outbreak! (ebola, sars, coronavirus, etc)

Despite the fact that I think that op/ed is pretty bad, I do think the question is worth asking of whether people with documented previous infection should be treated similarly to vaccinated people from the point of view of "can they go in a restaurant," etc. To the extent that the goal of the policy is to mitigate transmission in those spaces, the answer is at least maybe yes. To the extent that the goal of the policy is to encourage vaccination, obviously no. And if you do go that route, you obviously create a perverse incentive for people who don't want to get vaccinated to purposefully go out and get sick (thus increasing transmission and straining the medical system.)

I agree.

whether people with documented previous infection

in the USA producing documentation of infection would present a problem for a large number of people. our lack of a nationwide health system is a major obstacle to any systematic approach to public health.

…otm

My point above was that Marty Markary is not an expert and for someone as mild mannered as Ashish Jha to call him out, when he never does that, is telling.

Any conclusions Marty draws should be taken with a grain of salt because he is not an expert within infectious diseases and has been dead wrong many times before.

Like eephus says, I don't think anybody's downplaying immunity through infection, particularly if paired with vaccination. But studies have mostly come back showing that immunity through vaccination IS more durable, and even if it turns out not to be in some contexts, it's far safer to get vaccinated than intentionally expose yourself to it, which people ARE doing.

Likewise, immunity through infection WITHOUT vaccination before or after is definitely much less durable than if you get vaccinated before or after infection. If the CDC makes it sound like you getting the Vid once = "you're good", nobody will get vaccinated, plus it's also not true.

My friend who is vaxxed and boosted had had COVID *four times* since 2020. Yes, mostly different strains, and never "severe", but it shows that the belief if "I got it, I'll never get it again" is...not sound.

I mostly don't want to amplify somebody who wrote an op-ed arguing AGAINST masking kids in school last August, which Marty did.

But studies have mostly come back showing that immunity through vaccination IS more durable

Not sure about durability, but it seems like previous infections provide better protection against Omicron than vaccines:

By the week beginning October 3, compared with COVID-19 cases rates among unvaccinated persons without a previous COVID-19 diagnosis, case rates among vaccinated persons without a previous COVID-19 diagnosis were 6.2-fold (California) and 4.5-fold (New York) lower; rates were substantially lower among both groups with previous COVID-19 diagnoses, including 29.0-fold (California) and 14.7-fold lower (New York) among unvaccinated persons with a previous diagnosis, and 32.5-fold (California) and 19.8-fold lower (New York) among vaccinated persons with a previous diagnosis of COVID-19.

My friend who is vaxxed and boosted had had COVID *four times* since 2020. Yes, mostly different strains, and never "severe", but it shows that the belief if "I got it, I'll never get it again" is...not sound.

I mostly don't want to amplify somebody who wrote an op-ed arguing AGAINST masking kids in school last August, which Marty did.

I get it, but this is a bulletin board full of vaxxed-up, reasonable, non-brainwormed people. We don't need to protect anyone here.

Sorry I should have broken up those two quotes so it didn't look like you were replying to the CDC.

Not sure about durability, but it seems like previous infections provide better protection against Omicron than vaccines:

The study you quote ends in November 30 and took place in the US, so it's about delta, not omicron.

oh right.

xp Which means we really don't know what the situation is now. And we probably won't know for a while. That's annoying I know but it is what it is.

Seems like we won't really know about durability for a few years.

Of course, the big question, as always, is "when is this basically as dangerous as a flu or a bad cold for most people?" It's not "when will nobody ever catch it again?" And it sounds like if you are vaxxed and/or have already had COVID, we are getting close to that situation, but things could change.

I saw someone make the point recently that misinformation proceeds usually not via outright lies but via partial information, and that's pretty much my take on the WSJ editorial.

I think you can argue that "infection" provides better future protection than "vaccination" but also believe in vaccines ... because there's a massive risk to the former.

I can't track the evidence for these things (though in the UK it does seem that having Covid without a vaccination is related to ending up in Intensive Care Units).

that study about the protection being higher in those who were infected vs those who were vaccinated had a pretty huge confounder that they called out in the study, namely that the booster status of the vaccinated wasn't taken into consideration.

considering how few people were boosted when that study was run, that's....not a small detail.

it's even called out in the study:

After delta became the main strain, vaccines alone grew weaker against the virus and natural immunity got much stronger. This could be due in large part to the fact that vaccines began wearing off around the time delta spread, according to the study.

granted, we still are fairly low on the boost totem pole (25%!), but it was significantly lower than even that in October.

and i'm fairly certain the protection from a boosted person would come across very differently than someone who had waning two shot protection.

