Coronavirus

[oddoneout]

I have just skimmed through the first part of the nature article https://www.nature.com/articles/s41577-020-0338-x and one thing that strikes me is that male/female differences crop up several times. There was a programme that looked at this issue in medicine, prompted by the difference in Covid mortality between male and female patients https://www.radiotimes.com/tv-progra...he-fitter-sex/
I sympathise about trying to get information, but in some respects that has always been the case. I remember my son wanting to put flesh on the pros and cons of meningitis vaccination before agreeing to it, and as this was 20 years ago it was even more difficult to break through the 'official' line. On the plus side I think that the intense global interest in Covid vaccines means that more information is available than might otherwise be the case; the downside is that inevitably that will make for contradictory and/ or confusing outcomes. The other risk, as always, is findings taken out of context and used either deliberately or through ignorance, spreading misinformation.

I was interested to see the reference to smallpox vaccine giving greater protection from infection in general(ie beyond the specific). I had that jab when I was about 8 and looking at it now I'm not sure it was a good trade off for the lifetime of allergy problems it set off!

[LHC]

It does genuinely concern me that trying to get what I feel is unbiased info on vaccinations is so difficult. The industry naturally has convincing arguments , but there areas of concern.

What does the interested person make of this kind of information, for example . Clearly the authors see issues with some non- live vaccines with regard to negative non soecific effects, and especially how and in what order vaccinatios are give.

https://www.nature.com/articles/s41577-020-0338-x

Heres a Ted Talk by one of the authors. Dr Benn is Professor in Global Health at the University of Southern Denmark.
https://www.ted.com/talks/christine_...pt?language=en

To put this into perspective, worldwide over 39 million people have now received at least one dose of a coronavirus vaccine. In comparison, reports of people having a negative reaction, or in the worst case dying, after receiving a vaccine are vanishingly small. All of the clinical trials conducted, and indeed experience since the mass vaccination programmes started, show that the vaccines are safe.

[teamsaint]

To put this into perspective, worldwide over 39 million people have now received at least one dose of a coronavirus vaccine. In comparison, reports of people having a negative reaction, or in the worst case dying, after receiving a vaccine are vanishingly small. All of the clinical trials conducted, and indeed experience since the mass vaccination programmes started, show that the vaccines are safe.

Did you read the links ? They aren’t about covid jabs. And they do suggest some real issues, about negative non specific effects of non live vaccines , and the order in which vaccines are administered.
They also suggest that changing the kinds of vaccines used,( away from non-live) and the order they are given could save 1.1 million lives a year.

If you can point me to actual problems with the material I posted, then we can discuss them.

[oddoneout]

Did you read the links ? They aren’t about covid jabs. And they do suggest some real issues, about negative non specific effects of non live vaccines , and the order in which vaccines are administered.
They also suggest that changing the kinds of vaccines used,( away from non-live) and the order they are given could save 1.1 million lives a year.

If you can point me to actual problems with the material I posted, then we can discuss them.

TS, as you say the link you posted isn't about Covid vaccines and so , interesting as it is, might be better off not being discussed in the coronavirus thread to avoid confusion and getting at cross purposes?

[teamsaint]

TS, as you say the link you posted isn't about Covid vaccines and so , interesting as it is, might be better off not being discussed in the coronavirus thread to avoid confusion and getting at cross purposes?

Fair comment Odders, but it is of the moment in a sense , leading on from the posts about Norway and the Pfizer vaccine.

As we look as though we are heading into a world where many more vaccinations are being delivered, and with other issues around immunity, it is something that needs proper understanding, and I don’t feel that the current media discussions are tending to inform me in the way that I would like. And part of that understanding is how far there are real issues around vaccination,and the trust that we are asked to place in the industry that develops and sells them, so that we can make well considered judgements about our behaviour, and the risks associated, including the risk of not accepting a vaccine.

[LHC]

Did you read the links ? They aren’t about covid jabs. And they do suggest some real issues, about negative non specific effects of non live vaccines , and the order in which vaccines are administered.
They also suggest that changing the kinds of vaccines used,( away from non-live) and the order they are given could save 1.1 million lives a year.

