Rational answers to COVID-19 sceptics and anti-vaxxers

I know this post will not convince all sceptics. That is because in order to convince someone with scientific evidence and logic, that someone must first of all appreciate the value of scientific research and have a basic capacity for logical reasoning. Some people fail to meet one or both of these conditions, and consequently prove impervious to any attempt to change their minds. Tragically, unvaccinated sceptics have already ended up in hospital with COVID-19. Even as they are put on a mechanical ventilator, some literally continue to deny the pandemic or defend their decision not to get vaccinated. So this writing is not for them, for they are already lost. Instead, I write this for the otherwise reasonable people who have simply been misinformed by friends, relatives, conspiracy theorists, and quacks. This blogpost isn’t final, it will be updated if needed when I encounter more silliness on social media.

“COVID-19 is just the Flu”

No, that is incorrect. COVID-19 is caused by (variants) of SARS-CoV-2, which is a new pathogen. The flu is caused by different viruses. While some symptoms are similar, some of the symptoms of COVID-19 are really quite different from the seasonal flu (see this page on the CDC website). And COVID-19 has greater mortality rate (see for example this French study recently published in The Lancet). There’s a good reason that “SARS” in SARS-CoV-2 stands for “Severe Acute Respiratory Syndrome”, and that reason is that it ain’t the flu.

“The sudden rise in COVID-19 cases is due to increased testing, not because the actual number of cases is increasing.”

That is an over-simplication, and therefore incorrect. Epidemiologists don’t look at one number. There are several factors that inform healthcare professionals about how the pandemic is developing. They look at absolute number of positive tests, the relative percentage of positive tests out of all tests, the change in number of hospitalized COVID-19 patients, the number of deaths, and they use contact-tracing. All that kind of information combined, gives a reasonable indication of how the pandemic is developing. See also this page on the CDC website.

“The vaccines don’t work, because people who are vaccinated can still get sick. You can also die from the vaccine itself.”

First of all, it’s true that vaccinated people can still get COVID-19. None of the COVID-19 vaccines were ever claimed to be 100% effective at preventing infections. A relatively small number of vaccinated people may still get sick, and this is called a ‘break-through’ infection. But that doesn’t mean the vaccines don’t work. The risk of a COVID-19 infection is a lot lower when you’re vaccinated, and even if you do get infected the symptoms are less severe. That’s allready a huge benefit. Seatbelts aren’t 100% effective either, and people can also die from wearing a seatbelt, for example when a car becomes submersed in water. But that is an exceedingly rare event and seatbelts are statistically speaking far more likely to prevent death or serious injury than cause it. A similar kind of trade-off is made when judging the benefits of vaccination. An averse reaction from a vaccine that results in death is an exceedingly rare occurrence. Since vaccines are incredibly safe and are highly effective at preventing severe COVID-19, getting vaccinated is simply the smart thing to do.

“The number of vaccine deaths is underreported, and the number of COVID-19 deaths are exagerated.”

This claim contains an obvious contradiction. Either deaths are underreported in both cases, or both are exagerated. Pick a lane. But what do the actual facts tell us? They tell us that the number of COVID-19 deaths are very likely underreported. In India alone, there are probably at least 3 million more COVID-19 deaths than reported. And all vaccine related deaths that have been investigated so far, show that it is exceedingly rare to die from a vaccination. Thus, the benefits of vaccination vastly outweigh the risks. Further reading HERE, HERE, and HERE. Vaccines are safe and effective. Get the jab.

“COVID-19 has an IFR of just 0.15%, so the pandemic is not as deadly as the media tell us.”

That statement is incorrect, for a number of reasons. First, you can look up what the WHO has determined about the IFR value. A recent paper suggests that depending on the region you look at, the IFR can range from 0·00% to 1·62%, with an average of about 0·23% (though it can be less than 0·20% when the best medical treatment is available). So you can’t simply pull an IFR out of your hat and apply that to every region on earth. Secondly, the IFR is calculated as the ratio between the number of deaths and the number of infections. However, the real number of deaths is unknown, and the official figures are likely to be an underestimation. Likewise, the real number of infections are also unknown, as not everyone is tested. Therefore both the numerator and enumerator are based on uncertain values. Thus, the most accurate COVID-19 IFR value is still a matter of debate among researchers, and the article that claimed the 0·15% IFR value is attracting a fair bit of criticism from other scientists. Thirdly, even if you accept the IFR of 0·15% as correct, then that means COVID-19 is still 1·5 times more deadly than the flu (IFR = 0·10%). For these reasons only an idiot would base policy regarding corona-measures on just an IFR estimate.

