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My husband and I are 78 and nearly-76 respectively. Last month we went to a pharmacy where we're unknown, handed them our original cards for just our first shots and boosters, and asked for--and got!!--our 2nd bivalent vaccinations. We feel tremendous relief, and just wish we hadn't to sneak around to get this basic protection that's being offered in countries that are actually civilized (and not as political as the US GOP makes everything) about public health for their elders.

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I may get another right before the emergency ends (so, around the beginning of May) depending on my antibody level.

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Good to know! I'm in your age group and vaccination status group, and will follow your example. I've had all recommended shots, so just omitting my last booster info should do the trick. Thanks!

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You're welcome!

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It is difficult to understand the “down sides” to boosting. I have never seen this articulated anywhere. What, precisely, are the risks of boosting? Additionally, with bivalent booster uptake being so low in the US, it is doubly frustrating to see vaccine doses expiring rather than be given to people who desperately want them. Much of vaccine policy is not making much sense these days. The long delays and debates on boosting and reformulating are tough to watch while the world burns with COVID waves, over and over.

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The only risk I know of is that of “imprinting,” which was referred to obliquely in the post. I asked KJ about it in a comment. 🙂

Here’s wiki on the general phenomenon: https://en.m.wikipedia.org/wiki/Original_antigenic_sin

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I'd really like to see a system that treats vaccination appointments like all other scarce health resources: let people schedule boosters, and if someone who's higher priority comes along and needs it more, based on some set of objective criteria, you'd get rescheduled. That way doses wouldn't go to waste but we'd still acknowledge the fact that some people need boosters more than others.

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They're not scare now, are they?

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Currently no - but they have been in the past, and could easily become scarce again. We shouldn't take that for granted.

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I don't think they're going to become scare. They're a real money-maker for the pharmaceutical companies. Soon people (or they insurance, if they have it) will pay $130/shot, because the government's not going to be covering the cost any more.

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Horseshoe crabs blood is an example of a scarce resource that vaccines (and all injectable meds) depend on to make sure they don't kill you. If you think anti-vaxers are bad when they're wrong, imagine what the world would be like in a world without horseshoe crabs.

FYI vaccines recommended by ACIP are covered by ACA plans, with zero copay.

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I grew the up the ocean, and am fond of horseshoe crabs. But at this point my feeling is fuck 'em.

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Yeah… a COVID infection has a 1 in 5 chance of neurological and organ damage. I will take my chances with the vaccines, and YOU may take your chances on repeat infections.

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Paul. If you had been doing thorough reading, not conpromised by misinformation or liberatarian prpoganda, you would have taken note that post omicron, the vaccines were very effective at preventing deat/h and hospitalization. Pre-Omicron, the vaccines were effective at preventing infection, but because we failed as a society to take the multi-layered approach to quell transmission (consistant masking with high quality masks, sick leave for all, guarantees of appropriately filtered air in all public spaces, regular testing + vaccines, we screwed ourselves.

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My strong hunch is that they're still quite effective at preventing infection if you get enough of them at a high enough dose. We just underestimated the initial series. Subinfectious exposure probably helps too.

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Hello again. From my understanding, this is not the case. The virus outwitted the orginal vax formula--bivalents caught up a little, but are still dated. The less we do re masking, testing, air filtration, the more likely there will be other variations of concern that the current vaxes will not be able to handle.

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Vaccinated people do sometimes get COVID19. But when they do, far fewer wind up in the ICU. And among COVID19 patients in the ICU, it's the UNvaccinated ones who are far more likely to die.

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Your “nobody” fails the sniff test. The propaganda of which you speak is nothing of the sort. It’s a cautionary statement in my view. You’re entitled to your own view even if “everybody” else thinks you might be a bit overboard. Megan says it best. Have at it...and good luck.

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Ray, do see the Paul Farmer inspired medical magazine Peste-- no need to be polite when there are such high stakes-love that about them.

