COVID-19 Vaccination — Becoming Part of the New Normal

Peter Marks, Janet Woodcock, and Robert Califf wrote . . . . . . . . .

As the US emerges from the recent Omicron surge of the COVID-19 pandemic following close to a million deaths in the country attributable to COVID-19, many people are hoping that the worst is over. Widespread vaccine- and infection-induced immunity, combined with the availability of effective therapeutics, could blunt the effects of future outbreaks. Nonetheless, it is time to accept that the presence of SARS-CoV-2, the virus that causes COVID-19, is the new normal. It will likely circulate globally for the foreseeable future, taking its place alongside other common respiratory viruses such as influenza. And it likely will require similar annual consideration for vaccine composition updates in consultation with the US Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC). A recent meeting of the VRBPAC on April 6, 2022, resulted in a lively discussion and agreement on many considerations for planning for upcoming approaches to COVID-19 vaccine strain composition decision-making, development, and recommendations.

COVID-19 vaccines, developed and deployed in record time based on foundational scientific and clinical research conducted over the preceding decade, have conservatively saved tens of thousands of lives in the US and many more across the globe. Although data show that third doses of the mRNA COVID-19 vaccines provide more durable protection against the severe outcomes of hospitalization and death, only 45% of the US population has received a third vaccine dose, including only about 68% of those older than 65 years—the individuals at greatest risk of adverse outcomes from COVID-19. Because fourth doses of the mRNA COVID-19 vaccines were only recently authorized for those older than 50 years, it is too early to assess their effects on protection against serious outcomes of COVID-19 in the US. However, robust observational data from Israel with a large sample size showed additional protection against hospitalization and death in that population.

During this coming fall-to-winter period, 3 factors may come together to place the country’s population at risk of COVID-19, particularly those who are unvaccinated or who are not up-to-date with vaccination. These factors include (1) waning immunity from prior vaccine or prior infection, (2) further evolution of SARS-CoV-2, and (3) seasonality of respiratory virus infection, waves of which are generally more severe in the fall to winter months when individuals move their activities indoors.

By summer, decisions will need to be made for the 2022-2023 season about who should be eligible for vaccination with additional boosters and regarding vaccine composition. Administering additional COVID-19 vaccine doses to appropriate individuals this fall around the time of the usual influenza vaccine campaign has the potential to protect susceptible individuals against hospitalization and death, and therefore will be a topic for FDA consideration.

Those at greatest risk who might benefit most from vaccination include immunocompromised individuals and people older than 50 years, given the prevalence of comorbidities that increase the risk of severe disease and death in this latter group. Additional groups that might benefit include those who are unvaccinated (including children) or not up-to-date with vaccination (eg, those who have received only 1 dose of a COVID-19 vaccine or have not received a booster dose). The benefit of giving additional COVID-19 booster vaccines to otherwise healthy individuals 18 to 50 years of age who have already received primary vaccination and a first booster dose is not likely to have as marked an effect on hospitalization or death as in the other populations at higher risk (noted above). However, booster vaccinations could be associated with a reduction in health care utilization (eg, emergency department or urgent care center visits).

Around the same time that a decision is made regarding who should be eligible for vaccination, a decision will also need to be made on the COVID-19 vaccine composition. To provide maximal benefit across the entire age spectrum, careful consideration will need to be given to the choice of the SARS-CoV-2 variant(s) to cover in the COVID-19 vaccines for the fall and winter of the 2022-2023 season. This is because the variant(s) covered by the vaccine may have an important influence on both the extent and duration of protection against a future SARS-CoV-2 variant(s) that may circulate. Better alignment between the variant(s) covered by the vaccine and circulating variant(s) of SARS-CoV-2 might be expected to prevent a broader spectrum of disease, potentially for a longer time. In the event of a major fall or winter wave, a vaccine with optimal variant coverage might facilitate significant reductions in lost productivity and health care utilization from both acute and chronic complications of COVID-19, including postacute COVID-19 syndrome. Of note, in the past, such an overall public health benefit in an otherwise healthy younger population has been considered during the annual influenza vaccine campaign.

In terms of practical considerations, at the recent meeting of the VRBPAC, there was relatively uniform agreement that a single vaccine composition used by all manufacturers was desirable and that data would be needed to inform and drive the selection of a monovalent, bivalent, or multivalent COVID-19 vaccine.8 There was also general agreement that, should a new vaccine composition be recommended based on the totality of the available clinical and epidemiologic evidence, optimally it could be used for both primary vaccination as well as booster administration.

