Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance — COVID-NET, 14 States, January–August 2021

Link:https://www.cdc.gov/mmwr/volumes/70/wr/mm7043e1.htm?s_cid=mm7043e1_w

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What is already known about this topic?

The SARS-CoV-2 B.1.617.2 (Delta) variant is highly transmissible; however, whether it causes more severe disease in adults has been uncertain.

What is added by this report?

Analysis of COVID-NET data from 14 states found no significant increases in the proportion of hospitalized COVID-19 patients with severe outcomes during the Delta period. The proportion of hospitalized unvaccinated COVID-19 patients aged 18–49 years significantly increased during the Delta period.

What are the implications for public health practice?

Lower vaccination coverage in adults aged 18–49 years likely contributed to the increase in hospitalized patients during the Delta period. COVID-19 vaccination is critical for all eligible adults, including adults aged <50 years who have relatively low vaccination rates compared with older adults.

Author(s): Christopher A. Taylor, PhD1; Kadam Patel, MPH1,2; Huong Pham, MPH1; Michael Whitaker, MPH1; Onika Anglin, MPH1,2; Anita K. Kambhampati, MPH1; Jennifer Milucky, MSPH1; Shua J. Chai, MD3,4; Pam Daily Kirley, MPH4; Nisha B. Alden, MPH5; Isaac Armistead, MD5; James Meek, MPH6; Kimberly Yousey-Hindes, MPH6; Evan J. Anderson, MD7,8,9; Kyle P. Openo, DrPH7,8; Kenzie Teno, MPH10; Andy Weigel10; Maya L. Monroe, MPH11; Patricia A. Ryan, MS11; Justin Henderson, MPH12; Val Tellez Nunez, MPH12; Erica Bye, MPH13; Ruth Lynfield, MD13; Mayvilynne Poblete, MA, MPH14; Chad Smelser, MD15; Grant R. Barney, MPH16; Nancy L. Spina, MPH16; Nancy M. Bennett, MD17; Kevin Popham, MPH18; Laurie M. Billing, MPH19; Eli Shiltz, MPH19; Nasreen Abdullah, MD20; Melissa Sutton, MD20; William Schaffner, MD21; H. Keipp Talbot, MD21; Jake Ortega, MPH22; Andrea Price22; Shikha Garg, MD1; Fiona P. Havers, MD1; COVID-NET Surveillance Team

Publication Date: 29 October 2021

Publication Site: MMWR at CDC

COVID-19 Vaccination and Non–COVID-19 Mortality Risk — Seven Integrated Health Care Organizations, United States, December 14, 2020–July 31, 2021

Link:https://www.cdc.gov/mmwr/volumes/70/wr/mm7043e2.htm?s_cid=mm7043e2_w

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What is already known about this topic?

Although deaths after COVID-19 vaccination have been reported to the Vaccine Adverse Events Reporting System, few studies have been conducted to evaluate mortality not associated with COVID-19 among vaccinated and unvaccinated groups.

What is added by this report?

During December 2020–July 2021, COVID-19 vaccine recipients had lower rates of non–COVID-19 mortality than did unvaccinated persons after adjusting for age, sex, race and ethnicity, and study site.

What are the implications for public health practice?

There is no increased risk for mortality among COVID-19 vaccine recipients. This finding reinforces the safety profile of currently approved COVID-19 vaccines in the United States. All persons aged ≥12 years should receive a COVID-19 vaccine.

Author(s): Stanley Xu, PhD1; Runxin Huang, MS1; Lina S. Sy, MPH1; Sungching C. Glenn, MS1; Denison S. Ryan, MPH1; Kerresa Morrissette, MPH1; David K. Shay, MD2; Gabriela Vazquez-Benitez, PhD3; Jason M. Glanz, PhD4; Nicola P. Klein, MD, PhD5; David McClure, PhD6; Elizabeth G. Liles, MD7; Eric S. Weintraub, MPH8; Hung-Fu Tseng, MPH, PhD1; Lei Qian, PhD1

Publication Date: 29 October 2021

Publication Site: MMWR at CDC

5 Worst Cities for COVID-19 Case Count Trends

Link:https://www.thinkadvisor.com/2021/11/30/5-worst-cities-for-covid-19-case-count-trends/

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The latest COVID-19 Community Profile Report, which is produced by public health specialists at the CDC and another federal agency, shows that the overall number of new COVID-19 cases per 100,000 people fell to 504,056 in the week ending Nov. 28, down 21% from the total for the previous week.

