Happy Thanksgiving week! This is a friendly reminder that although there are a ton of circulating viruses, you and your family can have a healthy gathering while taking care of the larger community (i.e., overflowing hospitals). Here are a few key steps for this week:
Seemed the appropriate time of year for this - but a thousand thanks for your newsletter over the pandemic. It's been a shining beacon of data and rationality over a crazy few years.
Great post (as usual). I join the chorus of the people here who are deeply appreciative of what you do (like taking the time out during this busy stressful week to give us this post). The CDC is very lucky to have you.
Another friendly reminder: "No is a complete sentence." It's OK to punt holiday gatherings completely if, like Bartleby, you'd prefer not to. It doesn't make you Scrooge or the Grinch or Mr. Potter. I might see my parents on Thursday, I might not. I might cancel at the last minute, if I choose to. I may prefer to save my rapid tests for something I'd rather do. Or insist that my super uses one when he comes to fix my washing machine. Or save them for the next time my girlfriend and I want to hang out. You get the idea.
After all this time, all the vaccines and being super careful (always a KN95 mask, and all but necessary indoor activities with groups of people avoided,) I have come down with Covid. I am SO ANNOYED. That is probably the worst symptom I am having. I'm guessing that I must have forgotten to clean my hands before removing my mask. I'll be fine. Most people are not masking anymore here in NOVA. I really appreciate your work! Happy Thanksgiving!
You are a good egg. Thank you for this! All signs in my community this past weekend pointed to layering up with more Swiss cheese slices of mitigation between us and...well, everything else. I appreciate all of your work.
Aaand, I visited family for 5 days during Thanksgiving and tested positive for Covid today (for the first time ever). Some family members were "just getting over being sick" and one "got sick" while we were there. Had I known that, I wouldn't have gone, because I know that at least some family members are pretty casual about being careful. I'm immuno-compromised, so I am not happy that I was around sick people that were not being at all cautious. To them, they "just had a cold", and some didn't even cover their mouth and nose when they coughed or sneezed. . Sigh! I shouldn't have believed them, and should have worn my mask the entire time, rather than just part of the time. 3 other family members, thus far, have also tested positive for Covid. Live (I hope) and learn!
Can you address facts/fiction regarding the safety of mRNA vaccines. Local medical professional is saying it's not a natural substance to put in the body--not the dead virus but man-made. Also saying local doctors (in Colorado) are blaming mRNA vaccines for life-threatening respiratory illness with kidney destruction for young men who get the vaccines. I only see the rare risk of heart damage. Any truth in the data that you're seeing?
I'd love your take on how risky it is to get together with unvaccinated people. For some of us it is an easier decision than others to exclude them from holiday get togethers year after year. I've generally been of the feeling that lack of vaccination obviously poses a risk to *themselves* but doesn't necessarily pose any significantly increased risk to *others*, especially now that it's clear that fully vaccinated people can and do spread Covid. I know there's the separate issue of the exposure-risk-due-to-behavior difference between someone who's vaccinated and generally Covid conscientious and someone who is vehemently anti-vax or anti-mask and doesn't take Covid seriously at all.
But my question is *all other things being equal*, is there really a greater chance that a completely asymptomatic unvaccinated person is infectious where a completely asymptomatic vaccinated person wouldn't be? And if so, enough of a chance to avoid seeing them?
I am puzzled by one thing. The word began to spread, maybe a year ago, that N95s and KN95s were far preferable to cloth masks, and we should toss the cloth. Yet there are companies like Enro (I do not have any association with the company), whose masks I learned about through Wirecutter, that seem to have been thoroughly tested and that have come through with flying colors. Is the N95 guidance a too-blunt instrument or is it truly the only safe path to follow?
Once again your treatment algorithm is very helpful...thank you. Something more concerning is your suggestion about antivirals. I’ve read and heard recently that flu antivirals are in short supply and per your latest post “ Who is Dying from Covid” noted that coronavirus antiviral for > 65 and at risk are being underutilized. Seems as though the ball has been dropped and no one is addressing it. As someone that is in the over 65 crowd, healthy and have been vaccinated to the max and never had Covid-19, this is concerning and feels like ageism to me and should be addressed.
FNP here. Thank you for this very useful info. So COVID+ pt need to keep testing until antigen negative? I've had a couple pts who were on day 11 or after, mild cough, but feeling well and still testing positive. Does that mean they are still contagious?
Long time lurker, but I am going to ask this to see if you can chime in on something that is bothering me. I have noticed a lack of mentioning PCR testing for civilians. I am curious as to why. I understand the advantages and convenience of using antigen tests. I also understand the drawbacks of PCR tests as well. But you've not mentioned PCR testing for quite a few posts now. I am curious as to why this is. Was it an unconscious action or do the drawbacks of PCRs make you not really want to recommend them?
