Covid-19 #41: Collateral Damage

[RhaenysBee]

3 hours ago, rotting sea cow said:

Now countries with pretty decent vaccination rates are being hammered. Where are we going to put the blame? With those high vaccination, shouldn't have we expected a far more milder wave?

I think we definitely did expect a far milder wave which is part of the reason why it’s not mild. If we had the same restrictions in place AND added the vaccine, we may have seen those milder waves. Or not. And that would have had information value as well. 

1 hour ago, Zorral said:

That seems, um, well, short-sighted?  When we can see the maps here in the USA, for example and SEE where the surges and bed shortages are, and where they are not.  All summer the same states and areas that are anti-mask, anti-vaccination, anti-social distancing, while gathering in great numbers together indoors and out, surged out of control.  They are still surging with Delta out-of-control, and they are still not vaccinating.

While the areas where vaccination is strong did not surge with Delta all summer long -- did not surge at all.  And then in September at least some of those same areas, such as NYC, instituted a vaccination mandate for doing anything indoors.  We are still not ... surging.  But it is winter, and it is the holidays, and now we have all kinds of people coming in from all over, and our new cases are ticking up.

But the starkest difference between the states that surges all summer (and still are) and places like ours that did not, is vaccination rates.  We SEE it on the maps and in the numbers.

 

Yes it does, indeed, because it is. People by nature are short-sighted. And that’s hardly ideal in the grand scheme of things but I don’t know how much we can blame them for that. Companies want short term results, consumerism offers short term gratification, governments make short term policies. Covid restrictions are imposed and lifted for short-term effect. Or you know, hats off to the exceptions. 

What you describe for the US is great and inspires hope and makes me happy for the US. Although, as you underline it as well, it’s the US, and we (and when I say I we, I can only generalize as far as my country, not even the eastern region or the whole of Europe, let alone  globally) have very different qualities which contribute to potentially different patterns. My issue is that we in particular don’t see the things you describe and don’t know our own patterns. Maybe other European countries do, but again, they are them and we are us with different demography, geography, economy, healthcare infrastructure . We cannot really draw conclusions for ourselves based on US data, not even German or Austrian. 

And we don’t have data on vaccination, so we  have no way of finding correlation between a high number of cases/hospitalization/deaths in a demographic or region with low vaccination rate. We just see the 10000+ cases per day and 100-200 deaths per day, like we did in April when we didn’t have vaccines. So albeit short sited it’s not unreasonable to ask what exactly the vaccine is doing for us (in particular, because I’m happy from the bottom of my heart for the US and Portugal and Israel, but their vaccinations’ positive impact is not going to be the reason why my unvaccinated fellow citizens might drag their arses to a vaccination point, which would obviously be a component in seeing a milder 5th, 6th, 10th wave). It’s a show and tell thing, there’s only so many times you can tell people to do something (which they might not even want to do) when they see no point. 

And it doesn’t help that the one vague piece of information we do get is that 47% of hospitalized patients are actually vaccinated. Which may, to some extent, relate to the vague implication that the majority of hospitalized people are elderly, whatever the hell these terms actually mean.

Just to be crystal clear, I am by no means saying vaccines aren’t helping, of course they are, I had five different fights with my family this week because I keep harassing them to get boosters. I’m only saying that we need (local!) tangible proof that they are helping exactly to restore faith in them. And I’m also saying that what Padraig said, that if we didn’t put all our money on vaccines and perhaps also bet on restrictions and general public responsibility, we might be helping those vaccines help us instead of tripping them over. 

 

[Padraig]

4 hours ago, rotting sea cow said:

Now countries with pretty decent vaccination rates are being hammered. Where are we going to put the blame? With those high vaccination, shouldn't have we expected a far more milder wave?

The countries with the fewest cases right now in Europe are Spain, Sweden, Malta, Italy and Portugal.  In terms of vaccination, Spain is 3rd best, Sweden is 12th, Malta is 2nd, Italy is 8th and Portugal is 1st.  Out of around 40 countries.

Sweden is doing a little better than expected but there is a clear correlation between cases and vaccination.

