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.
Too bad we can't do the QR code upload for home tests, like the UK. Sadly, without a Public Health infrastructure and funding, this will be hard to achieve.
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.
“living in two realities”. i’ve been thinking about that a lot. i definitely do think there are people that do, but i think the vast majority of us are in this weird middle phase between epidemic and endemic. i’ve been trying for a week to put it in words. hopefully will have something out later this week
I think this "middle phase" has the potential of making the mental health crisis worse. Social media algorithms help create one's reality so it can seem that "life is back to normal" or "everyone is getting infected" which makes it even harder to feel like the information you have at hand to make decisions is accurate.
I also think we are heading into even more mental health issues in the next 1-3 years as people are navigating the epidemic/endemic. Our brains were not wired to be at a threat level this long and our brains are designed to handle threats with a community/support of a community. When there is a disconnect the brain can increase the feeling of a threat, and that just increases mental health issues.
I am grateful for you and other experts who have spent their time (and faced a lot of backlash and anger from people who didn't think COVID was a big issue) informing the public, but this is part of the overall problem. How people make decisions is even more dependent on which experts they rely on which makes the middle phase even harder.
Yes! This: "Our brains were not wired to be at a threat level this long and our brains are designed to handle threats with a community/support of a community."
I hit my own mental health low at about the 1.5-year mark, and it's been tough to claw my way back to some emotional balance. We have tried so hard to be careful, taking all the precautions and watching the data. However, despite rising cases, I'm starting to gingerly step into certain gatherings that are personally quite important to me. We have continued to avoid attending church services. However, after 2 years, I've lost relationships because almost nobody at church has been as careful as we have been. At what point do we just say, "Enough is enough! We're done waiting for this virus to be under reasonable control! We need to quit avoiding the parts of life that involve group participation."
For me, it feels like the worst threat on the horizon is not COVID per se, but what it and the 2020 election brought out in our toxic politics. After getting a better handle on the personalities impacting our current political situation and the actions they've taken in the last 2 years, I feel a strong sense of threat to the very existence of civil society as we have known it since the end of WWII. I understand why some people deny there is a threat. It's just too much emotionally to cope with, yet we ignore it at our own peril.
Yes! I need to be careful because my wife is undergoing chemo, so in many instances I let her lead and balance the "risk/reward." It is a bit like "If I got infected doing X, would I be okay with that?" So I will wear a mask shopping, on public transport, but not if we have a few friends over. We ate out a few weeks ago based on case counts but put a pause on that for now. So if we became infected seeing close friends, that is worth the risk. Getting shopping at the local store, nope not worth it.
The big issue, which I think a lot of us are grapping with, is less getting infected (Many people have moved to a place where they are basically homebound), but long covid. That is really what we both are worried about. I have friends who have had symptoms for months, and for two of them the fatigue is enough that it impacts their job. It is that unknown, that for me, pushes my brain at times back to a threat level.
Yes, the level of dys-social behavior has never been higher (in my experience) than the present, and as far as I can see is everywhere in the global North. KJ can correct me, but I don't think there was anything like this in the previous great pandemic.
I am so impressed with your post. I stated that the virus was going to have a long tail in post covid debilities, but you point a second long tail that in the long term may wreak more harm than the first. Thank you!
What guidance, if any, has the CDC issued to keep us from getting long Covid? Yes, it’s important to prevent hospitals from being overwhelmed, it’s important to save lives, yet I fear in 2-3 years we’ll all be living in a zombie long Covid apocalypse.
Once we’re infected, what can we do to prevent long Covid? Once we have long Covid, what can we do to cure ourselves?
Vaccines help. Also it is a smallish number that get long COVID. Even the percentages are probably lower bec the actual number or COVID infections is higher than reported. So it’s again it’s yes there is a risk if long COVID but we also need to keep it in context. The vast majority of people don’t have symptoms that impact their life long term.
So in an individual level chances are we won’t get long COVID. On a population level it makes a difference simply bec infection rates are so high.
A lot of diseases have long symptoms just like COVID. The big difference is people are paying attention bec of the numbers.
We in some level have to readjust risk assessments. We don’t think so much about risk when we get into a car or drive across the street. A big hiccup with COVID is we are constantly doing risk assessment and we suck at it.
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.
