Face Dances

Today will be covering some science, some philosophy as we inch closer to summertime.  Topics will include some quick disease burden updates, masks, vaccines, and becoming a card carrying member in society.

“Another Tricky Day” by The Who from the album Face Dances, the band’s first after the death of drummer Keith Moon

“We all get it in the end
(Just gotta get used to it)
We go down and we come up again
(Just gotta get used to it)
You irritate me my friend
(This is no social crisis)
This is you having fun
(No crisis)
Getting burned by the sun
(This is true)
This is no social crisis
Just another tricky day for you”

Hot Off the Presses, from the Journal of “Duh”

Stating the Obvious:  A Brief Update on Disease Burden

Right now, things continue to look great!  The number of cases per day is the lowest since last June.  Even more impressive is the number of weekly deaths is at the lowest since the beginning of the pandemic.  In New York last Sunday, there were more deaths inflicted by the Knicks ripping hearts out, losing their first playoff game with 0.9 seconds remaining, than there were from COVID-19.

Stating the Obvious:  COVID-19 Vaccination Rates Have Increased

Currently in the United States, we have fully vaccinated 39.8% of the population, and that number is rising, albeit it at a slower pace.*  Is this good or bad?  Depends on perspective.  Knowing that nearly 300 million doses have been given in the US and 1.7 billion doses worldwide, the general safety of these vaccines is now well established.  These vaccines are safe.  Furthermore, they are protective.  The good?  We are way ahead of the rest of the world in protecting our population as only 5% have been vaccinated worldwide.  The bad?  The fact that about 1/3 of adults in the United States have no intent on being vaccinated is horrifying.

*Technically, it would be hard, in the short term, to decrease vaccination rate.  Now if those chips in them lead to spontaneous combustion on July 4th……

Lee Roth or Hagar?  Who cares, it’s all about Eddie!

How Did We Make It Here?  Where is “Here” Anyways?

At some point, folks will engage in statistical debate as to how we arrived at our current point in the pandemic.  Fact is, the current numbers are getting better.  They are getting better all the time (they couldn’t get much worse).  As with most issues where a multi-prong approach was undertaken, there likely will be no single answer to how we arrived at our current place in the pandemic.  Part vaccination.  Part masking.  Part distancing.  Part viral mutation.  Part voodoo.   Continued data gathering and multiple regression analysis may assist in identifying how much of a part each intervention played and may help when the next pandemic hits.  Hopefully that will  not be for another 100 years or so.

So where is our current point in the pandemic?  I believe we are watching the beginning of the end of it.  It is not over yet, especially on a global scope.  There is still risk involved, but if we play are cards right, not only are we gonna have a great summer, we should avoid further surges akin to what we all lived through this past fall and winter.

“Hey Doc!  You Saying I Can Enjoy My Summer Now?”

Yes, you can!!!  I would anticipate that the level of disease burden should remain low for the duration of the summer.  This does not mean COVID-19 no longer exists.  This does not mean that you cannot contract it.  Basically, it is not an invitation to be attending some indoor rave or similar higher risk activity maskless without being vaccinated.

“Doc, You Said Enjoy My Summer…..Do I Still Have to Wear this F*&@ing Mask?”

So here is where science is going to meet philosophy.  If EVERYONE followed the CDC guidelines, if vaccinated, you should feel safe maskless in nearly all situations.  The CDC released some updated data this week on breakthrough cases.  To date, 10,262 cases of COVID have been reported among the vaccinated population.  Of these, 29% had no symptoms.  10% of breakthrough cases required hospitalization, and 2% resulted in death.  To fully grasp how well the vaccine has worked, let’s present these numbers a smidge differently.  101 million people in the United States were fully vaccinated at the time of the data pull.  There were 160 deaths due to COVID in this population since vaccinations began.  There are still 4,000 deaths EVERY WEEK in the United States due to COVID.  The vaccines work.  There is no other way to spin that.

