Category: Covid-19

Advisory Committee On Immunization Practices Meeting July 22, 2021

The Advisory Committee on Immunization Practices (ACIP) will meet with the CDC July 22, 2021 to discuss COVID-19 vaccine boosters for immunocompromised individuals and the association of the J&J vaccine with Guillain-Barre Syndrome. See the draft agenda here.

New FDA Warning Regarding association of Guillain-Barre Syndrome with J&J Covid-19 Vaccine

On July 13, 2021, the FDA issued a revision to the J&J COVID-19 vaccine fact sheets regarding the increased risk of Guillain-Barre Syndrome (GBS) with the vaccine. According to the announcement, the benefits still outweigh the risks for getting the vaccine and so far no causal association has been found. GBS is rare and has been associated with other vaccines, including the flu vaccine. GBS has not been associated with the mRNA vaccines, so far.

Results of CDC Emergency Meeting Today on COVID-19 Vaccine Safety

The ACIP presentation slide sets available for June 23, 2021 regarding safety of COVID-19 vaccine including myocarditis and pericarditis and booster doses are here. Updated CDC recommendations for myocarditis and pericarditis following mRNA COVID-19 vaccination are here. Data does not support recommending booster doses currently although monitoring will continue.

Update: CDC Emergency Meeting June 23-25, 2021 on COVID-19 Vaccine Safety Including Myocarditis

The CDC Advisory Committee on Immunization Practices (ACIP) emergency meeting is re-scheduled for June 23-25, 2021 to discuss COVID-19 vaccine safety including myocarditis after Vaccine Safety Technical Work Group assessment. You can find a webcast link and the draft of the working agenda details here. The Vaccines and Related Biological Products Advisory Committee report slide set summary as of May 31, 2021 is on slide 26. The American Academy of Pediatrics (AAP) news story is here.

Magnetically Speaking

Today I saw the story about a nurse practitioner in the Ohio state legislature who tried to demonstrate how the COVID-19 vaccine magnetized her. However, she was like Teflon—nothing stuck. This occurred during the Ohio state legislature hearing about House Bill 248, which would prohibit mandatory vaccinations. I gather it is still being considered, although not on the strength of the scientific evidence favoring any magneto-genic properties of the vaccine. Even the CDC has a web page debunking this.

You know, when we were grade school kids, we used to do this trick of placing a spoon on our noses. The spoon sticks to your nose mainly because of the oil on your skin. The school lunchroom monitors did not get a big kick out of this, for some reason. They would make us sit in the bleachers. They also caught us stuffing spinach and fruitcake into our milk cartons, which brought the same penalty.

The CDC forgot to mention the other important issue, though. Aliens are installing tracking devices into the injection site. They want to see how many people are going to the marijuana shops in the states where it’s legal to get free joints for getting the jabs. Those aliens got it all wrong. In fact, I guess it’s tough to get the jab in the first place. You only get the marijuana for actually getting the shot in the pot shop (try saying that three times really fast), not for proving that you already got one by showing your vaccination card (like at beer gardens). It turns out that health care professionals are leery of administering the injections at pot shops because of some federal law against using or selling marijuana. Imagine that.

Anyway, there is no scientific evidence for COVID-19 vaccines making you magnetic. And they won’t make you like fruitcake, either. Is there any evidence for human magnetism at all, meaning can you make metal objects stick to you as if you’re a human magnet? Probably not. There are some colorful characters out there who claim they’re magnetic, though.

But is there evidence for humans having magnetoreception or some kind of magnetic sense? There might be some evidence although definite conclusions can’t be made yet. In an earlier post I mentioned that scientists believe there is evidence supporting a magnetic sense in some animals including foxes.

Try the sticky spoon trick at home.

Crazy Like a Fox

I finally got a picture of a fox not far from our property—but not close enough to get a good image. That said, it led me to do a little reading on the web about foxes. The most interesting item is the idea foxes might be able to locate prey under deep snow by using some kind of magnetic sense involving a protein in the retina called a cryptochrome. I’m not sure if this has been conclusively proven yet, but some scientists have said that this explains why foxes are able to find mice hiding in deep snowdrifts. They use a comical nose dive leap to catch them. It looks crazy, but it might increase their hunting success rate. Maybe that’s the origin of the expression “crazy like a fox”. Other animals, including bears, might be able to use this magnetic sense. Let’s hope not.

