Omicron appears to be spreading among the immunized population
December 10, 2021 9:40 AM Subscribe

In South Africa, the U.K., and Denmark—countries with the best variant surveillance and high immunity against COVID—Omicron cases are growing exponentially. This is the simple math we have to keep in mind: A tiny percent of a huge number is still a big number. A largely mild but uncontrolled Omicron wave could cause a lot of pain, hospitalizations, and death across a country. The ultimate impact of Omicron will depend on how tiny that tiny percent is and how huge that huge number is.

Some other information about infections among the vaccinated that is keeping me up at night:

The epidemiological relevance of the COVID-19-vaccinated population is increasing

Many decisionmakers assume that the vaccinated can be excluded as a source of transmission. It appears to be grossly negligent to ignore the vaccinated population as a possible and relevant source of transmission when deciding about public health control measures.

Please note that the above link is a letter to the Lancet exploring several recent studies or events with relatively small sample sizes and may just be anxiety fuel.

posted by mecran01 (183 comments total) 32 users marked this as a favorite

Many decisionmakers assume that the vaccinated can be excluded as a source of transmission.

Did anyone actually think this?

It's been obvious for some time that the vaccines are moderately effective at best in stopping transmission but very effective in stopping serious illness and therefore not overwhelming healthcare services.
posted by fullerine at 10:15 AM on December 10, 2021 [40 favorites]

👏 Stop 👏 thinking 👏 of 👏 immunity 👏 as 👏 binary.

Immunity, like gender, like sexuality, like everything in life is a spectrum. It's not whether you're immune or not, it's whether your immune system stops an infection when challenged. If your immune system has everything it needs, infection stopped quick. If your immune system has most of what it needs, some symptoms. If your immune system has to start from scratch you're not going to have a good time.

It's better to think of immunity like a dice roll or a saving throw against being infected. If you're challenged by COVID and you're vaccinated your saving throw is the equivalent of trying to roll a 20 sided dice and getting a number larger than 2 or 3 . You're going to be successful a lot of the time. A variant may make it go up to a 4-6. Still not likely but the odds are worse. If you're not vaccinated and you're challenged by COVID you're probably going to have to roll a 17 or 18 or higher.

Every time you make an interaction you are rolling the dice. If you're wearing an N95 mask and vaccinated your saving throw goes down to 1. Only rolling a 1 on a 20 sided dice might get you infected. If you're out at a crowded restaurant, no mask, dozens of people around? You're still going to have to roll a 3 or less to get infected but because you're rolling the dice a ridiculous number of times you're probably eventually going to roll a 1, 2, or 3.

Our job as individuals is to make sure we have the largest number of winning numbers through vaccination and masking while rolling the fewest number of times by budgeting our social interactions.
posted by Your Childhood Pet Rock at 10:16 AM on December 10, 2021 [163 favorites]

^ I am not sure how scientific the DnD analogy is, but it works for me
posted by elkevelvet at 10:19 AM on December 10, 2021 [18 favorites]

Get that booster, yo.
posted by Going To Maine at 10:20 AM on December 10, 2021 [11 favorites]

hahah after having been un(der)employed for most of the year I have one (and possibly a second) new job. wooo. gonna milk this hard as a reason to be 100% remote. gonna stay home like a turtle in the winter. just me and my cats and some books (ok my husband too, hopefully he'll be onboard with this personal shutdown. oy...)

stay safe all, it wouldn't be the same Metafilter without you.
posted by supermedusa at 10:27 AM on December 10, 2021 [10 favorites]

"Why do boosters of the same vaccine increase effectiveness even against variants?"

Because your immune system never stops creating potential antibodies while exposed to an antigen. Every antibody that every person ever creates is slightly different. There's somewhere around quintillions of possible antibody combinations and your body is basically trying billions of them per day against every antigen (bad thing) it finds in your body. If it picks up a match, it clones the cell that has the match and stores a copy of it for use against that antigen.

When you get a booster dose your body is trying a whole new heap of random antibodies against the antigen. These antibodies all have different affinities towards certain parts of the antigen. The more you have on file, the bigger the chance of a slightly different antibody working way better against a variant that may have slightly different geometry in places. So the law of large numbers works in your favour.

Why don't we boost regularly? Because it sucks and because it doesn't necessarily increase effectiveness against antigens that are very similar to the original. Vaccines have an adjuvant in them which basically triggers the immune system which is why you might feel like complete shit 24-48 hours after the shot. Your body literally does think its sick and symptoms are your body's response to an attack, not the result of the antigen. We have to balance effectiveness against the real need for it against our ability to produce vaccines against the temporary and minor effects on us.
posted by Your Childhood Pet Rock at 10:29 AM on December 10, 2021 [38 favorites]

@Your_Childhood_Pet_Rock Every time you make an interaction you are rolling the dice. If you're wearing an N95 mask and vaccinated your saving throw goes down to 1.

That second link shares a number of studies that seem to indicate that many of the modifiers you mention: vaccination, masks, boosters--aren't as effective at shaping our die rolls as we think. One excerpt:

In Israel a nosocomial outbreak was reported involving 16 healthcare workers, 23 exposed patients and two family members. The source was a fully vaccinated COVID-19 patient. The vaccination rate was 96.2% among all exposed individuals (151 healthcare workers and 97 patients). Fourteen fully vaccinated patients became severely ill or died, the two unvaccinated patients developed mild disease [[4]].

The Omicron variant can likely outcompete Delta — and that could worsen the U.S. Covid-19 epidemic

Two jabs much less protective against Omicron infection, UK data shows. "a Pfizer booster jab raised the level of protection against both Omicron and Delta, providing about 70-75% protection against symptomatic infection with the former."

A sketch to explain how a new variant may appear milder even with no change in underlying virulence.
posted by BungaDunga at 10:38 AM on December 10, 2021 [6 favorites]

That second link shares a number of studies that seem to indicate that many of the modifiers you mention: vaccination, masks, boosters--aren't as effective at shaping our die rolls as we think. One excerpt:

That's one of the problems with respiratory diseases with infected close family contacts though. Intramuscular immunization is great for generating humoral immunity, not as great at mucosal immunity. Part of the body's immune system is all the snot and mucus that your body generates on the inside. It traps virions and your body regularly expels it either into the atmosphere as a cough or drains out of your sinuses into your throat where you swallow it and have it destroyed by stomach acid. Mucus contains a lower proportion of a different class of anti-bodies (IgA) which can help neutralize virions as well.

One of ways we get around this is by putting the antigen in places where mucosal immunity can generate. The FluMist flu vaccine does this by delivering a live attenuated flu virus straight to your nose where it directly challenges the mucosal immune system. Scientists are working on a similar sort of vaccine for COVID where it might be able to generate better mucosal immunity and provide a better barrier to infection in the first place without possibly waiting for infection to reach the humoral immune system which clears the infection quickly but doesn't necessarily stop an infection in the first place.
posted by Your Childhood Pet Rock at 10:43 AM on December 10, 2021 [32 favorites]

mecran01 I think we're talking about people who are already patients, many of whom are presumably already at higher risk. Neither the vaccine nor the virus is magic. This isn't trolling OR fringe cases, but something that is bound to happen in this context. We're just still not sure how often it's *likely* to happen, which is why this FPP is news - it's starting to seem more likely, possibly because of this variant.

We're gonna have breakthroughs. I personally had a breakthrough recently. Didn't get super-sick, but still feeling it. But I'm a fit person in my early forties with no other complications.
posted by aspersioncast at 10:45 AM on December 10, 2021 [4 favorites]

Are these fringe cases that statistically don't matter? I just don't know what to make of this list of seeming outliers.

Israel had one of the earliest and fastest rollouts of the vaccine, beginning almost a year ago in December 2020. We know that the Pfizer and Moderna vaccines lose a significant part of their effectiveness after 9 months. These outbreaks among vaccinated people are to be expected now and are the reason we need the booster in the first place.
posted by fuzz at 10:51 AM on December 10, 2021 [3 favorites]

Best possible case is that Omicron doesn't actually fuck people up worth worrying about, and acts as an informal self-spreading vax that's at least somewhat protective against the other strains...

Yeah nah, who am I kidding, this is 2021.
posted by flabdablet at 10:52 AM on December 10, 2021 [11 favorites]

I mean, is the writer of that letter engaging in high level professional trolling? Are these fringe cases that statistically don't matter?

It's probably not fringe but that doesn't mean it's meaningful or needed to report. First of all, the people are already in the hospital for something and got a second infection (what a nosocomial outbreak means) so they already have weakened immune systems. So it's not applicable to the general population.

Also the reporter was just throwing numbers all over the place, but the best I can guess 248 was the exposed population, 48 got sick, 14 got really sick or died (REPORTERS never combine these two! They are not the same thing. What the hell!!!) and the 2 unvaccinated is a useless aside considering 29 were sick with the nosocomial virus and had no covid symptoms worth reporting.
posted by The_Vegetables at 10:55 AM on December 10, 2021 [2 favorites]

I don't like this decade anymore, I want to go home.
posted by JanetLand at 11:19 AM on December 10, 2021 [31 favorites]

Bonus fun: at home kits don't require reporting like clinic/diagnostic setting tests do so we may be undercounting cases. Maybe by a little, maybe by a shitload.
posted by Slackermagee at 11:27 AM on December 10, 2021 [2 favorites]

From the article: "Vaccines and previous infections can blunt the virus’s worst effects. Even if protection against infection is eroded, which experts expect, given Omicron’s heavily mutated spike protein, protection against severe disease and death should be more durable. Hospitalizations, rather than cases, might be a better measure of the virus’s impact,..."

Everything we already know about COVID applies to Omicron: mask indoors, avoid large indoor groups, get boosters, fight like hell to vaccinate the rest of the planet and stop letting pharma companies profiteer while variants flourish!

I think we can expect boosters annually, probably eventually combined with annual flu shots, that include updates for current mutations of circulating corona viruses.
posted by latkes at 11:34 AM on December 10, 2021 [1 favorite]

flabdablet, honestly you are echoing my sentiments exactly. Masking/distancing and sensible precautions yes but maybe Omicron will do what we have not been able to do (at least in the US): have at least 70-80%% of the population either vaccinated or recovered from a natural infection. As someone who had COVID in the beginning, then got boostered a year later with vaccine, I'm looking out for the evidence is that an additional booster provides any benefit against Omicron.
posted by SinAesthetic at 11:45 AM on December 10, 2021 [1 favorite]

Is it possible to engineer a covid variant that outcompetes all others and is mostly harmless? This would be beautiful because the anti vaxxers would be our allies in spreading it.
posted by night_train at 11:47 AM on December 10, 2021 [3 favorites]

Is it possible to engineer a covid variant that outcompetes all others and is mostly harmless?

The trick is keeping it that way. Viruses are going to do what viruses do.

I'm hopeful about Omicron. It seems to be trending the way we'd hope, higher transmissibility, fewer symptoms, eventually fading into the background the way the Spanish Flu went and these things tend to do. The best case if you're a virus is being highly transmissible and not wrecking the host to the point that they can't spread you.
posted by mikesch at 12:03 PM on December 10, 2021 [4 favorites]

The "weaker Omicron" evidence is still very tentative. If it's spreading in a population that has already had loads of Delta (eg South Africa), it may look weak when it isn't, and since it can spread effectively between vaccinated/recovered people, it will find the vulnerable people much better than Delta can.

It's probably not more deadly than Delta on a per-person-infected basis but there's reason to think that it could sicken a lot of people.
posted by BungaDunga at 12:15 PM on December 10, 2021 [9 favorites]

If you want to keep up with the news on Omicron, you need to follow Zvi Mowshowitz. His latest update (from yesterday). tl;dr: if you're not worried about Omicron, you should be; if you are, you're probably not worried enough.
posted by verstegan at 12:20 PM on December 10, 2021 [5 favorites]

This better not be like the game Plague Inc., where after infecting everyone in the world you spend all your saved mutation points on something like 'organ liquification'.
posted by meowzilla at 12:21 PM on December 10, 2021 [14 favorites]

The best case if you're a virus is being highly transmissible and not wrecking the host to the point that they can't spread you.

A lot of people have said something along these lines over the last couple years, but the reality is that people take a long time to die of Covid, leaving plenty of time for the virus to spread to new hosts (actually the spread is mostly very early in the disease). There doesn't appear to be any selection pressure on coronavirus to becomes less virulent. It has likely successfully spread to other hosts by the time the serious consequences come into play, so from an evolutionary point of view, eventually severity doesn't really matter. The virus has moved on.

We may get fewer symptoms because we already have immunity through vaccination or prior infection (which may be what is happening in South Africa). That might be a good thing, but the big open question here is long Covid. If long Covid continues to leave a significant number of the infected with Omicron disabled, then this may end up being a very bad thing. Highly transmissible plus mild disease so we don't take strong measures against it would be a huge disaster if long Covid rates are similar to previous variants.

We don't have any direct evidence yet, of course, but we have seen significant long Covid from people who have been reinfected with other variants and we have seen significant long Covid in people with mild disease, so until we see evidence otherwise, we should probably assume Omicron will be the same. That means stronger measures immediately.
posted by ssg at 12:46 PM on December 10, 2021 [19 favorites]

I mean, is the writer of that letter engaging in high level professional trolling? Are these fringe cases that statistically don't matter? I just don't know what to make of this list of seeming outliers. I am asking this in good faith, not slyly suggesting that nothing we do matters.

I think the D&D metaphor is a great one here. In the same way that vaccination, masks and boosters add armour and reduce the number you need to roll to get infected, other factors that we have long known about like contact time and level of health reduce your armour and increase the roll you need to get infected.

This Israeli outbreak took place when a COVID-19 positive patient with three roommates wound up getting dialysis in hospital. This is a procedure where you are hooked up to a machine for a shift of around four hours or so, in this case the index patient (patient 0) was in the dialysis room with other patients for hours multiple times before they were identified as COVID-19 positive and moved to the appropriate ward. (In my experience, dialysis is like shiftwork and mostly the same people are in the clinic every time). So the exposure time was high; longer than even the most avant-garde tasting meal at a restaurant for the dialysis patients, and overnight for the roommates.

It's clear from the incident that health care workers (all healthy enough to work, all in their 20s-40s) had a lower risk than the hospital patients (obviously all sick enough to be in a hospital). If they were rolling a 20 sided dice, the health care workers had to roll a 2 or below and the patients had to roll a 5 or below to get sick. Which is a big difference.

And then, on the severity side, the health care workers had nobody get seriously sick (they don't say what proportion is asymptomatic vs. mild), while the patients had more serious than mild cases. Amongst the patients who were infected, it was an older population with other comorbidities, including 1/3 immunocompromised. Of the infected patients, for the ones under 70, if they rolled a 9 or below it was severe; for the ones 70 and up, if they rolled a 14 or below it was severe, and a 6 or below, they died.

And the final element is that because Israel was fast at vaccination, this was a population that had been vaccinated a long time ago and had no boosters; the median time since vaccination for infected people was about 180 days. (Surgical masks - not N95 respirators - were 'encouraged' amongst patients, but I'm willing to assume high compliance.)

So the things that have always helped still help; the problem is that 100% safe doesn't exist and never will again, and we have to get used to thinking about things that are in that unhappy realm between 0 and 100%. If vaccines reduced the number you needed to roll below to a 2, maybe with a new variant it's now a 5, and if you don't accept that and want your roll back down to a 2 you need to do other things that also reduce your roll; better masks, less time, more airflow -- or less activity (and fewer rolls). That sucks, but it's a problem of degree; the mistake was ever thinking that it was a 0.
posted by Superilla at 12:51 PM on December 10, 2021 [15 favorites]

Going To Maine: Get that booster, yo.

I will, yo. As soon as I can, which is not going to be this year. It's not like I don't want to...
posted by Too-Ticky at 12:57 PM on December 10, 2021 [2 favorites]

Is it possible to engineer a covid variant that outcompetes all others and is mostly harmless?

