COVID COVID-19 Coronavirus Containment Efforts

[mfb]

That discussion started with the idea "if you are vaccinated you can stop wearing a mask in certain places". That doesn't require anyone to show proof of vaccination to anyone.

 

[PeroK]

Just as a general observation: although masks are still officially mandatory in the UK, they are pretty much optional now. Many people in shops, at the gym and on public transport are not wearing them anymore. There are still signs and announcements but in practice if you don't want to wear a mask you can go largely unchallenged.

The "security" staff at the local supermarket just let people in now, masks or not. For a month or two they were actually, in very un-British fashion, not letting people in without masks - although, I think all you had to do was say you were exempt.

 

[russ_watters]

Just as a general observation: although masks are still officially mandatory in the UK, they are pretty much optional now. Many people in shops, at the gym and on public transport are not wearing them anymore. There are still signs and announcements but in practice if you don't want to wear a mask you can go largely unchallenged.

The "security" staff at the local supermarket just let people in now, masks or not. For a month or two they were actually, in very un-British fashion, not letting people in without masks - although, I think all you had to do was say you were exempt.

Interesting. A week ago they were still pretty much mandatory in my area. Enforcement is spotty, but largely unnecessary; everyone just wears them. I haven't been anywhere except a pharmacy since the CDC guidance changed, and I'll be interested to see how that changes.

 

[Astronuc]

COVID-19 pandemic was a ‘preventable disaster,’ made worse by a lack of global coordination and dithering, independent panel finds
Last Updated: May 12, 2021 at 2:03 p.m. ET
First Published: May 12, 2021 at 7:22 a.m. ET
https://www.marketwatch.com/story/c...dithering-independent-panel-finds-11620818573

The COVID-19 pandemic that has cost the lives of 3.3 million people around the world was a “preventable disaster” exacerbated by a lack of global coordination and dithering at every point of the outbreak, an independent panel said Wednesday.

The Independent Panel for Pandemic Preparedness and Response (IPPPR), a team of experts convened by the World Health Organization’s member states last May to review the world’s handling of the crisis, found weak links at every point in the chain of preparedness and response.

“Preparation was inconsistent and underfunded,” the panel said in a report. “The alert system was too slow—and too meek. The World Health Organization was under-powered. The response has exacerbated inequalities. Global political leadership was absent.”

And what was WHO's role in this? If they thought Chinese government was not being forthcoming, why didn't they sound the alarm? Also, governments are responsible for border control, which includes ensuring folks are not bring in communicable diseases from outside. If there was suspicion that a communicable respiratory (SARS-like) illness was being spread in China, then ALL passengers should have been surveilled before departure, or at the very least, everyone one on the planes should be wearing masks.

 

[russ_watters]

That discussion started with the idea "if you are vaccinated you can stop wearing a mask in certain places". That doesn't require anyone to show proof of vaccination to anyone.

It does if we want the guidance to be followed!

It would be interested to poll (if one could accurately) the vaccinated and unvaccinated to see which are more likely to stop wearing masks, given the new guidance.

 

[mfb]

It does if we want the guidance to be followed!

No one is forced to show anything to anyone with such a rule. Everyone has the option to keep wearing a mask.

 

[russ_watters]

COVID-19 pandemic was a ‘preventable disaster,’ made worse by a lack of global coordination and dithering, independent [WHO] panel finds...

And what was WHO's role in this?

Self-service.

Sure, it's technically true that we could stop a pandemic like this in its tracks, but in practice it requires compromises that people are probably never going to be willing to make anywhere but the most autocratic societies. "Lack of coordination and dithering" made the pandemic worse, but didn't create it, and good coordination and decisiveness would not have prevented it. Maybe the actual report is more helpful than that, but the press release tagline there isn't.

 

[russ_watters]

No one is forced to show anything to anyone with such a rule. Everyone has the option to keep wearing a mask.

You're missing the point/looking at the issue backwards. The point is everyone has the option to stop wearing a mask. And the people who will take that option are likely to be the ones who shouldn't.

 

[atyy]

You're missing the point/looking at the issue backwards. The point is everyone has the option to stop wearing a mask. And the people who will take that option are likely to be the ones who shouldn't.

