Denmark to permanently cease using AstraZeneca vaccine | Hacker News Reader

Denmark to permanently cease using AstraZeneca vaccine

reuters.com

178 pointsreddotX334 comments

Not giving it to 65+ people seems overly cautious. There are zero cases in that group and even just a small delay will mean many dead. This is trading a potential unlikely side effect for a large number of severe Covid cases in high risk groups.

Edit: yes I'm aware they have only a dozen or so dead per week but that also translates to hundreds of severe cases, missed elective surgeries, etc. For what would most likely result in zero side effects in the elderly group.

It's a real world example of a trolley problem. They're choosing to let a large group risk severe disease or death through inaction, rather than pulling the lever and have a small group be at risk due to their actions.

Correct. But to me it seems that pulling the lever to kill a few would be considered more culpable from legal perspective rather than not doing so (and let more people die). IANAL - I am curious to know how law perceives it.

Don't the COVID vaccine companies enjoy blanket immunity?

https://www.reuters.com/article/us-astrazeneca-results-vacci...

Slowely I'm getting the impression that a lot of decisions around AZ are politically driven. In Germany, the new recommendation is now to use Biontech for the second shot after AZ. In that recommendation, it is also stated that there are no studies nor data supporting that.

Quite funny, because there is, to my understanding, a study taking place in the Uk for that. It is expected to be done by end of April. Someone has to explain to me why that recommendation couldn't wait until there is data.

I guess that a decision needed to be made in a timely manner to provide guidelines for those who get their second dose before end of April?

Which would mean mixing vaccines without any trials done on the effects of this. As compared to using a second AZ shot, which has been analyzed and approved. Seems risky to my untrained eye.

And it wouldn't be hte first AZ related recommendation that changes every other week. We had so far:

- not for people over 65 because of underrepresentation in the trials

- not for people under 60 because of blood clots before any studies were finished

- Nobody wants AZ, so we will give it to everyone who is willing to take it

I don't see a strigent strategy here.

Can't argue with that. Everything about the AZ vaccine in politics and the media has been a shitshow so far. AZ themselves probably were caught off guard by the initial bad reporting and the wave of negative public reactions. They don't normally have to play the mass media game in their business.

It means getting a shot of AZ and two of Pfizer/biontech then. Seems reasonable, and this type of mixing is done all the time.

Complete nonsense. Do you honestly think the Danish medical authority gives a shit about the squabbling between the UK and Germany over AZ? To the point where they would even condemn people to death and put their careers at risk? I do not find that plausible at all. What I found plausible is that you are too gullible and do not realize that your "impression" was fed to you by the media, who definitely have a political agenda, one way or the other.

There are more poliical angles around AZ than just Brexit. Germany has a bunch of elections this year, for example. A lot of our screwed up Covid measures can be traced to a inner-party conflict about the Chancelor candidate for conservative party, Angela Merkel's government party at the moment. The same party that is up to the neck in a corruption sandal over mask contracts, and quite likely contracts for testing its as well.

No idea how the situation in Denmark is, so. Just one example how vaccines are used for political purposes in Germany, the Bavarian Prime Minister, Söder, and one of the two likely candidates for the chancelor candidacy, just placed a pre order for Russia's Sputnik V. The plan is to produce 2.5 millon doses in a plant in Bavaira by June or so. Never mention that Sputnik V has no EU approval, no study was submitted (what was that again with "faulty" AZ data?) and by June Germany will get up to 260 million doses the EU contracts.

EDIT: I read the 260 million in an article. Numbers from Statista don't back that up. And the EU isn't publishing any schedules. The supply chain guy in me is crying for a year now, first masks, now vaccines. Really frustrating. I really have to get a new job, right I have too much time on my hand it seems...

I was getting the impression that pretty much any government decision around COVID-19 was politically driven, not just AZ.

Actually that does not even sound very surprising.

Yeah, sounds about right. Having elections only seems to make these things worse.

I’ll tell you one thing that’s even worse than elections - no elections

Absolutely! But having elections in 2021 makes every Covid-related decision by definition political. And that doesn't help.

I should have made clear that the problem with elections is the timing, not elections in general. Governments should be focused on getting the population vaccinated as fast as possible now, and not worry about their / (re-)election chances.

As soon as you justify canceling elections for one crisis, you can cancel them for any crisis. You'll manufacture a crisis if necessary.

I never said we should cancel elections, quite the opposite. I just certain problems with conflicting incentives in the period before an election. Like weighing decision not just based on data and facts, but on public perception, media coverage and the impact on election chances. Covid had a shitty timing with that.

> But having elections in 2021 makes every Covid-related decision by definition political

Every COVID-related (or other) decision by or about government is political, by definition, independent of election timing.

Election timing may effect the degree to which the people of a democratic state have effectively direct input on an issue whose existence and political salience would not be regularly forseeable, but that’s a very different issue than whether decisions about that issue are “political”.

People often mean “partisan” when they say political. The parties of course control our definition of politics but that’s done with the consensus of party line voters, unfortunately the overwhelming majority of our electorate.

This much was clear in January 2020.

> a lot of decisions around AZ are politically driven.

Well, in the end "everything is politics" I guess. But one must also see it practically. In places where AZ is a small part of the vaccine strategy, skipping it just means a small delay. It's not a huge or risky decision to either stop using it or use it only in older groups.

In places where AZ forms the backbone of the vaccination strategy such as the UK, it's a much harder decision. The delay imposed by stopping general use of AZ means more deaths because it's a longer delay.

So different countries reaching different conclusions is natural.

> Slowely I'm getting the impression that a lot of decisions around ~AZ~ the pandemic are politically driven

I think that's exactly it. There is a tradeoff to be made here with likely deaths on both sides, and the government is choosing much higher numbers of deaths because it looks better for them politically. That's immoral and cowardly.

I don't see any way to justify the decision they've made logically.

This pandemic is basically this entire story. COVID deaths are much more visible than the missed cancers, the depression and drug abuse caused by lockdowns, so basically it’s an easy choice for governments, lockdowns are better politically.

That argument doesn't make a lot of sense to me.

It assumes that the numbers caused by the lock-downs are bigger than the numbers caused by Covid.

It assumes that there is not positives to the lock-downs (maybe some people is less depressed at home than at their work, not deaths by flu, etc..) and, most important, it assumes that not lock-downs would not increase deaths by other causes (intensive care overworked).

The number of deaths due to missed TB vaccinations alone will be a very substantial percentage of number of COVID deaths.

Maybe, maybe not. TB should be readily stopped by masking and distancing measures; we might get something of a respite from it. I'm not aware of any numbers in either direction yet.

Confidently stated, but the impact of lockdowns is likely more complex in reality. It may require years of research to tease out all the components; lockdown vs general pandemic stress, differences in implementation, etc. For example:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...

> Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas.

Less human contact, less stress, less suicide.

Less school, less stress, less suicide.

That is a narrative that misses the point of the thread and is generally not compatible with hard data. For example, the amount of suicides in US during 2020 went down.

Parent was talking about missed cancers and drug abuse, not suicides. Alcohol sales were up ~20% [1]—that too is hard data.

[1]: https://wineindustryadvisor.com/2020/11/16/nielsen-covid-bev...

Off-premises alcohol sales were up; the article indicates it's a shift from on-premises to off-premises, which... shouldn't be surprising, given a lot of those premises are shut.

And the number of deaths due to seasonal flues is practically 0. I actually do not think any of these statistics matter, because data driven decisions are not timely by definition. What mattered is that the entire western world failed to react in time.

CDC only tracks actual suicides, not attempts. Attempts and suicidal thoughts are up: https://www.aappublications.org/news/2020/12/16/pediatricssu...

Also, on the CDC stats, deaths by "unintentional injuries" is up by way more than suicides are down.

Has anyone not had suicidal thoughts since the lockdown?

But people will also miss cancer screenings, get depressed and so on when they stay at home because of an unmitigated pandemic running wild. It wouldn't be 2019 again without government intervention.

(PS: also, why would they miss a cancer screening when it's literally the only pastime that isn't shut down?)

> (PS: also, why would they miss a cancer screening when it's literally the only pastime that isn't shut down?)

I was literally looking forward to an expensive and unpleasant dentist appointment (dental implant). At least, some change in the routine.

> PS: also, why would they miss a cancer screening when it's literally the only pastime that isn't shut down.

Fear to go anywhere near a medical environment. Long delays and cancelled procedures and appointments because medical professionals had other priorities.

Wouldn’t both of those situations be vastly worse if there were fewer or less strict lockdowns?

Sorry I missed the context for your PS. Yes they'd be worse without lockdowns. OP's argument is actually an argument for the side.

The story with lockdown is a lot muddier. There's a good argument to be made on both sides, and weighing which decision is best with partial data is difficult.

I completely understand the initial lockdowns when we had no data. I would have done that too, although I would have acted sooner because I saw this threat clearly in January - why our governments were less competent across the board than some rando programmer is something I haven't forgiven.

What I don't understand is now that we have data, we're still doing lockdowns with no attempt to publicly weigh the pluses and minuses and justify three decision logically. I mean maybe it's the right thing to do, but I want to see them put some real thought into the decision, and not do it because it's what they're before, or what's politically viable.

There should be a clear logical argument being made, weighing the harms on both sides and choosing the lesser evil.

The point of the trolley problem is that it’s hard to make the right decision. Yet apparently anyone who doesn’t make a decision based on the move naive application of utilitarianism is a coward.

At a government level you have to be able to weigh bodies. Because there are often deaths or serious harm on both sides of a decision. Just because it's a hard decision doesn't mean there isn't a right choice that minimizes harm. This is also true of the trolley problem.

In this case one side is clearly tipping the scales by multiple orders of magnitude more. To choose that side for political reasons is cowardice and unethical.

I don't know if "weighing bodies" is the right approach to government, but even if it is people who "weigh bodies" are not likely to remain in power very long. There aren't a lot of humans who would support harvesting the organs of a healthy patient to save 5 sick ones, for example.

I put it crudely to be dramatic, but it is the core function of a government to choose between competing harms and benefits for different segments of the population (including populations outside their borders when it comes to foreign policy.)

> There aren't a lot of humans who would support harvesting the organs of a healthy patient to save 5 sick ones, for example.

That's a strawman. I'm not taking the position that the right decision is always choosing the least number of bodies. Maybe that is true, there are debates to be had there, but I'm not arguing that, and that's not comparable to the decision here with the AstraZenica vaccine.

Harvesting 5 organs from 1 healthy patient to save 5 sick patients is a variation of the trolley problem, not just a random straw man I picked. The fact that people who are surveyed are fine pulling a lever to kill 1 person to save 5 people from a runaway trolley but don't want to harvest the organs of 1 healthy person to save 5 sick people shows that these ethical problems are "difficult" as one person said up-thread.

This is the slippery slope of analogies. I'm not here to argue about trolley problems or organ harvesting.

I'm here to say that there's a clear right decision to be made here that will cause the fewest number of deaths by multiple orders of magnitude - and the Danes are making the wrong choice because they left the decision to their medical professionals who are biased to first do no harm. It is the role of government to make these kinds of hard decisions, and they need to step up to the plate and do the right thing. This oversimplifies the problem because the deaths from Covid-19 tend to be older people and the deaths from blood clots, tend to be younger. But then there's still a clear right choice to be made by just using the AstraZenica vaccine in older people. This is the sensible decision most countries have taken so far.

What do we do in cases where it's murky like the trolley problem or the organ problem? The government still has to choose, and not choosing is still a decision. In that case if there's no clear answer then maybe the decision doesn't matter that much - both paths are similar.

The trolley problem and the organ problem have been argued about ad nauseaum. I don't expect to add anything new to that. They're different problems. The trolley problem you should pick the 1 to die - it might end up being the worst choice still, but it's the one most likely to do the least harm, so the choice is obvious - IMHO. If I recall correctly, that 1 person is not innocent, they put themselves in this situation, but the 5 on the trolley are and didn't make a bad judgment call. That seems to matter to the ethics of the thing.

With the organ harvesting - all the people are equally innocent. You can't take the life of an innocent person to save the lives of 5 others, even though the math makes sense. That's crossing a line.

Again, they're hard problems, not everyone will agree. But it's the job of the government to choose in hard situations, and choosing nothing is a choice too.

For me, the difference is that people can handle the idea of getting sick and dying. It happens to everyone eventually and there's nobody to blame. People are much less happy about deaths that are directly tracable to someone's decision (e.g. continuing to use a vaccine that will kill some small number of people).

