Covid-19

[principal]

That’s not what mid was saying. What he said, is in his statement, what you said is a separate argument. Sure, if the country was a bit healthier, the pandemic may be marginally better here. However, then what is Italy’s excuse since they are one of the healthiest countries in the world? Our culture here is probably just as big of a factor as overall health as it relates to covid. Plus, a virus is going to do what a virus is going to do.

MiD can chime in, should he so choose, in regards to what he meant.

I think Italy has at least two problems:

1. An older population (one of the oldest in the world according to this website: https://www.statista.com/statistics/...-by-age-group/)
2. From what I recall at the beginning of the pandemic, Italy did a poor job of protecting the elderly (whether that was due to choices made or lack of preparedness or some other factor I do not recall).

If you have an older population and don't prioritize their protection, you are going to see a lot of death in a situation like the one we find ourselves in now.

I agree, the virus is going to do what the virus is going to do. It looks like we can mitigate to a degree, but a virus seems to find a way so that we are, at best, delaying the inevitable - and if we go the route of lockdowns we are destroying the economy and, arguably, delaying the development of herd immunity. As for the vaccines, it appears the one possible mitigating effort that might work may require a booster every 6-8 months (at least when a new variant such as delta becomes dominant).

Principal

[GIMMFD]

Below is an excerpt from an interesting article from the NIH website. The article was written in 2008 and discusses the difference between absolute risk and relative risk. It states that when determining the usefulness of a treatment it is the absolute risk reduction that should be considered moreso than the relative risk reduction. Here is the excerpt which explains each term and states that absolute risk reduction is "the most useful way of presenting research results to help your decision making".

Here is the excerpt:

"How do you interpret the results of a randomised controlled trial? A common measure of a treatment is to look at the frequency of bad outcomes of a disease in the group being treated compared with those who were not treated. For instance, supposing that a well-designed randomised controlled trial in children with a particular disease found that 20 per cent of the control group developed bad outcomes, compared with only 12 per cent of those receiving treatment. Should you agree to give this treatment to your child? Without knowing more about the adverse effects of the therapy, it appears to reduce some of the bad outcomes of the disease. But is its effect meaningful?

This is where you need to consider the risk of treatment versus no treatment. In healthcare, risk refers to the probability of a bad outcome in people with the disease.

Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. In this example, the ARR is 8 per cent (20 per cent - 12 per cent = 8 per cent). This means that, if 100 children were treated, 8 would be prevented from developing bad outcomes. Another way of expressing this is the number needed to treat (NNT). If 8 children out of 100 benefit from treatment, the NNT for one child to benefit is about 13 (100 ÷ 8 = 12.5)."

Here is the link: https://www.ncbi.nlm.nih.gov/books/NBK63647/

The reason I wound up reading this article is because someone sent an article to me regarding the efficacy of COVID vaccines which pointed out that the 95% figure we have heard is the relative risk reduction, not the absolute risk reduction. The article states that the relative risk reduction of the COVID shots ranges anywhere from 67% (AstraZeneca/Oxford and Johnson & Johson) to 94-95% (Moderna and Pfizer/BioNTech). It further states that the absolute risk reduction ranges from .084% (Pfizer) to 1.2-1.3% (AstraZeneca/Oxford, Moderna, Pfizer/BioNTech).

Now, I'm not sure what to make of all of this information. From what I recall the vaccine manufacturers are reporting the relative risk reduction figures (their calculations are all over the Internet and should not be tough to verify). It should not be hard to calculate the absolute risk reduction - the formula is provided above. If the absolute risk reduction is accurately reported above, why is the vaccine being pushed for those who are not in high risk categories?

MiD and XU_Lou - any thoughts?

Principal

Just to add to this, these statistical tests are called "Measures of Effects," it's used by epidemiologists to assess the relationship between an exposure event and outcome measure, they include (but aren't limited to):
- Absolute Risk: The incidence of the disease
- Attributable Risk: Difference in the risk between the exposed and unexposed groups (Att Risk = Incidence of disease in exposed - Incidence of disease in unexposed) or RR-1/RR (I'll explain RR)
- Number Needed To Treat (NNT): Number of individuals needed to be treated in order to benefit one patient; NNT = 1/Absolute Risk Reduction
- Relative Risk (RR): Expresses how much more likely an exposed person is to get the disease in comparison to an unexposed person, indicating relative strength of association between exposure and disease; RR = incidence in exposed/incidence in unexposed, where RR >1 suggests increased risk, and vice versa.
- Odds Ratio: Used in case-control studies, tells us how much more likely it is that a person with the disease was exposed to a risk factor than someone without the disease, the lower the disease prevalence, the more closely it approximates RR, and also in case-control studies OR describes how many times more likely an exposed individual is to have the disease compared to unexposed. OR = odds that a diseased person is exposed / odds that a non-diseased person is exposed
- Hazard Ratio: Estimate of the chances an event occurs in the treatment arm of a trial vs non-treatment arm, calculated similar to OR, and HR <1 indicates treatment arm had less likelihood of an event, and vice versa.

