You omit to give your age, which is highly relevant. Take the risks from the below paper* and then deduct another 95%+ to account for being fully vaccinated. Unless you’re either very elderly or seriously unwell (on the order of having leukaemia not just being mildly asthmatic) I suggest that the risk level is now low enough that it should not be driving your decisions, in the same way that you’re not dedicating this much effort to avoiding flu. (No, Covid isn’t flu, but when you are fully vaccinated then the risk level becomes comparable.)
It sounds like you’ve been overthinking this a lot. It’s time to live your life, see friends, enjoy yourself, and live again. There are more important thigs in life than squeezing out every last micromort of risk at the expense of all joy and of everything that makes life worth living.
*Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus
Point stands, I think. Once you’re fully vaccinated the risk—including risk of post-viral fatigue—is in the range we normally consider tolerable.
More generally, you need to balance risk reduction against actually enjoying your life. I would rather live a rich life than extend a grey and joyless existence, even if it means tolerating a small risk that said life will end early. That calculus shifts in the presence of large risks, but we aren’t talking about large risks now. I would encourage the OP, and everyone else who is vaccinated and still panicking worrying excessively about now-small risks, to look at the big picture and ask if they need a sense of perspective.
I’d find it helpful if folks had evidence to share about the level of risks other than death. (E.g. the risk of post-viral fatigue.) I agree that you need to balance risk reduction against actually enjoying your life, but I’ve been able to do that to my satisfaction and am interested in assessing the marginal risk of the items I noted in my post. I didn’t go much into the benefit side in the post, because that varies by individual, and I feel pretty capable of assessing the marginal benefit for myself. (I can assure you that my life is quite rich, and nothing close to grey and joyless, even though I haven’t leapt into indoor activities with unvaccinated people).
Once you’re fully vaccinated the risk—including risk of post-viral fatigue—is in the range we normally consider tolerable.
Do you have a source for this? I’ve seen good data about hospitalization and risk of death, but nothing about long COVID. They probably correlate, but I’ve seen suggestive data that they correlate less than I’d intuitively expect.
It definitely doesn’t feel like there’s enough data to be confident in saying ‘this is now a silly thing to care about or spend mental energy on’. Though I’d mostly agree if you live in an area with very low case counts.
Sorry, no source—but given the vaccines massively (>90%) reduce risk of other harms ie death & hospitalisation, I think the null hypothesis has to be that vaccines also massively reduce risk of long COVID.
I also start with a prior that a lot of discussion about long-COVID is low quality and I think it’s an example of post-viral fatigue rather than some brand-new thing. It gets lots of media hype, like anything vaguely scary and covid-related, but hard data seems to be hard to come by and often very low quality.
The [best source I’ve found] (https://institute.global/policy/hidden-pandemic-long-covid) finds a 30% reduction in P(Long COVID | infection after 2 vaccine doses). Infection reduction is about 85%, so total risk reduction is about 90%, MUCH less than the risk reduction for hospitalisation.
The study is based on 3,000 infected patients, all over 60, unclear how it generalises to younger people.
In general, there is SOME good quality research on long COVID, and it seems obvious to me that it is a legitimate thing and respects a good fraction of the harm of the pandemic. Even if overall research is much less high quality than I want.
Thanks for the source, I hadn’t seen it before. 90% risk reduction is still an order of magnitude, seems like a big deal to me.
One point to be aware of: I notice they don’t distinguish between the different vaccines, they just give a population-wide figure. The UK has used a combination of Pfizer and AstraZeneca, and on other metrics eg efficacy against symptomatic infection or hospitalisation, AZ is slightly to moderately worse than Pfizer. Assuming the same pattern holds for long covid, I would assume a >90% risk reduction for Pfizer (and Moderna with similar mRNA technology), which is the read-across relevant to American readers.
They said “No, Covid isn’t flu, but when you are fully vaccinated then the risk level becomes comparable.” So, what’s the evidence that long term heart and brain damage of COVID-19 is worse than the flu (or the cold for that matter) after you’re already vaccinated?
The general way to deal with drugs is to put the of burden of evidence on the drug that it helps with certain conditions (it’s called the precautionary principle in medicine). Nobody gathered evidence that any of the vaccines help against long COVID.