But, at the metropolitan area level, week-over-week changes ranged from a drop of 100% to an increase of 12%.

Author(s): Allison Bell

Publication Date: 30 Nov 2021

Publication Site: Think Advisor

Omicron is starting to spread around the world

Link:https://www.economist.com/graphic-detail/2021/11/29/omicron-is-starting-to-spread-around-the-world

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Days after a new variant of SARS-CoV-2 was identified in southern Africa, countries around the world are confirming that they have found cases of it too. The new strain of the virus, B.1.1.529, was first detected in genetic samples from Botswana and South Africa. (Nearly 150 cases have been confirmed in southern Africa since, although the true number is thought to be higher.) On November 24th South Africa’s health authorities told the World Health Organisation, which quickly labelled it a “variant of concern” and assigned it the Greek letter Omicron. Just how long—and where—it has been circulating is not yet clear.

Publication Date: 29 Nov 2021

Publication Site: The Economist

Covid Mortality Update for November 2021: Before the Omicron Variant

Link:https://marypatcampbell.substack.com/p/covid-mortality-update-for-november

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As noted earlier, the Hispanic excess mortality was about a level as the other non-White groups, but then spiked with Wave 2 and stayed very high.

The Asian group saw its excess mortality peak with Wave 3 — remember, that’s the large wave with the most COVID deaths. But they have been at about 30 – 35% excess mortality for the other waves.

The Black group looks like it’s slightly rising in excess mortality, but staying within a fairly narrow range of about 33% to 37% excess mortality.

The White group is definitely showing an increasing trend of excess mortality. Interesting.

Due to the White group’s increasing excess mortality, the overall population is showing an increasing trend — look, Whites have been the majority of deaths for a long time, as they’re the majority of old folks. That’s how that works.

Author(s): Mary Pat Campbell

Publication Date: 28 Nov 2021

Publication Site: STUMP at substack

COVID-19 Omicron Variant Hits Life Insurers’ Stock Prices

Link:https://www.thinkadvisor.com/2021/11/26/covid-19-omicron-variant-hits-life-insurers-stock-prices/

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Stock traders today appeared to assume that the omicron variant will hit life insurers harder than health insurers.

The stock prices of Anthem, Centene, Humana and UnitedHealth all dropped from 1.7% to 2.28% — less than the Dow Jones Industrial Average.

The stock prices of Ameriprise, Brighthouse Financial, CNO Financial, Equitable, Globe Life, Lincoln Financial, MetLife, Primerica Principal Financial Group, Prudential Financial and Unum Group all fell 3.5% to 5%.

The stock price of Reinsurance Group of America — a company that insures life insurers against spikes in mortality and longevity risk — fell 9.58%.

Author(s): Allison Bell

Publication Date: 26 Nov 2021

Publication Site: Think Advisor

Simpson’s Paradox and Vaccines

Link:https://covidactuaries.org/2021/11/22/simpsons-paradox-and-vaccines/

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So what the chart in the tweet linked above is really showing is that, within the 10-59 age band, the average unvaccinated person is much younger than the average vaccinated person, and therefore has a lower death rate. Any benefit from the vaccines is swamped by the increase in all-cause mortality rates with age.

I have mocked up some illustrative numbers in the table below to hopefully show Simpson’s Paradox in action here. I’ve split the 10-59 age band into 10-29 and 30-59. Within each group the death rate for unvaccinated people is twice as high as for vaccinated people. However, within the combined group this reverses – the vaccinated group have higher death rates on average!

