NEW: people obsess over vaccine uptake stats, eagerly comparing one country to others to see which has jabbed the highest share of its population, but what if I told you many — perhaps most — of those stats are wrong?

Time for a thread on bad Covid data and how it can cost lives
Let’s start with the most obvious sign of the problem:

In several European countries, the share of elderly people who have been vaccinated exceeds 100%.

To state the obvious, this is not possible.

But it’s not just a funny quirk, it has big implications.
In reality these countries won’t have reached 100%, so there are tens of thousands of unvaxxed elderly that are invisible, and no-one is going to visit someone to make sure they’re jabbed if they think everyone is jabbed.
And this is critically important, because due to their far greater vulnerability, jabbing the last few elderly people will save far more lives than jabbing far larger numbers of kids.
So what’s going on?

It all comes down to population data. In short, most governments don’t know how many people live in their country, so they estimate

Censuses are usually every decade, so right now, ~9 yrs on from the last one in many cases, the estimates are especially shaky
So what we’re really seeing when vaccine uptake exceeds 100%, is a country discovering it has more people that it thought it did.

But what that means is there could still be thousands of unvaccinated people out there.
When the US decennial census landed last month, it showed there were fewer white people than estimated, and more Asian & Hispanic people.

The result: white vax uptake higher than thought, but there are more unvaxxed Asian and Hispanic people than realised
And sticking with the US, it gets worse:

In Florida, vaccine uptake may have been hugely over-stated in official CDC figures, because people who were vaccinated while visiting Florida in winter but usually live elsewhere, have been counted in Florida’s vaccine coverage data.
In Miami-Dade, vax coverage among over-65s exceeds 100% in *more than half of all zipcodes*, in some cases passing 200%.

This is the "snowbird" effect: thousands of older folks went south to Miami in winter, got jabbed, then returned north
At the state-level, this causes a major discrepancy:

According to CDC data, just 3.7% of people aged 65+ have not yet had any vaccine dose.

But Florida’s department of health, which only includes Florida residents, says 12% of the elderly are still unprotected. More than 3x.
Again, this may just feel like a curious quirk, but it’s a matter of life or death.

As @redouad put it to us, "if we take a step back and imagine this as a new disease and we say that 10 per cent of the population is susceptible vs five per cent, that’s a huge difference"
And that’s exactly what played out in Florida.

If we trust CDC data, when Delta hit FL its elderly were as well-protected as those in Maryland. Just 10% unvaxxed.

But if we use residents only, its vulnerable elderly pop was twice as big — more like Georgia.

What happened next?
FL had a brutal wave, setting records for deaths. It looked much more like Georgia than Maryland, whose Delta wave has been much more muted.
As Miami Beach mayor @MayorDanGelber put it, the official data created a false sense of security in Florida, quite possibly contributing to people behaving less cautiously.
And the population denominator issue isn’t just a problem for vax uptake.

Here in England, anti-vax activists have been circulating data published by @UKHSA which appears to show case rates are higher among fully-vaxxed people than among the unvaxxed 🚨❓
But once again, this is due to misleading population data. NIMS — the system used by UKHSA — is known to double-count large numbers of working-age adults.

The result is NIMS thinks there are far more unvaxxed people than there are, pushing unvaxxed case rates artificially low.
When you use the @ONS’ population estimates, which — while still just that, estimates — don’t suffer the same double-counting flaw, it turns out that in all of those age-groups, the unvaxxed are actually much more likely to get Covid than the vaxxed, as we would expect.
There are still quirks — among the most elderly, the roles are reversed and ONS almost certainly overstates the population size, pushing unvaxxed case rates too low — but the persistent use of NIMS data, known to produce these misleading outcomes — is puzzling, to put it mildly.
So with that, here is the full version of our deep dive into the thorny issue of denominators, and the problems they can cause, from me and @mroliverbarnes ft.com/content/125fba…
And to conclude, here are 5 key take-aways:
1) National vax uptake figures could be out by ~2-5% in many cases, and among some subgroups the discrepancies will be much greater
2) So please stop eagerly saying country X is beating country Y because its uptake is 2-3% higher
3) Be especially careful when countries use markedly different denominators. e.g English stats are usually published using NIMS denominators (so will under-state uptake), while Scotland uses ONS (and is known to over-state uptake, at least in some age-groups).
4) Pay very careful attention to methodology and footnotes. Does the data you’re looking at include residents-only, or could it suffer from Florida’s snowbird problem?
And finally
5) Small errors in uptake rates can have huge impacts. The difference between 85% vaxxed and 95% vaxxed is better expressed as 15% vulnerable vs 5% vulnerable, i.e triple the death toll.
Addendum:

As @fedetiberti points out, we see the same thing in several Latin American countries like Argentina and in particular Peru, where in some instances vaccine uptake is in the 130%-140% range
Oh, and I really can’t end this without a shout-out to fellow Denominator Crusaders @PaulMainwood @VictimOfMaths @JamesWard73 and probably many many others. We’ve been banging on about this for several months.

