Please do everything you can to influence ACIP on a positive decision to offer the bivalent booster to the elderly and other vulnerable folks. Thank you for all you do!
The FDA's approval of modified booster rules on Tuesday was followed by approval by the CDC's ACIP on Wednesday. (As of Wed. afternoon (3PM PDT), CVS refused to provide the boosters to eligible individuals. I expect they will shortly.)
A couple of comments: Healthcare workers (as do most workers) do go to work sick. Part of this is they are casual or permanent part time without sick benefits: you don't work, you don't get paid. As a full time employee all my career (and I do realize how lucky I am), I could stay home when sick, but of course didn't always do that. If I had a sore throat but no fever, I would wear a mask when taking patient's blood as part of my role as a lab technologist...long before any pandemic came around.
Second: masks should never fully go away. After SARS in 2003, the province of Ontario developed excellent recommendations for healthcare workers when working with someone with an acute, respiratory infection (ARI), which was defined as a new or worsening cough or shortness of breath and/or fever. If a patient was entering a healthcare environment there was a sign (passive screening) and a box of masks for the patient to don if they had those symptoms. Staff would wear mask and eye protection when working with that patient. I still think anyone with respiratory signs and symptoms who must leave the house should wear a mask to limit spread to others...even if their COVID rapid test is negative: if you are symptomatic...wear a mask!
1. When I was in the hospital, if you were sick, and stayed home, someone else had to cover your patient load. That didn't mean they got to slough off when you came back. A lot of us worked sick and maybe masked or tried to find ways to not infect others.
2. If you're symptomatic, don't just mask up: STAY HOME.
I sure wish the CDC would update their guidance on masks in healthcare: they're tied to case rates which are unreliable and only getting worse. So exposure and risk are now "baked into" the guidance and immunocompromised and vulnerable people will get infected in healthcare settings--which should be a liability for the healthcare settings but isn't because they're "following the CDC".
I agree! I am not a researcher, scientist etc. but anecdotally have heard stories from a friend who lives in NY, Queens in fact, about elderly neighbors who had avoided COVID (!) but then when to get a hearing aid or something, and then caught it and was quite sick. She recovered, but still.
As they dropped masks at the tail end of Omicron surge they tied masks in healthcare to case counts: no one is testing or reporting--case counts are not useful or indicative of circulating virus.
Nosocomial infection has been a persistent problem but usually not associated with an aerosol-transmitted virus. More often we've seen bacterial infections, often coliform or streptococcal. Yes, people went to hospitals and got sick. No, not the same mechanism, necessarily.
Thanks for your continued sane and helpful reporting! Low wastewater levels of COVID-19 means that fewer people are infected. But the widespread abandonment of masks, social distancing, and even the abandonment of staying home when infected, means that in some cases, more people we know might be getting COVID.
That's true in my world where folks by and large were very cautious about exposure during the past 3+ years. Most of them are now taking more risks, and I know more people who have gotten COVID now than at any other time during the pandemic.
I recently heard Dr. Osterholm say the very same thing on his Covid-19 Update podcast, and that’s quite an eye-widening statement! I believe it, I understand it, and I wish it weren’t happening that way.
The CDC will likely issue a real report in a couple more years. At this point, they're not well-suited for front-line response. Which is why I try to keep up with the torrent of literature and read it critically. Yes, I discuss it here, but also with a number of colleagues and friends from bygone eras of clinical work... who are still in the clinics.
There's a component of infection-derived immunity that appears durable, but it's more responsive to the variant that induced it than mRNA-vaccine-induced immunity which seems to exhibit a broader spectrum of action. And infection-induced immunity derived from most of the Omicron variants was not as robust at that from pre-Omicron variants. I really wish we could get the virus to talk to its friend, Measles, and get its act together on mutation. If it'd just settle down and stop mutating randomly, we could have handled this a lot better. the measles vaccine is one of the long-term success stories both in terms of vaccine-acquired immunity and hybrid immunity.
This is interesting. Most people I know got COVID around a year ago. I haven't heard much recently. I work in a public-facing profession, and that was when mask mandates were lifted and things started operating more or less as usual. I also live in a highly vaccinated area. This makes me wonder if vaccine plus getting COVID is pretty good at providing immunity.
First, yes the combination of infection and especially subsequent vaccination, but for that matter, infection and vaccination in any sequence, appears to improve your immune response to the virus.
Too many people don't understand that with COVID-19, you're not one-and-done, so when they next have that respiratory infection they imagine it to be something else because, in their mind, they've had it and can't get it again.
There's an interval where hybrid immunity is indeed very strong, but over time, it wanes. Similarly, we've seen a degradation for people who were vaccinated and subsequently were infected because their primary circulating antibody response had depleted. That didn't mean they weren't protected, as the cellular immune response then kicked in, and may have provided a reduction in circulating virus sufficient to not be captured by rapid antigen testing. They didn't feel well, and should have stayed home in isolation but probably didn't, consigning their condition to "a cold", "Just the flu", or "allergies".