I and others have written to ONS, altering them to the concerns that this data is causing. It appears from a new blog they have released that they are aware of the issue and will use narrower age bands in the next release.

Author(s): Stuart Macdonald

Publication Date: 22 Nov 2021

Publication Site: COVID-19 Actuaries Response Group

When Will The FDA Approve Paxlovid?

Link: https://astralcodexten.substack.com/p/when-will-the-fda-approve-paxlovid

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For context: a recent study by Pfizer, the pharma company backing the drug, found Paxlovid decreased hospitalizations and deaths from COVID by a factor of ten, with no detectable side effects. It was so good that Pfizer, “in consultation with” the FDA, stopped the trial early because it would be unethical to continue denying Paxlovid to the control group. And on November 16, Pfizer officially submitted an approval request to the FDA, which the FDA is still considering.

As many people including ZviAlex, and Kelsey have noted, it’s pretty weird that the FDA agrees Paxlovid is so great that it’s unethical to study it further because it would be unconscionable to design a study with a no-Paxlovid control group – but also, the FDA has not approved Paxlovid, it remains illegal, and nobody is allowed to use it.

One would hope this is because the FDA plans to approve Paxlovid immediately. But the prediction market expects it to take six weeks – during which time we expect about 50,000 more Americans to die of COVID.

Perhaps there’s not enough evidence for the FDA to be sure Paxlovid works yet? But then why did they agree to stop the trial that was gathering the evidence? Or perhaps there’s enough evidence, but it takes a long time to process it? But then how come the prediction markets are already 90% sure what decision they’ll make?

Author(s): Scott Alexander

Publication Date: 22 Nov 2021

Publication Site: Astral Codex Ten

Ivermectin: Much More Than You Wanted To Know

Link:https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted

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About ten years ago, when the replication crisis started, we learned a certain set of tools for examining studies.

Check for selection bias. Distrust “adjusting for confounders”. Check for p-hacking and forking paths. Make teams preregister their analyses. Do forest plots to find publication bias. Stop accepting p-values of 0.049. Wait for replications. Trust reviews and meta-analyses, instead of individual small studies.

These were good tools. Having them was infinitely better than not having them. But even in 2014, I was writing about how many bad studies seemed to slip through the cracks even when we pushed this toolbox to its limits. We needed new tools.

I think the methods that Meyerowitz-Katz, Sheldrake, Heathers, Brown, Lawrence and others brought to the limelight this year are some of the new tools we were waiting for.

Part of this new toolset is to check for fraud. About 10 – 15% of the seemingly-good studies on ivermectin ended up extremely suspicious for fraud. Elgazzar, Carvallo, Niaee, Cadegiani, Samaha. There are ways to check for this even when you don’t have the raw data. Like:

The Carlisle-Stouffer-Fisher method: Check some large group of comparisons, usually the Table 1 of an RCT where they compare the demographic characteristics of the control and experimental groups, for reasonable p-values. Real data will have p-values all over the map; one in every ten comparisons will have a p-value of 0.1 or less. Fakers seem bad at this and usually give everything a nice safe p-value like 0.8 or 0.9.

GRIM – make sure means are possible given the number of numbers involved. For example, if a paper reports analyzing 10 patients and finding that 27% of them recovered, something has gone wrong. One possible thing that could have gone wrong is that the data are made up. Another possible thing is that they’re not giving the full story about how many patients dropped out when. But something is wrong.

But having the raw data is much better, and lets you notice if, for example, there are just ten patients who have been copy-pasted over and over again to make a hundred patients. Or if the distribution of values in a certain variable is unrealistic, like the Ariely study where cars drove a number of miles that was perfectly evenly distributed from 0 to 50,000 and then never above 50,000.

