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I'm not saying there _aren't_ problems with decision-making or guidance from our public health agencies, but this article uses really different standards for ju

by abeppu 4y ago

I'm not saying there _aren't_ problems with decision-making or guidance from our public health agencies, but this article uses really different standards for judging positions taken by those agencies than it does for any dissenting position, in a way that ends up being nonsensical. Sure, let's critically evaluate the guidance put forward by our public health institutions, but quoting a statement from Norway's equivalent institution without the backing evidence doesn't make the US "wrong". If the evidence available on the efficacy of vaccines for kids is so ridiculously wide that it goes from -99% to +370% risk of infection, then surely Norway is _also_ drastically overstating its case when it says (about kids) "previous infection offers as good of protection as the vaccine against reinfection" esp since it _also_ seems like the protective effect of prior infection is both uncertain and changing. How about flatly declaring that guidance was "wrong" about school closures because minority and poor kids did markedly worse at math? Obviously these decisions are complex trade-offs, and one can't conclude that the choice was "wrong" simply by pointing out one of the costs. How about quoting a CDC scientist, who cannot possibly have strong evidence when making the prediction "CDC guidance worsened racial equity for generations to come. It failed this generation of children." Generations to come? Show us the data that lets this scientist predict the far future with such confidence. I get that it's deeply unnerving when these institutions make sweeping recommendations based on less firm data than we would normally demand. But not recommending anything, or not taking decisive action because of the limited data would _also_ have been irresponsible. When schools first closed, we didn't know a lot of things, but it would have been pretty reckless if agencies said "well this is putting a lot of people in the hospital and spreading fast, but we don't have the data to give definitive guidance yet, so you're on your own. Depending on the range of things your communities choose, maybe in a few months we'll have the evidence to say something."

