SIO306: What Does the Massachusetts Outbreak Say About Vaccine Effectiveness?

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:11 Thomas: Hello and welcome to Serious Inquiries Only. This is episode 306. Back at it after a little bit of a vacation for me. I guess for the normies it wasn't, but for patrons and me. How's going, Lindsey?

0:00:18 Lindsey: Mm-hmm. And me. It's great, yeah.

0:00:24 Thomas: And you? No, I assumed you still did an episode while I was gone, but just for yourself.

0:00:28 Lindsey: Yeah, but nobody listened to it. Yeah. Yeah I did.

0:00:30 Thomas: Yeah. Well, you gotta upload it is the problem.

0:00:32 Lindsey: Oh. Oh, is that how that works?

0:00:34 Thomas: Yeah, no, you can't just talk into the mic. It doesn't, it's not like it's hooked into them, the listeners, directly. Directly, that's how I thought it worked at first. I was like, oh, yeah, they I bet

0:00:38 Lindsey: Okay. Yeah this is why you handle the podcasting side of it. I just it really was. Yeah yeah

0:00:46 Thomas: The episode you did was delightful though, we'll just I'll assume it was, um, so much to talk about today. I am really excited. Here's here's what, here's my plan, is my plan for Lindsey to sit us all down and tell us what the fuck is going on. That's my plan for this episode, because when it comes to the Delta, you variant, and COVID, and like whether or not you can get it when you're vaccinated now, and spreading, all this stuff, I have seen so much contradictory information, you know, I'll see. And from and again, that's the hard thing about this day and age of COVID is like it's not all from one side, too.

It's among people on the left. There are people who are posting things about how like, oh, and, you in Massachusetts, 75% of people who got it were vaccinated and something like that. And I sent that to you as just like, how can this possibly be true? What is this? What's happening? Because I think a lot, if I'm at all emblematic of the listeners, we could really use a nice chat with Dr. Lindsey Osterman here to tell us what the F is happening with this COVID vaccine stuff and whether or not they are protecting against Delta or they're not protecting. So that's what I hope you're going to do, but I've

0:01:14 Lindsey: Right yeah yeah

0:01:57 Thomas: Just volunteered you for this. So it's a big responsibility.

0:02:01 Lindsey: No, that Washington Post headline that you sent to me was very confusing. Like when I first saw it, I was like, oh, that's, I mean, something's not adding up there, but it wasn't immediately obvious what it was. But, but yeah, this ought to be fun.

0:02:05 Thomas: Yeah. So would you prefer to roast Sam Harris before doing that or after?

0:02:19 Lindsey: Yeah, I don't know if I can hold in my Sam Harris roast through through the entire.

0:02:21 Thomas: Okay. Okay. Go do it.

0:02:23 Lindsey: Okay. Yeah. So before we before we get to the breakthroughs, I did want to talk a little bit about some some trouble in the bromance between Sam Harris and and Brett Weinstein. Um, so Sam Harris interviewed Eric Topol a few weeks ago about vaccine hesitancy and Topol had a lot to say about the way that Brett and Heather, yeah, yeah. He's just, he's a cardiologist and I So he, he had a, a lot to say, a, Brett and Heathers coverage of things related, related to the pandemic. So, you know, he thinks that it's dangerous and ridiculous that they're doing the stunt with ivermectin on air where they both take ivermectin and, um, you know, their vaccine hesitancy.

0:02:44 Thomas: No. Is Topol actually a good guy? Oh, okay. Okay, okay, gotcha.

0:02:59 Thomas: Wow. They've gotten to that. Oh my God, these

0:03:03 Lindsey: Oh, yeah, yeah. Did you? I thought we talked about that, but maybe not.

0:03:03 Thomas: People. No, I just No, we haven't. They're taking ivermectin on, do they have COVID? They just oh It's like a condom against COVID.

0:03:11 Lindsey: No, they're taking it as a prophylactic. Yes, that

0:03:17 Thomas: A COVID con, maybe they should get in a giant condom, like in Naked Gun, whatever, whichever that one that was yeah that would work. Actually, that's just PPE. Oh,

0:03:22 Lindsey: Would probably work. Yeah. Mm hmm. Yeah, exactly. Yeah. No. They pulled this whole thing where they, you know. The entire time they were doing it, they were like, no, we're not saying that, you know, we are endorsing that other people do this, but here is us actually literally taking taking ivermectin on air as a, as a prophylactic. And I think they said that they have their kids taking it too. So that's pretty fun. Don't quote me on that though.

0:03:39 Thomas: My God, well,

0:03:46 Lindsey: I'm not.

0:03:46 Thomas: Fortunately, their kids are grown adults who are also profiting in their show. Like, they work on yeah, it's like, that one's, I'm pretty sure, one does the video and what, you know. So, don't feel too bad for their kids. Oh,

0:03:51 Lindsey: Oh, okay. Okay. I didn't know that. Yeah. But yeah, so they, so, so Harris did this interview and then Brett responded to that in episode 89 of the Dark Horse podcast and said that Sam was, oh, oh

0:04:09 Thomas: I'm so sorry, I misheard, I, okay, I just want to point out something, I was so terribly confused because I thought you said that uh, this doctor, went on Dark Horse and was criticizing them and I was just, I couldn't fathom the idea that those, those assholes would have someone on who disagreed with them. I was like, this whole time I've been swirling, like, how did they, was it a Borat situation where they like tricked, you know? And now I feel much more like, okay, I understand the world again, you Know, cause for a second, I thought you told me that that Weinstein and Heather Haying had someone on who actually disagreed with them. And now my world is back to where I thought it was in terms of those two. Okay. Thank you. Sorry for that.

0:04:20 Lindsey: No. Who's critical? Yeah.

0:04:49 Thomas: My fault.

