The Advisory Committee on Immunization Practices (ACIP) have scheduled a meeting for November 2, 2021 from 10 AM-5 PM, ET to discuss the Covid-19 vaccine for children ages 5-11.
This follows the FDA authorization for the vaccine in this age group, which was announced today on their web site.
A few days ago, I read the news story about COVID-19 antivaxx vigilantes interfering with the medical care of patients hospitalized with COVID-19. The writer interviewed Dr. Wes Ely, MD, MPH. He’s an intensive care unit (ICU) specialist at Vanderbilt University.
I first corresponded with Dr. Ely by email about 10 years ago when I wrote a blog called “The Practical Psychosomaticist.” I sort of poked fun of him in one of my posts about the chapter on psychiatrists and delirium in one of his books, Delirium in Critical Care, which he co-authored with another intensivist, Dr. Valerie Page, and published in 2011.
I can’t really tell the anecdote the way I usually told it to residents and medical students because of copyright rules but the antipsychotic drug haloperidol is mentioned. I made fun of the very short section “Psychiatrists and Delirium” in Chapter 9 (“Treatment of delirium in critical care”). It’s only a couple of paragraphs long and comically gives short shrift to the psychiatrist’s role in managing delirium. That’s ironic because I have always thought the general hospital psychiatric consultant’s role was very limited in that setting.
Maybe you should buy that book and, while you’re at it, buy the other one he recently published this month, Every Deep-Drawn Breath. My wife just ordered it on Amazon. It’s reasonably priced but in order to qualify for free shipping, she had to buy something else. It turned out to be Whift Toilet Scents Drops by LUXE Bidet, Lemon Peel (travel size, not that we’re traveling anywhere in this pandemic). Be sure to get the Lemon Peel.
In the email Dr. Ely sent to me and many others about the book, he said, “Every penny I receive through sales of this book is being donated into a fund created to help COVID and other ICU survivors and family members lead the fullest lives possible after critical illness. This isn’t purely a COVID book, but stories of COVID and Long COVID are woven throughout. I have also shared instances of social justice issues that pervade our medical system, issues that you and I encounter daily in caring for our community members who are most vulnerable.”
Anyway, the Anti-Vaxx vigilantes have played a big role in filling up the Vanderbilt ICU and many others by posting conspiracy theories about the COVID-19 vaccines on social media, which for some reason are hard to control. They persuade patients and their families that doctors are trying to kill them with the treatments that are safe and effective. Instead, they recommend ineffective and potentially harmful interventions such as Ivermectin, inhaling hydrogen peroxide, and gargling iodine.
There are different opinions about conspiracy theories and those who believe in them. Some psychiatrists say that conspiracy theories are not always delusional. One psychiatrist wrote a short piece in Current Psychiatry, Joseph Pierre, MD, “Conspiracy theory or delusion? 3 questions to tell them apart.” Current Psychiatry. 2021 September;20(9):44,60 | doi:10.12788/cp.0170:
What is the evidence for the belief? Can you find explanations for it or is it bizarre and idiosyncratic?
Is the belief self-referential? In other words, is it all about the believer?
Is there overlap? There can be elements of both.
The gist of this is that the more self-referential the conspiracy theory, the more like it is to be delusional.
Another article which expands on this idea is on Medscape: Ronald Pies and Joseph Pierre, “Believing in Conspiracy Theories is Not Delusional”—Medscape-Feb 04, 2021. According to them, delusions are fixed, false beliefs (something all psychiatrists learn early in residency) and usually self-referential. Conspiracy theories are frequently, but not necessarily, false, usually not self-referential, and based on evidence one can find in the world—often the internet. Conspiracy theories have blossomed during the COVID-19 pandemic. One of them is that it’s a government hoax. An important difference between the current pandemic and the flu pandemic of 1918 is the world wide web which makes it easier for many people to share the conspiracy theories.
Pies and Pierre describe a composite vignette of someone who has a conspiracy theory featuring many false beliefs about the COVID-19 vaccines ability to change one’s DNA, thinks that research results about the vaccines are faked, mistrusts experts, has no substance abuse or psychiatric history and no mental status exam abnormalities. He exhibits exposure to misinformation, biased information processing, and mistrusts authorities.
They would say he has no well-defined psychiatric illness and antipsychotic treatment (such as haloperidol) would not be helpful. However, similar to the approach with frankly delusional patients, they would argue against trying to talk the person out of his false beliefs. Instead, if the person can be engaged at all, the focus should be on trying to establish trust and respect, clarifying differences in the information sources available, and allowing time for the person to process the information. It would be more helpful to avoid confrontation and arguments, instead pointing out inconsistencies in the information the person has and contrasting it with facts. Countering misinformation with accurate information could be helpful.
There are two major routes to anti-vaccination beliefs of the severity under discussion here. One is the problem of conspiracy theories out there. The other is the florid delirium that can happen to patients admitted to ICUs with severe COVID-19 disease. The former may not be a classifiable mental illness per se, but the latter definitely is.
