I was reading a random post recently, and came across a mention of ‘Wandel durch Handel‘, in the context of whether embargoes or increased trade are more likely to induce political change.
So, this is not a particularly innovative concept, being an obvious special case of the ‘how much do you engage/meet people where they are vs. set boundaries?’ question.
However, in a debate (or other timing-critical or adversarial conversation) context, you could see how there being a specific name for this specific incarnation of this concept, and your opponent being able to wield it, would lend them an advantage, as you are momentarily confused, perhaps unwilling to ask what they mean, or waiting for context so you could respond appropriately.
So, how do you deal with this? One common tactic is to basically ignore what the other speaker is saying, and focus on your prepared talking points. This can be useful in many contexts (not just political contexts), but (I think) a much stronger method is to be better read, to do all the research on the topic at hand.
For the specific case of ‘Wandel durch Handel’ (which I just noticed has a rhyme that kind of rolls off the tongue, at least the way I pronounce German), general knowledge on foreign policy, international trade, or even speaking German, would have made a significant difference to being able to react to the concept. With warning, one could do the specific research/briefing mentioned above, before the interaction with the hostile person.
There are of course many elements of privilege/class/etc. involved in this conversation, not the least of which is “You don’t even know ‘X’?!? You must be uneducated!” All I can say is that there are people with different levels of rhetorical ability and expertise (and ‘expertise’) on all topics, and the Internet is a great help to level the playing field.
 “Wandel durch Handel (WdH, German for “Change through trade”), also known as Wandel durch Annäherung, is a term referring to a political and economic notion, mostly associated with German foreign policy, of increasing trade with authoritarian regimes in an effort to induce political change.”
 And also an obvious corollary to the concept of embargoes.
 You can see how this is somewhat similar to a ‘Gish Gallop‘, where instead of deploying a large number of arguments of questionable strength, one’s opponent merely throws jargon.
 I don’t exaggerate *that* much when I say ‘all’. If a conversation/meeting/presentation is important enough, you can afford to spend a couple of hours on research, and you can probably make it through dozens if not scores of pages/documents on the topic, which should be enough (assuming you already have a general grounding in the subject), to be able to at least converse intelligently about the specific topic in question.
 I use the word ‘hostile’ in the sense of ‘opposed goals’, not necessarily that they would be emotionally hostile. They would just be uninterested in working with you on a solution, hence their use of obstructive or adversarial rhetorical techniques.
tl;dr: Get COVID as few times as you can. Getting COVID the second time is just as likely to kill or disable you as the first time. COVID killed more people in Canada in 2022 than 2020 or 2021, and is disabling many more in an ongoing way. Use masks and better-filtered air to get COVID as few times as you can, and if you do get it, rest up for as long as you can while recovering.
It’s now been more than three years years since COVID-19 entered the world stage, and it’s worth a few minutes to take stock of what we know, where we are, and what we should be doing next.
Acute symptoms vary widely, from respiratory such as cough, fever, shortness of breath, and congestion/sputum, to musculo-skeletal with muscle & joint pain, headache and fatigue, to gastro-intestinal with abdominal pain, vomiting and/or diarrhea. Neurological (separate from nasal congestion) loss of taste and smell is perhaps the most well-known distinctive COVID symptom, made famous by online reviews of scented candles.
These acute symptoms also include death, although the exact number is difficult to measure for a number of reasons. The official ‘Case Fatality Rate‘ is generally measured to be around 1%, for example by the John Hopkins dashboard. Taking estimated numbers of non-tested and asymptomatic individuals into account, the actual overall ‘Infection Fatality Rate’ is generally calculated to be between 0.5-1% for ‘wild type’ virus. This rate is modified by age, risk factors, variant of interest (Alpha/Delta/Omicron/XBB1.5/etc), and vaccination status.
The end to COVID may still not be in sight yet, but we now have a lot more information about how to protect ourselves from it, and maybe, just maybe lighten the load on our overloaded and buckling healthcare system. It is possible to get back to the low case counts of mid-2021, we just need to work together and make sensible decisions. Stay safe out there.
“The organ damage experienced by patients with long COVID appears durable, and long-term effects remain unknown.”
“Cognitive impairments in long COVID are debilitating, at the same magnitude as intoxication at the UK drink driving limit or 10 years of cognitive ageing73, and may increase over time, with one study finding occurrence in 16% of patients at 2 months after infection and 26% of patients at 12 months after infection74”
“Few people with long COVID demonstrate full recovery, with one study finding that 85% of patients who had symptoms 2 months after the initial infection reported symptoms 1 year after symptom onset143. Future prognosis is uncertain, although diagnoses of ME/CFS and dysautonomia are generally lifelong.”
“The findings highlight the clinical consequences of reinfection and emphasize the importance of preventing reinfection by SARS-CoV-2.”
Other references and links in-line
A final word from r/wallstreetbets and the Bureau of Labor Statistics:
 Reasons why the number of deaths from COVID is difficult to measure include undercounting for reasons such as due to delayed or incomplete reporting of deaths due to institutional overload, delayed annotation of cause of death, and the fact that ‘coroners’ are a profession with inconsistent regulations and training requirements. Overcounting can occur when a person would have died anyway, or COVID is counted as one of a group of causes of death for that person. For this reason, ‘excess deaths’ are typically used in case of pandemic or war.
 ‘Case Fatality Rate’ is generally measured as (# of deaths confirmed attributed to COVID)/(# of cases of COVID detected). Incorrect attribution of cause of death can move this number in either direction (although measuring ‘excess deaths’ can help), and reducing the level of testing can lead to this number being overstated (you can look at the ‘test positivity rate’ to get a sense of how under-tested the population is (or how bad the outbreak is)). ‘Case Fatality Rate’ is generally assumed to be an overstatement of the fatality rate, if there are a large number of undiagnosed cases in the population, which are taken into account in the probably more accurate ‘Infection Fatality Rate’.
