Enormously grateful to Dr. Jetelina, yet once again, for her dedication to and brilliance at clear public-facing communications. Here’s what take from this, for those of us who need to stay clear of infection (older, immunocompromised):
>the data do not seem to support the idea that one booster per year is sufficient for us. I recognize that the CDC’s approach is focused on avoiding hospitalization, but as an older couple, who, like we did, got a rough case of Covid that was debilitating for a month+, said, “who wants to be this sick?”
>this also suggests to me that older and immunocompromised folks will continue to be sidelined much more than others in the ability to live some semblance of even Covid era normal life, even though we are a VERY large and growing group.
Am I missing something here? If anyone else has a thought on this, I would welcome it.
It drives me nuts. They're happy to wait until my father is a statistic to conclude, "Actually it would have been worthwhile to let him get boosted every six months."
What's especially awful is they're not letting people make their own judgments about risk tolerance, which varies person-to-person.
My father does not want to get COVID for very legitimate reasons. He knows he's not going to have sufficient protection for his risk tolerance at months 10 and 11.
This committee does not care if he spends months scared, huddled in his home, not seeing his grandchildren or friends. It's not that they don't recommend him and others get vaccinated; it's forbidden thanks to them for him to get a shot earlier. Not because it would be unduly dangerous - he has had several shots, and there's no indication he'd be harmed by an extra booster. But he cannot get it, because of them - regardless of his judgment about the risks he wishes to take.
I can't wait for the follow-up posts questioning why the public has turned against the public health bureaucracy, blaming it on failures to communicate and lack of public understanding rather than them performing an immoral task in the exercise of powers they ought not to have - to stop an old man from getting a vaccine voluntarily, when there's no indication of any undue danger to him from it, to allow him to mitigate a risk he does not wish to take.
Paul: what I am wondering is whether it is going to be forbidden, or whether uncovered by insurance. Not fair, of course, but in the latter case, at least it can be obtained.
According to husband's physician, if the Feds don't change their recommendations, one would have to lie/pretend to get a 2nd bivalent. Physician continues: if one is over 65, had a bivalent over 6 months ago, were going to travel or attend a large indoor gathering, he would do everything to obtain the 2nd bivalent. This approach makes my husband feel uncomfortable (ethically).
Mona: so not so very unlike trying to score weed in 1967 (unless you were, like Michael, at UCBerkeley). Kidding aside, though, I am with your husband in not wishing to do this by stealth, and I would also prefer to have my physician’s assessment on when and whether it would be appropriate for me. Bottom line, as your husband’s physician notes, this is something we ought to have a right to do--and it should also be paid for by Medicare. So, the question is, how to get that to happen? The only answer I can come up with is for anyone concerned to contact their governmental officials at every level, but I welcome other recommendations.
Mona: ah, forgot to answer your last question re orgs to get behind. I actually don’t have a good fix on this, but while I’m not on any social media, I do watch out for Twitter alerts from some of the Covid activist Twitterati like Gregg Gonsalves and Lucky Tran. They from time to time retweet action calls from various organizations like People’s CDC. What I have not found, however, is an activist organization that focuses specifically on those of higher risk because of age (and no, I don’t mean AARP😎). We are a VERY large and growing cohort, yet our collective voice seems to be almost completely missing in action here. In my tiny corner of the world, I have created an email blast list of about 50 folks to whom I send alerts (sparingly, and on something concrete and timely, so I don’t wear out my welcome). A small thing, but as they say, many hands make light work.
Mona: Reinhart is excellent, isn’t he? Your suggestions are of course excellent--for we as individuals have very small megaphones on our own. Where I think individuals can best have a chance to be heard--and this is often through an alert from an organization--is to do things like submit comments to hearings or on specific, concrete items of legislation or policy change (the booster issue eg), and encourage concerned friends and neighbors to do the same. For example, and I did learn of this through an advocacy organization, the NYC city council had a hearing re Covid recently. I wrote up my own comment, then circulated it to friends and neighbors to encourage them to write in as well, using what I had written if they wished to. I know of at least a few people who did that directly in response to my blast email. With elected officials, what I have learned over time is that, for the most part, you are not going to hear back, but officials do count up comments that come into their office to get a feel of what issues are important to their constituents. The more local an official is, the more impact even a few contacts can have. With Senators, it’s for sure a harder climb, but still worth doing, particularly if there is a specific, concrete issue in front of the Senator on which s/he has an opportunity to act.
Beautifully expressed. Captures exactly what is wrong with these self righteous medical bureaucrats. Apparently low risk and potentially some benefit, but don’t allow anybody to make their own decisions.
“CDC further clarified the goal of the vaccine program: Prevention of severe disease.” Sure glad we didn’t just have “prevention of severe disease” for polio, small pox, measles, etc. I am disappointed with that low bar goal. It should be to develop better vaccines that can eliminate this damaging disease.
This is also in contradiction with our flu vaccine model, which was highly debated a few years ago. Really interesting parallels coming to two different conclusions
Unfortunately, a vaccine alone isn't enough without a nearly universal vaccination program. That's how we stopped polio, for example. It's no coincidence that polio is coming back now that the anti-vaccine wackos have managed to reduce vaccination rates.
Stephen why do you make comments which are easily falsified with a few minutes of effort?
Countries with universal vaccination campaigns all had Covid soar anyway. This takes basic skills to fact check and with your IT background should pose no problem.
Portugal
"In Portugal, There Is Virtually No One Left to Vaccinate"
I bet you can guess - Covid exploded in Massachusetts, Vermont, and Connecticut anyway
Ok, ok, fine, we saw cases spike between 5x to 266x above their previous peaks, but what about those stubborn countries that had low uptake or none at all?
Like Slovakia at only 47% vaccine uptake? (4x increase in cases from previous peak)
Certainly Bulgaria must have been overrun with Covid then -no? If Denmark was 80% and saw 15x increase in cases, than what happened in Bulgaria with only 30% vaccine uptake?
What do you make of this? Honestly, I am curious how you could make a claim like above and (apparently?) not know that was incorrect? Does knowing this information change your priors?
