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. The state of Florida no longer recommends vaccines for this group.
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.
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.
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.
Or if you live in the uk and are under 50 (and not at greater risk) you won’t get the option. We aren’t banning it for under 50s, we are just only prepared to pay for the most at risk to have it, despite what some people think.
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.
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.
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!
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.
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).
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.
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.
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.
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.
Or if you live in the uk and are under 50 (and not at greater risk) you won’t get the option. We aren’t banning it for under 50s, we are just only prepared to pay for the most at risk to have it, despite what some people think.
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
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.
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!
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.
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
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.