Yes you are into complex ethical questions - there are obvious differences between a woman protecting a foetus that is still part of her own body, presumably with a vaccine that does not just have emergency approval! - and the covid case.
And you gloss over the real ethical issues with these other examples anyway, which are around free choice, social or medical pressure, and coercion (as is possible for UK care workers).
Chemical treatment of one person only because it might be good for some other person, or society in general, does indeed raise ethical questions for me.
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I think some of the anti-abortion crowd might take you up on that statement 
Free choice is as much a philosophical issue as an ethical one though, isnāt it?
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Iām not sureā¦philosophical issues to me are attempting to explain the nature of reality from an ethereal starting point (which may or may not include organised āreligionsā) and donāt get me wrong as I love pondering that sort of stuffā¦
Ethics appears to have many branchesā¦is it bio ethics that can be applied to the current situation or some other definition of ethicsā¦???
Free choiceā¦free willā¦the natural given rights to bodily autonomy/bodily integrityā¦
The rights enshrined in the Nuremberg codeā¦
Who really has the authority to decideā¦???
Ok so theoretically Iām currently sitting on the āabsolutely no way you would have to hold me down and forcibly inject me against my will and against the Nuremberg code to insure my compianceā side of the fenceā¦
At what point does legitimate resistance become crimes against humanityā¦???
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The Guardianās usual very English attempt at a ābalancedā viewā¦
In terms of āfree choiceā and philosophy, there are of course numerous perspectives, but all of them (that I can think of off hand) have ethical implications.
A basic approach would be to divide the philosophical traditions into the more continental (perhaps germanic) free will vs determinism discussions (freedom inside the individual) and the more external, anglo-saxon ācivil libertiesā approaches. They both get into very deep water very quickly: the real nature of physical reality, of time, of quantum uncertainty, and of consciousness - so not something we can get far into in an internet forum!
(It will come as no surprise to anyone that bothers to read my posts that my āgo toā philosopher on freedom would be Sartre every time: we are condemned to be free!)
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Their choice.
Itās too much of a moving target, especially now vaccination is starting to skew the incidence by age group.
However, lets try playing with some figuresā¦
Apologies if you arenāt good with numbers.
TL;DR - get vaccinated.
Actual infections are fairly flat across age groups, unlike admissions and deaths.
So, Iām going to assume that incidence per 100,000 is completely flat for simplicity and we can then work out the overall incidence.
Iām going to assume that the UK population is 68.25 million
From the Worldometer figures there were 1849148 cases (well, positive tests, for now letās not get tied up in whether this is different to cases).
Thus the overall incidence is 1849148/68250000 or 2.709% (2709 per 100000) for Jan/Feb/Mar 2021.
That ONS graphic is a pain in that it uses different ranges for incidence and uses absolute figures for deaths but it is at least broken down by age. Fortunately data on the age makeup of the population is reasonably easy to find for comparison.
Note the ONS graphic says 1.25% of the population (ish) tested positive but that was just one week, almost at the height of the recent wave.
Deaths in the week up to 29 Jan were 8063 - breakdown by age and converted to percentages that was:
| Age | Deaths | %age total deaths |
|---|---|---|
| Under 1 year | 0 | 0.00 |
| 1 to 14 | 0 | 0.00 |
| 15 to 44 | 96 | 1.19 |
| 45 to 64 | 850 | 10.54 |
| 65 to 74 | 1,253 | 15.54 |
| 75 to 84 | 2,382 | 29.54 |
| 85+ | 3,482 | 43.18 |
The total number of deaths in the 1st three months were 33663 so taking that and assuming the same percentage distribution we have:
| Age | Number of deaths | ||
|---|---|---|---|
| Under 1 year | 0 | ||
| 1 to 14 | 0 | ||
| 15 to 44 | 401 | ||
| 45 to 64 | 3549 | ||
| 65 to 74 | 5231 | ||
| 75 to 84 | 9945 | ||
| 85+ | 14537 |
From the age/ethnicity data 25.4% of us are aged 45-64 or 17.34 million.
If we assume that 17.34 * 2709/100000 or 469618 individuals in that group tested positive and 3549 of them died then the case fatality rate is 0.756% in that age group.
