Back on October 2, 2020, President Donald Trump was admitted to the Walter Reed Army Medical Center with COVID. One medicine probably saved his life. It wasn’t the one he had imagined.
Just a suggestion, Dr. Offit. Maybe you should continue to offer your newsletter for free so people who want to understand your sharp analysis can do so without regard to ability to pay. But like many other Substacks, maybe you should require payment for those who want to comment. That way, if uneducated trolls want to comment (see below), they at least have to pay for it.
Some of the comments by so-called professionals and people of science here are utterly biased and contemptible but few readers will be surprised.
We, the little people, are all exhausted by you but the good news is we have gotten adept at seeing through you with a swiftness that must surprise you, since we are “uneducated trolls” “anti-vaccine activists,” and “Covid deniers.”
Substack has become a place for truth to ferment and spread and your attempts to poison the well will surely fail. The American people are slowly waking up, but you know that. That’s why you’re here.
Since you are incapable, I will be embarrassed for you.
Just a side note: I went to a new doctor last week who was beside himself with glee when I told him I was unvaccinated. I was saving him the time and effort it would have taken to unpack a complex and difficult vaccine injury. You’re slowly losing physicians—once your wingmen—who refuse to hoist your lies and abuse on their patients anymore.
Remedesivir? If there are still people who would allow themselves or their loved ones to get within an inch of that drug, I don’t know of one and I doubt you do either. Shall we unpack the history of that drug together? From its very inception until today? Are you fearless enough to do that?
Good luck with your book. National Geographic is your publisher? Wasn’t that once a commendable and iconic publication? So sad to see America fall, isn’t it?
I don't know if your comment was directed at me or Dr. Offit, since you said, "Good luck with your book," and I have no book. But it ended up in my inbox, and I must admit that I'm curious why you bother to go to a doctor any more. If you have insurance, you're raising everybody else's premium needlessly. Maybe that's why you go, as you seem happy with the thought of "America's fall." I don't know what you even mean by that, but I think we are still a great nation, and I am sorry for those who are so angry with the world, and so filled with grievances. That can't be a pleasant way to live. I do hope you don't ever get bit by a rabid animal.
Right. I suggested maybe commenting should require payment (but people could still access the information for free). That way, anti-vaccine trolls would have to pay for saying such things. Dr. Offit could contribute all proceeds to non-profit vaccine research institutions! :)
Good point. I see you have the background to dispute them but I don't think they are likely to be persuaded. However, maybe some other readers who are on the fence will take the time to consider the evidence more thoroughly. 🤞
Yeah but, sometimes those of us who attempt to enlighten the trolls have to pay a price that gets weary. Refutation is often followed by trolls spouting their nonsense and claiming those reflecting the scientific literature are wrong, evil or worse. I’ve had several respond to my comments here, and on my own Substack that required a lot of effort to get over.
Was Dr Offit part of the treatment team? How does he know it was Trump who refused care and denied his illness? Many patients were told early on to go home if they were sick and only come back if they were unable to breathe or got really sick. That was standard.
Wasn’t the patient lucky that Remdisivir didn’t flood his lungs with fluid? And how amazing that he was treated “improperly” and survived the virus. And isn’t it a shame that the steroids weren’t heralded as a helpful treatment but not a lot of the general public know this. Wonder if other antivirals besides Pfizer’s new paxlovid were studied for early virus stage intervention. I am definitely going to read Offits book. We had a family member who got Covid in 20 and only lost taste and vomited for a day. (Tested positive) will be interested if he addresses those symptoms. Our famil
Thank you for describing the stages of the illness and the process of treatment, Dr Offit. And also for reminding us that we really did not know much about how to treat and probably still don’t. I am surprised that Paxlovid is mentioned as a solution. The treatment plan should be between doctor and patient and there are quite a few people who are not eligible for paxlovid.
Thank you so much Dr. Offit for the reminder of/primer on the natural history of COVID-19 infection and the role of the immune system and the drugs used to treat the infection (why/when they work is so important). It’s just science...
"Anti-vaccs" name calling has nothing to do with the effectiveness or the lack of effectiveness of a DRUG or VACCINE. If a drug or a vaccine is dangerous/ineffective the former "best practice" or "gold standard" should/would have stopped the trials or resulted in the pulling of the product off the market and stopped the consequences on an unsuspecting public. TRUST has been broken. Time to step up.
"If a drug or a vaccine is dangerous/ineffective the former "best practice" or "gold standard" should/would have stopped the trials or resulted in the pulling of the product off the market..."
And that is exactly what happens.
Why has trust been broken?
See the assertion above that there is no good evidence?
Below that was proven to be a flat out lie....but Brad refuses to be truthful.
Stick around here.....you will find 1000s of examples of anti-vaccs posting obvious lies.....and refusing to be honest.
The major reason for trust breaking is the anti-vaccs systematically lying.
Why would the drug not work in someone just because they had prior infection or vaccination? Can you explain this mechanism please? Do other antivirals or antimicrobials "fail to work" just because people have a degree of immunity?
Does aciclovir fail to work in those with shingles, because they had chickenpox in the past?
Does it fail to work in those with herpes recurrence?
Do antibiotics fail to work in those with meningococcal infection if they have previously been vaccinated?
Corticosteroids. If only we'd known early on that suppressing inflammation was so critical.
Somewhat tangentially, I recall early on that ER docs like Dr. Pierre Kory (who was effectively blacklisted for his later support of Ivermectin) noticed that patients had manifestations of hypoxia approximating Organizing Pneumonia, which is treated with corticosteroids. He was not the only one who made this observation, but it took him and others months to get the rest of the community to understand that this was not a normal situation.
Steroid use in infection is tricky...they usually worsen infections and given for the wrong indication, or at the wrong time, or in the wrong dose or by the wrong route can hasten serious illness and death. As Dr Offit has indicated, they are only of value in Covid's post acute stage and in those with hyperinflammatory response to the infection. Given early as some like Kory was trying (without any study evidence of their value) would and may have worsened the viraemic phase of the illness and caused severe problems.
The value of steroids was hypothesised early during the pandemic, which is why studies like RECOVERY were started and the confirmed findings that Dexamethasone halved fatality in serious infection was quickly disseminated in May 2020, after which it was widely used. Kory was not responsible for getting biomedical scientists on board.
Kory was "blacklisted" as you call it for promoting drugs like hydroxychloroquine (and later ivermectin when he accepted HCQ didn't actually work), the unfettered and unevidenced use of which was responsible for up to 13,000 US deaths in the US alone through toxicity in the first year of the pandemic (and no doubt many more subsequently).
Thanks for demonstrating that you have given up even the pretense of caring about facts and will just mindlessly lie....based on the data to date, that is intellectually the best you have got to offer!
Specifically required 'symptomatic, unvaccinated, nonhospitalized adults' and 'Key exclusion criteria were previous confirmed SARS-CoV-2 infection or hospitalization for Covid-19'.
If Mr. Trump were to get another bout of infection, I don't see RCT data indicating this would be an effective treatment.
There is no evidence that Paxlovid would make any difference.
Already, COVID related hospitalizations among the vaccinated previously infected cohort are small (so is mortality).
Today the population of high risk individuals, is both highly vaccinated and almost completely previously infected. Giving a drug that worked for a different viral strain that is long obsolete is foolish.
'Best Practice' calls for new data, and based on reasonable assumptions there would probably be no deaths in the placebo arm and likely no difference in hospitalizations either. The NNT would be enormous.
Maybe this info from Johns Hopkins is dumbed down sufficiently for you to understand.
The research base demonstrating the benefit of Paxlovid is quite substantial, but you need to want to see it, rather than looking for it with eyes tight shut.
Interesting to see that sales piece from Johns Hopkins cites *no* research to support its recommendation for the use of Paxlovid.
But you step right up. Keep your medicine cabinet stocked with Covid tests, test at your first sniffle, and then *demand* Paxlovid from your doctor whenever you are positive. And also make sure to get your mRNA booster whenever Fauci/CDC says. If you are lucky, you will have a doctor who doesn't care about truth and will just jump to your every demand.
