Some vaccinated people are getting COVID. What does this mean?

Some vaccinated people are getting COVID. What does this mean?
By Kristen Panthagani, PhD

Delta is here and headlines are reporting the rise in new cases and hospitalizations, including some who have been fully vaccinated. What does this mean? Does the fact that some vaccinated people are getting sick mean the vaccines aren’t working?

Some breakthrough infections are expected

Thankfully, no. Even if a vaccine prevents 99% of infections, it is not 100% perfect. This statement should be obvious, but let it sink in for a moment. There are no vaccines that perfectly prevent every single infection, and this is to be expected. If a vaccine prevents 99% of infections, then there is 1% that it doesn’t prevent.  Sometimes there are clear reasons why a vaccine might not protect everybody — for example if someone is immunocompromised, their body might not form as strong as an immune response to the vaccine, which means they may not have enough immunity to protect them from getting COVID.

So how many breakthrough infections should we expect? Well, it depends on the population and how many people are vaccinated. This is where things can start to get counterintuitive, but I promise you it’s simple math and fractions. Here are a few examples.

Let’s say there is a population of 1,000,000 people, and today, 5% of them were exposed to SARS-CoV-2 (1,000,000 x 5% exposed = 50k people exposed). Now let’s say only 10% of them are vaccinated, so we have 50k exposed x 10% vaccinated = 5k vaccinated people exposed. In this hypothetical example, let’s say that the vaccine prevents 99% of infections, and without vaccination, everybody who gets exposed becomes infected.  How many breakthrough infections (infections in vaccinated people) would we expect? If there are 5k vaccinated people exposed and the vaccine prevents 99% of infections, then we would expect 5k x 0.01 = 50 breakthrough infections. When you’re looking at large groups of people, even when vaccines work very, very well, we do expect some breakthrough cases. These cases do not mean the vaccines aren’t working, they just mean the vaccines aren’t absolutely perfect (which we already knew).

If cases go up, breakthrough infections go up

Now let’s mess around with these numbers a little bit. Let’s say a more contagious variant has come through and instead of having 50k people exposed today, 100k people are exposed. What do we expect to happen to breakthrough infections? Let’s assume that the percent of the population that’s vaccinated remains the same at 10%. So we have 100k exposed x 10% vaccinated = 10k vaccinated people exposed. The vaccine is still preventing 99% of infections, so we would expect 10k x 0.01 = 100 breakthrough infections. So even though vaccine efficacy is unchanged, because more people were exposed, we got more breakthrough infections. Increasing numbers of breakthrough infections does not necessarily mean the vaccines are working less well, it might just mean that more people are getting exposed to the virus. 

If vaccinations go up, breakthrough infections can go up

Alright, now for the most counterintuitive piece. What happens if instead of 10% of the population being vaccinated, 90% is vaccinated? And let’s use all the same assumptions from the last example: 100k are exposed and the vaccine prevents 99% of infections. We would get 100k exposed x 90% vaccinated = 90k vaccinated exposed. The vaccine is still preventing 99% of infections, so our breakthrough infections would be 90k x 0.01 = 900 breakthrough infections.  That’s way higher than the last example! Why is it higher? Not because the vaccines are working less well, not because the virus is more contagious, but simply because there are more vaccinated people. So counterintuitively, if the virus is still circulating in a population, a higher vaccination rate will lead to higher numbers of breakthrough infections, because the overall number of vaccinated people has gone up. 

Once we reach herd immunity, that will no longer be the case, as the high level of vaccinations will slow the spread of the virus, leading to fewer cases overall (and thus fewer breakthrough cases). But until we reach that point and the spread of the virus is increasing, breakthrough cases will also increase.

In summary, the number of breakthrough infections is not only dependent on vaccine efficacy, but is also determined by other variables, including:

  • The number of people exposed to the virus
  • The percent of a population that is vaccinated (counterintuitively)

Percent of hospitalizations who are vaccinated is an unreliable metric

Alright, you made it this far. Ready for some more math? Here we go.

A lot of headlines are reporting COVID hospitalizations and listing the percent of the hospitalized patients that were fully vaccinated. Hearing something like ‘15% of hospitalized COVID patients were fully vaccinated’ is alarming, right? It makes it sound like maybe the vaccines aren’t working that well? While I get why this is a tempting statistic to report, it is actually a very unreliable metric to use to figure out how well the vaccines are working. That statistic is influenced by a whole lot of variables, only one of which is vaccine efficacy. Here’s another hypothetical example to show why this is true.

Let’s say there were 100,000 people all exposed to SARS-CoV-2 on the same day. And let’s say that for those who are unvaccinated, the risk of hospitalization is 10% (10% of unvaccinated who are exposed will end up in the hospital), while the risk of hospitalization for vaccinated people is only 0.5%. 

First, let’s figure out what the vaccine efficacy would be in this example. Vaccine efficacy for hospitalization is calculated as:

Said in words, it measures how much a vaccine reduces the risk of a bad outcome relative to that risk in an unvaccinated individual. If this is a little hard to wrap your head around, don’t worry, just trust the math. For our hypothetical example, the vaccine efficacy is (10% – 0.5%)/10% = 95% efficacy. For someone who has been vaccinated, the relative risk of hospitalization has been reduced by 95% compared to an unvaccinated individual.

Now let’s look at the number that headlines like to report (but is an unreliable way to assess how well the vaccines are working): the fraction of hospitalizations that were fully vaccinated. 

This is calculated as:

While this fraction may seem to intuitively capture how well the vaccines are working, it very much does not. 

To see why, let’s break it down into two parts: the numerator (the top part of the fraction) and the denominator (the bottom part of the fraction). I know you remember this from elementary school, but what are two ways to make a fraction go up? Either the numerator goes up, or the denominator goes down. For this statistic, both of these can happen without the vaccine efficacy changing one bit, which is why it’s an unreliable metric to use. 

The numerator

The numerator is defined by the total number of vaccinated people who have been hospitalized. This is different from the numerator in the vaccine efficacy calculation as it is not the risk of hospitalization, it is just the raw number of hospitalizations. Unlike vaccine efficacy, it does not take into account how many people were exposed leading to those hospitalizations. This leads to problems. 

For example, as we saw before, if a higher percentage of the population is vaccinated (and all other variables are held constant, including the number of people exposed), this will lead to more breakthrough infections, simply because there are more vaccinated people. Because of this, a higher percentage of vaccinated people in the population can counterintuitively lead to higher numbers of vaccinated hospitalized patients. I know this is very hard to wrap one’s head around, so here’s a visualization:

breakthrough vaccination covid hospitalization

This is our hypothetical example where 100,000 people are exposed to COVID all at once, and the risk of hospitalization for the vaccinated is 0.5% and for the unvaccinated is 10%. The only thing that is changing in this graph is the overall percent of the population who is vaccinated (listed at the top of the graph); the number of COVID exposures and the vaccine efficacy are not changing. The height of the bars represent the raw number of hospitalized people in each group, and the labels (for the left two bars) show those numbers as a percent of total hospitalizations. The label on the left above the light blue bar shows the percent of hospitalizations who are vaccinated: this is the unreliable metric we’ve been talking about.  (Please note so no one gets confused, this is an overly simplified model that is meant to illustrate concepts, not predict specifics of real world data.)

So what happens to that light blue bar as vaccinations go up? As the percent of the population who is vaccinated rises, the number of vaccinated people who are hospitalized goes up (height of light blue bar), simply because there are more vaccinated people overall. The degree of protection the vaccine provides does not change in this example. Only the percent of the community who are vaccinated is changing. The height of that light blue bar is the numerator in the unreliable fraction we’ve been discussing, and if the numerator increases, the fraction (the label above the light blue bar) will increase. This means that as more people in a population get vaccinated, all else being equal, the percent of hospitalizations who are vaccinated will go up, even though total hospitalizations are going down.

The denominator

Now let’s look at the denominator of the unreliable fraction: total COVID hospitalizations (the red bar). Remembering fractions, if the denominator goes down, the fraction goes up. What can make total hospitalizations go down? You guessed it: more vaccinated people. And that is what we see in this example: as the percent of the population that is vaccinated goes up, total hospitalizations go down, counterintuitively driving the % vaccinated hospitalizations even higher! 

But at the very end of the graphic, it finally becomes intuitive. What happens when 100% of the population becomes vaccinated? 100% of hospitalizations must be vaccinated people, because there aren’t any unvaccinated people. “100% of hospitalizations were vaccinated” may sound scary, but it is misleading and not the right thing to look at. When the graphic gets to the point where 100% of people (and hospitalizations) are vaccinated, total hospitalizations is at its lowest point. And that is what we really care about: total hospitalizations.

