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Now that we have experienced Covid in our home, it is even more apparent how insane the government's current response is. It basically begs us to get infected, and to spread the disease. And the thing is, prevention isn'y hard - masks work. I spent a week in a covid hospital room with my dad and did not get covid - i masked, i washed my hands, i was careful. We have had a covid positive person in our house and, so far and knocking on all the wood, it hasn't spread (although I am waiting for the shoe to drop) - but we masked, we isolated, we tested - and test everyday, we have been careful. It's not hard - it feels like common sense. I just don't understand the 'offiical' guidelines, which seem to be encouraging disease spread. Teachers don't get days off for quarantine but use their already not enough sick days, masks are not required and barely encouraged, testing after the initial test is not encouraged (because you may test positive again... and then you would know you are contagious and stop spreading??? it makes no sense)

And when you do follow common sense protocols - you almost feel crazy, like you're being extreme.

sigh.

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Hospitals workers near me don't even have to test after getting COVID. They can come back to work after five days as long as they don't have a fever and symptoms are decreasing. I think at this point staffing shortages in fields like nursing and teaching are taking precedence over safety.

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Sep 13, 2022·edited Sep 13, 2022

The sad truth is that, generally, Americans *have* accepted it. Even in places like Boston suburbs, almost everyone has moved on. Public and private schools are all vaccines optional, masks optional, lunch inside, close to no precautions. I'm sure everyone has seen the NY subway's "You Do You" poster.

It is so, so tempting to decide to accept that exposure is inevitable, we've protected ourselves as best we can with vaccines, and rejoin the world in living like we used to. On the other hand, a 1:6000 chance (I'm 52) of dying is really not so great... and a 1:95 chance (my father is 85) seems totally unacceptable.

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As a person with Long Covid, I find this even more reprehensible. Even my closest friends who love and support me run about unmasked in crowded public stores and are adamant about their children having the 'freedom' to roam free of masking. Our world has grown increasingly smaller as we mitigate the very serious long term effects of this virus and the commitment to not becoming reinfected. I was vaxxed and boosted when I caught Omicron in June. Yes, vaccines and therapeutics must catch up but social distancing and masking are SO easy as a collective response to caring about our community. Befuddled.

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Great post and I’m starting to memorize some of these cdc graphs. They are just so convincing, and the Canadian one is really instructive as to absolute risks... which are always important to weight against relative risks.

I don’t follow twitter much, and I made the mistake of subscribing to dr vinay prasad’s substack. His letter today is a call to abandon masking in clinical situations like offices and clinics. It really haunted me all day as I saw patients, many of whom are suffering sequelae of covid like chronic headaches, shortness of breath, brain fog, etc. i prescribed paxlovid again multiple times for acute illness. I know most don’t see this, but we do every day in primary care. You are right.

I told Prasad to read some Jetelina, stop capitulating to the no-mask-as-purity-test ideological political crowd, profitable as it must be, and brush up on his literature ( 83% estimated reduced transmission risk with n95’s)

https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm

So hard to go high when they go low, or even worse, when they go rogue from the scientific consensus, messy truth seeking that it is. You do a great job đŸ’ª

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You've hit a couple of touchstones for me. I've been living with the stats and graphics, and recreating some of my own; this was a good presentation.

Prasad's substack offerings have been contrary to most of the published literature for awhile. I find them disturbing. I decided, after commenting a couple of times, that the abuse from his more rabid followers was hardly worth trying to provide more fact and data laden material to his conversations.

Oh, and in the last hour, I've seen references to transmission reductions ranging from your 83% citation to 96%, all for N95s. I'll keep mine around for as needed use.

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Gerry - Didn't realize you started a substack, hope you have time and energy for further pieces.

Prasad's vocal followers can definitely be disappointing, and Vinay himself has not once ever replied to comments on his substack I am aware of which makes it near useless to offer constructive feedback. Inexcusable any abuse you received, been there too.

However, I feel that something has gone terribly wrong with science - specifically published scientific literature - which is an enormous and complex topic to dig into in substack comments, but at the very least I urge caution in relying on most scientific papers - especially anything which is at the lower tier of study design (e.g., retrospective case control, surveys, any design not pre-registered) and fails basic replication stress tests. Which is, unfortunately, almost every study related to masks out there.