My community is claiming “green” level, yet my circle is also filled with cases. Our levels are set by hospital data only (which is disappointing/misleading) so I get that it isn’t a good metric of community infection. But, people think green means go! Maskless and passing it around. Our wastewater is much lower than previously but the level is still concerning. When rates have been extremely high, rates that are still very risky are being communicated as ok - back to pre-pandemic behavior.
Probably worth noting that using one's own social circle is exquisitely non-random. If you manage to dodge it at around the time people in your social circle are getting it - congrats, your risk went way down.
Yes, people weren’t getting covid because of their behavior. The vaccines might have also played a role, but get 100% of the credit. This commingling of careful behavior and vaccination have made it difficult for us to understand just how much protection from infection the vaccines provide. At the very least, the benefits of the vaccine have been overstated, possibly by quite a bit.
Contracted my first case of Covid late March 2 weeks before shoulder replacement. My husband also caught it from me. I have been vaccinated and boosted last with bivalent in October. Likely caught it in Drs office while waiting for a pre op physical. Open waiting room concept, no separation of sick-well and no masks. I hadn’t been near anyone prior to that and no contact with anyone with Covid. who Luckily I was able to undergo the surgery I had been waiting for 6 months. Recovery has been a little challenging. I’m grateful we’re healthy 70 year olds but still frustrated with healthcare in general how they e handled the pandemic. My profession was in healthcare... I loved it and believed in it. My PCP was of no help and will looking for a new PCP.
That is really crummy. The specialists I see from time to time still have masking required. Also, clearer waiting rooms, etc. Same with PCP's office. We are lucky. It is just terrible how the former administration allowed so much misinformation; also the politicization. Prior to the pandemic funding for public health in the US was being cut and scaled back. Good luck in finding a new practice!
I went to a *cancer center* recently who had made masks optional that day. I was the only one masked. As a long time Oncology nurse, that one surprised me.
It's really crazy and too politicized. Yes, masking can affect personal interactions esp with children I think, but I am a piano teacher who though carrying a reduced load of teaching amd still having in person students mask up. I am not picky about what kind as I wear an N-95, and hate ear loops, anyway. My husband and I relaxed about this time last year, and w/in a few weeks we both got COVID and it was miserable, I have upper respiratory issues, took Paxlovid, but both of us had the fatigue for some time afterwards. Do not want to chance long COVID. We are both 63 years old. So...we actually have lost elder family members who were in some health troubles already to COVID, and another family friend who was like a Dad to me, definitely picked up in a hospital. He had a host of health problems but had dodged it with care at home mostly from family for two and a half years. :-(
Recovering from shoulder surgery is a pain, period. I speak from experience. More than likely you contracted a strain not well covered by even the bivalent vaccine, likely an XBB subvariant. As to where, the doctor's office is as plausible as anywhere. Hope your recovery goes better. I'm 5 months out and still not as strong as I'd like to be.
A lot of the PCPs out there are not up to speed on COVID-19. If yours is otherwise a good fit, try to educate them, but tell them you're disappointed in their response to your bout of COVID-19. When I go to see mine, I get asked a lot of questions, all related to the Pandemic. He has some knowledge, but it doesn't always intersect with mine. He's been using my updates in how the clinic is run.
Now that the next booster is approved for the elderly, can you please give us your latest opinion of the risks involved with the "original antigenic sin" theory, which some experts warn is a real concern? As a 79 year old biologist (not MD), I have read many articles about this and still can't decide if getting shot #6 is good for the short term, but perhaps bad for the longer term, when new variants may pop up that my T-cell immunity (if I have any at this age!) will not react to. After each shot, I have gotten a test to show that my spike antibodies go way up for a few weeks, but drop to 1/10 of that level after a few months. That's OK if they let us geezers continue to get boosters periodically, but not so good if I may be harming the breadth of my T-cell response for future strains. Thanks for all you do!!!!
My doctors are also concerned about too frequent vaccinations. They also don’t believe the government knows the long term ramifications of what they are doing to our bodies. I am the most immunocomprised person in the US. Doctors opinion not mind. I will take the vaccine. As guidance changes every couple days my doctors have little confidence in anything. As I have been locked down for three years I am totally blown away by the incompetence of our government and the lack of concern for the most vulnerable by the non-vulnerable.
I respectfully suggest your docs' concerns are not based on the same literature I'm reading. For a number of reasons I'll not comment on incompetence in handling messaging and policy in the pandemic. No side is without blame.
Recently two of my friends got Covid, but their physicians would not prescribe Paxlovid. They said that Paxlovid was not longer effective with the newer mutations. -- Any thoughts on this? BTW, I live in Chicago
Spouse and I are recovered from Covid (except for continued fatigue). Our doctor agreed to Rx Paxlovid. Took the first dose in the evening, felt a huge improvement by the next morning. Second dose reduced our experience to a very, very mild cold. Just got better from there. Only side effect was the metallic taste, which was no big deal. So, we found it very effective against whatever variant we got. The only thing Paxlovid doesn't seem to help with is the fatigue.
