[input_sh]

I think you're vastly overestimating our capacity to build enough vaccines and distribute them over the world, as well as dealing with those who will refuse to vaccinate.

Even if we had a vaccine ready for the roll-out today, I don't see us going back to normalish until late 2021 at earliest.

As with any vaccine, you'd need about 80% of the population to vaccinate in order for herd immunity to kick in. I feel like we're gonna have trouble reaching that amount for years to come.

Getting a working vaccine is only step 1 towards eradication path, not the end goal.

[wang_li]

Pfizer is already mass producing their vaccine and are saying they’ll have 100 million doses available this year and are targeting 1.3 billion next year.

The US has five million people who tested positive and have recovered. Likely also another 30-50 million who were never tested because their symptoms were to minor. And another 66-165 million who have cross reactive T-cells.

Some researchers have concluded that the herd immunity threshold for sars-cov-2 could be as low as 10% or as high as 50%. I don’t think anyone sees it as high as 80%.

https://www.bmj.com/content/370/bmj.m3563

[celticninja]

https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

The mayo clinic suggests it could be 70%, and I have seen others suggest 80%. I have not seen anyone suggest as low as 10/20% so I think that suggestion is a huge outlier and even the paper you link says as much.

[bart_spoon]

There actually has been several papers posted to r/COVID19 that have suggested that the herd immunity threshold is likely overestimated. This is because vulnerability to infection isn't uniform across the population. Some people will be more likely to be infected, either due to biological reasons, like a weaker immune system, or sociological ones, like living or working in an area where transmission is far more likely. Most of the higher estimates of a herd immunity threshold of 70-80% are based on transmission dynamics from early in the pandemic, which mostly consisted of these people with higher probabilities of infection. Once this population starts to get burned out, the transmission of the virus also slows, which means that the herd immunity barrier also drops.

One of the papers hypothesized that this demonstrates why areas like NYC got hit so hard initially and have remained stable since. Seroprevalence surveys back in the early summer indicated that between 20-30% of NYC residents had contracted Covid already. The lockdowns obviously blunted the surge, but unlike other areas of the country, as NYC has opened back up, there hasn't been much of a second wave at all. With more than 2/3rds of the population still without any kind of exposure to the virus, you would expect a dense city like NYC to see a large increase. The paper concluded that this is evidence that might suggest that the herd immunity barrier is far lower than initially estimated. I've seen some papers suggest something closer to 20-50%, but nothing so low as 10%. I'll see if I can dig up some of the preprints to post here.

[lbeltrame]

That's because 70/80% estimates assume that the population is entirely vulnerable, while instead it looks like it's partially vulnerable. Hence the estimates would need adjustment.

[Izkata]

80% or so is accurate if there was no cross-reactivity and if asymptomatic is included in the case count. It's what was being reported in March or so when we didn't yet have evidence of cross-reactivity.

[jandrewrogers]

In most models, we currently assume herd immunity is 50%. We know it isn’t higher than that but we also have circumstantial evidence that it likely isn’t below 40%. A complicating factor is that we know the number of infections is much higher than the number of cases but we don’t know by how much and this is not something we can effectively measure retroactively, which makes it challenging to model precisely.

[breakfastduck]

Overly cautious about the herd immunity stuff here.

We're not going to eliminate the virus completely. That's a given, we should stop aiming for that.

If we get to a point where there's a stable number of daily deaths then we're good. (like we have for literally every single fatal illness.)

[SECProto]

> (like we have for literally every single fatal illness)

Smallpox. And if you consider within the borders of a given country, a dozen others (polio, measles, mumps, rubella, chickenpox).

[0xffff2]

Which countries have eliminated the latter 4? I would consider an illness "eradicated" if the vaccine is no longer regularly given. At least 10 years ago (when I was in the field), MMR and Chickenpox vaccines were still regularly administered in the US.

[SECProto]

> I would consider an illness "eradicated" if the vaccine is no longer regularly given

Fair enough. I would consider a virus eradicated when the general population gives zero thought to it, and effectively no one dies from it. Doesn't meet the strict medical definition, but I thought the description of "If we get to a point where there's a stable number of daily deaths then we're good" was overly pessimistic.

[ksk]

>I would consider an illness "eradicated" if the vaccine is no longer regularly given.

That's not how it works. Just because you don't see an outbreak for a while, that is never a reason to stop immunizing children. Pathogens can and do have natural reservoirs. This is why when some idiots stopped taking the Measles vaccines we had an outbreak here in the US.

https://en.wikipedia.org/wiki/Natural_reservoir

[0xffff2]

Of course that's how it works. We don't regularly administer small pox vaccines anymore because it has been eradicated except for a couple of very tightly controlled samples. That's what "eradication" means. My memory is slightly hazy, but I think we might have skipped Polio as well for anyone not going oversees, because Polio largely meets the definition of "eradicated" in the US. Meanwhile, we continue to administer MMR and Chickenpox vaccines because those diseases still exist in the wild. The very fact that Measles has returned is ipso facto proof that it was never eradicated, and the fact that (normal) people never stopped giving that vaccine to their kids is proof that no one ever believed it was.