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@Mona Kanin: Thank you for the Farmer link. Great man and physician - a modern Albert Schweitzer. Here a great article about him from Harvard:

https://www.harvardmagazine.com/2020/11/ebola

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Yes, use scary “mRNA” to bash the vax, exaggerate the side-effects, undersell the effects of Covid, and portray it all as the higher critical thinking.

Doesn’t work on anyone with a modicum of knowledge. Bad PR technique.

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Oh Paul....

You again??

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Take a long look at the "extensive side-effect profile" of a COVID-19 infection...

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Evidently you prefer to play the odds and support the deniers, Paul. You evidently are the ultimate risk-taker with the choices you promote and you have made it abundantly clear. Your critical scientific analytical approach to vaccinology is clearly 3-4 standard deviations beyond the the best public health minds on the planet. I can only wish you well and remind you that seat belts and helmets save lives, too. As for me, I will maintain vigilance and promote preventive measures for myself and my family because the recommendations make sense to me as an individual. You might wish to consider how you contribute to the risk levels for your friends, family and community. By declining to follow public health guidelines you put them at higher risk for hospitalization or death even if their risks don’t meet some nuanced statistic you require. I live with an immunocompromised spouse so I’m not about to challenge or quote micro-statistics esp if/when the worst outcome is the result of my own recalcitrance. If I choose nonchalance and my significant other succumbs, how will I live with myself? Could you? We’re all in this together, Paul. MD

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It seems that 'paul' seeks infantile attention. Responding to him encourages him.

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my research is heavily evidence-based; as a former librarian who understands best sources and how inforamation can be corrupted, I'd say you're imbibing propoganda

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@Mona and @Paul...imbibing propaganda as in "imbibing the Kool-Aid" unconscionably mixed by what I would suggest is an adoring proponent of the obfuscationists Dr Robert Malone and Dr Pierre Kory, the latter of whom has monetized his notoriety with a website dedicated to fleecing unwitting folks to the "glories" of the anti-parasite ivermectin. He deserves condemnation and censure, but......we live in a free society so anyone and everyone is free to drink "The Kool-Aid" and choose their own destiny, unfortunately, at the peril of the community in the case of an infectious, novel virus like SARS-Cov2. As for me and my compromised spouse, our T-cells are ready for smallpox, polio, DTp, hepatitis B, various strains of pneumococcus, re-activation of childhood V. zoster, seasonal flu, and SARS-Cov2 - all recommended by our Public Health advisors. We aren't risk takers except in the area of finance where age-appropriate risk in investing has proven to be quite acceptable over many decades.

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Hi Ray: I agree and yet disagree. Both Fauci and Francis Collins have spoken recently about how frustrating it has been to deal with misinformation/disinfection--that it carries far greater weight than science. Isn't this something all of us that value the common good, who value the human part of us all should be fighting? There's part of our society-often greed-based, that has for perhaps 4 decades attempted to undermine our common understanding of truth. In ways, they've won.

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Mar 23, 2023·edited Mar 23, 2023

While that risk-benefit calculation might be true for many people, it might be quite different for people with high risk of severe infection. Also I'm very curious about whether (or which) side-effects are due to the specific nature/mechanism of mRNA, such as the lipid nanoparticles, the exact molecular structure of the mRNA used in the vaccines, the structure of the spike protein produced as a result of the mRNA, etc. In other words how much of which side effects are generic to spike protein, and which to the type of vaccine (mRNA, protein subunit, etc.)? In the dawn of the age of precision health, it would be good to see a forum (like a conference) where this could be discussed starting from genuine collaborative curiosity. If this pandemic was a dress rehearsal for a future worse one, how do we learn from this experience, because the 'how' is as important as the 'what.'

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I totally agree! My second and third Moderna were awful for me. 48 solid hours of vomiting with the worst headache of my life (and I suffer from migraines, so I am no stranger to a bad headache). It was terrifying. A friend suffered neurological issues. I just want to know, for myself, is the MRNA platform? Was the dose too high? What causes the side effects to be so severe for me. I did not get a bivalent booster. And, after avoiding Covid for three years, my son has it now. I am terrified.

