COVID-19 Coronavirus Containment Efforts

[Vanadium 50]

I'm looking into acquiring one of those "spouse" things. Right now I have "girlfriend", which I don't keep in my house. This provides a buffer/enables quarantine in case of exposure.

When a young man gets married, he knows the true meaning of happiness.
But by then it's too late.

 

[Ygggdrasil]

We're told to get the first vaccine we can get, without considering the efficacy. I was already having mixed thoughts on that, but then the J&J vaccine got halted and the decision was re-made for me (my J&J vaccine appointment was for the day after the halt). The J&J vaccine is said to have between 66% and 75% efficacy. That's better than most flu vaccines but way, way worse than the 95% of the Pfizer/Moderna vaccines. To make it even more complicated, it takes 2 weeks to achieve full efficacy with the J&J vaccine vs 5 weeks for Pfizer/Moderna. I'd rather just stay home and wait 3 more weeks for the 95% than assume I'm good to go back to work/restaurants/parties after 2 weeks at 66-75%.

It's almost certainly better for policy to tell people to get the first available dose, but it's probably better for me to get the more effective one. Fortunately the J&J vaccine is going to end up as a small fraction of our first wave of vaccinations so "we" don't have to consider the ethics of that guidance if we don't want to...though it will matter for other countries, particularly less developed ones.

https://www.healthline.com/health-n...first-covid-19-vaccine-thats-available-to-you

One should exercise some caution in directly comparing the measured vaccine efficiencies in the trials for the various vaccines as the trials measured different outcomes and were done in different populations at different points in the outbreak:

"But comparing the efficacy of [the Pfizer and Moderna] vaccines to the efficacy of Johnson & Johnson’s is challenging because of differences in the designs of the Phase 3 clinical tests — essentially the trials were testing for different outcomes. Pfizer’s and Moderna’s trials both tested for any symptomatic Covid infection. Pfizer started counting cases from seven days after receipt of the second dose of vaccine, while Moderna waited until day 14 to start counting cases.​

​

J&J, by contrast, sought to determine whether one dose of its vaccine protected against moderate to severe Covid illness — defined as a combination of a positive test and at least one symptom such as shortness of breath, beginning from 14 or 28 days after the single shot. (The company collected data for both.)​

​

Because of the difference in the trials, making direct comparisons is a bit like comparing apples and oranges. Additionally, Pfizer and Moderna’s vaccines were tested before the emergence of troubling new variants in Britain, South Africa, and Brazil. It’s not entirely clear how well they will work against these mutated viruses."​

https://www.statnews.com/2021/02/02...eloped-by-pfizer-moderna-and-johnson-johnson/

I'd recommend reading the full piece linked above if you are interested in more about the differences between the various vaccines.

 

[mfb]

That's not what the CDC statistics show. Their numbers are 5800 post-vaccination cases, 400 hospitalizations, and 74 deaths.

That's out of 80 million, or 1/4 of the US population, and largely covering the high risk groups where we expect most deaths. Overall deaths are still ~500-1000 per day and were higher in the past. 74 deaths overall is close to zero compared to the unvaccinated population. The reduction of deaths is far better than the 95% efficacy for confirmed cases the phase III studies reported. Israel measured that first, the CDC numbers confirm it.

@jack action: Yes this is how good vaccines work.

If you took 5800 random unvaccinated cases, you would expect just over 100 deaths.

Vaccinated people are not representative for the general population.

 

[russ_watters]

One should exercise some caution in directly comparing the measured vaccine efficiencies in the trials for the various vaccines...
https://www.statnews.com/2021/02/02...eloped-by-pfizer-moderna-and-johnson-johnson/

I'd recommend reading the full piece linked above if you are interested in more about the differences between the various vaccines.

Thanks. That was informative, yet powerfully unhelpful (not your fault). It's somewhat shocking to me that such an important question evidently has no known answer.

A different take on the overall issue:
From a public policy perspective I think there is a good chance the current tack is going to backfire. If there is one thing skeptics are good at, it is finding discrepancies in a message -- even when they are unintentional and even sometimes when they don't exist.

While typing this Dr. Fauci appeared on my TV screen, with this exchange:
"So what we say to anyone who has doubts about getting a vaccine; it's up to you. Look at the data. The data speak for themselves."

Unfortunately it's not that simple and the data for some important parts of the issue are evidently not available or not useful/comparable.

 

[Vanadium 50]

Did I say that vaccines didn't work? Ever? You asked if there was a single death. I found 74, Yggdrasil found 9. Now you that you know the answer isn't what you expected you are free to argue that it's not important. But the number isn't zero.

