There is no significant risk of lasting negative health consequences after infection
That's simply false. In fact, there is an abundance of evidence of it.
https://chrismasterjohnphd.com/covid-19/finally-confirmed-vitamin-d-nearly-abolishes-icu-risk-in-covid-19
You're... citing someone with a PhD in nutritional science primarily interpreting a study with n=76, and trying to deduce from that a 96% decrease in fatality risk. That's not how those statistics work. You simply can't get that level of information from the studies cited.
One 35 year old friend of mine was on oxygen for four months and out of work for six months.
Another's (31) autonomic nervous system is fried and needs to be on vasoconstrictor drugs so she does not faint every time she stands up.
Four more in their thirties fought it off like a horrible flu plus smell issues.
There is evidence that the immunity provided by the RNA vaccines is stronger and possibly more reliable than that produced by natural infection for 3/4 of the population.
There is evidence of very weird and interesting infection of cardiac cells early in infection with implications that are not understood and might have interesting effects forty years down the line. Precautionary.
I also do not want to spread to people around me who are unvaccinated.
On another note, I remain flabbergasted and angry that very little research is going on in Europe and America about indomethacin and ivermectin.
I strong-upvoted this comment from CheerfulWarrior, to bring it from the negatives to the positives. I think CellBioGuy's comment was good, and a valuable contribution to the discussion. I think it's also useful for CheerfulWarrior to ask for citations, and useful to remind us of the risk of anecdotes here: we should share data like this, but it's true that there are meaningful risks of mis-reporting, of selection effects, and of over-updating-due-to-emotional-salience.
E.g., imagine 99/100 LessWrongers deciding not to comment because they haven't heard of their friends suffering long-term effects, while the 1/100 LWer whose friends are seeing serious sequelae does decide to comment, since they have the more interesting story to tell.
(I'm making these points as a procedural point, not because I disagree with CellBioGuy's conclusions. In this case, I do think long-term effects of COVID are not-super-rare in 30-50-year-olds, based on a variety of cobbled-together sources of varying quality, and based on first- and second-hand reports from my friends, people I follow on Twitter, etc.)
(Added: The tone is maybe not optimally friendly, but I think it's better to focus on epistemic content in this context.)
Whether you think there is evidence of "lasting" negative health consequences is going to depend on what you interpret as "lasting." There is lots of evidence SOME people still have symptoms a few months after infection.
What you wrote makes sense, except that you underestimate the risks for young people (others have already provided sources), and I am surprised that you included "not wanting to kill older family members by negligence" almost as a footnote -- is it really so rare for young people to interact e.g. with their parents? You only need to infect them once.
At the end, it is a quantitative decision; being among the first ones to take the vaccine is a risk, getting sick is also a risk; we disagree about the relative sizes of these risks... and also about government incentives (from my perspective, governments are mostly downplaying the risks of COVID-19, because their voters do not want to be inconvenienced).
My reading on that last point was that the government has incentive to declare the vaccines valid solutions to COVID-19 even if they haven’t been properly tested for efficacy and side effects, in the spirit of downplaying the risks of the epidemic. And similarly (in the spirit of steelmanning), the companies developing the virus need to do visibly better than their competitors and preferably come out before or simultaneously with them, for the sake of profits; incentives which also push towards incomplete/inadequate testing procedures.
However, my prior for...
They value safety of strangers higher than their own safety, and want to take the vaccine for the sake of all the people at risk in the society.
This is the wrong framing. Taking a vaccine does not exchange 5 personal utility against 5 external utility. The amount of damage prevented is way way higher than the amount of personal damage.
Say that, at the time the vaccine is available, (tell me if you think this is unrealistic). Then, the expected number of people you will infect is . So getting vaccinated will save people from getting Covid, in expectation. However, this is a probability distribution that includes outcomes where several people get it, so even if you somehow don't interact with old (or otherwise high-risk) people, you certainly cannot control that such people ultimately get it.
