADJUSTMENTS FOR OTHER INTERVENTIONS >• e.g., no distancing, no isolation, no gathering restrictions I'm... not sure about that? Delta is infecting people who just walk past each other in indoor spaces: https://www.wsj.com/articles/delta-variants-spread-outpaces-australias-covid-19-contact-tracers-11625045400 https://www.wsj.com/articles/delta-variants-spread-outpaces-... How can you get to 40-60% effectiveness if you have perfect mask wearing, but leave restaurants and bars open? Even wearing a N95 when going to the grocery store and post office or whatever isn't going to help if you then go to a bar and spend an hour maskless with your 100 closest unmasked friends.
- SpicyLemonZest 5y ago
  Restaurants and bars are open because people really want them to be, not because the CDC recommends it. The CDC offers some suggestions on how to manage the risks of opening restaurants, but there's nothing to change there because they've never revoked their early 2020 guidance that it's a big risk.
  - sbierwagen 5y ago
    If there is a secret hidden footnote to "NO ADJUSTMENTS FOR OTHER INTERVENTIONS" and "no distancing, no isolation, no gathering restrictions" that reads "just kidding about that, all restaurants and bars need to be closed immediately" then this slide deck is doing a very bad job of clearly recommending what public heath interventions should be done. Again, why would they recommend universal masking if they know for a fact that it wouldn't do anything? What's the point?
    - SpicyLemonZest 5y ago
      Why hasn't the FDA approved the vaccines, when health experts universally agree they're safe and effective and everyone should get one? I always hate when conversations come to this, because it comes across as a wild hot take, but there's a point where you've just gotta blame organizational dysfunction. It wouldn't be appropriate for the CDC to say "everyone ought to close indoor dining again" or "masks are pointless if you have them off 80% of the time to eat", and they certainly can't say "let's just let the unvaccinated people get sick". So they have to say some other stuff instead.
criticaltinker 5y ago
Wow these slides are packed with information and accompanying citations - truly a great resource for anyone following the literature regarding COVID-19 and especially the variants of concern. I need more time to digest this presentation, but there are two important topics that I feel are missing or at least underrepresented: 1) The effectiveness of early outpatient treatment using a combination of existing medicines (antibiotics, corticosteroids, antiplatelet/antithrombotic) [0a] [0b] 2) The risk of vaccine induced immune escape Regarding 2) The basic idea is that imperfect vaccines may cause selective pressure which further enhances the fitness of highly virulent pathogens. This may be particularly relevant to the widely deployed mRNA vaccines, which induce an immune response that is highly targeted towards the SARS-CoV-2 spike protein. Here are some peer reviewed publications on the topic, along with a few excerpts [1][2][3][4][5][6]. To be clear, the excerpts I'm providing below do not contradict any of the major points from the presentation. However, I do hope they illustrate that there is another important dimension to discuss when evaluating the evolutionary dynamics of SARS-CoV-2. Excerpts from [1]: - "A growing body of evidence suggests that the targets of several human vaccines are evolving" - "For example, resistance to influenza and herpes-virus drugs emerged within a few years of FDA approval, and resistance to antivirals rapidly arises within human immunodeficiency virus (HIV) and hepatitis C virus (HCV)-infected patients" - "The best documented example of vaccine resistance evolution occurred in Marek’s disease, a commercially important disease of chickens caused by Marek’s disease virus (Gallid herpesvirus II). There, two generations of vaccines were undermined by viral evolution. Those vaccines prevented disease, but even before the pathogen evolved, they did not prevent viral infection, replication, or transmission. Instead, Marek’s disease virus reached large population sizes even within vaccinated hosts and was able to transmit to new hosts. As a result, the virus was likely able to generate genetic diversity within vaccinated hosts, and vaccine-induced selection was able to act during transmission between hosts. The benefits of prophylaxis were thus missing." Excerpts from [2]: - "Here we show experimentally that immunization of chickens against Marek's disease virus enhances the fitness of more virulent strains, making it possible for hyperpathogenic strains to transmit. Immunity elicited by direct vaccination or by maternal vaccination prolongs host survival but does not prevent infection, viral replication or transmission, thus extending the infectious periods of strains otherwise too lethal to persist. Our data show that anti-disease vaccines that do not prevent transmission can create conditions that promote the emergence of pathogen strains that cause more severe disease in unvaccinated hosts." Excerpts from [3]: - "The spike protein receptor-binding domain (RBD) of SARS-CoV-2 is the molecular target for many vaccines and antibody-based prophylactics aimed at bringing COVID-19 under control." - "Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions. With the emergence of new strains of SARS-CoV-2 with altered transmissibility and immune evasion potential, a critical question is this: how easily can the virus escape neutralizing antibodies (nAbs) targeting the spike RBD?" - "Our modeling suggests that SARS-CoV-2 mutants with one or two mildly deleterious mutations are expected to exist in high numbers due to neutral genetic variation, and consequently resistance to vaccines or other prophylactics that rely on one or two antibodies for protection can develop quickly -and repeatedly- under positive selection." - "Strategies for viral elimination should therefore be diversified across molecular targets and therapeutic modalities" - "The speed at which nAb resistance develops in the population increases substantially as the number of infected individuals increases, suggesting that complementary strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) or that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification) are key to reducing the risk of immune escape" Excerpts from [4]: - "... evidence for vaccine-induced disease evolution is mounting for many diseases ..." - "... vaccines can reduce parasite fitness by preventing infection, reducing within-host growth, or preventing transmission. These have been shown to have very different evolutionary consequences for parasite virulence evolution" - "Vaccines which reduce within-host growth rates are predicted to increase virulence" - "Infection with multiple strains of the same parasite can result from