Ologies with Alie Ward - Booster Coronasode: Shots & Holidays with Vaccine Infodemiologist Jessica Malaty Rivera

Episode Date: November 24, 2021

You’re six to ten times LESS likely to catch COVID-19 if you’re vaccinated, and thus less likely to infect others. Great! But what about breakthrough cases? Who’s at risk for them? How many folks haven’t gotten vaccinated? Should pregnant people get the ol’ jab, what might happen with transmission rates in 2022, yearly booster questions, the ethics of vaccine distribution, myocarditis, Long COVID, quarantine fatigue and essentially whether the holidays are a good idea. Follow Jessica Malaty Rivera on Instagram and TwitterMore info on JessicaA donation went to Doctors About BordersMore episode links and infoSponsors of OlogiesTranscripts & bleeped episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, totes, masks… Follow @ologies on Twitter and InstagramFollow @alieward on Twitter and InstagramSound editing by Jarrett Sleeper of MindJam Media & Steven Ray MorrisTranscripts by Emily White of The WordaryWebsite by Kelly R. Dwyer  

Oh, hey, it's that squirrel building a winter nest in your barbecue. Allie Ward, back with an episode, nobody wants. But everybody needs. Here we are. We're on the cusp of 2022. It's still weird to wear pants with zippers. We live on Zoom. What's happening?

So after watching your aunt's forehead as she ate mashed potatoes last year on a screen, everyone's excited for hugs and cookies and layovers and using their toiletry kits again and scrolling on their phone as uncles watch football. So I thought I would absolutely just break my brain by making an extra urgent coronasode booster that we recorded yesterday. It's all about surges, immunity, booster shots, travel, the forecast of the pandemic. What are we doing? Who better to ask than someone you already love?

Anologist, you have met in previous coronasodes who is a microbiologist who earned her master's in emerging infectious diseases from Georgetown University School of Medicine. She's an infectious disease epidemiologist who was the SCICOM lead at the COVID tracking project and now works with Boston Children's Hospital. She specializes in explaining pandemics to people and 361,000 followers on Instagram. Rely on her daily for up-to-date data and flim flam busting and peer-reviewed study links and more. I texted her a couple of days ago and I was like, hey, can you spare a little time to

explain just what in the hell to do for the holidays? So before we get to that, a few thanks. Thank you to all the patrons at patreon.com slashologies for supporting the show for as little as 25 cents an episode, a cost of dollar a month to join, and submitting great questions. And thanks to everyone who sends their friends episodes and who subscribes and rates and reviews. I literally read every review like a creep so that I can pick a fresh one like this one from Nathan Wilk who wrote, I'm in awe of how this podcast manages to get a whole community to rally around even the most niche off-the-wall fields of study every week without fail.

Also congrats on the double marathons, DRG Sucre and Beth. Let's coffee. Okay. So let's get ready to stuff your stocking with just a whole lot of updates. We'll be chatting about how vaccines keep you safe from infection on COVID rates, forecasts, immunity, booster choosing, contagious explanations, reassurances, and the future of living with rather than dying from this spiky bitch of a virus with a truly wonderful matriarch of metrics, a triple return guest, and a slayer of lymph-lam vaccine infodemiologist, Jessica

Melody Rivera. We have so many questions. I mean, no one's been on allergies as much as you. Oh, that is such an honor. I'm sorry we've had to have you back 70 times, but thank you so much for doing it. I mean, can I also say maybe it's because we're at this point friends. Yes, that's also true. Like it's just nice to catch up.

Oh my God. And I know, you know, we're going into, obviously we're going into holidays. This is going to go up literally tonight. So this is also going to be a fresh as hell like steaming hot episode where the turnaround on it is going to be like breakneck pace because in North America at least, in the US, thanksgivings are coming up, holidays around the world are coming up, everyone is asking so many questions. And first off, I want to just ask how are we with infection rates globally around the world?

I know we've got about 50,000 coronavirus patients in the hospital in the US right now. Are we seeing it rise kind of with flu season tends to or what's going on? Yeah, so there's kind of an overall increase and having flu be worse than it was last year is definitely not helping this whole situation, especially as we're trying to protect our hospitals and our healthcare infrastructure from being strained. And because of that, it's so important that people get their flu shots and their COVID-19 vaccines to prevent another hospital surge that we saw last winter. Thanksgiving historically speaking, you know, pre COVID has always been kind of this catalyst

for major flu transmission. Like you notice a peak in flu cases the week and the two weeks after Thanksgiving and here we are a week of Thanksgiving, all of us are kind of bracing for impact and hoping that folks are vaccinated before they start doing their large gatherings and family reunions. I didn't realize that Thanksgiving was sort of like kickoff season for flu's every year. I didn't realize that. Yeah, it really is. Just like, can I have a bite of that cranberry sauce?

Same spoon. I mean, my most vivid memory of flu for myself was at Thanksgiving in high school and I was like, this is, I'm dying. This is it. This is what I get for putting olives on the tips of my fingers and then sucking them off with my mouth and touching everything. Sorry, fam. Well gross and also good to know.

