Natural immunity comes with a 10--25x greater risk of death, possibly much higher (see update) by COVID itself. (The risk from the vaccine, without a Covid infection, is effectively nil based on hundreds of millions of doses administered.)
Natural immunity comes with a ~9x greater risk of hospitalisation, again from Covid itself. There's effectively no risk from the vaccine, again with hundreds of millions of doses administered.
Among adults aged 65–74 years, effectiveness of full vaccination for preventing hospitalization was 96% for Pfizer-BioNTech, 96% for Moderna, and 84% for Janssen COVID-19 vaccines; among adults aged ≥75 years, effectiveness of full vaccination for preventing hospitalization was 91% for Pfizer-BioNTech, 96% for Moderna, and 85% for Janssen COVID-19 vaccines.
Note that "natural herd immunity" doesn't come without a near-total population infection rate, with a large number of deaths, prolonged medical care, and long-term health consequences. The vaccine-based risks are far, far, far lower.
There's also quite likely a much higher likelihood of long-term Covid symptoms or consequences.
This information is interesting, but a poor basis on which to shift policy from vaccination to infecting the entire population and blessing the survivors.
US CDC reports an 0.0016% fatality rate from all causes for vaccinated individuals. That's 100x lower than the incident fatality rate of 0.1% suggested by multiple countries with excellent Covid surveillance and reporting systems. Note that many early vaccine recipients were elderly (65+) and would have a higher natural death rate than the general population.
>This information is interesting, but a poor basis on which to shift policy from vaccination to infecting the entire population and blessing the survivors.
Only if we were starting from a point of nobody having been infected already. In LA, Chicago, NYC, Miami, ~50% of the population has been infected[0]. If the Israeli study is accurate, then all of those people should be considered as immune as vaccinated, therefore not requiring any additional vaccination. That should absolutely shift policy wrt vaccinations.
Those populations may not be comparable, the headline numbers are from people who were PCR tested to be positive, the population-wide studies are based on seropositivity and modelling. The Israeli study explicitly calls out that it may be undersampling asymptomatic infections.
Pfizer has a lot of supporters.
Funny for a corporation that is making substantial profits from our taxes.
Even funnier that no other treatments are even given to pacients - only this unique solution. Humanity has become a strange place.
It's good as a combination I think. You can get the vaccine to prevent major illness and death, and if you catch Covid as a breakthrough case, you'd be even more strongly immune thereafter, hypothetically.
How does it compare to natural immunity from a "breakthrough infection"? If risk of hospitalization is low and following immunity is stronger, that seems relevant to whether we some should get booster shots, esp when so many haven't been able to get their first round
Yes although the delta variant has undermined the efficacy of vaccines at preventing infection (from 91% to 66% [1]), it is still fairly effective at preventing severe outcomes such as hospitalization and death.
> but a poor basis on which to shift policy from vaccination to infecting the entire population and blessing the survivors
This is not at all what the paper is suggesting, and people should not be interpreting it as such. The fact is that a vast majority of people infected by SARS-CoV-2 will survive without any severe outcomes. In fact a significant proportion (at least 33% and up to 65% [2][3], perhaps even more [4][5]) will be completely asymptomatic.
This has implications for vaccine strategy because supply of doses is limited - these findings imply that individuals who are immunologically naive or vulnerable due to age and comorbidities should be prioritized for vaccination, rather than people who have already acquired robust and durable immunity from natural infection [6].
> This is not at all what the paper is suggesting, and people should not be interpreting it as such.
I don't think the OP meant that the paper is suggesting that, the article linked makes it clear that Senators (such as Rand Paul) are using this pre-print paper to suggest exactly that. Rand Paul has a lot of clout and influence over the various narratives in this country, especially against protective mandates. In his world, public policy would be non-existent, and the will of the people would be enacted through market forces (choosing to go to certain businesses based on their personal decisions to impose mandates as a business on their customers or employees). Then the market decides if we actually as a country naturally fight against the virus at all or instead help it spread, and further divide the country based on people's uninformed individual purchasing choices.
The science really doesn't enter the picture for Rand Paul, despite him being a medical doctor, because to him government intervention in anything is always inherently bad.
Anecdotally, I've seen many COVID patients experience re-infection after months on a COVID survival support groups on Facebook. ( assuming that people would not have any incentives to spread fake news on these kind of group ).
This is quite contradictory to the study. I'll guess we will have to wait for the peer-review process.
I'm looking for a source, though the 25x factor was part of the 29 July 2021 CDC leaked report.
I'm happy to correct / update my comment with a reputable source.
