141 Comments
Jan 10, 2023·edited Jan 10, 2023

Thank you. Your posts are always so informative. I especially love your posts on risks of COVID versus risks of other illnesses/accident rates as it helps me make informed decisions for my family.

My 5 year old son was in an accident at school this past week. His finger was shut in one of those heavy, reinforced, quick to close doors that have been installed for safety measures to protect against gun violence in schools. His finger tip was torn halfway off and it broke his finger. The ER Dr said this was happening more often with these doors. He called it before we even told him what happened- he knew it was the heavy, defense doors by how bad the trauma was to his finger. This got me thinking. Our school has spent thousands updating features of the school to make it as safe as it can against gun violence, but has done little this year to stop the spread of viruses in the school. This has even created days when less than half the class was in attendance because of the illness spread (RSV wave). I’d love to have a discussion with the school about a framework of safety inclusive of health safety. Are there any ways to look at risks of say gun violence in schools vs risk of spread that could lead to poor outcomes from COVID and other viruses in school? I’d like to try to make a case for why we should, at the very least, be focused on both areas. Is there a way to compare the risks of both? You were the first person I thought of given your amazing lessons about both COVID and guns- but I also understand if this is too sensitive of a subject.

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Jan 10, 2023Liked by Katelyn Jetelina

Excellent article! Thanks so much for all of this data rounded up in one place!

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If my own history is any benefit to long Covid sufferors. March 2020 caught it. Probably either the A or B strain from China. The C strain wss reaching the east coast at roughly the same time. Received 2 Moderna vaccinations in 2021 and later, one Moderna and one Pfizer booster and finally one Moderna bivalent in 2022. Back to 2020, was told in April I could consider myself recovered. My initial illness wasn't that severe, lots of symptoms but none severe enough to warrant hospitalization. However the initial fever, etc. went away but many of the other symptoms continued or even got worse as spring passed into summer and autumn 2020. By that time I was concerned to put it mildly. I lost 70% 0f hearing in one short hour or so period. Probably a blood clot. Never regained. I had my first heart arrhythmias in early 2021 or late 2020. Now am on heart medication. Had my first neurological issues, like ocular migraine type attacks same time period. Most recent one was three days ago. And on and on. These are not hypochondriac complaints; most are verified by the testing I've been having since 2021. The point of this screed is to once again reiterate that Long Covid is nothing to dismiss lightly. No matter what ones politics are or attitudes toward masking or vaccinations, take all possible measures to avoid getting it! The pandemic is not over. In fact the worse may not have come yet.

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Any news on when elders like me and my husband should get our 2nd bivalent vaccination? We're in our mid-to-late 70s. Our primary care doc says she doesn't know. We had our bivalent vaccinations September 8, 2022, just over four months ago. Our protection's waning!

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founding
Jan 10, 2023·edited Jan 10, 2023

Katelyn, Lengthy post, please give it some thought. Note that outside of the mask hypothesis we have nearly identical politics, so don't reject my critique as some MAGA nonsense.

_______

"A recent study showed that people (n = 2) taking a daily regimen of Ivermectin had 5 fewer cases per 100 than the control group (n = 17). Perhaps of note, the group taking Ivermectin was tested much less than the control arm, but the authors of the study didn't mention this difference."

Should we conclude "Ivermectin works"?

Of course not. The difference in testing alone invalidates the entire study, not to mention the extremely small sample sizes, nor the fact a retrospective study is bottom tier of science.

Yet here you conclude "Mask mandates in schools work" based on a nearly identical study, with the same flawed design, and the same glaring flaws.

Katelyn, please consider that the mask hypothesis may be incorrect. It could be that the 100 years of science showing masks didn't stop viruses was correct all along, and the recent deluge of weak studies showing benefit may be merely that - a deluge of weak studies. I know you are 2+ years deep into the hypothesis, and the sunk cost fallacy can be powerful, but that is still 6 years less than William Farr took to realize his error on Cholera. If you bother reading this I am sure you will want to drop the hundreds of studies you have on hand showing efficacy. I will address that at the end and show the quality of a study is inversely proportional to the efficacy of masks, indicating that we let bias dictate our outcome.

If you go back to first principles, the very premise that a mask could stop virions seems unlikely. They may make intuitive sense because you think breathing through something must perform some filtering effect, but that is because we are very poor at understanding incredibly small (or large) things.