rallison 4y ago
Agreed. I have a number of criticisms of the CDC, FDA and public institutions with respect to Covid, but this piece is highly biased and is misleading/wrong/cherry-picking with respect to the science. It seems the author has a general position of "interventions bad" and then works back from that to discredit anything related to interventions. For example, let's take just this single paragraph: > As of February, 75% of children in the U.S. already had natural immunity from prior infection. It could easily be over 90% of children today given how ubiquitous Omicron has been since then. The CDC’s own research shows that natural immunity is better than vaccinated immunity and a recent New England Journal of Medicine study from Israel has questioned the benefits of vaccinating previously infected persons. Many countries have long credited natural immunity towards vaccine mandates. But not the U.S. First, there's this statement: "The CDC’s own research shows that natural immunity is better than vaccinated immunity." The linked study, reading through it, makes a different claim. The study showed that completion of a course of primary vaccination PLUS having had a prior Covid infection led to reduced severe outcomes more than just having had the primary course of vaccination alone. And even there, the CI (0.27 (0.09–0.84)) on the first scenario overlaps with the CI for vaccination alone. It would be notable if this showed that prior infection alone conferred better protection than vaccination alone, which is the author's claim. This study doesn't show that. It shows infection plus vaccination confers better immunity than vaccination alone. And, well, that's what basically any expert would have predicted as the most likely result. The second linked study (the NEJM one) gets closer, but largely only looks at infection rates (it does have some commentary on severe covid-19 rates, but this isn't adjusted for any confounders). It's most useful as a study on how immunity against infection wanes since the last immunity-conferring event, although it allows for some cross comparisons, such as comparing infection rates for natural immunity alone vs 2 doses alone vs 3 doses alone vs hybrid immunity. Possibly the biggest caveat is that the rate of testing for the different cohorts wasn't adjusted for: > Although differences in testing rates among cohorts and among subcohorts within specified cohorts were observed, their overall magnitude was relatively small. The rate of PCR testing was typically lower in the recovered, unvaccinated cohort than in the other cohorts, so the level of protection in this cohort as compared with that in the two-dose cohort may have been overestimated. So, it makes it harder to directly compare across cohorts. But, even assuming the cross comparison does hold up if you did correct for testing rates, there are a couple of things to call out in this study. First, three doses had significantly better numbers than two doses. However, the three-dose cohort was new at the time of this study, so this cohort only has results for the very first time slice, and that time slice doesn't exist for the natural immunity scenario, so we can't directly compare them. Second, this study also seems to show, with respect to immunity, that infection followed by vaccination is better than infection alone. Third, and most notably given this piece's commentary, is vaccination after natural immunity has waned. The study linked explicitly ends with this sentence in its discussion section: > We found that protection against the delta variant waned over time in both vaccinated and previously infected persons and that an additional vaccine dose restored protection. Let's look back at the wording in the original piece: > a recent New England Journal of Medicine study from Israel has questioned the benefits of vaccinating previously infected persons It is telling that a study that ends by recommending a dose of vaccine to restore waning natural immunity is used to "question the benefits of vaccinating previously infected persons" in this piece. Now, there's a reasonable debate around how previous infection should be counted w.r.t. to immune status. E.g. one can make a reasonable case that documented prior infection plus a single dose should count as "fully vaccinated." Or, that hitting a minimum threshold on an antibody test should count as documentation of immunity. Etc. But, that's not what the piece is arguing - it misrepresents both of the studies linked in this one paragraph, and then puts forward a conclusion that is unsupported by either study. If anything, both studies provide evidence that is quite supportive of getting vaccinated at some point after infection, yet you'd never know that if you just read the paragraph from this piece. Pieces like this one are frustrating because they have the veneer of legitimacy - written by someone in the field, linking studies, etc. It takes a lot of time to really dive in to understand whether or not the claims being made are supported. And even then, it often takes broader knowledge of the state of research in the field. It's easy to cherry pick research that supports a bias while simply leaving out competing research. Ultimately, this piece does not come off as a good faith review of the scientific evidence.
civilized 4y ago
I agree - there may be some good stuff here (for all I know) but there's too much obvious unhinged polemic to take it seriously on its face. Someone with stronger mental hinges will need to pick through this and tell us how things shake out.
- bshipp 4y ago
  - darkerside 4y ago
    > ignore how much worse it would have been if lockdowns were not implemented, if air travel continued, and if we treated it like the flu This is some pretty heavy speculation. I agree the article was plenty biased (what isn't, as we've all learned these days), but I don't think it's a meritless argument, and it certainly isn't the straw man that you painted.
    - TimPC 4y ago
      Everything we know about infection science suggests that it would have been a lot worse. Travel restrictions dramatically reduce inter regional spread and lockdowns help reduce the number of people catching COVID locally. Given what we know about how the virus spreads it is basically impossible to argue these measures weren’t effective. There can be some degree of uncertainty over effect size but even comparative studies looking at similar regions that practiced good or bad lockdown policies had shown large effects. Of course anti-vaxxers want to compare bad lockdown policies in rural Utah to good ones in NYC and ignore population density and major factors that cause increased spread that are independent of lockdown policy. But real scientists can do better science than that. Reading critically will eliminate 90% of the badly biased junk arguments out there. We should practice that skill more.
      - origin_path 4y ago
