Tobold's Blog
Thursday, November 18, 2021
 
Triage

Europe is in the grip of the "4th wave" of Corona infections, basically caused by the combination of the delta variant plus colder weather being stronger than the "herd immunity" from vaccination. While there is a lot of misinformation on the internet about the vaccine, the 4th wave does provide us with rather accurate statistical information, because the numbers are so large. The two key results are that if you are vaccinated, you have an about 30 times lower chance to get infected with the corona virus than if you were unvaccinated; and once you catch the virus, if you are vaccinated you are 30 times less likely to die than if you are unvaccinated. Which means that if you count the whole chain from getting infected to dying, a currently not infected vaccinated person is a thousand times less likely to die from Covid than a currently not infected unvaccinated person.

What isn't said is that this statistical result is valid only as long as not all ICU beds are full, and all respirators are taken, which is a situation towards we are heading. At some point the health system is overloaded, and doctors will have to practice triage, which is deciding who lives and who dies based on a set of ethical criteria. And triage is bad news for the unvaccinated. One of the main principles of triage is that if you have two people needing treatment, but you can treat only one of them, you should treat the person more likely to survive the treatment. As the vaccine significantly increases your chance to survive, with everything else being equal, a doctor will always choose to give the respirator to the vaccinated person rather than the unvaccinated person, because the vaccinated person is more likely to be actually saved by it.

For obvious reasons the power that be are trying to not offend the part of the population that is hesitant to get vaccinated, and they are trying to nudge them towards vaccinations rather than talking harsh truths to them. But that harsh truth is that if you don't want to get vaccinated, you are a thousand times more likely to die from COVID now, and if the overall situation worsens on the current trajectory, you might be left to die in triage. The whole "get vaccinated for the good of the community" talk isn't wrong, but it isn't the main reason why you should get vaccinated. You should get vaccinated out of pure self-preservation, because the minor risk of secondary effects from the vaccine is negligible compared to the major improvement of your life expectancy if you take it.

Comments:
Tobold, I don't want to be mistaken for an anti-vaxxer here, but your numbers are WAY off.

The vaccines are better at preventing death than serious illness, and they're much better at preventing serious illness than symptomatic illness. It seems likely that getting vaccinated reduce your chances of dying from Covid by a factor on the order of 30; a quick google gave me this paper from the UK that gives a value of 32, so it's in that ballpark. But the effect of vaccination on on your chances of catching it are much less than that, with the effect on your chances of hospitalisation somewhere in between.
 
I have numbers from this week from one province of Germany, where the number of infections per 100,000 people among vaccinated people is 60, and the number of infections per 100,000 people among unvaccinated people is 1,800. Thus a similar factor of 30. Obviously the number could be skewed by underreporting of mild cases, but it shouldn’t be totally different.

I agree that the vaccine is best at preventing death, but that to me seems because to die from COVID you first need to be infected and then you need to get seriously ill and die, and the vaccine diminishes both of those probabilities.
 
By the way: I would admit that it is difficult to have accurate numbers for the exact difference of risk of infection, serious illness, and dying for vaccinated and unvaccinated people. With difficulties like people who have been vaccinated over 8 months ago probably being less protected than those vaccinated a few weeks ago. And maybe my math is wrong and you can’t simply multiply these probabilities.

But whatever numbers you have, they *all* say that vaccination *significantly* reduces your risk of dying, even if you receive equal treatment. And triage will probably result in unequal treatment, further disadvantaging unvaccinated people. So my point still stands: Save your own life, get vaccinated!
 
My issue with these kinds of reporting numbers is that they quietly leave out the base chances.
I mean a Faraday cage negates death from lightning strikes, yet no one uses them when going out for a walk.

Now Covid is infectious, but it still depends on where you live and how many contacts you have. An ICU nurse should think twice about it while someone on a remote farm has other odds.
So while your own self-preservation should be the goal, you should not blindly leap onto everything without checking its costs (which admittedly isn’t easy).

On the point of triage: What happens when the vaccine improves your chances of survival enough that you can, although barely, survive on your own, but a respirator would help further and an unvaccinated person can also be saved by taking away your respirator?

Unfortunately nothing is cut and dry. For me getting the vaccine wasn’t a question, but so is staying the hell away from other people and not running around with the belief that I’m immune and pre-Covid activities are fine again.

 
We leave out the base chance because 1) it is impossible to determine at an individual level, and 2) people generally have a hard time understanding probabilities. The *statistical* base chance of a person to die from COVID appears to be around 1 in 300. You can get to this number by taking a forecast of overall deaths divided by population, e.g. 1 million deaths in the US by the time Covid is under control divided by 300 million Americans. On an individual level, it is likely that there are some people who due to young age, good health, and isolated lifestyle have a base chance of below 1 in 1000 to die, or even below 1 in 10,000.

