Sibylla Bostoniensis

Ed Yong headed up The Atlantic's coverage of Covid as it rolled over us, becoming perhaps the most important journalist of the pandemic and arguably the best, for which reason he won the Pulitzer. You may recognize his name; you've seen me quote him (e.g.).

Ed Yong gave a talk at XOXO last August that was posted to YouTube last October, and only now came to my attention. It was an autobiographical talk, about what it was like for him.

And what it was like for him was it really sucked. It honestly sounds like it came damn close to killing him.

It is beautiful, elegiac, ascerbic, contemplative, bitter, incisive, and meditative. Ed Yong is still Coviding. Ed Yong is all out of fucks to give. Ed Yong learned that survival requires living life on your own terms.

It is, I think, to a certain sort of viewer, validating and thought provoking. I think it is an important testament as to what the toll was for at least one of the people who found themselves drafted to fight on the side of the angels and gave it all they had.

If you think that might be a thing you'd like, I think you'd like it. Thirty-six minutes.

2024 Oct 10: XOXO Festival [YT]: "Ed Yong, Journalist/Author - XOXO Festival (2024)".

EY: And third, this –

slide goes up: "HOW THE PANDEMIC DEFEATED AMERICA"

EY: –is not actually the talk you're going to get. This is the talk I've often given before about what we have learned from the hellscape of the last few years. But Andy suggested that this audience would like instead to hear something more personal. So, this is...

slide animates, black bars fade in, leaving: "HOW THE PANDEMIC DEFEATED ◾️ME◾️◾️◾️◾️"

Not actionable, but of possible interest to my readers: Eric Topol has an article up explaining the present state of development of nasal vaccines in the US for Covid. Nasal vaccines are a particularly exciting line of research because they are pursuing prevention of infection and sterilizing immunity. Nothing is ready for prime time yet, and all is jeopardized by the crumbling of the American state.

2025 Feb 14: Ground Truths (blog by Dr. Eric Topol on Substack): "A Covid Nasal Vaccine Update" subtitle: "Now 6 Ongoing Clinical Trials in the United States"

I'd been hearing from other Covid nerds that the new, hard-to-access hotness is the Novavax vaccine. I was surprised when I went to book our shots for yesterday that CVS was offering it. I hadn't had time to research it, but one of my guiding principles is, "In nature it is often better to be fast than right", so based on little more than peer pressure I went for it.

I looked a little bit into it after I got home, and apparently the manufacturer is claiming that there's still some – implied: clinically relevant – amount of IgG response from it after 11 months. (Chart here – I don't know if that will be visible to you, because they want visitors to the website to swear they are medical professionals. Note chart is logarthmic, so way less impressive than it looks at first glance.) Now, that's based on vaccine naive subjects who got a two shot series of Novavax (same as the two-shot series for the mRNA vaccines), three weeks apart, but may (or may not) be generalizable to people who were previously vaccinated with mRNA vaccines and get a one shot booster of Novavax.

There's also some speculation that it provides better mucosal protection than the mRNA vaccines (Pfizer and Moderna). I don't know the evidence for this, if any.

Also there's a theory that mixing and matching vaccines might confer better immunity, as mentioned in that first link.

(The other two reasons it is of interest is that it can be more agreeable to people who are leery of the mRNA vaccine technology and that it is less prone to side effects. I couldn't say: I got it with a Shingrix shot and now feel like I've been beaten with a stick.)

The other important thing I learned is that all remaining doses of Novavax on pharmacy shelves have expiration dates of March 31 or earlier (also on the Novavax site). It's possible the CDC, if it still exists, will extend those expiration dates the way they've done with Covid tests. So if you want a Novavax shot, there's especial reason to hurry. If there's someone reading this who hasn't been vaccinated at all, and wants the full Novavax experience, your initial series is supposed to be two shots at least three weeks apart, so you need to hustle.

If anybody has more insights into the pros and cons of Novavax they want to share, please drop a comment.

Various ID news, some US specific and actionable, some of general interest and not:

1) CDC drops recommended age for pneumococcal vaccine to age 50:

2024 Oct 24: NBC News: "CDC recommends pneumonia vaccine for adults 50 and older" (by Erika Edwards):

On Wednesday, an independent group of advisers to the CDC voted 14 to 1 to lower the age for routine pneumococcal vaccines to 50. [...]

