ER physician here. We are seeing trickles of COVID and a lot of Influenza-A right now. I’ve never seen Flu this late in the season; never in June. Some Flu cases vaccinated, some not. Why is this? My apology if you addressed this already in prior post. Mark/Tucson, AZ
yes we are having a terribly weird flu season and it is on the rise. we actually don’t have a good grasp (at ALL) about the interaction of co-circulating viruses. i do think masks and mitigation measures helped calm down flu a lot in 2020 but restrictions have been lifted for a while. my hypothesis is that the circulation of SARS-CoV-2 is impacting flu patterns. so you have high rates of COVID and low rates of flu. then COVID calmed down a little and flu took hold. and this cycle keeps going. we need to learn about this a whole lot more
Would you consider a future newsletter addressing "weird flu season" in North America & Europe compared to Asian countries where people have been wearing masks during flu seasons for years pre-Covid?
Shorter question: does Japan have a big, weird flu season in the summer when the masks come off? (My guess is "no," and we can learn from their experience if the data is accessible.)
I haven't looked at data on Japan & flu. I'll state from my experience living there for over 10 years & visiting a couple of times since, that Japan's flu season follows the typical Northern Hemisphere pattern. We didn't see universal masking pre-COVID in Japan. It was mostly people who felt under the weather, were being extra careful to avoid catching something, or wearing masks to reduce discomfort from air pollution and/or allergies. COVID moved masking rates up past 90% where they remain in most venues, though people do go to restaurants.
Thanks as always for your clear, data-based postings.
As a social scientist, I will note that Brandolini's Law has been in play since the beginning of the epidemic (and actually, in a wide variety of science-denying efforts for decades, going back to debates about the health implications of cigarette smoking and beyond).
I think scientists still often tend to shrug their shoulders when confronted with obvious woo and dis/misinformation. It is difficult and painful, and frequently futile to try to counteract people's irrational beliefs. It often takes a life-changing experience for someone to change their mind, especially if they have publicly espoused a contra-factual position. Many people will literally die rather than change.
That said, I think there are a lot of good attempts (including yours) to provide accurate information. The problem is that science-based communications are trying to use logic, facts and rational thinking to counter emotional, "magical" disinformation. Critical thinking is a learned skill, that requires effort and the ability to admit you are wrong and that someone else might be right. It is hard work, and many people were not taught the necessary skills and are too tired/overworked/bombarded by deceptive messaging about everything in their life to have the strength of will to learn to be critical and apply the skill regularly.
So true! We are dealing with this phenomenon in many areas of life, including our toxic politics surrounding the 2020 election and continuing efforts to make voting more difficult and/or impact whether our vote counts.
Even reasonable people are SO exhausted right now that they find it difficult to sort out truth from fiction. Part of it is information (and disinformation) overload. There is SO much news on SO many topics. It just eats away at the ability to apply critical thinking skills, even for those who have decently developed skills.
Regarding COVID, I came today looking for information on potential updated vaccines and the latest on treatments. I have had 3 shots, but I've wavered on the 4th. I feel like I haven't gotten a clear answer as to the benefit of a 4th that doesn't cover newer variants. And yet, I continue to limit my exposure to the public, being choosy about group events. I decline most group events, including regular church attendance, but have gone to a few events that have social/emotional importance- ie a funeral, a visit with one of my dad's lifelong friends who he may never see again, etc.
I really, really do not want to have the misfortune of getting long-COVID. I spent many years fighting chronic illness triggered by Lyme Disease, and though I function well now, I have some permanent damage. I don't want a reprise of that debacle. So, can I trust that a 4th injection will benefit me more than just the three? Can I trust that I can actually access early treatment and if I get it that it will prevent long-term symptoms? For now, my life is still limited in some ways. I'd like to have my life back, but I don't want to be sick. I wish there were better answers.
