With regard to pain management for in-office IUD procedures, as a family doc I started putting in IUDs in the 1970s when they first were introduced. Any caring, attentive provider would soon observe that this procedure could be very painful, especially in nulliparous women, (if you attended to your patient ~ 30 minutes after insertion) and could somewhat commonly cause a vaso-vagal response with an injurious fall.
Glad to hear that it only took 50 years for the Academy to recognize this problem and recommend treatment.
I have a question (that you may not know the answer to) about self-attestation at the pharmacy. Will the pharmacist report the reason to insurance (I would think so), and will that affect insurance going forward? Will you now have a condition listed in your insurance record?
That's a great question.... I'm hoping someone from the pharmacy/clinical/medical billing world will weigh in. From my knowledge/experience I lean towards no, but I don't know and/or trust that they won't need to add the (self-reported) diagnosis that "qualified" us for the vaccine. My personal thought is to be vague, something like - I have an autoimmune condition and my doctor recommended I receive the vaccine.
I also have a question about when to get the COVID shot if it isn't being updated. My husband and I are over 65, so eligibility isn't an issue. He last got his in September 2024 and I in November 2024. I was thinking we should get a second shot now and then an updated shot in the fall, but now I'm not sure. Thoughts?
Similar question on timing, given last vaccinations as well as timing if infected (how many months between is ideal to maximize immunity). Please cover this—so many questions out there!
Pretty sure previous reliable guidance is every 6 months when over 65. I would also use the guidance of 6 months post infection, as having Covid effectively replaced a vaccination.
I hope many of you were able to see the grilling Margaret Brennan served up to FDA chief Marty (CDC is a "kangaroo court") Makary yesterday on Face The Nation. Maybe he hadn't had his morning java:
FDA also said there's a preference for the LP.8.1 subvariant, but still left questions about it and the eligibility for the fall vaccines (https://covidandvaccineupdate.substack.com/p/lp81-fall-booster). Maybe answers will come from CDC's ACIP scheduled later this month.
It was a surprise that FDA authorized Moderna's mNEXSPIKE given Kennedy's claim that mRNA vaccines are dangerous and last week's cancelation of government funding for Moderna's development of mRNA flu vaccines, including for bird flu, which is still in the wings.
Thank you for this excellent COVID-related update. You state, "That means the same formula from last year will be used again," but also mention that "FDA approved Moderna’s next-gen Covid-19 vaccine." Is it possible that the CDC's approval of this new vaccine could come (assuming that it _does_ come) in time for us to get the new Moderna vaccine sometime this fall?
CDC's ACIP is meeting the last week this month. However, even if the advisors recommend Moderna's mNEXSPIKE, there's no director at CDC yet to endorse it. It could be Kennedy who decides. Moderna said they will offer the new jab in addition to their current one (https://covidandvaccineupdate.substack.com/p/flurry-of-vaccine-policies-with-questions).
The company had previously said they could target the latest LP.8.1 subvariant this fall, but did not provide that detail in announcing the FDA authorization of mNEXSPIKE.
EDIT: I'll keep comment up for history, but disregard the contents now. This was an error on the vaccine schedule website that has been fixed.
A point of clarification- the CDC recommendation around COVID-19 vaccination and pregnancy is not "shared decision making" like it is with kids. They explicitly say to delay vaccination during pregnancy.
If you hover over the gray box intersecting COVID-19 and Pregnancy it says "Delay vaccination until after pregnancy if vaccination is indicated." EDIT: (This is now fixed and says "No guidance/Not applicable")
I have seen news stories get this wrong, and it is unfortunate, but it should be reported accurately.
That hover over is a mistake that is trying to fix (but had to go back to HHS for permission). If you look at the legend the contraindication box (red) is missing - it go underlayed on the gray pregnancy box and that’s the hover over.
Oh that is interesting! I do hope HHS allows them to make it more clear. The same hover over shows up for RZV vaccination and pregnancy (which would be very rare). But then other others like pneumococcal it says "No guidance/Not applicable". That does make more sense though, because obviously in the printed version there will be no option to hover over something.
It is very unfortunate this has all been so confusing.
Wow, thank you for noticing! That is a small but important detail missing from much of the coverage I have seen. That’s not just “No Guidance/Not Applicable” or removal of a recommendation—it is a recommendation to delay vaccination in pregnancy altogether.
No wonder people are confused. I didn’t catch because I viewed it on my phone or didn’t think to hover. These small details matter. Our public health processes are far from perfect, but they exist for a reason: to ensure clarity, transparency, and trust. And I agree, the media is missing this.
Glad to hear it was just an error, but still unfortunate, as it adds to the overall confusion. I imagine reduced staffing has not helped with catching these kinds of mistakes either.
That information isn’t visible on mobile, in the PDF versions, or on the ADA compliant version and isn’t mentioned anywhere else including the notes and the appendix.
