OT - the Delta and Booster Thing

Booster versus no-booster for the vaxxed

Wiley Horne

Hi David,

True story from my extended family….happened in the past week:

There’s a wife, a husband, an 18-month baby. Husband and wife are double-vaxxed.

Dear friend of the wife is getting married. Prospect Park, Brooklyn. Wife wants to go. Husband says no, it’s a crazy risk. She talks him into it, they go.

Two days later, groom calls to say he’s got covid. Delta breakthrough apparently. Day or two later, wife is sick—positive for covid. Not a hospital case. She quarantines herself, husband taking care of baby (and furious). Two days later, baby has covid. That’s where we are this minute.

ANALYSIS:

1. Bill Tindall said a profound thing above: he got the Pfizer shot because Pfizer said it would keep virus out of his nasal packages and lungs.

2. If you’re double-vaxxed and get a breakthrough case, you will have virus incubating and then shedding for a time, even if you’re not hospitalized.

3. Example: Wife in this case double-vaxxed, incubated, and shed virus to her baby.

4. She will likely end up in the super-immune cohort.

5. But the baby is already collateral damage to her superimmunity, however his case resolves. Let alone the deep misery of getting thru this, even in best case.

6. Back to Bill T: avoid the incubation/shedding that goes with acquired immunity; get the booster when available to keep the virus from incubating and shedding to those nearest you.

Wiley, friend of David

One of the hazards of discussions...

John in NM

They wander.... that is also what keeps them interesting, but it can be frustrating when you want to discuss a specific topic.

The other frustrating part is that people often reply without fully reading the post to which they are replying. Or they read far too much into word choices and fixate on those. I've made those mistakes before, sure to do it again.

That is a distinctly modern effect....

John in NM

Life is very easy in this country, compared to many other places and compared to what it was like historically. This has made people extremely risk intolerant, they have largely lost the ability to cope with the existence of risks that they cannot control or manage. Thus all the fear of those who do not toe the line (not just on this subject either), and the efforts made to shut them up.

I've seen this effect among friends of all political persuasions, on many subjects beyond this one, lest anyone think I'm singling the virus talk out. Humans are closed minded largely because they are scared of the unknown, and the panicked reaction is to avoid looking at the scary thing rather than endeavoring to make the unknown into the known.

I admire efforts to do the latter, which I expect you know already. But it does take a conscious effort to avoid the panicked reaction as well.

Re: My dad is 73...so is my mother...

James Runchey

As someone who is 15 months from turning 90, and has severe shortness of breath, I fear if I got Covid. even with having 2 shots of Moderna, I doubt I would servive. I'll definitely opt for the third booster.

I think at 15 months shy of 90...

David Weaver

..I'd err on the side of action rather than observation, too.

You make a good case for what i'm pointing out here - it may not be the same rules for all when the smoke clears. A lot of us (based on the studies of other groups who either got vaccinated or have covid) have quite a bit of latitude in helping solve the problem - as mentioned in the israeli study, 66000 or so individuals (I didn't go back and check the observation) involved, all either with covid, vaccine or both - no deaths. That's a real luxury.

Based on the data thus far, you would probably be fine with two shots, but that's thus far, and we're all in this together and you have to do what you feel is right between you and your doc.

I only know four people who got their booster thus far. I post off and on on a rural forum and it's a horrible pool of misinformation. There are three of us in total who are urging the folks on there to seek truth and stop saying nonsense like "any data from a hospital is suspect".

At one point, I posted on there that age neutral, it would seem about 4-5% as likely for someone to end up in the hospital unless they were a real basket case (unfortunately that's what many of us are at the very end). Last week, the health system here wanted to make a point for the younger who think vaccinations aren't needed other than for the elderly and they released that 19 of 20 hospitalized individuals under 50 are unvaccinated. I used CDCs odds numbers to come up with the 4-5% based on current chance of getting covid and then current chance of getting hospitalized (vaccinated vs. not).