From US CDC:
Reports of death after COVID-19 vaccination are rare. More than 363 million doses of COVID-19 vaccines were administered in the United States from December 14, 2020, through August 23, 2021. During this time, VAERS received 6,968 reports of death (0.0019%) among people who received a COVID-19 vaccine. FDA requires healthcare providers to report any death after COVID-19 vaccination to VAERS, even if it’s unclear whether the vaccine was the cause.
The claim was "Natural immunity comes with a 10--25x greater risk of death". That's a statement about the chance of dying from the vaccine to the chance of dying from Covid.
The numbers you're actually using are something quite different: they're comparing the chance of dying from Covid if vaccinated, vs. the chance of dying from Covid if unvaccinated.
The only credible reports of Covid vaccine fatalities that I'm aware of were from the AZ and J&J ones, and seemed to be on the order of 100 cases in all European countries before the use of those vaccines was stopped at least for the at-risk group (young women).
If the chance of dying from the vaccine was only 10x lower than that of dying from Covid, we'd have millions of dead from the vaccine. We don't.
If we are going with differentiating "all causes" then surely this should be done with infections as well? I don't have numbers on hand but the last CDC report I saw (March 2020 to 2021 I think it was) had only 740 deaths "from [Delta variant of] COVID-19" compared to a few hundred thousand of "all causes" (with COVID). Granted even if those numbers are accurately relayed by my memory (and I doubt they are) the Delta stuff didn't take off until much later, but I'm kinda just making a point here. What that point is I dunno, but I'd just like more apples to apples comparisons in these discussions.
The AP pegs the average mortality rate at 1.8% for COVID-19, or 1 out of 55 cases.[1] The CDC says the mortality rate for vaccination is 0.0019%, which my imperfect math says is about 1 out of 53,000 vaccinations.[2] These statistics indicate natural immunity on average exposes the person to roughly 1,000x data-derived historical risk of death on average, when compared to vaccination, so I'm not sure what is the source of the lower figures in the earlier post. In any event, as a risk-weighted matter vaccination and weak immunity still seems better than infection and subsequent strong immunity. Just sayin'.
This is not a valid comparison because you're using the case fatality rate (1.8%), and case means symptomatic illness (a majority of infections are not symptomatic). A fair comparison would use the infection fatality rate (IFR), which is the risk of death after being infected.
Recent meta analyses estimate a global average IFR of ~0.15% [1], which is extremely biased by age. All age stratified IFRs show risk that decreases by orders of magnitude with age. We're talking IFRs below 0.003% for healthy young adults and children [2][3].
I'm not advocating against vaccination, just illustrating that the risk-reward profile is different for everyone based on their age and health. If you want to derive useful probabilistic risk estimates, there are many complex factors to consider.
Maybe from John Hopkins[1]? According to them, U.S. had fatality rate of 1.6%, albeit they use confirmed infections of 38.7 million vs. CDC estimates of 120 million.
Edit: It seems like CDC is inflating their infection rates compared to almost every other source. According to this[1] they also are more in-line with John Hopkins infection rates.
To note, mortality is rather similar in all sources I can find, but only CDC says 120 million were infected.
So then why are all other sources showing much lower infection rates?
I can't find what the date ranges are for John Hopkins' data. OurWorldInData says Feb 2020-Aug 27, 2021. The CDC link from GP says February 2020–May 2021.
Your links give the fatality rate for confirmed cases, which is basically useless. For the most part only people with significant symptoms bother to get tested and counted as cases, which skews the fatality rate artificially high. What matters is the actual fatality rate over all infections. The CDC documented their estimation methods on their site if you want to get into the details.
> The AP pegs the average mortality rate at 1.8% for COVID-19, or 1 out of 55 cases.
This is nowhere near correct. The global median IFR for Covid-19 is somewhere around 0.3%. It varies substantially by region, but 1.8% is far higher than even the highest legitimate estimate.
> Your source is a sole paper with one author, the guy who "estimated that the coronavirus could cause 10,000 U.S. deaths if it infected 1%"
That's an ad hominem, and a complete mis-representation of what he said at the time. The "guy" is one of the most-cited scientists in the world, and the publication is from the WHO. You just don't like what he has to say, so you dismiss it.
But sure, how many other sources do you need? His work is entirely consistent with everyone else...
> Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus.
