Happy Halloween! Is this respiratory season getting spooky? (I couldn’t resist.) Here is your State of Affairs. Influenza-like illnesses The climate of respiratory health in the United States (coined “influenza-like illnesses by CDC) continues to creep up but still remains below the “epidemic” level threshold. So far, this year seems to have landed somewhere between pre-pandemic years and last year.
Thanks for the epidemiological update. It parallels what I’m seeing in my little primary care world. With the capacity to do rapid tests for Covid, Flu A + B, and strep, I’m really amazed by how much of these three are really out there this Fall. I’ve been seeing that steady churn of Covid that never seems to die, but surprised with a decent number of influenza B cases over the past month. I’ll trust the CDC maps, but I’m glad I got my flu shot a bit earlier.
If you don’t test, you don’t know. For example, 40 something female with sore throat, only gets a rapid strep test at urgent care, but tests positive. Treated with amoxicillin. I see her a couple days later for regular/chronic problems, and she’s not feeling better so I do the above… turns out she has influenza B and Covid! Unusual case but wow. Just because we have one doesn’t mean we can’t have other simultaneous infections. This is the first trifecta I’ve seen though. She’s doing well, thank goodness and vaccines, despite necessary immunosuppressive meds. Added paxlovid to amox, too late to treat flu.
My XBB booster has held up to at least one unmasked Covid exposure so far (bat mitzvah party I couldn’t in good faith mask for).
And yeah, stealing Kit Kats is one of those sacrifices we make so our children eat less sugar themselves. Scientists also suggest that we alleviate the York Peppermint Patty burden for our children’s sake.
It was really shocking, although technically 2 viral and one strep bacterial. I think kids + immunosuppressant + presenteeism + no masking? Good luck out there :)
Something I wish we'd pay more heed to is the extent to which people with weak or non-functional immune systems pose a threat to one another. The cystic fibrosis community were the original "social distancers" long before the pandemic - people with cystic fibrosis are strongly urged to avoid one another.
I work in communicable disease, and we see coinfection all the time. It gets caught much more if someone is hospitalized because they get a full workup. Multiple GI, tick borne and GI, multiple respiratory. Especially if immunocompromised.
Seems that I read that Strep tests are fairly accurate, especially positive results.
What are the limitations of the rapid strep test?
There are several manufactures of rapid strep tests. Each manufacturer has designed their test to respond only to the presence of the particular streptococcal bacteria (Group A) responsible for strep throat. Other bacteria which are less much less likely to cause sore throats are not identified by the rapid strep test.
The test will not detect viral causes of sore throat.
A positive test response occurs when a reaction occurs between a protein on the surface of strep bacteria and chemicals in the test materials. Either living or dead strep bacteria will produce a positive reaction.
Most rapid strep tests have a sensitivity of 95%, meaning that the test will be positive in 95 of 100 patients who are documented to have strep throat via throat culture obtained at the same time. Since 5 of 100 patients with strep throat will be missed using a rapid strep test, all negative swab specimens should be sent for culture to confirm the absence of strep bacteria.
A positive culture requires antibiotics.
The rapid strep test has a 98% specificity. This means that 98 of 100 positive tests correctly indicate the presence specifically of Group A streptococcus bacteria; 2 of 100 positive results are "false positives" - indicative of similarities between various surface proteins found on strep bacteria and other non-strep bacteria
Actually I think there's good reason to belive that "having disease X" and "having disease Y" are not stochastically independent. If I was a gambling man, and you told me someone had strep, I'd totally put more odds on additional respiratory diseases.
For example one of the standard "gotchas" in probability is a panel of "independent" judges scoring a figure skating competition. Are their scores stochastically independent?
Answer: NOPE
If one of them is giving a high score that suggests that the person really is good.
The math should be the same with co-infections. If someone's already got strep it's that much more likely that they're prone to URTI's, and if you should place your bets on them having additional infections.
In my prior world as a breast oncologist, that was the mantra for reading mammograms. SEARCH SATISFACTION. If you find one breast cancer, don't pat yourself on the back and stop looking for a 2nd cancer. It happens!
My husband and son got COVID and were not tested for strep until later, which they both ended up having as well. Hard to catch these coinfections outpatient when the symptoms overlap so much!
