Corona Virus: It's a Marathon, Not a Sprint

[Zaxxon]

This is kind of a big deal.

Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID19

For 10 weeks, at least.


upload image anonymous

[stessier]

This is kind of a big deal.

Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID19

For 10 weeks, at least.


upload image anonymous

That's likely to keep changing, though, as we get more information. Seems a reasonable place to start.

[Zaxxon]

This is kind of a big deal.

Fully vaccinated persons who meet criteria will no longer be required to quarantine following an exposure to someone with COVID19

For 10 weeks, at least.


upload image anonymous

That's likely to keep changing, though, as we get more information. Seems a reasonable place to start.

Oh, absolutely. I'm not intending to knock it--it's absolutely a great place to start. It's just a very far cry from the headlines. It's 10 weeks. Effectively, it means little until it's altered to be a significantly longer period. I'm actually a little concerned about the headlines which are mostly 'don't need to quarantine anymore once vaccinated!' since the take-away for most folks will be that it's permanent, or at least holds for a significant duration.

[Smoove_B]

Oh, absolutely. I'm not intending to knock it--it's absolutely a great place to start. It's just a very far cry from the headlines. It's 10 weeks. Effectively, it means little until it's altered to be a significantly longer period. I'm actually a little concerned about the headlines which are mostly 'don't need to quarantine anymore once vaccinated!' since the take-away for most folks will be that it's permanent, or at least holds for a significant duration.

I'd love to know how many people are quarantining after an exposure right now. I totally get what you're saying, but I'm hoping the message is filtered into another positive reason to get the vaccine series, i.e. anything that will help uptake. I haven't actually seen news headlines on it yet so I don't know how it's being distorted, but yeah, it probably will be to a degree.

Any word yet on masks for people fully vaccinated?

No, not yet. I don't think that will happen until much, much later and unofficially I'd expect mask use to extend through the Fall of this year.

[El Guapo]

This is probably conservative relative to what we know, right? This seems like the minimum possible immunity period. The only concern I have on that is that if we under-sell the likely immunity benefits we could wind up creating a demand problem on people willing to take the vaccine.

[Smoove_B]

Yes. As someone living in a state where demand far-outweighs supply it's not great. I still think we're collectively as a nation in a huge supply bottleneck right now and soon enough the news stories will be pivoting to how states no longer have lines or demand - there will be photos and videos of mega clinics open and empty, begging people to show up.

[LordMortis]

Yes. As someone living in a state where demand far-outweighs supply it's not great. I still think we're collectively as a nation in a huge supply bottleneck right now and soon enough the news stories will be pivoting to how states no longer have lines or demand - there will be photos and videos of mega clinics open and empty, begging people to show up.

Soon is kinda wishywashy. Depending on where in the US (aka what's your weather) and the supply you receive, I'm thinking "soon" might be the case or might now. Locally, I peg the slow down to start in late May, when people start to get heavy on being cooped up when the weather is too good and they already missed early and mid spring and they still couldn't get in line. Essentially the supply will exceed the demand because people will give up on demanding. Cases will be down and we'll already have given up 14 months of our lives.

We can't knock the effort that has been put in. That this was largely done during an admin that was hostile to its rollout was nothing short of amazing but you have two groups of people: 1) Young people who see themselves as invulnerable and when spring comes and they can't get in line, that's it. 2) Not young people who've seen more springs than the ones they have to look forward to. They've already notched off one for the good everyone. Telling them in March and April, "we know it's hard but we'll be there by October. Don't be fooled by the summer slow down in spread" isn't going to keep the masses isolated and weekly self motivated checking a bad logistics system trying to interpret what the proper channels are to find out when they can register to register (not redundant typo) with what entity, that they may have proper guidelines in post shot etiquette sometime in the future.

If I didn't have as many health concerns as I do, I'd be cracking. I'm sure by late March if I still can't get in line with a date (and that is a high probability as of 2/8) the stress and fatigue are going to start overwhelming me. I imagine being healthy, young or not, and having to wait longer.

[Smoove_B]

Yeah, that's all fair. So much depends on (1) the volume of vaccine being pushed out to the states (i.e. what is the sustainable ultimate ceiling) and then (2) what is the state's ability to vaccinate? I think #2 is why I'm confident supply is going to quickly (~30 days) outpace delivery ability and then when that bottleneck clears (April? May?) it'll be regions of the US where they are sending vaccines that are going unused.

I saw some report earlier this week that even though J&J's approval will come in the next few weeks, they aren't going to be able to deliver vaccines to the U.S until late June / early July. Thanks, Trump.

