I think you misplace blame on social media for the drop in routine vaccinations.
Facebook was launched in 2004, Twitter in 2006. RFK Jr published "Deadly Immunity" in Salon and Rolling Stone in 2005. On The Daily Show Jon Stewart favorably interviewed RFK Jr later that year [1]. Joe Rogan launched his podcast the end of 2009. By 2022 Rogan had on some 2,000+ guests before finally interviewing RFK Jr. (I'm going to use RFK Jr as a surrogate for the spread of "disinformation").
All the tools for "mis/dis/mal information" have existed for a generation. Look at the google trend for RFK Jr [2]. Zero interest in him for 16 years following his Daily Show appearance. Clearly the arrival of social media did nothing for his reach.
What did make interest in his ideas explode?
As you said:
"Loss of trust in institutions"
Why does this only get a single sentence when it is the *primary* reason for the drop in routine vaccinations in your piece today?
You have a unique position to help the CDC. If you are truly interested in "righting the ship", there has to be self-reflection and accountability for the many mistakes made the past 3 years.
"The Institutions" were wrong about cloth masks, closing schools, vaccine mandates, and the vaccine making you a "dead end" for the virus [4] - all of which were incorrect ideas spread through social media. I'm not here to debate those points because they should be self-evident at this point.
-No one - republican or democrat - is wearing masks any more despite the high support 3 years ago in the West. (barring small echo chamber pockets on social media claiming to do so)
-Even you have admitted that closing schools was an area you were mistaken.
-Every country rolled back it's vaccine mandate once they became overrun with Covid despite 95% coverage.
-All countries except 4 now only recommend the vaccine to 60-65. This year boosters are at 5% uptake so it can't be just "republicans".
-Countries around the world are throwing away unused doses and cancelling contracts.
-Pfizer stock is at a 7 year low, Moderna back to pre-vaccine price of October 2020.
Again, self evident.
The globe has rejected the Covid vaccine just as fast as it embraced it. And it's not a "chicken or egg" philosophical question how this happened. RFK didn't somehow crack into the mainstream conversation, despite 18 years of trying, on his own - it was the failure of PH which made the public go searching elsewhere for answers, and they stumbled upon him.
Public Health suspended the key ethic of informed consent, convinced over half the world that they should mock, fire, and shun anyone who resisted, and is now left holding the bag" after cases and deaths exploded despite their predictions.
People who took the shot and felt like crap, only to feel like crap again when they got the virus anyway are not being "swayed by misinformation" in now rejecting further shots. They are clearly asking a logical question "If Public Health could be wrong on this, what else were they wrong on?"
That is why routine vaccines dropped. It's not rocket science. This was a self inflicted error by PH which created a chasm in trust. Trust is very hard to reclaim.
When someone wants to regain trust, they begin by acknowledging their mistakes and demonstrate contrition. That is what public health needs to do.
All I see is blame. Blame the republicans. Blame social media. Blame Joe Rogan. Blame Facebook, Twitter, YouTube and Reddit because they stopped censoring wrong-think.
Step back for a minute. Our government actually paid comedians and screenwriters [3] to promote a brand new pharma product which didn't do what it was supposed to [4], and lead to some of the most cringeworthy television in history [5], and there is no apology for Colbert's "VaxxScene" dance. He used to be funny. Now look at him. [6]
Do you truly want to help PH regain trust? What would that take?
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[1] This is wild to watch to remember how controversial subjects used to be hashed out:
Hi Michael- I appreciate your thoughts. I really do, but the blame game is getting really old. That’s all you do on here and it’s degrading. I have written *multiple* times on how much I need to improve. On what public health needs to do. In fact, I never once blamed anyone in this post. I said that “public health hasn’t kept up” with social media. Ive talked about trust in institutions before. Putting everything into 600 words is just not possible. I’ve talked about it on a ton of podcasts that I’ve shared on here about this too. I’m even traveling the country getting a multi-million dollar initiative to fix systemic issues in public health to build trust. Us, in public health, are literally killing ourselves to help turn the tide. We understand what went wrong. It’s all we talk about and all we are focused on right now. Beating down a dead horse doesn’t help.
You refuse to admit mistakes and apologize for your role in pushing covid hysteria. Tell the truth, that's all you have to do. If you still can't tell the truth about masks, for example, then you haven't learned anything and you won't build trust going forward.
I have read and greatly appreciate your post on this. I do not agree with Paul's characterization of this and claims of "pushing covid hysteria." That type of mischaracterization of your efforts is very clearly refutable by reading your body of posts. i'm sorry you have to deal with what I would call bullying statements like that.
Thanks for the reply and I will be courteous and refrain from posting for a while... after this one :)
I apologize on my tone - I always try to my best to be as dispassionate as possible, but having just rewatched Colbert's Vaxxscene skit probably didn't help (especially now realizing our tax dollars helped make that a reality).
To be clear - my rant on Public Health - is not directed at you. It's directed at the nebulous "Public Health" that has misinformed the public and is now stunned they aren't taken seriously anymore.
The "Public Health" that had Wallensky on CNN promoting the 2022 booster right after she came down with Covid **1 month after her booster** and was so sick she had to take Paxlovid. The Public Health that overstated the risks to kids and were forced to change their CDC presentation after being fact checked by a random mom from Georgia (KellyK). The Public Health that praised South Korea when things were going great and were quiet when it turned into a disaster. The Public Health that promoted embarrassing studies like Kansas Mask with a straight face while attempting to keep the Danmask RCT from being published. The Public Health that spent 4.3 trillion on this pandemic and got nothing in return (less than nothing, actually). The Public Health that cheered the termination of healthcare workers creating even fewer staffed beds. The Public Health that let Alex Berenson figure out the vaccines didn't stop transmission before they did, and then asked Twitter to censor him (great strategy! That's how science works!) On and on. I digress.
That's the PH I'm shaking my head at, because now, that PH is shocked that RFK Jr is finally getting all the attention he has desperately craved his whole life and appears to not know how this happened.
I'm not ranting *at* you, I'm ranting *to* you (I feel like there is a difference in there somewhere...)
It might be before your time, but there was a great skit in Mr Show, where Public Health officials standing outside an Amusement Park with a deadly roller coaster are befuddled why there are so many deaths starting at 8 a.m. and ending by 11 p.m. [1]
I feel like we are outside Thrill World, watching that same clueless Public Health.
We know why PH trust is shattered. We know what it would take to rebuild trust. I'm not so sure a "multi million dollar initiative to fix systemic issues" is what is needed.
An accounting of mistakes, with a goal of finding out how they proliferated and why the "error checking machinery" of science didn't catch them before randoms on Twitter would be a good start. A plan to ensure in the future we don't make similar mistakes. An apology.
"Here is what we gone wrong, here is how we didn't catch it, here are plans to ensure these mistakes aren't repeated".
You say "We understand what went wrong. It’s all we talk about and all we are focused on right now" but I am beating that dead horse because it doesn't seem like PH understands.
It honestly feels like a repeat of the Iraqi War (2nd one) where everyone knows we ****ed up, but we have to pretend it's all a big mystery how this happened and we just collectively move on and forget.
Now, I have to be off to pen a letter to the brilliant Dan Ariely who on the September 19th episode of the Michael Shermer Show commented he didn't understand how confidence in pharma could be at an all time low given "their success saving us all".
Happy Thanksgiving!
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[1] Regardless what you think of my comments, this is hilarious, I love how Bob Odenkirk's character gets back in line in the background even after David Cross dies
I appreciate the thoughtful response. I agree with (almost) everything you say here. Please don’t stop commenting, but just remember there is a person on the other side of this account; and I am doing everything in my power to make change from a little corner of the world.
We lost millions of people around the world unnecessarily (Economist projection) because of sociopathic lunatics like the people you’re bending over backwards to accommodate and pamper here. Begging them to be nicer to you.
@Katelyn, you don't realize how different you are than our public health officials. You present useful information and correct errors you have made. Not so much the case with Dr Wallensky, Dr Fauci, etc.
