Thank you for helping us think this through (as you so frequently do!) It just seems this action is falsely reassuring. If it takes around 3 days for an infected person's PCR to turn positive, and their PCR was 48 hours ago, then (assuming the PCR is always correct) doesn't a negative test just mean they weren't infected 5 days ago? Even if not infected now, they'd be at risk of picking up the virus on 15-20+ hours of flying where most passengers were unmasked. At least the sequencing might help (detect new variants). Meanwhile I believe a large % of people in the US aren't worried about transmission anyway. Plus waiting a week to implement the policy doesn't exactly signal urgent concern. I hope I'm missing something science-based about the rationale, and I realize the importance of reassuring the public - but false reassurance usually backfires eventually.
It does seem like a majority of our fellow Americans are no longer worried about transmission. I have more tests coming from the Federal government since they resumed shipping free tests (4 per household this time) to add to our store. We test regularly, but I feel like we’re probably outliers at this point.
I test frequently also and get frustrated that more people don't. I wouldn't have to restrict my activities so much if I could depend on others being responsible.
You will never be able to depend on others unless or until a catastrophic dead-in-24-hours variant comes along. That's when people will get back to masking. Short of that, they'll continue the slow route to extinction.
Seems we've mostly reached the point where protection is an individual or family decision hopefully based on an informed risk vs. benefit evaluation (Dr. Jetelina had a good piece on this a few months ago). Though what qualifies as "informed" is often fuzzy and our knowledge keeps evolving plus there are many points of disagreement on the implications (and methodology) of studies. But in principle, we are continuously doing risk vs. benefit evaluations and people vary widely where they sit on a specific risk and benefit (e.g., flying 4 hours to visit family, given various types of risk reduction). Even where risk-reduction is appropriately mandated (healthcare facilities in my county), it's not uniform: some will wear a surgical mask (1 step up from Swiss cheese in my opinion); others a well-fitted N95.
If you define protection as COVID shots, we are not at a point where that is based on individual decisions. COVID shots are still mandated. For example, college students at elite universities like Yale are mandated to have updated booster shots.
But if you just mean masks, then you are right, as mask mandates are far less often now.
Thank you for pointing that out - I didn't know there were still colleges that required Covid vaccination (especially boosters). What is the (stated) rationale for that, given the vaccines don't seem to be very good at preventing transmission?
Vaccines can reduce the potential impact, in terms of severity, hospitalization and death, and boosters fall into this realm as well. Similarly, non-pharmaceutical interventions, including improved air filtration (HEPA), improved outdoor air exchange, masking, social/physical distancing and to some extent, hand hygiene, will also help reduce transmission. The fact that we lost sight of these minor points regardless of the reason, has led to repeated surges. When you add the overwhelming number of variants that are emerging and their ability to evade immune responses, one begins to see benefits to requiring responsive populations... those where an explanation leads to a positive response designed to improve compliance. University populations have been generally receptive, overall, to a plethora of mitigation strategies catered to their student body populations.
Masks, especially, have proven effective according to Debbi Birx, who coordinated the response in the Trump administration, in limiting transmission. Evidence of this in engineering and clinical trials was reported in a Japanese report cited by Birx.
And let me take your last statement head-on. The original intent of the vaccines was to mute the degree of severe illness, hospitalization and death, not to prevent infection, or prevent transmission. Both of these are very high bars to meet. At the onset of vaccine research, the sole goal was to reduce mortality; the reduction in infective rate seen with the original vaccines responding to the original WA-1 virus was a serendipitous benefit. As new variants have emerged they have also manifested an ability to evade antibodies produced both by prior (ancestral variant) infection and vaccination. This is something we anticipated, at least to some extent. Simply put, we did not know how long immunity in the form of IgG-mediated antibodies from either infection or vaccine would persist.
The reason given by Yale is students live in congregate housing and attend mass events. The booster mandate does not extend to many older adults on campus like professors and staff because it’s assumed most don’t live in congregate housing and attend mass events.
The SCOTUS rulings eviscerating OSHA and CDC abilities to dictate workplace public health measures play into this much more than the concepts of congregate housing and mass events.
