Apoorva Mandavilli…
Apoorva Mandavilli on Twitter: “So: What exactly does the CDC’s mask guidance mean?
And should you trust it? It’s been a day. And a week. But it’s best to do this while everything is fresh, so here’s a 🧵” / Twitter
Last month, as the Food and Drug Administration paused use of Johnson & Johnson’s Covid-19 vaccine to evaluate the risk of blood clots in women under 50, many scientists noted that clots associated with birth control pills were much more common. Kelly Tyrrell, an ultramarathon runner in Madison, Wis., was advised to stop taking estrogen after blood clots were discovered in her lungs. The clots linked to the vaccine were a dangerous type in the brain, while birth control pills increase the chances of a blood clot in the leg or lung — a point quickly noted by many experts.
But the distinction made little difference to some women.
“Where was everyone’s concern for blood clots when we started putting 14-year-old girls on the pill,” one woman wrote on Twitter.
Another said, “If birth control was made for men it’d taste like bacon and be free.”
Some women heard, on social media and elsewhere, that they should not complain because they had chosen to take birth control knowing the risks involved. “That just made me double down,” said Mia Brett, an expert in legal history focused on race and sexuality. “This is such a common response to women’s health care — that we point out something and it’s dismissed.”
The torrent of fury online was familiar to experts in women’s health. “They should be angry — women’s health just does not get equal attention,” said Dr. Eve Feinberg, a reproductive endocrinologist and infertility specialist at Northwestern University. “There’s a huge sex bias in all of medicine.”
Dr. Feinberg and many of the women online acknowledge that contraceptives have given women control over their fertility, and the benefits far exceed the harms. Rebecca Fishbein, a 31-year-old culture writer, started tweeting about the inadequacy of birth control pills almost immediately after the announcement of the pause.
Still, “birth control is an incredible invention, thank God we have it,” she said last month in an interview. “I’ll fight anyone who tried to take it away.” contraceptives have also improved over the years, with intrauterine devices and oral options that offer an ultralow dose of estrogen. “Over all, it’s incredibly safe,” Dr. Feinberg said. “Everything that we do has risks.”
But Dr. Feinberg said it was crucial for health care providers to discuss the risks with their patients and coach them on worrisome symptoms — a conversation many women said they had never had. Kelly Tyrrell, a communications professional in Madison, Wis., was 37 when doctors discovered potentially fatal blood clots in her lungs.
Ms. Tyrrell is an endurance athlete — wiry, strong and not prone to anxiety.
In early 2019, she began waking up with a pain in her left calf. After one particularly bad morning, an urgent care visit revealed that she had high blood levels of “D dimer,” a protein fragment that indicates the presence of clots. She had been taking birth control pills for 25 years, but none of the doctors made a connection. Instead, they said that given her age, fitness and the lack of other risk factors, her symptoms were unlikely to be from a blood clot.
They sent her home with instructions to do stretches for her calf muscle. When she felt a tightness in her chest while running in Hawaii after her grandmother’s funeral, doctors said the cause was probably stress and anxiety. In July 2019, she finished a 100K race in Colorado and assumed her aching lungs and purple lips were the result of running for 19 hours at a high altitude. But she knew something was seriously wrong on the morning of Oct. 24, 2019, when she became short of breath after walking up a short flight of stairs.
This time, after ruling out heart problems, doctors scanned her lungs and discovered multiple clots. One had cut off blood flow to a portion of her right lung. “I instantly burst into tears,” Ms. Tyrrell recalled. The doctors put her on a course of blood thinners — and told her never to touch estrogen again. Ms. Tyrrell switched to a copper IUD. Over time, she added, the incident had escalated into a sharp rage that was renewed by the Johnson & Johnson news.
“Part of my anger was that a medication that I took to control my fertility ended up threatening my mortality,” she said. “I’m angry that I hadn’t been counseled better about that risk, or even what to look for.” The comparison was intended to reassure women of the vaccine’s safety. Instead, it has stoked anger in some quarters — not about the pause, but about the fact that most contraceptives available to women are hundreds of times riskier, and yet safer alternatives are not in sight.
Emily Farris, 36, was prescribed oral contraceptives at age 18 to help with migraines. In all of the conversations she has had with her many doctors over the years, “never once was blood clots brought up,” she said in an interview. On Twitter, some critics pointed out that the inserts with birth control packs clearly describe the blood clot risk. “My response is a bit incredulous to that,” said Dr. Farris, a political scientist at Texas Christian University in Fort Worth.