But humans don’t understand risk and probabilities. We buy lottery tickets in spite of the odds being astromical against us. We do very risky things, like fighting in a war, or flying to the moon. We simply don’t understand a 1 in 300 chance of dying well enough to make a good decision we won’t regret. And different societies come to different decisions based on the same probabilities. For example, you can freely buy Kinder Surprise Eggs in Europe, but they are illegal to import into the USA because of the risk of a child eating the whole egg and choking on the toy inside. Unless we assume very unhealthy eating habits of US children, the risk is the same on each continent, but societies response isn’t. And this risk is tiny, there have been only 10 reported cases of children suffocating from Kinder Surprise Eggs world wide, out of 30 billion eggs sold. A 1 in 3 billion chance of death requires government intervention, but when the government intervenes against a 1 in 300 chance of death we protest about overreach?
 
> For example, you can freely buy Kinder Surprise Eggs in Europe, but they are illegal to import into the USA because of the risk of a child eating the whole egg and choking on the toy inside.

The new model of the Kinder Surprise Eggs, where the toy and the chocolate are in separate half parts of the egg is freely available in the US.
But, I agree with the stupidity of this - the risk of a child dying from a Kinder egg is much lower that the risk of a child dying from an AR-15, but eggs were banned, and AR-15 are not.
 
> You should get vaccinated out of pure self-preservation, because the minor risk of secondary effects from the vaccine is negligible compared to the major improvement of your life expectancy if you take it.

The problem is that humans are really very bad of assessing such risks and taking steps to avoid them. And this goes not only for vaccination, but for many other things - tobacco use, heavy alcohol drinking, drug use - for many years there is scientific consensus that all those things are bad for your health and increase the rick of death or serious illness, but still many people deny the science and continue using them.

So, I don't think that appeals for self-preservation will work at this point. Whoever was concerned about falling sick is already vaccinated. For those who still refuse to, one possibility is economical pressure. For example, a news article I saw today: "Singapore to Stop Paying Medical Bills for Unvaccinated Covid-19 Patients". Or in some companies in the USA, unvaccinated people pay more in medical insurance premiums - since they are in much higher of getting sick. Or countries may introduce a "novax tax" - again, to pay for the increased medical expenses.






 
Tobold: “But humans don’t understand risk and probabilities. We buy lottery tickets in spite of the odds being astromical against us.”
Yes, the chance is abysmal. What if I told you there was a way for 30 times the chance?
My issue with the lack of base chances is that there is no relation and judgment is cast solely on the basis of “a better chance is better, therefore you must do it or you are bad” when it’s unlikely in either case.
I don’t know if there is a good way to illustrate the risks that is general enough for the average person. Something like “if you live in a city and see 3 different people a week your risk is X if vaccinated and Y if not”. Maybe interactive or something.

Kinder Eggs are not banned explicitly, but because “it is confectionery, and—
(1) has partially or completely imbedded therein any nonnutritive object, except that this subparagraph shall not apply in the case of any nonnutritive object if, in the judgment of the Secretary as provided by regulations, such object is of practical functional value to the confectionery product and would not render the product injurious or hazardous to health;” it is therefore adulterated and prohibited from import or production unless permitted.
So if you tried to sell bricks dipped in chocolate it would be illegal as well. That law predates Kinder Eggs by 30 years and it’s why the Kinder Joy variant is perfectly legal since chocolate and toy have their own department and likely the same choking hazard.
 
You're doing some very optimistic math with your initial calculation.

With a highly infectious disease like COVID, if you live an active life, the chances of being infected are 100%, the only difference is "sooner or later", or more precisely "when there's place in the hospital to treat you or when there isn't". So the only thing you can count on is the 1/30 reduction in the chance of it being lethal (which, important to note) is very variable depending on your age and comorbidities, so the 1/30 is an overall number which can be hardly generalized. If you want to know what applies to you, you should find the data corresponding to your specific (age/health status) situation.

For vaccination, and taking into account only YOUR risk of death (i.e. neglecting long-term COVID and risk for friends & family), the math is even easier: if I remember the italian data correctly, the total number of deaths associated to vaccine reactions (usually allergic shock) is lower than the total number of babies killed by COVID, so you're ALWAYS better off being vaccinated whatever your age group, except that if you are a healthy young kid you're converting a negligible risk into an even more negligible one, and if you're 60+ with cardiovascular disease you're converting a significant risk into a small one......
 
Post a Comment

<< Home
Newer›  ‹Older

  Powered by Blogger   Free Page Rank Tool