I've seen the data. It is all garbage. Observational studies filled with confounding and outdated studies that don't apply to the current state of population immunity. But you do you.
I've got it...I musn't link to articles that weren't DBPCRCTs, but I also musn't link to articles that analysed results (since analyses may have been chosen to get the results someone wanted), ......so I can't link to anything......You win! ...There is no evidence for anything at all! Insulin doesn't work for T1DM, antibiotics don't work for infections...nothing works!
You don't see why a scientists opinion for public consumption without serious citation, shouldn't be part of an academic discussion.
Also, link to serious observational research (at best), regurgitating tiny studies doesn't make your point. And, understand observational research - when proper prospective controls aren't pre-established are fundamentally flawed - you can decide the result you want - and then determine the controlling factors that will allow you to publish whatever you want.
I am not a practitioner of faith-based medicine. I don't 'believe' in drugs.
Evidence is required to substantiate an intervention.
If you think Paxlovid given to previously vaccinated and infected patients, reduces severe outcomes, Please present data.
The burden of proof is on he/she who recommends an intervention.
In this case it simply doesn't exist.
(Do you remember Tamiflu and the NI class of drugs, the USA spent billions on a 'pandemic' stockpile - for a drug that isn't effective, see Cochrane and BMJ? Hesitancy for non-approved antivirals -it is EUA authorized- is prudent).
Do be warned that I have little to no diplomacy when exposing inefficacious therapies, including those falsely claiming to be "evidence based". A spade should be called a spade.
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and claim you are "an enemy of flawed studies', all while reading Ding, Topol, long covid research etc.
You are the villain of your own substack, promoting an evidence-free probably inefficacious therapy, with the certainty it is evidence based.
Listen to your own song - start reading evidence critically.
Feel free to engage with research supporting your claim, shame on you for name calling and refusing.
Thank you for outing yourself as a teenage girl, name calling anyone who you disagree with.
If you can't prove your point, you are free to engage in pseudoscientific practice. I'm not saying paxlovid won't work. I am suggesting that if there is no compelling evidence - EPIC-HR is not - an endorsement of the drug is a-scientific.
Bring academic citations - I'm waiting and would be glad to change by mind.
Well, age specific IFR varies greatly, and of course we aren’t talking about just those under 30 years of age, are we? Most people are over the age of 50, and most of those with Covid are over 65.
IFR estimates have been produced throughout the pandemic; earlier more serious variants having higher IFRs than Omicron.
Early estimates averaged around 0.7% for the US.
Ioannidis, who has tended to produce estimates much lower than most, published the article I link to, but I’m happy to use him as a source.
He published IFR estimates for the under 60s, using internationally available data abd got the following:
0-19 = 0.0003%
20-29 = 0.002% (so not “zero” as you state)
30-39 = 0.011%
40-49 = 0.123%
50-59 = 0.35%
60-69 = 0.506%.
Of course for the over 70s the IFRs shoot up much higher.
Overall for the US, in the under 69 age group the average IFR is 0.18%.
So when I stated the US IFR was on average more like 0.3% (rather than 0.03%), I was probably underestimating it slightly once the IFRs in the over 70s are factored in. [It’s likely to be at least 0.5%]
Oh, and by the way, thanks for demonstrating you are a perfect example of doctors who should know better but who don't know how to critically analyze data.
My first thought was “I don’t know you and I’m not taking homework from you” you lazy, ignorant sod, but then I remembered that’s a favourite ploy of quacks. So here you are: there is by now quite an array of scholarly articles by highly-trusted sources and rather than lay out the lot (there are just too many) I’ll quote the “real-world” study reported by the CDC which showed that adults who took Paxlovid within 5 days of diagnosis had a 51% lower hospitalisation rate than those not given Paxlovid. Another is a UK study published in JAMA showing 67% reduction in hospitalisation and 81% reduction in deaths. Ethical scientists do not run experiments knowing that the outcome will include deaths.
It's a game of "No true Scotsman" with him, I'm afraid. He demands studies showing "X", but when presented with them he complains they are not RCTs, or that the studies weren't done well, or, (get this...) that the significant result *almost* wasn't significant.
Giving him numerous studies refuting his claims is like feeding a very hungry troll; he'll reject them, and bounce right back saying "You haven't shown me any evidence, so you are wrong!"
The goal posts will always move, or he'll pretend that you missed.
Seems so, Mike :-) I switched him off and now all I can do is recall that he called me a teenager, and smile and bat my eyelashes, in this old arthritic body 🤣🤣🤣
Read my first post - I asked for studies indicating effectiveness defined by clinical outcomes in previously the HR, infected and vaccinated cohort.
You failed to provide them.
A CI interval as wide a three semi trucks that is barely significant - indicates the intervention may very well be marginal. Did you learn about clinical research? There are CI thresholds for upper and lower bounds.
I haven't said you are wrong - except that your claim to answer my question hasn't been answered. When did I move goalposts?
First, link to your studies so we actually know what you are talking about.
Second, As noted above I have just explained why four studies cited by @Mike S have no relevance to the current question:
Is paxlovid effective at reducing severe covid19-Omicron outcomes in HR, vaccinated and previously infected population - the current context in the vast majority of todays population?
Third,
Stop name-calling, and grow up.
Don't act like some stereotypical angry, white, middle-age, childless, career women (which you may or may not be)
So sad how Offit sometimes becomes a parody of himself. He's recommending a drug when he has no clue if it might help, and doesn't even bother to explain to a future Mr. Trump that 'hey, this drug might work, but we really aren't sure given the lack of reliable rials for your situation and the current context'.
The question is does paxlovid work in HR previously infected AND vaccinated against C19 - none of your studies answer the question. BTW there must be RCT's to answer this question since the vast majority of the population is both vaccinated and previously infected. All your studies are flawed observational research, and still don't prove your point.
Here is the long version:
Your first study is NEJM's publishing of EPIC-HR. As I noted before the study doesn't support Offit's claim. Excluded from the study were vaccinated and/or previously infected.
Second study Debbinay et. al. (which you lined twice), included only 'first-ever positive test' - i.e. excluded previously infected. Also, as an observational study with half the effectiveness of EPIC-HR, it is likely correlation not a causative impact. In two population subgroups and low SES subgroup there is no statistical significance. How likely do you think Paxlovid only helps wealthy people?!? It barely met statistical (CI 95%) significance in the vaccinated cohort.
Third study Sun et. al., another observational study with low vaccination rates (25%) and small size (114 patients) - calling this study evidence is a joke, and it doesn't prove your point either.
Fourth study Lewnard et. al., retrospective observational study, again hardly counts as good evidence. There is large censoring of patients, which makes the results suspect. They note numerous limitations in drawing casual inference - read the whole list, for example: "our study has limitations... potential misclassification of immunity due to undiagnosed previous SARS-CoV-2 infections or those never reported to KPSC remains a concern, ... Second, unmeasured confounding could have hindered causal inference..."
They adjusted for vaccination and previous documented COVID, but not for serological positivity and not for both variates. Only 93 age 65+ were previously infected - too small for conclusions. Take a look at table S9 - untreated did better than treated in previously infected cohort and the sample size is too small.
Thank you for this. The reference stirs up so many memories. I wasn't there and admit to no first hand knowledge but watched and read every tidbit. If you recall, the former president had been on the campaign trail and preparing for the debates. Chris Christie his debate partner had been hospitalized with severe COVID complications. One of the former president's closest staff members (Hope Hicks) was dx with COVID and had to isolate on AIR FORCE 1. I believe he returned to travel and perhaps even the debate (my memory is clouded) despite being symptomatic. He tested positive but delayed the announcement until a midnight call to FOX NEWS. He had access to the finest ID physicians in the nation at WRMMC ( as I recall his consultants were from JHU ) and NIH is across the street, not to mention Dr. Fauci a phone call away. I have no doubt the medical staff did due diligence and offered the best known care. My guess is that DJT fought them all the way. His political advisors made sure that Dr. Conley humiliated himself and briefed the press with an unlikely story. The former president's COS whispered to reporters that DJT was in fact much sicker. DJT defied no doubt all medical recommendations and went for a ride around the hospital exposing the secret service agents in the car. I remember everyone wonder if the decadron high enabled his winded walk up the stairs on his return to the White House. Agree, much was not yet known at that time about the new medications but my best guess is that denial and " a show of strength " delayed the best care possible. And, of course, now we read that his personal physician was a covid denier.
