49 Comments

I really appreciate your blog posts, especially about COVID. With public interest waning and with a decreased demand or public interest for updated information, it is becoming harder to find science based information I can count on. So thank you so much for your work; I am very grateful!

Expand full comment

I really appreciate this as it’s become impossible to get accurate information with the lack of testing and most departments of health ramping down.

I just read that “ pandemic fatigue “ is overstated in the media and the people most at risk— front line, essential workers, people without paid sick leave, etc— are still very much interested in accurate information and how to keep themselves safe. Kaiser Family Foundation polls consistently show more people are still concerned but perceive that “back to normal “ is the norm, so they/ we think we’re in the minority of people who still recognize that the pandemic isn’t over. Information is power, and your information is so crucial. Thank you!

Expand full comment

Dr. Jetelina, could you please, please just throw in a couple of sentences about Evusheld occasionally? I did a google search of your name + Evusheld, and nothing came up. Looks like you have never mentioned this medication for the immune-compromised. How about an occasional mention? The immune-compromised mostly feel ignored and written off in discussions of covid, vaccination, etc. Please don't participate in that trend. Evusheld is a bit of a niche topic, but not all THAT niche. Something like 3% of the population is immune-compromised enough to qualify for it. You have a large readership, and are in a position to make a difference in the general ignorance about Evusheld. Please look for opportunities to mention it once in a while. A couple sentences a month from you could make a real difference.

For the immune-compromised Evusheld is the only way to get "vaccinated." The stuff has been available for 6 months, and is being distributed at a slow trickle. The main barrier to people getting it is lack of information. Patients who qualify have no idea this option is available. Doctors are very underinformed. It was bought and distributed to states by the government, and so was not advertised in the usual way. No pharma reps gave talks about it to doctors at dinners, or dropped by their offices with brochures. Some doctors do not even know Evusheld exists. Some are grossly misinformed -- they think it is only available for people with extremely compromised immune systems, such as people who just had an organ transplant. That is not true. They think there is almost none available. That is also not true. In 6 months, only about 1/3 of what was ordered has been given to patients -- the rest is gathering dust on shelves.

For those who are curious about Evusheld: It is an injection that gives people a long-lasting supply of antibodies that combat covid. People whose immune system is damaged do not make antibodies when vaccinated, so an injection of Evusheld is the only way they can be given antibodies. The main barrier to people getting it is lack of information.

The volunteer organization I work for has an Evusheld guide available at https://rrelyea.github.io/evusheld/guide/. There's also a site that helps you search for sites offering Evusheld near you: rrelyea.github.io/evusheld/. Both sites are free and do not ask you to register.

Expand full comment
Comment deleted
July 7, 2022
Comment deleted
Expand full comment

I'm happy to hear this Dr. Griffin exists! What is TWiV? Is he on Twitter or other social media?

Expand full comment

Your ability to write clear and helpful updates helps against the ever changing COVID dynamics. Thank you for continuing to be a stabilizing influence!

Expand full comment

Thank you for your, as always, thorough and timely synthesis and analysis. My spouse and I (both science and data types) continue to rely on your newsletters as we watch the community around us swim in a sea of SARS-CoV-2 without realizing or caring what the real situation is. You help us stay informed!

Expand full comment

Great info. Question- with the surge in local cities in Texas, but the variant booster coming in the fall, is it better to get a second booster (4th shot) now, or wait? And same question for kids 5-12 who have their full set but not a booster yet. It's going around my circle but I don't know that the current booster is much help. We do have a family member with health issues and we have avoided it so far.

Expand full comment

We appreciate your posts so much! While I know it must feel like a Sisyphean task, your Covid posts are especially important in this time of pandemic fatigue, as it is increasingly difficult to find data and insights rooted in science upon which we can make informed decisions. Thank you so very much!!!

Separately, has anyone else had the unfortunate experience of having a botched vaccination with their little one? We waited so long for her time and I am so sad this happened. I personally do not think any vaccine made it in, but the woman administering felt like a little did. I’ve talked with her pediatrician and we have a plan. But just curious if anyone else has experienced this and what plan you were given? Thanks!

Expand full comment

Quick Question: should we get our eight year old (who was vaccinated back in December) boosted now or wait for the Omicron specific booster in the Fall?

Expand full comment

Your blog is amazing for those of us who run COVID response for large companies. I was wondering, for those of us non-epidemiologists whose brains are increasingly full - could you add in parentheses the plain name designation for the letter and number COVID designations, if there is one? My brain simply can't keep track of them. For example "BA.4 (Omicron 4)" or whatever Delta was. [Google: "B.1.617.2 (Delta)"]

Expand full comment

It’s hurting my brain, too. We did this in the beginning of the pandemic, but too many people disagreed on nicknames making it even more difficult to keep track of. I’ll try and brainstorm an easier way for you

Expand full comment

No worries then - don't want to give you extra work, I'm already amazed at all you manage to accomplish at work and home, with this as the side project.

