Is It True Those Vaccinated Having a Better Chance of Survival Against Covid Variants?

There are lots of arguments about the Covid vaccine isn't good.  Besides not knowing if there are long-term effects of taking them,  many argued that those vaccinated are also having more infections.  More have landed up in hospitals as evidenced by this chart published daily by the Singapore Ministry of Health (MOH). 

Isn't that Proves Vaccine is not Good and Effective?

It is very true if one is looking at those numbers.  More are infected will mean vaccines are not effective.  People require oxygen and ICU supports will mean vaccines are not necessarily working.

This is not true if one analyses further to find out why.    It is due to the following reasons; 

1.  More Singaporeans are now vaccinated and therefore,  more will be infected;

2.  Vaccine protection will depend on one's physical condition.  The elderly ones will like to be infected even if they had the full doses.  Most of them landed in the hospital are either weak or reported to have underlying diseases;

3.  Most elderly ones are already fully vaccinated;  

4.  Bulk of those serving customers in markets, stalls, and counters must have been vaccinated under a certain requirement.  These people are constantly exposed to Covid infection.  Their chances of getting the infection are higher;

These factors have distorted the infection rate of the vaccinated and unvaccinated.  There are also other factors as illustrated in this article.

How Do We Judge?

If we must judge by vaccine effectiveness against catching Covid,  we must make sure they are compared fairly using the correct methods to minimise the variables,  the unknowns,  and the biases.  This article has some examples.  If not,  we could only compare how they perform after they have been admitted to the hospitals.   Hospital records are usually more reliable.

How They Perform in Hospital?

We can compare them in terms of attack rates which is base on the following formula:

The terminology is explained in this wiki.

Using this formula,  we can draw up the following 2 charts by collecting the real World data published by MOH.

Chart 1: Attack Rates of Severely ill (O2 +ICU)

This chart shows the attack rates of vaccinated and the unvaccinated, who are severely ill and required oxygen or ICU support. The data is extracted from Figure 7: Local Cases in the Last 28 Days by Vaccination Status & Severity of Condition.

Chart 2: The Attack Rates of Death

This chart shows the attack rates of vaccinated and the unvaccinated who have left the World. The data is extracted from Figure 7: Local Cases in the Last 28 Days by Vaccination Status & Severity of Condition.

We can that those unvaccinated are having worst performance in hospitals.  Many have lost their lives.

What about the Recovery Rate?

There is no such recovery rate formula for the 28-day fixed period as given by MOH.  But we can define it as Admission/Discharge rate as follows:

We can then come up with this chart that shows the hospital admission rate and the discharge rate of those infected people.

This chart clearly shows that when the cases in the KTV lounge broke up on 13 July,  most of the admission were either not vaccinated or having one dose.   When the cases in the Fishery market broke up on 18 July,  many full-dose people got infected.  This is because most of the people in the stall owners in the market were required to be vaccinated.  The other observation is that vaccinated people were discharged very quickly from the hospital.    

This other chart shows the same but in terms of numbers still remaining in the hospital for the 28-day interval.   It clearly shows that the number of discharges is much faster for vaccinated people.

The charts shown in this article is updated daily here

Why do We Need to Be Concern about Some Vaccine Effectiveness Studies (Part 1) ?

Rewritten on 1 September 2021

Some Vaccine Effectiveness Studies can give misleading results especially those having shorter timeframes and those using real World Data. This article will use real World data to illustrate why.

Reasons to Carry out Studies

It is not uncommon for countries to carry out vaccine effectiveness studies. They might have carried out the studies under their peers' or political pressure. They might want to find out why there are more people infected. Traditional and other accurate studies could cost a lot of money.

What's Vaccine Effectiveness and Efficacy?

Both are measuring how well the vaccine will work. The main difference is in the way of measurement. Vaccine Efficacy uses clinical trial data, whereas Vaccine Effectiveness uses real-World data. The other differences are as shown in this table.

