Allison Krug MPH
@KrugAlli
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Epidemiologist + pro coach specializing in health & wellness, runner, rider, hiker, hockey mom. Mil spouse. Passion for kids and education. 日本に4年間住んでた。
Virginia Beach
Joined February 2019
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Just published at BMJ Journal of Medical Ethics
👇👇
@KevinBardosh
@ID_ethics
@TrudoLemmens
@s_keshavjee
@VPrasadMDMPH
@MartyMakary
@sdbaral
@TracyBethHoeg
📢Read our new paper:
Analysis suggests Covid-19 boosters likely to cause a net clinical harm to young adults(18-29 yr), where total severe adverse events (SAEs) will outweigh Covid hospitalizations averted
Booster mandates are unethical because:1/13🧵
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Why is Moderna even asking for 4th dose for 18+ when that product was stopped for those <30 in many countries?
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People, I'm upset. Just heard UMICH requiring bivalent booster for fall 2023 to live on campus.
Must have doc by May 15 which means that vac will have precisely... How much protection by 90 days later?
No mod for people who have had COVID.
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This is so obvious, I'm sure it has been stated often but I missed it.
The reason the <5 vaccine will never have strikingly good vaccine effectiveness (VE) is because the comparison group (unvaxxed kids) are *so* well protected already, without vax.
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University of Toronto is bringing back vaccination requirements - primary series AND boosters.
No evidence or risk-benefit analysis offered.
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I also refused a booster and explained why to my doctor. She appreciated hearing and agreed.
Join the movement to demand appropriate evidence. 👇👇
No more COVID-19 shots without evidence , by
@VPrasadMDMPH
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If I could retweet him 400 times I would. 👇👇💯
Proud to partner w my co-authors on the
#UrgencyOfNormal
toolkit.
It’s time to define health as more than the absence of
#COVID
-19.
“Someone has to speak up for the kids.” - Pediatric ICU physician
@kwadwo777
Courage = our colleague 👇👇👇
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100%
If "gain of function" research did cause this pandemic, it may be the worst man-made disaster in the history of humanity. It makes Chernobyl and the sinking of the Titanic look like minor incidents. The pandemic has been a global holocaust. If human misbehavior did this,…
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"No one reassesses COVID mandates. When vaccine effectiveness went into the toilet with Omicron, not a single organization dropped the mandate. That suggests a failure to respond to new information."
Get your daily dose - another good one! 👇👇
@VPrasadMDMPH
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Agree. CDC needs to be dismantled, renamed, rebuilt from the ground up w/open-source peer review from the citizen scientists who have deconstructed the pandemic propaganda peddled in MMWR.
I revered CDC for 2 decades. Came to this realization more slowly than other epis.
@JHowardBrainMD
@KrugAlli
@RayPrisament
It’s not conspiracy, it’s simply the tactical and selective publication of ‘science’ (MMWRs etc.) to support policy that often over the past 2-years (more?) is supplied by politically appointed department heads. It’s bad for long-term credibility and will take years to reverse.
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"COVID19 does damage the brain. But not primarily by binding to neurons. Instead it creates irrational anxiety among a certain class of social media user who continually escalates what is necessary to “keep us safe.”
Excellent read 👇👇
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Focus on the 16-17 row at the bottom. Excess risk of myo continues to go up with booster. It is not "somewhere between first and second dose risk."
Colleges, camps, summer jobs, internships:
YOU CANNOT FORCE YOUNG MEN TO GET A BOOSTER
It is bad medicine and unethical.
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I've heard enough privately from clinicians I trust that someone needs to speak up for teens - boys and girls. Here's a note I would write to my teen self if I could.
Dysphoria is normal in adolescence.
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Is there a central list of colleges by vax requirement? My son is filling out applications. Not sure I'm good with sending him to one that REQUIRES a booster for young men.
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This is a lie. This is not actually what "public health people" think. Where I was trained, it was impressed upon us to think broadly, to engage stakeholders bc we knew that our own views had blind spots. This is a total lie, perhaps reflecting the bias of those in elite…
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The background rate is approx 2 per 1 mill persons over 7 days (FDA).
