I saw a new patient yesterday. She has debilitating long Covid, the type that causes post-exertional malaise. Getting exercise is not possible, as she will feel wrecked and depleted for 2-3 days afterwards. Had 3 shots before this hit about 1.5 years ago. Was not offered Paxlovid. Mid 30's.
Anyway, I asked her why she was seeing me out of her home state. She replied that she learned of me in a local long Covid group as a doctor who does not gaslight people suffering with long Covid, who wears a freaking mask in clinical encounters, and who is open to considering possible (though still not 100% proven) treatments for long Covid sufferers. I'm not doing anything crazy, just listening and giving counsel and collaborating with some people who are desperate.
Wearing a mask has cost me professionally, actually, and friendships suffer when I try to be careful during these predictable holiday waves. But I think being a bit more careful right now makes sense. Can I get a little Amen? It really sucks being clear eyed and risk averse most of the time. It's exhausting in its own way. But hoping not to be sick for Christmas... good luck everyone.
Thank you for wearing a mask--there are social and professional costs. You've been a beacon of sanity. The federally qualified health centers that I'm affiliated with asked for voluntary masking to almost zero response...It is so exhausting to take reasonable precautions and be labeled "anxious". As a fellow primary care physician, you get my support and more.
Thanks Jan - and getting some rational support from people like you and Dr. Jetelina is really good for morale. I absolutely let my guard down at times, but not in my capacity as a doc, and not in higher risk situations in high risk seasons!
It's so easy to feel nuts/unreasonable. As you've written, the price of isolation is too high--but what the heck is wrong with reasonable precautions? The stigma is real and it's unnecessary and beyond unfortunate. I was a patient at 2 offices recently, one was clearly okay with masking, the other treated me like I was insane (the average patient age was over 70..). It's demoralizing.
You absolutely get my Amen! It can feel so odd to be seen as odd when taking what are just sensible precautions. Every now and then, a little light shines, though. A friend who had received my send-ons of Dr. Jetelina missives and had pretty much greeted them with silence, wrote me before attending a holiday sing-a-long party to ask whether I thought she should ask the host to have everyone test. I wrote back absolutely yes, cited Dr. Jetelina’s last update post, and lo, everyone tested, and lo again, two people tested positive who hadn’t recognized their symptoms for what they were, and stayed home! Little victories, eh?
All the amens — I’m not a doctor, and I work from home…so my preference to wear a mask indoors hasn’t been a huge impact to my life. And yet, when I go out and I’m the ONLY person masking indoors, the social pressure is intense.
Thank you for being a beacon of hope and supportive safety for those who need it. ❤️
I am floored that you are an MD and wearing a mask has cost you professionally. Do you know the reasons why? Even I, admittedly someone who is not a big mask wearer, feel comforted when I go to a medical office where everyone is wearing them.
Thank you for listening to your patients and for continuing to let scientific reality govern your decision-making on infection control protocols, despite societal pressures to be done with it already. I have to be honest, MDs are collectively in my experience (and our SIL is an MD) terrible at listening to their patients and dealing with illnesses that don't fit neatly into a routine paradigm. And when our healthcare system and society as a whole both lack the sobriety and maturity to accept difficult realities but prefer to remake reality to our liking like we're shopping on Amazon, we get into some dark and hopeless times and places that we could have, should have avoided. It's shaping up that this winter is again going to be one of those times and places, I'm afraid -but we can each only control what we each decide and do, so thank you.
BIG AMEN! Shopping in Chicago today in big box stores, I was the only person in a mask. I was grateful, however, that no one looked at me funny! Now I am in my late 70s which I believe is obvious even though I'm masked and I do think that probably helps. But I am sure that there is lots of virus from asymptomatic people in the air around me as I know more people currently sick with covid than I have at any time during the entire pandemic! Keep up the good work!
You can get a freaking HUGE “Amen”. I am not looking forward to us clear-eyed Covid cautious types surveying the world 5-10 years from now and witnessing the widespread (and extreme?) health fallout from multiple infections and minimal to no mitigations. I wish we could save people now, but they aren’t saving themselves.
Dr. Jetelina, thank you, yet once again, for an incredibly clear and useful update! As I wrote to Dr. McCormick here, I actually was able to put your last one to concrete, beneficial use. A friend invited to attend a holiday sing along wrote to ask me whether I thought she should ask the host to have everyone test before coming. Citing your last update, I said, absolutely yes, she followed through, and it turned out two potential attendees tested positive for Covid and therefore did not attend. So, thank you again, so much, for your hard and good work!
I am absolutely shocked (and enraged, really) at the experience I’ve had trying to get myself and my 3 kids under 7 vaccinated this season.
We’ve stayed up on our vaccinations from the beginning (I was even one of the first to get vaccinated while pregnant). We go to a naturopathic doctor. This should have been easy.
And yet, despite it being over a year since we were all vaccinated our dr said the kids weren’t due for a vaccination in their annual appts last month. Without any info on WHEN they’ll be eligible…it just doesn’t say in the WA registry. (We’re in WA state) And the cost for her to supply adult dosages would be $1K per vial, so she’s had to opt out.
Since we don’t have health insurance (we’re self employed with health share insurance instead), there are only a few pharmacies with the bridge program.
