Risk reduction is the "name of the game": socially, I do feel awkward being the lone mask in many situations, but it's just not worth getting sick. A close friend didn't mask on a flight due to embarrassment, and is now quite ill with Covid--that's a no brainer for me (and his primary care provider)--it's the social situations that are so difficult to navigate right now, for me.
As it turns out, adults are completely vulnerable to peer pressure. Ironically, my mother lectured me on resisting peer pressure-- "if all of your friends jumped off a cliff, would you follow them?"-- and yet, I am the one still masking everywhere and being COVID cautious, and every parent I know is going along with the crowd. Solomon Asch's conformity experiments, in real time.
It depends on what game you're playing. The overwhelming majority of people aren't interested in playing the game of trying to avoid an endemic respiratory virus that they've likely already had multiple times. And they especially aren't interested in wearing masks, a practice with no statistical evidence of efficacy, and one that is very uncomfortable and limits communication and human connection.
Ah. It's "THIS" Paul here again. You always show up to spew your anti-science rhetoric. Glad to see you've swallowed the pro-sickness propaganda, hook, line, and sinker!
Just curious: was your friend vaccinated for COVID? Full complement of shots/boosters? You stated 'quite ill'. Are they 'compromised'? I know three people who are fully vaccinated, but, still caught COVID, but it wasn't severe.
I'm not sure about the person above, but I have a colleague who has had all of the vaccines, including the 2023 version. Has no health issues that they were aware of. And they got COVID about 10 days after their 2023 vaccine... and they're currently in the hospital ICU with COVID complications. They are in their mid-40s.
None of us should ever feel apologetic or timid wearing a mask in crowded/inside conditions if we want to reduce our risk. And the risks are real and the world is different than the game before the pandemic.
I’m feeling really disturbed by 2 articles in the NYT this week. One presents the brain and life wreckage so many kids sustain from football (and to a lesser degree other contact sports). The other shows the massive uptick in young adults reporting cognitive problems since the pandemic started, attributable to neurological damage from Covid (cited in this YLE post above). The conclusions are uncomfortable truths to say the least, and undeniably tragic.
I wouldn’t let my kid play football, and I get my daughter every single vaccine/booster, and if she wants to mask in high risk situations, I absolutely respect her strength and autonomy and rationality.
Another reason for the bad and worsening respiratory virus season this year… we know that COVID causes immune dysregulation. My guess is that we’re seeing the effects of a population-level decline in immune system health.
Also, we shouldn’t be surprised that there’s been low uptake of COVID vaccines, given that the Biden Administration “declared the pandemic over” (*snort*) and the CDC director herself— Maskless Mandy— parades around without any kind of respirator on. We are seeing zero good respiratory hygiene behavior from our “leadership” to model. People are getting attacked and mocked for wearing masks.
Also, I am in a lot of COVID cautious groups where parents cannot find places that will vaccinate their kids for COVID. Pharmacies would vaccinate kids under 5 while the pandemic emergency was going on, but with the end of it, pediatricians won’t order COVID vaccines— no pediatricians in my area in Georgia will carry COVID vaccines and never have, and I live in the 2nd largest city in this state— and pharmacies won’t vaccinate kids under a certain age. Many parents who WANT this protection for their kids simply can’t find anyone willing to vaccinate their children.
This Administration and the CDC have messed up this entire rollout and this entire pandemic. What we are seeing is the effects of their shoddy handling of every facet of the pandemic. It shouldn’t be a surprise. You can draw a direct line from their public proclamations and their behavior to the downstream effects we are seeing now. Idiocy.
Eh, there's enough doubt around the "immune dysregulation" thing that I think our efforts are better spent on more obvious points (masks work; vaccines work; being sick really sucks; covid still kills people; antivirals are amazing)
Also, it's a highly technical term that a lot of non-experts have seized on to suggest that Covid is like airborne AIDS or blood cancer. I really can't stress how spectacularly incorrect and tasteless that suggestion is. AIDS is AIDS. It's awful. Covid isn't AIDS and it doesn't make you immunocompromised. It puts your immune system out of whack for a little bit, because any virus will do that a little bit, since it causes your immune system to deploy its resources to prevent that particular virus. You can and should do what you can to reduce your viral load when you do catch covid, like taking the best possible antiviral you can get.
I haven't stopped wearing a mask and I avoid crowded situations whenever possible. Also vaccinated for all that I can get (RSV,flu and will get Novavax soon).
My household has never stopped wearing respirators everywhere outside of our own home/vehicle. We are all NOVIDs, and even better-- we've had zero illnesses of any kind in nearly 4 years. (We also never let up on fomite/hand hygiene.)
To the extent people avoid the Covid booster because they’ve had bad side effects in the past, some public messaging about Novavax might be helpful. Awareness of Novavax as an option is very low. I was amazed to meet a doctor last week who had just gotten the Pfizer booster and felt so crummy afterwards he had to take two days off from work. He had no idea a non-mRNA option existed. People also avoid the booster because they think the efficacy is lacking: they got a shot in the past and got covid anyway.
But the flip side to positive messaging about Novavax is Public Health probably doesn’t want to throw mRNA vaccines under the bus. So the public is left unaware and uninformed about Novavax. We are supposed to believe the three booster choices are interchangeable and equally good/bad, regardless of our age or sex.
Until the public understands there might now be a better booster choice for them, uptake will remain low.
The bigger scope problem here is if there is no money to promote vaccine uptake, there is a huge chance that these companies will stop making COVID vaccines. Pfizer and Moderna are posting large losses over lower-than-projected demand for 2023 vaccines, and Novavax is heavily in debt and trying to find ways to stay afloat. There is a huge, HUGE risk that we just won't have COVID vaccines moving forward. The Biden Administration's foolhardy "the pandemic is over!" proclamations have ensured that even (allegedly) liberal, educated, pro-vaxx people are skipping the 2023 vaccines. It was shortsighted and stupid of them to do this, and the CDC has not pushed back at all. It's disgusting, and predictable.