0:04:38 Lindsey: Mm-hmm. Yeah that's gonna be a theme of the whole episode so so good I'm glad you said it that way. Yeah, yeah, so so, yeah, so Sam had this guy on, they criticized Brett, and then Brett responded to it in Dark Horse and said that Sam was like unintentionally strawmanning their positions and that's you know nothing in their discussion actually threatened anything about what Brett and Heather have put forward, and he was also very annoyed that Sam and Eric didn't give Brett and Heather credit for being early and right about the lab leak hypothesis, so there's that.

0:04:52 Thomas: Oh, man.

0:05:04 Thomas: I bet. Yeah. Yeah.

0:05:19 Thomas: They were not right about it, by the way. Just FYI.

0:05:20 Lindsey: Yeah. It's always good to keep reminding people of that, um, but then, and this is really why I thought this was funny enough to bring up, um, Sam released an AMA and half of it was behind a paywall, as always, uh, so I couldn't listen to the last half of it, but the first half was just his reply to Brett's statements in Dark Horse. And as, as a prelude, I just want to say this: if, if I were to release a podcast episode in which I played like a satirical version of Sam Harris, I would choose a topic on which Sam thinks other people have a blind spot. And then I would criticize that blind spot using all the language that has been used to legitimately criticize Sam Harris's blind spots, but that he doesn't acknowledge as legitimate.

0:06:03 Thomas: He just doesn't get it the whole time.

0:06:06 Lindsey: Yeah. Yeah, and so I'd play that real straight, you know, just him saying, and with that in mind, here's what unfolds in Sam's prelude to this AMA. This is amazing. So Sam says that listeners have been suggesting that he have Brett on the podcast to clear things up, you notice to have a conversation.

0:06:08 Thomas: Oh, man.

0:06:21 Thomas: Yeah, sure.

0:06:22 Lindsey: That's what Sam Harris does, right? But Sam Harris doesn't think that's a good idea. And so I'm going to read a couple of quotes here. So he says, there are many cases in which merely having the conversation can be misleading. Couldn't agree more. He goes on to talk about like the compelling evidency for vaccine safety and the dangers of COVID. And he says that just like he won't give any air to a 9-11 truther on his podcast, he also won't get air to Brett's ideas.

0:06:25 Thomas: Yeah. Yeah mm-hmm. Yeah a race scientist though a-okay. Man. Man.

0:06:50 Lindsey: Exactly. So he says, quote, if you're in a social context where those fears, and he's talking about the vaccine safety, seem plausible, you've been lured into an information backwater that is not good for your mind and then a bit later in the context of comparing vaccine skepticism to conspiracy theories about election fraud he says quote the merely asking questions routine is bad faith or it's totally oblivious to the corrosive effects of asking certain questions again and again couldn't agree more, Sam.

0:07:20 Thomas: It's like someone, yeah, it's like you or I, or I don't know, something like Eli Bosnick just like possessed him. Do we cast a spell, possess him, but we can only, the rules are we have to do it, you know, in an indirect way. Like we have to totally roast him. We're not allowed to just come out with it. It's like that, some weird monkey's paw, something or other.

0:07:39 Lindsey: It's Hey, I don't know what you guys did at that pajama party.

0:07:41 Thomas: That's true. I, I can't, I, I can't reveal our secrets, but Yes, it may have resulted in this.

0:07:45 Lindsey: Yeah. Yeah, so this merely asking questions routine, corrosive, yeah. So then he says, quote, how will the just asking questions route look in the case of something, some virus, killing five or 10 or 20% of those it infects? Hopefully, we'll never know. And I'm like, yeah, Sam, hopefully, we will never live in a world where a particular portion of the population is routinely harassed, brutalized, incarcerated, and murdered at disturbingly high high rates. Because like just asking questions about a situation like that would be super awful. So yeah, hopefully we never we never know. And then this is the this is the cherry on top of the sundae. So he does all this. This is about 20 minutes of him talking about this. And then with 30 seconds left in the public feed version of the episode, he finally gets to listener questions. And he plays the following listener questions, the first one. So this listener asks, how can I inoculate my biracial children against the identity politics ideology they are bound to encounter at school and university. And as the theme music is, I swear to God, it's so good.

0:07:56 Thomas: Oh. Boy. Yep. Yeah.

0:08:44 Thomas: That's Not possible. This is not possible. Bum, bum, bum. That's Not, this is designed Yeah.

0:08:54 Thomas: This is, this, he, you know what, gonna do a big reveal and we're all gonna have to, you know, like, hand it to him, like, probably not worth all the like awfulness that you've done, but like, as pranks go, that's a pretty killer reveal that He was in on the joke the whole time that First Inoculate, like it could

0:09:06 Lindsey: It's pretty amazing. Yeah. Yeah, mm-hmm. And the last thing, the last you hear in the public feed version is him and his voice is fading out into the closing music or whatever, but he says, "Well, Walt, this is a question that is on the mind of many of us these days." It's You can't write this shit, it's So good.

0:09:29 Thomas: Oh my God, no. That's Too Perfect. No one could come up with that. Wow. I'm so glad you took the time to tell us that. I'm I, Would almost listen to Sam Harris again, man. That's tough, but yeah, it might be worth it for that. That's pretty, that's pretty stellar and again It's pretty, I don't know, revealing that Brett has and Heather have gotten so, so far full of shit and past it that even Sam Harris is like, okay, all right, you

0:09:33 Lindsey: Yep. You're Welcome. No, It Was enjoyable.

0:10:00 Lindsey: Yeah. You're

0:10:04 Thomas: Oh man. Well, that is fantastic. Shall we, uh, thank you for that. That's made my day.

0:10:09 Lindsey: Welcome. Yes.

0:10:10 Thomas: Now, shall we talk breakthrough infections and so forth?