I have some background in data and statistics - you never know if everything will fit that well when you get a sample unless you collected the statistics or have a lot of background (I don't). It turns out, that the odds based on the hospital sample are just a little over 5% for the under 50 crowd. It's not a real surprise. The group disavowed the data as being biased because it came from a hospital. What can you do.

I know there are some upset with my bringing up this topic because I think it's important to check cohorts and learn what's really working, what's not, what works in the short term, what works better in a model that's looking back through a few variants as we look to the future. Now, to the point of that gropu.

Unfortunately, one of the others who is in it with me on that one (and I know I'm wasting my time over there and have mostly stopped visiting - there's no use when people don't care if they're helping or not) has a spouse who received her third moderna shot, reacted very poorly to it, had a cardiac event and set off her pacemaker and she's in the hospital now).

To his credit, he posted it, and didn't hide it to fit his argument. This is part of what I was mentioning earlier about potential outsized reactions once we all have what they're referring to as "more flexible antibodies" that seem to perfect in some senses even after no further exposure (become reactive to a wider range of proteins). this is an interesting topic - in this case, that is the first person I've heard of getting the third shot and I would bet it will be a rarity. I will wait and see, but I'm not that interested in the adverse reaction for me - more the long term "flexibility of antibodies", because the objective to me is to not have covid in any volume in the community (or to have us completely indifferent symptomatically and outcome-wise to it).

I hope you have many long comfortable healthy years yet.

Re: Booster versus no-booster for the vaxxed

David Weaver

So, this is similar to a family situation prior to vax. BIL gets covid at work, he and his wife get it, then all three kids do. All three kids (including one very young) have a minor fever and slight fatigue for a couple of days, and BIL and SIL both had some symptoms (which would probably be classified as mild) for several days.

But they may not have stronger antibodies and be far better off than me (the israeli study says that - we need to see independent confirmation). My bronchitis is far worse than their covid was, and I've had bronchitis somewhere around 75 times. But I've had it so often that I don't pay much attention to it until I start to have severe muscle soreness from it or significant singificant prolonged lost sleep.

In my view, they quarantined, infected each other, all came out of it mild and with no known further infections.

I am currently (personally) hoping to get delta because I believe it is the safe move on my part, but I may not get it and I will continue to evaluate data, and if I feel ill, I will separate myself from others. I am not hoping to get data in a group full of sneezers.

What's being lost here is that you and I don't know what the better outcome is in the intermediate or even near, let alone long term. It may not be getting boosters. It may be. The data is so robust that it should be easy for us to see several cohorts, but it is not public (I would temporarily trade my metallurgical scope to get a look at it and drill down for my household).

What stands out to me is in the israeli study, 66000 or something individuals were tracked and there were zero fatalities from covid in the retrospective study. This is extremely strong evidence for terminal health for anyone who has either had covid or two shots - that is my ultimate goal - nobody that I know dies unnecessarily.

I am willing to be wrong - but I view this as a case of overfertilizing (the potential).

As I Posted above, I know four people who have gotten the third shot, and only from another forum. The first person to get the shot had a strong reaction to it, had a cardiac event and triggered her pacemaker. I think this is a sad outcome so far, but she should recover. At the outset of this, I voiced concern that strong reactions can sometimes create an overall worse outcome for a population (the meningitis vaccine comes to mind and its use as a placebo comparison is spurious at best when other vaccines are studied), even though for a given individual, the outcome may be better. This is a current event, and the other three got boosted yesterday and haven't posted. As the forum has turned antivax, I can't stand to read it so I may not check for a couple of days.

I doubt this kind of thing will be the norm, but it's a poor coincidence that it was the first person to get boosted on that group as it just feeds confirmation bias.

AT this point, I actually don't know anyone who has gotten a symptomatic case of covid who had two shots.

(For reference, the shot involved with the reaction above is moderna...I don't know that it matters, it's just one incident).

But we are on dangerous ground if we allow confirmation bias to keep us from observing overall outcomes and doing something intelligent, and that is studying multiple time periods or multiple mode models. The fertilizer reference is my point here - generally, the outcome is better in the garden with fertilizer. Sometimes more isn't better, though.

