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Comment by renaudg | Hacker News Reader

> The best case scenario is a new less deadly highly contagious strain that become the most dominant and spreads worldwide.

No, this scenario wouldn't be good news at all.

Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening.

In other words, the reduced risk of an infected person getting into hospital is dwarfed by the exponential increase in the number of sick people, and the net result is way more hospital admissions. This could easily overwhelm healthcare systems in the coming weeks and make them unavailable for anyone who needs them, not just Covid patients (unfortunately, these indirect casualties of Covid are undercounted)

Secondly, each new infection is an additional ticket in the great variant evolution lottery. The more infections, the higher the risk of a vaccine-escaping, serious disease-causing new variant being selected. Low vaccinations rates in South Africa, plus the high number of untreated HIV+ patients there (who struggle to get rid of Covid and are a perfect breeding ground for variants) are thought to have contributed to Omicron's emergence.

That's why "let it rip through so we get natural immunity" is such a short sighted stance.

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The thing is, vaccines were never advertised as tools to prevent infection. The story has always been that it reduces symptoms and hospitalization, so there are plenty of opportunities for the disease to get “tickets” in the evolution lottery. Between that, the animal reservoirs (COVID can spread to different species), and the millions of people in undeveloped countries who will never get a vax, COVID was guaranteed to mutate no matter what the public policy. Letting it rip is less a strategy and more an acknowledgement of reality.

The vaccine was initially sold as the tool to end the pandemic and get life back to 'normal'. The narrative has evolved to suit the deficiencies of the vaccine and keep profits from sinking.

Or if the virus gets irrelevant.

One doesn't exclude the other. People don't see an end with natural evolution, so the vaccine was/is the main focus for a long time.

They could have ended the wildtype pandemic. As soon as delta appeared it was impossible. They have 90% efficiency at best and you need 84% of all people protected to stop delta (1-1/R0 for R0=6). It's impossible to get such high vax rate.

Not necessarily. Eg the Netherlands has ~77% vaccination rate, which is pretty close to the quoted 84%.

I'd go so far as to say 77% is "good enough", ie. it's time to live with the virus and not change our ways because of it.

We’re at 80% vaccination in Spain… I think we can surpass 84%.

37.7M fully vaccinated, 47.35M population -- impressive!

I was initially assuming you were excluding kids or other people ineligible to get vaccinated.

It was kinda-possible to return to normality with delta though. The entire EU is above 70% of the total population, with some countries above 80%. And of the unvaccinated, most are children who are less susceptible in the first place.

But with Omicron, it's literally like we're back to March 2020. Norway (with 81% vaccination rate) went from normality to full lockdown in the past two weeks. I'm pretty sure that's coming everywhere else during the next month or so.

If lockdown is considered then it goes to show how little politicians know about the virus.

We need to treat Corona the same way we treat the flu and we should start now.

As an example the current number of hospitalizations here in Denmark is about 50% of the worst period for the 2017/18 flu.

The thing is that various governments have neglected hospitals and health care, that is the real problem that must be dealt with.

If omicron causes lockdowns again than this will literally happen every winter. Vaccines were the end state. There is nothing left to do but accept the risks and move on with life.

People scared about hospital capacity should be asking strong questions to their politicians about why they squandered 2 years of peoples short life with zero new capacity.

The public shouldn’t shoulder the failures of politicians nor these “experts”.

They pretty much did end the Delta pandemic in the Bay Area. We had a minor spike up and then it subsided without any major restrictions or strain on the healthcare system. Vaccination rates are 95%+ where I am, so 0.95 * 0.9 = 0.855 and it was still over the herd immunity threshold.

Any links to any marketing material "selling" the vaccine as the tool to end the pandemic?

Governments requiring it to work regularly again is the only "marketing material" you need.

The UK government absolutely did this.

> The narrative has evolved to suit the deficiencies of the vaccine and keep profits from sinking.

The narrative may have evolved but that was more due to the virus evolving rather than some conspiracy driven by Pfizer and Moderna to sell more shots. More people being vaccinated benefits everyone, not just the pharmaceutical companies, and saying otherwise is a bit paranoid.

