Yesterday, the CDC released much anticipated guidance for COVID-19. In all, the guidance is much more “relaxed,” as headlines are detailing. It’s difficult to organize my million thoughts, but here are a few: 1. Goal. I appreciated that the CDC clearly defined their goal: reduce severe disease. Some may not agree with it, but we finally have clarity on what the CDC is actually trying to control and prevent.
God, I needed someone to say this, and you say it so well. Carefully and clearly. The CDC's guidance is quintessentially "American" in its focus on individual preference and, sadly, in its choice of what's palatable (5 days) over what is actually in the data (the infectious period is longer than that). Finally, for those of us at medical high risk -- a non-trivial 9-15 million people, depending on which definition you select -- the latest guidance conveys that the CDC, like many in this country just... doesn't... care. Doesn't see our lives as worth protecting. It's a bitter reality.
As a high risk person and as a family doc I thank you for your practical explanation of the CDC guidance and recommendations for continuing individual risk reduction. However, I regret that out of kindness or professionalism or diplomacy, your list of the shortcoming in the CDC guidance does not explicitly call them out for abandoning the basic foundation of equitable population protection inherent in public health values to emphasize individual guidance. They continue to leave high risk people, the uninsured, those in medical deserts, those who have experienced discrimination unprotected. They put out guidance (out of isolation in 5 days) not based on good science. We are watching the destruction of the system of public health as a public resource.
Katelyn, this is a very much better newsletter than I felt the last one was. I appreciate your setting out the facts as you see them. I might quarrel with the notion that shifting the risk to the individual versus protecting the overall population is very "American". I think there are lots of times that Americans come together and accept limitations imposed on them in the interest of the good of all. But I am really glad to see you make critical comments of the CDC when appropriate and to candidly acknowledge that politics and public health policy have become intertwined. I think that is a terrible development and could (maybe) be somewhat altered by urging, not "suggesting" that people remain masked indoors all the time in public places out of concern for the safety of immunocompromised and older people. After all older people account for a huge slice of our population. I am confused though by your comment about the wedding. You said you will be. unmasked but using antigen tests. If I understanding it correctly that would probably protect other people from being infected by you if you are positive (you'll stay home, i assume) but how will that protect you from the doubtless many other people who are much less considerate?
Again, thanks for a great article. Speaking "truth to power" is hard but badly needed - congratulations.
I was hoping for a more broad societal reminder that if you are symptomatic with any upper respiratory infection (new cough, worsening cough, fever) and you need to go out: wear a mask and keep your hands clean. Many people have signs of COVID, test negative and go about their daily life with other contagious viruses, which we see as Rhinovirus outbreaks in other settings. Many other countries, before the pandemic, had this societal norm of wearing a mask when you were sick. I really hope this is a lesson we use moving forward!
As always, thank you so much for all that you do to keep us well informed, and for your honesty about how confusing it can be! It’s so hard to navigate the level of risk.
You mentioned that long Covid is still a big enough worry (at least for adults), even if one is up to date on vaccines, that it keeps you cautious. It has been a while since you wrote a post dedicated to long Covid - would you consider a post to update us on the latest research?
Let's be honest, the US has given up, covid has won and the collective decision has been made that 500 deaths a day is an acceptable price to return to pre-pandemic normal.
Even if that number goes up and hospitals are stressed again, I doubt that most people will be willing to change their behavior.
Thanks again for your cogent review of the confusing situation. Once again my very active otherwise very healthy immunocompromised husband and I are feeling like we’re being considered disposable. At least we are saving lots of money being unable to fly, travel, go to concerts or eat indoors at restaurants. Even some close friends don’t get why we can’t have dinner indoors at their house. Even with Evushield the prospect of getting Covid is very scary and likely life threatening.
"I just don’t want to get sick. (I just don’t have the time with two toddlers running around and a career.) " followed by "I’m going to a wedding this weekend and will not wear a mask, but we are antigen testing." Do as I say, not as I do? She knows and I know that antigen testing is not a guarantee to clear not masking. PCR can do that. Who is administering the antigen tests, how good is the sampling, and how good are the tests? We know from testing of the tests that quality is all over the place from worthless to very very good. None of this is controlled so therefore not masking at a wedding is a bad joke. Asserting that antigen tests are somehow going to make it okay is not okay. Depending on the sample and test quality, maybe you can catch a highly positive individual, but the less than highly positive, but still infectious will likely waltz right through. Holding out to followers that this is a sound procedure is a disservice to all of them.
