How exactly are vaccines,that don't prevent infection or transmission, supposed to help high-risk communities without Covid precautions like mask mandates? Vulnerable communities can no longer safely participate in public life. I can only get new shots, I can't get extra boosters because my conditions and status as high-risk caregiver don't qualify me to get them even though protection wanes. A single infection, even vaccinated and boosted, could permanently disable me and I cannot take that chance. I no longer see a future where I will ever be comfortable in public spaces again. Everyone seems fine with letting us die or be hostages in our own homes because public spaces aren't safe anymore. I'm so sick of this weak messaging even from people like yourself.
I wonder if a lawsuit using the ADA would work. It’s supposed to guarantee access. Mass ventilation plus UV light in all building HVAC systems would go a long way toward lowering risk—for Covid and other airborne diseases and inevitable future pandemics.
If it’s any (cold) consolation, the entire species is doing just about all it can to destroy itself as fast as possible, so it’s not just that people don’t care about people like you, which is monstrous selfishness. They don’t even care about their near-future *selves*, let alone their children.
That’s something other than monstrous selfishness. Total delusion.
Minimally rational, minimally enlightened self-interest—rational selfishness—would be a gigantic improvement.
Vaccinations, at the very least, do lower the risk of more severe outcomes even in the high risk community. It’s a line of defense. Yes in a perfect world everybody would mask up, every indoor space would be properly ventilated. But that world doesn’t exist. So each one of us does the best we can to manage our own lives with the tools that are available.
Every time someone tries to tell me (or maintain on the behalf of others) that their refusal to mask, ventilate, et al, is based on the sacred tenets of liberty, I tell them the truth: no libertarian thinker I know of thinks “liberty” means “I can do or not do anything I want and the hell with everyone else.”
Except one: the Marquis de Sade.
They get mad. I say, prove me wrong. You won’t find that in Adam Smith, Mill, etc. Not that I’ve read every word of every libertarian thinker—but, go ahead and prove me wrong.
Crickets.
This included my former grad advisor who refused to ever go on Penn’s campus again because of their mask mandate.
Oh, well. Fascism is the social organization and channeling of the worst sadistic and irrational impulses the species is capable of.
It’s thrilling to some/many to be released from the bonds of decency. Erich Fromm, Escape from Freedom, The Anatomy of Human Destructiveness, among many others who studied totalitarianism post-WWII. In fact, a chilling study of ex-Nazis in the 50s is titled They Thought They Were Free.
Freedom for me, not for thee.
Anyway, I hope my empathy has done what little it can for you. Certainly better than being told, “This is the way it is; deal with it (and shut up)”—not that Jetelina is saying or doing that.
Another example—apparently, a huge proportion of people are refusing to vaccinate their dogs for rabies:
“The new study, which is still in press but was published online by the journal Vaccine on August 26, reported that more than half of the 924 dog owners contacted in a nationally representative survey of 2,200 adults consider dog vaccines to be unsafe, ineffective, or unnecessary. More than a third of the dog owners surveyed believe canine vaccination can cause autism in pets. (There is no scientific evidence for autism in dogs or for a connection between autism and vaccination.)“
Rabies is 99.n% fatal if untreated. Treatment apparently includes post-exposure vaccination. People are starting to refuse that.
If we fall below 70% vax rate, rabid dogs and other mammals will start attacking people more often.
Are we just going to put up with/normalize this, too? Probably.
I read about this too and was rather annoyed. Autism in dogs? Seems that most states have rabies requirement for licensing. This is not good news. Less than a 100 years ago, annual deaths in the US was 100 or more and today it's 1 or 2 a year. Worldwide, Rabies is responsible for estimated 59,000 deaths annually. SMH
I have PTSD that makes wearing a mask trigger panic attacks if I wear on for more than an hour at a time. I only go out for necessities like groceries and doctor's appointments. I've been isolated since 2019 because I was helping my mother, who I'm still caregiver to, through cancer treatment.
My mom is extremely high-risk and I can't take the chance of getting Covid not just for me but because of my mother. I've never had Covid and it still took my life from me.
I’m very sorry to hear that. Is there any way to ameliorate the duration, frequency, or severity of the panic attacks—at least in re: N95s? I mean, not like this idea would not have occurred to you: this is meant helpfully and empathetically, not patronizingly! I’ve had my own issues of various kinds, so I’m not talking down; more like “talking across.” :)
But just in case—there are so many ways to attack it: drugs, behavioral methods, therapy of one kind or another. And all the combinations of all the variations thereof. Something that might have been tried in the past that didn’t work might work now, and so on. Also, just the act of trying out everything in sequence itself can have a kind of “second-order” or “meta” effect on the underlying issue: you’re taking control, and so on. (I tutor people for standardized tests; I’m no expert, but I have seen people who can beat their anxiety into a corner at least and get through.)
Good on you for taking care of your mother. Take care of yourself, too! All the best!
I have two Psychology degrees and I also have Generalized Anxiety Disorder as well as Bipolar Disorder. The incident that have me the PTSD happened when I was 15, I'm 41 now. It has not gotten better even with the immersion therapy of having to mask for the past 3.5 years. The panic attacks are triggered by the feeling on not being able to breathe. I also haven't had health insurance for 18 years.
