14 ms·

> This is a really good article on the immune system. I still don't particularly like it that much. None of this should be all that new. There were plenty o

> This is a really good article on the immune system. I still don't particularly like it that much. None of this should be all that new. There were plenty of knowledgeable people saying all along that sterilizing nutralizing immunity in the mucosa was unlikely to be achievable for a vaccine against a respiratory virus that most commonly had no viremic phase, particularly as a shot given in the arm. They were also saying that T-cells were the important thing to prevent disease and death and we shouldn't be focusing on preventing infection. Some other people who debated or disagreed with that perspective are now suddenly learning novel new things about the immune system. There's a good chunk of experts out there that were saying this all along though (if you were listening to them and not the headlines and blogs and twitter).

Vrondi 5y ago
You are quite right, but the media, the government, and many public health agencies have been ignoring this, focusing solely on antibody levels, and trying to keep them constantly high through ever more panicky calls for more and more boosters. For everyone, regardless of prior infection.
- f6v 5y ago
  Because some times you have to make a call. Some studies are now revealing that booster shots might be less effective in those who recovered (watched a guy present his unpublished data the other day). But it’s not that obvious.
- kurthr 5y ago
  This is for two reasons: One, measuring antibodies is MUCH easier than measuring T or B cell response. This is especially true early on in the pandemic, if you want to measure representative numbers of people, and you don't know when/whether they will be exposed or catch COVID (due to masking/lockdowns etc). Two, when your problem is that the hospitals are filling up and you're facing a labor shortage for some essential workers for a a few months... then boosting antibodies for 4-6 months to reduce retransmission rates and minimizing symptomatic cases makes a lot of sense.
  - eecc 5y ago
    So it's another case of KPI overfitting? Goodhart's law?
  - headsoup 5y ago
    Not really, when you look at where things ended up anyway, aside the issues with pumping up antibodies continuously. Another case of going for short term efficiency wins over doing things properly, but not so easily.
  - nradov 5y ago
    That was never a valid reason. They were just making things up without following evidence-based medicine practices. https://peterattiamd.com/covid-19-current-state-omicron/ https://peterattiamd.com/covid-19-current-state-omicron/
    - kurthr 5y ago
      I don't understand who your "they" is. In my opinion there were valid reasons for both decisions on antibodies and boosters. Since I know one of the people in your linked podcast, I will not comment on it.
      - nradov 5y ago
        No that's simply wrong. Antibodies are relatively unimportant and levels decline quickly. What actually matters far more is cellular immunity. Fortunately the vaccines and recovery from infection have both been shown to produce a significant level of durable cellular immunity in the vast majority of patients. Who do you personally know in the linked podcast? What are your medical qualifications? https://peterattiamd.com/covid-part2/ https://peterattiamd.com/covid-part2/
        EdwardDiego 5y ago
        Feel like that's a bit of a rude question to ask.
  - 5y ago
- YZF 5y ago
  Israel was one of the first place to boost (the first?) and I think the rationale there was not just about antibody levels. There were multiple factors. The emergence of Delta which to some extent bypassed the previous two vaccine doses. The decline in protection against severe disease over time (and specifically against delta). And yes, even temporary control of the community spread (which is maybe the more questionable aspect) to allow the country to remain more or less open while keeping hospital load and deaths under control. In Israel I also believe there is different policy for people that have been infected. This varies from place to place. Determining whether someone was or wasn't previous infected isn't that simple. You can do it if you have good contract tracing, testing, and more centralized health services like Israel does. Also many places didn't have a large enough portion of the population get infected in the first place so maybe not worth worrying too much about.
