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Comment by taeric | Hacker News Reader

"We further found that levels of exhaled viral RNA increased with self-rated symptom-severity, though individual variation was high." I was curious on how high the variation was, so checked that out. There is a fairly wide swing in measurements. Not clear what that means on things. Would love to see more conversation on that.

Most concerning on this, though, is "Levels of exhaled viral RNA did not differ across age, sex, time of day, vaccination status or viral variant." I think the data was clear enough that the vaccines are worth getting. However, this seems to shatter any thoughts folks may have that they are safer to others when they are vaccinated? I know that was at least a hope? (Question as I am not sure that was correct.)

I seem to remember a previous study that showed super spreaders exist out there. In that some individuals shed substantially more virus than others. In ways that we don't understand, yet.

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If you don’t get Covid because you got the vaccine, that’s a benefit to others.

That only happened for a few months in 2021. Since then theh haven't stopped anyone from getting it.

And if the vaccine makes you an asymptomatic carrier, that's a harm to others.

I think it's more useful to start with the question of what is actually happening, and examine the consequences from there. Otherwise, we find ourselves arguing in favor of our priors, which helps no one.

This PR article doesn’t do a good job explaining but it seems the severity was treated as an independent variable and controlled for, so with that assumption the article actually does imply vaccinated individuals shed less - yes the same amount when controlled for severity - but the cases are less severe.

Why I say that is because of the two paragraphs:

“”“ Mild and moderately symptomatic patients with COVID still exhale large amounts of virus, though severely symptomatic cases exhale higher levels on average, the study reports.

Vaccinated and unvaccinated patients exhale similar levels of virus over the course of infection, the research shows.”””

Edit: the actual preprint states “ We further found that levels of exhaled viral RNA increased with self-rated symptom-severity” so some of these statements in the PR article and article aren’t all squaring together.

My quote was from the study, directly.

My interpretation is basically that, to the extent that the vaccine reduces symptoms, it reduces shedding. If you still get sick, you are still shedding. If you are asymptomatic, you shed the same amount no matter your vaccination status.

Edit oops didn’t see it which comment was being referred to at first.

the study says severity was controlled for when assessing the impact of vaccination.

That leads to an obvious problem as vaccines lead to lower severity.

Yeah, I don't know how to make sense of the quote I pulled out, to be honest. Why say that, if everyone that had the vaccine was lower in symptoms? Seems to be the kind of thing you would only say if the vaccinated people in your study were represented across the spread?

It's pretty clear actually. The point the paper is making about vaccine status is this:

If you have strong symptoms, you shed lots of virus, regardless of whether you are vaccinated or not.

From separate studies, we know that if you are vaccinated, you are less likely to have serious symptoms.

Put the two together. Fewer people seriously ill is fewer people shedding lots of virus, and more people vaccinated is fewer people seriously ill

Having these as carve outs, though, gives me pause there. The claim seems to be that, on average, higher symptoms means more shedding. However, trying to control for any other variable results in no significant finding. This would imply that they did not find a correlation between vaccination and severity of symptoms in their testing.

I'm willing to chalk that up to them not having enough vaccinated people in their study. That fits the caveat they give regarding vaccinated people. It does not automatically support your read, though.

I don’t think this is quite right of a reading “This would imply that they did not find a correlation between vaccination and severity of symptoms in their testing.”

Instead, I think a more accurate rough understanding of their process is they first backed out the effect of severity and then checked if vaccine was correlated with that adjusted number - they found it wasn’t. They didn’t make an assessment on how vaccines effect severity.

My read wasn't that they made an assessment of vaccine on severity. Rather, I read that they found that it had no impact on transmission. They found that, on average, self reported severity correlated with transmission. However, they then state that transmission does not correlate with vaccination status.

I could hope that they mean there is no extra relation between vaccination status and transmission above reduced symptoms. I don't know why they would state it in the way they do if that is what they mean, though.

I agree it is poorly stated, but that is what they mean, no extra impact beyond reduced symptoms and the benefit thereof.

How do you know that?