Sadly, the food pyramid is _also_ politicized. Compare Harvard's Healthy Eating Plate which follows the science vs the officially published USDA MyPlate; some of the food items on the latter are absolutely the result of industry lobbying. :(
The new CDC guidelines are a complete “copout” and some of the worst data analytics I have witnessed. They should upset everyone – even if you oppose vaccine and mask mandates. CDC is paid to lead. Some key points
1. Although COVID is no longer racking piles of dead people per day filling up hospital parking lots, it can be dangerous and a regular case on a healthy adult age 40 can put them in bed for days and take 3 weeks to feel strong again. Long COVID is real.
2. The new variation appears to be in full spread mode a few days before major symptoms are shown.
3. Any rational organization would work to make testing increasingly accurate, easily available, and have results available quickly. Waiting 3 days to get a COVID appointment and then 3 more days to get results makes the testing worthless. The failure to stress quality testing was a lack of leadership.
4. The entire issue of when you can return requires REAL scientific investigation. You can return when you are no longer a spread risk. It may well be you feel fine, still test positive, and are not a spread risk. Or you might be a spread risk. The failure to articulate this and call for better investigation was a lack of leadership.
5. Make mask available for free when a person enters a store.
6. Put in place ventilation plans – especially for schools. This failure is viewed as CDC in the pocket of Big Pharma
7. The US needs to get over the mind set of “when you are sick”, you just suck it up and go to work (or school) – this terrible public health. There is ZERO chance you will get anyone to buy into public health initiatives when CDC leaves them hanging out to dry with their employer.
8. Pressing the need for vaccination without the other items and acknowledging lots of vaccinated folks get COVID – no credibility – simply sounds like you are business agents for pharma.
Yes, being an effective agent of chance requires pressing forward on the best path. That is the role you signed up for.
All the CDC is offering to the disabled or immunocompromised is thoughts and prayers. I will never pay attention to what they say again. This comes from someone with a MPH.
HI Katelyn, I am still wondering if you could explain how your antigen testing before the wedding would protect you from other less sensible people in attendance. Know you're probably very busy, but am confused.
Another comment- I am completely baffled about how ignoring the risks and sequelae of Covid infection is good for the economy. The same consequences that affect the economy exist.
Covid infection occurs-
-person is sick- misses work- disrupts work, affects ability to share parenting/family responsibilities
-person transmits to those in house- which then causes disruption above
-no test to negative- so now unmasks- goes back into society and transmits - see above.
-long covid is real and may affect ability to resume normal ADLs
-Yes, some people are asymptomatic but many are not. Symptoms impact ability to be productive. Long covid (1:5) means persistent symptoms affecting productivity.
-schools are now completely ignoring the risk to children and even more to those who work in schools. We had National Guard driving out buses and in our schools because there were so many people out. The current policy will enhance this problem because now we have no protection in guidance for people who should stay home or wish to. Instead the protocol will encourage re-entry way to soon and ensure higher transmission.
The unvaxxed have been blithely and unknowingly relying on those who have been acting responsibly to protect themselves and their community are now at higher risk. With the current messaging having no stress on personal or communal responsibility spread is for sure going to happen at a greater rate. There is no consideration that the unvaxxed have higher potential to burden the medical system.
As Fall progresses, with all the nice opportunities for encouragement of vectors to circulate, I can't see we will be in a better place having pretended that it will all be OK.
Hospitals are down 20-40% of bedside care givers. For rural hospitals it’s even worse.
Also- “risk” is much higher for Black people. The hospital algorithms are biased against us- not to mention human bias. Rich Black people, get worse care for covid19 than poor white people.
That said, as an older Black woman living in the State with the worst healthcare disparities in the country- I will not take any risk of getting covid. I wont go anywhere masks are not required. I cant take the risk.
I am a one-trick pony when it comes to long covid. I said sometime back that my fear was that everyone who had tested and diagnosed covid, was probably a long hauler whether they were asymptomatic or not... They just wouldn't see the lasting damage until years down the road. Even if we discount the danger of long covid, this virus hasn't exhausted its bag of mutations. By sheer fecundity of invention it's may come up with something with both high escape and high lethality and then where will we be with the CDC's laissez faire guidance? It's no good to declare victory and go home as the CDC seemingly has.
I am 85 and have had 4 doses of Moderna. I cannot take Paxlovid as it increases QTC interval and I take cardiac meds. That is the reason a number of people who get infected do not take Paxlovid. I have considered the antibody but do not qualify. I still use my N95 mask when I leave my property. I will get the Moderna variant vaccine when it is available. For me a mask is going to be part of my wardrobe whenever I leave home for the rest of my life.