separate infection events of co-circulating strains, or because the parasite has a rapid mutation rate and generates strain diversity through mutation within the host. Biologically, distinctions between ‘types’ of multiple infection matter because they affect the relatedness of the co-infecting parasites and relatedness can influence the optimal virulence strategy for the parasite" [0a] Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection (2020) https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltext https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltex... [0b] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) (2020) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1139&context=infectiousdiseases_articles https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a... [1] Why does drug resistance readily evolve but vaccine resistance does not? (2017) https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2016.2562 https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2016... [2] Imperfect Vaccination Can Enhance the Transmission of Highly Virulent Pathogens (2015) https://journals.plos.org/plosbiology/article?id=10.1371%2Fjournal.pbio.1002198 https://journals.plos.org/plosbiology/article?id=10.1371%2Fj... [3] Risk of rapid evolutionary escape from biomedical interventions targeting SARS-CoV-2 spike protein (April 2021) https://pubmed.ncbi.nlm.nih.gov/33909660/ https://pubmed.ncbi.nlm.nih.gov/33909660/ [4] The adaptive evolution of virulence: a review of theoretical predictions and empirical tests (2015) https://www.cambridge.org/core/services/aop-cambridge-core/content/view/30EC8AB1717BF7A173CF5E051DBB498F/S003118201500092Xa_hi.pdf/_div_class__title__The_adaptive_evolution_of_virulence__a_review_of_theoretical_predictions_and_empirical_tests__div_.pdf https://www.cambridge.org/core/services/aop-cambridge-core/c... [5] The phylogenomics of evolving virus virulence (2018) https://www.nature.com/articles/s41576-018-0055-5 https://www.nature.com/articles/s41576-018-0055-5 [6] Monitor for COVID-19 vaccine resistance evolution during clinical trials (Nov 2020) https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001000 https://journals.plos.org/plosbiology/article?id=10.1371/jou...
smaryjerry 5y ago
Delta is getting a crazy amount of press but for some reason most articles don’t show any of the articles stats. For instance rather than show cases or deaths, they show “percent of cases that are delta.” Here is the CDC chart showing cases and deaths by group. https://covid.cdc.gov/covid-data-tracker/#demographicsovertime https://covid.cdc.gov/covid-data-tracker/#demographicsoverti... Cases are increasing but even case increase is a tiny blip compared to winter. Cases have always been a poor metric to judge the pandemic as it doesn’t indicate the severity of the infection. Filter the graph by deaths and we can see COVID deaths have still yet to increase even a tiny amount from their already extremely low levels after vaccinations become mainstream. Yes there is a lag time between death and cases but that lag time is only two weeks.
- seriousquestion 5y ago
  Careful, I got buried by the downvote and flag brigade for pointing that out.
- Exmoor 5y ago
  > Cases are increasing but even case increase is a tiny blip compared to winter. If you look at the US as a whole cases are not are still well below the worst daily averages of last Christmas, but blip is a much stronger word than I'd use when the trend line is pointed up with no obvious end in sight. Drill down on the individual states with the most issues and you'll see that places like Louisiana are basically at the same point as they were in winter and will likely far exceed it. As you say, the fact that most of the most vulnerable age ranges have been vaccinated will certainly help the death tolls. The flip side of that, however, is that a much higher concentration of the deaths in those states are going to be younger individuals.
  - smaryjerry 5y ago
    True cases are equal in some areas like Louisiana and Florida. Florida is completely open with the worst possible scenario of practically no masks, low vaccine rates, and enormous crowds but has only 1.4 weekly deaths per 100,000, low but above the national average of .5 weekly deaths per 100,000. Compare this with deaths from all other causes which average about 16 weekly deaths per 100,000. So yea we have a problem but at the current rate you are more likely to die from a stroke than COVID. You are about half as likely to die by suicide. You are about 6 times as likely to die from heart disease than COVID. I’m just saying there are other things to be afraid of and focus on than the pandemic.
jpster 5y ago
If vaxxed people are still getting infected and transmitting Delta at similar rates as unvaxxed, then the reasons for getting vaxxed are: - lower your own chances of symptomatic disease, severe illness, hospitalization and death - and therefore, help keep the healthcare system from collapsing
- X6S1x6Okd1st 5y ago
  They aren't though.
  - deleted 5y ago
    [deleted]
  - jpster 5y ago
    Headline on Slide 17 in the deck: Delta variant vaccine breakthrough cases may be as transmissible as unvaccinated case
    - lostmsu 5y ago
      It does not confirm your point. It says roughly "if a vaxxed and unvaxxed people are equally sick (e.g. same strength of symptoms), they transmit equally". However, vaxxed people get sick ~20x less, so they transmit ~20x less overall. (20x is a bad estimate here, taken from efficiency against hospitalizations)
      - deleted 5y ago
        [deleted]
      - jpster 5y ago
        Not sure how you’re arriving at this translation of what’s on the slide. Can you explain?
        lostmsu 5y ago
        > No difference in mean Ct values in vaccinated and unvaccinated cases This refers to registered cases. Registered cases ~ symptomatic cases above certain threshold of symptoms (e.g. if you only have running nose or no symptoms whatsoever, you won't report anything). Suppose you have two separate groups of 100 people, one with all vaccinated, other with none vaccinated. In each, 1 member is sick and gets in contact with everyone. In unvaxxed group, say, you get 20 symptomatic cases, 30 asymptomatic cases, and 50 are lucky. In a vaxxed group (an example), you get 3 symptomatic cases, 10 asymptomatic cases, and 87 are lucky. Now according to my understanding the slide statement above applied to this though experiment says that every one in the 20 symptomatic cases from unvaxxed group has the same chance (individually) to transmit, as everyone of the 3 symptomatic cases of vaxxed group. But because vaxxed group has 6x less people on stage 2 who could transmit further, overall transmission rate is also almost 6x lower. E.g. the statement talks about sending chances, and not receiving chances. And overall transmission depends on both.

