August 2021 - Health Literacy Lab

Class, I’d like to correct something I said about the Covid vaccine. / August 20, 2021

Posted on August 20, 2021October 15, 2021 by Public Linguist

Teacher:

Good morning class. It’s come to my attention that a number of you are confused about what you’re hearing about maybe needing a Covid “booster” shot. So I thought it would be a good idea to review what we learned earlier in the semester and hopefully clear up any confusion.

Who wants to remind us why public health experts were so excited back at the end of last year, 2020 to announce that a vaccine for the Covid 19 virus had been developed?

Josh: The government experts, well everyone was excited. Dr. Fauci said that the vaccine ( I think Pfizer) has “absolutely exquisite levels 94 to 95% efficacy against clinical disease.” I remember my mother told me that one of the scientists who developed the first Covid vaccine was a black woman. That was so cool to hear.

Margarite: I wrote a report about this. Back in Jan 2021 they set a goal for the public: 1 million shots in arms in the first 100 days!

Deshawn: Yea but at the same time there were some “mutant” strains ( I like that word – mutant!) I think in England and Africa. But Dr Fauci said, Moderna and Pfizer vaccines seem to continue to be protective against the mutant strain. It is a very minor diminution. But the cushion that you have of efficacy is so large that it’s not going to negatively impact.

Teacher: Thank all. So class, back in January the vaccine was new and scientists knew it worked to protect people but, and this is an important “but”, some experts were looking ahead to see how well the vaccines would protect us if there were new strains or forms of the virus. Next week we’ll be learning about the evolution of vaccines and strains, but right now let’s stay focused on the fact that the new vaccines “worked.”

What do experts mean when we say the new vaccine worked.

Who wants to explain that?

Carlise: That means if you get the shot, actually the 2 shots, then you won’t get sick with Covid.

Teacher: OK Thank you Carlise. Anyone else?

Tamara: And if everybody got vaccinated the virus would die out – go away. YEA!

Angel: And if you didn’t get the vaccine you could get the Covid virus and get very sick. You wouldn’t have any protection. And some of the reasons why some people didn’t get the shot was they were scared, or they didn’t have enough information, or because of politics.

Teacher: OK So my question is this – pretty soon people in NYC will be able to get a “booster.”

Why would we need a booster if the vaccine worked?

I’ll give you a hint.

True Dr. Fauci and other health experts, from the start, have been celebrating the arrival of the Covid vaccines and urging everyone to get the shots.

But if you listened or read carefully you would have seen that scientists were sometimes careful to say that the vaccines had very high efficacy “against serious disease.” Or, in we were reading a science study for a professional journal – and don’t worry we won’t be doing that this year – we would have read about findings like this – researchers found a high (78%) efficacy for prevention of moderate to severe disease after vaccination.

Anybody want to explain this to the class?

OK I am not surprised there’s still confusion. So now we’re going to talk about what the vaccine was designed to actually do. And then we’ll look at the nature of immunology.

Before that. Let’s take a quick break.

Class, our word for today is “endemic” / August 18, 2021

Posted on August 18, 2021October 15, 2021 by Public Linguist

We’re hearing the first rumblings about the likelihood that the Covid pandemic is evolving to ultimately become “endemic”. We can add it to the long list of seemingly endless new verbiage we’ve tossed out to the masses:

And like the wearing of masks, and social distancing, and vaccination, the concept of “endemic” is, well fraught.

Public understanding of health and science.

One of my mantras on this blog is how important it is for the public to understand and trust what they hear from public health experts and how important it is to keep in mind how more than half of the adults in the US struggle to understand and use basic health and science information. ( for example see blog post from Jan. 15, 2021 “MRNA Needs a Better Messenger” or “We are not all in this together: public understanding of health and science in the time of COVID (June 2021).

As a quick example – NSF’s decades-long Public Understanding of Science surveys consistently show that US adults struggle with science concepts and information. About 50% of US adults incorrectly believe that “antibiotics kill viruses as well as bacteria.” And in another example, roughly 1/2 of adults agree that “the earliest humans lived at the same time as the dinosaurs.

So introducing and explaining that Covid 19 is likely here to stay is not going to be an easy lift. You can only imagine what it will trigger if poorly understood:

If it’s going to be here like winter flu then so what, why do I have to …get vaccinated, wear a mask, protect others…..
If it’s going to be here then what was all this last 18 months for. What did scientists learn.
Scientists – they don’t know what they’re talking about. One minute it’s enjoy summer, next it’s cover up again!

As Sarah Todd writes in Quartz this week,

“Endemic diseases, like chicken pox or malaria, are not novel, and the rates of infection

within a given population are fairly predictable. The Centers for Disease Control and

Prevention (CDC) says that endemic “refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.” Speaking with the New York Times this spring, professor of infectious disease epidemiology David Heymann said that becoming endemic was “the natural progression of many infections we have in humans, whether it is tuberculosis or HIV.””

