Coronavirus Taiwan Open - April-June 2022

Excellent points all around.

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Meanwhile, there’s been 1040 flu or pnu deaths in Taiwan in the past week alone.

If I am reading it correctly, the number of deaths due to flu/pneumonia appears to have more than doubled in the past six weeks. [top chart, red line]

As @FairComment pointed out, if they were plotted on the same graph as all the other things that kill people, with a linear scale, those would all be flat lines hugging Y=0.

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Eh not hypochondria. Just a listing of the steps to follow if you want your employer to pay you sick leave.

Or at least get a box of instant noodles from the Government.

I did all that crap and never got an instant noodles box. I feel left out.

So having nothing better to do, I wasted my morning messing around with the MOHW data. Here’s a few highlights.

Dividing deaths into ‘healthy’ (no comorbidities) and ‘unhealthy’ (all the rest), it looks like this for healthy people:

<30 30s 40s 50s 60s 70s 80s 90s
All deaths 13 3 18 20 55 70 102 78
unvaxed 11 3 10 11 30 48 49 49
vaxed 2 0 8 9 25 22 53 29
1 dose 1 0 1 1 6 2 6 5
2 doses 0 0 1 4 5 4 15 12
3 doses 1 0 6 4 14 15 32 12
4 doses 0 0 0 0 0 1 0 0

These are about 6.6% of all COVID deaths.

If we divide number of deaths by the total number of people in each agegroup we get a crude estimate of single-event risk for healthy people during a COVID (omicron) surge in Taiwan. This involves a rather suspect assumption that the entire population has no life-threatening illness (which is probably true for under 40s and increasingly less true for older people). However it’s the best we can do; and we can compare these numbers with 12-month all-cause mortality risk:

<30 30s 40s 50s 60s 70s 80s 90s
Pop (m) 7.3 3.5 3.8 3.6 3.1 1.5 0.7 0.1
covrisk/m 2 1 5 6 18 47 146 780
allrisk/m 277 847 2283 5023 9858 24874 77863 183656

We can’t really pull the same trick with ‘people who died while unhealthy’ because unhealthy people represent a much smaller (unknown) fraction of the population; their risk of death is therefore considerably higher than it would appear. So, taking care to remember what this number represents (“risk of being recorded as a COVID death per million population”), here’s the same calculation for the entire dataset:

<30 30s 40s 50s 60s 70s 80s 90s
Cov/mil 5 13 39 100 294 968 2893 12730

Taking log values is informative. Here ‘hcov’ and ‘ucov’ mean ‘healthy covid deaths’ and ‘unclassified covid deaths’ respectively. To be clear, these values are log(risk/million):

<30 30s 40s 50s 60s 70s 80s 90s
hcov 0.3 -0.1 0.7 0.7 1.2 1.7 2.2 2.9
ucov 0.7 1.1 1.6 2.0 2.5 3.0 3.5 4.1
allrisk 2.4 2.9 3.4 3.7 4.0 4.4 4.9 5.3

Note that:

  1. COVID risk for healthy people (and remember we’re talking about the risk of being recorded as a COVID death, which is not exactly the same as dying of COVID) is 2-3 orders of magnitude less than your all-cause risk. It is completely insignificant. Even if you have notable comorbidities, COVID represents only 2% of your all-cause risk until you’re well into old age - and even in your 90s, it’s only 7%. That’s not a 7% risk of dying, but a 7% risk that your death certificate (if you’re unfortunate enough to receive one) says “COVID” on it somewhere. 831,000 out of 834,000 80+ oldies completely failed to die ‘of or with COVID’. 52,000 of them die in a normal year.
  1. The COVID line has a slightly different slope to all-cause mortality, suggesting (but not confirming) that COVID was a partial factor in the CECC death list; but the fact that it’s an almost perfect straight line suggests that age and age-related disease was the primary factor.

  2. The ‘healthy’ line is decidedly nonlinear, suggesting some complex combination of factors in these cases.

It’s interesting to compare these numbers with, say, the UK, which publishes data collected in a similar manner. The main difference is that that UK has a different collection of chronic diseases in the general population, and the vaccination rate is ‘inverted’ relative to Taiwan (which has about 100% coverage in under 40s, falling to <80% in the 80+ group). These numbers are from Q4 2021, which would have been equivalent in character (I imagine) to Taiwan’s current omicron wave:

<30 30s 40s 50s 60s 70s 80s 90s
Ukcovid 77 201 505 1218 2235 3720 4435 2202
Ukpop 23.55 8.80 8.50 8.97 7.07 5.49 2.70 0.58
Ukrisk 3 23 59 136 316 678 1644 3771
Twrisk 5 13 39 100 294 968 2893 12730

The apparent risk is almost identical until you get to 70+; Taiwan then diverges dramatically. There are a whole bunch of possible interpretations; it may be, for example, that Taiwan is factoring in a lot more ‘ordinary’ deaths from old age than the UK did, or that Taiwan is relatively worse at treating COVID in the elderly, or that vaccination has a dramatic positive effect in older age groups (and no effect at all in younger ones). Again, though, relative to all-cause mortality, these numbers fade into the background noise.