Yesterday, I posted this article about a really cool Pre-Colonial Map of the Philippine Islands, made by a couple high school students (reddit link):
In my post, I mentioned that I collect historical atlases, and that my most common complaint was their lack of pre-colonial coverage. J said he wanted to hear about these atlases, so here you go!
I’ve always loved maps and geography; I had a Usborne children’s atlas when I was growing up, I remember learning about European (and world geography) from board games such as Diplomacy, Civilization, and Axis & Allies.
As I mentioned above, I had learned or noticed somewhere that all of these (along with our education in general) was very much from one euro-centric perspective, so when I was looking at historical atlases, I would always look for the one page on each of ‘pre-colonial Americas’ and ‘pre-colonial Sub-Saharan Africa’, and lament the paucity of information there.
Looking back, I know I’ve been collecting them for at least 20 years now, as I have acute memories of searching used book stores in St. Louis circa 2001-2 for atlases not written in English, so I could try to figure out the subject of each of the maps from context only. I remember them (both historical atlases and non-English atlases) being difficult to find at the time, there might be none or only one in each store, and I might already have that one (or it might be mostly copied from other atlases….more on that later!) The atlases that I’m going to list are the ones currently on my shelf. I know I’ve lost a few along the way, either to water damage or other reasons, but my shelf is still quite overflowing with them.
– “The Times Complete History of the World“: Probably the best and most comprehensive single historical atlas on the shelf. I’ve owned various versions of this atlas (or similar) over the years. This particular copy is the 8th edition, 2010, starting c. 5 million years ago with human origins. Great bathroom reading.
– “Atlas ofWorldHistory“, 1997. Looking at this one, I think I got it used much later than that, or at least I never really read it that much. I’m not sure why. It seems to be as comprehensive as the previous one (starting 4 million BCE, covering world civilizations as much as is generally done), but I think the slightly smaller pages and slightly less colourful maps might have dissuaded me (or perhaps I had already read my fill of others by the time I got this one). Looking at it with fresh eyes right now, it might have a fresh perspective, and better/more comprehensive views on non-European parts of the world, so you might want to take a look yourself.
– “The Historical Atlas of the World at War“, 2009: This is an interesting one, looking at world history (well, mostly the European canon) through the lens of warfare, from “Wars of Settlement and Cities”, to the “Iraq War” and “The War on Terror”. If you like red/blue battle diagrams and strategic ‘arrows and dates’ diagrams covering all the battles/wars you’ve heard of (and more), this may be the book for you.
– “The New Atlas of World History, Global events at a glance“, 2011: This is another odd one, with a very rigid structure. Every other two-page layout is a timeline page, with horizontal categories such as ‘politics & economy’, ‘religion & philosophy’, ‘science & technology’, and ‘arts & architecture’. The atlas tries to stick as closely as possible to regularly-spaced snapshots, long periods up until the advent of history/agriculture (~6000 BCE), every couple thousand or so years from then up until Bronze Age empires (1300 BCE), then every few hundred years or so from then until the fall of Rome (~500 CE), then every hundred years or so until 1492, then every 50 until the industrial revolution (1763), at which point things start to really accelerate. Looking at this one with fresh eyes, I remember that part of why I chose it was that the format of timeline:world map:timeline:world map forced the author to have something to say about all parts of the world in every snapshot, greatly increasing the coverage of areas outside the standard European canon. Similar to many others, this atlas has more to say about the first half of the 20th Century than the second half, perhaps because social change and a retreat from colonialism are not as interesting to people who like writing about warfare. Still a worthwhile addition.
We then skip over a few random D&D books, and a GURPS supplement to perhaps my favourite sci-fi series ever, to come to:
– “Encyclopedia of Classic Warfare: Battles throughout history from Megiddo to Waterloo“, 2011: Another one from the bargain bin ($20), it’s a “fully illustrated history of 170 key battles, campaigns, and wars from the ancient Egyptians to the end of the Napoleonic Wars.” It has pretty good world coverage, perhaps mostly limited by records than anything else. Each of the 170 are described in 1-3 pages of your standard ‘red vs. blue arrows’ maps, with maps to show location and key facts for context.
– “D-Day: The First 24 Hours“, 2003: The largest amphibious operation in history. It’s exactly what it says on the cover. It’s a bit much for me, it’s a lot more detail than I need about this (and it’s tiring to read about WWII), but it might have been where I first learned about Hobart’s Funnies.
Next, we have a couple of the other Usborne children’s books from my youth, perhaps my two favourites, followed by Scott McCloud’s excellent magnum opus ‘Understanding Comics’ which I would recommend to anyone, and its sequel, where he gives suggestions on how to solve some of the issues he raises in the first book.
– “Fighting Techniques of the Medieval World“, 2006: Just what it sounds like. 500-1500 CE, including a chapter on ‘Command and Control’. Looks like it may share some maps with the ‘Encyclopedia of Classic Warfare’ above, but it’s hard to tell because there are only so many ways to draw a ‘red vs. blue’ map, and the two books are quite different otherwise.
– “Journeys of Frodo“, 1981: Almost more of a travelogue than an atlas, this atlas has dozens of hand-drawn maps showing the day-by-day travels of the various members of the fellowship of the ring. I can’t help but think of ‘DM of the Rings‘, a re-imagining of the story if it were a D&D campaign in a world where no one knew Tolkien.