Here’s the rub though…..brace yourself, cause this is shocking.  There are a lot of dishonest folks out there.  Alright, not shocking, but is an issue.  Until very recently, mask mandates for anyone had not been lifted.  The data on breakthrough cases is therefore not reflective of how things will pan out when running around maskless.  My wager is that the vaccinated will remain very well protected, though there may be more breakthrough cases due to non-vaccinated folks running around maskless yet claiming they are.

While in a gambling mood, my next bet is that many of those out and about still wearing their masks are those who were vaccinated.  Lastly, I will double down that the majority of the unvaccinated are also not wearing their masks.  Much of the blame on this I place at the precipice of our politicians on both sides of the aisle who have continued to act with disregard for our population in the spirit of battling one another.

If you are vaccinated, therefore, my suggestion to you, for the time being, is enjoy freeing that face of yours if you are outdoors in a non-crowded situation.  Feel free indoors with folks you know if you are all vaccinated.  What you are waiting on at this point for complete freedom is a bit more data to show that even exposed in these areas you are not at risk.

Kids and Camp

If your only consideration regarding sending your child to camp is whether it is safe at this point in the pandemic, the answer for nearly all is “Yes!”  If you live in a home with people with major risk factors if they contract any illness, you may wish to reconsider.  If that camp is outdoors, and the rates of new COVID-19 cases remain as they are or better, let them enjoy it maskless.  More on maskless kids in a bit.

Paul McCartney, “The End of the End” off the album Memory Almost Full

The End

Sounds nice?  Agreed.  What do we need to do to ensure we can place that label on this pandemic?  Easy answer.  Vaccinate everyone for which we have assessed it to be safe for.  And not just here, we need to get this done for the world as a whole.  As long as there are bastions of illness worldwide, there remains risk of variant emergence that the vaccine will not be protective against, and risk of importation.

“What About Myocarditis in Kids After the Vaccine?”

The recent news regarding possible risk of myocarditis in younger individuals after vaccination against COVID-19 is a great example as to how the system is intended to function.  The clinical trials conducted to date demonstrate that the vaccine is safe with respect to significant and more common side effects.  Rare side effects can escape detection in clinical trials, and that is why we continue to monitor data in perpetuity with vaccines.  The data that triggered the question regarding myocarditis post COVID-19 vaccination can be found doing a VAERS site search.  VAERS will display all reports, and is great for fishing, but by no means are all reports vetted nor intended to show a causal relationship.  It is a great way to identify concerns requiring further attention.  As of today, there have been 154 cases of myocarditis reported post vaccination on VAERS for individuals ages 6 though 30 years of age.  There have been over 5 million vaccines given to adolescents ages 12 through 17 to date.  Assuming all of the 154 cases were in that limited age band, we would be looking at a 3 case per 100,000 vaccine rate of complication.   The next question of course is how often would there be evidence of myocarditis if those same folks were to have gotten COVID-19 infection itself.  This is what was the concern last year with the Kawasaki like syndrome some children were admitted for.  COVID-19 appears to cause myocarditis in about 4.5% of adults, but I could not find accurate data for similar in children.

Bottom line is that there may or may not be any additional risk of myocarditis from COVID-19 vaccination in youths.  If there is risk, it is extremely rare and should not dissuade young people from getting the vaccine.

Common Sense

Just because it is such a recurring theme……there are no chips in the vaccines.  Think about it folks.  You are so concerned you are being tracked by chips in a vaccine.  Yet you all sit in my office with smartphones and tablets.  Big Brother could easily be listening and watching you all day and night.  And that doesn’t bother you?  Seriously people, if the goal is to track people, there are a litany of far more efficient and superior ways to do this.

Also, there are no magnets in the vaccines.  Don’t show me another video from YouTube as proof.  Such a powerful magnet to hold up a coin on an arm would cause damage in an MRI machine.  Haven’t heard about shrapnel coming out of arms in an MRI?  Don’t think that there haven’t been tens of thousands of vaccinated folks put through an MRI yet?  Nobody has been requiring Stark Industry devices to stabilize their magnets before an MRI.

