We find ourselves in the middle of a COVID-19 wave. Again. If this summer follows the previous three, we should expect ~10-15% of Americans to get infected. A nursing home outbreak recently spilled over to my extended family. They had a lot of great questions, particularly about how to manage this virus in 2023. Here are some answers. I hope it helps you, too.
Please let people know that they can report their home test results - both positive AND negative, please! - at MakeMyTestCount.org.
If we can get that address into the public consciousness and get people used to reporting as a matter of course, it would be a great boon. When home multiplex tests come out this winter, you'll be able to report results of flu tests, too. Please - you have such a great reach, please use it to let people know about this resource!
I know 4 people in their late '70s who got Covid, phoned their internists (at reputable institutions on both coasts), and were told they did not need Paxlovid because their files did not indicate they were at increased risk for a serious case. My GP on the other hand, prescribed me and my wife Paxlovid to take with us on a trip, "just in case we needed it", even though we had no particular indicators other than our age (75 and 79). Worrisome that reputable doctors are not in sync with the CDC regarding a proven method to reduce risk of hospitalization and death from this serious disease.
My family has been cautious since we have multiple high-risk people in our family (but outside our household). Despite having VERY minimal indoor, unmasked exposures recently, my wife just tested positive last night on a rapid test. She was unmasked in two situations over the weekend, probably 6 minutes of total time.
My son and I are negative on PCR so far, but her line on the RAT yesterday was very dark and showed up immediately.
Thank you, Dr Jetelina for helping my family go nearly 3.5 years without an infection in the house and for this very timely advice. Now if only more people would listen to you! :)
Thank you for this post, which I've shared on my social media. (I'm sure no one will respond, though. Most people I know are tired of "Covid talk" and don't appreciate being reminded of it.) Many of my friends have been surprised when they or someone close to them gets Covid these days. "I thought it was over," they say.
In your post, you shared that most people can expect 1-2 infections per year. Given that, and the prevalence of long Covid, I’m hoping you’ll focus more on long COVID in future posts. Though my partner and I have age/health conditions that place us at higher risk for bad COVID outcomes, it’s long COVID that is most concerning to us.
In Dr. Bob Wachter's recent "The Final Covid-19 Grand Rounds: What Have We Learned?" video, you said that long Covid gives you pause, too, and that you have "many friends" who take heart failure medication because of the condition. But even so, you said that it's not enough to change your behavior at this point unless things get worse. I'm struggling to understand this thinking and your risk/reward calculations. How much "normal" is worth taking a chance on having to take heart failure medication? Or is there a middle ground - and if so, what is it? Only taking mitigations (like masking) before a long-awaited vacation and taking a chance on Covid/long Covid the rest of the time?
Where does public health fit in with regard to helping people to understand how to weigh the risks of long Covid moving forward? Dr. Ashish Jha's article in the Boston Globe today has the headline "With a few basic steps, most of us can finally ignore Covid." Really? With one in 10 infections resulting in Long Covid? The basic steps he outlines are getting vaccines (most Americans have not gotten the boosters), treatments like Paxlovid for those at risk (most are not getting these either, as even doctors seem confused about who qualifies for them), and improving air quality (I'd like to see data on what places are doing this; my suspicion is not many, given the results of the Aranet CO2 monitor I carry with me). Most health care workers are not wearing masks any more - even when caring for the sickest patients.
And even though last fall President Biden said he - and most people - don't think about Covid any more, his press secretary recently revealed (after Israeli delegation members tested positive) that the WH Covid testing protocol for all who meet with the President is still in place. A reporter asked her, "We're not in danger, though, right?" and she just smiled. Covid safe practices for thee and not for me seems to be the order of the day.
Journalist Ed Yong has done some great (as in Pulitzer winning) reporting on the effects of long Covid. These articles, especially:
Are antigen tests no longer being covered by Medicare? As a Kaiser Permanente member on their Medicare plan, I was shocked to find in July that Kaiser was no longer covering the test cost for its Medicare members, but Kaiser was still offering free tests to members on its non-Medicare plan. Seems crazy, since Covid-19 is more serious for old people.
Thank you for continuing to educate about the throat swabs increasing the probability of a positive result, especially early on! This applied to me and my family with our infections last year, and without knowing that information early we could have infected vulnerable people.
Do you have any thoughts about why the FDA and other US institutions continue to push nasal swab and downplay throat swabbing as not following the intended protocol instructions? It seems like the EU and other international public health groups were on that train going back to 2022. Any chance they'll change their tune in the future?
Thanks for this update. Is it true this wave appears to be smaller than last year’s? Also I will admit after being a fervent masker (always with an around the head N95 respirator) anytime I was inside anywhere in public spaces and no dining indoors I got tired in June. Now I only mask on subways, planes, public restrooms, elevators, movie theaters and other very crowded indoor spaces. I will also test after traveling before going out in public. I have eaten indoors a few times but tried to do this in relatively empty restaurants. What is your masking recommendation? Indoor dining?
Re instructions to swab throat and salvia — looking up salvia to see which body part I should swab, I found only the plant. Now I see from another reader’s comment that you meant saliva. You may want to fix the typo!