I think the mask hypothesis needs a serious re-examination. Certainly if you feel the n95 protects you by all means continue to wear it, but we have so many real world examples where the claims have failed in the real world we may want to consider that we were right pre-2020, that viruses can easily bypass masks. After all, mankind only discovered viruses after realizing there was a pathogen smaller than bacteria which could bypass ceramic water filters. Which we aptly (and perhaps prophetically) named "filter passing viruses".

I presently lean to this being the result of some (no directed) incentivized, bayesian, Gish Gallop, which would explain why the stronger the study, the weaker the effect, and repeated failure for the predicted results to materialize in places with extremely high n95 use (South Korea, Japan, Nursing Homes, California, etc).

We've already realized neck gaitors don't work. Cloth masks don't work. Surgical masks don't work.

For the same principles those fail at the very least we should consider if the mechanics of virion transmission also bypass n95 and we would need the next level in protection such as a PAPR (Powered Air Purifying Respirator) or even those full body protective suits worn in BSL-4 labs to block virions.

Enjoy your trip, if you want to chat more in depth when you get back shoot me an email.

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With respect, Andrejko's study you linked is among the poorest studies supporting the mask hypothesis out there - and that is quite an achievement considering competition like the "Kansas Mask Study" and "Two Hairstylists in Missouri".

Negative Case control study with low response rate on interviews, comparing two starkly different groups of people getting tested for vastly different reasons. Backlash caused her to silence her Twitter and it became punching bag example of bad studies even by pro mask people (Emily Oster IIRC notably did a write-up on this comparing it to a Johns Hopkins paper on lockdowns).

Out here in Cleveland, several hospitals and many (possibly most?) private practices already dropped masking months ago and everything is fine.

I think we should consider the possibility we were Gish Galloped on masks. The classic Peter Woit decree he applied to string theory feels applicable here: "A theory that can't predict anything is not a scientific theory".

For the last two years every claim seems to have been falsified over and over.

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deletedSep 14, 2022·edited Sep 14, 2022
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Similarly, there are several more studies that support masking. Some are small, some larger but for your reading enjoyment:

https://academic.oup.com/cid/article/75/1/e241/6370149

https://journals.asm.org/doi/pdf/10.1128/mSphere.00637-20

This is a quick review of articles. I'm on travel and don't have access to my archive of articles at home.

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"I'm on travel and don't have access to my archive of articles at home."

Enjoy your travels! You have my email - can always pick up when you are back home.

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See above Gerry reply to KB, somehow you found two studies not already in the 300 i've collected! Thanks :)

Will read through those tonight

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Part of it is search technique and terms, part of it is the fact I've archived... and read... well beyond 4k studies. I keep the ones I consider sufficiently rigorous to be useful, and cite those. I belong to a different entity for another week. I'm not sure "enjoy" is quite the right term for this travel. I'm finishing a weather forecast now, and then have to look at the Tropics for another one. Responding here with the best info I can come up with is a delightful diversion when I get tired during the day but not having the archives available is a pain. I should put them into cloud storage but accessing and indexing would pose problems.

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I know what you mean, I've only got my collection of mask studies mirrored on google sheets, everything else on my HDD (which is risky in itself to not have so much data not backed up in the cloud). Kinda lazy.

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Oster tore that study apart too. It was pretty bad. Not as bad as the Andrejko one, but bad. https://www.parentdata.org/p/lots-of-studies-are-bad

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I've maintained this list of all studies and some notable commentaries the last two years. Began with the list YLE posted to facebook on 11/15/2020 [1] (she shared from twitter user @nuanceORDEATH), and have been adding to it ever since. Studies beyond #294 in this list I haven't gone through yet.

Let me know which ones you feel are the strongest.

https://docs.google.com/spreadsheets/d/1ahaJui6Af0kGYMwHgAtnKCE6-bHbCLxnrQxuMC0kygA/edit?usp=sharing

[1] https://www.facebook.com/permalink.php?story_fbid=202002698114314&id=101805971467321

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Thanks I haven't seen that one, that's the type of experiments I have been wanting more of (I'm an engineer so I've been disappointed by the lack of fluid dynamic experiments)

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Misplaced your email. Please send it to me by email again. I'll respond as able.

