How long can we wait while flattening the curve?

[mathlete]

With the vaccine rolling out, we’re getting close to being able to say that places like Norway, Finland, Australia, New Zealand, South Korea, Japan, and Taiwan have officially “beat” COVID-19. Congratulations.

Honorable mentions for Germany for being a huge country with an old population in Western Europe, and doing as well as they have.

[habanero]

Honorable mentions for Germany for being a huge country with an old population in Western Europe, and doing as well as they have.

Germany currently, per capita, has about twice as many ICU patients as Sweden. Deaths per capita these days are roughly on par with the US (around 1000/day and 1/4 the population) - death counts per capita in the US and Germany have tracked almost perfectly for 2 months now. About 13% of tests in Germnay are positive. It's oddly enough gone quite a bit under the radar, but Germnay ain't doing very well in the 2nd wave.

[Davnasty]

Honorable mentions for Germany for being a huge country with an old population in Western Europe, and doing as well as they have.

Germany currently, per capita, has about twice as many ICU patients as Sweden. Deaths per capita these days are roughly on par with the US (around 1000/day and 1/4 the population) - death counts per capita in the US and Germany have tracked almost perfectly for 2 months now. About 13% of tests in Germnay are positive. It's oddly enough gone quite a bit under the radar, but Germnay ain't doing very well in the 2nd wave.

I know very little about Germany's situation right now, so I'm not commenting on how well they're doing, just adding some information.

Average age by country:
US: 38.1
Sweden: 41.2
Germany:45.9

So ICU and death stats are not going to work in Germany's favor.

[American GenX]

https://covid19-projections.com/path-to-herd-immunity/

This website makes a fantastic attempt at doing exactly that. :)

Interesting site!
Though from prior experience I'm automatically skeptical of any projection that assume infections will flatten out.. Americans have proven quite incapable of that

Yeah, the experts are often off on their predictions, so I take them all with a grain of salt.

I'll add that they say that COVID-19 is not going to be "beat", it is here to stay.  It will be endemic.

[deborah]

Looks like we probably had fewer deaths than normal in Australia in 2020.

https://www.abc.net.au/news/2021-01-16/deaths-from-respiratory-illnesses-lower-than-usual-amid-covid-19/13041324

[GuitarStv]

Looks like we probably had fewer deaths than normal in Australia in 2020.

https://www.abc.net.au/news/2021-01-16/deaths-from-respiratory-illnesses-lower-than-usual-amid-covid-19/13041324

Hmm.  Maybe now people will stop pretending that suicides skyrocket so much during restrictions that the 'cure is worse than the disease'.

[Abe]

Looks like we probably had fewer deaths than normal in Australia in 2020.

https://www.abc.net.au/news/2021-01-16/deaths-from-respiratory-illnesses-lower-than-usual-amid-covid-19/13041324

Hmm.  Maybe now people will stop pretending that suicides skyrocket so much during restrictions that the 'cure is worse than the disease'.

That article doesn't address suicides as they are reported in a separate system in Australia. However, this article suggests that suicide rates are stable:

https://www.abc.net.au/news/2020-11-19/coronavirus-queensland-suicide-mental-health-deaths-research/12886418

In the US I am almost certain that is has not gone up 8x due to the pandemic, at which point it would be on par with the current death toll. The most recent estimates suggest that high-risk areas (opioid-endemic) had a 30% uptick (projecting across all suicides this would be an increase from 44k to 57k, excess deaths of ~13k), but this included only three months of the pandemic (thus the pre-pandemic baseline increase accounted for most of it).

[mathlete]

Looks like we probably had fewer deaths than normal in Australia in 2020.

https://www.abc.net.au/news/2021-01-16/deaths-from-respiratory-illnesses-lower-than-usual-amid-covid-19/13041324

That's fantastic news!

[OtherJen]

Well, we've hit the 400,000 COVID death mark here in the US. That's equivalent to more than 134 9/11 death tolls.

https://www.nbcnews.com/news/us-news/u-s-covid-19-death-toll-nears-400-000-n1254575

[GuitarStv]

Well, we've hit the 400,000 COVID death mark here in the US. That's equivalent to more than 134 9/11 death tolls.

https://www.nbcnews.com/news/us-news/u-s-covid-19-death-toll-nears-400-000-n1254575

After 9/11 airport security started making me take my shoes off, taking naked pictures of me walking around, and prevented me from bringing more than a couple oz of shampoo.  Scary to imagine what they have in store for us after this . . .


:P

[Paper Chaser]

When do we think that we will start seeing the death curve flattened?  I do not expect to see much of a difference in the new case curve, but once the most vulnerable get the vaccine I do think we will see the total deaths start to flatten.  Maybe March?

