I understand that vaccines take time to make, but I don’t understand why the updated fall ‘24 booster won’t be released until *after* the summer surge.
If Public Health wants people to take Covid boosters once (or twice) a year, they need to be released *before* the surge.
My guess is FDA’s rationale for following the flu model is to maximize the number of people who get the covid boosters at the optimal time (right before the winter surge).
People get the flu vaccine in the fall because they haven’t had the flu and want to avoid it. But if you just had covid, you probably figure you don’t need the booster (natural immunity).
This is the lesson from the low covid booster uptake in Fall ‘23. Unfortunately, it appears we’re repeating the same mistakes.
BUT we took our COVID booster last fall (Oct. '23) so by July that is 9 months, so the timing is not predictable....I am just glad that in our area doctors will prescribe Paxlovid because I have taken it both times I have had COVID, including this past week, and it definitely helped.
Not that the Flu model is has a great track record. Since the Flu typically 40-60% with some really bad mismatched years. The selection is done in February for the fall season. However, as noted in last my substack, non-egg based vaccines can make possible delaying the selection closer to the flu season in the northern hemisphere. With SARS-CoV-2, the variants are evolving at greater rate. Making this using the flu model much like the virtual 'apples and oranges' comparison.
I have patients who would love a fall OR summer booster depending on how active they are going to be Ie travel/ work trips, big parties. They might vaccinate once a year but want the most current version. Also it seems that if you are more current to the circulating version of covid less probability of long Covid.
Public Health also needs to explore trials for prophylactic sprays and other hypothesized ways of mitigation. If the goal is to prevent spreadable illness, we need to look beyond vaccines (that people won’t get), masks (that people won’t wear), restrictions (that people won’t listen to), and improving air quality (the simplest thing that gets no traction, though I have air purifiers in each on my classrooms and all through my house). I hope the nose sprays I have been using don’t come with harmful effects, but they make me feel like I am doing something.
I suspect it has to do with waning protection. Get your booster in early July for the summer surge and you might not have much protection in January during the (larger) winter surge. Especially if we get a new variant.
Seems like biannual shots might make sense as long as we're having two waves a year but I doubt the CDC will go that way.
I like the idea of biannual shots, with an updated variant every 6 months (if appropriate).
By the time the boosters come out (when? … September / October), most people will have already been infected with JN.1 and new variants will be in circulation. So why bother getting the “new” booster?
Also, if it’s true that Novavax offers at least 8 months protection, a person could get boosted in June and be protected against both the summer and winter surges.
Novavax is JN.1. though. I'm a big fan of Novavax; It's the only one I had zero reaction to and I like the longer protection. But the MRNA vaccines are against kp3 which is going to be the circulating variant this fall. I'm a little unsure what I want to do.
I don't know your age, and I am not of the age or immune status to get two boosters a year. I am going with Novavax because I still haven't had Covid and loved not feeling like utter crap when I got boosted last fall. Epi Michael Osterholm said in his recent podcast that he was going to get Novavax as soon as it comes out and mRNA as his late winter/early spring booster. That could be an option for you if you qualify.
Replying to myself to say that on his recent podcast he said he just got the booster that’s currently available and will boost again with mRNA in four months.
Originally, it was JN.1 for all vaccines but the FDA changed their recommendation to KP.2. How well will this work with KP.3.1.1, the now dominate variant in the US? That's a question From Forbes:
"The FDA originally recommended the vaccines target the coronavirus’ JN.1 variant, but later changed this recommendation to advise manufacturers to focus on the KP.2 strain of the JN line after reviewing updated case data."
"Both Moderna and Pfizer said they were prepared to formulate either vaccine—and will make KP.2 vaccines after the FDA’s updated guidance—while Novavax said its manufacturing for a JN.1 shot is already underway and it won’t have a KP.2-specific shot ready in time for the fall."
I'm also a big fan of Novavax. Having experienced 24 hr misery after each mRNA vaccine I received, I was happy to get my first Novavax in late October. It slowed me down a little, but nothing like Moderna or Pfizer.
