Some New Science on Virus Transmission on Airplanes

[Auspicious]

Originally Posted by Dockhead

Logically incorrect. You assume what is most likely. Not arbitrarily one thing in the absence of proof to the contrary.

Two logical paths to the first end:

1. Risk. Consider probability and impact. Low probability events with high impact get great attention.

2. Proof. I take exception to your statement that vaccines reduce transmission as a spreader. In point of fact what gets demonstrated in trials is that it reduces transmission as a recipient of a viral load. The discussions I have read in scholarly journals are part of a consensus that vaccines do not prevent transmission by stopping spreaders from spreading.

[goboatingnow]

Originally Posted by Dockhead

Logically incorrect. You assume what is most likely. Not arbitrarily one thing in the absence of proof to the contrary.

That is how you choose between vaccinating the most likely to die, versus the most likely to spread.

If the vaccine prevents spreading, then vaccinate the most likely to spread.

If the vaccine only prevents dying, then vaccinate the most likely to die.

This is NOT complicated. Virtually all vaccines of other diseases, prevent one from spreading the disease against which one is vaccinated. So the most likely scenario is that the COVID vaccine will prevent spreading.

If that is the case, then vaccinating one grocery store clerk -- as in Valhalla's scenario -- could save hundreds or thousands of lives, versus vaccinating one nursing home resident, which might save one life. If this is the case, obviously vaccinate the grocery store clerk.

People, this is policymaking 101. Save the most lives, do the most good, with what you have. Be logical and rational.

You seem to simply ignore what you don’t like

The precautionary principle is a guiding light in medicine

No reliable data has yet emerged to confirm that the vaccine prevents transmission , we all hope it will , but as yet there is NO proof

Hence You proceed on the basis of data YOU DO KNOW exists which shows it prevents the disease

Your argument sounds good but only in theory

There simply isn’t enough real time data to pinpoint superspreaders , your example is exactly the opposite , supermarkets staff have exhibited very low transmission rates.

Few health authorities have anywhere like enough data to isolate groups in society that may BECOME super spreaders as there is little point doing it after the fact

Health authorities however do know from the first wave who are the vulnerable

In fact if you read the detail of countries rollout , yiu can see that many are adapting part of what you suggest, for example in Ireland in the first Wave it’s the nursing homes , front line health, meat factory works ( a super spreader site ) , certain transport and distribution .

Next in line are less vulnerable and groups that have been associated with outbreaks ( but didn’t get sick etc )

Your idea would be great , if we knew where all the infection centres were , but we don’t , not at all in fact, as the second wave has confounded experts over exact modalities ( ie countries that did great first time around are getting whacked )

So let’s prevent people dying first , then kill off the virus from the largely healthy or lightly infected

[Dockhead]

Originally Posted by Auspicious

Two logical paths to the first end:

1. Risk. Consider probability and impact. Low probability events with high impact get great attention.

The impact in both cases is the same -- death.

The question is whether you kill less people by stopping the spread, or by protecting people it's getting spread to. It's very simple.

Originally Posted by Auspicious

2. Proof. I take exception to your statement that vaccines reduce transmission as a spreader. In point of fact what gets demonstrated in trials is that it reduces transmission as a recipient of a viral load. The discussions I have read in scholarly journals are part of a consensus that vaccines do not prevent transmission by stopping spreaders from spreading.

If that's true, then naturally, you take the first route and protect the end people and forget about spreaders. If there is a consensus that vaccinating people doesn't stop spreading, then that settles the question as far as I'm concerned. I would be surprised, but I don't claim any special knowledge.


If you've read relevant scholarly articles, why don't you post links. I think would be interesting for a lot of us.

[Dockhead]

Originally Posted by goboatingnow

You seem to simply ignore what you don’t like

The precautionary principle is a guiding light in medicine

No reliable data has yet emerged to confirm that the vaccine prevents transmission , we all hope it will , but as yet there is NO proof

Hence You proceed on the basis of data YOU DO KNOW exists which shows it prevents the disease

Your argument sounds good but only in theory

There simply isn’t enough real time data to pinpoint superspreaders , your example is exactly the opposite , supermarkets staff have exhibited very low transmission rates.