Now, if your net utility of avoiding the vaccine is 5, the average utility for these people might be -300 or something, since they might straight up die from it. Which means you're exchanging a small amount of personal utility for a large amount of negative external utility, in this case -200. It is absolutely possible to value your own safety more than that of other people and still consider it a moral obligation to get vaccinated, as long as you don't value it a hundred+ times more.
Valid point, thanks. Although I'm not very fond of this kind of calculations of utility, your point is well made.
In my case, I probably wouldn't give my life for less than lives of a billion strangers, so that ratio would have to be extremely high, to the point where it's probably incalculable.
You are applying the incentive heuristic inconsistently. On the one hand you infer that if there was string evidence of long term effects, governments would be very vocal about it. But on the other hand, you ignore that these incentives would also apply to the Vitamin D effects that you cite. Governments would also surely have an interest to publicize an intervention that has a 25 fold reduction in risk. So the estimate is wrong or your conception of how governments work is wrong.
I suggest that it is both. Other answers have already mentioned that a 25 fold reduction in risk would be ridiculous, and governments just do not respond to incentives like that.
This study is a strong reason to fear prevalent long term consequences for cognitive performance after even mild Covid-19 infections.
On the other hand, you do not mention the strongest reason for supporting your view: the relatively underexplored long term effects of mRNA vaccines. However, if you worry about those, you should just get the traditional-style Oxford or J&J vaccines. Since they use the same technology as well established vaccines, taking them should be fundamentally as safe as getting your flu shot.
You are applying the incentive heuristic inconsistently. On the one hand you infer that if there was string evidence of long term effects, governments would be very vocal about it. But on the other hand, you ignore that these incentives would also apply to the Vitamin D effects that you cite. Governments would also surely have an interest to publicize an intervention that has a 25 fold reduction in risk. So the estimate is wrong or your conception of how governments work is wrong.
I fail to see any contradiction. Care to elaborate?
I ackno...
I think cutting the IFR by 25 on the basis of one study is a mistake, the chance of the study being fatally flawed is greater than 1 in 25. On the other hand 0.5% is overall CFR and would be lower for young people.
I think it's hard to cut risk of long term effects by more than a factor of 10 from published estimates. Note there is evidence of long term effects contrary to your claim, i.e. studies that do 6 week follow ups and find people still with some symptom. This isn't 6 months but is still surprisingly long and should shift our belief about 6 months at least somewhat. Also novel disease that attacks many parts of the body is some evidence. I agree the evidence is exaggerated to scare us but it feels like a different situation from reinfection where it actually is almost impossible to find instances except when immunocompromised.
But I think perhaps the most important is that even young people are currently limiting their activities in many undesirable ways in accordance with local government ordinances (which apply equally to old and young). Vaccination allows one to end or partially end these limitations--even if not in a legal sense, probably at least in a moral sense.
I also think you are probably overestimating vaccine risks (the main risk is that its effectiveness wanes, and that it interferes with future antibody responses from similar vaccines; not that you'll get horrible side effects) but that isn't necessary to explain why people want the vaccine now.
It's not often I see someone claim that the US medical regulation system is too lax.
The AstraZeneca vaccine was halted in the US for a month on the basis of a single, potential adverse event. Huge numbers of lives were on the line, and the US regulators were willing to hold up one of the frontrunner vaccine candidates for weeks on the basis of the faintest hint of unsafety.
There might be long-term adverse effects of the vaccine we don't know about, though no-one I've heard speak about vaccines seems to think these are likely to be severe; most vaccines are very safe. But if the FDA gives approval we can confidently assume that, at least over the timescale of the trial, the vaccine is extremely safe. In fact, we can assume we have far too much evidence of safety, that it should have been approved on the basis of substantially less evidence than we have.
As far as efficacy is concerned, as I understand it the Pfizer and Moderna vaccines have very simple designs (which were pre-approved by the – again, extremely over-conservative – FDA) and are overseen by an independent data-monitoring organisation. So while I agree their incentives are perverse, their ability to distort the data should be relatively limited.
(Here's a piece claiming the same is not true of the AZ/Oxford vaccine; I'm not sure how to evaluate this, but it's worth noting that the author is explicitly contrasting their data with the much more reliable Pfizer and Moderna data.)
