8 ms·

A grim warning from Israel: Vaccination blunts, but does not defeat Delta

57 points by rmason 5y ago

zeteo 5y ago
Israel went very heavily with Pfizer which ended up rather ineffective against Delta. With a more balanced mix they would have probably fared better.
- ezfe 5y ago
  > rather ineffective against Delta I mean, this isn't true... less effective, sure. But it's not ineffective by any measure.
  - zeteo 5y ago
    https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1 https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v... If they had advertised 42% effectiveness rating when it was first launched they'd have probably gone back to the drawing board. (This is what Pfizer did recently with a second version that was aimed specifically at Delta but didn't fare any better than the first version.)
    - robocat 5y ago
      Against the delta variant, the vaccine reduces transmission, significantly reduces severity, and significantly reduces risk of death: all extremely worthwhile goals. Read https://www.kff.org/policy-watch/covid-19-vaccine-breakthrough-cases-data-from-the-states/ https://www.kff.org/policy-watch/covid-19-vaccine-breakthrou...
jonnycomputer 5y ago
This article never really tackles the fact that p(infected|vaccinated) != p(vaccinated|infected). With high-vaccination rates in Israel, that matters a lot. In fact, the scariest statistic it gives--that nearly 60% of serious hospitalizations are fully vaccinated) gives the p(vaccinated|infected), not p(infected|vaccinated). Trivially, and to make the point, if 100% of people are vaccinated, then 100% of hospitalizations will be among the vaccinated--which tells you almost nothing about how likely it is to be hospitalized when vaccinated (beyond that its nonzero). An embarrassing failure for science.org
- Buttons840 5y ago
  p(i|v) = ( p(v|i) * p(i) ) / p(v) p(v|i) = 0.6 p(v) = 0.6 p(i) = ?; but it's high (record case counts) p(i|v) = p(i); high If Israel has a 60% vaccination rate, and 60% of those in the hospital are vaccinated, then doesn't this mean the vaccine has no effect on the chances of being hospitalized?
  - pgalvin 5y ago
    No, because you assume that a 10 year old has an equal probability of being hospitalised as a 90 year old (for example). Israel has a low overall vaccination rate because they have a very young population. If you restrict the sample to just >50 year olds (majority of hospitalisations), then both statistics look very different.
    - nradov 5y ago
      Based on CDC data a 90 year old has at least 30× the risk of hospitalization compared to a 10 year old. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
  - mint2 5y ago
    That is why considering age is important and why interacting variables make it so easy for statistics to mislead when talking to people who are less verse or aren’t aware of the topic being studied. About 78% of those above 12 are vaccinated in Israel, and the rate is even higher for those more susceptible to the virus. Without quantifying those factors, it’s going to lead to a garbage in garbage out assessment.
  - jonnycomputer 5y ago
    Well, the article says 78% of people 12 yo and older are vaccinated in Israel. Not sure what percent if you drop it to include everyone. 87% of those who were hospitalized were 60 or older (which doesn't match the general population). I imagine that vaccination rates are much much higher than 60% among those over 60. In the US its around 80%. But also, hospitalizations are much more likely the older you get. Moreover (and this was the point of the paper the article was discussing), the effectiveness of the vaccine may dwindle with time, and the 60+ crowd were among the first to get vaccinated. So, no, I don't think you can do so simple a calculation and conclude that. Instead of back of the envelope estimates, I think I'd just point to this study: https://www.nejm.org/doi/full/10.1056/NEJMoa2108891 https://www.nejm.org/doi/full/10.1056/NEJMoa2108891 Abstract: Background The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear. Methods We used a test-negative case–control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike (S) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients’ vaccination status. Results Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant. Conclusions Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.)
jvanderbot 5y ago
I keep hearing that Covid is never going away (see recent Atlantic article). How is it surprising when vaccines designed to prevent hospitalization don't prevent infection.
- micromacrofoot 5y ago
  It's not surprising if you're very familiar with how vaccines work, but most people are not very familiar with how vaccines work. This type of article is exactly what it says it is: a warning. Vaccines aren't a silver bullet and you still need to be a little careful right now. That's really the whole message. If you're already aware, that's great! help inform everyone else.
- Bellyache5 5y ago
  I have heard similarly from various outlets that "we'll just have to learn to live with Covid-19, like we do with the flu and other viruses that we're unable to eradicate". What I find curious is that SARS-CoV-1 (e.g. the original SARS circa 2003) seemed to eventually disappear overnight. It leaves me pondering two questions: 1. Did SARS-CoV-1 actually disappear or do we just not hear about it anymore? 2. What is different between SARS-CoV-1 and SARS-CoV-2 that makes us think the latter will persist indefinitely when the former seemed to disappear?
  - pricecomstock 5y ago
    There were only ever 8000 confirmed cases of SARS-CoV-1. It was able to be contained. Wikipedia mentions that quarantines were very effective because it wasn't often asymptomatically contagious. https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
  - nradov 5y ago
    SARS-CoV was less contagious and had a higher fatality rate, so it burned out quickly. There's no reliable evidence that it's still circulating in humans. SARS-CoV-2 is more contagious and less fatal so it has already spread worldwide. It also has multiple animal reservoirs so even if there was some way to simultaneously eliminate the virus from every human (there isn't), we would just catch it again from dogs or deer or something and the pandemic would restart.
