This year we kill it: Corona Virus Thread Mark II

[sihnfahl]

Before fun news: yay, Covid positive, quarantining, no symptoms.

In the 'no duh' category, the European Medicines Agency state they believe that with Omicron, Covid has gone from pandemic to endemic. Its high transmissibility, combined with its low hospitalization and mortality, means more folks are getting exposed, which might slow the spread of future strains a bit faster than the slower-transmitting Delta.

Also, researchers in Poland THINK they've found a gene that makes people more susceptible to Covid, increasing its danger to those individuals. It's hoped with a quick gene test, that those people are identified and greater precautionary measures can be taken. I suppose we'll wait and see.

[Squire Doodad]

Before fun news: yay, Covid positive, quarantining, no symptoms.

In the 'no duh' category, the European Medicines Agency state they believe that with Omicron, Covid has gone from pandemic to endemic. Its high transmissibility, combined with its low hospitalization and mortality, means more folks are getting exposed, which might slow the spread of future strains a bit faster than the slower-transmitting Delta.

That...makes no sense? Omicron is having lower mortality, yes, which is a good thing, but it also has ludicrous spread in comparison to anything we've seen before. From what we have seen, vaccines are more effective than natural immunity, and so Omicron being faster-spread doesn't mean it'll spread slower. Like...what? Did I misread that?
A pandemic vs endemic outbreak is defined by spread and reach. Omicron is affecting the entire world, it is absolutely a pandemic. "Endemic" means it is only happening in small areas.

Also, deaths happening at a lower rate would still mean millions upon millions dying. Wear a mask for sure.

[Lord Torath]

All I know is the hospitals are screaming from overcrowding due to the Omicron variant. I don't think we're into the endemic phase yet (At least I really really hope this isn't the Endemic Phase! So much worse than Flu Season!).

[sihnfahl]

From what we have seen, vaccines are more effective than natural immunity, and so Omicron being faster-spread doesn't mean it'll spread slower. Like...what? Did I misread that?

No, not misread. It's the idea behind it.

The EMA is taking the position that the natural immunity, while it is relatively short-lived, will be long enough in enough people to slow the spread of emerging Covid strains in the short term; in addition, that the reduction in deaths would hopefully carry on in the next major strain due to its prevalence.

In this sense, they're using the term 'endemic' to reflect a disease that we'll be regularly inoculating for, and hopefully with a mortality rate that's much lower than it has been.

Like how the flu is considered an endemic virus, even though it goes worldwide.

The flu is estimated to kill 200-500k / people a year worldwide. And they're taking the position that if we get Covid to that level, that's acceptable since there's been active efforts to prevent containment and a halt to Covid entirely. And that's why they're accepting of the number of deaths that result from Omicron.

All I know is the hospitals are screaming from overcrowding due to the Omicron variant. I don't think we're into the endemic phase yet (At least I really really hope this isn't the Endemic Phase! So much worse than Flu Season!).

There's been four waves in Florida. At this point, I'm going to say it's gone endemic because of the active efforts to prevent containment. We have means of controlling and treating it.

As for the hospitals, well, it was only a matter of time until there was a major strain that would spread faster and lead to a higher number of hospitalizations at a single point in time. But then... some folks only see the now.

[Lord Torath]

Just saw this on NPR:
Want to get omicron and just get it over with? Here's why that's a bad idea.

[farothel]

Just saw this on NPR:
Want to get omicron and just get it over with? Here's why that's a bad idea.

I can only agree with everything in the article.

[Chen]

The whole “get the virus and then be ok” is just an expansion of many other antivaxx conspiracy theories. It makes zero sense to intentionally infect yourself with something just to avoid getting that something….again. It makes sense less sense when vaccination gives you the immunity benefits of getting the disease without the actual downsides of the disease, in exchange for extremely minimal and/or rare downsides of the vaccine itself.