@David Bate: Hopes and dreams are being dashed worldwide. We all have some degree of pandemic fatigue and restrictions with masking and 30% of us decry or decline vaccines and/or boosters. Having to avoid congregating and travel is not what we humans appreciate. Nevertheless, if you are fully informed about dealing with death and dying from a deadly virus that keeps evolving and now capable of escaping a protective immune response, it forces one to re-order our priorities. If the Taiwan trip is worth the risk of getting ill or succumbing to the virus and its multisystems acute and chronic effects then only you can decide if it's worth the risk. For me, in a survivor mode, I would stay with our status quo - masking, boosters when appropriate/available, distancing and limiting any congregate activities even fully vaccinated as we are. Also, I am mindful that the latest CDC/NIH/FDA pronouncement that the last of 6 monoclonal antibody treatments has now lost its EUA status. This 1 hr infusion of the Lilly product Bebtelovimab (~$720M for 600,000 doses paid by US Taxpayers) "was not expected to neutralize omicron subvariants BQ.1 and BQ.1.1.......because they don't bind to the virus anymore" (Arturo Casadevall, MD Prof of Medicine JHH Baltimore, MD). Antibody cocktails may have a better profile than these MCAbs (Me). Paxlovid is a singular approach presently. Another protocol that has had significant outcomes is based on a repurposed drug hydroxyurea/hydroxycarbamide (HU). My colleague and I have entered >400 case reports from the nearly 2,000 COVID19 pos outpatients and some inpatients that were prescribed this unique protocol since mid-2020. It's only needed for 5 days, has demonstrated a prompt response evident within a matter of hours (a few up to 72 hrs), has shown NO Adverse Drug Reactions, appears safe and has FDA-approval that dates back decades for its continuous or discontinuous use in the congenital hemoglobinopathy sickle cell disease for young children to adults of all ages. The recovery stories are almost too incredible to believe and that is the conundrum. How can a 5-day regimen anchored by pills readily accessible for <USD$10.00 have such a profound effect on the SARS-Cov2 virus and its variants at any stage of infection. This drug needs an immediate RCT for comparison to current therapy of which there is NO approved protocol, only EUA protocols. Review the case reports thus far submitted in the CURE ID website devised by the NIH/CDC/FDA/C-Path after funding by the AHCA of 2012 specifically to address and solicit real world treatments by Clinicians worldwide using repurposed drugs. These governmental agencies recognize the enormous task of bringing new drugs into the armamentarium of COVD19 treatments as well as the expenses to the taxpayers, hence this initiative that has thus far attracted very few credible treatments as the list of top 10 drug protocols notes on the Website. The greatest number of reports came from hydroxychloroquine that has garnered the lion's share of publicity, politicization, and found to have zero benefits for any stage of COVD19 from multiple trials as recorded at ClinicalTrials.gov. The 2nd drug on the list is now HU with the >400 case reports described via the protocol responses my colleague and I have utilized in capturing several hundred cases. The entries are ongoing with the hope of displacing HCQ that is undeserving of any further attention in our opinion. Ivermectin never made the list but it. too was a "darling" that has been studied ad nauseum and found to be ineffective.
Check it out: <http://cure.ncats.io> (National Center for Advancing Translational Sciences is the source for the url)
Thank you for keeping us informed, and sacrificing time with your family by doing so. Please try to enjoy what's left of your holiday and keep making memories with your twins! Children grow up so fast and statistically you actually spend the majority of time with them for only the first 18 years or so. 💜
I live in an area where XBB is greater than 50% and work in public health. Our hospitalizations are the highest they’ve been in months, we actually have intubated patients again, and I’m talking to some quite ill people (102-103 fevers, terrible headaches, sore throat, bad body aches, and loss of smell/taste seems to have resurfaced.)
This is a rather worrisome wake-up call. I feel like most people have only the headlines about Omicron being mild and “more like a cold” in their heads.