Expand full comment

I understand your pain. I agree with Katelyn: There's got to be something do-able. I spend a LOT of time on the response for a major volunteer organization, have a medical background, and periodically have to go to my cheat-sheet.

@Katelyn: What about a "post" that's a translation table, and it gets updated every 'n' variants?

Expand full comment
Comment deleted
July 7, 2022
Comment deleted
Expand full comment
Comment deleted
July 7, 2022
Comment deleted
Expand full comment

Seems a bummer to ruin Pi with COVID. Leave us our Pi Day in peace, Covid!

Expand full comment

If you do back of the napkin math, it is important to provide a range of estimates values with estimate probabilities. This isn’t 1980.

The easy work is capturing the data (what is available) and graphing it. The hard work is estimating the future. We know from past covid variants there is a surge of growth (increasing number of infections) and then it levels off – a bunch of folks get this variant and the rest do not.

We also need a metric of “inconvenience”. If I get COVID and it only lasts 2 days, no big deal. If it fatigues me for 3 weeks a major nuance. If it kills me – not good.

These are not observations / critiques for your material which is great. Always much obliged you take the time to write this material.

The health community needs to step up its game – the virus is running circles around it. I have done this for a very long time – complexity exists whether you ignore it or not. Best not to ignore it. My suggestion is the health community pull in folks from industry (either direct from a firm or one of the long standing firms) to provide an additional view. These folks are used to complexity.

Expand full comment

I'm not sure the health community has a lot of stamina or mental health left, at the moment ( / the past couple years) to step up. I'm not even patient facing, just a corporate pandemic lead, and I'm

t i r e d ! Just bein' real.

Expand full comment

Thanks for acknowledging this depletion of energy among healthcare workers. I am personally doing ok, having remodeled my facial bones and cardiopulmonary physiology to accommodate for wearing an N95 10 hours a day. Mostly joking.

I no longer think of this period as a succession of waves, but rather a steady churning. I am routinely in examining rooms with patients for their regular problem reviews, only to learn they develop symptoms and test positive for covid the next day. Which means I’ve been hanging with them for 20-40 minutes during their most contagious windows.

Quality masking is essential right now. I am most exhausted having to deal with people who assert their displeasure wearing one as I see them in 50 sq ft rooms. Wrote a post and recorded about this last night actually for my own peeps.

Once again thanks for the acknowledgement, and thanks to Dr Jetelina for the updates

Expand full comment

Masking is so important. I hate it is not required anymore. I avoided the virus for 2 years tried to do our best to be safe and tested positive Monday and I’m vaccinated and boosted. I’m feeling really awful today and it’s pretty lonely and sad.

Expand full comment

I've been infected twice. Fully up to date now, but there were no vaccines when I was first infected in June 2020. I was, however, always masked and attentive. Based on outings from home in that timeframe, I know exactly where I was infected if not exactly by whom (it was at a military commissary). Our second round was immediately after traveling half-way across the country to relocate. Masked at every stop and fully up to date at that point, but this was at the start of BA.1/omicron. For me, omicron was somewhat less mild than the first infection but still not bad. That said, my wife's exhibiting long-covid signs post-omicron over 4 months later. And there's no local clinic for long-COVID nearby.

Masking is a key element. We sheltered at home in the first round. I'm more mobile now, but still mask selectively especially for high-occupancy indoor events. Masking, physical distancing and improved indoor ventilation systems are key elements in this struggle, and they're BASIC PUBLIC HEALTH MEASURES... they should not be the subject of any form of political commentary.

Expand full comment

THanks for handling the patient side of things. I'd have been there if I could.

Expand full comment

I'm also not (directly) patient-facing but I've had to answer a lot more patient questions than I'd have liked... sometimes that's easier when you're in the clinical setting. My team is pretty diverse, with clinical, epidemiology, nursing and lab folks, which helps, but I'm the recently retired guy who reads the bleepin' literature and talks to people to bring back better understand what's happening.

Expand full comment

Some of us are doing napkin math before we translate to a more formal model. The term you're looking for, overall, is "uncertainty". One way modelers accommodate for this is to use an ensemble solution method. This isn't the forum to discuss the various methods, but it's becoming time to abandon simple Bayesian methods and start looking at other systems. It might also be time to incorporate some more machine learning (Eric Topol, are you listening?) into the mix. I really don't have time to become a full-time modeler right now, but I'll apply a little more time. I'm more familiar with ensemble Kalman filter processes after the last 10 years, but Bayesian and Monte Carlo models are easy to make into ensembles. I've gotta get some computer time.

Expand full comment

What I've fallen back to for evaluation is looking first at TPR, then at the rate of testing (first derivative of # of tests over 7 days).Hospitalization is considered but the weight assigned is lower because of the lag, and similarly, ICU admissions. So far this has been an informal evaluation but I need to model it and see how it works out. Subjectively, it's been pretty good at indicating a new trend.

Great points. Thank you.