And even if you do test, you still might not know. My sister just got COVID for the first time (we are 100% N95 maskers indoors and out, but she has just taken a 10-day vacation to Switzerland).
She tested positive 3 weeks to the day after her Moderna 2023 vaccine. She was fully symptomatic (congestion, barking cough, exhaustion) for 8 days before she finally tested faintly positive on FlowFlex and iHealth. She had tested on Day 2, Day 4, Day 6, and Day 8– all clear until Day 8. She swabbed throat, cheeks, nose every time, first thing in the morning after blowing her nose.
Even if they test, no one is testing that much or that long (or that thoroughly) so I am guessing we are missing a LOT of COVID.
I completely agree, and I’ve heard this especially after a recent booster as neutralizing antibodies are high and viral shedding is low. Hope she is doing better! Can’t be much more careful, considerate, or diligent than what she did
Nothing presented indicates we are turning a corner with covid. We’ll know more after January.
Regardless, we should expect covid to be with us indefinitely and that means the decorum of our social gatherings, especially during the holidays, has to change. Meeting with others indoors will always be a risky undertaking as long as we don’t take precautionary measures. How do you get the cooperation of the people your meeting with when there is no customary precautionary standard, such as with a group getting in a car together. No one has to ask anyone else to please fasten their seatbelt. We just do it. Similarly with covid, we need to establish a certain level of cooperation without anyone having to ask for it. It would make a welcome difference in the foreseeable future if social gatherers routinely took rapid antigen tests before coming together. Presently, it appears that we are succumbing to the lowest common denominator of peer pressure. We just cross our fingers and hope for the best.
Instead, we should come up with a hygienic customary practice to keep everyone safer when socializing.
My county recently got rid of their COVID dashboard in favor of a respiratory illness dashboard. Mostly, it's a good thing. There are some weaknesses, but some interesting insights if we're willing to look.
Some interesting insights I saw:
- They test the air in schools for COVID now! Last week, only 9% of samplers found COVID. But just a few weeks ago, it was 58% (100% of samplers in high schools!). 0% of samplers found influenza since school has started.
- Looking at school absences, rhino- and enterovirus are the most common reason kids are currently missing school, although we have our first confirmed RSV absence already.
- The influenza wave was higher than any of our COVID peaks this year BUT....COVID never really goes away. Flu caused hospitalizations from mid-November through early-February and RSV October - January but COVID has caused them the past 12 months.
- Likewise, (ignoring co-infections), RSV killed one person in October and influenza killed 8 people from November - February. COVID killed at least one person every month and there were 7 months that surpassed the 12-month RSV + Flu deaths.
Not on the dashboard but baffling/interesting: COVID never really goes away in our wastewater. In some nearby counties that report flu and RSV and COVID, there's about 100+ times as much COVID as influenza A + influenza B + RSV. No clue how those viruses compare in terms of shedding into the water. But again, RSV and influenza go away from Valentine's Day through Halloween for the most part, COVID is just always with us.
This is really interesting! I think the transparency and public communication is helpful. Where are you located? It's encouraging to see this kind of work still happening.
One thing I wished we had that I see Illinois doing is wastewater data that includes RSV and influenza. Broken out by disease. But overall, I feel like they're doing a good job
Ooh, do you have a link regarding the air sensors? And do you have a sense of how much noise they make? That always seems to be an issue with these sorts of things.
Frustrated Pharmacy Tech here. The Novavax vials that we've received contain 5 doses. Once a dose is removed, they expire in 12 hours. So when ONE person requests Novavax, we end up throwing away FOUR doses at the end of day. It's horrible. The Moderna vials are now single-dose, so nothing is getting wasted.
Thank you for posting the virus data graphics. We post them in our vax area to encourage vaccine customers to talk up the benefits with friends and family.
Who got text messages from the CDC? I never did, not once since this started. I do live in Florida where DeathSantis made everything he could about Covid protections illegal (no mask mandates for schools no matter how bad it gets, lying about Covid data, etc.) We've never had any contact tracing either. We still don't get Covid information. The vaccines would be illegal here if DeathSantis had his way.
Thank you for bringing us important info that's easy to understand and easy to share. I rely on it.