Just reinventing the idea of a vaccine again - but a vaccine's not contagious precisely so you can control who receives it. Even if you could engineer a contagious harmless virus, people can still be reinfected; immunity is not binary.

the problem is that 100% safe doesn't exist and never will again

I have the hardest time thinking around this. Boostered, I still don't feel like I should be eating in restaurants, traveling on planes, or doing anything in public mask-free, but I see others doing these things (especially those saying "we're all vaccinated here"). So to get back to "normal", how do I need to change my thinking? Some are just ignoring the risk; I can't join them in unknowing what I know. But do I just need to knowingly accept inevitable infection, or is there actually a data marker to wait for? Two years in I still don't read anyone respectable talking about how to responsibly live a non-cloistered life; who should I be listening to?
posted by radagast at 1:12 PM on December 10, 2021 [20 favorites]

Has anyone checked on Madagascar lately?
posted by TheWhiteSkull at 1:18 PM on December 10, 2021 [6 favorites]

> if you're not worried about Omicron, you should be; if you are, you're probably not worried enough.

super useful information!
posted by glonous keming at 1:24 PM on December 10, 2021 [13 favorites]

So the things that have always helped still help; the problem is that 100% safe doesn't exist and never will again.

Well I mean technically it never existed but it's more a case of being able to go out and believing one's chances of not coming home are infinitesimally small.

I have the hardest time thinking around this. Boostered, I still don't feel like I should be eating in restaurants, traveling on planes, or doing anything in public mask-free, but I see others doing these things (especially those saying "we're all vaccinated here"). So to get back to "normal", how do I need to change my thinking? Some are just ignoring the risk; I can't join them in unknowing what I know. But do I just need to knowingly accept inevitable infection, or is there actually a data marker to wait for? Two years in I still don't read anyone respectable talking about how to responsibly live a non-cloistered life; who should I be listening to?

Ignorance/denial is bliss up until the point you're about to be sedated and put onto a vent wishing you had just gotten the damn vaccine and worn a mask. At this point the pandemic is still ongoing. There's no reason to even try to get back to "normal" right now. Nobody should be even trying for "normal" but the population is just so pandemic fatigued. Sadly, it's the ones that have the least to lose demanding that the most vulnerable cater to their every fucking social whim.

Healthcare workers already have their hands full having the last of the unvaccinated along with the breakthroughs coming through as winter becomes a never ending series of super spreader events. ICUs may not look full on a lot of the charts but a lot of those charts are calculating the availability of ICU beds based on staffing levels of this time last year. ICUs have gotten smaller and contracted over the past year through attenuation of staff from death and burnout. Just up my neck of the woods, NH and MA are out of beds. Most of the midwest is probably going to be running out if they haven't already.

Shit is hitting the fan all over again. If we want to keep people safe, especially those who can't avoid being exposed due to the government's disgraceful attitude of forcing people into harm's way to maintain the essentials of life, we need to minimize the amount we put them in jeopardy by being responsible with our social budgets. Every dice roll you don't give the virus is one chain of transmission you might have just stopped.
posted by Your Childhood Pet Rock at 1:37 PM on December 10, 2021 [16 favorites]

With the various anecdotal claims that omicron causes less severe disease, something I haven't seen considered is how rapid exponential spread can affect the sampling. If it takes about a week for symptoms to develop, but the spread is exponential with a doubling time of 2-3 days, then at any given time the overwhelming majority of people who have the disease will be in the pre-symptomatic phase. This could give the impression that the virus is less virulent than it actually is. By most accounts omicron is spreading exponentially and at a higher rate than previous variants, and the more rapid the spread, the more the average is weighted towards the recently infected.

I really hope that the claims that omicron causes less serious illness do bear out, but after all of the wishful thinking I've seen people engage in throughout the pandemic, it's getting hard to take optimism seriously.
posted by swr at 1:38 PM on December 10, 2021 [4 favorites]

So to get back to "normal", how do I need to change my thinking? Some are just ignoring the risk; I can't join them in unknowing what I know. But do I just need to knowingly accept inevitable infection, or is there actually a data marker to wait for? Two years in I still don't read anyone respectable talking about how to responsibly live a non-cloistered life; who should I be listening to?

I have a good friend who works in MedicalWorld and we've been talking about this. Here in the US, we don't have effective surveillance and there's not much appetite for strong nonmedical interventions at this point. The emerging consensus is that COVID vaccines are a three-dose series. Those of us who are there have the best level of protection we're gonna get for a while, and that level of protection is looking generally solid.

I know for myself that I've been quite reluctant to eat indoors, go back to the office, etc., not only because I was concerned about my own risk, but because I have very strong feelings about the fools who were doing this stuff when it was a seriously bad idea. The social dynamics are a big deal. The Cult of Forced Normality was, and remains, deeply unnerving. I'm still masking in stores and will as long as the staff are required to do so, because as another friend said, "Going in a store without a mask when the staff are required to wear them is some Downton Abbey shit."

We've seen a stunning range of systemic failures all around us - and yes, this is sadly a preview of the main attraction, climate change. All of it makes me angry, and it makes me terribly sad.

IANYD, and everyone needs to weigh their own risks. But we are living through a collective trauma event, and the balance of risk needs to account for our full range of needs as social animals. I know that I still need hugs, and I still need to laugh. I know that I'm going to die one day of something. I also know I was routinely riding trains into Penn Station in NYC pre-COVID during flu season with no mask and no vaccine.

This week I went back into the office in NYC for the first time since Before. I also dined indoors, in a place that was checking vax cards. It all felt super weird. But I'm slowly edging back into public life, because real talk, at this point in the US I'm already taking on COVID exposure risk on a constant basis even if I try to stay at home and follow the rules. I might as well claw back a little bit of mental health in the bargain.
posted by sockshaveholes at 1:52 PM on December 10, 2021 [31 favorites]

But do I just need to knowingly accept inevitable infection, or is there actually a data marker to wait for? Two years in I still don't read anyone respectable talking about how to responsibly live a non-cloistered life; who should I be listening to?

We essentially just keep asking this question over and over but the answer never changes: we don't know. Nobody knows! A "responsible" non-cloistered life depends on your definition of "Responsible." A lot of folks on MeFi would say that no such thing exists. (A smaller group would say it will never exist again, but...there's no more data for that than for anything else.) It also depends on who you consider "respectable," because a lot of those sources will be HIGHLY motivated to make the most conservative prescriptions possible, but that doesn't mean those prescriptions are the only ones or the only effective ones.

I will say that as someone who eats in restaurants and gathers with others, but wears masks religiously where recommended, my thinking goes:

So long as
1) I am vanishingly unlikely to occupy a hospital bed needed by someone else (so far, still good)
2) those beds still exist for the statistically unlikely case that I DO (again, so far, still good)
3) I remain able to minimize my contact with others, especially those with immune suppression or comorbidities, should I begin to have ANY symptoms or should one of my MANY and FREQUENT tests turn up positive
4) I have people able to pick up my essential responsibilities should I fall ill

...Then I have a risk budget to do the things that are critical to my well-being, even if they contain a potential risk of a covid infection. I do not do as many things, or as often; I do not see as many people, or spend as much time indoors. But to be blunt: It makes no sense for me to avoid COVID so hard that I die of suicide, and that was a real risk for me last year. Some mefites have made it clear to me that they disagree with this set of priorities, as is their right.

So those are my data markers: hospital beds, time since shots/boosters. Right now Omicron may mean a change to those data markers that requires me to scale back even further. If it becomes, as it was in unvaxxed April 2020, clear that anything short of full lockdown is a public menace, then so be it. But that is far from clear right now.
posted by We put our faith in Blast Hardcheese at 1:57 PM on December 10, 2021 [24 favorites]

It seems to be trending the way we'd hope, higher transmissibility, fewer symptoms, eventually fading into the background the way the Spanish Flu went and these things tend to do. The best case if you're a virus is being highly transmissible and not wrecking the host to the point that they can't spread you.

As I noted on a previous thread, the idea that this is simply "what [diseases] tend to do" is comforting, but not really that accurate. Additionally, to the extent that there can be selective pressures against lethality or severe disease, SARS-CoV-2 actually not likely to be subject to many of them. It's not very lethal in the big picture (it's no Black Death or Ebola or Marburg), so it's not really majorly culling the population of potential hosts. Unlike smallpox or polio, it has other escape routes - it's readily transmissible to and from non-human species, which means that it has a much bigger population of potential hosts than you're imagining, hosts in which human-specific aspects of lethality are irrelevant (and SARS-CoV-2 may pick up mutations in non-human hosts that affect how it behaves when it jumps back into humans in unpredictable ways.) Unlike diseases like cholera or Ebola, transmission, symptomaticity, and death are not at all tightly connected in SARS-CoV-2. Since most transmission is probably when infected people are just pre- or post-symptomatic, and most deaths are weeks later, those eventual deaths don't really affect the likelihood that SARS-CoV-2 gets passed on. And a bunch of the diseases I just mentioned remain more virulent than SARS-CoV-2, despite potentially being more subject to some of these potential selective pressures than SARS-CoV-2. A twitter thread from Carl Bergstrom goes into this a bit and has some helpful linked papers as well.

And as ssg points out, the connection between virulence and long Covid is unclear.

There are additionally three really big caveats for the "fewer symptoms" reports. One is the younger population in South Africa in general: younger people have milder cases, and so the idiosyncratic population mix where first Omicron spread might not be representative (even within South Africa, let alone globally), and there may be a lag before it spreads widely enough to hit more vulnerable portions of the population. Second, there's often a time lag between the first positive test or symptoms and hospitalization, and we're still pretty early on in that process. Finally, many of the infections are (or are thought to be) breakthrough infections in people who were vaccinated or who previously had Covid, which tend to be less severe since the immune system is a bit more prepared, but that doesn't mean that Omicron is less severe in populations that have gotten neither vaccines nor immunity via prior infection. This rough diagram from a biostats professor on twitter might help illustrate how this might make look Omicron milder than it actually is. (On a population level, of course, even if Omicron were milder, increased transmission might more than make up for it in the short term.)

None of this is a guarantee that our worst fears about Omicron will turn out to be true, of course (and let's hope they don't)! But it's unfortunately still premature to make calls on Omicron's severity, and it's wishful thinking to assume SARS-CoV-2 will evolve to be milder because that's what ostensibly normally happens.
posted by ASF Tod und Schwerkraft at 2:10 PM on December 10, 2021 [18 favorites]

It makes no sense for me to avoid COVID so hard that I die of suicide, and that was a real risk for me last year.

Yes. This. I have a full house of young adult children right now whose lives have all been disrupted by COVID pretty profoundly, even though none of them have been infected as far as we know. They're struggling with anxiety and depression and the lingering effects from deep isolation. They all came home not at the start of lockdown, but in the past 3-4 months. This is also affecting my risk calculus - I can't lock them in the house in good conscience. Not in the emotional states they're in. So they're vaxxed and getting boosted, and I'm accepting that they are making young adult choices when they leave the house.
posted by sockshaveholes at 2:12 PM on December 10, 2021 [17 favorites]

you need to follow Zvi Mowshowitz

God I remember when this guy was a professional Magic: The Gathering player.
posted by atoxyl at 2:15 PM on December 10, 2021 [2 favorites]

I mean, is the writer of that letter engaging in high level professional trolling?

Maybe a little bit, if you look him up?

Are these fringe cases that statistically don't matter?

relevant from the point of view of indicating that elderly people vaccinated ~6 months ago can be fairly susceptible to the virus (and that it can spread among younger and healthier vaccinated staff). We know that pretty well at this point, though (the study is from July so at the time this was more important news).

The vaccinated vs. unvaccinated deaths is way too small and specific a sample to be worth much. Especially since one of the unvaccinated mild cases was considerably younger than most of the affected population (although the other was not).
posted by atoxyl at 2:29 PM on December 10, 2021 [1 favorite]

It makes no sense for me to avoid COVID so hard that I die of suicide, and that was a real risk for me last year.

Was talking to a friend with teenagers last week, and apparently teenage attempted suicides have spiked with COVID. Not surprising in retrospect, but not really being reported either. It gave me a lot more sympathy for the "open the schools" crowd earlier this year.
posted by COD at 2:32 PM on December 10, 2021 [9 favorites]

Fuck this shit seriously
posted by moorooka at 3:12 PM on December 10, 2021 [6 favorites]

Get that booster, yo.

I'm in Sweden. They're still slowly boosting over-65s. Once they've done 80% of those, 50-64s get their go. Once 60% of those are done, then and only then my turn can come up. They don't seem to be hurrying, as Sweden's national epidemiological motto seems to be “what, me worry?”

I know people in Germany, Austria and the UK who got boosted last month.
posted by acb at 3:18 PM on December 10, 2021 [4 favorites]

Get that booster, yo.

Mrs. Example's was last week, and mine is tomorrow!
posted by Mr. Bad Example at 3:28 PM on December 10, 2021 [2 favorites]

Getting my booster on Tuesday, Apparently I slipped into a group which is a higher concern, and on Tuesday, in a separate appointment, it may be that someone tells me what it is.

After only knowing a small number of people who got it over 18 months, it has blasted through my dept in the last 2 weeks, with at least 5 people with infection, including my other half. No idea if any of them were Omicron. My SO is nearly better now and after a week & a half of wearing a mask around the house and having the windows wide open and her locking herself in the bedroom I somehow managed to avoid getting a dose myself. It looked pretty nasty up close. She is pretty fit and active and tried to do some light gardening, mostly to get some fresh air really, but had to sit down within 5 minutes.

This week of course we have had the news in the UK, well evidenced, that the Prime Minster was having it large all the way through the Xmas lockdown. Maybe with some minster, almost certainly senior civil servants, possibly some national level journalists, who knows? The party didn't happen, and if it did it obeyed all the rules (or laws as we call them) even though the only pertinent rule/law was: no parties.
posted by biffa at 3:59 PM on December 10, 2021 [2 favorites]

The unfortunate thing about COVID is that it has made me finally take some active steps to go out and do things instead of just sit around mope (a quotidian life of 80% stay home time is bearable if not great, but 99% stay home time is intolerable), and now it seems like it’s about to force us all back home. I was this close to having a regular board game thing!
posted by Going To Maine at 4:25 PM on December 10, 2021 [3 favorites]

Thank you all for the additional links. The link to Zvi Mowshowitz was super. As above, I wish there was some solid advice about how to live a life in what is likely to be long term dealing with COVID and the inevitable variants. I have traveled in the past two months and what I've done is quarantine for a week before traveling, get a rapid test before getting on the plane and then quarantine for five days after getting home and wear a mask at all times when out and about everywhere. I'm vaxxed and boosted too but I don't know, it still feels like this is still a shake of the dice.
posted by bluesky43 at 4:55 PM on December 10, 2021 [1 favorite]

This is what the whole decade is going to be like without a rapid vaccination program for the entire world. China recently pledged to provide 2 billion doses to the developing world, nowhere near the 11 billion required, but still ten times more than the 200 million pledged by the Biden Administration. This needs to change big-time if getting “back to normal” is ever even remotely going to be a thing.
posted by moorooka at 4:58 PM on December 10, 2021 [12 favorites]

Covax was supposed to deliver 2 billion doses this year and is on track for half that; Biden has pledged 1.1 billion doses.
posted by BungaDunga at 5:28 PM on December 10, 2021 [8 favorites]

Kind of wonder how many variants we'll get to before there is a global small-pox style eradication response (if ever) ? Seriously, force pharma companies to release the IP and get some generics going and mass-vaccinate globally. #peoplesvaccine
posted by phigmov at 5:34 PM on December 10, 2021 [2 favorites]

Moderna has about 2000 employees, I think it would be fair to give each of them a $10,000,000 payout (=20 billion total) and then just release all their patents into the public domain.
posted by Pyry at 5:36 PM on December 10, 2021 [6 favorites]

you need to follow Zvi Mowshowitz

>God I remember when this guy was a professional Magic: The Gathering player.

I just looked at his About page expecting to see "epidemiologist" or something relevant and see

The author, Zvi Mowshowitz is a member of the Magic: The Gathering Hall of Fame and has written extensively about the game and its strategies. He’s been heavily involved with rationality for a long time. He’s also been a professional trader and market maker, in both traditional and non-traditional markets, and was CEO of the personalized medical startup MetaMed.

