COVID-19 Megathread 6: Return of the Omicron

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

"Outdoor concerts" are not all created equal.

There is a big difference in terms of potential for transmission between e.g. this, Lollapalooza which just happened, with a huge crowd of people all very close to each other where they would be breathing right onto other people. In terms of airflow, that is in some ways a lot more similar to being indoors than "outdoors":



And this, an outdoor concert where there is a smaller and more spread out crowd, and everyone is not breathing directly onto other people:



This latter concert would probably not be too much of a problem, in particular if the people were careful there.

But the former is a significant risk, given that delta is much more easily transmissible than earlier variants. It is true that other things equal, being outdoors is much safer than being indoors, but context and specifics matter a lot, and remember that previous intuitions and experience about what is safe outdoors were based on the earlier virus which was only  ~1/2 or even ~1/3 as transmissible as delta.

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

You seem to be saying that there should be restrictions imposed on what kinds of outdoor gatherings should be held, and where. What is your view about events such as state fairs? Should those be proscribed? And how long should these restrictions be maintained for? Ought we to continue with restrictions until coronavirus cases have dropped significantly?

I don't have all the answers, and I try to be careful to not say what I don't know with pretty good confidence.

But I would say that recognizing that not all gatherings are equally risky falls under the same general principle as was applied during the March/April 2020 period, where in many areas there were restrictions on some, but not all, gatherings (for example, banning gatherings of more than 100 people, but not less).

Of course, it is not really the number of people at a gathering per se that increases risk the most, it is the density at which people are packed together and the airflow/ventilation. The people best equipped to make recommendations for what sorts of events would be scientists at CDC or elsewhere who are best informed. But it is inherently tricky and difficult to draw a line between what would be a sufficiently safe and well-ventilated event and what would not be, and especially to do so in a concise and easily understandable way.

There was a good NY Times article explaining many of the risk factors and how scientific understanding of how COVID spreads (aerosols, not just droplets) has changed since the beginning of the pandemic, and the implications of that for what measures are most likely to be effective:

https://web.archive.org/web/20210618035441/https://www.nytimes.com/2021/05/07/opinion/coronavirus-airborne-transmission.html

Canceling large densely packed events is not ideal; in a perfect world we could have them all. But it is certainly less costly to society overall than alternatives such as shutting down businesses or having remote learning in schools, or as is apparently going to start happening in Texas, canceling "non-essential" medical procedures.

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

There's some more (bad, but at this point not particularly unexpected) news on declining vaccine efficacy with some new research out from the Mayo Clinic, and it unfortunately looks like it is confirming the earlier findings from Israel of declining vaccine efficacy, in particular for the Pfizer vaccine but also to a lesser degree for Moderna.

In the USA in Mayo Clinic health sites in MN, WI, AZ, FL, and IA, Pfizer efficacy has dropped to 42% against infection, whereas Moderna vaccine efficacy has dropped to 76% against infection. The bad thing is that efficacy will probably continue to drop in future months, based on what has been reported from Israel where people were vaccinated earliest (primarily with Pfizer). This means that, unless all of this data is somehow totally wrong, many more vaccinated people are going to get breakthrough infections (although they will still be much less likely to be hospitalized or die). But we don't want vaccinated people getting infected and continuing to spread COVID, even if all the cases were mild and benign and even if things like long COVID did not exist, because this could lead to evolution of other variants that may not be so mild and benign for vaccinated people.

Speculatively, the reason why Moderna may be losing efficacy less quickly than Pfizer is that Moderna had larger doses of mRNA vaccine than the Pfizer jabs had.

Moderna may be superior to Pfizer against Delta; breakthrough odds rise with time

(Reuters) - The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19.

Moderna's vaccine may be best against Delta

The mRNA vaccine from Pfizer and BioNTech may be less effective than Moderna's against the Delta variant of the coronavirus, according to two reports posted on medRxiv on Sunday ahead of peer review. In a study of more than 50,000 patients in the Mayo Clinic Health System https://bit.ly/37Btmhf, researchers found the effectiveness of Moderna's vaccine against infection had dropped to 76% in July - when the Delta variant was predominant - from 86% in early 2021. Over the same period, the effectiveness of the Pfizer/BioNTech vaccine had fallen to 42% from 76%, researchers said. While both vaccines remain effective at preventing COVID hospitalization, a Moderna booster shot may be necessary soon for anyone who got the Pfizer or Moderna vaccines earlier this year, said Dr. Venky Soundararajan of Massachusetts data analytics company nference, who led the Mayo study.

