Excellent! I have the "getting the new Covid vaccine" talk with all my patients -- I may be a psychiatrist, but I am a physician and this is a topic I care about deeply. And I encourage it for their kids as well. I am currently mildly harassing my 25 year old to get her vaccine. She just started grad school and is in a classroom with a lot of other people. She is dragging her feet and it is making me anxious for her. She is not vaccine hesitant, just busy.
Hi Donna, and much respect for the good primary care immunization discussions with people - there is so much overlap between our fields as you know!
I don't think any of us ever know anything beyond a doubt, so I really do appreciate the guidelines developed by experts with institutional, professional, and multidisciplinary knowledge. Like you I'm trying to make the best decisions in real time, and the studies that keep coming out are encouraging and consistent.
I wish this virus were easier, less mutable, more predictable, and I certainly wish kids had some magical, innate immunity to its effects. In 2024 the stakes are much lower than 2020, but if smarter people than myself say that target practice on spike proteins helps with real, repeated infections with new mutant invaders, why let down our guards.
Thanks for the bravery and lucidity here. Vaccines have been turned into a lightning rod of ideological passion, but I appreciate the dispassionate presentation of good quality studies from top tier medical journals, with logical conclusions. As you've stated, at this point with a combination of shots and illnesses most kids are doing well, but some absolutely are not, and long Covid denialism is not based in facts. Thanks for presenting the options, people can choose their own adventure, but when you read really hostile commentary that is not grounded in studies like the ones we read in JAMA, NEJM, The Lancet, BMJ etc, it does not pass muster for fair discourse. I'm up to date with vaccinations, feel great, and have never had Covid.
Hi Grant, and thanks for acknowledging this. It's much easier to just shut up when the antivax crowd shows up and call you a murderer. When physicians like this guy pour gasoline on the fire it causes real harm. By quoting study after study in the Covidlandia posts I am trying to take myself out of the debate and present evidence first, logical commentary second. People like Offit, Fauci, and Hotez have thick armor against the onslaught of hostility, forged by a sincere desire to protect people's health and informed by their medical expertise and leadership. Glad to chip in a few words as a small voice in the crowd! And ultimately what I've written here is all about choice. People can choose for themselves.
Thank you, Ryan, for doing this research. Ohmygod, 82% of kids with MIS-C are unvaccinated! How can so many parents (and some of their doctors!) risk their children’s lives because they’d rather believe random “influencers”? Yes, research takes time and thought and the ability to put things together and then decide what has merit and what does not. Kids cannot do that for themselves (yet), they depend on the adults around them. I feel sad for the young people who are being let down.
P.S. I love the pie-eating photo. The look that girl is giving him is priceless!
Hi Liz - I've seen one case of MISC related to Covid ( I see almost all adults these days) and it was really bad. No full recovery to this day. The influencers like Rogen (former Ultimate Fighting Championship commentator and comedian) have an outsized influence when you consider their scientific and medical training. Hard to overcome that with many people in 20 minute visits, another reason I like to expand conversations about primary care stuff here. And glad you liked the pie eating photo, too! Made me recall Stand By Me, and less contentious moments perhaps.
I cannot fathom the substack even allows anti-vaxxers to spread disinformation. One that I ran across (under 'medical' topics) is blatantly selling snakeoil on substack. I thought that selling things was not allowed? Clearly I was wrong. Really no use engaging with pseudoscience posts in here. Now for a nice walk to blow off steam.
Agreed, KB. For some reason this stuff comes into my notes feed, and as you know it often bubbles up to the top of the substack trending stuff... so it's hard not to engage sometimes. The same social media pitfalls increasingly showing up here like twitter. Good to have honest debate, but the snakeoil should not be up for sale. I'm going for a run now, too, and then back to charts ;)
Thanks for continuing to advocate and write evidence based posts— and thank you for reading the misleading garbage so we don’t have to. I once reviewed a non fact based book written by a physician related to Dr. Oz, and was struck by the arrogance, ignorance and blatant disregard for ethics that is somehow permissible in the media and publishing.
Hi Jan, and I'm glad to read it every once in a while. The AAFP had a decent article about this situation when it occurs online. I guess their approach is best, but it is hard to keep letting the most strident, conspiracy-laced, hostile voices take up all the oxygen. Here is a sample:
Do not engage with false information online because this may increase visibility from website algorithms. It is best not to reshare or comment on misinformation, even in an attempt to correct it. For the same reason, beware of and ignore internet bots, trolls, and spam.
