Increases in COVID-19 Are Unrelated to Levels of Vaccination Across 68 Countries and 2947 Counties in the United States

S. V. Subramanian and Akhil Kumar wrote . . . . . . . . .

Vaccines currently are the primary mitigation strategy to combat COVID-19 around the world. For instance, the narrative related to the ongoing surge of new cases in the United States (US) is argued to be driven by areas with low vaccination rates. A similar narrative also has been observed in countries, such as Germany and the United Kingdom. At the same time, Israel that was hailed for its swift and high rates of vaccination has also seen a substantial resurgence in COVID-19 cases. We investigate the relationship between the percentage of population fully vaccinated and new COVID-19 cases across 68 countries and across 2947 counties in the US.

Methods

We used COVID-19 data provided by the Our World in Data for cross-country analysis, available as of September 3, 2021 (Supplementary Table 1). We included 68 countries that met the following criteria: had second dose vaccine data available; had COVID-19 case data available; had population data available; and the last update of data was within 3 days prior to or on September 3, 2021. For the 7 days preceding September 3, 2021 we computed the COVID-19 cases per 1 million people for each country as well as the percentage of population that is fully vaccinated.

For the county-level analysis in the US, we utilized the White House COVID-19 Team data, available as of September 2, 2021. We excluded counties that did not report fully vaccinated population percentage data yielding 2947 counties for the analysis. We computed the number and percentages of counties that experienced an increase in COVID-19 cases by levels of the percentage of people fully vaccinated in each county. The percentage increase in COVID-19 cases was calculated based on the difference in cases from the last 7 days and the 7 days preceding them. For example, Los Angeles county in California had 18,171 cases in the last 7 days (August 26 to September 1) and 31,616 cases in the previous 7 days (August 19–25), so this county did not experience an increase of cases in our dataset. We provide a dashboard of the metrics used in this analysis that is updated automatically as new data is made available by the White House COVID-19 Team (https://tiny.cc/USDashboard).

Findings

At the country-level, there appears to be no discernable relationship between percentage of population fully vaccinated and new COVID-19 cases in the last 7 days (Fig. 1). In fact, the trend line suggests a marginally positive association such that countries with higher percentage of population fully vaccinated have higher COVID-19 cases per 1 million people. Notably, Israel with over 60% of their population fully vaccinated had the highest COVID-19 cases per 1 million people in the last 7 days. The lack of a meaningful association between percentage population fully vaccinated and new COVID-19 cases is further exemplified, for instance, by comparison of Iceland and Portugal. Both countries have over 75% of their population fully vaccinated and have more COVID-19 cases per 1 million people than countries such as Vietnam and South Africa that have around 10% of their population fully vaccinated.

Enlarge image . . . . .

Relationship between cases per 1 million people (last 7 days) and percentage of population fully vaccinated across 68 countries as of September 3, 2021

Across the US counties too, the median new COVID-19 cases per 100,000 people in the last 7 days is largely similar across the categories of percent population fully vaccinated (Fig. 2). Notably there is also substantial county variation in new COVID-19 cases within categories of percentage population fully vaccinated. There also appears to be no significant signaling of COVID-19 cases decreasing with higher percentages of population fully vaccinated (Fig. 3).

Enlarge image . . . . .

Median, interquartile range and variation in cases per 100,000 people in the last 7 days across percentage of population fully vaccinated as of September 2, 2021

Enlarge image . . . . .

Percentage of counties that experienced an increase of cases between two consecutive 7-day time periods by percentage of population fully vaccinated across 2947 counties as of September 2, 2021

Of the top 5 counties that have the highest percentage of population fully vaccinated (99.9–84.3%), the US Centers for Disease Control and Prevention (CDC) identifies 4 of them as “High” Transmission counties. Chattahoochee (Georgia), McKinley (New Mexico), and Arecibo (Puerto Rico) counties have above 90% of their population fully vaccinated with all three being classified as “High” transmission. Conversely, of the 57 counties that have been classified as “low” transmission counties by the CDC, 26.3% (15) have percentage of population fully vaccinated below 20%.