> We find that age-specific IFRs estimated by the ensemble model range from 0.001% (95% credible interval, 0–0.001) in those aged 5–9 years old (range, 0–0.002% across individual national-level seroprevalence surveys) to 8.29% (95% credible intervals, 7.11–9.59%) in those aged 80+ (range, 2.49–15.55% across individual national-level seroprevalence surveys) (Fig. 2a). We estimate a mean increase in IFR of 0.59% with each five-year increase in age (95% credible interval, 0.51–0.68%) for ages of 10 years and older.
The CDC's current best estimate for US IFR for those under age 65 is 6,000 / 1,000,000 (0.6%). Reduce that by an order of magnitude for those under 50, and another order of magnitude for those under 18:
And finally, just to show you that the OP's estimate is widly wrong, here's a paper based only on China, from June 2020, citing a correct-for-the-time (but high for today) IFR of 0.66%:
The CFR (case fatality rate) is based on the number of reported cases, which falls short of the total number of incident cases.
The countries with the lowest CFR consistently report about 0.1% CFR. These countries also have the best surveillance, and this is likely near the actual IFR (incidence fatality rate).
The adjusted difference is closer to a 100x benefit for vaccination than a 1,000x. Both are of course immense improvements over no vaccination, at minimal risk.
That's good news for people who have already recovered from Covid. We should definitely take that into account for policies around opening up again, i.e. by treating recovered people like vaccinated people. Beside that it is of little use, is it? "Get Covid to be better protected from Covid" doesn't make a lot of sense to me, at least.
I seem to recall someone suggested that since a large percentage of the population is vaccinated and are therefore protected against severe covid, we should now actually try to catch it to develop a natural immunity to the virus.
I had skimmed and summarized such an article (submitted by someone else) a few weeks ago. I'm not sure that I would actually agree with it though. You can find it here:
The “problem” is that vaccinated people with the virus but experiencing no symptoms is that they still spread it to both unvaccinated and vaccinated alike. While many might not feel sympathy for the unvaccinated, a small % can’t get the vaccination, and there will still be that % of vaccinated people that do have a bad health outcome.
At this point the Delta variant is so contagious that there will be no significant herd immunity effect to protect unvaccinated individuals. They're going to get exposed and infected eventually no matter what we do.
Maybe. I quibble with "no significant herd immunity."
I'm in an area with a very high vaccination rate (>87% of those over age 12 having had at least one dose, >80% fully vaccinated). Our case counts are a fraction of the rest of the country. The country's rates would be expected to be 3x lower if we could simply extrapolate my locale's rates among vaccinated and unvaccinated people to those fractions of the population in the rest of the country. This seems to hold up in other high-vaccination regions, though obviously there are confounds.
The phase delay and greatly decreased count even makes me speculate that my locale (which is still using some mitigations) may be operating in a regime of Rt < 1.0 right now, and all case chains (slowly) geometrically decay from outside introductions from travel, etc. And we expect immunity to improve further, from kids being vaccinated and from more unvaccinated people getting infected.
Maybe this isn't true. But we seem, at the least, to be experiencing some benefit beyond the direct benefits for vaccinated individuals.
Case counts are meaningless as they largely reflect the level of testing. In most places there's not enough random population testing going on to get accurate infection counts. In the US the CDC estimates that infections are about 4× officially counted "cases".
My locale also has the highest reported rates of testing that you'll find. Indeed, if you discount case counts and choose objective measures of increases in hospitalization (small to moderate) or increases in deaths (not detectable yet), the picture is even more tilted in the direction I describe.
That is, it seems we undercount less here, so the difference in true rates is even greater than I claim above.
Unfortunately, hospitalization and death rates are not broken out by vaccination status, and are low enough that they'd be mostly noise even if they were. This precludes doing the same kinds of analysis with death or hospitalization data.
And, of course, the fact that my locale takes things more seriously on the whole is its own confound. That is, vaccination rates are not an independent variable.
My point is limited to problems with vaccinated people willfully exposing themselves to the virus on the basis their negative health outcome is low, and it might minimize bad health outcomes in the future. Even assuming that is true in most cases, they still carry and spread the virus. Point is vaccinated persons probably should not be willfully exposing themselves to the virus on the basis they are protected and will gain additional protections.
We don't need to. People could be given the option of testing, or of going into isolation for the incubation period. Several countries had great effect from ordering a lockdown and testing the entire population over a day or two, releasing those who are negative from lockdown, and repeating this process multiple times in badly affected areas. Slovakia did this and it seems to have been extremely effective, though obviously not enough to eradicate it: https://www.bmj.com/content/371/bmj.m4761
Irrelevant. What appeared to work temporarily in Slovakia last year has no bearing on management of the more contagious Delta variant. Community transmission in most countries is so widespread now that there's simply no practical way to isolate so many people. It's just too late for that to work.