Just an internist with no special training but Neither EPIC HR or EPIC sr apply so do you have an RCT that applies for vaccinated, previously infected patient over 50 or older with current strains to recommend paxlovid. Thanks for your time and consideration.
The drug is an antiviral, pure and simple, inhibiting viral replication. It doesn't stop working if someone previously had infection or vaccination and has antibodies. It is effective against all variants. It is not an immune based therapy.
Thanks for your post, Paul. Always informative. I seriously doubt that a stubborn and ignorant person like Trump would take your advice or that from any other health expert if he gets COVID-19 again. In fact, it’d be better if no advice is given so that natural selection ensues. Many of us want a better world.
The world is immeasurably worse under Biden. President Trump gave this country it's finest hour economically,and vaccine development for Covid came under his watch,through Operation Warp Speed.
If I were a betting man ,I would put my money you being ignorant,not President Trump.
Who "developed" the vaccines outside of the US, where their rollout sometimes beat that of the US to the tape? What makes you think that under a different administration, development would have necessarily been any slower?
The vaccine development was a global effort.As usual,the US picked up most of the tab. Thankfully President Trump recognized the urgency to invest.Sleepy Joe would not have a clue what was going on.
Sorry, but he's already had kids, so too late for natural selection! If what I read was true, Trump was pretty scared when he was hospitalized, the only reason he consented to do it. It's interesting how anti-science folks can easily change their minds when they are very ill. Not that Trump was anti-vaccine, as he originally took credit for them, but he's learned not to any more because he gets booed by his fans whenever he mentions them. I've seen others who got very sick (not just Trump) who quickly changed their minds when on death's door. I've often wondered how many anti-vaccine folks would NOT take the rabies vaccine if they were bitten by a rabid animal.
Last bastion, "anti-science" , "anti-vaccine" name calling. Thank Goodness Science and Medicine is not settled and most strive for more. This particular vaccine was neither "safe nor effective". It's time to STOP.
I don't know what words you are referring to when you said "name calling." Could you be specific? Were you referring to the words "anti-vaccine?" Is that now considered "name calling?" I thought it was merely stating somebody's actual position. What should we say instead? Every single decision, whether it be about taking ANY particular medication or vaccine or NOT taking any particular medicine or vaccine, entails potential risks and benefits, which may vary by subpopulations. There are NEVER risk-free decisions, and those who think otherwise are either untrained or fooling themselves. As for this particular vaccine being neither "safe nor effective," I'm a scientist with training in experimental design and statistics, so I'm perfectly capable of interpreting the data for myself. In my age group, the benefits clearly outweigh the risks, so I've taken each one when recommended. (I have experienced neither Covid nor adverse effects). I could care less if you take it or not. You make your choices, and I'll make mine. What's sad is that Trump was so excited about being the one who approved Operation Warp Speed, and when he announced he got the Covid booster, the crowd booed. Trump may be impulsive and narcissistic, but he's definitely not stupid. He will continue to get boosted, but will now keep his mouth shut about it.
The cliches. One may not consider a vaccine "safe" after being tested for only 3 months, but still opt-in for long studied vaccines. Does that mean they are "anti-science, anti-vaccine" due to one questionable vaccine? It was impossible for anyone to be declaring the Covid19 vaccine "safe or effective", long-term or short-term. Not enough "gold standard" protocols. My point, everyone whether trained in stats (science math) like me or you, or not. has the RIGHT to consent to what is put into their body. I also expect TRUTH, not supression of outcomes that contradict the narrative, so that I or any other person/parent can make an informed decision. Once the "anti-science, anti-vaccine" labels are thrown out, debate is lost. IMHO
I'm sorry if I've spoken in cliches and used words you consider insulting. Sometimes this subject gets to me, so my apologies. If I understand you correctly, you are not against all vaccines, and you still "opt-in" for other vaccines that you think have sufficient long-term safety data behind them. I get it. I've been skeptical of Big Pharma for years before Covid hit, and never took a drug unless it had been out for awhile. Then Covid came along, I'm older now, and I experienced Shingles shortly before Covid hit, so I knew my immune system wasn't what it used to be. (And no, I wasn't vaccinated! I had looked into Zostavax when my doctor recommended it but wasn't impressed by the efficacy data, and Shingles is usually not fatal, so I declined. I didn't know about the newer more effective vaccine Shingrix until after I got Shingles). During the pandemic, I listened to a number of podcasts by physicians, and Dr. Offit was a somewhat frequent guest. I grew to trust him, not only because of his demeanor, but because he reported the bad stuff about vaccines along with the good stuff, and he has his entire career if you look at all the books he's published. So that's why I subscribe to this newsletter. If people don't trust him, fine, but I'm not sure why they subscribe to him then. I agree that people have the right to consent to what is put into their body, and parents have that right for their kids with the exception of very rare cases when a child's life is in immediate and significant danger (e.g., some parents refuse all medical treatments for their kids for religious reasons and the child will die without it and then the courts intervene). I know schools require vaccinations for entry and that's a touchy subject. I won't go there because I don't feel sufficiently qualified to say whether that policy saves enough lives to justify the removal of self-determination, for which I'm usually an advocate. As for suppression of outcomes that contradict the narrative, I'm not sure what you are referring to there. I will reserve judgment until I see some solid evidence of that. (Yes, I've seen many accusations of that in other Substacks and news reports, but no evidence that withstands unbiased scrutiny IMHO. That doesn't mean mistakes weren't made during the heat of the pandemic, but that's to be expected with a novel virus about which little is known. To me, that's not the same as suppressing outcomes). I wish the Covid vaccine were more effective against infection, but Offit said even before it was approved that the purpose of a vaccine is to keep people out of the hospital and morgue, not to prevent infection, since antibodies only last so long. I think in my age group, it did that. It's hard to say if that's still happening because most of the 2,000+ Covid deaths per week are in older people, the large majority of whom did not receive the latest booster. What worries me now more than getting severe illness from Covid is getting postacute sequelae, which is more than simply "Long Covid." (first link). Early findings suggest vaccination may reduce that risk, but more research on that is needed. If you are concerned about long term effects of this vaccine, I've included the second link below on that which I found very helpful, although you might not trust it. It sounds like you've lost trust in anybody who says anything positive about the Covid vaccine, but I could be hearing you wrong. The mRNA technology has been tested and studied much longer than most people realize. I agree that we should have access to unbiased research data, and that's the reason I'm here on Dr. Offit's site. I'm confident I will learn both the good and the bad here. He's not only an expert on vaccines, but also a dad and grandpa, and I don't see him recommending things to his kids unless he sees that the pros outweigh the cons for them. I'm just curious why you're here. Looking for information, or something else? Just wondering. Sorry this is so long! I wish you the best.