But if you argue that way, you can say the ones who are mostly likely to take the wrong option would not have worn a mask in the first place, so the change in policy effectively doesn't have to take them into account.

 

[atyy]

A second thought - perhaps the calculation is that wearing a minimum standard mask (cloth, non-surgical, not N95) only cuts transmission by x. Vaccination still permits transmission by asymptomatic cases, by z (estimates range from 50-90%). If x is approximately z, then vaccination reduces transmission by the same amount as wearing a minimum standard mask, so they are interchangeable. So the question is what are reasonable estimates of x and z?

 

[russ_watters]

But if you argue that way, you can say the ones who are mostly likely to take the wrong option would not have worn a mask in the first place, so the change in policy effectively doesn't have to take them into account.

No, the prior policy was that everyone had to wear a mask. That means enforcement doesn't require proof of anything/invasion of privacy. You just station someone at the entrance to the supermarket (restaurant, mall, whatever) to police it. In my experience, this was essentially 100% effective at ensuring compliance. Very few people even tried to violate it and those who did seemed to be looking for Youtube fame (which they usually regretted later). Fewer still violated it successfully.

A "partial mandate" makes enforcement impossible; it's the same as no mandate.

 

[atyy]

No, the prior policy was that everyone had to wear a mask. That means enforcement doesn't require proof of anything/invasion of privacy. You just station someone at the entrance to the supermarket (restaurant, mall, whatever) to police it. In my experience, this was essentially 100% effective at ensuring compliance. Very few people even tried to violate it and those who did seemed to be looking for Youtube fame (which they usually regretted later). Fewer still violated it successfully.

A "partial mandate" makes enforcement impossible; it's the same as no mandate.

But at some stage we have to transition to not wearing masks. Presumably that is when everyone has been offered a vaccine? Is the US not there yet?

 

[Borg]

But at some stage we have to transition to not wearing masks. Presumably that is when everyone has been offered a vaccine? Is the US not there yet?

Exactly. My wife still doesn't feel comfortable going to indoor gatherings of 20 - 50 people where she knows that there are people who refuse to vaccinate. I've tried to explain to her that she is at little risk now that we're vaccinated and that the mask is mostly for the benefit of people who aren't vaccinated.

Someday in the future, people will mostly not wear masks anymore. We would be there quicker if we had herd immunity because everyone got vaccinated like they should. Unfortunately, that may never happen because a sizeable portion of the population won't vaccinate when there is plenty of opportunity to do so. At what point do you take the attitude with the purposely unvaccinated that we're not going to keep trying to protect you from your own stupidity?

 

[russ_watters]

But at some stage we have to transition to not wearing masks. Presumably that is when everyone has been offered a vaccine? Is the US not there yet?

We're about 2 weeks from the point where everyone who wants to be fully vaccinated with some urgency can be*. Of course eventually we'll have to get to a mask-free policy (and maybe soon). But that's not really what we're discussing. We're discussing the current policy.

Current CDC guidance/policy is that people who are not vaccinated should still wear masks. The value (lack thereof) of this policy is what I'm pointing out that people seem to have a hard time grasping.

*Technically if we include the J&J vaccine we're there now, but almost nobody is taking the J&J vaccine anymore. April 19 was the date the vaccines became available to everyone (minus the J&J pause). That puts us roughly to May 31 for everyone who wants it immediately to have it.

 

[atyy]

Exactly. My wife still doesn't feel comfortable going to indoor gatherings of 20 - 50 people where she knows that there are people who refuse to vaccinate. I've tried to explain to her that she is at little risk now that we're vaccinated and that the mask is mostly for the benefit of people who aren't vaccinated.

Someday in the future, people will mostly not wear masks anymore. We would be there quicker if we had herd immunity because everyone got vaccinated like they should. Unfortunately, that may never happen because a sizeable portion of the population won't vaccinate when there is plenty of opportunity to do so. At what point do you take the attitude with the purposely unvaccinated that we're not going to keep trying to protect you from your own stupidity?