That said, I will be opting for an mRNA vaccine once again this fall. Why? Because mid-March I experienced covid infection for the first time. Fortunately, my symptoms were short-lived and very mild. I'm guessing JN.1 was the culprit, but never confirmed. So I'm looking to add to my immunity profile by opting for something that addresses FLiRT mutations, but not looking forward to experiencing that 24 hr mRNA slump again.
The boosters aren't available (either the old one - my parents tried in vain to get one in late June and no luck - or the new one) because FDA wants it to be true that it's a seasonal virus and we get a Covid booster in the fall like we get a flu shot. (And maybe super vulnerable people get boosted again in late winter, like with flu depending on the length of the flu season). I understand wanting to simplify things for people, but wanting and reality are different! It feels like we should have a June booster and a November booster for now, with the way Covid is actually playing out.
I still haven't had Covid and I'm 10 months since my last booster, so I don't love that while sending my kids back to school and doing all the back to school stuff (maskless because I just can't be the only one). The bigger deal is with booster timing - I don't want to boost myself or my kids if we've just had an infection, so that would make us seem like part of the population who are opting out of the fall booster campaign. So I just have to cross my fingers that we get lucky.
Edited because I said CDC when I should have said FDA and it's been bothering me.
Yeah I think it seems location-dependent. Their experience makes me think it's not a feasible plan for all eligible people to make (to forgo a spring booster and wait until early summer to get boosted since that's when new waves start). My 75 year old dad ended up getting Covid for the first time in mid July. Who knows if a booster would've helped prevent it. His case has thankfully been extremely mild.
Welcome back from what sounds to have been a beautiful—and certainly well-earned-vacation. You and the team have once again given us a clear, informative report. I have been curious to see that the Northeast region remains lowest on COVID and wonder whether it is escaping the worst of the wave, or whether the wave is just late in coming. I also found your report on the H5H1 tremendously informative, including getting “under the hood” on the efforts CDC is making, which are usually invisible to the unaffected public. It is very sad to learn of the wave of monkeypox in Africa, also something about which I have seen nothing elsewhere, but which I hope is getting strong attention from appropriate governmental and humanitarian agencies.
This is anecdotal story. My wife and I are both 76 and healthy (normal BMI, no meds, been eating a LF-WFPB diet for 15 years, and exercise regularly). Our last booster was in Q4 of 2022. My wife’s lab work in Jan 2024 showed her Covid antibodies above 150 (the max of the test). We had no recollection of having a cold in 2023. But in ~Oct-2023, I felt like I could be coming down with a cold, but that feeling disappeared in less than 24 hours. My wife experienced the same thing a few days later.
I had my yearly lab work done about 2 months ago. My Covid antibodies also showed above 150. Even if I had a Covid exposure in Oct-23, I would think that my tested Covid antibody levels would have been quite low.
Our physician, about 1 month ago said the following: (1) he has also noted high Covid antibody levels in 80+% of his patients, and suggested, perhaps this is what herd immunity is like; and, (2) a lot of people that show up to the hospital/emergency-room for various reasons (unrelated to cold symptoms) test positive for Covid, but have no symptoms. We live in Miami Beach, and tend to be hermits. So, we don't get a lot of exposure.
One hypothesis. From a long ago flu study (deliberate injection in nasal passages, of various doses of Flu virus). the degree of sickness was proportional to the exposure. I think the recent similar UK study reported using Covid virus showed a comparable effect. So perhaps, my wife and I were exposed in Oct-2023 to one of the circulating Omicron variants, but a small dose. And, our immune system was sufficient to prevent sickness, but sufficient to also produce antibodies in our upper respiratory system (e.g. nasal passages). Hopefully, the kind of thing that would happen if/when we have a nasal-based Covid vaccine.
It would certainly be interesting if our experience is more than just anecdotal.
I've always wondered about this! It seems logical that if you were exposed to a virus and mounted an immune response that rendered you symptom-less, you would have antibodies and as much immunity as someone who felt terrible, right?
I was really hoping to be part of the control group, the people that never had COVID, but after four years of diligently avoiding it, I caught COVID at my mother's funeral. Guess isolating in my house gives me a week or so to sit with grief and my cough at the same time. :-/
I am curious about your statement that "vaccination rates are the same" this summer. Spring 2023, almost everyone I know got boosted. This year, almost no one I know was even aware it was possible to get a spring booster. My hypothesis is that immunity levels are much lower this summer owing to longer time since last vaccination - last fall for most folks.