We all had annual appts last month, and I’m STILL trying to puzzle this all out…none of us have gotten our winter COVID vaxs. I didn’t even know about the bridge program till I googled, bc my doctor (who has always been AMAZING except in this instance, which is clearly not on her) didn’t know about it.
So for people without support, or time, or energy/patience to figure this stupid COVID vax debacle out?? No wonder the US is so under-vaccinated. 🤦♀️
Nobody wants the shots. You could knock on everyone's door with needles at the ready and most people would still have no interest. The reasons are obvious to anyone paying attention.
How is this response even remotely on point? Erin is writing about having trouble getting a vaccine she actually wants, and you're writing about other people not wanting shots. Does your reading comprehension actually extend beyond single words? Do you tap out at noun phrases?
So, a box of 10 vials is a little over $1000, not each dose. Obviously if she cannot find 10 people then the office is out $$ for a while. Reimbursement is good, so... that’s not a barrier.
We chose to vaccinate those 3 and under who cannot get in the local pharmacy. It’s fairly available as the demand is low, around here.
She was very clear that it was $1K per dose, and that had it been $1K for a box, she would have covered the cost. Either way, she always goes above and beyond for her patients so I'm trusting that however it shakes out on her end, it's not feasible.
“The U.K. and Singapore, which have high vaccination rates, are seeing a steep increase in hospitalizations now that JN.1 has taken over. Last week, CDC warned about the potential impact of low vaccination rates in the U.S.”
I thought the vaccines were still protecting against severe illness?
Stacked on top of this, there's a demographic trend of median ages increasing in a lot of countries, even as life expectancy has gotten shorter from the pandemic. Singapore has an median age of 42, compared to an median age of 38 in the US. Doesn't seem like much, but it's not nothing either.
Im confused about the “high” vaccination rates in the UK. A very close friend of mine works in primary schools (= viral soup) in London, is 50, has multiple comorbidities, and cannot get vaccinated per NHS policy. She doesn’t qualify — she’s not sick enough or old enough, even though here she absolutely would be.
Supposedly only the elderly and very frail qualify for this batch of vaccines. So, are the vaccination rates actually high on a population level, or are they high within the small cohort allowed to access them?
We don't know if they do or not. There aren't any randomized controlled trials that have been done on the new shots. The Phase III trial for the original shots didn't show an all-cause hospitalization benefit. We don't know if any of the shots keep people out of hospitals.
I'm not an MD, but this is my concern: In our current universal "let it rip" environment, there will inevitably eventually be a variant - or variants - that will be sufficiently mutated away from and unlike the variants against which the prior vaccines have been specifically designed, that for especially some segments of the population the prior vaccine regimen will be largely ineffective to prevent severe illness and we'll see another large-scale wave of deaths. Hopefully that's not JN.1, but I have seen concerns expressed elsewhere that JN.1 will in fact lead to deaths on the scale seen in the winter of 20-21. With the flu, because it mutates more predictably, vaccines can stay ahead of the risk - but I get the impression we are a lot more exposed to this kind of risk with COVID.
Vaccination rates are high in the UK but booster rates are low because they are only available to those over 65 or with predisposing medical conditions. I was vaccinated 1 month ago but my wife was not eligible. She got a lot sicker than me. She avoided hospitalisation because she is GP and could organise treatment at home.
Apparently the plan for next year is to make the vaccine available for anyone willing to pay.
We need to discuss nutrient deficiencies that lead to disease.
Nearly everyone in the US has subclinical micronutrient deficiencies. I am no longer deficient after supplementing my diet with Vitamin K2 MK-7, Vitamin D3, and Magnesium. After >20 years on Atorvastatin and 6 months on supplements, my lipid profile is "normal" after stopping the Statin. The supplements cost < 40￠/day. They are not drugs. They are just absent from our diet and we need them to live healthy lives. People often start with ½ the dose we are now taking. I increased the dose to lower my LDL cholesterol and Blood Pressure.
Vitamin K2 MK-7 200 mcg
Vitamin D3 10,000 IU
Magnesium Glycinate 2000 mg
No more Statin side effects, feel 20 years younger
I do not take statins although my PCP continues to recommend/prescribe. Since 2008, many have questioned the benefits vs. the side effects (muscular, diabetes). While statins do appear to reduce cholesterol, they also seem to miss the mark w/respect to reducing heart attacks.
Rosuvastatin (Crestor) is the statin most likely to cause Type 2 Diabetes. I started the supplements to help heal Achilles Tendinopathy. Six months in I had a routine lipid panel. My LDL dropped to 66 (low). I stopped the statin and got my life back. No brain fog, no aches & pains. It's unfortunate that "prevention" isn't in the "Guidelines".
Given the rapid growth of JN.1 and the number of mutations, do you predict that it will create a large wave/tsunami of new Covid cases in the way that Omicron did? Also, I'm curious about the high vaccination rates of the U.K. and Singapore and the increase of hospitalizations due to JN.1. Are they using the same vaccines as we do or do they have different vaccines?
If we got Covid in September, a few days before the booster came out, would you go get your Covid booster now at the 3 month mark to try to avoid getting sick this season?? Rather than wait for this peak to subside and get it at 6 months for optimal immune response? Otherwise healthy family - 13, 15, 42, 54 (high BP and autoimmune condition) years old.