The shots were previously only recommended for adults 65 and older, and for children 5 and younger. [...]

Pneumococcal vaccines can help prevent infection from bacteria called Streptococcus pneumoniae. The bacteria can cause mild illnesses, such as ear and sinus infections, but can be deadly when they get into the lungs, bloodstream or lining of the brain and spinal cord (meningitis).

According to the CDC, 1 in 6 older adults who get either pneumococcal bloodstream infections or pneumococcal meningitis will die from the disease.

A quarter-million hospitalizations from pneumococcal pneumonia are estimated to occur every year in the U.S., according to the CDC.

Why the change? Turns out using white people as the yardstick for when to vaccinate wasn't such a bright idea:

“The peak in serious invasive pneumococcal infections occurs earlier in the Black population” at about 55 to 60, [Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center] said. [...]

The [National Association of Nutrition and Aging Services Programs], along with the National Hispanic Council on Aging and the National Caucus and Center on Black Aging, recently sent a letter to the ACIP urging members to lower the age recommendation for routine pneumococcal vaccines from 65+ to 50.

2) CDC recommending now COVID boosters later:

2024 Oct 23: CDC.gov press release: "CDC Recommends Second Dose of 2024-2025 COVID-19 Vaccine for People 65 Years and Older and for People Who are Moderately or Severely Immunocompromised" (bold is my emphasis, italic in the original):

October 23, 2024 - Today, CDC Director Mandy Cohen endorsed the CDC Advisory Committee on Immunization Practices' (ACIP) recommendation for people 65 years and older and those who are moderately or severely immunocompromised to receive a second dose of 2024-2025 COVID-19 vaccine six months after their first dose.

These updated recommendations also allow for flexibility for additional doses (i.e., three or more) for those who are moderately or severely immunocompromised, in consultation with their healthcare provider (a strategy known as shared clinical decision making).

This is interesting, and I really appreciate them doing this: the CDC now is saying, that shot of the new formulation that you just got? You should get a booster to it (if you're in the aforementioned groups) six months from whenever you got it.

Which is under the next presidential administration, whatever that will be.

Yall. The CDC just said, "Look, we might not be able to be there for you come next February. So we're going to tell you now what we would tell you then."

I kinda wanna give Mandy Cohen a hug.

Of course, I will be, absent any further information from the science, blithely ignoring the CDC's serving suggestion that this is only for the immunocompromised and the elderly, and continuing to get myself COVID shots every 6 months.

The CDC's press release continues (emphasis mine):

The recommendation acknowledges the increased risk of severe disease from COVID-19 in older adults and those who are immunocompromised, along with the currently available data on vaccine effectiveness and year-round circulation of COVID-19. The recommendation also provides clarity to healthcare providers on how many doses should be given per year to people who are moderately or severely immunocompromised and is meant to increase coverage of this second dose for that group.

Data continues to confirm the importance of vaccination to protect those most at risk for severe outcomes of COVID-19. Receiving recommended 2024-2025 COVID-19 vaccines can restore and enhance protection against the virus variants currently responsible for most infections and hospitalizations in the United States. COVID-19 vaccination also reduces the chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration.

This is me squinting at that, and observing: hmmm, I think there is a subtext here. The fact that they mention long Covid – which is not at all specific to the vulnerable groups – and the year-round circulating nature of Covid, along with the specificity of saying what this guidance is supposed to achieve suggests to me – and I am absolutely reading tea leaves here – CDC director Cohen doesn't approve of the regulatory capture of the CDC by hospital administrators and insurance interests (including Congress), which have restricted the CDC to recommending vaccinations to a much more limited population than would benefit from them, based on purely financial calculations, but is working within the constraints she must.

3) CDC decides recent mysterious Missouri human HPAI case(s) was animal-to-human transmission after all:

2024 Oct 24: NBC News: "Missouri bird flu patient didn't spread the virus to others, CDC says" (Erika Edwards and Berkeley Lovelace Jr.):

After the Missouri patient fell ill, several close contacts reported respiratory symptoms and health officials conducted serologic, or blood, tests to determine if the virus had spread among them. Test results on five health care workers who became ill after caring for the patient came back negative for any sign of the virus, Dr. Demetre Daskalakis, who heads the CDC’s National Center for Immunization and Respiratory Diseases, said during a media briefing.