I am all for Information which allows people to make fully informed decisions. When politics, media, money hijack information, people get hurt or die. I was very thankful that during my oldest's routine baby shots, that I had listened to a Dr. who told me that my son's reactions (three TDAP) were not "normal" and I switched to the Japanese TDAP which thankfully my son did not have any more reactions to. This is what I'm talking about. Information flow. My pediatrician listened to me and agreed. Had I not heard the TDAP warning from this Medical Doctor, my Son could have continued to have subsequent reactions that could have resulted in brain damage. With Covid, how many people were shamed, villified, called names...By media, politicians, medical practicioners....? I had contraindications for this "medical experiment". I made my decision for myself. I got Covid a year ago and it lasted for 3 days. I was exposed continually for the first two years of Covid to Covid and didn't get it. Unfortunately, the 4 people that I love most in this world, were forced, yes forced to get the medical experiment that was supposed to prevent Covid and prevent transmission. My children did not get Covid until after two shots, two boosters and a relative who had all those shots gave it to them. My brother-in-law died from the vaccine after getting it to "protect" his Mother. His death killed her, literally. I'm not anti drug, or anti science, or anti vaccine. I am against supression of information and hysteria. I started reading the studies coming out just after "it" hit the US. The data out today, 4 years out, is anything but "safe" or "effective". Why Dr. Offit wrote this? I wonder.
Your article reads like a pharmaceutical advertisement. I like to think that you suffer from some sort of brainwashing or complete lack of critical thinking skills, because the alternative
is that you are writing these lies knowing full well that the risks of your purported regimen far out weigh the benefits and that the risks include death and permanent disability.
Ignore trolls. That’s what pisses them off. Trolls like these clearly show the vast ignorance in this country. As I said in my post, let natural selection work its magic.
You cannot be considered "respected" if one,like Dr.Offit,must satisy their obsessive compulson to berate those who are not of the same political ideology as he.This happens every single time he opens his mouth.
Great communicator of medical science yes,but definitely some loose screws between the ears when he interjects politics.
As noted, your argument by assertion about quality is false and the CID paper is from real-world data from the largest HCP in Israel whose population was 75+% vaccinated.
The Israel paper (Debbiny et al) was looking to specifically EXCLUDE anyone with previous infection.
My opinion on retrospective observational studies - is but an opinion. If you want to argue a single retrospective observational study qualifies as actionable evidence feel free to cite the appropriate papers in research methodology, just like I cited my hesitancy.
As in my previous interactions with you, you seem to have a hard time with the details. I noted my hesitancy with paxlovid datasets relevance for Vaccinated AND previously infected. In your post you focus on a single variable (vaccinated) not both.
Dexamethasone was indeed the likely best treatment for him at the time. And your characterization, that we were still learning about the timing for MCA and antivirals was exactly correct, although some of us had started sorting that out. Unfortunately, we were still confused by the timing for dexamethasone… but once we realized its benefit was in reducing the effects of cytokine storm, that issue was on its way to resolution. Perhaps the biggest problem was the lead physician managing that particular patient had a patient who thought he was able to dictate, successfully, his own medical care. There’s little doubt in my mind that Trump checked out AMA and should have convalesced at WRNMC for upwards of a week rather than rushing a return to the White House. But that was how that particular patient played out.
Thank you for making this available. Retired and on a fixed income, I can’t afford to pay separately to read or listen to all I would like. Question: Do you think the behaviors witnessed over the past year or so are signs of damage to the patient’s brain?
He's always been a nut-case. That symptom appeared long before he got COVID-19. Now there is a fair chance he will be the president of the United States (again!) so be afraid. Be very afraid.
Decadron was/is highly effective and is cheap. Every time I hear this ivermectin conspiracy nonsense from Weinstein/Rogan/etc, about how the research was suppressed so that the vaccine could be approved, I always wish someone would ask him, “what about decadron?” Decadron is cheap, effective and safe, yet somehow it wasn’t surpressed in the same manner that you feel ivermectin was. Unless, of course, ivermectin (like hydroxychloroquine) does not work.
Dexamethasone has been available for many years, and is cheap and off patent. Chris is correct; when the covid deniers whine about how they were never any cheap drugs available for Covid and how pharma had ensured only expensive drugs could be used and HCQ was outlawed, they were all lying.
Another thing...HCQ and ivermectin aren't necessarily cheap, simply because they are repurposed and off patent...those who wished to make fortunes from this crisis have ensured they can do so by selling those drugs through telemedicine, coining it in big time, often to the tune of profits in the millions of dollar range. A private script for these drugs is expensive, coming in at several hundred dollars per course.
"Before traveling to the hospital, doctors administered the first drug, a monoclonal antibody preparation called Regeneron intravenously, beginning a 5-day course. (The FDA authorized Regeneron six weeks later.)"
I believe there is a typo in the sentence above. "Regeneron" is a biopharma that produces a number of monoclonal antibody therapeutics, not the drug itself. I believe the antibody preparation referred to is REGEN-COV®, which was a combination of 2 monoclonal antibodies, casirivimab and imdevimab, both of which bind to the SARS-CoV2 spike protein.
Just a suggestion, Dr. Offit. Maybe you should continue to offer your newsletter for free so people who want to understand your sharp analysis can do so without regard to ability to pay. But like many other Substacks, maybe you should require payment for those who want to comment. That way, if uneducated trolls want to comment (see below), they at least have to pay for it.
Some of the comments by so-called professionals and people of science here are utterly biased and contemptible but few readers will be surprised.
We, the little people, are all exhausted by you but the good news is we have gotten adept at seeing through you with a swiftness that must surprise you, since we are “uneducated trolls” “anti-vaccine activists,” and “Covid deniers.”
Substack has become a place for truth to ferment and spread and your attempts to poison the well will surely fail. The American people are slowly waking up, but you know that. That’s why you’re here.
Since you are incapable, I will be embarrassed for you.
Just a side note: I went to a new doctor last week who was beside himself with glee when I told him I was unvaccinated. I was saving him the time and effort it would have taken to unpack a complex and difficult vaccine injury. You’re slowly losing physicians—once your wingmen—who refuse to hoist your lies and abuse on their patients anymore.
Remedesivir? If there are still people who would allow themselves or their loved ones to get within an inch of that drug, I don’t know of one and I doubt you do either. Shall we unpack the history of that drug together? From its very inception until today? Are you fearless enough to do that?
Good luck with your book. National Geographic is your publisher? Wasn’t that once a commendable and iconic publication? So sad to see America fall, isn’t it?
Everything we once held dear…
I don't know if your comment was directed at me or Dr. Offit, since you said, "Good luck with your book," and I have no book. But it ended up in my inbox, and I must admit that I'm curious why you bother to go to a doctor any more. If you have insurance, you're raising everybody else's premium needlessly. Maybe that's why you go, as you seem happy with the thought of "America's fall." I don't know what you even mean by that, but I think we are still a great nation, and I am sorry for those who are so angry with the world, and so filled with grievances. That can't be a pleasant way to live. I do hope you don't ever get bit by a rabid animal.
https://my.clevelandclinic.org/health/diseases/13848-rabies
You don’t need to subscribe here in order to comment, unlike the substack offerings of Covid naysayers and anti-vaccine activists.
Right. I suggested maybe commenting should require payment (but people could still access the information for free). That way, anti-vaccine trolls would have to pay for saying such things. Dr. Offit could contribute all proceeds to non-profit vaccine research institutions! :)
Understood. 👍
But I think having comments open to all prevents these turning into echo chambers, like others have.
And it’s good to see the trolls scurry out from under their rocks and being refuted.
Good point. I see you have the background to dispute them but I don't think they are likely to be persuaded. However, maybe some other readers who are on the fence will take the time to consider the evidence more thoroughly. 🤞
Yeah but, sometimes those of us who attempt to enlighten the trolls have to pay a price that gets weary. Refutation is often followed by trolls spouting their nonsense and claiming those reflecting the scientific literature are wrong, evil or worse. I’ve had several respond to my comments here, and on my own Substack that required a lot of effort to get over.
Yeah, that’s unfortunate.
Was Dr Offit part of the treatment team? How does he know it was Trump who refused care and denied his illness? Many patients were told early on to go home if they were sick and only come back if they were unable to breathe or got really sick. That was standard.