I think it's important to remind readers that mask use in public spaces and test-to-gather to support mask removal for personal gatherings are reliable ways to step out from under the curve. We can limit the size of the curve if we return to the tools of a vaxPlus strategy.
Thanks for your work.
[I had a similar experience of being sidelined with side effects from each of 5 mRNA, and no side effects from recent Novavax :) ]
Thank you so much, as always, for the clear, succinct update! Two questions re wastewater data for Dr. Jetelina, or anyone who happens to know: I read a New York Times article reporting that, due to a dispute re the CDC move from Biobot to a new contractor, which is unlikely to be resolved before early next year, wastewater data is not being collected for about a quarter of the sites. This appears to explain why I have seen no reported data for NYC in recent weeks. Not having this data for NYC, of all places, for the whole of the holiday season, is beyond troubling. So:
1) if there is no wastewater data for NYC (or any other area without it now), what can we look to to determine trends for Covid during the holiday period?
2) can pressure be put on the CDC to get this dispute resolved BEFORE the holiday season is on us, and, if so, to whom at the CDC should such concerns be directed?
The NYC reports are a little old, but you can probably make educated guesses by looking at nearby counties: Nassau, Suffolk, Westchester, Rockland, Orange.
Thanks for the link, much appreciated (I had looked at what NYC has, which is useless, but hadn’t thought to look at NYS. It really is absurd that there are no samples for all of NYC. I have been extrapolating from eg Nassau, which biobot does have, and I think CDC, also. Problem, of course, is the density in NYC is much greater. Really a travesty that NYC has simply dropped out of the mix.
This is too complicated for this mere mortal😎, but I wonder whether looking at the Covid mortality trend line on the CDC site would work in the same way. That’s very easy to read.
We'll see. I'm still not sold on wastewater surveillance as the most appropriate thing as an ongoing measure of prevalence. It was originally conceived as a tool for early detection of new pathogens in an area. Some issues:
1. Super-poopers - some people shed a whole lot of viral RNA in their stool. Are they even infectious?How will this correspond to prevalence going forward? Or everyday risk?
2. People can have detectable RNA in their system for a very long time. Wastewater surveillance inherits this issue, since it's using the same tech (PCR). This really shouldn't be surprising: there's a reason that "archaeogenetics" is a field unto itself! We've found wooly mammoth DNA from 100,000 years ago. RNA and DNA fragments stick around.
3. There doesn't seem to be a strong consensus on how best to normalize the data. Some places are using estimates of flow rate based on census data, others are using pepper mild mottle virus (a plant virus thar shows up in a lot of people's stool)
4. Lack of consent/privacy - in some cases it's possible to drill down to a single block/building and narrow down to households/workplaces. During my recent bout of Covid, I'll confess that I started putting Clorox tabs in my tank for exactly this reason. Not very interested in non-consensual de-anonymization, on principle.
These are all good points. What I’d say is, it’s all relative. Right now, it seems to be the best proxy we have, and without it, it’s not clear to me what we have at present that can aid us in assessing risk. Any thoughts on that? What do you use?
Not sure I'd necessarily consider it the best proxy. Wastewater is supposed to be a proxy for prevalence, but if you think about it, prevalence is itself a proxy for something even less tangible and more subjective - "risk".
A crude but easy way to estimate prevalence might be to extrapolate from mortality rate. If we assume a mortality rate of 0.1% - one in a thousand - we could make a fair guess as to the prevalence based on that:
So for instance, as of today, I'm looking at 637 covid deaths in the past week, and a percent complete at 49.9%, so that's a 1277 covid deaths in the past week. Multiplying by 1000, I'm guessing that corresponds to, say, 1.3 million cases a week (rounding up a tad) or (again rounding up) 190,000 cases a day. And I think there's enough mixing and non-masking that the rates are fairly uniform. Having already had my XBB shot and having recently recovered from covid (and having confirmed that I acquired some nucleocapsid antibodies to add to my arsenal) I'm not *as* concerned about these rates as I might otherwise be.
Also the nice thing about using mortality data as a way to reconstruct prevalence (and risk) is if someone comes back to you and minimizes the risk of dying from covid, you've got them on the proverbial horns of a dilemma - they're either going to have to admit that the disease is way more dangerous, or that there are way more cases than they'd figured.
