CharonY

I think it is quite clear that the environmental impact is worse using bottled water. Production of bottles, resulting plastic waste and transport alone would have a negative impact that tap water does not have. I think studies looking at home water purification systems still show there will be net savings with respect to carbon footprint over buying bottled water. When it comes to health, it would depend whether one lives in an area where water quality is really poor. A lot of bottled water is in fact tap water, so fundamentally there is little difference.

It would be trivial to have RNA synthesized, and I am pretty sure that folks are doing it. The big issue though is that it is necessary to test safety or efficacy for the new mRNA. While the process is likely going to be faster, it would still require time and money. Meanwhile, the current vaccine has been surprisingly effective in preventing disease so the incentive to invest that is a bit lower. That being said, there is no fundamental guarantee that an adapted vaccine would be more effective. Predicting what works and what doesn't (or what is safe) is a bit difficult to predict when it comes to the immune system and mostly relies on empirical data. The thought is correct, but based on these and other consideration actually make the spike protein an attractive target. The spike protein (or rather a specific domain of the protein) needs to interact with the human ACE receptor. Thus there is some selective pressure to maintain the receptor binding domain, as larger mutations could weaken the interaction. Of course some mutations could enhance binding, but there is only a limited space where such mutations could occur. Because of the way they work, they are also readily accessible by the immune system and are very immunogenic. The envelope (E) and membrane (M) proteins have been studied on SARS-CoV-1 and have the fundamental problem of being fairly small and only have a relatively small domain exposed to the outside. As a consequence they were found to be only weakly immunogenic. The N protein (part of the nucleocapsid) has a number of other issues comparatively speaking. The biggest during the decision-making process was based on research on SARS-CoV-1, where it was found that using parts of the N protein elicited quite different responses. Some appeared to be protective, but then they also observed ADE (a phenomenon discussed in another thread in this forum). Thus figuring out a safe epitope for SARS-CoV-2 would have been risky. In addition, the N gene has exhibited about 2-3x the number of mutations compared to the S-gene (which was not really known at the time of vaccine development) and together it makes it a rather unattractive target.

Absolutely, and it is the bit that the richer nations have forgotten in their race to obtain vaccines for themselves. Together with the fact that they are also opposed to a patent waiver, things are likely going to get uglier for a while yet. It is one of the reasons why the WHO is trying to get more support for distribution of first doses of vaccines before looking at booster shots. Also one thing of note, if breakthrough infections resulting in a certain baseline level of transmission and reproduction, even high(ish) vaccination rates may not prevent the rise of new variants. So far we have variations coming from basically all corners of the world, it is just mostly random where more transmissible variants arise. Before delta, alpha (from the UK) was quickly replacing the original variant. In short it is dangerous to assume where new variants may come from. As you said, it is global problem.

Unfortunately not an isolated case, nor even specific to the US. In quite a few areas folks are not getting tested unless they have symptoms, are not required to isolate when positive, making mask mandates impossible and so on. The argument is that now that it is endemic we need to to treat it like other endemic diseases, which translates to we are not going to monitor it closely anymore and are not asking you to take extra precautions. This is a huge gamble and unfortunately the vulnerable are going to carry the risk.

Yes, and on top being asymptomatic does not equate to no health burden. But I think you are right. Folks still do not seem to realize how effective the virus is spreading, in part precisely because it does not immediately cause severe disease. By comparison, SARS caused maybe around 10k infections and 1k deaths. But if you talk to folks (even biology students) they do not seem to know the vast difference impact of the respective diseases. But also from the political side of things I am worried that folks in several areas are winding down tracing (even it it seemed to be done only halfheartedly in the first place) and testing. So we are going to run blind into a new situation, which is rather incomprehensible to me.

I have heard very mixed messages from health officials on that matter. Those I work closely with are for the most part nervous due to the unknowns. The highest priority in their mind is whether hospital beds will become limiting. Higher up on the food chain folks seem already start to transition. I.e. the focus there is how to live with the new reality of COVID-19 as an endemic (and potentially seasonal) disease. Yet for the latter science has, in my mind, not sufficient answers to make it clear how such a life would need to be in order to keep health burden at an acceptable (whatever it may be) level. For some, the living with COVID-19 appears to translate as pretend it is not there. Especially among young folks the attitude is a bit concerning.