The most effective solution to limit the reach of inaccurate online information is to expose internet users to more accurate than inaccurate information. Contribute to improving this balance by viewing, liking, resharing, and commenting on verified content from reliable sources.
If you have an online presence as a family physician, build and cultivate your audience. Post accurate information often and consistently. Develop a publication routine and stick to it. This will help you become your audience's go-to source for reliable information.
Medical misinformation is one of the most threatening challenges to global health. Misinformation can hinder the cohesiveness of societies by increasing existing social inequities, stigmas, gender disparities, and generational rifts. To a fatigued physician, discussing misinformation may seem futile, but the power of the physician-patient relationship should not be underestimated. Physicians are considered the most trusted messengers of medical information.4 We can use this privilege to help keep patients safe by educating ourselves and future physicians about strategies to fight misinformation."
The stories of kids with long COVID would break anyone’s heart. Sometimes I am thankful I got it in middle age and not during childhood, adolescence, or college. Kids are meant to run freely with other kids, not be bedridden for years (which is largely preventable). Thanks for this focus, doc.
I agree Amy. The pediatric hospital rotations during med school and residency were some of the most challenging, as every kid deserves good health and a good childhood, and it can be so heartbreaking when that is taken from them. I know most kids do OK with Covid, but as far as the studies show above and beyond, I'm choosing to play the game and bend the odds any way science tells me is worth the risk.
A while ago, after one of your spot-on posts, I asked if you would be my tele-doctor (I live in NH). If I remember correctly, you said that telehealth wasn't an option for you at the time, but you wouldn’t rule it out in the future. Nevertheless, I consider you my online, digital doctor on Substack for now (still hoping you'll change your mind about telehealth).
My wife and I are scheduled to get our shots today. We've gotten all of them since they became available in March 2021. We are both 70 years old and were teaching when COVID hit in the spring of 2020 and shut schools down.
Long COVID is what I worry about the most.
A former recreational, competitive runner I know got COVID in late winter or early spring of 2020. Because testing wasn’t yet available, we’ll never know for sure, but he had all the symptoms. He thought he had recovered from the initial illness until several weeks later, when he tried to go for a run. He was barely able to maintain a 20-minute mile pace—really just walking, and struggling to even do that. This same runner had finished the Chicago Marathon in October 2019 with a PR of 2:48 at the age of 48.
Even today, there are days when he can’t get out the door, and days when he feels better and can manage 3 or 4 miles at a 9:30 pace. The malaise fades for a few weeks but returns without warning.
Imagine kids struggling with this after having had COVID.
Getting COVID and surviving because you're up-to-date with all your shots is one thing. But getting COVID, surviving without being up-to-date—or worse, never being vaccinated at all—and then getting long COVID... I can’t understand why anyone would take that risk.
Thank you, Ryan, for all you do. Your patients are very fortunate to have you as their doctor.
Hi Arthur, and I am very humbled by your comment. I got several to the contrary on the "notes" section of Substack from anti-vax people calling me a "murderer" "complicit in genocide." Bonkers, and blind to the dispassionate studies like the ones above I sincerely try to analyze and present. The story of your runner friend is really hard to read. I feel bad for him and all the others who are struggling with long Covid. Vaccines and antivirals won't protect everyone, but as far as the studies can discern, they reduce risk so I'm all in until proven otherwise by smarter minds than my own. I'm glad you share the same mentality, and our mutual goal of preventing long Covid if we can. When I go for a run now at age 49, I try to be grateful that I can still do it, and that someday I won't be able to, either from CAD or Covid or something else. I have a patient with a similar story who needed a double lung transplant after barely surviving Covid, as she could not walk without becoming hypoxic, and lived with constant shortness of breath - a feeling worse than pain for most.
Anyway, many thanks for reading and for your support. I do telemedicine a lot, but I am only licensed to practice in PA and NJ, so people need to live there to see me. Maybe someday they will loosen the restrictions, but probably not. Will keep the expanded communication going here for as long as I can! Best of luck to you and your wife :)
Excellent! I have the "getting the new Covid vaccine" talk with all my patients -- I may be a psychiatrist, but I am a physician and this is a topic I care about deeply. And I encourage it for their kids as well. I am currently mildly harassing my 25 year old to get her vaccine. She just started grad school and is in a classroom with a lot of other people. She is dragging her feet and it is making me anxious for her. She is not vaccine hesitant, just busy.
