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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

cacatman

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Throat Swab PCRs
A U.S.-based occupational case study of 30 people found that a saliva PCR test was able to identify an omicron infection earlier than a nasal antigen test. In that time in between, they say some of the subjects were infectious before testing positive with a nasal antigen.
The preprint put out by researchers in Cape Town, South Africa found that when they used PCR nasal swabs, 100% of delta infections and 86% of omicron infections were identified. When they used PCR oral saliva swabs, 71% of delta infections and 100% of omicron infections were identified.


 

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cacatman

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Treatment for Non-Hospitalised Patients
Sotrovimab, nirmatrelvir-Ritonavir, Remdesivir (for pregnancy), molnupiravir are useful

 

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Danger of Early Research in Pandemic
A Canadian study that vastly underestimated the protection COVID-19 vaccines provide against the Omicron variant is being revised — but not before it spread widely on social media by anti-vaxxers, academics and even the creators of the Russian Sputnik V vaccine.

The Ontario preprint study, which has not yet been peer reviewed, suggested that any three doses of mRNA COVID-19 vaccines were just 37 per cent effective against Omicron infection, while two doses actually showed negative protection.

The preprint has been shared on Twitter more than 15,000 times in the two weeks since it's been published, according to Altmetric, a company that tracks where published research is posted online. That's in the top five per cent of all research it's ever tracked.
 

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Hair Loss Long Term Symptoms
1. Individuals may find their hair falling out in large clumps months after recovering from COVID-19.
2. Temporary hair loss can be normal after fever or illness, according to the AADA. Fever is a possible symptom of COVID-19. Some people see noticeable hair shedding two to three months after fever or illness.
3. This hair loss is a hair shedding process known as telogen effluvium. It occurs when more hairs than normal enter the shedding phase of the growth cycle at the same time. Fever or illness can push more hairs into this phase.
4. The shedding can last for six to nine months. For most, hair then stops shedding and returns to normal.
5. Among the millions of Americans who have had COVID-19, hair loss has been a common consequence for patients whose symptoms resolve relatively quickly and for those who develop long COVID, Esther Freeman, MD, PhD, dermatologist and epidemiologist at Boston-based Harvard Medical School and principal investigator for the COVID-19 Dermatology Registry, told The Atlantic. Researchers don't yet know exactly how prevalent hair loss is among COVID-19 patients. A study published by the Lancet in January 2021 found that 22 percent of virus patients at a China hospital reported hair loss months later.
6. Hair loss can also be caused by excessive stress or trauma, which millions of Americans had suffered amid the pandemic. Intense physical or emotional stress can push as much as 70 percent of your hair into the telogen phase, according to The Atlantic.


A total of 1136 patients have been reported to have de-novo hair loss following COVID-19. Notably, 958 patients experienced telogen effluvium (TE) (female/male ratio = 3,86:1), two female patients experienced anagen effluvium and 176 people had alopecia areata (female/male ratio of 19:3). Ten patients were reported to have ungual changes following the infection with the novel coronavirus: the individuals affected were 6 women and 4 men. COVID-19 can be associated to hair and ungual manifestations.
 

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No Raised Risk of COVID-19 with Asthma


All asthma phenotypes were associated with significantly increased risk for general practitioner-diagnosed COVID-19.
Risk for COVID-19 hospitalization was significantly associated with the following:

  • asthma with inhaled corticosteroid (ICS) use (adjusted HR = 1.27; 95% CI, 1.01-1.61);
  • intermittent ICS plus add-on asthma medication use (aHR = 2; 95% CI, 1.43-2.79);
  • regular ICS plus add-on asthma medication use (aHR = 1.63; 95% CI, 1.37-1.94); and
  • asthma with frequent exacerbations (aHR = 1.82; 95% CI, 1.34-2.47).
These phenotypes were also significantly associated with hospitalizations for influenza and pneumonia, according to the researchers.
 

cacatman

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Vaccination and Children
Here's the best article I've read to date that outlines the pros/cons in what I consider a balanced way.

Granted, it was actually an article written to address misinformation from a wildly popular internet doctor ZDoggMD (who I also watch), but there's still a ton of useful links and facts re: COVID and children.

I copied the entire letter just in case it get's taken down at some stage. Very very good info.


Dear. ZDoggMD,

During a recent social media kerfuffle, you referred to yourself as “arguably the biggest advocate for vaccination on social media“. Indeed, you’ve hosted credible individuals like Dr. Paul Offit who spoke eloquently on the dangers COVID-19 poses to children and how the vaccine can prevent these harms. You posted a video of your own daughter getting vaccinated. I’m glad she’s safe, and this video certainly helped others decide to vaccinate their children. I thought this video you made on vaccinating kids was fair, and your discussion of vaccine myths was mostly reasonable. You say that you’ve helped convince many skeptical people to get vaccinated. I am sure this is true. This is amazing and we all benefit from these successes.

