"The tests performed here were done fortnightly, as mentioned. It is possible to have a full clinical course of COVID-19 in less than 14 days, and I’m sure it’s also possible to have an asymptomatic infection that resolves in less than 14 days."
I tend to read CT early in the morning, while finishing my first cup of coffee. As a result, reading this I thought, "Why didn't they do antibody tests to see if someone was infected?"
And then, "Oh, right, vaccinated."
'However, the really disappointing part is where gender, age, ethnicity, IMD (“index of multiple deprivation", a measure of socioeconomic status/poverty) and staff group also impacted likelihood of getting the vaccine. Basically, this tells me that societal inequality, as well as potentially a false impression of invincibility among younger people, led to disparities in vaccine uptake.'
There's also a frequently-written-about phenomenon that members of some ethnic groups simply distrust the medical system. I have no idea if the UK experiences this to the same extent as the US, with our atrocious (in the literal sense--these were atrocities) history of things like the Tuskeegee Experiment and the Doctor J. Marion Sims inventing gynecology by experimenting on slaves without anesthetic.
Another wrinkle here: everyone in this study (if I read your summary correctly) was employed by the NHS. They certainly varied by SES, but that would inevitably correlate with educational level--in the healthcare business, physicians get paid more than nurses get paid more than nurses' assistants, to name three jobs. Did they correct for that?
Actually, interestingly enough, the vaccines should not interfere with a person's ability to be tested for COVID-19 antibodies. Specifically, there are antibody tests that target the virus nucleoprotein (N), which is not a vaccine component. So you can specifically differentiate natural immunity from vaccine-induced immunity by this method.
As it happens, SIREN participants are antibody-tested every 30 days. However, this does not appear to have been part of the case definition in the trial and wasn't used for the efficacy data reported here. I don't know why and it is not explained in the paper. I hope it comes up on peer review, because you raise an important point! I wonder if The Lancet accepts public comment on preprints and considers it during peer review. It may be worth communicating this question to them.
On to other matters in your comment: it's quite a shame that the systemic racism in past medical practice has reinforced mistrust. I think you make a very important point there, too.
Indeed, everyone in SIREN is a staff member at a publicly funded UK hospital. The study covers workers from every walk of life; this includes porters and security guards as well. You're right to think about how their monetary compensation and educational level may impact their vaccine hesitancy. The study authors, in the methods section, note that they examined the dataset for potential bias based on demographic factors, but they do not go into detail. I think that your point here, as well, is one that should be raised during peer review.
We see here that it is important to interrogate the content of preprints, because they do contain undetected flaws in logic or omissions. These two comments would likely require "minor revisions" to the piece, because it seems some of the work being requested has already been done, but the authors have not commented upon it in sufficient detail. Minor revisions are what one hopes for when submitting something for publication.
"The tests performed here were done fortnightly, as mentioned. It is possible to have a full clinical course of COVID-19 in less than 14 days, and I’m sure it’s also possible to have an asymptomatic infection that resolves in less than 14 days."
I tend to read CT early in the morning, while finishing my first cup of coffee. As a result, reading this I thought, "Why didn't they do antibody tests to see if someone was infected?"
And then, "Oh, right, vaccinated."
'However, the really disappointing part is where gender, age, ethnicity, IMD (“index of multiple deprivation", a measure of socioeconomic status/poverty) and staff group also impacted likelihood of getting the vaccine. Basically, this tells me that societal inequality, as well as potentially a false impression of invincibility among younger people, led to disparities in vaccine uptake.'
There's also a frequently-written-about phenomenon that members of some ethnic groups simply distrust the medical system. I have no idea if the UK experiences this to the same extent as the US, with our atrocious (in the literal sense--these were atrocities) history of things like the Tuskeegee Experiment and the Doctor J. Marion Sims inventing gynecology by experimenting on slaves without anesthetic.
Another wrinkle here: everyone in this study (if I read your summary correctly) was employed by the NHS. They certainly varied by SES, but that would inevitably correlate with educational level--in the healthcare business, physicians get paid more than nurses get paid more than nurses' assistants, to name three jobs. Did they correct for that?
Actually, interestingly enough, the vaccines should not interfere with a person's ability to be tested for COVID-19 antibodies. Specifically, there are antibody tests that target the virus nucleoprotein (N), which is not a vaccine component. So you can specifically differentiate natural immunity from vaccine-induced immunity by this method.
As it happens, SIREN participants are antibody-tested every 30 days. However, this does not appear to have been part of the case definition in the trial and wasn't used for the efficacy data reported here. I don't know why and it is not explained in the paper. I hope it comes up on peer review, because you raise an important point! I wonder if The Lancet accepts public comment on preprints and considers it during peer review. It may be worth communicating this question to them.
On to other matters in your comment: it's quite a shame that the systemic racism in past medical practice has reinforced mistrust. I think you make a very important point there, too.
Indeed, everyone in SIREN is a staff member at a publicly funded UK hospital. The study covers workers from every walk of life; this includes porters and security guards as well. You're right to think about how their monetary compensation and educational level may impact their vaccine hesitancy. The study authors, in the methods section, note that they examined the dataset for potential bias based on demographic factors, but they do not go into detail. I think that your point here, as well, is one that should be raised during peer review.
We see here that it is important to interrogate the content of preprints, because they do contain undetected flaws in logic or omissions. These two comments would likely require "minor revisions" to the piece, because it seems some of the work being requested has already been done, but the authors have not commented upon it in sufficient detail. Minor revisions are what one hopes for when submitting something for publication.