The fall/winter season always means more respiratory sickness—the weather changes, people head inside, and social networks change (school starts, holiday celebrations occur). But the last four years have resulted in very unusual patterns. This makes predicting this season a fool’s game. But I’ll take the bait and give it a shot.
As someone immunocompromised for fall for the first time and *still* recovering from my very first COVID case (caught from 2 family members coming into my house, one with symptoms not disclosed til the end of the visit.), I’m dreading the Fall and hoping I survive it. Very thankful for Paxlovid. I have no doubt I would be hospitalized otherwise.
Masking absolutely works. I masked through all other exposures (including as a hospital nurse with COVID patients) and came out negative. So since there are no accommodations for working from home at my company, I’m just going to be wearing the best masks I can find starting now.
As a communicable disease nurse, it’s going to be a very busy and probably ugly winter. The politicization hasn’t toned down at all. I suspect the uptake of vaccines to be fairly abysmal other than the older folks. I hope I’m wrong. With other opportunistic infections like invasive strep stepping on the coattails of our damaged immune systems, this could be a lot of heartache. I wish we could all just take common sense precautions instead of running headlong into a hurricane to prove a point.
Masks are helpful according to CDC: "Consistent use of a face mask or respirator in indoor public settings was associated with lower odds of a positive SARS-CoV-2 test result (adjusted odds ratio = 0.44). " not perfect but helpful. And of course when they are worn well (I can count on myself to do that, even when most people are impersonating santa with the placement of their masks) they are most helpful. Paul - read up. https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm
Agree but I can’t see it happening if they wouldn’t even give us hazard pay at the hospital. My post ended up being bad foreshadowing. 2 of the 3 people with COVID in my family also had a strep coinfection that was missed until now due to the similar symptoms. I bet it happens a lot unless you’re hospitalized and getting a full workup. What a nightmare, untreated strep is bad news.
Just wanted to remind you that South Korea has one of the highest masking rates in the world, using among the highest tier of masks consistently, yet had one of the worst outcomes in Covid mortality. That example should at least be a starting point of neutral conversations exploring how they failed at population level at every single country which tried them.
Also, now we have Anthony Fauci this weekend, when grilled with tough questions on CNN of all places, retreats to "well, yes at population levels the evidence is weak, but on a personal level I do believe they are helpful".
I suspect in this case the pre-2020 scientific consensus on masks was correct all along.
This makes me feel sorry for Dr Jerome Adams, Trump's Surgeon General. He got the unpleasant task in the very beginning of telling us "STOP BUYING MASKS. They are NOT effective in preventing general public from catching #Coronavirus." Once the mask mandates came, he looked like a fool and took a huge hit to his reputation. Turns out he may have been right all along.
Yup. I was on a grand jury last fall and they took great pains to instruct us on what could be regarded as evidence. Pretty much anything they told us is evidence...is evidence. Whether it's persuasive is really a matter of who you're trying to persuade. It's never absolute.
Good forecast, and for what it’s worth I agree. I’m guessing Covid “wave” first this fall with BA.2.86 since it’s by far the most contagious (of these 3 viruses), and booster uptake will be low and less effective than if we had a more closely matched vaccine. Not vaccine makers’ fault.
And I enjoy not being sick, so I’ll be wearing that N95 I never stopped wearing in higher risk situations.
When I get Covid I want it to be “worth it.” Family gathering instead of public bathroom kind of thing.
And I’ll be taking paxlovid, or oral remdesivir once it arrives.
p.s. I loved your latest post! but please please address rebound. I’m currently on day 6 of a hard rebound with a full return of symptoms and blaring positive antigen tests. I had to send my employer the CDC guidelines for reisolation (and I know a lot of people just can’t do it. But they could keep masking with good masks.) I’m immunocompromised, so I was already more likely to rebound and more likely to have extended viral shedding, so it wasn’t a real surprise. But I feel rebound is going to play a huge part in ongoing transmission.
