Two studies, one of seniors and the other of all ages, show Covid bivalent booster shots very effective at preventing severe disease

Katelyn Jetelina, right, interviews the CDC's Dr. Ruth Link-Gelles about boosters.

By Katelyn Jetelina

Your Local Epidemiologist

We got an early holiday present. One of the last puzzle pieces about the fall Covid-19 boosters was released today: data on the effectiveness against severe disease. We have nine lab studies and one real-world study showing the fall boosters provide:

• Greater protection against infection and transmission, by boosting our first line of defense—neutralizing antibodies. (See my previous updates here.)
• Broader protection, or the ability to create antibodies that “see” more virus parts and “attach” more strongly compared to the antibodies we have right now. (See my previous updates on this here.)
• Longer protection against infection and severe disease, even just by a few months. We are still at the mercy of time for this, but have promising data from the Beta bivalent vaccine clinical trials.

Until now, we didn’t know whether they provided additional protection against severe disease and hospitalization. We now have three real world analyses, and things are looking good.

The CDC released studies answering the same question from two different perspectives. The first study , in 22 large hospitals in 18 states, found that among patients 65 and older with no Covid-19 vaccination, effectiveness of the fall booster against hospitalization was 84%; among who had received mRNA vaccines, effectiveness was 73%.

The second study, at nine hospitals in 11 states, looked at emergency room and urgent care visits (a proxy for more severe disease) for patients of all ages. It found that among people with no vaccination, effectiveness of the fall booster against emergency room or urgent-care visits was 56%. Among the vaccinated, effectiveness was less with more recent vaccination (reflecting the fact that vaccine protection wanes over time). If someone got their last mRNA shot two to four months ago, effectiveness was 31%. If the last dose was more than a year ago, effectiveness was 50%.

Dr. Ruth Link-Gelles, program lead of Covid-19 vaccine effectiveness at the CDC, told me, "These vaccines provide pretty substantial additional protection, especially if it's been a long time since you got you last monovalent dose." But we still don't know how long protection will last, so studies will continue.

Bottom line: The fall boosters work. There is now evidence fall boosters broaden protection, help against infection, protect against severe disease, and (we think and hope) provide longer protection. There is one major problem though: more than 150 million people are eligible for a fall booster in the U.S. and have yet to get one.

Link-Gelles blamed that on Covid fatigue and people seeing fewer hospitalizations and deaths from the disease, but she said now is good time to get boosted because of holiday gatherings, especially with grandparents, who are more vulnerable. She said 28 million Americans over 65 have not gotten a booster.

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How to not pick up pounds during the holidays, and how to eat in general: Consume more in the morning, less in the evening

By Michael Crupain, Michael Crozien and Ted Spiker
National Geographic

Heading into the winter holidays, 'tis the time for eating — and plenty of it. But food can affect your body differently throughout the day, so let’s take a closer look at that internal timepiece.

Understanding your biological clock is the key to shifting your body to optimal function. The biological clock is your body’s automated energy conservation system, influencing behavior on a cellular level from sunset to sunset.

Some people live in opposition to their bodies’ natural instincts — and this is an important example of how food plays a role in the rhythm of life. About 15 million workers in the United States have shift jobs; they work nights and sleep during the day. Studies examining the health of these populations find that they have increased rates of both sleep issues and obesity. People who work the night shift tend to gain more weight than people with normal nine-to-five schedules.

Although we don’t completely understand the cause, the main suspect behind the disturbances in the health and metabolism of shift workers is that they are fighting their natural circadian rhythms — and their body’s instinctual notions of when to eat.

Our body clock and our food clock have a natural tension point: We crave food at night, but we function better when we eat earlier. Research has shown that in the absence of normal light and time cues, people are naturally the hungriest around the time that would correspond to 8 p.m. and least hungry at the time that would correspond to 8 a.m.

That basic instinct was an advantage in the early days of human existence, but in modern times it may be hurting us. One of the body’s most important hormones for dealing with food is insulin, which regulates the amount of glucose in the blood.

