And Another Thing is a sub-category of the Letters usually reserved for paid subscribers. I’m making this issue free for alla y’all.
Having been on the “Covid beat” in whatever unofficial capacity I can claim since the earliest whispers of the pandemic started in the waning days of 2019, I’ve spent a lot of time reading and learning from experts about Covid itself, about vaccines and virology, about public health and science communication, and about our communities of health. A lot of my information comes to me initially through my list of experts and professionals on twitter and through daily check-ins with Nature, The Lancet, Science-Based Medicine, JAMA, and digging down on press releases from the relevant pharmacology companies. It’s because of a year of tracking both publications and retractions that I know to take publications from the UK with an eye to potential retraction or debate, and to watch for the times when the CDC and FDA can’t agree, or when approvals in the US vary from those of other countries. I see when “my experts” disagree or take time to come to agreement on a question (like whether rapid testing is worthwhile, whether kids need priority vaccination, whether mandates make sense) and I actively follow those conversations as they evolve.
It’s time-consuming, usually a couple of hours a day at minimum, and it makes use of every information skill I’ve got. I generally don’t expect that everybody’s keeping up with the latest publications (and retractions) as much as I am, because it’s exhausting. I do it primarily because I know that there’s a not-small number of people who trust me to have relatively accurate and up-to-date information on what the heck is going on out there, and while I take that responsibility very seriously, it also strikes me as a symptom of a more complicated problem, which is that it’s hard for people to find a trusted source of good, accessible information and guidance. We’re all so freaking tired.
So anyway. What follows is a list of things I currently believe to be true about Covid-19, and some sources to back up why I believe those things.
Covid-19 is serious and has a higher IFR (infection to fatality ratio) than most strains of influenza.
Additionally, the death toll both from Covid itself and from the strain on healthcare systems (also known as “excess deaths”) is much higher than official estimates.
Piroth, Lionel, Jonathan Cottenet, Anne-Sophie Mariet, Philippe Bonniaud, Mathieu Blot, Pascale Tubert-Bitter, and Catherine Quantin. “Comparison of the Characteristics, Morbidity, and Mortality of COVID-19 and Seasonal Influenza: A Nationwide, Population-Based Retrospective Cohort Study.” The Lancet Respiratory Medicine 9, no. 3 (March 1, 2021): 251–59. https://doi.org/10.1016/S2213-2600(20)30527-0.
“The Pandemic’s True Death Toll | The Economist.” Accessed October 2, 2021. https://www.economist.com/graphic-detail/coronavirus-excess-deaths-estimates.
Vaccines are very effective, even against the Delta variant.
Getting vaccinated isn’t an impenetrable wall, but it means you’re much less likely to contract the illness in the first place (and if you haven’t gotten it, you can’t spread it). If you get a breakthrough infection, you’re infectious for fewer days than an unvaccinated person on average, and you’re much less likely to have complications up to and including death than an unvaccinated person.
Lederer, Katlyn, Kalpana Parvathaneni, Mark M. Painter, Emily Bettini, Divyansh Agarwal, Kendall A. Lundgreen, Madison Weirick, et al. “Germinal Center Responses to SARS-CoV-2 MRNA Vaccines in Healthy and Immunocompromised Individuals,” September 21, 2021. https://www.medrxiv.org/content/10.1101/2021.09.16.21263686v1.
Pilishvili, Tamara, Ryan Gierke, Katherine E. Fleming-Dutra, Jennifer L. Farrar, Nicholas M. Mohr, David A. Talan, Anusha Krishnadasan, et al. “Effectiveness of MRNA Covid-19 Vaccine among U.S. Health Care Personnel.” New England Journal of Medicine 0, no. 0 (September 22, 2021): null. https://doi.org/10.1056/NEJMoa2106599.
The following items in this group are pre-prints, which means they are not yet reviewed by other scientists in the field for accuracy or reliability. Because the science of Covid is moving extremely quickly (because pretty much all of our best minds are focused on some angle of the pandemic), pre-prints are a valuable source, but it’s important to follow up with information gathered from pre-prints to ensure the information wasn’t retracted after further consideration from the field. With that said:
Chia, Po Ying, Sean Wei Xiang Ong, Calvin J. Chiew, Li Wei Ang, Jean-Marc Chavatte, Tze-Minn Mak, Lin Cui, et al. “Virological and Serological Kinetics of SARS-CoV-2 Delta Variant Vaccine-Breakthrough Infections: A Multi-Center Cohort Study,” July 31, 2021. https://doi.org/10.1101/2021.07.28.21261295.