Posts on this site are automatically also published at Less Wrong [...]

So ymmv.
posted by trig at 5:41 PM on December 10, 2021 [18 favorites]

My partner is immunocompromised and works in health care. We are both fully vaccinated -- I got the booster just before Thanksgiving and she got a third full dose a week earlier. At this point, I'm just trying to stop looking forward to things like eating in restaurants or going out to a bar to play pinball again -- it just isn't looking safe enough for us for the forseeable future. I have tickets to a concert next year (purchased nearly 2 years ago, now, for a show that was originally scheduled for last year). I don't expect to attend. We go to places that require masking -- like we visit shops sometimes when I take a day off work, so we can avoid weekend crowds. But restaurants and bars don't seem at all doable. While I generally don't need much socialization and often prefer being at home over anywhere else, I am starting to miss eating a meal that I don't have to clean up after. And pinball.
posted by The Great Big Mulp at 5:41 PM on December 10, 2021 [4 favorites]

They're insisting on vax plus booster and masks

My experience has been that "insisting on masks" translates to "some 50% of masks will be worn below the nose and nobody will be enforcing anything".
posted by trig at 5:48 PM on December 10, 2021 [26 favorites]

CEO of the personalized medical startup MetaMed.

Oh wait, he was involved with MetaMed? The company who spun off from the Roko's Basilisk cult with initial funding from Peter Thiel under the premise that "People trained in the 1 in 3,000 skill of Rationality are better-equipped to sort through medical research than anybody else, so let's charge wealthy people enough to make them feel like they're getting personal care", but couldn't make it work?

He might have moved away from "people don't actually want to be treated by doctors, they just want the ritual of being treated by doctors" in intervening years, but there's been enough "if I use my superior intellect & Rationality then I can derive the world from first principles without being tainted by the common opinion" self-defined experts on the topic for my tastes.
posted by CrystalDave at 6:05 PM on December 10, 2021 [18 favorites]

My experience has been that "insisting on masks" translates to "some 50% of masks will be worn below the nose and nobody will be enforcing anything".

Do you work in a middle school, too?
posted by Big Al 8000 at 6:24 PM on December 10, 2021 [6 favorites]

The DnD metaphor isn't just mathematically sound, it helps with personal motivation. It helps you to keep each opportunity to practice an intervention separate in your mind, which is more motivating than a binary decision.
posted by lastobelus at 6:27 PM on December 10, 2021 [4 favorites]

Do you work in a middle school, too?

Hah, I admire your optimism about adults.
posted by trig at 6:34 PM on December 10, 2021 [8 favorites]

Mods, you can take this out, but I'm thinking seriously about going to Worldcon next week. They're insisting on vax plus booster and masks, and I'm not sure that going is much more dangerous than being in Philadelphia. Still, maybe the risk is higher than I think.

UKHSA has just released data on vaccine effectiveness against symptomatic Omicron infection. 2 dose vaccination is ~30% effective and 3 dose vaccination is ~75% effective. Protection against asymptomatic infection is going to be somewhat worse. This is early data, but it lines up roughly with where you'd expect given the in vitro studies.

If Worldcon is insisting on boosters, they're making the correct decision, but there's still going to be a significant number of people catching Omicron at the con itself unless the ventilation is good and effective (N95 type) mask use is consistently enforced.

The real problem is the people who go to a giant convention in the middle of an Omicron surge are a self selecting group with a high risk tolerance. These people are definitely going to be meeting up for dinner and karaoke and all kinds of risky activities outside the con. That is where the tidal wave of infections is going to come from.
posted by zymil at 6:51 PM on December 10, 2021 [26 favorites]

So to get back to "normal", how do I need to change my thinking?

If you're not back to "normal," now is probably not the time to bother to try to do that. But in my case, well, I literally have to stay out in the world for work now even if I quit all of my activities and lock myself up again for the rest of my life. It's kinda like "what's the point" when I can't actually cloister again.

Some are just ignoring the risk; I can't join them in unknowing what I know. But do I just need to knowingly accept inevitable infection,

Yes. I think with Omicron, we're all going to catch it now.

or is there actually a data marker to wait for?

Hahahaha, nobody knows.

Two years in I still don't read anyone respectable talking about how to responsibly live a non-cloistered life; who should I be listening to?

I wish there was some solid advice about how to live a life in what is likely to be long term dealing with COVID and the inevitable variants.

Nobody knows, probably not even Fauci, who would be my best guess. But in practice, it boils down to "wear masks around humans whenever possible and try to do things outside as much as you can and get your shots." "Social distancing" is something literally nobody is doing any more, so that one's out the window. Do whatever you like as long as you have a mask on around other humans. Preferably as good as you can get of one or layer them.

But I'm slowly edging back into public life, because real talk, at this point in the US I'm already taking on COVID exposure risk on a constant basis even if I try to stay at home and follow the rules. I might as well claw back a little bit of mental health in the bargain.

Yeah, THIS.
posted by jenfullmoon at 9:29 PM on December 10, 2021

My experience has been that "insisting on masks" translates to "some 50% of masks will be worn below the nose and nobody will be enforcing anything"

I literally work in a covid lab, and we cannot get staff to consistently wear masks correctly in the fucking labs with live covid, nevermind around site generally. If you've got half of people at least dicknosing rather than just fucking the mask off in the general public with no enforcement, you're doing well.
posted by Dysk at 9:36 PM on December 10, 2021 [30 favorites]

I mentioned the Lancet letter over dinner today and one question I now have is, would the infectivity of vaccinated cases have to do with the observation that SARS-CoV-2 has a significant pre-symptomatic shedding phase, so very lay-intuitively if the virus tends to multiply and transmit before the innate immune responses and/or vaccine-produced cell-mediated responses (T cells) have time to ramp up, then that trait would be the overall mechanism for transmission amongst vaccinated people. Because the letter's point isn't based on anything special about Omicron, it's about reading the studies of all the prior variants which may or may not point to lack of comprehensive epidemiological data about vaccinated transmission.
posted by polymodus at 9:49 PM on December 10, 2021 [2 favorites]

I literally work in a covid lab, and we cannot get staff to consistently wear masks correctly in the fucking labs with live covid, nevermind around site generally.

I'm not sure whether this should make me feel less angry towards the people I see with their noses out on public transport/in shops, etc, or even more mind-boggled as to why some people can't (or refuse to) get this most basic and simple thing right. Dysk, do you have any idea why these staff members aren't consistently masking properly?
posted by mydonkeybenjamin at 11:33 PM on December 10, 2021 [4 favorites]

Here in London 30% of reported cases are the Omicron variant. So I guess we'll know in a few weeks how bad it gets.

I agree that talking about "fear" kind of buys into reactionary and anti-vax rhetoric. We should take measures to protect the elderly and the vulnerable even if we're low risk ourselves. It's not about fear: in reality we're the ones who are the protectors, the guardians, of our community.
posted by TheophileEscargot at 11:41 PM on December 10, 2021 [3 favorites]

So many of these MetaFilter COVID threads seem to offer yet another new 'expert' and their views on the latest news. I prefer to stick with credentialed, experienced medical experts who have consistently proven to be astute over these past two years. One good place to start is reading the insights and advice of chair of the UCSF Dept. of Medicine, Dr. Bob Wachter, and the clinical medicine and epidemiology experts he retweets.
posted by PhineasGage at 11:41 PM on December 10, 2021 [17 favorites]

The unintentional side effect of everyone else taking less precautions than you: if it's as bad as they claim, you're going to see it hit everyone else first. Of course, the past two years have shown that people are good at denying that they're just like everyone else, and also they have short memories.
posted by meowzilla at 12:45 AM on December 11, 2021 [3 favorites]

My experience has been that "insisting on masks" translates to "some 50% of masks will be worn below the nose and nobody will be enforcing anything"

Ah around here we call that "NYPD style."

Haven't seen a cop correctly wearing a mask yet in NYC, even on subway trains. It's like they are walking around giving the middle finger -- with their noses -- to the public. As usual.

But hey 9/11 nevah forget.
posted by spitbull at 3:48 AM on December 11, 2021 [10 favorites]

When you get a booster dose your body is trying a whole new heap of random antibodies against the antigen. These antibodies all have different affinities towards certain parts of the antigen. The more you have on file, the bigger the chance of a slightly different antibody working way better against a variant that may have slightly different geometry in places.

Exactly. One analogy is that a virus is like a book that's been published in various editions with different edits and different covers. Your immune system isn't trying to do a Ctrl-F on the whole book letter for letter - with each vaccination or infection it just builds up the stock of paragraphs it remembers so it can use them in the future.
posted by kersplunk at 5:44 AM on December 11, 2021 [2 favorites]

in areas in which vaccines and boosters are easily available--a big caveat for sure--the risk to public health from covid to the best of my understanding is in the same ballpark as other dangerous daily activities like driving or smoking

This isn't remotely accurate. In the last month, covid has been killing way, way more people than driving, even if you just count direct deaths from covid.
posted by GCU Sweet and Full of Grace at 6:15 AM on December 11, 2021 [17 favorites]

In the UK about 5 people per day die in car accidents. About 120 per day are dying of COVID.
posted by TheophileEscargot at 6:55 AM on December 11, 2021 [24 favorites]

OK I've spent a day meditating and thinking about this part of this comment:

I will say that as someone who eats in restaurants and gathers with others, but wears masks religiously where recommended, my thinking goes:

So long as
1) I am vanishingly unlikely to occupy a hospital bed needed by someone else (so far, still good)
2) those beds still exist for the statistically unlikely case that I DO (again, so far, still good)
3) I remain able to minimize my contact with others, especially those with immune suppression or comorbidities, should I begin to have ANY symptoms or should one of my MANY and FREQUENT tests turn up positive
4) I have people able to pick up my essential responsibilities should I fall ill

And I'm trying to think of how to say this in a way that's going to be the least offensive and accusatory and I'm struggling so bear with me.

Not one single person in the COVID ward got up one morning and thought "you know, I'm high risk and there's ICU beds available so today I'm going to go out and probably get COVID". I can guarantee every person on that ward thought their chances were vanishingly small, they may have considered that beds were still available if they were super considerate, but I can guarantee that none of them thought they would actually get it and that they'd end up in the ICU.

Now as far as behaviors go, short of wandering into a COVID ward with no PPE, dining in a public place is probably one of the biggest risks an individual can take in regards to COVID, vaccinated or not. We have the data. The two biggest super spreaders of COVID were gyms and restaurants. Gyms can be mitigated but there's still a lot of VO2 activity which propels virions from unmasked people through the air. Restaurants on the other hand involve 45 minutes to two hours unmasked with people in other parties of unknown infection status around oneself in a probably enclosed area with unknown air circulation quality. It's Normandy but the beachhead is one's upper respiratory system and the virions are the hundreds of thousands of allied troops coming in for D-Day. How long can an upper respiratory system survive that onslaught? Who knows. One only gets to find out a few days to two weeks later. In terms of risk budgeting it's like if I was budgeting how to use my frequent flyer miles and I spent the bulk of them on a kamikaze flight into the deck of a US Navy ship.

Get takeout, stay masked while one gets in and out of the restaurant in five minutes, take it home, and enjoy it with friends there. You won't get overcharged on the wine either.
posted by Your Childhood Pet Rock at 7:48 AM on December 11, 2021 [18 favorites]

in areas in which vaccines and boosters are easily available--a big caveat for sure--the risk to public health from covid to the best of my understanding is in the same ballpark as other dangerous daily activities like driving or smoking- and yes those activities, like a virus, affect 3rd parties too. and of course these activities, also like spreading covid, are more likely to harm some groups than others.

I think we've seen that this is wrong but -

It's hard to tell from your comment what it is that you consider fearmongering. In my area, Toronto, case counts are rising but I would say up to this point, your assessment has been correct enough in that my kids can go to school and I can go to work in my public-including role and the risks of doing that are low enough to outweigh the benefits.

However, we're doing those things, as vaccinated as we can get (here in Ontario my child just was eligible for his first shot and has to wait for his second) in public health-mandated masked environments with some distancing (not so much in my child's class, and yes, they eat lunch together, and yes, some kids are bad at masks) and cleaning and not going out for indoor dining or going to movies and working out at a gym (and a workplace) where vaccine passports are required. (Although with Omicron, I may stop that activity.)

That's not fear, that's mitigation. The risk is lower in part because of those requirements.

The question is will the new variant require the same, or different, acts of mitigation. Casting a change in response to new information as solely fear is what's created a lot of issues. Wearing a mask is not about fear, it's about risk tolerance. Some of us won't drive without snow tires and some of us will. In some jurisdictions where there's a lot of snow, snow tires are required. No one is yelling at me in the parking lot for fearing snow when I have snow tires on. The challenge in a pandemic is that we impact each other more. But the choices aren't "live in fear" or "accept that you might die." There are so many moments of choice and options in between.

Also just wanted to nth the teen suicide issue - a friend of mine is a ER nurse in a pediatric hospital and has been dealing with this. She says it's not just that the overall numbers skyrocked, it's also that because teens are/were more locked down, by the time they got to the hospital they had tragically either succeeded or caused themselves permanent damage in their suicidal attempts - less suicidal ideation, more actual suicides. Friends aren't bringing their friends in. That's just one tiny (but urgent) area.
posted by warriorqueen at 7:52 AM on December 11, 2021 [12 favorites]

“Social distancing" is something literally nobody is doing any more Gently, of course they are. I wouldn’t want to extrapolate from my region to anyone else’s but social distancing is still very much a thing in many offices and businesses.

Not directed at anyone in particular, but I still find some of the “oh no we’re all going to get it” confusing. Hasn’t it been fairly clear since August that we were all very likely to eventually get some form of COVID? Even at the beginning of the effective mRNA vaccinations most doctors were being very conservative in their effectiveness estimates and we were hoping for a reduction in hospitalization as much as anything else. I know people are tired but especially among my students it’s frustrating to hear so much COVID fatigue translating into nihilism/fatalism. We’re probably all going to get it, but if we keep taking preventative measures fewer of us will be killed or permanently disabled by it. To me that seems worth it.
posted by aspersioncast at 9:07 AM on December 11, 2021 [3 favorites]

Not one single person in the COVID ward got up one morning and thought "you know, I'm high risk and there's ICU beds available so today I'm going to go out and probably get COVID".

I don't understand whether you think I am actually at high risk but stupidly expecting I'm not? I'm a healthy younger person with three shots and no comorbidities; I am not at high risk. My calculus is not predicated on "best way to never ever ever ever ever get COVID." It is predicated on not being a massive public health menace first and not dying of suicide due to isolation second.
posted by We put our faith in Blast Hardcheese at 9:11 AM on December 11, 2021 [13 favorites]

Social distancing" is something literally nobody is doing any more Gently, of course they are. I wouldn’t want to extrapolate from my region to anyone else’s but social distancing is still very much a thing in many offices and businesses.

I think the problem is that "social distancing" is a vague term and also now that we know about how the thing actually spreads, only useful in a small portion of its forms? Like, our stores aren't making people stand 6 feet away anymore and a lot of the plexiglass has come down, but that shit didn't help anyway really -- because touch contact/fomites weren't the primary mode of transmission.

Insofar as social distancing means fewer people in a given place, yes--many places are still limiting capacity and people are still limiting their activities; some offices are still allowing WFH and others are staggering their staff.

Get takeout, stay masked while one gets in and out of the restaurant in five minutes, take it home, and enjoy it with friends there. You won't get overcharged on the wine either.

But half our restaurants stopped doing takeout at all once reopening was allowed, and nobody fits in my home except me. AND the restaurant might have an outdoor space, which my apartment does NOT. Most of my friends are more comfortable gathering on a restaurant patio than in any of our tiny, stuffy, overcrowded homes where we need to be right on top of each other.
posted by We put our faith in Blast Hardcheese at 9:39 AM on December 11, 2021 [7 favorites]

Most of my friends are more comfortable gathering on a restaurant patio than in any of our tiny, stuffy, overcrowded homes where we need to be right on top of each other.

