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Apr 25, 2023Liked by Katelyn Jetelina

I just subscribed but I just went through the same analysis as the article for the "Do I Need a Spring Booster" with my son who is a biochemistry undergrad and a physician and came to the exact same conclusions as your article.

I just added a paid subscription and I like what I see in the other articles. I look forward to more articles. Thanks for the good work and the pragmatic approach.

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In case you need another vote of confidence from a physician like your son, I administered 5 boosters to 65+ year olds just today, including a little old sweetie of 98 years of age, who took an Uber to see me. Despite being 45 minutes late for her appointment, I agreed to see her b/c what kind of monster would turn her away for being late! I digress... weighing risks and benefits, knowns and unknowns, hunches and certainties... go with the experts and trust the process that permits/recommends these extra doses for higher risk and older individuals 💪

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Agreed! I got a booster for my 93y dad yesterday. He had Covid-19 3.5 weeks after his first bivalent last fall (he received it the first week it was available). Amazingly his first infection despite living in a retirement community where they all gather to eat. He had a mild case and was not eligible for Paxlovid due to his medications. He also had rebound (yes, it’s real and not only with Paxlovid) that lasted 24 hours of a stuffy nose and a positive rapid test again 3 weeks later. He almost died from influenza A in June, and I seriously considered a second flu vaccine for him this year but the incidence fell off so sharply this winter.

It was 6 months post covid infection and like I have said for some years, he will die but this should not occur due to something preventable.

Yay boosters! And he will again be first in line for his fall booster come October when we hit 6 months again.

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I’m glad your Dad is doing well! I have a special place in my heart for the nonagenarians I see.

If he does get Covid again, consider remdesivir infusion if you can find that through his PCP. Unfortunately my institution just stopped offering this.

And an oral formulation of remdesivir is just around the corner in clinical trials/approval. Very minimal chance of med interactions

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How does remdesivir compare to Paxlovid in terms of efficacy? Does remdesivir clear the virus more quickly, or with fewer side effects? What about rebound (and incidence of long Covid, post-treatment)? I have an elderly relative with multiple comorbidities and if he becomes infected (which seems inevitable), I am unsure if I should help him search far and wide for the infusion, versus picking up the pills at the pharmacy. I want to stack every card possible in his favor. Thank you for any light you can shed.

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I think paxlovid and remdesivir pretty similar reductions in severe disease when given early (see PINETREE study for remdesivir). Remdesivir has much fewer interactions, but logistically difficult. The oral formulation will be great. Good to have a plan in place with his primary doctor so it can be executed when he gets covid I agree. Sounds like you have some great questions, check out Dr Daniel Griffin on the TWIV podcast for clinical updates.

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Thank you!

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founding

As always, much appreciated. Both husband and I will go for our spring booster in early May. Your guidance has truly assisted these two 70+ immunocompromised humans make thoughtful decisions for ourselves.

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Any idea how the CDC will evaluate whether the Spring bivalent booster increases protection? This would be useful to know in terms of deciding:

1) Whether to extend the Spring booster to healthy people under 65,

2) Whether to recommend making Covid shots an annual or “every 6 months” shot

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Thanks for this update, Dr. Jetalina! I’m 62, no comorbidities, and received the bivalent booster last September. As much as I’d love a second booster, I’m reassured by your guidance and that of other experts I also trust, that I’m covered. I’ve seen the effectiveness of the bivalent booster with friends who became infected with Covid afterwards. In one case, a dear friend with several comorbidities. The bivalent and Paxlovid kept them out of the hospital, and they said Covid for them was like a bad cold.

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I am immune comprised, elderly and B cell depleted. I also have a genetic mutation that causes clotting. Do I really follow guidance for vaccination every 2 months and risk a stroke. CDC keeps changing guidance. Can I trust them? My specialists say “don’t be on the cutting edge because you may bleed”. I have been locked down for over 3 years. My son who is 35, fully vaccinated, and has the best of health care nearly died of Covid and now has long Covid.

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Thanks again YLE for being so proactive in helping us to think this through. I believe that over-65 + immunocompromised should consider getting second bivalent vaccine (I stopped calling new vaccinations "boosters" to get past the "enough already" hesitancy) by the end of May. Although all Covid-19 indicators are nosediving, I am thinking that the fall is the next time frame of concern and gov't funding is supporting the development of a new vaccine that is intended to be ready in the fall and better targeted to circulating variants at that time. So it will be important for vulnerable populations to have access to new generation vaccines at that time. But the new vaccine will probably require a 4 month separation from previous vaccination. That is the reason that one might consider getting a bivalent shot before the end of May so that they would be eligible for an improved vaccine anticipated for September/October. Hopefully, Covid will give us a rest and none of this will be necessary.