        No, lockdowns and masking had no effect independent of things like population density, that's been proven beyond doubt now. Even the German government formally reached that conclusion and they are some of the most fanatical maskers and lockdowners out there! What we (read: governments and academics) "know" about infection is clearly wrong. The predictions don't match real world outcomes. Germ theory is incomplete. "Reading critically will eliminate 90% of the badly biased junk arguments out there. We should practice that skill more." Great. Go and read critically the studies and data sets on these topics and you'll see why you need to revise your position.
rufus_foreman 4y ago
No one ever admits they were wrong anymore. They just say "decisions are complex". It's complicated.
- abeppu 4y ago
  I think with complex policy questions, we have to draw finer distinctions than "were you wrong?" - did you make a reasonable decision with the information available at the time, but later evidence showed that another decision would likely have had better outcomes? - did you make a poor decision which missed or disregarded information available when you made the choice? - did you make a choice which was appropriate for your declared aims at the time, but now priorities have changed? These decisions _are_ complex. That doesn't mean we can't find fault and demand improvement. But I think it's not constructive to merely highlight the negative outcomes; we have to find better processes which would make smarter choices next time.
  - darkerside 4y ago
    All of those outcomes should start with the admission that, you were wrong. Then you can start the discussion about why.
  - willcipriano 4y ago
    Expert opinion isn't very valuable with an out like that. Sure make recommendations, but if you want to use the force of law (ultimately a man with a gun) someone needs to be held to account when it turns out you were wrong.
    - ImPostingOnHN 4y ago
      Definitely, if you made a poor decision which missed or disregarded information available when you made the choice, you should be held accountable. If you made a trade-off that folks of a certain political persuasion believe was the wrong trade-off, but most people and most qualified experts believe was a reasonable trade-off? That's the job.
mc32 4y ago
Another aspect is the legal overreach that isn't much discussed. Things such as quarantine rules, various mandates, eviction bans without relief, etc. I think they had good intentions behind them and may have been necessary from certain points of view, but there are questions about their legality and continue to be challenged and some overturned.
- tbrownaw 4y ago
  > I think they had good intentions behind them All policies have good intentions. Whether it's that nobody is the villain in their own story or that the worst tyrannies are those done for the sake of their victims, having good intentions really doesn't count for much.
  - kmonsen 4y ago
    That is conflating two types of good intentions. One is that the writers have did intentions for society (what the parents means) or that they are good for a little group who write them. I don’t think anyone believes tax cuts for the richest is good for society anymore, and certainly not the people who wrote them last time around. They just wanted to pay less tax.
- hackflip 4y ago
  The road to hell is paved with good intentions
deleted 4y ago
[deleted]
timr 4y ago
> If the evidence available on the efficacy of vaccines for kids is so ridiculously wide that it goes from -99% to +370% risk of infection, then surely Norway is _also_ drastically overstating its case when it says (about kids) "previous infection offers as good of protection as the vaccine against reinfection" esp since it _also_ seems like the protective effect of prior infection is both uncertain and changing. The protective effect of prior infection is not uncertain, nor is it changing. There have been dozens of papers now, all saying the same thing: natural infection is at least as protective (if not more so) than even 3 doses of the current vaccines. If you are hearing otherwise, you are being misinformed. Full stop. Here's the latest paper in a long line of consistent evidence, last week in the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2203965 https://www.nejm.org/doi/full/10.1056/NEJMoa2203965 > No discernable differences in protection against symptomatic BA.1 and BA.2 infection were seen with previous infection, vaccination, and hybrid immunity. Vaccination enhanced protection among persons who had had a previous infection. Hybrid immunity resulting from previous infection and recent booster vaccination conferred the strongest protection. Norway is saying what it is, because we know that most people -- vaccinated or previously infected -- will eventually get re-infected. But even if you are re-infected, you will be well-protected against severe illness.
- wrycoder 4y ago
  I can understand how previous infection can confer immunity, especially since the immune response is built against live virus, not just spike protein. What I don’t understand is how vaccination and boosting using an mRNA vaccine that contains only spike protein from the original SARS2, and which is almost completely evaded by the BA.4 and BA.5 variants, can confer protection against severe illnesses caused by those variants. What is the biochemical process that provides that protection? EDIT: Is this protection just a happy mantra, or is it actually that there is no protection against the new variants, but the intensity of the disease from them is far less than from the original variant (and our treatment is getting better)?
  - MuchoMaas 4y ago
    One theory I have heard to explain this is that the vaccine is simply suppressing immune response, which helps prevent the cytokine storm that led to severe disease. Of course, this might also make infection more likely, which may explain why so many governments have stopped publishing the case rate breakdowns by vax status. It makes a kind of intuitive sense: if you make your own body produce some key portion of the virus, maybe your immune system gets tricked into thinking it's not such a big issue?
s1artibartfast 4y ago
>If the evidence available on the efficacy of vaccines for kids is so ridiculously wide that it goes from -99% to +370% risk of infection, then surely Norway is _also_ drastically overstating its case Not necessarily. You can have the data and you can have bad data. You can selectively ignore the good data to come to a drastically different decision and conclusion. Motivated thinking political or otherwise can bias the data that you select.
nradov 4y ago
There was never any valid justification for closing schools. It was a complete overreaction. Sweden kept primary schools open throughout the pandemic (without a mask mandate) and they did fine.
koheripbal 4y ago
Remember when US health policy makers told people NOT to wear masks in the beginning of the pandemic?

