Happy spring! With warmer weather comes a calming of the respiratory season. Hopefully. Viruses are definitely still circulating, but we are seeing some encouraging signs. A look back Doctor visits for fever and a cough (i.e., “influenza-like illnesses” or “ILI”) were back to pre-pandemic levels this season, but had some uncharacteristic patterns:
excess death line we will be taking one more step towards normalizing all of the covid deaths. Next step will to collapse all of the covid deaths into respiratory deaths and poof the pandemic will be gone. This is what the CD C is moving towards - hiding the data.
“Excess deaths (red line below) continue to be above the “epidemic threshold” (black line). We haven’t had a national conversation defining the new baseline. What do we now consider normal given that we have an additional threat in our repertoire? As we move out of the pandemic phase, this black line needs to shift up. “
Thanks again. Now we can shift our attention to other issues, like the climate, democracy, guns.... Sorry. As Gilda said, it's always something. Your posts continue to be extremely clear and helpful. I hope you get some rest!
Dr. Jetelina— why the “wash your hands” warning for Norovirus, but not one peep about masking after reporting the horrendous COVID-19 death toll over the last few months?
Thank you for educating us on the dynamism of pandemics. Like Dr. Fauci (but much less famous) I too started my medical career with one pandemic and am ending it with another. I was a third year med student when the 5th case of HIV in Chicago was on our service. My intern wouldn't even go in the patient's room. At that time infected patients had at most two hospitalizations before they completed their lives. I recall when in the 1990s I first encountered a patient on full anti-retrovirus therapy. I thought I was in the wrong room, the patient was muscular and vibrant.
We now are transitioning into that phase with COVID. Last week I participated in the care of patient with COVID who had multiple features to predict almost certain mortality based on 2020 data. The patient opted for "treat but don't intensify" level of care. Within a few days the patient began to recover. I then dove into the immunization record - all recommended doses had been given.
As with HIV we will continue to learn how to care for patients with this infection.
Would you consider doing an update on the status of drug-resistant Candida that seems to be a thing now? There were more signs about Candida than covid in my hospital yesterday. I was very weird.
Thank you again. I am still masking and washing my hands when I am around others. Having just recently come out of the hospital for surgery, I do not know what I was exposed to. It makes sense to me to monitor temperature and take covid tests for a period of time to stay informed.
I am concerned that we are going to an "it's all over" mentality prematurely. Given the mutability of the virus, and it's known track record of reinfectivity and going around the various barriers we have thrown up to stop it, I don't consider a lull in the numbers to justify any thoughts that we're into a permanent state of endemicity. That seems wishful thinking. Can epidemiology say with even 70% certainty that it is improbable the virus will not take a new form that will throw us back into a pandemic? We are in a zone of epistemic uncertainty and simply relying on past pandemic trajectories, while helpful, does not clear away the fog. Best to accept that we are not yet in the position to relax our defenses.
The best analogy I can summon is that of the outbreaks of wars. With each war over we thought it was the last for a long time ("the war to end all wars" with WWI) yet they kept and keep breaking out. I think with covid 19 we may be in a similar situation.
I would like to see another mortality chart that includes cardio and pulmonary causes. I know this would be terribly complicated to draw any causal conclusions but shifts (or a lack thereof) would be interesting, considering the suggested complications and effects of the disease. Great post as always.
Thanks for making this understandable to the average lay person - you're great!
Can you commet on how someone finds out the covid variant that has infected them? Also, if someone has been vaccinated several times, and never (to their knowledge) has been infected, is there a way to verify their infection status?
I'd be curious to hear more about this: " If this trend continues, having a high baseline throughout the year would be incredibly inconvenient". What are the implications if we have a steady higher-than-expected baseline of Covid transmitting year-round? Are other countries starting to see that with Covid-19? Has that played out with other novel viruses in the past? (1918 Flu, SARS).
Thank you for another great post. It's great to hear that covid in wastewater is nosediving.
But not where I live (California). Virus in wastewater is 3x Thanksgiving and 2x Christmas.
What does it mean when the amount of virus in wastewater seems to keep going up? How closely do wastewater levels track (actual) new cases? What's the best way to use wastewater levels to gauge transmission levels and assess personal risk?
At least in the past, covid has exhibited peaks and troughs. What if our future entails living with a permanently elevated level of virus and transmission?
Take a look (select "Central Marin Sanitary Agency" from "Sample Site" menu):
Thanks. It's a bit frustrating being a geezer these days. We know we're at elevated risk but there's precious little guidance on how often we need boosters. I know that a rapidly evolving virus is likely to require regular renewal of immunity, but this one is hard to get a grip on. Political interference from the "plandemic" and anti-vaccine cranks isn't helping any when it comes to getting reliable data.
We have Covid in our house for the first time. My 12 year-old is miserable. It’s not “just a cold” or mild. I regret letting my kids go to school unmasked this year. I just hope he doesn’t have long-term effects.
Good as per the reg.
A discussion in a bit on whether to boost, and what to boost with, would be useful. I'm sure you're already thinking it all through.
