Propaganda and hospital admission bias

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  • Tue, Oct 12, 2021 - 03:21pm

    #1
    SDHodges

    SDHodges

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    Propaganda and hospital admission bias

A look behind claims of some of the more insidious propaganda from NHS England aimed at getting pregnant women to get the jabs when viewed against hospitalization admission bias.

Almost a fifth of the most critically ill coronavirus patients in England in recent months were unvaccinated pregnant women, health officials said as they urged expectant mothers to get their jabs.;

NHS England said that, between July 1 and September 30, 17 per cent of Covid patients receiving treatment through a special lung-bypass machine were mothers-to-be who had not had their first dose of a Covid-19 vaccine.

The organisation said data also showed that pregnant women accounted for 32 per cent of all females aged between 16 and 49 in intensive care on extracorporeal membrane oxygenation (ECMO) – used when a patient’s lungs are so damaged by Covid that a ventilator cannot maintain oxygen levels.

NHS England said this figure has risen from 6 per cent at the beginning of the pandemic in March 2020.

https://www.standard.co.uk/news/uk/covid-vaccine-pregnant-women-nhs-england-ill-b959759.html

All of this sounds very scary and dramatic until you factor in that at the beginning of the pandemic it was revealed that there were only 15 ECMO beds in England maintained across just 5 hospitals operating 3 beds per centre.

https://www.theguardian.com/society/2020/feb/27/coronavirus-england-only-has-15-beds-for-worst-respiratory-cases

So the 6% back at the beginning of the pandemic represented just 1 pregnant patient and it would only require 3 pregnant women to get to 20%.

The statement that ECMOs are “used when a patient’s lungs are so damaged by Covid that a ventilator cannot maintain oxygen levels” is also misleading.

ECMO is administered to patients who have a reversible severe lung injury and is usually used for conditions such as very severe asthma, severe pneumonia and acute respiratory distress syndrome (ARDS)….In cases of very severe asthma, when it is often extremely difficult to use a conventional ventilator without damaging the lungs, ECMO is a really good support,” says Jo-anne.
https://www.rcn.org.uk/magazines/bulletin/2021/feb/ecmo-the-machine-that-breathes-for-you-covid-19

The fact that a very few pregnant women in the last 20 months have been treated with ECMO does not necessarily mean that they were “the most critically ill coronavirus patients in England”. It is more likely that those very few suffered from Pneumonia, ARDS and severe asthma and were obvious candidates for extremely scarce ECMO care resources.

Hospital Admissions Bias

The fact that these women were placed in ECMO care says rather a lot about various forms of admissions bias for certain groups.

Analysing data from ICNARC and comparing ICU fatality rates we can deduce that both currently pregnant and recently pregnant women are far more likely to be admitted to ICU than non-pregnant women.

ICNARC’s Mortality Data in Females aged 16-49 admitted to ICU: May 1st 2021 – 7th October 2021

Currently Pregnant: 3/218 (ICU-FR: 1.4%)
Recently Pregnant: 5/172 (ICU-FR: 2.9%)
Not Pregnant: 127/914 (ICU-FR: 13.9%)

https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports

Given the fatality rate is 10 times higher in the non-pregnant cohort (13.9%), we can either conclude that a pregnant woman is 10 times more likely to be admitted to ICU than a non-pregnant woman or we can conclude that pregnant women admitted to ICU are ten times less likely to die than non-pregnant women in the same age group and that pregnancy therefore offers 90% protection to mortality from Covid.

We tend to think of clinical outcomes such as hospitalization or ICU admission as being a reliable metric in assessing the severity of a disease. This is not the case as their are clear examples of admissions bias for different groups. Pregnant women are medically the most closely monitored and protected members of our societies. Any pregnant woman who presents at A&E is likely to be admitted to hospital as a matter of course and will be admitted to ICU for very close monitoring well before non-pregnant women of a similar age. To say that pregnant women are more at risk from Covid than non-pregnant women totally ignores this obvious admission bias confirmed by the hospitalization fatality rates.

We could conclude that pregnant women are more at risk of being admitted to hospital in general, regardless of the medical condition they present with.

We see a similar admissions bias when we examine the hospitalization fatality rates between the fully vaccinated and unvaccinated under 50s with PHE hospitalization data for 218,784 confirmed Delta infections – which show that the HFR in the vaccinated is 3 times higher than the unvaccinated.

Vaccinated: 27/366 (HFR: 7.4%) (IFR: 0.07%)
Unvaccinated 72/3044 (HFR: 2.4%) (IFR: 0.04%)

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1012644/Technical_Briefing_21.pdf

Given similar symptomatic presentation at A&E, either 2-3 times more of the unvaccinated are being admitted to hospital than the vaccinated or the vaccinated are 3 times more likely to die when hospitalized.

Unvaccinated people are more likely to be admitted to hospital either because it is assumed that they are more at risk than vaccinated people or there is a drive to intentionally hospitalize the unvaccinated when there is spare hospital capacity in order to increase the numbers and stoke the fear factor for getting vaccinated.

The operation of such admissions bias means that hospitalization rates tell us very little about any actual or scientific appraisal of the severity of relative cases of Covid and we can conclude that perceptions about which groups might be more at risk from Covid than others – actually end up driving hospital admissions of those groups in a feedback loop.

The data is clear though. Pregnant women are no more at risk of Covid than their non-pregnant peers and it is blatant propaganda from PHE England to suggest otherwise.  Admission bias needs to be taken into consideration in clinical trials and research that relieves on hospital admissions as clinical ‘evidence’.

  • Tue, Oct 12, 2021 - 03:30pm

    #2
    nordicjack

    nordicjack

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    Propaganda and hospital admission bias

Yes that is clearly biased propaganda.   For all we know all these figures could just represent one ( 1 ) only one pregnant hospitalization.

  • Tue, Oct 12, 2021 - 03:48pm

    #3
    SDHodges

    SDHodges

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    Propaganda and hospital admission bias

Direct link for ICNARC data.

https://www.icnarc.org/DataServices/Attachments/Download/43b1a83d-6828-ec11-9137-00505601089b

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