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Disagree on the recommendation not to push masking for currently healthy children as this blatantly disregards the risks of Long COVID resulting in no longer healthy children. Particulalry when you corrently point out how little states have done to address indoor air quality in schools (which would benefit much more than just COVID/other airborne illnesses, to include allergens and overall cognitive function once CO2 levels are lowered to healthy levels). Disappointing to say the least.

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Strong comment. We’ve given our daughter full autonomy to mask or not, and she chooses to mask indoors for the start of this school year, understanding we’re in a wave, she sees her grandparents often, and that Covid has unknown long term effects multiplied by the number of infections. She will likely take it off once things calm down (whenever that is) and there are still plenty of chances to contract covid during the school day as she’s not 100%.

Yet she’s the only kid out of 700+ in her school wearing a mask these first few days. That troubles me in so many ways.

Meanwhile I treated 7 outpatients for covid today alone in Jersey, on par with other surges anecdotally.

And what’s wrong with virtue signaling if your behavior is truly virtuous? When did “virtue” become something to negate in practice and scorn in our public dialogue? Do we not believe an act of simultaneous altruism and self-preservation can be a virtue?

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We’ve also given our 4 children full autonomy with regard to masking and they are still choosing to mask indoors at school whenever practical (a few do not have outdoor options for eating meals). Between their 3 schools (elementary, middle and high school), they are often one of the few if not the only children wearing masks (we are in a very anti-science area in Florida). We have a similar situation with regard to high risk grandparents (one who just finished cancer treatments), and I hope that my children continue to choose to mask throughout the school year so that we can continue to safely visit them, as well as keep our immediate family safe and healthy.

My husband and I mask if indoors around others outside of the home (work, grocery store, etc.), so we try to lead by example and have honest, age-appropriate discussions with the children about why we mask. We’ve also been quite frank that choosing to mask may lead to bullying (from peers and teachers) and that we understand if they choose not to mask in those situations. Thankfully, they have not encountered outright hostility or violence, mostly a few passive aggressive comments, but also some who truly are curious as to why they are still masking when everyone has told them COVID is over. I try to help the kids to have simple answers ready, such as “I don’t want to get sick” or “I have high risk family members.”

It is truly sad how individualistic we’ve become as a society and how that has morphed into hate towards those trying to protect themselves and others during an ongoing global health crisis. This is primarily due to the mainstreaming of conspiracy theories driven by fascist politicians. Truly crazy times.

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I am so impressed with this response thank you. I’m considering whether I should copy and paste our brief conversation here into a post… but I think it would generate a lot of hostility from parents who are ideologically opposed to masking. Yet it’s like oxygen for those of us who fully inform our children and then respect their autonomy to choose a socially penalizing, family-protecting, self-defending public health tool.

Think I should? I can anonymize your name, and seriously no pressure. This discussion has been helpful for me today either way! Thanks.

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Actually let’s just leave it here I won’t copy and paste, but once again thanks for your thoughts and the validation they provide.

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It is always a pleasure to find like-minded folks. Hope you have a lovely weekend. 💜😷

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I completely agree. Children are vectors, as well, and masking protects their parents and other relatives. I felt this assertion was not thought through. Just because people aren’t having their healthy kids mask doesn’t mean it’s not a good idea.

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There may be a subtlety here - I can be pro-masking, and I can ask someone else nicely to mask (whether or not they're in my immediate family) but also not be too keen on "pushing" masks on someone else. Either people are gonna mask or they aren't, and in case you haven't noticed the ones who are fiercely opposed to masking seem to be either actual or emotional toddlers. The latter get pretty darn violent, and it becomes a balancing act between protecting oneself from Covid and physical assault.

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This post was specifically targeted towards parents, so I read it as her advice for parents was not to “push” masking for their own children. As a parent, it is my responsibility to protect and educate my children, as well as protect others in our family who are at elevated risk. Studies have proven the common sense fact that children are vectors for illness.

Fortunately, I do not have to fear physical violence from my own children when I advise (“push”) them to mask. For those who do, I would advise those folks to seek appropriate resources since that issue is irrelevant to “pushing” masking.

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I'm not a parent but I do have a kid brother, a memory of my own childhood, and a four year old niece. I've seen a few outbursts in my day and surrender is sometimes the least bad option.