[artursapek]

COVID-19 is a slice of apple pie compared to Smallpox

[breakfastduck]

None of those are a common type of Flu, which we've never been able to cure, though.

[SECProto]

Covid-19 isn't a "common type of flu" either. The diseases I mentioned were certainly widespread and endemic. And they're all different types of virus.

[rsynnott]

How can people possibly still think COVID is a type of flu? This was perhaps forgivable in February, but...

[nradov]

The moving average of daily deaths in the US has been stable or declining for the past two months.

https://www.worldometers.info/coronavirus/country/us/

[vaughnegut]

A friend of mine in public health mentioned to me that it's not uncommon for second waves of epidemics to be less deadly, since many of the people most vulnerable to the disease would have already passed away during the first wave.

[breakfastduck]

I mean, that's just common sense, and something the media is actively choosing not to raise.

[mikeyouse]

This idea that the "Media" is this sinister entity trying to stop the spread of good news during a pandemic which the entire world has taken drastic steps to curtail yet which has still killed over 1.1 million people is just so silly.

[tfew]

The media optimizes for eyeballs and attention, and hence we see hysterical, inaccurate, and fear-based reporting. With all the noise they put it, it absolutely does crowds out facts showing that the virus is now likely less deadly than it was in the earlier phase of the pandemic.

"If it bleeds, it leads"

[nradov]

Technically this is know as "mortality displacement" or the "harvesting effect".

https://en.wikipedia.org/wiki/Mortality_displacement

[ffdjjjffjj]

That was true until last week. Deaths are now rising again, and daily new cases are approaching the level of the summer peak.

[breakfastduck]

Daily new cases means nothing - it's a completely artificial figure that can be inflated or deflated by simply changing how many tests are conducted.

Deaths is the only relevant measure.

[ffdjjjffjj]

It doesn’t “mean nothing”, it’s another data point. If you see test positivity rate remaining low but cases increasing - which we do in many areas with sufficient testing - then it does suggest more people are getting the virus.

You can also corroborate this by comparing it to new hospitalizations, which are also up.

“Deaths is the only relevant measure” - not sure where to start with this except to say that this is not at all what epidemiologists seem to think and I won’t address it further without some very dramatic reasoning and evidence.

[irq11]

” If you see test positivity rate remaining low but cases increasing - which we do in many areas with sufficient testing - then it does suggest more people are getting the virus.”

No, it suggests that you’re doing more testing, and finding more cases. Which, exactly as the OP said, is a metric that can be manipulated by doing more testing.

The whole reason we emphasize positivity rate is to try to compensate for the inherent bias in reporting raw case counts.

There have been far more cases than we have ever formally detected with testing. There’s plenty of room to increase that number by testing more people, but it will not affect hospitalizations or deaths - which is exactly what we’re seeing.

[chimprich]

Deaths are not an entirely useful measure to see how the pandemic is progressing because they are a lagging indicator.

Positive test rates measure what was happening about a week ago. Hospital admissions reflect activity a week or two before that, and deaths often get reported a month or more after the events that caused people to get infected.

You have to look at all the data to get an idea of what is happening.

[irq11]

There has been a slight uptick in weekly deaths, roughly on par with what was observed in the last week of September. Given the trend of the line and the delayed reporting from most states, it’s more accurate to say that deaths have flattened:

https://covid-19.direct/US?tab=daily

[komali2]

Doing so would ignore the sometimes dramatic effects survivors experience - from the people I know alone, this ranges anywhere from previous marathon runners still huffing and puffing their way up stairs despite having been otherwise symptom free for 6 months, to a man who survived by the skin of his teeth and it now appears will never be able to taste or smell again.

I don't know about you but I'm feeling like simply "getting to a stable number of daily deaths" doesn't cut it. Also, that statement alone doesn't make sense to me - a fatality rate of 50% could potentially maintain a stable rate of daily deaths... Of thousands.

[gadders]

Given the low fatality rate for COVID, wouldn't you just want to concentrate vaccination on those most at risk? i.e. the elderly, people with underlying conditions etc.

You don't need to eradicate the virus, just stop it affecting the most vulnerable. Everybody else can then carry on as normal (albeit with a slight chance of getting a nasty flu-like illness).