This. My housemates and I are not hugely social people, but in our circle of friends, we are The People With The Big House, so we have become the de facto gathering spot for a lot of social activity. Is this ideal for our own safety? No- and in fact one housemate’s SO got Covid about a week and a half ago and it’s just luck that nobody here caught it from them. But it’s been a social lifeline for everyone so we’re doing it anyway. Harm reduction.
posted by notoriety public at 10:01 AM on December 11, 2021 [2 favorites]

NZ suicide stats took a fair dip during lock-down / covid restrictions. Rates rising in NZ is a conservative canard for lifting restrictions and going back to BAU; usually fairly easily debunked by savvy media here. Obviously different countries/regions will have a different experience.

Having said that, most people have acknowledged the psychological strain associated with restrictions, lock-downs (and managed isolation) + declining social-license to enact the type of restrictions associated with eradication/elimination that worked the first time around in 2020 but have been more of a struggle in 2021 with Delta.
posted by phigmov at 10:59 AM on December 11, 2021 [3 favorites]

dining in a public place is probably one of the biggest risks an individual can take in regards to COVID, vaccinated or not

Part of the problem for me is my partner is bolstered and just…is tired of the restrictions, and won’t take any precautions other than (mostly) wearing a mask. Except at the gym, where he runs. And I just honestly don’t know what to do about it. I have no ability to control him, he’s a grown man. And it’s extra hard with all official guidance trying to reopen the economy rather than keep people safe.
posted by corb at 11:03 AM on December 11, 2021 [4 favorites]

Anyone who's interested in mucosal immunity w/r/t better immune coverage from respiratory diseases, Professor Akiko Iwasaki has put up a really good thread on Twitter regarding the mechanisms of mucosal immunity neatly summarizing the paper her and her colleagues just released.
posted by Your Childhood Pet Rock at 12:20 PM on December 11, 2021 [2 favorites]

I still find some of the “oh no we’re all going to get it” confusing.

I think that people have different ideas of "getting it" means. To them it might mean they are bedridden, hospitalized, or dead.

Even before vaccination, an estimated 50% of infections were completely asymptomatic, you wouldn't know unless you got tested. With vaccines, I would expect that percentage to be higher, but maybe not for the new variants.
posted by meowzilla at 12:35 PM on December 11, 2021 [3 favorites]

On the one hand, my work is limiting to 1-2 people per office regardless of space, everyone has to have masks on and you can only eat alone with the door closed, etc. in the office. On the other hand, all that went OUT THE WINDOW at the holiday party yesterday. I don't see anyone trying to maintain 6 feet of distance from anyone anywhere any more, people are grouped up and congregating as normal again. They have 6 feet in medical facilities and otherwise...not seeing it still going in stores.

I used to think I had a hope of not getting it, but well, look how that's gone.
posted by jenfullmoon at 3:28 PM on December 11, 2021

Kind of wonder how many variants we'll get to before there is a global small-pox style eradication response (if ever) ?

The answer is never, but that’s because Smallpox is weird in that it only infected humans. So once you can cure or vaccinate all the humans it goes away for good. Most diseases aren’t like that and can go back and forth between humans and other at which point eradication is nigh impossible.

Our best hope is that it mutates into something like the other coronaviruses that cause colds but by and large don’t kill as it’s likely here to stay.
posted by jmauro at 4:07 PM on December 11, 2021 [6 favorites]

It really does seem like in the fight against covid, we (not metafilter, obvs) are just collectively giving up. Just after omicron started being detected in the state, with case counts rising, my office just decided to go from 50% capacity and a predictable rotating schedule of work from home, to 100% capacity and a "bank" of time people can use, with managerial permission, to ad-hoc work from home. It's supposed to be used in case you get covid. Then about a day later, the governor announced a mask mandate for all businesses that aren't requiring vaccination, which we aren't. The mandate won't be enforced, because we already are supposed to be wearing one when away from our desks, and no one seems to give a shit about that.

Meanwhile I'm recovering from guillain barre syndrome, and don't yet know if I should get the booster or not. If the booster re-triggers it, that would be bad, I don't want to spend another 5 weeks in a hospital learning to walk again again, but if I got covid and it re-triggered it, I would probably just die.

Of course, I got a note from my doctor to work from home, but HR decided they'd only let me do that for a month, against medical advice. Sigh.
posted by mrgoat at 4:39 PM on December 11, 2021 [3 favorites]

@Nancy Lebovitz
Worldcon . . . insisting on vax plus booster

Discon III attendees must be fully vaccinated (i.e., booster not required) as of Dec 1 (to allow for two weeks for the vaccine to gain full effectiveness.)
posted by billm at 4:55 PM on December 11, 2021

It really does seem like in the fight against covid, we (not metafilter, obvs) are just collectively giving up.

That's what really scares me. We see Omicron coming, we've seen data from multiple countries showing it is a few times more transmissible than Delta and we're just doing ... nothing? Logically, our risk assessments have to change with the higher transmissibility, at all levels from the personal to the national, but I don't really see that happening. Our provincial government here said just a few days ago that they aren't really worried about Omicron, Delta is more of a concern. This seems like it will go quite badly.
posted by ssg at 5:32 PM on December 11, 2021

I think pandemic fatigue has just hit so bad that nobody wants to continue to do harsh things like lockdowns (hello, recall) or enforcing masking (since people get shot if you try that) or well....anything. Covid still has been happening even when harsh things everyone hates have been mandated and it's never gone down low enough for anyone to be pleased with the results, it gets to "substantial" at the lowest, and yet Covid still rages on. At least a good chunk of the US population is absolutely resistant to doing ANYTHING AT ALL about it. We can't win. What the hell else do you do but give up if we need close to 100% compliance and we're lucky to get over 50% about anything and 50/60ish percent IS NOT ENOUGH?

I'm not cool about it either, but we canNOT get everyone on board with saving their own lives or anyone else's. What do you do but give up?
posted by jenfullmoon at 6:29 PM on December 11, 2021 [5 favorites]

This long (on facebook but public) post from an ER doctor in Arlington, VA is worth a read.
posted by gudrun at 6:39 PM on December 11, 2021 [5 favorites]

We see Omicron coming, we've seen data from multiple countries showing it is a few times more transmissible than Delta and we're just doing ... nothing?

They're not doing nothing in New South Wales, they're opening up further. Because apparently the complacent fucks in charge think that having 94.5% of the "eligible" population vaccinated is a number that means something.

Meanwhile, since the first officially recorded case of Omicron in NSW, R_eff in NSW has leapt from around 1 to over 1.5.

Even assuming that Omicron does indeed cause severe disease in a much smaller proportion of cases than Delta, I honestly don't understand how any reasonable person could see exponential growth at that rate going anywhere but hospital overwhelm.

Also, given that Omicron apparently can cause almost no disease in vaccinated people, fewer people are going to believe that their mild scratchy throat or their one-day headache or a bit of fatigue or an ache and pain or two are in fact symptoms of COVID-19, which is going to cause a way lower rate of people presenting for testing; there is therefore likely to be much more Omicron circulating in the community at any time than the raw number of reported cases would suggest. Keep an eye on the test positivity rate in your area, if you can find it reported.
posted by flabdablet at 7:23 PM on December 11, 2021 [2 favorites]

But I think that is the question. If Omicron is more transmissible, especially among the vaccinated, and seems to be less serious, is that a good thing or a bad thing going forward? And I think we still have a week until the data tells us what is really happening.
posted by Windopaene at 8:30 PM on December 11, 2021

It's certainly a less bad thing than e.g. a variant with comparable lethality to Delta and comparable infectiousness to Omicron, but could only be an unambiguously good thing if the rate at which Omicron visited death and destruction on those who acquire it were less than that at which the vaccines do, a prospect that strikes me as wildly unlikely given Omicron's lack of safety and efficacy testing.

At any realistic rate of serious disease per infected capita, an exponentially growing outbreak of almost any highly infectious novel pathogen would bring even a reasonably well designed health system to its knees, let alone the janky patchwork of privatized bureaucracy that passes for a health system in the US.
posted by flabdablet at 9:32 PM on December 11, 2021 [2 favorites]

This isn't remotely accurate. In the last month, covid has been killing way, way more people than driving

that wasn't my point, as i tried to make extra clear at numerous points in the post. is covid killing more vaccinated people than driving? this kind of intentional misunderstanding is the fearmongering i am referring to.
posted by wibari at 9:36 PM on December 11, 2021 [1 favorite]

is covid killing more vaccinated people than driving?

Also, is its death rate per capita among the non-vaccinated higher or lower than that of unlicensed and/or drunk drivers? Because those would seem to be the fair comparisons if what we're after is getting a idea of the consequences of comparably freely chosen risks.
posted by flabdablet at 10:24 PM on December 11, 2021

> is covid killing more vaccinated people than driving?

Yes - COVID is killing roughly 30x more people than MVAs in both the US and UK, while best vaccines are about 90% (certainly <97%, which would be the break-even) effective against death, so even when vaccinated you are more likely to die of COVID than in a vehicular accident at present, although it comes and goes with infection peaks.
posted by memetoclast at 10:45 PM on December 11, 2021

Another useful source of info. is Dr. Katelyn Jetelina's blog.
She has a Masters in Public Health and a Phd in Epidemiology and Biostatistics.

Here is her most recent Omicron post.
posted by gudrun at 6:21 AM on December 12, 2021

The broader problem, wibari, is even if your hypothesis is correct, the full hospitals are impacting other medical availability (and, worldwide, risking more mutations.) So it really is on all of us to mitigate the risk. I still can’t tell if you’re advocating doing some things while taking some basic public health measures, or if you’re advocating a return to “normal” (no masks, distancing, vaccine passports, etc.) for the vaccinated.
posted by warriorqueen at 7:09 AM on December 12, 2021 [1 favorite]

Even reducing the risk to that of driving isn't saying much, driving is hilariously dangerous, a remarkable number of people are reckless drivers, and automotive safety isn't taken seriously either. And driving isn't exactly a freely chosen risk, it's a necessity of life in a lot of places.

But hey, I'm risk averse both with covid and driving.
posted by mrgoat at 8:39 AM on December 12, 2021 [2 favorites]

is covid killing more vaccinated people than driving?

I was interested to try to figure out the true answers to this question, since no one here has cited actual sources. MVAs do kill more people than covid, but 30x is a massive overestimate if you're interested in vaccinated people and the situation is more complicated than it initially seems, because death rate among vaccinated people of course also varies with case rate and age. Here's some facts, US-specific:

From wikipedia, the 2020 yearly motor vehicle fatality rate per 100k was 11.67. This averages out to 0.224 per week.
I found a page reporting a recent gallup poll saying that 83% of Americans use a car at least multiple times a week, and of course motor vehicle fatalities don't include only people who opt in to cars, so given this high proportion it is probably far to not try to multiply this in. I also don't know how these numbers represent kids.
Per age breakdowns for >=18y.o.s skew much younger than the covid per age breakdowns I use below, as you might expect.

Death rate data on the summer-fall surge from our world in data, all ages:

Jun 12, 2021 (minima in this data): weekly death rate of 0.14 per 100k for vaccinated, 1.04 for unvaccinated.
Aug 14, 2021 (maxima in this data): weekly death rate of 2.00 per 100k for vaccinaated, 12.79 for unvaccinated.
Oct 2, 2021 (closest to now in this data): weekly death rate of 0.82 per 100k for vaccinated, 5.00 for unvaccinated.

When you break things out by age group, it becomes very clear that these averages are driven by people 50+. The highest death rate for vaccinated 65-79 in that time period is 3.42, for 50-64 is 0.95, for 30-49 is 0.20, for 18-23 is 0.03. That is, among vaccinated 50+y.o.s the death rate has always [in this time window] been substantially higher than the motor vehicle fatality rate, for under 50s, it has always been comparable or much lower.

I do actually think that pre-omicron, many implications for personal risk of this kind of analysis are moderately clear, but the implications for collective risk remain murky to me. Also, I don't personally think that the rate of driving fatalities is an acceptable number and every time this comes up I wonder about how the mechanisms that lead to Americans (myself included) being fairly conditioned not to think about driving risk might be related to covid fatigue. And of course, this is all extremely pre-omicron. The unfortunate thing is, we're, as far as I can tell, still extremely pre-omicron in terms of having any good data.
posted by advil at 9:35 AM on December 12, 2021 [8 favorites]

I still can’t tell if you’re advocating doing some things while taking some basic public health measures, or if you’re advocating a return to “normal”

my opinion, i would advocate of course widespread vax and booster access. in communities above a certain threshold of vaccination (say, 70% of eligible), i dont think many of the restrictions go beyond pandemic theater, and they are just making people infuriated.

where i am, we are at 68% vax/eligible. there is an indoor mask mandate. nobody follows it, and nobody enforces it, at places where it would do most good like restaurants/bars/concerts (because expecting people to mask "between sips and bites" and for staff to enforce that is sheer idiocy). so it only gets enforced at places where nobody is eating or drinking, like supermarkets. i highly doubt a mask mandate under such conditions does more good than it is worth and instead simply annoys people and makes life more tedious.

then there's schools. again, in 70%+ vax'd areas, i dont think automatic 10 day quarantines make sense for everyone who was in contact with a child who tests positive. if a kid is positive, close contacts should get the chance to test negative and if uninfected should not have to quarantine. also, testing negative should get a person out of quarantine early.
posted by wibari at 12:58 PM on December 12, 2021 [2 favorites]

70% vaccination rate isn't sufficient, even before omicron's arrival, and a single number will never be appropriate for everywhere, since infection rates and the degree to which hospitals are overrun varies from place to place.
posted by PhineasGage at 1:28 PM on December 12, 2021 [5 favorites]

above a certain threshold of vaccination (say, 70% of eligible),

This is a useless statistic. It obscures more than it illuminates. If I have a community of very elderly and frail people, and children and teens, 80% of whom cannot have the vaccine, you reach 70% of eligible with 14% of the population vaccinated. Even at 100% of eligible (20% of total pop) opening up is a terrible idea. Meanwhile, a healthy adult population where 60% are vaccinated, but everyone is vaccine eligible looks worse on that stat, but its less problematic (if still a very bad idea) to open up.

70% is probably too low anyway. But if you're looking at percentages, it needs to be of total, but if eligible. The virus doesn't care about your eligibility criteria, it cares how big an unvaccinated population it has access to.
posted by Dysk at 6:43 PM on December 12, 2021 [3 favorites]

if the difference we're talking about is 97% (ideal) to 90% (actual) efficacy of vax to reduce the risk to that of, say, driving, then we are talking about a manageable problem. that's all i'm trying to say.

The 7% difference between 90% and 97% intuitively sounds small, but represents a 230% change in the odds (from 1 in 10 to 1 in 33). Conversely when rates go down, say from 90% to 50% (because vaccine efficacy diminishes by about 40% after six months), that intuitively feels like "about half" but in fact represents an 80% reduction in protection.

A strategy to control this thing exclusively or primarily with vaccines therefore requires very high efficacy and coverage rates for prolonged periods of time (years?). Between immune escape and waning efficacy, not to mention the social and political flash points, I think it's a very high-risk strategy. We're telling people "don't go into the ice-cold shark-infested water without a swim vest" but what gets understood is "if I have a swim vest, it's safe to go swimming in ice-cold shark-infested water".
posted by dmh at 7:09 PM on December 12, 2021 [6 favorites]

if the difference we're talking about is 97% (ideal) to 90% (actual) efficacy of vax to reduce the risk to that of, say, driving, then we are talking about a manageable problem.

The thing is, though, that we're not looking at some essentially constant risk level here as we would be for driving, but a dynamic risk level that rises with the size of any given outbreak.

Here's the basic arithmetic shape of the thing. It's an oversimplification, sure, because it assumes that susceptibility is evenly spread through a population which it isn't, but it's an essentially sound model that yields good intuitions about the loose shape of how these things work.

The key number to focus on is the Effective Reproduction Rate R_eff, which is the average number of other people each person who already has the pathogen will pass it on to in the course of their own infection.

If R_eff for any given pathogen and population is below 1, then the number of people infected will display exponential decay. If R_eff is above 1, the number of people infected will display exponential growth. If it's exactly 1, the number of people infected will remain roughly constant and we can then make reasonable comparisons to other roughly constant risks.

