Thanks for all the info. So if they aren’t tracking cases where infection occurred within the last 90 days does that mean the assumption is that those folks are reasonably protected?
that’s correct. it’s been our assumption for a while in the united states too. after 90 days the protection is a bit more random for people after infection
Sorry if this is redundant, but does that mean we presumed the same for omicron as well? Or that has just been historically true with previous variants.
I’m not sure how detailed our info is on how SA tracks vaxxed vs non-vaxxed, but would you think it is at least safe to assume it’s much more likely an “unknown” would be non-vaxxed r/t the documentation that goes with vaccination?
this is a really good question. and i thought long and hard about this. it honestly depends how they are investigating these. how do they pick which patient to verify first. is it a random sample? because if so, then i would assume the “unknowns” follow the same distribution on what we see now. do they start with the more severe of cases? i don’t know. so i don’t want to make sweeping conclusions with this data
YLE, Thanks for your November 21 Thanksgiving family gathering guidance. I believe so much has happened, especially with Omicron that updating this guidance would be very helpful. Specifically, you may want to consider the following:
All attendees at indoor gatherings should be fully vaccinated (+booster, if possible) except for <5 years old.
All attendees, even if vaccinated should take instant antigen home test within 24 hours before the event. (Given breakthrough infections with Delta and reinfections with Omicron)
Cracking open window + recommended (I use Blueair) air purifier (scaled to room size, if possible).
Lastly, it would be great to develop a notification template that could be used to effectively communicate Covid-19 "house rules" to friends and relatives invited to indoor holiday festivities. This is important because many of us are so uptight and politicized on this topic that important public health information too often is not shared with friends and relatives, and as a result, the virus flourishes and mutations continue. Making it easier with a template or a variety of several templates to choose from would go a long way. CDC should engage communications companies to get this done and spread the word to help reduce the number of Christmas and New Years' celebrations that spread Delta and Omicron instead of Joy events
As a new subscriber, I want to thank you for all your are doing with YLE - I pass it on.
Just wanted to say - thank you from one health scientist to another. Your blog is the perfect level of detail for a scientifically literate person to understand with enough detail to satisfy. I'm able to share general impressions from your blog with my team each week, and it makes a difference. So again, thank you. (PS: Finally found the donation button - could be more prominent).
+1. I just subscribed yesterday after a few months of reading for free. I've been following scientists of various stripes since the start of the pandemic to understand what's going on and to feel like I have access to high-quality rendition of facts. YLE has been a great source information that's very nicely written, and a lovely example of how to do science communication well.
This stands in stark contrast with the science comms from US government agencies like CDC, FDA, NIH, and the White House - which either oversimplify, make mistakes sans follow-up corrections, or sometimes go as far as offering-up noble lies in the name of greater welfare.
I'm also looking at the statistics for Bergen Co. Y'all are starting to trend up and the attack rate in Bergen is in excess of 1.0: You're back in a spreading environment.
Perhaps Katelyn will write a piece on population immunity misconceptions, or perhaps I will. And perhaps a discussion about how naturally acquired immunity is much more effective against the variant that triggered that immune response in the first place.
I would like to know in a bad flu season what are the stats?
Getting colds is ok (it is not yet proven to be a cold as much as it is not yet proven to be the same killing machine of March/ April 2020). We will build that herd immunity.
Vaccinated folks are not getting severe cases of COVID -
Therapeutics are effective at mitigating severity as well.
As of today - and we will know more - its ok for the flu season to trend up in the winter - its ok for the COVID to trend up in the winter - as long as the death rate is not high.
Yeah, what would be really nice would be something like "vaccination density" at a single point. What's the probability that a randomly chosen person at a given location is vaccinated?
Bergen Co., according to the NY tracker cited below, is 87% for single-dose, not fully vaccinated either by the 2-doses plus 2 weeks, nor the 2 doses plus boost plus 2 weeks criteria.At 67% for "fully vaccinated, you're below the threshold for population immunity calculated for either Delta or Omicron.
A couple of thoughts.
1. The sky isn't falling, but we remain in a pandemic state and NOT an endemic state. We need to be proactive, rather than reactive, and because of the early notification we received on Omicron, we have that opportunity.
2. Y'all, up in the Northeast are lucky in that overall, your vaccination rates are indeed higher than most of the rest of the country. That said, a stellar rate for a single county implies your belief that the virus... or a new variant with a higher attack rate... will respect the county borders.
3. We're still gaining data on Omicron, as Katelyn has said (and as I've said as well). as our knowledge increases, our reactions and recommendations will likely change. However, in the public health business, being cautious early and relaxing when you have a lot more information is the way we think.
So: Get vaccinated (or boosted); Mask up, especially if you venture indoors. Avoid mass gatherings and poorly ventilated spaces. Wash your hands. Frequently. Selt-isolate if you feel ill or have potentially been exposed. And pay attention. The information provided by Dr. Jetelina is solid.
Thanks so much for the additional insight, Gerry -
Consider, if you will, that almost 125k in the county have had COVID (natural immunity..) That would be a good % of the population. I think it's fair to consider us over 70% - and with the expansion of 5-11 that increases the denominator of those qualified.
Adding in the kids to the denominator is also less meaningful since all variants until the current Omnicon did not kill kids under 14 - NJ appears to be at 0. There is some data suppressed but for sure its not close to meaningful (of course unless it is your child - so I am talking statistically)
Respecting county borders - You're making a case that herd immunity is meaningless and I am not buying that. The takeaway from that assertion would be that until globally we are at 0 - there is a danger. Nope.
The challenge that we are facing as a society is that science is not science anymore. Statements like that assert herd immunity has no meaning - this makes people wary since science lately is moving the goalposts. Science used to have some standards.
Worse - how in the world would you expect people to rush and get vaccinated if you tell them the vaccination rate plus natural immunity over 70% is not good after you told them it was good? How can you expect that masks mean anything Especially after vaccination - if the vaccine works then the mask is theater.
The story must be strong and not coercive if you want to convince people.