	Vaccine Efficacy	Vaccine Effectiveness
Range	Selective group according to age, sex, ethnic & known medical condition	Real-World data is where is
Sample size	At least 30,000 selected participants are divided into 2 groups;  the vaccine and Placebo group	The community at large.  No grouping.  Large sample size.
Controls	The participants are not told about their vaccination status. Whether they were vaccinated using a vaccine or just plain salient water. Participants are asked to go back to the community and work as per normal routine.	Members in the community are well aware if they were vaccinated. The unvaccinated and those having only 1 dose will usually take extra effort & precautions to protect themselves. The government often introduce infection control measures
Testings	The participants are tested at regular intervals.	Testings are done on an ad-hoc basis
Exposures	The total and actual numbers of vaccinated and unvaccinated exposed to Covid is known	The total and actual numbers of vaccinated and unvaccinated cannot be accurately determined.
95% Confident Interval (CI) of Outcome	Usually narrow, not more than 10% except when the sample size is too small	Usually wide, can exceed 50% and sometimes can go negative. .
Outcome	Less biased because participants do not usually know what “vaccine” they have taken	Member unvaccinated or partly vaccinated will exercise extra precautions to control their activities.

The News Said Pfizer's Efficacy is only 39%

Are there no other means to accurately determine Vaccine Effectiveness?

Yes. There are many other ways and means. Some of the common ones are listed as follows:

a) Randomized Clinical Trials (RCT) ;

b) Placebo-Controlled Trials (PCT);

c) Matched case-control Studies

These study methods are similar to those Clinical Vaccine Trial tests used to determine Vaccine Efficacy. In fact, these other methods are variants. They claimed to be fairer and more accurate than the effectiveness measurement. Many of these studies are using selective candidates and not using real World data.

But they would not carry out these studies if the existing vaccine is still effective. This is mainly because it is not quite ethical to "bluff" those participants who have taken salient water instead of the vaccines. It is also expensive.

One other way is to do scheduled household visits. Every member of the household will be tested for infection at regular intervals. This will reduce the errors caused by not knowing how many had been exposed to the risk of infection. However, the result could still be biased because those unvaccinated are aware that they have not been vaccinated. They will take extra preventive precautions.

Updates From the Ministry of Health (MOH) of Singapore

What are the most common problems in Measuring Vaccine Effectiveness?

We often use real World data & the standard efficacy formula for effectiveness calculation. The accuracy of the results can be a problem.

The results can contain lots of unknowns & variables. What we are measuring is not the vaccine effectiveness. It could be the effectiveness of the vaccine plus the other control measures. The results could also be biased.

The standard formula compares the probability of the vaccinated against unvaccinated people. The formula does not work when the majority of the population has been vaccinated. An example is when the unvaccinated people approaching 0%.

Examples?

Singapore’s Ministry of Health (MOH) recently changed its reporting method. They used to tell the public about where and who were infected. Now, they concentrated on telling people about what will happen to vaccinated and unvaccinated.

The purpose is to encourage people to take vaccines. The MOH website presented 2 interesting charts. One showing the hospitalization of those infected (Figure 6). The other is showing the number of infections (Figure 10). The former is showing in a 28-day interval starting from 29 June 2021. the latter in a 14-day interval starting from 20 July 2021.

The charts give the following information

a) How many of the infected people are vaccinated and unvaccinated?;

b) How many of them are infected and how many are hospitalized?

c) How many are seriously ill requiring oxygen support, ICU bed and how many have died?;

Using the real World data collected from MOH, an attempt was made earlier using the standard formula of attack rates to work out the Vaccine Effectiveness but the results were quite a blizzard and confusing. These are as shown in the following examples.

Chart 1: % of Population vaccinated with 1 dose and full 2 doses

Chart 2: The Virus Attack Rates by Vaccination Status

Chart 3: Vaccine Effectiveness Calculation

Explanations?

Chart 1: This chart shows the vaccination status of Singapore residents over the period specified. The working example in this article will use the vaccination status as the base to work out the attack rates. It will assume entire Singapore is one community Chart 2: This chart shows the attack rates of vaccinated and the unvaccinated. The data is extracted from Figure 6: Local Cases in the Last 28 Days by Vaccination Status & Severity of Condition. The attack rate is explained in this wiki. Chart 3: This chart works out the vaccine effectiveness using the vaccination status as shown in Chart 1. The effectiveness is worked out based on the same formula in this wiki

Result Interpretation?