[warp]

There some risk of permanent or long lasting damage even if you do not die from the virus. (So it is more risky than just a nasty flu).

https://en.wikipedia.org/wiki/Long_Covid

[anoncake]

There is evidence that recovery sometimes takes more than a few weeks, but none for permanent damage (except in rare cases). The risk is overblown.

[majewsky]

SARS-CoV-2 relies on superspreading much more than e.g. the common cold. When you hear, for example, that each patient in a given area infects 1.2 other people on average, this doesn't mean that everyone spreads it to one or two people. It means that out of 10 infectious patients, 9 patients don't spread it to anyone else and the tenth patient spreads it to a dozen people at once.

Because of this high dispersion rate, it may make sense to earmark a certain amount of vaccine doses for people who are not themselves at risk of complications when contracting Covid, but who are at risk of becoming a superspreader.

(Disclaimer: I'm not an epidemiologist.)

[gadders]

I'm not saying don't give it to them as well, just do the vulnerable people first.

At least then we stand a chance of getting the economy back on its feet.

[majewsky]

"Just do the vulnerable people first" has the significant advantage of being easy to explain and implement, but it does not maximize the speed of economic recovery.

For instance, I'm a vulnerable person because of preexisting conditions, so I'll likely be offered a vaccine relatively soon after approval. But that won't have a large impact on economic recovery: I'm in the home office in a single-person household and don't have any care obligations, so I'm at a comparatively low risk anyway. And I won't change my current behavior until the disease is fully gone anyway.

[gadders]

My thoughts in treating the vulnerable first wasn't because I thought the vulnerable would then be able to go back out to work, but because the vulnerable would be relatively safe the people with no pre-exisiting conditions wouldn't have to stay home to stop the spread.

[input_sh]

Even if we vaccinate every vulnerable group, no vaccine has 100% success rate. That's why every vaccine we ever had relied on a huge majority of people having it to prevent the virus from reaching those whose vaccine failed.

Not to mention that we already know about long term side effects that have nothing to do with a specific age group, and that there's a chance of re-infection.

[rhino369]

Sure but it would reduce the number of deaths by a lot.

If we just vaccinated 65+ year olds, we'd cut deaths by 80X%, where X is the effectivelness of the vaccine. Even if the vaccine was only 80% effective, that's still 65% reduction.

Add in people with dangerous conditions, heart conditions, cancer, morbidly obese, etc., and you could probably knock it down further.

And as the percent of the population with immunity rises, the spread will slow quite a bit.

We don't need heard immunity to open back up.

[Jemm]

Vaccination is not 100% (more like 50%) effective and will really only help if we achieve herd immunity.

[krona]

As with any vaccine, you'd need about 80% of the population to vaccinate in order for herd immunity to kick in.

Wrong. The herd immunity threshold (HIT) for influenza is 33%-44%. HITs are different for every infectious disease. Current estimates for COVID-19 are 60-75%.

[tgb]

Isn't that a different number, though? You have to factor in that vaccines aren't 100% effective at preventing disease. Wikipedia spells it out in the vaccine section here [1]

[1] https://en.wikipedia.org/wiki/Herd_immunity

[krona]

True but you're also not taking in to account that far less than 100% of the population appear susceptible to the virus, especially in e.g. Japan and Germany, for various reasons.

[wbl]

Do you have a credible source? I've heard these claims multiple times and they done seem to be borne out by events or supported by repudiable epidemiologist.

[krona]

Here is a summary of at least 6 articles on pre existing t-cell immunity. https://www.bmj.com/content/370/bmj.m3563

Furthermore, I know of at least 3 leading statisticians that hypothesized (very early on) that the variance of infection trends pointed to pre-existing immunity in various populations. The evidence supporting this is mounting.

[russholmes]

The BMJ is not a credible source, it is the Daily Mail of medical journals. The author of that article, Peter Doshi, has form:

"I think the first thing we to review is who is Peter Doshi? And why is he so insistent on getting this data?

Peter Doshi received his BA in anthropology from Brown University, MA in East Asian studies from Harvard University, and Ph.D. in history, anthropology, and science, technology and society from the Massachusetts Institute of Technology. Those would be fine credentials for someone who is going to teach history or anthropology."

https://www.skepticalraptor.com/skepticalraptorblog.php/pete...

[krona]

For the lazy (cited 556 times as of now): https://www.cell.com/cell/pdf/S0092-8674(20)30610-3.pdf

[komali2]

Susceptible in what sense? Getting it and not having severe symptoms doesn't count as having benefitted from herd immunity - you still got it.

[tgb]

Wouldn't that be inherently included in the HIT calculation?

[jariel]

COVID is special though in that if it were only as deadly to the young as it were to everyone, I don't think we'd be referring to this as a pandemic.

