Thanks for another informative newsletter! As a public health professional who's lost faith in the CDC over its COVID-19 response and frustrated with how hard it is to find the latest reliable science, I take comfort in reading your newsletter as a trusted one-stop shop. My family still masks in public, is fully boosted, avoids indoor dining when possible (except at school), and tests before we gather indoors with anyone outside our household. In the past two weeks, my partner and one of our four kids had COVID-19. There's growing exhaustion among some in the household about continuing with what they feel are futile prevention measures. I'm still of the belief that we need to continue with prevention for our own sake AND public health. One personal motivator has been avoiding long term health issues associated with COVID-19. It would be helpful to hear your thoughts and the latest evidence on long term health issues stemming from COVID-19 infection. As time goes by and variants emerge, is the data showing we should be more or less concerned at an individual level for someone who is otherwise healthy and fully vaccinated?
I feel this in the primary care office, where it’s like running parallel jobs - one where I’m seeing patients, and the other where my inbox is getting flooded with messages/calls that need attention, many for Covid and Flu.
Oh, and my hospital system warned us that there is a severe national shortage of Tamiflu developing.
Would be nice to have some leadership step up and call for masks until Santa comes, politically poisonous as that might be.
I’m one of the outliers who found tamiflu to be very effective for me. I’ve had Flu A both with and without it. At the very least, it truncated my high fevers quickly. There is a drug called Xofluza that is approved for kids that aren’t high risk for flu complications now. My ped would only give tamiflu to kids with high risk conditions. They cited rare but serious psych effects. It’s talked about in this older FDA document. I don’t know if there have been updated studies about it. It looks like the concerns mostly stemmed from a Japanese study. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tamiflu-pediatric-adverse-events-questions-and-answers
I understand the sentiment that it’s never too late to get a booster. However it can be. It’s too late once you’ve died from Covid, and it’s too late once you’ve given a case of Covid to a loved one that puts them in the hospital or kills them.
Thank you for yet another important update. I loved the messaging on that UK Covid-19 booster banner. I'd love to see the U.S. steal that analogy and run with it. There's been such a lack of effective messaging on Covid boosters here in the U.S. Especially for older folks, being up to date is crucial as you emphasize. I guess I'm an outlier at 61, my arm is always ready for a vaccine or booster.
this is far and away the finest newsletter in the public-health-o-sphere. I was trained in public health in the 70s and, though I left the field in the 80s, I've maintained a population perspective, even in my area of psychiatry. Thank you, KJ
I love the visual aid created for the U.K. public health campaign. It's a quick, easy to understand metaphor that sells the benefit of boosters. The 1 in 3 boosting rate quoted in Katelyn's article is indeed a failure, the blame for which at least partially falls on health care experts and our government for failing to educate the public in simple, clear ways like this.
Thank you so much for this update. Could you share your thoughts on whether the uptick in RSV and flu could be partly caused by past COVID infections having weakened people's immune systems? I.e., that COVID damages the immune system and afterwards, even long after recovery from COVID, people are less able to fight off other infections? I have seen this theory cited. Thank you!
I've mostly seen doctors/public health experts (or at least those who appear to be) on Twitter theorizing that immune disregulation caused by prior COVID infections may be responsible for the rise in respiratory illnesses - or at least that this is very plausible and should be investigated. They cite studies like these, which discuss covid leading to immune disregulation, but these studies are from before this fall's wave of respiratory illness:
I am 81 years old and have gotten my flu vaccine and the fall booster. My fall covid booster was at the end of September. Should I be considering getting another booster. If so, when? Also, All my previous Covid vaccines and boosters have been Pfizer. Would it make sense to switch to another brand/type of booster? Thank you for all your wisdom.
I am under the impression that additonal boosters would not be provided to those who has the initial shots and the three subsequent boosters. Am I mistaken?
I don't think the tests are working preemptively. I had symptoms and tested negative 4 times over 5 days until I tested positive the day after Thanksgiving. My partner tested negative 4 times over 9 days with heavy symptoms before testing positive. I've heard a few stories like this over the last week. It may be spurious but I don't think so.
I’ve heard similar stories. I’m not sure if this is more likely to happen with home tests, multi-boosted people, or because of new variants - or some combo. But if a person doesn’t test positive until day 4 or 5 of their symptom onset, it will be extremely difficult for them to start Paxlovid early enough. Add to that the locations offering PCR tests are closing, and for the ones that are still open, turn around time for test results seems to be taking longer (2-3 days).
When dealing with a contagious virus - or in this case three contagious viruses - people have responsibilities to protect each other, in addition to protecting themselves.
Agree. I know so many younger people who have no idea that they are eligible for a bivalent booster, in part because when the original booster first came out, access was limited. There has not been the kind of advertising there was for the original booster.
Also, although not extremely hard, it is more difficult to find vaccines that obviously don't need co-pays. People are used to having to pay if they go to a pharmacy. And there are not nearly the efforts to reach people who do not have reliable transportation and/or who live far from a vaccination site as there were in the early days. Employers are also less willing to cut slack for vaccine-related absences now, even though logically this may hurt them in the long run.