THANK YOU! Very helpful as always. Have fun with your kids tonight! BTW I noticed last night that Alex Wagner was subbing for Rachel Maddow on MSNBC last night, because, she announced, Rachel has Covid. I think it is significant that they made it a "we're not going to hedge around it, but it's not a big deal, we are being responsible, it IS still out there" kind of moment.
We've been long advised that no-to-minimal side effects of the Covid vaccines did not indicate ineffectiveness, but a new study from (mostly) UCSF found otherwise. The increase in nAB of 140%-160% seems significant. Idk what nAB means, I'm just parroting the abstract. :-) Thoughts? https://www.medrxiv.org/content/10.1101/2023.09.26.23296186v1
I hope this isn’t true, honestly, because my kids and I never have any side effects from Pfizer or Moderna apart from a sore arm.
We have never had COVID, but we are super careful and mask everywhere (even outdoors) with N95/FFP3 masks. For us, the vaccine is our LAST line of defense, not our ONLY.
TY for this comprehensive update AND for your experience with Novavax. I was unable to locate it in Houston so I got the current Moderna vax with the same 48 hrs of flu-like sx. Due to my usual 48-hr side effects, I didn't get the RSV at the same time. Now I have a mild URI so I'm waiting to get the RSV. Still, so many folks are NOT GETTING immunizations for the usual reasons--I never get sick, I don't want to put that into my body. EPOCH Times continues to share negative effects of Covid vax in a way that suggests only unthinking folks would consent to it. One of the greatest achievements of medicine, Vaccinations, being not only dismissed but denigrated! TY again.
I’m in the Northeast and COVID is going strong. Nursing home outbreaks, hospitalizations, deaths are all high for my area. It’s part of my job to track and investigate them...these are COVID related complications and protracted hospitalizations, not people with other issues happening to test positive.
Do you have a sense of how much spread is nosocomial right now? My use of the health care system increased dramatically in September (PT for adhesive capsulitis) and it wasn't long before I got Covid.
Only in the sense of patients already hospitalized for other reasons contracting COVID during their stay. That is certainly happening and affecting length of stay. I’m immunocompromised and am pretty much only the one masking, even at places like a rheumatologist which has many immunocompromised patients. I did have a dermatologist who wore an N95 recently during my visit, which was great!
Now that some people have gotten the vaccine, is there any updated data on neurological side effects of RSV vaccine for adults ? Having a hard time deciding whether to get the shot (I'm 74 years old).
Love this. In spring availed myself of the 8 covid tests per month I was entitled to as an old lady. Recently also took advantage of the additional offer from the govt for 4. Here's the irony: even figuring in the extended expiration dates, the 2 boxes I just got will expire well before any of the dozen or so I scored this spring.
Covid appointments fraught again this year. Walgreen's appointment canceled last minute 10/6. We're now scheduled for 10/31 at a Rite Aid. When I heard Rite Aid declared bankruptcy and was closing stores, I backstopped us with appointments at Costco for 11/9. What a commotion (as my dear departed MIL would say).
I tested positive for COVID in August, so I'm hoping to get the Novavax vaccine this winter! My side effects were never as bad as yours, but I'd prefer no side effects at all for sure.
I would really like to see a YLE post on any data on effectiveness against infection, differentiating between those with “hybrid” or not. I understand this data is hard to come by…but isn’t anyone tracking this??
Thanks for the epidemiological update. It parallels what I’m seeing in my little primary care world. With the capacity to do rapid tests for Covid, Flu A + B, and strep, I’m really amazed by how much of these three are really out there this Fall. I’ve been seeing that steady churn of Covid that never seems to die, but surprised with a decent number of influenza B cases over the past month. I’ll trust the CDC maps, but I’m glad I got my flu shot a bit earlier.
If you don’t test, you don’t know. For example, 40 something female with sore throat, only gets a rapid strep test at urgent care, but tests positive. Treated with amoxicillin. I see her a couple days later for regular/chronic problems, and she’s not feeling better so I do the above… turns out she has influenza B and Covid! Unusual case but wow. Just because we have one doesn’t mean we can’t have other simultaneous infections. This is the first trifecta I’ve seen though. She’s doing well, thank goodness and vaccines, despite necessary immunosuppressive meds. Added paxlovid to amox, too late to treat flu.