That could be part of it for sure. I think the first do no harm mentality is a very strong bias in the medical community in general. And as pointed out elsewhere, it was the Danish medical authorities that made this call. They're the wrong people to do that.

I think there were broadly 3 strategies:

1. Do very little intervention, but perhaps isolate the vulnerable. This was the "Sweden strategy".

2. Do big interventions if cases rise, but only so far as is required to prevent hospitals being over-whelmed. This was the strategy in most of Europe, and in particular the UK.

3. Do big interventions with the intention of reaching "covid zero", including restrictions on international travel. This was the strategy of Australia, New Zealand, Taiwan and perhaps China (hard to get the full story).

Having spent the past year under (2) I wish I was living under (3). Sure it's painful in the short term, but compared to rolling lock-downs for over 12 months?

> but compared to rolling lock-downs for over 12 months?

So far. Add 6, 12 or 24 months.

So why not choose (1)?

This seems to have been the strategy in the past with similar risks. And it avoids the costs of freedom and live at the same time. What am I missing?

That it doesn't work. Sweden had to go back on it, and in many countries trying to do (1) ended up with hospitals full - like France. Everything was done to avoid a third lockdown this spring, but hospitals are at 150% capacity and here we are again. Are you aware of some magic trick that negates that?

Sweden did not "go back on it". They remain with significantly lighter restrictions than ~all of continental Europe:

https://www.folkhalsomyndigheten.se/the-public-health-agency...

As far as I can tell, their most stringent restrictions are limits on group gatherings to 8, and closing bars at 8pm:

https://www.bloomberg.com/news/articles/2021-03-30/swedish-h...

Contrast to France, Italy, the UK, Belgium, etc., where people have been forcibly restricted to their homes for a significant portion of the last year.

And Sweden has the worst infection and death rates per capita compared to all of Scandinavia:

https://www.statista.com/statistics/1113834/cumulative-coron...

https://journals.sagepub.com/doi/full/10.1177/14034948209802...

https://ourworldindata.org/coronavirus/country/sweden

But they faired much better than e.g. Spain and Belgium.

https://www.aljazeera.com/news/2021/3/24/swedens-2020-death-...

Which are incomparable due to a vast amount of variables ( culture, population density, population spread in housing, temperatures, weather, etc.)

That's patently false.

Everyone compares countries all the time.

You literally just did it a few posts up by comparing it to other Scandinavian countries which are all different from Sweden.

Covid zealots compare other countries to New Zealand when it's convenient.

All with different cultures climate population density etc.

If what you're saying is true then you can't make any claims about any country's success rate because they're all unique.

You're just selecting Sweden as incomparable because it doesn't fit your narrative.

Scandinavian countries have similar cultures, population densities, climates, customs ( e.g. people don't kiss on the cheek when they meet, which is what French people used to do pre-pandemic). They're more comparable between themselves than with Spain, with an entirely different climate, people living much closer together, etc.

New Zealand are isolated by water from everyone, lockdown is drastically easier in that case.

Swedes are European and share as much in common with Europeans as they do with other Scandinavian countries. Comparing Sweden to other European countries is a perfectly valid comparison.

You're cherry picking and choosing cultural aspects and labeling it as 'unquestionable fact' with no scientific evidence.

Classic Covid zealot move.

As a matter of fact, we're all human beings that like to congregate together and eat out and go to bars and coffee shops and see live music, and our biological drives have way more significance than anything cultural .

It's extremely disingenuous.

You have never visited any of those places, have you?

I don't know what "Covid zealot" is supposed to mean, but i think you need a reality check.

So, let's be clear: you make claims that aren't true (Sweden hasn't done what you originally claimed; they have significantly fewer restrictions than most of Europe, even today), and then when people point out the factual inaccuracies in your statements, you retreat to arguing about the wisdom of Sweden's choices.

Reasonable people can disagree about policy choices, but misrepresenting facts as a starting point does not make you look reasonable.

My claims are true, Sweden has significantly tightened restrictions. And to add insult to injury, their death rate is appalling, so their policy was indeed wrong on top of not working.

You said:

> Sweden had to go back on it

They did not. If your standard for "going back on it" is "adding some restrictions", then you are erecting a straw man argument. By this standard, every country in Europe "had to go back on it", as all of them changed their tactics over time.

Also, not incidentally: I'm aware of no legitimate source for the claim that Sweden's hospitals were "full" (which is a non-specific claim). Most sources I've read emphasized that hospitals were under stress -- like in most parts of the Europe -- with some hospitals closer than others to capacity, and resources being shifted around the nation to manage:

https://www.thelocal.se/20201211/is-the-second-wave-overload...

Again, you could take this article and put it in Paris, Berlin, London, Brussels or other major cities in Europe in December of 2020. Details matter, and vague claims that "hospitals are full" are meaningless.

When their policy is "let's avoid any restrictions and just ask people to stay away from each other", and then they add light ( compared to other countries) restrictions, how is that not "going back [on their initial policy]"? No other European country persisted with the "no restrictions" policy post-spring 2020.

And i never said the Swedish hospital system was "full", just that their death toll compared to their neighbours was appalling, and said neighbors had to add restrictions on movement from Sweden.

My understanding is that these restrictions were only imposed in December of last year (and are in force until at least 30 June), so I would tend to agree with the parent that they definitely changed directions.

They added some restrictions, certainly, but it's completely inaccurate to suggest that they've somehow reversed course -- the OP is erecting an ideologically rigid, straw-man argument that Sweden can never do anything differently at all, or they are somehow "going back on" their initial approach.

Overall, Sweden has taken a light touch with the pandemic, and continues to do so, even though, yes, they've adapted over time.

Of course they went back on their initial approach, same as the UK. If you say "no need to restrict anything, it will go away", your death toll is significantly hire than comparable countries, and then you enact restrictions, what is that? Yes, the situation and our knowledge of the virus and the pandemic is highly evolving and the UK took barely a few months before making a U-turn, while Sweden persisted for many months with their strategy, in spite of the death toll, and some research saying that the economic impact is still significant.

The secret to not having hospitals overwhelmed is to have enough capacity in the first place, but also to avoid superspreader events. Sweden did ban some gatherings and they did close down schools briefly.

Most other lockdown measures are questionable at best, including mandatory mask usage. They are clearly symbolic tools for the political class to signal that something is being done, but the data to support them is not very strong considering that there is not much of a control group.

> The secret to not having hospitals overwhelmed is to have enough capacity in the first place

Enough for what? Hospital capacity was wildly sufficient for regular times, but the pandemic turned that around. Even Germany, which has multiple times the capacity per capita than France, is struggling in that regard. What is "enough"?

> but also to avoid superspreader events

Lol. Events with more than 2000 people outside ( at the best of times, usually it has been flat out forbidden), and 6-100 inside have been forbidden in France since last year. That obviously didn't help.

> Most other lockdown measures are questionable at best, including mandatory mask usage. They are clearly symbolic tools for the political class to signal that something is being done, but the data to support them is not very strong considering that there is not much of a control group.

There is, check the US and Brazil.

> Enough for what? Hospital capacity was wildly sufficient for regular times, but the pandemic turned that around.

Indeed, "enough" for normal times is not the same as "enough" for pandemic times.

> Even Germany, which has multiple times the capacity per capita than France, is struggling in that regard. What is "enough"?

Of course it's a "struggle" to suddenly work at capacity, but Germany wasn't in the situation of having to turn down patients. To the contrary, Germany was able to pick up patients from neighboring countries. That's "enough".

> Events with more than 2000 people outside ( at the best of times, usually it has been flat out forbidden), and 6-100 inside have been forbidden in France since last year. That obviously didn't help.

How do you know that it didn't help? We know from epidemiological studies that superspreader events were responsible for causing a surge of cases in a short amount of time.

> There is, check the US and Brazil.

There really isn't, we have countries with strong lockdowns doing poorly and countries with weak lockdowns doing relatively well, and everything in between. Lockdown measures are also difficult to compare, as are populations, as is testing and reporting.

For example, Brazil with minimal lockdowns is doing just as poorly as Peru, with heavy lockdowns. Florida is doing better than many other US states with heavier restrictions. Japan is supposedly doing well with few restrictions, but also performs little testing.

There are lots of variables and unknowns here and one can always cherrypick data to argue for or against lockdowns in various forms.

That was during the first lockdown. More recently, they're closer to capacity:

https://www.dw.com/en/coronavirus-digest-germany-icu-capacit...

> How do you know that it didn't help? We know from epidemiological studies that superspreader events were responsible for causing a surge of cases in a short amount of time.

It didn't help in the sense that hospitals are overcapacity and new cases, hospitalisation and death rates were still exploding until the recent pseudo-lockdown.

"An intensive care doctor has warned that only five to 10% of intensive care beds are still available in parts of Germany."

In most countries, running at 90% ICU capacity is the normal state of affairs, Germany being an exception.

Of course you can always warn that the health care system is just about to collapse.

In 2015:

https://www.theguardian.com/society/2015/sep/19/nhs-collapse...

In 2016:

https://www.theguardian.com/society/2016/sep/10/hospitals-on...

In 2017:

https://www.theguardian.com/society/2017/feb/20/nhs-at-break...

In 2018:

https://www.theguardian.com/commentisfree/2018/apr/06/nhs-fa...

In 2019:

https://www.theguardian.com/society/2019/dec/02/nhs-winter-c...

In 2020:

https://www.theguardian.com/world/2020/mar/21/doctors-warn-c...

In 2021:

https://www.theguardian.com/world/2021/jan/09/nhs-counts-the...

Spoiler: The NHS did not collapse. Working right at the brink of collapse is normal.

> It didn't help in the sense that hospitals are overcapacity and new cases, hospitalisation and death rates were still exploding until the recent pseudo-lockdown.

According to your own source, hospitals are not over capacity. If you had a few super spreader events, that could obviously change rather quickly. Whether a "pseudo-lockdown" meaningfully slows spread is not so obvious.

It’s absolutely true that ICU capacity generally runs at 90% utilisation - ICU beds are bloody expensive (staffing etc). In NSW, Australia, where I live and work (and have worked in ICU) there is a statewide ICU service so if you need a bed and you’re on the other end of the state you can end up getting transferred 1500 km to be in one.

Having said that about utilisation, what pandemic beds requirements meant in the rest of the world and would have meant here is that no elective surgeries could be performed; leukaemia/cancer patient stem cell/marrow transplants couldn’t go ahead and trauma victims risked not being able to be cared for. This was absolutely the case in the UK during the height of things (friends are ortho/trauma surgeons over there and ended up working as assistants in nursing for 3-4 weeks in January).

So, with increase in ICU bed availability through adding new beds and with stopping any potential procedures that would electively require an ICU bed for recovery countries were able to basically meet demands (although many of my emergency colleagues in the UK reported having to determine who was going to be for ICU or not - ie top level care was not offered to some people during the height due to lack of resources) - there is now a massive backlog of patients requiring their baseline care to be fulfilled.

For example, another of my colleague’s mothers is a (retired) dermatologist in London. She was pulled back into work because there are now people presenting eith melanomas that were missed because no one was going for their regular care early in the year. And now they’ve spread and now people are dying because of this; not to mention the backup.

There’s no silver lining here.

You moved the goal post to encompass elective surgeries and other things.

The argument was: Did the hospitals overflow from Covid?

And they did not overflow anywhere in the world.

From the CBC: The latest on the coronavirus outbreak for April 20 [1]

> New Toronto field hospital prepares to accept patients as ICUs overflow

> Greater Toronto Area hospitals are so overwhelmed due to record COVID-19 admissions that some patients are being transferred to health-care centres outside the region.

[1] https://www.cbc.ca/news/canada/coronavirus-newsletter-april-...

Covid zealots say #believeTheSciene but the use the news media as scientific sources.

Post an actual link to ICU numbers if you truly '#believeTheScience'

Here I did it for you.

https://www.arcgis.com/apps/MapSeries/index.html?appid=078a3...

Do your own data analysis and see ICU admissions are only up 15% or so.

Also, according to other media outlets, ICUs in Toronto haven't filled up, they're 'NEAR capacity'.....which has been the story for over a year everywhere.

The media drums things up to make money and should not be used as evidence for your argument.

The media also said San Diego ICUs and Houston ICUs were overflowing but it didn't happen.