On a national level, I'm going to guess late Jan/early Feb. CA's case numbers are still rising enough to offset decreasing cases in other places. That being said, hospitalizations started declining in the red hot Midwest around Thanksgiving:



And 7 day average for deaths are declining in 14 states while flat in another 18, so hopefully that trend continues to improve:

On a national level, cases, hospitalizations and deaths are all officially declining:

[marty998]

On a national level, cases, hospitalizations and deaths are all officially declining:

[snipped lots of pretty graphs]

Steady on, you guys have just stepped down from the summit of Everest. Still above the proverbial 8,000 metre death zone.

But a decline is encouraging nonetheless.

[alsoknownasDean]

On a national level, cases, hospitalizations and deaths are all officially declining:

[snipped lots of pretty graphs]

Steady on, you guys have just stepped down from the summit of Everest. Still above the proverbial 8,000 metre death zone.

But a decline is encouraging nonetheless.

I wonder how much of that corresponds to Christmas/New Year being a number of weeks back. But yeah, hopefully things get better over there. I'm amazed that it's taken until now for the US to require quarantine for all international arrivals, but yeah, previous administration and all of that.

Interesting here about the tennis players complaining about spending 2 weeks in quarantine. Of course the countries many are coming from have tens of thousands of new cases per day. One of the players who complained about it recently tested positive.

[kenmoremmm]

optimism in the air?
https://evergreensmallbusiness.com/covid-19-economic-uncertainty-update/

[Kyle Schuant]

A lengthy and useful review of the effectiveness of various measures across countries.

https://www.nature.com/articles/s41562-020-01009-0

[American GenX]

Bad news if you were hoping for herd immunity from previous infection and the vaccine:

"Vaccines may not work against the coronavirus variant detected in South Africa, research shows. People may also face a risk of reinfection.  New research shows the mutated strain can evade the antibodies developed in response to vaccination or infection"

https://www.businessinsider.com/coronavirus-variant-south-africa-vaccines-2021-1

[former player]

Bad news if you were hoping for herd immunity from previous infection and the vaccine:

"Vaccines may not work against the coronavirus variant detected in South Africa, research shows. People may also face a risk of reinfection.  New research shows the mutated strain can evade the antibodies developed in response to vaccination or infection"

https://www.businessinsider.com/coronavirus-variant-south-africa-vaccines-2021-1

There have been nearly 100 million covid infections world-wide, so this is bad news but not entirely unexpected.

There doesn't seem to be much hope that enough vaccines will be given in time to entirely stop covid-19 even in economically advanced countries during 2021.  That means more time for the virus to mutate.  A realistic scenario is that covid-19 and its variants become as endemic as the flu but with a higher death and morbidity rate, especially in the elderly but unpredictably across entire populations.

[GuitarStv]

Bad news if you were hoping for herd immunity from previous infection and the vaccine:

"Vaccines may not work against the coronavirus variant detected in South Africa, research shows. People may also face a risk of reinfection.  New research shows the mutated strain can evade the antibodies developed in response to vaccination or infection"

https://www.businessinsider.com/coronavirus-variant-south-africa-vaccines-2021-1

Fuck.

[chemistk]

Bad news if you were hoping for herd immunity from previous infection and the vaccine:

"Vaccines may not work against the coronavirus variant detected in South Africa, research shows. People may also face a risk of reinfection.  New research shows the mutated strain can evade the antibodies developed in response to vaccination or infection"

https://www.businessinsider.com/coronavirus-variant-south-africa-vaccines-2021-1

It's important to share this type of information, but the hot takes are unnecessary.

From the article:

Pfizer has said it could update its shots to combat new variants in just six weeks.

"Based on Penny's data, it's likely that the vaccine is going to be somewhat less effective, but how much less effective we don't know,"

The research also did not look at other elements of the immune system, like B cells, which play a critical role in developing new antibodies.

Nathan Grubaugh, an epidemiologist from the Yale School of Public Health, said it's hard to tell how well laboratory tests translate to reality in the body. A 90% reduction in protection during a lab test "may still mean complete protection in a human," he told Insider.

Even if the variant does reduce how well current vaccines work, that doesn't mean protection from infection disappears completely, experts say.

"We often talk about immunity as sort of an all-or-nothing thing, but it's not," Jennie Lavine, a postdoctoral biology researcher at Emory University, told Insider.

The ideal level of protection is sterilizing immunity — when "we have such good immunity in the right places that the virus can't even replicate if it gets in," Lavine said.

"The Pfizer and Moderna vaccines are 95% effective — that's an extraordinary level of efficacy," Montefiori told CNN. "If it reduces to 90, 80, 70% effective, that is still very, very good and likely to have a major impact on the pandemic."

-----

And this is a Business Insider article covering a preliminary study. While they do a good job tempering the initial bad news, it's still incredibly premature to draw conclusions from the article.