Yeah. Well, where are we at with vaccination rates? Are we right under 60% in the US? Yeah, we're just under 60%, which, you know, is honestly painful. We're just inching along. You know, I do think that the influx of this large eligibility population ages 5 to 11, that's almost 30 million kids in this country, is going to help us. As of last week, I think 10% of that population is vaccinated, so that's almost 3 million

more people, at least getting one dose. But you know, nationwide, we're still under 60% and that's just not ideal. I don't know if you remember, we had those very lofty goals of having 70% by the summer and we're still not quite there yet. Right now, who can get the vaccine? Who is eligible, at least in the US, and how available is it in other parts of the world? Yeah. So, anybody in the United States who is age 5 and older can get the Pfizer vaccine in

the United States. And that is pretty big because that increases, like I said, the population by at least 30 million people in eligibility. Vaccines are not nearly as available in other countries, and that's because some countries were doing very different risk calculus on what was needed based on transmission there. I think a lot of people often compare the US with the UK, the UK has kind of been slow to approve pediatric vaccines because they had such a high adult vaccination rate. But as Delta kind of swept through and as a lot of mitigation efforts were slowly kind

of being eliminated throughout the community, you saw that the pediatric population became vulnerable again, kind of like what happened here in the United States. And so I think that they're scrambling to kind of get that data reviewed to make sure that they can extend the eligibility there. Canada is going to be approving the vaccine for kids, I think sometime this week, maybe? I mean, I could be wrong on that, but it's imminent. I know that they are very eager to have that as well. But when it comes to even bigger than these very privileged, very wealthy countries, the

continent of Africa is like less than 10% vaccinated. And that's horrifying because we know that variants and surges are very, very likely to emerge in under vaccinated and unvaccinated populations. So big, big important data here. The CDC reports that between August and September 2021, when Delta was establishing itself as the dominant strain, that the infection rates per 100,000 individuals were 6 to 10 times higher among unvaccinated people compared with vaccinated people of the same age group. 6 to 10 times more likely that you will be infected with this virus, suffer from it and

pass it on. It doesn't mean that breakthrough infections don't occur. So remember, one benefit to vaccination is not only making sure that you stay out of the hospital and don't get critically ill, but also the more it spreads, the more it mutates into variants. So flashback to last summer, anyone? Delta emerged in India in the context of a very unvaccinated population at the time. They've since now, I think, vaccinated over a billion people there, which is wonderful.

But we, as a global population, have a lot of vulnerability pockets because we don't have equal distribution of the vaccine, and that's very, very problematic. And we saw a big surge in the South in the US in September after a lot of summer cases. But now it's different parts of, at least in the US, that are going up. The Northeast and the Midwest do, epidemiologists know what's going on, what's happening with those patterns? Yeah. We've been following this pretty closely.

I think some of the states that we're watching most closely are states like Michigan, Minnesota, and Colorado. Colorado and Michigan, in particular, have had to amend their crisis care in hospitals, which is always a big red flag too, when you have to start to determine who is most likely to survive, as one of the triage questions when people are admitted to the hospital is a very, very troubling risk calculus that people have to go through in a hospital setting. But it's a cascade of consequences in that Colorado is a perfect example of mask usage and mask requirements are disappearing in a lot of different places.

Occupancy limitations and limitations on gatherings, et cetera, have been evolving as people are getting tired of this and as jurisdictions are ready to have more people become patrons of businesses as the holidays are coming up, and then also changes in weather, right? So Michigan and Minnesota and Colorado get really cold a lot earlier than a lot of other states. And so people are spending more time indoors, probably unmasked indoors for long periods of time with probably people whose vaccination status they might not know or maybe incomplete or even un-started.

So I think it's kind of a combination of the non-pharmaceutical interventions slowly disappearing in a number of places. So far, we haven't seen any signals from sequencing data to show any new variant activity, which is encouraging. I think a lot of people are very concerned that maybe this is a new variant, but so far there aren't any signals for that. But it's probably a combination too of even waning immunity from people who've been vaccinated several months ago, plus people kind of letting their guard down a bit and doing more high-risk

indoor activities. Now, I think that it's important to remind folks, all of this has to be considered as an additive combined effort to slow this rate of transmission, right? It's never one cancels out the other. And I think that's where we often get into this like stop and go pattern with these trends. It has to be combined. It's not that vaccines cancel out masks, it's not that masks cancel out occupancy things. And I think that's a lot of times what's happening.

And when you start to see all of these things kind of decrease in urgency and priority, you start to see surges again. So vaccines are not a cure-all. They're best used in concert with other safety measures like masks indoors, not licking other people's pudding spoons, and outdoor gatherings. And as a person who busts out a parka for 65 degree weather, I totally understand that northern climates might be struggling with it, at least one of those things. That makes sense.

I mean, yesterday I went to a birthday party outside. Whole thing was outside because I live in California. I was wearing a tank top. But if I were in Michigan late November, that's not going to happen. Yeah, no. Okay. So that's really interesting. And that was one of my next questions about variants.

Delta kind of surprised a lot of us in July and late June, July. Are we still dealing with this Delta variant? Has that been a big hiccup in not being where we want to be in terms of these rates going up? Is that much more transmissible? Yeah. Delta was certainly a big blow when it came to our momentum in getting folks to get vaccinated and getting folks to kind of slow the rates of transmission, because you and I've talked

about this before. It's kind of two things that we have to balance at the same time, high vaccination, low transmission. And those two things happen together for the best optimal results. Delta came in and kind of impeded with both. What's encouraging though is that the vaccine data, even in light of Delta, has continued to show that they offer strong protection against severe COVID, that they offer strong protection against hospitalizations and deaths, that even if vaccine effectiveness and immunity wanes a bit, it's not that Delta's canceling that out.

It's just making it more challenging. And that's kind of why we're in this now new phase of the booster conversation. It's very much related to the fact that Delta's kind of complicated this. So now my plans have changed. Yeah. Can you explain breakthrough infections? I think breakthrough infections took a lot of us by surprise, even though we knew that the vaccine would protect us against serious and life-threatening infection.

We knew that it was always like, we don't know transmission rates. That's kind of not the point right now. How likely is a breakthrough infection with the vaccine and the booster? So it's a difficult question to answer very precisely, because we don't actually have a good handle on breakthrough infection data that involves mild to medium cases of infection. The CDC made, in my opinion, a very regrettable decision early on to say that they're only going to track breakthrough infections that involve severe illness, hospitalizations, and death.

