Vaccine cards... national registry of everyone vaccinated... get the fuck out of here are you serious, this is where this shit is headed:

https://www.cnn.com/2020/12/02/health/covid-19-vaccination-kit-record-card/index.html

I fucking knew it when they created the databases to track controlled substance prescriptions and violated our right to medical privacy this is where this shit was headed... yea I'm pissed.

@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.

@ccc That doesnt explain why there would need to be a register that includes personally identifying information.. knowing "bob smith was vaccinated" isnt useful for what you describe but knowing "10% of health care workers are vaccinated" might be.

to track the sort of logistical information your talking about it could be done without the violation of personal privacy by instead simply tradcking the data one cares about (age, location, profession) of those vaccinated without needing to record their name or identifying information.

@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.

@ccc well no you dont really need to know it at a hospital level. Generally the way youd do it is similar to how we are already doing it.

1) announce vaccines are available only to healthcare workers at the current stage.

2) Ask all healthcare workers to apply at their hospital for a vaccine

3) see the demand and requests and begin distributing

You dont need to know who got vaccinated to do logistics all you need to know is who is requesting to be vaccinated and of the criteria you specify for each stage which criteria they match.

There is really no logistical advantage to having a database that has identifiable information, you just need to know who has placed themselves in the queue.

@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.

@ccc yea, I mean obviously there will be some local record of who gets what. Your personal doctor will have your name and personal files for example. thats fine, particularly if you have the right to purge that data at your leisure.

but as we agree a national registry is not needed

@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.

@ccc Well sort of... as I said you need to know who is in the queue. You obviously have no need to know what hospital workers arent vaccinated when those workers dont intend to get vaccinated. You would only need to know how many hospital workers there are that intend to get vaccinated and who have not.

Thus all you need to know is who is in the queue (people who want to get vaccinated and havent), not who is unvaccinated.

@freemo

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

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

@ccc for normal vaccines, no. But when its a vaccine that skipped several years of safety tests, has a real risk of life threatening ADE long-term, has emergency authorization to be distributed without the normal safety vetting, and has an exemption so if you die when you take it (or get injured) you cant sue for compensation... when all that happens to be the case for a vaccine, then yes, a great many hospital workers do not wish to be vaccinated.

@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.

@ccc I dont think a patient should have a right to demand that a doctor put their life at risk in order to vet them. What a patient would have a right to is a doctor that isnt actively sick, a doctor that is regularly checked for presence of the disease, a doctor that washes their hands, wears a mask, and takes all the precautions... but tahts as far as it goes.

The scenario your depicting is a very dangerous slope where doctors and nurses would be required to put their lives at risk, take drugs that have not been properly vetted for safety if they wish to keep their jobs. I dont think we have any right to demand a nurse or doctor both be on the front line and risk their lives AND take experimental drugs before the rest of us that could kill them if they wish to keep their jobs.

@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.

@ccc while I can understand that perspective,and I might even agree with you if we were talking about a vaccine with proven safety... it just doesn't make sense that a patient should have the right to pick doctors who put their lives at risk for your safety, or to allow doctors to have an advantage (draw in more patients) if they put their life at risk through taken an unproven vaccine.

Moreover if a doctor is taking the proper precations then even if they have the virus and they dont know you wont be at risk.. if they are disinfecting regularly, wearing a face mask and shield, and using fresh gloves, then there shouldnt be much of a risk to you.

If that doesnt satisfy you then you have the right to get the vaccine yourself, or do a televisit.

Doctors literally enter rooms and treat patients who are immunocompromised where even a little bacteria from a wall or a cold could easily kill them and yet they do so with a great track record of safety. So any such fears, presuming a doctor takes the right precations are moot in my eyes.

@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.

@ccc they have went through some very basic safety trials, yea.. typically 5 - 10 years worth hof safety trials down to a few months.

Basically they got through enough trials to know if you take it you probably wont die or get ill in the first few months. But they have absolutely no data regarding the likely hood of 6 month or more concerns.

ADE is the biggest concern that is only detected in longterm trials. This is where a vaccine will usually provide immunity and show normal healthy responses in the short period after taking a vaccine but after 9 months, a year, or more into the future (when long-term immunity sets in rather than short-term) if an immunized person gets the disease they will have a more severe reaction tot he disease than an unimunized person.

If ADE becomes an issue with the COVID vaccine, and we have absolutely no data to provide safety against this, it means people who take it could potentially be in for a death sentance in a a year or more. Health workers who will likely be exposed to covid long after the virus is rampant would be particularly vulnerable to such a situation.

