COVID-19 Megathread 6: Return of the Omicron

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Even if the vaccinated can spread the virus as easily as the unvaccinated, which I doubt, only the unvaccinated are going to get seriously ill.

I wish you were right, but unfortunately you are incorrect.

I can only assume that you didn't actually look at the CDC presentation (and other related studies and data that have come out over the past day or two), or else you didn't understand.

https://www.washingtonpost.com/context/cdc-breakthrough-infections/94390e3a-5e45-44a5-ac40-2744e4e25f2e/

According to the CDC, 15% of deaths in may and 9% of hospitalizations in the USA were among fully vaccinated people:



This time period (May) is while vaccines were still relatively "fresh" in the immune systems of most vaccinated Americans, and was also before the delta variant started becoming really prevalent/dominant. Once we start getting to the 6+ month period after people got their 2nd dose, and now that delta is prevalent rather than the earlier less virulent variants, there is plenty of reason to fear that this may go up further.

Here's a graph showing the CDC's estimated fatality rate and transmissability ranges for the delta variant. Clearly it is much more transmissable, but the worrying thing is also that it has a higher fatality rate. If you are not used to looking at graphs like this, the important thing you need to realize is the Y axis (fatality rate) is shown on a logarithmic scale, not a linear scale. That means that each unit by which you go higher on the graph is exponentially larger, not just linearly larger. So while visually it looks like the fatality rate is only slightly higher, it is higher by more than it looks.



CDC also references studies indicating that the delta variant has higher hospitalization and death rates (not surprising given the higher viral loads with the delta variant):



This unfortunately confirms a lot of what I was worried about and explained a couple of pages back in a few different posts in this thread. The fact that CDC's estimates are indeed that the delta variant has a higher fatality rate than previous variants is very bad, not just because it will directly mean more deaths (and more severe illness), but also because it suggests that viral evolution is NOT selecting for less deadly variants, but instead that deadliness and transmissablity are going hand in hand (both are associated with increased virulence and higher viral loads). That means that there is a very worrisome probability that the next variant that arises after Delta (and the one after that, and the one after that...) will have an even higher fatality rate. If virulence and the base fatality rate continue to rise as new more virulent variants evolve, then things will get hairy for those of who are vaccinated, even given that vaccines should continue to reduce our risk substantially relative to unvaccinated people (and that is even assuming that vaccine-resistant variants do not evolve). When you consider the possibility of getting re-infected multiple times by more virulent variants with higher fatality rates in the future, what are now small risks of death become larger.

The other important thing that we need to be on the lookout for is Long COVID from the delta variant in vaccinated people who were vaccinated a while ago and may have waning immunity. We simply don't know much about how prevalent and how severe that is yet because not enough time has passed and data is simply not really available yet.


Finally, lest you be confused, none of this is in any way "anti-vaccine." Quite the opposite. In fact, it makes it much MORE clear and important that we need to get EVERYONE vaccinated (not just in the USA, but in the entire world) using all means necessary, and we need to do it NOW. On the one hand, in the USA, we need to massively ramp up both the carrots and the sticks to get more of the "hesitant" people to get freely available life saving vaccines. Meanwhile, the Federal Government needs to step in and get vaccine production capacity ramped up on a true world-war-two-style all-out mobilization level. We need a crash program to produce vaccines much more quickly for the world's 8 billion people, as well as to produce more of any extra infrastructure needed to administer vaccines in other countries that lack that infrastructure (e.g. freezers for mRNA vaccines) and send them to developing countries across the world so that they have the supply much more quickly to get their populations vaccinated.

Otherwise, this is likely to get worse. The time for twiddling our thumbs has passed.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Its not good for society that unvaccinated people die but I mostly have apathy towards their fate within the US besides those who can't rather than won't get vaccinated.

I can certainly understand the sentiment, and part of me doesn't care (or cares less) if unvaccinated people die than vaccinated people die.

But the problem is the #s and proportions of vaccinated people who are dying are going up due to a combination of the impact of the delta variant and waning efficacy (exactly how much contribution each of these factors make is yet to be conclusively determined and will only be figured out over time as we gradually get more data), to the point that 15% of COVID deaths in May were fully vaccinated people, and only 85% unvaccinated.

The peak in vaccine doses administered per day in the USA was April 13, so in May most people would have been fairly recently vaccinated, i.e. not much time for the amounts of antibodies to go diminish, and May was also while only a small minority of US cases were from the Delta Variant. For both of these reasons the percentages of deaths occurring among vaccinated people may become higher when more recent data eventually gets released, and I would bet that probably is playing into the CDC's decision-making here.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Regarding the chart, that seems in line with a general reduction in deaths among unvaccinated individuals rather than a dramatic decrease in vaccine efficiency, given the CDC's graph still shows a very strong protection, and the total deaths per case increase is a third of what it was when we reached this point with the last wave.

I do have to wonder as far as more severe breakthrough cases how many of these are either elderly (who are generally more at risk from any infection) or nursing/hospital workers or people caring for sick (likely unvaccinated) family, who would be exposed to a much larger and more consistent viral load--has there been any study on this?

In the same presentation, they have other slides about how breakthrough cases seem to be worse for old people and people at nursing homes. The relatively higher risks for older people (and immunocompromised people) appear not to have changed and seem to be a general characteristic of COVID.

Due to this fact, if you are young and healthy and thinking about your own personal risk, I would be more worried about the possibility of long COVID as compared to hospitalization/death per se.