This is why looking at the percent of hospitalizations who are vaccinated is not a good way to assess vaccine efficacy. It is impacted by multiple variables including the vaccination rate in the community as well as any other variable that impacts the total number of hospitalizations. For example, what if elderly people are vaccinated first, then younger people are vaccinated later? In this scenario, as more people are vaccinated, the risk of unvaccinated people being hospitalized would drop, not due to anything inherent about the vaccine, but due to the dynamics of vaccine rollout (i.e. as vaccination progresses, the remaining unvaccinated are younger, and thus at lower risk for severe COVID). If the risk of hospitalization for the unvaccinated decreases, then: the total number of hospitalizations decreases, the denominator decreases, and the percent of hospitalizations who are vaccinated increases (even though the raw number of vaccinated hospitalized people is unchanged). I know that’s a lot, so here’s another graphic.

In this graphic (again a hypothetical scenario), to make things simple, the risk of hospitalization after vaccination stays constant at 0.5%, just like it was in the last example. However I made it so that as the rate of vaccination increases in the community, the risk of hospitalization for the unvaccinated decreases by 1% every time (it starts at 10% when nobody is vaccinated, then drops to 9% when 10% are vaccinated, then 8% when 20% are vaccinated, etc.). Please note this is an overly simplified simulation that is only meant to help you understand numbers and isn’t meant to model any specific real world situation.

If you compare it to the last graph, you will see that the height of the light blue bar (representing raw number of vaccinated hospitalizations) is identical. This makes sense, because the risk of hospitalization after vaccination is unchanged from the last example (it’s still 0.5% the whole time). But if you look at the label above the light blue bar, that is different compared to the last time: the fraction increases faster. Why? Look at the red bar: total hospitalizations drop faster compared to the last example. And because total hospitalizations is the denominator of the unreliable fraction, if they decrease faster, the fraction increases faster, even though the total number of vaccinated people who were hospitalized is unchanged.

This is an oversimplification because in the real world, if the demographics of the vaccinated group are changing as more people become vaccinated, you might expect the average risk of hospitalization for the vaccinated group to change as well (whereas in this example, it is held constant at 0.5%). Despite this simplification, the graphic still illustrates the overall point: if there are underlying demographic differences between the vaccinated and unvaccinated groups that impact their risk of hospitalization, then these differences in demographics can influence the fraction of hospitalized patients who are vaccinated, independently of any true change in how well the vaccine is working.

So, are the vaccines working?

So all that to say, figuring out how well the vaccines protect against the delta variant is complicated, and it takes more than looking at the percent of infections, hospitalizations, and deaths who have been vaccinated. To really figure it out, you have to take into account the overall number of people who have been vaccinated, how many people have been exposed (i.e. how fast delta is spreading through a community), the differences in age and underlying risk factors between vaccinated and unvaccinated groups, etc. That’s more than can fit in a headline, but if these variables aren’t considered, then it can lead to misleading conclusions.

So are the vaccines still working, even with delta circulating?

Yes. The figure below is a nice, big-picture way to visualize it: compare total cases to total deaths. In the past (pre-vaccination) era, every time cases went up (blue), deaths went up (red). But now in countries where a sizable portion of the country is vaccinated (UK and Portugal in this example), in recent weeks as cases have gone up, deaths have not gone up nearly to the same degree. The same is not seen for countries with low vaccination rates. 

If you’re looking more for specific numbers on vaccine effectiveness against delta, here’s a nice summary of some of the studies so far. A study published today in the New England Journal of Medicine assessing the effectiveness of the Pfizer vaccine against the delta variant found that vaccine effectiveness was 88% against symptomatic disease, while effectiveness against the alpha variant was 94%. A not yet peer-reviewed study assessing the delta variant found that the Pfizer vaccine was 96% effective against hospitalization. Check out this article for more details on other vaccines and variants. As delta continues to surge, I’m sure we will continue to have more analyses looking at vaccine effectiveness in the coming weeks. 

Delta is serious, and there will be some breakthrough infections. But this does not mean the vaccines aren’t working. The vaccines don’t completely eliminate the risk (as no vaccine ever does), but they do greatly reduce it. To figure out precisely how much they reduce the risk takes more than simple headlines, but requires nuanced, complex analyses that take into account many different variables, some of which may seem counterintuitive. And thankfully, so far the data has shown that the vaccines significantly reduce the risk of severe disease, even against delta. If you haven’t already, please look into getting vaccinated. The benefits of vaccination far outweigh the risks.

(Want more information on the COVID vaccines? Check out this article with a list of answers to frequently asked questions I’ve gotten about COVID vaccine side effects and efficacy.)

Pandemic contradictions: a sign of false information

Pandemic contradictions: a sign of false information
By Kristen Panthagani, PhD

One of the reasons false information and pandemic rumors can be so confusing and exhausting is the high degree of self-contradiction. Granted, not everyone believes every rumor simultaneously, but overall self-contradiction is often a hallmark of inaccurate information, and exposure to many different self-contradicting narratives (often with lots of emotion attached to them) can be highly disorienting and confusing. Here are a few examples I’ve run into over the last year:

“Spike protein shedding from vaccination makes it dangerous to be around vaccinated people” and “spike protein shedding from COVID infection is no big deal and there’s no need to social distance or wear a mask.”

“SARS-CoV-2 is not that dangerous” and “SARS-COV-2 is so good at making humans sick that it was clearly engineered.”

“A ~1% death rate from COVID is not a big deal” and “an extremely rare (<0.001%) nonfatal side effect from a vaccine is a very big deal.”

“If a 75-year-old with pre-existing conditions gets COVID and dies from pneumonia 4 days later, COVID was not the true cause” and “if a 75-year-old with pre-existing conditions gets the vaccine and dies from pneumonia 4 days later, the vaccine was definitely the true cause.”

“Most COVID cases are false positives” and “the case fatality rate is overestimated.” (If there were, in fact, fewer true COVID cases due to false positives, that would make the case fatality rate much higher.)

“Saying that ‘COVID is dangerous’ is fear-mongering” and “saying that ‘there is a massive network of elites who are secretly conspiring to take over the world by introducing a genetically engineered virus and forced vaccination with microchips’ is not fear-mongering.”

“The SARS-CoV-2 spike protein is dangerous” and “SARS-CoV-2 is not dangerous.”

“Foreign, non-replicating RNA from the vaccine inside human cells is dangerous” and “foreign, self-replicating RNA from the virus inside human cells is not a big deal.”

“Immune systems are naturally strong; they can handle the virus without help from the vaccine” and “immune systems can’t handle masks.”

“An observational study of ~30 people is enough to justify giving hydroxychloroquine for COVID” and “A randomized, blinded placebo-controlled trial of ~30,000 people is not large enough to justify giving the vaccine.”

“COVID isn’t real” and “COVID is a bioweapon.”

“The COVID vaccines contain unnatural ingredients that shouldn’t be put in a human body” and “livestock preparations of ivermectin are a good treatment for COVID.”

If you’ve felt like your brain has been in a fog trying to sort through all the COVID information out there, this may be part of the reason why. Self-contradicting narratives can create a swirl of confusion that makes it hard to know what is what. Hopefully seeing some of these contradictions clearly laid out makes it easier to see how these rumors don’t hold up.

If you’d like more information on some of the statements above, here are some explanations that go into the detail of the science behind them:

What do we do when experts disagree?

What do we do when experts disagree?
Kristen Panthagani, PhD

A friend of mine recently asked me how I respond to people who have opposing views about scientific issues like vaccines, and as evidence they cite people with credentials (i.e. PhDs, MDs) who agree with their position. This is a great question, and something I encounter all the time. Here are my thoughts.

Do credentials matter? On one hand, yes they do, because somebody who has gone through medical school has much more training in medicine than someone who has never taken care of a patient. Likewise, someone who has a PhD in the biological sciences has much more training in interpreting biological research studies than someone who has never done research before. So training matters, and credentials are a mark of training.

On the other hand, people can hold advanced degrees and still be very wrong. And if we blindly believe someone because they have an MD or PhD, what happens when another MD or PhD disagrees with them? We are at an impasse. The idea that the person with higher scientific credentials must be right is a logical fallacy called the appeal to authority fallacy. It is not always true that the person with higher credentials is correct; reality does not bend to the will or whims of experts.

So, if one expert says one thing and another says the opposite, what do you do? Right now I think this one is especially confusing, because the scientific community says “trust the experts!” but then when an expert says something a bit weird, they say “ignore them!” The rules of science are this: the best data and the best analysis win. It does not matter who is saying it; the data and analysis are all that really matter. Often, scientists with more credentials are better at recognizing good data and analysis, so that is why it usually makes sense to “trust the experts!” But sometimes, an expert or two might latch onto bad data for a variety of reasons (they got overly attached to their hypothesis and want to be right, they have a financial conflict of interest, the science conflicts with their ideological views, they need an audience, they are speaking outside their area of expertise). In these cases, it is best to ignore them.

So how do you handle this? The ideal way is to go look at the data for yourself. Unfortunately, effectively interpreting scientific literature requires a lot of training, and it is not a task I would put on someone who does not have a science or medical background. When people without the prerequisite scientific and medical training go and research a topic, usually what ends up happening is they read other people’s simplified interpretations and summaries of the data, rather than diving in the data for themselves. So they are not doing research in the scientific sense; rather they are gathering simplified summaries provided by other people (which are sometimes mixed with a large serving of opinion and speculation). This is through no fault of their own, as interpreting scientific data takes a lot of background knowledge and practice, and is not easily learned without formal training.