For males 18-29:
Dose 1 is 12x background rate
Dose 2 is 48x
Booster is 35x
Any org requiring vaccination at this point is mandating excess, unnecessary and life-altering risk for males.
Sobering data from FDA's June 7 meeting. The rate of myo/peri for all young males is elevated, but especially for 12-17 year olds. The question is will politicians and institutions acknowledge these data re mandates for this age group?
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Why should we drop mask mandates without metrics?
Not so much because they don't work, but because covid-hyperfocus is unhealthy.
Loss of agency is detrimental to psyche.
Uncertainty, inability to plan future bad for youth.
Masks are just a symbol of this myopia.
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The stadium holds 68,000. Let's assume most are 18-29 yr olds, 95% fully vaccinated. The latest CDC hosp rate data (not age stratified) suggests 0.19 per 100k hosp rate with breakthrough infection. I think the risk is tolerable?
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This "glitch" caused by the switch to N1-methyl- pseudouridine was intended to bypass the innate immunogenicity of mRNA, but in a horrible irony, the switch itself proved to be overtly immunogenic in more than 25%.
The FDA allowed mRNA technology to slip through a loosened…
More than a quarter of people injected with mRNA Covid jabs suffered an unintended immune response created by a glitch in the way the vaccine was read by the body, a study has found
No adverse effects were created by the error, data show, but Cambridge scientists found such…
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The headline is predictably incendiary but I agree 💯 I can also attest that it is truly very difficult to be a scientist at a univ and express dissenting opinion or question certain ideas. I'm a freelancer (which has its own perils) so I can tweet this.
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As we head into fall again, and organizations are tempted to slap mandates into place by reflex, please take a moment to consider this perspective
👇👇
📢 Our paper on COVID-19 vaccine policy has been published💉🦠
We discuss 12 unintended consequences of mandates and passports across society
& argue that pandemic vaccine policies have caused more social harm than good
Read the paper:
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This is happening because our public health priorities are upside down.
Deaths concentrated among older, unvaccinated.
Instead of resources/time/media pushing kid-oriented policy, we should be laser-focused on outreach to older adults.
The daily average for Covid deaths in this country is still above 2 and a half *thousand.*
2.5k Americans a day. A day.
And yet some say it's time to move on from the pandemic. It's 'peaked.' Back to normal. Off ramps. Etc.
How did we normalize mass death in this country?
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This Pfizer safety report with events as of 2/28/21 concludes:
- "no *new* safety signals"
- findings "consistent with known safety profile of the vaccine"
- "favorable benefit:risk balance"
Yet no epidemiological analysis was done. This is descriptive statistics only. No…
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I'm sorry, but I can't get behind this piece. Anti-vaccine is not equivalent to anti-thought. This is a fundamental misunderstanding that approaches arrogance. It's on us to discuss risks and benefits. Yeah... It's hard work. But isn't that why we chose medicine/public health?
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Devastating dissection of a CDC study designed to persuade, not inform. True, the statisticians knew what they were doing. I once thought getting published in MMWR would be an honor.
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Simplifying the message puts a demographic of young men at risk - high school/college age males, young professionals, military mbrs - are at unique risk of adverse events distinctly different than age 50+ and being coerced into booster.
Reporter cites top vaccine scientist Paul Offit saying a healthy young person unlikely to benefit from a booster
Walenksy's response: "We are simplifying our message: you need to get your fall booster if you're over the age of 12"
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Third year medical student demonstrates better critical thinking and courage than the experts. I would want him to care for my son.
👇👇👇
Failing our kids: Myocarditis in young boys, by
@Sensible__Med
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This will get me hate mail, but I'm going to say it. Long covid is real, I had it. LC can also be the product of long immersion in fear, dreading the inevitable, and post-covid hypervigilance. In other words, some LC is a self-fulfilling prophecy. Let's not make people sicker?
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"Mask mandates, enforced cohorts, cancelled athletics, and other non-pharmaceutical interventions disrupted learning and socialization, making the experience of childhood less pleasant and productive."
Return to "old normal" w/o threat of covid rules:
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I admire, respect and even love
@MonicaGandhi9
She saved my sanity a year ago.
But I strongly disagree that mandates are the answer. They would not have saved seniors most at risk of death. They're beyond the reach of a mandate.
