BNT162b2 Vaccine Booster and Mortality Due to Covid-19

https://www.nejm.org/doi/full/10.1056/NEJMoa2115624

by nkurz • 5 years ago

35 52 5 years ago

fxtentacle• 5 years ago

TLDR it works as expected.

Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.

epicureanideal• 5 years ago

Although the 3 per 100,000 death rate after 2 vaccinations is already very low. It's great that an additional vaccination would reduce it further, but after 2 vaccinations does it make sense to mandate a booster with these risk profiles?

Especially given that there are rare heart inflammation issues caused by the vaccine, I can see people having a difference of opinion about whether the booster is worth it compared to the risk, until the error bars on the risk measurement are narrowed down a bit.

hn_throwaway_993• 5 years ago

I agree with your point that with low death rates it's important to try to determine which subpopulations are at highest risk of both (a) succumbing to the virus should they become infected and (b) vaccine-related side effects.

With respect to myocarditis, though, note that it is rare, and those affected recover quickly [1], and there are some recommendations about potentially changing the injection site to be further from the heart to lower the incidence of this side effect [2].

1. https://newsroom.heart.org/news/young-people-recover-quickly...

2. https://www.scmp.com/news/hong-kong/health-environment/artic...

actually_a_dog3• 5 years ago

Here's a summary, quoted from the article:

RESULTS
A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (95% confidence interval, 0.07 to 0.14; P<0.001).
CONCLUSIONS
Participants who received a booster at least 5 months after a second dose of BNT162b2 had 90% lower mortality due to Covid-19 than participants who did not receive a booster.

This paper can't take omicron into account, but, it's definitely good news. I'll take a 90% lower mortality rate any day.

timr4• 5 years ago

I'll take a 90% lower mortality rate any day.

Really? Any day?

Read the part you quoted carefully: the death rate in the control group is 3 per 100,000. And if you read the rest of the paper, you'll see that the study population was entirely over age 50.

Remember that the risk of death from Covid-19 goes up exponentially with age -- something like 90% of all fatalities are over age 50 [1]. If you're in the typical HN demographic (<30 yo), your risk of mortality from Covid-19 is much lower than what is reported for baseline here.

I want to put this in perspective. Per The Book of Risks (chapter 8; annual risks) [2], your overall chance of dying in a typical year is 1 in 115 (~870 per 100,000) Your chance of being murdered is 1 in 11,000 (9 per 100,000). The chance you'll die of an accident is 1 in 2,900 (34 per 100,000). From a fall: 1 in 20,000 (5 per 100,000). By getting hit by a car while walking: 1 in 40,000 (2.5 per 100,000).

In other words, your all-ages chance of dying from Covid-19 after two doses is somewhere between your annual chance of dying from a fall, and dying after being hit by a car -- and it's much lower than that if you're under age 50! Divide that number by ten, and you're in the realm of risks that any sane person wouldn't even consider: the annual chance of dying by freezing, for example (1 in 3,000,000).

Point being: dividing a very small number by 10 is indeed a 90% risk reduction, but you have to weigh it against the costs very carefully. There are tons of reasons why I wouldn't take a 90% relative risk reduction, if the baseline risk were quite small (as it is here).

[1] https://www.statista.com/statistics/1254488/us-share-of-tota...

[2] https://www.amazon.com/Book-Risks-Fascinating-Facts-Chances/...

actually_a_dog3• 5 years ago

Yes. Any day, and twice on Sunday. If 90% of COVID deaths in the US could have been prevented (in fact, many could have been)[0][1], that cuts this whole thing down to a very bad flu season, comparable to the 1957 flu pandemic [3].

Would you rather not cut your risk by 90%?

Edit: Incidentally, I have been hit by cars while walking 3 times. No injuries, luckily, since they were very low speed impacts.

Why are you seemingly advocating against something (getting a booster shot) that's also extremely unlikely to harm you?

---

[0] https://www.thedenverchannel.com/news/national/coronavirus/n...

[1] https://www.kff.org/coronavirus-covid-19/issue-brief/covid-1...

[2] https://en.wikipedia.org/wiki/1957%E2%80%931958_influenza_pa...

nkurz3• 5 years ago

Your comparison points are great, but I think you are misreading the quote: "Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day)."

The death rate of the control group is .16 vs 2.98 per 100,000 people per day. If you annualize this by multiplying by 365 to make it comparable to your other figures, I think this means you get 65 deaths per 100,000 people per year for the booster group versus over 1000 deaths per 100,000 people per year for the double vaccinated but not boosted. Which is to say, the Covid risk is higher than all of the specific risks you mentioned with or without a booster. This might (or might not) suggest a different conclusion of the relative benefit of taking the booster.