Actually this is not true. Polio vaccines rolled out in the States do not stop transmission. This is what we saw in NY earlier this year. (see my previous post). This has caused quite the debate on whether we roll out other polio vaccines in the States, given the increasing vaccines hesitancy.
No doubt, but the opening paragraph of the article you posted does specifically call out "the danger of polio re-emerging in high-risk populations with low levels of immunity because of poor vaccine coverage." We're seeing the re-emergence of measles for similar reasons.
Susan Scheid. We too are elderly and have comorbidities. I had the same question about a booster. We are fully vaccinated and had the bivalent in Sept. I agree I do not want to get Covid even if is mild which I suspect it would not be due my cardiac status and age. We continue to wear an N95 mask whenever we leave our home and have escaped Covid but are seriously considering a booster before the fall as we hope to do some traveling before then. The one day of sore arm and fatigue is better than a month or more of fatigue and the chance of death. It seems to me that a higher level of immunity would be better than our current level to prevent infection. While there is not yet data the study will need to be done between folks who get a second bivalent booster and those with only one of the bivalent and that study will take a lot of subjects and some time for results which may be too late for us.
Hey, Michael: thanks for weighing in, and for the most part, I think your three points are right on target. (Dr. Topol, along with Dr. Jetelina, are two of my faves, for sure.) I think in re the CDC, the issue is as Dr. Jetelina has noted: the CDC, on a population level, is focused on preventing hospitalization, not infection. This is also the approach with their Community Levels guidance. For those of us who need to avoid infection, not just hospitalization, that approach is unfortunately not sufficient. Of course, as you note, vax is not the only tool in the shed, and is definitely insufficient on its own to help avoid infection, so we also use all the mitigation strategies you note. But my thinking is that, unless there is a medical contraindication, which doesn’t seem to be the logic here, we older and immunocompromised folks really ought to have access to a booster every 6 months. Even at 6 months, the waning from an already not so great level is really bad.
Can't disagree! And to add stuff: I had the bad luck to get the long version and am with you in hoping everybody get every shot and booster to avoid getting infected, or reinfected and have a long Covid sequelae. Long Covid makes a believer out of even the most hardened mask/vax denier..a kind of 'come-to-Fauci' moment!
Agree Susan-- but also, I as just wrote, we cannot prevent infection in a vacuum -- in a context of people who don't care about basic mandates of public health!
Something to think about, especially in the the context of those who are embracing the extremely poorly orchestrated Corchrane survey on mask efficacy. Koch and his like have invested millions in anti-science, anti-public health agendas. The Cochrane study is co-authored by someone who has ties to the Brownstone Insitute (and therefore The American Institute for Economic Research). When Dr. Jetelina commented several weeks that the majority of US need to think the pandemic is over (culture), this is in part is because of the overwhelming success of these anti-science, big $ folks--anti-government libertarians who have challenged the common good and changed OUR CULTURE-- even shaded the opinions of those on the left, and influenced mainstream media. It is truly disheartening.
Loyo: Agree completely. To me, that’s the point at which the CDC (and government as a whole) signaled complete capitulation relating to any effort to prevent infection, including not investing in faster development of, eg nasal vaccines, which Eric Topol and others have been sounding the alarm on repeatedly. Meanwhile, Big Pharma is awash in profits out of the pandemic and making more daily. What’s wrong with this picture, I wonder . . .
But we can't do this on our own. I wear N95 masks when in a crowded room or when travlening, KN95s in all other contexts, follow Jetelina, Topol, Gonsalves, Karan, Raifman, Prather, etc and don't trust the CDC. There are still 500 people dying a day. There are unknown numbers suffering from chronic diseases post and long term covid. We need leadership to get people to challenge the culture that this is OK. I as diligent as I am, I got covid (probably from a family member, even though I was masked.)
Bull. I trust the folks you list in that I accept the accuracy of their data and explanations and don't posit anyone is engaged in any sort of conspiracy. But I don't blindly accept their conclusions.
The relevant data here is neither mysterious nor overly complex. I am perfectly capable of understanding it. They've made a judgment about risks and benefits. It's based in part on that data, but also on their sociological suppositions about how health policy should be done, what is likely to be effective with the public, etc.
That judgment may be wrong; it also may be inapplicable to any particular individual's situation.
I respect their right and ability to make judgments about healthcare policy. I resent and think it's wrong that that judgment determines not only what is recommended or covered by government health programs, but what care and treatment individuals are able to access at all.
Paul: your statement, “I respect their right and ability to make judgments about healthcare policy. I resent and think it's wrong that that judgment determines not only what is recommended or covered by government health programs, but what care and treatment individuals are able to access at all” is important. I would add to that, not only are our government institutions failing us in this respect, but also in treating us like children in not giving us straightforward information, as complete as possible within the limits of what is known, that allows each of us, as sentient beings, to assess personal risk and act accordingly. It should not fall on Dr. Jetelina or any of the individuals who have been named who have stepped up to fill this vacuum to help us do that. We need to push at every level to make at least that available, if not more. Those of us who are at higher risk are not some tiny marginal group, and I am tired of being thought of that way. But the only way we have a chance of being recognized and heard on this is to speak loudly and often, en masse, as best we can.
“Not giving us straightforward information, as complete as possible” - bingo!
It’s possible that for a person who has already gotten all the recommended shots, going forward, getting a booster more than once a year is a BAD idea, even for those in the highest risk groups. If this is the case, please tell us so we don’t do something detrimental, like sneak extra boosters
Hi, Carl: thanks so much for weighing in. I was thinking, too, that I would be willing to spring for a bivalent in 6 months, if that’s possible, though it would be nice to have guidance on whether there is any medical downside. While vaccines do not do a good job of preventing infection, as we know, at least it’s some help, if not fully waned. Good point, too, about studies necessarily lagging beyond what is helpful to us in present time.