When I was a hospital nurse, I used N95s when they were available and allowed (long story.), surgical masks and eye protection otherwise. I had a lot of exposure. Since Omicron came around, I use Kn95 in indoor settings. Masking is still required in my current job. I do takeout only. I have been to large work events but wore kn95. For swabbing/testing people, I use n95 and eye protection. I test myself regularly (every 3-7 days) and have access to pcr testing. I have not been infected with COVID at this point to my knowledge.
Bravo. It's very comforting to see the results of common sense and discipline. I've not faced your risk profile (medical setting) but I too use N95 (headstraps only), no indoor dining, nothing indoors without masking, etc. For high-risk locations I cannot avoid (crowded public transportation) I often use an elastomeric "scary freak" mask with P100 HEPA filters. It's not fun, but I don't care. I do what I think is needed.
I personally hate the phrase “just the flu”, having lost a healthy cousin in their early 40s to it a few years back. Not seeing a lot of coinfection in the hospitalized (and they almost always get a combo swab), but when it does happen, flu and COVID especially in the setting of multiple comorbidities, the outcomes are not good.
Wow, 48 percent! And that was in outpatients. It is not easy at all to get tested for the flu in my area. In fact, when I recently suspected my son had the flu, I did a Labcorp on demand pcr Covid/Flu/RSV test at home and sent it out. I was right—Type A Flu positive. The urgent cares here won’t test for it, my peds office wouldn’t test for it. Unless I wanted to brave the hospital, it was down to the home pcr (which isn’t fast enough to allow for treatment, but that’s another rant for another day.) “Testing for both flu and COVID-19 viruses in patients experiencing symptoms of respiratory illness and vaccinations against both viruses should continue to be encouraged," Wan said.”
I assumed masking in China would temper this “let it rip” response to political instability and protests. Does anyone know if this wave is occurring in the context of people masking?
I’ve been quite comfortable doing public stuff with an N95 on (seeing patients, watching Avatar 2 with my daughter similarly masked- the only people in the theater doing so 😔)
If people are still masking, then are surgical type masks failing with these freakishly contagious variants?
In Canada, the hospitals want you to put on their blue surgical masks if you enter, even with an n95 on, so I put it over, but all medical professionals are in the blue surgical masks which I find puzzling
What about transmission into the eyes? Mucous membrane right? Is it possible that this new variant can infect the eyes too? (I'm wearing the non-FDA approve MicroClimate helmet AND N95 mask... guessing it might be a 90% proof protection...)
If X.B.B.1.5 is a B.A.2 descendant, does that mean there’s a chance some of the monoclonal antibody treatments ( and/or Evushield) might become useful once more? That would be very good news. Will testing this idea out be a priority for the companies who’ve lost their EUAs?
Once again, thank you so much, Dr. Jetalina, for keeping us updated, especially during the holiday season. Forewarned is forearmed! I also had hoped that 2023 would be quieter on the Covid front, but with China’s abrupt swerve away from their Zero Covid strategy to what at least some in China are dubbing “Zero Negative,” quiet is probably not going to be the case for Covid next year. I hope that despite all this, you can resume your break and spend more time with your family.
I'd be very interested in your thoughts about the article in Wall Street Journal on January 1 by Allysia Finley entitled "Are Vaccines Fueling New Covid Variants?" The article suggests that high rates of repeated vaccination are fueling the emergence of new immune-evading variants, with specific reference to xxb. Some of the reasoning seems strained -- both Singapore and New York metro area have high vaccination rates and are sites of xxb emergence, ergo there's a relationship! Uh, they are also crowded places with extensive connections to the world. And there's an aside about "disinformation" that suggests political motivation. But she cites some studies that seem to point to concerns. What's your take on this question?
And if you find a positive case, then you have to find and subsequently test everyone who was on the plane. No, test them directly. I view wastewater surveillance as a tool for looking for future outbreaks. It's not a great tool for pooling data and then having to establish who, on that plane, was sick.
Repeat testing 48-72 hours after a negative test would be advisable in virtually all cases, but especially where symptoms develop. One of the big, no, HUGE problems remains silent spread by asymptomatic carriers.
You don't think it would be useful just for the purpose of exposure notification? Or do you think that at this point we are all constantly exposed and you're either sufficiently masked and vaccinated or you're not?