[former player]

Here is some more (preliminary) bad news: the UK variant may not just be more contagious but also more deadly -

https://www.bbc.com/news/health-55768627

[American GenX]

Here is some more (preliminary) bad news: the UK variant may not just be more contagious but also more deadly -

https://www.bbc.com/news/health-55768627

I just came back to post that additional bad news.  You beat me to it.

[Paper Chaser]

On a national level, cases, hospitalizations and deaths are all officially declining:

[snipped lots of pretty graphs]

Steady on, you guys have just stepped down from the summit of Everest. Still above the proverbial 8,000 metre death zone.

But a decline is encouraging nonetheless.

I wonder how much of that corresponds to Christmas/New Year being a number of weeks back.

I'm sure that's part of it, but interestingly enough some regions of the US never really saw holiday spikes.

Also interesting, is the national rate of decline in cases, which is much steeper than previous declines (the small drops in late Nov and Dec were primarily due to less testing/reporting around holidays).

[MudPuppy]

Does your state post their data with a % positive number? Our state has had a modest decline in % positives.

[dandarc]

Doesn't look like the case in Florida anyway - testing is actually higher than it was in December if we can believe the state's dashboard. I'm sure it varies by area. Percent positive up statewide even with the increased number of tests, so I doubt it is just a post-holidays rebound.

[OtherJen]

On a national level, cases, hospitalizations and deaths are all officially declining:

[snipped lots of pretty graphs]

Steady on, you guys have just stepped down from the summit of Everest. Still above the proverbial 8,000 metre death zone.

But a decline is encouraging nonetheless.

I wonder how much of that corresponds to Christmas/New Year being a number of weeks back.

I'm sure that's part of it, but interestingly enough some regions of the US never really saw holiday spikes.

Also interesting, is the national rate of decline in cases, which is much steeper than previous declines (the small drops in late Nov and Dec were primarily due to less testing/reporting around holidays).

We didn't in Michigan. Our restaurants and bars have been closed for indoor service since early November, so no big workplace holiday parties, no packed restaurants on Thanksgiving, no NYE bashes. It's made a significant difference in controlling the spread.

[HBFIRE]

https://www.nbclosangeles.com/news/local/uc-irvine-scientists-working-on-covid-19-vaccine-that-would-attack-all-strains/2510566/?fbclid=IwAR31IASecjCyi4uWGJBlAh8hHwY0qzjENYVgUfP0GMXdyqAEn_rFaDIg9-c

[dandarc]

Reads a lot like the universal flu vaccine that was featured in the Pandemic documentary, although if I recall those scientists, rather than shooting to vaccinate against one or two dozen proteins were looking to target the 'unchanging' parts of the flu virus.

[Paper Chaser]

On a national level, cases, hospitalizations and deaths are all officially declining:

[snipped lots of pretty graphs]

Steady on, you guys have just stepped down from the summit of Everest. Still above the proverbial 8,000 metre death zone.

But a decline is encouraging nonetheless.

I wonder how much of that corresponds to Christmas/New Year being a number of weeks back.

I'm sure that's part of it, but interestingly enough some regions of the US never really saw holiday spikes.

Also interesting, is the national rate of decline in cases, which is much steeper than previous declines (the small drops in late Nov and Dec were primarily due to less testing/reporting around holidays).

We didn't in Michigan. Our restaurants and bars have been closed for indoor service since early November, so no big workplace holiday parties, no packed restaurants on Thanksgiving, no NYE bashes. It's made a significant difference in controlling the spread.

Since state approaches can vary a lot I find the "regional" data interesting. In some cases data for a "region" is dominated by a single large/populous state, but it's often the case that states within a region have pretty similar curves. The Midwest region saw declines begin before Thanksgiving, and there were no bumps for Thanksgiving or Christmas/New Years. It seems like most of the Midwestern states that I've looked at had very similar curves/timing, regardless of measures taken or how well those measures were followed. For example, my Midwestern state has been more lax than MI about indoor dining, etc. While lots of holiday gatherings that I'm aware of were scaled down, and involved limited travel, plenty of them still took place. Yet the data for cases, hospitalizations and positivity rate in my state essentially peaked at/before Thanksgiving and has been declining steadily since then. The virus is weird.

[Longwaytogo]

Strange times. I thought that Biden would try to pressure for some sort of stricter lockdown on the Federal level or even ban domestic flights for two weeks or something.

Instead the opposite seems to be happening with two High profile Governors of states (Newsom/CA and Cuomo/NY) with strict lockdowns having started to ease restrictions or end lockdowns.  Our gov Hogan (MD) out of nowhere suddenly insists that Schools can somehow open March 1st and lifted his indoor dining ban?

