66 Comments

Please, please continue to emphasize masking. The threat of severe disease is still significant for some populations, and long Covid remains a real risk.

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I think community masking is over and we can't bring it back. One way masking is the thing now. But, maybe a mask refresher is needed. Of the masked people I see, more than half have either:

-an insufficient mask type. Way too many "surgicals" and cloth(!) vs N95 type

-horrible fit - big gaps around nose and sides

FWIW, I'm 66 y.o. 4x vaxxed, OG Omicron recovered, and there is evidence that I may be protected a good bit by hybrid immunity, but I still mask in certain places like airports, crowded grocery stores. But not in others like uncrowded big box stores and hotel lobbies. I am not perfectly consistent with these choices. I typically use a KF94 with some tape on the nose bridge when I mask.

I spend my risk on eating out, but still prefer outdoor to indoor.

I've used a CO2 meter to guide my risk choices.

I test on any symptoms.

I plan on getting the new booster as soon as it comes out.

I think the best we can do now is try to understand the current situation as best we can and act accordingly.

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I'm wearing an N95 in any and all public indoor spaces, period. No exceptions. We're at the point where we have to rely on self defense since the national motto now appears to be "every man for himself."

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Clearly. Rotten shame masks got politicized.

Bob Wacther on twitter does good job of risk assessment. Check him out

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Although he gave pretty awful advice to his own wife. It's definitely possible for otherwise intelligent people to let emotions get in the way of sound judgment. Unnecessary traveling, even at this point during a pandemic, is selfish and irrational. Nobody *needs* to go to an in-person conference.

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In retrospect, yes. There is no "zero risk" for anything. It's about weighing risk vs reward. It is really hard to judge the relative risk in the current environment. Wacther is about as tuned in as anyone.

Nobody needs to leave their house for anything, these days. That would minimize the risk from all sorts of activity. But that's no way to live.

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No, Wachter was all about being selfish until his wife got it and even then. Plus his son had it early on and has risk factors. He is chair of medicine at UCSF. He should be setting an example as a leader.

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Indeed. And thanks for the tip on Wachter.

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Long covid is definitely the long tail of the Covid infection curve and is going to plague its sufferers for years. It is a horrible outcome and will be a public health burden for a long time. I hope, when she has the leisure, that YLE will gift us some data on the developing research.

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Aug 22, 2022·edited Aug 22, 2022

YES! What are the current hypotheses... the possible underpinning biology... potential analogues with other chronic conditions... how it's being investigated... and whether reported cases of long-covid-like post-vaccine syndromes likely share similar mechanisms?

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Such a nice, concise summary - thank you Katelyn! Re masking, very likely community masking is "over" and I'm seeing lots of tweets about the (potential) negative consequences of masking especially in school (learning facial expression cues). I don't know enough to have an opinion on that but how about some compassionate statements by trusted people to stop shaming people who *choose* to mask? By really good communicators who understand how much resentment there was for 'forced' (however well justified) masking. I'm fortunate to live in a community where I can wear my N95 in peace and harmony. So it's possible.

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Katelyn, I had the Salk injection and the attenuated virus on the sugar cube as a child.. Do ypu feel that I am probably protected against paralysis, or do you feel that I should get the current polio vaccine series? Also, had scratch smallpox vaccine as a child. Do you feel that I am protected against severe monkeypox? I am 75. Please address these questions. Thank you for all you have done to educate as all.

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Polio, monkeypox and covid. It's difficult to sort out the ranking of these in triaging our public health dollars. Covid retains the greatest uncertainty in how it will develop, so perhaps the best strategy is to put most of our resources into quick responses immediately to hMPX and Polio to slow them down, in order to buy precious time to get ready for a catastrophic variant developing in Covid. Which is not unlikely unfortunately. Katelyn said "buckle up". So true! But where it might also be advised is in reaction to global warming which is a major driver of the spread of pathogens and vectors steadily northwards (think Zika for one). It's happening at a far faster rate than predicted and there is abundant evidence that abrupt climate crashes have occurred in the past. So preparing for a rapid change in the heat levels (and the disease implications,) the CDC should start modeling and right away. Time's running out.

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All of which implies our public health system is in urgent need of substantially more funding. Would it be so unreasonable to divert a few hundred billions from making bombs, bullets, tanks, i.e. things that kill people, to funding public health which tries to save people's lives?? What are our true priorities: saving life or taking it?

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I, too, would like to add to the requests for guidance for we Boomers, born in the late '40s and '50s, who received polio vaccines as children (undoubtedly the Salk vaccine). I was born in '53 and seem to recall receiving the shot annually for a number of years before the oral vaccine came out. What is our status vis-à-vis the current outbreak and the modern vaccine?

