We face a choice: continue to ignore deaths from COVID-19 or prevent them. In collaboration with @RealOzSAGE, we call on the Australian government to act urgently to reduce transmission of COVID-19 by using the tools we have, instead of abandoning them. pic.twitter.com/vFt0iz57GY
— The John Snow Project (@JohnSnowProject) February 17, 2023
Credit where due:
… Last month, the vaccine maker was slammed for reportedly considering a dramatic price increase for the shot, which it had developed with the help of the federal government.
The proposal was also bad timing: The Biden administration was moving toward ending its designation of a public health emergency on May 11, which meant that federal funding for vaccines would soon dry up and uninsured Americans would have to pay out of pocket for their boosters.
Among the critics of Moderna’s reported consideration of a price increase — from about $26 a shot to as much as $130 — was Sen. Bernie Sanders, who has long advocated for government-funded health care and alleged the move would result in deaths…
Now, Moderna will be the sole manufacturer of COVID vaccines offering its shot for free to the uninsured. Under federal regulation, insurance companies are already required to foot the bill for COVID vaccines.
“Moderna remains committed to ensuring that people in the United States will have access to our COVID-19 vaccines regardless of ability to pay,” the company wrote in its statement.
“Moderna’s COVID-19 vaccines will continue to be available at no cost for insured people whether they receive them at their doctors’ offices or local pharmacies. For uninsured or underinsured people, Moderna’s patient assistance program will provide COVID-19 vaccines at no cost” after the public health emergency expires…
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Here's the press conf video of @DrTedros and Dr @mvankerkhove commenting on the incorrect @Nature piece on #COVID19 virus origins. Bottom line: @WHO & SAGO continue pushing to understand the origins & seek cooperation with China: pic.twitter.com/pxIDH8jWqw
— Gabby Stern (@gabbystern) February 15, 2023
China’s top leaders declared a “decisive victory” over COVID-19, claiming the world’s lowest fatality rate, although experts have questioned Beijing’s data as the coronovirus tore across the country after largely being kept at bay for three years.
China abruptly ended its zero-COVID policy in early December, with 80% of its 1.4 billion population becoming infected, a prominent government scientist said last month.
Though there were widespread reports of packed hospital wards and mortuaries, China recorded only about 80,000 COVID deaths in hospitals in the two months after dropping its curbs.
Some experts say the actual toll was far higher, as many patients die at home and doctors were widely reported to have been discouraged from reporting COVID as a cause of death…
However, leaders cautioned that while the situation is improving, the virus is still spreading globally and continues to mutate, according to state media.
The meeting stressed that China will increase the vaccination rate for the elderly, and strengthen the supply and production of medical goods. The PSC, China’s most powerful leadership body, urged all localities and departments to strengthen the medical service system, according to the report from the official Xinhua news agency.
The statement did not say how many had died from COVID, and comes weeks before China holds its annual parliamentary session and as policymakers look to revive an economy battered by three years of COVID restrictions…
How Deadly Was China’s Covid Wave?
Two months after China ended “zero Covid,” rough estimates suggest that between 1 and 1.5 million people died — far more than the official count.https://t.co/LjwC8Bh8Pg pic.twitter.com/JD3O8qqqHN
— Marc Veldhoen (@Marc_Veld) February 15, 2023
The world needs to ‘calm down’ about risks of a new #SARSCoV2 variant emerging from China, the former head of China's CDC says. The country is still experiencing some of the darkest days of the pandemic w/ the largest surge since the virus emerged in 2019 https://t.co/zQGhbTnrH5
— delthia ricks 🔬 (@DelthiaRicks) February 15, 2023
(link)
(link)
England covid update:
Hospitalisations with Covid still increasing but not that fast (10% over last week) – certainly nothing like the big increases we saw when Omicron first arrived. Zoe app has new infections flat or falling, so we'll see what happens next week! 1/3 pic.twitter.com/qP6xunGHaQ— Prof. Christina Pagel 🇺🇦 (@chrischirp) February 16, 2023
In the long term, we need a better solution than just watching wave after wave of Covid roll by… even if individually they aren't causing massive disruption, they are constantly adding to ill health of pop'n & causing more short and long term workplace & education absence. 3/3
— Prof. Christina Pagel 🇺🇦 (@chrischirp) February 16, 2023
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At least 6 million people have died from COVID-19 to date. But who dies is often not random. The same pattern is found around the world.