And what that does is basically create this cloud of confusion, because we could be knowing the incidents much more. Now what we do know is that the majority, the vast majority, over 95% of cases that are hospitalized. Are among the unvaccinated. Those breakthrough cases that do happen that are acute are often in very, very specific demographics that have been identified as high, high-risk populations. And those were among the first people to get invited to get additional dose, to get a booster

dose. Those who are immunocompromised, those are very high, like the colon pals, right? Those who have a lot of conditions that make them more likely to succumb to this disease because of their pre-existing conditions. Now that said, breakthrough infections are also inevitable in all cases. In all vaccine cases, because no vaccine has ever been 100% effective. But the all vaccines have always been intended to do two major things, to keep you out of the hospital and to keep you alive.

And the vaccines are still doing a remarkable job at both of those two goals. So I think it's kind of calibrating expectations of what the vaccine is intended to do. It's not to prevent you getting the slightest bit sick. It's to slow down the risk of that happening, to slow down the risk of transmission after you get sick and to keep you alive and keep you out of that hospital to free up those ICU beds. So remember, when COVID vaccines were announced, we never knew how much they were going to prevent transmission.

The goal is mostly to prevent y'all from dying on a ventilator or from burying your loved ones or orphaning your kids. The average funeral in America costs $7,640, but vaccines, those are free. So pretty neat vaccines. Thank you. But if you're strutting around alive, quite chuffed that you're vaccinated, and thus you can't be responsible for spreading it, I don't have the best news for you. So one study found that, quote, people infected with the Delta variant generally do not have

COVID-19 symptoms until two days after they start shedding the coronavirus. Or as one August 2021 headline in the journal Nature put it, Delta's rise is fueled by rampant spread from people who feel fine. And while COVID vaccines do cut the risk of transmitting the Delta variant, some studies suggest that that capability wanes after about three months, which is why boosting up, especially before gatherings, great idea. It's ACEs. Do that.

So a late October study, breezily titled, Community Transmission and Viral Load Kinetics of the SARS-CoV-2 Delta variant in vaccinated and unvaccinated individuals in the UK, a prospective longitudinal cohort study, casual, published in the journal Lancet, showed that while the vaccine reduces the risk of infection and it helps your body clear the virus out, get out. Get out of here. If you do have the vaccine, fully vaccinated individuals with breakthrough infections have a peak viral load similar to unvaccinated cases and can efficiently transmit infection

in household settings, including to fully vaccinated context, it says. So I can see your face right now. It looks like this. So why is this happening? Well, Delta, Delta, Delta. So a study carried out by University of California at Santa Cruz found that a breakthrough case with the Delta variant was twice as contagious as one with the Alpha variant of SARS-CoV-2. So one co-author of the study said that their findings, quote, possibly explain why we've

seen so much onward transmission of Delta despite widespread vaccination. We wish that vaccination were a little more widespread, but it is what it is. So despite the vaccines not being totally impervious armor against transmitting, it still affords people a giant advantage in fighting off the virus and being seriously ill if you get it. And Jessica mentioned the death of Colin Powell, who was fully vaccinated and died following a breakthrough case. But he also had a type of blood cancer called multiple myeloma, which if you've listened to the hematology episode from 2018, you might remember my dad has that as well.

So folks even who are fully vaccinated might not make the goods when it comes to antibodies, putting them at risk, especially from asymptomatic folks at gatherings. And I've even heard that some cancer patients are confused if they should even get a booster shot as some information is out there that says other parts of the world need the vaccine more. So just hold off. So a bunch of patrons asked about that too. Very big hearts.

But should anyone in the US at least at this point be holding off on a vaccine in hopes that it gets reallocated? I'll just, I'll give you a hint on that answer. No. Oh, that's such a good question. And I have so many thoughts on this. Unfortunately, withholding from a vaccine dose here does not mean that that vaccine or a vaccine that is allocated in the United States will be on a plane the next day and

then redistributed to a country in need or a population in need. Unfortunately, it doesn't work that way. The doses that have been purchased and allocated and often already open vials that are have a shelf life of X number of days, you withholding from that doesn't have a one-to-one kind of transfer rate to another place. And I wish that were the case. I wish it were to say like, hey, if X number of people decide to not get the booster dose, we can vaccinate this many people in this country because these are like the issue of

COVAX. The issue of donated doses is so much more political and has to do with these big cold chain logistics that are out of reach from your local CVS and Walgreens. You know, oftentimes I've heard from folks who've taken their kids to get the vaccine and they're saying, look, we've got all these doses that are going to be in the trash by the end of the day. Have you had your third dose and has it been six months since your last one? Like roll up your sleeve and take it because otherwise it's going to end up in the trash.

Not a one-to-one thing. And I wish that were the case. And that brings up a lot of issues of why and how come we can't do things like speed up the process of donating these doses and some of it has to do with like just really annoying admin and logistics. Now when it comes to folks who have very acute conditions that make them more likely to have bad reactions to this disease, that's why they were the first in line when it came to the eligibility extension.

That's why, you know, organ transplant recipients were some of the people who experienced the weakest immune responses to the vaccine, which is why they were on the top of the list. If you've received an organ transplant, if you are on immunosuppressant drugs, you are chronically ill. If you're over 65, if you work in healthcare and high-risk exposure settings or if you're pregnant, all of these things kind of increase your risk of having a bad outcome and getting a booster dose, which if you remember kind of why it was a two-dose regimen in the beginning, the first dose was to prime the immune system and the second was to boost.

The third is essentially another boost. It's another kind of like, hey, here's a reminder. This is what the spike protein looks like. If you see this guy kill him, and it's just another, you know, extension of that reminder to your body. And some good news there is that in late October, the White House helped broker a deal between the African Union, which reps 55 African countries and Moderna to get 110 million doses of the vaccine, 15 million of them arriving by the end of this year.

So do not be a hero. Having a half-used vial of vaccine hit a dumpster behind a Walgreens is not saving any lives, especially yours. Or your babies. You mentioned pregnant folks. Any new information that you would like to impart to people who are considering getting pregnant or are pregnant in terms of vaccine efficacy or safety? Yeah.