Here's a link to the study:

https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1.full.pdf

If this is indeed correct, then it looks like we are probably going to need booster shots every 6 months or so(maybe it could be stretched a few months longer) for the indefinite future going forward. And we had better hope that those booster shots are in fact (and remain) actually effective.

We need now to not only vaccinate the entire world to prevent or at least slow down the evolution of new and potentially even more dangerous variants, but also need to make booster shots for the entire world, and potentially to keep making them indefinitely.

So far, in almost a year, only 30.2% of the world's population has received 1 dose and 15.6% is fully vaccinated. That pace is way too slow and needs to be massively sped up.



What Biden should do now is simple - invoke the Defense Production Act to ramp up vaccine production capacity as quickly as physically possible by 10x (or however much needed) so that we have the ability to produce something like 8 billion new vaccine booster doses every 6-12 months for the indefinite future, along with the ingredients/inputs needed to make those doses (and more in the immediate term for the billions of people across the world who are still unvaccinated and need 2 doses).

Also use the Defense Production Act to mass produce the specialized freezers and other such specialized equipment needed to store mRNA vaccines and potentially also otherfuture vaccines if they prove as/more effective, and fulfill other logistical needs so that vaccines can actually be administered. Start figuring out creative logistical solutions like ways to get mobile freezers onto Air Force C-130s, with batteries to keep the vaccines frozen. Then fly those into remote areas in the developing world which don't have electricity and start vaccinating.

Try and get European countries and others involved in helping to do this as well, but the USA is the only country with the ability to lead in making this happen.

Here's to hoping that Biden does this and shows that he is the right leader to meet the moment, and is more competent than Trump was in handling the earlier pandemic.

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

I agree with Horus that it is kind of irrational to support a mask mandate but not a vaccine mandate. However, one thing to consider is that no vaccine is officially fully FDA approved and given that procedural rubber stamp. It is unfortunate that hasn't been able to happen yet, but hopefully it should be coming very soon at least for the Pfizer vaccine.

But even though at this point it seems pretty clear that the three vaccines in use in the USA are all safe (certainly far safer than the alternative of getting COVID!), the fact that they are not yet fully FDA approved through the normal (non-emergency use) procedures it makes it a lot harder to politically justify vaccine mandates for politicians. It would be very bad if, hypothetically, some politician supported a vaccine mandate and then the FDA didn't approve the vaccine. Once vaccines are actually fully FDA approved, I would expect more political support to move towards support for mandating them (either directly or indirectly).

The second important point is that when discussing masks, if you want to have an intelligent conversation about how effective they are, it is vitally important that you distinguish between different masks. Just like how (a page or two back) I was saying that all "outdoor concerts" are not equal transmission risks (because crowd density and airflow are important factors affecting transmissible), similarly not all masks are created equal in terms of efficacy.

Studies have found that cloth masks are only about 20-30% effective at filtering out aerosol particles. 20-30% is not nothing, and can make a difference especially on a mass level if EVERYONE is wearing them - because since viruses spread exponentially, even a small reduction in the transmission rate can lead to a substantially lower number of aggregate cases. On the other hand, on the individual level, that is only 20-30%, and you are going to get plenty of leaks with that and end up with a lot of infections. By contrast, N-95 masks (and their Chinese cousin KN-95) are about 95% effective at aerosol particle filtration, hence the 95 in the names. Surgical masks are somewhere in between.

The only reason that doesn't get said more commonly is that public health messaging has to be simple in order for everyone in the public to be able to understand it, and differentiating between types of masks is too hard for people who are barely paying attention to follow and remember/understand. Also, in addition, in the early period of the pandemic there was a shortage of N-95s.

If for some reason you really wanted to, you could maybe try to argue that N-95s are in some limited sense more effective than vaccines. This would be a silly thing to do, because it is not an either-or, and the senses in which masks and vaccines provide protection are totally different, but if you really wanted to say it, you could probably reasonably say that if you wear N-95s which are PROPERLY fit and worn CORRECTLY (which is not always the case) and if you wear them ALL THE TIME, then you would be less likely to get infected than if you were vaccinated with the J&J vaccine, which has relatively low efficacy against infection in comparison to the mRNA vaccines. After all, prior to the development of the vaccine, there are doctors and nurses who managed to avoid infection, while being frequently exposed to infectious patients, because they always wore N-95s and wore them properly (along with other PPE like eye protection/face shields).

But you would still be an idiot to not get vaccinated, with or without N-95s. Because if you do get infected, which eventually is basically certain to happen no matter how perfectly careful you wear N-95s, after that point masks provide 0% protection against hospitalization and death. That's a zero. Nothing. Whereas vaccines provide substantial protection against hospitalization and death, even if you do get infected. And even with the evidence of declining vaccine efficacy after ~6 months, at least so far that decline is predominantly just a decline in protection against infection, whereas, there is either just a small decline in efficacy against hospitalization/death, or else none (hard to tell so far due to statistical sampling uncertainty and small random variation).