Meanwhile on a personal level folks I've not seen since Sept are now inviting us for dinner/Super bowl, etc.? And I've heard multiple folks who have been taking it very seriously and been patient suddenly be like "may as well just all get it and see what happens" or "the Spanish flu lasted 18 months without a Vaccine, how long is this gonna take" etc.

Obviously the US hasn't really been "flattening the curve" at all or in a long time; but there has seemed to be a collective "we're done" in the last week. Anyone else noticing that at all?

[windytrail]

Strange times. I thought that Biden would try to pressure for some sort of stricter lockdown on the Federal level or even ban domestic flights for two weeks or something.

Instead the opposite seems to be happening with two High profile Governors of states (Newsom/CA and Cuomo/NY) with strict lockdowns having started to ease restrictions or end lockdowns.  Our gov Hogan (MD) out of nowhere suddenly insists that Schools can somehow open March 1st and lifted his indoor dining ban?

Meanwhile on a personal level folks I've not seen since Sept are now inviting us for dinner/Super bowl, etc.? And I've heard multiple folks who have been taking it very seriously and been patient suddenly be like "may as well just all get it and see what happens" or "the Spanish flu lasted 18 months without a Vaccine, how long is this gonna take" etc.

Obviously the US hasn't really been "flattening the curve" at all or in a long time; but there has seemed to be a collective "we're done" in the last week. Anyone else noticing that at all?

I am only following California's story closely, so can't comment on the other states. Here, even outdoor dining has been banned for weeks, despite there being no evidence that outdoor dining spreads the virus (the only study to look at this conflated outdoor and indoor dining into one metric). At least two lawsuits brought by the Restaurants Association are pending in the state, claiming that the outdoor dining ban was arbitrary and capricious. 

Secondly, the state had been using a secret algorithm to calculate projected ICU capacity (a metric used to keep counties locked down), claiming that the public "wouldn't understand" it, which, unsurprisingly, pissed off many people.

Third, the Governor is facing a recall effort, with 1.2 million of the 1.5 million signatures needed to qualify having already been gathered. His dining at the French Laundry restaurant in Napa with other households -- flouting local and state restrictions -- helped spearhead the recall campaign.

In sum, California is facing a huge backlash from its decision to ban outdoor dining and its ongoing failure to reopen public schools, despite having no solid evidence that these activities will spread the virus. The public has gotten smart and no longer tolerates such measures. That is why restrictions are being eased.

[HBFIRE]

Third, the Governor is facing a recall effort, with 1.2 million of the 1.5 million signatures needed to qualify having already been gathered. His dining at the French Laundry restaurant in Napa with other households -- flouting local and state restrictions -- helped spearhead the recall campaign.

In sum, California is facing a huge backlash from its decision to ban outdoor dining and its ongoing failure to reopen public schools, despite having no solid evidence that these activities will spread the virus. The public has gotten smart and no longer tolerates such behavior. That is why restrictions are being eased.

Spot on.  I'm a bit torn.  On the one hand, CA has done a relatively outstanding job in terms of managing covid (it remains one of the lowest states in terms of covid deaths per capita, despite having to deal with a huge population and population density -- just look at AZ for example, its close neighbor - nearly twice the deaths per capita).  On the other hand, the points you've outlined above are all accurate. 

[HPstache]

Strange times. I thought that Biden would try to pressure for some sort of stricter lockdown on the Federal level or even ban domestic flights for two weeks or something.

Instead the opposite seems to be happening with two High profile Governors of states (Newsom/CA and Cuomo/NY) with strict lockdowns having started to ease restrictions or end lockdowns.  Our gov Hogan (MD) out of nowhere suddenly insists that Schools can somehow open March 1st and lifted his indoor dining ban?

Meanwhile on a personal level folks I've not seen since Sept are now inviting us for dinner/Super bowl, etc.? And I've heard multiple folks who have been taking it very seriously and been patient suddenly be like "may as well just all get it and see what happens" or "the Spanish flu lasted 18 months without a Vaccine, how long is this gonna take" etc.

Obviously the US hasn't really been "flattening the curve" at all or in a long time; but there has seemed to be a collective "we're done" in the last week. Anyone else noticing that at all?

These sentiments you are seeing along with the "open in March for dining" stuff kind of makes sense.  At some point in the near future, the front line and most vulnerable people will have had their chance for the vaccine.  At which point the "I'm not seeing my family, staying in, not traveling, etc. to protect the most vulnerable" reasoning becomes less true and it becomes only a risk only to those most likely to have mild symptoms and an extremely low chance of death.

[Longwaytogo]

Third, the Governor is facing a recall effort, with 1.2 million of the 1.5 million signatures needed to qualify having already been gathered. His dining at the French Laundry restaurant in Napa with other households -- flouting local and state restrictions -- helped spearhead the recall campaign.