I'm not in one of those countries. I'm in Canada and the medium-sized city I live in has a dozen cases a day, which is an increase over the last few months. The large majority have not contracted it here yet. We continue to use mass testing and partial restrictions to control the rates, along with vaccination. I have no idea if this is a winning proposition in the long run especially with the new contagious variants. But it does seem to work in terms of case numbers so far.
You can't trust people to self report having covid. Because a very high percentage will lie about it. Same as rules that allow vaccinated people to not wear masks. Unvaccinate people will up and lie about being vaccinated.
I've had COVID multiple times since this all started, no symptoms, I have positive tests and Antibodies. The pressure of getting the vaccine finally got to me. I didn't want to get it. Coming from a science background, my understanding is that my body is neutralizing COVID before it can cause any clinically expressed inflammation.
The media, politics, and big pharma need to stay out of medicine, but it's too late.
>Beside that it is of little use, is it? "Get Covid to be better protected from Covid" doesn't make a lot of sense to me, at least.
"Get Covid to better protect others from Covid" - Stronger immunity results in less chances to get infected again and less viral spread when infected. Ie. given that existing vaccines don't protect much against infection by delta, and that once infected the vaccinated spread the virus like unvaccinated, one can see that the people with natural immunity are much more preferable to have around than vaccinated.
>once infected the vaccinated spread the virus like unvaccinated
You are spreading disinformation. Vaccinated people who do get sick are less likely to spread the virus, and have a high viral load in their system for a shorter duration:
---
A vaccinated person may have the same viral loads as an unvaccinated person, but that high level of virus lasts only three to four days compared with an unvaccinated person who could be contagious for up to 10 days, said Suresh Mittal, professor of virology at Purdue University’s College of Veterinary Medicine.
“Individuals who are vaccinated have a good immune response. If they get in contact with people who are infected, they might get infected, but the majority may not transmit,” he said.
(also replicated by the recent NBA study that I failed to bookmark, which also found that the Ct levels were similar with delta and prior variants, including old-school D614G although the average for delta was slightly lower but not within the statistical power of the study)
That means that while mRNA loads are similar in breakthrough infections they're composed of more viral debris and they clear faster. That suggests they're less transmissible.
During Alpha, 80% of breakthrough infection is Israel did not transmit in social settings:
There's no evidence that is free from massive confounding factors that delta is really that much of a game changer in vaccinated individuals. Its biggest effects is on pushing the herd immunity threshold across the population near enough to 100% as not to matter and for being twice as bad for unvaccinated individuals.
The reasonable evidence is still that vaccines work and are effective and safe and the best way to end the pandemic, and that delta is still largely transmitting and killing people through the unvaccinated population.
>The reasonable evidence is still that vaccines work and are effective and safe and the best way to end the pandemic, and that delta is still largely transmitting and killing people through the unvaccinated population.
the publicly available numbers that i mentioned (from MA, Israel, Singapore, UK) show that the chances of vaccinated to get infected is 25% of that of unvaccinated (400 out of 1400 with 65% vaccination rate, and that is without paying attention to an obvious fact that breakthrough infections are heavily undercounted due to vaccine softening the disease symptoms). The 25% chances is absolutely too big to speak about any meaningful effect on slowing the spread. Such conclusion clearly comes from basic statistical arithmetic, as well as from seasonal flu vaccine experience where the efficacy is in the same ballpark.
Vaccines appear to be less effective* against delta in general, and previous comparisons (like those that said vaccines are more effective [1]) were regarding earlier variants.
I have yet to see anything that confirms that the conclusions of the study would be similar for other variants. (If you have any links supporting that, please do share.)
Less effective at preventing infection, no less effective in preventing death or hospitalizations. We need to get everyone vaccinated to avoid the crush on our healthcare systems. Hospitals are facing bed shortages because many have given up on basic precautions in the USA.
can we change the URL to the paper?[0] The "article" is just blog spam consisting of a few quotes from the abstract of the paper. And I had to go find a cached version because the site was down.
I want to ask about source material for a minute. What is ThinkCivics? Why is it reasonable second-hand source for analysis of a non-peer reviewed article? Does it have editorial biases?
I am asking sincerely. It is a new site to me, and I don't know if it is a trustworthy source of information. The site is also unresponsive at the time I'm writing this.
Sure, but for someone who has already /survived/, it's worth knowing the value of those antibodies. And it's worth knowing that governments should not attack those survivors further for "not getting vaccinated" when they already have antibodies.