You are right the CDC graphs don't show a great decrease in efficacy in preventing death also. If there is a decline in efficacy, one would expect based on what has been observed so far in other countries like UK and Israel for it to first show up as a decline in efficacy against infection and against mild infection, rather than hospitalization/death. Then, maybe efficacy declines more with additional time against death/hospitalization as well (or maybe not so much if we are lucky). And it probably should go without saying, but also even with some declines in efficacy, people remain far better off being vaccinated than not.

But also, if there were a great decrease in efficacy, one would expect it to show up in later/newer data, not in the earlier data, both because more time will have elapsed since vaccinations, and also because delta will be more prevalent. At the least, the mRNA vaccines seem to be quite effective (remarkably so!) for at least the first 6 months or so. After that there is emerging evidence that they have declining efficacy, but the precise details about how much and how fast that is, and how much it applies for e.g. mild illness as compared to severe illness (and for long COVID) are still in the process of being figured out, with seemingly new studies gradually clarifying things a bit more each day or two.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

CDC Scaled Back Hunt for Breakthrough Cases Just as the Delta Variant Grew​​​​​​

Bloomberg identified more than 100,000 vaccine breakthroughs

The U.S. agency leading the fight against Covid-19 gave up a crucial surveillance tool tracking the effectiveness of vaccines just as a troublesome new variant of the virus was emerging. While the Centers for Disease Control and Prevention stopped comprehensively tracking what are known as vaccine breakthrough cases in May, the consequences of that choice are only now beginning to show.

...

But in the months since, the number of vaccine breakthrough cases has grown, as has the risk that they present. And while the CDC has stopped tracking such cases, many states have not. Bloomberg gathered data from 35 states and identified 111,748 vaccine breakthrough cases through the end of July, more than 10 times the CDC’s end-of-April tally.

...

The CDC said when it announced the change in May that it would continue to collect data on breakthrough cases if the infections resulted in hospitalization or death — a rare occurrence, since vaccines provide significant protection. The decision to stop tracking non-severe cases was made to “help maximize the quality of the data collected on cases of greatest clinical and public health importance,” the agency says on its website.

But that decision to follow not track mild or asymptomatic cases is now being questioned, including by state officials dealing with the virus on the front lines.

...

“When I saw CDC was going to stop tracking vaccinated people who get infected, my heart sank,” said Charity Dean, who helped lead California’s response to Covid as the state health department’s assistant director. “We lost our shot at being able to characterize how this variant is moving through the population and how new variants might emerge.”

...

“The more data you have, the better decisions you can make. So why would they knowingly turn away data which historically has been really important to have?” said Michael Kinch, director of the Center for Research Innovation in Business at Washington University in St. Louis. “For an administration that said they’ll be driven by the science, it makes no scientific sense.”

It seems by this point pretty clear that this was a mistake. You can't understand what you don't measure because you have chosen not to collect data on it.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

At what point do we just say that we've done all that we could if we can never truly get transmission to an "acceptable" level?

The answer to that is literally, never.

We don't stop vaccinating children against measles/mumps/polio/etc just because those have been brought basically under control (except for recent anti-vaxxer flareups), and we certainly wouldn't if transmission were higher.

COVID has also spread into a lot of wild (and domesticated) animal species. 2 New articles today about COVID in deer:

https://wtvbam.com/2021/07/30/usda-estimates-covid-19-exposure-to-over-50-of-michigans-deer-population/

and also COVID found in NYC sewers that seems to be from dogs and rats (with variants that may be antibody resistant for humans):

https://www.ibtimes.com/4-new-covid-19-variants-found-nyc-sewers-likely-antibody-resistant-3262705

If COVID can cross over and infect those animals in the first place, it can then evolve different variants in those animals, some of which may then subsequently cross back over into humans. Statistically, one would hope that most such variants will probably be harmless, but we can't assume that will always be the case.

This will need to be monitored closely, basically forever, no matter what else happens with the virus among humans, and we will need to be well prepared for the possibility of zoonosis or transmission back over to humans of variants that might be pretty severe, transmissable, and/or resistant to our existing defenses.

That is also a more general problem, the same thing could have happened with e.g. bird flu going back many years. We need much more global public health funding to deal with this stuff (it is much cheaper to fund global health prevention to avoid future pandemics than to wait for pandemics), and also really need to cut way down on situations that make zoonosis of potentially very nasty viruses more likely (e.g. chickens housed all closely together in unsanitary conditions).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Yeah, participating in Bear Week this summer is not a main steam thing. I get it.

So I want to know what the odds are that the sum of the percentage of the vaccinated + those who got Covid and are still here = herd immunity before enough time has passed to make likely that a new horrible and much more deadly strain mutates out as to which the vaccines are not effective. And given those odds, what policy changes seem appropriate, e.g., you need a chip encoded vaccine passport that is very hard to forge, to get inside anywhere, and those who do not enforce that are shut down. This odds and the degree of the calamity, should drive the policy, no?

The answer to that will be inherently speculative to a significant degree, but I agree it is a very important topic and it ought to be driving some far-reaching re-thinking of pandemic preparedness policy.

One of the better sources for informed speculation about this sort of thing seems to be the UK government's Scientific Advisory Group for Emergencies. They have a variety of reports that they have been preparing for the UK government trying to figure out the policy implications of these scientific questions:

https://www.gov.uk/search/all?organisations%5B%5D=scientific-advisory-group-for-emergencies&order=updated-newest&parent=scientific-advisory-group-for-emergencies

Probably (certainly hopefully!) the US government has similar reports, but I don't think they are publicly available.