The timeframe to determine the composition of the COVID-19 vaccine for the 2022-2023 season, to use alongside the seasonal influenza vaccine for administration in the Northern Hemisphere beginning in about October, is compressed because of the time required for manufacturing the necessary doses. A decision on composition will need to be made in the US by June 2022. Because of this timing, the FDA, in consultation with the VRBPAC, will need to arrive at a recommendation for the future composition of the US COVID-19 vaccines for 2022-2023 based on the available evidence and predictive modeling, with the understanding that there will be some inherent residual uncertainty about the further evolution of SARS-CoV-2. To date, the original, or prototype, vaccine composition deployed has been reasonably good at protecting against severe outcomes from COVID-19. However, a greater depth and duration of protection might be achieved with a vaccine covering currently circulating variants.

As plans are being developed for the coming fall and winter, it is critical that patients and caregivers understand the profound benefit of a booster dose of the mRNA vaccines or a second vaccine dose of any kind after the Janssen/Johnson & Johnson vaccine and that this understanding leads to action now in the face of a current uptick in infection rates. Clinicians should not be susceptible to inertia and should continue to recommend that patients get their COVID-19 vaccination status up to date, meaning primary vaccination and relevant booster(s). There is no evidence that getting vaccinated now will have adverse effects or toxicity that would preempt the administration of an additional vaccine dose in the fall months if there is evidence of waning of immunity, a new variant, or an adverse seasonal pattern.

Vaccines, as public health interventions, have been responsible over the past century for reducing an unimaginable amount of morbidity and for saving millions of lives. The eradication of smallpox and near elimination of several other infectious diseases are an unambiguous triumph of modern medicine. During the 2022-2023 COVID-19 vaccine planning and selection process, it is important to recognize that the fall season will present a major opportunity to improve COVID-19 vaccination coverage with the goal of minimizing future societal disruption and saving lives. With the plan for implementation of this year’s vaccine selection process, society is moving toward a new normal that may well include annual COVID-19 vaccination alongside seasonal influenza vaccination.

Source : JAMA Network

Opinion: Mixing Intermittent Fasting and Exercise

Jelena Damjanovic wrote . . . . . . . . .

Matthew Lees and Eric Williamson, both of the University of Toronto’s Faculty of Kinesiology and Physical Education, have studied the effects of intermittent fasting on muscle health in the general population and older adults. Lees, a postdoctoral researcher, and Williamson a PhD student and registered dietician, conducted the research with Associate Professor Daniel Moore.

“Finding ways to lose weight that are as simple as skipping a meal is very difficult because many people find it hard to manage their hunger while being in a caloric deficit,” Williamson says. “But, if they find that their hunger is well managed with intermittent fasting and they plan to exercise at the same time, then it can be an effective tool for losing fat.”

We spoke to Lees and Willamson about the benefits of complementing intermittent fasting with exercise.


What is intermittent fasting?

Eric Williamson: Intermittent fasting means going without food for an intentional period of time. There’s no real strict definition of how long that time has to be, but for the most part, it’s at least 12 hours. Most people will practice intermittent fasting with the intention of losing weight. The thinking behind this is that intermittent fasting will keep your insulin levels lower and by lowering insulin, which is known as the fat-storing hormone, you will lose body fat.

What does the science say about it?

EW: Research in this area provides ample evidence that the majority of people who practice intermittent fasting will typically lose weight, but not for the purported reason of lowering insulin levels. Rather, evidence shows that skipping meals does not typically lead to compensatory eating. So, if you skip breakfast, you will typically eat a little bit more at lunch, but you won’t eat as much as if you had eaten breakfast. That ends up putting you into a caloric deficit and, by the laws of physics, it is what leads to the loss of mass overtime.

What’s the appeal of intermittent fasting?

EW: Finding ways to lose weight that are as simple as skipping a meal is very difficult because many people find it hard to manage their hunger while being in a caloric deficit. But, if they find that their hunger is well managed with intermittent fasting and they plan to exercise at the same time, then it can be an effective tool for losing fat.

What’s the benefit of combining intermittent fasting and exercise?

EW: Research indicates that if you are going to practice intermittent fasting, you should combine it with exercise – in particular resistance training. The reason for that has to do primarily with protein metabolism. We know that having our protein intake in multiple feedings throughout the day is better for our lean mass and for lean mass retention over time. Muscle is a significant component of lean mass, so if you are fasting, you are skipping these opportunities for the effects of a protein intake on your muscle metabolism and risking muscle atrophy.