  - throwaway48375 5y ago
    I don't see how it is so hard. Every positive PCR gets reported to the local health department which reports it to the state DPH. If the state can use this data to send me a letter asking me to donate convalescent plasma surely they could add this information to their digital covid passport.
    - YZF 5y ago
      I think if the data is available it is perfectly reasonable, and even expected, to consider it. Like they do in Israel. I can't really comment on the US in this regard but I'd agree with you that if they can they should... Right now where I am (Canada) they don't even bother testing you unless you're at risk, so nobody knows...
deleted 5y ago
[deleted]
xupybd 5y ago
It's new to me. Sometimes it's nice to have an article rehash old knowledge and bring it into the current context. If for nothing other than to educate the ignorant like me.
- lamontcg 5y ago
  But the way it is written sounds like nobody on Planet Earth could have possibly predicted this and that the way B-cells and T-cells work is completely novel discoveries in 2022. There were people saying this is roughly would happen in mid-2020. Tony Fauci was saying he'd be happy if the VE against disease was only 50% in Fall 2020. He was trying to set expectations to about where we are right now. It gives the wrong impression to people who don't know anything about it and it undermines the vaccine messaging strategy. There's a stronger message that virologists and epidemiologists who were specialists in this kind of thing were grounded mostly in reality all along and THIS WAS THE PLAN AND THE PLAN IS WORKING. By claiming that we're radically learning new things it sounds like the whole thing was a clusterfuck. Getting a vaccine with around 50% efficacy against disease and 90% efficacy against hospitalization was always the winning strategy. We were just supposed to hit 80%-90% vaccination rates at least and the low vaccination rates are meaning that the Omicron wave was more of a burden on hospitals than it ever needed to be. What went wrong is that the vaccine trials were cut short. People who complain about that usually try to argue we cut short the "long term safety" outcome, which is nonsense because vaccine side effects are autoimmune conditions that either start turning up in a population 3 months after dosing or they don't. What we actually cut short was the _durability_ outcomes of the trials since that was the thing that would have taken 2 years and we didn't have the time. Turns out the headline 90% VE against infection numbers weren't durable but the damage was done once they made the initial headline splash and everyone entirely forgot that Fauci was setting expectations down around 50% beforehand. Then they felt they were lied to. Now they feel like the vaccine program was a failure. We're now back on track to the original plan, and its viewed as being a failure because the phase III results jacked the expectations up to the mRNA vaccines being magicsauce that would instantly end the whole pandemic. This article is still selling it like this is sort of Plan B in response to information that we could never have anticipated. Instead we're back on what was Plan A all along after the hypecycle got blown away by waning immunity and Delta and Omicron.
ssl232 5y ago
> There were plenty of knowledgeable people saying all along that sterilizing nutralizing immunity in the mucosa was unlikely to be achievable for a vaccine against a respiratory virus that most commonly had no viremic phase, particularly as a shot given in the arm. You are absolutely right, this has been my experience too. Pointing out what you did about (lack of) sterilising and (importance of) mucosal immunity usually got you downvoted here up until recently. It doesn't matter what your political persuasion is (I am, or at least I was, going into the pandemic, a left liberal), the idea that the vaccines would end the pandemic if only enough people got 1, 2, 3 or more doses was gaslighting from the beginning, probably arising from flippant remarks from politicians when asked for target dates to lift lockdown restrictions - "when X% are vaccinated!". And the idea that this was never what was being said about them this time last year is also gaslighting that's happening right now. The problem