86 Comments

I can give a little insight into the reasons for the slow booster uptake, at least anecdotally from a small Wisconsin town. I went to the local drug store last week, where I almost always get vaccinations (e.g., flu). They are "booked up" for the next 3 weeks for all vaccinations (has never happened before), and are no longer taking appointments after that because they have nobody to administer the shots, even though they have the vaccine on hand. On I went to the local hospital, it took 3 phone calls and 20 minutes: you make a vaccination appointment just like you make a doctor's appointment, and they are offered only on a few days. The situation is no better with flu vaccine (I'll skip the longer story about how my previously reliable Medicare Advantage Plan has managed to screw that up this year). I'm almost 80 and have the time and knowledge to navigate this obstacle course (professional background includes medical sociology and social epidemiology), but to me it represents a massive failure in our public health system. There should be vaccine trucks like ice cream trucks hitting the streets and public events. If the pandemic has proven anything, vaccination is not a "build it and they will come" event. When are we going to learn? As Michael Osterholm is fond of repeating, vaccines do not matter unless you can turn them into vaccinations.

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YLE is invaluable, so well explained, timely, clear. Absolutely essential reading. David E. Hoffman

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Thank you for the latest update. I'm the Head of School at a small school and daycare in south east Michigan and wanted to share our experience here since school started just four weeks ago. I've just spent the last 10 days receiving daily notifications of positive Covid-19 cases amongst the staff and students. It started with a 5 month old in the infant room. 10 days later we now have had at least 20 positive Covid-19 cases plus an outbreak of hand, foot and mouth, on top of this. Some staff and children got both viruses! We've also seen a couple of pneumonia cases amongst the youngest children. We've encouraged serial testing because most of the cases have not tested positive until 5 days after symptoms started , whether on a PCR or rapid antigen test. The kids Covid-19 symptoms have been generally mild - cough, sore throat, congestion but the adults have been hit hard. These are younger adults in their 20's and 30's. One was prescribed as Paxlovid due to breathing issues; as far as I know none had received their fall booster. It has been brutal and we've had to close classrooms due to this outbreak. Please continue to mask up in public spaces and get vaccinated is my advice. I would include the flu shot as well. Its going to be a long winter!

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Air purification can make a *really* big difference in covid transmission in crowded settings like schools. Most methods are expensive, but Robert Corsi, an engineer specializing in indoor air quality, has developed a way to inexpensively improvise them using box fans and blocks of HEPA filter material. Parents and even kids can make them. There's a lot of info about them online. Here's a link to the main site, and also a video or a 4th grader building one.

https://cleanaircrew.org/box-fan-filters/

https://www.youtube.com/watch?v=H2YELPNsImk

The great thing about air purification, besides the fact that it works well, is that unlike masks and testing it doesn't make anybody mad! Also, it's good for kids' overall health -- reduces allergens, smoke, crud in the air from pollution, and also germs from other airborne viruses besides covid.

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I work in a lower school in Texas and we are starting to see the littles get COVID and Flu is running high here already. No masks in school right now either and I get it, but this virus is exhausting! Sending healing thoughts!

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To you too and yes it is both physically and emotionally exhausting- no flu yet but seems like only a matter of time. Staff are voluntarily wearing masks again and so are some children who are old enough. Sending out multiple emails to parents informing them of cases over the last 10 days has certainly helped! Whenever I'm in a classroom I'm wearing a mask. Stay safe.

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Thank you for sharing this information, though it’s a bit chilling. I’ll echo the stories about younger people (under 50, so pre-bivalent, nearly a year past their first and only booster if they had a booster) getting hit pretty hard. I wonder if more messaging needs to happen for this age group, particularly parents of children?

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I agree more messaging about children would be great. I think the bigger message I am needing to emphasize to parents is "testing once and getting a negative result doesn't mean they don't have Covid-19 or are not infectious, you may need to test again and again!" Our parents though have been super supportive over the last two and a half years to us and have mostly kept their kids at home often for what may be a cold. I have also included the messaging "If you child seems "off" or "under the weather" (are they unusually tired or cranky etc. they may be coming down with an illness. However my daughter is a 5th grade teacher in a local public school and she is now not even informed if there is a positive Covid-19 test result in her classroom - so she is staying masked and parents just send their kids in sick.

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The problem also is that that sort of serial testing adds up quickly at $12/test. If you test a child for 3-5 times for each time they have a runny nose, that $36-$60 dollars multiplied by 6-8 times a school year, meaning you could be spending $216-$480 per child per school year on home tests

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That's true - we have options for free testing here as well but understand the issues with needing to test multiple times. Just one option to try and keep kids in school and daycare - if they test positive they are out for at least 5 days and for those who can't mask it is still 10 days or test to stay as another option. Plus if the staff get sick as a result there is no daycare or school options. We are a small school. I have a staff of 16 and last week 5 of them were out with Covid-19 - so depends where you want to put your resources. We can't find 5 replacements for infants and toddlers just like that! With moving staff around and myself also helping out we kept one room open but had to close the other. No easy choices whatever we do. But I appreciate your input.

