Coronavirus

[bkp_duke]

I would not call them libertarian. They are just selfish. True libertarians believe in liberty for all - not just for themselves.

Let us assume the risk of vaccine for the young and healthy is 1/10M. Risk of them getting Covid and infecting someone more vulnerable is 1/100. What is the correct thing to do ?

If we apply these kinds of risks to driving, we'd all agree that drivers should take a small risk for themselves in order to not put others at great risk - think of slamming on the brakes so as to not run over a pedestrian.

Basic problem is - when these unvaccinated people infect others, it is not obvious. Infact they may never know they infected someone and that someone had to be hospitalized (or worse). So they do not feel guilty and never take responsibility for their actions.

Poppycock. This is your own left-wing lens view of what libertarian should be, not what it actually is and how these people define themselves. The core tenant of libertarianism is minimal government and maximal personal freedom, with the only hard stops being for things like violent crime, etc. (i.e. takings ones liberty to DIRECTLY infringe upon the well being of another person).

Amazing how you will try to twist something to fit your own wants/wishes.

The anti-vax group found a home in the libertarians specifically for how "government hands off" libertarians are.

 

[EVNow]

Poppycock. This is your own left-wing lens view of what libertarian should be, not what it actually is and how these people define themselves. The core tenant of libertarianism is minimal government and maximal personal freedom, with the only hard stops being for things like violent crime, etc. (i.e. takings ones liberty to DIRECTLY infringe upon the well being of another person).

I don't want to get into right/left uni-axis nonsense. Ideology should be viewed as atleast 2 axis - and thus there are "left" & "right" wing libertarians.

All I'm saying is many people use the "libertarian" label for purely selfish ends. That doesn't mean all right-wing libertarians do that. Would Milton Friedman have been an anti-vaxxer / anti-masker ?

The Political Compass

some Political books from the Libertarian Left

www.politicalcompass.org

The Political Compass

some Political books from the Libertarian Right

www.politicalcompass.org

 

[shinytop]

I tested positive today. Only had mild cough and fever for about two hours. The directions that come with the test results say to quarantine for 10 days after start of symptoms so I only have 3 days to go. Many comorbidities but two vaxes and a booster seem to have worked.

 

[bhzmark]

I tested positive today. Only had mild cough and fever for about two hours. The directions that come with the test results say to quarantine for 10 days after start of symptoms so I only have 3 days to go. Many comorbidities but two vaxes and a booster seem to have worked.

“many comorbidities”

It would be nice if you and many like you had authoritative guidance to do or take something else that might improve your outcome beyond simply quarantining for 10 days with fingers crossed.

 

[Slipstream]

Multiplex PCR, not individuals.

Basically, think of taking 100 samples, mixing them, and running one test. That tells you if there is a single positive in any of those 100. If not, move on and repeat. If there is, re-divide and retest.

It's a cheaper, more efficient method of testing populations, but it is not viable when:
1) virus is at pandemic or endemic levels (i.e. this works with 1% infection rates and lower)
2) need individual by individual testing


Trust me, China didn't actually use 9 million individual tests during that time. Probably 1/100th of that.

Our institution did this. We called it batch testing. Efficient and useful when rates were low. I agree with you on less viability when the case numbers get too high (like right now).

Side-note: I’ve heard Omicron resistance and hospitalization data with Pfizer and J&J, but not Moderna. Anyone have data on Moderna? Thinking of doing Moderna for my booster (had Pfizer prior)...

 

[golfcart]

I would not call them libertarian. They are just selfish. True libertarians believe in liberty for all - not just for themselves.

Let us assume the risk of vaccine for the young and healthy is 1/10M. Risk of them getting Covid and infecting someone more vulnerable is 1/100. What is the correct thing to do ?

If we apply these kinds of risks to driving, we'd all agree that drivers should take a small risk for themselves in order to not put others at great risk - think of slamming on the brakes so as to not run over a pedestrian.

Basic problem is - when these unvaccinated people infect others, it is not obvious. Infact they may never know they infected someone and that someone had to be hospitalized (or worse). So they do not feel guilty and never take responsibility for their actions.

Anyone with the virus can infect others, vaccinated or unvaccinated. Vaccines can reduce your likelihood of being infected and likely reduce the period of time you are contagious if you become infected, but everything you said above applies for vaccinated folks as well particularly with Omicron.

I'm in agreement that vaccination is the right thing to do both from a self-interested perspective (to reduce your personal risk of severe disease and death) and a community-interested perspective (to lower the rate of transmission and reduce the burden on the healthcare system) but I think we need to be honest about what vaccination does and what it doesn't do. Once we acknowledge that vaccines do not prevent infection or prevent those infected from spreading the virus then it really becomes a discussion of tradeoffs.