Put simply, when people practice intermittent fasting without exercising, they are losing weight, but much of it often comes from the muscle in the lean mass. If they are exercising, then that shifts from a loss of muscle mass to a loss fat mass, so that’s a large benefit.

Are certain types of exercises better paired with intermittent fasting than others?

EW: Yes, the effects of resistance exercise in particular are so potent that you would likely still be able to preserve muscle, or at least not lose it as quickly, if you’re practicing intermittent fasting at the same time. On the other hand, if somebody was looking to gain as much muscle and strength as possible, like a powerlifter or bodybuilder, they may want to avoid intermittent fasting, because they’ll need both the stimulus of resistance training and protein feedings throughout the day. Some may find they still gain muscle while practicing intermittent fasting, but it likely won’t be as quickly as with regular meals and snacks.

Athletes who are trying to maximize performance should also be cautioned as they have very high energy needs; meaning, they’ll need a lot of food. If they’re practicing intermittent fasting, they’re limiting their opportunities to gain that energy. By missing protein feedings, they may not be at as high of a risk of atrophy, but they are risking maximizing their potential. Athletes who are eating more regularly throughout the day are going to be more likely to meet their energy needs, recover better and adapt to their training better.

Does it matter what time of day you choose to fast?

EW: There are potential benefits to practising intermittent fasting later in the day. Most people skip breakfast because it’s easy – you’re in a rush, you’re not that hungry because our appetites decrease as we sleep. But, from a metabolic perspective, you’re better off skipping your evening snack or dinner rather than breakfast.

There are a couple of reasons for that. One is that we’re more metabolically primed in the morning, not necessarily for protein intake, but for other nutrients. We tend to metabolize nutrients better in the morning. Secondly, nighttime is usually when the junk foods come out. So, if somebody says I’m not going to eat after eight, for example, they’re probably eliminating some of these calorically dense, low nutrient foods.

How does age factor in?

Matthew Lees: As we get older, we’re at an even higher risk of muscle atrophy. The body becomes less efficient at using the protein that we consume in the diet and that process, known as anabolic resistance, is made worse by being sedentary.

You see it happen with people after a hip fracture, for example. Even short periods of bed rest tend to lead to anabolic resistance. If you’re also truncating all of your meals within, say, an eight-hour timeframe within the day, you have long periods when you’re not feeding. There’s no anabolism occurring during that period, because there’s no feeding and without exercise that’s made even worse.

So, would you advise against intermittent fasting in older adults?

ML: From the perspective of muscle health, it’s just not ideal for an older person to engage in the practice of intermittent fasting, because it’s counterintuitive towards what’s best for muscle in an aging population. They need regular stimulation of the processes that build muscle and that’s what feeding and exercise do. Having a long period where you don’t consume any dietary protein is just not conducive to skeletal muscle health in an older population.

If your main goal is weight loss, then it can be a useful tool in younger populations if it fits into their lifestyle. But, for older people, weight loss is not always the principal goal and oftentimes it can be counterproductive. There are studies showing that a little bit of extra weight in older people is actually beneficial.

Is there anything else people should know about intermittent fasting?

EW: Intermittent fasting can be a useful tool for younger populations, who have a lower risk of atrophy. But, no matter the tool, I always recommend speaking with a professional before attempting to lose weight. There are some minor physical risks to weight loss, but the mental health concerns can be great. There’s mounting evidence to suggest that food relationship issues can present for some individuals who intentionally skip meals. For the reason of maintaining a positive relationship with food and body as well as to preserve or enhance physical health, I suggest that nobody attempt weight loss without speaking to a professional.

Source: University of Toronto

If You Thought COVID Was Over . . . . Congratulations, You’re an Idiot

Umair Haque wrote . . . . . . . . .

Uh oh. It’s ba-a-ack. Covid’s surging again, around the globe. In Hong Kong, the line is almost vertical — and this time, we’re talking about deaths. Britain, Austria, France, Germany, Switzerland, China, South Korea, the Netherlands, — all countries where Covid’s spiking, yet again. Finland has 85% more cases than last week. Austria has more cases now than at any point in the pandemic.

The WHO says all this is just “the tip of the iceberg.”

What happened here?

Let me try to say it politely. If you thought Covid was over, you’re an idiot. Sorry. I don’t mean to be rude, but people who bought this foolish notion, that “Covid is over,” need to get real, or we’ll be trapped in this Covid cycle for the foreseeable future. Let me explain the sad story of how we got here.

