Russian Roulette

R

If you were invited to play Russian roulette would you do it with COVID-19 or the COVID-19 vaccine?

Russian roulette is a lethal game of chance; you place a single round in a revolver, you spin the cylinder, place the muzzle of the gun against your head before pulling the trigger in hope that the loaded chamber does not align with the firing pin, which would cause the revolver to fire and kill you.

Most people would argue Russian roulette is a voluntary game and that you can opt-out of playing it if you want. This is not the case with COVID-19 Russian roulette. You can either become immune by being infected with the SARS-CoV-2 virus or by having one of the COVID-19 vaccines. As this virus is going nowhere soon and is likely to mutate and become endemic, i.e. remain circulating in the human population forever, you will at some stage get infected with this coronavirus or one of its variants. Yes, at some point everyone who is not self-isolating as a hermit on a deserted island will get some form of COVID-19. So you need to decide: do you want to take your chances with COVID-19 and the morbidity (sickness) and mortality (death) associated with it or have one of the COVID-19 vaccines. In other words, you need to choose your poison

For example, if you are between 40 and 50 years of age you have about 1 in 1000 chance of dying from COVID-19, a 1 in 300 chance of needing a ventilator or ITU admission, a 1 in 100 chance of needing to be hospitalised and 1 in 10 chance of getting long-COVID. On the other hand, if you have the vaccine you have about an 80% chance of getting a sore arm and some minor flu-like symptoms for a few days after the vaccine and if you have advanced MS you may notice a transient worsening of symptoms, similar to what happens when you have an infection and a temperature. These symptoms can largely be prevented or made milder by taking paracetamol and/or ibuprofen prophylactically. But the risk of the vaccine revolver firing and you developing a major rare potential complication from one of the vaccines is so small (probably in the order of 1 in 100,000 or even 1 in a million) that it can’t be compared to the risks of COVID-19.

Please remember that the very rare reported adverse events such as blood clots, disseminated coagulation. immune thrombocytopenia, transverse myelitis, sudden death, etc. have not necessarily been caused by the vaccine, they may simply be what is happening as part of the background rate of these disorders in the general population. You have to realise that when you are vaccinating the whole adult population shit will still be happening in the background; i.e. people will be getting DVTs, pulmonary emboli, myocardial infarctions, pneumonia, Bell’s palsy, etc. Life and biology continue as normal and all that has changed is that a vaccine is added to the mix. So when the EMA and MHRA say the benefits of these vaccines outway the risks; their advice is based on safety data from tens of millions of vaccinated adults. Their message can’t be any clearer: #GetVaccinated these #VaccinesAreSafe.

The European politicians have been irresponsible and simply stoked the fears people already have about these and other vaccines. This will not only cost European lives but will impact the uptake of vaccines in low and middle-income countries as well. This is tragic as the Astra-Zenica vaccine is the one that is going to play a major role in stopping the pandemic in these countries. Why do politicians employ and pay experts to work for the European Medicines Agency when they simply ignore their advice? Is there a more cynical or political reason to explains their motivation?

Now getting back to the point I made at the beginning of this post; if you are forced to play Russian roulette would you do it with COVID-19 or the COVID-19 vaccine?

I promised myself not today any more COVID-19 blog posts, but one of our MS nurses asked me to write this post. Hopefully, this will be the last one I do ;-(

Age-specfic mortality:
Levin et al. Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. European Journal of Epidemiology volume 35, pages1123–1138(2020).

COVID-19 Severity and ITU admissions:
Pijls et al. Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies. BMJ Open. 2021 Jan 11;11(1):e044640.

Long COVID-19:
ONS. The prevalence of long COVID symptoms and COVID-19 complications. 20-Dec-2020
Around 1 in 5 respondents testing positive for COVID-19 exhibit symptoms for a period of 5 weeks or longer
Around 1 in 10 respondents testing positive for COVID-19 exhibit symptoms for a period of 12 weeks or longer

Oxford-AstraZeneca adverse event profile:
Voysey et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021 Jan 9;397(10269):99-111.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

32 comments

  • Thanks Prof! COVID19 will be the elephant in the room for some time yet – I’d say keep the posts coming – they are invaluable.

  • Needed post today I think-word is flying around many parts of the US that the vaccine has killed more people than COVID-19. Peoppe claim to have “data” on this to back it up, but I’ve not seen anything convincing-and the “wisdom” keeps getting repeated!

  • For me, it’s an obvious answer.

    FWIW, I got offered Biontech today and so far, so good: tired, but slept badly last night so who knows.

  • Thank you, I have a question about receiving two shots of the vaccine. I have already been vaccinated with my 1st jab of the Moderna and I do plan on getting my second. Though from what I read, one shot gives decent protection. But since it is the job of the 2nd jab to ramp up the immune response, does that come with an increase risk of relapse? Especially since relapses tend to happen roughly six weeks after an infection, with the two shot vaccine, you are again stimulating the immune system four weeks out?

    • Re: “… increase risk of relapse…”

      This is unlike;y with vaccines, particularly if you are on a DMT.

  • Bravo Prof G well said!

    I had the AZ vaccine and, apart from feeling sick the next morning and being wiped out for a week, all good. I take the side effects as a positive sìgn, my body responded to the vaccine 🙂 yay!
    #getvaccinated

  • I think with the severity of this virus and the fact that it is is the worst of it’s kind in over 100 years you should definitely keep posting related blog entries.
    Of course still post lots about MS but you provide invaluable covid-19 news

  • Thank you for this post. Although I know the scare stories are just mad hysteria, it is good to hear the scientific truth from someone qualified to give it!