So it has become very, very clear from data from the UK and from the US that pregnant people are at a very, very high risk of very severe outcomes from COVID-19. So right now, the recommendation is that people who are trying to get pregnant, people who are pregnant, people who are breastfeeding, they should. Not they could, not may, that they should get vaccinated. Now, of course, it's a personal decision and it should be under the counsel of your provider and your OB, but the recommendation is overwhelming from CDC, FDA, ACOG. Really governing body and obstetric care and pediatric care has said that the evidence

is overwhelming, that the fetus and the pregnant person are so much better off from getting the vaccine than getting the illness. There have been some really horrifying statistics about women who are 100% healthy and that end up on breathing machines or end up having to go into preterm labor or having complications that cause the mom to actually perish from the disease. And it's just, now that we know that this is very preventable, severe illness for pregnant people, it's become a very strong recommendation that those folks get vaccinated. If you're like, why is this even an issue, especially if you were born in the 70s when

mom's ambilically mainline fetus' diet Pepsi? Well, see, pregnant folks were left out of the first trials of the vaccine. So we had a big zero for data there. Now it's proven to be safe and it's actually safer to have it. So a study published last month in the journal Science titled COVID-19 mRNA Vaccines Drive Differential Antibody FC Functional Profiles in Pregnant Lactating and Non-Pregnant Women and People. I got you, trans friends.

Noted that baby carriers experience both increased disease severity and morbidity upon infection with SARS-CoV-2. And it went on to explain that when you are cooking a babe, right, you got one in there. Your immune system has to adjust so that it doesn't attack this foreign body, aka the small human you are growing. So immunologically, you're doing a dance of like, keep us both safe from outside things, but also kind of chill out immune system. Don't treat my baby like a boil.

And that can lead to higher susceptibility to infections and pregnancy, including more severe COVID-19 cases and tragically mortality. It also takes pregnant and breastfeeding people a little longer to respond to their first dose of the vaccine. But after the second one, the response is closer to baseline, aka everyone else's. So if your Thanksgiving has more buns in the oven than just some Costco dinner rolls, talk to your healthcare provider about getting those shots. Okay, but which ones?

So many people myself included when I went to go get boosted on Friday. I suddenly was like, when the waiter comes and asks what you want to order and you suddenly realize that you haven't looked the menu and they're like, are you, do you want Pfizer or Moderna? And I was like, I got Moderna last time, but does that mean I should get Pfizer now? Cause I mean, I should stick with Moderna is Moderna, Moderna has higher rates of efficacy from what I've read, but Pfizer changed just for me a little. And so I suddenly was like, what's everyone else getting?

So I got a third Moderna, but what is the general thought on the cocktail of vaccines? If you've got a J&J, should you just like, peace out, J&J, I'm going to get a different, what do you do? Yeah. So, you know, they've done mix and match studies to find out what is the most effective booster or additional dose. And in all three accounts, Moderna, Pfizer and J&J and Moderna kind of performed the best when it came to increasing antibody levels and providing a robust immune response.

All that to say, you kind of have to base it too on what's available to you. The recommendation is right now, if you've had J&J boost with an mRNA vaccine, so Pfizer or Moderna. In case you're like, wait, is J&J mRNA, WTF? Just a reminder, Johnson & Johnson plus the AstraZeneca use an adenovirus vector carrying genetic info from SARS-CoV-2 to school your immune system. So they use a little virus rather than Pfizer or Moderna's vaccine instructions that are delivered via messenger RNA.

And if you've had Pfizer boost with Moderna, that's great data. If you've had Moderna, I think a lot of folks are sticking with Moderna just because the numbers are so good. But in all cases, it seems like boosting with an mRNA vaccine is the recommendation. Good to know. Can I ask you listener questions? People are excited. You're coming on.

They love you. They love you. All right. But before your questions, we're going to aim a money cannon toward our cause of the eulogist choosing. And the past few times she's been on, Jess had us send it to 500 women scientists. But since this is her record third time on, she's switching it up and will donate to Doctors Without Borders who care for COVID-19 patients in treatment centers and hospitals around

the world. They offer health education and mental health support. They provide training for vital infection prevention and control measures. And they support response efforts by local authorities. So that donation was made possible by sponsors of the show, which I genuinely like. Okay. Thanks sponsors. Now, a big question is on all of our minds.

I'm looking at you, patrons, Jess Swan, Kate Striello, Rayleigh Grimm, Rebecca Hatherly, Margaret Downs, Alice Rubin, Ively Sanchez, and me. Biggest question from listeners, holidays. What are we doing? Should we be doing holidays? Is January going to be an absolute shit show of hospitalizations? What are ... What's the matter, Pop?

I'm confused. Yeah. Yeah. It's a fair question and something that we've had to think about as a family as well. So kind of landscape of where we are with data, cases are increasing. We've seen about a 30% increase in the last 14 day average, positive tests are increasing. And hospitalizations, which were static for a while, have now started to inch up. And I think that's likely due to this kind of flu activity that we're seeing.

So since I mentioned Thanksgiving is oftentimes a big kickoff for flu season, I think it's extremely important that people have been vaccinated against the flu and for COVID-19. Dr. Fauci said the other day, and I agree with him, if you are vaccinated and the people that you are going to be spending your holiday with are fully vaccinated, that you can do so with ease, making sure that people are being mindful of any symptoms that they've had or any high risk exposure or activity they've had. If you feel like there's a question, take a test. I think that sometimes people use tests a little bit inappropriately for kind of red

like green light of what they can do. It's important to remember that a PCR test is probably their gold standard for letting you know if you have the virus and an antigen test or rapid antigen test is great if you're feeling kind of crummy and you're like, I just need to know that this is not COVID. That's the best time to use that test. It'll tell you if you have COVID-19 and especially if you're infectious because it's best if you take it if you're sick or symptomatic. So those are ways that you can have those holidays and do so with peace and not do so

on Zoom. You can do it in person and enjoy a wonderful meal with family and loved ones. So to recap, get your eggnog on as long as everyone's vaccinated for both flu and boosted with COVID 14 days beforehand. And if you want a surefire way to know you don't have COVID, take a PCR test and rely on an antigen rapid test. Really only if you feel sick, but you want to make sure it's not COVID. Then you can eat string beans, covered in mushroom soup.