0:10:13 Lindsey: Yes, we shall. Okay, so you, so the article that you sent me was from the Washington Post, and it had the headline, "CDC shows that three-fourths of people infected in Massachusetts coronavirus outbreak were vaccinated, but few required hospitalization." And so, yeah, you sent that to me and were a little bit confused. I'm sure lots of people were. And that headline, I think, is a little but misleading, because it's very easy to come away with the impression that, like, the vaccines don't work, right?

0:10:39 Thomas: Yeah.

0:10:41 Lindsey: I mean, in fact, you know, for people that are already thinking that vaccines are part of some, like, conspiracy of some sort to actually kill us all, those people are going to see that headline and be like, "See, I told you, like, you're even more likely to get the, the, the virus if you're vaccinated," right?

0:10:56 Thomas: Yeah. That's what it looked like from the numbers. It couldn't have possibly been right. I don't know. Something's up.

0:10:56 Lindsey: Yeah. Yeah. Yeah, there is, um, so the reporting in the article itself isn't terrible, um, but I would have liked to see them play up that, like, hey, by the way, the 75 doesn't say anything about vaccine effectiveness, which, which it doesn't. But yeah, yeah, that's going to be the meat of what we talk about. But here are the key takeaways from the Washington Post article, which I think are a fair summary of what's going on in the CDC report. So there is new evidence in the CDC report that vaccinated people can spread the Delta variant more easily than we've seen in older strains of COVID. Right. So they found that this is a quote from the Western Post article. They say, quote, the study found that vaccinated individuals carry as much virus in their noses as unvaccinated individuals.

0:11:14 Thomas: Can't wait to hear about this.

0:11:44 Lindsey: And we'll get to how they got that. And that seems to be essentially right. And, you know, for previous variants, the vaccine seems to seem to markedly reduce viral load, which prevents vaccinated folks from spreading the virus. But for Delta, it looks like that might not be true. And that's something to be concerned about. So findings like those presented in the CDC report report provide, I think, a very sound basis for the CDC's reversal about masking among vaccinated individuals. If vaccinated people transmit Delta as easily as unvaccinated people, then the world just got a hell of a lot more dangerous for people that are not vaccinated. They are no longer safer if they're just around vaccinated individuals, and that's really bad. So we need to mask in public to protect others. I mean, because, you know, there are plenty of unvaccinated people who aren't unvaccinated by choice. And that really sucks for them. This is a scary, a scary thing to come out for them." However, the Washington Post also notes that the cases of vaccinated individuals developing severe infections remain rare, and that's true.

0:11:44 Thomas: Yeah, yeah, yeah.

0:12:45 Lindsey: And, that proportionally, unvaccinated people are still much more likely to be infected than vaccinated people are. And that's also true. So, mostly, the findings presented in this case study are bad news for for unvaccinated folks and folks who have unvaccinated people in their household, right? And that's scary. So the question is, how do we square those takeaways with that headline finding that 75% of the people in this outbreak were vaccinated?

0:13:06 Thomas: Yeah. That Number makes it look like it's worse to to be vaccinated, like it's weird.

0:13:13 Lindsey: It does. It does, yeah. But luckily, that is not the case. Right, so about the CDC report. So this was published by Brown and colleagues in late July 2021, and it describes a case study of a particular COVID-19 outbreak that happened in Barnstable County, Massachusetts in like early to mid-July of 2021. And so Barnstable County is home to Provincetown. And in Provincetown, they host these annual events like Independence Week and Bear Week. I had never heard of these. I don't know if you have.

0:13:15 Thomas: Okay.

0:13:45 Thomas: In the animal sense? Or Never mind, that's fine. Okay.

0:13:50 Lindsey: Well, no, no. I'll tell you. So from the Provincetown tourism website, they say Bear Week is the largest gathering of bears in the world. Tens of thousands come to Provincestown during this annual event to go to bars, eat honey. No.

0:13:57 Thomas: Still hasn't told me still hasn'Told me, yeah. That

0:14:04 Lindsey: To go to parties, to bars and clubs throughout the town. You know what you're getting into when you attend. No, we're not talking about actual bears. That's from their tourism website.

0:14:05 Thomas: Still didn't clarify. Oh.

0:14:18 Thomas: Finally okay now it becomes clear there, yeah.

0:14:22 Lindsey: Yeah, so these are large events. They're attended primarily by gay men. And I only mentioned this because these events were connected to the outbreak and because this does become very relevant to interpreting some of the statistics later in terms of the demographics in this outbreak. So there were 469 cases in this particular outbreak, which was associated with multiple events and gatherings. And of those 469 cases, 346, or 74% of the cases, did occur in fully vaccinated people. Another finding that they talked about was that in a subsample of these cases, in 133 cases, they were able to perform genomic sequencing to determine which strains of COVID were represented in this outbreak.

0:15:08 Lindsey: And the vast majority of those sampled were the Delta variant. So it was like 89% of the sampled tests were from Delta. There was one additional case that was a Delta descendant. And in the other 10% of cases, they said that the genomic sequencing was not successful. So, it's entirely possible that all of these cases might have been Delta, but at least 90% of them were. So the findings that are being played up in the news coverage of this are that the majority of infected were vaccinated and the majority of the infections were caused by Delta, right? And then the report goes on to say that there were five infected persons in this outbreak who were hospitalized, and four out of those five were vaccinated. That's another finding that could sound bad. 80% of the people in this outbreak were vaccinated, right.

0:15:52 Thomas: Yeah.

0:15:52 Lindsey: Should say no deaths had been reported from this outbreak at the time of the report's publication. And I still don't think there have been, but I could have missed something there. And then another key finding that the report talks about is that they were able to analyze a metric from the PCR test, the COVID test, called threshold cycles in a subsample of the cases. So in 127 of the PCR tests from vaccinated people and 84 of the PCR tests for unvaccinated people. And this metric, these cycle thresholds essentially indicate how much virus is present in the sample. And the values on this metric looked very similar between the vaccinated and unvaccinated individuals. So this is where that claim comes from, that the vaccination may not reduce your risk of spreading the Delta variant, right?