The report that seems to bear most directly on the things you are wondering about is probably this one:

"Long term evolution of SARS-CoV-2, 26 July 2021"

They consider various possibilities for how the virus may evolve, how probable they are, and what the consequences are likely to be if they happen. You really have to read the full report (and really this should be mandatory reading for policy makers in general), but I will excerpt some of it here:

Can we predict the limits of SARS-CoV-2 variants and their phenotypic consequences?
 
As eradication of SARS-CoV-2 will be unlikely, we have high confidence in stating that there
will always be variants. The number of variants will depend on control measures.
We describe hypothetical scenarios by which SARS-CoV-2 could further evolve and acquire,
through mutation, phenotypes of concern, which we assess according to possibility. For this
purpose, we consider mutations in the ‘body’ of the virus (the viral genes that are expressed
in infected cells and control replication and cell response), that might affect virus fitness and
disease  severity, separately from  mutations  in the  spike  glycoprotein that  might  affect  virus
transmission and antibody escape.
We assess which scenarios are the most likely and what impact they might have and consider
how  these  scenarios  might  be  mitigated.  We  provide  supporting  information  based  on  the
evolution of SARS-CoV-2, human and animal coronaviruses as well as drawing parallels with
other viruses.

...

Scenario  One:  A  variant  that  causes  severe  disease  in  a  greater  proportion  of  the
population than has occurred to date. For example, with similar morbidity/mortality to
other  zoonotic  coronaviruses  such  as  SARS-CoV  (~10%  case  fatality)  or  MERS-CoV
(~35% case fatality). This could be caused by:

...

Likelihood of genotypic change in internal genes: Likely whilst the circulation of SARS-
CoV-2 is high. 
Likelihood of increased severity phenotype: Realistic possibility.
Impact: High.



...

Scenario Two: A variant that evades current vaccines. This could be caused by:

...

Antigenic shift - Likelihood: Realistic possibility.
Impact: High for a completely new spike, medium/low if a spike from a seasonal CoV is
introduced since we expect a proportion of the population to have antibodies to these
endemic viruses.

...

A longer-term version of shift whereby SARS-CoV-2 undergoes a reverse zoonotic event
into  an  animal  reservoir(s). -

Likelihood: Realistic possibility. Impact: Medium.

...

Antigenic drift -
Likelihood: Almost certain. Impact: Medium.

...





Scenario Three: Emergence of a drug resistant variant after anti-viral strategies. This
could be caused by:

...

Likelihood: Likely - unless the drugs are used correctly.  Impact: medium unless a scenario
arises where drugs are needed more widely.

...





Scenario Four: SARS-CoV-2 follows an evolutionary trajectory with decreased
virulence. This could be caused by:

...

Likelihood: Unlikely in the short term, realistic possibility in the long term.

It's hard to really summarize this in a simple way, you really just have to (and should) read it.




There are various other quite relevant and timely reports, e.g.


" How long will vaccines continue to protect against COVID-19?, 30 July 2021 "

Executive summary
1. It is highly likely that vaccine induced immunity to SARS-CoV-2 infection, and potentially
severe disease (but probably to a lesser extent) will wane over time. 
2. This is likely to be first detected by vaccine failures in vulnerable cohorts (for example a high
rate of infections in people vaccinated over time, including hospitalized cases).
3. It is therefore likely that there will be vaccination campaigns against SARS-CoV-2 for many
years to come, but currently we do not know what will be the optimal required frequency
for re-vaccination to protect the vulnerable from COVID disease.

- that waning being detected first in vulnerable cohorts, btw, is exactly what has been detected first and is what the CDC said they were detecting in the leaked presentation (older people and people in nursing homes being worst affected by early indications of waning vaccine efficacy).



and

"ONS: Short report on Long COVID, 22 July 2021"

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

(climbs on soapbox) Patriots!!!!!! Americans!!! Countrymen!!! Lend me your ears!!!!

So, it turns out that this George Washington fellow has been conspiring with the CCP (Chinese Communist Party, no wait I mean Continental Congress at Philadelphia) to forcibly MANDATE that Americans get inoculated against our virus friends. What is this guy's obsession with mandates? It's like he thinks he's got the mandate of heaven. Who does he think he is, some sort of Chinese Emperor? Get your socialism off my Medicare, George!


George Washington and the First Mass Military Inoculation

George Washington's military genius is undisputed. Yet American independence must be partially attributed to a strategy for which history has given the infamous general little credit: his controversial medical actions. Traditionally, the Battle of Saratoga is credited with tipping the revolutionary scales. Yet the health of the Continental regulars involved in battle was a product of the ambitious initiative Washington began earlier that year at Morristown, close on the heels of the victorious Battle of Princeton. Among the Continental regulars in the American Revolution, 90 percent of deaths were caused by disease, and Variola the small pox virus was the most vicious of them all. (Gabriel and Metz 1992, 107)

On the 6th of January 1777, George Washington wrote to Dr. William Shippen Jr., ordering him to inoculate all of the forces that came through Philadelphia. He explained that: "Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army . . . we should have more to dread from it, than from the Sword of the Enemy." The urgency was real. Troops were scarce and encampments had turned into nomadic hospitals of festering disease, deterring further recruitment. Both Benedict Arnold and Benjamin Franklin, after surveying the havoc wreaked by Variola in the Canadian campaign, expressed fears that the virus would be the army's ultimate downfall. (Fenn 2001, 69)

At the time, the practice of infecting the individual with a less-deadly form of the disease was widespread throughout Europe. Most British troops were immune to Variola, giving them an enormous advantage against the vulnerable colonists. (Fenn 2001, 131) Conversely, the history of inoculation in America (beginning with the efforts of the Reverend Cotton Mather in 1720) was pocked by the fear of the contamination potential of the process. Such fears led the Continental Congress to issue a proclamation in 1776 prohibiting Surgeons of the Army to inoculate.