The aim of public health measures - lockdowns, masks, social distancing, improved handwashing, contact tracing and isolation, vaccination programs and so on - is to get R_eff below 1 and keep it there. Because if it stays much above 1 for any length of time, then at some point the number of infected people will grow both greater and faster than healthcare systems are able to deal with. That's not fearmongering, that's just an acknowledgement of what exponential growth does.

If there were no public health measures in place, so the pathogen could just rip into the population unhindered, R_eff would be mostly determined by the pathogen's own natural contagiousness. The resulting number, called R₀, is different for each COVID variant.

Every public health measure has an associated damping factor (a number between 0 and 1) on viral contagiousness, and we can multiply R₀ by all of the factors for whatever public health measures remain in place to get R_eff. Remember, the name of the game is to drive R_eff below 1.

So let's play with some numbers. R₀ for the original strain of SARS-CoV-2 was somewhere near 3. What would it take to get R_eff below 1, using vaccination as the sole public health measure?

Let's assume for the sake of erring on the side of generosity that the vaccine we're using is 100% effective, so that anybody who is vaccinated both won't get and can't spread the infection. Everybody who does have it will try to spread it to 3 others. Therefore, reducing R_eff to 1 requires that 2 out of those 3 are not susceptible: we need a population-wide vaccination rate of 2 people in 3, or 67%.

What would we need in order to suppress Delta, which shows a R₀ closer to 5? Similar logic shows that the population-wide vaccination rate needs to be at least 80%.

Note well: these are population-wide rates, got by dividing the number of vaccinated people by the total number of people. Not by the number of eligible people, whatever that might be.

The general rule is that we can afford at most 100%/R₀ of the population not to be vaccinated in order to suppress the epidemic by immunity alone. And in the real world, no vaccine is 100% effective, so we also need to reduce that number accordingly.

R₀ for Omicron is not yet known, but it's looking likely to be at least twice that for Delta. So even if we had 100% effective vaccines against it, we could afford at most 10% of the population to be unvaccinated to suppress it. We don't. In fact the vaccine efficacy against Omicron is much lower than that for Delta; we'd need well south of 5% unvaccinated to keep this thing suppressed by immunity alone.

Again, that's population-wide, not "eligible". And since the number of ineligible people is already well over 5% of the population, immunity alone is not going to cut it. We're going to need the additional suppression provided by other public health measures - masking, movement restrictions, test trace and isolate - for a long time yet. If we let up on those, we will return to exponential growth and we will see health care system overwhelm. Again, this is not fearmongering, it's just what exponential growth does.
posted by flabdablet at 8:56 PM on December 12, 2021 [12 favorites]

Because if it stays much above 1 for any length of time, then at some point the number of infected people will grow both greater and faster than healthcare systems are able to deal with. That's not fearmongering, that's just an acknowledgement of what exponential growth does.

Yes, and then before long the number of infected people will be larger than the entire population of the planet. That's just how exponential growth works. Clearly it's not possible for a disease to actually show exponential growth in the long run, and in particular treating the growth as exponential tells you nothing about the peak in infections, cases or hospital demand if the disease is allowed to spread through the population because it has no peak - exponential growth would have the number of patients needing hospital care blow rapidly past any finite limit, including both the number of beds available and the number of people in existence.

Also, less than ideal vaccines don't just increase the proportion of the population that needs to be vaccinated in order to suppress the disease - if the vaccine is just slightly less effective or the disease just slightly better at spreading than in the scenario where 95% of the population need to be vaccinated, then no level of vaccination can achieve this goal. As you say, a certain proportion of infections need to be stopped depending on Reff, and that can be higher than the proportion that are actually blocked in vaccinated people. There was suspicion amongst experts this wasn't possible even with Delta, and it likely isn't with Omicron even with boosters.

This leads to an alternative strategy that some governments have been pursuing - use vaccines to try and keep the levels of hospitalisations and deaths manageable. It's not a particularly palatable alternative to many, but the alternative seems to be very substantial restrictions on all of society for the indefinite future and quite possibly forever. The proportion of the whole population that's been vaccinated is pretty irrelevant to that strategy since some people are at much higher risk of Covid-related hospitalisation and death than others. It is not possible to make up for inadequate vaccination levels amongst say over-65s by extending vaccination to 5-11 year olds because they're at so much lower risk of being hospitalised anyway. The UK may have passed peak Delta-related hospitalisations a while ago under this strategy despite having less than 70% of the population fully vaccinated due to extremely high uptake amongst at-risk age groups, though there seem to be some weird seasonal effects that make this hard to judge.
posted by makomk at 2:16 AM on December 13, 2021 [2 favorites]

Every time you make an interaction you are rolling the dice. If you're wearing an N95 mask and vaccinated your saving throw goes down to 1. Only rolling a 1 on a 20 sided dice might get you infected. If you're out at a crowded restaurant, no mask, dozens of people around? You're still going to have to roll a 3 or less to get infected but because you're rolling the dice a ridiculous number of times you're probably eventually going to roll a 1, 2, or 3.

There is also evidence that the size of the covid dose you receive can determine how well your vaccine will work. Even vaxxed and boosted people can probably get themselves a breakthrough case with a completely functional vaccine response by simply overwhelming their immune response with too much covid. You only have so many "defenders" of the various sorts that can fight off the virus and they can be overwhelmed by a covid zerg rush no matter how well you position and staff up your firebases. There also appears to a dose - severity connection for the same reason. This is why medical staff still wear their PPE even when they are fully vaxed and boosted and likely have also had previous infection. They know that it is still foolish to walk in front of a firing machine gun even though have the best bullet proof vest money can buy.
posted by srboisvert at 3:54 AM on December 13, 2021 [2 favorites]

Clearly it's not possible for a disease to actually show exponential growth in the long run

While technically true, this is a specious argument. Yes, technically all population growth (of a virus or any living organism) must follow at worst a logistic curve due to physical constraints from a finite planet or universe. Logistic curves have an initial exponential phase, however, which exhibits exponential growth during that phase. Left unchecked, that means that public health infrastructure gets overrun from too many COVID cases in the short run, not in the long run. That can potentially lead to an order of magnitude more people dying due to the pandemic in total. I’ve been known to call for more precision around the mathematically inaccurate over-use of the phrase “exponential growth” - yea, even here on Metafilter - but this is (a) not the mathematically relevant detail to be focused on here and (b) though you do address this detail in a later paragraph, what you’ve written is likely to become some pandemic deniers’ “gotcha” argument the way you’ve phrased it (leaving off the detail about phases of a logistic growth curve) and thus cause measurable harm.
posted by eviemath at 4:41 AM on December 13, 2021 [4 favorites]

Ignorance/denial is bliss up until the point you're about to be sedated and put onto a vent wishing you had just gotten the damn vaccine and worn a mask. At this point the pandemic is still ongoing. There's no reason to even try to get back to "normal" right now. Nobody should be even trying for "normal" but the population is just so pandemic fatigued. Sadly, it's the ones that have the least to lose demanding that the most vulnerable cater to their every fucking social whim.

Why should people not be trying for "normal"? As you say, the pandemic is ongoing, at some point we go to a point where the disease in endemic and there isn't a hard and fast rule on when that point is reached. As far as anyone can tell, we will have to deal with recurrent variants of this disease for years to come. So we have two choices:

We normalise our lives, which may not be exactly the way they were before but we accept that there is a new normal arrangement which is permanently different from the way we lived before. That might mean, for example, nightclubs and restaurants just not existing any more, culturally preferring private cars to shared forms of transportation.

We continue to live under some form of temporary emergency conditions where we accept certain restrictions temporarily that we would not countenance permanently.

(I guess we could also just pretend that nothing is different and go back 100% to the way things were before which is a form of "normality").

At some point early in the outbreak, it made most sense to accept that the situation was temporarily disordered and that we would have to accept certain temporary conditions. It doesn't make a lot of sense to me to pretend that *anything* we do now to control the pandemic is temporary unless there is a specific reason to think that condition X is only until a certain defined condition is met. That doesn't mean, oh let's just open up all the restaurants, but it does mean that whatever change you make to the way people eat in them is effectively a permanent one. It's the difference between saying that we had to not have weddings for a few months to deciding how the concept of a wedding will change.

In that context, I do think the risk-reward tradeoff has to be reconsidered. It's one thing to say that wearing facemasks on public transport as routine can stay forever, whatever I don't mind that particularly, but other measures have to be carefully balanced against the harms and costs.

It really does seem like in the fight against covid, we (not metafilter, obvs) are just collectively giving up. Just after omicron started being detected in the state, with case counts rising, my office just decided to go from 50% capacity and a predictable rotating schedule of work from home, to 100% capacity and a "bank" of time people can use, with managerial permission, to ad-hoc work from home. It's supposed to be used in case you get covid.

Surely for it to count as "giving up" rather than "accepting" there has to be a counterfactual. Some version of what we do instead. If Covid is now fully endemic then there is no fight that ends up with it going away, only a balanced set of containment measures that keep the harms at a certain level.
posted by atrazine at 6:29 AM on December 13, 2021 [2 favorites]

my opinion, i would advocate of course widespread vax and booster access. in communities above a certain threshold of vaccination (say, 70% of eligible), i dont think many of the restrictions go beyond pandemic theater, and they are just making people infuriated.

It's so weird to hear about different populations' responses. We have a mask mandate and vaccine passport rule for certain settings (gyms, indoor dining, bars, etc.) here, and I work in a fitness facility and also have been touring other ones recently. My kids are in public schools where masks are required for kids not in kindergarten. My friends are on transit, where masks are required, and my mother-in-law had to make a trip recently by train, ditto (and now vaccine passports on trains as well.)

Other than outdoors, in specific classes at my own gym (not my workplace where we have kept masks mandated even though adults could technically not wear them when 2m apart in a fitness class), and in small private gatherings, I haven't seen anyone without a mask. I've definitely seen people with their noses sticking out. But compliance is good.

It's infuriating a small number of people, sure. But overall - it's a mask, not a straightjacket. Also, vaccinated people recognize that vaccines are not a "Return To Normal" prize, the prize is that you probably won't die and maybe as a bonus you won't transmit Covid to someone who will die or be permanently or even just longer-term injured.

Despite that, cases are going up, which reflects for sure our government's decision to pack school kids into regular-sized classrooms and have them eat together, Delta, Omicron, and possibly some fatigue around the edges and lying and that kind of thing. Kid vaccines only arrived here 3 weeks ago and boosters for 50+ opened today (I'm booked for Thurs! yay!) and I hope that will be a game changer. They are recommending 8 weeks interval for doses for kids 5-11 but I may see if I can informed consent my way out of that with my 10 year old.

I feel for parents of kids 4 and under, no vaccines for them still. All of these people are on my mind as I see cases rise and hospitalizations with them. And I'm acutely aware of how hospital capacity issues and medical burnout impacts on everyone, because I've lost a child to that situation, pre-Covid.

To be clear, I'm not pro-lockdown except in local areas of extreme case counts. I think we should have schools open, art galleries, theaters at some capacity with vaccine passports, and gather with people based on good decisions around their vax status. Transportation is tricky but masks help.

I guess I just honestly don't get the idea that you should base your public health policy re: masks and capacity limits and vaccine requirements on effort rather than results. If Covid is spreading in your area and hospital and ICU admissions are rising, why would you not continue to mitigate? Because people are upset? Maybe it's about education.
posted by warriorqueen at 6:33 AM on December 13, 2021 [6 favorites]

Why should people not be trying for "normal"? As you say, the pandemic is ongoing, at some point we go to a point where the disease in endemic and there isn't a hard and fast rule on when that point is reached.

Beware of the ease with which you can be persuaded to believe things you want to be true. This inevitable endemicity argument is an assumption and not a fact and so far the evidence is pointing away from covid-19 becoming endemic any time soon as successive Variants of Concern have led to increasing loss of infection acquired immunity from previous strains. Maybe it will exhaust its viable evolutionary space and stabilize on the most infective version but there is no guarantee that won't be a virulent form that kills (or wrecks via long covid) even greater numbers of people than the current strains are. I for one am not terribly comfortable with a constantly circulating covid-19 virus that lops 11 years of my projected lifespan as I age into ever more vulnerable age groupings.
posted by srboisvert at 6:55 AM on December 13, 2021 [9 favorites]

Endemicity is surely ultimately a subjective societal rather than a scientific status?

i.e. any disease ultimately becomes endemic when society gets bored of it. (I'm not arguing that it will inevitably be less serious just that we will take it less seriously.)
posted by atrazine at 7:20 AM on December 13, 2021 [1 favorite]

Why should people not be trying for "normal"?

There is no normal available to us right now. Thousands of people are dying daily. One out of every hundred people over 65 in the US has died from Covid. Tens of thousands of people are in the ICU. Huge numbers of people suffer from significant disability due to long Covid. And now we have an Omicron wave coming that is already increasing cases very rapidly in many countries. That's not normal.

We can accept some public health measures even if they aren't "normal", in an effort to reduce death, serious illness and long-term disability or we can refuse to accept public health measures and accept a lot of death, illness and disability. There is no "normal" option. If we're going to accept that a lot of people are going to die because we want to be able to eat in restaurants whenever we want and so on, let's at least make that explicit. Calling it "normal" is just trying to hide the reality that our public health policies will cause significant harm to many, including death.
posted by ssg at 8:16 AM on December 13, 2021 [4 favorites]

at some point we go to a point where the disease in endemic

Isn't that assuming that we will either develop herd immunity or selection pressures will force Covid to become less virulent and it'll join common colds as a routine annoyance, two assumptions which are not guaranteed? If they are both false, we could be faced with 2020 going on forever.
posted by acb at 8:53 AM on December 13, 2021

We can accept some public health measures even if they aren't "normal", in an effort to reduce death, serious illness and long-term disability or we can refuse to accept public health measures and accept a lot of death, illness and disability. There is no "normal" option. If we're going to accept that a lot of people are going to die because we want to be able to eat in restaurants whenever we want and so on, let's at least make that explicit. Calling it "normal" is just trying to hide the reality that our public health policies will cause significant harm to many, including death.

Right, that's the point. We do in fact accept that a lot of people die and suffer ill health due to choices (in the loosest sense of the word) that we have made as a society. If Covid is a permanent part of our lives then probably society will rather ghoulishly accept a new set of compromises to balance out the death vs the restrictions required to prevent them.
posted by atrazine at 9:24 AM on December 13, 2021 [3 favorites]

I think the additional news though, is that the "new normal" adjustment will hopefully work both ways - as some people get Covid, others in their family -- especially as the 'new vaccine' argument fades -- will perhaps get vaccinated, pediatricians will be able to talk about vaccines as a whole including Covid, etc.
posted by warriorqueen at 9:58 AM on December 13, 2021 [1 favorite]

If Covid is spreading in your area and hospital and ICU admissions are rising, why would you not continue to mitigate? Because people are upset? Maybe it's about education.

Yes, because people are upset. The effects of media misinformation, disinformation and propagandizing are profound, and are driving many people's behavior, much more than mere logic or rationality. We left objective, consensus reality behind a few years ago, unfortunately; hyperreality is where we live, like it or not.
posted by LooseFilter at 10:12 AM on December 13, 2021

Sadly, it's the ones that have the least to lose demanding that the most vulnerable cater to their every fucking social whim.

That seems like a significant oversimplification if you… know people.
posted by atoxyl at 10:30 AM on December 13, 2021

If Covid is a permanent part of our lives then probably society will rather ghoulishly accept a new set of compromises to balance out the death vs the restrictions required to prevent them.

Right, there's always going to be balancing. My point is that certain people are trying to feed us some bullshit about "normal". There is no normal like 2019 in the near future. If we want to have a conversation as a society about what the tradeoffs are, sure, but if one side is calling for a return to normal, we aren't really talking about a shared reality.

Or to put it another way, I think we should push back against the "getting back to normal" framing because it implicitly prioritizes things like dining out over death and disability.

But I'd also disagree that Covid as we know it today is a permanent part of our lives. The situation is changing all the time. Treatments and vaccines are being rapidly developed (look at how far we've come already). I'm optimistic that we will figure out the mechanisms behind long Covid and potentially be able to treat it or help people avoid it. People are still getting their first vaccines every day and there is more we could do to convince them and make it easy for them. I think there are a lot of potential benefits to delaying infection for as many people as possible, as long as possible, through reasonably strong public health measures.