In 2020 we formed a family pod of ten in several houses in the midwest. We all moved to join our son, daughter in law, and grandkids. Our son is a hospital based palliative care physician. (His dad is a retired physician.) Our son encouraged us to be extremely careful with COVID and we were.
While working in the hospital, he contracted COVID twice, and their child got COVID last year in school. They very carefully isolated in the home and no other family members became ill. That was it until a week ago:
The POD of ten has seven documented positives, in one week. Despite isolation. Despite removing little kids from the home. We are waiting for the last three to convert. This variant is very different. Word from ER docs is that it's more contagious, as our little pod of ten would show.
Interesting, despite being really sick, our son's hospital PCR was negative, and a couple of hours later his antigen test was positive.
I have been isolating/masking for 3.5 years but think I was exposed at surgery center where
few staff and no patients except me were masked. Got sore throat/ nasal congestion 3 days later.NO ONE here in northern Indiana processing PCR tests locally, Walgreens sends out of state, 2-5,day turnaround. Mine neg, 56 hr. turnaround. but still have cold like stuff. And Medicare did NOT pay, cost $128. Hardly possible to get treatment within 5days, have a plan with your regular c doctor. Urgent Care doesn’t even give Paxlovid because doesn’t know patients’ health history.
Yes, I’m starting to hear of people I know who have tested positive. It seems to have caught a lot of us by surprise. My husband and I last got boosted in September 2022, and had planned to wait until this September to get the reformulated booster when it’s available. Should we get a shot sooner than that? We’re in our 60s and generally healthy (although my husband has asthma and teaches youth martial arts classes).
>for those of us over 65 who are not able to get the pills down, I am assuming there are still no non-pill alternatives, but if anyone knows differently, I am all ears.
>for those who can get the pills down, the recommendation still seems to be a 5 day course, rather than 10, despite what seems to be a large number of rebound events. Does anyone have current information on that?
I once read that nasal antigen swab tests should only be used in the nose, not in the throat or saliva. Article said this is because nasal swabs are specifically designed for the pH range of the nose, but not throat/saliva, so results won’t be accurate. Is that correct information? According to your article I can use nasal swabs in the throat. Looking for clarification. Thank you!
Please let people know that they can report their home test results - both positive AND negative, please! - at MakeMyTestCount.org.
If we can get that address into the public consciousness and get people used to reporting as a matter of course, it would be a great boon. When home multiplex tests come out this winter, you'll be able to report results of flu tests, too. Please - you have such a great reach, please use it to let people know about this resource!
I know 4 people in their late '70s who got Covid, phoned their internists (at reputable institutions on both coasts), and were told they did not need Paxlovid because their files did not indicate they were at increased risk for a serious case. My GP on the other hand, prescribed me and my wife Paxlovid to take with us on a trip, "just in case we needed it", even though we had no particular indicators other than our age (75 and 79). Worrisome that reputable doctors are not in sync with the CDC regarding a proven method to reduce risk of hospitalization and death from this serious disease.
My family has been cautious since we have multiple high-risk people in our family (but outside our household). Despite having VERY minimal indoor, unmasked exposures recently, my wife just tested positive last night on a rapid test. She was unmasked in two situations over the weekend, probably 6 minutes of total time.
My son and I are negative on PCR so far, but her line on the RAT yesterday was very dark and showed up immediately.
Thank you, Dr Jetelina for helping my family go nearly 3.5 years without an infection in the house and for this very timely advice. Now if only more people would listen to you! :)
Thank you for this post, which I've shared on my social media. (I'm sure no one will respond, though. Most people I know are tired of "Covid talk" and don't appreciate being reminded of it.) Many of my friends have been surprised when they or someone close to them gets Covid these days. "I thought it was over," they say.
This spring, the WHO recently posted to Twitter that research is showing that one in 10 infections (not people) results in Long COVID. https://twitter.com/who/status/1651227079684358151?s=46&t=g7UDUjbukmLu--Ko6LQ2cg
In your post, you shared that most people can expect 1-2 infections per year. Given that, and the prevalence of long Covid, I’m hoping you’ll focus more on long COVID in future posts. Though my partner and I have age/health conditions that place us at higher risk for bad COVID outcomes, it’s long COVID that is most concerning to us.
In Dr. Bob Wachter's recent "The Final Covid-19 Grand Rounds: What Have We Learned?" video, you said that long Covid gives you pause, too, and that you have "many friends" who take heart failure medication because of the condition. But even so, you said that it's not enough to change your behavior at this point unless things get worse. I'm struggling to understand this thinking and your risk/reward calculations. How much "normal" is worth taking a chance on having to take heart failure medication? Or is there a middle ground - and if so, what is it? Only taking mitigations (like masking) before a long-awaited vacation and taking a chance on Covid/long Covid the rest of the time?
