BNT162b2 Vaccine Booster and Mortality Due to Covid-19
nejm.org
nejm.org
Here is the Results section from the paper: A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day).
The risk of death is being reported per day, and not per year as many people seem to be assuming. They had 85,000 people in the control arm, and 137 of them died in the less than 2 month timeframe of the study. If you multiply the daily risk by 365 to make it an annual risk, you find the non-boosted (but already doubly vaccinated) group had a slightly greater than 1% chance of dying within a year. By most standards, and compared to most other situations, this is a considerable risk of death. By contrast, the boosted group had a less than .1% chance of dying per year, so it's not just that an elderly study population was already on the verge of death.
So unless you think 1 person out of 100 dying within a year is insignificant, it would be more helpful to point out the potential flaws in the study than to say the results don't matter. Should the data be trusted at all? Is the boosted group really comparable to the unboosted? Did they mishandle/miscount the way people were switched from one group to the other throughout the course of the study? Should those less than 30 years old even care? These are potentially good questions, but it's not reasonable to suggest that the study as printed shows that there is no real benefit to the booster.
(Obviously, if my math is wrong or if I'm misinterpreting the results, please correct me!)
Edit: Removed false/misleading bit.
I had some mild but persistent side effects from the second Pfizer dose (ear ringing and Eustachian tube dysfunction). It's gotten about 98% better - but not 100% - and I'm a bit nervous about the booster given that many people are reporting the side effects are somewhat more intense than the second shot.
If the booster is the final answer, maybe I'll take the risk. Not sure what I'll do though, if the new status quo is a booster required every 6 months, and you become a pariah in polite society if you're not "fully vaccinated"...
I don’t want to file a religious or medical exemption because I don’t have one. I want to file a “I shouldn’t have to do this” exemption.
1. I understand getting the vaccine is unpleasant (personally I was knocked out for 36 hours after the second dose with a high fever and body aches), but the linked study showed that the booster lowered chances of death by 90%. Yes, things like age and underlying health have a big impact, but many seemingly healthy people have either died or been hospitalized from that. Forgetting about mandates for a moment, on a personal level, why wouldn't you want to get something that showed such high efficacy against death and hospitalization that had such a low, temporally finite cost?
2. Just wanted to comment that I do agree that employer-initiated mandates make no sense to me if you are fully remote. Sure, restrictions on coming into an office unless you've been vaccinated make total sense to me, but mandating for remote employees makes no sense from the perspective of the reality of how the virus is transmitted.
Because they've already determined that their current health is already highly effective at keeping them out of hospital and death.
So you want them decrease their risk from 0.2% to 0.1% and in exchange expose them to a vaccine that's:
- Expires in a few months
- They've already had a history of reacting to (further shots always worse)
- No one takes liability for
- Relatively has higher risk of side effects among their profile
- Unknown long term risk
It doesn't seem like a good deal
> So you want them decrease their risk from 0.2% to 0.1%
The linked study said those that had gotten a booster had 10% of the risk of those that didn't, so using your first number it would be like 0.2% to 0.02%.
> Expires in a few months
It's unknown how long the booster would last, or if after the booster the recommendation would be to move to something annual like flu shots.
> They've already had a history of reacting to (further shots always worse)
The person I responded to didn't say what their reaction was, or if it was time limited. Also, "further shots always worse" is demonstrably false, I know a couple people who had bad (yet, again very short term) side effects with the second dose and barely anything for the booster.
> No one takes liability for
The US government specifically runs a National Vaccine Injury Compensation Program, https://www.hrsa.gov/vaccine-compensation/index.html
> Relatively has higher risk of side effects among their profile
The person I responded to didn't mention this
> Unknown long term risk
Vs. the now well-known long-term risks of contracting Covid, which given its prevalence seems highly likely that your long term choices are (a) never leave your house, (b) reduce likelihood and severity of infection with a vaccine, or (c) get Covid.
It's well within reason to expect that it won't be longer than the 2nd dose.
> The person I responded to didn't say what their reaction was
I kind of extrapolated based on the parent's parent. I had a personal example in mind. Chest pains after first shot, heart palpitations after 2nd, checked at ER. These are myocarditis signs and a booster makes me very uneasy. This I would guess is the most commonly brought up examples of potentially serious side effects.
> Relatively has higher risk of side effects among their profile
Just generalising, assuming young healthy male with no underlying health conditions.
> Vs. the now well-known long-term risks of contracting Covid, which given its prevalence seems highly likely that your long term choices are (a) never leave your house, (b) reduce likelihood and severity of infection with a vaccine, or (c) get Covid.
It's inaccurate to have "Never leave your house" as an option, situations are different. Different case numbers based on location, different personal lifestyles. On the other hand, the vaccine risk is fixed, you either take it or don't.
