[jnorthrop]

There no longer exists any real debate. Effectiveness of the vaccines have waned over time but as stated in the article "Our findings support the conclusion that COVID-19 vaccines remain the most important tool to prevent infection and death."

[formerly_proven]

A charitable interpretation of GP would be that he referred to ending of restrictions (masks, testing, papers please, lockdowns etc.) after a vaccine becomes widely available. These hopes have certainly been raised by politicians in late 2020 and early 2021 ("just have to get herd immunity through the vaccine and we're done"[1]). However, the reality is that e.g. in Germany case numbers and incidence numbers are reaching new all-time-highs every day now despite 70-75 % of all people being vaccinated.

These hopes were probably based on experiences with "normal" vaccines, which are apt to eradicate diseases through sterile immunity (though there are a bunch of exceptions to this, it's not like we're getting rid of the flu and some other stuff by vaccinations [2]). However, we since learned that a vaccine providing sterile immunity against COVID-19 seems to be off the table (as none of them are), so herd immunity against COVID-19 will likely never be a thing and eradicating COVID-19 is just not possible.

[1] Herd immunity was THE talking point in early 2021 in Germany. Also, remember a few countries trying to get herd immunity by intentionally letting the virus spread (great britain cough cough)?

[2] Sterile immunity seems to be difficult with respiratory diseases (flu, covid, cold, pertussis come to mind). Naively I'd guess that's because the critters have some time to multiply on the surface of the airways and be infectious before the immune system gets a chance to nuke 'em. If that's the explanation though I'm kinda wondering why the herd immunity theory was so common, so it's probably more complicated than that.

[Sohcahtoa82]

> However, the reality is that e.g. in Germany case numbers and incidence numbers are reaching new all-time-highs every day now despite 70-75 % of all people being vaccinated.

COVID cases are nearing all-time highs, but COVID deaths remain significantly lower than before. Source: https://ourworldindata.org/coronavirus-data?country=~DEU

[formerly_proven]

Which is great, but we're still seeing a large influx to ICUs which will cause problems allocating ICU beds shortly (unless the trend reverses). To get that trend reversal high incidence districts are getting more restrictions again.

Ironically we also had a reduction in ICU capacity during COVID because working conditions didn't improve so people reasonably resigned instead of being continually exploited. There has also been a huge increase in hostility towards nurses, doctors and medical personnel in general (mostly driven by the small but aggressive anti-vaxx "community"), which certainly doesn't help retain people.

[ifyoubuildit]

> we're still seeing a large influx to ICUs

Is this true? I've heard claims in both directions but seen no sources for either.

> mostly driven by the small but aggressive anti-vaxx "community

Same question as above. There's a massive push to fire all the essential workers that took the brunt of the pandemic early on if they happen to believe the growing body of evidence showing that they don't need the vaccine if they've already recovered.

That certainly doesn't help retain people either.

[formerly_proven]

> Is this true? I've heard claims in both directions but seen no sources for either.

https://www.dw.com/en/germany-hospitals-reach-critical-pande...

https://covid19.healthdata.org/germany?view=resource-use&tab...

https://www.thelocal.de/20211108/german-states-bring-in-toug...

https://www.dw.com/en/covid-german-health-chiefs-call-for-st...

https://thegermanyeye.com/hospitals%3A-the-intensive-care-un...

...

[ifyoubuildit]

Thanks for the links. I get a strong sense from these sources that cases are ticking up in Germany and government is considering more restrictions. I get less strong of a sense that ICUs are primarily filling with severe covid patients. Seems reasonable that if cases are going up, hospital admission (including ICU beds) would go up, but its hard to conclusively validate that from these.

[angelzen]

> we're still seeing a large influx to ICUs

The summer waves clobbered various hospital systems in the US on a region by region basis. Winter is likely to be worse. For example, right now Minneapolis is under heavy load, ICUs at >95% across the board. https://covidestim.org concurs, the Midwest is undergoing a wave.

https://datacentral.kitsapsun.com/covid-19-hospital-capacity...

[ifyoubuildit]

Thanks for the link. I'm not sure if it's showing a large influx due to covid though. For example, the top row in your second link shows 98% beds full, but n/a for covid patients. The second row says 75% ICU beds full, but only 14 positive for covid in the 7 day avg, and its not clear what of those are ICU patients.

It also isn't clear if these are patients in hospital for covid or they just happen to have covid (click on the links in the column headers to see the inclusion criteria).

[sojournerc]

Unless you've been infected already. Natural immunity is as good or better than the vaccine.

