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

Author: Public Linguist

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

Posted on 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

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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

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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.

Understanding health disparities in Covid vaccine access just got a lot harder / May 17, 2021

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The New York Times, most would agree, has done yeoman’s work in continuously reporting and updating information about Covid 19 vaccinations across the US. It’s daily “See How Your Vaccinations Are Going in Your County or State” – a map quilted in various shades of green to grey – allows you to hover over an area and get a quick report of vaccine status. 

 

 
The NYT commitment to accurate data in its reporting is historic and undeniable. 
For example, in the daily Covid vaccine reporting there are a series of visual arrays in the form of technical graphs and charts to represent things such as: 
New reported doses administered by day (compound line and graph chart)
Daily reported doses given by manufacturer (wave line graph)
When Might a Majority of People Be Vaccinated?  (line graph)
 
But the graph form I focus on today is the one the NYT used to answer the question, “ Are The Most Vulnerable Counties Being Vaccinated?” 
 
It’s been a long time since I read Tufte or studied Visualizing Data 101 but my work involves health disparities and health literacy and I was actively ready to dive into what the NYT was reporting. 
 

 

Forgive me for referring to this as a messy bubble chart.  Accurate name aside, 
the NYT choice of data design is at best, data geeks showing off their wares, and at worst, an elitist attitude about who needs to understand health disparities.   
 
Here’s my question….my version of what keeps me up at night. 
If the NYT, one of the most trustworthy sources of information in the world, continues to present only high barrier information intended for experts and elite readers, if they cannot make a commitment to presenting usable, consumable accurate data for a broader audience, then who where lies the mission of public enlightenment?
Because we have seen all too well, the information sources like NYT can’t bring themselves to share more democratically gets warped into “fake news” and repackaged truths.  I can see it now – “ Minorities and poor simply don’t want the Covid vaccine.” 

Covid is Like the Suez Canal

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This morning CNN posted a link to an ingenious interactive tool where you try to steer a ship through the Suez Canal.   


You control the rudder and the power – and keep trying not to crash into the banks and create a monstrous traffic jam!  

Needless to say, despite my NYC street parking prowess I crashed numerous times.!

IMAGINE...


One morning you wake up and public health experts have put aside their directives, pleas and shaming – and, for one brief moment, set out to create something a new way of talking to the public – something that grabs us and leads us to discover ( in the safety of our online worlds) what it might take to control a pandemic. Maybe they even think of the ship stuck in the Suez canal. 

In the CNN article, the captain of the lodged ship Yasha Gupta explains the importance of the wind in particular because these container ships are stacked so high. 

“Wind is a particularly important consideration for container ships because the stacked containers lends them a dizzying height.  “So you can imagine it’s just like a solid wall, which is faced against the wind,”  He says the wind effect is uncontrollable because the ship is in water. It’s not possible to hit the brakes in the same way you’d stop a moving car.

I’m sure, if someone asked nicely CNN ( and designer Mankarious) could reimagine communicating mask wearing, or social distancing or getting vaccines in just such a great, useable way.  

Their disclaimer works for me and could be emphasized to the user of the health info. 

Note: This is a non-scientific simplified interactive experience intended for illustrative purposes only. There are many factors that have not been accounted for, including (but not restricted to): the depth of water; proximity to the banks; interaction with passing ships; the turning circle; availability of tug boats and other weather conditions like visibility. We have also sped up the time it takes to maneuver a ship of this size. Master Mariner Andy Winbow and Captain Yash Gupta have been advisers.

Nobody reads my posts: until this week

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Nobody reads my posts with the exception of my small circle of indulgent friends and colleagues. My life’s work has been figuring out how to present #healthinformation so that people can understand it. Not all that exciting but it’s where I like to live.


So, what was I thinking when, earlier this week I came across a complicated graph in a newspaper I read and respect. Beautifully colored bubble graphs – incomprehensible to the average reader. What I call the start of a productive working day!

I posted the graphs on FB and asked for ideas about how the #data could be re-designed.

DAAAAAA I now see the error of my ways.
Unfortunately the graphic was about #Covidvaccine.
Now recall, very few people ever read my FB or blog ( again how not sexy is #informationarchitecture?)

But this week’s post was off the charts.
Overnight – I’m popular!!!!


Hundreds of viewers, tons of comments…..
All pretty mean spirited, #nastytirades , dismissive #memes #fakenews #vaccineconspiracies and even warnings about violating the #NurembergCode,
Not one comment about the graphs or my question.
You know how sometimes, among all the billions of bits of memories you store, a moment remains quite real and present. Well one of my tiny moments was a professor saying to the class (and I think quoting a psychologist (Miller) –
“When you’re arguing with someone, STOP. Say to yourself, “What that person is true.” And then ask yoursel, “what could this be true of?”
My Question:
Will spending lots of time thinking about this get me anywhere or is it more productive for me to just get on with the work I know I do well and makes a a few folks’ lives just a little better?

Rand Paul’s MASK OFF with Fauci: the old “theater” thing again

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Yesterday Rand Paul and Anthony Fauci went at it again at a Senate Hearing.  

In this corner we have Rand Paul the Ophthamologist cum virologist and mask-less champion. 