I was able to pull up the code for the regular and ADA compliant versions on my phone and it does contain the text that should be present on hover. For the regular version this says “Delay vaccination until after pregnancy if vaccine is indicated” (not the language used in the rest of the column) but the ADA compliant version says “No Guidance/Not Applicable”. Given the inconsistency I don’t believe that that text is supposed to be there.
It is in a weird place in the code where it would be easy to forget to update it, especially if it was a last minute change. Or someone could have “forgotten” because they wanted it there.
"Out of all of this, my biggest concern remains: The damage is already done. A wave of confusion due to unilateral political decision-making instead of established evidence-based processes, resulting in whiplash headlines, likely hurts trust, sows immense confusion, and in turn, reduces vaccine uptake."
As a physician I really respect the information I receive from your emails. I’m wondering why the scourge of antisemitism, a public health crisis, has not been addressed yet? Even one day after an attack of a group of peaceful human beings in Colorado by Molotov cocktails and a fire thrower? What has to happen to raise it to the level of a public health crisis for you?
This from the article regarding MAHA deserves repeating. "Social determinants of health, like poverty, were not addressed or acknowledged.". And if snap is cut or lunch at schools or medicade so more is being spent on health care costs can't we assume nutrition will be worse as will child health? Hipocritical liers. It is slow euthanasia not health they are after.
Exactly how are these benefits being cut? As for Medicaid, it’s being modified to include a work requirement for healthy adults similar to President Clinton’s welfare reform (that was subsequently reversed by President Obama). I believe SNAP and school lunch reforms are limited to healthy eating but could be wrong.
I was surprised to see the high numbers of cases of measles in Canada , especially given the country's smaller population. Why and where is this happening? (I live near the Canadian border.)
You list as a"pro" on the MAHA report "Emphasized prevention through lifestyle: better nutrition, physical activity, sleep, and less screen time." Those are all good things, but it would be even better(much better) if the report addressed the underlying causes of less than optimal lifestyles. E.g., " better nutrition": Why focus on lifestyles alone and not on getting rid of government subsidies for sugar and corn ( high fructose corn syrup) and/or adding subsidies for fruit and vegetables? Why not address the problem of"food deserts"? What about the low wages and long hours that encourage overconsumption of (often ultra processed, salty, fatty, sweetened) fast foods and junk food and take out foods? What about the artificially low cheapness of junk food due to low pay for the workers who produced them and anti union practices on the part of fast food companies and junk food producers? There are structural reasons for poor nutritional life styles. Likewise, there are structural reasons for lack of exercise, poor sleep, excess screen time. A public health approach based solely on scolding and cajoling people to get individuals to change their health-related behaviors when the health-related behaviors are largely due to structural factors is hardly worth calling a " public health approach." It is like dealing with contaminated water by telling people to boil their water rather than creating a pure water supply.
On summer waves, we are definitely seeing a wave of COVID here in Western Massachusetts and not only more people getting infected and reinfected, they're are stating this is the worst case they've experienced from mostly otherwise healthy people who've been boostered. What really worries me as someone who is highly vulnerable to severity if I ever get it (which I have not), how can I trust THIS CDC for accurate stats. I am disabled from Progressive MS and RA and have virtually 0- B cells left after intense DMD's for MS to keep me going. The MS has weakened my diaphragm. And I have a Primary genetic immune disease called CVID. I'm chair of my city's Commission on Disability and I'm petrified for the disabled/chronically ill residents I represent. Especially those who are low income and impoverished who also depend on Medicaid. Once again I ask you, where is the support and concern for the largest most diverse marginalized group in the world (WHO), and the country (CDC before Trump)? Tariffs will raise our Rx's prices as many come from China and manufacturers will be cutting back on labor so scarcity and quality will likely be a problem for drugs and supplies. Our wheelchairs which determine our independence as opposed to becoming institutionalized are largely electronic with components from China Insurance companies are already changing their formulary lists coverage. Co-pays, deductibles, premiums are going up as are denials of approvals. Medicare is in danger and Social Security has already been substantially diminished. Why are we not hearing Public Health officials with microphones not talking about this huge group of Americans at risk??
With regard to pain management for in-office IUD procedures, as a family doc I started putting in IUDs in the 1970s when they first were introduced. Any caring, attentive provider would soon observe that this procedure could be very painful, especially in nulliparous women, (if you attended to your patient ~ 30 minutes after insertion) and could somewhat commonly cause a vaso-vagal response with an injurious fall.
Glad to hear that it only took 50 years for the Academy to recognize this problem and recommend treatment.
I have a question (that you may not know the answer to) about self-attestation at the pharmacy. Will the pharmacist report the reason to insurance (I would think so), and will that affect insurance going forward? Will you now have a condition listed in your insurance record?
