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Comment by stingraycharles | Hacker News Reader

The question to me is: how much is the risk of the potential side effects of the AZ vaccine compared to the risks associated with COVID?

To me it strikes me that, even considering these rare side effects, the odds are still very much in favor for getting vaccinated.

Am I wrong here? If not, wouldn’t it then be irrational to be shutting down these vaccination programs?

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You're assuming that not taking this particular vaccine means getting COVID. There are alternatives, like waiting a bit more for an alternative vaccine.

> To me it strikes me that, even considering these rare side effects, the odds are still very much in favor for getting vaccinated.

The question isn’t is it better to get vaccinated with AZ or not vaccinated, but to get vaccinated with the AZ vaccine vs. a different vaccine with the delay that would be involved if AZ were pulled. That’s a tougher question that involves questions of relative risks and effectiveness and the logistical factors that dictate the timing differences.

Definitely for some age groups. For other age groups, it makes more sense to delay vaccination until an alternate vaccine can be used. That's why some countries are only allowing it for older people.

Show your work, please.

Not parent; just throwing this out there; but in Canada, the local provinces have been doing a relatively ok job of keeping track of covid statistics. In Alberta [0] we have a fairly diverse population, and should somewhat generalize to other regions.

It would certainly appear that if we assume the risk of vaccination is relatively constant, (The risk actually appears to be greater for younger, <55 y/o people), then it makes a lot of sense to prioritize the older populations.

https://www.alberta.ca/stats/covid-19-alberta-statistics.htm... -- scroll to the bottom for age distributions.

Edit: FWIW, I don't particularly support delaying vaccination for any age group, however it should be recognized that the risk is apparently non-zero. I for one will be getting mine as soon as it is available to me.

Thanks. Agreed that vaccinating the elderly first is a reasonable strategy, though it would also be smart to hit the people that spread the most (the "hubs" in a graph of physical interactions).

I'm trying to go through the rough numbers of risk/reward: Consider the potentially affected group with the lowest COVID death rate - women 20-29 years old. If all get the AZ vaccine, ~10 per million would have a CVST , and 3 would die, using the German numbers, which are higher than other countries. [1] (double these numbers to assume the side effect only affects women, and doses have been evenly distributed. Double them again to assume that this side effect only affects <65 years old, and doses have been split between the elderly and younger medical workers [2]).

If the COVID IFR is for 20-29 year olds is 0.01% [3], that's 100 per million that would die if infected. Maybe the IFR is lower for women, and with some effective treatments (dexamethasone, early recombinant antibodies) becoming available, but maybe it will be ~50% higher with prevailing variants.

So this vaccine may kill 12 per million women but save 100 per million. But the 100 per million is an unfair comparison - presumably less than the entire population will be infected while waiting for a different vaccine. Assuming 1/4 of infections are detected, there are 1000 new infections per million in Germany each day. It would take 120 days to infect 12% of the population and kill as many with this side effect as would have been saved by the vaccine, so if it will be a delay of less than four months to switch vaccines for this group, stop giving AZ and wait for another vaccine!

Huh, I didn't really expect this result, and for older age groups, the crossover point will come much sooner. Germany has decided that it only makes sense to only for 60+ year-olds, and maybe that's the right call, but I really wish they would be transparent about the reasoning.

[1] https://www.pei.de/EN/newsroom/hp-news/2021/210319-covid-19-... [2] https://www.statista.com/statistics/1195611/coronavirus-covi... [3] https://pubmed.ncbi.nlm.nih.gov/33289900/

I think the concern is that medical ethics say (roughly) you cannot give anyone a treatment which, based on odds, harms them.

If COVID rates in a country are low and the patient is young, then that patients personal risk from it is very low (low chance of catching it, low chance of harm if caught). If the vaccine has higher risks of harmful side effects, it would be unethical to administer it.

Medical ethics in general does not support harming one person to help another (eg. Giving one person a risky vaccine to help protect their grandmother who is vulnerable)

Nonsense. There are risks with all interventions and the ethics are clear. There are known adverse affects to all immunizations ( no not autism ) and that the odds of it happening is low enough for any individual that it is considered that the general benefit to the community is higher than the cost to the rare poor sod who gets a bad roll of the dice. But that's just reality. No intervention is without risk and anybody telling you they have an intervention without risk is selling homeopathic water drops.

https://www.cdc.gov/vaccines/vac-gen/side-effects.htm

Maybe I misread your comment or the parent, but I don't think this has anything to do with what they said.

The comment I was replying to said.

> I think the concern is that medical ethics say (roughly) you cannot give anyone a treatment which, based on odds, harms them

This is clearly not true as we do medical interventions all the time that we know may harm the patient on the assumption that most people will gain a benefit. It's naive and dangerous to spread the idea that the good medical intervention is a 100 percent safe one. That's the pitch of the "alternative" medical industry and only possible for 100 percent ineffective medication.