While this should be a great incentive to get vaccinated, I fear that some assume that after getting vaccinated there is no need for any precautions anymore. Yet, there is still a lot we need to understand for proper risk assessment.

From memory I think delta became dominant end of May in the UK and was reported about 90% by mid-June or so. Assuming all the Ct values are from May to now one would expect a substantial if not most numbers coming from the delta variant. That being said I am not sure where the abundance information was precisely derived from.

I have not been following the REACT releases as frequently as I should, but I have seen a recent release indicating that the viral load in vaccinated folks was lower, which seems to be different than the CDC report. However, the report did not (in my memory) separate out delta infections, so it could still have been a mix of alpha/delta infections. I also think that masks are a good measure at this point. Even ignoring COVID-19, these measures have prevented the influenza season and thereby prevented thousands of deaths. A change in our behaviour could have overall significant public health impact, even if we just follow customs (such as mask wearing when having a cough) that are common elsewhere.

Throughout the COVID-19 pandemic there have been key findings that have altered our understanding or required responses to this disease. For example, the realization that pre- or asymptomatic persons might be infectious has required a different approach to masking and social distancing. While we have several threads discussing the pandemic, I feel that recent developments justify a new topic, especially as it could be used to clarify potential misunderstandings. With the delta variant (B.1.617.2) gaining dominance we are seeing yet another change that requires us to re-think the trajectory of the pandemic. First of all, the transmission rate of this variant is much higher than estimates for the original strain. The CDC has compared it to chicken pox, which has a basic reproduction number (R0) of >10. What does it mean? First of all, this might indicate that vaccine-based herd immunity is entirely out of the picture. With a R0 of 10 you would need to have a total protection of >92% of the population. Since the effectiveness of the best vaccines against the delta variant are a bit lower than 90%, it means that even with no vaccine hesitation and even if we could vaccinate children with it, we won't hit the required target for herd immunity. This has been assumed to happen for a while now, and might be the least surprising bit of news. However, there are a few recent findings that have prompted changes in messaging, for example with regard to masking. The key issue here are the finding that folks with breakthrough infections have similar viral loads as unvaccinated folks. What does it mean? Fundamentally there some vaccinated folks that get infected with SARS-CoV-2. That in itself is not surprising. Historically, breakthrough infections happen for most vaccinations at low frequencies. Most of the time the focus is on illness, i.e. symptomatic manifestations of infections. However, as mentioned, the possibility of asymptomatic spread has changed that. The fact that vaccinated folks still have high titers means that folks with breakthrough infections could infect others and especially unvaccinated folks are at risk of becoming seriously ill. Vaccinated folks, for the most part do not seem to develop serious symptoms anymore, but it means that vaccinated folks could unwittingly infect and endanger un-or undervaccinated folks. This has prompted a reversal in the masking recommendation. Moreover, it has made many infectious disease experts nervous as in many countries mask mandates are being lifted. Unknowns: There are still many open questions. For example, in the US, the delta variant is causing more illness in younger folks, including children. It is not clear whether this is really a property of the virus, or just because younger folks tend not to be vaccinated. It is not certain whether the vaccine effectively protect from long-haul COVID symptoms. The rate of breakthrough infections is unclear, we know the lower end of the estimate based on detected cases, but since folks without symptoms typically do not get tested, we do not know exact numbers. Even in a highly vaccinated community it is possible that there is a large enough reservoir to allow new variants to develop. https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm?s_cid=mm7031e2_w https://www.medrxiv.org/content/10.1101/2021.07.31.21261387v1 Discussion points: As a whole it means that we are heading into new territory during fall and winter. The big question is whether the current vaccination rates are good enough to prevent mass hospitalization or will easing of restrictions make folks forget that the disease is still there and cause a new surge. Vaccine hesitancy will add fuel to this potential fire. The communication in many countries/states/provinces have been confusing to say the least and quite a few folks I have talked to seem under the impression that there is little danger left, despite the fact that even in highly vaccinated countries, especially younger folks are barely hitting 50% of full vaccinations. Moreover, most folks in the world are still unvaccinated, meaning that we will need to prepare for more variants. Everyone is being sick and tired of the situation, yet undoubtedly the world has changed yet again (and will continue to do so). A big decision at some point is to establish how many deaths we are comfortable with. With regard to flue, for example, the number is surprisingly high across countries and by any estimate, COVID-19 is going to eclipse it, unless very high vaccination rates are maintained, which is notoriously difficult. Edit Aug, 19, 2021: A new preprint has come out indicating that with the Delta variant Pfizer might only be 42% effective at preventing infections (not disease!) and Moderna was about 76%. https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1 This seem to highlight that behavioral prevention is still going to be important.

