Omicron variant

[Julian]

It seems that about 62000 people died in Scotland up to dec 20 2020. Very crudely, that's about 4800 every 28 days. Not very far from the number given as dying within 28 days of a vaccine above. I'm sure there are some other considerations that might need adjustments to be made, but that figure reassures me that the vaccine is not causing lots of deaths.

You beat me to it and just saved me some typing. That was exactly the calculation I was going to post.

Re the “not very far from” discrepancy I would point out that almost no one under 12 is being vaccinated and in fact there are very few people under 18 represented so far (https://spice-spotlight.scot/2021/12/15 ... test-data/). Also I have no data source to confirm that I’m hunch is correct but I think it quite likely that vaccine uptake was high in those with clinical vulnerabilities so essentially the population being looked at for the within-28-days-of-a-vaccine death figures is a subset of the overall Scottish population due it it having almost no one under 18 in it and possibly (although as mentioned this is just a hunch) a higher percentage of clinically vulnerable vs the population as a whole. Both those factors I would expect to drive the death rate higher vs the overall 4800 per 28 days figure for the overall population that you quoted.

Actually though this is all just a bit of context. I think the 5,500 figure quoted was cumulative rather than a run rate so comparing it to the general run-rate of deaths isn’t really meaningful since each day we are not vaxing the entire population. It does make the point though that quite a few people die every 28 days anyway for all sorts of reasons.

- Julian

[Wizard]

As a rational ethical person absolutely I would
At the point of treatment where that decision HAS to be made, to give it to someone to satiate a prejudice would be misanthropic and spiteful IMHO
- surely you can see that increasing the chance of wasting the effort is counterproductive? as a human? for the work we put in to designing equipment to keep sick people alive? (Yeah fair enough I get paid for that... but I do it because I want to see people pull through)

-sd

My view is that in the longer term allocating the consequences of decisions, like refusing the vaccine, to those who make that choice will modify behaviour and therefore ultimately save MORE lives than your short termist approach. I take this view because I want the best for society as a whole, I would say to take a short term view that supports decisions that are bad for society in aggregate is the wrong approach.

It is not about one virtuous approach and one evil one as you seem determined to portray it, but rather two different approaches both intended to ultimately benefit society. It is the same reason I favour vaccine passports (with no negative test option). By ramping up the consequences of foolish decisions we will hopefully reduce the number making such decisions.

You said you would give it to a vaccinated person with 1% chance of success over an unvaccinated person with 99% chance; you would give the one remaining spot to the case with 99 less chance of success
- and yet you seem to imply foolish decisions should be avoided??


-sd

As I said, I consider your view erroneous as it optimises the short term versus the long term. Despite thinking you are wrong I will resist name calling and rolling eyes, maybe you should try the same. People can take different views on complex subjects, some people can see that, some can't.

[servodude]

My view is that in the longer term allocating the consequences of decisions, like refusing the vaccine, to those who make that choice will modify behaviour and therefore ultimately save MORE lives than your short termist approach. I take this view because I want the best for society as a whole, I would say to take a short term view that supports decisions that are bad for society in aggregate is the wrong approach.

It is not about one virtuous approach and one evil one as you seem determined to portray it, but rather two different approaches both intended to ultimately benefit society. It is the same reason I favour vaccine passports (with no negative test option). By ramping up the consequences of foolish decisions we will hopefully reduce the number making such decisions.

You said you would give it to a vaccinated person with 1% chance of success over an unvaccinated person with 99% chance; you would give the one remaining spot to the case with 99 less chance of success
- and yet you seem to imply foolish decisions should be avoided??


-sd

As I said, I consider your view erroneous as it optimises the short term versus the long term. Despite thinking you are wrong I will resist name calling and rolling eyes, maybe you should try the same. People can take different views on complex subjects, some people can see that, some can't.