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For context just in case it matters, I'm 75, have no comorbidities, have been maximally vaxxed (zero side effects for the N-of-1 over here), wear a tight N95 indoors except at home, and am well aware of the poor outcomes of people who've had Covid, long Covid, and vaccines (and I know people in all 3 categories). I was upset when patients who strongly believed they were injured by vaccines told their stories at the Jan FDA meeting and were just politely thanked. Not listening to people is not a good plan for building public confidence nor for doing science. I'm very pro-vax---for me. (I'd be very pro-vax for most people if we had one that could stop transmission)

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Vaccines stop transmission only if a large enough segment of the population takes them early enough in the pandemic to prevent rapid spread and mutation and establish a level of population immunity. None of that happened and SARS-Cov-2 has gotten really good at evolving quickly.

Other factors are how easily a virus is transmitted and how many infection vectors there are. Also the length of the period between when you are infectious but asymptomatic (and therefore can pass it along without realizing you are doing so).

This is where properly designed and worn masks and physical distancing come into play. Protection from infectious disease is a multi-layered process. Think of your body as a medieval walled city. You've got a moat (distancing), a wall (mask) and standing army (antibodies). Vaccines expand the size and strength of your army, but relying on them as your sole defense is risky.

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I suspect there are ways to deploy vaccines in a more efficient way that really does reduce (or even prevent) transmission. Or, alternatively, reduce severity to the point where it's unnoticeable. It's just going to take a little time, and a lot of math.

For example, my girlfriend and I have been making a point to space out our boosters from one another, so our immunity peaks and troughs don't line up.

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Did you get measles after you were vaccinated or polio? If vaccine failure was this high for any other vaccine, people would be outraged not making excuses.

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Mar 23, 2023·edited Mar 23, 2023

As the COVID task force is disbanded, the NYT has stopped collecting data, and Dr. Birx is quoted in the WaPo saying “the immune compromised are less protected than a year ago “, it’s time to allow the higher risk people to get a booster. I hope the approval comes soon. Just learned that Michael Osterholm, despite very thorough precautions has Covid--he has advocated for another booster. He tried to get a booster and was denied. Permission to boost high risk people seems overdue.

https://www.cidrap.umn.edu/covid-19/episode-127-tough-two-weeks

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if you go to the pharmacy, they'll turn you down

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The 1st pharmacy we went to turned us down because they saw our card showing we'd had the bivalent (within a week of when it was 1st available).

But the 2nd pharmacy saw only our card with our first Vax records, back when those were 1st available. They immediately gave us our bivalent Vax injections, unaware that they were our 2nd ones.

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Mar 25, 2023·edited Mar 25, 2023

my husband feels that to do this would compromise his ethics, I understand that; but why will the Feds not approve the 2nd bivalent for those who want one in the context of so many people who think the emergency is actually over?

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My ethics in the pandemic evaporated when I used eBay early on in March 2020 to get around all the supposed restrictions on "hoarding."

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Oh, dear. I understand his position--my own husband felt that way, too. I argued that letting him remain at risk of Death By COVID would compromise my own ethics! Don't know if that argument would work for you. If not, I'm sure you'll both be very careful with masking and as much social isolation you can bear, until this country approves the "2nd bivalent" dose that civilized countries are starting to approve.

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founding

Oh no! I can't believe Dr. Osterholm was turned down! That makes NO sense. I listened to some of his podcast just yesterday (Thursday 3/23). The link is just above thank you. It is crazy to prevent folks who wish to be vaccinated to do so.

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Mar 23, 2023Liked by Jeremy Faust, MD

Thank you both for keeping your word on informing us about getting boosters earlier than this fall. I am worried for my frail 82-year-old parents, who are prime candidates. They NEED it. I am worried for myself: 57, healthful, active, fully vaxxed, still a “Novid”, and not wanting long Covid. I WANT it. I hear of people sneaking around the system to get boosted now if they’re not “due”. I hoped the decision-makers would approve another booster, so that this was not necessary. You both are my ears to the ground. I appreciate any intel you can offer!