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More from @jburnmurdoch

2 Oct
Really interesting story from @mjruehl in Singapore (82% of population fully vaxxed), where the transition from Zero Covid to living with the virus is not going smoothly to say the least. on.ft.com/3maIJnW

Lots of lessons here for Australia, New Zealand and others
As @mjruehl writes, Singapore's problem stems from the interplay of two factors:
• A population that has become extremely nervous and worried about *any* Covid
• A policy of mass testing asymptomatic people, many of whom rush to hospital after a positive, even if symptom-free
The local reaction has been, as ever, polarised. Healthcare professionals have criticised the mass testing policy [given the context in which it's being rolled out], while 25% of the population want a return to lockdown, and there are petitions to reintroduce quarantine hotels.
Read 7 tweets
15 Sep
NEW: lots of news recently on waning immunity against infection, but a study has now landed from Public Health England on how vaccines are faring against *severe disease & death*

This chart summarises key findings, but the paper is a real goldmine, so let’s dig into more detail:
First up, fresh data on protection against symptomatic infection. Key results:
• We knew protection started out lower among older groups. Now we know they also see the most waning
• Waning much more muted (if happening at all) among under-65s
• Moderna > Pfizer > AstraZeneca
Sticking with symptomatic infection, they also looked at a hot topic: the impact of the interval between first and second dose

Very short intervals (3 weeks, e.g in US) produce lower protection than longer intervals (e.g UK & Canada), though note overlapping confidence intervals
Read 23 tweets
23 Aug
NEW: in the last couple of weeks there have a *lot* of new studies out assessing vaccine efficacy, many of which have touched on the question of waning immunity.

Unsurprisingly, these have prompted a *lot* of questions.

Time for a thread to summarise what we do and don’t know:
Let’s start with last week’s Oxford paper, the most significant study to date on waning immunity to Covid.

The researchers found signs that vaccine efficacy against symptomatic infection erodes over time, and that waning may occur faster in some vaccines than others.
Unsurprisingly, this prompted a lot of questions.

Could it just be that the first people to be vaccinated were older, and perhaps more vulnerable to waning?

Nope. The study controlled for age.
Read 33 tweets
30 Jul
NEW: lots of attention on ONS Infection Survey today, but some confusion over how it should (and should not) be used to asses whether England’s fall in cases is "real"

Quick thread:

Most attention has gone on ONS “% of people testing positive” metric showing a continued rise
But "testing positive" is a lagging indicator of cases. It estimates how many *have* Covid today, not how many are *catching it* today.

Fortunately, ONS has re-introduced its incidence data (blue line), which is a much better yardstick for cases, though always 2 weeks old 😩.
So how to resolve issue of one lagging indicator, and one that’s 2 wks old?

Look to Scotland, where cases peaked 2 wks before England, so ONS indicators have had time to catch up

Turns out ONS incidence fell at exactly same time as cases 🙂. ONS positivity likewise, just lagged
Read 10 tweets
27 Jul
There’s a wild story about the women’s gymnastics at the Sydney Olympics in 2000, which I think is very relevant to what we’re hearing about Simone Biles, and the wider point of how the top level of elite sport is just as much mental as it is physical.
In the women’s all-round final in 2000, the organisers set the vault at the wrong height. Two inches too low. This was a pretty huge deal.

For competitors who have done thousands, maybe tens of thousands of vaults at a specific height, a two inch difference is night and day.
In the first round, 17 of 36 finalists fumbled the vault

One landed on her back. Clear gold-medal favourite, Russia’s Svetlana Khorkina (comfortably won qualifying) landed on her knees.

Total chaos, and nobody knew why. Athletes second-guessing themselves.
Read 13 tweets
27 Jul
Correcting an important misconception (this is my chart, but misleading commentary):
•There were thousands more cases among young men than women after ⚽️ matches, showing impact of Euros on transmission
•But not due to attending matches. It was indoor gatherings to watch games
Of course, that still means the transmission bump was driven by the football, but match attendance is only a small part of the cause. The bulk is mixing in pubs, bars, homes etc, plus some from crowded transport to and from those indoor gatherings (and matches).
Thoughts on implications:
• I would guess these watch parties happen at a much larger scale for England games at major tournaments than they do for typical club games, but we've not had pubs fully open during the season yet so that will be worth monitoring.
Read 5 tweets

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