Its not a perfect relationship but thats because of other factors.  Denmark was one of the first countries to remove all restrictions.  Ireland isn't helped by its proximity to the UK but we also kept removing restrictions when cases were going up, which was crazy (escalating the problem).  And we also embraced socialisation too much when they were reduced.

A high vaccination rate doesn't make countries immune from seeing an increase in cases.  Especially since we know that vaccination effectiveness does decline.

And you get the same sort of relationship when you look at deaths.  The 5 best countries are Malta, Sweden, Spain, France, and Portugal.  All in the top 12 countries in terms of vaccination (France 11th).

Over the next couple of months, the bigger factor will become boosters, I imagine.  Hopefully they will work as well as in Israel.

4 hours ago, RhaenysBee said:

Basically my problem is that we don’t see what the vaccine does for us, so we may slip into thinking it doesn’t do anything. 

This is a reasonable concern.  Despite vaccination, you have more cases now.  I could understand people deciding that vaccination didn't work.  But they are wrong.  The best comparator isn't last year (because we have Delta, less restrictions etc).  Its with those countries right now that have better vaccination rates.  If you do that, its clear that Hungary's biggest problem remains its low vaccination rate.

The only solution is vaccine mandates.

Europe looks bad right now, not because of the well vaccinated West but the poorly vaccinated East.

Edited to add: Main headline in Irish news is "Up to 50% not attending booster jab appointments in Ireland".  This might go back to RhaenysBee point.  We sold the initial vaccination rollout so much that people now feel lied to.  Its only those that read more into the news that realised that there was always a chance of a booster.  We get them for the flu after all.

In more positive news.  https://www.reuters.com/business/healthcare-pharmaceuticals/eu-drug-regulator-aims-conclude-merck-covid-19-antiviral-pill-approval-by-end-2021-11-18/

Quote

Marco Cavaleri said in a media briefing that a review on the use of Pfizer's COVID-19 vaccine in five- to 11-year-olds should see a recommendation by the end of this month and possibly as soon as the end of next week.

That should make a difference too.

[Clueless Northman]

3 hours ago, Filippa Eilhart said:

vaccines are obviously the solution, they just should be mandatory.

This.

The key reasons for the current wave is that vaccines don't protect 100% of the population, we've always known that there would be 5-10% people who would still have a weak immune response, and that there's a lot of unvaxx fools. ICUs were already pushed to the limit by 1st and 2nd waves in many countries, with basically 10% (if not less)  people hit by covid. When you have 20% unvaccinated and 10% with a failing immune response (because vaccines didn't work much or because they're old and got vaccinated in February so waning immunity), it's not a surprise a new wave comes and causes trouble.

Were 99.9% people vaccinated, we would see a wave, but a considerably weaker one. As said, the country to follow is Portugal right now.

 

22 minutes ago, Padraig said:

We sold the initial vaccination rollout so much that people now feel lied to.  Its only those that read more into the news that realised that there was always a chance of a booster.  We get them for the flu after all.

People don't really understand because, actually, there's too much talk about "boosters like for the flu". It's not that. It's a 3rd dose to achieve total immunity, just like with hepatitis or tick-borne encephalitis - who both require 3 doses in the initial vaccine run, then boosters years later. It's not a booster, it turns out, alas, that it's part of the initial vaccination process. There's no reason to assume a yearly booster will be needed, for now that's just Pharma bullshit talk to pretend they'll get plenty of money forever. In 18 months, covid hasn't escaped vaccines the way flu does. We'll know more 12 months from now actually.

[RhaenysBee]

1 hour ago, Padraig said:

This is a reasonable concern.  Despite vaccination, you have more cases now.  I could understand people deciding that vaccination didn't work.  But they are wrong.  The best comparator isn't last year (because we have Delta, less restrictions etc).  Its with those countries right now that have better vaccination rates.  If you do that, its clear that Hungary's biggest problem remains its low vaccination rate.

The only solution is vaccine mandates.

More cases would not necessarily be a problem if it was just more cases. The problem is that we have the same amount of hospitalization and deaths as we did in April. We wouldn’t be so bothered by the high number of cases if they came with significantly fewer serious/lethal ones. 