And with Omicron, strong public health measures will help us avoid potential overload of ICUs, nursing homes being overrun, and a lot of other awful consequences. The timing is very unfortunate with Christmas coming, but there's a lot of value in trying to reduce the peak of this coming wave.
posted by ssg at 10:30 AM on December 13, 2021 [3 favorites]

Endemicity is surely ultimately a subjective societal rather than a scientific status?

LOL no. “Endemic” has a specific technical meaning. Look it up. Don’t be an ignorant denialist.
posted by eviemath at 10:31 AM on December 13, 2021 [1 favorite]

Variants of Concern have led to increasing loss of infection acquired immunity from previous strains.

Isn't that assuming that we will either develop herd immunity or selection pressures will force Covid to become less virulent and it'll join common colds as a routine annoyance

I’m a little confused by the endemicity discourse in this part of the thread. “Endemic” doesn’t mean “not serious.” It means “not going away (but maybe growing closer to linearly than exponentially).” No?

People like to conflate endemicity with loss of virulence in a way that isn’t guaranteed. The error when people say “it’s just gonna become endemic” is the “just.” But the current evidence on immune escape - that it’s definitely happening but unlikely to be 100 percent, even with Omicron, and especially not when people have both prior infection and vaccination - seems quite consistent with an influenza sort of endemicity. That’s not a good thing, but it’s plausibly the thing we have locked in already.
posted by atoxyl at 10:42 AM on December 13, 2021 [3 favorites]

an influenza sort of endemicity

I was a “let’s do everything possible to keep this from happening” guy because I understood that this is a permanent cost. But I don’t think we did that, collectively (the only way to do it) and I don’t think it makes sense to act like people won’t end up living with that cost at some mostly steady state because that’s what people always have done.
posted by atoxyl at 10:50 AM on December 13, 2021

Will the virus become milder?

A recurring suggestion is that pathogens evolve, over some undefined period, to be more transmissible and less virulent, bringing virus and host towards a state of benign coexistence. If Omicron is spreading so quickly, some wondered, perhaps it will at least be milder. But experts say this expectation has no scientific basis. “Put simply, this has been one of the most baffling misinformation myths peddled during the pandemic,” said Prof Alan McNally, director of the Institute of Microbiology and Infection at the University of Birmingham. “There is almost no evidence of any human pathogenic virus evolving towards reduced virulence.”

The simplistic argument behind the idea is that if a pathogen kills its host, or makes them too sick to leave the house, then it gives itself a worse chance of propagating. So by the logic of survival of the fittest, there would be a selective pressure for milder strains. Sadly, the dynamic is more complex in the real world.

“It’s really unpredictable what will happen to the evolution of the host or the virus,” said Brian Ferguson, an immunologist at the University of Cambridge. “You can pick out examples of things going one way or the other depending on what point you want to make.”

In the case of coronavirus, there is also an obvious hole in the argument: transmission normally occurs before symptoms start or during the earliest stage of symptoms, meaning that severity of illness has little influence on the spread of the virus.

posted by TheophileEscargot at 11:48 AM on December 13, 2021 [4 favorites]

Meanwhile, here's a, um, viewpoint: "Where I Live, No One Cares About COVID

Outside the world inhabited by the professional classes in a handful of major metropolitan areas, many Americans are leading their lives as if COVID is over.

posted by PhineasGage at 12:16 PM on December 13, 2021 [3 favorites]

The idea that viruses evolve to be less virulent is most probably a myth, but the impact of population immunity acquired either through vaccination or infection is not. I would wager that the decreased infection severity observed so far in S.Africa is due to widespread immunity acquired the hard way (only ~30 percent vaccination). The big question is whether increased transmissibility outweighs decreased disease severity and therefore still overwhelms hospitals. We’ll find out soon enough based on what happens in Britain. Also, countries that managed to suppress spread but that still have a lot of unvaccinated individuals are highly vulnerable I would imagine. Depending on how much protection from severe disease natural immunity provides the American South and rural areas in general also could be in for another rough ride.
posted by eagles123 at 12:25 PM on December 13, 2021 [2 favorites]

The idea that viruses evolve to be less virulent is most probably a myth, but the impact of population immunity acquired either through vaccination or infection is not.

That is also my impression. Like obviously influenza did not stay 1918-virulent after 1918, but it’s not necessarily because of viral evolution. And it did remain a fluctuating threat forever, and accounts for significant morbidity and mortality every single year. But this probably will, too!
posted by atoxyl at 12:33 PM on December 13, 2021 [2 favorites]

Outside the world inhabited by the professional classes in a handful of major metropolitan areas, many Americans are leading their lives as if COVID is over.

I don’t think this is an untrue statement, to be honest (or you could also easily say “many Americans under the age of 30/40 are leading their lives as if COVID is over” and so on) but this twerp (a professional writer with affectations) isn’t really the one to explicate this convincingly.
posted by atoxyl at 12:40 PM on December 13, 2021 [2 favorites]

Which is why, Phineas Gage these folks seem to be getting more Herman Cain Awards...
posted by Windopaene at 12:40 PM on December 13, 2021 [4 favorites]

many Americans under the age of 30/40 are leading their lives as if COVID is over

Most people I know over the age of 70 certainly are getting their booster shots… and then otherwise living as if COVID is over.
posted by atoxyl at 12:43 PM on December 13, 2021 [1 favorite]

Outside the world inhabited by the professional classes in a handful of major metropolitan areas, many Americans are leading their lives as if COVID is over.

That whole article reads like the Before in a story with a tragic After.

But it is an eye-opening article for me, as someone who lives where people do care about Covid precautions. I'm not sure what I thought the other side was like, but not that... prosaic or something.
posted by daisyace at 12:56 PM on December 13, 2021 [3 favorites]

Yup, posting that link was definitely not an endorsement. Fascinating - and perhaps useful if any of our public health and political leaders read it - to hear that viewpoint stated so plainly.
posted by PhineasGage at 1:00 PM on December 13, 2021 [3 favorites]

Holy shit that piece in The Atlantic. Wow.
posted by warriorqueen at 1:08 PM on December 13, 2021 [5 favorites]

Outside the world inhabited by the professional classes in a handful of major metropolitan areas, many Americans are leading their lives as if COVID is over.

Matthew Walther is editor of The Lamp, a Catholic literary journal, and a contributing editor at the American Conservative.

Shocked, I am, to discover that.
posted by Grangousier at 1:16 PM on December 13, 2021 [9 favorites]

"Rural southwest Michigan" is pretty much all you need to understand about that article. I took a "vacation" (basically spending a few days by myself in a cabin on a lake and driving around for some scenery) in northern Michigan in August. My mother lives in a tiny town in a deep red county that currently has the highest rate of infection in the state. And the author is absolutely right that people are living as if the pandemic doesn't exist. When I was up north I think I saw maybe half a dozen people over 4 days who were wearing masks, and I am pretty sure that they were also visitors. Heck my mom sees a doctor whose office co-practitioner does not WEAR A MASK WHEN SEEING PATIENTS, let alone require his patients to wear a mask. And then everyone on the local Facebook page sends "prayers" on posts about entire families who are suffering/in the hospital/dying of Covid but dog forbid anyone suggest getting a vaccine or masking. ("Ivermectin" is the only mention of prevention that won't get you booted from the discussion). "So sad" everybody says but there's absolutely no sense that anyone thinks *they* are vulnerable. Until, of course, they are.

But by the same token I think even people who do care about Covid precautions are still getting it wrong. My firm was generally excellent in its Covid response. We converted to WFH right at the beginning of lockdown and stayed there until October of this year when a hybrid schedule was implemented. We have a vaccine mandate, masking is required in common spaces, and people (like me) who are high risk or have high risk people in their households are allowed to continue to WFH. And yet - Michigan is at its highest numbers since the beginning of the pandemic, our hospitals are breaking, and not only has no one said anything about sending people back to WFH, but they are having a holiday happy hour this week in our tiny kitchen area.
posted by Preserver at 1:32 PM on December 13, 2021 [5 favorites]

"Only the rich and educated dummies are wearing masks! Us salt of the earth types aren't."
[three paragraphs later]
"The elites are subjugating the masses by making them wear masks to show their caste!"

Well which is it, Mr. Debate-Team Also-Ran?

Sadly this does track with my experiences in southwest Michigan, outside of the little bubbles of GR/Lansing. In the immortal words of The Dude, you're not wrong, Walter, you're just an asshole.
posted by We put our faith in Blast Hardcheese at 1:33 PM on December 13, 2021 [4 favorites]

As I said a guy like Matthew Walter (decidedly professional/intellectual class, wants to be seen as something else) is not really the guy to say something of import, here. But it’s not inaccurate to my experience of rural anywhere America to say that people just don’t care that much. And besides the obvious that many of us are still working from home my experience of coastal urban professional America, at this point, differs primarily in that people are keeping up on their boosters and wearing masks in public where applicable. Otherwise they are gathering in houses, eating at restaurants, getting on airplanes etc. Especially, it seems, people who are young enough to be pretty sure that they’re not “high risk” and people who are old enough that they could realistically die anyway waiting for the world to be safer. It’s people in the middle zone who have just enough experience of declining health not to want to fuck it up for good who are most cautious.
posted by atoxyl at 1:54 PM on December 13, 2021 [2 favorites]

Cf. to that Atlantic piece, this crossed my desk a couple of days ago. These people are menaces to society.

“Local health departments in Missouri halt 'all COVID-19 work' after court ruling, AG letter,” Galen Bacharier, The Springfield News-Leader, 10 December 2021
posted by ob1quixote at 2:03 PM on December 13, 2021 [5 favorites]

differs primarily in that people are keeping up on their boosters and wearing masks in public where applicable

I mean that...is a pretty fuckin' big difference?

Hang around long enough here and you start to feel like getting vaccinated, getting boosters on schedule, masking, and working from home is barely a step better than just breathing your unvaxxed infectobreath in peoples' faces on purpose.
posted by We put our faith in Blast Hardcheese at 2:37 PM on December 13, 2021 [2 favorites]

Outside the world inhabited by the professional classes in a handful of major metropolitan areas, many Americans are leading their lives as if COVID is over.

In Michigan, where the author is from, at least this is 100% true of all kinds of ages in the rural areas based on my not very scientific but quite delicious sampling of a couple of Culvers that I stopped at when traveling back and forth from Chicago to Oakville, Ont. several times in the past year. Zero masks, indoor dining and a bunch of funny looks as we went in double masked in order to use the toilets. We got drive through and ate in our car in the pocket lot.

Then on the last trip on the way back we stopped at a Culver's that was closed to indoor service. Not because they were trying to mitigate covid but because they had insufficient staff to manage the dining area (according to the sign on the door). The sign didn't say it whether it was because people were off sick or because they had just quit but I did wonder if they had reaped what they were sowing.
posted by srboisvert at 2:47 PM on December 13, 2021 [5 favorites]

I mean that...is a pretty fuckin' big difference?

I agree, I just mean that people’s willingness to let the pandemic impinge on their lifestyle is clearly pretty low all around.
posted by atoxyl at 2:56 PM on December 13, 2021

I don’t know how accurate the following impression is, but it feels like the Venn diagram of people who were complaining about public health measures earlier and forcing much of the US to not respond adequately to the pandemic, and people who are now really pushing the “it’s endemic now anyways, nothing to be done but accept it and move on” line has a very large overlap. Which is obviously enraging - any time other people force you into some outcome and then make it out like it “just happened” or like they had nothing to do with the outcome, and you should just accept it as having been inevitable, is infuriating even when there aren’t lives on the line or not being able to see my family in forever. It also makes it difficult to respond graciously or whatever to folks who were in fact conscientiously supporting public health measures before, but have now kind of given up a little bit.

One thing I really notice here on Metafilter is how different perceptions of the pandemic and future possibilities are in (much, or at least specific parts of) the US versus other parts of the world, such as where I live. Almost no one is talking about endemicity with significant ongoing deaths and illness as a foregone conclusion here - and those who are tend more to be on the fringe and primarily getting their news and info from right wing US-based sources, not respected people in leadership positions. I’m sure the Venn diagram observation I began with is much more exhausting to deal with up close for US Mefites, and makes it hard to keep a more hopeful outlook on how the pandemic could end versus whether everyone across the globe just declares “Mission Accomplished” at some point. I do recommend seeking out global sources and experiences on the pandemic, though, in order to keep the more hopeful - but also more balanced - perspective that is necessary for dealing with this global pandemic globally in a better way. (And supporting the current resurgence in unionization and labor power that is the best bet for forcing improvements to the social safety net in the US that are necessary to make the public health measures needed for a better pandemic ending more feasible; and opposing the gerrymandering and voter suppression tactics from the Republican Party as vehemently as possible.)
posted by eviemath at 4:43 PM on December 13, 2021 [2 favorites]

So, eviemath, what non-U.S. country are you offering me permanent residency in?
posted by PhineasGage at 4:47 PM on December 13, 2021 [2 favorites]

That article is especially depressing because of the way he seems to want to have his cake and eat it too. He keeps saying things like "I don’t mean to deny COVID’s continuing presence", and even looks up ("for the purposes of this piece") how many people are confirmed to have died of covid so far in "my part of rural southwest Michigan" (136), because he's a responsible adult who cares about ethics in journalism. Then immediately afterwards he says "What I wish to convey is that the virus simply does not factor into my calculations or those of my neighbors". Just a neutral observer, just recording facts that carry no particular agency or consequences. Just sayin'. Definitely not reckoning with those deaths; not a sentence or even part of one about how maybe some of the behavior he so neutrally describes might have caused, you know, some of them. No comparing to death rates in previous years. No mentioning whether any of these people who are gone might have been worth trying to keep alive. We always hear about how small-town and rural America have real community and values, in contrast to those big cities where alienation reigns, but apparently his rural, i.e. sparsely populated, community is so disconnected that 136 people can go missing and "it strikes me with all the force of reports about distant coups in Myanmar." (Some people may claim they do feel something while reading about people being killed and tortured in another country, but they don't mean it. How could they?)

But listen, he's not a denier! He doesn't deny that covid exists in words! He does deny it in his actions, which he describes in detail, impassively, with distance, like a sociologist, because they aren't an active choice that he makes day in and day out, or the result of some serious moral conflict and debate. And the reason it's all fine is that he's in the majority: "I wager that I am now closer to most of my fellow Americans than the people, almost absurdly overrepresented in media and elite institutions, who are still genuinely concerned about this virus. And in some senses my situation has always been more in line with the typical American’s pandemic experience [...]" The reason it's fine is also that the bougie elite is way too strict about defining alcoholism, or what pregnant people shouldn't eat, and they're wrong. He believes they're wrong not because the serious adult that he is has examined the numbers and the science and come to a measured conclusion about the right tradeoff between health/disability/mortality and the bummer of not drinking. Or because he's examined the numbers and science and come to a measured conclusion about the right tradeoff between health/disability/mortality and the bummer of wearing masks. No. The reason he's right is because that feels nicer. Because "sophisticated adults are generally capable of winking at overly stringent guidelines", and he's a sophisticated adult. Carefully assessing whether a guideline actually is or is not too stringent is not sophisticated.

He's a sophisticated adult, like Europeans, but not like the American elites, who are only (upper) middle class, and advocate(d) for "silly" things like "no-fault divorce, factory-sliced bread, frozen meals, and, of course, infant formula", all of which are so clearly bad (and so clearly relevant) that it's not worth explaining.

It's "parochial" and "impossibly baroque" and "small-minded" and "puritanical" to consider questions like "Our oldest finally attended her first (masked) sleepover with other fully vaccinated 10-year-olds, but one of them had a sibling test positive at day care. Should she stay home or wear a face shield?" One spends Sunday mornings praying the rosary at home because one is good people; one doesn't work through the actual calculations of life and death, because one is not gauche and math is annoying.

One believes people who take covid seriously are doing so for reasons that "transcended public health and became a symbol". (Public health is somewhat important, of course.) And one reads about them and growls, "these people," and proudly walks bare-faced, which is not tribal at all, because that would be déclassé.