Maybe hopefully outdoor dinner, anyone? Bust out the parkas. That said, it's recommended and I agree with this recommendation that if you're not vaccinated that you don't travel. Some people have a really, really hard time with that. I think it's, you know, very discriminatory, but I also think that we are in the really difficult time right now with this pandemic, especially at this risk of a twin-demic of flu plus COVID.

With twins. That's right. That we know that if you are vaccinated, you're less likely to get the virus, to transmit the virus, and to get really, really sick with the virus. And so we want to eliminate as many variables when it comes to movement because a lot of people move during the holidays and they are on planes and trains and all kinds of things just to see people. I don't think we're out of the woods.

So it's not like everything's back to normal and everything's as bad as it was before because we had vaccines this year, you know, and that changes the game. We didn't have them last holidays. And so I think that people can still enjoy some holidays and some gatherings without as much fear and limitations as last year. Now what if you're cramming your pre-party immunizations into one afternoon? Is that a terrible idea? A lot of folks had questions about the flu shot as well as getting the booster, taking

them at the same time. Some people like Vanessa Frey wanted to know, is it safe to get a booster shot and a flu shot on the same day? Other folks like Kathleen Sacks said, I got the Pfizer COVID booster and the flu shot on the same day. The combination knocked me on my ass. So their husband says that it was the combo that knocked him out. But Kathleen says, I think he's making things up.

So Vesperhally says, I was told it was not recommended to get them both on the same day. So if you're going to get shot up, should you do them both on the same day or should you give yourself some time in between? So it actually is totally fine to get it on the same day and the same visit, especially now that we're kind of already well into flu season and the recommendation to have gotten your flu shot was ideally before Halloween. And so I would say nobody would recommend you delay that. You can get it on the same day.

The recommendation is you could split the arms, you can have one on one arm and one on the other. I think that most people often have a reaction to the COVID-19 vaccine, more so than the flu vaccine, just generally speaking from like people's experiences so far. And typically people have their reaction to the booster dose that is similar to or maybe a little bit less than the second dose. So kind of go in expecting that you could feel a little crummy, but it's not going to be harmful to you.

I think delaying one or the other would create more harm than getting it on the same day. And there's no recommendation to space them out. Okay. And as long as you're going to be having soup, have that soup, hang out in bed. Yeah. Plan it on a day where you can be low-key and just watch Netflix. Exactly. Katta Zirondi and Vesperhally, I think people want to know what's up with the effects of

the second and third shot? Why is it worse than the first one? No question. Why did I get so miserable after my third Vax? Vesperhally asked me too. Can you explain a little bit of what our immune system is doing to kind of knock us on our ass while we are making more antibodies? Yeah, that's such a good question.

So remember we were talking about earlier, the two-dose series was intended to give a preview to prime the immune system to kind of give an introduction to the antigen, which is the spike protein of the virus, and say, hey, this is what this looks like. It's not the whole virus, but all you need to know is what the spike protein looks like because then the antibodies can attach to the spike and make it impossible for it to enter the cells. So be on the lookout. The boost is kind of like a, you know, the first one is like a quiz and the second one

is like a test where it's like, okay, here we go, reminding you once again that this is the spike protein and the body kind of goes, kicks into gear and says, we've already seen this guy and it sends all those immune cells to the injection site and starts fighting it and creating more antibodies. And that process can make you feel kind of lousy. That process is your body kicking in saying, hey, there is something here that shouldn't be here. Let's fight it.

Let's kill it. And it can cause your physical body to feel a little crummy in the process of it doing, kicking it into high gear. The third dose is essentially a second boost. It's a second reminder to the body to say, hey, this is what you should be fighting if you see it. But again, it's not the actual virus, so it can't get you sick. It's just giving a preview of it, saying if you do see this, kick its butt, make sure

it doesn't infect cells, make sure it doesn't replicate inside cells so that you don't get very sick. Okay. So the vaccine absolutely puts those spike proteins on blast. Like this Facebook group I was in full of LA girls that would screenshot dating profiles and be like, do not date this guy. Girl don't. He will give you a scabie scare and then steal your PlayStation before ghosting you

for a former American apparel model. And yes, like the vaccine booster, it might make you feverish and achy, but you're much safer. So how often will our immune systems need to be reminded what this jabroni looks like or if he has a new alias? Katta Zirondi, Rob Lara, J.C.M., Sarah Wells, and Alina all had annual type questions and so did others. We had some questions about yearly boosters.

Cameron Brown and Katta Zirondi want to know, will we need to get boosters once a year or what will be the procedure to remain fully vaxed? And Alia Meyers wants to know, so is corona officially endemic? Is it like the flu? Is it like the cold? Yeah. Your listeners ask the best question. Literally, it's so, so good.

So first question, the definition for fully vaccinated has not changed and will likely not change for a good bit. And I think that should provide some comfort to folks. It's not that we are changing this and saying, you know, in order to be protected, you must get a booster. If you look at the language of what the CDC and FDA and ASIP said this last week, it said that those who are in these high risk populations should get boosters. The rest of the population that's 18 and over may get boosters.

So it's not an obligation to do so. It's saying, hey, this is a nice to have and it's available to you if you would like it. But the definition of fully vaccinated has not changed. You are still fully vaccinated. If you've received two doses of the mRNA vaccine, now there is, of course, that debate of like, should it have always been two doses for J&J? Regardless, the definition has not changed. Now that said, when it comes to the frequency of boosters, we don't know yet, right?