I know your intentions are good. Mine are, also. But in this case, I'm starting to think more like chess strategy and less like tactics, if you're familiar with chess discussion. There is also a part of my mental model that involves waiting to boost when there is a variant that evades the vaccine in a substantial way (substantial to me is mortality and morbidity). I have the luxury of being able to stay away from anyone who would be considered significantly at risk.

separately..

David Weaver

i'm happy to report I haven't gotten bronchitis in two years!

(not that anyone cares, but I'm pretty pleased with that!). I started reading NIH studies on my own when covid started, because I wanted to see what was tied to the worse outcomes (read, I didn't want to die, I didn't want to become a morbid case, and after those two, I really didn't want to get covid at all). I found some interesting informaiton that was never communicated to me previously - that there is a statistically significant increase in respiratory infections (This is pre-covid, not sure if covid is included) with a mean estimate of a factor of 4 when taking the trivalent flu vaccine. The confidence interval is wider that I'd prefer, but it's 2 stdev significance, regardless.

Respiratory illness may be no big deal to most. A day of coughing for me for any reason (coughing or sneezing) has better than a 50/50 chance of triggering 2-3 weeks of bronchitis. Around March last year when I learned that, it also became an exceptionally poor time to walk around for several weeks with a spastic cough.

There's a lot out there for us if we're willing to use it well, and just as it's potentially the case that the folks you mentioned will have a much better outcome in the long term even if not the short term, there's probably a significant chance that my lack of flu vaccine has nothing to do with not getting bronchitis (I will, of course, be tracking this - as my cases of flu in the last 20 years vs. bronchitis are probably about 30 to 1).

Re: Booster versus ... Seminal Work

H Bruce McCrory

David, what you bring up is seminal, and at this point beyond my ability to comment on. I look forward to more analysis. I think for my part, the results need to be precise, accurate, and simple enough for casual comprehension. All of it is fertile ground for chaotic misdirection, otherwise.

Re: separately..

Wiley Horne

Hi David,

1. Update……Mom, who is double-vaxxed, feeling better. So is 18-mo. baby.

2. Outlook….Both Mom and baby have gained longer-term immunity.

3. What was learned? When we make a decision on covid vaccination or covid exposure, it’s not simply personal risk-taking. My action affects me, and it affects those close. I make a decision for my family, in short. So my risk analysis must be at the family level.

In this case, the wife took a risk affecting the family—and all came out better in the long run. Would she do it again? Dunno.

So. What is the best decision? Not only for you and your bronchitis, or for me and my particular age/lung impairment—but for our families.

The risk profile will depend on many things, but I am saying that the scope of the risk analysis must be at the family level, not the purely personal.

Wiley

Re: OT - COVID shots - one more thing

johannaj

There is more to COVID than just a severe respiratory disease - it can affect other organs adversely. This is a really nasty virus.

I am 80. I got the initial two doses in February and plan to get a booster when it is time. The way for our country to beat this virus is to have the majority of people vaccinated. This is the way to really control a viral disease for entire populations.

Of course.....

David Weaver

..the overall consideration is a large part for me, both household and wider.

If one of my kids gets very ill, it's going to be worse for me. I'd say my brother in law (nobody got very sick in his household - he actually got sick right after getting the first vaccine shot - just unlucky timing) probably still was nearly a covid death His mrs was unhappy - my wife is her more hot headed sister. Such a thing in this house could lead to a lower post count on wood central.

The no bronchitis and flu vaccine is separate - I learned something because I read. It was something that nobody ever told me but it's plainly stated in peer reviewed studies. I can't expect my doc or P.A. to know that off of the top of their head.

In the case you're discussing, it's not just about who is getting covid now, it's what will things be both for them and for everyone who comes in contact with them two variants, or five variants from now? They may have far better immunity and the overall outcome might be positive.

