There are several new scientific developments regarding Covid-19 that might be useful to you, given that we are in a big wave right now. Here is a quick research roundup. (Note: I will dive deeper into long Covid next week. We’ve learned a lot more over the past year. Stay tuned.)
Thank you, Dr. Jetelina. This is very useful information. It’s reassuring that having six vaccinations for Covid-19 lessen my odds of getting long covid. Knowing a bit more about how hour plus exposure time is where transmission tends to happen is also helpful. I’m glad I still have plenty of masks and rapid at-home tests. The one question I have is the one you raised—when to test, especially when symptoms may “just” be slight congestion and fatigue.
I don't usually have a criticism, but this statement needs re-visiting: "Quick passersby at a grocery store are far less risky than staying in a house with someone infected. " Too many people are going to interpret this to mean little to no risk and forget that this is in comparison to the much larger risk in a home where you are likely unmasked and spending hours.
You should NEVER pop into the the Walmart or where ever else you like to pop, without a mask. Let's not forget the obscure finding from Australian health authorities who documented a FIVE-TEN SECOND passing contact as a source of infection at a time when this disease was orders of magnitude less infectious. https://www.theguardian.com/world/2021/jun/27/delta-covid-variant-may-be-edging-race-against-vaccines
[Update: Thanks to Martin for finally putting this story from Australia to sleep. It apparently is a result of very sloppy work and is not true. However, this does not mean that the time you spend in a store unmasked is going to work out well for you and should most definitely be avoided, especially if your dash includes standing in line to pay. Don't do that.
Unless you have the ability to see virus, as in clouds of cigarette smoke, your best bet is to mask indoors each and every time.]
But there have been more than enough stories of infections picked up more recently by going unmasked for "just a minute" into the viral soup of local commerce. Do not let the above finding she wrote about mis-lead you or others into thinking "quick" means zero. It does not.
Thank you. Really looking forward to the Long Covid update next week.
I really wish the CDC would be honest about contagiousness period. Too many people seem to believe that they’re safe after 5 days even if they’re still testing positive. I’d be curious what the average is now, if peak viral load is happening later.
Glad to know my multiple vaccinations provide added protection. I had Covid last summer and it proved to be mild. I am sure Paxlovid helped, as well. Too bad the anti-vax crowd keeps spreading disinformation based on nothing.
Thanks, as always, for keeping us updated so we can make informed, researched-based decisions.
Question about rapid tests/viral load: If the tests aren’t showing as positive until later in the course of infection (when viral load peaks), does that mean that a negative test (and cadence testing) earlier on indicates you aren’t infectious/as infectious as later? We have a group of friends using the “Osterholm Protocol” for meeting up more safely: negative rapid test, no symptoms, and no know COVID contacts. Is the testing piece still appropriate? Or should it be adjusted somehow? Thanks for your guidance!
Dr. Jetelina, I worry about the studies cited for several reasons:
1. One of the studies was funded by Pfizer, which has a vested interest in increased vaccine uptake.
2. More importantly, the data set from these studies ends either on 12/5/23 or 12/10/23 at the latest, depending upon which of the studies we're considering, with most of the data coming from ca October and November of 2023. That means that JN.1 had not reached prevalence in our population.
According to other info I've read (sorry, I don't have the citations offhand, but they were from peer reviewed studies) there is a concern that vaccinations that are not well-matched to predominant variants e.g. an XBB 1.5 targeted vaccine encountering JN.1, where such variants contain rather different sets of mutations, can result in a negative impact on T-Cell production and overall resistance to infection from these newer variants.
I fear that we are just not developing our vaccines quickly enough to fight this virus, which is a failing of our government's policies, but may be a losing battle even with the best efforts.
What do we do, then? Unfortunately, the solution (short term, at least) may be that we have to revert to greater mitigation measures, including mandatory masking, shutdowns of varying degrees, improved indoor air quality/ventilation, and creative methods for remote work/learning to avoid congregate settings. Of course, the political forces, motivated by economics, don't seem to be willing to go down this path.
I'd be curious to hear your response to these concerns and proposed possible solutions.
Thank you! A very good infectious disease physician at our state health department tried to get the epidemiologist modeler to say that Covid was seasonal at our monthly meeting about 2 months ago--I give them so much credit for still having a provider meeting--and the following month, it was clearly refuted by another physician right up front. As the pandemic feels interminable and there is so little data--your calm, evidence based information is appreciated more than ever.
My struggle is risk mitigation/protection vs isolation and this helps so much.