Ho, Ho, Ho! As a teacher I can tell you that the respiratory bugs are everywhere. Do we know if J.N1 is more severe? I honestly have been sick with strep, cold, sinus, and have tested negative each time. However, have not been able to time my next COVID shot. Got flu in September but I just could not do both at same time. Hopefully, I can do it soon.
I just saw a photo of the Supreme Court paying respect to Sandra Day O'Connor and one justice was masked--a rare sight. I recently ran the gauntlet at a physicians' office where I was the lone masked person in a poorly ventilated space. Thank you for continuing to inform and I really hope you don't get hate mail for this.
Re: anti-virals--there is an oral remdesivir out of China that has languished. A medication with less drug interactions would be a game changer.
As the CDC sends out HAN updates about low vaccinations and revives testtotreat--it feels like they're being muzzled somehow, or falling on deaf ears.
I was supposed to visit my clinic "around Christmas" for labs to check my cholesterol levels (PCP was concerned in July, otherwise I'm healthy, trying to exercise and eat right)
Based on reports such as Dr Jetelina's, I have decided I don't need to do this until later in the spring. The people who will be hanging around the lab lobby in late December will include many of the infected! Does that make sense?
Meanwhile my partner is negotiating with his PCP to get labs and COVID/flu shots from a home health provider, as he is age 60+, heart attack survivor, convinced that COVID would be treacherous. PCP isn't arguing with him, but they can't seem to find a way to get it done. PCP is increasingly reluctant to renew prescriptions for him without the labs.
I would not ignore medical care. I was the lone mask wearer in an oncology clinic last week. You could ask for the earliest appointment and wear a good mask.
Came here to ask that. The response from substack is distressing. Dr. Jetelina I've been a longtime supporter and feel a strong need to continue supporting you, but don't know if I can do so on this platform. I hope you will see this and make a public statement. Perhaps even a column, since this is very clearly public health-related. Thank you. https://www.theverge.com/2023/12/21/24011232/substack-nazi-moderation-demonetization-hamish-mckenzie
RE the last line about holiday shopping. The article immediately before this one in my email was about how stressful and physically debilitating this period has become for Amazon delivery and postal workers. So even better - if you need to shop online, tell your family that their presents are coming after the holidays!
Interesting opinion piece written by Dr Jerome Adams posted yesterday on the need for BARDA to focus on identifying new oral antivirals to fight covid. Our country’s pandemic policy is falling further behind.
Link to article “Project NextGen is Ignoring New Covid-19 Antivirals When We Need Them Most” follows:
Thanks for sending; look forward to reading! However, I will say that it’s incredibly difficult to develop antivirals. This is why we still don’t have a good one for flu or other viruses. I wrote about this a few years ago: https://yourlocalepidemiologist.substack.com/p/where-are-the-antivirals
Yes, it's difficult to develop antivirals, but it's also difficult to get them FDA approved. Here's the story of one antiviral that faced a split AdComm vote (5-8) that FDA ended up denying:
The drug also has a prestigious Scientific Advisory Board, including Time Magazine's Man of the Year (1996) AIDS researcher Dr David Ho, and a former chair of FDA's Pulmonary-Allergy Drugs Advisory Committee (PADAC) Dr Erik Swenson:
Now the company Veru that was seeking approval of its antiviral has needed to pivot to metabolic drugs because it's nearly out of money and doesn't have the resources to keep jumping through FDA's expensive hoops despite the fact that the antiviral has not just covid but all viral ARDS life-saving application.
Sabizabulin is NOT in a phase 3 RCT because the company cannot afford to do the trial.
I’m aware of the long list of reasons why FDA denied but they also seemed to stack the deck against Sabizabulin in the briefing documents prior to the AdComm meeting.
If you were dying of viral ARDS, would you rather do nothing or would you rather take a drug featured as promising by The New England Journal of Medicine?
So, you're referencing an interim analysis submitted to NEJM on July 6th, 2022 and the FDA PADA committee reviewed and voted on this November 9th, 2022.
Keep in mind that papers published in NEJM or other journals are the work of the authors, including any conclusions.
I posted a link to a report on the committee and they even provided a link to the meeting. https://www.youtube.com/watch?v=7uMTrZ1lSsY Yes, they had reasons to be concerned. Do note that "Panelists who voted no said they had concerns over the efficacy, small sample size and the uncertainties." but “There are hundreds dying a day,” Shapiro said. “If they’re dying of ARDS and lower lung disease, it should be pretty easily achievable to get a larger study and improve it.”
I don't know if this qualifies as "peer reviewed" yet the New England Journal of Medicine thought Sabizabulin was enough of a possible game changer that they published this in ahead of the FDA AdComm meeting:
My sense is that as with any therapy, it's hard to bring new drugs to market once there are already effective drugs for a condition, because clinical trials become more ethically fraught - the controls need to be given the standard of care, sooner or later, so it's harder to get a clean reading.
Add to that the fact that the drug manufacturers are publicly traded companies bound by SEC regulations, and you start to see why there's so much opacity surrounding drug approval.
Not for or against our current system (competition to "build a better mousetrap" is surely a good thing) just describing the system we've got.