My XBB booster has held up to at least one unmasked Covid exposure so far (bat mitzvah party I couldn’t in good faith mask for).
And yeah, stealing Kit Kats is one of those sacrifices we make so our children eat less sugar themselves. Scientists also suggest that we alleviate the York Peppermint Patty burden for our children’s sake.
👻
"If you don't test, you don't know". How true. Wish we were testing much more, but people are so over it.
I’m curious, if you know, how on earth does someone catch 3 viral infections at once? Please let us know so we can avoid a similar scenario!
It was really shocking, although technically 2 viral and one strep bacterial. I think kids + immunosuppressant + presenteeism + no masking? Good luck out there :)
Something I wish we'd pay more heed to is the extent to which people with weak or non-functional immune systems pose a threat to one another. The cystic fibrosis community were the original "social distancers" long before the pandemic - people with cystic fibrosis are strongly urged to avoid one another.
https://cystic-fibrosis.com/clinical/6-foot-rule
My mom has CLL and she makes a point to steer clear of others "like her."
Thanks - makes me wonder if one (or more) of the test results was a false positive?! That seems more likely than a trifecta in one person. 🤷♀️
I work in communicable disease, and we see coinfection all the time. It gets caught much more if someone is hospitalized because they get a full workup. Multiple GI, tick borne and GI, multiple respiratory. Especially if immunocompromised.
Remember Hickham's Dictum, a person can have as many diseases as they darn well feel like. Not unheard of, though uncommon.
Remember Occam's razor: the simplest (or most likely) explanation is usually the correct one.
Occam was not a physician, Dr. Hickham was.
I considered that too!
Seems that I read that Strep tests are fairly accurate, especially positive results.
What are the limitations of the rapid strep test?
There are several manufactures of rapid strep tests. Each manufacturer has designed their test to respond only to the presence of the particular streptococcal bacteria (Group A) responsible for strep throat. Other bacteria which are less much less likely to cause sore throats are not identified by the rapid strep test.
The test will not detect viral causes of sore throat.
A positive test response occurs when a reaction occurs between a protein on the surface of strep bacteria and chemicals in the test materials. Either living or dead strep bacteria will produce a positive reaction.
Most rapid strep tests have a sensitivity of 95%, meaning that the test will be positive in 95 of 100 patients who are documented to have strep throat via throat culture obtained at the same time. Since 5 of 100 patients with strep throat will be missed using a rapid strep test, all negative swab specimens should be sent for culture to confirm the absence of strep bacteria.
A positive culture requires antibiotics.
The rapid strep test has a 98% specificity. This means that 98 of 100 positive tests correctly indicate the presence specifically of Group A streptococcus bacteria; 2 of 100 positive results are "false positives" - indicative of similarities between various surface proteins found on strep bacteria and other non-strep bacteria
https://www.medicinenet.com/rapid_strep_test/article.htm
However, it remains a possible explanation but I posit that, since administration of amox, we're likely to see negative (maybe false negative?)
Actually I think there's good reason to belive that "having disease X" and "having disease Y" are not stochastically independent. If I was a gambling man, and you told me someone had strep, I'd totally put more odds on additional respiratory diseases.
For example one of the standard "gotchas" in probability is a panel of "independent" judges scoring a figure skating competition. Are their scores stochastically independent?
Answer: NOPE
If one of them is giving a high score that suggests that the person really is good.
The math should be the same with co-infections. If someone's already got strep it's that much more likely that they're prone to URTI's, and if you should place your bets on them having additional infections.
In my prior world as a breast oncologist, that was the mantra for reading mammograms. SEARCH SATISFACTION. If you find one breast cancer, don't pat yourself on the back and stop looking for a 2nd cancer. It happens!
That was actually true for me.
My husband and son got COVID and were not tested for strep until later, which they both ended up having as well. Hard to catch these coinfections outpatient when the symptoms overlap so much!
And even if you do test, you still might not know. My sister just got COVID for the first time (we are 100% N95 maskers indoors and out, but she has just taken a 10-day vacation to Switzerland).
