Cardiac Arrest Deaths x2.5

Ages 40-50 during 2021-2022, revised data from Clalit

Hebrew versions: תקציר בעברית פוסט מלא בעברית
English summary

Background

As promised, we are sharing the revised data for Cardiac Arrest and Stroke cases in Israel, 2017-2022, from Clalit Health Fund (4.8 million members as of 2022). This post will focus on cardiac arrests (ICD9 code 427.5, also referred to as ca).

A previous post analyzed incorrect data that was given to Ori Shabi, Adv. in response to a Freedom Of Information Act request. After sending a followup request, Clalit announced that the old data was incorrect and should be ignored.

New data

The new data is much more detailed, grouped by several parameters:

• Age (10 year groups)

• For 2017-2020 the data is yearly. For 2021-2022 the data is monthly

• Data is split into ca events and deaths

• Additionally, there is a table with no. of events in VACCINATED individuals

• ICD9 codes were provided in response, allowing better understanding of the data

• Clalit noted that the data comes from all of Clalit’s hospitals and for all of Clalit’s members including other hospitals. This may indicate that the total population covered is larger than Clalit’s members.

• Death entries include death at any time after the event, including after release from hospital

• Clalit added its standard disclaimers (see the clarifications in this post for example)

Analysis

Preliminary examination shows an unexplained 30% drop in cardiac arrest events and deaths of all ages during 2020, compared to previous years. A drop in the 50-90 age group is the biggest contributor to the general drop (these age groups mostly influence the number of ca events and deaths anyway). Age groups below 50 and above 90 did not exhibit such a drop. A possible explanation is a misdiagnosis due to positive Covid-19 tests, and if that is the case, it raises serious questions regarding the integrity of data from the Covid-19 pandemic era. Another possible explanation is that lockdowns reduced the risk of ca. Subsequent years (2021-2022) seem close to average. The drop in ca during 2020 is not reflected in all-cause mortality data.

When examining the different age groups, the 40-50 age group exhibited an explicit safety signal.

During 2021-2022, age group 40-50 exhibited x2.5 cardiac arrest Deaths vs. expected (27 deaths instead of 10.5, based on 5.25 cases/year avg. 2017-2020). Cardiac arrest Events jumped x2 vs. expected (38 cases instead of 19, based on 9.5 cases/year avg. 2017-2020).

Additionally, in 2020-2021 ca events were clearly more fatal than in other years in the 40-50 age group (2020: 11% survival rate, 2021: 18%), with 2022 showing a significant improvement (56%). This is observed by comparing ca events (in Blue) to ca deaths (in Red). A research from the United States checked OHCA (Out-of-Hospital Cardiac Arrests) responses and outcomes. The conclusions were:

The community response to OHCA was altered from March to May 2020, with less bystander CPR, delays in EMS response time, and reduced survival from OHCA.

If we compare the research to the data from Israel we see a similarity and a difference. The survival rate in both countries decreased (Israel 40-50 age group and USA research). Yet the overall number of cases in Israel showed a 30% decrease 2019-2020, while the USA research showed a 20% increase during those years. (Another US research found a 30% increase). Although this type of comparison is very crude, the inconsistency raises questions and further supports the possibility of misregistration and underreporting of ca cases.

2022 showed a higher survival rate in Israel, possibly due to higher engagement in CPR once the peak of the pandemic has passed, together with a major campaign to deploy public defibrillators and increase awareness in 2022 (1) (2) (3) (4) including the National Defibrillator Day (5) (6), Where’s Defi? interactive map, and the Shared Defibrillator project, all of which were launched in Israel in 2021-2022. The campaigns may suggest that authorities are aware of the rise in cardiac-related events despite denying it publicly.

Returning to the data, age groups above 50 displayed more moderate signals. Younger age groups (<40) did not exhibit clear safety signals and some have too few ca cases to be statistically reliable (although this does not negate the possibility of a safety issue).

Monthly data

Monthly data enables better understanding of existing signals. *See below for vaccination campaign timeline (provided as reference).