Moreover, if one really wanted to understand something, one should rely at least on peer-reviewed publications. The one OP has a paper (pre-print) as a background, but the main argument against vaccines (which does not appear in the paper) is on a random forum. The other argument presented here is someone's blog. At the same time there are hundreds (perhaps thousands) of peer-reviewed articles looking at effects and issues with the vaccine, which is a rather unprecedented number given the time frame. So given the fact that the lit quality might be low, it should make one skeptical if the loud voices are all on social media, blogs etc. rather than somewhere which is not reviewed by at least some folks. In fact there are some papers out there discussing potential risks, but the data has pretty much laid that to rest. This is why now folks need to conjure some nebulous future issues (as we currently have very little) and disseminate them on social media. This post here so far has already posted more than two less than trustworthy sources under the potential guise of asking questions. This is, unfortunately is how misinformation spreads and kills folks.

That is not how the immune system works. Antibodies are antibodies, they are formed in reaction to antigen regardless where they came from. Fundamentally the advantage of the mRNA vaccine is that you can actually rapidly formulate new vaccines based on new variants. So assuming we do proper monitoring of the variants it is more possible to keep up. The use of superbug is a bit silly, as antibiotics resistances has other causes and issues, and developing new antibiotics is vastly more difficult than reformulating a vaccine. However, if you just hope that there will be eventually immune folks, what you are saying is that you want to kill of a significant proportion of the population and just hope that the survivors do not have lasting damages. And even then we do not know whether the survivors remain immune. There are reports of folks infected multiple times, so there is little evidence (AFAIK) that an infection provides more immunity. If anything, all I read so far point in the opposite direction. And then on top, we do not actually know if previously infected folks are actually immune against the current dominant variants, plus if we let more folks infected, we create more mutants. So basically all the arguments against vaccines that I can derive from that comment, would be equally if not more true if we let the virus sweep through the population. Or in short, it sounds like a really dumb idea.

That seems reasonable but I cannot see anywhere in the statement how So unless there is somewhere where he said that specifically, it seems to be an erroneous interpretation on your end. Rather it just says that there are further dangers down the road. I.e. once the resistant variants arrive, we will be at the same stage as we were without the vaccine. The only argument I can think of is that it is a higher risk to vaccinate if a) the virus remains transmissible even if vaccinated and b) if the circulation of the virus is very high. The argument here is that under these conditions, we may lose the race in creating effective vaccines (the superbug argument). There are multiple issues with the argument, but even taken at face value, there likely won't be a time when the virus reservoirs vanishes on its own. I.e. the only way based on that argument would be total lockdown until the virus reservoir is low and then vaccinate. So take your pick, vaccinate now and risk getting resistant variants or lockdown now and then vaccinate. If someone uses that as an argument to never vaccinate, well, they obviously do not understand the issue at all.

Sorry, I don't think that I have the time to read through random blogposts just to identify and pick apart the various arguments that made (up). As Arete mentioned, folks make up increasingly inane arguments and one could spend a lot of unproductive time trying to debunk each of those. If you have a key question or have issues with understanding I'd be happy to help you along, but otherwise the short summary is that that person is wrong, as all data indicates that the catastrophe is what we are already seeing, millions of deaths without vaccination. The only alternative would have been massive levels of isolation and contact tracing, but that ship has sailed. Any other extrapolations of how bad things potentially could be pale to what already is and is based on shakier or non-existent data. In a similar vein https://www.nytimes.com/2021/07/30/us/covid-vaccine-hesitancy-regret.html

Can you give us a short summary of what you want to ask?