I totally agree with your plan, and testing positive and feeling bad are two important reasons to stay home and recover! Talk to your doc about additional antiviral treatment (Paxlovid) as some advocate for longer durations of therapy in your sort of situation. Best of luck and wishing you well
Interesting you should say that. At least 2 medical providers have offered my husband a 2nd course of paxlovid. He had an unusually late rebound (11 days after Paxlovid completion.) and has even had fevers again.
We have very different perspectives on this. I'd rather get it in a public setting (such as a bathroom) before the next time I see family. I can't imagine anything worse than being responsible for giving Covid to my immunocompromised mother. I'd much rather catch it in a public setting, well before seeing my parents.
Just a reminder, the countries that kept schools open throughout 2020 and didn't mask children also had Flu and RSV disappear so the hypothesis on causality should be reconsidered - other confounders must be at play. You had previously mentioned possibility of "Viral Interference" as an alternative hypothesis - have you given that any more thought?
I'm just pointing this out because your chart might give the impression that made any difference which we know is incorrect.
Of course, the "changed behaviors" hypothesis disrupted the patterns in unpredictable ways, it's reasonable question if it had more harm than benefit. I found this article linked within the stat article you shared interesting [1], especially because of how much time it spends discussing "immunity debt" without using that term.
At a high level, we need to consider why mitigation (school closure, business closure, stay at home orders, mandatory masking, etc) was followed by very high excess deaths, while reduction of mitigation was followed by a return to "baseline" mortality.
The hypothesis that without heavy mitigation excess deaths would have been even higher is falsified by the fact the countries that did less had the better outcomes in terms of mortality.
I think "seasonality" is something of misnomer. The driver, it seems to me, is close proximity to strangers in an indoor setting. Down south, that means air conditioned spaces during a long summer. Up north it means heated indoor spaces in winter. The low hanging fruit is to do as your Mother told you, and stay out of bars. And avoid crowds.
And can you please address optimum timing between the three vaccines (RSV, Flu, COVID booster)? Dr. Michael Osterholm said in his last Podcast that he would go RSV now, COVID ASP (end of Sept??), and flu as it starts to emerge, that he believes it’s very likely more effective to space than to take shots together (unless that’s the only way you’ll actually get them all). Summarized from Episode 137, Aug 10, 2023.
Quick Update: I just listened to the newest podcast from Dr. Osterholm (Episode 138), and he says looking at more data, he’s not as concerned about spacing…but is recommending RSV now for any eligible, COVID ASP (likely end of Sept), and then Flu once that activity is detected. Still curious if YLE recommends some spacing (a few weeks?) for best bet at optimal performance.
FDA had a vaccine meeting in June. I seem to recall that both Moderna and Pfizer said they could manufacture enough monovalent boosters so that shots would be ready in August, with Novavax close behind. It's now August, so where are our boosters?
Are boosters intentionally being held back, and if so why? Is there a plan to delay shots so that the first recipients are protected through the holidays (mRNA protection wanes after 3-4 months)? Or is the younger generation being used to re-build our "immunity wall" now that schools and colleges are back in session? Or is there a fear that if people got boosted during our current mini-surge, they would "get covid anyway right after my booster" (like last year)?
I received a call from my physical therapist's office yesterday asking me if I wanted to move up my appointment because because people were cancelling due to covid. I asked what percent had cancelled because of covid in the last week? "Out of 100 patients, probably 4 this week, and 2 the week before." Not exactly scientific, but that's roughly 4% this week and 2% last week, mostly adults and the trend line is increasing. This excludes back to school kids who are more at risk - so in schools these percentages are likely higher.
What percent of the population will have already been infected with the new variants by the time the monovalent boosters are finally released in September or October? Likely 20% - probably more. And how will we be able to know how well the new boosters work when the reality is a new immunity wall was being re-built a month or two before their release?
I am not sure how I feel about the boosters. Anecdotally, every single person I know who got the bivalent booster, with the exception of my parents, got Covid. Within 3-6 weeks after the shot. That is not compelling. And I wonder if this round will be a better match. Or more effective.
I observed the same thing - nearly everyone I know who got the booster got covid shortly thereafter. Likewise, my parents, who also were boosted, didn't get covid because they are super careful (83 and 81 yo). At a minimum, these anecdotes make me think the "efficacy" numbers touted by the CDC for the mRNA boosters are exaggerated. If I get a booster, it will be Novavax. I am done with mRNA.
