Global deaths due to SARS-CoV-2 are continuing to plummet and closing in on levels we only saw at the beginning of the pandemic. Although we are hopeful this continues due to increased vaccination and infection-induced immunity, many eyes are on four specific areas across the globe:
I am an internist in Chicago. I am getting more Covid-positive calls in my practice than at any other time in the pandemic. I am somewhat surprised that this wave is not getting more attention, though I completely agree with your reasons why. Most of my patients are confirming their Covid status with home testing only so there is no good way to keep track of the numbers. Does it really matter what the numbers are? Because of Long-Covid and the yet-unknown potential for long-term disability, sadly, I think they do.
We are basically living in two realities. One is in which life has returned to "normal" and COVID is seen as more of a catching a bad flu. Talking with friends, they are seeing in their local groups/lives people testing positive and getting out and about because they don't feel that bad, so the whole "quarantine" at home is out the window as well. The other is that in which people are proactively looking at numbers and making decisions on masking etc.
What is concerning is the long covid issues. There insurance companies were already reporting higher disability claims last year. The number of infections is so large, that long covid that impacts every day life will be relatively large and that is going to impact everything from employment to health care, to government benefits, to insurance rates increasing.
Thank you for your work and dedication to keeping us all informed. Your posts are always helpful. What I am still listening and looking for, and think the general public needs, is some expert help on which numbers to watch and what to do with them. Even here in Texas, there are business owners who would watch the "pandemic weather report" if they knew where to look and what to trust, and most importantly, what to do with that information. For people who remain at risk, unvaccinated, unprotected or desirous of avoiding Long Covid, I have been utilizing a complex combination of the Georgia Tech risk calculator (likely under reporting risk due to inaccurate numbers), https://covid19risk.biosci.gatech.edu, the rising curve of waste water surveillance data (when available) and the percent positives. The Walgreens data has recently been the most helpful. https://www.walgreens.com/businesssolutions/covid-19-index.jsp. I would love your take on what level of percent positive would correlate with a recommendation for indoor masking in light of underreporting. (a number that might be useful to business owners and individuals willing to listen) My rough guess has been >3% based on earlier definitions of spread from the Brown School of Public Health.
Thank you again, so much, for all your work -- for us high-risk (but not immunocompromised) under 50-year-olds, is your recommendation still to wait on grabbing a second booster? I'm hitting seven months from my first booster and getting worried about being able to make it through this wave without being infected.
The frequency of reinfections is surprising and significant, glad you pointed that out. I am also frustrated by the lack of good data – we've had 2-plus years to figure it out and it still feels like amateur hour.
My perception, admittedly based on anecdotal data, is that the "true" number on the US graph is still a vast underestimate right now. It feels like I know a similar number of people being infected to when the January peak was happening, but more people are relying on home tests and not showing up in the case numbers. For people I know who are more cautious, I've been advising to assume the situation is similar to January. I caught Covid for myself the first time about two weeks ago, on a trip to the Northeast. It was sequenced as BA.2.7. Initially I used a Cue test provided by my employer, which I think Cue reports in aggregate to public health authorities but may not show up in the official metrics.
I think that with a few months of broad rapid test availability and government distribution, now the norm for people with symptoms is to take a rapid test. So I'm suspecting even the test positivity numbers are suppressed by the most likely people to have Covid not taking the tests that count towards the metrics.
I'd be curious to hear your thoughts as well, since I'm just an amateur.
I so much appreciate the "True Cases" vs. "Reporting" graphic. I am hearing right and left from friends and acquaintances who have come down with Covid in the past two weeks--more than at any other time during the pandemic--and people who say "I've been so careful...." We have not given up masking indoors and we have watched the numbers here in the mid-Atlantic and decided that indoor restaurant dining is off the table AGAIN (after only having been "on the table" for a few short weeks in early April!!). 3 out of 4 of us have yet to catch covid. Our daughter had a totally asymptomatic infection, identified by school weekly rapid testing (confirmed by PCR), but none of the rest of the family (70, 65 and 19) ever caught it. I recognize pandemic fatigue and am really, REALLY tired of all the precautions, but we persist, nonetheless, despite the fact that many around us are "back to normal" in their social behaviors. Would love to see some science-backed guidance around how to match risk-reducing behaviors to community transmission/hospitalization/positivity levels. I imagine that those kinds of calculations must also necessarily take into account local vaccination rates. Down the road, it'd be interesting to revisit comparisons between those geographic/political regions that chose to go the "herd/infection-induced" immunity route vs. those that really pushed vaccination.