Just for interest, how protective is the small pox vaccine which I got as a child in protecting against monkey pox?
God, I needed someone to say this, and you say it so well. Carefully and clearly. The CDC's guidance is quintessentially "American" in its focus on individual preference and, sadly, in its choice of what's palatable (5 days) over what is actually in the data (the infectious period is longer than that). Finally, for those of us at medical high risk -- a non-trivial 9-15 million people, depending on which definition you select -- the latest guidance conveys that the CDC, like many in this country just... doesn't... care. Doesn't see our lives as worth protecting. It's a bitter reality.
As a high risk person and as a family doc I thank you for your practical explanation of the CDC guidance and recommendations for continuing individual risk reduction. However, I regret that out of kindness or professionalism or diplomacy, your list of the shortcoming in the CDC guidance does not explicitly call them out for abandoning the basic foundation of equitable population protection inherent in public health values to emphasize individual guidance. They continue to leave high risk people, the uninsured, those in medical deserts, those who have experienced discrimination unprotected. They put out guidance (out of isolation in 5 days) not based on good science. We are watching the destruction of the system of public health as a public resource.
Katelyn, this is a very much better newsletter than I felt the last one was. I appreciate your setting out the facts as you see them. I might quarrel with the notion that shifting the risk to the individual versus protecting the overall population is very "American". I think there are lots of times that Americans come together and accept limitations imposed on them in the interest of the good of all. But I am really glad to see you make critical comments of the CDC when appropriate and to candidly acknowledge that politics and public health policy have become intertwined. I think that is a terrible development and could (maybe) be somewhat altered by urging, not "suggesting" that people remain masked indoors all the time in public places out of concern for the safety of immunocompromised and older people. After all older people account for a huge slice of our population. I am confused though by your comment about the wedding. You said you will be. unmasked but using antigen tests. If I understanding it correctly that would probably protect other people from being infected by you if you are positive (you'll stay home, i assume) but how will that protect you from the doubtless many other people who are much less considerate?
Again, thanks for a great article. Speaking "truth to power" is hard but badly needed - congratulations.
I was hoping for a more broad societal reminder that if you are symptomatic with any upper respiratory infection (new cough, worsening cough, fever) and you need to go out: wear a mask and keep your hands clean. Many people have signs of COVID, test negative and go about their daily life with other contagious viruses, which we see as Rhinovirus outbreaks in other settings. Many other countries, before the pandemic, had this societal norm of wearing a mask when you were sick. I really hope this is a lesson we use moving forward!
As always, thank you so much for all that you do to keep us well informed, and for your honesty about how confusing it can be! It’s so hard to navigate the level of risk.
You mentioned that long Covid is still a big enough worry (at least for adults), even if one is up to date on vaccines, that it keeps you cautious. It has been a while since you wrote a post dedicated to long Covid - would you consider a post to update us on the latest research?
Let's be honest, the US has given up, covid has won and the collective decision has been made that 500 deaths a day is an acceptable price to return to pre-pandemic normal.
Even if that number goes up and hospitals are stressed again, I doubt that most people will be willing to change their behavior.
Thanks again for your cogent review of the confusing situation. Once again my very active otherwise very healthy immunocompromised husband and I are feeling like we’re being considered disposable. At least we are saving lots of money being unable to fly, travel, go to concerts or eat indoors at restaurants. Even some close friends don’t get why we can’t have dinner indoors at their house. Even with Evushield the prospect of getting Covid is very scary and likely life threatening.
"I just don’t want to get sick. (I just don’t have the time with two toddlers running around and a career.) " followed by "I’m going to a wedding this weekend and will not wear a mask, but we are antigen testing." Do as I say, not as I do? She knows and I know that antigen testing is not a guarantee to clear not masking. PCR can do that. Who is administering the antigen tests, how good is the sampling, and how good are the tests? We know from testing of the tests that quality is all over the place from worthless to very very good. None of this is controlled so therefore not masking at a wedding is a bad joke. Asserting that antigen tests are somehow going to make it okay is not okay. Depending on the sample and test quality, maybe you can catch a highly positive individual, but the less than highly positive, but still infectious will likely waltz right through. Holding out to followers that this is a sound procedure is a disservice to all of them.
Sadly, the food pyramid is _also_ politicized. Compare Harvard's Healthy Eating Plate which follows the science vs the officially published USDA MyPlate; some of the food items on the latter are absolutely the result of industry lobbying. :(
Excellent article as always!