105 points by zckao 5y ago

perihelions 5y ago

Anyone else notice that failed redaction attempt on slides 1 and 24?

chocolatkey 5y ago
Or just get the version that's not redacted: https://www.washingtonpost.com/context/cdc-breakthrough-infections/11fc6a11-20d7-466e-a654-c6bc8426f688/ https://www.washingtonpost.com/context/cdc-breakthrough-infe...
underseacables 5y ago
Perhaps they don’t want you to contact or question the federal employee that wrote the document.
- jonas21 5y ago
  Where "contact" is a euphemism for "send death threats to"?
  - underseacables 5y ago
    I wasn’t thinking that, but I see your point. That is a very real possibility these days.
tomjen3 5y ago
At this point I always check, just because. Such a common failure mode.
bpye 5y ago
First thing I noticed, cursor over the redacted region and it turned into a text selection cursor. Sigh.

jpster 5y ago

They did a prospective study of vaccine effectiveness vs infection and transmission among vaxxed healthcare and frontline workers. Seems biased from the start. Won’t it be confounded by their tendency to wear (better) PPE? Edited to add: I suppose it depends on their methodology. Quick glance at Thompson’s study, seems they compared vaxxed HCWs to unvaxxed HCWs. I don’t know if we would expect to see material PPE-wearing differences between those groups.