trhway 5y ago
78% vaccination, more than half of new are breakthrough, i.e. the vaccinated chances to get infected is more than 28% of that of unvaccinated. Similar numbers to MA https://www.bostonherald.com/2021/08/31/massachusetts-reports-1557-coronavirus-cases-hits-milestone-of-more-than-4-5-million-people-fully-vaccinated/ https://www.bostonherald.com/2021/08/31/massachusetts-report... - 65% vaccination rate - out of the 1144 current average new daily infections the 500+ are breakthrough, ie. the chances are 40%. The data is probably skewed by the fact that vaccines smooth the symptoms and thus the breakthroughs are probably much more undercounted.
- Retric 5y ago
  Vaccination is heavily correlated with age and age is heavily correlated with risk. So, you really need to do a more complex breakdown to understand what’s going on. Aka if 90% of the 80+ year old population is vaccinated and 0% of the under 12 year old population is vaccinated then being unvaccinated starts to look like a good option. Except what you really want is to be young.
  - trhway 5y ago
    >Vaccination is heavily correlated with age not really https://eu.boell.org/sites/default/files/2021-06/IL%2004.jpg https://eu.boell.org/sites/default/files/2021-06/IL%2004.jpg Except for teenagers as it was pointed out, though i usually didn't consider them because of being outliers wrt. history of vaccination. Well, lets consider them too. That is new cases by age http://cdn.statcdn.com/Infographic/images/normal/25295.jpeg http://cdn.statcdn.com/Infographic/images/normal/25295.jpeg Let's look at opposites: 60-69 - 90% vaccination, 8% cases, 0.5M population 10-19 - 25% vaccination, 40% cases, 1.4M population. I.e. almost 3x population, 5x cases with 25% vs 90% vaccination rate. Simple arithmetic - vaccinated chances to get infected are ~35% that of unvaccinated. Whatever way you slice and dice these numbers or the available numbers from other well vaccinated places like MA, UK, Singapore you always get in the 25%-40% ballpark.
    - seoaeu 5y ago
      Um, your graph shows that younger people are several times more likely to be unvaccinated than older people
coding123 5y ago
I don't think the vaccine is creating a strong memory cell response. The vaccine is probably just ramping up the immune system response for a few months. That alone would prevent death and since we don't really have anything else, it's still better than nothing.
- deleted 5y ago
  [deleted]
- mmastrac 5y ago
  Please don't post conjecture like this that has been categorically shown to be untrue. Vaccines are effective and have been shown to decrease infection and serious illness rates.
  - rubatuga 5y ago
    You think you’re fighting misinformation, but GP could be right in terms of T cell response.
    - criticaltinker 5y ago
      Vaccination has been shown to induce an immune response including T cells [1]. However, vaccination induces a slightly different immune response compared to natural infection [2][3] . These differences may account for variation in effectiveness between vaccine-induced and naturally acquired immunity. [1] Rapid induction of antigen-specific CD4+ T cells is associated with coordinated humoral and cellular immune responses to SARS-CoV-2 mRNA vaccination https://www.cell.com/immunity/fulltext/S1074-7613(21)00308-3 https://www.cell.com/immunity/fulltext/S1074-7613(21)00308-3 [2] Antibodies elicited by mRNA-1273 vaccination bind more broadly to the receptor binding domain than do those from SARS-CoV-2 infection https://pubmed.ncbi.nlm.nih.gov/34103407/ https://pubmed.ncbi.nlm.nih.gov/34103407/ [3] mRNA vaccination compared to infection elicits an IgG-predominant response with greater SARS-CoV-2 specificity and similar decrease in variant spike recognition https://www.medrxiv.org/content/medrxiv/early/2021/04/07/2021.04.05.21254952.full.pdf https://www.medrxiv.org/content/medrxiv/early/2021/04/07/202...
mig39 5y ago
Base Rate Fallacy on science.org ? https://en.wikipedia.org/wiki/Base_rate_fallacy https://en.wikipedia.org/wiki/Base_rate_fallacy
- neonate 5y ago
  That page explains the fallacy poorly. Like a lot of Wikipedia articles on technical topics, it gives an explanation that only makes sense to people who already know the concept (or at least I assume it does). For the rest of us, maybe someone could provide a clearer explanation?
  - SideburnsOfDoom 5y ago
    I think this is the same as my earlier comment here https://news.ycombinator.com/item?id=28273947 https://news.ycombinator.com/item?id=28273947 Quote: --- This number is meaningless without also knowing what percentage of the people are vaccinated. Compare: "80% of the people in hospital have $foo, and 80% of the general population has $foo" - $foo has no bearing at all on hospitalisation. "80% of the people in hospital have $spon, and 5% of the general population has $spon" - $spon is clearly linked to the majority of hospitalisations. "45% of the people in hospital have $bar, and 5% of the general population has $bar" - $bar is linked to higher rates of hospitalisation, _despite_ not being the majority of hospitalisations. Spoiler: for some age groups in the UK now, "being unvaccinated" is much like $bar. --- I would add now: "not $bar -" i.e. "being vaccinated" could make up "55% of the people in hospital" (or more) despite reducing the odds of it. and "not wearing seatbelt" -> "in hospital after a car crash" is probably like the $spon case. Those examples above of course come with the caveat "all other things being equal" which isn't the case if, e.g. that others have raised, the age breakdown of the whole population vs hospitalisation is different. That's why there are graphs of "over 50s, vaccinated vs. hospitalised" as a catogory.
criticaltinker 5y ago