1. The raw attack rate & the Effectiveness calculations appear to suggest that those unvaccinated has rate and effectiveness better than those vaccinated; this is not logical; 2. The effectiveness also went negative for those having 1-dose and also for those full-dose people recently; this is not possible.

Why Such Outcomes?

The following could be the reasons: 1. The real World data are biased. The unvaccinated know that they are vulnerable. They have either hibernate or took extra precautions themselves from being caught by Covid. On the other hand, many vaccinated people will usually not follow the protocols & SOPs.

https://www.zaobao.com.sg/news/singapore/story20210815-1182339?fbclid=IwAR0Rsk3_kM16hn7GdJWjV8vgBe0maztRB7efkCWVUw_b5Q8xAmX8749rt1U

2. The attack rate of the full vaccinated has gone negative because the spreading of the disease had gone unnoticed for some time. By the time it was discovered, many people, especially the elderly, had already been infected. The attacks on vaccinated people went record high.

3. Almost all the elderly and those people in customer service have been vaccinated in Singapore. The elderly are most vulnerable to infection and the customer service people are constantly exposed to infections. Their chances of being infected are much higher than unvaccinated.

4. The Government's various control measures have distorted the attack rates.

In Conclusion

If we use real World Data and the standard formula to work out the effectiveness, we are not actually measuring the vaccine effectiveness but a combination of vaccine effectiveness as well as other measures to prevent Covid-19 infection. These measures are shutdowns & isolations, mask wearings, etc. Part 2 of this article will suggest a method where we can monitor the effectiveness of this combination effect.

3rd Booster Shot in Israel Not Effective?

10 August 2021

The media is again spreading news about Israel's vaccine programme. This time, it is about the 3rd booster shot using Pfizer. Again, Israel Times is the first to report. There was not much news in other medias as before. The news were kind but the forumers were not. Many, especially those from the Twitters have blasted out without even checking what was reported.

The Times of Israel

This report originated again from the Times of Israel. It has the following qualifications:

a) Limited data not enough to draw conclusions on booster’s effectiveness;

b) Fourteen Israelis have been diagnosed with COVID-19;

c) Not clear whether the 14 infected before or after having the booster;

d) 11 of the 14 cases were over the age of 60;

e) two that were hospitalized were over 60; lastly,

f) Some 420,000 Israelis have been administered a third booster shot so far, in a drive that began last week.

In other words, it is advising readers not to rush into making a conclusion.

Are the results so far any good?

Without adding more, the result of the 3rd booster shot was better than expected for the following reasons:

a) The over-all effectiveness of 0.003% (14/420000) was 72 times better than the 0.24% obtained during the trial test of the 3 common vaccines in the US;

 

b) 11 of the 14 infected were of elderly who were over 60s;

Report Said Pfizer's Efficacy is only 39% Against Delta

Why Booster Shots people still can get infected?

One must know that vaccine does not offer 100% protection against Covid-19 infection. Vaccine helps human body to produce anti-bodies to fight Covid. The anti-body amount will depend on the physical conditions of the human. Elderly will produce less. Those with underlying diseases such as diabetes will produce even less antibodies.

The Israel's result is giving yet another encouraging news about the use of booster shots to tame Covid-19. This time, it worked among elderly people.

Any other countries have examples?

Bahrain and UAE switched to Pfizer as 3rd booster after having majority of their citizens taken SinoPharm. The switch for Bahrain was around 2 June 2021.

https://www.voanews.com/covid-19-pandemic/bahrain-offers-pfizer-biontech-boosters-those-previously-vaccinated-chinese-shot
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There was a similar report from Reuter.

https://www.reuters.com/world/middle-east/uae-bahrain-make-pfizerbiontech-shot-available-those-who-got-sinopharm-vaccine-2021-06-03/

The real World Chart of Bahrain is telling us that Pfizer as 3rd booster shot worked very well to tame the infection as well as the death rate. It was claimed that Bahrain offered Pfizer as 3rd shot because there were worries growing over China's SinoPharm shots.

Inactivated Vaccines are Safer with less Side Effects?