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.
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.
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).
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.
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.
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.
"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.
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.
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.
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...
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.
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.
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
State of Affairs: November 16
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.
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.
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).
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.
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.
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.
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.
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.
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.
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...
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.
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.
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