If N Texas runs out of ICU beds, doctors can consider a patient's vaccine status

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Zobel
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In reply to 01agtx • 1:39p, 8/20/21
AG
If you don't think doctors will put more effort into resuscitating a young child than an eighty year old I'm not sure what to tell you. I'm not implying any kind of nefarious intent. Doctors are people too.

Edit to add. Not a hill for me to die on. I'm basing this on things family and friends who are doctors have said to me. If that's wrong, it's probably me that's wrong.
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Jakeyjake
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In reply to planoaggie123 • 9:53p, 8/21/21
planoaggie123 said:
cc_ag92 said:
Close to it? You shame fat daily on this forum.
Are you planning on going next-level and yelling at people in public? What would this shaming look like?


Sorry I don't want to shame but when over 70% of COVID hospitalizations are overweight or obese it's hard not to call out.

My kids may have to be muzzled in school soon because of the overrun on hospitals due to people's poor life health choices. If we did not have a weight / obese issue in this country we would not have a COVID hospitalization issue and my kids could be normal in school.

https://www.google.com/amp/s/www.cnbc.com/amp/2021/03/08/covid-cdc-study-finds-roughly-78percent-of-people-hospitalized-were-overweight-or-obese.html

Edit: full disclosureI was in overweight category by a few pounds early in COVID. Once it became obvious how impacted people are that are overweight and have heart issues I have completely changed diet and increased exercise and lost 20 pounds and now in healthy BMI range. I made lifestyle changes and feel better.

Edit 2: this is a hospitalization debate so I would pose why would a healthy unvaccinated person be put in the back of the line to an overweight vaccinated. Just wrong. Overweight Is fueling this pandemic.


According to what I am reading the bed overflow is mainly limited to certain states and is not problematic for the rest of the country... it appears to be mainly the "fat states" including Lousiana, Alabama, and Texas. Why can't people just lose some freaking weight??? Sigh...
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NicosMachine
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In reply to Sandman98 • 12:36p, 8/22/21
AG
Sandman98 said:
03_Aggie said:
Why would vaccinated people be in the hospital?
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Zobel
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In reply to NicosMachine • 1:05p, 8/22/21
AG
We know from observing outbreaks (for example, measles) that being vaccinated in a highly vaccinated population is the lowest risk, and being unvaccinated in a highly unvaccinated population puts you at highest risk. Obvious enough. But being vaccinated in a highly unvaccinated population is higher risk than being unvaccinated in a highly vaccinated population. Vaccines aren't perfect and can be "overwhelmed" by heavy exposure.
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aggierogue
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In reply to bay fan • 1:21p, 8/22/21
AG
bay fan said:
Salute The Marines said:
Aggie95 said:
Can they treat lung cancer patients based on if they smoke?


If the hospitals were full of lung cancer patients I wouldn't have a problem with this.
Bingo. Additionally, can we stop comparing things that are not contagious and that have no readily available FREE vaccine that reduces the chance you need an ICU bed by magnitudes?
No.

Plenty of people who make poor lifestyle choices effect me and my insurance premiums.

Help me understand why vaccinated folks spend day and night on this forum lecturing others when they are supposed to be protected.
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NicosMachine
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In reply to Zobel • 2:55p, 8/22/21
AG
Zobel said:
We know from observing outbreaks (for example, measles) that being vaccinated in a highly vaccinated population is the lowest risk, and being unvaccinated in a highly unvaccinated population puts you at highest risk. Obvious enough. But being vaccinated in a highly unvaccinated population is higher risk than being unvaccinated in a highly vaccinated population. Vaccines aren't perfect and can be "overwhelmed" by heavy exposure.


How to explain Israel. They were highly vaccinated by January and are experiencing a surge. 60% of hospitalizations are vaccinated. That sounds like the worst vaccine ever. Has any vaccine ever had such poor results?
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Fitch
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In reply to aggierogue • 3:10p, 8/22/21
AG
aggierogue said:
bay fan said:
Salute The Marines said:
Aggie95 said:
Can they treat lung cancer patients based on if they smoke?
If the hospitals were full of lung cancer patients I wouldn't have a problem with this.
Bingo. Additionally, can we stop comparing things that are not contagious and that have no readily available FREE vaccine that reduces the chance you need an ICU bed by magnitudes?
No.

