Updated: 27 May 2021
(The Law of Large Numbers – Part 2)
One of my followers on Twitter, Gert Priem, was so kind to translate my latest blog in English, for which I’m very grateful. Many thanks!
“There are three kinds of lies: lies, damned lies and statistics”
“You wear guilt like shackles on your feet,
like a halo in reverse
I can feel the discomfort in your seat,
and in your head, it’s worse”
Halo, Depeche Mode.
Commercial companies such as Moderna, AstraZeneca, Janssen & Janssen and Pfizer / BioNTech can of course, only be expected to display their products as beautifully as possible in the pharmaceutical industry’s window, even if the reality has to be slightly embellished and distorted for this. The ultimate goal of these companies is to make a profit, to make a lot of profit, and that includes advertising, which is to emphasize the advantages and cover up the disadvantages.
This is well known in the medical world and has been described many times.
Therefore, it is not surprising that in their trials the above mentioned companies only reported the relative risk reduction as a result (1,2) and not the absolute risk reduction, a frequently used method by pharmaceutical companies to ensure that the results of studies are as favorable as possible. But also, virologists, microbiologists and even epidemiologists including several professors, defended this choice of reporting as the only correct one. I can be brief about this statement: It is incorrect and strongly distorts reality. n Yet it was only recently and way too late that in the medical literature attention was drawn to the sobering fact that this is not proper reporting, as I highlighted in my previous blogs on the Pfizer / BioNTech and Moderna vaccine. Recently, harsh criticism was leveled in The Lancet about the way the results were presented (3).
I can imagine that the differences between absolute and relative reduction are not familiar to the average (Dutch) person, and that the subject is difficult for the non-introduced. Still, I think it should be comprehensible for everyone, as it is very important to make a decision about whether to get vaccinated or not. Certainly, because now it is talked about vaccinating children. Of course, I could give the formulas here, but I think it is more illustrative to show the real outcomes of these measuring differences using the well-known ‘on the back of a beer mat’ method. I will try to do that in this blog.
As I mentioned earlier, the SARS-CoV-2 virus only leads to serious illness in a small amount of people who are infected, and death occurs even less. The chance of serious illness or death is strongly age dependent, as may be assumed known by now. n As a doctor I am not interested in a cough, some muscle pain, a few days of headache, fever, or diarrhea. In fact, in current medicine, for a large proportion of people with COVID-19 the duration of illness is shorter than the waiting time for an appointment with their General Practitioner. This is because any patient who dares to call their GP with even the mildest complaints or symptoms that could indicate COVID-19, is unrelentingly referred to a PCR testing facility by a large proportion of GPs and only may enter the doctor’s office with a negative test certificate (and a face mask). n And for those people examined by their doctor without having to show a negative test certificate, mostly a warm grog and Paracetamol (acetaminophen) are sufficient to combat the complaints and symptoms, and one can uneventfully get better. In short, most people do not become seriously ill, do not end up in hospital, and certainly do not end up in intensive care. And yet, this is the largest group of people who were included in the vaccine efficacy studies by their manufacturers and on which the judgment of efficacy of the various vaccines is based. In addition, only the relative risk reduction was mentioned, not the absolute risk reduction. n The relative risk reduction, in terms of efficacy of the vaccines, is therefore largely based on symptoms that are of little or no relevance in clinical practice, because these people would recover spontaneously within a maximum of a few weeks without the need for medical treatment.
Notwithstanding the above, I will use the reported relative risk reduction, which is listed as a maximum of 95% for the Moderna and Pfizer / BioNTech vaccines, to calculate the absolute risk reduction later in this blog. This is despite the fact that for patients whose immune system does not work properly, such as people after an organ transplant, people with hematological malignancies and the elderly, this efficacy is in all probability by no means achieved, as already stated in my previous blogs. .
My proposition therefore is, as I have argued more often, that at an individual patient level three clinical result data are relevant to assess the efficacy of the vaccines: The number of hospital admissions, the number of admissions to intensive care and the number of deaths. However, the available data of results from various studies is limited. Only reasonably reliable studies are available for death from COVID-19. In my earlier blog “Weeds in the Science Garden” I wrote about the many snags involved in determining the IFR. That blog is also about a serious, if not terminal form of Dunning-Kruger Disease, from which many ‘science journalists’ appear to be suffering. Fortunately for them without realizing it, because absent awareness of disease is a prominent symptom of this serious cerebral disease.
