36. Vaccine or Vaccination?

February 7, 2021 Minding Corona No Comments

This text is not for the faint-hearted. Even so, before you read on, make sure you understand that MUCH OF THIS IS STILL HYPOTHETICAL, HOWEVER, PROBABLE ENOUGH TO BE TAKEN INTO ACCOUNT.

February 6, 2021

 DailyTotal
Cases worldwide495.819105.906.560
Deaths worldwide14.5922.307.879

Please, in any case, read this short introduction

It’s not because psychotherapy works (very well, even) that psychotherapeutic models and techniques work. With scientific certainty, they don’t. [see: “Psychotherapy vs. Psychotherapies“]

It’s not because yearly 650.000 knee operations of a specific kind were performed in the US, with good results, that the procedure itself was effective. It wasn’t. [see: “A Tale of Placebo: Arthritis of the Knee“]

It’s not because some 250 Million people take antidepressants daily that these work very well apart from placebo. According to the type of study, their placebo-part ranges from 80% to practically 100%. [see: “Antidepressants on a Plate“]

Etc. etc.

Before you laugh away the following, you should have proper answers to many issues such as those above or at least one excellent depthless answer to one of them. Spoiler alert: there is none.

So:

It’s not because COVID-vaccinations (in broad context) work well that COVID-vaccines work well.

You may remember my image of the whirlpool in which material and mental factors play a role. [see: “COVID-Whirlpool“] Imagine being near the whirlpool. A few steps in one or the other direction are enough to keep safe or not. That’s all it needs ― not much. According to hypothesis, apparently, the vaccination is enough to perform this for the time being.

According to the same hypothesis, humanity is soon made to fly on only one decently acknowledged wing. If, for one reason or the other (many candidates exist), faith in the other wing evaporates, it doesn’t work anymore, and people may fall in droves.

I cannot readily think of a more dangerous situation in the past of humankind. At least, with science in mind and with what is at stake, it should be investigated. It should have been a year ago.

I send this message to the future: I did my best. Before you judge me, please take into account the whole situation. My name is Jean-Luc, not Lucky Luke the Lonesome Cowboy, although I can shoot pretty well if need be.

Curves and numbers

(from https://www.worldometers.info/coronavirus/)

There is some slowing down in these numbers, worldwide, hesitatingly, while the hope of many rests on the shoulders of vaccines. Massive campaigns are put in place to get as many people vaccinated as possible.

The quickest progress is made in Israel, with one-third of the population already vaccinated. Reports show excellent results in numbers of cases of infection and deaths (effectiveness up to > 90%). The differences between the vaccinate and the non-vaccinated are remarkable. A point of caution is that this comes during a tightening of the third Israeli lockdown. As to mortality in the total Israeli population, this is the curve today from https://www.worldometers.info/coronavirus/country/israel/:

Does this show the effect of the vaccines?

Several vaccine RCTs have revealed a high to very high efficacy. However, scrutinizing this research in light of placebo, nocebo, and blindness breach, the results of the studies may be seriously flawed. This means, they are inconclusive. I posted some rapid responses about this in the British Medical Journal:

These are not very uplifting.

Note that this is what science is supposed to be about: being critical. Different opinions need to be put beside each other. Ignoring something because the mind is – or is not – involved is preposterous and, in this case, dangerous.

Science is not just being critical up to where it doesn’t suit one anymore. Science doesn’t stop at the exit where money and status might be lost. It goes on and on. This eternal doubt and tenacity are why science is our only hope. If it is taken away, humanity is pretty lost. We need more science. Also, we need better science. This endeavor should never finish.

Stress virus?

As you may have read in my book ‘MINDING CORONA,’ COVID is more than simply a viral disease. As a matter of fact, virus is virus. The COVID disease is caused not by the virus but by a combination of factors in which the immune system and stress also play important roles. This combination forms a whirlpool in which people can get caught when making unfortunate moves at crucial times.

Of course, we’re not getting anywhere by looking at stress as an amorphous blob that inhabits one like some chemical element. Stress is about meaning. [see: “Not Stress but Meaning is a Cause of Disease.”] Thus, it is about striving for autonomy and life itself. [see: “The Autonomy and the Meaning”]

Social nocebo

In another article [see on RG: “The Role of Social Nocebo in COVID-19”], I expanded on ‘mass psychogenic illness:’ symptoms or illness that may befall many people in a joint happening that can also be seen as a whirlpool. This is a social whirlpool. It seems to happen regularly but is seldom reported. In many cases, there is shame or avoidance of guilt involved, and a covering it up with some somatic cloak, or just ignoring and forgetting it.

That is one of the reasons why I prefer the term ‘social nocebo:’ less negative connotation. Another reason is that it brings the happening closer to a domain of which much is already known: true placebo phenomena.

Vaccination

With ‘vaccination,’ I denote the whole bio-psycho-social context in which the vaccine-as-product is administered. Lending hope and positive expectation to many may diminish the power of social nocebo. This diminishment of nocebo may also be seen as a placebo. Opening the concept this way, we may look for insight in the literature about placebo.