You also stated that “we ultimately want the same thing: the best health for the most people”. With this in mind, I compiled several facts about the vaccine, virus, and children that every doctor who advocates for vaccines should share as widely as possible. Not all of the facts about the virus are catastrophic and not all facts about the vaccine are positive. I think we agree that nuance and balance are important. In compiling this information, I don’t mean to imply that you haven’t shared any of it. You absolutely have shared a lot of it, particularly information about how the virus has harmed children.

Facts about children and COVID-19​

  • Almost all kids will be fine: The vast majority of kids with COVID-19 will be fine. A child who contracts COVID-19 has an extremely low risk of dying. That the virus mostly spares children from severe disease is the only good thing I can say about it.
  • The virus can kill some children: While it’s true that a child who contracts COVID-19 has an extremely low risk of dying, millions of children have contracted the virus and rare harms have added up. According to the CDC’s COVID-19 data tracker, the virus has killed 1,131 children so far, most of them in the past 6 months. About 1 in 65,000 children in America have already died of COVID-19, and 2-3 children die of COVID-19 every day. This includes teenagers who were eligible to be vaccinated and some children without underlying conditions. The most common underlying conditions in children who die from COVID-19 are obesity and asthma. These children were robbed of many decades of life.
  • COVID-19 has hospitalized many children: Though death is the worst outcome from COVID-19, it is not the only bad one. Accurate numbers are hard to come by, but around 100,000 children have been hospitalized due to COVID-19. This means that about 1 in 740 American children have been hospitalized with COVID-19. More children are being infected than ever before, and therefore more children are being hospitalized now than ever before. Currently, 904 children are being hospitalized every day with COVID-19, an enormous number even accounting for incidental infections. During New York City’s recent omicron surge, 54% of hospitalized children had no comorbidities, and 70% were symptomatic. Just 2.1% of admissions were incidental infections from trauma. Though most children stay just a few days, with past variants, up to 33% of them need ICU-level care and 6-10%need intubation. Very rarely, children have needed amputations or lung transplants. Fortunately, frontline pediatricians say that the omicron variant is milder than the delta variant, however the greatly increased number of infections means that rare harms are still accumulating. These rare but severe harms are why it is misleading to simply compare the rates of myocarditis between the virus and the vaccine. The virus can do a lot more than cause myocarditis.
  • COVID-19-related myocarditis can be severe: Additionally, multisystem inflammatory syndrome in children (MIS-C) can cause severe myocarditis, and there have been at least 6,431 cases in the US, possibly many more. 55 children have died from this. Studies have reported coronary artery aneurysms and acute heart failure in children with MIS-C. Other common cardiac complications of myocarditis due to MIS-C include “shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation”. Cardiac arrhythmias have led “to hemodynamic collapse and need for ECMO support” in some children. This doesn’t happen with the vaccine.
  • We have a lot to learn about long COVID: We don’t know everything about long-COVID in children. However, some children are sick for a long time, and we have to be humble about the potential long-term complications from a new virus.
  • Kids have lost their parents: According to reports, “the number of kids who have lost a parent or in-home caretaker is an estimated 167,000.”
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Facts about the vaccine: Efficacy​

There is robust real-world evidence that the vaccine can keep adolescents healthy, alive, and out of the hospital. All pro-vaccine doctors should share this information as often as possible.

  • Study 1: In hospitalized adolescents, “179 COVID-19 case-patients, six (3%) were vaccinated and 173 (97%) were unvaccinated. Overall, 77 (43%) case-patients were admitted to an intensive care unit, and 29 (16%) critically ill case-patients received life support during hospitalization, including invasive mechanical ventilation, vasoactive infusions, or extracorporeal membrane oxygenation; two of these 29 critically ill patients (7%) died. All 77 case-patients admitted to the intensive care unit, all 29 critically ill case-patients, and both deaths occurred among unvaccinated case-patients.”
  • Study 2: “Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents.”
  • Study 3: “Among 272 vaccine-eligible (aged 12–17 years) patients hospitalized for COVID-19, one was fully vaccinated.”
  • Study 4: Vaccine effectiveness “…was 92% against SARS-CoV-2 infections irrespective of symptom status.”
  • Study 5: “97/102 children with MIS-C were unvaccinated. None of the 5 vaccinated MIS-C patients required respiratory or cardiovascular life support (invasive mechanical ventilation, vasoactive infusions, or ECMO) compared to 38/97 unvaccinated MIS-C patients.”
  • Study 6: “In 33 adolescents with MIS-C eligible for vaccination…0 had been fully vaccinated, 7 had received 1 dose.”
  • Study 7: “Of the case patients, 180 (40%) were admitted to the ICU, and 127 (29%) required life support; only 2 patients in the ICU had been fully vaccinated. The overall effectiveness of the BNT162b2 vaccine against hospitalization for Covid-19 was 94%. The effectiveness was 98% against ICU admission and 98% against Covid-19 resulting in the receipt of life support. All 7 deaths occurred in patients who were unvaccinated.”
An important caveat is that the vaccine may be less effective against omicron and future variants. However, the majority of children ages 5 and older who were admitted to the hospital during NYC’s omicron surge were unvaccinated.