I'm 69 years old and considered high risk due to age, hypertension, obesity. My last booster was in November 2023. Before going on international long-distance air travel later this month, I tired to follow your previous newsletter's reasonable recommendation to get my booster vaccination. I am insured by a Medicare Advantage Plan through UCLA with Kaiser Permanente Northern California, one of the largest insurers in Northern California. They informed me last week that they have no vaccine available anywhere in Northern California and they will not be able to provide any Covid-19 vaccination until the new vaccines become available in the fall. They report that they could not get ordered shipments of vaccine in June and decided not to order vaccines until the fall although the disruption of shipments was short and ended sometime in July according to a CVS pharmacist I spoke to when I got my booster vaccination there paying $190 out of pocket for it (and another $190 for my wife). When I called Kaiser Permanente's member services to request reimbursement for this booster vaccination they informed me after 45 minutes on the phone that I am not eligible because they do not reimburse any vaccinations through out-of network providers except those administered during emergency care visits. I will submit a claim for reimbursement regardless because Medicare covers booster vaccinations for my demographics, CDC just recommended it again, and Kaiser Permanente's policy is an unjustifiable neglect and refusal to care according to CDC guidelines and Medicare contracts. But I'm writing this here to suggest that such barriers to access to booster vaccinations may be a major contributing factor to the unexpected high summer wave of wastewater Covid virus in our state. And the price of $190 for a vaccination is prohibitive for at least 50% of Americans who live with less than $500 available for any emergency in their family and a clear deterrent for anybody living with a tight budget, especially the most vulnerable elderly multimorbid populations. In addition, I witnessed during my visit to the San Rafael Kaiser medical offices that many Kaiser employees did not wear any masks when meeting me or others including my primary care physician, the intake nurse, the receptionist and cashier and many staff members I met in the halls or elevators. Those that wore masks wore insufficient and often ill-fitted surgical masks only (e.g. nose free and loose) instead of the more protective N95 or KN95 masks. The primary care physician owned a KN95 masks but did wear it because it impeded her working comfort. When I commended the phlebotomist for wearing a mask while drawing my blood (during a previous visit in July most phlebotomists in that unit did not wear any masks at all) and asked him why he did wear an insufficient surgical mask and not a safer mask he responded that Kaiser only provides surgical masks for their staff and surmised that it is a cost saving policy. He was clearly unhappy about this because he had witnessed many people die of Covid while serving in the Philippines at the beginning of the pandemic. Clearly hospital staff and patients do deserve better especially in an organization that has a proud history of providing onsite care for injured workers. I would like to see such irresponsible medical and corporate policies be exposed and criticized on public health, ethical, and economic grounds in one of the next updates, maybe a health services research economist in the audience can help with crunching the numbers for the latter part. I don't think that saving pennies on PPE will even improve the bottom line of the insurer given the costs of replacement of sick staff and diagnosing and treating insured members who get infected by health care workers due to insufficient PPE and isolation practices. Also, does anybody know who at Kaiser could be contacted with a request to immediately update and change their inefficient and unsafe policies? All my previous inquiries regarding other issues remained unanswered or referred to a department defensively dealing with medico-legal issues and requiring filing formal legal claims, nobody willing to take a call or respond to teh constant of my e-mails. Thanks! Niklas Krause, MD, PhD, MPH, Professor Emeritus of Epidemiology and Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA)
I haven’t looked closely but recall there was concern last November about low rates of booster uptake relative to previous years (<20% receiving the fall 2023 bivalent booster). I think we could be dealing with very low vaccine immunity for infection coupled with virtually no masking or ventilation measures. 😞
Dr. Jetelina, thank you for the updates. Please help with sharing your voice in these matters: the mask ban in Nassau County passed, more likely to come. We need more voices, clear logical reasonable voices advocating for everyone's right to use personal protection in the face of current and future pandemics.