I eat an anti-inflammatory diet to help reduce systemic inflammation due to my having two degenerative inflammatory conditions (pervasive osteoarthritis and Achilles Insertional Calcific Tendonopathy, which is degeneration of the Achilles tendons that cause paiful bone spurs, the treatment is very painful and both conditions ate incurable). I cannot let anyone else shop for me. I cannot accept substitutions or different brands and my mom is very particular about what she likes as well. I'm also not paying for that. And I spent the last 2 years taking care of my sister's dog who just passed away a month ago and I'm still grieving that loss. I also have 2 Psychology degrees so I'm aware of the benefits of pet ownership. I'm so tired of the 'advice' from strangers. I have done and tried everything and none of it changes that fact that vulnerable communities can no longer safely participate in public life. I no longer see a future where I will ever be comfortable in public spaces again. And I'm not the only one who feels like this. We've been abandoned as expendable.
That must be hard to navigate Leslie. I also know some people with dysautonomia (which can arise from a wide range of disorders) who can't wear a mask for long. Sometimes they can tolerate N95/KN95s with exhalation valves (assuming others don't mind) - not always though.
Achilles rupture is a potential problem caused by Covid infection. I have Achilles Insertional Calcific Tendinopathy (degenerative and incurable) so a single Covid infection has the potential to permanently disable me. I'm a caregiver and that's not an option for me. And I live in Florida which currently has the highest levels lof hospitalizations from Covid on the country. Our governor would make the vaccines illegal if he could.
Coronaviruses appeared ~300 million years ago. They mingled with mammals 235 million years ago. They mingled with bats 50 million years ago. They mingled with our earliest hominid ancestors 3 million years ago, who often lived in caves alongside bats.
We "discovered" coronaviruses 60 years ago (I put in quote because of course, they were always there, we just didn't know it) and promptly decided they were the cause of the common cold and not a threat. Roughly 30 years ago, Ralph Baric hypothesized they could someday mutate into a very dangerous viruses (never mind they had 300 million years to do so already and hadn't achieved that feat), and after finding SARS 03 and MERS 15 burn out with no intervention and not impact all cause mortality, he argued (successfully) to Anthony Fauci and Francis Collins that we must start creating synthetic coronaviruses more deadly than what nature has produced in 300 million years, in case nature suddenly decides to produce them on their own.
But we don't believe that the grant proposals to make a new synthetic coronavirus at the Wuhan Lab with a Furin Cleavage site modification which were rejected by DARPA in 2018 were actually done through other sources of funding, that is of course a conspiracy, right?
Therefore, since we agree this is a natural coronavirus, which have been among us unknowingly for 300 million years, I suggest that however comfortable you were in public spaces unmasked pre 2020 is how comfortable you should be after 2020.
And while I am not personally religious, I do find the parables in the Bible relevant, so consider if you are like Adam and Even eating from the Tree of Knowledge - always naked, but only becoming afraid of your nakedness once it has been pointed out to you.
My suggestion, go live your life. Enjoy it. You only get one.
There's an important sense in which all pandemics in the past sesquicentury have been decidedly unnatural, regardless of origin - the insane speed at which they're able to travel around, thanks to planes, trains, cars and boats. Virus-host co-evolution that might otherwise be a slow, manageable, even civilized negotiation becomes a bloody war.
At this point, if someone comes along and tells me they're choosing risk avoidance over mitigation - I have to hand it to them. It's not for me, and certainly not for you, and while I don't think it's something people are affirmatively entitled to, I'm not about to question their priorities. If they don't like doing an activity enough for it to be "worth the covid" - hey, that's dependent on their own individual tastes, values, and risk appetite. Not really my place to question it. It costs me nothing to back the heck off.
Unfortunately, Covid infection doesn't prevent reinfection at all. Every exposure has the potential to infect. I cannot take the chance of getting even once.
Nobody claimed vaccines prevent all infection and transmission, but there's ample evidence that they reduce the probability of infection and transmission. Just like any other intervention!
Well, in fairness, it is misleading to aver that "nobody claimed vaccines prevent all infection and transmission". It is a fact (and old news) that President Biden, who obviously received bad advice from one of the cretins and/or suck-ups who advise him, did tell all of us in 'Murika on a very widely publicized video that "If you get vaccinated you will not catch COVID". P.S. I voted for Biden and I am certainly not a Trumpist.
That was pretty much true when he said it. At the beginning, vaccination prevented over 95% of cases. Unfortunately, with newer variants, the protection against infection has dropped significantly.
Yeah, there's only so much you can do with an incubation period of 2 to 3 days.
In the long run, the vaccines and antivirals could reduce the severity of infections to the point where infections can *safely* create something closer to sterilizing immunity, but even that would be an illusion. The best we can do is make covid so paucisymptomatic that it doesn't matter any more.
It would be nice to know whether people with mast cell activation syndromes (MCAS) who had difficult reactions to mRNA vaccines, are less likely to have difficult reactions to Novavax. Seems to be less likely in the general case, but I know people with MCAS who want a booster but not if there's something about spike protein (whether produced by mRNA or injected as spike fragments) that their overactivated immune systems just don't like...
THIS!!! No one is even willing to investigate this for answers for us. It's ridiculous that we have to go in to all this just making guessing with no support from experts.
I would like to get boosted before Halloween, so if Novavax isn’t ready soon, I will likely default to Moderna. It would be nice if we could get an ETA on Novavax so we can plan, but FDA doesn’t work that way.
Hate to complicate things but if half or so of infections are asymptomatic, many of us will get (and have gotten) vaxxed and have less efficacy. Not much we can do about that but at a populational level, I would think that must affect efficacy. Is anyone taking this into consideration?