My husband and I had the same experience: May 2022, except he did not get Paxlovid but when I caught it from him during the week following his onset, I did. It sure helped me, but both of us were really fatigued well into the summer! (2022)
Too many docs are afraid of Paxlovid for the potential side effects and the laundry list of potential drug interactions. In fact, most of the drugs it interacts with can safely be stopped for the 5 days of Paxlovid, rendering it a non-issue (there are some exceptions). I believe it should be provided widely and not solely to older patients. There are a couple of variants that have demonstrated some resistance to Paxlovid but to my knowledge, have not picked up steam.
I am 72, healthy and continue to mask everywhere I go in public for my and my 82 year old husband's well being. It's just not that hard.
Masking is easy and protects the most vulnerable who are usually invisible. I too have seen many new infections in those who are 100% vaccinated, healthy, and have had multiple Covid infections.
Working at the hospital with no mask mandate is heart breaking and unnecessary. Thanks for all the comments!!!
Thank you for continuing to find the limited data they’re still collecting and make some sense out of it for us. It’s not over and we’re no better prepared mentally or societally for another huge mutation event. Hope is never a strategy but it looks like it’s our number one right now
Thank you again. All of the links I find on the second bivalent booster are poorly worded, vague, "no need to rush" (??), under consideration, dodging the question. Look forward to your update when you have one.
Most unvaccinated individuals may receive a single dose of a bivalent vaccine, rather than multiple doses of the original monovalent mRNA vaccines.
I find that a bit confusing, and I'm not sure I agree with it. I'd rather see a second dose for those seeing initial vaccination 8-12 weeks after the first one whether it was monovalent or bivalent.
Can anything be done to speed up the approval of alternative antivirals? Public Health placed all it's eggs in the "vaccine" basket.
In the fourth year of COVID, "we have one effective antiviral that most physicians would use," Redfield said, referring to Pfizer's Paxlovid, which he recommends taking for confirmed infections. "That's terrible."
The FDA has the ability to enter into "mutual recognition agreements" with some but not all of its counterparts in other countries. More MRA's would help.
Good point, Remdesivir! Yet it doesn’t seem to work very well, if at all.
The lack of effective therapeutics indirectly contributes to misinformation. Sick people call their doctors and are told “sorry, I can’t/won’t prescribe anything.” So the sick turn to the internet, which is full of unofficial “cures.” We need more FDA approved therapies that work!
I understand your point about Redfield, yet he’s correct that Public Health pursued a vaccine-only strategy and shut down anything that might possibly cause hesitancy.
Given the low uptake of the bivalent, their strategy seems to have backfired.
"Public health" concentrated in getting a working vaccine because preventing an infection is always better than trying to treat it afterwards. This is true of medicine in general. The claims that "public health" somehow "shut down" will be popular with the anti-vaccine crowd but fail when closely examined.
It would help if you would get you information from an actual news site rather than "Just the News" which, in direct contradiction to its title and claimed purpose, is actually controlled by John Solomon, a far-right extremist and loyal Trump acolyte: https://en.wikipedia.org/wiki/John_Solomon_(political_commentator).
One has to dig a bit to find this information, of course. Personally, whenever I see something from a "news" source of which I have never heard, I scroll down to the "About" information and look for who is actually paying the bills. When it turns out to be someone who hangs out with the wackos at CPAC, the alarm bells go off.
If your definition of "working vaccine" is one that prevents infection, the current offerings are not "working vaccines," because they do not prevent infection. Nor do they prevent transmission.
By "actual news site" - do you mean the mainstream ones that Drs Jetelina's and River's thoughtful Op-Ed "Focus on communication, not misinformation" was submitted to but never picked up? Mainstream media is reluctant to publish anything that is even a tiny bit questioning of Public Health (CDC, FDA, etc), even if the messaging is from experts who are diplomatic, using helpful terms like "lessons learned" and "let's do it better next time."
The "central meaning" of the First Amendment, according to Justice William Brennan in his opinion for a unanimous Supreme Court (The New York Times vs Sullivan, 1964) is the right to * criticize * government and public officials.
There's a reason freedom of speech is the First Amendment. It's the most important.
I watch TWiV a lot and have for at least 2 years now. I don't always understand some of it, but it has helped me understand so much better. THANK you for posting all of these links. Brilliant!
I have to disagree that the 3 week interval was best here in the US. It probably was, at least initially, but some of us were observing trends suggesting we'd be better off with a longer interval. Likely, with the benefit of 20/20 hindsight, a longer interval 6 or 12 weeks, would have obviated the myocarditis issues, and likely seen a more robust T-cell training situation. That said, we kept to the original interval, things sorta worked, and now, as with the lab-leak investigation, it no longer matters, save for those very few people who are initiating their vaccine process now. At this point I'd hope we'd learned enough to increase the interval.
Having said that, thanks (one more time!) for the excellent summary. Loved it.