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It seems like we should be paying attention to the number experiencing Long Covid, in addition to the number dying. And to long-term effects of the virus besides Long Covid, like brain shrinkage and other organ damage (which, unlike Long Covid, may not be immediately apparent).

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Some of us are but the definition of what constitutes Long COVID is still a bit slippery and there are no defined lab tests to use to identify it: It's a diagnosis of exclusion. Over time, we, or more likely rheumatology, will characterize it better.

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Almost everyone in my community acts as if it's over. When I go out, I'm usually the only person masked, at work, in stores, restaurants (which I don't eat in), and social events. And the vax rate here is barely over 50%.

There is no interest in controlling the virus, instead people are just ignoring it. It seems inevitable that there will be another winter surge, and more variants.

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Thank you for all your hard work, and for reminding us that This. Is. Not. "Normal."-- that we cannot accept a covid death rate that makes it rank #3 in our causes of death as our "new normal!" The information you provide is invaluable, but the call to conscience may be even more so! Keep up the great work.

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Katelyn, love your analysis and summaries of this ongoing pandemic. If I could please make a small "word-smithing" suggestion. When you describe data like this:

"According to the CDC, vaccinated people with one booster had 3 times the risk of dying compared to people vaccinated with two boosters."

Might you instead say:

"According to the CDC, vaccinated people with one booster had A 3 times GREATER (or HIGHER) [the] risk of dying compared to people vaccinated two boosters."

No possibility of confusion there....

Best!

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« This isn’t a reflection of blame, but rather a measure of where we can do better. « 

Given that the reason we are failing is largely political, we wont fix the problem unless we are ready to judge what went wrong and who is responsible. I understand your desire to do your best given the political s**tshow. Staying above the fray means you wont offend anyone. Unfortunately, it also means your expertise wont be relevant to truly solving the problem. The sad fact is both political parties let us down and neither Trump nor Biden have the foggiest conception of PUBLIC health. For them this problem is one of personal responsibility, not public policy. We (I) never expected more from GOP. I had hoped (and was repeatedly told) that Biden and the democrats were different. They arent. They dont really care how many people die so long as it is not a big headline with adverse polling effects. Truth be told, they dont even really care to help people act in their own best interests for they have failed to provide the minimum data and information required to do so. We all know this. So hell yes we should be pointing fingers and hoping that blame will move our leaders to act responsibly. It is likely a vain hope, but it is the only arrow left in the quiver.

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The political reality on the ground is that the Democrats simply don't have a sufficient majority in Congress to much of anything on this subject. So rather than sit idly and bemoan the fact that they cannot move the needle, they have, indeed, moved on to other subjects where there is at least a possibility of progress.

That reality could absolutely change after the midterms, of course. They could lose control of Congress, or they could obtain a larger majority, though probably not enough to get COVID legislation done. Is the acknowledgment that they cannot get that legislation done following the poll numbers, or is it simply a pragmatic approach to governing? There is something to be said for moving on to other problems, as the country has no shortage of them.

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This supposes the democrats are doing all in their power besides congressional action. I find little evidence for this. For example, they have not pursued a nasal spray initiative like the one in India and China. This was discussed today in Axios. Or they could have clarified the CdC guidelines concerning masking in hospitals. But here too, nada. In fact, the CDC still seems reluctant to emphasize the fact, no longer even mildly controversial (no thx to the CDC) that covid is transmitted in the air (aerosol) and that it is important to control this especially in hospitals and schools. One might imagine Biden discussion Corsi-Rosenthal boxes as a cheap way to mitigate harm in public venues or even find ways of providing public money for this, OR AT LEAST ARGUING FOR IT to raise this prominently in the public mind. Or perhaps getting the CDC to track the disease better than it has. But it has cut back on monitoring and has failed to make centralize and rationalize the collection of data all the while urging people to make their own choices by responding to the data! This is incompetent at best and cynical at worst. Or, maybe the democrats might wish to raise GOP intransigeance and make it a political issue, e.g. The GOP want you to die of covid and wont help you avoid the disease. This is considered too politically fraught despite the majority of Americans supporting some public interventions. What is relevant is that the democrats, no more than the GOP, are « following the science. » The decision has been made to ignore the disease until such a time as it spikes and can not be ignored because, e.g. it is killing rich people rather than merely killing those down the socio economic ladder. You can bet that if covid were debilitating and killing wall street bankers, WaPo and NYT editorial writers and politicians that we would be hearing about the public health emergency. But the right people are dying and getting sick and debilitated so there is nothing to see here. Move on. And, sadly, many of us are ok with this. We dont want to point fingers and cast aspersions. We have accepted that a million covid deaths is ok and that another 300,000 this year is ok, and that long covid is ok. Or at least ok enough that we should not blame anyone or call out our leaders who have ALL failed us.

