May 25·edited May 25

I would love a tutorial on how and where to read wastewater data. Since the PHE is over, I've lost my usual data for cases/hospitalizations.

Thanks as always for the update!!

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Thank you, thank you for reliable information when so little public information is available. It helps senior citizens make decisions re: risk assessments.

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You recommended it's good to mask up and that masking needs to increase especially in the elderly and in times of high transmission. What's disappointing and what you didn't address about masking is that perhaps the most unsafe place for all of us now, especially those of us 65 and older, is going to the doctor, dentist, clinic or hospital, since masking is no longer required, and Covid-19 waste water surveillance levels are still higher in 2023 than they were in 2020 and 2021. Would really like to see you analyze hospital/healthcare acquired infection rates in an upcoming newsletter. I suspect it will be equal to or greater than household transmission with respect to risk of infection.

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I have to tell you that I have been seeing a spike locally in Covid after a very quiet period. We have numerous parents cancelling appointments due to a positive adult in the home. This has been the most since January. This is also in the setting of greatly reduced testing, AND only rapid home tests, due to the end of the PHE and cost of PCRs, so I still suspect there is much more. Parents are not testing kids, and when I see children that have symptoms that are a little quirky and suspicious for Covid, AND, the children with symptoms and a home high risk contact, they are mostly PCR negative when the parent allows (or asks) testing.

So I am concerned that we are not detecting it, and left wondering if the vaccination status and historical illness both somehow affect the sensitivity of the use of PCR, as we have seen people that did not convert to positive via PCR for days of testing (some are really committed to getting an answer when they “know” that when the whole house is positive and they have symptoms that it MUST be covid).

I rely now on Hospitalization data, which could take much longer given the population that gets hospitalized, and wastewater data which is not as readily available. It’s frustrating for us on the front lines. We ABSOLUTELY require masks for those visiting the office for illness (although the nose over mask still rules) and we all wear masks all the time but it is just not tenable to have well families mask. In the burbs masking is close to zero (but then again I don’t go out much still) but was in NYC and was impressed to see more masking there.

Please discuss air quality mitigation and please help with where and how to find good concise wastewater data!!

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Questions: Wouldn't wastewater be *the* metric right now? In the U.S., we have no reporting system that would capture real numbers of infections due to the ubiquitous use of home testing and widespread non-testing. If wastewater is still higher than in 2020 and 2021, doesn't that imply that SARS-CoV-2 is *not* nosediving? What am I missing?

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Glad to see the wastewater rates are down! Great for spring social lives, and great for the health of rats living in the sewer. Mostly joking, but with zoonotic reservoirs and mutation occurring in any host, I could be serious too!

Masking is my office is about 25% of staff, and about 75% of doctors. Patients I would guess 15%.

I’m a ventilation junkie, so if you write it I’ll read it. If anyone else is a ventilation junkie, I wrote this really long deep dive a while back. The shocking part for me was how bad the CO2 levels get in my car during a morning commute. Soporific. I always open the window and wear an N95 in a Lyft (in Philly where we do that a lot). Sorry it’s so verbose:


Makes me sad seeing all the collateral damage that has been wrought against vaccines for kids with this pandemic. The best I can counsel parents and adults is that vaccination is never risk free, but the benefits far outweigh the risks for CDC/ACIP recommended vaccines

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Two quickies on air quality.

One, the CDC recommendations are great, but much better is the new ASHRAE standards. These typically get built into building codes. Contact you local government to push them along.


Second, when ACH is low, as it will be in many buildings (and just about every home) for quite a while, add filtration. Four ways to do this.

Portable HEPA filters

MERV 13 HVAC filters (and put fan on "on" setting)

Corsi-Rosenthal boxes

Personal air filtration (masks!)

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"Things looking good right now" but wastewater is higher than in 2020 and 2021. Mixed messaging is not helpful in a pandemic. Are you saying that it is looking good for "normal" people but for"others" like the elderly, and immunocompromised folks it doesn't look so good so, they must continue to mask and for some isolate? This is a good way to further the normalization of the pandemic by reassuring the "normals" that they don't have a lot of risk and can do whatever they want without worrying about the "others". It encourages the acceptance of disease and deaths (anticipated 100,00 - 250,000 deaths per year) in the "others" by the "normals".

However, what is not getting publicity is that "normals" still have the risk of damage to their immune system that may not become apparent until the 3thd and 4th infection because the risk of long covid or post acute covid sequelae is not a one time risk, it is a cumulative risk. This is something that you don't address.

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Excellent, thank you. I'm curious whether Novavax will offer an updated booster this Fall, and if so, how accessible will it be for those looking for an alternative to mRNA? What good is it for FDA to authorize Novavax if it's not available at your local drugstore?

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Related to all this, Bob Wachter has put out another of his excellent tweet threads discussing the current status and how he is navigating it: https://twitter.com/Bob_Wachter/status/1660819438411866114

Two things, out of both Dr. Jetelina’s great article here and Dr. Wachter’s thread:

>The importance of wastewater: I join with all here who would be grateful for more information to understand better how to interpret that data.

>Use of rapid tests: I would be grateful for any information and advice Dr. Jetelina can offer targeted to those of us who are at high risk because of age. For example, Dr. Wachter writes: “As for other behaviors, I still test myself when I have symptoms or if I’m going to be in close contact with people I know to be vulnerable. Two negative tests 24-48 hours apart still reassure me that I don’t have Covid (or that, if I do, I’m not currently infectious).” I suspect there are many like our household whose friend groups are all “people we know to be vulnerable,” which suggests that everyone will need to test, even in the absence of symptoms, prior to gathering together. I worry that this is not feasible, all the moreso because Medicare no longer covers payment for OTC rapid tests.

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Despite the fact that COVID is waning accross the country for now, it's especially clear that those of us over 65 need to continue masking when & wherever possible. Now that COVID no longer appears to be newsworthy, without this newsletter, I would be clueless. Thanks for your excellent work!

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Thank you so much for this update! I still wear a mask in the grocery store and a few other places and feel like the only one. I'm very interested in the recommendations on ventilation. For the lay person, what does it take to have five air changes per hour, in a home for example? In a restaurant?

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I am very surprised at the 46% of respondents stating that they have worn a mask in the past 7 days. I have not seen anyone anywhere wearing masks. I recently traveled overseas and saw at most maybe two people wearing masks at a very, very busy airport terminal, maybe 1 person on the plane had a mask on. No one wears them in stores, church etc. For reference I live in Pennsylvania.

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My concern is that you’re saying that Covid is going down, but we’ve lost a ton of data due to places stopping recording, stopping testing, stopping reporting. How can we take this reduction seriously? The numbers have gone down by an implausible amount which I can only attribute to the end of tracking and data collection.

In my community in the last couple of weeks I’m seeing cases soar. I’m watching local doctors talking about a big influx in cases. So.... how do we get good data? How do we know when there is a wave?

I would pay good money for accurate information at this point.

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Curious what you think of the COVID spike in China? Estimated to have 65 million cases per week by the end of June. Is a new variant at play? Will we be able to find out? How will it affect the world? I’m immunocompromised, so I’m still masking everywhere. The number of medical professionals telling me loudly I don’t have to wear the mask is disheartening. I’m a nurse myself and think the best approach is not to mention it. If someone is masking now, it’s likely for good reason.

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I just want to bake you cookies and give you a big ole thank you hug! Thank you for continuing to keep us updated. We live in Texas and in a big city and fingers crossed we don’t see a wave this summer! Please keep us informed. I thought your gun violence update was just as important!

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