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Just trying to provide some practical perspective. When covid hit our house in May, we were daily testing the kids to see if they could go to school. One kid tested positive 3 days after us and the other never did. Between those 13 tests and adults testing themselves to see when they would go negative we spent over $300 on testing. It’s a real financial burden especially when parents may not be able to work and will end up short of money.

I think if a workplace wants to encourage people to serial test, they would be best served by providing enough home tests for their staff to test 5+ times each time they get sick.

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I agree - to be clear we do not requiring serial testing - in fact we don't require a test to return to work/school/daycare after the required 5 days self isolation - it is based on how they feel - how improved they are and they need to wear a mask through 10 days. I just know some staff and students like you did test multiple times before they tested positive. The main thing is to rule out Covid and only come to school (staff or student) if you are well regardless of the illness. This is something we look like we will be continuing to navigate for some time to come and we have and continue to evaluate our response and protocols based on not only our personal experience, local situation but ongoing guidance from the medical community.

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Thank you so much for this update! When possible, I'd also love updated guidance on masking and testing, given the current state of the pandemic. We have small kids, so all sorts of viruses are passing through our house now. We do a rapid test when someone has cold symptoms or fever, but don't repeat daily throughout the course of the virus. Is this something we should be doing? Relatedly, if we're planning to attend an event or see vulnerable family members, is the recommendation still to rapid test immediately before? Within 12 hours? The lack of federal guidance on all of this is really frustrating! Thank you, again, for all that you do!

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I wonder why there is very little federal guidance right now? A few guesses:

1) the pandemic is over - Biden was right,

2) the public stopped listening - because federal guidance was too overwhelming, confusing or later proved to be untrue,

3) our leaders have learned that the best way to avoid public backlash is to say nothing - minimizing criticism is more important than minimizing deaths,

4) we are now in the “calm before the storm” - once the surge begins (or maybe once Election Day passes), we will once again be inundated with federal guidance

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I think gov’t has pulled back because anything other than “Covid is over” is hugely unpopular with a LOT of people, and speaking truth damages electability. CDC is in theory immune to politics, but in practice it’s part of the show.

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I was fully vaccinated and had one booster, as per my age allowance at 49, nine months before I got Covid last June. I now have Long Covid and it has completely derailed my life. I am a marathon runner and was the picture of health prior to this happening. I have wondered if I had been permitted to get that second booster last Spring, would I be in this position? GET YOUR BOOSTER, PEOPLE. I am now in an odd position as I am desperately wanting the new bivalent booster but its a bit of a dice roll for LC patients as to how they'll respond. I plan on getting it anyway once I feel a bit more stable. That the CDC has removed mask mandates for healthcare settings is beyond appalling. That any physician would compare Covid 19 to the flu or a cold is almost malpractice. We must take this seriously as a nation and within our local communities. You never know if you'll end up with longer term ramifications from this virus and as one who is living in that realm, please heed my advice when I say you don't want to gamble. Mask up, get the jab and come to terms with the fact that we are still very much in a pandemic.

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Ugh, that sucks, and I'm sorry you're going through this. It makes me even less regretful about being insubordinate and getting extra shots before my immunity started to wane. I don't feel remotely guilty about preventing doses from going in the garbage.

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I just got back from Italy. I was very surprised to see no COVID precautions there and even fewer people masking than in the US. (I didn't mask most places either.) When I asked some Italians about it, they said that yes, they did lose a lot of people early in the pandemic, but everyone is very, very tired now, and ready to get back to life again. Their economy also was hit hard during this time. I think the preponderance and complexity of information and the fact that nothing has seemed to work to stem the disease has led to people throwing in the towel. I know I feel that way. My kid got COVID after spending most of her time alone in her studio apartment, so now she feels she might as well live life if she is going to get sick anyway.

I definitely appreciate these updates, but I am at the point where I don't know what I am going to do with this information.

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I think also those of us who have managed to avoid it thus far are a bit tired of being told by people who got it - probably the vast majority of humanity - that WE should be careful. I gave up a lot of things I love for over 2.5 years, just to avoid this disease, and I get to be done now.

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People sometimes say, "you're going to get it sooner or later, so why take precautions?" They're missing the point. The point is to have covid as infrequently as possible. Never having it is the ideal, but only having it once or twice in the next 5 years is a lot better than having it 8 or 10 times in the same period. While masking and other precautions are not guaranteed to keep you from ever getting covid, they are guaranteed to keep you from having it as often.