This is not an argument to not boost—I am just curious about it.
I wonder whether vaccines increase the number of asymptomatic cases? It’s possible we are living in a world where more people are infected, but many are asymptomatic and unaware, so they are out and about, spreading virus. 🤷♀️
Probably. It's a known phenomenon with livestock, and it's the reason they'll leave one chicken in the coop unvaccinated, to act as a "sentinel." Which is really sick and twisted and should turn you off of eating meat.
People like myself don't socialize at all so I know I've never had it even asymptomaticlly. I've never been exposed because I'm still living the lockdown life because I have no choice but to do that to keep myself and my very high-risk mom, who I take care of, safe.
Might also matter to what extent asymptomatic infection is transmissible (lot of "it depends" factors there); and IF it is, how much does vaccination reduce transmission. For example, some infections can be transmitted during their prodrome periods when the infected person has no symptoms. To what extent is SARS-CoV-2 like that? Even a PCR test takes a few days to cross the threshold for "positivity."
Well, the silly hope that silly non-virologists like me have is evident in the following rhetorical question: Does any person unwittingly become "vaccinated" simply by having had a non-symptomatic COVID infection?
Thank you Katelyn for these clear and complete recommendations (as usual!). One piece of additional info would be helpful for those considering Novavax-- what's the latest forecast on when this might become available? Thanks!
Scientifically, does that depend on to what extent vaccination reduces transmission (independent of other measures like good masking and ventilation)? I'd much rather my clinician and staff wore *effective* masks properly and the place was well ventilated. Of course, if there's evidence that vaccination significantly reduces transmission (flu, RSV, Covid), I'll change my opinion!
Nobody wears “effective” masks properly. I have to stop myself from facepalming.
Even when my 94 year old dad was hospitalized with influenza over a year ago, the nurses were not wearing masks, in his room, were not following infection protocols posted on his door, and would pull off their partially worn masks to talk to him.
My staff has taken to pulling down their masks as well. Given that, despite agreeing in concept, I am not sure what the best answer is. And I am very pro vaccine in general. But I am not sure how much it will matter. We all live in the world together outside of the doctor’s office.
My husband got Covid in August and I didn't get it even though we were in close contact until he tested positive. My elderly mother who spent a brief time with us in the car before he started experiencing symptoms got it. So we know he was infectious. It's safe to assume I was exposed and fought it off. Did I likely derive some protection from that exposure that didn't result in illness? Should I delay getting the booster because of this?
I've had the same experiences with multiple close contact exposures without getting sick or testing positive. I actually started to think that I might be genetically immune. But, then I got it in March of 2023. Thankfully, it was mild. Like you, I have wondered if multiple exposures without getting sick ends up being a bit like a vaccine by revving up the immune system.
"Despite the obvious knowledge that infectious particles can be shared through respiration, whether other constituents of the nasal/oral fluids can be passed between hosts has surprisingly never even been postulated, let alone investigated. The circumstances of the present pandemic facilitated a unique opportunity to fully examine this provocative idea. The data we show provides evidence for a new mechanism by which herd immunity may be manifested, the aerosol transfer of antibodies between immune and non-immune hosts."
Yes, I wonder this too. My son had it in March, and I was in the car with him for over and hour, both unmasked, while he was coughing and sneezing. Plus, we live together. I had zero symptoms and never tested positive. I like to think there was maybe some
I have wondered this for years now. It seems impossible that fighting an infection doesn't incur immunity even if you don't get symptoms--I mean, your body must have produced antibodies in the course of preventing you from getting sick, right? It is frankly mind boggling to me that the people who study viruses have no idea if this is true--but apparently, they don't!
"It seems impossible that fighting an infection doesn't incur immunity even if you don't get symptoms." Correct, it is, for the most part, "impossible" to not get some degree of immunity from "fighting an infection." I mean, how do you think you are "fighting the infection," if not through your immune response?
Interesting question. The problem is the emerging variants are significantly different than the ones that have been floating around all year. It’s lucky you didn’t get covid. Think of your booster as protection against emerging variants that will be dominant soon, and time your booster accordingly.
"Under 65 and not high risk: Wait at least 6 months. Ideally, get vaccinated once a winter wave starts taking off. (Getting it by Halloween is a good bet.) This is what I will be doing with my family. But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed."
Especially, this line: "But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed"
I was infected around the beginning of August, so can I expect some protection from my recent infection through the winter? It seems like any time before next spring would be too early to get the booster if I adhere to the 6-month minimum wait time rule.
I was also infected at the beginning of August. I am getting my booster at the end of November in advance of an early December international trip. It's a little early but I don't want to head into travel and holidays with waning immunity.
Hello, and thank you for the thoughtful, informative breakdown (as usual).
I personally know so many people who were infected in the last 4-6 weeks. For them (<65yo), waiting 6 months would mean boosting in February, which seems far too late for a winter surge. Would you still recommend boosting at that time? Getting it at < 6 months? Or waiting to 12 months post infection, which aligns somewhat with next autumn?
Katelyn: First of all, THANKS! You have been a source of great information for me since the beginning of the pandemic! I am a medical director at a boys sleep away camp and have used your information many times to get what I want!! Question, are you still waiting for Novovax? Just trying to decide what to do. I had very bad Covid in March of 2020 and have had all the Moderna vaccines but the knock the S$%t out of me. Would rather not have another reaction. Thanks for your response!!
