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Because it's a terrible policy prescription. If natural immunity is acceptable, what proportion of the unvaccinated-uninfected population will just take the risk? Half? More?

Millions of people will just (continue to) take the risk, get sick, go to hospital, and die (in decreasing proportions), incurring substantial personal and social costs along the way.

Accepting only vaccination as evidence of protection reduces the size of that risk-taking population, and the concomitant social costs.

Should there be a third policy option - accepting test-verified infection and recovery as of _now_ as evidence of protection, but discounting future recoveries? Based on the observational studies cited all over this thread , probably yes. Seems like associated costs would be higher though, and the only benefit would be less gnashing of teeth here and elsewhere, so its understandable the CDC isn't rushing to implement it.

Should those people just be allowed to assume the risk? Not while the costs are predominantly social. Insurance (or tax-payers) pay the financial costs, healthcare workers bear the burden of treating a preventable illness, and we all assume the risk that healthcare resources will be stretched to the point of unavailability. While risk-takers do pay into the same system, their premiums don't yet reflect the increased expected costs of their personal choice. While ICUs often run close to or at capacity in one hospital, rarely do they run close at every hospital in a region, as is happening in the south and will happen elsewhere. While it would be nice if there were more doctors, nurses and facilities able to treat patients, we're at war with the army we've got.

17 comments

To reply as the devils advocate to this comment, what is the tolerance to social costs that society is willing to bear? Also why would one segment of society have to do something that it doesn't want e.g. not bear risk if they want to?

Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

What about drinking and smoking? Maybe we should also ban these because these people will probably go on government health insurance when they come down with chronic health issues from too much alcohol or tobacco.

I guess I don't see where your argument about societal costs doesn't become a slippery slope.

Also full disclosure I'm 100% vaccinated and will get the booster in Dec.

>Should we tell people to get their BMI under 25 too? >What about drinking and smoking?

There's a lot of investment in trying to fix these problems already, or at least offset the costs. For example, there are "sin taxes" for things like cigarettes and alcohol, which means smokers and drinkers are paying disproportionately more taxes than those that don't.

You could argue that overweight folks are also paying disproportionately more simply by buying more food than someone who weighs 20% less.

All that aside though- forcing fat people to get skinny isn't a valid comparison to forcing people to take a vaccine. One takes a couple minutes and the other is something requiring an hour or more of dedicated time per day for potentially years (or a whole lifetime!).

Let's say, hypothetically, there existed a free shot which would immediately make its recipient a perfectly lean 20 BMI and grants all the benefits of health and exercise without the work. How many people would choose not to take it, and how would society view those that decided to walk around weighing 400lbs? That's really the apples to apples comparison here, and I think you'd find there would be very few folks walking around at 400lbs in that scenario.

Aside from DUI risk and passive smoking, most of these risks are specific to the person. I can't catch obesity from being in the same room as a obese person, and while public health costs go up from drinkers/smokers/heavy people, I haven't heard of ambulances being gridlocked outside a hospital due to a spike of lifestyle diseases.

Generally medical gridlock hasn’t been a problem, but this is a unique case in that ICU beds are filling up in some regions leading to _entirely preventable_ illness and death that is unrelated to covid.

Once that stops happening, I will care significantly less. But if I have the risk of not having an ICU bed if I get into a car crash because people aren’t getting vaccinated, that’s an unacceptable social outcome to me.

My personal take is that insurance should progressively cover less of covid treatment of unvaccinated (by choice- minors and immunocompromised being excluded from this policy) patients until it is having a minimal impact on our healthcare system. If people don’t want to get the vax, that’s fine, but I’m not pooling for your medical bills.

Sure, it could be played into a “forever war” by reducing hospital/ICU capacity, but I don’t really see a benefit to doing that.

>what is the tolerance to social costs that society is willing to bear? Also why would one segment of society have to do something that it doesn't want e.g. not bear risk if they want to?

Vaccines are already required to attend schools, daycare, college, to immigrate to the US, for many existing federal jobs, to join the military, most jobs in the medical field. These requirements have existed for 20+ years, society has tolerated these costs and benefited greatly.

I could see OSHA having a vaccine mandate that covers TDAP, MMR, polio and Hep B similar to the proposed covid mandate for large employers. But all of these are required to attend school and in other situations, so it isn't needed.

>What about drinking and smoking?

Drunk driving is a crime. Society doesn't tolerate it. We generally limit second hand smoke, banning smoking in restaurants and many other indoor buildings. Requiring vaccination to prevent the spread of infectious disease is analogous.