Washington suspected the only available recourse was inoculation, yet contagion risks aside, he knew that a mass inoculation put the entire army in a precarious position should the British hear of his plans. Moreover, Historians estimate that less than a quarter of the Continental Army had ever had the virus; inoculating the remaining three quarters and every new recruit must have seemed daunting. Yet the high prevalence of disease among the army regulars was a significant deterrent to desperately needed recruits, and a dramatic reform was needed to allay their fears.

Weighing the risks, on February 5th of 1777, Washington finally committed to the unpopular policy of mass inoculation by writing to inform Congress of his plan. Throughout February, Washington, with no precedent for the operation he was about to undertake, covertly communicated to his commanding officers orders to oversee mass inoculations of their troops in the model of Morristown and Philadelphia (Dr. Shippen's Hospital). At least eleven hospitals had been constructed by the year's end.

Variola raged throughout the war, devastating the Native American population and slaves who had chosen to fight for the British in exchange for freedom. Yet the isolated infections that sprung up among Continental regulars during the southern campaign failed to incapacitate a single regiment. With few surgeons, fewer medical supplies, and no experience, Washington conducted the first mass inoculation of an army at the height of a war that immeasurably transformed the international system. Defeating the British was impressive, but simultaneously taking on Variola was a risky stroke of genius.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Louisiana is a prime example of why you do not elect "moderate" Democrats.  Their "moderate" governor just passed a mask mandate.  Disgusting display of government overreach.

...and what's the problem with a mask mandate?

Are masks so expensive that they're taking a big chunk out of your paychecks?

I mean, they actually are fairly expensive if you want to have a mask that really has a large effect, i.e. N-95 or better. Cloth masks that most people wear have pretty little effect. Surgical masks are a bit better. But even people who have those very very often wear them incorrectly.

One thing that is sort of surprising given all the mask policies that have been implemented all over the world is that, at least in the USA, there has never really been a public information campaign teaching people how to properly use masks so that they are more effective.

Then again, I guess we shouldn't be surprised, since our political leaders (and even e.g. Fauci)all insist in leading by example by doing things like taking off their masks when they are talking (when you are talking is the worst time to take off a mask, because when you are talking you are going to spew more droplets/aerosol). So wearing masks so as to make them most effective is probably not top priority.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

I have a confession to make


I vastly overestimated how many Americans have had covid

I assumed that maybe 30-45% of Americans had it by March 2021, and, combined with vaccines, we would be at 80-85% immunity by now.

It’s obvious seeing the case rates rise that we were never close to 45% infected

You can also get re-infected. The same is true with other coronaviruses. Natural immunity wanes between half a year to 3 years or so for other coronaviruses, so it is not too surprising that should also be the case with COVID. The amount to which that is the case is a matter of ongoing research.

Natural immunity from previous infection certainly does help, but it is not going to do the trick forever (especially when new variants keep popping up).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Deaths arent ticking up at all. The variant is infecting people but no one is getting very ill from it. Hospitalizations continue to fall.

Cases in the UK beginning to fall as well, I think this is the last gasp of the virus.

After all this time, still nobody understands that hospitalizations and deaths are lagging indicators. I swear, we could be on wave #7 and we'll still be getting "but deaths are not going up" comments. In fairness, that makes sense for vaccinated cases, but it completely neglects the fact that a large portion of the population is not vaccinated (especially in many states where cases are surging the most in the south).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

What I do is compare the rate the deaths are going up compared to how they were previous times we've reached certain caseload milestones. They are still about a third per number of cases compared to last time, I suspect a big part of it being many highest risk people have already been vaccinated.

That is a bad/unscientific way to compare. With the delta variant, if you are comparing based on a raw level # of cases, deaths will tend to lag behind more than with previous variants, because it is more transmissable. The slopes of epidemiological curves depend on the R value for a virus, and that has changed.

Simple hypothetical example with simplified math:

1) With previous variants, suppose it took 10 cases 1 week to turn into 100 cases

2) Whereas suppose with the new variant, it takes 5 cases 1 week

3) Suppose that some indicator (hospitalizations or deaths) lags by 1 week.

4) With the new variant, after 1 week when you have 100 cases, you will have half as many instances of the lagging indicator (hospitalizations or death) as in the previous case with the old variants, because the lagging indicator will be proportional to 5 rather than to 10.


Of course, let me hasten to add that I would not expect deaths to go as high as before (unless cases REALLY explode) because it is true that many of the most vulnerable people are already vaccinated (or deceased). However, that doesn't mean that deaths/hospitalizations are not going to behave as a lagging indicator and go up, it just means that the *level* at which they go up to should be lower relative to the number of cases than before (or at least would be if all cases were accurately and reliably tested for).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

[...]