The most concerning thing is that you said "Public Health Business"... well public health is not business. I mean no disrespect but Doctors are commonly poor business people. Public health should be its own sector. Fauci has crossed the line all too often albeit as a Public Health Politician.
I like Katelyn as she is one of the few that even talks B-cell / T-cell immunity. That should be the most meaningful determination of protection.
And of course - health permitting - get vaccinated and be careful.
Larry, you make a number of points and there's a lot to parse. If I miss something, I'll come back to it after I get done with another mandatory task for tonight.
I differentiate between naturally-conferred immunity (derived from infection) and vaccine-conferred immunity because of the nature of the proteins produced in response to vaccination, especially with the mRNA vaccines. Naturally conferred immunity is actually fairly specific to the variant that caused it to initiate but may be significantly less effective against another variant, especially if it has several significant substitutions, deletions or additions to the Spike (S) protein and the receptor binding domain. This was one of the reasons Delta burned through the unvaccinated, but previously infected population, and we're seeing similar modifications with Omicron. Depending on who you read, Omicron is initiating breakthrough infections in the unvaccinated but previously infected population at a rate of 5-15 times that for breakthrough infections for vaccinated individuals.
Pediatric cases have been present throughout the pandemic and were much more prominent in Delta. With kids the last unvaccinated bastion, they are a natural target for a new and more adapted variant. We've seen kids in the ICU and pediatric deaths all along, but in the first surge, we saw more older people because they had more risk factors and comorbiditites that made them a better target. We also had the theory that kids didn't get sick, or not seriously sick, so there were a number who were never tested and assigned a different pneumonia diagnosis. The result: We missed a lot of pediatric cases early, despite some really bright docs raising the alarm. This was a failure of our ability to think outside the box of theoreticals we'd constructed including, "SARS is an adult disease". In addition, kids CAN contract the disease and have milder, or no symptoms but still spread it to families, within schools, and in the community at large.
And statistically speaking, I am skeptical of a number of the states' reporting. I live in a flyover state in the Southern Plains. I'm confident that the data released by the state's Health Department on case numbers was invariably delayed and the deaths were understated, to obfuscate the degree of illness here. There were days when I could call 5 clinicians and have a higher new case count in their ICUs than the state reported overall for the day, and it was noteworthy that the state effectively had NO excess deaths from March through December of last year. Unless people forgot how to die, this statistical presentation was unlikely to represent reality.
Using Provisional Deaths should provide valuable data and indeed, has, but its reporting wasn't mandatory until this year, if memory serves, and my state had to modify how it was reporting deaths to comply with that requirement. Suddenly, we had more COVID deaths daily than ever before, along with a media blitz from the Governor's office decrying having to change the reporting because it made the state look worse (more like realistic).
Population immunity is not meaningless but may have a different meaning than you believe. Breaking down vaccinated percentages by the smallest rational entity (in this case, counties) allows the epidemiologist to appreciate how vaccinations are going and get a better feeling for the demographics associated with vaccination. in Public health, you have to look at the public as the (singular) patient and that may mean, for some diseases with an R(0) of low order (at or near 1.0 or even lower) isolating at the county level is sufficient: You're looking at a small number of cases, perhaps with significant consequence, but it's unlikely to spread far and wide. When R(t) starts approaching 3, transmission isn't likely to limit itself to the patient's house, but will include wherever they travel: To the doctor, the grocery store, or the casino 3 counties away. for diseases with an attack rate of 8, like measles, that can become especially acute. SARS-CoV-2 is sufficiently aggressive that it has to be widely managed, and we have failed to do that because we've politicized any response.
Science is still science. What has changed is we're now seeing people with degrees in law or business, or another field, attempting to interpret the shorthand of scientists. For the record, my fields of science stretch far and wide, although I've many more papers published in medicine than say, meteorology. Each branch of science has its shorthand, and when someone who doesn't speak that jargon tries to get involved, there's misunderstanding and misinterpretation. Simply put, when we're talking amongst ourselves, we can get sloppy but that matters little in our professional scope because "everyone" understands we're simply not taking the time to tell the whole tale, since all the players at that moment know what metes and bounds of the discussion are. When a member of the public listens in on, say, a discussion of a potential Atlantic hurricane in the western Atlantic near the US, if they're listening to internal communication, they'll miss a lot of context. At no point have I indicated population immunity levels are meaningless, although there's sufficient literature to call that theory into question. What I have said is that it must be viewed on a much larger scale than at the individual county level. It is my contention that making mask wearing indoors contingent on the transmission levels for individual county transmission potential was an error. Instead we need to be looking at statewide, regional or national statistics.
I've already covered your possible misconception of the benefits of naturally conferred immunity in place of vaccine-conferred immunity.
And: The mask is not theater. Of the non-pharmaceutical interventions, it is perhaps the most beneficial method to reduce infections. Assuming a few things, of course.
1. The mask is a good-quality multi-later cloth mask, properly fitted and worn properly.
2. ALL persons are masked regardless of their vaccination or recovery status.
The remaining NPIs are all part of a multi-layer effort. No one mitigating practice alone is going to be sufficient.
When I spoke of the Public Health 'business' I was not referring to a business in common practice but the practice of Public Health as it is normally performed. I know a fair bit about science and medicine. I know a fair bit about identifying and isolating disease. I've learned that I'm best suited for an academic environment because I'm not a "business" person. But in this case I'm a medical professional rendering my best understanding and advice. Tony Fauci has not turned politician, save perhaps when he's dressed down abusive members of Congress, but he has been consistent in his message, that what he's providing is the best information based on the best data available at the time. Since I've not talked to him since all this began (and truth be told, I've not talked to him in perhaps 20 years) based on published reports on his workday patterns, I can only suspect I'm keeping up to him in the number of articles I read daily. Thus, my information is constantly in flux, and the opinion I give you in the morning may well have changed by late in the day. For Omicron, that's almost certain, as I do look for changes at least twice per day from the published reports from virologists, labs, health authorities and other epidemiologists. Tony does the same thing.
