Live data from Hacker News

Spread of Delta variant driven by both immune escape and increased infectivity

cam.ac.uk

91–100 of 120 posts

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#91
post #20

I was told this is a pandemic of the unvaccinated.

By whom? It's a pandemic, it affects everyone. It's right there in the name. I'm fully vaccinated, and I spent half an hour at a bank yesterday (wearing an N95) and I'm voluntarily quarantining for two weeks. It's a deadly disease. It doesn't care about your PR slogans or your political alignment. It does care about transmission, which is why avoiding unnecessary trips, wearing real ventilators (not cloth masks, Fauc…

It's extremely unlikely you're going to get COVID from your bank trip. Many, many healthcare workers treated COVID patients every day for nine months unvaccinated and didn't get COVID. You are vaccinated, it's only half an hour, and it's unlikely that anyone in the bank has COVID.

IMO wearing better masks is a great thing, and so is minimizing indoor time with strangers, but it's also possible to overdo COVID protection.

Most of the spread of COVID is among unvaccinated people doing things indoors and unmasked. Unfortunately, you being even more careful will not affect their behavior.

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#92
post #62
post #9

Earlier quoted context omitted.

Every article that leads with this kind of stat is guilty of lying by omission. The typical immune response produces 10,000-100,000 times more antibodies than “necessary” to fight an infection. If delta needs 8x more antibodies, then, well, our immune response is only overkill by a factor of 1,250-12,500. Perhaps that’s enough for some of the virus to escape. But it’s still plenty to prevent severe illness! Of course…

I'm open minded to what you're saying but help me understand how both this > The typical immune response produces 10,000-100,000 times more antibodies than “necessary” to fight an infection. can be true, and how vaccines are basically 90% effective at preventing symptomatic illness (kinda sorta, leaning towards the high end.) Feels like the numbers don't match up.

The short answer to your question is that it takes time to mount an antibody response.

Vaccines do one big thing: they "teach" the adaptive immune system how to produce antibodies for the virus, and in the process the body produces a ton of antibodies, which fade over time. The antibodies fade quickly-ish (months), the "learning how to make antibodies" fades much more slowly, if at all (decades).

1) You get symptoms if you don't have enough antibodies in the right place when the infection comes in. 2) You avoid severe illness if your body can produces enough new antibodies (if it doesn't have enough) fast enough before the virus infects the really vulnerable parts of you.

People who have symptomatic breakthrough infections probably didn't have enough antibodies left in their noses to counter the initial infection, but are able to very rapidly mount a new antibody response so they don't get sicker. The initial 100,000x overkill is full-body, and fades over time. Months later, a vaccinated person might not have enough antibodies floating around in their nose to completely neutralize an airborne bubble with 10,000 virus on it landing inside.

As someone else implied elsewhere, the immune system is super complex. I'm going to attempt an ELI15 here. Apologies in advance for the wall of text.

== A Story ==

There are two parts to the immune response, called "innate" and "adaptive".

The innate response are first responders. They kick in as soon as they notice the "wrong" thing floating around in your nose/airway/lung cells. This response produces the early symptoms associated with respiratory infections: inflammation, sneezes, coughs, sore throats, runny noses, fevers, etc. It's trying to get as many of the body's white blood cells (immune cells) into the area as possible to clear out this virus that is simultaneously infecting cells and reproducing like crazy: doubling every 20 minutes; by the time the innate system kicks in, your hijacked airway cells have probably produced millions of new virus already. The more virus, the stronger the innate response: more immune cells, more killing infected cells, more clearing of cellular debris, etc. Your nose is runny, your throat is inflamed, etc. -- it's a huge battle, with millions of your cells fighting billions of virus. The best they can do is try to stem the tide, and they very likely won't win on their own.

Fortunately for you, during all this, some of your cells take parts of the virus, and present it to the cells responsible for the adaptive immune response. These are the scientists sitting in the back lab figuring out how to produce "antibodies" -- these are the red shells in MarioKart. They are designed specifically to latch on to and inactivate the invading virus, and make it super easy for the rest of the immune cells in your body to recognize the virus as foreign and destroy it. Designing these antibodies takes some time, unfortunately, and meanwhile there's a huge battle going on for your airways. Antibodies are HARD to design: you want something that attacks ONLY the virus, and not, say, also your pancreas by accident, because then you get Type 1 diabetes, and, well, that's not so great.

There is a lot of time pressure, because the virus is winning, and if the back lab scientists have never seen anything like this virus before, designing the antibodies can take days, maybe even a week or more, and then producing them in mass quantities takes days longer. The virus could overwhelm the body in the meantime.

BUT! But, if your adaptive immune system's scientists have seen the virus before, say because you were vaccinated -- a process in which your immune system was presented with a bunch of parts of virus that were taken to the back lab and the scientists designed antibodies for it, WITHOUT the time pressure of an actual infection -- then they basically have blueprints ready to go. (Less time spent coming up with plans means less time for the virus to overwhelm you.)