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As parents/caregivers, we certainly need to choose when it is appropriate to choose our battles. I have 4 children, am the oldest of 5 children, have numerous nieces and nephews, and worked in daycare for many years during college, so try my best to leverage that experience and perspective when making such assessments. As such, I provide my children with the best information available and provide them with acceptable, age-appropriate options, and ultimately the choice is theirs to make. My children choose to mask at school, even though they are usually one of the few. I provide them options on masks depending on age, but typically N-95’s for the older kids and KF-94’s for the younger kids. Some prefer head straps, some prefer ear loops. Some choose to eat outside (when able), some choose to eat indoors. We’re all doing our best to make it through this insanity, and it isn’t without significant risk everyday compounded by the sheer stupidity of most of the rest of humanity. So far, no known cases of COVID in our household and no toddler tantrums from my kids. 😷

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The very different NYC hospitalization rates for unvaccinated adults vs vaccinated adults are still shocking to me - vaccination STILL making a big difference.

Very interesting about home air filters becoming 95% less effective due to charged wildfire particles. Amazing how much of the smaller particle/virus filtration may be electrostatic versus mechanical apparently.

And finally, I am bracing myself for disappointment regarding the CDC meeting. In an interview with PBS, Dr. Offit (whom I respect greatly) stated that he believes the new boosters should only be recommended for 75 yo and up:

https://www.pbs.org/newshour/health/your-fall-guide-to-covid-rsv-and-flu-vaccines

As an FDA advisor, he has a lot of influence and expertise...

Yet the game is not just reducing risk of hospitalization and death, but also reducing long Covid burden and disability, community spread, and boosting some modicum of herd immunity, even if temporarily through the anticipated peak Dr. Jetelina is talking about this December perhaps.

I don't think there is enough data out there to definitively determine whether boosters reduce long Covid, but just because enough studies haven't been done doesn't mean we can't take a small intuitive leap of faith?

Vaccination absolutely reduces long Covid risk, perhaps around 40% reduction according to this meta-analysis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9905096/

The same analysis showed up to 20% of people already experiencing long Covid reported improvement in symptoms after a booster.

Maybe I'll find time to leave public comment about this for the CDC meeting, but if anyone else has a similar (and more evidence based!) assessment regarding boosters and long Covid, please advise or leave a public comment by tomorrow. Any known studies on this would be greatly appreciated.

https://www.federalregister.gov/documents/2023/08/25/2023-18288/advisory-committee-on-immunization-practices

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That Offit comment sparked an intense wave of misinformation. He has no influence at ACIP, which determines policy. Don’t read into it too much. I was disappointed in PBS for that. Eligibility confusion is the last thing we need for the public

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I'm feeling my blood pressure coming down already, and I'm rolling up my sleeve as we speak ;) Seriously, thanks.

I'll forgive PBS, as I often watch Newshour while cooking dinner late, and it feels like the only nightly news that is still old school. But in this case, old school source quotation did spark misinformation agreed.

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Well, just had to look at the current CDC on covid boosters.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html

I expect it will be similar but recall the confusion when the bivalent came out. No need to get your blood pressure up. Offit is often misquoted or understood, I would like to watch the video. I think this has been his thoughts for some times, even last year.

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founding

I now from your previous posts that you regard him as a good source of advice, but I find him to be consistently opposed to recommending anything more than the least that can be done. Frankly I don’t pretend to understand it - perhaps it stems from his seeming obsession with the possible misleading impact on the immune system from too many vaccines leading it to defend against the wrong “enemy”. Or maybe just another timid academic, bureaucratic type who never wants to do anything until “all the evidence is in”. By which time many more will have died. I’ve seen him interviewed and he personable, well spoken and knowledgeable- all of which I feel are negative because it leads people to buy into his views.

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"he personable, well spoken and knowledgeable- all of which I feel are negative because it leads people to buy into his views." Yes, he very knowledgeable. Didn't realize this is a negative trait.

Seems like a lot of animosity stem from his one no vote on VRBPAC and Bivalent booster. Why, not that he was against boosting but "Committee member Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, agreed that additional booster doses were needed in the fall for some high-risk groups, but was unsure whether it should include the original omicron strain. Offit, who was one of the two "no" votes, said he would support a booster that targeted BA.4 and BA.5, rather than BA.1." Turned out,he was right. BA,1 was gone by the time the booster became available. He did support the new XBB.1 booster as a monovalent.

https://www.medpagetoday.com/opinion/faustfiles/100026

No, I not a hero-worshiping cult follower. I follow others as well.