My son's 2nd grade class just had a child return from having chicken pox. How do you not vaccinate against chicken pox? And why would you want to expose your child to that? Plus the risk of shingles later in life? It's unbelievably scary what misinformation is doing.
Varicella vaccine doesn’t reduce your risk from shingles later in life. Since it’s a live vaccine, you still carry the virus in you, just as if you naturally acquired chicken pox.
Also should mention that many countries in the EU (including UK) have not authorized varicella vaccine out of fears it would cause a rise younger populations to get shingles (which is happening in the US, though it’s debated whether due to varicella vaccine or general decline in health of our population).
This study has a glaring flaw which should be grounds for retraction (or a complete re-write of what the outcome shows).
Remember, shingles is a re-emerging infection of the varicella virus which has been dormant in your body ever since acquiring varicella naturally or through the vaccine*.
This study claims that being vaccinated with Varicella lowers your chances of getting shingles (2nd infection), but the comparison group is a **cohort of people who have never had their 1st infection in the first place**. From the study: "We were unable to assess the unvaccinated group’s underlying risk for HZ because we did not collect serological or medical record evidence of previous VZV infection." - that should be disqualifying. They don't know whether the "control group" actually had chicken pox yet, they didn't even bother to check for antibodies, despite making that study challenge.
It shouldn't be surprising that the vaccinated cohort has lower incidence of HZ than the unvaccinated cohort considering the vaccinated group has already been given a live attenuated vaccine. That science has already been settled. We know the varicella grants long lasting immunity against Varicella.
The open question is whether that live attenuated varicella vaccine can reduce odds of secondary infection (Shingles) better than naturally acquired Chicken Pox. This study claims to offer that answer, but as you can see, it cannot make that conclusion due to study design. In fact, it likely shows identical shingles rates.
Note that the number of breakthrough infections (shingles) in the vaccinated cohort.
- 5,339 out of 3,186,732 vaccinated (.168%) compared to 9,044 out of 3,185,335 in unvaccinated. (.284%) population who may-or-may-not have ever had chickenpox in the first place.
To put this into perspective, this study shows vaccinated children under 18 had a shingles incidence rate of 1.7 per 1,000, putting it completely in line with the age adjusted rates of older cohorts shingles incidence tracked by the CDC.
The right way to study this would have made sure the comparison group was cohort matched (age of vaccine = age of natural infection) of children *who already had chicken pox naturally confirmed serologically*. Then we would know whether the vaccine provides longer protection from secondary infection.
I did a deep dive on this subject out of personal interest when I got struck down by shingles earlier this year (worst, pain, ever), that is why I am already familiar with this study and it's glaring flaws. What is alarming is that this nonsense not only cleared peer review, it was accompanied by an editorial in Pediatrics as well as that glowing appraisal of the study in SciAm.
I generally grant charity to researchers who are paid by Pharm, but I have no other explanation as to how this didn't get shredded/filedrawered other than all involved with this study are funded by GSK, Pfizer, Merck, etc
You have a good post today on "how the public could be losing faith in vaccines", and here is a perfect example how our trust is dwindling.
Nonsense like this is uncritically repeated without skepticism. (and the first red flag with this study - how could this study be true in a world where the population is mass vaccinated against varicella yet shingles is rising?).
"Double check ideas you disagree with. Triple check those you embrace".
Funny how you accuse others of priors. Well, not really funny
It seems that you know just enough to be very wrong on a great many things, and you appear to have the time to flood the zone with excess prose that exposes your own priors
Here's some keywords that should lead you to research that challenges your priors:
attenuation of Oka strain
skin infectivity of Oka strain
attenuated Oka strain glycoprotein C expression
localization of wild-type VSV and attenuated Oka strain VSV in dorsal ganglia
rate of zoster occurrence exhibiting Oka strain genetics
Also you note that the rate of zoster has increased over time, but fail to acknowledge both that there was no increase in the rate following the introduction of vaccination for varicella, and that the rate has decreased or plateaued across all age groups over the last decade.
Finally, I could be wrong here but you appear to exhibit symptoms of a full-blown infection with the conspiracy virus that causes people to believe that "receiving funding from pharma" leads to "fabricating results favorable to pharma". Unfortunate, this is.
Sadly for you, nothing about chickenpox/shingles vaccination is as simple or clearcut as your apparently biased and perhaps limited self-education would make it out to be
John - Can you point out any mistakes in my critique of the SciAm study Katelyn posted?
I don't have any opinion on Varicella vaccine. I'm merely correcting the misinformation above, as Katelyn noted, a "lie travels faster than the truth". The SciAm study is misinformation (possibly disinformation given how hyped the study was in SciAm and the editorial accompanying it in Pediatrics) as it's claims are easily debunked should you take the time to actually read the study.
My kids are vaccinated from varicella, and in 6 years I will get Shingrix. Whether more countries start following the US in rolling out varicella vaccine as I expect to happen in the UK is of no concern to me.
If it turns out varicella vaccines have longer lasting immunity from a recurrence of shingles, that would be wonderful - especially for my children.
But I haven't seen that data yet. Perhaps it's out there. KB just posted a study, I will read that. It's definitely not the SciAm linked piece though.
Yes, I can. You characterized zoster as a "second infection" - there is no such thing. There is only one infection. Whether a kid contracts wild-type chickenpox or receives the attenuated Oka VZV in a vaccine, the virus goes dormant in certain nerves (dorsal ganglia). When this dormant virus re-activates for whatever reason, it travels along the neurons and erupts on the skin. This is zoster.
accessed over 6 million electronic health records for the occurrence of zoster - not chickenpox - in children under 18. The clinical presentation of zoster - "a single stripe of blisters on one side of the torso in the innervation area of a single nerve ganglion...chickenpox gives you an uncomfortable itch, shingles develop into excruciating blisters" - is very different than chickenpox.
Bottom line - it's 100% certainty that patients assessed with zoster were either exposed to wild-type VZV or received a vaccine.
Which leads to the likelihood that you have misunderstood the question that Weinmann et al. was asking. This was a population-level study of electronic health records that showed 1) clinical diagnosis of pediatric zoster, and 2) vaccine status. The question asked of the dataset was "what is the rate of clinical pediatric zoster in children who have/have not received the vaccine."
The validity of the conclusions does not hinge on "the unvaccinated group’s underlying risk for HZ" which was part of a complex paragraph explaining what the study could not address because of the limitations of clinical practice in the healthcare setting. Confirmation of serotype is a rarity (and I guarantee that some OptumRX program benefit manager working for UnitedHealthcare would deny coverage in 9,999 out of 10.000 cases).
But for all the wrong reasons you did say something that I think could be right - "identical shingles rates" in the vaccinated and unvaccinated. It's possible that the RATE of REACTIVATION of the latent virus in the nerves is the same in both groups, but the clinical presentation of zoster blistering is less in the vaccinated group due to the lack of expression of glycoprotein C in the vOka strain.
The statement I made earlier was "the varicella vaccine doesn't reduce your risk from shingles". (perhaps that may change with better data)
I also commented on why many countries have been hesitant to follow the US in the varicella vaccine campaign.
The study you shared does not compare shingles among vaccinated/natural cohorts, rather it supports the exogenous boosting hypothesis (i.e., being around kids with chicken pox provides immunity boost to adults from getting shingles) while acknowledging the reduction of Shingles (33%) was lower than previous models estimated.
"Discussion
This self controlled case series study found a reduced risk of zoster associated with exposure to a household contact with varicella, with modest but long lasting protective effects observed. Strong evidence suggests that in adults the risk of zoster within two years of exposure to a child with varicella in the household was 33% lower than in the baseline period, and in the 10-20 years post-exposure the risk was 27% lower."
Who’s being reckless? Are you replying to me? If so have you read my posts?
The study you shared shows that adults exposed to chickenpox have lower incidence of shingles. Exactly the reason I said many EU countries have yet to implement varicella vaccination - which my children are already vaccinated with.