Hi Susan I have read or looked at all the data I could find. It is apparent that the Governments main objective is to prevent serious disease and death on a POPULATION basis. This is correct and proper, but statistics are not comforting in all cases as they do not apply to the individual outlier. The most important things to prevent infection are masks, avoid crowds, wash your hands and get fully vaccinated. Many elderly cannot take medications that help if you do get infected. I cannot find data on the outcomes in elderly with high risk factors. There is no good data yet on potential immunosuppression from repeat vaccines in Covid although there is for some other viral infections. If you are elderly with risk factors, and on medications that prevent use of Paxlovid you will be guessing if is better to take a second booster of the current bivalent vaccine or not. I have not decided yet for myself.
Carl: thanks for weighing in and sharing what you know and what your thinking is at this point. Also, and really an aside to your points, as I think back on the lively discussion here and also see those, like Dr. Jetelina, weigh from a position of true on vaccines overall, I am wondering whether in fact (and I include myself in this) we are expecting more from Covid vaccines than they will ever be able to deliver. Dr. Topol has, I think, made a good case for the idea that a nasal vaccine could potentially protect v. Infection, and I know there are several under development, but it would be very interesting to understand more about the bigger picture in re vaccination, eg compare/contrast with flu, polio, and other vaccines. I hope Dr. Jetelina might consider that for a future post here.
I just want, also, to respond on the individual level issue. I agree with your description and explanation of the difference between policy geared toward the population level and making determinations on the individual level. What I think is and has been strongly missing as to the latter is good, clear, public-facing information geared specifically to higher risk groups, which, as we know, are far from confined to small cohorts. That has been missing throughout.
Hi Susan Some vaccines give lifelong protection such as polio and measles. Others do not. For Covid at this point the vaccines help but are not yet the final answer. There will be better ones in a few years, but that does not help for now. I agree there should be better guesses by the experts as to what high risk groups should do. That will be difficult for them in our current legal environment.
Hey, Carl: thanks so much for your additional smart observations. As a lawyer, I am not sure the legal environment is so much the problem as the political one. What I think, but of course I don’t know(!), is that what public health officials should do is provide the facts, including what is known and what is not known, sufficient for each of us to make our own determinations as to risk. Indeed, as I think about this, there are numerous websites that give lots of useful information, and what they do to avoid legal liability, is to offer a load of disclaimers (eg, this is not medical advice), along with the information they provide.
ACIP is currently permitting even old folks like me and my husband just one bivalent vaccination per year, until or unless they see "signals of waning vaccine effectiveness of bivalent vaccines."
What’s meant by “waning,” of course, is people like us getting hospitalized and dying. Rather than contribute to statistical changes that will save others' lives, two weeks ago my husband and I visited a pharmacy where we're unknown, bringing along only our cards from monovalent vaccinations.
We got our 2nd bivalent doses! Maybe they won't help at all; maybe they'll harm us somehow. The latter seems unlikely, since monovalents did us no harm at the 4-month interval and we're well into the 5th month since our 1st bivalent.
I swear, this process felt like trying to score marijuana in 1967.
Yep, they initially refused to authorize the pediatric vaccine for the same reason of lack of evidence of necessity. I recall the result of that meeting well, because the Delta wave was just hitting where I live as we were about to send our kids back to school. This included a mature adolescent who was not as free from risk as her younger sisters.
I was desperate to get her the vaccine before sending her back to school. But I could not, because not enough kids had died during the study periods to justify the vaccines.
The Delta wave fixed that. We had some of the highest death rates in the world for several weeks in a row. The pharmacies were overflowing with vaccines. But I could not get my kids the vaccines during that threat because of this committee.
I remember well when they finally authorized it. Delta was finally beginning to wane on its own; over a month of hell was finally ending. And only then, finally, did these benevolent souls say I could get my kids the vaccine.
Paul, this is absolutely case in point re your comment on which I just now responded. We should all be raising holy h**l with all levels of government on this.
Thank you! In the survey we did last summer we had a random sample of US adults look at CDC info on benefits of vaccination and risk, then asked them to compare the risks and benefits of vaccination after looking at the CDC website. We asked simple questions such as "according to the CDC, what is riskier" a) COVID-19 infection b) COVID-19 vaccination c) equally risky d) I don't know. The writing level of the CDC website is so high that many people who trusted CDC(another question we asked) had trouble understanding risks versus benefits after looking at the way the data was presented. If I could help change CDC website that is what I'd try to do!
Cameron: this is a really good point. There are so many examples of this. I think one thing among many we are sorely lacking is, quite simply, clear and accurate information that would allow each of us to better assess our own risk and take appropriate steps based on that.
I 100% agree there is a lack of clear and accurate information for personal decision making. I'm a math education professor at made a relative risk tool to help people with this, but a tool like what I made, but from a group of collective experts that is funded and updated would be amazing. www.covidtaser.com/relativerisk
Cameron: YES! Easy to use (and fun) visual tools like the one you link would help so much. I wonder whether the kinds of risk information I proposed to my city council could be set forth in this kind of way. Might be too complicated or uncertain in some cases, but I would think much could be done with your ingenious approach.
Thank you K Jetelina. But, the CDC has not helped my concern. I'm over 70, don't have underlying issues and am not worried about death or hospitalization. I'm worried about post-covid syndromes and long term covid. We got our bivalent on 09/15 and would like some protection against transmission, especially because we are surrounded by people, including loved ones, who don't give a s*it. So frustrating that our lives must be circumscribed because others refuse to wear masks in indoor public spaces. (Even our rural medical system is a bad role model--they wear surgical masks and not respirators when they see patients.So, how can we reduce risk of transmission in this context? I know the old bi-valent had limited efficacy re: transmission. Why isn't the CDC invested in limiting transmission and potential further variations?
Question: If we know that ancestral mRNA vaccines needed two doses, well spaced, to have maximal effectiveness, why do the folks who study this think a SINGLE dose of the NEW part of the bivalent vaccine maximizes the benefit of the new part of the bivalent? Granted, recipients have multiple doses of the ancestral vaccine, but actually and functionally only one dose of the NEW formulation.
OK - that makes some kind of sense. Does that then mean that the bivalent was pointless, given “the miracle of affinity maturation”? And - how does this relate (or not) to protection from severe illness and death, which, as I understand it, still shows some additional advantage to the bivalent? Could that bivalent just have been a regular original vaccine and give the same response?