Also, I'm not sure the vaccines will provide herd immunity even if everyone gets vaccinated, because one can still get an a mild or asymptomatic infection after vaccination, and transmit the virus. The estimates on how much the vaccines reduce transmission range from 50-90%. At the lower end, the vaccine would not provide herd immunity, even if everyone got vaccinated. So I think the vaccine is to protect oneself from serious disease (fortunately they seem very effective for that), but probably not so much for herd immunity.

 

[Borg]

Yes, I agree with all of that. Herd immunity is a bit of a mis-statement because being vaccinated doesn't truly keep you from getting Covid.

 

[PeroK]

Yes, I agree with all of that. Herd immunity is a bit of a mis-statement because being vaccinated doesn't truly keep you from getting Covid.

It does enough to prevent a pandemic so that we can lead normal lives. Everyone accepts that eradicating COVID is impractical, but mass vaccination allows us to return to near normality.

That's essentially what herd immunity is, surely. That there is enough immunity on average to prevent the disease spreading widely.

There are plenty of things we can all die of besides COVID.

 

[russ_watters]

Also, I'm not sure the vaccines will provide herd immunity even if everyone gets vaccinated, because one can still get an a mild or asymptomatic infection after vaccination, and transmit the virus. The estimates on how much the vaccines reduce transmission range from 50-90%. At the lower end, the vaccine would not provide herd immunity, even if everyone got vaccinated. So I think the vaccine is to protect oneself from serious disease (fortunately they seem very effective for that), but probably not so much for herd immunity.

Agreed, and because the range is wide/uncertain, and the current caseload still pretty high in the USA, I'd prefer to keep the mask mandates in place a little longer (at least in the USA).

 

[nsaspook]

https://www.theonion.com/cdc-guidelines-for-fully-vaccinated-people-1846450754

 

[Ygggdrasil]

Here's my attempt to explain the rationale behind the current CDC guidance:

Prior to vaccination, scientific evidence mainly pointed to regular cloth masks as effective at preventing infected people from spreading the disease but not very effective at preventing exposed people from becoming infected (as time went on and we learned more about the virus, evidence did begin to emerge for cloth masks being able to protect from infection). Under these circumstances (esp given shortages of N95 and similar masks that do protect against infection), a mask mandate makes sense since individuals need to rely on the actions of other to protect themselves from serious disease.

Now that the vaccine is widely available in the US, individuals do have a means to protect themselves against the risk of infection and serious disease. Therefore, people do not need to rely on the actions of other to make normal social activity reasonably safe. Yes, vaccines are not 100% effective at preventing infection, but for vaccinated individuals, infection will likely lead only to a mild cold and very rarely leads to hospitalization or death. In the pre-pandemic times, risking getting a mild-moderate cold was an acceptable risk of life.

A few counterarguments that one could raise: 1) The vaccine is not available to young children (age <11) and is not expected to be available in the US until the Fall. However, even unvaccinated young children are at low risk of serious disease, so this may be an acceptable risk. 2) Certain individuals either cannot be vaccinated (e.g. because of allergies) or vaccinations would not be expected to be effective for them (e.g. because they are immunocompromised). These populations would be at risk of serious disease (and in the case of immunocompromised individuals, elevated risk), and these populations would benefit from maintaining universal masking requirements.

 

[Ygggdrasil]

This Indian variant is a worry. The numbers are small, but if it really can evade the vaccine then we're in trouble.

The new variant observed in India (B.1.651) has two different mutations of concern L452R and E484Q. Mutations at E484 in the B.1.351 variant from South Africa and the P.1 variant from Brazil have previously been suggested to help the virus evade antibody-based immunity in both laboratory studies of the virus and in clinical trials on various vaccines. However, the antibody response is only one arm of the adaptive immune system (which tries to neutralize pathogens before they can infect the body) and it seems like the variants are not able to evade the cellular immune response (which helps the body eliminate pathogens once infected). Indeed, laboratory data suggests that T-cell response to the virus is not affected by any of the variants tested ( B.1.1.7, B.1.351, P.1, and B.1.427/B.1.428). Note that B.1.351 and P.1 share mutations at E484Q with the B.1.651 variant and the B.1.427/B.1.428 variants from California share the L452R mutation with the B.1.651 variant.