I'm not 'afraid' of the idea of natural immunity having an advantage, except for the fact that it's being weaponized, and while nobody's doing it HERE per se, that's why I like to be cautious with flinging that around

xp
You just said the vaccines didn't work! ;)

x-post. Yeah, Neanderthal ... the weaponising bit was what I was pondering but failed to articulate.

I mostly don't want to amplify somebody who wrote an op-ed arguing AGAINST masking kids in school last August, which Marty did.

i don't think we should mask kids in school fwiw. the evidence it has any positive impact on community transmission or even the rate at which teachers get covid is *incredibly* weak, which makes sense when you remember you've got 30 kids in a room for six hours, and masks aren't magic even when worn properly.

I mean, this is purely anecdotal, but I've gotten sick every year that I've taught. In early 2019 I got a horrible case of bronchitis that lasted for months, probably something I picked up while teaching. One of my students was out for a month that spring with pneumonia and I always kind of wondered if he got it from me. This school year is the first year of in-person teaching, ever, when I haven't been sick at all. And I have at least one student out with covid in any given week. There are a lot of solid arguments against masking in the schools, but the idea that masks aren't effective at protecting teachers is not one of them imo.

I mean, I can only speak to my son's direct experience and can only pile on another specific example of anecdotal data, but I do sincerely think that him wearing a KN95 mask to school has helped, considerably. I'm willing to admit that maybe we've just been lucky, that could be it. But he's had, since school started back in September, 6 kids in his class test positive for COVID. He's been considered a "close contact" twice, given that two of the positive cases were in his "pod", but has still (knocking wood heavily here and hoping I'm not tempting fate) not once tested positive. I just don't believe that he'd have been as lucky without the masking.

For the record, he's ten and double vaxxed as of December. His first "close contact" was prior to his vaccine series starting and second was just three weeks ago.

Fwiw, I'm not suggesting masks should be here to stay and I definitely agree with many of the arguments against them, I'm just saying that I personally felt the masks helped us during the last two surges.

And not to spam the thread here, but three our of my four nephews, all in districts with very lax mask wearing requirements, all caught it during the Omicron peak. Though they do also live in significantly less vaccinated communities.

yeah "they do also live in significantly less vaccinated communities" is it really.

having kids mask in schools might make sense when it's the icing on the cake of a series of NPIs. but in a society/community that is doing none of the more effective stuff, it's like telling people in a shootout to wear helmets (that don't fit).

Yes, I agree with that. Just still feel that my son's class wearing masks helped to keep the impact from being worse.

that feeling makes sense because we all know that in any given interaction, masks help.

but if you're in a room with 30 other kids for 6 hours a day (i.e. having essentially unlimited interactions), you run out of luck pretty quickly, even if the mask is 95% effective.

my hand wavy arguments and your anecdotes etc. don't matter though. the problem is there's weak and very very conflicted evidence that they help.

My anecdotes matter to me, a person who has to be in a tiny room with a bunch of sneezing kids. And there's always going to be weak evidence because schools are not set up to collect evidence. It's not like we have a bunch of studies where they took two similar-sized schools in similar-sized communities with the same general measures against covid and the same vaccination levels, had one school mask and the other not mask, and then tested the entire student body regularly.

but if you're in a room with 30 other kids for 6 hours a day (i.e. having essentially unlimited interactions), you run out of luck pretty quickly, even if the mask is 95% effective.

idk about that. In any given week I have at least one kid in each class out with covid. I have 30-person classes. The room is small. Everyone is masked. We haven't had any actual outbreaks, just isolated cases. Based on who is getting sick when, none of my kids seem to have caught it from each other. Maybe our luck is eventually going to run out, but it hasn't yet.

What confuses me is the widespread assumption that schools are fundamentally different from any other indoor space with a lot of people packed into it. If covid can spread, it can spread in schools. If masks work, they work in schools.

t's not like we have a bunch of studies where they took two similar-sized schools in similar-sized communities with the same general measures against covid and the same vaccination levels, had one school mask and the other not mask, and then tested the entire student body regularly.

they did this in the UK fwiw.

What confuses me is the widespread assumption that schools are fundamentally different from any other indoor space with a lot of people packed into it. If covid can spread, it can spread in schools. If masks work, they work in schools.

for sure. my point is that what happens in schools doesn't matter (even to the people in schools) if the community is on average being less strict about masks and other NPIs outside schools.

