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Great discussion.. I’ve been a long time lurker here..
It seems to me in our quest to return to normalcy we have 3 non-mutually exclusive methods of minimizing spread in large gatherings and confined spaces.. testing, masking and of course vaccination.

Testing for entry is costly, logistically difficult and not entirely effective (I have read that individuals may be infectious with Omicron a day or two prior to testing positive with a rapid antigen test).

Masking with high quality masks is relatively effective if not a mild pain in the butt. And of course very difficult to enforce beyond the point of entry… At a concert in Los Angeles in December I witnessed a guy nursing a drink the entire show so as not to keep his mask on.. The MC at the top of the show even suggested this as a mask avoidance technique to the audience(!!)

And finally of course proof of full vaccination (preferably with a boost).. IMHO this is by FAR the easiest and most effective way to reduce spread and may be the ONLY way to dramatically reduce hospitalizations and mortality (and thus impact on the healthcare system)

I‘m not at all opposed to testing or masking.. But if I had to choose one as society’s most effective tool, the choice is clear
 
What data is there showing infection rate due to Omicron for Vac vs unvac?
I keep hearing that being vac. Makes little difference whether one gets the Omicron variant VS someone unvac?

Sorry for the poor phrasing.
Hope my question is clear enough.



edit to say I found this

The clip sounds about right to me. In addition, if you are vaccinated and then become infected, it's likely to last fewer days, so there is less chance of you passing it on. So vaccination is a win-win.
 
Worldometers shows 8 deaths in Gibraltar since the start of March 2021. That scales to 80k in the US. They had no deaths until November 2020 but had 85 of their 101 total in the first two months of 2021. Their highest 7 day average in that stretch was 5, which scales to 50k/day in the US vs. our actual peak of ~3.5k/day.
 
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Worldometers shows 8 deaths in Gibraltar since the start of March 2021. That scales to 80k in the US. They had no deaths until November 2020 but had 85 of their 101 total in the first two months of 2021. Their highest 7 day average in that stretch was 5, which scales to 50k/day in the US vs. our actual peak of ~3.5k/day.
Yes - even in that chart you can see some deaths once in a while after Mar-21. I think he was looking at 7 day averages.

 
What data is there showing infection rate due to Omicron for Vac vs unvac?
I keep hearing that being vac. Makes little difference whether one gets the Omicron variant VS someone unvac?

Sorry for the poor phrasing.
Hope my question is clear enough.



edit to say I found this


There are new Omicron targeted vaccines undergoing trial now. Hopefully those will be more effective. Omicron is so mutated from the previous variants that the vaccines, which were designed for the original variant, have trouble giving good immunity. My partner found an article in one of the medical journals that only about 20% of the vaccinated and boosted population are getting Omicron. The rest are either not getting it at all or are getting extremely mild cases. Among all vaccinated and boosted populations, getting a bad case of Omicron is rare.

For about 80% of the population, three shots of vaccine is enough to pretty much prevent infection. For the other 20% three shots is enough to prevent bad cases. The unvaccinated and those who were vaccinated a while back and not boosted are having the worst outcomes with Omicron.

Great discussion.. I’ve been a long time lurker here..
It seems to me in our quest to return to normalcy we have 3 non-mutually exclusive methods of minimizing spread in large gatherings and confined spaces.. testing, masking and of course vaccination.

Testing for entry is costly, logistically difficult and not entirely effective (I have read that individuals may be infectious with Omicron a day or two prior to testing positive with a rapid antigen test).

Masking with high quality masks is relatively effective if not a mild pain in the butt. And of course very difficult to enforce beyond the point of entry… At a concert in Los Angeles in December I witnessed a guy nursing a drink the entire show so as not to keep his mask on.. The MC at the top of the show even suggested this as a mask avoidance technique to the audience(!!)