Which is why 99% of doctors are vaccinated, no matter how carefully they continue to keep wearing their N-95s and other PPE while continuing to treat COVID patients.



Actually, in one important sense Utah of all states (with their Republican governor and Republican legislature) has the most rational and informed policy towards masks in schools, because they are providing students with KN-95s. Regardless of anything else, that means they are recognizing the fact that all masks are not equally effective, which no other state that I am aware of actually acknowledges in their policies. However, Utah is not mandating that they actually worn, so I would guess in practice they are probably not going to get that much use. So make of that what you will.

And if schools really want to stop transition and protect kids (and teachers and kids' parents), it is also just as important that they pay attention to other things besides masks (mostly relating to ventilation), like how school lunches are handled. If you have a school mask mandate but then have 200 kids all spending 30 minutes a day in a crowded cafeteria together having taken their masks off and eating together, then given how infectious Delta is, I would be surprised if by the end of the school year pretty much every kid didn't end up getting infected. In that case, much of the point of having the kids wear masks while in class would be defeated. On the other hand, if kids went and ate outside (rather than in an indoor cafeteria) with each class of ~20-30 kids or so separated, that would be a totally different matter, and could help a lot.

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

As I was just saying...:

What Biden should do now is simple - invoke the Defense Production Act to ramp up vaccine production capacity as quickly as physically possible by 10x (or however much needed) so that we have the ability to produce something like 8 billion new vaccine booster doses every 6-12 months for the indefinite future, along with the ingredients/inputs needed to make those doses (and more in the immediate term for the billions of people across the world who are still unvaccinated and need 2 doses).

175 "experts" are saying essentially the same thing:

‘Act now’ on global vaccines to stop more-dangerous variants, experts warn Biden

Health officials and activists ramp up pressure on the administration to deliver on promises of global vaccine equity

More than 175 public health experts, scientists and activists on Tuesday demanded that President Biden take urgent steps to confront the global spread of the coronavirus, warning that without immediate action to inoculate the rest of the world, newer variants are likely to emerge — including ones that may evade vaccines’ protection.

“We urge you to act now,” the experts wrote in a joint letter to senior White House officials Tuesday and shared with The Washington Post. “Announcing within the next 30 days an ambitious global vaccine manufacturing program is the only way to control this pandemic, protect the precious gains made to date, and build vaccine infrastructure for the future.”

The health experts also address Biden directly in a separate letter, underscoring that the delta variant is causing a surge of infections across the globe, including in Africa, Latin America and Asia, where many residents have yet to receive a single dose. Meanwhile, they note, the United States has stockpiled more than 55 million doses of mRNA vaccines but is administering fewer than 900,000 per day, with millions of Americans still balking at getting the shots.

“At this rate, it would take over two months to administer just the vaccine doses currently stored,” wrote the authors, urging Biden to begin distributing millions of stockpiled doses per week.

...

The White House has been criticized for months by public health experts who say Biden has announced piecemeal steps to confront the global crisis but done too little to ramp up immediate vaccine production.

...

Staley and other letter-signers vowed increasingly intense protests, including targeting officials and companies that are perceived to be delaying the response. “Pharma took years before letting the rest of the world access their AIDS drugs,” he said. “We won’t let that happen with covid vaccines.”

...

In their letter to Biden, the experts demand that the administration commit to establishing 8 billion doses per year of mRNA vaccine capacity by the end of the year, exporting at least 40 million vaccine doses from the United States per month and helping set up vaccine manufacturing hubs around the globe.

The time has come for Biden to stop dawdling around and do anything and everything to increase global vaccine production and distribution through the roof. If Biden doesn't do that, he will be responsible for prolonging the pandemic. He is the only one with the power to bring this under actual control.

Biden does have the right rhetoric:

“From the beginning of my presidency, I’ve been very clear-eyed that we need to attack this virus globally, not just at home, because it’s in America’s self-interest to do so,” Biden said last week, pledging that the United States would serve as “the arsenal of vaccines, just as we were the arsenal of democracy during World War II.”

But so far he hasn't actually made that happen with actual action. It has only been empty rhetoric:

“This administration has been playing footsies with Moderna instead of leading on this issue,” Staley added, invoking Biden’s comparison of the fight against the pandemic to World War II. “Do you think Roosevelt asked Henry Ford if he could start building tanks, but only on the company’s timetable?”

