E Vaccines And Their Impact

I haven't posted for a while because I've been quite busy. Among other things, I wrote and published a new book. The book isn't about coronavirus itself. At least not directly. Instead, it is a thriller about the nature of blessing and curse in a world that can seem tremendously arbitrary. If you have religious leanings, you might enjoy it. It is available at josephcox.com/agent.

Here is a rundown of my thoughts at the present time:

  1. The vaccine's success raises the value of lockdowns and other measures. With a knowable closing date, these strategies can have their costs defined and allow planning. I would recommend more shutdowns and controls while the most vulnerable get protected.
  2. Sweden's pop-up in death rates (after a long hiatus) suggests that the bar for long-term protection is higher. How much higher is unclear. The pop could be due to expiring immunity, movement into communities that hadn't previously been exposed, or.... either way they didn't stay at near zero. I was wrong about this area of developing immunity. Promisingly, deaths per case have fallen.
  3. I'm not going to take the mRNA vaccines at this time. I trust the people involved (my sister runs a statistical analysis team working on the vaccine for one of the companies). It is just that the long-term data is unknown. I would, however, recommend it for older people. Long-term effects (or potential effects on the next generation) are less relevant and the risks are greater. For myself, I'm going to wait on either more data or the conventional vaccines. My kids won't be getting it for quite some time (I know it isn't approved for them).
  4. The vaccines will help *tremendously*. By protecting the old and most vulnerable they will cut death rates massively. Interestingly, we don't know if they prevent *infection.* We just know they cut symptomatic disease. So they may have little impact on herd immunity. They will, however, cut deaths. The average age of death in Israel is still hovering around 80 - getting to asymptomatic cases for >60s would be a wonderful thing.
  5. The big and very very hard question is: when is it enough? When is it enough to open society again? This is a question I have no answer for. It is one we constantly struggle with, and not just with corona. Motorcycles are legal. You can leave the home with the flu. Sugary drinks are legal. Smoking is highly limited. We're allowed to drive cars. In each of these cases, we've come to some sort of understanding of risks vs. freedoms. Corona will never totally go away. At least I don't think so. That's why the answer isn't: "we can stop when deaths are zero." The world doesn't tend to work that way. Zero-tolerance doesn't actually work. So we have to grapple with this question and it is a very very hard one.
  6. The questions surrounding China's role have to be examined. This is on two levels. One: was this very unusual virus engineered? Two: why did Asian countries seem to be so much less impacted? Yes, some are very efficient and organized. But others... well, they aren't known for their highly functional administrations. There are people looking at the possibility of earlier related viruses in the region - but why they didn't get to the rest of the world dents that theory. The fact is there are some questions we could use answers for.
  7. The third-world impacts remain terrible. Estimates are that more than a million have died of hunger. I'd imagine many more are stunted. This will have a terrible long-term cost. The good thing is we didn't just shut down. We flexed and bent and kept things somewhat on track. Yes, many lives were lost. But many more would have been lost without relieving the pressure of the most stringent measures.
  8. We got a taste of a new way of doing medicine. Fast, throw things at problem approaches. One might say 'agile medicine.' This way has obvious drawbacks and obvious benefits. With our old approach, we wouldn't have a solution for the elderly. Now we do. With our old approach, we wouldn't have dramatically improved treatment, but we have. I'd love us to learn lessons from this experience and apply them to more conventional issues like cancer, heart disease, and dementia. 
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My book isn't coronavirus itself. At least not directly. Instead, it is a thriller about the nature of blessing and curse in a world that can seem tremendously arbitrary. If you have religious ...

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Bruce Powers 4 days ago Member's comment

So do the vaccines really work? Is one better than the other?

Joseph Cox 1 day ago Author's comment

The data from the trials certainly supports it. But Israel is having a tough time despite leading the world in vaccinations. There are too many factors (from new strains to a lack of isolation) to figure out what effect the vaccines are having.

Bruce Powers 15 hours ago Member's comment

Well that doesn't sound particularly helpful. Are infections down? They can't link that to the high number of vaccinations?

Joseph Cox 15 hours ago Author's comment

Here is some data from Israel that is very promising: Fewer than 0.01% of people who received Pfizer's COVID-19 vaccine have contracted the virus more than a week after receiving the second dose, the Maccabi health fund said on Monday.