I don't think it's "the pandemic is over" proclamations that caused people not to get the vaccines. (I just looked at a definition of pandemic, and an argument could definitely be made that it is over.) I probably fall into the educated, liberal category and I have not gotten the booster yet, but I have gotten my flu vaccine. When I got my physical, the office did not have any boosters on hand - they have to play an expensive game of ordering just enough but not too much. Earlier in the season the message was mixed over who could/is allowed to get it. I am under 60 and have no comorbidities, so I was unable to get it when it first came out, and when I was eligible, I couldn't get an appointment. Stores near me had signs on their door saying they had run out so don't bother asking if you see the sign.
Honestly, I kind of forgot about it until I asked at my physical last week, so now I am going to look for availability again. The rollout of this booster has been rough compared to early ones that the government had a bigger hand in.
The "pandemic is over" proclamations have definitely driven a lower uptake-- why would anyone "risk" mRNA vaccines and their side effects for a threat that is over? I am a federal employee, and we were *required* to get the initial series and the first booster. But none of my coworkers are getting the 2023 vaccine because "Biden says the pandemic is over". These are all highly educated, mostly liberal folks working in national security. This messaging was absolutely damaging to vaccine uptake, and it was absolutely irresponsible (not to mention incorrect) to make such a declaration.
No, people are individually assessing the "threat" that covid poses to them, and for the overwhelming majority, that threat is tiny (near zero). Now that the fear propaganda has died down and employers can't force/coerce people into taking these shots anymore, demand has predictably cratered. Also, not only were people mandated/coerced into taking the original shots, they were lied to about their effectiveness.
They are assessing incorrectly, because people (as a group) are really dumb.
The data on the damaging effects of COVID are out there, people are just not paying attention until they get Long COVID. This is a horrendous public health and education failure.
But yeah, the vaccines are not as protective as they need to be, that much I can agree with you on. That said, I'll take 10% protection over zero, since no one is doing anything to prevent infection anymore.
Your take on the threat of COVID is wholly inaccurate and you're actively spreading disinformation.
I'm no capitalist, but your hope that Pfizer exits the market is extremely short-sighted. If Pfizer exits, Moderna also probably will. And Novavax is not going to be around long... The vultures are circling.
The way capitalism is supposed to work is the worst vaccine fails, and the better vaccines take over. That benefits everyone - even Pfizer (who stops losing money and can now use those resources to pursue products where they excel).
The economics of vaccines never work like that, and never have. Vaccines are a "common good" for which there is little incentive toward development and production. Most vaccines don't take the constant updating that flu and COVID do, so it takes government action/investment to keep these companies doing (extremely expensive) R&D to keep up to date. If they don't get that investment, they won't do it. There are no companies that can afford to do this COVID vaccine development and updating without government investment or some level of profitability.
There are no companies on the horizon who can do this. Vaccines should never be a capitalistic venture because there is no real money in vaccines. There needs to be government support.
Again, what you're advocating is a very uneducated and short-sighted stance that will have horrific effects on public health.
A big problem with capitalism is that it depends on a considerable amount of mandatory secrecy, especially where publicly traded companies are concerned. I believe this has a deleterious impact on a lot of regulatory transparency in the space of drug safety and efficacy, and public health. Martha Stewart and Elizabeth Holmes cast long shadows.
The NYT had an article a few weeks ago (link below) that very softly suggested Novavax might be better. I can understand the constraints of PH but mainstream papers don’t seem to want to say anything unfavorable about the mRNA vaccines. Hopefully word of mouth will soon kick in and give Novavax a boost. I’ve become a Novavax evangelist among my family and friends. Word of mouth builds slowly but can be very powerful.
Also good data that would allow us to compare different vaccines can be hard to come by, since it would constitute material information about publicly traded companies.
Thank you. Your column helps me make reasonable decisions about ppe. As a volunteer in a children's hospital, I rely on the printed ppe recommendations posted outside each patient's door. After reading your post, I will begin wearing my KN95 mask at all times in the hospital starting during my next shift. I am 76 yrs, had Covid twice between Jan and April of 2023 in spite of two Covid vaccinations and two boosters. Now, I have long Covid and hypothyroidism. Within the last month, I was vaccinated again for Flu, the most recent Covid booster, and RSV. When traveling to the hospital where I volunteer, I ride public transport, so I wear a mask on the train. Prevention is a better choice than the risk of illness.
But, I am guessing that, if your local children’s hospital is like ours, masks are not required. And the medical professionals are not masking. We are routinely the only folks masking in medical facilities.
Thanks as always for the common sense advice. It’s good to read up as much as we can, and do what we can to keep ourselves and each other safe. We just got back from Belgium and France 🇫🇷 on a WWI tour. Another time, and age when influenza devastated the world. We masked with N95s almost everywhere and got a booster a month before we left. I observed we were the only ones masked on the plane, airport, public transportation, museums etc. I’m retired healthcare professional and really did not care what anyone thought. When I did have a conversation about COVID people were uninformed of the risks. History repeats.
Another factor that I think might be part of this that I didn't see addressed (and I don't see it addressed as much as it should be) is the problems with testing for COVID. Without testing, people don't know they have COVID, so they just assume "allergies" or a "regular cold" and then carry on with their normal activities, which means they're probably infecting a TON of people since COVID is so highly transmissible.
1) PCRs are very VERY difficult to find in most areas now. In my 300k+ population area, Walgreens, CVS, city/county government, etc. shuttered their PCR testing locations and act completely amnesiac when you ask them about how to get PCRs.
2) PCRs are also are not covered by insurance anymore in many cases, and people cannot afford $175+ for a single test, let alone multiple members of a family.
3) PCRs are given indoors. Which means that to find out if you have COVID, you have to remove your mask... and possibly get COVID. In my COVID cautious circle, many of us avoid PCRs because if we don't actually have COVID, we might get it in the process of getting a PCR. Insane.
4) NAAT/molecular tests like Lucira, Metrix, and Cue are supposed to be more accurate than antigen tests and are supposed to be PCR-like in terms of accuracy, but are mostly unaffordable and inaccessible for most. The cost is astronomical (usually around $50/test)-- which means that it's not accessible for the overwhelming majority of individuals, let alone families-- and they're only sold online, which means you have to think ahead and have a stash of them on hand.
