The best of Inside Medicine, 2022 (Covid-19 edition).

Writing Inside Medicine is a labor of love for me. Thanks so much for reading it. As we head into 2023, let’s look at key moments in the newsletter this past year. Today, we’ll look at Covid-19 articles. (We’ll highlight some non-Covid articles tomorrow.) I chose these pieces either because they were popular or because they provided what I believe were unique perspectives at the time they were published, and which hopefully moved our thinking forward.

• When will one-way masking be safe enough for everyone? One-way masking is sufficiently safe for at-risk people when Covid cases are low enough. This piece highlighted two polarities. On one hand, individuals can indeed control most of their own risk via good masking. On the other, without help from the community at large, we force the medically vulnerable into dangerous situations, which we do not want to do.

• The million US Covid dead are younger than you think. When I’m not in the ER or writing this newsletter, I’m doing public health research, primarily on excess mortality from all causes. That lens helps me (and hopefully you) understand what’s really happening. A surprisingly high number of deaths from all causes have occurred in non-geriatric adults during the pandemic, a hard fact we can’t ignore. A lot of this is Covid. A lot of this is unintentional overdoses. Almost all of these deaths are preventable.

• Are repeat coronavirus infections really more dangerous than the first one? This article reconciled two simultaneous truths. For almost all people, the most dangerous Covid-19 infection is the first one. (Some research was misinterpreted as saying that repeat infections were more dangerous than that first—an inaccurate characterization). At the same time, getting infected repeatedly is a lot worse than not being reinfected. For some people, subsequent infections can have important health consequences. Avoiding Covid-19 remains an important goal—but people should not be scared into thinking that reinfections are routinely more deadly or debilitating than the first ones, when the opposite is almost always true.

• I also want to highlight a pair of articles I wrote about pediatric Covid-19 vaccines. I’m a physician and a parent. I won’t vaccinate my 3-year-old until the data are solid and Will we vaccinate our four-year-old with Moderna? (Yes!) (Note: we’d now be fine with Pfizer too. Read on…)

  In the first piece from January, I said that my spouse and I would not yet vaccinate our then 3-year old with Pfizer’s Covid-19 vaccine. At the time, Pfizer and the federal government were proposing vaccinating children under age 5 with a two-dose regimen that had been found to be safe but not effective. In the meantime, Pfizer would study a 3rd dose. Assuming it worked, the plan would have been to give 3rd doses to all the kids who had already received two. That seemed like a huge gamble to me, and one that most parents would not take. I took a lot of heat for this take, but I stand by it. Pfizer abandoned this plan, studying a 3-dose series before releasing the vaccine to our youngest children.

  So, when both Pfizer and Moderna came out with data in the spring showing that their vaccines are both safe and effective (the 3-dose series for Pfizer indeed worked, as did a 2-dose series by Moderna), we were eager to vaccinate our older child at the soonest possible time. (Our younger child is now just old enough to be vaccinated, and she has had her first of her two Moderna doses). I highlight this pair of articles now because I did something that I think people claim to do, but do not always: I followed the science. That meant changing my outlook and choices when the data changed.

• While it seems like 5 years ago, the initial Omicron wave mostly hit the US in January of this year. At the time, many people were clinging to the hope that Omicron was a milder variant (and it probably is). But it was so contagious, that I was worried that it would overwhelm the US hospital system. That was a well-founded concern. Inside Medicine served as the epicenter of a series of analyses that showed how the US healthcare system often buckled under the pressure of the Omicron wave, in the context of other demand for care. The Omicron Paradox: If it’s milder, why are hospitals on the brink of disaster?

If there are other pieces worth sharing, please mention them in the comments. Also, if there are pieces by others from other sources that you thought were important, please share those too. This community is made stronger by its collective expertise (and voracious reading)!

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Thank you for reading Inside Medicine. I’d like to pause for a special thanks to Benjy Renton, who has made so much of this newsletter possible via his skills, insights, and indefatigable willingness to work really weird and long hours when things absolutely have to happen. There are a bunch of other people I truly would like to name and thank for their help in 2022, but the list would be impossible to make without leaving someone important off. So I’ll leave it there and just say thank you to the entire community: whether you’re a reader, a contributor, or one of our partners at Bulletin or Substack, I’m proud that we’ve reached millions of eyes, and educated both the public, and public health leaders. With your continued support, we can make 2023 even more impactful. Thank you all!