Jtsummers 5y ago
If you know the effectiveness of PPE vs no-PPE, and the effectiveness of PPE w/ Vaccine vs PPE w/o Vaccine, you can estimate the effectiveness of the Vaccine alone, even if you don't have statistics for it by itself.

seriousquestion 5y ago

"Acknowledge the war has changed" Maybe it has? For example, DC has reported 11 homicides since its last reported COVID death.

rsa25519 5y ago
This is an unfair comparison because covid death reporting lags far behind other data
- deleted 5y ago
  [deleted]
- seriousquestion 5y ago
  That excuse stopped working a long time ago. It has been said as a defense every time there is a scare. Remember when Texas removed the mask mandate? Mass death predicted. We waited 2 weeks. Deaths dropped. Remember the beach photos, complete with an interview with the grim reaper? The hospitals are going to overflow? How many times have we heard this? Yet we still continue to make the same apocalyptic predications, as though it's the first time. The hospitals are fine and the deaths are low. We flattened the curve long ago. Look at the stats for yourself. 1 Covid death in the past 2 weeks in DC. Where they are now they are requiring masks even for the vaccinated and signaling lockdown. What about all the homicides? What about all the other causes of death? What about the rapidly accelerating income inequality as a result of lockdowns and mandates? What about the kids, who are extremely low risk, falling behind in school? https://www.nytimes.com/interactive/2021/us/washington-district-of-columbia-covid-cases.html https://www.nytimes.com/interactive/2021/us/washington-distr...
lefrenchy 5y ago
Well it’s a good thing homicides aren’t a contagious disease then right? If not it might be under the jurisdiction of the Center For Disease Control.
- AdrianB1 5y ago
  Google for 'gun violence epidemic' and you will find lots of high profile results pretending it is.

vsnf 5y ago

Slide 21 >Given higher transmissibility and current vaccine coverage, universal masking is essential to reduce transmission of the Delta variant Well that's very sad, if not entirely unexpected. How long will we be living in a masked world?

caetris1 5y ago
This virus will be here for eternity. It's a plot point in our story.
dylan604 5y ago
I know I'm tired now. When I read your "masked world", I heard it to the tune of REM's "Mad World"
- mnd999 5y ago
  Tears for Fears surely.
tomjen3 5y ago
Forever, or not another day. Depends on how we want to fight this.
arpa 5y ago
what's wrong with masked world? it helps stop the spread of other airborne diseases as well, it filters out (to some extent) the smog, facial recognition software has more trouble, so we regain at least some privacy...
- carnitas 5y ago
  Oh I don’t know, crushing depression, psychological atmosphere of fear, no biggy
  - arpa 5y ago
    If you think masks are depressing and fearful, just wait for the climate wars...

ramraj07 5y ago

Will anyone hold the CDC accountable for its screwups? Even misinformation by Fox News pales in comparison to the travesty that was CDCs recommendation to remove mask mandates for vaccinated people. If purported expert agencies can’t suppress their politics and idiocy and be cautious why can we ever expect the public to be careful?

jimbob45 5y ago
Did comparable agencies around the world make different or similar decisions in similar situations? Just because they were wrong doesn’t mean that they didn’t make the best decision possible with the available information and given circumstances.
- qbasic_forever 5y ago
  Yes, Israel reinstated its mask mandate immediately after they saw cases rise a month ago and their own studies indicated the delta variant was impacting vaccine efficacy or even transmitting from vaccinated persons: https://www.timesofisrael.com/israel-to-reinstate-indoor-mask-mandate-next-week-as-covid-19-cases-keep-rising/ https://www.timesofisrael.com/israel-to-reinstate-indoor-mas... Much of the data in this CDC slide deck is actually from these Israeli studies. I will also note Israel has already approved a third dose of mRNA booster shots for 60+ year old people based on the data they have seen with waning efficacy. The CDC as of now currently says boosters are not necessary for Americans "at this time"...
- ramraj07 5y ago
  Even assuming they were making the correct decisions in the beginning of the pandemic (which they were not), the decision recently to tell anyone vaccinated is fully safe is outrageous. There’s not a single expert who agreed that that was a good idea, and now thousands of people are dying because of it. The only reason to make that announcement was political and that’s exactly what I’m talking about. A scientific agency that puts politics before science. This and the fda authorization of the biogen drug have sealed the deal for me on how corrupted the US has become. It’s been coasting thanks to the good decisions made decades past, and finally it’s just fumes and the time couldn’t be more perfect.