As for your kid, who spent so much time alone in her studio apartment: That is awful, & I don't blame her for not wanting to do that any more. But it's not necessary to isolate that way these days. There are a lot of things that greatly reduce risk without isolating the user: Masking in all indoor public places. Groups of friends agreeing to test before they get together without masks. Being energetic about ventilating and using air purification. I have never isolated in my home except in the first few weeks of the pandemic. After that I have relied on masking in indoor public places (using a really good mask), air purification at my office, and testing before get-togethers with friends. We're coming up on 3 years of pandemic and I still have not had covid.

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Oct 6, 2022
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You are right. I meant that people figure there is no point in following the disease after getting vaccinated because they are going to get COVID anyway, and they have done what they reasonably could do to keep it in check without disrupting their lives unduly.

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Where are we at for boosters for littles? Under 12 and under 5? I've heard nothing since the adult ones were approved and the lack of talk is disconcerting.

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There have been some news reports with hints that mid-October approval may happen for 5-11. I haven’t heard anything about under 5. Would love an update from Katelyn on this. :)

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Thank you so much for all of your valuable info during Covid. My husband and I were both vaccinated with the bivalent booster in September-3 weeks later we both tested positive. Same with my niece. I know there was very little testing done before the new booster was rolled out. I haven’t been able to find any new information since September. Do you know if any new studies are being done on the effectiveness now that large numbers of people have been vaccinated? We had really hoped for some short-term immunity

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Hi Amy- Ugh so sorry to hear this. I haven’t seen any data yet, but I’m keeping an eye on it. I honestly don’t know how much info we will get, given we usually rely on Europe for effectiveness data and they are rolling out BA.1 booster (not our BA.5 booster).

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Thank you so much for responding. It seems like there are plenty of people getting COVID shortly after the new booster but it’s very frustrating that there’s no information out there about it

Also, I tested negative 10 times on the rapid antigen tests, negative twice on a nasal swab pcr, and it was only picked up on a saliva pcr. I can’t tell you how many people I know with symptoms that took a rapid test that came back negative and figured they had a cold and went about their life. We really need better testing if there is any hope for this to end :(

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How severe were your symptoms 3 weeks after the bivalent booster? I'm hoping not too bad? Definitely need to keep fighting the good community fight, but the sad reality is that rugged individualism (in the form of YLE layered protection, boosters, antiviral treatment, and stubbornly masking indoors despite the social penalty) is about the only approach we can control in a world that has moved on psychologically.

And even then it's a bit of randomness that determines who inhales enough virus to kindle Covid.

A real world study in BMJ last week showed that rapid nasal swabs are missing at least 20-30% of cases. This is either because many people have lower viral loads with repeat infections, or tests are getting messed up by the presence of circulating anti-nucleocapsid protein antibodies. Or people aren’t swabbing well. Swabbing the back of the throat before the nose can increase accuracy by 10% or more.

https://www.bmj.com/content/378/bmj-2022-071215

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Isn't that scenario consistent with the exposure having occurred within the first 14 days?

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Oct 5, 2022
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Also worth remembering: people often test positive on PCR's long after clearing a virus.

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Right, just saying I think we should wait a good month before drawing definitive conclusions about effectiveness of the bivalent. I always make a point to limit my exposure immediately before and after a booster, and get a PCR test right before.

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Didn’t Moderna and Pfizer start human clinical trials in early August? Might we have some information soon? I would really like to see an in-depth (with someone like you!) interview with Moderna/Pfizer scientists. Their portions of the FDA/CDC meetings are often the most illuminating.

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Thank you for this article . I think we have a vaccine messaging failure. The common believe now is that the vaccines don’t help at all against transmission and cases, but they certainly do up to a certain degree. The governments should really push the fall booster. 🙏🏼🙏🏼

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Many many anti vax people will tell you the vax is pointless because it does not protect against transmission. And it’s true that vax doesn’t reduce transmission. All that much. What they don’t get is that it reduces SEVERITY. I’ve gotten so sick of listening to these people say “haha, sheeple , it doesn’t even keep you from catching Covid” that I’d like to smack these people.

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Actually according to this article the vaccines do reduce transmission and cases “This must be a priority as vaccines continue to protect against death, severe disease, transmission, cases, and long COVID-19.”

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Its all very complex & unpredictable. Seems like having more info about case counts would be very useful. Why the hell are hospitals no longer routinely testing testing new admissions? The fraction of admissions testing covid positive is a pretty decent measure of amount of covid in the community a hospital serves -- the only decent measure we have! And besides, if hospitals don't test they will be putting covid positive people in rooms with covid negative ones. How can this possibly make sense? I can't even see an advantage to hospitals to dropping routine covid testing at admission. It doesn't take long. Is it the cost?