Does that mean people without a science or medical background should just give up? Not at all. I do recommend people “do their research” and read other people’s simplified summaries and interpretations. But as they do so, it’s important to recognize that they are not interpreting the primary data for themselves and rather are choosing which experts to trust and which experts to ignore.  Sometimes when a person decides which expert to trust, that decision may be influenced by factors other than the expert’s credentials or the validity of their argument. For example, maybe someone trusts a scientist because what they’re saying also happens to align with their political views, and their summary of the science is more appealing. This can happen on both sides of the political aisle.

Second, when trying to figure out what’s true, I would recommend taking into account what the majority of scientists are saying — often this will lead you to the right answer. If there are 10 doctors saying one thing and there are 10,000 doctors saying a different thing, chances are the 10,000 doctors are right. There are of course some cases in history where the 10,000 doctors were wrong, but those are the exceptions, and ultimately the lone crazy ones won them over with the data.

So to get back to my friend’s question, how would I respond to someone who is arguing a scientific point that is false but cites credentialed scientists who support that view? First, I try to get more information on what that scientist is saying. Sometimes there are legitimate points, and then we have some common ground to agree upon. But sometimes the statements of the scientist are completely baseless. In those cases, I try to focus more on the data and the rationale behind the arguments, rather than a battle of which credentialed person carries more weight.

But it’s also important to remember that the major issue behind these arguments often isn’t about data or credentials; it’s about trust. Many people simply don’t trust the CDC, the WHO, and other institutions, and are looking for other experts whom they feel are more trustworthy. Someone can bring all the data and reasoned arguments in the world, but if there isn’t any trust there, it’s probably not going to do much.

Dealing with anxiety and OCD during the pandemic

Dealing with anxiety and OCD during the pandemic
Interview with Dr. Eric Storch, PhD

While this blog is usually focused on COVID-19 and helping debunk misinformation, this post is a different. For this post, I wanted to dive into one of the other major health crises caused by the pandemic: the profound impact on mental health.

I had the opportunity to talk with one of my research collaborators, Dr. Eric Storch, a clinical psychologist who specializes in treatment of anxiety and obsessive-compulsive disorder (OCD). We talked about the mental health challenges brought on by the pandemic, both for the general public and those with pre-existing mental health disorders like anxiety and OCD. It was one of the most helpful conversations I’ve had during the pandemic; I hope it helps you too!

What is Obsessive-Compulsive Disorder?

Before we get to the interview, a brief background on OCD. While anxiety is generally well understood, OCD is less so. Many think of OCD as more of a personality trait, describing people who need things to be perfectly straight or need everything to be ‘just so.’ But that does not accurately describe the disease. OCD is a mental illness that is deeply distressing and exhausting. It is defined by people who have obsessions (such as unrelenting fear that the front door may be unlocked, possibly leading to a break-in) followed by compulsions that aim to unsuccessfully relieve that fear (repeatedly checking the door is locked, over and over, to the point where they are late for work.) Obsessions and their corresponding compulsions may vary widely — some examples are obsessions about germs (triggering a compulsion of excessive hand-washing), obsessions of religious guilt (triggering compulsions of repeated prayer rituals), obsessions of accidentally causing harm to others (causing compulsions of re-driving routes, making sure they didn’t accidentally hit a pedestrian), obsessions about being in the wrong relationship (causing compulsions of excessively monitoring their feelings and comparing to other relationships), obsessions about accidentally harming a newborn child (causing compulsions of excessively checking on the baby in the middle of the night), and many others. One of my good friends is making a documentary on some of the lesser known subtypes of OCD; check out her video at the end of this post to learn more. Dr. Storch specializes in treating OCD patients, which often includes helping them directly confront their fears and obsessions through exposure therapy.

Interview has been edited for length and clarity.

Kristen: Hi Dr. Storch! Thank you so much for being the very first interviewee for my blog! So my first question is more general: what are the mental health issues that have become more common during the pandemic, and do you have any recommendations on how to help people deal with them?

Dr. Storch: So the first question is certainly a complex one. Broadly speaking, those people that have had a mental health problem, usually it’s gotten worse during the pandemic, and there have also been significant increases of mental health problems overall. So at a given point about one in five people are struggling with a mental health issue, and this has gone up to about three in ten to four in ten. The most common have been depression, anxiety, and substance abuse. And when I say substance abuse I’m not talking about sitting at home with your spouse and having a bottle of wine each night. I’m talking about real substance abuse, like real hard-core stuff. As for the depression and anxiety — I think that people aren’t able to cope the ways that they used to and they aren’t able to connect with people. Anxiety is very much about the uncertainty of the world, and in addition to the pandemic you layer on these issues with social justice and political division. I think a lot of these things have come together and made for a very difficult year. For kids, one of the things that, on top of those factors, came out was that we saw reductions in reporting of child abuse. And in spouses, particularly women, we saw increases in reports of domestic violence (DV). The increase in DV is attributable to the fact that for people in abusive relationships, they’re now around each other 24/7. But the child abuse stuff and the fact that reports are going down – this is because you aren’t seeing the kids at school or at the doctor. So you’re really relying on a parent to report it, to say ‘yeah I beat my kid’, or a kid directly saying it, which just doesn’t happen as much. So those are a couple other facets that have been really concerning over time. And then across all these, when there’s some sort of additional stressor, that makes it worse. So like if you lose a job, you have financial stressors or you are at risk for COVID yourself or get COVID, these stressors exacerbate the problem at hand. So I think the uncertainty associated with these additional stressors sort of dumped another gallon of gas on the fire… or you know, I think we’re passed just dumping gas, I think it’s really kind of blown up.

There have been some silver linings – for example, telehealth has improved access to mental health services. I mean think about — if you lived in rural Texas hours away from a hospital, you could still see me. And there’s some movement to deregulate some of the state licensing boards or state licensure to make it more national so that that expertise can cross state lines. So in the case of OCD, there aren’t enough providers at this point, so now we’re increasing access via telehealth and that’s a good thing. At the same time, some of the challenges still persist like not enough providers or how many providers actually take insurance. So, you know, I think that those problems are still in place and it won’t change anytime soon.

Another silver lining is we’re talking about mental health even more than we did a couple years ago, and it’s not simply because someone shot up a school; it’s because people are aware that people are struggling. So I think that’s another positive. But again for the interventional components, it’s all about identifying the issues and then reaching out, and I think telehealth has improved that in some regards. But at the same time for a lot of people it’s not a good fit — I mean for a young person who’s capable and tech savvy it’s fine, but for every 30-year-old out there there’s a 70-year-old out there trying to figure out zoom who’s like ‘how do I do this?’ So we have to think about social determinants of health, and tech is a social determinant of health.

Kristen: Absolutely. How about for people who deal with anxiety or compulsions, and now they’re living in this pandemic, do you have advice on how to help them decide if their response (i.e. sanitizing, wiping down everything) is an appropriate level of caution, or if they’re going overboard and can tell themselves ‘no I don’t need to scrub that for the fourth time?’

Dr. Storch: I think there are a few ways you can think about it. And the first is: ask if the response is getting in the way? Is it causing impairment? For example, no one likes wearing a mask… it’s not fun. But it doesn’t really impair us: it’s just sort of an annoyance. So this would be an example of an appropriate response that’s not overboard, as you’re still able to function. The second piece to consider is the level of distress the trigger causes you. When you come across the trigger (say, during the pandemic, a grocery order is delivered to your house), how does your response compare to other people you know? Do you wipe down every single item with Clorox wipes three times? This is a really important additional feature to consider. I always joke back in the day there were those ‘What Would Jesus Do?’ wristbands, and I like to encourage people to think about someone who is a steady solid person in their life and who responds to situations well, and ask yourself what they would do in the same situation. Let’s say that person’s name is Ben – so I tell them to look and see if Ben’s worried about a given situation and how he’s responding to it, and use that as a sort of barometer on whether or not they should be concerned or if their response is inappropriate. If Ben wouldn’t wipe down the groceries three times, then maybe that’s an overly cautious and unnecessary response. So it’s sort of comparing yourself to other people in terms of your level of distress and how that’s comparing to your barometer. It’s also important to appreciate that there is some natural variation in how people respond to situations, and that’s absolutely fine. But that’s when you go back to that notion of impairment and duress – ask yourself if this response is causing you significant impairment in your life.

Another point to consider is the context of where you are, and that things change based on context. For example, if someone’s at summer camp in East Texas, certain kind of standards of hygiene might be a little bit different than if someone is scrubbing in before a surgery, and that’s a good thing. And along those lines, inflexibility tends to characterize more distressing responses. For example, if someone has to wash their hands the same way before a meal as they would before a surgery, and they get really upset if they aren’t able to maintain that high level of cleanliness in every situation, it is in those moments where you might think something is amiss.