From my perspective(not a doctor just a radiology tech who has been glued to this since the first notification from the WHO), the largest drawback to PCRs in the States is the fact you can pop positive on them for up to 3 months after infection. There are obviously waiting period for results with a PCR as well. But the latter is not as much a concern as it used to be as many results can be returned in less than 24 hours. Most can still receive a PCR test for a grand total of $0. The discussion around testing these days seems to exclude PCR options which is making it an underutilized tool(from my perspective).
Obviously PCRs are not as convenient as a test you can administer at home and have results in 20 minutes. But there is no reason for us to not use PCRs for follow-up testing in high risk situations, no? Even the CDC recommends testing 6 days after being exposed to covid regardless of vaccination status. Surely a PCR would be a better tool to pick up cases under these guidelines? I think if the medical field encouraged folks to regularly test a week after any very high risk event(family gathering, funeral, concert, travel etc.) it would genuinely help us move forward. I get that almost every activity can transmit omicron, but at some point our foot has to go down on emphasizing that people need to check themselves. Since society doesn't want mass-masking, emphasis needs to be put somewhere. Post-exposure testing is so under mentioned after family gatherings from most I know. I understand pandemic fatigue is real, but I don't see why messaging on testing after holidays being extremely important would be a bad thing.
I hope I don't sound arrogant or condescending. I have loved your posts and this is genuine curiosity. The CDC guidelines seem almost a minimum to break transmission and with PCRs being absent in your posts, I really am curious why this is in your literature. I was swabbed yesterday at a drive through and my PCR ran for influenza and covid. I got my results back in 22 hours. Not bad turnaround time for a weekend and all for $0!
All good advice, and I hope all had a good Thanksgiving.
I'd take a bit of exception to home testing (lateral flow rapid antigen tests) advice for the future. The biggest drawback to those tests compared to a properly performed PCR test is, rapid antigen tests have no mechanism to amplify the viral load; what you've got in the area sampled, usually the nasopharynx or anterior nares, is what the test has to work with. If concentrations are below the sensitivity of the test, or borderline, you might get a false negative test. Cadence testing is good to help with finding and clarifying a false negative test, and I've used it successfully for that purpose.
Symptoms are important, at least in the less sensitive lateral flow tests. If you're not symptomatic, you probably won't have sufficient viral load in the nose to test positive... but if you KNOW you were exposed, and 4-5 days have passed, it's OK to test; you could have an asymptomatic infection. Also, how you get ready before the test is important. I've seen package recommendations, and have discussed with colleagues, that blowing your nose before the test is a good practice and also helps standardize the testing procedure. Also, if administering the test, make sure to follow the package instructions as to where to sample, or if they're not clear, sample about as far back as you can see in the nose. The deep "brain biopsy" sampling done early in the pandemic has its place but there are possibilities for problems. The swab should be rotated, and the same swab used for both nares (sides of the nose). Follow the instructions for the medium used for the lateral flow test (it varies from manufacturer to manufacturer; I'm now good with at least 4 different tests and their only common point is 15 minutes of toe-tapping while you wait for a result.
In general terms, I've always treated a positive test as, well, a positive test. A negative is a "presumptive negative" but must be confirmed by retesting. Said retesting should be planned. I like to test 24 and 48 hours after the first negative test, and if symptoms subsequently develop, test again. If all are negative, you should be good.
I also like the idea of testing just before the event. One last check, to make sure everything is OK.
As an anecdote, I recently had an influenza-like illness. I'm fully vaccinated, and up to date including the bivalent booster (all Moderna). I've also had my annual flu shot. I was symptomatic and miserable, but 4 successive lateral flow tests were negative. My own primary care doc accepted this as "you've probably got a version of the flu we didn't cover in the vaccine", a position I agreed with. Unlike previous bouts of COVID, documented by positive PCR or home rapid antigen testing, I had none of the other ugly symptoms like loss of smell or taste. I just felt miserable for 7 days.
As always, I'm grateful for your advice. After dodging the coronavirus for three years, I finally came down with Covid. It's a disappointment, as I was cautious, but not really a shock. The coronavirus is ubiquitous. What really surprises me is how severe my case is. I'm a 66-year-old male in generally good health. I got my 4th Pfizer vaccination on Oct. 2. In principle, I should have peak immune response about now. Within 16 hours of my first symptom, I got started on Paxlovid. But my symptoms worsened by Day 3. To be clear, I'm not so sick as to need hospital care, but this is like a serious and enduring flu. I have a wicked sore throat, lung and sinus congestion, cough, chills, weeping eyes, aches, lethargy, and weakness. No fun at all! Any insights? Or is this just Covid roulette?