I mean we can compare us to higher vaccinated countries (they will obviously do better), but the more interesting question is why we are doing so poorly among the lot with similar (or even lower) vaccination rates.  To me it makes sense to compare us to Czechia, Poland, Croatia, even Slovakia, Slovenia. Some of these countries have even lower vaccination rates, but somehow their death stats are, thank goodness, miles away from our tragic numbers. What are they doing right? Do they have firm restrictions in place (I think firmer than ours)? Are their hospitals better equipped and staffed (hopefully, probably)?

3 hours ago, Paxter said:

Can you provide the names of the places you refer to above (either regions or countries)? I’d like to look at the post-vaccine data. 

all of the above mentioned, regionally central/eastern Europe. 

[Zorral]

1 hour ago, RhaenysBee said:

What you describe for the US is great and inspires hope and makes me happy for the US. Although, as you underline it as well, it’s the US, and we (and when I say I we, I can only generalize as far as my country, not even the eastern region or the whole of Europe, let alone  globally) have very different qualities which contribute to potentially different patterns. My issue is that we in particular don’t see the things you describe and don’t know our own patterns. Maybe other European countries do, but again, they are them and we are us with different demography, geography, economy, healthcare infrastructure . We cannot really draw conclusions for ourselves based on US data, not even German or Austrian. 

Very well said.  I apologize for not acknowledging that in my response-commentary.

Knowing how badly in most ways our country has handled the pandemic, and continues to handle it so badly that in many parts of our country, it isn't being handled at all -- I instinctively do not wish make such observations about other countries because we are not entitled to do that, as we know when we look at our maps and the stats.

[Filippa Eilhart]

I wonder if the high percentage of Sputnik and the Chinese vaccine, as well as AZ, is causing Hungary not to be doing so well. 

[Clueless Northman]

17 minutes ago, RhaenysBee said:

More cases would not necessarily be a problem if it was just more cases. The problem is that we have the same amount of hospitalization and deaths as we did in April. We wouldn’t be so bothered by the high number of cases if they came with significantly fewer serious/lethal ones. 

Which begs the question: are vaccinated people tested, at least in ratios close to unvaccinated? I bet in many countries vaccinated people have stopped giving a fuck unless they're really sick and it's obviously covid or maybe a bad flu, then they get tested, and of course pretty much all vaccinated that are tested are positive (thus high positivity rate), and all those with few or no symptoms are unreported and unseen, so there might actually be way more cases than reported, and the case to hospitalization ratio can't be compared to last spring (it's artificially higher now).

That, or as Filippa said, not enough MRNA vaccines. Chinese vaccines were okayish against vanilla covid but seem to be of lesser use, if any, against Delta (which means that China proper, despite being massively vaccinated right now, could be in trouble if outbreaks aren't systematically countered, or until China relies on updated vaccines).

[Paxter]

27 minutes ago, RhaenysBee said:

all of the above mentioned, regionally central/eastern Europe. 

Central Europe seven-day rolling averages for daily deaths per 100k people (as at today - source FT.com):

• Poland: 0.52
• Czech: 0.64
• Slovakia: 0.84
• Austria: 0.43
• Slovenia: 0.78

Central Europe seven-day rolling averages for deaths per 100k people (from the previous pre-vacc peak - source FT.com):

• Poland: 1.59 (April 14)
• Czech: 2.06 (March 12)
• Slovakia: 1.88 (March 2)
• Austria: 1.45 (Dec 21)
• Slovenia: 2.53 (Dec 7)

Plenty of time for things to get worse of course (at least a two week lag), so we can check the data again over the coming weeks / months. But right now the stats suggest that the vaccine is reducing harm. 

Bear in mind that the case numbers are much worse now than the pre-vacc peak for all of those countries except Poland.

[RhaenysBee]

3 minutes ago, Zorral said:

Very well said.  I apologize for not acknowledging that in my response-commentary.

