It Would Have Been Worse (part 2)

Having a peek under the bonnet of pro-vaccine claims

In part 1 of this series we gawped at two slides depicting case detection rate (COVID ‘cases’ per 100 viral tests) for PCR and LFD tests by month and year. These colourful analyses presented a visual summary of what most folk already know: that vaccines do not confer any benefit in terms of reduced infection rates. In fact, we may go as far as to say that vaccines appear to be making things worse, with LFD kit detection rates at an all time high for a quadruple-vaxxed nation.

“Ah, but those infections would have been far more severe without the protection of the jab”, say protagonists. A fair point indeed, but we really ought to check such claims against reality. I say ‘reality’ because these days science-types tend to rely on computer simulations to tell them what is happening instead of looking out of their office window. These simulations are only as good as the programming permits and often enshrine the very hypothesis that we’re trying to validate. This is not unlike a dog sniffing its own arse or a thief acting as their own prosecution in a court of law.

How Do We Define Reality?

This is the tricky bit because we want to bite into something solid for our main meal rather than a meringue. The current definition of a COVID case is far too flimsy for this purpose, being reliant on a single positive test result in a process that can churn out false positives like a chef shelling peas. We can strengthen the notion of a ‘case’ by considering COVID cases in relation to hospital bed use and this is how I’ve started out, for a whole bunch of such readily available data may be found here.

Among the beds we may count (day beds, night beds, ward beds, specialist unit beds etc) it is the mechanical ventilation (MV) bed within high dependency and critical care units that garners the most attention even though the ventilation facility is not always used (there’s more than one way to oxygenate a patient, and oxygen requirements for COVID cases are not as straightforward as the media would have us believe). The reason I place value on MV bed counts for COVID cases is not so much the MV aspect but the fact that this type of bed is associated with a greater degree of medical care and lower patient to nursing ratio: these beds are not used lightly.

When we get down to brass tacks we’re talking about use of expensive beds in preference to cheaper, and careful management of a precious resource by experienced clinical teams. That’s the sort of reality I have faith in. No registrar in their right mind is going to assign an expensive bed to a patient simply because they test positive.

Bed Games

In Hunting For Vaccine Benefit (part 6) I noticed something peculiar going on with allocation of MV beds for COVID cases from Jan 2022 onward, so let’s start at the beginning by taking a look at fractional bed use over time by bed type for all hospital patients, whether COVID cases or nay. I’ve defined fractional bed use as the proportion of beds used in relation to maximum bed availability over the period Mar 2020 - Aug 2022, this being 124,560 general beds and 5,702 MV beds:

A value of 1.00 on the y-axis (vertical) scale denotes 100% of available beds across NHS England are in use. We should note available bed capacity is not the same as total bed capacity since wards and sections of wards can be temporarily closed down for a number of reasons, including lack of nursing staff. Think of that 100% as 100% of what clinical teams have available to them for patient management on any given day.

You’ll see three dashed red lines. These mark vaccination roll-out for the initial, secondary and tertiary doses, with roll-out defined as the first day that administration across England exceeded 1,000 daily doses. I’m pretty certain that subscribers are going to home right in on that huge surge in MV bed use shortly after the vaccination programme got going. Now that is seriously intriguing!

We could argue that this was merely the 2020/21 winter season peak arriving as it always would but then we’d have to admit the awkward fact that vaccination did nothing to reduce the requirement for MV beds. In this regard we may note a complete lack of seasonal peak for 2021/22, this being a period that saw a record number of cases. Are we looking at benefits of the booster or are we looking at harm arising from the first two doses? Both are equally plausible arguments; then there’s the wrinkle of the vulnerable not surviving the 2021/22 winter season (survivorship bias). It is also worth comparing the (unvaxxed) first wave peak with the 2020/21 (vaxxed) seasonal peak.