To what degree could summer waves be caused by (more) intense heat forcing more people indoors? The world is just flat-out heating up and this summer has been especially brutal. June and July were also much hotter than usual
On my PCP recommendation, I didn't get a vaccine prior to my trip in late May/early June since it wasn't six months since my last vaccine. Upon returning, however, no vaccine was available and was told the vaccine addressing new variants would be available in Aug. Well, now it's Aug. Still no vaccines and one pharmacist said it would be ready in Sept. That's too late for my late Aug trip. Dang! Want a vaccine but no vaccines available for months.
Not sure why, but one could not find anyone with a Novavax since June. Traveling patients who were agreeable to a boost and eligible could not find in on the East coast, my sister could jot find on the West coast. What was the logic in that, especially given they were unlikely to produce a new one quickly?
As it has been, still a frustrating situation.
Nobody cares. Getting a patient to test is like trying to get someone to have an amputation electively.
Thank you, as always. As you say, apart from protective measures against covid, there's not much for a person here to do. But knowing the risks that poultry workers are running, and the terrible human cost of monkeypox in Africa, are at least spurs to compassion. The information can open up conversations about why we allow such separation from other humans, that children can die because they do not have access to immunizations or medical care. You continue to do a great service. And I'm glad you took a rest. Please take more--we count on you.
I can attest to the unpredictable nature of the current Covid wave: I contracted Covid during the last week of June 2024 and recovered (several negative tests over a week). Then I traveled to Alaska on July 18, 2024; I did not wear a mask, thinking, between vaccinations/boosters and recent illness, I was immune. On August 4, 2024, three days after returning from Alaska, I have Covid again. I am thankful the illness is very mild. White, 69yo, good health.
Ugh. My husband and I had been staying up to date on vaccines, yes masking always in crowded public spaces but no boosters since October '23. Well, we attended a family reunion in KY about 1.5 weeks ago, and one event was in a crowded and poorly ventilated restaurant and there was a big group of us. I wish I had been more "on guard". The meeting room at the lodge was very spacious and well ventilated, as was their dining area, but NOT this restaurant off site. Then the next night everyone was in this spacious meeting room they turned the ceiling fans OFF. sigh.....everyone talking and playing cards and eating and it got warm in there even though spacious.....
Monday as we were traveling home we both started feeling sick. Tested negative that night at home. By Weds. tested again and POSITIVE. Just our 2nd time ill. 1st time May '22. My husband just turned 65, I will in a few months. Last time I got Paxlovid he did not. This time we both have. By the time we started the meds on TH it was the 4th day! So one could easily miss the window for that, we did wait 48 hrs between the tests. The Paxlovid is not fun but I think it HELPS. He is recovering faster than I am but I am OK I think.
SO, folks~DO NOT go to crowded and poorly ventilated indoor spaces! We knew better but by the time we got to the place, we just went along with the family, those folks tended to be much more nonchalant about COVID. sigh...thank goodness for the vaccines, good masks available, and Paxlovid. ugh. It is OK to be cautious. We just got more relaxed than we had been...
I just do not get it that folks don't get it.....ie, that masking sometimes is OK!
My COVID vaccine injection missed the mark, causing chronic shoulder pain (SIRVA). Was the injection effective, or should I get another? Danger's rising fast here in Maine, and I'm elderly.
Thank you for this article and update. What specifically do you mean when you say get that indoor air flowing? Also, do you recommend an indoor air filtration type system, like a room air purifier?
I understand that vaccines take time to make, but I don’t understand why the updated fall ‘24 booster won’t be released until *after* the summer surge.
If Public Health wants people to take Covid boosters once (or twice) a year, they need to be released *before* the surge.
I hear you. FDA seems to be trying to fit Covid into the flu model, which doesn’t seem to be working very well for those of us paying close attention
My guess is FDA’s rationale for following the flu model is to maximize the number of people who get the covid boosters at the optimal time (right before the winter surge).
People get the flu vaccine in the fall because they haven’t had the flu and want to avoid it. But if you just had covid, you probably figure you don’t need the booster (natural immunity).
This is the lesson from the low covid booster uptake in Fall ‘23. Unfortunately, it appears we’re repeating the same mistakes.
BUT we took our COVID booster last fall (Oct. '23) so by July that is 9 months, so the timing is not predictable....I am just glad that in our area doctors will prescribe Paxlovid because I have taken it both times I have had COVID, including this past week, and it definitely helped.