And now a brief word on the meaning of any value of IFR. As the name Infection Fatality Rate implies, the number of fatalities will depend on the number of infected people. Because the delta variant of SARS-CoV-2 is far more infectious than the flu, the total number of fatalities will be a lot higher even if both IFR values were the same. In other words, the basic reproduction number R0 is far greater. The net-result is a much greater death-toll, unless measures are taken to either lower the R0 (by social distancing, wearing face masks, etc), or by lowering the case fatality rate (CFR) through improved treatment options.

Here’s another example to illustrate the point. The deadly hemorrhahic fever disease Ebola has a case fatality rate (CFR) of at least 50% (which in the case of Ebola will be pretty close to IFR)—but could be about 70% or even higher according to some estimates. Nonetheless, all Ebola outbreaks combined since 1976 have claimed no more than in the order of 11,000+ lives. That is because Ebola has an exceptionally low R0: you only get infected by direct physical contact with an Ebola patient. In other words, an incredibly deadly disease like Ebola is nothing to worry about. The IFR and CFR values clearly do not tell the whole story.

However, what does tell a story is the staggering number of COVID-19 deaths. Yes, the number of Ebola deaths is great, but it’s dwarfed by the millions of worldwide COVID-19 deaths. Minimize your chances of getting infected, get vaccinated.

“Face masks are for sheep, they don’t prevent COVID-19.”

Recent research says otherwise. Face masks do in fact help in limiting the spread of COVID-19. There is clearly more than enough evidence now. See also the information on this page of the WHO’s website. Furthermore, a recent study shows that aerosols play a more important role in transmission than previously thought. So don’t just wear a face mask, but also practice social distancing, avoid gatherings in poorly ventilated spaces, and (most importantly) get vaccinated. But what—to me at least—stands out more in the false claim by the anti-maskers, is the word ‘sheep’. That word is used often by COVID-19 sceptics in a derogatory way, to communicate that face mask wearing people are stupid people who just blindly follow the rules without thinking. But since studies have now shown that wearing a face mask helps prevent infection, wearing a face mask clearly isn’t stupid. Additionally, some people (such as myself) began wearing face masks even before they became mandatory, and continue to wear them even though they are no longer required in many public areas. Consequently, calling people who wear face masks ‘sheep’ is now just as idiotic as calling skydivers ‘sheep’ for using parachutes. So be reasonable, wear a face mask whenever appropriate. And, again, get vaccinated.

“Only vulnerable people should wear face masks, and they should self-isolate.”

First of all, SARS-CoV-2 is a new and rapidly mutating viral pathogen, so no one is safe. Second, COVID-19 has claimed over 600,000 deaths in the USA alone. The number of vulnerable people is clearly enormous. Obesity, one of the known risk factors for severe COVID-19, can almost be called a pandemic by itself. And diabetes, another common risk-factor, is well and truly a global pandemic. The numbers of people affected by one or more risk-factors is simply staggering. You can’t expect such a large part of the population to withdraw from public life. Third, face masks mainly work by protecting others from getting COVID-19 from you, not the other way around. Thus, the greatest effect of face mask wearing is only achieved when everyone wears them. Fourth, and finally; show some empathy, be a ‘mensch’. It only takes a bit of patience, and then this pandemic too—just as others that have plagued mankind—will pass. Every country with sufficient proportions of vaccinated people has seen a dramatic drop in hospitalizations and death. Those countries have ended lock-downs, they’ve started opening up bars and restaurants, and lifted travel restrictions. Once everyone has had a chance to be fully vaccinated, most—or maybe even all—remaining measures will cease. Until then, it’s really just such a trivial effort, and such a minor discomfort, to wear a face mask and to get vaccinated. If not for yourself, then do it for everyone else. As Spock once said: “The needs of the many outweigh the needs of the few. Or the one.” Be like Spock. Get vaccinated. It’s the logical thing to do.

“The COVID-19 vaccines only have emergency approval, they’re still experimental.”

Emergency use authorization (EUA) is still approval. No approval is ever given to medication that hasn’t at least been tested for safety and passed clinical trials. Consequently, there are currently no trials aimed at studying the safety of the vaccines anymore. Indeed, that phase has already been concluded, as it is in fact a requirement even for EUA. See also this document from the FDA for the Pfizer/BioNTech mRNA vaccine. The only important thing that researchers are currently investigating is how long the vaccines provide protection, and perhaps to what degree the vaccines protect against new SARS-CoV-2 variants. Furthermore, the vaccines are not the only medicines with emergency approval use. Some of the drugs used to treat COVID-19 in the hostpital also have emergency use approval, here is an example for tocilizumab. Just because you are only now finding out how organizations like the FDA and EMA approve new medications, doesn’t mean you should suddenly distrust the evidence-based medicine and the safety protocols used by those organizations and healthcare professionals for many decades. Innumerable doctors and biomedical researchers around the world want nothing more than to help people like you. So let them. Get vaccinated.