[Peelee]

The whole “get the virus and then be ok” is just an expansion of many other antivaxx conspiracy theories. It makes zero sense to intentionally infect yourself with something just to avoid getting that something….again. It makes sense less sense when vaccination gives you the immunity benefits of getting the disease without the actual downsides of the disease, in exchange for extremely minimal and/or rare downsides of the vaccine itself.

I dunno, it has a certain logic to it. What if instead of getting the full virus, we got a less potent version of the virus (like a weakened version or inactivated version of the virus)? Also, to speed up transmission, we could just inject it directly. That seems like it might be a decent idea. Do I smell a Nobel?

[NichG]

I dunno, it has a certain logic to it. What if instead of getting the full virus, we got a less potent version of the virus (like a weakened version or inactivated version of the virus)? Also, to speed up transmission, we could just inject it directly. That seems like it might be a decent idea. Do I smell a Nobel?

I wonder if Omicron's rate of spread has actually exceeded the maximum rate of vaccination we have the infrastructure and logistics to provide.

Anyhow, I guess it could make a little sense if you're 3x vax'd and can't avoid exposure to other people since we don't have Omicron specific boosters yet and there's no guarantee that variants deriving from Omicron won't increase in lethality. So getting it out of the way in a controlled manner where you know when you're infectious and can take vacation and preemptively quarantine could look like a viable choice on paper at least, if you aren't considering what that might do to hospital numbers if lots of people had the same idea.

But at least for me I'd rather just never get COVID at all, and what I need to do in order to have a chance of that isn't particularly onerous.

[Lord Torath]

Just leaving this here:
https://xkcd.com/2557/

"This plan may sound appealing to people who know a little about the immune system, but the drawbacks are clear to people who know a lot about the immune system and also to people who don't know anything about it."

[pendell]

Just leaving this here:
https://xkcd.com/2557/

"This plan may sound appealing to people who know a little about the immune system, but the drawbacks are clear to people who know a lot about the immune system and also to people who don't know anything about it."

Actually, there's an article in the Wall Street Journal today on Super-immunity , which occurs if you are vaccinated AND catch the disease. The article appears to be based on this study and this one

With both infection and vaccination, the immune system gets quicker, stronger and smarter after being exposed to a new challenge. Researchers have found that people who were infected by Covid-19 and later vaccinated crank out higher levels and a broader array of antibodies that last longer than do people who have only been vaccinated.

Similarly, a study last month by the Oregon Health and Science University found that vaccinated people who experienced breakthrough infections produced higher levels of antibodies that were up to 1,000% more effective than those generated two weeks after a second dose of the Pfizer vaccine. The researchers described this as superimmunity.

“I think this speaks to an eventual end game,” said co-author Marcel Curlin. “It doesn’t mean we’re at the end of the pandemic, but it points to where we’re likely to land: Once you’re vaccinated and then exposed to the virus, you’re probably going to be reasonably well-protected from future variants.” Dr. Curlin added: “Our study implies that the long-term outcome is going to be a tapering off of the severity of the worldwide epidemic.”

A study last month from South Africa found that people who were infected with Omicron produced antibodies that were more than four times better at neutralizing the Delta variant. Booster vaccines also improve the immune response by giving B-cells more time to mature—one reason antibodies after three Pfizer shots are capable in lab experiments of neutralizing Omicron while those after two aren’t.

But boosters train the immune system against the same target. Omicron’s myriad mutations create a bigger challenge for the B- and T-cells, and thereby strengthen the immune response. To use an analogy, if you train at doing push-ups, you’ll get stronger—but not as strong as if you also did pull-ups.

There's a lot more in the article which is fairly detailed for an opinion piece. Vaccination + infection gives better immunity than either alone, although vaxx+booster also train to the same goal.

Respectfully,

Brian P.

[Aedilred]

As I understand it, the principal purpose in the recommendation to wear a mask - improvised cloth one or not - is not to protect yourself from catching covid, but to reduce the risk of transmitting it to others if you are unknowingly infected. The question of whether the mask will protect you from a blast of pepper spray to the face is therefore the wrong question.

