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Well, I'm not flying to Vietnam tomorrow, so I'm not claiming I personally need a booster shot. However: - Vietnam is an epicenter right now, so my odds of ca

by blagie 5y ago

Well, I'm not flying to Vietnam tomorrow, so I'm not claiming I personally need a booster shot. However: - Vietnam is an epicenter right now, so my odds of catching COVID would be high. - They are well beyond hospital capacity, so if I do have a serious case, it's uncertain I'll receive quality care (and if I do, I'm taking a bed from someone else) We don't have full data, so the right way to think about this is with expected outcomes based on best available data. Best available data, in this scenario, places the likely reduction of risks of COVID19 as a much greater risk reduction than any potential risk of vaccines: - We do have multiple studies about how immunity wanes over time from vaccination. Those provide better ground-truth data than theoretical arguments. - We also have some estimates of breakthrough rates, and severity of infection We don't have good data on long COVID post-vaccine, so that's a place we need to make an educated guess and rely on theoretical arguments. You can plug whatever sane numbers you want, but in this scenario -- humanitarian work in an epicenter with limited hospital capacity -- a booster shot makes sense. For other scenarios -- for example general population -- whether a booster makes sense is still often within the very large error bars of the limited data, and reasonable people can disagree, much as the authors of the Lancet article and the CDC currently do. Once more data rolls in, we'll know.

theptip 5y ago
Mostly in agreement - I would note that the Lancet article gives a few arguments with citations as to why the vaccine efficacy decreases might be statistical artifacts, and so I think you may be a little over-confident on your bullet there. But I agree that there is data on both sides, and strongly agree with your general approach of accounting for the possibility that vaccine efficacy could be waning in your risk model and updating behavior accordingly.
LurkingPenguin 5y ago
> We do have multiple studies about how immunity wanes over time from vaccination. Those provide better ground-truth data than theoretical arguments. I believe the studies you're referring to are those that address efficacy against symptomatic infection, not severe illness. Unless you're in a high-risk group because of age or comorbidities, with two doses of an mRNA vaccine within the past 8 months, to my knowledge all studies to date indicate that the average person's protection against severe illness and hospitalization is exceedingly high. This is probably related to the T and B cell immunity created by your body's response to the vaccines, which are more difficult to measure than antibody titers. I traveled to/from a hotzone in Asia at the beginning of the pandemic and from Asia to the US and back to get vaccinated. My opinion as an expat and avid traveler is that if you have any concerns about your ability to receive adequate care in the case that you get sick, you should reconsider travel at this time. Since the vaccines clearly do not provide sterilizing immunity and everyone's immune response is different, there really are no guarantees, especially if you're going to be in environments where your exposure is high (both in terms of number of contacts and contacts that could lead to exposure of high viral loads).
- paulmd 5y ago
  This is my clear (amateur) conclusion as well. The exposure amount and dose varies, exposure in high-density hot zones is high risk and the cumulative dose does seem to pose some additional risk, as does the risk that you may not be able to receive a high level of clinical care in various areas. I'm not necessarily talking about adventures in southeast asia there either.
- blagie 5y ago
  Now we're getting into value systems. - How much do you value your life? - How much do you value the trip? - How much do you worry about spending two weeks in a hospital? - How much do you mind memory lapses and brain fog from long COVID? From what you wrote, it's clear we have at least somewhat different value systems. Since you're an avid traveler, you should realize that's good, common, and healthy.
  - LurkingPenguin 5y ago
    The subtle implication of your comment seems to be that I value my life and health less than you do? If so, I think that's unfair. But I'm happy to roll with it. If, in the face of substantial evidence that two doses of one of the mRNA vaccines remain highly effective at preventing hospitalization and death 8 months on, you still cannot tolerate the potential that you could end up in a hospital in a developing country, suffer from long COVID following infection and/or die, logic dictates that you should reconsider travel. You might strongly believe or suspect that a booster will provide meaningful additional protection to you, but the ongoing booster debate reflects the fact that at the current time, there is no conclusive proof that a booster will definitely reduce risk in healthy already vaccinated individuals, nor has any potential risk reduction that booster proponents believe exists been conclusively quantified. Put simply, just because one believes that they have meaningfully increased protection from a booster does not necessarily mean that they actually do. Science will eventually tell us but the data isn't in yet.
    - blagie 5y ago
      I don't think you've traveled so much if you think that's the implication, or at least not for long enough to soak in how values differ between cultures. No. That's not the implication. I don't know you well enough to tell you what the differences in our value systems are. Since you do ask, if I were to speculate, I would guess you value your life and comfort more than I value mine. I was never fearful of dying of COVID, or of hospitalization, even pre-vax. Americans place an exceptionally high value on their own life and comfort relative to most cultures. I've also been in several hospitals in developing countries, and that's also not something which has really concerned me. On the other hand, I suspect I am much more concerned about long COVID than you are. And no, we don't know much for sure about COVID, but we have to work from best available evidence. If there's e.g. a 50% chance that a booster shot increases protection from 30% breakthroughs to 15%, and a 50% chance it does nothing, that means I've reduced my odds of breakthrough by (30-15)*50% = 7.5%.
NoPie 5y ago
I think you are trying to overanalyse and overrule the experts here. Experts are saying that with the regards to the whole population currently community wide booster shots are not needed. It may not apply to each individual case (such as immunocompromised etc., or people with very specific risk, like those going to Vietnam) but this was never to be meant an individual assessment. Many people are confusing these two things. Even though it does not apply for majority of readers, trying to imagine a different situation for a specific individual is not necessary.
- blagie 5y ago
  That's unfair. I'm trying to overrule bad reporting, not experts. The experts made a nuanced point which seemed reasonable, and the reporters screwed it up.
lucideer 5y ago
> Vietnam is an epicenter right now, so my odds of catching COVID would be high. ho chi minh is an "epicenter" according to Vietnamese authorities (who have always taken a much stricter, "zero-covid-adjacent" approach to managing covid). While there is always risk, the case-rate is roughly the same as Germany & France (neither of which are in lockdown) & much lower than other western states like the US & UK. The entire country is in lockdown because this is an all-time high by Vietnamese standards (Vietnam have fared similarly to NZ in terms of case-rates before now), despite case-rate in e.g. Ha Noi being low, further mitigating risk factors. So no I don't think the odds of catching it would be significantly higher than wherever you currently reside, unless your humanitarian work is specifically treating covid patients, in which case of course you should get a booster but the destination country is completely irrelevant. Points about hospital capacity are obviously still relevant, but that's not necessarily going to be impacted by boosters as much as vaccination in general: full vaccination rate in Vietnam is only ~5% due to supply issues that are only exacerbated by over-subscription to boosters in western states.
matz1 5y ago
The odds of catching covid is high but the chance you are going to need hospitalization due to covid are very low. It doesn't make sense to lose the benefit gained from the humanitarian work just because the very low chance becoming seriously sick from covid.

