Thanks for the great summary. My wife and I still mask, still wash our hand with alcohol after being in stores. We are still exercising the same level of infection risk minimization as we did in 2020. Are we stupid or have some psychological addiction to feeling ourselves to be at risk? Emphatic no's to both questions. The pandemic is still here, declining leading indicators notwithstanding, could very suddenly jump in severity, has a huge zoonotic pool to breed further mutations that escape our monitoring and early warning systems, and having killed millions of us, still retains the capacity to kill millions more. In our opinion, the risk still justifies taking the minor precautions we do.
And that's not even counting RSV which at our age is a very real danger.
I know everyone is very pandemic weary and interest in infectious diseases is probably dropping off. But consider this: the people who are losing interest, some not inconsiderable fraction of them, have the luxury of going into "back to normal" thinking because large numbers of us did take the pandemic seriously and flattened the curve. [minor spelling correction edit just now,]
[BTW I recently changed my Substack name to "ilo" to reflect my Buddhist monastic ordination name. Old community members like the near-omniscient KB here may recall "Michael Sweney." That's me!]
It's all relative... Relative to me you are! I was worried you might think I was being snarky, I wasn't. You really are very knowledgeable. Mainly because you put a lot of work into research!
I’m 74 and live alone. I’m fully vaccinated for everything. I don’t leave the house much, don’t travel, and wear a mask in public places. I try not to panic. The frustrating thing is that my life is limited at a time when I have the free time to live a full life. I mostly worry about inhaling the virus. I worry much less about touching things. I wash my hands thoroughly when I return home. So far I came down with bronchitis for weeks but not Covid.
"We are seeing these surges because of the measures we took in 2020"
So...
"We need to take the measures we took in 2020 to reduce what we are seeing today"
Can you see why the public has "moved on"? (by that I mean, the 10% ceiling we hit for boosters, the near zero masking rates, the largely return to "normal" in schools, business, etc).
Were it not for reading Twitter and Substack, I don't think I would even realize Covid or Twin or Tripledemics are a thing still. Even Facebook has moved on (no one adding "I got my 4th dose" frames, picturing themselves in masks, etc like the old days). It's not something making the news, not in local papers (Plain Dealer for me). Even the weekend edition of the WSJ's only reference to Covid on the front page was a small blurb "China eased pandemic controls, as the country's leaders seek to lessen the pain of stringent zero-Covid policy that has exacted a heavy economic toll and stoked growing public resentment".
And I want to go back to something you said last week in the RSV is "Back:FAQ" from last week in your commentary on Immune Debt:
>"The pandemic delayed first infections of common viruses, like RSV, due to shut downs, social distancing, masking, etc. We saved thousands of lives doing this until we could get a COVID-19 vaccine. This was the right call."<
A comparison of Excess Mortality - a topic that used to be frequently invoked early in the pandemic - appears to contradict this statement. (I consider Excess Mortality the gold standard of outcome, anyone reading this and disagrees, please discuss with me below.)
If this was true, then we should see correlation between vaccine update, stringency of shutdowns, adoption of masks and excess mortality. Countries like Sweden, Denmark, and Finland which had kids in school nearly the entire pandemic, didn't mask young children, had low mask use relative to the rest of the world, should have poorer outcomes than countries like South Korea, Germany, Israel.
Yet the opposite is true.
Sweden has the second lowest excess deaths the entire pandemic after Norway. Zero excess deaths under the age of 65. South Korea meanwhile is poised to become one of the leaders in excess deaths - already in the first 30 weeks tracked of 2022 they have 215,000 deaths when trends predicted 170,000.
Let that sink in. South Korea, the beacon of masking, vaccination, GPS contact tracing, CCTV surveillance, and icon of "Doing It Right" now has the highest excess mortality in the world.
How can we argue "we saved thousands" doing something, when we can clearly see countries not doing that same thing didn't pay a consequence and even had better outcomes?
Katelyn you have done an incredible job writing, communicating, and building this blog/community the last two years.
I trust your dedication to the scientific process, but I urge you listen to Carl Sagan:
"Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition."
From the data I look at, it appears that multiple hypotheses have failed and continue to fail, but whether it is due to politics, or pride, or hubris, many public health officials are unable to accept they were wrong and update their priors. Don't get dragged down by them. We have entered a phase of gaslighting (see: "we never said the vaccine kept you from getting the thing you are getting vaccinated against" - again, you are one of the few to not be trapped by that like Walensky, Fauci, Bourla, etc) to denial.
All of these hypotheses - masking, social distancing, closing schools, selecting which business can be open, plexiglass at checkouts, Halloween candy chutes for trick-r-treaters... all of this was built from observational studies, models, and opinion pieces - the lowest tier of science. There is no shame in conceding that many of these hypotheses failed real world stress tests and experiments. It's not like these ideas were built from decades of repeated RCTs undergoing critical appraisal. We should have no obligation to continue to support and back claims which have been falsified, less we fall for the sunk-cost fallacy.
Something to consider is that several of the countries you named in regard to lower rates of excess mortality generally have better health overall than the US. High rates of obesity, heart disease, and diabetes made Americans vulnerable to a virus that has the ability to ravage multiple organ systems at once.
Additionally, some of us are not as concerned with dying from COVID, but we are very concerned about being debilitated from long COVID...a condition that we don't know how to treat, but know how to prevent (i.e., don't get COVID).
But many of the countries that have high excess mortality rates also have better health than the US. I am not at a point where I have any idea about what we should do. I am not a scientist, and so much of this is so new. But because it is all so new, I find what Michael has written to be intriguing, and I am certainly open to exploring it more. We have a finite number of resources to fight disease, and I want them to be used in the most effective way possible.
I understand what you are saying Gretchen, but that doesn't appear to be supported by the data. Additionally, adding on confounders like obesity to explain why our hypotheses repeatedly fail falls for the post-hoc fallacy - that is, offering reasons why what we predicted didn't happen after the fact.
We knew the obesity rates by nation, state, zip code all along. It seems to me that these are only invoked one directionally - to explain away our failed predictions, never to account for predictions or observations that support our increasingly politicized views. (i.e., Eric Topol may point to Obesity and Smoking to explain the 100% increase in deaths in South Korea, yet doesn't seem concerned with Obesity and Smoking rates when showing how much better Vermont fared to Mississippi).
Not once when the press was condemning Sweden for it's approach in 2020 and passing on models showing 30,000-80,000 excess deaths did they caution "but maybe because of their generally better health this may work out". It is only after the fact, after the predictions failed, that we see this sudden interest in confounders to explain why the hypothesis must still be true.
The claim was made that closing schools saved lives. We can show countries that didn't close schools and had better outcome.
The claim was made that wearing masks could stop, slow, or minimize Covid. We can show countries that didn't wear them, had great outcomes, countries that did wear them, had horrible outcomes, and everything in between.
The claim was made that the vaccines would halt transmission (not by Katelyn). We saw that didn't happen. Then the claim was that it would prevent death. Yet every single highly vaccinated country in the world has higher all cause mortality after vaccination than before.
Ok, you might say "but think how much more death they would have had", or perhaps "Ok, but consider the variants"- yet all the 2nd and 3rd world countries, which we lamented would suffer catastrophic Covid because the 1st world initially horded the vaccines, did just fine (well, by that I mean as "fine" as a 2nd or 3rd world country did before Covid).
If Norway's unusual 11% year over year increase in mortality would have been even higher had the country not been vaccinated, then we should see millions of deaths in unvaccinated countries. Where is the data to support this?
I am not trying to be argumentative. I am merely examining extraordinary claims and looking for extraordinary evidence to support the claims.
"Additionally, some of us are not as concerned with dying from COVID, but we are very concerned about being debilitated from long COVID...a condition that we don't know how to treat, but know how to prevent (i.e., don't get COVID)."
I respect that concern, and I urge you to take what personal steps you feel help you, but I also encourage you to be wary of talismans and unfalsifiable claims.
I don't think there is a way to prevent Covid. Vaccination doesn't do it, masks don't do it, isolating yourself doesn't do it. It's unavoidable less you live out your life in a positive pressure suit (though I suspect you will still get infected changing in and out of one).
And even if these things did work, that bring us full circle back to the intent of the post - we are facing a triple epidemic *because* of these measures in the first place.
