Katelyn, Your updates are always very informative and easily understood. My daughter-in-law recommended I subscribe and I am glad I did! She is a research biologist at the CDC in Atlanta. I was wondering if I should wait until October to get both the flu and new BA5 booster at the same time. Then you also had the same question near the end of today’s post! I am 73 and leaning towards waiting until October. I have always gotten my flu shot then and it has been effective. Thank you for your good work!
You don’t mention when your last booster was, how many you’ve had or if you’ve been infected before. I’m leery of the upcoming flu season so I’d consider the flu shot as soon as it’s available to you, and the bivalent COVID vaccine as available. Discuss this with your primary care physician though.
“Congress has stopped funding the coronavirus response and has invested very little into pandemic preparedness.“
The lack of funding for pandemic preparation planning frightens me as much as the early days of the pandemic did. We’re facing multiple public health emergencies yet, despite Administration requests there’s no bipartisan support to address the needed planning efforts.
I re-read your Apr 6th post on "Original Antigenic Sin" (OAS). Your bottom line then was "there is no definitive evidence of OAS in humans being an important concern for COVID-19." Any updates? Will Pfizer and Moderna's data on their bivalent vaccine give any clues? Thanks very much for your dedication, hard work, collaboration with others, and sharing the product with all of us.
this is a great question and I should give an update soon. there has been more research. one article published in Science found evidence of OAS and a few others showing no OAS. I’ve talked to numerous virologists about that science article and they said the results are very odd and they don’t really trust it. so not sure what to do with that info. but i think the bottom line is still important: we need to be responsive to our immune systems and right now that means another booster
I read the article but didn't understand if OAS meant that you would be less safe from infection or severe disease/death iOAS is a problem than if you didn't get another booster. Any help on this? Think I understand correctly that the existence of an actual OAS response is scientifically unclear.
@Katelyn, I liked your comment in your piece on OAS about the complexity of the discussion. It’s still complex and while there’s more research available it’s hardly settled. I’ll look at the Science article now, (missed that one) but the fact the lay press is talking about this means we have to get science based communication out there rather than the WaPo article, which seemed like a bunch of sound bites by some excellent talking heads but save for its last paragraph, was bereft of useful information.
The article by Van Zelm (https://www.science.org/doi/10.1126/sciimmunol.abq5901) you cited is a nice summary but the work by, especially, Kanu et Al, suffers from a small patient population, likely by either convenience or necessity. That’s not criticism of the work, but a result of years of clinical research. More a limitation than anything.
Van Zelm notes we could modify vaccine targets, something I’ve maintained for a long time. Substitutions/deletions to the plasmid capsule and membrane, while not unheard of, are less prevalent than Spike, although omicron tried to rewrite that book for capsid changes.
I need to see more studies before I agree with Paul Offit on this matter, but as I’ve been throughout the pandemic, I’m willing to change my views based on scientific evidence.
Isn't the more relevant normative question: "What's worse, OAS from vaccination or OAS from infection?" Based what I've read OAS from infection is generally worse.
The last paragraph got me too. Budgeting is applied ethics. The question arises of what would be so wrong in reallocating a few score billions of dollars, currently earmarked for the production of bombs, bullets, tanks, i.e. things that kill people, to public health, i.e. the endeavor to save lives?? What is our true priority? Killing people or saving them?
I've said this in other threads but we really need some system for smoothing costs.
Parametric insurance is a form of reinsurance (insurance for insurance companies and large organizations that self-insure) where instead of associating the claims to losses, they're associated to official, publicly available metrics and indices - crop yields, rainfall, heating and cooling degree days, etc. It seems to me that wastewater surveillance would dovetail nicely with this.
Instead of cities being blindsided with huge costs associated with pandemics, they could simply budget for insurance premiums to Lloyd's or Swiss Re or whoever, and those companies would pay whenever a pathogen is detected above a certain level.
From your closing important note: "Congress has stopped funding the coronavirus response and has invested very little into pandemic preparedness." What?!?! Have we learned nothing then?? Being prepared and responding with agility is key. And we know Covid and its mutations are still out there, along with who knows what else. So why not put the time and money into being ready? This is VERY frustrating to hear!!!
To be fair, under the ACA vaccines are considered to be preventative - thus they're fully covered by insurance, with zero copay. So really the government is passing the cost to health insurance companies and employers - as it arguably should. At the end of the day there's not much difference between taxing a person or business $100 to pay for X, and mandating that they pay $100 for X on their own.
But, sadly, there are still many people in this country without insurance, and those are often the same people who are vulnerable (except for people old enough to get Medicare.)
