HIV and ID Observations

An ongoing dialogue on HIV/AIDS, infectious diseases,
all matters medical, and some not so medical.

September 22nd, 2021

What I’ve Been Busy Doing, Besides Seeing Patients — and Bonus Animal-Related Infection Podcast

A 1914 postcard from New Zealand, where dogs have amazing abilities.

Long-time readers of this site (and I thank you deeply for that) might have noticed a lengthier gap than usual between today’s post and the previously published one.

Nearly three weeks! Wow! What on Earth is he doing? He must be really busy. That or just lazy.

In order to reassure you that the former is a better explanation for the silence than the latter, here are a few non-patient care things gobbling up the time that typically would go into crafting one of these posts:

1. ID fellowship interviews. COVID-19 notwithstanding, we continue to attract some truly brilliant, mission-driven, and just wonderful young physicians to this field. And can you blame them? It’s by far the most interesting and challenging medical subspecialty, arguably now more than ever.

But the process of reviewing applications, doing the interviews, and submitting our reports takes time — as it should. By the way, check out this paper that surveyed applicants and program directors after the first year of “virtual” recruitment to ID. Seems like virtual here to stay, at least in some capacity.

Just wondering — how many of those interviewees only put on the top half of their interview suits, and stuck with jeans, sweats, scrubs, or shorts for the bottom half? Zoom can’t tell!

2.  The NEJM FAQs on COVID-19 vaccines. Or should I write Covid-19 vaccines? For reasons only the editors understand and are keeping secret from me, here on NEJM Journal Watch we write it as COVID-19, while in NEJM itself, it’s Covid-19. Go figure.

But if you know of another content area with greater changes day by day — sometimes hour by hour — than these amazing vaccines, it would be news to me. These FAQs require constant attention and updating, and even then one feels hopelessly behind. Talk about a Sisyphean task, one that might not get easier for some time.

Note that I am both very proud (and surprised) that I spelled “Sisyphean” correctly without looking it up and very grateful to Amy Herman at NEJM Group for her help on this giant project.

3.  An opinion piece on the strange lack of guidance for booster doses with the one-shot J&J vaccine. Is the one-shot Johnson & Johnson vaccine less effective than the mRNA vaccines? Yes. Do we have evidence that giving an mRNA vaccine to prior adenovirus vaccine recipients boosts responses? Yes. Doesn’t even J&J think that its vaccine needs more than one dose?

Probably yes — their opinion further amplified by their press release of some of the ENSEMBLE2 data, though my co-author on the New York Times piece, Dr. Michael Lin from Stanford, still has some concerns:

We’ll see. Regardless, it’s just so strange that with all the chatter about boosting the Pfizer-BioNTech (especially) and Moderna vaccines, the 14 million Americans who got one shot of J&J still wait for guidance. “Soon,” say many experts. Will be glad when that day comes.

4.  Debating the top animal-related infections, with Dr. Jeanne Marrazzo. She’s the Chief of ID at the University of Alabama, a long-time friend and ID colleague, a scintillating conversationalist, and a true animal lover. One of my junior colleagues considers her a “hero” in ID. Who could be better for this O-F-I-D podcast? Note that I didn’t specify what I meant by “Top Animal Infection” — could be very serious, or having a cool life cycle, or just an amazing name, or having a great clinical anecdote, or some combination of all of the above.

So listen, learn, and laugh! And let me know in the comments if we left out one of your favorite animal-related infections. There are just so many.

(Quick aside — I got the idea for these silly drafts from one of my favorite writers in the world, Joe Posnanski. I even wrote him a fan letter! He does even sillier drafts with comedy writer Michael Schur on his “Poscast”, and gave me permission to do these Infectious Diseases ones since they don’t have overlapping content. He’s about to release a massive book, The Baseball 100. If you have even the slightest interest in baseball, I can’t recommend it strongly enough.)

(Transcript here, and also available on iTunes, Spotify, Overcast, or anywhere you get your podcasts.)

Categories: Health Care, Infectious Diseases


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9 Responses to “What I’ve Been Busy Doing, Besides Seeing Patients — and Bonus Animal-Related Infection Podcast”

  1. Ramesh Bharadwaj says:
    September 22, 2021 at 4:47 pm

    Do you have any guesses as to why the VRBPAC came with age 65 for boosters? The Israeli study was age 60 and older. Was there unpublished subgroup analysis showing maximal benefit in age 65 and over?
    And again thank you for the blog. Amazing insights and some lighter moments in these dreary times.