Your assessment of masks seems off... can you explain to me how immunocompromised individuals who would trivially die from even exposure to a cold manage to generally be safe for years on end when treated by doctors even thought they have to be in a clean room? If full protection (face shield, mask, gloves, fresh cloth body suit) were so ineffective wouldnt these people be dropping like flys every time a doctor visited them?

@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.

@ccc While ADE is far from certain it is a real risk. Yes over a million have died, its very serious. But on the chance ADE, a very real chance, ADE is a side effect of this vaccine, then what happens whe the covid death rate all of a udden doubles?

Taking risks where there is a complete unknown but very reasonable possiblity that the end result is that the death toll fromt he virus goes up and not down long term, thats not an acceptable risk.

Its a shame people are dying, but acting and doing anything, no matter how unsafe, just because of the bias that doing something feels like it is better than nothing, is not good reasoning.

We have enough historic examples of how lack of proper safety measures causes a cure to become worse than the disease. We shouldnt let that be the case here.

I am not suggesting the vaccine not be released at all. I am suggesting that given the very real threat that it can put you at a greater risk of death than the virus, it should be u to the the individual if they want to take it and we should make every effort to ensure no one is strong armed into taking it against their better judgement for their own safety.

@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?

@ccc There is really no way to know. The risk could be anywhere from 0 to 100% thats the problem. We cant even estimate it until we have long term data, its a complete unknown.

What I can say is this, doctors have been repeatedly warning of the ADE risk of a premature COVID vaccine int he scientific journals. I have seen no such journals that are capable of saying how high the risk is, but they do continually point out that ADE is observed in most varians of Coronavirus we know of and as such presents a very real risk here.

In the discussion from yesterday ont his topic one such journal I quoted said the following (though lacks specific numbers for aforementioned reasons):

ADE has been observed in SARS, MERS and other human respiratory virus infections including RSV and measles, which suggests a real risk of ADE for SARS-CoV-2 vaccines and antibody-based interventions. However, clinical data has not yet fully established a role for ADE in human COVID-19 pathology.

When so many doctors are continually warning us about COVID vaccines being premature, and there have been efforts to block the early approval of COVID by many in the medical community, it should raise red flags in its own right.

@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.

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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.

@ccc There is a big difference between making estimates for ourselves as to whether the risk reward is viable or not. I think its fine if you want to look at the risks and determine the vaccine is a safer bet, even with the unknowns, than not getting it.

The issue here is if you have a right to force others, directly or otherwise, to get the vaccine.

I dont care if you choose to get it, I do care if you choose to force medical professionals to get it or create a situation where a medical professional who doesnt get it can no longer find a job.

Thats the key here, we can speculate till the cows come home about whats likely or not and create any sort of guess numbers we want, doesnt really change the issue that when we are dealing with an undeniably higher danger from this vaccine than typical that we have no right to exert pressure on anyone to get it.

@freemo I certainly wouldn't want to force anyone to get the vaccine in the face of their own estimate as to the safety thereof.

But, by the same token, when I visit the doctor I wish to choose a doctor such that I minimise my own personal chances of dying as a result of visiting the doctor.

For the reasons I have given in my previous posts, I have concluded that my best chance of surviving the doctor's visit is to visit a doctor who has taken the vaccination (at least, until such a time as I myself am vaccinated).

So, then comes the question: should I be able to know, before visiting the doctor, whether or not the doctor has been vaccinated?

I would *want* to know, so that I can select a doctor who has been vaccinated. But merely knowing that therefore does exert an indirect pressure on doctors to not only get the vaccination, but moreover to advertise that they have got the vaccination. Is this indirect pressure on doctors more or less important than my desire to improve my odds of survival by avoiding the unvaccinated doctors?

@ccc by that same ogic do you also have a right to know what doctors have HIV so you can avoid them out of fear of accidentally contracting HIV.. A persons medical data id protected for a reason.

@freemo Hmmm. An interesting question, touching on and leading into all sorts of thorny ethical questions.

Let me propose a practical and straightforward way of dealing with this situation that seems, to me, to avoid at least most of the ethical pitfalls:

I propose that I should be allowed to ask the doctor whether or not he has received an HIV vaccine, and that the doctor's reply to that question is required to be truthful. To protect the doctor's privacy, the doctor's reply is permitted to be something along the lines of "I don't want to tell you" (or "I don't *have* to tell you", or similar); it must be truthful, but it is not *required* to be a direct yes-or-no.