– “The Historical Atlas of Knights & Castles“, 2010: From ‘The Legacy of Rome’ to somewhere in the 14th-16th centuries, this atlas covers what it says on the cover. As you might expect from the cover, it’s covered from a perspective that one would expect from someone who uses the word ‘Christendom’. There is however a chapter on Samurai, as a nod to the rest of the world beyond the heathens and Mongol hordes.
A couple of books from my mis-spent youth in the biological sciences. Voet & Voet, even though it’s by now decades out of date, is still really comprehensive on a lot of things. I learned Biological Sequence Analysis from one of the authors on the eponymous book, ways of thinking that I probable still use today.
– “Transit Maps of the World“, 2015: A more recent addition to my collection. Includes a bunch of the history of this type of representational map. I’ve always loved looking at transit maps (one of my prize souvenirs from our honeymoon is a puzzle of a commuter rail map of Tokyo), and I’ve wanted to for a while do some mathematical analysis of them. Let me know if that’s something you’d like to see.
This may not look like much, but this is the type of graph that shows in a very succinct way the economic pressures that shape societal behaviour. You can see the effects of changes in technology, changes in infrastructure, and wars. This is the kind of data that’s super-difficult to assemble, requiring painstaking assembly from centuries-old records and invoices, and yet greatly increases our understanding of the pressures that people of the time were feeling when they made their decisions.
– “The Times History of Europe“, 2001: If you look closely, you’ll see that this atlas shares many maps from the ‘Times Atlas of World History’ above, but focuses more on Europe (Natch). Not much else to say. Pretty Euro-centric, and only has four pages for pre-900 BCE Europe, the same number allocated to ‘The Battle of Salamis’. It also has a strange construction, where it shows a two-page snapshot map from the end of a time period, followed by two pages of smaller maps from during that time period. Just odd choices all around.
We then skip over my collection of landmark genomics and protein structure papers, and end up with:
– “Battles that Changed History: Key battles that decided the fate of nations“, 2010: From Megiddo, “the first battle to have been recorded in a methodical manner”, through Salamis, Waterloo, all the way to ‘Iraqi Freedom’, this atlas says it shows ’45 of history’s most significant battles’. The battles are covered in detail, with 8-12 pages for each, many more than other surveys of this kind. There are interesting choices made, however. Half of the battles are after 1800, with four from the Napoleonic wars, and similar numbers from each of the U.S. Civil war and the two World Wars. However, there are only four in total, from all of world history from East of the Fertile Crescent, two of which are from the war in Vietnam. In depth summaries, and a bunch of interesting things to say, but very likely playing to a specific audience.
– “Atlas of Air Warfare“, 2009: “With more than 120 detailed aerial combat maps”. Also from teh bargain bin, this is an atlas that really wants to talk about airplanes. There are two pages of discussion of balloons and zeppelins before it gets right into planes. It does discuss the ongoing use of balloons for observation and other purposes along the way, though. Pretty comprehensive, if you’re interested in planes, or the third dimension in general.
Above the books, you see (from top to bottom), my ‘Optimus Prime’ wall hanging, the classic game ‘Titan‘, recently reprinted, and ‘Serenissima‘, a renaissance trading and conflict simulation that I bought because I was sad that Age of Renaissance was out of print. The strangely capped pool noodle to the left is from my ‘Nerf gun wedding’, and is my rendition of a comically large Nerf dart.
There is also one other that didn’t make it onto my ‘oversized’ shelf:
This atlas (in two volumes) is another interesting oddity. It’s stunningly comprehensive for its small size, seemingly meant to be used as a reference book not just for maps but for much of history by someone who has learned much or most of it in the past, and wants to see how it all fits together.
I’ve always loved its relentless abbreviations:
Here you can see them used, even when it’s not necessary to save space:
…such as the ‘Vandal Kdm’, or the ‘Ostro.’ or ‘Visi.’ (goths), all abbreviations that would be relatively easily decodeable for someone steeped in the Western canon, but perhaps impenetrable for the average reader.
And that’s all for today! Let me know if you want a more in-depth review of one of these, or anything else you see here. This has been a super-fun trip down memory lane for me. I’m going to go peruse an old atlas now.
 When I was avidly reading them, I used to read them in the bathroom. They’re perfect for that, as each two-page spread is self-contained, so you can read it in any number of manageable chunks, depending on how much time you have.
 Feels like Civilization all over again, especially the ‘wars of settlement’…
 Vaguely reminiscent of perhaps the most famous visual history timeline, “Adams’ Synchronological Chart or Map of History“, which perhaps to continue to best express the classical British conception of history that continues to colour many peoples’ perceptions, whether or not they know it.
 David Brin has such wonderful ideas. I recommend starting with his short story ‘Aficionado‘.
 For me, this is similar to how when you look at a map in a historical atlas, and think about every dot on the map, and how each of them could easily have been someone’s doctoral thesis or life’s work.
 Obligatory. Note that the famous tablet seems to have been only one of many.
 Let me know if you want me to talk about these. I’ve been meaning to for a while, but it’s been like 20 years now.
 Note that there’s now a second edition. I’ve only ever really played my copy once, and I can’t give a useful review.
Early on in the pandemic, a blogpost came out entitled “Coronavirus: The Hammer and the Dance“. It talked about how, in a pre-vaccine world, to avoid overwhelming our healthcare system, but to allow as much semblance of normalcy as possible, we would need to have successive implementations and releases of various non-pharmaceutical interventions (read: lockdowns, public mask wearing, quarantines, etc.)
As difficult as it was to deal with the reality of that (no matter how much I thought I was mentally prepared for it), it’s perhaps even more tiring now, that in a COVID vaccine world, that with substantial anti-vaccination movements and vaccine hesitancy, and with a new variant (Omicron), that we have to continue this ‘Hammer and Dance’.