Any data on case rates/transmission in daycares? We've been getting new case emails every 2-3 days and it's unnerving. Not sure what to do or how long to wait this out. Public health won't shut down classrooms anymore unless multiple cases test positive on the exact same date. I feel like it's everywhere in under-5s right now.
Thank you for your always insightful updates! One topic I was hoping you could circle back on at some point, is the accuracy of antigen tests with the latest Omicron variations. I recall you posted something early on in the Omicron wave how they tended to work further into an infection than with previous variants. Is that still the case, or even getting worse? And if so, are manufacturers working on new version of antigen tests to better / earlier detect these Omicron variations (similar to vaccine development).
Odds and ends comments,. 1. Something odd is going on in the numbers from southeastern Montana. What are the data sources there? 2. With the advent of self testing kits, maybe wastewater surveillance is our most reliable data source? 3. This virus is extremely mutagenic and long term prediction (anything over a month, say) of it's future course is pretty difficult to say the least. Maybe we shouldn't relax too much.
Thanks so much, Katelyn! As the publicly reported data becomes increasingly less accurate, I depend more and more on your reporting the true story. Do you think a modified vaccine that includes omicron might help?
Hi- when could we see numbers on 4th shots. I am triple vaccinated, had COVID in January and I am 52, but want to maximize my fourth shot. Thank you for the last few words of not needing to be alarmed as my anxiety for the past three years has been debilitating at times. You always speak with truth.
Is there any data on reinfection window? So many of us got BA1 this winter…is it really a 90 day immunity period or is that an arbitrary number from the cdc?
I very much appreciate and share your covid-19 posts as I feel you are doing a very great service in this very dangerous time. I look forward to following your column for as long as possible as I think we live in a time when there will be a lot more difficult to control epidemics and and other medical things that your common sense writing will be helpful with.
One other comment -- any thoughts about RadVaC? Yes, it's a "homemade" intranasal vaccine, but they seem to do a lot better at keeping up with new strains. Any data on efficacy? I consider setting up a lab to make some, since we're still using the vaccine based on the original strain from two years ago, but don't know whether it's worth the effort. Thanks!
I am an internist in Chicago. I am getting more Covid-positive calls in my practice than at any other time in the pandemic. I am somewhat surprised that this wave is not getting more attention, though I completely agree with your reasons why. Most of my patients are confirming their Covid status with home testing only so there is no good way to keep track of the numbers. Does it really matter what the numbers are? Because of Long-Covid and the yet-unknown potential for long-term disability, sadly, I think they do.
We are basically living in two realities. One is in which life has returned to "normal" and COVID is seen as more of a catching a bad flu. Talking with friends, they are seeing in their local groups/lives people testing positive and getting out and about because they don't feel that bad, so the whole "quarantine" at home is out the window as well. The other is that in which people are proactively looking at numbers and making decisions on masking etc.
What is concerning is the long covid issues. There insurance companies were already reporting higher disability claims last year. The number of infections is so large, that long covid that impacts every day life will be relatively large and that is going to impact everything from employment to health care, to government benefits, to insurance rates increasing.
Thank you for your work and dedication to keeping us all informed. Your posts are always helpful. What I am still listening and looking for, and think the general public needs, is some expert help on which numbers to watch and what to do with them. Even here in Texas, there are business owners who would watch the "pandemic weather report" if they knew where to look and what to trust, and most importantly, what to do with that information. For people who remain at risk, unvaccinated, unprotected or desirous of avoiding Long Covid, I have been utilizing a complex combination of the Georgia Tech risk calculator (likely under reporting risk due to inaccurate numbers), https://covid19risk.biosci.gatech.edu, the rising curve of waste water surveillance data (when available) and the percent positives. The Walgreens data has recently been the most helpful. https://www.walgreens.com/businesssolutions/covid-19-index.jsp. I would love your take on what level of percent positive would correlate with a recommendation for indoor masking in light of underreporting. (a number that might be useful to business owners and individuals willing to listen) My rough guess has been >3% based on earlier definitions of spread from the Brown School of Public Health.
Thank you again, so much, for all your work -- for us high-risk (but not immunocompromised) under 50-year-olds, is your recommendation still to wait on grabbing a second booster? I'm hitting seven months from my first booster and getting worried about being able to make it through this wave without being infected.