Hi Donna, and much respect for the good primary care immunization discussions with people - there is so much overlap between our fields as you know!
I don't think any of us ever know anything beyond a doubt, so I really do appreciate the guidelines developed by experts with institutional, professional, and multidisciplinary knowledge. Like you I'm trying to make the best decisions in real time, and the studies that keep coming out are encouraging and consistent.
I wish this virus were easier, less mutable, more predictable, and I certainly wish kids had some magical, innate immunity to its effects. In 2024 the stakes are much lower than 2020, but if smarter people than myself say that target practice on spike proteins helps with real, repeated infections with new mutant invaders, why let down our guards.
Agree!
Thanks for the bravery and lucidity here. Vaccines have been turned into a lightning rod of ideological passion, but I appreciate the dispassionate presentation of good quality studies from top tier medical journals, with logical conclusions. As you've stated, at this point with a combination of shots and illnesses most kids are doing well, but some absolutely are not, and long Covid denialism is not based in facts. Thanks for presenting the options, people can choose their own adventure, but when you read really hostile commentary that is not grounded in studies like the ones we read in JAMA, NEJM, The Lancet, BMJ etc, it does not pass muster for fair discourse. I'm up to date with vaccinations, feel great, and have never had Covid.
Hi Grant, and thanks for acknowledging this. It's much easier to just shut up when the antivax crowd shows up and call you a murderer. When physicians like this guy pour gasoline on the fire it causes real harm. By quoting study after study in the Covidlandia posts I am trying to take myself out of the debate and present evidence first, logical commentary second. People like Offit, Fauci, and Hotez have thick armor against the onslaught of hostility, forged by a sincere desire to protect people's health and informed by their medical expertise and leadership. Glad to chip in a few words as a small voice in the crowd! And ultimately what I've written here is all about choice. People can choose for themselves.
Thank you, Ryan, for doing this research. Ohmygod, 82% of kids with MIS-C are unvaccinated! How can so many parents (and some of their doctors!) risk their children’s lives because they’d rather believe random “influencers”? Yes, research takes time and thought and the ability to put things together and then decide what has merit and what does not. Kids cannot do that for themselves (yet), they depend on the adults around them. I feel sad for the young people who are being let down.
P.S. I love the pie-eating photo. The look that girl is giving him is priceless!
Hi Liz - I've seen one case of MISC related to Covid ( I see almost all adults these days) and it was really bad. No full recovery to this day. The influencers like Rogen (former Ultimate Fighting Championship commentator and comedian) have an outsized influence when you consider their scientific and medical training. Hard to overcome that with many people in 20 minute visits, another reason I like to expand conversations about primary care stuff here. And glad you liked the pie eating photo, too! Made me recall Stand By Me, and less contentious moments perhaps.
I cannot fathom the substack even allows anti-vaxxers to spread disinformation. One that I ran across (under 'medical' topics) is blatantly selling snakeoil on substack. I thought that selling things was not allowed? Clearly I was wrong. Really no use engaging with pseudoscience posts in here. Now for a nice walk to blow off steam.
Agreed, KB. For some reason this stuff comes into my notes feed, and as you know it often bubbles up to the top of the substack trending stuff... so it's hard not to engage sometimes. The same social media pitfalls increasingly showing up here like twitter. Good to have honest debate, but the snakeoil should not be up for sale. I'm going for a run now, too, and then back to charts ;)
Thanks for continuing to advocate and write evidence based posts— and thank you for reading the misleading garbage so we don’t have to. I once reviewed a non fact based book written by a physician related to Dr. Oz, and was struck by the arrogance, ignorance and blatant disregard for ethics that is somehow permissible in the media and publishing.
Hi Jan, and I'm glad to read it every once in a while. The AAFP had a decent article about this situation when it occurs online. I guess their approach is best, but it is hard to keep letting the most strident, conspiracy-laced, hostile voices take up all the oxygen. Here is a sample:
https://www.aafp.org/pubs/afp/issues/2022/0800/editorial-countering-medical-misinformtion.html
"Online
Do not engage with false information online because this may increase visibility from website algorithms. It is best not to reshare or comment on misinformation, even in an attempt to correct it. For the same reason, beware of and ignore internet bots, trolls, and spam.