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founding

Hope is one of the others whom you also follow. Eric Topol. He is far more educated than I am and he seems to share my view of Offit's opinions (my added capitalization): "We also have A CERTAIN PHYSICIAN WHO is advocating the new booster for only age 75 years, WHICH IS PREPOSTEROUS. THE XBB.1.5 booster will address waned immunity in all people, and it is just a matter of bigger benefit for those at higher risk. Certainly people who are older than 65+ or immunocompromised should get a booster. Younger people should have the ability to make the choice as to whether they would like to have some enhanced protection"

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Yah, Offit can be a bit of an edgelord with this stuff, can't he?

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founding

I had to lookup “edgelord” but, when I did, I realized how applicable it was to Offit.

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Thank you so much for clarifying this. My husband and I have been flipping out ever since we saw the PBS report. I need surgery and am counting on being able to time my vaccinations for maximum infection protection during hospitalization and recovery.

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founding

Eligibility should be for all adults unless there is a shortage of and hence a need for rationing vaccines.

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Eligibility should be for all adults *and children.* Essentially, all those previously eligible.

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Long covid/long-term effects of multiple covid infections is the scary unknown for me. My adult children are a lot less concerned than before the vaccines came out, as if they are now bulletproof from severe disease. Does anyone get “ long flu”? Or have lingering systemic effects, like elevated liver enzymes and lung damage from other viruses?

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Hi Sara - I think we know more about SARS CoV2 than any other virus in history at this point, and a lot of what we are learning does seem to clarify murky post-viral syndromes from other viruses. Like chronic Epstein Barr, higher CV risk after flu for at least a year after infection, viral triggers with chronic fatigue syndrome/myalgic encephalomyelitis....

It's enough to make you want to be a hermit, but that's not living either. Risk reduction while balancing the balance of our short time here is the goal, to varying degrees among individuals.

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And when I say individuals, it's with a sigh. Dr. Jetelina I think sighs about this too, right? (Based on recent remarks on Ezra Klein Show)

I do wish we had a more communal, socially cohesive, altruistic culture, but a lot of the creation myth of America has always been about the rugged individual. Works for some situations, and is a complete disaster for others as we've seen and suffered.

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Tribalism is strong in our species.

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Don't forget about bacteria, wait for my next post !

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Are the vaccinated vs unvaccinated charts for people with Covid or general population? Vaccinated people still tend to be more careful and are less likely to catch Covid in the first place. But in these charts, the vaccine gets all the credit for the careful behavior.

An anti-vaxer isn’t likely to mask at the market or on a plane, right? Or insist on outdoor dining with friends.

I support vaccines, yet I’d like to see the vaccinated vs unvaccinated chart for people who are already infected with Covid. The relevant question is “if I get covid, how good are the vaccines at keeping me out of the hospital?”

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P.S. Here's a quote from the interviewer of the Pandemic Revisionism podcast: "And as a result, we sort of looked past a lot of what was going on. And in fact, looked past a lot of, for instance, that pretty soon the majority of deaths were among the vaccinated and started modulating or calibrating our sense of the state of play much more by the resuming normalcy of our own lives than by the mortality statistics, however large they may be."

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Great comment Dr. McCormick. I do take issue with the claim "Vaccination absolutely reduces Long Covid risk", though I understand why put faith in the meta analysis you cited. The studies included in the meta are suspect, and the meta may merely be "GIGO".

May be true, may not be true. I honestly don't know.

What I do know is that we have data showing that every highly vaccinated country saw Covid cases increase following vaccination - many of them it exploded (Denmark, South Korea are notable examples). We also saw all cause mortality increase following mass vaccination in almost every country (again, Denmark and South Korea notable examples), while the few countries which didn't vaccinate appear to have drops in cases and mortality. It seems plausible that the vaccine had the unfortunate consequence of making you resist a particular variant, while making you more susceptible to variants.

And this is exactly the problem documented by coronavirus titan Ralph Baric which he could neither explain nor solve in his decades of research developing corona vaccines in his mice.

Whether the vaccine caused this surge in Covid is up for debate, but we have to acknowledge - it did happen.

Regardless, most countries appear poised to only recommend further boosters to a limited set of people (over 65-75, specific immunocompromised). Even in those populations, I suspect the uptake will be even lower than last year, which seems like a safe bet.