Yahoo (which I don't usually read - but it's my email) had an article from an ER doc (and also Harvard Med teaching staff). He is differentiating the same thing I am - the first two shots put people in a different class vs. the unvaccinated.

https://finance.yahoo.com/news/delta-variant-unvaccinated-and-vaccinated-people-are-not-in-the-same-ballpark-in-terms-of-risk-141843308.html?.tsrc=daily_mail&uh_test=1_03

I read this to get the information on the two shot relative risk - to see if it was in there. It is, but interestingly, buried in it (this being an ER physician who is likely seeing a lot of covid patients).

[quote]“I think that given that we don’t have a real emergency on our hands with respect to breakthrough hospitalizations in the sense of we’re not having hospitals overflowing, it would be very wise to study what we should actually do, rather than guessing,” Faust said.[/quote]

Note that he mentioned the same things I mentioned early on (a couple of months ago?). The numerical need, if it really leads to anything better in the long term, and the notion that we may be "doing it to do it" because doing more makes us feel like we'll be better off.

Separately, this keeps circling back to implications that what I'm talking about is self-centered and can lead to worse outcomes for others. That's factually incorrect. I am talking about what leads to better outcomes, especially in potentially catastrophic situations (such as a variant that develops that's not well controlled by a vaccine, but is by a combination of vaccine and natural immunity gained over time).

He also touched on what I suggested very early on, too - when you have unvaccinated cohorts moving virus around at a much higher rate, then the booster over convincing the unvaccinated cohort may not yield much fruit.

What keeps coming up against my point is comparison on the first shots to unvaccinated, or deaths or severe illness of unvaccinated individuals. That's not what this discussion is about - it never has been except for attempts to push toward that or use evidence for a different situation instead of reviewing data from the actual scenario we're discussing.

I see in the article that relative death studies now have the vaccine against delta at 8 to 29 times more effective than being unvaccinated. I don't know if these are age or cohort adjusted- they're a little low (i would expect something like 50+ , but who knows - I can't actually get data to look at and parse).

you're right...

David Weaver

I anticipated some disagreement, but didn't expect even this discussion to continue to be pointed back to things not related to it (but that has occurred).

What I'm describing, I'm sure is being done in great detail at the CDC to guard against long shots or severe outcomes. But I'd imagine that it goes further - to predictive models that have inputs well beyond the next year or delta, and mu.

I would imagine they know very well how prior cases combinations have held up (relatively) against all of the variants and could likely say right away what the data shows as a bar for the booster (though the remaining unvaccinated cohort has a whole lot more effect on what we see in terms of total influence - that topic is off of my screen - it went political long ago).

I can also understand why the CDC wouldn't release a data tool for individuals to use and model (though it would be nice), because it could be an easy target for misinformation or choosing tiny insignificant data anomalies and claiming that they're a trend.

My initial suspicion was related to side effects, interest in lobbying for a booster, and long term flexibility of the whole community's immune response. Now, there's an article from israel suggesting that having a case of one of the prior variants leads to far better immunity against delta (Which is the point I was making), but that's one study, it's not yet peer reviewed (it appears to be from a university, but you never know) and data elsewhere ought to show the same thing. I'm sure *we* have it in spades, but it's not being discussed (which is different than looked at - I'm sure it's been reviewed). If our information conflicts with the israeli study results, it ought to be made public (but within the comfortable fact from that particular study that none in the "had covid" or vaccinated group died).

My observation of us as a society - on the whole - is that in a situation like this, we'll eventually get the wrong answer. But we won't be afraid to "act fast!", bias decisions and do something that's not the right answer early on because of many different human traits (ego, excessive misplaced empathy, the bias to act vs. observe, etc), and we generally like to wipe it away with "well, we did the best with what we knew at the time, so no big deal".

This thread has pretty much run its course. One of the things I'll be watching is the side effect profile from the booster as I'll be eligible for it very soon.

Hi, Johanna...

David Weaver

This topic was only comparing people who had been vaccinated with a look forward to the potential long-term immunity (effectively, what will it take to eliminate covid in general).