That is where I am. Also anecdotally, my kids got their third Pfizer in August 2022, went to school unmasked, lived life, and only one got Covid in March. None of the rest of us got it, despite him being heavily symptomatic in our home. My husband and I have not had shots since our third Moderna and Pfizer in November 2021. Paul Offitt and many others still would say we are well protected from severe outcomes. I hope they are right.
The government told the vaccine manufacturers to be ready for late September. Link to their official letter is below. Lots of bureaucratic verbiage, but the key words are "Manufacturers are advised that they should plan the updated COVID-19 vaccine supply and regulatory submissions so that the Food and Drug Administration (FDA) can take regulatory action and the Centers for Disease Control and Prevention (CDC) can make recommendations on vaccination by the latter part of September."
The latest news is late Sept/early Oct. I suspect there isn't much planning going on to the extent you propose (holding back to protect through holidays, using young people to build a wall, etc).
I think more likely it's economics and supply chain driven.
Moderna and Pfizer overestimated the demand for Covid Bivalent boosters last year - manufacturing 150 million of them with uptake being as low as 11 million and as high as 50 million (best data I can find).
That is a pretty significant loss (not for them, the govt bought them) and certainly the 2023 boosters will have even lower uptake.
Given the loss of funding/subsidies and lack of interest, it makes sense to prioritize their manufacturing and logistics on products with higher demand.
The plan for small rollout in September followed by more shots in October suggests they will leverage the early uptake data in Sept to better plan how much to make so we aren't stuck with inventory we have to discard. With the price of the vaccine supposedly rising 4x, I suspect insurance oversight will be pressing them to get their forecasts correct.
Texas school closed for a week because 20% of staff has Covid. Best guess: 20-50% of people attending schools (staff, students) will be “immunized” with one of the latest variants before the 2023 boosters are released 4-5 weeks from now. Whether intentional or not, the immunity wall is being rebuilt.
When I was just a pup at CDC, almost 50 years ago, the then-leader of influenza surveillance and response at CDC, Mike Gregg, was asked by a reporter whether the upcoming year was going to be a big flu year. He responded that if he could answer that question, he could get rich on orange juice futures. YLE is being properly humble about the difficulties of prediction in a complex environment. You have to try but you can't make promises.
I’m curious if anyone has data on whether the 65+ folks who opted for a second bivalent booster this Spring received enough additional protection to prevent severe disease and death? To the extent people are currently being hospitalized and dying, are the folks who took the Spring booster better off than their peers?
A few weeks ago I was reading about tree canopies and evidence that trees avoid having their branches touch adjacent trees' branches even when adjacent trees are of another species (maybe access to sunlight is the driver but they grow to where they are almost touching consistently). That came to mind when you mentioned the three virus' peaks not overlapping as some feared. If the same pattern occurs this winter it would be interesting to investigate if that behavior is more common than not.
Thank you so much for this info-filled update. One thing I am wondering about, if anyone has a thought, is the sequence in which to get the three shots. (We’d prefer not to get the Covid booster with the other two, to minimize side effects; we are unclear on side effect issues with the RSV, so not clear whether flu and RSV shots could be combined without problems.)
Hi Susan - hope that Dr Jetelina doesn’t mind me hopping in here. One study did show decreased antibody titers against RSV when rsv vax was given concomitantly with flu shot.
Also flu + covid boosters create more side effects when given simultaneously 10% of the time. Personal logistics play a part in how feasible it is to keep coming back… but I plan to space out my shots by a couple weeks.
Dr. McCormick, I am ALWAYS delighted when you pop in. Your insights and information are always useful. Thank you so much for this info--and the link to your Substack piece! All enormously helpful--and also validating about caution in combining shots in a single session. (And I will definitely consult with our doc, too, before making a final decision on the RSV shot.)
New 67 y.o. grandfather here! ...wondering a bit about RSV.
Wife and I planning on RSV vax ASAP mostly to help protect grandkid. Also, there is RSV monoclonal antibody treatment for the kid - mom is going to ask ped. about on next visit.