For example, this sensation article never happened:

https://www.google.com/amp/s/www.nbcsandiego.com/news/local/...

Do you have anything supporting your argument of hospital overflow with substance?

Or do you get all of your 'science' from the news media?

I'm not posting to try to convince you, as you're clearly beyond reason. I just find some aspects of your comments here interesting, and worth laying out for any third party who might read them.

First you attacked a comment (above), claiming they'd moved goalposts in their arguments, and then you claimed hospitals had not overflowed. Subsequently, you responded to a comment providing a citation saying they did, by demanding a different source - which is moving the goalposts, the very thing you criticized in someone else.

Here, look at this, another article showing Indian hospitals have overflowed, this time from Reuters:

> Indian hospitals turn away patients in COVID-19 ‘tsunami’ [1]

This is relevant because you yourself consider Reuters a citable source, at least when you like what it is saying [2].

That comment you cited Reuters in reminded me of another of your comments [3] (I actually did mark your words, as requested):

> Mark my words America is heading towards herd immunity as long as we stay this course, and this will be all over by the end of the year. (you, eight months ago)

How's that herd immunity coming along? Was it all over by the end of the year?

[1] https://www.reuters.com/world/india/indias-daily-coronavirus...

[2] https://news.ycombinator.com/item?id=26732877

[3] https://news.ycombinator.com/item?id=24277509

I'm glad you marked my words.

Texas had 40,000 people at a football game, has no covid restrictions, and is at record lows for Covid.

With the exception of Michigan almost every single state has reached record lows of Covid.

It's not an exact science but we have reached herd immunity in almost all of America within a few months of what I predicted.

All with only 25 to 40 percent vaccination number. So it's clearly not vaccination or restrictions providing the full herd immunity.

As for India sure I'll give you that. I should amend my statement to mean 'First world' countries with adequate ICU capacity had no ICU overflow.

You have to quote a third world country with the average personal income of 2000 dollars a month to support your argument because the hundreds and hundreds of other worldwide first and second world countries didn't have any hospital overflows. This is not surprising or unexpected and disingenuous of you to discredit hundreds of other countries in favor of a single country to support your argument.

However, the rest of the first world outside of India has had no hospital overflow.

Asking for a legitimate source this is not the news media.... is not 'moving the goal posts'.

You 'beleiveInScience' Covid zealots think the news media is science. I hate to break it to you but the news media is not a reliable scientific source. You should try to learn what science is before you #believe in it.

I'm not sure what you Covid zealots require to feel safe again.

I legitimately feel sorry for you.

You're in a permanent prison of fear.

I have to say, you never disappoint: you've moved the goalpost again.

You're implicitly conceding that contrary to your earlier assertions, there have been hospital overflows, but now are further restricting your claims to only apply to first and second world countries.

You're also ignoring the fact that I chose this particular article not because I couldn't find first world examples (I already did, see above), but because this one was from a source (Reuters) you've already endorsed by citing articles from it yourself.

Now you're writing a rambling attack to distract from the fact that you have nothing to support your claims, and can only try to evade the evidence against them.

Sure Ill concede that out of hundreds of countries, one third world country of India has had hospital overflows.

Any person with good faith and an honest mindset would agree that India is the exception not the rule.

Covid zealots are not known for honesty though.

I don't know what the f your problem is, but you're wrong. France is today, even past the worst of the current wave, still at more than 100% original capacity of ICU beds. (118% for France, 152% for the Ile de France region with Paris)

Official sources and raw data: https://www.france24.com/en/europe/20210310-paris-hospitals-... https://bonjour.tousanticovid.gouv.fr/app.html#chiffres

Are you going to shift the goalposts again and redefine to "Anglosphere first world countries"? Or are you going to admit you don't know what the hell you're talking about?

"Covid zealots" is a peculiar term, i'll give that. Makes little sense of course, but nothing you say does.

The first article that you linked was a news article and said "Near capacity" not "Over capacity" and the second link you posted didn't have ICU numbers that I could see.

ICU's run "near capacity" all the time, so the news source you linked is simply stating a normal situation in a sensational context.

See here: https://www.beckershospitalreview.com/patient-flow/2-healthc....

What I mean by Covid zealot is people who believe things that aren't real about Covid based on poor critical thinking and/or poor understanding of the data or some other reason that I don't understand.

The second link includes ICU numbers in the "rea" ( for reanimation, the French term for ICU). Pre-pandemic capacity is readily available online.

ICUs in France had their capacity doubled over last summer, and since the beginning of the year everything elective has been postponed to make place for Covid patients.

> What I mean by Covid zealot is people who believe things that aren't real about Covid based on poor critical thinking and/or poor understanding of the data or some other reason that I don't understand

So denialists that still fail to grasp the gravity of the situation, like yourself?

Unless, I'm missing something about that link you posted, it's just simply showing REA numbers increasing and not the total capacity of ICU.

Patient numbers are still NOT ICU capacity. Numbers can go up and still not be at capacity.

If I'm indeed not missing something that is either poor reasoning or a disengenuous citation.

If you get all of your information from the news media there's 'gravity to the situation' but if you look at statistics...

Covid is mostly over in the states and either over or on the downswing around the world, with the exception of a few third world countries.

You should look at statistics and not the news media.

In the U.S., States are at record lows of new infections and almost every state has lifted most of it's restrictions and we're not even at 40% vaccination rate.

Even New Zealand has opened it's borders to Austrailia and their vaccination rate is in the mid teens.

Covid's fatality rate in the states was around 0.00125 and I'm assuming other places as well.

Trying to understand the gravity of the situation that you claim exists.

It's like The 3 billion people who believe in God. Despite all evidence to the contrary the zealots will cling to their narrative.

> Covid's fatality rate in the states was around 0.00125 and I'm assuming other places as well.

Totally wrong. Johns Hopkins says the case fatality rate in the states is 1.8% [1]. Many others are worse, like Canada at 2.0% and 2.9% for the United Kingdom.

[1] https://coronavirus.jhu.edu/data/mortality

500,000 dead / 400 million people.

You can do the math.

Hell only 33 million in the states tested positive for contracting Corona.

33 million / 400 million

Which is infection rate of .0825

Even if you double it to account for non tested cases that .16% JUST CASES.

Even if you double that you're not even at 1% yet.

The experts err to the EXTREME side of safety.

These are the same experts that say only eat steak if it's well done and not to drink more than 2/3 cup of wine in an evening.

The divisor for case fatality is number of infections, not total population.

You can look up the definition.

so 572,674 / 32,124,869 = 1.8%

As I already said, and as you can look up yourself, in the link I gave.

No that's the chance of death if you're already infected.

The fatality chance for a healthy person in the general population is the measure of risk for the average person. Using the same measure of population that the R value uses to calculate infectiousness.

https://en.m.wikipedia.org/wiki/Basic_reproduction_number

Have you been using 1.8% chance of death as your chance of dying? I would be scared too.

For a healthy person to become infected is a very small number to begin with and highly biased towards the elderly or people with co morbidities.

You can legitimately lighten up. Your risk from this is infinitesimally small if you're under 55 and healthy.

If not it's still unbelievably small.

This is right from the Johns Hopkins page linked to above:

> fatality ratios (the number of deaths divided by the number of confirmed cases)

So you’re wrong. Again.

fatalities / infected = fatality rate of those infected.

It's literally the definitions of those words.

It's fine continue to be scared. I legit feel bad for you.

My state just lifted the mask mandate recently and were not even at 30% vaccination rate yet.

Feels good.

You're ignoring the reality, which is that people died preventable death and suffered preventable harm because hospitals were overwhelemed.

There are thousands of English HCPs talking about this. Here's one: https://twitter.com/seahorse4000/status/1386263023900319745?...

(That comment about staff is for their particular NHS trust, not the NHS as a whole)

We rationed oxygen

We shut the hospital

I was managing icu pts on amu

We stopped elective surgery

We had over 400 staff off with covid

I had 9 pts die on a single shift

Using twitter and the mainstream media are the new scientific sources.

interesting that you don't level the same at parent poster.

Parent poster was using links to mock the news media and evidence how unreliable and hypocritical they are.

You are using an anecdotal Tweet as an actual epidemiological citation.

It's very interesting to me how low the bar is for the Covid zealots scientific sources!

(2) leads to fewer deaths overall than (1). (1) gives better quality of life to the healthy than (2). (3) leads to fewer deaths than (1) or (2), but it requires political will. If you can pull it off, (3) is what you want. That's a big "if" though.

As a healthy person, I personally would have been better off under (1). However, I think the economic and emotional damage of that number of deaths would have been too much for society as a whole.

I'm not certain the emotional damage around the deaths would be worse than the emotional damage around the restrictions. Same with the economic damage, I'm entirely certain the the economic damaged caused by the death of a large amount of largely economically inactive persons would have been way less than the economic damage caused by forcibly shutting down large chunks of the economy.

The whole 1 vs 2 thing is just a matter of how much must the whole suffer for the benefit of the few?

Living in 2 i'm not sure 3 would have worked where i am ( France) to get to zero, especially considering Schengen and the fact that even if by some magic you get to zero cases, it can easily spillover by even a few people from neighboring countries or tourists. And i sincerely doubt it could have gotten to zero cases - every lockdown since the first one has been ignored by a non-negligeable amount of the population.

To be in (3) though you have to isolate your country right at the beginning before the action can be politically justified.

I'm quite surprised that China was able to pull it off, because they're a major trade economy and must have millions of people coming and going. Of course it helps to have a government that can take any action without regard for rights or political consequences.

This is impossible I think for a country like the US with vital land borders and constant trade across them. I think it's also very hard for democratic counties where people have rights.

The lock-downs imposed in (2) countries were very effective and given a bit more time (and political will) they could have transitioned to strategy (3).

Australia and China managed to do this.

If I look at the center of Amsterdam, in the past year there have been losts of tourists from all over Europe even when bars and restaurants are closed. So this means that any strict lock down would have to be coordinated at least within the EU.

In the past, EU countries did not want to delegate health care to the EU (except for approving medicine). So this would require lots of individual countries (including Sweden and, until this year, the UK) to suddenly agree on a single strict lockdown. Very unlikely to happen.

The lockdowns imposed in countries that only used them to prevent the hospital system being overwhelmed were very effective on average, but that's not enough. In order to reach Covid Zero you need lockdowns to be very effective everywhere. Take for example the UK - there were apparently some areas where cases kept growing even during the strictest lockdowns, and that's enough to ensure you'll never reach zero cases.

All the countries where this worked seem to have the advantage of being geographically and geopolitically distant from Italy, which meant they could take action against their outbreaks at a relatively early stage before they got deeply embedded in society. (Early on, cases were more or less a gradient radiating out from Italy, probably because they had a major outbreak which went completely undetected as in literally reporting zero cases country-wide despite having an awful lot more than that.)

You don't have the right to even smoke in a restaurant now, what's the right issue when talking about a health issue here. It needs the same reason as quarantine requirements being imposed on people. So many 'we are different' refuse to stay at home and wear masks.

The real tragedy is that most of countries are following UK and US as their model because most of their government policy makers are trained in US and US, and they don't have the capacity and courage to set out their own plans.

China actually had a bit of advantage here, as other countries started shutting out Chinese nationals, preventing their citizens from going abroad and reintroducing the virus. Also it seems like as the first hard hit place its citizens started to become wary of traveling abroad earlier.

I would have preferred a strategy of using financial incentives. Big fines for companies that refused to switch to remote work where it was feasible. An additional tax on indoor dining and shopping, to make curbside pickup more attractive. Fines and additional tax would go directly to lockdown financial relief.

>I wish I was living under (3). Sure it's painful in the short term, but compared to rolling lock-downs for over 12 months?

Having spent the last year under (3), I dream of 1 or 2.

That said, it very much dependent on the country. I live somewhere that is 20 x 20 miles in size (Hong Kong). The strictness of the border control (3 weeks in a hotel room if you leave and come back) make leaving pretty much impossible.

That, combined with extremely conservative local restrictions (not to mention the political situation) takes a significant toll after a while.

Most people in positions 1 and 2 can’t really leave their countries either, and depending on how strict 2 is you may not have been able to travel far within your country either.

This is mostly an artefact of the fact that HK is so small. At least you’re not in Macau, which is 30 sq km?

>At least you’re not in Macau, which is 30 sq km?

Macau has quarantine free travel with the Mainland, so that's >9 million sq km ;)

(3) only really works in isolated communities and islands such as those mentioned.