Now, that doesn't mean that that's why people actually wear masks. While some may do now, prior to and at the outset of the pandemic I suspect that the vast majority wore masks in order to protect themselves - and moreoever that the majority of people wearing masks in non-compulsory spaces even now do so for the same reason. For those people, yeah, their cloth masks are largely ineffective and they ought to be replacing them with a N95 or similar.

This is one of the misunderstandings that has caused problems with mask messaging. Early on, the view from some professionals and health authorities was that masks were ineffective. As a means of personal protection they were correct. But we would still have been better off if everyone had switched to wearing masks at the outset because as a means of controlling the spread of infection they are effective. It depends which question you're asking.

And this is the problem (or at least one of them) with claiming to be "led by the science" as many authorities did: you need to ask the right questions in order to get useful answers.

Although the last two years have scrambled my brain, there was also an issue in some jurisdictions that there was a massive mask shortage due to an increase in demand, and governments were thus reluctant to introduce mask mandates or promote them too heavily to the public because they were uncertain of maintaining a consistent supply even to health workers. Certainly in the UK it's notable that the switch to a mask mandate occurred only after mask production had been ramped up and supply was no longer critical. If this was a policy, it was an entirely practical one, but it might again have had an impact on public perception with people thinking that if masks really "worked" we'd be told to wear them.

[NichG]

As I understand it, the principal purpose in the recommendation to wear a mask - improvised cloth one or not - is not to protect yourself from catching covid, but to reduce the risk of transmitting it to others if you are unknowingly infected. The question of whether the mask will protect you from a blast of pepper spray to the face is therefore the wrong question.

Now, that doesn't mean that that's why people actually wear masks. While some may do now, prior to and at the outset of the pandemic I suspect that the vast majority wore masks in order to protect themselves - and moreoever that the majority of people wearing masks in non-compulsory spaces even now do so for the same reason. For those people, yeah, their cloth masks are largely ineffective and they ought to be replacing them with a N95 or similar.

This is one of the misunderstandings that has caused problems with mask messaging. Early on, the view from some professionals and health authorities was that masks were ineffective. As a means of personal protection they were correct. But we would still have been better off if everyone had switched to wearing masks at the outset because as a means of controlling the spread of infection they are effective. It depends which question you're asking.

And this is the problem (or at least one of them) with claiming to be "led by the science" as many authorities did: you need to ask the right questions in order to get useful answers.

Although the last two years have scrambled my brain, there was also an issue in some jurisdictions that there was a massive mask shortage due to an increase in demand, and governments were thus reluctant to introduce mask mandates or promote them too heavily to the public because they were uncertain of maintaining a consistent supply even to health workers. Certainly in the UK it's notable that the switch to a mask mandate occurred only after mask production had been ramped up and supply was no longer critical. If this was a policy, it was an entirely practical one, but it might again have had an impact on public perception with people thinking that if masks really "worked" we'd be told to wear them.

It was a bit worse than that. There was messaging specifically telling people not to bother wearing N95 masks because 'they wouldn't know how to use them correctly', when likely the real reason behind that choice was the supply shortages of N95 masks for healthcare workers. Which then sadly led to some hospitals making policies that N95s could not be used by the staff - even if there were plenty of masks or if the staff members provided their own - outside of specific aerosol generating procedures or the case of tending to infected patients.

[Tyndmyr]

As I understand it, the principal purpose in the recommendation to wear a mask - improvised cloth one or not - is not to protect yourself from catching covid, but to reduce the risk of transmitting it to others if you are unknowingly infected. The question of whether the mask will protect you from a blast of pepper spray to the face is therefore the wrong question.

The fabric in a cloth mask doesn't have any directionality built into it. If it doesn't protect one way, it doesn't protect the other.

And, even if you are sick, and are masking to protect others, a mask that is certified and tested for such a task is far more reliable than one that is not. I won't say that a cloth mask has absolutely no impact...but nobody would accept it as a reasonable substitute for welding, construction work, or any other task that requires a given level of filtration.