I'm personally happy doing continuous risk assessment and acting accordingly and if I did catch Covid then so be it, risks are extremely low already.
I don't see how the booster is guaranteed to be the final answer as the virus keeps mutating and spreading among the very large unvaccinated population.
I personally think that it will become endemic, thanks to the vaccine we would have enough immunity to keep us out of hospital and each time we get the virus it would act as a booster.
This thing is not going to end without something like world wide super strict lockdown(Wuhan style) or world wide vaccination(and probably some combinations as the vaccine itself reduces but doesn't completely stop the spread).
I feel the same way with masks. If you didn't do enough research, you could easily believe that anything with an N95 certification would be ideal for protective purposes, but plenty of N95 masks have valves which makes them useless for preventing infected individuals from infecting others. There are also cloth masks, gators, and so on. But to many people they all fall under the umbrella of the unspecific term "wearing a mask", and unless you explicitly look up the medical consensus, many sources of information are unlikely to also state "but not those masks."
It will keep evolving as the situation evolves.
I think, the danger lies in the fact that everything said by scientists on the media is oversimplification and technically wrong as a result of the simplification attempt. This can erode credibility significantly.
Still, regarding the study, it appears that taking the booster would be the better choice, considering most of us will catch the omicron variant at some point.
It would be interesting to know more about this side effect.
[0] https://vestibular.org/forum/dizziness/covid-19-vaccine-side... [1] https://journals.sagepub.com/doi/10.1177/01455613211048975?i...
Unfortunately I haven't learned anything interesting about what the mechanism of action might be. Especially with respect to the most interesting question - does this reaction to the vaccine mean I might have had an even worse reaction to a COVID infection? There are plenty of people who report tinnitus following COVID.
I wonder if you just happened to get ear ringing coincidentally around the time you got your second dose, and connected the dots even though it might not be causally related.
Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.
Especially given that there are rare heart inflammation issues caused by the vaccine, I can see people having a difference of opinion about whether the booster is worth it compared to the risk, until the error bars on the risk measurement are narrowed down a bit.
With respect to myocarditis, though, note that it is rare, and those affected recover quickly [1], and there are some recommendations about potentially changing the injection site to be further from the heart to lower the incidence of this side effect [2].
1. https://newsroom.heart.org/news/young-people-recover-quickly...
2. https://www.scmp.com/news/hong-kong/health-environment/artic...
My question is, are we already below the risks from seasonal flu? I do normally get the seasonal flu vaccine, but I didn’t last year or this year because I’m still practicing social distancing.
I guess I’m trying to put this in perspective.
1. Do boosters work at all?
2. Do boosters wane over time, just like the original shots did?
They answer only 1. They didn't even attempt to shed light on 2, which is a serious letdown. Given known waning vaccine effectiveness, at a minimum claims on booster effectiveness should be bracketed by time since boosting event.
Guess how things are looking? Ready to take the 5th booster shortly.
Lol, “never again” and Nuremberg code are just words easily forgotten.
Being a bit over-dramatic here, aren't we? Never mind factually wrong about
> Israel is effectively forcing everyone to be at the 4th booster by now.
How do you come up with this stuff?
This is technically correct, yet fundamentally misleading. The same statement, bracketed by time since triggering event:
"We've measured the position of iron balls thrown at different speeds from a 56m tall tower, 0.1 seconds after throwing, and found they were 90% likely to be found flying in the air."
Even better, show the plot of position by time, or at least clarify you are merely doing a point-in-time measurement. Time is a fundamental component of the vaccine effectiveness equation.
> RESULTS
> A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (95% confidence interval, 0.07 to 0.14; P<0.001).
> CONCLUSIONS
> Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.
This paper can't take omicron into account, but, it's definitely good news. I'll take a 90% lower mortality rate any day.
Really? Any day?
Read the part you quoted carefully: the death rate in the control group is 3 per 100,000. And if you read the rest of the paper, you'll see that the study population was entirely over age 50.
Remember that the risk of death from Covid-19 goes up exponentially with age -- something like 90% of all fatalities are over age 50 [1]. If you're in the typical HN demographic (<30 yo), your risk of mortality from Covid-19 is much lower than what is reported for baseline here.
I want to put this in perspective. Per The Book of Risks (chapter 8; annual risks) [2], your overall chance of dying in a typical year is 1 in 115 (~870 per 100,000) Your chance of being murdered is 1 in 11,000 (9 per 100,000). The chance you'll die of an accident is 1 in 2,900 (34 per 100,000). From a fall: 1 in 20,000 (5 per 100,000). By getting hit by a car while walking: 1 in 40,000 (2.5 per 100,000).
In other words, your all-ages chance of dying from Covid-19 after two doses is somewhere between your annual chance of dying from a fall, and dying after being hit by a car -- and it's much lower than that if you're under age 50! Divide that number by ten, and you're in the realm of risks that any sane person wouldn't even consider: the annual chance of dying by freezing, for example (1 in 3,000,000).
