25 October 2021
“Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing had happened.”
Winston Churchill
Earlier this month, a research report was published in World Psychiatry which explored the question: Are COVID-19 vaccines* as efficacious in people with substance use disorders?
The title of the article – ‘Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021‘ – kind of gives the game away, but in the process of exploring the issue they set out to investigate, the authors stumbled over an even more important truth. More on that further along in this article, but you’ll have to bear with me while I explain the study; I’m not giving the game away quite as easily as they did.
To answer their research question, the authors scraped de-identified data from the electronic health records of nearly 580 000 individuals enrolled in 63 health care organisations in the US.
All participants had been fully vaccinated against COVID-19 (2 injections of the Pfizer or Moderna products, or 1 injection of the Johnson & Johnson/Janssen product) between December 1, 2020 and August 14, 2021, and none had contracted COVID-19 prior to vaccination.
Most of the participants – almost 550 000 – did not have a substance use disorder (“non-SUD”), while just over 30 000 participants had a diagnosed substance use disorder (“SUD”), mostly involving either tobacco, alcohol, cannabis, cocaine or opioids.
3.6% of the non-SUD participants had a breakthrough infection (defined as “ICD-10 diagnosis code of ‘COVID-19’ [U07.1] or lab-test confirmed presence of ‘SARS coronavirus 2 and related RNA'” after being fully vaccinated) within the study period.
This is a shockingly high failure rate given that the vaccine roll-out did not commence in earnest in the US until well into the second quarter of 2021; only 10% of the total population had been fully vaccinated by March 11, and it took until August 15 to hit 50% fully vaccinated.
It’s a reasonably safe assumption, therefore, that a large percentage of the participants in this study were not fully vaccinated until quite late in the study period. Yet in the space of perhaps 3-4 months, 3.6% of fully vaccinated, community-dwelling participants with an average age of 55, became sick enough to seek medical care.
Comparing this breakthrough infection rate to the estimate (based on seroprevalence studies that measure antibodies against SARS-CoV-2) that it took over a year for 20% of the entire – and at the time largely unvaccinated – population of the United States to become infected with SARS-CoV-2, and furthermore that many of these infections were asymptomatic and hence did not result in a medical encounter, the 3.6% breakthrough infection rate is quite shocking, and highly discordant with the marketing campaign that these shots are “90%+ effective at preventing COVID-19!”
But it gets worse. The vaccine failure rate accelerated rapidly toward the end of the study period. In the non-SUD population,
“The rate of breakthrough infection steadily increased from 0 cases/person-day in January 2021 to 0.0009 cases/person-day in June 2021, and then reached 0.0049 cases/person-day in August 2021 (5.4 times faster than in June 2021).”
Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021
Of the SUD participants, after adjustment for adverse socioeconomic determinants of health and comorbid medical conditions, only those with a cannabis use disorder were at heightened risk (5.4%) of breakthrough infection compared to non-SUD participants.
A similar pattern of rising risk of breakthrough infections over the course of the study period was observed in SUD participants:
“The rate of breakthrough infection in the SUD population steadily increased from 0 cases/person-day in January 2021 to 0.001 cases/person-day in June 2021 to 0.0025 cases/person-day in August 2021 (2.5 times faster than in June 2021).”
Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021
The risk of becoming infected after receiving the jab looks like this:
Does that look like a vaccine that is maintaining its efficacy at preventing infection and illness to you?
Worse still, of those non-SUD participants who experienced a breakthrough infection, 17.5% were hospitalised and 1.1% died within the study period, whereas in the cohort that was not diagnosed with a breakthrough infection, 0.5% were hospitalised and 0.2% died.
Of the SUD population who were diagnosed with a breakthrough infection, the overall risk for hospitalisation was 22.5%, compared to 1.6% in the matched non-breakthrough cohort. Furthermore, 1.7% in the breakthrough cohort died, compared to 0.5% in the matched non-breakthrough cohort.
While the researchers were unable to determine from the electronic health records whether the hospitalisations and deaths in the breakthrough cases were due to COVID-19 or were associated with other medical conditions, they inferred that “the large and significant differences between breakthrough and matched non-breakthrough cases indicate that COVID-19 infection contributed”.
For the purposes of this study, the researchers only extracted data for fully-vaccinated individuals, so unfortunately it is not possible to make a direct comparison of rates of infection, hospitalisation and death in unvaccinated vs “fully vaccinated” individuals within this cohort.
However, since previous research indicated that only 1-5% of people diagnosed with COVID-19 required hospitalisation, the fact that roughly one-fifth of breakthrough cases in this study were admitted to hospital is striking.
(Side note: According to the University of Oxford QCovid Risk Calculator, my own risk of hospitalisation for COVID-19, had I been living in the UK during the first peak of the pandemic, would have been 0.0335%. That sounds one heck of a lot better to me than the 0.63% risk of being hospitalised that fully vaccinated non-SUD participants in this study had.)
If the jab is so effective at reducing severe illness in the event of infection, why did such a high proportion of people who received it end up in hospital… or dead? Are we seeing the emergence of original antigenic sin and antibody-dependent enhancement, which plagued previous attempts to develop coronavirus vaccines?
With 56% of the population fully vaccinated, the case fatality rate (percentage of people who die of COVID-19) in the US is higher now than it was at at the same time last year, before the vaccine roll-out began, and is on a steep upward trajectory:
Excess mortality (the difference between the observed number of deaths in a specified time period and the expected numbers of deaths in that same time period) is twice as high now than at the same time last year, before the vaccine roll-out began:
Countries that had a faster vaccine roll-out and have a significantly higher proportion of their population fully vaccinated than the US – such as Singapore, Israel, Iceland, Germany and the UK – have had broadly similar experiences to the US, with case fatality rates and excess mortality surging after mass vaccination campaigns began.
And we’re supposed to believe that COVID-19 vaccines are saving lives?
So how did the authors of the study on risk of breakthrough infections in people with vs without a substance use disorder grapple with the rather startling data they uncovered? Read and marvel:
“The rate of severe COVID outcomes in vaccinated individuals with breakthrough infections is known to be much lower than in infected unvaccinated individuals32. However, the outcome analyses in our study showed that hospitalization and death risks were significantly different between vaccinated SUD patients with breakthroughs and those without breakthrough, after matching for demographics, adverse socioeconomic determinants of health, comorbid medical conditions, and vaccine types.”
Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021
In other words, “we just found that fully vaccinated people are getting sick and dying at a ridiculously high rate but surely that can’t be true because the experts have told us it’s not true”.
Although, to their credit, after exploring and discounting various explanations for their unexpected (to them, at least) findings, they eventually conclude that
“Overall, our results suggest that vaccine breakthrough infections can result in significant adverse outcomes, including death, based on the analysis of the fully vaccinated population from a nationwide real-time electronic health record database.”
Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021
And, further to their credit, they call for more studies to “evaluate the long-term effectiveness of COVID-19 vaccines”, “monitor outcomes, including hospitalization and mortality, associated with breakthrough infection” and “compare outcomes of COVID-19 infection in vaccinated versus unvaccinated SUD populations”.
Let’s hope that, having stumbled across the truth, they follow their own advice and don’t just hurry off as if nothing has happened.
* I’m well aware that COVID-19 injections do not fulfil the technical definition of “vaccines” (although The Ministry of Truth is fixing that little problem by changing the definition of vaccines and vaccination), but it gets tiresome to place scare quotes around every instance of the word, so please just humour me when I use the v word while discussing scientific papers that employ it unquestioningly, OK?
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