Wasn’t the patient lucky that Remdisivir didn’t flood his lungs with fluid? And how amazing that he was treated “improperly” and survived the virus. And isn’t it a shame that the steroids weren’t heralded as a helpful treatment but not a lot of the general public know this. Wonder if other antivirals besides Pfizer’s new paxlovid were studied for early virus stage intervention. I am definitely going to read Offits book. We had a family member who got Covid in 20 and only lost taste and vomited for a day. (Tested positive) will be interested if he addresses those symptoms. Our famil
Thank you for describing the stages of the illness and the process of treatment, Dr Offit. And also for reminding us that we really did not know much about how to treat and probably still don’t. I am surprised that Paxlovid is mentioned as a solution. The treatment plan should be between doctor and patient and there are quite a few people who are not eligible for paxlovid.
Thank you so much Dr. Offit for the reminder of/primer on the natural history of COVID-19 infection and the role of the immune system and the drugs used to treat the infection (why/when they work is so important). It’s just science...
Nope. There is no good evidence for Paxlovid in somebody with prior immunity.
And none for Remdesavir either.
Yes there is.
Some has been posted here.
There is zero evidence of any honesty from the anti-vaccs.
Can you repost?
The only one I saw was a retrospective sample, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00118-4/fulltext
where previously infected comprised just a few hundred and the combination of previously infected AND vaccinated was not listed.
I'd love to see robust data. Please share.
Albus doesn't know what he is talking about. Ignore him.
I bet he knows what the IFR of Covid is though, unlike you.
"Anti-vaccs" name calling has nothing to do with the effectiveness or the lack of effectiveness of a DRUG or VACCINE. If a drug or a vaccine is dangerous/ineffective the former "best practice" or "gold standard" should/would have stopped the trials or resulted in the pulling of the product off the market and stopped the consequences on an unsuspecting public. TRUST has been broken. Time to step up.
"If a drug or a vaccine is dangerous/ineffective the former "best practice" or "gold standard" should/would have stopped the trials or resulted in the pulling of the product off the market..."
And that is exactly what happens.
Why has trust been broken?
See the assertion above that there is no good evidence?
Below that was proven to be a flat out lie....but Brad refuses to be truthful.
Stick around here.....you will find 1000s of examples of anti-vaccs posting obvious lies.....and refusing to be honest.
The major reason for trust breaking is the anti-vaccs systematically lying.
It really is exactly that simple.
Why would the drug not work in someone just because they had prior infection or vaccination? Can you explain this mechanism please? Do other antivirals or antimicrobials "fail to work" just because people have a degree of immunity?
Does aciclovir fail to work in those with shingles, because they had chickenpox in the past?
Does it fail to work in those with herpes recurrence?
Do antibiotics fail to work in those with meningococcal infection if they have previously been vaccinated?
Corticosteroids. If only we'd known early on that suppressing inflammation was so critical.
Somewhat tangentially, I recall early on that ER docs like Dr. Pierre Kory (who was effectively blacklisted for his later support of Ivermectin) noticed that patients had manifestations of hypoxia approximating Organizing Pneumonia, which is treated with corticosteroids. He was not the only one who made this observation, but it took him and others months to get the rest of the community to understand that this was not a normal situation.
Steroid use in infection is tricky...they usually worsen infections and given for the wrong indication, or at the wrong time, or in the wrong dose or by the wrong route can hasten serious illness and death. As Dr Offit has indicated, they are only of value in Covid's post acute stage and in those with hyperinflammatory response to the infection. Given early as some like Kory was trying (without any study evidence of their value) would and may have worsened the viraemic phase of the illness and caused severe problems.
The value of steroids was hypothesised early during the pandemic, which is why studies like RECOVERY were started and the confirmed findings that Dexamethasone halved fatality in serious infection was quickly disseminated in May 2020, after which it was widely used. Kory was not responsible for getting biomedical scientists on board.
Kory was "blacklisted" as you call it for promoting drugs like hydroxychloroquine (and later ivermectin when he accepted HCQ didn't actually work), the unfettered and unevidenced use of which was responsible for up to 13,000 US deaths in the US alone through toxicity in the first year of the pandemic (and no doubt many more subsequently).
https://www.sciencedirect.com/science/article/pii/S075333222301853X#sec0075
Thanks for demonstrating that you have given up even the pretense of caring about facts and will just mindlessly lie....based on the data to date, that is intellectually the best you have got to offer!
If only we had 40 years of experience with systemic steroids in inflammatory lung infections... wait! We did,
...And it took time to determine which steroids worked and when and in whom. Similarly for steroids in Covid.
I am concerned the Paxlovid recommendation is misinformation.
Can someone direct me to the evidence that shows paxlovid provides benefit to previously infected and vaccinated individuals who contact COVID?
The approval trial EPIC-HR : https://www.nejm.org/doi/full/10.1056/nejmoa2118542
Specifically required 'symptomatic, unvaccinated, nonhospitalized adults' and 'Key exclusion criteria were previous confirmed SARS-CoV-2 infection or hospitalization for Covid-19'.
If Mr. Trump were to get another bout of infection, I don't see RCT data indicating this would be an effective treatment.
You want an RCT where the placebo outcome is death?
There is no evidence that Paxlovid would make any difference.
Already, COVID related hospitalizations among the vaccinated previously infected cohort are small (so is mortality).
Today the population of high risk individuals, is both highly vaccinated and almost completely previously infected. Giving a drug that worked for a different viral strain that is long obsolete is foolish.
'Best Practice' calls for new data, and based on reasonable assumptions there would probably be no deaths in the placebo arm and likely no difference in hospitalizations either. The NNT would be enormous.
Maybe this info from Johns Hopkins is dumbed down sufficiently for you to understand.
The research base demonstrating the benefit of Paxlovid is quite substantial, but you need to want to see it, rather than looking for it with eyes tight shut.
https://publichealth.jhu.edu/2024/why-more-people-should-be-prescribed-paxlovid-for-covid
Interesting to see that sales piece from Johns Hopkins cites *no* research to support its recommendation for the use of Paxlovid.
But you step right up. Keep your medicine cabinet stocked with Covid tests, test at your first sniffle, and then *demand* Paxlovid from your doctor whenever you are positive. And also make sure to get your mRNA booster whenever Fauci/CDC says. If you are lucky, you will have a doctor who doesn't care about truth and will just jump to your every demand.
I've seen the data. It is all garbage. Observational studies filled with confounding and outdated studies that don't apply to the current state of population immunity. But you do you.
Don't bother linking to articles written by MD's who can't attach primary research.
I'd like to see RCT's in the target population - HR, previously vaccinated and infected.
Show it to me, my eyes are wide open. I'm waiting.
You mean like the RCT's for staunching the bleeding of someone that is hemorrhaging large amounts of blood?
All you have offered here is second rate sophistry.
Any half-competent practitioner understands that vaccination status is irrelevant for determining if Plaxovid is appropriate.
https://www.nejm.org/doi/full/10.1056/NEJMoa2309003
RCT result: null
dj thinks there have never been any antivirals tested before paxlovid except tamiflu.
Aw... C'mon
A little humility with the history of anti-virals (NI's like Tamiflu)...
Any half-competent practitioner would actually make a reasonable argument instead of quaking about sophistry with irrelevant examples.
Anyway, in my last back-and-forth with you, you played a bait and switch game, when you couldn't validate the question I asked.
I've got it...I musn't link to articles that weren't DBPCRCTs, but I also musn't link to articles that analysed results (since analyses may have been chosen to get the results someone wanted), ......so I can't link to anything......You win! ...There is no evidence for anything at all! Insulin doesn't work for T1DM, antibiotics don't work for infections...nothing works!
Really?
You don't see why a scientists opinion for public consumption without serious citation, shouldn't be part of an academic discussion.
Also, link to serious observational research (at best), regurgitating tiny studies doesn't make your point. And, understand observational research - when proper prospective controls aren't pre-established are fundamentally flawed - you can decide the result you want - and then determine the controlling factors that will allow you to publish whatever you want.
You are a perfect example of why the HHS/NIH/FDA & CDC is garbage today... full of pharma sales people who don't know how to critically analyze data.
Try to keep up with credible data. I have no idea what you could possibly base your nonsensical claims on.