I've also been talking of cellular immunity but most people do not understand it. It's an immunology topic, and one I learned on the transplant service (I only thought I'd learned it in my first immunology course). There's also a lot more to the circulating immune globulins than most people understand.
I've consistently, since they became available, recommended people get vaccinated. All too often, though, I encounter people who've heard from a friend of some adverse effect that can't be tracked down. to some minor blip statistically (think myocarditis) that is above the background level of prevalence, but unlikely to rise to a major adverse event, and which so far, has not killed anyone post-vaccine but has caused long-term issues for those, especially younger patients, who see long-term debilitation when they're hit as a COVID-effect.
If you have other questions, let me know, and perhaps Katelyn will step in and moderate.
Not sure it's about moderating as we have a fabulous base of agreement.
1. Vaccinate
2. Take the necessary precautions
Masks - as you share, the amount of proper masks, worn properly is so low as to render it basically useless. Masks in kids - more useless and probably dangerous with the germs staying closer to the mouth/nose than without.
So the biggest difference is that I am not a scientist - I do read a fair bit and I do check the statistics.
The death rate for kids -aged 0 to 17 is insignificant - statistically speaking. 630 kids from Jan 2020 to Dec 1, 2021... 23 months 630 dead. Given the draconian lockdowns, it would be fair to say that the other side of the stick or unintended consequences, is that thousands committed suicide (above the delta) making the lockdowns more fatal than the disease.
If you have stats where kids under 17 because of COVID experienced some adverse effects I would like to know (i am an active parent with the school board and would love to understand if there is information that shows significant effects)
And Public Health sector did not take into consideration "the unintended consequences" of how the government official actions would affect life. Politicians used this as a tool to "energize the base". Some of the numbers are horrible as is the waste of financial and human capital as a result of the politics. Many people would suggest that Florida did a great job balancing life and pandemic. All the prognostications of mass death, well, fell flat.
The dynamic we are discussing really is important as is the balance between mitigation and suffocating a society.
My intention has been to be respectful as i honor your profession and your knowledge, trusting i have done as much!
Shutdowns for significant illness have been used before but these often occurred in countries that didn't have our tradition of bickering about perceived slights to our individual rights. Thus, they were long enough, effective and over soon enough.
I remain of the opinion that, had we enforced mandatory lockdown, and the NPI usage, for 4-6 weeks longer, we would have been able to drive cases down to very close to pre-pandemic baselines. In other words, we'd have beaten it for a period of time, perhaps long enough to drive it unto the zoonotic reservoir until we had adequate vaccines. Then, had we required vaccines as soon as they were out, and had the effort to vaccinate been world-wide, we could have beaten down the disease.
Instead, we had rhetoric about "breaking the curve" which tended to mean, to the uninitiated, to get cases to start dropping, and then things were OK. We could stop masking, distancing, attending rock concerts and going out to crowded bars. Vaccines became a social or political option. This represented a complete misunderstanding of the dynamic of viral spread in a population naive to the virus and fully lacking a sensitized immune system. We have repeated this scenario for each wave. We've emerged, save after the Winter surge, with numbers that plateau higher than the last one, and then we reenter the upswing cycle. At some point, we have to take control but I fear the politics and lack of civil social discourse about this disease mean it's likely to enter an endemic phase that's much more devastating than influenza.
And, we're seeing state legislatures and governors enacting laws crippling their own states' public health functions, by removing the ability to implement mandatory restrictions, and allowing evasion of vaccinations that have made our country safer for decades. All to, as you note, "energize the base".
Had this country undertaken the measures to protect small businesses that Europe took, we could have survived the draconian lockdowns. I'll point out that, due to our age, my wife and I didn't venture out save for groceries, doctor's appointments and pharmacy visits, for nearly 6 months: Our governor had a mandatory "safer at home" policy that restricted the older segment but failed to account for the others who were at risk, AND then actively sought to suppress reporting of real numbers to the public.
If you want to look at Florida as an exemplar, you have to also look at the fact that they failed to report their numbers adequately, prosecuted a data scientist who didn't follow the party line and applied the data as they arrived rather than allowing them to be "quality controlled" (in a couple of fields, that's euphemistic for, "changed to meet what we'd expect rather than what the sensors are seeing"), and crippled their healthcare communities. Inappropriate use of monoclonal antibody therapies, and rhetoric designed solely to cripple public health efforts are not a good example.
I appreciate your attempt to be respectful. I've spent the last couple of years trying to keep people safe, especially in a particular non-profit I'm involved with. Even there, the reluctance to look at verifiable data has been scary. Keep trying. Recognize that medical statistics sound a lot like the statistics you grew up using... but they're not. They're part of that short-hand notation we use. The meaning isn't always as obvious as you think, and that's actually more difficult for someone who has spent the time coming up to speed from a completely different community.
Katelyn has been providing solid information. I try to do the same when I respond here.
Thanks for the conversation it has been enjoyable and civil.
I will never stop looking at data. even from my untrained eye.
Right now I am looking at fatalities.
I would appreciate it if you had some insight into children 17 and under. Right now they appear to be almost not affected at all.
BTW - I am not sure why FL isn't an example - (Rebekah Jones's story fell apart - please check into this). Overall if there was a data issue the longitudinal data would have been corrected. Certainly, the lack of lockdowns and other policies with the lack of increased deaths appears to show a successful managing of a horrible situation.
I realize it is not all obvious but we can look back and learn from the past. That's my FL example - i don't know of a better state to look at.
Have a great Sunday - enjoy some football. (assuming though you're more into college than Pro's...given your a southern fly over state)
Also in Bergen County. Unfortunately, we're seeing a lot of breakthrough cases. I actually know of a few, including one young (early 20s) person who was vaccinated not long ago (not yet boosted). Hopefully breakthroughs cases remain mild, especially in higher risk populations. I just can't imagine how Omicron is going to alter the breakthrough rate, even in our highly vaccinated area, and what it could mean for disease severity, since we don't yet truly know that aspect. Also upsetting is that so many parents are not getting boosted (and plenty still not vaccinated) AND are not getting their under 12 children vaccinated. I fear what this means for winter.