Although the last two years have scrambled my brain, there was also an issue in some jurisdictions that there was a massive mask shortage due to an increase in demand, and governments were thus reluctant to introduce mask mandates or promote them too heavily to the public because they were uncertain of maintaining a consistent supply even to health workers. Certainly in the UK it's notable that the switch to a mask mandate occurred only after mask production had been ramped up and supply was no longer critical. If this was a policy, it was an entirely practical one, but it might again have had an impact on public perception with people thinking that if masks really "worked" we'd be told to wear them.

Prioritization is a reasonable goal, but again, clarity in messaging helps.

An early Fauci quote, for instance, is as follows: "The typical mask you buy in the drug store is not really effective in keeping out virus, which is small enough to pass through material. It might, however, provide some slight benefit in keep out gross droplets if someone coughs or sneezes on you."

He later clarified this as being motivated by a desire to conserve masks for health care personnel...but if that is indeed true, then this can be called nothing other than deception. And if not true, well, it is a mistruth in either case.

If one needs to prioritize, one must tell folks what's happening. Misinformation will obviously begin to take root if official sources are spreading it.

[NichG]

The fabric in a cloth mask doesn't have any directionality built into it. If it doesn't protect one way, it doesn't protect the other.

Redirecting airflow matters. Put anything in front of someone's mouth and when they're talking/coughing/sneezing/etc, its worth about a meter of effective distancing. If you're in a closed room with an infected person and there's no air circulation at all, then eventually ambient levels will matter more (especially with higher viral loads from delta and omicron), but the 'no directionality' thing is wrong.

And, even if you are sick, and are masking to protect others, a mask that is certified and tested for such a task is far more reliable than one that is not. I won't say that a cloth mask has absolutely no impact...but nobody would accept it as a reasonable substitute for welding, construction work, or any other task that requires a given level of filtration.

Yes, a fitted N95 reduces risk by a factor of ~4 versus cloth or no mask for self-protection and about ~8 for source control (reducing infections to others) vs a cloth mask. And something like a half-mask elastomeric respirator is potentially another factor of 3x on top of that (though if it's got an open exhale valve, it's not going to do anything more than the cloth mask would for source control, or could even be worse than wearing nothing depending on the positioning and diameter of the valve if it e.g. creates a faster air jet in response to overpressure).

See e.g. https://www.microcovid.org/paper/14-...-sources#masks

[Rater202]

Does anyone remember when the pandemic was first getting started and sources were like "it's potentially fatal for people over forty, smokers, people with respiratory issues, or diabetics but everyone else it's only slightly worse than the flue and children doesn't seem to be at risk. You should still take precautions to limit the spread so that it doesn't get to people it could kill" and then over time healthy young people started dying from it and kids were getting infected bad enough to be hospitalized and then it turned out it had long term effects and could potentially cause permanent damage to every part of your body and in general, it's so much worse than we initially thought it was?

Is anybody else kind of just... Kind of peeved about that.

[Chen]

While it certainly is not harmless in younger people, the risk of serious consequences increases DRAMATICALLY with age and/or co-morbidities. Looking here at Quebec, 96.6% of deaths were age 60+. 99.4% were 40+.

Comparing to the flu has two big issues. One is that it is way more transmissible which makes its overall impact far worse even if individual outcomes may be similar. The second problem is that a lot of people hear “flu” and understand “a cold”. Flu is actualy fairly dangerous to the very old and very young and kills a lot more than people generally think it does.

Its basically the law of large numbers coming into force here. Its so widespread that even if something is statistically low likelihood, you’re going to have those events occur just due to sheer numbers. Media is certainly not helping that particularly when theres more extreme outlier events that occur. A young child dying of COVID will still make headlines but its rare to even see a report at all of a child dying of the flu.

[farothel]

Indeed. It's the same with the omicron variant. People get less sick, but if a lot more people are infected (as it's more infectious), you still get a lot of people in hospitals. When I see the numbers here in Belgium, we have at the moment record numbers of infections (like a lot of countries), the hospital numbers are also going up, but luckily less than the infection rate. And ICU numbers are still going down (which is a good thing). Similar numbers are seen all over Europe.

