Things that went whizzing by that I want to remember: First: I had been thinking that mRNA vaccines gave you 1/8 the risk of catching the virus, 1/20 the risk of passing it on, and 1/50 the risk of dying from it. But this appears to suggest that the numbers are more like 1/8, 1/8, 1/25. And with the Delta variant having an R[0] of 7.5 suggests that the epidemic is almost fully self-sustaining in a fully vaccinated population. And it also raises the possibility that, unless infection-acquired immunity is stronger than mRNA vaccine immunity, it needs only one small mutation to become self-sustaining no matter what the primed-immune-system status of the population...
Even if you're fully vaccinated, or as fully vaccinated as current tech permits, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext is of interest. They find guaranteed cognitive deficits due to COVID infection. And yes, 100% anything in biology is a big red flag. But there's another one -- https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v2 -- which, yes, preprint, but they use the baseline for a big longitudinal study to find that you've got guaranteed brain tissue loss from COVID. So perhaps they're not finding the truly mild cases; perhaps a certain percentage of the population is for reasons of genetic luck immune to these effects. Perhaps larger studies would provide greater resolution and nuance. But for now, for risk assessment purposes, I think it would be prudent to consider these two papers likely to be substantially correct.
That's not actually the scary stuff; the scary stuff is https://www.biorxiv.org/content/10.1101/2021.02.23.432474v2 which finds universal Lewy body formation in a macaque model post-COVID. (Lewy-body dementia is fatal, even less well understood than Parkinson's, and at the present state of the art they can only detect Lewy bodies via specialised work post-mortem.) If that holds in humans -- a very large if, but one to which we cannot attach any present facts -- the 10 year mortality rate of COVID is plausibly 100%.
The medarchive paper on brain scans looks like a lot of data mining to me. The table of comparisons to controls and the p-values seems to confirm some randomness in the calculated values. I would put this down as an early study that needs to be followed up far more rigorously.
I can only hope that the macaque study is not applicable to humans. My guess is that we will know in 10 years what the human outcome is. This will require those who are fairly young to be followed - not much point in following 70/80 year olds. The BSE scare and suspected vCJD proved relatively low risk. (I was eating v rare steaks in the 1980s in the UK before I emigrated. So far so good after 30+ years. The incidence of vCJD in the UK proved very low in actuality. The only downside is that the US blood banks will still not accept a blood donation from me.) Sometimes these animal links prove not so serious.
I am more concerned about the long Covid incidence in the young. Disability that could develop and last for a long term is serious. I can just imagine how the increasingly confrontational disability system in the US will generate a lot of misery for these people.
Those papers are only information about risk in your context if you yourself do something different.
What you've done here is to tell a story that minimises perceived risk; "maybe it's not that bad". And, well, sure, things are almost never either as good or as bad as they initially seem.
"Here's some published stats on nigh-guaranteed cognitive impairment" (with support from a second study that provides a mechanism) isn't an "initially seem"; it's some stuff at least provisionally in the domain of facts.
Insistence on established scientific certainty is the wrong way to respond to a pandemic because it completely fails as harm mitigation. It closely corresponds to harm maximisation. And here we are with increased evidence of harm, in the form of an indication that it's greater than we thought.
So my argument is that it's appropriate to treat this as information and thus absolutely time to do something different.
The precautionary principle is fine when the societal risk of an event is not fully known, but the effect of an event is very high, for example, global heating, asteroid impacts.
But there are so many individual risks that taking the precautionary principle for individual actions would be paralyzing. Don't get me wrong here. In the case of Covid, vaccinations should be a no-brainer. Wearing masks and social distancing should be similar until the virus is truly beaten, but the Australian and New Zealand experience shows that the virus will penetrate any defense except herd immunity. If it turned out that just being a carrier also had harmful effects, we would be in real trouble as there would be no defense at all unless we tested everyone every day and put anyone shown to be carrying the virus in an isolation camp in the hope of reducing the spread.
At some point, we will get a new virus with both the incubation period of Covid, but with the mortality rate that is very high. That may prove unstoppable with the social change effects of the Black Death.
Our gracious host has above posted a careful analysis that herd immunity is not an available option.
The available peer-reviewed information -- that Lancet article -- is that ANY COVID infection leads to cognitive decline. No data on whether or no this is reversible, or cumulative. This runs into areas where medical knowledge mostly isn't.
I would suggest that the precautionary principle is not what applies, here; the approach that applies here is preventing harm. It's not _hypothetical_ harm.
It is only self-sustaining IF the assumptions remain valid. This is a static model, not a dynamic model.
Consider, if the macaque study was true for humans, humanity, for all but a few resistant to any infection would be wiped out. Obviously, this has never happened before in history. Yes, human reproduction will allow for the race to continue, but with short lives, until eventually it kills everyone before reproductive age. I don't buy this.
Secondly, if it becomes self-staining even for the vaccinated, the smart fraction of the population will adapt with permanent mask-wearing and social distancing. In a decade or so, all the unmasked will die and the transmission rate will fall. Even the most stubborn ant-vaxxers will change their behavior in the face of serious plague mortality rates.