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As you say the data lags, but it does appear that in the US the expected number of deaths returned to baseline around March of 2022. That is to say, excess deaths are largely back to normal (though the large increase we have seen in accidental deaths the past two years lag much more than other causes so this is still variable).

Consider in May there were 229,262 total deaths in the US, which is probably in-line with what we would expect had the trend of the last 20 years continued of ~2% year-over-year increases and we ignored 2020 and 2021.

Here's visualization in table form:

https://imgur.com/a/FD47ywN

You can see by around week 12 of 2022 deaths trended back to expected levels - though in May (starting week 18) I believe there were ~4200 Covid deaths, so depending how you model expected mortality that's only a 2% slice of the pie so easy to miss out on that signal.

Put another way, while 400 deaths a day is tragic, that is only 5% of total daily deaths, and in terms of excess death it may be as little as 2%. As you noted the vast majority are among the very elderly, almost certainly with several comorbidities.

I am not trying to sound cold (though I do get detached when data diving), only trying to explain why I think the vast majority of the world has "moved on" from Covid as I think you and your readers sense (judging form comments, a frequent complaint).

I don't think an additional 2% deaths than normal among a predictable elderly cohort can be expected to cause much alarm among the public - especially when the MSM is now regularly focusing on the learning losses and increases in depression among our children (see recent NYT, WaPo pieces for example) [1][2][3]. That seems to be grabbing more headlines and attention. For now. Fall could change things.

I do have an additional question I would love for you to tackle after reviewing all cause mortality trends across the world:

Why did South Korea have a nearly 100% increase in all-cause mortality this past spring? This is unprecedented, even the worst points in the US Covid pandemic we never hit more than 44% increase in deaths. (see https://imgur.com/a/B0gn6Gg for South Korea all cause mortality). For 2022 they are a running a net +30% more deaths than usual which is very sad (160K deaths first 21 weeks of 2022 vs 120K expected).

This seems to be a counterfactual to the claim that high vaccination rates would solve excess deaths. What happened in South Korea?

__________________

[1] https://www.nytimes.com/2022/09/07/opinion/school-covid-learning-loss.html

[2] https://www.washingtonpost.com/opinions/2022/09/05/national-school-test-scores-covid-lost-progress/

[3] https://www.washingtonpost.com/opinions/2022/08/23/my-kids-wont-wear-masks-school/

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Could the lower number of deaths in double boosted be due to lifestyle choices that would be more likely in those willing to get double boosted, including masking, not going to the fair or concerts, etc.? I think so. This "tear off your masks" attitude is very frustrating.

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While lifestyle may provide some side benefits, it's pretty obvious the immunological benefits are paramount in these groups.

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Sep 13, 2022·edited Sep 13, 2022

Thank you for your thoughtful, evidence-based, thorough work. I look to you for providing credible information. This post made me sad. Honestly, I feel like our leaders in Washington have adopted a "we have the tools to fight this virus" attitude and seem to be ignoring that the current death rate is 400+ people per day - and rarely is there any mention of the risk of Long Covid. Furthermore, there seems to be little interest in funding for the development of nasal mucosal vaccines which purport to target transmission in Covid-19 and future variants.

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Several friends and colleagues have tested positive for Covid for the first time in recent weeks. A few thought they were immune because they had been exposed several times but never tested positive. A couple followed "political recommendations" over CDC guidelines. The others admittingly let their guards down and stopped wearing masks.