Where does public health fit in with regard to helping people to understand how to weigh the risks of long Covid moving forward? Dr. Ashish Jha's article in the Boston Globe today has the headline "With a few basic steps, most of us can finally ignore Covid." Really? With one in 10 infections resulting in Long Covid? The basic steps he outlines are getting vaccines (most Americans have not gotten the boosters), treatments like Paxlovid for those at risk (most are not getting these either, as even doctors seem confused about who qualifies for them), and improving air quality (I'd like to see data on what places are doing this; my suspicion is not many, given the results of the Aranet CO2 monitor I carry with me). Most health care workers are not wearing masks any more - even when caring for the sickest patients.
And even though last fall President Biden said he - and most people - don't think about Covid any more, his press secretary recently revealed (after Israeli delegation members tested positive) that the WH Covid testing protocol for all who meet with the President is still in place. A reporter asked her, "We're not in danger, though, right?" and she just smiled. Covid safe practices for thee and not for me seems to be the order of the day.
Journalist Ed Yong has done some great (as in Pulitzer winning) reporting on the effects of long Covid. These articles, especially:
https://www.theatlantic.com/health/archive/2023/04/long-covid-symptoms-invisible-disability-chronic-illness/673773/
https://www.theatlantic.com/health/archive/2023/07/chronic-fatigue-long-covid-symptoms/674834/
Would love to hear more on this topic from you, Dr. Jetelina. Appreciate all your communication to date.
Are antigen tests no longer being covered by Medicare? As a Kaiser Permanente member on their Medicare plan, I was shocked to find in July that Kaiser was no longer covering the test cost for its Medicare members, but Kaiser was still offering free tests to members on its non-Medicare plan. Seems crazy, since Covid-19 is more serious for old people.
Thank you for continuing to educate about the throat swabs increasing the probability of a positive result, especially early on! This applied to me and my family with our infections last year, and without knowing that information early we could have infected vulnerable people.
Do you have any thoughts about why the FDA and other US institutions continue to push nasal swab and downplay throat swabbing as not following the intended protocol instructions? It seems like the EU and other international public health groups were on that train going back to 2022. Any chance they'll change their tune in the future?
Really looking forward to hearing more on this statement by YLE: I would delay a fall booster by at least six months; more on this later).
Thanks for this update. Is it true this wave appears to be smaller than last year’s? Also I will admit after being a fervent masker (always with an around the head N95 respirator) anytime I was inside anywhere in public spaces and no dining indoors I got tired in June. Now I only mask on subways, planes, public restrooms, elevators, movie theaters and other very crowded indoor spaces. I will also test after traveling before going out in public. I have eaten indoors a few times but tried to do this in relatively empty restaurants. What is your masking recommendation? Indoor dining?
Re instructions to swab throat and salvia — looking up salvia to see which body part I should swab, I found only the plant. Now I see from another reader’s comment that you meant saliva. You may want to fix the typo!
Curious what your thoughts are about taking metformin to reduce risk of long covid.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext
Thanks for all.
In 2020 we formed a family pod of ten in several houses in the midwest. We all moved to join our son, daughter in law, and grandkids. Our son is a hospital based palliative care physician. (His dad is a retired physician.) Our son encouraged us to be extremely careful with COVID and we were.
While working in the hospital, he contracted COVID twice, and their child got COVID last year in school. They very carefully isolated in the home and no other family members became ill. That was it until a week ago:
The POD of ten has seven documented positives, in one week. Despite isolation. Despite removing little kids from the home. We are waiting for the last three to convert. This variant is very different. Word from ER docs is that it's more contagious, as our little pod of ten would show.
Interesting, despite being really sick, our son's hospital PCR was negative, and a couple of hours later his antigen test was positive.
I have been isolating/masking for 3.5 years but think I was exposed at surgery center where
few staff and no patients except me were masked. Got sore throat/ nasal congestion 3 days later.NO ONE here in northern Indiana processing PCR tests locally, Walgreens sends out of state, 2-5,day turnaround. Mine neg, 56 hr. turnaround. but still have cold like stuff. And Medicare did NOT pay, cost $128. Hardly possible to get treatment within 5days, have a plan with your regular c doctor. Urgent Care doesn’t even give Paxlovid because doesn’t know patients’ health history.
Yes, I’m starting to hear of people I know who have tested positive. It seems to have caught a lot of us by surprise. My husband and I last got boosted in September 2022, and had planned to wait until this September to get the reformulated booster when it’s available. Should we get a shot sooner than that? We’re in our 60s and generally healthy (although my husband has asthma and teaches youth martial arts classes).
Noooo, Dr. Jetelina, please don't tell people not to bother reporting. Omg. I'm an epi with a LHD and it's still a reportable!!! I'm gonna cryyyyy.
Two questions to anyone here re Paxlovid:
>for those of us over 65 who are not able to get the pills down, I am assuming there are still no non-pill alternatives, but if anyone knows differently, I am all ears.
>for those who can get the pills down, the recommendation still seems to be a 5 day course, rather than 10, despite what seems to be a large number of rebound events. Does anyone have current information on that?
I once read that nasal antigen swab tests should only be used in the nose, not in the throat or saliva. Article said this is because nasal swabs are specifically designed for the pH range of the nose, but not throat/saliva, so results won’t be accurate. Is that correct information? According to your article I can use nasal swabs in the throat. Looking for clarification. Thank you!