Few health authorities have anywhere like enough data to isolate groups in society that may BECOME super spreaders as there is little point doing it after the fact

Health authorities however do know from the first wave who are the vulnerable

In fact if you read the detail of countries rollout , yiu can see that many are adapting part of what you suggest, for example in Ireland in the first Wave it’s the nursing homes , front line health, meat factory works ( a super spreader site ) , certain transport and distribution .

Next in line are less vulnerable and groups that have been associated with outbreaks ( but didn’t get sick etc )

Your idea would be great , if we knew where all the infection centres were , but we don’t , not at all in fact, as the second wave has confounded experts over exact modalities ( ie countries that did great first time around are getting whacked )

So let’s prevent people dying first , then kill off the virus from the largely healthy or lightly infected

I'm not ignoring anything. What you write here could be right. You are certainly correct that trying to stop the spread with vaccination will only work if we can identify groups of people who are spreaders. AND, if vaccinated people are actually prevented thereby from spreading (Auspicious' point). I think it's not that hard to identify what kind of people have a lot of social contact. In Finland at least, where more than 50% of new cases are successfully contact traced, there is a huge amount of data on who exactly is spreading the virus. Maybe in different countries it's harder to get.

My only concern is that policy decisions are not being made in a knee jerk manner for the sake of short term results, ignoring the longer term goal of stopping the pandemic. If "preventing people dying first, then killing off the virus from the largely healthy" results in fewer deaths (and other consequences) in the long run, then obviously that's what you want to do.

As I have written, how to prevent the most death (and other consequences) is an empirical question which can be answered by modelling what we do know.


There is, however, one other aspect to this -- the moral one. Essential workers -- largely the working poor, disproportionately Black -- the people who perform services for all of us and can't hide at home like most middle class white people can -- might deserve some priority. Maybe in any case, even if it doesn't reduce spreading of the virus, some part of the initial supplies of the vaccine should start going to these people. Their risk of dying if infected may be less than nursing home residents, but their risk of infection is higher, and as we've discussed there are consequences from the disease short of death, which are harmful. The working poor are a particularly hard hit sector of society and may deserve a little extra priority in any case.

[Auspicious]

Originally Posted by Dockhead

The impact in both cases is the same -- death.

The question is whether you kill less people by stopping the spread, or by protecting people it's getting spread to. It's very simple.

You're taking something multi-variate and treating it as binary.

The key to the absence of any proof or even indication that the vaccine prevents spreaders from spreading is that even as the vaccine is rolled out people should continue wearing masks AND distance AND avoid gatherings entirely AND practice good hygiene (i.e. hand washing, avoiding touching one's face (hard for inveterate beard strokers), blocking sneezes and coughs, and liberal use of disinfectants). Here in the US we're looking at June or July for vaccinations to plateau and then we're going to have to keep working on education for those (idiots) who won't vaccinate. I suggest end of 2021 is the earliest we'll see polio, MPT, tetanus levels of vaccination (all down in the US due to anti-vaxxers).

Originally Posted by Dockhead

If you've read relevant scholarly articles, why don't you post links. I think would be interesting for a lot of us.

I have a Google Scholar news feed (just like the general Google news feeds). I delete the daily feed to keep my inbox from bogging down after I read (or skim) any articles that get my attention. I don't save papers (although I do share links in real time with technical family and friends) or take notes. I don't have time.

[Dockhead]

Originally Posted by Auspicious

. . . The key to the absence of any proof or even indication that the vaccine prevents spreaders from spreading is that even as the vaccine is rolled out people should continue wearing masks AND distance AND avoid gatherings entirely AND practice good hygiene (i.e. hand washing, avoiding touching one's face (hard for inveterate beard strokers), blocking sneezes and coughs, and liberal use of disinfectants).. . .

I don't quite understand what you're saying here. Which implies what here? Are you saying that we don't have confidence that the vaccince prevents spreading, therefore we should continue other measures in the mean time? Or what?


