It’s been a long time coming and I should have done this sooner but I wanted to say thank you for your work -- for doing and sharing it so well with all of us. In the last three plus years, trust (in people, institutions, ourselves) has been hard to come by. Thank you for being a beacon of hope that one day reliable, science- based, public health information will be accessible and heard by all. Even if I did not have an immune-compromised child for who we try daily to make the best health and life decisions possible, I would continue reading your updates, thankful for the facts and truth. Thank you.
I was very disappointed in the NYT piece yesterday, and I'm equally disappointed in this posting. We're over three years into this pandemic, and I'm stunned that a post like this does not even mention Long COVID. If we use only one barometer of the risk from a C19 infection (premature death), we are overlooking and minimizing a very important part of the equation. I know people are working hard to erase the pandemic from their memories, and LC is a stubborn and unwelcome reminder that it is still with us. I didn't expect to see that kind of thinking reinforced on these pages.
Binary thinking always gets us into trouble and conflict. I’ll accept that the pandemic is “over” with these conditions that exist along a continuum:
* the world is changed and there is no getting back to pre-pandemic normal for those who don’t want to get Covid repeatedly.
* viral transmission occurs along a continuum between droplets and airborne particles
* initial amount of virus inoculation matters in terms of disease development.
* N95 masks work very well to reduce transmission, but masking exists along a continuum from sloppy gators to cloth to surgical to well fitting N95s. Like Dirty Harry said: “if you’re going to shoot, shoot.” If you’re going to mask, mask... and with SARS CoV-2 that means a well fitting N95 or bust.
* Covid is still worth trying not to get. Older people in particular still have risks of severe disease. Long Covid is rough and worth trying to avoid. Risk of collateral damage to the cardiovascular and neurological systems in particular can be acute, subacute, and chronic/permanent.
* listen to experts about boosters going forward. Try not to become a CDC/ACIP level expert yourself.
* take Paxlovid already.
* and when we do get Covid, let’s try to make it worth the risk. Getting Covid because we are too self conscious to wear an N95 on a plane, and thereby at the very least ruin our vacation and possibly more, is not worth it in my opinion. I just took an 8 hour flight recently and the CO2 ppm while in flight stayed around 1900. I checked it for fun. On the ground stuck waiting for clearance to take off it was 3000! Maybe 5% of people mask on planes, so I know it’s not cool. The people in front of me were both floridly sick, coughing, sneezing, and actually groaning. No masks. I had an N95 on and did not get sick at all, Covid or not.
* getting Covid because we had good friends and family over for dinner, or sleepovers for kids trying to have a good childhood again - that’s totally worth it in my opinion.
* good ventilation rules, and the great outdoors are great again.
Are these non-binary caveats true? Do they exist along a continuum? Then let’s call off “the pandemic.”
I would love to have you do a piece on Long Covid. This is a much more scary threat to me than death. I have a history of EBV and I keep reading how that is a risk factor. It seems the general focus with Covid has been the acute phase of the illness. Now we know there are long term health impairments as other viruses have shown (measles, HIV, HPV, herpes, varicella, polio). Long term disability for an unknown number of people could have a significant impact on maintaining democracy, the economy, and the social order.
I am advocating for air filtration and/or ventilation in schools, public buildings, workplaces, restaurants, gyms, libraries, movie theaters and all public venues.
I am advocating for continued public availability of vaccines and treatments, instead of the "commercialization" promoted by the Biden administration since ~a year ago. I am advocating for quality masks in medical facilities (KN95s, KF94s, N95s) and testing of patients for the most impactful viruses including COVID upon admission to the hospital when community transmission is significant. I am advocating for a strong research and public outreach/information program. Outreach/info networks of trusted messengers who are supported with public funds. I am advocating for strong sequencing programs that monitor which variants are circulating.
I am advocating for robust data collection and publication.
I am advocating for *not* kicking people off Medicaid, by way of the current "eligibility redetermination" that policymakers state openly will eliminate health insurance for millions of Americans, of whom half or more simply cannot overcome the bureaucratic hurdles of re-enrollment.
How is it possible that House Republicans made eliminating $79 Billion of unspent COVID funds a condition for their "debt ceiling compromise"? What I am asking is, how is it possible that $79 Billion were left unspent while public school buildings are left in their dismal state and thousands of people are becoming newly disabled by COVID every week or month - I don't know the numbers - we have no data anymore?