I'm not name calling I'm pointing out that a strategy to deny treatment to people BECAUSE they have a different opinion to yourself is wasteful, unethical, misanthropic and spiteful

It would play in to, or confirm, the accusations of segregation leveled by those of an anti vax bent
It's impractical and counter productive; it's not good practice

If you want to encourage folk to get vaccinated it would be advisable to inform them that the decision might eventually factor in to the decision to treat them should resources become over worked
- that would have the same net effect without the malice and waste of resources

As I said before you are entitled to your view but don't be surprised if when you air it, the perception of it, and its failings are addressed

And the wee picture things are just a fun shorthand
-sd

[servodude]

Actually though this is all just a bit of context. I think the 5,500 figure quoted was cumulative rather than a run rate so comparing it to the general run-rate of deaths isn’t really meaningful since each day we are not vaxing the entire population. It does make the point though that quite a few people die every 28 days anyway for all sorts of reasons.

- Julian

One of the awkward anomalies trying to convince the hesitant in Australia to start vaccinating was that by July only 2 people had died in 2021 from COVID
- fewer than had died from confirmed vaccine reactions; which led to the AZ vaccine being something you, literally, couldn't give away

Glad to say that once the roll out proper started it went at a pretty good pace to get decent coverage

-sd

[9873210]

It seems that about 62000 people died in Scotland up to dec 20 2020. Very crudely, that's about 4800 every 28 days. Not very far from the number given as dying within 28 days of a vaccine above. I'm sure there are some other considerations that might need adjustments to be made, but that figure reassures me that the vaccine is not causing lots of deaths.

The number should only be the same if the number of vaccinations is the same as the population size.* Since the UK (and probably Scotland) vaccination rate is about 1.8 per person the numbers (5500 and 4800) should not be the same if vaccinations were independent of death.

With independence the number of deaths with 28 days of vaccination would be 1.8 x 4800 = 8640, so either vaccination is very highly protective of non-Covid deaths, or more likely, people selected for vaccination are more robust on average. I suspect that terminal patients in hospice care are unlikely to be given a vaccine, and these people account for a meaningful fraction of deaths.

* If you want a proof of this consider the sizes of the set of all person days in Scotland during the year, the subset where that particular person died within 28 days of that particular date, and the intersections of these sets with a random set of person days, a set of person days unrelated to death and one related to deaths.

[Mike4]

Also, can the 'excess deaths' methodology be used here?

Take a cohort of vaccinated people and compare the number of deaths in that cohort in 2020 with the number of deaths in the same cohort in 2021, i.e. post-vaccination, crudely speaking, to determine the additional death rate caused by vaccination?

[Steveam]

From the FT:

“Ferguson said that the data provided “no strong signal of an intrinsically reduced severity of Omicron versus Delta”. But he added that a “much more definitive judgment” could be made “within a week” as more data emerge on Omicron-related admissions, which are increasing “quite sharply” in London and Manchester.

The findings on severity were based on analysis of 120,000 Delta cases and 15,000 suspected Omicron cases, alongside 24 Omicron hospitalisations and more than 1,000 Delta hospitalisations. The preliminary research suggested people infected with Omicron were as likely to show symptoms and require hospital treatment as Delta patients.”

Best wishes,

Steve

[servodude]

From the FT:

“Ferguson said that the data provided “no strong signal of an intrinsically reduced severity of Omicron versus Delta”. But he added that a “much more definitive judgment” could be made “within a week” as more data emerge on Omicron-related admissions, which are increasing “quite sharply” in London and Manchester.

The findings on severity were based on analysis of 120,000 Delta cases and 15,000 suspected Omicron cases, alongside 24 Omicron hospitalisations and more than 1,000 Delta hospitalisations. The preliminary research suggested people infected with Omicron were as likely to show symptoms and require hospital treatment as Delta patients.”

Best wishes,

Steve

Here's the thing... they're taking about observing a 30% reduction in severity.
Now that's simultaneously great, possibly accurate and if true probably won't be noticed
In pandemics viruses spread geometrically
- if you were working as an engineer with that kind of thing you'd use dB rather than a % because you'd be looking for something representative of how the system works
30% reduction that's a gain of 0.7... which is literally the 3dB point where you consider things to not really matter (it's where you would say the pass band ends on a filter)

Or from a different perspective... if the cases are doubling every 2 days how long before your 30% benefit is consumed?
- it would be measured in hours (EDIT: from any given point )

-sd

[Mike4]