COVID-19 hit some countries harder than others. But the same groups of people were hit hardest everywhere.
The UN and the World Health Organization (WHO) have now established a working group to study who was the hardest hit, and why. The work is being led from Trondheim.
Who dies involves multiple factors, including where people live, where they were born, working conditions, education and how much they earn…
The UN and WHO commissioned NTNU’s research center with the assignment. The work is so extensive that CHAIN asked the international research community for help in the WHO’s Bulletin of the World Health Organization journal.
The response was not long in coming. More than 50 established researchers from all over the world are now going through 15,000 research articles that NTNU’s university library has identified. Six employees from the University Library are involved in the work.
The results are not yet clear, but so far the pandemic appears to have made existing social differences more apparent, and even reinforced them. This seems to apply not only in countries with limited financial resources, but also in those with strong economies.
“COVID-19 has been a double burden for disadvantaged groups. They’ve been harder hit by the virus, and they also suffered the most from the consequences of the measures, such as loss of work and income, social isolation and reduced access to health services,” says Eikemo…
The results of the study will be ready in the second half of 2023.
Worth reading the whole thing:
The imposition of lockdowns during the covid-19 pandemic had one overarching aim: to prevent hospitals from being overwhelmed. Governments hoped to space out infections, buying time to build capacity. In the end, however, much of this extra capacity went unused. England’s seven “Nightingale” hospitals closed having received only a few patients, as did many of America’s field hospitals. A study of Europe’s experience in Health Policy, a journal, found only one example where there were more covid patients than intensive-care beds: in the Italian region of Lombardy on April 3rd 2020. Although there are now stories of overwhelmed Chinese hospitals, as the country confronts a great exit wave, it is too soon to know whether these are isolated examples or represent broader, systematic failure.
Outside China, covid weighs less heavily on people’s minds these days. Yet health-care systems in much of the rich world are closer to collapse than at any point since the disease started to spread. Unlike for unemployment or gdp, there are few comparable, up-to-date figures on health-care performance across countries. So The Economist has trawled statistics produced by countries, regions and even individual hospitals to paint a picture of what is going on. The results suggest patients, doctors and nurses are experiencing the brutal after-effects of the pandemic.
Start with Britain, which produces high-quality data. The National Health Service (nhs), the country’s state-run provider, is in dire straits. Just before the pandemic struck, someone with a medical issue requiring urgent but not immediate attention, a category that includes those suffering strokes and heart attacks, waited on average 20 minutes for an ambulance. Now they wait longer than an hour and a half (see chart). The number of lengthy “trolley waits”—the time between a decision to admit a patient and arriving at a hospital ward—has jumped.
Other countries have less comprehensive statistics, but equally miserable populations. In September Ipsos, a pollster, released a global survey that included a question on the quality of local health care. In almost all of the 20-odd rich countries surveyed, people were less likely than in 2021 to say that the service on offer to them was “good” or “very good”. In Britain the share saying so fell by five percentage points. In Canada it fell by ten, in Italy by 12…
America is doing better than most countries, thanks to the vast amount of money it spends on health care and the excess capacity this funds. But it is not doing well. Average hospital-occupancy rates recently exceeded 80% for the first time. Even in the darkest days of the pandemic few states reported paediatric wards under stress (which we define as 90% or more beds being occupied). In early November fully 17 states were in this position, the result of a rise in all sorts of bugs in kids.
The collapse in the quality of health care is contributing to an astonishing rise in “excess deaths”—those above what would be expected in a normal year. In many rich-world countries 2022 proved deadlier even than 2021, a year of several big waves of covid. Monthly deaths across Europe are currently about 10% higher than expected. Germany is in the middle of a vast mortality wave: weekly deaths have been more than 10% above normal since September. In early December they were 23% higher.