I just read a valid reason for wastewater surveillance of inbound aircraft I can identify with: To get the genomic sequences of the variants we're seeing come into the country. THAT is a worthwhile exercise. Trying to do it to for surveillance is still a sorta futile exercise, but I can still have my mind changed.
I’m curious about airplanes from China where half the passengers have Covid. Are these half-infected planes outliers? Does this mean roughly half the people in China have Covid right now (suggesting some type of peak, hopefully)? Or are these people who already knew they had Covid and are leaving China in the hopes of seeking medical treatment, perhaps because they have a comorbidity? Or maybe they are fleeing because they fear future civil unrest as the country becomes unglued? It seems logical that people flying from China to other countries are likely a wealthier segment and/or the elite class.
I don’t think Xi is embracing a “let it rip” policy so much as he finally realized that his government can no longer control and suppress the virus, so his best political move was to give the appearance that he is finally acquiescing to the pleas from his people and increasing personal freedom.
@BayDog: Agreed, but who will pay for it? Not likely the airlines. HIPPA privacy issues may come in to play incredible as it may seem. Our efforts to get case reports into the CURE ID website (<https://cure.ncats.io>) noted those HIPPA restrictions with our patient experience questionnaire as we entered the info into the website's solicited "real-world" COVID19 treatments with the repurposed drug HU (hydroxyurea/hydroxycarbamide - not to be confused with the thoroughly studied and inefficacious hydroxychloroquine or its politicized "4th cousin" ivermectin, both repeatedly undergoing RCTs and reported in ClinicalTrials.gov. HIPPA will not even permit recording a patient's City nor the the patient's actual age, only an age-range. Lots of good data left on the table when such info can't be reported "by Law". Imagine the "small city" I envision as an airplane full of passenger providing the waste water for analysis - a privacy issue looming? A bit over-stated perhaps? It's a reality as I view it. The case reports in the section for COVID19 number >400 and there were NO adverse effects, rebounds, or failures of cure even after just a few days of the HU. The FDA approved the drug decades ago and it's actively being prescribed on a continuous basis for the congenital disorder of sickle cell disease (SCD) even for children of 2 yrs of age. Some reports note that of the African victims of SCD, the incidence of COVID19 deaths is far less in those Countries with people taking HU for SCD symptoms mitigation as compared to non-SCD people also living in Africa or other countries who did not have access or desire to take HU. We dearly want to get this drug into trials. We envision a prompt and dramatic acceptance once credibly large studies are initiated and compared to any other repurposed drug treatment. Getting an "audience with his highness" (the RCT DB/Placebo controlled) and trying to get an inexpensive drug used for another disorder has been an ongoing challenge and are major barriers. Imagine taking HU capsules for 5 days for $3.55 from CVS vs Paxlovid 5 days for $530-751 taxpayer Fed price and molnupirivir $700 taxpayer Fed price both not officially approved but designated as EUA. China would do well to examine these case reports and use its resources to save its population from large numbers of deaths that are increasing by the day.
Testing the wastewater will let us uncover, I suppose, a deadly variant but beyond that I don't see it being good for much else since we know China is pretty much fully infected and we know we aren't going to do anything to restrict spread in this country. The only effective move is closing border to everyone and that's not going to happen.
It’s possible the *real* reason western countries are re-imposing covid test restrictions on travelers from China is to prevent sick foreigners from entering countries and demanding medical treatments that will soon be in short supply.
Thank you for helping us think this through (as you so frequently do!) It just seems this action is falsely reassuring. If it takes around 3 days for an infected person's PCR to turn positive, and their PCR was 48 hours ago, then (assuming the PCR is always correct) doesn't a negative test just mean they weren't infected 5 days ago? Even if not infected now, they'd be at risk of picking up the virus on 15-20+ hours of flying where most passengers were unmasked. At least the sequencing might help (detect new variants). Meanwhile I believe a large % of people in the US aren't worried about transmission anyway. Plus waiting a week to implement the policy doesn't exactly signal urgent concern. I hope I'm missing something science-based about the rationale, and I realize the importance of reassuring the public - but false reassurance usually backfires eventually.