Vaccine mandates would have prevented severe illness and death,
@CarlosdelRio7
, because these vaccines really really work
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Leslie and Eric 👇👇 team up to call for more time in school with rational policy.
It’s Madness to Quarantine Schoolchildren
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It is time to speak up. If you've been sitting on the sidelines wondering if the fight was worth it, it is. The evidence is on our side. Now is the time to fight unethical mandates for these last holdouts. Be a part of ending the coercion before students have to upload proof.
As of yesterday, we are holding at 13 of the top 100+ colleges still requiring COVID vaccines. This is not about science.
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"The proper use of the Covid vaccine in children is thus to offer it so that it can be used — in consultation between parents and physicians — on children with specific health needs, rather than a blanket positive recommendation for everyone."
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This plus
@MaryanneDemasi
excellent substack are well worth reading if you're wondering what the latest mask fuss is all about.
I may be dimwitted, but it seems simple enough - Cochrane reviewed RCTs on mask interventions and found there was no evidence they work to control…
1. UNMASKING THE NEW YORK TIMES' ZEYNEP TUFEKCI
According to a Cochrane statement and internal emails, Zeynep Tufekci falsely accused a recent Cochrane review author for misinterpretations of the review on masks.
What will the
@katiekings
w/
@NYTOpinion
do?
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Apparently everyone is talking about HPV vaccine right now. This is a complex question, and I have a couple thoughts this morning.
1. Kids have 4x as many vaccines today as we did when we were in high school. I just checked my shot record. It had DTP, Polio, MMR on it in 1987.
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Universities and colleges which are mandating boosters for young people are entirely out of step with the science.
It is no wonder that many academics have been silenced in a culture like this, immune to reason and fair appraisal of evidence.
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I need to get something off my chest. I've been studying myocarditis data for three days. But that is not what's weighing a bit heavy tonight, despite that sunrise run 😜💕
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💯 support for this decision. With 40% of kids already having natural immunity, vaccines available for highest risk, and masks demonstrating paltry effectiveness, it's well past time to return life to normal for kids. I support smart mandates, *not* one size fits all.
Today, I withdraw my support on Gov Newsom's vax mandates for kids; Bay Area counties said will release mask mandates for adults 8 weeks after 5-11 vax but CADPH/CDC says not for kids; AGAIN IN CA, KIDS MORE RESTRICTED THAN ADULTS (bars>>>schools). NOT RIGHT
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I've been working very hard to understand the mRNA vac approval process and how it may have set the stage for adverse events - could some of these issues have been predicted? Could strategic vacc of only the high risk avoided collateral damage?
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JAMA Peds publishes myo/peri study on kids - *without* stratifying for male/female?
And threw out 75% of cases due to not having medical records to review?
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New study in Nature shows correlation between vac/booster and presumed infectiousness (correlation with Ct values). Higher Ct after vax and booster vs unvax (less infectious); wanes over time (2-4 months).
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💯 Kids who already felt excluded were driven more and more into the virtual world where exclusion is extremely visible and painful, across multiple platforms.
The toxic cocktail of reduced in-person interactions coupled with increased social media exposure = devastating.
We should have seen this coming. We fought like heck to keep schools open but we were up against a lot. Now we have this.
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To all those who support the pursuit of truth without bias, to those who have the courage to question a prevailing wind, to those who stand for the silent...know that there are many who share your perspective and appreciate your candor.
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@j_g_allen
She's smart but this doesn't answer the question - what benefit do masks have for kids, 98.8% of whom are immune?
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Thank you for sharing this👇👇
At some point the CDC must acknowledge that prior infection gives more complete immunity due to IgA lining mucosa.
CDC: Modify booster rec - high risk only
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The answer here is do not attend any of these colleges.
Covid vax mandates are a symptom of vacuous policy and near-zero critical thinking. It's not a place where you'll grow.
Almost one week later and we’re still at 75 colleges mandating COVID vaccines for healthy young adults that have already had the virus and fully recovered.
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CDC's own slides paint a different picture. There are some who wish for you to live in fear and deliberately distort the data so you feel compelled to vax, even if your child has natural immunity by now.