The inserts for most medications have a long list of possible side effects, placing “a high burden for folks to try to sort through medical research, to sort through what probability and statistics mean,” she said. Even with a Ph.D.-level education, “I can’t assess those risks,” Dr. Farris added. “I think most Americans need someone to translate what the legalese kind of pamphlet is into real terms.”
For Ms. Tyrrell, that elucidation came much too late. Her lungs have not felt the same since her diagnosis, but she is not sure whether that is because of lingering damage from a previous blood clot, new clots that she should be worried about or simply her age, she said, adding, “It’s never not on my mind anymore.” In this episode we have the pleasure of speaking with Kelly Tyrrell.Kelly is the Director of Research Communications at University of Wisconsin-Madison and an accomplished ultra-runner.
Over the past four years, she has made it on the podium in several ultra-marathons, earning the top spot in three. #5 The Privilege to Run with Kelly Tyrrell | Audio Length: 01:02:18 (vurbl.com)
Wait for the data, some said. And now, that data has arrived. There is no evidence – based on epidemiologic investigation and whole genomic sequencing – that the Sept. residence hall outbreak caused spillover into the community. Description of a University COVID-19 Outbreak and Interventions to Disrupt Transmission, Wisconsin, August – October 2020 | medRxiv
@AjayKSethi talks about herd immunity, COVID-19 vaccination, and how we should start thinking about safely getting back to the activities we care about —-> Badger Talks – When will we achieve herd immunity? – YouTube
Back to basics regarding herd immunity and the % vaccinated statistic as evidence for achieving it. In my ID epidemiology class, which just wrapped up, I teach the following assumptions inherent in those calculations and the prospect for herd immunity (applied to SARS-CoV-2): 1/8
Assumption 1: The disease agent is transmitted within a single host species. This seems true. We know humans can infect animals but there is no evidence that animals are a significant source of infection for people (i.e., a non-human reservoir). https://cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html… 2/8
Assumption 2: Transmission must be relatively direct. This is true. Majority of people are infected with SARS-CoV-2 through exposure to respiratory droplets within close range of someone who is infectious. https://cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html… 3/8
Assumption 3: Vaccination or natural infection produces solid immunity. So far, this is true. Immunity from vaccines last at least six months and is preferred over immunity from natural infection, which may not be as robust. New variants are the wildcard, hence “the race”. 4/8
Assumption 4 applies to the % vaccinated calculation: The probability of an infected person encountering every other person in the population is the same (i.e., random mixing). This assumption is never met because people don’t randomly mix. Neither do cattle in a herd. 5/8
Back-of-the envelope math to estimate how much vaccination is needed to achieve herd immunity is problematic because those who are vaccinated are not representative of those who are not, and right now unvaccinated people are gathering (e.g., children). 6/8
Talk about the U.S. or an entire state achieving herd immunity is just silly. But people >16 in a household or at a gathering where everyone is vaccinated can feel confident that there won’t be an outbreak of COVID-19 in their herd. 7/8
We just need to focus on encouraging people to choose vaccination. As more people are vaccinated, case rates and hospitalizations will go down further and stay down (barring variants escaping immunity), and we will all begin to feel safer and even more normal as a community. 8/8
Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe – The New York Times (nytimes.com)
The Pandemic’s Trauma Won’t Just Go Away – The Atlantic
No evidence of COVID-19 spread to local community after UW–Madison residence hall outbreak (wisc.edu) May 21, 2021 By Kelly April Tyrrell
2021 Ultra-running races in Wisconsin
(1) Matthew Wisniewski on Twitter: “In January 2020, after a decade living with ovarian cancer that included 110 chemo infusions and losing her hair three times, Joan wrote in her Caring Bridge journal, “Life can be a joyful experience, no matter what you are handed. Always try to laugh more than you cry.” https://t.co/Uqtob2AVXS” / Twitter
(2) Opens video on how COVID-19 vaccines are made, 4 seconds in, hears:
“The science of vaccinology …” – Bing
Covid vaccines & teens with heart inflammation…
What’s behind the thrombotic events that appear to be linked to the AstraZeneca and Johnson & Johnson vaccines? @rkhamsi explains the leading theories.
Worth your time. The Vaccine-Related Blood Clot Mystery Must Be Solved.