Last week, the Florida State Surgeon General issued new guidance on the COVID vaccines based on an analysis they performed. One of their findings: “an increased risk of cardiac-related death among men 18-39” for the mRNA vaccines.
Another consideration for the risk bucket: because these vaccines are so new, we don’t know the longer term implications of taking them.
Question - how much weighting should be applied to a possible long term risk that is currently unknown but could be severe? If we exclude the “unknown future” from our cost/benefit math, we are saying “there is zero chance of any long term harm.” But in the real world, we know some things do in fact cause long term harm.
Please help me to understand why you and others write that prevention of death and hospitalization are the primary goals of the vaccine. Weren’t those secondary endpoints in the clinical studies?
Fwiw, I’m pro-vax bit have come to develop a degree of skepticism re experts who seem to reflexively paper over any concerns.
I’ve always found you to be nuanced and thus one of my main sources for info, so I ask with all respect and curiosity.
This is a really good question. And, honestly, as a nation we didn’t define what the goal of vaccines were until about a month ago. There’s always been a debate whether it’s to prevent severe disease or to prevent infections. It’s still being debated, which is why you’ll see different viewpoints on whether benefits outweigh risks. I think this caused a ton of confusion. Yes, infections were the primary endpoint for clinical trials.
What I think people are getting confused about is that SARS-CoV-2 infection ≠ COVID-19. The former is an infection by the virus irrespective of the presence of symptoms, whereas the latter is the symptomatic disease. Someone with an asymptomatic SARS-CoV-2 infection does not have COVID-19, just as someone with an asymptomatic HIV infection does not have AIDS.
It also turned out that the vaccines did, in fact, prevent SARS-CoV-2 infections to a large extent, but this was a pleasant surprise and not a primary efficacy endpoint. And the impressive figures for prevention of infections were for the ancestral/Wuhan strain. The ability to prevent some infections (symptomatic or not) has persisted with subsequent variants and subvariants (as best I can tell), but the degree to which those infections are reduced, and the duration of time during which those infections are reduced, have decreased with the evolution of the virus.
I think many are conflating SARS-CoV-2 infection with COVID-19, and they are not the same. It may seem to be a subtle distinction, but without making the distinction, we run the risk of confusing not only the public but also ourselves. Such confusion can breed mistrust, particularly if it is amplified by those who (for reasons unknown to me) wish to propagate the message that the vaccines are dangerous, a fraud, or whatever other excuse they can manufacture to get the public to avoid the vaccines.
These are excellent points. They raise a thorny issue: at what point will we no longer be obliged to *know* if we're infected? There hasn't been a disease in human history with this much asymptomatic testing.
My own personal answer to this is: when my own health insurance stops paying for covid tests.
Thanks. Feel free to quote me, with or without attribution. I'm only interested in trying to keep the facts straight (and there are a lot of facts to keep straight).
You're welcome, and thanks for your reply (and the several others on this YLE post, and others), and for the additional analogies. They are useful, I believe, in offering a more concrete perspective of risks and mitigation.
Yes, I read Katherine Wu's article last year when it came out, and I have referenced it a few times myself. I agree it's a viewpoint that needs to be more widely shared.
With the growing concerns about long COVID and impacts after COVID, I would love to hear more about efforts to find some method for stopping infection more effectively (nasal vaccines, etc.).
When I read the early studies I felt like prevention of hospitalization and death was very prominent in the writing. There were many charts in the peer reviewed literature about prevention of hospitalization and death. I know there were also charts about prevention of infection. I felt it was clear pretty early on in the research that the vaccine was more effective against hospitalization than death than infection. I don't know if this answers your question but I feel like the scientists writing the papers have always cared about prevention of hospitalization and death. I'm sure there was media saying that that the main point of the vaccine was to prevent infection infection but I'm not as familiar with exactly what the media was saying about it.
