To Vaccinate or Not---The Rat Flu Odyssey Continues

[altacoup]

Today, my entire experience kind of puzzles me. I was driving into town and saw a van with a COVID vaccine sign in an recently closed commercial space. I passed it, turned pulled in and asked whether they were doing boosters. They told me that they were. They had Pfizer only. I explained that I was under 65 with no real medical issues and had received the second Moderna dose in March. I was told, no problem you qualify for a booster. I showed them my "Docket" immunization record for the two previous shots, filled out a form, asked about payment. I was told that the booster is free. The funny thing is that I was never asked for my ins, info. I received the shot. Sore arm, but no side effects, so far. The company that administered the shot was NOMI Health. It seems legit.?. There was a governmental seal on the truck, and a website. Kind of a strange experience.

NOMI health is legit. Got my first 2 shots from them. And they are administering free COVID test through out Utah.


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[SumJongGuy]

guys...

an excellent post was written, and
I was in-agreement right up to the point of 'blaming judges' - blaming judges is not going to solve anything.

I am going to set-aside the matter of Internment -
the world was a different place in 1942, and it does not compare to the matter of vaccination mandates for covid in 2021 ( and 2022 ) ;
weeks ago, I said the mandate - an Executive Order - would be challenged in the courts...

I recognize that Executive Orders Should have authority - and yet
yesterday, I read Oklahoma is not going to require Oklahoma's National Guard to comply with the mandate
( the fine print is If they are Federally-activated, the mandate may be enforced )

.

This and 99% of the other pushback actually has very little to do with how effective or safe vaccines are or aren't. It's all about challenging the authority of the duly elected United States Executive Branch to require those who voted differently to do anything those duly elective officials mandate. The ban of mask and vaccine mandates by red state governors and legislatures is all about waging a Cold Civil War against Washington DC and anyone opposed to Trump's reign.

It's polyass to the core. Vaccine mandates are just a symptom of the illness, not the cause of it. Is there a vaccine for treason? If so that's what we really need ASAP.

[summit]

Re: the math, I found this pretty succinct (if potentially optimistic):

Attachment 392637

The math is basic, but it is not quite so simple.

Read here: https://allnurses.com/understanding-...ation-t561777/ I wrote that almost 7 years ago when I was just getting into epi. (There are a few missing sentence fragments from when they copied to their new platform and most of the replies are gone)

Basically, it is not enough to do (1- (1/R0)) which is what your graphs shows, and conclude that is the fraction of the population you must then immunize. You need to consider uptake vs what part of the population you are actually vaccinating and the effectiveness of the vaccines. If we take a generous Ve of 75% for the aggregate of all the accepted vaccines out there with voluntary boosters, well do the math and you'll see you'll never hit herd immunity. If you can target for vaccination 90% of the population, you need to vaccinate about 99% of that 90% of the population with something that is 96% effective, which means mandated boosters. In reality it could be a bit less, but not a whole lot less.

Similarly the problem is not just that R0 for Delta is higher than Wuhan Classic, it is that Ve against Delta infection is markedly lower, particularly with certain vaccines (JJ).

[jono]

That is not all of the basic math.

Read here: https://allnurses.com/understanding-...ation-t561777/ I wrote that almost 7 years ago when I was just getting into epi. (There are a few missing sentence fragments from when they copied to their new platform)

Basically, it is not enough to do (1- (1/R0)) which is what your graphs shows, you need to consider uptake in the part of the population you are actually vaccinating and the effectiveness of the vaccines. If we take a generous Ve of 75% for the aggregate of all the accepted vaccines out there with voluntary boosters, well do the math and you'll see you'll never hit herd immunity. If you can vaccinate 90% of the population, you need to vaccinate about 99% of that 90% of the population with something that is 96% effective, which means mandated boosters. In reality it could be a bit less, but not a whole lot less.

