Last week, I interviewed White House Covid-19 Response Coordinator Dr. Ashish Jha for Medpage Today and Inside Medicine. The video and transcript is now online and free on Medpage Today and the full audio and transcript can be found here (see below).
Thanks for asking Dr. Jha the questions that my circle of elderly friends want answered. To me, it’s clear that the Feds, FDA and states avoid explaining what "data" they have defined that will be required to determine if a second booster will be authorized by the ponderous FDA system. Waiting to see what Israel determines from how their elderly fare does not seem to be acceptable proactive scientific analysis to me. By that time, a lot of compromised older folks will probably find their booster potency has waned or worst disappeared. This is frustrating to those folks who want to be proactive with their healthcare and feel that the rest of the healthcare system is done with Covid.
I know people who are doing work-arounds to get a second booster shot by claiming they have not gotten an earlier shot. They are using a false name, made-up DOB, claiming they’ve forgotten their vaccination cards and have no insurance. They pay cash to a busy and distracted pharmacy staff. These are proactive people who believe the medical system has made a decision that they are expendable. Care becomes a do-it-yourself sense of preservation. They do not want to be remembered as the folks who fell through the federal cracks in the system.
Thank you so much for this and the direction you took this interview. Thank you to Dr. Jha who used his knowledge to explain public health and where we are in terms we can understand. It is still tricky to navigate and I read the comments of this community and I still hurt for all as this Pandemic has been life changing. That being said my hope is that we realize even more how important community is and that we must help others.
Thank you for asking him the hard questions. Here are my concerns about his answers: 1) Masking in health care settings is tied to transmission levels which are completely unreliable--I applaud California for continuing masking in healthcare settings, 2) ACIP just declined to offer a second COVID booster to at risk people, 3) Paxlovid requires a healthcare provider willing to prescribe it--my PCP isn't a fan. I just read an interview with Dr. Fauci in the Globe where he ties deaths to lack of boosters and lack of Paxlovid--but the people can't just access these treatments/vaccines. So, as you noted, your readership tend to be concerned and more cautious and Jha's responses unfortunately don't inspire a lot of confidence that healthcare settings will be safe, that at risk individuals can access vaccines or Paxlovid, and as the narrative is that "it's over" it's creating a situation where at risk/concerned/cautious people are more and more isolated. I listened to the Osterholm podcast this week and he admitted that the less at risk are going to move on, as they should. It leaves a situation where we have two realities and difficulty with how to co-exist. As Osterholm said, the 400 dead each day are people who were loved. Jha just doesn't project that same level of empathy.
One additional question: You asked Dr. Jha whether masks should be required in healthcare facilities forever?He responded that he leans a lot on CDC Guides, and that the CDC's focus is where you have high levels of transmission, asking people to wear a mask in healthcare facilities makes a lot of sense. He added that in places with very little transmission, saying it's not required also makes a lot of sense. Here's my concern:
A year ago, the CDC changed its map metrics from transmission levels to community levels. But, if you compare the same map side by side, the community map looks green and yellow (medium-low risk). But, the same map depicting transmission shows red and orange (high and substantial risk) across the U.S. And, since the CDC made the map metric change 160,000 people have died of Covid. So, which map is most accurate as a guide for mask usage? How can the 2 maps be so different? Dr. Jha also acknowledges 368 or 400 still die per day from Covid, and that it's still too high and concerning to him. That leads me to believe there is still high virus transmission out there and that masks are still a good idea - yet, I'm usually one of the only people still wearing one when I go out in public. And right now, with these case numbers, going to a maskless medical or dental provider would give me hives.
Well done. The following exchange covers what I am asked about the most (by far):
“Faust: James writes: as of today, there's no guidance regarding whether older and high-risk people who received the bivalent booster in September/October are eligible for an additional boost this April and May. Is this decision going to wait until fall of 2023? How do people who need to be up-to-date more than once a year stay up-to-date?
Jha: We've always been guided by evidence on this, and the FDA makes this decision when they see evidence that an additional shot protects people against serious illness and death, then they make a recommendation. …”
In short, there are no current guidelines or recommendations for James and others who are understandably concerned.