So, that tells you something about the population-wide effects of Omicron, but population effects are equal to individual effects times overall virulence…and what are the individual effects of Omicron, and how is it different from ‘wild-type’, ‘Alpha’, and ‘Delta’?
According to this article, Omicron is 2.7-3.7 more infectious than Delta among vaccinated & boosted individuals, but about the same as Delta among the unvaccinated, suggesting that some sort of ‘immune evasiveness’ is at play.
This article suggests that: “Compared with patients who had the delta variant, omicron patients had a 53% reduced risk of hospitalization, a 74% reduced risk of ICU admission and a 91% reduced risk of death.” (Original paper)
Here, on the lower chart, you can clearly see the five peaks of the (so far) five waves of the pandemic (in Canada). The first peak, in early 2020, of (probably) exclusively wild-type, hitting the entirely unvaccinated population hard, then a (relatively) calm 2020 summer, followed by the second peak in late 2020 and early 2021 likely brought on by winter forcing people indoors, relaxation of restrictions, and complacency. Vaccines began to be approved in December, and were rolled out through the first part of 2021, blunting the third wave (mostly Alpha) and the fourth wave (mostly Delta) in the fall and early winter. As you can see, the fifth wave was quite different, with Omicron blazing through the population, multiple times more contagious than Delta, but also less deadly on a per-case basis, but overall leading to a wave about as large as the initial first early 2020 pre-vaccine wave.
So, we’ve all heard about the acute COVID symptoms that are included in the above, and there have been some issues with people taking a while to recover from these, but more serious, and less talked-about is the phenomenon of ‘Long COVID’ or ‘Post-COVID syndrome‘.
As a respiratory disease, it is perhaps not unexpected that COVID would attack and damage the lungs. However, much of the attack on organs done by COVID is thought to be because of extracellular expression of ACE-2, the doorway that COVID uses to get into cells and multiply.
So, we know that all kinds of things can happen, but how often do they happen? This study, performed in the highly-COVID-tested population Faroe islands, is likely to have included all of the relevant population that contracted COVID (from April to June 2020, so pre-vaccine, all wild type variant). Four months ‘after’ COVID, half of the population studied continued to have at least one symptom (most often fatigue, lost of smell/taste, and/or joint stiffness).
This much larger study of 270,000 people in the U.S. used six months of HMO data, and found that “over 1 in 3 patients had one or more features of long-COVID recorded between 3 and 6 months after a diagnosis of COVID-19. This was significantly higher than after influenza.” In addition, “[f]or 2 in 5 of the patients who had long-COVID features in the 3- to 6-month period, they had no record of any such feature in the previous 3 months.”
“You might have a mild case,” Laurie Bedell, 42, of Pittsburgh, said. “But most people that have long Covid had mild cases.”
She caught the virus in December 2020 and continues to have debilitating pain, fatigue and other symptoms that have transformed her from a healthy, physically active woman to a chronically ill person unable to walk or do any form of exercise for more than 5 to 10 minutes at a time.
“I am terrified,” she said. “I don’t know that I would survive another infection.”
There is currently only anecdotal evidence, but studies are sure to follow, but:
People with long Covid “have good reason to be worried, unfortunately,” said Dr. John Baratta, founder and co-director of the UNC Covid Recovery Clinic in Chapel Hill, North Carolina.
“We have seen people in our clinic who have been reinfected with Covid with the other variants,” he said. “They have new or worsened long Covid symptoms after their reinfection.”
Third, continue to limit the amount of time you spend sharing air with people outside your ‘bubble’. COVID is an airborne disease, and transmits much more easily indoors, where ventilation is poorer. Consider contactless delivery, masked curbside pickup, and socially distanced and/or masked walk’n’talks.
The end to this thing may or may not be in sight, but it’s probably not Omicron, and you want to get Omicron as few times as possible.
 There are limitations on the precision of PCR and the classification of variants, but any study that didn’t do whole genome sequencing would have the same limitations. It increases my confidence in the study that they were very precise about what they were measuring.
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Nausea or vomiting
Congestion or runny nose
Some of these symptoms are very common and can occur due to many conditions other than COVID-19, the disease caused by the coronavirus called SARS CoV-2. If you have any of the symptoms, contact a doctor or other health care provider, who can assess your risk and help you determine the next steps.
Emergency Warning Signs of Severe COVID-19 — When to Call 911
If you or someone in your household is experiencing any of the following symptoms, call 911 or your local emergency room right away and let the operator know that you are calling for someone who might have COVID-19:
Persistent pain or pressure in the chest
Inability to wake up or stay awake
Bluish lips or face
There are other possible symptoms of COVID-19. Call your doctor or health care center regarding any symptoms that are severe or concerning to you.
 Angiotensin Converting Enzyme 2, a transmembrane protein involved in blood pressure regulation, and extensively studied because of its relation to hypertension.
That being said, with more evidence from Canada and elsewhere, the NACI is now saying that:
“Due to the observed AstraZeneca safety profile and risk of VITT, offering an alternative product with a more acceptable safety profile and expected comparable immunogenicity profile, while enabling individuals to make an informed choice is ethically justifiable. This is expected to lead to increased accessibility and acceptability for those who were initially offered a first dose of the AstraZeneca vaccine, including those who are most at risk of COVID-19.”
In this, they are weighing the apparent increased risk of death from VITT against the dangers to an un-immunized individual (and of an un-immunized population), and the expected timeline for mRNA vaccine availability vs. the increased risks of COVID variants that are resistant to a single dose of a vaccine.
As always, your decision should be made in consultation between you and your doctor. I’m planning to get an mRNA vaccine (Pfizer or Moderna) for my second dose, but I don’t know when, yet. Likely within the next month or two.