Hi John, if anything could provide proof of the statement that it doesn't require a brain to be intelligent, this virus does. Using brute force mutational rapidity, it is mimicking an intelligent adversary countering our attempts to quell it. I think even if we had perfect informational awareness, i.e. at any time x we knew everyone who had the virus, what the viral load, what strain, etc. - even with all that we would still be unable to predict what would be the state of affairs at time y. Or maybe I'm being too pessimistic.
I understand what you're saying and the USA's response overall certainly could've been better. Would more and better data change that? I'm not sure, but it certainly can't hurt and I'd rather have as much vision as possible. In fact, I'd like a better disease infrastructure in general to prepare us for future pathogens.
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.
Looking at a bit more of the data, I'm realizing my perception may be off from living in Wisconsin and having just visited the Northeast, which means I've been right in the middle of the two biggest hotspots in the USA.
Any insights on how you were infected? Did you have any unmasked time indoors or on public transportation? Dining? This type of information is so hard to come by, and yet feel important for those trying to prevent and protect at-risk family members. Thank you if you feel comfortable sharing. :)
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.
Agree, and would love to see some updated information on effectiveness of high-quality, well-fitted one-way masking with Omicron variants, as well as updated information on how long the virus survives in the air (in a way that is infectious—some good info out of UC Davis but pre-Omicron), so that we can better decide about “normal” actives such as travel, etc.
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).
I have heard that for home tests, Flowflex detects omicron the best. (Buy the white box only and from a known retailer; the blue box are not the real product).
Thanks for sharing! I am afraid I am not a scientist so I have a hard time understanding this. I think it is saying antigen tests work, but show results later than PCR. Not sure it tells me how much later for Omicron vs Delta (or even Alpha/Beta). Also it looks likes this is from December 2021, so when we are still in the early phase of Omicron. Is there any more recent data. And I am also curious whether manufacturers are developing newer versions of these antigen tests that are more tailored to detecting Omicron better/earlier.
Ah, there are some complex interactions and effects of timing of positivity and symptoms based on if a person is vaccinated or not (some experts are saying there are earlier symptoms in vaccinated people since their immune system is "primed" to respond, but this might also apply to previously infected people as well). You can see that it takes about 6 months for science, experiments, data analysis and publishig to report on what's happening. This is extremely fast! Since we are still IN Omicron, we'll need to wait about 6 months for the data on what is happening now. There is no indication that the antigen tests need improving upon. This level of sensitivity and accuracy is great.
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.
Maximizing the 4th shot. Has anyone yet done a large cohort study, subdivided into age and gender groups, of people who took two vaccinations and two boosters of The Pfizer and Moderna products? There are 16 possible vaccination sequences and is it possible that certain sequences might elicit significantly different reactions from the immune system? I'm not aware of any group studying along these lines; i think we've all assumed roughly equivalent protection regardless of product and sequencing.
Thank you for this and I am not considered high risk so I will talk with my Dr and see what he says. So stinking confusing and our healthcare workers deserve the world for all of their dedication, heart and courage! Wish more would have their backs.
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?
Danish study during omicron identified a lot of reinfections in 20 to 60 day timeframe, I think median was 35 days, (they save their pcr samples so able to determine different variants for each infection & rule out extended infections). Shortest timeframe CDC has identified for reinfection was 23 days. From multiple anectdtoes, reinfections after a month or month & half have become a lot more common during omicron waves. https://www.forbes.com/sites/victoriaforster/2022/04/07/cdc-identifies-covid-19-reinfections-as-little-as-23-days-apart/?sh=16a534787458
It is best to look at other country's data for re-infection data (S. Africa is best), and some states as reported by YLE above, but the way that the CDC recommends quarantine and testing after exposure in people previously infected, negatively impacts our ability to capture these reinfections. A positive test within the 90 day period *could* be interpreted as the same infection unless the doctor-patient diad happened to have captured a negative test in the interim. Since negative testing is not recommended, it is only in very vigilant situations where this would be captured.
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!
The cases reported are definitely not accurate. Anytime there is a positivity above 5%, statistically you know there is a significant undercount. Look here for some positivity information from Walgreens (if you're in the US). https://www.walgreens.com/businesssolutions/covid-19-index.jsp
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.
Too bad we can't do the QR code upload for home tests, like the UK. Sadly, without a Public Health infrastructure and funding, this will be hard to achieve.
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.