Not that the Flu model is has a great track record. Since the Flu typically 40-60% with some really bad mismatched years. The selection is done in February for the fall season. However, as noted in last my substack, non-egg based vaccines can make possible delaying the selection closer to the flu season in the northern hemisphere. With SARS-CoV-2, the variants are evolving at greater rate. Making this using the flu model much like the virtual 'apples and oranges' comparison.
I have patients who would love a fall OR summer booster depending on how active they are going to be Ie travel/ work trips, big parties. They might vaccinate once a year but want the most current version. Also it seems that if you are more current to the circulating version of covid less probability of long Covid.
IKR????? Makes NO sense.
Public Health also needs to explore trials for prophylactic sprays and other hypothesized ways of mitigation. If the goal is to prevent spreadable illness, we need to look beyond vaccines (that people won’t get), masks (that people won’t wear), restrictions (that people won’t listen to), and improving air quality (the simplest thing that gets no traction, though I have air purifiers in each on my classrooms and all through my house). I hope the nose sprays I have been using don’t come with harmful effects, but they make me feel like I am doing something.
I suspect it has to do with waning protection. Get your booster in early July for the summer surge and you might not have much protection in January during the (larger) winter surge. Especially if we get a new variant.
Seems like biannual shots might make sense as long as we're having two waves a year but I doubt the CDC will go that way.
I like the idea of biannual shots, with an updated variant every 6 months (if appropriate).
By the time the boosters come out (when? … September / October), most people will have already been infected with JN.1 and new variants will be in circulation. So why bother getting the “new” booster?
Also, if it’s true that Novavax offers at least 8 months protection, a person could get boosted in June and be protected against both the summer and winter surges.
Novavax is JN.1. though. I'm a big fan of Novavax; It's the only one I had zero reaction to and I like the longer protection. But the MRNA vaccines are against kp3 which is going to be the circulating variant this fall. I'm a little unsure what I want to do.
I don't know your age, and I am not of the age or immune status to get two boosters a year. I am going with Novavax because I still haven't had Covid and loved not feeling like utter crap when I got boosted last fall. Epi Michael Osterholm said in his recent podcast that he was going to get Novavax as soon as it comes out and mRNA as his late winter/early spring booster. That could be an option for you if you qualify.
Replying to myself to say that on his recent podcast he said he just got the booster that’s currently available and will boost again with mRNA in four months.
Well, the current Novavax vaccine (available today) is XBB.1.5. I will get their JN.1 when it comes out, but who knows when that will be?
Is it confirmed that mRNA will target KP3? I wasn’t sure if that had been decided yet.
Originally, it was JN.1 for all vaccines but the FDA changed their recommendation to KP.2. How well will this work with KP.3.1.1, the now dominate variant in the US? That's a question From Forbes:
"The FDA originally recommended the vaccines target the coronavirus’ JN.1 variant, but later changed this recommendation to advise manufacturers to focus on the KP.2 strain of the JN line after reviewing updated case data."
"Both Moderna and Pfizer said they were prepared to formulate either vaccine—and will make KP.2 vaccines after the FDA’s updated guidance—while Novavax said its manufacturing for a JN.1 shot is already underway and it won’t have a KP.2-specific shot ready in time for the fall."
https://www.forbes.com/sites/ariannajohnson/2024/08/05/updated-covid-vaccines-are-coming-effectiveness-whos-eligible-and-more/
I'm also a big fan of Novavax. Having experienced 24 hr misery after each mRNA vaccine I received, I was happy to get my first Novavax in late October. It slowed me down a little, but nothing like Moderna or Pfizer.
That said, I will be opting for an mRNA vaccine once again this fall. Why? Because mid-March I experienced covid infection for the first time. Fortunately, my symptoms were short-lived and very mild. I'm guessing JN.1 was the culprit, but never confirmed. So I'm looking to add to my immunity profile by opting for something that addresses FLiRT mutations, but not looking forward to experiencing that 24 hr mRNA slump again.
I hope the Novavax will be studied more and become available.
Yes but they cannot produce a new variant vaccine quickly enough, regrettably.