There is no effect without side effects and no benefit without risk.

What are these medical interventions we do with patients that provide them with outcomes that are statistically more unsafe than inaction?

While I am not qualified to answer the question, this question reminded me of the backstory of Jove Empire in EVE Online: https://eve.fandom.com/wiki/Jove_Empire#Jovian_Disease

I've seen numbers from germany that suggest across all vaccines manufactured the risk is roughly 1/8500 (~0.00011) for severe adverse events, while Ioannidis somewhat recently published a systematic review finding the global IFR roughly 0.0014 for covid - so it would seem the vaccine risk is about an order of magnitude lower than covid, but I do think it's a tough and important question to consider because many people are at much higher risk for covid (which mean others are much lower) and there are a great deal of asymptomatic people that may already have better immunity than these vaccines can provide.

Unfortunately I'm not expecting much calm rational debate on the nuances of getting the vaccine. This whole pandemic has felt like an emotional rollercoast void of logic.

(and please don't take my vaccine numbers as an authoritative risk assessment - there's a lot that goes into assessing such a number and I don't want to sound like I'm confident those numbers are correct)

I recommend the Meyerowitz-Katz and Merone survey of IFR [1] over Ioannidis. The tl;dr is an IFR estimate 0.68%. Consensus in the epidemiology community is that Ioannidis has become a politicized hack, consistently pushing lowball estimates.

Of course, your argument is still valid even with the lower estimate, I just think it becomes more complicated. Unfortunately, this case is quite a bit more complicated because COVID fatalities are heavily weighted to older ages, while this purported VIPIT is appearing largely in younger, otherwise healthy people.

[1]: https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v...

[2]: https://sciencebasedmedicine.org/what-the-heck-happened-to-j...

Thank you. Very interesting read. I have never understood some of the low IFR estimates. If you look e.g. at numbers for New York State. They have had 50.905 covid related deaths (https://www.worldometers.info/coronavirus/country/us/) and roughly 20.000.000 inhabitants. That sets a pretty clear lower boundary on IFR of 0.0025. And clearly not everyone in New York State has had covid.

picking one of the hardest hit areas in the world doesn't set a lower boundary on IFR.

> The tl;dr is an IFR estimate 0.68%

What's funny, not amusing is the Chinese said they thought the IFR was about 0.7% back in Feb 2020. Lots of people decided to not believe that for reasons. But here we are. And yet people still refuse. For 'reasons'

> so it would seem the vaccine risk is about an order of magnitude lower than covid

If you get infected, or did you account for the risk of getting covid in the first place ?

And with all that COVID has easily identifiable risk factors that impact the probability of severe outcome by order of magnitude, do vaccine side effects have comparable risk predictors ?

So, from where I'm standing, if you're young, healthy and able to avoid high risk COVID areas you're much better off skipping vaccination till they figure out the risk factors or vaccinate enough higher risk groups that it's no longer an issue.

I would advice to interpret the IFR reported by the Ioannidis paper with an extreme amount of caution. One of the authors criticized (which is quite an understatement) by Ioannidis went into a detailed rebuttal in [1]. A second thread [2] also gives a very detailed analysis of issues with the paper.

[1] https://twitter.com/GidMK/status/1376304539897237508 [2] https://twitter.com/AtomsksSanakan/status/137593538213983437...

I'd personally be extremely cautious of a rebuttal in a twitter thread rather than a professional rebuttal which is how these sorts of things should be sorted out in the scientific world. A twitter thread to rebut a peer reviewed paper actually makes me sad that this is where scientists go during a period where we need their input more than any other time.

Also, fwiw I followed antibody testing studies for the better part of a year and anything over 0.004 IFR was rare. I was surprised to see it as low as 0.0014 from this review expecting close to 0.002-0.003 but 0.0068 is incredibly high.

That's a valid, but still weird take to me. Academic publishing takes a very long time. Every paper I was involved in took many months from submission to eventual publishing (completely ignoring the time it takes to prepare a submission).

Ioannidis published something extremely controversial (if not even flawed) and one of the main authors he attacked responded with a lengthy explanation so that this manuscript would not remain unchallenged. I found that aspect way more important than the venue of response. Would you prefer to leave Ioannidis' work unchallenged for potentially months instead?

I've seen multiple published (not peer reviewed) rebuttals published in academic papers within a week or two during this pandemic. Not everything published needs to be peer reviewed before going before a wider audience - twitter simply isn't the platform for generating useful dialog - maybe for any context, but certainly not in an academic context.

edit: do you recall the paper that made waves in the U.S. claiming covid causes heart damage? That paper was published and editted prior to peer review based on criticism multiple times within a week or two IIRC - the appropriate way to handle conflict in science isn't by trying to get twitter to chime in and make things personal. Ioannidis "attacks" were unprofessional - in my mind, though, they were absolutely not on the level of trying to call out an author on twitter.

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