Other large outdoor events have returned this summer, in part because of the availability of vaccines. Attendees at the recent Lollapalooza music festival, which packed people into downtown Chicago, had to either provide proof of vaccination or show a negative coronavirus test from the previous 72 hours.
[...]

FWIW, that is exactly what happened recently in the Netherlands... An outdoor music festival which checked for vaccination & negative tests... The result was a massive spike in cases. So don't be too surprised if the same ends up happening in the Chicago/Illinois area. One thing important to realize is that the Delta variant is a lot more transmissible than the old virus used to be, so while it didn't transmit well outdoors in the past, it does so more now than before. Contact tracing in Australia (pretty much one of the only places where contact tracing is still possible) found cases of outdoor spread with as little as 15 seconds of contact with the Delta variant.

964 people got COVID-19 after an outdoor music festival, despite compulsory negative tests, vaccines, or other proof of immunity

Nearly a thousand people tested positive for the coronavirus after attending a two-day outdoor festival in the Netherlands on the weekend of July 3.

Figures from health officials in Utrecht indicated that 448 were exposed during the first day of the festival, and 516 the second day. The figures were reported by Algemeen Dagblad, a Dutch daily newspaper.

More cases are likely to be identified in the coming days, one official said, the online news portal Dutch News reported.

Information about whether the festivalgoers developed symptoms from the infection — and if so, how badly — was not immediately available.

Among vaccinated people who developed "breakthrough" infections, symptoms are typically milder.

The Verknipt festival, which attracted about 20,000 visitors, was one of the first after the country relaxed its COVID-19 measures on June 26, local media RTV Utrecht reported.

Before entry, visitors were asked to prove that they had been vaccinated, had recovered from COVID-19 recently, or had tested negative for COVID-19.

In the space of 2 weeks or so, daily cases in the Netherlands spiked from about 500 to more than 10,000 a day. They have since gone back down, fortunately, through some combination of this no longer being allowed, continuing vaccinations, and people being more careful in response to that.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

I expect South Dakota to explode in COVID cases due to the motorcycle rally.

Everyone said that last year too. But it never happened.

Wrong, that is precisely what happened last year too, and it was a significant contributor to the pandemic in nearby states as well.

https://www.msn.com/en-us/health/medical/cdc-2020-sturgis-motorcycle-rally-caused-widespread-transmission-of-covid-19/ar-BB1ghT69

https://www.worldometers.info/coronavirus/usa/south-dakota/

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Sadly, there is more to fear than fear itself (even if you are sensible enough to be vaccinated). Such as the possibility that you will get into a car accident or something similar and need emergency medical care, but not be able to get a hospital bed due to (mostly) the unvaccinated idiots clogging up all the hospitals in certain areas. Or long COVID. Chronic conditions that can last for years (or who knows how long, potentially for the rest of your life) are no joke.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

I expect South Dakota to explode in COVID cases due to the motorcycle rally.

Everyone said that last year too. But it never happened.

You remember wrong.

Aside from SD, there were also surges in nearby states that were attributed to the rally.

It did.

That study from those economists was debunked.

I guess you mean 'debunked' in the same sense that COVID was shown to be a 'myth' by some youtubers.

In seriousness, actual constructive criticism of studies is always a welcome thing with the scientific method, but it appears that is not what you are interested in.

https://eu.usatoday.com/story/news/factcheck/2020/09/17/fact-check-sturgis-rallys-covid-19-cases-misstated-online-post/3458606001/

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

There is an acceptable amount of risk that we all carry in our lives, all the time. I could be killed in a crash driving from work. But I wear my seatbelt and accept that risk.

This is true, but there is a risk that when you get into your car crash, you will find that the hospital can't take you if it is too full of COVID patients, which is the point that seems to be starting to be reached in Florida, Texas, and some other areas. Given that the hospital need not be full of COVID patients, is that a risk you think you should need to take? This could be the difference between getting killed in your car crash or surviving it. Kind of like wearing your seatbelt, actually!

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

So we're supposed to live in a permanent state of depression, anxiety and fear? Not sure what the point of your response was.

Fighting a virus and fighting a war are pretty similar. The quote makes perfect sense.

The point was wrong, so I rebutted it. We *do* have things to fear other than fear itself, and to say otherwise in general is a foolish statement. Yes, it sounded good politically at the time FDR said it, but as a general risk-management procedure, it is foolish to think like that.

In a war, you should definitely fear things other than fear itself, such as being shot or hit by artillery shrapnel.



Anyway, as far as the virus goes and how to approach it (a different question than the merits of that FDR quote), I would say that there are other things we can do besides just "living in a permanent state of depression, anxiety and fear" on the one hand, or letting it run totally rampant on the other hand. I would say that is a false dichotomy.

Since this followed from a discussion of large gatherings, I would say that it would be reasonable right now to avoid large gatherings/festivals in order to make it more likely that other more important things such as schools for children can be run safely without resulting in the medical system getting overwhelmed.

And of course there are many other things we should be doing more broadly such as massively ramping up vaccine production and solving logistical problems preventing quick vaccination in much of the world (we should set as a goal to have the global capacity to produce and administer vaccines for the entire world within a few months for potential new variants), overcoming vaccine hesitancy in countries where that is a problem such as the USA through combinations of increasingly large carrots and also increasingly large sticks, increasing funding for monitoring COVID and other viruses in animals that could cross over to humans, and working to reduce the probability of future zoonosis (better sanitation, not encroaching as much on habitats of wild animals with potentially dangerous viruses), reviewing and strengthening biosecurity protocols, etc etc etc.