No vaccine "halts" transmission. They may reduce transmission, and most of them gracefully reduce enough to get the Rf under 1 (although some only do in conjunction with NPIs), thus helping to slow and eventually stop outbreaks, which often include breakthrough infections, but the idea that any vaccine "halts" transmission is an impossible standard.
Joe I recall you had an interesting comment a few weeks back regarding South Dakota uptake in a separate post of Katelyns, so I will pull a comment I made in that same post (I remember specifically because I am an immense fan of George Carlin, plus it was a good comment) [0]
"...Katelyn has been one of the few voices from the beginning pointing out this wasn't a sterilizing vaccine and reminding readers we didn't have enough information on impact of transmission, and for that she should be commended.
Yet Public Health did not present that message. The message was clear and unambiguous - get the vaccine and you can't get covid. Just like lay people would expect of any vaccine. Whether it was Fauci [1], Rachel Maddow [2], the CEO of Pfizer [3], Stephen Colbert [4], or the CDC [5], the message was continuously amplified from all directions - Covid vaccines stop Covid. This was how there was support for business and school vaccine mandates for covid shots - the public believed that herd immunity was in sight thanks to the vaccine.
I agree wholeheartedly. We masked for 2.5 solid years. We got vaccines the second we were eligible. We avoided events, restaurants, parties, etc. And we watched others live normally, choose not to vaccinate, and recover quickly from Covid and others who were cautious like us get seriously ill. It has been maddening all the way around. What I do know is that we cannot continue to live in fear and isolation. And I am not going to make my children, often the only ones masked in a room, mask any longer unless they have respiratory symptoms. The toll that this sort of vigilance has taken on our family has been a whole other virus. And the evidence makes me feel as if we were duped. I am still very much afraid of Covid and long Covid, but we lost two years of a finite childhood.
"Sweden has the second lowest excess deaths the entire pandemic after Norway."
According to whom?
According to Our World In Data, by 07/21/2022 (the most recent date for data on all of the following countries), cumulative excess mortality looked like this:
Several countries appear to have beaten Sweden in cumulative excess mortality per capita.
Now, Sweden's excess mortality figure is still rather good, and it's interesting to discuss why. For example, Swedes appear to have avoided *large* gatherings, and seemed quite aggressive about expecting symptomatic people to stay home. Sweden also has generous family leave, including provisions for adult caregivers of schoolchildren to stay home to keep sick kids at home and out of school.
"Let's combine Swedish openness with typical American expectations to show up at work and school sick!" sounds like it might miss what *did* work about Sweden's approach. Germany has a stereotypically workaholic culture, and it hasn't done much worse than Sweden per capita. The Asian countries listed are stereotypically industrious, too, and they seem to have done better than Sweden overall.
EDITED TO ADD: Substack is wrecking the formatting of my list of figures, and my editing isn't fixing it. Sorry about that.
You can recreate this table https://imgur.com/a/NyLxc85 by going to mortality.org > data > STMF > CSV, dropping into a pivot table, filtering for sex to "b" (both), then selecting the years you want (use d_total for total deaths). Mortality.org pulls direct from each countries respective CDC equivalent, the lag time varies country-to-country so some have very little 2022 data, others go up to 40+ weeks.|
The IMGUR I linked above is my last update I made reader-friendly on may 25th, I have more current data, but it takes me a bit of time to make it clean for general audience, but you will see that things have only gotten worse in 2022 for many countries hailed as "doing it right". Perhaps later today I can re-update.
The link you gave in Our World in Data bases the projections on a model rather than straight historical average (they previously used straight historical average then changed this about a year back - not to be cynical, but I suspect because they weren't liking the results). I will try to find the documented change, I went through this in detail way back, try to find my work.
As you noted, adjusting that chart for country population would be better way to present data - as the graph you posted makes Norway look like it had a better outcome than Sweden, even though they have nearly identical excess death as a percent of the population.
Consider that Our World in Data projects South Korea having only 42,000 excess deaths. Here are raw deaths per year
2015 - 280766
2016 - 279257
2017 - 284548
2018 - 298030
2019 - 294080
2020 - 309530
2021 - 316897
2022** - 216945 < only 30 weeks of 2022 recorded, but historically should have only 170K
So OWID model says 42K, but consider if we used as baseline...
5 year average (baseline of 287K deaths expected) - 96,000 excess deaths
3 years average (baseline of 292K deaths) - 89,000 excess deaths
Linear Forecast (baseline of 301K deaths) - 71,372 excess deaths
You can see, there is no reasonable way OWID could have come up with a projection of only 42K in South Korea for excess deaths.
(I feel your pain btw of Substack formatting in comments!)
As for your explanations for why Sweden still did so well, I feel like they aren't falsifiable explanations. I mean no offense, but again, feels like ascribing excuses because our predictions didn't pan out. Post hoc.
Bottom line, all these countries put their kids in schools without masks (largely) and paid no consequence. In fact they did better than us. Yet 2 years after we have this data, we still see stories claiming "it was the right thing to do" see LA Times recent column "Closing schools in the pandemic was bad. Keeping them all open would have been worse"
I get that Randi Weingarten and the people who promoted measures like this have to cling to their failed hypothesis, their reputation is on the line, and probably having a difficult time facing their mistakes so falling for true believe syndrome/sunk cost.
I can't help but see the data continue to disprove these claims.
"As for your explanations for why Sweden still did so well, I feel like they aren't falsifiable explanations. I mean no offense, but again, feels like ascribing excuses because our predictions didn't pan out."
My intention wasn't to explain why Sweden did so well so much as to point out that those in other countries proposing policies to imitate Sweden should consider whether their proposed policies really are imitating – or even can imitate – Sweden in the relevant respects.
It's quite common in medicine (and life more generally) not to get neatly falsifiable information. When we can't run controlled experiments, we look for natural experiments. But what makes a good natural experiment, and what that experiment really shows, can be contested.
"Bottom line, all these countries put their kids in schools without masks (largely) and paid no consequence."
But that's not all they were doing – and I question whether students were "largely" unmasked in the sample of countries I chose.
If you're limiting your inquiry to whether it was feasible to keep school open (masked or not), then countries with overall different approaches who nonetheless shared the commonality of keeping schools mostly open (even schools in Sweden temporarily closed in reaction to outbreaks at those schools) make a fairly persuasive case that yes, it's feasible. But a lot of folks who just want "normalcy" don't limit their inquiry to that.
>"It's quite common in medicine (and life more generally) not to get neatly falsifiable information. When we can't run controlled experiments, we look for natural experiments. But what makes a good natural experiment, and what that experiment really shows, can be contested."
Completely agree. I would add that this is why it is so important to frame our hypotheses tentatively, and be careful of espousing certainty. I feel that many claims of what to do (close schools in this instance) were made with great certainty. The nuance was left out.
My concern is that now we have enough data to show so many things we tried didn't matter, there's a sizable number of experts still not accepting that we can reject these hypotheses.
The history of medicine is 99% "oh it turns out this didn't work or made things worse". Evidence based medicine is less than a generation old. We shouldn't be surprised if things we did based off observational studies and models turned out to not work. I just don't want to be stuck having to pretend they do once it becomes obvious they didn't. I'm pro medicine. Married to a surgeon, spend my time deep journals and fascinated with the history of medicine. But it's a disservice to medicine to not consider we got a lot wrong on our response. I feel like that is what is happening.
>"But that's not all they were doing – and I question whether students were "largely" unmasked in the sample of countries I chose."
Nordic countries were largely unmasked relative to the rest of the world, especially children.
They had fantastic outcomes. South Korea is mask capital of the world. Terrible outcome.
This comes in the heels of so many other failed predictions. Redfield "if 80% of the country masked, Covid would be crushed - June 2020; "Throwing Gas on Fire" when Texas lifted masks March 2021 and had identical outcome as everywhere else; "Airline industry will be slammed with delays as pilots and staff fall sick" after Mask mandate lifted in April 2022, and this didn't happen.
We only discovered viruses after something invisible was passing through our ceramic chamberland filters in the 19th century, which we dubbed "filter passing viruses". We can't be surprised that after masks failed in 1918 they would fail again. They have never passed RCT, yet we find 300 observational studies easily. That is telling 2 years later in my opinion on the falsifiability being ignored.