I have a friend that lives in the suburbs of Atlanta and his wife has been fully vaccinated for almost a month now because no one is registering to be vaccinated. Completely different situation here in NJ where I'm realistically not expecting to get my first vaccination until late March.

[LordMortis]

Completely different situation here in NJ where I'm realistically not expecting to get my first vaccination until late March.

My father is 79 with multiple underlying conditions. He was just allowed to register to get in line this week. No ETA when the first shot will be given but at least he's finally in line. He's been working on this and I have been poorly assisting as best I can for a month. Mom, being 77 with no underlying conditions, has already said screw it. She's still following all of the precautions, but the vaccination is already something she's through jumping through hoops for (which does not make me thrilled).

Forgetting all of the antivax crowd, I'm just imagining the people wanting to get vaccinated now to get on with their lives in late March, with no path to vaccination and the weather getting better, and then in early May with spread hitting a deep valley and still no path to vaccination while they have already been bending the rules.

OTOH, my little sister somehow got her first vaccination already, presumably because of her value in the Nat Guard reserves. The first vaccination laid her low for three days straight. I know I'll need do planning for mine. Vacation time. If it kicked her ass and our genes are similar with me being less healthy, I fear I'm in for a whole world of suck when I get a number.

[malchior]

I can't believe I missed this.

https://twitter.com/nytimes/status/1360233315899498496

[Defiant]

How to properly wear two masks — and other mask-fitting tips following recent CDC advice

[Ralph-Wiggum]

I've been double-masking the last week+. The biggest issue with it so far is that my glasses fog up much worse when double masking than it ever did with a single mask. I guess I was under the impression that a tighter fit = less fogging, but that doeesn't seem to be the case. This is especially annoying since I had finally found a tight fitting cloth mask that didn't fog my glasses at all.

[Max Peck]

My experience with double masking has been the opposite. It effectively eliminated the fogging problems I had when wearing just a cloth mask, even my best fitting one.

[hitbyambulance]

How to properly wear two masks — and other mask-fitting tips following recent CDC advice

What to do: Layer a cloth mask on top of a surgical or medical procedure mask. This helps the entire setup fit more snugly and eliminates gaps around the sides of the face or nose. Make sure the fit is comfortable and doesn’t have gaps.

What not to do: Do not combine two disposable masks, which are not designed to fit tightly. Wearing more than one disposable mask at a time will not improve fit.

but it says nothing about combining two cloth ones. why?

[The Meal]

It has specifically excluded double cloth masking as being meaningfully beneficial.

[LawBeefaroni]

I've been double-masking the last week+. The biggest issue with it so far is that my glasses fog up much worse when double masking than it ever did with a single mask. I guess I was under the impression that a tighter fit = less fogging, but that doeesn't seem to be the case. This is especially annoying since I had finally found a tight fitting cloth mask that didn't fog my glasses at all.

The more layers, the more resistance from the cloth and the less air goes out through it. This means more air gets forced out around the mask, including the top, which fogs glasses.

There's probably a point where adding layers actually makes things worse.

[The Meal]

A cloth mask over my KN95 mask has definitely created more fogging and more escape around the edge. I just tried the KN95 but held in place with a mask extender (I think Max Peck linked to these: ) and it works much better.

[hitbyambulance]

It has specifically excluded double cloth masking as being meaningfully beneficial.

https://www.clothmasks.ca/

good information here.

[Max Peck]

A cloth mask over my KN95 mask has definitely created more fogging and more escape around the edge.

The CDC explicitly says not to double-mask with a KN95. Given the shape of an N95/KN95 mask, I'd guess that the pressure from wearing a cloth mask over it might mess with the fit. As described on the CDC site, double-masking is specifically a technique to improve the fit of a procedural mask and doesn't really apply to anything else.

Has anyone been able to try out a mask fitter/brace with a procedural mask? I've tested the elastic band version, but it didn't work well for me, probably because the elastic doesn't conform to the contour of the bridge of my nose, so it actually seemed to make the fit of the top of the mask worse. A tucked-and-knotted procedural mask gives me a good fit with no fogging, but if I add the elastic band fitter to the mix, my glasses fogged up almost immediately. Unfortunately, I don't have a way to make a contoured fitter and don't want to invest any money in the way of finding a way to purchase one just to test it out when I already have multiple better solutions.