gok 5y ago

So the entire delta-has-same-transmissibility-regardless-of-vaccination panic is from 145 cases in Massachusetts, on a bullet point that confuses mean and median.

notabee 5y ago

Stumbled upon some truly cursed knowledge (if it's true, though I fervently hope not). Imagine a followup pandemic not of more Covid but of neurodegenerative disease from this. Not just in the most severe cases. 1. https://twitter.com/fitterhappierAJ/status/1417435633212182552 https://twitter.com/fitterhappierAJ/status/14174356332121825... 2. https://www.sciencedirect.com/science/article/pii/S0969996116302947 https://www.sciencedirect.com/science/article/pii/S096999611...

anonuser123456 5y ago
I think you are conflating two separate issues.
- notabee 5y ago
  Am I? Level of olfaction impairment and cognitive impairment have tracked together according to some other sources. Again, I'll be glad if this isn't true. He was most struck by three findings: One, he said, was the frequency with which people who had been exposed to the coronavirus had subsequent problems with memory. About 60 per cent had cognitive impairment, and for 1 in 3, the symptoms were severe. Second, his findings indicate that the severity of a COVID-19 patient’s illness does not predict cognitive problems. “What puts you at risk of having the cognitive problems is just having been infected, regardless of how badly ill you were,” he said. “You may have had very mild COVID, but if you were infected and you are older, you are at risk of having these issues.” And, third, losing the ability to smell, which has been commonly reported among COVID-19 patients, is correlated with cognitive troubles. “They track together quite well,” de Erausquin said. “The more severe your lack of smell, the more severe your cognitive impairment.” https://www.smh.com.au/world/north-america/covid-19-could-lead-to-cognitive-decline-new-research-suggests-20210730-p58ea1.html https://www.smh.com.au/world/north-america/covid-19-could-le...
lamontcg 5y ago
> cursed can we please stop using this stupid word? calling things "cursed" is the opposite of bringing any clarity to the world.

mjevans 5y ago

Page 3 is the chart they need to have on display for anyone that doesn't trust the vaccines.

aaccount 5y ago
Those values are for a 100,000 people, If you do the calculation for the people not affected 99.9785% of vaccinated are not infected 99.8714% of un-vaccinated are not infected 99.9999% of vaccinated are not hospitalized 99.9975% of un-vaccinated are not hospitalized 99.99996% of vaccinated are not dead 99.99904% of un-vaccinated are not dead This is such a small difference.
- mikenew 5y ago
  My odds of getting in a car wreck today are tiny. If I wear a seatbelt today it will almost certainly not matter. My odds of getting in a car wreck over the course of years are not so tiny, and wearing a seatbelt makes a big difference.
  - pixxel 5y ago
    Stop with this seatbelt analogy. At least until the government demands you start ingesting them.
- adrianN 5y ago
  If you write it in permille the differences appear even smaller. But if you look at the actual number of people who will die if we keep the pandemic going and don't get the vaccination rates up, the difference is suddenly in the millions of people.
- zamfi 5y ago
  …in just one given week, though. And that week was not so bad; in January we had case rates many multiples higher. But maybe if you count infections per second, instead of per week, you can get a number so close to 100% not dead that it’s a rounding error: pandemic solved!

throwawaysea 5y ago

A couple questions for those who might know: 1. Slide 16 mentions India but the details aren't clear. Is this study's focus on breakthrough cases and spreading of Delta based off data in India? I know India was where Delta originated and that it blindsided them because COVID measures that worked well for previous variants did not work anymore - so does that simply mean that the most data on Delta happens to be in India due to the larger cumulative number of Delta cases there? And if so how applicable is that data to the US, given that the type of vaccine administered is different and may have different (reduced) efficacy compared to Pfizer or Moderna, and since other factors (population size, density, healthcare quality, etc) may also be different and influence the data? 2. The graphs on Slides 20-21 are unclear to me. My interpretation is that they have four different scenarios and are using the bottom-left one, which assumes a higher R0 representing the Delta variant, and a lower assumption of natural immunity of 5% - basically the more conservative outlook. The graph itself seems to be indicating a probability of increase in cases, and we presumably want to be below 0.5. The legend shows three colors for universal masking, masking of the unvaccinated, and no masking. But the graph itself has five color bands - are the other color bands just hybrids? So the color between beige and lilac represents some vaccinated people masking and all unvaccinated people masking? And no masking is not an option per this graph even at 100% vaccination, because the probability of cases increasing would be around 80% still? If the natural immunity is higher (the bottom-right graph), then there is no need for universal masking in nearly all levels of vaccination? Am I interpreting all that correctly?