To estimate the number of deaths, or the Infection Fatality Rate (IFR), I initially used the study by Levin et al. (4). However, a better overview of John Ioannidis from July 2021 is available now, an update of two previous studies (6). Based on the data from this study, I’ll start calculating again on the back of the beer mat.
If available, I will only use the IFR from high-income countries, being often higher in rich countries than in poor countries. Most likely because in these countries sick and frail elderly people do live longer than in poor countries.
For 2 middle-income countries, IFR was 0.3%, versus 2.8% in 12 high-income countries (range 1.3%-7.2%).
The reliability interval of the estimated IFR in this age group ranges from 1.3% to 7.2%. The category ‘elderly people’ pertains to people older than 70 years. Ioannidis shows that, when the number of over-85s increases, the IFR also increases as expected. Nevertheless, even for the 20% share of people aged over 85 – in the total group of elderly people – the point estimation of the IFR does not exceed 4.3%. Furthermore, in terms of IFR, I assume the worst-case scenario with an IFR of 7.2% and a 95% effectiveness of the vaccines on mortality. We now know for sure that the latter is a way too optimistic estimate in this age category.
Let’s choose an 80-year-old man from this group, who is already in the early stages of dementia, has two new hips and a new knee, one leaking and one fluttering heart valve, some calcified vessels, diabetes, and hypertension. Because of this misery, the chances that he will make it to the next year are not very good. The Grim Reaper’s Scythe is supplied in many shapes and sizes at this age and Mr. Reaper is not very selective in the use of his Scythe at this age. However, the man is very eager to one last time see his daughter, who has emigrated to Timbuktu to teach how to perform rain dances, so he wants to stay alive for the next twelve months at all costs, until his daughter visits him.
In my opinion he fits in the group with the highest IFR, the one of roughly 7,2 and I strongly advise him to take the vaccine. I also assume that the effect of the vaccine for him is optimal, and his relative risk reduction is 95% as well. n Now, suppose we have a whole group of these cheerful, sweet, and loud creaking ramshackle oldies who all want to see their rain dancing daughter one more time and continue to live at all costs until this is realized. Calculating with a relative risk reduction of 95%, his risk of death falls from 7.2% to 0.36%. The absolute risk reduction of death is therefore 6.8%. In other words, if this man gets vaccinated, the chance of dying from (or with) COVID-19 is reduced from 7.2% to 0.36%.
Based on this, if I calculate the Number Needed to Vaccinate, in the most favorable case the outcome is 1/0.068 = 15 people. In order to save a cheerful creaking oldie aged over 80 from death from COVID-19, I have to vaccinate at least roughly 15 people. That’s pretty reasonable, right? If I take the price of a Pfizer / BioNTech of 12 Euro per vaccine, then I must spend 180 Euro to be able to vaccinate five sweet oldies, giving one of them the chance to see his daughter one more time dancing in a cheerful African skirt. There is no shortage of rain in this country, the Netherlands. n All this under the assumption that they will not succumb to their fluttering and leaking valves, calcified vessels, or the shriveled kidneys in the meantime. You get it, Mr. Reapers Scythe, with which even the best vaccine cannot cope.
The next person is a 59-year-old legal philosopher who has been making a living as a vaccination proponent for years and wants to lead by example and certainly gets vaccinated. Ioannidis shows a point estimate of the IFR of 0.27% for the age group but does not provide a reliability interval. Now, our legal philosopher drinks quite heavily, only Chablis of course, eats fast food regularly in the mess hall of the University of Amsterdam, and spends all day thinking about how to convince the mob to get them all vaccinated. That causes a good amount of stress, and for the sake of convenience I assume that he has a higher IFR. Let’s assume his IFR has approximately doubled by all that stress, to 0.50%. Therefore, the relative risk reduction of 95% in this case results in an absolute risk reduction from 0.50% to 0.025%, being 0.475%.
Suppose we have a whole flock of legal philosophers, all philosophizing very hard about how to get all Dutch people on a needle, sitting in their small dark rooms at the University of Amsterdam all day long, writing their vaccination propaganda for the Health Council, with only one pleasure a day in the feeding shed of this stronghold of knowledge and wisdom. How many of these legal philosophers need to be vaccinated to save this one legal philosopher from certain death from COVID-19. That is quite easy to calculate: in the most favorable case, it would be 1/0.00475 = 210 freaked out legal philosophers. And for just 12 Euro per vaccine, it costs about 2,520 Euro to save one legal philosopher. By God I may hope that we do not have that many legal philosophers in the Netherlands, and I sincerely hope that in this case benefits exceeds costs, but if it were for people with a useful and valuable profession for society, that price would still be quite reasonable.