[throw0101a]

This is does not appear to be true:

"Antibodies elicited by mRNA-1273 vaccination bind more broadly to the receptor binding domain than do those from SARS-CoV-2 infection"

* https://www.science.org/doi/10.1126/scitranslmed.abi9915

> These findings suggest that among persons with previous SARS-CoV-2 infection, full vaccination provides additional protection against reinfection. Among previously infected Kentucky residents, those who were not vaccinated were more than twice as likely to be reinfected compared with those with full vaccination. All eligible persons should be offered vaccination, including those with previous SARS-CoV-2 infection, to reduce their risk for future infection.

* https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm

[sojournerc]

I don't know enough about immunology to say whether "binding more broadly" confers more immunity or not.

It would certainly go against prior knowledge about human immune responses for a single spike protein (vaccine) to elicit a greater immune response than _the actual virus_.

That CDC study is so bad I'm surprised they had the gall to publish it with the conclusion they did. Testing positive says nothing about severity of infection.

> were about five times more likely to test positive for the infection than people who had been vaccinated

Testing positive is not a very good metric. Were they hospitalized? Was it severe? Did they even get sick, or just test positive?

They even admit to a sampling flaw in the discussion:

> Second, persons who have been vaccinated are possibly less likely to get tested. Therefore, the association of reinfection and lack of vaccination might be overestimated.

The best study on this so far is from Israel with a much larger sample in a highly vaccinated country. Here's a Harvard doctor discussing the contradictory studies.

https://brownstone.org/articles/a-review-and-autopsy-of-two-...

> For a low-risk person, which includes most people with natural immunity, a 35% risk reduction is more marginal in terms of absolute risk.

> Based on the solid evidence from the Israeli study, the Covid recovered have stronger and longer-lasting immunity against Covid disease than the vaccinated. Hence, there is no reason to prevent them from activities that are permitted to the vaccinated. In fact, it is discriminatory.

[angelzen]

I found a Feb 2021 piece from Derek Lowe a good 30k ft overview of how the immune system works. tl;dr it is stochastic, with a wide range of antibodies having different effects against an infection, some of them even negative (OAS). Usually the aggregate effect is positive, and the infection is cleared out.

"It's important to realize, though, that all immune responses to a viral infection generate a mixture of neutralizing and non-neutralizing antibodies. That's one of the things about the immune system - it revs up production of a wide variety of antibodies, selected from the untold billions of them circulating around in your bloodstream. Some of them bind to one part of the pathogen, and some to another. And they bind in different conformations, sticking to different parts of the surface of the invading virus from different directions."

It is conceivable that a targeted vaccine is more effective at shutting down an infection than natural immunity by focusing the immune system to produce a narrow band of very effective antibodies. The tradeoff is that a virus mutation can create a catastrophic situation where the same antibodies are less effective, possibly having negative efficiency enhancing the infection. The risk is amplified by vaccinating the entire population with the exact same protein sequence, creating hundreds of millions of living incubators for the virus to learn how to evade the narrow antibody response.

We are creating a biological landscape prone to black swan events. Good luck convincing any total vaxer that this is a very real risk. They will laugh and sneer and maybe call you criminal because obviously the data shows the vaccines are safe and effective. "Hahaha, I've been told that we're all going to be dead by now, look at those peddling conspiracy theories." Just like the Wall Street crowd created the run-up to the 2008 crisis. Who could have possibly predicted that CDOs were prone to a black swan?

https://www.science.org/content/blog-post/antibody-dependent...

[throw0101a]

> We are creating a biological landscape prone to black swan events. Good luck convincing any total vaxer that this is a very real risk. They will laugh and sneer and maybe call you criminal because obviously the data shows the vaccines are safe and effective.

If you don't survive the problems of today, then there's no point in worrying about tomorrow's possibilities because you're dead.

The data does show that the COVID vaccines are generally safe and pretty effective. Not 100%, but the perfect is the enemy of the good, and so let's try to improve our lot now so we have a chance to fight for later.

[angelzen]

Generally speaking, under 50 populations survive covid fairly well. Under 18 survive almost perfectly, with a higher survivability rate than drowning. Therein lies the problem: we expose the young(er) populations to a black swan event.

Please spend a few minutes to refresh on the data. Some nice dashboards from Singapore (ongoing delta wave), but also e.g. King County, WA (Seattle) shows similar data, though you have to drill down a bit (Demographics tab, then Deaths metric). For example in the past 30 days a total 12 deaths in the under 50 population, for a total of 10% of total covid deaths. Or, since the pandemic started, a death rate of 22/100k or less in all age groups <50, going as low as 0-3/100k for under 30s.

This is not to say that people, especially the elderly, should not get vaccinated if they choose so. It is only a reminder that there is a perception problem around covid and that the long term risk calculus is more complicated.

https://www.moh.gov.sg/covid-19/statistics

https://kingcounty.gov/depts/health/covid-19/data/daily-summ...