I had shingles right after Easter. It was horrible. Was certain a tumor exploded in my brain and I was going to die. That’s why I’ve already read all these studies because I wanted to understand why young healthy people are getting it and why I couldn’t have gotten a shingrix vaccine before 50 to have prevented this.
Nov 14, 2023·edited Nov 14, 2023Liked by Katelyn Jetelina
This is not surprising. The messaging from respected and trusted voices has been all over the place the past three years. For people on the fence, I can see why they would fall prey to mis/disinformation.
Paxlovid rebound occurs 20% of the time, which is about 10x higher than without - see link to US News article below. But the public was told Paxlovid rebounds only happen 2% for a long time despite personal experience contradicting this. When public health officials don’t set the record straight, trust is lost.
Or maybe some folks don't understand the limitations of clinical trials vs. large-scale deployment. And even this is not a particularly large sample (142). And, of course, one study does not constitute Absolute Truth. It would need to be confirmed, preferably with a larger sample.
Maybe more people need to read past the first paragraph. It has nothing to do with public officials "not setting the record straight." It has a great deal to do with getting solid information on a rapidly-evolving virus in an environment when far too many politicians see advantages in withholding or simply lying about evidence (e.g. Florida).
Personal anecdote aside, did you go to the hospital or put on a ventilator? That the question you should be asking. Considering that high risk people (immunocompromised, immunosenescence, transplants and comorbidities, not surprised that it slightly higher. However, the study has some serious limitation (n 142) and there are still ongoing trials. This is how we learn more about what I consider, still, a novel virus.
Doctors I know estimate Paxlovid rebound at 50% based on what they observe with their patients. Some also prescribe it for 10 days (not 5) to prevent rebound.
I’m curious whether Paxlovid rebound is associated with higher incidence of long covid?
So my hot take on Paxlovid as someone who experienced it, is that I think it could come down to metabolism. Basically, all medication is predicated on having a shitty metabolism, which makes it more effective but also potentially less safe. The original intended population for Paxlovid had shitty metabolisms that reduced expression of the enzyme CYP3A4, so in essence they had higher doses. In the general population, the doses were effectively lower because it got metabolized too fast, and a lot of people (including me) really needed longer courses.
I ended up going on Paxlovid for ten whole days after my rebound started (which included both symptoms returning and my tests flipping back to positive). No regrets. During the entire course of my illness I was symptomatic for exactly two days - once on Day 1, and again on Day 11 (rebound day). Both times, the Paxlovid knocked out my symptoms within 12 hours. I don't think I've ever had such an impressively fast acting anti-viral.
And then there were these pleasant surprises:
- My PCR went back to negative within three weeks of my initial infection
- Despite dramatically reducing my viral load, I still managed to develop nucleocapsid antibodies. So if anyone's worried about Paxlovid somehow getting in the way of an effective immune response...well...they can keep it to themselves.
I told my doctor about what I'd done after the fact, so he'll know for future reference. He appreciated the info.
I’m glad it worked for you, and I wouldn’t hesitate to take it.
The problem is most people can’t convince their doctors to prescribe a 10 day course. Some people have trouble getting their doctors to prescribe it at all, but that’s a different story.
To be clear, I went full on doctor-shopping junkie mode. I got lucky: the first 5 days were paid by the city's test to treat, the next five were paid by my insurance, and the last one was an act of charity by a pharmacist who happened to have a discount (I paid $2.13). I hope my doctor uses the info I reported to him, for future reference.
On Day 12 - after I'd restarted on Paxlovid - my symptoms were resolved, my fatigue had lifted. That was also the day I got a call from my super asking if I had a leak in my ceiling over my PTAC. I did - there was a burst pipe two floors above me, the apartment immediately above me had gotten completely flooded. I needed to be fully functional that day, and I can't begin to imagine how any of this would have played out if I'd been "out of it" on Day 12 like I was on Day 11.
Thanks to Paxlovid, I had the wherewithal to handle an acute emergency in my living space that I couldn't possibly have handled otherwise.
In case it's not obvious, it's been a rough few months.
"Rebound" common with biphasic diseases. It's really an inflammatory phase as your immune system (in my mind) is finishing the job. As far as
I can tell, course of antimicrobials do not clear all of the pathogens. Your immune system does the rest. Overuse of antimicrobials has lead to AMR and I hope we don't do the same for Paxlovid.
I'm so stunned that over 2x more people in the survey believe Ivermectin treats COVID than in 2021. Speechless, really. What a mountain we have to climb.
This is such important news to share and get out. It does not help when you have governors and misled state officials who make a law that pediatricians can’t refuse to see patients who are not immunized. I feel so sad that we are going backwards and so far apart! Thank you for sharing and as a teacher I know how important vaccinations are.
The U.S. becomes dumber by the month. Reliable information is readily available, but too many think they know better than reality and others choose to remain willfully ignorant. People are just plain stupid.
For some reason when I read the title I thought the article was about a new strategy to get routine vaccines - a drop-in clinic for vaccines, no appointment needed. Sadly it was not a happy story of innovation, but a sad story about the impact of misinformation.
A wonderful pediatrician serving in the California state legislature has successfully spearheaded a drive to get vaccinations mandated as a requirement for children entering kindergarten. Only medical exceptions are allowed. Opposition was furious and stubborn, but reason prevailed!
It is not surprising 1 in 8 parents believe there is antifreeze in vaccinations. Perhaps the warning about polyethylene glycol allergy could be better worded to make clear PEG is NOT the same as ethylene glycol. I’ve even seen warnings claiming PEG IS a component of antifreeze.
WV was a huge success with Covid-19 vaccines too. One of my hero’s (Julia Faustino) supports the vaccine information diffusion network there. The Washington Post is writing a story about it; will share when it’s published!
Nov 14, 2023·edited Nov 14, 2023Liked by Katelyn Jetelina
Native West Virginian here. For as much as she fails in many ways, WV has always had a strict vaccine policy and not allowed non-medical exemptions. Growing up, I did know that choosing not to vaccinate was a thing.
I'd be appreciative if YLE explain a bit more about "some diseases, like measles, require 95% coverage to maintain herd immunity," or point us to information that explains this? How does that work, eg why some diseases and not others? What does it mean if we don't have "herd immunity?" Is the entire "herd" then at risk to get the disease? Pandemic level spread in the herd? Or just the proportion that's unvaccinated? For example, in the cited Ohio case with the 9th lowest MMR vaccination coverage last year, in the measles outbreak last year 85 children got sick, and 36 were hospitalized. While full protection especially for children would seem to be the best goal, that seems like a very small number, and not "herd level" widespread disease.
Important question, with implications for Covid. If neither prior infection nor vaccination stops viral transmission, does that imply we can't even theoretically achieve herd immunity against Covid? Whereas with measles, is the idea that we CAN achieve herd immunity if nearly everyone has been vaccinated or previously infected because there's essentially no population-level 'reservoir' of the virus (i.e., a chance encounter between someone who is protected and someone who isn't is very unlikely to occur and even if it resulted in transmitting the infection it wouldn't spread to others)? A clear def with examples would be helpful!
The hope is one day we get a pan-coronaviruses vaccine that works against any variant and that enough people take it. Never again will the public tolerate a vaccine mandate.
I'm always going to believe that the mandates probably would've worked if people had been allowed to antibody-test out of them. Maybe at their own expense, if moral hazard is an issue.
Adding, I also think something a bit less heavy handed than vaccine passports might have worked better. Like, a simple tax incentive, or making the 2021 tranche of pandemic assistance contingent on getting at least two doses of the vaccine.
I'm not so sure. The US is only a fraction of the world population. Even if everyone in the US had been vaccinated, the mutations would have happened elsewhere. And since COVID vaccinations don't prevent you getting COVID nor transmitting it, it seems like it would have to be with us forever. Am I missing something?
Nothing 100% prevents anything but vaccination (and immunity in general) certainly reduce the probability of infection and transmission (fewer days, lower viral load).