Kristen: That makes perfect sense. So it’s really that concept of excess that is key. So we’ve been talking about these more general, collective stressors like the pandemic, the political tension, the social justice issues, and I know for me those are the ones I’ve felt the most because I haven’t lost my job or gotten sick. But there are also the acute stressors, for example having a loved one die of COVID or losing a job – do you have a sense of what’s been the biggest driver of people’s general deterioration in mental health during the pandemic?

Dr. Storch: Yeah I think that the uncertainty is really a major driving force behind this. I think the most helpful kind of thing I might say is focus on trying to bring about certainty. So even when you think about OCD and anxiety, one of the driving factors is this aspect of doubt and uncertainty. So with anxiety, it might be ‘am I going to get a good job, and what if I don’t?’ It’s all about feeling uncertain if I will or won’t get it, and that makes me really uncomfortable. Or I’m not sure if my house will be broken into. And I think COVID has jumped on that anxiety surrounding uncertainty: how long will this go? Will we ever be able to see family again? Will my business stay afloat? Will my job be cut? All of these things come in and bring uncertainty. I think the best idea is to try to introduce certainty into your life as much as you can. For example, my wife would chew a lot on whether or not we should take a trip – say it was September and we were thinking maybe things will be different in November? They probably won’t, and instead of leaving it up in the air, to bring more certainty, just plan that they won’t be so that at least for that trip, the decision is certain.

Kristen: I really like that – do you have another example of how people can try to introduce certainty in their day-to-day lives?

Dr. Storch: So if you’re concerned that there may be financial ramifications, consider what can you do now to prepare for that. Maybe you kind of pull back on certain things and start saving a little bit of money. That would be one example. Or if you’re in one of these high risk groups, saying OK here are the things I can do to maintain safety. I think a lot of people take a passive approach, which problematic for folks because they’re making the decision to let something else make decisions for them, and that brings more uncertainty and stress. And ultimately you may be wrong, you may make the wrong choice and cancel a trip that didn’t need to be cancelled, but you made a choice still. All of the behavioral therapies that we do involves making a choice to confront as opposed to avoid. When you’re depressed and we’re doing something called behavior activation, it is making a choice to get out and be active, or confront a problem as opposed to avoiding it.

I think the other piece of learning how to cope effectively is finding meaning and perspective. There is old psychiatrist, now deceased, Viktor Frankl who was in the Holocaust. And I love his concept of in the face of unmovable obstacles, it’s about changing your perception of those obstacles and finding meaning in your response to them. So our entire world has been upended and so thinking about how do you arrive at meaning, how do you change the way you’re perceiving this in order to move forward. From the meaning standpoint, perhaps it’s that we did our small part – how we helped people.

Kristen: Man’s Search For Meaning by Viktor Frankl is one of my all time favorite books. (Everybody should read it.) So my last question — you’ve already touched on this a bit, but what are the most effective strategies for dealing with anxiety and stress during the pandemic? When I’ve googled this, all I find is stuff like breathing exercises and stuff like that, which… maybe that is helpful, but was hoping there was more than that. So what actually works? 

Dr. Storch: If we’re talking clinically, I think one of the most effective tools is the idea of exposure. With exposure therapy all you’re doing is exposing people to the excessive and what doesn’t reflect reality. In the course of COVID, our risk level has gone up, so things we might not have previously had to do, now we have to do, so we tailor our treatment to current public health standards. Now what’s important is that for most people, their OCD isn’t centered around contamination stuff, and when it is, it’s really specific. We’ve had some folks where contamination OCD is all about COVID, but for the majority it’s not. It’s the same old stuff they had before the pandemic, for example… They’re worried that if they see a red spot, that’s blood, and they could get HIV from that. Now even when someone does have COVID-related OCD — your public health guidelines are really clear on what the appropriate response is: you wear a mask and social distance, and it’s the excess that’s really the problem. Going out and getting your groceries to go? Not excessive. Washing your hands after being outside? Not excessive. And we always want to target the stuff that’s in excess.

So to your question of what’s helpful, I think it’s really directly confronting the excessive, exaggerated triggers that are provoking anxiety. It’s all about learning, in essence, what is the feared outcome that I have? And that’s I think the key. It’s not about being reckless. For example, if someone is someone’s OCD is a fear of accidentally stabbing themselves with a hypodermic needle and contracting disease – when we say ‘confronting the fears’, we’re not going out and having them dip their hands in sharp boxes. We might go and touch the outside of a sharps box. But there’s a clear line between what’s actually dangerous and the hypothetical exaggerated danger that can trigger these excessive responses. And the second piece is to reflect on how you’re interpreting the world and tweak it to be consistent with the way the world operates. Third thing is do the stuff that makes you feel good. Like exercise on a daily basis, get a good night’s sleep, hang out the people you love. All these things make a huge difference. And then pursue areas that you weren’t able to pursue but that give a sense of meaning, whether it’s family game night to doing things to help other people, I think all of these things are ways of taking control of the situation and also feeling better about yourself.

To learn more about Obsessive-Compulsive Disorder, stay tuned for thie documentary Mind Games, produced by my good friend and cousin Rachel Immaraj. Learn more about her story in the video below.

The author(s) of this blog are responsible for the blog content; statements on this website do not necessarily reflect the official views of the authors’ employers or affiliated institutions. This blog is not intended to provide medical advice; please consult with your physician if you have questions about medical treatments or health concerns.

Fact-Check: Dr. Mercola’s “How COVID-19 ‘Vaccines’ May Destroy the Lives of Millions”

Fact-Check: Dr. Mercola’s “How COVID-19 ‘Vaccines’ May Destroy the Lives of Millions”
Kristen Panthagani, PhD

There is an article circulating entitled “How COVID-19 ‘Vaccines’ May Destroy the Lives of Millions” (on Mercola, it’s behind a subscription wall) that is arguing that the COVID vaccines are dangerous. I have seen this article reposted multiple times on his site, so I thought I’d go ahead and debunk it. Here are the summary points from the article, and why they aren’t true.

Claim 1: “The COVID-19 vaccine really isn’t a vaccine in the medical definition of a vaccine. It’s more accurately an experimental gene therapy that could prematurely kill large amounts of the population and disable exponentially more.”

This claim has several falsehoods in it, so let’s address them one at a time. First, the medical definition of a vaccine is a substance that induces an immune response to a pathogen, building immunity to it. Therefore, the COVID vaccines are vaccines, because they induce immune responses to the pathogen SARS-CoV-2, and after people have been vaccinated, they have immunity against COVID.

Are the mRNA vaccines "experimental?"

Now the “experimental gene therapy” claim. First, when we call a drug or vaccine experimental, what does that mean? It means that the drug or vaccine is currently in the testing stage (clinical trials). For example, if someone has cancer, their doctor might recommend they enroll in a clinical trial that is testing a new experimental treatment. It is unknown whether the treatment will work on not, so it is called “experimental.”

So, are the COVID mRNA vaccines still in the testing stage? No. They have already completed the testing stage, which was the Phase III clinical trials. The test to see if the vaccines work has been completed, and we know the results (they work very well), so these vaccines are no longer “experimental.” If you’d like to understand the results of the clinical trial yourself, here is a video that explains it.

Are the mRNA vaccines "gene therapy?"

Now, the gene therapy claim. Are the COVID vaccines gene therapy? Traditionally, the term “gene therapy” is used to describe a treatment that inserts a piece of DNA into the human genome to fix a broken human gene (DNA code), often through use of a viral vector. Is that what the COVID mRNA vaccines are doing? Not at all. The mRNA vaccines do not use a viral vector, they are not made of DNA, they do not edit the human genome, and their purpose is not to fix a broken human gene. Here is an explanation of the difference between DNA and mRNA, and why the COVID mRNA vaccines will not alter your genome.

Are the mRNA vaccines dangerous?

Now the final claim in this statement: that the vaccines “could prematurely kill large amounts of the population and disable exponentially more.” This is not true. The mRNA vaccines were tested in tens of thousands of people during the phase III clinical trials, and there were no serious adverse events related to the vaccines in these trials.

And just like we do for every other vaccine, we are still monitoring for vaccine safety even after the mRNA vaccines were authorized for general use. One way we do this is through the Vaccine Adverse Events Reporting System (VAERS). This is a website where anyone who experiences any negative health event after receiving the vaccine can report it. And doctors are required to report any deaths that occur after vaccination.

But, it’s very important to note that these VAERS reports are made regardless of whether or not the vaccine had anything to do with the negative health event. Someone could die of a drug overdose after getting the vaccine, and that could be reported to VAERS. That does not mean that the vaccine caused a drug overdose; that would be physically impossible. 

So, how do we tell if the events reported to VAERS are caused by the vaccine or not? By analyzing the reports, and comparing them to background levels of those same events. Let’s look at miscarriages as an example. Miscarriage is quite common: an estimated 1 in 8 pregnancies ends in miscarriage. So if you tracked 80 different pregnant women, about 10 of them would likely report miscarriages due to natural causes. Now let’s say all of those 80 woman got vaccinated. You would still expect about 10 of them to have miscarriages for reasons unrelated to the vaccine. But to each individual, the reason for miscarriage is often unknown, so those women might report their miscarriage to VAERS, uncertain if the vaccine caused it or not. Because millions of people are getting vaccinated right now, we expect that some negative health events will happen near the time of vaccination, just due to chance. The way we test if the vaccine actually had anything to do with the negative health event is to look at the VAERS reports and see if the rate of that health event reported to VAERS is higher than would be expected from other causes. If it is, then that tells us the negative health event might be connected to the vaccine. If it’s not, then that tells us that these VAERS reports are likely capturing background levels of that health event, unrelated to the vaccine. And so far, that is what we see for miscarriages: rates of miscarriage reported to VAERS are not above the expected background levels of miscarriage.