This is a guy who once protested against Bush not because of any deep convictions grounded in values and humanity, but just to "set [himself] apart from the reactionary banality of life in flyover country." So when he sees people taking a stand against covid, he knows better. It's all a game, you know. The best part is when you make a liberal cry. Hypocrisy works a treat for that. Combine with willful ignorance and you're golden.
posted by trig at 4:48 PM on December 13, 2021 [18 favorites]

Almost no one is talking about endemicity with significant ongoing deaths and illness as a foregone conclusion here - and those who are tend more to be on the fringe and primarily getting their news and info from right wing US-based sources, not respected people in leadership positions.

I don’t know where you live but again to discuss this I think we have to separate the technical concept of endemicity - established circulation of a disease in the population - from the various possible outcomes of that. That the virus is headed towards being endemic in a technical sense is by far the mainstream view among public health and infectious disease researchers I follow - who are certainly mostly based in North America but not the least bit fringe or disreputable. They are not necessarily saying that this means “significant ongoing deaths” because a.) that part is difficult to predict and b.) they obviously strongly endorse vaccination and measures to reduce the lethality of the disease as much as possible, and would like to believe these campaigns will be successful.

When I say that it is possible that endemic COVID will continue to cause a significant number of deaths and serious illnesses I don’t particularly mean to spread a sense of doom. Rather it’s a counterpoint to the view that I tend to see in right-wing propaganda, that endemicity inevitably means that the disease will become increasingly harmless. Plus I want to put the diseases we already live with in proper perspective - maybe it will be “just the flu,” but the flu is a serious public health issue and a fight that we have been fighting with vaccinations and antivirals for years.
posted by atoxyl at 5:50 PM on December 13, 2021 [2 favorites]

and not only has no one said anything about sending people back to WFH, but they are having a holiday happy hour this week in our tiny kitchen area."

Yeah, my town/work have been lauded for their Covid response, but in-person stuff is now sometimes happening, and they seem determined to Not Go Backwards, and they actually announced that they're getting rid of the mandatory every-two-weeks testing requirement for the vaccinated as of mid-January (note: two weeks after everyone returns from the holidays) because our case rate is so low. I would bet large amounts of money by mid-January they have to take that one back.
posted by jenfullmoon at 6:30 PM on December 13, 2021

Right, atoxyl, reputable public health people don’t just go “well, we’re just going to have this higher rate of death and long term debilitating illness now. No other outcome was possible. Nothing we can do but accept it.” They work to prevent that outcome. And will continue to work to prevent that outcome, even as our provincial goal of eradication becomes less and less likely. The language they use to talk about our future vis a vis COVID is one of probabilities or likelihood, not one of foregone conclusions or defeatist revisions of recent history. Whereas a lot of the right wingers in my area, well, they don’t have a temporally consistent belief in how harmful COVID is or will be in the future. They don’t seem to have latched on to the mistaken idea that it will necessarily become less harmful over time, but they do claim half the time that it is not that harmful in the first place. The other half the time they concede that it is harmful, but are perfectly okay with that because “freedom” is more important and they claim that there’s nothing we can do about it anyways. That is most definitely a fringe belief in my area.

(I think a fair number of people in my region are worried about COVID sticking around and hope that it becomes less harmful, and kind of make the decision to tentatively go with that so they don’t feel overwhelmingly anxious all the time, or constantly enraged at the small number of idiots who are preventing us from more effectively dealing with the pandemic. But also understand that they aren’t experts in the area and will listen to people who are, and understand that COVID is still harmful at present and will follow public health guidelines to protect themselves and other people. It’s the part where some people claim that the problem is unsolvable while simultaneously being the main/only obstacle to solving the problem that I was complaining about.)
posted by eviemath at 9:24 PM on December 13, 2021 [1 favorite]

LOL no. “Endemic” has a specific technical meaning.

Obviously it has a specific meaning but whether a specific stable level of incidence (i.e. an endemic situation) is treated as an acceptable background or not is socially mediated. Otherwise why would we even have terms like hyperendemic (though admittedly that gets used in at least two different ways) if not to disambiguate between stable situations that are / are not acceptable?

I note that in this opinion piece by Peter Sands, of the Global Fund to Fight AIDS, Tuberculosis, and Malaria he makes the point that how malaria, TB, and HIV are described, including by public health professionals, is inconsistent and depends on who is being affected and how rich they are. The best examples are TB and HIV. HIV has no meaningful animal reservoir, TB is a bit more complicated but in either case an extensive testing/contact tracing/treatment campaign *could* eliminate the disease worldwide and such campaigns have worked in wealthy countries.

It is much more common to refer to HIV as endemic in geographies where new infections *exceed* deaths than in wealthy countries where new infections are lower, that's despite that being precisely the wrong way around. Arguably countries like the UK which are targeting zero new infections by 2030 and have a prevalence number which has barely grown in the last decade are the ones with endemic HIV.

So I do not think it is so simple to restrain ourselves to only the purest epidemiological definitions of endemic/epidemic/pandemic when public health professionals themselves don't do so.

Right, atoxyl, reputable public health people don’t just go “well, we’re just going to have this higher rate of death and long term debilitating illness now. No other outcome was possible. Nothing we can do but accept it.” They work to prevent that outcome.

They do but they're (regrettably?) not in charge. We run in our societies in all sorts of ways which are not in line with public health advice. Public health professionals certainly don't just shrug their shoulders and say, "well I guess some people will smoke and drink" but society as a whole does. To some extent that reflects genuine democratic preference, to some extent it reflects malign meddling of economically interested malefactors. See also the role of the automobile in society, our modern diets. I'm not suggesting this is particularly wise but once the novelty of the emergency situation wears off, that does tend to happen.

Meanwhile, here's a, um, viewpoint: "Where I Live, No One Cares About COVID

That's uh, quite something. Is this actually an accurate description of behaviour and attitudes in the American Midwest? I'm not sure whether the editor of a TradCath literary journal is quite my go to source for that sort of thing.

And in some senses my situation has always been more in line with the typical American’s pandemic experience than that of someone in New York or Washington, D.C., or Los Angeles.

There is the underlying and unsurprising implication here that these large cities are unusual and that "normal" Americans live in deeply rural areas when that simply isn't true as a matter of empirical fact. In fact, nowhere in southwest rural Michigan is more than about 40 minutes driving from either South Bend or Kalamazoo and the "typical" American lives either in or immediately adjacent to that kind of medium sized metropolitan area. Quick googling shows me that in fact, Kalamazoo had a school mask mandate until a few weeks ago which they only dropped after hitting a vaccination threshold.

As far as my wife and I are concerned, an atmosphere of parochialism hangs upon relentless adherence to CDC directives.

I guess that's fair, most countries have had fairly parochial and wildly divergent responses to Covid and it is true that the relentless American mania for school closings looks a little odd from, say, France. However you can't just ignore the fact that this has a lot more to do with how the French chose to spend their transmission risk budget than a different objective assessment of school spread. Would the author I wonder think it a good idea to require signed documentation to be out on the streets? France required that. It's pretty parochial not to look at the totality of the measures taken.
posted by atrazine at 5:46 AM on December 14, 2021 [4 favorites]

They do but they're (regrettably?) not in charge.

… You want the people who don’t care about trying to do any attempt at mediating negative effects of COVID to be in charge?

That’s a take.

Personally, I’m super glad the folks in decision making positions (in public health or politicians) in my province care more about preventing death and long COVID. We locked down early enough and for long enough at the start of the pandemic that we eliminated COVID locally by the middle of last summer. And through a combination of ongoing masking, careful border measures (which have, fortunately, evolved to one’s that give protection without limiting travel as much), a decent system for surveillance testing, and “circuit-breaker” lockdowns when new outbreaks arose, we got back to no community spread twice after that, and were minimally impacted by later waves. That means that now that we’re seeing a more serious outbreak, people are not totally exhausted from ongoing restrictions, so tightening up distancing, gathering limits, and masking requirements or even stronger measures if necessary is politically feasible. Just saying, it’s possible y’all. And if you’re feeling discouraged about other humans, look to a wider array of global experiences to get some hope back.
posted by eviemath at 6:32 AM on December 14, 2021

Meanwhile, here's a, um, viewpoint: "Where I Live, No One Cares About COVID

That's uh, quite something. Is this actually an accurate description of behaviour and attitudes in the American Midwest? I'm not sure whether the editor of a TradCath literary journal is quite my go to source for that sort of thing.

I can't speak for the entire American Midwest, but it is super accurate for a good chunk of Michigan.
posted by Preserver at 6:40 AM on December 14, 2021 [2 favorites]

Overall, atrazine, maybe we have some serious miscommunication going on? Your responses to the article from The Atlantic that folks linked seem entirely reasonable. You do seem to agree that it would be more useful if people used terms like endemic more carefully or precisely (and not in a manner biased by colonial attitudes or racism). I think that your own use (aside from your more nuanced distinction between the epidemiological situation and the politics of whether it is treated as acceptable or not in your last comment) is contributing to the unhelpfully inaccurate uses, though. (Also, as I understand it, although I am not an epidemiologist, “endemic” is more a description of the long-term, average situation. Eg. an endemic disease can have specific outbreaks or clusters from time to time. Some definitions.)
posted by eviemath at 6:48 AM on December 14, 2021

And I see that I’m also confusing atoxyl and atrazine. Apologies!
posted by eviemath at 7:01 AM on December 14, 2021 [1 favorite]

eviemath: other parts of the world, such as where I live.

I'm getting more and more curious as to where that might be. Would you care to enlighten me? Vague is, of course, fine.
posted by Too-Ticky at 8:04 AM on December 14, 2021

I'm getting more and more curious as to where that might be. Would you care to enlighten me? Vague is, of course, fine.

I'm pretty sure it is that mythical utopian land that is thought of as north of the United States (though a huge portion of the population actually lives south of a lot of Michigan). They've managed to have 1/3rd of the covid catastrophe that the United State has had despite being entirely lacking in warm winter weather regions and later access to vaccines (as well as using some less effective vaccines).
posted by srboisvert at 8:31 AM on December 14, 2021 [3 favorites]

I live in rural SW Michigan. (Paw Paw to be exact)

The article in The Atlantic is fully accurate. Even while cases are spiking and the state Health Department issued a mask advisory, 90% of folks in grocery stores and WalMart and Tractor Supply Company wander the aisles without masks and without cares for social distancing.

I, uh, wear a mask.
posted by toddforbid at 8:36 AM on December 14, 2021 [4 favorites]

Just saying, it’s possible y’all.

I mean, no. It WAS possible, theoretically, 19 months ago, if absolutely everything else about the nation 19 months ago had somehow been miraculously the exact opposite of everything that it actually was. But it's no longer possible in the United States.
posted by We put our faith in Blast Hardcheese at 8:37 AM on December 14, 2021 [4 favorites]

I'd say it is still possible in Democratic Party dominant regions. I have been fighting with my building management for the last 4 months to enforce the indoor masking mandates that went back into effect in Illinois in September. All I got was excuses and no movement/enforcement whatsoever from the state, city, or my building manager. The predominately young tenants had about 30% compliance maybe. Then this past week once it became clear what was coming the building management put signs back up and mask compliance in the building has gone way up. A couple I had a yelling match with just last week who insisted they didn't have to mask up because they were vaccinated are now masked and sheepishly avoiding riding the elevator with me (win-win for me).

People can adjust their behaviors to circumstances when the communication is clear and the threat is obvious. The problem with large chunks of America is that the only communication channel is Fox News.
posted by srboisvert at 9:08 AM on December 14, 2021 [3 favorites]

A couple I had a yelling match with just last week who insisted they didn't have to mask up because they were vaccinated

I really agree about how quality communication is necessary. So many people who are, in principle, on board with covid measures are working with incredibly outdated - or just plain wrong - information about how it spreads (vaccination means you don't get or spread covid, 6 feet apart will protect you, partitions will protect you, less than 15-30 minutes of exposure is fine, surgical masks and cloth masks are super, you're definitely, reliably not infected if you tested negative 24 hours ago or right after an exposure or 4 days after an exposure but also you're living with someone who's potentially exposed on a regular basis or...)

It's amazing how misinformed you can be even when you're someone who both cares and regularly watches (non-alternative-facts) TV and reads (non-alternative-facts) newspapers. I see this with friends and family and it's really worrying.
posted by trig at 9:54 AM on December 14, 2021 [3 favorites]

Back to the science itself, here's a good summary of the latest insights in the effort to understand Omicron, from Dr. Eric Topol at Scripps Research.
posted by PhineasGage at 9:55 AM on December 14, 2021 [3 favorites]

I'd say it is still possible in Democratic Party dominant regions.

A big component of the process Eviemath described is border controls. Do you really see Chicago shutting its highways and requiring vaccination cards/negative tests to enter city limits? CAN it even do that? (I am seriously asking--I know that it is possible for the city/county to be stricter than the state but never to be less strict than the state, but no idea if that extends to literally closing the city/county.)
posted by We put our faith in Blast Hardcheese at 10:06 AM on December 14, 2021 [3 favorites]

There aren’t many countries on earth that managed to eliminate community spread of COVID for any significant period of time. Certainly nowhere in the US came anywhere remotely close regardless of the political party in charge. My northern US very Democratic state dropped to like 50 confirmed cases per day at its lowest in summer 2021. Of course testing always misses cases.
posted by eagles123 at 10:12 AM on December 14, 2021 [2 favorites]

surgical masks and cloth masks are super

Ha! I recently had to go to the hospital for a scan (in Canada) and they made me take off my KN94 mask and put on one of their surgical masks.
posted by ssg at 10:39 AM on December 14, 2021 [2 favorites]

Overall, atrazine, maybe we have some serious miscommunication going on?

I'm perhaps not being sufficient clear where I'm making cynical predictions about how people will act and where I'm being normative.

… You want the people who don’t care about trying to do any attempt at mediating negative effects of COVID to be in charge?

Possibly too many layers of nesting there to be clear. The "they do" referred to public health professionals taking steps to reduce suffering, my point is that outside of frightening and novel situations, societies give a lot less weight to the judgement of public health professionals and not just when it comes to infectious disease. I see how that sentence could also read to say that the people who regrettably are not in charge are public health professionals who don't aim to reduce suffering (a category that I doubt has many people in it).

So I think that now that people have grown used to what was a novel threat, we will see the risk balancing that society does take over from the scientific judgement. For the absence of doubt, I don't think that the way society balances risks generally (and that counts for every society I have visited and lived in) is very good.
posted by atrazine at 11:02 AM on December 14, 2021 [2 favorites]

https://www.google.com/amp/s/www.axios.com/colorado-governor-polis-covid-mask-mandates-d7c62e9e-33a4-41c8-b9f8-5b0345c7a2c1.html

Even in a Democratic state like Colorado the governor (a Democrat) is starting to give up. Granted I’m not a big fan of Polis, but I see absolutely no indication political leadership anywhere is willing to take the steps necessary to eradicate SARS-COV 2. The only countries that came close to temporarily halting detectable cases were in east Asia and Australia/New Zealand, and they’ll have to basically wall themselves off from the rest of the world to stay SARS COV 2 free if they ever get to that status again. We’re basically still flattening the curve to protect hospitals whether we want to admit it or not.
posted by eagles123 at 11:35 AM on December 14, 2021 [3 favorites]

One wild thing is watching the UK have a whole-of-government freakout over Omicron. They're generally running around as if Omicron is actually dangerous. They're bringing in the Army to speed up boosters, they're pulling GPs off their usual duties to staff vaccination centers, they're advising people work from home. And this is Boris Johnson's Tory government. BoJo is giving prime-time speeches about what's happening.

The US has had, what, Dr Fauci asking people to go get their boosters now if they haven't already? Have there been other visible government responses? We haven't even officially "detected" omicron in every state, even while 20% of tested cases in Washington are coming back Omicron, so it's almost certainly everywhere by now and we're just not sequencing enough. There's still rhetoric around about how we "shouldn't panic." It all feels very March 2020.
posted by BungaDunga at 12:44 PM on December 14, 2021 [3 favorites]

And I see that I’m also confusing atoxyl and atrazine. Apologies!