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

With these caveats, it does seem like the covid death rate among vaccinated people is in fact substantially lower than the death rate for flu.   And thus I'm not sure why vaccinated people should need to take more precautions to avoid covid than they do against the flu.

Hopefully you don't end up as one of the ~20% or so of patients with long COVID (or maybe ~10% of vaccinated patients, we'll have to see how the numbers turn out), because if you end up like the person I know who still can't breathe normally a year later, it will be a hell of a lot harder to keep denying its existence.

Sorry, but long COVID is not just like the flu. And yes, it does exist. And doesn't just exist, but is quite common.



And...

The point being that Covid is very much not the flu, but if we can get people to get their shots, we can turn it into the flu. What I mean by that is we will have new variants as the flu does and perhaps need new shots each year, but doing so will reduce the risk of serous illness or death massively for the general public at which point I feel most Americans can comfortably live their lives as they did before.

Same to you.

Although I would agree that your point about the potential for successful mass vaccination to greatly reduce hospitalization and deaths is essentially right on its own merits, it fails to acknowledge the existence of long COVID, since as far as we know so far vaccination doesn't have the same sort of dramatic reductions for long COVID as vaccination appears to have for hospitalization and death.

A true comfortable "return to normal" requires not just fixing the hospitalization and death issues, but also addressing long COVID in some other way than simply just saying "a large share of the population will have a significant new harmful chronic medical condition, and that's perfectly fine!"

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

Do we have any studies on the prevalence of long Covid in breakthrough cases? It may be significantly lower.

There is not that much information yet. There should start being a lot more over the next few months. What I am doing is waiting for a big, high quality, clear study to come out before making any big decisions.

One study of Israeli health care workers found that 19% of vaccinated breakthrough cases got long COVID. That is roughly the same ballpark as the chance of getting long COVID with a normal infection. On the other hand, this had a very small sample size, and also it might be the case that HCWs are more likely to get long COVID in the first place (maybe if they are health care workers they get higher viral loads and higher viral loads lead to more long COVID???)

Of course, your chances of getting a breakthrough infection itself are still lower than of getting a non-breakthrough infection, but if the idea of the back-to-normalers is that we are not going to control COVID at all and just going to let it run totally rampant forever, then I figure that the chance of getting a breakthrough infection eventually will get close to 100%, so that doesn't make a difference.

Another study a couple days to a week ago found about a 50% reduction in the chance of getting long COVID if you are vaccinated. No idea if that declines over time, and if so how much. That is definitely better than a 0% reduction, but way lower than I would like it to be.

https://slate.com/technology/2021/08/long-covid-breakthrough-infection-vaccinated.html

New article worth a read:

https://www.theguardian.com/commentisfree/2021/aug/12/when-it-comes-to-breakthrough-cases-are-we-ignoring-long-covid-once-again

On 1 May, the US Centers for Disease Control and Prevention stopped tracking breakthrough infections that did not lead to hospitalization or death. Its rationale was to “​​maximize the quality of the data collected on cases of greatest clinical and public health importance”, making the continued assumption that non-hospitalized Covid cases are not important but “mild”: without complications, manageable at home, where patients fully recover in two weeks.

I have dealt with persistent symptoms for 17 months – an illness now called “long Covid” – and not collecting data based on this assumption is an enormous mistake, one that has persisted throughout the pandemic and has severe consequences moving forward.

We know much more about long Covid than we did this time last year – enough for us to know it’s severe. Research has found ongoing endothelial dysfunction, hypometabolism in the brains of long Covid patients, microclots in long Covid blood samples, reduced aerobic capacity and impaired systemic oxygen extraction in non-hospitalized patients without cardiopulmonary disease, disrupted gut microbiota that persists over time, damage to corneal nerves, immunologic dysfunction persisting for at least eight months, numerous findings of dysautonomia (a common post-viral disorder of the autonomic nervous system), and countless other conditions.

In a cohort of non-hospitalized patients, 31% were dependent on others for care; our own paper from the Patient-Led Research Collaborative found over 200 multi-systemic symptoms that impaired the ability to work and function in daily life. We also found high levels of cognitive dysfunction and memory loss that were as common in 18-29-year-olds as those over 70, a finding that is starting to be highlighted in children and teenagers as well.

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

Keep in mind though that some of the new shots are not actually new people at all though... some are people who already got vaccinated sneaking booster shots already despite them not being formally authorized yet, since you can see on the news that other countries already have started giving out booster shots, and in addition the USA is throwing away a bunch of unused doses anyway...