The most effective solution to limit the reach of inaccurate online information is to expose internet users to more accurate than inaccurate information. Contribute to improving this balance by viewing, liking, resharing, and commenting on verified content from reliable sources.
If you have an online presence as a family physician, build and cultivate your audience. Post accurate information often and consistently. Develop a publication routine and stick to it. This will help you become your audience's go-to source for reliable information.
Medical misinformation is one of the most threatening challenges to global health. Misinformation can hinder the cohesiveness of societies by increasing existing social inequities, stigmas, gender disparities, and generational rifts. To a fatigued physician, discussing misinformation may seem futile, but the power of the physician-patient relationship should not be underestimated. Physicians are considered the most trusted messengers of medical information.4 We can use this privilege to help keep patients safe by educating ourselves and future physicians about strategies to fight misinformation."
The stories of kids with long COVID would break anyone’s heart. Sometimes I am thankful I got it in middle age and not during childhood, adolescence, or college. Kids are meant to run freely with other kids, not be bedridden for years (which is largely preventable). Thanks for this focus, doc.
I agree Amy. The pediatric hospital rotations during med school and residency were some of the most challenging, as every kid deserves good health and a good childhood, and it can be so heartbreaking when that is taken from them. I know most kids do OK with Covid, but as far as the studies show above and beyond, I'm choosing to play the game and bend the odds any way science tells me is worth the risk.
Hi again, Ryan,
A while ago, after one of your spot-on posts, I asked if you would be my tele-doctor (I live in NH). If I remember correctly, you said that telehealth wasn't an option for you at the time, but you wouldn’t rule it out in the future. Nevertheless, I consider you my online, digital doctor on Substack for now (still hoping you'll change your mind about telehealth).
My wife and I are scheduled to get our shots today. We've gotten all of them since they became available in March 2021. We are both 70 years old and were teaching when COVID hit in the spring of 2020 and shut schools down.
Long COVID is what I worry about the most.
A former recreational, competitive runner I know got COVID in late winter or early spring of 2020. Because testing wasn’t yet available, we’ll never know for sure, but he had all the symptoms. He thought he had recovered from the initial illness until several weeks later, when he tried to go for a run. He was barely able to maintain a 20-minute mile pace—really just walking, and struggling to even do that. This same runner had finished the Chicago Marathon in October 2019 with a PR of 2:48 at the age of 48.
Even today, there are days when he can’t get out the door, and days when he feels better and can manage 3 or 4 miles at a 9:30 pace. The malaise fades for a few weeks but returns without warning.
Imagine kids struggling with this after having had COVID.
Getting COVID and surviving because you're up-to-date with all your shots is one thing. But getting COVID, surviving without being up-to-date—or worse, never being vaccinated at all—and then getting long COVID... I can’t understand why anyone would take that risk.
Thank you, Ryan, for all you do. Your patients are very fortunate to have you as their doctor.
Hi Arthur, and I am very humbled by your comment. I got several to the contrary on the "notes" section of Substack from anti-vax people calling me a "murderer" "complicit in genocide." Bonkers, and blind to the dispassionate studies like the ones above I sincerely try to analyze and present. The story of your runner friend is really hard to read. I feel bad for him and all the others who are struggling with long Covid. Vaccines and antivirals won't protect everyone, but as far as the studies can discern, they reduce risk so I'm all in until proven otherwise by smarter minds than my own. I'm glad you share the same mentality, and our mutual goal of preventing long Covid if we can. When I go for a run now at age 49, I try to be grateful that I can still do it, and that someday I won't be able to, either from CAD or Covid or something else. I have a patient with a similar story who needed a double lung transplant after barely surviving Covid, as she could not walk without becoming hypoxic, and lived with constant shortness of breath - a feeling worse than pain for most.
Anyway, many thanks for reading and for your support. I do telemedicine a lot, but I am only licensed to practice in PA and NJ, so people need to live there to see me. Maybe someday they will loosen the restrictions, but probably not. Will keep the expanded communication going here for as long as I can! Best of luck to you and your wife :)
Kudos to you for your efforts Ryan, you're performing a great public service.