And finally of course proof of full vaccination (preferably with a boost).. IMHO this is by FAR the easiest and most effective way to reduce spread and may be the ONLY way to dramatically reduce hospitalizations and mortality (and thus impact on the healthcare system)

I‘m not at all opposed to testing or masking.. But if I had to choose one as society’s most effective tool, the choice is clear

Pre-pandemic normal is never going to happen again. The virus has changed society forever. The questions we have to ask is how to we create a new normal with a virus that is weakened, but still worse than any flu variant we've ever faced. We will be dealing with a disease that could potentially fill hospitals to over capacity if we aren't careful. We also have to face the fact that we're going to have fewer health care workers for the next generation or so. We've lost many to death, disablement, or burn out and the schools are not able to attract enough recruits to replace them.

When we have an Omicron specific booster available, that might help, but the effectiveness of giving the same vaccine over and over again wanes with time. The Israelis have found that the added benefit of a 4th dose of the same vaccines give virtually no added benefit over 3 doses. Maybe we can seasonally adjust the vaccine yearly to whatever mutations COVID had done over the year and that will work.

The virus is not going away, it's here to stay as part of the world we live in. We need to adjust to deal with that reality. Another factor in that reality is how is the virus going to mutate and when. There is already a mutation of Omicron that is more contagious than the first Omicron, but vaccination is more effective against that that Omicron-1.
 
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Pre-pandemic normal is never going to happen again.
Agreed.. Should have said asymptotically approaching normalcy 🙄

(iOS once changed asymptomatic to asymptotic on me, so felt compelled to use it here)

Long COVID aside (which perhaps I shouldn’t so easily dismiss) if everyone in crowded/confined spaces were fully vaccinated then this would be more endemic like the flu..

As a fully vaxxed and boosted person (as is my whole family) it’s the long COVID that probably concerns me most.. My sister (in hyper vaxxed Marin county) had the brain fog and queasiness for THREE weeks and it seems this spectrum of no symptoms to weird stuff for months is going to be a point of major study going forward..

There’s no doubt in my mind having more people fully vaccinated would be greatly beneficial and I have no clue at this point how to achieve that. 3 of my friends who I thought were moderately intelligent people remain unvaccinated for various (lame IMHO) reasons…. At this point I have to confess I would be fine with a bubble of fully vaccinated people in crowded/confined spaces that I might visit and let this continue to burn its way through the anti-vax crowd elsewhere… Yes I know many will be hospitalized and possibly die and create incubators for new variants…. But honestly what options do we have now?
 
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I guess I would like to respond to said snippiness at the risk of enflaming the situation.. I am fascinated at how intelligent people can be influenced by incorrect or incomplete information.. I would never call such a person an idiot however.

This individual appears to be an absolutist (and there is a lot of that going around).. I never said anyone swayed by misinformation wasn’t smart, just perhaps a bit less so. I also never claimed being in a vaccine bubble was absolutely safe, just statistically more so..

All things considered, if there is a better solution than proof of vaccination for entry into crowded or confined spaces with respect to total safety and impact on the healthcare system (not to mention encouraging vaccination in itself).. I’m all ears.
 
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will be something we'll have to learn to live with back in October and nobody agreed

I don't think many would have disagreed with that in October. I do think it's really unclear exactly how the end game will play out, though. And WHEN it is time to "live with it" is another question. And what will living with it look like, exactly? I think no one knows at this point.

Right now, with 2500 deaths per day in the US, giving an entire severe flu season worth of deaths in about a month, is not "living with the virus." That's dying with the virus.

We can probably live with the virus once we have enough immunity to the virus. It's very unclear (to me at least) exactly what the IFR will be in the case of basically 100% of people having strong natural immunity (from multiple rounds of vaccination (hopefully), possibly with added infection). But we're nowhere near that at this point, unfortunately. Some countries are closer to it - take highly vaccinated Portugal for example - but their 50 deaths per day still scales to 1650 deaths per day in the US (neglecting age adjustment), which is still extraordinarily high - and due to their very high vaccination rate, I would expect many (even most) of them to be of vaccinated elderly people. And this is with "mild" Omicron, and it's not clear at all the virus will remain "milder" - and in any case it's quite possible that Omicron is more dangerous (if not more virulent) than the original virus (hard to say exactly how it compares).