Since full immunity from the vaccine is believed to take about 2 weeks after the second dose, we conducted sensitivity analyses by using a 1-month lag on the percentage population fully vaccinated for countries and US counties. The above findings of no discernable association between COVID-19 cases and levels of fully vaccinated was also observed when we considered a 1-month lag on the levels of fully vaccinated.

We should note that the COVID-19 case data is of confirmed cases, which is a function of both supply (e.g., variation in testing capacities or reporting practices) and demand-side (e.g., variation in people’s decision on when to get tested) factors.

Interpretation

The sole reliance on vaccination as a primary strategy to mitigate COVID-19 and its adverse consequences needs to be re-examined, especially considering the Delta (B.1.617.2) variant and the likelihood of future variants. Other pharmacological and non-pharmacological interventions may need to be put in place alongside increasing vaccination rates. Such course correction, especially with regards to the policy narrative, becomes paramount with emerging scientific evidence on real world effectiveness of the vaccines.

For instance, in a report released from the Ministry of Health in Israel, the effectiveness of 2 doses of the BNT162b2 (Pfizer-BioNTech) vaccine against preventing COVID-19 infection was reported to be 39%, substantially lower than the trial efficacy of 96%. It is also emerging that immunity derived from the Pfizer-BioNTech vaccine may not be as strong as immunity acquired through recovery from the COVID-19 virus. A substantial decline in immunity from mRNA vaccines 6-months post immunization has also been reported. Even though vaccinations offers protection to individuals against severe hospitalization and death, the CDC reported an increase from 0.01 to 9% and 0 to 15.1% (between January to May 2021) in the rates of hospitalizations and deaths, respectively, amongst the fully vaccinated.

In summary, even as efforts should be made to encourage populations to get vaccinated it should be done so with humility and respect. Stigmatizing populations can do more harm than good. Importantly, other non-pharmacological prevention efforts (e.g., the importance of basic public health hygiene with regards to maintaining safe distance or handwashing, promoting better frequent and cheaper forms of testing) needs to be renewed in order to strike the balance of learning to live with COVID-19 in the same manner we continue to live a 100 years later with various seasonal alterations of the 1918 Influenza virus.

Source: Springer

What’s for Lunch?

Boiled Mackerel Set Meal at Aji no Masafuku in Fukuoka, Japan

The price is 1,100 yen (plus tax).

Years of Exposure to Air Pollution and Road Traffic Noise May Raise Heart Failure Risk

Exposure to air pollution and road traffic noise over the course of many years may be associated with an increased risk of developing heart failure, and the correlation appears to be even greater in people who are former smokers or have high blood pressure, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

“We found that long-term exposure to specific air pollutants and road traffic noise increased the risk of incident heart failure, especially for former smokers or people with hypertension, so preventive and educational measures are necessary,” said Youn-Hee Lim, Ph.D., lead author of the study and assistant professor in the section of environmental health within the department of public health at the University of Copenhagen in Copenhagen, Denmark. “To minimize the impact of these exposures, broad public tactics such as emissions control measures should be implemented. Strategies like smoking cessation and blood pressure control must be encouraged to help reduce individual risk.”

This analysis examined the impact of long-term environmental exposure, specifically from air pollution and road traffic noise, on the development of heart failure in a group of female nurses in Denmark over a 15-to-20-year period.

Researchers collected data from a prospective study of over 22,000 members of the all-female Danish Nurse Cohort study. The women were 44 years of age and older at study enrollment and living in Denmark. Participants were recruited in 1993 or 1999, and when they enrolled, each woman completed a comprehensive questionnaire on body mass index, lifestyle factors (smoking, alcohol consumption, physical activity and dietary habits), pre-existing health conditions, reproductive health and working conditions. Information on heart failure diagnoses was gathered throughout the 20-year follow by linking study participants to the Danish National Patient Register, which includes records on all health care provided at hospitals in Denmark. Patient data was collected through December 31, 2014.