She tested positive 3 weeks to the day after her Moderna 2023 vaccine. She was fully symptomatic (congestion, barking cough, exhaustion) for 8 days before she finally tested faintly positive on FlowFlex and iHealth. She had tested on Day 2, Day 4, Day 6, and Day 8– all clear until Day 8. She swabbed throat, cheeks, nose every time, first thing in the morning after blowing her nose.
Even if they test, no one is testing that much or that long (or that thoroughly) so I am guessing we are missing a LOT of COVID.
I completely agree, and I’ve heard this especially after a recent booster as neutralizing antibodies are high and viral shedding is low. Hope she is doing better! Can’t be much more careful, considerate, or diligent than what she did
Nothing presented indicates we are turning a corner with covid. We’ll know more after January.
Regardless, we should expect covid to be with us indefinitely and that means the decorum of our social gatherings, especially during the holidays, has to change. Meeting with others indoors will always be a risky undertaking as long as we don’t take precautionary measures. How do you get the cooperation of the people your meeting with when there is no customary precautionary standard, such as with a group getting in a car together. No one has to ask anyone else to please fasten their seatbelt. We just do it. Similarly with covid, we need to establish a certain level of cooperation without anyone having to ask for it. It would make a welcome difference in the foreseeable future if social gatherers routinely took rapid antigen tests before coming together. Presently, it appears that we are succumbing to the lowest common denominator of peer pressure. We just cross our fingers and hope for the best.
Instead, we should come up with a hygienic customary practice to keep everyone safer when socializing.
I totally agree!
My county recently got rid of their COVID dashboard in favor of a respiratory illness dashboard. Mostly, it's a good thing. There are some weaknesses, but some interesting insights if we're willing to look.
Some interesting insights I saw:
- They test the air in schools for COVID now! Last week, only 9% of samplers found COVID. But just a few weeks ago, it was 58% (100% of samplers in high schools!). 0% of samplers found influenza since school has started.
- Looking at school absences, rhino- and enterovirus are the most common reason kids are currently missing school, although we have our first confirmed RSV absence already.
- The influenza wave was higher than any of our COVID peaks this year BUT....COVID never really goes away. Flu caused hospitalizations from mid-November through early-February and RSV October - January but COVID has caused them the past 12 months.
- Likewise, (ignoring co-infections), RSV killed one person in October and influenza killed 8 people from November - February. COVID killed at least one person every month and there were 7 months that surpassed the 12-month RSV + Flu deaths.
Not on the dashboard but baffling/interesting: COVID never really goes away in our wastewater. In some nearby counties that report flu and RSV and COVID, there's about 100+ times as much COVID as influenza A + influenza B + RSV. No clue how those viruses compare in terms of shedding into the water. But again, RSV and influenza go away from Valentine's Day through Halloween for the most part, COVID is just always with us.
This is really interesting! I think the transparency and public communication is helpful. Where are you located? It's encouraging to see this kind of work still happening.
I'm in Madison, Wisconsin.
One thing I wished we had that I see Illinois doing is wastewater data that includes RSV and influenza. Broken out by disease. But overall, I feel like they're doing a good job
Agreed, thank you for sharing this
Ooh, do you have a link regarding the air sensors? And do you have a sense of how much noise they make? That always seems to be an issue with these sorts of things.
I'm not sure what kind they use or how loud they are, but here's one of the researcher's sites.
https://dho.pathology.wisc.edu/
Frustrated Pharmacy Tech here. The Novavax vials that we've received contain 5 doses. Once a dose is removed, they expire in 12 hours. So when ONE person requests Novavax, we end up throwing away FOUR doses at the end of day. It's horrible. The Moderna vials are now single-dose, so nothing is getting wasted.
Thank you for posting the virus data graphics. We post them in our vax area to encourage vaccine customers to talk up the benefits with friends and family.
Some pharmacies hold “Novavax Clinics” and vaccinate people in groups of five to avoid the waste. Thank you for offering your customers choices!
Thank you! I'll bring that up with our manager. Great idea!
I got the idea from Liberty Pharmacy in Georgetown, TX. They keep a list and call people to set up clinics.
There must have been tons of waste when the government was paying for everything.
Who got text messages from the CDC? I never did, not once since this started. I do live in Florida where DeathSantis made everything he could about Covid protections illegal (no mask mandates for schools no matter how bad it gets, lying about Covid data, etc.) We've never had any contact tracing either. We still don't get Covid information. The vaccines would be illegal here if DeathSantis had his way.
