Part 1 pandemic focus: Risk-benefit approach on the jab
Are you confused with all the conflicting information about the jab? How do you make an informed decision? There has been so much contradictory information out there that I thought it was time to help readers make a decision based on the risk-benefit approach and support you during the pandemic. I am putting together a 3 part blog series to discuss an approach to the jab, what a nutritionist is doing to manage his risk and how an integrative pharmacist is supporting her health before vaccination. Welcome to Part-1:
Most would agree that to make an informed decision, one needs to assess the pros and cons of each option. In medicine, if you are at high risk (e.g. history of heart attack, stroke etc), the benefits of starting a cholesterol-lowering agent like a statin may outweigh the risks (side effects like muscle aches and pain). If we were to apply the same philosophy with the COVID-19 jab, reflecting on the following questions may assist you in making an informed decision:
- What are your risk factors for severe or critical illness (What is your baseline risk)?
- How will the jab benefit you? (What are the benefits?)
- How do you feel about the rare known serious adverse effects or the unknown long-term risks that new technology brings? (What is your risk tolerance?)
What happens if you catch the virus?
Data from Wuhan[i] estimate 81% of cases were asymptomatic/mild, 14% had severe illness (shortness of breath, low blood oxygen saturation) and 5% had critical illness (respiratory failure, septic shock, and/or multiple organ dysfunction or failure)
Risk of severe and critical Covid-19 is different for every individual
Risk factors for severe covid-19 and hospital admission, and risk factors for death as a result of covid-19 include older age, male sex, non-white ethnicity, being disabled, and pre-existing medical conditions including autoimmune conditions, obesity, cardiovascular disease, diabetes, respiratory disease, smoking and hypertension.[ii]
Each person has a different risk factor for severe and critical Covid-19 hence individual risk assessment is key.
What is your risk of death and hospitalisation from Covid-19?
The University of Oxford developed the QCovid® Online Risk calculator to help clinicians facilitate discussion on the risk of death and hospitalisation from Covid-19 with patients ≥ 19 years old. It is based on the UK population (higher case loads than Australia and New Zealand), short-term data and users have to agree to to its license use:
Base on the Calculator, my risks are as follows:
For me, I would be asking myself:
How do I feel about my risks of catching and dying from COVID-19? There is no right or wrong answer as everyone’s perception of risk can be different.
The actual effectiveness of the Pfizer vaacine
Data[iii] quoted for vaccine efficacy are based on relative numbers. This is a comparison between groups and does not reflect the actual absolute numbers.
For example, to win Lotto with 1 ticket, the chance of winning is 1 in 45,379,620. What if you bought 2 tickets?
You would have doubled your chance of winning lotto (100%=relative number) however the absolute chance is 2 in 45,379,620 (overall number).
Looking at the Pfizer vaccine[iv], vaccine efficacy is 95% (relative number) while the absolute risk reduction is 0.84%.
While the vaccine may reduce severity and hospitalisation, how much would depend on your baseline risk. Would an absolute risk reduction make a significant difference to your baseline risk?
What are the risks associated with the Covid-19 vaccines?
It takes 10 years to produce a safe enough vaccine and because of the pandemic, the Covid-19 vaccines were fast-tracked. For tried and true vaccinations in the past, most adverse effects present soon after vaccination.
However, Covid-19 vaccines are novel technology and these rules may or may not apply: only time will tell. Unlike the more traditional vaccines, there is no long-term safety data with these vaccines.
There have been some early warning signals following mass vaccination worldwide: rare serious adverse events associated like clots and inflammation of the heart. These were not picked up during initial studies so it can take time to determine the long-term consequences of novel technology. A rare outcome multiplied by millions of people can add up to a significant number: so far, there have been 10,000 injury claims against the vaccine in Australia.
With the advent of new variants (Omicron etc) the vaccine is less effective than we think and any benefit can wane with time whereby booster shots are already recommended.
Both the vaccinated and un-vaccinated can transmit COVID-19.
If you want to keep track of reported adverse effects in Australia, you can search the Database of Adverse Events Notification
Apart from the jab, what can we do to improve our health?
Fear is a great opportunity to take action for one’s health. If we know the risk factors for catching Covid-19, why don’t we encourage healthy weight and important diet and lifestyle practices. Adequate nutrition and hydration play an important role in the improvement and rehabilitation of patients with Covid-19.
Everyone whether vaccinated or not can benefit from boosting their immune system. Read my “Top 3 supplements” to boost your immune system by subscribing here
[i] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. doi:10.1001/jama.2020.2648 https://jamanetwork.com/journals/jama/article-abstract/2762130 (accessed 4 September 2021)
[ii] Williamson, E.J., Walker, A.J., Bhaskaran, K. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 584, 430–436 (2020). https://doi.org/10.1038/s41586-020-2521-4 (https://www.nature.com/articles/s41586-020-2521-4#citeas) accessed 4/9/21
[iii] Polack, PP ,Thomas SJ, Kitchin, N, Absalon J, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020; 383:2603-2615
DOI: 10.1056/NEJMoa2034577 https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=featured_home (accessed 4/9/21)