Plenty of people who make poor lifestyle choices effect me and my insurance premiums.

Help me understand why vaccinated folks spend day and night on this forum lecturing others when they are supposed to be protected.
Probably a combination of empathy, self-interest, or derision, depending on the individual.
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In reply to Fitch • 3:13p, 8/22/21
Fitch
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In reply to [removed post] • 3:15p, 8/22/21
AG
Sums up my position pretty well TBH.
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In reply to Fitch • 3:19p, 8/22/21
Zobel
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In reply to NicosMachine • 3:21p, 8/22/21
AG
This is a form of the base rate fallacy.

In the clinical trials they randomly distributed patients between vaccine and placebo arms, making sure both sides were evenly matched for age, pre-existing conditions, etc. Then, if you have a hypothetical 100 people get sick, and 95 of them are in the placebo arm, you can have confidence to say that represents a relative risk ratio between the two arms. Because the groups are the same size, and the risk is spread evenly between them, you're trying to make sure you aren't accidentally measuring something other than the placebo vs vaccine.

Israel is real world. Risk groups aren't evenly spread between people who got the vaccine and who didn't. There isn't an even number of people between the two groups.

Nearly all of the older residents are vaccinated (>90% vaccination rate over 50) and nearly all of the unvaccinated are younger (85% of unvaccinated are under 50). As we know the risk curve for hospitalization and death with covid grows exponentially with age.

When you adjust for vaccination rates and risk of hospitalization by age, you find that the vaccines retain >80% efficacy vs severe disease. This website goes through it in detail and is the source for this table.


If you don't care for that analysis, you can look at the reports straight from the Israeli ministry of health, which reports 88% efficacy against hospitalization (slide 7).
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NicosMachine
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In reply to Zobel • 4:00p, 8/22/21
AG
Zobel said:
This is a form of the base rate fallacy.

In the clinical trials they randomly distributed patients between vaccine and placebo arms, making sure both sides were evenly matched for age, pre-existing conditions, etc. Then, if you have a hypothetical 100 people get sick, and 95 of them are in the placebo arm, you can have confidence to say that represents a relative risk ratio between the two arms. Because the groups are the same size, and the risk is spread evenly between them, you're trying to make sure you aren't accidentally measuring something other than the placebo vs vaccine.

Israel is real world. Risk groups aren't evenly spread between people who got the vaccine and who didn't. There isn't an even number of people between the two groups.

Nearly all of the older residents are vaccinated (>90% vaccination rate over 50) and nearly all of the unvaccinated are younger (85% of unvaccinated are under 50). As we know the risk curve for hospitalization and death with covid grows exponentially with age.

When you adjust for vaccination rates and risk of hospitalization by age, you find that the vaccines retain >80% efficacy vs severe disease. This website goes through it in detail and is the source for this table.


If you don't care for that analysis, you can look at the reports straight from the Israeli ministry of health, which reports 88% efficacy against hospitalization (slide 7).
Vaccines result in 67.5% absolute risk reduction according to the article. The relative risk reduction would be what? The chart states that 1,302,9112 individuals were untaxed and that 214 had severe cases (.0164%). Of the vaccinated population of 5,634,634, 301 had severe cases (.0053%). Vaccination decreased relative risk of a severe Covid case by .011% in the total population. It was certainly more effective in the older population with a relative risk reduction of .0783%. I would contend that the low relative risk reduction combined with the lack of data regarding long-term vaccine effectiveness and risk is the main reason many young, healthy people are eschewing the vaccine. It is not unreasonable.
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Zobel
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In reply to NicosMachine • 4:02p, 8/22/21
AG
Relative risk reduction versus severe disease is what is shown in that table. Efficacy is just another name for hazard ratio.

If you want to reduce your risk of severe disease or hospitalization by ~90%, get the vaccine.

Edit to add - sorry, I don't see an absolute risk calculation in either of the two links. Can you clarify where you're getting that from?
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t - cam
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In reply to 03_Aggie • 4:08p, 8/22/21
AG
03_Aggie said:
Why would vaccinated people be in the hospital?


How did this get 40 stars?