Thanks, once again, for continuing to plug away. At least the choir is listening. The information on viral load peaking, transmission, and non-seasonality was particularly interesting to me. Public health requires so much calm perseverance in the face of terrible things! Thank you.
Again, the study measuring vaccine effectiveness is very flawed and biased. These "studies" are the equivalent of big pharma propaganda, not useful "science"
1) Study period is only 2 months, what the data would show beyond that is anyone's guess. 2 months is a very short time period that tells you next to nothing.
2) First 7 days after injection is excluded...why? Once the shot goes into your arm, you should be considered vaccinated.
3) Only measures against COVID-19 hospitalizations (however that is determined) and not all-cause hospitalizations.
Thank you so much for the update. I appreciate the time that you put into these. I work in healthcare and I have had multiple exposures to Covid from patients who tested later and found out they had it, and suspected Covid exposures from people who do not test and just assume that everything is "just a cold." To my knowledge, I have only had Covid once. I was wondering if Covid exposures for short periods of time act almost like a vaccine and actually keep the antibody and/or T cell response primed? I'm not suggesting that anyone should do this on purpose. I'm just genuinely curious about this.
Your last post said that people develop symptoms sooner in the infection cycle now that most of us have prior exposure via some combination of vaccination and infection. That seems consistent with this post that says viral load now peaks a few days after symptom onset, instead of around symptom onset.
So i wonder if that means that antivirals like paxlovid are useful later (as compared to the starting point of "has symptoms") than they used to be, because the real starting point has to do with viral replication. It's anyone studying alternative paxlovid dosing regimens?
I've also wondered that about rebound, and if perhaps paxlovid would be more effective if it were administered for 7 days instead of 5. (Or started later, or for fewer days ... I suspect the very first study used 5 days, was found to be effective, and wonder if anyone has looked into improving that.)
Question: Received Novavax XBB 1.5 booster in October. Is there any data on waning yet? Or the need for re-boosting? I wear an N95 indoors, but I'm in a vulnerable age group and want as much vaccine protection as possible. Thanks!
Thank you, Dr. Jetelina. This is very useful information. It’s reassuring that having six vaccinations for Covid-19 lessen my odds of getting long covid. Knowing a bit more about how hour plus exposure time is where transmission tends to happen is also helpful. I’m glad I still have plenty of masks and rapid at-home tests. The one question I have is the one you raised—when to test, especially when symptoms may “just” be slight congestion and fatigue.
I don't usually have a criticism, but this statement needs re-visiting: "Quick passersby at a grocery store are far less risky than staying in a house with someone infected. " Too many people are going to interpret this to mean little to no risk and forget that this is in comparison to the much larger risk in a home where you are likely unmasked and spending hours.
You should NEVER pop into the the Walmart or where ever else you like to pop, without a mask. Let's not forget the obscure finding from Australian health authorities who documented a FIVE-TEN SECOND passing contact as a source of infection at a time when this disease was orders of magnitude less infectious. https://www.theguardian.com/world/2021/jun/27/delta-covid-variant-may-be-edging-race-against-vaccines
[Update: Thanks to Martin for finally putting this story from Australia to sleep. It apparently is a result of very sloppy work and is not true. However, this does not mean that the time you spend in a store unmasked is going to work out well for you and should most definitely be avoided, especially if your dash includes standing in line to pay. Don't do that.
Remember the early research and the "15 minute " rule? Don't count on that, either. https://www.npr.org/sections/goatsandsoda/2020/10/09/922385856/coronavirus-faq-whats-the-deal-with-the-15-minute-rule
Unless you have the ability to see virus, as in clouds of cigarette smoke, your best bet is to mask indoors each and every time.]
But there have been more than enough stories of infections picked up more recently by going unmasked for "just a minute" into the viral soup of local commerce. Do not let the above finding she wrote about mis-lead you or others into thinking "quick" means zero. It does not.
Thank you. Really looking forward to the Long Covid update next week.
I really wish the CDC would be honest about contagiousness period. Too many people seem to believe that they’re safe after 5 days even if they’re still testing positive. I’d be curious what the average is now, if peak viral load is happening later.
Glad to know my multiple vaccinations provide added protection. I had Covid last summer and it proved to be mild. I am sure Paxlovid helped, as well. Too bad the anti-vax crowd keeps spreading disinformation based on nothing.
Thanks, as always, for keeping us updated so we can make informed, researched-based decisions.