At this point it is widely recognized that viral evolution is undermining the effectiveness of the current vaccines at preventing infection (~91% to ~66%) [1] and symptomatic illness (~95% to ~65%) [2]. Still, the benefits of vaccination remain significant - vaccines are helping prevent severe outcomes like hospitalization and death for many people. Researching formulations that are more robust to viral resistance is already becoming a top priority. Diversifying viral elimination strategies at the population level will also be critical. Mandatory nonpharmaceutical interventions such as lock-downs and masking may help slow the spread of the virus, but at this point those measures will not stop the spread, because SARS-CoV-2 is highly contagious and primarily transmitted through the air (as acknowledged by the WHO and CDC) [3]. [1] Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021 https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm [2] Resurgence of SARS-CoV-2 Infection in a Highly Vaccinated Health System Workforce https://www.nejm.org/doi/full/10.1056/NEJMc2112981 https://www.nejm.org/doi/full/10.1056/NEJMc2112981 [3] Airborne transmission of respiratory viruses https://www.science.org/lookup/doi/10.1126/science.abd9149 https://www.science.org/lookup/doi/10.1126/science.abd9149
- nomel 5y ago
  > Researching formulations that are more robust to viral resistance is already becoming a top priority. Are you aware of any good resources to help a lay person understand the basic concepts around this?
zz865 5y ago
I remember earlier in the year talk of a Delta variant booster, but I haven't seen anything recently. Anyone have details? Edit: looks like its in development. https://www.npr.org/2021/07/09/1014744345/pfizer-is-pursuing-a-booster-shot-and-new-vaccine-targeting-the-delta-variant https://www.npr.org/2021/07/09/1014744345/pfizer-is-pursuing...
- icelandicmoss 5y ago
  I got the impression it was just another dose of the same vaccine(s) already available rather than a new thing. I heard something about tests on vaccine combinations (i.e. different types of vaccine for your 1st & 2nd dose) a while back though but I can't remember the details, does anyone know what happened with that?
threeseed 5y ago
I wonder if the solution is to look to structural reforms which are going to be more sustainable over the long term. e.g. 4 day work week (2 days full shutdown) to reduce transmission by preventing people going into offices and businesses. And mandatory training and financial support to all businesses to move online and remote.
belter 5y ago
"Vaccine efficacy, effectiveness and protection" https://www.who.int/news-room/feature-stories/detail/vaccine-efficacy-effectiveness-and-protection https://www.who.int/news-room/feature-stories/detail/vaccine... Vaccine efficacy is found in trials, vaccine effectiveness is dynamic depending WHEN you calculate it and its found after 'deployment in the field' "A vaccine’s efficacy is measured in a controlled clinical trial and is based on how many people who got vaccinated developed the ‘outcome of interest’ (usually disease) compared with how many people who got the placebo (dummy vaccine) developed the same outcome. Once the study is complete, the numbers of sick people in each group are compared, in order to calculate the relative risk of getting sick depending on whether or not the subjects received the vaccine. From this we get the efficacy – a measure of how much the vaccine lowered the risk of getting sick. If a vaccine has high efficacy, a lot fewer people in the group who received the vaccine got sick than the people in the group who received the placebo." vs "Vaccine effectiveness is a measure of how well vaccines work in the real world. Clinical trials include a wide range of people – a broad age range, both sexes, different ethnicities and those with known medical conditions – but they cannot be a perfect representation of the whole population. The efficacy seen in clinical trials applies to specific outcomes in a clinical trial . Effectiveness is measured by observing how well the vaccines work to protect communities as a whole. Effectiveness in the real world can differ from the efficacy measured in a trial, because we can’t predict exactly how effective vaccination will be for a much bigger and more variable population getting vaccinated in more real life conditions."
- doitLP 5y ago
  Thank you. This distinction is often forgotten and the terms used interchangeably in articles and debates
nonomaybeyes 5y ago
If it's true that vaccines blunt the symptoms of infection, and that breakthrough cases still are as contagious as without vaccine (same viral load), then there could be more asymptomatic spreading by people who are not aware that they are contagious.
- SideburnsOfDoom 5y ago
  > and that breakthrough cases still are as contagious as without vaccine (same viral load), I would _not_ assume that this is settled science. This out today: https://www.medrxiv.org/content/10.1101/2021.08.30.21262701v1 https://www.medrxiv.org/content/10.1101/2021.08.30.21262701v... > These data indicate that vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.
lr4444lr 5y ago
Hypothetical: Israelis were vaccinated very early compared to a lot of other countries. Maybe this is really just building the case for a booster? What's the correlation between hospitalization, severity, and time since last jab?
resource0x 5y ago
Some updates from Israel (based on Wednesday Sept 01 data) "Some 11,246 new cases out of around 145,000 tests that were performed on Wednesday were diagnosed with the virus, the Health Ministry reported on Thursday evening, with 7.9% of those screened testing positive – the highest percentage since the start of the pandemic. Israel is in first place in the world in the number of daily cases per capita in the last seven days, according to international reports." Source: https://www.jpost.com/health-and-wellness/coronavirus/israel-tops-10000-new-daily-covid-cases-for-third-day-running-678451 https://www.jpost.com/health-and-wellness/coronavirus/israel... To put it in perspective: 11246 cases in Israel, in proportion to the population, is roughly equivalent to 400K cases a day in US.
- e40 5y ago
  Does anyone know what Israel is doing in terms of lockdowns, etc? Are they back to business as usual, or something else?
  - helge9210 5y ago
    After two weeks in June mask mandate is back. Mass gatherings are limited. Certain fasciitis are available only to vaccinated. Practically, nobody cares anymore. Compared to first lockdown, when streets were totally empty (a sight to behold), last half a year is business as usual.
subsubzero 5y ago
