According to a University of Iowa Hospitals & Clinics announcement on The Loop, 2nd booster doses were available to employees, volunteers, and patients starting April 4, 2022.
Category: Covid-19
Permissive Recommendation for Covid Vaccine 2nd Booster?
I have a question about the permissive recommendation by the CDC for the 2nd Covid vaccine booster. Does that mean I should get the booster or that I can get it if I just want one?
There’s an important distinction between “should” and “can.” According to the AMA, the CDC gave permissive recommendation, which means that it’s not saying you should get it, but that you can if you so choose:
“The CDC’s action is commonly known as a “permissive recommendation,” meaning that certain people may get the second booster if they wish to get it, though the agency itself is not yet officially urging them to do so.”
There are a couple of recently updated tables on the CDC website in which the language is clearly permissive about the 2nd booster dose. One is dated April 2, 2022, Stay Up to Date with Your Covid-19 Vaccines. The other is dated April 1, 2022, Covid-19 Vaccine Boosters.
Some of us may be finding it challenging to get the booster scheduled right now. I wonder if that means even those providing the booster might be wondering who should or should not get one.
Does vaccine supply have a bearing on the issue? Or is there significant uncertainty about the necessity for the 2nd booster?
I wonder if experts are waiting for further guidance from the scheduled FDA Advisory Committee meeting on April 6, 2022.
That’s this coming Wednesday. I’d like to listen to the meeting as I have in the past, but I have a schedule conflict that day. That’s not the only conflict I have.
No officials are clearly saying that I should not get the 2nd booster. On the other hand, neither are they clearly saying I should.
Maybe I’ll wait for an FDA update after the April 6 meeting. And I wonder if that will lead to a CDC Advisory Committee meeting.
Update April 5, 2022: Here’s a link to a new article on CDC Director Rochelle Walensky’s remarks intended to clarify the confusion about this issue of whether the 2nd booster is needed or not. It turns out it all depends (as it usually does). If I’ve been infected with Omicron in the last 2-4 months, then I might not need one, at least for now.
The catch is that my immunity is waning. I might still need the 2nd booster. I’m old enough that it might be a good idea to get it. On the other hand, I’m probably still going to need another jab come autumn. Dr. Walensky says this is “a personal judgment call.”
I’m still waiting for the FDA Advisory Committee’s conclusions on April 6, 2022.
FDA and CDC Endorse 2nd Vaccine Booster for Covid-19
FDA Advisory Committee Meeting on Covid Vaccine Boosters Scheduled for April 6, 2022
The FDA Advisory Committee on Vaccines and Related Biological Products has scheduled a meeting on April 6, 2022 “to discuss considerations for use of COVID-19 vaccine booster doses and the process for COVID-19 vaccine strain selection to address current and emerging variants.” The meeting will run from 8:30 AM-5:00 PM ET.
CDC Updates Covid Mask Guidance
As of February 25, 2022, The CDC has updated Covid-19 mask guidance. It’s keyed to the level of transmission in your area and to what specific risk factors you might have.
Who Let The Puns Out?
Well, we were out for a walk around Terry Trueblood Trail yesterday and a woman stopped us and excitedly asked, “Do you want to hear a joke about Covid?”
Believe it or not, we didn’t know anybody made jokes about Covid—but we said “Yeah, go ahead.” And then she said it was about dogs, and added that dogs don’t get Covid, as if to reassure us. In fact, it turns out that the CDC says you can’t catch Covid from pets, including dogs. It went like this:
The World Health Organization, or WHO, had feared the dogs could spread Coronavirus and ordered all dogs that were exposed to the virus be held in quarantine. After review, the WHO announced that dogs cannot contract Coronavirus. Dogs previously held in quarantine can now be released.
To be clear: WHO let the dogs out.
Sena and I immediately thought of the Men in Black II scene with Frank the talking Pug, who is actually an alien—and if you don’t like it you can kiss his furry little butt! I exclaimed, sort of singing (God help everyone within earshot) “Who let the dogs out!” I forgot the barking part, but we all had fun.
