We are losing ~400 Americans a day. In the last 7 days, we have lost 2,299 people. During August 2022 alone, we lost 15,284 Americans to COVID-19. This means COVID-19 remains the third leading cause of death in our repertoire of threats. And it’s largely preventable. In the U.S., death rates are not back to pre-pandemic times; excess deaths are still
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.
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.
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.
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)
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 💪
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).
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.
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.
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."
« 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.
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.
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?
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.
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.
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.
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.....
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.
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.
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.
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.
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.
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 💪
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).
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.
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.
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!
« 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.
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/
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.
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.
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.
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.....
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.
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.