TL;DR: if you’re under 70 and in good health, the chance of you making it onto the CECC’s justification-for-existence list is very, very small indeed; or from a different viewpoint, if you have a scheduled appointment with the grim reaper, you are overwhelmingly more likely to die of something other than COVID. Corollary: if you don’t want to die of-or-with the lurgy (or indeed of-or-with anything else), be healthy.

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With delta the “vaccination” gave you about an 20 years advantage over unvaxxed people against dying of covid. For healthy under 50s this did not outweigh the risk of getting vaccinated in first place. It’s a bit hard for UK numbers because many already have acquired natural immunity which is simply better than getting vaccinated.

So yes with delta the vaccination for old/fat people really made sense - with omicron it’s a bit hard to tell. It could be that it still makes some sense - or it could be that natural immunity from pre omicron simply helps other countries over Taiwan…

Yes, there’s a definite signal in favour of the vaccines here for a very specific subset of the population … even with omicron. But in the context of their all-cause risk - which is higher than the average as a result of their comorbidities - it’s not entirely obvious if it’s an important signal. To ascertain that, we’d need to know what fraction of the vaccinated and unvaccinated populations have comorbidities - and that information just isn’t available.

I deliberately made no comment here about the relative costs and risks of getting vaccinated there because it would have just made that post incomprehensible.

@FairComment: my estimate of expected age-at-death is 78 for this dataset. For vaccinated people with no comorbidities, it’s also 78. For unvaccinated people with no comorbidities, it’s 75. This is of course subject to considerable uncertainty because of the age quantization and the very small numbers we’re working with. For someone to die of cancer (or any of the other serious diseases on the list) at an average of 3 years prior to their expected lifespan strikes me as no great tragedy.

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It would be interesting to note the outcomes once you factor in VAERS data. As of today, the number of deaths in the 65 and over age group is 1007. The rest of the Taiwan age group data is located here.

Yeah, I didn’t even attempt to go there because of the inevitable slew of denial that would follow, but even if you were to accept that the vaccines don’t hurt anybody (despite overwhelming evidence - the US VAERS death count is apparently up to 28,000, or about 100 per million) vaccines still cost “lives” in terms of the money spent on them. You can view this in (at least) two ways:

  1. The insurance value of a life-year in the West is US$50-100k, and since Taiwan must have spent at least US$2B vaccinating 20 million people, there should have been some payback to the tune of 30,000 life-years. As a crude estimate - from the observation that 75% of deaths were over 70 - we might generously say that each death represents 10 lost life years (it almost certainly wasn’t, since 95% appear to have been in end-of-life care, but let’s say it’s 10 years). Did the vax programme save 3000 (elderly) lives? Maybe. Maybe not. I don’t think anybody can even say for sure, because the data you need to make an estimate isn’t there. But that brings us to the second way of assessing effectiveness.

  2. Could we have spent US$2B and saved 30,000 life-years in some other way? In other words, what was the missed opportunity cost? Might we have saved the lives of (say) 600 thirtysomethings with $2B ($3.3m per life)? Again, I don’t know. But I suspect we could have done. And I think most people in their 80s would agree that their own lives are not as important as those of their children and grandchildren.

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Dang. A 26-sigma event. That’s like a super-nova black swan event.
Anyway… maybe those who had been trying to have a baby and couldn’t during COVID-19, but had been vaccinated, can try a bit harder now that the vaccines wear off, supposedly.

image

To see what could cause the extreme drop in births, go back 9 months from May 2022, so to September 2021.

Taiwan was a poster child for successful vaccination. 91% of all Taiwanese residents received a vaccine dose. By October 1, 2021, 56% of ALL people of Taiwan received Covid vaccines.

Covid vaccines are known to “disrupt the menstrual cycle” and lower sperm counts. It is possible that some women, for a period of several months, could not conceive and become pregnant due to these disruptions. Because all Taiwanese women were vaccinated at almost the same time, those disruptions created a precipitous drop in birth rates.