Other than maintaining good IAQ, anything were missing?
Sounds advice, as always. But I would love some guidance on how to find an effective mask that fits properly.
Most mask guidance seems very general--e.g., buy N95s. If I drill deeper, it can become mind-blowingly complex--e.g., spreadsheets of data incomprehensible to a layperson. Not much credible guidance in between, at least not that I've seen.
Where do you buy yours, Dr. McCormick? Anything special with sizing other than a standard seal check upon donning? I’m an newly immunocompromised public health nurse, and I can tell I’m going to need some very high quality masks for the fall.
I’ve ordered mine through Home Depot, and I’ve been fit tested by the hospital in one, and for me at least the seal is excellent so hope that helps you too
I don't think I've heard anyone propose or even wonder this... Might fly in certain circles but the vast majority of people have moved on from using respirators at all. Good idea, though.
I looked at these, but I’m curious…do they restick? When I worked in the hospital, I pretty much left my mask untouched for the 8 hours but I’m in an office now and like to take a drink now and then.
They do restick, but you have to be careful pulling off. I asked ReadiMask this question and they sent some info but it was some time ago. They tend to be pretty responsive, so feel free to reach out on the website. I often wear these once I’m through security in an airport and then on a plane, but I’m not removing. I have removed at the doctor’s office (as a patient) and popped back on.
They are incredibly “breathable.” Very comfortable to me. They look a little odd, but N95’s don’t seem to fit my head/face well, and these are a complete seal.
Gosh, I’m just thrilled to hear parents are asking about COVID vaccines for their kids at all. I’m a public health nurse and that age group has had terrible uptake.
I saw a school in Kentucky has already shut down due to high levels of staff and student illness:
https://www.today.com/health/news/kentucky-school-district-cancels-classes-covid-flu-strep-rcna101536
https://www.wkyt.com/2023/08/24/multiple-ky-schools-close-due-illness-start-new-year/
Oh, I guess it’s multiple Kentucky schools now.
As someone immunocompromised for fall for the first time and *still* recovering from my very first COVID case (caught from 2 family members coming into my house, one with symptoms not disclosed til the end of the visit.), I’m dreading the Fall and hoping I survive it. Very thankful for Paxlovid. I have no doubt I would be hospitalized otherwise.
Masking absolutely works. I masked through all other exposures (including as a hospital nurse with COVID patients) and came out negative. So since there are no accommodations for working from home at my company, I’m just going to be wearing the best masks I can find starting now.
As a communicable disease nurse, it’s going to be a very busy and probably ugly winter. The politicization hasn’t toned down at all. I suspect the uptake of vaccines to be fairly abysmal other than the older folks. I hope I’m wrong. With other opportunistic infections like invasive strep stepping on the coattails of our damaged immune systems, this could be a lot of heartache. I wish we could all just take common sense precautions instead of running headlong into a hurricane to prove a point.
Masks are helpful according to CDC: "Consistent use of a face mask or respirator in indoor public settings was associated with lower odds of a positive SARS-CoV-2 test result (adjusted odds ratio = 0.44). " not perfect but helpful. And of course when they are worn well (I can count on myself to do that, even when most people are impersonating santa with the placement of their masks) they are most helpful. Paul - read up. https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm
If we're all about you-do-you, then in the long run the only real, equitable solution is hazard pay for pretty much all in-person work.
Agree but I can’t see it happening if they wouldn’t even give us hazard pay at the hospital. My post ended up being bad foreshadowing. 2 of the 3 people with COVID in my family also had a strep coinfection that was missed until now due to the similar symptoms. I bet it happens a lot unless you’re hospitalized and getting a full workup. What a nightmare, untreated strep is bad news.
“Masking doesn’t work” - funny, nearly everyone I know who stopped masking got Covid shortly thereafter.
After YEARS of trolls...please don't respond, just report
Usually I ignore trolls. My comment isn't for him, it's to help others who might be swayed with a little common sense.
Just wanted to remind you that South Korea has one of the highest masking rates in the world, using among the highest tier of masks consistently, yet had one of the worst outcomes in Covid mortality. That example should at least be a starting point of neutral conversations exploring how they failed at population level at every single country which tried them.
