Three Things Thursday

Vaccines, variants, and so much talk about colonoscopies

Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is indeed a radical selfless act of loving others (read: we need to redefine what it means to be healthy), “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week.

Hoping these posts help to educate and empower you
to be healthy and create healthy communities.

Here we go… Three Things Thursday for October 13, 2022.

Bivalent COVID Boosters Approved for Kids 5-11 Years

Yesterday the FDA and CDC approved the bivalent COVID booster shot for children between the ages of 5-11 (prior to yesterday only individuals 12 years of age and older were eligible for the new bivalent booster). Like the previous versions of the COVID vaccines (made with the genetic material from the original SARS-CoV-2 strain),
the new bivalent booster is safe and effective.

And just so we are all clear — effective means that the vaccines provide protection against severe disease and death.

Children ages 6 and older can receive the Moderna boost. The Pfizer boost is available to kids ages 5 and older. The booster dose is available to kids who received their most recent COVID vaccination at least two months ago. However, it is highly recommended that individuals wait at least three months from their last shot or a previous diagnosis of COVID before getting the booster.

In light of emerging new variants, an uptick in cases in Europe, and the winter months (with indoor gatherings and influenza season) upon us, getting vaccinated has never been more critical.

BQ.1.1 Subvariant

The highly contagious and immune-evasive BQ.1.1 subvariant of the SARS-CoV-2 virus (with three mutations on the spike protein) is spreading worldwide. In the UK, cases of the BQ.1.1 subvariant are doubling every week. In the US, where the BA.5 subvariant is the most common, the BQ.1.1 subvariant is spreading faster than other subvariants (like BA.2.75.2) that we are watching with great interest/concern.

Why are the public health and medical communities concerned?
In addition to easily and quickly spreading from person to person (meaning BQ.1.1 is wicked contagious), treatments, including antibody therapies like Evusheld, are NOT responding to infections caused by BQ.1.1. This means we have lost effective tools to treat individuals who are suffering from COVID. As a result, disease modelers are beginning to wonder if a new wave of COVID hospitalizations and deaths is in our future.

What can we do?
Get vaccinated. The COVID vaccines, in particular the new bivalent booster, are effective at preventing severe disease and death caused by the BQ.1.1 subvariant. In the absence (or dwindling number) of treatment options, we must prevent severe disease and death. This can be done through vaccination.

The Colonoscopy Study Everyone Is Talking About

(In a much-needed break from COVID) Colonoscopies have been in the news a lot this week. This is the result of a new study published in the New England Journal of Medicine. The results of the study have been interpreted by some as casting doubt on the use of a colonoscopy in preventing colorectal cancer. Bloomberg published an article summarizing the study with the headline —

“Screening Procedure Fails to Prevent Colon Cancer Deaths in Large Study.”

[Important facts: colorectal cancer is one of the leading causes of cancer mortality in the US. And colonoscopies are (thought to be?) essential because colon cancer is highly treatable when it is found early.

Previous research suggests that colonoscopies reduce deaths from colorectal cancer by 60 to 70 percent. The study published this week found only an 18% reduction in colorectal cancer among thousands of men and women in Europe who were 'invited' to get a colonoscopy. And the new research found the reduction in deaths from colorectal cancer was too small to be considered statistically significant.

This is not good news.

HOWEVER — there are important limitations to the new study that need to be considered. Most importantly, more than half of the research participants who were 'invited' to get a colonoscopy never showed up for their colonoscopy. I think it is safe to say — we cannot conclude that the colonoscopy did not prevent cancer when a colonoscopy was not performed. When a deep dive into the results among those who did show up for a colonoscopy was completed, the researchers found the risk of developing colon cancer decreased by about 31%. Deaths decreased by a significant proportion — ~50%.

Dr. William Dahut, the Chief Scientific Officer at the American Cancer Society noted:

"It's hard to know the value of a screening test when the majority of people in the study didn't get it done.”

It is likely that the study is getting so much attention because it challenges commonly held assumptions about just how protective colonoscopies can be. It is unlikely that the findings of this one study will lead to changes in U.S. screening recommendations. In fact, the American Cancer Society stresses that —

“Preventive cancer screenings are the best and most trusted way to save lives.”

All adults 45 years of age or older should be screened for colorectal cancer.

The events/news of this past week surrounding the colonoscopy study should remind all of us that we cannot make health decisions based on a single headline. As we navigate new health information, we must remember that the medical/health sciences are narrative. While there is a beginning, middle, and end to each of the research articles that are published, each article also builds on the other. In the introduction to a scientific paper, the authors are required to summarize the previous findings in other studies and clearly state how their study is both unique and how it is situated in the canon/history of existing research (on average, epidemiology papers cite/reference at least 25 previous studies in the introduction section). The canon of medical/health research also includes in-depth discussions and acknowledgment of the limitations and biases that were part of each study (and potentially a body of research).

We cannot make decisions based on a single research finding. Instead, we must work like detectives to unearth the preponderance of the evidence. From this, we can construct a risk-benefit analysis. And from that analysis, policies and guidance can be created to improve the health of individuals and communities.

I also recommend finding trusted sources of information. The internet can be a dark place and finding up-to-date and reliable summaries of research can be hard. Sifting through 1000s upon 1000s of articles in a multidecade history of research is a full-time job, and reading the entire history will not provide you with the information you need to get reliable answers to questions that you have. Start reading (sign up for their daily newsletter) STAT News. Follow Helen Branswell! Subscribe to get updates from me here!

Ask questions and engage in dialog. I think we all need to step away from Facebook, Twitter, and the Google search engine (and maybe even the TV news). It is time to ask questions — take them to your physician. Find a local epidemiologist. Ask this epidemiologist mama (of two kiddos) your questions. Acknowledge what you know and don’t know. And engage in a conversation (not internet research or arguing).

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On a personal note — it is birthday week at our house; both kids have birthdays this week. As part of the celebration, we held a “cookies & cream ice cream taste test” at our house over the weekend. We tried lots of ice cream! Breyer’s cookies and cream is definitely the best traditional cookies and cream. Ben & Jerry’s is the best ice cream overall. Hands down. The chocolate “milk & cookies” was amazing.

we conducted a taste test of all of the brands of cookies and cream ice cream. After a blind taste test, it was determined that Breyer’s cookies and cream is the best traditional version of cookies and cream. However, Ben & Jerry’s chocolate milk and cookies ice cream was the best overall.

Have a question? About public health or ice cream?!?!