Great figure by
@jeremyfaust
says it all
COVID is a far greater threat to kids than flu is
And you know what dramatically lowers risk and keeps kids out of the hospital?
Vaccines
If your kid 5 or older isn't vaccinated, its time
Full article:
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💯Have nothing to add to this bad AD other than...Bravo
@VPrasadMDMPH
👇👇
Normalizing vaccine induced myocarditis is not good medicine nor public health, by
@VPrasadMDMPH
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Symptom severity, loneliness, poor physical activity linked to LC symptoms.
Need to recognize that we've put kids in a state of hyper-body-vigilance.
🚨Bombshell: New Study on Long COVID in kids and young adults FAILS to link COVID to Long COVID
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Summer camp requiring booster?
@urgencyofnormal
team wrote a letter seeking end of vaccine mandates.
Links and data here for your letter to camp directors.
👇👇👇
You are not alone, but mandates will only end if parents speak up and refuse to comply.
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Must read 👇👇
@TracyBethHoeg
explains how the Florida cardiac death study fits with current scientific inquiries into excess risk for young males post mRNA vac.
A Level-Headed Look at The Florida Vaccine Study
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@VPrasadMDMPH
Looks like
@MonicaGandhi9
vindicated. T cells and memory B cells for the win in those <49.
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For parents who have kids dx with ADHD -
this was interesting. 75% of kids are started on meds without any parent coaching on behavior training.
New research suggests that all kids should be started with parent behavior training (PBT) first.
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I'm still a woman, just not a girlie one. That's ok! Please try to accept yourself for the incredible and unique person you are TODAY, and the person you will develop into over TIME. Avoid making permanent changes. There's no backspace you can hit to delete surgery, drugs.
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If you care about quality, and wish you were better at appraising evidence, read this critique.
@VPrasadMDMPH
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💯
@kerpen
Cornell mandating primary series.
I believe 2 things must change:
1. CDC must come clean - there is no evidence for vax at this point for <50 (like EU doing)
2. Admins at colleges must process their nobility, sense of duty during time of need...and move on...it's…
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Why punish a kid for something his parents did?
And why is going to a concert punishable?
What am I missing?
Just kicked a player off my youth football team because I found out his parents went to a Taylor Swift concert
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I know folks might tire of me talking about myocarditis, but getting tired of hearing about this does not make the risk go away. IF your organization is requiring vaccination and does not allow exemption for those with prior covid, you are treating males and females differently.
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Epidemiologists have a nose for bias. They sniff it out, identify the direction it pushes results, acknowledge it, and move on toward truth. But on Twitter, you're signal-boosted for over-confidence. That's bias, folks. Real scientists are not adamant.
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Changing my body didn't solve the underlying crisis of confidence, self image. I still struggle with these things, but I have gained tools to manage.
The answer is time, not puberty blockers or surgery. These change the body but not the person.
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To handle the toxicity of this environment, it is tempting to join a tribe. But if you do, then you lose that critical impartiality so vital to the pursuit of real science. Real inquiry does not seek the win, it seeks truth.
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@sarahbeth345
Dems in power are oblivious to the progressives they are losing. First-gen progressives are particularly closeted, betrayed by the party they thought was tolerant and inclusive, they must acknowledge that their conservative Rep family mbrs were right on some things all along.
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@tnicholsmd
@DrJBhattacharya
@GovRonDeSantis
100% pro vac. I speak to people at gas stations and grocery stores. I specifically try to reach those who have not been vaccinated yet. I listen to their concerns and provide specific information to answer their objections. One can be pro vac, pro safety, anti mandate.
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Teens: Sometimes it takes TIME for the world to catch up to the incredible person you are! If I met you, I am sure I would tell you this: "I love you for precisely who you are right now, and the person you will become. Be patient. The world will catch up."
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Time to accept:
- vaccines for highest risk age 40+ and health conditions we've known for 20 months
- immunity from prior infection for those who have already survived
- vaccines, masks for anyone who desires
- continue doing our best to treat ALL who become ill
🙏
Something is deeply broken with your COVID policy if the more vaccine doses you get in your arm, the more layers of mask you wear, and the more restrictions you face
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I personally think it is well past time to have open conversations about how much we're reaching for medications to manage through life vs old-school time in nature, reflection, self-awareness, spirituality, connections with other humans, adult role models, sports, exercise, ...
