[eddieroger]

Frame it as the safety of the vaccine, not the efficacy of it. If it was about efficacy, it would lead with the 25% lower risk because of COVID safety. But, these days, there are people who think vaccines are dangerous just because, so saying that taking the vaccine or not has equal mortality puts that to rest (or at least does for those who find science real).

[zosima]

The reduction in all-cause mortality was independent of covid deaths.

Which seems to suggest that there was big differences between the groups other than the vaccination.

This of course does not change that the vaccine seems mostly safe, but it definitely calls in to question whether the protection against covid death was vaccine-mediated or due to some other difference between the groups.

Therefore this paper is moderately strong evidence for the vaccine being safe, but quite weak evidence for the vaccine being efficacious.

[pygy_]

The vaccinnated group was 1 year older on average, and had mode cardiovascular risk factors.

Covid has long term health consequences, and these are proportional to the severity of the acute infection.

People who died of a stroke of a heart infarction 6 months down the line were not counted as "covid death", even though covid is known to increase their incidence in the next year.

[pygy_]

Another factor that may play a role: the people who chose not to take the vaccine may be prone to taking bad decisions more broadly, leading to a higher mortality rate.

[oldgradstudent]

If true, that means the groups are different in many other aspects other than the vaccine.

The study does not control for the differences. No causality can be inferred.

[disgruntledphd2]

I mean, it's plausibly something around trust in medical authorities which correlates with both vaccine and other treatment refusal.

[lesuorac]

Covid hospitalizations where half in the vaccinated group (as % of pop) than unvaccinated. That's extremely desirable when you're in a situation where you have do dedicate whole wings (and then some) of hospitals to a singular disease.

Sure, it's not a silver bullet but it's at least stainless steel.

[zosima]

I am speaking about what the paper shows.

There are other sources of evidence for efficacy. This paper is not a very strong source of evidence for efficacy due to some obvious uncontrolled difference between groups.

[gopher_space]

I wouldn't bother critiquing methodology without current, masters-level experience in the domain. I make incorrect assumptions when I'm even narrowly outside my own lane, and end up asking questions that clearly demonstrate e.g. my inability to parse fig. 4a.

[zosima]

I wouldn't bother commenting if I were hallucinating figures. There is no figure 4a.

If you look at figure 4 in the supplemental material you also see, per your expertise, that covid vaccine protects against traumatic injury. However even adjusting for the protective effect against traumatic injury there is still quite a large protective effect against all-cause mortality. So the beneficial effect of the vaccine is not solely caused by its protective effect against traumatic injury.

Or it could be, bold proposition I know, that there is a difference between the groups that both protects against traumatic injury and protects against all-cause mortality, independently of the vaccine.

[_DeadFred_]

OP's point was more 'How would you measure unvaccinated people that lived because vaccinated people weren't filling the ER, so there were beds/staff to spare'?

That unvaxed outcome would need to go in the 'vaxed lives saved' column somehow, or else it looks like 'outcomes were the same either way' because the lives saved from vaccination spill over into the non-vaxed group because the vaccine prevented the healthcare system from melting down.

[stocksinsmocks]

I don’t think it’s possible to know anything conclusive about the safety for a few decades and a generation or two of affected kids can be observed. Given that finding harm would embarrass important aristocrats, I don’t think that evidence would ever be found in the foreseeable future. That mRNA and lipid nano particles were never found to be safe until the exact moment of crisis is awfully convenient for its investors.

I say decades because of the study below. Certainly, the authors could have published it for engagement bait or malice or some reason.

https://www.gavinpublishers.com/article/view/detection-of-pf...

[vineyardmike]

Where do you get decades? That study says 200 days.

[xracy]

I interpret this as the comment saying "we won't know how this affected things until decades from now." Which can likely be attributed to existing vaccine skepticism and is unlikely to result in them changing their opinion in the next ever.

What I think a lot of people who are anti-vax miss is the risk of the vaccine compared to the risk of COVID. They feel like they're being asked something risky in a vacuum, when in fact, they're being asked for something with (as best as we can tell) limited risk against a backdrop of a dangerous virus that killed millions and caused a global pandemic.

Even if they could demonstrably prove the vaccine created a higher risk of outcomes for people who took it, the risk compared to getting COVID is de minimus, and the likelihood of getting COVID is high. I would be surprised if there was a significant population of people who had avoided it at this point.

[ifyoubuildit]

> What I think a lot of people who are anti-vax miss is the risk of the vaccine compared to the risk of COVID

Why do people still frame this as either/or? How many people out there didn't get covid after they got some number of shots?

The only real scenario is covid with n shots, where n >= 0. In other words, when you got covid, how many shots had you gotten.

(Not anti vax myself, though generally avoid whatever drugs I reasonably can)

[array_key_first]

We know that the vaccines lower your risk of bad outcomes if you get covid.

[blackqueeriroh]

Many people have never had Covid.

[stocksinsmocks]

You really aren’t going to know how this MRNA in egg and sperm cells are going to affect offspring until you have offspring to observe. Effects like wolbachia could take multiple generations to observe.

[velcrovan]

mRNA can't cause wolbachia. Wolbachia is a bacterium that actually lives inside cells and gets transmitted through eggs to offspring. it's a persistent organism that reproduces. There's not a way for mRNA to grow bacteria.

mRNA is just a molecule that breaks down, and the mRNA in these vaccines is extremely fragile and temporary. Once injected it enters whatever cells are nearby (muscle cells)and ribosomes read it to produce the inert spike protein. The mRNA itself is gone within hours. Your cells have enzymes specifically designed to break down RNA because cells naturally produce and dispose of mRNA constantly as part of normal function.