It's not a binary.

Sure, you should be able to take the risk (if an adult and mentally competent, and maybe also fully informed). It's a free country (or so they claim).

But when your choices rack up huge medical bills that the rest of us have to pay, then your freedom to do what you want collides with our freedom to not have to pay for it. If you're free to spend my money, then I'm less free.

But that isn't absolute, either. We let people drive, and emit carbon dioxide, and play loud music, all of which impose negative externalities on others. We even let people be obese and smoke, which impose financial costs on the rest of us. (And yet, there's been a massive anti-smoking campaign over the last 10 or so years...)

Societal costs is a slippery slope, or something like it. As a society, we're trying to find a place to stand on it that isn't "no healthcare for you because you make stupid choices", and also isn't "here's the public's checkbook for you to make full use of to try to undo the consequences of your bad choices". There are no simple answers. (And it's not just Covid.)

You are assuming that getting vaccinated is a burden, and then comparing it to challenges that many people take years, or longer, to overcome. That makes absolutely no sense.

Getting vaccinated takes just a few minutes, and has no long term consequences for virtually everyone, and does not require ongoing effort of any kind.

In no way is getting vaccinated comparable to struggling with obesity, quitting cigarettes, or alcoholism. Sorry, but your comparisons are, frankly, bizarre.

Wasn’t that the whole point of Michelle Obama’s healthy school lunch drive? And the conservatives who are largely against mandated vaccines today also declared that initiative as government going too far. People living in conservative states are also far more obese than liberal ones (California vs Texas, for example). Conservatives, at least, are being consistent.

The social costs of forgoing the vaccine are unique in that they arrive all at once. Smoking, drinking, obesity, etc. increase lifetime healthcare costs, but realize those costs over a long period of time. Hospitals are sized appropriately, more can be built if projections indicate more need, doctors can be trained, etc.

A policy that accepts infection-recovery as equivalent to vaccination unconditionally and removes most/all other restrictions could result in lots of those social costs over a very short period of time, much shorter than the timescale on which resources can adjust. So much so that resources become exhausted, and the costs compound from merely high to truly awful. Personal choice resulting in an impaired standard of care for unrelated people in need for unrelated reasons should probably be discouraged or proscribed.

Once the risk of resource exhaustion is eliminated, a policy that's less than a full-court press for vaccination might be reasonable. But that risk is primarily determined by the size of the covid-naive population, which can only be reduced by vaccination or infection...

> To reply as the devils advocate to this comment, what is the tolerance to social costs that society is willing to bear? Also why would one segment of society have to do something that it doesn't want e.g. not bear risk if they want to?

It has been debated to death and one of the thing we can't negotiate with is time so at some points some actions have to been taken, some things conceded. We can keep on debating the benefits of smoking and individual freedom but we as a society (our institutions) have decided that smoking or not wearing shoes inside restaurants is not allowed.

At some points our society decided that it wants everyone (let's put aside the special immunodeficient, babies, etc. cases) to be vaccinated.

Now why should I be obliged to risk my health by going to restaurants, social events or work where I am taking the risk to get covid because other people are fine with the risk (or are not fine but refuse to get the vaccines on the ground that it's not a health matter but a compliance to law matter for them. I know one) ? It's like smoking, don't blow it in my direction. Vaccines/pass/etc. are a necessity for the vast majority to enjoy life as it was, to get some freedom back.

People willing to participate in society without following the rules that society put in place to participate safely should not be allowed to join in without restrictions. It's my opinion, not a logical conclusion to any reasoning about our laws and how we behave as as specie/culture.

It's fine if they don't get the vaccines but it's not fine to put others at risk.

We can debate the fairness aspect of this decision or the framework in which freedom and liberties are defined and understood but at some points reality force us to take a stance.

There'll never be a perfect solution that reconcile everyone's visions of freedom.

With all that being said I strongly believe that keeping on debating publicly these aspects of the situation 24/7 is harming our recovery or transition to a better situation. These `debates` are just maintaining the illusion that options are still on the table, that we have the luxury to debate them, that somehow the longer we beat the same old dead horse maybe covid problems will magically disappear, that debating and coming to the same set of possible conclusions is somehow useful.

It's a resource vs demand at this point.

Socialized healthcare systems already deal with this. For example being obese or a smoker will put you at the bottom of the list for organ transplant.

Given how unvaccinated covid cases are filling up some ICUs, why shouldn't we prioritize ICU access against eligible unvaccinated people?