Knowing how badly in most ways our country has handled the pandemic, and continues to handle it so badly that in many parts of our country, it isn't being handled at all -- I instinctively do not wish make such observations about other countries because we are not entitled to do that, as we know when we look at our maps and the stats.

Oh no apology necessary, it’s a discussion. And I don’t suppose I pinpointed my exact meaning and scope when I brought up this concern.

Well, very few countries managed to handle the pandemic well, and that’s no surprise. Even if one did it wouldn’t entitle them to tell others how to do so because what works on an island in the middle of Oceania, doesn’t work in the middle of mainland Europe, but I could have brought up any other example.

2 minutes ago, Filippa Eilhart said:

I wonder if the high percentage of Sputnik and the Chinese vaccine, as well as AZ, is causing Hungary not to be doing so well. 

I don’t know, it could be a factor. Impossible to tell for sure without exact data. Sputnik and AZ are allegedly holding up well against delta. Sinopharm efficiency is hit or miss, but it was also the first to get boosted from August on. Our first booster campaign was targeted at the 60+ age group who received sinopharm for that reason exactly. Referring back to the vague press conference data from earlier today, the majority of vaccinated hospitalizations and deaths are Pfizer because that’s what the majority of the eldest age groups had received. 

1 minute ago, Clueless Northman said:

Which begs the question: are vaccinated people tested, at least in ratios close to unvaccinated? I bet in many countries vaccinated people have stopped giving a fuck unless they're really sick and it's obviously covid or maybe a bad flu, then they get tested, and of course pretty much all vaccinated that are tested are positive (thus high positivity rate), and all those with few or no symptoms are unreported and unseen, so there might actually be way more cases than reported, and the case to hospitalization ratio can't be compared to last spring (it's artificially higher now).

That’s a excellent point indeed. The fact is, people don’t really get tested at all, they never have. We are 37th in Europe in terms of tests per million population. It is entirely possible that our disastrous mortality rate would be far better if it was diluted in a much larger number of cases. Last year there were estimations about the real number of cases, which they thought to be 3-4 times the stats. 

[RhaenysBee]

9 minutes ago, Paxter said:

Central Europe seven-day rolling averages for daily deaths per 100k people (as at today - source FT.com):

• Poland: 0.52
• Czech: 0.64
• Slovakia: 0.84
• Austria: 0.43
• Slovenia: 0.78

Central Europe seven-day rolling averages for deaths per 100k people (from the previous pre-vacc peak - source FT.com):

• Poland: 1.59 (April 14)
• Czech: 2.06 (March 12)
• Slovakia: 1.88 (March 2)
• Austria: 1.45 (Dec 21)
• Slovenia: 2.53 (Dec 7)

Plenty of time for things to get worse of course (at least a two week lag), so we can check the data again over the coming weeks / months. But right now the stats suggest that the vaccine is reducing harm. 

Bear in mind that the case numbers are much worse now than the pre-vacc peak for all of those countries except Poland.

Impressive, thank you! I will have to learn to find data with such efficiency. It’s reassuring for me at least. I do stand by my view that we need our own public vaccine data.  

[Zorral]

CDC

Morbidity and Mortality Weekly Report (MMWR)

COVID-19 Vaccination and Non–COVID-19 Mortality Risk — Seven Integrated Health Care Organizations, United States, December 14, 2020–July 31, 2021
Weekly / October 29, 2021 / 70(43);1520–1524

https://www.cdc.gov/mmwr/volumes/70/wr/mm7043e2.htm?s_cid=mm7043e2_w

Quote

Short version: The authors compared mortality rates between 6.4 million people vaccinated against COVID and 4.6 million unvaccinated people, between last December and this July. The really startling part is that, after excluding all COVID-related deaths, the unvaccinated people had mortality rates that were more than triple than those of people who received the Pfizer and Moderna vaccines, after adjusting for age, sex, race/ethnicity, and study site.

The numbers themselves are pretty shocking. Remember these figures exclude all COVID-related deaths, which in the study were defined as any death that took place within 30 days of a COVID diagnosis or a positive COVID test — which seems like an intentionally quite over-inclusive definition of what constitutes a COVID-related death.