Bears don’t have a comical leap when they hunt. They’re anything but comical when they’re surprised. A land surveyor in Alaska surprised a brown bear recently and got badly mauled. The Associated Press news item title was “10 Seconds of Terror: Alaska man survives bear mauling.”

It’s a harrowing story although the man’s telling of it is almost eerily non-dramatic. He’s pretty matter-of-fact about the whole thing. It turns out he’s lived in Alaska for 40 years. He personally knows five other people who’ve been mauled by bears in Alaska. He even sounds like it would have been all the same to him if he’d been killed rather than injured. He didn’t sound like he was depressed or even unhappy, just calmly matter-of-fact.

That’s exactly how several Alaskans talk about what sounds like an absolute traffic jam of UFOs in the skies over the state. I guess I should call them Unidentified Aerial Phenomena (UAP) now that we have a government task force (The U.S. Office of Naval Intelligence) assigned to investigating them. It sounds a little crazy. I sometimes wonder if this might be an attempt to draw attention away from other things happening in the country that’s getting a lot of press. That might be crazy like a fox.

I’ve watched the show Aliens in Alaska a few times. Ordinary, everyday Alaskans tell their stories about the UAP they’ve witnessed. They all describe them in the same way the guy talked about getting mauled by a bear, even the ones who say they’d been abducted by aliens. One guy was pretty frank about his UAP story, and even joked that maybe he was putting himself at risk for getting hustled off to the Alaskan Psychiatric Institute (API). Most of the time, when people are telling these stories on other TV shows, they always seem to be a little hysterical, which makes them a little less convincing. But the way Alaskans tell their stories, it’s like hearing how they got mauled by a bear, no big deal (“…oh, and did I ever tell you how I won 10 straight games of cribbage, all with at least one perfect 29 score?”).

Come to think of it (for no particular reason), I’ve never heard of any episodes of bear mutilations. There are plenty of stories about cattle mutilations, which are often attributed to aliens. How come bears don’t get the same treatment? Maybe because they’d fight back. Getting back to that mauled land surveyor, when I was a land surveyor’s assistant back in the day in Iowa, the only trouble I had with animals was with pesky cows trying to tip our tripods over out in the fields—probably as revenge for cow-tipping. I didn’t tip cows. They never put the salad fork in the right place (rim shot).

Anyway, I saw a commercial recently made by Alaska Governor Mike Dunleavy, talking up Alaska as a major tourism destination, also touting the state as having one of the highest vaccination rates in the country for COVID-19, although that has been fact-checked. According to the commercial, among the many exhilarating experiences you can have in Alaska is to see the bears.

He didn’t mention the aliens (which I’d rather see than bears), even though it could be one of the biggest draws to the place given the soaring interest in UAP. Crazy like a fox.

COVID-19 Long Haul: Pizza in the Pan Again?

I remember a scene in the 1979 movie The Jerk, starring Steve Martin as Navin. He was telling Marie (played by Bernadette Peters) about pizza in a cup. They were both eating pizza in a cup. At the time, this was funny because it was ludicrous to think of pizza being served in a cup. It was almost unthinkable. Now you can find recipes for pizza in a cup all over the web. Things have changed.

But what does that have to do with COVID-19 Long Haul Syndrome? As a retired consultation-liaison psychiatrist, I can tell you that it’s beginning to look like things have not changed when it comes to doctors thinking somebody has a psychiatric syndrome if he presents with symptoms that can’t be medically explained. In other words, it’s easier to invent pizza in a cup then to rethink the mind-body dualism puzzle.

That seems to be happening with COVID-19 Long Haulers. I’m beginning to see the telltale signs of somatoform-type labels eventually getting applied to patients who get mild symptoms that sound like COVID-19 early on, but which often don’t get severe enough to require hospitalization. They tend to be younger, and develop long-term symptoms, some lasting for over a year, that sound a lot like what many doctors used to page me about—medically unexplained symptoms (MUS). They have fatigue, often have breathlessness, and pain for which medical tests often turn up negative results. When doctors substitute other words for MUS that they believe are less stigmatizing, there is a predictable backlash by patients who reject the new, softer label. Pizza in a pan.

Further, I noticed a study sponsored by Beth Israel Deaconess Medical Center listed on Clinical Trial dot gov called Mind Body Intervention for COVID-19 Long Haul Syndrome (first posted April 22, 2021). Participants will be assessed using the Somatic Symptom Scale-8 (SSS-8) which measures somatic symptom burden and was developed in the context of evaluating the DSM-5 somatic symptom disorder diagnosis. Pizza in a pan again.

