Coronavirus

[nebo113]

It seems that the lack of trust in conventional medicine/big pharma by people with advanced degrees described here is just the flip side of the coin that has "I love the poorly educated"  Trumpists having no trust in the mainstream media. 

The part I don't understand is how selective the distrust is. In the broadest sense, I suppose I'm skeptical about biomedicine too. However, that's really more of a philosophical position about truth and authority. As a practical matter, I obviously live my life within the system. Most anti vaccine and vaccine hesitant people do too. In fact, the arguments against vaccines are mostly firmly within a biomedical paradigm.

I suspect some of the vaccine hesitance expressed on this board is less a distrust of scientists and more a distrust of government. I distrust many of my country's current elected leadership. Those elected leaders set policy and decide budgets and appoint executives at government agencies. Distrusting elected leadership erodes trust in government agencies like the FDA. That transference of distrust is a subconscious process, not easy to recognize in oneself.

For me, it isn't a generalized distrust of government.....just the current covidiot at the top of the current government.  I'll get a vaccine if/when Tony Faucci gets his.

[downer]

Given the resistance to wearing masks, can you imagine the resistance to mandatory vaccines in the US? It is easier to imagine it being well accepted in more socially conforming societies.

I expect there will be pressure on politicians to enact laws preventing mandatory vaccinations, especially in those states where large numbers of people think that the virus is a liberal conspiracy against freedom.

Of course, your reasons for being skeptical of a vaccine are valid, for everyone else it is about their irrational beliefs?

I haven't noticed you demonstating any humility about the chances that you are wrong about anything. If you want to descend into snark, well, that's your choice.

[pigou]

I realize my view on healthcare is opposite to just about everyone else's, but I wish health insurers had more flexibility to deny claims when people engage in highly risky behavior. If you violate public health orders and get infected at a party with 30 people... claim denied. Decline a vaccine that is available to you without a valid medical reason and get sick? Claim denied.

Make the financial consequences visible enough and you don't need to persuade people about the public health benefits of various measures. You just have to count on the fact that they don't want to risk paying $10,000 out of pocket because they had to go to a party. And if someone really thinks COVID is a hoax or the vaccine will implement them with microchips, then they should have no problem declining medical care or, when they realize it's not a hoax after all, picking up the tab for it.

Edit: personally, I'll look at the data from Phase III trials before making a decision. But given the Phase I results so far, I suspect efficacy will be a bigger unknown than adverse reactions.

[writingprof]

In the time of coronavirus, a poem about America:

https://twitter.com/Guinz/status/1280698069932277760

Hilarious and sad.

[Caracal]

Of course, your reasons for being skeptical of a vaccine are valid, for everyone else it is about their irrational beliefs?
[/quote]

I haven't noticed you demonstating any humility about the chances that you are wrong about anything. If you want to descend into snark, well, that's your choice.
[/quote]

I might be wrong about all sorts of things, which is why I prefer to outsource my decisions on vaccines to people who have expertise. I actually think there's something pretty unpleasant about telling us you wouldn't get a hypothetical vaccine, the larger public health be damned, but other people who don't trust experts are a bunch of deluded rubes causing a crisis.

[apl68]

More will get the vaccine because employers will likely make it mandatory.

Maybe. I think it's more likely that many employers will simply say that a vaccine is available, so remote work and staggered schedules and other accommodations aren't necessary. Most employers won't want to deal with grievances and medical exemption paperwork that requiring vaccine would prompt. Large employers may arrange vaccine shots onsite, which will help.

That will surely be the most effective way of spreading vaccination when it becomes generally available.  Vaccine-skeptical employees will have to answer for themselves which are they more afraid of--getting the disease, or trusting the vaccine?  I imagine most will go for the vaccine.  The young invincibles who don't fear getting sick in the first place will be another story.  I kind of like puget's idea of making them bear the medical costs if they get sick.  Then again, a lot of them already don't think they need insurance anyway.

I think we're probably going to have a high rate of take-up for the vaccine among those who consider themselves to be at risk, or are mindful of their own potential to become spreaders.  I'll certainly take it when the opportunity comes, so as not to risk spreading it to co-workers, family, patrons, etc.

