Covid #35: I am the Alpha and the Omega.

[Clueless Northman]

It's trickier to track covid in vaccinated people, with Delta to boot. Symptoms changed a bit. If it just looks like you have a typical cold for 4-5 days, will you get tested? You'd need to test most of your population every couple of months, considering how diverse and now less obvious covid symptoms are. So of course you're going to miss most of the breakthrough cases, and not just the asymptomatic ones. When it comes to vaccinated people, we might well be back to testing barely 1/4 of all cases, like in early 2020.

[Cas Stark]

Don't we already know that millions of people have had covid who were never tested and so don't show up in the official tally?  I don't think that is justification to completely give up on trying to track breakthrough cases, especially as now it begins to look as if breakthrough cases are happening more often than what was expected.  

[Padraig]

13 minutes ago, Clueless Northman said:

It's trickier to track covid in vaccinated people, with Delta to boot. Symptoms changed a bit. If it just looks like you have a typical cold for 4-5 days, will you get tested? You'd need to test most of your population every couple of months, considering how diverse and now less obvious covid symptoms are. So of course you're going to miss most of the breakthrough cases, and not just the asymptomatic ones. When it comes to vaccinated people, we might well be back to testing barely 1/4 of all cases, like in early 2020.

But if I understand Cas correctly, the US isn't tracking diagnosed breakthrough cases (unless they are hospitalised or died).  That's crazy.  Knowing the likelihood of such cases seems very important.

One could compare to European countries but restrictions should also reduce breakthrough cases.  The UK might give a good indication in the coming weeks I suppose, as they have removed restrictions.

2 hours ago, L'oiseau français said:

Still, do you want to be one of them after you’re fully vaccinated?

It is a horrible lottery to win.  When they talk about most cases arising in those that have pre-existing conditions, I wonder is that the same for those in these hospitals?  But presumably there are regular testing in hospitals, so they would capture all breakthrough cases?

Israel is going forward with a booster shot for over-60s..  It will be interesting to see whether that changes things there.  I really hope they aren't required, as too much of the world hasn't had 1 shot yet.  But they did start their vaccination campaign earlier than everyone else.

China does it right here I suppose.  It mass tests whole cities.

[Xray the Enforcer]

24 minutes ago, Clueless Northman said:

It's trickier to track covid in vaccinated people, with Delta to boot. Symptoms changed a bit. If it just looks like you have a typical cold for 4-5 days, will you get tested? You'd need to test most of your population every couple of months, considering how diverse and now less obvious covid symptoms are. So of course you're going to miss most of the breakthrough cases, and not just the asymptomatic ones. When it comes to vaccinated people, we might well be back to testing barely 1/4 of all cases, like in early 2020.

I know all of this. The CDC still could have chosen to at least track all the cases it did find of breakthrough infection but it didn't even do that. 

[Zorral]

 

[Mudguard]

5 hours ago, Werthead said:

Seeing a lot of discussion at the moment on the required herd immunity level for Delta which seems to put it out of practical reach. The previous figure of 85% was for OG non-Greekified COVID and people have been crunching numbers for Delta for months and seem to have come up with a figure of between 98% and, er, 130%. The latter case means that herd immunity for Delta, even with vaccines + prior infections, is impossible, and in the former case it is practically impossible (assuming more than 2% of the population can't take the vaccine for whatever medical reason or their immune system is so compromised it won't help, or they are morons).

This conclusion - from an American perspective - is relatively dark, suggesting that COVID will, due to the above reasons, become endemic and there will be permanent standing waves of the disease until better vaccines are developed (we know they're on their way, some attuned to Delta specifically, but no timescale) or unless Delta itself mutates into a variant that spreads as fast but is less serious (possible but not a given). Vaccine hesitancy and anti-vaxx rates in the USA are much higher than in other countries, so the virus becoming endemic in the United States would cause huge numbers of deaths every year, permanently, until anti-vaxx numbers fall or the government intervenes more forcibly to make vaccinations mandatory.

What is quite interesting (given both threads are ten days old) is that people from the UK have asked how those factors figure in with the rates there, but since the threads are US-centric they didn't seem able to engage. This article paints a much rosier picture of COVID's morbidity in the UK - once a high immunity level is reached even if herd immunity is unachievable - falling to match or below that of flu, with an R rate of below 0 in the summer and above 0 in the winter, matching other winter diseases. The UK's relatively high rate of vaccine take-up has helped make the situation here much more optimistic than in the UK.