It's not clear to me whether this virus will have a permanent effect on life expectancy, even with 100% immunity. It seems that it likely will, but I hope that the situation changes - or at least that the disease becomes less common. It's not just the IFR that is relevant - the number of infections is crucially important in the "steady state." I don't know where that's going to settle, since we're (shockingly) still in a situation where there is so little natural immunity.

It's not clear to me whether natural immunity from vaccination and infection will fade and this will be like some coronaviruses where reinfections frequently occur, and whether those infections will truly resemble the common cold (right now, I think the data strongly suggests that infections of people with strong natural immunity (vaccination + prior infection) are substantially worse than a "common cold" - and are possibly even worse than influenza).

One reason to delay truly "living with it" is the availability of therapeutics. The impact of Paxlovid will become more clear as it becomes more available, and we might get an idea of whether it is beneficial in the event of mild infections in people who are NOT at high risk. Right now it's hard to get! A reason for some people to delay living with the virus! More time will also give us a chance to understand any downsides to Paxlovid (side effects, unexpected impacts, etc.) .

Another reason to delay is the unknowns with respect to long COVID. We'll learn more about this and how serious a risk it actually is in the vaccinated and boosted (to me it seems like it is low risk for these folks, but I wouldn't bet on it being "low enough" yet). And we may learn that early attack with Paxlovid (if it has an excellent safety profile) improves outcomes there as well.

It seems like we are in a place now for the people who are vaccinated and boosted and generally healthy to resume their lives with some precautions, depending on their personal risk tolerance. However, it definitely seems like it depends on personal risk tolerance and considerations with respect to specific health issues. In general, people seem to be a lot less healthy than they think.

I'm quite healthy (I think I'm actually right about being healthy, haha), but I plan to attempt to delay contracting the illness until we are at a point where it is easy to get immediate diagnosis and immediate safe treatment, regardless of severity of symptoms. I plan to start going back out to indoor rock climbing next week, but I'll be masked with an N95 with safety glasses as well, and I'll be as careful about hygiene as possible. It's definitely a huge increase in risk to do so, but to me it seems like it's time and probably getting to the level of acceptable risk, given the benefit. But N95 mask will be remaining firmly on at all times while indoors for the next couple months at least.
 
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I don't think many would have disagreed with that in October. I do think it's really unclear exactly how the end game will play out, though. And WHEN it is time to "live with it" is another question. And what will living with it look like, exactly? I think no one knows at this point.

Right now, with 2500 deaths per day in the US, giving an entire severe flu season worth of deaths in about a month, is not "living with the virus." That's dying with the virus.

We can probably live with the virus once we have enough immunity to the virus. It's very unclear (to me at least) exactly what the IFR will be in the case of basically 100% of people having strong natural immunity (from multiple rounds of vaccination (hopefully), possibly with added infection). But we're nowhere near that at this point, unfortunately. Some countries are closer to it - take highly vaccinated Portugal for example - but their 50 deaths per day still scales to 1650 deaths per day in the US (neglecting age adjustment), which is still extraordinarily high - and due to their very high vaccination rate, I would expect many (even most) of them to be of vaccinated elderly people. And this is with "mild" Omicron, and it's not clear at all the virus will remain "milder" - and in any case it's quite possible that Omicron is more dangerous (if not more virulent) than the original virus (hard to say exactly how it compares).

It's not clear to me whether this virus will have a permanent effect on life expectancy, even with 100% immunity. It seems that it likely will, but I hope that the situation changes - or at least that the disease becomes less common. It's not just the IFR that is relevant - the number of infections is crucially important in the "steady state." I don't know where that's going to settle, since we're (shockingly) still in a situation where there is so little natural immunity.

It's not clear to me whether natural immunity will fade and this will be like some coronaviruses where reinfections frequently occur, and whether those infections will truly resemble the common cold (right now, I think the data strongly suggests that infections of people with strong natural immunity (vaccination + prior infection) are substantially worse than a "common cold" - and are possibly even worse than influenza).