Seemed the appropriate time of year for this - but a thousand thanks for your newsletter over the pandemic. It's been a shining beacon of data and rationality over a crazy few years.
Great post (as usual). I join the chorus of the people here who are deeply appreciative of what you do (like taking the time out during this busy stressful week to give us this post). The CDC is very lucky to have you.
Another friendly reminder: "No is a complete sentence." It's OK to punt holiday gatherings completely if, like Bartleby, you'd prefer not to. It doesn't make you Scrooge or the Grinch or Mr. Potter. I might see my parents on Thursday, I might not. I might cancel at the last minute, if I choose to. I may prefer to save my rapid tests for something I'd rather do. Or insist that my super uses one when he comes to fix my washing machine. Or save them for the next time my girlfriend and I want to hang out. You get the idea.
After all this time, all the vaccines and being super careful (always a KN95 mask, and all but necessary indoor activities with groups of people avoided,) I have come down with Covid. I am SO ANNOYED. That is probably the worst symptom I am having. I'm guessing that I must have forgotten to clean my hands before removing my mask. I'll be fine. Most people are not masking anymore here in NOVA. I really appreciate your work! Happy Thanksgiving!
You are a good egg. Thank you for this! All signs in my community this past weekend pointed to layering up with more Swiss cheese slices of mitigation between us and...well, everything else. I appreciate all of your work.
Aaand, I visited family for 5 days during Thanksgiving and tested positive for Covid today (for the first time ever). Some family members were "just getting over being sick" and one "got sick" while we were there. Had I known that, I wouldn't have gone, because I know that at least some family members are pretty casual about being careful. I'm immuno-compromised, so I am not happy that I was around sick people that were not being at all cautious. To them, they "just had a cold", and some didn't even cover their mouth and nose when they coughed or sneezed. . Sigh! I shouldn't have believed them, and should have worn my mask the entire time, rather than just part of the time. 3 other family members, thus far, have also tested positive for Covid. Live (I hope) and learn!
Can you address facts/fiction regarding the safety of mRNA vaccines. Local medical professional is saying it's not a natural substance to put in the body--not the dead virus but man-made. Also saying local doctors (in Colorado) are blaming mRNA vaccines for life-threatening respiratory illness with kidney destruction for young men who get the vaccines. I only see the rare risk of heart damage. Any truth in the data that you're seeing?
I'd love your take on how risky it is to get together with unvaccinated people. For some of us it is an easier decision than others to exclude them from holiday get togethers year after year. I've generally been of the feeling that lack of vaccination obviously poses a risk to *themselves* but doesn't necessarily pose any significantly increased risk to *others*, especially now that it's clear that fully vaccinated people can and do spread Covid. I know there's the separate issue of the exposure-risk-due-to-behavior difference between someone who's vaccinated and generally Covid conscientious and someone who is vehemently anti-vax or anti-mask and doesn't take Covid seriously at all.
But my question is *all other things being equal*, is there really a greater chance that a completely asymptomatic unvaccinated person is infectious where a completely asymptomatic vaccinated person wouldn't be? And if so, enough of a chance to avoid seeing them?
Thanksgiving blessings to you and your family. Thank you so much for all you do every day.
Thank you as usual for the excellent advice.
I am puzzled by one thing. The word began to spread, maybe a year ago, that N95s and KN95s were far preferable to cloth masks, and we should toss the cloth. Yet there are companies like Enro (I do not have any association with the company), whose masks I learned about through Wirecutter, that seem to have been thoroughly tested and that have come through with flying colors. Is the N95 guidance a too-blunt instrument or is it truly the only safe path to follow?
Once again your treatment algorithm is very helpful...thank you. Something more concerning is your suggestion about antivirals. I’ve read and heard recently that flu antivirals are in short supply and per your latest post “ Who is Dying from Covid” noted that coronavirus antiviral for > 65 and at risk are being underutilized. Seems as though the ball has been dropped and no one is addressing it. As someone that is in the over 65 crowd, healthy and have been vaccinated to the max and never had Covid-19, this is concerning and feels like ageism to me and should be addressed.
FNP here. Thank you for this very useful info. So COVID+ pt need to keep testing until antigen negative? I've had a couple pts who were on day 11 or after, mild cough, but feeling well and still testing positive. Does that mean they are still contagious?
Thanks much. You are great. Happy Thanksgiving to you and your family.
Hi Dr.Katelyn!
Long time lurker, but I am going to ask this to see if you can chime in on something that is bothering me. I have noticed a lack of mentioning PCR testing for civilians. I am curious as to why. I understand the advantages and convenience of using antigen tests. I also understand the drawbacks of PCR tests as well. But you've not mentioned PCR testing for quite a few posts now. I am curious as to why this is. Was it an unconscious action or do the drawbacks of PCRs make you not really want to recommend them?