The vaccines do seem to help against outcomes like hospitalization but if we look at an issue like brain damage there’s no statistical significant difference between whether or not the person was hospitalized. It’s been a while since I read up on heart damage and from what I remember that also didn’t need hospitalization to occur.
Nobody gathered evidence that any of the vaccines help against long COVID.
Nobody could have within the time frame. Have you noticed how there’s always one bunch of people complaining that everything has been slowed down by bureaucracy, and another saying that nothing has been tested thoroughly enough?
The sentence said nothing about requiring testing. We could just say: “You get 5$ extra per vaccine dose if you show it helps reduces long COVID by 90%”.
They are not required to show it to get their vaccine to market. Generally, the idea is to make it easier to bring vaccines to market and then pay extra for proof that the vaccine does desirable things.
Yes, you are paying money for important information
You are not, because money can’t buy time in the required sense. If the purchasers of the drug can’t afford to wait to study the long term impact, it is no good paying the providers extra, because there is no way they can accelerate time.
That’s different then slowing down response via bureaucracy.
You are assuming the very lesswrongian assumption that all bureaucracy is unnecessary. It’s more complicated than that. If you remove the checks and balances, you don’t get the same results faster , you get worse results faster.
You are not, because money can’t buy time in the required sense. If the purchasers of the drug can’t afford to wait to study the long term impact, it is no good paying the providers extra, because there is no way they can accelerate time.
That’s just wrong. You can run multiple studies. Moderna/Pfizer didn’t have information about whether the vaccine reduces transmission in the first trial that lead to bringing the vaccine to market. It’s information they gathered in later trials and there’s no reason why the couldn’t have run tests for long COVID on patients of those trials.
Recruiting more patients for clinical trials accelerates the trial and costs money. Recruiting the amount of patients that allowed Moderna and Pfizer to get their vaccines approved when they did cost hundreds of millions of dollars.
You are assuming the very lesswrongian assumption that all bureaucracy is unnecessary.
I’m not sure why you want to strawman. I never said that I reject all bureaucracy. I’m just for less of it and smarter regulation. I’d love to see a law that criminalizes intentionally witholding information about biosafety breaches from the public.
As Pakinson described, he British foreign service managed to get by with orders of magnitude less bureaucrats when they had an actual empire to manage then they have employed afterwards. Bureaucracy grows like cancer and is hard to reduce.
Hydra manages to have bureaucracy that does independent quality testing. The FDA doesn’t manage to do any independend quality testing and thus fails to remove fraudulent products like those of Ranbaxy from the market within reasonable trimeframes and manages to approve drugs where their scientific advisory panel says they don’t work.
The FDA combines a lot of resistence to bringing drugs to the market with little action to provide actual safety.
If you remove the checks and balances, you don’t get the same results faster , you get worse results faster.
In this case we got vaccines with extremely high side effects compared to the vaccines that we usually use as a result of the regulation. While they might not cause lasting harm, being ill for a day isn’t nothing.
Without regulation we would have used well understood and easy to scale up vaccine technology earlier in 2020. The regulation we have only allowed for vaccines with patent protected technology to be effectively brought to market and unfortunately that came with a lot of disadvantages.
I’m aware that parallelism is how you usually speeds things up. I am saying that it doesnt work in cases where you are studing a long term phenomenon.
As Pakinson described, he British foreign service managed to get by with orders of magnitude less bureaucrats when they had an actual empire to manage then they have employed afterwards
They also didn’t mind millions starving. You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don’t know if that’s right , but you could consider it.
In this case we got vaccines with extremely high side effects compared to the vaccines that we usually use as a result of the regulation
I’m aware that parallelism is how you usually speeds things up. I am saying that it doesnt work in cases where you are studing a long term phenomenon.
You can’t study effects of COVID a few years out. At the same time we could now have information about what 6-month after infection effects the vaccines prevent.
You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don’t know if that’s right , but you could consider it.
I can also consider that increased bureaucracy and regulation is due to God making it happen. There are a lot of bad explanations that I can consider.
If the increased bureaucracy is due to increased value of individual wellbeing, we would only see it in situations where the point of the regulation is increased wellbeing. Few people think about tax law as being primarily about wellbeing, yet the complexity of it grows constantly.
Just like cancer grows naturally bureaucracy does as well. Pakinson did good work on describing how it works.
That’s hindsight fallacy.