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NicosMachine
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In reply to Zobel • 4:09p, 8/22/21
AG
Zobel said:
Relative risk reduction versus severe disease is what is shown in that table. Efficacy is just another name for hazard ratio.

If you want to reduce your risk of severe disease or hospitalization by ~90%, get the vaccine.

Edit to add - sorry, I don't see an absolute risk calculation in either of the two links. Can you clarify where you're getting that from?
90% of what? As my odds of hospitalization are approaching zero, the "90% reduction" means very little in light of the unknown long-term effectiveness and risks of the vaccine. We all have different risk tolerance. There is no right or wrong risk tolerance. My tolerance for an extremely low (near zero) chance of hospitalization without the vaccine is greater than my tolerance for the unknown associated with the vaccine. The fact vaccine guidance has changed so much in 6 months does not illicit much confidence in those with low chance of hospitalization. And, thank you for your information. It is very nuanced and reasoned. I've actually learned a bunch from your posts.
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In reply to t - cam • 4:09p, 8/22/21
NicosMachine
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In reply to t - cam • 4:12p, 8/22/21
AG
t - cam said:
03_Aggie said:
Why would vaccinated people be in the hospital?


How did this get 40 stars?
Because the initial vaccine guidance suggested the vaccine was 95% effective at preventing Covid. That number is now down to 67% (and dropping). Maybe people are still under the false impression the vaccines are 95% effective.
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bay fan
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In reply to Jakeyjake • 4:12p, 8/22/21
S
Jakeyjake said:
planoaggie123 said:
cc_ag92 said:
Close to it? You shame fat daily on this forum.
Are you planning on going next-level and yelling at people in public? What would this shaming look like?


Sorry I don't want to shame but when over 70% of COVID hospitalizations are overweight or obese it's hard not to call out.

My kids may have to be muzzled in school soon because of the overrun on hospitals due to people's poor life health choices. If we did not have a weight / obese issue in this country we would not have a COVID hospitalization issue and my kids could be normal in school.

https://www.google.com/amp/s/www.cnbc.com/amp/2021/03/08/covid-cdc-study-finds-roughly-78percent-of-people-hospitalized-were-overweight-or-obese.html

Edit: full disclosureI was in overweight category by a few pounds early in COVID. Once it became obvious how impacted people are that are overweight and have heart issues I have completely changed diet and increased exercise and lost 20 pounds and now in healthy BMI range. I made lifestyle changes and feel better.

Edit 2: this is a hospitalization debate so I would pose why would a healthy unvaccinated person be put in the back of the line to an overweight vaccinated. Just wrong. Overweight Is fueling this pandemic.


According to what I am reading the bed overflow is mainly limited to certain states and is not problematic for the rest of the country... it appears to be mainly the "fat states" including Lousiana, Alabama, and Texas. Why can't people just lose some freaking weight??? Sigh...
So the least vaccinated states? I'm shocked.
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t - cam
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In reply to aggierogue • 4:14p, 8/22/21
AG
aggierogue said:
bay fan said:
Salute The Marines said:
Aggie95 said:
Can they treat lung cancer patients based on if they smoke?


If the hospitals were full of lung cancer patients I wouldn't have a problem with this.
Bingo. Additionally, can we stop comparing things that are not contagious and that have no readily available FREE vaccine that reduces the chance you need an ICU bed by magnitudes?
No.

Plenty of people who make poor lifestyle choices effect me and my insurance premiums.

Help me understand why vaccinated folks spend day and night on this forum lecturing others when they are supposed to be protected.


People seem to be completely blind to or just Unwilling to understand the medical system crisis that is happening right now. I'm 41 years old, my dad had a nearly fatal heart attack at age 44. Luckily he got immediate attention and was able to survive. I may not be as lucky if it were to happen to me today and that is very scary.

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bay fan
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In reply to aggierogue • 4:15p, 8/22/21
S
aggierogue said:
bay fan said:
Salute The Marines said:
Aggie95 said:
Can they treat lung cancer patients based on if they smoke?


If the hospitals were full of lung cancer patients I wouldn't have a problem with this.
Bingo. Additionally, can we stop comparing things that are not contagious and that have no readily available FREE vaccine that reduces the chance you need an ICU bed by magnitudes?
No.