So, with the NACI saying that:
– If you got Pfizer or Moderna for your first shot, you should get the same (or the other) for your second shot (strong recommendation)
– If you got AstraZeneca for your first shot, you can get AstraZeneca, or Pfizer, or Moderna for your second shot (and that they understand why people might prefer Pfizer or Moderna to AstraZeneca for their second shot)
The next question is ‘when do you get your second shot?’
There are a few factors at play here:
– The total local number of COVID cases
– The number of cases of more dangerous variants (and wanting to stamp the total local number of cases so as to avoid evolving more dangerous variants)
– Vaccine type & availability
– The waiting time for maximum effectiveness (and whether a third shot will be necessary/allowed/possible/etc…)
– The total local number of COVID cases:
Currently, in Ontario, the number of cases per day is trending downwards by 20-40%, week on week:
This is great news! However, there is also disturbing news that a new variant, ‘Delta’ (B.1.617.2), with about 60% greater transmissibility is starting to take over. (Some more Ontario-specific news on the Delta variant.) Specifically, it is estimated that while one vaccine dose is 60-80% effective against ‘wild-type’ COVID, and two doses are >85%, against the Delta variant, one dose is only about 30% effective, and it requires two doses to be about 80% effective.
– The number of cases of more dangerous variants (and wanting to stamp the total local number of cases so as to avoid evolving more dangerous variants)
So, people might want to get their second dose as soon as possible, in order to protect as much as they can against the new Delta variant (and any others that may arise). (This has the added side-benefit of reducing the total number of cases, and reducing the number of chances that COVID-19 has to mutate into other variants.)
– Vaccine type & availability
From the NACI: “Canada is anticipating large supplies of mRNA vaccines in the summer months that will be sufficient to complete the second dose in all age groups for whom immunization is recommended.”
So, availability of mRNA vaccines seems to no longer be a concern.
– The waiting time for maximum effectiveness (and whether a third shot will be necessary/allowed/possible/etc…)
So, here’s where it gets tricky. Because all of these vaccines are super-new, there is a limited amount of data on exactly when the ‘sweet spot’ is as far as how far doses should be spaced from each other for maximum effectiveness. Also, the presence of variants and vaccine mixing complicates matters.
(The minimum number of days are based on general scientific understanding of how vaccines work, along with the number of days between doses in the clinical trial. The maximum number of days was based on ’emerging evidence of the protection provided by the first dose of a two-dose series’ and ‘limited COVID-19 vaccine supply and ongoing pandemic disease’.)
“If your first dose was:
– AstraZeneca: you can get AstraZeneca, Moderna, or Pfizer for your second dose when you are eligible and it’s at least 12 weeks after your first dose.
– Moderna or Pfizer: you should get the same vaccine for your second dose when you are eligible and it’s at least 28 days after your first dose. You can switch between Moderna and Pfizer safely if the original vaccine you got is not readily available.”
“With informed consent, individuals can choose between a second dose of AstraZeneca or an mRNA vaccine, at an eight to 12-week interval, recognizing that while waiting 12 weeks helps to ultimately provide more protection, some may choose to receive their second dose sooner to have the increased protection provided by a second dose earlier. All of these options provide protection against COVID-19, including the Delta variant, and have been deemed safe.”
So, knowing all of this, which vaccine should you get for your second shot, and when? As I said above, this decision should be made between you and your doctor, but given the data above, it would make sense to weigh your perceived day-to-day danger level (along with mounting dangers from Delta and other variants) against the knowledge that waiting a bit longer could give you greater immunity overall. I’ll be 8 weeks out from my first immunization this coming weekend, and I can see myself waiting a couple of weeks after that for my second shot (which I intend to be a mRNA vaccine). (There is also some evidence that waiting 12 weeks leads to better mRNA vaccine effectiveness in older people.)
I’m still making my decision, though, as it may be that the extra overall vaccine effectiveness may not be meaningful, as the overall effectiveness may be ‘high enough’ (especially in reducing or eliminating serious COVID effects), and the extra security from emerging variants (and getting to enjoy more of the summer) may be worth it.
Let me know what you think for your own situation.
As always, thanks for reading, and stay safe!
P.S. If you want a more in-depth discussion of how the immune system works, and why vaccine mixing makes sense, let me know in the comments below! I had thought that this would be necessary to explain NACI’s vaccine mixing recommendation, but I think their ethical arguments are more directly relevant at the moment. (And this post is already quite long.)
P.P.S. Some more references I glanced at but only used for background:
These have a whole bunch of interesting graphs that I didn’t have time to get into:
Here are a bunch of articles that I didn’t have time to get into:
[This is a fast-moving and controversial topic, so if you’re reading this, you may disagree with what I say, or I may be wrong. Please feel free to read the sources linked throughout my post. If in doubt, please consult with your doctor. Also, I’m writing this as much for myself, to process all the things that I’ve been hearing and reading, so this may or may not address your specific case. #notmedicaladvice]
By the time you read this, if all goes well, I will have received my first vaccine dose. I’ll be getting the AstraZeneca-made vaccine, for a bunch of reasons, perhaps best summed up by this quote from our Prime Minister:
1) The initial R&D of the vaccine, including the conceptualization, and very likely in vitro (cell culture) tests and in vivo (animal) tests, both to show safety and effectiveness
2) Three phases of increasingly large clinical trials, to test for safety & effectiveness
3) Formal approval
The above process is the one for the U.S. FDA, but other jurisdictions will have similar processes. In Canada, the National Advisory Committee on Immunization (NACI) does a review of the evidence, and makes an approval decision. As vaccines can have risks as well as benefits, the NACI may approve vaccines for certain demographics, and not others. A common example of this might be restricting approval to adults 18 and over, due the difficulties and ethical restrictions of testing on children. Indeed, the current statement on the AstraZeneca vaccine includes such a statement:
“The AstraZeneca COVID-19 vaccine is authorized for use in Canada for adults 18 years of age and over. Health Canada has determined that it is a safe and effective vaccine.”