5) Rapid antigen tests (RATs) are generally more affordable, but are simply ineffective tools. Reports are showing that RATs are missing upwards of 60% of positive COVID cases. My own household member just had their first bout of COVID in October, and they were fully symptomatic (coughing, congestion, exhaustion) for *** 8 FULL DAYS *** before testing positive on Flowflex and iHealth, which are supposed to be some of the most sensitive RATs on the market. They tested on Day 2, Day 4, and Day 6 (first thing in the morning, swabbing throat/inner cheek/nasal passages), and it still took 8 days to test positive. Had they trusted the first 6 days of testing, they would have infected our whole household and heaven knows who else.
6) Because RATs are missing infections, or not finding them until many days after symptoms start, people are finding out they are positive when they are outside of the 5-day Paxlovid window. Which means that infections might be far worse than they ordinarily would be if people could get access to Paxlovid.
Again, the way the CDC and Biden Administration have handled this pandemic is absolutely horrid. They have failed on tools, messaging, vaccine rollout, etc. Because of this, we are literally sitting ducks for whatever pandemic comes next (which experts in epidemiology and virology are saying is inevitable within the next decade), and this inept Administration and its pathetically political CDC have positioned the American people to openly embrace the next deadly pathogen and refuse information, respirators, vaccines, treatments, testing, etc-- assuming we could even get vaccines and testing in time to make any difference. Well done.
"Again, the way the CDC and Biden Administration have handled this pandemic is absolutely horrid." Who was it in the oval office when this pandemic started again? You seem to have forgotten that in your need to blame everything on Biden.
Nope. Trump was an absolute psychopath. He handled it terribly.
Biden ran on saving us from COVID, and has done everything in the Trump playbook. I wish more of my fellow liberals could see this instead of believing that everything he's done is great on COVID. I voted for Biden, enthusiastically, and have watched him behave worse than Trump and lose more people and not care. I'm not excusing him just because he has a (D) next to his name. And my fellow Dems shouldn't, either. Pay attention to data and behavior, not glowy messaging.
"Pay attention to data and behavior, not glowy messaging." Yeah, that's me, just a chump for "glowy messaging" who is incapable of rationally evaluating the situation.
In your determination to jump on the "Blame Biden" bandwagon, you have completely ignored the dogged opposition to every single thing this administration has attempted to do by a "Republican" Party that has become a hotbed of anti-vaccine, anti-masking, anti-public health, and anti-science dogma.
The notion that Biden has behaved "worse than Trump" is clearly at odds with reality.
I must say that I agree, but it's really a mess, and became too politicized, and Trump, OMG God Help Us All no matter whether one is liberal, conservative, independent, ..
I think there's another huge factor in play with respect to difficulty remembering, concentrating, etc.... screen time. Digital distraction. Whatever you want to call it.
At the beginning of the pandemic, screen time was already a problem. BUT reliance on Chromebooks and apps for education did not go away when virtual school ended. Teachers continue to rely on these electronic tools for learning, and this isn't doing kids any favors.
We know that screens create shorter attention spans. I suspect they are contributing to these other cognitive issues, also. As more adults work from home than they did pre-pandemic, and just the way technology is rapidly changing, I think this is contributing to these cognitive issues for everyone from young children to older adults.
I am not suggesting that long covid isn't a factor for some, but I know my attention span and concentration has been plummeting for a few years, and I only had covid recently. I think we need to consider more about some of these external factors.
Agree - my attention span decreased majorly in 2020-21 due to all my social media and screen time. I got covid in 2022. Since 2021 I’ve forced myself to read BOOKS - not articles and just scrolling - and it’s gotten better.
"Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system."
Thanks for the information. I had a feeling that all 3 of these were increasing in my area. I work in healthcare and I've heard a lot of reports from our patients saying that they or a family member have been ill. A new trend that I'm seeing is very few people test for Covid now. It's like they simply would rather not know if they have it. I suspect that is because they don't want to be forced to isolate and miss school or work. If they play the "ignorance is bliss" game, they can go back when they feel better. If they test for Covid and are positive, they have to miss a full week and many can't afford to do that.
The "testing industrial complex" is a huge waste of resources. We have performed billions of covid tests over the past 3+ years and it hasn't had any affect on the spread of the virus. A virus this contagious is simply not controllable.
The expense of tests also may be an issue. I have a friend who works with kids. She has been sick, so has taken a COVID test a couple of times while she had symptoms. They came back negative, and she didn't test again because, at $15 a pop, she doesn't feel it is worth it.
In addition to long COVID and other (medical and socio-economic) reasons for the reported rise in brain fog/cognitive symptoms, I wonder if the shortages of ADHD medications have something to do with it, along with the dysfunction of the retail pharmacy sector? I know several young people who have been struggling to get their prescriptions filled, because the pharmacy is out of stock, or because they no longer answer their phone and require in-person visits.
Example: In New York State, stimulant medications require a new prescription every 30 days; and if the doctor sends a new prescription, say, 25 days after the last one, the pharmacy won't just wait until 30 days to fill it - they will not fill it at all unless the patient contacts them to request it. And many pharmacies are so understaffed that they no longer answer their phones. So you can stand in line to get them to refill it, then either wait for them to do so on the spot, or find out it's not in stock and have to come back in person again.
That's a lot to manage for young people who are already struggling with executive function...
Dr. Jetelina, how do you assess whether to mask in crowded areas like airports? It seems like the risk of catching COVID in such a space would always be high, even when COVID rates are down, so I was surprised you had stopped doing so. I’m not asking sarcastically but am genuinely looking for some guidance as I decide whether or not to mask in various situations. Thanks.
I have always appreciated your data driven approach, but I think it is jumping the gun to say the increase in those reporting memory and concentration issues is from long Covid. In my primary care practice we are getting slammed with patients with these concerns. Some of them clearly have long Covid and sure long Covid is probably being missed in many people, but 10:1 I am seeing people for whom work from home doesn’t work, for whom the current labor market doesn’t work, and/or for whom relationships with family, friends and their community have not yet recovered from isolation. Anxiety is out of control. Loneliness and depression are sky high. Is some of that long covid? Maybe. But all of it? Even most of it? No way. I know of no data to back up your assumption. In its absence, ask those of us in the trenches so we can start asking the right questions and getting the data we need. It would be much more productive than assuming.