As far as criticizing the libertarians. I think that there is plenty of criticism to go around to various political groups and given the high value libertarians tend to place on individual liberty they generally require more persuasion to give up those liberties for the greater good. That said, most libertarian leaning folks I know are supportive of getting vaccinated just less supportive of mandates, lockdowns, and closures. The specific complaints that I see in libertarian circles are the following:

1. There is very little discussion given to the tradeoffs with lockdowns, school closures, mask mandates, and vaccine mandates. Instead people are shamed, ostracized from society via vax passes, and fired from their jobs for choosing not to get vaccinated (even if they have been infected previously). I am firmly in the pro-vax camp but I understand the complaint. These steps are an unprecedented infringement on individual liberties and there needs to be clear guidelines on why and how long this will be done for with metrics, milestones based on those metrics, and a path back to normalcy.
2. Firing unvaccinated healthcare workers (who have probably already had it multiple times) during a surge of cases is stupid... especially given that the vaccinated can catch and spread omicron at reasonably high rates.
3. The tradeoffs of vaccination point to a very clear cut decision to get vaccinated if you are over 50, those tradeoffs are much less obvious if you are under 18. Some people will therefore choose to not vaccinate their children until the side effects have been studied for more time. This is not a completely unreasonable position for some parents to take so stop shaming them for it because it isn't helping.
4. If the vaccine is so great at stopping COVID then why are vaccinated people so worried about what un-vaccinated people are doing? They have their vaccines and are protected. If the vaccines aren't so great then why are people getting fired for not being vaccinated?
5. Why are we mandating that federal workers (most of whom are are full-time telecommuters currently) be vaccinated in order to keep their jobs?
6. Why are certain viewpoints, which are not factually incorrect but sort of in that gray area, being suppressed as misinformation on certain platforms while other viewpoints are not and why does there seem to be a political slant to which ones are suppressed?

I have rebuttals to some of the points above but I don't think any of them are unreasonable or unworthy of discussion.

 

[golfcart]

I tested positive today. Only had mild cough and fever for about two hours. The directions that come with the test results say to quarantine for 10 days after start of symptoms so I only have 3 days to go. Many comorbidities but two vaxes and a booster seem to have worked.

Wishing you the best. You have taken the steps to protect yourself and the numbers are strongly in your favor that you will be fine.

 

[madodel]

I’m not sure what to make of that Attia podcast and also Attia’s appearance on Joe Rogan. His points, and doctors similar to him are:

1) lamenting the censorship of discussion of vaccine risks
2) concluding that because vaccines pose risks to healthy young people, and their risk from covid is low, young people without risk factors should not get vaxed (utterly oblivious to the general health policy concerns of unvaxed healthy young ones potentially spreading more virus to higher risk individuals, even while they are realtively asymtomatic)
3) he and his fellow similar-minded doctors,and the others that Joe Rogan has hosted, state authoritatively that Hydroxycholoriquin and Ivermectin is safe and effective when dosed appropriately and when given *early* in covid disease stage. All the studies that show no efficacy dosed people that were already hospitalized, i.e., too late.
4) Separate from hydrooxy and ivermectin issues, they lament the lack of good research and resulting guidance on prophylactic or early (pre-hospitalization) treatment or any over-the-counter treatments.
5) They generally complain about lockdowns and mask-wearing and temperature taking at the doors of businesses.

I’m sympathetic to #4, but the rest of their points are very poorly supported and poorly argued and they seem surprisingly oblivious to general health/vaccine policy or any “flattening the curve” or viral shedding by the asymptomatic -type concerns. Are they also against the polio vaccine? ?

Regarding #4, It does seem that the recently postive-tested/infected and mildly symptomatic have little to do except wait until they feel worse to be bad enough to get rationed monoclonal antibodies or other treatments that seem reserved for the worse off.

When positive tested or even high risk exposed should one take or do anything except watch their pulse ox and temp waiting for things to get worse?

zinc, quercitin, Vit D, famotidine/Pepcid AC all have youtube videos touting their benefits, but no reliable authority seems willing to say anything about them or other possible OTC treatment or even Rx treatment that is administered outside of hospitalization.

The absence of guidance for early and home treatment is frustrating, but people like Attia and his ilk are not filling that void. THey seem to have a weird libertarian tilt to their medical conclusions that make them less reliable.

