COVID-19

Covid-19 discussion, bring your own statistics
OffTheRock
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Re: COVID-19

Post by OffTheRock » Fri Aug 20, 2021 9:17 pm

lpm wrote:
Fri Aug 20, 2021 3:06 pm
shpalman wrote:
Fri Aug 20, 2021 11:46 am
Ventilator bed occupancy is heading for 23% of its peak value (just over 4000 on the 24th of January); hospital occupancy peaked just under 40000 about a week before that and you're now at 16% of that value. If I can take those peak values as an indication of your capacity, then you'd already be back in the Yellow zone according to Italy's rules (where despite the lower vaccination coverage we have about half the death rate you do, but I expect some of the regions which are currently full of domestic holiday makers are going to ruin this shortly).
This % is the metric to watch. Not case numbers.

I said before that we were 3 doublings away from crisis mode which is about right - 3 doublings would be 184% of Jan ventilators and 128% of Jan hospital occupancy. That's the sort of level when people start dying in corridors. We'd need to slam into lockdowns if we were heading to this point.

But it's pretty impossible to race up to 3 doublings with R=1.1 or even R=1.3. Vaccination prevents acceleration.
Our critical care and respiratory wards are pretty f.cked right now tbh. I don't think we've got 3 doublings unless we can send the patients elsewhere. We could possibly open some surge capacity but judging from the e-mails appearing across the trust all afternoon, I doubt we could staff it anyway because we don't have enough staff to staff ordinary levels this weekend. I suspect the reason we haven't gone back onto OPEL 4 is because we've been cancelling non-emergency admissions for the last couple of weeks. And it's only f.cking August.

Millennie Al
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Re: COVID-19

Post by Millennie Al » Sat Aug 21, 2021 1:11 am

lpm wrote:
Fri Aug 20, 2021 2:55 pm
The govt wants infections to flow steadily through under 30s. They don't want to slow that pace with masks in schools or ventilation in nightclubs. I don't understand why the twitter commentariat doesn't understand this.
I wonder if the government is doing this deliberately to try to ensure that the unvaccinated get the best chance of acquiring natural immunity from infection before the first vaccines start to wear off. I'm not sure they're competent enough to think of that, and surely not smart enough to see that it would then also make the natural immunity tend to wear off for a lot of people in a short period, making us vulnerable to any infection still around (or imported).
Covid-19 - Don't catch it: don't spread it.

Herainestold
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Re: COVID-19

Post by Herainestold » Sat Aug 21, 2021 2:25 am

Millennie Al wrote:
Sat Aug 21, 2021 1:11 am
lpm wrote:
Fri Aug 20, 2021 2:55 pm
The govt wants infections to flow steadily through under 30s. They don't want to slow that pace with masks in schools or ventilation in nightclubs. I don't understand why the twitter commentariat doesn't understand this.
I wonder if the government is doing this deliberately to try to ensure that the unvaccinated get the best chance of acquiring natural immunity from infection before the first vaccines start to wear off. I'm not sure they're competent enough to think of that, and surely not smart enough to see that it would then also make the natural immunity tend to wear off for a lot of people in a short period, making us vulnerable to any infection still around (or imported).
The first vaccines should be wearing off about now, just in time for Delta round two. Expect carnage in the autumn. I expect 2022 to be like this year, recurring waves of new variants hitting waning vaccinated people. Batten down the hatches.
Vaccination saves lives. Lockdowns stop transmission.

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Bird on a Fire
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Re: COVID-19

Post by Bird on a Fire » Sat Aug 21, 2021 2:30 am

shpalman wrote:
Fri Aug 20, 2021 2:22 pm
Herainestold wrote:
Fri Aug 20, 2021 2:12 pm
If we are just going to put up with this level of death and destruction -another 30 000 deaths per annum added on top of influenza and other plagues-
we are going to have to increase NHS capacity. More beds, more ICU beds, more doctors, more nurses, more support staff. Where are we going to get them? You can build things quickly, but it takes years to train staff. Is anybody in charge thinking about this?
Some of the covid deaths will be instead of other plagues; well, it will kill people who were going to die of something else anyway, but a few years earlier.