The series for general beds provides a sorry snapshot of mass closure of health services across the nation, with a paltry 40% fractional use back in Mar 2020. The people of England were always going to pay the price for this at some point, and in more ways than one. Was this necessary? I suspect history is going to reveal that it was not.

Those sharp dips in general bed use indicate that ward staff are able to enjoy mince pies, parties and cake each December, whilst HDU/ICU staff soldier on with duties regardless of festivities. But note the sudden ramp down in MV bed use after December 2021. That’s rather peculiar and unlikely to be clinically-driven. This might be a regional rather than a national decision and is worth further investigation for it could give a false impression of vaccine benefit to anybody doing an MV bed count. No such dip is found for general beds use of which has continued to rise.

At this juncture we ought to flip to looking at a similar chart for COVID bed use alone to clarify a couple of things…

COVID Bed Use

I find it ironic that peak bed use for COVID cases took place just after vaccination roll-out began, though we are deep into the 2020/21 seasonal peak at this point. If the vaccines conferred benefit in terms of a reduction in case severity shouldn’t we ideally see a third wave peak that is smaller than the first wave, rather than larger, or is that asking too much?

If we take general bed use as a proxy for moderate COVID symptoms requiring hospitalisation and MV bed use as a proxy for severe symptoms requiring intensive care then vaccine benefit would be realised as a divergence between rates of use for these two bed types. It’s hard to judge this from eyeballing of this slide, so here’s a slide we first saw in Hunting For Vaccine Benefit (part 6):

In this slide of the ratio between MV and general beds occupied with COVID cases divergence in the two time series in the previous slide would be expressed as a lowering of ratio values. As we can plainly see the ratio rocketed soon after vaccine roll-out began and we could argue as to whether this was caused by onset of the 2020/21 seasonal peak or vaccine harm (or both).

Worth noting is the reluctance for the ratio to drop after the 2020/21 seasonal peak had passed. Bizarrely, we find the ratio peaking in June 2021 when COVID cases were minimal. The puzzle here is what is keeping the ratio inflated over such a span of time, when we’d expect it to rise and fall with infection. Could this be a lingering and most unbeneficial effect of the vaccines or a change in how things are done at the sharp end?

Yes, there is evidence of a decline in the ratio straight after booster roll-out but this looks as though it is part of a general decline from June 2021 peak severity. No doubt this finds its way into official reports as a sign of booster benefit with no mention of the background decline in reliance on MV beds. Then there’s that short-lived upturn in the ratio during late October that turns into a puzzling plummet, heralding a most mysterious change.

The Puzzling Plummet

All mysteriously changes come Jan 2022 when general bed use for COVID cases rockets (see first slide) and MV bed use declines. This is not a gradual change, as we may expect from building vaccine and viral-induced immunity within a population, so we must look to policy and protocol as drivers of this change. It’s as if an executive decision has been made to admit and treat excess COVID cases under standard care protocols in 2022 rather than rely on enhanced care that requires those precious MV beds.

Whatever the reason(s) we are not looking at a slide of clear evidence of vaccine benefit. Either nothing much has changed despite triple and quadruple dosing or vaccines are exacerbating COVID symptoms. Right now the phrase “it could have been worse” appears to be as woolly as my knitted swim wear!

An idea

One possibility for the decline in COVID MV beds in favour of general bed use is a decision to return to normal standards of healthcare and free up high-end resources for all those folk who’ve always needed them (and a fair few folk who’ve been forced to wait for treatment). There’s a hint of this in the following slide in which non-COVID MV bed use is the mirror image of COVID MV bed use:

Upon consideration of both slides we now see that the decision to move treatment of COVID from HDU/ICU units and into general wards from Jan 2022 onward has permitted an increase in generalised MV bed use. I am sure this is a good thing and may well be a sign of improved methods of care for COVID cases, including use of previously shunned drug therapies. As a numbers guy I can only guess, but what strikes me is how easy it is for authorities to claim these changes as evidence of vaccine benefit when they may well be nothing of the sort.

Kettle On!