Who among the Vaccinated are At Risk of Dying if they get COVID-19?

Risk prediction of Covid-19 related Death and Hospital Admission in Adults after Covid-19 vaccination: national prospective cohort is a study published in the British Medical Journal on September 17, 2021

What is the use of the study?

The study is about how the authors developed, used, and verified the QCovid3 algorithm to determine who among the vaccinated are at risk of hospitalization and death if they get COVID-19 after vaccination.

According to the authors, the results of this study are to target specific groups for clinical trials, prioritization of vaccine boosters, future preventive treatment, shielding, and for the clinicians and the vulnerable individuals to talk about how to reduce their risk.

What did the investigators consider to know who are at risk?

The QCovid3 algorithm used age, sex, ethnic origin, Townsend deprivation (a measure of material wealth), body mass index, a range of comorbidities, and SARS-CoV-2 infection rate as variables to calculate covid-19 mortality.

Who did they study?

The research involved the whole nation of England and followed 6,952,440 people age 19-100 years old who received one or two doses of the ChAdOx1 nCoV-19 (OxfordAstraZeneca) or BNT162b2 (Pfizer-BioNTech) vaccines.

The Results:

The hazard ratio is the risk of an event (death or hospitalization) relative to exposure (COVID-19) after getting COVID vaccination.

The hazard ratios were the highest for the following

Down’s syndrome (12.7-fold increase)
Kidney transplantation (8.1-fold)
Sickle cell disease (7.7-fold)
Care home residency (nursing home) (4.1-fold)
Group B (3.6-fold) and group C chemotherapy (4.3-fold)
Recent bone marrow transplantation or solid organ transplantation ever (2.5-fold)
HIV/AIDS (3.3-fold)
Dementia (2.2-fold)
Parkinson’s disease (2.2-fold)
Neurological conditions (2.6-fold)
Liver cirrhosis (3.0-fold).

Other conditions associated with increased COVID-19 deaths:

Chronic kidney disease
Blood cancer example – leukemia, lymphoma
Epilepsy
Chronic obstructive pulmonary diseases like emphysema and chronic bronchitis
Coronary heart disease
Stroke
Atrial fibrillation
Heart failure
Thromboembolism like blood clots in the legs or lungs
Peripheral vascular disease
Type 2 diabetes (with highest risks among those with HbA1c ≥59 mmol/mol (>7.5%).

The authors tested the accuracy of the QCovid3 algorithm, and it is 74.1% accurate.

COVID-19 Deaths following Vaccination

The figure below shows the hazard ratio for COVID-19 deaths following vaccination for different races, stages of chronic kidney disease (CKD), glycosylated hemoglobin levels or HbA1c among diabetics, chemotherapy, residence, and medical problems.

COVID-19 Hospitalizations following vaccination

The figure below shows the hazard ratio for COVID-19 hospitalizations following vaccination for different races, stages of chronic kidney disease (CKD), glycosylated hemoglobin levels or HbA1c among diabetics, chemotherapy, residence, and medical problems.

The table of chemotherapy groups can be found at this link.

An example of an interpretation of the above figure is that the Pakistani and Indian groups had a twofold increased hazard of COVID-19 deaths and hospital admission compared to whites.

People with Down syndrome, who have been vaccinated have a 12.86 and 2.55 hazard ratio for COVID-19 deaths and hospitalization respectively.

This study does not mean that you have a higher chance of dying from COVID-19 if you get the vaccine, but rather it aims to identify the people who are still at risk of dying from COVID-19 despite the vaccines.

If you are one of the groups mentioned above, consider reducing your risks with better blood sugar control, weight reduction, and behavior modification.

The University of Oxford QCovid calculator is available here. BMJ says the following about the QCovid calculator,

PLEASE NOTE: This implementation of the QCovid risk calculator is NOT intended for use supporting or informing clinical decision-making. It is ONLY to be used for academic research, peer review, and validation purposes, and it must NOT be used with data or information relating to any individual.

Question

Suppose the U.K. had an early treatment protocol for COVID-19 like the Update to the I-MASK+ Prevention & Early Outpatient Treatment Protocol for COVID-19. Would their entire data on hospitalization and deaths be the same?

Knowledge about Covid-19 is rapidly evolving. Knowledge updates as new studies are made.

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Reference:

Hippisley-Cox J, Coupland C A, Mehta N, Keogh R H, Diaz-Ordaz K, Khunti K, et al. Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study BMJ 2021; 374:n2244 doi:10.1136/BMJ.n2244

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