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Prof Jeffrey S Morris

@jsm2334

Jun 7

How can excess deaths be higher in 2021 in 2020 if vaccines had any benefit?

This is a good question I see many ask.

Some conclude from this question that vaccines must have been completely ineffective, or perhaps even have made things worse.

In this thread, I will show that this is not the contradiction that it appears to be.

If you look at the available data and studies and think through the various relevant factors, it is clear that the following are simultaneously true:
1. Excess deaths in the world were higher in 2021 than 2020
2. Vaccines were highly effective in reducing risk of covid death, the primary driver of excess deaths.
3. The excess deaths in 2021 would have been MUCH WORSE had there not been covid vaccines.

The key factors I will highlight in this thread include:
1. Far more people were exposed to COVID-19 in 2021 than 2020
2. In most places, the strict containment measures of 2020 were lifted in 2021
3. The variants emerging in 2021 were demonstrably more transmissible than those in 2020
4. The vast majority of people in the world were unvaccinated for most of 2021
5. Vaccines were highly effective in 2021, but not perfect.

1. Far more people were exposed to COVID-19 in 2021 than 2020

While the pandemic first emerged and was most disruptive in 2020, relatively few people were actually exposed to SARS-CoV-2 in 2020.

Below are plots of confirmed COVID-19 cases over time in the world from OWID

We see that only 1% (10k per 1m) of the world had confirmed COVID-19 cases in 2020, while another 2.5% (25k per 1m) had confirmed COVID-19 cases in 2021.

So we see 2.5x more confirmed COVID-19 cases in 2021 than 2020, with 2021 a full pandemic year and 2020 only a partial pandemic year.

Of course, most SARS-CoV-2 infections are not formally documented as confirmed cases, so more than 1% were exposed to SARS-CoV-2 in 2020.

Serology studies from around the world provide more information about what % were exposed to SARS-CoV-2.

Serology tests measure SARS-CoV-2 antibodies in the blood to measure whether an individual shows evidence of exposure to SARS-CoV-2, whether or not they were ever documented as a confirmed case.

Bobravitz et al. (2021) published a meta-analysis of 968 serology studies with >9 million participants from 74 countries all over the world.

They found that the median seroprevalence ranged from 0.6% in East Asia to 19.5% for Sub-Saharan Africa, with high-income countries including Western Europe and the USA having median seroprevalence 4.1%.

Seroprevalence studies are notoriously difficult to conduct to get unbiased estimates of population exposure, but whatever the precise numbers are, this meta-analysis makes it clear that the VAST MAJORITY of people in the world were not exposed to SARS-CoV-2 in 2020.

journals.plos.org/plosone/articl…

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Prof Jeffrey S Morris

@jsm2334

Jun 6

https://x.com/bmj_company/status/1798751750046019666

Mostert et al. published a paper in BMJ Public Health “Excess Mortality across countries in the Western World since the COVID-19 pandemic: ‘Our World in Data’ estimates of January 2020 to December 2022”
()

The paper presents excess death estimates for 47 Western countries from the publicly available “World Mortality Dataset” (Karlinsky and Kobak, 2021) and reports excess deaths from 2020-2022, with 13 countries peaking in 2020, 21 in 2021, and 12 in 2022.

Their conclusion expresses surprise that excess deaths continued from 2020 into 2021 and 2022 “despite the implementation of containment measures and COVID-19 vaccines” claiming “this raises serious concerns.”

They discuss several potential causes of excess deaths, but do not delve into any detail about the evidence or lack thereof for any of them based on existing literature and data.

Their conclusion is that “government leaders and policymakers need to thoroughly investigate the underlying causes of persistent excess mortality”, implying there is not already substantial evidence for what the primary driving factor is, and that studies investigating potential causes of excess deaths are not being done.

Overall, I welcome any call for more studies characterizing how the pandemic affected mortality rates and investigating potential primary and secondary contributing factors. I’m always in favor of more data and studies (and that they are appropriately analyzed using valid statistical approaches).