In the UK all eyes on the ONS figures which should come out at the end of the week and confirm the degree to which cases seem to continue to be dropping despite the country relatively opening up to business as normal, which might indicate that the above outcome is happening already, which would be spectacularly good news. It would also show a way out of the pandemic globally: get the fuck vaccinated, yesterday.

Take these estimates with a huge heaping handful of salt.  They are very rough estimates that depend on all sorts of assumptions, many of which we do not have a good handle on.  For example, these herd immunity calculations are based on knowing what the R0 value is, and unfortunately, the R0 number is extremely hard to determine precisely because it depends on so many factors.  The R0 value is not an intrinsic property of the virus that you can measure in the lab.  It depends on local conditions like population density, cultural behavior, the weather, etc.  Think of it as a fudge factor that we use to very roughly account for a huge host of factors relevant to the rate that an infection spreads that are very difficult for us to measure and model.  

Some of these projections also depend on assumptions regarding how long the vaccines will remain effective, and how long a person that has recovered from infection will be immune from reinfection.  A common assumption I've seen in the media for a long, long time has been that immunity lasts for about a year, but this is just a guess with very little supporting evidence.  There have been so many erroneous assumptions about the coronavirus from the start of this pandemic, beginning with the assumption that transmission was primarily through large droplets, based on shitty research conducted many decades ago.  Same thing about the efficacy of masks, which were based on on a couple very small, shitty studies done decades ago.  There is a common tendency to point to a single study and erroneously claim that it either proves or disproves something.

As you note, we have the ability to make new vaccines tailored to the new variants, if needed.  Once full approval of these vaccines are obtained, the approval process for the new versions should go through much, much quicker, like we have with the annual influenza vaccine.

Vaccine mandates from employers and governments are also coming out in the US.  Also, the percentage of unvaccinated in the US varies with age, with much higher rates of vaccination for the elderly who are most vulnerable.  There is a small but significant portion of the elderly that still remains unvaccinated, so the US will still see a significant amount of death for a while, but I think it's very unlikely that we'll see huge numbers of deaths again.  As more and more data comes in showing how well the vaccines are working, more and more of the people sitting on the fence are finally getting vaccinated.

Republicans politicians and media are starting to worry that their voter base is shrinking faster than Democrats, so they are finally starting to push vaccination to their followers.  This should help with one of the largest blocks of the vaccine hesitant.

Bottom line, I think claims that SARS-CoV-2 will cause huge amounts of deaths every year in the US and other countries for the foreseeable future, despite the availability of extremely effective vaccines, are way too pessimistic are veering into fear mongering.

[Mudguard]

54 minutes ago, Xray the Enforcer said:

I know all of this. The CDC still could have chosen to at least track all the cases it did find of breakthrough infection but it didn't even do that. 

Generally, the local state, county, etc. health authorities are the ones actually tracking the cases, including breakthrough infections.  I'm almost 100% sure that this data is all transmitted to the CDC.  They have the data, but just have chosen not the share it.  Often, the asserted rationale for not sharing this type of data is that they don't want to confuse people because they think the data is hard to understand or interpret, or they don't want to cause panic, or that they are concerned that sharing this data will cause the vaccine hesitant to think that the vaccines aren't working and thus reduce the likelihood that these people will get vaccinated, etc.

Personally, I hate when they do this, and I'd much rather have access to all the data so that I can make an informed decision rather than relying on so-called "experts" that I don't really have a high degree of trust in.

[williamjm]

1 hour ago, Clueless Northman said:

It's trickier to track covid in vaccinated people, with Delta to boot. Symptoms changed a bit. If it just looks like you have a typical cold for 4-5 days, will you get tested? You'd need to test most of your population every couple of months, considering how diverse and now less obvious covid symptoms are. So of course you're going to miss most of the breakthrough cases, and not just the asymptomatic ones. When it comes to vaccinated people, we might well be back to testing barely 1/4 of all cases, like in early 2020.

If you are trying to work out what % of breakthrough infections there you don't necessarily need to test everybody, you need to do randomised testing so it's not dependent on people choosing to come forward for testing. I don't know whether the CDC is doing that, but it seems like a big missed opportunity to gather data if they are not.