Thank you so much for all that you do. You've helped me and my patients through the pandemic!
I have a technical question (I'm a psychiatrist not an immunologist). I've seen some papers that indicate the mRNA vaccines lead to an increase in IgG4 levels, which may impair our immunologic responsiveness to COVID-19 if we've had repeated boosters. What is your take on this? Thanks!
I’m a preschool teacher in Austin. I Tried to get vaccine on Monday since many in my school comminity are starting to get the new strain. I instead for THE FIRST TIME got symptoms and a positive test Monday night. Mostly lung congestion -not sore throat or headache. but it wasn’t available yet. Very mild and I’m up to date on my mRNA vaccines. Should his be enough to get me through until 6 months (March 15th) or should I risk lower immunity memory and get it sooner? Thanks so much about helping the teachers!
My husband and I are in our late 70s with comorbidities. I keep reading that new latest vaccine will be available "sometime this week." This is Thursday. We're terribly eager to find out WHEN!!
I am in need of timing advice. My kids both had covid in the last 2 weeks. While I felt unwell during that time frame, I never tested positive. I never have. I plan to get the kids vaccinated in December. My youngest and I have a trip to Paris planned for March. Does it make any sense for me to wait until December to have more protection in March? I mask everywhere except home, don’t go out to eat, etc…
No it’s not “guaranteed illness.” I’ve traveled safely to Europe and across the US. Wear a mask at airport and on airplane, stay at hotel with good ventilation and windows that open, bring nose spray (Enovid) and eat outdoors. Walk everywhere, especially parks. Drink Guinness outdoors .
Sure, I missed museums and theater, but 80% of London is 100% better than staying home!
And that is how one can truly “live with Covid” ( if no complicating health factors or care of compromised elders), NOT by ditching all the Swiss cheese mitigations! Good for you.
Pretty much exactly how I do it, although, given the HEPA filters on planes, and that I tend to fly business class, I'll take the mask off once the plane is airborne and circulation is going full blast. I'll also go out to restaurants, if I can find a table a good distance from others. But the mask goes on when I am either in crowds or places where I can't control my distancing. Oh - and I tend to go for dark Mexican beer, not Guinness. ;-)
At the same time, I'm not about to judge someone for picking risk avoidance over risk mitigation. It's the objectively safer choice, and if someone has the discipline to pull it off, more power to 'em.
And if I happen to get covid as a result of a "discretionary" activity, I'm not gonna blame anyone except myself, however many precautions I've taken.
It's not about discipline. I have no choice but to limit everything I do down to basic necessities like grocery shopping and doctor's appointments. And I always mask. These activities are limited to an hour at a time because I have PTSD that makes wearing a mask longer than that trigger panic attacks. I have two degenerative, incurable, inflammatory conditions and I'm caregiver to my extremely high risk cancer survivor mom. There is no choice. I'm a hostage because vulnerable communities can no longer safely participate in public life. I no longer see a future where I will ever be comfortable in public spaces again. And I don't trust anyone anymore. I also live in Florida where DeathSantis has made everything about Covid mitigations illegal (except vaccines because he couldn't pull that off). They have lied to us about Covid data throughout the pandemic and have made us an even more unsafe state. I can't move nor would I want to, it's too cold everywhere else.
We are trying to time ours for mid January travel. Husband and I are both over 65 and finally planned a month-long trip to New Zealand, including a cruise with balcony room. Was hoping to wait for the vaccine until November or December, but wondering if we'll be at risk with all this spreading happening now. Both fully vaccinated, both never had COVID that we know of.
"Under 65 and not high risk: Wait at least 6 months. Ideally, get vaccinated once a winter wave starts taking off. (Getting it by Halloween is a good bet.) This is what I will be doing with my family. But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed."
So now you are saying that if you are not high risk and have been vaccinated and infected, that within six months from last infection, we have "very little/no protection against infection until" we get another boost? Healthy people with hybrid immunity are not typically getting another infection within six months. And the "other layers" you are talking about is masking? So someone who has been vaccinated and boosted and gets an infection and decides to wait six months to get another booster is supposed to be masking? That guidance seems off.
What about children < 6 years old who got the primary series AND a bivalent booster last year? It sounds like the new guidance is that they CANNOT get a monovalent booster now?
How exactly are vaccines,that don't prevent infection or transmission, supposed to help high-risk communities without Covid precautions like mask mandates? Vulnerable communities can no longer safely participate in public life. I can only get new shots, I can't get extra boosters because my conditions and status as high-risk caregiver don't qualify me to get them even though protection wanes. A single infection, even vaccinated and boosted, could permanently disable me and I cannot take that chance. I no longer see a future where I will ever be comfortable in public spaces again. Everyone seems fine with letting us die or be hostages in our own homes because public spaces aren't safe anymore. I'm so sick of this weak messaging even from people like yourself.
I completely understand and empathize.
I wonder if a lawsuit using the ADA would work. It’s supposed to guarantee access. Mass ventilation plus UV light in all building HVAC systems would go a long way toward lowering risk—for Covid and other airborne diseases and inevitable future pandemics.
If it’s any (cold) consolation, the entire species is doing just about all it can to destroy itself as fast as possible, so it’s not just that people don’t care about people like you, which is monstrous selfishness. They don’t even care about their near-future *selves*, let alone their children.
That’s something other than monstrous selfishness. Total delusion.
Minimally rational, minimally enlightened self-interest—rational selfishness—would be a gigantic improvement.