In sum, California is facing a huge backlash from its decision to ban outdoor dining and its ongoing failure to reopen public schools, despite having no solid evidence that these activities will spread the virus. The public has gotten smart and no longer tolerates such behavior. That is why restrictions are being eased.

Spot on.  I'm a bit torn.  On the one hand, CA has done a relatively outstanding job in terms of managing covid (it remains one of the lowest states in terms of covid deaths per capita, despite having to deal with a huge population and population density -- just look at AZ for example, its close neighbor - nearly twice the deaths per capita).  On the other hand, the points you've outlined above are all accurate.

Similarly torn.

Somehow Maryland seemed to avoid the original Northeast (NY, NJ, CT) surge last Spring and the Summer surge in the south (FL, TX,AZ) and even the recent Holiday/winter surge wasnt as bad as most places.

So on the one hand it's like keep it up we're fairing well. But on the other hand This Virtual school is for the birds :(

[Paper Chaser]

Cases continue to see significant decline, now across all regions:


As for CA specifically:


While they're now trending in the right direction like most of the US, they've now had more than 3 million confirmed cases, which means more than 1 in every 13 Californians has contracted COVID. Those numbers aren't much better than the Dakotas last fall when they were getting all kinds of criticism and political fallout. And CA has had much tighter restrictions than the Dakotas did. I think some criticism of leadership is valid.

[waltworks]

Something like 6% of our state is vaccinated now. That's almost entirely frontline/medical and elderly/vulnerable people. Once we hit ~15-20%, that entire population (assuming they're willing) will have been vaccinated, and there's really no reason to keep doing any locking down at that point, IMO. March seems like a doable target to hit those numbers at least here, so if MD is similar, I'm not surprised they plan to send kids back to school then (though to be fair they should have been in school the whole time).

-W

[HBFIRE]

While they're now trending in the right direction like most of the US, they've now had more than 3 million confirmed cases, which means more than 1 in every 13 Californians has contracted COVID. Those numbers aren't much better than the Dakotas last fall when they were getting all kinds of criticism and political fallout. And CA has had much tighter restrictions than the Dakotas did. I think some criticism of leadership is valid.

The Dakotas have tested ~ 500 K/M population.  They are approaching 2000 deaths / M population.   CA has done over 1 M/1M residents (yes, more tests than actual population), and has under 1 K deaths / M population.  Covid positives need to be taken in context with testing volume.  It's largely a function of how many cases you are identifying, and not real infection numbers.  Unfortunately there is still a lot of testing volume variance from state to state.  This is why I think deaths per million is a better apples to apples comparison. 

[deborah]

Something like 6% of our state is vaccinated now. That's almost entirely frontline/medical and elderly/vulnerable people. Once we hit ~15-20%, that entire population (assuming they're willing) will have been vaccinated, and there's really no reason to keep doing any locking down at that point, IMO. March seems like a doable target to hit those numbers at least here, so if MD is similar, I'm not surprised they plan to send kids back to school then (though to be fair they should have been in school the whole time).

-W

Depends what your aim is. At least 30% of people with even mild cases have debilitating after effects. Is your aim to minimise deaths or to reduce the ongoing problems?

The more people who get it, the more variations we’ll have. The latest variations (British and South African) are supposed to cause more deaths in younger people and are more virulent.

[GuitarStv]

Something like 6% of our state is vaccinated now. That's almost entirely frontline/medical and elderly/vulnerable people. Once we hit ~15-20%, that entire population (assuming they're willing) will have been vaccinated, and there's really no reason to keep doing any locking down at that point, IMO. March seems like a doable target to hit those numbers at least here, so if MD is similar, I'm not surprised they plan to send kids back to school then (though to be fair they should have been in school the whole time).

-W

Depends what your aim is. At least 30% of people with even mild cases have debilitating after effects. Is your aim to minimise deaths or to reduce the ongoing problems?

The more people who get it, the more variations we’ll have. The latest variations (British and South African) are supposed to cause more deaths in younger people and are more virulent.

One in twenty fully vaccinated people will still get regular covid.  Estimates are that about one in five fully vaccinated people will get the UK variant of covid.  To date we still don't know if fully vaccinated people can transmit the virus to those who have not been vaccinated, so health professionals are saying that we should act as though they can.

20% of population is nowhere near enough to provide herd immunity.

[HBFIRE]

One in twenty fully vaccinated people will still get regular covid. 

Careful, this is not what 95% efficacy means....the phase 3 trial results concluded you are 95% less susceptible to getting sick compared to someone not vaccinated (initial trials were to determine your protection from getting sick, not infected).  How susceptible you are to getting sick is mostly a function of how prevalent the virus is in your environment.  With herd immunity, the chances of getting sick if you are vaccinated is close to 0.  Of those vaccinated, we should expect a very low rate and we should expect it to continually decline as more of the population gets vaccinated and infected.  Israel is actually gathering this data as we speak.