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Michael Osterholm caught Covid last week despite thorough precautions: we deserve the option of another booster: https://www.cidrap.umn.edu/covid-19/episode-127-tough-two-weeks

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Thank you so much. My friend and I were discussing this yesterday. As two immunocompromised over 65 year old women, we have worked hard to keep covid from putting us in the hospital. Your information is timely as always.

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founding

Lots of things worry me about our handling of Covid, but what troubles me most is the *absolute* lack of government and other messaging about the potential long-term effects of even a mild infection. Right now, it seems, we are at the point where most people seem to be thinking: getting Covid is no big deal, just like a cold, who cares? Never mind the 300-400 daily deaths from the disease. And never mind the growing body of papers that show long-term and possibility permanent increased risk of heart attacks and strokes (for just one reference, see Eric Topol's "Ground Truths" article "Heart attacks and strokes late after Covid", published recently). I guess this cuts close to the bone: my 27-year-old previously fit and healthy daughter got Covid quite early, and now has heart and neurological damage that may require coronary surgery and, at its worst, means she now has to use sticks to get around. So a question, Katelyn and Jeremy: why are you not writing about this? Perhaps if scientists started shouting from the rooftops about the increased MI and stroke risk, maybe people would start realizing that this disease is set to change the future of human life expectancy, and not for the better.

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Yes!!! My 12 year/old has COVID right now, the first in our family. Despite three Pfizer vaccines, he has been the sickest I have ever seen him. I am nervous for myself, my husband, and my younger son. And I am also terrified of what this means for my eldest’s overall health.

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I am so sorry about your daughter. This has been too polticized from the beginning and still is. Thank you for your input!

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A mild case of Covid *can* have long-term effects, but it doesn't *always* have long-term effects. And it's even more complicated than that - all these effects are superimposed on what's now a non-trivial amount of aging - three years! How do we tease out the effects of a viral infection from the slings and arrows of outrageous fortune? Then there's the fact that other viruses can and do have long-term effects (in fact that's what gives long covid its plausibility). This isn't to dismiss your concerns, just that public messaging on that is really tricky, and hard to walk back if you get it wrong.

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founding

Totally agree. But even consistently communicating that Covid (of whatever severity) can lead to long-term illnesses that are disabling or even fatal might just persuade more people to wear masks, get vaccinated (even if that's a short-term measure) and so forth. This would be a very good thing. Right now I see two phenomena: (1) people carrying on with their lives as if Covid didn't exist (until they catch it, which they invariably do, often more than once), and (2) a lot more people dying "unexpectedly" in their 50s and 60s than I've ever seen in my life -- a few of them friends. And just somehow I don't think that's a coincidence, although I have no data to support that. Trouble is, the people in group (1) don't seem to have heard about the people in group (2)...

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Thank you for this update! I would get my Bivalent booster today if I could. 61 with comorbidities. I really appreciate your Substack. Keep up this wonderful source of trusted information.

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One group that wasn't included but should is caretakers of people at risk. Having them fully and doubly vaccinated can only help reduce the spread of infection.

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I so wish this to be true. I haven't seen evidence that being vaccinated materially reduces the probability that an infected (but vaccinated) person will transmit the virus, nor that a vaccinated person will be less likely to get infected if exposed. (If I'm wrong someone please let me know!) But there's good evidence that IF infected, the infection will probably be less severe, and somewhat less likely to lead to long Covid.

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Being vaccinated reduces the risk you will get covid. Right after the shot it reduces it a lot, like 90%, and that slowly wears off over the next 6 mos or so. So if caretakers are vaxed they are less likely to give someone covid because they are less likely to have it. (Of course they should also wear masks.)