Marcy - IMHO - the cup is more than 1/2 full here - there are so many positive signs for society concerning COVID.
The 7 day average for fatalities in NJ = 0
Bergen County has an 87% vaccination rate - remember when everyone would be excited at 70%???
A colleague has strep
I have bronchitis right now
The world will spin and we need to modulate our anxiety and start using facts and science. Katelyn presents wonderful and accurate information from which you can use to help you choose what course of action you and your family can take -
I am sure 100% that the sky is not falling and we are, from all information we have today - are close to or at the stage that COVID endemic not a pandemic.
God-speed - I wish you all well and you and your family should stay safe -
I agree. I'm grateful so many in our area are vaccinated. However, so many of the children I work with are in unvaccinated families. And Omicron does appear concerning, although I'm not panicking yet. I also worry about my elderly parents, and what that could mean with Omicron. I'm hoping to get some reassurance in the next few weeks. I appreciate your rational and calm approach. Thanks!!!
I wish we can have more and more rational approaches - Katelyn is ration from all I read so that's why I am happy to support her.
As for our concerns - like ANY illness or danger in life - we have to do our part. Consider wearing seat belts - we wear them because it is clear they save lives. Vaccines prevent illness - masks help a little with transmission (not a lot since we don't wear them properly most of the time nor do we change them at intervals that would be considered protection).
Our parents need to be properly vaccinated - and wear masks and mitigate their exposure in public. That is all we can do while living our idea of a quality life.
Have a great Saturday - its beautiful here today, enjoy it before the freeze!
How is it possible that the vaccination status of 75% of hospitalised Covid patients is unknown?? Is that not tracked by their national statistics office?
The data re unvaccinated in South Africa hospitals needs to be interpreted in the context of the proportion of the population vaccinated. 24% sounds good, but if that's similar to the proportion of vaccinated people in the population, then it sounds really bad (ie immunization is not reducing hospitalization).
Vaccination uptake in Africa overall is poor. Contributing to this are mis/disinformation on social media and online media broadcasts, straightforward vaccine hesitancy and inability to store the mRNA vaccines in the required cold environments Thus, 24% is consistent with the population vaccination rate.
Would you be able to write something up on underlying physical properties of viruses that make them more transmissible, virulent, immune evasive etc? It seems thar a lot of the descriptions of which genes do what involve "extrinsic" characteristics - "when this mutation is present, the virus appears to infect more people more quickly". Yeah, but...why? Does it float better? Last longer on surfaces? Etc
What do we know about the progress on research and approval of a vaccine for the next age bracket? Are there any predictions about when it might be available? 6 months to 4 years old, right?
Please, where does the CDC say full vaccinated = boostered? Their travel page still says 2 weeks after 2 doses (1 JnJ). They also are still saying in articles that full effect is at 2 weeks, despite other studies out there saying 3…I just saw 4 even, re booster. Thank you!
Thank you! I hadn’t read this before and didn’t understand why. Thank you for clarifying! My almost 17yo is 8.5 moths post V2. So waining and not fully vaxxed now. “Only 59.7% of the United States is fully vaccinated (which the CDC defines as not having a booster, which really needs to change)”. Doesn’t the CDC also say that only fully vaxxed should be the ones traveling (even domestic)? If approved soon (it’s taking too long), how many days post booster would be full “enough”? I read a study that said it takes 3 weeks (for Pfizer I think) to reach its full protection.
I eventually realized that the statement included "not" re booster and full vax. I 100% agree that a booster should be needed to be "fully vaccinated".
The immune system in adolescents isn't the same as the immune system in a 60-yr-old. There's published evidence of circulating IgG at higher levels for teenagers after 6 months than for adults. The cut-off numbers are rather arbitrary, but I expect you'll see a go-ahead sooner than later for 11-17 patients receiving a booster.
From what I've seen, I thought those studies were really for the younger ones, up to 15. Pfizer asked FDA for approval days ago for 16-17, but no mention from either place has been made since. 16-17 were approved 6 months ago for EUA. 12-15 was more recent. My kiddo is 1 month away from 17. And, in those studies, I wonder if they considered those that hit puberty earlier than normal. I hope you're right that mine is really an "adolescent".
I wouldn't say they "can't" mutate in both directions at once, but rather that often mutations that allow immune escape may negatively affect other viral functions. We don't know why and how SARS-CoV2 causes disease, so we can't really know what these mutations are doing to the virus in terms of severity of disease (yet).
I think of it more in terms of what the proteins are doing. The shape of the protein affects what other proteins it can bind to (in this case the spike protein binds to the ACE receptor). Mutations may affect the ability of antibodies to bind to the spike protein, but then they might also affect the ability of the spike protein to bind to its receptor. It's easiest to understand if you visualize 3D surfaces fitting together. The better they fit, the better they bind. It's a little more complex than that, but I think the visualization helps. It's really about the physics and chemistry of 3D shapes binding and/or changing their conformation like machines.
I forgot to say that mutations change the shape of the protein. Mutations result in changes in the subunit parts of the protein, switching out one part for another.
Thanks for my weekend dose of PANDEMIC XANAX. We also have two unvaccinated little ones and my anxiety keeps escalating!
Thank you for this information!
Thanks for all the info. So if they aren’t tracking cases where infection occurred within the last 90 days does that mean the assumption is that those folks are reasonably protected?
that’s correct. it’s been our assumption for a while in the united states too. after 90 days the protection is a bit more random for people after infection
Sorry if this is redundant, but does that mean we presumed the same for omicron as well? Or that has just been historically true with previous variants.
I’m not sure how detailed our info is on how SA tracks vaxxed vs non-vaxxed, but would you think it is at least safe to assume it’s much more likely an “unknown” would be non-vaxxed r/t the documentation that goes with vaccination?
this is a really good question. and i thought long and hard about this. it honestly depends how they are investigating these. how do they pick which patient to verify first. is it a random sample? because if so, then i would assume the “unknowns” follow the same distribution on what we see now. do they start with the more severe of cases? i don’t know. so i don’t want to make sweeping conclusions with this data
Good point. Thanks!