Literally, right now we are seeing case rates explode, but the number of casualties is paradoxically very low because it's mostly the younger cohorts getting sick - which is probably a social function of things like 'back school' and 'risky behaviours' among younger groups.

If we could get everyone 50+ vaccinated, we may be largely safe - maybe not 'back to normal safe' - but the combination of 'partial herd immunity', 'much lower rates of hospitalization' etc. may mean we can 'kind of get back to normal'.

[C1sc0cat]

Some of the longer term effects are scary though - I suspect that younger people might not be so blasé about chronic illness.

At minimum younger people who have had covid are looking at a lot more regular check-ups for the rest of there life.

[logicchains]

> Some of the longer term effects are scary though - I suspect that younger people might not be so blasé about chronic illness.

There's not a single peer-reviewed study showing a significantly higher frequency of long-term adverse effects in healthy individuals compared to other respiratory illnesses.

[C1sc0cat]

There's initial results that indicate that its likely - you wont get hard data for another decade plus - but take it from me you don't want to get CKD or similar organ damage.

[impendia]

Various experts are predicting that the winter will be quite bad. See for example:

https://covid19.healthdata.org/global?view=infections-testin...

https://covid19.healthdata.org/united-states-of-america?view...

But notice, in the latter chart, that in the US the number of infections is predicted to peak in January and then start going down. It seems plausible that by March, we'll achieve some level of herd immunity, relative to the precautions that are currently being taken. We might have a situation like Europe over this pas summer, with small numbers of cases until a second spike in Fall/Winter 2021. That would buy us the spring and summer to roll out a vaccine.

Of course, I'm far from sure that this is what will happen -- but it certainly seems plausible to me.

[Jemm]

Those charts are already inaccurate. I wouldn't rely on them.

[impendia]

Rely on them? I agree, certainly not. But at least they describe a plausible scenario.

[halfmatthalfcat]

It's been estimated that 80% of the population needs to have been infected to achieve herd immunity. That means ~240 million people in the United States need to be infected. We're at 8.7 million infected. No way we get herd immunity anytime soon.

[impendia]

Herd immunity is relative.

For example, I'm a professor at the University of South Carolina. Here we've had around 2,500 confirmed Covid cases, and perhaps around 10,000 cases in actuality. Nearly all of them happened in the first few weeks of the semester, and now the positive test rate is extremely low.

Looking around town, it's pretty clear what happened. There are some students that have acted like nothing is happening, partying and drinking constantly. That population has presumably hit herd immunity already. Meanwhile, there are many students (and staff) that are exercising precautions, and not venturing out a lot, and probably few of them have contracted the disease.

Now, we can't just go back to normal, or else cases would spike among this second group -- but locally it seems that we can afford to relax a bit.

And, also, we're at 8.8 million confirmed infected -- the actual numbers are presumably much higher.

[bleepblorp]

None of the vaccines currently on the table are even remotely good enough for 'back to normalish.' The attack rate for this virus is so high that a vaccine good enough (i.e. multiple 9s effectiveness) to allow 'back to normal' almost certainly isn't possible.

The most we're going to get out of a vaccine is a tool that can be used in conjunction with physical distancing, and masks, to keep the infection rate and hospitalization rate sustainable.

Even with a vaccine, COVID-19 will remain one of the leading causes of death among the sick and elderly. The percentage of chronically ill people who live, and the percentage of people who make it past age 65, will plummet.

Everyone who's alive now will almost certainly need to socially distance (and should wear an N95/KN95 mask in public indoor spaces) for the rest of their lives.

What's happening now is humanity's normal.

[lbeltrame]

> None of the vaccines currently on the table are even remotely good enough for 'back to normalish.' The attack rate for this virus is so high that a vaccine good enough (i.e. multiple 9s effectiveness) to allow 'back to normal' almost certainly isn't possible.

Is it? Current studies, AFAIK, give very variable attack rates, from low zeros to around 30%. Only higher if due to close contacts for longer periods of time (carriers, fishing boats, meat packing plants). This preprint on trasmission dynamics and evidence from September[1] has lower figures.

> Everyone who's alive now will almost certainly need to socially distance (and should wear an N95/KN95 mask in public indoor spaces) for the rest of their lives.

I wonder how we're even supposed to build a society that can live without any or very reduced form of contact. I think it's socially unsustainable.

[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3692807

[giantDinosaur]

No offense, but this is one of the worst comments I've ever read on hackernews. You have not a single piece of evidence for any of your claims, and they fly directly in the face of all reasoning about how a disease like this is most likely to work once it becomes long-term endemic.

[artursapek]

> dealing with those who will refuse to vaccinate

What's there to deal with? Let people make that personal choice and leave them alone.