Worth noting that I'm not anti-vaccine but there's not enough focus on natural immunity. And I'm not encouraging people to forego vaccines and to go lick doorhandles
No, there is no survivorship bias apparent here. The samples appear to be representative of the populations they were investigating. They were looking at the risk of infection. Dead people don’t get infected, so they were not part of the populations studied.
1) possibly, but in Israel nearly all deaths are over 60 but most infections are not so maybe not so much
2) depends on the question: if you ask if you should get vaccinated or get covid, then yes. If you ask whether it’s as safe to be around a recovered as a vaccinated, then not really
Is there any case for offering people a dose of COVID-19 at the peak of their vaccine immunity and scheduled when people can self isolate? It just seems we’re all going to get a variant of COVID at some point before it becomes like another flu that occurs yearly?
It sounds like that might be our endgame now. If covid becomes endemic, which may be inevitable, then the only question is whether you want your body to be prepared for its first infection or not.
I wonder if this could end up like the 'common cold' coronaviruses, where future generations build up immunity through exposure very early in life, resulting in mild infections in adulthood.
That would beg an interesting question: how lethal would 'common colds' be if we hadn't all been exposed to them multiple times throughout our childhoods?
Circumstantial evidence indicates that one of the common cold coronaviruses, HCoV-OC43, probably caused a worldwide pandemic in 1889 and killed a lot of people. Symptoms were very similar to COVID-19. Now most of us get infected as children and gain natural immunity which protects us later in life. So long term the same thing will probably happen with SARS-CoV-2, but in the short term we should still use vaccines to save as many lives as possible.
The flip side is that delta is very likely optimally transmissible/virulent.
Once immunity is built up to delta, then it'll be forced to evolve to achieve immune escape and that'll make it mutate much more than it has and pick immune escape mutations that will make it "worse" in the immune naive population. Immune escape will come at a cost.
And the scientific evidence of "waning immunity" in the headlines these days is likely wrong and a gigantic lesson in confounding factors. The HCoV-229E common cold coronavirus evolves to escape immunity, and this one probably will as well:
So our immune systems will evolve and take the edge off of all future coronavirus infections, but the virus will also have to evolve and be forced to make tradeoffs and will become less virulent in the process.
So if you caught one of the common cold coronaviruses right now and had zero inherited immunity to it, then it would probably still be somewhat mild since it would have been evolving for hundreds of years to be more stealthy than virulent. If you caught the original pandemic version though it would probably suck about as hard as SARS-CoV-2 right now.
The common cold is caused by a bunch of viruses, including both rhinoviruses and coronaviruses. There's four different human coronaviruses that we know about, one of which (HKU1) was only discovered surprisingly recently.
The fact it is that the virus will be around with us for a while, and everyone will probably get it at some point. Vaccination will help when dealing with it.
This pre-print study has been discussed a few times on HN recently [1][2].
Many people are commenting that this paper is flawed by survivorship bias. While it would be useful to know the "cumulative" risk of SARS-CoV-2 infection, the fact is that a vast majority of people survive initial infection. So it is also useful to know the pure risk associated with reinfection - to inform public health policy and vaccine research.
That is why the purpose of this research is to evaluate the risk of reinfection by directly comparing the effectiveness of natural immunity and vaccine-induced immunity in the context of the delta variant, which has mutations that confer partial immune escape. This research is significant because it is one of the first and largest studies to do so.
Is there a difference in the immunity provided? What I mean is, does natural immunity do better at suppressing the transmission of covid19 than vaccine immunity? If that is the case, wouldn't that be an argument for encouraging every low-risk healthy person to develop natural immunity to suppress the spread to immunocompromised people?
It says that if you already got covid, the possibility of reinfection is 2.4 times lower if you also get the vaccine than if you don't get it. Now I guess that you multiply that natural immunity from 13x to 31x. Isn't cool?
From what I've seen, this is where we seem to have lucked out. In that if you get Covid as a vaccinated person, it will still dramatically reduce your chances of being hospitalized or dying from it.
> August 25, 2021 — The Health Department today released new data on vaccine effectiveness and breakthrough cases, hospitalizations and deaths. Between January 17 and August 7, 2021, 96.1% of COVID-19 cases, 96.9% of COVID-19 hospitalizations, and 97.3% of COVID-19 deaths in New York City were in people who were unvaccinated or not fully vaccinated. Additionally, for the same time period, 0.33% of fully vaccinated New Yorkers have ever been diagnosed with COVID-19, 0.02% have been hospitalized with COVID-19, and 0.003% have died due to complications with COVID-19.
