By now you’ve probably heard there’s a new Covid booster available, designed to give greater protection from the Omicron variants BA.4 and BA.5. (New Covid Boosters Coming Soon) This is the first improvement in the Covid vaccine since its original production in 2020. This new vaccine will also provide protection from the original Covid variants.

Covid has now become endemic, just like influenza. That means we can expect it to remain in our population indefinitely, with seasonal variations, must like the flu. For most people, especially the elderly and those with compromised immune systems, this means an annual Covid booster, just like the flu. The question now is when to take the boosters and should they be taken together or separately?

The White House is promoting people take them together. That should make you skeptical right away.  Ashish Jha, White House Covid coordinator, on September 6^th said, “I really believe this is why God gave us two arms — one for the flu shot and the other one for the Covid shot.” Does he really believe that was God’s motivation to give us two arms? On the other hand, Dr. Anthony Fauci, President Biden’s chief medical adviser, says, “Get your updated Covid-19 shot as soon as you are eligible.” So, should you follow the White House’s advice and get both boosters right away?

Medical experts may differ in their opinions, and they often do. But there is plenty of evidence to suggest separating the two boosters makes sense. The reason for this is based on the knowledge that flu vaccine effectiveness erodes pretty quickly over the course of a flu season. A vaccine dose given in early September may offer little protection at the height of the flu season which is usually in February or even March. “If you start now, I am not a big fan of it,” said Florian Krammer, an influenza expert at Mount Sinai School of Medicine in New York. “I understand why this is promoted, but from an immunological point of view it doesn’t make much sense.”

Helen Branswell, writing for Statnews.com, says a number of studies have shown that the benefit of a flu shot wanes substantially over the course of a flu season – exacerbating effectiveness problems that are frequently seen when some of the strains in the vaccine aren’t well matched to the strains making people sick. Work done by researchers from the Kaiser Permanente Vaccine Study Center and the Harvard School of Public Health estimate vaccine effectiveness declined by about 18% for every 28-day period after vaccination.

A study done by scientists at the Centers for Disease Control and Prevention (CDC) and elsewhere showed that the vaccine’s protection against flu that is severe enough to trigger hospitalization decreased by between 8% and 9% per month after vaccination. In older adults, who are more likely to get seriously ill from flu, the decline happened at a rate of about 10% to 11% per month.

“You’ve got about four months of pretty solid protection,” said Emily Martin, an associate professor of epidemiology who specializes in flu at the University of Michigan School of Public health. Martin was an author of this study.

When is the right time to get your flu shot?

Most experts will advise you to wait at least until the end of October to get a flu shot, though they’ll attach the caveat that if you start to hear about flu activity picking up where you live, you should accelerate your plans. “I’ll follow very carefully the activity in the community,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “If it starts to pick up, I’ll move immediately. Otherwise, I’m counting on sometime in late October, early November.”

As usual, getting your healthcare advice from the White House is probably a bad idea.

Our federalist system is designed to allow states to be “laboratories of democracy” where policies can be tried at the state level before they become nationalized. This is a good thing. Just look at the state of California for validation of this thesis. One look at how California is addressing climate change and you know what not to do in your state.

The Wall Street Journal editorial board calls out California for their man-made energy crisis. They say, “Californians narrowly averted rolling blackouts on Tuesday, but the threat looms all week amid an unpleasant but not unusual heat wave. This ought to be a warning about how the government force-fed green energy transition is endangering grid reliability, but Democrats and the media can’t break out of their climate-change conformity to think clearly, or think at all.”

Climate change seems to be the knee-jerk explanation for everything that goes wrong in California – heat wave, drought, water shortage, blackouts, brownouts, high gas prices – you name it. But WSJ editors say California’s climate hasn’t suddenly changed. Triple-digit temperatures aren’t unprecedented even in early September, despite Governor Gavin Newsome’s claims. After all, most of California is a natural desert. What has changed in recent years is California’s electric generation.