From risk management perspective obesity and pandemics have completely different risk characteristics. Pandemics are contagious and deaths can grow exponentially, leading to catastrophic outcomes. Obesity is constraint to individuals.

On the other hand. A vaccine that is not as rigorously tested as normal and is used on 80% of the population can also lead to catastrophic results. No one really knows the long term effects for sure. So I understand the paranoia on two sides.

You actually want to use as many different vaccines as possible so no single vaccine can exterminate your population. That’s why I belief natural immunity should be counted as a valid ‘vaccine’, if the science shows it offers similar protection.

When I drink or smoke or I’m overweight, that doesn’t affect the health of my neighbor. It also doesn’t overcrowd hospitals causing innocent people to die because they can’t find treatment[1].

There also isn’t a vaccine for being overweight.

(We should probably mandate seasonal flu vaccines too.)

1. https://www.washingtonpost.com/health/2021/09/12/alabama-ray...

> Should we tell people to get their BMI under 25 too?

Japan does this and has a 3.6% obesity rate compared to our 42%. Doesn’t seem that terrible of a slope to slip down.

https://www.nytimes.com/2008/06/13/world/asia/13fat.html

It is a slippery slope fallacy. You only have to look back through the history of vaccines and see. We have had vaccine mandates before and guess what? No dictatorship installed. It's easy to point at democracies all over the world. Mandated vaccinations never led to "okay now do this ______ to improve your health or else" . Also no one says bring in the police, just make it so that if you want a job then get the vax or bring in a reason from your doctor that says you can't take it because of some medical condition. Simple.

> Should we tell people to get their BMI under 25 too?

Overweight people can't transmit their overweightness to me through a virus or bacterium that they breathe into the air.

If they could, then yeah, we'd probably have some kind of legal mandate on it. Just like we have a bunch of restrictions on smoking now, because indeed, that's something that you push into the air.

The general rule is that your rights stop where others begin. Most issues of health are purely personal, but infectious diseases are not. Because they're infectious.

Overweight people already have their costs internalized: that's what your insurance rates are.

This is also actually tremendously fair, because if you're fat but don't suffer any lifestyle illnesses, then your insurance rates are low - you are actually able to support your mass. But once those conditions start ticking up, so do your insurance rates.

The US basically leads the way on addressing the social externalities of obesity as they relate to the healthcare system.

it's not clear that people who smoke, eat, and/or overeat actually consume more healthcare over a lifetime. most people incur the majority of their healthcare expenses as they slowly die over the last several years of their life. the last few years just come sooner for unhealthy people.

Obesity tends to kill people before they get old enough to incur real costs in medical care. It's like cigarette smoking, it actually saves the healthcare system money and resources because smoking tends to kill people before they get very old.

Also, I can't catch obesity by simply sharing the same room with someone who is obese like I can with COVID.

Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

No matter how obese someone is, I'm not going to catch their obesity by breathing the same air as them.

Your drinking is regulated. When you step into a car drunk, you are putting others at risk and it stops being your problem and starts being society's problem.

The same is true here. You are stepping into society on a state of health that presents risks to everyone around you.

> Should we tell people to get their BMI under 25 too? Overweight and obesity are going to cost much more in increased healthcare costs than COVID will in the coming decades (pls prove me wrong..).

You are the one making this claim. Back it up with some evidence.

> I guess I don't see where your argument about societal costs doesn't become a slippery slope.

Your admitting this, why even bring up your points if you know they dont matter? There's no reason to argue this point

> Should we tell people to get their BMI under 25 too?

That policy hurts farmers, so it's not viable for a different reason.

If hospital beds become filled to >50% capacity because of the obese then maybe we can start making this comparison.

Because of unvaccinated people many of us face significantly worse hospital care right now.

> What about drinking and smoking?

Literally Whataboutism. Don’t take the irrelevant bait.

The line seems to be drawn at socializing the risks of full hospital ICUs in a region

Edit: why the downvote to near-dead? I thought that's what the author emphasized :\

He isn't serious about this. Guarantee he has a tweet or liked a tweet from 2020 raging about Cheeto Mussolini's White Supremacy Vax. It's just politics, and has been, since early 2020.

Let us put the gays to the camps, they impose external costs to the healthcare system too (but we won't, because they are a holy symbol for these people).

The thing that makes COVID dangerous is it's contagion not so much it's direct effects.

If COVID were not highly transmissible, then the relatively low risk of death would make it spooky, but it's not likely we'd even see it on the news.