South Korea recently had its worst spike, but I'm not convinced its overall outcome has been terrible.
I'd say the "How well do masks work, and when?" question is separable from "Can we find ways to keep schools open?" (whether with masks or not) question. Better air circulation and filtration can reduce the risk of spread even without masks. When do we decide it's still risky enough to mask, anyhow?
I don't know how far Sweden got with its 2018 "budget measure essentially marks the first attempt by a national government to officially recognize better ventilation and high IAQ (Indoor Air Quality) as a way to protect public health" by the time COVID hit, but if Swedes were already attentive to indoor air quality, as well as more compliant with government recommendations to reduce travel and large gatherings, and to stay home if symptomatic, those measures help disrupt transmission even without masks. Meanwhile, even Sweden recommended masking in congested commuter transit – not all mass transit has the aggressive air filtration that airline cabins often have!
"[M]ore than 80% of Swedes reported they had adjusted their behaviour, for example by practising social distancing, avoiding crowds and public transport, and working from home. Aggregated mobile data confirmed that Swedes reduced their travel and mobility during the pandemic."
Masks don't have to catch every last tiny particle to help. Masks both catch the payload of the largest droplets and baffle airflow around the mask-wearer to spread the fine particles less far. Dose of inoculant matters to severity of infection, and, during phonation,
"masks effectively block aerosols, forcing the breath to exit at the sides. From there, the aerosols travel upward, rising with the upward flow of body heat from the singer."
Baffling the jets of air we emit so that larger drops are caught and smaller ones stick closer to us to hitch a diluting ride on our body's heat plume seems mechanically effective in reducing others' exposure risk, particularly to severe infection. Reduction isn't complete prevention, obviously. When is risk high enough to justify baffling our breath? Not always, evidently. But "masks don't work" studies may be underpowered:
I have too many other distractions right now to get deep into the weeds of the math of this one. Regarding the proposed superlinear efficacy for masks, I concede "the model permits superlinear efficacy" ≠ "we have empirically verified superlinear efficacy", but as the mom of young kids in a school system where the backlog in bugs seems to be ripping through like wildfire, for now, I'm bagging my breath for choral rehearsals. I expect to do so in medical buildings from now on:
I have underlying conditions that can mimic "coming down with something" at any time, so for me, "stay home if symptomatic" nearly amounts to house arrest. "I get these symptoms without being contagious" used to amount to a free pass to nearly always ignore "stay home if you're sick" advice, but I've rethought that. Those who normally have no cold/flulike symptoms whatsoever perhaps can afford to just stay home on those rare occasions they feel ill, but that's not me.
Lots to read through, but have to call it a night. Quick though:
"South Korea recently had its worst spike, but I'm not convinced its overall outcome has been terrible."
70,000 - 90,000 excess deaths for a country of 52 million across 2.5 years is terrible. I am not sure how else to frame that. In April they had all mortality double. No country saw anything like that the entire pandemic I am aware of. Need to drill down to NYC during March 2020 to get to that level of increase mortality.
Our World In Data is one source, easily accessible to layfolk. Their cumulative mortality graphing widget is quite handy, though it's not per-capita mortality, just total:
In your "Lessons Not Learned" paragraph you mention masking, staying home while sick, and getting vaccinatedy, but nothing about air qualit. You are great, but it seems to me you consistently neglect to inform and remind people of the protective benefits of ventilation and air purification. Please please talk them up more!
Air purification, done energetically, can give you risk reduction at about the same level as masking and it is much more acceptable to the public. There are a LOT of people who absolutely HATE masks, and are enraged if you even mention them. I think it is unlikely that their attitudes will ever change. Here is an actual quote from someone I had a discussion with online, in the course of which I mentioned that I still masked in indoor public places:
"The last two years were some of the worst years of my life, and they were not due to the disease. Nobody I know died or was even severely ill. Like it or not the mask is the symbol of the hell we were put through for no reason and of the fact that we learned absolutely nothing."
Air quality engineer Richard Corsi has built a great site giving information about protecting people by improving air quality.. It's here: https://cleanaircrew.org
He designed a simple, inexpensive, highly effective air purifier you can build yourself. Here's a video where a 4th grader demonstrates building one. https://www.youtube.com/watch?v=H2YELPNsImk&t=3s
Hi Katelyn. Thanks for your work. I've been reading you since day one I think.
Here's my story: I'm 76 and my wife is 63. We're both fully vaccinated (2 & 3/2021) and fully boosted (12/2O21 & 10/22-divalent). We are both cautious; masks around folks we don't know and hand sanitizer everywhere. In spite of this we both tested positive about 3 weeks ago. I got monoclonal infused and she got Paxlovid. We both recovered quickly after that.
My point here is that for many of us who followed the guidance diligently we still contracted the disease. This has created an undercurrent of the sense that it was all pretty pointless, as we have friends who did not vaccinate or boost, got Covid and recovered fine...though it took them quite a while to get back to "normal". This sort of story creates a headwind for Covid vaccines in particular, but also vaccines in general. Science needs to do a better job.Just warning someone in the face of all the conflicting "evidence" may not move the needle as much as we feel necessary.
Please keep writing though. The fog have not lifted quite yet.
I'm glad you recovered quickly! The thing people need to understand is that vaccination against covid is not highly protective against catching covid. What it protects you against is getting gravely ill, and it does quite a good job with that.
Also, just a note about being cautious: You said you mask around people you do not know. It's actually just as important to mask around people you DO know. People can be contagious without knowing they're infected and without feeling sick. When I'm with people I do know at my home or office I run a powerful air purifier that gives 11 airs changes per hour (this greatly reduces the amount of virus-bearing dust in the air), AND we sit 10 feet apart. For gatherings with several friends or family members we all do rapid tests the day of and day before getting together.
True that. But initial messaging was that the vaccines provided protection; without many qualifiers. It has only recently changed to "it may not protect you" but it will help keep you out of the hospital and/or allow for quicker recovery. The populations expectation of vaccines is that they prevent diseases. If you get a shingles vaccine (2) you don't get shingles. If you get a rubella vaccine,...polio, etc. Messaging from political and scientific / medical leaders gave no basis by which to understand that these vaccines were not like others in that they did not necessarily provide the prevention the public has grown to expect. That is less than optimal optics.
Initially, the vaccines provided excellent protection, not only against COVID-19 (i.e., symptomatic SARS-CoV-2 infection), but also against any infection (symptomatic or asymptomatic) by the ancestral SARS-CoV-2 strain.
As variants have arisen, however, the degree of protection against infection, and the duration of that protection, have decreased, seemingly with every iteration of the variants and subvariants, to the point now that protection against infection and the duration of that protection is minimal (if not absent).
So the initial messaging was substantially correct at the time, and the current messaging (given the mutations in the virus) also is correct.
It is quite possible that the current COVID-19 vaccines do still prevent disease (i.e., COVID-19) while not preventing many (if any) SARS-CoV-2 infections. To know if this is true would require ascertaining how many of those vaccinated with SARS-CoV-2 infections have asymptomatic infections, how many of those vaccinated have symptomatic infections (namely, COVID-19), and the corresponding numbers in those unvaccinated. I have not seen such a study, though.
Yes, you're right, it's more accurate to say the vaccines were good protection against infection by the original strain. Still, by the time most people got their first vaccination Delta was becoming prevalent, and then 6 mos. later Omicron started, so in practice there probably were not many people at all whose vaccinations got to go up against the original strain. I also do not know how many vaxed people are having asymptomatic infections. However, being asymptomatic is not the same as not being infected. Asymptomatic people can still transmit the virus.
Delta became dominant in the US by early July, 2021. At that point, about 2/3 of eligible recipients (12 and older) had been vaccinated, so I disagree with your statement that there "were not many people at all whose vaccinations got to go up against the original strain." The majority had been vaccinated prior to the dominance of Delta. Even with the arrival of Delta, the vaccines had a significant (though reduced, relative to the ancestral strain) protective effect against infection by that variant.
And I did not claim that being asymptomatic is the same as not being infected, since you can't have an asymptomatic infection without...you know...being infected. And I agree that, if infected, one can transmit the infection, irrespective of the presence or absence of symptoms.
