My next appt with DrJ

xlyzd: I looked at Table 1 and saw the vaccinated faring better (as expected), especially from 2 wks after 2nd shot.. from there it's 0.3% of vaccinated who were infected vs. 2.4% of unvaccinated who were infected (difference is 8 fold). There's only a month or so of data so with more time those gaps should widen dramatically. The level of spread in the outside community would factor in as well.

Edit: sorry my 2.4% number is wrong!! It does seem to be much closer as you've said, but the sample size is very small as Quin points out below.

In the last paragraph the authors conclude that the effects of vaccination are benefiting both the vaccinated and the unvaccinated, as vaccine immunity helps outbreaks to peter out before spreading through entire nursing homes.

Behavioral practices (masking etc) are also contributing, but data from Table S2 aims to single out the effect of the vaccination campaigns.. it shows the effect in counties with low, moderate, and high rates of infection. From the time of the vaccine clinics you can see the incidence rate among both groups (vax and no vax) drop significantly every 2 weeks. The drops are most significant in counties where infection rates were high.

Post Edited (potsnpans) : 5/29/2021 10:47:19 AM (GMT-6)

(I have tried to cover all the points raised in order to clarify the study and my thoughts about it. It is not my intent to instill fear or doubt in those who have already been vaccinated.)
The sample size was small?
280 nursing homes across 21 states?
I thought this a much better cross section than using the data from one hospital or one city. Also, it is more likely that the unvaccinated were exposed to the breakthroughs since they were living in the same population. If using the general population, the argument could be made that unvaccinated people had fewer cases because they stayed at home and were never exposed.
I am not sure where the 0.3% comes from. There were fewer unvaccinated to compare to the vaccinated (I recall some 3000+ compared to 18000+). That is why I said to use the percentage next to numbers for easier comparison. The percentage represents the percent of that particular population (for instance 882 of 1 shot residents were breakthroughs from a population of 18,000+ or 4.5% of the total population of vaccinated residents compared to 173 unvaccinated cases from a population of 3000+ or 4.3% of the total population of unvaccinated residents.) Studies can be difficult to understand. It helps to use the Tables and Supplements presented. This one was actually very clear compared to some that are nearly impossible to decipher.
In addition the study was published by the New England Journal of Medicine, one of the top five most respected medical journals. I would be skeptical of the numbers otherwise. I really am interested in the truth.
There are a few studies that are in progress but not yet published, making comparisons. I recall one being in England that is comparing the likelihood of unvaccinated family members being infected by a vaccinated breakthrough case. Those numbers were also lower than I would expect, but more astounding is that there were 24,000 households in the study. 24,000 breakthrough cases in England (pop: 56,000,000) and the CDC has reported only 9000+ for the entire United States (pop: 328,000,000). I would have to check the exact percentage of people vaccinated in each country at the time the study was conducted to verify the discrepancy and I would if I were trying to persuade anyone that we (in the US, anyway) are not being given the whole truth.
I am not trying to persuade anyone of anything. I have read comments here from people wondering if they should be vaccinated and their only information seems to be what the CDC and Dr Fauci are saying; that unvaccinated people are taking a dangerous risk, inferring that there will be huge numbers of unvaccinated covid cases compared to the "tiny" or "rare" number of breakthrough cases. Maybe the people who are not vaccinated do not have to be as worried as they have been told they should be. I prefer data to mainstream opinion and now that the CDC has announced that they will no longer be reporting breakthrough cases (unless hospitalized or dead) there is no way to know what is going on.
The CDC has been very slow to acknowledge Lyme disease after years of misleading information. I do not know how to suddenly begin trusting their information. I would have to erase my brain from the time I first tested positive for Lyme (13 years after an erythema migrans rash that an RN said was a spider bite) and began reading everything about the disease. The CDC's information then was very different from what Lyme sufferers were saying. At one time it was 100% denied that Lyme symptoms could continue after a few weeks of antibiotics. Today the CDC has a sub-section titled "Post Treatment Lyme Disease Syndrome".
Back to the NEJM study. Not only are the numbers similar but Table 1 shows that 0-14 days after 1 shot, 4.5% of residents were breakthrough cases compared to only 4.3 regular cases of covid in the unvaccinated residents.
(According to what the CDC and Fauci are saying I would have expected the unvaccinated covid cases to be at least 10 to one or 50 to one of the vaccinated breakthroughs, even with just one shot since that gives some protection. I would never expect that there could be less cases in unvaccinated people. Never.)
The study concludes: "Our observation of a reduced incidence of infection among unvaccinated residents suggests that robust vaccine coverage among residents and staff, together with the continued use of face masks and other infection-control measures, is likely to afford protection for small numbers of unvaccinated residents in congregate settings." Of note is the inclusion of the robust coverage of the staff, not only residents, although in the previous paragraph they state: "We observed inconsistent patterns in the incidence of infection among residents relative to rates of vaccination among staff members (Table S3)" and if you take the time to review Table S3, you will see that in some cases the percentage of covid cases in the vaccinated and unvaccinated residents was either the same or higher when compared to High Staff Vaccination and the opposite with Low Staff Vaccination.
For instance only 1.1% of fully vaccinated (2 dose) patients were breakthroughs in homes with Low Staff Vaccination compared to 1.2% of fully vaccinated breakthroughs in homes with High Staff Vaccination.
Should the doctors conducting the study have stated this more clearly than reporting "inconsistent patterns"? I wonder if the NEJM would have published a study that concluded that staff vaccinations did not make much of a difference in whether or not the residents acquired infection?

