4. Testing fatigue. People are tired of covid and worrying about it and testing for it. The number of people I know (in Maryland) who are sick or have sick kids but haven't tested because "it's just a cold" "covid's over, it can't be covid" "we all have allergies" is astounding. And they don't want to test for covid (just to be safe/sure) and get cranky when you suggest it.
It throws in a whole new level of "how do we negotiate this part of the pandemic".
In NJ people with kids are doing the “we don’t want to tear because we don’t want to know it’s COVID” or they test, find out it’s COVID, and still continue life as normal.
I think this is true but frustrating. As a culture we are so caught up in attempting to minimize the disruption that we extend it. If the messaging were matter of fact, set realistic expectations and treated it pragmatically people would probably be able to handle it better. Leadership spends way too much time catering to those who don't want to deal reality. In their attempts to placate instead of inform, the message minimizes what people expect. Then, when the predictable thing happens, everyone is shocked
Yes, exactly. I think that, as a pragmatist, this has been one of the most frustrating aspects. in trying to placate people's fears and frustrations, they're extending the pandemic and making it worse. And everyone seems to fall prey to this. The changing of the metrics is the most glaring example. It makes it easy for people to then believe what they want, rather than the reality of the situation
Anecdotes are about as helpful as absolute case rates right now, but I'll share a quick one anyway. In my family practice today I had three patients with Covid-like syndromes, all of whom ensured me they just had allergies, a head cold, or a sinus infection.
Two had not bothered to even perform a rapid antigen test, and the other could not grasp the concept that a negative rapid antigen test might not be 100% reassuring (as he coughed repeatedly before I could escort him away, mask down of course as I entered the room).
All three failed to disclose their symptoms despite repetitive, routine pre-visit questioning, only telling us of their symptoms after they started their visit. They had waited "a long time" for said visit, and would be damned if they were going to be told to reschedule.
I appreciate trading stories and advice and find YLE extremely helpful - but the reality is that we here are in a small bubble of comprehension, compassion, and comfort with uncertainty.
The masses have stopped even trying, and that informs my decisions as much as any data unfortunately.
I mean, I kinda get it? I just had minor elective surgery on my scalp. I'm scheduled to get the stitches out next week. And I'm sure as heck not going to get a PCR test before then, because I'm triple boosted, the stitches are painful, and because I really do get awful hay fever every year - for a bigger chunk of the year, thanks to global warming (that last bit isn't just me, and maybe it would be useful to pay attention to pollen counts: https://www.pnas.org/doi/10.1073/pnas.2013284118)
Oklahoma has also relabeled waste water so no one really knows what they are looking at. I am going to assume that the case count is medium to high and continue to avoid indoor gatherings, wear my N95, and continue to get my boosters. All of this hiding of numbers does nothing to increase my trust in the CDC.
Thanks! I’ve been suspicious that the level of underreporting of cases has been growing, as the relationship of the trend in deaths to the trend in new cases (on a lagged basis) just hasn’t made any sense for the past few months. I suspected the relatively mild symptoms of omicron, coupled with the availability of free at-home testing was contributing. Are IHME’s projections back on track? They have been severely undershooting in their mortality forecast throughout early 2022 and now I’m wondering if they hadn’t recalibrated for underreporting of cases until recently.
Thank you Dr. Jetelina. As mask mandates were dropped a couple weeks ago here in Washington (state) my elementary teacher husband and kids (ages 7, 7 and 13) have continued to mask and we all mask anytime we are indoors in public spaces. My 7 year olds are 2 of less than 5 in their class masking. We do it to protect ourselves, particularly vulnerable family members and friends, and because it still seems to be the right and smartest thing to do. Your explanation and details help to further confirm this decision when we've said "numbers are better, but..." many times recently. Including that we haven't had a notice from either school about a covid case in 3+ weeks, which I want to believe is true (they've been on top of it throughout), but also hesitate to believe is accurate. Thank you for the incredible work you do.
Thanks again--this analysis supports my deep concerns about the nearly complete lack of masking in our community, and underscores the dismal effects of dismantling public health infrastructure. Oy.
I want my decisions to be data-driven, but with the limited visision we have in the USA, it's more of an educated guess. That's really frustrating and it makes no sense we haven't devised complete and competent surveillance yet!
As someone with multiple high-risk factors with a child in school, where other kids and staff are not wearing masks puts vulnerable people like me in danger, and more than likely, many more of us die unnecessarily due to our current approach.
To protect myself and ensure I'm around to raise my daughter, I wear an N95 mask inside my home and sleep in my home office, which is separate from our main house. I am fortunate to have this space and deeply empathize with others who are not as privileged.
If others are interested, on this CDC page, you can download the CDC's explanation (https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html) for the change from Community Transmission to COVID-19 Community Levels under "Scientific Brief: Indicators for Monitoring COVID-19 Community Levels and Making Public Health Recommendations."