0:16:37 Lindsey: It looks like the viral load was similar in both groups. And additionally, the cycle threshold values, they weren't just similar between the two groups. They indicated very high viral load in the two group, which is more evidence supporting the the idea that Delta is like very transmissible, um, but one, one more key finding, and I think this will actually segue us nicely into that, into that point, is that, um, they, they gave, they reported the types of vaccines that were represented in the breakthrough vaccinations that they got in this, in this outbreak. So they essentially said like the percentages of people that had Pfizer, Moderna, and JRJ that developed a breakthrough infection. And so their numbers were as follows. So 46% of the people in the outbreak had Pfizer. 38% of people in outbreak had Moderna.

0:17:23 Lindsey: And 16% of the that had breakthrough infections had Johnson & Johnson. And I think that this is an But this is an interesting thing to key in on because I think it does kind of, it could be interpreted or misinterpreted in a way similarly to that 75%, right? So if I'm looking at that and I'm seeing that like the majority of these breakthrough infections were with Pfizer and Moderna and only 16% were with J&J, I might go, hey, wait, does that mean J&J is much more protective against breakthrough infections?

0:17:28 Thomas: Interesting but Even I can tell you, you got to look at the base rate of people that are vaccinated with those, right?

0:18:00 Lindsey: Exactly, right? And they do provide that information. So in the Massachusetts population of vaccinated people, 56% of those vaccinated in Massachusetts got Pfizer versus the 46% in this outbreak. 38% got Moderna versus the 38% inthis outbreak. And only 7% got J&J versus the 16% that had breakthrough cases in this outbreak. And so from those things, it kind of gives you a sense that, like, actually, J&J is overrepresented in this outreach, versus how many people actually had J&J in the population. Population, right? So I, that this is an important point to lead in because the percentages alone within this sample of cases in this outbreak don't tell you anything about vaccine effectiveness, right, because in order to know about effectiveness, you have to know the percentages in the sample and the percentages in the population that were vaccinated, right. And so that's what's super annoying about various outlets featuring the 75% of their headlines, because there is zero, a way that that number communicates anything helpful and true to readers about how much these vaccines are helping to prevent infection,

0:18:18 Thomas: Yeah.

0:18:28 Thomas: So That occurred to me, of course, but I still felt, and, and maybe you can, you're going to clarify what the numbers really Mean but it still felt to me like even if the vaccination rate was like, like, I don't know, 90% in this population, 75% of the cases being vaccinated seemed like not, I dunno. I guess I don't know. Maybe I don't know how to like properly think about that. Like, what would be a good number? Like, if, if you had a, you know, very high rate of vaccination, you know, would 75% be a good number? Yeah. It's like, see, it's only 75%. It just still just seems like such a big number is the problem. Okay, sorry, I'll let you get to it.

0:19:09 Lindsey: Yeah.

0:19:41 Lindsey: Yeah, I mean, no, that is exactly where we're going. And like, yeah yeah, actually, if it was 90% of the people in that were at these events and got exposed that were vaccinated, yeah 75% would actually be really good, right, Right. If you if you look at it in terms of like a relative risk reduction standpoint, which is what we'll do in a second.

0:19:54 Thomas: Really? Okay.

0:20:01 Lindsey: So then like they discuss limitations in the end of their paper. And the first limitation they discuss is the most important one. And it's it's the one that sheds light on this question about how to interpret the 75 percent. So they say, quote, data from this report are insufficient to draw conclusions about the effectiveness of COVID-19 vaccines. As population level vaccination coverage increases, vaccinated persons are likely to represent a larger proportion of COVID 19 cases. And again, this is the most important thing to drill down on. This analysis is being interpreted by some to mean that the vaccinated are actually like more likely to become infected. But this analysis was not designed to to look at effectiveness. We don't have the information we need. Like in order to evaluate effectiveness, as you said before, you have to have the base rates. You need to know what percentage of vaccinated attendees became sick and what percentage of unvaccinated attendees became sick, and make that comparison.

0:20:01 Thomas: But

0:20:51 Lindsey: All we actually know is what percentage of sick people were vaccinated. And that tells you more about your sample characteristics than it does about vaccine effectiveness. So referring back, I'm

0:21:01 Thomas: Is there no way to sort of take an educated guess at what those other numbers would be, okay?

0:21:07 Lindsey: Going to try to do that. I thought for a minute that I would be able to do this in a more focused way, but it's actually surprisingly hard to get the data that you would need in order to do that. But I did my best. I think I'm going to do something that's compelling. But So yeah, so but referring back to the Provincetown website, right? So they indicated that tens of thousands of people attend these annual events, right? That were connected with the outbreak. And yeah, it could very well be the case that the vast majority of attendees were vaccinated. And that out of those tens of 1000s of vaccinated attendees, 346 became infected, which would be a fraction of a percent. And that the 123 unvaccinated infections were actually a large proportion of the unvaccinated attendees. And we just don't have that information.

0:21:08 Thomas: Okay. Okay. Yeah.

0:21:53 Thomas: Good point when you put it that way, so you could construct, and we don't know, again, but like if you, I wish there was a better, like, a visual chart to go with this, you know? Of like, yeah, do an audio chart, damn it. No, because these are tough things for a layperson to keep in mind. But when you put it that way, but you're saying we don't know for sure that that's the case. So I guess in fairness, we don't know that that's, but at least could be an explanation for this that would be consistent with vaccines still being really fucking good, Right. OK.

0:21:55 Lindsey: Yeah. Yeah, I know.

0:22:15 Lindsey: Yes.

