This week Fred and I discuss the rising number of variants and the results of a study conducted by Clalit Health Services and Tel Aviv University reporting on real-world data that shows less effectiveness of the Pfizer vaccine against the South African variant. We review that that means and also discuss the reports of side effects from Astrazeneca of Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination (see also Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination), and the challenge we have of assessing risk vs reward
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Raw Transcript
Nick van Terheyden
Hi, this is not the neck 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 work with their employees to improve their health outcomes and look at overall cost reductions for the employee health improvement programs. So again, Nick, this week, we’re seeing a lot of stuff about variants. Perhaps you could dive into that a bit for us.
Nick van Terheyden
Yeah, so it’s complicated. Some people spend their entire careers focused on this, in fact, somebody that you and I both know, reasonably well. So trying to sort of summarize this for the audience to get the highlights are important. So first of all, viruses, this is what they do they change, they’re not very good at copying. It’s like they can’t see the original copy very well, when they write down the new one, these variants emerge, lots of them, in fact, hundreds in this particular case, but there are some that emerge that are are of significance, we hear about them be 117, which is known as the UK variant, but shouldn’t be because we try not to label things based on locations because that sort of creates a problem in the future, which shouldn’t be the case. It’s not the you know, it was the UK that created it as an example. So Israel had, has essentially progress, the furthest I think down the path of vaccination. So they have the largest number of people vaccinated. And in their case, they have the largest number with Pfizer. I think they have potentially some others possibly Madonna don’t know about Johnson and Johnson, they have a large data set their own about 60%. You know, go go Israel. The news out of there is a little bit concerning because what I’ve seen is with people that are vaccinated, the now tracking to see whether they get infected and there seems to be an increased incidence of an infection. With the South African variant, again, inappropriately named, but everybody gets it. So it’s easier to sort of understand. And as a result, more people who have been vaccinated can still get infected. And I know for some folks, they’re going to say, Wait, I’ve been vaccinated, unprotected, doesn’t work that way. Just think about your flu shot. Sometimes you’ve got that flu shot, you’ve still got flu, that’s the way vaccination works. It’s not a wall where bang, you’re, you’re prevented from getting disease. So this, this is what’s happening with the South African variant. But what I would emphasize is, even though that’s the case, the value of the vaccination is still extraordinarily high, because it is still preventing severe disease and death now, well, it prevented 100%, I don’t think we can say with certainty, but it’s really close. I’m not aware of any cases of anybody that’s been vaccinated, that subsequently might get the disease or one of the variants, then suffering from severe disease and actually dying.
Fred Goldstein
Yeah, it’s really an interesting issue about the variants. And the Israel obviously gives us a bunch of data about this. So you know, as I as I look at it, and say to myself, we’ve got this situation now, where if the viruses out there in the population, and it’s just spreading, it’ll do what you talk about, it’ll mutate, it’ll create these variants. And the more virus we have out there, and people, the more opportunities obviously, for that to occur. So the Israel study was interesting, because what they found is there are breakthroughs that are they they’re calling these folks, you get a breakthrough of infection, as you talk about it’s low, lower risk. But the number of people with breakthroughs, when they looked at it were much higher without South African variant, which means they were expecting it to be about one case in their population. And they found eight times that amount, if I believe, right, which shows that it is able to those mutations allow it to infect a little bit better than the other variants, and so potentially breakthrough for the vaccine, which points to this whole population health approach we’ve been trying to deal with, and get the countries to follow, which is keep your non pharmaceutical interventions going, where are those masks, you know, go ahead and keep your social distancing. We know it’s tough, it’s really a pain. But now is really not the time to loosen up. And we’re seeing these outbreaks. Now we see what’s happening in Michigan, with the B 117 variants spreading, and we know we’ve got this South African variant in the country, the question is, it’s a race, can we keep the variants down long enough to get enough people vaccinated that very few people get infected, so we can better control the virus? So it’s really fascinating to watch. And I know, Nick, you’ve also been looking at Madonna and the AstraZeneca vaccine. So what’s happening there?
Nick van Terheyden
Yeah, so again, those are the three primary ones for our country. I know there are, you know, multiple others, I think there’s a total of 11 could be 13. don’t recall, vaccines in use around the world, we’re sort of focused on the three that we have the most information about Madonna’s the other one, that’s the messenger RNA virus, virus platform or vaccine platform. And it’s been, you know, relatively widely used, but it’s showing or apparently showing slightly less effectiveness over time. And this is a study of the blood. So when you take the blood, you look at the antibody and the antibodies declined. Now, to be clear, that does not necessarily mean you are no longer resistant or you’re not getting the value, we still know that these are highly valuable. We may need booster shots. And you know, back to the Pfizer experience in Israel, we heard from Pfizer that they said their vaccine was highly effective against the South African variant. And now we’re hearing it’s not well, that’s the difference between laboratory experience and real world experience. And in the laboratory, they tested look for that immunity affecting the test you and showed it, but in the real world, it didn’t. So that’s part of the complexity that we’re challenged with. Now on AstraZeneca, lots of talk about this, with you know, some countries suspending the use. And based on the data, we know that there is a side effect of the vaccine that is essentially creating some clotting problems. So what we have is one in 250,000, based on the current data, I don’t know if people think that’s high or low, but essentially that’s the rate. But we also know what that vaccine does in terms of preventing death. Let’s be clear, and if you do the calculation of the case mortality rate at about 1% We essentially fool the risk of 80 or so people suffering from this side effect. We’re saving 130,000 lives. These are the calculations that I know you make all the time in Population Health
Fred Goldstein
yet, and I’m so glad you brought that up. And even the other issue, and I’m gonna steal a little bit of your thunder, Nick, because you’re always good at this. You talk about clickbait. And these come out his headlines, you know, 80 people or breakthrough, you know, in Israel, but when you or even now the numbers, but when you look at it, and you say, what is the relative risk? What are the real numbers? It’s small? Yes, we’ve had breakthroughs of 1000s of people playing United States, but we’ve had millions of people vaccinated. And so the overall success, it would be like saying, Well, you know, we had x 1000s of people die in car accidents. So we should just get rid of cars. But no, we had millions and millions of people do miles and miles and be productive and move materials and do their work. And that’s how you have to look at these things, and really understand deeper in the energy point out so well, Nick, it is about ratios,
Nick van Terheyden
nailed it. Fred, can’t think of a better example, to amplify that point. We are terrible at assessing risk. And essentially, we get in the car every day, and we drive to the airport and then worry about getting on the plane, the plane might crash. But in fact that drive to the airport is more risky based on the stats that we know out. But we’re more comfortable with that. It’s the same with these vaccines and vaccine administration, not diminishing the issue that for some somebody that has that severe side effect. That’s a terrible thing. And it’s something that we want to avoid, but we have to assess risk and make appropriate decisions all the time.
Fred Goldstein
Absolutely. Once again, another fantastic week. Nick, pleasure to join you. This is Fred Goldstein with accountable health. Thanks so much for listening. And please reach out to us if you’d like some more information or help with your employee programs.
Nick van Terheyden
And this is Dr. Nick, I’m the incrementalist here with incremental insights for better business, better health.