Yes but the first priority was getting as many people immune as quickly as possible given the initial hope of full immunity (infection and spread not just attenuation of severity). As things slowed down we should have pivoted to the evidence based approach. Longer intervals.
We in the trenches can encourage longer intervals ;-)
You're correct. Very decent vaccine efficacy after 8 week interval. And there were several factors in the interval during trials, including a need to reproduce the interval tested in Phase 1, a need to get people boosted up as fast as possible, and a lack of experience in the mRNA world with real vaccines against viruses, allowing the interval to be picked as a SWAG. Sometimes science is messy.
I intend to get the Spring booster (79 years old). All of my shots til now have been Pfizer. Stick with Pfizer or move to Moderna for this shot? Thanks.
Thank you for the great information as always. Really appreciated. Are they doing any studies on Families who haven't gotten it? My husband, myself, my daughter and her kids, and my Dad and Stepmom have not gotten it, knock on wood. Wondering if it's because we have been so darn careful or if there is some genetic component. Thank you!
I'm less convinced that subset exists, but admit the possibility. If they do, it's likely a case of preexposure to sarbecovirus/coronavirus in a manner that trained the cellular immune system. Of course it's possible they had prior immunity manifested as IgA, and just flat blocked it. But I remain skeptical 'til someone has a good, plausible working theory.
Depends on the type of "blood work" performed. I'm reasonably certain I was exposed in Jan 2020 and sick 5 days later... concurrent with the time I started looking at what was going on. However, the lab work at the time had no concept of what they were looking for, as the sequence data had just come into full view. My PCP and I chased this several months later but the antibody assays were qualitative, and insensitive at the time. After my documented "1st" infection, July 2020, I was recruited into a convalescent plasma research program. The assay they used was experimental, much more sensitive, and specific for SARS-CoV-2.
Over the last several years, the antibody assays have improved, but with our improved knowledge of the durability of circulating IgG antibodies, the definitive tests have transitioned to testing CD8+ T-cells for specific activity against the virus, and this is an expensive assay. I'm looking forward to better tests as time goes on.
But we go back to the fact that it is within reason that you're either immune, or lucky. Considering the number of times I've contracted the disease and the fact that I'm sort of knowledgeable and careful, I'd love for us to determine how some are not getting the virus. And then work to make that resistance available to the world.
Working in science and healthcare I'm very familiar with the testing which has two lines. One that shows whether you've had COVID and the other the vaccine. Living with MS I've had my antibodies tested several times, and I haven't had COVID. Moreover, I don't get why some people are almost bragging about the fact that they have had it several times.
I just want to point out that I'm not bragging that I've been infected several times. It's a failure on my part, or simply a set of poor circumstances. I consider it a personal failure because I know and try to exercise best practices.
I was reading an article late last night about detection of antibodies and the difficulty in identifying those that are specific to SARS-CoV-2, or for that matter most other viruses. At some point that technology will be much improved. Today it remains fairly rare.
I've also been involved in health care off and on for decades.
The trouble with someone like me who uses every single "piece of Swiss cheese" at his disposal is that I'm pretty much useless scientifically. No competent researcher would want me in a clinical trial.
If I do manage to dodge it completely - at least during the officially designated public health emergency phase - I'll owe it in large part to the charity - er, hybrid immunity - of others. And horseshoe crabs.
I had a nasty cold in 2005 that left me with permanent laryngeal reflux.
Couple of thoughts. The study is small, as noted, which lends itself to problems. OAS remains an interesting subject, but in this case I've not seen enough evidence to convince me it's playing a role in SARS-CoV-2 responses. Then again, this could be the smoking gun.
I'll admit I'd not kept up with the HIV-1 issue; I obviously need to read more.That said, I suspect we'll find, actually, with regard to the S1/ACE2 mechanism, those who are not readily infected have a modification to the ACE2 receptor site making capture of the spike S1 protein difficult or impossible. I would also like to see a cardiovascular workup and their response to hypertension... But I'm just thinking out loud.
Please do everything you can to influence ACIP on a positive decision to offer the bivalent booster to the elderly and other vulnerable folks. Thank you for all you do!
On it! (For what it's worth, I have a good feeling about it...)
In the Washington Post this morning.
"FDA okays second omicron booster for people at high risk from covid"
https://www.washingtonpost.com/health/2023/04/18/covid-booster-older-americans
The FDA's approval of modified booster rules on Tuesday was followed by approval by the CDC's ACIP on Wednesday. (As of Wed. afternoon (3PM PDT), CVS refused to provide the boosters to eligible individuals. I expect they will shortly.)
A couple of comments: Healthcare workers (as do most workers) do go to work sick. Part of this is they are casual or permanent part time without sick benefits: you don't work, you don't get paid. As a full time employee all my career (and I do realize how lucky I am), I could stay home when sick, but of course didn't always do that. If I had a sore throat but no fever, I would wear a mask when taking patient's blood as part of my role as a lab technologist...long before any pandemic came around.