0:22:29 Lindsey: Yeah absolutely. Right. And I mean and we do know something about the proportions of different segments of Massachusetts residents who are fully vaccinated. And and I think that we can make some educated guesses about the relevant demographics at this at these events. Right. That could shed some light on how proportional these rates of infection were. Um, so, uh, as the Washington Post reported, 69% of eligible Massachusetts residents had been vaccinated at the time that they were doing this report, but that includes people who are age 12 and older, right? So the, these events that we're talking about are primarily attended by adult men and the median age of the people in the outbreak, for instance, was 40 years old. And if you look at the vaccination percentages by age, Higher uh. Proportions of people are vaccinated in the population as you look at older and older age brackets.

0:23:15 Lindsey: So for instance, 75% of people 18 and older are vaccinated in Massachusetts, and 87% of People 65 and older Are vaccinated in Massachusetts. So we don't know what the vaccination rate was among attendees precisely. But conservatively, I think it's reasonable just based on age alone to place it somewhere between exactly, which I honestly don't know how that interacts here, right?

0:23:35 Thomas: Not even bringing in the Bear demographic. Yeah. Well, it's got to be a more liberal demographic. And we know that there's a firm partisan split on vaccinations.

0:23:48 Lindsey: Yes. That, that was my thought as well.

0:23:48 Thomas: Right. Yeah, So also the gay community might be an interesting subset that could go either way, I guess, but it could even be more vaccinated, more willing to do that because of past experience with like the AIDS epidemic and so forth. But I could also see it going either way like the mistrust of doctors maybe. And so just for fun, I did a little bit of searching into this and I found actually the Tegan and Sarah Foundation. I guess that's a band. I've heard of them, but I don't know the band. Do you know the Band Tegan, Sarah?

0:23:50 Lindsey: Right. Yeah uh I vaguely I've never listened to him oh

0:24:20 Thomas: Well, they apparently have a foundation and it seems to be focused on like LGBTQ things. And they did like a survey of, you know, vaccine attitudes among LGBTQ plus. And I thought it'd be cool. We don't have the time to go deep in this and, you know. Have Lindsay take it apart or anything. But interestingly, and this This was as of June, so a few months. Responded to this survey, 90% of whom were LGBTQ+, were very likely to get vaccinated. It says that two-thirds were already fully vaccinated, and of those who weren't, 84% were trying to get vaccinated as soon as possible.

So, seems pretty strong. Now, here's what's interesting, though, and the reason I wanted to bring it up. The numbers are a little bit worse among trans people because they might not trust the health system after, you know, like what they've had to deal with, with doctors and, and all that. So I think it, it may, and again, they were just less willing. They weren't like full, you know, the numbers don't say they're fully anti-vax or anything. It's just, they were less willing to get the vaccine than the, than the

0:24:33 Lindsey: Okay wow yeah right yeah

0:25:27 Thomas: Others. And there's, and so I think that maybe should, I don't know, be a lesson to us. If, if you know any trans Trans people, they might, again, have a different experience of medicine, health and science. Like there may be reasons why they are hesitant on these things. And we should try to keep that in mind. Not that we shouldn't do everything we can to get everybody vaccinated, but that, you know, maybe maybe your approach might be a little different if you knew a trans person who was hesitant about the vaccine, for example. So I just thought that was interesting.

0:25:55 Lindsey: Yeah absolutely no that's super interesting. You should, yeah,

0:25:58 Thomas: Based on that evidence, I mean, maybe the so maybe the vaccination among the gay community could be even higher. I don't know, but I guess we'll have to ignore it for the sake of your, your number crunching. Cause we don't have a firm date on it, but all

0:25:58 Lindsey: You should send that to me.

0:26:09 Lindsey: No, but I think that that does sort of, reinforce what I was saying is that if you're only estimating vaccination rates based on age, I think that's a conservative estimate. I think, I suspect, even having not seen the data that you're citing here, that yes, I think the people who attended these events probably were even more highly vaccinated than even the very highly vaccinated populace of Massachusetts. You know, if that's the case, right, then these numbers actually look even better than I might be saying they are. Okay. So, so, but yeah, conservatively just based on age, right. I think it's reasonable to say that this, this crowd that was attending these events was probably had a vaccination rate somewhere between 75% and 87% just based upon age. And it could be higher than that. And so if we make that assumption, that would put the relative risk reduction due to vaccination somewhere between 6% and 58%.

0:26:59 Lindsey: In other words, in this conservative estimate that I'm doing, the risk of being infected was reduced by vaccination somewhere between 6% and 58% in this particular outbreak, right? But if I know SIO listeners, and if I don't know you, Thomas, you're probably not satisfied by a 52% range of estimates.

0:27:15 Thomas: It's a wide range. Yeah.

0:27:16 Lindsey: Yeah. So I was able to find some data sources that allowed me to estimate a little more precisely what the vaccine relative risk reduction in Massachusetts Massachusetts looks like in a recent sample of statewide cases, which are, you know, based on recent evidence, likely to be dominated by the Delta variant. Because, you know, that's really what we want to know here, right? Like, how well are these vaccines standing up to the Delta variant? Are breakthrough infections skyrocketing, right. Yeah, so I found, I found a COVID-19 vaccine report that just came out this week from the Massachusetts Department of Public Health. They apparently release these regularly. And what is contained in each of these reports is cumulative counts of breakthrough cases, hospitalizations, and deaths. And they provide this information in each report for two consecutive weeks. So you can look at the cumulative totals of cases as of July 31st, and then in the next column, they have the cumulative total as of August 7th.

So with those two sets of numbers, I can look look at the number of new cases, new breakthrough infections, just for the week of July 31st to August 7th, right, just by subtracting the first cumulative total from the second. And that's helpful, potentially, right?

0:27:41 Thomas: Right.

0:28:27 Lindsey: Because then I can compare the new breakthrough infections that happened that week to the new infections among the unvaccinated for the same week in Massachusetts. And I can do that because the New York Times has been aggregating cases by state, right. So I can just sort of go in and manually add up the total cases that happened in Massachusetts during this week, and then subtract out the number that were breakthrough cases. So essentially what I've got based on this data is I was able to estimate how many breakthrough infections happened during the week of July 31st to August 7th, and the number of cases among unvaccinated people for that same week. And if I have those two things, and I have information about vaccination rates in the state, then I can essentially calculate a risk reduction value for the entire state of Massachusetts for that particular week. Yeah.