What is not being said is some people are on the brink of death anyways and being vaccinated will not stop that trajectory(dying). The older you are the weaker your immune system is. A 97 year not vaccinated would most likely die after getting covid, either from the virus itself or an infection that happens after the body is weakened by the virus. The same fully vaccinated person may or may not die, if they do die its going to happen anyways but will be listed as a hospitalization/death from covid. A few other things about Israels vaccine program. - They started early(12/20) so I imagine alot of the populace is starting to run into vaccines that are less effective than if they were administered late Spring like US/UK and Europe. - I don't know what the obesity levels are like in that country but the CDC says there is a strong correlation between being obese and covid severity with a person. - Of the hospitalizations mentioned there is a strong indication of age being a cause for more severe illness: >Of the 514, 59% were fully vaccinated. Of the vaccinated, 87% were 60 or older
- nradov 5y ago
  That's reasonably accurate but it's nothing new. The other endemic "common cold" coronaviruses already had a high fatality rate for frail elderly patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095096/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095096/ There is a strong correlation between national obesity rates and COVID-19 death rates. https://www.bmj.com/content/372/bmj.n623 https://www.bmj.com/content/372/bmj.n623
- Dwelve 5y ago
  Those people that are on the brink of death don't get the vaccine and probably skew the metric in the other way. If you know the cancer patient has 2 weeks left you're not going to vaccinate him. If that same cancer patient dies with covid it'll be counted as an unvaxxed covid death
nradov 5y ago
How is this grim? Case numbers are mostly irrelevant now. What really matters is the death rate. Very few vaccinated people die, and the death rate for unvaccinated children is also extremely low. All of us are likely to become a "case" at some point no matter what we do. https://www.businessinsider.com/delta-variant-made-herd-immunity-not-possible-astrazeneca-developer-2021-8 https://www.businessinsider.com/delta-variant-made-herd-immu...
- inter_netuser 5y ago
  case numbers of course matter, because vaccines do not guarantee you will not end up with long covid, or many other consequences of a rough viral infection. Countless millions will live with a permanent disability their entire life.
  - baumy 5y ago
    > Countless millions will live with a permanent disability their entire life. Extraordinary claims require extraordinary evidence. I see no reason to believe this at all. Side effects from a viral infection, and specifically coronaviruses, lasting for months or even a year or two afterward in uncommon cases are well documented. To say that "countless millions will live with a permanent disability" with regard to a virus that has only even existed in humans for ~2 years now is completely unfounded, and over dramatic.
    - deleted 5y ago
      [deleted]
rock_artist 5y ago
Israel indeed provides nice stats for Covid. Especially where some of the population aren’t fully complying with suggested/requested measures. So we pretty much see the vaccination performance. If it’s for health reasons (not leisure or traveling, PCR testing is free and there are many places available each day to test without scheduling. Anyway, I was “fully vaccinated” on March 2020 iirc. I didn’t yet get the 3rd/booster shot. And I’m writing this being isolated with mild symptoms after testing positive for Covid. (Hoping symptoms will regress and I’ll be out within 10 days). I have no reliable assumption from where I got it and me and my oldest son are the only ones tested positive out of my close family and others we’ve been in touch with.
dlevine 5y ago
The important thing is that the vaccines are having a large effect on Covid-related deaths. Despite the current number of reported cases in Israel being equal to (or even a bit over) the January peak, the number of deaths is much lower. According to Google's numbers, their current 7-day average number of deaths is 23, while in January they had a 7-day average of about 65. And it looks like the deaths peaked in the past week. https://www.google.com/search?q=israel+covid+cases&rlz=1C1CHBF_enUS743US743&oq=israel+covid+cases&aqs=chrome..69i57j0i131i433i512l2j0i512l3j0i131i433j0i131i433i512l3.3128j0j7&sourceid=chrome&ie=UTF-8 https://www.google.com/search?q=israel+covid+cases&rlz=1C1CH... For reference, the numbers in Florida (where vaccination rates are significantly lower) look a lot different. You have many more cases and more deaths than the January peak. https://www.google.com/search?q=florida+covid+cases&rlz=1C1CHBF_enUS743US743&sxsrf=AOaemvID_gOTqLL-QbEY79sgjTI5FtJUzA%3A1630617587318&ei=8z8xYaDbEtOd-gSWpbhg&oq=florida+covid+cases&gs_lcp=Cgdnd3Mtd2l6EAMyBAgjECcyCAgAEIAEELEDMgsIABCABBCxAxCDATIFCAAQgAQyBQgAEIAEMggIABCABBCxAzIFCAAQgAQyBQgAEIAEMgsIABCABBCxAxCDATIFCAAQgAQ6BwgjELECECc6BggAEAcQHkoECEEYAFDesyVYgrslYJPBJWgAcAJ4AIABoQOIAf4KkgEJMS40LjAuMS4xmAEAoAEBwAEB&sclient=gws-wiz&ved=0ahUKEwjgoLnwm-HyAhXTjp4KHZYSDgwQ4dUDCA8&uact=5 https://www.google.com/search?q=florida+covid+cases&rlz=1C1C...
- nradov 5y ago
  Vaccines are very effective at reducing the death rate but when making comparisons between countries or states we also have to adjust for population demographics. Florida has a median age of 42 whereas in Israel it's only 30. And more importantly Florida has 21% of the population over age 65 whereas in Israel it's only 12%. We know that age is a huge risk factor.
arminiusreturns 5y ago
> What is clear is that “breakthrough” cases are not the rare events the term implies. As of 15 August, 514 Israelis were hospitalized with severe or critical COVID-19, a 31% increase from just 4 days earlier. Of the 514, 59% were fully vaccinated. Of the vaccinated, 87% were 60 or older. “There are so many breakthrough infections that they dominate and most of the hospitalized patients are actually vaccinated,”
croes 5y ago
Better article about the vaccine effectiveness https://news.ycombinator.com/item?id=28221798 https://news.ycombinator.com/item?id=28221798