In the opposite corner, Dr Anthony Fauci Director NIH National Institute of Allergies and Infectious Disease 

       
The sparring this time was about why we are still telling people to wear a mask after vaccination.  
NOTE: (Most of what I’ve put down is paraphrase)  You can listen in  – “Dr. Fauci, Senator Rand Paul argue over masks at hearing” 



Paul: with a right cross  –  If we’ve had the injection and we have immunity, then isn’t telling people to wear a mask just THEATER . 
Where’s the proof that we have significant re-infection, hospitalization and death?  
Dr. Fauci:  left & right cross  – Well as of YET in the US we don’t have a significant variant circling around.  So we can’t know that. 
Fauci: uppercut  –  Let me just state for the record, masks are not theater.  Masks are protective and we have….(interrupted)
Paul: right cross – If you have immunity (masks) are theater….you’re wearing a mask to give comfort to others. 
Where’s your proof that people can be re- infected? There is not proof.
Paul: jab -“telling people to continue to wear masks (even 2 masks) is“Policy is based on “conjecture”.  *
*The word implies some kind of “guess work”.  Fine for an episode of NCIS, but not really for Covid public health policies (including the many changing policies we’ve seen in the last year).   The recommendation to wear a mask even after vaccination and immunity is based on the scientific evidence available at the time.  
Fauci crosses:  The studies you’re talking about (BTW, he names the precise authors of the studies), were in-vitro (in a test tube or something outside the body).  Oh and BTW the authors clearly state that they don’t know if this protection would happen in our real bodies (remember I’m paraphrasing)
  

Paul: low blow   You want people to wear masks for another couple of years.”  “You’ve been vaccinated and you parade around with two masks for show….You’re defying everything we know about immunity by telling people to wear a mask.” 
Fauci: Gloves off –  You’re not hearing what I’m saying about variants. (despite multiple Paul interruptions about nanny state and rewarding people after they’ve been vaccinated by setting them free from their masks).
Fauci then gives a short, elegant and understandable presentation of the facts as they are right now in the US.  Troubling Covid variants 117, (UK) 526, 427, 429 (CA).
Would be so good and productive if public health departments and local agencies could get out good, understandable and repeated information about Covid variants: 
  1. What is a variant?
  2. Why should we care about them?
  3. What do scientists know about the Covid variants?
  4. What does this mean for protecting myself and my family, and my community?
Wash, 
Rince, 
Repeat.

NYS Covid Vaccine Form Earns a Go-Fix-Me

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I’m starting up GO FIX ME installments on this blog. 

The mission – no less than purging our land of public health communication filled with self-involved, gratuitous, gobbledygook language, that makes it difficult and often impossible for readers to understand and take action.  

(How’s that for a mission!)

Here’s my first specimen and I’m hoping in the spirit of crowd sourced good writing you’ll join in and send more fixes.  

Back story on this salvage job.

3 days ago I posted about the “high barrier” ridiculously complex and vague questions NYS was using in its survey for people to register for the Covid 19 vaccine.  

Well as of this writing the painfully tortured ( easily fixable survey ) is still alive and well. 

So I’ll take a stab at fixes and hope you can contribute ones as well. 

______________________________________
NYS DOH Original Question Exhibit 1
A Fix 
Do you have any of the following health problems/conditions?
(Or)
Has a doctor ever told you that you have one of these health problems/conditions?
(Show the list of health problems included in NYS Section 3)
.
.
.
Yes 
No
Not sure/Don’t know 
_________________________________________________________________________

NSDOH Original Question  Exhibit 2

A Fix  (not sure I even understand the original question – a little help here readers???)
Are you an essential worker that works with the public? 
Yes
No
Not Sure/ Need More Information*
*Writers would define what this category of essential workers is. 
NYSDOH Question Exhibit 3 

A Fix 
Do you live in a group setting (congregate living) for example an assisted living facility, nursing home, group home, homeless shelter, prison, or detention center?
.
Yes
No
Not Sure
 
I hope some of you will join in for these  GO FIX ME!  
Being an accidental critic is a lonely job. 

Connecticut Vaccine Portal: other states take note!

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My last post sliced into the incomprehensible language and format NY State used in a key gateway form that New Yorkers had to navigate in order to register to get the Covid Vaccine. 

NYS could get some lessons in clear communication by checking out it’s own next door neighbor – Connecticut – Ct.gov.  Connecticut has written and  designed a web portal that is inviting, user-friendly –  helps a consumer feel that they can manage to:

  •  determining eligibility
  • schedule an appointment 
I use three screen shots that show how they staged the topic of eligibility, specifically when you may live in congregate housing.  (Recall NYS poses this eligibility category as a survey question and makes no effort to explain what this means. 
Who is Eligible?  


Congregate Housing 

Explaining Congregate Housing 

While the reading level of the last graphic – explaining congregate housing could be tweaked to be less complex, this portal does no less than 3 important things:
 
  1. it makes getting information about obtaining the Covid Vaccine “low-barrier” 
  2. it communicates to people that Ct cares about them, which builds trust and good will
  3. it provides and may teach the consumer new information while they accomplish their task.

Bravo!

Unequal Access to Covid Vaccine: start with NYS Form

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Present Biden directed all states to make all adults eligible for COVID vaccines by May 1.  A major call to address health equity and access to the vaccine for all. 

Apparently, NYS hasn’t gotten the message.  Or at least that’s what its     COVID VACCINE FORM (still live as of 3-15-21) says to me. 

Here are 3 “bet you can’t figure this one out” questions (from the form) meant for the average person trying to get through the first hurdle of registering for a Covid Vaccine. 


“comorbidity”  – nice word you likely won’t hear outside of your medical training.

“public-facing” – again nice word if you’re a systems developer, marketing person or a silhouette artist who doesn’t have a good command of language. 

“congregate setting” – easily identified with religious gathering, and maybe group home dwellers. 


Dear NYS Covid Form writers: 

The average US adult reads at 8th grade level or lower.
If you want to help people get Covid vaccinated, this HIGH BARRIER form has got to go.  

President Biden asked us to “all do our part”. 
 NYS,  I or any number of health communication writers are ready to help you.  
 
No questions asked.

           




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