If we were to do those sorts of things, we could avoid "living lives in a permanent state of depression, anxiety and fear" while also not simply pretending that the risks are not significant and just sweeping them under the rug and ignoring them.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Please I am begging for people to not to live in fear and keep the economy going but take all precautions and tools we have at our disposal to fight this pandemic. please

There is a middle ground between this "living in fear" talking point (which I think is largely a straw man) and simply not trying to control the virus at all and having large festivals and/or having in-person schools without wearing masks like the governors of Florida and Texas want.

It is not "living in fear" to not go to large festivals or to think that they ought not to be held right now. It is simply responsible behavior. There are plenty of other things we can do besides going to large festivals to amuse ourselves.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Same sort of story in Texas as in Florida... Asking people to get vaccinated and/or wear a mask is a bridge too far, but apparently it is just fine to put on hold "non-essential" medical treatment:


Gov. Greg Abbott asks Texas hospitals to delay nonessential procedures as COVID-19 patients strain capacity

Abbott's request was one of several steps to address rising coronavirus case numbers and hospitalizations. He did not back down from his refusal to allow local mask mandates.

Gov. Greg Abbott announced new moves Monday to fight the coronavirus pandemic as it rages again in Texas, including asking hospitals to again put off certain elective procedures to free up space for COVID-19 patients.

Still, the governor did not back down on his refusal to institute any new statewide restrictions on businesses or to let local governments and schools mandate masks or vaccines.

Instead, Abbott announced he had written to the Texas Hospital Association asking hospitals to "voluntarily postpone medical procedures for which delay will not result in loss of life or a deterioration in the patient’s condition." As coronavirus was consuming the state last summer, Abbott took a more restrictive approach and banned elective surgeries in over 100 counties before ending the prohibition in September.

Note that the definition of "elective" or "non-essential" is fairly broad, and last time around included some medical procedures/appointments that, while not imminently needed as an immediate life/death matter, nevertheless are not good for people's health to delay, including things like "non-essential" cancer screenings.

But apparently the average Texas Republican primary voter that Abbott is trying to appeal to thinks that it is better to delay those sorts of things than to wear masks and get vaccinated.

Hopefully the hospitals/hospital association in TX tells Abbott to go **** himself and come up with some sort of actual policy instead, since Abbott is asking them to "voluntarily" delay those procedures.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

It is worth reminding people that there has been absolutely NO surge in covid deaths in blue America (with a small number of local exceptions).

It never ceases to amaze me how after all this time, so many people STILL do not understand that hospitalizations and deaths lag cases.

Kind of like how, just a few pages back in this thread and just a week ago, people STILL didn't think that deaths would rise in Florida and Texas when cases were rising there but hospitalizations/deaths were still lagging (spoiler: they are rising now).

Deaths arent ticking up at all. The variant is infecting people but no one is getting very ill from it. Hospitalizations continue to fall.

Cases in the UK beginning to fall as well, I think this is the last gasp of the virus.

After all this time, still nobody understands that hospitalizations and deaths are lagging indicators. I swear, we could be on wave #7 and we'll still be getting "but deaths are not going up" comments. In fairness, that makes sense for vaccinated cases, but it completely neglects the fact that a large portion of the population is not vaccinated (especially in many states where cases are surging the most in the south).

What I do is compare the rate the deaths are going up compared to how they were previous times we've reached certain caseload milestones. They are still about a third per number of cases compared to last time, I suspect a big part of it being many highest risk people have already been vaccinated.

That is a bad/unscientific way to compare. With the delta variant, if you are comparing based on a raw level # of cases, deaths will tend to lag behind more than with previous variants, because it is more transmissable. The slopes of epidemiological curves depend on the R value for a virus, and that has changed.

Simple hypothetical example with simplified math:

1) With previous variants, suppose it took 10 cases 1 week to turn into 100 cases

2) Whereas suppose with the new variant, it takes 5 cases 1 week

3) Suppose that some indicator (hospitalizations or deaths) lags by 1 week.

4) With the new variant, after 1 week when you have 100 cases, you will have half as many instances of the lagging indicator (hospitalizations or death) as in the previous case with the old variants, because the lagging indicator will be proportional to 5 rather than to 10.


Of course, let me hasten to add that I would not expect deaths to go as high as before (unless cases REALLY explode) because it is true that many of the most vulnerable people are already vaccinated (or deceased). However, that doesn't mean that deaths/hospitalizations are not going to behave as a lagging indicator and go up, it just means that the *level* at which they go up to should be lower relative to the number of cases than before (or at least would be if all cases were accurately and reliably tested for).

There are some reasons why cases (and hospitalizations and deaths) are less likely to go up as much in northern and more Dem states:

1) Climate: less reliance on air conditioning in the summer implies more open windows/better ventilation, which implies that aerosols dissipate more quickly and hence less viral spread (same thing that happened last summer). The converse is true in the winter, which is why last summer there were more cases in the south in the summer, and why there were more cases in the north (and also in Europe) during the winter.

2) Vaccination: general higher vaccination rates in more Dem areas imply lower overall levels of cases, deaths, and hospitalizations.

3) Masks/compliance with public health measures: same as with vaccinations; generally higher compliance imply lower levels of all three of cases/deaths/hospitalizations.