In the case of an HIV vaccine, I expect the answer from most doctors would be "There is no such thing as an HIV vaccine". COVID is different, inasmuch as there *is* now a COVID vaccine. If I restrict myself to visiting doctors who both have received the COVID vaccine and are willing to tell people that they have, then I can be sure that I am visiting doctors who have been vaccinated, satisfying my concerns for my personal well-being; at the same time, any individual doctor has the option of keeping his own vaccination status secret.

@ccc Ok so lets take that scenario.

While it may seem fair on the surface lets realize how this will actually play out:

People who are scared of HIV, mostly homophobes but not all, are likely to take "I dont wish to answer that" as being functionally equivalent to "yes I have HIV".

The end result is that those with HIV have no real protection, they will be treated as if they have HIV whether they say yes or refuse to answer. So they will loose their livlihood and patients all the same.

While it may seem or even sound fair on the surface, in practice it is really no different than forcing them to divulge their medical history and if they refuse to effectively get fired or loose their job

@freemo Ah. I thought I had resolved that potential pitfall by limiting the question to not a question of whether or not they had the disease; but rather to a question of whether or not they had taken a vaccine for the disease. So you can't ask whether they *have* HIV. Just whether they've been vaccinated for it.

@ccc Sorry I missed that. so presumably in this scenario since there is no vaccine for HIV you wouldnt really be able to ask anything useful?

@freemo Yeah. You can ask the doctor whether or not he's received an HIV vaccine, and the doctor can truthfully reply that there's no such thing as an HIV vaccine, and that's about that. You learn nothing about the doctor's HIV status.

@ccc ok, so with that said there is a pill that can prevent HIV it isnt a vaccine, and is only given to people in high-risk same-sex sex situations.. i read about it a while ago.

So that isnt exactly the same, but its similar so lets just create a hypothetical here (one that isnt too different from the COVID case in some ways).. Imagine the HIV prevention pill were in fact a vaccine. It is a high risk HIV vaccine with some potential for side effects so generally is not given to the general public, like the pill I mentioned. The only people a doctor will give the pill to are people who engage in high-risk HIV behaviors and is almost exclusivly administered to those who have same-sex intercourse with multiple partners.

As such by asking if someone took this hypothetical HIV vaccine it would effectively reveal to the patient that they are gay. Would you still support your scenario where they would be obligated to answer truthfully?

@freemo ...huh. I did know that there were such things as antiretroviral treatments, but I somehow thought they were more complex than pills.

Okay. Under that hypothetical, yes I would, but only so long as it was very well understood that answers like "I don't want to tell you" or suchlike would also be permitted; the only answer prohibited would be a direct lie.

@ccc

https://www.health.ny.gov/diseases/aids/general/prep/faqs.htm

Alright, well clearly we disagree on this, but not sure there is much left to be said, I wouldnt agree with that scenario.

All I can say is that no matter how well understoof it may be that "I dont want to tell you" is permitted I dont think that woulds top someone from treating "I dont want to tell you" as equivelant to an admission of guilt. If someone is, for example homophobic they would almost certainly only go to doctors who answer "no" and any other answer would be treated, whether true or not, as an admission to engaging in same-sex intervourse

Similarly with a covid vaccine the end result is just as damaging, the vast majority of the public, even those who think the vaccine is too risky to take it for themselves would likely ask their doctor if their vaccinated and only go to doctors who say yes. Effectively causing doctors who say "I dont want to answer" to be out of a job.

Imagine an exaggerated situation like COVID but just exaggerated to prove the point. Imagine COVID killed half of all people who got it, so pretty much anyone would be scared shitless of covid (though even at the current rates people are more than scared enough)... now imagine there was some vaccine that 2was 100% effective but killed 90% of the people who took it. Obviously no one in the general population would take it because they are safer to take their chances on the virus. But at the same time the virus is so deadly no one would go to a doctor unless that doctor openly admits to taking the vaccine, since they only care about their own lives not the doctors

The end result in such a scenario is effectively that doctors and nurses would either need to take the vaccine and risk a 90% chance of death (which is clearly not in their best interest), or would be out of a job as no one would hire them.

To me that's equivalent to the situation you are putting them in. Many doctors and nurses feel the vaccine is not safe and poses a higher risk than the virus and dont wish to take it. By forcing them to honestly answer if they took the vaccine or not effectively puts them in a position where "I dont know" and "no" are the same in the sense that they are out of a job. As such it forces them to take a dangerous medication if they wish to keep their job.

I'm sorry but I cant see that as fair or healthy.