> from August 7, unvaccinated New Yorkers are 3.1 times more likely to get COVID-19 than fully vaccinated New Yorkers. Additionally, unvaccinated New Yorkers are almost 10 times more likely to be hospitalized with COVID-19 than those who are fully vaccinated
The numbers here in the Israeli study seem very different from recent UK data which show pfizer and natural immunity being about the same. I'm not sure what accounts for the difference.
Sounds a bit like survivor bias. People who have already recovered once (and not died) are more likely to recover a second time (and not die). In the control group, people who have never had the virus, some have a harder time with it.
The story talks about the study finding not only reduced risk of hospitalization but also increased risk of breakthrough infection (i.e., getting it a second time). It doesn't mention death or mortality at all as far as I can see.
What's the basis for your claim that it's about death rates?
You don't have to be looking for death rates to be affected by survivorship via.
If the pool of people you're studying is people who got it a second time, they cannot have died when they contracted it the first time by definition (i.e you simply cannot die and then continue living and participate in a subsequent study)
That said, you can account for this confounding factor and perhaps the study did account for that (didn't read it). I'm just pointing out that the question cannot be dismissed just by looking at whether death rates are part of the study or not
> You don't have to be looking for death rates to be affected by survivorship via.
I didn't say you did, but the post I was replying to said it the study here sounded like it. It didn't at all really considering the death rate is vastly lower than the infection rate and the infection rate differences were so huge.
> That said, you can account for this confounding factor and perhaps the study did account for that (didn't read it). I'm just pointing out that the question cannot be dismissed just by looking at whether death rates are part of the study or not
I didn't dismiss it, on the contrary I gave the poster a chance to substantiate their claim.
You cannot conclude anything about the 16x difference (TFA says 13x, by the way) from the number of dead patients.
As a made up example to illustrate this point, assume that people are either "lucky" or "unlucky". Unlucky people die when they get the virus. Lucky people never die. Assume that one person per million is unlucky, and assume that the vaccine does absolutely nothing. Then this experiment on one million people would find one death in the vaccinated and zero deaths in the control group, inferring that natural immunity is infinitely better.
It doesn't have to do with the percentage who die, but rather the variation in susceptibility.
If 2% of people are 80% likely to die from COVID, and the rest have a baseline 0.1% risk. Assume prior infection provides no protection:
* 1000 (of whom 20 are particularly vulnerable) people are naturally infected; .001 * 990 =~ 1 people of average susceptibility die; 16 maximally susceptible people die. Total of 17 deaths.
* Then, you are left with 983 people, (of whom 4 are particularly vulnerable). Upon reinfection, .001 * 983 =~ 1 person of average susceptibility dies; 3.2 people of high susceptibility die. There's a total of ~4 deaths.
This is a 4x reduction in deaths even if there's no protection from prior infection.
Why do you believe "a small percentage of COVID-19 patients die" (which is only true compared to, say, Ebola) has any relevance to the results of this study?
The argument I was replying to is the numbers are skewed by survivorship bias, but given >98% of people survive that's only going to skew the numbers 2% or so not 600% or whatever.
We have evidence, in adults, of long-term effects from Covid. These effects aren't benign, either, e.g. permanent damage to the brain's grey matter. We have zero evidence of long-term side effects from the vaccine.
Ceteris paribus, infection is riskier than vaccines to adults. (I can think of zero diseases for which the vaccines are fine for adults and harmful to children and whose infections are harmful for adults and fine for children.)
This study is compelling evidence for creating an analog to the vaccine passport for the provably previously infected. It is not good evidence for intentional infection.
The vaccine risk is strictly a subset of the viral risk.
Getting the virus entails getting a lot more of the spike mRNA pumping out a lot more spike protein along with all the rest of the viral machinery and real infectious virions, infecting more cells than just in the muscle of your arm, attacking your heart, lungs, kidneys, etc.
Getting the virus is always going to be worse, for everyone, than getting the vaccine.
Which is also why people refusing to get the vaccine because they've been infected is dumb, because they already beat everything in the vaccine.
It isn't a strict subset. Vaccine risk includes cellular expression of spike protein in a scattershot way throughout your circulatory system (mRNA vaccine). Viral infection expresses whole virus, not just sprotein, and isn't targeted at or tramitted through the circulatory system, but instead the respiratory system.
There are differences, and s-protein expression may trigger mild autoimmune disorders.
You've got that backwards, the virus spreads through the bloodstream and produces thrombosis and thrombocytopenia. It isn't "scattershot" its more multi-organ "carpet bombing". And it kills through causing major autoimmune reactions, and even when patients live can causes several permanent autoimmune issues (diabetes, etc).