YLE, Thanks for your November 21 Thanksgiving family gathering guidance. I believe so much has happened, especially with Omicron that updating this guidance would be very helpful. Specifically, you may want to consider the following:
All attendees at indoor gatherings should be fully vaccinated (+booster, if possible) except for <5 years old.
All attendees, even if vaccinated should take instant antigen home test within 24 hours before the event. (Given breakthrough infections with Delta and reinfections with Omicron)
Cracking open window + recommended (I use Blueair) air purifier (scaled to room size, if possible).
Lastly, it would be great to develop a notification template that could be used to effectively communicate Covid-19 "house rules" to friends and relatives invited to indoor holiday festivities. This is important because many of us are so uptight and politicized on this topic that important public health information too often is not shared with friends and relatives, and as a result, the virus flourishes and mutations continue. Making it easier with a template or a variety of several templates to choose from would go a long way. CDC should engage communications companies to get this done and spread the word to help reduce the number of Christmas and New Years' celebrations that spread Delta and Omicron instead of Joy events
As a new subscriber, I want to thank you for all your are doing with YLE - I pass it on.
Alan Brownstein, MPH
Cold Spring, NY
Just wanted to say - thank you from one health scientist to another. Your blog is the perfect level of detail for a scientifically literate person to understand with enough detail to satisfy. I'm able to share general impressions from your blog with my team each week, and it makes a difference. So again, thank you. (PS: Finally found the donation button - could be more prominent).
+1. I just subscribed yesterday after a few months of reading for free. I've been following scientists of various stripes since the start of the pandemic to understand what's going on and to feel like I have access to high-quality rendition of facts. YLE has been a great source information that's very nicely written, and a lovely example of how to do science communication well.
This stands in stark contrast with the science comms from US government agencies like CDC, FDA, NIH, and the White House - which either oversimplify, make mistakes sans follow-up corrections, or sometimes go as far as offering-up noble lies in the name of greater welfare.
Brilliant update.
My county is 87% (Bergen county) which bodes really well for herd immunity.
The National rate means little to me given how well vaccinated my area is.
Before we get anxious about the National vaccination rate shouldn’t we check out town and county? (Even the state rate is meaningless.)
I'm also looking at the statistics for Bergen Co. Y'all are starting to trend up and the attack rate in Bergen is in excess of 1.0: You're back in a spreading environment.
Perhaps Katelyn will write a piece on population immunity misconceptions, or perhaps I will. And perhaps a discussion about how naturally acquired immunity is much more effective against the variant that triggered that immune response in the first place.
Gerry,
This is going to be controversial -
I would like to know in a bad flu season what are the stats?
Getting colds is ok (it is not yet proven to be a cold as much as it is not yet proven to be the same killing machine of March/ April 2020). We will build that herd immunity.
Vaccinated folks are not getting severe cases of COVID -
Therapeutics are effective at mitigating severity as well.
As of today - and we will know more - its ok for the flu season to trend up in the winter - its ok for the COVID to trend up in the winter - as long as the death rate is not high.
Yeah, what would be really nice would be something like "vaccination density" at a single point. What's the probability that a randomly chosen person at a given location is vaccinated?
Bergen Co., according to the NY tracker cited below, is 87% for single-dose, not fully vaccinated either by the 2-doses plus 2 weeks, nor the 2 doses plus boost plus 2 weeks criteria.At 67% for "fully vaccinated, you're below the threshold for population immunity calculated for either Delta or Omicron.
A couple of thoughts.
1. The sky isn't falling, but we remain in a pandemic state and NOT an endemic state. We need to be proactive, rather than reactive, and because of the early notification we received on Omicron, we have that opportunity.
2. Y'all, up in the Northeast are lucky in that overall, your vaccination rates are indeed higher than most of the rest of the country. That said, a stellar rate for a single county implies your belief that the virus... or a new variant with a higher attack rate... will respect the county borders.
3. We're still gaining data on Omicron, as Katelyn has said (and as I've said as well). as our knowledge increases, our reactions and recommendations will likely change. However, in the public health business, being cautious early and relaxing when you have a lot more information is the way we think.
So: Get vaccinated (or boosted); Mask up, especially if you venture indoors. Avoid mass gatherings and poorly ventilated spaces. Wash your hands. Frequently. Selt-isolate if you feel ill or have potentially been exposed. And pay attention. The information provided by Dr. Jetelina is solid.
Thanks so much for the additional insight, Gerry -
Consider, if you will, that almost 125k in the county have had COVID (natural immunity..) That would be a good % of the population. I think it's fair to consider us over 70% - and with the expansion of 5-11 that increases the denominator of those qualified.
Adding in the kids to the denominator is also less meaningful since all variants until the current Omnicon did not kill kids under 14 - NJ appears to be at 0. There is some data suppressed but for sure its not close to meaningful (of course unless it is your child - so I am talking statistically)
https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-by-Sex-and-Age/9bhg-hcku/data
Respecting county borders - You're making a case that herd immunity is meaningless and I am not buying that. The takeaway from that assertion would be that until globally we are at 0 - there is a danger. Nope.
The challenge that we are facing as a society is that science is not science anymore. Statements like that assert herd immunity has no meaning - this makes people wary since science lately is moving the goalposts. Science used to have some standards.
Worse - how in the world would you expect people to rush and get vaccinated if you tell them the vaccination rate plus natural immunity over 70% is not good after you told them it was good? How can you expect that masks mean anything Especially after vaccination - if the vaccine works then the mask is theater.
The story must be strong and not coercive if you want to convince people.
The most concerning thing is that you said "Public Health Business"... well public health is not business. I mean no disrespect but Doctors are commonly poor business people. Public health should be its own sector. Fauci has crossed the line all too often albeit as a Public Health Politician.