by blagie 5y ago

theptip 5y ago

Mostly in agreement - I would note that the Lancet article gives a few arguments with citations as to why the vaccine efficacy decreases might be statistical artifacts, and so I think you may be a little over-confident on your bullet there. But I agree that there is data on both sides, and strongly agree with your general approach of accounting for the possibility that vaccine efficacy could be waning in your risk model and updating behavior accordingly.

LurkingPenguin 5y ago

> We do have multiple studies about how immunity wanes over time from vaccination. Those provide better ground-truth data than theoretical arguments. I believe the studies you're referring to are those that address efficacy against symptomatic infection, not severe illness. Unless you're in a high-risk group because of age or comorbidities, with two doses of an mRNA vaccine within the past 8 months, to my knowledge all studies to date indicate that the average person's protection against severe illness and hospitalization is exceedingly high. This is probably related to the T and B cell immunity created by your body's response to the vaccines, which are more difficult to measure than antibody titers. I traveled to/from a hotzone in Asia at the beginning of the pandemic and from Asia to the US and back to get vaccinated. My opinion as an expat and avid traveler is that if you have any concerns about your ability to receive adequate care in the case that you get sick, you should reconsider travel at this time. Since the vaccines clearly do not provide sterilizing immunity and everyone's immune response is different, there really are no guarantees, especially if you're going to be in environments where your exposure is high (both in terms of number of contacts and contacts that could lead to exposure of high viral loads).