Ke, Ruian, Pamela P. Martinez, Rebecca L. Smith, Laura L. Gibson, Chad J. Achenbach, Sally McFall, Chao Qi, et al. “Longitudinal Analysis of SARS-CoV-2 Vaccine Breakthrough Infections Reveal Limited Infectious Virus Shedding and Restricted Tissue Distribution,” September 2, 2021. https://doi.org/10.1101/2021.08.30.21262701.
Kissler, Stephen M., Joseph R. Fauver, Christina Mack, Caroline G. Tai, Mallery I. Breban, Anne E. Watkins, Radhika M. Samant, et al. “Viral Dynamics of SARS-CoV-2 Variants in Vaccinated and Unvaccinated Individuals,” August 25, 2021. https://doi.org/10.1101/2021.02.16.21251535.
Shamier, Marc C., Alma Tostmann, Susanne Bogers, Janet de Wilde, Jeroen IJpelaar, Willemijn A. van der Kleij, Herbert de Jager, et al. “Virological Characteristics of SARS-CoV-2 Vaccine Breakthrough Infections in Health Care Workers,” August 21, 2021. https://doi.org/10.1101/2021.08.20.21262158.
Several of these pre-prints were covered in this piece:
HuffPost. “How Long Are You Contagious When You Have A Breakthrough Infection?,” September 30, 2021. https://www.huffpost.com/entry/breakthrough-covid-infections-how-long-contagious_l_6154cbaae4b0487c855a2463.
Vaccines are safe for almost everyone, including kids and pregnant people.
Klein, Nicola P., Ned Lewis, Kristin Goddard, Bruce Fireman, Ousseny Zerbo, Kayla E. Hanson, James G. Donahue, et al. “Surveillance for Adverse Events After COVID-19 MRNA Vaccination.” JAMA, September 3, 2021. https://doi.org/10.1001/jama.2021.15072.
“Low Dose of Pfizer-BioNTech Vaccine Is Safe and Effective in Children Ages 5 to 11, Companies’ Study Finds.” Washington Post. Accessed September 26, 2021. https://www.washingtonpost.com/health/2021/09/20/covid-vaccine-for-children/.
“Pfizer and BioNTech Announce Positive Topline Results From Pivotal Trial of COVID-19 Vaccine in Children 5 to 11 Years | Pfizer.” Accessed September 26, 2021. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results.
“Myocarditis and How to Think about It… like a Cardiologist | Science-Based Medicine,” September 18, 2021. https://sciencebasedmedicine.org/myocarditis-and-how-to-think-about-it-like-a-cardiologist/.
Government of Ontario, Ministry of Health and Long-Term Care. “Medical Exemptions to COVID-19 Vaccination” Government of Ontario, Ministry of Health and Long-Term Care. Accessed October 2, 2021. https://health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/medical_exemptions_to_vaccination.pdf.
MPH, Ilona T. Goldfarb, MD. “Wondering about COVID-19 Vaccines If You’re Pregnant or Considering Pregnancy?” Harvard Health, January 7, 2021. https://www.health.harvard.edu/blog/wondering-about-covid-19-vaccines-if-youre-pregnant-or-breastfeeding-2021010721722.
We are still very dependent on keeping community spread down to reduce the frequency of exposures most people will encounter. Even vaccinated people are more likely to eventually be infected if they are exposed frequently in their daily lives. With that in mind:
Bundgaard, Henning, Johan Skov Bundgaard, Daniel Emil Tadeusz Raaschou-Pedersen, Christian von Buchwald, Tobias Todsen, Jakob Boesgaard Norsk, Mia M. Pries-Heje, et al. “Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers.” Annals of Internal Medicine 174, no. 3 (March 16, 2021): 335–43. https://doi.org/10.7326/M20-6817.
“Eight Key Questions on the Danish Facemask Study | The Spectator.” Accessed September 26, 2021. https://www.spectator.co.uk/article/eight-key-questions-on-the-danish-facemask-study/amp?__twitter_impression=true&s=09&utm_source=pocket_mylist.
STAT. “Merck’s Antiviral Pill Reduces Hospitalization of Covid Patients,” October 1, 2021. https://www.statnews.com/2021/10/01/mercks-antiviral-pill-reduces-hospitalization-of-covid-patients-a-possible-game-changer-for-treatment/.