Speaking of anti-virals - there is an Israeli company pushing Nitric Oxide nasal spray - https://buyenov.com - with at least one reported study (funded by them) showing impressive responses with nasal viral loads. There don't see to be any newer studies, and I tend to be suspicious when the only data is from the company. Have you heard of this? If so, do you have any opinions? At least one clinical person noted that they are only measuring nasal levels, and if the virus has gotten past the nose, we know nothing of what it is doing. But - as another commenter noted, if we can't get people to take vaccines, if there are other effective interventions, we should promote those. Just don't want to be going down the ivermectin primrose path....
I use nasal sprays. Sometimes Enovid, sometimes Covixyl, and daily Xlear. There is some data showing they are all effective at reducing viral load. Anecdotally, despite caring for a kiddo with covid, no one in our home got it. Maybe the data will show they are useless, but my bet is they do help. People won’t mask. People are iffy on shots. It boggles my mind we are not encouraging anything that might help. Covixyl and Xlear are both reasonably priced.
I know your question wasn't for me, but I've been using Enovid for nearly a year after my doctor recommended it to me. I haven't gotten covid (although I am still fairly careful), including two trips to London in 2023.
My husband and I, who are both vaxed and boosted (most recent Novavax mid-Oct '23) were dining indoors in a crowded restaurant with low ceilings a week ago, and 3 days later he had covid and I didn't. (Our lunch was supposed to be on the patio, but when we arrived, the restaurant informed us it was "too cold to eat outside" so I reluctantly ate indoors because two people had traveled over an hour to meet with us.)
I can't say for sure my husband caught covid at lunch (he had a haircut right before) so I don't know if somehow the combo of Enovid and Novavax spared me from an infection. He cough seemed shallow (no lower lung involvement). After 4 days on Paxlovid he started testing negative but of course will finish the full 5 day treatment. Data point of one, but I always find other people's anecdotes interesting.
I'm still trying to understand Public Health better (thank you YLE!) yet my best guess is even if Enovid works, because it's expensive and somewhat error prone (what if you damage your nose? what if you fail to use it consistently? what if it causes you to ditch your mask?), it would never be promoted by US Public Health because it's not something that everyone can access or use appropriately and might encourage undesirable behavior.
I agree with that sentiment, but some folks, like myself, have had very terrible reactions. My care team does not recommend any more for me. Many others are anti vax or don’t feel the need or whatever the case may be. My point is that uptake is so low that we need to think of other ways to deal with covid. People won’t mask; I am often the lone person in a mask. But, people will take medicine if they are sick.
I just heard about another long Covid story. The woman is 29 years old and has had to quite graduate school. She has lost her energy and focus. Where is the best place to get solid information on long Covid. The whole family is trying to figure this out!
I'm concerned about the slow rate of development for mRNA vaccines against new variants. In practice the manufacturers should be able to keep up with the emergence of new variants in the middle of ongoing production.
I do see the value of full clinical trials before approving "universal" vaccines against spike S2 and/or nasal vaccines, but let's get on with it!
I saw a new patient yesterday. She has debilitating long Covid, the type that causes post-exertional malaise. Getting exercise is not possible, as she will feel wrecked and depleted for 2-3 days afterwards. Had 3 shots before this hit about 1.5 years ago. Was not offered Paxlovid. Mid 30's.
Anyway, I asked her why she was seeing me out of her home state. She replied that she learned of me in a local long Covid group as a doctor who does not gaslight people suffering with long Covid, who wears a freaking mask in clinical encounters, and who is open to considering possible (though still not 100% proven) treatments for long Covid sufferers. I'm not doing anything crazy, just listening and giving counsel and collaborating with some people who are desperate.
Wearing a mask has cost me professionally, actually, and friendships suffer when I try to be careful during these predictable holiday waves. But I think being a bit more careful right now makes sense. Can I get a little Amen? It really sucks being clear eyed and risk averse most of the time. It's exhausting in its own way. But hoping not to be sick for Christmas... good luck everyone.
Thank you for wearing a mask--there are social and professional costs. You've been a beacon of sanity. The federally qualified health centers that I'm affiliated with asked for voluntary masking to almost zero response...It is so exhausting to take reasonable precautions and be labeled "anxious". As a fellow primary care physician, you get my support and more.
Thanks Jan - and getting some rational support from people like you and Dr. Jetelina is really good for morale. I absolutely let my guard down at times, but not in my capacity as a doc, and not in higher risk situations in high risk seasons!
It's so easy to feel nuts/unreasonable. As you've written, the price of isolation is too high--but what the heck is wrong with reasonable precautions? The stigma is real and it's unnecessary and beyond unfortunate. I was a patient at 2 offices recently, one was clearly okay with masking, the other treated me like I was insane (the average patient age was over 70..). It's demoralizing.
Very demoralizing. I appreciate so much the voices of sanity in these comments. Thanks to all.
You absolutely get my Amen! It can feel so odd to be seen as odd when taking what are just sensible precautions. Every now and then, a little light shines, though. A friend who had received my send-ons of Dr. Jetelina missives and had pretty much greeted them with silence, wrote me before attending a holiday sing-a-long party to ask whether I thought she should ask the host to have everyone test. I wrote back absolutely yes, cited Dr. Jetelina’s last update post, and lo, everyone tested, and lo again, two people tested positive who hadn’t recognized their symptoms for what they were, and stayed home! Little victories, eh?
Wow! You've given me some courage to bring this up with my family. Strong work.
Courage calls to courage, and you give me courage! Good luck with the family; I can relate!
Fantastic!