Basically when we got the bivalent we weren't starting from scratch. The bivalent is probably marginally better for non-naive hosts, but for people who haven't yet had any exposures, keeping up with circulating variants is essential and indirectly beneficial for the rest of us.
Thanks for the great summary as always. I was just starting to wonder about whether I needed another booster, now 6 months past my last one, - this post addressed this concern, thanks!!
Exactly, they need enough of you to die so they have evidence to justify allowing it in the future, because they're unable to reason from anything but statistical data and humans are just statistics to them
Yes- after enough people get very sick and/or die they may change their minds. With virtually no downside, they just won’t permit the option to practice “an ounce of prevention is worth a pound of cure”. People should not be allowed to make their own decisions because the “experts” know better. Horrible condescension.
Nothing I’ve read or seen suggests it would be detrimental. Of course extremely remote negative outcomes are always possible. But nothing that would outweigh the potential benefit.
What are the ramifications of going to the pharmacy and getting a Covid vaccine shot 6 months after your last shot other than having to pay for it? $130?
Thank you for this excellent summary. I think many people believe they will be better protected getting a booster every 6 months, especially older and immunocompromised people. Perhaps this is because the primary mRNA series was 2 shots and then we've had 3 booster opportunities since then - roughly 5 shots in 2 years (if I'm remembering correctly?). Now that boosters will have an annual frequency going forward, it would be nice if the CDC could clarify whether a 6 month schedule is "okay - no downside" or "not recommended - don't try this at home, folks."
Some people have so much faith in the vaccines/boosters, or are so scared of getting covid, or just want to return to normal, they might be tempted to take matters in to their own hands and get boosted every 6 months. When something is "safe and effective," there's an implicit "only when used as directed."
As everything is in due whatever you want mode people should have the right to determine if they feel they need a second vaccination every year. A politician should not have control over my body. Most of them have shown how incompetent they are
Hey Ron, I understand your concern I really do; the liberty element can never be unvalued. But would you want that same logic to apply to parents sending their unvaccinated child with measles to the classroom your child attends? In Latin there's that phrase non nobis nascimur-
We have to consider the safety of others always. If you were in the service and deployed, you'ld always take the lives and safety of your squad over your own liberty to do as you wanted. 🙂🇺🇲. All of us cede some of our autonomy in the interest of our countrymen and it's not really tyranny to try to protect others.
Here in Boston, the city is recommending another shot if it has been six months since the last one. And they are providing free vaccination sites. I’m not sure how they are paid for.
Exceptionally well presented, but it appears that the group I am most interested in, the immunocompromised/immunosuppressed, was not addressed. As a transplant recipient over 65 years of age, I feel marginalized yet again. I know there are studies out there tracking us, but I'm seeing less and less information about what they are finding. It's now been three years since I have been unable to live the relatively normal life that I'd planned for post- transplant, and am segueing from resigned to angry that a significant percentage of the population has not been taken into account regarding vaccine boosters.
Salamander, I am totally with you on this. I think one of the things that needs to happen is ALL of those of us at higher risk, due to age and/or immunocompromised status have to keep on speaking up, as a phalanx, to all levels of government, and remind them we are a very large cohort of taxpayers and voters, and that we will not quietly consent to being thrown under the bus once again. I’ve put elsewhere what I sent to my city council’s subcommittee as one idea, if anyone wishes to crib from it. But the key thing is to speak up and to keep speaking up.
Question for hive mind: is it such a good idea for everyone to get their boosters at the same time? It seems like one possible consequence of that is our immunity ends up waning simultaneously. I've been wondering if it might be a good idea for members of the same household to space out their boosters from one another - especially as we move towards annual boosters. Thoughts?
Enormously grateful to Dr. Jetelina, yet once again, for her dedication to and brilliance at clear public-facing communications. Here’s what take from this, for those of us who need to stay clear of infection (older, immunocompromised):
>the data do not seem to support the idea that one booster per year is sufficient for us. I recognize that the CDC’s approach is focused on avoiding hospitalization, but as an older couple, who, like we did, got a rough case of Covid that was debilitating for a month+, said, “who wants to be this sick?”
>this also suggests to me that older and immunocompromised folks will continue to be sidelined much more than others in the ability to live some semblance of even Covid era normal life, even though we are a VERY large and growing group.
Am I missing something here? If anyone else has a thought on this, I would welcome it.
It drives me nuts. They're happy to wait until my father is a statistic to conclude, "Actually it would have been worthwhile to let him get boosted every six months."
What's especially awful is they're not letting people make their own judgments about risk tolerance, which varies person-to-person.
My father does not want to get COVID for very legitimate reasons. He knows he's not going to have sufficient protection for his risk tolerance at months 10 and 11.
This committee does not care if he spends months scared, huddled in his home, not seeing his grandchildren or friends. It's not that they don't recommend him and others get vaccinated; it's forbidden thanks to them for him to get a shot earlier. Not because it would be unduly dangerous - he has had several shots, and there's no indication he'd be harmed by an extra booster. But he cannot get it, because of them - regardless of his judgment about the risks he wishes to take.
I can't wait for the follow-up posts questioning why the public has turned against the public health bureaucracy, blaming it on failures to communicate and lack of public understanding rather than them performing an immoral task in the exercise of powers they ought not to have - to stop an old man from getting a vaccine voluntarily, when there's no indication of any undue danger to him from it, to allow him to mitigate a risk he does not wish to take.
Paul: what I am wondering is whether it is going to be forbidden, or whether uncovered by insurance. Not fair, of course, but in the latter case, at least it can be obtained.
Agreed. That would be totally fine, not perfect but would assuage my concerns.
According to husband's physician, if the Feds don't change their recommendations, one would have to lie/pretend to get a 2nd bivalent. Physician continues: if one is over 65, had a bivalent over 6 months ago, were going to travel or attend a large indoor gathering, he would do everything to obtain the 2nd bivalent. This approach makes my husband feel uncomfortable (ethically).