Second: masks should never fully go away. After SARS in 2003, the province of Ontario developed excellent recommendations for healthcare workers when working with someone with an acute, respiratory infection (ARI), which was defined as a new or worsening cough or shortness of breath and/or fever. If a patient was entering a healthcare environment there was a sign (passive screening) and a box of masks for the patient to don if they had those symptoms. Staff would wear mask and eye protection when working with that patient. I still think anyone with respiratory signs and symptoms who must leave the house should wear a mask to limit spread to others...even if their COVID rapid test is negative: if you are symptomatic...wear a mask!
Yes, this is EXACTLY the correct protocol to follow. Why we aren't is beyond me.
Couple of things.
1. When I was in the hospital, if you were sick, and stayed home, someone else had to cover your patient load. That didn't mean they got to slough off when you came back. A lot of us worked sick and maybe masked or tried to find ways to not infect others.
2. If you're symptomatic, don't just mask up: STAY HOME.
I sure wish the CDC would update their guidance on masks in healthcare: they're tied to case rates which are unreliable and only getting worse. So exposure and risk are now "baked into" the guidance and immunocompromised and vulnerable people will get infected in healthcare settings--which should be a liability for the healthcare settings but isn't because they're "following the CDC".
I agree! I am not a researcher, scientist etc. but anecdotally have heard stories from a friend who lives in NY, Queens in fact, about elderly neighbors who had avoided COVID (!) but then when to get a hearing aid or something, and then caught it and was quite sick. She recovered, but still.
Medical appointments or heaven forbid an admission are now high risk: case counts are of no value and shouldn't be the metric, in my opinion
As they dropped masks at the tail end of Omicron surge they tied masks in healthcare to case counts: no one is testing or reporting--case counts are not useful or indicative of circulating virus.
Nosocomial infection has been a persistent problem but usually not associated with an aerosol-transmitted virus. More often we've seen bacterial infections, often coliform or streptococcal. Yes, people went to hospitals and got sick. No, not the same mechanism, necessarily.
Thanks for your continued sane and helpful reporting! Low wastewater levels of COVID-19 means that fewer people are infected. But the widespread abandonment of masks, social distancing, and even the abandonment of staying home when infected, means that in some cases, more people we know might be getting COVID.
That's true in my world where folks by and large were very cautious about exposure during the past 3+ years. Most of them are now taking more risks, and I know more people who have gotten COVID now than at any other time during the pandemic.
I recently heard Dr. Osterholm say the very same thing on his Covid-19 Update podcast, and that’s quite an eye-widening statement! I believe it, I understand it, and I wish it weren’t happening that way.
The statement being knowing more people now who have Covid than at any other point during the pandemic.
This might mean natural immunity is more protective than vaccines, but if this is true, the CDC will never tell us so.
The CDC will likely issue a real report in a couple more years. At this point, they're not well-suited for front-line response. Which is why I try to keep up with the torrent of literature and read it critically. Yes, I discuss it here, but also with a number of colleagues and friends from bygone eras of clinical work... who are still in the clinics.
There's a component of infection-derived immunity that appears durable, but it's more responsive to the variant that induced it than mRNA-vaccine-induced immunity which seems to exhibit a broader spectrum of action. And infection-induced immunity derived from most of the Omicron variants was not as robust at that from pre-Omicron variants. I really wish we could get the virus to talk to its friend, Measles, and get its act together on mutation. If it'd just settle down and stop mutating randomly, we could have handled this a lot better. the measles vaccine is one of the long-term success stories both in terms of vaccine-acquired immunity and hybrid immunity.
Oh, CDC. I grew up believing that institution to be the Gold Standard. Sigh.
This is interesting. Most people I know got COVID around a year ago. I haven't heard much recently. I work in a public-facing profession, and that was when mask mandates were lifted and things started operating more or less as usual. I also live in a highly vaccinated area. This makes me wonder if vaccine plus getting COVID is pretty good at providing immunity.
A bunch of people I know who recently got sick were "NOVID" up until that point. But some are getting infected for the 2nd or 3rd time!
First, yes the combination of infection and especially subsequent vaccination, but for that matter, infection and vaccination in any sequence, appears to improve your immune response to the virus.
Too many people don't understand that with COVID-19, you're not one-and-done, so when they next have that respiratory infection they imagine it to be something else because, in their mind, they've had it and can't get it again.
There's an interval where hybrid immunity is indeed very strong, but over time, it wanes. Similarly, we've seen a degradation for people who were vaccinated and subsequently were infected because their primary circulating antibody response had depleted. That didn't mean they weren't protected, as the cellular immune response then kicked in, and may have provided a reduction in circulating virus sufficient to not be captured by rapid antigen testing. They didn't feel well, and should have stayed home in isolation but probably didn't, consigning their condition to "a cold", "Just the flu", or "allergies".
