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Jan 17, 2023Liked by Katelyn Jetelina

I'm not schooled in Medicine or Statistics. But I was in IT, so I can follow or design a logical string or process to a desired end. I'm also old enough to have been drafted into the military, and been subjected to the Friday afternoon vaccinations that left us all sick for 2 days, but kept us from sickness in Vietnam.

I can read graphs, and follow a factual narrative that doesn't descend into pure opinion. <<<Thank you for this post.>>>

I feel a need for a small personal narrative, as follows: The first 3 Covid mRNA shots had me with a bit of a sore arm, which I welcomed, as I figured my immune system was at work. The Bivalent shot was murder, bad sick for two days; my PCP herself had the same experience. That misery aside, I was glad for it.

IMHO, the value of vaccinations is going to be tragically shown by what has begun to happen in China.

Please continue your Local Epidemiologist writings.

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Jan 17, 2023·edited Jan 17, 2023

Good summary, thanks.

IMHO there is one sore point, however: The argument "yes, the mRNA vaccines cause myocarditis in rare cases, but COVID does so much more often" is really sort of past its expiry date. Given that protection against infection has become weak and short lived and that there may be a lot more sub-clinical cases (both, after vaxx and after infection, see the troponin findings) I would think it's not crazy to ask if there might be cumulative damages. Are repetitive boosters really the way to go for young people then? Will my heart be in better shape after 4x COVID + 10x booster than after 5x COVID? Also proper age / sex stratification is really mandatory when talking about myocarditis.

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author

Thanks for your comment. I agree that age/sex stratification for myocarditis is key. And that we must constantly monitor whether benefits outweigh risks for everyone. I don't think that is crazy. This post's intention wasn't to dive into myocarditis, but deaths. Maybe a future post should explore this very topic.

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Even the FL surgeon general was able to limit their recommendation to males 18-39.

Anyone who is "refuting" myocarditis concerns for young men by mixing in all ages and sexes, fails to acknowledge that the vaccine has negligible protection against infection after quick waning (after all, other posts will argue that the vaccine is a success because it protects against severe disease), and fails to acknowledge that young men have the lowest risk of myocarditis from actual covid is not really arguing in good faith anymore.

The rest of the post seems good but the above is why many people don't take these sorts of rebuttals seriously. They're not all morons.

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Since protection against ANY level of infection is way down, but protection against SEVERE infection and death are still significant, I wonder if we will be able to tease out the true differential risk of myocarditis. Working off of the assumption that almost all 18-39 year old male will eventually get COVID, to one degree or another, that means we will have large cohorts of COVID + Vax and COVID + no Vax, and we should be able to see whether the myocarditis rates are equivalent, worse for the C+V group, or worse in the C+no V group.

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Your analysis is too broad and you are selling vaccines as the end all be all. Break it down into age groups because one size for all solution kills innocent people.

Break it down by age, preexisting conditions and then risk. You will find it’s unlikely for all the age groups to end with the same result.

Totally unfair to make this statement

“ No one denies COVID-19 vaccines can have rare but severe effects. The question is how severe they are and how often they occur compared to infection.”

Compare severe effects with severe infection.

Avoiding infection isn’t the goal. Staying Alive is.

It’s likely the healthy athlete under 29 isn’t going to die from Covid but has a risk if they take the vaccine.

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Larry, that breakdown HAS been done. And we know that the highest benefit for vaccination is in the older groups and people with comorbidity. That, however, does not equate to no benefit for all other age groups, as studies have shown that serious illness is less at all ages and both sexes.

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Thanks Dr Bussey - I did not address the "no benefit" but I was addressing the "risk /benefit." Saying it "helps everyone" is not science its rhetoric. (FYI - i am vaccinated)

Broken down by age and comorbidity - I have never seen this statistic. Where may one find this.

lets stay with school aged kids under 17 or 18 as one group and under 29 for another.

How many deaths by COVID without comorbidity?