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Long COVID was predicted to bring “an ocean of patients with titanic needs.” That’s not what’s happened.
Good article. Surveys the development of the literature.
h/t
@MrsPitbull
via
@slate
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I am one of them. As a result, I'm questioning it ALL, not just COVID-era polices. All of it. The pandemic only highlighted the existing biases.
"Federal officials used pliant news outlets and social media to declare anything that diverged from CDC diktats to be “misinformation.” The result, and Walensky’s true legacy, is that many Americans came to distrust the CDC’s guidance." by
@CarlSchramm
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CDC could have remedied bad messaging in June '21. This thread worth reading. Every word applies to primary series today, even more so due to background of natural immunity.
@VPrasadMDMPH
@rfsquared
@venkmurthy
Amy Beck
The CDC made 5 MISTAKES in it's analysis of myocarditis risk and benefit for young adults, and this is a big deal
Allow me to detail them for you
[thread]
Our OP-ED now out!
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"He said vaccinated people are overestimating the danger that Covid poses to them. He recalled younger vaccinated people telling him they aren't comfortable dining inside restaurants yet.
'I just think that the risk perception here is way off,' he said."
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This is why vaccine mandates which do not consider individual health status and prior infection are unethical👇👇
Sharff et al used advanced search tools and report estimate in line with other international databases.
No surprise that publications like Chu, who actively looked for
#myocarditis
in a study-setting or Sharff, who at least actively searched patients' medical files find much higher incidences which without doubt are closer to the true values...
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I uninstalled Twitter from my phone because the toxicity was getting in the way of science. It was causing anxiety and distraction.
I care about real science, not winning. I can accept being wrong, because what matters most to me is truth. I admire those who question.
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Have to say - agree here. Army, Navy - firing people with immunity from prior infection (but not vax) is not a smart move. With 1+ dose, they have the best protection nature offers. Still...you let them go.
The Bias of Experience, by
@VPrasadMDMPH
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Always a good feeling when you wake up with the same concerns as
@VPrasadMDMPH
🤣💪- gonna take a listen while running. Extrapolations and exaggerations are on my mind as well.
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They question, they seek collaboration, they go to sleep at night with a new question to ask the next day. They are NEVER DONE. The truth is what matters. Not winning.
On Twitter...the win matters for many.
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All universities with a vaccine mandate should read this letter before coercing students to get a COVID vaccine. Recent NEJM study shows effectiveness of natural immunity better against symptomatic Omicron than 3 doses. No rationale for mandates.
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Pronouns can be changed, bodies can be changed, but despair and disappointment will follow if the underlying crisis of self-acceptance isn't addressed. Gender is a continuum. You don't need to change your sex to match your sense of self, identity.
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Friends, I didn't think this could be true but I'm beginning to believe it is quite possible. I was patient during the pandemic, giving people the benefit of the doubt, assuming they meant well. This is no longer the right course of action. People mean what they're doing and if…
What's happening in our states and from our college campuses is a Marxist Cultural Revolution modeled after Mao's. It is being executed through the Democratic Party, which is increasingly proving itself to be a traitorous mafia.
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2. Vaccines are life-saving, but every intervention has potential to harm. Sometimes acting causes a harm, sometimes not acting. These are complex decisions, and no one should be shamed for thinking through a vaccine decision carefully.
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@anish_koka
Thank you so much for weighing in, Anish. The sad thing for me is these kids are almost always healthy, no comorbidities. CDC should have been more strategic about vaccine recommendations given the possibility of harm > benefit in some.
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Important commentary on vaccine mandates for teens. 👇There's plenty of room for conversation about individualized protection through vaccination, but not the way this mandate is written. US policy again out of step with other nations.
@VPrasadMDMPH
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Brilliant rhetorical analysis. 👇👇👇
The media is so out of touch. I have to wonder if anyone else is cancelling their subscriptions? I've stopped subscribing to 4 outlets. It's not even about the money. It's a matter of principle.
A study in media framing
As of July 20, 2.8% of kids <5 had received at least one dose of the Covid vaccine
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New research letter from Portugal adds to our growing understanding of protection from prior infection.