It does seem like a majority of our fellow Americans are no longer worried about transmission. I have more tests coming from the Federal government since they resumed shipping free tests (4 per household this time) to add to our store. We test regularly, but I feel like we’re probably outliers at this point.
I test frequently also and get frustrated that more people don't. I wouldn't have to restrict my activities so much if I could depend on others being responsible.
You will never be able to depend on others unless or until a catastrophic dead-in-24-hours variant comes along. That's when people will get back to masking. Short of that, they'll continue the slow route to extinction.
Exactly!
Seems we've mostly reached the point where protection is an individual or family decision hopefully based on an informed risk vs. benefit evaluation (Dr. Jetelina had a good piece on this a few months ago). Though what qualifies as "informed" is often fuzzy and our knowledge keeps evolving plus there are many points of disagreement on the implications (and methodology) of studies. But in principle, we are continuously doing risk vs. benefit evaluations and people vary widely where they sit on a specific risk and benefit (e.g., flying 4 hours to visit family, given various types of risk reduction). Even where risk-reduction is appropriately mandated (healthcare facilities in my county), it's not uniform: some will wear a surgical mask (1 step up from Swiss cheese in my opinion); others a well-fitted N95.
If you define protection as COVID shots, we are not at a point where that is based on individual decisions. COVID shots are still mandated. For example, college students at elite universities like Yale are mandated to have updated booster shots.
But if you just mean masks, then you are right, as mask mandates are far less often now.
Thank you for pointing that out - I didn't know there were still colleges that required Covid vaccination (especially boosters). What is the (stated) rationale for that, given the vaccines don't seem to be very good at preventing transmission?
Vaccines can reduce the potential impact, in terms of severity, hospitalization and death, and boosters fall into this realm as well. Similarly, non-pharmaceutical interventions, including improved air filtration (HEPA), improved outdoor air exchange, masking, social/physical distancing and to some extent, hand hygiene, will also help reduce transmission. The fact that we lost sight of these minor points regardless of the reason, has led to repeated surges. When you add the overwhelming number of variants that are emerging and their ability to evade immune responses, one begins to see benefits to requiring responsive populations... those where an explanation leads to a positive response designed to improve compliance. University populations have been generally receptive, overall, to a plethora of mitigation strategies catered to their student body populations.
Masks, especially, have proven effective according to Debbi Birx, who coordinated the response in the Trump administration, in limiting transmission. Evidence of this in engineering and clinical trials was reported in a Japanese report cited by Birx.
And let me take your last statement head-on. The original intent of the vaccines was to mute the degree of severe illness, hospitalization and death, not to prevent infection, or prevent transmission. Both of these are very high bars to meet. At the onset of vaccine research, the sole goal was to reduce mortality; the reduction in infective rate seen with the original vaccines responding to the original WA-1 virus was a serendipitous benefit. As new variants have emerged they have also manifested an ability to evade antibodies produced both by prior (ancestral variant) infection and vaccination. This is something we anticipated, at least to some extent. Simply put, we did not know how long immunity in the form of IgG-mediated antibodies from either infection or vaccine would persist.
The reason given by Yale is students live in congregate housing and attend mass events. The booster mandate does not extend to many older adults on campus like professors and staff because it’s assumed most don’t live in congregate housing and attend mass events.
The SCOTUS rulings eviscerating OSHA and CDC abilities to dictate workplace public health measures play into this much more than the concepts of congregate housing and mass events.
Thank you. Any word on the effectiveness of the fall booster against the new strain offshoots on the horizon that you spoke of?