Claim 2: “Since mRNA normally rapidly degrades, it must be complexed with lipids or polymers. COVID-19 vaccines use PEGylated lipid nanoparticles, and PEG is known to cause anaphylaxis.”

It’s true that mRNA rapidly degrades, and it’s true that they are stabilized in part by putting them in a tiny drop of lipid (lipid is the medical word for fat). My friend Dr. Sana Zekri has written a little bit about this here. And it’s true that there have been super rare reports of anaphylaxis after some of the mRNA vaccines. So far, 5 people out of every 1,000,000 people who have gotten the Pfizer vaccine have had anaphylaxis, and 3 out of every 1,000,000 people for the Moderna vaccine. Anaphylaxis is dangerous but treatable, so that is why they are screening and keeping a close eye on people who have a history of anaphylaxis.

Claim 3: “Free mRNA can signal danger to your immune system and drive inflammatory diseases. As such, injecting synthetic thermostable mRNA (mRNA that is resistant to breaking down) is highly problematic as it can fuel chronic, long-term inflammation”

This statement seems to be implying that the mRNA vaccines will never degrade and will just circulate for a long time in the human body because they are ‘thermostable,’ in turn causing all sorts of problems. First, this is not true. Second, this is kind of odd given Claim #2 from this same article, which talks about how the mRNA is fragile. So what is the truth; is mRNA fragile or is it so stable it will stay around forever? 

The answer is mRNA is fragile, and is definitely not ‘thermostable’. The word ‘thermostable’ means stable at warm temperatures. In the lab when we work with mRNA, we have to constantly keep in cold (on ice) to keep it from degrading. There is a joke in research that if you look at your mRNA sample wrong, it will degrade. (This is why I personally hate working with RNA, and prefer DNA, which is much more stable). The mRNA vaccines also require cold temperatures to be stable, which is why they are stored at very cold temperatures. So no — these mRNA vaccines are not “thermostable”, and they do not circulate in your body indefinitely, but are degraded relatively soon after they are injected.

Claim 4: “Many commonly reported side effects from the COVID-19 gene therapy “vaccines” appear to be caused by brain inflammation.”

Uhhh… nope. Brain inflammation would cause things like altered mental status, memory loss, inability to walk, etc. I am guessing what they’re trying to blame on “brain inflammation” is actually reactogenicity, which are the signs of the immune system appropriately responding to the vaccine. These are the same symptoms of a mild cold like fatigue, fever/chills, etc. These are normal and expected, and not signs of “brain inflammation.”

Claim 5: “Anyone with an inflammatory disease such as rheumatoid arthritis, Parkinson’s disease or chronic Lyme and those with acquired immune deficiency/dysfunction from any microbial pathogen, brain trauma or environmental toxin are at high risk of dying from COVID-19 mRNA vaccines”

From a medical perspective, this is essentially a very random list of syndromes that honestly just doesn’t make any sense. It’s like they pulled a random list of diseases out of a hat. But to address their claims, there is no evidence that the COVID mRNA vaccines increase risk of death. In the clinical trials, there were no deaths caused by the vaccines, and in the ongoing monitoring of the vaccine safety data, the rate of death is proportionate to what is to be expected in the population at large. You have to remember that on average in the US, ~7500 people die every day due to all sorts of causes. And when millions of people are being vaccinated, that means that some people will happen to die (from other causes) close to the time of vaccination. This does not mean the vaccine caused it — to figure that out, you have to look and see if there is an increase in deaths relative to what’s expected. Here’s what the data shows:

Reports of death after COVID-19 vaccination are rare. More than 339 million doses of COVID-19 vaccines were administered in the United States from December 14, 2020, through July 19, 2021. During this time, VAERS received 6,207 reports of death (0.0018%) among people who received a COVID-19 vaccine. FDA requires healthcare providers to report any death after COVID-19 vaccination to VAERS, even if it’s unclear whether the vaccine was the cause. Reports of adverse events to VAERS following vaccination, including deaths, do not necessarily mean that a vaccine caused a health problem. A review of available clinical information, including death certificates, autopsy, and medical records, has not established a causal link to COVID-19 vaccines. However, recent reports indicate a plausible causal relationship between the J&J/Janssen COVID-19 Vaccine and TTS, a rare and serious adverse event—blood clots with low platelets—which has caused deaths.” Source: CDC

For more details and context on how to interpret the VAERS reports, check out this post.

Heard another rumor about COVID vaccines not addressed here? Check out this post tackling 10 common COVID myths circulating online, explaining why none of them are true.

Ten COVID mRNA Vaccine Myths Debunked

Ten COVID mRNA Vaccine Myths Debunked
By Kristen Panthagani, PhD

Here are some of the most common myths I’ve seen circulating online about the mRNA vaccines, and why they don’t hold up. Please share with those trying to sort vaccine fact from fiction.

Myth #1: The COVID mRNA vaccines aren't actually vaccines, they are experimental gene therapy.

A vaccine is a substance that stimulates an immune response, providing immunity against a pathogen. The COVID vaccines do that; they are vaccines. They are also not ‘experimental.’ That term is used to describe vaccines or therapeutics that are currently being studied in clinical trials. Once the clinical trials have been completed, as they have been for the mRNA vaccines, they are no longer ‘experimental.’ The experiment (the trial) has been done, and we know the results. They are also not gene therapy in the sense that they do not alter human DNA, and their purpose is not to replace a faulty human gene, which is what we usually think of when we say ‘gene therapy.’

Myth #2: The COVID mRNA vaccines aren't vaccines because they don't prevent people from getting infected and they don't prevent transmission.

The COVID vaccines do prevent symptomatic infection very, very well. That is what the clinical trials showed. The issue of transmission is a little more complex – the trials didn’t specifically study if the vaccines prevent transmission, they only studied if the vaccines prevented symptomatic infection. So the trials didn’t give us any data on whether or not they prevent transmission, and we couldn’t say one way or the other. That being said, the fact that they prevent symptomatic infection makes many scientists very hopeful that they will prevent transmission, and there is now data coming out to support this. What’s definitely false is to say that we know the vaccines *don’t* prevent transmission. That’s not true.

Update: since writing this article, more studies have come out looking at asymptomatic infection after vaccination, and guess what?! They significantly reduce asymptomatic infection too.

Myth #3: There are no data supporting the safety and efficacy of the vaccines.

False. Both mRNA vaccines have completed stage 1, 2, and 3 clinical trials, which is the standard set of clinical trials for safety and efficacy testing of any vaccine or therapeutic. Here is the data for the Pfizer vaccine, here is the data for the Moderna vaccine.

Here is a much easier way to understand the data (this is for the Pfizer vaccine specifically):

Myth #4: VAERS reports show that lots of people have been having serious reactions and dying from the vaccines.

False. The Vaccine Adverse Events Reporting System (VAERS) is a system that allows anyone to input any event that is temporally related to the vaccine, but may or may not actually be connected to the vaccine. They are not confirmed reports, anyone can log in and file something. Someone could die in a car accident driving home from getting the vaccine, and that could be entered as a report as ‘temporally related to the vaccine.’ But clearly, vaccines do not cause car accidents. You can’t just read the reports and assume everything in there was truly caused by the vaccines. That doesn’t work — it takes analysis of the VAERS data compared to background levels of those events to determine if there is a causal link with the vaccine. The CDC has done this, and has found that majority of the VAERS reports are mild side effects like fatigue and headache. They also analyzed the deaths and compared it to the expected rate of death in the population, and have not found any results to suggests deaths are causally related to the vaccine.

Myth #5: The COVID mRNA vaccines contain aluminum, mercury, and heavy metals.

No they don’t. The ingredients are:
1. The mRNA
2. Lipids (types of fat), including polyethylene glycol (PEG)
3. Salts (containing ions that are naturally found in the body)
4. Tromethamine (commonly used to maintain pH balance, Moderna vaccine only)
5. Sucrose (sugar)


Here are the sources for Pfizer and Moderna vaccine ingredients.

Myth #6: The mRNA vaccines contain aborted fetuses.