Together these suggest that while the variants may be able to infect vaccinated individuals (due to evading antibody-based immunity), the infection is unlikely to result in serious disease (due to pre-existing cellular immunity).

Consistent with this notion, clinical trial data from vaccine trials support the notion that vaccines may show lower protection against infection by variants with mutations at position E484 of the spike protein but are still very effective at preventing hospitalizations and death. For example, https://ir.novavax.com/news-releases/news-release-details/novavax-confirms-high-levels-efficacy-against-original-and-0showed 96% efficacy in the UK but only a 55% efficacy in South Africa (where the B.1.351 variant is widespread). However, in both locations, the vaccine showed 100% protection against severe disease, including all hospitalization and death. Similarly, the Phase 3 trials of the Johnson & Johnson vaccine showed lower protection against infection in Brazil and South Africa versus the US, but similar protection against severe-critical COVID-19. Cohort studies done in Qatar tell a similar story for the Pfizer mRNA vaccine; slightly lower effectiveness at preventing infection (75% from B.1.351 vs 90% for the B.1.1.7 variant which lacks mutation at E484) but still 97% effective at preventing severe, critical or fatal disease.

So far, the vaccines do seem like they should be reasonably protective against hospitalizations and deaths from the new variants. Of course, the more the virus is allowed to continue replicating uncontrolled in various populations across the world, the greater the chance that new variants could continue to evolve.

 

[mfb]

You're missing the point/looking at the issue backwards. The point is everyone has the option to stop wearing a mask. And the people who will take that option are likely to be the ones who shouldn't.

Not everyone. The option is only there if they are vaccinated (and only in some places), in that case their risk to get infected and the risk that they infect others is small even without a mask.

That means enforcement doesn't require proof of anything/invasion of privacy.

Nothing changed in that aspect.
Supermarkets can simply keep their mask requirements. Most probably will, as checking vaccination records is too much effort.
Other places - I mentioned offices as example - can give people the choice between "keep wearing a mask" and "show that you were vaccinated, then you don't need to wear a mask". No proof of anything required, it's purely optional.

A "partial mandate" makes enforcement impossible; it's the same as no mandate.

That's clearly wrong as general statement. There are places where "wear a mask or show you are vaccinated" can be implemented. Other places can just keep the general mask mandates.

 

[nsaspook]

IMO the enforcement issues will disappear quickly as large private enterprise locations drop mask requirements. There will be little or no enforcement of VAX status at the vast majority of locations once some critical mass of locations drop mask requirements with no checks. Several large retailers and supermarket chains adopted CDC guidance on masks today with more expected next week.

Sin City didn't waste time either.
https://www.fox5vegas.com/coronavirus/heres-the-updated-mask-guidance-for-fully-vaccinated-people-at-casinos-on-las-vegas-strip/article_e3364990-b4f6-11eb-bcc3-9f8c6b0135e7.html

Nearly all Las Vegas Strip casinos have announced they no longer require guests to wear masks if they have been fully vaccinated.

 

[atyy]

Agreed, and because the range is wide/uncertain, and the current caseload still pretty high in the USA, I'd prefer to keep the mask mandates in place a little longer (at least in the USA).

Regarding caseload - are medical facilities anywhere in the US still under stress? If there isn't, that might be another reason for relaxing the mask mandate (even considering that it may effectively be a full relaxation due to enforcement impracticability).

Also, the US will soon be vaccinating 12- to 15-year-olds, which makes it consistent with effectively fully relaxing the mask mandate.

I guess the main concern is whether case loads go up enough to stress medical systems after a full relaxation of masking.

 

[Vanadium 50]

It would be interested to poll (if one could accurately) the vaccinated and unvaccinated to see which are more likely to stop wearing masks, given the new guidance.

As a psychology experiment? Maybe.

As some kind of measure of public health policy? I'm not so sure. I think many people think they are fully vaccinated who are not. Perhaps as many as 25 million people in the US.

"Fully vaccinated" means "received last dose plus two weeks". But the name sounds like it means "received last dose" and this is reinforced by government statistics using "received last dose" to count "fully vaccinated". For various reasons, some of them even good, they want these numbers to be as high as possible, so they have adopted a particular definition. It is not surprising if many people misunderstand.

