The choice is not just between the vaccinated covid patient or the unvaccinated covid patient. Lately, the choice has been between the unvaccinated covid patient and the cancer patient, or the person living with pain who needs a hernia repair, or some urgent but perhaps not immediately life-threatening surgery. It doesn't seem fair to defer cancer treatment to provide treatment for a condition that could easily have been avoided.
You're not wrong about that choice; it's incredibly unfair and these stories are without a doubt happening. I think in this instance there is a difference being emphasized between critical and non-critical care. Ultimately, we are not going to be keeping COVID-19 patients altogether out of hospitals. For a patient with cancer, just to pick one of the examples, most treatments are at least somewhat immunosuppressive. Putting them into a hospital for a treatment that might be able to wait could mean putting their lives at possible risk.
However, I absolutely hate that situation. It feels awful to have written what I just wrote. Delays in cancer treatment can risk the patient's life--though the truly urgent cases would not be deferred in this way, it's hard to predict sometimes what a delay can do--and delays in any needed treatment have serious quality of life impacts. I am fiercely judgmental of irresponsible people who do not do their best to avoid severe COVID-19 and create a hospital environment where the patients who need care most--both with and without COVID-19, because in quite a few cases it simply cannot be avoided. However, just because I think these people have done something morally wrong does not justify committing the additional moral wrong of letting them die. And to be very clear, when someone needs to be hospitalized with COVID-19, they are pretty certain to die without that hospitalization.
It is one of the most horrible situations, this rationing of care, that I have ever encountered in my life. There are not a lot of easy choices here. Terrible suffering is taking place. We need to get COVID-19 under control.
Somewhat related to Carl's question, I was wondering if you had any thoughts on the implications of Delta-Omicron cross-immunity for vaccination. Increasingly, it seems clear that Omicron infection by itself doesn't really yield Delta immunity, just as Delta infection doesn't yield Omicron immunity. But it *does* looks like Omicron infection in *vaccinated* individuals enhances immunity to both Delta and Omicron (see, e.g., https://secureservercdn.net/50.62.198.70/1mx.c5c.myftpupload.com/wp-content/uploads/2022/01/MEDRXIV-2021-268439v2-Sigal.pdf).
My question is: does this imply that an Omicron-specific vaccine might elicit cross-immunity in previously vaccinated people, but not in immunologically naive people? What about unvaccinated people who were infected with an earlier strain, then reinfected with Omicron?
Good question. This comes back to the concept of Original Antigenic Sin that we've discussed on here before. It is possible that upon seeing something close enough related to Delta to be vaguely similar (there is clearly cross-reactivity between anti-Delta and anti-Omicron neutralizing antibodies, for example), the immune response will be biased towards the first pathogen seen. Too much bias would be bad, of course, but with a balanced response that is Omicron-specific and new alongside a Delta-specific (or, really, WHN-01 specific) an Omicron-sequence booster could provided expanded protection against this new variant as well as reinforce past responses. I am sure the clinical studies of this new thing will look into neutralization of many past variants.
You provide good information. However your statment "healthcare is a human right" is a common error. To have a right to something implies there is an obligation for someone available to provide it. Short question: who has that obligation and where did it come from? The right to healcate is certainly not in the Bill of Rights. Here is a great answer to that question. There is no such right. https://ari.aynrand.org/issues/government-and-business/individual-rights/health-care-is-not-a-right/ . There is no ratoional logical refutation that I have ever heard of and of course the common response is the altruistic, socialist response. How is that working out so far? It'a going to get worse https://www.healthgrades.com/pro/7-reasons-doctors-are-leaving-medicine
Allowing sick people to die without offering available lifesaving interventions is depriving them of life, liberty, and to some extent property without due process of law--per the 14th amendment. We don't even visit such a fate on convicted, incarcerated criminals, all of whom are provided healthcare during their incarceration.
But rights are not what is written in a document, necessarily. There is a moral obligation to render healthcare to those who would die without it. Everyone has a right to treatment. It is, in fact, ensconced in US law with regard to emergency medical services.
Since you clearly disagree--and this is clearly out of scope for this venue--I encourage you to realize your beliefs on this topic by creating a living will that states you should not be provided with any emergency medical care unless prior insurance authorization or upfront payment is given. You're free to do that, and it would be logically consistent with your position here.
But again, given how far off topic this is, this is the last I'll be commenting on this particular thread; I would appreciate your adopting the same practice.