Given this, I think it seems plausible to conduct double blind trials on whether another booster helps Long Covid symptoms. With so many people hesitant, it should be much easier to recruit willing participants to take a chance they get a placebo.

And if it turns out, a booster does help, than that can give insights into how to approach "Long Flu", Post Viral Syndrome, PANDAS, EBV induced Mono, etc.

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Hi Michael and thanks for your thoughtful comment, although I don’t agree with it. I have to run so apologies for not fully responding to each contention - but I’ll just quickly reply with this haunting graph and hope that a picture is worth a thousand words!

https://ourworldindata.org/grapher/united-states-rates-of-covid-19-deaths-by-vaccination-status

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There are a number of ways a graph like that could unintentionally be incorrect*.

To test that graph, a simple and definitive answer would be to look at all cause mortality by country. If it was true that unvaccinated people were dying at high rates, and vaccinated people dying at rates pre-pandemic, than we would expect to see highly vaccinated countries returning back to pre-pandemic mortality.

Do you disagree?

And this is why I find the OWID chart you share suspect, because in fact we find almost no rhyme or reason between vaccination campaigns and all cause mortality the last 3 years.

https://imgur.com/a/2t4sh8D

Running through the list:

- Australia, highly vaccinated, only starts seeing excess deaths at end of 2021 and a significant spike in 2022, how could this be given the OWID chart?

-Bulgaria, massive spike in excess deaths 2020-2021, does not get vaccinated, sees deaths decline in 2022

- Canada saw large spikes in mortality 2020, slight improvement post vaccination 2021, then bigger spike 2022

- Germany sees large spike 2020, and slight increases 2021 and 2022, despite being "master class in Science communication" (CNBC)

-Finland, Norway, Denmark see steady growth and then a pop in 2022 (erasing their previous lead over Sweden in excess deaths)

- UK and US examples of high mortality 2020-2021, but then start to recede in 2022 closer to baseline - how is this possible in the US since we aren't as highly vaccinated as other countries?

- France, Israel, Portugal - all countries which saw increase in 2020 and remained increased 2021, 202, despite mass vaccination campaigns. Why?

- Korea, and here is what I find truly perplexing, the media darling of "doing it right", with their contact tracing, community respect of high quality masking at all times, high vaccination rates - South Korea has among the worst outcomes of Covid in the entire world, and a staggering excess mortality spike in 2022. How can this be?

How can the mess above mesh with the graph you posted from OWID?

Which is the simpler explanation: whatever complicated story has to be crafted to explain excess mortality spiking across the world post vaccination, in most countries, but not all,

-Or-

*That the methods used to create the OWID data were flawed for the following reasons:

1) Any death which occurred within 2 week time frame following vaccination is grouped into the "unvaccinated cohort"

2) Certain people who were of advanced age died before they got their shot for various reasons. Indeed the graph you shared is entirely driven by the 65+ cohort in the csv data.

3) Testing practices varied between healthcare situation. A patient who comes into ICU may not be tested for Covid if they were vaccinated - especially in 2021 when it was still believed it was a sterilizing vaccine.

4) Difficulty in finding vaccination status meant that anyone who died where they didn't have a record of vaccination was considered unvaccinated. This was brought to my attention when the NYCHealthy charts were being shared in late 2021 showing similar data as OWID, but someone went back and re-ran the data months later once more vaccination records were matched and found the gap closed. Yet the original charts were what were shared, by the time data was updated no one cared any more.

5) Base Rate fallacies which they try to account for, are still problematic as they are estimating the population rates, which is very difficult to precisely predict above the age of 65 because if only 5% are unvaccinated, it's such a small number that it becomes statistically sensitive to the smallest changes if assumed population is off by slight estimate.

6) Critical, what I want to know is all-cause mortality, not "deaths from covid". And that is why the population data is useful - it doesn't show the same outcome as this chart.

7) Why does the OWID chart you shared show the difference between vaccinated and unvaccinated nearly evaporate by April 2022 in the US when other countries had significant excess mortality spikes starting around this point?

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That is interesting that Dr. Offit made that comment. Why do you think he believes it should only be for people 75 and up? I remember he did not like boosters for young adults (especially men) because of the myocarditis risk, but it was over a year ago that I saw that interview with him.