And even the omicron is still dangerous: see the story of Hana Horka I saw in the news this morning.

[sihnfahl]

Is anybody else kind of just... Kind of peeved about that.

Not really, because it was what we were seeing at the initial outbreak.

The folks mentioned would be the fastest to come down with visible symptoms.

[Peelee]

Does anyone remember when the pandemic was first getting started and sources were like "it's potentially fatal for people over forty, smokers, people with respiratory issues, or diabetics but everyone else it's only slightly worse than the flue and children doesn't seem to be at risk. You should still take precautions to limit the spread so that it doesn't get to people it could kill" and then over time healthy young people started dying from it and kids were getting infected bad enough to be hospitalized and then it turned out it had long term effects and could potentially cause permanent damage to every part of your body and in general, it's so much worse than we initially thought it was?

Is anybody else kind of just... Kind of peeved about that.

Not really - it was a new virus, we were finding out things as we went.

[Sermil]

Well, it's 2022 now, maybe the thread title has a chance of being right this time... sigh

[Chen]

It harms young people as well.

It can harm young people no doubt. The outcomes in young people, though, are generally much less severe. We’re never going to remove all the risks from COVID.

We need to also distinguish personal risk vs societal risk. At a societal level COVID being transmitted freely is problematic since just the sheer numbers tend to overwhelm your hospital capacity. This increases both your risk of a bad COVID outcome (since if you do get severely sick there may not be hospital capcity to treat you) and it increases your risks of other bad outcomes if hospital space is limited. So even if the risk to you is minimal (see below) you still want to prevent it spreading.

At an individualized risk level though, COVID is not a high risk disease if you are healthy and even relatively young. Once you are double vaccinated (even without boosters) the individualized risk is even lower. I havent looked up the numbers specifically but I imagine your risk of death or severe harm from COVID, once you’re vaccinated, is probably well in line other every day activities that we’ve simply decided to live with the risks of (driving comes to mind though again I havent actually run the numbers).

[Bartmanhomer]

Well, it's 2022 now, maybe the thread title has a chance of being right this time... sigh

I think this virus is going to be here for a long time with so many variants mutating there's no telling when it will end.

[NichG]

It can harm young people no doubt. The outcomes in young people, though, are generally much less severe. We’re never going to remove all the risks from COVID.

We need to also distinguish personal risk vs societal risk. At a societal level COVID being transmitted freely is problematic since just the sheer numbers tend to overwhelm your hospital capacity. This increases both your risk of a bad COVID outcome (since if you do get severely sick there may not be hospital capcity to treat you) and it increases your risks of other bad outcomes if hospital space is limited. So even if the risk to you is minimal (see below) you still want to prevent it spreading.

At an individualized risk level though, COVID is not a high risk disease if you are healthy and even relatively young. Once you are double vaccinated (even without boosters) the individualized risk is even lower. I havent looked up the numbers specifically but I imagine your risk of death or severe harm from COVID, once you’re vaccinated, is probably well in line other every day activities that we’ve simply decided to live with the risks of (driving comes to mind though again I havent actually run the numbers).

It's important to actually run the numbers when saying something like this.

The annual risk of death in a car accident in the US is about 1 in 8000. Let's say you get a fresh infection by a new COVID variant every year for the rest of your life. I can't find recent demographically separated data, but the pandemic average stats in the US are something like:

0-40 yrs of age is 20k deaths out of 29m cases, so roughly 1 in 1500.
40-65 is 200k deaths out of 17m cases, so roughly 1 in 100.
65+ is 600k deaths out of 6m cases, so roughly 1 in 10.

Now that includes prevax cases/deaths, and doesn't include asymptomatic cases. So let's optimistically say a factor of 10 from unreported asymptomatic cases, and a factor of 10 from vaccination (could be 20, could be 5, depends on the variant, frequency of boosting, etc)

That means if you're less than 40, ongoing COVID adds an extra 5% of risk of death relative to your risk of dying in a car accident - roughly half the impact of airbags.