From a public policy perspective I think there is a good chance the current tack is going to backfire.

Do you think backfiring matters? Right now, it's not as if there are piles and piles of vaccine and nobody wants to take it. When we get to the last 10%, do you think that they will even remember what nonsense was spouted months back, much less have it influence their behavior?

 

[russ_watters]

Did I say that vaccines didn't work? Ever? You asked if there was a single death. I found 74, Yggdrasil found 9. Now you that you know the answer isn't what you expected you are free to argue that it's not important. But the number isn't zero.

It's unclear to whom or what post those first two sentences are responding to there. But the rest is a response to @mfb and I I agree/I didn't like that take either.

Do you think backfiring matters? Right now, it's not as if there are piles and piles of vaccine and nobody wants to take it. When we get to the last 10%, do you think that they will even remember what nonsense was spouted months back, much less have it influence their behavior?

I think we're a lot close to it mattering than you think it is. When the eligibility opened-up I aggressively sought-out a vaccine. But I'm starting to see smatterings of news stories about rural areas being unable to fill vaccine appointments. Even a lack of urgency (vs hesitancy vs refusal) will cause the numbers to start to drop off and I think that will probably become significant soon. Like, in the next few weeks and at perhaps 60%. But we'll see.

And yes, maybe I'm not typical, but I did pause briefly when the first appointment I saw was a J&J vaccine, before booking it. To me the difference in efficacy is really big and the fact that the numbers aren't directly comparable doesn't make the problem better.

 

[PeroK]

The latest official figures from the UK on vaccine hesitancy are here:

https://www.ons.gov.uk/peoplepopula...hesitancygreatbritain/17februaryto14march2021

The headline is that the numbers have reduced significantly. Possibly only 6%.

Our vaccine programme has slowed in terms of first-timers as most vaccinations now are second shots, and it will be at least couple of months yet before we see how many people have not come forward.

 

[russ_watters]

Overall deaths are still ~500-1000 per day and were higher in the past. 74 deaths overall is close to zero compared to the unvaccinated population. [quote order reversed]

These absolute qualitative declarations are really not helpful. The number is *not* zero and we should be trying to understand what the risk is, not declaring that it is "effectively zero" and therefore presumably doesn't need to be looked into.

Here's the source for V50's 74 deaths number, that the news articles are about:
https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html

That's out of 80 million, or 1/4 of the US population...

No, that's the wrong number. 80 million is the number fully vaccinated yesterday (75 million per the timing of the report), but unless they are vaccinating people on ventilators in ICUs, people vaccinated recently haven't yet had a chance to die from COVID. Since it takes 2 weeks post vaccination to achieve full immunity and about 6 weeks from exposure to death on average, the number of fully vaccinated available to die on the day the report was issued was only about 18 million. 12 million the week before, or 15.5 that week (average). We could work backwards to find the pool for each week so far, but it is quite small.

You're probably reacting to the news reports on the trials indicating no one vaccinated died from COVID during the trials or it's "100% effective at preventing death" (paraphrase), but the trials were too small and short to show reliable statistics on deaths in vaccinated people. Less than one death during the trial still allows for hundreds or thousands of deaths of vaccinated people in the general public.

 

[Vanadium 50]

It's unclear to whom or what post those first two sentences are responding to there.

Sorry, dropped the quote. mfb.

 

[Vanadium 50]

But I'm starting to see smatterings of news stories about rural areas being unable to fill vaccine appointments.

I'm not so sure how much of this is hesitance vs. distribution. I might even say "organization". It's pretty clear that the distribution of doses doesn't match the distribution of the population, and it's also the case there is "vaccine tourism" - people driving far away because that was the closest spot that had any. In my own case, there are plenty of first doses to be had, but the number is throttled by the number of second doses a month later. They want zero doses administered if there is not a corresponding dose in 28.0000 days. (I kid, but the window seems to be 2 hours) They could process more if 28.000 was 27-29. I doubt very much that 3% makes a huge difference.

 

[Ygggdrasil]

I'm not so sure how much of this is hesitance vs. distribution. I might even say "organization". It's pretty clear that the distribution of doses doesn't match the distribution of the population, and it's also the case there is "vaccine tourism" - people driving far away because that was the closest spot that had any. In my own case, there are plenty of first doses to be had, but the number is throttled by the number of second doses a month later. They want zero doses administered if there is not a corresponding dose in 28.0000 days. (I kid, but the window seems to be 2 hours) They could process more if 28.000 was 27-29. I doubt very much that 3% makes a huge difference.