Ayelet Wolf 14 hours ago Member's comment

That does sound good, but there's no way to know if those people would have gotten it anyway. Isn't the country still in lockdown? So who would they catch it from?

Joseph Cox 14 hours ago Author's comment

Lockdown or not, we currently have the 3rd highest known infection rate in the world over the last 7 days. And #2 is Andorra. At our current rate, >700/million are getting infected daily. It was 1,000/million a week or so ago.

This isn't quite apples to apples, of course. That is a daily rate of 0.001%. So, over 10 days the general population would see a 0.01% infection rate and I don't know how long the data set is for.

It is notable that of those who were infected none had a fever or were hospitalized. They had no symptoms. They were tested due to known exposure to others.

As per your recommendation, I'm signed up for my first shot Feb 10th.

www.ynetnews.com/health_science/article/Hk2URcnku

Harry Goldstein 3 weeks ago Member's comment

I was looking forward to taking the vaccine but friends told me that it was inadvisable since I am allergic to penicillin. Apparently that can be very dangerous. Will need to check with my doctor to see if it's true.

Ayelet Wolf 3 weeks ago Member's comment

I have read that those with allergies could have an adverse reaction. So yes, best to consult with your doctor. But I wouldn't worry too much, of the millions who have already been vaccinated, we've only read about a handful who have gotten seriously ill as a result. Your risk from Covid is far greater.

Joseph Cox 3 weeks ago Author's comment

One person here with a penicillin allergy had a severe shock. Don't know how common it is. My wife is going in tomorrow. She has allergies to various tapes and one med. Hopefully, all will be fine.

Susan Miller 3 weeks ago Member's comment

It sounds like Israel will soon be the safest place in the world to be? By far the world leader in percentage of population vaccinated:

www.moneycontrol.com/.../...-covid-19-6294641.html

Joseph Cox 3 weeks ago Author's comment

And the lead is growing.

Jack S. Chen 4 weeks ago Member's comment

You make some interesting observations about China. I will add a few comments to consider:

1. I suspect China was affected far more than they admit. To be blunt, they are very likely lying about their numbers. And anyone who says otherwise is censored.

2. They were far more aggressive in their lockdowns than other countries. In the US many states refused to have lockdowns, and of those that did, many people refused to listen. In China, people were literally locked in their homes and they used surveillance to ensure compliance.

The above to factors probably had a far worse impact than other countries realize, but which we will also likely never know about in more depth.

Joseph Cox 4 weeks ago Author's comment

Even so, countries like Cambodia, Vietnam, Thailand and Malaysia weren't hit nearly as hard as countries in the West. There is some other factor at force. Of course they could have extreme censorship too but I doubt Thailand, Malaysia and Vietnam could pull it off.

Alexis Renault 1 month ago Member's comment

I'm surprised you aren't willing to take the vaccine. Surely they've done extensive testing to make sure the are safe. But can you offer a brief explanation of the difference between mRNA vaccines and conventional vaccines?

Joseph Cox 1 month ago Author's comment

On extensive testing: They have a few months of follow-up, at best. A normal vaccine goes through five years. We know it is perfectly safe for a few months.

Joseph Cox 1 month ago Author's comment

I expect I *will* be willing. Just gonna let the higher risk groups - for whom the downsides happen to be lower - go first.

As I understand it the basic difference is this: the mRNA gets your own cells to create a protein on themselves that resembles the tell-tale 'spike' of the coronavirus. Our body recognizes those cells as the enemy (even though they are harmless) and it triggers the immune response (and programming).

The conventional vaccine introduces a neutered version of the virus itself which the body then learns to fight.

The mRNA approach might be perfect and awesome and amazing. It might cure all sorts of other ailments. But our human trial follow-up data lasts only a few months (at best) and excludes certain groups - like pregnant women.

I'd categorize people like this:

Shorter expected lifespan (e.g. old): fire away.

Above childbearing/fathering age: step up next (that's me).

In child-bearing/fathering age: watch what happens to others.

Younger: there's no rush - the virus is very little danger to you.

As far as immunity from the vaccine is concerned, we still don't know that it prevents infection or spread. All we know is that symptomatic infections are dialed back.