If you can point me to actual problems with the material I posted, then we can discuss them.

I wasn’t referring in particular to your linked articles, but more to put into perspective any concerns about the COVID vaccines following on from the BMJ article.

The article you post does include some interesting observations, but I would underline the note of caution from the paper “ the studies reporting deleterious NSEs have been observational and have been assessed to be at a high risk of bias”, and suggest that a lot more work is needed to demonstrate that the deleterious NSEs are actually caused by the vaccines, and if so, why.

[oddoneout]

Fair comment Odders, but it is of the moment in a sense , leading on from the posts about Norway and the Pfizer vaccine.

As we look as though we are heading into a world where many more vaccinations are being delivered, and with other issues around immunity, it is something that needs proper understanding, and I don’t feel that the current media discussions are tending to inform me in the way that I would like. And part of that understanding is how far there are real issues around vaccination,and the trust that we are asked to place in the industry that develops and sells them, so that we can make well considered judgements about our behaviour, and the risks associated, including the risk of not accepting a vaccine.

I agree but I still think that at present it might be better to put a bit of space between that wide debate and the more specific Covid vaccine one. The news from Norway is not what one would wish to hear, but on the other hand it is in the public domain, and it is to be hoped that this will be the pattern as the vaccine is rolled out - adverse effects reporting not being suppressed. There is of course a less positive side to that as mentioned in my previous post, where something is taken out of context and/or in ignorance and attracts undesirable attention.
By the time I reach the front of the queue I'm hoping there will be enough results to reassure me that my previous experience of vaccines(not just the smallpox), my difficulties with allergies(a constantly changing scene) and worsening fibromyalgia won't cause difficult side effects. I'm getting there at the moment in one respect as I know the vaccine is a different kind from the ones I've had in the past, but as a naturally anxious soul sorting out the other two might take longer. Just being told 'It'll be fine' is not enough!

[Simon B]

It does genuinely concern me that trying to get what I feel is unbiased info on vaccinations is so difficult. The industry naturally has convincing arguments , but there areas of concern...

https://www.nature.com/articles/s41577-020-0338-x

Is the core difficulty bias/vested interest, or is it more that these are intractably difficult questions to answer? Is it that, really, this is in an area of "nobody knows" level complexity?

Consider this in the context of the statement "For example, we do not know how BCG vaccine protects against tuberculosis" from within the linked article. This for a vaccine that has been in use since the 1920s. Medicine is littered with such things. The precise mechanism of action of common antidepressant drugs is another one that comes to mind. "Nobody knows" seems to be not far off the truth

Said article is largely qualitative musings rather than quantitative data, though no doubt the numbers are to be found in its references for those with the time and skill to interpret them. Numbers are the only way to sensibly decide how worried to be about any concern of such intertwined complexity. Globally, a profusion of scientists will inevitably be engaged in an unending debate about any such issue, constantly chipping away trying to unpick correlation versus causation. The proportionate differential effects on the risks to most of our individual lives are too small to be worth worrying about.

In that context, preventing 1.1 million deaths a year sounds a staggeringly large effect considering global annual mortality is something like 60 million a year. 1 in 60 deaths worldwide preventable by considering an issue almost nobody paid any attention to until recently? Or would they be largely exchanged shortly after for some other mortal outcome that is being overlooked? It seems literally incredible.

[french frank]

Now that the vaccines have been developed, does that mean that any data now has to be empirical? That would mean sticking the vaccine in arms, monitoring what happens and adjusting the roll-out programme accordingly if needs be. How else can they be confident that the vaccine is anywhere close to 100% safe for all ages and conditions?

[teamsaint]

Is the core difficulty bias/vested interest, or is it more that these are intractably difficult questions to answer? Is it that, really, this is in an area of "nobody knows" level complexity?