So I can do with this data what I couldn't do with the data from this particular outbreak that they reported in this thing that was quoted by the Washington Post, so here are some highlights from that report from the Massachusetts Department of Public Health, some additional calculations that I did. So as of August 7th, there have been just under 10,000 breakthrough infections reported in Massachusetts total, right, and more than 3.6 million people have been fully vaccinated in Massachusetts. So that means that breakthrough cases have happened in 0.23 percent of fully vaccinated residents.

0:28:56 Thomas: Okay.

0:29:45 Lindsey: So less than a quarter of a percent of vaccinated residents have had a breakthrough case, right? Also, as of August 7th, there have been 445 breakthrough hospitalizations. So that's 0.01%, one hundredth of one percent of vaccinated Massachusetts residents have been hospitalized. And as of the same date of August seventh, there've been 106 breakthrough deaths, deaths, which is 0.002% of vaccinated Massachusetts residents, right? So bottom line here is that overall, if we look at all the breakthrough cases that have been recorded, very few vaccinated individuals are getting sick, and very, very fewer are becoming seriously ill and dying, right? But now we still want to know what these rates look like in the most recent cases, which are dominated by Delta.

0:30:31 Lindsey: And we want to get a sense of how these numbers compare to new infection rates among the non-vaccinated. So in order to look at that, I did a comparison between the numbers of new cases that happened between July 31st and August 7th among fully vaccinated residents versus unvaccinated individuals in Massachusetts.

0:30:49 Thomas: Does this show have the best science person or does this show have the best Science person? This is I am enjoying this immensely. What hardest working science person in podcast business? I say right here if that's a category.

0:30:49 Lindsey: Right? Oh, man. Yeah, I tried a bunch of different strategies, actually. I'm surprised at how difficult it is to actually get the numbers you need to do this kind of thing. If it had been easier, I would have done it for the country, but it's, it is what it is. So, um, anyway, so during that week, between July 31st and August 7th, there were 5,912 total new infections, 2,232 of those were breakthrough infections, so those were among fully vaccinated individuals, and that means that, yeah, and that mean that breakthrough infections accounted for 37.75% of the new infections during that week.

0:31:08 Thomas: Yeah. Wow.

0:31:37 Thomas: Another number that seems scary and then I just have to keep in mind, you know, like if we're dealing with a highly vaccinated vaccinated population still seems not bad, I guess.

0:31:39 Lindsey: I, yeah, exactly. Right. 'Cause 64% of the total Massachusetts population is vaccinated, right? So that's actually looking pretty good so far. Infection rates are proportionally lower among unvaccinated or among vaccinated folks, so right, that's good. But what I, what I did, and to, to get a sense of like how different the rate of infection was for this week for vaccinated versus unvacculated people, was to calculate a relative risk reduction value for, for all Massachusetts residents, right?

And so this is a rough estimate, right, I only examined, like, you know, one week of cases, so that's a one sample of cases, and this, you know, I'm not able to take into account the medical histories of Massachusetts residents and stuff, but I think that taking this week as a sample of infections does reflect something meaningful about the relative risk of infection in Massachusetts right now, as Delta is spreading through communities, right. So just to remind people, if you recall from our Brett and Heather episode, the relative risk reduction describes the percentage by which cases decline in the vaccination group compared to an unvaccinated group. And so you get this value by subtracting the vaccinated COVID rate from the unvacculated rate and then dividing that difference by the unvaccinated rate. And that gives you the percentage decline in risk in cases as a function of being vaccinated, vaccinated.

I, um, so I mean, we spend more time on this in that episode if anybody wants to go listen to that again, but, um, but yeah, so, so approximately 4.4 million Massachusetts residents are vaccinated. Out of those 4. 4 million, again, 2,232 of them had a confirmed COVID case last, during this week, right, which is 0.05% of the vaccinated population.

0:31:49 Thomas: Okay. Sure.

0:33:24 Lindsey: Approximately 2.5 million Massachusetts residents are unvaccinated, and out of those, 3,680 of them had a newly confirmed case of COVID during this week, which is 0.15%. So the relative risk reduction based on this one week is about 66%, meaning that if you're a resident of Massachusetts, you were 66% less likely to develop a new COVID infection during that particular week if you were vaccinated. And so this is consistent with what health authorities have continued to say, which is that these vaccines are still highly effective in preventing infection, even against Delta, but it also reflects the concerns that led the CDC to reverse its guidance on masking.

0:34:04 Thomas: Sure. Yeah.

0:34:05 Lindsey: Yeah. The new cases last week.

0:34:06 Thomas: Yeah, which is how you want them to be. We can talk about that in a minute, you know, like we I think we should revisit kind of that previous episode a little bit, but go ahead. I don't want to.

0:34:15 Lindsey: Yeah, yeah, so the new cases this week were likely to have been overwhelmingly caused by the Delta variant, brilliant. And it does appear that the vaccines were somewhat less effective against Delta compared to older variants, right? Which was up around, you know, estimates above 90% for pre-Delta variants, 100%.

0:34:28 Thomas: Yeah yeah. Still should be noted though that this was just purely based on infections or not infected and still adding in that, right, correct me if I'm wrong, is the severity that it's not just the, yeah, the massive, maybe I shouldn't say a hundred percent in context of that.

0:34:47 Lindsey: No.

0:34:48 Thomas: We're not claiming it's a hundred% effective. Not just the 66%, is that what you said? 60 something percent reduction.

0:34:56 Lindsey: Yeah, 66%. Yeah.

0:34:58 Thomas: There's also seems to be a massive benefit in terms of severity, right? Is that still true even with Delta?