Eventually, the virus will be subdued with periodic booster shots that keep the winter flu under control, at least for those vaccinated. (I haven't had the flu for years.)
The UK is going through a counterintuitive moment where infection rates are declining against all the models being expressed via epidemiologists up until a week or so ago. From what I see there is a lot of guessing as to why, with plausible explanations. Another month will indicate whether the expected growth rate of cases resumes as modeled or not.
The US is still proceeding as per models. My own county, having stupidly publicly expressed the opinion it was effectively over, now has a positivity rate that should be closing down business establishments. (They won't.) Infection rates are low, but that will be transient if the models are correct.
There are some good things coming out of this. Firstly, some large companies are reversing their stand on return to the office by September. This, plus self-sustaining infections, will cement the change in work conditions, and help (eventually) to get family supportive legislation enacted to try to get wore workers to overcome the shortage. [It won't be long before the GOP start demanding the undocumented be given dangerous work to maintain supply chains in the food industry]
The severe drought in California cannot be hand-waved away. It will be interesting to see how this plays out. Despite the screams of farmers, I suspect the other 98% of the economy will eventually win out over water allocations, albeit with restrictions. I only hope we don't lose all the fish first. [Getting rid of lawns would be desirable. You cannot hide watered grass so it will be easy to catch scofflaws.].
So the bottom line is this:
1. The most susceptible to infection will slowly be reduced in the population through mortality. This includes the naturally weakened, and those deliberately courting infection.
2. Behavioral changes will reduce the transmission rate. We may well revert to self-isolation practices again to aid this.
3. Periodic booster shots to handle more virulent strains.
4. Social changes aiding the needed behavioral changes. One obvious change is less meat-eating reducing the need for shoulder to shoulder work in animal processing plants where outbreaks often start. (sadly the recent new outbreaks in my CA county are in the retirement homes and skilled nursing facilities. Ironically in a new center to help the homeless.)
5. Over a period of time, the population genetics will result in low transmission and infection rates for this disease.
We had best hope that the macaque monkey experiment is not as lethally applicable to humans as this will make the feared wave of dementia support look like an easily handled problem for health care by comparison.
"Consider, if the macaque study was true for humans, humanity, for all but a few resistant to any infection would be wiped out. Obviously, this has never happened before in history."
Disease is a candidate cause for that human genetic bottleneck ~75 thousand years ago; lots of species go extinct due to disease. It's for-real a thing.
The idea that the vaccinated can separate from the vaccinated and allow the later to die has all sorts of systemic problems, starting with the practicality of "separated". Systems -- that thing that keeps us fed and the lights on -- persist as systems. We can have a different one, but we can't have a partial social system.
Even if you're fully vaccinated, or as fully vaccinated as current tech permits, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext is of interest. They find guaranteed cognitive deficits due to COVID infection. And yes, 100% anything in biology is a big red flag. But there's another one -- https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v2 -- which, yes, preprint, but they use the baseline for a big longitudinal study to find that you've got guaranteed brain tissue loss from COVID. So perhaps they're not finding the truly mild cases; perhaps a certain percentage of the population is for reasons of genetic luck immune to these effects. Perhaps larger studies would provide greater resolution and nuance. But for now, for risk assessment purposes, I think it would be prudent to consider these two papers likely to be substantially correct.
That's not actually the scary stuff; the scary stuff is https://www.biorxiv.org/content/10.1101/2021.02.23.432474v2 which finds universal Lewy body formation in a macaque model post-COVID. (Lewy-body dementia is fatal, even less well understood than Parkinson's, and at the present state of the art they can only detect Lewy bodies via specialised work post-mortem.) If that holds in humans -- a very large if, but one to which we cannot attach any present facts -- the 10 year mortality rate of COVID is plausibly 100%.
The medarchive paper on brain scans looks like a lot of data mining to me. The table of comparisons to controls and the p-values seems to confirm some randomness in the calculated values. I would put this down as an early study that needs to be followed up far more rigorously.
I can only hope that the macaque study is not applicable to humans. My guess is that we will know in 10 years what the human outcome is. This will require those who are fairly young to be followed - not much point in following 70/80 year olds. The BSE scare and suspected vCJD proved relatively low risk. (I was eating v rare steaks in the 1980s in the UK before I emigrated. So far so good after 30+ years. The incidence of vCJD in the UK proved very low in actuality. The only downside is that the US blood banks will still not accept a blood donation from me.) Sometimes these animal links prove not so serious.
I am more concerned about the long Covid incidence in the young. Disability that could develop and last for a long term is serious. I can just imagine how the increasingly confrontational disability system in the US will generate a lot of misery for these people.
Information causes change.
Those papers are only information about risk in your context if you yourself do something different.
What you've done here is to tell a story that minimises perceived risk; "maybe it's not that bad". And, well, sure, things are almost never either as good or as bad as they initially seem.