Because our current vaccines are ineffective at preventing infection and transmission, plus skepticism is growing even among early enthusiasts, I’d be curious to know more about early treatments that are in the pipeline.
Paxlovid appears to be a good first start yet many doctors are now steering patients away from it due to rebound and the need to restart isolation, not to mention a long list of medications that are counter indicated. It’s crazy nobody knows just how often rebound occurs, but obviously it’s more than 2%, which likely causes a whole secondary wave of inadvertent transmission and infection. Add to that the Israeli study that suggests Paxlovid really only helps those over 65 avoid hospitalization and death.
Paxlovid is in short supply and is available only to a small number of the most vulnerable (over 65, immunocompromised, comorbidities, etc).
We need more therapeutics, ones that work against any variant, ones without rebound, ones that don’t inadvertently create more transmission.
"our current vaccines are ineffective at preventing infection and transmission" This is not true, as the article makes plain, Nobody ever promised you either a rose garden or a vaccine that could be taken once and would be 100% effective forever. Keeping current with vaccinations will *reduce* your chances of getting ill and *reduce* your chances of serious illness if you do get sick.
Reduce not eliminate. No vaccine or any other prophylactic technique has ever been or ever will be 100% effective. "Less than 100% effective" and "ineffective" are not synonymous. Numbers exist between 0 and 100.
Do we need better therapies? Absolutely. And drug companies are working to find them. My sense from reading Dr. Jetelina's articles is that the same things about SARS-Cov-2 that make it hard to prevent also make it hard to treat.
But finding better therapies and finding more effective prophylactic measures are not mutually incompatible activities. Exactly the opposite, in fact. Right now our prophylactic measures are masks (KN/N 95 or the equivalent) and vaccination. 100% effective? No. Effective? Yes.
Can someone clarify the difference between "asymptomatic infection" and "being a carrier" for a pathogen? I'm guessing that infection involves an immune response while carrier doesn't. Some folks over here are wondering if they could acquire the infection from a carrier (such as someone recently recovered from infection, PCR-neg, but just happens to be carrying some live virus around). Or is this really a valid question??
Thanks KB - this is helpful, and in an 'interesting' way, because neither the Wiki article nor several others (in a convenience Internet sample!) distinguished asymptomatic infection from a carrier state-at a practical level, they're 2 names for the same thing. I suppose there might be some state where for example, I touched something with live virus and now it's on my hand and maybe before I have a chance to disinfect my hand I'm some version of "not infected carrier," but maybe that's irrelevant practically. And I believe an asymptomatically infected person can transmit virus if they have enough of it - so if we happened to sample them at the right time their PCR Ct value might be <35? (understanding there's a probability distribution of transmission at various Ct values)
It’s my understanding the rate of rebound for Paxlovid users is higher than “the natural history of SARS-Cov2 that has been observed in the past two years.”
Rebound is serious and must be dealt with because it’s discouraging both doctors and patients from using Paxlovid, plus leading to a second round of infectiousness, which creates inadvertent transmission.
Thanks for this. One of the problems is we do not have a clear definition for "Paxlovid rebound," or if we do, it's not being used consistently.
Compare this (from "CDC Health Advisory for COVID-19 Rebound After Paxlovid Treatment" dated May 24, 2022):
"COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative."
Versus this:
"If you take Paxlovid, you might get symptoms again," CDC director Dr. Rochelle Walensky told CBS News.
Why does this matter? It matters because:
1) People who finish Paxlovid should keep testing for 8 days to see if they get a new positive. Even if symptoms don't return, a new positive means "rebound;"
2) Without a clear and consistently communicated definition for "rebound," people will not know when they need to restart isolation;
3) What about people who keep testing positive for several days after finishing Paxlovid (i.e, they don't first test negative). Is this a rebound, meaning do they need to restart isolation, and if so, at what point? Neither of the above definitions contemplates this scenario yet I know 2 people in this category.