"Normalization" of this widespread preventable death of the vulnerable and preventable creation of legions of disabled people, is a cheapening of human life as we arguably haven't seen in ~8 decades in "the West."
Thank you for the update. My family has still been operating with masks indoors in crowded spaces, and avoiding large gatherings. And I guess we’ll just keep on with that, even if most aren’t. The side benefit is that we’ve avoided getting any sickness for the most part. 🤷♀️
Thank you for keeping us informed. At 65, with some higher risk medical conditions, I do still worry about catching Covid, from the standpoint of long Covid and the potential unknowns of underlying organ and autoimmune damage.
Question: What are your thoughts about Novavax versus mRNA vaccines, should both be offered this Fall? Can someone receive Novavax as a booster after having 7 mRNA vaccines? Is there any data suggesting one will be more effective or more durable over the over - will there ever be a vaccine that will be more protective against transmission?
Thank you! I appreciated your comment (and paraphrasing) that COVID is not at the top of our mind. This is the sticky part for me. We are seeing uptick in wastewater and hospital admissions, here too. There has got to be an easier way/more understanding of how to navigate this thing. I am 53, pretty healthy, five vaccines and two infections. I am a teacher and I wore my mask in the airport and while boarding and unloading. We begin school in a month and my young students truly need to see my mouth in order to learn. The delays in speech as well as social and emotional are truly astounding. We really need a cohesive strategy to understanding this virus as in how dangerous is it to our bodies at this point? Can we know that? Truly appreciate all that you are doing to keep us informed.
I can't help wishing that people would mask in indoor public places, and at least in medical buildings! Those little signs saying FEEL FREE TO MASK BUT IT'S NO LONGER NECESSARY is giving a message I find it threatening, because it validates the feelings of everyone who just wants to behave as if Covid has been licked and we should go back to all our old behaviors.
I'm deeply disappointed that our beloved local epidemiologist is spreading the normalization of avoidable long-term disability of millions of people, avoidable deaths of so many parents and grandparents, perpetuation of permanent fear of immunocompromised people, unfettered hospital-acquired COVID, and endless trauma of children who see the lives of their family members cheapened.
see the realistic assessment of the John Snow project here
Yep. I am no longer a "novid", though 3 years and 4 months of avoidance was a pretty good run. I got infected due to a "superspreader" who came to work "not that sick" and infected over 30 people in June at church where masks are merely "recommended" now. So, yes, Covid-19 is STILL alive and well and not "done". So I still appreciate what little surveillance efforts remain to keep us informed, though this data is harder for the general public to find now. I really wish that the west would adopt a more positive attitude toward prophylactic masking during the season when there's more airborne respiratory illnesses in circulation (flu, Covid, RSV, and, now the new one, HMPV). It's such an easy thing to do, wearing a mask in crowded spaces. Targeted public health messaging that promotes the health benefits of masking (protect others when you have symptoms, save sick leave by avoiding infection, protect yourself in crowded spaces, mask so you can stay well to enjoy the holidays and protect elder loved ones, etc.,) would be very much welcomed this fall and winter.
Thank you for your Herculean efforts to keep us informed these past few years. Yours is the voice I turn to most and whose advice I share with friends and family. Your clear communications and explanations have helped to keep my partner and me from getting infected (so far). We are both retired seniors with pre-existing conditions that make us high risk. We’ve kept up with vaccines and, because of our high risk status, have continued the “Swiss cheese model” of mitigation despite the hit on our on social lives.
Everyone we know who is our age and in similar health is back to 2019 behaviors with no mitigations. No one is talking about COVID or seems worried about Long COVID. (That goes for the unmasked staff, residents, and visitors at my 93 year old mother’s nursing home, too.)
And yet…I watched Dr. Bob Wachter’s recent “Final COVID-19 Grand Rounds” (link below) and was struck by the statement you made about Long COVID:
“I struggle with Long COVID a lot and the risks - and where to place long COVID in my repertoire of risks…I don’t want to get infected. It’s not inhibiting me from living life and going to a bar or concerts, but it’s certainly not something I want to gamble with. I have a lot of friends who are on heart failure medication that are my age for the rest of their life because of Long COVID.”