Just so we're clear, I do actually think that it's going to be possible to eradicate covid eventually - at any rate, still worth trying. We may have set ourselves back a decade, but it's doable. I'm basing this on the staggering amount of low hanging fruit that's yet to be picked:
1. We haven't even begun to phase in buildings with improved ventilation and filtration.
2. Multivalent vaccines are still in their early stages
3. Sure, there may be animal reservoirs, but we don't know how long immunity might last in animals, and we haven't even begun a concerted campaign to mass vaccinate domestic, farmed, and commensal mammals
Thx for your thoughtful response. What I was specifically referring to was the definition of primary and secondary endpoints in the clinical trials - which then become label claims. Idk, but had heard, that prevention of infection was the primary endpoint. The others were secondary.
(Sorry for the weeds-my job used to be clinical research)
Oh I know what you are saying now. I remember seeing those words in the writing but I didn't think about those words explaining what the most important goal was. But obviously it seems like the word primary conveys to the reader that pervention of infection was the most important goal. I always thought prevention of hospitalization and death seemed like the most important goal but that was just a personal feeling when I was reading the articles.
From a public health standpoint, I think it is also valid to consider the benefit of younger people getting boosted to help them not infect older people who are at serious risk.
You raise an interested moral dilemma for public health and their spreadsheet math. I agree with you up to a point. How far should one take this logic? Is it fair to recommend (or worse, mandate) that all babies should be vaccinated just to protect the eighty year olds who refuse to wear masks and opt to vacation on cruise ships? What about children? Teens?
Great point, given how effective these vaccines have been at stopping transmission. We should expect young people to make certain sacrifices to save their elders. If our sons get myocarditis we should treat them like we treat our military vets.
Thank you, Dr. Jetalina, for your labor of love (and big congrats!)! Like so many others, your work has been a lifeline for me during these crazy times. We are a family of four, all vaccinated and boosted once. My children got their Pfizer boosters before school started, and my husband and I were boosted last fall. We have been very careful, masking indoors all day, every day at work and school until recently. Feeling very unsure about the new booster. My husband has tested positive for Covid pre vaccine, so, ostensibly, he has some good immunity. My boys and I have never had a positive test. Moderna 2 and the booster incapacitated me for a solid two days of a headache so bad I wondered if I had an aneurysm and endless vomiting. I was unable to care for my family or myself. We just recently got over “just a respiratory virus” (RSV, Covid, and influenza swabs were negative), and I would take that week of congestion, headache, coughing, and feeling yuck over the 48 hours of vomiting misery any day. I don’t know what to do. Paul Offitt would say I am well protected. My doctor says “maybe try Pfizer.” I was hoping there might be a different vaccine to try because it’s hard to know why I had such a reaction but most of my friends (early 40s and healthy) sailed through with minimal side effects. I don’t want to leave myself vulnerable, but I am scared.
Thank you so much for writing this post. When I heard about the Florida debacle I was so comforted to know that you'd be writing about it shortly.
I know you probably have an epic list of things to write about, but if it's not on there already, could you please add "Nasal vaccines for COVID"? I've been reading about the potential for sterilising immunity with those still-in-development vaccines, which is wildly exciting to me as someone who's been masking and in a small bubble for the entire pandemic.
If patient has arrhythmia following covid in mid September, should the patient wait to get new booster until arrhythmia clears? My husb tested positive, I did not but felt weird symptoms - I had covid in may and felt similar in sept despite repeated negative rapid tests.
I await echocardiogram and am having PVCs though continuing work and usual activities.
So question is if symptoms of mycocarditis exist, should one get the 3rd booster.
Here's what the CDC website says about how to handle a history of myocarditis:
"People who have a history of myocarditis or pericarditis unrelated to vaccination [sic] may receive any currently FDA-approved or FDA-authorized COVID-19 vaccine after the episode of myocarditis or pericarditis has completely resolved. This includes resolution of symptoms attributed to myocarditis or pericarditis, as well as no evidence of ongoing heart inflammation or sequelae as determined by the person’s clinical team. For people who have a history of myocarditis associated with MIS-C or MIS-A, see COVID-19 vaccination and MIS-C and MIS-A."
After hearing that the fall booster would provide some protection against infection, at least in the short term, my husband waited two weeks and then went to work without a mask. It took 3 days in the office and he then started to show symptoms and I followed two days later. Symptoms lasted almost two full weeks. I know there were no human studies done on the bivalent booster. Is it reasonable to pass on the messaging that these new booster provide protection again infection without any studies? My niece also tested positive 3 weeks after her booster.
