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>the risk of developing symptomatic COVID-19 was 27 times higher among the vaccinated, and the risk of hospitalization eight times higher This sounds convincin

>the risk of developing symptomatic COVID-19 was 27 times higher among the vaccinated, and the risk of hospitalization eight times higher This sounds convincing, but then in the next graf: >For instance, the higher hospitalization rate in the 32,000-person analysis was based on just eight hospitalizations in a vaccinated group and one in a previously infected group. And the 13-fold increased risk of infection in the same analysis was based on just 238 infections in the vaccinated population, less than 1.5% of the more than 16,000 people, versus 19 reinfections among a similar number of people who once had SARS-CoV-2.

cestith 5y ago
Are you saying 32,000 people isn't a large enough study to be meaningful?
- epistasis 5y ago
  For low-prevalence events the number of events that happened is just as important for statistical power as the big 32,000. Especially when doing relative risk, the confidence interval on that "27 times" could be extremely large.
  - peteradio 5y ago
    True, but we aren't comparing a 1 to 0 or 1 to 2. Its 238 to 19. sqrt(238)=+/-15 sqrt(19)=+/-4 (if the numbers are to be believed) . 238/19=12.5 (238-15)/(19+4)=9.7 so it becomes 20% less on the lower end of the fluctuation which is only nominal.
- Hinrik 5y ago
  It's more about the small effect sizes of 8 people vs 1. Still a lot of room for noise in the result.
  - cestith 5y ago
    True, but where's a better study at the moment? I think it would be easier to gather more studies and do a cross-study meta analysis rather than recruiting a million people into a single study to eliminate the effects of noise. The "27 times" is factually their finding in one study, which someone might read as being given too much weight in the article but doesn't change the data.
AndrewBissell 5y ago
Have you ever looked at the numbers on the vaccine trials? Especially the ones in children under 18?
kiba 5y ago
To develop natural immunity, you would need to get infected with the virus, no? That's considerably more risky than getting the vaccine. If you do get infected with the virus after vaccination, wouldn't you also develop natural immunity?
- foobar2021 5y ago
  I think the worry with natural infection is if the timing is such to provide durable immunity. But it’s not like the vaccines have had 5 years of trials to determine the best wait between the 2 and 3 doses so kind of a moot point.
  - BFatts 5y ago
    Why 5 years? Why not 1? Why not 50? What's so special to people about 5 years? I keep hearing people say "it hasn't been tested long enough" followed by "I'd take it in about 5 to 10 years" which is a HUGE difference. Is it just that "time has passed", because a year has passed since the Pfizer-BioNTech vaccine was first given to test subjects. But I guess it's up to people - their body, their choice. Even though we live in what is commonly referred to as a "society". We agree to live by certain rules and norms that allow us to coexist. There is a faction of fools out there who resist being a part of society, but claim all of its privileges. These are sub-human individuals who just seek some form of control over others. That has to stop.
    - loveistheanswer 5y ago
      >Why 5 years? Why not 1? Why not 50? What's so special to people about 5 years? Clinical trials are conducted over many years (rather than just 1) for historical safety reasons[1] >There is a faction of fools out there who resist being a part of society, but claim all of its privileges. These are sub-human individuals This is hate speech, especially considering the disproportionate rates of black and hispanic people who are unvaccinated. [1]https://www.brightfocus.org/clinical-trials/how-clinical-trials-work/phases-clinical-trials https://www.brightfocus.org/clinical-trials/how-clinical-tri...