How many deaths by vaccine without comorbidity?

Then you can convince people that a healthy athlete is better off taking a vaccine than not. Remember, the vaccine does not stop transmission so its only about protecting yourself. .

If there is a study that would shut up a lot of people.

Do we trust the CDC and the medical community post pandemic? I do not think so given the plethora of inaccurate information we were fed.

Although its a separate subject the CDC took down a gun study showing the defensive use of guns save lives because an advocacy group said it was not helping their cause. That does not give a warm and fuzzy feeling to anyone to trust the CDC does it?

Dr Bussey, lumping it all together is not honest assessment of the situation.

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Larry, I’m not sure about whether you will accept the data, and quite frankly, I’m somewhat concerned as to whether you would accept ANY data, no matter how well sourced. With that caveat, this graph from an Axios website, extracted from CDC data (which I will readily acknowledge is often quite opaque and hard to access at times) shows you the relative death rates from COVID-19 by age and vaccination status. Hopefully that will satisfy at least part of your question (age related risks). As to comorbidity, I’m not sure what that would add, other than demonstrating that you do worse with comorbidities than without. And given the size of the differences within the same age cohort between unvaccinated and vaccinated, at a minimum I think you can safely say that vaccines aren’t killing people with comorbidities. What is less certain is whether, if you stripped out all comorbidities (amongst young people I think the biggest would be obesity and prior chronic respiratory problems) from the youngest populations, whether there would be no difference in death rates for healthy vaccinated vs unvaccinated. I’d bet the data is out there to demonstrate that one way or another, but it will involve a lot a data sifting. One of the things I’ve said since the beginning of the pandemic is that there will be 1000s of epidemiology Master’s Theses and Ph.D. Dissertations coming out of the COVID data for years, if not decades. The above question might be one of them. :-). Anyway, here is the link, with a nice visualization. https://www.axios.com/2021/10/19/age-coronavirus-risk-vaccines

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Doc - I do love data. I do respect data. Here is the challenge i think that is real.

Maybe I was not clear about the distrinction between deaths without comorbidities and vaccinated deaths without comorbidities.

I do not think people with comorbidities are being killed by the vaccine. I think they are probably excellent candidates for the vaccine.

It is the healthy age groups that have no comorbidities that may not need to take the risk of a vaccine, as little as the risk is, its may be greater than the risk of dying from covid.

My issue to start is that we are using a broad brush to say use this - instead of addressing people, like individuals with their own health history that may or may not support a vaccine. (remember I am vaccinated at 62 with some health issues).

As a Dr, and I see you are a MD, before you set a treatment for a patient you look at the specifics.

If we can look at recent data and we should have just short of 3 years of data that supports a broad brush then it would serve us well to make the bold statement that everyone should be vaccinated.

I am only focused on healthy people that are young and may be taking a risk - however small - by getting vaccinated.

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I imagine we will get closer to an answer as more research is done. Here is another example (found in today’s JAMA News Network that just came in my email: TL:DR - this was a study of users of the military health system, with a significant number of them in the 18-44 yr old range, and about 2/3rds male. Those who got infected without vaccination had longer, more severe symptoms than those who had been vaccinated. They didn’t use the term “long Covid” but they were talking about longer than 28 days. Of interest, if after their initial infection, they got vaccinated, then their likelihood of continuing with long covid symptoms dropped by 40% or so, compared to those who still didn’t get vaccinated. Nobody died (or at least I didn’t see that in the data) so we can’t answer that part of your question, but I think their is growing compelling evidence that even healthy males do better with vaccination than without. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800554?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_content=wklyforyou&utm_term=011823