“The long-term side-effects of the mRNA vaccines are unknown.”

It is extremely unlikely for vaccine related side-effects to appear after a long period of time. The mRNA vaccines break down quite rapidly, due to the way mRNA is treated in the cytoplasm of cells. See also this excellent explanation of how the Pfizer/BioNTech mRNA vaccine was developed, and how it works. And when you know a bit how mRNA vaccines work, you will come to understand that any side-effects from the vaccine can only appear within a relatively short period after vaccination. The reason for that is that mRNA is broken down rather fast. The only thing that remains after that is your own immune response, just as it is with any other type of vaccination. The first mRNA vaccinations where given well over a year ago, and no side-effects have been reported other than those that occur with a short period after vaccination. No vaccine has ever been known to cause side-effects that appear after a long time. There is nothing to worry about, just get vaccinated.

“The vaccines are made by ‘Big Pharma’, I don’t trust them.”

It’s true that the large pharmaceutical companies that produce effective and safe COVID-19 vaccines are making a lot of money. Nevertheless, all approved vaccines first passed independent testing in clinical trials, to demonstrate both efficacy and safety. The clinical trials are conducted by independent academic researchers, in many hospitals, with tens of thousands of participants. After publication in high-ranking, peer-reviewed medical journals, the evidence is presented to a drug authority, like the FDA. Then it is either approved, or not approved. And approval isn’t some technical formality, they really look at the data carefully. If something isn’t right, it won’t get approved. For example, the Sputnik V vaccine has not yet been approved by Europe’s EMA because the developers failed to submit research data.

But beyond the strict approval rules, enough evidence has come in from the field showing that the vaccines are highly effective in preventing COVID-19 related death or severe illness. Hospitals all over the world are beginning to see that most of their COVID-19 patients are either unvaccinated, or partially vaccinated. And hospitals don’t really care about “Big Pharma”. For example, one of the most prescribed medicines for patients with severe COVID-19 is dexamethasone. And dexamethasone is dirt cheap. If doctors wanted to make “Big Pharma” a lot of money, there are plenty of more expensive alternatives that they could have prescribed instead. If you don’t trust pharmaceutical companies, then at least just trust the doctors and academic researchers. They know what they’re doing, and they recommend getting vaccinated. So get vaccinated.

“COVID-19 only affects old people and people with underlying conditions, so I don’t need the vaccine.”

That is just plainly incorrect. It may be true that people over 65 and people with certain underlying conditions statistically have a greater chance of getting severe COVID-19, but that doesn’t mean young, healthy people don’t get sick as well. Many “anti-vaxxers” boast that they won’t get infected, because they live so healthily, take vitamin D3 supplements, and therefore have such a strong immune system that they are immune to COVID-19. But they are kidding themselves. That’s not how immunity works. Since SARS-CoV-2 is a new pathogen, no one on earth will have any immunity against it, except those who’ve either already gotten COVID-19 or were vaccinated. Specific acquired immunity against a novel pathogen can only be achieved after infection by that pathogen, and an even stronger immune response may be achieved by vaccination. You can look this up in any introductory academic textbook on immunology, even older books that existed long before the COVID-19 pandemic. For example, the second figure in the first chapter of Basic Immunology gives examples of several infectious diseases that have been drastically reduced, or almost eradicated, by vaccination. The best and safest way to produce the most anti-bodies against SARS-CoV-2 is by getting vaccinated, not by getting sick with COVID-19. The vaccinations also indirectly confer some protection to vulnerable people by limiting the spread of COVID-19, a phenomenon known as ‘herd-immunity’. There is only one logical course of action, and that is to get vaccinated.

“In England, 43% of the COVID-19 patients on the ICUs were vaccinated. That proves the vaccines don’t work that well.”

That is a well known statistical fallacy. You can’t directly compare numbers of vaccinated, partially vaccinated and unvaccinated patients like that. For a proper comparison, you must look at the number of vaccinated patients with regards to the size of the vaccinated population, and then do the same for the unvaccinated. That will then give you two proportions that you can compare with each other. Allow me to illustrate that principle with an example.