The moment you scale a virion to something human size, say a beachball, then the burden of the mask hypothesis becomes clear. When scaled to a beachball, the micropore in an n95 is scaled to the size of the Epcot Center Buckyball, the micropore in the surgical mask is scaled to the size of the entire Magic Kingdom, and the micropore in a cloth mask is scaled to the size of downtown Orlando.

Framed another way, you could place roughly 3,000 covid virions side by side in a single micropore of an n95.

Here you may be tempted to interject "but they travel on larger droplets" or "what about the electrostatic effects"?

These are the claims the hypothesis has to prove. For a trapped virion in a mask, how many breaths does it take to dislodge/nebulize the virion so it breaks free? How long does the electrostatic charge last in a cloth mask (certainly what the children in the Boston study were wearing)? In a Surgical mask? Short of wearing a form fitted n95, with surgical tape around the sides, most of your breathing will be pulling in air from the path of least resistance - the gaps against your nose, the sides of the mask, where your chin meets - when scaled to the beachball, these gaps scale between the size of the Grand Canyon to the state of Texas. How can masks prevent virions entering your lungs when a significant amount of your breath is pulling air through the sides and gaps?

The claim is extraordinary, so where is the extraordinary evidence?

Is the study you cited from Boston "extraordinary"?

1/2

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Thank you so much for your updates. Vital to all of us! My question is do we know when we will need/have the next booster? I got the omicron booster in October 2022. Won’t that protection wane soon? I’ve seen nothing about next steps. Anything happening?

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Great article and so helpful! Have you heard any updates regarding older folks and immunocompromised people getting a 2nd bivalent booster? Many in this cohort received their bivalent boosters early September. I've had a few people asking. Thank you.

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Still grateful for all you do and how well you do it.💗

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Jan 10, 2023·edited Jan 10, 2023

More good stuff! (Except I shoulda got Moderna...)

There are a lot of experts shamelessly sniping at each other over the "Covid creates immune deficiencies" topic. Very hard for lay people to un-puzzle.

Any chance you could do a "what we know, what we don't know" on this?

I would think with so many infections, we should see something measurable by now.

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Dear Katelyn, Thank you as always for your helpful summary. I appreciate your clear updates as we navigate through the COVID maze. Happy 2023 to you and your family.

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Should we continue to get boosters? I got covid last month and I am fully vaccinated/boosted. So if the hybrid immunity is stable for 8 months, should I get a booster in August?

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Thank you, Dr Jetelina, for a wonderful post that connects the science in to actionable steps by subgroup! This is *exactly* the type of information that people need to restore trust! I wish the CDC had told people over 50 to get only the Moderna bivalent booster back when it first came out. I know that supplies were low, yet transmission levels were also low, so waiting a few weeks probably was okay. Unfortunately, both my parents (80+) and two sisters (50+) got Pfizer, because it was the only thing available. Three weeks later, one of my sisters got Covid (first time).

Yesterday's Wall Street Journal had an article "Where Are the Next Covid Treatments?" The article states: "One study found that half of hospitalized patients who die from Covid have a contraindication with Paxlovid." (link below) In addition to better vaccines, we also desperately need new therapies, especially since XBB.1.5 has rendered most old therapies ineffective.

https://www.wsj.com/articles/where-are-the-next-covid-treatments-vaccine-booster-shots-doctors-pandemic-paxlovid-treatment-fda-antibodies-11673203403

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Greetings, I liked your post today a lot, and it caused me to go from a free subscriber to paying to support your work. Unless allowing comments from non-paying subscribers causes you increased costs from SubStack, I suggest you allow comments from non-paying subscribers unless doing so invites trolling jerks. I have found other SubStack authors from leads I have gotten from the comments of other SubStackers. Up to you, obviously. Thanks for doing what you do.

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I am eager for your commentary on the recent article in the Am J PUb Health (lead author Tu). The good news was that deaths, ER visits, and hospitalizations were down among the vaccinated. But by the same measure, it appears that infections were MORE common among vaccine recipients than among those with "natural" immunity. I for one am skeptical of how we even define infections, and the article is somewhat opaque on that issue. But the anti-vaxxers are running with this. "What other vaccine makes us MORE likely to get the infection?" they say. Thanks!

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Thanks so much! Did they say anywhere what the magnitude of better T-cell immunity was of Moderna vs Pfizer? Similarly, any data on mixing the two (at one point the advice was mix them and then it was “it doesn’t matter”). In other words, does the Moderna advantage occur as soon as you switch to it or does having prior Pfizer vaccines impact that?

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Thank you for you level headed, articulate, fact-based, clear information.

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