Writer Ed Young captures what he refers to as the “dispiriting dilemma” in his Atlantic article “How The Pandemic Now Ends” CDC now recognizes that the US will not get to herd immunity factoring in Delta’s RO. And thus scientists understand,

“This means that the “zero COVID” dream of fully stamping out the virus is a fantasy. Instead, the pandemic ends when almost everyone has immunity, preferably because they were vaccinated or alternatively because they were infected and survived. When that happens, the cycle of surges will stop and the pandemic will peter out. The new coronavirus will become endemic—a recurring part of our lives like its four cousins that cause common colds. It will be less of a problem, not because it has changed but because it is no longer novel and people are no longer immunologically vulnerable.”

Young states, “If endemicity is the future, then masks, distancing, and other precautions merely delay exposure to the virus—and to what end?”

So class, how would you explain “endemicity”?

Covid Infection Breakthroughs: 2 things scientists knew all along ? / August 12, 2021

Posted on August 12, 2021October 15, 2021 by Public Linguist

As I’ve disclosed many times over the last year, I was one of the millions relieved and thankful to get my Covid vaccinations as soon as they were available to me. Part of my ghosting behavior this summer on this blog and other media is that I admit to being bit laid low – bewildered and not a bit enraged by the millions who still won’t get vaccinated.

The supposed “vaccine hesitant” (I’ve been working on a post about that phrase is just so off base.

But to the debacle at hand today. A ubiquitous medical journalist whom I like a lot – CNN’s Sanjay Gupta – penned an article. “What’s in a name? The term breakthrough infection” raises doubts about vaccines, but it shouldn’t.”

Gupta argues, with support from other experts, that it’s not a good idea to use the term “breakthrough infection” to refer to the condition of folks we know or hear about who are testing positive or have gotten sick with Covid even though they got vaccinated.

Gupta says things are more nuanced than that.

“breakthrough infections “only serves to alarm those of us who are already vaccinated, and potentially discourage those are are hesitant.”

OK, up to there, I’m with you Sanjay.

But then the bait and switch.

First there’s Dr. Barney Graham, deputy director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases. His lab had input into developing the Moderna vaccine.

“The vaccines were always designed to focus against disease in the lower airways [the lungs] – not in the upper airways [the nose and upper throat],”

Graham goes on to explain why it was important to develop a vaccine that would prevent infection from traveling to the lungs.

OK I get it. No infection in the lungs. People don’t wind up deathly ill and on respirators.

But then the zinger. Gupta quotes Graham saying,(referring to the vaccine)

“It wasn’t designed to protect the upper airways as much,”

Wait. Hold on. Did I know that?

Wait….. then the coup d grace. Gupta quotes a statement Dr. Anthony Fauci made at a White House Covid-19 Response briefing last week.

Let’s call it the [Dr] Anthony Fauci Reveal

“The vaccines are doing exactly what we’re asking them to do when it comes to keeping you out of the hospital, out of serious disease and certainly preventing your death,”

The article goes on to offer up added reasons why the “breakthrough infection” phenomenon is :

A) not surprising… no big deal…we knew it would happen all along B) and therefore we shouldn’t think of it as “breakthroughs”

the article uses some not-to-easy-to-grasp number arguments about proportion of people vaccinated vs number of people who get sick ( reader keep in mind that the vast majority of adults in the US struggle with numeracy/ numbers skills).
a mention that there’s no nationwide data available on asymptomatic and mild breakthrough cases;
and the point that levels of coronavirus antibodies diminish over time;

“This [diminishing] is “not a glitch” according to Dr. Monica Gandhi. “… our blood and our noses can’t hold all of the antibodies they’ve ever produced; if antibody levels didn’t drop, “our blood would be thick as paste.”

Dr. Gupta’s article ends with a clear declaration from Dr. Francis Collins, director of the National Institutes of Health. Referring to the term “breakthrough infection”:

“I think the term is terrible because it’s scaring people and making it sound as if the vaccines don’t work. Let me say very clearly: The vaccines are incredibly effective in preventing hospitalizations, severe cases – over 90%. So, let’s not let the language get in the way of that,” he said on CNN last week.

I leave you with this – I’m a fairly smart lady, haven’t tested to be low health literate, and follow Covid coverage to near distraction. In all my monitoring and analysis of experts and media endlessly talking to the public about Covid and particularly the Covid vaccines all these months, I don’t recall one instance when any of these central science understandings and expectations for the vaccine was communicated clearly to us.

We keep telling everyone “Get Vaccinated”.

These seeming bait and switch reveals won’t help.