What is going on? Politicians, at both a national and regional level, are taking the blame—and occasionally deserve it. But the forces creating the chaos are common across countries, and are linked to a shared experience of the pandemic. They may also, in the short term at least, be almost impossible for governments to overcome…
Organ damage for 59% of patients w/ #LongCovid continues 1 yr after initial symptoms. New comprehensive study of organ impairment in LongCovid shows organ damage for >1/2 of patients. 536 studied. Research in Royal Society of Medicine journal https://t.co/tdMKLVJsSZ
— delthia ricks 🔬 (@DelthiaRicks) February 15, 2023
Pfizer Inc and its German partner BioNTech SE are gearing up for a 2024 trial with Moderna Inc at London's High Court in competing patent lawsuits over their rival COVID-19 vaccines. https://t.co/Z4jAqcY9RS
— Reuters Health (@Reuters_Health) February 17, 2023
The @WHO has released a case definition for #LongCOVID in children & teens. Symptoms may be different from those in adults; must persist at least 2+ mos post-#COVID19 & feature fatigue, loss of smell, headaches &/or loss of appetite to meet the diagnosis.https://t.co/rGbueu5gAD pic.twitter.com/n4jkQNjsk4
— Laurie Garrett (@Laurie_Garrett) February 16, 2023
Muscle biopsy in-depth assessment in people with #LongCovid w/ exercise symptoms compared with 2 control groups shows microvascular abnormalities with reduced capillaries, immune cell dysregulation, distinct gene expression signaturehttps://t.co/ngv2vKhcLn @ChariteBerlin pic.twitter.com/ED8OJ2zNQ2
— Eric Topol (@EricTopol) February 16, 2023
Fixed it. @VirusesImmunity you’re the best. Thanks for letting me help as we set the record straight on the pathophysiology of #LongCovid. Full read here: https://t.co/GO0blQMziA pic.twitter.com/sFOdAxgDcw
— Putrino Lab (@PutrinoLab) February 15, 2023
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I'm used to being followed on Twitter, but this was the first time a reporter (@shawnchitnis @KPIXtv) followed me around – on my Saturday morning Noe Valley bagel/coffee/Farmer's Market routine – to see how I'm approaching masking in various settings.https://t.co/OVFpOYcNJl
— Bob Wachter (@Bob_Wachter) February 15, 2023
Two extremely stupid state legislators in Idaho have introduced legislation that would make it a misdemeanor to administer COVID vaccines in the state. https://t.co/JRboxfJIq8 via @TPM
— Josh Marshall (@joshtpm) February 16, 2023
On The Road – arrieve – Sights around San José
NeenerNeener
Monroe County, NY:
65 new cases on 02/14/23.
95 new cases on 02/15/23.
94 new cases on 02/16/23.
Our new case counts are changing much in either direction.
rikyrah
Thank you for the continued information. I really appreciate it
NotMax
China lied, people died.
Amir Khalid
Malaysia’s Ministry of Health reported 281 new Covid-19 cases yesterday, for a cumulative reported total of 5,040,368 cases. 280 of these new cases were local infections; one new case was imported. It also reported no deaths, for an adjusted cumulative total that remains at 36,954 deaths – 0.73% of the cumulative reported total, 0.73% of resolved cases.
18,724 Covid-19 tests were conducted yesterday, with a positivity rate of 1.4%.
There were 9,399 active cases yesterday, 24 more than the day before. 319 were in hospital. Eight confirmed cases were in ICU; of these patients, two confirmed cases were on ventilators. Meanwhile, 257 patients recovered, for a cumulative total of 4,994,015 patients recovered – 99.1% of the cumulative reported total.
The National Covid-19 Immunisation Programme (PICK) administered 1,655 doses of vaccine on 16th February: 75 first doses, 73 second doses, 574 first booster doses, and 933 second booster doses. The cumulative total is 72,780,139 doses administered: 28,128,292 first doses, 27,540,389 second doses, 16,309,176 first booster doses, and 802,282 second booster doses. 86.1% of the population have received their first dose, 84.3% their second dose, 49.9% their first booster dose, and 2.5% their second booster dose.
Lapassionara
I ditto what Rikyrah said. Thanks, AL, for keeping us informed.
Matt McIrvin
The wastewater numbers around Massachusetts are still on a halting and bouncy decline from the 2022-23 XBB.1.5 wave. I’m not seeing anything like the rapid drop and temporary lull of a few months we got after the 2021-22 Omicron wave, probably because not as many people have post-infection resistance–we keep getting these local outbreaks. It probably is closer to what endemic COVID looks like, and it’s not a great picture. I can’t even tell if the deaths from the winter wave have reached their peak yet–the lags in these numbers and spotty cadence of reporting can make the profile of the peak hard to figure. It does seem to me as if the winter wave was deadlier here than it was in most of the country. My best guess is that that was because XBB.1.5 became dominant earlier here. If so that might imply that other areas are in for worse later.