Lastly, providing flexible thinking to help inform personal decision-making in the real world makes a lot of sense. Your example about anticipating a wedding event in the months ahead was an excellent example. Perhaps a list of activities that may represent increased risks might be compiled (e.g. air travel, theater) or will this drive people crazy? What do you think?

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Thank you so much, Katelyn, for this. It answered questions for me that I hadn't even been thinking of (like whether to get a booster prior to a late-July wedding, and when). And the dissection of risk levels and advice by age, comorbidities, and prior infection/vaccination history makes this incredibly useful and actionable. (Of course, that kind of clarity and usefulness is what we have all come to expect from YLE!)

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Btw, I thought it was kind of strange that the new ACIP/CDC guidance for 2nd bivalent included age and immunocompromised, but not chronic disorders (e.g. Heart, lung, diabetes, cancer obesity). Is there more guidance on this? I could not find any info on CDC website??? Clearly these patients are subject to more serious outcomes when infected. YLE recommends 2nd jab for >65 with comorbidities. But what about under 65 who is obese, diabetic, COPD? What do pharmacists do when presented with an under 65 patient with comorbidity who wants 2nd bivalent? I bet I am missing something - if anyone knows the answer , please advise -thx.

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founding

I think that there is no sensible answer - but the experts believe that it would make things more complicated and disrupt the “messaging”. The CDC and FDA have shown a great reluctance to expand access to vaccination. Personally I believe that is due to a fixed and wrong notion that the important thing is to get more people vaccinated and that that goal somehow conflicts with giving better protection to more people who want/need it. There is also a bureaucratic negative response to expanding vaccination until “more data” is available. This despite the clear evidence from millions and millions of vaccinations that they are safe and effective. Leftover reaction to the thalidomide failure.

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70 y/o. Got the 2nd bivalent shot yesterday. I had to run an errand in a store next to another store with a pharmacy, and there was an open appointment, so I booked it. They had Pfizer, so it’s what I got. Done!

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Solid. The message gives the facts truthfully. And in the end, the choice is yours! I really love our YLE! Oh yeah!

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About Side Effects.

The fall booster gave me a 2-day misery of feeling sick - a solid 7 out of 10. Spring booster scheduled for this coming Friday.

I'll be a bit smarter about being prepared for a lousy weekend.

And - huge thank you to Katelyn Jetelina for the many straightforward and clear analyses.

Politics being the highest science of Man <grin>, please consider it as a career adjunct.

Best

Heinz

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Got the Moderna.

A bit weird - zero reaction, almost no soreness at injection site.

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founding

I'm looking for an up to date list of what the comorbidities are. Thank you

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At age 71 (no comorbidities), having had all the possible vaccinations, including the bivalent booster last March, my husband and I had planned to get another booster. We had just opened ourselves up to taking some unmasked risks — going unmasked to a restaurant with friends and taking a singing class (large room with high ceilings, few people). After all these years of avoiding COVID, it got us. We’re both home sick now, taking Paxlovid. Hurray for hybrid immunity? Am I right to assume that we should wait for whatever is available vaccination in the fall?

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founding

Yes we are in a community highly educated, many hospital centers and universities, yet no one masks hardly at all. My husband and I got COVID last May (2022) I got Paxlovid, we have mild co-mordities, we both recovered BUT had a miserable summer basically. Things had opened up a lot, we were wearing KN95s that were not up to par. My MIL is 93 and my husband has to visit her regularly~and ever since then we wear N95s. We look weird, but we would rather not risk getting it.

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Thank you! Since I have a lot of public exposure to all kinds and ages of people I got my booster today.

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I am in the group that had the first three shots, had horrible side effects from Moderna 2 and 3, and cannot get guidance on a booster. I truly wish there were other options. I am a sitting duck for Covid, but I cannot go through 48+ hours of being incapacitated with vomiting and headache (and I have migraines, so I know a bad headache, and this pain was terrifying). And then several weeks of not feeling normal. Medical professionals cannot tell me if Pfizer might be a better option. Is the issue Moderna was too high a dose? Is the issue the platform? It is shameful that there are no other options for those of us unwilling to risk another MRNA vaccine. Especially those of us who who prefer not to get Covid and want to do the right thing.

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author

There are a lot of people like you, including me. I react completely terribly to mRNA vaccines (doesn’t matter what type). My husband has no reaction. I don’t know why we are the unlucky ones, but mRNA vaccines are the most reactogentic vaccines we’ve ever had and we need alternatives. Novavax should be coming out with a bivalent in fall. Also, you may be interested in the post that is coming Thursday on mucosal vaccines

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And living with MS, ironically, adenovirus vaccines make me have a flare-up. So I'm sitting here waiting for all the vaccines to be mRNA. I was so scared leading up to my first jab Feb 2021, but because I work in science and medicine, I rolled up my sleeve and believed in the 20+years of research. I didn't have no symptoms, but not like the three months down the rabbit hole I get from the other vaccines I've had.