As the Omicron surge faded, on the one side, there were politicians, pundits, and public officials, who all converged on a certain story. A narrative. Covid was “evolving to become the flu.” And since Omicron was relatively mild, as soon its surge began to wane, “Covid was over.” This narrative spread across the West, especially — and soon enough, it was on the lips of Prime Ministers and pundits and Heads of Public Health Agencies. We were going to “live with Covid,” because now “the pandemic was ending.”

Life was going to go back to “normal” again.

Let’s take a few examples. The head of America’s CDC proclaimed, “I do anticipate that this is probably going to be a seasonal virus.” The head of the CDC’s Preparedness Center said he hopes this is “the last real large surge from SARS-CoV-2.” Top advisors to Biden urged him to “learn to live with the virus.” Advisors to PM Boris Johnson said Omicron was a “ray of light” towards Covid becoming like the common cold.

What happened as a result? Country after country dropped Covid precautions. All of them.

But they didn’t just drop distancing and mask mandates. Many countries, like the UK, dropped testing and surveillance of Covid too. So now, not only were people more likely to get it, governments can’t even track the spread.

At exactly the same time that a new variant was emerging. A “subvariant,” as the lingo goes at this point — Omcrion BA2, which is kind of like Turbo Omicron, because it’s 80% more infectious than Omicron, which itself was hyper infectious compared to Delta and Alpha. It’s almost as contagious as measles, and measles is the most contagious disease we know of.

On the other side, there were doctors and scientists. The good ones — not the few who parroted the line which is politically palatable. They warned, in unison, that lifting all precautions just as a new variant was emerging was going to be disastrous. It was idiotic. Anyone with a working knowledge of high school biology could, they warned, predict what was going to happen next. Covid would surge, all over again, fast.

Who was right? The pundits and politicians — or the scientists and experts? You probably don’t need me to tell you, unless, of course, again, you’re an idiot.

On Feb 17 2022, Denmark became the first country to drop all its Covid restrictions. All of them. No masks. No distancing. Nothing. Astonishingly, this policy was backed by the State Serum Institute, its public agency which was monitoring and evaluating the pandemic. What do you do when your government is making decisions like that? Never mind. What happened next? Deaths and hospitalisations exploded. The line surged vertically. And now? “About 1½ times more Danes are now hospitalized with COVID-19 than ever before during the pandemic.”

The next example’s so obvious to see it’s actually funny. Britain dropped Covid precautions on Feb 24th. Like Denmark, all of them. Masks, distancing, all of it. On Feb 27th, its Covid cases hit an inflection point — and began to surge, all over again. Just three days later.

LOL.

There are three kinds of people when it comes to Covid. The idiots of the right wing we know all too well — they won’t take vaccines and deny science. The idiots of the center, though, are the ones who will debate the points above as if such basic realities need fine-grained statistical modelling replete with differential equations and multivariate analysis to explain them. They don’t. Any good doctor or scientist will tell you the same thing. It looks simple because it is simple.

Cases, hospitalizations, deaths literally exploding just days after countries lifted all Covid precautions? Just as a new variant emerging was emerging? It doesn’t take a genius to figure out what happened here. It takes an idiot to deny it.

I use the word idiot in the classical Greek sense. For them, there was no figure lower than the idiot — the self-centred one, the narcissist, the selfish kind of person. The idiot was someone without virtue. Only private interests mattered to them — gain, profit, comfort, and so on. Greek life was built on virtue, and for the Greeks, nobody was more dangerous than the idiot, because they couldn’t contribute to the common good, and without the common good, there was no democracy or civilization.

Whom would the Greeks call idiots today? People who think wearing a mask is some kind of existential attack on their “freedom,” not a net gain of it, increasing public health for all. Freedom? That’s what the Ukrainians are fighting for. Wearing a mask is just common sense, because, yes, the science says it works. Or maybe people who want to believe the pandemic’s over, so life can “get back to normal” — having completely lost sight of the virtues of wisdom, compassion, fairness, and truth.

Remember the two sides? The Covid-is-over side, and the…science side? Who was right? It should be obvious by now. Remember the country that saw Covid cases explode all over again in a classic inflection point just three days after it lifted all precautions? LOL. You couldn’t have a more obvious examples of what’s true.

Covid was not over — just as the scientists and doctors said. Removing all precautions did indeed lead to disastrous outcomes. And yet, even now, the idiots of both sides, left and right will deny it. The right never wanted to fight Covid. But the centre and left gave up on it without much of a fight. Yes, really.

