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Omicron Variant Post #2

Fully agree with this -- though I'm not optimistic that hospitals will allow much of it.

Which booster shot to get and when?

This sounds like serious confounding. In all likelihood, prison docs had X doses and triaged, and then repeated.

I will say though -- I do still think Moderna primary was likely better, but I've (since writing) found out that the booster is half the dose of the primary dose -- so I doubt Moderna's increased efficacy translates to the booster.

Which booster shot to get and when?

Adding in post: Omicron both increases short term value of booster and may increase risk of hitting any lifetime cap (its further evidence for more future variants that will warrant boosting)

Which booster shot to get and when?

On somewhat further investigation (really limited here -- lets not lean too much on it) -- the Moderna boosters are half the dose of the Moderna primaries. If you believe, as I do, that the primary reason for increased Moderna efficacy in trials was due to dosing, then the reduced booster dose means that the reason I give above (higher efficacy) is no longer a relevant factor.

I do think @npostavs is right that this study is likely quite confounded. Though I do still believe Moderna primary doses had reasonably better efficacy against OG covid, and in all likelihood against delta and now omicron.

Which booster shot to get and when?

I'm in basically the same boat as you, 30ish adult, Pfizer regime completed in April. I too have been lazy and uninterested in side effects (knocked out for a day after second dose). And I too am exceptionally interested in hearing discussion of "should I" as well as timing/choice thoughts. So -- just throwing out my thoughts. (Caveats: I'm an econ/stat type, my last bio-ish class was in high school and I remember none of it).

Should we get boosters?

I think my basic answer is "yes". The longer answer is:

  • if it will allow you to reduce other precautions: yes. Free, very low risk of complications and reduces risk of covid -- allowing precautions to relax.
  • if you got covid, and have been vaxxed: don't bother.
  • if you don't/can't risk compensate (have already relaxed all precautions, or will never), haven't had covid: yes, but YMMV in terms of benefits.

I haven't given any consideration to "lifetime mRNA vax limits" until your mention, I have no idea how plausible that is -- but my current belief is "20% chance that's a real issue down the line".

So take everything below as being "conditional on getting a booster at all."

Timing

I plan to try to get a booster in a few weeks. The holidays are subsequently anything in January/feb are likely to be high risk for everyone. It doesn't seem unlikely to me that in terms of picomorts or QALY risk (etc) this winter -- where we still face reasonable case counts, but effective treatment regimes are still being rolled out and assessed (for now) -- is probably the highest risk period (for covid-19) remaining. Waiting until after winter thus makes little sense to me. If it going to happen in the next 6 months, it should probably be in the next month.

Choice

I have a mild preference for a Moderna booster over a Pfizer booster. Moderna efficacy seems to have been consistently a smidge higher for everything -- likely because its a larger dose (ETA: looks like booster dose is smaller so this factor may be ignorable). This + the benefits of some variation in vaccine regime makes it seem preferable. Two points on this however:

  • This is a small risk change -- not worth it if it forces you to change plans or to do something "risky" without a booster. Given the choice I would choose Moderna -- I'm not sure its worth much to search it out.
  • These benefits come with some risks. I've had two doses of Pfizer, and no reactions that warranted hospitalization or the like. No guarantees here -- but switching it up does add some risk. (so does just another round of pfizer).
  • "Larger moderna dose" may be a negative if you are worried about some "lifetime limit on mRNA doses".

ETA:

Wrapup

Would genuinely like to hear more debate on "should", "timing", and "choice". "Should" seems likely it will be well covered by media shortly. But "timing" and "choice" are things I doubt I'll see outside of this venue.

How do you learn to take more beautiful pictures with a camera?

Look at their photos. If you like them, they know their subject (though perhaps not how to teach it). If you don't like them, find a new instructor. Rinse and repeat. Most tutorial people put their photos online to some extent, so this shouldn't be hard -- and unlike many domains (e.g. woodworking) -- looking at the photo on your screen should be enough to judge it pretty well.

If you can't tell if you like them, I suspect that your first step should be to try to develop your "taste". Start by just looking at tons of pictures. I recommend one of the photo-apps that isn't instagram, though instagram can work. Flickr used to serve this role. For a while I think 500px did. Not sure where to go now -- but I would try those at first. Look at pictures. Rate them in your head -- based on your opinion. Once you're confident looking at a photo and judging it -- start trying to figure out what about them you like and dislike. "Thats too high contrast" or "I love the black and white", or "I love the aerial perspectives". Then go and try to change the pictures you take in that manner and/or return to YouTube to find someone who's pictures are like that.

Why haven't we celebrated any major achievements lately?

Honestly I think the celebrations stopped being "valued" by the people who could organize them.

A big celebration involves a lot of planning effort and a fair bit of cash. And it can easily wind up looking like there was substantial corruption in choice of vendors, etc.

On top of that, for cash strapped local govs, the Q "can this money be better spent elsewhere" is real and all consuming.

What does vaccine effectiveness as a function of time look like?

I think this is right here, though I'd push it forwards a little. 7 days incubation +a few days to detect for some people etc, and you're probably looking at reasonable protection even on t+1 and t+2. I think basically the "dose+ 14 days" is coming down to the fact that it takes us up to 14 days to detect. Otherwise, those two numbers (and pieces of guidance) are suprisingly similar.

The big caveat to all this is that the NEJM figure (based on Pfizer's EUA submission) is focused on OG covid, not covid 2.0.

But the math I did back when I got my shot (based on that figure + an incubation period), was that within 2 days I was at like 70% efficacy.

Risk Budgets vs. Basic Decision Theory

I think a large factor for people making decisions around covid risk is not just the risk they are posing to themselves, but also the risk they are imposing on others. Insofar as "risk I impose on others" enters my utility function, this is going to change a lot of your conclusions pretty quickly. The reason being that "risk imposed on others" is growing super-linearly in most activities.

E.g. If I go to a restaurant and then meet a friend, I've incurred much more risk to the friend than if I didn't go to the restaurant. If I then meet a third friend separately, the risk to that friend is increased by each of the prior interactions, and so forth. Each additional activity poses additional risk to all the people involved in later activities. This is classic exponential growth type stuff, but all we need is super-linear growth in risk.

Once you have something (bad) growing super-linearly like that, it should be pretty straightforward to see that even if the net utility from each of two different actions is positive, the utility from doing both actions may be less than the utility of doing just one. Insofar as the thing that is growing super-linearly is about 'micro-covids', it makes sense that some things are better and worse on that scale (eating inside a restaurant vs going on a walk with a friend), and so accounting for that differential cost makes sense. And now we're firmly in 'budget' territory -- different costs for different activities all of which i like, but with some kind of max on how much I can reasonably spend.

How poor is US vaccine response by comparison to other countries?

This (US export ban) is news to me. Can you link to a source for that?

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