[Puget]

More will get the vaccine because employers will likely make it mandatory.

Maybe. I think it's more likely that many employers will simply say that a vaccine is available, so remote work and staggered schedules and other accommodations aren't necessary. Most employers won't want to deal with grievances and medical exemption paperwork that requiring vaccine would prompt. Large employers may arrange vaccine shots onsite, which will help.

That will surely be the most effective way of spreading vaccination when it becomes generally available.  Vaccine-skeptical employees will have to answer for themselves which are they more afraid of--getting the disease, or trusting the vaccine?  I imagine most will go for the vaccine.  The young invincibles who don't fear getting sick in the first place will be another story.  I kind of like puget's idea of making them bear the medical costs if they get sick.  Then again, a lot of them already don't think they need insurance anyway.

I think we're probably going to have a high rate of take-up for the vaccine among those who consider themselves to be at risk, or are mindful of their own potential to become spreaders.  I'll certainly take it when the opportunity comes, so as not to risk spreading it to co-workers, family, patrons, etc.

To be clear, that was pigou not me. I can understand the temptation but don't think this is a good idea-- its a slippery slope to deciding who deserves healthcare (do you not get health coverage for your diabetes because you should have exercised and eaten better?). I do think there can and will other natural consequences -- no vaccine, no school/college is an obvious one that is already the case most places for other vaccinations. Also maybe no air/train travel, no returning to work in person, etc. There is strong precedent for requiring compliance with public health measures in this way.

[Treehugger]

More will get the vaccine because employers will likely make it mandatory.

Maybe. I think it's more likely that many employers will simply say that a vaccine is available, so remote work and staggered schedules and other accommodations aren't necessary. Most employers won't want to deal with grievances and medical exemption paperwork that requiring vaccine would prompt. Large employers may arrange vaccine shots onsite, which will help.

That will surely be the most effective way of spreading vaccination when it becomes generally available.  Vaccine-skeptical employees will have to answer for themselves which are they more afraid of--getting the disease, or trusting the vaccine?  I imagine most will go for the vaccine.  The young invincibles who don't fear getting sick in the first place will be another story.  I kind of like puget's idea of making them bear the medical costs if they get sick.  Then again, a lot of them already don't think they need insurance anyway.

I think we're probably going to have a high rate of take-up for the vaccine among those who consider themselves to be at risk, or are mindful of their own potential to become spreaders.  I'll certainly take it when the opportunity comes, so as not to risk spreading it to co-workers, family, patrons, etc.

To be clear, that was pigou not me. I can understand the temptation but don't think this is a good idea-- its a slippery slope to deciding who deserves healthcare (do you not get health coverage for your diabetes because you should have exercised and eaten better?). I do think there can and will other natural consequences -- no vaccine, no school/college is an obvious one that is already the case most places for other vaccinations. Also maybe no air/train travel, no returning to work in person, etc. There is strong precedent for requiring compliance with public health measures in this way.

Yes, this attitude scares me. I am a never smoker who was diagnosed with lung cancer last year. However, I found out (a nurse at a practice to which I was referred clued me in) that I was most definitely not believed. My original oncologist (whom I "fired") went on and on and on in my visit notes about how I was a smoker and lying to his face about it. (Believe me, it was a lot more than a simple "patient denies smoking, but I have my doubts".) In any case, even without such policies, I found that misinformation in file distressing and wound up spending a long time dealing with it. I can't even begin to imagine the nightmare if I was actually going to be denied insurance coverage because of it.

[pigou]

Health insurers can already deny coverage for certain high-risk activities that are specified in the insurance plan. For example, if you get a head injury during bungee jumping, you may be on the hook for the costs. It's more common in less regulated areas of insurance, e.g. travel insurance. If you travel to a war zone, you're on your own if you need health care. Notably, it's not just imprudent behavior, but explicitly engaging in high-risk activity. If you go on a hike and get injured because you were clumsy, they'll still cover your expenses. But if you're climbing Mt. Everest, that activity is excluded and requires supplemental insurance.