I would think that whether or not the vaccine prevents spreading, then surely we must continue other measures, until the pandemic is fully stopped, no? We don't vaccinate everyone in one day in any case; there will still be some vulnerable people right up until the day this whole nightmare is over, right?

[Auspicious]

Originally Posted by Dockhead

I don't quite understand what you're saying here. Which implies what here? Are you saying that we don't have confidence that the vaccince prevents spreading, therefore we should continue other measures in the mean time? Or what?

I think you'll find that many people consider vaccination to be a free pass to return to the old normal. There is much education to do.

By the way, a Google search for 'do vaccines prevent transmission' turned up two interesting FAQs. One from the CDC says that my estimate for how long it will take to really get ahead of the pandemic was optimistic. They say six months to a year after availability of a vaccine to the general public (June or July in the US) so end of 2021 to middle of 2022. The second is from Johns Hopkins which says explicitly that the vaccines are unlikely to reduce transmission from infected to uninfected. The impact on spread is that people who don't get infected (vaccinated, accounting for efficacy) don't/can't spread the virus BECAUSE THEY DON'T HAVE IT and therefore the disease.

Also of interest is the contraindications (source: UK mainstream media - either BBC or Guardian, I forget) for the Pfizer vaccine. One can only hope that contraindications for the various vaccines don't overlap.

[GordMay]

Originally Posted by Dockhead

... Just one minor point -- Hegel never used the term "cognitive dissonance", which is a term from psychology, invented in 1957 (Hegel having died in 1831). Nor "projection", which is another term from psychology, not philosophy. The "F" on that paper, for the pretentious misuse of references, by one who has never read a page of what is referred to, stands.

The question is, did Hegel address the phenomenon, and (if so) how; not which words he used to describe it (or not)?

[GordMay]

Originally Posted by Dockhead

... My only concern is that policy decisions are not being made in a knee jerk manner for the sake of short term results, ignoring the longer term goal of stopping the pandemic. If "preventing people dying first, then killing off the virus from the largely healthy" results in fewer deaths (and other consequences) in the long run, then obviously that's what you want to do...

Shouldn't our short term goal(s) be to achieve short term results, without ignoring the long(er) term goals, which would be addressed in our long(er) term actions?
(stop the bleeding, start the breathing & beating; then deal with the broken bones etc.)

[GordMay]

Originally Posted by Dockhead

... I would think that whether or not the vaccine prevents spreading, then surely we must continue other measures, until the pandemic is fully stopped, no? We don't vaccinate everyone in one day in any case; there will still be some vulnerable people right up until the day this whole nightmare is over, right?

Indeed. It's part of the conventional wisdom.

[valhalla360]

Originally Posted by goboatingnow

What is known as a fact , is the vaccine prevents the disease, other assumptions are just that. Hence since deaths are the worst outcome of Covid ( or maybe you disagree ) It makes the decision to vaccinate those most vulnerable to death first. But clearly the intention is to vaccinate everyone as quickly as practical, that’s the summary of my logic and The logic of any public health official I’ve listened too

Not at all. It's a fact, that once you have had it, you have a degree of immunity. How much might be up for debate but no question it provides a level of immunity. But heck, the vaccine immunity is only an estimate also. As it goes out to the general public that percentage will likely change. Also, we have no real idea of how long the immunity provided by the vaccine will be.

It's also a fact that once you are immune, if exposed you won't be generating huge numbers of the virus, nor for as long. It's only a question of to what degree this will be.

So we are working from a base of lots of PARTIAL facts.

Sure, deaths are a worst case scenario but that doesn't mean vaccinating the most vulnerable is the best way to minimize deaths. (Look up thread for the discussion on why that is).

Given the rush, we don't have time to be conducting 20-30yr studies, so we are proceeding on partial facts and as you say, everyone is going to have the vaccine available to them soon. This is a discussion of prioritization, not a suggestion that grandma will never get the vaccine.

[Dockhead]

Originally Posted by Singularity

Model-informed COVID-19 vaccine prioritization strategies by age and serostatus
https://www.medrxiv.org/content/10.1...0190629v2.full
""A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old.""