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I think he is most concerned with data showing reduced hospitalization and death, and I look forward to his analysis after the cdc makes its final recommendation. I do respect his restraint, even as I am biased towards being gung-ho with boosters! He writes a substack too, I recommend it from my homepage in case you don’t read it yet

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Thank you for your reply! I will look for his substack and I look forward to reading yours too. Have a great week!

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Sep 7, 2023Liked by Katelyn Jetelina

Another incredible helpful post! Might you think about doing one on how to manage return to school/work after having COVID or being exposed? It seems like it's time for an update. Should we be "testing" negative prior to return or 5 days out with another 5 masked still holds? Thank you!

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This is such a good question. I think the good middle ground is get them back after 5 days, because school is so important, but ask them to mask and give them the “why”. This may help with compliance

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One person asked if they go back to school after 24 hours of testing positive for COVID. This tells me that people are not reading the guidance at all. They are creating their own guidance off of what feels good to them. We do need someone with some sort of credibility to remind folks. It's incredible.

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Part of the issue is that the schools have no policy on this anymore.

When I complete the absence form for my kids' schools, it asks what the symptoms are... I would check boxes for sore throat, stomachache, etc., but it never asks for a diagnosis. There is no reporting to the school if they have covid, flu, strep, etc.

Therefore, no one is checking to see if they are out five days (or if they've even been tested for covid). If parents dismiss it as a cold, they send the kids back whenever they want.

I live in a very health-conscious, politically left-leaning community where the school district took every covid precaution imaginable for two years. But now they're done, and no one asks or tells when a child has covid.

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Agree. The schools are back to actively discouraging kids from missing school regardless of illness since they will fall behind and do poorly on the standardized testing which determines their funding. They have chosen a policy of ignorance is bliss at the detriment of society as a whole. Kids are a significant vector for COVID (and other illness). There really is no good excuse as the schools have the capability to communicate/share missed work through virtual means, but they have abandoned all of the beneficial alternative learning modes that COVID unlocked. We've actually regressed beyond pre-pandemic postures in my opinion.

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This is a good question. I am frustrated by the colleges that went from having almost all classes online and dorms mostly closed in 2020-2021 to "Eh, you have COVID. We don't even have a way to have you isolate from your roommate" now. This post gives lots of info for a middle ground, but I am still wondering about isolation.

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I think one of the best ways to control the spread in dorms would be to match recently boosted (or recovered) students with ones who aren't recently boosted/recovered. Maybe 6 months apart? And under no circumstances should seriously immunocompromised students room together

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founding

Get lost, troll

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Dr. Jetelina... As always, I appreciate the clear, direct, informed, pertinent message. Today, I'm thinking and thanking for the shouting about ventilation.

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founding

OSHA dropped the ball bc of quasi-regulatory capture and cost. Psychotic, especially given guaranteed future pandemics, but that’s really-existing capitalism for ya.

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Jan. 2022 SCOTUS blocked ODHA from enforcing shot or test. I wonder what would occur if OSHA demanded new and higher ASHRAE standards for IAQ as part of mission to ensure safe and healthful working conditions.

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founding

Thomas would write for the majority (from Harlan’s aircraft carrier-sized gigayacht off the coast of Indonesia) that since OSHA wasn’t specified in the Articles of Confederation, it has no power to do anything.

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‘Political inertia’ is one way to put it. Pardon that I’m not as gentle as you, KJ, but I texted POTUS last evening and suggested he pull up his big boy pants. :)

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"In one of the best mask studies I’ve seen, school mask mandates also reduced transmission and absences."

Katelyn,

This was a terrible study, and I politely pointed out the reasons why last year.

Quick review of criticisms of "EpiEllie" NEJM Study:

1) The authors had organized and promoted a Change.org petition to get Boston to re-instate mask mandates before this was published.[1] Was there any doubt that the authors were NOT going to use the weakness of observational studies to show them what they wanted? They fail to mention this in disclosures, as well as their previous OpEds begging for masks to come back [1]. The authors entered this paper with clear bias. The same reason I would be skeptical of a paper by Peter McCullough claiming to find Ivermectin beneficial, I am skeptical of a paper written by EpiEllie and her pro-child-mask colleagues.

2) The authors included schools in their "mask group" which had actually received mask-waivers, demonstrating they were not thorough in data collection - only thorough enough to give the result they clearly wanted. [2] This warrants retraction.