scythe 5y ago
The bigger problem is that the risk of hospitalization post-vaccine appears to be lower than the risk of death pre-vaccine. If seven of those eight hospitalized post-vaccine would have died when naively infected, then the difference disappears. Seven out of 32000 is 0.02%, while the risk of death from COVID-19 is 0.4%. And if you remove hospitalization as an endpoint, you're basically dependent on self-reports. That's not to say I don't believe the conclusions -- they should survive this critique -- but there is reason to expect a little inflation of the ORs.
refurb 5y ago
But that seems intuitive? If you survive the first Covid infection, you’re biased towards less severe symptoms for the 2nd infection (ignoring even any immune response). Basically all the folks who died from Covid are excluded from this population.
pacbard 5y ago
>the risk of developing symptomatic COVID-19 was 27 times higher among the vaccinated, and the risk of hospitalization eight times higher The denominator in those odds ratios seem to fishy to me. Comparing people who were previously infected with COVID and vaccine recipients does some weird conditioning on getting COVID, so it should hide risks of developing symptomatic COVID and hospitalization for people who got COVID previously. It seems to me that the risks should be "cumulative" for people who were previously infected (i.e., the denominator should include symptomatic infections and hospitalizations for previous COVID variants and not just delta) rather than "zeroing" those risks for this group and just focus on delta re-infection. The decision to only focus on delta infections will bias up the OR estimates for vaccine (in)effectiveness, so we should read the results of this paper as the possible upper bound of the ORs. Also, the study compares the risk of delta infection, meaning that people cannot really just say "I won't get vaccinated because natural immunity is better" as the variants that provided that natural immunity are not "dominant" anymore, meaning that the opportunity to acquire natural immunity against delta is probably close to zero at this time. Also also, isn't it something that is known that natural immunity is better than vaccine-acquired immunity? The trade-off is that natural immunity has the "side effect" of actually having to fight off and survive the illness?
- AndrewBissell 5y ago
  > Also also, isn't it something that is known that natural immunity is better than vaccine-acquired immunity? Yes, I pointed this out elsewhere in the thread, but it has somehow been verboten until very recently to state it in regards to Covid. My brother-in-law was even told by the people administering his vaccine that having had a prior Covid case put him at more risk and made it even more essential that he get vaccinated.
  - nybble41 5y ago
    It does not seem unreasonable to me to extrapolate that people who caught COVID-19 once are more likely, as a group, to be exposed to it again in the future. That would be a matter of their environment rather than their individual resistance to the virus. I haven't seen any studies on that issue, though. In any case the vaccine is safe, effective, and way better than actually catching COVID-19. And in the event that you did already recover from COVID-19, getting the vaccine doesn't hurt and will boost your immunity even further. So—unless you have a specific medical condition which dramatically increases your changes of an adverse reaction–you should just get the vaccine.