Similarly the problem is not just that R0 for Delta is higher than Wuhan Classic, it is that Ve against Delta infection is markedly lower, particularly with certain vaccines (JJ).

Yeah, I wasn't trying to shortcut all the details with that, it's just a useful visualization. For most people the eyes glaze over before they finish the most basic math, unfortunately. OTOH, math can be done a lot of different ways (as long as it's not done wrong) and still get the right answer. For example, a very simple view would be that the numbers on the vertical axis there represent the required level of immunity (net of all sources, considering effectiveness of each, etc.) to get R=1 at the curve. Getting more specific needs more, of course, but more tools and perspectives are useful if you're trying to get through to the mathematically disinclined.

[summit]

Indeed, but put more succinctly, you realistically need to vaccinate greater than 88% of everyone aged 5 and up, including boosters, if you want herd immunity to Delta. That is not possible in the current political climate.

[jono]

Indeed, but put more succinctly, you realistically need to vaccinate greater than 88% of everyone aged 5 and up, including boosters, if you want herd immunity to Delta. That is not possible in the current political climate.

Yup. With 90% effectiveness delta isn't going away without other measures. Hopefully the numbers for boosted people start to show a bump.

[JimmyCarter]

Kids (5 and 8) got their first shots this AM. Town did a pretty nice job with the clinic at the local middle school. Snacks, juice boxes, a therapy golden retriever, etc. The post-shot waiting room was the auditorium with some Disney/Pixar movie playing.

Takeaway from them both is basically that “it hurts worse than the flu shot did”. Pain seems to be mitigated by the atypical application of high sugar breakfast treats.

[Hopeless Sinner]

Kids (5 and 8) got their first shots this AM. Town did a pretty nice job with the clinic at the local middle school. Snacks, juice boxes, a therapy golden retriever, etc. The post-shot waiting room was the auditorium with some Disney/Pixar movie playing.

Takeaway from them both is basically that “it hurts worse than the flu shot did”. Pain seems to be mitigated by the atypical application of high sugar breakfast treats.

Probably a sense of great relief for the parents.

[DougW]

This needs to get viral. Thanks!

My evil part of me would love to start a chant at the hill on opening day if the anti vaxx show up to protest , Singapore Singapore

[JimmyCarter]

Probably a sense of great relief for the parents.

Not quite relief yet but we’re getting there…

[riser4]

Kids (5 and 8) got their first shots this AM. Town did a pretty nice job with the clinic at the local middle school. Snacks, juice boxes, a therapy golden retriever, etc. The post-shot waiting room was the auditorium with some Disney/Pixar movie playing.

Takeaway from them both is basically that “it hurts worse than the flu shot did”. Pain seems to be mitigated by the atypical application of high sugar breakfast treats.

That kind of mitigation seems to work well in the short term.

[SumJongGuy]

Two more weeks to some peace of mind.. 2 months to full peace of mind. I hope all is well in the meantime. THANK YOU for getting your kids vaxxed.. teachers thank you.. immune compromised thank you.. everyone but you know who thanks you..

[LongShortLong]

We can probably vaccinate our way out of this. While your various statements about the math are correct, I disagree on the inputs. We simply don't know R0. So we can't accurately calculate the herd immunity threshold. It may be the case that R0 is too high, but we don't know that.

We also know that a heterogeneous vaccination program creates pockets of spread, and these pockets create a lot of cases in the vaccinated population. Cases that otherwise would not occur. As we immunize those pockets (via vaccination or infection), Covid will run out of willing hosts.

Consider also measles. By Jono's graph, it has an R0 of 18, requiring a vaccination rate above 94% to reach herd immunity. Yet, US vaccination rates are only 92% for adolescents (https://www.cdc.gov/nchs/fastats/measles.htm). Surely measles vaccine is also not 100% effective against measles, and surely protection wanes. Even if measles vaccine were 100% protective, measles ought to be spreading wildly and yet it is well contained at a few hundred cases per year.