I and my family are fine, showing no signs of permanent aftereffects from our bout in late January.
NotMax
Too many countries’ parties place a higher priority on the long-term continuation of governance over the long-term continuation of the governed,
SFAW
Meanwhile, in Real ‘Murica:
https://www.kpvi.com/news/regional_news/idaho-lawmakers-introduce-legislation-to-criminalize-those-who-administer-covid-vaccines/article_57de487d-c401-52b7-92a5-a3787ff39a1e.html
ETA: On NextDoor, in my area (central MA), there are a couple of anti-vaxxers who keep posting bullshit about how the side effects of the vaccines are worse than COVID. (OK, maybe I’m exaggerating a little, but not much.) Idaho’s idiocy is one of the results of this “thinking” carried to it’s end point.
Betty Cracker
Here in DeSantistan, the surgeon general our ambitious governor imported from California to undermine faith in public health measures is scouring data to find evidence to support his hypothesis (vaccines bad!) and writing to the CDC and FDA again. From The Tampa Bay Times:
Gotta feel for the UF professors who have to treat this raving nutjob (who makes double their salaries!) like a serious person.
Also, dog help us if any other contagious disease hits while these lunatics are in charge — and really a generation or more after they’re gone. They’ve thoroughly convinced a quarter to a third of the population that masks and vaccines are government mind control.
SFAW
@Betty Cracker:
Someone should ask DeathSanus whether he’s vaccinated (and boosted).
And the data I’ve seen — although I confess to not researching this assiduously — indicate that mRNA vaccines are relatively safer than the virus vector vaccines.
ETA:
Which is probably a nice way of saying Ladapo et al. started with a conclusion, then got the (selected) data to fit.
Searcher
@SFAW: Criminalizing the standard of care is kind of the Republican go-to move.
Matt McIrvin
@SFAW: I think DeSantis has said publicly that he got the initial shots but has refused to get any of the boosters. He may well be lying about all of this but who knows.
lowtechcyclist
@NotMax:
Let’s not overlook India. 126 cases, 1 fatality in a nation of 1.4 billion people? That would be a fucking miracle. And in each of these threads, India’s reported similarly miraculous numbers.
Matt McIrvin
(My best guess is that DeSantis is tailoring that message to match the behavior of the median elderly Fox News fan–many of them got the initial vaccine shots in winter/spring 2021 because when you’re old, you’re used to going to the doctor and doing what they say, but then they got sufficiently propagandized by Tucker Carlson or whoever to become belated antivaxxers. DeSantis was promoting vaccination during the initial push, too, but he sees which way the wind blows in right-wing territory.)
SFAW
@Matt McIrvin:
So you’re saying they got “woke” to the dangers [sic]of vaccines?
NotMax
@Matt McIrvin
Too busy stuffing fluorescent tubes up their butts to find time for medical treatment.
//
Matt McIrvin
@SFAW: There also seem to be a lot of people whose conspiracy brain gets triggered specifically by the idea of getting regular boosters indefinitely as opposed to a one-and-done shot. Getting one shot for something or other, that’s normal, but if you have to go back every year or every six months, now they own you.
Matt McIrvin
…Also, I think we can’t discount the influence of wingnut doctors and nurses, down to the GP level. Many may be avoiding booster vaccines because a medical professional told them to. The Florida government is bringing that pressure to bear from the top.
EarthWindFire
@Matt McIrvin: Yep. My spouse switched to another GP when his old one revealed herself as an anti-COVID vax nut. She’s apparently prescribed ivermectin and cured “thousands of patients”, according to an acquaintance of ours. And this is in a fairly liberal area where there is no statewide effort to discredit the vaccine.
Soprano2
I had a GP who wrote op-eds in the paper that revealed him to be a raving right-winger. I changed GP’s and found a younger doc who I like a lot better. I don’t know what his political leanings are because we never talk about politics, but he was happy that I got the Covid boosters so that’s enough for me. I never told that doctor why I switched; I can only imagine what he’s telling his patients about COVID.