Hindsight fallacy would be saying that it would have been predictable when the pandemic started that the process leads to vaccines with higher side-effects. What I said was just that it did lead to vaccines with higher side-effects. That’s an observation that does come from hindsight and it would have been possible for regulation to produce no net damage in this case. At the same time I have written about how regulation increases side-effects of drugs before, so it’s not completely a thesis that comes out of hindsight.
If we look at vaccines, vaccines that get developed in a way where the inventor of the vaccine vaccinates himself early are more likely to be safe then ones that get validated through clinical trials where increasing the chance of the trials finding a clinical effect is more important then reducing side effects.
You could write a regulation that the first human in which a new vaccine gets tested as to be the CEO of the vaccine company to create skin-in-the-game. Such regulation wouldn’t slow down vaccine development but would help with safety.
You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don’t know if that’s right , but you could consider it
You could also consider that the truth lies somewhere between.
If the increased bureaucracy is due to increased value of individual wellbeing, we would only see it in situations where the point of the regulation is increased wellbeing
Which is to say : “if the increased bureaucracy is entirely due to increased value of individual wellbeing...”
If we look at vaccines, vaccines that get developed in a way where the inventor of the vaccine vaccinates himself early are more likely to be safe then ones that get validated through clinical trials where increasing the chance of the trials finding a clinical effect is more important then reducing side effects.
I am finding that hard to parse. How are you defining “safe”, how are you checking that they actually took their miracle cure, and why are you placing so much confidence on a single (at best) data point?
It’s easy to justify having some non-zero level of regulation by looking at the quackery prevalant in the nineteenth early twentieth century. And claiming to have benefited from a cure you had never personally taken is quackery 101.
I completely lost my sense and smell and it did return over the next few months, for the record. Therefore, I wouldn’t consider that damage final in all cases.
I am super skeptical of that whole brain damage thing. Brains change, from all kinds of things. I can’t help but notice that everywhere they see statistically significant differences is downstream of smell and taste, and actually closely resembles previously described brain changes in people with chronic rhinitis that blocks the sense of smell through ordinary means.
I’m in my mid-30s, and I’d say, moderately asthmatic, which probably falls into the same risk category you had in mind. I’m not sure what led you to believe that I’ve been avoiding seeing friends or enjoying myself, and squeezing out risks at the expense of everything that makes life worth living—refraining from indoor events with people who’re unvaccinated hasn’t had much of an impact on my quality of life, but it will have a bigger impact on my quality of life now that events are loosening restrictions. Hence my post.
I think it’s clear that IFR is low among people of my risk level, but as the other folks who replied to your comment noted, I think it’s worth considering effects other than death. I’d be interested to know if anyone has evidence on that.
You omit to give your age, which is highly relevant. Take the risks from the below paper* and then deduct another 95%+ to account for being fully vaccinated. Unless you’re either very elderly or seriously unwell (on the order of having leukaemia not just being mildly asthmatic) I suggest that the risk level is now low enough that it should not be driving your decisions, in the same way that you’re not dedicating this much effort to avoiding flu. (No, Covid isn’t flu, but when you are fully vaccinated then the risk level becomes comparable.)
It sounds like you’ve been overthinking this a lot. It’s time to live your life, see friends, enjoy yourself, and live again. There are more important thigs in life than squeezing out every last micromort of risk at the expense of all joy and of everything that makes life worth living.
*Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus
https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v7
IFR is not the only thing that matters. Avoiding long term heart and brain damage is also important.
Point stands, I think. Once you’re fully vaccinated the risk—including risk of post-viral fatigue—is in the range we normally consider tolerable.
More generally, you need to balance risk reduction against actually enjoying your life. I would rather live a rich life than extend a grey and joyless existence, even if it means tolerating a small risk that said life will end early. That calculus shifts in the presence of large risks, but we aren’t talking about large risks now. I would encourage the OP, and everyone else who is vaccinated and still
panickingworrying excessively about now-small risks, to look at the big picture and ask if they need a sense of perspective.I’d find it helpful if folks had evidence to share about the level of risks other than death. (E.g. the risk of post-viral fatigue.) I agree that you need to balance risk reduction against actually enjoying your life, but I’ve been able to do that to my satisfaction and am interested in assessing the marginal risk of the items I noted in my post. I didn’t go much into the benefit side in the post, because that varies by individual, and I feel pretty capable of assessing the marginal benefit for myself. (I can assure you that my life is quite rich, and nothing close to grey and joyless, even though I haven’t leapt into indoor activities with unvaccinated people).