Because their paper states it. That’s what is meant by “when accounting for etc” in:

“We found that vaccinated and unvaccinated participants exhaled similar numbers of SARS-CoV-2 RNA copies (Fig 2C), when accounting for age, sex, presence of co-morbidities, days since symptom onset and symptom severity”

That... doesn't say anything about them exhaling less? It specifically says that they exhibit the same. You can make a logical jump to say that, combined with a high variance but statistically significant link to self reported symptoms, that maybe vaccinated would have people that self report lower levels. But, that is specifically not in the comparison that you quoted. It says only that vaccinated and unvaccinated are not distinguishable.

It’s saying indistinguishable when adjusted for severity.

It’s like saying night and day in Yosemite are equally bright when effects of the sun and moon are controlled for.

Look, this doesn’t appear to be sticking, it’s a basic statistical modeling thing. At this point the options are accept it at face value, study stats, or be like the kid saying “why” 100 times after every explanation.

But they specifically say that differently? As I said in another, you are jumping from severity correlating with vaccine to get to this idea. But, they actually call out self reported severity as correlating. Such that, if the correlations were strong enough it would have also showed up in their control for that variable.

Stated differently, you have variables

  A = self-reported severity
  B = amount shed
  C = vaccinated status

If A and B are correlated, and A and C are correlated, there will a floor to how correlated B and C can be. Their later sentence is that the correlation between B and C is below the significance floor. They never comment on how correlated A and C are. You could argue there is another variable D = Actual Severity, but that is not covered in the statements I remember.

This is where the mistaken reasoning is, they aren’t measuring or reporting on that naive correlation between B and C that you’re focusing on.

They are saying after backing out the correlation between A and B to get adjusted B, there is no correlation between C and adjusted B. That is an ELI5 explanation of their statement “controlled for” about the factors like severity.

Yes their focus is not on how A and C relate, but we know that relation from other sources.

That is what controlled for means. “Hello” means a greeting in English. It’s the definition. Same concept, it’s the meaning of controlled for. It’s what it was defined to mean.

The quote they use is "We found no impact of vaccination status, viral variant, age, sex, or presence of co-morbidities." Specifically, in the section "Exhaled SARS-CoV-2 RNA levels increased with self-reported symptom severity," they say that they found folks with reported severe symptoms were higher than the others. However, it is worded and presented such that really only "severe" was higher. Indeed, figure 3c shows that vaccinated individuals have similar spikes as otherwise. (The CI is actually higher and wider on the chart for vaccinated?) That chart also highlights that people reporting "none" exhale more than people that report "some" and has peaks as high as those that say severe. Really, the "severe" just shows that at that level it is harder to ignore for anyone. (The min is higher.)

Now, the section "Vaccinated and unvaccinated individuals exhaled similar levels of SARS-CoV-2 RNA," calls out the actual high data points for unvaccinated as being actually higher, with a max of 876 to 549. Though, again, it shows the CI is wider for vaccinated.

Again, I'm mostly willing to get behind the claim that vaccinated people shed less. But that isn't strongly supported by the data. The data does support that super spreaders of 500+ exhaled breaths are unvaccinated.

So, if you want to limit the claim to "vaccinated people are kept from severe symptoms," I feel that is mostly known and agreed with today. If you try to move the claim to "vaccinated shed less than unvaccinated," the data clearly indicates that is not supported. Again the 95% CI is higher for vaccinated individuals on this study.

Look, I’m explaining how to interpret the experiment results they report, which they base their analysis and conclusions on.

What I’m doing is going to the original foundation. What you’re looking at is the decorations they put on the foundation.

I’ve explained over and over what their foundational experiment showed as described. stop being hung up on the decorations.

The decorations are pretty bows and wrapping paper. That’s what you’re focusing on. Stop it.

Bob went to France and got annoying no one said “hi” to him. His friend tried to explain what they said, “bonjour” meant hi. He wouldn’t accept it.

We went to the land of academics, I explained what the academese means. You’re not accepting it, focusing instead on the wrong thing.

No, you are adding to it. Literally. Their data shows that vaccinated has a wider and higher 95% CI for exhaled. There are larger outliers in unvaccinated, but the signal in the data that they can isolate shows that you cannot claim vaccinated shed less. Which is why they don't claim that.