Here's the thing... they're taking about observing a 30% reduction in severity.
Now that's simultaneously great, possibly accurate and if true probably won't be noticed
In pandemics viruses spread geometrically
- if you were working as an engineer with that kind of thing you'd use dB rather than a % because you'd be looking for something representative of how the system works
30% reduction that's a gain of 0.7... which is literally the 3dB point where you consider things to not really matter (it's where you would say the pass band ends on a filter)

Or from a different perspective... if the cases are doubling every 2 days how long before your 30% benefit is consumed?
- it would be measured in hours (EDIT: from any given point )

-sd

But Sir, SIR, to me as a layman, a 30% "reduction in severity" could mean the difference between all of the 'severe' patients with Delta needing hospital treatment and none of the Omicron.

I.e. loads of Delta patients get so sick as to cross the threshold for needing hospital treatment, but perhaps none of the Omicron patients whilst getting very sick, will get quite as sick and therefore hopefully not need hospital admission.

This is presumably flawed thinking, but I bet it is how the bod on that apocryphal bus thinks, and possibly quite a few journalists and politicians too.

[NotSure]

But Sir, SIR, to me as a layman, a 30% "reduction in severity" could mean the difference between all of the 'severe' patients with Delta needing hospital treatment and none of the Omicron.

I.e. loads of Delta patients get so sick as to cross the threshold for needing hospital treatment, but perhaps none of the Omicron patients whilst getting very sick, will get quite as sick and therefore hopefully not need hospital admission.

This is presumably flawed thinking, but I bet it is how the bod on that apocryphal bus thinks, and possibly quite a few journalists and politicians too.

This is a very important point, and I'm not sure which is correct. If you shift the entire bell curve 30% to the left, then the (let's say) +3 sigma that end up very ill or worse may be massively reduced. However, if you just multiply the bell curve by 0.7, then SD's point stands.

[servodude]

But Sir, SIR, to me as a layman, a 30% "reduction in severity" could mean the difference between all of the 'severe' patients with Delta needing hospital treatment and none of the Omicron.

I.e. loads of Delta patients get so sick as to cross the threshold for needing hospital treatment, but perhaps none of the Omicron patients whilst getting very sick, will get quite as sick and therefore hopefully not need hospital admission.

This is presumably flawed thinking, but I bet it is how the bod on that apocryphal bus thinks, and possibly quite a few journalists and politicians too.

This is a very important point, and I'm not sure which is correct. If you shift the entire bell curve 30% to the left, then the (let's say) +3 sigma that end up very ill or worse may be massively reduced. However, if you just multiply the bell curve by 0.7, then SD's point stands.

Really good points both of you

I don't have a good definition for how that reduction in severity has been derived (forgive me I read it in the news! )
- I've been considering it along the lines of proportionality fewer people needing hospital (and those that do being proportionality less ill)
Mostly because if it was a change that sliced the top off the curve, i.e. dropped the significance below the threshold for admission, the Guateng province in SA we've seen discussed wouldn't have had an 18 fold increase in people going to hospital; it would have gone unnoticed because it was effectively trivialized


-sd

[scotia]

One of the awkward anomalies trying to convince the hesitant in Australia to start vaccinating was that by July only 2 people had died in 2021 from COVID
- fewer than had died from confirmed vaccine reactions; which led to the AZ vaccine being something you, literally, couldn't give away

-sd

I understand the initial reluctance in Australia, but it now looks like no country will be able to avoid Covid, and a vaccination policy will be eventually be required world-wide.
As you are probably well aware, with deaths mounting in Scotland, the over 75s (myself included) were mighty glad to get the A-Z vaccine - or any other that was offered. It might be overstating the rush to say that we were knocking one another down to get there first, but its certainly true that the uptake among us oldies was very high. So I got A-Z in February and April, followed by Pfizer in October.
And thank you, scientists and engineers, for the vaccines.