The boosters aren't available (either the old one - my parents tried in vain to get one in late June and no luck - or the new one) because FDA wants it to be true that it's a seasonal virus and we get a Covid booster in the fall like we get a flu shot. (And maybe super vulnerable people get boosted again in late winter, like with flu depending on the length of the flu season). I understand wanting to simplify things for people, but wanting and reality are different! It feels like we should have a June booster and a November booster for now, with the way Covid is actually playing out.
I still haven't had Covid and I'm 10 months since my last booster, so I don't love that while sending my kids back to school and doing all the back to school stuff (maskless because I just can't be the only one). The bigger deal is with booster timing - I don't want to boost myself or my kids if we've just had an infection, so that would make us seem like part of the population who are opting out of the fall booster campaign. So I just have to cross my fingers that we get lucky.
Edited because I said CDC when I should have said FDA and it's been bothering me.
Sorry to hear your parents weren't able to get a booster. For what it's worth, though, my wife got her most recent booster in late June.
Yeah I think it seems location-dependent. Their experience makes me think it's not a feasible plan for all eligible people to make (to forgo a spring booster and wait until early summer to get boosted since that's when new waves start). My 75 year old dad ended up getting Covid for the first time in mid July. Who knows if a booster would've helped prevent it. His case has thankfully been extremely mild.
Got a crystal ball? ;-)
Welcome back from what sounds to have been a beautiful—and certainly well-earned-vacation. You and the team have once again given us a clear, informative report. I have been curious to see that the Northeast region remains lowest on COVID and wonder whether it is escaping the worst of the wave, or whether the wave is just late in coming. I also found your report on the H5H1 tremendously informative, including getting “under the hood” on the efforts CDC is making, which are usually invisible to the unaffected public. It is very sad to learn of the wave of monkeypox in Africa, also something about which I have seen nothing elsewhere, but which I hope is getting strong attention from appropriate governmental and humanitarian agencies.
I AGREE!
This is anecdotal story. My wife and I are both 76 and healthy (normal BMI, no meds, been eating a LF-WFPB diet for 15 years, and exercise regularly). Our last booster was in Q4 of 2022. My wife’s lab work in Jan 2024 showed her Covid antibodies above 150 (the max of the test). We had no recollection of having a cold in 2023. But in ~Oct-2023, I felt like I could be coming down with a cold, but that feeling disappeared in less than 24 hours. My wife experienced the same thing a few days later.
I had my yearly lab work done about 2 months ago. My Covid antibodies also showed above 150. Even if I had a Covid exposure in Oct-23, I would think that my tested Covid antibody levels would have been quite low.
Our physician, about 1 month ago said the following: (1) he has also noted high Covid antibody levels in 80+% of his patients, and suggested, perhaps this is what herd immunity is like; and, (2) a lot of people that show up to the hospital/emergency-room for various reasons (unrelated to cold symptoms) test positive for Covid, but have no symptoms. We live in Miami Beach, and tend to be hermits. So, we don't get a lot of exposure.
One hypothesis. From a long ago flu study (deliberate injection in nasal passages, of various doses of Flu virus). the degree of sickness was proportional to the exposure. I think the recent similar UK study reported using Covid virus showed a comparable effect. So perhaps, my wife and I were exposed in Oct-2023 to one of the circulating Omicron variants, but a small dose. And, our immune system was sufficient to prevent sickness, but sufficient to also produce antibodies in our upper respiratory system (e.g. nasal passages). Hopefully, the kind of thing that would happen if/when we have a nasal-based Covid vaccine.
It would certainly be interesting if our experience is more than just anecdotal.
I've always wondered about this! It seems logical that if you were exposed to a virus and mounted an immune response that rendered you symptom-less, you would have antibodies and as much immunity as someone who felt terrible, right?
I was really hoping to be part of the control group, the people that never had COVID, but after four years of diligently avoiding it, I caught COVID at my mother's funeral. Guess isolating in my house gives me a week or so to sit with grief and my cough at the same time. :-/
Gentle hugs for you from this old lady. Experiencing both sorrow and illness must be awful.
Liking your post only to express sympathy.
I am so sorry~that is all so hard! Prayers..