[Fragile Bird]

Authorities in Canada are estimating 90% of the population needs to be vaccinated to achieve herd immunity.

[Werthead]

30 minutes ago, Mudguard said:

Take these estimates with a huge heaping handful of salt.  They are very rough estimates that depend on all sorts of assumptions, many of which we do not have a good handle on.  For example, these herd immunity calculations are based on knowing what the R0 value is, and unfortunately, the R0 number is extremely hard to determine precisely because it depends on so many factors.  The R0 value is not an intrinsic property of the virus that you can measure in the lab.  It depends on local conditions like population density, cultural behavior, the weather, etc.  Think of it as a fudge factor that we use to very roughly account for a huge host of factors relevant to the rate that an infection spreads that are very difficult for us to measure and model.

Whilst this is true, we do know that Delta is more easily transmissible than the original variant or Alpha, and the very rapid spread of the variant has shown this to be true. So the R number will be higher than prior variants in the same like-for-like situation/setting.

Quote

 

Republicans politicians and media are starting to worry that their voter base is shrinking faster than Democrats, so they are finally starting to push vaccination to their followers.  This should help with one of the largest blocks of the vaccine hesitant.

Bottom line, I think claims that SARS-CoV-2 will cause huge amounts of deaths every year in the US and other countries for the foreseeable future, despite the availability of extremely effective vaccines, are way too pessimistic are veering into fear mongering.

 

I think the USA has started drawing close to its vaccine ceiling; not as low as some feared, but a great deal lower than most hoped. There's still quite a few people who can be convinced or talked into getting vaccinated, but it does look like there's a hardcore ~20% of people who will refuse to get vaccinated. That's a problem as it leaves the US total vaccination takeup at a lower rate than is ideally required for herd immunity against OG COVID, and way lower than for Delta, whilst the UK will get a lot closer (though even in the UK we're starting to bump up against younger people refusing to take the vaccine, though a lot of those can probably be convinced; the hardcore refuseniks hopefully will be well under 10% of the population, under half the problem in the US).

[Luzifer's right hand]

Personally I have decided to test myself after I have done something risky despite the fact that I got two shots already.

Even if the unvaccinated people I interact with are acting pretty stupid they could still infect people that can't get a vaccine.

[DMC]

30 minutes ago, Werthead said:

I think the USA has started drawing close to its vaccine ceiling; not as low as some feared, but a great deal lower than most hoped. There's still quite a few people who can be convinced or talked into getting vaccinated, but it does look like there's a hardcore ~20% of people who will refuse to get vaccinated.

Yeah it should be noted that it's not just partisanship or age.  Education, income and race are factors as well:

Quote

The lag among people of color isn’t just about an unwillingness to get the jab. The Kaiser Family Foundation found in April that significantly more unvaccinated Black and Hispanic adults than white adults didn’t know where or when they could get a vaccine. More fundamentally, unvaccinated people of color were far more likely than white Americans to say they hadn’t gotten the vaccine because they didn’t have enough time or were worried about missing work, according to KFF’s June survey. Similarly, PRRI found that Black Americans were slightly more likely than Americans as a whole to say a lack of child care or transportation was a barrier to getting vaccinated.

It does seem like more outreach about the relatively minor side effects could pay dividends as well. KFF found in June that 60 percent of Hispanic adults and 55 percent of Black adults were concerned about side effects, slightly more than the 51 percent of white adults who said the same. And slightly more people of color mentioned being wary of getting vaccinated as a reason for not having had the shot, which may have something to do with their long history of experiencing inequities in the health care system.

Misinformation among these groups also almost certainly plays a role.  All in all, polls range from about 20-30% of Republicans and 10-25% of Independents say they won't get vaccinated.  Whether all that adds up to 20% overall, well I guess we'll see.

[Clueless Northman]

2 hours ago, Padraig said:

But if I understand Cas correctly, the US isn't tracking diagnosed breakthrough cases (unless they are hospitalised or died).  That's crazy.  Knowing the likelihood of such cases seems very important.

Oh sorry. Read this a bit too quickly, I think. If it's tracking contacts of already diagnosed cases, it's indeed reckless not to do it anymore. I was merely thinking of hoping to test any person with some kind of symptoms to check if it's covid or not, something which will happen less often with vaccinations and evolution of symptoms with Delta.