I would choose a mix of (1) and (2), but no matter what we say here it won't change the past.

Going forward we can either choose the goal of no masks, no vaccine pass and no restrictions this year. Follow Texas for more on how that works.

Or we can go on with restrictions and random shutdowns when infections rise above an arbitrary level.

I know i would choose the first option.

Canada, specifically Quebec has been in full on curfew for a long time now. It hasn't helped and cases keep rising with now being the highest.

[1] should have been the best strategy.

Indeed, having your freedom taken away like that is an overreaction.

Until recently nobody in the US had the idea of removing restrictions and allowing 40.000 to gather for sport events.

That was until Texas did it and they are doing just as well as those with restrictions.

https://fee.org/articles/texas-has-fewer-covid-cases-than-mi...

Except it's not the government, or any politicians for that matter. It is the decision of medical professionals, basically the danish version of FDA decided to stop using Astra Zeneca vaccine. They have that level of power here in Denmark.

That's the problem. They're strongly biased towards the do no harm side of the balance - even when inaction causes much greater harm. It's simply a blind spot for them.

They're the wrong group to make the call here, and the politicians should overrule them.

Politicians don't make that determination right now. Self driving cars are a pretty good example. There's evidence right now showing that most systems are safer than human drivers. Yet still they are not permitted for use despite the fact that it will almost certainly result in fewer deaths.

Doctors are supposed to do no harm.

And erroring on the side of caution is what tends to happen in democracies. An authoritarian government is much more suited to taking bold and controversial action. I’ll personally stick with the overly cautious government.

No! There are NOT likely deaths on both sides. That’s the insanity!

There are certain deaths on one side (no vaccine) and virtually certain absence of any deaths on the other side.

It is cowardice and self importance triumphing over reason and morality. Imo

The blood clots have already caused deaths, unless I'm mistaken. At any rate it's not "virtually certain absence of any deaths". I agree with your conclusion, but the premise has some issues.

A few deaths out of 6 million defies any confident statistical pronouncements. It is rounding error. That we are so cautious as to halt rollout because of rounding error only speaks to how very cautious and rigorous we’re being with the rollout. People without the background to understand what 6/6,000,000 means in a medical research context will hear these fud statements and opt not to get the vaccine. Some of the people will die because they read smart peoples comments in web forums and thought they would be safer not getting vaccinated. You are throwing the switch in the trolley problem if you are telling people to ignore the scientific consensus and spreading anti vax fud. People need to accept the responsibility that entails.

> You are throwing the switch in the trolley problem if you are telling people to ignore the scientific consensus and spreading anti vax fud.

I'm not spreading any FUD. I'm as far from an anti-vaxer as you can get. I think you didn't read my comments.

> A few deaths out of 6 million defies any confident statistical pronouncements. It is rounding error.

But it does suggest there is a problem there. I took issue with your no deaths on the pro vaccine side. That's not true, as you admit.

> People without the background to understand what 6/6,000,000 means in a medical research context will hear these fud statements and opt not to get the vaccine.

This is sadly true. That's the same odds as dying from lightning in a given year. People suck at evaluating risk. I had many arguments with my parents about the risks from the vaccine, when it's literally lower than the risk of getting out of bed in the morning. People are irrational and it makes me sad. I'm also irrational, and I don't always catch it.

I disagree with “it does suggest there is a problem there.”

Without statistical evidence we cannot make that claim. There may be a problem, but there is so far no statistical evidence to suggest so. There are anecdotal findings but there are anecdotes about space aliens and we don’t craft policy around that (that the public is aware of.)

Despite having 1 dose of AZ already in my arm, it would give me great peace of mind to find some logical basis for this decision. Until then, I'll continue to suspect politics.

  Country after country appears to have taken a turn doubting the vaccine.  It would be normal for one or two outliers to behave this way, but for so many to defy logic - appearing to take turns falling in line with the EU message - it starts to smell a bit funny.

I've written this before, but if Britain (having left the Union) pulls this off and Europe continues to flounder, it is potentially catastrophic for the Union.

This would be correct if Covid was very widespread in Denmark, most of the at-risk >65 population wasn't vaccinated already and there weren't alternatives available very shortly. But none of these are true, so the overall ethical decision becomes more complicated than that.

It's fallacious to describe this as an instance of the trolley problem, as there's also the public's trust in vaccines to consider. You'll see that the rest of Europe have arrived at a different conclusion, largely due to the fact that Covid is much more widespread there.

Decsions like that undermine trust. Now scepical people can point at Denmark and say: "See, it is dangerous, I don't take it" Because nobody will take time to understand how and why Denmark came to that conclusion. Not in a time where people are happy only reading half of a headline.

You mean people outside of Denmark. Inside of Denmark people will look at the next vaccine the government decides to go with and feel more willing to trust it precisely because their government withdrew support of the one causing clots

> They're choosing to let a large group risk severe disease or death through inaction, rather than pulling the lever and have a small group be at risk due to their actions.

I think your interpretation of the relative risks is wrong, but I’m open to seeing the calculations by which you come to this conclusion.

I mean the 65+ group is also most at risk of dying of Covid. I don’t see the moral hazard here. I understand that you can argue against vaccinations of younger people whose Covid risk might be eclipsed by the thrombosis risk. But for old people it seems simply stupid.

_Are_ there unvaccinated over-65s in Denmark? AIUI it's generally a bit ahead of the EU curve, and over-70s are generally done in most European countries.

I had to look up "AIUI" because I didn't understand your comment, it turns out it's a capitalization for "as I understand it", so you basically made your comment less readable to avoid typing 15 characters, which at a modest typing speed will take about 3 seconds to type. So if you've read this far it means it's already been a negative return to type the shortcut.

As far as I know most EU countries are on a similar trajectory and only differ by a few percent (I.e. they use all the vaccines they get and most have only the common procurement).

What can differ is which groups are vaccinated, e.g. Sweden has 19% vaccinated with at least 1 dose but the coverage by age group is e.g 85% in 80-89 and just 35% in 70-79 and 60-69 is only 10%.

Yes. Elsewhere in the thread, I linked the official Danish vaccine calendar [1] (from today, April 14) which estimates that 65 years and above will complete vaccination end of May, though this is subject to change based on actual deliveries. The vaccines in the plan do not include AstraZeneca though they do include Johnson & Johnson as can be seen from the more detailed plan [2]. Neither plan is available in English unfortunately.

[1] https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio... (in Danish)

[2] https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio... (in Danish)

The 65+ group are to a large extend already vaccinated or have begun vaccinations with other vaccines in Denmark.

The expected overall delay from not using AstraZeneca until all adults have been vaccinated is 3-4 weeks.

Current death rate in Denmark is 2/day. Population 5.8 Million.

Sounds like a while lot more deaths than potential clot cases (not to mention clot deaths, which might be zero in a population that small).

Norway has ~10 deaths from Covid in the <60 age range throughout the entire pandemic, and 3 deaths from AstraZeneca-related side effects in the same age group.

But only a small minority of the <60 population has been vaccinated; almost exclusively healthcare workers. You would expect the deaths from side effects to eclipse the number of covid deaths if vaccination continued.

So it's a pretty safe assumption at this point that AZ is a bad option for younger age groups in countries with similar numbers, assuming that other vaccines will soon be available (they will)

Sure, but at the same time 3 is too small a number to have any confidence in that expectation.

Looking at the rates from other countries where AZ has been deployed more heavily, it seems like Norway mostly had bad luck, and the rate is fairly small.

Though as you say for the younger population the risks with covid are also small and the choice ultimately depends on the infection rate in the country.

An interesting question is if there actually is any public health argument in favour of vaccinating the inhabitants in the countries that have managed to keep it out completely? There the choice is between taking on the risks of the vaccine versus just not allowing travel, and the public health impact of the latter isn't very clear.

Even New Zealand presumably can't keep its border sealed indefinitely.

Northern Europe's greater observed incidence of this side effect is obviously one of the deciding factors of Denmark's decision. It could be a statistical anomaly, but concluding is premature at this point, especially when comparing with globally-reported AstraZeneca-related blood clots.

Even at half the incidence of deaths reported in Norway, which would be on the order of 1:100,000, it puts the risk of a 25-year old dying from the vaccine at ~5 times the risk of dying of a Covid infection. At one tenth incidence, it's an even bet. That seems unlikely.

This seems like a pretty obvious decision to me, when looking at the Covid incidence in these countries. Given that alternative vaccines are available. I'm surprised at the level of controversy, honestly. Given the presumed science-based background for the topic. Just use one of the others.

Lies, damn lies, statistics, and statistics with low sample sizes.

In the UK they've had 13.5 million people under 60 vaccinated as of April 8, and a grand total of 79 cases and 19 deaths. The number of COVID deaths in people under 60 is more than 9000.

You're blaming the qualitative difference in the observations on sample size when Denmark, Norway and Germany all observe the same effect to differing degrees - namely, rare blood clots approximately an order of magnitude more frequent than data from Europe as a whole indicates.

You should at least acknowledge that the UK has a per-capita Covid lethality of 15 times that of Norway, and that this might also be a relevant factor in these decisions.

Denmark as low number of cases and down to 7 day average of 2 deaths. Assuming they have lockdown measures in place they aren’t risking much from dropping AstraZeneca.

Exrended lock down measures aren't without costs either.

Denmark has been slowly opening up the last month (schools/daycares/offices) and will continue to open shopping centers and restaurants the coming months.

A <72-hour negative tests is required for e.g. hairdressers and restaurants.

Plans for opening up travel to other countries and returning without quarantines during the coming months are in place.

We do very rigorous testing, and the number of cases/deaths has not risen over the last month despite opening up parts of society, so the assumption is that we can open up more (carefully).

Denmark is number two worldwide with respect to tests per inhabitant with 5.1 million tests for each 1 million inhabitants (i.e. 5.1 tests per inhabitant). Generally less than 0.5% of the tests are positive

The >65 population in Scandinavia is largely vaccinated already, and incidence of new cases is low. So it's a decision that might be questioned, but which would have small real-world consequences even if it turned out to be incorrect in isolation.

That part of the decision might just be the combination of uncertainty combined with the public's skepticism towards this particular vaccine. Giving an impression of listening to the public might have been considered a better overall choice than making a big communication effort for little real-world benefit. Other vaccines will be available very shortly for the few >65 people not yet vaccinated.

Sweden’s numbers are illustrative here, with COVID cases rising steadily since January, but deaths are going down.

> The >65 population in Scandinavia is largely vaccinated already, and incidence of new cases is low.

80+ population is largely vaccinated. 70+ isn't, and 60+ is barely begun, at least in Sweden.

But most deaths are in 80+, so current situation is that hospital admissions are trending up (because adults are largely unvaccinated), ICU is trending up (because 50+ are unvaccinated) but deaths are trending down (because 80+ are vaccinated).

For now, I agree, probably best to keep using it. But if turns out there is need to re-vaccinate yearly (2x again), the decision is not as obvious.

It's kinda complicated, while I'm 100% on board with vaccinating, I do see the problem..

"You have some chance of getting Covid" then "If you get Covid you have some chances of getting seriously ill, permanent damage or die"

"You have 100% chance of getting the vaccine" then "If you get the vaccine, you have come chance of dying"

So it's not super simple to calculate the risk, especially not for me, so I shouldn't comment at all..

The thing is that in the 60+ group or 65+ group it's not that complicated: there have been zero concerns about the virus there, but the disease is very dangerous in that group. The difference in risk of dying from Covid vs dying from vaccination is large, even with Denmarks quite low spread.

It's quite possible that people under 60, or perhaps only women under 60 should not take it. In that group, the numbers are at least starting to be possible to compare. Which is why many countries have stopped it in that group (despite the risk of covid death even in that group being higher!).

So it's indeed not very simple, but you can always find a group where even conservatively counting the risk is enormous from the disease and tiny from the vaccine.

Not really. We have already vacinated most of the high risk groups and our hospitals are not at risk of capacity.

It just means that people like me who are at the end of the queue will lose six months more of our lives waiting for a vaccine (they have also paused J&J, I am assuming that one is gone too).

I’m assuming it’s similar to Sweden in terms of vaccinated over 60 and fraction of vaccines that are AZ?

Sweden has only around 10% given a first dose in the 60-69 group yet and a huge fraction of the doses given to that group are now AZ, so that mRNA vaccines can be given to other groups.