I hope that you’ll continue to address the emerging research on Long COVID in your future posts. Yes, it’s not 2020 anymore and, as Dr. Ashish Jha likes to say “We have the tools.” Studies are showing that vaccines and Paxlovid alone don't entirely prevent Long Covid, though. Disability rates are rising. This is where the story is - and where ongoing guidance is needed.
Again - with appreciation for all of your hard work! You make a difference.
UCSF Department of Medicine: “The Final COVID-19 Grand Rounds”
Thank you for this update. It’s so hard to find out what’s going on with Covid nowadays, so your updates are very much appreciated.
I am keeping my fingers crossed that the updated Novavax monovalent booster is available to everyone this Fall, and that it’s widely accessible. I have had a hard time finding comparison data on effectiveness between Novavax and mRNA.
Thank you so much for all of the clear and understandable information that you have provided. Your information has helped us significantly.
You stated "COVID-19 is increasing; don’t be surprised to hear more people getting infected around you. I already am. This isn’t enough reason to change my personal behaviors, but that time may come this fall. "
My wife and I are among those that have recently had Covid and we are interested in knowing what your recommended personal behaviors are at this time?
I, also, have been in remiss in thanking you for your ongoing work that helps us to get our head around this thing. Yesterday’s NYT article hit a chord with me - one of anger and disappointment. The light breezy tone that included several factual errors ( see, for example, “immunity”) conveyed a dangerous message to convince folks even more of the false assumption that COVID is no longer anything to worry about. It’s part of an ongoing national mantra to move on. As you say, things are improved- greatly- but we are not, if ever will we be, out of the woods. Your thoughtful and clear comments have never been more needed.
Thanks as always for the helpful update. I would really love to learn how to interpret wastewater data myself - if you did an article on this, I'd be so grateful I can't understand it at all, have looked for other explainers, but nothing for the non-scientist. That I've found anyway. It seems to be the little bit of data we have left.
It’s been a long time coming and I should have done this sooner but I wanted to say thank you for your work -- for doing and sharing it so well with all of us. In the last three plus years, trust (in people, institutions, ourselves) has been hard to come by. Thank you for being a beacon of hope that one day reliable, science- based, public health information will be accessible and heard by all. Even if I did not have an immune-compromised child for who we try daily to make the best health and life decisions possible, I would continue reading your updates, thankful for the facts and truth. Thank you.
I was very disappointed in the NYT piece yesterday, and I'm equally disappointed in this posting. We're over three years into this pandemic, and I'm stunned that a post like this does not even mention Long COVID. If we use only one barometer of the risk from a C19 infection (premature death), we are overlooking and minimizing a very important part of the equation. I know people are working hard to erase the pandemic from their memories, and LC is a stubborn and unwelcome reminder that it is still with us. I didn't expect to see that kind of thinking reinforced on these pages.
Binary thinking always gets us into trouble and conflict. I’ll accept that the pandemic is “over” with these conditions that exist along a continuum:
* the world is changed and there is no getting back to pre-pandemic normal for those who don’t want to get Covid repeatedly.
* viral transmission occurs along a continuum between droplets and airborne particles
* initial amount of virus inoculation matters in terms of disease development.
* N95 masks work very well to reduce transmission, but masking exists along a continuum from sloppy gators to cloth to surgical to well fitting N95s. Like Dirty Harry said: “if you’re going to shoot, shoot.” If you’re going to mask, mask... and with SARS CoV-2 that means a well fitting N95 or bust.
* Covid is still worth trying not to get. Older people in particular still have risks of severe disease. Long Covid is rough and worth trying to avoid. Risk of collateral damage to the cardiovascular and neurological systems in particular can be acute, subacute, and chronic/permanent.
* listen to experts about boosters going forward. Try not to become a CDC/ACIP level expert yourself.
* take Paxlovid already.
* and when we do get Covid, let’s try to make it worth the risk. Getting Covid because we are too self conscious to wear an N95 on a plane, and thereby at the very least ruin our vacation and possibly more, is not worth it in my opinion. I just took an 8 hour flight recently and the CO2 ppm while in flight stayed around 1900. I checked it for fun. On the ground stuck waiting for clearance to take off it was 3000! Maybe 5% of people mask on planes, so I know it’s not cool. The people in front of me were both floridly sick, coughing, sneezing, and actually groaning. No masks. I had an N95 on and did not get sick at all, Covid or not.