Vaccinations, at the very least, do lower the risk of more severe outcomes even in the high risk community. It’s a line of defense. Yes in a perfect world everybody would mask up, every indoor space would be properly ventilated. But that world doesn’t exist. So each one of us does the best we can to manage our own lives with the tools that are available.
No one has a right to spread a potentially deadly disease to others.
Every time someone tries to tell me (or maintain on the behalf of others) that their refusal to mask, ventilate, et al, is based on the sacred tenets of liberty, I tell them the truth: no libertarian thinker I know of thinks “liberty” means “I can do or not do anything I want and the hell with everyone else.”
Except one: the Marquis de Sade.
They get mad. I say, prove me wrong. You won’t find that in Adam Smith, Mill, etc. Not that I’ve read every word of every libertarian thinker—but, go ahead and prove me wrong.
Crickets.
This included my former grad advisor who refused to ever go on Penn’s campus again because of their mask mandate.
Oh, well. Fascism is the social organization and channeling of the worst sadistic and irrational impulses the species is capable of.
It’s thrilling to some/many to be released from the bonds of decency. Erich Fromm, Escape from Freedom, The Anatomy of Human Destructiveness, among many others who studied totalitarianism post-WWII. In fact, a chilling study of ex-Nazis in the 50s is titled They Thought They Were Free.
Freedom for me, not for thee.
Anyway, I hope my empathy has done what little it can for you. Certainly better than being told, “This is the way it is; deal with it (and shut up)”—not that Jetelina is saying or doing that.
Another example—apparently, a huge proportion of people are refusing to vaccinate their dogs for rabies:
“The new study, which is still in press but was published online by the journal Vaccine on August 26, reported that more than half of the 924 dog owners contacted in a nationally representative survey of 2,200 adults consider dog vaccines to be unsafe, ineffective, or unnecessary. More than a third of the dog owners surveyed believe canine vaccination can cause autism in pets. (There is no scientific evidence for autism in dogs or for a connection between autism and vaccination.)“
Rabies is 99.n% fatal if untreated. Treatment apparently includes post-exposure vaccination. People are starting to refuse that.
If we fall below 70% vax rate, rabid dogs and other mammals will start attacking people more often.
Are we just going to put up with/normalize this, too? Probably.
https://thebulletin.org/2023/09/rabid-anti-vaxxers-could-help-spread-deadly-disease/
I read about this too and was rather annoyed. Autism in dogs? Seems that most states have rabies requirement for licensing. This is not good news. Less than a 100 years ago, annual deaths in the US was 100 or more and today it's 1 or 2 a year. Worldwide, Rabies is responsible for estimated 59,000 deaths annually. SMH
Damn! It's the shots! Clearly that explains my cat's limited vocabulary and obsession with string - he done got the autisms.
Best rant of the year, bar none. Permission to scrape and broadcast ? .
Sure, use it in good health.
Until there are laws that stop that behavior one has to protect themselves in whatever way they are able to.
I have PTSD that makes wearing a mask trigger panic attacks if I wear on for more than an hour at a time. I only go out for necessities like groceries and doctor's appointments. I've been isolated since 2019 because I was helping my mother, who I'm still caregiver to, through cancer treatment.
My mom is extremely high-risk and I can't take the chance of getting Covid not just for me but because of my mother. I've never had Covid and it still took my life from me.
I’m very sorry to hear that. Is there any way to ameliorate the duration, frequency, or severity of the panic attacks—at least in re: N95s? I mean, not like this idea would not have occurred to you: this is meant helpfully and empathetically, not patronizingly! I’ve had my own issues of various kinds, so I’m not talking down; more like “talking across.” :)
But just in case—there are so many ways to attack it: drugs, behavioral methods, therapy of one kind or another. And all the combinations of all the variations thereof. Something that might have been tried in the past that didn’t work might work now, and so on. Also, just the act of trying out everything in sequence itself can have a kind of “second-order” or “meta” effect on the underlying issue: you’re taking control, and so on. (I tutor people for standardized tests; I’m no expert, but I have seen people who can beat their anxiety into a corner at least and get through.)
Good on you for taking care of your mother. Take care of yourself, too! All the best!
I have two Psychology degrees and I also have Generalized Anxiety Disorder as well as Bipolar Disorder. The incident that have me the PTSD happened when I was 15, I'm 41 now. It has not gotten better even with the immersion therapy of having to mask for the past 3.5 years. The panic attacks are triggered by the feeling on not being able to breathe. I also haven't had health insurance for 18 years.
I live near a Campus that is great for wandering its outer perimeter, particularly in early evening.
Having a dog to care for is a HUGE help with PTSD, believe me. And the dog will be the 'must do' of such wandering.
Walmart and Amazon and other vendors, all will deliver.
I eat an anti-inflammatory diet to help reduce systemic inflammation due to my having two degenerative inflammatory conditions (pervasive osteoarthritis and Achilles Insertional Calcific Tendonopathy, which is degeneration of the Achilles tendons that cause paiful bone spurs, the treatment is very painful and both conditions ate incurable). I cannot let anyone else shop for me. I cannot accept substitutions or different brands and my mom is very particular about what she likes as well. I'm also not paying for that. And I spent the last 2 years taking care of my sister's dog who just passed away a month ago and I'm still grieving that loss. I also have 2 Psychology degrees so I'm aware of the benefits of pet ownership. I'm so tired of the 'advice' from strangers. I have done and tried everything and none of it changes that fact that vulnerable communities can no longer safely participate in public life. I no longer see a future where I will ever be comfortable in public spaces again. And I'm not the only one who feels like this. We've been abandoned as expendable.