All the amens — I’m not a doctor, and I work from home…so my preference to wear a mask indoors hasn’t been a huge impact to my life. And yet, when I go out and I’m the ONLY person masking indoors, the social pressure is intense.
Thank you for being a beacon of hope and supportive safety for those who need it. ❤️
I am floored that you are an MD and wearing a mask has cost you professionally. Do you know the reasons why? Even I, admittedly someone who is not a big mask wearer, feel comforted when I go to a medical office where everyone is wearing them.
Thank you for listening to your patients and for continuing to let scientific reality govern your decision-making on infection control protocols, despite societal pressures to be done with it already. I have to be honest, MDs are collectively in my experience (and our SIL is an MD) terrible at listening to their patients and dealing with illnesses that don't fit neatly into a routine paradigm. And when our healthcare system and society as a whole both lack the sobriety and maturity to accept difficult realities but prefer to remake reality to our liking like we're shopping on Amazon, we get into some dark and hopeless times and places that we could have, should have avoided. It's shaping up that this winter is again going to be one of those times and places, I'm afraid -but we can each only control what we each decide and do, so thank you.
Keep up your good work! Its needed.
You are a rarity. I was in an oncology suite in a major cancer center. Not a mask to be seen other than mine. From patients or providers.
Amen for sure. And thanks for being such a good example to others.
BIG AMEN! Shopping in Chicago today in big box stores, I was the only person in a mask. I was grateful, however, that no one looked at me funny! Now I am in my late 70s which I believe is obvious even though I'm masked and I do think that probably helps. But I am sure that there is lots of virus from asymptomatic people in the air around me as I know more people currently sick with covid than I have at any time during the entire pandemic! Keep up the good work!
Ditto. Masking. Limiting large group friend gatherings. I am starting to feel a bit like a crazy person.
We went back to asking all patients to mask in office. That’s interesting that she sought you out for that...
I don’t understand not offering Paxlovid especially as older folks with meds often cannot take it.
Younger? Good grief, offer it.
We have long Covid kids, equally tragic. Sometimes takes a while to figure it out as the history of Covid gets very overlooked.
OMG and the flu? It’s an explosion.
You can get a freaking HUGE “Amen”. I am not looking forward to us clear-eyed Covid cautious types surveying the world 5-10 years from now and witnessing the widespread (and extreme?) health fallout from multiple infections and minimal to no mitigations. I wish we could save people now, but they aren’t saving themselves.
AMEN!! I wish that more doctors had your good sense and decency.
Amen.
Dr. Jetelina, thank you, yet once again, for an incredibly clear and useful update! As I wrote to Dr. McCormick here, I actually was able to put your last one to concrete, beneficial use. A friend invited to attend a holiday sing along wrote to ask me whether I thought she should ask the host to have everyone test before coming. Citing your last update, I said, absolutely yes, she followed through, and it turned out two potential attendees tested positive for Covid and therefore did not attend. So, thank you again, so much, for your hard and good work!
I am absolutely shocked (and enraged, really) at the experience I’ve had trying to get myself and my 3 kids under 7 vaccinated this season.
We’ve stayed up on our vaccinations from the beginning (I was even one of the first to get vaccinated while pregnant). We go to a naturopathic doctor. This should have been easy.
And yet, despite it being over a year since we were all vaccinated our dr said the kids weren’t due for a vaccination in their annual appts last month. Without any info on WHEN they’ll be eligible…it just doesn’t say in the WA registry. (We’re in WA state) And the cost for her to supply adult dosages would be $1K per vial, so she’s had to opt out.
Since we don’t have health insurance (we’re self employed with health share insurance instead), there are only a few pharmacies with the bridge program.
We all had annual appts last month, and I’m STILL trying to puzzle this all out…none of us have gotten our winter COVID vaxs. I didn’t even know about the bridge program till I googled, bc my doctor (who has always been AMAZING except in this instance, which is clearly not on her) didn’t know about it.
So for people without support, or time, or energy/patience to figure this stupid COVID vax debacle out?? No wonder the US is so under-vaccinated. 🤦♀️
🤯
Nobody wants the shots. You could knock on everyone's door with needles at the ready and most people would still have no interest. The reasons are obvious to anyone paying attention.
Disappear troll
But, but, Paul got 7 likes..... First time ever.
Yeah, sad. Guess the world has “adapted” - as in drifting his way.🤮
How is this response even remotely on point? Erin is writing about having trouble getting a vaccine she actually wants, and you're writing about other people not wanting shots. Does your reading comprehension actually extend beyond single words? Do you tap out at noun phrases?
Call your county department of health. They often have vaccine programs for people like you.
https://doh.wa.gov/you-and-your-family/immunization
So, a box of 10 vials is a little over $1000, not each dose. Obviously if she cannot find 10 people then the office is out $$ for a while. Reimbursement is good, so... that’s not a barrier.
We chose to vaccinate those 3 and under who cannot get in the local pharmacy. It’s fairly available as the demand is low, around here.
She was very clear that it was $1K per dose, and that had it been $1K for a box, she would have covered the cost. Either way, she always goes above and beyond for her patients so I'm trusting that however it shakes out on her end, it's not feasible.
“The U.K. and Singapore, which have high vaccination rates, are seeing a steep increase in hospitalizations now that JN.1 has taken over. Last week, CDC warned about the potential impact of low vaccination rates in the U.S.”