My wife saw a lot of vaccine hesitancy among her patients of all backgrounds early on. she kept telling them this was the only way to not get severely ill or die. Everyone of her patients is a comorbidity for COVID. But some people didn't trust the government and there was also a lot of political crap. Now she says it is mostly all just old angry white guys who refuse to get vaccinated. And she doesn't care about politics just practicing medicine without being verbally threatened. Most everyone else (but not all) of her patients have gotten vaccinated.

As to vaccine risk, in 2 years my wife has seen 0 patients with cardiac problems from vaccine but has seen a large number of cardiac issues (A-Fib, other arrhythmia, myocarditis, etc) with COVID patients. Granted she only sees adults but any cardiac issue (which appears to be principally myocarditis in young males) is self-limiting from vaccination, unlike the heart damage done by the virus. As of this past weekend every patient on her cardiology service in the hospital had COVID. So if they want to discuss the risk of vaccine versus getting COVID that's fine, but to me at least it's pretty well settled after almost 2 years. YouTube videos are not valid medical trials. This may come as a shock but there are some people on the Internet who are lying sociopaths or just grifters.

Also I think I posted here recently that most of the COVID patients in her hospital were on high flow oxygen. She clarified that yesterday that everyone in their COVID filled ICU are on vents. So while the less severe is mostly upper respiratory, but the severe cases aren't much different than prior cases.

 

[bhzmark]

I regret using the phrase "weird libertarianism." I should have said, "Their medical conclusions seem the product of some unspecified axe to grind or agenda to further." who knows what motivates them and I think it really is not important.

The more important and practical (not theoretical) point I hoped to make was that the one point of agreement I have with Attia and his like-minded MD friends was that there is not enough research and guidance on prophylactic (in addition to vaccine of course) and early treatment for covid.

Does anyone know of any good sources for this?

I would think that medical systems where the payors and providers are combined such the VA medical system or Kaiser or Geisinger, or virtually every other country, would have the proper incentives find cheap, safe and effective early treatment but I don't see anything from them or anywhere.

The only thing I found remotely promising was this collection of covid trials and research Covid-19 living Data

but nothing sorting the signal from the noise.

 

[heltok]

Like Peter Attia said in the podcast, you need to separate science vs advocacy. When they are trying to talk science they get attacked for belonging to an outgroup with regards to advocacy. Which is very sad and something we should do our best to avoid. If they state they believe that giving a [healthy 7 year old kid vaxxed with two doses of pfizer] a booster is likely not improving his life expectancy, that is their scientific viewpoint. Then they get attacked for advocating a libertarian view point, for belonging to the Joe Rogan outgroup and for being in the same crowd as the people who promoted Ivermectin. That is not science. I recommend the end of the podcast when they talk about that science can be ’flip flopping’ as new evidence comes in and we need to be able to forgive people for having been wrong.

 

[AlanSubie4Life]

think we need to be honest about what vaccination does and what it doesn't do. Once we acknowledge that vaccines do not prevent infection or prevent those infected from spreading the virus then it really becomes a discussion of tradeoffs.

Coronavirus has never been about case counts. It's all about the load on the healthcare system (there's a time-varying correlation between case counts and hospital loading).

I'm not interested in denying care to the unvaccinated, and I also want to be sure that people who need to get hernia surgeries or whatever are able to get those in a timely manner (in addition to not compromising on care for more serious conditions). Already my closest Urgent Care is closed, since they are having to devote resources elsewhere in the system. That's not fair to vaccinated individuals (or anyone!).

So, that leaves us little choice. Vaccination is required. What is extremely clear is that it is extremely effective at keeping people out of the hospital, against all variants.

Regarding protection of prior infection against future infection, there's a mix of evidence out there, but since the mRNA vaccines are essentially zero risk, clearly vaccination is indicated in the case of prior infection, assuming some delay (> 3 months) since infection. By stacking natural immunity from a full course of vaccination onto infection-acquired immunity, that provides some of the strongest possible protection (shown time and time again), better than a boosted vaccine, and that's obviously what is needed right now. There's ample evidence out there for this now. There's not really anything to debate - in all flowcharts, vaccination is the best course of action both for individuals and for society.

The tradeoffs of vaccination point to a very clear cut decision to get vaccinated if you are over 50, those tradeoffs are much less obvious if you are under 18.

I'm not aware of any risks not addressed by NSAIDs posed by the mRNA vaccines in young people (notwithstanding allergies to the ingredients, etc., which are fairly well understood at this point so we can exclude those children from this discussion). Is there any serious risk from mRNA vaccines to youth? I think there is not. Only rare cases of mild myocarditis, which is easily resolved.

until the side effects have been studied for more time.

What are you expecting to see? Based on all historical precedent, we know that there will be no long term consequences. There has never been in history a vaccine with long term effects that were not known immediately.