I also think you're excessively sceptical of the evidence of long-term risks from COVID in young people. But in my case, avoiding a significant risk of (a) a really unpleasant and really long (multi-week) illness, and (b) accidentally killing people is sufficient for me to want to take a vaccine as soon as possible, even without a (in my estimation quite small, but nontrivial) risk of long-term sequelae.
There is no strong proof for such effect. Such proof would greatly increase acceptance of governments' policies, so there is a strong incentive to publish any such proof.
Trump spent months speaking about vaccines being soon available. Now we have the evidence that a vaccine works and the FDA will wait three weeks before to think about whether or not to approve the vaccine.
There would be strong incenties to start vaccinating now and vaccinating as soon as possible is a prime goal of the US president but still not done because the system is dysfunctional to an extend that even after spending years deregulating the FDA and having months to prepare for the moment of the vaccine.
While we do have slighlty more functioning governments in Europe, our governments are also not spending as much more on science to deal with COVID-19 as would desireable.
There's a study that German researchers did do that says:
Findings In this cohort study including 100 patients recently recovered from COVID-19 identified from a COVID-19 test center, cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis.
There's a recent study that suggest 20% of COVID-19 patients develop diagnoseable mental health issues. Here it's worth noting that 20% is not the upper bound as mental illness that gets developed through physical trauma often takes longer to show up (see the literature on depression due to head trauma).
Neither of those are surprising because our priors for this Coronavirus should come from the last problematic Coronavirus which was SARS with produced long-term mental health issues in a even larger number of patients and chronic fatigue syndrome (which might be a result of myocardial inflammation).
Divide that by 25 and stockpile large quantities of vitamin D in case you get the disease (https://chrismasterjohnphd.com/covid-19/finally-confirmed-vitamin-d-nearly-abolishes-icu-risk-in-covid-19)
Even if the Vitamin D treatment they did in the study would have such an effect, you don't get that by stockpiling vitamin D and taking it when you get symptoms.
Orally taken Vitamin D takes a while to be converted into it's active form and in the study they gave that active form intravenously.
Pfizer's vaccine requires extremely low temperatures, so there is a danger that in some locations it will be transported or stored incorrectly, causing greater risk than that suggested by the trials so far
Damaged mRNA doesn't cause additional risks. It just won't produce the desired proteins.
Given the studies that we have that do suggest long-term problems from COVID-19 and no evidence for long-term problems due to the vaccine, you need pretty high double standards to consider the vaccine more risky then getting infected with COVID-19.
Your 20% link is the cardiology link repeated. I think I know the link you meant: this Lancet study?
(I'd caution that a number of journalists mis-read the abstract and reported that nearly 20% of people had a first-time mental health diagnosis after COVID - that isn't so! Only 5.8% had a first time diagnosis. The near-20% (18.1%) includes people already diagnosed with a mental health condition. You might have known this already but I wasn't sure from your phrasing, and this specific error on this study is common so I thought I'd mention it.)
For clarity's sake, is "Damaged mRNA doesn't cause additional risks. It just won't produce the desired proteins." the claim that:
A) the vaccine mRNA can only become inert when stored improperly, or that
B) the probability of changes to the mRNA due to the incorrect handling producing a dangerous, unintended protein is vanishingly small?
I would assume B is correct but perhaps there is something about the chemical reactions that take place at higher temps that do result in what is better views as a non-mRNA compound that is incapable of producing any protein.
Findings In this cohort study including 100 patients recently recovered from COVID-19 identified from a COVID-19 test center, cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis.
What does that mean? I don't understand the meaning, severity or prognoses related to "cardiac involvement" and "ongoing myocardial inflammat...
I appreciate this question—good to see someone willing to go against the hyperscrupulous LW consensus. I think many people want the vaccine because of a vague idea that it will accelerate the time at which things are back to normal. Most people have suffered more from the indirect effects of the pandemic (job losses, business closures, stress, isolation) than from COVID itself.
Please don't forget that some young healthy people are essential workers who might not really have a choice about this.
they value safety of strangers higher than their own safety, and want to take the vaccine for the sake of all the people at risk in the society.