Mona: so not so very unlike trying to score weed in 1967 (unless you were, like Michael, at UCBerkeley). Kidding aside, though, I am with your husband in not wishing to do this by stealth, and I would also prefer to have my physician’s assessment on when and whether it would be appropriate for me. Bottom line, as your husband’s physician notes, this is something we ought to have a right to do--and it should also be paid for by Medicare. So, the question is, how to get that to happen? The only answer I can come up with is for anyone concerned to contact their governmental officials at every level, but I welcome other recommendations.
I think it's more effective to find an organization with whom to rally--rather than try to do this on our own. I'm in Massachusetts and regularly write-call Warren/Markey (in general, good people) on the issue and have not gained traction. The WSWS is strong on the issue, as the People's CDC. Dr. Eric Reinhart (https://www.thenation.com/article/society/fix-public-health-argument/?utm_campaign=SproutSocial&utm_content=thenation&utm_medium=social&utm_source=twitter) is trying to change culture for young physicians, like himself. Who else is working in this arena-- people we could get behind?
Mona: ah, forgot to answer your last question re orgs to get behind. I actually don’t have a good fix on this, but while I’m not on any social media, I do watch out for Twitter alerts from some of the Covid activist Twitterati like Gregg Gonsalves and Lucky Tran. They from time to time retweet action calls from various organizations like People’s CDC. What I have not found, however, is an activist organization that focuses specifically on those of higher risk because of age (and no, I don’t mean AARP😎). We are a VERY large and growing cohort, yet our collective voice seems to be almost completely missing in action here. In my tiny corner of the world, I have created an email blast list of about 50 folks to whom I send alerts (sparingly, and on something concrete and timely, so I don’t wear out my welcome). A small thing, but as they say, many hands make light work.
Mona: Reinhart is excellent, isn’t he? Your suggestions are of course excellent--for we as individuals have very small megaphones on our own. Where I think individuals can best have a chance to be heard--and this is often through an alert from an organization--is to do things like submit comments to hearings or on specific, concrete items of legislation or policy change (the booster issue eg), and encourage concerned friends and neighbors to do the same. For example, and I did learn of this through an advocacy organization, the NYC city council had a hearing re Covid recently. I wrote up my own comment, then circulated it to friends and neighbors to encourage them to write in as well, using what I had written if they wished to. I know of at least a few people who did that directly in response to my blast email. With elected officials, what I have learned over time is that, for the most part, you are not going to hear back, but officials do count up comments that come into their office to get a feel of what issues are important to their constituents. The more local an official is, the more impact even a few contacts can have. With Senators, it’s for sure a harder climb, but still worth doing, particularly if there is a specific, concrete issue in front of the Senator on which s/he has an opportunity to act.
Beautifully expressed. Captures exactly what is wrong with these self righteous medical bureaucrats. Apparently low risk and potentially some benefit, but don’t allow anybody to make their own decisions.
“CDC further clarified the goal of the vaccine program: Prevention of severe disease.” Sure glad we didn’t just have “prevention of severe disease” for polio, small pox, measles, etc. I am disappointed with that low bar goal. It should be to develop better vaccines that can eliminate this damaging disease.
This is also in contradiction with our flu vaccine model, which was highly debated a few years ago. Really interesting parallels coming to two different conclusions
It would be great if you ever wanted to write more in a Substack about this!
Unfortunately, a vaccine alone isn't enough without a nearly universal vaccination program. That's how we stopped polio, for example. It's no coincidence that polio is coming back now that the anti-vaccine wackos have managed to reduce vaccination rates.
Stephen why do you make comments which are easily falsified with a few minutes of effort?
Countries with universal vaccination campaigns all had Covid soar anyway. This takes basic skills to fact check and with your IT background should pose no problem.
Portugal
"In Portugal, There Is Virtually No One Left to Vaccinate"
https://www.nytimes.com/2021/10/01/world/europe/portugal-vaccination-rate.html
Yet, cases would then explode 5x higher than the highest peak of 2020:
https://ourworldindata.org/coronavirus/country/portugal#what-is-the-daily-number-of-confirmed-cases
_____________________________
Denmark
"How Denmark Beat Covid and the Lessons the World Could Learn"
https://blogs.ed.ac.uk/s2252587_global-health-challenges-an-introduction-2021-2022sem1_v2/2021/10/06/how-denmark-beat-covid-and-the-lessons-world-can-learn/
Then after this story, cases exploded 15x the previous high of 2020
https://ourworldindata.org/coronavirus/country/denmark#what-is-the-daily-number-of-confirmed-cases
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Ok, but certainly South Korea was spared with their mass vaccinations and stringent masking, right?
"S.Korea says it reaches goal of 70% vaccinations for COVID-19"
https://www.reuters.com/world/asia-pacific/skorea-says-it-reaches-goal-70-vaccinations-covid-19-2021-10-23/
Well, no, cases would spike 266x times the previous high, going on to break the US record of excess mortality during Spring 2022.
https://ourworldindata.org/coronavirus/country/south-korea#what-is-the-daily-number-of-confirmed-cases
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Fine, but what about the states in the US that hit the highest vaccine uptake?
"Mass., Vermont, Connecticut lead the nation in vaccination rates"
https://www.boston.com/news/coronavirus/2021/09/12/massachusetts-vermont-connecticut-high-covid-19-vaccination-cdc/
I bet you can guess - Covid exploded in Massachusetts, Vermont, and Connecticut anyway
Ok, ok, fine, we saw cases spike between 5x to 266x above their previous peaks, but what about those stubborn countries that had low uptake or none at all?
Like Slovakia at only 47% vaccine uptake? (4x increase in cases from previous peak)
https://ourworldindata.org/coronavirus/country/slovakia#what-is-the-daily-number-of-confirmed-cases
How about South Africa at 36% update? (1.2x increase from previous peak)
https://ourworldindata.org/coronavirus/country/south-africa#what-is-the-daily-number-of-confirmed-cases
Certainly Bulgaria must have been overrun with Covid then -no? If Denmark was 80% and saw 15x increase in cases, than what happened in Bulgaria with only 30% vaccine uptake?