Plenty of people who make poor lifestyle choices effect me and my insurance premiums.

Help me understand why vaccinated folks spend day and night on this forum lecturing others when they are supposed to be protected.
Zobel said it clearly enough to be easy to understand. "Being vaccinated in a highly unvaccinated population is higher risk than being unvaccinated in a highly vaccinated population. Vaccines aren't perfect and can be "overwhelmed" by heavy exposure." Does that "help"?
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t - cam
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In reply to NicosMachine • 4:17p, 8/22/21
AG
NicosMachine said:
t - cam said:
03_Aggie said:
Why would vaccinated people be in the hospital?


How did this get 40 stars?
Because the initial vaccine guidance suggested the vaccine was 95% effective at preventing Covid. That number is now down to 67% (and dropping). Maybe people are still under the false impression the vaccines are 95% effective.


We won't be in the hospital for COVID.

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Zobel
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In reply to NicosMachine • 4:19p, 8/22/21
AG
When it comes to the meaning of relative risk or vaccine efficacy, the answer is simple - whatever your baseline risk is, vaccine efficacy reduces that. If your risk is high, it reduces a high risk to a lower one. If your risk is low, it reduces the small risk to an even smaller one.

Your estimation of the personal risk from the virus seems to be understated, and your estimation from the risk of the vaccine seems to be overstated. But that's just from where I sit. I'm not trying to change your mind, but I do think it is important to base decisions on good info.

I think the nuance is important, because even though people want clear answers, sometimes there aren't any. Whatever we thought we know about vaccine efficacy vs original type went out the window with delta. What we think we know now about delta may change in the future. The good thing is that the evidence of the safety of the vaccines has not changed, and the efficacy of the vaccines against hospitalization has held up and is still around 90% even vs delta. That should give you confidence.

I was a vaccine holdout until a couple of people I know got it and had a really crappy time. Young, fit people (mid twenties) I personally know and work with have told me that they didn't feel back to normal for months, both from l like a physical ability to workout / run aspect and from a brain fog. That isn't on an mortality or hospitalization statistic from the CDC. I wanted no part of that
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NicosMachine
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In reply to Zobel • 4:19p, 8/22/21
AG
Zobel said:
Relative risk reduction versus severe disease is what is shown in that table. Efficacy is just another name for hazard ratio.

If you want to reduce your risk of severe disease or hospitalization by ~90%, get the vaccine.

Edit to add - sorry, I don't see an absolute risk calculation in either of the two links. Can you clarify where you're getting that from?
For absolute risk I simply took the difference of unvaccinated population experiencing severe case of covid and the vaccinated population experiencing severe case of Covid (%unvax w/ severe covid - %vax w/severe covid). I believe that provides a measure of absolute risk reduction. I may be wrong, but that is my gut instinct - they way I measure risk in my head.
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In reply to NicosMachine • 4:21p, 8/22/21
AG
Im not sure if you did or didn't, but you'd need to break that into age cohorts for it to have any real relevance.
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In reply to Zobel • 4:27p, 8/22/21
AG
Zobel said:
Im not sure if you did or didn't, but you'd need to break that into age cohorts for it to have any real relevance.
The absolute risk reduction of the vaccination for the entire population (of the Israeli data you posted) was .011%. The absolute risk reduction for the vaccinated over 50 population was 7x greater, at .0783%.
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Fat Black Swan
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In reply to Zobel • 5:53p, 8/22/21
AG
Zobel said:
This is a form of the base rate fallacy.

In the clinical trials they randomly distributed patients between vaccine and placebo arms, making sure both sides were evenly matched for age, pre-existing conditions, etc. Then, if you have a hypothetical 100 people get sick, and 95 of them are in the placebo arm, you can have confidence to say that represents a relative risk ratio between the two arms. Because the groups are the same size, and the risk is spread evenly between them, you're trying to make sure you aren't accidentally measuring something other than the placebo vs vaccine.

Israel is real world. Risk groups aren't evenly spread between people who got the vaccine and who didn't. There isn't an even number of people between the two groups.