"Here's some published stats on nigh-guaranteed cognitive impairment" (with support from a second study that provides a mechanism) isn't an "initially seem"; it's some stuff at least provisionally in the domain of facts.
Insistence on established scientific certainty is the wrong way to respond to a pandemic because it completely fails as harm mitigation. It closely corresponds to harm maximisation. And here we are with increased evidence of harm, in the form of an indication that it's greater than we thought.
So my argument is that it's appropriate to treat this as information and thus absolutely time to do something different.
The precautionary principle is fine when the societal risk of an event is not fully known, but the effect of an event is very high, for example, global heating, asteroid impacts.
But there are so many individual risks that taking the precautionary principle for individual actions would be paralyzing. Don't get me wrong here. In the case of Covid, vaccinations should be a no-brainer. Wearing masks and social distancing should be similar until the virus is truly beaten, but the Australian and New Zealand experience shows that the virus will penetrate any defense except herd immunity. If it turned out that just being a carrier also had harmful effects, we would be in real trouble as there would be no defense at all unless we tested everyone every day and put anyone shown to be carrying the virus in an isolation camp in the hope of reducing the spread.
At some point, we will get a new virus with both the incubation period of Covid, but with the mortality rate that is very high. That may prove unstoppable with the social change effects of the Black Death.
Our gracious host has above posted a careful analysis that herd immunity is not an available option.
The available peer-reviewed information -- that Lancet article -- is that ANY COVID infection leads to cognitive decline. No data on whether or no this is reversible, or cumulative. This runs into areas where medical knowledge mostly isn't.
I would suggest that the precautionary principle is not what applies, here; the approach that applies here is preventing harm. It's not _hypothetical_ harm.
It is only self-sustaining IF the assumptions remain valid. This is a static model, not a dynamic model.
Consider, if the macaque study was true for humans, humanity, for all but a few resistant to any infection would be wiped out. Obviously, this has never happened before in history. Yes, human reproduction will allow for the race to continue, but with short lives, until eventually it kills everyone before reproductive age. I don't buy this.
Secondly, if it becomes self-staining even for the vaccinated, the smart fraction of the population will adapt with permanent mask-wearing and social distancing. In a decade or so, all the unmasked will die and the transmission rate will fall. Even the most stubborn ant-vaxxers will change their behavior in the face of serious plague mortality rates.
Eventually, the virus will be subdued with periodic booster shots that keep the winter flu under control, at least for those vaccinated. (I haven't had the flu for years.)
The UK is going through a counterintuitive moment where infection rates are declining against all the models being expressed via epidemiologists up until a week or so ago. From what I see there is a lot of guessing as to why, with plausible explanations. Another month will indicate whether the expected growth rate of cases resumes as modeled or not.
The US is still proceeding as per models. My own county, having stupidly publicly expressed the opinion it was effectively over, now has a positivity rate that should be closing down business establishments. (They won't.) Infection rates are low, but that will be transient if the models are correct.
There are some good things coming out of this. Firstly, some large companies are reversing their stand on return to the office by September. This, plus self-sustaining infections, will cement the change in work conditions, and help (eventually) to get family supportive legislation enacted to try to get wore workers to overcome the shortage. [It won't be long before the GOP start demanding the undocumented be given dangerous work to maintain supply chains in the food industry]
The severe drought in California cannot be hand-waved away. It will be interesting to see how this plays out. Despite the screams of farmers, I suspect the other 98% of the economy will eventually win out over water allocations, albeit with restrictions. I only hope we don't lose all the fish first. [Getting rid of lawns would be desirable. You cannot hide watered grass so it will be easy to catch scofflaws.].
So the bottom line is this:
1. The most susceptible to infection will slowly be reduced in the population through mortality. This includes the naturally weakened, and those deliberately courting infection.
2. Behavioral changes will reduce the transmission rate. We may well revert to self-isolation practices again to aid this.
3. Periodic booster shots to handle more virulent strains.
4. Social changes aiding the needed behavioral changes. One obvious change is less meat-eating reducing the need for shoulder to shoulder work in animal processing plants where outbreaks often start. (sadly the recent new outbreaks in my CA county are in the retirement homes and skilled nursing facilities. Ironically in a new center to help the homeless.)
5. Over a period of time, the population genetics will result in low transmission and infection rates for this disease.
We had best hope that the macaque monkey experiment is not as lethally applicable to humans as this will make the feared wave of dementia support look like an easily handled problem for health care by comparison.
"Consider, if the macaque study was true for humans, humanity, for all but a few resistant to any infection would be wiped out. Obviously, this has never happened before in history."
Disease is a candidate cause for that human genetic bottleneck ~75 thousand years ago; lots of species go extinct due to disease. It's for-real a thing.
The idea that the vaccinated can separate from the vaccinated and allow the later to die has all sorts of systemic problems, starting with the practicality of "separated". Systems -- that thing that keeps us fed and the lights on -- persist as systems. We can have a different one, but we can't have a partial social system.