“From the perspective of where we are with this investigation, I think we’ve got the conclusion,” Daskalakis said.

One blood test on a household member of the patient who became ill suggested the person did have H5 antibodies. A second test was unable to confirm the finding.

It appears that the two people became sick at the same time from the same source — likely some kind of animal or animal product, the CDC said. Both people developed symptoms, which were mostly gastrointestinal, simultaneously.

“We arrived at the same conclusion using different lines of evidence as it relates to person-to-person transmission,” said Dr. Nirav Shah, the CDC's principal deputy director. All of the people who fell ill have since recovered.[...]

Cases are increasing in the West

The virus is continuing to spread from infected birds and cows to people, however. [...]

That links to:

2024 Oct 22: NBC News: "Bird flu cases in people quietly tick up, with dozens reported across 6 states (by Evan Bush):

The Summary:

• Four new presumed cases of bird flu in farmworkers in Washington state bring the U.S. total to 31.

• The risk that the virus will mutate to spread easily between people is low, but experts say ongoing transmission in cows is worrisome.

• The arrival of flu season brings added risks, as viruses can swap genetic material if two infect a host at once.

4) Speaking of influenza: a new treatment for it is in the works:

2024 Oct 24: Sci Show (on YT) [science journalism]: "This New Drug Makes the Flu Less Deadly". Click through to watch.

This science explainer discusses something that is not yet ready for primetime – the paper it discusses is about it proving effective in mice – but which is a promising new approach to developing a treatment for influenza. Not a preventive measure like a vaccine, but an intervention for after one has contracted the flu, that stops how influenza virus (specifically) causes a cytokine storm. The segment explains some fascinating things about how influenza affects the body and what they're trying to do.

Americans! If you are uninsured and cannot afford a $200 list price for vaccination, try to get your booster before the end of August (this coming Saturday).

While the newly formulated vaccines are better targeted at the circulating COVID variants, uninsured and underinsured Americans may have to rush if they hope to get one for free. A CDC program that provided boosters to 1.5 million people over the last year ran out of money and is ending Aug. 31.

The agency drummed up $62 million in unspent funds to pay state and local health departments to provide the new shots to those not covered by insurance. But "that may not go very far" if the vaccine costs the agency around $86 a dose, as it did last year, said Kelly Moore, CEO of Immunize.org, which advocates for vaccination.

People who pay out-of-pocket at pharmacies face higher prices: CVS plans to sell the updated vaccine for $201.99, said Amy Thibault, a spokesperson for the company. [...]

New York state has about $1 million to fill the gaps when the CDC's program ends, said Danielle De Souza, a spokesperson for the New York State Department of Health. That will buy around 12,500 doses for uninsured and underinsured adults, she said. There are roughly one million uninsured people in the state.

From:
2024 Aug 26: ABC News: "The new COVID vaccine is out. Why you might not want to rush to get it" by Arthur Allen, Eliza Fawcett, and Rebecca Grapevine.

2024 July 5: NYTimes: "A Defiant Biden Says Only the ‘Lord Almighty’ Could Drive Him From the Race"

2024 July 17, 2:20 p.m.: Politico, reporting on interview in BET News: "Biden says he’d reevaluate campaign if medical condition emerged"

2024 July 17, 6:00 p.m.: CNN: "President Joe Biden tests positive for Covid-19"

(h/t u/lurklurklurky here)

2024 May 9: thinkglobalhealth.org: "Where COVID Has Shifted Flu and RSV Seasons" by Wan-Jen Lee, Hao Kai Tseng, et al. "In some countries, peaks in flu hospitalizations occurred 4.3 weeks early on average relative to the pre-COVID era":

The COVID-19 pandemic claimed millions of lives and interrupted global society—but along the way it also changed the transmission landscapes of respiratory pathogens, including influenza (flu) virus and respiratory syncytial virus (RSV). [...]