3) They claim in the discussion that the testing differences didn't matter between masked and non-masked schools, but you can see in the supplement that this is clearly false. This should be disqualifying [3]

4) Obvious Data Dredging - look at how high cases were in both cohorts back when everyone was masking. The chart cuts off the "before", but that is a relevant metric as it removes potential seasonality conflicts. And the obvious question - why were cases so high when all districts were masking? (I know the answer - we retreat to the "Swiss Cheese" excuse anytime cases are high and everyone is masking)

5) Logically this makes no sense. The remaining people today that cling to the mask hypothesis have now said cloth masks don't work, surgical masks barely work, what we need is "fit tested n95s with no gaps". Yet this study claims that loose fititng cloth masks (which is what these kids wore) made some massive difference. That is ridiculous and has been falsified by RCT already.

You have a large audience and are passing along nonsense like this without being critical. Why not employ the same rigor assessing this study as you did in the DANMASK study? [4] DANMASK didn't find benefit of community masking, and you had a lengthy post picking apart the study. Yet repeatedly, I see you promote much weaker studies without skepticism, and as a result, you are sliding into superstition.

Sagan:

"Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition."

_____________________

[1] https://twitter.com/EpiEllie/status/1429102872470433795

https://www.bostonglobe.com/2022/02/11/opinion/its-too-soon-lift-school-mask-mandate/

[2] For example, here are schools announcing exemption which are included in the "mask cohort" of the study (11 districts in total had exemptions the authors appeared to be unaware of)

https://www.kingphilip.org/important-mask-update-2/

https://www.cbsnews.com/boston/news/massachusetts-schools-mask-mandate-lifted-list-dese/

[3] Search for this phrase in supplemental documents:

“ …the following close contacts are exempt from testing and"

https://www.nejm.org/doi/suppl/10.1056/NEJMoa2211029/suppl_file/nejmoa2211029_appendix.pdf

[4] https://www.facebook.com/permalink.php?story_fbid=pfbid01SraZhfgd3fvJ969SrsjufxCuWE92DJRTW8dXbYqMFemjX5WYVUwD85GPJbMFVQyl&id=101805971467321

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Sep 7, 2023·edited Sep 7, 2023Author

Thanks for your comment. A lot of your concerns were addressed yesterday in an updated Appendix released by NEJM on this study. Would love to hear your thoughts on that update. Observational studies are messy, but I thought they did a great job uncovering all the stones they possible could through sensitivity analyses. This was not done in other mask studies, hence my comment above.

Re: advocacy and science overlap. I don’t think it’s fair to say that because someone leads a response (like I did in Texas) or advocates for something (like Ellie on masks) automatically means bias is in a study. Especially one published in NEJM, with an intense peer review process. There are plenty of people that advocate for breast cancer screenings, for example, but also publish on the topic.

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Thank you for pointing out that the authors have responded to the critiques (apparently this trending on Twitter or whatever it's called now? X?). Going through the rest now, but their claim that the issue of waivers not being statistically significant appears to be more bad science.

Follow with me, as I may have gotten this wrong (only had 45 minutes to review):

The authors originally had constructed a complex model which was not pre-registered**, which I (and others) have argued allowed them ability to generate a Post-Hoc analysis to yield the results they had been campaigning for through petitions, letters to the editor, and social media prior to their studies.

It turns out that they weren't aware that several school districts in fact had several schools with mask waivers, and the authors included them into their complex model as schools which did have mask mandates.

The authors didn't catch this, the NEJM "intense peer review process" didn't catch this either, it was "citizen scientists" who caught this mistake.

This is where it gets really interesting, as this wound up serving as unintentional blinding.

Now the authors have to go back and reanalyze their data, and they re-run their results, excluding the districts that in fact had mask waivers (worth pointing out they still don't know if the schools in this new cohort stopped wearing masks once granted waivers).

If their hypothesis is correct, this would mean the effect (44.9 additional cases per 1000) should rise - after all, they mistakenly included schools without masks in their study, and since they claim masks matter, now that they can remove non-masked schools they thought were wearing masks, the benefit should rise - maybe to 47.6?

Instead, by removing districts which they thought were wearing masks but maybe weren't, their effect falls to 41.2

Rather than be curious how it could be possible that pulling out some schools they thought wore masks but didn't actually *increased* the number of cases per 1000 in their mask group, they ignore this, and frame it positively "well at least there is still a difference of differences - albeit smaller than we originally thought".

