Higher Risk of Infection in Up-to-Date Vaccinated

this is Dr mobin Syed from drbean.com welcome to one more show today's discussion is very interesting it is a pre-print study from Cleveland Clinic same team that had done a previous study that became very controversial and that was that the more boosters or more doses of a vaccine somebody gets there is a higher risk of infection this study is actually very very interesting there is nothing no conspiratorial message in here but there is a very interesting takeaway and what they are demonstrating is that the people Healthcare employees of Cleveland Clinic Ohio who are up to date according to the cdc's definition of up to date they had a higher risk of covert infection compared to those who were not up to date so I believe that right here we'll start a thread in your mind and that is why is this case so I'm going to explain that and I'm going to review the study with you however if somebody is thinking about immune system exhaustion I've done a video before called T Cell exhaustion watch that although that is not the mechanism that we are discussing today so let's start so starting with Dr bean.com this uh website and its access there is a link in the description that gives you access I believe that this is the last day and the weekend that we will offer this for this low price and then from the next weekend we'll bring it to a regular price of ninety seven dollars and then after that we'll bring it to the courses which would all have their own individualized prices and I also want to show you that we have a new library page I think you would really enjoy it and this this page you can visit for free just go to Dr bean.com and go to video library and you would be able to see these various um topics that we have covered so if you want if you would like to get more medical education or just support this work you can actually become a part of Dr Bean now with this here is the study that we are talking about risk of coronavirus disease 2019 among those up to date and not up to date on covid-19 vaccination so the up-to-date is the cdc's definition of those who have gotten the new bivalent vaccine this is a preprint so if you read here this article is a preprint and has not been certified by peer review it reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice so let's start I have gone over the PDF of this study as well I am now going to go to my drawings I think you'll love the drawings today I have a I have one drawing in which I believe I have discussed this whole study in one drawing so we'll reach there when we talk about why the mechanism of this study so these are gifts for Humanity and they're continuing the study is risk of coronavirus disease as we just discussed nabine Patrick Amy Stephen Department of infectious diseases Cleveland Clinic Ohio infectious prevention and then quantitative Health Science and the and so these are the Cleveland Clinic I wanted to show you the summary first this this one diagram is sufficient for the summary then there is another diagram that is sufficient for the for the mechanism so the summary is among 48 344 King age people and Clinic employees and they say in their manuscript that they are relatively younger population so among these population those not up to date on covid-19 vaccination had a lower risk of covid-19 than those up to date the current CDC definition provides a meaningless classification of risk of covid-19 in the adult population so then the question may be in your mind that what is that lower risk in not up to date so here is someone who is not up to date and here is someone who is up to date and this little red thing is the coronavirus it is hugging the other one so what is the the difference the hazard ratio is 0.77 for not up to date those who did not have the bivalent vaccine yet they had has a ratio of 0.77 which means 26 percent sorry actually is 23 percent less likelihood of infection compared to those who are up to date and I wanted to make this statement here this is now my statement and it can be discarded and thrown out and said to be wrong but I I saw for this team's last study that there were people who were just phds who were trying to just imply that this number of this amount of difference is just useless difference that is not the case it is statistically significant number one number two if you think about it the point of the vaccine is actually not to say that unvaccinated or not up to date will be lesser than the vaccinated and for the risk and that is okay that is a small difference well the vaccine is supposed to create a large difference so the that I believe is gaslighting to just say oh this is just a small difference so here the difference is actually statistically significance and and decent enough and that is 23 percent less likelihood or the hazard ratio is 70. 0.77 the confidence interval is 0.69 to 0.86 so it can even be up to 31 percent less likelihood and if you look at the p-value that is also significant so this is statistically significant data because the size of the study is actually decent and tell me if you like this diagram where the covet is kind of kissing one of us so then there can be one more question in your mind and that is that maybe this is because the people who are up to date they are more they have more comorbidities or they have advanced their age and so on so what this group did was they separated out they stratified with age and they took the subgroup of 65 Plus and they did the same model analysis on them and they had a very similar result as they got with the overall results so age or age related other aspects were not a factor so then the question becomes why did they do this study so before I continue on I want to make sure that this is clear that the study it's a preprint and it shows that those who are according to the definition of CDC those that are up to date on the vaccine booster they are they have a higher risk of infection covid-19 infection catching the coping 19 infection compared to those who are not up to date so that is a basic message now the question is why did this team do the study what were they thinking so let's see they said in their manuscript that hey CDC has defined being up to date so CDC changed the definition of up to date two six years and plus everyone will only be called up to date if they have gotten the latest bivalent vaccine anyone who does not have the bivalent vaccine will not be called up to date so this was the background for this team and they said you know what here is the