Also, now we have Anthony Fauci this weekend, when grilled with tough questions on CNN of all places, retreats to "well, yes at population levels the evidence is weak, but on a personal level I do believe they are helpful".
I suspect in this case the pre-2020 scientific consensus on masks was correct all along.
This makes me feel sorry for Dr Jerome Adams, Trump's Surgeon General. He got the unpleasant task in the very beginning of telling us "STOP BUYING MASKS. They are NOT effective in preventing general public from catching #Coronavirus." Once the mask mandates came, he looked like a fool and took a huge hit to his reputation. Turns out he may have been right all along.
People who rely only on evidence are incapable of thinking for themselves.
All-ya-all -
Best to leave him without responses.
Oh but it's so funnnnnnnnnn. Seriously it's about 3/16 of why I come here
Ooh, RCTs! Null hypothesis! Now I'm shaking
You have a fundamental misunderstanding of how context dependent evidence is
This person's clueless (unsurprisingly) regarding the distinction between "evidence" and "proof." Anecdotes can absolutely be evidentiary.
Yup. I was on a grand jury last fall and they took great pains to instruct us on what could be regarded as evidence. Pretty much anything they told us is evidence...is evidence. Whether it's persuasive is really a matter of who you're trying to persuade. It's never absolute.
Bingo! If anecdotes have no meaning, how did Chinese medicine evolve over 23 centuries?
You wouldn't know what a null hypothesis was if it walked right up to you with a name tag
Good forecast, and for what it’s worth I agree. I’m guessing Covid “wave” first this fall with BA.2.86 since it’s by far the most contagious (of these 3 viruses), and booster uptake will be low and less effective than if we had a more closely matched vaccine. Not vaccine makers’ fault.
And I enjoy not being sick, so I’ll be wearing that N95 I never stopped wearing in higher risk situations.
When I get Covid I want it to be “worth it.” Family gathering instead of public bathroom kind of thing.
And I’ll be taking paxlovid, or oral remdesivir once it arrives.
p.s. I loved your latest post! but please please address rebound. I’m currently on day 6 of a hard rebound with a full return of symptoms and blaring positive antigen tests. I had to send my employer the CDC guidelines for reisolation (and I know a lot of people just can’t do it. But they could keep masking with good masks.) I’m immunocompromised, so I was already more likely to rebound and more likely to have extended viral shedding, so it wasn’t a real surprise. But I feel rebound is going to play a huge part in ongoing transmission.
I totally agree with your plan, and testing positive and feeling bad are two important reasons to stay home and recover! Talk to your doc about additional antiviral treatment (Paxlovid) as some advocate for longer durations of therapy in your sort of situation. Best of luck and wishing you well
Interesting you should say that. At least 2 medical providers have offered my husband a 2nd course of paxlovid. He had an unusually late rebound (11 days after Paxlovid completion.) and has even had fevers again.
We have very different perspectives on this. I'd rather get it in a public setting (such as a bathroom) before the next time I see family. I can't imagine anything worse than being responsible for giving Covid to my immunocompromised mother. I'd much rather catch it in a public setting, well before seeing my parents.
Fair enough, glad you are tying to protect her. Maybe tighten up your game 1-2 weeks before visiting?
Yeah, that's pretty much my MO. I give them the full package when I'm getting ready to visit them - PCR test for flu/covid/RSV and 2 rapid tests.
Twoish weeks before mid Nov is Halloween.
Halloweeen smart this year, folks.
Don't forget to wear a reflective vest!
Just a reminder, the countries that kept schools open throughout 2020 and didn't mask children also had Flu and RSV disappear so the hypothesis on causality should be reconsidered - other confounders must be at play. You had previously mentioned possibility of "Viral Interference" as an alternative hypothesis - have you given that any more thought?
I'm just pointing this out because your chart might give the impression that made any difference which we know is incorrect.
Of course, the "changed behaviors" hypothesis disrupted the patterns in unpredictable ways, it's reasonable question if it had more harm than benefit. I found this article linked within the stat article you shared interesting [1], especially because of how much time it spends discussing "immunity debt" without using that term.