_Microft 5y ago
The colored bands seem to be semi-transparent, so all can be shown in the same graph instead of having to show an own one for each of them (i.e. it is purely a display problem where the bands overlap).

X6S1x6Okd1st 5y ago

page 18 seems to be indicating that Delta is ~2x more likely to have all of the bad outcomes relative to ancestral strain. That combined with how much more infectious this is makes it truly worrying. One interpretation of the fact that Israel has such different numbers on vaccine effectiveness is that effectiveness starts dropping ~6 months in. We'll need to start doing 3rd shots for lots of people ~now.

koheripbal 5y ago
2x the extremely low rate for vaccinated people is still very low - hence the extra efforts needed to vaccinate people.
- X6S1x6Okd1st 5y ago
  Yes, it's important, in the US we are largely demand constrained, however globally we are supply constrained. IMO the world just got a lot darker.

sbierwagen 5y ago

Slide 20: >Given increased transmissibility, lower VE, and current vaccine coverage, NPIs needed to reduce transmission of Delta variant >Masking: >• Source control 40-60% effective >• Personal protection 20-30% effective >NO ADJUSTMENTS FOR OTHER INTERVENTIONS >• e.g., no distancing, no isolation, no gathering restrictions I'm... not sure about that? Delta is infecting people who just walk past each other in indoor spaces: https://www.wsj.com/articles/delta-variants-spread-outpaces-australias-covid-19-contact-tracers-11625045400 https://www.wsj.com/articles/delta-variants-spread-outpaces-... How can you get to 40-60% effectiveness if you have perfect mask wearing, but leave restaurants and bars open? Even wearing a N95 when going to the grocery store and post office or whatever isn't going to help if you then go to a bar and spend an hour maskless with your 100 closest unmasked friends.

SpicyLemonZest 5y ago
Restaurants and bars are open because people really want them to be, not because the CDC recommends it. The CDC offers some suggestions on how to manage the risks of opening restaurants, but there's nothing to change there because they've never revoked their early 2020 guidance that it's a big risk.
- sbierwagen 5y ago
  If there is a secret hidden footnote to "NO ADJUSTMENTS FOR OTHER INTERVENTIONS" and "no distancing, no isolation, no gathering restrictions" that reads "just kidding about that, all restaurants and bars need to be closed immediately" then this slide deck is doing a very bad job of clearly recommending what public heath interventions should be done. Again, why would they recommend universal masking if they know for a fact that it wouldn't do anything? What's the point?
  - SpicyLemonZest 5y ago
    Why hasn't the FDA approved the vaccines, when health experts universally agree they're safe and effective and everyone should get one? I always hate when conversations come to this, because it comes across as a wild hot take, but there's a point where you've just gotta blame organizational dysfunction. It wouldn't be appropriate for the CDC to say "everyone ought to close indoor dining again" or "masks are pointless if you have them off 80% of the time to eat", and they certainly can't say "let's just let the unvaccinated people get sick". So they have to say some other stuff instead.

