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Correcting Berenson's optimally wrong take on vaccination and hospitalization risk from JAMA study

Updated: Dec 31, 2021

Alex Berenson is again misinterpreting/misrepresenting scientific data, this time saying this JAMA study shows vaccines “don’t stop Covid hospitalizations and deaths” in a recent substack post


He is talking about this very nice cohort study published this week in JAMA Internal Medicine from the N3C network looking at ~665k patients given at least one dose of SARS-CoV-2 vaccine between December 2020 and September 2021 based on electronic medical record (EMR) data from a large health system network.


The focus of the study was effect of immunocompromise on breakthrough infection rate and severity. They found that indeed immunocompromise led to higher rate of breakthrough infection. Here is the key figure showing that the rate of breakthrough infections was higher in those with various immune dysfunction conditions:



They also also looked at proportion of COVID-19 patients that were outpatient, inpatient, and severe and found significantly higher proportion of immunocompromised were inpatient or severe. You can see the definitions of severity in the paper. They did this comparison both for the 17,262 breakthrough infections (1837 in immunocompromised) among the 665k vaccinated, as well as for 2,737,963 prevaccination COVID-19 cases (71,220 in immunocompromised) in the N3C network.


Here is a plot of the proportion of hospitalizations that were outpatient/inpatient/severe in each vaccination/immunocompromise subgroup:


The data corresponding to these plots are given in the supplementary table 4:

The intended purpose of this table is to show that in both vaccinated and unvaccinated COVID-19 patients, immunocompromised had 1.5x higher risk of admission (inpatient, 20.7% vs. 14.8%, and 35.1% vs. 21.1%, respectively) and 3.0x higher risk of severe disease (2.1% vs. 0.7%, and 6.0% vs. 1.9%, respectively).


But Berenson reads something else into this table. He reads into this table that the vaccines don’t “keep hospitals from being overrun” and on the basis of this, he produces his headlines "Vaccines don't stop COVID hospitalizations or deaths"


I'm not sure how he concludes that here. This table doesn’t tell you anything about the relative rate of hospitalized infections between vaccinated and unvaccinated.


It only tells you the relative distribution of outpatient/inpatient/severe in COVID-19 patients who were unvaccinated (revaccinated infections) or vaccinated (breakthrough infections).


And looking at the numbers, we see that vaccinated COVID-19 patients are 1.5-1.75x less likely than unvaccinated COVID-19 patients to require hospital admission (inpatient, 14.8% vs. 21.1% for immunocompromised, and 20.7% vs. 35.1% for non-immunocompromised ) and 2.7-3.0x less likely to have severe disease (0.7% vs. 1.9% for immunocompromised, and 2.1% vs. 6.0% for non-immunocompromised).


Note that these ratios are the same magnitude as seen for immunocompromised vs. non-immunocompromised:

  • Immunocompromised COVID-19 patients had a 1.5x higher risk of admission and 3.0x higher risk of severe disease than non-immunocompromised COVID-19 patients.

  • Unvaccinated COVID-19 patients had ~1.5x higher risk of admission and ~3.0x higher risk of severe disease than vaccinated COVID-19 patients.

We have to be careful to not overinterpret the comparison of pre-vaccinated vs. post-vaccinated infections, since this was not a primary comparison of the study and the pre-vaccination infections tended to occur during an earlier time period than the post-vaccination infections.


However, for the sake of argument in showing how far off Berenson's take on these data are, if these results held up causally, this would suggest the benefit of vaccination in reducing the risk of a COVID-19 patient requiring admission or having severe illness is of the same order of magnitude as curing someone's medical condition leading to immune dysfunction (if that were possible). It seems to me that these data suggest that the vaccines are doing something clinically beneficial. And this doesn't even account for the fact that a much lower proportion of post-vaccination infections end up as "patients" in a hospital at all. The data in this paper condition on hospitalization, i.e. based on the fact they come from a hospital network, the data include only patients, i.e. individuals that in fact DO end up in the hospital.

if we wanted to calculated the vaccine effectiveness vs severe disease, we’d have to compare, between vaccinated and unvaccinated, the probability of a severe hospitalized infection, which would be obtained by multiplying together 3 components:


Pr(severe hospitalized infection) = Pr(infection) x Pr(hospitalization | infection) x Pr(severe disease | hospitalized infection)


This paper only deals with the 3rd component. In numerous studies the vaccines also show some benefit for the first two components as well, so that combining all 3 components the vaccines demonstrate 75-90% effectiveness in protecting against severe infections.


So once again, Alex Berenson's take is about as wrong as wrong can be. This very nice paper that demonstrates immunocompromised individuals have higher risk of breakthrough infections, and these infections tend to be more severe. Incidentally, it also suggests the risk of a COVID-19 patient requiring admission or having severe illness is substantially lower in vaccinated than unvaccinated patients.