That must be hard to navigate Leslie. I also know some people with dysautonomia (which can arise from a wide range of disorders) who can't wear a mask for long. Sometimes they can tolerate N95/KN95s with exhalation valves (assuming others don't mind) - not always though.
Exhalation valves make masks worthless.
Achilles rupture is a potential problem caused by Covid infection. I have Achilles Insertional Calcific Tendinopathy (degenerative and incurable) so a single Covid infection has the potential to permanently disable me. I'm a caregiver and that's not an option for me. And I live in Florida which currently has the highest levels lof hospitalizations from Covid on the country. Our governor would make the vaccines illegal if he could.
Coronaviruses appeared ~300 million years ago. They mingled with mammals 235 million years ago. They mingled with bats 50 million years ago. They mingled with our earliest hominid ancestors 3 million years ago, who often lived in caves alongside bats.
We "discovered" coronaviruses 60 years ago (I put in quote because of course, they were always there, we just didn't know it) and promptly decided they were the cause of the common cold and not a threat. Roughly 30 years ago, Ralph Baric hypothesized they could someday mutate into a very dangerous viruses (never mind they had 300 million years to do so already and hadn't achieved that feat), and after finding SARS 03 and MERS 15 burn out with no intervention and not impact all cause mortality, he argued (successfully) to Anthony Fauci and Francis Collins that we must start creating synthetic coronaviruses more deadly than what nature has produced in 300 million years, in case nature suddenly decides to produce them on their own.
But we don't believe that the grant proposals to make a new synthetic coronavirus at the Wuhan Lab with a Furin Cleavage site modification which were rejected by DARPA in 2018 were actually done through other sources of funding, that is of course a conspiracy, right?
Therefore, since we agree this is a natural coronavirus, which have been among us unknowingly for 300 million years, I suggest that however comfortable you were in public spaces unmasked pre 2020 is how comfortable you should be after 2020.
And while I am not personally religious, I do find the parables in the Bible relevant, so consider if you are like Adam and Even eating from the Tree of Knowledge - always naked, but only becoming afraid of your nakedness once it has been pointed out to you.
My suggestion, go live your life. Enjoy it. You only get one.
There's an important sense in which all pandemics in the past sesquicentury have been decidedly unnatural, regardless of origin - the insane speed at which they're able to travel around, thanks to planes, trains, cars and boats. Virus-host co-evolution that might otherwise be a slow, manageable, even civilized negotiation becomes a bloody war.
At this point, if someone comes along and tells me they're choosing risk avoidance over mitigation - I have to hand it to them. It's not for me, and certainly not for you, and while I don't think it's something people are affirmatively entitled to, I'm not about to question their priorities. If they don't like doing an activity enough for it to be "worth the covid" - hey, that's dependent on their own individual tastes, values, and risk appetite. Not really my place to question it. It costs me nothing to back the heck off.
Unfortunately, Covid infection doesn't prevent reinfection at all. Every exposure has the potential to infect. I cannot take the chance of getting even once.
Nobody claimed vaccines prevent all infection and transmission, but there's ample evidence that they reduce the probability of infection and transmission. Just like any other intervention!
Well, in fairness, it is misleading to aver that "nobody claimed vaccines prevent all infection and transmission". It is a fact (and old news) that President Biden, who obviously received bad advice from one of the cretins and/or suck-ups who advise him, did tell all of us in 'Murika on a very widely publicized video that "If you get vaccinated you will not catch COVID". P.S. I voted for Biden and I am certainly not a Trumpist.
That was pretty much true when he said it. At the beginning, vaccination prevented over 95% of cases. Unfortunately, with newer variants, the protection against infection has dropped significantly.
Yeah, there's only so much you can do with an incubation period of 2 to 3 days.
In the long run, the vaccines and antivirals could reduce the severity of infections to the point where infections can *safely* create something closer to sterilizing immunity, but even that would be an illusion. The best we can do is make covid so paucisymptomatic that it doesn't matter any more.
For those waiting to get Novavax, it would be nice to know now whether the wait is weeks or months.
It would be nice to know whether people with mast cell activation syndromes (MCAS) who had difficult reactions to mRNA vaccines, are less likely to have difficult reactions to Novavax. Seems to be less likely in the general case, but I know people with MCAS who want a booster but not if there's something about spike protein (whether produced by mRNA or injected as spike fragments) that their overactivated immune systems just don't like...
THIS!!! No one is even willing to investigate this for answers for us. It's ridiculous that we have to go in to all this just making guessing with no support from experts.
Yep. My husband is getting Pfizer on Monday. I am either getting NovaVax, or, if it is not available, nothing.
I would like to get boosted before Halloween, so if Novavax isn’t ready soon, I will likely default to Moderna. It would be nice if we could get an ETA on Novavax so we can plan, but FDA doesn’t work that way.
Agreed. It’s really frustrating.
Hate to complicate things but if half or so of infections are asymptomatic, many of us will get (and have gotten) vaxxed and have less efficacy. Not much we can do about that but at a populational level, I would think that must affect efficacy. Is anyone taking this into consideration?
This is not an argument to not boost—I am just curious about it.