A 2x increase
https://ourworldindata.org/coronavirus/country/bulgaria#what-is-the-daily-number-of-confirmed-cases
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What do you make of this? Honestly, I am curious how you could make a claim like above and (apparently?) not know that was incorrect? Does knowing this information change your priors?
Actually this is not true. Polio vaccines rolled out in the States do not stop transmission. This is what we saw in NY earlier this year. (see my previous post). This has caused quite the debate on whether we roll out other polio vaccines in the States, given the increasing vaccines hesitancy.
No doubt, but the opening paragraph of the article you posted does specifically call out "the danger of polio re-emerging in high-risk populations with low levels of immunity because of poor vaccine coverage." We're seeing the re-emergence of measles for similar reasons.
Ah, yes, much better. Thanks.
Yes! Nasal vaccines, eg.
Susan Scheid. We too are elderly and have comorbidities. I had the same question about a booster. We are fully vaccinated and had the bivalent in Sept. I agree I do not want to get Covid even if is mild which I suspect it would not be due my cardiac status and age. We continue to wear an N95 mask whenever we leave our home and have escaped Covid but are seriously considering a booster before the fall as we hope to do some traveling before then. The one day of sore arm and fatigue is better than a month or more of fatigue and the chance of death. It seems to me that a higher level of immunity would be better than our current level to prevent infection. While there is not yet data the study will need to be done between folks who get a second bivalent booster and those with only one of the bivalent and that study will take a lot of subjects and some time for results which may be too late for us.
Carl and Susan,. We too are an elderly couple with immuno compromised and co- morbidities. We're not rocket scientists but follow dictums:
1. Trust YLE, Eric Topol, Caitlyn Rivers and the CDC.
2. Get all the shots allowed, wear masks and wash hands!
3. Don't assume the pandemic is over yet. New troublesome mutations are more likely than not
That's it!
Hey, Michael: thanks for weighing in, and for the most part, I think your three points are right on target. (Dr. Topol, along with Dr. Jetelina, are two of my faves, for sure.) I think in re the CDC, the issue is as Dr. Jetelina has noted: the CDC, on a population level, is focused on preventing hospitalization, not infection. This is also the approach with their Community Levels guidance. For those of us who need to avoid infection, not just hospitalization, that approach is unfortunately not sufficient. Of course, as you note, vax is not the only tool in the shed, and is definitely insufficient on its own to help avoid infection, so we also use all the mitigation strategies you note. But my thinking is that, unless there is a medical contraindication, which doesn’t seem to be the logic here, we older and immunocompromised folks really ought to have access to a booster every 6 months. Even at 6 months, the waning from an already not so great level is really bad.
Can't disagree! And to add stuff: I had the bad luck to get the long version and am with you in hoping everybody get every shot and booster to avoid getting infected, or reinfected and have a long Covid sequelae. Long Covid makes a believer out of even the most hardened mask/vax denier..a kind of 'come-to-Fauci' moment!
Oh, my, Michael, I am still laughing at the idea of a “come to Fauci” moment!!
I'm thinking of applying for a copywrite on that one!
Agree Susan-- but also, I as just wrote, we cannot prevent infection in a vacuum -- in a context of people who don't care about basic mandates of public health!
Hi, Mona: agree wholeheartedly that this is a big problem.
Something to think about, especially in the the context of those who are embracing the extremely poorly orchestrated Corchrane survey on mask efficacy. Koch and his like have invested millions in anti-science, anti-public health agendas. The Cochrane study is co-authored by someone who has ties to the Brownstone Insitute (and therefore The American Institute for Economic Research). When Dr. Jetelina commented several weeks that the majority of US need to think the pandemic is over (culture), this is in part is because of the overwhelming success of these anti-science, big $ folks--anti-government libertarians who have challenged the common good and changed OUR CULTURE-- even shaded the opinions of those on the left, and influenced mainstream media. It is truly disheartening.
Loyo: Agree completely. To me, that’s the point at which the CDC (and government as a whole) signaled complete capitulation relating to any effort to prevent infection, including not investing in faster development of, eg nasal vaccines, which Eric Topol and others have been sounding the alarm on repeatedly. Meanwhile, Big Pharma is awash in profits out of the pandemic and making more daily. What’s wrong with this picture, I wonder . . .
But we can't do this on our own. I wear N95 masks when in a crowded room or when travlening, KN95s in all other contexts, follow Jetelina, Topol, Gonsalves, Karan, Raifman, Prather, etc and don't trust the CDC. There are still 500 people dying a day. There are unknown numbers suffering from chronic diseases post and long term covid. We need leadership to get people to challenge the culture that this is OK. I as diligent as I am, I got covid (probably from a family member, even though I was masked.)
Bull. I trust the folks you list in that I accept the accuracy of their data and explanations and don't posit anyone is engaged in any sort of conspiracy. But I don't blindly accept their conclusions.
The relevant data here is neither mysterious nor overly complex. I am perfectly capable of understanding it. They've made a judgment about risks and benefits. It's based in part on that data, but also on their sociological suppositions about how health policy should be done, what is likely to be effective with the public, etc.
That judgment may be wrong; it also may be inapplicable to any particular individual's situation.
I respect their right and ability to make judgments about healthcare policy. I resent and think it's wrong that that judgment determines not only what is recommended or covered by government health programs, but what care and treatment individuals are able to access at all.
Paul: your statement, “I respect their right and ability to make judgments about healthcare policy. I resent and think it's wrong that that judgment determines not only what is recommended or covered by government health programs, but what care and treatment individuals are able to access at all” is important. I would add to that, not only are our government institutions failing us in this respect, but also in treating us like children in not giving us straightforward information, as complete as possible within the limits of what is known, that allows each of us, as sentient beings, to assess personal risk and act accordingly. It should not fall on Dr. Jetelina or any of the individuals who have been named who have stepped up to fill this vacuum to help us do that. We need to push at every level to make at least that available, if not more. Those of us who are at higher risk are not some tiny marginal group, and I am tired of being thought of that way. But the only way we have a chance of being recognized and heard on this is to speak loudly and often, en masse, as best we can.