I thought the vaccines were still protecting against severe illness?
They do! Four things:
1. high vaccination rate does not equal 100%
2. There are people that are vaccinated but unfortunately that’s not enough, like severely immunocompromised.
3. What we aren’t seeing in the graphs is decoupling over time. The rate of infection increase is far higher than hospitalizations.
We just got a Denmark preprint last week showing that vaccination this fall has a 70% effectiveness against hospitalization.
Stacked on top of this, there's a demographic trend of median ages increasing in a lot of countries, even as life expectancy has gotten shorter from the pandemic. Singapore has an median age of 42, compared to an median age of 38 in the US. Doesn't seem like much, but it's not nothing either.
Im confused about the “high” vaccination rates in the UK. A very close friend of mine works in primary schools (= viral soup) in London, is 50, has multiple comorbidities, and cannot get vaccinated per NHS policy. She doesn’t qualify — she’s not sick enough or old enough, even though here she absolutely would be.
Supposedly only the elderly and very frail qualify for this batch of vaccines. So, are the vaccination rates actually high on a population level, or are they high within the small cohort allowed to access them?
I wonder this too. Perhaps high among those eligible but not high in general?
We don't know if they do or not. There aren't any randomized controlled trials that have been done on the new shots. The Phase III trial for the original shots didn't show an all-cause hospitalization benefit. We don't know if any of the shots keep people out of hospitals.
Troll
No. YOU don't know. You're projecting your willful ignorance on everyone else.
I'm not an MD, but this is my concern: In our current universal "let it rip" environment, there will inevitably eventually be a variant - or variants - that will be sufficiently mutated away from and unlike the variants against which the prior vaccines have been specifically designed, that for especially some segments of the population the prior vaccine regimen will be largely ineffective to prevent severe illness and we'll see another large-scale wave of deaths. Hopefully that's not JN.1, but I have seen concerns expressed elsewhere that JN.1 will in fact lead to deaths on the scale seen in the winter of 20-21. With the flu, because it mutates more predictably, vaccines can stay ahead of the risk - but I get the impression we are a lot more exposed to this kind of risk with COVID.
Vaccination rates are high in the UK but booster rates are low because they are only available to those over 65 or with predisposing medical conditions. I was vaccinated 1 month ago but my wife was not eligible. She got a lot sicker than me. She avoided hospitalisation because she is GP and could organise treatment at home.
Apparently the plan for next year is to make the vaccine available for anyone willing to pay.
We need to discuss nutrient deficiencies that lead to disease.
Nearly everyone in the US has subclinical micronutrient deficiencies. I am no longer deficient after supplementing my diet with Vitamin K2 MK-7, Vitamin D3, and Magnesium. After >20 years on Atorvastatin and 6 months on supplements, my lipid profile is "normal" after stopping the Statin. The supplements cost < 40￠/day. They are not drugs. They are just absent from our diet and we need them to live healthy lives. People often start with ½ the dose we are now taking. I increased the dose to lower my LDL cholesterol and Blood Pressure.
Vitamin K2 MK-7 200 mcg
Vitamin D3 10,000 IU
Magnesium Glycinate 2000 mg
No more Statin side effects, feel 20 years younger
I was on Atorvastatin starting some 20 years ago, also. My PCP has 'migrated' me through several Statins through that time; currently on Rosuvastatin.
Also on Vitamin D3 at 6000 IU, and have forever been taking SLONIACIN at 1500 mg.
I do not take statins although my PCP continues to recommend/prescribe. Since 2008, many have questioned the benefits vs. the side effects (muscular, diabetes). While statins do appear to reduce cholesterol, they also seem to miss the mark w/respect to reducing heart attacks.
See NNT for more information:
https://thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/
Rosuvastatin (Crestor) is the statin most likely to cause Type 2 Diabetes. I started the supplements to help heal Achilles Tendinopathy. Six months in I had a routine lipid panel. My LDL dropped to 66 (low). I stopped the statin and got my life back. No brain fog, no aches & pains. It's unfortunate that "prevention" isn't in the "Guidelines".
Given the rapid growth of JN.1 and the number of mutations, do you predict that it will create a large wave/tsunami of new Covid cases in the way that Omicron did? Also, I'm curious about the high vaccination rates of the U.K. and Singapore and the increase of hospitalizations due to JN.1. Are they using the same vaccines as we do or do they have different vaccines?
If we got Covid in September, a few days before the booster came out, would you go get your Covid booster now at the 3 month mark to try to avoid getting sick this season?? Rather than wait for this peak to subside and get it at 6 months for optimal immune response? Otherwise healthy family - 13, 15, 42, 54 (high BP and autoimmune condition) years old.
Ho, Ho, Ho! As a teacher I can tell you that the respiratory bugs are everywhere. Do we know if J.N1 is more severe? I honestly have been sick with strep, cold, sinus, and have tested negative each time. However, have not been able to time my next COVID shot. Got flu in September but I just could not do both at same time. Hopefully, I can do it soon.
I just saw a photo of the Supreme Court paying respect to Sandra Day O'Connor and one justice was masked--a rare sight. I recently ran the gauntlet at a physicians' office where I was the lone masked person in a poorly ventilated space. Thank you for continuing to inform and I really hope you don't get hate mail for this.