Now that the triple-demic is here and flu and RSV are taking up more and more hospital beds, does the CDC need to rethink the way it calculates “Covid-19 Community Levels by County,” which determines risk based on Covid cases (undercount) and hospital beds consumed *only* by Covid?
Our Health Dept. Is working on messaging that masks are recommended indoors for everyone 2+ while respiratory infections are high. It’s decoupling the masking recommendations from only COVID. Let’s see how it goes in terms of compliance, but can’t hurt. The CDC needs to get rid of the “green light” map of COVID levels. Even with vastly reduced testing, COVID transmission levels still show a different story!
We're feeling it at home here in Germany. My 10 year old has been sick 5 times with different mostly cold-like illnesses in the last month. Nothing serious but she's missed a ton of school. Her school shortened their schedule last week due to # of sick teachers and this week told us "just expect school to randomly start late or end early" because so many teachers were calling in sick last minute. I had a work meeting last week where literally every parent in my work group called in sick - all home sick with sick kids. It's craziness.
I should have said, this is really a state of affairs for “northern hemisphere” or at least western countries. it seems that we are all experiencing the same. hang in there!!
It looks like that hasn’t been updated since February. Do you know if there’s still an EUA to give it to immunocompromised ambulatory patients within 8 days of symptom onset? They are the population most affected by the complete lack of effective monoclonal antibodies, so that would at least be something.
You commented on the Southern Hemisphere's flu season as many cases, not too bad in terms of hospitalizations: do you know what their flu vaccine uptake was like? I know so many people are vaccination-tired...but we need to get our rates up especially for influenza, and get people boosted for COVID! I must note that I see very few masks here in Ontario in public indoor places...sadly!
Thanks for another informative newsletter! As a public health professional who's lost faith in the CDC over its COVID-19 response and frustrated with how hard it is to find the latest reliable science, I take comfort in reading your newsletter as a trusted one-stop shop. My family still masks in public, is fully boosted, avoids indoor dining when possible (except at school), and tests before we gather indoors with anyone outside our household. In the past two weeks, my partner and one of our four kids had COVID-19. There's growing exhaustion among some in the household about continuing with what they feel are futile prevention measures. I'm still of the belief that we need to continue with prevention for our own sake AND public health. One personal motivator has been avoiding long term health issues associated with COVID-19. It would be helpful to hear your thoughts and the latest evidence on long term health issues stemming from COVID-19 infection. As time goes by and variants emerge, is the data showing we should be more or less concerned at an individual level for someone who is otherwise healthy and fully vaccinated?
I feel this in the primary care office, where it’s like running parallel jobs - one where I’m seeing patients, and the other where my inbox is getting flooded with messages/calls that need attention, many for Covid and Flu.
Oh, and my hospital system warned us that there is a severe national shortage of Tamiflu developing.
Would be nice to have some leadership step up and call for masks until Santa comes, politically poisonous as that might be.
I’m one of the outliers who found tamiflu to be very effective for me. I’ve had Flu A both with and without it. At the very least, it truncated my high fevers quickly. There is a drug called Xofluza that is approved for kids that aren’t high risk for flu complications now. My ped would only give tamiflu to kids with high risk conditions. They cited rare but serious psych effects. It’s talked about in this older FDA document. I don’t know if there have been updated studies about it. It looks like the concerns mostly stemmed from a Japanese study. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tamiflu-pediatric-adverse-events-questions-and-answers
I understand the sentiment that it’s never too late to get a booster. However it can be. It’s too late once you’ve died from Covid, and it’s too late once you’ve given a case of Covid to a loved one that puts them in the hospital or kills them.
Thank you for yet another important update. I loved the messaging on that UK Covid-19 booster banner. I'd love to see the U.S. steal that analogy and run with it. There's been such a lack of effective messaging on Covid boosters here in the U.S. Especially for older folks, being up to date is crucial as you emphasize. I guess I'm an outlier at 61, my arm is always ready for a vaccine or booster.
this is far and away the finest newsletter in the public-health-o-sphere. I was trained in public health in the 70s and, though I left the field in the 80s, I've maintained a population perspective, even in my area of psychiatry. Thank you, KJ
I love the visual aid created for the U.K. public health campaign. It's a quick, easy to understand metaphor that sells the benefit of boosters. The 1 in 3 boosting rate quoted in Katelyn's article is indeed a failure, the blame for which at least partially falls on health care experts and our government for failing to educate the public in simple, clear ways like this.
Thank you so much for this update. Could you share your thoughts on whether the uptick in RSV and flu could be partly caused by past COVID infections having weakened people's immune systems? I.e., that COVID damages the immune system and afterwards, even long after recovery from COVID, people are less able to fight off other infections? I have seen this theory cited. Thank you!