That's a great question.... I'm hoping someone from the pharmacy/clinical/medical billing world will weigh in. From my knowledge/experience I lean towards no, but I don't know and/or trust that they won't need to add the (self-reported) diagnosis that "qualified" us for the vaccine. My personal thought is to be vague, something like - I have an autoimmune condition and my doctor recommended I receive the vaccine.
I also have a question about when to get the COVID shot if it isn't being updated. My husband and I are over 65, so eligibility isn't an issue. He last got his in September 2024 and I in November 2024. I was thinking we should get a second shot now and then an updated shot in the fall, but now I'm not sure. Thoughts?
Similar question on timing, given last vaccinations as well as timing if infected (how many months between is ideal to maximize immunity). Please cover this—so many questions out there!
I have the same question.
Same question as well
Pretty sure previous reliable guidance is every 6 months when over 65. I would also use the guidance of 6 months post infection, as having Covid effectively replaced a vaccination.
I hope many of you were able to see the grilling Margaret Brennan served up to FDA chief Marty (CDC is a "kangaroo court") Makary yesterday on Face The Nation. Maybe he hadn't had his morning java:
https://www.youtube.com/watch?v=WGH23FhqZxY
I did! I thought Margaret was on fire. She did a fantastic job holding him accountable.
She's usually tough. But I sensed real frustration and anger with Makary.
He was not impressive.
CNN brought to you by Pfizer.
FDA also said there's a preference for the LP.8.1 subvariant, but still left questions about it and the eligibility for the fall vaccines (https://covidandvaccineupdate.substack.com/p/lp81-fall-booster). Maybe answers will come from CDC's ACIP scheduled later this month.
And yes, between Kennedy and Makary, they sure have made a mess of who's eligible for what. Their show on X along with the NIH head reminded one of the Three Stooges (https://covidandvaccineupdate.substack.com/p/flurry-of-vaccine-policies-with-questions).
It was a surprise that FDA authorized Moderna's mNEXSPIKE given Kennedy's claim that mRNA vaccines are dangerous and last week's cancelation of government funding for Moderna's development of mRNA flu vaccines, including for bird flu, which is still in the wings.
Thank you for this excellent COVID-related update. You state, "That means the same formula from last year will be used again," but also mention that "FDA approved Moderna’s next-gen Covid-19 vaccine." Is it possible that the CDC's approval of this new vaccine could come (assuming that it _does_ come) in time for us to get the new Moderna vaccine sometime this fall?
Same question. Will we hear from Moderna on this?
CDC's ACIP is meeting the last week this month. However, even if the advisors recommend Moderna's mNEXSPIKE, there's no director at CDC yet to endorse it. It could be Kennedy who decides. Moderna said they will offer the new jab in addition to their current one (https://covidandvaccineupdate.substack.com/p/flurry-of-vaccine-policies-with-questions).
The company had previously said they could target the latest LP.8.1 subvariant this fall, but did not provide that detail in announcing the FDA authorization of mNEXSPIKE.
EDIT: I'll keep comment up for history, but disregard the contents now. This was an error on the vaccine schedule website that has been fixed.
A point of clarification- the CDC recommendation around COVID-19 vaccination and pregnancy is not "shared decision making" like it is with kids. They explicitly say to delay vaccination during pregnancy.
https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-medical-condition.html
If you hover over the gray box intersecting COVID-19 and Pregnancy it says "Delay vaccination until after pregnancy if vaccination is indicated." EDIT: (This is now fixed and says "No guidance/Not applicable")
I have seen news stories get this wrong, and it is unfortunate, but it should be reported accurately.
That hover over is a mistake that is trying to fix (but had to go back to HHS for permission). If you look at the legend the contraindication box (red) is missing - it go underlayed on the gray pregnancy box and that’s the hover over.
Oh that is interesting! I do hope HHS allows them to make it more clear. The same hover over shows up for RZV vaccination and pregnancy (which would be very rare). But then other others like pneumococcal it says "No guidance/Not applicable". That does make more sense though, because obviously in the printed version there will be no option to hover over something.
It is very unfortunate this has all been so confusing.
Just FYI- it's been fixed now :)
Great news, thank you!
Wow, thank you for noticing! That is a small but important detail missing from much of the coverage I have seen. That’s not just “No Guidance/Not Applicable” or removal of a recommendation—it is a recommendation to delay vaccination in pregnancy altogether.
No wonder people are confused. I didn’t catch because I viewed it on my phone or didn’t think to hover. These small details matter. Our public health processes are far from perfect, but they exist for a reason: to ensure clarity, transparency, and trust. And I agree, the media is missing this.
Thank you for sharing.
Just in case you aren't following, I'm pinging for your awareness. Dr Jetelina above says this is an error that will be fixed.