You may have tried to go to the land of academics, but you are injecting stronger claims into what this paper reports than they are making. They never say anything about controlling for severity. They only show that self reported severity correlates with more shedding. Though, again, that is with a very high variance across the board for the other severity. Their chart showed, and all they claim, is that there is a correlation of "severe" with higher shedding over the other reported values. Note that this is not reporting that self reported symptoms correlates. It is specifically self reported "severe" does. Indeed, their data shows that folks that report "none" have higher 95% ranges than "mild" reports do.

This is the quote where they state they controlled for severity aka “accounted for”. I already posted it btw. Have a good day. Keep denying it.

“ We found that vaccinated and unvaccinated participants exhaled similar numbers of SARS-CoV-2 RNA copies (Fig 2C), when accounting for age, sex, presence of co-morbidities, days since symptom onset and symptom severity”

Right, and if you read the data they use to make this claim, you see that it supports the fact that vaccinated shed as much as unvaccinated. If you restrict your claim to "vaccinated don't get severe symptoms, and therefore don't have the highest shedding," I agree with you. What you cannot claim, is that vaccinated shed less. At the 95% CI of the data, vaccinated is actually higher for the sample size they have here.

Again, their data literally shows that, outside of samples outside the 95% CI, you can't tell vaccinated from unvaccinated.

I think if you are arguing that this is only breakthrough cases in vaccinated individuals, the stronger claim probably sticks, but they don't have the data to make that claim in this study.

Bonjour. It is clear the proverbial horse does not want water.

Am I misstating the data? Which literally shows more virus exhaled by 95% of all vaccinated versus 95% of unvaccinated?

And where do they state that vaccinated exhale less than unvaccinated? Specifically, where do they say that? They show the total range of exhaled values is larger for unvaccinated, but the 95% range is higher for vaccinated.

It looks dangerously like you are forcing the reading for what you want the truth to be. Not for what the data supports. Note that i want that same value for the truth. I just don't see the data supporting it. And the paper seems to agree, as they are not making as strong of a claim as you are.

This is consistent with the scenario in which the vaccine trials did not lead to the desired outcome ("the pandemic will be cured by the vaccine"), and so institutional powers tried to dress it up as a success. Note that the researchers and authors of this paper do not need to be involved for this to be true. They simply publish a factual result, but it is somehow deformed/ignored during the course of public service campaigns. "Vaccine lowers severity of symptoms" becomes "vaccines work".

More speculatively, with this in mind, it is troubling to think of how the vaccine safety trials may have been interpreted, and why major pharmaceutical companies insisted upon total civil immunity.

>If you are asymptomatic, you shed the same amount no matter your vaccination status.

Which, importantly, is "not nearly as much as a sick person". "Asymptomatic" is just a very very low grade infection, not some magic "you are chock full of virus that you are shedding but somehow unaffected" state.

unfortunately the CDC said early on that if you're vaccinated, you can't spread covid, that's clearly not the case. At this point, the vaccine only seems to prevent severe hospitalization (and that's assuming you still have immunity from your last dose, since it appears your protection wanes to almost nothing after 4-6 months)

Has it been shown that the vaccine keeps you from getting it?

I do think it is worth calling out my point is FAR from a panic moment. The study calls out they had very few vaccinated people, for one. For two, again, the data is clear that you are much safer for yourself if you are vaccinated.

Receiving the COVID vaccine does not prevent the contraction of COVID or ability to spread it, it only lessens the symptoms after infection

Intuitively, it seems that if it reduced symptoms after infection, than it would have been seen as correlated to exhalation.

Now, I realize that it could just negatively correlate with self-reporting symptoms? Or it could be that that correlation between self reporting and how much you exhaled was just very lightly correlated, such that the other correlation is low? Neither of which would be that surprising, I guess. They do disappoint me, for some reason.

> it only lessens the symptoms after infection

No, it also lowers the possibility of becoming ill in the first place, which does make one less likely to infect others

> I think the data was clear enough that the vaccines are worth getting

Unlike like measles or polio, these misnamed 'vaccines' don't prevent getting the disease nor transmitting the virus. I think young healthy people should get the disease, recover, develop antibodies, and be done with it. We did this for chicken pox until a couple decades ago.