Here in Canada the AZ vaccine was never approved for use in people 65+, and it had nothing to do with the blood clotting issues. The blood clots only seem to affect under-50 people, but it seems like there might be other reasons to avoid giving it to the elderly

That was the case in many countries due to early signals of low efficacy in old people. Those concerns have since disappeared and these side effects have appeared. So in some countries the approval was entirely reversed from “only under 65” to “only over 65”.

Vaccine availability from other sources can also figure into it.

> There are zero cases in that group and even just a small delay will mean many dead.

Not really. AZ is a small fraction of the total vaccines being deployed in Denmark.

> For what would most likely result in zero side effects in the elderly group.

The elderly group is almost fully vaccinated because they were prioritized; allowing AZ to go forward with that group would have no meaningful effect on the delay in overall vaccination completion, or its expected impacts. This is explicitly noted in the article as part of the reason Denmark.made the decision.

This decision seems illogical to many commenters here, but I assume the decision was made by professionals with all the data in front of them.

Which then raises the question, why did these professionals make a decision so different than the "obvious" opinion here?

Professionals make wrong decisions all the time, often because the wrong professionals are the ones making them.

Are people already forgetting how masks were actively disrecommended by 'professionals' at the start of the pandemic while plenty here and in other places were similarly saying that masks are obviously good?

> Are people already forgetting how masks were actively disrecommended by 'professionals' at the start of the pandemic while plenty here and in other places were similarly saying that masks are obviously good?

We are talking about science, I thought. Phrases like "obviously good," really are not in the scientific spirit.

Professionals also said that double-masking is even more obviously, obviously good. But that obvious obviousness was, quite obviously, wrong. [0]

[0] https://dossier.substack.com/p/the-cdcs-double-mask-mannequi...

Nothing in the article states that double masking is not good. It merely states that the study doesn't give any reliable conclusions.

Are you saying it's obviously good, but you can't tell it helps?

As far as I can tell nobody but you is using the phrase 'obviously good' for that particular claim and is simply the case of a specific study being touted and then turning out it has flaws which does happen all the time and isn't what we were talking about.

You must have listened to the wrong "experts" then. There was a bit of an initial, politically influenced confusion in the US at the beginning up until about June. However, where I live all experts recommended wearing masks from the start. They did say that people should not rush to buy FFP2 masks and chirurgical masks at a time when there was a shortage of those for health professionals, which was definitely the right recommendation at the time. The most drastic "disrecommendation" I've ever heard by an expert was to point out that you don't need to wear a mask if you keep proper distance and follow all other hygiene measures.

In a nutshell, they did recommend not to wear masks for a short time during the beginning of the pandemic but at least the experts I've heard always provided the right justification - to prevent shortage.

>There was a bit of an initial, politically influenced confusion in the US at the beginning up until about June

You are downplaying it - they were actively taking a stance against them in the US and June was already quite late into the pandemic.

The WHO themselves were advising people NOT to wear a mask and that it might be even more dangerous to wear one than not to wear it months into the pandemic.. They also only revised this in June.

https://twitter.com/whowpro/status/1243171683067777024

First, we'll have to ignore the US because the government interference and rampant irrationality there caused hundreds of thousands of lives lost. Regarding the EU: I feel a certain irony, because I was among those who complained that experts give the wrong advice for noble reasons (partly due to good information from HN, btw), called it a "King's Lie" and was heavily downvoted for it on various social media. So I'll be the first to admit that some officials were not as clear about it as they should have been.

However, many people fail to correctly interpret official statements, especially those made by WHO at the time. You only ever officially recommend something in evidence-based medicine if there is evidence of its beneficial effects, never out of a gut feeling. They should have said "we are using masks because we believe they work but we're short of them and so you shouldn't buy them" and instead said "there is no evidence that wearing masks is beneficial and it could even be dangerous" to prevent shortage. The WHO's statement lacked transparency but if they had stated that everybody should wear masks in March 2020, the effects would have been disastrous for health authorities all over the world. National health authorities did the very same at the time, and I used to point out that a "King's Lie" like this, no matter how noble the motives, will likely backfire - as evidenced by your statements.

Still, if you listened closely, no expert I know of has ever said in any interview that masks don't help. That's all I wanted to point out.

As far as I can tell people are just looking for excuses. It might very well be the case that whoever wrote that WHO statement actually believed it.

Either way - my point was that people here can and do often outperform 'decisions made by experts', no matter the reason why that's the case.

> The WHO's statement lacked transparency but if they had stated that everybody should wear masks in March 2020, the effects would have been disastrous for health authorities all over the world

Even if that's what was happening, the way they did it - saying they are ineffective rather than, say vaguely saying they dont advise them - has fueled an anti-mask movement still alive today. It's very hard to believe that it was a good decision overall on top of being straight-up wrong.

"First, we'll have to ignore the US because the government interference and rampant irrationality there caused hundreds of thousands of lives lost. "

Oh it did eh? Weird because that same "irrational" government is responsible for getting us vaccinated before almost any other country. The so called rational EU seems to be having a lot of issues right now.

Maybe lay off the Trump propaganda and look at how the US handled the vaccine rollout correctly. I've been vaccinated for over a month and my family has been as well. None of my EU friends have even been scheduled yet. Our economy is opening back up and yours is not, maybe ignoring what we did isn't such a great idea?

> The WHO themselves were advising people NOT to wear a mask and that it might be even more dangerous to wear one than not to wear it months into the pandemic.. They also only revised this in June

To protect yourself. The revised and current advice is to wear masks to protect the others and avoid propagating the virus. Why does everyone complaining about the masks thing miss that?

And as others have already said, the lack of PPE across the world would have made recommending masks for everyone highly irresponsible.

> The revised and current advice is to wear masks to protect the others and avoid propagating the virus.

This was a mistake. If authorities were going to be lying about masks anyway, the message should have been that they protect the wearer. People care more about themselves than they do about strangers.

> If authorities were going to be lying about masks anyway,

Who said they ( as if all authorities across the world are a singular entity) are lying about it?

> To protect yourself. The revised and current advice is to wear masks to protect the others and avoid propagating the virus. Why does everyone complaining about the masks thing miss that?

This might just be availability bias, but most of the people I see complaining about mask use also respond badly to other calls to lessen their negative impact on their family/neighbors/tribe/comrades/countrymen/fellow humans.

"You must have listened to the wrong "experts" then."

Dr. Fauci is a wrong expert? I love how when the narrative doesn't fit then suddenly the expert becomes the 'wrong-expert' even though the entire time everyone gets beat over the head with lIsteN to scIeNce & eXperts.

You're just subjectively choosing which people you agree with like anyone else but telling yourself they're the correct experts so you know the supposedly undeniable truth.

People on this platform, I assume, are familiar with the scientific consensus on these topics and generally side with the science. But one has to understand, that these decisions are not made directly by scientists but by politicians who have scientific advisors. And as politicians, they will factor in a lot more than just the hard science on a topic, which can result in seemingly unscientific decisions that go against the "obvious" findings.

Except this decision was made by the relevant authorities and not by politicians. If anything, Danish politicians are probably not keen on this decision, but have chosen to respect it.

It should also be noted that Denmark has a relatively low infection rate, which is probably why politicians has decided not to interfere in the decision.

It should also be noted that public health officials are usually the lowest rungs of the ladder when it comes to ability in medicine. Running your own practice, running a research institute or chair or even just working in a hospital is far more interesting financially as well as for the challenge. Becoming a public servant as a doctor is a way out when your marks are just above passing or your motivation is insufficient for anything with even minimal amounts of stress (of course not atm, but that is an exception).

I'd really like to see some data on this, because that's a giant assumption to make. There's many reasons an able person would choose to work in public health beyond that they are apparently too bad at medicine to do anything else.

Agreed the competent are most likely to run their own practice. This is true of virtually any field.

> as politicians, they will factor in a lot more than just the hard science on a topic

Are we really going to allow ourselves to slide into such naivete, especially after we have suffered through a year-long global orgy of corruption and violence at the hands of these same politicians?

I wonder what science the Biden administration used to determine it really should sell all those weapons to the UAE. [0]

What was the science behind the West's decision - also led by Biden - to continue bombing civilian infrastructure in Yemen? [1]

Politicians use science as a rallying cry, not as an actual philosophical fundamental. We would be a lot better off if they even tried to practice people-ruling while utilizing the "hard science," but we must all come to the realization that they are simply science-adjacent. None of the ghouls in elected office - in any country on the planet - have any idea how to incorporate "science," into the act of ruling over others. But perhaps the more important question is: why should we even value such an incorporation, if it were valid?

Scientists study the natural world, observe it, and document it for others to observe on their own. Politicians - if we were to be very charitable - move other peoples' money around & redistribute it. There is only a small overlap in these concentric circles and it's probably too large as it is. The mandate of the politician is largely illogical, and for this reason trying to conflate it with science is not just sophomoric and ridiculous - it's incredibly dangerous.

[0] https://news.antiwar.com/2021/04/13/biden-to-proceed-with-tr...

[1] https://yemendataproject.org/

The scientific consensus on issues like this as they emerge evolves rapidly though. And I think "degree of uncertainty" is something that is lost on educated lay people when they try to keep up to date with the science. Just look at the messaging surrounding masks in March 2020.

Public health issues are further complicated by what messages are thought to result in the best population behavior. There are articles in medical journals discussing the issue of people refusing to take the less strong vaccine, it is an entire topic of research in itself how to communicate with the public. It is not out of the question to strategically spread somewhat false messaging, like "all the vaccines are the same!" when obviously they are not.

Finally, this kind of thing is always going to involve value judgements that don't have an objective answer. How different is death of a 20 year old vs death of an 80 year old? How do you compare side effects like partial paralysis vs permanent lung damage? They are apples to oranges problems. But in cases where we have to act cohesively as a population, a judgement has to be made by someone. Plus in general I think medicine tends to not trust people to make their own well thought out decisions, for better or worse.

Messaging around masks is a perfect example of politics ignoring science and public health officials just trying to justify political decisions by cherry-picking studies or plainly stating falsehoods "for the greater good".

The “Science” is used as a religion these days.

My theory is that what is call as 'science' today has replaced mainstream religion. So it is indeed a from of religion.

Most human have a "religion" template in them and they fill in that with some prevailing common belief. In the past it used to the religion containing gods, now it's environment, the virus etc. (Though with the environment/virus as with traditional religion, there are always elements of truth mixed in)

Because it's a kind of a trolley-problem that makes people make wrong decisions because of how society assigns blame. If the vaccine kills 1 person, they can be held directly responsible for that death. However, if the lack of vaccine kills 100 people, their deaths are the result of COVID, and would not be considered the result of the decision. In trolley problem terms, they would be blamed for pushing someone in front of the train to save others, but not for their inaction leading to a larger number of deaths.

https://en.wikipedia.org/wiki/Trolley_problem

And someone has already updated the wikipedia page:

https://en.wikipedia.org/wiki/Trolley_problem#Example_with_C...

And I think in general people are inherently equipped to handle the idea of getting sick and dying. It happens to everyone eventually; it's unavoidable. Death from something another person's actions can be blamed for is much less tolerable.

From Norway, where I wouldn't be surprised if authorities arrive at the same conclusion in next few days, it can be summarized pretty quickly:

-Risk of death from side effects in <65 patients is estimated at 3x higher than the international consensus, based on local observations. Unknown why this is the case, but seems unlikely to just be a statistical anomaly.

- >65 population is largely vaccinated already

-Vaccines from other manufacturers are expected to be available for everyone shortly

-Covid is under control and new cases are few. Risk of dying from infection in a given month is extremely low. When risk of death from vaccine is estimated at the order of 1 in 50.000, (ballpark figure based on memory), the vaccination risk outweighs Covid risk by far. Would be a tough call if other vaccines wouldn't be available, but they will be. It's not a long delay.

-Given the above, it's crucial to make sound ethical decisions to maintain public's trust in vaccinations and health authorities. This is not the last time we need to trust health authorities with our wellbeing.

In closing, summarized very briefly: there is a lot of orthodoxy regarding vaccination strategy in the community of science-interested folks. It's very fascinating to watch part of this consensus being challenged with good scientific arguments.

Because 'professionals' have no more clue than the rest of us.

"Science is the belief in the ignorance of experts. When someone says ‘science teaches such and such’, he is using the word incorrectly. Science doesn’t teach it; experience teaches it" - Feynman.