Consider this in the context of the statement "For example, we do not know how BCG vaccine protects against tuberculosis" from within the linked article. This for a vaccine that has been in use since the 1920s. Medicine is littered with such things. The precise mechanism of action of common antidepressant drugs is another one that comes to mind. "Nobody knows" seems to be not far off the truth

Said article is largely qualitative musings rather than quantitative data, though no doubt the numbers are to be found in its references for those with the time and skill to interpret them. Numbers are the only way to sensibly decide how worried to be about any concern of such intertwined complexity. Globally, a profusion of scientists will inevitably be engaged in an unending debate about any such issue, constantly chipping away trying to unpick correlation versus causation. The proportionate differential effects on the risks to most of our individual lives are too small to be worth worrying about.

In that context, preventing 1.1 million deaths a year sounds a staggeringly large effect considering global annual mortality is something like 60 million a year. 1 in 60 deaths worldwide preventable by considering an issue almost nobody paid any attention to until recently? Or would they be largely exchanged shortly after for some other mortal outcome that is being overlooked? It seems literally incredible.

Thanks Simon.
Understanding these things can be difficult if not impossible for the lay person.
I suppose part of my concern lies in the nature of the public debate. The modern enthusiasm for glossing over difficulties or potential problems is part of my concern . Deliberate misinformation is of course a problem too.

I suppose I would like to see and hear those with real expertise address the more difficult areas,( such as the one I linked to) but I don’t really see that happening in the non academic mainstream, for whatever reason.Perhaps most people really do like straightforward messages, or binary arguments.

As to the final point you make, yes it seems incredible. But the conclusion, even if the effect is exaggerated, is significant, and needs addressing.

Maybe addressing the doubts and difficult areas , a process which I see as a strength, might be seen as a weakness by others who are trying to get a message across.

[Simon B]

Thanks Simon.
Understanding these things can be difficult if not impossible for the lay person.
I suppose part of my concern lies in the nature of the public debate. The modern enthusiasm for glossing over difficulties or potential problems is part of my concern . Deliberate misinformation is of course a problem too.

I suppose I would like to see and hear those with real expertise address the more difficult areas,( such as the one I linked to) but I don’t really see that happening in the non academic mainstream, for whatever reason.Perhaps most people really do like straightforward messages, or binary arguments.

As to the final point you make, yes it seems incredible. But the conclusion, even if the effect is exaggerated, is significant, and needs addressing.

Maybe addressing the doubts and difficult areas , a process which I see as a strength, might be seen as a weakness by others who are trying to get a message across.

To state the obvious, the broader issue is an enormous "topic" and one which has been thrown into sharp relief by recent global events. It's also worth remembering that the real detail of any contemporary scientific endeavour can often only be properly understood by a very few fellow experts in identical or closely related areas, never mind the lay person. In the case of things which require actions of or directly impacts on the "general public" someone has to translate.

Even at their most concise the conclusions that can properly be drawn from evidence can often only be stated in terms like "There is a 75% probability at the 95% confidence interval that action X is associated with outcome Y given predicates A, B and C". Quantifiable uncertainty is about as good as it gets. Messages like this seem to earn increasingly infantilised responses in what passes for "public debate". As you allude to, there seems to be a craving for translation into overly simplistic yes/no good/bad formulations. Reality is more inconvenient than that and pretending otherwise doesn't make that any less true.

This seems to be but one manifestation of a broader trend: The abolition of nuance. Historical figures, past actions of nations, yellow fruit pastilles, vaccines - either you're with us or against us.

[Simon B]

In terms of clear communication of the risks of Covid nothing I've seen does better than this, from Prof D Spiegelhalter.

https://www.bmj.com/content/370/bmj.m3259

Something similar could surely be done for the vaccine(s). The problem with that would be that it would underline how much more difficult a consideration it is for younger cohorts to have it.

Looking at it in the terms this article outlines, it's obvious that the vaccine would have to be remarkably dangerous to the 85+ age group to make taking it a poor risk-reward tradeoff. Excluding Covid, underlying mortality risk for them is 1/6 per annum anyway - the same as playing one round of Russian roulette. Getting Covid once a year doubles every cohort's underlying risk. If the new more infectious variants continue to rampage through the population it's reasonable to assume 1/3 would get it each year. If the vaccine offers even 50% mortality risk reduction in the 85+ group, all things being equal it would have to precipitate the demise of 1/36 them p.a. to be a zero-sum-game. Even at this (hopefully completely implausible) level, it would already be disappearing into the background of all the other risks faced by this cohort.