It’s the health inequities that are concerning and which we’re really highlighted during the pandemic. Some of us have seen this in our work already but pre-pandemic calling this out fell on deaf ears. And now, it seems Congress has again developed selective hearing loss.
Well at least we have guaranteed issue, thanks to the ACA. And robust tax credits to pay for a plan on a state or federal exchange. If this infrastructure survived the Trump administration, it can survive anything.
Is there information on how long people need to wait between getting the old booster and getting this new one? I have read everything from 4-6 weeks between boosters to 4 months.
A subset of the population cannot take the mRNA vaccines due to deleterious side effects. What’s available or in the works for them? Evusheld? protein vaccines (the long awaited but never released Novovax)? living with fingers crossed?
Almost, or all of the reactions seem now to tie to a sensitivity to polyethylene glycol. It’s use in the mRNA vaccines is at a sufficiently low level reactions weren’t anticipated but the law of unintended consequences came through again.
Hello. I had 2xAZ, then Pfizer as 1st booster. I had a bad reaction to the mRNA and didn’t want to try another for my 2nd booster so I waited till Novavax was approved. No nasty side-effects at all.
Hello, Dr. Jetelina. Could you answer a question (semi-related to boosters), either here or in a later edition?
I am hearing that immunity lasts only about a month after covid infection. But in the next breath, the doctors are saying that "hybrid immunity" (immunity from a vaccine + prior infection) basically gives you superpowers to fight infection. So, which is it?
Is the month or so of immunity after infection only for people who are not vaccinated/boosted? Because then hybrid immunity would not be reliable. I don't see anyone parsing the difference between vaccinated/boosted and not for how long immunity lasts. Thank you!
That last paragraph got me. I’m hopeful for the bivalent vaccine though. This will require a new level of education for the public, especially relative to first timers. Though at this point, I doubt many will finally succumb to “the jab.”
Thank you for another insightful piece. You write "Vaccine recommendations do not equal vaccination." - that's true, but it's important to note that official recommendations do very much impact what's covered by insurance, with no co-pays. The Affordable Care Act is unambiguous about preventative care being fully covered by all private and public health insurance - and this includes any and all vaccines affirmatively recommended by ACIP.
There is a well written piece on monitoring for common characteristics in variations which arise in immunocompromised individuals as a possible way to target vaccines. It is in the Science News COVID newsletter today:
Thanks Katelyn. It occurs to me that perhaps the mutation rate may be slowing a little? It appears we went from Wuhan through to BA.5 pretty quickly, but it seems a while since we had a new VOC. I would welcome your thoughts on this. Here in Australia we are coming out of the latest Omicron wave and Spring is coming so we are hoping for a summer break, health care workers badly need a rest. All the best for winter for all in the Nth Hemisphere.
Not at all. RNA virus modify at a phenomenal rate. That’s still occurring but we haven’t seen too many threatening to outcompete omicron and it’s subvariants. Your main influencer for summer is reducing congregate indoor gatherings.
I just read the news today that Jill Biden has experienced a Paxlovid rebound. Just like the President. Just like Fauci.
Clearly, the 2% rebound rate from Pfizer is waaay too low. Does the “2% myth” persist in an effort to “encourage” certain desired behavior? Don’t the American people deserve to know the true number so they can assess individual risk/benefit and make informed decisions?
When transparency is lacking, it’s human nature to question the veracity of everything else that’s being said.
PS: Does anyone know where the "Paxlovid guidance" came from that once you're done with Paxlovid, you can re-enter society without a mask two days after you test negative? My husband had a Paxlovid rebound, and his doctor told him to wait a minimum of five days after testing negative.
I'm a huge fan of our First Lady, yet the reality is she probably unwittingly infected people in the last few days. I'd hate to be sitting next to someone on an airplane who just finished Paxlovid, tested negative two days ago and now assumed they were free to move about the cabin, so to speak.
It's my understanding that the FDA has only authorized home tests for detecting infection; the tests aren't FDA approved for confirming that a person is no longer infectious. So where did this return to normal two days after testing negative rule come from?
I’m picturing a major drop in viral load induced by Paxlovid, the immune system not mounting as large a response, with less recruitment of cellular immunity, followed by the cessation of paxlovid after a premature 5 days, an accelerated bump in viral load, followed by a larger immune response. Still like 5-10% seems right in my experience/estimation. We are not seeing a rebound that sends people to the hospital or the grave, and sometimes a less vigorous immune response is good as the collateral damage it wreaks on our own bodies accounts for a significant fraction of morbidity and mortality this whole time. I’m a primary care doc without the scientific researcher mentality, but clinically I’m not sweating paxlovid rebound in 5-10% at this time. I’m still intuitively hoping antivirals =less max viral load =reduction in long covid
Thank you, KB. You really understand this stuff! We see "2% rebound for Paxlovid" in the newspapers all the time, so I guess I'm more focused on how the public evaluates risk prior to taking Paxlovid. If people think the risk of rebound is only 2%, they are more likely to take it vs say a 30-50% rebound rate. My husband (61) had a rebound and isolated for nearly 3 weeks! His doctor had warned about rebound and advised him not to take Paxlovid.