Let me put that in perspective for you. We’re two years into a global pandemic. Just two. And of those two years, we’ve only had fully working measures against the virus for one. Vaccines and masks and distancing. We’ve had just one year of really fighting the virus — and even that’s at the cost of hesitance and infighting and skepticism from, shockingly, even institutions like public health agencies. We have really only fought the virus for one year.

This is a global pandemic. One year of fighting it is not going to be enough. Especially knowing what we know now. Our vaccines fade in efficacy, fast. So do boosters — lasting maybe ten weeks or so, before they begin to lose potency. That leaves us with basic precautions like masking and social distancing.

If we don’t follow those precautions, then Covid will keep recurring. And no, it won’t be “the flu.” Covid is evolving, and will continue to evolve. There’s every chance — let me beat an old drum for a moment — that tomorrow’s variants will be deadlier. How deadly? We don’t know, but Covid could easily recombine with SARS or MERS and then we have a virus with Omicron’s infectiousness, but a mortality rate between 15 and 40%. (By the way, when I say that, I get piled on, harassed, and called names. So don’t take it from me. Listen to Dr. William Haseltine of Harvard Med, saying exactly that.)

And we are making that path of evolution — the deadly one — more likely right now. Why?

Well, think about what the policies of the last few months really did. They said to old people, young people, kids, the immunocompromised — “You’re on your own. Good luck! It’s your problem now. The rest of us” — meaning healthy working age people, basically — “are going to get back to ‘normal’. Covid’s over!! Ha-ha!!”

So we left all these groups at the mercy of the virus. That’s not just morally bankrupt, because of course the test of a civilized society is how it cares for its most vulnerable, and in this case, we just left them to die.

It’s scientifically incredibly dangerous, stupid, and reckless. Because it’s in immunocompromised bodies that Covid mutates out of control, and new variants emerge through recombination. It’s an immunocompromised person, for example, that variants can co-infect, and recombine, because they will stay sick for a long time. Now imagine an elderly one. Now imagine a world of them, just being left for dead.

We are giving Covid a perfect opportunity to become something worse. We’re handing it our world and civilisation on a silver platter — and daring it to feast. What do we do if Covid does recombine with SARS or MERS? Then we die. Or at least many of us do. No, that’s not a joke or an exaggeration. It is reality. Remember how bad Delta was? Even if we have some degree of immune protection now, it’s not going to make us invulnerable to worse strains of Covid, which will invariably kill and hospitalise scores of people. Yes, really.

That is already what’s happening all over again.

This wave hasn’t hit America yet. That is because waves always tend to hit America last. But when it does? It’s not going to be pretty. Less than half of Americans are boosted — and that’s a lower number than in plenty of countries where Covid’s surging all over again. The first two vaccines don’t give you as much protection against Omicron, especially BA2, as against the first variants — that is what waning efficacy means. America will be hit hard by this variant, yet again. And that was all eminently predictable. It’s incredible, given all that, that the CDC let this happen.

We are in the middle of a titanic, historic set of government failures. Truly incredible ones. How is it that Denmark’s public health agencies let this happen? America’s CDC? The list goes on and on. How is it even possible that the people tasked with protecting public health, safeguarding it, paid serious and significant sums to do it…don’t…by denying science and ignoring evidence…and instead cherry-picking facts and nitpicking over details?

We all know the answer to that. Because it’s what’s politically palatable. It’s what Presidents and Prime Ministers want. It’s what a certain segment of the population wants. They don’t care if grandma dies — they just want to go the gym in peace. Hey, no pain, no gain, amirite?! They don’t appear to know how to use the minds they appear not to have.

Our entire governments are pandering to this segment of people. Our entire governments. Public health agencies, governors, heads of state. They are letting them dictate terms, and ignoring the science, hoping that there won’t be political fallout. There’s just one tiny problem. These people are goddamned idiots.

Remember when I said the Greeks said idiots were people who weren’t concerned with virtue, because they were selfish and short-sighted and greedy? What virtue is all this centrally about?

Truth. It was true what the science said. Lifting precautions after just one year of really fighting a global pandemic — and just two years into it — was far too soon. Far too soon. Science predicted yet another wave — and here we are. It was true before it happened, because of course science gives us the power to know. And it’s true now.

But truth these days doesn’t seem to matter. The very centrists who attack the right for falling for Trump’s or Putin’s or whomever demagogues Big Lies…are the very ones…to believe in their own Big Lies. Especially about public health. The pandemic’s ending! Covid’s over! Life, go back to ‘normal’! Yay!! Never mind if it leaves literally every group in society other than healthy working age people abandoned, forgotten, and at profound, severe risk. A risk that then comes back to hit even those idiots who denied it, new variants emerging into a forever pandemic.