Panicking isn’t useful. Having discussions about how to effectively deal with risk isn’t panicking, talking about panicking is strawmanning.
Ok, reworded to something else.
Do you have a source for this? I’ve seen good data about hospitalization and risk of death, but nothing about long COVID. They probably correlate, but I’ve seen suggestive data that they correlate less than I’d intuitively expect.
It definitely doesn’t feel like there’s enough data to be confident in saying ‘this is now a silly thing to care about or spend mental energy on’. Though I’d mostly agree if you live in an area with very low case counts.
Sorry, no source—but given the vaccines massively (>90%) reduce risk of other harms ie death & hospitalisation, I think the null hypothesis has to be that vaccines also massively reduce risk of long COVID.
I also start with a prior that a lot of discussion about long-COVID is low quality and I think it’s an example of post-viral fatigue rather than some brand-new thing. It gets lots of media hype, like anything vaguely scary and covid-related, but hard data seems to be hard to come by and often very low quality.
The [best source I’ve found] (https://institute.global/policy/hidden-pandemic-long-covid) finds a 30% reduction in P(Long COVID | infection after 2 vaccine doses). Infection reduction is about 85%, so total risk reduction is about 90%, MUCH less than the risk reduction for hospitalisation.
The study is based on 3,000 infected patients, all over 60, unclear how it generalises to younger people.
In general, there is SOME good quality research on long COVID, and it seems obvious to me that it is a legitimate thing and respects a good fraction of the harm of the pandemic. Even if overall research is much less high quality than I want.
Thanks for the source, I hadn’t seen it before. 90% risk reduction is still an order of magnitude, seems like a big deal to me.
One point to be aware of: I notice they don’t distinguish between the different vaccines, they just give a population-wide figure. The UK has used a combination of Pfizer and AstraZeneca, and on other metrics eg efficacy against symptomatic infection or hospitalisation, AZ is slightly to moderately worse than Pfizer. Assuming the same pattern holds for long covid, I would assume a >90% risk reduction for Pfizer (and Moderna with similar mRNA technology), which is the read-across relevant to American readers.
They said “No, Covid isn’t flu, but when you are fully vaccinated then the risk level becomes comparable.” So, what’s the evidence that long term heart and brain damage of COVID-19 is worse than the flu (or the cold for that matter) after you’re already vaccinated?
The general way to deal with drugs is to put the of burden of evidence on the drug that it helps with certain conditions (it’s called the precautionary principle in medicine). Nobody gathered evidence that any of the vaccines help against long COVID.
The vaccines do seem to help against outcomes like hospitalization but if we look at an issue like brain damage there’s no statistical significant difference between whether or not the person was hospitalized. It’s been a while since I read up on heart damage and from what I remember that also didn’t need hospitalization to occur.
Nobody could have within the time frame. Have you noticed how there’s always one bunch of people complaining that everything has been slowed down by bureaucracy, and another saying that nothing has been tested thoroughly enough?
The sentence said nothing about requiring testing. We could just say: “You get 5$ extra per vaccine dose if you show it helps reduces long COVID by 90%”.
How do they show something wthout testing it?
They are not required to show it to get their vaccine to market. Generally, the idea is to make it easier to bring vaccines to market and then pay extra for proof that the vaccine does desirable things.
Specifically, you are paying them extra money to show it.
Yes, you are paying money for important information. That’s different then slowing down response via bureaucracy.
You are not, because money can’t buy time in the required sense. If the purchasers of the drug can’t afford to wait to study the long term impact, it is no good paying the providers extra, because there is no way they can accelerate time.
You are assuming the very lesswrongian assumption that all bureaucracy is unnecessary. It’s more complicated than that. If you remove the checks and balances, you don’t get the same results faster , you get worse results faster.
That’s just wrong. You can run multiple studies. Moderna/Pfizer didn’t have information about whether the vaccine reduces transmission in the first trial that lead to bringing the vaccine to market. It’s information they gathered in later trials and there’s no reason why the couldn’t have run tests for long COVID on patients of those trials.
Recruiting more patients for clinical trials accelerates the trial and costs money. Recruiting the amount of patients that allowed Moderna and Pfizer to get their vaccines approved when they did cost hundreds of millions of dollars.