I've mostly seen doctors/public health experts (or at least those who appear to be) on Twitter theorizing that immune disregulation caused by prior COVID infections may be responsible for the rise in respiratory illnesses - or at least that this is very plausible and should be investigated. They cite studies like these, which discuss covid leading to immune disregulation, but these studies are from before this fall's wave of respiratory illness:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536991/
and
https://www.nature.com/articles/s41586-021-03553-9#MOESM4
I'm not a medical professional so it's hard to know how to evaluate these theories. I'd love to get Dr. Jetelina's take on it.
I thought T cell exhaustion was a known effect? https://www.science.org/doi/pdf/10.1126/science.ade4427
Thanks!
Once again. Thanks for the update.
I am 81 years old and have gotten my flu vaccine and the fall booster. My fall covid booster was at the end of September. Should I be considering getting another booster. If so, when? Also, All my previous Covid vaccines and boosters have been Pfizer. Would it make sense to switch to another brand/type of booster? Thank you for all your wisdom.
I am under the impression that additonal boosters would not be provided to those who has the initial shots and the three subsequent boosters. Am I mistaken?
I don't think the tests are working preemptively. I had symptoms and tested negative 4 times over 5 days until I tested positive the day after Thanksgiving. My partner tested negative 4 times over 9 days with heavy symptoms before testing positive. I've heard a few stories like this over the last week. It may be spurious but I don't think so.
I’ve heard similar stories. I’m not sure if this is more likely to happen with home tests, multi-boosted people, or because of new variants - or some combo. But if a person doesn’t test positive until day 4 or 5 of their symptom onset, it will be extremely difficult for them to start Paxlovid early enough. Add to that the locations offering PCR tests are closing, and for the ones that are still open, turn around time for test results seems to be taking longer (2-3 days).
Is it really a public health failure or a failure of people taking responsibility for themselves?
When dealing with a contagious virus - or in this case three contagious viruses - people have responsibilities to protect each other, in addition to protecting themselves.
You would think but particularly here in America that has not been a selling poing or reality
In a civilized country, that would be true, yes.
It's both. Almost no effect in the real world has one and only one cause. Also feedback loops.
Agree. I know so many younger people who have no idea that they are eligible for a bivalent booster, in part because when the original booster first came out, access was limited. There has not been the kind of advertising there was for the original booster.
Also, although not extremely hard, it is more difficult to find vaccines that obviously don't need co-pays. People are used to having to pay if they go to a pharmacy. And there are not nearly the efforts to reach people who do not have reliable transportation and/or who live far from a vaccination site as there were in the early days. Employers are also less willing to cut slack for vaccine-related absences now, even though logically this may hurt them in the long run.
Now that the triple-demic is here and flu and RSV are taking up more and more hospital beds, does the CDC need to rethink the way it calculates “Covid-19 Community Levels by County,” which determines risk based on Covid cases (undercount) and hospital beds consumed *only* by Covid?
Our Health Dept. Is working on messaging that masks are recommended indoors for everyone 2+ while respiratory infections are high. It’s decoupling the masking recommendations from only COVID. Let’s see how it goes in terms of compliance, but can’t hurt. The CDC needs to get rid of the “green light” map of COVID levels. Even with vastly reduced testing, COVID transmission levels still show a different story!
We're feeling it at home here in Germany. My 10 year old has been sick 5 times with different mostly cold-like illnesses in the last month. Nothing serious but she's missed a ton of school. Her school shortened their schedule last week due to # of sick teachers and this week told us "just expect school to randomly start late or end early" because so many teachers were calling in sick last minute. I had a work meeting last week where literally every parent in my work group called in sick - all home sick with sick kids. It's craziness.
I should have said, this is really a state of affairs for “northern hemisphere” or at least western countries. it seems that we are all experiencing the same. hang in there!!
Have you done a recent explainer on long Covid? I am trying to encourage a man in his late 20's to get vaccinated for the first time.
Just wanted to add a note to encourage those who can donate blood and plasma (a lot of the restrictions on donation have been eased recently), especially those with hybrid immunity of recent infection and an updated booster. With the EUA withdrawn for the last viable monoclonal antibody infusion, convalescent plasma is being eyed again, and showing great neutralizing antibody activity against the BQ.1 variants. Link (preprint study): https://www.news-medical.net/news/20221130/Plasma-from-vaccinated-and-COVID-19-convalescent-subjects-as-passive-immunotherapy-against-the-new-Omicron-BQ11-XBB-and-BF7-variants.aspx
It looks like that hasn’t been updated since February. Do you know if there’s still an EUA to give it to immunocompromised ambulatory patients within 8 days of symptom onset? They are the population most affected by the complete lack of effective monoclonal antibodies, so that would at least be something.
You commented on the Southern Hemisphere's flu season as many cases, not too bad in terms of hospitalizations: do you know what their flu vaccine uptake was like? I know so many people are vaccination-tired...but we need to get our rates up especially for influenza, and get people boosted for COVID! I must note that I see very few masks here in Ontario in public indoor places...sadly!