My husband and I are in the 23% of those eligible who have gotten our second boosters (just within the past two weeks). When we got our first booster shots, in November 2021, I was confident they’d protect us during holiday season travel. But then, of course, the Omicron wave hit. So far we’ve avoided getting infected, but I’m less confident about the protective ability of our second boosters as we prepare for a summer road trip to visit family.
I’m willing to keep getting booster shots every few months if necessary, but because I’m one of those people who suffers debilitating flu-like symptoms for a day or two afterwards, I’d love to know that it’s worth it because the shots are actually protecting me.
Hi Katelyn, can you give an update on preventative covid measures like evushield? For our family, we have one member who is on rutuximab once a year for MS, and was eligible for and was eligible for a evushield set of shots in April. On the other end, we have a 5 year old ready to start school. I don't really know what to do. We kinda feel like our whole family needs to be in a bubble.
What do you see coming up for people like us, and how can we lower the risks?
Are neutralizing antibodies the goal? Or is it preventing hospitalization and death? Because as I understand it the vaccines are still protecting us quite well against the latter.
yes they are but waning a bit. i don’t know what the goal is. this is a huge problem in the US is that it hasn’t been defined. we do know though that an updated virus should increase B-cell coverage (see my original antigenic sin post).
I appreciate the analysis, and the enumeration of the things we don't know.
My question is. . . at what point should we take the best available information, and just start making and distributing vaccines? I worry, particularly with the FDA, of analysis paralysis and they decide what the best choice is two months too late.
If it was me, I'd take Moderna's recommendation, and just start.
As a pediatrician, I agree with Dr Paul Offit that the goal should be to decrease hospitalizations and death and not trying to prevent a mucosal disease with yearly boosters. He thinks that the 3 dose series is enough to do this. I hope he's correct. Thanks for your excellent essays, as always.
Again, thank you. For me and I have been following the science as well as our own family doctors. We are eligible to be boosted and we are. My daughter and I got COVID in December and January. My dr has recommended that I wait until closer to the fall to receive my second boost. I am 52 and eligible. I know this differs from the broad message so it’s confusing and I can only imagine how confusing it is if you don’t have access to a regular physician.
Of particular interest to me is the spike ferritin nanoparticle vaccine- the so-called "all variant" shot under development at Walter Reed. Is this going to be the magic cure-all some hope for?
"Why aren’t we leveraging social science as much as bench science to increase effectiveness of vaccine rollouts?"
In meteorology and severe storms, we know how to predict a severe event (tornado, large hail, damaging winds) pretty accurately and with sufficient lead time to allow the public to hear a warning and get into a safe room, yet so many of them recognize the issuance of a warning as a call to action to find that video camera and stand out unprotected and unprepared to get video of the storm.
With vaccinations, we're seeing the same things. The call to action (GET VACCINATED, YOU DOLT) is simple, straightforward and unambiguous. yet the uptake is non-trivial. NOAA's National Weather Service has spent years investigating this and while headway's been made, it's been slow. I have been involved in improving warnings and uptake, with NWS for nearly 20 years. and remain baffled by the problem.
NWS has had a big social media presence and exposure. Yet, I'm not convinced they've done all they could do to amp up the social medial data and (dare I say, "Training" and "Social Media" In the same sentence?) and attempt to train the public to the Call to Action when a weather warning (or a vaccine recommendation!) is issued.
We also have to deal with the degree of disinformation we're seeing and integrating. A friend of a friend on Instagram doesn't EVER constitute a trusted and reliable resource unless you know him, have checked him out, and have verified his background and potential action. And then you should be suspicious.
Interested to learn more about the new Sanofi vaccine, based on flu technology and is a vaccine company familiar with updating their platform every year and disturbing across the globe. Maybe a future post once more data is available?