@David Bate: Hopes and dreams are being dashed worldwide. We all have some degree of pandemic fatigue and restrictions with masking and 30% of us decry or decline vaccines and/or boosters. Having to avoid congregating and travel is not what we humans appreciate. Nevertheless, if you are fully informed about dealing with death and dying from a deadly virus that keeps evolving and now capable of escaping a protective immune response, it forces one to re-order our priorities. If the Taiwan trip is worth the risk of getting ill or succumbing to the virus and its multisystems acute and chronic effects then only you can decide if it's worth the risk. For me, in a survivor mode, I would stay with our status quo - masking, boosters when appropriate/available, distancing and limiting any congregate activities even fully vaccinated as we are. Also, I am mindful that the latest CDC/NIH/FDA pronouncement that the last of 6 monoclonal antibody treatments has now lost its EUA status. This 1 hr infusion of the Lilly product Bebtelovimab (~$720M for 600,000 doses paid by US Taxpayers) "was not expected to neutralize omicron subvariants BQ.1 and BQ.1.1.......because they don't bind to the virus anymore" (Arturo Casadevall, MD Prof of Medicine JHH Baltimore, MD). Antibody cocktails may have a better profile than these MCAbs (Me). Paxlovid is a singular approach presently. Another protocol that has had significant outcomes is based on a repurposed drug hydroxyurea/hydroxycarbamide (HU). My colleague and I have entered >400 case reports from the nearly 2,000 COVID19 pos outpatients and some inpatients that were prescribed this unique protocol since mid-2020. It's only needed for 5 days, has demonstrated a prompt response evident within a matter of hours (a few up to 72 hrs), has shown NO Adverse Drug Reactions, appears safe and has FDA-approval that dates back decades for its continuous or discontinuous use in the congenital hemoglobinopathy sickle cell disease for young children to adults of all ages. The recovery stories are almost too incredible to believe and that is the conundrum. How can a 5-day regimen anchored by pills readily accessible for <USD$10.00 have such a profound effect on the SARS-Cov2 virus and its variants at any stage of infection. This drug needs an immediate RCT for comparison to current therapy of which there is NO approved protocol, only EUA protocols. Review the case reports thus far submitted in the CURE ID website devised by the NIH/CDC/FDA/C-Path after funding by the AHCA of 2012 specifically to address and solicit real world treatments by Clinicians worldwide using repurposed drugs. These governmental agencies recognize the enormous task of bringing new drugs into the armamentarium of COVD19 treatments as well as the expenses to the taxpayers, hence this initiative that has thus far attracted very few credible treatments as the list of top 10 drug protocols notes on the Website. The greatest number of reports came from hydroxychloroquine that has garnered the lion's share of publicity, politicization, and found to have zero benefits for any stage of COVD19 from multiple trials as recorded at ClinicalTrials.gov. The 2nd drug on the list is now HU with the >400 case reports described via the protocol responses my colleague and I have utilized in capturing several hundred cases. The entries are ongoing with the hope of displacing HCQ that is undeserving of any further attention in our opinion. Ivermectin never made the list but it. too was a "darling" that has been studied ad nauseum and found to be ineffective.
Check it out: <http://cure.ncats.io> (National Center for Advancing Translational Sciences is the source for the url)
Ray Sullivan, MD
Thank you for taking the time away from your family to keep your subscribers informed. It’s helpful and very much appreciated.
Thanks always for your insightful thoughts. It seems that the many unexpected turns of COVID-19 have led to more humility in predictions.
Please do focus on your family especially during these precious holidays with your growing daughters
Thank you for keeping us informed, and sacrificing time with your family by doing so. Please try to enjoy what's left of your holiday and keep making memories with your twins! Children grow up so fast and statistically you actually spend the majority of time with them for only the first 18 years or so. 💜
Take care of yourself!
Is there any info about the XBB.1.5 symptomatology and severity? Thanks for the heads-up!
I live in an area where XBB is greater than 50% and work in public health. Our hospitalizations are the highest they’ve been in months, we actually have intubated patients again, and I’m talking to some quite ill people (102-103 fevers, terrible headaches, sore throat, bad body aches, and loss of smell/taste seems to have resurfaced.)
This is a rather worrisome wake-up call. I feel like most people have only the headlines about Omicron being mild and “more like a cold” in their heads.
What kind of PPE have you been using and over the last 3 years how effective have your protocols been at keeping you infection-free?
When I was a hospital nurse, I used N95s when they were available and allowed (long story.), surgical masks and eye protection otherwise. I had a lot of exposure. Since Omicron came around, I use Kn95 in indoor settings. Masking is still required in my current job. I do takeout only. I have been to large work events but wore kn95. For swabbing/testing people, I use n95 and eye protection. I test myself regularly (every 3-7 days) and have access to pcr testing. I have not been infected with COVID at this point to my knowledge.
