[whatshisface]

I think the issue with being hesitant about mRNA vaccines is that they're probably not as bad for you as an mRNA virus. The mRNA virus will definitely inject mRNA into you to make your cells do its evil bidding, and it is fairly unlikely that the vaccine, which only injects one part of the virus' mRNA into some cells, could somehow be worse than the virus, which injects everything in the vaccine plus mRNA encoding several other proteins, and replicates boundlessly to boot.

The mRNA that Pfizer puts in to the lipid nanoparticles isn't even as dangerous as the virus's equivalent - the version of the spike protein it encodes is mutated at a point to prevent it from making the conformal change that wrenches membranes open.

[rory]

To play devil's advocate, the retort to this is that if you don't get the vaccine you're some <100 percentage more likely to get the virus, but if you do get the vaccine you're 100% likely to get the vaccine.

I think the related mistake some vaccine-hesitant people make is that they greatly underestimate their likelihood to get the virus in the future. This is reinforced by some pro-vaccine people (incorrectly) claiming we can eradicate the virus through high vaccination rate.

[giantrobot]

> This is reinforced by some pro-vaccine people (incorrectly) claiming we can eradicate the virus through high vaccination rate

A high vaccination rate of high efficacy vaccine(s) can most certainly eradicate a disease. A virus can't do a whole lot without a host to incubate and spread it. If potential hosts can't meaningfully incubate or spread the virus, it stops spreading.

Once the good vaccines (80+% efficacy) became available, if they could have magically been distributed to everyone, COVID would be entirely contained by now and on the way to being eradicated in the population at large. Only the most remote reservoirs would contain the virus at transmissible levels.

That is not saying some 70% vaccination rate will eradicate the virus. It will bring the infection rates down to below pandemic and epidemic levels. If someone is unvaccinated for medical reasons but everyone around them is vaccinated the virus has a pretty huge moat to cross to infect them. Even when the vaccinated get a breakthrough infection the odds of it being serious are very low as is its transmissibility.

[rory]

It seems like you are basically agreeing with me while pretending to disagree. Of course we could eradicate the virus with a magically high vaccination rate using a magically effective vaccine. But that's not possible in our current reality.

By insinuating that we can eradicate the virus using current technology and current infrastructure, it causes vaccine-hesitant people to see their choice as a type of prisoner dilemma. When in reality, their choice is more like "do I want to get initial immunity via the vaccine, or do I want to (eventually) get it via the virus.

[giantrobot]

We can eliminate viruses with current technology and current infrastructure. We've done it with several diseases already.

The vaccine "hesitant" don't have a prisoner's dilemma. They're not understanding or being misled about probabilities.

A symptomatic COVID infection has a fairly high probability of a "long haul" case and a smaller but still relatively high probability of hospitalization. It should be painfully clear that with a high infection rate the hospitalization rate is high enough to flood hospitals and cause follow-on effects like non-COVID emergencies being unable to receive proper treatment.

Waiting to gain immunity to COVID through natural exposure has a high chance of a long haul condition, hospitalization, and death. On the other hand the vaccines have a chance of side effects so low as to be effectively none. Once vaccinated the chance of breakthrough symptomatic infection is low and the chance of long haul conditions, hospitalization, and death are extremely low.

There's no dilemma about vaccines for anyone being rational. Even if you're hesitant about mRNA vaccines (despite hundreds of millions of doses with no problems) there's viral vector vaccines readily available.

[nradov]

We cannot eliminate the SARS-CoV-2 virus with current vaccines. I would encourage everyone to get vaccinated if they can, but the virus is here to stay.

https://www.cnbc.com/2021/09/07/who-says-covid-is-here-to-st...

https://www.businessinsider.com/delta-variant-made-herd-immu...

[rory]

Again, it seems like you're basically agreeing with the trappings of argument. I am talking specifically about eradicating SARS-COV-2, not eliminating a virus in abstract. It's obvious that there are some viruses we are able to eradicate, but it is also obvious that there are some we are not.

The rest of your comment is punching ghosts. Keep in mind that most people are not rational, and empathizing with irrational people is a more effective method of influence than scorn.