As a counter point, in the 2017-2018 flu season, there were no protective measure taken. In 2020, the majority of people, especially in areas of high density, wore masks, reduced travel, washed hands more often, maintained distance, etc.
The number of cases/hospitalizations/deaths from flu in the US were the lowest recorded by far (though complete records don't go back that far). This shows that those protective measures were effective.
There are flu vaccines every year. But they are not targeted for one strain ... they are developed many months in advanced based on a guess of what variants might be most common. Sometimes they guess right, often they do not. Most people don't get them.
On the other hand, in 2017-2018, vanishingly few people were wearing masks, or social distancing, people weren't avoiding (or governments prohibiting) high density gatherings.
As a father of two kids unable to be vaccinated I disagree. The risk of long term health issues is worrying for many parents. You are welcome to do what you feel is best for your family but we shouldn't consider systematic widespread exposure as a solution.
In short, "infection parties" are an unnecessary risk when vaccines exist. Even if you do nothing else to protect your child and they experience a breakthrough case, they're a lot less likely to be hospitalized and potentially suffer lifelong effects if they've been vaccinated.
It’s only a “non-issue” if you’ve no consideration for others. With R(t)>>1 your children presumably spread it to others unless they were completely quarantined immediately after exposure. And the children/adults they infected likely spread it too.
This exponential spread makes it quite likely someone died from the infection chain rooted in your children.
This is why the “unmask the kids” movement I see from other parents is complete nonsense. While it’s nice that kids are at less risk of severe cases, it only matters that they can transmit the virus.
Right, but those deaths were in an environment when there were interventions to protect people. Take away those interventions and you have more deaths.
That's (probably) correct for the population as a whole, but the case is much less clear as far as kids are concerned.
For example, look at the 0-14 graph of excess deaths at https://euromomo.eu/graphs-and-maps. It would be very hard to say that 2020 and 2021 are any different from any other year as far as kids are concerned. During that time we had all sorts of lockdown on, lockdown off, masks on, masks off, vaccines, school open, school close, but the graph stays within its normal pre-covid variance irrespective of all these interventions.
It is a bit reckless to push beta version treatments to children, especially when the expected benefits are minor. Kids already handle Covid exceedingly well naturally. Remember that mRNA vaccines have never been deployed at scale before and we have no clue what the long term effects might be. 20 years from now this will be a different conversation.
Chickenpox (varicella) is a herpesvirus which remains dormant in the patient after the acute infection phase. That's why it can reactivate later in life as shingles. It has almost nothing in common with coronaviruses.
It is not controversial. It is what data strongly indicates, and should be the top comment. As a parent of school age children and with impending school reopening I have recently participated in Covid discussions on this forum to learn more (thanks to people posting and engaging in polite conversation). I had some idea that Covid was less dangerous for kids, but had no idea how much less. I am shocked by the disconnect between data and the public health discourse in this country (USA) pertaining to Covid and kids. On the bright side, I am heartened that the risks for kids are minimal and entirely acceptable, with or without masks, vaccines, lockdowns, school closures, covid passports and whatnot. Though please stay at home if you have symptoms, this is not the time for foolish Covid parties.
Bottom line: Life involves risk, and kids are too subject to some small, but not zero risk. The Covid fatality rate for children is 1/1000 the fatality rate for old people, in line with other risks kids face daily in their lives. For all intents and purposes there are 2 different pandemics: mostly normal for kids and 0.2-1.0% IFR for adults. As an adult, take the vaccine ASAP (I did). But please stop assuming that kids share the same risk profile. They are emphatically LESS likely to develop complications. After infection, they are likely to buildup strong natural immunity against future strains (see OP article). Caveat: the virus mutates and/or CDC estimates may be wrong, so the situation may deteriorate in the future.
* For 0-17s, total 'deaths involving covid' as of 08/25 is actually a bit smaller: 385. For comparison, 'deaths involving influenza' are 188, in influenza-suppressed season. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm.
