1) Big risk rate differences but dataset appears to lack behavioral/social data that would help identify potential confounders related to differences in exposure/viral dose at exposure
2) Lacks safety outcome data, so hard to discuss risks vs. benefits
3) Use of time period to set lower bound of effect is questionable. Behavioral differences related to the time periods, and how they shift, are much more of an unknown and are historically contingent.
4) Authors neglect biases related to exposure risk beyond "cautiousness."
Cautiousness = masking, distancing
Other exposure risks = social communities (beyond home geographic area controlled for)
No good data/analysis to deal with much of these.
5) Irresponsible public communication of rate difference describing it as or implying it to be *fully* the effect of boosters.
It is essential at this moment to either educate public on confounding or to at least not falsely suggest such large effects.
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Media reporting on boosters
Scientific discussions on boosters
Booster approval
Clinical and public health guidances on boosters
These are all being based on evidence of "waning immunity" which itself is predominantly based on reduced vaccine effectiveness.
🧵 Big problem is...
Vaccine effectiveness is contingent on many things.
Not just immunity.
So reductions to effectiveness can not be assumed to be due to waning immunity.
Viral dose affects likelihood of infection.
If typical viral dose exposures increase over time periods (e.g. due to waning behaviors or waning policies that prolong social interactions, reduce mask use, drive interactions indoors), then vaccine effectiveness will drop.
The real-world data controlled for some confounders but no suggestion they controlled adequately for things that might make someone more likely to pursue a booster but also less likely to be exposed and/or exposed to high viral doses. E.g. community factors, mask use, etc.
People who care enough to get boosted might also have been more careful with masking or might be from communities less hard hit (social too, not just geographic).
It's good there's a mask mandate, but @NYCSchools@DOEChancellor are not adequately:
– providing masks
– educating on or requiring masks of sufficient quality: medical grade at least, better to double mask or N95
– set up to monitor/ensure correct use
For vaccine mandates, unlike LA schools, @NYCSchools@DOEChancellor are failing to protect students, staff, families, and the community by mandating vaccination for all 12 or older.
Centrist Democrats, progressives, and the left should be ashamed.
Scott Gottlieb, corporate law firms, and McDonalds are leading more on public health than they are.
Sorry to be harsh but we need a reality check and a principles check.
Law firms lead on remote while anti-worker de Blasio and sycophantic unions force workers to return in-person needlessly, while parents aren’t given remote options for school. wsj.com/articles/covid…
McDonalds self-implements indoor dining closure while only Hawaii has capacity limits or closures for high risk venues. wsj.com/articles/delta…
The vaccine-focused approach of the last 8 months has failed.
It overly focused on vaccines to control spread and stop severe illness. It ignored and relaxed NPI (non-pharmaceutical interventions) policies e.g. mask mandates, venue restrictions, and contact tracing.
Vaccine policy has been inadequate.
First inequitably delivered, then with wide availability with little attention to needed outreach and supports, and now with mandates that coerce and divide. This approach has not succeeded in reaching the 85-90% needed for herd immunity.