[native_samples]

This is the sort of argument that causes people to reject vaccination.

1. "a smaller but still relatively high probability of hospitalization."

The risk of hospitalization for COVID is (in the UK, other countries are comparable) something like 0.1% per week for the 65-75 age range [1]. It is much lower for younger people. Ignoring the actual probability of getting infected is not legitimate - people care about overall outcomes. Claiming this is a "relatively high probability" is the sort of false claim that creates resistance to vaccination, because it makes the people promoting vaccination look mis-informed. Especially when they claim to be more rational and have better information than the people they're criticizing, this is guaranteed to piss people off and make them double down on their position. After all, someone who tried to convince them they were wrong just demonstrated an incorrect understanding of risks, and vaccination vs infection is all about marginal risks.

2. "A symptomatic COVID infection has a fairly high probability of a long haul case"

Long COVID isn't even a definable thing, so talking about it will immediately reduce your credibility with those who don't want to take a vaccine. You really have no idea what the probability is given that long COVID isn't a real disease, in the sense of having a defined set of diagnosable symptoms.

Injuries from taking the vaccine on the other hand are definable. Most countries have databases with entries describing those injuries, but they are incomplete so it's hard to know the full risk. Most pre-COVID studies suggest the under-reporting rate is anywhere from 10x to 100x, so the true numbers are certainly quite high, especially as under-reporting for COVID vaccines is clearly much higher: lots of people claim the vaccine made them sick for a day or three, but don't report this. So people who talk about the risk of long COVID but never talk about the risk of long vaccine look biased and irrational (i.e. not doing a cost/benefit analysis).

3. "It should be painfully clear that with a high infection rate the hospitalization rate is high enough to flood hospitals"

There are quite a few countries have got through prior waves in which nobody was vaccinated without hospitals being overloaded. Switzerland for example publishes long term data on hospital capacity. As you can see [2], at no point did the country run out of beds or even come close. In fact ICU beds have been decommissioned over the past year because there were too many, and regular hospital beds were never more than 10% COVID occupied. Therefore, this is not painfully clear, especially as you're using vague terms like "flood" and "high".

4. "Waiting to gain immunity to COVID through natural exposure has a high chance of a long haul condition, hospitalization, and death"

The COVID IFR estimates published by the WHO is ~0.2%. This is not "a high chance ... of death".

5. "There's no dilemma about vaccines for anyone being rational"

You have just demonstrated that you don't understand the actual risk levels involved with COVID, so it would be wise to refrain from criticizing other people's rationality.

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

[2] https://www.covid19.admin.ch/en/hosp-capacity/icu

[giantrobot]

The death rates for COVID infections in the US is sitting pretty at about 1% [0]. The hospitalization rate is over 5% [1] on average and way higher in some regions.

Meanwhile influenza's IFR in the US, which includes pneumonia from an infection, is about 0.05% and the hospitalization rate about 1% [2].

As for vaccines, you're full of shit. Feeling sick for a few days after a vaccine is not in any way similar to actually being infected with COVID. Besides the symptoms being extremely mild and in no way debilitating they're not communicable! If you get vaccinated and go to work you won't vaccinate your entire office by accident.

So far in the US we've got about 40 million known cases of COVID with over 600,000 deaths. We have hundreds of millions of fully vaccinated adults with very few deaths from the vaccines. One of the two things is orders of magnitude safer than the other. Hint: catching COVID is not the safe one.

[0] https://coronavirus.jhu.edu/

[1] https://pubmed.ncbi.nlm.nih.gov/33617808/

[2] https://www.cdc.gov/flu/about/burden/2019-2020.html

[Ancapistani]

AFAIK, it’s generally accepted that this particular virus has multiple animal reservoirs.

In the US, even white-tailed deer can be carriers: https://www.aphis.usda.gov/aphis/newsroom/stakeholder-info/s...

Unless I’m missing something here, 100% vaccination of human beings with a 100% efficacy vaccine would not eliminate COVID-19.