Author(s): Scott Alexander

Publication Date: 17 Nov 2021

Publication Site: Astral Codex Ten at substack

Covid-19 Breakthrough Hospitalizations Concentrated Among Most Vulnerable

Link:https://www.wsj.com/articles/covid-19-breakthrough-hospitalizations-concentrated-among-most-vulnerable-11637499602

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At the Medical University of South Carolina, nearly all fully vaccinated Covid-19 patients in the ICU have weak immune systems from prior health problems, said Andrew Goodwin, the section chief of critical care. The rest are elderly, which can also compromise the body’s defense against illness.

Truveta Inc., a firm that aggregates hospitals’ medical data for research, found among 1.7 million fully vaccinated people that those with diabetes, chronic lung disease and chronic kidney disease were about twice as likely to be hospitalized for breakthrough cases as vaccinated people without these conditions.

The likelihood of having a breakthrough infection was still low, though confirmed infections were more common for people with these illnesses. About 1.5% of roughly 110,000 people with chronic kidney disease had one, for example. But Truveta found about a quarter of breakthrough patients with chronic kidney disease wound up hospitalized. The likelihood of hospitalizations for people with breakthrough cases but without underlying health problems was about 7.5%.

Breakthrough deaths are hitting older people the hardest, amplifying a well-worn pandemic pattern. Exclusive data the Journal reviewed from the Epic Health Research Network, which analyzes data from the medical-record software company Epic Systems Corp., shows about 80% of breakthrough deaths among the vaccinated are in people ages 65 and older. The data included records for 19.5 million fully vaccinated people. Among all Covid-19 deaths this year, that age group represents closer to 69%, according to the CDC.

Author(s): Jon Kamp, Melanie Evans

Publication Date: 21 Nov 2021

Publication Site: Wall Street Journal

Why Puerto Rico leads the U.S. in COVID vaccine rate — and what states can learn

Link:https://www.npr.org/2021/10/27/1049323911/puerto-rico-leads-the-us-in-covid-19-vaccine-rates-and-what-states-can-learn

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It’s in Puerto Rico, where more than 73% of the total population is fully vaccinated. The U.S. national average is just over 57%.

The high vaccination rate stands in contrast to Puerto Rico’s initial vulnerability to the coronavirus. Four years after Hurricane Maria destroyed the electricity grid, power outages still occur regularly. Many municipalities face a shortage of health care facilities and workers.

The U.S. territory responded with some of the strictest pandemic measures in the country, including nonessential-business closures, stay-at-home orders and mask mandates.

……

Its successes aside, Feliú-Mójer noted that COVID-19 has still killed over 3,200 people in Puerto Rico. And she remains concerned about vaccine equity — particularly in rural communities or among older adults who can’t get out of their homes or don’t know how to make an appointment. She says the high overall vaccination rate can hide gaps in coverage.

“You have to look beyond that big number,” she said in a separate interview with NPR. “But then you look at certain municipalities like Loíza, a town in coastal northern Puerto Rico that’s predominantly Black and [a] very poor municipality. Their vaccination rate is about 55%. And so when you look at some of the social determinants that impact communities like Loíza, then they’re not doing as well.”

Author(s): PATRICK JARENWATTANANON, AYEN BIOR, SARAH HANDEL

Publication Date: 27 October 2021

Publication Site: NPR

Predictable country-level bias in the reporting of COVID-19 deaths

Link:https://www.sciencedirect.com/science/article/pii/S2667319321000124

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We examine whether a country’s management of the COVID-19 pandemic relate to the downward biasing of the number of reported deaths from COVID-19. Using deviations from historical averages of the total number of monthly deaths within a country, we find that the probability of underreporting of COVID-related deaths for countries with the most stringent policies was 58.6%, compared to a 28.2% for countries with the least stringent policies. Countries with the lowest ex ante healthcare capacity in terms of number of available beds underreport deaths by 52.5% on average, compared to 23.1% for countries with the greatest capacity.

https://doi.org/10.1016/j.jge.2021.100012

Author(s): Botir Kobilov, Ethan Rouen, George Serafeim

Publication Date: Summer 2021

Publication Site: Journal of Government and Economics