I absolutely agree. It's terrible optics. You can't possibly be any angrier than I am about the messaging from the government. I can't think of anything to do about it except try to correct the misconceptions in on forums like this. Doesn't seem to matter who's in the White House, you get the same mealy-mouthed dishonest jerks yapping half-truths in the media.
For what it's worth, it's actually not true that all other shots protect against infection. Even the polio shot is only something like 99% effective. And I just looked up the shingles shot, & CDC says for people younger than 70 with healthy immune systems it's 97% effective against infection. For people age 70+ it's 91% effective. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html
And of course everybody knows the flu shot is nothing like 100% effective -- on average, it's more like 50% effective. But that's way better than nothing.
Data and public perception often don't sync up. We are told to get a flu shot so we don't get the flu...or shingles shot so you don't get shingles. Look at the advertising language relating to shingrix. There may be some small print on the last screen, but it's pretty clearly the sale of protection from shingles.
But don't want anyone to think this makes me angry. It was apparent to me from the outset that government and other thought leaders / spokes-personas didn't know what was going on. But they couldn't say that. They had to appear in control otherwise the population can get antsy. What it did was make me sad that we (the scientific / medical community) were not better at leading our people through the mess. That on again off again thing that Fauci did with masks did a tremendous disservice to not just the people, but their believability in the scientific and medical communities ability to provide the insight and care they needed.
Two big lessons here...in my opinion anyway;
1 We were not prepared!
2 Our initial messaging to the population was worse than our lack of preparedness!
Yes, you are correct. The part that doesn’t make sense to me is it seems that the recently boosted are disproportionately getting Covid. Is this because people who have already gotten Covid are passing on the new bivalent booster?
Or it could be that people who were recently boosted feel more protected so they are exposing themselves to people more in their day-to-day activities, i.e. dining out more than they used to, or attending a concert, etc.
And/or those who are more likely to have weakened immune systems less able to resist symptomatic infection (aged, on immunosuppressive medication, etc.) are those more likely to have been motivated to get the bivalent booster.
"The part that doesn’t make sense to me is it seems that the recently boosted are disproportionately getting Covid."
Do you have a link to a study or article that documents this, or is this simply something that you think is true based on your social circle ("seems to me") or some other anecdotal source?
In physics, there’s the concept of “terminal velocity.” If you drop a brick out of an airplane, at some point it hits terminal velocity, which means the rate at which it’s falling is constant. It’s physically impossible to fall faster; acceleration is zero.
At what point does the coronavirus become so contagious that it’s not possibly for it to become more contagious? I would think/hope we’re close to that point.
I heard a doctor say that the coronavirus will just get more and more contagious. Physics, at least, would suggest this isn’t true.
Thank you so much!! Although we are both healthy and about 50, our doctor has told us that long covid is still a big risk and that we must take full precautions. We're following that advice and so far have not been infected (as far as we know), but it's very seriously affecting our mental health and relationships, and interfering with accessing necessary medical care. If there is info out there that could allow us to open up even a little bit more, in at least some circumstances, it would be a huge, huge relief. We're really struggling, and there is just no information available to the general public.
Thank you thank you thank you,! You know YLE was the very first Substack newsletter I ever subscribed to and even after I unsubscribe from all the rest, yours won't be one of them! You're the gold standard.
As someone who has had chronic fatigue syndrome for 6+ years, I am very interested in long Covid. My symptoms improved after my second vaccination. I’m now more like a woman with minimal energy and stamina, than someone unable to function. I’m thrilled and curious if there’s been any talk of a correlation. I’m 74, no Covid, vaccinated, retired.
I find it interesting that the small print on the CDC Flu Map says "This system monitors visits for respiratory illness that includes fever plus a cough or sore throat, also referred to as ILI, not laboratory confirmed influenza and may capture patient visits due to other respiratory pathogens that cause similar symptoms." So could that purple not be just Flu but overall Flu/RSV/Covid combined?
That's right. I think everyone assumes that our surveillance in public health is top tier because of the level of scientific discovery during the pandemic, but this is just not the case. We scrape from the bottom, which provides a fuzzy picture of what's going on. That said, COVID and Flu are well separated by now, so I'm confident in saying this doesn't include Covid. However, RSV could be in there. Testing is pretty robust right now, though, which would help separate the two.
Could you post an article on repeat cases of Covid? How common is it? Are most cases in the unvaxed? Is it clinically worse than the first case? Thanks! You do great work here. Many thanks for all your efforts.
I just received an issue of Dr. Jeremy Faust's Inside Medicine Substack newsletter and the guest of honor on it is our Dr. Katelyn Jetalina! Dr. Faust is quite complimentary of his guest. Congratulations Katelyn!
Hello Katelyn! I don't know if you take "letters to the editor", but I'm in a situation where I'd love to apply some science to the choices of a non-profit.
I sing with a chorus. They've long had a policy of requiring two COVID vaccinations. They're now updating the policy to require everyone to be "fully vaccinated" as defined by the CDC, chasing that definition as it may change over time. We also allow members to sing unmasked if they test negative same-day with an at-home test.
I'm wondering whether this actually improves safety for members. I know that choruses are a highly at-risk group for spreading COVID, and many of our members are (well) over 65, so there are multiple risk factors. But aren't vaccinated people still highly likely to become contagious? Assuming everyone attending a rehearsal is asymptomatic, is a "fully vaccinated" person safer to have around than a "vaccinated" person?
Obviously there are health benefits to the individual from being fully vaccinated. I'm focused on the health benefit to others.
Because I had difficulty receiving and sending emails during October, I probably missed any possible repl;y to my question so I am reasking. Because I have CLL, a type of leukemia, the original vaccines could not produce antibodies with my blood. In May I had an infusion of EVUSheld. I am having a second infusion this Friday, 11/18. Is this infusion a protection from the Omicron strain of the virus? Would this provide a protection which would allow more freedom in my life? Is there data as to the effecacy of this medication.
Question: You mentioned co-infection with 2 viruses. Is it also possible that a "tri-infection" could occur since all three of these respiratory viruses are circulating at the same time? 🤔
I wasn't familiar with Hickman but my graduate school microbiology advisor was fond of saying "the microbes don't give a damn what you think!" I've always considered him a wise person.
Thanks for the great summary. My wife and I still mask, still wash our hand with alcohol after being in stores. We are still exercising the same level of infection risk minimization as we did in 2020. Are we stupid or have some psychological addiction to feeling ourselves to be at risk? Emphatic no's to both questions. The pandemic is still here, declining leading indicators notwithstanding, could very suddenly jump in severity, has a huge zoonotic pool to breed further mutations that escape our monitoring and early warning systems, and having killed millions of us, still retains the capacity to kill millions more. In our opinion, the risk still justifies taking the minor precautions we do.
And that's not even counting RSV which at our age is a very real danger.
I know everyone is very pandemic weary and interest in infectious diseases is probably dropping off. But consider this: the people who are losing interest, some not inconsiderable fraction of them, have the luxury of going into "back to normal" thinking because large numbers of us did take the pandemic seriously and flattened the curve. [minor spelling correction edit just now,]
[BTW I recently changed my Substack name to "ilo" to reflect my Buddhist monastic ordination name. Old community members like the near-omniscient KB here may recall "Michael Sweney." That's me!]
Should change your picture/avatar to an image saying “formerly Michael Sweney” (I remember you :)
Coulda, shoulda, didn' wanna! But I did get an image 🙂
It's all relative... Relative to me you are! I was worried you might think I was being snarky, I wasn't. You really are very knowledgeable. Mainly because you put a lot of work into research!
I’m 74 and live alone. I’m fully vaccinated for everything. I don’t leave the house much, don’t travel, and wear a mask in public places. I try not to panic. The frustrating thing is that my life is limited at a time when I have the free time to live a full life. I mostly worry about inhaling the virus. I worry much less about touching things. I wash my hands thoroughly when I return home. So far I came down with bronchitis for weeks but not Covid.
I can't but feel we are stuck in this loop:
"We are seeing these surges because of the measures we took in 2020"
So...
"We need to take the measures we took in 2020 to reduce what we are seeing today"
Can you see why the public has "moved on"? (by that I mean, the 10% ceiling we hit for boosters, the near zero masking rates, the largely return to "normal" in schools, business, etc).