However, this study does not accurately represent the existing understanding about sources of excess deaths, downplaying the COVID-19 deaths that are clearly the driving factor throughout 2020-2022, as I will show, and implicitly magnifying the potential role of vaccines beyond what is supported by the data.

Also, many popular media articles about this study, including the Telegraph article () entitled “Covid vaccines may have helped fuel rise in excess deaths”, blatantly misrepresent the content of the paper.

They make it sound as if the paper was primarily about vaccines, which it is not, or provides evidence for vaccines being a potential driving factor, which it does not.

This misrepresentation is so egregious that BMJ felt the need to post a statement about it() and, who knows, may be considering retraction of the article.

In this thread, I will discuss some of these points.bmjpublichealth.bmj.com/content/2/1/e0…
telegraph.co.uk/news/2024/06/0…

https://x.com/bmj_company/status/1798751750046019666

First, I am not sure why this article is classified as “original research” and not a “narrative review” or “commentary”.

There is no primary data collection or original data analysis in this paper.

The study design and text and equations for the methods are almost verbatim from the public repository for the World Mortality Data set (WMD, Karlinsky and Kobak 2021 ) which is also where they got their data. The authors cite the paper, but it is highly unusual in an “original research” article to have such large sections match so closely with an existing publication and with nothing new added.

Their results are simply the publicly available excess deaths from Karlinsky and Kobak’s WMD for 47 countries, aggregating by month and year to get total excess counts in 2020, 2021, and 2022, with the results simply showing that there were excess deaths in 2020, 2021, and 2022, which has been well known for a long time.

I have no idea how BMJ Public Health considered this manuscript sufficiently novel for publication as an “original article”.

The remainder of the paper consists of a narrative-driven review of various aspects of the pandemic and a commentary suggesting further investigation of causes of excess deaths, following the format of a “narrative review” or “commentary”, not an original research article.elifesciences.org/articles/69336

Outside of the fact that the work is not original, there is nothing wrong with presenting excess deaths data by 2020, 2021, and 2022.

While the paper closely tracks with Karlinsky and Kobak’s work in many ways, it ignores one of the primary points made in Karlinsky and Kobak’s article: the fact that the excess deaths track so closely with covid deaths.

Below I plot the WMD excess death data from Karlinsky and Kobak (black) overlaid with covid-attributed deaths (red) and vaccines given (blue) for 100 countries from all over the world, including most of the 47 Western nations in this paper plus many others (and these plots go all the way through the end of 2023).

It is clear from looking at these data that:
1. High excess deaths predominately occur in spikes.
2. These spikes precisely correspond to spikes in COVID-attributed deaths
3. These spikes are during times of local COVID-19 waves

This close correspondence makes it clear that these “COVID-attributed deaths” are the primary drivers of excess deaths not just in 2020, but throughout 2021 and 2022, as well.

Failure to acknowledge this is a glaring omission in this paper.

Read 17 tweets

Prof Jeffrey S Morris

@jsm2334

May 2

In this thread I will make some comments on the recently published paper in Cureus entitled "Increased age-adjusted cancer mortality after the third mRNA lipid nanoparticle vaccine dose during the covid-19 pandemic"

The title is extremely misleading, given their data do not show an increase in age adjusted cancer mortality, and the paper provides no evidence relating the cancer mortality trends to the 3rd doses of mRNA vaccines given in the country outside of simple post hoc arguments based on the fact they were given in 2022.

Their paper shows that the age-adjusted cancer mortality remains stable and in fact slightly decreases, but it decreases at a slower rate than predicted by linearly extrapolating pre-pandemic decreases in cancer mortality from 2010-2019.

They don't provide any evidence that the vaccinated or those receiving 3rd dose boosters are at any higher risk of cancer death than those of similar age/co-morbidity status who didn't, or otherwise provide any evidence that vaccination is responsible for the arrest of the pre-pandemic decreasing trend and not any one of the many other factors greatly impacting life in Japan during the pandemic.