So sorry for your mother's death, may her memory be a blessing. Hopefully you have a quick and full recovery from covid
I am curious about your statement that "vaccination rates are the same" this summer. Spring 2023, almost everyone I know got boosted. This year, almost no one I know was even aware it was possible to get a spring booster. My hypothesis is that immunity levels are much lower this summer owing to longer time since last vaccination - last fall for most folks.
Good point- I was mainly referring to fall vaccination rates. I have yet to see numbers from this Spring but I bet you’re right
I'm 69 years old and considered high risk due to age, hypertension, obesity. My last booster was in November 2023. Before going on international long-distance air travel later this month, I tired to follow your previous newsletter's reasonable recommendation to get my booster vaccination. I am insured by a Medicare Advantage Plan through UCLA with Kaiser Permanente Northern California, one of the largest insurers in Northern California. They informed me last week that they have no vaccine available anywhere in Northern California and they will not be able to provide any Covid-19 vaccination until the new vaccines become available in the fall. They report that they could not get ordered shipments of vaccine in June and decided not to order vaccines until the fall although the disruption of shipments was short and ended sometime in July according to a CVS pharmacist I spoke to when I got my booster vaccination there paying $190 out of pocket for it (and another $190 for my wife). When I called Kaiser Permanente's member services to request reimbursement for this booster vaccination they informed me after 45 minutes on the phone that I am not eligible because they do not reimburse any vaccinations through out-of network providers except those administered during emergency care visits. I will submit a claim for reimbursement regardless because Medicare covers booster vaccinations for my demographics, CDC just recommended it again, and Kaiser Permanente's policy is an unjustifiable neglect and refusal to care according to CDC guidelines and Medicare contracts. But I'm writing this here to suggest that such barriers to access to booster vaccinations may be a major contributing factor to the unexpected high summer wave of wastewater Covid virus in our state. And the price of $190 for a vaccination is prohibitive for at least 50% of Americans who live with less than $500 available for any emergency in their family and a clear deterrent for anybody living with a tight budget, especially the most vulnerable elderly multimorbid populations. In addition, I witnessed during my visit to the San Rafael Kaiser medical offices that many Kaiser employees did not wear any masks when meeting me or others including my primary care physician, the intake nurse, the receptionist and cashier and many staff members I met in the halls or elevators. Those that wore masks wore insufficient and often ill-fitted surgical masks only (e.g. nose free and loose) instead of the more protective N95 or KN95 masks. The primary care physician owned a KN95 masks but did wear it because it impeded her working comfort. When I commended the phlebotomist for wearing a mask while drawing my blood (during a previous visit in July most phlebotomists in that unit did not wear any masks at all) and asked him why he did wear an insufficient surgical mask and not a safer mask he responded that Kaiser only provides surgical masks for their staff and surmised that it is a cost saving policy. He was clearly unhappy about this because he had witnessed many people die of Covid while serving in the Philippines at the beginning of the pandemic. Clearly hospital staff and patients do deserve better especially in an organization that has a proud history of providing onsite care for injured workers. I would like to see such irresponsible medical and corporate policies be exposed and criticized on public health, ethical, and economic grounds in one of the next updates, maybe a health services research economist in the audience can help with crunching the numbers for the latter part. I don't think that saving pennies on PPE will even improve the bottom line of the insurer given the costs of replacement of sick staff and diagnosing and treating insured members who get infected by health care workers due to insufficient PPE and isolation practices. Also, does anybody know who at Kaiser could be contacted with a request to immediately update and change their inefficient and unsafe policies? All my previous inquiries regarding other issues remained unanswered or referred to a department defensively dealing with medico-legal issues and requiring filing formal legal claims, nobody willing to take a call or respond to teh constant of my e-mails. Thanks! Niklas Krause, MD, PhD, MPH, Professor Emeritus of Epidemiology and Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA)
I haven’t looked closely but recall there was concern last November about low rates of booster uptake relative to previous years (<20% receiving the fall 2023 bivalent booster). I think we could be dealing with very low vaccine immunity for infection coupled with virtually no masking or ventilation measures. 😞
I think that is our experience: we went 9 mos. and then got COVID after that time fr last booster Oct. '23
Well… I think we need to elevate the science of how covid affects the immune system and look at the dynamics with epidemiology. I still say New Zealand public health has got it right. https://www.phcc.org.nz/briefing/long-covid-aotearoa-nz-risk-assessment-and-preventive-action-urgently-needed
Dr. Jetelina, thank you for the updates. Please help with sharing your voice in these matters: the mask ban in Nassau County passed, more likely to come. We need more voices, clear logical reasonable voices advocating for everyone's right to use personal protection in the face of current and future pandemics.