Were it not for reading Twitter and Substack, I don't think I would even realize Covid or Twin or Tripledemics are a thing still. Even Facebook has moved on (no one adding "I got my 4th dose" frames, picturing themselves in masks, etc like the old days). It's not something making the news, not in local papers (Plain Dealer for me). Even the weekend edition of the WSJ's only reference to Covid on the front page was a small blurb "China eased pandemic controls, as the country's leaders seek to lessen the pain of stringent zero-Covid policy that has exacted a heavy economic toll and stoked growing public resentment".
And I want to go back to something you said last week in the RSV is "Back:FAQ" from last week in your commentary on Immune Debt:
>"The pandemic delayed first infections of common viruses, like RSV, due to shut downs, social distancing, masking, etc. We saved thousands of lives doing this until we could get a COVID-19 vaccine. This was the right call."<
A comparison of Excess Mortality - a topic that used to be frequently invoked early in the pandemic - appears to contradict this statement. (I consider Excess Mortality the gold standard of outcome, anyone reading this and disagrees, please discuss with me below.)
If this was true, then we should see correlation between vaccine update, stringency of shutdowns, adoption of masks and excess mortality. Countries like Sweden, Denmark, and Finland which had kids in school nearly the entire pandemic, didn't mask young children, had low mask use relative to the rest of the world, should have poorer outcomes than countries like South Korea, Germany, Israel.
Yet the opposite is true.
Sweden has the second lowest excess deaths the entire pandemic after Norway. Zero excess deaths under the age of 65. South Korea meanwhile is poised to become one of the leaders in excess deaths - already in the first 30 weeks tracked of 2022 they have 215,000 deaths when trends predicted 170,000.
Let that sink in. South Korea, the beacon of masking, vaccination, GPS contact tracing, CCTV surveillance, and icon of "Doing It Right" now has the highest excess mortality in the world.
How can we argue "we saved thousands" doing something, when we can clearly see countries not doing that same thing didn't pay a consequence and even had better outcomes?
Katelyn you have done an incredible job writing, communicating, and building this blog/community the last two years.
I trust your dedication to the scientific process, but I urge you listen to Carl Sagan:
"Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition."
From the data I look at, it appears that multiple hypotheses have failed and continue to fail, but whether it is due to politics, or pride, or hubris, many public health officials are unable to accept they were wrong and update their priors. Don't get dragged down by them. We have entered a phase of gaslighting (see: "we never said the vaccine kept you from getting the thing you are getting vaccinated against" - again, you are one of the few to not be trapped by that like Walensky, Fauci, Bourla, etc) to denial.
All of these hypotheses - masking, social distancing, closing schools, selecting which business can be open, plexiglass at checkouts, Halloween candy chutes for trick-r-treaters... all of this was built from observational studies, models, and opinion pieces - the lowest tier of science. There is no shame in conceding that many of these hypotheses failed real world stress tests and experiments. It's not like these ideas were built from decades of repeated RCTs undergoing critical appraisal. We should have no obligation to continue to support and back claims which have been falsified, less we fall for the sunk-cost fallacy.
Something to consider is that several of the countries you named in regard to lower rates of excess mortality generally have better health overall than the US. High rates of obesity, heart disease, and diabetes made Americans vulnerable to a virus that has the ability to ravage multiple organ systems at once.
Additionally, some of us are not as concerned with dying from COVID, but we are very concerned about being debilitated from long COVID...a condition that we don't know how to treat, but know how to prevent (i.e., don't get COVID).
But many of the countries that have high excess mortality rates also have better health than the US. I am not at a point where I have any idea about what we should do. I am not a scientist, and so much of this is so new. But because it is all so new, I find what Michael has written to be intriguing, and I am certainly open to exploring it more. We have a finite number of resources to fight disease, and I want them to be used in the most effective way possible.
I understand what you are saying Gretchen, but that doesn't appear to be supported by the data. Additionally, adding on confounders like obesity to explain why our hypotheses repeatedly fail falls for the post-hoc fallacy - that is, offering reasons why what we predicted didn't happen after the fact.
We knew the obesity rates by nation, state, zip code all along. It seems to me that these are only invoked one directionally - to explain away our failed predictions, never to account for predictions or observations that support our increasingly politicized views. (i.e., Eric Topol may point to Obesity and Smoking to explain the 100% increase in deaths in South Korea, yet doesn't seem concerned with Obesity and Smoking rates when showing how much better Vermont fared to Mississippi).
Not once when the press was condemning Sweden for it's approach in 2020 and passing on models showing 30,000-80,000 excess deaths did they caution "but maybe because of their generally better health this may work out". It is only after the fact, after the predictions failed, that we see this sudden interest in confounders to explain why the hypothesis must still be true.
The claim was made that closing schools saved lives. We can show countries that didn't close schools and had better outcome.
The claim was made that wearing masks could stop, slow, or minimize Covid. We can show countries that didn't wear them, had great outcomes, countries that did wear them, had horrible outcomes, and everything in between.
The claim was made that the vaccines would halt transmission (not by Katelyn). We saw that didn't happen. Then the claim was that it would prevent death. Yet every single highly vaccinated country in the world has higher all cause mortality after vaccination than before.
Ok, you might say "but think how much more death they would have had", or perhaps "Ok, but consider the variants"- yet all the 2nd and 3rd world countries, which we lamented would suffer catastrophic Covid because the 1st world initially horded the vaccines, did just fine (well, by that I mean as "fine" as a 2nd or 3rd world country did before Covid).
If Norway's unusual 11% year over year increase in mortality would have been even higher had the country not been vaccinated, then we should see millions of deaths in unvaccinated countries. Where is the data to support this?
I am not trying to be argumentative. I am merely examining extraordinary claims and looking for extraordinary evidence to support the claims.
"Additionally, some of us are not as concerned with dying from COVID, but we are very concerned about being debilitated from long COVID...a condition that we don't know how to treat, but know how to prevent (i.e., don't get COVID)."
I respect that concern, and I urge you to take what personal steps you feel help you, but I also encourage you to be wary of talismans and unfalsifiable claims.
I don't think there is a way to prevent Covid. Vaccination doesn't do it, masks don't do it, isolating yourself doesn't do it. It's unavoidable less you live out your life in a positive pressure suit (though I suspect you will still get infected changing in and out of one).
And even if these things did work, that bring us full circle back to the intent of the post - we are facing a triple epidemic *because* of these measures in the first place.
No vaccine "halts" transmission. They may reduce transmission, and most of them gracefully reduce enough to get the Rf under 1 (although some only do in conjunction with NPIs), thus helping to slow and eventually stop outbreaks, which often include breakthrough infections, but the idea that any vaccine "halts" transmission is an impossible standard.
Joe I recall you had an interesting comment a few weeks back regarding South Dakota uptake in a separate post of Katelyns, so I will pull a comment I made in that same post (I remember specifically because I am an immense fan of George Carlin, plus it was a good comment) [0]
"...Katelyn has been one of the few voices from the beginning pointing out this wasn't a sterilizing vaccine and reminding readers we didn't have enough information on impact of transmission, and for that she should be commended.
Yet Public Health did not present that message. The message was clear and unambiguous - get the vaccine and you can't get covid. Just like lay people would expect of any vaccine. Whether it was Fauci [1], Rachel Maddow [2], the CEO of Pfizer [3], Stephen Colbert [4], or the CDC [5], the message was continuously amplified from all directions - Covid vaccines stop Covid. This was how there was support for business and school vaccine mandates for covid shots - the public believed that herd immunity was in sight thanks to the vaccine.
That is not the case."
[0] my full comment: https://yourlocalepidemiologist.substack.com/p/a-better-booster-campaign/comment/9958167
[1] https://thehill.com/homenews/sunday-talk-shows/553773-fauci-vaccinated-people-become-dead-ends-for-the-coronavirus/
[2] https://twitter.com/albertbourla/status/1377618480527257606
[3] https://twitter.com/aginnt/status/1475193955704881152
[4] https://www.youtube.com/watch?v=sSkFyNVtNh8
[5] https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e3.htm?s_cid=mm7013e3_w
I agree wholeheartedly. We masked for 2.5 solid years. We got vaccines the second we were eligible. We avoided events, restaurants, parties, etc. And we watched others live normally, choose not to vaccinate, and recover quickly from Covid and others who were cautious like us get seriously ill. It has been maddening all the way around. What I do know is that we cannot continue to live in fear and isolation. And I am not going to make my children, often the only ones masked in a room, mask any longer unless they have respiratory symptoms. The toll that this sort of vigilance has taken on our family has been a whole other virus. And the evidence makes me feel as if we were duped. I am still very much afraid of Covid and long Covid, but we lost two years of a finite childhood.