Facts about the vaccine: Safety​

  • Vaccine myocarditis frequency: The rate of vaccine myocarditis varies widely from one study to another, but it is primarily a concern for adolescent boys after their second vaccine dose. One study from Hong Kong found a rate of 1 in 2,700 for male adolescents after their second shot, while one study from Denmark found no increased rate at all in young men from the Pfizer vaccine. Most studies find a rate in between these two extremes. This article summarizes the available studies well and overall, a rate of about 1 in 7,000 adolescent boys after their second shot seems a reasonable estimate to me. The Pfizer vaccine, which is what children receive, is safer than the Moderna vaccine, and a long interval between the two doses lowers the risk. The risk for younger children and from boosters is much lower than this. As very few adolescents are getting their second shot currently, I am confident that the number of times each of us has discussed this topic exceeds the number of children currently hospitalized with it.
  • Vaccine myocarditis severity: While its exact rate isn’t clear, an extremely consistent finding is that vaccine myocarditis is much less severe than viral myocarditis. This is often overlooked by those who merely compare the rates of the two conditions and neglect that the virus can cause much more than myocarditis. Short-term outcomes in vaccine-myocarditis from multiple case series and government agencies in different countries have been consistently favorable. All studies on this topic report that “most vaccine-associated myocarditis events have been mild and self-limiting” and “most cases of suspected COVID-19 vaccine-related myocarditis in people younger than 21 are mild and resolve quickly“. Most individuals are hospitalized, but almost all leave in just a few days after receiving simple treatments. In the entire world, no child has needed to be intubated as far as I know and none have died. Most, though not all, are symptom-free after follow-up. Experts in the subject universally agree that “we do not have any conceivable danger signal that would outweigh the benefit of vaccination“. As one person wryly put it, “Every hospital has a covid ward. No hospital has a vaccine injury ward.” Nonetheless, long-term monitoring for potential cardiac scarring is needed, and we both agree the condition should not be minimized.
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I would not consider you “arguably the biggest advocate for vaccination on social media” when it comes to children​

Having acknowledged the many positive contributions you’ve made to children this pandemic, let me explain why I would not consider you “arguably the biggest advocate for vaccination on social media” when it comes to children. In fact, your podcasts have spread a great deal of misinformation about COVID-19 and children. Meanwhile, vital information remains unmentioned.

For example, I apologize if missed it (you have a lot of material), but I’ve not heard you mention any of the studies showing vaccines protect adolescents. Two of these studies preceded videos (here and here) you made on vaccinating children, but you did not mention them. Why not? Your audience will certainly know the vaccine can cause myocarditis. This is entirely appropriate of course, and I’ve written several detailed, nuanced articles on this topic where I argued that “vaccine-myocarditis should not be trivialized”. However, your audience will not know the vaccine is extremely effective at preventing rare, but catastrophic outcomes in adolescents. Don’t you think parents should know this information?

I’d really love to be proven wrong, but it’s hard to imagine there will ever be a segment on your podcast with Dr. Vinay Prasad called “7 Real-World Studies Showing the Vaccine Works in Adolescents”. This is astonishing when you think about it. Shouldn’t the biggest advocate for vaccination on social media be willing to share accurate information about the vaccine for children at every opportunity? Shouldn’t the biggest advocate for vaccination on social media have shared these important results multiple times already? I suspect if these studies showed the vaccine failed to protect adolescents, you and Dr. Prasad would have discussed them as often as vaccine-myocarditis, which is to say all the time. This approach doesn’t seem “nuanced” or “alt-middle” to me.

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Additionally, you’ve made problematic statements about children and COVID-19. In a podcast from 4/2021, you questioned whether school closings were justified by saying,

Even though this thing has killed less than you know, or, or about as many as flu would kill in a normal year in kids, I say hardly any. I mean, again, it’s not, that’s not that’s not compassionate to the people who’ve lost children. Right?
I’ve never argued for closing schools, but I recognize this is an extremely misleading comparison and inappropriate way for “the biggest advocate for vaccination on social media to speak” about dead children. When you said this, over 300 children had died of COVID-19, a number that would have been significantly higher without mitigation measures. Anti-vaxxers would agree with you, but I don’t think 300 dead children is “hardly any”. We don’t talk about children who die in school shootings this way. Of course, we routinely vaccinate children for diseases that killed fewer children than this.