I'm not YLE but I'll bite. Simply put, it's because measles has an insanely high basic reproduction number - in a naive population, one person would infect 19 people on average. So as long as only 5% of the population is susceptible, the 19 people they would be infecting are most likely immune they would be infecting are immune and the disease stays contained in the 5% of the population that's susceptible.
This is why, during the 2019 measles outbreak in Brooklyn, the city actually did mandate that everyone in certain zip codes get measles shots. I wasn't quite in one of those zip codes, but I do ride the subway, so I had my doctor at the time give me an antibody test, and because it came back empty, I got an MMR booster at the tender age of 44.
Thank you, appreciate that. Just to make sure, if your antibody test had come back with antibodies, you would have been immune, yes? If so, in this case "infecting others" means others would receive the virus, but if 95% were already immune, they would not be at risk.
So Covid has a similar "insanely high" reproduction rate that the herd needs to protect against? I guess that differs based on the variant, right?
Thank you very much! So if I understand, with an R0 of 12 to 18 for measles (very quick search https://pubmed.ncbi.nlm.nih.gov/28757186/ and even that report shows a great deal of variability in the R0), herd immunity to shoot for would be 92% to 94%. And with an R0 of 2 to 6 for Covid (https://www.weforum.org/agenda/2020/05/covid-19-what-is-the-r-number/), herd immunity to work toward would be 50% to 86%. I realize those R0 numbers are by no means solidly established and probably for covid at least strongly depends on the variant. But still, this helps explain the difference in desired herd immunities for these different viruses, and the relationship between the virus reproduction number (in a given population) and desired herd immunity. Very helpful and appreciated.
Katelyn, I'm from Montana & am sorry to see it's not included in any of your charts. When Covid first took off, our HHS under Governor Steve Bullock (D) published a very helpful daily log of Covid cases, hospitalizations, and deaths by county. In Nov. 2020, when Bullock was term-limited, Greg Gianforte (R) was elected & introduced sweeping changes that included eliminating virtually all mandatory masking & vaccination, and soon the daily public reports on Covid infections & hospitalization were stopped. Is it safe to assume this lack of data availability has extended to non-Covid information and is why MT isn't included on any of your charts? Is there any other State not included, & for the same reason?
"†† Montana did not report school vaccination data. Utah changed the way data were reported between the 2021–22 and 2022–23 school years and is excluded from year-to-year comparisons."
Our local health care corporations and owners of all major hospitals, MaineHealth and Northern Light, here in Maine (population one point million) that employ almost forty thousand staff between them made the decision early in the Pandemic to require all staff to be vaccinated.
The “we won’t be vaccinated under any conditions” fanatics predicted that they’d lose a massive number of their nursing staff and of course doctors by the dozens. Both MaineHealth and Northern Light put out almost identical press releases late in the Pandemic — MaineHealth wth 26,000 staff had lost less than 50 nursing staff out of some 4,000; Northern Light said they also lost less than 50 from a nursing staff of of nearing 2,500.
In both cases, that included those who quit because they wouldn’t get vaccinated and those who were fired because they wouldn’t get vaccinated. Worth also noting was MaineHealth pointed out that that nursing staff comprised all levels of nursing so it included CNAs to NPs.
I mention that because I was supposed to get a neurological evaluation for the severe head trauma which at that time had occurred two years prior.
(How severe? The cardiac critical care unit had to revive me ten times after emergency services had already revived me once. Don’t come down a set of stairs backwards and hit your left temple. Just don’t.)
They couldn’t do it because too many CNAs who are used as companions to see if we got seizures while staying on the unit on the neurological unit had refused to get vaccinated had quit or been fired. So it didn’t happened. So far we’ve not done it as Lamotragine and several other meds are managing the seizures reasonably well.
I'm not sure what you're saying here: that MaineHealth & Northern Light lied about/misreported the number of staff they lost, or that even such a seemingly small loss can have serious consequences, or something else? I'm glad your seizures are being managed reasonably well with meds, & hope you can get the kind of neuro evaluation you need soon ;)
No, I’m saying the anti-vaccination fanatics made a claim, as did they repeatedly, that masking would cost businesses staff.
This one got more play in the media because of it being health care related. And it wasn’t known how many staff would quit which is why both MaineHealth and Northern Light thought it important to release press statements saying that the number of staff losses was minimal.
It is pretty amazing that they lost only 100 staff out of 40,000! I'm just sorry that so much of that loss was in the particular office that affected your ability to get the study you needed.
The seizures are low level, akin to a really bad shaking to their worse, and as I said manageable (mostly) with three anti-seizure meds. The meds also control the dizziness, a worse problem for obvious reasons as falling down with head injury is a bad idea, and my loss of vision has been brief over the past months.
Look severe head trauma is a Very Bad Thing. The best that a medical care team can do is keep it stable as there are no cures. And it has surprises — I spent the first three months of the Pandemic in-hospital because I blacked out, something we didn’t know I did, while walking downtown and woke up sitting on the sidewalk two blocks away having shattered my right knee patella. No memory what-so-ever of it happening.
So they got me to Maine Medical Center, I spent fifty days there with surgery and rehab, went home and shattered it again within a week. This time they discovered I I’d picked up a severe staph infection the first time I was in-hospital so that got me another fifty days there. I had private rooms both times and my iPad & iPhone, but it’s still a long time to be there.
And I had a third surgery as well, so that’s how I started the Pandemic off.
So the knee doesn’t support me anymore which means I wear a brace all but when I’m getting showered with the help of my personal care assistant. And eventually I’ll need surgery for the torn meniscus I managed to have in the last six months when I wrenched knee somehow.
Thanks for this info as always! Somewhat unrelated question (and sorry if this was already mentioned in a previous post of yours) but I have had trouble finding COVID shots for my kids--have you heard about this at all?
Appreciate your post very much have been reading since the early covid days--appreciate you sharing your expertise!
If you are having issues with walk-ins, up here (Ohio) pediatric vaccines seem to only be available through appointment (saw a kid just 2 weeks at a CVS with an appointment get Flu/Covid vaccines).
Not sure your location, but have you gone through all major pharmacies online scheduling services? (Up here it's CVS, Walgreens, DrugMart, CostCo).
Katelyn,
I think you misplace blame on social media for the drop in routine vaccinations.
Facebook was launched in 2004, Twitter in 2006. RFK Jr published "Deadly Immunity" in Salon and Rolling Stone in 2005. On The Daily Show Jon Stewart favorably interviewed RFK Jr later that year [1]. Joe Rogan launched his podcast the end of 2009. By 2022 Rogan had on some 2,000+ guests before finally interviewing RFK Jr. (I'm going to use RFK Jr as a surrogate for the spread of "disinformation").
All the tools for "mis/dis/mal information" have existed for a generation. Look at the google trend for RFK Jr [2]. Zero interest in him for 16 years following his Daily Show appearance. Clearly the arrival of social media did nothing for his reach.
What did make interest in his ideas explode?
As you said:
"Loss of trust in institutions"
Why does this only get a single sentence when it is the *primary* reason for the drop in routine vaccinations in your piece today?
You have a unique position to help the CDC. If you are truly interested in "righting the ship", there has to be self-reflection and accountability for the many mistakes made the past 3 years.
"The Institutions" were wrong about cloth masks, closing schools, vaccine mandates, and the vaccine making you a "dead end" for the virus [4] - all of which were incorrect ideas spread through social media. I'm not here to debate those points because they should be self-evident at this point.
-No one - republican or democrat - is wearing masks any more despite the high support 3 years ago in the West. (barring small echo chamber pockets on social media claiming to do so)
-Even you have admitted that closing schools was an area you were mistaken.
-Every country rolled back it's vaccine mandate once they became overrun with Covid despite 95% coverage.
-All countries except 4 now only recommend the vaccine to 60-65. This year boosters are at 5% uptake so it can't be just "republicans".
-Countries around the world are throwing away unused doses and cancelling contracts.
-Pfizer stock is at a 7 year low, Moderna back to pre-vaccine price of October 2020.
Again, self evident.
