Why Discriminate Against Unvaccinated?

21 October 2021

Nowadays,   it is common for countries to restrict the movement of the unvaccinated.  Some do not allow unvaccinated to enter PUBs,  some,  to enter malls and public places. This has made many people very unhappy.   Some even take the matter to the street,  protesting against the Government for unfairness and discrimination, and for disrupting their daily and family life. This article will try to illustrate why there is such a rule using the available data provided by MOH of Singapore.

Singapore's New Covid Rule

Singapore changed its Covid rule on 9 October 2021.  The new rule allows only groups of up to 2 fully vaccinated persons to dine in at hawker centres and coffee shops, and to enter shopping malls and attractions.  The Authority did not elaborate much on the reasons for such a move when they first announced the new rule. 

 

Possible & Likely Reasons for such Move

The following are the possible and likely reasons:

1.  The number of those severely ill patients requiring oxygen support and ICU has risen exponentially;  most of these patients are unvaccinated and many of them are seniors;

3.  The existing and available medical facilities have almost been exhausted;  it is expensive and wasteful to increase the facilities unless it cannot be avoided.   

The Explanatory Charts

MOH has published several data and charts as shown in the appendix.   Among them,  only the following chart could explain and back up the reasons.  This chart shows that the Not-Fully-Vaccinated (NFV) are using up more than 50% of oxygen and ICU facilities at the present date.  But the number of unvaccinated at present is less than 10% of the population if we were to exclude those below 12 years old.

Click picture to enlarge

   

The following charts expanded from the MOH's data show the attack rate of those severely ill patients recently admitted to the hospital.      The rate is worked out based on this formula

The working of such a formula is explained in this wiki.

The chart shows  the % of people who become severely ill after  having exposed to Covid-19. 

1)  Attack Rate for Severely ill Vaccinated/Not-Fully-Vaccinated (NFV) Patients

2)  Number of Deceased

One can readily see from the above 2 charts that the attack rate of the unvaccinated and the number of death have risen significantly in recent weeks.  Most of the death are Not-Fully-Vaccinated patients (NFV).    They, unfortunately, loaded up the existing and available medical facilities.   This must-have prompted the Singapore Government to introduce the new Covid Rule as the first step to restrict the movements of the NFV.

References:

1)  Singapore's New Covid Rule:  sg.gov

2)  Attack Rate Definition:  Wikipedia

3)  Chart source 1:  MOH,  Singapore

4)  Chart source 2:  Latest Update of Covid-19 MOH Charts

How Best to Verify if an Air-conditioning Fan Coil Requires a Chemical Washing

Chemical washing of air conditioning units is always expensive.   It is a difficult decision to make for the novice especially when the air conditioner is still in good working condition after the last servicing.  Also,  chemical washing of air conditioning units can be messy involving a lot of after-service work such as floor cleaning,  etc.  This article will describe a simple and yet cost-effective way to verify if chemical washing is necessary.

How They Tell? 

The very experienced will often determine if a chemical washing is required by just visually inspecting the condition of the fan coil.  The more responsible mechanics might carry out air flow, refrigeration pressure, or cooling coil temperature measurements.  But the result of these is just "Greeks" to the Novice.  Some might like to be convinced if the expensive chemical washing work is required.  

A quick and dirty method to tell if chemical washing is required is to use backlight inspection.  This method will use a bright light shining from the back of the fan coil unit.  The Novice can easily use this method to verify if a chemical washing is required.  

What's Needed? 

All one needs is a very bright inspection lamp that can be inserted behind the coils.  This lamp must be small & thin enough to "snake" through the very narrow space around and behind the axial fan as shown. 

This brightly lighted lamp behind the cooling coils will allow one to inspect the fins.   If the fins are badly clogged with dirt,  one could hardly see the bright light emitted by the lamps.   

Where to Buy this lamp?

This lamp can be purchased from Internet Shopping.  

The alternative is to construct such a lamp using the following components from eBay:

To make these cheap eBay lamps as inspection lamps,  one might have to stiffen the lamp wiring with some sort of thin gauge stainless wire or equivalent.  

One could also construct this inspection lamp quickly using  SMD LEDs powered by AA-size batteries with steel wire as stiffener as shown in the following picture.  The number of batteries to be used will depend on the rating of the LEDs.   Usually,  3 batteries would be more than enough to power up the LED lamp.  The addition of a small copper heat sink would ensure lasting performance.   The SMD LEDs can be extracted from spoilt LED lamps.

 The Result

    

Why do We Need to Be Concern about Some Vaccine Effectiveness Studies (Part 2) ?

In Part 1,  we found that those studies done using real World Data are actually not measuring the vaccine effectiveness but a combination of vaccine and the other Covid-19 control measures.   These other control measures are shutdowns & isolation,  mask-wearing, etc.    This Part 2 will suggest a way where we can use to monitor how effective are these combined Covid-19 control measures.  We can term this "the effectiveness of the Covid-19 control measures". 

How?

By comparing the attack rates of Covid-19 against those data obtained from the vaccine efficacy trial results or an acceptable level or limit.

What data?

From the vaccine efficacy trial results for the 3 vaccines,  namely,  Pfizer, Moderna & Johnson & Johnson,   we can obtain the following data:

a)  The average attack rate for the vaccine group was 0.24% and for the placebo group,  1.25%.  The standard efficacy formula is as follows

b)  Using the same standard formula,  we can plot out a chart showing the attack rates of the vaccine group against vaccine efficacy as shown in the following chart

Chart 1:  Attack rates of Vaccinated Group at various Vaccine Efficacies

Comparing the Attack Rates

Using the attack rates at various vaccine efficacies,  we can draw up a chart showing how effective is the Covid control measures as compared to the vaccine efficacies shown in Chart 1.  This is Chart 2 which plotted  "the Attack Rates by Vaccination Status".  This chart uses Singapore MOH's Real World Data

Doubleclick picture for latest updates

Interpretation?