The vaccine is not “gene therapy.”  Vaccines using mRNA as a means to produce proteins for the body to target is not able to alter your DNA.  The vaccine is not a retrovirus.  There are no experiments ongoing to alter the DNA of the masses.  Unless they are spiking your drinking water…….

Let Darwinism Apply

Based on current data, it appears that if you are vaccinated, you may return to life as normal.  The recommendations made by the CDC reflect such.  With the assumption that the relaxation of the rules for the vaccinated are in reality relaxing the rules for all, the question that will be answered shortly for all is whether that poses a real risk to those who are in fact vaccinated.  The data reviewed to date has largely been accumulated in a society in which masks and distancing restrictions have been the rule.  The best scenario is that the vaccine induced protection continues to perform similarly with the added opportunities for disease exposure.

While I wish that there was some form of warning given —  something along the lines of “you have six weeks until we lift all restrictions in the United States as it pertains to COVID-19,” there was none before making the change.  Enable anyone who wants the vaccine to get it this week and be completely vaccinated at the time of restriction lifting.  Reason for the warning?  Again, there are too many people that are not vaccinated that will simply be behaving as if they have been.  At the same time, if they cannot harm a vaccinated person, then it is unreasonable to permit people to both elect non-vaccination for themselves and maintenance of restrictions on others.

Sitting from my vantage point, I know how this ends for many of you.  You really don’t think that COVID-19 can hurt you.  Until it does.  You don’t act to protect yourself out of fear that you will cause harm to yourself.  I get it.  You are past the experimental phase for this vaccine.  Don’t become a statistic.  First time I witnessed how these fears become a bad reality?  When a patient with Down’s Syndrome was not vaccinated by a parent because they thought vaccines would worsen their child’s issues and the child died from a vaccine preventable bacteria that caused an ear infection and then went straight to their brain.

Miles Davis, “The Mask (Parts 1 & 2)” live in NYC, June 1970

Vaccine Mandates for Work and Proof of Vaccination

Similar principle as mentioned in last section applies here.  Do non-vaccinated individuals place vaccinated individuals at significant risk?  If the answer is no, then let people have their choice.  If the data begins to show that non-vaccinated, unmasked individuals are leading to increased breakthrough cases in the vaccinated population, it will need to be revisited.  Choice is fine when the only harm is to yourself.  It is not when you harm others.  Think this is unfair?  Let us review some other common situations you don’t think twice about regulating for the same reason:

Needing a driver’s license to drive a car.  And, even with said license, not being able to drive your vehicle 140 mph down the Long Island Expressway after pounding drinks with friends.

Not being able to smoke [favorite flammable leaf] at your desk at work.

Not being permitted to use a public pool as a place to defecate.

Never been applied to an infectious disease you say?  Read up on Thomas Guerra.  He intentionally spread HIV.  Is showing up to work with cold symptoms when non-vaccinated in the COVID era escalate to the same level?  Let the debate begin.

I will state that I am not a fan of having to carry cards around as proof of immunity.  I think it is a slippery slope, and don’t want to see it in society.  At the same time I can see how an employer should be able to mandate it in many cases.  You want your health care provider unvaccinated and unmasked treating you after treating COVID patients?  Less obvious, but how about your hairdresser?  From a customer service perspective there are many that would demand vaccination from those working with them and the employer should be able to offer such service.

Ponder, because this is going to be the most critical upcoming decision for society.  How to regulate good behavior without the State being too invasive.  Perhaps in deciding a path through this, we can find ways to manage firearms.  Yes, people have a right to them.  The frequency of inappropriate usage though is disturbing.  Bullets and breaths, very different in some ways, but both capable of leaving all parties in a box.

Lastly, it is really easy to make counterfeit vaccination cards.  If you are interested in learning how to make your very own fake zircon encrusted COVID-19 vaccination card, click here for step by step instructions.

Kids and Masks

The kids are not the issue here. They rarely get significant illness.  They almost never have fatal disease.  Why mask them?  To protect the adults that refuse vaccination?  The same adults that also refuse to wear a mask?  Everyone at this point who desires a vaccine can have one.  Protect yourself.  Free the kids.  It cannot be any simpler than that.  As stated earlier, you cannot reasonably expect to be able to both choose not to protect yourself and insist that others be restricted to protect you.  It is the definition of selfish.