The globe has rejected the Covid vaccine just as fast as it embraced it. And it's not a "chicken or egg" philosophical question how this happened. RFK didn't somehow crack into the mainstream conversation, despite 18 years of trying, on his own - it was the failure of PH which made the public go searching elsewhere for answers, and they stumbled upon him.
Public Health suspended the key ethic of informed consent, convinced over half the world that they should mock, fire, and shun anyone who resisted, and is now left holding the bag" after cases and deaths exploded despite their predictions.
People who took the shot and felt like crap, only to feel like crap again when they got the virus anyway are not being "swayed by misinformation" in now rejecting further shots. They are clearly asking a logical question "If Public Health could be wrong on this, what else were they wrong on?"
That is why routine vaccines dropped. It's not rocket science. This was a self inflicted error by PH which created a chasm in trust. Trust is very hard to reclaim.
When someone wants to regain trust, they begin by acknowledging their mistakes and demonstrate contrition. That is what public health needs to do.
All I see is blame. Blame the republicans. Blame social media. Blame Joe Rogan. Blame Facebook, Twitter, YouTube and Reddit because they stopped censoring wrong-think.
Step back for a minute. Our government actually paid comedians and screenwriters [3] to promote a brand new pharma product which didn't do what it was supposed to [4], and lead to some of the most cringeworthy television in history [5], and there is no apology for Colbert's "VaxxScene" dance. He used to be funny. Now look at him. [6]
Do you truly want to help PH regain trust? What would that take?
______________________
[1] This is wild to watch to remember how controversial subjects used to be hashed out:
https://www.cc.com/video/uwf623/the-daily-show-with-jon-stewart-robert-f-kennedy-jr
(someone should archive this video for posterity)
[2] https://trends.google.com/trends/explore?date=all&geo=US&q=RFK%20Jr&hl=en
[3] https://thepeoplesvoice.tv/bidens-hhs-and-cdc-paid-screen-writers-and-comedians-to-mock-the-unvaccinated/
[4] https://docs.google.com/document/d/1ndHlJkSnQ7wqYxUQROcN6jBY154HZOK4Z8pZATC0DbQ/edit?usp=sharing
[5] https://www.youtube.com/watch?v=sSkFyNVtNh8&t=2s
[6] https://www.thewrap.com/the-late-show-canceled-tuesday-stephen-colbert-has-covid/
Hi Michael- I appreciate your thoughts. I really do, but the blame game is getting really old. That’s all you do on here and it’s degrading. I have written *multiple* times on how much I need to improve. On what public health needs to do. In fact, I never once blamed anyone in this post. I said that “public health hasn’t kept up” with social media. Ive talked about trust in institutions before. Putting everything into 600 words is just not possible. I’ve talked about it on a ton of podcasts that I’ve shared on here about this too. I’m even traveling the country getting a multi-million dollar initiative to fix systemic issues in public health to build trust. Us, in public health, are literally killing ourselves to help turn the tide. We understand what went wrong. It’s all we talk about and all we are focused on right now. Beating down a dead horse doesn’t help.
You refuse to admit mistakes and apologize for your role in pushing covid hysteria. Tell the truth, that's all you have to do. If you still can't tell the truth about masks, for example, then you haven't learned anything and you won't build trust going forward.
I had a whole post about my mistakes…
I have read and greatly appreciate your post on this. I do not agree with Paul's characterization of this and claims of "pushing covid hysteria." That type of mischaracterization of your efforts is very clearly refutable by reading your body of posts. i'm sorry you have to deal with what I would call bullying statements like that.
Katelyn,
Thanks for the reply and I will be courteous and refrain from posting for a while... after this one :)
I apologize on my tone - I always try to my best to be as dispassionate as possible, but having just rewatched Colbert's Vaxxscene skit probably didn't help (especially now realizing our tax dollars helped make that a reality).
To be clear - my rant on Public Health - is not directed at you. It's directed at the nebulous "Public Health" that has misinformed the public and is now stunned they aren't taken seriously anymore.
The "Public Health" that had Wallensky on CNN promoting the 2022 booster right after she came down with Covid **1 month after her booster** and was so sick she had to take Paxlovid. The Public Health that overstated the risks to kids and were forced to change their CDC presentation after being fact checked by a random mom from Georgia (KellyK). The Public Health that praised South Korea when things were going great and were quiet when it turned into a disaster. The Public Health that promoted embarrassing studies like Kansas Mask with a straight face while attempting to keep the Danmask RCT from being published. The Public Health that spent 4.3 trillion on this pandemic and got nothing in return (less than nothing, actually). The Public Health that cheered the termination of healthcare workers creating even fewer staffed beds. The Public Health that let Alex Berenson figure out the vaccines didn't stop transmission before they did, and then asked Twitter to censor him (great strategy! That's how science works!) On and on. I digress.
That's the PH I'm shaking my head at, because now, that PH is shocked that RFK Jr is finally getting all the attention he has desperately craved his whole life and appears to not know how this happened.
I'm not ranting *at* you, I'm ranting *to* you (I feel like there is a difference in there somewhere...)
It might be before your time, but there was a great skit in Mr Show, where Public Health officials standing outside an Amusement Park with a deadly roller coaster are befuddled why there are so many deaths starting at 8 a.m. and ending by 11 p.m. [1]
I feel like we are outside Thrill World, watching that same clueless Public Health.
We know why PH trust is shattered. We know what it would take to rebuild trust. I'm not so sure a "multi million dollar initiative to fix systemic issues" is what is needed.
An accounting of mistakes, with a goal of finding out how they proliferated and why the "error checking machinery" of science didn't catch them before randoms on Twitter would be a good start. A plan to ensure in the future we don't make similar mistakes. An apology.
"Here is what we gone wrong, here is how we didn't catch it, here are plans to ensure these mistakes aren't repeated".
You say "We understand what went wrong. It’s all we talk about and all we are focused on right now" but I am beating that dead horse because it doesn't seem like PH understands.
It honestly feels like a repeat of the Iraqi War (2nd one) where everyone knows we ****ed up, but we have to pretend it's all a big mystery how this happened and we just collectively move on and forget.
Now, I have to be off to pen a letter to the brilliant Dan Ariely who on the September 19th episode of the Michael Shermer Show commented he didn't understand how confidence in pharma could be at an all time low given "their success saving us all".
Happy Thanksgiving!
___________________
[1] Regardless what you think of my comments, this is hilarious, I love how Bob Odenkirk's character gets back in line in the background even after David Cross dies
https://www.youtube.com/watch?v=yX92-GEKpEc
I appreciate the thoughtful response. I agree with (almost) everything you say here. Please don’t stop commenting, but just remember there is a person on the other side of this account; and I am doing everything in my power to make change from a little corner of the world.
We lost millions of people around the world unnecessarily (Economist projection) because of sociopathic lunatics like the people you’re bending over backwards to accommodate and pamper here. Begging them to be nicer to you.
This is why fascism is winning.
Exactly!
@Katelyn, you don't realize how different you are than our public health officials. You present useful information and correct errors you have made. Not so much the case with Dr Wallensky, Dr Fauci, etc.
My son's 2nd grade class just had a child return from having chicken pox. How do you not vaccinate against chicken pox? And why would you want to expose your child to that? Plus the risk of shingles later in life? It's unbelievably scary what misinformation is doing.
Varicella vaccine doesn’t reduce your risk from shingles later in life. Since it’s a live vaccine, you still carry the virus in you, just as if you naturally acquired chicken pox.
Also should mention that many countries in the EU (including UK) have not authorized varicella vaccine out of fears it would cause a rise younger populations to get shingles (which is happening in the US, though it’s debated whether due to varicella vaccine or general decline in health of our population).
Yes, it lowers the risk of shingles. 2019 study showed a rate of shingles was 38 (vaccinated with varicella) vs. 170 (not vaccinated) per 100K https://www.scientificamerican.com/article/two-for-one-chickenpox-vaccine-lowers-shingles-risk-in-children/
Katelyn,
This study has a glaring flaw which should be grounds for retraction (or a complete re-write of what the outcome shows).