A study has come out of israel comparing a bunch of different groups (I've already forgotten the full set of details, but from it, I saw this)

* individuals who had covid previously but no vaccine were 6 to 13 times less likely to get the delta variant vs. individuals who only received the vaccine

* individuals who had covid and one shot of pfizer were half again as likely to get the delta variant (as in, having covid previously plus vaccine made even stronger immunity, so figure 12-26 times less likely to get the delta variant than vaccinated individuals)

I've seen this study spun two different ways:

* "recovered covid patients who refused vaccine punished by being twice as likely to get covid again" (ignoring the fact that the study said they were at least six times less likely to get delta than people who were vaccinated and never had covid).

* "natural immunity better than the vaccine"

Both of those are incomplete, but they show how people will pick what they want out of a data set and use it.

That leads to two questions for me - what is the relative risk for people who got the vaccine first and then got covid as a breakthrough, and what will it be compared to the booster. We don't know this yet, but israel will probably have some data soon. We will eventually, too. The other thing I'd like to know is if the order of covid and vaccine matters. Getting covid without the vaccine is too risky (I was vaccinated as soon as eligible, so it's already for me, personally, not possible, anyway). But I'd also like to know if the effect is as strong for people like me who are not compromised - if we get covid after getting the vaccine.

I don't know if all of that is communicated as well, but the issue is this - if getting a mild case of covid after the vaccine (or even asymptomatic) makes me 6 to 13 times better off against the next variant (6 months down the road), and would do the same for everyone in my household, it's not necessarily a clear case that the booster is the right answer.

Anecdotally, everyone in my extended relatives group who is older had no side effects at all with either shot, and I would bet a breakthrough case is worse for older individuals, so I could very easily see a case where the recommendation isn't the same for different groups. It should take less than a month to start getting preliminary data from israel - that will be valuable.

I think this topic might be too in depth at this point for the forum - but it was worth noting at the outset, because there is potentially a lot of information in the israeli study if it shows to be consistent and then can be duplicated forward-looking picking the individuals in the study group ahead of time so that there's no bias in their picking - just whether or not they choose to get a booster).

Re: OT - COVID shots - one more thing

frank morgan

Tracking COVID-19 vaccine distribution:How many people have been vaccinated in the US? So far, 169,592,873 Americans — or 51.1% of the total population — have received the full course of vaccinations necessary to protect against COVID-19, according to the CDC

Re: OT - COVID shots - one more thing

johannaj

Frank, I should have said that over 70% of the population would have to be vaccinated - I should not have simply said "the majority". It really bothers me that there are so many people who refuse to be vaccinated.

Re: OT - COVID shots - one more thing

TomD

The virus is out of the bag, I don't know of any serious opinion at this point that takes seriously the idea that vaccination or anything else is putting it back in the bag. The vaccine does not stop infection, replication, or transmission, it in fact isn't a vaccine to the extent that recently the CDC created a new definition of "vaccine" that does not require it to confer immunity, only sorta a best efforts at it. The semantics are not so much the thing, relative to concerns about the unvaccinated, what is important to understand is that vaccinated people are far from pulling their weight on this, and given that many unvaccinated people are incentivized to not get infected, while the vaccine crowd is expecting "back to normal", I am not sure who is the greatest risk. Particularly since it is more than possible that a vaccinated person might kill an unvaccinated, but not very likely in the opposite direction.

It is important to understand that large proportions of the population can't and far larger parts shouldn't get the vaccine. Very weak or compromised people can't take it; some people react; heart disease in some cases; and most of the young, etc... Israel got a lot of UnV. people dying at one point, but that is to be expected due to the fact that many old people can't take it, or if they do, do not get much effect from it. So when you hear about people who are infected, or dying who are not vaccinated, they may not have been asking for it.

It is also worth understanding, just to mention two very ProV entities, that both the WHO, and the UK advisory group have recommended not vaccinating under 15 year of age people. And the trials currently underway for under 12s in the US will not be complete until '24, or '25. So unless we just keep re-writing the law on no basis, we should not be touching people in those age groups for years.

In the EU, and many other places, proof of prior infection (not backed up by any crap about weekly tests, etc...) is equal to proof of vaccination. So that cohort is out. That is a huge number, because while 10% ish in the US officially tested positive for COVID, a lot larger number already has had the infection. It is malpractice to vaccinate them.