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

Keep in mind though that some of the new shots are not actually new people at all though... some are people who already got vaccinated sneaking booster shots already despite them not being formally authorized yet, since you can see on the news that other countries already have started giving out booster shots, and in addition the USA is throwing away a bunch of unused doses anyway...

Is there any evidence for this, at all?

https://www.msn.com/en-us/news/us/11-million-americans-are-believed-to-have-obtained-unauthorized-covid-19-vaccine-booster-shots/ar-AANaEGm

https://www.msn.com/en-us/news/us/lying-about-vaccination-status-crossing-state-lines-pretending-to-forget-id-some-people-are-going-to-intense-lengths-to-get-unauthorized-covid-booster-shots/ar-AAN1PxW

Also happening with kids who are under 12 and not yet formally approved by the FDA

https://www.wbrc.com/2021/08/15/parents-are-sneaking-underaged-children-vaccines-pediatricians-advise-against-it/

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

https://twitter.com/travisakers/status/1427377370273665027

Who could have possibly predicted that things wouldn't go smoothly trying to open schools for in-person classes for a population of totally unvaccinated (at least for the under 12s), unmasked students (probably mostly all sitting in poorly ventilated indoor classrooms with no attempt to improve the ventilation, and eating together indoors in large communal cafeterias with hundreds of students at once, all at the same time) in the middle of a massive surge of a new variant that is ~2x or so as contagious as the previous Alpha variant, and while local hospitals, along with basically other hospital in the state as well as in nearby states have run out of ICU beds. After all, we have reports from other countries like India and the UK that the Delta variant seemed to be more infectious, and also that children seemed to be getting more often infected, leading to the logical conclusion that the same thing couldn't possibly happen in America, because American children are different from Indian children and British children, since American children are American, whereas those other children "over there" are not.

Since nobody could have possibly foreseen the possibility of large numbers of students getting infected with the highly contagious delta variant (and then spreading it to their family members when they go home) under such conditions, I guess it was totally impossible to deal with this pro-actively and make any sort of contingency plans for what would happen next in the unexpected event that this transpired. So instead of being pro-active in response to a disaster that nobody could have foreseen, it is a good thing that we can be re-active, and moreover have those reactions be constrained by gubernatorial fiat to rule out some of the reactions that would be more likely to have a mitigating effect.

As people, it is gratifying to know that we belong to such a wise, prudent, and farsighted species. 10/10 would lemming-cliff-jump again.

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

You are most likely going to get COVID multiple times in the next decade.

Yep, this is a very important point. The thing which we should be concerned about is that right now, we don't know what the effects of being infected a large number of times are.

We know that you have, for example, a certain percentage chance of dying from getting COVID one time based off of demographics.

However, suppose that you have one moderate case that requires hospitalization and a bit of oxygen, but not ventilation and is not life threatening. In that case, what happens if you get infected a second time? Is your risk of a more serious case and death higher than it would have been if you were not infected previously? It seems plausible that could be the case.

Or, what if you get COVID once, and you are basically asymptomatic or lightly symptomatic, but... it turns out on the cellular level, you have some lung scarring as a result (this sort of thing has been found repeatedly, e.g. https://www.ksat.com/news/local/2021/06/12/covid-19-survivors-even-with-mild-symptoms-could-see-lifelong-lung-complications-san-antonio-doctor-says/). So what happens the second time you are infected after that? If your lungs are not in as good a shape the second time going in, does your chance of death increase? And what if you suffer further lung damage, or other effects from being infected the second time? Does that then increase your chance of death when, two years later, you get infected for the third time?

More so than any real risk of getting infected once, that is what I am concerned about. We simply do not know the cumulative effects over time. And because we don't yet know, it would be wise to be careful until we know more.

Because of this massive delta wave, we probably will start knowing more about that soon. Over time there are going to be more and more people who were infected in the earlier waves who will start being re-infected with the Delta variant. Scientists will be looking at how they react to re-infection, and will start being able to do studies with enough re-infections to start drawing some inferences. Hopefully the inferences will be encouraging.

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

Is Biden intentionally trying to kill off Republican voters?

By this point, Biden should know that if he tells Republicans to get vaccinated, then that will make them LESS likely to get vaccinated, because Republicans will always simply reflexively oppose anything that any Democrat says, without any sort of thought or reflection.

Given this, you would think that if Biden actually wanted them to get vaccinated, he would tell them NOT to get vaccinated. That would then, perversely, cause them to get vaccinated just because it is contrary to what Biden would be saying.

Biden isn't dumb (right? () )

So does he have some other plan up his sleeves?