0:35:03 Lindsey: Absolutely. Yeah. That is very much still true even with Delta. Yeah so risk is reduced by vaccination every single step of the way here. Here, vaccinated folks are less likely to be infected. And if they are, they are vanishingly unlikely to to experience severe illness, even against Delta. Yeah.

0:35:20 Thomas: I think what we're saying here is go get the fuck vaccinated if you haven't, please. Thank you.

0:35:22 Lindsey: Yeah. Yeah. This, you know, like I said at beginning, the the people for whom this is most scary, the stuff that came out in this report are people who are unvaccinated. And that doesn't include, you know, a lot of people who would like to be and can't be, you know, either for age concerns or because, you know, they're immunocompromised or something. And, um, yeah, so I think that we should be taking these findings seriously. Um, so that was most of what I wanted to focus on. That's, that's, the, the piece that, that really addresses, you know, how do we get the 75%, um, it, that's being headlined and stuff.

The discussion section of the CDC report, they also talk about a couple of other limitations that I think are interesting that people might, I don't know, want to hear about. So one additional limitation they point out is that asymptomatic breakthrough infections might be underrepresented in their study because of detection bias.

So meaning that while it looks like most of the vaccinated folks in this particular outbreak got symptoms, we can't have a great sense of that because asymptomatic people are less likely to get tested unless they're actually part of some study where they're just getting tested regularly, right?

0:35:35 Thomas: You

0:36:30 Lindsey: So there could have been a higher kind of asymptomatic infection rate here than was actually reported in the study or detected by it, right, Yeah. Another limitation they talked about was that the demographics of cases likely reflect those of attendees at public gatherings, right, given that these events were marketed to adult male participants. So that speaks in part to some of the things we've already talked about. But one sort of peripheral finding that they talked about was that the vast majority of people with breakthrough infections in this outbreak were men, and the vast minority were over the age of 40. So, that was the majority of breakthrough cases in their sample, but they were hastening to add, like, that doesn't mean that men over the age of 40 are necessarily at more risk of breakthrough infections.

0:36:37 Thomas: Hmm. Interesting.

0:37:02 Thomas: Huh? Right.

0:37:14 Lindsey: It says far more, more about the events that people were attending or that seemed to be associated with the outbreak. And then the last thing they note, and I thought that this was interesting as a qualification to the thing about spread and viral load, they noted that the metric that they used from the PCR test to estimate viral load was probably actually a very crude measure of viral load. And so while Yeah, so while the results were consistent with there being similar viral load between the vaccinated and unvaccinated persons, and that's something we should take seriously and we should definitely mask up in public, noted that, like, they really need to replicate that finding with more precise measures before they, you know, can definitively say that there's no sort of reduction in viral load due to vaccinated status.

And so I thought that was an interesting qualification there. It's possible that we'll see evidence come out, you sometime in the near future indicating that, you actually, there is some benefit here. But I don't know, overall, it does seem like Delta is way more transmissible, even among vaccinated people. So yeah, so that's, that's most of it. I do know. So takeaways, you now, we haven't been lied to about vaccine effectiveness,

0:37:39 Thomas: Huh. Yeah, yeah, yeah.

0:38:25 Lindsey: It seems like the vaccines are still showing high effectiveness in preventing infection, especially severe infection, even among, even with the Delta variant sort of, you know, being dominant now. But yeah, Delta seems to be causing more breakthrough infections than previous strains. So get vaccinated.

0:38:25 Thomas: Yeah.

0:38:41 Thomas: Inarguable. You know, Delta is more dangerous. Delta is more of a concern than before pre-Delta. You should be more concerned, you know, vaccinated Or not. So inarguable, but it still really helps to put that number in context, because just the bare bones headline of like 75% of these infections were actually breakthrough, it just is like, to the lay person, I'm sure it was disastrous, what kind of response that would have triggered in people, I think. I mean, I'm decently educated on these things and I still was like, what in the hell? You know, it feels like though, you shouldn't be particularly scared of getting serious COVID infection if if you're vaccinated still, right? I mean, it's still, it protects you a lot. And even if you were to get a breakthrough infection overwhelmingly,

0:38:49 Lindsey: Yeah. Yeah, Correct. You'd be fine.

0:39:32 Thomas: Yeah, they're not, they'RE not dangerous. So still very, uh, very positive to be vaccinated. Please get vaccinated and help them try to make sure others in your life do.

0:39:39 Lindsey: Yes. That the reporting about how scary it is, I think is, is putting us all back in sort of a psychological place where we're forgetting that like, yeah, there is a lot of protection offered by these vaccines. And that should be a lot of reassurance. Yeah.

0:39:52 Thomas: Maybe we should take just a few minutes to circle back as the zoom meeting people say, probably to our episode on the CDC recommendations that were controversial when the CDC said vaccinated People no longer need a mask. Some people have taken this recent news as, you know, a vindication of their opinion that the CDC was, was full of it or was made a bad decision. How are you thinking about that? Both, I guess, both that original episode, how we did it and now, yeah.

0:40:05 Lindsey: Yeah, well, the time, I think that the evidence that they had in front of them supported that change in guidelines. I don't Think that Delta had dominance in the US yet. And I think that that really was the thing that changed the game here, right? Um, so that's that's my thinking. I think that, you know, it was, uh, it was appropriate and nice for vaccinated people to have a little bit of a break this summer, and then the situation changed and their recommendations changed with it, and that's, uh, that's kind of what they ought to be doing. I Don't know. What do you think? Not

0:40:31 Thomas: Yeah. Yeah. I think that the the biggest counter argument to us would be like, well, this made it, you inevitable that Delta was gonna get worse, was this, but I don't know, I still feel like the main problem is people not getting vaccinated. The Problem Wasn't That some people who are vaccinated maybe didn't wear a mask. And also, I believe that the people were right. Like, if you disagreed with us, or if you, I think you were right to the extent that people took the guidance wrong. And we said this at the time.