I wonder whether vaccines increase the number of asymptomatic cases? It’s possible we are living in a world where more people are infected, but many are asymptomatic and unaware, so they are out and about, spreading virus. 🤷♀️
Probably. It's a known phenomenon with livestock, and it's the reason they'll leave one chicken in the coop unvaccinated, to act as a "sentinel." Which is really sick and twisted and should turn you off of eating meat.
I've been wondering the same. It's kind of hard to believe that we've never had COVID when so many around us have.
People like myself don't socialize at all so I know I've never had it even asymptomaticlly. I've never been exposed because I'm still living the lockdown life because I have no choice but to do that to keep myself and my very high-risk mom, who I take care of, safe.
Interesting question.
Might also matter to what extent asymptomatic infection is transmissible (lot of "it depends" factors there); and IF it is, how much does vaccination reduce transmission. For example, some infections can be transmitted during their prodrome periods when the infected person has no symptoms. To what extent is SARS-CoV-2 like that? Even a PCR test takes a few days to cross the threshold for "positivity."
Well, the silly hope that silly non-virologists like me have is evident in the following rhetorical question: Does any person unwittingly become "vaccinated" simply by having had a non-symptomatic COVID infection?
Well....that's sort of how vaccines were discovered. Milkmaids exposed to cowpox....
I guess this takes you down a weird blind alley where you have to start asking philosophical questions, like, "What does it mean to have a disease?"
Thank you Katelyn for these clear and complete recommendations (as usual!). One piece of additional info would be helpful for those considering Novavax-- what's the latest forecast on when this might become available? Thanks!
With all the political interference and static regarding Covid as well as all vaccines, the healthcare setting got no love and attention.
In the northeast, it’s common for flu vaccine to be mostly mandatory in healthcare.
There have not been comments yet about Covid.
From an epidemiologist perspective, thoughts on healthcare providers and vaccination?
Scientifically, does that depend on to what extent vaccination reduces transmission (independent of other measures like good masking and ventilation)? I'd much rather my clinician and staff wore *effective* masks properly and the place was well ventilated. Of course, if there's evidence that vaccination significantly reduces transmission (flu, RSV, Covid), I'll change my opinion!
Nobody wears “effective” masks properly. I have to stop myself from facepalming.
Even when my 94 year old dad was hospitalized with influenza over a year ago, the nurses were not wearing masks, in his room, were not following infection protocols posted on his door, and would pull off their partially worn masks to talk to him.
My staff has taken to pulling down their masks as well. Given that, despite agreeing in concept, I am not sure what the best answer is. And I am very pro vaccine in general. But I am not sure how much it will matter. We all live in the world together outside of the doctor’s office.
My husband got Covid in August and I didn't get it even though we were in close contact until he tested positive. My elderly mother who spent a brief time with us in the car before he started experiencing symptoms got it. So we know he was infectious. It's safe to assume I was exposed and fought it off. Did I likely derive some protection from that exposure that didn't result in illness? Should I delay getting the booster because of this?
I've had the same experiences with multiple close contact exposures without getting sick or testing positive. I actually started to think that I might be genetically immune. But, then I got it in March of 2023. Thankfully, it was mild. Like you, I have wondered if multiple exposures without getting sick ends up being a bit like a vaccine by revving up the immune system.
There's also this:
https://www.medrxiv.org/content/10.1101/2022.04.28.22274443v1.full-text
Here's the abstract:
"Despite the obvious knowledge that infectious particles can be shared through respiration, whether other constituents of the nasal/oral fluids can be passed between hosts has surprisingly never even been postulated, let alone investigated. The circumstances of the present pandemic facilitated a unique opportunity to fully examine this provocative idea. The data we show provides evidence for a new mechanism by which herd immunity may be manifested, the aerosol transfer of antibodies between immune and non-immune hosts."
Yes, I wonder this too. My son had it in March, and I was in the car with him for over and hour, both unmasked, while he was coughing and sneezing. Plus, we live together. I had zero symptoms and never tested positive. I like to think there was maybe some
Immune boost.
I have wondered this for years now. It seems impossible that fighting an infection doesn't incur immunity even if you don't get symptoms--I mean, your body must have produced antibodies in the course of preventing you from getting sick, right? It is frankly mind boggling to me that the people who study viruses have no idea if this is true--but apparently, they don't!
"It seems impossible that fighting an infection doesn't incur immunity even if you don't get symptoms." Correct, it is, for the most part, "impossible" to not get some degree of immunity from "fighting an infection." I mean, how do you think you are "fighting the infection," if not through your immune response?
Interesting question. The problem is the emerging variants are significantly different than the ones that have been floating around all year. It’s lucky you didn’t get covid. Think of your booster as protection against emerging variants that will be dominant soon, and time your booster accordingly.
Yes but affinity maturation isn't too shabby
I'm a little confused about this part:
"Under 65 and not high risk: Wait at least 6 months. Ideally, get vaccinated once a winter wave starts taking off. (Getting it by Halloween is a good bet.) This is what I will be doing with my family. But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed."
Especially, this line: "But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed"
I was infected around the beginning of August, so can I expect some protection from my recent infection through the winter? It seems like any time before next spring would be too early to get the booster if I adhere to the 6-month minimum wait time rule.
Agreed, this was very unclear language from Dr. J.
I was also infected at the beginning of August. I am getting my booster at the end of November in advance of an early December international trip. It's a little early but I don't want to head into travel and holidays with waning immunity.
Hello, and thank you for the thoughtful, informative breakdown (as usual).