paulmd 5y ago
This is my clear (amateur) conclusion as well. The exposure amount and dose varies, exposure in high-density hot zones is high risk and the cumulative dose does seem to pose some additional risk, as does the risk that you may not be able to receive a high level of clinical care in various areas. I'm not necessarily talking about adventures in southeast asia there either.
blagie 5y ago
Now we're getting into value systems. - How much do you value your life? - How much do you value the trip? - How much do you worry about spending two weeks in a hospital? - How much do you mind memory lapses and brain fog from long COVID? From what you wrote, it's clear we have at least somewhat different value systems. Since you're an avid traveler, you should realize that's good, common, and healthy.
- LurkingPenguin 5y ago
  The subtle implication of your comment seems to be that I value my life and health less than you do? If so, I think that's unfair. But I'm happy to roll with it. If, in the face of substantial evidence that two doses of one of the mRNA vaccines remain highly effective at preventing hospitalization and death 8 months on, you still cannot tolerate the potential that you could end up in a hospital in a developing country, suffer from long COVID following infection and/or die, logic dictates that you should reconsider travel. You might strongly believe or suspect that a booster will provide meaningful additional protection to you, but the ongoing booster debate reflects the fact that at the current time, there is no conclusive proof that a booster will definitely reduce risk in healthy already vaccinated individuals, nor has any potential risk reduction that booster proponents believe exists been conclusively quantified. Put simply, just because one believes that they have meaningfully increased protection from a booster does not necessarily mean that they actually do. Science will eventually tell us but the data isn't in yet.
  - blagie 5y ago
    I don't think you've traveled so much if you think that's the implication, or at least not for long enough to soak in how values differ between cultures. No. That's not the implication. I don't know you well enough to tell you what the differences in our value systems are. Since you do ask, if I were to speculate, I would guess you value your life and comfort more than I value mine. I was never fearful of dying of COVID, or of hospitalization, even pre-vax. Americans place an exceptionally high value on their own life and comfort relative to most cultures. I've also been in several hospitals in developing countries, and that's also not something which has really concerned me. On the other hand, I suspect I am much more concerned about long COVID than you are. And no, we don't know much for sure about COVID, but we have to work from best available evidence. If there's e.g. a 50% chance that a booster shot increases protection from 30% breakthroughs to 15%, and a 50% chance it does nothing, that means I've reduced my odds of breakthrough by (30-15)*50% = 7.5%.

NoPie 5y ago

I think you are trying to overanalyse and overrule the experts here. Experts are saying that with the regards to the whole population currently community wide booster shots are not needed. It may not apply to each individual case (such as immunocompromised etc., or people with very specific risk, like those going to Vietnam) but this was never to be meant an individual assessment. Many people are confusing these two things. Even though it does not apply for majority of readers, trying to imagine a different situation for a specific individual is not necessary.

blagie 5y ago
That's unfair. I'm trying to overrule bad reporting, not experts. The experts made a nuanced point which seemed reasonable, and the reporters screwed it up.

lucideer 5y ago

> Vietnam is an epicenter right now, so my odds of catching COVID would be high. ho chi minh is an "epicenter" according to Vietnamese authorities (who have always taken a much stricter, "zero-covid-adjacent" approach to managing covid). While there is always risk, the case-rate is roughly the same as Germany & France (neither of which are in lockdown) & much lower than other western states like the US & UK. The entire country is in lockdown because this is an all-time high by Vietnamese standards (Vietnam have fared similarly to NZ in terms of case-rates before now), despite case-rate in e.g. Ha Noi being low, further mitigating risk factors. So no I don't think the odds of catching it would be significantly higher than wherever you currently reside, unless your humanitarian work is specifically treating covid patients, in which case of course you should get a booster but the destination country is completely irrelevant. Points about hospital capacity are obviously still relevant, but that's not necessarily going to be impacted by boosters as much as vaccination in general: full vaccination rate in Vietnam is only ~5% due to supply issues that are only exacerbated by over-subscription to boosters in western states.

matz1 5y ago

The odds of catching covid is high but the chance you are going to need hospitalization due to covid are very low. It doesn't make sense to lose the benefit gained from the humanitarian work just because the very low chance becoming seriously sick from covid.