ccc @ccc@qoto.org

@freemo Did a bit of poking around (i.e. briefly googled) and found a paper on the subject: https://pubmed.ncbi.nlm.nih.gov/32785649/

The abstract (which is all I've read) suggests that ADE in COVID vaccines is "unlikely" and gives a few reasons why - including that people who have previously had COVID (and thus whose immune systems already know to fight it off) are *not* where most of the fatalities are.

So.

Let's assume that the odds of an ADE-type effect are *no greater* than one in three. (From the looks of that paper, it seems that the actual odds are a good deal smaller than that). And let's assume that an ADE-type effect flat-out doubles the lethality of the virus. Then it is still *very* sensible to have the vaccine, as I will now show.

Let's assume that without the vaccine, everyone will eventually get COVID at some point in their lives. Similarly, if the vaccine has an ADE effect, everyone will get the virus after getting the vaccine.

Anyone who gets the virus has, on average, a 3% chance of death (as implied by current statistics). Therefore, anyone who doesn't get the vaccine has a 3% chance of death.

If there is an ADE effect, that doubles - goes up to six percent. But as the paper above suggests, there is a less than one in three chance of and ADE effect turning up. So the odds of dying of COVID is you get the vaccine are less than one-third of 6% - i.e. less than 2%.

Therefore, there is less risk of dying of COVID if you take the vaccine than if you do not.

--------------

So. How to handle this in a practical sense? I do agree with you that people should not be *forced* to take the vaccine. But, by the same token, if I am visiting a doctor then I want to know that (a) it is safe for me to do so, and (b) that the doctor understands how to find the treatment route with the highest probability of success. For both reasons (a) and (b), I would heavily prefer that the doctor that I visit is one who does not refuse the vaccination.

@freemo Hmmm. Not being a medical professional myself, I know absolutely nothing about ADE. How probable would you guess it is, and how much effect does it have? Is a doubling of the death rate typical?

@freemo This virus has been out for a year, and one-point-seven million people have died. Waiting another four years would mean the deaths of approximately another seven million people - which, as I understand, is the reason why this vaccine got fast-tracked.

> Your assessment of masks seems off...

Yeah, it's a Fermi estimate. About half of my assessments are almost certainly off, one way or the other - I'm kind of hoping that they approximately cancel out, but I wouldn't be at all surprised to find out that the actual odds of dying as a result of visiting an unvaccinated doctor are off from my estimate by an order of magnitude or more. And yes, that includes my assessment of the effectiveness of masks.

@freemo As I understand it, the currently available vaccines have gone through some basic trials. Not as much as the full understand-it-all type safety trials - there hasn't been enough time for those, yet - but enough to be fairly certain that having the vaccine is a good deal less lethal than *not* having the vaccine and risking the virus.

But let's consider an unvaccinated doctor who takes good precautions. What are my chances of dying if I visit that doctor, in person?

First of all, if I get the virus, I've got a straight-out 3% chance of dying from it (source: https://www.worldometers.info/coronavirus/ ) That's the average odds across all age groups, all countries, worldwide - the elderly or immunocompromised have lower odds, the young and healthy have better odds, and so on. But let's run with 3% chance of death if I have the virus and do a bit of a Fermi estimate.

Now, in consulting with a doctor, I'll need to spend some time in the doctor's room, with my symptoms being investigated. (Let's assume, for the sake of argument, that I'm facing a problem that requires the doctor to see my symptoms in-person). That's a small room, and I may have to remove my mask and say 'ah' while he pushes my tongue down... since this virus is so terribly eager to spread, the odds are that if the doctor has the virus then I will get the virus. But what are the odds that the doctor has the virus?

Face masks and shields and so forth will help. They're imperfect defenses, but they are defenses; they help to prevent the doctor from contracting the virus himself. But let's consider the doctor having regular self-tests (and temporarily closing down his own practice if he finds he has the virus) Now, how often does the doctor self-test?

The test may take a day or so of analysis in a very overworked lab to get a result; and the materials used in the test also have a cost. So self-testing once a week feels about right. There are 52 weeks in a year - this is a Fermi estimate so I'm rounding that to 50. Let's assume that a non-vaccinated doctor gets the virus once in any given year, on average.