1. Chart 2 illustrated that Singapore has good control over Covid-19 infection at present. It uses a combination of the following measures:

a) Vaccination: To date, 80% of the 5.9 million residents have received full-dose and 85% of them have at least 1-dose;

 b) Mask wearing & social safety distancing for all residents are compulsory for all indoor as well as outdoor activities;

 c) All social, religious gatherings and sporting events are controlled by having a cap on the maximum number of attendees as well as other controls;

         d) Business events and other events are curtailed;

e) Other measures are as shown here

2. The above control measures in Singapore are showing to have a Covid attack rate even better than the 95% vaccine efficacy;

3. The remaining 15% of the unvaccinated residents in Singapore have exercised good control measures to prevent themselves from getting infected. As many as 60,000 Singaporeans have already been infected before Singapore rolled out its vaccination program in Feb 2021. They would have the natural immunization without acquiring vaccines. Many could have been infected without noticing it because they were asymptomatic. The unvaccinated residents in Singapore have better attack rates at the present moment.

4. We can use this method to monitor how effective are our control measures and what would happen if we relax any of the control measures.

Conclusion

1. We could monitor the effectiveness of the control measures implemented in various countries by comparing the Covid-19 attack rates of the residents against those of the Vaccine Trial Tests;

2. The real World Data cannot be used to measure the vaccine effectiveness unless one can discount the effect due to all the biases and other Covid-19 control measures that will affect vaccine effectiveness calculation;

3. The standard formula cannot be used when more people in the population have been vaccinated.

The charts and table as shown will be updated daily and presented on this webpage.

Coronavirus Vaccination Status in Hong Kong

17 May 2021

Notices

The data and graph from SCMP are readable again from 22 November onwards.   The other Graphs have been updated

Hong Kong Government has been publishing data about the number of people taking Sinovac and BioNTech coronavirus vaccines.   The data has been collated and plotted by South China Morning Post (SCMP) of Hong Kong and a copy of which is mimicked here for the convenient of the readers

Courtesy: SCMP

The data has also been analyzed and graphically plotted as shown in the following which is self-explanatory

2)  Total Number of Covid-19 Doses in Hong Kong

3)  Daily 1st Covid-19 Doses in Hong Kong

4)   Daily Covid-19 Doses in Hong Kong

5)  Cummulative 1st Covid-19 Doses in Hong Kong

6)  1st Dose growth against average in Hong Kong 

The pick-up rate of the 1st dose takers was fast in the first month after the roll out. Hong Kong rolled out a vaccination plan at the end of Feb 2021.  The growth was later boosted by introducing BioNTech in early March.  But this growth rate had a setback and dropped to -70% against the average at the end of March. This was because BioNTech was suspended for 10 days for a packaging problem. The growth pick up steam from 4th April. By mid-April, it grew to 88% against the average. Growth slowly declined thereafter to the present -39%  on 19 May.

 

7)  % Population with at least 1 Dose & with Full Doses

For more other details,  please refer to this other webpage:  

The Comparison of Real World Covid Charts

Hong Kong Vaccination Data Download in CSV file

     

https://tinyurl.com/h5j7zb9e

The Updates From the Ministry of Health (MOH) of Singapore

8 September 2021

12 September 2021 Update:   MOH has stopped publishing details about infection and death rate according to vaccination status.  This page will not be updated.

Singapore's Ministry of Health (MOH) has recently changed its reporting format.   It now concentrates on reporting how well the vaccinated and unvaccinated Singapore residents have performed when they have been infected.    The idea is to encourage more residents to take vaccines.  It paid special attention to those elderly aged residents who are most vulnerable to be infected.

This article is using these MOH's real World data and transforms some of them to show the vaccine effectiveness used in Singapore as an example.  The information has been used on this webpage.   

Note:  The information in this article will be updated daily until further notice.  

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

This chart shows the vaccination status of Singapore residents over the period specified. It can be used to roughly estimate the vaccine effectiveness by assuming entire Singapore as one community

Chart 2: Infection According to Vaccination Status

This chart shows the number of infections according to Vaccination Status as shown in MOH Figure 3: Local Cases in the Last 28 Days by Vaccination Status & Severity of Condition

Chart 3: The Virus Attack Rates by Vaccination Status (Infection)

This chart shows the attack rates of vaccinated and the unvaccinated of those infected. The data is extracted from the same source as Chart 2. The attack rate is explained in this wiki.

TTSH Breakout on 28 April 2021

Bukit Merah Breakout on 13 June 2021

KTV Breakout on 13 July 2021

Fishery Market Breakout on 18 July 2021

Dormitory in Woodlands Breakout on 23 Aug 2021

Note The attack rate is for a 28-day interval as stated by MOH from 9 Sept 2021

Chart 4: 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 3: Local Cases in the Last 28 Days by Vaccination Status & Severity of Condition. The attack rate is explained in this wiki

Note 1:  6.00E-5 in vertical scale=0.006%

Note 2: The attack rate is for a 28-day interval as stated by MOH

Chart 5: 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 3: Local Cases in the Last 28 Days by Vaccination Status & Severity of Condition. The attack rate is explained in this wiki

Note 1:  6.00E-6 in vertical scale=0.0006%

Note 2: The attack rate is for a 28-day interval as stated by MOH

Note 3:  No Death so far 1 dose; one Fully dosed 90-year-old died on 17 August

The MOH Real-World Data in CSV file

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.