by abeppu 4y ago

rallison 4y ago

Agreed. I have a number of criticisms of the CDC, FDA and public institutions with respect to Covid, but this piece is highly biased and is misleading/wrong/cherry-picking with respect to the science. It seems the author has a general position of "interventions bad" and then works back from that to discredit anything related to interventions. For example, let's take just this single paragraph: > As of February, 75% of children in the U.S. already had natural immunity from prior infection. It could easily be over 90% of children today given how ubiquitous Omicron has been since then. The CDC’s own research shows that natural immunity is better than vaccinated immunity and a recent New England Journal of Medicine study from Israel has questioned the benefits of vaccinating previously infected persons. Many countries have long credited natural immunity towards vaccine mandates. But not the U.S. First, there's this statement: "The CDC’s own research shows that natural immunity is better than vaccinated immunity." The linked study, reading through it, makes a different claim. The study showed that completion of a course of primary vaccination PLUS having had a prior Covid infection led to reduced severe outcomes more than just having had the primary course of vaccination alone. And even there, the CI (0.27 (0.09–0.84)) on the first scenario overlaps with the CI for vaccination alone. It would be notable if this showed that prior infection alone conferred better protection than vaccination alone, which is the author's claim. This study doesn't show that. It shows infection plus vaccination confers better immunity than vaccination alone. And, well, that's what basically any expert would have predicted as the most likely result. The second linked study (the NEJM one) gets closer, but largely only looks at infection rates (it does have some commentary on severe covid-19 rates, but this isn't adjusted for any confounders). It's most useful as a study on how immunity against infection wanes since the last immunity-conferring event, although it allows for some cross comparisons, such as comparing infection rates for natural immunity alone vs 2 doses alone vs 3 doses alone vs hybrid immunity. Possibly the biggest caveat is that the rate of testing for the different cohorts wasn't adjusted for: > Although differences in testing rates among cohorts and among subcohorts within specified cohorts were observed, their overall magnitude was relatively small. The rate of PCR testing was typically lower in the recovered, unvaccinated cohort than in the other cohorts, so the level of protection in this cohort as compared with that in the two-dose cohort may have been overestimated. So, it makes it harder to directly compare across cohorts. But, even assuming the cross comparison does hold up if you did correct for testing rates, there are a couple of things to call out in this study. First, three doses had significantly better numbers than two doses. However, the three-dose cohort was new at the time of this study, so this cohort only has results for the very first time slice, and that time slice doesn't exist for the natural immunity scenario, so we can't directly compare them. Second, this study also seems to show, with respect to immunity, that infection followed by vaccination is better than infection alone. Third, and most notably given this piece's commentary, is vaccination after natural immunity has waned. The study linked explicitly ends with this sentence in its discussion section: > We found that protection against the delta variant waned over time in both vaccinated and previously infected persons and that an additional vaccine dose restored protection. Let's look back at the wording in the original piece: > a recent New England Journal of Medicine study from Israel has questioned the benefits of vaccinating previously infected persons It is telling that a study that ends by recommending a dose of vaccine to restore waning natural immunity is used to "question the benefits of vaccinating previously infected persons" in this piece. Now, there's a reasonable debate around how previous infection should be counted w.r.t. to immune status. E.g. one can make a reasonable case that documented prior infection plus a single dose should count as "fully vaccinated." Or, that hitting a minimum threshold on an antibody test should count as documentation of immunity. Etc. But, that's not what the piece is arguing - it misrepresents both of the studies linked in this one paragraph, and then puts forward a conclusion that is unsupported by either study. If anything, both studies provide evidence that is quite supportive of getting vaccinated at some point after infection, yet you'd never know that if you just read the paragraph from this piece. Pieces like this one are frustrating because they have the veneer of legitimacy - written by someone in the field, linking studies, etc. It takes a lot of time to really dive in to understand whether or not the claims being made are supported. And even then, it often takes broader knowledge of the state of research in the field. It's easy to cherry pick research that supports a bias while simply leaving out competing research. Ultimately, this piece does not come off as a good faith review of the scientific evidence.