>Unlike like measles or polio

The polio vaccine children receive today in the United States is non-steralizing.

If this anti-vaxxer assumption was meaningful, we wouldn't have fewer cases of polio.

>We did this for chicken pox until a couple decades ago.

Fun, because that's having great side effects, notably, that shingles sucks ass, and now that there isn't a giant amount of chickenpox virus in every closed space because kids are vaccinated, my generation has a 1/3 chance to develop shingles, even at a young age. Meanwhile, those kids that were vaccinated do not have such worries.

Oh, and >get the disease, recover, develop antibodies, and be done with it

I guess you aren't familiar with people getting covid multiple times, regardless of vaccination status? It's like how everyone told my mom you can't get mono more than once, despite her having flare ups every year.

The public never knew shit about infectious agents and I really don't care about their opinion, much in the same way I don't ask my grandfather who stopped using Windows in 1996 where to find the network settings.

I'm not familiar with _unvaxed_ people getting coronavirus multiple times (prior infection confirmed by antibody blood test).

I got it once and blood tests show continued strong antibodies. Since then I haven't even had the flu in a couple years. I have heard of many vaxed people getting coronavirus multiple times, including prominent world leaders.

>I'm not familiar with _unvaxed_ people getting coronavirus multiple times (prior infection confirmed by antibody blood test).

Then you simply aren't paying attention. Most of my anti-vax relatives have gotten covid multiple times.

Do they know this from a blood test that looks for antibodies? That is what I did for testing.

The nasal swab amplication test looks for fragments in the air intake filter, not actual infection.

By the way, I had vaccines for polio measles tetanus and others. Being in decent physical health, my doctor confirmed I was not in a risk group which would benefit from the jab which was authorized for emergency use only. The risk/reward for my profile was not worth it.

It absolutely happens, I don't know how you're not familiar with it: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

> I think the data was clear enough that the vaccines are worth getting. However, this seems to shatter any thoughts folks may have that they are safer to others when they are vaccinated?

That's not the correct conclusion from this statement though. Taking the vaccine increases the likelihood that your immune system will be able to get kill the virus almost immediately after exposure, so that you don't start exhibiting symptoms at all. You can still get COVID and thus exhibit symptoms after being vaccinated, it's just less likely.

However, this statement is concerning those who got infected and then started exhibiting symptoms. Of those, i.e. when your immune system wasn't able to immediately deal with the virus and needs to learn how to do it, the viral load expelled was roughly the same in every case, peaking at 8 days. That's probably not too unexpected really, but it does seem to indicate that the immunity given by the vaccine is probably all or nothing for any particular variant you're exposed to - it either works immediately and stops you getting ill, or the immune system still has to start from scratch in figuring it out.

I'm game to see more on that. This study specifically, shows that you can be vaccinated and get it. You will have fewer symptoms, but still shed just as much virus. That is literally what their callout was about, no?

If you are claiming that you are less likely to get it when you are vaccinated, that kind of contradicts a lot of what I've seen out there. I'm happy to learn that is mostly paranoia, though? I haven't actually followed too much there, as it doesn't seem to impact my behavior. I'll get vaccinated when eligible, just as I have done for other things for most of my life.

> This study specifically, shows that you can be vaccinated and get it. You will have fewer symptoms, but still shed just as much virus.

no. the study shows that the vaccine status doesn't change how much you shed for a given level of symptoms. aka high symptomatic => high viral shed. lowly symptomatic => low viral shed.

from the actual pre-print's[0] abstract:

> We further found that levels of exhaled viral RNA increased with self-rated symptom-severity, though individual variation was high. Levels of exhaled viral RNA did not differ across age, sex, time of day, vaccination status or viral variant.

0. https://www.medrxiv.org/content/10.1101/2023.09.06.23295138v...

Apologies, that is inline with what I meant. You will shed proportional to your level of symptoms. If you were vaccinated and still get heavily sick, you will still shed as any other heavily sick person.

That said, the caveat of "though individual variation was high" makes me curious if some of the correlation to self-rated symptom goes away when you only look at something like vaccination status.

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