All are fully vaccinated and had at least one booster, and until recently, many had been mask compliant. Fortunately, none have been very ill or hospitalized. The most symptomatic are under forty years old and not eligible for the second booster. Each has tested positive for at least seven days and one person for eight days.

My spouse is immune compromised; we wear masks in public inside. I wear a mask daily at work; we do not eat inside restaurants. If visiting family, we all test prior and are sensitive to each other's comfort zones. So far, nobody in our family, including kids, has tested positive. I am not afraid of Covid but of what comes after. I have two nurse friends that suffer from long-covid. I can assure you I do not want any part of it.

I have been a nurse for many years. I was ready to do something different in health care; in January 2020, I enrolled in a Public Health degree program. I quickly learned the importance of public health and knew I had picked the right program. I have enjoyed reading your newsletter and shared it with several healthcare friends.

Do you grant interviews? I want to interview you for a class project.

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founding

There are probably corresponding numbers for Long COVID. If too many people are still getting infected, then we'll continue to see increasing numbers for LC. Entirely preventable.....

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We're seriously concerned that "Long COVID" may produce a lot more chronically ill patients in the future, overwhelming the health care system over a longer span than COVID did acutely.

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Our attempts to manage this epidemic are being stymied by political leaders who are more concerned with their re-election than public health. To wit, NY Governor Hochul, who ended the mask mandate on mass transit recently. Media comments had an "oh well, what can we expect" attitude, pointing to the widespread lack of compliance with the unpopular mandate and the governor's campaign for re-election. But this is crucial. In NYC now, mask wearing is fading away, at a time when there are hundreds of new positive tests every day. Maybe few are dying, but as pointed out, these are on the whole preventable deaths.

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I am curious to see where this goes. Chicago, also a highly vaccinated city, lifted their public transit mask mandate in April. They did not see a spike in cases, but, of course, we haven't entered a high transmission season yet. When I was in Chicago a couple of weeks ago about 20% of people were wearing masks on mass transit. I am not convinced that Hochul lifting the mask mandate is going to have a huge effect at this point, but will be following.

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To be fully vaccinated and boosted is to care about oneself and those around us. To mask in a closed spaced is really a no-brainer. What's the big deal? Inconvenience, we hear. Those folks haven't got the message, the pandemic virus is still with us because lots of poorly compliant folks choose to "do it their way". Then there are treatments. A few have been thrust into the public eye (too often by social media and self-serving folks with lofty credentials). Some pharmaceuticals have been in clinical trials large and small, repeatedly. Some "darling" drugs have appeared in dozens of trials and yet none have stood the test of time. Some trials are repeated over and over when high-profile advocates get the ear of a Legislator. There ARE repurposed drugs that have a significant effect on the SARS-Cov2 virus as evident in hundreds of test positive unvaccinated as well as vaccinated people. Some drugs has yet to be studied formally. Why? No profit incentive for off-patent inexpensive generic drugs. What about the fact that in one case there have been no deaths, no hospitalizations, a prompt response and after 2+ yrs no long-Covid after a mere 5 days of Rx easily purchased for <$10 at a local pharmacy. The FDA wants the participation of practicing physicians and Nurse Practitioners to provide their real-world clinical experiences with off-label, repurposed FDA-approved drugs. EUA drugs don't come cheap even if the Federal Gov't provides it free to the public. EUA products still require immense resources to bring them to the local pharmacy, and it's not evenly distributed as many pharmacists advise. Get more information at <https://cure.ncats.io> Check the CURE ID mission statements from the NIH, FDA, CDC, NCATS, C-path creators of this valuable resource as well as the COVID19 case reports and clinical observations from licensed practitioners. Those 400 people that die every day after getting infected do not have to die if treatments are freely shared. Ask your caring physician or NP to review this NIH/FDA initiative. Ask him/her to delve into the cellular biology of COVID19 as it compares to another disease, sickle cell anemia. Check the late effects of some COVID19 victims as it relates to the neuromuscular dysfunctions seen in myesthenic syndromes. There are viable treatments and they are safe under the care of attentive practitioners. Be an advocate for repurposing. Thank you.