Interesting, thanks. Btw, I think I mischaracterized whatever 2 day rule seems to be afoot re leaving isolation after taking Paxlovid. The rule followed by the Bidens, if I understand correctly, is all you need to do is test negative for two days in a row, and then you’re cleared to re-enter society.
Thank you for asking that. I am going to bring it up on a different computer to try to see it, but am visually compromised so i, too, can not read it. Size is a problem, but often can be addressed. Worse are low contrast, as in that graph, or spidery fonts. (Just as people think of being louder rather than using different wording when someone has hearing loss, so, too, do people think of enlargement for visual problems when they need to keep contrast and font in mind. When i decided to try to learn some recent virology in 2020 i found that virus diagraming is totally outside the capabilities of my eyes, so there are worse things than poorly designed pharma company graphs.). BTW, the font at this site is GREAT!
Katelyn, Your updates are always very informative and easily understood. My daughter-in-law recommended I subscribe and I am glad I did! She is a research biologist at the CDC in Atlanta. I was wondering if I should wait until October to get both the flu and new BA5 booster at the same time. Then you also had the same question near the end of today’s post! I am 73 and leaning towards waiting until October. I have always gotten my flu shot then and it has been effective. Thank you for your good work!
You don’t mention when your last booster was, how many you’ve had or if you’ve been infected before. I’m leery of the upcoming flu season so I’d consider the flu shot as soon as it’s available to you, and the bivalent COVID vaccine as available. Discuss this with your primary care physician though.
“Congress has stopped funding the coronavirus response and has invested very little into pandemic preparedness.“
The lack of funding for pandemic preparation planning frightens me as much as the early days of the pandemic did. We’re facing multiple public health emergencies yet, despite Administration requests there’s no bipartisan support to address the needed planning efforts.
I re-read your Apr 6th post on "Original Antigenic Sin" (OAS). Your bottom line then was "there is no definitive evidence of OAS in humans being an important concern for COVID-19." Any updates? Will Pfizer and Moderna's data on their bivalent vaccine give any clues? Thanks very much for your dedication, hard work, collaboration with others, and sharing the product with all of us.
this is a great question and I should give an update soon. there has been more research. one article published in Science found evidence of OAS and a few others showing no OAS. I’ve talked to numerous virologists about that science article and they said the results are very odd and they don’t really trust it. so not sure what to do with that info. but i think the bottom line is still important: we need to be responsive to our immune systems and right now that means another booster
I believe that Science article is this one: https://www.science.org/doi/10.1126/sciimmunol.abq5901. I got to it from a Wash Post Aug 23rd article on boosters tthat openly raised OAS as an issue: https://www.washingtonpost.com/health/2022/08/22/coronavirus-immune-response-boosters/ So the question is out there in the lay press. Thank you for pursuing this question. My wife and I will get our 3rd booster regardless (ages 67 and 68), but I worry about others.
I read the article but didn't understand if OAS meant that you would be less safe from infection or severe disease/death iOAS is a problem than if you didn't get another booster. Any help on this? Think I understand correctly that the existence of an actual OAS response is scientifically unclear.
@Katelyn, I liked your comment in your piece on OAS about the complexity of the discussion. It’s still complex and while there’s more research available it’s hardly settled. I’ll look at the Science article now, (missed that one) but the fact the lay press is talking about this means we have to get science based communication out there rather than the WaPo article, which seemed like a bunch of sound bites by some excellent talking heads but save for its last paragraph, was bereft of useful information.
The article by Van Zelm (https://www.science.org/doi/10.1126/sciimmunol.abq5901) you cited is a nice summary but the work by, especially, Kanu et Al, suffers from a small patient population, likely by either convenience or necessity. That’s not criticism of the work, but a result of years of clinical research. More a limitation than anything.
Van Zelm notes we could modify vaccine targets, something I’ve maintained for a long time. Substitutions/deletions to the plasmid capsule and membrane, while not unheard of, are less prevalent than Spike, although omicron tried to rewrite that book for capsid changes.
I need to see more studies before I agree with Paul Offit on this matter, but as I’ve been throughout the pandemic, I’m willing to change my views based on scientific evidence.
