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Sunday, September 19, 2021

Show me the Science

It is an interesting time right now with the pandemic that surrounds us. For at least eighteen months, the greatest scientific minds in the world have labored to comprehend this SARS-CoV-2 virus and its threats, characteristics, and avoidance. We have all heard the parroting of "follow the science," and that has become increasingly difficult as the populace confuses fact for fiction, see Vaccines and Movies (September 2021). There is some variety around the country regarding COVID reaction, and America is not alone in variety, see Pandemic Regulation a World Away (September 2021).

The ongoing nature of the threat has implicated workers' compensation in a variety of ways. Just last week, I heard of an instance of treatment delay due to COVID-19. Though I heard predictions that might occur again, this was the first concrete instance to reach me. A quick Internet search revealed that various hospitals have been canceling "elective" surgeries since August: Broward, Hillsborough, and elsewhere.

Unfortunately, some may hear that and think they cannot get care. Hospital and government officials urge people to understand that if they are in need of care, they can get it. One administrator stressed
"Do not delay needed care. Hospitals across the state are open and they’re taking care of people that need health care."
The cancellations or delays regard "nonurgent procedures." Of course, there is also recognition that if such are "put off for too long, (that) could cause patients more issues down the road." There is, unfortunately, some delay occurring in the delivery of some medical attention due to the immediate issues of COVID-19 treatment.

Back to the science. In August, we began to hear that everyone would soon be eligible for "booster shots" of the vaccine. I have been a big fan of vaccination. See The Future's So Bright (February 2021), Vaccination Tribulation (February 2021), and It's Simple Economics (March 2021). The moment I could get it, I signed up and lined up. If I were offered a booster, I would sign up again. Since the August promises, I have been anticipating it. After all, we were all promised its "a simple rule, eight months after your second shot, get a booster shot." I like simple.

Then last week, the Food and Drug Administration (FDA) weighed in. This FDA "advisory panel overwhelmingly rejected a plan Friday to give Pfizer COVID-19 booster shots across the board." That decision does not bind the FDA and does not prevent boosters. If you do not already know someone who has had a third shot, that should surprise you. The boosters have been administered in various instances already, including for people with serious potential immune issues, medical complication potentials, and of advanced age. In fact, the same FDA panel that rejected the "booster for everyone" proposal unanimously endorsed a third shot for those "65 or older or (who) run a high risk of severe disease."

According to the data submitted to the FDA, "vaccine protection against COVID-19 infection wanes approximately 6 to 8 months following the second dose." This is interesting for the many who received Moderna and Pfizer. One wonders if the outcome is different in the "one dose" paradigm of Johnson & Johnson. The data referred to is from "recent data from Israel and the United States."

This panel has been described in the press repeatedly as "influential." CNBC notes that the FDA has nonetheless not "always followed the advice of its committee, (but) it often does." The question on many lips, apparently, is whether the FDA will follow the recommendation. That news outlet posited on Friday afternoon that "a final FDA decision could come in a matter of hours." For some reason, I cannot get Judge Smails out of my mind as I note that.

Some are critical of the "third jab." The World Health Organization (WHO) has repeatedly voiced its opposition. That agency's head said in August "We cannot accept countries that have already used most of the global supply of vaccines using even more of it." The WHO, by its own description "dedicated to the well-being of all people and guided by science," has made its position in this instance upon either the politics or economics of vaccine deployment. Some WHO officials have more stringently "condemned countries offering boosters." The logic of this criticism is intriguing, if for no other reason, in its premise of a "global supply." That implies a communal ownership of resources, which some may advocate but is not necessarily held universally. 

Throughout this pandemic, with masks and more, there has been a similar lack of clarity as to the science. If the mantra is going to persistently be "follow the science," then perhaps consistently that science should be made clear to us all. In 2020 we were told not to wear masks, the science did not support them. Later, some of the same scientists admitted they misled us so we would not hoard the masks. They admitted their mask advice was not scientific. If science supports masks, show us. If it supports one kind, but not others (fabric), show us. If we are to "follow the science," tell us the science, and do not mislead us (it damages your credibility). If there is science that says boosters benefit some people but not others, show us.