Time and data will tell and so much of that depends on how many more people get vaccinated and how slowly we can reduce the rate of transmission. Jess says that so much of that depends on how much we can slow that transmission rate and how many people get vaccinated. Because remember, you are contagious for less time if you've gotten the jab. And right now, people are just straight up over quarantines and 30% of the adults in the US have yet to get their first shot. So if I were to bet or predict, I can see a COVID-19 vaccine becoming an annual vaccine

similar to the flu vaccine. But I don't think that we are ready because of the data to say anything like it's going to be every six months. Now when it comes to endemicity, that is very much the future of COVID-19. And I don't think that we should be sulking or looking at it as a failure. It's a very kind of common outcome for an infectious disease. H1N1 became endemic, right? It's a very regularly circulating flu virus now.

And endemicity is something we can manage through what I just mentioned, through high vaccination, through low transmission, through over time a human immunity, like what we were talking about before, herd immunity, where this disease becomes more of a nuisance and less of a catastrophe to our society. So it's very likely that this virus is here to stay. But we are going to be better for it over time as we have more people immune and more people vaccinated and hopefully less and less disrupted by this disease. It won't be a pandemic forever, but this disease isn't really going anywhere.

Isn't that wild? I keep thinking back to March 2020 when I thought two weeks was just an extraordinary amount of time for everyone to hunker down and Marie Kondo their closets. What a historic two weeks this will be, my tiny, optimistic, naive brain said to itself. Some folks like Celeste wants to know why natural immunity is not being considered as protected in the US, but it is in Europe. So if you've already had COVID, what's your antibody status? If you've had it maybe once or twice or whatever.

Yeah. Another great question. So there's no denying here in the US that natural infection elicits an immune response. What is not usually included in that conversation is the fact that it's not standardized, right? Person A could get COVID, person B could get COVID, person C could get COVID, and they could have three wildly different immune responses. Some could have some antibodies, some could have a ton of antibodies, some could have zero. And sometimes it's dependent on whether it was a mild infection or a very severe infection

and sometimes it's just completely random. So because of that, and I've actually read some papers that are very interesting about how COVID-19, it kind of almost doesn't really act like a normal virus in the sense that usually you do have memory of a virus when you've been infected to protect you from getting sick from it again. But that memory isn't as strong as it is with other diseases. So I think people often try to compare it to like, oh, well, you know, remember back in the day when they would send us to school to get chicken pox, I'm like, well, one, that

was pre-vericella vaccine. And two, we didn't know any better, right? We knew that like that was the best way to prevent a reinfection, to prevent getting sick again. But it's also proven to be a complication for other folks. It increases your likelihood of getting shingles later in the future, it made other people have other issues later down the line. And I think comparing the two is not apples to apples.

So because of that, we know that the vaccine actually elicits a much broader immune system response that includes things like B cells and T cells. What do those do? Okay. B cells are amazing because B cells create more antibodies over time. They create more antibodies even after you get infected and it's like, oh, hang on, I need more of these guys to come kick in and like fight this antigen. And T cells are like killer cells that go in and they actually kill the virus.

So because of that, it's not a fair comparison. It's not that they don't mean anything. In fact, there is data from here in the US and from Israel and the UK to show that folks who were previously infected and vaccinated are among the most protected in the population, which is pretty cool. Hey, who there had COVID and a vaccine? Who? Yes, you.

Treat yourself to a tiny imperceptible butt dance in celebration. You deserve it. But. But getting an infectious disease is not a public health strategy to manage infectious diseases because of the unknowns of COVID-19, right? The unknowns of who's going to get really sick. The unknowns of who's going to get long COVID. And that is something that we are still learning about and it's way too risky to play that

game. And is long COVID considered kind of like a chronic inflammatory situation at this point? It really depends. Again, it's not like a very uniform condition. Some people recover from COVID and then have a reemergence of symptoms. Some people, you know, experience a nausea, which is the loss of smell and taste. And then months later develop perosmia, which is like an altered sense of smell and taste where food smells rancid and taste rancid and they can't really tell what's spicy and

what's not. Some people have prolonged tinnitus, which is the ringing in the ear. Some people have chronic inflammation because this disease is respiratory. It's vascular. It's neurological. It's all these things. Well, because of that, I mean, especially in kids, this complication missy, the multi-system inflammatory condition, is very risky for kids because essentially it is a very severe

inflammation response that can cause things like myocarditis and pericarditis. And in many cases, if it involves hospitalization, it involves death in that pediatric population. Now, a few folks asked about vaccine side effects. And if there are any common lasting ones other than just better survival rates, I've never died, but it seems like survival is a nice side effect. But there are databases that collect info from people about their side effects, mild side effects, how long they last, their severity, although Jessica notes that because those are open databases, it's a little bit harder to parse out who has been logging what side

effects and the legitimacy or motivation behind reporting them. But if you get an annoying text from vSafe after you receive a COVID-19 vaccine asking how you're feeling, let them know because it helps scientists and your fellow humans. Now, as far as deaths resulting from the vaccines, among 442 million doses of vaccine, five deaths have been directly linked caused by blood clots resulting from the Johnson and Johnson vaccine. And now the doctors know this correlation. They can better prevent and treat it if it happens in the future.

The experience of severe adverse events are exceptionally rare. And the CDC and the FDA review every single report of a severe adverse event, especially those that involve death. They go through everything like medical records and you know, coroner reports and autopsy reports all etc. Just to make sure that they understand like what the actual risk benefit profile is for these vaccines. And so far, it seems that these vaccines are very well tolerated in every population, even

more so among the kids. And that's probably because they got this like perfect dose for them, like this 10 micrograms seems to be clutch for that age group where they have very, very mild reactions, very short lived reactions that resolve between one to two days. And most reactions post vaccine happen within hours, days, maybe weeks after vaccination. And so it's very unlikely that something were to happen like tinnitus or like a chronic inflammation several weeks later after the vaccine. Now that said, there is a concern with the incidence of myocarditis among adolescent

boys post vaccination. Now that risk, if you actually look at the incidence of myocarditis with COVID is less than that. Not to mention the fact that myocarditis is an exceptionally difficult thing to diagnose. You kind of have to do an invasive biopsy to really get confirmation of it. And there's actually a plethora of viruses that can cause it. So it's not something specific to COVID-19 or even COVID-19 vaccines. And so I think this is where risk and hazard kind of get a little bit cloudy because you're

dealing with the kids and people get really anxious about that. Okay. I looked into this and one expert on pediatric heart inflammation, someone named Dr. Brian Feingold at the Children's Hospital of Pittsburgh, echoed that COVID-19 itself is much more likely to damage the heart permanently for those worried about their little ones. Now, from Smologites to other little critters, a couple more questions if you have a few minutes. Of course. I love it.