There are also a ton of documented issues with sleep after a COVID infection (very VERY common in the Long Covid community), and we know that chronic sleep deficits negatively impact mental health.
It really isn't an assumption to link COVID infections to mental health issues. There is a preponderance of evidence pointing in that direction.
You are right, there are definitely links between long covid and mental health. But it a big leap from that to say that the massive increase in concentration issues is attributable to this alone or even mostly. A lot happened to people and their brains during the pandemic that was not Covid itself. Anxiety was increasing even before the pandemic. We saw lots of mental health issues in kids doing remote learning long before most of them got Covid. I’m not saying Covid isn’t part of it, but let’s not rule out the many other things going on in the world that also need to be considered, so that we can get more data and address these issues more comprehensively.
Wow. Referencing that NYT article about brain fog and saying it is "undoubtedly long covid" is irresponsible. Yes while Long Covid may be the cause in a small number of cases, another significant cause is likely anxiety and other mental health challenges that were seriously exacerbated by pandemic. As the NYT article states but you omit "The sharp increase captures the effects of long Covid for a small but significant portion of younger adults, researchers say, most likely in addition to other effects of the pandemic, including psychological distress. But they also say it’s not yet possible to fully dissect all the reasons behind the increase." Please be more responsible when you relay information.
Thanks for your comment. I see how these few sentences may seem irresponsible, but as an epidemiologist, I’ve thought about this a lot. One huge strength to this disability data is that we’ve had it for decades. This is great because we can look at other events, like 9/11 or the 2008 recession, which were also stressful for a lot of people (albright not as stressful on a national level like covid) and didn’t have an impact on disability data. I think it’s also interesting that this didn’t rise for other age groups. I would argue that the pandemic was equally as stressful for all age groups (if not more stressful for older adults). Like I said, more probing is needed
Every working parent I know is absolutely drowning, and has been since the start of the pandemic. I think the pandemic just made clear how unsupported we all are and that realization continues to affect our mental health. I went 36 years without any need for therapy or meds, but now 3 years in I still need both. I also know several women who were diagnosed with ADHD or ASD the past few years though their symptoms aren’t different from when they were younger, there is just more awareness now.
This is absolutely my anecdata, too, from my personal point of view as a single parent. But that isn't the only issue. Long COVID is absolutely destroying people's ability to function, and that can't be explained away as "stress".
I guess I’m just lucky, I don’t know a single person in real life with long covid (or new health symptoms post-covid). It absolutely exists, it’s just hard to put so much weight on that when I don’t see any examples in my own life.
Well, and lots of the TMS/MBS experts believe that long Covid is nervous system disregulation. I have read so many stories of people who have healed simply by doing work to get out of the constant state of “fight or flight” and fear. It’s fascinating. The brain is a remarkable organ.
I appreciate your response. This pandemic is unprecedented and I don't think that we can compare its effects to anything else. Given the many other factors at play, including as others have mentioned social media, pressures on families, effects of isolation etc., there just isn't sufficient support for the assumptions you made. I am a parent to four teens/young adults, ages 13 through 21. The pandemic itself has been phenomenally hard on that age group. I understand your commitment to providing concise and digestible content but sweeping statements without sufficient evidence actually fuel anxiety.
Exactly, they were already a vulnerable group. I'm not surprised that the pandemic itself (not the virus per se) would have a more significant impact on the cognition of younger people.
This seemed odd to me too without further explanation and research. The pandemic times were tough, but there were many fewer things to do and fewer big decisions to be made. As soon as I read that stat, I thought that perhaps getting more back to "normal" could be some of the cause. Many parents said that the one thing they appreciated about the pandemic time was not rushing around to kids' activities, and the age range of the forgetfulness falls right in the range of the busiest child care years.
Just dropping in to say that risk reduction is fine, but it's also OK to have a lower risk appetite and remain true to that, peer and family pressure notwithstanding. So if you still think that the residual risk is still too high even after various forms of mitigation, or if you find the mitigation itself takes away from your enjoyment of something - whether it's a funeral, or a wedding, or a party, it is TOTALLY okay to skip it, and "No" is a complete sentence that doesn't require further explanation.
(Also, it's a 100% legit strategy to bluff, and say that you don't want to do something and have a set of demands in mind)
Long Covid and the subsequent brain fog and cognitive injury that it causes are very real problems that have not been adequately addressed at a national level. With your platform it would be great if you could campaign for more research. There are multiple other sequelae of long Covid that are crying for research dollars
Risk reduction is the "name of the game": socially, I do feel awkward being the lone mask in many situations, but it's just not worth getting sick. A close friend didn't mask on a flight due to embarrassment, and is now quite ill with Covid--that's a no brainer for me (and his primary care provider)--it's the social situations that are so difficult to navigate right now, for me.
As it turns out, adults are completely vulnerable to peer pressure. Ironically, my mother lectured me on resisting peer pressure-- "if all of your friends jumped off a cliff, would you follow them?"-- and yet, I am the one still masking everywhere and being COVID cautious, and every parent I know is going along with the crowd. Solomon Asch's conformity experiments, in real time.
yes!! Thank you!
"Risk reduction is the name of the game"
It depends on what game you're playing. The overwhelming majority of people aren't interested in playing the game of trying to avoid an endemic respiratory virus that they've likely already had multiple times. And they especially aren't interested in wearing masks, a practice with no statistical evidence of efficacy, and one that is very uncomfortable and limits communication and human connection.
Ah. It's "THIS" Paul here again. You always show up to spew your anti-science rhetoric. Glad to see you've swallowed the pro-sickness propaganda, hook, line, and sinker!
Just curious: was your friend vaccinated for COVID? Full complement of shots/boosters? You stated 'quite ill'. Are they 'compromised'? I know three people who are fully vaccinated, but, still caught COVID, but it wasn't severe.
I'm not sure about the person above, but I have a colleague who has had all of the vaccines, including the 2023 version. Has no health issues that they were aware of. And they got COVID about 10 days after their 2023 vaccine... and they're currently in the hospital ICU with COVID complications. They are in their mid-40s.
This makes a strong case for better vaccines.