I see China and India are reporting like conservative states, freely lying about the death toll.
dmsilev
@Betty Cracker:
VAERS is, by design, unreliable. It’s intended as a clearinghouse for any potential issues, just as a starting point for investigations rather than the final word. Famously, someone once sent in a report to VAERS saying that a vaccine turned him into the Incredible Hulk, and the report was accepted.
Matt McIrvin
@EarthWindFire: I am still a bit puzzled by the conversation I had with someone at the physical therapy gym I was using in 2021 (when medical folk could get vaccinated but few other people could), who said that all the therapists there were vaccinated except for one who had “sold her slot on eBay”. Yes, I am aware that is not supposed to be a thing.
YY_Sima Qian
On 2/15 the China CDC provided a summary of state of the COVID-19 pandemic in China as of 2/13:
As of 2/13, ~ 3,491M vaccine shots have been injected in Mainland China, 93% of the total population have taken at least 1 shot, 90.6% have completed their primary courses. Among the > 60 y.o. cohort, 96.1% have taken at least 1 shot, 96.6% of those eligible completed their primary courses, & 92.3% of those eligible taken at least 1 booster shot.
Taiwan, Hong Kong & Macau do not appear to be publishing daily data dumps, so I am using data from Worldometer.
On 2/16, Hong Kong reported 196 new positive cases & 2 new deaths. There have been 13,431 total COVID-19 deaths to date.
On 2/16, Macau reported 0 new positive cases & 0 new deaths. There have been 121 total COVID-19 deaths to date.
On 2/16, Taiwan reported 16,742 new positive cases & 61 new deaths. There have been 17,319 total COVID-19 deaths to date.
Matt McIrvin
@EarthWindFire: My GP is fine though she did at one point pass on the anecdotal reports of COVID vaccination causing shingles flare-ups (which did get some legit medical attention, and was not an obviously absurd idea, but much later turned out to not have statistical support). It wasn’t to warn me off COVID vaccines, though, it was to support my decision to get the second Shingrix shot first.
I did see firsthand (from her nurse practitioner, who did my so-you-got-COVID telemedicine call) the reluctance to prescribe Paxlovid for mild cases, but I believe that came from a reasonable interpretation of CDC/FDA guidelines–whether those guidelines are good or not is another question.
kalakal
Glad to say that both Mrs kalakal and myself seem to have weathered a week of Covid pretty well, I won’t say its been fun, but we’ve both had far worse illnesses.
More or loss feel back to normal, very slight sore throat, a bit sniffly and rather tired. Will take a test today I think.
Vaccines are wonderful, this is a disease that’s killed millions and we, 2 people in their 60s, basically had a bad cold and a mild fever
Matt McIrvin
@kalakal: Sounds like you got off easy with the sore throat–that was the worst for me. It wasn’t the first symptom like with many cases; it started late–but when it hit, it was one of the most intense sore throats I’ve ever had, a burning irritation more like a strep infection than like a typical cold.
I also had sort of a late symptom rebound where I felt like I was almost done, then got this sort of deep tracheal or bronchial cough. But that’s happened to me with the common cold before; it’s almost typical.
YY_Sima Qian
The CCP regime declaring “victory” over COVID-19 will only generate snorts in response from the vast majority of the Chinese population, & is transparently a face saving exercise. OTOH, I am not seeing much of a propaganda campaign for this. Pushing this narrative hard will only cause more resentment.
It’s actually worthwhile to click through to the NYT interactive page on the different models of COVID-19 related deaths through the exit tsunami. Of course, not knowing the parameters & assumptions that went into the different models, (we will have to wait for the peer reviewed papers), it is difficult to assess how good they are. Relatively small tweaks in the parameters & assumptions can have a large impact, but at least the NYT was good enough to show the confidence intervals, which in all but 1 models are quite wide.
The interactive also compared the average estimates of deaths in China calculated by the different models, & compared them to the ROW. The lowest average estimate among the models places China at just below Taiwan & Australia, the worst performing among former “Zero COVID” countries/territories (ex-Hong Kong). The highest average estimate among the models places China considerably higher than Taiwan & Australia, but still lower than countries that never practiced “Zero COVID” such as Canada & Israel, & much lower than the likes of the US & the UK. As I have said before, I highly doubt China managed to do as well as the likes of New Zealand & South Korea, due to the lower vaccination/boosting rate among the elderly vulnerables. To me, Taiwan represents the lower bound of China’s COVID-19 related deaths through the exit tsunami, since the elderly vaccination/boosting rates were likely similar before their respective openings. However, Taiwan has much greater health care resources per capita than China.