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It's no wonder that so many people aren't getting boosters as the only way to get good information these days is to be proactive. I know quite a few people who think the original boosters they got months ago still keeps them from being infected and most people don't seem to know about long covid nor know the chance of getting long covid. I am seeing people reporting that their doctors are now saying that covid is just like the flu and when asked about long covid are told that well the flu caused the same thing, it just wasn't talked about. It very much becomes a feeling of everyone for themselves.

I do wonder if health organizations or universities that are still doing random testing can help with giving an idea of case numbers. For example, the City University of New York does weekly random testing and reports the weekly resorts per campus and overall. With 24 campuses in NYC and workers living within the tri state area, it is a pretty good cross section. Last Jan, it was hitting the 20% positivity rate. Right now it is 1.5%. I've followed the numbers for the past two years and it has reflected the overall community spread. https://www.cuny.edu/coronavirus/

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When I went for my physical in August, my dr wore her mask as a chin strap and then asked me to remove my mask so she could look down my throat. She then told me Covid is basically just a cold now. Just switched doctors

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Yeah, ironically that data could actually become better for assessing local prevalence as everyone starts dropping precautions.

Speaking of spread on college campuses, an experiment I'd love to see: what happens if recently vaccinated (or infected and recovered) roommates are paired with those who are less recently vaccinated (or infected and recovered)? Say, X/2 months apart, where X is the boosting interval we ultimately settle on? Would this help to limit transmission among roommates? It seems like it would be a pretty easy experiment! And since colleges also do their own health services it could even have observable fiscal impacts.

If that works, maybe it could be generalized to households: in an n member household, people could get their shots X/n months apart, where X is the individual booster interval.

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Count me as one of the 7.6 million! It feels good to be in that group. I just worry about what late spring has in store for us as my personal immunity wanes.

Regarding the Ebola outbreak: I’d love to know more, but my anxious nature can only handle so much right now. I’ve spent the last 2.5 years living in a state of constant anxiety about Covid I can only handle Ebola if and when it becomes a bigger threat.

Thank you for everything you do to help communicate science to your community. 💗

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Are you worrying about late spring because of the once-a-year booster idea that's been floated? If so, I share your concern. There seems to be no doubt that protection against severe illness wanes over time. The public health messaging doesn't make sense: One the one hand, "hurry up and get your bivalent booster if you're 4-6 months out from your last one or from a case of covid." On the other hand, "from now one we may just do yearly boosters, as we do with the flu shot." Plus covid and flu aren't comparable because flu is very seasonal and covid -- who knows? Maybe weakly seasonal? Maybe not seasonal at all? If we move to a once-yearly covid booster I'm going to try to get another one midway-through the year, even if I have to pay cash for it -- unless I read something suggesting that's a bad idea.

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The COVID anxiety has been incredibly difficult for me as we. Katelyn is where I get my news as it is honest helpful information!

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Any news on the bivalent booster getting approval for children ages 5-11?

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I can’t thank you enough for this newsletter. For us non-scientists and non-medical folks, getting real and reliable and professional information and data is a huge blessing! It’s almost impossible to find elsewhere. I am in my 70s, fully vaccinated (all Moderna). In July, before the bivalent booster was out, everybody was urged to go ahead and get the 2nd regular booster. I did that in July and shortly thereafter the bivalent booster was issued. So I will wait until December or January to get the new booster. Maybe by then we will know what virus is heading up the new wave and they will have another new, more specific booster. But we can’t keep chasing after whatever comes next. Our government needs to wise up, provide needed funding for testing, data collection, research, production, distribution, and education. What will it take for them to wake up? Another devastating surge? There is so much wasteful spending that we could use to the benefit of all our citizens. Wake up, you politicians!!!!

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I went to get my bivalent booster at Walgreens yesterday. On the plus side, their website was easy to use, and I was able to select Pfizer or Moderna.

The older couple waiting alongside me had just been recently exposed to Covid on a cruise ship. Another lady had just gotten over Covid, but what does that mean? Got over Covid a month ago - or yesterday? There was also a slow-moving line of about six people waiting to pick up meds. Was anyone there to pick up Paxlovid? Nobody was wearing masks, except me and the pharmacists. And don’t get me started about vaccination sites that also offer Covid testing - good grief.

Question: why must vaccines/boosters be offered only in indoor settings that are high risk for getting Covid? It would be nice to have drive through or outdoor options.

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I remember that kind of thing when I got my very first Covid shot, and then I decided it was like running across a mine field to get to safety, and, well, this is war.

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And the whole process from start to finish takes something like 45 minutes, for a jab that literally takes 30 seconds.

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My colleague got the new booster, then got Covid 3 weeks later. She’s still glad she got it of course, but is uncertain she’ll get the next one at all. We just need more government advertising to reduce this kind of hesitancy.

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