At a high level, we need to consider why mitigation (school closure, business closure, stay at home orders, mandatory masking, etc) was followed by very high excess deaths, while reduction of mitigation was followed by a return to "baseline" mortality.
The hypothesis that without heavy mitigation excess deaths would have been even higher is falsified by the fact the countries that did less had the better outcomes in terms of mortality.
______________
[1] Original you need Stat account to read:
https://www.statnews.com/2022/05/25/viruses-that-were-on-hiatus-during-covid-are-back-and-behaving-in-unexpected-ways/
Archive version to bypass account lock:
https://archive.li/H3YzP
Previous discussion on similar topic:
https://yourlocalepidemiologist.substack.com/p/the-common-viruses-for-our-kids-may/comment/9248722
I think "seasonality" is something of misnomer. The driver, it seems to me, is close proximity to strangers in an indoor setting. Down south, that means air conditioned spaces during a long summer. Up north it means heated indoor spaces in winter. The low hanging fruit is to do as your Mother told you, and stay out of bars. And avoid crowds.
Yeah, and against a backdrop of global warming, "seasonality" sorta goes out the window
Should we be getting the flu shot in September then? I usually wait until mid October.
And can you please address optimum timing between the three vaccines (RSV, Flu, COVID booster)? Dr. Michael Osterholm said in his last Podcast that he would go RSV now, COVID ASP (end of Sept??), and flu as it starts to emerge, that he believes it’s very likely more effective to space than to take shots together (unless that’s the only way you’ll actually get them all). Summarized from Episode 137, Aug 10, 2023.
Quick Update: I just listened to the newest podcast from Dr. Osterholm (Episode 138), and he says looking at more data, he’s not as concerned about spacing…but is recommending RSV now for any eligible, COVID ASP (likely end of Sept), and then Flu once that activity is detected. Still curious if YLE recommends some spacing (a few weeks?) for best bet at optimal performance.
Per my doctor: Flu shot on Halloween. Covid shot +/- 2 weeks.
Yeah I was planning on waiting until November for covid booster since we had Covid in June.
It depends on your age and where you live.
FDA had a vaccine meeting in June. I seem to recall that both Moderna and Pfizer said they could manufacture enough monovalent boosters so that shots would be ready in August, with Novavax close behind. It's now August, so where are our boosters?
Are boosters intentionally being held back, and if so why? Is there a plan to delay shots so that the first recipients are protected through the holidays (mRNA protection wanes after 3-4 months)? Or is the younger generation being used to re-build our "immunity wall" now that schools and colleges are back in session? Or is there a fear that if people got boosted during our current mini-surge, they would "get covid anyway right after my booster" (like last year)?
I received a call from my physical therapist's office yesterday asking me if I wanted to move up my appointment because because people were cancelling due to covid. I asked what percent had cancelled because of covid in the last week? "Out of 100 patients, probably 4 this week, and 2 the week before." Not exactly scientific, but that's roughly 4% this week and 2% last week, mostly adults and the trend line is increasing. This excludes back to school kids who are more at risk - so in schools these percentages are likely higher.
What percent of the population will have already been infected with the new variants by the time the monovalent boosters are finally released in September or October? Likely 20% - probably more. And how will we be able to know how well the new boosters work when the reality is a new immunity wall was being re-built a month or two before their release?
I am not sure how I feel about the boosters. Anecdotally, every single person I know who got the bivalent booster, with the exception of my parents, got Covid. Within 3-6 weeks after the shot. That is not compelling. And I wonder if this round will be a better match. Or more effective.
I observed the same thing - nearly everyone I know who got the booster got covid shortly thereafter. Likewise, my parents, who also were boosted, didn't get covid because they are super careful (83 and 81 yo). At a minimum, these anecdotes make me think the "efficacy" numbers touted by the CDC for the mRNA boosters are exaggerated. If I get a booster, it will be Novavax. I am done with mRNA.
That is where I am. Also anecdotally, my kids got their third Pfizer in August 2022, went to school unmasked, lived life, and only one got Covid in March. None of the rest of us got it, despite him being heavily symptomatic in our home. My husband and I have not had shots since our third Moderna and Pfizer in November 2021. Paul Offitt and many others still would say we are well protected from severe outcomes. I hope they are right.