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Whether Covid vaccination reduces the likelihood of transmission (independent of other prevention measures which are also important!) is an important question because it served as rationale for vaccine mandates. *IF* the vaccine protects me and only me, then it's a personal decision (taking into account my potential need for care from and ability to care for others if infected). If the vaccine is very good at preventing transmission, the argument for mandates is stronger (especially the longer that prevention lasts). There are some studies that appear to show reduced transmission at least for several weeks (https://www.medrxiv.org/content/10.1101/2022.08.08.22278547v6), but I hope we can get an update from my favorite epidemiologist or a systematic review.

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Anecdotally - I have a few vaccinated friends who got Covid but managed not to pass it along to their cats. Hard to think of a better "natural experiment."

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For the most part, there *aren't* any mandates any more, so it's kind of moot, and I feel like the anti-vaxers have poisoned the well. If I had a time machine, I would gradually introduce "soft" mandates, like tying vaccination to some sort of refundable tax credit, and calling it a day, without the more heavy handed stuff like vaccine passports.

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May we please have a comment to indicate that if you have not had covid yet, it's important to do everything you can not to get it? May we have an analysis, from a public health/mental health perspective about how difficult it is for those of us in the minoriy, those of us who believe the government has lost the masking/vaccine culture wars, disinformation wars? The Feds threw up their hands and said, oh, we can't encourage people to be healthy, so let's just give up. Have you read this:

https://www.pestemag.com/lost-to-follow-up/broken-sociality? And, please explain why those of us who know better don't have an option other than having a more isolated life.

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founding

I agree so very much. It's horrid the public/mental health aspects have affected me personally though I have slight co-morbidities at age 63, had COVID May 2022 took Paxlovid but it was indeed nasty. I have had anxiety/depression disorder for years under treatment thankfully but the last 3 years have been blessed in many ways as my husband has a very good IT job BUT my work as an independent music teacher and free lance musician has been changed. I taught on Zoom for awhile but folks in the area have not been anxious to do that, and so teachers who took students back in person sooner had an advantage. That is anecdotal, and so many have much tougher problems. In this society handicapped and also folks in the lower wage earning part of society have been ignored. In my mostly upscale town folks are going about their lives now but I have friends in minority communities and even with middle to upper middle class lifestyles have lost MANY relatives and friends.

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so agree

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Excellent article, thank you. And, same.

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It’s a great article and I completely agree.

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founding

I just read the article: thank you so much, this writer articulates so much so very well!

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I haven't had it yet, and I understand the importance of not getting it. But on some level I'm envious of people who get it and recover, thereby reaching a kind of closure. Part of my fear of getting covid is rational - if nothing else, it would get in the way of my current life and career goals. But part of it is simply fear of the unknown, which isn't 100% rational.

I'm also a little annoyed when people who've had Covid lecture me about how

1. It's inevitable (apparently not! I haven't had it yet. Moreover I know people who died natural deaths within the past three years without ever getting Covid - they won!)

2. I'm not being cautious enough (more cautious than you, if you think it's all about caution). I don't avoid places, but I do swap out N95's daily, and I've had seven shots total

3. I must have had it already (nope. I get PCR tests every week and rapid tests every 4 days)

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(What I won't do is gather indoors with friends and family who are not vaccinated, not careful, will not mask. I don't hang out with people who don't respect my boundaries... and I'm still not dining-out indoors)

As of last week and according to Topol, approximately 10-15% of Amerians have never had covid. You are lucky, but there's no closure once you get it. Many have reoccuring infections-- a friend, covid-careful, PhD in a health field, 50 years old, has had covid 4 times--all post omicron. Each time you get covid the potential insult to body systems amplifiers. The incidenced of post covid syndromes, which includes Long Term Covid but alwo presents other ways the immune system or vascular system threatens is significant in. I skimmed this thread-- I know people mentioned heart attacks and stroke -- early studies showed lower testosterone levels in some men, loss of grey matter in the brain of many, greater likelihood of diabetes, highly liklihood of dementia--oh joy!