With, ~90% of Biden voters vaccinated and only about ~50% of Trump voters vaccinated, Biden also knows that a large majority of people who die of COVID are likely to be Republicans. By continuing to encourage Republicans to get vaccinated, Biden can ensure that they won't get vaccinated, and the voter pool will over time be purged of more and more Rs. It's true that in any individual wave, the numbers of deaths are limited. But when unvaccinated Republican voters who have suffered some minor lung damage from their first or second infection get re-infected for a third time, and a fourth time in subsequent ongoing waves, with each additional round of recurring infections, more of them will die and pretty soon we are talking about enough voters dead to swing an election, especially when the partisan difference in vaccination rates is so large.

So is Biden crazy - or genocidal - like a fox? Was this the plan all along?

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

Is Biden intentionally trying to kill off Republican voters?

No.  Biden is giving the best advice he can for all Americans.  If one segment of the population chooses to disregard that advice then it's their problem, not his.

But Biden KNOWS that if he simply "gives the best advice he can for all Americans," that in fact Republicans WILL disregard it. Which allegedly he doesn't want them to do.

If he actually doesn't want them to disregard that advice, then it stands to reason that he should give them the OPPOSITE advice. Perhaps Biden should try changing his rhetoric, and say that his plan has been going great to get Democrats to get vaccinated while Republicans don't, and that he wants to kill off unvaxxed Republicans in this way. If he says that, then unvaxxed Republicans will gain a new motivation to avoid dying and to get vaccinated in order to thwart Biden's scheme. So Biden should be out there encouraging Republicans to not get vaccinated, while encouraging Democrats to get vaccinated. That will result in more Republican vaccinations than the current messaging.

It's not just one group. It's republicans/libertarians for sure, but also hispanics and blacks.

White Dems have the highest vaccination rates (along with Asians), while Republicans have the lowest. Blacks and Hispanics are somewhere in between. I have not seen any data on Black and Hispanic vaccination rates broken down by partisanship, but I suspect if you broke it down that you would find that Blacks and Hispanics who are educated and/or Dems have markedly higher vaccination rates than non-college Republican whites. Independent and Republican Black/Hispanics are likely dragging down the overall Black/Hispanic vaccination rates, similarly to how Republican White voters are dragging down the overall White vaccination rate. The only reason why the overall White vaccination rate is as high as it is is the stellar out-performance by White Dem vaccinates.

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

Is there any data on what % of new COVID cases, hospitalizations, and deaths are breakthrough cases?

The only data I could find was from Virginia.

Unfortunately, the CDC stopped collecting data on breakthrough cases back several months ago when they (along with Biden) were in full "mission accomplished" mode. And they haven't resumed it either, even now that it is very clear that they should.

Thus, we lack good clear information about what is going on in the US. The best sources of information on the US is probably the recent Mayo Clinic study. That only applies to what they are seeing in their particular hospitals, but it is presumably fairly similar in other hospitals in the US in other hospital systems.

Other than that, the only thing that can be done is to look at other countries such as the UK and Israel which have functional public health systems and are actually collecting data to try and understand what is going on.

The USA lacks any sort of functional coherent public health system, just like the USA did back in the 1918 Pandemic. And from the looks of it, we will also lack a coherent public health system in the next Pandemic as well, and therefore will be doomed to a piss-poor response to future pandemics as well. For that, you can thank Federalism.

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

As it turns out, CDC has just come out with a brand new study on breakthrough infections in the USA. Like with the Mayo Clinic study, the data is pretty limited and not comprehensive, but when you are making no attempt to systematically collect data, you gotta take what you can get. Anyway, they found 91% vaccine efficacy against infection prior to the dominance of the Delta variant, which has dropped subsequently to 66% vaccine efficacy (but with a wide confidence interval between 26%-84% since the data is so pathetically limited).

https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm?s_cid=mm7034e4_w

During Delta variant–predominant weeks at study sites, 488 unvaccinated participants contributed a median of 43 days (IQR = 37–69 days; total = 24,871 days) with 19 SARS-CoV-2 infections (94.7% symptomatic); 2,352 fully vaccinated participants contributed a median of 49 days (IQR = 35–56 days; total = 119,218 days) with 24 SARS-CoV-2 infections (75.0% symptomatic). Adjusted VE during this Delta predominant period was 66% (95% CI = 26%–84%) compared with 91% (95% CI = 81%–96%) during the months preceding Delta predominance.

In general this seems in line with what earlier data was indicating from Israel, Mayo Clinic, etc.

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

Just curious…

Any vaccinated people starting wearing masks again when going out?  Any choosing not to mask up?