Had we not repeatedly heard that we had some short term immunity, we would have continued to mask.
Ugh I’m so sorry to hear this. As I mentioned in a comment below, this is the great debate right now. We only have human studies on antibodies, and it’s clear the boosters increase antibodies. Antibodies correlate with prevention. There are new subvariants circulating, though, that we don’t quite understand yet so maybe he got one of these?
Anything is possible, but we live in a suburb of NYC where supposedly it is predominantly BA5.
I just really wish that the messaging was different, given the lack of any human studies. Of course we still would get the recommended boosters, but we would have continued to remain cautious. If the booster was really effective, I would think that 3 weeks would have provided more protection.
5 vaccines and a recent COVID infection and I’m still uncomfortable going anywhere without a mask now
I do want to thank you again for all of the time that you spend educating those of us that don’t have a medical background. It is so greatly appreciated!
This is such a hard story to hear, especially for those of us who have been very cautious and used multiple “tools” to avoid infection. It also makes me wonder to what extent the amount of exposure (near an infected person all day indoors) has something to do with the chances of infection. Would the vaccine have been more protective for a passing exposure or with greater ventilation? These are the types of risks I’m weighing every day. Is it okay to walk through a restaurant to get to outdoor seating? How risky is it to remove a mask indoors at a meeting for a speaking portion only? And the list goes on…
I hope you are feeling well and now have broader immmunity.
Thank you for this excellent newsletter! Can you address in a future edition whether people with Long Covid should get the bivalent booster? I have heard differing accounts - some people with long Covid experience symptom improvement after a booster, some see no effect, and some have worsening symptoms/relapse. It has been almost three months since my initial Covid infection (which I contracted in August while fully vaccinated and 2x boosted with Pfizer) but I still have severe and debilitating extreme fatigue / cognitive impairment / POTS. These symptoms have been improving slowly over time, but it would be devastating to get the bivalent booster only to have the symptoms worsen again and go back to square one.
Thanks, as always, for your info. My son originally got the J&J because he only wanted one shot. He ended up getting a Moderna booster in January because his school required it. Is the J&J totally off the market now in the US? Interestingly, he is the only one in our household that has not gotten COVID despite living in a dorm, going to concerts, working in person, and living with me when I got COVID after four mRNA vaccines - two initial Pfizer, one Pfizer booster, and one Moderna booster (I did isolate at home). Makes me wonder if J&J was discounted too quickly. . . In any case, I don't think he will be inspired to get a bivalent booster!
J&J followed by an MRNA booster was one of the most effective combos, if I recall correctly. That said, I am also a “Novid” with 3 Pfizers and a Moderna, a ton of exposure (hospital nurse until this year, still work with the public) and lots of testing. There are currently studies about possible genetic markers for those with heavy exposure who never get infected. It’s interesting.
Thank you for these data. Could you comment on the risk/benefit balance of getting boosters in this and other younger cohorts in those with a previous history of covid. I am particularly interested in those who have a history of covid during the omicron period.
I am interested in this as well. I was unfortunate enough to have omicron before eligible for the booster and am wondering if the booster is worth it at this point, or at what point it will be beneficial.
Your myocarditis chart is very different from the one presented at the recent CDC ACIP meeting where the bivalent booster was approved. That chart showed a myocarditis rate following the 1st booster for 16-17 year old boys of **188** per million.
Hey Katelyn, I did a similar analysis when I was threatened to lose my job, but came to a slightly different result. If you have the time, I’d like to know what I missed and how to improve/update my numbers.
Can we please get some more coverage and attention regarding Novavax?
It doesn’t wane or need variant-based boosters and is less risky in terms of side effects, being protein-based and similar to a flu-shot rather than mRNA (which clearly seems to be a failed experiment in terms of providing sterilizing immunity).
I would love to see more data from Israel who has approved and adopted it earlier but I think we will see too late that the politicized slow-walking of it will cost the US in the long run.