Point being: dividing a very small number by 10 is indeed a 90% risk reduction, but you have to weigh it against the costs very carefully. There are tons of reasons why I wouldn't take a 90% relative risk reduction, if the baseline risk were quite small (as it is here).
[1] https://www.statista.com/statistics/1254488/us-share-of-tota...
[2] https://www.amazon.com/Book-Risks-Fascinating-Facts-Chances/...
Would you rather not cut your risk by 90%?
Edit: Incidentally, I have been hit by cars while walking 3 times. No injuries, luckily, since they were very low speed impacts.
Why are you seemingly advocating against something (getting a booster shot) that's also extremely unlikely to harm you?
---
[0]: https://www.thedenverchannel.com/news/national/coronavirus/n...
[1]: https://www.kff.org/coronavirus-covid-19/issue-brief/covid-1...
[2]: https://en.wikipedia.org/wiki/1957%E2%80%931958_influenza_pa...
Depends entirely on the cost vs. the benefit. As I said, a 90% relative reduction is meaningless without knowledge of the baseline risk.
And once you know the baseline risk, you can do the math instead of just reacting emotionally.
No emotion involved, at least not from me. Seems clear enough to me. You seem to be the one having an emotional response here.
How tiny? It matters. Your risk of a bad outcome from Covid-19 is extremely tiny.
(Also, by the way: the costs are greater than what you pay for the shot. Miss a day of work? Spend a day in bed? That's a cost.)
> it benefits everybody you probably won't infect if you get exposed to the virus.
We have no evidence of this, nor do we have any reason to believe elevated antibody levels will continue indefinitely. Antibodies from the third shot will wane, just as the antibodies from the second shot waned, and antibodies always wane after antigen exposure. It's how our immune systems work.
The death rate of the control group is .16 vs 2.98 per 100,000 people per day. If you annualize this by multiplying by 365 to make it comparable to your other figures, I think this means you get 65 deaths per 100,000 people per year for the booster group versus over 1000 deaths per 100,000 people per year for the double vaccinated but not boosted. Which is to say, the Covid risk is higher than all of the specific risks you mentioned with or without a booster. This might (or might not) suggest a different conclusion of the relative benefit of taking the booster.
Or am I the one who is misreading the numbers?
> over 1000 deaths per 100,000 people per year for the double vaccinated but not boosted.
We know this isn't even close to true by looking at aggregate numbers. For example, a truly conservative back-of-the-napkin calculation: 800k deaths in the US @ 50M reported cases (which we know is low by a factor of at least 2...) -> 1600 per 100,000. And many of those (half?) happened prior to vaccines; many now happen in the unvaccinated population. It's fairly obvious that 1000 per 100,000 is much too high an estimate.
(...and this isn't even the correct number to compare...what you really want is absolute risk per person, which will be far lower than the risk if you get infected, which is what I've estimated above. If you do that calculation, you get ~240 per 100,000 in the US over the entire pandemic. That's somewhere between the annual risk of dying in an accident (1 in 700) and the annual risk of dying from cancer (1 in 500).
Generalizing from the sample in the study is problematic for a bunch of different reasons -- not the least of which is that it's an older group of people -- but I didn't want to get caught up in a debate about IFR estimates.
Could you expand on this, or suggest the right search terms? My intuition is that it will be a little bit lower than straight multiplication, but that this a low enough probability that we can get a pretty good approximation by ignoring the "impossibility" of an individual dying multiple times during that year. Is there another complicating factor?
>> over 1000 deaths per 100,000 people per year for the double vaccinated but not boosted. > We know this isn't even close to true by looking at aggregate numbers.
I agree it seems extremely high, but I think this is the clear claim of the paper. There were 85,000 people who were never vaccinated, and over the 54 day period of the study, 137 of them died. Thus if you were to extend the study to a year, you should expect more than 1000 deaths. As I see it, the possibilities are a) the paper is lying, b) I'm grossly misinterpreting what it says, or c) the current death rate in Israel for those older than 50 is about 1% even among the doubly vaccinated. If you have time to read it more closely, I'd love to hear what your thoughts on the discrepancy.
Edit: I realize I should've added another option d) the statistics are hopelessly confounded and the results don't mean anything. My current suspicion is that if people who contract Covid early are no longer eligible for receiving a booster, the apparent Covid incidence in the not-boosted arm may be drastically inflated, but I'm not sure if this is a large enough effect to negate the result.
Do the math, death rate is 0.008% (boosted) vs 0.16% (unboosted) for aged 50 and above. Still super low. And we're getting better and better at treating this thing.
Get it if you *want* it. Don't if you don't. I do not want it or need it thank you very much.