ER physician here. We are seeing trickles of COVID and a lot of Influenza-A right now. I’ve never seen Flu this late in the season; never in June. Some Flu cases vaccinated, some not. Why is this? My apology if you addressed this already in prior post. Mark/Tucson, AZ
yes we are having a terribly weird flu season and it is on the rise. we actually don’t have a good grasp (at ALL) about the interaction of co-circulating viruses. i do think masks and mitigation measures helped calm down flu a lot in 2020 but restrictions have been lifted for a while. my hypothesis is that the circulation of SARS-CoV-2 is impacting flu patterns. so you have high rates of COVID and low rates of flu. then COVID calmed down a little and flu took hold. and this cycle keeps going. we need to learn about this a whole lot more
Would you consider a future newsletter addressing "weird flu season" in North America & Europe compared to Asian countries where people have been wearing masks during flu seasons for years pre-Covid?
Shorter question: does Japan have a big, weird flu season in the summer when the masks come off? (My guess is "no," and we can learn from their experience if the data is accessible.)
I haven't looked at data on Japan & flu. I'll state from my experience living there for over 10 years & visiting a couple of times since, that Japan's flu season follows the typical Northern Hemisphere pattern. We didn't see universal masking pre-COVID in Japan. It was mostly people who felt under the weather, were being extra careful to avoid catching something, or wearing masks to reduce discomfort from air pollution and/or allergies. COVID moved masking rates up past 90% where they remain in most venues, though people do go to restaurants.
Thanks as always for your clear, data-based postings.
As a social scientist, I will note that Brandolini's Law has been in play since the beginning of the epidemic (and actually, in a wide variety of science-denying efforts for decades, going back to debates about the health implications of cigarette smoking and beyond).
I think scientists still often tend to shrug their shoulders when confronted with obvious woo and dis/misinformation. It is difficult and painful, and frequently futile to try to counteract people's irrational beliefs. It often takes a life-changing experience for someone to change their mind, especially if they have publicly espoused a contra-factual position. Many people will literally die rather than change.
That said, I think there are a lot of good attempts (including yours) to provide accurate information. The problem is that science-based communications are trying to use logic, facts and rational thinking to counter emotional, "magical" disinformation. Critical thinking is a learned skill, that requires effort and the ability to admit you are wrong and that someone else might be right. It is hard work, and many people were not taught the necessary skills and are too tired/overworked/bombarded by deceptive messaging about everything in their life to have the strength of will to learn to be critical and apply the skill regularly.
So true! We are dealing with this phenomenon in many areas of life, including our toxic politics surrounding the 2020 election and continuing efforts to make voting more difficult and/or impact whether our vote counts.
Even reasonable people are SO exhausted right now that they find it difficult to sort out truth from fiction. Part of it is information (and disinformation) overload. There is SO much news on SO many topics. It just eats away at the ability to apply critical thinking skills, even for those who have decently developed skills.
Regarding COVID, I came today looking for information on potential updated vaccines and the latest on treatments. I have had 3 shots, but I've wavered on the 4th. I feel like I haven't gotten a clear answer as to the benefit of a 4th that doesn't cover newer variants. And yet, I continue to limit my exposure to the public, being choosy about group events. I decline most group events, including regular church attendance, but have gone to a few events that have social/emotional importance- ie a funeral, a visit with one of my dad's lifelong friends who he may never see again, etc.
I really, really do not want to have the misfortune of getting long-COVID. I spent many years fighting chronic illness triggered by Lyme Disease, and though I function well now, I have some permanent damage. I don't want a reprise of that debacle. So, can I trust that a 4th injection will benefit me more than just the three? Can I trust that I can actually access early treatment and if I get it that it will prevent long-term symptoms? For now, my life is still limited in some ways. I'd like to have my life back, but I don't want to be sick. I wish there were better answers.
Thank you for this post.
Because our current vaccines are ineffective at preventing infection and transmission, plus skepticism is growing even among early enthusiasts, I’d be curious to know more about early treatments that are in the pipeline.