The body’s secretion of and response to insulin follows a circadian rhythm. Studies suggest that sensitivity to insulin is highest during active phases (when we are awake) and most insulin resistant during their typical sleeping hours. Mealtime has a big effect on what happens to your blood-sugar levels; if you eat the same meal in the morning and at night, your blood sugar will increase more in the evening than in the morning.

Fat cells also appear the most insulin sensitive early in the day, with a peak at noon; they are about 50 percent more sensitive midday than they are at midnight. This means that your body is primed to eat at certain times. In fact, eating at the “wrong” time can throw off everything. One study found that those who ate lunch earlier lost more weight than those who ate later. A related study found that those who ate later burned less energy.

Research has shown that our body’s natural rhythm is to want food later, even though it has a negative effect on our overall health. Why are our body’s food cravings out of sync with our circadian rhythm? During periods when we didn’t know when our next meals would come, the human body may have evolved the need for a food-storage mechanism. In that era, humans didn’t live long enough to experience the harms of late-night eating—and in any case, the body only cared about surviving the next day, not the next decade.

Today, we no longer need that extensive storage ability because food is plentiful. We have to consciously override our ancient instincts and make smart choices about when to eat—and that means more in the morning, less later on.

This excerpt is adapted from What to Eat When: A Strategic Plan to Improve Your Health and Life Through Food, originally published by National Geographic Partners, LLC, on December 31, 2018. Copyright © 2019 Michael F. Roizen and Michael Crupain. Compilation copyright © 2021 National Geographic Partners, LLC. All rights reserved.

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Federal audits reveal widespread overcharges, other errors in Medicare Advantage plans; Humana and United stand out

Illustration by Eric Harkleroad, Kaiser Health News, from federal Medicare data

By Fred Schulte and Holly K. Hacker
Kaiser Health News

Recently released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average.

Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by Kaiser Health News through a three-year Freedom of Information Act lawsuit, which was settled in late September.

A review of the audits reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

UnitedHealthcare and Louisville-based Humana, the two biggest Advantage insurers, accounted for 26 of the 90 contract audits over the three years.

Eight audits of United plans found overpayments, while seven others found the government had underpaid. Humana's 11 audits with overpayments included plans in Florida and Puerto Rico that CMS had audited twice in three years.

The Florida Humana plan also was the target of an unrelated audit in 2021 by the Department of Health and Human Services inspector general. That audit, which covered billings in 2015, concluded Humana improperly collected nearly $200 million by overstating how sick some patients in its Medicare Advantage plans were. Officials have yet to recoup any of that money, either.

In an email, Humana spokesperson Jahna Lindsay-Jones called the audit findings "preliminary" and noted they were based on a sampling of 2015 claims.

"While we continue to have substantive concerns with how CMS audits are conducted, Humana remains committed to working closely with regulators to improve the Medicare Advantage program in ways that increase seniors' access to high-quality, lower cost care," Lindsay-Jones wrote.

Medicare Advantage is an alternative to original Medicare and is primarily run by major insurance companies. As it has gained popularity among seniors, CMS has fought to keep its audit procedures, and the mounting losses to the government, largely under wraps. That approach has frustrated both the industry, which has blasted the audit process as "fatally flawed" and hopes to torpedo it, and Medicare advocates, who worry some insurers are getting away with ripping off the government.

Insurers can have some claims excluded from the audit by claiming hardship, such as the closure of clinics where the services were rendered. Hardship requests and other documents obtained by KHN in the lawsuit shed light on the secretive audit process.

Reacting to the audit findings, Iowa Sen. Chuck Grassley called for “aggressive oversight” to recoup overcharges. Grassley is the top Republican on the Senate Finance Committee, which oversees health insurance. He said, “CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments.”

How Medicare Advantage works

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify patients' conditions. Only about 5% of Advantage plans are audited each year.