It's going to be mid-September
Thanks - I keep hearing different timeframes and didn’t know a date had been set. What’s your source, please?
The government told the vaccine manufacturers to be ready for late September. Link to their official letter is below. Lots of bureaucratic verbiage, but the key words are "Manufacturers are advised that they should plan the updated COVID-19 vaccine supply and regulatory submissions so that the Food and Drug Administration (FDA) can take regulatory action and the Centers for Disease Control and Prevention (CDC) can make recommendations on vaccination by the latter part of September."
https://www.hhs.gov/about/news/2023/07/13/letter-covid-19-vaccine-manufacturers.html
Thanks! Mandy Cohen of CDC now saying boosters will be released in late September, not early October as she previously indicated.
https://www.webmd.com/covid/news/20230814/new-covid-shots-will-available-september
Thanks, I had not seen that update.
The latest news is late Sept/early Oct. I suspect there isn't much planning going on to the extent you propose (holding back to protect through holidays, using young people to build a wall, etc).
I think more likely it's economics and supply chain driven.
Moderna and Pfizer overestimated the demand for Covid Bivalent boosters last year - manufacturing 150 million of them with uptake being as low as 11 million and as high as 50 million (best data I can find).
That is a pretty significant loss (not for them, the govt bought them) and certainly the 2023 boosters will have even lower uptake.
Given the loss of funding/subsidies and lack of interest, it makes sense to prioritize their manufacturing and logistics on products with higher demand.
The plan for small rollout in September followed by more shots in October suggests they will leverage the early uptake data in Sept to better plan how much to make so we aren't stuck with inventory we have to discard. With the price of the vaccine supposedly rising 4x, I suspect insurance oversight will be pressing them to get their forecasts correct.
Texas school closed for a week because 20% of staff has Covid. Best guess: 20-50% of people attending schools (staff, students) will be “immunized” with one of the latest variants before the 2023 boosters are released 4-5 weeks from now. Whether intentional or not, the immunity wall is being rebuilt.
https://www.dallasnews.com/news/texas/2023/08/24/texas-school-district-closes-for-week-following-staff-covid-19-infections/?outputType=amp
That sounds about right.
My favorite type of hybrid immunity is....someone else's
🤣
Are we still a month out from updated covid vaccines?
Mid to late September for the new monovalent
When I was just a pup at CDC, almost 50 years ago, the then-leader of influenza surveillance and response at CDC, Mike Gregg, was asked by a reporter whether the upcoming year was going to be a big flu year. He responded that if he could answer that question, he could get rich on orange juice futures. YLE is being properly humble about the difficulties of prediction in a complex environment. You have to try but you can't make promises.
I’m curious if anyone has data on whether the 65+ folks who opted for a second bivalent booster this Spring received enough additional protection to prevent severe disease and death? To the extent people are currently being hospitalized and dying, are the folks who took the Spring booster better off than their peers?
Love your posts.
A few weeks ago I was reading about tree canopies and evidence that trees avoid having their branches touch adjacent trees' branches even when adjacent trees are of another species (maybe access to sunlight is the driver but they grow to where they are almost touching consistently). That came to mind when you mentioned the three virus' peaks not overlapping as some feared. If the same pattern occurs this winter it would be interesting to investigate if that behavior is more common than not.
Thank you so much for this info-filled update. One thing I am wondering about, if anyone has a thought, is the sequence in which to get the three shots. (We’d prefer not to get the Covid booster with the other two, to minimize side effects; we are unclear on side effect issues with the RSV, so not clear whether flu and RSV shots could be combined without problems.)
Hi Susan - hope that Dr Jetelina doesn’t mind me hopping in here. One study did show decreased antibody titers against RSV when rsv vax was given concomitantly with flu shot.