Expand full comment

With Clay Jenkins' post yesterday, it seems the variants may already be here. Or at least in Dallas, where they've raised the Covid risk to yellow. Husband is immunocompromised, so I'm extremely worried we'll have to start isolating again. The whole thing just makes me so sad and frustrated.

Expand full comment

A doctor in the family told those of us who got Covid on our Ireland vacation (3 of us) to avoid hard exercise or anything that would drive our heart rates up for the next month. I'll search your archives to see if you mention this. I've not heard anyone else say this. Thank you for this newsletter, Kaitlyn.

Expand full comment

Given what we know & don't know about BA.5, this (The Boston Globe) makes me furious.

"Dr. Catherine Brown, a state epidemiologist at the Department of Public Health, said that residents were watching the movement of the pandemic on a “granular” level early in the pandemic. Now, 'We’re in a different time. We’re 2½ years later. We have the pharmaceutical tools. We have preventive tools,” like vaccines, antivirals, and monoclonal antibody treatments. Daily numbers aren’t going to affect the recommendations for people to use them, Brown said."

What can the lay person do to shake up the lack of public health leadership at all levels?

Thx.

Expand full comment

Here in the Bay Area, the BA2 wave was dropping after a mid-May peak and then the case counts leveled in June. Our local wastewater added in BA4/5 at that point and then you could see the upward BA5 slope nullifying the BA2 drop. However, the region's wastewater all showed a peak around June 25 -- remains TBD if July 4 weekend impacts this. But if that's the BA5 peak (still larger than Delta for sure, less than BA1 or 2), this seems to be good evidence of each wave creating some measure of immune response.

Related to immune response, is there any pediatric data on longer term efficacy (3+ months) for both the primary series and with the booster? I feel like this is one of the missing pieces as we look towards fall past the BA5 wave.

Expand full comment

Oregon numbers reflect a slow but steady increase in hospitalizations. We seem to be at a plateau in new infections, which given our vaccination rates seems a little worrying. A lot of virus is obviously still out there circulating, mostly B.4/5 here but the psychology of pandemic weariness is making it harder to get the public actively involved. The broadcast media is still trying to keep the public informed but its major watchers are in an older demographic. I hope we just roll out a B.1 booster and start getting shots in arms.

Expand full comment

thanks for this comment. i’ve been internally debating whether to continue given public fatigue and how much other events are (probably rightfully so) competing for our attention. it’s an exhausting world out there right now.

Expand full comment

Please, please keep on reporting! You're one of the linchpins that hold the center together! Moderate your efforts but don't abandon them! There are worst pathogens perhaps than covid out there on the distant horizon. Keep us informed! I suspect that every reader of this newsletter passes on the info to many others so there is a multiplier effect in the good you do!

Expand full comment

Just an addendum to my own comment: it behooves all of us to keep an eye on the big picture which is global warming and all the public health implications of that- from melting ice and permafrost releasing ancient pathogens into the environment, to migration of known pathogens to new areas, to increased zoonotic crossovers. Thank goodness our public health infrastructure has been strengthened by the ongoing pandemic..

Expand full comment

Please keep going with covid info, Dr. Jetelina. I cannot find any other source of up-to-date information on what's actually going on, and without that info, it's impossible to understand risk. Also, just the fact that you are emphasizing that the pandemic is not over is a huge mental health boost. My doctor says there is still real danger and to avoid infection, but when essentially everyone else is back to having normal (or nearly normal) fun, it's hard not to feel a little crazy sometimes.

Expand full comment

Please continue your focus on COVID. It’s obvious that someone has to, and it’s not happening in many places where it should! Your work can help influence leaders to lead in this moment.

Expand full comment

Please continue, both for your deep dives (these exist on Twitter but they can be ephemeral given Twitter's nature) and also the healthy discussion from the paid subscribers (doesn't exist elsewhere!)

Expand full comment

As a corp crisis lead, I find it helpful to keep a finger on the pulse, say weekly. It used to be hourly pulse checks (or really every single minute of every single day that wasn't taken up by something else). But these days we're in steady state - a weird and bad steady state, but nonetheless steady at the new normal - so weekly is mostly what I need. It's hurricane / wildfire season in North America, so that can bump up in priority depending on what's happening, but we kind of always need to have Covid in the background.

Or if we're dealing with something like Omicron 1 and Covid suddenly jumps to the forefront again.

Katelyn if you want to ping me privately, we could survey my crisis manager colleagues for what they think. I'm just one data point.

Expand full comment

Please keep writing about covid. My family and I are so appreciative of you and the information you provide. It's been incredibly helpful.

Expand full comment

Anecdotally, in advance of a very large family reunion with folks flying in from all across the country and a few international... we mostly all just got Covid (or currently have it and are staying home), despite all being vaccinated and boosted and careful. For most of us, we've avoided COVID pretty well to date (except the frontline workers)... but this point in time is different. And it's happening with significant geographic dispersion. Katelyn called it.

Expand full comment