Or am I the one who is misreading the numbers?

gomox2• 5 years ago

Is the control group composed of fully (2 dose) vaccinated individuals only? Or do they put non vaccinated people in there as well? I couldn't figure it out.

bellyfullofbac• 5 years ago

We obtained data for all members of Clalit Health Services who were 50 years of age or older at the start of the study and had received two doses of BNT162b2 at least 5 months earlier.

angelzen2• 5 years ago

Given that boosters are an attempt to counteract waning vaccine vaccine effectiveness, there are two fundamental questions:

1. Do boosters work at all?

2. Do boosters wane over time, just like the original shots did?

They answer only 1. They didn't even attempt to shed light on 2, which is a serious letdown. Given known waning vaccine effectiveness, at a minimum claims on booster effectiveness should be bracketed by time since boosting event.

hedgehog• 5 years ago

It hasn't been long enough, they will probably do another paper in six months once that data is available.

kelnos• 5 years ago

How could they answer #2? Boosters have only been a thing for, what, a couple months now?

whb07• 5 years ago

Israel is effectively forcing everyone to be at the 4th booster by now.

Guess how things are looking? Ready to take the 5th booster shortly.

Lol, “never again” and Nuremberg code are just words easily forgotten.

angelzen2• 5 years ago

"We've measured the position of iron balls thrown at different speeds from a 56m tall tower and found they were 90% likely to be found flying in the air."

This is technically correct, yet fundamentally misleading. The same statement, bracketed by time since triggering event:

"We've measured the position of iron balls thrown at different speeds from a 56m tall tower, 0.1 seconds after throwing, and found they were 90% likely to be found flying in the air."

Even better, show the plot of position by time, or at least clarify you are merely doing a point-in-time measurement. Time is a fundamental component of the vaccine effectiveness equation.

avalys2• 5 years ago

Is it too early to conclude whether booster effectiveness will also wane in 6 months?

I had some mild but persistent side effects from the second Pfizer dose (ear ringing and Eustachian tube dysfunction). It's gotten about 98% better - but not 100% - and I'm a bit nervous about the booster given that many people are reporting the side effects are somewhat more intense than the second shot.

If the booster is the final answer, maybe I'll take the risk. Not sure what I'll do though, if the new status quo is a booster required every 6 months, and you become a pariah in polite society if you're not "fully vaccinated"...

jbd28• 5 years ago

Data is showing T cell response is great from 2 doses so you won’t be a burden on the hospital. Looking like cases will diverge from hospitalizations soon and vaccinations will move to flu-like in “strongly encouraged and taken up by the responsible”

ed25519FUUU• 5 years ago

I’m in a similar boat and I hate it. I did both vaccines and I’m otherwise healthy, very low risk of hospitalization or death. My workplace has said vaccination is a requirement (even though I’m remote!) and I think boosters will be part of that.

I don’t want to file a religious or medical exemption because I don’t have one. I want to file a “I shouldn’t have to do this” exemption.

hn_throwaway_993• 5 years ago

Two things I'm honestly curious about in your response:

1. I understand getting the vaccine is unpleasant (personally I was knocked out for 36 hours after the second dose with a high fever and body aches), but the linked study showed that the booster lowered chances of death by 90%. Yes, things like age and underlying health have a big impact, but many seemingly healthy people have either died or been hospitalized from that. Forgetting about mandates for a moment, on a personal level, why wouldn't you want to get something that showed such high efficacy against death and hospitalization that had such a low, temporally finite cost?

2. Just wanted to comment that I do agree that employer-initiated mandates make no sense to me if you are fully remote. Sure, restrictions on coming into an office unless you've been vaccinated make total sense to me, but mandating for remote employees makes no sense from the perspective of the reality of how the virus is transmitted.

TechBro8615• 5 years ago

Do the moral thing and quit. Don’t let someone coerce your into a decision you don’t feel is right for yourself.

mrtksn2• 5 years ago

Maybe you can consider another vaccine as a booster if this one did not acted well on you?

I don't see how the booster is guaranteed to be the final answer as the virus keeps mutating and spreading among the very large unvaccinated population.

I personally think that it will become endemic, thanks to the vaccine we would have enough immunity to keep us out of hospital and each time we get the virus it would act as a booster.

This thing is not going to end without something like world wide super strict lockdown(Wuhan style) or world wide vaccination(and probably some combinations as the vaccine itself reduces but doesn't completely stop the spread).

nonbirithm• 5 years ago

I think the media might have unintentionally done themselves in by using the terminology "vaccinated" with no qualifiers in much of the coverage of the virus in the past two years. Soon we might have to be careful to state "vaccinated, but only within the last six months" or "vaccinated, but with the version targeting omnicron". I can't imagine it will be easy for all the existing articles from months ago to be updated now that we have new information.

I feel the same way with masks. If you didn't do enough research, you could easily believe that anything with an N95 certification would be ideal for protective purposes, but plenty of N95 masks have valves which makes them useless for preventing infected individuals from infecting others. There are also cloth masks, gators, and so on. But to many people they all fall under the umbrella of the unspecific term "wearing a mask", and unless you explicitly look up the medical consensus, many sources of information are unlikely to also state "but not those masks."

ulnarkressty2• 5 years ago

Same here, no vertigo before in my life - had it for both doses, longer the second time, still not 100% recovered. I even voluntarily filled in my info on the Pfizer side-effects page, but didn't hear anything back. Did you manage to find out what exactly goes wrong with the inner ear after the vaccine?