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founding

My brother who is a microbiologist and worked in a lab for the USDA in MD, knows a lot about plant genetics but indeed much science in general, said that mRNA vaccines had been in development for years, and are overall very safe! Check out microbe.tv for You Tube programs https://www.microbe.tv/ for science education, reviews of papers and research about SARS COVID-2 and many other topics in virology, etc.

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I've worked in science for nearly 30 years. mRNA vaccines have been in development for the last 20, fortunately for us. It wasn't a matter of if, only when. And this won't be the last pandemic most of us see in our lifetime.

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founding

Absolutely agree and thank you for posting this reply. I have had arguments even with close friends who have been too politicized to listen to science and evidence! I surely hope that the next one we will be better educated and prepared. I worry for so many that don't have health insurance, have underlying conditions under age 65. So, when I purchase good N95s that don't fit me correctly or KN95s, I give them away. I try to steer folks to newsletter like this one!

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founding

This is really good to know, even though my husband and I have not had severe reactions to the mRNA vaccines.

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Is reactogenicity linked to immunogenicity on an individual level?

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author

because even though about 20% people have acute side effects from the vaccines, the benefits still outweigh the risks of infection.

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It would be nice if we could make predictions on which people would experience bad reactions to the mRNA shots, wouldn't it?

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There has been some analysis done on VAERS which suggests that certain batches of COVID shots are much more likely to produce bad reactions than the other batches.

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It definitely would. I haven’t had anything more than a sore arm with any other vaccine.

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Many well-controlled studies indicate that they do prevent infection, although not perfectly. No medication is perfect. Here is a Cochrane Review article cataloguing the evidence. https://pubmed.ncbi.nlm.nih.gov/36473651/

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It won't matter. This guy is notorious troll who ignores evidence that doesn't synch up with his ideology. Be aware, also, that he has a habit of making statements without any accompanying references. Press him for data and you might get a link to an article that doesn't actually support his claim. Obvious tactics, but someone will always take the bait.

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author conclusions from that Cochrane Review:

"Implications for practice Due to the trial exclusions, these results cannot be generalized to pregnant women, individuals with a history of SARS-CoV-2 infection, or immunocompromized people. Most trials had a short follow-up and were conducted before the emergence of variants of concern."

So pregnant women were excluded from these trials, yet in the U.S. pregnant women were urged to get COVID shots by public health.

Also excluded were those who already had COVID at least once. Many comments posted here are from those who got COVID.

"most....were conducted before the emergence of variants of concern." So it seems these were mostly just the initial trials that were done when there was only the original COVID circulating. But this review article was written in Dec. 22, after the emergence of new variants, which have been seen as less dangerous than the original COVID but still quite infectious. Seems to me the most recent trials would be much more important today for decision making than those older trials.

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Paul, what frustrates me about the tone of your posts is that you sort of crowd out more nuanced perspectives that imagine possible worlds in which your conclusions are supported by facts. It's quite possible, for example, that at some point we'll be able to drive prevalence sufficiently low, or find sufficiently good antivirals, that vaccinating certain people won't be worth the trade off. That hasn't been the case so far - but it could be, eventually.

Leaping to the conclusion that we're already there, with scant evidence, only serves to contribute to polarization.

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founding

NO vaccines for anything can completely prevent infection. These can for awhile ie ca 3 months. HOWEVER they have demonstrably proved effective at preventing severe disease and death. I hope the scientific community and the government will focus some funding/research and development of more antivirals as well as access to remdesivir.

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I was just on a high school facebook group. We’re 72. Someone asked about the newest booster. One guy said my wife’s a doctor and I’m not getting it. Another guy said I’m a doctor and I’m not getting it. As you’ve discussed before about communication: What makes these people make blanket statements without supporting reasoning? Why do they lob information to people with whom they have no idea what their circumstances are? When did people forget about common sense and think of others outside themselves? I put your post in the thread YLE. Thanks for all you do.

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Did you pregame with an NSAID and acetaminophen? If you are this reactive, modulating your cytokines and inflammatory mediators downwards should not really matter much in terms of vaccine efficacy, especially since this is not your immune system’s first look. That being said, even with these meds on board, 24-48 hours of being out of commission can still happen for some (if not most) who have previously reacted this way 😟.

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Apr 26, 2023·edited Apr 26, 2023

Yes, and Zofran. My children were terrified I was dying. It was awful. I was totally incapacitated. I have never been that sick with an actual illness before.

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As a 74 yr old - if I get the spring booster (first bivalent was the first week it was available last September) am I still going to be able to get the (planned to be) regularly scheduled fall booster - or do I have to choose one or the other?

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