I think it will generally be allowed that unprotected sex is better sex than protected sex. And so one needn’t be an idiot to opt for unprotected sex if there were, say, only a one in a hundred chance of thereby contracting an STD. Not so if that STD were HIV. HIV is no longer the death sentence it once was, but even at one in a thousand I’d sure as hell be ‘tarping that load’. Similarly then, a younger healthier person might regard masking and distancing as akin to wearing a condom to avoid an easily curable STD, whereas someone like me would regard it as akin to avoiding HIV.
If each of us has either been vaccinated or already had Covid, then we needn’t mask and distance. Assuming vaccination or surviving Covid endows immunity from being a carrier, if either of us has been vaccinated or already had it, then we needn’t mask and distance. So it’s only if neither of us has been vaccinated or already had it that we need to mask and distance.
The number of such pairs is diminishing with each passing day. All other things being equal will it ever reach zero? No. But all other things are not equal. The virus can’t survive unless it keeps finding new hosts. And it will run out of hosts sometime – though not a long time – before that number of pairs approaches zero. So provided there isn’t a variant that can bypass our natural and artificial immunities, very soon now we’re all going to be fine. Well, except of course for those who won’t be.
Some people are more vulnerable to the vaccine than to the virus. Some people only think they’re more vulnerable to the vaccine than to the virus. And some people won’t take the vaccine on some kind of principle. So my question is:
Why should the rest of us – by which I mean those who have been vaccinated – give a shit? Whatever their reasons for not being vaccinated, these people are only dangerous to each other. And so if they’re worried about having any truck with others who are likewise unvaccinated, let them self-isolate. And if they’re not willing to self-isolate, then let them either suffer the consequence or crow that there weren’t any. Isn’t this precisely the view we take of people who don’t ‘tarp that load’?
Well, not quite. Since there’s no way to tell who has and has not been vaccinated, people who can’t take the virus have no way of knowing from whom they need to isolate themselves. Enter the so-called Covid passport.
And what exactly is the objection to Covid passports? That they discriminate against people who can’t be vaccinated. Well duh! But for what other than to facilitate discrimination did you imagine was the role of borders and passports?
To repeat: People who can’t or won’t be vaccinated are of no danger to those of us who have been. They’re a danger only to each other. But they have a right to know who these ‘others’ might be. So if you don’t like the idea of Covid passports – and I agree they could be too easily forged – how ‘bout branding a scarlet letter on the forehead of those who can’t or won’t be vaccinated?! That’s a far more reliable way to ensure they drink from their own designated water fountains.
Categories: Everything You Wanted to Know About What's Going On in the World But Were Afraid to Ask, Social and Political Philosophy
The Covid Vaccine, like most other vaccines, does not provide anyone full immunity from a disease. The vaccine provides some amount of protection against serious illness if you do get COVID. It is being reported that the first dose of the vaccine might be 80% effective at reducing the effects of Covid, and the second dose might boost that to 90% (for people who aren’t elderly or have serious comorbidities that compromise their health.)
Global News, May 3, 2021 reported: “more than 6,000 Canadians have reported contracting COVID-19 after receiving a first dose. Two hundred and three people were hospitalized and 53 people died of COVID-19 after receiving one shot of the vaccine. ” (Out of 75 million fully vaccinated Americans, 5,800 got COVID-19, and 74 died.)
A Vaccination Passport tells you nothing more than that you got a shot. It isn’t a guarantee that you can’t get Covid and it doesn’t tell others that you don’t currently have Covid and are asymptomatic.
Control of contagious diseases by traditional “non-pharmaceutical measures”, chiefly restrictions on mobility and (to the extent that they work) mask mandates, treats the problem as one of collective action. The appeal of vaccination is that it converts, at least partially, the problem into one of rational self-interest, making it tractable. (Accepting curative treatment for one’s own infection accomplishes the same thing where such treatment exists, as it does for tuberculosis but not for Covid.) In both cases, the individual is told of the risks and efficacy but the truthful message is, “Take these shots and you will be less likely to get seriously ill than if you don’t”, or, “Take these pills for six months and your health will be much better than if you didn’t.” The impact on the community can be seen as a happy by-product of the individual’s decision to take the vaccine but the individual need not be motivated by such considerations and may even be indifferent to them. (The state still reserves the right to coerce treatment where self-interest is insufficient.)