Isn't the more relevant normative question: "What's worse, OAS from vaccination or OAS from infection?" Based what I've read OAS from infection is generally worse.
Can you explain that a bit? OAS initiated by vaccine, if there is such a thing, appears somewhat less durable than OAS derived from primary infection.
The last paragraph got me too. Budgeting is applied ethics. The question arises of what would be so wrong in reallocating a few score billions of dollars, currently earmarked for the production of bombs, bullets, tanks, i.e. things that kill people, to public health, i.e. the endeavor to save lives?? What is our true priority? Killing people or saving them?
I've said this in other threads but we really need some system for smoothing costs.
Parametric insurance is a form of reinsurance (insurance for insurance companies and large organizations that self-insure) where instead of associating the claims to losses, they're associated to official, publicly available metrics and indices - crop yields, rainfall, heating and cooling degree days, etc. It seems to me that wastewater surveillance would dovetail nicely with this.
Instead of cities being blindsided with huge costs associated with pandemics, they could simply budget for insurance premiums to Lloyd's or Swiss Re or whoever, and those companies would pay whenever a pathogen is detected above a certain level.
From your closing important note: "Congress has stopped funding the coronavirus response and has invested very little into pandemic preparedness." What?!?! Have we learned nothing then?? Being prepared and responding with agility is key. And we know Covid and its mutations are still out there, along with who knows what else. So why not put the time and money into being ready? This is VERY frustrating to hear!!!
To be fair, under the ACA vaccines are considered to be preventative - thus they're fully covered by insurance, with zero copay. So really the government is passing the cost to health insurance companies and employers - as it arguably should. At the end of the day there's not much difference between taxing a person or business $100 to pay for X, and mandating that they pay $100 for X on their own.
But, sadly, there are still many people in this country without insurance, and those are often the same people who are vulnerable (except for people old enough to get Medicare.)
It’s the health inequities that are concerning and which we’re really highlighted during the pandemic. Some of us have seen this in our work already but pre-pandemic calling this out fell on deaf ears. And now, it seems Congress has again developed selective hearing loss.
Well at least we have guaranteed issue, thanks to the ACA. And robust tax credits to pay for a plan on a state or federal exchange. If this infrastructure survived the Trump administration, it can survive anything.
Exactly. Those most vulnerable continue to be most vulnerable in many ways. 😭
does Medicare cover the costs and do we know what the charges will be since we have to pay the 20% copay?
Yes, the ACA applies to Medicare. There should not be a copay for vaccination, ever.
Is there information on how long people need to wait between getting the old booster and getting this new one? I have read everything from 4-6 weeks between boosters to 4 months.
A subset of the population cannot take the mRNA vaccines due to deleterious side effects. What’s available or in the works for them? Evusheld? protein vaccines (the long awaited but never released Novovax)? living with fingers crossed?
Almost, or all of the reactions seem now to tie to a sensitivity to polyethylene glycol. It’s use in the mRNA vaccines is at a sufficiently low level reactions weren’t anticipated but the law of unintended consequences came through again.
Hello. I had 2xAZ, then Pfizer as 1st booster. I had a bad reaction to the mRNA and didn’t want to try another for my 2nd booster so I waited till Novavax was approved. No nasty side-effects at all.
Hello, Dr. Jetelina. Could you answer a question (semi-related to boosters), either here or in a later edition?
I am hearing that immunity lasts only about a month after covid infection. But in the next breath, the doctors are saying that "hybrid immunity" (immunity from a vaccine + prior infection) basically gives you superpowers to fight infection. So, which is it?
Is the month or so of immunity after infection only for people who are not vaccinated/boosted? Because then hybrid immunity would not be reliable. I don't see anyone parsing the difference between vaccinated/boosted and not for how long immunity lasts. Thank you!
That last paragraph got me. I’m hopeful for the bivalent vaccine though. This will require a new level of education for the public, especially relative to first timers. Though at this point, I doubt many will finally succumb to “the jab.”
Thank you for another insightful piece. You write "Vaccine recommendations do not equal vaccination." - that's true, but it's important to note that official recommendations do very much impact what's covered by insurance, with no co-pays. The Affordable Care Act is unambiguous about preventative care being fully covered by all private and public health insurance - and this includes any and all vaccines affirmatively recommended by ACIP.