What you have here is the European "precautionary principle" in action. Whatever you do, don't get blamed for anything - whether you make any forward progress or not.

At 60 you have a 1 in 100 chance of being dead in the next year anyway. A 1 in a million extra risk on top of that is a rounding error.

The zero extra risk option is no longer available.

I've had the AZ jab. It's perfectly fine and does the job. And those downvoting this post are saying that I should be dead instead.

Not sure it's that illogical.

mRNA vaccines are apparently better and don't seem to have serious side effects, so only using those is correct if it doesn't delay immunity too long.

According to the article, this might cause a 4 weeks delay: currently Denmark has around 2 deaths per day, thus possibly causing 60 additional deaths, which would match a vaccine death rate of 1/100000.

Denmark has a 6 million population, and it seems AstraZeneca kills around 1/1000000 so it seems COVID is only 10x more lethal than the vaccine in the general population.

However death rates for COVID are much higher in the elderly while vaccine clot rates are much higher in young people, so the AstraZeneca vaccine might be more lethal in present day Denmark for young people.

Even among elderly people they can eliminate their COVID risk by isolating but they would be forced to take the vaccine risk if the government only offers the AstraZeneca vaccine.

Finally any vaccine deaths can be more easily attributed to the person who made the decision to continue using the vaccine thon COVID deaths.

+ most elderly have already been vaccinated or are in between shots.

The note [0] (in Danish) published by the danish health authority with the reasoning for this puts the number a bit higher at around 5 to 10 per 1,000,000 [1], another thing that the note points out is if they start the vaccine program up with the AZ vaccine again, it may delay it in the older population even more as they think many people would say no to it.

[0]: https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio...

[1]: 1/40000 chance of serious complication with a around 20-40% chance of death, source: [0].

Because they may see that reducing the J&J supply to zero doesn’t meaningfully change the time to fully vaccinated.

Because they may see that clotting worries would harm public trust in vaccines, delaying or preventing us from getting to herd immunity.

Because they may see the number of people tested for blood clots, indicating the number is much higher than 1 in a million.

Because they may see that trading a week of paused administration at this point is a reasonable price to pay to ensure we get to herd immunity.

To me the problem with these kind of blanket decisions is:

(a) The reasoning is often either not communicated, or is poorly communicated.

(b) It takes away a risk/benefit decision from people that are mostly capable of making on their own. Don't want to take the risk of a rare side effect? Wait for an mRNA vaccine. Think the risk of COVID for your particular scenario is higher? Let me accept the risk.

There isn't a way that a single model of the scenario produces the 'correct' or 'safest' decision for everyone. Also, there is no good reason that a person of sound reasoning cannot make this decision for themselves.

0. It's not like the vaccines get discarded or the factory slows down - every dose that isn't purchased by rich western countries is one that will go elsewhere, possibly saving even more lives.

1. Professionals might have data we don't have - maybe they've used up their stock of AZ but have plenty of other vaccines.

2. They might be making more nuanced calculations. For example, if they've already vaccinated all their high-risk groups, the risk-to-reward trade off for younger groups might be worse.

3. Alternately, they might be being more conservative than you and I. I'm expecting the end of vaccine roll-outs to mean lockdowns and masks end permanently and the entire economy comes out of hibernation, which is a big pay-off. But between the vaccine's less-than-100% success rate, the risk of new variants, people who can't be vaccinated, international travel and so on, they might feel my benefits are too speculative to have a place in their calculations.

4. Healthcare ethics can be a complicated matter, and they've probably spent longer agonising about it than we have. After all, you and I are talking about pulling a hypothetical lever - they're the ones who'll actually be pulling it and cleaning up the splattered blood.

5. They might be particularly worried about the vaccine-hesitant, feeling hesitancy is a bigger risk than the deaths caused by vaccine rollouts taking a few months longer. They might feel the best way to reassure the vaccine-hesitant is to be demonstrably extra-vigilant, rather than providing reassurance that might sound like denial or cover-up.

6. Public health comms has to be inclusive of even the dumbest people in the population. Nuanced, complex messages might get lost in the mix. With this, the message is "WE NOT GIVE YOU BAD VACCINE. YOU GET VACCINE WE GIVE YOU GOOD VACCINE." - very simple!

> This decision seems illogical to many commenters here, but I assume the decision was made by professionals with all the data in front of them.

The decision was made by politicians who only consider public reaction. Public reaction which is decidedly uninformed, and without all data in front of them.

I wish you were right. What you say should have been the case. All over the world though, we see the true nature of high-level decisions.

What do you have to back up that it is a decision made by “politicians”?

Sundhedsstyrelsen (the Danish Health Authority) makes that recommendation to not use it, not the government. Some parties are discussing giving a choice of AZ, but Sundhedsstyrelsen has then said that _that_ is a decision outside of their realm. But the recommendation is made outside of the government and parliament.

People are different and have different interests. There is no reason to believe that a highly insulated public health bureaucrat will make an optimal choice for any particular individual or for society as a whole.

Medical professionals tend to be overly cautious when evaluating threats. The CDC says a woman should never have two glasses of wine in a single meal (or any if she's fertile and sexually active) but we laugh this off as the CDC being the CDC and ignore it. It's their job to be concerned about health risks and so they are. Doubtless they'd ban downhill skiing, driving over 35 mph, and parachuting if they could but thankfully we don't give them that power.

But we do give them the power to ban medicines and that's where actual trouble can start.

And it's understandable. If every time a Japansese person stole something you heard about it sooner or later your intuition would be convinced that they're all a bunch of thieves. If you heard about every bicycle accident you'd be scared to ever ride. US cops do hear about it every time one of their number is killed and we can see the resulting paranoia with which they treat the public. And the people at health regulatory agencies get fed a constant stream of medical mishaps.

To counteract this bias any organization really needs to make explicit cost benefit analyses with real numbers if they're going to make sensible decisions. We force highway safety and toxicology regulators to do this. We really ought to have the medical regulator do it as well but for some reason we don't.

This seems like another overreaction that will be interpreted - rightly or wrongly - in the UK in political (Brexit) terms rather than medical or scientific (although they are clearly an important consideration).

It's difficult to see how Denmark isn't failing its population with this decision.

The sad part is that AstraZeneca chose to sell the vaccine at cost, making no profit. This amount of negative publicity with no good reason will make them (and others) think twice about such a gesture.

Like half of the bad publicity for AZ is their own fault. The blood clotting issue is not, but the bad studies and the poor communication totally are.

Getting a warning letter from an US agency for publishing outdated data in a press release is quite a feat.

"The company says the agreed cut-off point for data was 17 February, by which time there had been 141 cases and efficacy was 79%. Within 48 hours, AstraZeneca had added more recent data. On a total of 190 cases, there was 76% efficacy (and as always 100% against severe illness and death). It’s not much of a difference." [0]

[0]: https://www.theguardian.com/business/2021/mar/26/how-the-ast...

Is this supposed to be some mitigation? A pharma company has a responsibility to publish accurate and up to date data. Full stop.

That baffled me. They got a huge amount of stick for measuring up to the pre-determined cutoff point, which as I understand it is the correct way to do a scientific study if you want your results to actually be valid...

From what gathered, AZ said they had final data, but hadn’t actually finished the analysis, but preliminary numbers looked similar to interim so they just used those.

This.

The reason it is risky to measure data after a predetermined stop point is that it lets human bias play a role in making conclusions.

It is very subtle, but this human behavior has been a contributor to the replication crisis:

https://en.m.wikipedia.org/wiki/Replication_crisis

"It's not much of a difference" is a terrible excuse. This isn't about the percentage points they were off, this is about how such a thing looks in the public.

When you get a warning from a gov agency that you shared outdated data that just looks terrible. Just don't do anything in a press release that could even remotely look like you're trying to cheat with your data. It's a terrible idea in a situation like this.

How is that sad? Do you think the CEO and shareholders approved that deal because their hearts are so good and pure, to help humanity? No, it was to become a vaccine manuf. in a time of pandemic, to make big bucks (since at cost sales end in August this year).

Oxford scientists came up with the vaccine and the deal to manufacture it with a partner. It looked like a great deal until it turned out that AZ is completely incompetent.

How is AZ incompetent? On other aspects than PR, that is. Their vaccine is working, it is sufficiently effective by anyones standard. That mRNA vaccines turned out to be better is great, but it was not sure a year ago.

I think incompetent is harsh, but they had a bad data submission and also a dosing error. Neither is a good look. Neither ended up being a big problem but they could’ve been.

Yeah, that was an issue. I cannot tell how much of an issue, because I have zero experience with medical trials. As do most people, I assume, getting upset about that. Regardless, AZ got approval in the UK and from EMA in the EU. And these entities job is clinical trial assessment.

Unless I am going to refuse any and all drugs and medical treatment, I will have to trust e.g. EMA that the stuff I take when being sick is safe and working as intended.

I’ve got a little bit of FDA experience, but of course no COVID-19 EUA experience. Based on what we submitted to the FDA and the comments we received, I would personally think it most likely there were many issues with AZ’s materials, at least as far as their attempts to seek approval from the FDA went.

A good heuristic for how big/rare of a problem would be to try to find another instance of NIAID publicly scolding a company seeking approval. Doesn't happen.

They failed to deliver and respect the contract with the EU. This and what their CEO said about the differences in contracts between UK and EU (timing and best efforts - while the differences did not justify the different treatment). They cared so little about PR that some science communicators (like Burioni in Italy) stopped to defend the AZ vaccine because of the total lack of statements and communications from AZ, even if they have a positive opinion about the vaccine itself.

Well, my interpretation is that AZ did, in fact, not violate the EU contract. The contract states "best effort", not penalties and even redemnifies AZ from delivery delays in case these delays are caused by additional orders from the EU. And guess what the EU did, IMHO mainly to media and public pressure, earlier this year.

Given the bad press AZ got, reverting to a "no comment" strategy is not such a bad idea. Anything they say will be used against them anyway.

"Best effort" has a specific meaning in a contract, which is different from everyday use; this is why AZ could still be found in violation of the contract. This does not change the fact they have been unable to deliver by a huge margin and informed the UE with a short notice.

A company that just avoid commenting on issues your product could have or misinformation regarding it does not seem a company that cares about that. Hard for me that they had a good PR strategy.

I wrote drafts and analyzed procurement contracts for smaller volumes and less critical parts before. Of course with legal support. And all these contracts included initial delivery schedules (as an annex), delivery SLAs and penalties. And they were all considerably longer than the AZ contractthat was published. Fun fact, they didn't sacrifice 5 pages to talk about the order form.

The AZ contract has none of that. Ultimately, it would need a court to decide that. Once the point of discusing contract terms, the relation ship between supplier and customer is already ruined.

Good :) So you know what the contract and "best effort" mean and the kind of forces driving both parties. "customer is already ruined": that is why they would probably EU will not go to a court but it just ordered 50 M vaccines from Pfizer, while rumours of the EU not renewing the contract with AZ are getting stronger (some EU/EEA countries have plans to move forward without it).

I just see a bad behaviour and PR from AZ. That and having a CEO that says that UK got it first because of the "best effort" clause when both UK and EU contracts have does not seem very professional to me IMHO. I am not sure why that happened.

Yeah, $20 a shot vs $3 a shot buys a lot of influence.

Still, it’s good that someone stepped up the the plate, otherwise most people on earth would remain unvaccinated.

What would also help is if the UK and the US would export vaccine to other countries, like the rest of the world does. Sharing is caring?

EDIT: https://www.statista.com/chart/24555/vaccine-doses-produced-...

Well...not really. The UK manufacturing capacity is tiny from a global perspective. The EU tried to scapegoat the UK for their failure to run an efficient procurement, but that was just irrational politicking. The U.S. obviously has more manufacturing capacity, but like the UK it basically has no chance of dealing with the pandemic without mass vaccination, so exports are a political non starter.

What was really required was a globally coordinated response to the design, test, manufacture, and distribution of COVID-19 vaccine candidates, through the WHO/CEPI with the backing of the security council members. Unfortunately with the major countries locked in various levels of sub-explosive warfare with each other (and our international institutions gravely weakened*) we've ended up with a scramble powered by commerce and nationalism.

Edit: *through malice and incompetence

> so exports are a political non-starter

...in the US and the UK. In the end it's also a reflection of what is important to a nation. Should the strong help the weak? Is it every man for themselves? Thank you for making my point.

I think pointing to "international organizations" to do something, when you could have done something yourself, is a weak argument.