Back to Covid. Consider California and New York. 62% and 67% fully vaxxed. Both states have nearly flat case rates, suggesting they are near herd immunity. But what about OMG Colorado. Colorado is 62% vaxxed. Cases have doubled over a two month period. That's a week over week rate of ~8% growth (compare to 80% wk/wk growth and higher in earlier times). Colorado is also close to herd immunity.

Aye, but what about NPIs you say. I wanna go to the bar without a mask. As we drop restrictions, that will help Covid. We'll need a higher immunization rate to counter. The effectiveness of current anti-covid measures is also a squishy number because it's hard (impossible?) to measure. Many restrictions are gone already. As vaccination (and recoveries) rise, my guess is we'll be able to drop the rest.

I think y'all, and the CDC, are attempting to clutch defeat from the jaws of victory.

[jono]

I think y'all, and the CDC, are attempting to clutch defeat from the jaws of victory.

Nah. More pointing out that NPI's, as you mention, need to carry some of the load. More would be faster.

I'm also still optimistic about increasing immunity with time--one way or another. Gets weird when delta stops outgrowing the birth rate, maybe; required for school has to be feasible soon.

Worth noting that all these mathematical models are built simplified for people who don't do calculus. If they accounted for variable levels of immunity and, consequently, contagiousness, instead of just assuming all or nothing for each individual person the explanation for what happens with measles would be slightly better. But NPI's (like contact tracing) probably make much more of a difference than that level of error, so...meh.

[SumJongGuy]

Worth noting that all these mathematical models are built simplified for people who don't do calculus. If they accounted for variable levels of immunity and, consequently, contagiousness, instead of just assuming all or nothing for each individual person the explanation for what happens with measles would be slightly better. But NPI's (like contact tracing) probably make much more of a difference than that level of error, so...meh.

Even that dumbed down we're up against a community who fought to ban exponential math in predicting sea level rise here in North Kakalaki. Did it in a ridiculously flawed attempt to protect their property values on the coast. But legit here all "official: models have to take the current values and a previous point to calculate a Y=Mx+B trend. Nothing allowed with a ^.. So, good luck convincing them things could get real bad in a hurry without certain actions or inactions.. No such witchcraft voodoo maths allowed LOL!

[summit]

We can probably vaccinate our way out of this. While your various statements about the math are correct, I disagree on the inputs. We simply don't know R0. So we can't accurately calculate the herd immunity threshold. It may be the case that R0 is too high, but we don't know that.

That's some optimism you have. Yes, R0s are estimated, but please find me a more optimistic number than 6-7 to assist my optimism?

Consider also measles. By Jono's graph, it has an R0 of 18, requiring a vaccination rate above 94% to reach herd immunity. Yet, US vaccination rates are only 92% for adolescents (https://www.cdc.gov/nchs/fastats/measles.htm). Surely measles vaccine is also not 100% effective against measles, and surely protection wanes. Even if measles vaccine were 100% protective, measles ought to be spreading wildly and yet it is well contained at a few hundred cases per year.

2xMMR is about 97-99% effective for measles and hardly appears to wane with age. Thankfully so, otherwise we'd be screwed.

I discussed in my previous post and articles that the simple Q0 calculation is not completely real world accurate, but it is close. Mixing of subpopulations matters. You can download a Reed-Frost model simulator if you want something more accurate (you can also find for R), or if so inclined download the Gleam-Viz client and burn up hours making a model and running it on the server. (I made a rudimentary nCOV-2019 model back in January 2020 that scared the crap out of me).

Back to Covid. Consider California and New York. 62% and 67% fully vaxxed. Both states have nearly flat case rates, suggesting they are near herd immunity. But what about OMG Colorado. Colorado is 62% vaxxed.

The problem is low VE-I in the setting of Delta supplanting Alpha/WT as the only circulating strain. Plus whatever other factors are present that might be actual waning.