This isn’t true, and the lack of testing during the phase 3 trials to see if there were non-symptomatic cases was a deliberate design choice to avoid answering that question.

I’m all in on vaccination, but let’s not rewrite history.

That’s not completely true either. The UK phase 3 trial of the AZ vaccine included weekly testing to catch asymptomatic cases.

I've heard that but then why do people say we need to get vaccinated to protect the most vulnerable members of society if the vaccine isn't actually slowing the spread and doesn't prevent infection?

EDIT:

To be clear I already had COVID and didn't have any serious symptoms so the argument about a hospital bed doesn't necessarily apply to me. Beyond that I actually got vaccinated, my question centers around the disparity of treatment we are giving individuals who are vaxxed and those who are not if both are capable of spreading. Further it brings in the question of vaccine mandates if they are much less effective then we were led to believe.

If you're vaccinated and become infected, you will have less of a viral load, and thus will spread less viral particles to others. The duration of infection will also be much shorter, thus lessening the time you can spread the infection to others. The vaccine also prevents some, but not all, infections in the first place.

You're also less likely to take up a hospital bed that someone who is more vulnerable than you needs.

> I've heard that but then why do people say we need to get vaccinated to protect the most vulnerable members of society if the vaccine isn't actually slowing the spread and doesn't prevent infection?

Why are you (and others) thinking that since vaccines aren't 100% effective it doesn't help protecting other people ?

What kind of dissonance cognitive gets you there ?

Why are you blind to the fact that a vaccine that mostly works still help reducing infections and why do you equate that to "vaccines don't work to protect others (since some vaccinated people can still infect others) so I shouldn't get vaccinated" ?

How come you are working from a yes/no, full-or-nothing angle ?

A glass of water won't 100% quench your thirst when you haven't drunk in a long time so you won't take it ?

The vaccines do prevent infections and slow the spread. They just don't prevent all infections.

Vaccinated people are between 60-80% less likely to infect others, and they are infectious for less amount of time.

the vaccines may not have been advertised as that, since the evidence during development for that was marginal. but recent evidence suggests that it does prevent infection. unfortunately, less true with omicron.

> The thing is, vaccines were never advertised as tools to prevent infection.

A lot of people believed they were. I've spent some time arguing with people that the punishments for not taking the vaccine were too extreme, and that government-supported firing of people from their jobs was a bad idea.

It was extremely common for people to argue that the vaccine would cut down on transmission (which is basically saying infection) and end the pandemic. Without that pillar it gets quite hard to justify the discrimination against unvaccinated people in Australia. Not sure about the rest of the world but I assume there is a similar story.

this is why i was, and continue to be, against the various vaccine mandates. My employer said to me "upload your vax card or get an exemption else be fired". It was a bridge too far for me and I submitted for an exemption request on grounds of personal conscious. However, a couple weeks later we get another email that says if your exemption request is denied you are fired. I could have taken a moral stand but i have a wife + 2 kids and a MIL dependent on my income and I decided it wasn't worth it. I ended up canceling my request and uploading my vax card.

In the US the politicians know a law mandating the vaccine is a non-starter. So, instead, they encouraged and supported employers threatening their employees. I guess it's ironic that everyone is quitting everywhere anyway.

> The thing is, vaccines were never advertised as tools to prevent infection.

In the USA? Yes, they were. There was no mention of a future need for boosters. There was a simple promise of safety, and for things to return to normal.

No, they were promoted as drastically reducing the chance of severe symptoms and hospitalizations.

Literally everything I read about vaccine efficacy said that the metrics they tracked were about reducing the incidence of symptoms and serious disease. They didn't even test people in the clinical trials for COVID unless they started showing symptoms.

Now, certainly, some media outlets may have been irresponsibly or ignorantly misinterpreting all this and pushing the narrative that it would make everyone immune. But that's not the CDC or WHO's fault.

> There was no mention of a future need for boosters.

Not sure what that has to do with anything. Things change.

> There was a simple promise of safety, and for things to return to normal.

You must have been reading some really watered-down news, and not actually reading what public health officials were saying.