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:face_with_open_eyes_and_hand_over_mouth:

Crikey.

I think I’d want to see data to the end of the year, monthly, before drawing any conclusions about vaccination - there could be other explanations - but it sure doesn’t look good. Taiwan was unique in that we had a far, far higher proportion of reproductive-age people getting vaccinated - 100% as opposed to 40,50,60% in most other countries.

Even if it wasn’t the vaccines, it’s reasonable to infer that (if that’s real rather than a statistical glitch) that something to do with the COVID response was the cause.

Does anyone know if a positive Covid test is required at the time of death, for these deaths to be classified as an official “Covid death”?

I get the impression that a positive COVID test is all that is required. As Andrew pointed out, there seems to be no requirement that the person died of something obviously COVID-related. There was an article from a while back in the local rag regarding an apparent COVID death of a 30-year-old. Such things are of course very ambiguous because reporters aren’t clinicians, but it appears she presented originally with septicemia.

The lack of clarity here doesn’t inspire one with confidence.

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So one may be completely asymptomatic, with Covid possibly contributing zero percent to the death, but since they tested positive to Covid (at some indeterminate date in the past) it is labelled as a “Covid death”?

The descriptions in the news articles following “COVID deaths” imply that’s the case. What seems to happen is that the corpse gets swabbed and … OMG, it’s positive, he died of COVID. Not dissimilar to what happened elsewhere of course, and as @slawa said in a different context, it’s the way the WHO wanted it done.

I’ve no doubt a few people are dying with the classic COVID progression to death. But there seems to be an awful lot of noise in the reports.

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I guess they make sure it’s not a suicide or drowning (as of recently), then it’s a COVID death with 調查中 in the symptoms column?

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Wouldn’t it be then be more accurate to label these, as say, “Cancer (lung) death” with accompanying Covid positive swab at time of death? Something like:

Chronic heart disease death (Covid pos. at T.O.D.)

Chronic diabetes death (Covid pos. at T.O.D)

Terminal lung cancer death (Covid pos. at T.O.D.)

Since, there’s simply no detail on whether Covid contributed anything at all to the actual death?

It seems that to label these as “Covid deaths” is inaccurate and quite unscientific. I mean, if they are not sure what actually caused the death, or what percent Covid even contributed to it, then how can they boldly declare it ‘a death by Covid?’

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The obvious solution would be, like, you know, just duplicate the normal format for death certificates, which in most countries follows logic like this (UK guidelines) and which is designed to facilitate statistical accuracy, transparency, and a red-flag system for suspicious deaths:

The MCCD is set out in two parts, in accordance with World Health Organisation (WHO)
recommendations in the International Statistical Classification of Diseases and Related
Health Problems (ICD). You are asked to start with the immediate, direct cause of
death on line Ia, then to go back through the sequence of events or conditions that led
to death on subsequent lines, until you reach the one that started the fatal sequence. If
the certificate has been completed properly, the condition on the lowest completed line
of part I will have caused all of the conditions on the lines above it. This initiating
condition, on the lowest line of part I will usually be selected as the underlying cause
of death, following the ICD coding rules. WHO defines the underlying cause of death
as “a) the disease or injury which initiated the train of morbid events leading
directly to death, or b) the circumstances of the accident or violence which
produced the fatal injury”. From a public health point of view, preventing this first
disease or injury will result in the greatest health gain. Most routine mortality
statistics are based on the underlying cause. Underlying cause statistics are widely
used to determine priorities for health service and public health programmes and for
resource allocation. Remember that the underlying cause may be a longstanding,
chronic disease or disorder that predisposed the patient to later fatal complications.

You should also enter any other diseases, injuries, conditions, or events that contributed
to the death, but were not part of the direct sequence, in part two of the MCCD. The
conditions mentioned in part two must be known or suspected to have contributed to the
death, not merely be other conditions which were present at the time.

I don’t know for sure, but I would imagine Taiwan’s death certificates are (or were, back in times of sanity) filled out in more-or-less the same way. Replacing this with some ad-hoc alternative looks - at best - like incompetence. Of course, if a country has spent an eye-watering amount of money on doing X and it turns out that the statistics indicate that they probably should have done Y (and that X was largely unimportant) you wouldn’t want the statistics to flag that up, particularly if you were the person responsible for spending said money (in part upon your own salary).

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Suspicious, this is based on a comparison between May 2021 and May 2022. Might just mean than Taiwaneses have more babies when they are partially locked indoor. (edit: or another reason, cannot interpolate on just one month)