The only word people like this is idiots. Yes, we live in an age where truth is a contemptible thing, mocked and hated and scorned. But this? This will take history’s breath away. These people just…let a pandemic…go on and on? When they had vaccines, which they didn’t share with the world? And then they stopped wearing masks and distancing, even as those vaccines waned? While new variants were emerging? Leaving the old, young, ill, and sick to…just…get infected…and die…even if that was the surest way to produce even worse variants?

Whew. History will whistle, the way one is tempted to do, when confronted with idiocy of such staggering proportions that there’s nothing left to say, because words can’t possibly do justice to it. All that’s left it to shake your head in pity at the unutterable stupidity of it, make a sound like a cry, a mewl, and wonder.

What happens to make people into such hardened, relentless, mercilessly self-destructive idiots? What do you even do with them, except wave goodbye, as you watch them walk off the nearest cliff, telling you they’re going to fly?

Source :

Trying to Change Your Body? Be Nicer to Yourself

Nancy Brown wrote . . . . . . . . .

While running a weight loss study, Gary Foster asked a patient what she thought of the program.

“What I’m most grateful for,” she said, “is teaching me a sense of self-compassion.”

This intrigued Foster because self-compassion was a small part of their work.

The team primarily focused on measurable things, like body composition and metabolic rate. Researchers also tracked levels of hunger and depression.

In progress reports, patients were asked a series of adherence questions, such as how close they came to reaching their weekly goals for intake and activity. They also were asked, “What did you do to be kind to yourself this week?”

“When I had setbacks, I treated myself as I would a friend,” she told Foster. “I wasn’t the enemy. And that’s so critical for weight loss.”

Foster soon began encouraging all his patients to be nicer to themselves. Subsequent studies recommended positive self-talk. Then, just as quickly as it emerged, this theme faded. Not because he lost interest; because the people funding his work wanted him to target other things.

Those studies went so well that Foster continued to explore evidence-based approaches to wellness in the community setting. This passion is what brought him to WW (then known as Weight Watchers) in 2013.

Within a few years, he noticed a recurring theme from WW members. Or, rather, he noticed it again.

“What’s in your head is as important as what’s on your plate,” Foster said. “It’s how you think about yourself and it’s how you think about the journey. It’s those two things together. It’s not particularly novel, but it’s powerfully effective.”

Since rediscovering this key to helping people make healthy changes, Foster has built on it. He’s created a practical, science-based framework to keep anyone on track toward any goal.

This story is mostly about the message. Yet it’s also about the messenger.

It’s the story of a guy who set out to help others … and wound up discovering that the best way to do so is by showing them how to help themselves.

* * * * * * * * *

Foster remembers exactly when he first learned the joy of directly improving someone else’s life.

It was in high school, while serving food to people who were homeless. The feeling it stirred in him was so profound that he sought more of it.

The pursuit led him to enter the seminary. And to coach youth basketball. It’s even why he left the seminary; prayer time conflicted with other opportunities to directly help people.

“What drove me was more than a cathartic duty to serve,” he said. “I felt a very palpable impact when I helped people. It sort of gave me ‘inspiration juice.'”

Foster went from seminary to Duquesne University in Pittsburgh. He earned a degree in psychology – working in a prison psych ward along the way – but wasn’t sure of what to do next.

A college adviser recommended he work with psychologists while trying to figure it out. That adviser also helped Foster return to his hometown of Philadelphia, landing him interviews at the University of Pennsylvania School of Medicine.

Neither job intrigued him much at the time. On a whim, Foster joined the team studying obesity.

Having never needed to lose weight, he wanted to understand what it was like. So he read the book “The Pain of Obesity,” which delves into the emotional struggle of trying to shed pounds in the context of pervasive weight-based stigma. Then he began working with patients one-on-one and in groups.

He quickly developed deep empathy. Most of all, he found plenty of “inspiration juice.”

* * * * * * * * *

As it turned out, Foster was in the right place at the right time.

The Penn team studying obesity boasted many leaders in the field, including Dr. Albert Stunkard, author of “The Pain of Obesity.” These experts became his mentors, collaborators and friends.

Meanwhile, the field was about to take off. Bariatric surgery and other science-based, game-changing treatments were on the way.

The need for it all was about to take off, too.