civilized 4y ago

I agree - there may be some good stuff here (for all I know) but there's too much obvious unhinged polemic to take it seriously on its face. Someone with stronger mental hinges will need to pick through this and tell us how things shake out.

bshipp 4y ago
- darkerside 4y ago
  > ignore how much worse it would have been if lockdowns were not implemented, if air travel continued, and if we treated it like the flu This is some pretty heavy speculation. I agree the article was plenty biased (what isn't, as we've all learned these days), but I don't think it's a meritless argument, and it certainly isn't the straw man that you painted.
  - TimPC 4y ago
    Everything we know about infection science suggests that it would have been a lot worse. Travel restrictions dramatically reduce inter regional spread and lockdowns help reduce the number of people catching COVID locally. Given what we know about how the virus spreads it is basically impossible to argue these measures weren’t effective. There can be some degree of uncertainty over effect size but even comparative studies looking at similar regions that practiced good or bad lockdown policies had shown large effects. Of course anti-vaxxers want to compare bad lockdown policies in rural Utah to good ones in NYC and ignore population density and major factors that cause increased spread that are independent of lockdown policy. But real scientists can do better science than that. Reading critically will eliminate 90% of the badly biased junk arguments out there. We should practice that skill more.
    - origin_path 4y ago
      No, lockdowns and masking had no effect independent of things like population density, that's been proven beyond doubt now. Even the German government formally reached that conclusion and they are some of the most fanatical maskers and lockdowners out there! What we (read: governments and academics) "know" about infection is clearly wrong. The predictions don't match real world outcomes. Germ theory is incomplete. "Reading critically will eliminate 90% of the badly biased junk arguments out there. We should practice that skill more." Great. Go and read critically the studies and data sets on these topics and you'll see why you need to revise your position.

rufus_foreman 4y ago

No one ever admits they were wrong anymore. They just say "decisions are complex". It's complicated.

abeppu 4y ago
I think with complex policy questions, we have to draw finer distinctions than "were you wrong?" - did you make a reasonable decision with the information available at the time, but later evidence showed that another decision would likely have had better outcomes? - did you make a poor decision which missed or disregarded information available when you made the choice? - did you make a choice which was appropriate for your declared aims at the time, but now priorities have changed? These decisions _are_ complex. That doesn't mean we can't find fault and demand improvement. But I think it's not constructive to merely highlight the negative outcomes; we have to find better processes which would make smarter choices next time.
- darkerside 4y ago
  All of those outcomes should start with the admission that, you were wrong. Then you can start the discussion about why.
- willcipriano 4y ago
  Expert opinion isn't very valuable with an out like that. Sure make recommendations, but if you want to use the force of law (ultimately a man with a gun) someone needs to be held to account when it turns out you were wrong.
  - ImPostingOnHN 4y ago
    Definitely, if you made a poor decision which missed or disregarded information available when you made the choice, you should be held accountable. If you made a trade-off that folks of a certain political persuasion believe was the wrong trade-off, but most people and most qualified experts believe was a reasonable trade-off? That's the job.