The Centers for Disease Control has released a study that concludes the efficacy of vaccination may wane over time. The various vaccines are not consistent in that regard, providing the best news for those who received Moderna last spring. The reason for a distinction is unclear; some conjecture it "could be because of higher mRNA content in the Moderna vaccine or the difference between the timing between doses." The rates of protection from this study were: Moderna 93%, Pfizer 88%, and Johnson & Johnson 71 %.

However, as efficacy wanes, then it may be necessary for booster or repeated jabs to be undertaken. That vaccine efficacy can be varied, and that boosters may be required is not something isolated to SARS-CoV-2. In fact, boosters are not uncommon at all. Does efficacy wane for some people (over 65) and not for others? Or, is this decision based on supply and demand like the early mask advice?

As the world waits to hear whether the U.S. will undertake widespread third, or "booster," jabs, it is noteworthy that other countries have already done so more widely than the FDA committee recently recommended. Israel is a notable example. The plans of many nations are discussed here. Of course, those plans are as subject to change as our own might be. 

So, as we follow our mantra and "follow the science," unfortunately we are left with questions. Were we "following the science":

  1. in August when it was announced that everyone could get a booster starting in September?
  2. when the CDC concluded vaccine protection wanes?
  3. when the FDA panel concluded that only some people need boosters?
  4. when the WHO concluded boosters are not necessary?

If so, with all due respect, "show me the science" (channeling Cuba Gooding, Jr., Jerry Maguire (Tristar, 1996). The CDC science seems to me (I am not a scientist) to suggest that efficacy wanes and booster shots benefit. A panel of scientists says that boosters are not recommended for some, but are for others. Is that a scientific conclusion about efficacy and disease? 

Though largely lacking in national news, a local report here in Paradise approached an "infectious disease expert." He explained that the vaccine efficacy is waning, suggesting that boosters are a likely eventuality. Specifically, that "it is assumed at some point, that the third shot will be recommended for all." That is "assumed," and thus unlikely science. He adds that “the good news though is that the immunity hasn’t waned enough yet for the outside panel to recommend the booster dose to the general population." Thus, one expert provides an explanation that is perhaps of assistance: your immunity is diminishing, and a booster is in your future, but not yet. OK, why not? How diminished must one get?

Are decisions being made based on something other than the science we are so often told to follow? If a booster is a good idea for people over 65, what is the science that demonstrates it is not a good idea for someone younger? Show me the science. If that conclusion is true, explain to us why the science was ignored in August with the announcement of widespread boosters. Or, if not, explain why the science is being ignored now with the recommendation against the boosters for all. Is the guiding force consensus rather than science? Or, is the decision one of supply and demand? Is it one of economics?

If the decisions are being made upon some standard other than science, then why can't that simply be admitted? Perhaps credibility could be bolstered by showing people the science? If the science does not exist, perhaps they could just say so? Maybe we shouldn't announce/proclaim coming boosters if the science does not support it, or deny boosters if the science does support them? And, in either instance, I know it would benefit me for a credible scientist to explain that science to us all. I appreciate the local expert's opinions in explaining the logic of the FDA committee decision, but I would still like to "follow the science." Show me the science.

If you are unvaccinated, while the experts debate whether you can get a booster, you can certainly get your first dose(s). I highly recommend it (not a scientist). Certainly, you can still become ill with COVID after vaccination, as demonstrated by the recent stories out of Massachusetts.  Yes, many vaccinated people still get COVID. But according to Healthline, "In all states, the rate of breakthrough cases among the fully vaccinated is below 1 percent." And, "fatal cases of COVID-19 among vaccinated people are either very low or virtually zero in 48 states." Doubt the vaccination if you wish, but this is actual data, from actual infections. This is science.