Quite apart from the actually low personal risk from taking a vaccine, why does this strike you as odd? This is perfectly normal and good human behaviour, and if you don't share it there is probably something quite a bit wrong with you.
I share the emotional reaction but I don't think attacking someone's character in response to a question is acceptable.
A neglected motivation: If I'm vaccinated, and my friends are vaccinated, I can hang out with my friends again
You have a good summary.
Point Against manadatory Vaccination: Decreases trust in Government. There will be rebellion.
Point for vaccination in young people: Covid does have serious effects other than death. A decrease in brain and cardiovascular function is entirely possible in young healthy people. To just use fatality rates may not be not an accurate measure of risk.
Young people may also be more social or work in jobs where they are more likely to spread it. Taking a vaccine may give you the confidence to go about your socialising and work without fear or guilt of infecting others.
Imagine a bar or restaurant advertising that their entire staff is vaccinated, I imagine that they will be likely to attract more business.
In principle, I want to be vaccinated against every disease I can be, provided the risk of side effects is sufficiently low.
In practice, I will absolutely not be among the first or even second wave of voluntary covid vaccine getters. I got an annual flu shot for 25 years, and stopped after multiple years of my wife pointing out that every single time I did, I got sick within 36 hours, and was unable to work for 10 days. I'd never noticed the correlation before. I've never had unusually strong side effects to any other vaccine, but experiences like this give me pause and make me weigh things differently. I also am sufficiently able to reduce my risk of covid exposure through behavior that the marginal benefit of me getting it, to me and others, is well below average.
There may be a (potentially unconscious) desire for people to signal that they are not an "anti-vaxxer". This term is a very strong cultural pejorative lately. It's similar to being referred to as a conspiracy theorist and almost as negative as being considered a racist. No idea how much this may be contributing to publicly professed enthusiasm for the vaccine but maybe social signaling in this respect is a component.
I think there is totally irrational fear going on in society on vaccines. First of all it is really hard to develope a vaccine that is more dangerous than the infection itself. There have been vaccines that were incredibly dangerous to take in the early 19th century and some vaccines in the early 20th century could kill you too, but they would kill you in one of 10 000 cases. But this vaccine can’t kill you under any circumstances. Phizer vaccine will get ineffective if it’s too warm which means nothing will happen if you let it wait outdoors in warm temperatures and inject it later on. virusu, hence components of the in vaccines loose their potency in warmth they don’t get more dangerous. And you just underestimate the danger too. As long you aren’t 12 years old covid is dangerous. There have been one million infections and 10 men between 20-29 died in Germany. Assuming 100 000 men in this age group where infected and that that 2000 of them ended up in a hospital, you are simply better off taking the vaccine. No one who was vaccinated ended up in a hospital. So how dangerous could a vaccine be
What's the model under which the vaccine is more dangerous than the virus it's based on? That's not unknown, but it would be quite weird.
I have absolutely no inside-understanding of how vaccines work, and I don't know whom I could trust right now, given how much political pressure, twisted incentives and increased polarization (due to the crazy anti-vaccine movement) there is. My risk model treats all the available vaccines as "drug that was developed under political and financial pressure and whose trials ended much sooner than is normally the case".
My risk model treats all the available vaccines as "drug that was developed under political and financial pressure and whose trials ended much sooner than is normally the case".
I think we can do better than that, even in the current information climate. Drugs can be almost anything and have almost any goal. Vaccines are a pretty narrow class of treatment that are attempting to do one thing- give you an immune memory that will trigger if infected by a disease. They do that by exposing you to some part of the disease. The natural cap of badness of that attempt is giving you the disease itself- anything more needs an explanation.
Some examples off the top of my head where a vaccine caused effects you wouldn't get from the disease itself (not all of which rendered the vaccine net negative):
Of these, we'd expect #3 to show up nigh immediately upon immunization, and is not dependent on how many people were exposed to actual covid, so we have a fairly large sample size. I vaguely recollect that where #2 was a factor, it was pretty universally true, not a rare reaction- so the sample size is probably large enough for that too.