I am so sorry.....
None of us should ever feel apologetic or timid wearing a mask in crowded/inside conditions if we want to reduce our risk. And the risks are real and the world is different than the game before the pandemic.
I’m feeling really disturbed by 2 articles in the NYT this week. One presents the brain and life wreckage so many kids sustain from football (and to a lesser degree other contact sports). The other shows the massive uptick in young adults reporting cognitive problems since the pandemic started, attributable to neurological damage from Covid (cited in this YLE post above). The conclusions are uncomfortable truths to say the least, and undeniably tragic.
I wouldn’t let my kid play football, and I get my daughter every single vaccine/booster, and if she wants to mask in high risk situations, I absolutely respect her strength and autonomy and rationality.
https://www.nytimes.com/2023/11/13/upshot/long-covid-disability.html
https://www.nytimes.com/interactive/2023/11/16/us/cte-youth-football.html
Yeah, I read the CTE article too. Football can't obsolesce fast enough.
Yes I agree!
Another reason for the bad and worsening respiratory virus season this year… we know that COVID causes immune dysregulation. My guess is that we’re seeing the effects of a population-level decline in immune system health.
Also, we shouldn’t be surprised that there’s been low uptake of COVID vaccines, given that the Biden Administration “declared the pandemic over” (*snort*) and the CDC director herself— Maskless Mandy— parades around without any kind of respirator on. We are seeing zero good respiratory hygiene behavior from our “leadership” to model. People are getting attacked and mocked for wearing masks.
Also, I am in a lot of COVID cautious groups where parents cannot find places that will vaccinate their kids for COVID. Pharmacies would vaccinate kids under 5 while the pandemic emergency was going on, but with the end of it, pediatricians won’t order COVID vaccines— no pediatricians in my area in Georgia will carry COVID vaccines and never have, and I live in the 2nd largest city in this state— and pharmacies won’t vaccinate kids under a certain age. Many parents who WANT this protection for their kids simply can’t find anyone willing to vaccinate their children.
This Administration and the CDC have messed up this entire rollout and this entire pandemic. What we are seeing is the effects of their shoddy handling of every facet of the pandemic. It shouldn’t be a surprise. You can draw a direct line from their public proclamations and their behavior to the downstream effects we are seeing now. Idiocy.
Please finish the Biden quote. He said, “ The pandemic is over, but Covid is still around.”
What about your local health departments for the pediatric vaccines? We’ve been getting a fair number of kids for COVID vaccines at ours.
Agree with the ped vaccine issue, but there’s no real evidence to back up your immune dysregulation point.
Yes, there definitely is. Here are just two (of MANY) easily discovered articles about it.
1) https://libguides.mskcc.org/CovidImpacts/Immune
2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9568269/
Eh, there's enough doubt around the "immune dysregulation" thing that I think our efforts are better spent on more obvious points (masks work; vaccines work; being sick really sucks; covid still kills people; antivirals are amazing)
Also, it's a highly technical term that a lot of non-experts have seized on to suggest that Covid is like airborne AIDS or blood cancer. I really can't stress how spectacularly incorrect and tasteless that suggestion is. AIDS is AIDS. It's awful. Covid isn't AIDS and it doesn't make you immunocompromised. It puts your immune system out of whack for a little bit, because any virus will do that a little bit, since it causes your immune system to deploy its resources to prevent that particular virus. You can and should do what you can to reduce your viral load when you do catch covid, like taking the best possible antiviral you can get.
agree~
I haven't stopped wearing a mask and I avoid crowded situations whenever possible. Also vaccinated for all that I can get (RSV,flu and will get Novavax soon).
My household has never stopped wearing respirators everywhere outside of our own home/vehicle. We are all NOVIDs, and even better-- we've had zero illnesses of any kind in nearly 4 years. (We also never let up on fomite/hand hygiene.)
Same here in our home... knocking on wood!!
Same.
To the extent people avoid the Covid booster because they’ve had bad side effects in the past, some public messaging about Novavax might be helpful. Awareness of Novavax as an option is very low. I was amazed to meet a doctor last week who had just gotten the Pfizer booster and felt so crummy afterwards he had to take two days off from work. He had no idea a non-mRNA option existed. People also avoid the booster because they think the efficacy is lacking: they got a shot in the past and got covid anyway.
But the flip side to positive messaging about Novavax is Public Health probably doesn’t want to throw mRNA vaccines under the bus. So the public is left unaware and uninformed about Novavax. We are supposed to believe the three booster choices are interchangeable and equally good/bad, regardless of our age or sex.
Until the public understands there might now be a better booster choice for them, uptake will remain low.
I completely agree. I think this is where the pharma company could step up. The challenge is two-fold for public health:
1. there is no money for vaccine campaigns
2. public health can’t be seen as promoting one vaccine becuase then we are considered “pharma shrills”
The bigger scope problem here is if there is no money to promote vaccine uptake, there is a huge chance that these companies will stop making COVID vaccines. Pfizer and Moderna are posting large losses over lower-than-projected demand for 2023 vaccines, and Novavax is heavily in debt and trying to find ways to stay afloat. There is a huge, HUGE risk that we just won't have COVID vaccines moving forward. The Biden Administration's foolhardy "the pandemic is over!" proclamations have ensured that even (allegedly) liberal, educated, pro-vaxx people are skipping the 2023 vaccines. It was shortsighted and stupid of them to do this, and the CDC has not pushed back at all. It's disgusting, and predictable.
I don't think it's "the pandemic is over" proclamations that caused people not to get the vaccines. (I just looked at a definition of pandemic, and an argument could definitely be made that it is over.) I probably fall into the educated, liberal category and I have not gotten the booster yet, but I have gotten my flu vaccine. When I got my physical, the office did not have any boosters on hand - they have to play an expensive game of ordering just enough but not too much. Earlier in the season the message was mixed over who could/is allowed to get it. I am under 60 and have no comorbidities, so I was unable to get it when it first came out, and when I was eligible, I couldn't get an appointment. Stores near me had signs on their door saying they had run out so don't bother asking if you see the sign.
Honestly, I kind of forgot about it until I asked at my physical last week, so now I am going to look for availability again. The rollout of this booster has been rough compared to early ones that the government had a bigger hand in.