With a more realistic vaccine risk profile, the same sort of arguments can be applied fairly convincingly to the 75+ and 65+ cohorts.

After that, the exponential falloff in both underlying and Covid risk with decreasing age rapidly starts to make questions around even remote risks from the vaccine a lot more pertinent.

Whatever you decide the threshold of vaccine "safety" is in the 85+, it needs to be 300x "safer" to start giving it to 20-year-olds and have it be similarly insignificant in terms of the underlying risks they face. That's before you consider them having 65 years more to experience any long-term consequences...

[Dave2002]

In terms of clear communication of the risks of Covid nothing I've seen does better than this, from Prof D Spiegelhalter.

https://www.bmj.com/content/370/bmj.m3259

Something similar could surely be done for the vaccine(s). The problem with that would be that it would underline how much more difficult a consideration it is for younger cohorts to have it.

Looking at it in the terms this article outlines, it's obvious that the vaccine would have to be remarkably dangerous to the 85+ age group to make taking it a poor risk-reward tradeoff. Excluding Covid, underlying mortality risk for them is 1/6 per annum anyway - the same as playing one round of Russian roulette. Getting Covid once a year doubles every cohort's underlying risk.

I think that's not quite what the article states - that's an approximation which holds for low values of risk. I'm not aware yet of articles which consider repeat infections on a periodic basis, which would arise if - as seems plausible, this type of coronavirus becomes endemic.

If the new more infectious variants continue to rampage through the population it's reasonable to assume 1/3 would get it each year. If the vaccine offers even 50% mortality risk reduction in the 85+ group, all things being equal it would have to precipitate the demise of 1/36 them p.a. to be a zero-sum-game. Even at this (hopefully completely implausible) level, it would already be disappearing into the background of all the other risks faced by this cohort.

With a more realistic vaccine risk profile, the same sort of arguments can be applied fairly convincingly to the 75+ and 65+ cohorts.

After that, the exponential falloff in both underlying and Covid risk with decreasing age rapidly starts to make questions around even remote risks from the vaccine a lot more pertinent.

Whatever you decide the threshold of vaccine "safety" is in the 85+, it needs to be 300x "safer" to start giving it to 20-year-olds and have it be similarly insignificant in terms of the underlying risks they face. That's before you consider them having 65 years more to experience any long-term consequences...

The argument that safety issues re vaccination need to be considered carefully for younger age groups makes sense. That doesn't mean that younger people shouldn't be vaccinated, and at present the plan in the UK is that eventually they should be. By the time that they are scheduled to be offered a vaccine, hopefully the risks for those groups will have been more thoroughly evaluated.

Trying to quantify risks does make sense, both for populations and for individuals, but isn't an added factor the unpleasant nature of the disease? The various possible outcomes following infection in an individual range from seemingly virtually no effect to very severe, unpleasant, painful and distressing. Further, recovery times - if recovery with medical intervention is possible and required - may be long, with consequent effects on other aspects of national health services. The nature of the disease does mean that in some societies there will be significant efforts to counter it, rather than let it rip through the whole population. If it were milder there'd be less concern.

[Anastasius]

A friend in Deal, well into his 80s is still waiting to hear of a vaccination opportunity. He had been advised that when it eventually becomes available to him, he will most likely have to get it in either Dover or Ashford, both involving significant journeys to high infection areas for him. This despite there being a suitable small hospital in Deal. Great organisation, what?

While I sympathise with your viewpoint, extending the concept would surely involve a huge logistical effort in establishing vaccination hubs at every single hospital in the country. Not to mention the possibility of vaccine wastage. There are enough 'no-shows' already. Widening the distribution network would surely increase that and not be very efficient.

[Anastasius]

Not if one's own benchmark is the very opposite of that of some of those you are seeking to communicate with.

From the early days of the pandemic: https://news.sky.com/story/coronavir...id-19-11958076

Too complex for me to understand, Bryn. I struggle with double-negatives or is this a triple-negative ?