It’s true that at that point COVID-19 had killed about the same number of children as a bad flu season, a disease for which we vaccinate children. However, it makes no sense to compare the death tolls of the two viruses in this way. Mitigation measures that dented COVID-19 obliterated the flu. During the same time period when COVID-19 killed 300 children, 1 child died of the flu. Though your guests often claim otherwise, anyone who can count knows that COVID-19 is much deadlier for children than the flu. However, since they heard misinformation, your listeners will be misinformed. This is a pattern, as I will discuss.

You’ve repeatedly platformed guests who spread blatantly false information about covid-19 and children​

Beyond this, you’ve repeatedly platformed guests who spread blatantly false information about COVID-19 and children, always minimizing the dangers of the virus and alwaysoverstating harms of the vaccine. I’m not talking about doctors who reasonably have different opinions about grey areas, such as the need for boosters in young people or vaccine mandates.

Rather, many of your guests simply get the most basic facts wrong over and over again or selectively omit information to advance a grossly misleading narrative. It’s been horrifying but fascinating to witness in real time how myths about COVID-19 and children get created in the closed media echo chamber of contrarian doctors and then widely disseminated on Fox News and The Wall Street Journal, influencing policy for large parts of the country with tragic consequences. These myths get cleverly branded as “nuance”, and those who seek to provide accurate information are accused of “groupthink“.

For example, Dr. Marty Makary claimed on your podcast that there’s “never been a documented case of an entirely healthy kid dying of COVID“. He referenced his “analysis with FAIR Health” to claim no healthy child had died of COVID-19. In his analysis, 3 children, all with underlying conditions, died of COVID-19. Based on these 3 children, Dr. Markary informed your listeners that “there was not a single healthy kid who’d died”. He neglected to mention that his “analysis” reported on fewer than 1% of the pediatric deaths at that time.

It’s clearly extremely rare for a healthy child to die of COVID-19, but several had by the time Dr. Makary made his false claim (here, here, here, here, here, here, here, here). A five-second Google search was all it took to learn he was spreading misinformation to your audience. Moreover, in a study of 121 decedents under 21 years, about 25% were healthy, information that was available when Dr. Markary made his false claim. Though you and I both know that the most common underlying conditions in children who die of COVID-19 are obesity and asthma, Dr. Makary wants people to believe only children with devastating conditions such as leukemia die from COVID-19. Who knew your prior discussion with him about “COVID-19 Fake News” was actually a preview of coming attractions?

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Additionally, in a podcast from 2/2021 called “Should We Vaccinate Kids for COVID“, Dr. Prasad spread misinformation, saying “it is generally not controversial to argue that SARS-CoV-2 in kids is roughly, roughly the same as influenza, maybe even less severe than influenza, seasonal influenza in kids”. At least 227 children had died of COVID-19 when he said this, while 1 child died of the flu during this time. In the past two years, COVID-19 killed over 1,100 children while the flu killed 4 children. In the same time period when COVID-19 hospitalized over 8,300 children ages 5-11, the flu hospitalized just 9 children this age. So no, COVID-19 is not “maybe even less severe than influenza” for children, but your listeners will think that it is.

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Dr. Prasad further said that the risk of a child dying of COVID was “about one in a million” and “let’s say to save that one life, you gotta inoculate a million kids with vaccination to save one life”. As at least 227 children had died of COVID-19 when he said this, a death rate of 1 in a million would necessitate 227 million pediatric infections. In reality, there are just 74 million children in the USA. Unless 300% of American children had contracted COVID-19 by this time last year, this too is false.

Your guests have labored to create fear, uncertainly, and doubt about vaccinating children​

In addition to downplaying the severity of COVID-19 for children, many of your guests have labored to create fear, uncertainly, and doubt about vaccinating children. Unsurprisingly, Dr, Makary spread misinformation about the vaccine, tweeting on 11/2021 the false information that no healthy child ages 5-11 died of COVID-19 and that he expected “15 would die from the vax 2nd dose“. This was absurd anti-vaccine nonsense, but a lot of people trust him. Subsequent data showed the vaccine has proven extremely safe in this age group, with 11 verified myocarditis cases after 8.7 million vaccine doses. 7 of these children have recovered and 4 were “recovering.” No children died. Have you shared this important information yet?

As you know, Dr. Prasad opposed the Emergency Use Authorization (EUA) for children. He claimed in May 2021 that an EUA for children was not needed since “after all adults are vaccinated” COVID-19 would no longer threaten children. As I pointed out at the time, Dr. Prasad wildly overestimated vaccine uptake in adults and irresponsibly neglected the possibility of new variants. I have previously criticized his writing on COVID-19 and children for its gross omissions of key facts and lack of nuance. Dr. Prasad even suggested on your podcast “Should We Vaccinated Kids for COVID“, that fevers after vaccination were legitimate points against the pediatric EUA. You largely agreed saying, “Imagine you do this to hundreds of thousands of children. Just by sheer happenstance, you’re gonna have a certain number of complications, just in terms of febrile complications”.