Soundgarden at Lollapallooza 2010 performing “Face Pollution”

And Because I Am Still Angry…..

Someone saw fit to send an email accusing our office of several heinous activities.   Started with a simple comment to our vaccine request email address: “This is promoted for children…..ridiculous.” Quotations are directly from the email I received for responding as follows, remainder is commentary for your knowledge and/or amusement.

My response? “I am willing to entertain discussion. Is there some data you are looking at that is driving your commentary?  Are your feelings the same for adults?  What proposal do you have for ending what has been a costly pandemic (and I mean the cost of lives, not financial.  Money comes, money goes, but death is permanent based on my life experience)?” I know, perhaps a bit sarcastic, but would you expect any different from me at this point?

Here are accusations that followed and some answers should you share the same concerns:

“There has been an over abundance of fraud (insurance coding) and it’s disgraceful”

We assume this is a reference to a commonly held belief that everyone is using the system to profit off COVID-19.  Insurance companies made record profits this year.  This is possible only if they generate more in premiums than they spend on care.  Since the premiums did not change in advance of the pandemic, this means that less was spent on care.  Not surprising since there were no elective or non-urgent surgeries, people deferred basic maintenance care, and generally were not sick much of the year since they lived isolated.  Insurance coding follows set rules.  The insurance companies monitor and manage those that do not follow them (because it cuts into profits).  Did some folks find a way to steal (commit fraud)?  Sure.  This is not new human behavior as discussed earlier regarding mask wearing.  Did the whole medical industry?  Please.

“The survival rate is 99% yet people are being convinced to take the vaccine for free french fries and hamburgers.”

The survival rate is well above 99%.  At 99% survival rate, the person should be buying the vaccinator french fries and hamburgers for sparing them the 1 in 100 chance of dying from a disease.  There are very few among us that would permit ourselves to be injected for a hamburger and fries.  Those same folks are likely high risk from getting COVID-19, so again, a “thank you” is in order.

“A non-FDA approved vaccine that bypassed all animal trials and skipped to humans.”

A link to the results of animal trials.  And yes, approved under emergency use authorization.  Because human clinical trials deemed it safe and effective.  After 1.7 billion served, that has not changed. Some of the trials of the technology predate COVID-19, and you get get some flavor for these here.

“I’m sorry but I find it borderline criminal to promote gene therapy for children.”

Already mentioned previously, but COVID vaccination is not gene therapy.  But while we are at it, we do promote gene therapy in children when appropriate.  Such as if you had Leber’s Congenital Amaurosis.

“It’s against the law for non-medical professionals to promote a vaccine without discussing the adverse effects (part of the Nuremberg Code).”

Adverse effects and questions are discussed.  We also provide documentation from the manufacturer.  Our staff works under our direction and does promote vaccination, including against COVID-19. But the reason for my anger may now be clear to many of you.  This person decided to likens giving the vaccine to the medical experimentation that happened in WWII Death Camps.  They happened to pick the anniversary of my grandfather’s death to send the email.  Since he was one of two survivors of his entire family (including parents, grandparents, aunts, uncles, siblings, and cousins) from Aushwitz, this response is in his memory. My grandmother, who emerged from the same camp at age 18 years (after 2.5 years interned), was the sole survivor of her family.  For more about what the Nuremberg Code is really about, click here.  To read more about why it is inappropriate to refer to them regarding COVID-19 vaccine, read here.  If you are ever in Washington DC, the United States Holocaust Memorial Museum is one of the most sobering places you can ever visit.  It will help you appreciate what my grandfather always told me, which is I live in the best country in the world for freedom.  Not without its own warts, but still the best.  And on this Memorial Day Weekend, I thank all those in that have participated in the defense of and given their lives to protect this nation and allow it to be that beacon of light.

Post authored by Jason Halegoua PhD, MD, MBA, FAAP.  Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004.  In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.