This is scary low VE-I:


So if you have CO at 62% but actually 25-50% of those are susceptible to infection, you have a problem in terms of herd immunity. And that is why I say we have to boost EVERYONE. The good news is that a booster of Pfizer provides an additional 90+% reduction or maybe even 96% reduction in risk of infection versus having 2 doses, in the setting of Delta prevalence, which is pretty remarkable and encouraging... new data! For anyone keeping score that is about as good of immunity as vaccines get, up there with measles and tetanus.

(CO) Cases have doubled over a two month period. That's a week over week rate of ~8% growth (compare to 80% wk/wk growth and higher in earlier times). Colorado is also close to herd immunity.

We are running >10% positivity which means our community case capture sucks. Sure the spline slope delta is not as bad as it was 1 year ago, but it is BAD. I am not convinced we have plateaued in this wave and I doubt we will with holiday/travel/tourist induced cases imminent.


I do believe we have to be close, but by close I think we are 2/3 to 3/4 through the area under the curve, but we are at 80% of where we peaked in Dec 2020, which is already past where we were forecasted to peak, and the trend is UP:


We are boned (compare Nov 2020 to now):


It will get worse before it gets better:


Are we close? I hope so. I think between boosters, mandates and infections we'll get to endemic-land mid-winter or spring, optimistically. It is gonna suck until then. But I also made the same prediction this spring, pre-Delta and pre-vaccine uptake plateau, thinking right now would optimistically be the end of the pandemic.

ETA OK I better get back to adulting.

[schindlerpiste]

I wouldn't be surprised if the COVID vaccine will be something that we will need to get every year. I wonder what the conversation was when the flu vaccine first hit the market.

[bennymac]

some of you did your homework - love the discussion and learning

[bennymac]

[wooley12]

I wouldn't be surprised if the COVID vaccine will be something that we will need to get every year. I wonder what the conversation was when the flu vaccine first hit the market.

Conversation, pro and con, was 1/1000th of what we have today. Anti's didn't have much of a platform other than IRL conversation and letters to the editor.

[AK47bp]

Way to go Doug.


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[plugboots]

Conversation, pro and con, was 1/1000th of what we have today. Anti's didn't have much of a platform other than IRL conversation and letters to the editor.

Yup. Also the flu vaccine is developed differently every year as I recall. The CDC figures out which viruses are around with potential to invade the US, and they pick the three most prevalent/dangerous and developed a vaccine based on those 3, and then administer it. So it’s different every year.
For some basic info for a lot of you folks, there’s a podcast called “Stuff you should know”, and they talk about mRNA vaccines.
great basic stuff

https://www.iheart.com/podcast/105-s...work-88752715/

[jono]

I wouldn't be surprised if the COVID vaccine will be something that we will need to get every year. I wonder what the conversation was when the flu vaccine first hit the market.

While that's not a terrible scenario, we still have every reason to hope it goes more like polio than flu. Maybe 3 or 4 shots provide lasting immunity. The fact that the present approach starts with a too-short interval (justified in order to stand up immunity fast) certainly leaves room for that.

Note in Summit's post that both of the cited improvements via booster are relative to fully vaccinated people (albeit with waned AB's--still, see that graph, it ain't zero). So even though we're 6 months older, it turns out we're probably better off boosted than we were after 2 shots. (And given the timing, aren't those vs. delta?)

Full Singapore with boosts giving 98-99% protection (even if it was only for 6 months) would impact the political landscape.

[skaredshtles]

O rly?

I wonder if he has blamed the brown people yet...

[SumJongGuy]

There might be a one shot solution but the downside is probably a week of really shitty side effects.. And the obvious that deployment and global public penetration's the key to enough herd immunity for annual boosts to not to be required.'

One thing we do know is that this virus doesn't mutate anywhere near as much as the flu does.. and those mutations are why we do need annual flu shots instead of one and done..