In short it says "COVID-19 community levels are better predictors of deaths and ICU utilization 3 weeks later than community transmission levels at the county level."
What I think would help increase trust is links to the data and analysis so others like Dr. Jetelina can evaluate and validate.
Given this, do you have any plans for updating the Riding the Waves framework? I really found that useful in my own decision-making, and it's a shame the data isn't there to support it now. I can look at trends and mask up when they rise, but when they start to go down again, how do I know when it's reasonable to unmask, eat in a restaurant, etc?
This was a fascinating suggestion on how to split the difference between case rate and positivity rate - use the geometric mean. I don't know if it actually answers the question of how many people are getting infected every day, but in a sense who cares? The value of a measuring device is often about comparing two measurements (an "unusual" measurement to a socially agreed upon "normal" measurement) - in order to determine a course of action. It's not always about determing a true state of nature.
After 2 years of outrunning Covid, our family got hit. My husband went in for a pcr test. He has several risk factors. He got the antivirals that day. I tested positive at home the next day but thankfully only one risk factor and it truly feels like a cold. Two days in I’m much improved. So far our girls are fine. We’re all as vaccinated as can be. We notified the 5 people we were around. As this (hopefully continues) to become more like a cold, is it necessary to push for testing data?
yes case data is still incredibly important. even if people are fully vaccinated (particularly the older and with comorbidities), it won't be mild like the cold.
Totally agree. Being a diagnosed long hauler who is fully vaxxed and double boostered, but still wears masks, I can testify that no one who is compos mentis should want to risk having the long version. Unfortunately for public health down the road, undoubtedly many already have long covid but are unaware of it.
Thanks for putting this out there. Now they have changed the metric (irresponsible IMHO) the people who have been vaxed and practiced safety measures are relaxing, not masking and going back into the world. For most of them it means inconvienience if they catch it. What no one seems to be saying much about is the people who have blithely lived on, ignoring what they should do, having the advantage of being insulated by those around them who have taken the effort to be careful. I think we are going to see an increase of cases in those people who have been claiming there was no risk but no longer have others keeping them safe.
My personal "case risk" involves seeing how many people in my circles have omicron. For the past three weeks here in upstate NY it seems that every day someone I know personally is coming down with covid. Our numbers county-wide don't look too bad but in my daily life it's everywhere. So, mask stays on.
I am also in Upstate NY. I know this post says it is not inevitable to get it, but I am not so sure! So many people I know say that they are kind of relieved to have recently got it because now they can stop worrying so much about avoiding it
Yep, my neighbors were vigilant since the start of the pandemic and then came down with it, through an exposure while masked/vaccinated/boosted. They are going through two weeks of misery as it goes from person to person in their family but they also expressed that sense of relief. My husband's philosophy is, "We'll all get it eventually, but this week never seems like a good week for it!"
That relief about infections is frustrating, because especially with omicron, people can get infected again in only 1 month, with some data of more system long term damage from repeated infections.
Yes, cases are being underreported, and the CDC isn't trying to correct this, nor are they accurately informing us of the level of risk and transmission in our local area.
But why aren't they telling us? Is it because it's hard to gather correct information and communicate it? Or, in the eyes of the CDC, is there some benefit when the rest of us underestimates the level of risk?
While I'm not accusing the CDC of incompetence (or malfeasance), I don't think this "underreporting" - cases, risk, transmission - is an accident or an oversight. If people don't want vaccines and boosters, infection is another path to immunity. Even for people who choose vaccines and boosters, breakthrough infections and transmission still happen. We need better vaccines.
And we need better therapeutics. I can't wait to hear more about Biden's "test and treat." Fingers crossed that will be widely available by this Fall.
Two weeks ago I expressed concern that home testing was skewing public new case data downward and so here's confirmation that it might be the case. I am very concerned that the BA.2 spread is very underreported here in Oregon so rely more on induced like wastewater testing. For the Oregon OHA omnium gatherum data site including variant numbers, wastewater, breakthrough, etc. google OHA covid data dashboard.
As for masking, Multnomah County where I live is probably experiencing a very high number of new cases, flying under the radar since the majority will never be tested; masking is very much in order.
Unfortunately TPR is also less reliable given the use of home tests and changes to federal test reporting requirements that will no longer require all negative tests to be reported. Everyone is ready to be "back to normal", unfortunately that also means seeing the disparities that exist in health outcomes and were so apparent with COVID continue and worsen.
What we need is random sampling
Maybe test people when they're called for jury duty
Thank you. I think possibly need to add:
4. Testing fatigue. People are tired of covid and worrying about it and testing for it. The number of people I know (in Maryland) who are sick or have sick kids but haven't tested because "it's just a cold" "covid's over, it can't be covid" "we all have allergies" is astounding. And they don't want to test for covid (just to be safe/sure) and get cranky when you suggest it.
It throws in a whole new level of "how do we negotiate this part of the pandemic".
In NJ people with kids are doing the “we don’t want to tear because we don’t want to know it’s COVID” or they test, find out it’s COVID, and still continue life as normal.
😔 that's happening here as well. They don't want to test because they don't want to have to quarantine or otherwise disrupt their life
I think this is true but frustrating. As a culture we are so caught up in attempting to minimize the disruption that we extend it. If the messaging were matter of fact, set realistic expectations and treated it pragmatically people would probably be able to handle it better. Leadership spends way too much time catering to those who don't want to deal reality. In their attempts to placate instead of inform, the message minimizes what people expect. Then, when the predictable thing happens, everyone is shocked
Yes, exactly. I think that, as a pragmatist, this has been one of the most frustrating aspects. in trying to placate people's fears and frustrations, they're extending the pandemic and making it worse. And everyone seems to fall prey to this. The changing of the metrics is the most glaring example. It makes it easy for people to then believe what they want, rather than the reality of the situation
Anecdotes are about as helpful as absolute case rates right now, but I'll share a quick one anyway. In my family practice today I had three patients with Covid-like syndromes, all of whom ensured me they just had allergies, a head cold, or a sinus infection.
Two had not bothered to even perform a rapid antigen test, and the other could not grasp the concept that a negative rapid antigen test might not be 100% reassuring (as he coughed repeatedly before I could escort him away, mask down of course as I entered the room).
All three failed to disclose their symptoms despite repetitive, routine pre-visit questioning, only telling us of their symptoms after they started their visit. They had waited "a long time" for said visit, and would be damned if they were going to be told to reschedule.
I appreciate trading stories and advice and find YLE extremely helpful - but the reality is that we here are in a small bubble of comprehension, compassion, and comfort with uncertainty.
The masses have stopped even trying, and that informs my decisions as much as any data unfortunately.
I mean, I kinda get it? I just had minor elective surgery on my scalp. I'm scheduled to get the stitches out next week. And I'm sure as heck not going to get a PCR test before then, because I'm triple boosted, the stitches are painful, and because I really do get awful hay fever every year - for a bigger chunk of the year, thanks to global warming (that last bit isn't just me, and maybe it would be useful to pay attention to pollen counts: https://www.pnas.org/doi/10.1073/pnas.2013284118)
Oklahoma has also relabeled waste water so no one really knows what they are looking at. I am going to assume that the case count is medium to high and continue to avoid indoor gatherings, wear my N95, and continue to get my boosters. All of this hiding of numbers does nothing to increase my trust in the CDC.
Thanks! I’ve been suspicious that the level of underreporting of cases has been growing, as the relationship of the trend in deaths to the trend in new cases (on a lagged basis) just hasn’t made any sense for the past few months. I suspected the relatively mild symptoms of omicron, coupled with the availability of free at-home testing was contributing. Are IHME’s projections back on track? They have been severely undershooting in their mortality forecast throughout early 2022 and now I’m wondering if they hadn’t recalibrated for underreporting of cases until recently.
Thank you Dr. Jetelina. As mask mandates were dropped a couple weeks ago here in Washington (state) my elementary teacher husband and kids (ages 7, 7 and 13) have continued to mask and we all mask anytime we are indoors in public spaces. My 7 year olds are 2 of less than 5 in their class masking. We do it to protect ourselves, particularly vulnerable family members and friends, and because it still seems to be the right and smartest thing to do. Your explanation and details help to further confirm this decision when we've said "numbers are better, but..." many times recently. Including that we haven't had a notice from either school about a covid case in 3+ weeks, which I want to believe is true (they've been on top of it throughout), but also hesitate to believe is accurate. Thank you for the incredible work you do.
Thanks again--this analysis supports my deep concerns about the nearly complete lack of masking in our community, and underscores the dismal effects of dismantling public health infrastructure. Oy.
I want my decisions to be data-driven, but with the limited visision we have in the USA, it's more of an educated guess. That's really frustrating and it makes no sense we haven't devised complete and competent surveillance yet!
Dr. Katelyn, thank you for coherently putting the challenges into words.
Another complexity we now have to navigate is the CDC, NYT, and local health departments' denominators are not aligned as I've outlined here - https://twitter.com/josephporcelli/status/1512481064765517826
As someone with multiple high-risk factors with a child in school, where other kids and staff are not wearing masks puts vulnerable people like me in danger, and more than likely, many more of us die unnecessarily due to our current approach.
To protect myself and ensure I'm around to raise my daughter, I wear an N95 mask inside my home and sleep in my home office, which is separate from our main house. I am fortunate to have this space and deeply empathize with others who are not as privileged.