“living in two realities”. i’ve been thinking about that a lot. i definitely do think there are people that do, but i think the vast majority of us are in this weird middle phase between epidemic and endemic. i’ve been trying for a week to put it in words. hopefully will have something out later this week
I think this "middle phase" has the potential of making the mental health crisis worse. Social media algorithms help create one's reality so it can seem that "life is back to normal" or "everyone is getting infected" which makes it even harder to feel like the information you have at hand to make decisions is accurate.
I also think we are heading into even more mental health issues in the next 1-3 years as people are navigating the epidemic/endemic. Our brains were not wired to be at a threat level this long and our brains are designed to handle threats with a community/support of a community. When there is a disconnect the brain can increase the feeling of a threat, and that just increases mental health issues.
I am grateful for you and other experts who have spent their time (and faced a lot of backlash and anger from people who didn't think COVID was a big issue) informing the public, but this is part of the overall problem. How people make decisions is even more dependent on which experts they rely on which makes the middle phase even harder.
Yes! This: "Our brains were not wired to be at a threat level this long and our brains are designed to handle threats with a community/support of a community."
I hit my own mental health low at about the 1.5-year mark, and it's been tough to claw my way back to some emotional balance. We have tried so hard to be careful, taking all the precautions and watching the data. However, despite rising cases, I'm starting to gingerly step into certain gatherings that are personally quite important to me. We have continued to avoid attending church services. However, after 2 years, I've lost relationships because almost nobody at church has been as careful as we have been. At what point do we just say, "Enough is enough! We're done waiting for this virus to be under reasonable control! We need to quit avoiding the parts of life that involve group participation."
For me, it feels like the worst threat on the horizon is not COVID per se, but what it and the 2020 election brought out in our toxic politics. After getting a better handle on the personalities impacting our current political situation and the actions they've taken in the last 2 years, I feel a strong sense of threat to the very existence of civil society as we have known it since the end of WWII. I understand why some people deny there is a threat. It's just too much emotionally to cope with, yet we ignore it at our own peril.
Yes! I need to be careful because my wife is undergoing chemo, so in many instances I let her lead and balance the "risk/reward." It is a bit like "If I got infected doing X, would I be okay with that?" So I will wear a mask shopping, on public transport, but not if we have a few friends over. We ate out a few weeks ago based on case counts but put a pause on that for now. So if we became infected seeing close friends, that is worth the risk. Getting shopping at the local store, nope not worth it.
The big issue, which I think a lot of us are grapping with, is less getting infected (Many people have moved to a place where they are basically homebound), but long covid. That is really what we both are worried about. I have friends who have had symptoms for months, and for two of them the fatigue is enough that it impacts their job. It is that unknown, that for me, pushes my brain at times back to a threat level.
Yes, the level of dys-social behavior has never been higher (in my experience) than the present, and as far as I can see is everywhere in the global North. KJ can correct me, but I don't think there was anything like this in the previous great pandemic.
You might like https://peterturchin.com/age-of-discord/ He writes about cycles of instability in the history of the US.
I am so impressed with your post. I stated that the virus was going to have a long tail in post covid debilities, but you point a second long tail that in the long term may wreak more harm than the first. Thank you!
What guidance, if any, has the CDC issued to keep us from getting long Covid? Yes, it’s important to prevent hospitals from being overwhelmed, it’s important to save lives, yet I fear in 2-3 years we’ll all be living in a zombie long Covid apocalypse.
Once we’re infected, what can we do to prevent long Covid? Once we have long Covid, what can we do to cure ourselves?
Vaccines help. Also it is a smallish number that get long COVID. Even the percentages are probably lower bec the actual number or COVID infections is higher than reported. So it’s again it’s yes there is a risk if long COVID but we also need to keep it in context. The vast majority of people don’t have symptoms that impact their life long term.
So in an individual level chances are we won’t get long COVID. On a population level it makes a difference simply bec infection rates are so high.
A lot of diseases have long symptoms just like COVID. The big difference is people are paying attention bec of the numbers.
We in some level have to readjust risk assessments. We don’t think so much about risk when we get into a car or drive across the street. A big hiccup with COVID is we are constantly doing risk assessment and we suck at it.
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.
Hi John, if anything could provide proof of the statement that it doesn't require a brain to be intelligent, this virus does. Using brute force mutational rapidity, it is mimicking an intelligent adversary countering our attempts to quell it. I think even if we had perfect informational awareness, i.e. at any time x we knew everyone who had the virus, what the viral load, what strain, etc. - even with all that we would still be unable to predict what would be the state of affairs at time y. Or maybe I'm being too pessimistic.