One reason to delay truly "living with it" is the availability of therapeutics. The impact of Paxlovid will become more clear as it becomes more available, and we might get an idea of whether it is beneficial in the event of mild infections in people who are NOT at high risk. Right now it's hard to get! A reason for some people to delay living with the virus! More time will also give us a chance to understand any downsides to Paxlovid (side effects, unexpected impacts, etc.) .

Another reason to delay is the unknowns with respect to long COVID. We'll learn more about this and how serious a risk it actually is in the vaccinated and boosted (to me it seem like it is low risk for these folks, but I wouldn't bet on it being "low enough" yet). And we may learn that early attack with Paxlovid (if it has an excellent safety profile) improves outcomes there as well.

It seems like we are in a place now for the people who are vaccinated and boosted and generally healthy to resume their lives with some precautions, depending on their personal risk tolerance. However, it definitely seems like it depends on personal risk tolerance and considerations with respect to specific health issues. In general, people seem to be a lot less healthy than they think.

I'm quite healthy (I think I'm actually right about being healthy, haha), but I plan to attempt to delay contracting the illness until we are at a point where it is easy to get immediate diagnosis and immediate safe treatment, regardless of severity of symptoms. I plan to start going back out to indoor rock climbing next week, but I'll be masked with an N95 with safety glasses as well, and I'll be as careful about hygiene as possible. It's definitely an huge increase in risk to do so, but to me it seems like it's time and probably getting to the level of acceptable risk, given the benefit. But N95 mask will be remaining firmly on at all times while indoors for the next couple months at least.
For me it's N95 until it's shown to be safe in a restaurant or movie theater (relatively safe means one contracted case in greater than 1000 shows for movie theater). I'm not sure when it will be safe to be in a crowded elevator, airplane, or bus--not for a couple of years at least.
 
Agreed.. Should have said asymptotically approaching normalcy 🙄

(iOS once changed asymptomatic to asymptotic on me, so felt compelled to use it here)

Long COVID aside (which perhaps I shouldn’t so easily dismiss) if everyone in crowded/confined spaces were fully vaccinated then this would be more endemic like the flu..

As a fully vaxxed and boosted person (as is my whole family) it’s the long COVID that probably concerns me most.. My sister (in hyper vaxxed Marin county) had the brain fog and queasiness for THREE weeks and it seems this spectrum of no symptoms to weird stuff for months is going to be a point of major study going forward..

There’s no doubt in my mind having more people fully vaccinated would be greatly beneficial and I have no clue at this point how to achieve that. 3 of my friends who I thought were moderately intelligent people remain unvaccinated for various (lame IMHO) reasons…. At this point I have to confess I would be fine with a bubble of fully vaccinated people in crowded/confined spaces that I might visit and let this continue to burn its way through the anti-vax crowd elsewhere… Yes I know many will be hospitalized and possibly die and create incubators for new variants…. But honestly what options do we have now?

Omicron is quite possibly the most contagious virus we've ever encountered (at least in the modern era). Omicron-1 was up around measles and Omicron-2 appears to be about 30% more contagious. Compared to earlier variants Omicron is not as deadly, but it's still much more deadly than the flu.

Long COVID is a serious long term problem. Some people had COVID in 2020 and still have long COVID symptoms. My partner is among them. She can function, but she gets tired easily and there are days when she can't do much more than sit on the couch. She's on low dose natrexone which is helping. Currently that's an off label use, but it has shown some promise with long COVID. It's uncertain if that's something to be done for a short period or if it's permanent.

If COVID continues to hospitalize as many people as Omicron does now, that's not sustainable long term. The hospital systems of the world are in a state of perpetual crisis and the people working there can't take much more. The bulk of people in hospitals are unvaccinated and a larger percentage survive, but it still puts a huge strain on the system.

For all those people who are libertarian about it, the unvaccinated in hospitals are costing you money. Insurance rates have gone up and they will likely go up more. We live in a society, we're not big cats living on our own in the jungle. Th unvaxed are costing us all money and taking up hospital resources some of the vaxed are going to need for other services, even if we don't get seriously ill with COVID.