Doing the Touchy Math on Who Should Get a COVID Vaccine First
Mathematicians model pandemic scenarios by plugging thorny ethical and logistical issues into calculations
https://www.scientificamerican.com/a...vaccine-first/
""The consensus among most modelers is that if the main goal is to slash mortality rates, officials must prioritize vaccinating those who are older, and if they want to slow transmission, they must target younger adults.

“Almost no matter what, you get the same answer,” says Harvard epidemiologist Marc Lipsitch. Vaccinate the elderly first to prevent deaths, he says, and then move on to other, healthier groups or the general population."

WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply.
https://www.who.int/docs/default-sou...rsn=bf227443_2

These are useful and relevant resources. Thanks for posting them. I have now read all three of them carefully. I have also read several of the articles footnoted in the WHO document.

The last linked resource is the most important one -- it's the WHO roadmap for prioritizing the vaccine. This is a worked-out, concrete plan for how to do it. We've been discussing the question in the abstract, but practically speaking doing the modelling and preparing the plans is a months long process and it's too late today with vaccination programs already in practical implementation, to start from a clean sheet of paper. So our discussion is somewhat pointless, other than for intellectual interest.

For policymakers, there isn't really any feasible way to deviate from this -- the time for action is now (maybe even a month ago), and this action needs to follow from a well worked-out plan, and this is it.

It is interesting to note, however, that the WHO SAGE plan does not indeed recommend prioritizing nursing homes residents, but rather, "Older adults defined by age-based risk specific to country/region; specific age cut-off to be decided at the country level." The first two articles discuss prioritizing adults over 60, not nursing home residents. These are very different groups.

A very interesting document is referenced in the WHO SAGE Roadmap, here: https://apps.who.int/iris/bitstream/...=1&isAllowed=y

This is the "values framework" for setting priorities, a superbly crafted piece of policy work. I believed it's copied from the WHO document on policymaking for pandemic measures. It says in part:

"Human Well-Being
Protect and promote human well-being including health, social and economic security, human rights and civil liberties, and child development.
"As of 1 September 2020, globally, over eight hundred thousand people have died from COVID-19 disease, many more have suffered from significant clinical disease and over 25 million cases of SARS CoV-2 infection have been reported.15 The pandemic’s negative impact on health has not been limited to COVID-19 mortality and morbidity. Essential public health services have been disrupted in many countries, including routine immunization services (increasing the risk of vaccine-preventable disease like measles); prevention and treatment services for non-communicable diseases and their complications (including hypertension, diabetes, cancer, cardiovascular and chronic respiratory diseases); maternal and child health services; and mental health and rehabilitation services (a key to healthy recovery following severe illness from COVID-19).16,17,18,19,20,21,22,23
"Health is not, however, the only dimension of well-being that has been severely affected by the pandemic. The closures of businesses, interruptions to trade, transport, and value chains, reduced consumer and business demand, and concomitant slowdown in economic activity have caused severe economic harms, undoing many recent gains made in global poverty reduction, and destroying or threatening the livelihoods and access to food of millions.24,25,26,27,28 School closures have not only resulted in significant setbacks in learning for over 1.5 billion young people, worldwide, they have also undermined their socioemotional development, and in many cases their physical health and safety.29 Lockdowns and travel restrictions have separated loved ones for long periods of time, isolating many. This pandemic thus continues to negatively impact numerous human rights, including the right to health, freedom of movement, food, an adequate standard of living and education.

"The human well-being principle requires that those making vaccine allocation and prioritization decisions determine what vaccine deployment strategies will best promote and protect all the implicated dimensions of well-being,30 including strategies for containing transmission, reducing severe disease (including long term sequelae) and death, or a combination."
Bit of thread drift, but many of our pandemic discussions on CF have been about policy, not science. Policy informed by science, but ultimately questions of policy. Some have argued -- sometimes quite aggressively -- that the ONLY legitimate goal of policy concerning the pandemic is reduction of death, and some have even argued that not only should we ignore any consideration besides reducing death, but that deaths should be counted 1:1, without regard to life-years involved.