[servodude]

One of the awkward anomalies trying to convince the hesitant in Australia to start vaccinating was that by July only 2 people had died in 2021 from COVID
- fewer than had died from confirmed vaccine reactions; which led to the AZ vaccine being something you, literally, couldn't give away

-sd

I understand the initial reluctance in Australia, but it now looks like no country will be able to avoid Covid, and a vaccination policy will be eventually be required world-wide.
As you are probably well aware, with deaths mounting in Scotland, the over 75s (myself included) were mighty glad to get the A-Z vaccine - or any other that was offered. It might be overstating the rush to say that we were knocking one another down to get there first, but its certainly true that the uptake among us oldies was very high. So I got A-Z in February and April, followed by Pfizer in October.
And thank you, scientists and engineers, for the vaccines.

There was pretty quickly no doubt that everywhere would have to face COVID; the plan was hopefully to vaccinate people before they did.

The messaging around the AZ vaccine was particularly terrible. With people trying to downplay, and deny, the issues that were revealed about it. There was quite a bit of tawdry and unhelpful flag waving coupled with some media FUD. Disappointing particularly because it was being made locally. Going forward Moderna look to be setting up a plant nearby so that will be interesting.

Anyhow there was a bit of a slow start but I think we're currently at about 93% of over 12s being double jabbed (in Vic) - my booster's booked in for the first week in Jan (a week after my 5mth since the second)
- and I'm waiting for pre-fight PCR results for the Xmas holiday
Which is probably about as much as one could hope for at this stage
- I expect it all to be revaluated in the new year when we know what this Omicron thing really is all about

-sd

[scotia]

From the FT:

“Ferguson said that the data provided “no strong signal of an intrinsically reduced severity of Omicron versus Delta”. But he added that a “much more definitive judgment” could be made “within a week” as more data emerge on Omicron-related admissions, which are increasing “quite sharply” in London and Manchester.

The findings on severity were based on analysis of 120,000 Delta cases and 15,000 suspected Omicron cases, alongside 24 Omicron hospitalisations and more than 1,000 Delta hospitalisations. The preliminary research suggested people infected with Omicron were as likely to show symptoms and require hospital treatment as Delta patients.”

Best wishes,

Steve

In counting low probability independent events, a poisson distribution is often assumed to obtain a measure of the statistical accuracy. This gives a standard deviation equal to the square root of the number. And if you want better than a 95% probability, you should take two standard deviations. So if there had been 25 Omicron hospitalisations, the 95% confidence spread would be 15 to 35. From this I think that you can see that we can currently only make very rough estimates of Omicron severity. We need more data.

[servodude]

From the FT:

“Ferguson said that the data provided “no strong signal of an intrinsically reduced severity of Omicron versus Delta”. But he added that a “much more definitive judgment” could be made “within a week” as more data emerge on Omicron-related admissions, which are increasing “quite sharply” in London and Manchester.

The findings on severity were based on analysis of 120,000 Delta cases and 15,000 suspected Omicron cases, alongside 24 Omicron hospitalisations and more than 1,000 Delta hospitalisations. The preliminary research suggested people infected with Omicron were as likely to show symptoms and require hospital treatment as Delta patients.”

Best wishes,

Steve

In counting low probability independent events, a poisson distribution is often assumed to obtain a measure of the statistical accuracy. This gives a standard deviation equal to the square root of the number. And if you want better than a 95% probability, you should take two standard deviations. So if there had been 25 Omicron hospitalisations, the 95% confidence spread would be 15 to 35. From this I think that you can see that we can currently only make very rough estimates of Omicron severity. We need more data.

Notwithstanding the sparse data, this suggests that the claim (and degree) of reduced severity would be based on the relative incidence of hospitalization? (Some of us were mumbling about it earlier in the thread having seen figures bandied about - but without a methodology for how they were derived)

-sd

[scotia]

Notwithstanding the sparse data, this suggests that the claim (and degree) of reduced severity would be based on the relative incidence of hospitalization? (Some of us were mumbling about it earlier in the thread having seen figures bandied about - but without a methodology for how they were derived)