Well, shows what I know. Thanks for setting me straight about the studies.

But it does matter to the individual - student or teacher - what the level of safety is in the classroom. If covid is surging - whether it's because of lax community protocols or for any other reason - it makes a difference to me knowing that my students and I are protected in this space that I'm responsible for. It makes a difference to families that are trying hard to minimize covid risk, because the school is one area that they have no control over. And that, at the very least, means fewer students out because parents are worried by high levels of covid in the community.

right. there is an apparent tension between public health (where the effect of school masking on the aggregate school community is dubious to non-existent) and individual health (where it's more plausible, although again pretty anecdotal).

and it's certainly a problem (for school funding, if nothing else) if people stop coming to public schools because they implement policies that make students or teachers feel unsafe, even if they are empirically or logically safe according to an idiot (me).

(although by the same token, it's a problem if kids and teachers move to more permissive school districts or private schools because of covid policies, e.g tribal politics, impression more "chill" schools are more likely to stay open, be less unpleasant/frightening for kids, have better learning outcomes, whatever.)

I think a lot of schools have the teachers open the windows and/or use air purifiers, so it's not just a total stew of stagnant sick kid air in there. My wife is a teacher/librarian, so she has to see ALL the students. So far (fingers crossed!), she hasn't gotten sick. She is definitely sick of wearing a mask, but I don't think she'd be down with all the kids taking them off. Maybe? We are in SF, so like 95% of the kids are vaccinated.

She's been a "close contact" so many times she just ignores the messages at this point.

anecdotally, i will say it's completely deranged that my 20 month old (!) has to wear a "medical grade mask". he shits his pants regularly! i don't think the mask is helping.

is SFUSD requiring vaccination for 12+ or 5+?

Nope. RMDE. I don't understand why these vaccines (for an actual RAGING disease) are special. Maybe if someone made a regular-old dead virus vaccine, they could require it? God knows what logic is driving everyone.

That being said. SFUSD has pretty high vaccination rates (at least among the rich).

that's surprising. LAUSD requires it for 12+. i guess the school board politics in SF are particularly fraught right now though?

(you could drive a bus through the fallacies in this article, but i do think LAUSD has done a pretty good job by the standards of the US https://news.yahoo.com/how-los-angeles-became-the-national-leader-for-keeping-schools-open-155005220.html)

I didn't see that requirement in the article:

“L.A. Unified has led with some of the highest safety measures in the nation — and that is our required masking, both indoors and outdoors; our weekly testing of all of our students and staff regardless of vaccination status; and our very high vaccination rates,” LAUSD medical director Dr. Smita Malhotra recently explained, adding that 100 percent of staff and 90 percent of students 12 and older are now inoculated.

I don't think anywhere in the US is REQUIRING vaccines for school kids, but I may be wrong.

you are wrong. it came into force last week. i assume it's partly people being given time to comply and partly medical excemptions.

https://laist.com/news/education/here-are-the-covid-19-requirements-for-la-unified-students-coming-in-spring-2022

all schools in california will be required to require vaccination for 12+ from the start of the next school year btw. some school districts have chosen to require it earlier.

actually no

that last sentence is wrong. LAUSD is requiring it though.

Oh cool. I'm sure we'll follow suit shortly.

https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/

Upon full FDA approval of age groups within a grade span, CDPH will consider the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians prior to implementing a requirement. Following existing statute, full approval of ages 12+ corresponds to grades 7-12, and full approval of ages 5-11 corresponds to grades K-6. Students who are under the age of full approval, but within the grade span, will be required to be vaccinated once they reach the age of full approval (with a reasonable period of time to receive both doses), consistent with existing procedures for other vaccines. The requirement will take effect at the start of the term following full approval of that grade span, to be defined as January 1st or July 1st, whichever comes first. Based on current information, the requirement is expected to apply to grades 7-12 starting on July 1, 2022. However, local health jurisdictions and local education agencies are encouraged to implement requirements ahead of a statewide requirement based on their local circumstances.

the expectation is that CA will require it for 12+ (and possibly 5+) from July 1, but that's contingent on full FDA approval (i think we're still under EUA for <=15)

that’s great. yet another thing for school admins to deal with though.

i mean it's one of many vaccines they're required to check for, so it's hopefully not a ton of extra administrative work. admittedly they probably don't get as many death threats about the other vaccines.

i'm struggling to find a link for this right now, but the requirement is causing one very expensive burden on LAUSD schools: for now at least they are keeping the remote option for anyone who wants it, and in practice it's mostly being used by families who refuse to vaccinate their kids.