Say you have a population of 100 million, and 90% of the population is vaccinated. That means 90 million are vaccinated, and 10 million unvaccinated. Now let’s say that there are 10 million patients with COVID-19 in the hospitals. Of those patients, 4·3 million of them will be vaccinated and 5·7 million will be unvaccinated. But now you can already see that’s a whopping 5·7 million out of 10 million unvaccinated, compared to just 4·3 million out of 90 million vaccinated. Yikes! That means 57% of the unvaccinated population ended up in the ICU, compared to just 5·11% of the vaccinated population, a difference of more than one order of magnitude!

These numbers are of course fictitious, I chose them because they are easy to work with and to clearly make my point. Because whenever you see a percentage, you must always ask: A percentage of what? Scientists are looking at the real population data—using the correct statistics—and it is abundantly clear that the vaccines (and particularly the mRNA vaccines) work really well. Trust the numbers, get vaccinated.

“The mRNA vaccine will alter my DNA”

No, it won’t. This has already been fact-checked. mRNA breaks down quickly. Your DNA is in the nucleus, which mRNA cannot enter. Also, the Moderna and Pfizer/BioNTech mRNA vaccines have successfully passed phase III clinical trials. One of the things the authorities specifically check for is whether a vaccine causes DNA changes that turn humans into zombie mutants, or melts them into a bubbling green puddle of genetic protoplasm. You may rest assured, the mRNA vaccines are safe.

“Viruses always evolve to be less deadly, so the new SARS-CoV-2 variants are less lethal.”

Nope, that’s not true. The claim here is that because a virus can only multiply and spread effectively from living hosts, any successful virus will always evolve to keep their hosts alive as long as possible. In other words, viruses always evolve to become less lethal. But unfortunately, that statement is incorrect. While it is true that some viruses become less deadly over time, there are also viruses that become more deadly, or stay pretty much the same. That is because there may exist certain evolutionary constraints that limit the ways a virus can adapt. Take Ebola, for example, a highly infectious viral disease with a case fatality rate of at least 50%. Ebola spreads through direct contact with the bodily fluids of an infected person. But this leaking of bodily fluids also causes the hypovolemic shock that is the most important cause of death in Ebola patients. Thus, the infection pathway of the Ebola virus is inextricably linked with its lethality. In other words, it’s unlikely that the Ebola virus will evolve to become both less lethal and at the same time more infectious. That is the constraint of evolution in this particular virus. And the Ebola virus is just one example, see this fact-check for more information. Similar constraints may apply to SARS-CoV-2, showing that you cannot cherrypick some over-simplified evolutionary theory to predict what’s going to happen. You always need to look at the data coming in from the field, and the data about new dominant strains of SARS-CoV-2 are clearly telling us that COVID-19 is becoming more infectious, but unfortunately no less deadly. In fact, recent research (that I also referenced regarding use of face masks) suggests that viral RNA is more readily detected earlier in the COVID-19 infection. So, also when infected individuals are pre-symptomatic or asymptomatic. That means that the most important infection pathway takes place long before someone becomes hospitalized or dies from COVID-19 in isolation, which also means that mortality rate is less likely to be an important constraint in the evolution of SARS-CoV-2. Because if most people infect others before they get fully symptomatic, then the virus isn’t really going to care what happens to its host once the infected human is put in isolation upon becoming symptomatic. So it’s definitely okay to be worried, and now is the time to get vaccinated if you haven’t already.

“A distinguished professor and Nobel prize winner said that vaccines are dangerous and don’t work.”

First of all, we know from all the tests and the data from hundreds of millions of vaccinations that the vaccines are safe and that they are effective. Second, there’s not a single Nobel prize winning scientist in modern history who won the award without publishing in peer-reviewed magazines. Unsurprisingly, you will find that the Nobel laureates who are said to be critical of vaccinations have not published anything in peer-reviewed journals to support those theories.

However, there are indeed a few Nobel prize winners who became a bit nutty, later in life. This phenomenon is known as Nobel disease. One such Nobel prize laureate, Luc Montagnier, apparently moved to China, were he has “researched” non-peer-reviewed crackpot theories related to homeopathy.

And finally, there is another good reason why this argument fails. Against possibly one or two Nobel prize winners on the side of the anti-vaxxers, there are literally more than a hundred Nobel laureates who actively promote vaccinations against COVID-19. In other words, we have more Nobel prize winners on our side than the anti-vaxxers can shake a stick at. Not to mention the countless other distinguished scientists who also support the vaccinations. So, if titles and academic honors mean more to you than scientific publications, then you should still get vaccinated.

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