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I was born in 1950 and received injections of the Salk vaccine and ate them sugar cubes with the Sabin vaccine.

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Yes, I had the same question. I was born in '48 and got the Salk vaccine along with nearly everyone else, since there was no wackadoodle anti-vaccine movement back then.

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I wonder if Americans are going to have to learn that lesson all over again. The United States of Amnesia.

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I wonder if it would be a good idea to add 1 dose of OPV (to be given after 3 doses of IPV) to our current polio vaccine strategy. It would decrease the likelihood of significant circulation of poliovirus in the community (as it would provide strong gut-level IgA immunity), without increasing the risk of paralysis.

Of course, the biggest problem we face is people not getting vaccinated at all. We need more community outreach, as well as tightening immunization laws. Walking around unvaccinated against disease like polio and measles (without a valid medical reason) should NOT be a legal option!

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Agreed. In the parlance of biohazard risk mitigation, OPV could be seen as a "regrettable substitution"

OPV isn't bad in and of itself, it's just that it's not worth the tradeoff in areas where wild polio is considered to have been eradicated. Hopefully this particular outbreak burns out, without the attenuated virus mutating into something gnarly.

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Eek, that's disturbing

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Regarding the Polio outbreak in NYC, this is where good public health policy can make an impact. Community engagement, stakeholder involvement, public education and meeting the community where they live, work, and play to provide mobile vaccination clinics would be the best approach to increase vaccination rates in Williamsburg and Bed-Sty

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We really need to ask people to stay home for a couple weeks whenever they get a live attenuated replication competent vaccine. They certainly shouldn't be boarding airplanes.

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True, although the person who brought this vaccine derived polio virus to New York State may have been someone (probably unvaccinated) who traveled to a place where OPV was in use, got infected with it, and then came back home not realizing they had been infected and were shedding virus. Telling the vaccine recipient to stay home for a few weeks would make no difference in that case.

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Or we just make quarantining after *all* travel the norm, like we do with non-human organisms. It's kinda nuts that we don't.

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I’m an American born in 1974, and I’ve been assuming that all of us U.S.-born kids my age with normal, non-anti-vaxxer parents, who got all our shots, are fine with respect to polio. Is that still the case?

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I am wondering this too. My kids got all the required vaccines for school, so I figured they were OK, but now I am wondering.

I am surprised that there are such low levels of vaccination in parts of NY (where I live), but the state only eliminated the religious exemption after the 2019 measles outbreak, also in Rockland County. I thought students who had previously received a religious exemption now had to get vaccines, but I may be wrong. I do know that my son had to stay home until he got the meningitis vaccine once NY implemented the requirement. It was quite the situation because doctors' offices didn't have enough. The school district had to arrange the county department of health to come in and provide the vaccine to students.

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Aug 22, 2022·edited Aug 22, 2022

I remember lining up for polio injection in school around 1960 or early 60’s (born in ‘51). What I don’t remember (and I suspect many don’t) is having multiple injections. Do you know how many were given at that time? My mother (an RN, who had polio in the late 40s) had us fully vaccinated by standards of the time, but 60 years later, how protected are we? The priority should be vaccinating kids of course, but will there come a time when boosters will be recommended for old geezers like me?

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I just received a summons to sit on a grand jury, so I'll be getting another shot shortly beforehand. This will be #7. Serving on a jury is a civic duty; getting Covid isn't, and there's plenty of vaccine to go around.

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Hypervaxed, how have you managed to get so many vaccinations? In my state and health system it was a struggle at first to get two, then it was a struggle to get one's own preferred boosters. The general culture was of scarcity and "take what's available,". Even now, I can't request a fifth booster despite being in an at-risk category. How did you do it?

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Nobody checks anything. All I had to do was schedule the appointment and leave my card at home.

I have no reason to believe there would be any legal liability. At the very worst, the insurance company could, at some much later date, decide that they paid the provider's claim in error, at which point they could short the provider on subsequent claims and the provider could attempt to bill me.

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Depends on the state. In my state, you have to sign an attestation, which my attorney husband says would constitute an E felony for falsifying.

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I'd expect it would still have to be initiated by someone who was somehow "harmed" by my getting a shot. Not something for which I'd expect fishing expeditions. The only party that I can imagine might be adversely impacted would be (a) me (b) whoever's paying or (c) someone else that I'm depriving of a shot. For (a) I'd think that the only upshot would be that I wouldn't have a leg to stand on if I experienced an adverse side effect - that's a risk I'm willing to accept. This seems unlikely, since the extra shots are almost certainly what's keeping me from getting Covid. Probably not perfect, but enough to ride out a few waves. For (b) it would be my insurance company, I guess. At worst, I might owe money to someone someday. They might try to threaten something more serious, but nothing I couldn't plea bargain. As for (c), tens of millions of doses have gone to waste already and over 100 million Americans eligible for their boosters haven't gotten them.