Unfortunately, as Margie points out in a “glass-half-empty” sort of way, individual protection from no vaccine is absolute. (Salk polio vaccine and tetanus toxoid are pretty close but the latter is a non-contagious special case.) The benefit to the collective, vaccinated and unvaccinated, is greater the more people are vaccinated: two randomly selected vaccinated people placed in a stuffy room together are much less likely to transmit virus from one to the other than are a randomly selected pair who are discordant for vaccination. So collective-action elements of the problem remain. The good news is that those elements decay rapidly as more people choose vaccination for their own self-interest. The disease is just nasty enough, and the vaccines are safe enough, that most people over 30 will have reason to want to be vaccinated. (The ICUs are filling up with 50-70-year-olds, not 35-year-olds, but there are enough of the latter that it concentrates the mind in at least the higher-risk communities.) What the over-30s in the low-risk neighbourhoods, the ones where test positivity is never more than 1 or 2%, and what the under-30s everywhere will do is an open question. Ontario just announced that its re-opening (what’s left of it) will begin in mid-June only if first doses have been given to 80% of eligibles and a good start made on second doses. We shall soon see.
Notice I’m not talking about herd immunity, the property that causes cases to go to zero (at least in one location at one time) and thus protects the unvaccinated. I’m just talking about a level of immunity that keeps cases among the unvaccinated and the small numbers of unlucky vaccinated at some tolerable level, chiefly gauged by ICU capacity: those 300,000 delayed surgeries in Ontario will never get done if the ICU is always full of unvaccinated Covid patients, even if we otherwise don’t give a shit about them. (It only takes a few extra ICU admissions to bugger the system because the critically ill take a long time to die, or, sometimes, get better. If it becomes public knowledge that nearly all were unvaccinated because of sloth, rule-flouting, or “principle”, there will be social bitterness directed against them. Not giving a shit about them might have to extend to giving them palliative care instead of intubating them, if doing the latter results in hot-zone hospitals never being able to treat fixable, health problems among residents of their catchment areas, who frame these wants as rights. This is the result of public policy decisions, for sound fiscal reasons, to place tight capacity limits on a collectivized health care system. We should at least be honest about what we are doing.)
I see the role for vaccination certificates as more for the protection of the vaccinated, not to alert the non-vaccinated that the person she is sharing air (or a drinking fountain — haven’t seen one of those in years!) with is a fellow traveler. The audience of a symphony orchestra is mostly older and well-off and will presumably have been enthusiastically vaccinated. Yet if there are cases in the community, an unvaccinated patron (or musician) could shed enough aerosolized (yes!) virus (maximal the day before symptoms appear) to overwhelm the immunity of some audience members and cause disease. Even if most cases are mild, the public health authorities would be under great pressure to close the venue, playing havoc with a carefully re-started concert season. Requiring all persons entering the hall to show proof of vaccination would reduce the risk of transmission to near zero because there would be no discordant pairs of contacts inside the venue. (Disclosure: I am a donor to, but not an employee of, the Toronto Symphony Orchestra. I don’t know if the TSO is planning to use vaccination certificates. I do know they are planning a 2021/22 performance season.) The objection that the certificate attests only to having received the injection, not that one is truly immune, is a straw man because the whole point of the certificates recognizes than not all those injected are immune. If immunity was total, there would be no need for certificates because the vaccinated would not have to worry about the the unvaccinated soprano singing her lungs out on the stage (or the cougher in the seat next to her.) And perhaps there isn’t. Perhaps by the time fall rolls around there will be so few cases that no one gives a shit about vaccination certificates, either. We can obsess about Quebec changing the Constitution unilaterally.
Finally, the Public Health Agency of Canada story cited by Margy about infections after vaccination represents a worst-case scenario. Only 2274 of those infections (to 26 April, millions of vaccinations ago) occurred more than 14 days after a first dose and, of course, few Canadians have had a second dose yet. The hospitalization rate of 9% implies that these cases were older and frailer or fatter, as does the death (so far) rate of 2.3%. Indeed, people over 70 still accounted for 29% of the Covid hospital admissions and 57% of the deaths in Ontario during the past two weeks. (https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance/covid-19-data-tool?tab=ageSex) This demographic should have been substantially vaccinated long enough ago to be immune. Of course we know that vaccination uptake lags in the highest-risk communities. (“For ye have the poor always with you; . . .”, otherwise known as the socio-economic determinants of health.) But as cases continue to fall, due to vaccination, the opportunity for a vaccinated person, however poor or frail, to be exposed in the first place will diminish and cases among the vaccinated will nearly disappear.