“Not giving us straightforward information, as complete as possible” - bingo!
It’s possible that for a person who has already gotten all the recommended shots, going forward, getting a booster more than once a year is a BAD idea, even for those in the highest risk groups. If this is the case, please tell us so we don’t do something detrimental, like sneak extra boosters
Baydog: “If this is the case, please tell us so we don’t do something detrimental, like sneak extra boosters” Yes!
Yes!
Would love to see/hear YLE and Eric Topol in a deep discussion about COVID. Two trustworthy and highly transparent sources.
Hi, Carl: thanks so much for weighing in. I was thinking, too, that I would be willing to spring for a bivalent in 6 months, if that’s possible, though it would be nice to have guidance on whether there is any medical downside. While vaccines do not do a good job of preventing infection, as we know, at least it’s some help, if not fully waned. Good point, too, about studies necessarily lagging beyond what is helpful to us in present time.
Hi Susan I have read or looked at all the data I could find. It is apparent that the Governments main objective is to prevent serious disease and death on a POPULATION basis. This is correct and proper, but statistics are not comforting in all cases as they do not apply to the individual outlier. The most important things to prevent infection are masks, avoid crowds, wash your hands and get fully vaccinated. Many elderly cannot take medications that help if you do get infected. I cannot find data on the outcomes in elderly with high risk factors. There is no good data yet on potential immunosuppression from repeat vaccines in Covid although there is for some other viral infections. If you are elderly with risk factors, and on medications that prevent use of Paxlovid you will be guessing if is better to take a second booster of the current bivalent vaccine or not. I have not decided yet for myself.
Carl: thanks for weighing in and sharing what you know and what your thinking is at this point. Also, and really an aside to your points, as I think back on the lively discussion here and also see those, like Dr. Jetelina, weigh from a position of true on vaccines overall, I am wondering whether in fact (and I include myself in this) we are expecting more from Covid vaccines than they will ever be able to deliver. Dr. Topol has, I think, made a good case for the idea that a nasal vaccine could potentially protect v. Infection, and I know there are several under development, but it would be very interesting to understand more about the bigger picture in re vaccination, eg compare/contrast with flu, polio, and other vaccines. I hope Dr. Jetelina might consider that for a future post here.
I just want, also, to respond on the individual level issue. I agree with your description and explanation of the difference between policy geared toward the population level and making determinations on the individual level. What I think is and has been strongly missing as to the latter is good, clear, public-facing information geared specifically to higher risk groups, which, as we know, are far from confined to small cohorts. That has been missing throughout.
Hi Susan Some vaccines give lifelong protection such as polio and measles. Others do not. For Covid at this point the vaccines help but are not yet the final answer. There will be better ones in a few years, but that does not help for now. I agree there should be better guesses by the experts as to what high risk groups should do. That will be difficult for them in our current legal environment.
Hey, Carl: thanks so much for your additional smart observations. As a lawyer, I am not sure the legal environment is so much the problem as the political one. What I think, but of course I don’t know(!), is that what public health officials should do is provide the facts, including what is known and what is not known, sufficient for each of us to make our own determinations as to risk. Indeed, as I think about this, there are numerous websites that give lots of useful information, and what they do to avoid legal liability, is to offer a load of disclaimers (eg, this is not medical advice), along with the information they provide.
That should have been “weigh from a position of true knowledge on vaccines overall”
ACIP is currently permitting even old folks like me and my husband just one bivalent vaccination per year, until or unless they see "signals of waning vaccine effectiveness of bivalent vaccines."
What’s meant by “waning,” of course, is people like us getting hospitalized and dying. Rather than contribute to statistical changes that will save others' lives, two weeks ago my husband and I visited a pharmacy where we're unknown, bringing along only our cards from monovalent vaccinations.
We got our 2nd bivalent doses! Maybe they won't help at all; maybe they'll harm us somehow. The latter seems unlikely, since monovalents did us no harm at the 4-month interval and we're well into the 5th month since our 1st bivalent.
I swear, this process felt like trying to score marijuana in 1967.
Yep, they initially refused to authorize the pediatric vaccine for the same reason of lack of evidence of necessity. I recall the result of that meeting well, because the Delta wave was just hitting where I live as we were about to send our kids back to school. This included a mature adolescent who was not as free from risk as her younger sisters.
I was desperate to get her the vaccine before sending her back to school. But I could not, because not enough kids had died during the study periods to justify the vaccines.
The Delta wave fixed that. We had some of the highest death rates in the world for several weeks in a row. The pharmacies were overflowing with vaccines. But I could not get my kids the vaccines during that threat because of this committee.
I remember well when they finally authorized it. Delta was finally beginning to wane on its own; over a month of hell was finally ending. And only then, finally, did these benevolent souls say I could get my kids the vaccine.
Oh, what a horrible experience! I swear, the people making these rules must not have young children, aged parents, or relatives with comorbidities.
Paul, this is absolutely case in point re your comment on which I just now responded. We should all be raising holy h**l with all levels of government on this.
Well said! But I was in UC Berkeley that year and it wasn't hard at all! 😉
It sure was hard in rural Vermont!
SLSRHP and Michael: OMG, what a hilarious way to show our age! Love it!
Thank you! In the survey we did last summer we had a random sample of US adults look at CDC info on benefits of vaccination and risk, then asked them to compare the risks and benefits of vaccination after looking at the CDC website. We asked simple questions such as "according to the CDC, what is riskier" a) COVID-19 infection b) COVID-19 vaccination c) equally risky d) I don't know. The writing level of the CDC website is so high that many people who trusted CDC(another question we asked) had trouble understanding risks versus benefits after looking at the way the data was presented. If I could help change CDC website that is what I'd try to do!
Cameron: this is a really good point. There are so many examples of this. I think one thing among many we are sorely lacking is, quite simply, clear and accurate information that would allow each of us to better assess our own risk and take appropriate steps based on that.