If we move the pandemic black line up to the
excess death line we will be taking one more step towards normalizing all of the covid deaths. Next step will to collapse all of the covid deaths into respiratory deaths and poof the pandemic will be gone. This is what the CD C is moving towards - hiding the data.
“Excess deaths (red line below) continue to be above the “epidemic threshold” (black line). We haven’t had a national conversation defining the new baseline. What do we now consider normal given that we have an additional threat in our repertoire? As we move out of the pandemic phase, this black line needs to shift up. “
Thanks again. Now we can shift our attention to other issues, like the climate, democracy, guns.... Sorry. As Gilda said, it's always something. Your posts continue to be extremely clear and helpful. I hope you get some rest!
Dr. Jetelina— why the “wash your hands” warning for Norovirus, but not one peep about masking after reporting the horrendous COVID-19 death toll over the last few months?
Thank you for educating us on the dynamism of pandemics. Like Dr. Fauci (but much less famous) I too started my medical career with one pandemic and am ending it with another. I was a third year med student when the 5th case of HIV in Chicago was on our service. My intern wouldn't even go in the patient's room. At that time infected patients had at most two hospitalizations before they completed their lives. I recall when in the 1990s I first encountered a patient on full anti-retrovirus therapy. I thought I was in the wrong room, the patient was muscular and vibrant.
We now are transitioning into that phase with COVID. Last week I participated in the care of patient with COVID who had multiple features to predict almost certain mortality based on 2020 data. The patient opted for "treat but don't intensify" level of care. Within a few days the patient began to recover. I then dove into the immunization record - all recommended doses had been given.
As with HIV we will continue to learn how to care for patients with this infection.
Thank you for being part of the learning process.
Would you consider doing an update on the status of drug-resistant Candida that seems to be a thing now? There were more signs about Candida than covid in my hospital yesterday. I was very weird.
Thank you again. I am still masking and washing my hands when I am around others. Having just recently come out of the hospital for surgery, I do not know what I was exposed to. It makes sense to me to monitor temperature and take covid tests for a period of time to stay informed.
I am concerned that we are going to an "it's all over" mentality prematurely. Given the mutability of the virus, and it's known track record of reinfectivity and going around the various barriers we have thrown up to stop it, I don't consider a lull in the numbers to justify any thoughts that we're into a permanent state of endemicity. That seems wishful thinking. Can epidemiology say with even 70% certainty that it is improbable the virus will not take a new form that will throw us back into a pandemic? We are in a zone of epistemic uncertainty and simply relying on past pandemic trajectories, while helpful, does not clear away the fog. Best to accept that we are not yet in the position to relax our defenses.
The best analogy I can summon is that of the outbreaks of wars. With each war over we thought it was the last for a long time ("the war to end all wars" with WWI) yet they kept and keep breaking out. I think with covid 19 we may be in a similar situation.
I would like to see another mortality chart that includes cardio and pulmonary causes. I know this would be terribly complicated to draw any causal conclusions but shifts (or a lack thereof) would be interesting, considering the suggested complications and effects of the disease. Great post as always.
Thanks for making this understandable to the average lay person - you're great!
Can you commet on how someone finds out the covid variant that has infected them? Also, if someone has been vaccinated several times, and never (to their knowledge) has been infected, is there a way to verify their infection status?
I'd be curious to hear more about this: " If this trend continues, having a high baseline throughout the year would be incredibly inconvenient". What are the implications if we have a steady higher-than-expected baseline of Covid transmitting year-round? Are other countries starting to see that with Covid-19? Has that played out with other novel viruses in the past? (1918 Flu, SARS).
Thank you for another great post. It's great to hear that covid in wastewater is nosediving.
But not where I live (California). Virus in wastewater is 3x Thanksgiving and 2x Christmas.
What does it mean when the amount of virus in wastewater seems to keep going up? How closely do wastewater levels track (actual) new cases? What's the best way to use wastewater levels to gauge transmission levels and assess personal risk?
At least in the past, covid has exhibited peaks and troughs. What if our future entails living with a permanently elevated level of virus and transmission?
Take a look (select "Central Marin Sanitary Agency" from "Sample Site" menu):
https://coronavirus.marinhhs.org/surveillance
Thanks. It's a bit frustrating being a geezer these days. We know we're at elevated risk but there's precious little guidance on how often we need boosters. I know that a rapidly evolving virus is likely to require regular renewal of immunity, but this one is hard to get a grip on. Political interference from the "plandemic" and anti-vaccine cranks isn't helping any when it comes to getting reliable data.
We have Covid in our house for the first time. My 12 year-old is miserable. It’s not “just a cold” or mild. I regret letting my kids go to school unmasked this year. I just hope he doesn’t have long-term effects.
Thanks as always for a clear summary of the state of affairs. The Guardian ran a somewhat alarmist story today about H5N1 influenza jumping from birds to a variety of mammal species. Might be something to keep an eye on. https://www.theguardian.com/environment/2023/mar/21/bird-flu-peru-sea-lions-suffer-death-beach-aoe-h5n1
Hard to make a constructive comment when you covered the material so well. Thanks.