Fortunately regulators with skin in the game used accurate numbers, didn’t panic about post-vaccination fevers, and wisely issued an EUA for children. Had they taken Dr. Prasad’s advice, no healthy child under the age of 16 would be vaccinated today. Your daughter, my son, and their entire classroom would all be unvaccinated. Could schools stay open then? Of course not. They are having a hard time already.

Another of your guests, Dr. Jay Bhattacharya, explicitly opposes vaccinating children against COVID-19. He’s been very clear that “I don’t think if there’s any good reason to vaccinate kids that young did for kids, they face a vanishingly small risk from COVID itself, near zero from mortality from COVID…I think that it is a mistake to think about this, as good for kids. It’s not good for kids.” How is this at all different from something that Andrew Wakefield might say about vaccinating children? It’s not, of course.

It gets worse. In an article titled, “The Ill-Advised Push to Vaccinate the Young“, he wrote,

The idea that everyone must be vaccinated against COVID-19 is as misguided as the anti-vax idea that no one should. The former is more dangerous for public health.
In the middle of the worst pandemic in 100 years, he feels it is “more dangerous for public health” to vaccinate everyone than to vaccinate no one. This is astonishing. He actively wants children infected saying “those who are at minimal risk of death” should “live their lives normally to build up immunity to the virus through natural infection”. It’s no wonder congressmen and judges ridicule him and repeatedly deem his testimony unreliable.

In contrast, you handed him a microphone multiple times and portrayed him a sympathetic victim, saying he had been “censored“. Though he wants children to get the virus not the vaccine, you lavished him with praise, telling him “You’re fearless, you’re compassionate, you’re rational”. That’s how I feel about frontline pediatricians taking care of a sick children in the ICU now or begging misinformed parents to vaccinate their child in the clinic. Maybe it’s becoming clear why I don’t think of you as “the biggest advocate for vaccination on social media” when it comes to children.

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Predictably, Dr. Bhattacharya used the platform you gave him to spread misinformation. He claimed that “early in the epidemic and we’re killing patients with ventilators”. Who is this “we” he is talking about I wonder? He’s never come close to treating a COVID-19 patient, or any patient for that matter. Despite his spectator status, he’s happy to spread baseless conspiracy theories about doctors who actually have real-world responsibility for treating COVID-19. As I discussed previously, not only is there no evidence that doctors killed patients through aggressive intubations, it directly contradicts all the available evidence. Your listeners won’t know that. The notion the people died from ventilators not COVID-19 was just an internet rumor, though a dangerous one given the violence against healthcare workers today.

Moreover, even though 300 children had died of COVID-19 and tens of thousands had been hospitalized when you interviewed Dr. Bhattacharya in April 2021, he merely said children’s “risk of COVID is quite small”. There’s a reason so few of your guests are willing to enumerate how COVID-19 has harmed children. They aren’t stupid. They know normal people won’t think hundreds of dead children and tens of thousands of hospitalized children as something to brush off.

So instead of simply stating the facts, they dance around them by saying “the risk of suicide in non-COVID times is typically 10 times higher“. What does this have to do with whether children should be vaccinated against COVID-19? Absolutely nothing. I discussed previously why these factoids are useless distractions designed to pacify people about the danger COVID-19 poses to children. It’s true that COVID-19 has killed 10 times the number of children that die in bike accidents each year. But this is not an argument in favor of vaccinating children against COVID-19 is it?

Unsurprisingly, Dr. Bhattacharya also warned against vaccinating children on your podcast, saying “there’s a chance they’re gonna miss two days of school because they have headache, fever and muscle aches from the vaccine”. You basically agreed saying “you’re assuming all the risks with none of the benefits, if the risk is minuscule.” It apparently didn’t occur to either of you that children could get vaccinated on a Friday or that they might miss school (or worse) because they contracted COVID-19.

You and your guests have repeatedly declared the pandemic over​

Additionally, you and your guests have repeatedly declared the pandemic over. In May 2021, you discussed Dr. Makary’s infamous prediction of herd immunity by April 2021 by telling him:

You were pretty much right about everything, ’cause cases have plummeted, natural immunity does contribute, and probably the left was like, “Oh, who is this fascist going on Fox News, “saying that this thing’s over?”
It turns out “the left” was right about Dr. Makary’s ridiculous prediction, and he’s been pretty much wrong about many things. Would the biggest advocate for vaccination on social media mock the virus by saying “variants, shmariants“? You did that several times. Who can forget you laughing about “variants, shmariants” along with Dr. Monica Gandhi in a podcast called “The End of the Pandemic” from 2/2021? You warned then not about the virus, but about a “contagion of panic and fear”.