There’s a lot. Placebo is real and robust.

This is not about other vaccines. In my view, COVID is special in its stress-relatedness, in the appearance and disappearance of a COVID-whirlpool. Nevertheless, the principle of a whirlpool may be relevant to many other psycho-somatic illnesses.

Bringing it all together,

my apprehension about effectiveness of the COVID vaccine is considerable. Note that I am no anti-vaxxer; on the contrary, [see: “Vaccination Hesitancy: the Good, the less Good, and the Ugly”]. But, as said, good science doesn’t stop quickly.

There may be much placebo involved in the vaccine studies, especially in the age ranges where it matters most. With little data – being all we’ve got in these studies – and thus with huge uncertainty, I calculate a placebo-effect of +/- 8O% concerning severe COVID cases in the Pfizer study. [see on RG: “Efficacy of placebo-vaccine administration on occurrences of severe COVID-19”]

Note also that in this study, people were blinded as to receiving a vaccine versus a placebo. In real-world, there is no blindness. People know they get the vaccine. Thus, the placebo effect may be higher.

One may ask whether any placebo can be so powerful?

The short answer is: yes. [see: “How Active is Placebo?”] A side-note to this: We know little about the placebo of vaccinations. We know more about the placebo of medications and increasingly about medical procedures, including operations. In any of these, studies occasionally show huge effects.

Like: more placebo than pharmaco.

20%? 40%? 80%?

In the case of COVID vaccination, we don’t know. Proper studies to find out have not been done. If the placebo-effect of the COVID vaccination is substantial, then we are at risk of floating on a placebo cloud, massively. In that case, the situation may be much more dangerous than that of antidepressants.

What if the cloud bursts? With medication, such a burst is rather individual. With vaccination, it is rather social, with problems way more difficult to contain.

I have written about this in “Why it Matters to Know the Real Effectiveness.”

There is reason to be cautious. It is not a question of ‘freedom or no freedom.’ A division in two opposing camps ’for versus against lockdown’ doesn’t make sense to me. It hinders both parties in trying to reach a good global picture to be reached as a stable equilibrium. It leads to a labile equilibrium in which the strongest party wins, creating much stress near a lurching whirlpool.

That should be avoided.

As said, this is all hypothetical

as is also the basis upon which the mass vaccinations are being rolled out.

If the hypothesis of this text is correct, I see two main consequences:

  • The vaccinations are making the situation extremely, insanely dangerous. Namely: Many people do not understand the ‘power of placebo,’ equating it with sheer make-belief and deception. While, of course, placebo is deception – one way or another – the ‘power of placebo’ is far from a deception. If the placebo-deception gets punctured, it may deflate into nothing or may even flip-flop towards a social nocebo phenomenon. The real strength of the second wing lies in the ‘power of placebo,’ not in the placebo itself. This brings us to:
  • Much more attention should go to the mind as a causal factor (thus also important towards management). One can do so socially and individually. This is not to say that it would be unimportant in the other case. The lack of attention to ourselves is mind-boggling anyway.

Things are not black or white.

If the vaccination placebo is vast, it points to a way – within ourselves – to alleviate the present problems enormously, rashly, with little cost, little need for lockdown, and more positive outcomes than merely COVID-related.

This is about fully being human. The main question then would be:

Do we dare?

ADDENDUM

February 21, 2021

 DailyTotal
Cases worldwide372.498111.638.837
Deaths worldwide8.4932.471.484

Since mid-January, worldwide cases are dropping markedly. Two weeks later, also mortality. This trend is continuing. It is not a glitch.

Why are COVID-19 cases dropping fast?

Several reasons have been put forward:

  1. behavior change: people worldwide have finally got the hang of wearing masks and social distancing
  2. seasonality: winter months being corona months
  3. partial immunity: many people having been infected, thus immunized naturally
  4. vaccines/vaccinations

Personally, at present, I don’t believe in 1, since I see no reason for it. It seems like whatever explanation after the facts, something in which humans excel (including me).

Also, I don’t believe in 2. If anything, seasonality should be moving us in the opposite direction.

A substantial factor may be 3.

About 4, we don’t know how much, but the vaccines by themselves probably contribute. Note that the diminishment of cases began before the vaccinations started being rolled out.

Where is 5: the mind in all this? Where can it be? One can only hypothesize. A seemingly good explanation to me is the mindset brought about by the vaccinations’ success in studies and media. A good job has been done in pushing this. The social nocebo spell may have been taken away by bringing hope that the end of the tunnel may be approaching.

In conclusion, factors 3, 4, and 5 may be taking energy out of the COVID whirlpool. Which factor is most important?

Of course, the dropping in cases is super. Also, we should definitely continue with the vaccinations.

Still, for obvious reasons and more, it is crucial to know what really happened, is happening, and will probably happen. Most of all, we urgently need to know who we are. The viral threat is still present. The next threats will be with us soon enough.

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