Estimates are that about one in five fully vaccinated people will get the UK variant of covid.

Source?  This seems wildy inaccurate.  Likely someone misinterpreted something.

[GuitarStv]

One in twenty fully vaccinated people will still get regular covid. 

Careful, this is not what 95% efficacy means....it means you are 95% less susceptible to being infected compared to someone not vaccinated.  How susceptible you are is a function of how prevalent the virus is in your environment.  With herd immunity, the chances of being infected if you are vaccinated is close to 0.  Of those vaccinated, we should expect a very low infection rate and we should expect it to continually decline as more of the population gets vaccinated and infected.  Israel is actually gathering this data as we speak.

Valid.  One in twenty fully vaccinated people will still get regular covid if exposed.  Of course, in most of the US the chances of exposure seem pretty high.

Estimates are that about one in five fully vaccinated people will get the UK variant of covid.

Source?  This seems wildy inaccurate.  Likely someone misinterpreted something.

Moderna said that there was a sixfold reduction from 95% to 70% effective (or 3 in 10 exposed will be infected) against SA, (not UK variant - seems to be unchanged against that one):
https://investors.modernatx.com/news-releases/news-release-details/moderna-covid-19-vaccine-retains-neutralizing-activity-against

Pfizer hasn't commented yet, but I'd be surprised if there isn't a similar issue given how the same techniques were used to develop both vaccines.

[Davnasty]

Something like 6% of our state is vaccinated now. That's almost entirely frontline/medical and elderly/vulnerable people. Once we hit ~15-20%, that entire population (assuming they're willing) will have been vaccinated, and there's really no reason to keep doing any locking down at that point, IMO. March seems like a doable target to hit those numbers at least here, so if MD is similar, I'm not surprised they plan to send kids back to school then (though to be fair they should have been in school the whole time).

-W

Depends what your aim is. At least 30% of people with even mild cases have debilitating after effects. Is your aim to minimise deaths or to reduce the ongoing problems?

The more people who get it, the more variations we’ll have. The latest variations (British and South African) are supposed to cause more deaths in younger people and are more virulent.

One in twenty fully vaccinated people will still get regular covid.  Estimates are that about one in five fully vaccinated people will get the UK variant of covid.  To date we still don't know if fully vaccinated people can transmit the virus to those who have not been vaccinated, so health professionals are saying that we should act as though they can.

20% of population is nowhere near enough to provide herd immunity.

That's not what Ander's Tegnell said :)

https://www.cnbc.com/2020/04/22/no-lockdown-in-sweden-but-stockholm-could-see-herd-immunity-in-weeks.html

Tegnell said sampling and modeling data indicated that 20% of Stockholm’s population is already immune to the virus, and that “in a few weeks’ time we might reach herd immunity

Sorry, this article from last April isn't all that relevant to your post but it seemed like a good segue. I came across it this morning and thought it was an interesting artifact from the debate we were having in this thread 9 months ago.

[HBFIRE]

Valid.  One in twenty fully vaccinated people will still get regular covid if exposed.  Of course, in most of the US the chances of exposure seem pretty high.

Sorry, how did you come up with this 1/20 number will get covid if exposed?   This isn't what 95% efficacy means.  You're misinterpreting what the trial results mean.

Moderna said that there was a sixfold reduction from 95% to 70% effective (or 3 in 10 exposed will be infected) against SA, (not UK variant - seems to be unchanged against that one):

No, its a six fold reduction in neutralizing titers.  This does not translate to a 6 fold decrease in efficacy.  It's far more complicated than that.   Gotta be careful with interpreting this information.

The Moderna vaccine had geometric mean titers (GMT) of around 800,000-1,000,000 following the second dose when using the approved 100ug dose. If you assumed every patient had a 6-fold reduction in those titers, they would give titers that are still quite high (~150,000) and still capable of being strongly neutralizing. This assumption is backed by the pseudovirus neutralization data showing that despite these lower titers, you can still neutralize the variant virus pretty efficiently.

By itself, 6x reduced does not mean too much. If the theoretical cut-off for antibodies to be affect is a GMT of 50,000 - then even a 6x reduction would still result in excess antibodies. Of course, this is a gross simplification, we do not know exactly cut-offs or correlates of protection, and there are other aspects to immunity outside of antibodies. Overall though, the big key data is that the sera can still neutralize pseudovirus without escape.

[GuitarStv]

Valid.  One in twenty fully vaccinated people will still get regular covid if exposed.  Of course, in most of the US the chances of exposure seem pretty high.

Sorry, how did you come up with this 1/20 number will get covid if exposed?   This isn't what 95% efficacy means.  You're misinterpreting what the trial results mean.