Well, the narrative being disconnected from facts is a different conversation.

We got to return to normal for about 2 months (June and July!) Maybe next year we’ll get 3 months, but I wouldn’t count on it.

Who cares about the advertising? The data is in, and the vaccines do both - they decrease your chance to be infected and they make symptoms much more mild if you are infected. The combination of factors is why hospitalisation rates in highly vaccinated countries plummeted.

Or at least they did until omicron. Unfortunately 2 doses of the existing vaccines are pretty ineffective against omicron. 3 doses make the vaccines work better - but I’m honestly a little concerned.

> That's why "let it rip through so we get natural immunity" is such a short sighted stance.

That is absolutely not what the OP said, fwiw

> Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening.

No it's not, if delta infected say 1b humans and omicron infects 4b humans deaths can easily be offset by a lower fatality rate

The problem is that (higher) exponential growth will cause many more hospitalizations to happen in a much shorter time interval. That can make the wave more deadly even if the virus is somewhat milder.

You're missing the point. If Delta kills, say, a million people, and Omicron only kills half a million people, but Omicron kills that halved amount in, say, 1/10th the time, Omicron is more likely to lead to overwhelmed hospitals.

I wish they would just triage unvaccinated people below everyone else so hospital capacity would stop being a problem.

That would make sense but been the originally strains did not overwhelm hospitals. New York has the highest and craziest number of cases and deaths at the beginning and didn’t put one person onto the ship that was provided for temporary beds. Hospitals did not run out of beds and now the biggest problem is running out of staff, the same as every industry. At our local hospital all of the nurses quit for better, higher paying jobs. We’re running at less hospital labor than even pre pandemic, aren’t building new hospitals, and the highest peaks in cases and deaths were while the strictest lockdowns and mask mandates were already in place. There is complete fear overload and yet all attempts at preventing spread, even vaccines, have failed. They reduce symptoms but do not stop the spread. That’s how contagious this virus is, without any symptoms whatsoever people are spreading the virus, even with masks on, and limits on how close they can be to people. We now have vaccines, we have even pills that have been approved, we also know healthy lifestyle fights against it, yet we are still in a 2 year long “state of emergency.” Letting it rip through is not an option we can choose, it will happen regardless of what we do.

> didn’t put one person onto the ship that was provided for temporary beds

It wasn't for lack of need.

https://www.nytimes.com/2020/04/02/nyregion/ny-coronavirus-u...

> But the reality has been different. A tangle of military protocols and bureaucratic hurdles has prevented the Comfort from accepting many patients at all.

> On top of its strict rules preventing people infected with the virus from coming on board, the Navy is also refusing to treat a host of other conditions. Guidelines disseminated to hospitals included a list of 49 medical conditions that would exclude a patient from admittance to the ship.

> Ambulances cannot take patients directly to the Comfort; they must first deliver patients to a city hospital for a lengthy evaluation — including a test for the virus — and then pick them up again for transport to the ship.

If the emergency and need was that bad they would have absolutely figured out simple logistics to get people on a ship. The fact is most people were told go home and wait it out and are still told that and that is the treatment most people receive. There is no point in continuing our state of emergency when our emergency services are not and never were at risk. Every single lockdown and mask measure put in place has had no significant impact on the spread of the virus. It is that contagious.

> New York has the highest and craziest number of cases and deaths at the beginning and didn’t put one person onto the ship that was provided for temporary beds

The ships weren't for COVID patients, they were for non-COVID cases so that hospitals could focus on the overflow of COVID patients that they were better equipped to handle. Turns out that at the beginning of a global pandemic, not a lot people opted to go to the hospital even if they needed to because of fear of infection.

>marginally lower case fatality rate

The op didn't state marginally could you please share where you are getting this from?

The first publicly confirmed death globally from Omicron was reported just yesterday (source: https://www.reuters.com/world/uk/britain-says-omicron-spread...

Given that the South African study discussed in this Washington Post article included 78k people, none of whom died if the above Reuters article is correct, doesn't this suggest that the case fatality rate is a lot lower (not marginally lower)?

It's growing exponentially and deaths are a lagging indicator. The true denominator is far from 78k people.