criticaltinker 5y ago

Wow these slides are packed with information and accompanying citations - truly a great resource for anyone following the literature regarding COVID-19 and especially the variants of concern. I need more time to digest this presentation, but there are two important topics that I feel are missing or at least underrepresented: 1) The effectiveness of early outpatient treatment using a combination of existing medicines (antibiotics, corticosteroids, antiplatelet/antithrombotic) [0a] [0b] 2) The risk of vaccine induced immune escape Regarding 2) The basic idea is that imperfect vaccines may cause selective pressure which further enhances the fitness of highly virulent pathogens. This may be particularly relevant to the widely deployed mRNA vaccines, which induce an immune response that is highly targeted towards the SARS-CoV-2 spike protein. Here are some peer reviewed publications on the topic, along with a few excerpts [1][2][3][4][5][6]. To be clear, the excerpts I'm providing below do not contradict any of the major points from the presentation. However, I do hope they illustrate that there is another important dimension to discuss when evaluating the evolutionary dynamics of SARS-CoV-2. Excerpts from [1]: - "A growing body of evidence suggests that the targets of several human vaccines are evolving" - "For example, resistance to influenza and herpes-virus drugs emerged within a few years of FDA approval, and resistance to antivirals rapidly arises within human immunodeficiency virus (HIV) and hepatitis C virus (HCV)-infected patients" - "The best documented example of vaccine resistance evolution occurred in Marek’s disease, a commercially important disease of chickens caused by Marek’s disease virus (Gallid herpesvirus II). There, two generations of vaccines were undermined by viral evolution. Those vaccines prevented disease, but even before the pathogen evolved, they did not prevent viral infection, replication, or transmission. Instead, Marek’s disease virus reached large population sizes even within vaccinated hosts and was able to transmit to new hosts. As a result, the virus was likely able to generate genetic diversity within vaccinated hosts, and vaccine-induced selection was able to act during transmission between hosts. The benefits of prophylaxis were thus missing." Excerpts from [2]: - "Here we show experimentally that immunization of chickens against Marek's disease virus enhances the fitness of more virulent strains, making it possible for hyperpathogenic strains to transmit. Immunity elicited by direct vaccination or by maternal vaccination prolongs host survival but does not prevent infection, viral replication or transmission, thus extending the infectious periods of strains otherwise too lethal to persist. Our data show that anti-disease vaccines that do not prevent transmission can create conditions that promote the emergence of pathogen strains that cause more severe disease in unvaccinated hosts." Excerpts from [3]: - "The spike protein receptor-binding domain (RBD) of SARS-CoV-2 is the molecular target for many vaccines and antibody-based prophylactics aimed at bringing COVID-19 under control." - "Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions. With the emergence of new strains of SARS-CoV-2 with altered transmissibility and immune evasion potential, a critical question is this: how easily can the virus escape neutralizing antibodies (nAbs) targeting the spike RBD?" - "Our modeling suggests that SARS-CoV-2 mutants with one or two mildly deleterious mutations are expected to exist in high numbers due to neutral genetic variation, and consequently resistance to vaccines or other prophylactics that rely on one or two antibodies for protection can develop quickly -and repeatedly- under positive selection." - "Strategies for viral elimination should therefore be diversified across molecular targets and therapeutic modalities" - "The speed at which nAb resistance develops in the population increases substantially as the number of infected individuals increases, suggesting that complementary strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) or that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification) are key to reducing the risk of immune escape" Excerpts from [4]: - "... evidence for vaccine-induced disease evolution is mounting for many diseases ..." - "... vaccines can reduce parasite fitness by preventing infection, reducing within-host growth, or preventing transmission. These have been shown to have very different evolutionary consequences for parasite virulence evolution" - "Vaccines which reduce within-host growth rates are predicted to increase virulence" - "Infection with multiple strains of the same parasite can result from separate infection events of co-circulating strains, or because the parasite has a rapid mutation rate and generates strain diversity through mutation within the host. Biologically, distinctions between ‘types’ of multiple infection matter because they affect the relatedness of the co-infecting parasites and relatedness can influence the optimal virulence strategy for the parasite" [0a] Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection (2020) https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltext https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltex... [0b] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) (2020) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1139&context=infectiousdiseases_articles https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a... [1] Why does drug resistance readily evolve but vaccine resistance does not? (2017) https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2016.2562 https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2016... [2] Imperfect Vaccination Can Enhance the Transmission of Highly Virulent Pathogens (2015) https://journals.plos.org/plosbiology/article?id=10.1371%2Fjournal.pbio.1002198 https://journals.plos.org/plosbiology/article?id=10.1371%2Fj... [3] Risk of rapid evolutionary escape from biomedical interventions targeting SARS-CoV-2 spike protein (April 2021) https://pubmed.ncbi.nlm.nih.gov/33909660/ https://pubmed.ncbi.nlm.nih.gov/33909660/ [4] The adaptive evolution of virulence: a review of theoretical predictions and empirical tests (2015) https://www.cambridge.org/core/services/aop-cambridge-core/content/view/30EC8AB1717BF7A173CF5E051DBB498F/S003118201500092Xa_hi.pdf/_div_class__title__The_adaptive_evolution_of_virulence__a_review_of_theoretical_predictions_and_empirical_tests__div_.pdf https://www.cambridge.org/core/services/aop-cambridge-core/c... [5] The phylogenomics of evolving virus virulence (2018) https://www.nature.com/articles/s41576-018-0055-5 https://www.nature.com/articles/s41576-018-0055-5 [6] Monitor for COVID-19 vaccine resistance evolution during clinical trials (Nov 2020) https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001000 https://journals.plos.org/plosbiology/article?id=10.1371/jou...