When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes, or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.

Overall, CMS auditors flagged diagnostic billing codes — which show what patients were treated for — as invalid more than 8,600 times. The audits covered records for 18,090 patients over three years.

In many cases, auditors found that the medical credentials of the health-care provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether.

The rates of billing codes rejected by auditors varied widely across the 90 audits. Seven health plans had fewer than 10% of their codes flagged, but the rate of invalid codes topped 80% at a defunct New York HMO.

One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six. In three cases, the health plans said the records were destroyed in floods. Another cited a warehouse fire, and two said the records couldn’t be turned over because a doctor had been convicted for his role in illegally distributing millions of oxycodone pills through his network of pain clinics.

Other Medicare Advantage health plans said they had no luck retrieving medical records from doctors who had moved, retired, or died — and in some cases been arrested or lost their licenses for misconduct.

CMS found most excuses wanting, telling health plans that it granted exceptions only in “truly extraordinary circumstances.” CMS said it receives about 100 of these requests for each year it audits and approves about 20% of them.

Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.”

Protecting Taxpayers

The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans in the 2011-13 audits at $650 million, but how much it will eventually claw back remains unclear.

Payment errors continue to be a drain on the program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses in 2022 at $11.4 billion.

“This isn’t a partisan issue,” said Sen. Sherrod Brown (D-Ohio). “I’ve requested a plan from CMS as to how they plan to recoup these taxpayer-funded overpayments and prevent future overbilling.”

Leslie Gordon, acting director of health care for the Government Accountability Office, the auditing arm of Congress, said CMS needs to speed up the audit and appeals process to get quicker results.

“That is money that should be recovered,” Gordon told Kaiser Health News.

As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should.

America's Health Insurance Plans, an insurance industry lobby, criticized Kaiser’s reporting on the newly released audits as “misleading,” while the pro-industry group Better Medicare Alliance said the audits were “in some cases, more than a decade old.”

Jeff De Los Reyes, a senior vice president at the GHG Advisors health-care consulting group, said he believes the health plans have improved their documentation in recent years. But, he said, “Coding is never 100% perfect and there will be errors despite the best of intentions.”

Rep. Katie Porter, a Democrat from Southern California and a critic of Medicare Advantage, countered: “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with policy pnalysis and polling, KHN is one of the three major operating programs of the Kaiser Family Foundation, an endowed nonprofit organization providing information on health issues to the nation.

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58% of Kentucky adults say the pandemic is over for them, and resistance among the unvaccinated to getting a shot is increasing

By Melissa Patrick
Kentucky Health News

Four in seven Kentucky adults (57%) think the pandemic is over in the state and more than 80% say concerns about Covid-19 will not keep them from attending or hosting gatherings during the holiday season, according to a Foundation for a Healthy Kentucky poll taken from Oct. 29 to Dec. 4. 

"Kentuckians are, I think as a general matter, determined that this pandemic is over," Ben Chandler, president and CEO of the foundation, said Tuesday. "They're going to behave like it for the most part during the holidays."

Chandler that's appropriate, if people are up-to-date on their Covid-19 and flu vaccinations, keeping their hands washed and staying home when they are sick. But the poll found that resistance among unvaccinated Kentuckians to getting vaccinated to protect them from the disease continues to increase.

Foundation for a Healthy Kentucky graph; click on it to enlarge.

The poll found that 59% of Kentucky adults said it is "not likely at all" that Covid-19 will prevent them from attending or hosting a small gathering with friends and family this holiday season and 22% said it is "not too likely" that Covid-19 will impact this decision. Only 4.4% said it is "very likely" and 12.5% said it is "somewhat likely" that Covid-19 will affect their decision to gather with others over the holidays. 