Of course due to both a very long and very racist history of trying vaccines out on various groups, including blacks, there is low, low vaccination levels in those communities. I'm not going to tell them what they should think.

Pregnant women have a lot to think about, or trying women. They may consult their doctors and be told not to take the vaccine due to some of the scary studies, or because they have conditions of concern, but that is a potentially large group. The Rowe decision was the private right to consult one's doctor, which led to the privacy right to an abortion, but if you cut out the private right to consultation, you are undermining Choice.

Vaccinated people are their own greatest threat because they will evolve variants that escape the vaccine, that is the nature of evolution. I don't imagine that is where the Delta variant came from, but it is where vaccine resistant variants will come from. Vaccinating into a pandemic is a huge no no, and a product of putting out a vaccine at a high rate of speed. There is a trade off there. What isn't there is the idea that UnV people are threatening V people's health through generating slippery variants.

There are a lot of people who, like me live in the bush, and never see anyone from week to week. Since only 4% of the population has got it in Canada, and 10% in the US, it is really easy to not get it if you are trying not to get it. Most people may not have that option, but many do have it.

So overall feel happy, people are constantly trying to divide you, stop watching whomever is pushing out all the bad information. If it is simple A vs B you are being played. Hang out in the handtool section and see how complicated the threads over there get on something like sharpening. Consider whether it is likely that medicine, politics, vaccines, etc... Distill neatly into a binary choice.

Re: Booster versus no-booster for the vaxxed

TomD

"5. But the baby is already collateral damage to her superimmunity, however his case resolves. Let alone the deep misery of getting thru this, even in best case."

How so? Is the baby deeply sick? In a population of 15 million we have one under 12 who died, might have been very ill to start with. The kid trials will not be over for 3-4 years in the US. There is no risk calculation that justifies immunizing kids, but there is a push to give shots to babies, which is flatly immoral. What the family should do is get records of the event, to spare the baby any future assaults on it's person.

My sister in-law lost a child shortly after birth, from heart disease. Here only option at the time was a series of open heart surgeries for the child, and here is the cool part, all that surgery would have been done without anesthetic. Goes to show how doctors feel about suffering in children and their long term memory of it.

Frankly...

Jesse Cloud

This post and others like it scare the bejeebers out of me.

We have "armchair epidemiologists" drawing conclusions from questionable studies (not peer reviewed, low sample sizes, etc.) and coming up with some very scary advice.

Please folks, don't act on this kind of stuff. Ask a respected doctor about any course you might follow. There is just too much bad advice in the media.

Frankly...

David Weaver

I don't see anything where I suggested anyone not do what they and their doctor were comfortable with. This is far beyond that.

It's a little reassuring to me that after I brought all of this up, an ER physician and Harvard staff physician more or less said the same thing - should we be doing more analysis about whether or not blasting away with boosting is the right idea.

You'll note that I also mentioned that we'd like to see confirmation of the israeli study, and in combination with a piece of data I showed above (59% of hospital admissions for covid in israel are fully vaccinated - a lower rate than the unvaccinated cohort but not minimal) could still fit together (no information provided in the israeli release - of course - about individuals unvaccinated but who had covid or vaccinated and also who had covid vs. just vaccinated). Israel will be giving us booster data soon - and we will have our own.

There's nothing scary in any of this, nor is any of it a suggestion for anyone else. We're waiting and seeing at this point. I'm somewhat surprised that nobody else thinks like this - it's not an "i'm thinking because I'm going to take an action outside of my own door", because I'm not - it's a supposition of wondering if we're acting to act because that feels right or is policy coming from a longer-term strategy (we don't know).

For the time being, our hospitalization data is better than israel's based on what the CDC tells us, or at least as good and being sliced and diced a different way (but our unvaccinated cohort is larger).

No clue why the pondering would be off limits for anyone who studies other population data sets and how they change over time.

It bothers me less...

David Weaver

.because I've already gotten two shots and so have all of my relatives...