Post Edited (xlyzd) : 5/29/2021 3:04:03 PM (GMT-6)

xlyzd: If you're looking for real world efficacy rates (vax vs no vax) there have been many studies published recently. The NEJM report was published because it can demonstrate with confidence the effect of mass vaccinations in congregate settings/nursing homes.

With that said, in Table 1 I was looking at >14 days after second dose where we have 38 cases or 0.3% in vax group. Then, assuming that >42 days after first vaccination clinic is the same length of time for the unvaccinated group, there I see 12 cases which is also 0.3%.

The 12 is out of 3,732 and I called 3,732 a small sample size.. but I understand that the question remains: why don't we see a percentage more indicative of the 90% effectiveness that is typically seen elsewhere? Or in other words, why isn't the number in the unvaccinated group around 3% as opposed to 0.3%?

First I would say that vaccine efficacy is lower in the higher age groups.. and I'd also expect efficacy to drop a little further considering the overall health of nursing home residents. Maybe we should be expecting around 1% as opposed to 0.3%.

I also think an important factor is that the unvaccinated group benefits by living in congregate settings where most others are now vaccinated. This benefit of "herd immunity" is shown to have been achieved in Table S2 and I think it influences the (vax vs no vax) efficacy numbers.

Beyond that I honestly don't know. Maybe there's another explanation that you and I are missing, or maybe it's variance.

xlyzd: you're right! I should have been more careful with my words as there doesn't seem to be "many" real world studies that have made it to publication yet. Here are a couple that did:

https://www.thelancet.com/journals/lancet/article/piis0140-6736(21)00947-8/fulltext

https://jamanetwork.com/journals/jama/fullarticle/2779853

Once in a while I like to check out the /r/COVID19 subreddit. It seems every few days a new real world study posted there but yeah, not "many" have been published.

Other studies that I've seen were released either by the CDC or by health agencies outside of the US. Maybe it's incorrect to say that these were "published" but I think they're very important nonetheless.

RainyCloud said...
Girlie have you had your phone appointment yet? If so, how did it go?
Hope you're doing well!

Not yet - it’s coming up in June - end of June.

I am going to do another “round” of my protocol - prob start Monday

RainyCloud said...
Ah got it, well hope you keep us updated!
Good luck on your protocol!

I will def update after my appt.

I always get sidetracked during the appt and afterwards realize I didn’t get all my questions answered…. even tho they’re written down and in front of me!