Being vaccinated didn't seem to matter when making the decision to attend or host a small holiday gathering, as 73% of those who were vaccinated with at least one booster, 86% of those who were  vaccinated with no boosters and 91% of those who were not vaccinated said they were either not likely at all or not too likely to let Covid-19 impact their decision to attend or host a small holiday gathering

Further, the poll found that more men (69%) than women (50.2%) said they were not likely at all to let Covid-19 prevent them attending or hosting a small holiday gathering.

Hanukkah begins Sunday, Dec. 18; Christmas is Sunday, Dec. 25, and Kwanzaa starts Dec. 26.

The poll was the latest edition of the Vaccines in Kentucky Poll, which the foundation has sponsored four times since February 2021.When asked if they thought the pandemic was over in Kentucky, 41.5% of the respondents said it was. That was an increase over the summer, when 31.7% said it was. 

The share of Kentucky adults who said the pandemic was not over decreased to 56.6% in the latest poll, down from 65.4% in the summer. 

And when asked if the pandemic was over as it pertains to their own lives, 58.1% of the respondents said it was, up from 53.3% in the summer poll. This rate was highest among Kentucky adults who were not vaccinated (80.1%), followed by those vaccinated but not boosted ( 61%) and those vaccinated with at least one booster (42.2%).  

Foundation for a Healthy Kentucky graph; click on it to enlarge.

The poll also found that nearly three-quarters of vaccinated Kentuckians (73%) were either "very likely" or "somewhat likely" to get an annual Covid-19 booster if that were recommended like annual flu shots are.

The groups of vaccinated Kentuckians most resistant to getting an annual Covid-19 booster in the future were those who live in suburban counties (37%) and those between the ages of 30 and 45 (39.5%), either saying they were either "not too likely" or "not likely at all" to receive an annual booster. 

In rural and urban counties, about 75% of Kentucky adults in these areas said they would be very or somewhat likely to get a booster if recommended.

Foundation for a Healthy Kentucky graph; click on it to enlarge.

Since the first Vaccines in Kentucky Poll was taken in February 2021, an increasing share of Kentucky adults have said that getting vaccinated is a personal choice, rather than part of everyone's responsibility to protect the health of others. That view rose to 65% in the latest poll, marginally more than the 63% found this summer. In February 2021, shortly after vaccines became available, polling showed a nearly even split on the question. (Each number in the statewide sample has an error margin of plus or minus 3.4 percentage points.)

The belief that vaccination is a personal choice is greatest among rural Kentuckians, with 72% of them saying they agree with that statement and 27% of them saying getting vaccinated is everyone's responsibility to protect the health of others. In suburbs, the numbers were 66% and 32%, respectively; in cities, they were 57.5% and 41.8%. 

The latest poll also found that the number of unvaccinated people in Kentucky who said they will "definitely not get the vaccine" has increased to 75.2% in the latest poll, up from 63.5% in the summer. 

The poll, which was funded by the foundation, was conducted by the University of Cincinnati's Institute for Policy Research. It surveyed a random sample of 855 Kentucky adults via landline and cell phones.

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New cases of the flu outnumber new cases of the coronavirus in Kentucky, but deaths from Covid-19 went back up last week

Centers for Disease Control and Prevention map, adapted by Kentucky Health News

By Melissa Patrick and Al Cross
Kentucky Health News

Newly confirmed cases of influenza are outpacing new cases of the coronavirus in Kentucky, and the state is among the national leaders in new flu cases. Meanwhile, though, deaths from Covid-19 are going up.

The Centers for Disease Control and Prevention has Kentucky, 10 other states and the District of Columbia in the “very high” category of flu-like illnesses. That's based on reports for the week ending Dec. 3, when Kentucky had at least 7,192 new cases. The previous figure was 6,398. The CDC says "at least" because unlike Covid-19, flu cases do not have to be reported to health authorities.

In the week ended Sunday, Dec. 11, the state Department for Public Health reported 5,214 new coronavirus cases, an average of nearly 745 per day. That's 9% lower than the week before, when the state was averaging 821 new cases per day. Of last week's cases, 14.5% were in people 18 and younger.