...but I'm surprised the data isn't compelling enough to do it for something like 95% of folks over 50. (it's 76% in my county for age 65+).

Not a gamble i'd take.

How differences can arise

Wiley Horne

Hi David,

How do reasonable people talk past each other on this subject?

This distinction may be useful:

1. National policy based on statistics.

Epidemiology tries to figure out how and where to direct the Nation’s response to Covid. Booster vs. no-booster for example. Use statistics to compare both courses of action in terms of most likely outcome, and standard deviations. Goal: How should the US allocate covid resources to achieve the greatest long-term health benefit for all our families and people?

2. Individual family policy.

Mom and Dad, both double-vaxxed, try to figure out how to avoid the worst case outcome for themselves, 2 kids, two sets of grandma and grandpa. Plus protect income from 1-2 jobs. Choice is booster vs. no booster—challenge their immune systems with a no-virus booster, or with the live-virus contagion in the air.

——Worst-case with booster: immunity improved, but not as robust compared to incubating live virus.

——Worst-case with live-virus incubation: parents may miss work in case of breakthrough, or may infect kids, or may infect any or all grandparents since shedding begins before symptoms manifest.

DIFFERENCE: Epidemiologists at Harvard et al. may rationally recommend a different plan for the US overall, than Mom and Dad decide for their family. Because Mom and Dad can’t average outcomes over 300 million people—they must avoid even 1 of their number going to ICU, or being out of work for 2-4 weeks with the whole family quarantined.

Wiley

Ditto.

(Message Deleted by Poster)

This was my point from the outset...

David Weaver

..that a policy with a higher resolution would likely be more appropriate, but the pondering has some to do with political groups, etc, considering perception and wanting to do things that aren't necessarily optimal because they are either afraid of perception, or because they think differences in perception will make a suboptimal policy optimal.

My suggestion was simple - make decisions based on experience and modeling what's occurred against future chances.

The comment about the current policy being open to a wider group was a bit troubling to me while there's division within the CDC and among former officials, and skepticism from physicians about widespread boosting instead of at least a short period of data collection about benefit and side effects.

(I had a conversation with my doc about statins a few years ago because I was sitting on mortality and morbidity data and he said something about the guidelines. I mentioned that prior to age 65 and with no prior events, there was no benefit in life expectancy or morbidity, after that - it may have been after 70, statin prescription had an average life expectancy increase of 2 years. Instead of telling me to can it, he asked if I'd bring the data the next time, I did, and he found it interesting. A year or two later, the guidelines changed. I went and read the studies supporting statin use, and frankly, they sucked. The conclusion from them from generally small number studies was that minor events improved with statin prescription and that lower numbers are correlated with better outcomes. What they failed to report with any large cohort size was the outcome of major events, and what the improvement was for someone who had high numbers made lower with statins).

It turns out that numbers lowered with statins in younger individuals have no correlation with improved outcome (that is, the person with improved cholesterol numbers doesn't have the same outcome in mortality and morbidity as the person with the same lower numbers without taking statins - this would've been easily observable in a study group. *This is true even with high risk individuals who didn't have a prior event*). At the same time as our first conversation, correlation with better mortality and morbidity was found with lower cholesterol numbers below the "action point" that was already established, so there was a push from some cardiology groups to prescribe statins to people who didn't have clinically high cholesterol. Sort of "they're shown to be good for everyone".

...except they're not. Thank goodness that was squashed by outcome data. If an independent analysis and a separate mortality study hadn't been done in the UK, what would've been the next step. *why in the world would we not measure the same outcomes in the US*? The studies relied on didn't ask these questions or ask if the outcomes of the group taking statins improved - why not?

These are easy things to data mine. With electronic records, it should only be easier yet.

In the event that a booster is beneficial, it's something that could be determined in 6 weeks from the vulnerable group. With pfizer above 80% and moderna above 90%, what is the rush? It's not statins, so the outcomes could be different. The fact that the white house group is rushing to act "to stay ahead of the curve" when there isn't consensus within the CDC isn't something I find admirable. It's not nearly as clear as the first two shots (which you obviously don't see me question).