It spreads to others quickly, and many people get very sick even if they don't die, hospitals fill up and it makes it very difficult to operate a healthcare facility.

Consider the 'no policy' effect: if we did nothing in response to COVID, it would spread like a fire, and without 'flattening the curve' - which we mostly have done, it would badly degrade our ability to function. People not able to tend for the older population because they themselves are sick, hospital staff going down, people in hospitals with other ailments going down etc..

So because of that it's a community problem.

If you want to think about it from an 'individual choice' perspective, consider what it would mean if you didn't take proper precautions while doing an activity, and ended up killing someone even by accident, that's manslaughter.

Given a rational population with some reasonable, conscientious objectors, we should be at about 95% vaccination, which is plenty. There's room for the serious objectors, the problem is there's way too much arbitrary and misinformed skepticism.

So it's not like wearing a seatbelt or eating too much carbs, which is mostly a personal issue.

COVID is inherently a systematic problem.

>Because it's a terrible policy prescription. If natural immunity is acceptable, what proportion of the unvaccinated-uninfected population will just take the risk?

You're making a calculation not regarding health, but regarding public reaction. The problem is that the public health community sucks as far as making these calculations go; I don't think I need to list all the missteps here. IMHO, they know a lot about epidemiology, nothing about the public. So it's best to just make the right policy and not to try 4D chess with the public, that tends to backfire.

Just about anyone who has remained unvaccinated so far is already taking the risk you pointed out*. No point in spending resources chasing recovering patients we don't really have to vaccinate right now.

Now I don't agree with using antibody test results (these kits aren't standardized, so the relation between immunity and the results isn't clear), but an actual record of recovery should do. As the article notes, that's what many other countries in the world do.

* Excluding the very few people who actually have a good reason to not vaccinate due to certain extremely rare immune system ailments.

> Accepting only vaccination as evidence of protection reduces the size of that risk-taking population, and the concomitant social costs.

That is effectively coercing people to undertake a medical procedure for their own or for society’s good. The ethics of doing that should be concerning, considering the social and ethnic makeup of the vaccine hesitant, and the checkered history of coercive medical intervention.

I’d much rather see the carrot used than the stick.

This is absurd. Vaccine efficacy is measured against natural antibodies resulting from a recovery.

I cannot get the vaccine and I’m effectively a second class citizen. I was sick and recovered - my immune system is working as designed.

If hospitals didn’t overflow and society didn’t crumble for most of 2020 (when there was 0% vaccination), it’s odd to argue that it will now that there is 65% vaccination.

It seems like a policy of forcing people with natural immunity to be vaccinated could have negative externalities if there are other countries in the world that don't have enough vaccines.

So? If lots of people independently choose to take the risk and they're not harming anyone else, why shouldn't they be allowed to?

The impact on the hospital system could be blunted simply by saying "This wing is for COVID patients, when it fills up further COVID patients will be turned away" and leaving the other wings for normal hospital patients. They have to do this for quarantine reasons anyway. Now that COVID is essentially preventable, it's a huge misallocation of resources to let all the hospital fill up with people who chose not to prevent it while leaving other ER patients to their fate.

We can test for natural immunity. That then counts as fully vaccinated.

If natural immunity is acceptable, what proportion of the unvaccinated-uninfected population will just take the risk? Half? More?

That's on them. It's not your job to police their choices, and especially not to impose "papers please" on everyone else. No thanks.

Millions of people will just (continue to) take the risk, get sick, go to hospital, and die (in decreasing proportions), incurring substantial personal and social costs along the way.

https://www.theatlantic.com/health/archive/2021/09/covid-hos...

Quote from article: "In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease."

So we have a situation where media-induced fear is causing people to panic until they rush to the hospital. It's certainly possible given that half of the hospitalizations are...not even meaningfully hospitalizations if they were mild or asymptomatic. What does this do to your narrative then, about how dangerous this is and how many millions will "continue to" take the risk?

Accepting only vaccination as evidence of protection reduces the size of that risk-taking population, and the concomitant social costs.

Nonsense. Over 100 million Americans had covid already.[0] We now know that antibodies from past infection are superior to vaccination.[1] [2] So why would you make this arbitrary demand for vaccination as the proof, when the antibodies are what count?

[0] - https://www.publichealth.columbia.edu/public-health-now/news...

"A new study published in the journal Nature estimates that 103 million Americans, or 31 percent of the U.S. population, had been infected with SARS-CoV-2 by the end of 2020."

[1] - https://www.science.org/content/article/having-sars-cov-2-on...