This falsifies their hypothesis to me. They used statistical techniques completely open to "goal seeking" (i.e., data dredging, p-hacking, post-hocking) which could *possibly* provide them the answers they are seeking (obviously I feel that way).

And due to their initial carelessness, we had a test to see if that was the case - now we know the answer.

____________

Re: advocacy and science overlap. Breast cancer screening is good example. In recent years we have come to realize perhaps there may be an epidemic of overdiagnosis - screening too many people which finds trivial cancers which causes unnecessary treatment which inflates 5 year survival rates - a messy and complicated topic, but we have seen this many times before (the South Korea Thyroid Cancer "epidemic" which was caused by overdiagnosis) so I assume this is not a controversial stance.

Now, because it is complicated topic, and there is large debate on when and who to screen for Breast Cancer, I would be skeptical of a paper showing we should screen 20 year old healthy women for breast cancer if the authors had been on social media advocating for this approach, writing change.org petitions, etc - they would seem invested in the outcome and representing a fringe position.

Likewise I would be skeptical of a paper arguing no one should be screened for breast cancer, if it too was by authors similarly waging a campaign halt screening.

EpieEllie and her colleagues are on the record promoting a fringe position - cloth masks on children - which has been debunked globally. So yes, my skepticism levels increase (fi that's even possible) when I come across a paper by fringe social scientists.

And yes, I do feel that failure to report in your "Disclosures" that you had an active campaign to mask children in the very districts they studied warrants retraction.

____________________

** For non science readers, pre-registering has you show your work up front before you start analyzing, allowing critique and input from colleagues, and preventing you from HARKING. In this NEJM study, if you have the full data sets, there are an infinite number of ways you could assess the data. You could run 30 analyses searching for the answer you want, and when you find it on your 31st attempt, you only report that and build your study around it - not reporting the 30 previous data attempts. I am not saying this is what happened, or if it did it was intentional.

But the fact that removing schools they though wore masks weakened their claim suggests this was entirely possible.

The "pre registration revolution" is part of what caused the "Replication Crisis"

http://www.psychologicalscience.org/observer/research-preregistration-101#.WR3GyFPyvOT

https://www.nature.com/articles/d41586-018-07118-1/

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While I do knock EpiEllie for her sunk-cost fallacy mask views, I do have to credit this paper she posted yesterday - appears to be a fantastic detailed fantastic walkthrough of how to apply "difference-in-differences" models in social science. I hope to get time to do a full run-through in the coming week, thought you may find this neat.

https://twitter.com/EpiEllie/status/1699811983254540757?s=20

https://link.springer.com/article/10.1007/s40471-023-00327-x

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Hi Dr. Jetelina, I am not sure how best to ask you a question that is not on the current topic, but here goes: Are you comfortable with anyone over 65 (?) getting the RSV vaccine, without consulting their provider? I know that in earlier posts you have noted side effects and were waiting on more data. I have not been able to find an update on your thinking. Thanks!

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Age 82; got the RSV shot 3 days ago.

I did consult with my PCP, but there was no requirement for an RX at the pharmacy for getting the RSV shot. The shot had no sore arm or other side effect.

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I desperately hope they allow covid vaccines for all. My 15 year old has been vaccinated with all available, just waiting for the new, but has gotten covid twice. She starts cosmetology school next week.

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author

I have a good feeling they will allow vaccines for all. Just like flu.

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founding

Even if they don’t, one benefit of the chaos is no one checks age or cares, at least when I’ve gotten boosted.

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I feel like a better term for the role of the federal government here is "facilitate" rather than "allow." The latter suggests they have the ability to "forbid" covid vaccines, which they really don't at this point. Full FDA approval creates a loophole for off-label use, and on the ACIP side, worst-case-scenario is that people might have to pay out of pocket. Whatever ability the feds had to restrict access to vaccines, they ceded back to the states when the PHE ended.

Finally, insurance companies have a strong incentive to pay for most approved vaccines, since it's an incredibly easy way to meet the 80% "medical loss ratio" requirements. RELAX.

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founding

I think doctors and walk- clinics are very reluctant to give COVID shots if it hasn’t been expressly recommended. Withholding such a recommendation is tantamount to making it very difficult for people to get them even if the full FDA approval has been granted.

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I'm unaware of any healthcare provider willing to administer boosters as you're describing. To the contrary, all I've investigated - including the big pharmacy chains and our local walk-in clinics and doctors' offices - track patients' shot history and have refused to give a booster so far this year to patients who had the last one - even though that was almost a year ago

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That's not my experience. No provider has ever turned me away from a shot, and I've had seven total.