 

1 hour ago, Zorral said:

 

Hopefully this is indeed correct. Specially the bit about Delta having a shorter incubation period meaning not only that you can contaminate people faster (less than 36 h instead of 3-4 days), but also that symptoms will appear faster (so possibly shorter, pre-symptomatic contagion phase, and at the very least not a longer one). Ideally, Delta infections overall could be shorter, including symptomatic phase, but I won't bet on it.

[DireWolfSpirit]

It may come as a surprise to the more well versed, but there could be some confusion to what's being referenced when you use the term breakthrough. This is especially true for portions of the public outside the medical community.

Here's an article on Covid breakthrough and what exactly that refers to.

Just feeling like some layman's terminology could be useful.

https://www.health.com/condition/infectious-diseases/coronavirus/what-is-covid-breakthrough-infection

From the article-

 

What is a breakthrough infection?

By the CDC's definition, a breakthrough infection is a COVID case that occurs in someone who is fully vaccinated, meaning 14 or more days after completing the recommended doses of an authorized vaccine. (Remember, it takes time for your immune system to build protective antibodies against COVID, so you're not fully vaccinated until two weeks after you've finished your vaccine regimen.)

 

[DireWolfSpirit]

Israel is going to be offering a 3rd Pfizer to those already vaccinated to attempt to lessen these aforementioned breakthrough cases.

https://www.huffpost.com/entry/israel-third-pfizer-shot-delta-breakthroughs_n_6104cf05e4b0048f361d7a07

I hope the U.S. soon follows suit. The willing should not have to wait on the last footdraggers who have refused to act and get their shots by now.

Besides we can do both at the same time. Continue offering the belated shots to the hesitant while offering the booster to those who've already did the right thing imo.

[DireWolfSpirit]

3 hours ago, Chataya de Fleury said:

I’ll take a booster in a heartbeat. Or even a second round of a different shot if that could be shown to work.

We need to start mandating vaccines in order to do anything (unless legitimate medical excuse). No shirt, no shoes, no vaccine, no service. Sadly, that’s totally not going to happen. 

We had one guy at work get the vaccine after he heard a rumor that one could only fly coach on Delta if not vaccinated 

I'm all for it, if we can't sell them we should hoodwink them into protecting themselves and others.

[Mlle. Zabzie]

3 hours ago, Chataya de Fleury said:

I’ll take a booster in a heartbeat. Or even a second round of a different shot if that could be shown to work.

We need to start mandating vaccines in order to do anything (unless legitimate medical excuse). No shirt, no shoes, no vaccine, no service. Sadly, that’s totally not going to happen. 

We had one guy at work get the vaccine after he heard a rumor that one could only fly coach on Delta if not vaccinated 

I sort of believe whither Disney and Walmart, whither the country.  Each company has announced a vaccine mandate for at least some of their employees.  This is important.

[Mr. Chatywin et al.]

2 hours ago, Mlle. Zabzie said:

I sort of believe whither Disney and Walmart, whither the country.  Each company has announced a vaccine mandate for at least some of their employees.  This is important.

 

 

[DireWolfSpirit]

3 hours ago, Chataya de Fleury said:

Alternately, tell the hedge fund bros an unsubstantiated rumor that they will have to FLY COACH 

Important: Disney mandate applies to salaried and non union employees. Disney must collectively bargain with each union. No one had better ever tell me that “unions are always teh bestest” ever again. F—-cking unions are screwing the American public over this. Because they are.

The head of the AFL-CIO has endorsed vaccine requirement.

https://thehill.com/business-a-lobbying/business-a-lobbying/565195-afl-cio-backing-vaccine-requirement-for-workers

Various Local unions may not be yet on board, but that would be in defiance of their International Leadership and would be due to the democratic dissent of their rank and file as anything like that (to comply or not) would be put to a vote within the Locals.

 

[DMC]

3 hours ago, Chataya de Fleury said:

No one had better ever tell me that “unions are always teh bestest” ever again. F—-cking unions are screwing the American public over this. Because they are.

It's pretty shitty to use this to castigate unions.  First of all, most of them are just saying they reserve the right to negotiate any mandate, which, ya know, is the entire idea of collective bargaining.  Second, they have a responsibility to defend the rights of their members, even the really stupid ones, so this is kinda like shitting on a defense attorney for doing their job.