Absolute Risk is the likelihood of an event happening under certain conditions or parameters. Absolute Risk Reduction is the absolute difference in one group (usually control) and the group receiving treatment, the percentage basically tells you how much the risk of something happening decreases if a certain intervention is done. So let's say you make a little square, with 4 boxes, the x axis is Adverse Event, and the two boxes A & B correlate to Occurs or Doesn't Occur, y correlates with Experiment as the first option (for A & B), Control the second treatment for boxes C & D; (so now, adverse event occurs, and is in the experimental group is A; adverse event doesn't occur, and is in the experimental group is box B; adverse event occurs and is in the control group C, and adverse event doesn't occur and is in the control group box D). This box sets up all of your calculations. Absolute Risk Reduction is calculated as: C/C+D - A/A+B.

Relative Risk Reduction tells us how much lower the modified risk is than the starting risk as a population, and is calculated as 1-RR. I don't know if the numbers are relative risk reduction or absolute risk reduction that the companies used, but I'll look into it.

[principal]

An article that addresses the relationship between overall health and the likelihood of serious illness, hospitalization, and death from COVID:

https://www.jpost.com/health-science...nalysis-677426

An excerpt:

"Severe COVID-19 – hospitalization, treatment in an intensive care unit, mechanical ventilation and even death – has been associated with higher body mass index, the Centers for Disease Control has said. Specifically, obesity defined by BMI increases the odds of hospitalization by 76%, Boaz showed in a paper that is soon to be published but has not yet been peer reviewed. She said the likelihood of ICU admission increases by 67%, mechanical ventilation by 119% and death by 37% – all according to recent studies."

To my earlier point, the doc referenced in the article says this about public health policy:

"She stressed that public health policy should be directed at improving diet quality, especially among youths who are much more likely to follow healthful practices if taught from an early age."

I do not see this as the main thrust of public health policy in this country.

Principal

[Muskie in dayton]

Apparently I was more sarcastically cryptic than I intended (none of the three interpretations were right).

Lloyd I understand the issue, but my point is that medical issues related to one's poor decision making are not at all unique to the covid vax, so that becomes a very bad (not to mention unethical) reason to deny medical care. Even more importantly, it's a TERRIBLE way to try and motivate the vax-hesitant. I'll explain.

By now the majority of the hesitant (at least those with no logical reason like natural immunity or vax allergies) are so because they don't trust the government, the medical/pharma community, or both. So coercion, bullying and other forceful tactics won't work. In fact they'll just increase their recalcitrance. If anyone thinks "hey, let's just start denying medical care to the unvaccinated, and they'll all just decide to go get the jab", is sorely mistaken. This will only exacerbating the problem.

Separate topic but Lloyd, help me understand. I hear many reports of hospitals being at capacity, including very creditable sources. But I look at hospital census data on-line for the same geographies, and it appears there are beds available. What gives?

[Muskie in dayton]

MID - “It’s not FDA approved!”
Not FDA approved!
Xville- FDA approved!
SB- FDA ?
The FDA ?
MID. Lou and SB-do we trust the FDA?!
“Y’all really trust the FDA?!” it's the "guvment." Nah!!

Huh? Are you drinking and posting again, Bobbie?

[Muskie in dayton]

It's not a "liberal narrative" when I post a chart reflecting hospitalization numbers and deaths in the state of Florida.
It's just a set of numbers that have no politics.
I hope they come down for whatever reason. Loosing people to a disease that may have been prevented with a vaccine seems a tragedy to me.

Oh, you just happened to pick Florida, despite the fact that at least a dozen other States are spiking to new record levels. But your point was just to promote the vax. I see, so you selected Florida because their vaccination rates are so low. Except that they are not - they are right at the national average.

DeSantis is in the cross-hairs of the liberal media, and this is simply a manifestation of what your TV is telling you, whether you realize it or not. Turn off the CNN Paul.

[Lloyd Braun]

Apparently I was more sarcastically cryptic than I intended (none of the three interpretations were right).