We continue: There is, for example, a Dutch Minister of Public Health, Welfare and Sports (VWS), who has fallen prey to the behavioral unit of his own advisory body, and, like a gramophone record that gets stuck, mechanically chants that everything and everyone must be vaccinated against the SARS-CoV-2 virus, including dogs, cats, horses and ferrets, couches, and kitchen chairs.
At 43, he fits the age group 40 to 49, so according to Ioannides his IFR is 0.082%. Now this minister is under a lot of stress, as his ministry has lost 5.1 billion in receipts. In addition, every night he suffers from terrible nightmares about huge piles of rejected face masks, which he bought for 100 million from his partner Van L. In his nightmares this whole pile of face masks starts moving, so he must run for his life in order not to get buried under them, while the face masks are getting closer and closer. Just when he is starting to suffocate under the pile, he wakes up all sweaty and with a pounding heart from this bad dream, after which he thinks he sees receipts whirling down like snowflakes again and again behind his bedroom window in the dark. Another stressor is that his multi-colored shoes are frequently smeared by plodding in the corona swamp in which he is struggling to move forward. And then there are malefactors who call him ‘little clown clusterfuck’ so you now understand: This minister has a very hard life, and his IFR will be on the high side.
We therefore must presume it to be doubled, and instead of being 0.082% should rather be 0.16%. The vaccine provides a relative risk reduction of 95%, so the absolute risk of dying from COVID-19 for this minister drops from 0.16% to 0.008%, and the absolute risk reduction is therefore 0.152% in the most favorable case. n Suppose we had a whole army of ministers at VWS, who all walk in muddy multicolored shoes, all chant the same chants, and all are addressed by their civil servants with the honorable title ‘little clown clusterfuck’. Although this is the ultimate nightmare for many Dutch people, the question is how many of these multi-colored floury potatoes should be vaccinated to save this one specific Minister of Public Health, Welfare and Sports from being suffocated by COVID-19, partly caused by an enormous pile of masks? n In the most favorable case, there are 1/0.00152 = 658 repeating human gramophone records on flower shoes. The cost for the vaccination of all these ministers is 658 x 12 = 7,896 Euro. I wonder if that budget would be approved by his colleague in Financial Affairs, but it probably will. Provided he doesn’t lose the receipt.
Second to last, there is a CEO of a major vaccine manufacturer who would undoubtedly have his 20-year-old daughter vaccinated against the SARS-CoV-2 virus. Of course, his daughter has no say in this, because when vaccinated publicly, this shows confidence in the vaccine, and therefore is good for business and even better for the wallet.
Now, daughter has always listened carefully to her father, she is already using a cholesterol lowering agent, a blood pressure reducer, just in case, an anticoagulant (you never know with those vaccines, safety first!), an antidepressant and an antipsychotic drug for prophylaxis. She is therefore the epitome of psychological and physical health. She could do some more sports, but unfortunately, because of that terrible disease against which she finally is happily being vaccinated, the sports clubs and gyms were closed: Even for daughters of CEOs of large pharmaceutical companies, life is not always easy.
According to Ioannides her IFR is therefore approximately 0.014%. Let’s assume her not being able to exercise also doubles her IFR, from 0,014% to 0, 0228%. The vaccination provides a relative risk reduction of 95%, so her absolute risk of dying from COVID-19 falls from 0.028% to 0.0014% and her absolute risk reduction is 0.027%. Now suppose the CEO of this major vaccine manufacturer, using a Dutch idiom, has “pissed outside the pot” on his business trips, how many 20-year-old illegitimate daughters would he have to have procreated to save his only legal daughter from COVID-19? At best, he would need 1/ 0.0002776 = just 2704 illegitimate daughters. Although I consider him capable of a lot, I think this is a bit adding insult to injury. However, the cash register does ring emphatically at the company, and I think that his 2021 bonus will be particularly generous, as saving his daughter will earn his company no less than 44,448 Euro.Unfortunately, that sum isn’t paid out of his own pocket, but that does not matter, because there are people around who do pay tax, isn’t it?
Our last person is a somewhat out-of-favor neurologist wearing rubber clogs, always dressed in T-shirts with the strangest texts. A neurologist who is particularly stubborn and sometimes a bit awkward as well, is now quite ashamed of his colleagues, who, dressed in blue coats, masks, and splash goggles, indiscriminately let themselves be ignored and, without even a trace of criticism, participated in the behavioral experiment concocted by the muddling flower shoe mentioned above.