[The Meal]

The CDC explicitly says not to double-mask with a KN95. Given the shape of an N95/KN95 mask, I'd guess that the pressure from wearing a cloth mask over it might mess with the fit. As described on the CDC site, double-masking is specifically a technique to improve the fit of a procedural mask and doesn't really apply to anything else.

Yep, that's what got me to move away from what I had been doing. The cloth mask that I use has a band that goes around my head, so it's much more comfortable than something that only hangs off my ears. I was thinking of using the cloth mask over top the KN95 purely as a comfort feature, but the mask extender for the KN95 accomplishes that all in its own. Live, experiment, listen-to-the-CDC, and learn.

[Ralph-Wiggum]

Just to be clear, the CDC is recommending the double masking not because the extra layers help filter out more, but because the second mask will press against the first making a tighter fit? Does this mean that if I have one mask that fits tightly by itself, a second mask isn't necessary? And is there a good way to test if a mask fits tightly enough?

[Max Peck]

And is there a good way to test if a mask fits tightly enough?

[Kraken]

I've been double-masking the last week+. The biggest issue with it so far is that my glasses fog up much worse when double masking than it ever did with a single mask. I guess I was under the impression that a tighter fit = less fogging, but that doeesn't seem to be the case. This is especially annoying since I had finally found a tight fitting cloth mask that didn't fog my glasses at all.

The more layers, the more resistance from the cloth and the less air goes out through it. This means more air gets forced out around the mask, including the top, which fogs glasses.

There's probably a point where adding layers actually makes things worse.

I get less fogging when both masks have nose wires. I can get a good enough seal along the top edge to drive the exhaust down and to the sides.

[Little Raven]

Woo hoo!

We’ll Have Herd Immunity by April

Covid cases have dropped 77% in six weeks. Experts should level with the public about the good news.

[stessier]

Woo hoo!

We’ll Have Herd Immunity by April

Covid cases have dropped 77% in six weeks. Experts should level with the public about the good news.

I can't read the link. What math do they use to show 70% vaccination by April?

[Zaxxon]

Oh God. It was bad and clearly wrong when Elon Musk suggested that we'd be largely back to normal by the end of April last year, and it's bad when this goober suggests the same for April this year.

[Little Raven]

He's not saying 70% vaccination rate. He's arguing that the current drop in numbers indicates that way more people are developing natural immunity than we've previously estimated.

Amid the dire Covid warnings, one crucial fact has been largely ignored: Cases are down 77% over the past six weeks. If a medication slashed cases by 77%, we’d call it a miracle pill. Why is the number of cases plummeting much faster than experts predicted?

In large part because natural immunity from prior infection is far more common than can be measured by testing. Testing has been capturing only from 10% to 25% of infections, depending on when during the pandemic someone got the virus. Applying a time-weighted case capture average of 1 in 6.5 to the cumulative 28 million confirmed cases would mean about 55% of Americans have natural immunity.

Now add people getting vaccinated. As of this week, 15% of Americans have received the vaccine, and the figure is rising fast. Former Food and Drug Commissioner Scott Gottlieb estimates 250 million doses will have been delivered to some 150 million people by the end of March.

There is reason to think the country is racing toward an extremely low level of infection. As more people have been infected, most of whom have mild or no symptoms, there are fewer Americans left to be infected. At the current trajectory, I expect Covid will be mostly gone by April, allowing Americans to resume normal life.

Antibody studies almost certainly underestimate natural immunity. Antibody testing doesn’t capture antigen-specific T-cells, which develop “memory” once they are activated by the virus. Survivors of the 1918 Spanish flu were found in 2008—90 years later—to have memory cells still able to produce neutralizing antibodies.

Researchers at Sweden’s Karolinska Institute found that the percentage of people mounting a T-cell response after mild or asymptomatic Covid-19 infection consistently exceeded the percentage with detectable antibodies. T-cell immunity was even present in people who were exposed to infected family members but never developed symptoms. A group of U.K. scientists in September pointed out that the medical community may be under-appreciating the prevalence of immunity from activated T-cells.

Covid-19 deaths in the U.S. would also suggest much broader immunity than recognized. About 1 in 600 Americans has died of Covid-19, which translates to a population fatality rate of about 0.15%. The Covid-19 infection fatality rate is about 0.23%. These numbers indicate that roughly two-thirds of the U.S. population has had the infection.

In my own conversations with medical experts, I have noticed that they too often dismiss natural immunity, arguing that we don’t have data. The data certainly doesn’t fit the classic randomized-controlled-trial model of the old-guard medical establishment. There’s no control group. But the observational data is compelling.