While the paper summarizes a large and important data set and does some nice things (like compute age-adjusted rates), the general conclusions they make, and certainly the conclusions that people are representing about the paper on social media, are not supported by the data.

cureus.com/articles/19627…

First, some positives.

This paper analyzes a large data set of population-level cancer death rates in a large country, Japan, and this type of large data set is valuable for assessing trends during the pandemic.

The authors duly recognize that changing age distributions over time impact the cancer incidence and death rates, so compute age-adjusted cancer mortality estimates which is the right approach to assess changes over time.

They also looked at subgroup analyses by cancer type and age, which provide useful breakdowns in smaller groups that can shed light on the trends.

However, the paper does not show a total increase in age-adjusted cancer death rate in Japan during the pandemic, and certainly not from 2021 to 2022 when "3rd doses" were given, in spite of what its title implies.

As can be seen in their own data, the age-adjusted rates were actually stable throughout the pandemic from 2020 to 2021 when the first 2 vaccine doses were given and 2022 when the 3rd doses were given to some, and in fact the age-adjusted cancer death rate actually decreased from 2021 to 2022.

They do show "excess deaths" increased from 2020 to 2021 and then 2022.

So where do these excess cancer deaths come from if not from increasing cancer death rates?

Read 9 tweets

Prof Jeffrey S Morris

@jsm2334

Feb 28

Here I will briefly discuss this paper you linked talking about negative effectiveness observed in some subgroups for a small subset of studies

I will first summarize their points, and then go through every study they mention.

It is not a reasonable viewpoint that vaccines have negative effectiveness and make covid risks worse based on the many published studies and data

Here is their overall conclusions: that these rare cases where negative VE is observed is likely causedThey discuss some of these ,biases by confounding bias in settings where true VE is very small such as Omicron vs infection long after vaccination

First they mention negative effectiveness estimates are rare even for omicron - with many studies finding only positive effectiveness, and the cases of negative effectiveness typically only in one of numerous subset analyses with small sample size and few events

They point to these factors and suggest the negative point estimates are likely resulting from bias

Read 10 tweets

Prof Jeffrey S Morris

@jsm2334

Jan 31

An Epoch Times article discusses a recent paper by FDA researchers assessing safety of Pfizer and Moderna bivalent boosters given to 8,638,661 and 5,240,178 individuals, respectively, comparing incidence rate of 18 different serious adverse events of special interest (including various cardiovascular events) in data bases from Carelon Research, CVS Health, and Optum.

Out of all 18 events, they only identified safety signals for:
1. anaphylaxis for both vaccines 18-64yr in 1 out of the 3 data bases (but not the other 2), and
2. myocarditis/pericarditis for 18-35yr for Pfizer vaccine in 1 out of the 3 data bases (but not the other 2)
They concluded results were consistent with previous studies and supporting the safety profile for these vaccines

However, the Epoch Times article highlights the following numbers, suggesting they are from this paper:
1. anaphylaxis rate was 74.5 cases per 100k person-years following Pfizer vaccination
2. anaphylaxis rate was 109.4 cases per 100k person-years following Moderna vaccination
3. myo/pericarditis rate was 131.4 cases per 100k person-years
These figures to a novice reader might make one think that the rate of anaphylaxis per person is
1 per 1342 (100,000/74.5) after Pfizer,
1 per 914 (100,000/109.4) after Moderna,
and the rate of myo/pericarditis is
1 per 761 (100,000/131.4) after Pfizer,
which would seem alarmingly high, seemingly contradicting the conclusions of the paper. However, this is completely false.

As I will show in this thread, these figures:
1. were not even reported in the paper, but computed for the Epoch Times article from Table 3.
2. were actually mis-computed from Table 3 in the paper
3. based on rate per person-year is not the most useful summary for incidence after vaccination given the time frame for these events varies from 2 days (anaphylaxis) to 28 or 42 days after vaccination, and easily misconstrued/misinterpreted.