is that this is a very nuanced subject. Everyone thinks they know what's going on, because they've been told it's simple: get vaccinated/boosted, work from home and do as we say and this will all be over. Much of the data being used to justify this was one or more of badly collected, badly analysed or badly interpreted by dishonest politicians, journalists, scientists and members of the public pushing their own (or their bosses') agendas. Instead of opponents' arguments being heard and countered in public ("sunlight is the best disinfectant"), they have been deplatformed under the auspices of "public safety". Scientists have lost their jobs for saying something to counter the narrative - it has become illegal to disagree with the scientists the politicians listen to, under punishment of losing your livelihood. It has been a total shitshow that has exposed how corrupt the whole system is. It has made me quite depressed at how little we've apparently learned since the last century. I thought we were living in the age of science, but what we have right now is far, far from it; maybe we should call it the age of misinformation - driven by humans' psychological maladaptation to their own incredible invention, the internet.
- spookthesunset 5y ago
  Couldn't have said it better. When I had multiple smart people I knew in real life yelling what amounts to word salad at me about how I'm so misguided and horrible for asking basic questions about the data... ...that is when I knew this whole thing was gonna last a long time and devolve into a complete shitshow. If people were allowed to express critical opinions and the general public was made aware of the actual numbers regarding covid risk we would have never done any of the things we did over the last two years. These anointed "experts" still have not told people to chill the fuck out about covid and children. We have two years of publicly available data saying they are at virtually no risk. Yet the CDC and Fauci both act like covid is some kind of grave danger to children. Dig deep enough into most of the pro-"what we've done"'s arguments and they are nothing more than thinly disguised appeals to authority.
mrjangles 5y ago
It was just common sense. Flu vaccines have never been much more than 50% effective. The idea that you can just vaccinate against such a hugely virulent virus like COVID, and expect it to stop spreading with such ineffectual vaccines just made no mathematical sense what so ever. If people didn't understand that it is because they didn't want to.
- spookthesunset 5y ago
  > If people didn't understand that it is because they didn't want to. "Listen to the experts". The experts never said any of that. Nor did the media. Critical thinking has been shunned the last two years. I mean you can think critically but lord help you if you say what you think online or in person. It's the in person bullying that is the worst, by the way.
  - chrononaut 5y ago
    > or in person Interestingly I think all conversations that I have had in-person, with someone or a group of people I know, have been civil. In fact the only times where I was able to have healthy discussions were in-person. Healthy online discussions with people I know in the real world? Nope. Healthy online discussions with people I don't know in the real world? Doubly nope.
    - spookthesunset 5y ago
      I’ve been yelled at by almost everybody I know for even asking if what we are doing in reaction to Covid will harm us more than Covid. Literally yelled at. Yon should consider yourself lucky.
jerry1979 5y ago
> we shouldn't be focusing on preventing infection. I'm confused by what you mean. I have read headlines that say mRNA vaccines reduce the risk of infection by 91%, but it seems like you have more nuanced information from knowledgeable people. So, who should I look to to get the "real" information about what to expect from vaccines and public health? [0] https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-risks.html https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-ri...
- _0ffh 5y ago
  I think these were measured shortly after reaching full vaccination status (>=14 days after second shot). That seems to be a different thing than, say, six months after vaccination.
- the_doctah 5y ago
  It would be neat to see the same study ran against Omicron with people who were vaccinated 18 months ago. You know, to mirror actual reality.