Remember, shingles is a re-emerging infection of the varicella virus which has been dormant in your body ever since acquiring varicella naturally or through the vaccine*.
This study claims that being vaccinated with Varicella lowers your chances of getting shingles (2nd infection), but the comparison group is a **cohort of people who have never had their 1st infection in the first place**. From the study: "We were unable to assess the unvaccinated group’s underlying risk for HZ because we did not collect serological or medical record evidence of previous VZV infection." - that should be disqualifying. They don't know whether the "control group" actually had chicken pox yet, they didn't even bother to check for antibodies, despite making that study challenge.
It shouldn't be surprising that the vaccinated cohort has lower incidence of HZ than the unvaccinated cohort considering the vaccinated group has already been given a live attenuated vaccine. That science has already been settled. We know the varicella grants long lasting immunity against Varicella.
The open question is whether that live attenuated varicella vaccine can reduce odds of secondary infection (Shingles) better than naturally acquired Chicken Pox. This study claims to offer that answer, but as you can see, it cannot make that conclusion due to study design. In fact, it likely shows identical shingles rates.
Note that the number of breakthrough infections (shingles) in the vaccinated cohort.
- 5,339 out of 3,186,732 vaccinated (.168%) compared to 9,044 out of 3,185,335 in unvaccinated. (.284%) population who may-or-may-not have ever had chickenpox in the first place.
To put this into perspective, this study shows vaccinated children under 18 had a shingles incidence rate of 1.7 per 1,000, putting it completely in line with the age adjusted rates of older cohorts shingles incidence tracked by the CDC.
The right way to study this would have made sure the comparison group was cohort matched (age of vaccine = age of natural infection) of children *who already had chicken pox naturally confirmed serologically*. Then we would know whether the vaccine provides longer protection from secondary infection.
I did a deep dive on this subject out of personal interest when I got struck down by shingles earlier this year (worst, pain, ever), that is why I am already familiar with this study and it's glaring flaws. What is alarming is that this nonsense not only cleared peer review, it was accompanied by an editorial in Pediatrics as well as that glowing appraisal of the study in SciAm.
I generally grant charity to researchers who are paid by Pharm, but I have no other explanation as to how this didn't get shredded/filedrawered other than all involved with this study are funded by GSK, Pfizer, Merck, etc
You have a good post today on "how the public could be losing faith in vaccines", and here is a perfect example how our trust is dwindling.
Nonsense like this is uncritically repeated without skepticism. (and the first red flag with this study - how could this study be true in a world where the population is mass vaccinated against varicella yet shingles is rising?).
"Double check ideas you disagree with. Triple check those you embrace".
*Edited with input from John M Kelly
"Double check ideas you disagree with. Triple check those you embrace". Let us know when you plan to take your own advice. No evidence of that so far.
I vaccinated my kids for Varicella, now critically appraising a study which should match my priors. There you go.
Again, always with the ad hominem, never actually engaging in a dialectic about the substance of what I am saying.
How about reading the study, considering the flaws I point out, and offering a defense or rebuttal?
Funny how you accuse others of priors. Well, not really funny
It seems that you know just enough to be very wrong on a great many things, and you appear to have the time to flood the zone with excess prose that exposes your own priors
Here's some keywords that should lead you to research that challenges your priors:
attenuation of Oka strain
skin infectivity of Oka strain
attenuated Oka strain glycoprotein C expression
localization of wild-type VSV and attenuated Oka strain VSV in dorsal ganglia
rate of zoster occurrence exhibiting Oka strain genetics
Also you note that the rate of zoster has increased over time, but fail to acknowledge both that there was no increase in the rate following the introduction of vaccination for varicella, and that the rate has decreased or plateaued across all age groups over the last decade.
Finally, I could be wrong here but you appear to exhibit symptoms of a full-blown infection with the conspiracy virus that causes people to believe that "receiving funding from pharma" leads to "fabricating results favorable to pharma". Unfortunate, this is.
Sadly for you, nothing about chickenpox/shingles vaccination is as simple or clearcut as your apparently biased and perhaps limited self-education would make it out to be
John - Can you point out any mistakes in my critique of the SciAm study Katelyn posted?
I don't have any opinion on Varicella vaccine. I'm merely correcting the misinformation above, as Katelyn noted, a "lie travels faster than the truth". The SciAm study is misinformation (possibly disinformation given how hyped the study was in SciAm and the editorial accompanying it in Pediatrics) as it's claims are easily debunked should you take the time to actually read the study.
My kids are vaccinated from varicella, and in 6 years I will get Shingrix. Whether more countries start following the US in rolling out varicella vaccine as I expect to happen in the UK is of no concern to me.
If it turns out varicella vaccines have longer lasting immunity from a recurrence of shingles, that would be wonderful - especially for my children.
But I haven't seen that data yet. Perhaps it's out there. KB just posted a study, I will read that. It's definitely not the SciAm linked piece though.
Yes, I can. You characterized zoster as a "second infection" - there is no such thing. There is only one infection. Whether a kid contracts wild-type chickenpox or receives the attenuated Oka VZV in a vaccine, the virus goes dormant in certain nerves (dorsal ganglia). When this dormant virus re-activates for whatever reason, it travels along the neurons and erupts on the skin. This is zoster.
The group conducting the study - which you didn't link to (Weinmann et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748320/)
accessed over 6 million electronic health records for the occurrence of zoster - not chickenpox - in children under 18. The clinical presentation of zoster - "a single stripe of blisters on one side of the torso in the innervation area of a single nerve ganglion...chickenpox gives you an uncomfortable itch, shingles develop into excruciating blisters" - is very different than chickenpox.
Bottom line - it's 100% certainty that patients assessed with zoster were either exposed to wild-type VZV or received a vaccine.
Which leads to the likelihood that you have misunderstood the question that Weinmann et al. was asking. This was a population-level study of electronic health records that showed 1) clinical diagnosis of pediatric zoster, and 2) vaccine status. The question asked of the dataset was "what is the rate of clinical pediatric zoster in children who have/have not received the vaccine."
The validity of the conclusions does not hinge on "the unvaccinated group’s underlying risk for HZ" which was part of a complex paragraph explaining what the study could not address because of the limitations of clinical practice in the healthcare setting. Confirmation of serotype is a rarity (and I guarantee that some OptumRX program benefit manager working for UnitedHealthcare would deny coverage in 9,999 out of 10.000 cases).
But for all the wrong reasons you did say something that I think could be right - "identical shingles rates" in the vaccinated and unvaccinated. It's possible that the RATE of REACTIVATION of the latent virus in the nerves is the same in both groups, but the clinical presentation of zoster blistering is less in the vaccinated group due to the lack of expression of glycoprotein C in the vOka strain.
Just saying
Perhaps this is better?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190015/
The statement I made earlier was "the varicella vaccine doesn't reduce your risk from shingles". (perhaps that may change with better data)
I also commented on why many countries have been hesitant to follow the US in the varicella vaccine campaign.
The study you shared does not compare shingles among vaccinated/natural cohorts, rather it supports the exogenous boosting hypothesis (i.e., being around kids with chicken pox provides immunity boost to adults from getting shingles) while acknowledging the reduction of Shingles (33%) was lower than previous models estimated.
"Discussion
This self controlled case series study found a reduced risk of zoster associated with exposure to a household contact with varicella, with modest but long lasting protective effects observed. Strong evidence suggests that in adults the risk of zoster within two years of exposure to a child with varicella in the household was 33% lower than in the baseline period, and in the 10-20 years post-exposure the risk was 27% lower."
Did you closely read this study?
Who’s being reckless? Are you replying to me? If so have you read my posts?
The study you shared shows that adults exposed to chickenpox have lower incidence of shingles. Exactly the reason I said many EU countries have yet to implement varicella vaccination - which my children are already vaccinated with.
I had shingles right after Easter. It was horrible. Was certain a tumor exploded in my brain and I was going to die. That’s why I’ve already read all these studies because I wanted to understand why young healthy people are getting it and why I couldn’t have gotten a shingrix vaccine before 50 to have prevented this.