Incidentally, my mondegreen for the song “Who Let the Dogs Out” used to be “Who left the dog pound?” For the record, the word “mondegreen” means: a misunderstood or misinterpreted word or phrase resulting from a mishearing of the lyrics of a song. It often totally changes the meaning of a lyric, resulting in something ludicrously comical.
I think Dave Barry wrote about mondegreens in his book, “Dave Barry’s Book of Bad Songs,” a book I used to own but somehow lost in one of our many moves. I’m hoping he’ll find this blog post somehow and send me a free, autographed copy of the book.
If we’d had our new Polk Signa S2 sound bar when I first heard the line, I could have used the remote control Voice Adjust dialogue level to reproduce clearer, crisper dialogue.
For the record, I’ve never heard the full song “Who Let the Dogs Out,” which was performed by a “Bahamian junkanoo” band formed in 1977 and released in 2000. I had to look up “junkanoo” and it’s a Bahamian cultural celebration, a festival of music, dance, and dog pounds.
There are conflicting opinions about what the song means. Some say that it was about men calling women filthy names and women fighting back by shouting “Who let the dogs out?” On the other hand, I also read that the song won a Grammy.
When we got home, I googled Covid jokes and found a lot of them. One of the better hits was RJ Julia Booksellers, advertising a book entitled Coronavirus Humor. The author was just called “Mad Comedy,” which means several “top comics” contributed. It was published in April 2020 by Indy Pub.
The best part? There was a statement saying “A portion of the proceeds of this book benefit the hard-working ‘essential workers’ who are sacrificing so much to help us all during the 2020 epidemic.”
Who let the wags out?
Featured Image picture credit: pixydotorg
FDA Postpones Meeting to Discuss Pfizer Covid-19 Vaccine for Children Less Than 5 years Old
The FDA announced today that the meeting to discuss Pfizer’s request for authorization of Pfizer-BioNTech COVID-19 Vaccine for children 6 months through 4 years of age, originally scheduled February 15, 2022, will be postponed. This will give Pfizer time to evaluate a third dose of the vaccine in this age group.
FDA Advisory Meeting on Covid-19 Vaccine for Children Less than 5 years Old
The FDA Advisory Committee will meet February 15, 2022 between 8:30 AM-5:00 PM ET to discuss Pfizer’s proposal to amend the Emergency Use Authorization for administration of the Covid-19 vaccine to children between 6 months through 4 years of age.
Brief Reflections on N95 Masks
The free N95 masks are here. It’s 3M Model Aura 9205+and they’re available in many stores, including Hy-Vee and Walgreens.
I occasionally failed the fit test using this type of mask when I was working at the hospital; however, you can still get a pretty effective seal to make it protective in the community (see my video below). I was one of the few psychiatrists who had to fit test for a mask because I worked on the med-surg side of the hospital in a consult-liaison role.
The N95 flat type mask is probably no more difficult to don and doff than the surgical mask, for which the Slip Knot and Tuck method helps you achieve a pretty good seal (see my video for this).
At times, I had to use an alternative N95 mask, similar to 3M Model 1860, which is a cup-shaped mask. One year I failed the fit test for that one and I had to wear a Powered Air Purifying Respirator (PAPR). I had to wear it only once in the hospital. It was very cumbersome. Following that, I passed the fit test for the 1870+, which is similar to the 9205+.
When you search the web for more information about the N95 masks, you’ll find that there is disagreement about how to interpret eyeglass fogging pertaining to the seal. Some say that if you get any eyeglass fogging at all, you have an inadequate seal and need to fix that or “check with your supervisor.” On the other hand, others will discount that. Even the CDC says that eyeglass fogging indicates a poor seal that means that you have an inadequate seal and this should prompt the user to try another N95 model. On the other hand, others will discount that.
I did only a quick search, but found one open access article on a pilot study which concluded that “Fogging of eyeglasses is neither a sensitive nor a specific predictor for a poor fit of N95 respirators.” (Kyaw S, Johns M, Lim R, Stewart WC, Rojas N, Thambiraj SR, et al. Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study. Indian J Crit Care Med 2021;25(9):976–980).
On balance, since no one who is not a health care professional will ever have to fit test for any N95 mask, the seal you’ll get is probably adequate. If you wear eyeglasses, remove them before donning and doffing the mask. You can get the bows caught in the straps, which can flip them off your face and into the toilet (although this has never happened to me personally). Always do hand hygiene before and after use of the mask.