Paxlovid appears to be a good first start yet many doctors are now steering patients away from it due to rebound and the need to restart isolation, not to mention a long list of medications that are counter indicated. It’s crazy nobody knows just how often rebound occurs, but obviously it’s more than 2%, which likely causes a whole secondary wave of inadvertent transmission and infection. Add to that the Israeli study that suggests Paxlovid really only helps those over 65 avoid hospitalization and death.
Paxlovid is in short supply and is available only to a small number of the most vulnerable (over 65, immunocompromised, comorbidities, etc).
We need more therapeutics, ones that work against any variant, ones without rebound, ones that don’t inadvertently create more transmission.
When will “Test to Treat” be for EVERYONE?
"our current vaccines are ineffective at preventing infection and transmission" This is not true, as the article makes plain, Nobody ever promised you either a rose garden or a vaccine that could be taken once and would be 100% effective forever. Keeping current with vaccinations will *reduce* your chances of getting ill and *reduce* your chances of serious illness if you do get sick.
Reduce not eliminate. No vaccine or any other prophylactic technique has ever been or ever will be 100% effective. "Less than 100% effective" and "ineffective" are not synonymous. Numbers exist between 0 and 100.
Do we need better therapies? Absolutely. And drug companies are working to find them. My sense from reading Dr. Jetelina's articles is that the same things about SARS-Cov-2 that make it hard to prevent also make it hard to treat.
But finding better therapies and finding more effective prophylactic measures are not mutually incompatible activities. Exactly the opposite, in fact. Right now our prophylactic measures are masks (KN/N 95 or the equivalent) and vaccination. 100% effective? No. Effective? Yes.
Can someone clarify the difference between "asymptomatic infection" and "being a carrier" for a pathogen? I'm guessing that infection involves an immune response while carrier doesn't. Some folks over here are wondering if they could acquire the infection from a carrier (such as someone recently recovered from infection, PCR-neg, but just happens to be carrying some live virus around). Or is this really a valid question??
Thanks KB - this is helpful, and in an 'interesting' way, because neither the Wiki article nor several others (in a convenience Internet sample!) distinguished asymptomatic infection from a carrier state-at a practical level, they're 2 names for the same thing. I suppose there might be some state where for example, I touched something with live virus and now it's on my hand and maybe before I have a chance to disinfect my hand I'm some version of "not infected carrier," but maybe that's irrelevant practically. And I believe an asymptomatically infected person can transmit virus if they have enough of it - so if we happened to sample them at the right time their PCR Ct value might be <35? (understanding there's a probability distribution of transmission at various Ct values)
It’s my understanding the rate of rebound for Paxlovid users is higher than “the natural history of SARS-Cov2 that has been observed in the past two years.”
Rebound is serious and must be dealt with because it’s discouraging both doctors and patients from using Paxlovid, plus leading to a second round of infectiousness, which creates inadvertent transmission.
Thanks for this. One of the problems is we do not have a clear definition for "Paxlovid rebound," or if we do, it's not being used consistently.
Compare this (from "CDC Health Advisory for COVID-19 Rebound After Paxlovid Treatment" dated May 24, 2022):
"COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative."
Versus this:
"If you take Paxlovid, you might get symptoms again," CDC director Dr. Rochelle Walensky told CBS News.
Why does this matter? It matters because:
1) People who finish Paxlovid should keep testing for 8 days to see if they get a new positive. Even if symptoms don't return, a new positive means "rebound;"
2) Without a clear and consistently communicated definition for "rebound," people will not know when they need to restart isolation;
3) What about people who keep testing positive for several days after finishing Paxlovid (i.e, they don't first test negative). Is this a rebound, meaning do they need to restart isolation, and if so, at what point? Neither of the above definitions contemplates this scenario yet I know 2 people in this category.
"We can’t continue with a process that leaves kids constantly two years behind." AMEN.