I like Katelyn as she is one of the few that even talks B-cell / T-cell immunity. That should be the most meaningful determination of protection.
And of course - health permitting - get vaccinated and be careful.
Larry, you make a number of points and there's a lot to parse. If I miss something, I'll come back to it after I get done with another mandatory task for tonight.
I differentiate between naturally-conferred immunity (derived from infection) and vaccine-conferred immunity because of the nature of the proteins produced in response to vaccination, especially with the mRNA vaccines. Naturally conferred immunity is actually fairly specific to the variant that caused it to initiate but may be significantly less effective against another variant, especially if it has several significant substitutions, deletions or additions to the Spike (S) protein and the receptor binding domain. This was one of the reasons Delta burned through the unvaccinated, but previously infected population, and we're seeing similar modifications with Omicron. Depending on who you read, Omicron is initiating breakthrough infections in the unvaccinated but previously infected population at a rate of 5-15 times that for breakthrough infections for vaccinated individuals.
Pediatric cases have been present throughout the pandemic and were much more prominent in Delta. With kids the last unvaccinated bastion, they are a natural target for a new and more adapted variant. We've seen kids in the ICU and pediatric deaths all along, but in the first surge, we saw more older people because they had more risk factors and comorbiditites that made them a better target. We also had the theory that kids didn't get sick, or not seriously sick, so there were a number who were never tested and assigned a different pneumonia diagnosis. The result: We missed a lot of pediatric cases early, despite some really bright docs raising the alarm. This was a failure of our ability to think outside the box of theoreticals we'd constructed including, "SARS is an adult disease". In addition, kids CAN contract the disease and have milder, or no symptoms but still spread it to families, within schools, and in the community at large.
And statistically speaking, I am skeptical of a number of the states' reporting. I live in a flyover state in the Southern Plains. I'm confident that the data released by the state's Health Department on case numbers was invariably delayed and the deaths were understated, to obfuscate the degree of illness here. There were days when I could call 5 clinicians and have a higher new case count in their ICUs than the state reported overall for the day, and it was noteworthy that the state effectively had NO excess deaths from March through December of last year. Unless people forgot how to die, this statistical presentation was unlikely to represent reality.
Using Provisional Deaths should provide valuable data and indeed, has, but its reporting wasn't mandatory until this year, if memory serves, and my state had to modify how it was reporting deaths to comply with that requirement. Suddenly, we had more COVID deaths daily than ever before, along with a media blitz from the Governor's office decrying having to change the reporting because it made the state look worse (more like realistic).
Population immunity is not meaningless but may have a different meaning than you believe. Breaking down vaccinated percentages by the smallest rational entity (in this case, counties) allows the epidemiologist to appreciate how vaccinations are going and get a better feeling for the demographics associated with vaccination. in Public health, you have to look at the public as the (singular) patient and that may mean, for some diseases with an R(0) of low order (at or near 1.0 or even lower) isolating at the county level is sufficient: You're looking at a small number of cases, perhaps with significant consequence, but it's unlikely to spread far and wide. When R(t) starts approaching 3, transmission isn't likely to limit itself to the patient's house, but will include wherever they travel: To the doctor, the grocery store, or the casino 3 counties away. for diseases with an attack rate of 8, like measles, that can become especially acute. SARS-CoV-2 is sufficiently aggressive that it has to be widely managed, and we have failed to do that because we've politicized any response.
Science is still science. What has changed is we're now seeing people with degrees in law or business, or another field, attempting to interpret the shorthand of scientists. For the record, my fields of science stretch far and wide, although I've many more papers published in medicine than say, meteorology. Each branch of science has its shorthand, and when someone who doesn't speak that jargon tries to get involved, there's misunderstanding and misinterpretation. Simply put, when we're talking amongst ourselves, we can get sloppy but that matters little in our professional scope because "everyone" understands we're simply not taking the time to tell the whole tale, since all the players at that moment know what metes and bounds of the discussion are. When a member of the public listens in on, say, a discussion of a potential Atlantic hurricane in the western Atlantic near the US, if they're listening to internal communication, they'll miss a lot of context. At no point have I indicated population immunity levels are meaningless, although there's sufficient literature to call that theory into question. What I have said is that it must be viewed on a much larger scale than at the individual county level. It is my contention that making mask wearing indoors contingent on the transmission levels for individual county transmission potential was an error. Instead we need to be looking at statewide, regional or national statistics.
I've already covered your possible misconception of the benefits of naturally conferred immunity in place of vaccine-conferred immunity.
And: The mask is not theater. Of the non-pharmaceutical interventions, it is perhaps the most beneficial method to reduce infections. Assuming a few things, of course.
1. The mask is a good-quality multi-later cloth mask, properly fitted and worn properly.
2. ALL persons are masked regardless of their vaccination or recovery status.
The remaining NPIs are all part of a multi-layer effort. No one mitigating practice alone is going to be sufficient.
When I spoke of the Public Health 'business' I was not referring to a business in common practice but the practice of Public Health as it is normally performed. I know a fair bit about science and medicine. I know a fair bit about identifying and isolating disease. I've learned that I'm best suited for an academic environment because I'm not a "business" person. But in this case I'm a medical professional rendering my best understanding and advice. Tony Fauci has not turned politician, save perhaps when he's dressed down abusive members of Congress, but he has been consistent in his message, that what he's providing is the best information based on the best data available at the time. Since I've not talked to him since all this began (and truth be told, I've not talked to him in perhaps 20 years) based on published reports on his workday patterns, I can only suspect I'm keeping up to him in the number of articles I read daily. Thus, my information is constantly in flux, and the opinion I give you in the morning may well have changed by late in the day. For Omicron, that's almost certain, as I do look for changes at least twice per day from the published reports from virologists, labs, health authorities and other epidemiologists. Tony does the same thing.
I've also been talking of cellular immunity but most people do not understand it. It's an immunology topic, and one I learned on the transplant service (I only thought I'd learned it in my first immunology course). There's also a lot more to the circulating immune globulins than most people understand.