"When danger is growing exponentially, everything looks fine until it doesn't."
Megan McArdle, Washington Post, March 10, 2020
This quote is a reminder that there are situations where decisions are necessary before the ideal amount of quality data is available. Using the best available data, sound analytical thinking, and risk-benefit analysis, recommendations could exist with the caveat they will be reassessed as more reliable information becomes available.
Do you know if Israel or any country has data on the usefulness for an April/May booster? I am comfortable waiting until September for a vaccine+flu shot but the messaging here in the U.S. is sorely lacking.
Thank you Dr Faust for your valiant try at getting helpful answers from Jha. However, again, you (and the public) received vague responses with nothing new.
Good line of questioning, and a good interview. I appreciate the time and thought that you put into these.
My husband and I are 59 and 63 respectively, fully vaxxed/boosted, and continue to mask in all indoor settings outside of our home. We will continue to select outdoor seating in restaurants, travel by car vs flying wherever possible, and have Paxlovid pre-plans established with our providers. A good stash of tests has a home in our closet. For the foreseeable future, this is the plan.
I really, really hope we see studies and data flow outward about bivalent boosters and wastewater monitoring and other surveillance continues to be done. That vulnerable groups do not get forgotten as many of them feel they are. I wish for a pharmaceutical industry that would be proactive and do things in the public interest, like work on treatments that would help high risk groups, as Evushield and monoclonal antibodies are not useful anymore with new variants.
Most of all, though, I wish everyone saw this as a critical community goal, that being, to keep *all* people safe, and lived accordingly.
You're an excellent interviewer :) This jumped out: I've read studies that report vaccines reduce long covid by about 15%. I haven't seen studies that find being vaccinated reduces long Covid by 50%, 80% and 90%. Is this across all age groups? For the immunocompromised? Are you familiar with the studies Dr. Jha cites? (I would love to read them).
We won't know when there is high transmission level because we have very little reliable data Even Johns Hopkins tracker is shutting down I believe in part because data is no longer available so in the end our CDC took a page from Donald Trumps playbook "too many cases make me look bad"
Dr Jha lovely fellow and skilled talking head Replace CDC director or maybe just resurrect her original approach to the job
Thanks for asking Dr. Jha the questions that my circle of elderly friends want answered. To me, it’s clear that the Feds, FDA and states avoid explaining what "data" they have defined that will be required to determine if a second booster will be authorized by the ponderous FDA system. Waiting to see what Israel determines from how their elderly fare does not seem to be acceptable proactive scientific analysis to me. By that time, a lot of compromised older folks will probably find their booster potency has waned or worst disappeared. This is frustrating to those folks who want to be proactive with their healthcare and feel that the rest of the healthcare system is done with Covid.
I know people who are doing work-arounds to get a second booster shot by claiming they have not gotten an earlier shot. They are using a false name, made-up DOB, claiming they’ve forgotten their vaccination cards and have no insurance. They pay cash to a busy and distracted pharmacy staff. These are proactive people who believe the medical system has made a decision that they are expendable. Care becomes a do-it-yourself sense of preservation. They do not want to be remembered as the folks who fell through the federal cracks in the system.
Thank you so much for this and the direction you took this interview. Thank you to Dr. Jha who used his knowledge to explain public health and where we are in terms we can understand. It is still tricky to navigate and I read the comments of this community and I still hurt for all as this Pandemic has been life changing. That being said my hope is that we realize even more how important community is and that we must help others.
Thank you for asking him the hard questions. Here are my concerns about his answers: 1) Masking in health care settings is tied to transmission levels which are completely unreliable--I applaud California for continuing masking in healthcare settings, 2) ACIP just declined to offer a second COVID booster to at risk people, 3) Paxlovid requires a healthcare provider willing to prescribe it--my PCP isn't a fan. I just read an interview with Dr. Fauci in the Globe where he ties deaths to lack of boosters and lack of Paxlovid--but the people can't just access these treatments/vaccines. So, as you noted, your readership tend to be concerned and more cautious and Jha's responses unfortunately don't inspire a lot of confidence that healthcare settings will be safe, that at risk individuals can access vaccines or Paxlovid, and as the narrative is that "it's over" it's creating a situation where at risk/concerned/cautious people are more and more isolated. I listened to the Osterholm podcast this week and he admitted that the less at risk are going to move on, as they should. It leaves a situation where we have two realities and difficulty with how to co-exist. As Osterholm said, the 400 dead each day are people who were loved. Jha just doesn't project that same level of empathy.