definitions now there are people who are not vaccinated then there are people who are vaccinated but with the previous vaccine types and then there are people who are bivalent vaccinated and only the bivalent vaccinated are called up to date and they are recommended by CDC for six plus so this team said all right so that is what is the recommendation let's go and figure out what kind of efficacy this is offering so the thought again continued with the researchers thought they said we are in xbb time frame right so we have we are newer variants and xbb Dom became dominant in Ohio on 29th January 2023 which they took as day 0 for their study the study was 100 days long study so they said all right we are in this xbb state the bivalent is the definition of the up to date that is the guidance the recommendation from CDC so let's see how does it work with xpb and here is what they said this is from the manuscript they said given this lack of effectiveness of the bivalent vaccine against the xbb variant so they refer to another study which could not find the effectiveness so they said given this lack of Effectiveness which are predominantly circulating strain at this time it is reasonable to question whether individuals up to date with a vaccine of questionable Effectiveness are protected against covid-19 compared to those that are not up to date meaning sure we are seeing that there is a efficacy problem so why not we analyze it why not we try to figure it out with with proper methods so the purpose of this study was to evaluate whether individuals who were not up to date on covid-19 vaccination had a higher risk of covid-19 than those who are up to date so once again this is just a summary of what I showed you before and that is that the results were the hazard ratio in not up to date was 0.77 now the question becomes why so the researchers present two reasons I'm not going to go out on a conjecture to say what I think and I want to make sure that we understand what researchers said we can all then discuss separately that what we think it may be here is what researchers said researchers said there are two reasons for this difference but there can be two reasons I'm sure that there can be more than that but they looked at two one they said that xbb variant is actually has escaped to a larger accident this vaccine so vaccine is not effective against the xbb so expecting the vaccine to be to work against xbb is kind of not the right thing secondly this is very interesting and I I see this for the first time in a study where the researchers directly address CDC and cdc's decision making and they said CDC doesn't consider infection as an up-to-date States state of a person and that is true CDC does not consider infection as up to date right so that is also kind of a lack of cdc's attention to this and then the second reason is that unvaccinated had previous infection or not up to date had previous infection protecting them so let me explain this I think I'm I'm pretty excited about this one diagram that can explain the whole reasoning behind this study here is a diagram imagine that we had three umicron or early Omicron ancestors starting all the way from Wuhan and alphas and deltas and those so they are here so we passed through that phase where these were the variants then came umicron variants and then ba4 ba5 bqs and then came the xbb and their cousins so they say that what is happening is that those who are not up to date they had to these individuals who were not up to date they had to just keep traversing this era and they had to experience infection for example by Omicron and as they were infected by Omicron the infection to very close to their cousins next cousins allowed this this infection better protection because in variation the umicron is very close or closer towards xvb so a previous infection was protective on the other hand a bivalent vaccine what it did was look at this person this person got the vaccine and then pole vaulted over majority of the omicrons because the vaccine was somewhat protective and ended up Landing in the xbb time frame where the vaccine efficacy had been reduced and now this person was exposed to xbb while this person was not exposed to the previous variant very well because vaccine was protecting and so this person got attacked by xbb and had less protection so those who were not up to date they had a higher rate of actually exposure to the previous variants and because of that the researchers think they were better protected in xbb time and those who were protected by the vaccine they kind of went over the more recent ones and they actually did a an experiment on that or they did the analysis this is a retrospective study what they did was they looked at both cases up to date and not up to date with the very recent infections they just collected that cohort of data and they compare these these two with each other and there was no difference so that means in vaccinated up to date or not if somebody was recently infected they had better protection with the xbb but if somebody was just recently vaccinated with the up-to-date definition vaccination by villain they were not very well protected by xpb so this one diagram actually presents all of their mechanisms here so I think it's a pretty cool diagram I signed it too for this reason so back here so these are the two reasons that they thought now some details this was a hundred day study and if you just wanted to hear this much that what is the study what were the mechanisms what were the thinking this is it I think that you like what they said in their conclusions I'll reach there in a minute uh just some more details for the completion sake 100 day study retrospective study free print as you can see there were 48 344 Cleveland Ohio Clinic employees that were participating in it the mean age was 43 plus relatively younger population three percent got censored because they left the clinic during this study period now there were 27 percent of these individuals who were finally participating in the study they who were up to date the remaining were not up to date three percent became infected 1474 became infected in these hundred days forty six percent were documented covered positive 76 percent tested at least once positive for covet 87 percent had at least one dose of the vaccine but that doesn't mean they all had the up-to-date dose they would have the previous doll doses only 27 percent had up-to-date those 92 percent were previously exposed to an infection or vaccination 76 percent were covered