Nearly all of the older residents are vaccinated (>90% vaccination rate over 50) and nearly all of the unvaccinated are younger (85% of unvaccinated are under 50). As we know the risk curve for hospitalization and death with covid grows exponentially with age.

When you adjust for vaccination rates and risk of hospitalization by age, you find that the vaccines retain >80% efficacy vs severe disease. This website goes through it in detail and is the source for this table.


If you don't care for that analysis, you can look at the reports straight from the Israeli ministry of health, which reports 88% efficacy against hospitalization (slide 7).


Why did he use August vaccination rates for a study that analyzed data between mid-January and mid-July? How useful is the analysis on efficacy against Delta when the Delta outbreak started in June?
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atmtws
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6:00p, 8/22/21
AG
Choosing not to vax vs choosing not to eat healthy.
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Fat Black Swan
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In reply to Zobel • 6:13p, 8/22/21
AG
I did an age cohort analysis of hospitalization rates and vaccination rates in Texas. Based on the current vaccination rates and the hospitalization rates for each age cohort, the base risk of hospitalization in Texas has been reduced ~72% (assuming 95% efficacy).

Accounting for natural immunity and an r-naught 2x the previous outbreaks, given the current hospitalization rate relative to the previous two, either Delta is 70-110% more virulent or the vaccines are only 50-70% effective against Delta.
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In reply to Fat Black Swan • 6:37p, 8/22/21
Fat Black Swan
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In reply to [removed post] • 6:59p, 8/22/21
AG
Just pointing out that there's no way the vaccines are 90-95% effective against Delta based on current data in Texas, which is supported by recent data on breakthrough case, hospitalization, and fatality rates from July and August in states like Illinois, Tennessee, and Massachusetts. It also appears the relative rate reductions are decreasing as time goes on.

It doesn't seem out of the question that you could see summer and winter outbreaks of different variants for the foreseeable future with similar 50-70% efficacy of bi-annual vaccines and similar 25-50% annual chance of infection.

If that ends up being the case, there's a large grey area that any mandates would willingly ignore.

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Zobel
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In reply to Fat Black Swan • 7:24p, 8/22/21
AG
I dono, as I said if you don't care for that analysis use the Israeli government analysis.

Quote:
I did an age cohort analysis of hospitalization rates and vaccination rates in Texas. Based on the current vaccination rates and the hospitalization rates for each age cohort, the base risk of hospitalization in Texas has been reduced ~72% (assuming 95% efficacy).

I don't understand what you mean assuming 95% efficacy. Efficacy is the risk reduction.

Quote:
Accounting for natural immunity and an r-naught 2x the previous outbreaks, given the current hospitalization rate relative to the previous two, either Delta is 70-110% more virulent or the vaccines are only 50-70% effective against Delta.

It's both. Vaccine efficacy is lower vs delta and delta is probably a little more dangerous. At least that is what the studies of the UK, Canada, and Singapore found.

I don't know how the reproductive rate enters into it.
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Fat Black Swan
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In reply to Zobel • 7:50p, 8/22/21
AG


Quote:
I don't understand what you mean assuming 95% efficacy. Efficacy is the risk reduction.


[Base Hospitalization Rate
-
(Age group 1 - Efficacy rate X vaccination rate X hospitalization rate X population rate
+
Age group 2 - Efficacy rate X vaccination rate X hospitalization rate X population population rate
+
Age group 3 - Efficacy rate X vaccination rate X hospitalization rate X population rate)]
/
Base Hospitalization Rate
=
Reduction in hospitalization rate for the population

Quote:
I don't know how the reproductive rate enters into it.


Higher percentage of the population infected in a shorter period of time. 2x the base number of people infected in an outbreak window.
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Zobel
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In reply to Fat Black Swan • 8:03p, 8/22/21
AG
I'm not sure I follow. Why calculate hospitalization risk based on an assumed efficacy when you can back calculate the efficacy?
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Fat Black Swan
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In reply to Zobel • 8:46p, 8/22/21
AG
Zobel said:
I'm not sure I follow. Why calculate hospitalization risk based on an assumed efficacy when you can back calculate the efficacy?


To analyze the reasonableness of the efficacy rates by estimating the reduced risk of hospitalization for the entire state and comparing that to actual hospitalizations.
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