I’m not sure why you want to strawman. I never said that I reject all bureaucracy. I’m just for less of it and smarter regulation. I’d love to see a law that criminalizes intentionally witholding information about biosafety breaches from the public.
As Pakinson described, he British foreign service managed to get by with orders of magnitude less bureaucrats when they had an actual empire to manage then they have employed afterwards. Bureaucracy grows like cancer and is hard to reduce.
Hydra manages to have bureaucracy that does independent quality testing. The FDA doesn’t manage to do any independend quality testing and thus fails to remove fraudulent products like those of Ranbaxy from the market within reasonable trimeframes and manages to approve drugs where their scientific advisory panel says they don’t work.
The FDA combines a lot of resistence to bringing drugs to the market with little action to provide actual safety.
In this case we got vaccines with extremely high side effects compared to the vaccines that we usually use as a result of the regulation. While they might not cause lasting harm, being ill for a day isn’t nothing.
Without regulation we would have used well understood and easy to scale up vaccine technology earlier in 2020. The regulation we have only allowed for vaccines with patent protected technology to be effectively brought to market and unfortunately that came with a lot of disadvantages.
I’m aware that parallelism is how you usually speeds things up. I am saying that it doesnt work in cases where you are studing a long term phenomenon.
They also didn’t mind millions starving. You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don’t know if that’s right , but you could consider it.
That’s hindsight fallacy.
You can’t study effects of COVID a few years out. At the same time we could now have information about what 6-month after infection effects the vaccines prevent.
I can also consider that increased bureaucracy and regulation is due to God making it happen. There are a lot of bad explanations that I can consider.
If the increased bureaucracy is due to increased value of individual wellbeing, we would only see it in situations where the point of the regulation is increased wellbeing. Few people think about tax law as being primarily about wellbeing, yet the complexity of it grows constantly.
Just like cancer grows naturally bureaucracy does as well. Pakinson did good work on describing how it works.
Hindsight fallacy would be saying that it would have been predictable when the pandemic started that the process leads to vaccines with higher side-effects. What I said was just that it did lead to vaccines with higher side-effects. That’s an observation that does come from hindsight and it would have been possible for regulation to produce no net damage in this case. At the same time I have written about how regulation increases side-effects of drugs before, so it’s not completely a thesis that comes out of hindsight.
If we look at vaccines, vaccines that get developed in a way where the inventor of the vaccine vaccinates himself early are more likely to be safe then ones that get validated through clinical trials where increasing the chance of the trials finding a clinical effect is more important then reducing side effects.
You could write a regulation that the first human in which a new vaccine gets tested as to be the CEO of the vaccine company to create skin-in-the-game. Such regulation wouldn’t slow down vaccine development but would help with safety.
No,not even for five extra dollars a dose.
You could also consider that the truth lies somewhere between.
Which is to say : “if the increased bureaucracy is entirely due to increased value of individual wellbeing...”
I am finding that hard to parse. How are you defining “safe”, how are you checking that they actually took their miracle cure, and why are you placing so much confidence on a single (at best) data point?
It’s easy to justify having some non-zero level of regulation by looking at the quackery prevalant in the nineteenth early twentieth century. And claiming to have benefited from a cure you had never personally taken is quackery 101.
I completely lost my sense and smell and it did return over the next few months, for the record. Therefore, I wouldn’t consider that damage final in all cases.
I am super skeptical of that whole brain damage thing. Brains change, from all kinds of things. I can’t help but notice that everywhere they see statistically significant differences is downstream of smell and taste, and actually closely resembles previously described brain changes in people with chronic rhinitis that blocks the sense of smell through ordinary means.
I’m in my mid-30s, and I’d say, moderately asthmatic, which probably falls into the same risk category you had in mind. I’m not sure what led you to believe that I’ve been avoiding seeing friends or enjoying myself, and squeezing out risks at the expense of everything that makes life worth living—refraining from indoor events with people who’re unvaccinated hasn’t had much of an impact on my quality of life, but it will have a bigger impact on my quality of life now that events are loosening restrictions. Hence my post.
I think it’s clear that IFR is low among people of my risk level, but as the other folks who replied to your comment noted, I think it’s worth considering effects other than death. I’d be interested to know if anyone has evidence on that.