The state attributed 51 more deaths to Covid-19, up from 28 the week before and higher than a month of weekly reports before that, which showed an average of 45 deaths per week. Kentucky's pandemic death toll totals 17,580. 

The flu has killed at least 29 Kentuckians this season. The Lexington-Fayette County Health Department reported Dec. 7 that six were in its jurisdiction. “The flu is hitting hard in Lexington,” spokesman Kevin Hall said in an email. “There are already more total lab-reported cases in the first 9 weeks this season than in the previous three years combined.”

The state's weekly Covid-19 report shows that the share of Kentuckians testing positive for the coronavirus was 8.63%, up just a bit from 8.14% the week before. The figures do not include at-home tests. 

All said, it appears that when it comes to cases and positivity rates, Covid-19 Kentucky remains on a the rough plateau seen for about three months.. 

Covid-19 hospitalizations barely increased last week, after taking a big jump in the last one, and the number of severely ill patients went down. Hospitals reported 388 patients with Covid-19 Monday morning, an increase of five over the prior Monday; 45 were were in intensive care, down 14; and 19 were in need of mechanical ventilation, down 10. 

The weekly new-case incidence rate was 15.82 cases per 100,000 residents, down from 16.29 the week before. The top 10 counties were Bath, 38.9 cases per 100,000;  Powell, 33.5; Washington, 33.1; Leslie, 30.4; Calloway, 30; Hart, 29.3; Simpson, 27.7; Metcalfe, 27; Montgomery, 26.9; and Union, 26.8.

The New York Times ranks Kentucky's coronavirus incidence rate 20th among states, even with a 16% drop in cases in the last two weeks. 

Nationwide, the Times reports, "Conditions are worsening across the country, with reported cases and hospitalizations up more than 25 percent in the past two weeks and test positivity rates rising quickly."

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Number of Ky. counties with high and medium Covid-19 risk tick up a bit; Beshear says it's likely due to 'post-Thanksgiving bump'

CDC map, adapted by Ky. Health News

By Melissa Patrick
Kentucky Health News

The number of Kentucky counties with high and medium risk of Covid-19 transmission on the latest Centers for Disease Control and Prevention map released Thursday were about the same as the week before, when they were higher than they had been for a while. 

At his weekly news conference Thursday, which was held before the map was released, Gov. Andy Beshear said recent increases in counties with high and medium transmission risk in the previous map,, and the increase in cases on Monday's weekly state report, were likely due to a "post-Thanksgiving bump." He said the pandemic in Kentucky still appears to be on a general plateau, but he expects cases will tick up for a few weeks before they come back down. 

"Here's the good news, though: It is nowhere near what we saw after each of these holidays the last couple of years," Beshear said. "This means Covid has fundamentally changed and our highs are going to be a lot lower and that's a very good thing for all of us." 

The latest risk map, which looks at both cases and hospital data to determine risk of transmissions, shows 12 Kentucky counties at high risk, up from 10 the week before. High-risk counties, shown in orange, were in Western Kentucky except for Bourbon, Nicholas and Pike counties. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

Medium-risk counties, shown in yellow, numbered 44 this week, down from 48 on the previous map. These counties are found in several pockets across the state, mainly in the east and south. Again, barely a majority of the state's 120 counties (64) have a low risk of Covid-19 transmission, shown in green. 

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC also has a transmission-level map that shows the level of virus spread in each county, at one of four levels. It shows 13 Kentucky counties with a moderate level of transmission and the rest have either substantial or high levels of transmission. This data is largely used by researchers and health-care facilities.

State officials have encouraged Kentuckians to use the other CDC map to guide their preventive measures.

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Epidemiologist says the dreaded triple-demic is here, with RSV, flu and Covid-19 cases all rising together

Centers for Disease Control and Prevention map

With national rates of influenza, Covid-19 and respiratory syncytial virus rising together, the "dreaded and much anticipated triple-demic is finally here," epidemiologist Katelyn Jetelina writes in her newsletter, Your Local Epidemiologist. 