I understand what you're saying and the USA's response overall certainly could've been better. Would more and better data change that? I'm not sure, but it certainly can't hurt and I'd rather have as much vision as possible. In fact, I'd like a better disease infrastructure in general to prepare us for future pathogens.
j'accord!
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.
Looking at a bit more of the data, I'm realizing my perception may be off from living in Wisconsin and having just visited the Northeast, which means I've been right in the middle of the two biggest hotspots in the USA.
Any insights on how you were infected? Did you have any unmasked time indoors or on public transportation? Dining? This type of information is so hard to come by, and yet feel important for those trying to prevent and protect at-risk family members. Thank you if you feel comfortable sharing. :)
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.
Agree, and would love to see some updated information on effectiveness of high-quality, well-fitted one-way masking with Omicron variants, as well as updated information on how long the virus survives in the air (in a way that is infectious—some good info out of UC Davis but pre-Omicron), so that we can better decide about “normal” actives such as travel, etc.
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).
I have heard that for home tests, Flowflex detects omicron the best. (Buy the white box only and from a known retailer; the blue box are not the real product).
https://www.medrxiv.org/content/10.1101/2021.12.22.21268274v1 (preprint so take in that context)
Thanks for sharing! I am afraid I am not a scientist so I have a hard time understanding this. I think it is saying antigen tests work, but show results later than PCR. Not sure it tells me how much later for Omicron vs Delta (or even Alpha/Beta). Also it looks likes this is from December 2021, so when we are still in the early phase of Omicron. Is there any more recent data. And I am also curious whether manufacturers are developing newer versions of these antigen tests that are more tailored to detecting Omicron better/earlier.
Ah, there are some complex interactions and effects of timing of positivity and symptoms based on if a person is vaccinated or not (some experts are saying there are earlier symptoms in vaccinated people since their immune system is "primed" to respond, but this might also apply to previously infected people as well). You can see that it takes about 6 months for science, experiments, data analysis and publishig to report on what's happening. This is extremely fast! Since we are still IN Omicron, we'll need to wait about 6 months for the data on what is happening now. There is no indication that the antigen tests need improving upon. This level of sensitivity and accuracy is great.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2791915?resultClick=1 TL;DR multiple tests needed, day 4 of sx is most sensitive for Ag and day 3 of sx for PCR. (But this is not for Omicron)
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.
Maximizing the 4th shot. Has anyone yet done a large cohort study, subdivided into age and gender groups, of people who took two vaccinations and two boosters of The Pfizer and Moderna products? There are 16 possible vaccination sequences and is it possible that certain sequences might elicit significantly different reactions from the immune system? I'm not aware of any group studying along these lines; i think we've all assumed roughly equivalent protection regardless of product and sequencing.
What numbers are you looking for? Does this help? https://www.nejm.org/doi/full/10.1056/NEJMoa2201688
Thank you for this and I am not considered high risk so I will talk with my Dr and see what he says. So stinking confusing and our healthcare workers deserve the world for all of their dedication, heart and courage! Wish more would have their backs.
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?
Danish study during omicron identified a lot of reinfections in 20 to 60 day timeframe, I think median was 35 days, (they save their pcr samples so able to determine different variants for each infection & rule out extended infections). Shortest timeframe CDC has identified for reinfection was 23 days. From multiple anectdtoes, reinfections after a month or month & half have become a lot more common during omicron waves. https://www.forbes.com/sites/victoriaforster/2022/04/07/cdc-identifies-covid-19-reinfections-as-little-as-23-days-apart/?sh=16a534787458
It is best to look at other country's data for re-infection data (S. Africa is best), and some states as reported by YLE above, but the way that the CDC recommends quarantine and testing after exposure in people previously infected, negatively impacts our ability to capture these reinfections. A positive test within the 90 day period *could* be interpreted as the same infection unless the doctor-patient diad happened to have captured a negative test in the interim. Since negative testing is not recommended, it is only in very vigilant situations where this would be captured.
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?
The cases reported are definitely not accurate. Anytime there is a positivity above 5%, statistically you know there is a significant undercount. Look here for some positivity information from Walgreens (if you're in the US). https://www.walgreens.com/businesssolutions/covid-19-index.jsp
We can't, as I'm sure you know. We can't be confident in anything related to Covid (other than what Dr. Jetelina reports).