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founding

yes it's sad and difficult~

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Weirdly I'm pretty sloppy about indoor dining, although I mask religiously on subways. I figure, your typical pizza parlor or diner, with its busy kitchen, probably has damn good ventilation - otherwise Covid would be the least of our worries - it would have burned down long ago.

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founding

I get it! I sure hope you do not because it's miserable and very disruptive. My husband and I had it May 2022 when everyone in our area was "relaxing" we recovered OK (so far) I took Paxlovid. But it really messed up my work, and summer somewhat. No lectures to give as far as COVID goes. I have a friend whose grandchildren NONE of them have been vaxxed and they are ALL 6 years old and younger. Lucky so far they had COVID, 4 of the 5, with no as far as can be told ramifications. BUT we were wearing KN95s that turned out to be defective so as soon as we were out of the 10 days we have worn only N95s. I have watched tons of reviews and tests also. Hang in there!

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Yeah, I never really trusted KN95's. N95's have been my go-to since fall of 2020 - I pretty much disregarded the guidance that they be conserved for health care workers. I wear a new one every time I go out, because I don't care to get Covid or some nasty fungal infection from a re-used mask.

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Mar 25, 2023·edited Mar 25, 2023

I'm in that category: I have not had covid, and am definitely at risk because of my age and one comorbidity. I'm vaxed and boosted to the max, & I wear a good mask in all public places, and so far that's working. At this point I do not think it is reasonable to expect people to mask in public places. Here's why: If you wear a good mask yourself, carefully fitted, and very very consistently, you have very substantial protection. Yes, you would be more protected if everyone else was masked too, but not all that much more protected than you arevwhen they're unmasked (especially since most people do not wear good, well-fitting masks anyhow). It's probably only 5 or 10% of us that are this much at risk, at this point. I don't think it's reasonable to expect the other 90 or 95% to mask in public just to slightly increase the safety of the remaining 5-10%. I also don't think that expecting others to get vaxed or boosted for our sake is reasonable (though I think they should do it for their own sake). If everyone was vaxed & boosted then yeah, there would be less covid around, but not enough less to make a big difference in the safety of people like you and me.

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I wish that they had crafted some sort of "risk score" instead of the rigid eligibility categories. And also that instead of having fixed "phases" in the initial roll-out, they had done something more fluid, where

1. Anyone can go ahead and schedule an appointment

2. If someone who's higher priority comes along and wants your dose, they'd be able to bump you to a later appointment with, say, 48 hours

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There’s public space like stores, and then there are health care facilities— I think mitigation should be higher in the latter. Worst nightmare is a hospital stay where masks are optional.

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Yeah, definitely do what you can to avoid trips to the hospital. For instance, wear a reflective vest when walking around outside in the dark.

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Oh, agree about hospitals and also places like infusion centers, where there will be many sick and immunocompromised people.

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I feel like we need to rethink the idea of putting lots of immunocompromised people in the same place at the same time. Maybe even recommend that immunocompromised people make a point to avoid one another, which is what people with cystic fibrosis do.

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Thanks!

Just to contextualize the following question, I am happy either to never get another booster again or to get one every n months till I die—or anything in between. 🙂 Whatever is warranted—ie, is the best, most educated guess for my demographic profile.

So, given that, would I be correct in assuming that rare side effects aside, it seems like the only real downside to boosting is the risk of imprinting? That’d be a real risk: you don’t want to anchor your immune system to an extinct species. (General info on this for anyone curious here: https://en.m.wikipedia.org/wiki/Original_antigenic_sin)

Do we have any data yet on whether and how strongly imprinting occurs? Could we ever gather such data or are we stuck with biological common-sense guesses (we might be)?

I’m presuming no new consequential variant here, of course, and no new vax formulations.

Do we have a sense of inter-omicron cross-immunity? I know we have to use biological proxy measures in the lab, etc, that only model antibody reaction (I think!). But perhaps we can infer from populational data.

Finally, long Covid risk enters the calculus insofar as every infection either resets your chances or, worse, actually increases your chances. Do we have a bead on that yet? The magnitude of risk matters a lot of course.