Here are the CDC guidelines wrt the second dose of the mRNA vaccines:

"Interval between mRNA doses​

​

The second dose of Pfizer-BioNTech and Moderna vaccines should be administered as close to the recommended interval as possible, but not earlier than recommended (i.e., 3 weeks [Pfizer-BioNTech] or 1 month [Moderna]). However, second doses administered within a grace period of 4 days earlier than the recommended date for the second dose are still considered valid. If it is not feasible to adhere to the recommended interval and a delay in vaccination is unavoidable, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be administered up to 6 weeks (42 days) after the first dose. Currently, only limited data are available on efficacy of mRNA COVID-19 vaccines administered beyond this window."​

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

I was allowed to schedule my second Pfizer dose (which I get tomorrow ) within a 3 day window 19-21 days after my first dose, so second dose scheduling woes are likely site dependent.

 

[PeroK]

Here are the CDC guidelines wrt the second dose of the mRNA vaccines:

"Interval between mRNA doses​

​

The second dose of Pfizer-BioNTech and Moderna vaccines should be administered as close to the recommended interval as possible, but not earlier than recommended (i.e., 3 weeks [Pfizer-BioNTech] or 1 month [Moderna]). However, second doses administered within a grace period of 4 days earlier than the recommended date for the second dose are still considered valid. If it is not feasible to adhere to the recommended interval and a delay in vaccination is unavoidable, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be administered up to 6 weeks (42 days) after the first dose. Currently, only limited data are available on efficacy of mRNA COVID-19 vaccines administered beyond this window."​

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

I was allowed to schedule my second Pfizer dose (which I get tomorrow ) within a 3 day window 19-21 days after my first dose, so second dose scheduling woes are likely site dependent.

We're not bothering with any of this nonsense in the UK!

 

[mfb]

Did I say that vaccines didn't work? Ever? You asked if there was a single death. I found 74, Yggdrasil found 9. Now you that you know the answer isn't what you expected you are free to argue that it's not important. But the number isn't zero.

You claimed going to party without mask would cancel the vaccine efficacy in terms of reducing deaths.

I knew about Israel's study which saw zero deaths, I didn't know the CDC had released larger datasets in the meantime. I asked a question. No need to interpret any malicious intent into it. The statement I made - it's almost 100% reduction - is strengthened by the CDC numbers.

These absolute qualitative declarations are really not helpful. The number is *not* zero and we should be trying to understand what the risk is, not declaring that it is "effectively zero" and therefore presumably doesn't need to be looked into.

The question was how risky it is for a vaccinated person to go to a party vs. an unvaccinated person avoiding that party. We don't need four significant figures for that comparison. I didn't say it wouldn't need to be looked into. I have no idea how you got that idea.

Yes of course the number of fully vaccinated people is ramping up over time. One would need to study the full integral for a better comparison. Feel free to do that. I didn't want to write a publication, I made a rough comparison.

 

[Vanadium 50]

You claimed going to party without mask would cancel the vaccine efficacy in terms of reducing deaths.

I most certainly did not, especially not "a" single party. You're setting up a straw man.

No need to interpret any malicious intent into it.

Really.

At the risk of giving you more fodder for misinterpretation, how effective is a lockdown? Nobody knows, but an upper limit is (US population x fraction who might become infected x IFR)/fatalities. That's (330M x 100^ (can't be bigger than that) x 1% (still a guess))/570K = 5.8.

What is the same number for a vaccine? It's 1/(1-x) where x is the efficacy. If we use Russ' numbers of 67-95% that works out to 3-20.

5.8 is in between 3 and 20: i.e. remaining locked down and vaccination provide comparable protection. I note in passing that age variations are much, much larger than this. That is, who you are matters much, much more than what you do.

Consider two people: Person A's plan is to get vaccinated, and as soon as it kicks in, go back to life as it was. Mingle with whomever they want to, whenever they want to, maskless and undistanced. Person B's plan is to remain un-vaccinated, but stay isolated and locked down. (FWIW, I have relatives in both categories - so real people make decisions like these) We just established that their protection from risks are comparable. So while we might look askance at Person A's choices, it's Person B who has become the pariah. We have suggestions upthread that one cannot even be friends with Person B.

I wondered why that is. I still wonder.

One can question these numbers, but that way is fraught with peril. For example, you could say that the 5.8 numbers is too high: 1% is more like 0.3% when you consider the asymptomatic cases, and 100% is unrealistic - maybe it should be 50%. Fine., But then you have concluded that lockdowns are ineffective. So why are we 13 months into one? (Again, in passing I note that they were originally intended to flatten the curve, and if you hold this view, that's exactly - and all - that they did)

Or you could say we shouldn't include J&J in the calculation, since it's use is suspended. But it wasn't suspended for lack of efficacy, it was suspended because of a perceived high rate of side effects. The US government is certainly not telling people who were vaccinated with J&J to go and get themselves some Pfizer or Moderna.