The frequency of reinfections is surprising and significant, glad you pointed that out. I am also frustrated by the lack of good data – we've had 2-plus years to figure it out and it still feels like amateur hour.
My perception, admittedly based on anecdotal data, is that the "true" number on the US graph is still a vast underestimate right now. It feels like I know a similar number of people being infected to when the January peak was happening, but more people are relying on home tests and not showing up in the case numbers. For people I know who are more cautious, I've been advising to assume the situation is similar to January. I caught Covid for myself the first time about two weeks ago, on a trip to the Northeast. It was sequenced as BA.2.7. Initially I used a Cue test provided by my employer, which I think Cue reports in aggregate to public health authorities but may not show up in the official metrics.
I think that with a few months of broad rapid test availability and government distribution, now the norm for people with symptoms is to take a rapid test. So I'm suspecting even the test positivity numbers are suppressed by the most likely people to have Covid not taking the tests that count towards the metrics.
I'd be curious to hear your thoughts as well, since I'm just an amateur.
I so much appreciate the "True Cases" vs. "Reporting" graphic. I am hearing right and left from friends and acquaintances who have come down with Covid in the past two weeks--more than at any other time during the pandemic--and people who say "I've been so careful...." We have not given up masking indoors and we have watched the numbers here in the mid-Atlantic and decided that indoor restaurant dining is off the table AGAIN (after only having been "on the table" for a few short weeks in early April!!). 3 out of 4 of us have yet to catch covid. Our daughter had a totally asymptomatic infection, identified by school weekly rapid testing (confirmed by PCR), but none of the rest of the family (70, 65 and 19) ever caught it. I recognize pandemic fatigue and am really, REALLY tired of all the precautions, but we persist, nonetheless, despite the fact that many around us are "back to normal" in their social behaviors. Would love to see some science-backed guidance around how to match risk-reducing behaviors to community transmission/hospitalization/positivity levels. I imagine that those kinds of calculations must also necessarily take into account local vaccination rates. Down the road, it'd be interesting to revisit comparisons between those geographic/political regions that chose to go the "herd/infection-induced" immunity route vs. those that really pushed vaccination.
Any data on case rates/transmission in daycares? We've been getting new case emails every 2-3 days and it's unnerving. Not sure what to do or how long to wait this out. Public health won't shut down classrooms anymore unless multiple cases test positive on the exact same date. I feel like it's everywhere in under-5s right now.
Thank you for your always insightful updates! One topic I was hoping you could circle back on at some point, is the accuracy of antigen tests with the latest Omicron variations. I recall you posted something early on in the Omicron wave how they tended to work further into an infection than with previous variants. Is that still the case, or even getting worse? And if so, are manufacturers working on new version of antigen tests to better / earlier detect these Omicron variations (similar to vaccine development).
Odds and ends comments,. 1. Something odd is going on in the numbers from southeastern Montana. What are the data sources there? 2. With the advent of self testing kits, maybe wastewater surveillance is our most reliable data source? 3. This virus is extremely mutagenic and long term prediction (anything over a month, say) of it's future course is pretty difficult to say the least. Maybe we shouldn't relax too much.
Thanks so much, Katelyn! As the publicly reported data becomes increasingly less accurate, I depend more and more on your reporting the true story. Do you think a modified vaccine that includes omicron might help?
Hi- when could we see numbers on 4th shots. I am triple vaccinated, had COVID in January and I am 52, but want to maximize my fourth shot. Thank you for the last few words of not needing to be alarmed as my anxiety for the past three years has been debilitating at times. You always speak with truth.
Is there any data on reinfection window? So many of us got BA1 this winter…is it really a 90 day immunity period or is that an arbitrary number from the cdc?
I very much appreciate and share your covid-19 posts as I feel you are doing a very great service in this very dangerous time. I look forward to following your column for as long as possible as I think we live in a time when there will be a lot more difficult to control epidemics and and other medical things that your common sense writing will be helpful with.
One other comment -- any thoughts about RadVaC? Yes, it's a "homemade" intranasal vaccine, but they seem to do a lot better at keeping up with new strains. Any data on efficacy? I consider setting up a lab to make some, since we're still using the vaccine based on the original strain from two years ago, but don't know whether it's worth the effort. Thanks!
How can we be confident that the cases reported are accurate when fewer cases are being reported?