But none of that changes the fact that hospitalizations and deaths lag cases, which is a fundamental and (you would think) intuitive property of the virus. As cases go up, hospitalizations and deaths will also go up - with a lag. They will go up to varying degrees depending on how much vaccinations and demographics can reduce the death rate, but nevertheless they will go up. And it doesn't take a rocket scientist to understand that. And yet people keep making the same incorrect prediction that as cases go up, hospitalizations and deaths won't, despite having been incorrect the first 20 times.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Deaths lagged cases by about two weeks in every previous surge; e.g. nationally cases peaked around Jan 13 and deaths peaked around Jan 26.  And cases have now been rising for well over a month.  

You apparently have not bothered to look and see that in fact deaths ARE going up:

https://www.worldometers.info/coronavirus/usa/florida/

https://www.worldometers.info/coronavirus/usa/texas/

As I mentioned earlier though, one would expect longer lag times for a virus with a higher R (because the median hospitalized patient will be more recently infected if infections are rising more rapidly).

There is also likely some degree of underreporting/delayed reporting of deaths (there was in previous surges, which subsequently got revised upwards, but only after the fact).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

I can’t agree with this either.
Once you are vaccinated, the threat of covid is much less than the threat of the flu or any number of other virus.

(checks notes)

Yup, completely ignoring long COVID.

Not to mention ignoring various other things such as potential future viral evolution, the unknown degree to which vaccine efficacy declines over time, and the fact that the efficacy of booster is still unknown (we can be hopeful, but hope is not a plan). But let's focus on long COVID, because that is IMO pretty clearly the most significant risk for young healthy vaccinated people, and it is a significant risk that you underestimate at your own peril.


Among other things, people who have been infected with COVID have been found by the most comprehensive study so far to have lost a couple of IQ points as a result (with small losses even:

https://www.news.com.au/technology/science/human-body/british-study-finds-intelligence-hindered-by-coronavirus/news-story/980383a23c88a98a97de8dc18e6f5a02

That includes mild cases where you naively wouldn't expect any serious long-lasting damage.



Is brain damage a significant thing?

Yup, loss of a few IQ points seems to be pretty serious and worth being careful to avoid. I value my brain. But maybe that is just me.


Can people who are vaccinated get long COVID? Does vaccination lower your chances of getting long COVID?

Yes, people who are vaccinated definitely get long COVID (including from very mild cases). The chances are not really well known yet, but a study a few days ago found that being vaccinated lowered the chance of getting long COVID by about 50%. Don't get me wrong, that is better than 0%, and I would gladly take 50% over 0%, but that is not the reduction from the base risk one would hope for. The base risk of long COVID is something like 10-30% (fairly wide variation because it has not been as well studied as one would hope and also long COVID is still not that clearly defined). A 50% reduction of that would put you at 5-15% chance of getting long COVID from a breakthrough infection. Another Israeli study a couple of days ago found that ~19% of vaccinated breakthrough infections resulted in long COVID (although small sample and this was a study of medical personnel/nurses, so it may not be representative of the general public).

So those both seem in the same general sort of range, but new information continues to come out and that is not at all determinate yet.

But anything remotely like a 5-15% chance is not a small chance. It is in a totally different league from the chance of death for e.g. young vaccinated people from COVID, and given the symptoms one would be foolish to ignore that.



Is the risk and/or severity of long COVID higher with Delta than with previous variants?

This is not yet known because not enough time has passed with the Delta variant being dominant. But it would be sort of surprising if that were NOT the case, given that everything else about the Delta variant seems to be worse.


Is there any precedent for this?

Yup, there was the same sort of thing with SARS-1. "Long SARS":

https://www.thefreelibrary.com/Outcomes+of+SARS+survivors+in+China%3a+not+only+physical+and...-a0369220546

There were studies ~10 years after SARS-1 that found that many SARS-1 survivors still had serious symptoms. I would be very interested to see follow-up on how they are doing today (and also how SARS-1 survivors have fared against COVID), but I haven't seen any such studies yet.


Is the cumulative probability of getting long COVID higher if you are re-infected with COVID, as GeorgiaModerate's relative was, higher than if you are only infected with COVID a single time?

I don't think we know yet, but it would stand to reason that to some extent or another, the answer to that is yes. We don't yet know if it is a great extent or a small extent.

And frankly, covid is likely going to be with us forever.  If you are vaccinated and still afraid of covid, you are going to be living in fear your entire lift.

What exactly do you mean by "living in fear"?

For example, when I drive a car, I am aware that there is a chance of getting into a car accident and dying or getting seriously injured (as well as killing or seriously injuring other people). This is something that I would like to avoid. Consequently, when I am driving I try to drive carefully and defensively, avoid excessive speeding especially in environments when it is unsafe, be sure to look over my shoulder when changing lanes, be careful about passing on single lane roads, etc. And yes, I do wear my seatbelt also. And when making travel plans for any long cross-country journeys, one small factor that I consider in deciding whether to fly or drive is the fact that flights are safer. So, am I "living in fear" of car accidents?

I have been taking and intend to keep on taking similar sorts of efficacious but low cost precautions with regards to COVID. They are not going to be 100% effective, but if everyone did this it would make a difference.

This behavior does have a cost. I probably get to my destination a few seconds slower. So, am I "living in fear"? After all, I am changing my behavior based upon risk and cost-benefit analysis. If there were 0 risk of car accidents and the like, then I would instead always drive as fast as I could, swerve to change lanes recklessly, and as a result could save some small amounts of time on my car trips (also giving me less time to listen to NPR tho ).