Alexis Renault 4 weeks ago Member's comment

I would think that the scientists are able to infer if there would likely be any long-term complications and that the FDA, before approving would look into this as well. Even if there are some long term impact, it would likely minimally affect a small percentage of the population - COVID itself is far riskier.

That being said, the same argument could be made for COVID itself. We don't know what the long-term impact will be for people who have it. Did it cause permanent damage to their hearts, lungs or brains? I've read reports that it does. And children could develop complications as well. We just don't know. But we do know that at least right here and now, Covid is far more likely to kill people and the economy, than the vaccine.

Joseph Cox 3 weeks ago Author's comment

Alexis Renault, you make an excellent point on unknown effects. My wife is getting scheduled for a vaccination (she is an audiologist) and I'll follow when the opportunity arises.

Joseph Cox 4 weeks ago Author's comment

Biology - and ecology and economics and all the complex systems sciences - are full of unintended consequences. It is just extremely hard to know what will happen in biology without actually running the trials. We ran trials, but the timeline was very short. Yes, there are potential long-term risks of corona which we also don't know. But we know the risks weigh heavily towards the old and unhealthy (overweight, high BP, diabetic etc...). The higher risk you are, the clearer the equation. The lower risk, the more value in waiting to see what happens to the higher risk. It looks like lower risk people won't have any choice but to wait.

As a micro-example. there were no pregnant women in the trials. But they will get the vaccine. Do we expect any problems? No. In fact, we're pretty sure about it. But the unexpected happens in biology all the time.

The Australian Cane Toad is a great ecological example.

I do believe it will be fine. I'll just be more confident with more time.

Texan Hunter 4 weeks ago Member's comment

Joseph Cox, there is no shame in saying you don't want to be a Guinee pig for the vaccine. It's probably fine, but let others take the risk first!

Ayelet Wolf 4 weeks ago Member's comment

This is a good point, but as I said below, we still have no idea what the long term affects of a covid infection are either. True be told, I'm glad I won't be the first to get the vaccine too. But once my turn comes around, I think I will be quite eager.

Ayelet Wolf 4 weeks ago Member's comment

I recall reading an article that a study (I think out of Israel) showed that Covid caused damage to male's sperm count. Would be scary if some of the kids who had Covid end up being sterile when they grow up! Hopefully the damage isn't permanent.

Michele Grant 4 weeks ago Member's comment

Unless where you live the rules are different, it will likely be quite a while before you can even get the vaccine. Those of us who are young and healthy are low priority.

Assuming everything goes smoothly, by then you might be far more eager to take it. Especially if those who take it are offered more freedom than those who don't.

Joseph Cox 4 weeks ago Author's comment

They expect >60s in Israel will have their second dose by the end of January. They also expect that by the time the >70s are done, potential fatalities will have been cut by 75%.

Susan Miller 1 month ago Member's comment

Congrats on the new book!

Joseph Cox 1 month ago Author's comment

Thanks!

William K. 1 month ago Member's comment

Very interesting and quite insightful. Certainly the virus has changed everything, and more certainly the rapid spread has shown just how incredibly incompetent most of the folks "in charge" actually are. From the local officials in the Wuhan area ti our president Trump, they all made many wrong choices, even when the facts were obvious. So why should I trust the judgement of a person who made so many wrong choices? Their judgement was suspect before, now they are proven to be following the wrong agenda.

Joseph Cox 1 month ago Author's comment

The right choice is not always obvious. Arguing about which 'agenda' is right is also a constant reality. There are straight up wrong agendas (self-dealing), but people tend to follow them in the margins. Debates and struggles on weighing the the economy vs. saving lives vs. freedom are important to have and support.

Long-term, the belief that there are people 'in-charge' who can be as competent as we sometimes expect them to be is itself suspect. 'Sciences' in highly complex fields full of feedback (think economics as an example) very often get things very wrong. At the other extreme we might have the sciences physics or chemistry which are quite predictable. Most things are in the middle. The practice of medicine is more towards the science end - but as we march outwards towards even something as seemingly simple as pandemic modeling we end up closer to the 'science' end of things.

We didn't focus on the technocrats, in countries like Belgium or states like New York, who also got things terribly wrong. And, of course, we ignore the victims in the third-world who were never actors to begin with.

It seems like terribly wrong is often unavoidable.

Andrew Armstrong 1 month ago Member's comment

Very thoughtful, thanks.