Well, case patterns continue to vary greatly across the world. For example, after reaching ridiculous heights, France and Australia are on the descent. Japan’s cases are gaining speed, and interestingly, U.K., Canada, and South Africa have stalled after their initial descent.
Just wanted to let you know that I shared this information, particularly the info on the effectiveness of boosters against the new variants, with the woman who cleans our house (and does myriad other things beyond my capacity). It convinced her to go get her booster shot today. So THANKS
(I just want to take a quick moment to say how much I appreciate your efforts to make all this data and technical information accessible and understandable to a general audience. As someone who develops technical documentation for a living, I know how much work it takes to do that well. Thank you!)
In the UK part of the reason for the stall may be increasing use of RATs finding more asymptomatic patients.
I have a strong suspicion that using cases to determine vaccine efficacy results in bias. The assumption required for the analysis is that the unvaccinated behave the same as the vaccinated, and this is unlikely to be true. Less concern about Covid and less interaction with the health system would be likely with unvaccinated subjects. Page 13 of https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1018416/Vaccine_surveillance_report_-_week_37_v2.pdf shows that there is something happening unless you want to believe that the vaccinated are at higher risk of Covid.
Thanks for another great article. Do you know- are there data and discussions out there about post-covid syndrome? Experiencing it in my house and it’s incredibly disruptive; and, there seems to be very little known about it or how to address it. Would love to read a post of yours on it, if possible. Thanks, D.
Have some questions about the graph showing evolution of covid-19's infection fatality ration in England. Am having a discussion with someone about how to think about the info in it, and need to know more. It appears that this graph was put together for this blog, is that right? If not, can you provide a link to the original source, so I can read the info there?
Here are the things I'm wondering about: Are the Covid cases & fatalities on the graph for vaccinated and unvaccinated people combined? Or just for vaccinated people? Same question regarding the flu cases and fatalities. Also, seems a bit odd that graph compares covid data from England with flu data from New Zealand. Any special reason for that?
I am not complaining about the graph! Just need clarification about the IFR's show there, so as to be more able to draw conclusions about where things stand.
Your posts are wonderful, and I write this comment Not to criticize. But I often find interpretations of risk ratios when they include adjectives, so during my latter decades of teaching I advised my students to avoid phrases like "times higher". So when I read "BA.2 has a +126% growth rate over BA.1" I think if BA.2 and BA.1 had the same growth rate, I would write BA.2 had +0% growth rate over BA.1, so +126% growth rate over BA.1 must mean that BA.1 has (1 + 1.26) times the BA.1 growth rate, which I doubt is the intended meaning. Similarly, when I read "IFR is still about two times higher than the flu," I'm thinking it could mean that the SARS-CoV-2 IFR is about three times that of the flu (i.e., "two times higher" = as high plus two times more). Without the actual numbers, I find the phrasing ambiguous. But I have neither a day job nor two young children nor write a daily column, so this is just my attempt to be helpful. https://go.unc.edu/vjs, https://go.unc.edu/EPID
Should vac & boosted seniors 76-85 yrs old get tests to see their levels of antibodies & if low ( whatever that is), get a third booster shot ( & mix Pfizer/Moderna)? Natalie Shawn
That’s great if omicron’s case fatality rate is lower than delta’s, yet is anyone assessing the prevalence of and impact of people taking off-label early treatment such as Fluvoxamine (which as of November 2021 is now part of Johns Hopkins covid protocol, see link below)
Dr Jetelina- Could you please provide information regarding Pfizer request to FDA for 6mths - 4 year olds that could be happening today? I would really like your guidance and insights here. Thank you!
I was wondering if any studies have been done on the difference in rates with people who had the J&J vaccine vs the others. Especially in regards to boosters vs no booster. I know someone who had the J&J but refused to get a booster. He ended up with Covid and 3 weeks later is still sick with it. Others I know who have been positive for Covid have had much milder symptoms and have had boosters - none of them originally had the J&J
Very interesting material today. I don't like to comment at COVID-related venues like some broken record or like some morbidly obese person sitting in his basement eating cookies (that's a Trump wisecrack) obsessing about ONE hobby horse (viz. flawed communication issues during the pandemic) BUT . . . . . I need to know what you meant by "Cases" in the text below, copied from today's report. This is important because there is the continuing conflation in both medical literature about, and news coverage regarding, the concepts "case", "infection", "PCR positivity", etc. This is materially important because Case Definition is almost the number one thing to get locked in for every epidemiology inquiry, including even when reading pertinent literature, not to mention the obvious confusion that can arise, for example, from the definition of "Case" as used in the Pfizer and Moderna randomized controlled trials of mRNA vaccine, etc. As well, it is my understanding that various states use a wandering array of definitions of "COVID case" in their reporting. In some places, just "blowing a positive" on your PCR test makes that person a "Case". In other places, you must not only have a positive PCR test result but also have a CLINICAL picture that "fits" (i.e. some combo of signs, symptoms, etc.). Hell, in some states we are not even told anything about COVID case dynamics.
------------------------------
You wrote today [asterisks are mine]: "In the United States, *cases* and test positivity rates continue to decline. Because both metrics are mirroring each other (rather than showing opposite trends), I’m confident this is the “true” trend and not a testing capacity or testing behavior phenomenon. The raw number of *cases*, though, continues to be greatly underreported".
Question about household attack rates vs primary attack rates. Is there a way of "factoring out" household spread when evaluating the benefits of living alone? I've read different estimates at various times during the pandemic, for various places. How much risk am I mitigating simply by being a single person household?
Also - based on covidestim.org the "stalling" in the decline seems to be emerging in NYC as well.