 

[Ygggdrasil]

As a psychology experiment? Maybe.

As some kind of measure of public health policy? I'm not so sure. I think many people think they are fully vaccinated who are not. Perhaps as many as 25 million people in the US.

"Fully vaccinated" means "received last dose plus two weeks". But the name sounds like it means "received last dose" and this is reinforced by government statistics using "received last dose" to count "fully vaccinated". For various reasons, some of them even good, they want these numbers to be as high as possible, so they have adopted a particular definition. It is not surprising if many people misunderstand.

Immunity is not a binary state that suddenly switches on two weeks after the second dose. Looking at the clinical trial data (e.g. for the Pfizer vaccine), once can see signs of protection ~ 2 weeks after the first dose:

https://www.nejm.org/doi/full/10.1056/nejmoa2034577

Note that because the incubation period of the disease is can be up to two weeks, many of those diagnosed with COVID-19 a week or two after the first dose probably got infected prior to receiving the vaccine.

Large scale observational data from Israel suggests that there is 46% protection against infection 14-20 days after the first dose, 60% protection 21-27 days after the first dose, and 92% protection 7 days after the second dose. Protection certainly increases such that people are maximally protected 1-2 weeks after the second dose, but fortunately, people still experience some protection if they relax cautionary measures before then.

 

[Vanadium 50]

Immunity is not a binary state that suddenly switches on two weeks after the second dose.

Oh, I agree. My point is that the CDC has a definition of "fully vaccinated". They also have statistics on how many people are "fully vaccinated" - one that uses a different definition. Nobody should be surprised if this causes confusion. Indeed, we should be surprised if it doesn't.

 

[russ_watters]

As a psychology experiment? Maybe.

As some kind of measure of public health policy? I'm not so sure. I think many people think they are fully vaccinated who are not.

Sure, a poll could easily address both:

1. Are you fully vaccinated?
2. Do you war a mask indoors(at x,y,z locations)?
3. If not fully vaccinated will you comply with mask mandates? Even if they are not enforced?
4. What was the date of your second vaccination?

 

[nsaspook]

Interesting data point about containment efforts.

https://finance.yahoo.com/news/covid-zero-havens-reopening-harder-210000541.html

Now that mass inoculation drives are allowing other parts of the world to normalize and open up to international travel, experts and residents are starting to question whether walling off from Covid is worth the trade-off, if implemented long-term.

“The whole world is not going to be Covid Zero,” said Rupali Limaye, director of behavioral and implementation science at the International Vaccine Access Center at Johns Hopkins School of Public Health. “That’s not an option here.”
...
Vaccination Lag

A major obstacle to reopening is the slow vaccine rollout in these Covid havens, due to a combination of supply limitations and citizens’ lack of urgency about fronting up for shots.
...
Nonetheless, Covid havens face a growing dilemma. If vaccinations don’t pick up pace, they risk being stuck in a perpetual cycle, unable to move past the pandemic.

“If their vaccination rates are low, that further jeopardizes their ability to open up,” Low said. “If so, the earlier ‘victory’ of these places over Covid-19 would have been a Pyrrhic one.”

 

[russ_watters]

As I was saying:

The Centers for Disease Control and Prevention's announcement Thursday that fully vaccinated people largely no longer need to wear a maskhas left many Americans wondering: If there are no enforcement measures, won't people just lie about their vaccination status?
...
Michael McCullough, a psychology professor at the University of California, San Diego, said the new guidance will enable unvaccinated people to flout rules with "impunity."

"Many will lie. Many are lying, have been lying," he said. "In some ways, this is a really perfect recipe for lots of people to be dishonest about whether they got vaccinated...
"It isn't just an honor system. Many people don’t want the vaccine on ideological grounds," Caplan said. "It's not the same as saying we’re going to rely on you to pay at checkout."

Lee agreed.

"My intuition is, given the situation, a lot of people feel they are justified not to take vaccinations," he said. "Therefore, they are going to feel more justified to lie to you as well."

https://www.usatoday.com/story/news...t-americans-honest-vaccine-status/5107686001/