Because the first-round vaccination campaign hasn’t reached as many people as we’d like for a lot of reasons, many in countries with good vaccine access but lower-than-ideal vaccination rates are looking to third doses and boosters as one of these mitigation measures. For some people, a third dose is helpful, but for most of the population, the science says:
Boosters are sometimes, but not always, useful.
Benotmane, Ilies, Gabriela Gautier, Peggy Perrin, Jérôme Olagne, Noëlle Cognard, Samira Fafi-Kremer, and Sophie Caillard. “Antibody Response After a Third Dose of the MRNA-1273 SARS-CoV-2 Vaccine in Kidney Transplant Recipients With Minimal Serologic Response to 2 Doses.” JAMA 326, no. 11 (September 21, 2021): 1063–65. https://doi.org/10.1001/jama.2021.12339.
“FDA Advisory Committee Votes Unanimously in Favor Of COMIRNATY® Booster for Emergency Use in People 65 and Older and Certain High-Risk Populations | Pfizer.” Accessed September 26, 2021. https://www.pfizer.com/news/press-release/press-release-detail/fda-advisory-committee-votes-unanimously-favor-comirnatyr.
Rosner, Helen. “What COVID Booster Shots Can and Can’t Do.” The New Yorker, September 23, 2021. https://www.newyorker.com/news/q-and-a/what-covid-booster-shots-can-and-cant-do.
Now, one of the things that was very reassuring in the early days of the pandemic was that kids didn’t seem to be contracting the illness as often as adults, and that the younger you were, the less likely you were to have a serious case. This meant that even when schools were closed to all but remote learning, it was with the intention of protecting vulnerable adults, rather than out of fear for kids themselves. And while it’s still true to an extent that kids are lower risk than the elderly, we’re learning more all the time about the potential long-term effects of Covid, even when the initial infection was asymptomatic. And when it comes to the protection granted by age, things have changed dramatically with the Delta variant.
In the Delta era, kids get Covid at similar rates to other age cohorts. They are also experiencing adverse outcomes, including “long covid,” permanent disability, and death.
Further, because kids under 12 are the only cohort that remains entirely unvaccinated, they’re currently at the lead of several major regional case surges in the past six weeks, and the capacity of the healthcare system to handle both the Covid cases and all the other pediatric emergencies is under extreme strain. Spread among kids, and how to slow it while they wait for vaccines, is at the front of mind for most of my sources. But because Delta and the pediatric surges are relatively new (most case counts only started to climb in August), the majority of our knowledge is limited to case numbers and epidemiological projections.
“Covid: One in 20 Secondary-Age Children Infected in England.” BBC News, October 1, 2021, sec. Health. https://www.bbc.com/news/health-58763845.
Toronto. “School-Aged Children Now Account for More COVID-19 Cases per Capita than Any Other Age Group in Toronto,” September 27, 2021. https://toronto.ctvnews.ca/school-aged-children-now-account-for-more-covid-19-cases-per-capita-than-any-other-age-group-in-toronto-1.5602385.
Julia Raifman. “This Month, a Record Number of US Children Died of COVID-19. And the Month Is Not over. Children Rely on Adults and Policymakers to Protect Them. ➡️ Community Mask Policies ➡️ Vaccine Delivery in Schools + Neighborhoods, to Kids + Everyone Thank You @AAPNews for Tracking Https://T.Co/XH6NgdiMbf.” Tweet. @JuliaRaifman (blog), September 27, 2021.
Ontario COVID-19 Science Advisory Table. “Update on COVID-19 Projections.” Accessed September 28, 2021. https://covid19-sciencetable.ca/sciencebrief/update-on-covid-19-projections-11/.
Lewis, Dyani. “Long COVID and Kids: Scientists Race to Find Answers.” Nature 595, no. 7868 (July 14, 2021): 482–83. https://doi.org/10.1038/d41586-021-01935-7.
“New Analysis Shows Benefits of Offering Two Doses of COVID-19 Vaccine to Children Aged 12-17 Clearly Outweigh Risks.” Accessed October 3, 2021. https://www.rsm.ac.uk/media-releases/2021/new-analysis-shows-benefits-of-offering-two-doses-of-covid-19-vaccine-to-children-aged-12-17-clearly-outweigh-risks/.
Because of these statistics compared to the current relative safety data on vaccines, I believe kids of all ages should be vaccinated as soon as appropriate dosages are established and approved.
Mandates and “passporting” are legal in the US and Canada.