You mocked a young couple you saw on a plane for “wearing two masks, a full goggles, like they’re flying a plane”. You said this cautious behavior was a “pet peeve” of yours and that young, healthy people “need to be out doing their thing. Instead, they’re hiding behind two face shields”. These passengers bothered you so much, you mocked them on a subsequent podcast, saying they were “wearing like hazmat suits on a plane…What are you doing? I mean, it looks cool, but not really.” You spoke passionately against “shaming parents for not getting their kids vaccinated”. I agree. But you’re clearly OK shaming certain people, namely young people who are trying hard to avoid the virus. Do you feel they are doing something wrong?

Dr. Prasad seems to feel that way. At the literal peak of death for the entire pandemic, during the winter wave of 2021, on a day when 3,322 Americans died, he sarcastically tweeted,

I want to write a children’s book about a bear who didn’t want to leave home till it was perfectly safe. He never left and life passed him by.
Hundreds of thousands of Americans have died since he sent that mocking tweet. I guess you could say life passed them by.

After the delta variant ravaged India, you said in May 2021 that “everybody’s wetting their pants about it” and that the variant “isn’t driving a lot of that poor outcome”. You continued, “Hope is accurate. It’s not like we’re slinging a lie”. Though the death rate remained low, the delta variant would go on to kill hundreds of American children, including unvaccinated teens who were eligible to be vaccinated. Hope, sadly, is not always accurate. The virus has proven it doesn’t listen to contrarian doctors who claim we’ve reached herd immunity month after month and that we need to stop “living in fear“.

The idea that anyone who tries to avoid the virus is “living in fear” is a common theme for contrarian doctors. I’ll confess, I’ve never understood it. Fear can be an awful feeling. I had nightmares right before COVID-19 hit NYC, and I had to take medication to sleep for the first time ever. I was spared the worst of it, but in nearby hospitals they had to use forkliftsto move the dead bodies. I hope the people who had to do that are doing OK. Some healthcare workers, especially nurses who’ve travelled from one hotspot to the next, have seen thousands of people die this pandemic. One of them said, “War doesn’t even compare to this“. Maybe you should have one of them as a guest. Someone who has actually treated a lot of COVID-19 patients would certainly bring a new perspective.

No one likes being afraid of course, but few of us would be alive today without the capacity to feel fear. We neurologists know that people who lose their amygdalae don’t function too well in the world. Though fear it unpleasant, it is useful and necessary. There have been legitimate reasons for people – even young, healthy ones – to be afraid this pandemic. Getting a “mild” case of COVID-19 can be a really miserable experience.

Moreover, as my friend Loretta said, the best way to reduce fear is to reduce danger. Maybe if more people feared the virus, the headlines wouldn’t read “U.S. sets fresh records for Covid hospitalizations and cases with 1.5 million new infections“. Maybe the pandemic would be closer to over. Soon, 1 out of every 300 Americans will have died from the virus.

You don’t see it this way it seems. You and Dr. Gandhi even made a podcast in 10/2020 titled “How to Stop Living in Fear of COVID” where you said “the fear that’s driving this pandemic has been heartbreaking to see”. I wonder how many of your listeners decided to stop fearing the virus. I wonder what happened to them and their families. (Notably, Dr. Monica Gandhi wrote an excellent essay on vaccinating children.)

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Your guests have credibility partly because they are your guests, and you once had a well-deserved reputation as a vaccine-advocate who didn’t tolerate anti-vaccine nonsense​

You are not responsible for what your guests say, of course. However, you are responsible for who is on your show and how your respond to them. As few of your guests work with sick children, they are shielded from the consequences of their words, as are you. They’ll never work in an overwhelmed pediatric hospital, and, except for Dr. Offit, doctors who actually work with sick children are unlikely to be on your program to encourage pediatric vaccination. Why is that?

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It seems odd to me that you haven’t had multiple pediatricians on to speak about what they are seeing in the hospital right now. I am sure there are plenty of wonderful pediatricians who would be happy to be on your show. As an adult neurologist/psychiatrist, I know I’d learn a ton from listening to you talk to them. Like nearly all of your guests, I have no idea what it is actually like to care for a child in the ICU. I bet your listeners know even less.

Since you and your guests advocate for adult vaccination, I know you’ll perceive this letter as “friendly fire”. I sent you a draft of this letter to make sure there were no glaring inaccuracies, and you made it clear that I should instead focus on the “actual anti-vaxxers.” I hope it’s clear by now that countering anti-vaccine misinformation is exactlywhy I am writing this letter. If Dr. Bhattacharya is not an “actual anti-vaxxer” when it comes to children and COVID-19, then who is?