More people here named after chemicals starting with “at” than one might think.
posted by atoxyl at 1:16 PM on December 14, 2021 [1 favorite]

Meanwhile my state's covid reporting got hacked and that haven't released any case or death data since Dec. 3. Judging by the hospitalization spike in the data they have released, though, it's all going to be very this is fine.gif once they do!
posted by advil at 3:28 PM on December 14, 2021 [1 favorite]

A big component of the process Eviemath described is border controls.

You have to test people coming in, and follow up with them to test again in three days or ensure they follow quarantine restrictions, yeah. And my province’s third wave was kicked off by a family that had a big family gathering with sub-members who came from Ontario and didn’t follow the requirements. But in general, the clear and consistent communication from provincial public health officials had most people understanding why the requirements were in place and on board with them, and people who have been all “this is tyranny!” have been quite unpopular.

Most states have acted like that’s not something they have the power to do (unlike Canadian provinces), and possibly that’s true for this sort of thing. At least, I always thought states couldn’t legally set up any sort of restrictions on travel at their borders. And then I drove into California along a non-interstate, where there is a checkpoint and every vehicle has to stop for agricultural border controls. So maybe it is legal in other situations as well? The feasibility for a state like Illinois is a separate issue, of course. There simply aren’t as many roads in Canada, even between the larger provinces.
posted by eviemath at 4:53 AM on December 15, 2021 [2 favorites]

Although, I meant to add, you could just test everyone regularly and not treat new arrivals differently. That’s kind of what we’re doing now. Except the province decreased availability of asymptomatic rapid tests in mid to late fall and relied a little over-much on proof of vaccination without enough backup measures, so our current outbreak got big fast. But a major testing push in combo with some restrictions on gathering limits and such looks like it will control that relatively quickly. And people are discouraged of course, but understand the need and aren’t as exhausted as folks elsewhere report from having to be on a higher level of alert for quite as long, so taking strong enough measures to control the latest outbreak is still a political possibility (popular, even) here.
posted by eviemath at 5:02 AM on December 15, 2021 [1 favorite]

The biggest problem is that a lot of places in the US are too integrated to accept arbitrary borders based on jurisdictional lines. Not from a political perspective but just a practical one. Think of a border like NH/MA. Between I-93 and US-3 alone, a seven mile gap, there are thirteen border crossings. You would have to man each one of those border crossings with state troopers and because there are so many crossings you'd be staffing them thinly to the point if one or two state troopers becomes corrupt in enforcement you basically have no border for the virus.

Western Australia has been one of the best places in the world to ride out COVID. It's a state on an island and it has two border crossings, one in Eucla and one in Kununurra. They have whole squads of WA Police with full chains of command on both crossings to ensure accountability. Anyone getting through that border is serving two weeks in hotel quarantine before being let into the population. My cousin is just finishing his now, he's moved back to Perth from Sydney last week.

The UK not becoming a literal fortress keeping out COVID is unforgivable though. They had every advantage in fighting the virus and they squandered it. Literally fucking squandered every opportunity because that fucking mop top just wanted to roleplay being the PM and enjoy the prestige without doing any of the work. Like he's done with every endeavor he's ever fucking tried.
posted by Your Childhood Pet Rock at 7:18 AM on December 15, 2021 [1 favorite]

(Also, just popping back in to say thanks for that very thoughtful reply, atrazine.)
posted by eviemath at 11:26 AM on December 15, 2021 [1 favorite]

Granted I’m not a big fan of Polis, but I see absolutely no indication political leadership anywhere is willing to take the steps necessary to eradicate SARS-COV 2.

That ship sailed in March 2020, friend. At this point, the goal is harm reduction. Since CO borders KS, NE, WY, & UT, there is simply nothing the state can do that won’t be undone by the neighbors.
posted by Big Al 8000 at 5:17 PM on December 15, 2021 [4 favorites]

Even if you can get humans to obey Covid restrictions, good luck with deer. SARS-CoV-2 isn't going away.
posted by BungaDunga at 7:18 PM on December 15, 2021 [1 favorite]

Oh, I'm well aware. It just seemed like some were suggesting we could eliminate or contain COVID using existing NPI's like masking. I could have misread/misinterpreted though. If so, I apologize. At this point, the NPI's mainly serve the purpose of keeping hospitals from being overrun. Vaccines are really the only method to protect yourself on a personal level over the long term.

Based on how things are going, it looks like another large winter wave, most probably larger tha any before in terms of case counts, is invetible at this point. In the UK cases are starting to explode. They just recorded their highest daily case count of the pandemic yet by a good margin. Meanwhile in South Africa cases might be peaking in the hardest hit regions. Reports from South African scientists and health officials strongly suggest much milder impacts in terms of hospitalizations and death. Most attribute that to previously acquired immunity from vaccination and prior infection. As always, the unvaccinated make of the vast majority of hospitalizations. Of course, nobody is willing to pop the champagne just yet, but any good news is welcome. It should be noted that South Africa was only between 25 and 35 percent vaccinated at the start of the Omicron wave.

Also, there is a study that suggests Omicron spreads faster because it replicates more quickly in bronchial tissue but at the same time less well in lung tissue compared to the original variant. That's the first time I've seen a plausible mechanism for reduced virulence and increased transmissibility that doesn't involve pre-existing immunity or immune evasion. Again, of course, that is very preliminary and not definitive, and nobody is saying to pop champagne or let down guard. Still, also again, I'm ready for any hint of good news considering its probably too late to prevent another large wave of infection, and it doesn't seem like there is much appetite for additional measures to combat spread, at least in the US.
posted by eagles123 at 9:08 PM on December 15, 2021 [2 favorites]

As always, the unvaccinated make of the vast majority of hospitalizations.

This may not be the case in the UK. So far there are only ten people in hospital, but the majority are vaccinated. Given the data we've seen from the UK on vaccine effectiveness for two Pfizer or two AZ shots (against symptomatic infection, not hospitalization yet) and the proportion of people in the UK who are vaccinated and their age ranges, I don't think it would be surprising if the majority of people who end up in hospital are vaccinated. This may be the case in many countries with similar vaccination rates, unless they can give a lot of boosters very fast.
posted by ssg at 10:18 PM on December 15, 2021 [4 favorites]

I just watched TWiV and the hosts were quite critical and dismissive of the Omicron bronchial study. Amy told them to go back and relearn y = mx + b because the press release graph is ridiculously misleading and could be interpreted in a way contrary to the claims.
posted by polymodus at 5:56 AM on December 16, 2021

I’m not surprise the TWIV hosts shit on the study. However, it should be noted that they, probably rightly, shit on most of the research discussed in the media. They’ve been pretty dismissive of the idea of “variants” making a meaningful difference all along.
posted by eagles123 at 7:41 AM on December 16, 2021

Working with researchers at Icahn School of Medicine at Mount Sinai in New York, they tested a protein-based vaccine designed to jump start an IgA immune response, administering it to mice through injections, as is commonly done with systemic immunizations, and also intranasally. They then exposed mice to multiple strains of influenza viruses. They found that mice which had received vaccine intranasally were much better protected against the respiratory influenza than those that received injections. Nasal vaccines, but not the shot, also induced antibodies that protected the animals against a variety of flu strains, not just against the strain the vaccine was meant to protect against.

posted by craniac at 9:37 AM on December 16, 2021

I don't think it would be surprising if the majority of people who end up in hospital are vaccinated

I thought that this was maybe already the case in the U.K., even, for the reason you suggest - vaccination coverage in people over 70 is very high, but overall risk of serious illness if you’re 80 and vaccinated may still be higher than if you’re 20 and not. Especially 6+ months after the last dose.
posted by atoxyl at 10:54 AM on December 16, 2021 [1 favorite]

‘The Media Variant’ Hits New York City

Yesterday, I jumped in line at my local City MD, at Lexington and 79th. By the time I got swabbed two hours later, the blue check mafia had worked itself into a full-on Omicron meltdown. What remained of the media-holiday-party industrial complex collapsed in a single afternoon.

It began, as these things often do, in the group chats. Everyone seemed to know someone who’d tested positive that very morning. Suddenly, it all spilled on to Twitter. “we’re calling the wave of COVID currently ravaging Brooklyn ‘The Media Variant,’” tweeted BuzzFeed’s Julia Reinstein. Business Insider’s Jake Swearingen wrote: “you have about 12 hours left to get covid if you want to stay on trend.” The writer Jamie Lauren Keiles: “everyone who is anyone has covid right now.”

posted by BungaDunga at 11:52 AM on December 16, 2021 [2 favorites]

More people here named after chemicals starting with “at” than one might think.
posted by atoxyl at 1:16 PM on December 14 [+] [!]
Meanwhile my state's covid reporting got hacked and that haven't released any case or death data since Dec. 3. Judging by the hospitalization spike in the data they have released, though, it's all going to be very this is fine.gif once they do!
posted by advil at 3:28 PM on December 14 [+] [!]

(Metaponysterical!)
posted by dmh at 1:01 PM on December 16, 2021 [5 favorites]

‘The Media Variant’ Hits New York City

Turns out chuds didn't live just in the underground. Some made it to the surface and got hired as a columnist for New York magazine.
posted by Your Childhood Pet Rock at 2:20 PM on December 16, 2021 [1 favorite]

More info on the outbreak in Norway.

My take: a little bad news (that we already knew about) but a lot of good or very good news:

Bad news:
* over 70% of people (out of over 110) with 2 vaccine doses caught Omicron at a single dinner party. Omicron is contagious AF even if you are vaccinated.

Good news:
* however, of the 80+ people infected, zero were hospitalized 2 weeks out
* most reported mild to moderate symptoms: Cough, runny nose, fatigue, sore throat, headache and fever were most common, only 12% reported loss of smell (anosmia) or trouble breathing (dyspnea)
* 99% reported at least one symptom, suggesting that asymptomatic illness may be rare with omicron, which could help avoid spread

Even better news:
* none of the people had received a 3rd booster dose, suggesting an upper limit for severity - in a similar but boosted cohort, we'd expect even better outcomes.

Remaining questions:
* the median age was 38, oldest was 68, so this doesn't say much about how Omicron is in older populations.
* two weeks is too soon for any info about long covid, though I belive the low rates of anosmia and dyspnea are a good sign.
posted by soylent00FF00 at 4:45 PM on December 16, 2021 [2 favorites]

Poop:

It's interesting that wastewater surveillance seemed to track cases pretty closely during past waves, but that is no longer seems to be the case with the current wave: poop report dashboard. That kind of tracks with what was observed in South Africa, and it suggests testing is now missing a lot of cases. Clicking through on a regional basis, it looks like the divergence exists in the southern and western regions of the United States but not in the midwest and northeast. To me that suggest either Omicron is present in the west and south and not the northeast, which doesn't seem to match other reports, or it suggests that the difference arises from divergent testing practices. I've thought all along that relying on cases to track spread and set metrics creates perverse incentives to undertest for less than scrupulous political actors.

Meanwhile, cases seem to be peeking in S. Africa's Gauteng province, and hospitalizations are slowing. Gauteng is S. Africa's most densely populated province by far.

As a sidenote, it's not always clear both in S. Africa and the US whether hospital admissions are due to COVID or due to other conditions and patients are testing positive for COVID during screenings. For example, this report on hospitalizations due to "breakthrough" cases in the US mentions this limitation. Apparently S. Africa periodically releasees reports that clarifies this discrepancy, but its not always included in these data trackers. A S. African demographer heavily involved in tracking excess deaths tweets extensively about issues related to data collection in his country.

In the US, the NFL recently revised its COVID guidelines in an interesting way. In addition to enhanced NPIs, they relaxed rules for allowing vaccinated asymptomatic players to return to the field. The relaxation likely occurred because teams were in danger of needing to forfeit games because too many players were being quarantined. I think that dilemma points to a larger issue that Omicron's enhanced ability to spread may cause pressures on hospitals, schools, and other essential businesses due to employees needed to isolate due to positive tests. Of course, as mentioned above, if you don't test, its less of a problem .....

I just watched TWiV and the hosts were quite critical and dismissive of the Omicron bronchial study. Amy told them to go back and relearn y = mx + b because the press release graph is ridiculously misleading and could be interpreted in a way contrary to the claims.

To add to what I posted above, from what I can tell listening to TWIV, they've been skeptical from the beginning as to the impacts of observed mutations to the virus on observed differences in transmissibility and virulence. I completely understand why. Virology relies on experimental lab studies, but most of the studies used to characterize the variants either rely on in vitro experimentation or correlation epidemiological studies. For example, the studies estimating R values seem to be household transmission studies that match new variants with existing variants with perhaps some additional matching of participant groups on relevant variables (e.g., age, co-morbities) if your lucky. I dimly remember from grad school several threats to the validity of inferences drawn from these quasi-experimental designs.

I mention the above to highlight the point that its devilishly difficult to determine whether observed changes in spread and virulence between variants are due to inherent changes in the biology of the virus or changes in host behavior and host biology (e.g., changes in immunity due to prior infection or vaccination and changes in behavior). I was thinking of this I was watching a basketball game with a stadium full of spectators. Last year at this time the NBA still played in empty arenas. I keep that in mind when I hear reports of Omicron's unprecedented spread. To me, it's kind of expected that it would spread faster if it's able to evade antibodies and people are engaging in more interactions. I'd also expect infections to be milder if there is more population immunity due to prior infections and vaccination.
posted by eagles123 at 9:38 PM on December 16, 2021 [1 favorite]

Imperial College study of all known Omicron infections in the UK to Dec 11 says we still don't have enough evidence to make any judgements about severity. There still isn't enough hospitalization data to reach any conclusions.

Note that the data doesn't indicate that hospitalizations look lower, but we can't say for sure yet. The data currently show very similar hospitalizations to Delta, but there is very little data with only 24 having attended hospital. We'll see once more data comes in.
posted by ssg at 10:05 AM on December 17, 2021 [5 favorites]

It's not the first time I've heard empiricism being leveled against TWiV, but I think there are couple of different parts to appreciating their view. For example with the HKU paper, their specific criticism was that the graph lacked a zero point. That would be a pretty big lapse, and it was enough for them to skip the rest of the paper.

As to their general stance, the way they explain it is if we just simply use scientific common sense (if there can be such a thing), then it is absurd to see a 70 x change in infectiousness. What's driving this is predominantly human behavior: in particular, they emphasize the pockets of unvaccinated actors and the 80/20% rule. All the variants are pretty much the same, for practical purposes, and it is wishful thinking for people to blame and media-hype the problems on mutant variants. So for empiricists, I would even argue that the TWiV folks are quite good at applying scientific thinking in a straightforward manner, and so they are being critical about that balance between anthropogenic vs virus's mutations being a factor of each wave of infection.

The other point they've suggested is that Omicron is quite possibly just a streetlight effect. The world has much better testing now compared to last year, so if there was this capacity last year, we might just as see Delta spreading as fast.
posted by polymodus at 4:20 PM on December 17, 2021

That wasn’t meant as a criticism of TWIV. I generally agree with their takes.
posted by eagles123 at 5:31 PM on December 17, 2021 [1 favorite]

All the variants are pretty much the same, for practical purposes

If that were actually the case it wouldn't explain why NSW has seen a 3x rise in the reproduction rate over the last few weeks, while Victoria's is only just now starting to grow. Both States have had similarly fuck-it-we're-done non-containment policies in place for much the same amount of time, but NSW is where Omicron was first detected in Australia. And cultural differences between the two States are really very minor, certainly nowhere near enough to explain a 3x reproduction rate discrepancy on behavioural grounds.
posted by flabdablet at 3:10 AM on December 18, 2021 [3 favorites]

« Older The loose boys are back | Chill Out Newer »

This thread has been archived and is closed to new comments

MetaFilter

Omicron appears to be spreading among the immunized population
December 10, 2021 9:40 AM Subscribe

Tags

Share

Omicron appears to be spreading among the immunized population December 10, 2021 9:40 AM Subscribe

Tags

Share

Omicron appears to be spreading among the immunized population
December 10, 2021 9:40 AM Subscribe