Smoking is tricky not least because it's only probabilistically increasing a risk. But if you attend a birthday party with 30 of your closest friends while such gatherings are prohibited an 10 of you get sick... yeah, I doubt they all got independently infected buying groceries. Especially in cases like we have seen in New York, where the host had symptoms, knew they had symptoms, and decided to throw the party anyway. Then we have people who had a positive COVID test, but decided to go to parties anyway -- and others got infected.

I'm not advocating for some blanket rule about refusing coverage for "bad" behavior. But people who flaunt public health orders and recklessly infect others? Yeah, they can pay up. And people can sue each other to figure out whether the person hosting or attending the party should have to pay.

[apl68]

My apologies to both Puget and pigou for the confusion. 

[mythbuster]

I teach about drug and vaccine development as part of my science courses. As such I have had many discussions with students about "Big Pharma". What I have seen is that the distrust of Big Pharma is really a distrust of an organization who prioritizes $$ over public well-being. And for that I'm all with them.
     But then I break it down with them and ask if they distrust the scientists who work at Big Pharma? Usually the answer is no (there are a few who call them sell-outs). These scientists are doing good research, but often don't have control over which project they work on. The malaria vaccine will get cut for lack of profit potential- go work to develop another male impotence drug instead. This gets their attention. I make my students realize that as future scientists they often will be removed from those decisions about priority, funding, etc. I tell my students if they want to be part of those decisions, they need to understand business, policy, politics, and how to sway the public. All things many scientists have actively avoided.
   I then ask them who SHOULD develop drugs and vaccines, given the HUGE R+D costs (which we detail). They don't have a good answer and come to the realization that your choices as essentially private industry or government funding.
    So my take on the vaccine is this- if we have one approved it will be because of a Herculean effort on the part of the science community, both Big Pharma and government funded. It truly would be the achievement of my post-Space Race generation. BUT, I won't be injected with it until I see a fully peer reviewed and accepted publication in a major journal documenting is efficacy. I will NOT just take the word of policy makers unless they have the science degrees to back them up. I also will look side-eyed at the CEOs of the company that makes the thing, unless they declare that it to be rolled out in a no-profit type scenario.

As an aside, to AmLitHist, your old doctor was right about the first Chicken Pox Vaccine. It had very poor efficacy in protecting adults from Shingles recurrence. Hence why it has now been twice replaced with better versions. The data on Shingrix (the latest version) is phenomenal. Protective immunity generated by patients in their 80s! I will be at my doctors doorstep on my 50th birthday just to get it.

[AmLitHist]

Thanks for that confirmation about the first varicella shots, Mythbuster.  Thanks too for your much clearer and more eloquent discussion of my thoughts about the eventual COVID vaccine.

[Caracal]

    So my take on the vaccine is this- if we have one approved it will be because of a Herculean effort on the part of the science community, both Big Pharma and government funded. It truly would be the achievement of my post-Space Race generation. BUT, I won't be injected with it until I see a fully peer reviewed and accepted publication in a major journal documenting is efficacy.

Is that how this would work? My understanding was that you have a phase three trial to test the efficacy and safety of the vaccine and if the data looks good, it is submitted to the FDA for approval. Are those studies usually published in journals? Are they made available as part of the approval process?

[Caracal]

A small bit of good news, particularly as it relates to young kids and schools.

https://pediatrics.aappublications.org/content/early/2020/07/08/peds.2020-004879


And this is probably petty, but when I suggested there were some promising signs pointing to this conclusion a couple of months ago, a certain poster, wrote this.

The concern everywhere I've seen that has real scientists involved is indeed that little kids spread everything, even if they themselves aren't all that sick.  It's a lovely thought that somehow people with the worst hygiene habits are somehow not going to be spreading a highly contagious disease, but that's not a science thought based on everything we know about other viruses and kids. Epidemiology isn't my specialty, but my colleagues who are (close enough colleagues that I can call them up and say, "Hey, it's Polly.  What's the real scoop on ...?) are much more trustworthy sources than your interpretation from "news" sources that you didn't even bother to name so we could judge their credibility.

[Cheerful]

Should faculty over age 65 be teaching in-person at a university or public school this fall?  Over age 70?