Here are the numbers:

Among people who received both doses of the Pfizer and Moderna vaccines, the standardized mortality rates per 100-person years among people who had received both doses were, respectively, 0.35 and 0.34. Among unvaccinated people, the mortality rate was 1.11, i.e., more than three times higher. Again this excludes all COVID-related deaths, even extremely broadly defined.

The effect was still very much present among those who got the J&J vaccine, although it wasn’t as extreme, as the mortality rate for J&J recipients was 0.84, relative to 1.47 in the unvaccinated comparator group.

If you look at the data in more detail, the tripled mortality risk among the unvaccinated for non-COVID-related death is very consistent across all age groups, except among teenagers, where the mortality rates across both groups were almost non-existent (0.01). ....

 

[Paxter]

Just wanted to call out a few unfancied countries for quietly kicking some ass with the vaccine rollout. 

We all love hating on Bolsonaro but Brazil is up to 77% of their total population with at least one dose. That is significantly better than Germany. They are using mostly Western jabs (Pfizer and AZ) supplemented by CoronaVac. 

Chile, Argentina and Uruguay are all beating Brazil, with Chile closing in on nearly 90% of the population vacced. 

Morocco is bossing Africa and has more people with at least one jab as a % of its population than Greece (67%). 

Sri Lanka is easily leading its peers in South Asia at 75% with at least one dose. And I previously mentioned Malaysia who are leading the pack of the larger SE Asian nations. 

ETA: I want to end on a negative note. Bangladesh is down at 32% with at least one dose and is suffering a huge shortage of doses. There is some vacc hesitancy but that is not the full story. This is happening all over the globe unfortunately. 

[williamjm]

1 hour ago, Paxter said:

Just wanted to call out a few unfancied countries for quietly kicking some ass with the vaccine rollout. 

We all love hating on Bolsonaro but Brazil is up to 77% of their total population with at least one dose. That is significantly better than Germany. They are using mostly Western jabs (Pfizer and AZ) supplemented by CoronaVac. 

Chile, Argentina and Uruguay are all beating Brazil, with Chile closing in on nearly 90% of the population vacced.

I did see a statistic that South America has the largest vaccination % of any continent.

[Clueless Northman]

1 hour ago, Zorral said:

CDC

Morbidity and Mortality Weekly Report (MMWR)

COVID-19 Vaccination and Non–COVID-19 Mortality Risk — Seven Integrated Health Care Organizations, United States, December 14, 2020–July 31, 2021
Weekly / October 29, 2021 / 70(43);1520–1524

https://www.cdc.gov/mmwr/volumes/70/wr/mm7043e2.htm?s_cid=mm7043e2_w

Dang, this is insane.

Does it mean that a lot of covid deaths aren't considered as such because people aren't tested when sick, or because they die weeks later, or because they die of complications from covid, or because they die from some opportunistic disease taking advantage of covid damages? Basically, most of the difference is at the end of the day due to covid? Or is there not just some amount of causation, but also a strong mere correlation - basically, unvaccinated people are more careless and live a riskier life, and are therefore have a global far higher mortality rate? Which, considering it was lockdown time more or less, wouldn't be that much of a stretch - it would mostly be that vaccinated people were way more cautious during that specific pandemic time and didn't go out that much or had many exposure to random deadly threat.

But if the latter hypothesis explained a significant share of the difference, then the difference should be bigger for J/J vaccine.

[Padraig]

4 hours ago, Clueless Northman said:

There's no reason to assume a yearly booster will be needed, for now that's just Pharma bullshit talk to pretend they'll get plenty of money forever. 

Hopefully.  6 months ago we (including myself) were saying the same thing about the 3rd dose.  That's why Israel is a very interesting case study.  They have gotten a relatively low vaccination rate but the 3rd dose did help kill off their last wave.  Hopefully it lasts.

2 hours ago, Filippa Eilhart said:

I wonder if the high percentage of Sputnik and the Chinese vaccine, as well as AZ, is causing Hungary not to be doing so well. 

Interesting point.  As mentioned, the Chinese vaccine doesn't seem to be great.