Similarly it is 0.05% in the 15-44 age group (27.64million, 749k positive tests and 401 deaths)
Iād prefer data in smaller age ranges, and it is probably out there, but I donāt have all week.
Note that vaccinations had reached over 30million by the end of March so there will be some vaccination effect in the above figures - it will skew rates towards younger age groups, and indeed we see that in the number of positive cases being noticeably lower in older groups.
The estimation of thrombotic events for the AZ vaccine is roughly 11 events per million doses administered (of which not all fatal by any means).
So, if all 17.34million 45-64 year olds had been vaccinated with AZ just prior to that three month interval there would have been potentially 17*22 or 374 clots (ignoring the age distribution as I canāt quickly find any data - probably fewer in practice as the peak for clots with AZ is younger).
Set 374 clots against 3549 deaths and the vaccine is a clear win but donāt forget that in addition to death Covid causes thromboembolic events with a significantly higher incidence - up to 1 in 5 in cases ill enough to need hospital treatment - than the vaccine does. I havenāt got detailed figures for total hospital admissions in that 3-month period but by cutting that number by 95% a lot of morbidity (as well as mortality) will be prevented.
For 15-44 year olds youād perhaps expect 608 clots if everyone were vaccinated with AZ which is more than the 401 deaths in that group but not all the clots will be fatal so there is still a benefit from vaccination, plus there is still prevented morbidity in this age group, just not quite as much as in the older groups as fewer get ill enough to require hospital treatment.
For my money it is absolutely clear that the vaccine is preferable to getting Covid, even if you are below 45, at least when the pandemic is in full swing.
How well the AZ vaccine stacks up when we have enough of the population vaccinated to get the deaths and hospital admissions to, say, 1% of their peak rates is a bit less clear but those rates can only be achieved by getting every one immune and the best way to do that is to get vaccinated.
And if you think Iāve argued against AZ - well, go for Moderna or Pfizer, but get vaccinated.
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Our neighbour also developed a clot with Pfizer. I had thought it was the day after, but turns out it was a couple of days later and the docs also think he was predisposed because of having had covid 3 months earlier.
Having Covid is associated with thrombosis, including cerebral venous thrombosis at a higher rate than background or amongst vaccinated individuals.
And it can kill you in even more interesting ways as well:
Whatever age you are - get vaccinated.
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Not sure about the usefulness of these figures Paul. On first glance the problems are:
- assumption that positive tests = all cases - I donāt think this is defensible
- the age ranges - why 15-44? - this makes it almost completely irrelevant to the discussion we were having, which was focused on āhealthy young peopleā (which I was taking to mean under 25s from another set of figures - the deaths in your range might well all be over25)
- similarly - where are comorbidities?
- various other assumptions along the way.
Iām still inclined to my view that there are āstill a lot of unknownsā therefore.
By the way, how do you account for the early findings (eg. from infected cruise ships) that very large percentages of cases were asymptomatic, or the various research efforts that have found anywhere between 20 and 85% of cases asymptomatic or unreported? Is it now your view that in the UK its āworld-beatingā test and trace system has actually found all cases?!
Got better ones?
Not being snarky BTW, itās quite hard to find data in the public domain which is reasonably reliable without spening a lot of time hunting it down and doing analysis.
I think it is - it is one of the reasons that I concentrated on the beginning of 2021. Had we been talking about the beginning of 2020 I would have agreed (and made the point several times in various fora at the time that we were massively under-estimating cases).
I agree, and said in my post above that they were too wide. 15-29,30-44 etc would have been better. But the ONS data broke the numbers down by age fairly coarsely so I was a bit stuck with it.
Again, if you have data which separates out for co-morbid/not comorbid individuals please share.
Of course there are. It was an analysis which took me about an hour. I think you are being overcritical here. Iām not trying to advise SAGE just provide a bit of data which is more precise than the bulk figures for the purposes of interested discussion.
Yes, there are but the breakdown of data that I did more supports your contention that the advantage of vaccination for those aged < 45 is a harder case to make than it refutes it. Itās not an impossible case to make, I think, but certainly harder.