False. Vaccines do not contain aborted fetuses. Some vaccines do use what are called fetal cell lines. This is not the same thing as fetal tissue. Fetal cell lines are cells that were derived from a sample taken from a single aborted fetus decades ago, and a few of the cells have been artificially replicating in a lab since then. Cell lines like this are common in science for all sorts of tissue types, not just fetal cells (adult kidney cell lines, adult lung cell lines, etc.) When you hear about ‘in vitro’ studies or testing drugs in a dish, they often use cell lines like these. Some vaccines use fetal cell lines to produce the vaccine (for live attenuated virus vaccines), but the fetal cell lines are not included in the final vaccine preparation. There are never any fetal cells in any vaccines. Furthermore, as the mRNA vaccines are not live attenuated virus vaccines, fetal cell lines are NOT used to produce the mRNA vaccines. Sometimes fetal cell lines are used in one or more of the experiments in the lengthy development process of vaccines, but not in the final vaccine production step. The mRNA vaccines did use fetal cell lines in one of the research steps. You can read more about that here. It’s important to note that the use of fetal cell lines is not specific to vaccine research, as these cell lines are widely used in many areas of medical research.

Myth #7: The PEG used in the mRNA vaccines is highly toxic and dangerous.

False. PEG, which stands for polyethylene glycol, is a type of lipid (fat) that is used to coat the mRNA vaccines, as well as other therapeutics. It is also commonly used as a laxative (miralax). PEG does seem to cause anaphylaxis very, very rarely. Remember that things like peanuts can cause anaphylaxis as well, yet we don’t label them as ‘toxins’ or start campaigning against peanut butter. If peanut butter could prevent COVID, I don’t think anyone would be labeling it as highly toxic or dangerous, but of course we would not give it to people who had a peanut allergy. Same thing goes for the vaccines — the risk of anaphylaxis is very, very low for the general population, but of course we’re going to be careful with people who have a known allergy. 

Here is a published review of cases of anaphylaxis after COVID vaccination.  They found the chance of anaphylaxis was 5 in a million for the Pfizer vaccine, and 2.5 in a million for the Moderna vaccine. While anaphylaxis is certainly serious, it is also readily treatable with epinephrine, and nobody died from the anaphylactic reaction.

Myth #8: The mRNA vaccines will make women sterile.

False. This was based on the rumor that there was similarity between the COVID spike protein used in the vaccines and a protein in the placenta. But they aren’t similar. There is no issue. I wrote a whole blog post about this one, check it out here.

Myth #9: The COVID mRNA vaccine side effects are as bad as getting COVID.

False. The COVID mRNA vaccines can cause mild side effects like fever, chills, and malaise shortly after getting the vaccine. These are usually mild and last only a day or two. I experienced these side effects after my second dose; it was about the intensity of a mild cold, and only lasted about 8 hours. While this is slightly worse than the side effects of other vaccines like the flu shot, it is nowhere near as bad as getting COVID. Even when people don’t have to be hospitalized, COVID infection can make people sick for weeks. I’ve heard it described as ‘the sickest I’ve ever been in my life.’ And for some, they never fully recover. Some people have not been able to taste food for months. And, of course, COVID can kill people. So the side effects from the vaccine, while slightly annoying, are nothing compared to COVID.

Myth #10: If I get the vaccine and I have a rare reaction, it will be my fault, but if I decline vaccination and then get COVID, it's not my fault.

I think this logical flaw trips up a lot of people when weighing the risks and benefits of vaccines. No vaccine (or any drug, for that matter) is 100% without side effects, and so you always have to weigh the risk of the side effects against the risk of the disease the vaccine is protecting against. In the case of the COVID vaccines, the risk of serious side effects are minuscule, and the risk of serious complications from COVID are substantial. So the math clearly favors getting the vaccine. But one thing that can throw people off is many people feel like they’ll be more ‘responsible’ if they have a rare side effect from the vaccine (because they made an active decision to get vaccinated), but will feel less ‘responsible’ if they get COVID after declining vaccination, since that’s based on a passive decision not to get the vaccine. So don’t let this logical flaw trip you up. If you don’t get the vaccine, you’re at way higher risk for getting COVID. If a person has the opportunity to prevent something from happening and they choose not to, they are still responsible for the outcome of that decision.

When you can never be wrong: the unfalsifiable hypothesis

When you can never be wrong: the unfalsifiable hypothesis
By Kristen Panthagani, PhD

If there was one single scientific concept I could teach everyone in the country right now it would be this: what is an unfalsifiable hypothesis, and why do they confuse everyone.

This concept alone explains a lot of the confusion and conspiracy theories around the COVID pandemic… why many still insist that Bill Gates was involved in planning the pandemic or that there are microchips in vaccines. 

What is a hypothesis?

Before we get to unfalsifiable hypotheses, let’s start with what a hypothesis is. In very simple terms, a hypothesis is a tentative explanation that needs to be tested. It’s an idea formed on the available evidence that is maybe true, but still needs to be explored and verified. For example, at the beginning of the pandemic, many had the hypothesis that hydroxychloroquine is an effective treatment for COVID.  

Hypotheses are the jumping off points of scientific experiments. They define what question we want to test. And that brings us to one of the most important qualities of a valid scientific hypothesis: they must actually be testable. Or said another way, they must be falsifiable.

What is a falsifiable hypothesis?

What does it mean for a hypothesis to be falsifiable? It means that we can actually design an experiment to test if it’s wrong (false). For a hypothesis to be falsifiable, we must be able to design a test that provides us with one of three possible outcomes:

1. the results support the hypothesis,* or

2. the results are inconclusive, or 

3. the results reject the hypothesis. 

When the results reject our hypothesis, it tells us our hypothesis is wrong, and we move on.

*If we want to be nitpicky, instead of saying the results ‘support’ our hypothesis we should really say ‘the results fail to disprove our hypothesis.’ But, that’s beyond the scope of what you need to know for this post.

When the results reject our hypothesis, it tells us our hypothesis is wrong, and we move on.

That is the hallmark of a falsifiable hypothesis: you can find out when you’re wrong. So then, what is an unfalsifiable hypothesis? It is a hypothesis that is impossible to disprove. And it is not impossible to disprove because it’s correct, it’s impossible to disprove because there is no way to conclusively test it. For unfalsifiable hypotheses, every test you run will come up with not three, but two possible outcomes: 

1. the results support the hypothesis or

2. the results are inconclusive. 

Results reject the hypothesis‘  is missing. No amount of testing will ever lead to data that conclusively rejects the hypothesis, even if the hypothesis is completely wrong.

For unfalsifiable hypotheses that happen to be true (i.e. love exists), this is not a huge issue, because it’s usually pretty obvious that they’re right, despite their unfalsifiability. The problem arises for unfalsifiable hypotheses that are more tenuous claims.

In these cases, people may deeply believe they’re right, in part, because it is impossible to find conclusive evidence that they’re wrong.  Every time they try to test if their claim is true, they only find inconclusive evidence. And again, this is not because the hypothesis is correct, it’s because the hypothesis is set up in a way where a definitive “no that’s wrong” is impossible to find. A great example is the hypothesis that there are microchips in the vaccines. You could say ‘well just look in one and see if it’s there!’ And somebody checks and finds no microchip. End of story? Well no.. someone could argue ‘well the microchips are just too small to detect!’ or ‘They will know to take it out of the vials before they are scanned!’ Excuses are made so that the negative results are no longer negative results, but instead are inconclusive. Thus every possible result from any test we do can be deemed inconclusive by those who believe the hypothesis is correct. This makes the hypothesis, for the sake of the people who believe in it, unfalsifiable. This is why conspiracy theories are so hard to debunk… many of them are unfalsifiable hypotheses.

Why do these trap people so effectively? Two reasons. First, for a believer of the hypothesis, all they see is inconclusive data (which they can usually make fit their narrative). They never see any data disproving it, so it makes it easy for them to believe they’re right. And second, because it’s impossible to conclusively disprove it, we can’t go and… conclusively disprove it. This makes it easy for people to stay trapped in an unfalsifiable hypothesis they want to believe in, even when it’s 100% wrong.

So how do you know if you’ve been trapped into believing an unfalsifiable hypothesis? Ask yourself… how would I know if this was false? What evidence would come forward that would convince me? If the answer is ‘well, I’m waiting for the results of this study to decide‘ or ‘I’m waiting for the outcome of this particular event to know,’ then that suggests you’re not trapped in an unfalsifiable hypothesis, as you are open to actual evidence showing you that you’re wrong. (But, only if you do actually change your mind if that evidence fails to support your hypothesis, rather than finding an excuse why that event or evidence doesn’t actually disprove it.)

But, if the answer relies not on specific events or outcomes but primarily on the opinion of other believers, then you may be trapped in an unfalsifiable hypothesis, because that isn’t evidence… it’s just group think.

Fact-checking Dr. Frank Shallenberger’s COVID Vaccine Letter

Fact-checking Dr. Frank Shallenberger’s COVID Vaccine Letter
By Sana Zekri, MD

There has been a letter circulating written by Dr. Frank Shallenberger emphasizing the uncertainty and alleged danger of the COVID vaccine. However, much of the information is either blatantly false or taken out of context. Below is a point-by-point response to the claims of Dr. Shallenberger, including sources.

“Dear Patients and Friends,

Last week I must have been asked 20 times about the new COVID vaccines. Here are my thoughts. Please pass this information onto many as you can. People need to have fully informed consent when it comes to injecting foreign genetic material into their bodies. The COVID vaccines are mRNA vaccines. mRNA vaccines are a completely new type of vaccine. No mRNA vaccine has ever been licensed for human use before. In essence, we have absolutely no idea what to expect from this vaccine. We have no idea if it will be effective or safe.”