I was under the impression that efficacy of a vaccine meant the percentage reduction in a disease in a group of people who received a vaccination in a clinical trial.  So, if a vaccine has 95% efficacy, that means that 1 in 20 people in the control group of the study still got the disease after vaccination.

Could you explain what you believe vaccine efficacy means, and what I'm getting wrong?

[HBFIRE]

I was under the impression that efficacy of a vaccine meant the percentage reduction in a disease in a group of people who received a vaccination in a clinical trial.  So, if a vaccine has 95% efficacy, that means that 1 in 20 people in the control group of the study still got the disease after vaccination.

Could you explain what you believe vaccine efficacy means, and what I'm getting wrong?

No problem, I think a lot of people think this.  The phase 3 trial was actually just testing for efficacy against getting sick.

Pfizer, for example, recruited ~ 43 K volunteers.   Then they waited for 170 people to become symptomatic with Covid-19 symptoms and tested them.  Out of these 170, 162 had received a placebo shot, and just eight had received the real vaccine.

Then they determined the relative difference between those two groups. This is called "efficacy".   Essentially, the data results from this study showed that those who were vaccinated represented only ~ 5% of those who ended up "sick" and tested positive.   95% were unvaccinated.

Notice it didnt measure infection rates, as many in the study could have been asymptomatic.

[GuitarStv]

I was under the impression that efficacy of a vaccine meant the percentage reduction in a disease in a group of people who received a vaccination in a clinical trial.  So, if a vaccine has 95% efficacy, that means that 1 in 20 people in the control group of the study still got the disease after vaccination.

Could you explain what you believe vaccine efficacy means, and what I'm getting wrong?

No problem, I think a lot of people think this.  The phase 3 trial was actually just testing for efficacy against getting sick.

Pfizer, for example, recruited ~ 43 K volunteers.   Then they waited for 170 people to become symptomatic with Covid-19 symptoms and tested them.  Out of these 170, 162 had received a placebo shot, and just eight had received the real vaccine.

Then they determined the relative difference between those two groups. This is called "efficacy".   Essentially, the data results from this study showed that those who were vaccinated represented only ~ 5% of those who ended up "sick" and tested positive.   95% were unvaccinated.

Notice it didnt measure infection rates, as many in the study could have been asymptomatic.

Where are you getting that definition from?

It doesn't match:
https://en.wikipedia.org/wiki/Vaccine_efficacy
"Vaccine efficacy is the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group, using the most favorable conditions."

of https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section6.html
"Vaccine efficacy/effectiveness (VE) is measured by calculating the risk of disease among vaccinated and unvaccinated persons and determining the percentage reduction in risk of disease among vaccinated persons relative to unvaccinated persons. The greater the percentage reduction of illness in the vaccinated group, the greater the vaccine efficacy/effectiveness."

or this article from the NY Times (https://www.nytimes.com/2020/12/13/learning/what-does-95-effective-mean-teaching-the-math-of-vaccine-efficacy.html), which breaks down the exact numbers and infection rates used in the covid trial to explain efficacy . . .

21,830 were in the placebo group (162 got infected)
21,830 were in the vaccine group (8 got infected)

Since roughly the same numbers would be expected to get infected in both groups, 8/162 gives us 5% of people who we expected were exposed to covid and were fully vaccinated became sick in the trial.

[HBFIRE]

Where are you getting that definition from?




or this article from the NY Times (https://www.nytimes.com/2020/12/13/learning/what-does-95-effective-mean-teaching-the-math-of-vaccine-efficacy.html), which breaks down the exact numbers and infection rates used in the covid trial to explain efficacy . . .

21,830 were in the placebo group (162 got infected)
21,830 were in the vaccine group (8 got infected)

Since roughly the same numbers would be expected to get infected in both groups, 8/162 gives us 5% of people who were fully vaccinated who became sick.

I believe you're mistaken.

See the bolded part, this is where you're messing up.  These numbers represent those who got symptomatic and then tested positive for covid, not total infections.  They only tested those who got sick.

Efficacy, in terms of this trial, was trying to measure your probability of getting "sick" with covid (symptomatic) with the vaccine compared to someone not vaccinated.  So the results don't mean you have a 5% chance in general of getting infected.  It's a 5% chance of getting "sick"/symptomatic compared to someone unvaccinated with the disease prevalence in the environment during the study.

The 5% statistic, does not represent your probability of getting infected with covid.  It's taking a pool of people who got sick (out of a much larger pool), and determining what percentage was vaccinated.  That's all.  So, if the data is robust enough to be reliable, we can say those who are vaccinated reduce their chances of getting sick with covid by 95% (not taking age or other characteristics into account).  Real world data is going to differ for a lot of reasons -- a big one being disease prevalance in the environment.

It will be interesting to get more data regarding infection rates once it comes out, but we're not there yet.