-sd

I agree - even with much improved statistical accuracy, there remain many obstacles to estimating Omicron Severity. In an ideal world, we would have an accurate count of all Omicron infections, and we would have an accurate count of all of these which have merited hospitalisation, and all of these which died, due to Omicron. And we would need all of these numbers to be subdivided into those who were unvaccinated , and those who were vaccinated, and further subdivided with different vaccination regimes. So I think we can probably forget about that
Perhaps the ratio of deaths to hospital admissions may change as Omicron becomes dominant - and that may give us some idea on severity.
I am tempted to say that the ratio of infections to admissions may also be a marker - but I fear that reported infection rates (symptomatic and un-symptomatic) are a very variable quantity, particularly in a virus which may easily become un-noticed. Also (in the UK) I have also seen a marked skewing of infections related to primary school pupils - holidays can't come too soon!
And my biggest concern is that the Omicron virus is so infective that it will result in large numbers of quarantined hospital staff - resulting in changes to admissions policies.
So I think that any accurate estimate of severity is going to prove difficult .

[servodude]

So I think that any accurate estimate of severity is going to prove difficult

Indeed.
To a degree it all feels a bit academic, "angels on a pin" type stuff, when faced with the apparent increase in infectiousness
- practically even "less sick" people raise the chance of "collateral damage" when they are using up hospital resources

I've got my fingers crossed but it's going to be a tense few weeks
- sd

[Hallucigenia]

But Sir, SIR, to me as a layman, a 30% "reduction in severity" could mean the difference between all of the 'severe' patients with Delta needing hospital treatment and none of the Omicron.

I.e. loads of Delta patients get so sick as to cross the threshold for needing hospital treatment, but perhaps none of the Omicron patients whilst getting very sick, will get quite as sick and therefore hopefully not need hospital admission.

This is presumably flawed thinking, but I bet it is how the bod on that apocryphal bus thinks, and possibly quite a few journalists and politicians too.

This whole business of severity is complicated, and words like "milder" really aren't helpful. But if you look eg at the study from the South African "BUPA", what they are saying is that 7 people end up in hospital in the current wave, for every 10 people that were hospitalised in the previous wave. And the hospital stays in SA are shorter according to the Saffer Health Minister per the slides I posted recently.

Although they control for age and vaccination status, they don't adjust for the fact more people in this wave have previous exposure to SARS2 (which has been rampant in Africa, but in a young population), so they can't say whether that's responsible or because omicron is intrinsically less "nasty".

The report from Ferguson's team at Imperial is here :
https://www.imperial.ac.uk/media/imperi ... ort-49.pdf
The distribution of Omicron by age, region and ethnicity currently differs markedly from Delta, with 18–29-year-olds, residents in the London region, and those of African ethnicity having significantly higher rates of infection with Omicron relative to Delta. Hospitalisation and asymptomatic infection indicators were not significantly associated with Omicron infection, suggesting at most limited changes in severity compared with Delta...

We found a significant increased risk of an Omicron case compared to Delta for those with vaccine status AZ 2+weeks post-dose 2 (PD2) , Pfizer 2+w PD2, AZ 2+w post-dose 3 (PD3) and PF 2+w PD3 vaccine states with hazard ratios of 1.86 (95%CI: 1.67-2.08), 2.68 (95%CI: 2.54-2.83), 4.32 (95%CI: 3.84-4.85) and 4.07 (95%CI: 3.66-4.51), respectively...

Omicron was associated with a 5.41 (95% CI: 4.87-6.00) fold higher risk of reinfection compared with Delta. This suggests relatively low remaining levels of immunity from prior infection

This has obviously fed into the UKHSA risk assessment :
There are insufficient data to fully assess severity, which is expected in the early period of emergence of a new variant. However, on the data available in the UK, there is no signal that supports a difference in the intrinsic virulence of the Omicron virus compared to Delta.

UKHSA technical briefing on variants :
https://assets.publishing.service.gov.u ... ing_32.pdf
18% (141) of Omicron index cases gave rise to a secondary household case, compared to 10% (11,593) of Delta index cases.

UKHSA vaccine survey :
https://assets.publishing.service.gov.u ... eek-50.pdf
2 doses of vaccine are between 65 and 95% effective at preventing symptomatic disease with COVID-19 with the Delta variant, with higher levels of protection against severe disease including hospitalisation and death. There is some evidence of waning of protection against infection and symptomatic disease over time, though protection against severe disease remains high in most groups at least 5 months after the second dose...

