190 Comments

Thanks for this! Curious about your advice re: delaying 2nd booster for those under 50. How soon before those of us in our 40s are eligible for a 2nd booster? You say Over 50 should get 2nd booster now and they will still be able to get Omicron booster in the fall. Is that because the Omicron booster won’t be available for 5+ months and so if you get a booster NOW you’ll be eligible again by then? But because Under 50 won’t be eligible for another month or more their window won’t be open again in time for the Omicron booster when it first arrives? I’m trying to figure out just how long I’ll be feeling like a sitting duck. I’m in my 40s and healthy but it’s been 8 months since my 1st booster…

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This confused me too, I already got my 2nd booster (I have asthma) and I guess everyone I know is either immunocompromised, exposed or older, but I didn't even realize people under 50 weren't technically eligible yet! I think anyone I know taking it seriously has already had 2nd booster regardless of health, to be honest.

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No, not everyone. I take this verrrrry seriously but I'm an attorney and won't sign an affidavit that I'm immune compromised when I'm not (which is what I've been asked to do when I've tried to get a 2nd booster).

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Wow, where do you live? I haven't had it at Target or CVS. I'm in TX so of course..not big on regulation. Heck I know someone who's dr had him get the 2nd booster a month after he got the first one just because he kinda threw it in with the flu shot, didn't ask if he already had it and the friend was out of it at the time I guess.

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Massachusetts

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Weird, I've never had to sign any affidavits

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CVS (also Target) makes you do it when you make an appointment online. I haven't tried to do a walk-in there. No doctor's office or medical clinic associated with a hospital near me will do it without proof of immunocompromised status.

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I'm curious about this as well! Many places don't really ask for 'proof' of moderate-severe immunocompromised status, so I could easily go and get my 2nd booster now but I don't want it to interfere with my eligibility for a better one in Fall.

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Honestly I wish this had been my experience. Maybe it's stricter here in Massachusetts. Everywhere I've tried requires either proof of immunocompromised status or asks you to sign an affidavit to that effect, which I don't feel comfortable doing.

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Thanks for the update!

Hoping you will cover Novavax soon? Some folks on Twitter are very high on it due to “no signs of waning” and “protection to all variants”.

As someone who has had 2x Pfizer and a Moderna booster and never infected, I’m highly considering that as my next course (because I want to avoid getting C19 ever) but haven’t seen the data to support the above claims.

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author

Novavax will be authorized soon. They are having some serious manufacturing issues. Unfortunately, I don't think they will be ready in time for a Omicron booster (I would totally stand in line for that). TBD

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They're in P3 trials for the omicron boost.

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founding

Yes, I'd love a "reality check" on Novavax as well. Keep hearing the same things, but can't find the info.

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Thanks for this update. We've been watching what others in the field have been saying about this for weeks now and this is right in line with what we have been reading.

One caveat: I don't think it's a good idea to say things like "Another booster now will not only prevent infection but will prevent severe disease." Too many people seem to translate this as "vaccination is a magic shield offering a 100% guarantee" (some out of ignorance, some out of malice) and then insist that "vaccination doesn't work" because vaccinated people can still get sick. I'd rather see statements like ""Another booster now will substantially reduce your chances of infection and severe disease." We have data to back that up, after all.

Thanks for reminder about the importance of proper masking, though. Too many people still seem not to understand that a properly fitted KN/N95 or equivalent is your best first line of defense. It's like a Medieval walled city with a standing army inside. Any invader that gets past the wall still has to deal with the army, but you really want to just keep the enemy out in the first place.

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We can't save the ignorant nor should we expend precious resources trying to. If they want to say vaccination doesn't work, fine with me. Those of us here know that these boosters come with no guarantees. A booster will not prevent infection. That's well known.

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It's not about saving the ignorant, it's about accurate communication. And clearly it is not "well known" in enough places. Far too many public venues are still requiring vaccinations but not masking, which is worse than useless as it creates a false sense of security. We need to make sure the facts are properly communicated.

And I don't see how simply writing "will reduce the chances of" expends more precious resources than writing "will prevent."

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The misinformation is intentional. People who can't see that by now are never going to catch on. This false sense of security is all part of the theater we have been subjected to. The ridiculous idea that you can take off a mask in a restaurant, but need to wear it when you leave your table is a huge clue that we are being played. But the science-based facts are out there competing with the narrative (propaganda, basically) people want to hear. YLE touches on this when she brings up the disgusting CDC map. The facts are properly communicated and well-known, but compete with purposeful disinformation and ignored by those who cherry-pick for convenience. I really see no purpose in trying to sway the "vaccination doesn't work" crowd. To what end? Why bother?

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Jul 13, 2022·edited Jul 14, 2022

It’s my understanding the US has purchased 3.2 million Noravax Covid vaccines (enough for less than 0.5% of our country’s population), and that these vaccines will only be made available to those who have not yet opted to be vaccinated with Pfizer, Moderna and/or J&J. In other words, because I followed the CDC’s vaccine and booster guidance, I’m not eligible for what many claim is a superior vaccine, even though my second booster was months ago and is longer providing me with meaningful protection.