My community is claiming “green” level, yet my circle is also filled with cases. Our levels are set by hospital data only (which is disappointing/misleading) so I get that it isn’t a good metric of community infection. But, people think green means go! Maskless and passing it around. Our wastewater is much lower than previously but the level is still concerning. When rates have been extremely high, rates that are still very risky are being communicated as ok - back to pre-pandemic behavior.
Probably worth noting that using one's own social circle is exquisitely non-random. If you manage to dodge it at around the time people in your social circle are getting it - congrats, your risk went way down.
Yes, people weren’t getting covid because of their behavior. The vaccines might have also played a role, but get 100% of the credit. This commingling of careful behavior and vaccination have made it difficult for us to understand just how much protection from infection the vaccines provide. At the very least, the benefits of the vaccine have been overstated, possibly by quite a bit.
remember my discussion of a layered mitigation strategy? You're describing its success.
Contracted my first case of Covid late March 2 weeks before shoulder replacement. My husband also caught it from me. I have been vaccinated and boosted last with bivalent in October. Likely caught it in Drs office while waiting for a pre op physical. Open waiting room concept, no separation of sick-well and no masks. I hadn’t been near anyone prior to that and no contact with anyone with Covid. who Luckily I was able to undergo the surgery I had been waiting for 6 months. Recovery has been a little challenging. I’m grateful we’re healthy 70 year olds but still frustrated with healthcare in general how they e handled the pandemic. My profession was in healthcare... I loved it and believed in it. My PCP was of no help and will looking for a new PCP.
That is really crummy. The specialists I see from time to time still have masking required. Also, clearer waiting rooms, etc. Same with PCP's office. We are lucky. It is just terrible how the former administration allowed so much misinformation; also the politicization. Prior to the pandemic funding for public health in the US was being cut and scaled back. Good luck in finding a new practice!
I went to a *cancer center* recently who had made masks optional that day. I was the only one masked. As a long time Oncology nurse, that one surprised me.
It's really crazy and too politicized. Yes, masking can affect personal interactions esp with children I think, but I am a piano teacher who though carrying a reduced load of teaching amd still having in person students mask up. I am not picky about what kind as I wear an N-95, and hate ear loops, anyway. My husband and I relaxed about this time last year, and w/in a few weeks we both got COVID and it was miserable, I have upper respiratory issues, took Paxlovid, but both of us had the fatigue for some time afterwards. Do not want to chance long COVID. We are both 63 years old. So...we actually have lost elder family members who were in some health troubles already to COVID, and another family friend who was like a Dad to me, definitely picked up in a hospital. He had a host of health problems but had dodged it with care at home mostly from family for two and a half years. :-(
Recovering from shoulder surgery is a pain, period. I speak from experience. More than likely you contracted a strain not well covered by even the bivalent vaccine, likely an XBB subvariant. As to where, the doctor's office is as plausible as anywhere. Hope your recovery goes better. I'm 5 months out and still not as strong as I'd like to be.
A lot of the PCPs out there are not up to speed on COVID-19. If yours is otherwise a good fit, try to educate them, but tell them you're disappointed in their response to your bout of COVID-19. When I go to see mine, I get asked a lot of questions, all related to the Pandemic. He has some knowledge, but it doesn't always intersect with mine. He's been using my updates in how the clinic is run.
Now that the next booster is approved for the elderly, can you please give us your latest opinion of the risks involved with the "original antigenic sin" theory, which some experts warn is a real concern? As a 79 year old biologist (not MD), I have read many articles about this and still can't decide if getting shot #6 is good for the short term, but perhaps bad for the longer term, when new variants may pop up that my T-cell immunity (if I have any at this age!) will not react to. After each shot, I have gotten a test to show that my spike antibodies go way up for a few weeks, but drop to 1/10 of that level after a few months. That's OK if they let us geezers continue to get boosters periodically, but not so good if I may be harming the breadth of my T-cell response for future strains. Thanks for all you do!!!!
My doctors are also concerned about too frequent vaccinations. They also don’t believe the government knows the long term ramifications of what they are doing to our bodies. I am the most immunocomprised person in the US. Doctors opinion not mind. I will take the vaccine. As guidance changes every couple days my doctors have little confidence in anything. As I have been locked down for three years I am totally blown away by the incompetence of our government and the lack of concern for the most vulnerable by the non-vulnerable.
I respectfully suggest your docs' concerns are not based on the same literature I'm reading. For a number of reasons I'll not comment on incompetence in handling messaging and policy in the pandemic. No side is without blame.
Vey few of us are really concerned by the OAS concept any more. It was worth considering but there's little supporting evidence for it.
Thank you for helping us stay informed!
Recently two of my friends got Covid, but their physicians would not prescribe Paxlovid. They said that Paxlovid was not longer effective with the newer mutations. -- Any thoughts on this? BTW, I live in Chicago
Spouse and I are recovered from Covid (except for continued fatigue). Our doctor agreed to Rx Paxlovid. Took the first dose in the evening, felt a huge improvement by the next morning. Second dose reduced our experience to a very, very mild cold. Just got better from there. Only side effect was the metallic taste, which was no big deal. So, we found it very effective against whatever variant we got. The only thing Paxlovid doesn't seem to help with is the fatigue.