For a brief time when things were looking up, I went without, but now it is N-95 time any time I am indoors anywhere other than my own residence. Combined with Moderna vaccination, that is hopefully enough to avoid long COVID, and the odds are relatively good for that at least in the short term. I'll reconsider this policy if/when:
a) the Delta wave subsides a lot
b) and/or when new information/studies come out regarding vaccine efficacy against long COVID or the severity/treatability/longevity of long COVID
c) and/or if a future vaccine comes out that provides strong verified sterilizing immunity (a nasal one might at some point).

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

Prediction: The epicenter of the COVID-19 outbreak in the United States is going to have shifted North to the state of Georgia within one week's time, fueled by numbers in the Southern part of the state.

We're starting to get to the point again where case counts are sort of misleading for a combination of reasons. An indicator of that is the fact that the positivity rate is so high, especially in hotspots like Florida.

1) In some areas, it has gotten to the point where testing capacity is limited/delayed and you have to check multiple places to get a test.

2) Some people who think they may be sick are deliberately NOT getting tested, to avoid rules at school/work that if you test positive you have to quarantine. Kinda like how Trump said, if you don't test, we don't have cases...

3) Some people won't bother getting tested even if they are sick unless they have something more than a mild case.

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

If that mattered, the fatality rate before the vaccine rollout would have been higher in the US rather than the UK, it was the other way around. The US population is a bit younger, but I'm not sure if the difference was meaningful.

Earlier in the pandemic, the UK had less testing per capita than the USA (not at the very beginning, but in e.g. late 2020). So if you are looking at CFRs, the ratio of deaths to reported cases, that difference may be attributable to a lower proportion of cases being reported at that time in the UK than in the USA.

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

Nevertheless, I can see a justification for masks as long as we are masking vaccinated adults.  But once a kid is vaccinated, there is really no justification for masks at all.  The risk is just so infinitesimal as to not merit any significant intervention.

What are you talking about? There is plenty of justification for masks even when kids are vaccinated. Namely, if the vaccinated kids get sick, they can still pass on the virus and infect other people such as their parents and their teachers, even if the virus does nothing to the kids themselves. And then those parents and teachers will also infect other people in the general public etc. And this will lead to a lot more deaths and cases of long COVID over time.

Regarding the rest of your post, yes, it would be nice if the FDA could move quicker on getting vaccination going for kids. Basically the way the CDC and FDA have been acting throughout the pandemic is to require the usual standards of evidence before they say something is true. That has made them in a number of instances slow to react to new information. It has some benefits, however, because if for example FDA says that the vaccine is safe for kids but then it turns out not to be, that would only increase public distrust and anti-vax sentiment over the long run.

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

Are you saying then, that school mask mandates should become permanent?

No, I never said that. I simply said that children getting infected and spreading the virus will result in a lot more deaths and long COVID etc. That is true right now while we are going through this Delta wave, but there is no particular reason to think it will always be true in the future. It should be less the case in the future due to (hopefully) higher vaccination rates in addition to more widespread natural immunity from previous infections.

It is true it might also be the case at some other times in the future - for example if we get another variant that is even more deadly than Delta and is vaccine resistant, then the choice would at that point either be to accept a lot more deaths, or to adopt mitigation measures such as masks to limit the damage. But that is hypothetical which hopefully won't come to pass.

But if it does come to pass, if we are wise then we should be prepared for it.

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

So, my 87 year old grandpa, residing in a Florida assisted living home has now tested positive for COVID. Thankfully he is fully vaccinated, so I expect him to be okay in the end. But the poor guy is being taken two hours away to Jacksonville to be sequestered with other COVID positive seniors for at least two weeks. It's still not something that should be happening anymore. Furthermore; my aunt, dad, and grandma all had to get tested and quarantine until they get their results.

I've theorized that my grandpa got the virus from a worker at the home. Thanks, DeSuckass!
I've always, notoriously, loathed him; but now it's personal with me. F*** this incompetent scumbag!

As if I needed more to be angry about lately...I seriously feel like I'm losing my mind. I had a nice break from it for a short time, but we're right back to this country feeling like an apocalyptic wasteland to me...literally. People abandoned their cars on major highways here last night because of the tropical storm. Everything just sucks...my pig can't even make me feel better anymore.

Hopefully he will be ok, and likely he will be. Hang in there in the meantime.

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

There isn’t a good choice for the Biden administration here. Unlike last year, shutdowns are not justified given the existence of the vaccine, but he challenge is still getting people to take it. As much as I want a vaccine mandate, it wouldn’t work.

It’s time to consider a reverse disinformation campaign with Facebook and YouTube. The idea is to argue that liberals made the Delta variant and/or that the liberals want to discredit the Trump vaccine to keep masks forever. It’s not ethical, but it’s probably one of the more effective ways at doing this.