Just wanted to let you know that I shared this information, particularly the info on the effectiveness of boosters against the new variants, with the woman who cleans our house (and does myriad other things beyond my capacity). It convinced her to go get her booster shot today. So THANKS
(I just want to take a quick moment to say how much I appreciate your efforts to make all this data and technical information accessible and understandable to a general audience. As someone who develops technical documentation for a living, I know how much work it takes to do that well. Thank you!)
In the UK part of the reason for the stall may be increasing use of RATs finding more asymptomatic patients.
I have a strong suspicion that using cases to determine vaccine efficacy results in bias. The assumption required for the analysis is that the unvaccinated behave the same as the vaccinated, and this is unlikely to be true. Less concern about Covid and less interaction with the health system would be likely with unvaccinated subjects. Page 13 of https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1018416/Vaccine_surveillance_report_-_week_37_v2.pdf shows that there is something happening unless you want to believe that the vaccinated are at higher risk of Covid.
Thanks for another great article. Do you know- are there data and discussions out there about post-covid syndrome? Experiencing it in my house and it’s incredibly disruptive; and, there seems to be very little known about it or how to address it. Would love to read a post of yours on it, if possible. Thanks, D.
Have some questions about the graph showing evolution of covid-19's infection fatality ration in England. Am having a discussion with someone about how to think about the info in it, and need to know more. It appears that this graph was put together for this blog, is that right? If not, can you provide a link to the original source, so I can read the info there?
Here are the things I'm wondering about: Are the Covid cases & fatalities on the graph for vaccinated and unvaccinated people combined? Or just for vaccinated people? Same question regarding the flu cases and fatalities. Also, seems a bit odd that graph compares covid data from England with flu data from New Zealand. Any special reason for that?
I am not complaining about the graph! Just need clarification about the IFR's show there, so as to be more able to draw conclusions about where things stand.
Your posts are wonderful, and I write this comment Not to criticize. But I often find interpretations of risk ratios when they include adjectives, so during my latter decades of teaching I advised my students to avoid phrases like "times higher". So when I read "BA.2 has a +126% growth rate over BA.1" I think if BA.2 and BA.1 had the same growth rate, I would write BA.2 had +0% growth rate over BA.1, so +126% growth rate over BA.1 must mean that BA.1 has (1 + 1.26) times the BA.1 growth rate, which I doubt is the intended meaning. Similarly, when I read "IFR is still about two times higher than the flu," I'm thinking it could mean that the SARS-CoV-2 IFR is about three times that of the flu (i.e., "two times higher" = as high plus two times more). Without the actual numbers, I find the phrasing ambiguous. But I have neither a day job nor two young children nor write a daily column, so this is just my attempt to be helpful. https://go.unc.edu/vjs, https://go.unc.edu/EPID
Should vac & boosted seniors 76-85 yrs old get tests to see their levels of antibodies & if low ( whatever that is), get a third booster shot ( & mix Pfizer/Moderna)? Natalie Shawn
Sooo what on earth is going on with these rumors about Pfizer pursuing approval for <5s? Are they just going in with "eh it's safe, so why not?"
Thank you for this invaluable snapshot of the state of this pandemic.
Thanks for the write up!
I think there is a typo in this sentence: "How much cases increases, though..."
That’s great if omicron’s case fatality rate is lower than delta’s, yet is anyone assessing the prevalence of and impact of people taking off-label early treatment such as Fluvoxamine (which as of November 2021 is now part of Johns Hopkins covid protocol, see link below)
https://www.hopkinsguides.com/hopkins/ub?cmd=repview&type=479-1225&name=30_538747_PDF
It seems that we are hitting a plateau in the northeast US, just like they did in South Africa and the UK. Any thoughts as to why?
Dr Jetelina- Could you please provide information regarding Pfizer request to FDA for 6mths - 4 year olds that could be happening today? I would really like your guidance and insights here. Thank you!
I was wondering if any studies have been done on the difference in rates with people who had the J&J vaccine vs the others. Especially in regards to boosters vs no booster. I know someone who had the J&J but refused to get a booster. He ended up with Covid and 3 weeks later is still sick with it. Others I know who have been positive for Covid have had much milder symptoms and have had boosters - none of them originally had the J&J
Very interesting material today. I don't like to comment at COVID-related venues like some broken record or like some morbidly obese person sitting in his basement eating cookies (that's a Trump wisecrack) obsessing about ONE hobby horse (viz. flawed communication issues during the pandemic) BUT . . . . . I need to know what you meant by "Cases" in the text below, copied from today's report. This is important because there is the continuing conflation in both medical literature about, and news coverage regarding, the concepts "case", "infection", "PCR positivity", etc. This is materially important because Case Definition is almost the number one thing to get locked in for every epidemiology inquiry, including even when reading pertinent literature, not to mention the obvious confusion that can arise, for example, from the definition of "Case" as used in the Pfizer and Moderna randomized controlled trials of mRNA vaccine, etc. As well, it is my understanding that various states use a wandering array of definitions of "COVID case" in their reporting. In some places, just "blowing a positive" on your PCR test makes that person a "Case". In other places, you must not only have a positive PCR test result but also have a CLINICAL picture that "fits" (i.e. some combo of signs, symptoms, etc.). Hell, in some states we are not even told anything about COVID case dynamics.
------------------------------
You wrote today [asterisks are mine]: "In the United States, *cases* and test positivity rates continue to decline. Because both metrics are mirroring each other (rather than showing opposite trends), I’m confident this is the “true” trend and not a testing capacity or testing behavior phenomenon. The raw number of *cases*, though, continues to be greatly underreported".
Question about household attack rates vs primary attack rates. Is there a way of "factoring out" household spread when evaluating the benefits of living alone? I've read different estimates at various times during the pandemic, for various places. How much risk am I mitigating simply by being a single person household?
Also - based on covidestim.org the "stalling" in the decline seems to be emerging in NYC as well.