It’s ridiculous that it’s only available as a primary series as at this point in the game there are vaxxers and anti-vaxxers; very few of the latter care about the scientific differences of various vaccines, hence the minimal Novavax uptake as a primary series.
IMO if we can experiment on the entire population with novel and moderately useful mRNA vaccines, we should have full access to the more traditionally developed and likely more useful Novavax.
Hello. The bivalent boosters for kids 5 and older just got approved. Do you have any data on whether there is a higher risk of myocarditis with moderna vs pfizer in males between 5-12.
"Only you can weigh those benefits with risks, but to me the story is still clear: everyone should get a fall booster."
But there are other costs to getting the booster that are under your control. So it's not only "you can weigh" based on benefit and risks of the booster alone. If you don't get a booster you might not be able to go to school. Your immigrant family may not be acceptable for entry into the U.S. You might lose you job if you don't get the booster, or not be hired.
I think it is also important to mention, since CDC shoved in fine print, that males between 18-39 are recommended more spacing. They really should have done more to advertise it for clinicians and parents, but I can understand the worry. When I mention it, I'm often met with surprise.
"An 8-week interval between the first and second primary series doses of Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines may be optimal for some people ages 6 months–64 years, especially for males ages 12–39 years, as it may reduce the small risk of myocarditis and pericarditis associated with these vaccines."
Another consideration for the risk bucket: because these vaccines are so new, we don’t know the longer term implications of taking them.
Question - how much weighting should be applied to a possible long term risk that is currently unknown but could be severe? If we exclude the “unknown future” from our cost/benefit math, we are saying “there is zero chance of any long term harm.” But in the real world, we know some things do in fact cause long term harm.
Please help me to understand why you and others write that prevention of death and hospitalization are the primary goals of the vaccine. Weren’t those secondary endpoints in the clinical studies?
Fwiw, I’m pro-vax bit have come to develop a degree of skepticism re experts who seem to reflexively paper over any concerns.
I’ve always found you to be nuanced and thus one of my main sources for info, so I ask with all respect and curiosity.
This is a really good question. And, honestly, as a nation we didn’t define what the goal of vaccines were until about a month ago. There’s always been a debate whether it’s to prevent severe disease or to prevent infections. It’s still being debated, which is why you’ll see different viewpoints on whether benefits outweigh risks. I think this caused a ton of confusion. Yes, infections were the primary endpoint for clinical trials.
I will preface my reply with an acknowledgement that I am not 100% certain of what I am about to write, but I am reasonably confident it is correct.
As stated in their press release of November 18, 2020 (see https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine), Pfizer/BioNTech had as their primary efficacy endpoint the prevention of COVID-19. And in the Phase 3 trials they achieved that in 95% vs. placebo.
What I think people are getting confused about is that SARS-CoV-2 infection ≠ COVID-19. The former is an infection by the virus irrespective of the presence of symptoms, whereas the latter is the symptomatic disease. Someone with an asymptomatic SARS-CoV-2 infection does not have COVID-19, just as someone with an asymptomatic HIV infection does not have AIDS.
It also turned out that the vaccines did, in fact, prevent SARS-CoV-2 infections to a large extent, but this was a pleasant surprise and not a primary efficacy endpoint. And the impressive figures for prevention of infections were for the ancestral/Wuhan strain. The ability to prevent some infections (symptomatic or not) has persisted with subsequent variants and subvariants (as best I can tell), but the degree to which those infections are reduced, and the duration of time during which those infections are reduced, have decreased with the evolution of the virus.
I think many are conflating SARS-CoV-2 infection with COVID-19, and they are not the same. It may seem to be a subtle distinction, but without making the distinction, we run the risk of confusing not only the public but also ourselves. Such confusion can breed mistrust, particularly if it is amplified by those who (for reasons unknown to me) wish to propagate the message that the vaccines are dangerous, a fraud, or whatever other excuse they can manufacture to get the public to avoid the vaccines.
These are excellent points. They raise a thorny issue: at what point will we no longer be obliged to *know* if we're infected? There hasn't been a disease in human history with this much asymptomatic testing.
My own personal answer to this is: when my own health insurance stops paying for covid tests.