I suggested then and suggest now, that the goal of policy should be much broader than simply reducing death. It should rather be aimed at public health as a whole. And indeed at human well-being as a whole, as so well articulated in this WHO statement.

[valhalla360]

Originally Posted by Auspicious

The second is from Johns Hopkins which says explicitly that the vaccines are unlikely to reduce transmission from infected to uninfected. The impact on spread is that people who don't get infected (vaccinated, accounting for efficacy) don't/can't spread the virus BECAUSE THEY DON'T HAVE IT and therefore the disease.

I think you are confusing a direct blocking of transmission vs a passive blocking of transmission.
- Sure, if someone is already infected, vaccinating them won't do anything. They already have a heavy viral load reproducing in the body and the body is already learning how to fight it off. In this case, at best the vaccine will have no impact...at worst, it could confuse the bodies response. But until the body learns how to fight off the virus and then clears the virus, they will remain infectious.
- If someone is vaccinated and then after developing immunity, they are exposed...as your the end statement says....dont/can't spread the virus BECAUSE THEY DON'T HAVE IT. There might be a stray case where you touch the virus with your hand and then touch another person transferring the virus to a 3rd person transferring it but that's drastically less likely than a direct transfer from an infected individual.

[Singularity]

Originally Posted by Dockhead

....It is interesting to note, however, that the WHO SAGE plan does not indeed recommend prioritizing nursing homes residents, but rather, "Older adults defined by age-based risk specific to country/region; specific age cut-off to be decided at the country level." The first two articles discuss prioritizing adults over 60, not nursing home residents. These are very different groups.

The references don't include lots of details. I'm uncertain why you are bringing up this (nursing home) topic, except that you're trying to make a point "but they didn't say the nursing homes" so as to support some alternative narrative. Such is tedious/distracting from the point at hand.

I suggested then and suggest now, that the goal of policy should be much broader than simply reducing death. It should rather be aimed at public health as a whole. And indeed at human well-being as a whole, as so well articulated in this WHO statement.

So in science we'd say that:
"If it's true that "simply reducing death" is the dependent variable in the system designed to achieve XYZ......to reject this truth is a type ________ error of hypothesis testing."

So suppose there's a policy maker who says "I would like to achieve positive outcomes XYZ" and he's got two options:
1) Most addresses the dependent variable
2) Less addresses the dependent variable

NOW, if option 1 is the most timely, cost-effective means of achieving XYZ, why should we follow him when he wants to exercise option 2?

Can we agree that a policy maker who insists on exercising option 2 above (that less addresses the dependent variable) is sadly incompetent when there were many, many other policy-makers (most in fact) who wanted to exercise option 1?

In your experience what do you call the __________ error?

And suppose that the policymaker who wanted to exercise option 2...is proven wrong later....how should people deal with him when he says "oh, but it was all too complicated" when in fact the supermajority of expert opinion said that this "option 2" promoter was wrong all along, and had pointed out evidence to him all along that this was always the case?

[goboatingnow]

Originally Posted by valhalla360

Not at all. It's a fact, that once you have had it, you have a degree of immunity. How much might be up for debate but no question it provides a level of immunity. But heck, the vaccine immunity is only an estimate also. As it goes out to the general public that percentage will likely change. Also, we have no real idea of how long the immunity provided by the vaccine will be.



It's also a fact that once you are immune, if exposed you won't be generating huge numbers of the virus, nor for as long. It's only a question of to what degree this will be.



So we are working from a base of lots of PARTIAL facts.



Sure, deaths are a worst case scenario but that doesn't mean vaccinating the most vulnerable is the best way to minimize deaths. (Look up thread for the discussion on why that is).



Given the rush, we don't have time to be conducting 20-30yr studies, so we are proceeding on partial facts and as you say, everyone is going to have the vaccine available to them soon. This is a discussion of prioritization, not a suggestion that grandma will never get the vaccine.

Your logic has not suggested anything other then the typical priority approaches agreed by most responsible public health officials and supported by the makers of the vaccine is the right one

Your horse has died , stop flogging it