I also found a comprehensive article on line, “The Medical System Should Have Been Prepared for Long COVID” by Alan Levinovitz, which presented a thorough description of the problem many patients have with physicians telling them their symptoms are “all in their heads.” Unfortunately, this now includes the symptoms of COVID-19 Long Haul Syndrome. In all fairness, I think most physicians try not to give patients that impression. For many years, I was often consulted to assist primary care and specialist physicians in “convincing” patients to think “both/and” about symptoms which could not be medically explained. In fact, that was part of my approach because, believe it or not, some patients were stuck in an “either/or” mindset about symptoms: physical vs psychological, body vs mind, eventually reaching invalidating conclusions like real vs not real. It’s not helpful, partly because physicians tend to get stuck in that mindset as well. We can’t seem to get the pizza out of the pan and into a cup.

Levinovitz mentions that some patients with COVID-19 Long Haul Syndrome have symptoms similar to another syndrome which had been linked to somatoform illness, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). There is a great deal of information about it on the CDC website although the cause is still unknown. The CDC language treads very carefully on the issues of causation and treatment—and manage to draw a sort of dotted-line link between ME/CFS and COVID-19. It’s the same old pan.

Levinovitz also mentions Postural Orthostatic Tachycardia Syndrome (POTS), another poorly understood syndrome. I remember presenting a Grand Rounds about a patient with this POTS to my colleagues in the Psychiatry Department when I was an Assistant Professor. I invited the cardiologist who consulted me about the issue in one of his patients—who he suspected of having anxiety as the primary issue. Years later, I was consulted by another doctor about a different patient who definitely had abnormal test results (Tilt Table) consistent with POTS, did not suffer from anxiety, yet still thought psychiatry might have something to offer. The patient was puzzled but polite about why a psychiatrist was consulted. Pizza in the pan.

It’s very difficult for physicians to convey, in all humility, “I don’t know, but I still care.” The reasons why are complicated. The push for medical certainty, the packed medical clinic schedules, the limited time to spend with patients. It’s easy to say we must reimagine the way we practice medicine. It’s very hard to do. It’s a lot harder than reimagining the path from pizza in the traditional pan to pizza in a cup.

Unmasked Means Fully Vaccinated?

We were on our way home yesterday and drove by a couple of restaurants (Wig & Pen Pizza and Vine Tavern and Eatery) with crowded parking lots. We have not seen that since the COVID-19 pandemic hit a year ago. This seemed to coincide with the CDC announcement of the new mask guidance indicating you can ditch the mask both outdoors and indoors—if you’re fully vaccinated. The updated guideline was a little hard to find on the CDC website, I noticed. It didn’t jump right out at you like the update on the pause of the Johnson & Johnson vaccine.

I checked the websites for both restaurants. They still say you have to wear masks. Pretty soon after that CDC update, news headlines appeared which provoked a few questions. How do you tell the difference between unmasked and masked persons who say they’re fully vaccinated? One headline said something like, “Get vaccinated or keep wearing your mask.”

And I saw a new term today, “vaccine bouncers.” Nobody wants to be a vaccine bouncer. In other words, since you can’t tell by looking at somebody if they’re fully vaccinated, how are you going to confirm the vaccination status of anyone? I don’t think there’s a lot of confidence in the ability to reliably detect the Pinocchio effect. And, regrettably, vaccination cards can be faked.

Some of us are vaccine hesitant. And some of us are unmask hesitant. Even though Sena and I are fully vaccinated, we still tend to wear masks indoors for now. And to be fair, the CDC guidelines stipulate that you should abide by local rules on wearing masks if required by public transportation and stores. But those guidelines are rapidly changing, maybe a little too rapidly for those who paid attention to daily scary news about upticks in coronavirus death rates when people sing too loud.

I feel like telling us to ditch the masks might be another way of offering an incentive to get vaccinated. Most of us hate masks. They’re hot, confining, make us feel too stifled to breathe easily, and so on. On the other hand, getting infected with COVID-19 is the ultimate respiration suppressor. As a recently retired general hospital psychiatric consultant, I’ve been called to critical care units to help manage anxiety in patients bucking respirators, which means they were fighting the ventilator tube. I didn’t have a whole lot to offer.

I think incentives are better than mandates, though (don’t spend it all in one place!). The best incentive is doing something to help all of us recover from the pandemic.