The availability of multiple approved vaccines has led to comparisons of the four vaccines currently approved for use in Canada: Johnson & Johnson, AstraZeneca, Pfizer, and Moderna
This being a fast-moving topic, affecting millions (really, billions) of people, science news is being reported on a daily basis in the popular press, which has a number of effects:
Because the topic is fast-moving, there is a lot of news, not all of it checked to normal standards of scientific rigor.
Number of adverse event reports by vaccine name up to and including April 16, 2021 (n=3,738) Vaccine name Non-serious reports Serious reports Total reports Total number of doses administered Total non-serious report rate* Total serious report rate* Total report rate*
Non-S Ser Total Total Rate R(ser) R(non-ser)
Pfizer-BioNTech 1,762 395 2,157 7,183,048 24.53 5.50 30.03
Moderna 1,311 83 1,394 1,843,805 71.10 4.50 75.60
COVISHIELD 124 36 160 491,171 25.25 7.33 32.58
AstraZeneca 11 9 20 615,582 1.79 1.46 3.25
Unknown 1 6 7 N/A NaN NaN NaN
* Per 100,000 doses administered.
(‘COVISHIELD’ refers to the AstraZeneca vaccine, under a slightly different brand name.)
Overall, between all the vaccines administered, there have been:
(Please note that this number of 19 per ~9.5 million may go up or down, but as it stands, it’s about at 2 per million, or 1/4 as dangerous as being a pedestrian, or 1/13th as dangerous as driving a car for a year. (2017 data))
(Please also note that all of these vaccines seem to have similar rates of serious and non-serious side effects.)
The item at the top of the news at present is that there are currently specific questions about blood clots and the AstraZeneca vaccine. Health Canada performed a review, and determined:
Health Canada’s review of the available information concluded that a link between the use of AstraZeneca COVID-19 Vaccine and COVISHIELD and the risk of these blood clots with low platelets is possible. The risk of these events is very rare, and the overall benefits of the vaccine in protecting Canadians from COVID-19 continue to outweigh its potential risks.
Health Canada did not identify risk factors, such as age or gender, for these very rare events, and is not restricting the use of the vaccine at this time.
A potential mechanism for the combination of blood clots with low platelets is the triggering of an immune response by the vaccine, leading to a condition similar to that seen sometimes in patients treated with the blood thinner medication heparin.
In the UK, this incidence seemed to be:
The potential risk of blood clots with low platelets is very rare. Based on their vaccination rate as of March 31, 2021, the United Kingdom Medicines and Healthcare Products Regulatory Agency estimated the overall risk of these blood clots to be approximately 4 people in a million who receive the vaccine. Reported cases of these adverse events have been seen after the first dose, usually within the first 14 days after immunization.
While the overall population risk seems low, when people have options, they will move to optimize their decisions with whatever information they have available, especially when there may or may not be demographic effects on these issues. At its worst, this leads to ‘vaccine shopping’, exacerbating outbreaks, but at its best, it involves people making educated decisions about their personal risks and benefits from taking a particular vaccine. Indeed, from the NACI April 23rd statement:
“At this time and based on current evidence, NACI recommends that the AstraZeneca COVID-19 vaccine may be offered to individuals 30 years of age and older without contraindications, if the individual does not wish to wait for an mRNA vaccine and the benefits outweigh the risk.”
This represents the fact that individuals between the ages of 30 and 40 are at reduced risk for COVID (compared to older individuals), and they may be at the same or increased risk for these blood clots.
There has been speculation that this is auto-immune linked, but the current (not yet published) research has not found (or ruled out) a link yet. (Numbers are still very small, and this is a tricky determination to make.)
However, if you know that you are more susceptible to auto-immune issues (especially those with high estrogen levels), you might want to consult with your doctor, or wait if it remains safe for you to so, while the science is worked out. Ultimately, only you (with your doctor) can make this determination.
Overall, the title of this post still stands. There are a small number of rare side effects associated with these vaccines (mainly PEG allergic reactions for Pfizer & Moderna, and blood clots for AstraZeneca), both of which are detectable and generally treatable. I’m planning to get my shot tomorrow morning, and I believe that the vast majority should also, as soon as they can.
 “The Pfizer-BioNTech COVID-19 vaccine is contraindicated in:
– Individuals who have ever had a severe allergic reaction (i.e. anaphylaxis) to a previous dose of an mRNA vaccine or to any of its components (including polyethylene glycol (PEG) and/or polysorbate) or its container, should not get either mRNA COVID-19 vaccine. PEG can rarely cause allergic reactions and is found in products such as medications, bowel preparation products for colonoscopy, laxatives, cough syrups, cosmetics, skin creams, medical products used on the skin and during operations, toothpaste, contact lenses and contact lens solution. PEG also can be found in foods or drinks but is not known to cause allergic reactions from foods or drinks.
– Vaccination should be deferred in symptomatic individuals with confirmed or suspected SARS-CoV-2 infection, or those with symptoms of COVID-19.
– As a precautionary measure and in light of the need to be able to monitor for COVID-19 vaccine adverse events without potential confounding from symptoms of COVID-19 or other co-existing illness, it would be prudent to wait for all symptoms of acute illness to completely resolve.
– Individuals who have received another vaccine (not a COVID-19 vaccine) in the past 14 days.
– Individuals under the age of 16: The safety and efficacy in children under 16 years of age have not yet been established. The manufacturer plans to conduct clinical trials in children.
