[beepboopbeep]

This man is claiming that staying at home increases deaths... He's also claiming a vaccine could be years away.

I also see zero evidence as to why he should be considered a credible source for effective covid treatments. The man is an economist at a university. Am I looking at the wrong Robin Hanson?

[skosch]

You've got the right Robin Hanson.

The key argument is that there is lots of uncertainty, but variolation is probably worth trying. And if volunteers can be found, why not? One shouldn't need to be a virologist to credibly make that argument.

[zbjornson]

Well, for one, orthopoxviruses cause skin lesions, replicate in keratinocytes, dermal fibroblasts and other skin cells and evoke strong immune responses there. Coronaviruses don't.

[pmayrgundter]

I've been looking into this.. you might be interested in my work on a Live Virus Skin Vaccine for CoV2. Comments welcome!

https://docs.google.com/document/d/1x91Ef7G6xbm77DcRDvjAXbFm...

[powersnail]

I'm not a medicine professional, so I'm just curious here.

Since variolation has basically the same principle as vaccination, it's hardly an alternative to vaccination. Is it really worth trying?

To me (with my very crude understanding), proposing variolation as an alternative to vaccination is akin to proposing knife without a handle as an alternative to a regular knife.

Is there any case where vaccination fails to work, while variolation succeed?

[frank2]

A vaccine is months or years away whereas variolation can be deployed right now.

[powersnail]

To deploy it, wouldn't it need to be tested just like a vaccine? Or is it suggested to just deploy virolation without testing?

[frank2]

>is it suggested to just deploy [variolation] without testing?

Yes: the blog post by economist Robin Hanson suggested deploying it without waiting for the results of testing. (Of course, it would be good to test as fast and as much as possible concurrent with the deployment.)

"deploying it": making available to the public a variolation service or procedure designed by medical experts.

[vikramkr]

If we're lowering the standard, why only lower it for inoculation? We can just start deploying the dozen+ vaccines we have in development too if we decide testing isn't important.

[janekm]

The reason a vaccine is months or years away is only because we are testing whether it is safe enough to give to billions of people. The reason we do that is because a virus can cause disease both directly but also in unexpected ways (e.g. by immune over-reaction to some of the viral RNA in some individuals). Variolation as a public policy would have to go through the same safety testing for the same reasons (as it is a form of vaccination with un-weakened virus). You would also still have to produce doses of the variolate, both in terms of replicating the virus and bottling it.

There is no real time advantage to variolation. Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now (a case could be made... allow volunteers to be given the candidate vaccine of their choice in larger numbers than normal clinical trials, scaling up as the risk profile of each candidate vaccine is known).

[frank2]

I am not an expert (but neither are you, I am guessing).

>Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now

The advantage variolation has over the 30 vaccine candidates, I am guessing if the question is what to do before the results of testing are available is that most of those 30 candidates will turn out after being tested to fail to confer significant immunity.

I believe that the fate of most vaccine candidates for any disease is that testing reveals that the candidate fails to confer immunity to most or all of the people it is given to. Also I believe that it usually takes at least a year to produce enough of a vaccine to test, then test, then analyze the results of the testing.

[vikramkr]

Variolation could fail as well. It would still need to be tested for safety and efficacy.

[BurningFrog]

The point you're missing is that there is no vaccine for Covid-19.

If there was, no one would consider variolation.

[janekm]

There are 30 candidate vaccines (probably a lot more by now). 32 if you include the two that are non-weakened forms of virus that are being proposed for variolation.

[pmayrgundter]

Are these 2 others actual registered trials? Or are you referring to public proposals for such, like Hanson's?

I'm working on just such a public proposal [1] and have been in correspondence with Hanson but haven't heard of any registered.

[1] "SARS-CoV2 Live Virus Skin Vaccine" - https://tinyurl.com/y8ujrcze

[bradj]

Having "candidate vaccines" is very different from having a "vaccine". Variolation is a reasonable alternative to the lack of a known, effective vaccine.

[vikramkr]

Variolation as a term only applies to smallpox. Giving small doses of the live virus as hanson suggests is literally just a lame vaccine. It's also not known to be safe or effective and would have to go through all the trials anyway.

[vikramkr]

You have to test variolation too. There are dozens of vaccine candidates, if we are willing to ignore safety and efficacy testing we can start vaccinating people today.

[emiliobumachar]

This is a key insight. All of the benefits of variolation today skipping tests can be had by vaccination today skipping tests.

[ggreer]

Not entirely accurate. We know variolation will provide immunity. The main risk is to the volunteer, not to others. A vaccine might not provide immunity. That would make the patient a vector for the disease and endanger others.

[BurningFrog]

Right. I think the proposal is simply to actually test variolation.

[tinus_hn]

So are you claiming if everyone stays at home food will magically keep appearing on their doorsteps?

[beepboopbeep]

Just to clarify further - the man cites nothing but his own blog articles but makes sweeping statements as though they are fact. This is speculation on medical approaches for an understudied virus by a man totally unqualified who feels it unnecessary to inform his audience as such.

How else can one describe fraud?

[jimmyswimmy]

He's an economist, sure, and is proposing an idea that others can consider and, perhaps, study. I am not looking to this blog post as a source of treatment ideas but instead as a source of ideas.

I've been reading about the importance of the viral load in survival against this disease. His proposed variolation approach is one I've personally considered. Much like families of old had chicken pox parties for their kids, the idea of just getting this over with as safely as possible has some appeal.

Yet it is an approach out of favor for good reason. For most diseases the risk can be significant and historically we've been able to improve survival via quarantine and treatment. This disease is apparently harder to quarantine due to a long latency period and asymptomatic cases. And we have no effective treatment for the worst cases.

It is interesting however to consider that for patients inoculated with preliminary vaccine, it is considered unethical to give a "challenge dose" of virus, while this guy proposes doing so for those with no protection whatsoever. I can't get past that, and am too risk averse to try his idea even in a carefully controlled setting. I'll keep wearing my mask, washing hands and wait it out for now.

There is hope that we will discover a variant of this disease which is less dangerous. In that case I think the approach he recommends is more reasonable.

[vikramkr]

As you said, Pox parties and all weren't exactly a brilliant solution - now your kid would be carrying the chickenpox virus amd have a risk of shingles later, and using things like saliva from lollipops means that your kids are also now at risk if getting all sorts of fun diseases like hepatitis. There's a reason we use vaccines. We dont know the long term risks of covid (case in point, recently it's become clear that it can trigger blood clots and strokes in otherwise low risk individuals, and the inflammatory syndrome in children is highly concerning). That's why we dont do challenge doses.

There are companies deliberately breeding strains that are less dangerous (attenuated strains) for use as a vaccine, so people are working on that actively. It's not one of the approaches further along in trials though.

[DagAgren]

He is not a credible source on this, or pretty much anything else. He has some utterly reprehensible views, and is part of a very questionable cult of self-important people.

https://rationalwiki.org/wiki/Robin_Hanson

[jimmyswimmy]

Meh. I have never heard of him before, but he has a clearly expressed idea which isn't completely unreasonable. I evaluated the idea on its own merits, and that's where I found it lacking. The man matters nothing to me, only his idea.

I submit that this is the only reasonable way of evaluating ideas. We can't all be perfect for all time in history.

Edit. Having now read your link, I am less interested in following his blog, but my analysis of his proposal is unchanged knowing more about him.