Thanks. Feel free to quote me, with or without attribution. I'm only interested in trying to keep the facts straight (and there are a lot of facts to keep straight).
You're welcome, and thanks for your reply (and the several others on this YLE post, and others), and for the additional analogies. They are useful, I believe, in offering a more concrete perspective of risks and mitigation.
Yes, I read Katherine Wu's article last year when it came out, and I have referenced it a few times myself. I agree it's a viewpoint that needs to be more widely shared.
With the growing concerns about long COVID and impacts after COVID, I would love to hear more about efforts to find some method for stopping infection more effectively (nasal vaccines, etc.).
When I read the early studies I felt like prevention of hospitalization and death was very prominent in the writing. There were many charts in the peer reviewed literature about prevention of hospitalization and death. I know there were also charts about prevention of infection. I felt it was clear pretty early on in the research that the vaccine was more effective against hospitalization than death than infection. I don't know if this answers your question but I feel like the scientists writing the papers have always cared about prevention of hospitalization and death. I'm sure there was media saying that that the main point of the vaccine was to prevent infection infection but I'm not as familiar with exactly what the media was saying about it.
Just so we're clear, I do actually think that it's going to be possible to eradicate covid eventually - at any rate, still worth trying. We may have set ourselves back a decade, but it's doable. I'm basing this on the staggering amount of low hanging fruit that's yet to be picked:
1. We haven't even begun to phase in buildings with improved ventilation and filtration.
2. Multivalent vaccines are still in their early stages
3. Sure, there may be animal reservoirs, but we don't know how long immunity might last in animals, and we haven't even begun a concerted campaign to mass vaccinate domestic, farmed, and commensal mammals
Thx for your thoughtful response. What I was specifically referring to was the definition of primary and secondary endpoints in the clinical trials - which then become label claims. Idk, but had heard, that prevention of infection was the primary endpoint. The others were secondary.
(Sorry for the weeds-my job used to be clinical research)
Oh I know what you are saying now. I remember seeing those words in the writing but I didn't think about those words explaining what the most important goal was. But obviously it seems like the word primary conveys to the reader that pervention of infection was the most important goal. I always thought prevention of hospitalization and death seemed like the most important goal but that was just a personal feeling when I was reading the articles.
From a public health standpoint, I think it is also valid to consider the benefit of younger people getting boosted to help them not infect older people who are at serious risk.
You raise an interested moral dilemma for public health and their spreadsheet math. I agree with you up to a point. How far should one take this logic? Is it fair to recommend (or worse, mandate) that all babies should be vaccinated just to protect the eighty year olds who refuse to wear masks and opt to vacation on cruise ships? What about children? Teens?
Great point, given how effective these vaccines have been at stopping transmission. We should expect young people to make certain sacrifices to save their elders. If our sons get myocarditis we should treat them like we treat our military vets.
Thank you, Dr. Jetalina, for your labor of love (and big congrats!)! Like so many others, your work has been a lifeline for me during these crazy times. We are a family of four, all vaccinated and boosted once. My children got their Pfizer boosters before school started, and my husband and I were boosted last fall. We have been very careful, masking indoors all day, every day at work and school until recently. Feeling very unsure about the new booster. My husband has tested positive for Covid pre vaccine, so, ostensibly, he has some good immunity. My boys and I have never had a positive test. Moderna 2 and the booster incapacitated me for a solid two days of a headache so bad I wondered if I had an aneurysm and endless vomiting. I was unable to care for my family or myself. We just recently got over “just a respiratory virus” (RSV, Covid, and influenza swabs were negative), and I would take that week of congestion, headache, coughing, and feeling yuck over the 48 hours of vomiting misery any day. I don’t know what to do. Paul Offitt would say I am well protected. My doctor says “maybe try Pfizer.” I was hoping there might be a different vaccine to try because it’s hard to know why I had such a reaction but most of my friends (early 40s and healthy) sailed through with minimal side effects. I don’t want to leave myself vulnerable, but I am scared.
Thank you so much for writing this post. When I heard about the Florida debacle I was so comforted to know that you'd be writing about it shortly.