Bravo. It's very comforting to see the results of common sense and discipline. I've not faced your risk profile (medical setting) but I too use N95 (headstraps only), no indoor dining, nothing indoors without masking, etc. For high-risk locations I cannot avoid (crowded public transportation) I often use an elastomeric "scary freak" mask with P100 HEPA filters. It's not fun, but I don't care. I do what I think is needed.
I personally hate the phrase “just the flu”, having lost a healthy cousin in their early 40s to it a few years back. Not seeing a lot of coinfection in the hospitalized (and they almost always get a combo swab), but when it does happen, flu and COVID especially in the setting of multiple comorbidities, the outcomes are not good.
Wow, 48 percent! And that was in outpatients. It is not easy at all to get tested for the flu in my area. In fact, when I recently suspected my son had the flu, I did a Labcorp on demand pcr Covid/Flu/RSV test at home and sent it out. I was right—Type A Flu positive. The urgent cares here won’t test for it, my peds office wouldn’t test for it. Unless I wanted to brave the hospital, it was down to the home pcr (which isn’t fast enough to allow for treatment, but that’s another rant for another day.) “Testing for both flu and COVID-19 viruses in patients experiencing symptoms of respiratory illness and vaccinations against both viruses should continue to be encouraged," Wan said.”
I assumed masking in China would temper this “let it rip” response to political instability and protests. Does anyone know if this wave is occurring in the context of people masking?
I’ve been quite comfortable doing public stuff with an N95 on (seeing patients, watching Avatar 2 with my daughter similarly masked- the only people in the theater doing so 😔)
If people are still masking, then are surgical type masks failing with these freakishly contagious variants?
Very interesting question (especially as more medical personnel seem to be back in surgical masks in some settings)!
In Canada, the hospitals want you to put on their blue surgical masks if you enter, even with an n95 on, so I put it over, but all medical professionals are in the blue surgical masks which I find puzzling
Really hard to comprehend…!
What about transmission into the eyes? Mucous membrane right? Is it possible that this new variant can infect the eyes too? (I'm wearing the non-FDA approve MicroClimate helmet AND N95 mask... guessing it might be a 90% proof protection...)
If X.B.B.1.5 is a B.A.2 descendant, does that mean there’s a chance some of the monoclonal antibody treatments ( and/or Evushield) might become useful once more? That would be very good news. Will testing this idea out be a priority for the companies who’ve lost their EUAs?
Once again, so clearly and expertly explained, THANK YOU.
Once again, thank you so much, Dr. Jetalina, for keeping us updated, especially during the holiday season. Forewarned is forearmed! I also had hoped that 2023 would be quieter on the Covid front, but with China’s abrupt swerve away from their Zero Covid strategy to what at least some in China are dubbing “Zero Negative,” quiet is probably not going to be the case for Covid next year. I hope that despite all this, you can resume your break and spend more time with your family.
As always. Thank you.
I'd be very interested in your thoughts about the article in Wall Street Journal on January 1 by Allysia Finley entitled "Are Vaccines Fueling New Covid Variants?" The article suggests that high rates of repeated vaccination are fueling the emergence of new immune-evading variants, with specific reference to xxb. Some of the reasoning seems strained -- both Singapore and New York metro area have high vaccination rates and are sites of xxb emergence, ergo there's a relationship! Uh, they are also crowded places with extensive connections to the world. And there's an aside about "disinformation" that suggests political motivation. But she cites some studies that seem to point to concerns. What's your take on this question?
We are still better off than we were at this time last year...
That's not saying much, but worth remembering.
And I really don't understand China sitting on its hands while doing the zero Covid thing. After OG Omicron hit, what did they think would happen?
Today's headline: "U.S. to require Covid testing of air passengers arriving from China."
Seems to me that airplane wastewater testing should precede that.
And if you find a positive case, then you have to find and subsequently test everyone who was on the plane. No, test them directly. I view wastewater surveillance as a tool for looking for future outbreaks. It's not a great tool for pooling data and then having to establish who, on that plane, was sick.