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Have you discussed all these additional boosters with your doctor?

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Another good reason to get a polio booster - heterologous immunity against Covid!

https://www.frontiersin.org/articles/10.3389/fmed.2021.710010/full

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A recent MMR vaccine might also protect against Covid, but apparently this benefit applies only to males:

https://pubmed.ncbi.nlm.nih.gov/34187707/

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Ooh, I didn't realize that it was only for males. I had two MMR's in 2019 and a TDAP in February 2022

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Aug 22, 2022·edited Aug 22, 2022

I'm female. In 2018 at age 50, a test revealed I did not have measles antibodies. So I took the first shot of MMR and on day 14 had a fever for 3 days and fatigue so bad I never went back for shot 2. My husband got covid in May 2022, and I could not have been more exposed. I developed very mild covid symptoms for 48 hours (sore throat, light cough, but no fever or fatigue). I never tested positive, both on multiple home tests, PCR and even (a month later) antibody (I was in low hundreds, consistent with vaccine). I felt like I'm the opposite of an asymptomatic: symptoms without ever testing positive. Even though I kept testing negative, I stayed home for 10 days to make sure I didn't spread anything to others.

It's totally possible the Moderna vaccines and boosters helped protect me, but my husband had the exact same vaccine schedule and got full blown covid (including lengthy Paxlovid rebound). I can't help but wonder whether the single MMR vaccine helped protect me from getting full blown covid. After I got the antibody results which suggest I never had covid, I asked my doctor to run a measles antibody test. I was off the charts with antibodies (something like < 25,000, highest level). As it turns out, I think it would have been better to test my mumps antibodies, since that seems to be the part of MMR that might possibly protect against covid.

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In all the discordant couples in my life, it seems like it's the male that tests positive.

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Interesting. Sherry and I both got careless on a cruise back in June and wound up with COVID. I have a very mild (a low-level head cold, essentially) while she didn't get off the couch for a week. We both had MMR shots within the last several years.

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Thanks for providing an anecdote that doesn’t fit. That’s useful in terms of refuting the hypothesis.

I hope you and Sherry are feeling better!

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What gave you the idea that I was trying to confirm or refute anything? I don't recall making a claim one way or the other. Personal anecdotes can't, all by themselves, confirm or refute anything.

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If anything your account is somewhat confirmatory. Usually men get hit harder than women; in your case the MMR shot may have reduced the severity of your illness but not hers.

In my case, heterologous immunity may be preventing me from getting sick at all, but I'm also more careful than most (I won't be doing any travel for the foreseeable future)

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My understanding of the Scientific Method is that all you need is one piece of data to refute a hypothesis. My own experience matches what Hypervaxed said about "discordant couples" - the man gets covid and tests positive, the woman tests negative even with mild symptoms. So it's refreshing to hear your story.

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deletedAug 23, 2022·edited Aug 23, 2022
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Meh, I feel like during a raging pandemic it's probably pretty defensible just to wing it and disregard the clunky clinical trial system. My priority is adding whatever layers of Swiss cheese that I can add. In the meantime, protecting myself against a growing local threat of polio can't hurt.

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Here's an idea for how to pay for pandemics: parametric insurance, using wastewater surveillance to create an index.

https://content.naic.org/cipr-topics/parametric-disaster-insurance

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The BA5 decent sure look slow. Lots of moving parts, but could be a few months until we're back down to low levels of last Spring. Hopefully new booster, plus low levels, plus lots of folk with hybrid immunity will give a good run without another big surge.

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Dr Jetelina

My husband just received mono clonal antibodies (MAB) as a very high risk person with a new Covid infection. We were scheduled to get polio vaccinations 48 hours after the (MAB) in a limited time NYS clinic it took me a week to find. No physician will even discuss with us the factors that may be present with getting both in such a short time.

What should I be researching or considering? Thank you.

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I know I had something in the early 1950’s ?? But at 79 years old I have no clue what or how much vaccine I received. Should I boost up or chase a repeat? I’d sure hate to burden my family with an easily preventable communicable disease.

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founding

Can you offer recommendations for timing and frequency of PCR and antigen testing for family visiting us - coming from LA to Palo Alto by car, staying in hotels, eating in restaurants. Thanks, in any case.

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I would do a home test before you get together each time. The PCR test isn't really useful in these situations.

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