My husband and I are in the 23% of those eligible who have gotten our second boosters (just within the past two weeks). When we got our first booster shots, in November 2021, I was confident they’d protect us during holiday season travel. But then, of course, the Omicron wave hit. So far we’ve avoided getting infected, but I’m less confident about the protective ability of our second boosters as we prepare for a summer road trip to visit family.
I’m willing to keep getting booster shots every few months if necessary, but because I’m one of those people who suffers debilitating flu-like symptoms for a day or two afterwards, I’d love to know that it’s worth it because the shots are actually protecting me.
Hi Katelyn, can you give an update on preventative covid measures like evushield? For our family, we have one member who is on rutuximab once a year for MS, and was eligible for and was eligible for a evushield set of shots in April. On the other end, we have a 5 year old ready to start school. I don't really know what to do. We kinda feel like our whole family needs to be in a bubble.
What do you see coming up for people like us, and how can we lower the risks?
Thanks.
Thanks again. You are the best!
Are neutralizing antibodies the goal? Or is it preventing hospitalization and death? Because as I understand it the vaccines are still protecting us quite well against the latter.
yes they are but waning a bit. i don’t know what the goal is. this is a huge problem in the US is that it hasn’t been defined. we do know though that an updated virus should increase B-cell coverage (see my original antigenic sin post).
Agreed!
Very informative. I count on you to provide evidence-based information, and I will always respond positively.
I appreciate the analysis, and the enumeration of the things we don't know.
My question is. . . at what point should we take the best available information, and just start making and distributing vaccines? I worry, particularly with the FDA, of analysis paralysis and they decide what the best choice is two months too late.
If it was me, I'd take Moderna's recommendation, and just start.
As a pediatrician, I agree with Dr Paul Offit that the goal should be to decrease hospitalizations and death and not trying to prevent a mucosal disease with yearly boosters. He thinks that the 3 dose series is enough to do this. I hope he's correct. Thanks for your excellent essays, as always.
Again, thank you. For me and I have been following the science as well as our own family doctors. We are eligible to be boosted and we are. My daughter and I got COVID in December and January. My dr has recommended that I wait until closer to the fall to receive my second boost. I am 52 and eligible. I know this differs from the broad message so it’s confusing and I can only imagine how confusing it is if you don’t have access to a regular physician.
A very useful web resource on up to date covid vaccine development projects world wide is:
https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker
Recommend highly.
Of particular interest to me is the spike ferritin nanoparticle vaccine- the so-called "all variant" shot under development at Walter Reed. Is this going to be the magic cure-all some hope for?
Thank you for all you do! I would be lost without you.
"Why aren’t we leveraging social science as much as bench science to increase effectiveness of vaccine rollouts?"
In meteorology and severe storms, we know how to predict a severe event (tornado, large hail, damaging winds) pretty accurately and with sufficient lead time to allow the public to hear a warning and get into a safe room, yet so many of them recognize the issuance of a warning as a call to action to find that video camera and stand out unprotected and unprepared to get video of the storm.
With vaccinations, we're seeing the same things. The call to action (GET VACCINATED, YOU DOLT) is simple, straightforward and unambiguous. yet the uptake is non-trivial. NOAA's National Weather Service has spent years investigating this and while headway's been made, it's been slow. I have been involved in improving warnings and uptake, with NWS for nearly 20 years. and remain baffled by the problem.
NWS has had a big social media presence and exposure. Yet, I'm not convinced they've done all they could do to amp up the social medial data and (dare I say, "Training" and "Social Media" In the same sentence?) and attempt to train the public to the Call to Action when a weather warning (or a vaccine recommendation!) is issued.
We also have to deal with the degree of disinformation we're seeing and integrating. A friend of a friend on Instagram doesn't EVER constitute a trusted and reliable resource unless you know him, have checked him out, and have verified his background and potential action. And then you should be suspicious.
Interested to learn more about the new Sanofi vaccine, based on flu technology and is a vaccine company familiar with updating their platform every year and disturbing across the globe. Maybe a future post once more data is available?