Re: anti-virals--there is an oral remdesivir out of China that has languished. A medication with less drug interactions would be a game changer.
As the CDC sends out HAN updates about low vaccinations and revives testtotreat--it feels like they're being muzzled somehow, or falling on deaf ears.
I was supposed to visit my clinic "around Christmas" for labs to check my cholesterol levels (PCP was concerned in July, otherwise I'm healthy, trying to exercise and eat right)
Based on reports such as Dr Jetelina's, I have decided I don't need to do this until later in the spring. The people who will be hanging around the lab lobby in late December will include many of the infected! Does that make sense?
Meanwhile my partner is negotiating with his PCP to get labs and COVID/flu shots from a home health provider, as he is age 60+, heart attack survivor, convinced that COVID would be treacherous. PCP isn't arguing with him, but they can't seem to find a way to get it done. PCP is increasingly reluctant to renew prescriptions for him without the labs.
I would not ignore medical care. I was the lone mask wearer in an oncology clinic last week. You could ask for the earliest appointment and wear a good mask.
off-topic: are you considering moving away from Substack as your platform? ( https://www.theatlantic.com/ideas/archive/2023/11/substack-extremism-nazi-white-supremacy-newsletters/676156/ )
Came here to ask that. The response from substack is distressing. Dr. Jetelina I've been a longtime supporter and feel a strong need to continue supporting you, but don't know if I can do so on this platform. I hope you will see this and make a public statement. Perhaps even a column, since this is very clearly public health-related. Thank you. https://www.theverge.com/2023/12/21/24011232/substack-nazi-moderation-demonetization-hamish-mckenzie
RE the last line about holiday shopping. The article immediately before this one in my email was about how stressful and physically debilitating this period has become for Amazon delivery and postal workers. So even better - if you need to shop online, tell your family that their presents are coming after the holidays!
America the stupid.
Sounds like you should move away.
Interesting opinion piece written by Dr Jerome Adams posted yesterday on the need for BARDA to focus on identifying new oral antivirals to fight covid. Our country’s pandemic policy is falling further behind.
Link to article “Project NextGen is Ignoring New Covid-19 Antivirals When We Need Them Most” follows:
https://thehill.com/opinion/4366619-project-nextgen-is-ignoring-new-covid-19-antivirals-when-we-need-them-most/amp/
Thanks for sending; look forward to reading! However, I will say that it’s incredibly difficult to develop antivirals. This is why we still don’t have a good one for flu or other viruses. I wrote about this a few years ago: https://yourlocalepidemiologist.substack.com/p/where-are-the-antivirals
Yes, it's difficult to develop antivirals, but it's also difficult to get them FDA approved. Here's the story of one antiviral that faced a split AdComm vote (5-8) that FDA ended up denying:
https://www.washingtontimes.com/news/2023/jan/23/fda-should-approve-more-therapeutics-to-prevent-co/
Since the time of FDA's denial, this drug has demonstrated further antiviral capabilities in independently run studies:
https://ir.verupharma.com/news-events/press-releases/detail/172/veru-announces-preclinical-results-from-expanded
https://ir.verupharma.com/news-events/press-releases/detail/173/veru-announces-preclinical-study-results-that-demonstrate
The drug also has a prestigious Scientific Advisory Board, including Time Magazine's Man of the Year (1996) AIDS researcher Dr David Ho, and a former chair of FDA's Pulmonary-Allergy Drugs Advisory Committee (PADAC) Dr Erik Swenson:
https://ir.verupharma.com/news-events/press-releases/detail/167/veru-announces-appointment-of-dr-david-d-ho-as-chairman
https://ir.verupharma.com/news-events/press-releases/detail/181/veru-announces-appointment-of-dr-erik-swenson-and-dr
Now the company Veru that was seeking approval of its antiviral has needed to pivot to metabolic drugs because it's nearly out of money and doesn't have the resources to keep jumping through FDA's expensive hoops despite the fact that the antiviral has not just covid but all viral ARDS life-saving application.
https://ir.verupharma.com/news-events/press-releases/detail/188/veru-reaches-agreement-with-fda-on-new-phase-3-clinical
From what I've have seen, we are not utilizing the antivirals we have now. Too many cases are not getting paxlovid for a variety of reasons, most of them seems rather lame. I have my eye on VV116 and wonder where we are on this. See, that Sabizabulin is now in a phase 3 RCT. This link provide the information on why the FDA asked for another trial. https://www.healio.com/news/pulmonology/20221110/fda-panel-votes-against-sabizabulin-eua-for-covid19-at-risk-for-ards#:~:text=The%20FDA%26rsquo%3Bs%20Pulmonary-Allergy%20Drug%20Advisory%20Committee%20voted%208-5%2C,that%20further%20evaluates%20the%20efficacy%20of%20the%20drug.
Sabizabulin is NOT in a phase 3 RCT because the company cannot afford to do the trial.
I’m aware of the long list of reasons why FDA denied but they also seemed to stack the deck against Sabizabulin in the briefing documents prior to the AdComm meeting.
If you were dying of viral ARDS, would you rather do nothing or would you rather take a drug featured as promising by The New England Journal of Medicine?
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200145
So, you're referencing an interim analysis submitted to NEJM on July 6th, 2022 and the FDA PADA committee reviewed and voted on this November 9th, 2022.
