The respiratory illness storm ravages on. And it’s only November. Here is where we are with the “triple threat.” RSV Cases of RSV continue to skyrocket. Data shows we are testing a lot, though, as test positivity rates are not as high as in 2021. This is likely attributed to increased knowledge, which is good news. In addition, there are hints that RSV is peaking. With RSV, antigen test positivity rates usually peak before PCR, and that’s what we are seeing now. Cases may soon follow.
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,]
"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.
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 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?
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? 🤔
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,]
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.
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 was so hoping this state of affairs would include the latest on long Covid.
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.
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?
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.
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? 🤔