I know you probably have an epic list of things to write about, but if it's not on there already, could you please add "Nasal vaccines for COVID"? I've been reading about the potential for sterilising immunity with those still-in-development vaccines, which is wildly exciting to me as someone who's been masking and in a small bubble for the entire pandemic.
If patient has arrhythmia following covid in mid September, should the patient wait to get new booster until arrhythmia clears? My husb tested positive, I did not but felt weird symptoms - I had covid in may and felt similar in sept despite repeated negative rapid tests.
I await echocardiogram and am having PVCs though continuing work and usual activities.
So question is if symptoms of mycocarditis exist, should one get the 3rd booster.
Thanks
Here's what the CDC website says about how to handle a history of myocarditis:
"People who have a history of myocarditis or pericarditis unrelated to vaccination [sic] may receive any currently FDA-approved or FDA-authorized COVID-19 vaccine after the episode of myocarditis or pericarditis has completely resolved. This includes resolution of symptoms attributed to myocarditis or pericarditis, as well as no evidence of ongoing heart inflammation or sequelae as determined by the person’s clinical team. For people who have a history of myocarditis associated with MIS-C or MIS-A, see COVID-19 vaccination and MIS-C and MIS-A."
Here's the link to the page: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#myocarditis-pericarditis
After hearing that the fall booster would provide some protection against infection, at least in the short term, my husband waited two weeks and then went to work without a mask. It took 3 days in the office and he then started to show symptoms and I followed two days later. Symptoms lasted almost two full weeks. I know there were no human studies done on the bivalent booster. Is it reasonable to pass on the messaging that these new booster provide protection again infection without any studies? My niece also tested positive 3 weeks after her booster.
Had we not repeatedly heard that we had some short term immunity, we would have continued to mask.
Ugh I’m so sorry to hear this. As I mentioned in a comment below, this is the great debate right now. We only have human studies on antibodies, and it’s clear the boosters increase antibodies. Antibodies correlate with prevention. There are new subvariants circulating, though, that we don’t quite understand yet so maybe he got one of these?
Anything is possible, but we live in a suburb of NYC where supposedly it is predominantly BA5.
I just really wish that the messaging was different, given the lack of any human studies. Of course we still would get the recommended boosters, but we would have continued to remain cautious. If the booster was really effective, I would think that 3 weeks would have provided more protection.
5 vaccines and a recent COVID infection and I’m still uncomfortable going anywhere without a mask now
I do want to thank you again for all of the time that you spend educating those of us that don’t have a medical background. It is so greatly appreciated!
This is such a hard story to hear, especially for those of us who have been very cautious and used multiple “tools” to avoid infection. It also makes me wonder to what extent the amount of exposure (near an infected person all day indoors) has something to do with the chances of infection. Would the vaccine have been more protective for a passing exposure or with greater ventilation? These are the types of risks I’m weighing every day. Is it okay to walk through a restaurant to get to outdoor seating? How risky is it to remove a mask indoors at a meeting for a speaking portion only? And the list goes on…
I hope you are feeling well and now have broader immmunity.
Thank you for this excellent newsletter! Can you address in a future edition whether people with Long Covid should get the bivalent booster? I have heard differing accounts - some people with long Covid experience symptom improvement after a booster, some see no effect, and some have worsening symptoms/relapse. It has been almost three months since my initial Covid infection (which I contracted in August while fully vaccinated and 2x boosted with Pfizer) but I still have severe and debilitating extreme fatigue / cognitive impairment / POTS. These symptoms have been improving slowly over time, but it would be devastating to get the bivalent booster only to have the symptoms worsen again and go back to square one.
Thanks, as always, for your info. My son originally got the J&J because he only wanted one shot. He ended up getting a Moderna booster in January because his school required it. Is the J&J totally off the market now in the US? Interestingly, he is the only one in our household that has not gotten COVID despite living in a dorm, going to concerts, working in person, and living with me when I got COVID after four mRNA vaccines - two initial Pfizer, one Pfizer booster, and one Moderna booster (I did isolate at home). Makes me wonder if J&J was discounted too quickly. . . In any case, I don't think he will be inspired to get a bivalent booster!