From my perspective(not a doctor just a radiology tech who has been glued to this since the first notification from the WHO), the largest drawback to PCRs in the States is the fact you can pop positive on them for up to 3 months after infection. There are obviously waiting period for results with a PCR as well. But the latter is not as much a concern as it used to be as many results can be returned in less than 24 hours. Most can still receive a PCR test for a grand total of $0. The discussion around testing these days seems to exclude PCR options which is making it an underutilized tool(from my perspective).
Obviously PCRs are not as convenient as a test you can administer at home and have results in 20 minutes. But there is no reason for us to not use PCRs for follow-up testing in high risk situations, no? Even the CDC recommends testing 6 days after being exposed to covid regardless of vaccination status. Surely a PCR would be a better tool to pick up cases under these guidelines? I think if the medical field encouraged folks to regularly test a week after any very high risk event(family gathering, funeral, concert, travel etc.) it would genuinely help us move forward. I get that almost every activity can transmit omicron, but at some point our foot has to go down on emphasizing that people need to check themselves. Since society doesn't want mass-masking, emphasis needs to be put somewhere. Post-exposure testing is so under mentioned after family gatherings from most I know. I understand pandemic fatigue is real, but I don't see why messaging on testing after holidays being extremely important would be a bad thing.
I hope I don't sound arrogant or condescending. I have loved your posts and this is genuine curiosity. The CDC guidelines seem almost a minimum to break transmission and with PCRs being absent in your posts, I really am curious why this is in your literature. I was swabbed yesterday at a drive through and my PCR ran for influenza and covid. I got my results back in 22 hours. Not bad turnaround time for a weekend and all for $0!
All good advice, and I hope all had a good Thanksgiving.
I'd take a bit of exception to home testing (lateral flow rapid antigen tests) advice for the future. The biggest drawback to those tests compared to a properly performed PCR test is, rapid antigen tests have no mechanism to amplify the viral load; what you've got in the area sampled, usually the nasopharynx or anterior nares, is what the test has to work with. If concentrations are below the sensitivity of the test, or borderline, you might get a false negative test. Cadence testing is good to help with finding and clarifying a false negative test, and I've used it successfully for that purpose.
Symptoms are important, at least in the less sensitive lateral flow tests. If you're not symptomatic, you probably won't have sufficient viral load in the nose to test positive... but if you KNOW you were exposed, and 4-5 days have passed, it's OK to test; you could have an asymptomatic infection. Also, how you get ready before the test is important. I've seen package recommendations, and have discussed with colleagues, that blowing your nose before the test is a good practice and also helps standardize the testing procedure. Also, if administering the test, make sure to follow the package instructions as to where to sample, or if they're not clear, sample about as far back as you can see in the nose. The deep "brain biopsy" sampling done early in the pandemic has its place but there are possibilities for problems. The swab should be rotated, and the same swab used for both nares (sides of the nose). Follow the instructions for the medium used for the lateral flow test (it varies from manufacturer to manufacturer; I'm now good with at least 4 different tests and their only common point is 15 minutes of toe-tapping while you wait for a result.
In general terms, I've always treated a positive test as, well, a positive test. A negative is a "presumptive negative" but must be confirmed by retesting. Said retesting should be planned. I like to test 24 and 48 hours after the first negative test, and if symptoms subsequently develop, test again. If all are negative, you should be good.
I also like the idea of testing just before the event. One last check, to make sure everything is OK.
As an anecdote, I recently had an influenza-like illness. I'm fully vaccinated, and up to date including the bivalent booster (all Moderna). I've also had my annual flu shot. I was symptomatic and miserable, but 4 successive lateral flow tests were negative. My own primary care doc accepted this as "you've probably got a version of the flu we didn't cover in the vaccine", a position I agreed with. Unlike previous bouts of COVID, documented by positive PCR or home rapid antigen testing, I had none of the other ugly symptoms like loss of smell or taste. I just felt miserable for 7 days.
As always, I'm grateful for your advice. After dodging the coronavirus for three years, I finally came down with Covid. It's a disappointment, as I was cautious, but not really a shock. The coronavirus is ubiquitous. What really surprises me is how severe my case is. I'm a 66-year-old male in generally good health. I got my 4th Pfizer vaccination on Oct. 2. In principle, I should have peak immune response about now. Within 16 hours of my first symptom, I got started on Paxlovid. But my symptoms worsened by Day 3. To be clear, I'm not so sick as to need hospital care, but this is like a serious and enduring flu. I have a wicked sore throat, lung and sinus congestion, cough, chills, weeping eyes, aches, lethargy, and weakness. No fun at all! Any insights? Or is this just Covid roulette?