I guess I would like to respond to said snippiness at the risk of enflaming the situation.. I am fascinated at how intelligent people can be influenced by incorrect or incomplete information.. I would never call such a person an idiot however.

This individual appears to be an absolutist (and there is a lot of that going around).. I never said anyone swayed by misinformation wasn’t smart, just perhaps a bit less so. I also never claimed being in a vaccine bubble was absolutely safe, just statistically more so..

All things considered, if there is a better solution than proof of vaccination for entry into crowded or confined spaces with respect to total safety and impact on the healthcare system (not to mention encouraging vaccination in itself).. I’m all ears.

Intelligence and wisdom are two separate things. I've known some people of very modest intelligence who were very wise and some people who were brilliant and were complete fools.

The SF author Robert Heinlein made the point in one of his books that humans aren't rational creatures, they are rationalizing creatures. Everyone is subject the allure of confirmation bias. Some people are brutally honest about following the facts in some parts of their lives and fall into believing bunk ideas in other areas.

The Dunning-Kruger effect is also something even smart people can fall into. Especially smart people who are geniuses in one area. They tend to be convinced they are geniuses in all areas and quite often they aren't. The Dunning-Kruger effect is the tendency for people who know a little about a subject to think they know everything, but in reality they are spouting garbage. This is what drives some people to think they know more than Anthony Fauci about infectious diseases. Real experts in a subject know what they don't know and are usually willing to say they don't know something. So they sound more uncertain than the ignorant who are sure they know everything about the subject.
 
Apparently, Omicron is deadlier than the first China variant of Covid.

The odds of death case by case is worse, or overall deadlier because there are so many more cases but the individual case risk is lower? I thought it was the latter, but I may be wrong.

I did have both original recipe and Omicron and I was clearly more sick with Omicron, though it only lasted about 2 days. The original illness felt like an asthma attack that lasted about 2-3 weeks.
 
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Omicron is quite possibly the most contagious virus we've ever encountered (at least in the modern era). Omicron-1 was up around measles and Omicron-2 appears to be about 30% more contagious.

I think it's possible, but this is extremely difficult to measure. Measles isn't a novel virus, and immunity against measles seems to be quite robust (thankfully, since it is not uncommon for measles to destroy your immune system and make you vulnerable to everything which you previously were immune to!).

For coronavirus, it's difficult to determine whether increases in rate of spread and how quickly a variant takes over from other variants are due to shorter serial interval, or greater transmissibility, or immune escape characteristics of the new variant.

Remember that the original virus spread extremely quickly as well (Wuhan & NYC come to mind). We had similar levels of mitigations in place over Christmas & New Year's this past year, so you'd expect rapid spread in the absence of immunity (which was definitely in short supply!). And indeed the results seemed similar. (I'd guess a similar (same order of magnitude) number of people in NY were infected in the initial wave - perhaps as much as half the number as were infected by Omicron? I haven't really gone back and dug into the numbers, but under-ascertainment was huge in that first wave in NYC. WAGs here.)

I think it's fairly clear that Omicron is considerably more contagious than the original given the substantially higher numbers of cases observed in most places...but as contagious as measles? Tough to make that comparison at this time. Maybe in a few months or a year, after there's been some time to study spread in various different scenarios, we'll have a better idea of the exact numbers. I'd guess an R0 of 6 or 7, but really a total WAG.

Fauci is optimistic at least, though note that he doesn't like to talk about "endemicity" - seems to me we have a ways to go before we can talk about that and what that might look like. Malaria and tuberculosis are also endemic. Hopefully we don't have that sort of situation!

 
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All things considered, if there is a better solution than proof of vaccination for entry into crowded or confined spaces with respect to total safety and impact on the healthcare system (not to mention encouraging vaccination in itself).. I’m all ears.

At this point I am not sure how well proof of vaccination would actually work especially in highly vaccinated areas or countries. For example, supposedly Israel has 97 or 98% compliance so I imagine most breakthrough cases being spread are from the vaccinated. Perhaps it is because the vaccine works so well that symptoms are reduced or to the point of being asymptomatic so many go about their daily business.