Fair point. Wish they would use some sort of testing after arrive, though. Agree with all of Katelyn’s concerns.
Repeat testing 48-72 hours after a negative test would be advisable in virtually all cases, but especially where symptoms develop. One of the big, no, HUGE problems remains silent spread by asymptomatic carriers.
You don't think it would be useful just for the purpose of exposure notification? Or do you think that at this point we are all constantly exposed and you're either sufficiently masked and vaccinated or you're not?
I just read a valid reason for wastewater surveillance of inbound aircraft I can identify with: To get the genomic sequences of the variants we're seeing come into the country. THAT is a worthwhile exercise. Trying to do it to for surveillance is still a sorta futile exercise, but I can still have my mind changed.
I’m curious about airplanes from China where half the passengers have Covid. Are these half-infected planes outliers? Does this mean roughly half the people in China have Covid right now (suggesting some type of peak, hopefully)? Or are these people who already knew they had Covid and are leaving China in the hopes of seeking medical treatment, perhaps because they have a comorbidity? Or maybe they are fleeing because they fear future civil unrest as the country becomes unglued? It seems logical that people flying from China to other countries are likely a wealthier segment and/or the elite class.
I don’t think Xi is embracing a “let it rip” policy so much as he finally realized that his government can no longer control and suppress the virus, so his best political move was to give the appearance that he is finally acquiescing to the pleas from his people and increasing personal freedom.
Testing airplane wastewater is a brilliant idea!
@BayDog: Agreed, but who will pay for it? Not likely the airlines. HIPPA privacy issues may come in to play incredible as it may seem. Our efforts to get case reports into the CURE ID website (<https://cure.ncats.io>) noted those HIPPA restrictions with our patient experience questionnaire as we entered the info into the website's solicited "real-world" COVID19 treatments with the repurposed drug HU (hydroxyurea/hydroxycarbamide - not to be confused with the thoroughly studied and inefficacious hydroxychloroquine or its politicized "4th cousin" ivermectin, both repeatedly undergoing RCTs and reported in ClinicalTrials.gov. HIPPA will not even permit recording a patient's City nor the the patient's actual age, only an age-range. Lots of good data left on the table when such info can't be reported "by Law". Imagine the "small city" I envision as an airplane full of passenger providing the waste water for analysis - a privacy issue looming? A bit over-stated perhaps? It's a reality as I view it. The case reports in the section for COVID19 number >400 and there were NO adverse effects, rebounds, or failures of cure even after just a few days of the HU. The FDA approved the drug decades ago and it's actively being prescribed on a continuous basis for the congenital disorder of sickle cell disease (SCD) even for children of 2 yrs of age. Some reports note that of the African victims of SCD, the incidence of COVID19 deaths is far less in those Countries with people taking HU for SCD symptoms mitigation as compared to non-SCD people also living in Africa or other countries who did not have access or desire to take HU. We dearly want to get this drug into trials. We envision a prompt and dramatic acceptance once credibly large studies are initiated and compared to any other repurposed drug treatment. Getting an "audience with his highness" (the RCT DB/Placebo controlled) and trying to get an inexpensive drug used for another disorder has been an ongoing challenge and are major barriers. Imagine taking HU capsules for 5 days for $3.55 from CVS vs Paxlovid 5 days for $530-751 taxpayer Fed price and molnupirivir $700 taxpayer Fed price both not officially approved but designated as EUA. China would do well to examine these case reports and use its resources to save its population from large numbers of deaths that are increasing by the day.
Testing the wastewater will let us uncover, I suppose, a deadly variant but beyond that I don't see it being good for much else since we know China is pretty much fully infected and we know we aren't going to do anything to restrict spread in this country. The only effective move is closing border to everyone and that's not going to happen.
It’s possible the *real* reason western countries are re-imposing covid test restrictions on travelers from China is to prevent sick foreigners from entering countries and demanding medical treatments that will soon be in short supply.
Right. Or, dealing with a lot of dead people. Which is itself a pretty serious public health/sanitation issue.