This week Fred and I discuss the assessment of risk in the context of vaccines and their effectiveness at combatting the COVID19 disease and the challenge of putting risk in perspective.
The numbers you hear don’t tell the story and even when you think you understand the data, you may not as the inputs and environment keeps changing both improving things but also making things worse.
We talk vaccine effectiveness, breakthrough infections, risk and relative risk and why all of this is so important as we watch variants emerge
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Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with accountable health here helping employers look at their health improvement programs for their employees, and also working on COVID. So Nick, you and I have been noodling a bunch of numbers, looking at a lot of things associated with risk, and what does it mean, etc? Why don’t you give us some insights on what you’ve been finding and what you’re thinking about?
Nick van Terheyden
Yeah, so I, I love math. I’m one of those weird people, I actually did what was called double maths at school, which probably means nothing in this country. But I was Pure and Applied and stats. And I still love it, I still enjoy numbers, you know, give you some certainty, or at least they try to. And that’s the problem. I think. We’re hearing an awful lot about a term that I’ve heard very frequently in the last week or so called breakthrough infections. What does that mean? So it means somebody that’s been vaccinated, but still gets infected. And obviously, that’s what gives everybody pause, and you go, Well, wait a second, if I got vaccinated, I still got infected. What was the point? Right? Well, first of all, we have to look at the total numbers. So what does that mean? And who could that happen to? And it’s actually surprisingly larger than most people think. Because it just go back to the original data, the first studies that were published said, 95%, effective. So quick calculation in the head, this is what I can do without a calculator. 100 minus 95 plus 5% of people can and potentially still do, but not necessarily. So this is all probability, which makes it much, much harder, can get infected. So if you take a million people, and that 5%, so that’s the lowest end of all the best of the effectiveness, roughly speaking, that’s 50,000 people that can get infected with COVID-19. That sounds like a lot, right? For
Fred Goldstein
sure. Sure does, when but when you think about that, that’s 50,000 people that are getting infected, potentially now in that when they studied it, which was when nobody was vaccinated. So you now have a different environment, you have people reacting differently, their behavioral change and things. So that changes the numbers too. And people need to begin to factor that in as they think about their vaccines, right?
Nick van Terheyden
Well, I’m you see, that’s exactly the point, you bring up exactly the challenge that we have. So that was then. And we had no, you know, no vaccines around all of those things. Now we do. So that 5% is going to be if anything, much less, because there’s less opportunity for the virus to be picked up by somebody that has a vaccination, because it increases your resistance, and I keep going back to the flu, if you get the flu vaccine, you’re not guaranteed not to get flu, you’re just less likely. And if you do get it, and here’s what’s important, you get it much less severely. I know I’ve had that experience. And I get my flu vaccine every year. So what what are the numbers say there? Well, again, one of the numbers I’ve heard is 7%, which sounds like a lot, maybe it doesn’t to some people, but seven out of 100 people, you know, multiplies up. That’s a lot of folks. And when you think about that, as a um, what is the 7%? That’s people that get severe disease, which everybody goes and looks at and sees the intensive care units and challenges and so forth. You know, well, that’s a lot of people that are potentially getting severe disease despite getting the vaccine. But it’s 7% of the 5%, which is already less. So what number we are, while we’re at point 000 5% or about 500 of that group that got COVID-19. So all the others didn’t get severe disease. They just had a mild version, or maybe were asymptomatic. But there was a small subset out of your million. That’s now reducing things.
Fred Goldstein
Yeah, so that actually reduced it to what was the statistic similar to what you told
Nick van Terheyden
us? So I tried to look around for something proportional. And roughly speaking, please don’t hold me to it. Any statisticians out there. You know, these are all rough numbers. It’s about the same risk of getting severe COVID post vaccine as it is a dying in a plane or airplane accident.
Fred Goldstein
Yep. So let’s also add in another compounding factor, Nick, which is you will recognize this. So we’ve got people who are vaccinated. So now as you’re out in the community, Do you have less likelihood of risk of contracting the disease from somebody else? But at the same time, we’re now seeing these introductions of variants that we don’t know fully yet how well the vaccines may work for some of the newer ones, but they’re figuring out so far pretty good. Some are as good as before, some are not quite as good in terms of the new variant, but still effective. So that then if we don’t get the numbers up high enough, and we let this virus continue to mutate like it will,
we may get a variant that changes the game again, right.
Nick van Terheyden
I think that’s exactly right. And one of the reasons that we are pushing so hard. And you know, this point I heard this morning, that the whole of the us think about this, here we are, April, the 19, the whole of the United States above the age of 16. So we’ve got some additional studies and trials going on, is now eligible and vaccine is available for them throughout the United States. That’s fantastic news. But what we need is aligned bags out the door, all socially distinct, of course, for people lining up to get their vaccination because exactly the point for it, we have to reduce the overall spread. Because once that declines, what everybody wants out of this, I think, is to get back to some level of normality. And let’s call normality not having to put a mask on all the time and all these other limitations, we’re still going to have some of that in certain instances. But you need that disease to disappear, the pool of it the available risk, to dissipate. And here’s a term we haven’t talked about in a while. But everybody should know just go back to the old video, you’ll learn all about the R naught has to go below the number one, so we’re now declining, and the lower it is, the better. And we see a decline.
Fred Goldstein
Yeah, and I believe they are not in Israel right now is well below one. And I think I may have seen point two as the last one, which is exactly where we want to get to, and we can do it, if we do the right things. Today, as you said, on the 19th, what 31,670,846 people that have had COVID, and we’ve had 567,216 deaths, it’s not a small number of deaths, folks, that’s a ton of people, even when compared to other diseases in a normal year. And we need to remember that and that’s why it’s so important, as you point out Nick to know these numbers, understand them well enough to be able to make the right decisions. And that is looking at these vaccines as the better solution to solving this problem. And that This is Fred Oh, go ahead.
Nick van Terheyden
I was just gonna say 100% agree, Fred. And, you know, even you and I, you, you, you have deep understanding expertise in this area, I’m a superficial sort of pass on this. I hope we’ve explained it well enough to try and at least appreciate that you can’t just take the media generated numbers at face value and have to think about it as risk in the big scheme of things. You get in your car and drive to the airport and then say I’m not willing to get on the airplane because I’m frightened of dying, and I’m not dissipating the issue of fear of flying. But from a risk perspective, that decision doesn’t make sense. And we’re doing the same thing with vaccines.
Fred Goldstein
Absolutely. Well, thanks for introducing us to this topic, Nick. And this is Fred goes from mechanical health. If you have any questions or would like to reach out to us, please do so. And
Nick van Terheyden
back to you, Nick. And this is Dalton Aegon the incrementalist here with incremental insights for better business, better health.