The mRNA in vaccines never enters the cell nucleus where DNA is stored, so it can't integrate into your genome or affect reproductive cells in that way. And it doesn't replicate itself either.

And millions of babies have been born to vaccinated parents by now. If the effects you are talking about were even possible they would definitely have shown up by now.

[stocksinsmocks]

I’m not suggesting comirnanty is wolbachia. If there is reproductive harm, or reproductive harm passed on to children, then we will not know for a long time.

I believe that you’re well read on the CDC’s messaging on this topic. I’d like to bring to your attention that glyphosate was scientifically shown to pose no harm, but that key paper was retracted 25 years later. Pfizer is making over $10B/yr on comirnanty and at one point it was over $50B. Would you lie for that kind of money? Could you imagine someone who would?

[rainsford]

Obviously there are confounding variables besides vaccination status, but I find it pretty compelling that the decrease in COVID mortality among the vaccinated group was significantly larger than the decrease in all-cause mortality of that group. This suggests whatever the difference was between the two groups, besides vaccination, either had a much larger impact on COVID than other causes of death or that the vaccine had some positive impact.

One example of the former explanation I could imagine is that people who got vaccinated against COVID were probably also more likely to take other preventative measures, like wearing a mask or avoiding larger crowds of people. Those precautions would be more likely to be effective against a contagious disease like COVID but less likely to protect them against some other causes of death like heart disease.

I'm not sure how likely I find that as an explanation compared to the alternative that the vaccines provide at least some level of protection. My observation was that widespread measures specifically meant to defend against COVID, like masking and social distancing, largely went away well before the end of the time period covered by this study, at least in the US.

Amusingly, I suspect the anti-vax contingent would likely be bothered by data suggesting anything the COVID vaccinated group was doing differently protected against COVID, since their position seems to largely be that not only is the COVID vaccine useless, but so are any other measures meant to reduce the spread.

[disgruntledphd2]

I think that's mostly fair, but given that we can't randomly assign vaccine administration this sort of study is the best we're gonna get.

Like, the major takeaway is that the vaccine is safe, I think that we've already established that it works to reduce Covid hospitalisations.

[jmull]

> but quite weak evidence for the vaccine being efficacious

That’s directly contradicted by the results of the study. E.g.,

“Vaccinated individuals had a 74% lower risk of death from severe COVID-19 (weighted hazard ratio [wHR], 0.26 [95% CI, 0.22-0.30]) and a 25% lower risk of all-cause mortality (wHR, 0.75 [95% CI, 0.75-0.76])…”

It’s pretty clear a lot of unvaccinated people who died of covid would be alive today had they gotten vaccinated.

(I would point out the current yearly vaccine they are putting out is potentially a different story since covid is changing and so is the vaccine. I’d talk to my dr about whether to get that or not.)

[pama]

The simple explanation is that the causal agent for the excees of the non-covid deaths is the same SARS-CoV2 virus, but death comes later and not at the acute phase of the disease.

[Chris612]

If the vaccine was randomly administered among the study population, I'd buy this as the simple explanation.

Not sure it follows so cleanly with the actual study setup

[pygy_]

There is plenty of evidence beside this study.

[underlipton]

There was a study that showed that cancer patients who receive a MRNA COVID vaccine live longer. This could also be for extrinsic reasons, but IIRC the study considered the reason to be a pronounced immune response that also attacked cancer cells.

So there's a chance that the vaccine provokes a general immune response that's protective against a number of mortality-causing issues.

[DebtDeflation]

A 25% reduction is huge, even if you account for the fact that people who get vaccines tend to be more health conscious to begin with, when you consider that outside of the very sick and very old Covid has a mortality rate under 1%.

[soperj]

1 out of 100 when billions are getting it is gonna be a large number. Mortality rate has gone down substantially since the vaccines.

[ceejayoz]

I like to ask people who talk about a 1% mortality rate if they'd go to a football game in a stadium with 100k seats if 1k of those seats randomly had a small bomb attached.

[altcognito]

> Covid has a mortality rate under 1%.

I hate it when blanket statements like this creep in.

Which Covid? The initial version was definitely more deadly than later versions.

What about future covids? Are you willing to guarantee every version of covid from here on out will be less deadly? It is the general case to be true, but it is not some sort of law.

[a_cardboard_box]

Yes, but they incorrectly called it all-cause mortality under Findings. "Mortality" on it's own would be fine. "Mortality from other causes" would be better.

[disgruntledphd2]

It's a term of art. The audience for this paper would understand, rather like many denizens of HN know what TDD is.

[a_cardboard_box]

The paper doesn't even use it consistently. At first it uses "all-cause mortality" to mean "all causes except COVID", and then in the results section it uses the same phrase to mean "all causes including COVID". The whole purpose of terms of art is to increase the specificity of language, but they're not doing that here. Their usage of the term is confusing.

Edit: I'm wrong. I could have sworn it said that the groups had similar all-cause mortality, but it doesn't.

[Timon3]

Where do you see them using "all-cause mortality" to mean "all causes except COVID" in the beginning? I skimmed over all uses of the term before the "Results" chapter, none of them seem to exclude COVID deaths?