57 points by rmason 5y ago

Israel went very heavily with Pfizer which ended up rather ineffective against Delta. With a more balanced mix they would have probably fared better.

ezfe 5y ago
> rather ineffective against Delta I mean, this isn't true... less effective, sure. But it's not ineffective by any measure.
- zeteo 5y ago
  https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1 https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v... If they had advertised 42% effectiveness rating when it was first launched they'd have probably gone back to the drawing board. (This is what Pfizer did recently with a second version that was aimed specifically at Delta but didn't fare any better than the first version.)
  - robocat 5y ago
    Against the delta variant, the vaccine reduces transmission, significantly reduces severity, and significantly reduces risk of death: all extremely worthwhile goals. Read https://www.kff.org/policy-watch/covid-19-vaccine-breakthrough-cases-data-from-the-states/ https://www.kff.org/policy-watch/covid-19-vaccine-breakthrou...

jonnycomputer 5y ago

This article never really tackles the fact that p(infected|vaccinated) != p(vaccinated|infected). With high-vaccination rates in Israel, that matters a lot. In fact, the scariest statistic it gives--that nearly 60% of serious hospitalizations are fully vaccinated) gives the p(vaccinated|infected), not p(infected|vaccinated). Trivially, and to make the point, if 100% of people are vaccinated, then 100% of hospitalizations will be among the vaccinated--which tells you almost nothing about how likely it is to be hospitalized when vaccinated (beyond that its nonzero). An embarrassing failure for science.org

Buttons840 5y ago
p(i|v) = ( p(v|i) * p(i) ) / p(v) p(v|i) = 0.6 p(v) = 0.6 p(i) = ?; but it's high (record case counts) p(i|v) = p(i); high If Israel has a 60% vaccination rate, and 60% of those in the hospital are vaccinated, then doesn't this mean the vaccine has no effect on the chances of being hospitalized?
- pgalvin 5y ago
  No, because you assume that a 10 year old has an equal probability of being hospitalised as a 90 year old (for example). Israel has a low overall vaccination rate because they have a very young population. If you restrict the sample to just >50 year olds (majority of hospitalisations), then both statistics look very different.
  - nradov 5y ago
    Based on CDC data a 90 year old has at least 30× the risk of hospitalization compared to a 10 year old. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
- mint2 5y ago
  That is why considering age is important and why interacting variables make it so easy for statistics to mislead when talking to people who are less verse or aren’t aware of the topic being studied. About 78% of those above 12 are vaccinated in Israel, and the rate is even higher for those more susceptible to the virus. Without quantifying those factors, it’s going to lead to a garbage in garbage out assessment.
- jonnycomputer 5y ago
  Well, the article says 78% of people 12 yo and older are vaccinated in Israel. Not sure what percent if you drop it to include everyone. 87% of those who were hospitalized were 60 or older (which doesn't match the general population). I imagine that vaccination rates are much much higher than 60% among those over 60. In the US its around 80%. But also, hospitalizations are much more likely the older you get. Moreover (and this was the point of the paper the article was discussing), the effectiveness of the vaccine may dwindle with time, and the 60+ crowd were among the first to get vaccinated. So, no, I don't think you can do so simple a calculation and conclude that. Instead of back of the envelope estimates, I think I'd just point to this study: https://www.nejm.org/doi/full/10.1056/NEJMoa2108891 https://www.nejm.org/doi/full/10.1056/NEJMoa2108891 Abstract: Background The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear. Methods We used a test-negative case–control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike (S) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients’ vaccination status. Results Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant. Conclusions Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.)

jvanderbot 5y ago

I keep hearing that Covid is never going away (see recent Atlantic article). How is it surprising when vaccines designed to prevent hospitalization don't prevent infection.

micromacrofoot 5y ago
It's not surprising if you're very familiar with how vaccines work, but most people are not very familiar with how vaccines work. This type of article is exactly what it says it is: a warning. Vaccines aren't a silver bullet and you still need to be a little careful right now. That's really the whole message. If you're already aware, that's great! help inform everyone else.
Bellyache5 5y ago
I have heard similarly from various outlets that "we'll just have to learn to live with Covid-19, like we do with the flu and other viruses that we're unable to eradicate". What I find curious is that SARS-CoV-1 (e.g. the original SARS circa 2003) seemed to eventually disappear overnight. It leaves me pondering two questions: 1. Did SARS-CoV-1 actually disappear or do we just not hear about it anymore? 2. What is different between SARS-CoV-1 and SARS-CoV-2 that makes us think the latter will persist indefinitely when the former seemed to disappear?
- pricecomstock 5y ago
  There were only ever 8000 confirmed cases of SARS-CoV-1. It was able to be contained. Wikipedia mentions that quarantines were very effective because it wasn't often asymptomatically contagious. https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
- nradov 5y ago
  SARS-CoV was less contagious and had a higher fatality rate, so it burned out quickly. There's no reliable evidence that it's still circulating in humans. SARS-CoV-2 is more contagious and less fatal so it has already spread worldwide. It also has multiple animal reservoirs so even if there was some way to simultaneously eliminate the virus from every human (there isn't), we would just catch it again from dogs or deer or something and the pandemic would restart.

trhway 5y ago

78% vaccination, more than half of new are breakthrough, i.e. the vaccinated chances to get infected is more than 28% of that of unvaccinated. Similar numbers to MA https://www.bostonherald.com/2021/08/31/massachusetts-reports-1557-coronavirus-cases-hits-milestone-of-more-than-4-5-million-people-fully-vaccinated/ https://www.bostonherald.com/2021/08/31/massachusetts-report... - 65% vaccination rate - out of the 1144 current average new daily infections the 500+ are breakthrough, ie. the chances are 40%. The data is probably skewed by the fact that vaccines smooth the symptoms and thus the breakthroughs are probably much more undercounted.