Check out Dr. Jason Salemi's website. He's a professor of public health at the University of South Florida. https://covid19florida.mystrikingly.com/
The CDC only gets what the states submit. I don't trust this data is at all accurate.
Thank you for bringing us important info that's easy to understand and easy to share. I rely on it.
I think it's important to remind readers that mask use in public spaces and test-to-gather to support mask removal for personal gatherings are reliable ways to step out from under the curve. We can limit the size of the curve if we return to the tools of a vaxPlus strategy.
Thanks for your work.
[I had a similar experience of being sidelined with side effects from each of 5 mRNA, and no side effects from recent Novavax :) ]
Thank you so much, as always, for the clear, succinct update! Two questions re wastewater data for Dr. Jetelina, or anyone who happens to know: I read a New York Times article reporting that, due to a dispute re the CDC move from Biobot to a new contractor, which is unlikely to be resolved before early next year, wastewater data is not being collected for about a quarter of the sites. This appears to explain why I have seen no reported data for NYC in recent weeks. Not having this data for NYC, of all places, for the whole of the holiday season, is beyond troubling. So:
1) if there is no wastewater data for NYC (or any other area without it now), what can we look to to determine trends for Covid during the holiday period?
2) can pressure be put on the CDC to get this dispute resolved BEFORE the holiday season is on us, and, if so, to whom at the CDC should such concerns be directed?
I welcome any information anyone has on this.
For what it's worth, NYS is doing its own wastewater surveillance:
https://www.health.ny.gov/environmental/wastewater.htm
The NYC reports are a little old, but you can probably make educated guesses by looking at nearby counties: Nassau, Suffolk, Westchester, Rockland, Orange.
Thanks for the link, much appreciated (I had looked at what NYC has, which is useless, but hadn’t thought to look at NYS. It really is absurd that there are no samples for all of NYC. I have been extrapolating from eg Nassau, which biobot does have, and I think CDC, also. Problem, of course, is the density in NYC is much greater. Really a travesty that NYC has simply dropped out of the mix.
This is too complicated for this mere mortal😎, but I wonder whether looking at the Covid mortality trend line on the CDC site would work in the same way. That’s very easy to read.
We'll see. I'm still not sold on wastewater surveillance as the most appropriate thing as an ongoing measure of prevalence. It was originally conceived as a tool for early detection of new pathogens in an area. Some issues:
1. Super-poopers - some people shed a whole lot of viral RNA in their stool. Are they even infectious?How will this correspond to prevalence going forward? Or everyday risk?
2. People can have detectable RNA in their system for a very long time. Wastewater surveillance inherits this issue, since it's using the same tech (PCR). This really shouldn't be surprising: there's a reason that "archaeogenetics" is a field unto itself! We've found wooly mammoth DNA from 100,000 years ago. RNA and DNA fragments stick around.
3. There doesn't seem to be a strong consensus on how best to normalize the data. Some places are using estimates of flow rate based on census data, others are using pepper mild mottle virus (a plant virus thar shows up in a lot of people's stool)
4. Lack of consent/privacy - in some cases it's possible to drill down to a single block/building and narrow down to households/workplaces. During my recent bout of Covid, I'll confess that I started putting Clorox tabs in my tank for exactly this reason. Not very interested in non-consensual de-anonymization, on principle.
These are all good points. What I’d say is, it’s all relative. Right now, it seems to be the best proxy we have, and without it, it’s not clear to me what we have at present that can aid us in assessing risk. Any thoughts on that? What do you use?
Not sure I'd necessarily consider it the best proxy. Wastewater is supposed to be a proxy for prevalence, but if you think about it, prevalence is itself a proxy for something even less tangible and more subjective - "risk".
A crude but easy way to estimate prevalence might be to extrapolate from mortality rate. If we assume a mortality rate of 0.1% - one in a thousand - we could make a fair guess as to the prevalence based on that:
https://gis.cdc.gov/grasp/fluview/mortality.html
So for instance, as of today, I'm looking at 637 covid deaths in the past week, and a percent complete at 49.9%, so that's a 1277 covid deaths in the past week. Multiplying by 1000, I'm guessing that corresponds to, say, 1.3 million cases a week (rounding up a tad) or (again rounding up) 190,000 cases a day. And I think there's enough mixing and non-masking that the rates are fairly uniform. Having already had my XBB shot and having recently recovered from covid (and having confirmed that I acquired some nucleocapsid antibodies to add to my arsenal) I'm not *as* concerned about these rates as I might otherwise be.