cestith 5y ago

Are you saying 32,000 people isn't a large enough study to be meaningful?

epistasis 5y ago
For low-prevalence events the number of events that happened is just as important for statistical power as the big 32,000. Especially when doing relative risk, the confidence interval on that "27 times" could be extremely large.
- peteradio 5y ago
  True, but we aren't comparing a 1 to 0 or 1 to 2. Its 238 to 19. sqrt(238)=+/-15 sqrt(19)=+/-4 (if the numbers are to be believed) . 238/19=12.5 (238-15)/(19+4)=9.7 so it becomes 20% less on the lower end of the fluctuation which is only nominal.
Hinrik 5y ago
It's more about the small effect sizes of 8 people vs 1. Still a lot of room for noise in the result.
- cestith 5y ago
  True, but where's a better study at the moment? I think it would be easier to gather more studies and do a cross-study meta analysis rather than recruiting a million people into a single study to eliminate the effects of noise. The "27 times" is factually their finding in one study, which someone might read as being given too much weight in the article but doesn't change the data.

AndrewBissell 5y ago

Have you ever looked at the numbers on the vaccine trials? Especially the ones in children under 18?

kiba 5y ago

To develop natural immunity, you would need to get infected with the virus, no? That's considerably more risky than getting the vaccine. If you do get infected with the virus after vaccination, wouldn't you also develop natural immunity?

foobar2021 5y ago
I think the worry with natural infection is if the timing is such to provide durable immunity. But it’s not like the vaccines have had 5 years of trials to determine the best wait between the 2 and 3 doses so kind of a moot point.
- BFatts 5y ago
  Why 5 years? Why not 1? Why not 50? What's so special to people about 5 years? I keep hearing people say "it hasn't been tested long enough" followed by "I'd take it in about 5 to 10 years" which is a HUGE difference. Is it just that "time has passed", because a year has passed since the Pfizer-BioNTech vaccine was first given to test subjects. But I guess it's up to people - their body, their choice. Even though we live in what is commonly referred to as a "society". We agree to live by certain rules and norms that allow us to coexist. There is a faction of fools out there who resist being a part of society, but claim all of its privileges. These are sub-human individuals who just seek some form of control over others. That has to stop.
  - loveistheanswer 5y ago
    >Why 5 years? Why not 1? Why not 50? What's so special to people about 5 years? Clinical trials are conducted over many years (rather than just 1) for historical safety reasons[1] >There is a faction of fools out there who resist being a part of society, but claim all of its privileges. These are sub-human individuals This is hate speech, especially considering the disproportionate rates of black and hispanic people who are unvaccinated. [1]https://www.brightfocus.org/clinical-trials/how-clinical-trials-work/phases-clinical-trials https://www.brightfocus.org/clinical-trials/how-clinical-tri...

scythe 5y ago

The bigger problem is that the risk of hospitalization post-vaccine appears to be lower than the risk of death pre-vaccine. If seven of those eight hospitalized post-vaccine would have died when naively infected, then the difference disappears. Seven out of 32000 is 0.02%, while the risk of death from COVID-19 is 0.4%. And if you remove hospitalization as an endpoint, you're basically dependent on self-reports. That's not to say I don't believe the conclusions -- they should survive this critique -- but there is reason to expect a little inflation of the ORs.

refurb 5y ago

But that seems intuitive? If you survive the first Covid infection, you’re biased towards less severe symptoms for the 2nd infection (ignoring even any immune response). Basically all the folks who died from Covid are excluded from this population.

pacbard 5y ago

>the risk of developing symptomatic COVID-19 was 27 times higher among the vaccinated, and the risk of hospitalization eight times higher The denominator in those odds ratios seem to fishy to me. Comparing people who were previously infected with COVID and vaccine recipients does some weird conditioning on getting COVID, so it should hide risks of developing symptomatic COVID and hospitalization for people who got COVID previously. It seems to me that the risks should be "cumulative" for people who were previously infected (i.e., the denominator should include symptomatic infections and hospitalizations for previous COVID variants and not just delta) rather than "zeroing" those risks for this group and just focus on delta re-infection. The decision to only focus on delta infections will bias up the OR estimates for vaccine (in)effectiveness, so we should read the results of this paper as the possible upper bound of the ORs. Also, the study compares the risk of delta infection, meaning that people cannot really just say "I won't get vaccinated because natural immunity is better" as the variants that provided that natural immunity are not "dominant" anymore, meaning that the opportunity to acquire natural immunity against delta is probably close to zero at this time. Also also, isn't it something that is known that natural immunity is better than vaccine-acquired immunity? The trade-off is that natural immunity has the "side effect" of actually having to fight off and survive the illness?

AndrewBissell 5y ago
> Also also, isn't it something that is known that natural immunity is better than vaccine-acquired immunity? Yes, I pointed this out elsewhere in the thread, but it has somehow been verboten until very recently to state it in regards to Covid. My brother-in-law was even told by the people administering his vaccine that having had a prior Covid case put him at more risk and made it even more essential that he get vaccinated.
- nybble41 5y ago
  It does not seem unreasonable to me to extrapolate that people who caught COVID-19 once are more likely, as a group, to be exposed to it again in the future. That would be a matter of their environment rather than their individual resistance to the virus. I haven't seen any studies on that issue, though. In any case the vaccine is safe, effective, and way better than actually catching COVID-19. And in the event that you did already recover from COVID-19, getting the vaccine doesn't hurt and will boost your immunity even further. So—unless you have a specific medical condition which dramatically increases your changes of an adverse reaction–you should just get the vaccine.