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Larry - thanks for stimulating me to do some more searching around. One comorbidity I forgot about diabetes (which is referenced in the below link). Additionally, this study (link below) was done before vaccines were available, so it also answers a part of your question about illness and death in the young, specifically, that otherwise healthy young adults could end up in the hospital with severe disease. One thing I did notice is that the options of “comorbidity” and “no comorbidity” were both zero, and yet lower down in the provided chart, many of the deaths were associated with obesity. So I don’t know whether the researchers didn’t consider obesity a medical comorbidity or whether there was some other reason for the mainly “zeros” in the specific comorbidity variables. Here is the link. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243343

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The people making this argument aren't doing so honestly though. They're comparing the risk of dying from the vaccine to the risk of -anything- from the vaccine. As we all fully admit, yes, the vaccine has risks, but those risks, an apples and apples comparison, are lower than the risks of COVID, which is incredibly likely you're going to get.

The fact that a 29 year old healthy athlete isn't likely to die from COVID but comparing it to the risk of the vaccine, which they absolutely are not going to die from either, ignores the fact that a 29 healthy athlete -who is vaccinated- is far less likely to have health issues from COVID, even if those health issues are not fatal.

Compare apples and apples. Don't ignore the health concerns from COVID for the unvaccinated, even for a 29 year old healthy athlete.

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Joe - I hope your spot on. Problem is that data surrounding children does not appear to support that. No many kids school aged have died without comorbidity. And I admit I have not seen any data sets recently.

I am sure that healthy kids are more likely to be struck by lightening than die from covid. Do the problems from vaccines reallly exceed those numbers?

Where are the data?

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Jan 18, 2023Liked by Katelyn Jetelina

It is exhausting just reading about the stupidity over Covid deaths. And I'm a layman. I can't imagine what it's like to try to negate all these contradictions as a professional. Keep up the great work!

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Jan 17, 2023·edited Jan 17, 2023

Do you have a version of this in an “easily-turned-into-a-poster” format that I could post in my office? I’m a pulmonologist and I run into the vaccine hesitant in addition to the clearly anti-VAX people every single day. Ugh!

If you don’t have such a format, would you mind if I printed this out and posted it on my waiting room wall?

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Seriously.

This post was lights out.

Mic drop.

I feel like I’m home.

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Excellent post! Some just want to believe in conspiracies even when the facts are presented to them. Keep up the incredible work.

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I am fully vaxed and boosted. However, I am not sure I will keep getting boosters once or twice a year because I remain unconvinced that the benefits outweigh the risks. The good news is I’m willing to read things, mull them over, and decide accordingly. Unfortunately, this post does little to convince me that boosters will provide benefits to me going forward.

A few high level questions/observations:

1). For “All-cause deaths by vaccination status, England” - why not break the chart out by age? Why end the chart at May 2022, the point where the blue and red lines touch? Presumably, after May 2022 the red line is higher than the blue line (or perhaps the two lines are indistinguishable). Your whole argument is based on “blue line is always above red line”, so if that reverses, wouldn’t that be important to look at and understand - especially since that’s our best predictor of what the future holds? I visited the website from which this data comes, and the data is as current as yesterday - so why are 7.5 months of data missing from the chart?

2). For “Excess Deaths and COVID Deaths in Young Adults (age 18-49)” - the chart appears to end around February or March 2022, meaning nearly a full year’s worth of data is missing. Why? It would also be interesting to see data from before the pandemic begins. The real story here seems to be that excess deaths were lower before the pandemic started but increased (accidental overdose, suicide?) during the pandemic, perhaps due to lockdown measures. Also, I’m not sure a 49 year old should be considered a “young” adult. Maybe the 30 and 40 year olds are being lumped in with the actual “young adults” (teens and 20-somethings, who have very low risk of dying from covid) to make the purple “COVID-19 Deaths” more scary. One ethical question that I wish got more attention: is it moral to recommend vaccines to young people in the hopes that this benefits the vulnerable (i.e., through reducing transmission)?