The new CDC guidelines are a complete “copout” and some of the worst data analytics I have witnessed. They should upset everyone – even if you oppose vaccine and mask mandates. CDC is paid to lead. Some key points
1. Although COVID is no longer racking piles of dead people per day filling up hospital parking lots, it can be dangerous and a regular case on a healthy adult age 40 can put them in bed for days and take 3 weeks to feel strong again. Long COVID is real.
2. The new variation appears to be in full spread mode a few days before major symptoms are shown.
3. Any rational organization would work to make testing increasingly accurate, easily available, and have results available quickly. Waiting 3 days to get a COVID appointment and then 3 more days to get results makes the testing worthless. The failure to stress quality testing was a lack of leadership.
4. The entire issue of when you can return requires REAL scientific investigation. You can return when you are no longer a spread risk. It may well be you feel fine, still test positive, and are not a spread risk. Or you might be a spread risk. The failure to articulate this and call for better investigation was a lack of leadership.
5. Make mask available for free when a person enters a store.
6. Put in place ventilation plans – especially for schools. This failure is viewed as CDC in the pocket of Big Pharma
7. The US needs to get over the mind set of “when you are sick”, you just suck it up and go to work (or school) – this terrible public health. There is ZERO chance you will get anyone to buy into public health initiatives when CDC leaves them hanging out to dry with their employer.
8. Pressing the need for vaccination without the other items and acknowledging lots of vaccinated folks get COVID – no credibility – simply sounds like you are business agents for pharma.
Yes, being an effective agent of chance requires pressing forward on the best path. That is the role you signed up for.
All the CDC is offering to the disabled or immunocompromised is thoughts and prayers. I will never pay attention to what they say again. This comes from someone with a MPH.
HI Katelyn, I am still wondering if you could explain how your antigen testing before the wedding would protect you from other less sensible people in attendance. Know you're probably very busy, but am confused.
Another comment- I am completely baffled about how ignoring the risks and sequelae of Covid infection is good for the economy. The same consequences that affect the economy exist.
Covid infection occurs-
-person is sick- misses work- disrupts work, affects ability to share parenting/family responsibilities
-person transmits to those in house- which then causes disruption above
-no test to negative- so now unmasks- goes back into society and transmits - see above.
-long covid is real and may affect ability to resume normal ADLs
-Yes, some people are asymptomatic but many are not. Symptoms impact ability to be productive. Long covid (1:5) means persistent symptoms affecting productivity.
-schools are now completely ignoring the risk to children and even more to those who work in schools. We had National Guard driving out buses and in our schools because there were so many people out. The current policy will enhance this problem because now we have no protection in guidance for people who should stay home or wish to. Instead the protocol will encourage re-entry way to soon and ensure higher transmission.
The unvaxxed have been blithely and unknowingly relying on those who have been acting responsibly to protect themselves and their community are now at higher risk. With the current messaging having no stress on personal or communal responsibility spread is for sure going to happen at a greater rate. There is no consideration that the unvaxxed have higher potential to burden the medical system.
As Fall progresses, with all the nice opportunities for encouragement of vectors to circulate, I can't see we will be in a better place having pretended that it will all be OK.
Hospitals are down 20-40% of bedside care givers. For rural hospitals it’s even worse.
Also- “risk” is much higher for Black people. The hospital algorithms are biased against us- not to mention human bias. Rich Black people, get worse care for covid19 than poor white people.
That said, as an older Black woman living in the State with the worst healthcare disparities in the country- I will not take any risk of getting covid. I wont go anywhere masks are not required. I cant take the risk.
White privilege is real in America.
I am a one-trick pony when it comes to long covid. I said sometime back that my fear was that everyone who had tested and diagnosed covid, was probably a long hauler whether they were asymptomatic or not... They just wouldn't see the lasting damage until years down the road. Even if we discount the danger of long covid, this virus hasn't exhausted its bag of mutations. By sheer fecundity of invention it's may come up with something with both high escape and high lethality and then where will we be with the CDC's laissez faire guidance? It's no good to declare victory and go home as the CDC seemingly has.
I am 85 and have had 4 doses of Moderna. I cannot take Paxlovid as it increases QTC interval and I take cardiac meds. That is the reason a number of people who get infected do not take Paxlovid. I have considered the antibody but do not qualify. I still use my N95 mask when I leave my property. I will get the Moderna variant vaccine when it is available. For me a mask is going to be part of my wardrobe whenever I leave home for the rest of my life.
Just for interest, how protective is the small pox vaccine which I got as a child in protecting against monkey pox?