positive at least once during B their employment so with this data here are some more interesting differences or comparisons they found in the data number one those who were previously infected and exposed to BQ ba4 ba5 more recent variants these individuals in xbb time had substantially significantly lower risk of infection compared to those who were either up to date on the prevalent or whoever three oh Micron time remember that diagram with the three piles of Omega the Sask of twos so before the the left one the wuhans and the Deltas and the alphas and the early Unicron so earlier Micronor or not infected at all compared to them those who were infected with ba45 had much lower risk of infection with xbb makes sense then they stratified that means the growth and they looked at them in in certain matched groups they're stratified by most recent infection I mentioned that before that up to date or not up to date but infected more recently they had them all compared to each other and they found out that there was no difference in Risk so it was really the latest infection that was providing the protection and that is one of the statements they made in their manuscript that the recent infections are robust protections that doesn't mean that one should go and get the infection infection has its own risks even up to death although much more reduced nowadays plus infection still has long covert just like vaccine has vaccine injury as well as one of the possibilities so meaning just protect yourself and then if not known to be previously infected those individuals who were not known that they were infected so they could have been asymptomatic and they'd say that in their study limitations that it may be that some people were asymptomatically infected in either of the groups and we do not know that so those who are not known to be infected previously sorry Kyrie is sleeping next here in those those who were up to date had a higher risk of infection compared to those who were not up to date so that is also interesting now some interesting points that I want to read from the manuscript and I specifically want to read from the manuscript so nobody thinks that this is my point of view because or I am making up something because the covid-19 bivalent vaccine provided some protection against the ba4 and 5. those not up to date were more likely than those up to date to have acquired be a four or five lineage infection when those lineages were dominant it is now well no that's our scope to infection provides more robust protection than vaccination and they have studies for that therefore it is not surprising that not being up to date according to the CDC definition was associated with a higher risk of lineage infections which in turn then provided protection with xpb I mentioned it I just wanted to make sure that I show you similarly they talk about the studies finding question the wisdom of promoting the idea that every person needs to be up to date on covid-19 vaccination as currently defined at this time it is often stated that the primary purpose of vaccination is to prevent severe covet and death we certainly agree with this but it should be pointed out that there is not a single study that has shown the covid-19 bivalent vaccine protects against severe disease this is actually my own curiosity as well I am going to actually now look for those studies that are looking for vaccines and their protection and the efficacy for severe cases at least one prior study has failed to find a protective effect of the bivalent vaccine against the xbb lineage people may still choose to get the vaccine but an assumption that the vaccine protects against severe disease and death is not reason enough to unconditionally push a vaccine of questionable Effectiveness to all adults and finally they say in conclusion and please remember this is a preprint so it is entirely possible that the reviewers look at the data they come back and they question the the manuscript and they say change it so this is we're looking at a preprint or this study this preprint never gets published because of let's say errors or shortcomings so please keep in mind we are talking about a preprint and that means it cannot be used for decision making in conclusion this study found that not being up to date on covid-19 vaccination by the CDC definition was associated with a lower risk of covid-19 than being up to date this study highlights the challenge of counting on protection from a vaccine when the effectiveness of the vaccine decreases over time as new variants emerge that are antigenically very different from those used to develop the vaccine and this is a this is no conspiracy this is nothing bad this is a correct thing that hey for the more recent variants the vaccine will have to be up to dated or updated and if it is not vaccine is kind of protecting against something else and the variants are going in a different direction it also demonstrates the Folly of risk classification based solely on receipt of a vaccine of questionable Effectiveness while ignoring protection provided by prior infection so I think that prior infection should be taken into account with all discussions whenever CDC like agencies make their decisions they should be open-minded towards someone who is infected of course they should not say go get the infection but they should be open to making sure that if somebody is infected then they consider them as protected as well for some duration at least so this is the discussion please like subscribe and share and if you have if you would like to support this work there are links in the description uh you can get access to Dr Bean there is a link with very very inexpensive one-time price to get access to Dr Bean you can buy me a coffee you can use PayPal you can become part of sub Stacks or patreon or even this YouTube channel and for those who are paid members every Wednesday we have two Zoom sessions one at one PM Pacific time and the other one is at 6 PM Pacific time where we talk many things and we are kind of a little less censored as compared to Here on YouTube and we just discuss on Zoom whatever we like to so if you would like to participate in those discussions you can become part of sub stack patreon or this YouTube paid member thank you very much have a nice weekend I'll see you on Monday and Happy Father's Day thank you

Channel: Drbeen Medical Lectures

Views: 53,448

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Id: 2IiLilFUt88

Length: 26min 10sec (1570 seconds)

Published: Sat Jun 17 2023