The study group lived in rural, urban and suburban areas throughout Denmark. To best measure individual exposure to air pollution and road traffic noise, researchers maintained records of each individual’s residential addresses, including any moves to new residences from 1970 and 2014. To determine levels of air pollution, the yearly average concentrations of two components, fine particulate matter (PM2.5) and nitrogen dioxide (NO2), were measured using a Danish air pollution modeling system. Road traffic noise levels within a three-kilometer radius from the participants’ residential addresses were estimated using a validated model system called Nord2000 and measured in decibels (dB), the standard unit for the intensity of sound.

The analysis of various pollutants and their effects on incident heart failure found:

  • For every 5.1 µg/m3 increase in fine particulate matter exposure over three years, the risk of incident heart failure increased by 17%;
  • For every 8.6 µg/m3 increase in NO2 exposure over three years, the risk of incident heart failure increased by 10%;
  • For every 9.3 dB increase in road traffic noise exposure over three years, the risk of incident heart failure increased by 12%; and,
  • Increased exposure to fine particulate matter and status as a former smoker were associated with a 72% increased risk of incident heart failure.

“We were surprised by how two environmental factors – air pollution and road traffic noise – interacted,” Lim said. “Air pollution was a stronger contributor to heart failure incidence compared to road traffic noise; however, the women exposed to both high levels of air pollution and road traffic noise showed the highest increase in heart failure risk. In addition, about 12% of the total study participants had hypertension at enrollment of the study. However, 30% of the nurses with heart failure incidence had a previous history of hypertension, and they were the most susceptible population to air pollution exposure.”

The study has several limitations. Researchers did not have information on additional variables that may have affected the results of the analysis, such as measures for each individual’s exposure to indoor air pollution or occupational noise; the amount of time spent outdoors; glass thickness of the windows of their home, which may influence noise pollution levels; if they had a hearing impairment; or individual socioeconomic status. Additionally, almost one-fourth of the original participants in the Danish Nurse Cohort were excluded from the final analysis because information was missing at the beginning of the study or at the study’s completion, so selection bias may be a contributing factor. The researchers also note that since they investigated Danish female nurses’ exposure levels and health outcomes, a generalization of the results to men or other populations warrants caution.

Previous research has shown an association between air pollution and cardiovascular disease, and the American Heart Association detailed a collection of research on the risks of pollution in a scientific statement in 2004, with additional updated findings added in 2010. In 2020 the American Heart Association American Heart Association published a scientific statement and policy guidance to address the implications of air pollution amid the COVID-19 pandemic and beyond. The policy statement discusses policy guidance at the local, state and federal levels to improve the health of our communities. Short-term exposure to high levels of some air pollutants has also been linked to heart failure.

Source: American Heart Association

Codfish Cakes

Ingredients

3 tablespoons olive oil
1 large onion, finely chopped (about 1-1/2 cups)
1-1/2 teaspoons salt
1/4 teaspoon freshly ground pepper
1-1/4 pounds cod fillets, bones removed
2 tablespoons finely chopped fresh tarragon leaves
1 egg, lightly beaten
3 dashes Tabasco, or to taste
1/3 cup dry bread crumbs

Method

  1. Heat oven to 200°F.
  2. Heat 1 tablespoon olive oil in a skillet over medium heat. Add onion, 1/2 teaspoon salt, and 1/8 teaspoon pepper. Cook until onions are translucent, about 5 minutes. Set aside.
  3. Cut fish into large chunks. Pulse in a food processor to coarsely chop. Transfer to a medium bowl.
  4. Add onion, tarragon, egg, and Tabasco and combine well. Add remaining salt and pepper. Form eight 3-inch patties; dredge them in bread crumbs, shaking off excess.
  5. Heat l tablespoon oil in a large skillet over medium-low heat. Cook 4 patties until browned, about 4 to 5 minutes on each side. Remove to a baking sheet, cover with aluminum foil, and keep warm in oven.
  6. Wipe out skillet, return to heat, and add remaining olive oil. Cook remaining patties and serve immediately with tartar sauce and salad.

Makes 4 servings.

Source: What to have for Dinner


Today’s Comic