I personally know so many people who were infected in the last 4-6 weeks. For them (<65yo), waiting 6 months would mean boosting in February, which seems far too late for a winter surge. Would you still recommend boosting at that time? Getting it at < 6 months? Or waiting to 12 months post infection, which aligns somewhat with next autumn?
Katelyn: First of all, THANKS! You have been a source of great information for me since the beginning of the pandemic! I am a medical director at a boys sleep away camp and have used your information many times to get what I want!! Question, are you still waiting for Novovax? Just trying to decide what to do. I had very bad Covid in March of 2020 and have had all the Moderna vaccines but the knock the S$%t out of me. Would rather not have another reaction. Thanks for your response!!
Any ACIP insight on when Novavax us tobr reviewed for recommended approval?
If I knew that information I'd be using it for making money and attempting not to get caught for securities fraud; I certainly wouldn't be sharing it.
Waiting on the FDA.
Dear Dr. Jetelina,
Thank you so much for all that you do. You've helped me and my patients through the pandemic!
I have a technical question (I'm a psychiatrist not an immunologist). I've seen some papers that indicate the mRNA vaccines lead to an increase in IgG4 levels, which may impair our immunologic responsiveness to COVID-19 if we've had repeated boosters. What is your take on this? Thanks!
I’m a preschool teacher in Austin. I Tried to get vaccine on Monday since many in my school comminity are starting to get the new strain. I instead for THE FIRST TIME got symptoms and a positive test Monday night. Mostly lung congestion -not sore throat or headache. but it wasn’t available yet. Very mild and I’m up to date on my mRNA vaccines. Should his be enough to get me through until 6 months (March 15th) or should I risk lower immunity memory and get it sooner? Thanks so much about helping the teachers!
My husband and I are in our late 70s with comorbidities. I keep reading that new latest vaccine will be available "sometime this week." This is Thursday. We're terribly eager to find out WHEN!!
CVS and Walgreens have the new vaccines now!
Fantastic! I just had surgery but will get the updated vaccine as soon as I cab leave the house. Such good news.
I am in need of timing advice. My kids both had covid in the last 2 weeks. While I felt unwell during that time frame, I never tested positive. I never have. I plan to get the kids vaccinated in December. My youngest and I have a trip to Paris planned for March. Does it make any sense for me to wait until December to have more protection in March? I mask everywhere except home, don’t go out to eat, etc…
Then why travel? That's a guarantee of illness.
No it’s not “guaranteed illness.” I’ve traveled safely to Europe and across the US. Wear a mask at airport and on airplane, stay at hotel with good ventilation and windows that open, bring nose spray (Enovid) and eat outdoors. Walk everywhere, especially parks. Drink Guinness outdoors .
Sure, I missed museums and theater, but 80% of London is 100% better than staying home!
And that is how one can truly “live with Covid” ( if no complicating health factors or care of compromised elders), NOT by ditching all the Swiss cheese mitigations! Good for you.
Pretty much exactly how I do it, although, given the HEPA filters on planes, and that I tend to fly business class, I'll take the mask off once the plane is airborne and circulation is going full blast. I'll also go out to restaurants, if I can find a table a good distance from others. But the mask goes on when I am either in crowds or places where I can't control my distancing. Oh - and I tend to go for dark Mexican beer, not Guinness. ;-)
At the same time, I'm not about to judge someone for picking risk avoidance over risk mitigation. It's the objectively safer choice, and if someone has the discipline to pull it off, more power to 'em.
And if I happen to get covid as a result of a "discretionary" activity, I'm not gonna blame anyone except myself, however many precautions I've taken.
It's not about discipline. I have no choice but to limit everything I do down to basic necessities like grocery shopping and doctor's appointments. And I always mask. These activities are limited to an hour at a time because I have PTSD that makes wearing a mask longer than that trigger panic attacks. I have two degenerative, incurable, inflammatory conditions and I'm caregiver to my extremely high risk cancer survivor mom. There is no choice. I'm a hostage because vulnerable communities can no longer safely participate in public life. I no longer see a future where I will ever be comfortable in public spaces again. And I don't trust anyone anymore. I also live in Florida where DeathSantis has made everything about Covid mitigations illegal (except vaccines because he couldn't pull that off). They have lied to us about Covid data throughout the pandemic and have made us an even more unsafe state. I can't move nor would I want to, it's too cold everywhere else.
We are trying to time ours for mid January travel. Husband and I are both over 65 and finally planned a month-long trip to New Zealand, including a cruise with balcony room. Was hoping to wait for the vaccine until November or December, but wondering if we'll be at risk with all this spreading happening now. Both fully vaccinated, both never had COVID that we know of.
"Under 65 and not high risk: Wait at least 6 months. Ideally, get vaccinated once a winter wave starts taking off. (Getting it by Halloween is a good bet.) This is what I will be doing with my family. But remember, we have very little/no protection against infection until we do. So, other layers of protection are especially needed."
So now you are saying that if you are not high risk and have been vaccinated and infected, that within six months from last infection, we have "very little/no protection against infection until" we get another boost? Healthy people with hybrid immunity are not typically getting another infection within six months. And the "other layers" you are talking about is masking? So someone who has been vaccinated and boosted and gets an infection and decides to wait six months to get another booster is supposed to be masking? That guidance seems off.
This is why I'm planning on doing alternate six months with my partner - best of both worlds, minimizing household spread.
What about children < 6 years old who got the primary series AND a bivalent booster last year? It sounds like the new guidance is that they CANNOT get a monovalent booster now?