Portugal highly vax (98% 2+ doses).
People with prior inf had better protection against inf with Omi BA.5 than those w/o prior inf.
Study did not meas severe dis/death.
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Covid risk is shaped like a 🏒 hockey stick. Flip it over for vax myo risk. This issue matters.
Universities, consulting firms, gyms, etc should not be mandating this vaccine - personalized medicine is possible. We have the data.
Shout out to
@walidgellad
in the vid!
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Bob, have you done the math? Show me before I even think about a booster. And show me for 16-24 yr olds.
e) Should you still get a booster? Absolutely – if you HAVE been infected, hybrid (infection+vax) immunity is surely better than either alone, & vax has nearly zero risk. Each infection carries some risk of a severe case, risk of infecting others, & risk of Long Covid... (6/7)
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@EvanDonovan
@GovRonDeSantis
@WFLA
I would have liked to see a conversation beforehand off cam talking over the fact that they have a choice, give them the data directly, and let them decide. The way this appeared to go down was similarly theatrical, putting students in the crossfire. Imbalance of power. My $0.02
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Very proud of our team and this extended essay discussing why vaccine mandates are unethical. Below is our reply to a letter published in response. It's now open access - thank you BMJ Journal of Medical Ethics.
Finally, not unrelated, here is our (now open access) recently-written rebuttal about why college covid booster mandates are & always were unethical.
w/
@KrugAlli
@sdbaral
@ID_ethics
@s_keshavjee
@TrudoLemmens
@VPrasadMDMPH
@MartyMakary
&
@KevinBardosh
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More than 1000 colleges mandate vaccination (primary series) as well as 300 which require a booster.
These colleges are mandating a medical intervention for students - 80% of whom have already recovered from covid. CDC has not updated its risk-benefit analysis for Omicron.
There are currently more than 300 colleges that mandate vaccine boosters.
Some are considering requiring a fourth dose.
While well-intended, these policies might cause more harm than good, argue
@LeslieBienen
,
@KrugAlli
, and
@shvetaraju
.
1/4
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@kate_freedomer
@NewsatSMES
@SMECAtlanta
I shared this with my boys on the way to school this morning. Immediate reactions, not edited:
"That's just cruelty." (13 yo)
"Clearly, cardboard up at lunch is not the only thing wrong at that school. It's a symptom of other issues." (16 yo)
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🎯 Careful and transparent analysis of who benefits from booster vaccination necessary to restore trust in recommendations.
cc
@KevinBardosh
@ShiraDoronMD
@TracyBethHoeg
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New JAMA paper showing hosp rates in vax, vax+boost and unvax. A couple thoughts beyond the headline finding (10x reduction in hosp among vax). Short 🧵
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@crabb_vicki
I've spent over an hour listening to what
@TheEliKlein
has to say while running, and every word made sense. In fact, an outside perspective is a good reality check. Science and medicine should make some sense?
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The marginal benefit is almost unmeasurable.
But why?
Young kids have many seasonal coronavirus infections, lining their mucosa with cross-reacting SIgA. A study in Japan of pre-pandemic saliva samples found adults with protective Abs. Higher levels assoc with younger age.
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Here's to a great summer, teens. Build yourself up every day, drop the self-doubt, and plan your future. Your body is resilient and beautifully formed. Trust it.
💞💞
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What happens when cases go up?
Well articulated review of...the truth.
If there had been more of this throughout the pandemic, we might have more seniors vaccinated by now and fewer rules for kids.
@VPrasadMDMPH
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Some SUNY schools have wisely dropped the booster requirement for students. I imagine this change applies to all SUNY schools, so did some simply forget to update the website?
SUNY Oneonta (L), SUNY Brockport (R).
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I respect
@EricTopol
but his substack rips Dr. Offit and fails to appreciate his larger point - why push boosters on young healthy people? There is no data.
Also - this graph looks like healthy vaccinee bias? The two groups look substantially different diverging on day zero.
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Absolutely incredible...a great win.
🔥🔥"Never give up."🔥🔥
Some great news for Jesse (Without Papers Pizza) all charges dropped. He lost his family pizza business because he decided that all everyone including unvaccinated people should be able to be served food during the segregation passport system days.
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