Vrondi 5y ago

You are quite right, but the media, the government, and many public health agencies have been ignoring this, focusing solely on antibody levels, and trying to keep them constantly high through ever more panicky calls for more and more boosters. For everyone, regardless of prior infection.

f6v 5y ago
Because some times you have to make a call. Some studies are now revealing that booster shots might be less effective in those who recovered (watched a guy present his unpublished data the other day). But it’s not that obvious.
kurthr 5y ago
This is for two reasons: One, measuring antibodies is MUCH easier than measuring T or B cell response. This is especially true early on in the pandemic, if you want to measure representative numbers of people, and you don't know when/whether they will be exposed or catch COVID (due to masking/lockdowns etc). Two, when your problem is that the hospitals are filling up and you're facing a labor shortage for some essential workers for a a few months... then boosting antibodies for 4-6 months to reduce retransmission rates and minimizing symptomatic cases makes a lot of sense.
- eecc 5y ago
  So it's another case of KPI overfitting? Goodhart's law?
- headsoup 5y ago
  Not really, when you look at where things ended up anyway, aside the issues with pumping up antibodies continuously. Another case of going for short term efficiency wins over doing things properly, but not so easily.
- nradov 5y ago
  That was never a valid reason. They were just making things up without following evidence-based medicine practices. https://peterattiamd.com/covid-19-current-state-omicron/ https://peterattiamd.com/covid-19-current-state-omicron/
  - kurthr 5y ago
    I don't understand who your "they" is. In my opinion there were valid reasons for both decisions on antibodies and boosters. Since I know one of the people in your linked podcast, I will not comment on it.
    - nradov 5y ago
      No that's simply wrong. Antibodies are relatively unimportant and levels decline quickly. What actually matters far more is cellular immunity. Fortunately the vaccines and recovery from infection have both been shown to produce a significant level of durable cellular immunity in the vast majority of patients. Who do you personally know in the linked podcast? What are your medical qualifications? https://peterattiamd.com/covid-part2/ https://peterattiamd.com/covid-part2/
      - EdwardDiego 5y ago
        Feel like that's a bit of a rude question to ask.
- 5y ago
YZF 5y ago
Israel was one of the first place to boost (the first?) and I think the rationale there was not just about antibody levels. There were multiple factors. The emergence of Delta which to some extent bypassed the previous two vaccine doses. The decline in protection against severe disease over time (and specifically against delta). And yes, even temporary control of the community spread (which is maybe the more questionable aspect) to allow the country to remain more or less open while keeping hospital load and deaths under control. In Israel I also believe there is different policy for people that have been infected. This varies from place to place. Determining whether someone was or wasn't previous infected isn't that simple. You can do it if you have good contract tracing, testing, and more centralized health services like Israel does. Also many places didn't have a large enough portion of the population get infected in the first place so maybe not worth worrying too much about.
- throwaway48375 5y ago
  I don't see how it is so hard. Every positive PCR gets reported to the local health department which reports it to the state DPH. If the state can use this data to send me a letter asking me to donate convalescent plasma surely they could add this information to their digital covid passport.
  - YZF 5y ago
    I think if the data is available it is perfectly reasonable, and even expected, to consider it. Like they do in Israel. I can't really comment on the US in this regard but I'd agree with you that if they can they should... Right now where I am (Canada) they don't even bother testing you unless you're at risk, so nobody knows...

deleted 5y ago

[deleted]

xupybd 5y ago

It's new to me. Sometimes it's nice to have an article rehash old knowledge and bring it into the current context. If for nothing other than to educate the ignorant like me.

lamontcg 5y ago
But the way it is written sounds like nobody on Planet Earth could have possibly predicted this and that the way B-cells and T-cells work is completely novel discoveries in 2022. There were people saying this is roughly would happen in mid-2020. Tony Fauci was saying he'd be happy if the VE against disease was only 50% in Fall 2020. He was trying to set expectations to about where we are right now. It gives the wrong impression to people who don't know anything about it and it undermines the vaccine messaging strategy. There's a stronger message that virologists and epidemiologists who were specialists in this kind of thing were grounded mostly in reality all along and THIS WAS THE PLAN AND THE PLAN IS WORKING. By claiming that we're radically learning new things it sounds like the whole thing was a clusterfuck. Getting a vaccine with around 50% efficacy against disease and 90% efficacy against hospitalization was always the winning strategy. We were just supposed to hit 80%-90% vaccination rates at least and the low vaccination rates are meaning that the Omicron wave was more of a burden on hospitals than it ever needed to be. What went wrong is that the vaccine trials were cut short. People who complain about that usually try to argue we cut short the "long term safety" outcome, which is nonsense because vaccine side effects are autoimmune conditions that either start turning up in a population 3 months after dosing or they don't. What we actually cut short was the _durability_ outcomes of the trials since that was the thing that would have taken 2 years and we didn't have the time. Turns out the headline 90% VE against infection numbers weren't durable but the damage was done once they made the initial headline splash and everyone entirely forgot that Fauci was setting expectations down around 50% beforehand. Then they felt they were lied to. Now they feel like the vaccine program was a failure. We're now back on track to the original plan, and its viewed as being a failure because the phase III results jacked the expectations up to the mRNA vaccines being magicsauce that would instantly end the whole pandemic. This article is still selling it like this is sort of Plan B in response to information that we could never have anticipated. Instead we're back on what was Plan A all along after the hypecycle got blown away by waning immunity and Delta and Omicron.

