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App\Entity\Article {#1094
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  -title: "COVID Boosters for the Body Politic: One Size Fits All?"
  -slug: "covid-boosters-for-the-body-politic-one-size-fits-all"
  -introtext: "<p class="reader-text-block__paragraph">As a card-carrying&nbsp;<a href="https://davidkatzmd.com/" rel="nofollow">member of the public health community</a>&nbsp;(OK, there is no actual membership card, but you get the idea)- I loathe to oppose official public health policy pertaining to COVID, or any topic for that matter, for fear of aggravating an established distrust.&nbsp;</p>\r\n"
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    <p class="reader-text-block__paragraph">Be that as it may, I write to share misgivings about the prevailing approach to boosters, which seems composed in equal parts of “more is better” and “one size fits all.”&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">COVID vaccines have done a great deal of good and accelerated our incremental return to pre-pandemic norms.&nbsp;To be blunt, I am&nbsp;<a href="https://www.linkedin.com/pulse/covid-vaccine-adverse-event-reporting-how-vaers-veers-david/" rel="nofollow">an unreserved proponent</a>.</p>\r\n
    <p class="reader-text-block__paragraph">But the vaccines are, of course,&nbsp;<a href="https://www.linkedin.com/pulse/covid-vaccines-your-heart-david-l-katz-md-mph-facpm-facp-faclm/" rel="nofollow">imperfect</a>, both in their efficacy and in their safety, and thus should be doled out always and only with careful attention to&nbsp;<a href="https://us.sagepub.com/en-us/nam/clinical-epidemiology-evidence-based-medicine/book8792" rel="nofollow">risk/benefit tradeoffs</a>- the constant barometer of medical propriety.&nbsp;I am not convinced that is being done.</p>\r\n
    <p class="reader-text-block__paragraph">First, the idea that we should simply&nbsp;<a href="https://www.nytimes.com/2022/01/06/health/covid-vaccines-boosters.html" rel="nofollow">keep increasing the number of boosters</a> to defend against new strains of SARS-CoV-2 is more of a leap of faith than science.&nbsp;I am not aware of any prior vaccination campaign that operated this way.&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">Boosters, historically, are used in three settings: (1) to rejuvenate an immune response attenuated by a lengthy period (e.g., on the order of a decade) of non-exposure.&nbsp;Here, good examples are immunizations for&nbsp;<a href="https://www.cdc.gov/vaccines/acip/index.html" rel="nofollow">measles and tetanus</a>; (2) to enhance the initial antibody response in people with impaired immunity.&nbsp;Here, a&nbsp;<a href="https://www.sciencedirect.com/science/article/pii/S1044532318300678" rel="nofollow">two-dose flu vaccine</a>&nbsp;in the frail elderly is a good example; and (3) finally, vaccine variants are at times developed to address new microbial strains.&nbsp;These are not exactly boosters, but close enough; the&nbsp;<a href="https://www.huffpost.com/entry/flu-shot_b_2257520" rel="nofollow">annual flu shot</a>&nbsp;is the best example here.</p>\r\n
    <p class="reader-text-block__paragraph">The repetitive dosing of SARS-CoV-2 vaccines is none of the above.&nbsp;Rather, it is an attempt to compensate for the “strength” of the immune response which is lacking in its specificity.&nbsp;In other words, if the antibodies are not quite right for the current viral strain in circulation, bumping up their count may- in theory- compensate.</p>\r\n
    <p class="reader-text-block__paragraph">To be fair, this is more than theory now, with&nbsp;<a href="https://www.nejm.org/doi/10.1056/NEJMoa2200674" rel="nofollow">studies showing enhanced protection</a>&nbsp;with boosters.&nbsp;But the relevant metric is not just the gross intended effect, but the net margin of benefit over risk.&nbsp;That means defining benefit appropriately, and capturing all relevant risk.&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">The benefit of vaccination against a now endemic virus is not reliably measured by counting cases, but rather by disease severity.&nbsp;If in certain groups the risks of severe illness with and without additional boosters are commensurately low, the calculus of benefit must adjust.</p>\r\n
    <p class="reader-text-block__paragraph">The risks of provoking inflammation, which is what stimulating the immune system repeatedly does, include potential contributions to slowly evolving conditions, such as heart disease,&nbsp;<a href="https://www.nature.com/articles/d41586-022-00912-y" rel="nofollow">diabetes</a>, neurodegenerative diseases, autoimmunity, and cancer.&nbsp;Maybe some number of COVID boosters does none of this- but we should concede it will be some time before we know.</p>\r\n
    <p class="reader-text-block__paragraph">One thing we do know is that most medical interventions are bounded by a therapeutic window, where the right dose is better than either less, or more.&nbsp;The correct answer is almost never “more is better,” so if that is true of COVID boosters- they are an anomaly.</p>\r\n
    <p class="reader-text-block__paragraph">Yet that may be the lesser issue.&nbsp;The greater issue is that millions upon millions of us have been infected with COVID, and a sizable plurality if not majority of us millions by more than one strain.&nbsp;Native immunity is never irrelevant, yet our public health policy is all but mute to it.&nbsp;For those of us who have had COVID, our first vaccine was a booster; our second was another.&nbsp;How many are we supposed to get?&nbsp;What, for us, is the incremental benefit of each additional booster- if any?&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">As for risks, however modest they may be, they wax in significance as benefit wanes. &nbsp;In my personal case, I’ve had COVID more than once, and been vaccinated twice.&nbsp;My symptoms of&nbsp;<a href="https://www.linkedin.com/pulse/long-covid-chronic-fatigue-syndrome-david-l-katz-md-mph/" rel="nofollow">long COVID</a>, only now subsiding after well over a year, were exacerbated by vaccination. Since I have reason to doubt any meaningful benefit of further boosting given my blend of naturally acquired immunity and prior immunization, I am disinclined to chance even modest risk.&nbsp;My position is far from radical, and I think our public health policies should accommodate it.</p>\r\n
    <p class="reader-text-block__paragraph">They do not.&nbsp;My wife, whose situation is similar to mine, is a volunteer at an area non-profit helping refugee women establish new careers in the U.S.&nbsp;She loves the work, and the sisterhood, and they love her.&nbsp;But she cannot return, because I have advised her against more “boosting”- and the official policy is that boosters are required.&nbsp;With natural immunity plus two vaccines, she has been boosted- but our persistently blinkered pandemic policies are blind to it.</p>\r\n