Some people think it is not a big deal. I had it when I was in elementary school. At 43, I still remember how miserable I was.
This is not surprising. The messaging from respected and trusted voices has been all over the place the past three years. For people on the fence, I can see why they would fall prey to mis/disinformation.
Paxlovid rebound occurs 20% of the time, which is about 10x higher than without - see link to US News article below. But the public was told Paxlovid rebounds only happen 2% for a long time despite personal experience contradicting this. When public health officials don’t set the record straight, trust is lost.
https://www.usnews.com/news/health-news/articles/2023-11-14/covid-rebound-occurs-in-1-in-5-people-taking-paxlovid
Or maybe some folks don't understand the limitations of clinical trials vs. large-scale deployment. And even this is not a particularly large sample (142). And, of course, one study does not constitute Absolute Truth. It would need to be confirmed, preferably with a larger sample.
Maybe more people need to read past the first paragraph. It has nothing to do with public officials "not setting the record straight." It has a great deal to do with getting solid information on a rapidly-evolving virus in an environment when far too many politicians see advantages in withholding or simply lying about evidence (e.g. Florida).
Personal anecdote aside, did you go to the hospital or put on a ventilator? That the question you should be asking. Considering that high risk people (immunocompromised, immunosenescence, transplants and comorbidities, not surprised that it slightly higher. However, the study has some serious limitation (n 142) and there are still ongoing trials. This is how we learn more about what I consider, still, a novel virus.
https://www.statnews.com/2023/11/13/study-suggests-covid-rebound-is-far-more-common-with-paxlovid-than-without/
Doctors I know estimate Paxlovid rebound at 50% based on what they observe with their patients. Some also prescribe it for 10 days (not 5) to prevent rebound.
I’m curious whether Paxlovid rebound is associated with higher incidence of long covid?
So my hot take on Paxlovid as someone who experienced it, is that I think it could come down to metabolism. Basically, all medication is predicated on having a shitty metabolism, which makes it more effective but also potentially less safe. The original intended population for Paxlovid had shitty metabolisms that reduced expression of the enzyme CYP3A4, so in essence they had higher doses. In the general population, the doses were effectively lower because it got metabolized too fast, and a lot of people (including me) really needed longer courses.
I ended up going on Paxlovid for ten whole days after my rebound started (which included both symptoms returning and my tests flipping back to positive). No regrets. During the entire course of my illness I was symptomatic for exactly two days - once on Day 1, and again on Day 11 (rebound day). Both times, the Paxlovid knocked out my symptoms within 12 hours. I don't think I've ever had such an impressively fast acting anti-viral.
And then there were these pleasant surprises:
- My PCR went back to negative within three weeks of my initial infection
- Despite dramatically reducing my viral load, I still managed to develop nucleocapsid antibodies. So if anyone's worried about Paxlovid somehow getting in the way of an effective immune response...well...they can keep it to themselves.
I told my doctor about what I'd done after the fact, so he'll know for future reference. He appreciated the info.
I’m glad it worked for you, and I wouldn’t hesitate to take it.
The problem is most people can’t convince their doctors to prescribe a 10 day course. Some people have trouble getting their doctors to prescribe it at all, but that’s a different story.
To be clear, I went full on doctor-shopping junkie mode. I got lucky: the first 5 days were paid by the city's test to treat, the next five were paid by my insurance, and the last one was an act of charity by a pharmacist who happened to have a discount (I paid $2.13). I hope my doctor uses the info I reported to him, for future reference.
On Day 12 - after I'd restarted on Paxlovid - my symptoms were resolved, my fatigue had lifted. That was also the day I got a call from my super asking if I had a leak in my ceiling over my PTAC. I did - there was a burst pipe two floors above me, the apartment immediately above me had gotten completely flooded. I needed to be fully functional that day, and I can't begin to imagine how any of this would have played out if I'd been "out of it" on Day 12 like I was on Day 11.
Thanks to Paxlovid, I had the wherewithal to handle an acute emergency in my living space that I couldn't possibly have handled otherwise.
In case it's not obvious, it's been a rough few months.
Wow!
Keep in mind the the original EUA was for 5 days only. It has been recently fully licensed. However, evidence does not suggest a second course so far. https://www.yalemedicine.org/news/what-is-paxlovid-rebound-covid-rebound
Yes, there seems to be some suggestion that it help with PASC.
https://www.npr.org/sections/health-shots/2022/11/08/1134982401/new-va-study-finds-paxlovid-may-cut-the-risk-of-long-covid
Also, potential therapeutic
https://www.reuters.com/business/healthcare-pharmaceuticals/us-nih-launches-long-covid-trials-pfizers-paxlovid-other-therapies-2023-07-31/
No evidence for ten day course so far but there are more studies.
Meh. The existence of rebound ought to be thought of as sufficient evidence of *probable benefit* of a longer course, from a Bayesian standpoint.
"Rebound" common with biphasic diseases. It's really an inflammatory phase as your immune system (in my mind) is finishing the job. As far as
I can tell, course of antimicrobials do not clear all of the pathogens. Your immune system does the rest. Overuse of antimicrobials has lead to AMR and I hope we don't do the same for Paxlovid.
I'm so stunned that over 2x more people in the survey believe Ivermectin treats COVID than in 2021. Speechless, really. What a mountain we have to climb.
Refer to steve valendra’s comment.
This is such important news to share and get out. It does not help when you have governors and misled state officials who make a law that pediatricians can’t refuse to see patients who are not immunized. I feel so sad that we are going backwards and so far apart! Thank you for sharing and as a teacher I know how important vaccinations are.
The U.S. becomes dumber by the month. Reliable information is readily available, but too many think they know better than reality and others choose to remain willfully ignorant. People are just plain stupid.
For some reason when I read the title I thought the article was about a new strategy to get routine vaccines - a drop-in clinic for vaccines, no appointment needed. Sadly it was not a happy story of innovation, but a sad story about the impact of misinformation.
A wonderful pediatrician serving in the California state legislature has successfully spearheaded a drive to get vaccinations mandated as a requirement for children entering kindergarten. Only medical exceptions are allowed. Opposition was furious and stubborn, but reason prevailed!
It is not surprising 1 in 8 parents believe there is antifreeze in vaccinations. Perhaps the warning about polyethylene glycol allergy could be better worded to make clear PEG is NOT the same as ethylene glycol. I’ve even seen warnings claiming PEG IS a component of antifreeze.
What is the story with West Virginia? Looks like success -- how please?
WV was a huge success with Covid-19 vaccines too. One of my hero’s (Julia Faustino) supports the vaccine information diffusion network there. The Washington Post is writing a story about it; will share when it’s published!
Native West Virginian here. For as much as she fails in many ways, WV has always had a strict vaccine policy and not allowed non-medical exemptions. Growing up, I did know that choosing not to vaccinate was a thing.
I would also suspect the rise in homeschooling (for whatever reason) may be contributing to this.
I'd be appreciative if YLE explain a bit more about "some diseases, like measles, require 95% coverage to maintain herd immunity," or point us to information that explains this? How does that work, eg why some diseases and not others? What does it mean if we don't have "herd immunity?" Is the entire "herd" then at risk to get the disease? Pandemic level spread in the herd? Or just the proportion that's unvaccinated? For example, in the cited Ohio case with the 9th lowest MMR vaccination coverage last year, in the measles outbreak last year 85 children got sick, and 36 were hospitalized. While full protection especially for children would seem to be the best goal, that seems like a very small number, and not "herd level" widespread disease.
Important question, with implications for Covid. If neither prior infection nor vaccination stops viral transmission, does that imply we can't even theoretically achieve herd immunity against Covid? Whereas with measles, is the idea that we CAN achieve herd immunity if nearly everyone has been vaccinated or previously infected because there's essentially no population-level 'reservoir' of the virus (i.e., a chance encounter between someone who is protected and someone who isn't is very unlikely to occur and even if it resulted in transmitting the infection it wouldn't spread to others)? A clear def with examples would be helpful!