The prevalence of cardiac arrest cases is known to be seasonal, i.e. more events during the winter, yet the sharp spikes in cardiac arrest events cannot be dismissed. Unfortunately, earlier monthly data from Clalit (pre-2021) was not included in the request. Such data could have assisted in establishing a year-round baseline. As mentioned earlier, the graph above is mostly influenced by the 50-90 age group.

The younger age groups have statistically very few events, therefore a 3-month moving average was used in the graph. The graph clearly shows ca waves which do not fit the seasonal pattern, but this may be due to the limited statistical data.

By carefully studying the graph of monthly ca events age 40-50 (age group which produced the strongest safety signal in 2021), we can discover where the x2 ca events originate from:
14 ca events during January-May 2021, then later 6 cases at the end of summer (September-October 2021) exhibit an extraordinary pattern which does not fit the seasonal model. This may or may not be related to the 90% vaccination rate of this age group during January-March 2021, and 65% boosted on August-October 2021.

Daily number of vaccine doses

Regarding age group 40-50 :

In 2017-2019, 6,3,4 died yearly from ca, respectively.

Of the 22 cardiac arrest events of 2021, 18 had died.

This data only covers the 40-50 age group and only part of the population of Israel.

2022 still shows a yearly ca rate higher than pre-pandemic years. On January 2022 the 2nd booster was approved, this time only 4% took it in the 40-50 age group. Of the total 16 ca events of 2022, 9 had died.

Age-grouped all-cause mortality chart

For the 40-50 age group, the age-grouped mortality chart (based on CBS data) shows safety signals on January-February 2021, August-October 2021, January-March 2022, and then July and November 2022.

The correlation between cardiac arrest deaths, all-cause mortality, and vaccination timeline is striking.

Vaccinated vs. Unvaccinated

The data we received included an additional table - Monthly Cardiac Arrest Events in Vaccinated, grouped by age, Dec. 2020 to Dec. 2022.

A Vaccinated person is defined as someone who received any number of Covid19 vaccine doses, any time prior to the ca event (unlike other FOIA requests which are based on complex MOH definitions). Therefore, an Unvaccinated person may be defined as someone who has not gotten any Covid19 vaccine at all, and the Unvaccinated figure can be computed by subtracting the number of Vaccinated events from the total events.

We tested the monthly no. of events in each of the two groups by summing all events in all ages per month.

The most disturbing signals are the peaks on March and May 2022, which only appear in the vaccinated. On January 2022 the second booster was approved. Already on February the ratio between events in the two groups shifts from 1:2.4 (Jan.) to 1:5.7 (Feb.) . The main contributors to those peaks are the 60+ age groups. Reminder: The vaccinated status did not change - a vaccinated person is someone who received at least one dose.

Additionally, On December 2022, 23 ca events were in vaccinated, out of 24 total events (all age groups).

Data for number of deaths in the vaccinated group was also requested but was not supplied by Clalit.

Conclusion

There are other clear indications of a significant rise in emergency cardiovascular events in Israel. Prof. Retsef Levi’s article, which was peer-reviewed and published under Nature Magazine, marked the beginning of an ongoing scientific research into this phenomenon and its causes. His article was faced with criticism by the Israeli Ministry Of Health. Yet the MOH officially acknowledged that it does not have information regarding cardiac arrest events for 2021-2022, and is waiting for the Central Bureau of Statistics to send them the data. CBS also confirmed that Mortality by Cause Of Death stat. for 2021 (and 2022) has not been published yet (as of Aug. 24, 2023).

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Israel’s Institute of Forensic Medicine had closed its doors (1) (2) due to overwork (21 bodies arrived along the weekend) and understaffing (third of the doctors quit). This may or may not be related to cardiovascular events.

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Reference data

Israel’s vaccine approval timeline

12.2020 - Ages 60+
1.2021 - Ages 35+ and 16+ at risk
2.2021 - Ages 16+
5.2021 - Ages 12+
8.2021 - 1st booster
11.2021 - Ages 5+
1.2022 - 2nd booster for ages 18+
7.2022 - Ages 6 months+

Daily number of vaccine doses

Percent of vaccinated by age group (May 2023)

Percent of vaccinated by age group. Source: IMOH dashboard