https://www.ecdc.europa.eu/en/covid-19/ ... isk-groups
Severity of COVID-19 is associated with increased age, male sex, and pre-existing medical conditions [1-3]. Underlying health conditions reported among adult patients with severe COVID-19 disease include diabetes [4-6], obesity [4,7], hypertension [3,4], history of heart failure[4,8], ischaemic heart disease [4,17,18], solid organ tumours [4,9], chronic obstructive pulmonary disease (COPD) [4,10], chronic respiratory disease[4], chronic kidney disease [4,11,12], immune compromised status [4], cancer [4,13,14], neurologic conditions [4,15], smoking [4,16], and pregnancy [14,17]. Severe disease is here defined as ICU or hospital admission, mechanical ventilation, or death.
references are in this pdf
That's good news, then - the UK can source its extra hospital capacity from a few years in the future.
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Martin_B
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Re: COVID-19

Post by Martin_B » Sat Aug 21, 2021 2:44 am

shpalman wrote:
Fri Aug 20, 2021 6:07 pm
lpm wrote:
Tue Jul 27, 2021 11:02 am
People are desperate to force the "it was football" narrative, no matter the facts.
...
9000 cases

Also, apparently, tennis fans and football fans behave differently?
Strawberries and cream are an effective prophylaxis?
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Herainestold
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Re: COVID-19

Post by Herainestold » Sat Aug 21, 2021 2:46 am

Martin_B wrote:
Sat Aug 21, 2021 2:44 am
shpalman wrote:
Fri Aug 20, 2021 6:07 pm
lpm wrote:
Tue Jul 27, 2021 11:02 am
People are desperate to force the "it was football" narrative, no matter the facts.
...
9000 cases

Also, apparently, tennis fans and football fans behave differently?
Strawberries and cream are an effective prophylaxis?
Probably as good as ivermectin.
Vaccination saves lives. Lockdowns stop transmission.

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lpm
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Re: COVID-19

Post by lpm » Sat Aug 21, 2021 7:49 am

shpalman wrote:
Fri Aug 20, 2021 6:07 pm
lpm wrote:
Tue Jul 27, 2021 11:02 am
People are desperate to force the "it was football" narrative, no matter the facts.
...
9000 cases

Also, apparently, tennis fans and football fans behave differently?
The argument was never that football didn't cause cases. It was that they were merely another part of story along with increasing pub going, schools, gyms, parties, cinemas, public transport and all the rest.

It was about the stupidity of the people attempting to force graphs to fit, pointing to spikes 3.5 days after a match or different male vs female rates, with blatant cherry picking and ignoring of inconvenient pre football stats.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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lpm
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Re: COVID-19

Post by lpm » Sat Aug 21, 2021 7:58 am

OffTheRock wrote:
Fri Aug 20, 2021 9:17 pm
lpm wrote:
Fri Aug 20, 2021 3:06 pm
This % is the metric to watch. Not case numbers.

I said before that we were 3 doublings away from crisis mode which is about right - 3 doublings would be 184% of Jan ventilators and 128% of Jan hospital occupancy. That's the sort of level when people start dying in corridors. We'd need to slam into lockdowns if we were heading to this point.

But it's pretty impossible to race up to 3 doublings with R=1.1 or even R=1.3. Vaccination prevents acceleration.
Our critical care and respiratory wards are pretty f.cked right now tbh. I don't think we've got 3 doublings unless we can send the patients elsewhere. We could possibly open some surge capacity but judging from the e-mails appearing across the trust all afternoon, I doubt we could staff it anyway because we don't have enough staff to staff ordinary levels this weekend. I suspect the reason we haven't gone back onto OPEL 4 is because we've been cancelling non-emergency admissions for the last couple of weeks. And it's only f.cking August.
A few weeks ago we were trying to estimate the point when the NHS would break. So your thoughts would be useful.

By break, meaning India style dying untreated in corridors or being on a drip in the car park or mass deaths when O2 ran out. What we are starting to see in Florida. The level that would be a national crisis, bringing the country to a grinding halt even if the govt refused to impose an emergency lockdown.

Clearly this level is worse than the Jan peak. We seemed quite a way from collapse, even if there were a handful of local instances causing preventable deaths.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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shpalman
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Re: COVID-19

Post by shpalman » Sat Aug 21, 2021 9:00 am

shpalman wrote:
Fri Aug 20, 2021 11:46 am
Woodchopper wrote:
Fri Aug 20, 2021 7:35 am
lpm wrote:
Thu Aug 19, 2021 1:28 pm
Each case in under 30s is the equivalent of a vaccine dose.

We spent months tracking daily vaccine numbers, celebrating milestones achieved. Now we get to celebrate cases in the same way. If 300,000 under 30s get partial immunity in a week that's another step closer to herd immunity. But if it's 200,000 via infection and 100,000 via vaccination then everyone gets agitated about the 200,000 figure. It's even worse on twitter than it is on here - people unbelievably slow to adapt to the new climate and still trotting out 2020 presumptions.