Lloyd I understand the issue, but my point is that medical issues related to one's poor decision making are not at all unique to the covid vax, so that becomes a very bad (not to mention unethical) reason to deny medical care. Even more importantly, it's a TERRIBLE way to try and motivate the vax-hesitant. I'll explain.

By now the majority of the hesitant (at least those with no logical reason like natural immunity or vax allergies) are so because they don't trust the government, the medical/pharma community, or both. So coercion, bullying and other forceful tactics won't work. In fact they'll just increase their recalcitrance. If anyone thinks "hey, let's just start denying medical care to the unvaccinated, and they'll all just decide to go get the jab", is sorely mistaken. This will only exacerbating the problem.

Separate topic but Lloyd, help me understand. I hear many reports of hospitals being at capacity, including very creditable sources. But I look at hospital census data on-line for the same geographies, and it appears there are beds available. What gives?

To be clear I was not advocating for denying treatment to the unvaccinated as stated in the first reply. Denying medical treatment is unethical in general. I was however simply pointing out that not all personal choices are created equal and this is in fact a special circumstance that is straining the health system among other things. On a very basic level we already charge people more for poor choices. How many insurances have “incentives” for the wellness physical and not using tobacco? Quite a few. The Diocese of Cleveland does and anyone employed by the Diocese of Cleveland gets “incentives” for not smoking and getting a preventative exam. In reality this is a penalty for smoking to the tune of $20/month or something in that ballpark. Is that ethical? I think it is because there are ample resources to quit smoking. It’s incredibly difficult but not impossible.

Rather than denying treatment, there are human choices being made every day on some level to give treatment to one person over another. I am faced with this situation pretty much every day during covid spikes. Let’s say I am coordinating treatment for covid and there is one bed left. Or one appointment left for an infusion. Or one ventilator. Or one _____ whatever the resource may be. Let’s say I have two orders on my desk and know there is only one resource, how do I choose which patient to have treatment today and which one to delay until tomorrow? Often times the risk for complications is equivalent with the exception of vaccination status. When all things are equal I typically give treatment to the unvaccinated individual first, and at times begrudgingly once I hear why they chose not to be vaccinated. But I know that the outcomes are worse for the unvaccinated so my thought process is that there’s a better chance the vaccinated individual can wait an extra day and probably be ok. Try explaining that to the vaccinated patient when they get bumped…

Regarding beds available I would have to see an example… I don’t have access to other states’ data but in Ohio we are not at capacity in most areas. Still many rooms available for now. The outpatient side has been picking up for 2 weeks though, which usually results in hospitalizations in another 2 weeks.

[paulxu]

Oh, you just happened to pick Florida, despite the fact that at least a dozen other States are spiking to new record levels. But your point was just to promote the vax. I see, so you selected Florida because their vaccination rates are so low. Except that they are not - they are right at the national average.

DeSantis is in the cross-hairs of the liberal media, and this is simply a manifestation of what your TV is telling you, whether you realize it or not. Turn off the CNN Paul.

I didn't select Florida for low vaccination rates. I selected it because it was the first state whose daily death average was higher than earlier surges in the course of combating the disease. Others are following.
A lot of southern states have worse vaccination rates, and are suffering the same rising hospitalization/death totals.
Florida's elderly have done a great job in getting the vaccine and their hospitalizations are showing a rising total of younger, unvaccinated people.

Yes, I'm for people getting vaccinated. Yesterday's study on 43,000 cases in Los Angeles indicated a 29 times greater risk of hospitalization for the unvaccinated.
https://www.gov/mmwr/volumes/70/wr/m...cid=mm7034e5_w

Florida's situation seems to me to be a good example of a much earlier comment I made on this thread.
Covid is the first time in my life that I can remember a national public health emergency becoming a political issue...and I don't think that's good for the country.
Having worked in a triage setting, I support efforts like getting the vaccine so good people like LLoyd aren't faced with those difficult decisions, and we have enough medical resources to treat everyone when needed.

[noteggs]

Since Pfizer’s approval, got an email Miami U that states they are “carefully considering” vaccine mandates for staff and students for in class. Minus the normal religious and medical stuff. As of now, 75% are already fully vaxed. Wonder if the mask mandate goes away if they do? Nah probably not…

Update: X will require all students to be vaccinated prior to the spring semester.

[XU_Lou]

Do you remember when vaccines were are ticket out of this pandemic? Then remember when they said we needed a booster 8 months after getting the jab? Well, we're now down to 6: https://www.reuters.com/business/hea...sj-2021-08-25/

We all need to invest in Pfizer and Moderna....