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What's the effect on severe outcomes such as hospitalisation and death? My understanding for a while has been that vaccinations are quite effective for these against Omicron while not being particularly effective against infection. Should this cause me to update my beliefs?
I think it’s complicated. If ADE is occurring without any neutralization, as far as I know this means the vaccine is plainly increasing infectivity and severity, but not necessarily significantly. The whole point of a vaccine is to launch antibodies to neutralize, not enhance infectivity.
Population-level surveys are really terrible at telling us anything about vaccine protection because of the Selection Effect. The healthiest 1% of people are much more likely to take all recommended health measures, like vaccines. So for instance, those who get the flu vaccine in the summer have half the all-cause mortality over the summer, not because the vaccine was effective, but because the cohort of people who opt-in to optional recommended health practices are going to be healthier than the average.
At the same time, there exists a bottom 1% of healthy people who literally eschew all health interventions and keep terrible lifestyle habits. Some of these are alcoholics, homeless, schizophrenics, shut-ins, whatever. They are far more likely to be unvaccinated because they are far less likely to participate in any health intervention.
Whenever the media talks about population surveys saying unvaccinated have higher hospitalization, it means virtually nothing without factoring in the above, plus factoring in invisible damages of vaccination. Hence there’s a need to look at other kinds of studies: sera studies and controlled studies. Controlled studies found no difference in mortality with 20k adherents, and sera studies have results like in OP.
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