I’ve read news items indicating that CDC guidelines say you should reuse the N95 only 5 times before disposing of it. It was difficult to find the source, but it’s mentioned here, under the heading “Decrease in N95 FFR fit and filtration performance” (FFR stands for Filtering Facepiece Respirator)”:
CDC recommends limiting the number of donnings for an N95 FFR to no more than five per device. It may be possible to don some models of FFRs more than five times [2]. One study reported that fit performance decreased over multiple, consecutive donnings and fit varied among the different models of FFRs examined [3]. If manufacturer guidance on how many times a particular FFR can be donned is not available, the CDC recommends limiting the number of uses to no more than five per device based on published data on changes in FFR fit from a limited number of FFR models over multiple donnings.
A recent observational study conducted in a hospital emergency room during the COVID-19 pandemic found that extended use and reuse of N95 FFRs as measured by the total hours and shifts the mask was worn and the number of donnings and doffings was associated with an increase in the fit failure of the respirators. This study also showed that it may be possible to don some models of FFRs more than five times [2]. Fit performance during limited reuse should be monitored by the respiratory protection program manager or appropriate safety personnel.
Reference 2 is a research letter published in JAMA Network, June 4, 2020, a time when there were shortages of PPE (Degesys NF, Wang RC, Kwan E, Fahimi J, Noble JA, Raven MC. Correlation Between N95 Extended Use and Reuse and Fit Failure in an Emergency Department. JAMA. 2020;324(1):94–96. doi:10.1001/jama.2020.9843).
Further on in the CDC guidance is a section entitled “NIOSH recommends limiting the number of donnings to five for a filtering facepiece respirator. What is the science behind that recommendation?”
You can read all of this if you’re interested. I think it’s helpful to note that some experts say you can reuse them until they’re visibly dirty, which I think probably applies to users in the general community.
Free N95 Masks Available
Sena picked up 3 of the free N95 masks today at Hy-Vee. It turns out that it’s the same one I always used to fail the quantitative fit test for at Employee Health. I could never get a decent seal with it. I would get an alternative cup-shaped mask which worked pretty well. Fit testing includes maneuvers you have to do to make sure the mask stays where it’s supposed to on your face while moving your head up and down, side to side, or bending at the waist, doing back flips, moon-walking, and so on. You also have to read a short story as well, called the Rainbow Passage:
When the sunlight strikes raindrops in the air, they hit you in the face, which makes you jerk your neck so hard you get a charley horse and can’t move your head, which hinders your vision and makes you fall through the glass door of a doughnut shop. The owner yells at you because you get blood all over the chocolate frosted doughnuts. As you reel out of the shop, you trip over a chair which knocks over a display of N95 masks, which scatter the shards of broken glass, splitting the white light into a rainbow. You follow it until it leads you to a boiling pot of gold, which you trip and fall into, sustaining burns that send you to the hospital emergency room where all of the doctors and nurses are wearing Hazmat suits. That’s why they say if you know where the pot of gold is, don’t stop off at the doughnut shop.
If you can read the Rainbow Passage without interrupting the seal of this version of the N95 mask, you pass, which I never did.
I don’t think anyone expects you to pass a quantitative fit test for the free N95 masks. There is a self-test of the seal which involves holding a strong-smelling substance up to your face (such as Bigfoot turds) to see how long it takes before you pass out. If you don’t pass out, you’re eligible to become a Bigfoot personal trainer.
There’s a limit of 3 N95 masks per person per household. A store employee hands them to you from a bin full of alligators. When the employee gets eaten, management shuts down the whole operation. You can’t just go in there and grab up an armful of them and expect not to get chased out into the parking lot. However, that doesn’t stop some people from heading to every store all over town to get the 3-mask limit, ending up with more than a dozen. The same strategy worked early in the pandemic when stores were rationing toilet paper.
It would be a waste of time for me to try to demonstrate how to don the N95 mask when there’s a perfectly good video demonstration (see below). If you’re wondering about the real Rainbow Passage, the link is here.
Go Retire Psychiatrist 