Uh,
I am not a practitioner of faith-based medicine. I don't 'believe' in drugs.
Evidence is required to substantiate an intervention.
If you think Paxlovid given to previously vaccinated and infected patients, reduces severe outcomes, Please present data.
The burden of proof is on he/she who recommends an intervention.
In this case it simply doesn't exist.
(Do you remember Tamiflu and the NI class of drugs, the USA spent billions on a 'pandemic' stockpile - for a drug that isn't effective, see Cochrane and BMJ? Hesitancy for non-approved antivirals -it is EUA authorized- is prudent).
Thank you for outing yourself as anti drug and anti science.
On your own substack you claim:
"""
Do be warned that I have little to no diplomacy when exposing inefficacious therapies, including those falsely claiming to be "evidence based". A spade should be called a spade.
"""
and claim you are "an enemy of flawed studies', all while reading Ding, Topol, long covid research etc.
You are the villain of your own substack, promoting an evidence-free probably inefficacious therapy, with the certainty it is evidence based.
Listen to your own song - start reading evidence critically.
Feel free to engage with research supporting your claim, shame on you for name calling and refusing.
When you can't debate, the last bastion is: "anti-science, sceince denier, anti-drug". Is that a psychology "best practice"? IIHO it is not.
Thank you for outing yourself as a teenage girl, name calling anyone who you disagree with.
If you can't prove your point, you are free to engage in pseudoscientific practice. I'm not saying paxlovid won't work. I am suggesting that if there is no compelling evidence - EPIC-HR is not - an endorsement of the drug is a-scientific.
Bring academic citations - I'm waiting and would be glad to change by mind.
And, grow up.
yes.
we got the result:
https://www.nejm.org/doi/full/10.1056/NEJMoa2309003
not statistically significant.
Show me any evidence that the "placebo outcome is death" in a disease with about a 0.03% IFR even in the immune naive. I'll wait.
IFR for Covid is more like 0.3%, rather than 0.03%. ...Just sayin'
Source? Population? Timeframe?
IFR in those under 30 is about 0
Well, age specific IFR varies greatly, and of course we aren’t talking about just those under 30 years of age, are we? Most people are over the age of 50, and most of those with Covid are over 65.
IFR estimates have been produced throughout the pandemic; earlier more serious variants having higher IFRs than Omicron.
Early estimates averaged around 0.7% for the US.
Ioannidis, who has tended to produce estimates much lower than most, published the article I link to, but I’m happy to use him as a source.
He published IFR estimates for the under 60s, using internationally available data abd got the following:
0-19 = 0.0003%
20-29 = 0.002% (so not “zero” as you state)
30-39 = 0.011%
40-49 = 0.123%
50-59 = 0.35%
60-69 = 0.506%.
Of course for the over 70s the IFRs shoot up much higher.
Overall for the US, in the under 69 age group the average IFR is 0.18%.
So when I stated the US IFR was on average more like 0.3% (rather than 0.03%), I was probably underestimating it slightly once the IFRs in the over 70s are factored in. [It’s likely to be at least 0.5%]
….are you OK with that?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613797/
Oh, and by the way, thanks for demonstrating you are a perfect example of doctors who should know better but who don't know how to critically analyze data.
My first thought was “I don’t know you and I’m not taking homework from you” you lazy, ignorant sod, but then I remembered that’s a favourite ploy of quacks. So here you are: there is by now quite an array of scholarly articles by highly-trusted sources and rather than lay out the lot (there are just too many) I’ll quote the “real-world” study reported by the CDC which showed that adults who took Paxlovid within 5 days of diagnosis had a 51% lower hospitalisation rate than those not given Paxlovid. Another is a UK study published in JAMA showing 67% reduction in hospitalisation and 81% reduction in deaths. Ethical scientists do not run experiments knowing that the outcome will include deaths.
It's a game of "No true Scotsman" with him, I'm afraid. He demands studies showing "X", but when presented with them he complains they are not RCTs, or that the studies weren't done well, or, (get this...) that the significant result *almost* wasn't significant.
Giving him numerous studies refuting his claims is like feeding a very hungry troll; he'll reject them, and bounce right back saying "You haven't shown me any evidence, so you are wrong!"
The goal posts will always move, or he'll pretend that you missed.
Seems so, Mike :-) I switched him off and now all I can do is recall that he called me a teenager, and smile and bat my eyelashes, in this old arthritic body 🤣🤣🤣
You are as old as you feel. 😉
Hey!
First, why are you gendering me?
second, Don't forget what I wrote below:
Stop name-calling, and grow up.
Don't act like some stereotypical angry, white, middle-age, childless, career women (which you may or may not be)
Excuse me,
Read my first post - I asked for studies indicating effectiveness defined by clinical outcomes in previously the HR, infected and vaccinated cohort.
You failed to provide them.
A CI interval as wide a three semi trucks that is barely significant - indicates the intervention may very well be marginal. Did you learn about clinical research? There are CI thresholds for upper and lower bounds.
I haven't said you are wrong - except that your claim to answer my question hasn't been answered. When did I move goalposts?
Why do you presume I'm a male?
Ms. Sutherland,
First, link to your studies so we actually know what you are talking about.
Second, As noted above I have just explained why four studies cited by @Mike S have no relevance to the current question:
Is paxlovid effective at reducing severe covid19-Omicron outcomes in HR, vaccinated and previously infected population - the current context in the vast majority of todays population?
Third,
Stop name-calling, and grow up.
Don't act like some stereotypical angry, white, middle-age, childless, career women (which you may or may not be)
You don’t know what you are talking about. You haven’t read those studies, you don’t understand the context, you are one of the brainwashed.
I know that anyone with basic reading skills can see that the anti-vaccs have made many obviously factually incorrect claims about the papers.
There is none.
Yeah, didn't think so.
So sad how Offit sometimes becomes a parody of himself. He's recommending a drug when he has no clue if it might help, and doesn't even bother to explain to a future Mr. Trump that 'hey, this drug might work, but we really aren't sure given the lack of reliable rials for your situation and the current context'.
You accuse Dr Offit of recommending a drug "when he has no clue if it might help"? Seriously? Do you have any idea who you are talking about?
You of course, know much more about the pharmacotherapy of infectious diseases than him, I presume.....lol.
It is the responsibility of those claiming an intervention works to substantiate their claims - this is how medicine works.
It isn't me who is making this argument many others have.
Have you heard of Drs. Tom Jefferson, Vinay Prasad et. al. - they all make similar arguments?
Do you remember the disastrous waste of NI drugs (e.g. Tamiflu) which don't appear more effective than tylenol?
I’ve posted below just a few of the studies that show paxlovid is of benefit.
Did you actually read the studies?!?
None of them support your argument.
The question is does paxlovid work in HR previously infected AND vaccinated against C19 - none of your studies answer the question. BTW there must be RCT's to answer this question since the vast majority of the population is both vaccinated and previously infected. All your studies are flawed observational research, and still don't prove your point.
Here is the long version:
Your first study is NEJM's publishing of EPIC-HR. As I noted before the study doesn't support Offit's claim. Excluded from the study were vaccinated and/or previously infected.
Second study Debbinay et. al. (which you lined twice), included only 'first-ever positive test' - i.e. excluded previously infected. Also, as an observational study with half the effectiveness of EPIC-HR, it is likely correlation not a causative impact. In two population subgroups and low SES subgroup there is no statistical significance. How likely do you think Paxlovid only helps wealthy people?!? It barely met statistical (CI 95%) significance in the vaccinated cohort.
Third study Sun et. al., another observational study with low vaccination rates (25%) and small size (114 patients) - calling this study evidence is a joke, and it doesn't prove your point either.
Fourth study Lewnard et. al., retrospective observational study, again hardly counts as good evidence. There is large censoring of patients, which makes the results suspect. They note numerous limitations in drawing casual inference - read the whole list, for example: "our study has limitations... potential misclassification of immunity due to undiagnosed previous SARS-CoV-2 infections or those never reported to KPSC remains a concern, ... Second, unmeasured confounding could have hindered causal inference..."