* getting Covid because we had good friends and family over for dinner, or sleepovers for kids trying to have a good childhood again - that’s totally worth it in my opinion.
* good ventilation rules, and the great outdoors are great again.
Are these non-binary caveats true? Do they exist along a continuum? Then let’s call off “the pandemic.”
I would love to have you do a piece on Long Covid. This is a much more scary threat to me than death. I have a history of EBV and I keep reading how that is a risk factor. It seems the general focus with Covid has been the acute phase of the illness. Now we know there are long term health impairments as other viruses have shown (measles, HIV, HPV, herpes, varicella, polio). Long term disability for an unknown number of people could have a significant impact on maintaining democracy, the economy, and the social order.
I am advocating for air filtration and/or ventilation in schools, public buildings, workplaces, restaurants, gyms, libraries, movie theaters and all public venues.
I am advocating for continued public availability of vaccines and treatments, instead of the "commercialization" promoted by the Biden administration since ~a year ago. I am advocating for quality masks in medical facilities (KN95s, KF94s, N95s) and testing of patients for the most impactful viruses including COVID upon admission to the hospital when community transmission is significant. I am advocating for a strong research and public outreach/information program. Outreach/info networks of trusted messengers who are supported with public funds. I am advocating for strong sequencing programs that monitor which variants are circulating.
I am advocating for robust data collection and publication.
I am advocating for *not* kicking people off Medicaid, by way of the current "eligibility redetermination" that policymakers state openly will eliminate health insurance for millions of Americans, of whom half or more simply cannot overcome the bureaucratic hurdles of re-enrollment.
How is it possible that House Republicans made eliminating $79 Billion of unspent COVID funds a condition for their "debt ceiling compromise"? What I am asking is, how is it possible that $79 Billion were left unspent while public school buildings are left in their dismal state and thousands of people are becoming newly disabled by COVID every week or month - I don't know the numbers - we have no data anymore?
https://projects.propublica.org/nonprofits/organizations/43314093
"Normalization" of this widespread preventable death of the vulnerable and preventable creation of legions of disabled people, is a cheapening of human life as we arguably haven't seen in ~8 decades in "the West."
Thank you for the update. My family has still been operating with masks indoors in crowded spaces, and avoiding large gatherings. And I guess we’ll just keep on with that, even if most aren’t. The side benefit is that we’ve avoided getting any sickness for the most part. 🤷♀️
Thank you for keeping us informed. At 65, with some higher risk medical conditions, I do still worry about catching Covid, from the standpoint of long Covid and the potential unknowns of underlying organ and autoimmune damage.
Question: What are your thoughts about Novavax versus mRNA vaccines, should both be offered this Fall? Can someone receive Novavax as a booster after having 7 mRNA vaccines? Is there any data suggesting one will be more effective or more durable over the over - will there ever be a vaccine that will be more protective against transmission?
Thank you! I appreciated your comment (and paraphrasing) that COVID is not at the top of our mind. This is the sticky part for me. We are seeing uptick in wastewater and hospital admissions, here too. There has got to be an easier way/more understanding of how to navigate this thing. I am 53, pretty healthy, five vaccines and two infections. I am a teacher and I wore my mask in the airport and while boarding and unloading. We begin school in a month and my young students truly need to see my mouth in order to learn. The delays in speech as well as social and emotional are truly astounding. We really need a cohesive strategy to understanding this virus as in how dangerous is it to our bodies at this point? Can we know that? Truly appreciate all that you are doing to keep us informed.
I can't help wishing that people would mask in indoor public places, and at least in medical buildings! Those little signs saying FEEL FREE TO MASK BUT IT'S NO LONGER NECESSARY is giving a message I find it threatening, because it validates the feelings of everyone who just wants to behave as if Covid has been licked and we should go back to all our old behaviors.