Why on earth would the US export when it's supply-constrained itself? Of course, the US can and will export once it has sufficient supply. But countries exist in large part to look after the self-interest of their own population. It would rightly be a complete political non-starter for the US to start shipping vaccines elsewhere while it still needed more doses domestically.

Don't you think Europe is supply-constrained? What about India/Russia/China?

If these countries didn't export, Israel wouldn't have any vaccine, Australia wouldn't have any vaccine, Canada wouldn't have any vaccine, New Zealand wouldn't have any vaccine. And let's not even talk about the rest of the world.

But yeah, it's inconvenient. I get it. Greed is good! Let them starve.

Wouldn’t the greedy thing be to export all the vaccines you produce for maximum profit?

Everyone is supply constrained. Actually, the US is probably the country that is the least supply constrained.

Yet the EU and even India/China/Russia are exporting vaccines. This speaks a lot.

The strong should protect the weak; they still have to put their own oxygen mask on first though.

Protecting your citizens is the first duty of government. There is a political failure here, but the domestic mass vaccination programs aren’t part of it.

> in the US and the UK. In the end it's also a reflection of what is important to a nation. Should the strong help the weak? Is it every man for themselves? Thank you for making my point.

The UK has no ban on vaccine exports. It is more accurately the case that nobody has ordered vaccines from the UK except for the UK itself, because the UK had absolutely zero vaccine manufacturing facilities.

And of course it is factually false in any case: https://www.dw.com/en/australia-receives-astrazeneca-vaccine...

The EU (after encouraging other countries to invest in facilities in the EU) changed its mind and interdicted vaccines going to Australia. So they got some manufactured from the UK instead. But somehow it is the UK that is the bad guy!

Looking at exported vaccine doses is a blunt measure

The lipids used in Pfizer's come from UK, Moderna exported vaccines from EU are actually brewed in Switzerland and finished in Spain for export

The UK mostly doesn't export its vaccines, because it makes much more sense for them to just set up other factories manufacturing them in other countries. Which is what AZ has done.

You say they chose, but wasn't this a condition that came from Oxford in negotiations?

"Citing the attack from Macron and unfounded accusations over safety and efficacy, Bell [0] said the company could re-think its philanthropic stance. “There’s a point at which AstraZeneca could just say, ‘you’ve got to be joking, we’re going to stop [charging cost price] now because we’re not getting any credit for what we’re doing.’ The share price has gone down, not up. We’re making more vaccines than everybody else. This is a safe and effective vaccine, but nobody seems to care,” he said this week."

[0]: Sir John Bell, the Oxford University professor who helped drive the vaccine’s development

> “This is a safe and effective vaccine”

> Sir John Bell, the Oxford University professor who helped drive the vaccine’s development

Since academics traffic in reputation, this is an example of a conflict of interest I think.

The vaccine's safety and efficacy is not based on one person's opinion, it's an established fact.

^ This is misinformation.

AZ is a profit driven pharma manufacturing company. Oxford University developed the vaccine.

When Oxford licenced the vaccine to AZ -- it was at the institence of Bill Gates a major donor to Oxford and shareholder of AZ. The licence allows AZ to make a profit -- after the pandemic.

Before a certain 'letter to Oxford' from Gates, Oxford was planning on giving away the vaccine to anyone who wanted to manufacture it.

So I find it particularly disgusting that people are falling over themselves to associate AZ with altruism when the company isn't really even holding up it's bargain.

Rumours are that AZ is constantly trying to make a profit by shipping the vaccine produced in Europe outside Europe. It can make a profit this way because it only has to sell 'at cost' but the cost varies depending on the facility that produced it giving rise to a profit incentive.

> The licence allows AZ to make a profit -- after the pandemic.

After could be as early as 1st July 2021.

https://www.reuters.com/article/health-coronavirus-astrazene...

The quotes in this article contradict what you're saying:

https://www.theguardian.com/business/2021/mar/26/how-the-ast...

It seems like a far stretch to call this political?

If they're confident that they can source enough doses of another vaccine that has better efficacy and is not linked to serious side effects (even if very rare) then it makes sense for them to go with that one and drop AZ.

But if the alternative is no vaccine or AZ then it is indeed vastly better to continue using AZ.

Denmark's population is also less than 6 million so they don't need a massive supply compared to larger countries.

I'm currently living in Denmark. They are performing 200k PCR tests per day, that's literally 1/30th of the population every day.

If they could source the vaccines, they have the infrastructure to vaccinate the population in a month.

Of course, Denmark is part of Europe and therefore bears equal parts responsibility for the EU vaccination program joke.

It is about picking a safer and possibly better alternative costing a few weeks delay.

In Denmark, at least among the people I talk to, there isn't much confidence in AZ. The feeling is that Moderna or Pfizer are safer with higher protection (also against mutations).

So the common feeling here is really that the government would fail the population by using AZ instead of the (possibly better) alternatives.

Isn't this rather because AstraZeneca is sold at cost whereas other jabs are for profit? Then Google history of corruption of companies like Pfizer. I sound cynical, but I don't believe one bit that politicians are doing something out of their good will.

Also, like it or not, the anti-vax pro-corona[0] movement is relatively large here, so using a vaccine that has possible fatal side-effects may give momentum to that movement, even if using it could save lives from a utilitarian point of view.

[0] One of their slogans is literally "Corona, yes please! The virus isn't dangerous." https://www.ooc.one/

1 of 40.000 apparently risk "serious side effects". This is a lot higher than I thought.

Scandinavia has arrived at numbers that are many times higher than the international consensus, due to local observations.

It seems very unlikely to be a statistical anomaly, although it isn't known yet whether it's due to incomplete observations from abroad or due to local environmental or genetic factors. It would obviously be poor science to ignore the observations; they are well documented at this point.

A medical description of one of the danish cases is currently in preprint https://www.researchsquare.com/article/rs-408726/v1

Thanks for the link. No treatment with immunoglobulin was given in this case, which might explain why it ended unfavorably.

Also, if you're interested, the team of doctors at three Norwegian hospitals have just published their case study of the 5 Norwegian healthcare workers who experienced these rare blood clots.

https://www.nejm.org/doi/full/10.1056/NEJMoa2104882

The authors conclude

"Although rare, VITT is a new phenomenon with devastating effects for otherwise healthy young adults and requires a thorough risk–benefit analysis. The findings of our study indicate that VITT may be more frequent than has been found in previous studies in which the safety of the ChAdOx1 nCoV-19 vaccine has been investigated."

Thanks, this report is, while describing rare events, sobering

Here is an official statement from the Danish Health Authorities about why AstraZeneca has been removed from the rollout:

https://www.sst.dk/en/English/news/2021/Denmark-continues-it...

The main takeaway is:

"In the midst of an epidemic, it has been a difficult decision to continue our vaccination programme without an effective and readily available vaccine against COVID-19. However, we have other vaccines at our disposal, and the epidemic is currently under control. Furthermore, we have come a long way towards vaccinating the older age groups where vaccination has a tremendous potential impact on preventing infection. Age is the main risk factor for becoming severely ill from COVID-19. The upcoming target groups for vaccination are less likely to become severely ill from COVID-19. We must weigh this against the fact that we now have a known risk of severe adverse effects from vaccination with AstraZeneca, even if the risk in absolute terms is slight,"

It's funny how "listen to the science" goes right out the fucking window the second the actual scientists say something people don't want to hear. Then it's all "akshually public health officials are just politicians" and "akshually public health officials are bad scientists" and "akshually I know better than the scientists with my PhD in Internets".

Science doesn't say what the right risk tradeoffs are for society as a whole. That's a political decision.

Perhaps they should close their roads too, because people die from traffic accidents ...

Denmark (along with the other Scandinavian countries and the UK) have almost the lowest traffic-related death rate in the world too.

As far as I can tell, Denmark are reporting such a high rate of death from the AZ vaccine relative to the number of doses deployed, that the risk would actually be quite bad compared to driving. However, the absolute numbers are tiny so the uncertainty is enormous. It's quite possible they were just unlucky.

The number of traffic-related fatalities in Denmark is around 200 per year, see e.g. [1]. Blood clots appear in 4 per 1M people (UK numbers, [3]) or 10 per 1M (Denmark numbers, [2]). That would mean about 24 to 58 Danish people would get blood clots from their first shot. Denmark had 2447 covid deaths, [4]. If you zoom in on certain age-groups, then perhaps Denmark's decision could still make sense, though.

[1] https://www.statista.com/statistics/573861/number-of-traffic...

[2] https://www.thelocal.com/20210318/ten-blood-clot-cases-found...

[3] https://cosmosmagazine.com/health/medicine/covid-19-vaccinat...

[4] https://github.com/CSSEGISandData/COVID-19

[2] states:

> ten cases of blood clots have been found in Denmark in people subsequent to taking the AstraZeneca vaccine.

and later,

> A total of 140,000 people in Denmark have received at least one dose of the AstraZeneca vaccine.

If you extrapolate these numbers you would expect ~410 patients with blood clots from AZ if you gave the vaccine to everyone in Denmark.

The history of medical ethics is interesting. We’ve sort of drifted from pure utilitarianism. One problem is that since everyone dies eventually and our statistics aren’t complete, you can usually come up with ways to justify doing pretty much anything from a utilitarian standpoint.

If we weren't using pure utilitarianism what justification could we have for using the force of the law to prevent people from taking medicines they judge will be good for their health?

There are a lot of vehicles that we don't operate on public roads, for safety reasons - if you want to go "down that road".

What a huge shame. The risk/benefit analysis does not support this decision at all.

The risks of blot clotting from a variety of other sources are orders of magnitude higher (looking at you hormonal contraception) but those are risks that large sections of the population gladly accept.

How does the risk/benefit not support it when end of vaccination of 65 and older is done in Denmark in three days?

What analysis have you read of it? The one released by the danish health authority [0] does seem to support the decision, even if you may not agree in the outcome.

[0]: (In Danish) https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio...

In both the comments and in other discussions, I've seen a lot of trolley problem analogies. This is a spectacularly bad analogy.

In the trolley problem, the people on the tracks have no choice! With regards to vaccines, we can give people a choice. A competent government would respect people's agency. It would say "Hey folks, the virus kills 1/N and the vaccine kills 1/M, take your pick."

When people learn the M is several orders of magnitude greater than N, they will act accordingly.

People don't have a great history of dealing with probability on a strictly rational basis.

Did they even compute/estimate how many more people are going to die because of this decision, or how many will be saved?

Also, since experts have said that the side-effects occur because of an immune-reaction to the adenovirus that is used as the delivery mechanism of the vaccine, what are the chances that the people who have side-effects would die (or at least have the same kind of complications) from covid?

Denmark are done giving vaccines to 65 and older on Friday. How many do you think can die in a few days that a vaccine could have saved?

The current official Danish vaccine calendar [1] (updated April 14) estimates that the group of citizens between 74 and 65 years will complete vaccination end of May.

[1] https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio... (in Danish)

I feel it should be still accessible privately in that case for those who are willing to accept the risk of side effects.

Alright! Who will they sell their remaining doses to?

The numbers (77% of vaccinations were with the BioNTech vaccine) suggest that they are doing just fine with the much more expensive but less controversial option.

Which is cool, but some countries are just looking for raw vaccine for now, no matter which one it is.

The EU will phase out the usage of AstraZeneca and Johnson & Johnson's vaccines entirely, according to Reuters [1]. Instead they plan to focus on mRNA approaches like Biontech/Pfizer and Moderna.

[1] https://www.reuters.com/article/us-health-coronovirus-eu-vac...

And there I was thinking it couldn't get any worse... I should know better by now.

EDIT: It is close to impossible to find accurate delivery schedules for the EU. I hate that, if the answer to "When will how much be delivered?" is a "Enough by Qx" I always assume nobody has the slightest idea how much will be delivered when. Doesn't help to build trust. Statista has some numbers fr Germany by Quarter, no idea how accurate those are:

https://www.statista.com/statistics/1199643/coronavirus-covi...

Based on these numbers, kicking out J&J and AZ Germany will loose 27 million doses in Q2 alone. With another 55.8 million in Q3. That's roughly one months worth of deliveries in Q2 and Q3 each. i really hope that decision is thought through and Moderna / BioNTech-Pfizer are up to cover the delta. Only last week I was so sure in June the EU would be through with almost all first shots, now not so much anymore.

EDIT 2: They are ending these contracts after expiry, end of 2021. So no short term impact, if true.