Thanks, again!

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Nice coincidence: Eric Topol just posted on Long Covid: https://erictopol.substack.com/p/preventing-long-covid

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Probably worth remembering that there's a constant supply of immunologically naive humans being created, and we all benefit indirectly when they get the state of the art formulations. Fatty blobby thymuses notwithstanding. Go team!

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Is there a MEDICAL downside to getting this booster if you are over 80 but have no comorbidities? Will it somehow have a negative effect on our immune systems such as being challenged too much?

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Age 82. I have what could be considered comorbidities - prediabetic, and CKD at the border of 3a and 3b.

MEDICAL downside? Yes, maybe. The possible downside is that I had a fierce 2-day reaction to the bivalent booster, as did my much younger (Asian) PCP. I would gladly take the 2-day misery.

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I wish I could give this 10 'likes' to raise it to the top of the discussion. How could we study/find out the answer to Barbara's question? (am guessing the answer differs for different genetic and clinical scenarios)

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I wish the Epidemiologist would respond!!!! Thanks for your support.

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No *known* comorbidities. I feel like there's an element of privilege to *knowing* one's own comorbidities. For instance, I know someone who was able to get a reasonable accommodation to keep working from home, thanks to an expensive genetic test.

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Mar 26, 2023·edited Mar 26, 2023

Seems to me that having an attentive PCP is the key.

Mine is an NP, with a doctorate, a DNP. She also happens to be a family friend to my son.

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Absolutely. A steady, attentive PCP and good health insurance.

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founding

I thought your description of my thymus as a "useless blob of fat" was unnecessarily cruel and thymusistic, but otherwise, I loved the column. As always. All our lives are based on risk-vs-benefit analysis, in which we don't have enough specific information. And political posturing compromises what information we do get. I'll get a booster after the six month wait from my last one.

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You beat me to it about the “useless blob of fat” 🤣! YLE, thanks for the combo of crisp analysis with a morning giggle.

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“Useless blob of fat” is not only funny, it’s true and provides readers a good visual of what’s going on.

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Assuming there's anything capable of responding in the 'elderly' thymus, I wonder if giving thymosin would boost thymic function? I read that some people are using it but haven't seen whether there are validated clinical results.

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I'm gonna steal the word "thymusistic" without attribution

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Can only hope that there is still significant interest in the question of boosters being effective or not, useful or not, and then making them available if needed, especially in light of the news that there are at least two new variants (most notably in India) that are picking up steam.

We will have many disease vectors to cope with as climate change speeds up. Hope we stand firm on the need for enhanced public health funding and research.

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We should be demanding that our electeds continue to fund research, that significant energy goes into bringing all-variant vaccines to market and that researchers work to refine nasal vaccines and bring them to market.

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I'm fairly optimistic that we'll have that eventually, but it's going to take a while.

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Thanks for addressing this question. In the "land of the free" what a freakish irony that whereas vaccine mandates are compared to Nazi Germany’s persecution of the Jews, vaccine anti-mandates (you can’t get the vaccine booster even if you want one*) barely raises an eyebrow. (*Unless you have a doctor who will prescribe and a pharmacy that cooperates.)

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Mar 24, 2023·edited Mar 24, 2023

There are discussions going on, so we must all stay hopeful ... https://www.wsj.com/articles/fda-may-authorize-additional-covid-19-booster-shots-c85c0672

And for those interested in contacting the FDA and CDC to share your desire to see an end to the de facto moratorium on 6-month bivalent Covid Vaccine boosters, you can contact the FDA at 'cberocod@fda.hhs.gov' (that's the FDA Center for Biologics Evaluation and Research) and the CDC here: https://wwwn.cdc.gov/dcs/contactus/form?fbclid=IwAR0akwP8SFOhTE57kZ5Cn2kDUiWScf3G04Cj7kHjO82CpryzAo4DIkAVhC0

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Dont' forget to include the US Preventive Services Taskforce in your lobbying efforts - they're relevant.