The "pandemic is over" proclamations have definitely driven a lower uptake-- why would anyone "risk" mRNA vaccines and their side effects for a threat that is over? I am a federal employee, and we were *required* to get the initial series and the first booster. But none of my coworkers are getting the 2023 vaccine because "Biden says the pandemic is over". These are all highly educated, mostly liberal folks working in national security. This messaging was absolutely damaging to vaccine uptake, and it was absolutely irresponsible (not to mention incorrect) to make such a declaration.
No, people are individually assessing the "threat" that covid poses to them, and for the overwhelming majority, that threat is tiny (near zero). Now that the fear propaganda has died down and employers can't force/coerce people into taking these shots anymore, demand has predictably cratered. Also, not only were people mandated/coerced into taking the original shots, they were lied to about their effectiveness.
They are assessing incorrectly, because people (as a group) are really dumb.
The data on the damaging effects of COVID are out there, people are just not paying attention until they get Long COVID. This is a horrendous public health and education failure.
But yeah, the vaccines are not as protective as they need to be, that much I can agree with you on. That said, I'll take 10% protection over zero, since no one is doing anything to prevent infection anymore.
Your take on the threat of COVID is wholly inaccurate and you're actively spreading disinformation.
Please finish Biden’s quote. He said, “The pandemic is over, but Covid is still around.”
Hopefully Pfizer will soon exit the market - capitalism’s creative destruction at work!
I'm no capitalist, but your hope that Pfizer exits the market is extremely short-sighted. If Pfizer exits, Moderna also probably will. And Novavax is not going to be around long... The vultures are circling.
The way capitalism is supposed to work is the worst vaccine fails, and the better vaccines take over. That benefits everyone - even Pfizer (who stops losing money and can now use those resources to pursue products where they excel).
The economics of vaccines never work like that, and never have. Vaccines are a "common good" for which there is little incentive toward development and production. Most vaccines don't take the constant updating that flu and COVID do, so it takes government action/investment to keep these companies doing (extremely expensive) R&D to keep up to date. If they don't get that investment, they won't do it. There are no companies that can afford to do this COVID vaccine development and updating without government investment or some level of profitability.
There are no companies on the horizon who can do this. Vaccines should never be a capitalistic venture because there is no real money in vaccines. There needs to be government support.
Again, what you're advocating is a very uneducated and short-sighted stance that will have horrific effects on public health.
A big problem with capitalism is that it depends on a considerable amount of mandatory secrecy, especially where publicly traded companies are concerned. I believe this has a deleterious impact on a lot of regulatory transparency in the space of drug safety and efficacy, and public health. Martha Stewart and Elizabeth Holmes cast long shadows.
The NYT had an article a few weeks ago (link below) that very softly suggested Novavax might be better. I can understand the constraints of PH but mainstream papers don’t seem to want to say anything unfavorable about the mRNA vaccines. Hopefully word of mouth will soon kick in and give Novavax a boost. I’ve become a Novavax evangelist among my family and friends. Word of mouth builds slowly but can be very powerful.
https://www.nytimes.com/2023/11/06/well/live/covid-vaccines-novavax.html?smid=nytcore-ios-share&referringSource=articleShare
(The reader comments are worth checking out! No wonder people don’t want boosters)
Also good data that would allow us to compare different vaccines can be hard to come by, since it would constitute material information about publicly traded companies.
I had to drive 45 minutes for my Novavax vaccine. I know I’m privileged to be able to do so. I wish it were more readily available.
Thank you. Your column helps me make reasonable decisions about ppe. As a volunteer in a children's hospital, I rely on the printed ppe recommendations posted outside each patient's door. After reading your post, I will begin wearing my KN95 mask at all times in the hospital starting during my next shift. I am 76 yrs, had Covid twice between Jan and April of 2023 in spite of two Covid vaccinations and two boosters. Now, I have long Covid and hypothyroidism. Within the last month, I was vaccinated again for Flu, the most recent Covid booster, and RSV. When traveling to the hospital where I volunteer, I ride public transport, so I wear a mask on the train. Prevention is a better choice than the risk of illness.
But, I am guessing that, if your local children’s hospital is like ours, masks are not required. And the medical professionals are not masking. We are routinely the only folks masking in medical facilities.
Thanks as always for the common sense advice. It’s good to read up as much as we can, and do what we can to keep ourselves and each other safe. We just got back from Belgium and France 🇫🇷 on a WWI tour. Another time, and age when influenza devastated the world. We masked with N95s almost everywhere and got a booster a month before we left. I observed we were the only ones masked on the plane, airport, public transportation, museums etc. I’m retired healthcare professional and really did not care what anyone thought. When I did have a conversation about COVID people were uninformed of the risks. History repeats.
absolutely agree!
Another factor that I think might be part of this that I didn't see addressed (and I don't see it addressed as much as it should be) is the problems with testing for COVID. Without testing, people don't know they have COVID, so they just assume "allergies" or a "regular cold" and then carry on with their normal activities, which means they're probably infecting a TON of people since COVID is so highly transmissible.
1) PCRs are very VERY difficult to find in most areas now. In my 300k+ population area, Walgreens, CVS, city/county government, etc. shuttered their PCR testing locations and act completely amnesiac when you ask them about how to get PCRs.
2) PCRs are also are not covered by insurance anymore in many cases, and people cannot afford $175+ for a single test, let alone multiple members of a family.
3) PCRs are given indoors. Which means that to find out if you have COVID, you have to remove your mask... and possibly get COVID. In my COVID cautious circle, many of us avoid PCRs because if we don't actually have COVID, we might get it in the process of getting a PCR. Insane.
4) NAAT/molecular tests like Lucira, Metrix, and Cue are supposed to be more accurate than antigen tests and are supposed to be PCR-like in terms of accuracy, but are mostly unaffordable and inaccessible for most. The cost is astronomical (usually around $50/test)-- which means that it's not accessible for the overwhelming majority of individuals, let alone families-- and they're only sold online, which means you have to think ahead and have a stash of them on hand.