And frankly, covid is likely going to be with us forever.

If you get long COVID, yes, it could be with you forever. It would kind of suck to have chronic fatigue for potentially as long as the rest of your life, to name one symptom of long COVID. You know what that means, "chronic fatigue"? It doesn't just mean you are tired. The name makes it sound far less bad than it is. To anyone who doesn't know, look it up. Or honestly, maybe don't look it up. I would sort of rather not know that it exists and is a significant possibility, in a way.

I don't want anything at all approaching a 5-15% chance of that from infection. That is way too high of a chance to just sit back and passively accept.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Deaths lagged cases by about two weeks in every previous surge; e.g. nationally cases peaked around Jan 13 and deaths peaked around Jan 26.  And cases have now been rising for well over a month.  

You apparently have not bothered to look and see that in fact deaths ARE going up:

https://www.worldometers.info/coronavirus/usa/florida/

https://www.worldometers.info/coronavirus/usa/texas/

As I mentioned earlier though, one would expect longer lag times for a virus with a higher R (because the median hospitalized patient will be more recently infected if infections are rising more rapidly).

There is also likely some degree of underreporting/delayed reporting of deaths (there was in previous surges, which subsequently got revised upwards, but only after the fact).

I know deaths are going up in states with lower vaccinations rates.  They are not going up in states with high vaccination rates.  That was the whole point of my post with the graphs.

Let's review what you said:

It is worth reminding people that there has been absolutely NO surge in covid deaths in blue America (with a small number of local exceptions).

Here's a graph from the Washington Post of the states with the highest current average deaths per 100k residents:

My interpretation of that was that you do not expect deaths to increase in "blue America" if cases keep rising.

If my interpretation of what you said is correct and indeed you would be surprised by deaths (and/or hospitalizations) going up in places like New York and California, then if I were you, I would be prepared to be surprised...

... because cases are already going up in blue states...

https://www.worldometers.info/coronavirus/usa/california/

https://www.worldometers.info/coronavirus/usa/new-york/

https://www.worldometers.info/coronavirus/usa/illinois/

In CA/NY/IL they are all going significantly up, and if you look at pretty much every other state (whether blue or red), you will see the same thing.

It is true that most of the deaths in "blue America" should be expected to occur among unvaccinated people, but your point was not about vaccination status, but about "blue states" vs "red states."

Additionally, some of the deaths in blue states will also be among vaccinated people. How much that is the case is TBD and depends upon how much vaccine efficacy declines over time and is lower for delta, which we don't yet know for sure, but we can look to other countries where we see some indications that efficacy does decline. Those indications are not 100% clear, but they are there nonetheless.

Wait for more data to come out before prematurely declaring victory and imagining that "blue states" have nothing to be worried about and that deaths are not going to rise in blue states also. That is, sadly, a false hope.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

You haven’t been advocating for the equivalent of getting to your destination a few seconds later.
You’ve been advocating for the equilavent of not going to the destination at all because you are afraid of a car crash.

You are suggesting that people should not be going to big public events like concerts and birthday parties even if they are vaccinated.

If this is how you are thinking now, you are going to be missing out on a lot for years to come.
And this is indeed living in fear.

I would say that my desired "destination" is to live a happy and fulfilled life (at least insofar as possible in this rather screwed up world). To be sure, going to big public events can contribute to that, but it is not the same thing. There are other things that can function as pretty good, though imperfect, substitutes at least for the time being, such as smaller gatherings and televised/streamed concerts.

As one example, I don't think I lost out on much, if anything, of significance from the fact that the Olympics didn't have large in-person crowds (or tbh from the fact that it was delayed for a year - and I also don't think I would have missed out on much more if it had been delayed a bit longer until vaccinations were more widespread in Japan). IMO the benefit of there not being large crowds significantly outweighed any benefit from having large in-person crowds. The COVID situation is serious in Japan, with a large delta surge going on now that would be a lot worse if the Olympics had large in-person crowds.

People in Japan who might have attended the Olympics in person lost out on relatively more. But they also gained more from the pandemic not being made even worse there.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

There is a huge difference between what we are seeing in place like Illinois


Compared to what we are seeing in Florida right now

I certainly agree with that. But you could have said a similar thing about the way that cases surged in the south ("red states") in the summer of 2020, but things were relatively better in the north ("blue states").

This did not mean that northern/blue states were safe... it just meant that their big surges were coming later (i.e. when it got colder).

As far as Florida goes, just a reminder, but its vaccination rate is pretty much at the national average... The reason why cases, hospitalizations, and deaths are surging in Florida is not that it has an unusually low vaccination rate, because it doesn't.

The reasons why cases are surging there have a lot to do with climate (air conditioning) and tourism. By the time we get to winter, when the climactic conditions are different and it is very cold in the north, then things will be different. Any northern states that still have vaccination rates close to the national average are at grave risk of looking pretty similar to how Florida looks now, because they are going to have a lot more indoor air circulation as people try to keep warm (just as people have been trying to keep cool in Florida in the air conditioning).


edit -

More concretely ---

Currently, Florida is at 59% with 1 dose and 49% fully vaccinated. Illinois is at 63% with 1 dose and 49% fully vaccinated. That is a bit better, but not much. Michigan is at 53% with 1 dose and 49% fully vaccinated - which in fact is worse than Florida. So if you think that what is happening in Florida can't happen in blue states further north just because of vaccination rates, might want to think about that pretty carefully before betting anything important on it.