E-post: t.b.wyller@medisin.uio.no
Institutt for klinisk medisin
Universitetet i Oslo
og
Geriatrisk avdeling
Oslo universitetssykehus
Han har bidratt med design, vurdering og klassifisering av bivirkningsmeldingene, fortolkning av resultatene, utføring av de statistiske testene samt utforming og bearbeiding av manuskriptet.
Torgeir Bruun Wyller er spesialist i indremedisin og i geriatri, professor og overlege.
Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.
Klinisk institutt 2
Universitetet i Bergen
og
Medisinsk avdeling
Haraldsplass Diakonale Sykehus
og
Enhet for sykehjemsmedisin
Bergen kommune
Han har bidratt med design, vurdering og klassifisering av bivirkningsmeldingene, fortolkning av resultatene og bearbeiding av manuskriptet.
Bård Reiakvam Kittang er spesialist i indremedisin og i infeksjonssykdommer, professor og overlege.
Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.
Klinisk institutt 2
Universitetet i Bergen
og
Medisinsk avdeling
Diakonhjemmet sykehus
Hun har bidratt med design, vurdering og klassifisering av bivirkningsmeldingene, fortolkning av resultatene og bearbeiding av manuskriptet.
Anette Hylen Ranhoff er spesialist i indremedisin og i geriatri, professor og seksjonsoverlege.
Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.
Statens legemiddelverk
Hun har bidratt med design, fortolkning av resultatene og bearbeiding av manuskriptet.
Pernille Harg er cand.pharm. og seniorrådgiver.
Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.
Medisinsk avdeling
Bærum sykehus
Han har bidratt med design, vurdering og klassifisering av bivirkningsmeldingene, fortolkning av resultatene og bearbeiding av manuskriptet.
Marius Myrstad er ph.d., spesialist i indremedisin og i geriatri og overlege.
Forfatteren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Han har mottatt forelesningshonorar (ikke-vaksinerelatert) fra Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, MSD og Pfizer.
This misleading title feeds the anti-vaxxer movement, and contributes to vaccine hesitancy among the public. A more accurate title would be «No clear link between nursing home deaths and COVID-19 vaccination.»
The review states: «There are around 35,000 nursing home patients in Norway and about 45 deaths among these patients per day.»
The review did not report actual death rates after vaccination. That is a fundamental defect in the review. Unless there was a documented increase in deaths, attributing any of them to the vaccine is unwarranted speculation.
Five additional quotations from the review:
«It must be emphasised (sic) that these estimates are very uncertain…»
«Many of the reports did not contain sufficient clinical information to form an impression of the patient’s clinical course and a possible causal link between vaccination and death. Almost half of the reporting parties did not submit additional information. In particular, there was a lack of information about which phase of life the patients were in, and whether their health and general condition were already rapidly or slowly deteriorating before vaccination.»
«It is therefore practically impossible to determine with any certainty how much of a role the vaccine played in the deaths.»
«Our findings cannot…be used to estimate the incidence of vaccine-related deaths.»
«Such an assessment requires nuanced and detailed clinical information, which in many cases was not available. The estimates are therefore uncertain.»
To publish «likely» conclusions after so many caveats was inappropriate.
We thank Dr. Gatrell for his comments on our article (1). Our title is merely descriptive; the residents included in our review actually died shortly after covid-19 vaccination.
We agree that epidemiological data on excess mortality in the nursing home population during the period of vaccination would also be interesting. Nevertheless, we feel that such data, in a population with a high short-term mortality and multiple confounding factors, would not made a possible association between vaccination and death clearer.
Our main approach was another. We scrutinized available clinical information regarding 100 deaths suspected to be causally linked to covid-19 vaccination. Among these, the Norwegian Institute of Public Health had initially categorised 83 as possibly related to vaccination. As Dr. Gatrell correctly addresses, clinical data were scarce, but we nevertheless reclassified the relationship as unlikely in 59 cases. Thus, we do not agree that our work in any way feeds the anti-vaccination movement. On the contrary, we argue that when a suspicion of a causal link between vaccination and death was made public (2), not trying to clarify these 100 cases more likely would have encouraged vaccination scepticism.
Literature:
1. Wyller TB, Kittang BR, Ranhoff AH et al. Nursing home deaths after COVID-19 vaccination. Tidsskr Nor Legeforen 2021. doi: 10.4045/tidsskr.21.0383
2. Torjesen I. Covid-19: Norway investigates 23 deaths in frail elderly patients after vaccination. BMJ 2021; 372: n149.
The article mentions, «there will most likely have been far more than 100 deaths in nursing homes in a close temporal relationship to vaccination in the relevant time period. Our findings cannot therefore be used to estimate the incidence of vaccine-related deaths.»
This is a statistical argument. However, the experts examined the clinical histories of each of the 100 residents who died. They also had the event reports from the staff.
These data allowed the subsequent causal analysis. Causal analysis disconfirms the purely statistical argument quoted above.
The causally derived numbers therefore do instead positively allow their use to estimate the incidence of vaccine-related deaths.
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