Haloperidol is not the main solution for either problem.
I just read a news item saying that the Blank Park Zoo in Des Moines, Iowa is administering COVID-19 vaccine to the animals there. I wondered how that would go, especially with large animals. I figured the zoo staff would be using dart guns. Talk about vaccine hesitance.
Then I saw a YouTube showing animals at the Louisville Zoo in Kentucky getting their shots. Apparently, they can get sick from COVID-19 infection. There were a few disparaging comments from viewers. Would 70 zoos vaccinate their animals if it weren’t safe and effective?
The animals didn’t seem to mind it. In fact, they were probably more cooperative than some humans. Of course, they got treats. But we give gift cards, beer, lottery prizes, turkey-flavored candy corn—which don’t really work. About 25% of Iowans don’t plan to get the vaccine according to a Des Moines Register news story.
Will the animals get boosters?
Featured image credit: Jim & Sena Amos at Henry Vilas Zoo in Madison, WI in 2009.
The messaging on COVID-19 boosters is being clarified by the CDC and the FDA in separate announcements, posted September 1, 2021.
The CDC update is here. The FDA announcement is here. The FDA plans to hold a virtual meeting about the issue September 17, 2021 from 8:30 AM to 3:45 PM EST and it will be livestreamed on the agency’s YouTube channel. Background material will be made available to the public two days before the meeting.
“Those who are tardy do not get fruit cup.”
Judging from the slides in Dr. Sarah Oliver’s presentation, “Framework for booster doses of COVID-19 vaccines” in the ACIP meeting this afternoon, there is limited data to support COVID-19 vaccine boosters for the general population at this time. The target populations for boosters would be the residents of Long Term Care Facilities (LTCF), health professionals, and those over 65 and 75 years of age, although the goal of ensuring that as many unvaccinated individuals get vaccinated should be actively pursued. There will continue to be further meetings to discuss the role of boosters.
This morning I put on my shirt and noticed the pocket flap puckers for the umpteenth time. I also got a reminder about how difficult it is to keep fingernail clippings from zinging all over the bathroom. I did a quick web search and saw that both problems are perennial with no great solutions. There’s an eerie resemblance to the COVID-19 vaccine hesitancy challenges.
One author says the shirt pocket flap pucker problem (say that three times quickly right now!) is caused by shirt manufacturers who fail to hem correctly and by shirt wearers who fail to properly launder them. Various solutions to the nail clipping problem involves innovative modifications to clipper design and other ingenious suggestions you can try yourself, including clipping with your digits inside a sandwich bag to catch the flying parings.
In other words, there are system changes and user changes, which seems to apply to the vaccines as well. For example, there are some researchers investigating the use of intranasal immunization. This has a few advantages, including maybe helping those who are afraid of needles, which is a population probably bigger than we think.
There are systems advantages as well as challenges to the intranasal route. It capitalizes on the IgA immunity cells in the nasal mucosa, which could help prevent travel of the virus to the lungs. The University of Iowa Hospitals & Clinics research team has found that this works in mice. On the other hand, other researchers are abandoning the approach because they haven’t had success in early human trials. And the vaccine injections are highly effective by comparison. Side effects of the intranasal might include more than just wanting to make you sneeze. Although you could cover your nose with a sandwich bag or maybe pinch your nostrils shut with a pair of nail clippers (but what to do with the nostril parings?). Some raise concerns about how close you get to the brain. There was a reported case of Bell’s Palsy after an intranasal influenza vaccination in 2002. Incidentally, the likelihood of getting Bell’s Palsy after the COVID-19 jab is less than getting it from the virus infection itself (MedPage Today report June 2021).
Congress could pass laws preventing shirt manufacturers from making them with pocket flaps in the first place. After all, what pickpocket would be bold enough to try to pick your shirt pocket, assuming you buttoned it? Or the President could write an executive order mandating the owners of shirts with pocket flaps launder them properly, or at least iron them. There could be a door-to-door campaign to distribute innovative nail clippers, or offer free pedicure and manicure services (only after full licensing, of course).
Well, anytime you need my innovative suggestions you can always choose to opt out.
See today’s updated guidelines from the CDC about what activities are safer once you’ve been fully vaccinated.
Just some quick thoughts on the Virtual Information Session on COVID-19 Vaccines, Session 2 on 4/19/2021. This was another enlightening presentation. I just noticed that you’ll have to scrub forward to about 10 minutes and 30 seconds to start playback on the YouTube recording. This gap might be edited out in the near future.
It’s worth noting that the risk for getting blood clots from COVID-19 infection is greater than the risk for getting them from the vaccines, according to Dr. Pat Winokur, University of Iowa and Dr. Caitlin Pedati, IDPH. There were other educational answers to very good questions from the audience.
Don’t forget the third session on Saturday, 4/24/2021 at 10:00 a.m. in Spanish only for the YouTube event while the WebEx event will be a bilingual event. See this link for full details.
Go Retire Psychiatrist 