Obesity rates in the U.S. have skyrocketed from about 12%-15% when his career began in the early 1990s to beyond 40% today.

* * * * * * * * *

Over the next decade, Foster oversaw many studies and published dozens of papers, establishing himself as a leading voice.

So when that woman raved about the power of self-compassion, something he’d hardly considered as part of the solution, Foster could’ve dismissed it as not fitting his research. Instead, he thought, “Boy, maybe we’re not focused on the things that matter.”

Foster began digging into the mental approach to taming obesity and liked what he found. Then came a new job and new priorities. For many years, his work revolved around crunching cold, hard numbers.

Then Foster got another job, the one at WW.

To immerse himself, he traveled the country, meeting with WW members and coaches.

Dr. Gary Foster (Photo courtesy of WW)
Through talking with WW members and coaches, Gary Foster recognized the importance of the mind in shaping the body. (Photo courtesy of WW)
He was looking for the sweet spot “at the intersection between what people want and what science can deliver.” He found it in the importance of the mind in shaping the body. And as he absorbed this realization, he heard a distant bell clanging for the first time in years.

“It was like, ‘Oh yeah, this isn’t the first time I’ve heard that,'” Foster said.

Only this time he was in a position to do something about it.

* * * * * * * * *

Foster began collecting thoughts in need of reframing, then putting them in a new frame.

For instance, consider this paradox: People often say they won’t be happy until they achieve a certain number on a scale. Yet research shows it’s more difficult to reach the number on the scale if they’re unhappy.

Foster’s solution has a bit of a Zen vibe: “At the beginning of the journey, the more you value your body as it is – seeing it as something worth taking care of, something you want to be kind to and to nourish – the easier the journey gets.”

Getting people to buy into such thoughts required debunking long-held myths, such as the notion that tough love shows strength and self-compassion shows weakness.

“Saying harsh things to yourself – things you wouldn’t say out loud, let alone to another person – is demotivating,” he said. “Remember, when you’re saying those harsh things, that’s you you’re talking about! And you are your most important ally.”

He eventually came up with seven pillars for lasting change:

  • Embrace self-compassion
  • Build helpful thinking styles
  • Set goals and form habits
  • Lean into your strengths
  • Value your body
  • Find your people
  • Experience happiness and gratitude

Foster bolsters each pillar with simple, proven techniques. Examples: To increase gratitude, think of three good things in your life. To be more self-compassionate, try talking to yourself as if you were talking to a friend.

Here’s a sample inner dialogue for someone trying to lose weight when they encounter a day that goes off-script: “Things happen. The key is not to let a big meal or a missed workout lead to a vicious cycle of negative thoughts that in turn lead to more missteps.”

“It’s inevitable that you will encounter setbacks,” Foster said. “If you’re self-critical and you don’t have self-compassion, you won’t do well. This is true everywhere, whether it’s parenting, relationships or work productivity.”

People hearing Foster present these ideas often asked where they could learn more. So he ended up writing a book about it. “The Shift – 7 Powerful Mindset Changes for Lasting Weight Loss” was published in late 2021.

* * * * * * * * *

While working on the manuscript, Foster began taking a closer look at his own mindset. He particularly targeted the connection between his diet and his health.

Since age 6, Foster has managed Type 1 diabetes. Anyone familiar with the condition understands what a chore that is. Hour by hour, year by year, he’s monitored his blood sugar using whatever is the latest technology. Tools may make it easier, yet it remains a constant challenge.

At 40, he developed celiac disease. That meant even more lifestyle modifications and daily accommodations.

Like everyone else, Foster has good days and bad days watching what he eats. But it wasn’t until writing the book that he gave himself credit for having been so successful for so long.

The bigger takeaway was that it gave him a new lens through which he could view those inevitable bad days. He looks at it with the pride of someone with a high winning percentage and the humility to recognize that he can’t win them all. Then he consoles himself with compassionate self-talk.

“Instead of saying, ‘My blood sugar is over 200 again today. What the heck? I’ve been at this for decades and I still can’t get it right!,’ now it’s like, ‘Hey, show some self-compassion. Yeah, my prediction was off, but I’m in the game. I can plan better next time.'”

So take it from Gary Foster, the psychologist and the scientist, and from Gary Foster, the patient: This stuff works.

Source: American Heart Association

Those Who Believe in Herd Immunity Cannot Do the Math

Kevin Kavanagh, MD wrote . . . . . . . . .