5) Rapid antigen tests (RATs) are generally more affordable, but are simply ineffective tools. Reports are showing that RATs are missing upwards of 60% of positive COVID cases. My own household member just had their first bout of COVID in October, and they were fully symptomatic (coughing, congestion, exhaustion) for *** 8 FULL DAYS *** before testing positive on Flowflex and iHealth, which are supposed to be some of the most sensitive RATs on the market. They tested on Day 2, Day 4, and Day 6 (first thing in the morning, swabbing throat/inner cheek/nasal passages), and it still took 8 days to test positive. Had they trusted the first 6 days of testing, they would have infected our whole household and heaven knows who else.
6) Because RATs are missing infections, or not finding them until many days after symptoms start, people are finding out they are positive when they are outside of the 5-day Paxlovid window. Which means that infections might be far worse than they ordinarily would be if people could get access to Paxlovid.
Again, the way the CDC and Biden Administration have handled this pandemic is absolutely horrid. They have failed on tools, messaging, vaccine rollout, etc. Because of this, we are literally sitting ducks for whatever pandemic comes next (which experts in epidemiology and virology are saying is inevitable within the next decade), and this inept Administration and its pathetically political CDC have positioned the American people to openly embrace the next deadly pathogen and refuse information, respirators, vaccines, treatments, testing, etc-- assuming we could even get vaccines and testing in time to make any difference. Well done.
You might consider ordering a mail in PCR from Labcorp, buying swabs separately, and doing a group test for your entire household.
If that test is positive, follow up with some rapid tests.
"Again, the way the CDC and Biden Administration have handled this pandemic is absolutely horrid." Who was it in the oval office when this pandemic started again? You seem to have forgotten that in your need to blame everything on Biden.
Nope. Trump was an absolute psychopath. He handled it terribly.
Biden ran on saving us from COVID, and has done everything in the Trump playbook. I wish more of my fellow liberals could see this instead of believing that everything he's done is great on COVID. I voted for Biden, enthusiastically, and have watched him behave worse than Trump and lose more people and not care. I'm not excusing him just because he has a (D) next to his name. And my fellow Dems shouldn't, either. Pay attention to data and behavior, not glowy messaging.
"Pay attention to data and behavior, not glowy messaging." Yeah, that's me, just a chump for "glowy messaging" who is incapable of rationally evaluating the situation.
Pfui. I am paying attention to the data. Are you? Because I seriously question the claim that Biden "has done everything in the Trump playbook." I mean: Ivermectin, hydroxychloroquine, "Chinese flu," etc. Viz. https://www.kff.org/coronavirus-covid-19/issue-brief/comparing-trump-and-biden-on-covid-19/
In your determination to jump on the "Blame Biden" bandwagon, you have completely ignored the dogged opposition to every single thing this administration has attempted to do by a "Republican" Party that has become a hotbed of anti-vaccine, anti-masking, anti-public health, and anti-science dogma.
The notion that Biden has behaved "worse than Trump" is clearly at odds with reality.
I must say that I agree, but it's really a mess, and became too politicized, and Trump, OMG God Help Us All no matter whether one is liberal, conservative, independent, ..
Yes, I don't want to give the impression that I think the lack of an actual public health system in the USA isn't a disaster waiting to happen.
I think there's another huge factor in play with respect to difficulty remembering, concentrating, etc.... screen time. Digital distraction. Whatever you want to call it.
At the beginning of the pandemic, screen time was already a problem. BUT reliance on Chromebooks and apps for education did not go away when virtual school ended. Teachers continue to rely on these electronic tools for learning, and this isn't doing kids any favors.
We know that screens create shorter attention spans. I suspect they are contributing to these other cognitive issues, also. As more adults work from home than they did pre-pandemic, and just the way technology is rapidly changing, I think this is contributing to these cognitive issues for everyone from young children to older adults.
I am not suggesting that long covid isn't a factor for some, but I know my attention span and concentration has been plummeting for a few years, and I only had covid recently. I think we need to consider more about some of these external factors.
Agree - my attention span decreased majorly in 2020-21 due to all my social media and screen time. I got covid in 2022. Since 2021 I’ve forced myself to read BOOKS - not articles and just scrolling - and it’s gotten better.
According to a recent study, COVID infections were associated with a higher risk for RSV in children in 2022:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10582888/
This is the conclusion of the researchers:
"Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system."
Thanks for the information. I had a feeling that all 3 of these were increasing in my area. I work in healthcare and I've heard a lot of reports from our patients saying that they or a family member have been ill. A new trend that I'm seeing is very few people test for Covid now. It's like they simply would rather not know if they have it. I suspect that is because they don't want to be forced to isolate and miss school or work. If they play the "ignorance is bliss" game, they can go back when they feel better. If they test for Covid and are positive, they have to miss a full week and many can't afford to do that.
The "testing industrial complex" is a huge waste of resources. We have performed billions of covid tests over the past 3+ years and it hasn't had any affect on the spread of the virus. A virus this contagious is simply not controllable.
See the sad thing is, I almost agree with this, but you really aren't the best messenger, thanks to all the bile you spew.
The expense of tests also may be an issue. I have a friend who works with kids. She has been sick, so has taken a COVID test a couple of times while she had symptoms. They came back negative, and she didn't test again because, at $15 a pop, she doesn't feel it is worth it.
In addition to long COVID and other (medical and socio-economic) reasons for the reported rise in brain fog/cognitive symptoms, I wonder if the shortages of ADHD medications have something to do with it, along with the dysfunction of the retail pharmacy sector? I know several young people who have been struggling to get their prescriptions filled, because the pharmacy is out of stock, or because they no longer answer their phone and require in-person visits.
Example: In New York State, stimulant medications require a new prescription every 30 days; and if the doctor sends a new prescription, say, 25 days after the last one, the pharmacy won't just wait until 30 days to fill it - they will not fill it at all unless the patient contacts them to request it. And many pharmacies are so understaffed that they no longer answer their phones. So you can stand in line to get them to refill it, then either wait for them to do so on the spot, or find out it's not in stock and have to come back in person again.
That's a lot to manage for young people who are already struggling with executive function...