I've consistently, since they became available, recommended people get vaccinated. All too often, though, I encounter people who've heard from a friend of some adverse effect that can't be tracked down. to some minor blip statistically (think myocarditis) that is above the background level of prevalence, but unlikely to rise to a major adverse event, and which so far, has not killed anyone post-vaccine but has caused long-term issues for those, especially younger patients, who see long-term debilitation when they're hit as a COVID-effect.
If you have other questions, let me know, and perhaps Katelyn will step in and moderate.
Gerry - you're a wealth of information.
Not sure it's about moderating as we have a fabulous base of agreement.
1. Vaccinate
2. Take the necessary precautions
Masks - as you share, the amount of proper masks, worn properly is so low as to render it basically useless. Masks in kids - more useless and probably dangerous with the germs staying closer to the mouth/nose than without.
So the biggest difference is that I am not a scientist - I do read a fair bit and I do check the statistics.
The death rate for kids -aged 0 to 17 is insignificant - statistically speaking. 630 kids from Jan 2020 to Dec 1, 2021... 23 months 630 dead. Given the draconian lockdowns, it would be fair to say that the other side of the stick or unintended consequences, is that thousands committed suicide (above the delta) making the lockdowns more fatal than the disease.
If you have stats where kids under 17 because of COVID experienced some adverse effects I would like to know (i am an active parent with the school board and would love to understand if there is information that shows significant effects)
And Public Health sector did not take into consideration "the unintended consequences" of how the government official actions would affect life. Politicians used this as a tool to "energize the base". Some of the numbers are horrible as is the waste of financial and human capital as a result of the politics. Many people would suggest that Florida did a great job balancing life and pandemic. All the prognostications of mass death, well, fell flat.
The dynamic we are discussing really is important as is the balance between mitigation and suffocating a society.
My intention has been to be respectful as i honor your profession and your knowledge, trusting i have done as much!
Larry
Shutdowns for significant illness have been used before but these often occurred in countries that didn't have our tradition of bickering about perceived slights to our individual rights. Thus, they were long enough, effective and over soon enough.
I remain of the opinion that, had we enforced mandatory lockdown, and the NPI usage, for 4-6 weeks longer, we would have been able to drive cases down to very close to pre-pandemic baselines. In other words, we'd have beaten it for a period of time, perhaps long enough to drive it unto the zoonotic reservoir until we had adequate vaccines. Then, had we required vaccines as soon as they were out, and had the effort to vaccinate been world-wide, we could have beaten down the disease.
Instead, we had rhetoric about "breaking the curve" which tended to mean, to the uninitiated, to get cases to start dropping, and then things were OK. We could stop masking, distancing, attending rock concerts and going out to crowded bars. Vaccines became a social or political option. This represented a complete misunderstanding of the dynamic of viral spread in a population naive to the virus and fully lacking a sensitized immune system. We have repeated this scenario for each wave. We've emerged, save after the Winter surge, with numbers that plateau higher than the last one, and then we reenter the upswing cycle. At some point, we have to take control but I fear the politics and lack of civil social discourse about this disease mean it's likely to enter an endemic phase that's much more devastating than influenza.
And, we're seeing state legislatures and governors enacting laws crippling their own states' public health functions, by removing the ability to implement mandatory restrictions, and allowing evasion of vaccinations that have made our country safer for decades. All to, as you note, "energize the base".
Had this country undertaken the measures to protect small businesses that Europe took, we could have survived the draconian lockdowns. I'll point out that, due to our age, my wife and I didn't venture out save for groceries, doctor's appointments and pharmacy visits, for nearly 6 months: Our governor had a mandatory "safer at home" policy that restricted the older segment but failed to account for the others who were at risk, AND then actively sought to suppress reporting of real numbers to the public.
If you want to look at Florida as an exemplar, you have to also look at the fact that they failed to report their numbers adequately, prosecuted a data scientist who didn't follow the party line and applied the data as they arrived rather than allowing them to be "quality controlled" (in a couple of fields, that's euphemistic for, "changed to meet what we'd expect rather than what the sensors are seeing"), and crippled their healthcare communities. Inappropriate use of monoclonal antibody therapies, and rhetoric designed solely to cripple public health efforts are not a good example.
I appreciate your attempt to be respectful. I've spent the last couple of years trying to keep people safe, especially in a particular non-profit I'm involved with. Even there, the reluctance to look at verifiable data has been scary. Keep trying. Recognize that medical statistics sound a lot like the statistics you grew up using... but they're not. They're part of that short-hand notation we use. The meaning isn't always as obvious as you think, and that's actually more difficult for someone who has spent the time coming up to speed from a completely different community.
Katelyn has been providing solid information. I try to do the same when I respond here.
Thanks for the conversation it has been enjoyable and civil.
I will never stop looking at data. even from my untrained eye.
Right now I am looking at fatalities.
I would appreciate it if you had some insight into children 17 and under. Right now they appear to be almost not affected at all.
BTW - I am not sure why FL isn't an example - (Rebekah Jones's story fell apart - please check into this). Overall if there was a data issue the longitudinal data would have been corrected. Certainly, the lack of lockdowns and other policies with the lack of increased deaths appears to show a successful managing of a horrible situation.
I realize it is not all obvious but we can look back and learn from the past. That's my FL example - i don't know of a better state to look at.
Have a great Sunday - enjoy some football. (assuming though you're more into college than Pro's...given your a southern fly over state)
I assume 87% of eligible though (but wonder about under 12)…our town/county data doesn’t say. And boosters now needed to be “fully vaccinated”.
Per the cdc is is of the population. I assume eligible population which means down to 5 years old. 924000 population cdc bases 87% from 809000.
Also in Bergen County. Unfortunately, we're seeing a lot of breakthrough cases. I actually know of a few, including one young (early 20s) person who was vaccinated not long ago (not yet boosted). Hopefully breakthroughs cases remain mild, especially in higher risk populations. I just can't imagine how Omicron is going to alter the breakthrough rate, even in our highly vaccinated area, and what it could mean for disease severity, since we don't yet truly know that aspect. Also upsetting is that so many parents are not getting boosted (and plenty still not vaccinated) AND are not getting their under 12 children vaccinated. I fear what this means for winter.