Still, regarding the study, it appears that taking the booster would be the better choice, considering most of us will catch the omicron variant at some point.

sharken• 5 years ago

The vertigo effect you describe, was that right after each dose, or at a later point.

It would be interesting to know more about this side effect.

avalys2• 5 years ago

I filled out a VAERS report and never heard from anyone about it.

Unfortunately I haven't learned anything interesting about what the mechanism of action might be. Especially with respect to the most interesting question - does this reaction to the vaccine mean I might have had an even worse reaction to a COVID infection? There are plenty of people who report tinnitus following COVID.

tguvot2• 5 years ago

antibody levels after booster are much higher compared to after second shot. there is a chance that it will last longer

sterlind• 5 years ago

Countering this anecdata with my own: I have several rare diseases and I'm quite disabled. I didn't get noticeable effects from my first two Pfizer doses (at least nothing I could distinguish from my chronic illness), while the third gave me flu-like symptoms for 2-3 days. I was happy about this because it told me it was working, and I returned to my (crappy) baseline afterwards with no lingering effects.

I wonder if you just happened to get ear ringing coincidentally around the time you got your second dose, and connected the dots even though it might not be causally related.

ohCh6zos• 5 years ago

I'm sorry to hear it was flu-like for you. I'm in the same boat, and it was flu like for me too.

amanaplanacanal• 5 years ago

It makes sense that the booster might lower mortality from an already very low rate.

My question is, are we already below the risks from seasonal flu? I do normally get the seasonal flu vaccine, but I didn’t last year or this year because I’m still practicing social distancing.

I guess I’m trying to put this in perspective.

drno123• 5 years ago

There is a low risk of heart inflammation related to the Covid vaccine for young males. Is this risk the same regardless of number of booster doses that you take, or does it go up with each additional booster? If it goes up - is the function linear, slower than linear or faster then linear?

spurgu3• 5 years ago

Good question. Very relevant question. It seems to be looked at in a vacuum.

jimmyearlcarter• 5 years ago

I want to know what percentage of those who died also suffered form comorbidities. Also this is for people aged 50 and above, what about healthy young people?

Do the math, death rate is 0.008% (boosted) vs 0.16% (unboosted) for aged 50 and above. Still super low. And we're getting better and better at treating this thing.

Get it if you *want* it. Don't if you don't. I do not want it or need it thank you very much.

exegete• 5 years ago

Agree that we’re getting better at treating it. You seem to be praising those treatments and not wanting to get the vaccine. I don’t understand the idea that medicine that prevents the disease is bad but medicine after the disease is ok?

peteradio• 5 years ago

I think people like it because it scales with the actual disease. It may be irrational as far as resource allocation but it is maybe a bit more transparent.

nkurz3• 5 years ago

I'm going to do this as a top-level comment because I think it's important. Throughout this thread, a number of people seem to be misreading the numbers and arguing that the results are unimportant because they show that the booster reduces a tiny risk (0.00298%) to an even tinier one (0.00016%). In general, this is a fine argument to make, but I don't think it's well supported by this paper.

Here is the Results section from the paper: A total of 843,208 participants met the eligibility criteria, of whom 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day).

The risk of death is being reported per day, and not per year as many people seem to be assuming. They had 85,000 people in the control arm, and 137 of them died in the less than 2 month timeframe of the study. If you multiply the daily risk by 365 to make it an annual risk, you find the non-boosted (but already doubly vaccinated) group had a slightly greater than 1% chance of dying within a year. By most standards, and compared to most other situations, this is a considerable risk of death. By contrast, the boosted group had a less than .1% chance of dying per year, so it's not just that an elderly study population was already on the verge of death.

So unless you think 1 person out of 100 dying within a year is insignificant, it would be more helpful to point out the potential flaws in the study than to say the results don't matter. Should the data be trusted at all? Is the boosted group really comparable to the unboosted? Did they mishandle/miscount the way people were switched from one group to the other throughout the course of the study? Should those less than 30 years old even care? These are potentially good questions, but it's not reasonable to suggest that the study as printed shows that there is no real benefit to the booster.

(Obviously, if my math is wrong or if I'm misinterpreting the results, please correct me!)

spurgu3• 5 years ago

The study is somewhat skewed since its comprised of people 50+ years old, which have a significantly higher risk to begin with compared to young healthy adults.

Edit: Removed false/misleading bit.

gomox2• 5 years ago

The 1 in 107 number you seem to be alluding to from the link is the odds of dying in a car crash in your entire life, not in any given year.

BNT162b2 Vaccine Booster and Mortality Due to Covid-19

Related Stories