3.). For the two charts “USA Age 18-39” comparing circulatory system deaths, you state “Vaccination roll-outs correlated with a stunning reversal of this trend.” For “a stunning reversal” to be true, wouldn’t we need to see the red line *decrease* in a meaningful way? Instead, it remains stubbornly high (between 125 and 130) even once the vaccination rate exceeds 60%. The chart ends in February 2022, meaning nearly a year’s worth of data is (again) missing - why? I’m also curious why the definition of “young adult” has now changed (18-49 in last chart, 18-39 here).

On January 26 the FDA will hold a “Vaccines and Related Biological Products Advisory Committee.” Wouldn’t it be important to understand the last year’s worth of data in order to make fully informed decisions about whether the current generation of vaccines/boosters have benefit going forward? The FDA needs to base decisions on data from January 2023, not January 2022. It’s my understanding that the CDC now projects that at least 95% of the country has already had covid. If we ignore the last year’s worth of data, policy makers will be unable to understand the impact of widespread natural immunity and how this should inform vaccine/booster recommendations going forward.

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Great questions. I had the same several months ago. I accessed the UK data myself and did some basic spreadsheet analysis. Several stunning signals appear:

https://www.youtube.com/watch?v=UbuBhTLK9i8&t=1014s

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You say that but I know a checker at 7-11. Her boyfriend is a fireman. He was perfectly healthy before he got the shot, but only one year later, he was ran over by the truck! Avoid the jab, don't be a truck mat.

</snark>

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founding

Oh my! Thank you so much for the update.? Shows You can never be too careful…and I so needed that belly laugh 😂

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The anti-vax movement started at the beginning of the pandemic ignoring every person who had COVID and then died of COVID, but then insisting that every person who had the COVID vaccine and then died after must have died from the vaccine. It's almost like one fits their narrative and the other did not.

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The 20 million lives saved by the vaccines are based on modeling data only. My question is, the Pfizer vaccine trials indicated that we had to vaccinate approximately 20,000 people to prevent a single Covid-19 death. With approximately 250 million people in this country fully vaccinated, the best we could have ever predicted, based on the trial data that was acquired when the vaccine was best matched to the pathogen (ie the Wuhan ancestral strain), is 12,500 lives saved. I don’t think it possible that the 3.2 million US lives saved is anywhere near accurate for this reason. The model is off by at least a factor of 300.

Can you explain how and why the model could be so irreconcilable with the best data we have?

Thank you.

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Since the vaccine trials we've had far more data about who has died and their vaccination status, and we can project for their demographic the rates of the unvaccinated who died compared to the rates of the vaccinated who died, and project those out to the rest of the country what it would have been if there were zero people who were vaccinated. I think the discrepancy of the two numbers was that trials predated more infectious strains such as delta, and the rates of infection increased greatly, and thus a lot more people would have died were people not vaccinated. The "20,000 people" number was likely based on a lower assumed infection rate that was more common before delta.

But even then, regardless of the exact number, it's very clear the vaccines have saved lives, and very likely a large number of them.

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You are correct that subsequent strains are more infectious. However it was only the delta strain that was more infectious AND more pathogenic. It's been more than a year where the world has been facing various omicron strains that we can hopefully agree is significantly less virulent than delta and the original Wuhan.

The vaccine effectiveness against Omicron is also substantially lower. Putting these two points together, it is not unreasonable to use the trial outcomes as the upper limit on vaccine effectiveness. BTW, there were no "assumptions" about infection rates and/or death rates. These numbers are taken directly from the published trial outcomes in the NEJM and the subsequent updates from Pfizer after six months where a single Covid-19 related fatality was prevented by vaccinating approximately 20,000 participants.

I am not at all suggesting that the vaccines haven't saved lives. I am only saying that these estimates cannot be reconciled with what the trials would have predicted.

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? I am not saying it is "mild" either. I am saying that the assumptions in the modeling study are not given and do not seem to account for the decreasing pathogenicity of the circulating variants as well as the well-documented waning effectiveness of the vaccines.