    <p class="reader-text-block__paragraph">Such, then, are my impassioned qualms; shared only with reluctance.&nbsp;That reluctance is by no means an excess of diffidence - I have spent a career speaking my truths to relevant powers, and dealing with whatever consequences ensued (quite unpleasant at times).&nbsp;Rather, for policy in public health to do its intended good, there must be trust in it.&nbsp;When those of us with relevant credentials battle one another on public display, that trust is jeopardized.&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">I would go further and say that such internecine battles over all matters of public good- from COVID response policies, to addressing climate change, to&nbsp;<a href="https://www.annualreviews.org/doi/10.1146/annurev-publhealth-032013-182351" rel="nofollow">what diet is best for health</a>, to voting rights and the defense of democracy, and many other matters besides – are&nbsp;<a href="https://www.linkedin.com/pulse/death-discord-david-l-katz-md-mph-facpm-facp-faclm/" rel="nofollow">the great blight of our time</a>.&nbsp;The rampant flow of disinformation and the amplification of&nbsp;<a href="https://www.huffpost.com/entry/nutrition-advice_b_3061646" rel="nofollow">every idle opinion</a> in the Internet echoes is fuel to ravaging conflagrations.&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">But debate and disagreement are healthy; they are the vital forces of dialogue. &nbsp;So, too, are civility, respect, and a capacity to listen.&nbsp;Those systems are beleaguered; they, not dissent, are the deficiency. &nbsp;Like a body with some working organ systems and others in failure, the whole regresses to the depths of its greatest weakness.</p>\r\n
    <p class="reader-text-block__paragraph">So it is that this is a bad time for dissent.&nbsp;But it is always a bad time for submission to&nbsp;<a href="https://heated.medium.com/america-runs-on-dietary-dogma-bced08691c82" rel="nofollow">dogma</a>, too.&nbsp;I regret them both.</p>\r\n
    <p class="reader-text-block__paragraph">To be clear, this is dissent along a middle path- the “<a href="https://zdoggmd.com/tag/alt-middle/" rel="nofollow">alt middle</a>” as a friend would say- that neither treats current public health policy as sacrosanct, nor throws it under the bus.&nbsp;To gain and retain the trust of us all, I implore my colleagues in positions of public health authority to speak to us all in our diversity of circumstances.&nbsp;They might do well to recall that&nbsp;<a href="https://journals.sagepub.com/doi/abs/10.4278/ajhp.101103-CIT-359" rel="nofollow">the “public” is a fiction</a>&nbsp;in the service of statistical summation; in reality,&nbsp;there are just us- individuals, in our varied multitudes.&nbsp;</p>\r\n
    <p class="reader-text-block__paragraph">My hope is that the best way to make things right for all is to assert with calm candor what we keep getting wrong for one.</p>
    """
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    "function" => "finishView"
    "class" => "Symfony\Component\Form\Extension\DataCollector\Proxy\ResolvedTypeDataCollectorProxy"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/src/Controller/ArticleController.php"
    "line" => 220
    "function" => "createView"
    "class" => "Symfony\Component\Form\Form"
    "type" => "->"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 181
    "function" => "show"
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    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
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    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/runtime/Runner/Symfony/HttpKernelRunner.php"
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    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
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  [
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    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
  ]
]
Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:56
Show trace 
[
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-csrf/TokenStorage/SessionTokenStorage.php"
    "line" => 56
    "function" => "get"
    "class" => "Symfony\Component\HttpFoundation\Session\Session"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-csrf/CsrfTokenManager.php"
    "line" => 70
    "function" => "getToken"
    "class" => "Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/form/Extension/Csrf/Type/FormTypeCsrfExtension.php"
    "line" => 82
    "function" => "getToken"
    "class" => "Symfony\Component\Security\Csrf\CsrfTokenManager"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/form/ResolvedFormType.php"
    "line" => 134
    "function" => "finishView"
    "class" => "Symfony\Component\Form\Extension\Csrf\Type\FormTypeCsrfExtension"
    "type" => "->"
  ]
  [
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    "function" => "finishView"
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    "function" => "finishView"
    "class" => "Symfony\Component\Form\Extension\DataCollector\Proxy\ResolvedTypeDataCollectorProxy"
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    "function" => "finishView"
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    "function" => "createView"
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    "function" => "show"
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    ]
    "function" => "require_once"
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]
Symfony\Component\Security\Core\Authentication\Token\Storage\UsageTrackingTokenStorage:41
Show trace 
[
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-core/Authentication/Token/Storage/UsageTrackingTokenStorage.php"
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    "function" => "handle"
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    "class" => "Symfony\Component\HttpKernel\DependencyInjection\LazyLoadingFragmentHandler"
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    "function" => "renderFragment"
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    "function" => "displayBlock"
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    "line" => 367
    "function" => "displayWithErrorHandling"
    "class" => "Twig\Template"
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    "function" => "render"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 181
    "function" => "show"
    "class" => "App\Controller\ArticleController"
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    "function" => "run"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
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    "function" => "require_once"
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]