For example, hospitalisations are about three doublings away from being a crisis. In 2020, three doublings wasn't a lot - easily got there in few weeks. But in the 2021 land of the vaccinated it's a huge gulf. We're basically fine for the rest of the year.
I think we have to wait and see. R is about 1 now but it will probably increase as we move into Autumn and Winter. If people drop social distancing Delta will spread rapidly. If so the circa 2-5% of double vaccinated people who will still need hospital treatment may add up rather quickly.
Ventilator bed occupancy is heading for 23% of its peak value (just over 4000 on the 24th of January)...
At a national level, the number of COVID patients in Intensive Care is holding steady, with just over 850 patients. This seems like good news because it is much lower than the winter peak but this is around a fifth of the national ICU capacity

"around a fifth" means 20%, then, just like I said?
molto tricky

OffTheRock
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Re: COVID-19

Post by OffTheRock » Sat Aug 21, 2021 10:55 am

we’re probably a long way from people dying in huge numbers in the streets. But it’s also not exactly functioning normally with just a few covid patients. And summer would have been a good point to make a much bigger dent in the waiting lists.

A few things happening:
Covid patients in hospital. Not sure how many because the number given is covid positive patients. They stop being counted as covid patients 14days after their first +ve test. No idea if that applies to the national stats or just local ones.
Staff off with Covid, despite having a very high vaccination rate. Also staff self-isolating. Some of those came back to work this week, but many trusts are insisting that double vaccinated household contacts must still stay away from work.
Staff off sick for other reasons. A lot of noro about. A lot of stress & mental health issues after the last year. Also annual leave because of school holidays & staff leaving.
Staffing issues in care homes meaning there’s nowhere to discharge patients to.
Non-covid patients having more complex issues than normal and needing to stay in hospital longer
A lot of tourists this year meaning some hospitals are serving a much larger population than normal

A lot of this isn’t necessarily unusual. It’s the time of year it’s happening in. Having every ICU bed in the region in use just doesn’t happen in August. Nor does having to cancel routine operations or having high levels of staff sickness. The problem is that this isn’t going to get better from September onwards once we have normal winter viruses circulating, so it’s difficult to see how an increase in covid patient numbers is going to be sustainable. Some of those problems will have sorted themselves out i.e. fewer staff on holiday and fewer tourists once schools go back but they will get replaced by others.

We have drafted in the army to drive ambulances though. Presumably they can combine this with their other day job of delivering groceries to supermarkets.

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shpalman
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Re: COVID-19

Post by shpalman » Sat Aug 21, 2021 11:01 am

molto tricky

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lpm
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Re: COVID-19

Post by lpm » Sat Aug 21, 2021 2:04 pm

OffTheRock wrote:
Sat Aug 21, 2021 10:55 am
we’re probably a long way from people dying in huge numbers in the streets. But it’s also not exactly functioning normally with just a few covid patients. And summer would have been a good point to make a much bigger dent in the waiting lists.

A few things happening:
Covid patients in hospital. Not sure how many because the number given is covid positive patients. They stop being counted as covid patients 14days after their first +ve test. No idea if that applies to the national stats or just local ones.
Staff off with Covid, despite having a very high vaccination rate. Also staff self-isolating. Some of those came back to work this week, but many trusts are insisting that double vaccinated household contacts must still stay away from work.
Staff off sick for other reasons. A lot of noro about. A lot of stress & mental health issues after the last year. Also annual leave because of school holidays & staff leaving.
Staffing issues in care homes meaning there’s nowhere to discharge patients to.
Non-covid patients having more complex issues than normal and needing to stay in hospital longer
A lot of tourists this year meaning some hospitals are serving a much larger population than normal

A lot of this isn’t necessarily unusual. It’s the time of year it’s happening in. Having every ICU bed in the region in use just doesn’t happen in August. Nor does having to cancel routine operations or having high levels of staff sickness. The problem is that this isn’t going to get better from September onwards once we have normal winter viruses circulating, so it’s difficult to see how an increase in covid patient numbers is going to be sustainable. Some of those problems will have sorted themselves out i.e. fewer staff on holiday and fewer tourists once schools go back but they will get replaced by others.

We have drafted in the army to drive ambulances though. Presumably they can combine this with their other day job of delivering groceries to supermarkets.
Florida is currently at about 140% of the UK Jan peak, in terms of hospitalizations.