Retric 5y ago
Vaccination is heavily correlated with age and age is heavily correlated with risk. So, you really need to do a more complex breakdown to understand what’s going on. Aka if 90% of the 80+ year old population is vaccinated and 0% of the under 12 year old population is vaccinated then being unvaccinated starts to look like a good option. Except what you really want is to be young.
- trhway 5y ago
  >Vaccination is heavily correlated with age not really https://eu.boell.org/sites/default/files/2021-06/IL%2004.jpg https://eu.boell.org/sites/default/files/2021-06/IL%2004.jpg Except for teenagers as it was pointed out, though i usually didn't consider them because of being outliers wrt. history of vaccination. Well, lets consider them too. That is new cases by age http://cdn.statcdn.com/Infographic/images/normal/25295.jpeg http://cdn.statcdn.com/Infographic/images/normal/25295.jpeg Let's look at opposites: 60-69 - 90% vaccination, 8% cases, 0.5M population 10-19 - 25% vaccination, 40% cases, 1.4M population. I.e. almost 3x population, 5x cases with 25% vs 90% vaccination rate. Simple arithmetic - vaccinated chances to get infected are ~35% that of unvaccinated. Whatever way you slice and dice these numbers or the available numbers from other well vaccinated places like MA, UK, Singapore you always get in the 25%-40% ballpark.
  - seoaeu 5y ago
    Um, your graph shows that younger people are several times more likely to be unvaccinated than older people

coding123 5y ago

I don't think the vaccine is creating a strong memory cell response. The vaccine is probably just ramping up the immune system response for a few months. That alone would prevent death and since we don't really have anything else, it's still better than nothing.

deleted 5y ago
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mmastrac 5y ago
Please don't post conjecture like this that has been categorically shown to be untrue. Vaccines are effective and have been shown to decrease infection and serious illness rates.
- rubatuga 5y ago
  You think you’re fighting misinformation, but GP could be right in terms of T cell response.
  - criticaltinker 5y ago
    Vaccination has been shown to induce an immune response including T cells [1]. However, vaccination induces a slightly different immune response compared to natural infection [2][3] . These differences may account for variation in effectiveness between vaccine-induced and naturally acquired immunity. [1] Rapid induction of antigen-specific CD4+ T cells is associated with coordinated humoral and cellular immune responses to SARS-CoV-2 mRNA vaccination https://www.cell.com/immunity/fulltext/S1074-7613(21)00308-3 https://www.cell.com/immunity/fulltext/S1074-7613(21)00308-3 [2] Antibodies elicited by mRNA-1273 vaccination bind more broadly to the receptor binding domain than do those from SARS-CoV-2 infection https://pubmed.ncbi.nlm.nih.gov/34103407/ https://pubmed.ncbi.nlm.nih.gov/34103407/ [3] mRNA vaccination compared to infection elicits an IgG-predominant response with greater SARS-CoV-2 specificity and similar decrease in variant spike recognition https://www.medrxiv.org/content/medrxiv/early/2021/04/07/2021.04.05.21254952.full.pdf https://www.medrxiv.org/content/medrxiv/early/2021/04/07/202...

mig39 5y ago

Base Rate Fallacy on science.org ? https://en.wikipedia.org/wiki/Base_rate_fallacy https://en.wikipedia.org/wiki/Base_rate_fallacy

neonate 5y ago
That page explains the fallacy poorly. Like a lot of Wikipedia articles on technical topics, it gives an explanation that only makes sense to people who already know the concept (or at least I assume it does). For the rest of us, maybe someone could provide a clearer explanation?
- SideburnsOfDoom 5y ago
  I think this is the same as my earlier comment here https://news.ycombinator.com/item?id=28273947 https://news.ycombinator.com/item?id=28273947 Quote: --- This number is meaningless without also knowing what percentage of the people are vaccinated. Compare: "80% of the people in hospital have $foo, and 80% of the general population has $foo" - $foo has no bearing at all on hospitalisation. "80% of the people in hospital have $spon, and 5% of the general population has $spon" - $spon is clearly linked to the majority of hospitalisations. "45% of the people in hospital have $bar, and 5% of the general population has $bar" - $bar is linked to higher rates of hospitalisation, _despite_ not being the majority of hospitalisations. Spoiler: for some age groups in the UK now, "being unvaccinated" is much like $bar. --- I would add now: "not $bar -" i.e. "being vaccinated" could make up "55% of the people in hospital" (or more) despite reducing the odds of it. and "not wearing seatbelt" -> "in hospital after a car crash" is probably like the $spon case. Those examples above of course come with the caveat "all other things being equal" which isn't the case if, e.g. that others have raised, the age breakdown of the whole population vs hospitalisation is different. That's why there are graphs of "over 50s, vaccinated vs. hospitalised" as a catogory.