Glad to hear it was just an error, but still unfortunate, as it adds to the overall confusion. I imagine reduced staffing has not helped with catching these kinds of mistakes either.
It’s already been fixed. Credit where it’s due for quickly fixing!
That information isn’t visible on mobile, in the PDF versions, or on the ADA compliant version and isn’t mentioned anywhere else including the notes and the appendix.
I was able to pull up the code for the regular and ADA compliant versions on my phone and it does contain the text that should be present on hover. For the regular version this says “Delay vaccination until after pregnancy if vaccine is indicated” (not the language used in the rest of the column) but the ADA compliant version says “No Guidance/Not Applicable”. Given the inconsistency I don’t believe that that text is supposed to be there.
It is in a weird place in the code where it would be easy to forget to update it, especially if it was a last minute change. Or someone could have “forgotten” because they wanted it there.
"Out of all of this, my biggest concern remains: The damage is already done. A wave of confusion due to unilateral political decision-making instead of established evidence-based processes, resulting in whiplash headlines, likely hurts trust, sows immense confusion, and in turn, reduces vaccine uptake."
Makes me wonder whether this was intentional!!!
Does the CDC update provide for two COVID shots per year for those 65 and older without other risk factors? Or only one?
As a physician I really respect the information I receive from your emails. I’m wondering why the scourge of antisemitism, a public health crisis, has not been addressed yet? Even one day after an attack of a group of peaceful human beings in Colorado by Molotov cocktails and a fire thrower? What has to happen to raise it to the level of a public health crisis for you?
This from the article regarding MAHA deserves repeating. "Social determinants of health, like poverty, were not addressed or acknowledged.". And if snap is cut or lunch at schools or medicade so more is being spent on health care costs can't we assume nutrition will be worse as will child health? Hipocritical liers. It is slow euthanasia not health they are after.
Exactly how are these benefits being cut? As for Medicaid, it’s being modified to include a work requirement for healthy adults similar to President Clinton’s welfare reform (that was subsequently reversed by President Obama). I believe SNAP and school lunch reforms are limited to healthy eating but could be wrong.
Thank you I’m so grateful for having a trusted reliable source to learn health information from!
I was surprised to see the high numbers of cases of measles in Canada , especially given the country's smaller population. Why and where is this happening? (I live near the Canadian border.)
https://health-infobase.canada.ca/measles-rubella/
Thanks for posting
What the MAHA report got right is so minor compared to all the giant red flags flapping in the wind.
You list as a"pro" on the MAHA report "Emphasized prevention through lifestyle: better nutrition, physical activity, sleep, and less screen time." Those are all good things, but it would be even better(much better) if the report addressed the underlying causes of less than optimal lifestyles. E.g., " better nutrition": Why focus on lifestyles alone and not on getting rid of government subsidies for sugar and corn ( high fructose corn syrup) and/or adding subsidies for fruit and vegetables? Why not address the problem of"food deserts"? What about the low wages and long hours that encourage overconsumption of (often ultra processed, salty, fatty, sweetened) fast foods and junk food and take out foods? What about the artificially low cheapness of junk food due to low pay for the workers who produced them and anti union practices on the part of fast food companies and junk food producers? There are structural reasons for poor nutritional life styles. Likewise, there are structural reasons for lack of exercise, poor sleep, excess screen time. A public health approach based solely on scolding and cajoling people to get individuals to change their health-related behaviors when the health-related behaviors are largely due to structural factors is hardly worth calling a " public health approach." It is like dealing with contaminated water by telling people to boil their water rather than creating a pure water supply.
On summer waves, we are definitely seeing a wave of COVID here in Western Massachusetts and not only more people getting infected and reinfected, they're are stating this is the worst case they've experienced from mostly otherwise healthy people who've been boostered. What really worries me as someone who is highly vulnerable to severity if I ever get it (which I have not), how can I trust THIS CDC for accurate stats. I am disabled from Progressive MS and RA and have virtually 0- B cells left after intense DMD's for MS to keep me going. The MS has weakened my diaphragm. And I have a Primary genetic immune disease called CVID. I'm chair of my city's Commission on Disability and I'm petrified for the disabled/chronically ill residents I represent. Especially those who are low income and impoverished who also depend on Medicaid. Once again I ask you, where is the support and concern for the largest most diverse marginalized group in the world (WHO), and the country (CDC before Trump)? Tariffs will raise our Rx's prices as many come from China and manufacturers will be cutting back on labor so scarcity and quality will likely be a problem for drugs and supplies. Our wheelchairs which determine our independence as opposed to becoming institutionalized are largely electronic with components from China Insurance companies are already changing their formulary lists coverage. Co-pays, deductibles, premiums are going up as are denials of approvals. Medicare is in danger and Social Security has already been substantially diminished. Why are we not hearing Public Health officials with microphones not talking about this huge group of Americans at risk??