And rising. A couple of weeks and it could be 175%.

Of course different healthcare systems, but I suspect Florida levels would on the verge of breaking the UK. Troops, govt resignations, refusal to go to work.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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Bird on a Fire
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Re: COVID-19

Post by Bird on a Fire » Sun Aug 22, 2021 7:02 pm

The UK really is a crazy outlier in terms of number of new cases at the moment.

Looking at weekly trends here, https://www.worldometers.info/coronavir ... ekly_table, and ignoring countries with <1 million population, the only places with more new cases per capita are Georgia, Cuba, Israel, Malaysia, Botswana and Eswatini. It's 22nd in the world if you keep the tiny islands in too. Not the kind of list you normally see the UK on, for health outcomes or anything else.

Deaths are a bit better, with UK at 67 and Israel at 49 (or for growth rates, UK at 66 and Israel at 29). But it does seem that having a successful early vaccination rollout hasn't been particularly useful for preventing deaths, compared to other countries that haven't been able to get vaccines yet, which I find quite surprising.

I'd assumed countries that were earlier to vaccinate would be able to keep some of the lowest death rates in the world, but I think instead the advantage (for some, at least) will be in levels of economic activity?
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Woodchopper
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Re: COVID-19

Post by Woodchopper » Sun Aug 22, 2021 8:15 pm

Bird on a Fire wrote:
Sun Aug 22, 2021 7:02 pm
The UK really is a crazy outlier in terms of number of new cases at the moment.

Looking at weekly trends here, https://www.worldometers.info/coronavir ... ekly_table, and ignoring countries with <1 million population, the only places with more new cases per capita are Georgia, Cuba, Israel, Malaysia, Botswana and Eswatini. It's 22nd in the world if you keep the tiny islands in too. Not the kind of list you normally see the UK on, for health outcomes or anything else.

Deaths are a bit better, with UK at 67 and Israel at 49 (or for growth rates, UK at 66 and Israel at 29). But it does seem that having a successful early vaccination rollout hasn't been particularly useful for preventing deaths, compared to other countries that haven't been able to get vaccines yet, which I find quite surprising.

I'd assumed countries that were earlier to vaccinate would be able to keep some of the lowest death rates in the world, but I think instead the advantage (for some, at least) will be in levels of economic activity?
One explanation is waning antibodies in the states that vaccinated early. That would be consistent with high cases but low mortality. I think.

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Bird on a Fire
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Re: COVID-19

Post by Bird on a Fire » Sun Aug 22, 2021 8:26 pm

Yes, I think that's quite well supported by some recent studies. Hopefully they can get boosters out in time before immunity wanes any further and/or one of these countries breeds a resistant variant.

It seems that it's the combination of early vaccination and removing all restrictions that does it. I note that many countries, even those with lower cases and higher vaccination rates than the UK, are sticking with masks and distancing for the time being.

The UK seems to be taking that adage about "if you can't be a good example, be a horrible warning" to heart ;)
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Millennie Al
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Re: COVID-19

Post by Millennie Al » Mon Aug 23, 2021 1:26 am

Bird on a Fire wrote:
Sun Aug 22, 2021 8:26 pm
Hopefully they can get boosters out in time before immunity wanes any further and/or one of these countries breeds a resistant variant.
Really? What happened to the "catastrophic moral failure"? Why should we be administering boosters which may not even be necessary when so many people around the world have had none and the world is still constrained by supply?
Covid-19 - Don't catch it: don't spread it.

Herainestold
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Re: COVID-19

Post by Herainestold » Mon Aug 23, 2021 1:45 am

Millennie Al wrote:
Mon Aug 23, 2021 1:26 am
Bird on a Fire wrote:
Sun Aug 22, 2021 8:26 pm
Hopefully they can get boosters out in time before immunity wanes any further and/or one of these countries breeds a resistant variant.
Really? What happened to the "catastrophic moral failure"? Why should we be administering boosters which may not even be necessary when so many people around the world have had none and the world is still constrained by supply?
I think boosters should be limited to the immuno compromised and frail elders in congregate living facilities, for the time being. The rest of us can rely on NPIs for the next year or two to enable jabs to be given to developing countries.
Vaccination saves lives. Lockdowns stop transmission.