Keep in mind that papers published in NEJM or other journals are the work of the authors, including any conclusions.
I posted a link to a report on the committee and they even provided a link to the meeting. https://www.youtube.com/watch?v=7uMTrZ1lSsY Yes, they had reasons to be concerned. Do note that "Panelists who voted no said they had concerns over the efficacy, small sample size and the uncertainties." but “There are hundreds dying a day,” Shapiro said. “If they’re dying of ARDS and lower lung disease, it should be pretty easily achievable to get a larger study and improve it.”
In short, Veru reported on Sept 23rd, 2023, "Veru Reaches Agreement with FDA on New Phase 3 Clinical Trial for Sabizabulin for Broader Indication: Hospitalized Adult Patients with Any Type of Viral Acute Respiratory Distress Syndrome (ARDS)". https://www.globenewswire.com/news-release/2023/09/26/2749503/11676/en/Veru-Reaches-Agreement-with-FDA-on-New-Phase-3-Clinical-Trial-for-Sabizabulin-for-Broader-Indication-Hospitalized-Adult-Patients-with-Any-Type-of-Viral-Acute-Respiratory-Distress-S.html
We will see...
Other than the Washington Times and Very press releases, do you have any other direct links to peer reviewed studies on this?
PS: If I were in the hospital *dying* from viral ARDS and my choices were:
1) Do nothing
2) Take a drug with strong evidence supporting it (but not FDA approved)
I would absolutely choose #2!
So maybe we should expand "compassionate use"?
I don't know if this qualifies as "peer reviewed" yet the New England Journal of Medicine thought Sabizabulin was enough of a possible game changer that they published this in ahead of the FDA AdComm meeting:
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200145
My sense is that as with any therapy, it's hard to bring new drugs to market once there are already effective drugs for a condition, because clinical trials become more ethically fraught - the controls need to be given the standard of care, sooner or later, so it's harder to get a clean reading.
Add to that the fact that the drug manufacturers are publicly traded companies bound by SEC regulations, and you start to see why there's so much opacity surrounding drug approval.
Not for or against our current system (competition to "build a better mousetrap" is surely a good thing) just describing the system we've got.
Roche covering up data for Tamiflu didn't help either.
Really? Do you have a source?
Speaking of anti-virals - there is an Israeli company pushing Nitric Oxide nasal spray - https://buyenov.com - with at least one reported study (funded by them) showing impressive responses with nasal viral loads. There don't see to be any newer studies, and I tend to be suspicious when the only data is from the company. Have you heard of this? If so, do you have any opinions? At least one clinical person noted that they are only measuring nasal levels, and if the virus has gotten past the nose, we know nothing of what it is doing. But - as another commenter noted, if we can't get people to take vaccines, if there are other effective interventions, we should promote those. Just don't want to be going down the ivermectin primrose path....
I use nasal sprays. Sometimes Enovid, sometimes Covixyl, and daily Xlear. There is some data showing they are all effective at reducing viral load. Anecdotally, despite caring for a kiddo with covid, no one in our home got it. Maybe the data will show they are useless, but my bet is they do help. People won’t mask. People are iffy on shots. It boggles my mind we are not encouraging anything that might help. Covixyl and Xlear are both reasonably priced.
I know your question wasn't for me, but I've been using Enovid for nearly a year after my doctor recommended it to me. I haven't gotten covid (although I am still fairly careful), including two trips to London in 2023.
My husband and I, who are both vaxed and boosted (most recent Novavax mid-Oct '23) were dining indoors in a crowded restaurant with low ceilings a week ago, and 3 days later he had covid and I didn't. (Our lunch was supposed to be on the patio, but when we arrived, the restaurant informed us it was "too cold to eat outside" so I reluctantly ate indoors because two people had traveled over an hour to meet with us.)
I can't say for sure my husband caught covid at lunch (he had a haircut right before) so I don't know if somehow the combo of Enovid and Novavax spared me from an infection. He cough seemed shallow (no lower lung involvement). After 4 days on Paxlovid he started testing negative but of course will finish the full 5 day treatment. Data point of one, but I always find other people's anecdotes interesting.
I'm still trying to understand Public Health better (thank you YLE!) yet my best guess is even if Enovid works, because it's expensive and somewhat error prone (what if you damage your nose? what if you fail to use it consistently? what if it causes you to ditch your mask?), it would never be promoted by US Public Health because it's not something that everyone can access or use appropriately and might encourage undesirable behavior.
I think anti virals are more palatable to folks than vaccines at this point.
Why? An ounce of prevention…
I agree with that sentiment, but some folks, like myself, have had very terrible reactions. My care team does not recommend any more for me. Many others are anti vax or don’t feel the need or whatever the case may be. My point is that uptake is so low that we need to think of other ways to deal with covid. People won’t mask; I am often the lone person in a mask. But, people will take medicine if they are sick.
I just heard about another long Covid story. The woman is 29 years old and has had to quite graduate school. She has lost her energy and focus. Where is the best place to get solid information on long Covid. The whole family is trying to figure this out!
I'm concerned about the slow rate of development for mRNA vaccines against new variants. In practice the manufacturers should be able to keep up with the emergence of new variants in the middle of ongoing production.
I do see the value of full clinical trials before approving "universal" vaccines against spike S2 and/or nasal vaccines, but let's get on with it!