This is complicated by the fact that at least one of the covid vaccines is using an entirely new mechanism. This could leave us vulnerable to certain problems like the adjuvants, that take a long time and large sample size to catch.
Certainly some people are very sensitive and medically excused from vaccines- but those people are pretty screwed if they catch the actual disease too. The only reason not getting the vaccine is viable for them is herd immunity.
I'm not an expert and I haven't looked into this very long. But there are mechanistic models that can help us predict the risk here, and I think it's a mistake to use the entire collection of FDA-monitored treatments as a reference class.
My risk model treats all the available vaccines as "drug that was developed under political and financial pressure and whose trials ended much sooner than is normally the case".
And what other drugs do you believe have been in that reference class? Without that, it doesn't tell you much. All drugs are developed under financial pressure.
Direct finanical motivations seems to be even less strong in this case. Big Pharma is more in it for the goodwill then for the profits. If you read market analysis like How much could Pfizer make from a COVID-19 vaccine?:
And while there will be massive COVID-19 vaccine sales, he actually doesn’t see pharmaceutical companies in general making significant profits off of them in the long run.
[...]
So why race to be first? Conover said other incentives, along with profit, would include a company being able to generate goodwill with governments and patients.
And what other drugs do you believe have been in that reference class?
I don't know.
Without that, it doesn't tell you much.
I disagree. It allows me to shift those products from the category "drugs backed by the authority of academia and years of rigorous research" to "drugs that you take because important people and your echo chamber say that you should".
I must admit, I've had some lingering doubts about drug testing before. But I never investigated those because it would take me too much time to gather the necessary knowledge to even distinguish whom to trust (especially since I find biology completely uninteresting - my high school teacher made sure of that). But I'm certain that the incentives of researchers and administrative bodies are more aligned with telling the truth in the case of ordinary drugs, than they are in case of Covid vaccines.
Direct finanical motivations seems to be even less strong in this case.
Thank you. I do not believe the guy quoted in the article because I don't know his incentives, but that prompted me to look up the stock price of Pfizer and to my untrained eye it doesn't look like investors believe the company will reap great profits from this. This strikes out my concern about financial incentives. The other concerns (about political pressure and lowered scrutiny) remain.
I can only speak for myself, but the simple fact is that we need to be about 70% of the population to be immune in order for anything resembling normalcy to return. With a 90% protection rate for new vaccines, this means about 80% of people need to either get sick or get the vaccine. Given how few people already have antibodies in many places, this means that pretty much everybody who isn't a vaccine denier needs to get vaccinated. That's why I will get vaccinated as soon as I am able to.
Is there some additional reason to be concerned about side effects even after the point at which the vaccine has passed all the required trials, relative to the level of concern you should have about any other new vaccine?
This vaccine has been approved much more quickly, and in an environment of much higher political pressure, than most. That is a reason to be more cautious about it than one might be about, say, the flu or pertussis vaccines.
I am of the same sentiment, and I've been afraid to post a less-than-perfect argumentation. So thanks for being the nail that stands out. I'll add these reservations:
I have a question: viruses mutate all the time. There are already multiple strands around the world. Will the same vaccine work on all of them? How long is it guaranteed to work?
I have a friend who has been taking HCQ for a chronic illness since long before the pandemic, as it’s been historically used for. They have to go in for regular retinal checks to ensure that they aren’t going blind, and they are other significant concerns. They’re on it because those risks aren’t as bad as the effects of their chronic illness that HCQ relieves. But those risks are still bad. And if HCQ doesn’t help, then they definitely don’t want to give it out to everyone.
Assuming that's true, then that risk is associated with chronic intake of HCQ. But the recomended use against Covid is to take it only after noticing symptoms, and before hospitalization. It's a short use.
Clearly a lot of people on LW want to take it ASAP. I strongly don't want that - to the point where I will most likely emigrate if it becomes obligatory in my country. Please help me understand what I'm missing. Here is my understanding:
I can only think of two reasons why young, knowledgeable people are so excited about taking the vaccine: