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.
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!
Thanks for posting this. Does MakeMyTestCount provide a map of the US so we can see areas where infections are increasing?
Unless you live in an area that monitors wastewater and publishes the results, the only reliable indicator that we have now of increased covid activity in your area is hospitalizations. which is a lagging indicator and not very useful in terms of protecting oneself.
Given that we have an airborne virus and a highly mobile population, I would not place too much faith in localized testing data. Best to assume you're at risk regardless of what local hospitalization or wastewater data show.
I am not affiliated with them, but I assume that the frequency and granularity they're going to be able to provide will be determined by how many people report their tests, because of the risk of de-anonymization/re-identification. For instance if there's a geographic area in which only one person reports a positive test in a given period, they'd only be able to say "less than 10 cases." Not a conspiracy, just privacy laws.
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.
All 4 did OK, 2 of them said it was like the worst case of flu they ever had. The ultimate outcome of my micro sample of n=4 is in line with the big picture statistics that say that most people will come through an infection OK, but why go with those odds if there is a simple pill that might really help you out?
My parents 76 and in pretty good health, both of the their (reputable) GPs said Pax wasn’t necessary (vaxxed x5). Everyone we know who took it at their age had rebound & you can’t do a second course. There is research happening now because the hypothesis is the dose / strength isn’t correct and the virus isn’t clearing your system. So people were sicker longer.
I have asthma & MS (also vaxxed x5) got it early May for the first time, and my GP & neuro both said the day I tested positive to monitor. Day one and two sickest I’ve been since mono in high school a million years ago. Day three things started to look up. We all agreed Pax not necessary. So the CDC blanket statement that everyone above 65 (I’m much younger) should take it is not clinically indicated without factoring individual co-morbidities, other meds, etc.
Not an expert at all, but I thought I read that “rebound infections”) resumption of symptoms) had been seen to occur whether or not a patient received Paxlovid. Possibly due to insufficient drug uptake. But not an infection actually DUE to Paxlovid?
For example, due to CKD, i can only get Renal Paxlovid prescribed, 1/2 the strength of regular Paxlovid, since my kidneys may have a problem clearing a full strength dose. So maybe if i get Covid, use Renal Paxlovid, get a rebound, it could be due to not getting enough Paxlovid to zap all the virus in me? But the above research seems to indicate that the virus did not change after Paxlovid, just that the drug didnt do a complete enough job. Perhaps like an antibiotic might not completely stop a bacterial infection, so another dose or antibiotic might be needed. But that doesnt mean there is a problem with the antibiotic causing new disease, it just means the antibiotic didnt completely do its job on the first try.
In retrospect I should have done this. Then when I got covid for the first time on 10/5 I probably could have gotten another rx from the city hotline and avoided the dreaded Paxlovid rebound by taking it for 10 days.
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:
I concur with everything you've outlined here. How people have gone "back to normal" feels like insanity to me. I've watched several friends develop long COVID (their lives are forever changed), others developed autoimmune or chronic diseases "out of the blue" (I can't help but think this are related to COVID infections bringing them out), and two people I know have had mini-strokes, one was very healthy 33 (practices gymnastics in their free time, very athletic) and the other was a 21 year old college student. Both were told related to their recent COVID infections.
I was also disappointed to see in posts here that one stated something along the lines of "the public health of the nation is tied to the health of the economy". I mean, really? Do we believe this BS that they've been feeding us? When the "economy is doing well, it just means rich ppl are getting richer bc we are back to work making capital for them from our labor. In a follow-up newsletter about public health messaging it said something about the importance of public health messaging being separated from politics. Now, how are you going to make a statement like "the health of the people depends on the health of the economy" and not call that political?
I'm saddened to see the "don't bother" reporting your test comment. You could say "waste water is where it's at" or rather "waste water is all we have left because robust testing data collection and tracking has been defunded". That's the more accurate statement.
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.
I agree - this seems crazy. I'm also a Kaiser member - in California; our state Public Health Emergency doesn't end until mid-November, and yet I've been told (at pharmacy) that we can't get reimbursed for rapid tests. I don't understand the rationale - however much Medicare/Kaiser would spend on rapid tests, it would probably be cost effective, since one hospitalization of an older person would cost exponentially more than a bunch of rapid tests.
Medicare itself has rules about what can be covered. I remember the Biden administration had to do some kind of finagling to give Medicare recipients free tests.
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?
In all sincerity: The instructions on home tests were printed during a different era of the virus. So when the epidemiologist recommends to swab the throat, I do.
Unfortunately, I tested positive yesterday on a throat swab, but my nasal-only swab taken moments later was negative. I was flabbergasted! I don't really feel all that awful; had I not tested my throat, I'd be out at a concert tonight unwittingly infecting the folks around me.
I'm sorry about your positive test. I guess reasonable people can disagree on this - to me, it comes down to "How hard am I required to look for something before declaring that it's not there?" As a layperson "whatever it says on the box" seems like a fair place to draw the line. If it doesn't pick up something it shouldn't pick up, that's on the FDA - not me. Philosophically, my moral responsibility ends with the official instructions on the box.
I don't think you were being flippant, just frustrated.
My Husband and I were infected in early February and we are eagerly awaiting the fall booster but a bit nervous about the month of August and first half of September (assuming boosters are out mid-Sept). We easily wear masks in grocery stores and places so simple to mask and clearly not worth the chance of infection…but will be sad to give up indoor dining (again) and work meetings/events are tricky. I would really like to understand more about longer-term impacts of multiple infections.
If you have had COVID that recently, you are probably still more immune than, say, me, who has had 5 doses of two vaccines, but had COVID over 500 days ago. Yeah, I can't wait for my next booster.
Teacher here too and we start I service next week. It still shows we are low in my county, but to mask in meetings? I work with young kids who are developing their language skills so must see my mouth. Just wish for so many things to go away with this virus!
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?
What Dr. Jetelina and other seem to have written (I could be misreading) is that the number of cases is high, but fewer people are getting seriously ill due to almost everyone having some level of immunity, whether from vaccination or actual survival of the disease. That's what Steven Novella wrote here, certainly: https://sciencebasedmedicine.org/summer-covid-wave
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!
Our doctor was happy to Rx it for us on the basis of the pre-print of that study. If you decide to do that (in addition to Paxlovid), ask your doctor about the extended release version of metformin. Lots of people get GI symptoms on the regular kind (we definitely did, then we switched to ER and all was well).
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.
This is just anecdotal but thought I would share. I have not had covid as best I know. Wore masks everywhere until this year, when I started only wearing them in what I felt were high risk situations. I am fully vaccinated. I used the nasal spray Xclear after I was indoors for more than five mins even if wearing a mask. It causes nasal irritation requiring blowing your nose. I have felt this to be a very important step in removing inhaled droplets fairly quickly after they entered your nasal passageway. I tested whenever I felt I was exposed and when I had any symptoms that might be covid. I have not been sick since the beginning of covid and wearing masks and using Xclear. I did start air travel the second year of covid, wore masks etc. Did not take them off in the airport or on the plane. This June I took a long awaited vacation to Ireland. I decided no masks would be worn. Not in airports, on my flights or anywhere in Ireland. I did not get sick. I just took another flight trip to Maine and wore no masks etc. Again I did not get sick. I am flying again the end of August but will wear a mask. I think my risk will be slightly greater now than earlier this year so why take a chance, even with somehow never getting sick these last three years. I know the masks kept me from colds, flu and possibly strep. I don't know if I have the genes and they protected me or it was my hyper vigilance (which I was able to do because I am retired) protected me. But I sure as heck don't want to get sick with the new wave so MASK it will be for awhile more.
I was already using Xlear for allergy symptoms and chronic sinus issues when the pandemic came. No known COVID infection despite heavy exposure as a hospital nurse and lots of testing. Don’t know if it’s related or not, but I continue to use it.
Xclear instructions say to blow nose before using product, not after. My doctor recommends both products for Covid prevention (in addition to masking during high risk indoor situations). Xclear is easier to get and cheaper than Enovid. Also, according to instruction packet, you can use Xclear an unlimited number of times. Enovid is probably more effective though.
No concerns from you doc about extensive and prolonged use of Enovid? That’s been my only concern because the company says they don’t have any data on it?
I haven't asked her this directly, yet she did say that when she gets home from work (after riding home on public transportation), she usually uses Xclear unless she's on a really crowded subway car, in which case she uses Enovid/SaNOtize. In addition to not wanting to overdo it with Enovid, she's trying to be mindful of cost. She toggles back and forth between the two based on perceived risk.
Apparently the FDA and DoJ sued the makers of Xclear for perceived false covid claims, so the company fought back with this:
Enovid appears to be even better than Xclear at preventing covid (but it's expensive, hard to get, and you probably shouldn't use it every single day):
Where are you folks buying Enovid (or XClear)? I hesitate to trust Amazon since it has a reputation for allowing counterfeit products (not these products specifically, I mean in general).
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).
This fall’s booster will be a monovalent shot targeting XBB.1.5. It would be nice if it were released now to help with back-to-school. I’m not a doctor, yet if you can play it safe for another month or two, it’s probably much better to get the updated booster which more closely matches currently circulating variants.
After 5 mRNA shots (all Moderna), I’m planning to go with Novavax, which is protein based and is supposed to offer longer protection. Hopefully this year Novavax will be more widely available than in 2022.
>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 recommend listening to the TWIV (This Week in Virology) podcast - you might find your answer there, although I'm not sure how to search the archives. Dr. Daniel Griffin, who's treated many people with Covid in NYC, on each episode reviews the latest research. The "rebounds" in his opinion (based on the literature) are due to the natural course of Covid (the second week is when people usually get really sick if they haven't been treated). The benefit of Paxlovid is that even with a "rebound," most people don't need to be hospitalized.
That's a very good suggestion, though sad to say, I tried that, and my PCP advised it was a no go. Good as she is, I'm not altogether sure she's right on this, but so far it's a dead end. Looks like metformin may be a possibility though, as I see it comes in liquid form. Hopefully, I won't need such an intervention, but as my mom was a girl scout leader, I had no choice but to learn to be prepared!
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!
I’m not Dr. Jetelina but the official FDA stance is only swab nose. The FDA is generally going to be extremely cautious. Reality is many of us, including me, tested positive when I added in back of throat swab first and then nasal. I did another test with nose only after my positive throat and nose result because i was curious and I tested negative when I only did nose. That’s anecdotal but good enough for me. Also in the UK they test throat and nose. I doubt their swabs are somehow designed very differently. A rapid test expert Michael Mina has also said adding back of throat swab to nasal swab will make rapid test more sensitive but you should do both and not just a throat. If you add throat to nose here’s how to do it (and I recommend Binax Now rapid tests because their swabs are much longer and therefore easier to swab back of throat): https://www.businessinsider.com/how-to-swab-throat-covid-rapid-tests-guide-2022-1
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!
Thanks for posting this. Does MakeMyTestCount provide a map of the US so we can see areas where infections are increasing?
Unless you live in an area that monitors wastewater and publishes the results, the only reliable indicator that we have now of increased covid activity in your area is hospitalizations. which is a lagging indicator and not very useful in terms of protecting oneself.
Not yet, but we're working on that for MakeMyTestCount's companion site, WhenToTest.org. Expect a big update to that site by the end of this fall.
Sounds useful and exciting. I think real-time, local data will increase usage and word-of-mouth. Good luck unleashing the power of crowdsourcing!
Thank you Liz! What a great resource and addition. We will spread the word.
Given that we have an airborne virus and a highly mobile population, I would not place too much faith in localized testing data. Best to assume you're at risk regardless of what local hospitalization or wastewater data show.
I am not affiliated with them, but I assume that the frequency and granularity they're going to be able to provide will be determined by how many people report their tests, because of the risk of de-anonymization/re-identification. For instance if there's a geographic area in which only one person reports a positive test in a given period, they'd only be able to say "less than 10 cases." Not a conspiracy, just privacy laws.
Bless this Dr. Ruark!! Thank you!!
Thanks for the reminder! I just reported my (negative) test
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.
What was the outcome of the 4 people who didn’t get Paxlovid?
All 4 did OK, 2 of them said it was like the worst case of flu they ever had. The ultimate outcome of my micro sample of n=4 is in line with the big picture statistics that say that most people will come through an infection OK, but why go with those odds if there is a simple pill that might really help you out?
My parents 76 and in pretty good health, both of the their (reputable) GPs said Pax wasn’t necessary (vaxxed x5). Everyone we know who took it at their age had rebound & you can’t do a second course. There is research happening now because the hypothesis is the dose / strength isn’t correct and the virus isn’t clearing your system. So people were sicker longer.
I have asthma & MS (also vaxxed x5) got it early May for the first time, and my GP & neuro both said the day I tested positive to monitor. Day one and two sickest I’ve been since mono in high school a million years ago. Day three things started to look up. We all agreed Pax not necessary. So the CDC blanket statement that everyone above 65 (I’m much younger) should take it is not clinically indicated without factoring individual co-morbidities, other meds, etc.
The consideration might be the increased likelihood of a rebound case.
Not an expert at all, but I thought I read that “rebound infections”) resumption of symptoms) had been seen to occur whether or not a patient received Paxlovid. Possibly due to insufficient drug uptake. But not an infection actually DUE to Paxlovid?
https://health.ucsd.edu/news/press-releases/2022-06-21-covid-19-rebound-after-taking-paxlovid-likely-due-to-insufficient-drug-exposure/
For example, due to CKD, i can only get Renal Paxlovid prescribed, 1/2 the strength of regular Paxlovid, since my kidneys may have a problem clearing a full strength dose. So maybe if i get Covid, use Renal Paxlovid, get a rebound, it could be due to not getting enough Paxlovid to zap all the virus in me? But the above research seems to indicate that the virus did not change after Paxlovid, just that the drug didnt do a complete enough job. Perhaps like an antibiotic might not completely stop a bacterial infection, so another dose or antibiotic might be needed. But that doesnt mean there is a problem with the antibiotic causing new disease, it just means the antibiotic didnt completely do its job on the first try.
My physician informed me that taking Paxlovid increased your chances of rebound by 10%. We did not discuss why that might occur.
In retrospect I should have done this. Then when I got covid for the first time on 10/5 I probably could have gotten another rx from the city hotline and avoided the dreaded Paxlovid rebound by taking it for 10 days.
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.
GREAT POST. People are determined to believe what they want to hear and those in leadership positions have been only too happy to oblige.
I concur with everything you've outlined here. How people have gone "back to normal" feels like insanity to me. I've watched several friends develop long COVID (their lives are forever changed), others developed autoimmune or chronic diseases "out of the blue" (I can't help but think this are related to COVID infections bringing them out), and two people I know have had mini-strokes, one was very healthy 33 (practices gymnastics in their free time, very athletic) and the other was a 21 year old college student. Both were told related to their recent COVID infections.
I was also disappointed to see in posts here that one stated something along the lines of "the public health of the nation is tied to the health of the economy". I mean, really? Do we believe this BS that they've been feeding us? When the "economy is doing well, it just means rich ppl are getting richer bc we are back to work making capital for them from our labor. In a follow-up newsletter about public health messaging it said something about the importance of public health messaging being separated from politics. Now, how are you going to make a statement like "the health of the people depends on the health of the economy" and not call that political?
I'm saddened to see the "don't bother" reporting your test comment. You could say "waste water is where it's at" or rather "waste water is all we have left because robust testing data collection and tracking has been defunded". That's the more accurate statement.
Your form of “unproductive anxiety” seems to manifest itself as an argumentative broken record that nobody cares to listen to
HI Paul. You are back again. Nice to see some predictability in an unpredictable world. :-)
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.
I agree - this seems crazy. I'm also a Kaiser member - in California; our state Public Health Emergency doesn't end until mid-November, and yet I've been told (at pharmacy) that we can't get reimbursed for rapid tests. I don't understand the rationale - however much Medicare/Kaiser would spend on rapid tests, it would probably be cost effective, since one hospitalization of an older person would cost exponentially more than a bunch of rapid tests.
Medicare itself has rules about what can be covered. I remember the Biden administration had to do some kind of finagling to give Medicare recipients free tests.
Thanks for adding ts insight. Kaiser may not be the source of this strange policy, then.
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?
Uh, maybe because throat swabbing triggers a powerful gag reflex? I for one refuse to use tests except as directed.
Enjoy your false negative result then.
Whatever. Not using a test as directed just gives you an invalid result, not a false anything. Directions exist for a reason.
I apologize, I shouldn't have been so flippant.
In all sincerity: The instructions on home tests were printed during a different era of the virus. So when the epidemiologist recommends to swab the throat, I do.
Unfortunately, I tested positive yesterday on a throat swab, but my nasal-only swab taken moments later was negative. I was flabbergasted! I don't really feel all that awful; had I not tested my throat, I'd be out at a concert tonight unwittingly infecting the folks around me.
Here's a photo of my results: https://twitter.com/xtingu/status/1687545148182233088?t=toLT9Q-Fs-aWy9bNIHKTtw&s=19
Anyway, again, I'm sorry I was flippant in my original reply. It wasn't cool. ❤️
I'm sorry about your positive test. I guess reasonable people can disagree on this - to me, it comes down to "How hard am I required to look for something before declaring that it's not there?" As a layperson "whatever it says on the box" seems like a fair place to draw the line. If it doesn't pick up something it shouldn't pick up, that's on the FDA - not me. Philosophically, my moral responsibility ends with the official instructions on the box.
I don't think you were being flippant, just frustrated.
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).
My Husband and I were infected in early February and we are eagerly awaiting the fall booster but a bit nervous about the month of August and first half of September (assuming boosters are out mid-Sept). We easily wear masks in grocery stores and places so simple to mask and clearly not worth the chance of infection…but will be sad to give up indoor dining (again) and work meetings/events are tricky. I would really like to understand more about longer-term impacts of multiple infections.
If you have had COVID that recently, you are probably still more immune than, say, me, who has had 5 doses of two vaccines, but had COVID over 500 days ago. Yeah, I can't wait for my next booster.
Yes! As a teacher headed into the germ war zone, I planned on having my kids and I boosted in the fall.
Teacher here too and we start I service next week. It still shows we are low in my county, but to mask in meetings? I work with young kids who are developing their language skills so must see my mouth. Just wish for so many things to go away with this virus!
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?
What Dr. Jetelina and other seem to have written (I could be misreading) is that the number of cases is high, but fewer people are getting seriously ill due to almost everyone having some level of immunity, whether from vaccination or actual survival of the disease. That's what Steven Novella wrote here, certainly: https://sciencebasedmedicine.org/summer-covid-wave
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!
thanks for the catch 😉 fixed
Thanks for the sage advice. :-)
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.
I'm not an MD, but to me, this evidence is clear and risks minimal... enough to ask my doctor for it if I got an infection.
Our doctor was happy to Rx it for us on the basis of the pre-print of that study. If you decide to do that (in addition to Paxlovid), ask your doctor about the extended release version of metformin. Lots of people get GI symptoms on the regular kind (we definitely did, then we switched to ER and all was well).
I believe it was only given to overweight and obese subjects.
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.
This is just anecdotal but thought I would share. I have not had covid as best I know. Wore masks everywhere until this year, when I started only wearing them in what I felt were high risk situations. I am fully vaccinated. I used the nasal spray Xclear after I was indoors for more than five mins even if wearing a mask. It causes nasal irritation requiring blowing your nose. I have felt this to be a very important step in removing inhaled droplets fairly quickly after they entered your nasal passageway. I tested whenever I felt I was exposed and when I had any symptoms that might be covid. I have not been sick since the beginning of covid and wearing masks and using Xclear. I did start air travel the second year of covid, wore masks etc. Did not take them off in the airport or on the plane. This June I took a long awaited vacation to Ireland. I decided no masks would be worn. Not in airports, on my flights or anywhere in Ireland. I did not get sick. I just took another flight trip to Maine and wore no masks etc. Again I did not get sick. I am flying again the end of August but will wear a mask. I think my risk will be slightly greater now than earlier this year so why take a chance, even with somehow never getting sick these last three years. I know the masks kept me from colds, flu and possibly strep. I don't know if I have the genes and they protected me or it was my hyper vigilance (which I was able to do because I am retired) protected me. But I sure as heck don't want to get sick with the new wave so MASK it will be for awhile more.
I was already using Xlear for allergy symptoms and chronic sinus issues when the pandemic came. No known COVID infection despite heavy exposure as a hospital nurse and lots of testing. Don’t know if it’s related or not, but I continue to use it.
There is genetic allele that predisposes to NOT getting COVID 19. Check out This Week in Virology
TWIV Clinical Update July 22. Can’t post link for some reason.
I have had similar success with Enovid.
Xclear instructions say to blow nose before using product, not after. My doctor recommends both products for Covid prevention (in addition to masking during high risk indoor situations). Xclear is easier to get and cheaper than Enovid. Also, according to instruction packet, you can use Xclear an unlimited number of times. Enovid is probably more effective though.
No concerns from you doc about extensive and prolonged use of Enovid? That’s been my only concern because the company says they don’t have any data on it?
I haven't asked her this directly, yet she did say that when she gets home from work (after riding home on public transportation), she usually uses Xclear unless she's on a really crowded subway car, in which case she uses Enovid/SaNOtize. In addition to not wanting to overdo it with Enovid, she's trying to be mindful of cost. She toggles back and forth between the two based on perceived risk.
Apparently the FDA and DoJ sued the makers of Xclear for perceived false covid claims, so the company fought back with this:
https://www.biospace.com/article/releases/xlear-provides-new-data-to-the-dept-of-justice-study-showing-nasal-spray-reduces-covid-19-infections-by-62-percent-included/
Enovid appears to be even better than Xclear at preventing covid (but it's expensive, hard to get, and you probably shouldn't use it every single day):
https://www.jpost.com/special-content/can-a-spray-prevent-covid-745624#
And Enovid can reduce viral load if one is either exposed or infected:
https://www.bloomberg.com/press-releases/2022-07-13/newly-published-phase-3-study-in-people-with-covid-19-shows-sanotize-nitric-oxide-nasal-spray-reduced-viral-load-by-99-within
I also use Covixyl. It is available on Amazon.
Where are you folks buying Enovid (or XClear)? I hesitate to trust Amazon since it has a reputation for allowing counterfeit products (not these products specifically, I mean in general).
I buy Xlear from Amazon and Walgreen’s. I bought Enovid from Israel Pharm.
Thanks!
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).
This fall’s booster will be a monovalent shot targeting XBB.1.5. It would be nice if it were released now to help with back-to-school. I’m not a doctor, yet if you can play it safe for another month or two, it’s probably much better to get the updated booster which more closely matches currently circulating variants.
After 5 mRNA shots (all Moderna), I’m planning to go with Novavax, which is protein based and is supposed to offer longer protection. Hopefully this year Novavax will be more widely available than in 2022.
I haven’t read much about the Novovax one, but I definitely would rather wait for the targeted booster.
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 recommend listening to the TWIV (This Week in Virology) podcast - you might find your answer there, although I'm not sure how to search the archives. Dr. Daniel Griffin, who's treated many people with Covid in NYC, on each episode reviews the latest research. The "rebounds" in his opinion (based on the literature) are due to the natural course of Covid (the second week is when people usually get really sick if they haven't been treated). The benefit of Paxlovid is that even with a "rebound," most people don't need to be hospitalized.
It's fully approved by the FDA so maybe talk to your doctor about getting it filled at a pharmacy that does compounding?
That's a very good suggestion, though sad to say, I tried that, and my PCP advised it was a no go. Good as she is, I'm not altogether sure she's right on this, but so far it's a dead end. Looks like metformin may be a possibility though, as I see it comes in liquid form. Hopefully, I won't need such an intervention, but as my mom was a girl scout leader, I had no choice but to learn to be prepared!
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!
I’m not Dr. Jetelina but the official FDA stance is only swab nose. The FDA is generally going to be extremely cautious. Reality is many of us, including me, tested positive when I added in back of throat swab first and then nasal. I did another test with nose only after my positive throat and nose result because i was curious and I tested negative when I only did nose. That’s anecdotal but good enough for me. Also in the UK they test throat and nose. I doubt their swabs are somehow designed very differently. A rapid test expert Michael Mina has also said adding back of throat swab to nasal swab will make rapid test more sensitive but you should do both and not just a throat. If you add throat to nose here’s how to do it (and I recommend Binax Now rapid tests because their swabs are much longer and therefore easier to swab back of throat): https://www.businessinsider.com/how-to-swab-throat-covid-rapid-tests-guide-2022-1
As a layperson, I think it's 100% legit just to use tests as directed on the box.