I donāt think anyone is denying that Covid has a high asymptomatic rate, but the ONS data on antibody prevalence does not support the idea that we are still missing > 80% of cases. If we were the 4 million official cases would imply half of the UK would be positive for antibodies even without the effect of the vaccine. The ONS data is 50% as of w/e 14th March - at that point about 25 million 1stdoses of vaccine had been administered so 20-25 million people out of 34 million would be because of vaccination.
However, even if you suggest that the ātrueā case number was 2x higher than the official one (based on the above) that only reduces the case fatality rate which was a peripheral figure in my arguments - it does not reduce the absolute number of fatalities, which were the numbers I used to argue benefit from vaccination.
[edit - above two paragraphs tweaked having fixed some broken mental arithmetic]
The cruise ship data not sure but they were not exactly scientifically controlled and they are now pretty old, the population data should be more reliable.
Are we identifying all cases? No. But I donāt think it unreasonable to suggest weāre getting most of them now.
I donāt think I disagreed with that assertion did I?
I think the difference between us is that despite the unknowns that we both acknowledge, you still draw the conclusion: āWhatever age you are - get vaccinatedā. I donāt quite get the leap from uncertain evidence to certain conclusion - it looks like a leap of faith to me.
Iām happy to live with the uncertainty, to accept that we canāt be quite that definite yet, to wait for good information (particularly for my 17-year-old son - which is of course why Iām interested in that age group) - to decide on vaccination for myself, but at the same time to also respect the right of others to make different choices.
I wonder, also, if underlying this difference is a broader difference in perspective. I see the pandemic not just as a health issue, but as one relatively small (!) manifestation of climate/ecological breakdown. Along with other effects such as pollution, flooding, wildfires, droughts, agricultural failures, mass migrations - and the resulting social conflict, war, etc - this depends ultimately not on vaccination decisions, but on thousands of other decisions about lifestyle and politics.
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But thatās true for most things is it not?
Ultimately evidence and reasoning can get you so far but the final crossing of the Rubicon to a firm decision requires faith - faith in data or faith in a divine power or faith in yourself (or a mix of all three) but faith nonetheless.
I think the case for vaccinating anyone over 45 at present can readily be made based on present evidence - you are much less likely to die or suffer long term morbidity if you are vaccinated and the benefit rises with age.
For those under 45 I agree it is more nuanced, individual benefit is smaller given the much lower chance of illness serious enough to be hospitalised and chance of longer term morbidity is also lower. But I think that you can still make the argument that, at an individual level there is overall slight benefit. At least give me credit for trying to run the numbers 
Although finding hard evidence would be even more difficult my feeling is that there is a moral, reason for the < 45 cohort to get vaccinated in that, otherwise, they will be a reservoir not only of infection but of opportunities for further mutation - one thing that is clear about SARS-COV-2 is that it mutates at the drop of a hat. Donāt fall into the trap of looking at benefit only in terms of mortality, there is also the morbidity of Covid on the individual from infection but donāt forget the morbidity of our reaction to the pandemic - lockdown, lack of travel and holidays, furlough, economic impact - all of these directly affect the < 45 age group.
However once we get into low endemic rather than pandemic levels of infection vaccines must be safe and Iām not sure AZ quite cuts it.
You only have to look at India to see what Covid can do to a less than robust health system (a point I made at length early on - mortality rises massively if you canāt save the salvageable because you ran out of resources).
Whatās the joke?
āThere are two kinds of people in the world: those who can extrapolate from incomplete data sets andā¦ā
Iām not sure we are as far apart as you seem to think on that point. I also have a 17 year old son and worry greatly for his future and, yes, all of the things you mention will be the challenges that his generation face and, yes, they are largely the fault of ours.
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Love your reasoned explanations Paul. Thank you!
Izzy x
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Iām off for my 3rd dose tomorrow. Have no worries about having it .
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And here is me - THANKING previous generations for their stance on society, embracing science and getting themselves and their kids vaccinated against small pox and polio!
And thus making sure that following generations never have to worry about these diseases again.
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Very happy that all my adult kids have now had their first dose 
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