Solar and wind power have rapidly expanded thanks to rich government subsidies along with the state’s renewables mandate. California recently outlawed sales of all gas-powered vehicles by 2035 (see Green Energy Delusions). These policies have made it harder for baseload gas and nuclear generators that run around the clock to make money. Many have shut down, and the result is that the state often lacks sufficient power when the sun goes down.

California’s summer electric generation capacity increased by about 10,700 megawatts (MW) between 2010 and 2020 – potentially enough to power eight to ten million homes. The problem is that gas-fired capacity during this time declined by 4,390 MW and nuclear by 2,150 MW. Solar and wind surged 17,000 MW, but those sources can’t be commanded to run when people need them. (This energy can’t be efficiently stored.)

Therefore, the state must rely on imports from other states in the evenings, especially during heat waves. But these imports are becoming less dependable since California’s neighbors are also losing base-load generators owing to their own renewable buildouts. Arizona lost about half of its summer coal-generating capacity between 2015 and 2020.

(Sounds much like the U.S. dependency on foreign oil imports when we could be drilling for that oil in our own country.)

The result of these policies is an energy crisis when heat waves span the Southwest like the one this past week. That means asking users to turn up their thermostats and providing incentives for industrial businesses to power down. A desalination plant in Carlsbad cut water production by about 20% earlier this week to free up power for homes. That only adds to the stress when the state is also experiencing a drought.

In other crisis intervention steps, the state has installed temporary gas-fired generators to run during grid emergencies. In other words, the state that is working so hard to banish fossil fuels has become more dependent on them. Los Angeles’ municipal utility is generating nearly 30% of its electricity from coal, some of which is being shared with the rest of the state. Imagine how much worse this situation will be when gas-powered vehicles are eliminated! WSJ says, “Call it Gavin Newsom’s dirty little climate secret.”

The cost of this energy policy malpractice is not just uncertainty about energy availability. Electricity prices in California’s wholesale market surged Tuesday evening to about $1,700 per MWh compared to the normal $100 and $67 a year ago. All of this explains why residential electric rates in California have risen by 50% in the past two years – three times more than they have nationwide.

Californians paid on average about 29 cents per kilowatt hour in June, by far the most in the continental U.S. and twice as much as in neighboring states. Rates are only going higher. Green-energy subsidies don’t make electricity cheaper. They create market distortions that threaten the grid and raise prices.

Aren’t you glad we can learn from California’s mistakes?

The wait in line at the fast-food restaurant is getting longer. So is the que at the check-out of your local grocery. The time you spend on hold, waiting to talk to a real person on the telephone seems endless for banks, airlines, the phone or electric company; you name it! All these situations are frustrating, but they don’t have much to do with real problems, like your health. What if you have to wait longer to see your doctor?

That’s what is happening more and more these days. Covid-19 has caused some of that waiting, but there’s a more ominous reason for this waiting – there just aren’t enough doctors. Elaine K. Howley, writing for Time magazine, says data published in 2020 by the Association of American Medical Colleges (AAMC) estimates that the U.S. could see a shortage of 54,100 to 139,000 physicians by 2033. The American Medical Association (AMA) estimates these numbers between 37,800 and 124,000 physicians over the same time period, a slightly more optimistic guess. But clearly there is a big problem looming and no quick way to fix it.

The shortfall is expected to span both primary and specialty care fields. “The physician shortage can justly be characterized as a looming public-health crisis, “says James Taylor, group president of the leadership solutions division at AMN Healthcare, the largest care staffing agency in the U.S. He adds that the types of shortages and poor access to care that have been common in rural and underserved urban areas for the past few decades will become more common nationwide. “Health care delayed is often health care denied, and a growing number of Americans are going to experience this unfortunate fact.” 

The greatest concern is primary care. A September 2021 report from the Kaiser Family Foundation noted that 83.7 million people in the U.S. live in a designated primary-care health professional shortage area (HPSA), and more than 14,800 practitioners are needed to remove the HPSA designation. Certain parts of the country – the West and South – will be more affected, and rural regions will be more severely short-staffed than urban or suburban regions, according to Dr. Stephen Frankel, a pulmonologist and the executive vice president of clinical affairs at National Jewish Health in Denver.