A lot of folks, Derek Allen, Kathleen Sacks, Alia Myers, Annalisa DeYoung, Lauren Harder, Susan Gottlieb, all had great questions in Annalisa's words. Cervodological or zoonotic, full illness question. Annalisa lives in Michigan where white-tailed deer are almost as ubiquitous as squirrels and some recent studies have come out saying that deer are just lousy with COVID. What? Are they getting it from us? Are they getting it back to us?

What's happening? Yeah. Yeah. It's so, so interesting. So, you know, zoonosis and zoonotic diseases, I studied emerging infectious diseases in grad school. So we spent a lot of time talking about animals. And if you look at the history of human diseases, about 50% of them have some sort of animal

origin. It's not that surprising that, like, we are dealing with something that spilled over from an animal species to humans. Now, it can go the other way, too, right? If you probably remember earlier, I think it was either earlier this year or late last year because what is time, there were minks on a farm in some place in Europe that got it from the people who were on the farm and they had to cull all those minks. It was horrible because diseases can transfer from host to host when there are sufficient

mutations that allow it to be transmissible and infect another host species. Now, there is some really interesting data to show that deer are catching COVID, likely from humans. Oh, deer. Servids with COVIDs. Okay. So according to a study published by the National Academy of Sciences, literally today, it was just published today.

This is the freshest hell episode, people. The researchers wrote, we evaluated 624 serum samples from wild deer in four U.S. states for SARS-CoV-2 exposure and antibodies were detected in 40%, 40% of the deer. So, Illinois, let me hear you say COVID deer, Michigan, COVID deer, New York, you have COVID deer, Pennsylvania, don't feel left out, throw your hands up for COVID deer. In Iowa, a recent study also suggests 80% of your deer have a touch of the COVID. So what if you're one of the 45 states that were not included in these studies? Don't worry, you probably have COVID deer too and scientists just haven't tested yet.

So how are the deer getting it? I read this whole damn article to find out, who's sharing smoothies with deer? What's happening? Are people going to the movies with deer, casinos? So scientists postulate, quote, multiple activities bring deer into direct contact with people, including captive servit operations, okay, field research, conservation work, wildlife tourism, wildlife rehab, supplemental feeding and hunting. Contact with contaminated water sources has also been suggested as a potential transmission

route, they say. Now, Atlanta, let's hear it for COVID orders. Yes, seven at the Georgia Aquarium are recovering behind the scenes after showing some symptoms of sneezing, runny noses, lethargy and coughing, which I'm sorry, but a lethargic otter. Ah, they only get cuter. They're very much on the mend. They're going to survive. But zoo tigers, gorillas have tested positive for COVID.

Some apes at the San Diego Zoo are even vaccinated, which I think should count toward California's vaccination rates. They did their own research and they were like, jab it up. Nature is probably going to be a ton of research on other populations to kind of see which animals that are in close proximity to humans have detectable antibodies or who have, you know, culture-able virus in their body. But it's something that like we're still learning about because we know that this disease is not done evolving because it continues to spread and that presents a challenge to not

just humans, but to animals that live in close proximity to us. That stuff is so, so fascinating. Not something I thought, you know, as they say, would be on the bingo cards. Yeah. Like dear, haven't COVID, didn't even consider it. Bats are like, don't look at me, man. Speaking of cards, how about vaccine cards? I mean, even the idea of vaccine air quotes passport is not something new, right?

If you've been a traveler and you've traveled to places like Southeast Asia or to Africa, most likely had to get a yellow fever vaccine and you've had to probably present what we call a yellow fever card. And that is considered your passport to allow you to enter a country that has a high incidence of that disease. In the same way that, you know, in order to enter a college, you have to, especially if you're, you know, traveled or if you're an international student, you need to do a TB test regularly to make sure that you are not carrying this very, very transmissible disease.

Vaccines have always been intended to be part of a way for community to continue to be a community, to exist together. And anytime there are situations in which the incidence of a disease could present a, you know, barrier to those communities existing, whether it's schools or whether it's military or whether it's people getting on airplanes and traveling to other countries, there has to be a way in order to protect the general public. And vaccine mandates and vaccine requirements have been very, very standard in that case. Now, when it comes to things like healthcare settings too, think about all of the vaccines

that your provider has to get so that they as your provider are not causing harm. When you're in the, you know, hospital, you see them wearing badges that say they got their flu season vaccine. There are just so, so many instances in which this has been part of the process. I think that right now, because of this, all eyes are on the regulatory system, which previously only had like us nerdy eyes really looking at it because we were the only ones who really cared. Everybody's scrutinizing things like emergency use authorization versus FDA approval.

And I think I've said this multiple times and it's worth repeating. The standards for things like safety and efficacy are no different. We have EUA's in the case of emergencies and we are very much still in a public health emergency. So when it comes to these vaccines being mandatable, there is still precedent for that because we have provided enough data, in fact, more data than any vaccine in the history of vaccines to show that these vaccines create benefits to our communities. And I think that once these vaccines in all age groups receive their full FDA approval

5-0, having already received that for the adult population, we'll start to see more. But I am very grateful at the end of the day that we used this EUA so appropriately to show the sense of urgency without cutting corners, without taking any shortcuts on things that matter like safety and efficacy to make sure that we have these tools in our toolkit to help actually alleviate the burden of COVID-19 in our population. What I wish could have been more prioritized was a comms campaign to go with it, right? We spent all this money on the regulatory process to make sure that Operation Warp Speed was able to develop and distribute, manufacture, et cetera, all these vaccines.