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jimbob
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Re: COVID-19

Post by jimbob » Wed Aug 25, 2021 8:14 am

This is some take.

https://twitter.com/MartinKulldorff/sta ... 81153?s=20
Martin Kulldorff
@MartinKulldorff
·
17h
For thousands of years, disease pathogens have spread from person to person. Never before have carriers been blamed for infecting the next sick person. That is a very dangerous ideology.
Have you considered stupidity as an explanation

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Re: COVID-19

Post by nezumi » Wed Aug 25, 2021 10:33 am

jimbob wrote:
Wed Aug 25, 2021 8:14 am
This is some take.

https://twitter.com/MartinKulldorff/sta ... 81153?s=20
Martin Kulldorff
@MartinKulldorff
·
17h
For thousands of years, disease pathogens have spread from person to person. Never before have carriers been blamed for infecting the next sick person. That is a very dangerous ideology.
I don't do the Twitter, but did anyone link Typhoid Mary?

I'll be disappointed if nobody jumped on the single most obvious refutation of that statement.
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Sciolus
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Re: COVID-19

Post by Sciolus » Wed Aug 25, 2021 10:59 am

Yes, the replies seem pretty thorough, including Aids, leprosy, STIs, ...

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Woodchopper
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Re: COVID-19

Post by Woodchopper » Thu Aug 26, 2021 7:10 am

tl;dr study suggests that natural infection provided longer lasting and stronger protection against infection, symptomatic disease and hospital admission compared to vaccination.

Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections

Abstract

Background:
Reports of waning vaccine-induced immunity against COVID-19 have begun to surface. With that, the comparable long-term protection conferred by previous infection with SARS-CoV-2 remains unclear.

Methods:
We conducted a retrospective observational study comparing three groups: (1)SARS-CoV-2-naïve individuals who received a two-dose regimen of the BioNTech/Pfizer mRNA BNT162b2 vaccine, (2)previously infected individuals who have not been vaccinated, and (3)previously infected and single dose vaccinated individuals. Three multivariate logistic regression models were applied. In all models we evaluated four outcomes: SARS-CoV-2 infection, symptomatic disease, COVID-19-related hospitalization and death. The follow-up period of June 1 to August 14, 2021, when the Delta variant was dominant in Israel.

Results:
SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021. The increased risk was significant (P<0.001) for symptomatic disease as well. When allowing the infection to occur at any time before vaccination (from March 2020 to February 2021), evidence of waning natural immunity was demonstrated, though SARS-CoV-2 naïve vaccinees had a 5.96-fold (95% CI, 4.85 to 7.33) increased risk for breakthrough infection and a 7.13-fold (95% CI, 5.51 to 9.21) increased risk for symptomatic disease. SARS-CoV-2-naïve vaccinees were also at a greater risk for COVID-19-related-hospitalizations compared to those that were previously infected.

Conclusions:
This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant.
https://www.medrxiv.org/content/10.1101 ... 21262415v1

Obviously this shouldn’t be seen as supporting antivaxxers as Covid infection has far worse side effects, starting with death.

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Re: COVID-19

Post by shpalman » Thu Aug 26, 2021 8:42 am

Woodchopper wrote:
Thu Aug 26, 2021 7:10 am
tl;dr study suggests that natural infection provided longer lasting and stronger protection against infection, symptomatic disease and hospital admission compared to vaccination.
...
https://www.medrxiv.org/content/10.1101 ... 21262415v1

Obviously this shouldn’t be seen as supporting antivaxxers as Covid infection has far worse side effects, starting with death.
Death confers 100% protection against coronavirus infections, forever, so I don't know why more anti-vaxxers don't just die.
molto tricky

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Re: COVID-19

Post by PeteB » Thu Aug 26, 2021 8:58 am

Interesting - saw this question about the study

https://twitter.com/andrew_croxford/sta ... 5693250562

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Woodchopper
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Re: COVID-19

Post by Woodchopper » Fri Aug 27, 2021 1:39 pm

Here’s some commentary:

Having SARS-CoV-2 once confers much greater immunity than a vaccine—but no infection parties, please
https://www.sciencemag.org/news/2021/08 ... on-parties

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Re: COVID-19

Post by raven » Fri Aug 27, 2021 11:25 pm

Woodchopper wrote:
Thu Aug 26, 2021 7:10 am
tl;dr study suggests that natural infection provided longer lasting and stronger protection against infection, symptomatic disease and hospital admission compared to vaccination.
My first thought was that seems plausible, because infection exposes the immune system to all the proteins in the virus, not just the spike protein as vaccines do.

Then I realised that comparing people who've survived one bout to people that haven't had it might not be comparing like with like. You've maybe selected people with robust immune systems or people who are just for whatever reason less susceptible to it.

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