smaryjerry 5y ago

Delta is getting a crazy amount of press but for some reason most articles don’t show any of the articles stats. For instance rather than show cases or deaths, they show “percent of cases that are delta.” Here is the CDC chart showing cases and deaths by group. https://covid.cdc.gov/covid-data-tracker/#demographicsovertime https://covid.cdc.gov/covid-data-tracker/#demographicsoverti... Cases are increasing but even case increase is a tiny blip compared to winter. Cases have always been a poor metric to judge the pandemic as it doesn’t indicate the severity of the infection. Filter the graph by deaths and we can see COVID deaths have still yet to increase even a tiny amount from their already extremely low levels after vaccinations become mainstream. Yes there is a lag time between death and cases but that lag time is only two weeks.

seriousquestion 5y ago
Careful, I got buried by the downvote and flag brigade for pointing that out.
Exmoor 5y ago
> Cases are increasing but even case increase is a tiny blip compared to winter. If you look at the US as a whole cases are not are still well below the worst daily averages of last Christmas, but blip is a much stronger word than I'd use when the trend line is pointed up with no obvious end in sight. Drill down on the individual states with the most issues and you'll see that places like Louisiana are basically at the same point as they were in winter and will likely far exceed it. As you say, the fact that most of the most vulnerable age ranges have been vaccinated will certainly help the death tolls. The flip side of that, however, is that a much higher concentration of the deaths in those states are going to be younger individuals.
- smaryjerry 5y ago
  True cases are equal in some areas like Louisiana and Florida. Florida is completely open with the worst possible scenario of practically no masks, low vaccine rates, and enormous crowds but has only 1.4 weekly deaths per 100,000, low but above the national average of .5 weekly deaths per 100,000. Compare this with deaths from all other causes which average about 16 weekly deaths per 100,000. So yea we have a problem but at the current rate you are more likely to die from a stroke than COVID. You are about half as likely to die by suicide. You are about 6 times as likely to die from heart disease than COVID. I’m just saying there are other things to be afraid of and focus on than the pandemic.

jpster 5y ago

If vaxxed people are still getting infected and transmitting Delta at similar rates as unvaxxed, then the reasons for getting vaxxed are: - lower your own chances of symptomatic disease, severe illness, hospitalization and death - and therefore, help keep the healthcare system from collapsing

X6S1x6Okd1st 5y ago
They aren't though.
- deleted 5y ago
  [deleted]
- jpster 5y ago
  Headline on Slide 17 in the deck: Delta variant vaccine breakthrough cases may be as transmissible as unvaccinated case
  - lostmsu 5y ago
    It does not confirm your point. It says roughly "if a vaxxed and unvaxxed people are equally sick (e.g. same strength of symptoms), they transmit equally". However, vaxxed people get sick ~20x less, so they transmit ~20x less overall. (20x is a bad estimate here, taken from efficiency against hospitalizations)
    - deleted 5y ago
      [deleted]
    - jpster 5y ago
      Not sure how you’re arriving at this translation of what’s on the slide. Can you explain?
      - lostmsu 5y ago
        > No difference in mean Ct values in vaccinated and unvaccinated cases This refers to registered cases. Registered cases ~ symptomatic cases above certain threshold of symptoms (e.g. if you only have running nose or no symptoms whatsoever, you won't report anything). Suppose you have two separate groups of 100 people, one with all vaccinated, other with none vaccinated. In each, 1 member is sick and gets in contact with everyone. In unvaxxed group, say, you get 20 symptomatic cases, 30 asymptomatic cases, and 50 are lucky. In a vaxxed group (an example), you get 3 symptomatic cases, 10 asymptomatic cases, and 87 are lucky. Now according to my understanding the slide statement above applied to this though experiment says that every one in the 20 symptomatic cases from unvaxxed group has the same chance (individually) to transmit, as everyone of the 3 symptomatic cases of vaxxed group. But because vaxxed group has 6x less people on stage 2 who could transmit further, overall transmission rate is also almost 6x lower. E.g. the statement talks about sending chances, and not receiving chances. And overall transmission depends on both.