  2. Betsy Brown MD says:
    September 22, 2021 at 7:28 pm

    Thanks, I was just thinking about you, missing the blog, and hoping that all is well. Good to know you are just busy!

  3. Loretta S says:
    September 23, 2021 at 9:27 am

    Great interview! I wish it was longer. 🙂 Although I must confess that in the interest of time, I always read the transcripts of these interviews instead of listening to them. I think toxoplasmosis would be near the top of my list, mainly because of the behavioral changes it causes in mice. Instead of saying, “Run away! Run away!” when it detects the scent of a feline, a mouse may actually approach the feline without fear. The parasite causes very specific changes in the mouse’s response to certain scents. I’m sure the cats are fine with that: a prey animal that lets the predator catch it! Fascinating.

    Also on my list would be Leptospirosis, another rodent-associated illness. Very interesting, because both humans and animals, especially dogs, can become quite ill from it. And it seems like it can be acquired in various ways, including walking or wading through flood waters. That seems especially relevant today, when episodes of flooding have been making headlines seemingly nonstop.

  4. David Kaufman says:
    September 23, 2021 at 12:43 pm

    Since my son is practicing in New Zealand in a sheep raising community, I would like to add Orf (partially because it has such a great monosyllabic name)

  5. Mehri McKellar says:
    September 24, 2021 at 7:01 am

    Hi Paul,

    Welcome back!

    Just curious as to whom you are giving the 3rd COVID-19 vaccine to in your HIV patient population. I’ve been sticking to the ‘advanced and untreated HIV” CDC criteria so far. However, our EMR (Epic) took it upon itself to flag all of our HIV+ patient charts (which can be seen by the patient) that they are ‘overdue for a 3rd vaccine’. The Wizard of Oz wasn’t able to sort by CD4 counts or viral loads, I guess. I’m having to explain to a lot of patients why I’m not giving them the 3rd just yet. I realize this is a dynamic situation but I’d love to hear what others are doing.

    Thanks as always for the excellent posts and great discussions.

    Mehri McKellar, Duke University

    • Paul Sax says:
      September 24, 2021 at 12:59 pm

      Hi Mehri, not yet recommending them for healthy HIV patients, though with the latest decision on boosters, many qualify for other reasons.
      -Paul

  6. john mosby says:
    September 24, 2021 at 2:12 pm

    My pharmacist and PCM keep telling me that even though I’ve had a PPSV23 vaccination after age 65, I’m due for another every 5 years or so. But CDC recommendations are that I need only that final one, even though I have CKD and AF.
    Why, please, and how can I convince them (or myself) otherwise?

  7. Holly Batterman says:
    September 28, 2021 at 12:37 am

    Loved your podcast Paul and Jeanne! We recently in my lab, assisted in the diagnosis of a case of plague from Lake Tahoe, and I absolutely loved that scene in Hamnet about how the plague worked its way to England in the 1500s. I also love tularemia, (being from CA where Tulare county is), I had an an amazing case in an HIV + patient with a huge axillary node, he was a landscaper in Marin County, thought it was Bartonella initially, but ultimately grew francisella, the State PHD was very interested as it was the first case in Marin since the early 1950s. I am however disappointed that you didn’t include Bartonella species (which I worked on as a fellow)

  8. Joel Gallant says:
    September 29, 2021 at 8:36 am

    I loved the zoonosis interview! You both did a wonderful job and picked great diseases. (Paul, I might have mentioned that adult schistosomes are said to leave in copulo—a state of permanent copulation. If ever there was a Latin term worth knowing, that would be the one.)

    If I’d been asked, I would have mentioned loa loa, because…

    – It has a cool lifecycle.
    – I once saw a case in a small ER where the ophthalmologist on call refused to come in and extract the worm because he’d never heard of it. An opportunity lost. I should have tried it myself, but I didn’t think my malpractice would cover slicing into the guy’s conjunctiva.
    – The name is cool. I wish the disease were called “loaloiasis” but apparently it’s just “loiasis”…or even more boring, “loa loa filariasis”
    – Talking about it makes you want to sing the song by the Kingsmen

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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