Bogart, Nicole. “Do Vaccine Mandates Violate Canadians’ Charter Rights?” Coronavirus, September 1, 2021. https://www.ctvnews.ca/health/coronavirus/do-vaccine-mandates-violate-canadians-charter-rights-1.5569971.
“How OSHA Can Conjure Biden’s Soft Vaccine Mandate: Explained.” Accessed October 2, 2021. https://news.bloomberglaw.com/safety/how-osha-can-conjure-bidens-soft-vaccine-mandate-explained.
Johnson, Carrie, Danielle Kurtzleben, and Lindsay F. Wiley. “Can The Government Make Me Get The COVID Vaccine?” NPR, August 12, 2021, sec. The NPR Politics Podcast. https://www.npr.org/2021/08/12/1027132680/can-the-government-make-me-get-the-covid-vaccine.
Lowe, Julie, and Samuel E. Trosow. “Surfing the Fourth Wave: Riding out a Charter Challenge to University and College Vaccination Mandates.” CanLII Authors Program, 2021. https://www.canlii.org/en/commentary/doc/2021CanLIIDocs1946#!fragment//BQCwhgziBcwMYgK4DsDWszIQewE4BUBTADwBdoByCgSgBpltTCIBFRQ3AT0otokLC4EbDtyp8BQkAGU8pAELcASgFEAMioBqAQQByAYRW1SYAEbRS2ONWpA.
AP NEWS. “Small Agency, Big Job: Biden Tasks OSHA with Vaccine Mandate,” September 16, 2021. https://apnews.com/article/joe-biden-business-health-coronavirus-pandemic-henry-mcmaster-f33acd986ad5045e48088a832c6f9903.
Wills, Matthew. “What Makes Vaccine Mandates Legal?” JSTOR Daily, September 3, 2021. https://daily.jstor.org/what-makes-vaccine-mandates-legal/.
With legal challenges largely defeated, the tide of mandates and passporting seems to be growing across the US, UK, and Canada, and the good news is:
Mandates and passporting are working to improve vaccination rates and protect our communities.
“Canada’s 4 Largest Provinces See Vaccine Uptake Boosted by Mandates | CBC News.” Accessed September 30, 2021. https://www.cbc.ca/news/canada/ottawa/vaccine-passport-effect-uptake-canada-provinces-1.6190697.
Dada, Sara, Heather Battles, Caitlin Pilbeam, Bhagteshwar Singh, Tom Solomon, and Nina Gobat. “Learning from the Past & Present: Social Science Implications for COVID-19 Immunity-Based Documentation.” Humanities and Social Sciences Communications 8, no. 1 (September 27, 2021): 1–9. https://doi.org/10.1057/s41599-021-00898-4.
All that said, concerted efforts have been and continue to be underway to undermine all this evidence, and we need to be on the alert for those who are willfully and deliberately misleading people in ways that are leading to thousands of deaths. If someone is telling you a mitigation strategy does more harm than good, they’re usually either lying or sharing something they believe, but that is untrue. Mitigation matters. Keep it up. Because:
Disinformation is causing harm.
Mach, Katharine J., Raúl Salas Reyes, Brian Pentz, Jennifer Taylor, Clarissa A. Costa, Sandip G. Cruz, Kerronia E. Thomas, et al. “News Media Coverage of COVID-19 Public Health and Policy Information.” Humanities and Social Sciences Communications 8, no. 1 (September 28, 2021): 1–11. https://doi.org/10.1057/s41599-021-00900-z.
Boot, Arnout B., Katinka Dijkstra, and Rolf A. Zwaan. “The Processing and Evaluation of News Content on Social Media Is Influenced by Peer-User Commentary.” Humanities and Social Sciences Communications 8, no. 1 (September 10, 2021): 1–11. https://doi.org/10.1057/s41599-021-00889-5.
“Cognitive Illusions and How Not to Write About COVID-19 and Children | Science-Based Medicine.” Accessed September 26, 2021. https://sciencebasedmedicine.org/cognitive-illusions-and-how-not-to-write-about-covid-19-and-children/?s=09&utm_source=pocket_mylist.
Hotez, Peter. “COVID Vaccines: Time to Confront Anti-Vax Aggression.” Nature 592, no. 7856 (April 27, 2021): 661–661. https://doi.org/10.1038/d41586-021-01084-x.
“State Medical Boards vs. COVID-19 Misinformation, an Update | Science-Based Medicine,” September 27, 2021. https://sciencebasedmedicine.org/state-medical-boards-vs-covid-19-misinformation-an-update/.