They adjusted for vaccination and previous documented COVID, but not for serological positivity and not for both variates. Only 93 age 65+ were previously infected - too small for conclusions. Take a look at table S9 - untreated did better than treated in previously infected cohort and the sample size is too small.
Thank you for this. The reference stirs up so many memories. I wasn't there and admit to no first hand knowledge but watched and read every tidbit. If you recall, the former president had been on the campaign trail and preparing for the debates. Chris Christie his debate partner had been hospitalized with severe COVID complications. One of the former president's closest staff members (Hope Hicks) was dx with COVID and had to isolate on AIR FORCE 1. I believe he returned to travel and perhaps even the debate (my memory is clouded) despite being symptomatic. He tested positive but delayed the announcement until a midnight call to FOX NEWS. He had access to the finest ID physicians in the nation at WRMMC ( as I recall his consultants were from JHU ) and NIH is across the street, not to mention Dr. Fauci a phone call away. I have no doubt the medical staff did due diligence and offered the best known care. My guess is that DJT fought them all the way. His political advisors made sure that Dr. Conley humiliated himself and briefed the press with an unlikely story. The former president's COS whispered to reporters that DJT was in fact much sicker. DJT defied no doubt all medical recommendations and went for a ride around the hospital exposing the secret service agents in the car. I remember everyone wonder if the decadron high enabled his winded walk up the stairs on his return to the White House. Agree, much was not yet known at that time about the new medications but my best guess is that denial and " a show of strength " delayed the best care possible. And, of course, now we read that his personal physician was a covid denier.
Just an internist with no special training but Neither EPIC HR or EPIC sr apply so do you have an RCT that applies for vaccinated, previously infected patient over 50 or older with current strains to recommend paxlovid. Thanks for your time and consideration.
Nevermind Mike S. He is clueless.
Yes Ty. Ty. Sounds like he is pro dr offit so he is just trying to protect so good intent.
The drug is an antiviral, pure and simple, inhibiting viral replication. It doesn't stop working if someone previously had infection or vaccination and has antibodies. It is effective against all variants. It is not an immune based therapy.
Are you an intern in medicine?
Thanks for your post, Paul. Always informative. I seriously doubt that a stubborn and ignorant person like Trump would take your advice or that from any other health expert if he gets COVID-19 again. In fact, it’d be better if no advice is given so that natural selection ensues. Many of us want a better world.
The world is immeasurably worse under Biden. President Trump gave this country it's finest hour economically,and vaccine development for Covid came under his watch,through Operation Warp Speed.
If I were a betting man ,I would put my money you being ignorant,not President Trump.
Who "developed" the vaccines outside of the US, where their rollout sometimes beat that of the US to the tape? What makes you think that under a different administration, development would have necessarily been any slower?
The vaccine development was a global effort.As usual,the US picked up most of the tab. Thankfully President Trump recognized the urgency to invest.Sleepy Joe would not have a clue what was going on.
The vaccine development was a global effort.
The US didn’t pick up the tab. It implemented OWS which aided vaccine distribution in the US.
Democrats move slow,especially under Sleepy Joe
Sorry, but he's already had kids, so too late for natural selection! If what I read was true, Trump was pretty scared when he was hospitalized, the only reason he consented to do it. It's interesting how anti-science folks can easily change their minds when they are very ill. Not that Trump was anti-vaccine, as he originally took credit for them, but he's learned not to any more because he gets booed by his fans whenever he mentions them. I've seen others who got very sick (not just Trump) who quickly changed their minds when on death's door. I've often wondered how many anti-vaccine folks would NOT take the rabies vaccine if they were bitten by a rabid animal.
Last bastion, "anti-science" , "anti-vaccine" name calling. Thank Goodness Science and Medicine is not settled and most strive for more. This particular vaccine was neither "safe nor effective". It's time to STOP.
I don't know what words you are referring to when you said "name calling." Could you be specific? Were you referring to the words "anti-vaccine?" Is that now considered "name calling?" I thought it was merely stating somebody's actual position. What should we say instead? Every single decision, whether it be about taking ANY particular medication or vaccine or NOT taking any particular medicine or vaccine, entails potential risks and benefits, which may vary by subpopulations. There are NEVER risk-free decisions, and those who think otherwise are either untrained or fooling themselves. As for this particular vaccine being neither "safe nor effective," I'm a scientist with training in experimental design and statistics, so I'm perfectly capable of interpreting the data for myself. In my age group, the benefits clearly outweigh the risks, so I've taken each one when recommended. (I have experienced neither Covid nor adverse effects). I could care less if you take it or not. You make your choices, and I'll make mine. What's sad is that Trump was so excited about being the one who approved Operation Warp Speed, and when he announced he got the Covid booster, the crowd booed. Trump may be impulsive and narcissistic, but he's definitely not stupid. He will continue to get boosted, but will now keep his mouth shut about it.
The cliches. One may not consider a vaccine "safe" after being tested for only 3 months, but still opt-in for long studied vaccines. Does that mean they are "anti-science, anti-vaccine" due to one questionable vaccine? It was impossible for anyone to be declaring the Covid19 vaccine "safe or effective", long-term or short-term. Not enough "gold standard" protocols. My point, everyone whether trained in stats (science math) like me or you, or not. has the RIGHT to consent to what is put into their body. I also expect TRUTH, not supression of outcomes that contradict the narrative, so that I or any other person/parent can make an informed decision. Once the "anti-science, anti-vaccine" labels are thrown out, debate is lost. IMHO
I'm sorry if I've spoken in cliches and used words you consider insulting. Sometimes this subject gets to me, so my apologies. If I understand you correctly, you are not against all vaccines, and you still "opt-in" for other vaccines that you think have sufficient long-term safety data behind them. I get it. I've been skeptical of Big Pharma for years before Covid hit, and never took a drug unless it had been out for awhile. Then Covid came along, I'm older now, and I experienced Shingles shortly before Covid hit, so I knew my immune system wasn't what it used to be. (And no, I wasn't vaccinated! I had looked into Zostavax when my doctor recommended it but wasn't impressed by the efficacy data, and Shingles is usually not fatal, so I declined. I didn't know about the newer more effective vaccine Shingrix until after I got Shingles). During the pandemic, I listened to a number of podcasts by physicians, and Dr. Offit was a somewhat frequent guest. I grew to trust him, not only because of his demeanor, but because he reported the bad stuff about vaccines along with the good stuff, and he has his entire career if you look at all the books he's published. So that's why I subscribe to this newsletter. If people don't trust him, fine, but I'm not sure why they subscribe to him then. I agree that people have the right to consent to what is put into their body, and parents have that right for their kids with the exception of very rare cases when a child's life is in immediate and significant danger (e.g., some parents refuse all medical treatments for their kids for religious reasons and the child will die without it and then the courts intervene). I know schools require vaccinations for entry and that's a touchy subject. I won't go there because I don't feel sufficiently qualified to say whether that policy saves enough lives to justify the removal of self-determination, for which I'm usually an advocate. As for suppression of outcomes that contradict the narrative, I'm not sure what you are referring to there. I will reserve judgment until I see some solid evidence of that. (Yes, I've seen many accusations of that in other Substacks and news reports, but no evidence that withstands unbiased scrutiny IMHO. That doesn't mean mistakes weren't made during the heat of the pandemic, but that's to be expected with a novel virus about which little is known. To me, that's not the same as suppressing outcomes). I wish the Covid vaccine were more effective against infection, but Offit said even before it was approved that the purpose of a vaccine is to keep people out of the hospital and morgue, not to prevent infection, since antibodies only last so long. I think in my age group, it did that. It's hard to say if that's still happening because most of the 2,000+ Covid deaths per week are in older people, the large majority of whom did not receive the latest booster. What worries me now more than getting severe illness from Covid is getting postacute sequelae, which is more than simply "Long Covid." (first link). Early findings suggest vaccination may reduce that risk, but more research on that is needed. If you are concerned about long term effects of this vaccine, I've included the second link below on that which I found very helpful, although you might not trust it. It sounds like you've lost trust in anybody who says anything positive about the Covid vaccine, but I could be hearing you wrong. The mRNA technology has been tested and studied much longer than most people realize. I agree that we should have access to unbiased research data, and that's the reason I'm here on Dr. Offit's site. I'm confident I will learn both the good and the bad here. He's not only an expert on vaccines, but also a dad and grandpa, and I don't see him recommending things to his kids unless he sees that the pros outweigh the cons for them. I'm just curious why you're here. Looking for information, or something else? Just wondering. Sorry this is so long! I wish you the best.
