Covid-19 – Page 5 – Go Retire Psychiatrist

Permissive Recommendation for Covid Vaccine 2nd Booster?

I have a question about the permissive recommendation by the CDC for the 2^nd 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 2^nd 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 2^nd 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 2^nd 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.

AMA Update on Covid-19 2nd Vaccine Booster

The AMA published an update on the Covid-19 Vaccine 2nd booster and the YouTube presentation is only a couple of days old and pretty thorough. While the CDC indeed gave a permissive recommendation, it sounds like another jab would be recommended in the fall anyway, likely targeting variants. The FDA Advisory Committee still has a meeting scheduled for April 6, 2022. It sounds like Medicare and private insurance will cover the cost. The Federal funding outlook doesn’t sound as positive for the uninsured.

Second Covid Vaccine Booster Got Any Mojo?

Tomorrow’s April Fool’s Day and I thought I’d get this post up today so it wouldn’t get confused with a joke.

I’m genuinely a little confused about the FDA and CDC approval of the 2^nd Covid vaccine booster. It’s almost like this vaccine is getting a mojo of some kind, at least with some experts.

Although I’m not keen on getting another jab, I’ll do it if there is reasonable evidence to support it. Not everyone on the FDA Advisory committee is for it. Dr. Paul Offit was quoted in a news story as saying, “We’re going to have to learn to live with mild disease at some point.”

Dr. Offit is the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. I’ve heard him speak at FDA Advisory Committee meetings during public Zoom meetings on the subject and I respect his opinion. He doesn’t think frequent boosting is a reasonable thing to do. I’m inclined to agree with his opinion that most people won’t do it anyway. I’m sure he’ll have more to say at the April 6 FDA Covid Vaccine Advisory Committee meeting.

I was not surprised to learn that of the 90 million Americans who got their initial Covid vaccine series, only about half got the first booster. What kind of mojo is that?

Even the Pfizer drug company CEO, Albert Bourla, says frequent boosting is impractical.

There is some serious doubt in my mind about the booster mojo. Sena says that it would be helpful if more local infectious disease experts would express their own opinions about the direction this vaccination strategy is going. She has a point.

Does the Covid vaccine booster have any mojo? What do you think?

Featured image picture credit: pixydotorg.

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.

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

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.

Slip Knot and Tuck Mask Fit

I saw the video the CDC suggested for getting a closer fit using a surgical mask. I had a tough time following how to tie the knot in the loops. Either the demonstrator went too fast or I was too slow (probably the latter.) I found a couple of videos on slip knots and crochet knots (another name for slip knot, evidently). There are probably dozens of YouTubes on how to do the Knot and Tuck.

Since the toughest part of the Knot and Tuck method is tying and adjusting the knot to hug the edge of the mask as closely as possible, I practiced a little. See what you think of the slip knot and tuck in my YouTube video below. Using a slip knot allows you to easily move the knot closer to the side of the mask, allowing a tighter fit. Tucking also helps. It also helps prevent my glasses from fogging up. It’ll never be perfect but it’s better than letting the sides flop open.

Covid-19 Omicron Variant Update

This is just a short message wishing a safe and happy holiday to all. I’m passing readers a couple of links to update information on the Covid-19 Omicron variant and how to stay as safe as possible this winter.

First is the Rounding@Iowa link to the Omicron Variant update. It’s an interview with University of Iowa Hospitals & Clinics (UIHC) infectious disease expert, Dr. Patricia Winokur, MD. It’s about a 16 minute interview. Highlights are that it’s important to get the booster for solid protection against variants including Omicron and that the Covid-19 vaccine is, in general, likely to turn out to be a 3-shot vaccine similar to others, such as the Hepatitis and Shingles vaccines.

The other link is to UIHC infectious disease specialist Dr. Daniel Diekema, MD and his thoughts about the Omicron variant. They echo those of Dr. Winokur and the emphasis again is on the importance of getting vaccinated.

Lastly, there is some guidance by UIHC in a graphic below on how to stay safe from getting infected with Covid-19, (whatever the variant) during winter activities. Happy Holidays!

My Definitive Journey Revisited

A couple of days ago, I got my retirement gift from The University of Iowa. It’s a about a year and a half late because of the Covid-19 pandemic, but it’s welcome nonetheless. Normally there is an Annual Faculty Retirement Dinner, but it had to be cancelled. It’s a stunningly beautiful engraved crystal bowl with the University logo on it. It came with a wonderful letter of appreciation. It reminded me of my blog post in 2019, “My Definitive Journey.”

It’s a definitive symbol of the next part of my journey in life. For years I’d been a fireman of sorts, which is what a general hospital psychiatric consultant really is. The other symbols have been the fireman’s helmet and the little chair I carried around so that I could sit with my patients. I have changed a little.

I still have my work email access, which I’m ambivalent about, naturally. I check it every day, partly because of Fear of Missing Out (FOMO), but also to delete the junk mail. I still get a lot of it. I get a rare message from former trainees, one of whom said it “pained” her to learn I’m now Professor Emeritus.

I have not seriously considered returning to work. That doesn’t mean I have not been occasionally nostalgic for some aspects of my former life.

The poem, “El Viaje Definitivo” by Juan Ramon Jimenez evokes mixed feelings and thoughts now. I have gone away. But in looking back at the past, I now see now that the birds didn’t always sing. The tree was not always green.

I don’t miss my former home, the hospital, as keenly now, which is now a much harder place to work since the Covid-19 pandemic began.

And there is little that is definitive about my journey forward from where I now stand. I’m a little less afraid than I was over a year and a half ago. And the birds sing where I am now, sometimes more clearly than before.

El Viaje Definitivo (The Final Journey)

… and I will go away.

And the birds will stay, singing

And my garden will stay

With its green tree

And white water well.

And every afternoon the sky will be blue and peaceful

And the pealing of bells will be like this afternoon’s

Peal of the bell of the high campanile.

They will die, all those who loved me

And every year the town will be revived, again

And in my circle of green white-limed flowering garden