Looking at the paper, what they actually found for incidence was:
1. anaphylaxis from d0-d1 after bivalent vaccine booster occurred at rate between 1/4.3m and 1/430k for Pfizer, and between 1/2.6m and 1/260k for Moderna
2. myo/peri-carditis from d0-d21 after bivalent vaccine booster occurred at rate of 1/27k for Pfizer and 1/29k for Moderna
3. For 5-17yr olds, the myo/peri-carditis rate from d0-d21 after bivalent vaccine booster occured at rate between 1/535k and 1/54k for Pfizer, and <1/50k for Moderna
4. For 18-64yr olds, the myo/peri-carditis rates from d0-d21 after bivalent boosters was 1/53k for Pfizer and 1/55k for Moderna

These are in line with previous literature, and not alarming -- the calculation and inclusion of the rates per person-year in the Epoch article appear to be trying to exaggerate the risk

I'll transparently explain where I get these numbers from in this thread...

theepochtimes.com/health/fda-fin…

First, let's consider the anaphylaxis data. Here is the part of Table 3 containing the number of cases and person-years of follow up for two vaccines for the different age groups.

Privacy rules forbid them from publishing any raw counts <11 in the table, so "<11" means some unknown number between 1 and 10.

Based on that I compute the event rate per 100,000 person years.

For Pfizer, we see that combining age groups, the event rate is between 4.3 and 42.7 anaphlaxis events per 100k person-years

This is significantly lower than the 74.5 per 100k person-years that Epoch put in their article -- not sure where they got that from.

However, this is not a very meaningful measure since this event is only defined at d0-d1 after vaccination, meaning a person is only at risk for 2 days for this event.

It would be more meaningful for us to consider the proportion of individuals who experience anaphylaxis in d0-d1 after the vaccine, i.e. at the individual level, not person-years.

To compute the incidence per person, we need to consider the number of individuals given each vaccine in each age group, which was given in Table 2 in the paper:

Read 12 tweets

Prof Jeffrey S Morris

@jsm2334

Jan 8

1/n
Annals of Internal Medicine just published our epidemiological study of vaccine effectiveness in children and teens during the delta and omicron waves based on large USA pediatric cohorts accounting for nearly 4% of the USA pediatric population.

The study found strong vaccine effectiveness vs. infection, severe disease, and ICU during the delta wave for adolescents and the omicron wave for children and adolescents, with no evidence of increased risk of cardiac outcomes.

Senior authors are Yong Chen, Christopher Forrest, and Jeffrey S Morris, and Lead authors are Qiong Wu and Jiayi (Jesse) Tong.

#PEDSNet #COVID_19 #COVIDVaccine @ChildrensPhila @UPennDBEI @PennMedicine

acpjournals.org/doi/10.7326/M2…

2/n
Study Data
This study was done using electronic medical records data from PEDSnet, a network of 8 USA pediatric health systems across 23 states and the District of Columbia, capturing nearly 4% of all children and adolescents in the USA, including large primary care systems, including the Children’s Hospital of Philadelphia, Nationwide Children’s Hospital, and Nemours Children Health.

This study included a total of 77,392 adolescents (45,007 vaccinated) during the Delta wave, a total of 111,539 children (50,398 vaccinated) and 56,080 adolescents (21,180 vaccinated) during the Omicron wave, with extensive follow up of these cohorts providing the longest follow up among studies of pediatric vaccine effectiveness.

3/n
Study Cohorts
For the Delta substudy, we identified adolescents vaccinated between July 1, 2021 and November 30, 2021, and found a matched cohort of unvaccinated individuals, choosing for each an index date such that the distribution of index dates in vaccinated and unvaccinated individuals matched (preventing calendar time confounding), and requiring health encounters in the system to avoid healthcare seeking behavior confounding.

For the Omicron substudies, we identified children (age 5 to 11) and adolescents (age 12 to 20) vaccinated between January 1, 2022 and November 30, 2022, again choosing an unvaccinated control cohort with index dates chosen such that vaccinated and unvaccinated distributions matched.

For each individual, we had access to extensive demographic and medical information including vaccination status, COVID-19 outcomes, and various potential confounders that we could take into account.

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