[GuitarStv]

Where are you getting that definition from?




or this article from the NY Times (https://www.nytimes.com/2020/12/13/learning/what-does-95-effective-mean-teaching-the-math-of-vaccine-efficacy.html), which breaks down the exact numbers and infection rates used in the covid trial to explain efficacy . . .

21,830 were in the placebo group (162 got infected)
21,830 were in the vaccine group (8 got infected)

Since roughly the same numbers would be expected to get infected in both groups, 8/162 gives us 5% of people who were fully vaccinated who became sick.

I believe you're mistaken.

See the bolded part, this is where you're messing up.  These numbers represent those who got symptomatic and then tested positive for covid, not total infections.  They only tested those who got sick.

Efficacy, in terms of this trial, was trying to measure your probability of getting "sick" with covid (symptomatic) with the vaccine compared to someone not vaccinated.  So the results don't mean you have a 5% chance in general of getting infected.  It's a 5% chance of getting "sick"/symptomatic compared to someone unvaccinated with the disease prevalence in the environment during the study.

The 5% statistic, does not represent your probability of getting infected with covid.  It's taking a pool of people who got sick (out of a much larger pool), and determining what percentage was vaccinated.  That's all.  So, if the data is robust enough to be reliable, we can say those who are vaccinated reduce their chances of getting sick with covid by 95% (not taking age or other characteristics into account).  Real world data is going to differ for a lot of reasons -- a big one being disease prevalance in the environment.

It will be interesting to get more data regarding infection rates once it comes out, but we're not there yet.

So your argument is that more people may have been vaccinated and infected . . . but were asymptomatic?

[HBFIRE]

So your argument is that more people may have been vaccinated and infected . . . but were asymptomatic?

I'm not making any argument here, just trying to clarify what we can actually conclude from the vaccine studies done so far.  I think it's important to be careful with that, as there is a ton of misinformation going around.   The statement "you have 1 in 20 chance of getting infected if you are vaccinated" is a very wrong conclusion to make for a multitude of reasons.  The primary one, of course, is that chances of infection are relative to disease prevalance.  The other big one is that we didn't test for infection rates among vaccinations.   It's also wrong to conclude from the studies "1 in 20 chance of getting sick with covid" with a vaccination, as thats not what was concluded either.  The only thing the limited study concluded is that ~ 5% of those who got sick with covid during the trial period were vaccinated.   Many inferences can be drawn from this, but we have to be careful to not draw conclusions that aren't necessarily accurate.

[GuitarStv]

So your argument is that more people may have been vaccinated and infected . . . but were asymptomatic?

I'm not making any argument here, just trying to clarify what we can actually conclude from the vaccine studies done so far.  I think it's important to be careful with that, as there is a ton of misinformation going around.   The statement "you have 1 in 20 chance of getting infected if you are vaccinated" is a very wrong conclusion to make for a multitude of reasons.  The primary one, of course, is that chances of infection are relative to disease prevalance.  The other big one is that we didn't test for infection rates among vaccinations.   It's also wrong to conclude from the studies "1 in 20 chance of getting sick with covid" with a vaccination, as thats not what was concluded either.  The only thing the limited study concluded is that ~ 5% of those who got sick with covid during the trial period were vaccinated.   Many inferences can be drawn from this, but we have to be careful to not draw conclusions that aren't necessarily accurate.

My original point was simply that these vaccines do not provide full protection against covid . . . and that people should not assume that it does.

[Longwaytogo]

So your argument is that more people may have been vaccinated and infected . . . but were asymptomatic?

I'm not making any argument here, just trying to clarify what we can actually conclude from the vaccine studies done so far.  I think it's important to be careful with that, as there is a ton of misinformation going around.   The statement "you have 1 in 20 chance of getting infected if you are vaccinated" is a very wrong conclusion to make for a multitude of reasons.  The primary one, of course, is that chances of infection are relative to disease prevalance.  The other big one is that we didn't test for infection rates among vaccinations.   It's also wrong to conclude from the studies "1 in 20 chance of getting sick with covid" with a vaccination, as thats not what was concluded either.  The only thing the limited study concluded is that ~ 5% of those who got sick with covid during the trial period were vaccinated.   Many inferences can be drawn from this, but we have to be careful to not draw conclusions that aren't necessarily accurate.

My original point was simply that these vaccines do not provide full protection against covid . . . and that people should not assume that it does.

Sure it's not FULL protection; but 95% is pretty damn effective especially as more people get the Vaccine your less and less likely to be exposed.

Also seems we need to be careful not to undersell the vaccine. Already in the US as much as half the population is skeptical of it.

I've already heard multiple people this week "well if it doesn't work against the UK/South Africa/CA varirty anyway then why bother get it"

Fine line I guess between overselling/underselling but I would think in the US at least overselling it is the less of two evuls3 right now ?