Exactly my experience, save I was also relieved of the fatigue component.
My husband and I had the same experience: May 2022, except he did not get Paxlovid but when I caught it from him during the week following his onset, I did. It sure helped me, but both of us were really fatigued well into the summer! (2022)
Too many docs are afraid of Paxlovid for the potential side effects and the laundry list of potential drug interactions. In fact, most of the drugs it interacts with can safely be stopped for the 5 days of Paxlovid, rendering it a non-issue (there are some exceptions). I believe it should be provided widely and not solely to older patients. There are a couple of variants that have demonstrated some resistance to Paxlovid but to my knowledge, have not picked up steam.
Thank you for this update!!
I am 72, healthy and continue to mask everywhere I go in public for my and my 82 year old husband's well being. It's just not that hard.
Masking is easy and protects the most vulnerable who are usually invisible. I too have seen many new infections in those who are 100% vaccinated, healthy, and have had multiple Covid infections.
Working at the hospital with no mask mandate is heart breaking and unnecessary. Thanks for all the comments!!!
Thank you for continuing to find the limited data they’re still collecting and make some sense out of it for us. It’s not over and we’re no better prepared mentally or societally for another huge mutation event. Hope is never a strategy but it looks like it’s our number one right now
Thank you again. All of the links I find on the second bivalent booster are poorly worded, vague, "no need to rush" (??), under consideration, dodging the question. Look forward to your update when you have one.
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-changes-simplify-use-bivalent-mrna-covid-19-vaccines. Looks like bivalent only and one shot for primary series?
I see this:
Most unvaccinated individuals may receive a single dose of a bivalent vaccine, rather than multiple doses of the original monovalent mRNA vaccines.
I find that a bit confusing, and I'm not sure I agree with it. I'd rather see a second dose for those seeing initial vaccination 8-12 weeks after the first one whether it was monovalent or bivalent.
Can anything be done to speed up the approval of alternative antivirals? Public Health placed all it's eggs in the "vaccine" basket.
In the fourth year of COVID, "we have one effective antiviral that most physicians would use," Redfield said, referring to Pfizer's Paxlovid, which he recommends taking for confirmed infections. "That's terrible."
https://justthenews.com/government/federal-agencies/biden-administration-inhibiting-operation-warp-speed-antivirals-former
The FDA has the ability to enter into "mutual recognition agreements" with some but not all of its counterparts in other countries. More MRA's would help.
Good point, Remdesivir! Yet it doesn’t seem to work very well, if at all.
The lack of effective therapeutics indirectly contributes to misinformation. Sick people call their doctors and are told “sorry, I can’t/won’t prescribe anything.” So the sick turn to the internet, which is full of unofficial “cures.” We need more FDA approved therapies that work!
I understand your point about Redfield, yet he’s correct that Public Health pursued a vaccine-only strategy and shut down anything that might possibly cause hesitancy.
Given the low uptake of the bivalent, their strategy seems to have backfired.
"Public health" concentrated in getting a working vaccine because preventing an infection is always better than trying to treat it afterwards. This is true of medicine in general. The claims that "public health" somehow "shut down" will be popular with the anti-vaccine crowd but fail when closely examined.
It would help if you would get you information from an actual news site rather than "Just the News" which, in direct contradiction to its title and claimed purpose, is actually controlled by John Solomon, a far-right extremist and loyal Trump acolyte: https://en.wikipedia.org/wiki/John_Solomon_(political_commentator).
One has to dig a bit to find this information, of course. Personally, whenever I see something from a "news" source of which I have never heard, I scroll down to the "About" information and look for who is actually paying the bills. When it turns out to be someone who hangs out with the wackos at CPAC, the alarm bells go off.
If your definition of "working vaccine" is one that prevents infection, the current offerings are not "working vaccines," because they do not prevent infection. Nor do they prevent transmission.
By "actual news site" - do you mean the mainstream ones that Drs Jetelina's and River's thoughtful Op-Ed "Focus on communication, not misinformation" was submitted to but never picked up? Mainstream media is reluctant to publish anything that is even a tiny bit questioning of Public Health (CDC, FDA, etc), even if the messaging is from experts who are diplomatic, using helpful terms like "lessons learned" and "let's do it better next time."
The "central meaning" of the First Amendment, according to Justice William Brennan in his opinion for a unanimous Supreme Court (The New York Times vs Sullivan, 1964) is the right to * criticize * government and public officials.
There's a reason freedom of speech is the First Amendment. It's the most important.
Correct. Couldn't have stated it better.
Absolutely! Thank you for making this point.
I watch TWiV a lot and have for at least 2 years now. I don't always understand some of it, but it has helped me understand so much better. THANK you for posting all of these links. Brilliant!