Also flu + covid boosters create more side effects when given simultaneously 10% of the time. Personal logistics play a part in how feasible it is to keep coming back… but I plan to space out my shots by a couple weeks.
https://mccormickmd.substack.com/p/should-i-get-the-rsv-vaccine
Dr. McCormick, I am ALWAYS delighted when you pop in. Your insights and information are always useful. Thank you so much for this info--and the link to your Substack piece! All enormously helpful--and also validating about caution in combining shots in a single session. (And I will definitely consult with our doc, too, before making a final decision on the RSV shot.)
Thank you for this! Fits with Dr. Osterholm’s thinking (Podcast #137).
Dr. McCormick, have you heard anything about shared clinical decision making for the RSV vaccine for immunocompromised under age 60? Even though this document was updated 8/1, it doesn’t seem to mention it, unless I’m missing it. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html
With a novel virus when do we typically get a break or get ahead? I mean our students are suffering on all levels, it is really heart wrenching.
New 67 y.o. grandfather here! ...wondering a bit about RSV.
Wife and I planning on RSV vax ASAP mostly to help protect grandkid. Also, there is RSV monoclonal antibody treatment for the kid - mom is going to ask ped. about on next visit.
Other than maintaining good IAQ, anything were missing?
Sounds advice, as always. But I would love some guidance on how to find an effective mask that fits properly.
Most mask guidance seems very general--e.g., buy N95s. If I drill deeper, it can become mind-blowingly complex--e.g., spreadsheets of data incomprehensible to a layperson. Not much credible guidance in between, at least not that I've seen.
Have you tried the 3M Aura? That’s my favorite, and I’ve tried A LOT unfortunately…
https://www.3m.com/3M/en_US/p/d/b00051022/
Thank you!
Where do you buy yours, Dr. McCormick? Anything special with sizing other than a standard seal check upon donning? I’m an newly immunocompromised public health nurse, and I can tell I’m going to need some very high quality masks for the fall.
I’ve ordered mine through Home Depot, and I’ve been fit tested by the hospital in one, and for me at least the seal is excellent so hope that helps you too
I really wish fit testing could be made available to the general public, maybe with its own CPT code and reimbursable as preventive care.
I don't think I've heard anyone propose or even wonder this... Might fly in certain circles but the vast majority of people have moved on from using respirators at all. Good idea, though.
I love ReadiMask—they seal directly to your face so there are no leaks. NIOSH approved.
I looked at these, but I’m curious…do they restick? When I worked in the hospital, I pretty much left my mask untouched for the 8 hours but I’m in an office now and like to take a drink now and then.
They do restick, but you have to be careful pulling off. I asked ReadiMask this question and they sent some info but it was some time ago. They tend to be pretty responsive, so feel free to reach out on the website. I often wear these once I’m through security in an airport and then on a plane, but I’m not removing. I have removed at the doctor’s office (as a patient) and popped back on.
They are incredibly “breathable.” Very comfortable to me. They look a little odd, but N95’s don’t seem to fit my head/face well, and these are a complete seal.
We just got covid for the first time this summer because we vacationed and let our guard down BUT these are the masks we have used for the past couple of years while traveling and cruising (and not catching covid). They are my daughter’s favorite kid size mask too. It’s the Powecom kn95 masks. They have a 20% off sale on their masks right now. https://bonafidemasks.com/?omnisendContactID=61d3ab45276deb00207ed36d&utm_campaign=campaign%3A+Back+To+School%3A++25%25+Off+Coupon+Code+Extended%21+See+Coupon+Code+Inside%21+%2864df6927e9f48328ede191d8%29&utm_medium=email&utm_source=omnisend
I also wear Powecom!
I like these a lot. They don't sit right on your face and give a tight seal.
https://evolvetogether.com/collections/adult-size-face-masks
Don't forget that N95 masks are still covered pre-tax by flex spend and health savings accounts!
Parents are frustrated with the lack of information about whether their child will be eligible for the new covid booster. Doctors are frustrated too!
This does damage to uptake.
The new infant RSV ppx, how quickly will insurers actually pay if we order it? History says it will be a battle.
Just received my first shipment of influenza vaccines. We start with those. The rest we shrug our shoulders and say, I don’t know...
Gosh, I’m just thrilled to hear parents are asking about COVID vaccines for their kids at all. I’m a public health nurse and that age group has had terrible uptake.