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Thanks for this, Leslie.
Will we actually know to what extent cases have fallen as a result of vaccination vs seasonality or cumulative deaths of the most vulnerable or one of the other variables?
I was watching how the cases and deaths are dropping steadily in the Ukraine. Their vaccine doses are only 2 per hundred people and it has only been 87 days since the first dose. Canada’s vaccine doses are 54 per hundred and it has been 159 days since the first dose.
I guess we’ll know more this fall when flu season rolls around. It is predicted that Covid will still be part of the viral mix.
Margy asks a good question. It probably can’t be answered but I’m going to hope Paul can indulge me several paragraphs to explain why not. In general it is not possible to look at a series of events and extract causality from those observations. That’s why we do experiments. But even if you are applying an intervention of proven efficacy, you can’t prove ipso facto that it caused the improvement seen in this particular situation. Even comparing control measures applied in different jurisdictions—Canada vs. Ukraine—involves trying to control for known differences between the two and you still have all the unknown confounders, which you can’t control for, not knowing what they are. Some things you can rule out: the Ontario government’s enhanced stay-home order of 16 April could not have caused case numbers to peak on that day and begin falling the next day. But the earlier version issued 2 weeks earlier just before Easter Weekend could have, as could the spontaneous drop in mobility that would have happened anyway after the holiday visiting subsided. The continued steady fall in cases since then might be due to the stay-home orders, except that they are not being enforced rigorously, except against indoor businesses, but perhaps that’s all you need. “But on the other hand…” ad nauseam.
The scientific method allows one to make predictions about the future — “What can we expect will happen if we do X?”— based on evidence from, in this case, randomized controlled trials, i.e., experiments, the best evidence there is because all the variables, known and unknown, will be distributed between the two arms, leaving the effects of the intervention easy to spot, especially if large. So we know vaccines work in people to whom they are given. We can predict confidently that vaccinated people will suffer less disease than the unvaccinated provided they are similar to the subjects in the trials.
But suppose most of the vaccines are given to people at low risk of becoming infected—the old and middle-aged who don’t go out, the fin tech workers-from-home, the people in better-off neighbourhoods, the health-conscious people who floss and exercise regularly and wear masks and sunscreen and don’t ride motorcycles. In Ontario, the first wave of vaccine outside nursing homes went to those self-starting sharp-elbowed people, and much less was taken up in higher-risk neighbourhoods where all the cases were occurring, driven by more-contagious variants which came along at the same time. In that case, even with lots of people vaccinated, all you do is prevent those deaths that would have occurred if those people had got infected, which they now don’t. But you still have lots of cases in the not-yet-vaccinated high-risk neighbourhoods, and will do until vaccination makes headway there, as it is now beginning to do.
For these reasons, my educated guess is that, other than having eliminated cases in nursing homes, the impact of vaccination on case numbers in Ontario is still modest. Most of the recent fall here is likely for the usual reasons that Margy alludes to. I don’t think it’s possible to tease this out to assign a percentage to any one variable. The real test will come later, when social contact resumes when more people have been solidly vaccinated and have had time to become immune.
One blind spot in Ontario’s vaccination strategy was that South Asians were overlooked. There was great “woke” emphasis placed on reaching ahead of everyone else the usual “marginalized” grievance-prone groups who have actually done rather well out of this pandemic. But the Indo-Pakistani community in Brampton and Toronto has been clobbered, both in terms of cases and in numbers of ICU admissions. So many cases that even if only 2 percent need ICU, that is a big burden. And transmission is very high — nearly all our cases now are the UK variant.
So in assessing the “effectiveness” (real-life) instead of just the “efficacy” (clinical experiment) of vaccination, the test is going to be when people start mingling and gathering, maskless and indoors. You have to look ahead, not back. The lockdown-lovers on the Left have criticized the Doug Ford government incessantly for “opening up too soon” previously—they would prefer Never—but *if* enough of the right mix of people have been vaccinated, we should see this fall just a dribble of cases and no Fourth Wave, ever, for as long as immunity lasts.