. This is not a completely unreasonable position for some parents to take so stop shaming them for it because it isn't helping.

I think when armed with factual information, it's an unreasonable position. This is a position based on misinformation, unfortunately.

there is not enough research and guidance on prophylactic (in addition to vaccine of course) and early treatment for covid.

There's been a great deal of research on this (it was well known that vaccines were going to take a while so this is what they looked at in the meantime!!!). Other than losing a tremendous amount of weight, getting to "normal weight" (which is scientifically proven to be essentially impossible, which is hard for me to believe but it seems to be true), my understanding is that there's very little to be done in terms of prophylactic care. You can help around the edges by not being deficient in Vitamin D or C or whatever, but it's not likely a significant help, otherwise it would be very well publicized at this point.

Regarding early treatment - I think there's a very well established standard of care at this time (early intervention remains critically important as has been well known from the first few months). Unfortunately with overwhelmed hospitals it's likely hard for best known outpatient treatment regimens to be followed for every individual, and of course mAbs that work are in short supply.

No one is trying to hide information here! No magic bullets exist at the current time.

Natural immunity is the best bet. Get vaccinated & boosted; get your natural immunity. It's a 90% solution at least, and these other prophylactics & early treatments are perhaps going to gain another 1-2% (just a guess).

Overall, this is really not a complicated picture. KISS principle is in full effect.

 

[AlanSubie4Life]

Vaccines work. Prior week data provided (unfortunately have to subscribe to the newsletter or use Wayback to get this info) to allow delta calculations for those interested (note that there are raw numbers and rates; most people are vaccinated at this point, about 67%). Doesn't look great for the unvaccinated.

https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/COVID-19%20Watch.pdf

57% of hospitalizations over the last week, in a much less numerous, much less vulnerable group, were of unvaccinated individuals. 25 deaths unvaccinated and 3 deaths vaccinated. The vaccinated group is much more numerous, more vulnerable and older.

It's pretty clear how to reduce hospital loading, and that really is the only goal at this point. If there's another solution I'm open to it.

It'll be interesting to see how these graphs evolve as omicron cases convert to hospitalizations (I expect lower conversion rates, and very low death rates for the vaccinated). If you squint I think you can probably see the impact of boosters on lower death rates in the death graph.

 

[golfcart]

Coronavirus has never been about case counts. It's all about the load on the healthcare system (there's a time-varying correlation between case counts and hospital loading).

I'm not interested in denying care to the unvaccinated, and I also want to be sure that people who need to get hernia surgeries or whatever are able to get those in a timely manner (in addition to not compromising on care for more serious conditions). Already my closest Urgent Care is closed, since they are having to devote resources elsewhere in the system. That's not fair to vaccinated individuals (or anyone!).

So, that leaves us little choice. Vaccination is required. What is extremely clear is that it is extremely effective at keeping people out of the hospital, against all variants.

Regarding protection of prior infection against future infection, there's a mix of evidence out there, but since the mRNA vaccines are essentially zero risk, clearly vaccination is indicated in the case of prior infection, assuming some delay (> 3 months) since infection. By stacking natural immunity from a full course of vaccination onto infection-acquired immunity, that provides some of the strongest possible protection (shown time and time again), better than a boosted vaccine, and that's obviously what is needed right now. There's ample evidence out there for this now. There's not really anything to debate - in all flowcharts, vaccination is the best course of action both for individuals and for society.



I'm not aware of any risks not addressed by NSAIDs posed by the mRNA vaccines in young people (notwithstanding allergies to the ingredients, etc., which are fairly well understood at this point so we can exclude those children from this discussion). Is there any serious risk from mRNA vaccines to youth? I think there is not. Only rare cases of mild myocarditis, which is easily resolved.


What are you expecting to see? Based on all historical precedent, we know that there will be no long term consequences. There has never been in history a vaccine with long term effects that were not known immediately.



I think when armed with factual information, it's an unreasonable position. This is a position based on misinformation, unfortunately.



There's been a great deal of research on this (it was well known that vaccines were going to take a while so this is what they looked at in the meantime!!!). Other than losing a tremendous amount of weight, getting to "normal weight" (which is scientifically proven to be essentially impossible, which is hard for me to believe but it seems to be true), my understanding is that there's very little to be done in terms of prophylactic care. You can help around the edges by not being deficient in Vitamin D or C or whatever, but it's not likely a significant help, otherwise it would be very well publicized at this point.

Regarding early treatment - I think there's a very well established standard of care at this time (early intervention remains critically important as has been well known from the first few months). Unfortunately with overwhelmed hospitals it's likely hard for best known outpatient treatment regimens to be followed for every individual, and of course mAbs that work are in short supply.