By the time you're 40-65, it adds about as much risk of death again as driving - basically as if you lived in a place where driving is twice as dangerous.

And if it's still around by the time you're 65+, it adds 8x the risk of driving.

[farothel]

I think this virus is going to be here for a long time with so many variants mutating there's no telling when it will end.

At some point it will become endemic, where it will become more seasonal like the flu. And I know that pharmaceutical companies are working on a way to incorporate the COVID vaccine with the flu vaccine, so you can go for your yearly flu shot and get a COVID booster at the same time. There are even scientists who think the omicron is actually the variant that will be the one that initiates that switch, although I feel it's a bit too early to tell (although I do hope they are right).

[Bartmanhomer]

At some point it will become endemic, where it will become more seasonal like the flu. And I know that pharmaceutical companies are working on a way to incorporate the COVID vaccine with the flu vaccine, so you can go for your yearly flu shot and get a COVID booster at the same time. There are even scientists who think the omicron is actually the variant that will be the one that initiates that switch, although I feel it's a bit too early to tell (although I do hope they are right).

I have a very curious question to ask: what's an endemic?

[NichG]

Endemic doesn't mean mild, it just means that a disease is native to an area. So 'hoping that this is the one that makes the transition to endemic' is sort of like 'hoping that this is the one that makes the disease impossible to dislodge'.

[Bartmanhomer]

Endemic doesn't mean mild, it just means that a disease is native to an area. So 'hoping that this is the one that makes the transition to endemic' is sort of like 'hoping that this is the one that makes the disease impossible to dislodge'.

Ok. Thank you for telling me.

[Squire Doodad]

It can harm young people no doubt. The outcomes in young people, though, are generally much less severe. We’re never going to remove all the risks from COVID.

We need to also distinguish personal risk vs societal risk. At a societal level COVID being transmitted freely is problematic since just the sheer numbers tend to overwhelm your hospital capacity. This increases both your risk of a bad COVID outcome (since if you do get severely sick there may not be hospital capcity to treat you) and it increases your risks of other bad outcomes if hospital space is limited. So even if the risk to you is minimal (see below) you still want to prevent it spreading.

At an individualized risk level though, COVID is not a high risk disease if you are healthy and even relatively young. Once you are double vaccinated (even without boosters) the individualized risk is even lower. I havent looked up the numbers specifically but I imagine your risk of death or severe harm from COVID, once you’re vaccinated, is probably well in line other every day activities that we’ve simply decided to live with the risks of (driving comes to mind though again I havent actually run the numbers).

COVID has a notable chance of leaving someone with a long lasting disability or chronic illness in the form of Long COVID. This applies to young children as well as the old, though the fine points are not fully understood.
While young people may fare better on the whole, a, say, 1/7 chance is very much high enough that acting like children are borderline-immune would leave massive swaths of the population with various disabilities. I think the estimates were somewhere from 1/5 chance of Long COVID issues to 1/30, but I can't recall.

COVID is more than just a respiratory illness. I have seen people get COVID and come out with a heart condition, and then if they got it again they'd be at drastically higher risk.

===

On the endemic note:
In this context, endemic refers to COVID not being prevalent on a global scale despite persisting in various communities. This would mean that while it would circulate and be a danger, it won't overwhelm the medical system and from there can be more readily controlled.

[Chen]

It's important to actually run the numbers when saying something like this.

The annual risk of death in a car accident in the US is about 1 in 8000. Let's say you get a fresh infection by a new COVID variant every year for the rest of your life. I can't find recent demographically separated data, but the pandemic average stats in the US are something like:

0-40 yrs of age is 20k deaths out of 29m cases, so roughly 1 in 1500.

Hmm maybe this is where things are diverging. Looking at the numbers here in quebec the 0-40 year old bracket account for 0.3% of deaths(~39) for 55.1% of cases (~462k) which is about 1 in 11.8k. Thats almost 10x less severe than the number you have up there. Even if round it up to 0.4% to conservatively correct for any rounding error on the 0.3% its still around 1 in 8.8k.