Question about rapid tests/viral load: If the tests aren’t showing as positive until later in the course of infection (when viral load peaks), does that mean that a negative test (and cadence testing) earlier on indicates you aren’t infectious/as infectious as later? We have a group of friends using the “Osterholm Protocol” for meeting up more safely: negative rapid test, no symptoms, and no know COVID contacts. Is the testing piece still appropriate? Or should it be adjusted somehow? Thanks for your guidance!
Dr. Jetelina, I worry about the studies cited for several reasons:
1. One of the studies was funded by Pfizer, which has a vested interest in increased vaccine uptake.
2. More importantly, the data set from these studies ends either on 12/5/23 or 12/10/23 at the latest, depending upon which of the studies we're considering, with most of the data coming from ca October and November of 2023. That means that JN.1 had not reached prevalence in our population.
According to other info I've read (sorry, I don't have the citations offhand, but they were from peer reviewed studies) there is a concern that vaccinations that are not well-matched to predominant variants e.g. an XBB 1.5 targeted vaccine encountering JN.1, where such variants contain rather different sets of mutations, can result in a negative impact on T-Cell production and overall resistance to infection from these newer variants.
I fear that we are just not developing our vaccines quickly enough to fight this virus, which is a failing of our government's policies, but may be a losing battle even with the best efforts.
What do we do, then? Unfortunately, the solution (short term, at least) may be that we have to revert to greater mitigation measures, including mandatory masking, shutdowns of varying degrees, improved indoor air quality/ventilation, and creative methods for remote work/learning to avoid congregate settings. Of course, the political forces, motivated by economics, don't seem to be willing to go down this path.
I'd be curious to hear your response to these concerns and proposed possible solutions.
Thank you for your important work!
Thank you! A very good infectious disease physician at our state health department tried to get the epidemiologist modeler to say that Covid was seasonal at our monthly meeting about 2 months ago--I give them so much credit for still having a provider meeting--and the following month, it was clearly refuted by another physician right up front. As the pandemic feels interminable and there is so little data--your calm, evidence based information is appreciated more than ever.
My struggle is risk mitigation/protection vs isolation and this helps so much.
Thanks, once again, for continuing to plug away. At least the choir is listening. The information on viral load peaking, transmission, and non-seasonality was particularly interesting to me. Public health requires so much calm perseverance in the face of terrible things! Thank you.
Again, the study measuring vaccine effectiveness is very flawed and biased. These "studies" are the equivalent of big pharma propaganda, not useful "science"
1) Study period is only 2 months, what the data would show beyond that is anyone's guess. 2 months is a very short time period that tells you next to nothing.
2) First 7 days after injection is excluded...why? Once the shot goes into your arm, you should be considered vaccinated.
3) Only measures against COVID-19 hospitalizations (however that is determined) and not all-cause hospitalizations.
4) This isn't a randomized controlled trial
5) Healthy vaccinee bias not accounted for
Fully vaxed and following your guidance. I appreciate your insights.
Thank you so much for the update. I appreciate the time that you put into these. I work in healthcare and I have had multiple exposures to Covid from patients who tested later and found out they had it, and suspected Covid exposures from people who do not test and just assume that everything is "just a cold." To my knowledge, I have only had Covid once. I was wondering if Covid exposures for short periods of time act almost like a vaccine and actually keep the antibody and/or T cell response primed? I'm not suggesting that anyone should do this on purpose. I'm just genuinely curious about this.
Your last post said that people develop symptoms sooner in the infection cycle now that most of us have prior exposure via some combination of vaccination and infection. That seems consistent with this post that says viral load now peaks a few days after symptom onset, instead of around symptom onset.
So i wonder if that means that antivirals like paxlovid are useful later (as compared to the starting point of "has symptoms") than they used to be, because the real starting point has to do with viral replication. It's anyone studying alternative paxlovid dosing regimens?
I've also wondered that about rebound, and if perhaps paxlovid would be more effective if it were administered for 7 days instead of 5. (Or started later, or for fewer days ... I suspect the very first study used 5 days, was found to be effective, and wonder if anyone has looked into improving that.)
Have you heard anything about allowing a 2nd updated Covid vaccine for elderly and immunocompromised like last year?
Great stuff, and reassuring studies. I've shared this with my Substack peeps, thank you!
Question: Received Novavax XBB 1.5 booster in October. Is there any data on waning yet? Or the need for re-boosting? I wear an N95 indoors, but I'm in a vulnerable age group and want as much vaccine protection as possible. Thanks!
Thank you so much for the updates! This information is very helpful (and some of it is really reassuring!). I appreciate you!!!