If others are interested, on this CDC page, you can download the CDC's explanation (https://www.cdc.gov/coronavirus/2019-ncov/science/community-levels.html) for the change from Community Transmission to COVID-19 Community Levels under "Scientific Brief: Indicators for Monitoring COVID-19 Community Levels and Making Public Health Recommendations."
In short it says "COVID-19 community levels are better predictors of deaths and ICU utilization 3 weeks later than community transmission levels at the county level."
What I think would help increase trust is links to the data and analysis so others like Dr. Jetelina can evaluate and validate.
Given this, do you have any plans for updating the Riding the Waves framework? I really found that useful in my own decision-making, and it's a shame the data isn't there to support it now. I can look at trends and mask up when they rise, but when they start to go down again, how do I know when it's reasonable to unmask, eat in a restaurant, etc?
This was a fascinating suggestion on how to split the difference between case rate and positivity rate - use the geometric mean. I don't know if it actually answers the question of how many people are getting infected every day, but in a sense who cares? The value of a measuring device is often about comparing two measurements (an "unusual" measurement to a socially agreed upon "normal" measurement) - in order to determine a course of action. It's not always about determing a true state of nature.
https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1009374
After 2 years of outrunning Covid, our family got hit. My husband went in for a pcr test. He has several risk factors. He got the antivirals that day. I tested positive at home the next day but thankfully only one risk factor and it truly feels like a cold. Two days in I’m much improved. So far our girls are fine. We’re all as vaccinated as can be. We notified the 5 people we were around. As this (hopefully continues) to become more like a cold, is it necessary to push for testing data?
yes case data is still incredibly important. even if people are fully vaccinated (particularly the older and with comorbidities), it won't be mild like the cold.
Plus the possible long term effects are far more severe than the common cold, even for the vaxxed.
Totally agree. Being a diagnosed long hauler who is fully vaxxed and double boostered, but still wears masks, I can testify that no one who is compos mentis should want to risk having the long version. Unfortunately for public health down the road, undoubtedly many already have long covid but are unaware of it.
Thanks for putting this out there. Now they have changed the metric (irresponsible IMHO) the people who have been vaxed and practiced safety measures are relaxing, not masking and going back into the world. For most of them it means inconvienience if they catch it. What no one seems to be saying much about is the people who have blithely lived on, ignoring what they should do, having the advantage of being insulated by those around them who have taken the effort to be careful. I think we are going to see an increase of cases in those people who have been claiming there was no risk but no longer have others keeping them safe.
My personal "case risk" involves seeing how many people in my circles have omicron. For the past three weeks here in upstate NY it seems that every day someone I know personally is coming down with covid. Our numbers county-wide don't look too bad but in my daily life it's everywhere. So, mask stays on.
I am also in Upstate NY. I know this post says it is not inevitable to get it, but I am not so sure! So many people I know say that they are kind of relieved to have recently got it because now they can stop worrying so much about avoiding it
Yep, my neighbors were vigilant since the start of the pandemic and then came down with it, through an exposure while masked/vaccinated/boosted. They are going through two weeks of misery as it goes from person to person in their family but they also expressed that sense of relief. My husband's philosophy is, "We'll all get it eventually, but this week never seems like a good week for it!"
That relief about infections is frustrating, because especially with omicron, people can get infected again in only 1 month, with some data of more system long term damage from repeated infections.
Oh, that is sad to hear.
Yes, cases are being underreported, and the CDC isn't trying to correct this, nor are they accurately informing us of the level of risk and transmission in our local area.
But why aren't they telling us? Is it because it's hard to gather correct information and communicate it? Or, in the eyes of the CDC, is there some benefit when the rest of us underestimates the level of risk?
While I'm not accusing the CDC of incompetence (or malfeasance), I don't think this "underreporting" - cases, risk, transmission - is an accident or an oversight. If people don't want vaccines and boosters, infection is another path to immunity. Even for people who choose vaccines and boosters, breakthrough infections and transmission still happen. We need better vaccines.
And we need better therapeutics. I can't wait to hear more about Biden's "test and treat." Fingers crossed that will be widely available by this Fall.
Two weeks ago I expressed concern that home testing was skewing public new case data downward and so here's confirmation that it might be the case. I am very concerned that the BA.2 spread is very underreported here in Oregon so rely more on induced like wastewater testing. For the Oregon OHA omnium gatherum data site including variant numbers, wastewater, breakthrough, etc. google OHA covid data dashboard.
As for masking, Multnomah County where I live is probably experiencing a very high number of new cases, flying under the radar since the majority will never be tested; masking is very much in order.
Nice resource. Thanks.
Unfortunately TPR is also less reliable given the use of home tests and changes to federal test reporting requirements that will no longer require all negative tests to be reported. Everyone is ready to be "back to normal", unfortunately that also means seeing the disparities that exist in health outcomes and were so apparent with COVID continue and worsen.