ssl232 5y ago

> There were plenty of knowledgeable people saying all along that sterilizing nutralizing immunity in the mucosa was unlikely to be achievable for a vaccine against a respiratory virus that most commonly had no viremic phase, particularly as a shot given in the arm. You are absolutely right, this has been my experience too. Pointing out what you did about (lack of) sterilising and (importance of) mucosal immunity usually got you downvoted here up until recently. It doesn't matter what your political persuasion is (I am, or at least I was, going into the pandemic, a left liberal), the idea that the vaccines would end the pandemic if only enough people got 1, 2, 3 or more doses was gaslighting from the beginning, probably arising from flippant remarks from politicians when asked for target dates to lift lockdown restrictions - "when X% are vaccinated!". And the idea that this was never what was being said about them this time last year is also gaslighting that's happening right now. The problem is that this is a very nuanced subject. Everyone thinks they know what's going on, because they've been told it's simple: get vaccinated/boosted, work from home and do as we say and this will all be over. Much of the data being used to justify this was one or more of badly collected, badly analysed or badly interpreted by dishonest politicians, journalists, scientists and members of the public pushing their own (or their bosses') agendas. Instead of opponents' arguments being heard and countered in public ("sunlight is the best disinfectant"), they have been deplatformed under the auspices of "public safety". Scientists have lost their jobs for saying something to counter the narrative - it has become illegal to disagree with the scientists the politicians listen to, under punishment of losing your livelihood. It has been a total shitshow that has exposed how corrupt the whole system is. It has made me quite depressed at how little we've apparently learned since the last century. I thought we were living in the age of science, but what we have right now is far, far from it; maybe we should call it the age of misinformation - driven by humans' psychological maladaptation to their own incredible invention, the internet.

spookthesunset 5y ago
Couldn't have said it better. When I had multiple smart people I knew in real life yelling what amounts to word salad at me about how I'm so misguided and horrible for asking basic questions about the data... ...that is when I knew this whole thing was gonna last a long time and devolve into a complete shitshow. If people were allowed to express critical opinions and the general public was made aware of the actual numbers regarding covid risk we would have never done any of the things we did over the last two years. These anointed "experts" still have not told people to chill the fuck out about covid and children. We have two years of publicly available data saying they are at virtually no risk. Yet the CDC and Fauci both act like covid is some kind of grave danger to children. Dig deep enough into most of the pro-"what we've done"'s arguments and they are nothing more than thinly disguised appeals to authority.

mrjangles 5y ago

It was just common sense. Flu vaccines have never been much more than 50% effective. The idea that you can just vaccinate against such a hugely virulent virus like COVID, and expect it to stop spreading with such ineffectual vaccines just made no mathematical sense what so ever. If people didn't understand that it is because they didn't want to.

spookthesunset 5y ago
> If people didn't understand that it is because they didn't want to. "Listen to the experts". The experts never said any of that. Nor did the media. Critical thinking has been shunned the last two years. I mean you can think critically but lord help you if you say what you think online or in person. It's the in person bullying that is the worst, by the way.
- chrononaut 5y ago
  > or in person Interestingly I think all conversations that I have had in-person, with someone or a group of people I know, have been civil. In fact the only times where I was able to have healthy discussions were in-person. Healthy online discussions with people I know in the real world? Nope. Healthy online discussions with people I don't know in the real world? Doubly nope.
  - spookthesunset 5y ago
    I’ve been yelled at by almost everybody I know for even asking if what we are doing in reaction to Covid will harm us more than Covid. Literally yelled at. Yon should consider yourself lucky.

jerry1979 5y ago

> we shouldn't be focusing on preventing infection. I'm confused by what you mean. I have read headlines that say mRNA vaccines reduce the risk of infection by 91%, but it seems like you have more nuanced information from knowledgeable people. So, who should I look to to get the "real" information about what to expect from vaccines and public health? [0] https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-risks.html https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-ri...

_0ffh 5y ago
I think these were measured shortly after reaching full vaccination status (>=14 days after second shot). That seems to be a different thing than, say, six months after vaccination.
the_doctah 5y ago
It would be neat to see the same study ran against Omicron with people who were vaccinated 18 months ago. You know, to mirror actual reality.