Now, regardless of where your adaptive immunity learned to make antibodies, when your body is ready, it goes to TOWN: we are talking trillions of antibodies produced in days, they literally flood your whole body. At peak there could be hundreds of thousands of antibodies for every virus particle. At this point, unless the virus figures out a way to hide from antibodies, it has more or less no chance. It's over. You've won. Your body will still need to clear the battlefield, so you may still have symptoms for a bit while this happens.

For vaccinated folks, there may even still be antibodies floating around from the vaccine, making everything much easier. There may be so many antibodies floating around that the virus doesn't even stand a chance -- it gets neutralized really fast (and transmission is blocked); there may just be a few antibodies around, but the adaptive response kicks in fast (mild symptomatic illness) and wipes the floor a few days later.

I hope this helps paint the big picture (with timelines) of what happens when a virus lands in your nose. I'm sure the HN crowd can imagine all sorts of edge cases here, and when hundreds of millions of people are infected with a single virus, basically any edge case with probability greater than 1e-6 is going to happen >100 times.

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#93
post #85

Earlier quoted context omitted.

That unvaccinated people are higher risk of getting and spreading Covid? I agree, although I'm not sure what is the significance of the 4:1 ratio. Ontario's numbers suggest a risk ratio closer to 7:1 or 8:1 right now.

Ok clearly you don't want to discuss this honestly if you want to hand-wave away the fact that unvaccinated people have much stricter testing requirements and as a consequence are tested substantially more often.

No you are right, reported cases alone can't tell the full picture. Mandatory testing can skew the numbers and probably undercounts vaccinated people. Same if vaccinated people are significantly more likely to be asymptomatic and therefore have no reason to voluntarily go get tested (but if that is the case, it brings us back to "pandemic of the unvaccinated" to some extent).

The breakdown is similar on weekends, holidays, etc which suggests that mandatory testing does not skew the numbers significantly in Ontario at least.

But as I said: reported cases blah blah, they paint a fairly clear picture to me but there is a lot of complexity there.

What about ICU numbers?

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#94
post #89
post #87

Earlier quoted context omitted.

If somebody has only had 1 shot, it is fair to say that they "have received the vaccine safely", but they are not yet "fully vaccinated". Hence the discrepancy between the 197m and 173m.

If that's the interpretation you want to go with, then the rule has to be followed consistently by reporting deaths from Covid19 among all people who "received the vaccine safely" instead of restricting such reporting to the "fully vaccinated". Just a few lines above, he is counting as "unvaccinated" all people who are not "fully vaccinated". Again, trust in people doing this song & dance would be higher if they did…

I see it as addressing two different concerns.

Addressing somebody whose concern is "the vaccine might not be safe", it makes sense to point to the large number of people who have been given a dose and been fine. I don't think a lot of people are in the halfway point where they think 1 shot is safe but 2 shots are unsafe.

Addressing somebody whose concern is "the vaccine might not be effective", it makes sense to look at the effectiveness of the recommended 2-shot course.

Anybody promoting anything will point to their most favorable numbers and try to keep it simple. Press release + nuance is a rare combination. This is not a research paper, it's a conclusion derived from research, and the governor is trying to get that bottom line conclusion out to the public: that it is safer to get vaccinated than not. As somebody who is smart enough to have questions about the details, you're also able to look up the answers to those questions. Does what you've found lead you to a different conclusion?

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#95

> “The team found that the Delta variant virus was 5.7-fold less sensitive to the sera from previously-infected individuals, and as much as eight-fold less sensitive to vaccine sera” I read this as “natural immunity is better”. Unless I’m reading that wrong, why don’t we hear more about this? I’m vaccinated AND got a breakthrough infection and I’m worried that my immunity is weaker than that of my wife who was unvacc…

Dumb people are going to want to go to covid parties to get infected naturally because it is better immunity.. Public health messages need to be kept simple. Natural immunity should be better because you are exposed to all the same proteins in the vaccine plus more and also possibly for a longer period of time and at a higher quantity. Now that you had delta, you should be immune to delta and partially immune to what…

And this is exactly the kind of reasoning that leads smart people to distrust public health messages.

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#96
post #93

Earlier quoted context omitted.

Ok clearly you don't want to discuss this honestly if you want to hand-wave away the fact that unvaccinated people have much stricter testing requirements and as a consequence are tested substantially more often.

No you are right, reported cases alone can't tell the full picture. Mandatory testing can skew the numbers and probably undercounts vaccinated people. Same if vaccinated people are significantly more likely to be asymptomatic and therefore have no reason to voluntarily go get tested (but if that is the case, it brings us back to "pandemic of the unvaccinated" to some extent). The breakdown is similar on weekends, hol…

If you're interested in my opinion on efficacy wrt severe outcomes please see my comment here: https://news.ycombinator.com/item?id=28460959

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#97
post #94
post #89

Earlier quoted context omitted.