But Hungary is still doing far better than other countries like Romania, Bulgaria and Latvia (all of whom are seeing truly appaling fatality levels).  Actually, Latvia is interesting as it has similar overall vaccination levels to Hungary but Latvia's vaccination rate for those over 60 is 64%, while Hungary is at 80%.  That has left Latvia very exposed.  It has done well enough vaccinating younger people, which isn't particularly useful when you can't vaccinate your older age group.

https://qap.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#age-group-tab

1 hour ago, Zorral said:

CDC

Morbidity and Mortality Weekly Report (MMWR)

COVID-19 Vaccination and Non–COVID-19 Mortality Risk — Seven Integrated Health Care Organizations

The conclusion here is that people who get vaccinated are generally more health conscious?  Very surprising results.  And very interesting.  Thanks.

Edited to add:

17 minutes ago, Clueless Northman said:

Which, considering it was lockdown time more or less, wouldn't be that much of a stretch - it would mostly be that vaccinated people were way more cautious during that specific pandemic time and didn't go out that much or had many exposure to random deadly threat.

But if the latter hypothesis explained a significant share of the difference, then the difference should be bigger for J/J vaccine.

J&J was supposedly often given to homeless people (and similar) because it was 1 shot.  That might explain why it didn't perform well compared to the other vaccines.

Vaccinated people behaving differently (and thus reducing their risk of dieing of other causes) is an interesting point also.

https://www.nytimes.com/2021/11/17/world/europe/covid-vaccine-germany-europe.html

And if people can read the NY Times article, it is an interesting view of the problems in Germany and other neighbouring countries.

[Mr. Chatywin et al.]

This could also go in the U.S. politics thread, but I think it's more fitting to post it here to see if there are comparable examples abroad. Florida Governor Ron DeathSantis is the first governor to sign legislation allowing him to fine businesses and hospitals for implementing vaccine mandates as a term of employment. This is absolutely batshit crazy in my eyes and goes against everything he's claimed about supporting businesses' rights on basically every other subject. Are people seeing leaders doing this anywhere else (also worth noting he's done the same shit with face mask mandates, targeting schools in particular)?

[The Anti-Targ]

9 hours ago, rotting sea cow said:

 

Now countries with pretty decent vaccination rates are being hammered. Where are we going to put the blame? With those high vaccination, shouldn't have we expected a far more milder wave?

 

What's your definition of high vaccination rates? If it's anything less than 95% of people aged 12+ being double vaccinated, then it is not high in an epidemiological sense. Several months ago modellers looking at the epidemiology of Delta concluded that you need 95% of the eligible population vaccinated to start seeing something like a herd immunity effect. Some people poo pooed that figure at the time, but it seems like the modellers are being proven right, so I poo poo those previous poo pooers.

I think if you are going to compare Northern Dec-Feb 2020-21 to Northern Dec-Feb 2021-22, with countries that have moderate vaccination rates (12+ between 80% and 90% double vaccinated), there should be fewer hospitalisations and deaths this time around. Total case numbers might not be down very much. But really, with how the pandemic played out over the last almost 2 years the best we can hope for out of vaccination programmes is reduced hospitalisations and deaths, among vaccinated people. There is unlikely to be any kind of herd immunity protection for unvaccinated people if there is reliance on vaccination alone. If a country wants to prevent a lot of unvaccinated people from getting the disease then things like vaccine passports for some / many / most places of business where people gather indoors would be needed. And of course good contact tracing and mask use by everyone.

[Luzifer's right hand]

The system that collects the epidemiological here is collapsing under the load and the health ministry asked labs and regional governments to stop reporting negative tests. So if you see a test positivity rate of 100% soon for Austria that will be the cause. 

[Luzifer's right hand]

https://www.bbc.com/news/world-europe-59343650

Full lockdown in Austria starting Monday.

[Knight Of Winter]

3 hours ago, Luzifer's right hand said:

https://www.bbc.com/news/world-europe-59343650

Full lockdown in Austria starting Monday.

On that note, Austria just became first European country to mandate covid vaccination.

https://www.politico.eu/article/austria-mandatory-coronavirus-vaccination-february/