This week Fred and I review the potential change to vaccine dosing schedule and why this may be a way to mitigate the rare instance of myocarditis seen, especially in younger populations
We talk about what the future holds that has some experts viewing this as a cyclical virus that emerges in ongoing waves or cycles
What does all this mean for everyone – we see a move to a more targeted approach to prevention and protection that would allow everyone to take a more nuanced approach to choices depending on their personal assessment of risk
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with Accountable Health here helping health care plans, providers and the employers with the population health improvement programs. So Nick, one of the area’s that’s been discussed a bit is this whole thing of how close together are far apart to you space those vaccines? And apparently, there’s some new thinking based on perhaps some side effects.
Nick van Terheyden
Yeah, so we’ve known for a while that there are side effects, I mean, that’s never been an new piece of data. I mean, I think that there is side effects with almost all treatments that we have. And it’s always a risk reward ratio. But one of the things that I think people have been increasingly concerned about is the the challenge with inflammation around the heart. So this myocarditis, one of the things that people may or may not have noticed is that with vaccines, so with a regular delivery of the vaccine, the to dose, you get the same dose, although they different doses, depending on what you pick. But when it comes to the booster, we’ve seen a reduction in the dose. And now there’s now some thinking that perhaps increasing the time between the vaccine doses, and I’ll be the first one to say that, you know, you can go back and look at my history and say, I called out the UK for, you know, guessing their way out in terms of the schedule of vaccination. Maybe that was a little bit unfair, but I still felt like they didn’t have the data, but maybe their approach of you know, so what they did was they focused on getting the first dose into arms to as many people as possible and extended the, the duration between the two doses. And I think there’s a ready made data set that we may be able to mine into to actually see if that reduced the very small incidence of heart inflammation. And and it’s particularly troubling, because it occurs in the younger generation more than older people. So you know, those are the people you want to protect the most.
Fred Goldstein
Absolutely. And I think, you know, correct me if I’m wrong, as a physician, there’s myocarditis associated with getting COVID to right. Yes, that’s
Nick van Terheyden
right. And that’s obviously worse. Let’s be clear. But, you know, the younger you are, you know, the tougher that sort of decision. And, you know, that’s even why some vaccines have not been approved. And, you know, maybe preferred for younger generation. And indeed, I think even was there a gender difference, if I recall,
Fred Goldstein
might have been more in younger males, I think, yeah. It
Nick van Terheyden
always seems to be well, that’s not true. It’s not always the boys. But in this particular instance, that was my recollection, although that may
Fred Goldstein
not be true. Right, right. And the other thing that was interesting was this NPR article that talked about this whole issue of the future, the pandemic looking clear as we learn more about infection, what did you see in that that you found interesting? Or how different was it from some of the things we’ve been discussing?
Nick van Terheyden
Well, let’s let’s let’s be clear, crystal would not seem opaque by comparison, I don’t know that we are seeing maybe things are clearing up a little but they’re still awfully cloudy. This virus continues to surprises that said, what we’ve seen with the latest variant is that it’s run through a fair proportion of the population. So you were either vaccinated, or you got it, or you got both of those instances. So you could have been vaccinated and Gossett and would have had a milder version of the disease. We’ve reached a point where an awful lot of people have had it. And at this point, we’re looking at what this is going to mean, in the future. Does this move to a seasonal or wavelike instance of the disease? And what does it mean in terms of all of the public health measures and what’s appropriate, and we’re seeing some pullback by countries. We talked about Denmark last week. You know, based on the science, they’ve said they’re stopping their COVID protocols. I think we’ve seen it in some countries. Obviously, the big thing is, can we open up international travel? That’s, you know, where there’s a lot of economy tied up. And, you know, commerce, there are still some countries that are pretty tightly locked down, but I read something talking about New Zealand is, you know, potentially open to America, Americans this spring, which, you know, seems relatively soon. What are the requirements going to be? I think we’re going to be living with this, but it’s not endemic. Right, Fred.
Fred Goldstein
Yeah, it just seems to be that you know, and there are all sorts of different terms for endemic or different explanations of what they mean by endemic. And I’ve heard some that say it’s just where you have a flat level of the infection going on or the disease within your population. Others will say, No, there is some variation. Obviously, what we’re seeing with this is cyclical. And you can see it go up here in Florida teams to go up every July comes back up in December drops off. And it’s interesting, because I’ve sort of taken myself and looked at how do I schedule various events, or travel or things, potentially family trips, and try to hit them during the lows? And I think that’s something we’ll see over time. And then the question becomes, as we may see a different variant, obviously, omicron had much lower abilities to create severe infection in people, but it was spread more, does the next one like that or not, and just adjusting what you may need to do over time. But I do think we’re beginning to see, you know, the ability to loosen up a bit. And hopefully, we don’t see another form of delta or something come out that might evade something.
Nick van Terheyden
Yeah, it is moving to a cyclical I at least, it seems to be implied that it’s moving to a cyclical instance. And I, you and I have talked a lot about this, in our discussions, this is always about assessing your own personal risk and taking, you know, the appropriate measures. This was true, you know, for our discussion on masks, you know, you asked me directly what I wear, and you know, I will wear a lower grade mask, I feel less at risk for a variety of reasons. And you know, this is going to be true for travel, it does bother me slightly, because now that means, you know, when you’re planning travel, you’re going to have to think about this. And, you know, the one thing that the airlines are good at is surge pricing. So they’re going to start pricing based on when COVID travel is open, oh my god, the prices go up. It’s like the summer holidays.
Fred Goldstein
That’s a fascinating idea. They’re naked, probably right on target. It’s just it’s, it’s but it is really interesting to watch. And I think we, you know, we can begin to do things, I think as long as we, as you say, look at our individual risk and reward with those types of activities and figure out what we’re willing or not willing to be able to risk. The other interesting point about that NPR story was, they’re still looking at what the data is for those over 50. You know, it looks pretty good. And so who knows, we’ll see how that impacts some of us more elderly folks here. But once again, thanks, maybe for yourself, Fred Gray hair to show it there. So it’s another fantastic week. Nick, thanks so much. And for those who are watching, if you’d like to get more information on this, Fred Goldstein, please go to Accountable Health. llc.com
Nick van Terheyden
and this is Dr. Nick, I’m the incrementalist here with incremental insights for better business, better health.
