Summer Solstice Unlockdown

[lpm]

But is that vaccine proved to be safer than the Covid vaccines?

Don't want to sound like the fuckwits, but it seems plausible that an expert could say we should wait for more data. And that it's even considered an area to debate shows how tiny the risk of the actual virus is to teenagers.

[bob sterman]

But is that vaccine proved to be safer than the Covid vaccines?

Not sure I've read of any fatal adverse events associated with the HPV vaccine.

Incidence of Guillain-Barré is about 1 per million for the HPV vaccine, 8 per million for the Johnson & Johnson COVID vaccine and about 6 per million for the Johnson & Johnson COVID vaccine.

However, it's perhaps tough to compare as the HPV vaccine is mostly given only to adolescents.

[Gfamily]

HPV vaccination for adolescent boys. Main benefit is preventing cervical cancer.

Hah! That’s what I posted…the thought “wait, that’s surely not helping adults”

Vaccinating them for when they become adults I guess!

Vaccinating the boys - to protect the the girls (when they all become adults).

Main thing is - the direct benefits to the boys are not as substantial (prevention of some HPV related cancers that are much less common than cervical cancer).

I assume that any vaccination programme has the immediate benefit to the community in reducing the infection rate in the vaccinated, but also a significant benefit to the wider community of reduced transmission rates within the community.

Also, there's increased benefit to men who have sex with men.

[Pishwish]

A thread indicating that outcomes for children in the US could overwhelm hospitals there.

[Woodchopper]

A thread indicating that outcomes for children in the US could overwhelm hospitals there.

That thread seems a bit odd.

It cites a figure of 33% of child hospital admissions needing ICU treatment. However, in the UK 4% of child hospital admissions went to the Pediatric ICU.

I had a look at the source linked from the tweet, and it states that:

Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization.

This is a small sample and it only covers children with "complete medical chart reviews". So it doesn't cover all pediatric hospital admissions, and I assume that those with complete medical chart reviews may be more sick than the others.

So the UK figure maybe closer to the mark, though obviously its difficult to compare as the UK and US may have different standards for ICU admission.

[temptar]

Only 16-18.

According to the experts the benefits to 12-16 year olds are extremely low and the extremely low risks could be higher. It's unethical of countries to vaccine children to benefit adults.

This assumes children don't get Covid-19 (but they do) or if they do, it is negligible as an illness (it isn't without serious cases). Children benefit from being vaccinated and they contribute to increased levels of community immunity. So that last sentence sounds like an excuse. For the record, Ireland is now vaccinating the over 12s.

On the comment re rubella as an example: while the MMR changed perspectives, initially that was given to girls around the age of 12, on average before they were sexually active, to protect their own unborn children in the future rather than just to protect the pregnant women around them.

On HPV for boys, I gather there is some evidence to suggest vaccination reduces rates of throat cancer too. It isn't sex specific in that context.

HPV targets adolescents with a view of getting there before they are sexually active. Note,the Daily Mail contributed to the debate over HPVbeing highly emotional.

The thing is, vaccination is never protection at a purely pindividual level. It is always to protect both individual and community. This is why we talk about herd immunity. We immunise people to stop the spread to more vulnerable people and we start that when kids are very young. Your argument could be extended to why should my kids be vaccinated to benefit your kids eventually, if you see vaccination as solely being an individual protection. There are highly vulnerable kids whose parents are keeping them from school. They shouldn't have to consider that.

[Tessa K]

Would it ever be possible to eradicate Covid in the same way that smallpox was?

[Woodchopper]

Only 16-18.

According to the experts the benefits to 12-16 year olds are extremely low and the extremely low risks could be higher. It's unethical of countries to vaccine children to benefit adults.

This assumes children don't get Covid-19 (but they do) or if they do, it is negligible as an illness (it isn't without serious cases). Children benefit from being vaccinated and they contribute to increased levels of community immunity. So that last sentence sounds like an excuse. For the record, Ireland is now vaccinating the over 12s.

On the comment re rubella as an example: while the MMR changed perspectives, initially that was given to girls around the age of 12, on average before they were sexually active, to protect their own unborn children in the future rather than just to protect the pregnant women around them.

On HPV for boys, I gather there is some evidence to suggest vaccination reduces rates of throat cancer too. It isn't sex specific in that context.

HPV targets adolescents with a view of getting there before they are sexually active. Note,the Daily Mail contributed to the debate over HPVbeing highly emotional.

The thing is, vaccination is never protection at a purely pindividual level. It is always to protect both individual and community. This is why we talk about herd immunity. We immunise people to stop the spread to more vulnerable people and we start that when kids are very young. Your argument could be extended to why should my kids be vaccinated to benefit your kids eventually, if you see vaccination as solely being an individual protection. There are highly vulnerable kids whose parents are keeping them from school. They shouldn't have to consider that.