So why is Person B wicked, evil and unworthy of friendship when Person A is just being dumb?

 

[mfb]

You claimed going to party without mask would cancel the vaccine efficacy in terms of reducing deaths.

I most certainly did not, especially not "a" single party.

Then please explain what you meant, for reference here the relevant quotes:

"I'm not going to get vaccinated" and "I'm going to get vaccinated and then run out and indulge in all the risky behaviors I've missed" have (in that [40-49] age bracket) comparable risks.

I think I am comparing it to going to a party without a mask.

This is not about the overall efficacy of a lockdown (spreading the cases over a larger period of time to limit maximum hospital load is an effect that would need to be included there). This is about the individual risk.

The 67% is an estimate for the efficacy (symptomatic COVID) of J&J but that's not the reduction in the chance to die. We know it's far, far better for Pfizer/BNT and Moderna at least - even higher than the ~95% reduction in symptomatic COVID the phase III trials measured.

PS: I think both behaviors are irrational in the US in the current situation.

 

[Wrichik Basu]

Don't want to derail the ongoing discussion, but the situation is getting really pathetic in our capital city. Patients have died gasping for oxygen at a Delhi hospital. This is not the sole incident; same situation in several other places. I don't want to bring in any political views, but the Govt. could certainly do better at procuring and transporting the vital gas.

 

[Vanadium 50]

What do you expect the government to do once 100% of oxygen production is already going to hospitals?

 

[nsaspook]

How do you stop something like this?

 

[Cobul]

After more than a year. Have they already figured out what caused Covid cases to be mild, moderate or severe? Does it have to do generally with the strength of your immune system like fighting colds?

 

[russ_watters]

I'm not so sure how much of this is hesitance vs. distribution. I might even say "organization". It's pretty clear that the distribution of doses doesn't match the distribution of the population, and it's also the case there is "vaccine tourism" - people driving far away because that was the closest spot that had any. In my own case, there are plenty of first doses to be had, but the number is throttled by the number of second doses a month later. They want zero doses administered if there is not a corresponding dose in 28.0000 days. (I kid, but the window seems to be 2 hours) They could process more if 28.000 was 27-29. I doubt very much that 3% makes a huge difference.

I'm not sure about the distribution vs population. I've "heard" that the "collar counties" around Philly were under-served but never really saw any data. And yes, I drove further from Philly to get mine. But more and more stories are cropping-up about un-filled appointments.

The pause on J&J vaccinations is going to throw off the numbers over the next several weeks, but a quick look on the CVS website shows about half of their ~200 locations in PA have available appointments. That's the first I've seen it above single digits (but I hadn't checked since I booked my appointment last week). It includes several within a 10 mile radius -- on Sunday I drove 40 miles for my first dose. I'm also seeing from the CDC data that 2nd doses of Pfizer/Moderna are now exceeding first doses.

Other stories:
https://www.cnn.com/2021/04/21/health/us-coronavirus-wednesday/index.html
https://www.inquirer.com/health/coronavirus/pennsylvania-covid-vaccine-herd-immunity-20210421.html

I think "ambivalence" or "hesitancy" is starting to become a factor. We may see vaccination rates peak in the next couple of weeks if they haven't already. It appears that the pause in J&J vaccinations meant they also weren't shipping them (bad idea IMO), so it will take a few weeks to clear any backlog that exists once they start shipping again. If the total vaccinations don't go up significantly in the week or two after they are released, we'll have our answer. In the week before the pause, about 2.5 M of 21 M doses administered were J&J.

 

[Vanadium 50]

I got Dose 1 (Moderna) yesterday. In talking with the people distributed it, i confirmed my suspicion: Dose 2 is throttling things. The number of Dose 1s being given now is driven by the number of Dose 2s they think they will have in 28 days. They have many more doses on hand today than they can promise a second dose will be available for.

I think that a 2 hour window on the 28 days may be a bit extreme.

I think "ambivalence" or "hesitancy" is starting to become a factor.

Like I said, I got Dose 1 yesterday. I had a chance to "jump the line". Is waiting my turn "hesitant"? Maybe. Maybe not.

 

[russ_watters]

I got Dose 1 (Moderna) yesterday. In talking with the people distributed it, i confirmed my suspicion: Dose 2 is throttling things.