I have argued for months that we could save more American lives if those with prior Covid-19 infection forgo vaccines until all vulnerable seniors get their first dose. Several studies demonstrate that natural immunity should protect those who had Covid-19 until more vaccines are available. Half my friends in the medical community told me: Good idea. The other half said there isn’t enough data on natural immunity, despite the fact that reinfections have occurred in less than 1% of people—and when they do occur, the cases are mild.

But the consistent and rapid decline in daily cases since Jan. 8 can be explained only by natural immunity. Behavior didn’t suddenly improve over the holidays; Americans traveled more over Christmas than they had since March. Vaccines also don’t explain the steep decline in January. Vaccination rates were low and they take weeks to kick in.

My prediction that Covid-19 will be mostly gone by April is based on laboratory data, mathematical data, published literature and conversations with experts. But it’s also based on direct observation of how hard testing has been to get, especially for the poor. If you live in a wealthy community where worried people are vigilant about getting tested, you might think that most infections are captured by testing. But if you have seen the many barriers to testing for low-income Americans, you might think that very few infections have been captured at testing centers. Keep in mind that most infections are asymptomatic, which still triggers natural immunity.

[malchior]

Let's see. Overly optimistic. Written by a non-epidemiologist. On the WSJ Opinion page. About Covid? I'm going to take a reasonable guess that this isn't going to hold up. Worse we don't need reasons to offer up disincentives to vaccinate when time is of the essence.

[LordMortis]

Woo hoo!

We’ll Have Herd Immunity by April

Covid cases have dropped 77% in six weeks. Experts should level with the public about the good news.

Here's what I don't get, and it started with Smoove's talk about the huge unexplained drop, lest we think my thunk is an attack on conservative optimism and non mask wearing anti vaxers. This huge drop takes us down to the place where we are still above the rates at which we shuttered everything and which also back to about where we were pre Halloween, a time we were battening down the hatches to prepare for the start of a predicted rise at Halloween to last until the two weeks after New Year spike. To me, the drop (or presumptive return to flattening) looks very well explained and it looks like our hospitals should still be in a state of being overloaded, even if they're not bodybags in semi-truck freezers overloaded.

To me, experts have been overstating the good news, even if it is good news and we should keep going. The TV version of experts (Scott Gottlieb, etc...) say we are probably at about 40% lower contraction rates (I don't think they say immunity because the unkowns are still too large) based on reduced spread from previous contractions and immunizations, which puts us about half way there with regard to "herd immunity". He/they postulate that virus variants should be having a harder time finding new hosts and spreading.

[Smoove_B]

Yeah, this is really just his hot-take on why cases are dropping. It goes back to the article that the Atlantic (and others) posted - we don't know the reason why right now and it's likely a multitude of reasons that we don't quite understand. To follow his logic he's skirting the "herd immunity" mentality that was popularized last year and implying this isn't really a big deal anymore because more people had it, didn't have problems and have recovered. Instead (he's arguing) we should be vaccinating the vulnerable and under-served with his theory that so many more adults have already developed natural immunity.

I mean, it's definitely a way to look at everything and bet it all on a single element.

FWIW, his opinion is not endearing him to the greater field of public health.

EDIT: You're killing me, Smalls

[Isgrimnur]

vaccinating the vulnerable and undeserved

Again...

[Zaxxon]

Yeah, this is really just his hot-take on why cases are dropping. It goes back to the article that the Atlantic (and others) posted - we don't know the reason why right now and it's likely a multitude of reasons that we don't quite understand. To follow his logic he's skirting the "herd immunity" mentality that was popularized last year and implying this isn't really a big deal anymore because more people had it, didn't have problems and have recovered. Instead (he's arguing) we should be vaccinating the vulnerable and undeserved with his theory that so many more adults have already developed natural immunity.

I mean, it's definitely a way to look at everything and bet it all on a single element.

FWIW, his opinion is not endearing him to the greater field of public health.

Pretty much my more considered take (after the initial hot-take upthread). I mean, he's right that if the numbers keep dropping at their current rate, things will look pretty peachy on 5/1/21. But we don't know that his stated reasons for the drop are accurate.

I mean, come on:

The data certainly doesn’t fit the classic randomized-controlled-trial model of the old-guard medical establishment. There’s no control group. But the observational data is compelling.

OK, sure. But we can also observe that global warming eradicates pirates.

I don't take issue with him espousing the theory that things are going to continue looking better. It seems like making the specific prediction of an open, normal-ish country at the end of April is where he oversteps, to me. I'd like nothing more than to see normalcy in May, giving us months to finish preparing before my kids return to school in the fall. But I'll wait for a known (or at least somewhat scientific consensus-based) expectation of same before I get too worked up about it.