It is true that these are the first mRNA vaccines to be deployed. However, this is a culmination of years of research; the tech has been under research as a potential vaccine and cancer fighting methodology for years. Dr. Shallenberger’s claim that ‘we have absolutely no idea what to expect… if it will be effective or safe’ is not true. The short-term safety and efficacy are known because that’s what the clinical trials were for. This is how safety and efficacy of all vaccines and drugs are evaluated. Among the 22,000 people who received the Pfizer vaccine and the 15,000 who received the Moderna vaccine, there were no major safety issues, and the vaccine was ~95% effective at preventing COVID infection. For comparison, if a total of 37,000 people of similar demographics to the vaccine trials were infected with COVID, we would expect more than 350 deaths, based on a case-fatality of 1%, and an unknown number of people with persistent symptoms, respiratory disease, and other organ failures.  It is true that the long-term outcomes of the vaccine are not known. But, we also don’t know the long-term outcomes from COVID infection. So, as of right now, based on the data that we have, these mRNA vaccines are much, much safer than getting infected with COVID, by a huge margin. For a more thorough dissection of the safety data on the vaccine as well as a discussion of long-term side effects, see this video.


“Traditional vaccine simply introduce pieces of a virus to stimulate an immune reaction. The new mRNA vaccine is completely different. It actually injects (transfects) molecules of synthetic genetic material from non-humans sources into our cells. Once in the cells, the genetic material interacts with our transfer RNA (tRNA) to make a foreign protein that supposedly teaches the body to destroy the virus being coded for. Note that these newly created proteins are not regulated by our own DNA, and are thus completely foreign to our cells. What they are fully capable of doing is unknown.”

First of all, he keeps using the phrase “genetic material,” which is confusing. The vaccines use mRNA, which is very, very, very different than DNA. The injected mRNA encodes for the spike protein of the novel coronavirus. Getting into the details of how our cells convert mRNA to proteins using tRNA and liposomal fusion and whatnot is beyond the scope of this answer. What is important to know is that the mRNA cannot affect our DNA, and it cannot change our genetic code. Dr. Shallenberger also suggests that because the protein is completely foreign, we have no idea what impact it will have. But that’s not a valid argument, because that’s literally the same way that all other vaccines work: all vaccines expose you to “foreign” proteins from the virus, and your immune system responds to the foreign protein, forming immunity to it. This is also how our bodies generally create immunity – the body recognizes foreign proteins or particles (antigens) and the body produces antibodies that are designed to neutralize those antigens. Your body is exposed to foreign proteins constantly; this is why we have immune systems. The last part of his statement is fallacious due to the premise of the first part of his statement.

“The mRNA molecule is vulnerable to destruction. So, in order to protect the fragile mRNA strands while they are being inserted into our DNA they are coated with PEGylated lipid nanoparticles. This coating hides the mRNA from our immune system which ordinarily would kill any foreign material injected into the body. PEGylated lipid nanoparticles have been used in several different drugs for years. Because of their effect on immune system balance, several studies have shown them to induce allergies and autoimmune diseases. Additionally, PEGylated lipid nanoparticles have been shown to trigger their own immune reactions, and to cause damage to the liver.”

We must first address the quietly asserted idea that mRNA inserts into our DNA. The mRNA does not insert into our DNA. mRNA does not have the capability of inserting into DNA. DNA is scanned to make mRNA, but mRNA is not scanned to produce DNA in the cell. This is basic biology.

Next, we will address the claims regarding polyethylene glycol, or PEG. First, it is important to know, though, that using PEG to coat medicines has been around since the 1970s, and PEGylated medicines have been on the market since 1990, in the United States. PEG can also be used as a laxative when ingested, and is used in facial fillers for cosmetic procedures, and is a common component in beauty products. The medicines that are typically PEGylated are usually administered in much larger amounts than what is used in the vaccine. So there is more PEG dosage with other PEGylated medicines than with these mRNA vaccines.  The dosages of PEG in these vaccines are miniscule.

PEG coating allows certain medicines to last longer in our body and prevents those medicines from overstimulating the immune system and degrading quickly, as Dr. Shallenberger accurately posits. The medicines that are usually PEGylated actually become more inert by being PEGylated, because PEGylation tends to limit the amount of immune reaction and cross-reactivity. There are some rare case reports of PEG being associated with different auto-immune problems, but aside from these being so rare that it took thousands and thousands of people to get PEG drugs before these was found to be possible problems, there are no trials that actually demonstrate this effect, only case reports. Regarding his claim about liver toxicity — earlier, less refined versions of PEG were found to sometimes accumulate in the liver, but they did not demonstrate signs of causing liver toxicity. For a discussion of the rare incidences of anaphylaxis after COVID vaccination in individuals with a history of allergies, see this article.

“These new vaccines are additionally contaminated with aluminum, mercury, and possibly formaldehyde. The manufacturers have not yet disclosed what other toxins they contain.”

This is blatantly false, the ingredients are listed here for the Pfizer mRNA vaccine and here for the Moderna mRNA vaccine. Check out this explanation of what some of these ingredients are.

“Since viruses mutate frequently, the chance of any vaccine working for more than a year is unlikely. That is why the flu vaccine changes every year. Last year’s vaccine is no more valuable than last year’s newspaper.”

Dr. Shallenberger’s assertion is only partially true. Some viruses do mutate frequently, others do not. The polio vaccine and measles, mumps, rubella vaccine have not significantly changed since they were first introduced because the viruses are so stable. So far, unlike its coronavirus cousins, the novel coronavirus does not appear to undergo rapid mutation, particularly in the important spike protein domain, which is what the mRNA vaccine induces immunity against. For a more detailed discussion of the recent UK strain and what that means for vaccination, check out this article. However, regardless of how long the current vaccines provide immunity, the idea that it is somehow useless, even if immunity doesn’t last forever, is completely false. 

“Absolutely no long-term safety studies will have been done to ensure that any of these vaccines don’t cause the cancer, seizures, heart disease, allergies, and autoimmune diseases seen with other vaccines. If you ever wanted to be guinea pig for Big Pharma, now is your golden opportunity.”

Dr. Shallenberger is pointing out that this vaccine does not have long term safety data for it. He is 100% correct. It would be good to acknowledge that other vaccines do have rare adverse events associated with them, and very rarely those adverse cause chronic health problems. However, when you are looking at the risks of the vaccine, you have to weigh them against the risks of the disease it is protecting against. A good case to look at is the relationship between measles infection and the uniformly fatal pansclerosing encephalitis that rarely affects people years after they get measles. People vaccinated against measles don’t die of immediate measles-related disease, and also do not die of late onset pansclerosing encephalitis. Overall, more lives are saved and more morbidity is avoided by vaccinating against measles, despite adverse events from the vaccine, than by letting measles run rampant.

At the end of the day, neither COVID nor the COVID vaccine have long term data, but as a physician, I can personally tell you that people who get COVID and survive don’t always just go back to normal. And we still don’t know the longer-term outcomes associated with infection because… the virus has only been around for a year.

“Many experts question whether the mRNA technology is ready for prime time. In November 2020, Dr. Peter Jay Hotez said of the new mRNA vaccines, “I worry about innovation at the expense of practicality because they [the mRNA vaccines] are weighted toward technology platforms that have never made it to licensure before.” Dr. Hotez is Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine, where he is also Director of the Texas Children’s Hospital Center for Vaccine Development.”

I don’t know the context of Dr. Hotez’s quote and couldn’t find the interview where he said that – though I believe it’s something he could have said. Dr. Hotez has been quoted as recently as November 25th that he would take any effective vaccine that was developed including the Moderna one, with the expectation that additional vaccines will also be developed if the vaccine pans out to be less effective in the long term. Dr. Hotez says this not because immunity waning is an expected outcome, but because Dr. Hotez is a super practical man. He was my professor in medical school. Recently, he himself received the Pfizer mRNA vaccine, thus it is inaccurate to suggest he is somehow opposed to these vaccines.

‘Michal Linial, PhD is a Professor of Biochemistry. Because of her research and forecasts on COVID-19, Dr. Linial has been widely quoted in the media. She recently stated, “I won’t be taking it [the mRNA vaccine] immediately – probably not for at least the coming year. We have to wait and see whether it really works. We will have a safety profile for only a certain number of months, so if there is a long-term effect after two years, we cannot know.”’

This quote from Dr. Michal Linal is taken out of context. What she actually said was that she believes in the safety of mRNA vaccines, though she doesn’t know whether or not there will be prolonged immunogenicity, again, because of the lack of time-based data. Here’s the actual full interview for context.

‘In November 2020, The Washington Post reported on hesitancy among healthcare professionals in the United States to the mRNA vaccines, citing surveys which reported that: “some did not want to be in the first round, so they could wait and see if there are potential side effects”, and that “doctors and nurses want more data before championing vaccines to end the pandemic”.’