The hope is one day we get a pan-coronaviruses vaccine that works against any variant and that enough people take it. Never again will the public tolerate a vaccine mandate.
My guess is people will not take it. The mandates have done so much damage.
I'm always going to believe that the mandates probably would've worked if people had been allowed to antibody-test out of them. Maybe at their own expense, if moral hazard is an issue.
Adding, I also think something a bit less heavy handed than vaccine passports might have worked better. Like, a simple tax incentive, or making the 2021 tranche of pandemic assistance contingent on getting at least two doses of the vaccine.
Because it mutates as it does, I have read herd immunity with Covid is an impossibility. True? I don’t know.
Self fulfilling prophecy. If enough people had gotten vaccinated and boosted, we might know the answer, but now we never will.
I'm not so sure. The US is only a fraction of the world population. Even if everyone in the US had been vaccinated, the mutations would have happened elsewhere. And since COVID vaccinations don't prevent you getting COVID nor transmitting it, it seems like it would have to be with us forever. Am I missing something?
Nothing 100% prevents anything but vaccination (and immunity in general) certainly reduce the probability of infection and transmission (fewer days, lower viral load).
I'm not YLE but I'll bite. Simply put, it's because measles has an insanely high basic reproduction number - in a naive population, one person would infect 19 people on average. So as long as only 5% of the population is susceptible, the 19 people they would be infecting are most likely immune they would be infecting are immune and the disease stays contained in the 5% of the population that's susceptible.
This is why, during the 2019 measles outbreak in Brooklyn, the city actually did mandate that everyone in certain zip codes get measles shots. I wasn't quite in one of those zip codes, but I do ride the subway, so I had my doctor at the time give me an antibody test, and because it came back empty, I got an MMR booster at the tender age of 44.
Thank you, appreciate that. Just to make sure, if your antibody test had come back with antibodies, you would have been immune, yes? If so, in this case "infecting others" means others would receive the virus, but if 95% were already immune, they would not be at risk.
So Covid has a similar "insanely high" reproduction rate that the herd needs to protect against? I guess that differs based on the variant, right?
I'd have assumed so, yes
Thank you. Trying to understand the "herd immunity"/risk/transmission relationships and this helps.
HIT = 1 - (1/R0)
HIT is the herd immunity threshold
R0 is the basic reproduction number
Thank you very much! So if I understand, with an R0 of 12 to 18 for measles (very quick search https://pubmed.ncbi.nlm.nih.gov/28757186/ and even that report shows a great deal of variability in the R0), herd immunity to shoot for would be 92% to 94%. And with an R0 of 2 to 6 for Covid (https://www.weforum.org/agenda/2020/05/covid-19-what-is-the-r-number/), herd immunity to work toward would be 50% to 86%. I realize those R0 numbers are by no means solidly established and probably for covid at least strongly depends on the variant. But still, this helps explain the difference in desired herd immunities for these different viruses, and the relationship between the virus reproduction number (in a given population) and desired herd immunity. Very helpful and appreciated.
Katelyn, I'm from Montana & am sorry to see it's not included in any of your charts. When Covid first took off, our HHS under Governor Steve Bullock (D) published a very helpful daily log of Covid cases, hospitalizations, and deaths by county. In Nov. 2020, when Bullock was term-limited, Greg Gianforte (R) was elected & introduced sweeping changes that included eliminating virtually all mandatory masking & vaccination, and soon the daily public reports on Covid infections & hospitalization were stopped. Is it safe to assume this lack of data availability has extended to non-Covid information and is why MT isn't included on any of your charts? Is there any other State not included, & for the same reason?
In the source CDC data (https://www.cdc.gov/mmwr/volumes/72/wr/mm7245a2.htm?s_cid=mm7245a2_w) she pulled that bar chart from:
"†† Montana did not report school vaccination data. Utah changed the way data were reported between the 2021–22 and 2022–23 school years and is excluded from year-to-year comparisons."
Our local health care corporations and owners of all major hospitals, MaineHealth and Northern Light, here in Maine (population one point million) that employ almost forty thousand staff between them made the decision early in the Pandemic to require all staff to be vaccinated.
The “we won’t be vaccinated under any conditions” fanatics predicted that they’d lose a massive number of their nursing staff and of course doctors by the dozens. Both MaineHealth and Northern Light put out almost identical press releases late in the Pandemic — MaineHealth wth 26,000 staff had lost less than 50 nursing staff out of some 4,000; Northern Light said they also lost less than 50 from a nursing staff of of nearing 2,500.
In both cases, that included those who quit because they wouldn’t get vaccinated and those who were fired because they wouldn’t get vaccinated. Worth also noting was MaineHealth pointed out that that nursing staff comprised all levels of nursing so it included CNAs to NPs.
I mention that because I was supposed to get a neurological evaluation for the severe head trauma which at that time had occurred two years prior.
(How severe? The cardiac critical care unit had to revive me ten times after emergency services had already revived me once. Don’t come down a set of stairs backwards and hit your left temple. Just don’t.)
They couldn’t do it because too many CNAs who are used as companions to see if we got seizures while staying on the unit on the neurological unit had refused to get vaccinated had quit or been fired. So it didn’t happened. So far we’ve not done it as Lamotragine and several other meds are managing the seizures reasonably well.
I'm not sure what you're saying here: that MaineHealth & Northern Light lied about/misreported the number of staff they lost, or that even such a seemingly small loss can have serious consequences, or something else? I'm glad your seizures are being managed reasonably well with meds, & hope you can get the kind of neuro evaluation you need soon ;)
No, I’m saying the anti-vaccination fanatics made a claim, as did they repeatedly, that masking would cost businesses staff.
This one got more play in the media because of it being health care related. And it wasn’t known how many staff would quit which is why both MaineHealth and Northern Light thought it important to release press statements saying that the number of staff losses was minimal.
It is pretty amazing that they lost only 100 staff out of 40,000! I'm just sorry that so much of that loss was in the particular office that affected your ability to get the study you needed.
It’s debatable whether I needed or not.
The seizures are low level, akin to a really bad shaking to their worse, and as I said manageable (mostly) with three anti-seizure meds. The meds also control the dizziness, a worse problem for obvious reasons as falling down with head injury is a bad idea, and my loss of vision has been brief over the past months.
Look severe head trauma is a Very Bad Thing. The best that a medical care team can do is keep it stable as there are no cures. And it has surprises — I spent the first three months of the Pandemic in-hospital because I blacked out, something we didn’t know I did, while walking downtown and woke up sitting on the sidewalk two blocks away having shattered my right knee patella. No memory what-so-ever of it happening.
So they got me to Maine Medical Center, I spent fifty days there with surgery and rehab, went home and shattered it again within a week. This time they discovered I I’d picked up a severe staph infection the first time I was in-hospital so that got me another fifty days there. I had private rooms both times and my iPad & iPhone, but it’s still a long time to be there.
And I had a third surgery as well, so that’s how I started the Pandemic off.
So the knee doesn’t support me anymore which means I wear a brace all but when I’m getting showered with the help of my personal care assistant. And eventually I’ll need surgery for the torn meniscus I managed to have in the last six months when I wrenched knee somehow.
Oh, what a tough time you've had!! I'm so sorry, & hope you can remain stable with no more falls <3
Thanks for this info as always! Somewhat unrelated question (and sorry if this was already mentioned in a previous post of yours) but I have had trouble finding COVID shots for my kids--have you heard about this at all?
Appreciate your post very much have been reading since the early covid days--appreciate you sharing your expertise!
If you are having issues with walk-ins, up here (Ohio) pediatric vaccines seem to only be available through appointment (saw a kid just 2 weeks at a CVS with an appointment get Flu/Covid vaccines).
Not sure your location, but have you gone through all major pharmacies online scheduling services? (Up here it's CVS, Walgreens, DrugMart, CostCo).
Our pediatrician’s office (through Akron Children’s) also has it too.