Considerations for other patient groups
– Guidance for special populations, including for example breastfeeding or pregnant individuals, individuals with allergies, individuals with autoimmune conditions, or individuals who are immunocompromised due to disease or treatment, is available in the Vaccination Recommendations for Special Populations guidance document.
Precautions during vaccination should be taken for:
– Patients who have a bleeding problem, bruise easily or use a blood-thinning medicine should receive the vaccine. Individuals receiving long-term anticoagulation with either warfarin or heparin are not considered to be at higher risk of bleeding complications following immunization and may be safely immunized through the intramuscular route as recommended, without discontinuation of their anticoagulation therapy.
– There is some evidence to suggest that instramuscular administration may be safer when given with a small gauge needle (23 gauge or smaller) and when firm pressure is applied to the injection site for 5 to 10 minutes
– Individuals with a history of severe allergic reactions (i.e. anaphylaxis) not related to vaccines or injectable medications—such as allergies to food, pet, venom, environmental, or latex, etc. should be offered the COVID-19 vaccines.
– An extended period of observation post-vaccination of 30 minutes is recommended for these groups
– For more detailed recommendations on people with allergies, please consult the Vaccination Recommendations for Special Populations guidance document.
There are events that so significant, so momentous, that they sear themselves into the psyche. I say ‘sear’, because these moments are often negative events, such as the Challenger explosion, or 9/11, but these events can also be positive, such as the first person on the moon, or the one that happened yesterday morning, the 2020 U.S. Presidential Election being called for Joe Biden & Kamala Harris.
We had an endlessly raging sense that this was not normal, and it was difficult to focus on other things, when there could be a new evil or stupid thing being done each day or week, that could potentially harm thousands or millions of people. Earlier in the week, it had become clear that barring a catastrophe, Biden would win the election, so my tension level had gone down significantly (especially when it became obvious that Fox News and the Bush/Rubio wing of the Republican party would not support such an illegal seizure of power as Trump was contemplating).
But it still felt odd, and somehow wrong, to focus on other projects until this was well and done. The actual calling of this election for Biden was an important step on this road to normalcy, and perhaps also an indication that we could take our eye off the ball and relax for just a second…
For us, this happened when we were out in the wilderness, in one of our favourite spots, when S’s watch buzzed, and showed us the following message:
…indicating that the newpaper(s) of record were now willing to put their credibility behind the fact that Biden was going to win this election.
We expressed our happiness a little bit, and then immediately wanted to check which state it was that had made the difference, and it turns out that it had indeed been Pennsylvania, as had been suspected all along:
While looking at this map, we encountered some other people coming the opposite way on the trail, and perhaps cathartically, or just to have some human connection to share this experience, I made hand motions and cheered, to which they replied that they had also just heard.
Admittedly, people who drive to an art gallery in the wilderness so that they can go walking on a trail will tend towards certain demographics, but it is telling that within minutes, we all knew this most significant bit of news, suggesting how much everyone around the world was on tenterhooks.
Here’s hoping that we remember this moment as a turning point. Keep pushing my friends, this is not over yet.
 (It feels like there’s a whole book to be written about why all of my positive examples (and many of my negative ones) have to do with space flight/exploration/travel…probably having something to do with space travel representing all of humanity working together to solve a problem…a super-poignant one for me was the landing of ‘Curiosity’, I remember exactly where I was, and how verklempt I was that this little robot had gone so far (560 million km, to land so exactly (within 2.4km), and they cared so much about it that they had altered the orbit of the Odyssey orbiter (not done trivially) so that they could check on Curiosity immediately after landing…There are also probably comments about how the advent of television makes these moments possible, such that all of humanity can experience something in real time, and so viscerally through the visual medium.)
 It will remain to be seen whether this moment is as changing of the course of history/presaging a new era as the other ones mentioned. For the sake of the planet, we hope so.
 The election was officially held on the Tuesday, and it was finally called on the Saturday morning.
 (The link is people dancing on and around a car to the tune ‘All I want for Christmas is you’, along with commentary that contrary to when this song is normally heard (endlessly in retail areas in the month(s) leading up to Christmas), it was actually pleasurable, and led to people being verklempt, because of the incredible catharsis and sense of relief: “this was the first time i heard this song in 2020 and it was absolutely the best possible occasion
 Remember, there are two senate runoff elections happening in Georgia that will decide things like how much healthcare Americans get for decades to come, and there is still the ‘lame duck’ session where Trump will have some power to cause damage. There will likely be an unimaginable amount of money flowing into that election, and the most incredible GOTV campaign that you can imagine, both of which you can help with.
This had been predicted by many observers, and we had been seeing the slow march in this direction for days, as the mail-in votes in Pennsylvania were being counted:
But it’s one thing to know almost for certain that something is coming, and another thing entirely to see it actually happen.
If there’s one thing that I feel that we’ve learned during these last 9 months of pandemic isolation, it’s that there is a significant difference between understanding something intellectually, and the full-on emotional experience.
People were saying that this election might not be decided until late this week, and that it might be a nail-biter…
…similar to ‘life will not go back to normal until there is a vaccine, and that will not happen until late 2021 at the earliest’…a nail-biter that one is living through is very different than one that one is merely discussing in theory. I would posit that people around the world lost a significant amount of sleep (and not just those counting ballots) from the stress over the starkly divided U.S., perched on a ‘knife’s edge‘.
But it now looks like we have a way forward. The current numbers are juust over the biggest barrier, and the overall trend is good. Barring some catastrophe, Joe Biden will be the next president of the United States, and as he alluded to in his ‘not-quote-a-victory-speech-speech’: “We believe when the count is finished we’ll be the winner“, that it is time for the country (really, the world), to come together to heal.
“What brings us together…is so much stronger than anything that can tear us apart.”