"The natural immune protection that develops after a SARS-CoV-2 infection offers considerably more of a shield against the Delta variant of the pandemic coronavirus than two doses of the Pfizer-BioNTech vaccine, according to a large Israeli study that some scientists wish came with a “Don’t try this at home” label. "

[2] - https://www.bloomberg.com/news/articles/2021-08-27/previous-...

And we know based on the current evidence those antibodies will last for decades. [3]

[3] - https://www.nature.com/articles/d41586-021-01442-9

The answer is not "probably yes." The answer is a resounding yes, but the answer is also that no proof should be needed unless you work in a hospital where vaccination requirements already existed. We don't need a "papers please" society. If you're concerned for your health, get vaccinated if you don't have antibodies already. Wear a mask when cases go above N in your area. That's how simple this is. There's no need for building systems of control that will turn into systems of enslavement.

Meanwhile, you have a situation where healthcare resources are being intentionally fired or are quitting because of the idiotic mandates. [4]

[4] - https://www.nbcnews.com/news/us-news/new-york-hospital-pause...

"An upstate New York hospital system said it will be forced to "pause" maternity services this month because some employees' refusal to get vaccinated against Covid-19 has caused staffing shortages."

This is entirely a manufactured problem.

While risk-takers do pay into the same system, their premiums don't yet reflect the increased expected costs of their personal choice.

We've been hearing for YEARS about how bad insurance companies are. How they make record profits each and every year and still pass on higher premiums, higher deductibles, and shittier service to their customers. So why are people feigning concern for health insurance corporation bottom lines already? Wake up.

While ICUs often run close to or at capacity in one hospital, rarely do they run close at every hospital in a region, as is happening in the south and will happen elsewhere. While it would be nice if there were more doctors, nurses and facilities able to treat patients, we're at war with the army we've got.

https://www.theatlantic.com/health/archive/2021/09/covid-hos...

"In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of disease."

The media induced panic that causes people to flood the hospitals when they get a sniffle, because of fear. The situation with hospitalizations appears to have been exaggerated.

I believe your prediction of behavior to be wrong and careless and it also may highlight why public healthcare never got too far in the US.

It's not only not a terrible policy position, natural immunity will turn out in the end to be the ONLY effective thing which gets us to to herd immunity.

At this point I don't understand why this isn't obvious.

You make a targeted vaccine, in this case it will be evaded. We see it right now. That will continue. Natural immunity will cast a wider net and be proven much more effective.

WXYZ-TV posted the following question on facebook a few days ago and received 155k responses.

"After the vaccines were available to everyone, did you lose an unvaccinated loved one to COVID-19? "

https://www.facebook.com/80221381134/posts/10158207967261135...

The responses are not what you would expect. Certainly not what the media narrative is.

>>Should those people just be allowed to assume the risk? Not while the costs are predominantly social.

Then eliminate socialized healthcare. Your imposition of socialized healthcare is now being used to rationalize imposition of forced injections. Government can have a healthcare system that is entirely opt-in, for both taxation, and coverage.

Or how about just deprioritize unvaccinated individuals with COVID when there is a shortage of ICU beds.

Additionally, the only plausible way to do it would be to test for seroconversion. That's a blood draw, so it doesn't save anyone from a needle, and overall it's probably more work and more expensive than vaccination.

Given how simple the vaccine is there really should be a zero tolerance policy (barring a real medical reason). I think the president had the right idea with his mandate. To be a part of society those people can take one tiny shot (or two) .

>Because it's a terrible policy prescription.

And the government is ignoring the same science they are asking us to follow. It’s no wonder people are revolting. Although I am vaccinated I did take a antibody test before I did so and wouldn’t have if I had the natural antibodies. It’s almost the same lie they tell when they call this a vaccine- it’s really not. I really understand why people are pissed and I will fully support them in any way I can.

I feel like the entire comment thread after yours has gotten lost in hypothetical discussions about some ethical question about interventions that haven’t been shown to work. Not quite the usual dialog I expected here.

What the CDC recently said is that vaccination also reduces your chance of reinfection significantly, at near zero risk. So universal vaccination is a strictly dominant strategy for personal health, with or without any other interventions (diet, exercise, etc). Why wouldn’t a non-political organization recommend universal vaccination therefore (above age 12)? It makes for simple, cheap, and effective messaging.

If they said not to take a care of your health in some other equally proven way, then it would likely seem to be politically motivated and damage their trustworthiness. That probably has happened too (such as saying to mask outside, until they got more data), but we aren’t blindly trusting them in this, or anything.