Irregular influenza and RSV trends occurred worldwide throughout the pandemic. In 2020, South Africa's winter influenza epidemic seemed to have stopped entirely. In 2021, the United States grew sick as RSV surged off season. In 2022, Chile reported an early start to its influenza season, and by the end of the year, the World Health Organization (WHO) and the European Centre for Disease Prevention and Control issued a joint statement warning about the early kick-off of the influenza season epidemic and intensified RSV activity in Europe. At the time COVID-19 was still a public health emergency of international concern (PHEIC), and many public health experts worried about a collision of these diseases, coining them a twindemic or tripledemic.

Yet the shift remained even as COVID-19 slowed. An out-of-season RSV epidemic occurred in early 2023 in Beijing, and as of April 2024 influenza season has started early in Australia.

[...]

Patterns in Hospitalizations Pre- Versus Post-Pandemic
Our research uncovered substantial changes when focusing on six countries—Australia, Brazil, England, France, Turkey, and the United States. Those countries kept comprehensive reports of influenza and RSV hospitalizations between 2017 and 2023.
The influenza hospitalizations have peaked in the five temperate countries, excluding Brazil, 4.3 weeks earlier on average since the 2019–2020 season. Peaks in RSV hospitalizations were more erratic. They arrived 1.3 weeks earlier on average in the five temperate countries after the pandemic, but during the 2020–2021 season a notable 11.2 weeks average delay in RSV hospitalization offset subsequent differences.
Overall, the impact of COVID-19 is likely diminishing over time. In the 2021–2022 season, the average peaks for influenza and RSV among all countries occurred 3.8 and 5.9 weeks earlier, respectively, relative to 3.1 and 2.9 weeks earlier in the 2022–2023 season. However, on comparing pre- and post-pandemic numbers across these temperate countries, the differences in average hospitalization rates are not significant.

[...]

Much more at link.

I was recently surprised to find that a friend of mine was still using homestyle fabric masks at this point.

Fabric masks are better than nothing, but not a lot better than nothing. I seem to recall hearing that tests show they filter out about 40% of particulate matter that we care about.

Fabric masks with filter inserts aren't actually any better. Fabric masks don't seal around the face and even if they did, they don't force air through the filter inserts. Instead the filter inserts force air through the fabric around the filters.

Surgical masks are better than fabric masks of any type, but again they're not great. I recall them being at best around 80% effective.
If you're serious about protecting yourself, you should be shooting for 95% or better. That means N95 or KN95 "respirators" or better technology.

N95 is the US standard; KN is the Korean standard. Both are nominally disposable masks, but they can be reused. The big pragmatic difference between them is that N95s have elastic straps that go around the back of the head; KN95s have elastic straps that go behind the ears.

Okay, the other big pragmatic difference is that because N95s are manufactured for the American market, and because Americans generally don't wear masks except for industrial purposes, they are heartbreakingly plain. There's one vendor who makes them in black, pink, and light blue. In contrast, KN95s are made for the Asian market, and because in Asia the general public wear masks all the time, masks are ordinary consumer goods, and consequently KN95s come in a vast profusion of fashion prints and colors.

If you want to avail yourself of KN95s but you don't want the backs of your ears abraided, there's a variety of very cheap technologies you can get or make to otherwise affix the mask to your face. I got some of what are referred to as "nurses headbands", which are fabric headbands with buttons on either side, that wind up just behind one's ears; one loops one's KN95 elastics over the buttons instead of over one's ears. These tend to come with cheesy medical themed prints, such as cartoon stethoscopes or EKG traces, but solid colors are available.

Beyond disposable masks, there are elastomeric masks. Think gas masks. These have two obvious advantages: they're not disposable, so you might save money in the longer run, and they can take cartridges that filter at better than 95%. If you are immunocompromised, this is something you want to seriously consider. You may want to consider it even if you're not immunocompromised.
You may have heard of something called fit testing. It's pretty much what it sounds like, it's testing to make sure that one's respirator actually is working as well as it is supposed to. The problem with respirators is frankly human faces: they are squishy, have moving parts, and are not made to narrow tolerances. So any given respirator may work more or less well for any given human face, e.g. yours. The only way to know is to try it and to check. That's what fit testing is for.
One can get all formal and rigorous about fit testing, and buy special equipment to do it. But the basic premise is really quite simple: if you can smell something through your mask, it's not filtering at 95% or better. Fragrances and smoke are good proxies for scentless contaminants like aerosolized saliva from out of other people's lungs. What formal fit testing consists of is checking to see if you can smell things through your mask. In the absence of the special equipment necessary to do that, you can just sniff.