RSV is a common virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults.

The weekly Centers for Disease Control and Prevention influenza-like illness (ILI) surveillance, which includes a tally of patients that go to the doctor with a fever and a cough and/or a sore throat is a general indication of the climate of respiratory health in the United States. The report does not include laboratory-confirmed flu cases. 

The ILI map for the week ending Nov. 26 shows that every state but four have a high or a very high ILI activity level. The CDC puts Kentucky's ILI activity level among the very highest. 

Jetelina writes of the national map, "This level is truly unprecedented; we’ve never seen such high levels of ILI activity at this time of year."

Hospitalizations for respiratory illness are also on the rise. CDC Director Rochelle Walensky said Monday, “Hospitalizations are the highest now than they have been in the past decade.” 

In Kentucky, Covid-19 hospitalizations increased for the second week in a row, taking a big jump in this week's Covid-19 report. Hospitals reported 383 Covid-19 patients Monday morning, an increase of 102 over the prior Monday. That same report showed that nearly 80% of the state's inpatient beds and 81% of its intensive-care beds were occupied. 

Jetelina points out that while ILI surveillance offers an overall view of respiratory illness in the U.S, surveillance for specific diseases also exist, but is imperfect. 

RSV: CDC data shows that RSV continues to rise, although we may be seeing the first signs of peaking on a national level, Jetelina reports. She adds that this is expected given that the positivity rate for RSV tests have already clearly peaked. 

Flu: "Flu cases are increasing and increasing fast," Jetelina writes. She notes that flu hospitalizations are lagged, but increasing. "We expect hospitalizations to continue to rise in weeks to come," she writes. 

Kentucky's latest flu report shows that flu activity in Kentucky continues to rise. In the week ending Nov. 26, the state confirmed 6,378 cases of the flu, up from 3,470 the prior week. So far, the total number of confirmed cases during this flu season is 15,909. 

As Inside Medicine reported, for the first time during the pandemic, flu hospitalizations overtook Covid-19 hospitalizations last week. "This may be a one-off occurrence since Covid-19 hospitalizations are increasing now, too, but it is noteworthy," she writes. 

Jetelina adds that epidemiologist are hopeful that the U.S. flu season will follow what has happened in the Southern Hemisphere (Australia specifically) where there has been a high number of flu cases but a moderate level of hospitalizations. 

Covid-19: "Covid-19 is on the rise across the globe due to the combination of seasonal changes, behaviors changes, and the variant soup. In the U.S., all signs point to the beginning of a wave. For example, SARS-CoV-2 in wastewater is rapidly increasing across all regions," she writes. 

In Kentucky, the state Department for Public Health reported 5,751 new coronavirus cases last week, or an average of 821 per day. That's a nearly 49% jump over the week before, when the state reported 3,866 new cases. But that number that was 43% lower than the week before, indicating that Kentucky continues to be on a rough plateau. 

"One major concern is the rapid rise in hospitalizations among older adults, which has exponentially increased 28% in the past two weeks," Jetelina writes. "This is partly (or wholly) due to abysmal vaccination rates—only 1 in 3 adults over the age of 65+ have their fall Covid-19 booster. A public health failure. Without a recent booster, many people are technically vaccinated but not protected." 

Bottom line, she concludes, "This viral season is like no other. . . .  I’m especially concerned for hospital systems, kids under 5, and adults over the age of 65, as they are at highest risk." 

She adds, "There’s a lot we can do: mask, test before seeing loved ones, get that airflow moving, stay home when you’re sick. The least you can do for a healthy season is get a flu and fall Covid-19 booster. If you haven’t gotten one yet, it’s never too late." 

Jetelina is a California epidemiologist and biostatistician who says she writes the newsletter on Substack as a way to translate public-health science for everyday use, helping people to make evidence-based decisions. She is also a consultant to a number of organizations, including the CDC.

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