I have to disagree that the 3 week interval was best here in the US. It probably was, at least initially, but some of us were observing trends suggesting we'd be better off with a longer interval. Likely, with the benefit of 20/20 hindsight, a longer interval 6 or 12 weeks, would have obviated the myocarditis issues, and likely seen a more robust T-cell training situation. That said, we kept to the original interval, things sorta worked, and now, as with the lab-leak investigation, it no longer matters, save for those very few people who are initiating their vaccine process now. At this point I'd hope we'd learned enough to increase the interval.
Having said that, thanks (one more time!) for the excellent summary. Loved it.
Yes but the first priority was getting as many people immune as quickly as possible given the initial hope of full immunity (infection and spread not just attenuation of severity). As things slowed down we should have pivoted to the evidence based approach. Longer intervals.
We in the trenches can encourage longer intervals ;-)
What specialty "in the trenches" if I may ask?
You're correct. Very decent vaccine efficacy after 8 week interval. And there were several factors in the interval during trials, including a need to reproduce the interval tested in Phase 1, a need to get people boosted up as fast as possible, and a lack of experience in the mRNA world with real vaccines against viruses, allowing the interval to be picked as a SWAG. Sometimes science is messy.
I intend to get the Spring booster (79 years old). All of my shots til now have been Pfizer. Stick with Pfizer or move to Moderna for this shot? Thanks.
It's been recommended to mix in a Moderna or two with the Pfizer or vice-versa!
Thank you for the great information as always. Really appreciated. Are they doing any studies on Families who haven't gotten it? My husband, myself, my daughter and her kids, and my Dad and Stepmom have not gotten it, knock on wood. Wondering if it's because we have been so darn careful or if there is some genetic component. Thank you!
Same here. I’m curious about it, too.
I'm less convinced that subset exists, but admit the possibility. If they do, it's likely a case of preexposure to sarbecovirus/coronavirus in a manner that trained the cellular immune system. Of course it's possible they had prior immunity manifested as IgA, and just flat blocked it. But I remain skeptical 'til someone has a good, plausible working theory.
I’ve had blood work done several times. I’ve never had Covid.
Same. Bloodwork and frequent PCR and rapid tests, and relative lack of exposure all point to my never having had covid, in any meaningful sense.
Depends on the type of "blood work" performed. I'm reasonably certain I was exposed in Jan 2020 and sick 5 days later... concurrent with the time I started looking at what was going on. However, the lab work at the time had no concept of what they were looking for, as the sequence data had just come into full view. My PCP and I chased this several months later but the antibody assays were qualitative, and insensitive at the time. After my documented "1st" infection, July 2020, I was recruited into a convalescent plasma research program. The assay they used was experimental, much more sensitive, and specific for SARS-CoV-2.
Over the last several years, the antibody assays have improved, but with our improved knowledge of the durability of circulating IgG antibodies, the definitive tests have transitioned to testing CD8+ T-cells for specific activity against the virus, and this is an expensive assay. I'm looking forward to better tests as time goes on.
But we go back to the fact that it is within reason that you're either immune, or lucky. Considering the number of times I've contracted the disease and the fact that I'm sort of knowledgeable and careful, I'd love for us to determine how some are not getting the virus. And then work to make that resistance available to the world.
Stay virus free. That's a good thing.
Working in science and healthcare I'm very familiar with the testing which has two lines. One that shows whether you've had COVID and the other the vaccine. Living with MS I've had my antibodies tested several times, and I haven't had COVID. Moreover, I don't get why some people are almost bragging about the fact that they have had it several times.
I just want to point out that I'm not bragging that I've been infected several times. It's a failure on my part, or simply a set of poor circumstances. I consider it a personal failure because I know and try to exercise best practices.
I was reading an article late last night about detection of antibodies and the difficulty in identifying those that are specific to SARS-CoV-2, or for that matter most other viruses. At some point that technology will be much improved. Today it remains fairly rare.
I've also been involved in health care off and on for decades.
The trouble with someone like me who uses every single "piece of Swiss cheese" at his disposal is that I'm pretty much useless scientifically. No competent researcher would want me in a clinical trial.
If I do manage to dodge it completely - at least during the officially designated public health emergency phase - I'll owe it in large part to the charity - er, hybrid immunity - of others. And horseshoe crabs.
I had a nasty cold in 2005 that left me with permanent laryngeal reflux.
There is a large scale, longitudinal study still open for people that don't think they've ever had it. First step is testing.
Couple of thoughts. The study is small, as noted, which lends itself to problems. OAS remains an interesting subject, but in this case I've not seen enough evidence to convince me it's playing a role in SARS-CoV-2 responses. Then again, this could be the smoking gun.
I'll admit I'd not kept up with the HIV-1 issue; I obviously need to read more.That said, I suspect we'll find, actually, with regard to the S1/ACE2 mechanism, those who are not readily infected have a modification to the ACE2 receptor site making capture of the spike S1 protein difficult or impossible. I would also like to see a cardiovascular workup and their response to hypertension... But I'm just thinking out loud.
Thank you!