* CDC estimates that a full 26M kids were infected by Covid, for a fatality rate of 14/M. Total number of kids is 78M, so even the absolute numbers won't get catastrophically worse as long as the virulence of the virus stays the same. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
* The total number of school age children fatalities from all cases in US is 5,497, for a 134/M fatality rate. Covid is 10 times less dangerous than just living as a kid. Just the drowning fatality rate is 10/M, same ballpark as Covid. https://www.cdc.gov/nchs/fastats/child-health.htm
* Unfortunately, not all kids are equally healthy. In the first year of the pandemic, 25 kids died in UK. 'around 15 had life-limiting or underlying conditions, including 13 living with complex neuro-disabilities'. '6 had no underlying conditions'. No CDC data. https://www.bbc.com/news/health-57766717
* Whenever you hear 'the hospitals are filling up', do they specifically provide Covid numbers, or are leaving you to fill in the blanks and guess 'Covid'. Tennessee Health Commissioner: 'Children’s hospitals here are on pace to be completely full by the end of next week. Which ones? “All of them,” she said'. Reality: As of 07/31, 41 with enterovirus, 22 with RSV, 10 with Covid, 8 with adenovirus, plus some small tail. No CDC data. https://twitter.com/ifihadastick/status/1423326573185454080
* The CDC director, Rochelle P Walensky, is a co-author of the infamous John Snow Memo, claiming 'Furthermore, there is no evidence for lasting protective immunity to SARS-CoV-2 following natural infection, and the endemic transmission that would be the consequence of waning immunity would present a risk to vulnerable populations for the indefinite future.'. This has been a cornerstone for draconic Covid policies, and has been recently debunked by a number of studies, including the OP article. Shame. https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
I agree if you sign a waiver saying you get no healthcare in the rare case that your infection requires hospitalization.
That's my stance on prescription medication, too, in case you think I'm just being an asshole about CV. I'd sign a waiver for the freedom to buy antidepressants.
But first you would need to get infected to acquire such immunity. Pretty much defeats the purpose when it could cause severe outcomes which you wanted to avoid in the first place. But rather, even though you may get the infected after vaccination, it will lower the chance of severe outcome by nearly as much.
I’d rather acquire natural immunity via the vaccine route.
Some of the numbers in the tables seem strange to me. Looking at the participants, it is hard to understand how the mean and sd of the ages and age distributions can be exactly the same. Moreover, apparently the odds of being hospitalized are 160-times greater for vaccinated vs unvaccinated second infection individuals. Perhaps the dramatic differences are due to very low numbers - I did not see the raw numbers for symptomatic infection and hospitalization. But if I were reviewing this paper, I would wonder how they got their age distributions to match so closely.
It's a matched cohort study. They're starting with a large population in both of their target groups, and then picking pairs of demographically identical people (e.g. age, sex, location), one from each group, for the study. So you'd certainly expect the age distributions to match up exactly.
It'd be more worrying if criteria they weren't doing the matching by also were exactly identical. That's not the case, all kinds of secondary characteristics such as comorbidities are roughly but not exactly the same.
They couldn't have matched the time of infection, since not everyone in the study was (re-)infected during the study period. The point of the study was to see if there was a difference in the infection rates, so just picking from the people who got infected would have completely distorted the results.
But they would have arranged the study such that both people in the matched pair were considered for exactly the same time period. E.g. if the vaccinated person in pair was fully vaccinated on April 20th, they would have started counting re-infections for the previously infected person of the pair from April 20th too.
Local infection rates should be the same, since the pairs would be matched from the same geographic area and the study contstruction ensured they were considered for exactly the same time period.
Natural immunity comes with a ~9x greater risk of hospitalisation, again from Covid itself. There's effectively no risk from the vaccine, again with hundreds of millions of doses administered.
Among adults aged 65–74 years, effectiveness of full vaccination for preventing hospitalization was 96% for Pfizer-BioNTech, 96% for Moderna, and 84% for Janssen COVID-19 vaccines; among adults aged ≥75 years, effectiveness of full vaccination for preventing hospitalization was 91% for Pfizer-BioNTech, 96% for Moderna, and 85% for Janssen COVID-19 vaccines.
https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e3.htm
Note that "natural herd immunity" doesn't come without a near-total population infection rate, with a large number of deaths, prolonged medical care, and long-term health consequences. The vaccine-based risks are far, far, far lower.
There's also quite likely a much higher likelihood of long-term Covid symptoms or consequences.
This information is interesting, but a poor basis on which to shift policy from vaccination to infecting the entire population and blessing the survivors.
Update: the article is also a dupe of an earlier substantial discussion: https://news.ycombinator.com/item?id=28307224 (260 comments).
US CDC reports an 0.0016% fatality rate from all causes for vaccinated individuals. That's 100x lower than the incident fatality rate of 0.1% suggested by multiple countries with excellent Covid surveillance and reporting systems. Note that many early vaccine recipients were elderly (65+) and would have a higher natural death rate than the general population.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/ad...
I've clarified the vaccine vs. natural infection risks based on criticism of unclear language.