So while it’s possible that people who opt for a second booster now will still be eligible for the omicron booster this fall, it wouldn’t surprise me if the double-boosted folks aren’t relegated to the back of the line.

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A question from a grateful subscriber: My daughter just tested positive (after having avoided it for 2 1/2 years, living in Mississippi and working full time in the restaurant industry). Though she is quite symptomatic, her rapid tests over 3 days were negative. Her main symptoms are: sore throat, headache, aches and fatigue -- no runny nose/typical cold symptoms. When she talked to her doctor, he said to do another test but swab the back of her throat (as for strep). That test was immediately positive. We've all been told many times that the rapid tests aren't always accurate and can take several days/repeated tests to show positive. But I don't believe I've heard the advice of swabbing the throat before. According to her doctor, he's seen the same thing happen many times. Why is this advice not given regularly -- as an alternative if symptomatic and getting negative results -- on the rapid tests? Thanks for any insights about what seems to be an oversight. At least I know now that this should be in the testing repertoire. I appreciate so much your contribution to our understanding and management of Covid -- thank you.

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In an older newsletter from Jan 5, 2022 Jetelina did write about swabbing the throat. Apparently the rapid tests in the UK instruct you to do a throat and nose swab (like you swab your throat then each nostril all with the same one swab). But the tests in the US that are FDA authorized were not tested on the throat, only the nose, so the FDA authorization doesn't apply to the throat method and health care providers here won't recommend the throat-swab method. When I tried to look into it I found articles expressing concern that it could lead to false positives but I can't fact-check this.

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Yeah, the throat swabbing is a bridge too far for me. It's not what the tests were designed for, and you can get to the nasopharynx just fine if you stick the swab straight back horizontally instead of upwards. I gag every time I try to swab my throat.

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Thank you for the invaluable information! I have been holding off getting my second booster because I thought waiting until fall would provide "better" protection and was hopeful that the more specific Omicron booster would be available. Will be looking for an appointment today. Also, just want you to know how much I appreciate your newsletter. I have been meaning to obtain a paid subscription - well today I did. Thank you!

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founding

Is there any data on how long the 4th shot (2nd booster) lasts? Does it fade similarly to the other shots? People over 50 or immunocompromised had their 2nd boosters early this year - they will be hitting the 6 month post-booster mark soon ... there's been no discussion of a 5th shot (3rd booster) or waiting if the protection lasts longer after 2nd?

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Jul 13, 2022·edited Jul 13, 2022

Thank you for this information. Most people have become so relaxed it’s kinda scary. I’m on Day 9 of infection after vaccinations and a booster and still positive. I’m still in isolation and waiting it out for a negative because I don’t want to infect my daughter. I truly hope people will listen and try to help stop the spread. I will share your work. Thank you!

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Thank you for this article. It convinced someone close to me to get the fourth shot.

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I keep hearing on anecdotal outdoor transmission lately - has anyone seen any reliable info? We’ve eaten outside 1x on a patio where were were the only family during the pandemic and we were hoping to do that again on an upcoming road trip spot, this increase in transmissibility and huge increase in cases has me concerned we should just not. I’d love some insight on outdoor transmission in this wave.

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I treat it like cigarette smoke, if smoke would linger it's not safe, least not for long exposures. If it's a stuffy humid patio it's not safe. Or a lot of people. I am allergic to most air where people are so I rarely have mine off any way, lucky me.

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I kinda have treated it the same, hence the only 1x outdoor restaurant experience since it began. It just seems unknown what the real distance and duration outdoors determines actually catching it. Thank you for your thoughts!

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I have a friend who caught it solo hiking last week ... and I heard several reports of same during Delta wave

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How easy would it be to assess acquiring the infection outdoors? For example, the hiker could have stopped at a store in the day or 2 before the hike, even if (though less likely) they were masked in the store.

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I think there's this tendency, especially among the lucky few of us who haven't gotten infected yet to attribute any infection to some sort of misstep. The alternative, that it really is possible to do everything right and still get it, is existentially terrifying.

We all want Covid to be deterministically avoidable, even if it isn't

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True but I've also found most people don't remember details too well, and upon grilling stories change

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I can't imagine grilling people I love about how they got infected. It feels selfish.

Would I prefer it if when they told me a blow by blow about what they did in the days leading up to their bout of Covid, so I can make sure not to do what they did? Sure. But that's a "me problem"

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Jul 14, 2022·edited Jul 14, 2022

If you're immunocompromised and they care about you they don't mind grilling. If they aren't someone you're risking seeing or in your bubble generally then no point stressing them out. Most people I know wouldn't mind though, they are just as interesting in figuring it out

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I can totally imagine it. It's selfish for them to not share it without interrogation.

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I can't be sure how much of it is luck, but I can learn from the experiences of others and that is the critical importance of searching for missteps and oversights. If you find them and they are something you had not considered, then adjusting your protocol to cover that is a good thing. Information is always good to gather and analyze.