My best WAG remains ~ 800K – 1.2M deaths. I am skeptical of the models that calculated ~ 1.5 – 1.6M deaths. Hong Kong’s death rate through the 1st couple of waves would have translated to ~ 2.2M deaths for Mainland China’s ~ 1.4B people. Hong Kong’s > 80 y.o. vaccination rate was absolutely abysmal (< 30% fully vaccinated & < 10% boosted as of Feb. 2022) at the start of the exit wave. Mainland China’s > 80 y.o. vaccination rate was decidedly lackluster (~ 65% fully vaccinated & ~ 40% boosted) at the start of the exit tsunami, but nothing like Hong Kong’s level.
YY_Sima Qian
@kalakal: Glad to hear it!
VOR
Yes, I agree this is a serious concern. Epidemiologists like Dr. Michael Osterholm have been predicting a major epidemic for decades, but COVID is not what they expected. Apparently the ongoing bird flu has crossed species into marine mammals like seals. If it manages to mutate into a human flu then we are in big trouble.
This last election cycle the Republican candidate for Governor of Minnesota was a COVID-denying anti-vax medical doctor. Don’t tell me this is not a mainstream Republican position.
Jharp
“Now, Moderna will be the sole manufacturer of COVID vaccines offering its shot for free to the uninsured. Under federal regulation, insurance companies are already required to foot the bill for COVID vaccines.”
My very strong opinion is 99% of the dumbshits who refuse to buy health insurance will also be anti vaxxers.
Though maybe some kids with morons for parents will benefit.
SFAW
@Matt McIrvin:
What they don’t realize is that the first shot contained the Soros/Gates tracking-and-mind-control picochips, and that subsequent “boosters” are just to cover their (not needle) tracks. So those vaxxed-but-not-boosted quasi-anti-vaxxers are already primed to be turned into Sorosbots.
As the saying goes: Mwa-ha-ha-ha (and, yes, I’m rubbing my hands in an evil-scientist fashion while saying that)
kalakal
Hmmm. My Covid recovery may not be going as well as I thought. Mrs kalakal has just informed me today is Friday. Up till a minute ago I could have sworn it was Thursday . Not quite up to Ray Milland, he lost an entire weekend but none the less…
😄😄😄😄😄
Bill Arnold
TL;DR A large study shows that many autoimmune diseases are being diagnosed much more often in people who have had PCR-verified COVID-19. (“mortality” is added as a statistical check.) The adjusted hazard ratios are large, ranging from 1.78 to 3.21. Largish confidence intervals even though this is a big study. (hazard ratio is the risk ratio between tested-positive and not-tested-positive.)
Large study:
“Between January 1st, 2020 and December 31st, 2021, 3,814,479 participants were included in the study (888,463 cases and 2,926,016 controls).”
Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study (EClinicalMedicine, 9 January, 2023)
Bill Arnold
That The Economist piece is seriously downplaying the effects of SARS-CoV-2 infection. The large retrospective cohort studies e.g. the ones that involve the US VA records database make it clear that COVID-19 seriously increases the risk of many other conditions and is associated with increased risk of post-acute mortality.
In the US just acute cases are AFAIK Grim-Reaping at spot #3 after heart disease and cancer, and some heart disease is definitely being caused by COVID-19.
Barbara
@Bill Arnold: Of course this is my personal view only, but I think that it will take years to sort out the complications resulting from Covid — including whether it is so correlated with increased diagnosis of autoimmune disorders that it might be considered contributory. One of the many non-obvious things I have learned about our fragmented and insurance driven health care universe is that having a diagnosis can be important to actually receiving care. Physicians may feel that they should diagnose an autoimmune disorder in equivocal circumstances, rather than waiting and watching. I don’t know whether this is true with follow on symptoms of Covid, but I’ve seen it — especially with behavioral health issues. No diagnosis, no referral.
StringOnAStick
@Matt McIrvin: There’s plenty of wing nut MD’s and nurses; I’m related to some. Antivax medical people are nearly a 100% match with out there RW politics. I’m still amazed that my FOX watching, old Bircher father has been religious about getting every shot and booster, but he’s 91 and desperately afraid of dying.