Worth noting that in the most recent JVCI Statement they don't make the ethical argument mentioned by lpm.

They do though base the argument on costs (side effects of vaccination) versus benefits (effects of infection) and on wider epidemiology they state that:

Modelling from the University of Warwick[footnote 8] and from Public Health England[footnote 9] indicate that vaccinating children and young people could have some impact on hospitalisations and deaths in older adults. The extent of such benefits is highly uncertain. By autumn 2021, all eligible adults should have been offered 2 doses of COVID-19 vaccine. A successful adult COVID-19 immunisation programme would mean that education staff and adult household members of pupils and students should have been vaccinated, reducing the risk of onward transmission from children to adults in school or at home, respectively.

So it appears that the argument against vaccinating is based upon costs and benefits, rather than ethical considerations.

[Woodchopper]

Would it ever be possible to eradicate Covid in the same way that smallpox was?

Probably not. Smallpox didn't have an animal reservoir.

Covid definitely can infect mammals and if it is endemic in wild animals it'll be impossible to eradicate.

[lpm]

Only 16-18.

According to the experts the benefits to 12-16 year olds are extremely low and the extremely low risks could be higher. It's unethical of countries to vaccine children to benefit adults.

This assumes children don't get Covid-19 (but they do) or if they do, it is negligible as an illness (it isn't without serious cases). Children benefit from being vaccinated and they contribute to increased levels of community immunity. So that last sentence sounds like an excuse. For the record, Ireland is now vaccinating the over 12s.

Like everyone else I assumed vaccines would make sense for under 18s. But the UK's JCVI (https://en.wikipedia.org/wiki/Joint_Com ... munisation) said wait a minute. They are the ones being incredibly careful. When you have tiny benefits on the head of one pin against tiny risks on the head of another pin, you need experts to do the weighing instead of us amateurs jumping to conclusions on the internet.

It's hard to remember the huge cliff face of relative risk and we see a 40 year old very ill and panic that a child will experience the same. But in the UK probably a couple of million children have already been infected with the virus with remarkably low illness levels. You can't look at headline figures of children hospitalised - children with serious pre-existing conditions are highly vulnerable but they are also being vaccinated where appropriate.

We've seen previous examples of impulsively rushing to vaccinate, most famously 1976, and the rule seems to be you don't f.ck around with this weapon in our arsenal - it's too important for overall public health to make simplistic assumptions.

On the comment re rubella as an example: while the MMR changed perspectives, initially that was given to girls around the age of 12, on average before they were sexually active, to protect their own unborn children in the future rather than just to protect the pregnant women around them.

On HPV for boys, I gather there is some evidence to suggest vaccination reduces rates of throat cancer too. It isn't sex specific in that context.

HPV targets adolescents with a view of getting there before they are sexually active. Note,the Daily Mail contributed to the debate over HPVbeing highly emotional.

From google, rubella was a serious disease that seemed to hit 5-9 year olds so I'd be surprised if the old vaccines weren't given till 12. Obviously it's very bad disease for pregnant women but presumably there were nasty implications for a tiny proportion of those 5-9 year olds. As always with MMR "debates", none of us has a clue how bad the diseases were because we never see them any more.

For HPV google says it started for girls in 2008 and was a full 10 years before the decision was made to extend it to boys in 2018. I'm happy for JCVI to make these decisions with such care but presumably they'll speed up for looking at Covid vaccinations.

The thing is, vaccination is never protection at a purely pindividual level. It is always to protect both individual and community. This is why we talk about herd immunity. We immunise people to stop the spread to more vulnerable people and we start that when kids are very young. Your argument could be extended to why should my kids be vaccinated to benefit your kids eventually, if you see vaccination as solely being an individual protection. There are highly vulnerable kids whose parents are keeping them from school. They shouldn't have to consider that.

We are pretty certain that our highly vaccinated populations are close to herd immunity from adult vaccination alone. We could crush cases to near zero with a modest lockdown of shutting pubs, nightclubs and gyms again. There is an easy pathway that protects all children and keeps schools open - but adults want to go to the pub.

It's obviously not acceptable to say "vaccinate children because I need that extra herd immunity to go nightclubbing".

Our children as a cohort protect themselves and each other with vaccinations. As a group they get special protections because they don't get to choose. We don't impose medical interventions with a net cost on children as a group simply to benefit adults as a group.

[lpm]

So it appears that the argument against vaccinating is based upon costs and benefits, rather than ethical considerations.

But that is the ethical argument I described. If it's a net benefit to children as a group, do it. If it's a net cost to children as a group but with benefits to unvaccinated adults, don't do it.