This neurologist has three children, including a 10-year-old son. Now, none of the sparse hairs on his bald head would even think for a moment having his son vaccinated against the SARS-CoV-2 virus. Luckily there are always people who do think of their fellow man and who, out of compassion for the squeaky, ramshackle oldies, do have their children vaccinated without hesitation. After all, you are doing it for someone else…
The son is a bit playful, jumps on the trampoline for at least an hour every day, does not have the appetite of his father, and is therefore completely healthy. The IFR of the perfectly healthy son of the grumpy neurologist on clogs is, according to Ioannides, approximately 0.0027% at the age of 10 years. Suppose the son of the grumpy neurologist has inherited some of the bad habits of his father and plays games on his PlayStation way too much and way too often, his IFR would be at the maximum of 0.005%. Now suppose that the brain of the grumpy neurologist suddenly refuses service, and he immediately drives to the Public Health Service (GGD) to have his son vaccinated anyway, then the absolute risk of his son dying from COVID-19 would drop from 0.005% to 0, 00025%. n The absolute risk reduction would therefore become 0.005% – 0.00025% = 0.00475% How many ten-year-old sons of by Corona madness freaked out neurologists would have to be vaccinated to save that one son of that one grumpy neurologist? That is 1/0.0000475 = 21,053 10-year-old sons. The corresponding invoice therefore amounts to 252,631 Euro. With that, the last hair fell, even where he still would never give it a second thought to have his son vaccinated, not for a vaccination passport and certainly not for a holiday in the new vaccine-fascist Europe, from the bald head of the grumpy neurologist. Mind you, the above are the most favorable figures for advocates of childhood vaccination, with the lowest number of Number Needed to Vaccinate. n Suppose the nasty neurologist would throw the PlayStation in the trash can, puts his son on judo and football, and only lets him eat rabbit food and seaweed: Possibly his IFR drops to 0.0005%. In that case, the reduction in risk of dying from COVID-19 for the son is 0.0005% x 0.05 = 0.000025%. So, one would have to vaccinate 1/0.000025 = 40,000 sons of neurologists to save that one single son of this awkward one. This would cost society 480,000 Euro per son saved. That is still far less than throwing 5.1 billion Euro into the ‘Hofvijver’ (pond) in The Hague, but I would advise to keep the receipt, as you can never know…
The question now arises, how many people dare to let their children participate in a lottery, offering a chance to win the grand prize of 1 in 21,053 or even 1 in 40,000, but at the cost of being totally unsure whether their child has time for life to grow old healthfully. In any case, the awkward neurologist is not going to let that happen to his children
There are virologists, microbiologists and medical doctors in the Netherlands who think it a good idea to vaccinate children and adolescents. Apparently, they have little knowledge of the Number Needed to Treat, let alone the Number Needed to Harm, all in concern of an experimental vaccine technique of which we do not know the possible negative consequences in the long term at all. n They have united in a scary private club, where terms like ‘restraint’, ‘modesty’ and ‘prudence’ are dirty words. In steamy academic complacency and raunchy arrogance, they brew their smelly brown advice for ‘little clown clusterfuck’, who was inspired by a stroke of genius to keep his flower shoes in perfect shape. He’ll just gets ahead of himself.
One of these people is Károly Illy, once a pediatrician, but apparently since short not that concerned anymore about the best interests for and health of children, which he was and is supposed to defend. For sake of convenience, he also renounced the principle of ‘first do no harm’, which allows him much more freedom of action. It may cost some children, but there are still plenty. He wants to vaccinate all children from the age of 12 and has probably been thoroughly and extensively informed in this regard by the CEOs of the aforementioned vaccine manufacturers, enabling him to give well-founded advice to the often mentioned sad, but vain little clown.
David Eberhard, in his unparalleled TEDx talk about the ‘Security Junky Syndrome’ based on the book ‘The Basic Laws of Stupidity’, freely translated the following, never to be forgotten majestic statement:
“Stupidity is everywhere, regardless of education level, intelligence quotient or titles obtained.”
Apparently, it is a requirement to be allowed to join the Dutch Outbreak Management Team.
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2. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2021; 384:403-416.
3. COVID-19 vaccine efficacy and effectiveness—the elephant (not) in the room. The Lancet, April 21st, 2021.
4. Assessing the age specificity of infection fatality rates for COVID‐19: systematic review, meta‐analysis, and public policy implications. European Journal of Epidemiology, 2020 Dec;35(12):1123-1138.
5. Mortality in patients admitted to intensive care with COVID-19: an updated systematic review and meta-analysis of observational studies. Anaesthesia 2021 Apr;76(4):537-548