https://www.newsday.com/long-island/politics/nassau-mask-ban-fines-p8ofk03l
To what degree could summer waves be caused by (more) intense heat forcing more people indoors? The world is just flat-out heating up and this summer has been especially brutal. June and July were also much hotter than usual
On my PCP recommendation, I didn't get a vaccine prior to my trip in late May/early June since it wasn't six months since my last vaccine. Upon returning, however, no vaccine was available and was told the vaccine addressing new variants would be available in Aug. Well, now it's Aug. Still no vaccines and one pharmacist said it would be ready in Sept. That's too late for my late Aug trip. Dang! Want a vaccine but no vaccines available for months.
Not sure why, but one could not find anyone with a Novavax since June. Traveling patients who were agreeable to a boost and eligible could not find in on the East coast, my sister could jot find on the West coast. What was the logic in that, especially given they were unlikely to produce a new one quickly?
As it has been, still a frustrating situation.
Nobody cares. Getting a patient to test is like trying to get someone to have an amputation electively.
Sigh.
based on this study: https://journals.asm.org/doi/10.1128/mbio.01088-24 what are your thought about using a daily dose of Loratadine (Claritin) prophylactically?
Thank you, as always. As you say, apart from protective measures against covid, there's not much for a person here to do. But knowing the risks that poultry workers are running, and the terrible human cost of monkeypox in Africa, are at least spurs to compassion. The information can open up conversations about why we allow such separation from other humans, that children can die because they do not have access to immunizations or medical care. You continue to do a great service. And I'm glad you took a rest. Please take more--we count on you.
I can attest to the unpredictable nature of the current Covid wave: I contracted Covid during the last week of June 2024 and recovered (several negative tests over a week). Then I traveled to Alaska on July 18, 2024; I did not wear a mask, thinking, between vaccinations/boosters and recent illness, I was immune. On August 4, 2024, three days after returning from Alaska, I have Covid again. I am thankful the illness is very mild. White, 69yo, good health.
Ugh. My husband and I had been staying up to date on vaccines, yes masking always in crowded public spaces but no boosters since October '23. Well, we attended a family reunion in KY about 1.5 weeks ago, and one event was in a crowded and poorly ventilated restaurant and there was a big group of us. I wish I had been more "on guard". The meeting room at the lodge was very spacious and well ventilated, as was their dining area, but NOT this restaurant off site. Then the next night everyone was in this spacious meeting room they turned the ceiling fans OFF. sigh.....everyone talking and playing cards and eating and it got warm in there even though spacious.....
Monday as we were traveling home we both started feeling sick. Tested negative that night at home. By Weds. tested again and POSITIVE. Just our 2nd time ill. 1st time May '22. My husband just turned 65, I will in a few months. Last time I got Paxlovid he did not. This time we both have. By the time we started the meds on TH it was the 4th day! So one could easily miss the window for that, we did wait 48 hrs between the tests. The Paxlovid is not fun but I think it HELPS. He is recovering faster than I am but I am OK I think.
SO, folks~DO NOT go to crowded and poorly ventilated indoor spaces! We knew better but by the time we got to the place, we just went along with the family, those folks tended to be much more nonchalant about COVID. sigh...thank goodness for the vaccines, good masks available, and Paxlovid. ugh. It is OK to be cautious. We just got more relaxed than we had been...
I just do not get it that folks don't get it.....ie, that masking sometimes is OK!
My COVID vaccine injection missed the mark, causing chronic shoulder pain (SIRVA). Was the injection effective, or should I get another? Danger's rising fast here in Maine, and I'm elderly.
Thank you for this article and update. What specifically do you mean when you say get that indoor air flowing? Also, do you recommend an indoor air filtration type system, like a room air purifier?