[Woodchopper]

So it appears that the argument against vaccinating is based upon costs and benefits, rather than ethical considerations.

But that is the ethical argument I described. If it's a net benefit to children as a group, do it. If it's a net cost to children as a group but with benefits to unvaccinated adults, don't do it.

Fair enough. I'll rephrase and suggest that the argument is based upon a utilitarian assessment rather than a principle that one shouldn't vaccinate children in order to prevent transmission to adults.

As for your suggestions, it seems that their argument is that: its a net cost to 12-15 year old children, and any benefits to adults are highly uncertain, so don't.

[OffTheRock]

A thread indicating that outcomes for children in the US could overwhelm hospitals there.

That thread seems a bit odd.

It cites a figure of 33% of child hospital admissions needing ICU treatment. However, in the UK 4% of child hospital admissions went to the Pediatric ICU.

I had a look at the source linked from the tweet, and it states that:

Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization.

This is a small sample and it only covers children with "complete medical chart reviews". So it doesn't cover all pediatric hospital admissions, and I assume that those with complete medical chart reviews may be more sick than the others.

So the UK figure maybe closer to the mark, though obviously its difficult to compare as the UK and US may have different standards for ICU admission.

Does the US figure include PIMS? The U.K. figures don’t, it’s reported separately, but I think 40-50% of children admitted to hospital with PIMS require ICU treatment. That might explain some of the difference although not all of it.

[Woodchopper]

A thread indicating that outcomes for children in the US could overwhelm hospitals there.

That thread seems a bit odd.

It cites a figure of 33% of child hospital admissions needing ICU treatment. However, in the UK 4% of child hospital admissions went to the Pediatric ICU.

I had a look at the source linked from the tweet, and it states that:

Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization.

This is a small sample and it only covers children with "complete medical chart reviews". So it doesn't cover all pediatric hospital admissions, and I assume that those with complete medical chart reviews may be more sick than the others.

So the UK figure maybe closer to the mark, though obviously its difficult to compare as the UK and US may have different standards for ICU admission.

Does the US figure include PIMS? The U.K. figures don’t, it’s reported separately, but I think 40-50% of children admitted to hospital with PIMS require ICU treatment. That might explain some of the difference although not all of it.

That I don't know. It would help to know what proportion of children suffer from PIMS (as far as I remember it is very rare).

[lpm]

So it appears that the argument against vaccinating is based upon costs and benefits, rather than ethical considerations.

But that is the ethical argument I described. If it's a net benefit to children as a group, do it. If it's a net cost to children as a group but with benefits to unvaccinated adults, don't do it.

Fair enough. I'll rephrase and suggest that the argument is based upon a utilitarian assessment rather than a principle that one shouldn't vaccinate children in order to prevent transmission to adults.

As for your suggestions, it seems that their argument is that: its a net cost to 12-15 year old children, and any benefits to adults are highly uncertain, so don't.

I think their argument is that it could be a net cost rather than it is, and they want to think about it for a while. They haven't decided yet. Based on conclusions drawn by other similar committees of experts elsewhere, I wouldn't be surprised if they eventually decide to invite 12-16. Medical ethics is obviously a highly specialised area but there's a bit of jump because 16 year olds are largely capable of making their own medical choices but 12 year olds are more limited.

But what this isn't is the UK "using it as an excuse" to not vaccinate children. Twitter has corroded some people's brains and you hear them saying the decision is due to a shortage of Pfizer and similar conspiracy nonsense.

[Woodchopper]

But that is the ethical argument I described. If it's a net benefit to children as a group, do it. If it's a net cost to children as a group but with benefits to unvaccinated adults, don't do it.

Fair enough. I'll rephrase and suggest that the argument is based upon a utilitarian assessment rather than a principle that one shouldn't vaccinate children in order to prevent transmission to adults.

As for your suggestions, it seems that their argument is that: its a net cost to 12-15 year old children, and any benefits to adults are highly uncertain, so don't.

I think their argument is that it could be a net cost rather than it is, and they want to think about it for a while. They haven't decided yet. Based on conclusions drawn by other similar committees of experts elsewhere, I wouldn't be surprised if they eventually decide to invite 12-16. Medical ethics is obviously a highly specialised area but there's a bit of jump because 16 year olds are largely capable of making their own medical choices but 12 year olds are more limited.

But what this isn't is the UK "using it as an excuse" to not vaccinate children. Twitter has corroded some people's brains and you hear them saying the decision is due to a shortage of Pfizer and similar conspiracy nonsense.

I agree, on both points.

[Bird on a Fire]

HPV vaccination for adolescent boys. Main benefit is preventing cervical cancer.

Hah! That’s what I posted…the thought “wait, that’s surely not helping adults”

Vaccinating them for when they become adults I guess!

Vaccinating the boys - to protect the the girls (when they all become adults).