J&J followed by an MRNA booster was one of the most effective combos, if I recall correctly. That said, I am also a “Novid” with 3 Pfizers and a Moderna, a ton of exposure (hospital nurse until this year, still work with the public) and lots of testing. There are currently studies about possible genetic markers for those with heavy exposure who never get infected. It’s interesting.
I work for a health department and we do not offer J&J. It’s not something we can order or administer anymore.
Right, we do stock Novavax, although the demand for it as a primary series has been very low.
Thank you for these data. Could you comment on the risk/benefit balance of getting boosters in this and other younger cohorts in those with a previous history of covid. I am particularly interested in those who have a history of covid during the omicron period.
I am interested in this as well. I was unfortunate enough to have omicron before eligible for the booster and am wondering if the booster is worth it at this point, or at what point it will be beneficial.
Your myocarditis chart is very different from the one presented at the recent CDC ACIP meeting where the bivalent booster was approved. That chart showed a myocarditis rate following the 1st booster for 16-17 year old boys of **188** per million.
Hey Katelyn, I did a similar analysis when I was threatened to lose my job, but came to a slightly different result. If you have the time, I’d like to know what I missed and how to improve/update my numbers.
https://www.dropbox.com/s/zgxwu7h51sfmmav/Req%20for%20Relig%20ExemptionV4p0.pdf?dl=0
Can we please get some more coverage and attention regarding Novavax?
It doesn’t wane or need variant-based boosters and is less risky in terms of side effects, being protein-based and similar to a flu-shot rather than mRNA (which clearly seems to be a failed experiment in terms of providing sterilizing immunity).
3 doses of Novavax also seems to be enough for mucosal immunity (don’t have the study handy but here’s a layman’s explanation: https://twitter.com/doneford/status/1576395937152278528)
Also, zero myocarditis in 18,000 doses in Singapore:
https://www.channelnewsasia.com/singapore/novavax-nuvaxovid-covid-19-vaccine-18000-doses-5-severe-reactions-2948716
Sorry I should say wanes less. It seems like subsequent mRNA boosters also wane more quickly than initial.
NVAX durability at 6 months is closer to initial and 3rd dose shows huge jump (sorry I don’t have the link to the study containing this graph: https://twitter.com/doneford/status/1576404689045766144).
https://ir.novavax.com/2022-02-28-Novavax-Announces-Extended-Durability-of-Protection-Against-Infection-and-Disease-in-United-Kingdom-COVID-19-Vaccine-Phase-3-Clinical-Trial
I would love to see more data from Israel who has approved and adopted it earlier but I think we will see too late that the politicized slow-walking of it will cost the US in the long run.
It’s ridiculous that it’s only available as a primary series as at this point in the game there are vaxxers and anti-vaxxers; very few of the latter care about the scientific differences of various vaccines, hence the minimal Novavax uptake as a primary series.
IMO if we can experiment on the entire population with novel and moderately useful mRNA vaccines, we should have full access to the more traditionally developed and likely more useful Novavax.
Hello. The bivalent boosters for kids 5 and older just got approved. Do you have any data on whether there is a higher risk of myocarditis with moderna vs pfizer in males between 5-12.
"Only you can weigh those benefits with risks, but to me the story is still clear: everyone should get a fall booster."
But there are other costs to getting the booster that are under your control. So it's not only "you can weigh" based on benefit and risks of the booster alone. If you don't get a booster you might not be able to go to school. Your immigrant family may not be acceptable for entry into the U.S. You might lose you job if you don't get the booster, or not be hired.
However, none of these “costs” has anything to do with science.
I think it is also important to mention, since CDC shoved in fine print, that males between 18-39 are recommended more spacing. They really should have done more to advertise it for clinicians and parents, but I can understand the worry. When I mention it, I'm often met with surprise.
"An 8-week interval between the first and second primary series doses of Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines may be optimal for some people ages 6 months–64 years, especially for males ages 12–39 years, as it may reduce the small risk of myocarditis and pericarditis associated with these vaccines."
It is an asterisk note on their clinical guidance, where the main text is just a range. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#not-immunocompromised