If you doubt me, just listen to the “actual anti-vaxxers”. They often see your guests as allies. One journalist accurately described Dr. Makary as the “darling of the anti-vaxxers“. Anti-vaccine super-crank RFK Jr. has amplified Dr. Prasad and Dr. Makary. He can recognize doctors who he feels validate his message. Anti-vaxxers eagerly support your guests on social media, and that matters. In contrast, doctors who seek to provide accurate information are blocked en masse. It seems your guests don’t really value discussion and debate. I guess they just need a safe space.

The fact that your guests are not “actually anti-vaxxers” makes them appear more credible when they discourage vaccinating children. Their misinformation is much more pernicious than obviously ridiculous anti-vaxxer balderdash. Since they are not saying COVID-19 is a 5G hoax by Bill Gates to microchip us all, their misinformation is much harder for the average person to recognize. But telling parents more children died from the flu last yearthan COVID-19 or that the vaccine will likely kill as many children as the virus is absolutely misinformation. Most people can easily spot anti-vaccine quacks. In contrast, your guests have credibility partly because they are your guests, and you once had a well-deserved reputation as a vaccine-advocate who didn’t tolerate anti-vaccine nonsense.

Now, instead of refuting this nonsense, you’ve legitimized and amplified those who spread it. Your listeners think they are getting “nuance,” and that only you and your “fearless” guests will level with them about the vaccine’s imperfections. In reality, much of the time your listeners heard incomplete information and misinformation. Reasonable people can differ about various policies, such as mandates for children. But such debate requires that people come to the table equipped with the same facts. Your guests have made that an impossibility.

Furthermore, I believe your guests, with their impressive credentials, supreme confidence, and enormous media reach, bear as much responsibility for truly abysmal pediatricCOVID-19 vaccination rates as the “actual anti-vaxxers”. It’s no wonder just 18% of children ages 5-11 are fully vaccinated against COVID-19. Their misinformed parents think COVID-19 “less severe than influenza” or that healthy children have zero risk from the virus. The only thing they know about the vaccine is that it can cause myocarditis.

COVID-19 will fade into the background one day. However, sick children will be your guests’ lasting legacy. And since sick children (and sick teachers) lead to closed schools and disrupted learning, this too will be their legacy. Your guests often utter the words “schools must be open“. This empty mantra is a form of virtue signalling for them. However, they’ve opposed every method of limiting spread of the virus in schools, and the results have been entirely predictable, both for children and their schools. Essentially every article I’ve written here has advocated for vaccinating children. I wanted to do more than say “schools must be open”. I actually wanted schools to be open and safe.

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The biggest advocate for vaccination on social media should strive to share accurate, thorough information about covid-19, vaccines, and children​

You’ve lamented “tribalism” before, and I am sure you know that sharing complete, accurate information about the virus and the vaccine will put you at odds with most of your guests. They don’t want your audience to know that 1,131 children (is that hardly any?) have died in the USA and that nearly 100,000 more have been hospitalized, some intubated in the ICU. They don’t want your audience to know anything about the vaccines, except that it can cause myocarditis, that it can cause myocarditis, and that it can cause myocarditis.

You’ve previously not shown much of an openness to criticism or other opinions. You mocked a doctor whose prediction of mass death turned out to be spot on, calling him a “prophet of doom and fear”. You seem aghast that your history of pro-vaccine activism does not immunize you against criticism today. You reflexively portray yourself as a victim, claiming you are being “cancelled” or “banned” when anyone disagrees with you. You mock your critics by saying “the Gorksi tribe showing up doing the usual pronoun dance at me“. You’re convinced that basically everyone besides you is “so ineffective, because they’re more keen to score social media points by taking down one of their own that to actually get the job done of convincing people to vaccinate“.

I suspect either you or your fans will dismiss this entire article as a “take down”. I promise I don’t intend it that way. No one likes being criticized. I sure don’t. Our natural reaction is to view our critics as ill-informed or malevolent. However only they can show us our errors and make us better.

You are a gifted speaker with a large audience, drastically larger than mine will ever be. Your fans can even buy merch at the ZDoggMD fan shop or join the “ZPAC Supporter Tribe“. There’s no JoHo apparel for sale, yet. You’ve shared a lot of solid, valuable information on vaccines and children. You are conscious to let people know that your child was vaccinated. I’m 100% positive you’ve convinced many parents to vaccinate their children against COVID-19. I hope my articles have convinced a few.

I’ve written critical articles about many other doctors here, but I’ve never written to them. They’ve never shown they care a lick about being thorough and accurate. I think you do. So, I hope you’ll agree with me that the biggest advocate for vaccination on social media should strive to share accurate, thorough information about COVID-19, vaccines, and children. The stakes are high, and the consequences of misinformation are real. Hector Ramirez, whose unvaccinated 15-year-old-daughter died of COVID-19 this summer, said:

I don’t want any other parent to go through what I did — seeing my daughter perfectly healthy one day, then following a week and a half, she’s gone.
According to news reports, “He didn’t get the shot for his daughter, and he regrets it”. Her death was preventable with a simple vaccine. Hundreds of children will die similar deaths this year. We should try to change that.