There is a well written piece on monitoring for common characteristics in variations which arise in immunocompromised individuals as a possible way to target vaccines. It is in the Science News COVID newsletter today:
http://view.societyforscience-email.com/?qs=4256ea4fcad2019385ec79d854fef655bf48ff039acb6df53ca486a9f69f607eecdf3e669a9406f45948e8b98881fab0c3076acdd65984ec8668d2caa001e7feb62c1e5caca1ce90ce20644287fef5ea
Thanks Katelyn. It occurs to me that perhaps the mutation rate may be slowing a little? It appears we went from Wuhan through to BA.5 pretty quickly, but it seems a while since we had a new VOC. I would welcome your thoughts on this. Here in Australia we are coming out of the latest Omicron wave and Spring is coming so we are hoping for a summer break, health care workers badly need a rest. All the best for winter for all in the Nth Hemisphere.
Not at all. RNA virus modify at a phenomenal rate. That’s still occurring but we haven’t seen too many threatening to outcompete omicron and it’s subvariants. Your main influencer for summer is reducing congregate indoor gatherings.
I just read the news today that Jill Biden has experienced a Paxlovid rebound. Just like the President. Just like Fauci.
Clearly, the 2% rebound rate from Pfizer is waaay too low. Does the “2% myth” persist in an effort to “encourage” certain desired behavior? Don’t the American people deserve to know the true number so they can assess individual risk/benefit and make informed decisions?
When transparency is lacking, it’s human nature to question the veracity of everything else that’s being said.
PS: Does anyone know where the "Paxlovid guidance" came from that once you're done with Paxlovid, you can re-enter society without a mask two days after you test negative? My husband had a Paxlovid rebound, and his doctor told him to wait a minimum of five days after testing negative.
I'm a huge fan of our First Lady, yet the reality is she probably unwittingly infected people in the last few days. I'd hate to be sitting next to someone on an airplane who just finished Paxlovid, tested negative two days ago and now assumed they were free to move about the cabin, so to speak.
It's my understanding that the FDA has only authorized home tests for detecting infection; the tests aren't FDA approved for confirming that a person is no longer infectious. So where did this return to normal two days after testing negative rule come from?
Thanks for the link. Sorry, I don't see anything re-entering society without a mask two days after you test negative.
I’m picturing a major drop in viral load induced by Paxlovid, the immune system not mounting as large a response, with less recruitment of cellular immunity, followed by the cessation of paxlovid after a premature 5 days, an accelerated bump in viral load, followed by a larger immune response. Still like 5-10% seems right in my experience/estimation. We are not seeing a rebound that sends people to the hospital or the grave, and sometimes a less vigorous immune response is good as the collateral damage it wreaks on our own bodies accounts for a significant fraction of morbidity and mortality this whole time. I’m a primary care doc without the scientific researcher mentality, but clinically I’m not sweating paxlovid rebound in 5-10% at this time. I’m still intuitively hoping antivirals =less max viral load =reduction in long covid
I love TWiV! Will watch this episode soon, thanks.
Thank you, KB. You really understand this stuff! We see "2% rebound for Paxlovid" in the newspapers all the time, so I guess I'm more focused on how the public evaluates risk prior to taking Paxlovid. If people think the risk of rebound is only 2%, they are more likely to take it vs say a 30-50% rebound rate. My husband (61) had a rebound and isolated for nearly 3 weeks! His doctor had warned about rebound and advised him not to take Paxlovid.
Interesting, thanks. Btw, I think I mischaracterized whatever 2 day rule seems to be afoot re leaving isolation after taking Paxlovid. The rule followed by the Bidens, if I understand correctly, is all you need to do is test negative for two days in a row, and then you’re cleared to re-enter society.
But rebound can occur anywhere from 2-8 days. 😬
Is that graphic saying that the monovalent booster is more than 2x as effective as the bivalent one, against BA.4/5?
(6.2 fold increase for monovalent versus 2.6 fold increase for bivalent)
What are the three categories of the last graph? (Green, Orange, and Purple).
It's great to see data, but we need to be able to understand what we are looking at.
Thanks!
Thank you for asking that. I am going to bring it up on a different computer to try to see it, but am visually compromised so i, too, can not read it. Size is a problem, but often can be addressed. Worse are low contrast, as in that graph, or spidery fonts. (Just as people think of being louder rather than using different wording when someone has hearing loss, so, too, do people think of enlargement for visual problems when they need to keep contrast and font in mind. When i decided to try to learn some recent virology in 2020 i found that virus diagraming is totally outside the capabilities of my eyes, so there are worse things than poorly designed pharma company graphs.). BTW, the font at this site is GREAT!
Of course I'll jump right on the booster - right before my jury duty. Clearly the time to get a booster is immediately before
(a) vaccines stop being free
(b) before I'm required, by law, to spend hours on end with random strangers, and no mask mandate
At any given time, it's easier to get a booster than it is to get a doctor to write a note requesting an excuse from jury duty.