I 100% agree there is a lack of clear and accurate information for personal decision making. I'm a math education professor at made a relative risk tool to help people with this, but a tool like what I made, but from a group of collective experts that is funded and updated would be amazing. www.covidtaser.com/relativerisk
Cameron: YES! Easy to use (and fun) visual tools like the one you link would help so much. I wonder whether the kinds of risk information I proposed to my city council could be set forth in this kind of way. Might be too complicated or uncertain in some cases, but I would think much could be done with your ingenious approach.
Thank you K Jetelina. But, the CDC has not helped my concern. I'm over 70, don't have underlying issues and am not worried about death or hospitalization. I'm worried about post-covid syndromes and long term covid. We got our bivalent on 09/15 and would like some protection against transmission, especially because we are surrounded by people, including loved ones, who don't give a s*it. So frustrating that our lives must be circumscribed because others refuse to wear masks in indoor public spaces. (Even our rural medical system is a bad role model--they wear surgical masks and not respirators when they see patients.So, how can we reduce risk of transmission in this context? I know the old bi-valent had limited efficacy re: transmission. Why isn't the CDC invested in limiting transmission and potential further variations?
Question: If we know that ancestral mRNA vaccines needed two doses, well spaced, to have maximal effectiveness, why do the folks who study this think a SINGLE dose of the NEW part of the bivalent vaccine maximizes the benefit of the new part of the bivalent? Granted, recipients have multiple doses of the ancestral vaccine, but actually and functionally only one dose of the NEW formulation.
Because a sufficient number of boosters already creates antibodies that neutralize Omicron lineages, thanks to the miracle of affinity maturation
OK - that makes some kind of sense. Does that then mean that the bivalent was pointless, given “the miracle of affinity maturation”? And - how does this relate (or not) to protection from severe illness and death, which, as I understand it, still shows some additional advantage to the bivalent? Could that bivalent just have been a regular original vaccine and give the same response?
Basically when we got the bivalent we weren't starting from scratch. The bivalent is probably marginally better for non-naive hosts, but for people who haven't yet had any exposures, keeping up with circulating variants is essential and indirectly beneficial for the rest of us.
Thanks for the great summary as always. I was just starting to wonder about whether I needed another booster, now 6 months past my last one, - this post addressed this concern, thanks!!
If you're over 65, you probably, do, but the CDC is failing those of us who are.
Exactly, they need enough of you to die so they have evidence to justify allowing it in the future, because they're unable to reason from anything but statistical data and humans are just statistics to them
Yes- after enough people get very sick and/or die they may change their minds. With virtually no downside, they just won’t permit the option to practice “an ounce of prevention is worth a pound of cure”. People should not be allowed to make their own decisions because the “experts” know better. Horrible condescension.
Ron Wiesman (below) asked a great question. Would it be detrimental for those who have had one bi-valent 6 months ago to get another?
Also wondering this.
Nothing I’ve read or seen suggests it would be detrimental. Of course extremely remote negative outcomes are always possible. But nothing that would outweigh the potential benefit.
What are the ramifications of going to the pharmacy and getting a Covid vaccine shot 6 months after your last shot other than having to pay for it? $130?
Do note: according to my husband's physician we will have to lie (say we've lost our vaccine cards, forgot our IDs) to get a 2nd bi-valent.
Thank you for this excellent summary. I think many people believe they will be better protected getting a booster every 6 months, especially older and immunocompromised people. Perhaps this is because the primary mRNA series was 2 shots and then we've had 3 booster opportunities since then - roughly 5 shots in 2 years (if I'm remembering correctly?). Now that boosters will have an annual frequency going forward, it would be nice if the CDC could clarify whether a 6 month schedule is "okay - no downside" or "not recommended - don't try this at home, folks."
Some people have so much faith in the vaccines/boosters, or are so scared of getting covid, or just want to return to normal, they might be tempted to take matters in to their own hands and get boosted every 6 months. When something is "safe and effective," there's an implicit "only when used as directed."
As everything is in due whatever you want mode people should have the right to determine if they feel they need a second vaccination every year. A politician should not have control over my body. Most of them have shown how incompetent they are
Hey Ron, I understand your concern I really do; the liberty element can never be unvalued. But would you want that same logic to apply to parents sending their unvaccinated child with measles to the classroom your child attends? In Latin there's that phrase non nobis nascimur-
We have to consider the safety of others always. If you were in the service and deployed, you'ld always take the lives and safety of your squad over your own liberty to do as you wanted. 🙂🇺🇲. All of us cede some of our autonomy in the interest of our countrymen and it's not really tyranny to try to protect others.
Choosing to take a shot when one is an adult doesn’t endanger anybody else. Your example just isn’t relevant.
Here in Boston, the city is recommending another shot if it has been six months since the last one. And they are providing free vaccination sites. I’m not sure how they are paid for.
Hi John, where have you seen this recommendation for another booster shot? And where? Thank you.
It was a phone call from the city. It may have been to their over-65 list.
It include a list of vaccination sites and hours.
Exceptionally well presented, but it appears that the group I am most interested in, the immunocompromised/immunosuppressed, was not addressed. As a transplant recipient over 65 years of age, I feel marginalized yet again. I know there are studies out there tracking us, but I'm seeing less and less information about what they are finding. It's now been three years since I have been unable to live the relatively normal life that I'd planned for post- transplant, and am segueing from resigned to angry that a significant percentage of the population has not been taken into account regarding vaccine boosters.
Salamander, I am totally with you on this. I think one of the things that needs to happen is ALL of those of us at higher risk, due to age and/or immunocompromised status have to keep on speaking up, as a phalanx, to all levels of government, and remind them we are a very large cohort of taxpayers and voters, and that we will not quietly consent to being thrown under the bus once again. I’ve put elsewhere what I sent to my city council’s subcommittee as one idea, if anyone wishes to crib from it. But the key thing is to speak up and to keep speaking up.
I am so grateful for your clear, timely information! A thousand thankyous are not enough.
Question for hive mind: is it such a good idea for everyone to get their boosters at the same time? It seems like one possible consequence of that is our immunity ends up waning simultaneously. I've been wondering if it might be a good idea for members of the same household to space out their boosters from one another - especially as we move towards annual boosters. Thoughts?