Great analysis of what's important on this. A focused discussion of/debate on the covid vaccines would be very useful. Your points on finding areas of agreement and asking how do we know that on various aspects are spot on.
"Many observational studies show that, among vaccinated people, the risk of being hospitalized for (or with) Covid is lower than among unvaccinated people. But the question is whether there is actual causation or mere correlation."
Excellent point!
These comparisons are definitely a bit challenging, since it isn't even a simple "unvaccinated versus vaccinated" comparison? An "unvaccinated" person might or might not have had a prior COVID infection (even if by a different variant), which confers some immunity, perhaps in some instances considerable (on par with or even higher than vaccination(s)). As well, a "vaccinated" person, someone who had a prior vaccination or vaccination series, still isn't a monolithic thing. The number of shots they received, including whether they had a second or third (or even fourth) shot as a booster, which manufacturer's vaccine(s) were used (e.g. J&J versus one of the mRNA vaccines versus the newer Novavax, recognizing that one can mix and match vaccines with some boosters), the time elapsed since the most recent shot, and the differences between the variant with which they're infected and the one for which their vaccine(s) were designed may all play a role.
Then one needs to factor in various risk factors, such as age (older people are significantly more at risk of hospitalization from COVID, as well as severe outcomes or death) and certain comorbidities, to further get to more apples-to-apples comparisons.
Although it doesn't dive much into that full set of subtleties, here's one recent comparison that might be interesting, in a report from the Washington State Department of Health for (basically) the month of June 2023:
"... some people are more risk averse than others and will both get vaccinated and avoid crowded areas. If they don't get hospitalized, was it because of the vaccine or their cautious behavior?"
The table on page 6 of that report notes that, across age groups and even in younger age groups – presumably much less likely than elderly people to be cautious in their day-to-day lives to avoid COVID, although that's just an unverified assumption on my part – hospitalization rates were considerably higher for people who were unvaccinated, as contrasted with people "who received at least one booster dose."
As well, the charts on pages 7-on suggest that even those who "completed primary series" of vaccination had hospitalization rates not that much worse than those who received a booster, and considerably better than those who were unvaccinated.
It's still entirely possible that, say, even among 12-34 year old people, those who were sufficiently conscientious (and trusting of healthcare providers) to receive at least a full primary series or even a booster might also have attributes that make them less likely to be hospitalized with COVID. Perhaps on balance they're wealthier, or more health-conscious, or more cautious in their risk-taking generally in life, or? (But I'm thinking this might at least help us get closer to possible answers?)
Excellent, very helpful analysis, I highlighted
„I am smart enough to know who’s right, but you aren't, so I need to protect you from conspiracy theorists“,
for re-use.
Thank you Christoph! To be fair, Tyler never says that explicitly, but that’s definitely the impression I got after reading and re-reading his op-ed.
I am aware of that, Tian, and I had exactly the same impression, and you just summed it up perfectly.
Great analysis of what's important on this. A focused discussion of/debate on the covid vaccines would be very useful. Your points on finding areas of agreement and asking how do we know that on various aspects are spot on.
Thank you Bobby!
"Many observational studies show that, among vaccinated people, the risk of being hospitalized for (or with) Covid is lower than among unvaccinated people. But the question is whether there is actual causation or mere correlation."
Excellent point!
These comparisons are definitely a bit challenging, since it isn't even a simple "unvaccinated versus vaccinated" comparison? An "unvaccinated" person might or might not have had a prior COVID infection (even if by a different variant), which confers some immunity, perhaps in some instances considerable (on par with or even higher than vaccination(s)). As well, a "vaccinated" person, someone who had a prior vaccination or vaccination series, still isn't a monolithic thing. The number of shots they received, including whether they had a second or third (or even fourth) shot as a booster, which manufacturer's vaccine(s) were used (e.g. J&J versus one of the mRNA vaccines versus the newer Novavax, recognizing that one can mix and match vaccines with some boosters), the time elapsed since the most recent shot, and the differences between the variant with which they're infected and the one for which their vaccine(s) were designed may all play a role.
Then one needs to factor in various risk factors, such as age (older people are significantly more at risk of hospitalization from COVID, as well as severe outcomes or death) and certain comorbidities, to further get to more apples-to-apples comparisons.
Although it doesn't dive much into that full set of subtleties, here's one recent comparison that might be interesting, in a report from the Washington State Department of Health for (basically) the month of June 2023:
https://doh.wa.gov/sites/default/files/2022-02/421-010-CasesInNotFullyVaccinated.pdf
"... some people are more risk averse than others and will both get vaccinated and avoid crowded areas. If they don't get hospitalized, was it because of the vaccine or their cautious behavior?"
The table on page 6 of that report notes that, across age groups and even in younger age groups – presumably much less likely than elderly people to be cautious in their day-to-day lives to avoid COVID, although that's just an unverified assumption on my part – hospitalization rates were considerably higher for people who were unvaccinated, as contrasted with people "who received at least one booster dose."
As well, the charts on pages 7-on suggest that even those who "completed primary series" of vaccination had hospitalization rates not that much worse than those who received a booster, and considerably better than those who were unvaccinated.
It's still entirely possible that, say, even among 12-34 year old people, those who were sufficiently conscientious (and trusting of healthcare providers) to receive at least a full primary series or even a booster might also have attributes that make them less likely to be hospitalized with COVID. Perhaps on balance they're wealthier, or more health-conscious, or more cautious in their risk-taking generally in life, or? (But I'm thinking this might at least help us get closer to possible answers?)