Throwing this "study" out as unassailable fact is just as irresponsible as making unsubstantiated claims about vaccine dangers

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Yes, I am aware of this modeling study. The key statement, given in the end is "Vaccine efficacies against infection, and symptomatic and severe disease for different vaccine types — for each variant and by time since vaccination — were drawn from published estimates."

The authors do not cite which published estimates they are using. That is the crux of my position. Their estimated counterfactual outcome is solely based on the vaccines' effectiveness in preventing Covid deaths. I am merely suggesting that the best data that we have is from the trials themselves. That is the only time we had two matched groups randomized to placebo/vaccine.

Of course I admit that vaccine efficacy measured in a trial may not be the same as vaccine effectiveness measured on a population. However, as I mentioned earlier, a factor of 300 difference between the trial and the real-world is difficult for me to accept prima facie.

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The UK Surveillance data is quite interesting. You have shown us the ASMR (age standardized mortality rates) in the UK during the pandemic. At first glance it seems that mortality rates are substantially higher in the unvaccinated. However, if this were truly the case, this should raise an important question. Covid mortality represents less than five percent of All Cause Mortality in England. The vaccination seems to be having a strong effect on preventing death from causes other than Covid. Is this happening? If so, why? If anything, it should lead us to investigate further.

The problem we are having with this graph is that it is plotting age standardized mortality rates. The reality is that the age distribution of the unvaccinated is much different than the vaccinated. Compared to the “standard” population to which standardization weighting is calibrated, the unvaccinated cohort is much younger and the vaccinated are much older. This will exaggerate the contribution of the mortality rates in the older unvaccinated and minimize that of the younger unvaccinated. The opposite happens in the vaccinated.

If you were to sum all the deaths in each group (vaccinated vs unvaccinated) and divide by the person-years in each group, you will find that the mortality rate in the unvaccinated is less than ½ of the vaccinated. This is not necessarily because the vaccines are causing deaths; it’s because the mortality rates in the unvaccinated are much lower because they are much younger.

I suggest you dispense with age-standardization and look at each age group over time. The UK Surveillance data set that you are referring to has this information. You will find something very interesting as I and others did.

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Good job. As a doctor I do expect to see adverse affects from vaccine (hopefully rare) but logic suggests that Covid infections themselves will likely cause the same rare cardiac events and likely at higher frequency. At 69 It was Covid infection not vaccine or boosters which knocked me into A fib which I had once before 15 years ago.

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founding

And again, a masterful job. Thank you. I'm reading Barbara Tuchman's A Distant Mirror, about the fourteenth century in Europe. And I remember Extraordinary Popular Delusions and the Madness of Crowds. In some ways, humans have not progressed much, preferring magic and paranoia over truth, evidence, or reason. Or even kindness. Crazy stuff, but I guess we're stuck with us. Your work is a great blessing.

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I sometimes despair at the stupidity and gullibility of humans. An absurd example is a friend who recently shared on social media a photo of a “train” of Starlink satellites that had been launched in mid January 2020. Her comment on the photo concluded “and the COVID disease arrived soon after.”

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Thank you for this post. It is hard for me to understand why so many attribute all of this to the vaccines rather than COVID itself. Often we're making connections where there are no connections to be made, but it's interesting to me that the default seems to be to connect it to the vaccine and not COVID.

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In view of the avalanche of data that is finally coming out about the dangers of the mRNA vaccines you still support them? Who is now anti-science?

Continuing to support these dangerous vaccines with suspicious data interpretation does not reassure those who have become skeptical and suspicious of all vaccines.

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What data are you referring to that was not addressed here? The post literally begins with a review of the data typically cited for the vaccines' danger. She addressed all of it.

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I expect that question to either go unanswered or answered with link to some rando's blog.

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Which "avalanche of data" would that be, then? Aside from whatever rubbish is being posted on right wing blogs or crackpot YouTube channels, that is.

To answer your second question: you are, it would seem.

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