If that's the interpretation you want to go with, then the rule has to be followed consistently by reporting deaths from Covid19 among all people who "received the vaccine safely" instead of restricting such reporting to the "fully vaccinated". Just a few lines above, he is counting as "unvaccinated" all people who are not "fully vaccinated". Again, trust in people doing this song & dance would be higher if they did…

I see it as addressing two different concerns. Addressing somebody whose concern is "the vaccine might not be safe", it makes sense to point to the large number of people who have been given a dose and been fine. I don't think a lot of people are in the halfway point where they think 1 shot is safe but 2 shots are unsafe. Addressing somebody whose concern is "the vaccine might not be effective", it makes sense to loo…

> I don't think a lot of people are in the halfway point where they think 1 shot is safe but 2 shots are unsafe.

In fact, there seems to be grounds to believe that people are extra susceptible to infection and illness during the period between the first shot and the two weeks following the second. Lumping people in that group are together with others who have never received a shot has the effect of keeping the number of hospitalizations and deaths from Covid19 among the vaccinated low.

As of 8/30, the rate of known deaths from Covid19 among those fully vaccinated has risen to 11/100,000 roughly 0.01 percent. It takes time to get exposed, infected, hospitalized, and die. We are a long way from that rate stabilizing. In the meantime, if things go as planned, there won't be anyone to compare with (but, of course, the definition of "fully vaccinated" will keep changing as needed).

> it is safer to get vaccinated than not.

Is it? Even if one has had Covid19?

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#98

Earlier quoted context omitted.

Lower hospitalization rates amongst the vaccinated seem to suggest less people are getting seriously ill.

Which is an important point. While the vaccinated are still getting COVID, and even sometimes ending up in the ICU, they very often aren't ending up hospitalized or in the ICU. The vast majority of ICU patients are unvaccinated [1]. [1] https://www.ncdhhs.gov/news/press-releases/2021/08/27/adult-...

It's tempting to look at vaccinated/unvaccinated as a perfect RCT and the unvaccinated are a control group. This clearly isn't the case. There are surely many confounders at play.

Looking at this release's underlying report they mention:

"The age-adjusted mortality rate among unvaccinated individuals was 5.00 cases per 100,000 unvaccinated population and the age-adjusted mortality rate among vaccinated individuals was 0.33 per 100,000 vaccinated individuals for the four-week period ending August 28, 2021."

So the difference in mortality rate is roughly ~5 in 100,000 of the population. This is a very low number. Does it obviously override any possible confounders to indicate a strong signal? Also remember this is age-adjusted. I would imagine this difference is substantially smaller for cohorts omitting the elderly. Is there a material benefit to younger reasonably healthy people? It seems the question is muddier than is typically made out.

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#99

> “The team found that the Delta variant virus was 5.7-fold less sensitive to the sera from previously-infected individuals, and as much as eight-fold less sensitive to vaccine sera” I read this as “natural immunity is better”. Unless I’m reading that wrong, why don’t we hear more about this? I’m vaccinated AND got a breakthrough infection and I’m worried that my immunity is weaker than that of my wife who was unvacc…

Dumb people are going to want to go to covid parties to get infected naturally because it is better immunity.. Public health messages need to be kept simple. Natural immunity should be better because you are exposed to all the same proteins in the vaccine plus more and also possibly for a longer period of time and at a higher quantity. Now that you had delta, you should be immune to delta and partially immune to what…

"Public health messages need to be kept simple." is something I almost agree with. The problem comes is when the simplicity starts leaving things out and edges into "not the full truth," at which point people can identify that you have -- perhaps not intentionally -- deceived them. That lowers trust.

This current pandemic is an excellent example of what happens when you have lowered trust.

Re: Spread of Delta variant driven by both immune escape and increased infectivity

#100
post #48

Earlier quoted context omitted.

> Dumb people How did we get to the point where we have to act like other humans are mentally inferior/incapable just for experiencing reality in their own unique way if it differs from our own? e: me irl https://i.imgur.com/is5pp8k.gif

in the olden days dumb people just died and didnt reproduce. We have overcome a lot of natural selection so there are likely many more dumb people than in the past. We all share the same reality that you have a .5% chance of dying from covid. If you choose not to take lifesaving vaccinations then you are dumb, especially if you are in a high risk category where the risk of death is 1-5% Im not at all in favor of mand…

> olden days dumb people just died and didnt reproduce.

It seems like this is not an internally consistent statement.

If "dumbness" is genetic and smart people make smart offspring and dumb people make dumb offspring, where do today's dumb people come from? Clearly, not the dumb people who died and did not reproduce.

The correct statement is that people who were not well adapted to their environment died. Some of them actually died after reproducing.

> same reality that you have a .5% chance of dying from covid.

One, "known" averages and individualized "probabilities" are different things.

Two, see https://news.ycombinator.com/item?id=28460412

Now you are confounding the probability of a random infected person dying with the probability of a randomly picked person in your own demographic group dying from Covid19.

For example, 3,145 females between 30-39 years of age died from Covid19 between 01/01/2020-09/04/2021. It looks like there are about 22 million people in that age group which corresponds to 0.014% probability of a randomly picked person in that group dying from Covid19 within that period.

[1]: https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-by-Sex...

Post reply on HN