mc32 4y ago

Another aspect is the legal overreach that isn't much discussed. Things such as quarantine rules, various mandates, eviction bans without relief, etc. I think they had good intentions behind them and may have been necessary from certain points of view, but there are questions about their legality and continue to be challenged and some overturned.

tbrownaw 4y ago
> I think they had good intentions behind them All policies have good intentions. Whether it's that nobody is the villain in their own story or that the worst tyrannies are those done for the sake of their victims, having good intentions really doesn't count for much.
- kmonsen 4y ago
  That is conflating two types of good intentions. One is that the writers have did intentions for society (what the parents means) or that they are good for a little group who write them. I don’t think anyone believes tax cuts for the richest is good for society anymore, and certainly not the people who wrote them last time around. They just wanted to pay less tax.
hackflip 4y ago
The road to hell is paved with good intentions

deleted 4y ago

[deleted]

timr 4y ago

> If the evidence available on the efficacy of vaccines for kids is so ridiculously wide that it goes from -99% to +370% risk of infection, then surely Norway is _also_ drastically overstating its case when it says (about kids) "previous infection offers as good of protection as the vaccine against reinfection" esp since it _also_ seems like the protective effect of prior infection is both uncertain and changing. The protective effect of prior infection is not uncertain, nor is it changing. There have been dozens of papers now, all saying the same thing: natural infection is at least as protective (if not more so) than even 3 doses of the current vaccines. If you are hearing otherwise, you are being misinformed. Full stop. Here's the latest paper in a long line of consistent evidence, last week in the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2203965 https://www.nejm.org/doi/full/10.1056/NEJMoa2203965 > No discernable differences in protection against symptomatic BA.1 and BA.2 infection were seen with previous infection, vaccination, and hybrid immunity. Vaccination enhanced protection among persons who had had a previous infection. Hybrid immunity resulting from previous infection and recent booster vaccination conferred the strongest protection. Norway is saying what it is, because we know that most people -- vaccinated or previously infected -- will eventually get re-infected. But even if you are re-infected, you will be well-protected against severe illness.

wrycoder 4y ago
I can understand how previous infection can confer immunity, especially since the immune response is built against live virus, not just spike protein. What I don’t understand is how vaccination and boosting using an mRNA vaccine that contains only spike protein from the original SARS2, and which is almost completely evaded by the BA.4 and BA.5 variants, can confer protection against severe illnesses caused by those variants. What is the biochemical process that provides that protection? EDIT: Is this protection just a happy mantra, or is it actually that there is no protection against the new variants, but the intensity of the disease from them is far less than from the original variant (and our treatment is getting better)?
- MuchoMaas 4y ago
  One theory I have heard to explain this is that the vaccine is simply suppressing immune response, which helps prevent the cytokine storm that led to severe disease. Of course, this might also make infection more likely, which may explain why so many governments have stopped publishing the case rate breakdowns by vax status. It makes a kind of intuitive sense: if you make your own body produce some key portion of the virus, maybe your immune system gets tricked into thinking it's not such a big issue?

s1artibartfast 4y ago

>If the evidence available on the efficacy of vaccines for kids is so ridiculously wide that it goes from -99% to +370% risk of infection, then surely Norway is _also_ drastically overstating its case Not necessarily. You can have the data and you can have bad data. You can selectively ignore the good data to come to a drastically different decision and conclusion. Motivated thinking political or otherwise can bias the data that you select.

nradov 4y ago

There was never any valid justification for closing schools. It was a complete overreaction. Sweden kept primary schools open throughout the pandemic (without a mask mandate) and they did fine.

koheripbal 4y ago

Remember when US health policy makers told people NOT to wear masks in the beginning of the pandemic?