Dear god. I assume you also have "vaccines are made from babies", "only vaccinated folks die" and "can you catch vaccines from other people"?

It is a desperate overextrapolation of possibilities. Akin to saying eating bacon gives you cancer. There is a kind of mechanism, but ignores the whole biology between mechanism and outcome.

That is a good summary and there is nothing in the paper to suggest anything of that sort and the link provided by op seems to be a random forum post that appears rather incoherent to me. Fundamentally non-neutralizing antibodies can increase protection (as the paper pointed out), which as a whole is a good thing, and from skimming the lit some papers suggest that they may provide more robustness against variants. Moreover, while it is true that ADE relies on non-neutralizing antbodies, it is not that they automatically cause it. The effects seems to be highly dependent on the virus and I think has been reported in HIV, Ebola and Dengue, but not in coronavirus infections for example. The single most important bit however is that any vaccine-related ADE would be detected in phase III trials, as they would manifest as vaccinated folks would then have a worse response to COVID-19 than unvaccinated folks. During the rollout we have even more and better data than pretty much any other vaccine and still there is no trace of it. So, no the paper does not indicate anything OP is suggesting, as others already pointed out.

These are great points, though I would be careful to give Trump too much credit. He is just the last in a long line of anti-science movements, going back at least to the early 2000s (or at least that is what I personally remember). What has shifted is perhaps the tone, for a while folks at least tried to make it sound reasonable that the Earth was only 6k years old.

Uh, I got some bad news for you there, mate (at least with respect to delta).

From what a quick screening of the lit it seems that most call for more data (the current sports medicine article makes a couple of good suggestions). I.e. it is necessary to understand more about the transition process. Some of the articles that you and I shared indicated mixed results (i.e. decline in certain performances after transition but no decline in others in the tested period). Considering that much of the research only started a few years ago it is hardly surprising. That being said, as one can see in this thread, there are a lot of assumptions being made, and even if they turn out to be true, there is not enough weight of evidence to support it. To take a well known issue as an example, if there were only a dozen of papers in total describing climate change, folks would not scramble to address this issue (and of course, even after thousands of studies the response is still rather muted).

I think the Intoscience and Peterkin's points are great. Wearing masks can also be seen not as an individual measure but a broader public health effort. The aim is overall reduction of spread with requires broad scale collaboration. If one only focuses on individual benefits the last year has shown that the overall outcome is actually worse. So normalizing wearing masks, even in situations where it is not strictly necessary, can encourage wearing in situation where it is beneficial. A few studies have come out indicating that the delta variant might generate a viral load 1000x higher than the original strain (https://www.medrxiv.org/content/10.1101/2021.07.07.21260122v2, which also explains some data that I have seen in our samples) and together with increasing info on breakthrough infections, wearing masks seems to be still important to protect vulnerable folks (incl unvaccinated) but also to curb the reservoir and reduce other burdens of the disease (such as neurological symptoms, which might also manifest in vaccinated folks, though data is still a bit sparse).

If one follows the actual data, it is actually not terribly conflicting. The issue is more of one nuance. Masks have a higher impact on the wearer not infecting others, but offers only limited protection in most cases. It is not nothing, but even cloth masks provide a little bit of barrier. As iNow mentioned, specific masks and respirators can provide more protection for the wearer, but requires proper fitting and correct use, which is not often feasible for day-to-day use for many folks.

I think debunking has become a bit of an issue, many folks have been increasingly resilient to that. So much in fact that even the most ridiculous notions are getting a serious platform.

I think in the last few decades it does seem that in most Western countries the right has weaponized anti-science sentiments and made it part of their platform. A common sentiment I hear from colleagues is that progressive/left parties ignore science when inconvenient, conservative/right parties attack science. While the situation could reverse if the progressive parties become more authoritarian, it is certainly not the trend (in developed countries) for the last few decades.