Contingency planning for an open economy by April can deliver hope to those in despair and to those who have made large personal sacrifices.

Yeah, and giving that hope only to see it dashed again can cause a whole lot more despair.

[Blackhawk]

All we need is for the theory about two separate semi-populations (anti-safety and safety) to be the right one, have everyone listen to this and then run back together for a big group death-hug.

[Smoove_B]

I think what (maybe) the greater public doesn't understand or appreciate is that epidemiology (and public health) is a gigantic mix of skills, practitioners and specialists; we're far from being monolithic. The reason I point this out is because looking at the data (and analyzing the why) is a specific type of epidemiology. For what I do (or I guess, did), it's about how? what happened? Same tools. Same types of processes but a different application of the information. There are other epidemiologists that only do research and some that only work in infectious disease control. The point being, our lens for viewing the same topic is going to be slightly different, even though we're all in the same profession.

For what we're dealing with now, the epidemiology *should* be driving policy. In other words, the data we're gathering and analyzing should be telling us what's working and what's not working. It gives us a framework to adjust - to evaluate a current policy (don't wear masks!) and modify it because we're seeing a change in practice or behavior is making a difference (wear masks!) in the number of cases.

When you publish an OpEd like this, it's suggesting that it's going to be time for us real soon to go back to "normal". This was a point raised Anonymous Bosch in another thread (I think) about telling the truth:

Some medical experts privately agreed with my prediction that there may be very little Covid-19 by April but suggested that I not to talk publicly about herd immunity because people might become complacent and fail to take precautions or might decline the vaccine. But scientists shouldn’t try to manipulate the public by hiding the truth.

It's not that we're hiding the truth. There is no "truth" that cases will be lower by April and we'll have "herd immunity". That's a prediction about cases; that's his theory. To put this out there like it's fact will absolutely drive policy decisions as numerous governors,mayors and politicians will latch on to his theory because it's what they want to hear. The public will latch on because it's what they want to hear.

The truth is we have no idea what's happening so we should continue with the current plan until we have more information about what's going on. Broadcasting this like he's speaking for the greater public health community at large is at best disingenuous. In truth, it's dangerous.

[gilraen]

It matters how much information the scientists release because it changes public behavior. If someone says "there will be very little COVID in April", and people drop all precautions, suddenly you have a spike in April, and people scream that scientists are wrong again...and ultimately that doesn't help with public trust. So can't blame the scientists for keeping all but the most solid proven theories to themselves.

[malchior]

The truth is we have no idea what's happening so we should continue with the current plan until we have more information about what's going on. Broadcasting this like he's speaking for the greater public health community at large is at best disingenuous. In truth, it's dangerous.

My gripe tbh is that he is making this loose opinions that is in a long line of loose or unsupported opinions that have largely been argued only in one political sphere and have consistently undercut response. But to the dangerous angle, he plays the 'old-guard' card that Zaxxon pointed out. To paraphrase it, he is saying that its the 'experts' again -- quoted just like Cuomo used it -- are holding us all back from returning to our lives. That's where it gets dangerous. None of us like this but this brand of fantasy thinking is what killed a lot of people and it'll continue to rub me the wrong way even if he ends up being right.

[LordMortis]

OK, sure. But we can also observe that global warming eradicates pirates.

Heeeey. I see what you did there. We all know it has been the receding quantity of pirating that caused climate changes and the less pirates we have the faster "global warming" occurs.

[Zaxxon]

OK, sure. But we can also observe that global warming eradicates pirates.

Heeeey. I see what you did there. We all know it has been the receding quantity of pirating that caused climate changes and the less pirates we have the faster "global warming" occurs.

Man, if I knew all I had to do to fight climate change was take to the high seas and commit to a life of derring-do, I'd have done that rather than solar panels.

[Lorini]

Just started reading The Data Detective by Tim Harford which talks about exactly this. It's unfortunate that WSJ chose to publish that Op Ed because when it doesn't happen we know the author will be long gone.

[Isgrimnur]

OK, sure. But we can also observe that global warming eradicates pirates.

Heeeey. I see what you did there. We all know it has been the receding quantity of pirating that caused climate changes and the less pirates we have the faster "global warming" occurs.

Man, if I knew all I had to do to fight climate change was take to the high seas and commit to a life of derring-do, I'd have done that rather than solar panels.

Where do I make my mark?