criticaltinker 5y ago

At this point it is widely recognized that viral evolution is undermining the effectiveness of the current vaccines at preventing infection (~91% to ~66%) [1] and symptomatic illness (~95% to ~65%) [2]. Still, the benefits of vaccination remain significant - vaccines are helping prevent severe outcomes like hospitalization and death for many people. Researching formulations that are more robust to viral resistance is already becoming a top priority. Diversifying viral elimination strategies at the population level will also be critical. Mandatory nonpharmaceutical interventions such as lock-downs and masking may help slow the spread of the virus, but at this point those measures will not stop the spread, because SARS-CoV-2 is highly contagious and primarily transmitted through the air (as acknowledged by the WHO and CDC) [3]. [1] Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021 https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm [2] Resurgence of SARS-CoV-2 Infection in a Highly Vaccinated Health System Workforce https://www.nejm.org/doi/full/10.1056/NEJMc2112981 https://www.nejm.org/doi/full/10.1056/NEJMc2112981 [3] Airborne transmission of respiratory viruses https://www.science.org/lookup/doi/10.1126/science.abd9149 https://www.science.org/lookup/doi/10.1126/science.abd9149

nomel 5y ago
> Researching formulations that are more robust to viral resistance is already becoming a top priority. Are you aware of any good resources to help a lay person understand the basic concepts around this?

zz865 5y ago

I remember earlier in the year talk of a Delta variant booster, but I haven't seen anything recently. Anyone have details? Edit: looks like its in development. https://www.npr.org/2021/07/09/1014744345/pfizer-is-pursuing-a-booster-shot-and-new-vaccine-targeting-the-delta-variant https://www.npr.org/2021/07/09/1014744345/pfizer-is-pursuing...

icelandicmoss 5y ago
I got the impression it was just another dose of the same vaccine(s) already available rather than a new thing. I heard something about tests on vaccine combinations (i.e. different types of vaccine for your 1st & 2nd dose) a while back though but I can't remember the details, does anyone know what happened with that?

threeseed 5y ago

I wonder if the solution is to look to structural reforms which are going to be more sustainable over the long term. e.g. 4 day work week (2 days full shutdown) to reduce transmission by preventing people going into offices and businesses. And mandatory training and financial support to all businesses to move online and remote.

belter 5y ago

"Vaccine efficacy, effectiveness and protection" https://www.who.int/news-room/feature-stories/detail/vaccine-efficacy-effectiveness-and-protection https://www.who.int/news-room/feature-stories/detail/vaccine... Vaccine efficacy is found in trials, vaccine effectiveness is dynamic depending WHEN you calculate it and its found after 'deployment in the field' "A vaccine’s efficacy is measured in a controlled clinical trial and is based on how many people who got vaccinated developed the ‘outcome of interest’ (usually disease) compared with how many people who got the placebo (dummy vaccine) developed the same outcome. Once the study is complete, the numbers of sick people in each group are compared, in order to calculate the relative risk of getting sick depending on whether or not the subjects received the vaccine. From this we get the efficacy – a measure of how much the vaccine lowered the risk of getting sick. If a vaccine has high efficacy, a lot fewer people in the group who received the vaccine got sick than the people in the group who received the placebo." vs "Vaccine effectiveness is a measure of how well vaccines work in the real world. Clinical trials include a wide range of people – a broad age range, both sexes, different ethnicities and those with known medical conditions – but they cannot be a perfect representation of the whole population. The efficacy seen in clinical trials applies to specific outcomes in a clinical trial . Effectiveness is measured by observing how well the vaccines work to protect communities as a whole. Effectiveness in the real world can differ from the efficacy measured in a trial, because we can’t predict exactly how effective vaccination will be for a much bigger and more variable population getting vaccinated in more real life conditions."

doitLP 5y ago
Thank you. This distinction is often forgotten and the terms used interchangeably in articles and debates

nonomaybeyes 5y ago

If it's true that vaccines blunt the symptoms of infection, and that breakthrough cases still are as contagious as without vaccine (same viral load), then there could be more asymptomatic spreading by people who are not aware that they are contagious.

SideburnsOfDoom 5y ago
> and that breakthrough cases still are as contagious as without vaccine (same viral load), I would _not_ assume that this is settled science. This out today: https://www.medrxiv.org/content/10.1101/2021.08.30.21262701v1 https://www.medrxiv.org/content/10.1101/2021.08.30.21262701v... > These data indicate that vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.

lr4444lr 5y ago

Hypothetical: Israelis were vaccinated very early compared to a lot of other countries. Maybe this is really just building the case for a booster? What's the correlation between hospitalization, severity, and time since last jab?

resource0x 5y ago

Some updates from Israel (based on Wednesday Sept 01 data) "Some 11,246 new cases out of around 145,000 tests that were performed on Wednesday were diagnosed with the virus, the Health Ministry reported on Thursday evening, with 7.9% of those screened testing positive – the highest percentage since the start of the pandemic. Israel is in first place in the world in the number of daily cases per capita in the last seven days, according to international reports." Source: https://www.jpost.com/health-and-wellness/coronavirus/israel-tops-10000-new-daily-covid-cases-for-third-day-running-678451 https://www.jpost.com/health-and-wellness/coronavirus/israel... To put it in perspective: 11246 cases in Israel, in proportion to the population, is roughly equivalent to 400K cases a day in US.

e40 5y ago
Does anyone know what Israel is doing in terms of lockdowns, etc? Are they back to business as usual, or something else?
- helge9210 5y ago
  After two weeks in June mask mandate is back. Mass gatherings are limited. Certain fasciitis are available only to vaccinated. Practically, nobody cares anymore. Compared to first lockdown, when streets were totally empty (a sight to behold), last half a year is business as usual.