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Per 100k in Scotland it looks as though its a pandemic of the vaccinated. Would be great to see data analyzed by an expert such as Jeff Morris. According to the article by Blaze, shows a trend of “negative efficacy” of Covid-19 vaccinations. This is not accurate, I hope. But it sure can look convincing.

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Yes, I understand; that's why I wrote that this explanation is mathematically incorrect--it relates to inaccuracy in data for an individual, rather than a population. I was trying to illustrate the general idea of uncertainty based on limited data. As you often point out, the level of certainty of data is an important factor that most people overlook.

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Peter J. Yim
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23 ene 2022

There is a slightly bifurcated argument for COViD-19 vaccination these days: (a) COVID-19 vaccination does not prevent infection but it does prevent hospitalization and death (b) Get the booster because the COVID-19 vaccination wanes in its ability to prevent infection.


I state that because there is a recent health dept. study that "seems" to show that those with "partial vaccination" - ie without booster shot - have roughly equivalent hospitalization/mortality outcomes as compared with the "fully vaccinated" - those with booster shot.


https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/421-010-CasesInNotFullyVaccinated.pdf


Alternatively - the apparent hospitalization/mortality outcome benefit may be just an artifact of poor classification of the vaccination status of the subjects - if vaccination record could not be found subjects are classified as unvaccinated.

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But my point remains that Covid infection is a major cause of death for young adults


Agree, 100%. Actually it could be > 100%. We briefly discussed the OD increase on another thread - ~ 6.2k/yr (14.7*421) in the 35-44 age group which doesn't come close to explaining all the excess non-covid mortality. I'm open to the possiblilty that most of the excess deaths are due to Covid.


Everyone says they are over-counting to scare people. Perhaps they're undercounting so as not to create undue panic. Look at NYC during the initial wave which was fast and furious. I seriously doubt many of the massive excess deaths were due to ODs, suicides, delayed cancer screenings, etc. The time fra…



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GF
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I would like to thank Professor Morris and all those who participate in this blog, because you manage to keep the right tones and make the discussion more productive. I live in Italy, I am a jurist and I deal with administrative law. In my country, the level of public debate has never been so low. The televisions only let folkloristic personalities present the reasons for doubt about vaccines. There are "philosophers" who claim, literally, that the unvaccinated are "idiots" and "criminals" who should be arrested by the carabinieri. Much of this climate is due to the government, which has put all its eggs in the vaccine basket and, when it saw that they were not as effective as hoped…


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Jeffrey Morris
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Thank you so much for your thoughtful comments. What you are describing sounds a lot like what is going on in the USA except even more extreme mandates. So sad and destructive for our societal fabric as you duly note. As you mentioned, I have pointed out positions in the official government scientific leaders that have not followed the data as well — you’d probably like my Texas A&M seminar linked below — and I share your passion to find the center between misinformed denial on one side and over aggressive policy on issues not yet scientifically established on the other side I try to walk the line — but my focus lately has been on a large group coalescing together again…

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Jeffrey Morris,

We are in a time of extreme uncertainty with authorities on occasion blatantly lying (Masks don’t work for general public, then they do: Lab leak theory total rubbish, conspiracy theory – then it could well be true: the vaccines will stop the virus in its tracks – well we all know what’s actually happening there). This is a time when we most of all need open debate, discussion, and research where all sides and opinions will be heard and considered. Instead we have unprecedented campaigns of censorship where some of the most qualified, brilliant, and highly published scientists in the very areas of concern are being shut down from social and mainstream (and sometimes scientific) media (e.g., Robert…


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My Dad was a biochemist (PhD) who spent the majority of his career in what pharmaceutical companies call "regulatory affairs" -- a lot of going back and forth between his company and the FDA over new drug applications and related issues. So he had a front-row view of the good and the not-so-good on both sides of the process.


When it came to drug safety, he said many times to us in his family, "You can never prove that a drug is safe: you can only show that it is not safe for certain people in certain situations." To balance off that kind of inherent risk, drugs are tested for effectiveness -- whether they (hopefully) provide important benefits. Covid afte…


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Richard Noakes
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01 ene 2022

As long as people keep following the vaccine protocol there never will be an end to this "pandemic" : https://ambassadorlove.wordpress.com/2021/12/08/covid-19-patent-horrors/

The ONLY way to do that is with my free cure - kill the virus BEFORE it becomes anything else:

Covid Crusher: Mix one heaped teaspoon of Iodine table salt in a mug of warm clean water, cup a hand and sniff or snort the entire mugful up your nose, spitting out anything which comes down into your mouth. If sore, then you have a virus, so continue morning noon and night, or more often if you want, until the soreness goes away (2-3 minutes) then blow out your nose and flush away, washing your hands afterwards, until when you…


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