[giantrobot]

Animal reservoirs are usually only meaningful if there's significant interaction with those animals and humans and a meaningful ability for the virus to spread between species. Most people don't snuggle up next to a white tailed deer every night so the chance of catching COVID from one is pretty low.

Even if clusters emerged from animal reservoirs, a vaccinated human population would help keep the r0 value below one and allow for containment. COVID had an r0 above one and little meaningful mitigations against its spread early on so it quickly got to epidemic and then pandemic levels.

[rory]

The claim being debated is eradication, so containment is a serious goalpost shift.

[giantrobot]

Eliminating a virus is eliminating community spread i.e. containment of infection clusters.

[codycraven]

I don't know the stats behind it, but I've heard from news that those with the vaccine do still host the virus when exposed and even continue to pass it along (although they experience lesser/no symptoms).

If vaccinated people do become infected at the same or similar rate to unvaccinated (and a whole lot of other assumptions), it almost seems like there is a scenario where the vaccine could be worse than the virus because we're essentially creating many Typhoid Marys that continue to host and spread the virus unaware that they're contagious, giving the virus a massive pool to mutate within.

[giantrobot]

> If vaccinated people do become infected at the same or similar rate to unvaccinated (and a whole lot of other assumptions)

They do not though. You getting sick from any virus is a function of your particular immune system, the viral load you're exposed to, the virus' infection mechanisms, and your manner of exposure.

Vaccines affect the first two points. They train your immune system to recognize the virus as something its seen before and it has ready antibodies to fight. Your immune system responds more efficiently to the virus and neutralizes it faster meaning that any point during your "infection" you've just got fewer virus particles to shed and spread to others.

If you're exposed to a high viral load you might become symptomatic, your white blood cells can only work so fast, with a breakthrough infection but since your immune system is pre-trained for the virus it'll be a shorter and likely a less severe infection than if you were unvaccinated.

The Typhoid Marys you're describing are the massive pools of completely unvaccinated people getting sick. The unvaccinated remain infected longer and end up producing more copies of the virus from their infected cells. If the virus generates a beneficial mutation (named variant) after a trillion replications and each unvaccinated person produces a billion replications (made up round numbers) then we'd expect a variant every thousand people infected. If a vaccinated person only produces a million replications then it'll take far longer for a vaccinated population to generate a variant. You may never even see a variant emerge if the infection rate drops below pandemic and epidemic levels.

[whatshisface]

That's not a retort, that's a question. "Do the odds of getting the virus attenuate its expectation value enough to make it equal to the expectation value of the vaccine?"

The answer to the question is related to the question of how many people are going to get this thing before it stops spreading. From what I've heard we're looking at 70-80% based on herd immunity estimations, which is not a lot of risk attenuation on the virus side. If someone wants to chime in with a better-justified estimate, I'd appreciate that.

[nradov]

Those herd immunity level estimates were based on R0 estimates for earlier variants. The Delta variant is so contagious that there will be no significant herd immunity effect to protect unvaccinated people. Almost all of us will eventually be exposed no matter what we do, but fortunately the vaccines are very effective at preventing deaths.

https://www.businessinsider.com/delta-variant-made-herd-immu...

[SkyMarshal]

True, and also keep in mind that expectation value incorporates not just relative odds of occurrence, but relative harm as well.

The immediate harm of getting the vaccine is much lower than the immediate harm of contracting the virus, and furthermore the vaccine reduces both the odds and harm of the virus.

All that is factored into the comparative E(V) too.

[rory]

No, it's not a question, because vaccine-hesitant people generally aren't doing the math like you are. They're just saying "<100 is better than 100, so I'll go with the option that might be fine."

[SkyMarshal]

> This is reinforced by some pro-vaccine people (incorrectly) claiming we can eradicate the virus through high vaccination rate.

Considering we’ve eradicated other diseases with vaccinations, this is not an inherently incorrect assessment.

[nradov]

We eradicated smallpox and (almost) polio because there were no animal reservoirs and the vaccines were highly sterilizing. Those criteria do not obtain with SARS-CoV-2. Many other mammal species can catch and spread the virus. The original bats which presumably transmitted it to humans are still out there. And vaccinated people can also still catch and spread the virus; there is probably some reduction in contagiousness but the magnitude is unclear.