This is a fascinating example of cultural differences.

I wonder if this provides some insight to which societies will be more or less likely to allow driverless vehicles, which suffer conceptually from the same type of trade off.

Nobody would be banning the AstraZeneca vaccine if it were the only one we had. But so long as alternative vaccines are available, there is a "why take the (very small) risk when you don't have to?" argument.

Driverless vehicles aren't a valid comparison. They're either safer than human drivers or they're not, something easily proven by monitoring and statistics.

DVs will be safer for some but will have edge cases (like all vaccines).

This is the well known trolly problem playing out (as discussed elsewhere in this community).

And one can probably put London's Sadiq Khan "part and parcel" attitude on the other side of the scale.

This is why you can't trust politicians and governments: they make decisions to cover their asses while robbing you the ability to decide what and how much risk you want to take.

Except the recommendation is made outside of the government and parliament. And some parties are even arguing for giving people a choice.

That’s seems like a bit draconian.

There is no “safe drug”, “unsafe drug”. It’s a continuum and it’s balanced by the benefit.

I find it hard to believe there isn’t a subgroup where the benefit of the vaccine doesn’t outweigh the risk.

There certainly is, but there's also other vaccines which don't exhibit this problem. Why should we administer AstraZenica or J&J when Moderna and Pfizer are available and don't have any correlated blood clot issues?

Because they aren't 'available'. The EU is currently at just 15% vaccinated. Stopping the use of some vaccines means it will take longer and longer to vaccinate people during which time more people will die, not to even speak of the other negative effects of the prolonged pandemic.

Because in the during the four week delay in vaccinations many more people will die from Covid-19 than would be affected by side effects from the AZ or JJ vaccines. The truly responsible thing to do is to continue to administer the AZ and JJ vaccines until the other vaccines are available.

Supply. I would agree with you otherwise, but if we rely solely on Pfizer and Moderna it’s going to be well into 2022 before the Western countries get vaccinated. I read today Canada was supposed to take deliver of 10M AZ doses, which would vaccinate ~1/7th of their population. That’s not happening now.

Because people are waiting for vaccines and getting the disease instead?

There exists no other vaccines until they are in a person's arm. AZ shots are currently available in X quantity for people. The others are not.

Because there aren’t enough Moderna and Pfizer, and every day we don’t vaccinate, more people get sick and die, people can’t see their friends and family or live normally, and parts of the economy remain shut down.

The cost is really severe! Especially globally, many countries have hardly been able to vaccinate at all.

You also don't know how severe the blood clotting problem is. It may escalate over extended time. We also don't know the mechanism by which it's causing blood clotting. That's the problem.

People are looking at this like it's just one case in millions or just 6 deaths in 6.8 million doses for J&J. You don't know that because we don't know what is going on. We just know the symptom; we don't know the "disease". It may be a permanent risk for all recipients. It may cause permanent damage for all recipients. It may be something that happens in 10% of the recipients over the next 10 years. All we know is that it's doing something that it should not and there is no explanation how.

"Let's give out a vaccine that we know is harmful to an unknown degree," is not a reasonable response.

The solution is to stop production and distribution of the vaccine you know is broken and instead ramp up production of the ones that do not have harmful side effects.

This sounds compelling but Covid also seems to produce long run risks in about 10% of those who get it, not to mention the deaths. You’re only looking at one side of the ledger but could make all the same points with more frequency on the other side.

Given that Astrazenca has the same issue, and given that both vaccines use Adenoviruses (known to cause clotting issues) then it is a reasonable bet the J and J issues are like AZ. Those are similar to Heparin induced clotting and Germany’s Erlich institute has given guidelines for treatment.

What is the likelihood AstraZenca's supplying problems and the sour relationship between it and the EU influenced the decision for Denmark to permanently cease using this vaccine ?

I do not understand the math going on here and in multiple countries: a very rare side effect that we can't even clearly attribute to the AZ vaccine, and now the J&J vaccine, VS the clear and present danger of a deadly pandemic: COVID and emerging, more lethal variants.

For AZ the evidence is pretty strong the clots are a real side effect. It is indeed rare, but it mostly effects young people, who are extremely unlikely to die from COVID. I don't understand discontinuing entirely, but given the vaccine alternatives available I think it makes perfect sense to direct young people elsewhere.

Does anyone know how many doses of other, presumably safer, vaccines Danemark has?

Perhaps they have the luxury to choose which jab to use, in which case it seems logical to prefer the safer one. TFA mentions that the decision would delay vaccine rollout by 4 weeks.

What is the impact of that delay?

Looks like 1-2 deaths per day.

But then again, we are vaccinating the most vulnerable populations first. And they won't see much delay.

Personally, I think this is going to further increase the risk of additional delays.

So more vaccines for the third world. Since this seems to be a regular talking point - if the Europe governments don't want them they could be shipped to poor countries - and since contracts are probably take or pay - this can be done for very low cost.

Denmark has a low population with a low infection rate. They can afford to wait for alternative vaccines. The same action in other countries could be a disaster.

Did this happen in the trials? I'm surprised, you'd think the risk - benefit balance would fall in favour of vaccinating.

The trials were too small to detect these rare side effects.

There are limits of what you can find in a trial. That's why there's sideeffect monitoring after you put something into realworld use.

A one-in-a-million effect doesn’t show up in trials that are run on 30,000 people. (Even if it does happen once, it is hard to quantify because these clots happen without the vaccine too, only maybe half/one-third as often.)

Combined with the JnJ halt this postpones Denmark's vaccine program from vaccinating all grown-ups this summer to year's end instead.

The article says it’s a four week pushback and that 70%+ are already getting Pfizer.

Why not allocate most of the Pfizer to the young and give the AZ exclusively to the older people?

Theoretically Pfizer has higher efficacy, especially with variants. Giving Pfizer to the old and AZ to the young probably saves more lives than the other way around. If you decide that you don't want to give AZ to the young any more, it doesn't follow that it's then a good idea to give it to the old, especially if you have enough supplies of Pfizer to vaccinate the old.

All the vaccines have 100% efficacy in preventing ICU admissions so far.

You should be careful comparing numbers from vaccines as they are collected in different environments; there were fewer variants present when first vaccines were on trail.

not quite

>Hospitalization data for 129 of the fully vaccinated cases is incomplete, Sutfin said. But for the 117 people for whom hospitalization records are known, 11 were hospitalized.

https://www.freep.com/story/news/local/michigan/2021/04/06/v...

"However, since February 1, eight people with vaccine breakthrough have been hospitalized. DOH is investigating two potential vaccine breakthrough cases where the patients died."

https://www.doh.wa.gov/Newsroom/Articles/ID/2720/Cases-of-CO...

Hospitalizations are not necessarily ICU admissions.

(We should expect some ICU admissions, though. A perfect 100% is not going to hold forever, but that it's taking this long is a really great sign.)

It all comes down to guessing how to best convince the unconvinced to actually vaccinate.

People usually react badly to getting "second-class medicine", if it is mandated. (Elderly people were asking, which vaccine they would get the good-one or the bad-one, literally).

I would suggest to simply offer both to everyone and leave people the choice, if they want to risk a one-in-a-million chance of complications (for women, 0 for men AFAIK) or get the other 4 weeks later with the associated risks.

And there are people who are a bit iffy about mRNA vaccines.

Correction: The risk is not 0 for men, only a fair bit lower.

Also it's more like 1 in 100K for women with AZ. Still very unlikely so I don't understand the need for people to under state it by 10x.

From Science Table Covid-19 Advisory board to Ontario: https://covid19-sciencetable.ca/wp-content/uploads/2021/04/S...

Which is the newest I could find on that matter.

> VIPIT seems to be rare, occurring in anywhere from 1 in every 125,000 to 1 in 1 million people

So, 1 in 100K seems to be the number to be on the safe side. But with rather rare events, it is probably hard to get an exact number there.

If I'm reading the source used by that link correctly though, the 1 million number comes from taking total number vaccinated as the denominator. My understanding was if you are a young woman, the estimate is closer to 1 in 100K. If you aren't it's probably even less likely than 1 in a million.

Does Denmark actually have older people to give it to? A lot of EU countries are restricting it to over 60s only, but AFAIK the Denmark vaccine program has gone quicker than most EU ones; there may not be many if any over 60s available.

This decision delays the vaccine program with around 2 weeks 65+ will be done in the end of week 17 and 50+ in end of week 21.

In the danish source below you can on the last pages see the before and after calender with the decision.

Source in Danish: https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio...

They used to give AZ to mostly younger people as the side effects where seen to be stronger than for the PFE.

A fear could be that when they start to give the PFE to younger people, they will see the same stuff as with AZ as it triggers the same immune response.

Pfizer has been distributed to many young people in other countries though and no such issue has popped up. Not saying it's outside the realm of possibility, but I think it's increasingly unlikely. Plus it'd be no surprise to me for the mRNA vaccines to have somewhat different side effect profile than the "traditional" ones.

It also seems that different countries have different criterias for what side effects they tolerate.

Do they not have the Pfizer and Moderna vaccines?

Article says they do.

[citation needed]

https://www.dr.dk/nyheder/indland/professor-efter-vaccine-st...

After vaccine stop by Johnson & Johnson: If we only have Pfizer and Moderna we won't be finished until end of 2021

That is a guess made by one person. The article doesn't indicate that they really say down and did the math.

There's a very special kind of arrogance going on in all the comment threads about the Covid vaccine suspensions.

These decisions are being made by professionals. They have been trained to do exactly this kind of decision. They have access to the best possible data on both the risks of the vaccine, the risks of Covid in their local context, and the impact these decisions have on the national vaccination schedules.

But everyone in the comments is just absolutely sure that the experts are totally incompetent, and a HN reader with access to Wikipedia is better equipped to know what the right decision is. Why?

The evidence has consistently shown that the experts have a track record of making terrible decisions that trend towards covering their own asses, and then coming up with The Science to justify their decisions post-hoc.

> These decisions are being made by professionals.

sure, but there are "professionals" on the other side of the debate that say the opposite. thus, discussions will happen.

also, these kinds of bans automatically lead to people across the planet not getting the vaccine due to fear.

case in point: a hard-hit European country got 1.3 million AZN doses. 800k are unused as no one wants to use them. the population would rather wait for the "good" vaccines :)

One obvious reason is that, in all this time, none of these professionals have explained their decision in terms of costs/benefits. So either they are not thinking in those terms or they don't think it is worth sharing the basis for their decisions. Let's see their models.

The official statement from the Danish Health Authority is quite thorough. Perhaps not a model, but there is a lot of nuance and they definitely consider the impact of their recommendation : https://www.sst.dk/-/media/Udgivelser/2021/Corona/Vaccinatio...

For Germany, the latest AZ decision is not data based. recommending Biontech as a second shot after AZ, without trials and sudies for that, is the opposite of data driven. That's all I can comment on that, because I now nohing about clinical trials.

I do know one or two things about supply chains. And that knowledge tells me, that German authorities have zero idea what they are doing. If there is a vaccination schedule, I doubt there is one, it is not taken into account during these decisions. Because after ever such decision, nobody talks about the impact on the schedule. Seems to be different for Denmark so.

Surely you must have observed a few bad decisions made by these professionals over the last year? Enough, perhaps, to doubt that they are actually selected for competence, to doubt that their goals align with those of society?

Because only the experts that confirm your point of view are right, everyone else is a sham, this is the world we live in right now. Whatever sides we have, they are just as bad. People laugh about anti-vaxers and conspiracies, yet comments that call these decisions political conspiracies are upvoted and promoted.

The graphic in this Guardian article [1] suggests that for age 40+ the number of covid-related ICU admissions prevented vs. no. blood clots has a factor 10 gap. Of course, clots might be more severe than ICU admission. But still, it looks to me like stopping for over 40 is a huge mistake. Very disappointing.

[1] https://www.theguardian.com/society/2021/apr/07/under-30s-in...

Yeah, and that's based on the relatively low levels of Covid in the UK recently too... I'm not sure there's anywhere in Europe whose Covid outbreak is currently as under control as the UK's.

In Scandinavia it seems that the amount of cases with blood clots are higher than in the rest of the world.

Pfizer and J&J also have the blood clotting issue. At this rate these countries will have no vaccine left to pick from.

Source? I think you are incorrect about Pfizer. Given it is mRNA based, to the best of my knowledge it hasn’t been linked to blood clots in any way.

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