"Sweden has the second lowest excess deaths the entire pandemic after Norway."
According to whom?
According to Our World In Data, by 07/21/2022 (the most recent date for data on all of the following countries), cumulative excess mortality looked like this:
July 31 2022:https://ourworldindata.org/grapher/cumulative-excess-deaths-covid?country=SWE~DNK~DEU~KOR~NOR~JPN~TWN
which, when divided by country population, looks like this, in decreasing order:
Germany:110409/83130000 = 0.00132814868Sweden:11271/10420000 = 0.00108166986South Korea:42917/51740000 = 0.00082947429Norway:3547/5408000 = 0.00065588017Denmark:2260/5857000 = 0.00038586306Taiwan:7487/23570000 = 0.00031764955Japan:26432/125700000 = 0.00021027844
Several countries appear to have beaten Sweden in cumulative excess mortality per capita.
Now, Sweden's excess mortality figure is still rather good, and it's interesting to discuss why. For example, Swedes appear to have avoided *large* gatherings, and seemed quite aggressive about expecting symptomatic people to stay home. Sweden also has generous family leave, including provisions for adult caregivers of schoolchildren to stay home to keep sick kids at home and out of school.
"Let's combine Swedish openness with typical American expectations to show up at work and school sick!" sounds like it might miss what *did* work about Sweden's approach. Germany has a stereotypically workaholic culture, and it hasn't done much worse than Sweden per capita. The Asian countries listed are stereotypically industrious, too, and they seem to have done better than Sweden overall.
EDITED TO ADD: Substack is wrecking the formatting of my list of figures, and my editing isn't fixing it. Sorry about that.
You can recreate this table https://imgur.com/a/NyLxc85 by going to mortality.org > data > STMF > CSV, dropping into a pivot table, filtering for sex to "b" (both), then selecting the years you want (use d_total for total deaths). Mortality.org pulls direct from each countries respective CDC equivalent, the lag time varies country-to-country so some have very little 2022 data, others go up to 40+ weeks.|
The IMGUR I linked above is my last update I made reader-friendly on may 25th, I have more current data, but it takes me a bit of time to make it clean for general audience, but you will see that things have only gotten worse in 2022 for many countries hailed as "doing it right". Perhaps later today I can re-update.
The link you gave in Our World in Data bases the projections on a model rather than straight historical average (they previously used straight historical average then changed this about a year back - not to be cynical, but I suspect because they weren't liking the results). I will try to find the documented change, I went through this in detail way back, try to find my work.
As you noted, adjusting that chart for country population would be better way to present data - as the graph you posted makes Norway look like it had a better outcome than Sweden, even though they have nearly identical excess death as a percent of the population.
Consider that Our World in Data projects South Korea having only 42,000 excess deaths. Here are raw deaths per year
2015 - 280766
2016 - 279257
2017 - 284548
2018 - 298030
2019 - 294080
2020 - 309530
2021 - 316897
2022** - 216945 < only 30 weeks of 2022 recorded, but historically should have only 170K
So OWID model says 42K, but consider if we used as baseline...
5 year average (baseline of 287K deaths expected) - 96,000 excess deaths
3 years average (baseline of 292K deaths) - 89,000 excess deaths
Linear Forecast (baseline of 301K deaths) - 71,372 excess deaths
You can see, there is no reasonable way OWID could have come up with a projection of only 42K in South Korea for excess deaths.
(I feel your pain btw of Substack formatting in comments!)
As for your explanations for why Sweden still did so well, I feel like they aren't falsifiable explanations. I mean no offense, but again, feels like ascribing excuses because our predictions didn't pan out. Post hoc.
Bottom line, all these countries put their kids in schools without masks (largely) and paid no consequence. In fact they did better than us. Yet 2 years after we have this data, we still see stories claiming "it was the right thing to do" see LA Times recent column "Closing schools in the pandemic was bad. Keeping them all open would have been worse"
https://www.latimes.com/business/story/2022-11-08/closing-schools-in-the-pandemic-was-bad-but-keeping-them-open-would-have-been-worse"
I get that Randi Weingarten and the people who promoted measures like this have to cling to their failed hypothesis, their reputation is on the line, and probably having a difficult time facing their mistakes so falling for true believe syndrome/sunk cost.
I can't help but see the data continue to disprove these claims.
"As for your explanations for why Sweden still did so well, I feel like they aren't falsifiable explanations. I mean no offense, but again, feels like ascribing excuses because our predictions didn't pan out."
My intention wasn't to explain why Sweden did so well so much as to point out that those in other countries proposing policies to imitate Sweden should consider whether their proposed policies really are imitating – or even can imitate – Sweden in the relevant respects.
It's quite common in medicine (and life more generally) not to get neatly falsifiable information. When we can't run controlled experiments, we look for natural experiments. But what makes a good natural experiment, and what that experiment really shows, can be contested.
"Bottom line, all these countries put their kids in schools without masks (largely) and paid no consequence."
But that's not all they were doing – and I question whether students were "largely" unmasked in the sample of countries I chose.
If you're limiting your inquiry to whether it was feasible to keep school open (masked or not), then countries with overall different approaches who nonetheless shared the commonality of keeping schools mostly open (even schools in Sweden temporarily closed in reaction to outbreaks at those schools) make a fairly persuasive case that yes, it's feasible. But a lot of folks who just want "normalcy" don't limit their inquiry to that.
Appreciate the civil discourse :)
>"It's quite common in medicine (and life more generally) not to get neatly falsifiable information. When we can't run controlled experiments, we look for natural experiments. But what makes a good natural experiment, and what that experiment really shows, can be contested."
Completely agree. I would add that this is why it is so important to frame our hypotheses tentatively, and be careful of espousing certainty. I feel that many claims of what to do (close schools in this instance) were made with great certainty. The nuance was left out.
My concern is that now we have enough data to show so many things we tried didn't matter, there's a sizable number of experts still not accepting that we can reject these hypotheses.
The history of medicine is 99% "oh it turns out this didn't work or made things worse". Evidence based medicine is less than a generation old. We shouldn't be surprised if things we did based off observational studies and models turned out to not work. I just don't want to be stuck having to pretend they do once it becomes obvious they didn't. I'm pro medicine. Married to a surgeon, spend my time deep journals and fascinated with the history of medicine. But it's a disservice to medicine to not consider we got a lot wrong on our response. I feel like that is what is happening.
>"But that's not all they were doing – and I question whether students were "largely" unmasked in the sample of countries I chose."
Nordic countries were largely unmasked relative to the rest of the world, especially children.
They had fantastic outcomes. South Korea is mask capital of the world. Terrible outcome.
This comes in the heels of so many other failed predictions. Redfield "if 80% of the country masked, Covid would be crushed - June 2020; "Throwing Gas on Fire" when Texas lifted masks March 2021 and had identical outcome as everywhere else; "Airline industry will be slammed with delays as pilots and staff fall sick" after Mask mandate lifted in April 2022, and this didn't happen.
We only discovered viruses after something invisible was passing through our ceramic chamberland filters in the 19th century, which we dubbed "filter passing viruses". We can't be surprised that after masks failed in 1918 they would fail again. They have never passed RCT, yet we find 300 observational studies easily. That is telling 2 years later in my opinion on the falsifiability being ignored.
I might be quite wrong.
South Korea recently had its worst spike, but I'm not convinced its overall outcome has been terrible.
I'd say the "How well do masks work, and when?" question is separable from "Can we find ways to keep schools open?" (whether with masks or not) question. Better air circulation and filtration can reduce the risk of spread even without masks. When do we decide it's still risky enough to mask, anyhow?