Flashes

Flashes

No flash messages were created.

Server Parameters

Server Parameters

Defined in .env

Key Value
APP_ENV 
"dev"
APP_SECRET 
"0a988e63f011514eaabfc650b599af4d"
CORS_ALLOW_ORIGIN 
"*"
DATABASE_URL 
"mysql://bbndb_rctuser:33F5W25z40or0f7@localhost:3306/rct_bbntimes"
GOOGLE_RECAPTCHA_SECRET_KEY 
"6LdV5fgpAAAAANxzTG8ZMfIjil1wu-1vrQvnUt-x"
GOOGLE_RECAPTCHA_SITE_KEY 
"6LdV5fgpAAAAAENKcn73MJAhQrbtQeqgyC4wDLMP"
MAILER_DSN 
"smtp://no-reply%40rct.dev.bbntimes.com:Bl6%26gLD48%26Of919@rct.dev.bbntimes.com:465"
MARIADB_PASSWORD 
"i!87pK&!85ezc8"

Defined as regular env variables

Key Value
APP_DEBUG 
"1"
BASE 
"/public"
CONTEXT_DOCUMENT_ROOT 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com"
CONTEXT_PREFIX 
""
DOCUMENT_ROOT 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com"
FCGI_ROLE 
"RESPONDER"
GATEWAY_INTERFACE 
"CGI/1.1"
HTTPS 
"on"
HTTP_ACCEPT 
"*/*"
HTTP_ACCEPT_CHARSET 
"ISO-8859-1,utf-8;q=0.7,*;q=0.7"
HTTP_ACCEPT_ENCODING 
"gzip, br, zstd, deflate"
HTTP_ACCEPT_LANGUAGE 
"en-us,en;q=0.5"
HTTP_CONNECTION 
"close"
HTTP_COOKIE 
"tudorwatch_lang=ru; PHPSESSID=qthihj72n6jadri8m52glt1vn3"
HTTP_FORWARDED 
"for="3.145.103.54";host="rct.dev.bbntimes.com";proto=https"
HTTP_HOST 
"rct.dev.bbntimes.com"
HTTP_USER_AGENT 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
HTTP_X_FORWARDED_FOR 
"3.145.103.54"
PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
PATH 
"/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin"
PATH_INFO 
""
PHP_SELF 
"/public/index.php"
PP_CUSTOM_PHP_CGI_INDEX 
"plesk-php81-fastcgi"
PP_CUSTOM_PHP_INI 
"/var/www/vhosts/system/rct.dev.bbntimes.com/etc/php.ini"
QUERY_STRING 
"_path=_format%3Dhtml%26_locale%3Den%26_controller%3DApp%255CController%255CArticleController%253A%253ArelatedArticles"
REDIRECT_BASE 
"/public"
REDIRECT_HTTPS 
"on"
REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_HTTPS 
"on"
REDIRECT_REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/covid-boosters-for-the-body-politic-one-size-fits-all"
REDIRECT_REDIRECT_SCRIPT_URL 
"/science/covid-boosters-for-the-body-politic-one-size-fits-all"
REDIRECT_REDIRECT_SSL_TLS_SNI 
"rct.dev.bbntimes.com"
REDIRECT_REDIRECT_STATUS 
"200"
REDIRECT_REDIRECT_UNIQUE_ID 
"Z7mP8ZDyWLT8YV1VjBpAJwAAAIM"
REDIRECT_SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/covid-boosters-for-the-body-politic-one-size-fits-all"
REDIRECT_SCRIPT_URL 
"/science/covid-boosters-for-the-body-politic-one-size-fits-all"
REDIRECT_SSL_TLS_SNI 
"rct.dev.bbntimes.com"
REDIRECT_STATUS 
"200"
REDIRECT_UNIQUE_ID 
"Z7mP8ZDyWLT8YV1VjBpAJwAAAIM"
REDIRECT_URL 
"/public/science/covid-boosters-for-the-body-politic-one-size-fits-all"
REMOTE_ADDR 
"127.0.0.1"
REMOTE_PORT 
"26019"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"https"
REQUEST_TIME 
1740214257
REQUEST_TIME_FLOAT 
1740214257.8749
REQUEST_URI 
"/_fragment?_path=_format%3Dhtml%26_locale%3Den%26_controller%3DApp%255CController%255CArticleController%253A%253ArelatedArticles"
SCRIPT_FILENAME 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
SCRIPT_NAME 
"/public/index.php"
SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/covid-boosters-for-the-body-politic-one-size-fits-all"
SCRIPT_URL 
"/science/covid-boosters-for-the-body-politic-one-size-fits-all"
SERVER_ADDR 
"5.196.1.209"
SERVER_ADMIN 
"[no address given]"
SERVER_NAME 
"rct.dev.bbntimes.com"
SERVER_PORT 
"443"
SERVER_PROTOCOL 
"HTTP/1.1"
SERVER_SIGNATURE 
"<address>Apache Server at rct.dev.bbntimes.com Port 443</address>\n"
SERVER_SOFTWARE 
"Apache"
SSL_TLS_SNI 
"rct.dev.bbntimes.com"
SYMFONY_DOTENV_VARS 
"APP_ENV,APP_SECRET,DATABASE_URL,MARIADB_PASSWORD,CORS_ALLOW_ORIGIN,MAILER_DSN,GOOGLE_RECAPTCHA_SECRET_KEY,GOOGLE_RECAPTCHA_SITE_KEY"
UNIQUE_ID 
"Z7mP8ZDyWLT8YV1VjBpAJwAAAIM"

Parent Request

Return to parent request (token = 602731)

Key Value
_controller 
"App\Controller\ArticleController::show"
_firewall_context 
"security.firewall.map.context.main"
_links 
Symfony\Component\WebLink\GenericLinkProvider {#3588
  -links: [
    3709 => Symfony\Component\WebLink\Link {#3709
      -href: "/build/runtime.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3707 => Symfony\Component\WebLink\Link {#3707
      -href: "/build/644.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3706 => Symfony\Component\WebLink\Link {#3706
      -href: "/build/502.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3705 => Symfony\Component\WebLink\Link {#3705
      -href: "/build/app.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3704 => Symfony\Component\WebLink\Link {#3704
      -href: "/build/view-more.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3703 => Symfony\Component\WebLink\Link {#3703
      -href: "/build/term-condition.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3702 => Symfony\Component\WebLink\Link {#3702
      -href: "/build/contact.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3701 => Symfony\Component\WebLink\Link {#3701
      -href: "/build/scroll-infinite-article.js"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "script"
      ]
    }
    3700 => Symfony\Component\WebLink\Link {#3700
      -href: "/build/app.css"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "style"
      ]
    }
    3699 => Symfony\Component\WebLink\Link {#3699
      -href: "/build/cookie-style.css"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "style"
      ]
    }
    3698 => Symfony\Component\WebLink\Link {#3698
      -href: "/build/term-condition-css.css"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "style"
      ]
    }
    3697 => Symfony\Component\WebLink\Link {#3697
      -href: "/build/contact-css.css"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "style"
      ]
    }
    3696 => Symfony\Component\WebLink\Link {#3696
      -href: "/build/comment-css.css"
      -rel: [
        "preload" => "preload"
      ]
      -attributes: [
        "as" => "style"
      ]
    }
  ]
}
_route 
"article_show"
_route_params 
[
  "category" => "science"
  "slug" => "covid-boosters-for-the-body-politic-one-size-fits-all"
]
_security_firewall_run 
"_security_main"
_stopwatch_token 
"4562f6"
category 
"science"
slug 
"covid-boosters-for-the-body-politic-one-size-fits-all"