Why have the US death rates not come down?

It is 9 months since vaccines were rolled out in the US.
61% have received at least 1 dose.
54% are fully vaccinated.

The ratio between cases and deaths should have increased by now.
(Fewer deaths per case = bigger ratio)

Thread 👇
One possibility is that there are still many people who are not vaccinated, and these figures represent infection & death among the unvaccinated subgroup.

And if the unvaccinated are predominantly over 65, it would mean more deaths. See NYT article👇

2/

nytimes.com/2021/06/21/us/…
The above article states that in 11 states, at least 20% of older adults have not received even one dose.

The most logical explanation for the above graph is the combination of factors (older age group + being unvaccinated) existing in a large number of people.

3/
“Deaths have been concentrated among the unvaccinated. The CDC released studies showing that unvaccinated Americans were 4.6 times as likely to be infected, 10 times as likely to be hospitalized and 11 times as likely to die”

writes @jon_kamp in @WSJ

4/
wsj.com/articles/covid…
However, hospitals say the death rates have not come down, and that the age group has shifted to younger people. @jon_kamp writes that in Tampa General, the ICU patient’s age is only 46.

He finds that the share of deaths among <54 segment has increased to over 20%.

5/
“97% of COVID-19 deaths are in unvaccinated or partially vaccinated people” - report from Pennsylvania.

Death was 7.9 times more likely among these subgroups, when compared to fully vaccinated people.

The % of people needing ICU is more this year.

6/

media.pa.gov/pages/health-d…
In summary, it appears that even a relatively high rate of vaccination coverage will not bring down the death rate (as defined as the ratio of daily reported deaths / cases).

Reports indicate that most of these deaths are among those who have not had 2 doses of vaccine.

7/
What does this mean for the rest of the world?

Hybrid immunity is a potential solution: that is 1 dose vaccine among those who previously had COVID-19.

At least 2 antigen exposures will be required to keep deaths down, either by 2 dose vaccine or by hybrid immunity.

8/
The current % of vaccine coverage (2/1 dose):

UK 66/73
Canada 70/76
India 14/43
Vietnam 6.2/27
Zambia 1.6/1.7

Note: level of protection also depends on seroprevalence from natural infection. e.g. 80% seroprevalence was recently reported from unvaccinated people in Mumbai.

9/
The % vaccination coverage by country, @nytimes

See above thread 👆for context

nytimes.com/interactive/20…

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More from @RajeevJayadevan

17 Sep
Past infection did not provide additional protection from breakthrough infections.

ICMR study on 614 healthcare workers, half of whom each got covishield & covaxin.

Breakthrough infection rate was 13% in those with & without past infection.

1/6

assets.researchsquare.com/files/rs-88876…
Breakthrough infection rate is not provided for type of vaccine. Only overall number is given (13%, 81/614)

Antibody levels are seen to drop with time as expected.

Peak antibody levels are lower & the decline faster for covaxin, but this does not imply lower protection.

2/
The reason why a lower antibody level does not mean lower protection is that there are multiple components in the immune system that provide protection. Not all of them are measurable.

Besides, the study does not provide data that lower antibody level led to more infections.

3/
Read 7 tweets
16 Sep
Multiple issues with the widely quoted NEJM Israel study on boosters

Long thread👇

1. Authors report a lofty reduction in infections & severe cases by a factor of 11.3 & 19.5 in the primary analysis, where rates are compared between boosted & non boosted groups.

But ...

1/
2. In secondary analysis, this factor is down to 5.4. Secondary analysis compares rates within the SAME group, by timeframe. This is more believable not only because comparison is within the same group, but also because we know higher antibody levels reduce infection rates.

2/
Note: secondary analysis is available ONLY for infections, not severe cases.

In other words, we do not yet know if this 5.4-fold reduction in ‘infection’ will translate to reduction in hospitalisation/death later.

3. No mention of number of people who were hospitalised.

3/
Read 12 tweets
13 Sep
Detailed graphical representation of the story of the US elementary school teacher who infected 12 of her masked students by reading aloud without mask.

Lessons:

1. Multiple factors have to be in place to prevent outbreaks

2. Aerosol spread infects people both near & far

1/ Image
3. Masks did not protect the children from getting infected.

4. The teacher was unvaccinated, and had attended social gatherings.

5. She developed mild “allergy” symptoms which she chose to ignore (this could happen to anyone: wisdom is easier in hindsight)

2/ Image
6. Children in the next classroom also got infected, showing how far aerosols can travel

7. This also shows physical spacing is of limited value (think cigarette smoke in a room, spacing doesn’t change how the smoke spreads or smells)

3/
Read 6 tweets
28 Aug
Natural infection provides greater protection than (Pfizer) vaccination

Large study from Israel compared 3 groups of people

1. Past infection
2. Pfizer-vaccinated individuals
3. Those who had both

Please see WHOLE thread👇

1/
Large cohort of 673,676 vaccinated, 62883 past infection, & 42,099 vacc + past infection. The groups were matched to exclude confounding.

They looked at remote & recent past infection separately. Those who were infected in 2021 had greater protection than 1 year ago.

2/
The vaccinated group had a 27-fold greater risk of SYMPTOMATIC breakthrough infection compared to natural infection. The risk was 13-fold for ALL breakthrough infections.

A single dose of vaccine further increased the level of protection for those who had past infection.

3/
Read 14 tweets
26 Aug
Vaccines prevent deaths.

Audit of 281 COVID-19 deaths in Ernakulam showed that 98.2% of the deaths occurred among those who had not been (fully) vaccinated. i.e. only 1.8% of deaths were fully vaccinated.

@RajeevJayadevan Quoted in The Hindu today.

thehindu.com/news/cities/Ko…
🔺All deaths among the fully vaccinated, occurred in people older than 60.

The current vaccination coverage in adults is 68% (1 dose) & 24% (2 doses)

We can say the % of fully vaccinated is 24%, yet deaths in that category was only 1.8% - that is 92.5% lower than expected.

2/
These figures from death audits aren’t enough to calculate vaccine effectiveness.

But when we compare with current vaccination coverage, we get an idea of how much lower the deaths are among the fully vaccinated.

1.8% (observed rate) is 92.5% lower than 24% (expected rate*)

3/
Read 7 tweets
18 Aug
The reason why children are easily able to get rid of the SARS-CoV-2 virus is due to a super-efficient innate immune system in their airways, as was hypothesised earlier (not from ‘less ACE2 receptors’).

Innate immunity is our “rapid response unit”.

1/4

nature.com/articles/s4158…
Innate immunity refers to those defence mechanisms that are the “first responders”- even before an exact ID of the attacker is known.

Adults respond less efficiently.

As a result, there is an imbalance between the various departments of our immune system, which isn’t good.

2/
SARS-CoV-2 virus is super-replicating, and turns off our innate immunity early (interferons are part of this) to aid the “stealth factor”.

It is harder to do so in children - who have a hyper-alert system that outperforms adults in the 1st 4 days of infection, authors find.

3/
Read 4 tweets

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