I say this all as someone who doesn’t even have pronouns in my Twitter bio.

Author​


  • Jonathan Howard
    Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.
 

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Association of Major Depressive Symptoms With Endorsement of COVID-19 Vaccine Misinformation Among US Adults


Investigators measured depressive symptoms from surveyed adults via the Patient Health Questionnaire 9-item (PHQ-9), and conducted population-reweighted multiple logistic regression analysis to examine the link between moderate to severe depressive symptoms and endorsement of ≥1 item of vaccine information. They further adjusted for sociodemographic features in determining associations.

Of the 15,464 survey respondents, 63.6% were women and mean respondent age was 47.9 years. Respondents were predominately White (76.7%), followed by Black (9.7%), Hispanic (6.6%), then Asian (4.7%).

Similar to previous national assessments during COVID-19, one-quarter (26.9%) of respondents identified moderate or greater depressive symptoms on the PHQ-9. About one-fifth (19.2%) endorsed at least 1 vaccine-related statement of misinformation on the survey; such statements included:
  • “The COVID-19 vaccines will alter people’s DNA”
  • “The COVID-19 vaccines contain microchips that could track people”
  • “The COVID-19 vaccines contain the lung tissue of aborted fetuses”
  • “The COVID-19 vaccines can cause infertility, making it more difficult to get pregnant”
Respondents with presence of depressive symptoms were more than twice likely to endorse COVID-19 vaccine misinformation (odds ratio [OR], 2.33; 95% CI, 2.09 – 2.61). Respondents endorsing ≥1 misinformation item were significantly less likely to be vaccinated (OR, 0.40; 95% CI, 0.36 – 0.45) and significantly more likely to report resistance to vaccination (OR, 2.54; 95% CI, 2.21 – 2.91).

Among the 2800-plus respondents to answer a subsequent survey in July, the presence of depression in the first survey from May was linked to a greater likelihood of endorsing even more information in July compared with the prior survey (OR, 1.98; 95% CI, 1.42 – 2.75).

Each of these correlates remained statistically significant when investigators adjusted for respondent sociodemographic features, as well as self-reported ideology and political party information. Though the findings do not provide conclusion on causation, the assessment of second-wave survey respondents suggested to investigators that misinformation was unlikely to cause depression.

“In general, negative biases are apparent in information processing even in the absence of depression,” they wrote. “Individuals with major depressive symptoms often exhibit a more pronounced negativity bias, a form of attentional bias in which thoughts with negative valence receive greater focus.”

 

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Vaccines Provide Protection Against Severe Illness

10.6 million residents from NC provided info for the study.

Analyzing these data, the researchers found that all three vaccines, especially the Pfizer and Moderna mRNA vaccines, provided high levels of protection against hospitalization and death at least 6 months after vaccination.

The Pfizer vaccine was 88.7% and 90.5% effective at preventing hospitalization and death, respectively, due to COVID-19 at 7 months after vaccination. Similarly, the Moderna vaccine had an effectiveness of over 94% against hospitalizations (94.1%) and death (95.5%) at the end of 7 months after the first dose.

At 6 months following vaccination, the Johnson & Johnson vaccine was 80% effective in preventing hospitalizations and 70% effective in protecting against death.

Similar to the effectiveness against SARS-CoV-2 infections, the efficacy of all three vaccines in preventing severe illness was lower in individuals aged 65 years and older.

“First, all three vaccines are durably effective against severe disease leading to hospitalization and death. Thus, unvaccinated people should get vaccinated right away.”

“Second, the Pfizer vaccine is less durable than the Moderna vaccine, so the Pfizer vaccine recipients should get boosters sooner than the Moderna vaccine recipients.”

“Third, older adults have lower vaccine effectiveness and higher risks of hospitalization and death than younger people, so there is a greater urgency for older adults to get booster shots.”

“Fourth, the effectiveness of the Johnson & Johnson vaccine starts to decline after 1 month, so perhaps the Johnson & Johnson vaccine recipients should be administered a second dose after 1 month; if a second dose needs to be taken soon after the first one, there is no practical advantage of taking the Johnson & Johnson vaccine.”

“Finally, because the majority of the vaccinees in the U.S. were vaccinated more than 7 months ago and only a small percentage of the population has received boosters, waning immunity is likely contributing to the breakthrough infections with the Omicron variant. Thus, vaccination and boosting is our best hope against the Omicron variant or any new variants that may arise in the future,” added Dr. Lin.

 

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