One additional question: You asked Dr. Jha whether masks should be required in healthcare facilities forever?He responded that he leans a lot on CDC Guides, and that the CDC's focus is where you have high levels of transmission, asking people to wear a mask in healthcare facilities makes a lot of sense. He added that in places with very little transmission, saying it's not required also makes a lot of sense. Here's my concern:
A year ago, the CDC changed its map metrics from transmission levels to community levels. But, if you compare the same map side by side, the community map looks green and yellow (medium-low risk). But, the same map depicting transmission shows red and orange (high and substantial risk) across the U.S. And, since the CDC made the map metric change 160,000 people have died of Covid. So, which map is most accurate as a guide for mask usage? How can the 2 maps be so different? Dr. Jha also acknowledges 368 or 400 still die per day from Covid, and that it's still too high and concerning to him. That leads me to believe there is still high virus transmission out there and that masks are still a good idea - yet, I'm usually one of the only people still wearing one when I go out in public. And right now, with these case numbers, going to a maskless medical or dental provider would give me hives.
Well done. The following exchange covers what I am asked about the most (by far):
“Faust: James writes: as of today, there's no guidance regarding whether older and high-risk people who received the bivalent booster in September/October are eligible for an additional boost this April and May. Is this decision going to wait until fall of 2023? How do people who need to be up-to-date more than once a year stay up-to-date?
Jha: We've always been guided by evidence on this, and the FDA makes this decision when they see evidence that an additional shot protects people against serious illness and death, then they make a recommendation. …”
In short, there are no current guidelines or recommendations for James and others who are understandably concerned.
"When danger is growing exponentially, everything looks fine until it doesn't."
Megan McArdle, Washington Post, March 10, 2020
This quote is a reminder that there are situations where decisions are necessary before the ideal amount of quality data is available. Using the best available data, sound analytical thinking, and risk-benefit analysis, recommendations could exist with the caveat they will be reassessed as more reliable information becomes available.
Thank you Jeremy. This was very helpful.
Do you know if Israel or any country has data on the usefulness for an April/May booster? I am comfortable waiting until September for a vaccine+flu shot but the messaging here in the U.S. is sorely lacking.
Thank you Dr Faust for your valiant try at getting helpful answers from Jha. However, again, you (and the public) received vague responses with nothing new.
Good line of questioning, and a good interview. I appreciate the time and thought that you put into these.
My husband and I are 59 and 63 respectively, fully vaxxed/boosted, and continue to mask in all indoor settings outside of our home. We will continue to select outdoor seating in restaurants, travel by car vs flying wherever possible, and have Paxlovid pre-plans established with our providers. A good stash of tests has a home in our closet. For the foreseeable future, this is the plan.
I really, really hope we see studies and data flow outward about bivalent boosters and wastewater monitoring and other surveillance continues to be done. That vulnerable groups do not get forgotten as many of them feel they are. I wish for a pharmaceutical industry that would be proactive and do things in the public interest, like work on treatments that would help high risk groups, as Evushield and monoclonal antibodies are not useful anymore with new variants.
Most of all, though, I wish everyone saw this as a critical community goal, that being, to keep *all* people safe, and lived accordingly.
You're an excellent interviewer :) This jumped out: I've read studies that report vaccines reduce long covid by about 15%. I haven't seen studies that find being vaccinated reduces long Covid by 50%, 80% and 90%. Is this across all age groups? For the immunocompromised? Are you familiar with the studies Dr. Jha cites? (I would love to read them).
but thanks for asking the questions anyway
We won't know when there is high transmission level because we have very little reliable data Even Johns Hopkins tracker is shutting down I believe in part because data is no longer available so in the end our CDC took a page from Donald Trumps playbook "too many cases make me look bad"
Dr Jha lovely fellow and skilled talking head Replace CDC director or maybe just resurrect her original approach to the job