And remember smoke itself is one of the other things masks that filter better than 95% of fine particulate matter are good for, and something all of us should be prepared for more encounters with. There's multiple reasons in this day and age to have a supply of quality PPE.

Canonical link: https://siderea.dreamwidth.org/1833954.html

The internet is full of people enraged by the US CDC's reduction – and all but elimination – of isolation guidelines for COVID, pointing out that the CDC's new guidelines seem to be more about what is good for "the economy" – which is to say, good for business interests – than what is good for the health of the people.

I don't think anyone's wrong to be enraged. Nothing that I am about to say is meant to make anyone feel better about the CDC's decision. I do not explain this as any kind of excuse.

There is a sense in which the CDC's decision is right. Not good, mind you, but correct: it brings their guidance back into alignment with our larger society's beliefs about the value of human life and health.

( Ours has never been a society that has particularly highly valued the health and well-being of the people of it... Read more [2,460 words] )

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There's been some real question whether getting too many Covid vaccines might have some deleterious effect on the immune system, but there's not really an ethical way to study that in humans.

To our rescue, a scoundrel in Germany who sold the service of getting Covid shots on behalf of antivaxxers so they wouldn't have to, and in the process, got 217 Covid shots in a 29 month period.

There was a study of him just published in the Lancet. tl;dr: he's fine.

2024 Mar 4: the Lancet (high-prestige, peer reviewed scientific journal): "Adaptive immune responses are larger and functionally preserved in a hypervaccinated individual" by Katharina Kocher, Carolin Moosmann, et al.:

Prime-boost vaccinations can enhance immune responses, whereas chronic antigen exposure can cause immune tolerance. In humans, the benefits, limitations, and risks of repetitive vaccination remain poorly understood.

Here, we report on a 62-year-old male hypervaccinated individual from Magdeburg, Germany (HIM), who deliberately and for private reasons received 217 vaccinations against SARS-CoV-2 within a period of 29 months (figure A; appendix 1 tab 1). HIM's hypervaccination occurred outside of a clinical study context and against national vaccination recommendations. Evidence for 130 vaccinations in a 9 month period was collected by the public prosecutor of Magdeburg, Germany, who opened an investigation of this case with the allegation of fraud, but criminal charges were not filed. 108 vaccinations are individually recorded and partly overlap with the total of 130 prosecutor-confirmed vaccinations (appendix 2 p 12). To investigate the immunological consequences of hypervaccination in this unique situation, we submitted an analysis proposal to HIM via the public prosecutor. HIM then actively and voluntarily consented to provide medical information and donate blood and saliva.

This procedure was approved by the local Ethics Committee of the University Hospital of Erlangen, Germany. Throughout the entire hypervaccination schedule HIM did not report any vaccination-related side effects. From November 2019, to October 2023, 62 routine clinical chemistry parameters showed no abnormalities attributable to hypervaccination (appendix 1 tab 2). Furthermore, HIM had no signs of a past SARS-CoV-2 infection, as indicated by repeatedly negative SARS-CoV-2 antigen tests, PCRs and nucleocapsid serology (figure A; appendix 1 tab 1).

Also of note:

In saliva, HIM had detectable anti-spike IgG, unlike the control participants (appendix 2 p 12 F).

And in conclusion:

In summary, our case report shows that SARS-CoV-2 hypervaccination did not lead to adverse events and increased the quantity of spike-specific antibodies and T cells without having a strong positive or negative effect on the intrinsic quality of adaptive immune responses. While we found no signs of SARS-CoV-2 breakthrough infections in HIM to date, it cannot be clarified whether this is causally related to the hypervaccination regimen. Importantly, we do not endorse hypervaccination as a strategy to enhance adaptive immunity.