I don't know how far Sweden got with its 2018 "budget measure essentially marks the first attempt by a national government to officially recognize better ventilation and high IAQ (Indoor Air Quality) as a way to protect public health" by the time COVID hit, but if Swedes were already attentive to indoor air quality, as well as more compliant with government recommendations to reduce travel and large gatherings, and to stay home if symptomatic, those measures help disrupt transmission even without masks. Meanwhile, even Sweden recommended masking in congested commuter transit – not all mass transit has the aggressive air filtration that airline cabins often have!
https://www.mynewsdesk.com/camfil/pressreleases/swedish-government-takes-historical-steps-to-improve-residential-living-with-better-ventilation-and-filtration-solutions-2192304
https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/covid-19/how-to-protect-yourself-and-others-covid-19-recommendations/symptoms-of-covid-19/
https://www.euronews.com/my-europe/2020/12/18/sweden-tells-citizens-to-wear-masks-on-public-transport-as-it-struggles-with-covid-19-resu
https://www.meetings-conventions.com/News/Airlines/Plane-filtration-lowers-Covid-risk-masks-still-necessary
"[M]ore than 80% of Swedes reported they had adjusted their behaviour, for example by practising social distancing, avoiding crowds and public transport, and working from home. Aggregated mobile data confirmed that Swedes reduced their travel and mobility during the pandemic."
https://theconversation.com/did-swedens-controversial-covid-strategy-pay-off-in-many-ways-it-did-but-it-let-the-elderly-down-188338
Masks don't have to catch every last tiny particle to help. Masks both catch the payload of the largest droplets and baffle airflow around the mask-wearer to spread the fine particles less far. Dose of inoculant matters to severity of infection, and, during phonation,
"masks effectively block aerosols, forcing the breath to exit at the sides. From there, the aerosols travel upward, rising with the upward flow of body heat from the singer."
https://scitechdaily.com/sing-on-certain-face-masks-prevent-covid-19-transmission-without-distorting-voice/
Baffling the jets of air we emit so that larger drops are caught and smaller ones stick closer to us to hitch a diluting ride on our body's heat plume seems mechanically effective in reducing others' exposure risk, particularly to severe infection. Reduction isn't complete prevention, obviously. When is risk high enough to justify baffling our breath? Not always, evidently. But "masks don't work" studies may be underpowered:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499874/
I have too many other distractions right now to get deep into the weeds of the math of this one. Regarding the proposed superlinear efficacy for masks, I concede "the model permits superlinear efficacy" ≠ "we have empirically verified superlinear efficacy", but as the mom of young kids in a school system where the backlog in bugs seems to be ripping through like wildfire, for now, I'm bagging my breath for choral rehearsals. I expect to do so in medical buildings from now on:
https://www.athenahealth.com/knowledge-hub/clinical-trends/yes-patients-do-catch-the-flu-in-doctors-offices
I have underlying conditions that can mimic "coming down with something" at any time, so for me, "stay home if symptomatic" nearly amounts to house arrest. "I get these symptoms without being contagious" used to amount to a free pass to nearly always ignore "stay home if you're sick" advice, but I've rethought that. Those who normally have no cold/flulike symptoms whatsoever perhaps can afford to just stay home on those rare occasions they feel ill, but that's not me.
Lots to read through, but have to call it a night. Quick though:
"South Korea recently had its worst spike, but I'm not convinced its overall outcome has been terrible."
70,000 - 90,000 excess deaths for a country of 52 million across 2.5 years is terrible. I am not sure how else to frame that. In April they had all mortality double. No country saw anything like that the entire pandemic I am aware of. Need to drill down to NYC during March 2020 to get to that level of increase mortality.
Can you provides links to the Excess Mortality in various countries data?
Our World In Data is one source, easily accessible to layfolk. Their cumulative mortality graphing widget is quite handy, though it's not per-capita mortality, just total:
https://ourworldindata.org/grapher/cumulative-excess-deaths-covid?country=~USA
^ That shows the USA's, but you can add and subtract countries.
See my reply in other nested column on the issues with OWID
https://yourlocalepidemiologist.substack.com/p/state-of-affairs-november-16-2022/comment/10512851
In your "Lessons Not Learned" paragraph you mention masking, staying home while sick, and getting vaccinatedy, but nothing about air qualit. You are great, but it seems to me you consistently neglect to inform and remind people of the protective benefits of ventilation and air purification. Please please talk them up more!
Air purification, done energetically, can give you risk reduction at about the same level as masking and it is much more acceptable to the public. There are a LOT of people who absolutely HATE masks, and are enraged if you even mention them. I think it is unlikely that their attitudes will ever change. Here is an actual quote from someone I had a discussion with online, in the course of which I mentioned that I still masked in indoor public places:
"The last two years were some of the worst years of my life, and they were not due to the disease. Nobody I know died or was even severely ill. Like it or not the mask is the symbol of the hell we were put through for no reason and of the fact that we learned absolutely nothing."
Air quality engineer Richard Corsi has built a great site giving information about protecting people by improving air quality.. It's here: https://cleanaircrew.org
He designed a simple, inexpensive, highly effective air purifier you can build yourself. Here's a video where a 4th grader demonstrates building one. https://www.youtube.com/watch?v=H2YELPNsImk&t=3s
Hi Katelyn. Thanks for your work. I've been reading you since day one I think.
Here's my story: I'm 76 and my wife is 63. We're both fully vaccinated (2 & 3/2021) and fully boosted (12/2O21 & 10/22-divalent). We are both cautious; masks around folks we don't know and hand sanitizer everywhere. In spite of this we both tested positive about 3 weeks ago. I got monoclonal infused and she got Paxlovid. We both recovered quickly after that.
My point here is that for many of us who followed the guidance diligently we still contracted the disease. This has created an undercurrent of the sense that it was all pretty pointless, as we have friends who did not vaccinate or boost, got Covid and recovered fine...though it took them quite a while to get back to "normal". This sort of story creates a headwind for Covid vaccines in particular, but also vaccines in general. Science needs to do a better job.Just warning someone in the face of all the conflicting "evidence" may not move the needle as much as we feel necessary.
Please keep writing though. The fog have not lifted quite yet.
I'm glad you recovered quickly! The thing people need to understand is that vaccination against covid is not highly protective against catching covid. What it protects you against is getting gravely ill, and it does quite a good job with that.
Also, just a note about being cautious: You said you mask around people you do not know. It's actually just as important to mask around people you DO know. People can be contagious without knowing they're infected and without feeling sick. When I'm with people I do know at my home or office I run a powerful air purifier that gives 11 airs changes per hour (this greatly reduces the amount of virus-bearing dust in the air), AND we sit 10 feet apart. For gatherings with several friends or family members we all do rapid tests the day of and day before getting together.
True that. But initial messaging was that the vaccines provided protection; without many qualifiers. It has only recently changed to "it may not protect you" but it will help keep you out of the hospital and/or allow for quicker recovery. The populations expectation of vaccines is that they prevent diseases. If you get a shingles vaccine (2) you don't get shingles. If you get a rubella vaccine,...polio, etc. Messaging from political and scientific / medical leaders gave no basis by which to understand that these vaccines were not like others in that they did not necessarily provide the prevention the public has grown to expect. That is less than optimal optics.
Initially, the vaccines provided excellent protection, not only against COVID-19 (i.e., symptomatic SARS-CoV-2 infection), but also against any infection (symptomatic or asymptomatic) by the ancestral SARS-CoV-2 strain.
As variants have arisen, however, the degree of protection against infection, and the duration of that protection, have decreased, seemingly with every iteration of the variants and subvariants, to the point now that protection against infection and the duration of that protection is minimal (if not absent).
So the initial messaging was substantially correct at the time, and the current messaging (given the mutations in the virus) also is correct.
It is quite possible that the current COVID-19 vaccines do still prevent disease (i.e., COVID-19) while not preventing many (if any) SARS-CoV-2 infections. To know if this is true would require ascertaining how many of those vaccinated with SARS-CoV-2 infections have asymptomatic infections, how many of those vaccinated have symptomatic infections (namely, COVID-19), and the corresponding numbers in those unvaccinated. I have not seen such a study, though.
Yes, you're right, it's more accurate to say the vaccines were good protection against infection by the original strain. Still, by the time most people got their first vaccination Delta was becoming prevalent, and then 6 mos. later Omicron started, so in practice there probably were not many people at all whose vaccinations got to go up against the original strain. I also do not know how many vaxed people are having asymptomatic infections. However, being asymptomatic is not the same as not being infected. Asymptomatic people can still transmit the virus.