At any rate, my point is that the federal government isn't really standing in the way of anyone getting shots, since for the most part they're not paying.

Even if you were to "cheat" by walking into a pharmacy and saying you were immunocompromised or something - at the very worst you might get a balance bill at some point. Here's how that might theoretically happen: the insurance company finds out that they paid a previous claim in error, so they short the provider on subsequent payment batches. But again, I find this unlikely because it's such an easy way to meet their MLR's.

If providers aren't giving the bivalent *right now* that's 100% understandable, because they anticipate that the XBB shot will be available shortly.

When there was a significant measles outbreak in Brooklyn in fall of 2019, I was able to get an extra MMR shot on the basis of failing an antibody test. It's hard to imagine covid shots wouldn't evolve into a similar paradigm.

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My youngest (age 9) is absolutely terrified of needles. It was a huge struggle to get him to sit still for his covid booster. I want to save that fight for covid, so how is the effectiveness of the flu mist nose spray vaccine?

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It’s great to know that flu shot protection wanes less quickly for kids, so even though flu won’t likely peak until end of November, it makes sense for kids to get their flu shots now. This frees up appointments in October and November for the older crowd seeking vaccines closer to the holidays.

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Got the flu shot about 2 weeks ago. PCP chided me for getting it too early.....

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It seems antigen tests are failing to identify Covid until several days into symptoms for people I know this past couple of months. Is there anything to make them more accurate earlier? Are the new variants just not showing up?

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author

Unfortunately there’s not much more we can do to detect earlier. Swabbing the throat before the nose can help. Serial testing also can help.

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Sep 7, 2023·edited Sep 7, 2023

We just invested in at-home molecular tests for our elderly parents, in the hopes that they’ll be able to know they’re infected sooner (=get on Paxlovid much sooner). For them to serve their purpose, we have to be willing to use the tests , which will possibly mean blowing quite a bit of money on negative tests. We’re grateful we can build this into our budget, and hopeful these tests will somehow become affordable to everyone, or at least all the elderly.

I’m hoping we’re not mistaken in our understanding that these pricey tests detect infection many days earlier than the antigen tests.

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The molecular tests (CUE and Lucira) are on par with lab-based PCR.

But yes they're quite pricey, even at sale prices.

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I’m relieved the tests are so sensitive. Repeated testing is definitely going to add up though. :/

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Yeah, $10-$12 a pop is a pretty big ask. That's why these days when someone else wants me to test before hanging out with them, I either ask for reimbursement OR cancel the invitation. Not using up one of my tests or high quality masks that I need for next time I see my mom.

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founding

Having rapid tests that are about as good as lab-based PCR tests are well worth those prices for visiting older and otherwise more vulnerable people like your mother. If they are as good as claimed here.

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founding

No offense intended, but can you cite some scientific evidence/research confirming their equivalence to PCR tests? We’ve been relying on hard to find and very expensive PCR tests which our children take before visiting us for several days to a week. It would be wonderful to be as confident in a less expensive and rapid test. It would even eliminate the current (modest) risk of their being infected between the time of the PCR test and the time - several days later - when they get the results.

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Technically their doctor could prescribe Paxlovid off-label, even without a test, based on other factors like prevalence, symptoms, and known/credible exposures. It makes me wish we'd kept exposure notification apps around a bit longer.

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I got a cat partly for companionship but secondarily to act as a household covid mineshaft-canary. Mainly looking at signs like appetite loss or lack of interest in toys. Catfood is cheaper than rapid tests!

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Can you comment on risk of mycarditis after COVID-19 vaccination for adolescent males?

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She’s addressed this in previous posts.

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So helpful thank you!

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How much increased protection does a (good) mask afford an individual in a situation where others are unmasked? I'm hearing a lot of arguments that "we don't need to require masks at X event because if you want to mask, you're basically just as safe as if everyone masked" and I would love to know what the actual research on this (if there is any) shows at this point. Thanks.

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YLE - can you comment on your understanding and interpretation of the significance of the recent Cochrane article reviewing studies on masking and handwashing for control of respiratory viral illnesses?

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Thank you so much for another very informative news letter. It's wonderful to have a place to go to get the most updated correct information. I'm very interested in what comes out about the new Covid vaccine as I am a compromised senior citizen.

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