Current data are placing the final nails in the coffin of herd immunity. The first study which prompted hopes that wide-scale herd immunity may have been obtained was published on September 2, 2021. The study analyzed 1,443,519 blood donation samples between July 2020 and May 2021. In May 2021, 83.3% of the individuals had antibodies to SARS-CoV-2. However, blood donors may be composed of health-conscious individuals who are more likely to be vaccinated. In the article, 20.2% of the specimens had infection-induced antibodies. This means that 63.1% of the individuals had antibodies from vaccination. As of May 15, 2021, 49.7% of the United States population had received at least one dose of a SARS-CoV-2 vaccine.

Thus, in the study’s population, 20.2% of the patients who donated blood in May 2021 had had an infection. Of those donating blood, a total of 63.1% were vaccinated, but one would expect just 49.7%. By adding 49.7% and 20.2%, one can estimate that 69.9% of the population had at least some immunity to SARS-CoV-2 in May of 2021.

Recently another study was published in JAMA Network which found that 72% of residents in Los Angeles County had protective immunity to SARS-CoV-2 in April 2021. On viewing this data, many felt that a degree of herd immunity had been reached and if outbreaks were to occur, they would be regionalized and confined to areas with lower vaccination rates.

However, this did not happen. The United States endured another large surge from the Delta and Omicron variants.

The Delta variant is about 50% more transmissible than the wild type of virus and the Omicron variant has been found to be 2.7 to 3.7 times more infections than the Delta variant. Both variants have infected a large number of individuals.

Since the May 15, 2021 survey of SARS-CoV-2 seropositivity in the United States, we have had more than double (2.17 times) the number of cases of SARS-CoV-2. Of course, some of these may well be reinfections and breakthrough infections. The United Kingdom is reporting that with Omicron cases, at least 9.5% these are reinfections. The Omicron peak so far comprises about 22 million cases (December 15 to January 25) in the United States, so it can be assumed that reinfections and breakthrough infections will produce some decrease in the estimates of the total number of unique cases.

If we now assume an infection rate of 2.0 times, then 40% of our population has been infected with SARS-CoV-2. (Double the May 15, 2021, estimate of 20%). We may well have over 90% of the United States population with some immunity. But we are still at the height of a severe surge, with a new variant, the stealth Omicron, looming; and this variant’s infectious potential appears to be even greater, as it is outcompeting Omicron. It is unclear if this potential is due to an ability of the stealth Omicron to escape immunity or if the variant is finding the last remnants of immune-naive individuals.

As the pandemic continues to progress, reinfections and outbreak infections are causing the ‘vaccinate and all will be well’ advocates and the ‘herd immunity’ advocates to change their narratives.

The original goal of both groups was to prevent disease and end the pandemic. In the summer of 2020, a goal for vaccine approval was to “prevent disease or decrease its severity in at least 50% of people who are vaccinated.” However, the prevention of disease has been emphasized, with the initial Phase III trial for Moderna having its primary end point as “the efficacy of the mRNA-1273 vaccine in preventing a first occurrence of symptomatic COVID-19” and Pfizer announcing its vaccine prevented 100% of symptomatic cases in adolescents age 12 to 15.

According to the United Kingdom’s Imperial College COVID-19 response team, a two-dose vaccine (AstraZeneca and Pfizer) provides a vaccine effectiveness in the prevention of symptomatic disease between 0% and 20% with the Omicron Variant, and a previous infection gave a protection of 19%. However, unlike infections, you can safely receive a booster with an mRNA vaccine. Three-dose vaccinations provide a vaccine effectiveness for the prevention of symptomatic disease from Omicron of between 55% and 80%.

Now both advocacy groups are stating the primary goal for vaccines and herd immunity is the prevention of severe disease, as defined by hospitalizations and deaths.

Preventing hospitalizations and deaths in those who are infected is an important goal. Although hospitalizations are surging from the Omicron variant, the system no longer has redundancy in staffing and large number of workers are becoming infected and off of work because of COVID-19 infections. Thus, even outpatient infections which occur en masse can cause great disruptions in critical services, resulting in patients with non-COVID illnesses having difficulty obtaining treatment. Even patients with true emergencies may be waiting hours, which can greatly affect treatment and survival for those with cardiovascular diseases.

COVID-19 mutations are evading our immunity and at the same time our immunity is waning. Herd immunity to disease and the eradication of SARS-CoV-2 is no longer possible.SARS-CoV-2 is becoming endemic. Endemic means we have lost the fight to eradicate this virus. Whether we live or die with SARS-CoV-2 now depends upon how rigorously we adopt and implement public health mitigation strategies.

Source: Infection Control Today