Delta became dominant in the US by early July, 2021. At that point, about 2/3 of eligible recipients (12 and older) had been vaccinated, so I disagree with your statement that there "were not many people at all whose vaccinations got to go up against the original strain." The majority had been vaccinated prior to the dominance of Delta. Even with the arrival of Delta, the vaccines had a significant (though reduced, relative to the ancestral strain) protective effect against infection by that variant.
And I did not claim that being asymptomatic is the same as not being infected, since you can't have an asymptomatic infection without...you know...being infected. And I agree that, if infected, one can transmit the infection, irrespective of the presence or absence of symptoms.
Um, ok.
I absolutely agree. It's terrible optics. You can't possibly be any angrier than I am about the messaging from the government. I can't think of anything to do about it except try to correct the misconceptions in on forums like this. Doesn't seem to matter who's in the White House, you get the same mealy-mouthed dishonest jerks yapping half-truths in the media.
For what it's worth, it's actually not true that all other shots protect against infection. Even the polio shot is only something like 99% effective. And I just looked up the shingles shot, & CDC says for people younger than 70 with healthy immune systems it's 97% effective against infection. For people age 70+ it's 91% effective. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html
And of course everybody knows the flu shot is nothing like 100% effective -- on average, it's more like 50% effective. But that's way better than nothing.
Data and public perception often don't sync up. We are told to get a flu shot so we don't get the flu...or shingles shot so you don't get shingles. Look at the advertising language relating to shingrix. There may be some small print on the last screen, but it's pretty clearly the sale of protection from shingles.
But don't want anyone to think this makes me angry. It was apparent to me from the outset that government and other thought leaders / spokes-personas didn't know what was going on. But they couldn't say that. They had to appear in control otherwise the population can get antsy. What it did was make me sad that we (the scientific / medical community) were not better at leading our people through the mess. That on again off again thing that Fauci did with masks did a tremendous disservice to not just the people, but their believability in the scientific and medical communities ability to provide the insight and care they needed.
Two big lessons here...in my opinion anyway;
1 We were not prepared!
2 Our initial messaging to the population was worse than our lack of preparedness!
Unfortunately, everyone I know who is getting Covid right now are the ones who recently got latest bivalent booster. It makes no sense.
Yes, you are correct. The part that doesn’t make sense to me is it seems that the recently boosted are disproportionately getting Covid. Is this because people who have already gotten Covid are passing on the new bivalent booster?
Or it could be that people who were recently boosted feel more protected so they are exposing themselves to people more in their day-to-day activities, i.e. dining out more than they used to, or attending a concert, etc.
If even true (it might not be), then:
And/or those who are more likely to have weakened immune systems less able to resist symptomatic infection (aged, on immunosuppressive medication, etc.) are those more likely to have been motivated to get the bivalent booster.
"The part that doesn’t make sense to me is it seems that the recently boosted are disproportionately getting Covid."
Do you have a link to a study or article that documents this, or is this simply something that you think is true based on your social circle ("seems to me") or some other anecdotal source?
Strictly anecdotal
Thanks. Then I would give the observation the weight it deserves. ;-)
In physics, there’s the concept of “terminal velocity.” If you drop a brick out of an airplane, at some point it hits terminal velocity, which means the rate at which it’s falling is constant. It’s physically impossible to fall faster; acceleration is zero.
At what point does the coronavirus become so contagious that it’s not possibly for it to become more contagious? I would think/hope we’re close to that point.
I heard a doctor say that the coronavirus will just get more and more contagious. Physics, at least, would suggest this isn’t true.
I was so hoping this state of affairs would include the latest on long Covid.
Yes, I agree. There's lots of us out there and we represent the true "long tail" of the epidemic. I wish YLE would pivot to address our population.
happy to cover long covid and latest evidence! will focus on this for next week
Thank you so much!! Although we are both healthy and about 50, our doctor has told us that long covid is still a big risk and that we must take full precautions. We're following that advice and so far have not been infected (as far as we know), but it's very seriously affecting our mental health and relationships, and interfering with accessing necessary medical care. If there is info out there that could allow us to open up even a little bit more, in at least some circumstances, it would be a huge, huge relief. We're really struggling, and there is just no information available to the general public.
Thank you thank you thank you,! You know YLE was the very first Substack newsletter I ever subscribed to and even after I unsubscribe from all the rest, yours won't be one of them! You're the gold standard.
As someone who has had chronic fatigue syndrome for 6+ years, I am very interested in long Covid. My symptoms improved after my second vaccination. I’m now more like a woman with minimal energy and stamina, than someone unable to function. I’m thrilled and curious if there’s been any talk of a correlation. I’m 74, no Covid, vaccinated, retired.
I'm attempting to wade through this report https://royalsocietypublishing.org/doi/10.1098/rsif.2021.0865 on indoor relative humidity and Covid . Thoughts? I live in New England and I think I need to get a new humidifier.
I tried to read it. Skipped to the conclusion and I think I should get a humidifier. I’m in RI - RH in my house is 42% right now.
Our “leaders” seem to no longer be leading.
I find it interesting that the small print on the CDC Flu Map says "This system monitors visits for respiratory illness that includes fever plus a cough or sore throat, also referred to as ILI, not laboratory confirmed influenza and may capture patient visits due to other respiratory pathogens that cause similar symptoms." So could that purple not be just Flu but overall Flu/RSV/Covid combined?
That's right. I think everyone assumes that our surveillance in public health is top tier because of the level of scientific discovery during the pandemic, but this is just not the case. We scrape from the bottom, which provides a fuzzy picture of what's going on. That said, COVID and Flu are well separated by now, so I'm confident in saying this doesn't include Covid. However, RSV could be in there. Testing is pretty robust right now, though, which would help separate the two.
https://www.cdc.gov/flu/weekly/usmap.htm - at the top
Could you post an article on repeat cases of Covid? How common is it? Are most cases in the unvaxed? Is it clinically worse than the first case? Thanks! You do great work here. Many thanks for all your efforts.
I wrote about this a few months ago. Not much has changed since. Check it out here: https://yourlocalepidemiologist.substack.com/p/epidemiology-of-reinfections
I just received an issue of Dr. Jeremy Faust's Inside Medicine Substack newsletter and the guest of honor on it is our Dr. Katelyn Jetalina! Dr. Faust is quite complimentary of his guest. Congratulations Katelyn!
Hello Katelyn! I don't know if you take "letters to the editor", but I'm in a situation where I'd love to apply some science to the choices of a non-profit.
I sing with a chorus. They've long had a policy of requiring two COVID vaccinations. They're now updating the policy to require everyone to be "fully vaccinated" as defined by the CDC, chasing that definition as it may change over time. We also allow members to sing unmasked if they test negative same-day with an at-home test.
I'm wondering whether this actually improves safety for members. I know that choruses are a highly at-risk group for spreading COVID, and many of our members are (well) over 65, so there are multiple risk factors. But aren't vaccinated people still highly likely to become contagious? Assuming everyone attending a rehearsal is asymptomatic, is a "fully vaccinated" person safer to have around than a "vaccinated" person?
Obviously there are health benefits to the individual from being fully vaccinated. I'm focused on the health benefit to others.
Thank you!
-- Ethan
Because I had difficulty receiving and sending emails during October, I probably missed any possible repl;y to my question so I am reasking. Because I have CLL, a type of leukemia, the original vaccines could not produce antibodies with my blood. In May I had an infusion of EVUSheld. I am having a second infusion this Friday, 11/18. Is this infusion a protection from the Omicron strain of the virus? Would this provide a protection which would allow more freedom in my life? Is there data as to the effecacy of this medication.
There does seem to be a trend that direction. Perhaps a false sense of protection?
Great summary of the current situation!
Question: You mentioned co-infection with 2 viruses. Is it also possible that a "tri-infection" could occur since all three of these respiratory viruses are circulating at the same time? 🤔
Technically, this is possible
Thanks! Let's hope it stays possible but highly improbable.....
I wasn't familiar with Hickman but my graduate school microbiology advisor was fond of saying "the microbes don't give a damn what you think!" I've always considered him a wise person.
That's awesome!
Your citation is from Wikipedia (https://en.wikipedia.org/wiki/Hickam%27s_dictum).
It is standard practice to cite your source when quoting material.
i would love to hibernate. sign me up!
Sign me up too! Wake me up when Daylight Savings Time kicks back in!