My job is endless because we haven't really put all of the messaging and the communication strategies necessary to make this easy for people to make an informed choice. And that's why we're still at what 59.1% vaccinated. And that's what I think the most frustrating is this thinking of science communication as an afterthought and therefore kind of fueling things like vaccine hesitation and vaccine confusion and even allowing the space for misinformation to kind of take hold in people's minds. Have they done any data crunching on how many deaths these vaccines have prevented?

Well, I do know that most recently when we hit that horrible milestone of 750,000 deaths in the United States, which is already an undercount, that the last 200,000 deaths in that amount were vaccine preventable. And that really shook me to hear, to know that that number did not have to grow, that number continued to grow in the absence of vaccines at a rate that was very troubling. You know, when I was working at the COVID tracking project, when we hit these huge milestones, we would just face it with such dread. But now we have these tools to prevent death.

And it kills me that the number is not actually stopping to grow. But throughout the pandemic, Jess has been such a trusted and reliable source for information answering questions via Twitter and her Instagram stories. And I am 100% positive that her work in this space has saved lives, full stop, rather not full continue. And, you know, on that note, last question from listeners, Jasmine Alexandra says, what are some good resources to share with family members who haven't or won't get vaccinated? And what's the most effective way to approach the conversation?

Obviously, I think a lot of that is fear based. And so it never seems good to try to discuss fears with anger and condescension. Any thoughts on that? Yeah. You know, I recently shared a post about this because the holidays are coming. We're probably going to be seeing some of those family members whose politics and views on science we wildly disagree with. And it can be very difficult to be in close fellowship with them. But I will say that listening is actually more effective than you think.

Because at the end of the day, it really is sometimes fear or it really is sometimes history or trauma or really, really real experiences that are ignored by either their medical provider or their community or people around them who can't help them cross over from fear into knowledge and, you know, empowerment to make those choices. So I think listening first before reacting and before trying to outdate somebody and before you try to out fact somebody or to question their sources or to mock and name call, all of those things at the end of the day cause more fear, cause more division, cause more shame and isolation.

And people don't make good choices when they are bogged down by those sentiments. So I think that helping folks understand that there are trusted, reliable resources, helping folks understand that this isn't about politics, that this is about community, public health and that those are very good altruistic things that we should all kind of ascribe to that's, I mean, so think about us who have children, like how many times a day we spend teaching our children how to be good humans, how to be better members of society. Like this kind of all boils down to this of how are we going to be better people in our communities and not live like we make individual choices and only exist as individuals.

When you kind of wrap those messages together and show people that, you know, vaccines are not just for you, they're for everybody. It can kind of soften some of those very strong feelings of isolated individual health. But on the bright side, favorite thing about what you do. I already know the most frustrating thing. Obviously, it's pretty clear favorite thing about this work. I, to see people desire to do this work, knowing how frustrating it is and feel inspired to enter a career of public health, epidemiology and even science communication is very inspiring to me.

I've spent a lot of time doing like teaching and education and actually doing so informal classroom settings and I didn't know how much I enjoyed that. And to see folks be like, how do I do what you do when I grow up is deeply, deeply motivating to continue doing this work. And you're obviously, you give out so much great information on Instagram, on Twitter. Are you being pressured into TikTok? I'm being pressured constantly to do TikTok, but it scares me. I'm so scared of TikTok.

I cannot. It stresses me out. Same boat. I just did an episode with Hank Green about TikTokology and I just joined. I have two videos. It's going poorly, but I will text you on the side if I figure out how to use the buttons because obviously your services are needed on as many platforms as you possibly have the bandwidth for. I mean, your push has a lot of weight in my brain.

So like that's very motivating for me to give it another shot or at least think about it, pray about it. So ask smart people questions that seem obvious, but are really not. So for more on Jessica Malati Rivera, follow her at the links in the show notes. Pressure her to learn TikTok so she can teach me how to get better at it. Find us at oligies on Twitter and Instagram. I'm at Allie Ward on both Allie has 1L and Allie underscore oligies on TikTok. I do that poorly.

Thank you to Aaron Talbert for admitting the Facebook oligies podcast group full of great people. Hello, oligies, subredditors. Thank you to sister team Bonnie Dutch and Shannon Feltis for the merch help, as well as Noel Dilworth and Susan Hale for helping with so much behind the scenes. Emily White of The Wordery is a professional transcriptionist who makes transcripts, which are free at alleyward.com slash oligies dash extras alongside some bleeped episodes by Caleb Patton. If you need them, Stephen Ray Morris and secret Rodriguez Thomas help make smologies,

which are small, shorter versions of classic episodes that are classroom safe. Those are up for free every other week in the feed. Nick Thorburn wrote and performed the theme music lead editor is the exceptionally infectiously witty Jared Sleeper. And if you listen to the end of this, I tell you a secret. And this week it's that. Number one, this episode was so stressful to make just because it's such a quick turnaround. And also some people's families you're gathering with, everyone is vaccinated.

You're like, who doesn't get vaccinated? But there are a lot of us out there who might be attending gatherings with a mixed vaccine status for various reasons. And honestly, I'm not going to lie. It's a little stressful to be like, I hope no one has this and passes it on because honestly, everyone just wants everyone else to be okay. It's a little difficult. So if you're out there and you're like, whoo, and doing some breathing exercises to try

to figure your holiday plans and try to forecast your entire future, I get it. And I see you. Anyway, stay safe as you can. Another episode will drop later this week, which I think you will like. It'll come out on Sunday. And then we're back to our regular schedule. Okay. Be safe.

Masks up if you can. Bye-bye. I know that a squirrel built a nest under the barbecue lid. Let's see if he's in there. Okay. Watch this. There he is. You can see him.

He's right there.