Also the nice thing about using mortality data as a way to reconstruct prevalence (and risk) is if someone comes back to you and minimizes the risk of dying from covid, you've got them on the proverbial horns of a dilemma - they're either going to have to admit that the disease is way more dangerous, or that there are way more cases than they'd figured.
THANK YOU! Very helpful as always. Have fun with your kids tonight! BTW I noticed last night that Alex Wagner was subbing for Rachel Maddow on MSNBC last night, because, she announced, Rachel has Covid. I think it is significant that they made it a "we're not going to hedge around it, but it's not a big deal, we are being responsible, it IS still out there" kind of moment.
We've been long advised that no-to-minimal side effects of the Covid vaccines did not indicate ineffectiveness, but a new study from (mostly) UCSF found otherwise. The increase in nAB of 140%-160% seems significant. Idk what nAB means, I'm just parroting the abstract. :-) Thoughts? https://www.medrxiv.org/content/10.1101/2023.09.26.23296186v1
nAb = neutralizing antibodies
I hope this isn’t true, honestly, because my kids and I never have any side effects from Pfizer or Moderna apart from a sore arm.
We have never had COVID, but we are super careful and mask everywhere (even outdoors) with N95/FFP3 masks. For us, the vaccine is our LAST line of defense, not our ONLY.
Great news about the Novavax! Thanks for the timely update
TY for this comprehensive update AND for your experience with Novavax. I was unable to locate it in Houston so I got the current Moderna vax with the same 48 hrs of flu-like sx. Due to my usual 48-hr side effects, I didn't get the RSV at the same time. Now I have a mild URI so I'm waiting to get the RSV. Still, so many folks are NOT GETTING immunizations for the usual reasons--I never get sick, I don't want to put that into my body. EPOCH Times continues to share negative effects of Covid vax in a way that suggests only unthinking folks would consent to it. One of the greatest achievements of medicine, Vaccinations, being not only dismissed but denigrated! TY again.
I’m in the Northeast and COVID is going strong. Nursing home outbreaks, hospitalizations, deaths are all high for my area. It’s part of my job to track and investigate them...these are COVID related complications and protracted hospitalizations, not people with other issues happening to test positive.
Do you have a sense of how much spread is nosocomial right now? My use of the health care system increased dramatically in September (PT for adhesive capsulitis) and it wasn't long before I got Covid.
Only in the sense of patients already hospitalized for other reasons contracting COVID during their stay. That is certainly happening and affecting length of stay. I’m immunocompromised and am pretty much only the one masking, even at places like a rheumatologist which has many immunocompromised patients. I did have a dermatologist who wore an N95 recently during my visit, which was great!
Now that some people have gotten the vaccine, is there any updated data on neurological side effects of RSV vaccine for adults ? Having a hard time deciding whether to get the shot (I'm 74 years old).
Love this. In spring availed myself of the 8 covid tests per month I was entitled to as an old lady. Recently also took advantage of the additional offer from the govt for 4. Here's the irony: even figuring in the extended expiration dates, the 2 boxes I just got will expire well before any of the dozen or so I scored this spring.
Covid appointments fraught again this year. Walgreen's appointment canceled last minute 10/6. We're now scheduled for 10/31 at a Rite Aid. When I heard Rite Aid declared bankruptcy and was closing stores, I backstopped us with appointments at Costco for 11/9. What a commotion (as my dear departed MIL would say).
Love that "what a commotion"!
Stealing your MIL’s great saying. What a commotion, indeed!
I tested positive for COVID in August, so I'm hoping to get the Novavax vaccine this winter! My side effects were never as bad as yours, but I'd prefer no side effects at all for sure.
Is there yet any sufficient data to know whether the current crop of boosters for covid are effective against the jn1 strain?
I would really like to see a YLE post on any data on effectiveness against infection, differentiating between those with “hybrid” or not. I understand this data is hard to come by…but isn’t anyone tracking this??