Main thing is - the direct benefits to the boys are not as substantial (prevention of some HPV related cancers that are much less common than cervical cancer).

Well I'd probably call not having intermittent outbreaks of warts on your nob a benefit too. HPV sounds pretty lame even if you don't get cancer from it.

[sTeamTraen]

We are pretty certain that our highly vaccinated populations are close to herd immunity from adult vaccination alone.

Is that true, though? My understanding of "Herd immunity" is that the population R number goes (well below) one. The infectiousness of delta seems to mean that that is hard to achieve. What we do seem to have achieved is to get the IFR from ~2% down to ~0.1%, a factor of 20 which probably reflects (in one direction or the other) some combination of vaccine efficacy, a skewed distribution of the ages of infectees, and continuous changes in the circumstances of infection.

If I thought that vaccinated people were 90-95% less likely to pass Covid on, I would be more in favour of mandatory vaccines for certain jobs, vaccine passports, sympathy for people who won't invite their unvaccinated family members to their wedding, etc. But from what I can tell, the benefits of being vaccinated are mostly for oneself, plus to some extent for the healthcare system (but that's at one or two levels of remove for most people's calculations). In those circumstances, the moral argument for more coercion of people to get vaccinated seems to me to be less convincing than with, say, whooping cough.

[shpalman]

I'm double vaccinated but I could still catch it and for a few days at least still spread it if I do catch it. So unvaccinated people, who are more likely to be infected and more spready for longer if they are infected, can get the f.ck away from me.

[shpalman]

We are pretty certain that our highly vaccinated populations are close to herd immunity from adult vaccination alone.

Is that true, though? My understanding of "Herd immunity" is that the population R number goes (well below) one. The infectiousness of delta seems to mean that that is hard to achieve.

The number of new cases each day is only slowly increasing so Rt is obviously only a little bit more than one despite the high R0 of Δ.

[lpm]

Yes, it's not just the mathematical equation, we also need to add in basic social distancing, masks, working from home. Under 2019 behaviours we'd be a long way off herd immunity. Under current behaviours obviously R isn't far off 1, one way or the other (although that's with schools temporarily closed).

The vaccines significantly reduce transmission, via both reduction in RNA being spewed out during infection and reducing the number of days of infectiousness. A fair bit of coercion is justified.

[Bird on a Fire]

We are pretty certain that our highly vaccinated populations are close to herd immunity from adult vaccination alone.

Is that true, though? My understanding of "Herd immunity" is that the population R number goes (well below) one. The infectiousness of delta seems to mean that that is hard to achieve.

The number of new cases each day is only slowly increasing so Rt is obviously only a little bit more than one despite the high R0 of Δ.

Is that accounting for the decreasing number of tests?

[Woodchopper]

Yes, it's not just the mathematical equation, we also need to add in basic social distancing, masks, working from home. Under 2019 behaviours we'd be a long way off herd immunity. Under current behaviours obviously R isn't far off 1, one way or the other (although that's with schools temporarily closed).

The vaccines significantly reduce transmission, via both reduction in RNA being spewed out during infection and reducing the number of days of infectiousness.

Yes, indeed.

[shpalman]

Is that true, though? My understanding of "Herd immunity" is that the population R number goes (well below) one. The infectiousness of delta seems to mean that that is hard to achieve.

The number of new cases each day is only slowly increasing so Rt is obviously only a little bit more than one despite the high R0 of Δ.

Is that accounting for the decreasing number of tests?

What decreasing number of tests?

[KAJ]

The number of new cases each day is only slowly increasing so Rt is obviously only a little bit more than one despite the high R0 of Δ.

Is that accounting for the decreasing number of tests?

What decreasing number of tests?

From coronavirus.data.gov.uk/details/testing last months "All Pillars" numbers.

Code: Select all

date	newTestsByPublishDate
2021-08-15	674,509
2021-08-14	656,190
2021-08-13	826,362
2021-08-12	815,286
2021-08-11	845,795
2021-08-10	751,448
2021-08-09	728,011
2021-08-08	689,437
2021-08-07	662,089
2021-08-06	795,658
2021-08-05	828,867
2021-08-04	850,249
2021-08-03	722,419
2021-08-02	727,637
2021-08-01	671,342
2021-07-31	677,371
2021-07-30	840,189
2021-07-29	866,068
2021-07-28	913,452
2021-07-27	800,665
2021-07-26	812,126
2021-07-25	791,097
2021-07-24	757,969
2021-07-23	911,753
2021-07-22	1,016,134
2021-07-21	1,042,385
2021-07-20	888,078
2021-07-19	1,076,936
2021-07-18	1,041,184
2021-07-17	784,623
2021-07-16	979,046
2021-07-15	1,181,072