No one is trying to hide information here! No magic bullets exist at the current time.

Natural immunity is the best bet. Get vaccinated & boosted; get your natural immunity. It's a 90% solution at least, and these other prophylactics & early treatments are perhaps going to gain another 1-2% (just a guess).

Overall, this is really not a complicated picture. KISS principle is in full effect.

That’s all fine I don’t have any qualms with what you wrote. I’m just saying let’s be honest about what vaccines do (and don’t do) and let’s not beat up parents for being nervous about vaccinating their kids. Kids are at extremely low risk and there was a enough coverage of myocarditis in young men to make people nervous. Hell the WHO even says

More evidence is needed on the use of the different COVID-19 vaccines in children to be able to make general recommendations on vaccinating children against COVID-19.

COVID-19 Vaccines Advice

www.who.int

The rest of it was just a response to the “libertarian” comment. I stated clearly that I think vaccination is the best course of action for both self interested reasons and content interested reasons. But I’m not gonna advocate that we force someone to get it in order to make a living or go to the grocery store… especially given the fact that governments rarely give back powers they gain during emergencies. Just look at what homeland security has become since 9/11.

 

[AlanSubie4Life]

Great thread. My interpretation is that Omicron may save lives by forcing out Delta. We may well see deaths continue to decline in the US, depending on exactly how virulent it is (I really don't know - it's tough with that many cases though...I guess I generally still expect deaths to increase a bit in the short term, given the number of unvaccinated and the generally young patient compositions so far). But even if deaths rise in the short term, it appears that in the future they will be lower than they would have been with continued Delta circulation. (So the integrated death count will be lower than with Delta alone, is what I am saying.)

We'll only know precisely how virulent it really is after the damage is done.

https://twitter.com/x/status/1478845210763218944

I wonder whether it is transmissible enough to burn itself out completely. I guess Trevor had a thread on those dynamics earlier.

 

[EVNow]

Interesting tweet. Vaccinated vs unvaccinated, pre and post infection.

https://twitter.com/x/status/1475584479540486148

 

[dhanson865]

uggh from the reddits today

https://i.redd.it/bkappb7quw981.jpg

https://i.redd.it/1w2xx87quw981.jpg

https://www.reddit.com/r/pics/comments/rwt70k

 

[scottf200]

Kids are at extremely low risk

It is really unclear that you are following the kid issue closely. As well remember that 0-5 year olds are not protected. Pfizer April and Moderna March?

 

[Jeff N]

Omicron is sometimes replicating in the mouth and throat a day or two before showing up in the nose.

Emerging Data Raise Questions About Antigen Tests and Nasal Swabs

A new study adds to evidence that common rapid tests may fail to detect some Omicron cases in the first days of infection.

www.nytimes.com

 

[golfcart]

It is really unclear that you are following the kid issue closely. As well remember that 0-5 year olds are not protected. Pfizer April and Moderna March?

I have a kid and just spoke with our pediatrician so I take offense to your remark. Fear monger all you want. Don’t believe me take it from left leaning sites like the NYT (unfortunately paywalled)

Omicron is not more severe for children, despite rising hospitalizations

Omicron and kids

Or NPR

What we know so far is that omicron is milder in both children and adults.

NPR Omicron and kids

It’s hilarious, I’m not anti vax at all and people get worked up over my comments. As I posted above, the WHO actually says

Children and adolescents tend to have milder disease compared to adults, so unless they are part of a group at higher risk of severe COVID-19, it is less urgent to vaccinate them than older people, those with chronic health conditions and health workers.

More evidence is needed on the use of the different COVID-19 vaccines in children to be able to make general recommendations on vaccinating children against COVID-19.

WHO vaccine advice

I’m not just pulling this stuff out of my ass. I agree that the more vaccinated people the better I just don’t have the same authoritarian tendencies that some seem to have on this issue. We can agree to disagree I guess.

 

[winfield100]

Anyone with the virus can infect others, vaccinated or unvaccinated. Vaccines can reduce your likelihood of being infected and likely reduce the period of time you are contagious if you become infected, but everything you said above applies for vaccinated folks as well particularly with Omicron.

The specific complaints that I see in libertarian circles are the following:

you somewhat answer your question yourself

If the vaccine is so great at stopping COVID then why are vaccinated people so worried about what un-vaccinated people are doing? They have their vaccines and are protected. If the vaccines aren't so great then why are people getting fired for not being vaccinated?

Biology is not static.
Evolution is continuous.
unvaccinated at basically “human bioreactors, capable of churning out mutations”
“plague rats” by another description