That’s bad news for many patients. Dr. John Baackes, CEO of L.A. Care Health Plan, the largest publicly operated health plan in the U.S., says, “If we’re not able to address the physician shortage, more patients will experience delays in access to primary care, a critical component to improving the health of our communities and reducing overall health care costs.” Lower income populations are expected to be the most impacted.

The lack of primary care physicians drives many people to emergency rooms when care is needed. The same is true of rising Medicaid enrollment, a reality created by ObamaCare and encouraged by the American Rescue Plan of the Biden Administration. They have increased eligibility ceilings for Medicaid and even eliminated income requirements as an emergency response to the Covid pandemic. The result of these two initiatives is millions of more Americans on Medicaid, but no corresponding increase in the number of primary physicians who will accept Medicaid patients. The inevitable result is more people seeking their primary care through emergency rooms.

What is causing the physician shortage?

“It’s hard to point your finger at one thing. It’s kind of a perfect storm of many things,” says Dr. Scott Holliday, associate dean of graduate medical education at the Ohio State University College of Medicine in Columbus. These factors are interconnected and complex, and they start with the journey to becoming a physician. They include time, cost, and availability of medical training.

Dr. Frankel says the issue boils down to “an increased demand and relatively fixed supply in the physician labor market” It takes time and money to train physicians and there are a limited number of medical schools in the U.S. which have not kept up with the demand for new physicians. Postgraduate training, internships and residencies, have also been limited for many years. The slots are funded by the Centers for Medicare and Medicaid Services (CMS), and no significant expansion in this funding has occurred since 1997. A modest increase in funding, enough to support 1,000 residency positions, was part of the Covid-19 relief bill passed in 2020.

The aging of the U.S. population is certainly contributing to the crisis. Older citizens require more medical care and the U.S. senior population is growing. “By 2035, there will be more seniors aged 65 or older than children aged 17 or younger – the first time this demographic imbalance has occurred in the nation’s history,” Taylor says. He says, “Older people see a physician at three or four times the rate of younger people and account for a highly disproportionate number of surgeries, diagnostic tests, and other medical procedures.” 

To make matters worse, many physicians are retiring earlier than previous generations. For some, the urgency to retire has grown recently, as burnout rates spiked during the pandemic. According to a March 2021 survey conducted by Merritt Hawkins for the Physicians Foundation, 38% of physicians said they would like to retire in the next year.

What’s the solution?

Sorry, there’s no simple solution. Here are some possible solutions mentioned in the article by Ms. Howley:

• Increased funding – for more medical school and residency training slots
• Debt relief – student loan forgiveness, especially to incentivize primary care physicians. Local communities in need of physicians should consider offering these.
• Technology – to promote alternative medicine such as telemedicine to increase efficiency, especially in rural areas.
• Expanding the care team – to include a more multidisciplinary care-team approach using nurse practitioners and physician assistants to fill in the gaps.
• Reducing the paperwork burden – to make physicians more productive, spending more time with patients and less with paperwork. Delegate this work to others.
• Boosting diversity and equity in medicine – (Time magazine had to include this. It’s not clear how the color of the doctor’s skin actually impacts the doctor shortage.)

Here’s my personal opinion:

• When doctors can be sure they are in charge of the patient’s care, and not some government agency or the hospital system they work for;
• When they are protected from the malpractice lawyers that advertise incessantly on television;
• When people show them the respect they deserve for the many years of training and sacrifice necessary to receive their medical licenses;
• When they are relieved of the mounting burden of paperwork and regulations necessary to get paid;
• When the cost of their training doesn’t put them decades in debt;
• When the workload doesn’t drive them to retire early and they can look forward to taking care of patients, again;
• Then, and only then, will we solve our physician shortage problem. Until then, get ready to wait longer to see a doctor. But if socialized medicine ever gets through Congress, all bets are off.