[rory]

Inherently, no. Currently, yes.

[hammock]

What about the 100+ million in the US with natural immunity to the mRNA virus?

Edit: 40+ million

Edit 2: perhaps it is 100+ million when counting estimated unreported cases- I do recall getting this 100+ number from the CDC itself

[whatshisface]

Well, there are two groups roughly speaking of people with natural immunity. One group, those who have already had the virus, seem to be fairly well protected according to that one Israeli study. Obviously, going out and getting the virus to protect yourself from the virus is an idea straight out of Catch-22, so I assume you're talking about the other group. ;)

As for people with natural immunity but who haven't had it, that's everyone. Every person has what are called "naive B-cells," covered in random antibodies. One of them probably binds to coronavirus in some way, and that would be how your body would get started fighting the infection if you got it. However, the fact that people have some natural ability to fight it off explains why not everyone dies from it (every virus would kill you if you had no immune response, that's why HIV is deadly), but it's of little consolation to the people who found out too late that their natural immunity wasn't enough.

If there was a test to see in advance who would fight off the coronavirus without realizing they had it, I guess that would be a way to save some money and inconvenience giving them shots, but since we don't know for sure in advance who will or won't have an easy case, that's why we have to get vaccinated.

[mjevans]

It would probably cost less to just administer a proven safe and effective vaccine anyway than it would to test that person even once.

3 shots of Pfizer ~ 60 USD < -- VS -- > 100+ USD ~ Single test to see if someone's infected, surely a test to see if someone is naturally immune at best costs this or more.

#

Pfizer seems to cost about 20 USD per dose, so even with the three dose regime (2 initial shots plus a later booster) is expected to cost under 100 USD; most of the other shots cost less.

https://www.biospace.com/article/comparing-covid-19-vaccines...

As there is no currently known technology to reliably test if someone is immune I'll grab data for the next closest similarity: a test to see if someone is presently infected. Nearly all of those tests cost in the range of 100 to 200 USD, with some rare outliers above and beneath.

https://coronavirus.jhu.edu/from-our-experts/q-and-a-how-muc...

https://www.talktomira.com/post/how-much-does-coronavirus-co...

[jcranmer]

The actual case counts for the US appear to be about 40 million right now, not 100 million.

I also wonder how many people who claim to have natural immunity actually have that natural immunity. The tale of Manaus is cautionary here.

[nradov]

Case counts are meaningless because most infections were never tested. The CDC estimates that 120M Americans have been infected as of July 2021.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

[s1artibartfast]

The official CDC estimate is 100 million plus, based one estimated unreported cases and serology testing.

[mthoms]

“Natural” immunity? You’ve been politely asked before to stop using this misleading phrase.

Your insistence on using it is telling.

What you really mean is disease-induced immunity.

[whatshisface]

You have some natural immunity to viruses before you get them, that's why you can survive viruses. That's little consolation to anyone in the ER, of course.

[mthoms]

Of course, but the context was 100 million people (or however many) are "immune".

He's referring to people who've had the virus.

[lamontcg]

They already beat the mRNA from the actual real "live" replicating virus. They have very little to fear from the mRNA in the vaccine.

Infection followed by an mRNA vaccine also acts as a boost which provides broad neutralization against mutated spikes and possibly some pan-sarbecovirus immunity.

[grayhatter]

what about them? Just that they exist?

[rejectedandsad]

The vaccine generalizes better without the annoyance to deathly consequences of actually contracting the virus.

[mikeyouse]

A recent study had a great chart:

https://www.nejm.org/na101/home/literatum/publisher/mms/jour...

(Figure 4 here: https://www.nejm.org/doi/full/10.1056/NEJMoa2110475)

For essentially all 'side effects' of the vaccine - you're substantially more likely to experience them if you get Covid. Not only is the notion of avoiding the vaccine to avoid the side effects misguided, it's actively increasing your chances of getting those very same side effects.