Then my Fermi estimate suggests that I have a 2% chance (roughly) of getting the virus in any single visit to an unvaccinated doctor. If I get it, I get a 3% chance of death. So, merely by visiting an unvaccinated doctor, I get a six in a thousand chance of dying as a direct result of the visit.

Therefore, if I can't tell whether a doctor has taken the vaccination or not, I should not visit the doctor unless either (a) I have been vaccinated (this will take a while, I am not a health worker and the vaccines can only be produced so fast) or (b) I believe that I have at least a six in a thousand chance of dying if I *don't* visit the doctor.

@freemo You are right - a doctor should not put his own life at risk in order to vet a patient. But, as a patient, I also should not be expected to put my life at risk when going to the doctor.

And the way this virus spreads, *any* interaction with another human being carries a small but potential risk of picking up said virus. It doesn't *have* symptoms for the first several days - for some people, particularly if they are healthy people, it might never have symptoms at *all*. So, if I need to interact with someone, there is a small-but-finite chance of picking up the virus. (This is *especially* the case if I need to interact with someone who needs to look into my mouth, because I need to remove my own mask to permit that).

So, in order to reduce the risk to my own life, I should be able to select to visit a doctor who *has* received the vaccination. I shouldn't have the right to force a doctor to receive the vaccination; but I should have the right to select a different doctor if I find that the doctor I would have visited has not received said vaccination.

@freemo ...oh, dear.

Now I'm suddenly seeing a second use for a national registry of people who have been vaccinated. It would prevent a prospective patient from needing to check with each doctor who might treat him, individually, who might have been COVID vaccinated. Which - from a patient's point of view - might very well otherwise become a necessary precaution in a few months' time.

@freemo

....wait wait wait wait up right there.

Hospital workers who don't *intend* to get vaccinated? Is that a thing that happens?

@freemo On a national level, you *do* need to know how many health workers per hospital have *not* been vaccinated, so you know where to send the sharply limited supply of vaccines.

You don't need to know *who* they are.

The national registry is a very lazy solution to the first of these. (There are other solutions; some of which don't spill over into the second of these).

...so yeah, I think we're broadly in agreement with regards to what is or is not truly necessary.

@freemo Sure, there's better ways to handle that particular pro. The doctor actually giving the vaccination needs to know who he's giving it to, but only so that he can be sure that he gives the second dose after the correct interval - I don't see any immediate reason to send that information any further.

@freemo That's true - knowing that 10% of the health care workers in this particular hospital are vaccinated would be enough for that. (You would have to go down to a specific hospital - so that you know where to send the vaccinations - and at the very least someone in that hospital would need to know exactly who has and has not been vaccinated).

There are better ways to handle that particular pro, I have no doubt. And... on top of that, no matter how it's handled, that information is only really useful until COVID's been broken as much as smallpox has been broken. So, even then, the need for the data is *very* temporary.

@freemo While I can see a number of cons to such a scenario, I can also see a very important pro as well.

In short, your health systems *really* need to keep track of who has or has not been vaccinated. Ideally, you need to end up with everyone vaccinated; but you're not going to get there, because there are eight billion people on the planet, each needs two doses, and sixteen billion doses are NOT going to be easy or quick to get manufactured.

So you hit the healthcare workers first; the people most likely to die if they get COVID; the over-60s and those with comorbidities. But every last dose of the vaccine is needed, because there are NOT going to be enough doses, not for a long time... so the doses that there are, need to be distributed as optimally as possible. And in order to distribute those doses as optimally as possible... the people handling the logistics *do* need to know who has or has not already been vaccinated.

Some sort of database is the most straightforward way to keep track of that.

That's the pro; the big argument in favour of this national registry.

Merry Christmas, all!

@xyzzy
go east

@xyzzy

Get can of beans

@xyzzy

Ask serial killer to please stick with English

@xyzzy

Ask serial killer to stop shredding documents

@xyzzy

Ask serial killer about confidential documents

@xyzzy

Get WARRANT from BOOKSHELF

@xyzzy

Inspect serial killer

@xyzzy

Inspect bookshelf