If all the appointments are filled, sure. If they are holding back doses yet still have open appointments and extra vaccine then throttling still would not be causing a bottleneck. So did you ask or do you know if all the appointment slots were filled?

Like I said, I got Dose 1 yesterday. I had a chance to "jump the line". Is waiting my turn "hesitant"? Maybe. Maybe not.

How hard did you have to work to get the appointment? On the day I became eligible the first thing I did when I woke up was spend 15 minutes searching for available appointments on pharmacy websites. I was able to find an appointment within a distance I was willing to drive. If I hadn't found one on the first try I was prepared to check multiple websites every couple of hours throughout the day until I found one. I consider that to be a fairly aggressive effort. But no I was not going to try to jump the line. Now, a week and a half later, there are lots of open appointments even with fewer doses available.

Ambivalence comes between aggressiveness and hesitancy. It is like "yeah I'll get vaccinated but I'm having kind of a busy week and I don't want to drive far and I don't feel like putting effort into searching multiple websites so I'll wait until other people tell me that it's easy to get an appointment and I don't like waiting in line so I hope that they don't have a long wait at the pharmacy when I get there so I'll see how it goes for my friends..." That person would still answer a survey "definitely getting vaccinated" but they would affect the rate of vaccinations if there are a lot of them.

 

[Vanadium 50]

All of the slots were filled.

When you schedule here, they look out 5 days. I made it to a place only 4 miles away on the 10th day of eligibility, so it was scheduled on the 5th. I checked a couple of times a day. There were a few dozen slots available when I signed up and they went fast. An hour later there weren't any. I also signed up for alerts from the county, and got one today. Left hand, right hand.

At this exact moment, there is one dose available in the next 5 days. 10 AM tomorrow. I am guessing a cancellation.

 

[StevieTNZ]

Don't want to derail the ongoing discussion, but the situation is getting really pathetic in our capital city. Patients have died gasping for oxygen at a Delhi hospital. This is not the sole incident; same situation in several other places. I don't want to bring in any political views, but the Govt. could certainly do better at procuring and transporting the vital gas.

For starters, they could have delayed elections and compaigning sooner, and stopped religious festivals going ahead. Your Government sounds incompetent and stupid.

 

[hmmm27]

Walked into the drugstore for some medication, saw a sign, signed up... a couple hours later they called me, said they had some no-shows that day. So, 1 down, 1 to go. It's AZ-O, and every media site pulls different stats out of their ass to bolster whatever their agenda-du-jour happens to be on that one, so no clue if I'da been better off having a Coke, instead.

Does anybody know the real (not distribution-based) optimum time between doses ? Is the two dose regimen even the best ? or was that just to get everybody a little bit vaccinated in the shortest period of time.

 

[Wrichik Basu]

Your Government sounds incompetent and stupid.

I wanted to write exactly that, but was not sure if it would be allowed here as politics is banned. There are many things that could have been done to alleviate the situation.

 

[BillTre]

Your Government sounds incompetent and stupid.

It seems to be a problem found in many places.

 

[StevieTNZ]

The New Zealand Government is an exemplary example of how to handle Covid-19.

 

[BillTre]

They should to be commended. (especially compared with Trump, Balsonaro, etc.).

 

[PeroK]

The New Zealand Government is an exemplary example of how to handle Covid-19.

If you took the NZ population and its government and transplated it to western Europe and squeezed it somewhere in between the Benelux countries, you would have been hit just as hard by COVID as those countries.

 

[Rive]

There are many things that could have been done to alleviate the situation.

Kind of a rule, that where the first wave did not hit hard the followup were welcomed with negligence (and so the story ends with a disaster).
We (mid-Europe) did that too.

 

[russ_watters]

If you took the NZ population and its government and transplated it to western Europe and squeezed it somewhere in between the Benelux countries, you would have been hit just as hard by COVID as those countries.

What, you're not giving them credit for choosing to be an island nation? That took considerable long-term planning!

 

[Vanadium 50]

I think they are an archipelago nation. Does two make an archipelago?

 

[mfb]

Does anybody know the real (not distribution-based) optimum time between doses ? Is the two dose regimen even the best ? or was that just to get everybody a little bit vaccinated in the shortest period of time.

Ideally you would repeat the phase III trials with 10 different periods between the doses, but that's not realistic. It's generally expected that there is a large time range that leads to very similar results. The difference between 3 and 4 weeks is probably irrelevant.

 

[StevieTNZ]

If you took the NZ population and its government and transplated it to western Europe and squeezed it somewhere in between the Benelux countries, you would have been hit just as hard by COVID as those countries.

Don't assume that.