Based on antibody testing of blood donors, 98.4% of the adult population now have antibodies to COVID-19 from either infection or vaccination compared to 22.7% that have antibodies from infection alone...

After 2 doses, observed vaccine effectiveness against symptomatic disease with the Delta variant reaches approximately 65 to 70% with AstraZeneca Vaxzevria and 80 to 95% with Pfizer-BioNTech Comirnaty and Moderna Spikevax...

after a booster dose of the Pfizer-BioNTech vaccine, vaccine effectiveness increases to 93.8% among those who received the AstraZeneca vaccine as their primary course and 94.3% among those who received the Pfizer-BioNtech vaccine as their primary course...

Effectiveness against hospitalisation of over 90% is also observed with the Delta variant with all 3 vaccines...after a booster dose of the Pfizer-BioNTech vaccine, vaccine effectiveness against hospitalisation increases to 98.8%...

vaccine effectiveness against symptomatic disease with the Omicron variant is significantly lower than compared to the Delta variant...2 weeks after a Pfizer booster dose, vaccine effectiveness increased to around 71% among those who received AstraZeneca as the primary course and around 76% among those who received Pfizer as the primary course

ie GET YOUR BOOSTER!

[Julian]

But Sir, SIR, to me as a layman, a 30% "reduction in severity" could mean the difference between all of the 'severe' patients with Delta needing hospital treatment and none of the Omicron.

I.e. loads of Delta patients get so sick as to cross the threshold for needing hospital treatment, but perhaps none of the Omicron patients whilst getting very sick, will get quite as sick and therefore hopefully not need hospital admission.

This is presumably flawed thinking, but I bet it is how the bod on that apocryphal bus thinks, and possibly quite a few journalists and politicians too.

This is a very important point, and I'm not sure which is correct. If you shift the entire bell curve 30% to the left, then the (let's say) +3 sigma that end up very ill or worse may be massively reduced. However, if you just multiply the bell curve by 0.7, then SD's point stands.

Indeed. Terms like "30% less severe" are bandied about by the media and then of course find their way into general conversations but severity is far too complicated a concept to distil into a single number. I confess that when I heard the "30% less severe" claims I assumed it was 30% fewer hospitalisations vs Delta which should be relatively easy to measure once enough Omicron-confirmed admissions have been seen (assuming that admission criteria remain constant or that any differences have been adequately accounted for) but even then the 30% figure could be hiding other important factors such as Omicron hospital admissions having shorter or longer average stays in hospital compared to Delta admissions, or once in hospital a differing percentage of those Omicron admissions ultimately ending up in ICU vs Delta, and I'm sure a lot of other stuff too.

- Julian

[Wizard]

You said you would give it to a vaccinated person with 1% chance of success over an unvaccinated person with 99% chance; you would give the one remaining spot to the case with 99 less chance of success
- and yet you seem to imply foolish decisions should be avoided??


-sd

As I said, I consider your view erroneous as it optimises the short term versus the long term. Despite thinking you are wrong I will resist name calling and rolling eyes, maybe you should try the same. People can take different views on complex subjects, some people can see that, some can't.

I'm not name calling I'm pointing out that a strategy to deny treatment to people BECAUSE they have a different opinion to yourself is wasteful, unethical, misanthropic and spiteful

It would play in to, or confirm, the accusations of segregation leveled by those of an anti vax bent
It's impractical and counter productive; it's not good practice

If you want to encourage folk to get vaccinated it would be advisable to inform them that the decision might eventually factor in to the decision to treat them should resources become over worked
- that would have the same net effect without the malice and waste of resources

As I said before you are entitled to your view but don't be surprised if when you air it, the perception of it, and its failings are addressed

And the wee picture things are just a fun shorthand
-sd

You continue to position your OPINION as fact, I am not name calling, but some may consider such an approach as arrogant and closed minded.

As I have said, I consider actions have consequences and those consequences showed be born, as far as possible, by those making the decision. That is just a matter both efficiency and morality. Again, I am not name calling, but the approach you advocate looks to many as one that results in the avoidable death of some due to the actions of others. An approach that could ultimately change that is the socially responsible thing to do, an approach such as the one you prefer is to the detriment of society and therefore the very definition of being misanthropic.

All IMHO.