  • The other thing is that once a risk is known about it can be mitigated. this is why we don’t have tons and tons of MS patients dying from PML, monitor lymphocytes if they’re lymphopenia then you take them off the treatment and try a different one.

    Your job become managing side effects rather than managing MS which is far more hideous.

    Same with Covid.

    most likely AstraZeneca will be asked by the regulator to come up with a risk management plan, which they will do, and it will involve close monitoring and treating these side effects. If doctors know these potential side effects are potential side effects they will look out for them and they will treat them.

    Whereas, for Covid-19… we’ve already seen the havoc that wreaks. I have friends working in ICUs in the UK, the reports in the press were “damped down”. It was disabling and killing previously fit people in their 30’s and 40’s, this was deliberately played down to avoid panic. It is an extraordinarily dangerous disease whose cost will be borne for generations to come.

    Thank you ProfG for highlighting just how many orders of magnitude MORE dangerous the disease is than its vaccine. If I had the opportunity to be vaccinated, (I’m not in the UK, we’re still waiting for the jabs here) I’d grab it with both hands.

  • Great article, thanks for sharing. Keep up the great work Prof – following from Australia and your advice is invaluable on all fronts.

  • Well said 👏👏👏
    I really don’t think the Russian roulette point can be made often enough! Vaccine wins every time.

        • English: Do you know the specific article in which these figures are published?
          I would really appreciate it
          Thanks a lot
          Fran

          • English: No idea where profG gets his figures from there are soo many sources to choose from, but whats your point? You can do a search as can I but.
            Adverse events can got from the regulators EMA, FADA websites, as for effects of covid take your pick search new england journal or the Lancet,

      • Some general references added. However, the purpose of the post is not to provide an overview of risks but to simply compare the 1 in 1,000 risk of death from COVID-19 with the 1 in 100,000 or 1 in 1,000,000 risk of serious adverse events from the vaccine. In other words, the risk the vaccine poses is two or three orders of magnitude smaller than the risk of COVID-19.

  • Thanks professor Giovannoni
    I hope you are well
    I pray for you
    God bless you for your kindness and dedication as a medical doctor
    My question is about the statistics:

    “For example, if you are between 40 and 50 years of age you have about 1 in 1000 chance of dying from COVID-19, a 1 in 300 chance of needing a ventilator or ITU admission, a 1 in 100 chance of needing to be hospitalised and 1 in 10 chance of getting long-COVID. On the other hand, if you have the vaccine you have about an 80% chance of getting a sore arm and some minor flu-like symptoms “
    Are this numbers published in a medical journal ?
    Can you provide the link?
    Thank you very very much
    Take care of yourself
    We all have learned a lot with you

    • Go onto to the MHRA website the side effects of the different vaccines are there. Go on to pubmed type COVID-19 and review andthere are hundreds of papers.

  • Yes to vaccine. However, I take Ocrevus and I live in British Columbia, Canada and our vaccine roll out is struggling. It is an age based schedule and despite having MS and taking Ocrevus I don’t meet the threshold for early vaccine. My turn won’t be until late May. Also we don’t have enough to go around so in this general public phase our dosing is going to be 4 months apart. What I want to know is will this help or hinder the potential antibody blunting of Ocrevus?#livinginaninformationvoid

    • 4 months apart this is longer than in the UK at three months. The zeneca data is the longer between the stronger the subsequent antibody response, but you will see the UK vaccine data surfacing in the next copule of weeks I suspect. The ocrelizimab data will start appearing soon first israel and a smattering of US and then the UK

  • Hello Doctor- Please don’t stop posting important Covid news and personal insights. You ask “Why do politicians employ and pay experts to work for the European Medicines Agency when they simply ignore their advice? Is there a more cynical or political reason to explains their motivation?”

    This whole mess has been fascinating to me (here in former “Trump Land”;.. so happy to say the word “former”). I was a licensed psychologist prior to my MS retirement. The political reason is simple, as I see it- VOTES. As a politician, you want as many people as possible to flip the lever to your name, FOR ANY REASON. You get the votes, you win the game. Trump shows us that. Who cares about the dead people (they can’t vote). There’s a % of the population that is not as bright as you and I think they are. Another % that is suspicious. Another % that grew up being unhappy with the other “smart kids”. Etc. etc. etc. Trump has shown us just how substantial and significant the overall combined % is, that you can get to vote for you. We have a lot of “bad apples” here in the US, enough to flip an election when combined with other voters. Just wake them up and get them to vote. Add that to perhaps another large % of voters who have a better formulated sincere reason to voting for you, and you win. The crap we’ve had to watch for the past four years, it’s just unbelievable.

    Today, the politicians on Trump’s former “side”, are lining themselves up for the next run off, which involves capturing the votes of the %’s I mentioned above. (Those people were woke up with the help of talk radio and the like too, it was not Trump alone.) You won’t keep that %’s attention by telling them they are wrong (get a vaccine). Telling people they are “wrong”, in most social situations, does not work. Have you seen the recent survey data? Half of republicans in the US plan not to get vaccinated. The decision to have voted for him involves a lot of underlying psychological stuff, that when “activated”, still cannot be undone. Trump knew that.

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