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For example, if you encounter an event that has a very low chance of happening enough times, the chance that it will eventually happen is pretty high. Since we've been on the topic of definitions, what does "N95" really mean in real-life terms? Suppose I'm wearing a certified N95 mask properly. Is the definition is that 95% of virus-size particles that might be present in ambient air don't pass *with each inhale?* Not a cheerful thought in the age of super-contagious variants. This feels parallel to the weather forecast % chance of rain, which is reported in intervals of 15 minutes, 60 minutes, parts of the day, and whole days. "5% chance" translates into very different experiences depending on the measurement period.

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In math these things are called indeterminate forms.

If X---> zero

And

Y-->infinity

Then

X times Y --> ????

Hard problems!

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You won't get enough to get infected provided your seal is good.

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founding

I was at an outdoor concert at the end of June and strongly believe I contracted it there. Anecdotal, but it kicked my ass and I consider myself young, healthy, and low-risk. I'm worried about the long term effects as my cough is now getting WORSE.

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Infected elsewhere.

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Um, no. They had another vector. It's not circulating in the atmosphere.

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My inclination when people offer theories about when they tell me how they got it is to believe them. It's their narrative, and I don't really think it's my place to question it.

And let's face it, outdoor transmission, while unlikely, isn't impossible. And some infectious virus could linger in the air, depending on conditions.

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I should have been clearer; they were basically travelling alone and hiking alone. They were sharing the trails with people, especially going the other way, and it is possible they went in the store. I think its possible to catch it outdoors just a lot less likely ... and it is of course possible they caught it when not actually on the trail. Still, AFAIK from teh anecdotes I have access to, they were indoors with anyone else for any sustained period, with or without a mask.

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You don't need a sustained period indoors. You just need to be indoors without a mask.

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It is highly unlikely that, in an outdoor environment, where turbulent mixing is the norm in what we call the 'boundary layer', and where there is never really any non-movement of air, that they acquired sufficient viral load to be infected. In this case, highly unlikely approximates an asymptotic approach to zero. A trivial encounter in a store, where mixing is less prevalent, and aerosols are likely to linger in the air for much longer periods, can yield higher aerosolized viral loads.

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If you are the only family on a well-ventilated outdoor patio (meaning no high walls or shrubs) it would take a miracle for one of you to become infected. Outside, air will take anything away and if nobody else is around, there's nothing to take away. You have to have people around and proximity and lingering time in order to accomplish getting infected outdoors.

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Could the fact that there are now so many animal reservoirs be a factor in outdoor transmission?

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Unlikely, unless you're spending a lot of time up close and personal to one of those reservoir elements. The normal turbulent mixing in the lower atmosphere will disperse a lot of aerosol very quickly.

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Specific atmospheric conditions a factor? Spitballing here

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In my spare time I'm also an operational meteorologist. Even in "calm" conditions, there's sufficient air movement outdoors, assuming you're not in an enclosed area, and even copses of trees or small ravines tend to have a flow vector. What we perceive as dead still really has air movement.

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And in that dead still we perceive, we can smell somebody's cigarette smoke at a good distance. Outdoors is not bullet-proof.

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The dynamics of mask entrapment are more nuanced than simply smelling smoke.

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The OHA is recommending but not mandating indoor masking again. Our hospitalization rates are going up again and so also are our new infections. We all just have to keep up our guard. Thanks to the medical community (including our good doctor KJ) for their efforts at keeping us safe.

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On a related note: a number of performing arts organizations here in St. Louis now have mandatory masking policies for all staff and audience members. I don't know if this is happening in other cities, but I would be surprised.

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Berkeley, CA has some venues that are all masked other than performers. I really appreciate the policy!

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Glad to hear it. Seems to be a trend, which is good.

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Also curious about outdoor spread of BA.5. Any thoughts welcome. Thank you!!!

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founding

If only the CDC put out this kind of clear guidance. Sigh.

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On getting a booster now will preclude eligibility for fall: Jha was reported as saying it won't but the quote is less clear: The bottom line: Jha noted that overall, it is up to the FDA and the CDC to confirm that people who get boosted now can do so again in the fall, but that the data so far suggests that "getting vaccinated will not preclude you from getting a variant-specific vaccine later this fall or winter."

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also remember we still don't have funding out of Congress so I'm not fully clear on what a fall vax campaign even looks like

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Thank you for this article. My husband and I are on day 10 of what seems to be BA 5 (we're in the SF Bay Area), and are still testing *very* positive, strong red lines. I've seen reports of people testing positive for 20 days. This article seems to say we should quarantine until we have a negative test, no matter how long, and I wanted to confirm that. I don't want to get anyone sick, but I also feel bad for our cooped up (healthy) 7 year old.

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I have a faint line positive on day 12. I got covid from my 3 y/o who recovered quickly and tested negative on day 6. My husband still wants me to quarantine even though every doctor will say I can end quarantine after day 5 with no test.

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I feel for you! We ended up quarantining until day 15, even though we were still positive until day 17.

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