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very valuable--thank you

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So I actually think that this is one important respect in which ending the federal emergency could actually make it a little easier to get boosters. Determining who gets vaccinated will cease to be under direct federal jurisdiction - it will revert to being a matter between you and your doctor, as it ultimately should be.

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Avoiding severe disease sounds good until you realize that Long COVID, even if it leaves you long-term disabled, is excluded from the FDA's and CDC's definition of severe disease. Boosting every 6 months, by reducing infection, would reduce Long COVID and with it severe Long COVID, which has not gone away to the degree that severe acute COVID has. Given the evidence that vaccination reduces the probability of Long COVID given infection, it probably does even better than that.

Restricting boosters to the elderly and immunocompromised excludes those at elevated risk of Long COVID. The official line is that there are no predictors of who will get Long COVID. This is nonsense. Of course people who have ALREADY had a post-viral syndrome (including past Long COVID, ME/CFS etc.), are at higher risk of having another one, just like people who have had one heart attack are at elevated risk of having a second. People with ME/CFS are also vulnerable to significant exacerbation with each subsequent infection.

Beyond that, Long COVID is clearly related to dysautonomia, so those who already have a dysautonomia diagnosis should be considered high risk. Also the hypermobile https://www.rcpjournals.org/content/clinmedicine/21/1/53.

Long COVID is the primary threat from COVID at this point, and yet it excluded from consideration when it comes to vaccination policy. It doesn't count as severe disease, no matter how severe. Evidence on risk factors is simply ignored, and high risk individuals qualify neither for boosters, nor for Paxlovid if infected.

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Here’s my question: will we be *allowed* to get a second bivalent booster if we want one? I’m almost 71, my husband is 77. Because we both got COVID last September, we didn’t get this shot until December, so presumably we are still more or less protected, but I wouldn’t turn one down in June if it’s an option.

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Nobody knows yet. It's being decided by CDC and related agencies. But it is apparently not difficult to just walk in and get a second booster. Several here describe how they did it. Yes, you would be breaking the rules, but you would not be taking a booster away from somebody else. There's no shortage of the bivalent vaccine. I'm just coming up on 6 months since I got my first bivalent, and if the rules do not permit me to get another one than I will just find a way to go around the rules. I think it's about as evil as jaywalking.

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Although jaywalking is more dangerous, especially at night. Wear a reflective vest if possible.

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Depends on what you mean by "allowed." Honestly, if you walked into a pharmacy and asked for a shot, and left your CDC card and insurance info at home, they'd probably jab you. The only way that could conceivably get you in trouble - and this is a stretch - would be if whoever paid for the shot were to find out - well after the fact - that a vaccine was administered that wasn't deemed to have been "medically necessary." They could, at some point, short the pharmacy on future claims to recoup the payment. At that point the pharmacy could decide to bill you. Would either of these things happen? I very much doubt it. Could they? Yes.

Once the FDA fully approves regularly updated boosters things get considerably simpler. Your primary care doctor could then prescribe extra boosters, if they see fit, "off label." The FDA disclaims jurisdiction over off-label use (they just don't allow companies to *advertise* off label use)

OK, so let's say your doctor prescribes an extra booster. The question becomes, will your insurance pay for it? That's where ACIP recommendations come into play. Under the Affordable Care Act (ACA, aka Obamacare), preventive services are covered by most plans - without any copays or deductibles. These are defined either as vaccines recommended by ACIP, or grade A or B recs issued by the US Preventive Services Taskforce (which I'd like to see our heroine write about at some point). If the booster is not officially recommended by ACIP - then your mileage may vary, because beyond the basic federal laws, insurance is regulated largely at the state level because of the McCarran-Ferguson Act (simplifying a bit, there's also self funded ERISA plans, etc). Most states have "external appeal" systems in place, and your doctor could make a compelling case for medical necessity of an extra booster, in which case your insurance company might very well pay for it.

Full disclosure - I've had seven Covid shots total (hence my handle) my last one was in early September.

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