At this point, I don't think there is really much more that can be done other than to embrace the carnage. Try and look on the bright side. At least most of the anti-vaxxers who are dying are Republicans. So while it is sad when anyone dies needlessly, at least over the long run this will mean fewer Republican votes.

https://www.sorryantivaxxer.com/

https://www.reddit.com/r/HermanCainAward/

https://hermancainmedal.com/

https://melmagazine.com/en-us/story/herman-cain-awards

So tbh the best thing - not purely out of desperation/resignation at there being nothing else you can really do - but also if you genuinely want there to be fewer deaths, may well be to gloat at the deaths, because if Conservatives see a huge number of progressives gloating at how all the Republicans are dying, then they might take the vaccine just in order to prevent progressives from being able to continue to gloat. Sounds sort of like a way to own the libs. Maybe the new Conservative boomer facebook meme could be something like: Ha, take that lib, I got vaxxed, didn't die!

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

As much as I hate to give Mitch McConnell credit for doing anything good... He did suffer from Polio as a child, and consequently is pretty pro-vaccine.

https://nypost.com/2021/07/28/mcconnell-to-run-pro-vaccine-ads-to-combat-misinformation/

His support for vaccination (including apparently running ads encouraging vaccination using his own campaign funds) might perhaps be helping persuade some Kentucky R voters who otherwise would not have been vaccinated.

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

People need to be arrested and fined for violating COVID restrictions and for any disorderly conduct related to violations.

Come to Australia then.

Jewish congregation gets $30,000 in fines and shut down for an illegal gathering.

https://www.abc.net.au/news/2021-09-07/victoria-police-responding-possible-breaches-religious-gathering/100441768

Weird that ABC try and write the article without using the word 'jewish' until the 23rd paragraph.

It must suck to have ongoing lockdown like that and not even have the benefit of eliminating delta.

Meanwhile over in New Zealand, they did a proper lockdown, rather than the half-assed one that the idiot running New South Wales did. As a result, whereas the virus keeps spreading in Sydney and you still have strict lockdown, in New Zealand the cases have been going sharply down for the last week, down from 70ish to now 15 today. All of New Zealand except for Auckland (where the cases seem to be restricted to at this point) is now able to go to lower stage restrictions, and if things hold up the rest of the country will be back to normal (and not just American style "normal," but normal without the virus) pretty soon.

Hypothetically, if the whole world had acted this way at the very beginning, it might have been possible to quickly eliminate COVID in the same way that SARS-1 was eliminated. But at this point, sadly that is probably effectively impossible since it has multiple animal reservoirs.

And since it now has animal reservoirs, we will now always need to be on the lookout for the possibility of a worse virus, perhaps substantially different from the current one, crossing back over into humans over the next decades and centuries, similar to concerns about bird flu. On the bright side though, the world will be ****ed by climate change anyway, so if we get some new SARS-COV-3 crossing over from deer or rats with a 20% fatality rate maybe 20-30 years from now down the line, it won't much matter that point since the world will already be on fire regardless.

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

Got my first Pfizer shot today.

Although there is no COVID-19 in Western Australia still glad to get this process underway.

Arm is a bit sore, but apart from that, feeling fine.

21 days until my 2nd shot.

Don't get your 2nd shot in 21 days (unless for some reason you have to).

There is evidence that if you have a longer interval between your first and second shot, you will end up with longer lasting/more effective immunity (and specifically so for the Pfizer vaccine).

I'd suggest researching further yourself, but as a starting point:

https://www.businessinsider.com/delay-second-dose-pfizer-covid-coronavirus-vaccine-immune-response-study-2021-7

Giving the second dose of Pfizer's two-dose COVID-19 vaccine eight weeks after the first is the "sweet spot" to protect against the fast-spreading Delta variant, a UK research group has said.

A study posted Friday, led by Oxford University, found that delaying the second dose up to 10 weeks boosted antibodies and "helper" T cells  that support the immune system higher than giving it at three weeks, as recommended by Pfizer.

Two doses of Pfizer's shot boosted immune responses higher than one dose, no matter the time between doses, the study authors from the universities of Oxford, Newcastle, Liverpool, Sheffield, and Birmingham added. Waiting longer to get a second dose presents a trade-off because people are less protected against the coronavirus after just one shot.

So especially given that there is no outbreak in Western Australia, it makes sense to wait up to ~8 weeks or so for the #2. If you were in the midst of a raging outbreak, it might be a slightly harder call, but luckily for you, you are not! Hopefully it stays that way for a while.