Dr. Jetelina, how do you assess whether to mask in crowded areas like airports? It seems like the risk of catching COVID in such a space would always be high, even when COVID rates are down, so I was surprised you had stopped doing so. I’m not asking sarcastically but am genuinely looking for some guidance as I decide whether or not to mask in various situations. Thanks.
I have always appreciated your data driven approach, but I think it is jumping the gun to say the increase in those reporting memory and concentration issues is from long Covid. In my primary care practice we are getting slammed with patients with these concerns. Some of them clearly have long Covid and sure long Covid is probably being missed in many people, but 10:1 I am seeing people for whom work from home doesn’t work, for whom the current labor market doesn’t work, and/or for whom relationships with family, friends and their community have not yet recovered from isolation. Anxiety is out of control. Loneliness and depression are sky high. Is some of that long covid? Maybe. But all of it? Even most of it? No way. I know of no data to back up your assumption. In its absence, ask those of us in the trenches so we can start asking the right questions and getting the data we need. It would be much more productive than assuming.
There is a growing body of data showing mental health issues-- especially anxiety and depression-- after a COVID infection. Here's one: https://n.neurology.org/content/100/17_Supplement_2/1998
There are also a ton of documented issues with sleep after a COVID infection (very VERY common in the Long Covid community), and we know that chronic sleep deficits negatively impact mental health.
It really isn't an assumption to link COVID infections to mental health issues. There is a preponderance of evidence pointing in that direction.
You are right, there are definitely links between long covid and mental health. But it a big leap from that to say that the massive increase in concentration issues is attributable to this alone or even mostly. A lot happened to people and their brains during the pandemic that was not Covid itself. Anxiety was increasing even before the pandemic. We saw lots of mental health issues in kids doing remote learning long before most of them got Covid. I’m not saying Covid isn’t part of it, but let’s not rule out the many other things going on in the world that also need to be considered, so that we can get more data and address these issues more comprehensively.
Wow. Referencing that NYT article about brain fog and saying it is "undoubtedly long covid" is irresponsible. Yes while Long Covid may be the cause in a small number of cases, another significant cause is likely anxiety and other mental health challenges that were seriously exacerbated by pandemic. As the NYT article states but you omit "The sharp increase captures the effects of long Covid for a small but significant portion of younger adults, researchers say, most likely in addition to other effects of the pandemic, including psychological distress. But they also say it’s not yet possible to fully dissect all the reasons behind the increase." Please be more responsible when you relay information.
Thanks for your comment. I see how these few sentences may seem irresponsible, but as an epidemiologist, I’ve thought about this a lot. One huge strength to this disability data is that we’ve had it for decades. This is great because we can look at other events, like 9/11 or the 2008 recession, which were also stressful for a lot of people (albright not as stressful on a national level like covid) and didn’t have an impact on disability data. I think it’s also interesting that this didn’t rise for other age groups. I would argue that the pandemic was equally as stressful for all age groups (if not more stressful for older adults). Like I said, more probing is needed
Every working parent I know is absolutely drowning, and has been since the start of the pandemic. I think the pandemic just made clear how unsupported we all are and that realization continues to affect our mental health. I went 36 years without any need for therapy or meds, but now 3 years in I still need both. I also know several women who were diagnosed with ADHD or ASD the past few years though their symptoms aren’t different from when they were younger, there is just more awareness now.
This is absolutely my anecdata, too, from my personal point of view as a single parent. But that isn't the only issue. Long COVID is absolutely destroying people's ability to function, and that can't be explained away as "stress".
I guess I’m just lucky, I don’t know a single person in real life with long covid (or new health symptoms post-covid). It absolutely exists, it’s just hard to put so much weight on that when I don’t see any examples in my own life.
Well, and lots of the TMS/MBS experts believe that long Covid is nervous system disregulation. I have read so many stories of people who have healed simply by doing work to get out of the constant state of “fight or flight” and fear. It’s fascinating. The brain is a remarkable organ.
I definitely had cognitive issues over the summer caused by.....
GLOBAL WARMING
My air conditioners simply couldn't keep up with the heat and humidity, and I lost a lot of sleep.
I was a Novid until this autumn
I appreciate your response. This pandemic is unprecedented and I don't think that we can compare its effects to anything else. Given the many other factors at play, including as others have mentioned social media, pressures on families, effects of isolation etc., there just isn't sufficient support for the assumptions you made. I am a parent to four teens/young adults, ages 13 through 21. The pandemic itself has been phenomenally hard on that age group. I understand your commitment to providing concise and digestible content but sweeping statements without sufficient evidence actually fuel anxiety.
The top reader comments all attributed mental decline in young adults to social media.
THAT is irresponsible. Social media has been around for a while, but the stark downturns started with COVID.
Mental health has been declining among young people far before the pandemic.
Isn’t social media one of the drivers of mental decline (even before covid)?
Exactly, they were already a vulnerable group. I'm not surprised that the pandemic itself (not the virus per se) would have a more significant impact on the cognition of younger people.
Maybe you should read some of the comments and understand their rationale before casting judgement.
I have read it. I stand by my comment.
Right, with the PANDEMIC, which seriously impacted mental health. There are many factors involved. That’s the point.
I completely and totally agree with that.
This seemed odd to me too without further explanation and research. The pandemic times were tough, but there were many fewer things to do and fewer big decisions to be made. As soon as I read that stat, I thought that perhaps getting more back to "normal" could be some of the cause. Many parents said that the one thing they appreciated about the pandemic time was not rushing around to kids' activities, and the age range of the forgetfulness falls right in the range of the busiest child care years.
Just dropping in to say that risk reduction is fine, but it's also OK to have a lower risk appetite and remain true to that, peer and family pressure notwithstanding. So if you still think that the residual risk is still too high even after various forms of mitigation, or if you find the mitigation itself takes away from your enjoyment of something - whether it's a funeral, or a wedding, or a party, it is TOTALLY okay to skip it, and "No" is a complete sentence that doesn't require further explanation.
(Also, it's a 100% legit strategy to bluff, and say that you don't want to do something and have a set of demands in mind)
Long Covid and the subsequent brain fog and cognitive injury that it causes are very real problems that have not been adequately addressed at a national level. With your platform it would be great if you could campaign for more research. There are multiple other sequelae of long Covid that are crying for research dollars