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I think downplaying the negative effects of masks might actually work against people wearing them because people then don't believe other things you say. For example, it has been very difficult for my son to learn in his foreign language classes because of masks. They are also uncomfortable to wear all day in indoor workplaces, especially in environments without air conditioning (not uncommon in the Northeast). I have really gotten to hate them. I wear them when in close environments or when asked, but no longer wear them in places where there is a lot of room to spread out, such as Home Depot.

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Your approach sounds reasonable and being cautious in closed in environments makes a lot of sense when the filtration systems may be suboptimal. A School environment like a language class certainly could be problematic for a student. Perhaps the masking can be relaxed during the conversation part and masked for the listening and written component. (computer typing?? I’m showing my age talking about pencil and paper!)

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Schools are challenging environments, but that's why there was money to improve HVAC systems in schools, allowing us more freedom to consider unmasking. Unfortunately, a lot of money went unspent or was reallocated for other purposes.

I look at the environment when I go somewhere. I prefer to eat outdoors, but if I'm inside a "big box" store like Home Depot, I'm not too worried unless I encounter someone with an obvious respiratory issue and then I "see and avoid". I've transitioned to N95s exclusively, and I'm familiar with fit-testing and the need to check them. I've seen a lot of N95 wear where fit testing was pretty obviously not an issue, so the masks are doing no one any good.

But the fact is, masks, even less effective masks than the N95, work to reduce transmission. Masks, and vaccinations are our most effective tools to prevent serious illness and death.

@SD, I understand how you dislike masks. I have to work to be empathetic because I wore them so long and often that, when we had to mask-up again, it was second nature. For someone who's not spent a long time around the medical establishment, it's less likely to be something you got accustomed to. I understand. I do have to work to remember it sometimes. Despite what some people say, I'm human.

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Well said; I couldn't have said it more eloquently than you.

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What is this medication that prevents long Covid?

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There are no medications I am aware of that are known to prevent Long COVID because we don't know, exactly A) what it is, or B) what it all entails. There is some evidence that boosters reduce the apparent incidence, and there's been hints that Paxlovid might help, but none of these are definitive. Similarly, there was a hint that dexamethasone might help prevent or treat because of its anti-inflammatory effects (as a steroid) but this is yet, to my knowledge, to be confirmed.

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Ref: ABSTRACT: https://www.researchgate.net/publication/361862164_Immunization_with_674-685_fragment_of_SARS-Cov-2_spike_protein_induces_neuroinflammation_and_impairs_episodic_memory_of_mice

The mechanisms for the cognitive disorder seen in long Covid, colloquially known as brain fog, likely are the result of Neuroinflammation as described in this murine lab model. A fragment of the spike protein injected into mice induces the Neuroinflammatory process resulting in disruption of memory (maze skill as I recall from a discussion with the Institute’s Director Maryna Skok D.Sci.). The memory loss in these standard lab mice is recovered with choline. The target is the a7 nicotinic acetylcholine receptor. The prodrug Acetylcholine, the critical ubiquitous neurotransmitter appears to be the key to restoring the receptor function in humans. Mitochondria have these receptors and when they are dysfunctional, energy production in multi organ systems are disrupted (renal and hepatic failure, endothelial, myocardial injuries as well as marrow dysplasia’s among them. Ravistigmine, readily available as Exelon may be the means to clear the brain fog of COVID19 at any stage of the disease. (An anecdotal brain fog case was dramatic in this regard). Based on critical care patients that are comatose with advanced COVID19 patients, when given 3 days of std dose Hydrea followed by incremental dosing of pyridostigmine there have been dramatic responses with cognition, diminishing O2 demand, restoration of swallowing functions and liberation from ventilators, not once, but dozens of times in the inpatient setting. Dr Skok’s team has an upcoming study and will incorporate HYDREA attempting to identify its role with the a7NAChRs in her spike protein Neuroinflammation model. (Personal communication).

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I'll look at this later today. I'm on TDY and sorta busy.

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Please review this website for details. Click on any of the case reports and also review the discussion forum under Covid19. Thanks.

https://cure.ncats.io/explore/cases/case-details/22182

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