I know deaths lag cases. I mentioned just the cases in the south African study because those are the earliest cases we have. None of the 78,000 cases up to 7th Dec in South Africa resulted in a reported death up to 13th Dec.

This can be deduced from yesterday's Reuters article I linked which said the first reported death globally was in the UK (not South Africa) and from the fact that the study looked at 78,000 cases of Omicron from 15 November 2021 to 7 December 2021 (source: https://www.discovery.co.za/corporate/news-room). At the time the Reuters article was published we were 6 days after even the most recently reported of those South African cases.

I wasn't trying to present the global denominator - that is far higher than 78,000 since it includes all countries, not just the 78k reported in the South African country.

> None of the 78,000 cases up to 7th Dec in South Africa resulted in a reported death up to 13th Dec.

Covid takes about 3 weeks to kill. The Omicron epicenter in SA has a much younger demographic than in western countries.

Pretty much every estimate of exponential growth has turned out to be logarithmic. Which makes sense. That’s how % of new nodes reached in a random walk through a graph works.

> The first publicly confirmed death globally from Omicron was reported just yesterday

With Omicron, not from Omicron. It's an important distinction.

The headline says "with" and the first bullet point says "from". The first paragraph says

"the first publicly confirmed death globally from the swiftly spreading strain"

And the next paragraph says "Britain gave no details on the death other than the person had been diagnosed in hospital."

However I wasn't referring to the news article but actual statements from UK government ministers and health officials' failure to be specific when questioned. For all we know the person was hit by a bus.

If the person was hit by a bus or died from a cause other than Omicron then that would strengthen the point I was making in the post you replied to which was

>>doesn't this suggest that the case fatality rate is a lot lower (not marginally lower)?

> Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening.

With the current data available from SA, EU, and UK, the CFR has not been shown to be marginally lower, but dramatically lower. Things could change, of course, but right now the first part of your statement is really the case (as observed).

Yep, the result of a large number multiplied by a small number is still a large number. It's definitely a worry.

Good explanation of why a milder more contagious variant is bad news : https://twitter.com/AdamJKucharski/status/134356742510788198...

Or more simply, 5x as contagious but 1/2 as deadly? That's still a lot more deaths.

Good chance it means more deaths sooner, but fewer total deaths.

No it’s not. Contagion spread is logarithmic, and has obvious upper bounds. E.g. about a third of the us has gotten Covid. 5x contagious does not give you 166% of the population infected. Nor does it give you 100%. Probably not even 90%. I would bet no more than 50% over the next year.

Half as deadly on the other hand is a big deal. It’s not just deaths, it’s also hospitalizations. If you imagine the bell curve of outcomes, the deaths are the small tail on the right and the hospitalizations are the fatter bit on the right. If you get to move everything to the left a bit, you remove the biggest chunk of the population from getting hospitalized in the first place.

It sounds like you don't know the first thing about epidemiology modelling : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962332/

there really can't be an "exponential" increase in the number of cases, whatever that means, given that there's a hard upper bound which is the number of hosts.

While technically correct, you and I both know what they meant by exponential. Sure, there's a limit, but if we're looking at function that is exponential until it reaches an inflection point where there's simply less hosts to infect than possible...

a rate of change in the rate of change, to wit a second order derivative

By exponential, you mean there’s a steep part but you don’t really know the difference between exponential and logarithmic.

The rapid slowdown of infections is FAR below 100% of people.

> Sure, there's a limit, but if we're looking at function that is exponential until it reaches an inflection point where there's simply less hosts to infect than possible...

What do you think I meant by this? Do you think I believe that the rate of infection will keep going up literally exponentially until it hits 7 billion then turn flat, or do you think that by my usage of 'inflection point' maybe I had more nuance than that?

I took it to mean you’re claiming growth is exponential or nearly exponential until it nears 100% like a sigmoid function.

But that’s wrong. Growth stalls out much much earlier. It’s just not right to call disease spread exponential.