I'm deeply disappointed that our beloved local epidemiologist is spreading the normalization of avoidable long-term disability of millions of people, avoidable deaths of so many parents and grandparents, perpetuation of permanent fear of immunocompromised people, unfettered hospital-acquired COVID, and endless trauma of children who see the lives of their family members cheapened.
see the realistic assessment of the John Snow project here
https://johnsnowproject.org/insights/flattening-the-curve/
It didn't have to be this way, and it still doesn't.
Yep. I am no longer a "novid", though 3 years and 4 months of avoidance was a pretty good run. I got infected due to a "superspreader" who came to work "not that sick" and infected over 30 people in June at church where masks are merely "recommended" now. So, yes, Covid-19 is STILL alive and well and not "done". So I still appreciate what little surveillance efforts remain to keep us informed, though this data is harder for the general public to find now. I really wish that the west would adopt a more positive attitude toward prophylactic masking during the season when there's more airborne respiratory illnesses in circulation (flu, Covid, RSV, and, now the new one, HMPV). It's such an easy thing to do, wearing a mask in crowded spaces. Targeted public health messaging that promotes the health benefits of masking (protect others when you have symptoms, save sick leave by avoiding infection, protect yourself in crowded spaces, mask so you can stay well to enjoy the holidays and protect elder loved ones, etc.,) would be very much welcomed this fall and winter.
Thank you for your Herculean efforts to keep us informed these past few years. Yours is the voice I turn to most and whose advice I share with friends and family. Your clear communications and explanations have helped to keep my partner and me from getting infected (so far). We are both retired seniors with pre-existing conditions that make us high risk. We’ve kept up with vaccines and, because of our high risk status, have continued the “Swiss cheese model” of mitigation despite the hit on our on social lives.
Everyone we know who is our age and in similar health is back to 2019 behaviors with no mitigations. No one is talking about COVID or seems worried about Long COVID. (That goes for the unmasked staff, residents, and visitors at my 93 year old mother’s nursing home, too.)
And yet…I watched Dr. Bob Wachter’s recent “Final COVID-19 Grand Rounds” (link below) and was struck by the statement you made about Long COVID:
“I struggle with Long COVID a lot and the risks - and where to place long COVID in my repertoire of risks…I don’t want to get infected. It’s not inhibiting me from living life and going to a bar or concerts, but it’s certainly not something I want to gamble with. I have a lot of friends who are on heart failure medication that are my age for the rest of their life because of Long COVID.”
I hope that you’ll continue to address the emerging research on Long COVID in your future posts. Yes, it’s not 2020 anymore and, as Dr. Ashish Jha likes to say “We have the tools.” Studies are showing that vaccines and Paxlovid alone don't entirely prevent Long Covid, though. Disability rates are rising. This is where the story is - and where ongoing guidance is needed.
Again - with appreciation for all of your hard work! You make a difference.
UCSF Department of Medicine: “The Final COVID-19 Grand Rounds”
https://youtu.be/e3pjp4jf208
Thank you for this update. It’s so hard to find out what’s going on with Covid nowadays, so your updates are very much appreciated.
I am keeping my fingers crossed that the updated Novavax monovalent booster is available to everyone this Fall, and that it’s widely accessible. I have had a hard time finding comparison data on effectiveness between Novavax and mRNA.
Thank you so much for all of the clear and understandable information that you have provided. Your information has helped us significantly.
You stated "COVID-19 is increasing; don’t be surprised to hear more people getting infected around you. I already am. This isn’t enough reason to change my personal behaviors, but that time may come this fall. "
My wife and I are among those that have recently had Covid and we are interested in knowing what your recommended personal behaviors are at this time?
I, also, have been in remiss in thanking you for your ongoing work that helps us to get our head around this thing. Yesterday’s NYT article hit a chord with me - one of anger and disappointment. The light breezy tone that included several factual errors ( see, for example, “immunity”) conveyed a dangerous message to convince folks even more of the false assumption that COVID is no longer anything to worry about. It’s part of an ongoing national mantra to move on. As you say, things are improved- greatly- but we are not, if ever will we be, out of the woods. Your thoughtful and clear comments have never been more needed.
Thanks as always for the helpful update. I would really love to learn how to interpret wastewater data myself - if you did an article on this, I'd be so grateful I can't understand it at all, have looked for other explainers, but nothing for the non-scientist. That I've found anyway. It seems to be the little bit of data we have left.