The choice is not just between the vaccinated covid patient or the unvaccinated covid patient. Lately, the choice has been between the unvaccinated covid patient and the cancer patient, or the person living with pain who needs a hernia repair, or some urgent but perhaps not immediately life-threatening surgery. It doesn't seem fair to defer cancer treatment to provide treatment for a condition that could easily have been avoided.
You're not wrong about that choice; it's incredibly unfair and these stories are without a doubt happening. I think in this instance there is a difference being emphasized between critical and non-critical care. Ultimately, we are not going to be keeping COVID-19 patients altogether out of hospitals. For a patient with cancer, just to pick one of the examples, most treatments are at least somewhat immunosuppressive. Putting them into a hospital for a treatment that might be able to wait could mean putting their lives at possible risk.
However, I absolutely hate that situation. It feels awful to have written what I just wrote. Delays in cancer treatment can risk the patient's life--though the truly urgent cases would not be deferred in this way, it's hard to predict sometimes what a delay can do--and delays in any needed treatment have serious quality of life impacts. I am fiercely judgmental of irresponsible people who do not do their best to avoid severe COVID-19 and create a hospital environment where the patients who need care most--both with and without COVID-19, because in quite a few cases it simply cannot be avoided. However, just because I think these people have done something morally wrong does not justify committing the additional moral wrong of letting them die. And to be very clear, when someone needs to be hospitalized with COVID-19, they are pretty certain to die without that hospitalization.
It is one of the most horrible situations, this rationing of care, that I have ever encountered in my life. There are not a lot of easy choices here. Terrible suffering is taking place. We need to get COVID-19 under control.
Somewhat related to Carl's question, I was wondering if you had any thoughts on the implications of Delta-Omicron cross-immunity for vaccination. Increasingly, it seems clear that Omicron infection by itself doesn't really yield Delta immunity, just as Delta infection doesn't yield Omicron immunity. But it *does* looks like Omicron infection in *vaccinated* individuals enhances immunity to both Delta and Omicron (see, e.g., https://secureservercdn.net/50.62.198.70/1mx.c5c.myftpupload.com/wp-content/uploads/2022/01/MEDRXIV-2021-268439v2-Sigal.pdf).
My question is: does this imply that an Omicron-specific vaccine might elicit cross-immunity in previously vaccinated people, but not in immunologically naive people? What about unvaccinated people who were infected with an earlier strain, then reinfected with Omicron?
Good question. This comes back to the concept of Original Antigenic Sin that we've discussed on here before. It is possible that upon seeing something close enough related to Delta to be vaguely similar (there is clearly cross-reactivity between anti-Delta and anti-Omicron neutralizing antibodies, for example), the immune response will be biased towards the first pathogen seen. Too much bias would be bad, of course, but with a balanced response that is Omicron-specific and new alongside a Delta-specific (or, really, WHN-01 specific) an Omicron-sequence booster could provided expanded protection against this new variant as well as reinforce past responses. I am sure the clinical studies of this new thing will look into neutralization of many past variants.
You provide good information. However your statment "healthcare is a human right" is a common error. To have a right to something implies there is an obligation for someone available to provide it. Short question: who has that obligation and where did it come from? The right to healcate is certainly not in the Bill of Rights. Here is a great answer to that question. There is no such right. https://ari.aynrand.org/issues/government-and-business/individual-rights/health-care-is-not-a-right/ . There is no ratoional logical refutation that I have ever heard of and of course the common response is the altruistic, socialist response. How is that working out so far? It'a going to get worse https://www.healthgrades.com/pro/7-reasons-doctors-are-leaving-medicine
Allowing sick people to die without offering available lifesaving interventions is depriving them of life, liberty, and to some extent property without due process of law--per the 14th amendment. We don't even visit such a fate on convicted, incarcerated criminals, all of whom are provided healthcare during their incarceration.
But rights are not what is written in a document, necessarily. There is a moral obligation to render healthcare to those who would die without it. Everyone has a right to treatment. It is, in fact, ensconced in US law with regard to emergency medical services.
Since you clearly disagree--and this is clearly out of scope for this venue--I encourage you to realize your beliefs on this topic by creating a living will that states you should not be provided with any emergency medical care unless prior insurance authorization or upfront payment is given. You're free to do that, and it would be logically consistent with your position here.
But again, given how far off topic this is, this is the last I'll be commenting on this particular thread; I would appreciate your adopting the same practice.