“…it wouldn’t take that big of a polling error in Trump’s favor to make the election interesting. Importantly, interesting isn’t the same thing as a likely Trump win; instead, the probable result of a 2016-style polling error would be a Biden victory but one that took some time to resolve and which could imperil Democrats’ chances of taking over the Senate. On the flip side, it wouldn’t take much of a polling error in Biden’s favor to turn 2020 into a historic landslide against Trump.”
While many were undoubtedly hoping for the latter, undoubtedly record Republican turnout meant that we ended up with the former.
 I wonder if this is how empires happen…that those in the hinterlands are so affected by the decisions made, or the culture projected, that they start to identify with the leaders, rooting for them as they root for themselves…
In just over two days, Election Day in the United States will have drawn to a close. Normally, I would say ‘the election in the United States will be over’, but as anyone who is reading this knows, these are not normal times.
I was talking with a friend of mine on Friday, and he asked me how I was doing. I told him I was ‘really tense about Tuesday’. He looked over to his other screen, and said ‘89 to 10‘. We both immediately knew what he meant. The situation in the U.S. is so pervasive that not only has it overloaded numbers, but days of the week.
To give you an idea of how people are feeling,
Problematic Jim Jeffries commented on the Daily Show that just being able to name so many members of the U.S. administration, including people in such insignificant jobs as ‘Deputy Press Secretary', is a sign that something is terribly wrong. The whole point of a representative democracy is that we don’t always need to know the names of the people in positions of power, that there is some trust that they will do their jobs properly.
One other friend of mine opined today that he now understood what he now understood what it felt like to be Polish on March 3, 1933.
It is no wonder then, that the rest of the world (and probably much of the U.S.) is on tenterhooks, waiting for the result…a result that may be inconclusive, or swing back and forth for days, with large numbers of people yelling and committing violence, attempting to muddy the waters and intimidate a result.
So, what do we do?
For people currently residing in the United States, especially those with the power to vote (and those who can vote from overseas), there are various ways to make one’s voice heard, the most important at this moment being voting or helping others vote.
But what about all the rest of us, those of us who will be affected by the results, but have no direct say over the outcome?
Well, we might have to accept that there’s not a lot we can do about U.S. politics…but…
…We can donate to NGOs that promote justice in the world (such as the SPLC & the EFF), you can promote justice at home (remember, ‘All politics is local‘), and you can help remind people online that they are supported, and that there are other people out there who believe in a better world.
I guess that’s what I’m trying to do here today. You are not alone. ‘Peace, Order, and Good Government‘ may be a Canadian saying, but I feel that most people in the world would want/prefer this. Working together, we can make this happen, and sooner than you might expect.
 There are a whole bunch of interesting arguments that are out of scope, about this lack of representation. Some of them are ‘taxation without representation’ arguments that are fascinating, but are out of scope.
Last weekend, we went out of town for the first time since the pandemic started. I had been looking forward to it for some time, but it took me a while to really understand why.
We have an annual tradition of going ‘apple picking’ each fall, where ‘apple picking’ is code for going on a weekend road-trip and exploring the area a couple of hours from where we live. We have some favourite haunts, but we’ve been finding over the years that we’ve been doing it that we enjoy a little more variety in the locations we visit.
Which brings me to last week.
As I said, I’d been looking forward to our trip, but had had difficulty articulating exactly why. I’ve always looked forward to the trip, a vacation away from the cares and maintenance of daily life & work.
I had realized (and managed to articulate) that I needed a vacation, somewhere around a week or two before the trip, but it wasn’t until we were on the trip that I realized why it was so incredibly important.
The title of this post comes from the computer game ‘The Elder Scrolls IV: Oblivion’, where long-suffering guardsmen say it as a commentary on the sameness and tediousness of their existence.
While I likely enjoy my job more than they do, I understand the sentiment, especially through the endless samey ‘now’ of the work from home grind. I didn’t realize until halfway through our trip, I think when we were talking about the day-by-day ordering of our schedule. This being small-town Ontario, the trip takes on a very different character, depending on which places we visit on the Saturday of the weekend, when things are still open. Even in a pandemic, this character is very different between Saturday and Sunday.
It was this difference from trip to trip (I think) that highlighted to me the real reason why I so desperately needed to ‘get away’ from town/home. It was the sameness, the day-to-day sameness that was so grinding me down. Even though I asked that we spend our most valuable Saturday on visiting what we knew were our ‘old favourite’ places where we normally travel, it was still really different from the day-to-day at home, and even very different from each of the other times we’ve been out there. Some of this difference was because of the pandemic, because we didn’t eat inside any buildings, or stay inside any buildings with other people for longer than necessary, but also because when you’re that much more conscious of it, and it’s such a scarce commodity, each moment inside a bookstore is a rare and special occasion, and even now, I remember them more acutely than many other trips to many other places.
I’ve always found our brains’ natural filtering ability fascinating, how the trip back is always much shorter than the trip there, how one is able to focus so intently on one thing, even outdoors. But the downside of this automatic filtering is that if one day is pretty much the same as the previous, they will start to run together, and it will seem like one amorphous mass, and like that nothing has really happened, or that one hasn’t really done anything, even though a large amount of time has passed…
You may or may not know that this was the main reason I started this blog (or perhaps why continuing to write it ‘stuck’).
Since we got back, I’ve taken action to improve a few things in my life, cleaned my room, etc…
I may or may not be out of my rut, or the ‘lockdown mindset’, but I’m feeling a lot better, and a lot of it is because I trusted myself and my ability to interrogate my feelings.
Winter is coming, and now is a good time to look for and bring out the sun inside yourself, to help others find the sun inside them, to warm and entertain and provide variety during these long months ahead.