Marcy - IMHO - the cup is more than 1/2 full here - there are so many positive signs for society concerning COVID.
The 7 day average for fatalities in NJ = 0
Bergen County has an 87% vaccination rate - remember when everyone would be excited at 70%???
A colleague has strep
I have bronchitis right now
The world will spin and we need to modulate our anxiety and start using facts and science. Katelyn presents wonderful and accurate information from which you can use to help you choose what course of action you and your family can take -
I am sure 100% that the sky is not falling and we are, from all information we have today - are close to or at the stage that COVID endemic not a pandemic.
God-speed - I wish you all well and you and your family should stay safe -
I agree. I'm grateful so many in our area are vaccinated. However, so many of the children I work with are in unvaccinated families. And Omicron does appear concerning, although I'm not panicking yet. I also worry about my elderly parents, and what that could mean with Omicron. I'm hoping to get some reassurance in the next few weeks. I appreciate your rational and calm approach. Thanks!!!
I wish we can have more and more rational approaches - Katelyn is ration from all I read so that's why I am happy to support her.
As for our concerns - like ANY illness or danger in life - we have to do our part. Consider wearing seat belts - we wear them because it is clear they save lives. Vaccines prevent illness - masks help a little with transmission (not a lot since we don't wear them properly most of the time nor do we change them at intervals that would be considered protection).
Our parents need to be properly vaccinated - and wear masks and mitigate their exposure in public. That is all we can do while living our idea of a quality life.
Have a great Saturday - its beautiful here today, enjoy it before the freeze!
Where can I find that please? I’ve been looking at our local health department.
i used this vaccine tracker - https://data.democratandchronicle.com/covid-19-vaccine-tracker/new-jersey/bergen-county/34003/
its from the CDC
How is it possible that the vaccination status of 75% of hospitalised Covid patients is unknown?? Is that not tracked by their national statistics office?
The data re unvaccinated in South Africa hospitals needs to be interpreted in the context of the proportion of the population vaccinated. 24% sounds good, but if that's similar to the proportion of vaccinated people in the population, then it sounds really bad (ie immunization is not reducing hospitalization).
Vaccination uptake in Africa overall is poor. Contributing to this are mis/disinformation on social media and online media broadcasts, straightforward vaccine hesitancy and inability to store the mRNA vaccines in the required cold environments Thus, 24% is consistent with the population vaccination rate.
Exactly.
Would you be able to write something up on underlying physical properties of viruses that make them more transmissible, virulent, immune evasive etc? It seems thar a lot of the descriptions of which genes do what involve "extrinsic" characteristics - "when this mutation is present, the virus appears to infect more people more quickly". Yeah, but...why? Does it float better? Last longer on surfaces? Etc
Hi :) thoughts on nature’s immunity w/ Omicron
https://www.youtube.com/watch?v=m2vI4XczqZ8
What do we know about the progress on research and approval of a vaccine for the next age bracket? Are there any predictions about when it might be available? 6 months to 4 years old, right?
Please, where does the CDC say full vaccinated = boostered? Their travel page still says 2 weeks after 2 doses (1 JnJ). They also are still saying in articles that full effect is at 2 weeks, despite other studies out there saying 3…I just saw 4 even, re booster. Thank you!
YLE was saying that the CDC is not yet requiring a booster to be considered fully vaccinated, and that is what needs to change.
After reading many times since post came out, I just now noticed that. Thanks!
Thank you! I hadn’t read this before and didn’t understand why. Thank you for clarifying! My almost 17yo is 8.5 moths post V2. So waining and not fully vaxxed now. “Only 59.7% of the United States is fully vaccinated (which the CDC defines as not having a booster, which really needs to change)”. Doesn’t the CDC also say that only fully vaxxed should be the ones traveling (even domestic)? If approved soon (it’s taking too long), how many days post booster would be full “enough”? I read a study that said it takes 3 weeks (for Pfizer I think) to reach its full protection.
I eventually realized that the statement included "not" re booster and full vax. I 100% agree that a booster should be needed to be "fully vaccinated".
The immune system in adolescents isn't the same as the immune system in a 60-yr-old. There's published evidence of circulating IgG at higher levels for teenagers after 6 months than for adults. The cut-off numbers are rather arbitrary, but I expect you'll see a go-ahead sooner than later for 11-17 patients receiving a booster.
From what I've seen, I thought those studies were really for the younger ones, up to 15. Pfizer asked FDA for approval days ago for 16-17, but no mention from either place has been made since. 16-17 were approved 6 months ago for EUA. 12-15 was more recent. My kiddo is 1 month away from 17. And, in those studies, I wonder if they considered those that hit puberty earlier than normal. I hope you're right that mine is really an "adolescent".
that’s correct to an extent. i talked about this trade off on a post a few days ago. check it out here: https://yourlocalepidemiologist.substack.com/p/omicron-update-nov-29
I wouldn't say they "can't" mutate in both directions at once, but rather that often mutations that allow immune escape may negatively affect other viral functions. We don't know why and how SARS-CoV2 causes disease, so we can't really know what these mutations are doing to the virus in terms of severity of disease (yet).
So more of a project management thing? Becoming contagious and virulent is "overscoped"
I think of it more in terms of what the proteins are doing. The shape of the protein affects what other proteins it can bind to (in this case the spike protein binds to the ACE receptor). Mutations may affect the ability of antibodies to bind to the spike protein, but then they might also affect the ability of the spike protein to bind to its receptor. It's easiest to understand if you visualize 3D surfaces fitting together. The better they fit, the better they bind. It's a little more complex than that, but I think the visualization helps. It's really about the physics and chemistry of 3D shapes binding and/or changing their conformation like machines.
I forgot to say that mutations change the shape of the protein. Mutations result in changes in the subunit parts of the protein, switching out one part for another.