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.


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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.

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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.

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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.

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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.

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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 :) ]

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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.

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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.

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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

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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.

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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.

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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).

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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).

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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.

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Great news about the Novavax! Thanks for the timely update

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Is there yet any sufficient data to know whether the current crop of boosters for covid are effective against the jn1 strain?

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