https://www.nature.com/articles/s41591-023-02521-2
https://www.chop.edu/news/long-term-side-effects-covid-19-vaccine
I am all for Information which allows people to make fully informed decisions. When politics, media, money hijack information, people get hurt or die. I was very thankful that during my oldest's routine baby shots, that I had listened to a Dr. who told me that my son's reactions (three TDAP) were not "normal" and I switched to the Japanese TDAP which thankfully my son did not have any more reactions to. This is what I'm talking about. Information flow. My pediatrician listened to me and agreed. Had I not heard the TDAP warning from this Medical Doctor, my Son could have continued to have subsequent reactions that could have resulted in brain damage. With Covid, how many people were shamed, villified, called names...By media, politicians, medical practicioners....? I had contraindications for this "medical experiment". I made my decision for myself. I got Covid a year ago and it lasted for 3 days. I was exposed continually for the first two years of Covid to Covid and didn't get it. Unfortunately, the 4 people that I love most in this world, were forced, yes forced to get the medical experiment that was supposed to prevent Covid and prevent transmission. My children did not get Covid until after two shots, two boosters and a relative who had all those shots gave it to them. My brother-in-law died from the vaccine after getting it to "protect" his Mother. His death killed her, literally. I'm not anti drug, or anti science, or anti vaccine. I am against supression of information and hysteria. I started reading the studies coming out just after "it" hit the US. The data out today, 4 years out, is anything but "safe" or "effective". Why Dr. Offit wrote this? I wonder.
Your article reads like a pharmaceutical advertisement. I like to think that you suffer from some sort of brainwashing or complete lack of critical thinking skills, because the alternative
is that you are writing these lies knowing full well that the risks of your purported regimen far out weigh the benefits and that the risks include death and permanent disability.
Your attack on one of the most respected physicians in our country is ludicrous.
Ignore trolls. That’s what pisses them off. Trolls like these clearly show the vast ignorance in this country. As I said in my post, let natural selection work its magic.
https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00012-3/fulltext
😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂😂
You cannot be considered "respected" if one,like Dr.Offit,must satisy their obsessive compulson to berate those who are not of the same political ideology as he.This happens every single time he opens his mouth.
Great communicator of medical science yes,but definitely some loose screws between the ears when he interjects politics.
https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00012-3/fulltext
https://journals.asm.org/doi/10.1128/aac.01117-21
and more.....
https://www.nejm.org/doi/full/10.1056/nejmoa2118542
https://academic.oup.com/cid/article/76/3/e342/6599020
https://pubmed.ncbi.nlm.nih.gov/35653428/
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00430-3/fulltext
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00118-4/fulltext
As noted above - all of these studies are poor quality evidence.
None of them support Paxlovid is the current context (80% of population vaccinated and previously infected).
Whoops....
As noted, your argument by assertion about quality is false and the CID paper is from real-world data from the largest HCP in Israel whose population was 75+% vaccinated.
Here we go again, second rate practitioner,
The Israel paper (Debbiny et al) was looking to specifically EXCLUDE anyone with previous infection.
My opinion on retrospective observational studies - is but an opinion. If you want to argue a single retrospective observational study qualifies as actionable evidence feel free to cite the appropriate papers in research methodology, just like I cited my hesitancy.
As in my previous interactions with you, you seem to have a hard time with the details. I noted my hesitancy with paxlovid datasets relevance for Vaccinated AND previously infected. In your post you focus on a single variable (vaccinated) not both.
People make mistakes. No one is above scrutiny.
Dexamethasone was indeed the likely best treatment for him at the time. And your characterization, that we were still learning about the timing for MCA and antivirals was exactly correct, although some of us had started sorting that out. Unfortunately, we were still confused by the timing for dexamethasone… but once we realized its benefit was in reducing the effects of cytokine storm, that issue was on its way to resolution. Perhaps the biggest problem was the lead physician managing that particular patient had a patient who thought he was able to dictate, successfully, his own medical care. There’s little doubt in my mind that Trump checked out AMA and should have convalesced at WRNMC for upwards of a week rather than rushing a return to the White House. But that was how that particular patient played out.
Thanks for the comments.
"but once we realized its benefit was in reducing the effects of cytokine storm, that issue was on its way to resolution.'
Could you please provide the data that supports cytokine storms as being common from covid?
Thanks,
These should get you started. The data are pretty convincing, and were clinically obvious by July/August 2020 in high volume centers.
https://virologyj.biomedcentral.com/articles/10.1186/s12985-022-01814-1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365923/
Thank you,
I look forward to reading them.
Thank you for making this available. Retired and on a fixed income, I can’t afford to pay separately to read or listen to all I would like. Question: Do you think the behaviors witnessed over the past year or so are signs of damage to the patient’s brain?
He's always been a nut-case. That symptom appeared long before he got COVID-19. Now there is a fair chance he will be the president of the United States (again!) so be afraid. Be very afraid.
Be afraid we will return to a stronger economy for all Americans and that the dream of being a homeowner for our young again becomes a reality.
Oh, please.
you beat me to it by seconds
Do you think the vaccine explains Bidens decline?
I'm not qualified to diagnose, but I'm gonna say ding dong donny has presented some of those symptoms since before COVID
Dementia Joe has presented muddled thinking since he entered politics.The definition of a loser.
100% agree, butcher biden is by no means any better upstairs
You either violated health privacy or you aren't telling the truth. Which one?
I want to know why when I block Albus, I still see his comments. I guess I will have to file a bug report with Substack.
Decadron was/is highly effective and is cheap. Every time I hear this ivermectin conspiracy nonsense from Weinstein/Rogan/etc, about how the research was suppressed so that the vaccine could be approved, I always wish someone would ask him, “what about decadron?” Decadron is cheap, effective and safe, yet somehow it wasn’t surpressed in the same manner that you feel ivermectin was. Unless, of course, ivermectin (like hydroxychloroquine) does not work.
"Decadron was/is highly effective and is cheap."
Data please.
Dexamethasone has been available for many years, and is cheap and off patent. Chris is correct; when the covid deniers whine about how they were never any cheap drugs available for Covid and how pharma had ensured only expensive drugs could be used and HCQ was outlawed, they were all lying.
Another thing...HCQ and ivermectin aren't necessarily cheap, simply because they are repurposed and off patent...those who wished to make fortunes from this crisis have ensured they can do so by selling those drugs through telemedicine, coining it in big time, often to the tune of profits in the millions of dollar range. A private script for these drugs is expensive, coming in at several hundred dollars per course.
Small correction. The monoclonal antibody treatment was called REGEN-COV. The company that made it is Regeneron.
"Before traveling to the hospital, doctors administered the first drug, a monoclonal antibody preparation called Regeneron intravenously, beginning a 5-day course. (The FDA authorized Regeneron six weeks later.)"
I believe there is a typo in the sentence above. "Regeneron" is a biopharma that produces a number of monoclonal antibody therapeutics, not the drug itself. I believe the antibody preparation referred to is REGEN-COV®, which was a combination of 2 monoclonal antibodies, casirivimab and imdevimab, both of which bind to the SARS-CoV2 spike protein.
See: https://www.regeneron.com/downloads/treatment-covid19-eua-fact-sheet-for-hcp.pdf