In a math classroom, you are right. But when we're in a context of talking about the disease on an internet forum, you are being needlessly pedantic and extremely nitpick-y if you expect people to describe the ways infections grows as "similar to a sigmoid function" rathan than the well-understood and extremely common "exponential growth" term.

I don’t really care if you say sigmoid when you mean exponential, my point is that both of those are wrong. People shudder in fear of the phrase “exponential” but disease does not spread exponentially. It never does. That’s a laymen fairy tail and it does a great deal of harm in understanding the disease.

Exponential is not well understood. People don’t know what it means, as evidenced by the fact that they consistently use it incorrectly.

>disease does not spread exponentially. It never does. That’s a laymen fairy tail and it does a great deal of harm in understanding the disease.

>Exponential is not well understood. People don’t know what it means, as evidenced by the fact that they consistently use it incorrectly.

Well, in typical Dunning-Krüger fashion you're lecturing us laymen about the wrong use of "exponential", but it seems that you are the layman when it comes to epidemiology modelling.

Diseases of course spread in an initially exponential phase, not logarithmically as you boldly claim in another comment.

Epidemiologists talk about exponential disease growth all the time, here's one example : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962332/

Not the original commenter and agree with your sentiment.

That said, from what we know about random graph models, once the transmission rate passes a certain threshold, the cumulative number of eventually infected individuals will NOT scale exponentially as the transmission rate increases.

You're speaking about initial growth rate though, not convergent size of the once-infected population, which is definitely exponential and relevant if you care about minimizing simultaneous hospitalizations.

A brief initial exponential phase that doesn’t explain the average state of the system is a poor mental model.

Epidemiologists do frequently use exponential growth in discussions of theoretical spreading, but they are not correct. It does not fucking matter. They’re just wrong. Is the long term spread of a disease exponential. No. We can say this with 100% confidence. Why? Because they do not increase exponentially over time. They QUICKLY hit ceilings and inflection points.

This is the problem. If you call a system exponential because it looks like that at the beginning, your estimates of the middle and end will be hugely off. Massively wrong.

It is obviously apparent looking at Covid that it does not spread exponentially. The impact of this understanding is enormous. In an exponential model, a virus that is twice as infectious could be expected to infect 4x as many people over the same period. If the model is logarithmic, twice as infectious will likely result in LESS THAN TWICE the number of people infected.

Scary predictions that a small increase in spreading will exponentially increase the number of infected people do not hold up against observed real world data. We should be cheering on a more spreadable but less deadly disease. Scale matters, of course, but we aren’t seeing anything like that.

If you want to come back to this in one year and check to see if omicron infected even twice the number of people that delta did over the same time period that’s a bet I’d surely take.

That is the https://en.wikipedia.org/wiki/Logistic_function, which is pretty close to exponential growth followed by logarithmic saturation.

Look, no need to be pedantic about this : the only thing that counts here is whether it's still in the initial exponential phase by the time we hit maximum hospital capacity. It seems likely.

Natural immunity is the ONLY way back to a sane planet. It's time you take a step back, look at what happened for two years now, and realize we don't need this insanity anymore.

Given how quickly the virus can infect people and put them in the hospital if unchecked by masking/social distancing/etc. and vaccines, just letting everyone get infected would rapidly overwhelm our health care system and cause a lot of deaths that could have been prevented.

If the world had collectively done nothing about COVID over the past two years, sure, the pandemic might be "over" by now, but the total death toll would likely be much higher than what we'll probably end up with when all this is actually over, given our current path.

I'm not thrilled with how the past two years have gone, but it could have been much, much worse. It could also have been much better, if it weren't for people using the virus to score political points.

Even with a mix of vaccines and natural immunity, I don't think we can rely on natural immunity to solve this. That just doesn't pass the smell test.

The world “experts” clearly didn’t do anything at all these last two years if they are still freaking out about “healthcare collapse”.

There is zero excuse to push lockdowns, masks or any of that nonsense at this point to “protect healthcare”. Healthcare should have been “protected” by now if this is supposed to be a normal thing

> Natural immunity

Gaining herd natural immunity implies a lot more death. Also natural immunity wanes after a while, and variants can work around it.

So no, it's not the only way, nor is it even a certain way at all.

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