It's like, yeah, I think the science seems to be totally right that you don't need to wear a mask if you're vaccinated at the time. Again, this is in the past. Now with Delta, we should just be wearing masks. Just do it. But at the Time, the science seemed totally correct. But I I guess maybe the CDC and others and me, and I don't know, maybe we didn't properly account for how badly people would follow this guidance. You know, that just seemed to turn it into, okay, no one has to wear a mask or it's just honor system. And that wasn't good.

And I think, again, I think I said this at the time, but like, it's hard because I think that was a concern then and the CDC was mindful of it. But I also at a certain point, you're like, well, maybe your job is to represent the science and then, you know, hope that people actually make good decisions with it, not try to hide what the science is. You know, even though even those studies were saying, like, it's actually fine, you don't need to do this, et cetera,

0:41:09 Lindsey: Getting vaccinated. Yeah. Yeah.

0:41:37 Lindsey: Yeah.

0:42:23 Thomas: Et cetera, to go against that science because people are going to react badly to your recommendations. It feels like a harder place to be in for politically and to to maintain trust in the CDC. But I don't know. I guess I don't know what to make of it. I don't think that this was like the cause of Delta taking over. I think, again, it's people not getting vaccinated.

0:42:32 Lindsey: Yeah.

0:42:46 Thomas: Yeah.

0:42:44 Lindsey: It was on. Yeah, I think so, too.

0:42:47 Thomas: And so it's hard to it's harder to be too mad at anyone other than the Republicans who are causing vaccine hesitancy. Like that's the main problem here. But I think that, you know, the people who disagreed with the CDC then have been probably somewhat vindicated. I guess I got to hand it to them a little bit. You know, I think that this was definitely a concern that they raised and, you know, it seems to have happened. I do think that we need to, I'm glad we put out this episode and you did the breakdown for us because a lot of those same people are sharing that headline as though this means that, like, you, we're all just fucked, like they're like, the vaccines don't work, et cetera, et cetera. And that's not true. So

0:42:55 Lindsey: Mm hmm. Yeah. No.

0:43:27 Thomas: I'm, I'm really glad we're clarifying that, but yeah, I guess that's my thoughts on it. Um, in the end, as you say, changing, and I did, I did this whole bit on comedy shoeshine the other week. Like it's, to me, it's not that hard to just change based on the recommendations, you know? Like I'll, I'll try to stop from yelling about it for another 10 minutes but like the main complaint of conservatives, the main response seemed to be, oh yesterday you said that, you know, and today you're saying, and it's, it's not that hard to just put that in a different voice and just be like, okay, yesterday they said that we don't have to wear masks, today they say we have to wear a mask, so I'll just wear a mat. Yesterday there was a tornado warning, today no tornado warning, so oh wait, tomorrow another tornado warning, I guess, you know, it's not actually that hard to change

0:43:44 Lindsey: Mm hm. Mm hum.

0:44:15 Lindsey: Yeah

0:44:15 Thomas: Things like that. It's like, are you, are you an adult? Are you a functioning human being? I mean, it'S pretty easy to just be like, Oh, recommendations changed. Everybody. Uh, seems like maybe there's good, good reason for that. Like, you know new Science, new data. It doesn't strike me as that difficult to just follow the recommendations, even if they change once every fucking half a year, you know.

0:44:15 Lindsey: Yeah. Yeah yeah. No, I agree with that. I mean, I I was a little a little bit hesitant about the original change to the CDC guidelines, but I was persuaded also that that at the the time, yeah, no, when Delta was not, did not have dominance in the United States, there really, there really was not a risk to vaccinated people being unmasked, so the fact that it has changed with the rise of Delta makes absolute sense, nobody is, they're, they're not like ricocheting wildly on on these recommendations.

0:45:04 Thomas: Yeah. Yeah.

0:45:05 Lindsey: They make absolute sense in in the light of how the actual circumstances are changing. So yeah.

0:45:10 Thomas: Well, Thanks so much for that breakdown, Lindsey, truly phenomenal work, uh, I seriously, I I think you are a gem in the podcasting world and I hope that people share this episode and and maybe benefit from Lindsay's hard work, everybody. She does the work that the, yeah, that the Dark Horse idiot IDW morons don't do when it comes to actually researching this stuff. So So please share this far and wide. You know, it's, I think this will make you feel a lot better, made me feel a little bit better about those headlines. Again, you know, Delta is, it's not to downplay Delta, but, you, there are, many, many, many stages along the way of, oh, this Delta is nothing to, oh, Delta is the end of the world and vaccines don't work, like there's a lot of stages along along the way there. And I think knowing where we are is a little, is better than just crying, you know, like we're dead. Having

0:45:27 Lindsey: Blushing.

0:46:04 Lindsey: Yeah.

0:46:04 Thomas: The proper numbers helps a lot, I think. So thanks so much for that. All right. As usual, if you have any questions, that Patreon thread, I was a little late, but you know in my defense, we hadn't had an episode in the month yet. So that August Patreon Q&A thread is up. So as the month goes on, post your questions there and we will have a fun Q&A at the end of the month.

0:46:08 Lindsey: Yeah, yeah.

0:46:24 Lindsey: Can't wait.

0:46:25 Thomas: But that's it for me for now. So yeah, we'll see you next time.

0:46:36 Clip: Thank you so much for listening to Serious Inquiries Only. If you like the show, the absolute best thing you can do is support us at patreon.com slash SeriousPod. The second best thing you can do, is please share it on social media or by word of mouth. Speaking of social media, follow me on Twitter at Serious Pod. If would like to be Facebook friends, send me a request at facebook.com Thomas podcast. If not up for that level of intimacy, that's fine. Maybe you want to join the discussion at facebook.com slash groups slash SIO members. Thank you again for listening. We'll see you next time.