I don’t know what to tell you, people make bad bets all the time, including doctors and nurses. Many people were feeling hesitant about the vaccines until the safety data came out, and then made an informed decision based on that data. If the deluge of vaccine selfies in my social media feed is any indication, many health care providers are quite enthusiastic about getting the vaccine.

“Since the death rate from COVID resumed to the normal flu death rate way back in early September, the pandemic has been over since then. Therefore, at this point in time no vaccine is needed. The current scare tactics regarding “escalating cases” is based on a PCR test that because it exceeds 34 amplifications has a 100% false positive rate unless it is performed between the 3rd and 5th day after the first day of symptoms. It is therefor 100% inaccurate in people with no symptoms. This is well established in the scientific literature.”

This statement is blatantly false. Death rates from COVID-19 are consistently and considerably higher than seasonal flu and even the most recent epidemic flu. Also, COVID is not the flu. Furthermore, it’s not just cases that are increasing: hospitalizations and deaths are increasing as well. We have several articles on this very blog where Dr. Panthagani and I write about the difference between COVID and the flu, the difference in the death rate, and also the false assertion regarding ‘false positive pandemic’.

“The other reason you don’t need a vaccine for COVID-19 is that substantial herd immunity has already taken place in the United States. This is the primary reason for the end of the pandemic.”

I don’t know what the basis of this claim is, but it is also blatantly false. The fact that our hospitals are filling up with COVID patients speaks pretty definitively to the fact that we don’t have enough herd immunity to keep our ICUs and hospitals from filling up.

“Unfortunately, you cannot completely trust what you hear from the media. They have consistently got it wrong for the past year. Since they are all supported by Big Pharma and the other entities selling the COVID vaccines, they are not going to be fully forthcoming when it comes to mRNA vaccines. Every statement I have made here is fully backed by published scientific references.”

He doesn’t include any references.

“I would be very interested to see verification that Bill and Melinda Gates with their entire family including grandchildren, Joe Biden and President Trump and their entire families, and Anthony Fauci and his entire family all get the vaccine.”


“Anyone who after reading all this still wants to get injected with the mRNA vaccine, should at the very least have their blood checked for COVID-19 antibodies. There is no need for a vaccine in persons already naturally immunized.”

This is one of Dr. Shallenberger’s few reasonable points that might hold water. There is a different risk:benefit ratio for those who have already gone through COVID because there is likely a lower risk of infection in these people, and so the benefit of vaccination is lower. It should be noted; however, that there are documented cases where people have gotten COVID more than once and the second time was worse than the first time. 

Of course, as has been pointed out before, we do not know if vaccine-mediated immunity to COVID 19 will still be effective a year from now. That’s something only time will tell. Here is what the CDC currently says about the need to get vaccinated after getting COVID:

“Due to the severe health risks associated with COVID-19 and the fact that re-infection with COVID-19 is possible, people may be advised to get a COVID-19 vaccine even if they have been sick with COVID-19 before. At this time, experts do not know how long someone is protected from getting sick again after recovering from COVID-19. The immunity someone gains from having an infection, called natural immunity, varies from person to person. Some early evidence suggests natural immunity may not last very long. We won’t know how long immunity produced by vaccination lasts until we have a vaccine and more data on how well it works. Both natural immunity and vaccine-induced immunity are important aspects of COVID-19 that experts are trying to learn more about, and CDC will keep the public informed as new evidence becomes available.”

“Here’s my bottom line: I would much rather get a COVID infection than get a COVID vaccine. That would be safer and more effective. I have had a number of COVID positive flu cases this year. Some were old and had health concerns. Every single one has done really well with natural therapies including ozone therapy and IV vitamin C.. Just because modern medicine has no effective treatment for viral infections, doesn’t mean that there isn’t one.

Yours Always,

Frank Shallenberger, MD, HMD”

There are several problems with this statement. First of all, COVID is far, far, far more dangerous than the vaccine. Second, Dr. Shallenberger keeps calling COVID the flu. It is not the flu. Finally, it should be noted that Dr. Shallenberger’s ‘ozone therapy’ is not in any way a ‘natural treatment’, as it involves injecting ozone gas into the blood (ozone is a free-radical producing oxygen molecule) which does not happen ‘naturally’. Here is what the FDA has to say about ozone. For more information on Dr. Shallenberger’s background, check out this article.

Dr. Sana Zekri, MD is a Family Medicine with Obstetrics Physician. His particular interests are in public health, global health, women’s health and working towards justice in medicine. He is currently an Assistant Clinical Professor at SUNY Upstate, in Syracuse, New York. The views expressed on this website do not necessarily reflect the official views of the author’s employers or affiliated institutions.

A scientist looks at the COVID vaccine data

A scientist looks at the COVID vaccine data
By Kristen Panthagani, PhD

Trying to decide if you’re going to take the COVID vaccine? Me too. And I decided the best way to make that decision was to look through the data. I figured there are a lot of people like me who want to understand the data for themselves. So if that’s you, check out this hand-animated walk through of the Pfizer COVID vaccine safety and efficacy data.


A big thank you to Dr. Peter Hotez, MD, PhD for taking the time to answer some questions for this video!

Minor notes:

Side effects shown at @3:48 are common side effects for ages 16-55 after Dose 1. Side effects were generally lower for age 55+, and higher after Dose 2 for both age groups. I didn’t want to overwhelm people with graphs so didn’t draw out every single one; see all side effect data here. If you’re curious why the participant numbers @1:52 and @7:09 don’t perfectly match, see Figure 1 here


@9:13 Vaccine efficacy of 95% indicates that the relative risk of getting COVID is reduced by 95% with vaccination relative to placebo.

What are mRNA vaccines, and will they turn me into a GMO?

What are mRNA vaccines, and will they turn me into a GMO?
By Kristen Panthagani, PhD

COVID vaccines are on the horizon! And sadly, vaccine misinformation is on the rise as well. One claim that has been circulating for a while now is the idea that mRNA vaccines will somehow mess with people’s DNA and turn them into genetically modified organisms. Is this true?


Lol no. Not at all. Here’s why.


What is mRNA?

Before we get to the vaccine, let’s start with some basics of what mRNA is. You may remember that RNA has something to do with DNA, and they share two of the same letters so they’re probably related. Turns out you’re right… they are related, but they are not the same thing.

DNA is the stuff that makes up your genome. Think of DNA as the official master copy of your genetic code. Every cell (with a few exceptions) has its own master copy which contains the instructions to make all the machinery in the cell. Because it’s the master copy, DNA is guarded very, very carefully. And you probably remember that DNA is a code… there are only four letters in that code (A, C, G, and T), and with those four letters, all the instructions for the human body are spelled out. 

But DNA doesn’t actually do the stuff in the cell, it only has the instructions for it. So how does the cell turn those instructions into actions? The first step is to make a photocopy of the specific instructions needed for whatever task is at hand. Those photocopies are made out of RNA. There are different types of RNA, but for the sake of this blog, all you need to know about is messenger RNA (mRNA). mRNA is essentially a photocopy of small segments of your genome. 

So what does mRNA do (and why is it in a vaccine?). mRNA meets up with some machinery in the cell (ribosomes, to be specific), and translates the four letter mRNA code into proteins. Proteins are built of amino acids, and every three letter sequence in the mRNA code corresponds to a specific amino acid (for example, the sequence G-A-C encodes for the amino acid called aspartate.) As ribosomes read through the mRNA code, a protein is formed by making a chain of amino acids in exactly the right order based on the mRNA sequence. Those amino acid chains then fold up in just the right way to make a functional protein, which then go do their job inside the cell.

Why are we putting mRNA in vaccines?

Vaccines work by introducing a small part of a virus or bacteria (but not the whole thing) into the body so that our immune systems can learn to recognize it. In the past, scientists have done this by taking one of the viral proteins and putting that protein in the vaccine. Our immune systems learn to recognize the viral protein, and then we are ready to attack it when the real virus comes around. 

The idea behind mRNA vaccines is we are going one step upstream in this process. Instead of putting the viral protein in the vaccine, we put the instructions for the viral protein in the vaccine: the mRNA. Our cells automatically know what to do with mRNA and will translate it into the correct protein. In the case of the COVID vaccine, the mRNA encodes for the coronavirus spike protein. Then, just like with other types of vaccines, our immune systems will learn what that spike protein looks like and will form antibodies against it. Then, if the real virus comes around, we will already have the antibodies ready to destroy it.

So, will mRNA vaccines mess with my genome?

No. This process only runs in one direction. DNA encodes for mRNA which encodes for proteins; this doesn’t run in reverse. mRNA does not do anything to your DNA. And this is why your genome is 100% safe from any foreign mRNA you may encounter. Your cell knows not to edit something as important as its master copy (DNA) because a random photocopy (mRNA) came around. There are molecular fail-safes to make sure this never happens. So no, mRNA vaccines will definitely not turn you into a GMO.

Still confused? For this topic in particular, I think pictures are helpful. So I made my very first You Can Know Things video which explains what mRNA is, how it encodes for proteins, and why the COVID vaccines most definitely will not turn you into a GMO. Check it out!