subsubzero 5y ago

What is not being said is some people are on the brink of death anyways and being vaccinated will not stop that trajectory(dying). The older you are the weaker your immune system is. A 97 year not vaccinated would most likely die after getting covid, either from the virus itself or an infection that happens after the body is weakened by the virus. The same fully vaccinated person may or may not die, if they do die its going to happen anyways but will be listed as a hospitalization/death from covid. A few other things about Israels vaccine program. - They started early(12/20) so I imagine alot of the populace is starting to run into vaccines that are less effective than if they were administered late Spring like US/UK and Europe. - I don't know what the obesity levels are like in that country but the CDC says there is a strong correlation between being obese and covid severity with a person. - Of the hospitalizations mentioned there is a strong indication of age being a cause for more severe illness: >Of the 514, 59% were fully vaccinated. Of the vaccinated, 87% were 60 or older

nradov 5y ago
That's reasonably accurate but it's nothing new. The other endemic "common cold" coronaviruses already had a high fatality rate for frail elderly patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095096/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095096/ There is a strong correlation between national obesity rates and COVID-19 death rates. https://www.bmj.com/content/372/bmj.n623 https://www.bmj.com/content/372/bmj.n623
Dwelve 5y ago
Those people that are on the brink of death don't get the vaccine and probably skew the metric in the other way. If you know the cancer patient has 2 weeks left you're not going to vaccinate him. If that same cancer patient dies with covid it'll be counted as an unvaxxed covid death

nradov 5y ago

How is this grim? Case numbers are mostly irrelevant now. What really matters is the death rate. Very few vaccinated people die, and the death rate for unvaccinated children is also extremely low. All of us are likely to become a "case" at some point no matter what we do. https://www.businessinsider.com/delta-variant-made-herd-immunity-not-possible-astrazeneca-developer-2021-8 https://www.businessinsider.com/delta-variant-made-herd-immu...

inter_netuser 5y ago
case numbers of course matter, because vaccines do not guarantee you will not end up with long covid, or many other consequences of a rough viral infection. Countless millions will live with a permanent disability their entire life.
- baumy 5y ago
  > Countless millions will live with a permanent disability their entire life. Extraordinary claims require extraordinary evidence. I see no reason to believe this at all. Side effects from a viral infection, and specifically coronaviruses, lasting for months or even a year or two afterward in uncommon cases are well documented. To say that "countless millions will live with a permanent disability" with regard to a virus that has only even existed in humans for ~2 years now is completely unfounded, and over dramatic.
  - deleted 5y ago
    [deleted]

rock_artist 5y ago

Israel indeed provides nice stats for Covid. Especially where some of the population aren’t fully complying with suggested/requested measures. So we pretty much see the vaccination performance. If it’s for health reasons (not leisure or traveling, PCR testing is free and there are many places available each day to test without scheduling. Anyway, I was “fully vaccinated” on March 2020 iirc. I didn’t yet get the 3rd/booster shot. And I’m writing this being isolated with mild symptoms after testing positive for Covid. (Hoping symptoms will regress and I’ll be out within 10 days). I have no reliable assumption from where I got it and me and my oldest son are the only ones tested positive out of my close family and others we’ve been in touch with.

dlevine 5y ago

The important thing is that the vaccines are having a large effect on Covid-related deaths. Despite the current number of reported cases in Israel being equal to (or even a bit over) the January peak, the number of deaths is much lower. According to Google's numbers, their current 7-day average number of deaths is 23, while in January they had a 7-day average of about 65. And it looks like the deaths peaked in the past week. https://www.google.com/search?q=israel+covid+cases&rlz=1C1CHBF_enUS743US743&oq=israel+covid+cases&aqs=chrome..69i57j0i131i433i512l2j0i512l3j0i131i433j0i131i433i512l3.3128j0j7&sourceid=chrome&ie=UTF-8 https://www.google.com/search?q=israel+covid+cases&rlz=1C1CH... For reference, the numbers in Florida (where vaccination rates are significantly lower) look a lot different. You have many more cases and more deaths than the January peak. https://www.google.com/search?q=florida+covid+cases&rlz=1C1CHBF_enUS743US743&sxsrf=AOaemvID_gOTqLL-QbEY79sgjTI5FtJUzA%3A1630617587318&ei=8z8xYaDbEtOd-gSWpbhg&oq=florida+covid+cases&gs_lcp=Cgdnd3Mtd2l6EAMyBAgjECcyCAgAEIAEELEDMgsIABCABBCxAxCDATIFCAAQgAQyBQgAEIAEMggIABCABBCxAzIFCAAQgAQyBQgAEIAEMgsIABCABBCxAxCDATIFCAAQgAQ6BwgjELECECc6BggAEAcQHkoECEEYAFDesyVYgrslYJPBJWgAcAJ4AIABoQOIAf4KkgEJMS40LjAuMS4xmAEAoAEBwAEB&sclient=gws-wiz&ved=0ahUKEwjgoLnwm-HyAhXTjp4KHZYSDgwQ4dUDCA8&uact=5 https://www.google.com/search?q=florida+covid+cases&rlz=1C1C...

nradov 5y ago
Vaccines are very effective at reducing the death rate but when making comparisons between countries or states we also have to adjust for population demographics. Florida has a median age of 42 whereas in Israel it's only 30. And more importantly Florida has 21% of the population over age 65 whereas in Israel it's only 12%. We know that age is a huge risk factor.

arminiusreturns 5y ago

> What is clear is that “breakthrough” cases are not the rare events the term implies. As of 15 August, 514 Israelis were hospitalized with severe or critical COVID-19, a 31% increase from just 4 days earlier. Of the 514, 59% were fully vaccinated. Of the vaccinated, 87% were 60 or older. “There are so many breakthrough infections that they dominate and most of the hospitalized patients are actually vaccinated,”

croes 5y ago

Better article about the vaccine effectiveness https://news.ycombinator.com/item?id=28221798 https://news.ycombinator.com/item?id=28221798