It's good to have someone smart explain the big picture AND offer solutions to make things better going forward. This is a terrific post, thank you for your work!
I have ME/CFS, which I fear leaves me highly vulnerable to long Covid, so my husband and I continue to be extra careful. I haven't felt safe to swim in an indoor public pool since Omicron hit, and if it weren't for Omicron I would be in Virginia right now enjoying a break from Maine's long winter.
Since learning about the coming Omicron variant, I have been coming to grips with the reality that this pandemic is not going away, and that I am not likely to feel safe anytime soon. The endemic picture you paint isn't exactly hopeful, from where I stand. But Katelyn, I am so appreciative of the work you put into sending these missives. I want to know the facts, and you offer the best of what we know clearly and compassionately. I can FEEL that they are sent with love, and that makes all the difference.
Thanks for the update. Locally, here in Hawaii, I was VERY disappointed to hear one of our local physician leaders Pooh-Pooh N-95 and KN-95 masks, stating that because they weren’t fit-tested they were thus ineffective, discounting the fact that cloth and surgical masks are not fit tested and that in fact even a non-fit-tested KN-95/KF-95 is going to still filter out more virus than a cloth or surgical mask. It was the kind of down-playing that plays right into the hands of all the denialists and minimalists.
Masks have two tasks- (1) protect the wearer from exposure to droplets and smaller particulates in the environment (from infected persons); and (2) protect surrounding persons from exposure to droplets etc. produced by the mask wearer. Fit testing addresses (1)- protection of the wearer. Poor fit much reduces protection of the wearer (but not as low as zero). A non- or low-achieving fit tested mask still addresses (2) to a useful degree, reducing quantity and projection of particulates into surrounding air. In industry ,only task (1) is needed for protection from industrial toxic agents. Exhalation valves are included to reduce pressure produced by exhalation. It took us all a while to recognize that masks, respirators for disease control should not have unfiltered exhalation valves (usually meaning having no exhalation valves, though filtered ones are available). For example masks with exhalation valves are now banned on commercial air routes.
Yeah, it seems there are real downsides to acrooss-the-board universal N95's (cost, environmental impact) that aren't really worth it if the N95's aren't fitted properly. Especially when cases are plummeting. We can make them available to people who need them the most (immunocompromised people, people who may be at high risk of long covid) and we can also throw in "fit testing" and "training" as services reimbursable by insurance.
I happen to fall into the group that believes an N95 is really best used when it's fitted and fit-tested. I've been fitted, and tested enough that sealing my mask is second nature, but my wife is used to a different protocol in her field, so she's less concerned (although more careful now than when she was in practice) with the same degree of seal I want to see. Training the public to properly seal their masks would be a daunting task unless we've got a YouTube fiend (or TikTok?) who could popularize it (which really isn't a bad thought) and if properly sealed, N95s can easily prove uncomfortable if worn all day long. So, between fit-testing and discomfort, I fear the masses might have a little difficulty using the masks correctly or for longer periods.
"All of these groups are struggling right now because we all want this pandemic to be over too, but we aren’t collectively taking the necessary measures to actually end it."
SAY IT LOUDER FOR THE PEOPLE IN THE BACK!!
Thank you for this writeup! I'm currently cooped up at home with Omicron (day 4!), hoping to see a negative test in my future soon. To clarify, please confirm my understanding: Current general epidemiological opinion is that once you've rapid-tested negative *after* a confirmed positive infection, and symptoms are gone, it's safe to end isolation?
There are some immunologists and virologists on Twitter pointing out that immunity from COVID is very short-lived. There are stories on Twitter of people who got Omicron in December, tested negative, and are now positive again.
We aren’t seeing information about Long COVID in the media, either, but more and more COVID survivors of even mild infections are becoming disabled or debilitated by persistent symptoms that seem to have no treatment. There is also growing evidence that kids who get COVID are at higher risk for diabetes.
What are ways to spread the word more loudly about these issues? I think it might go a long way to counter some vaccine hesitancy if we communicate plainly about the risks of even mild infections. How do we amplify that?
Megan, for me twitter has not helped my fear at all surrounding this virus as anyone can post and it may seem like the truth. The NYT and the NIH have good information on Long Covid. Just wanted to let you know what has helped me in the 24 hour news cycle.
It does indeed look like we are on the DESCENT with our epi curve now. And that is in fact DECENT news. I have a question -- what is the best evidence you would cite to a non-believer for the assertion (which you repeat today) that the virus can be transmitted by asymptomatic people? Thanks.
I read the op-ed article whose link you inserted when speaking about an open mind.
Actually, I had read it when it was first published. I opened it with a view towards tolerant curiosity. Not for long. I was astonished and appalled at the ignorance and lack of compassionate world-view the author had. It dripped with self-righteousness and was coming from a very privileged perspective. All the while, I was aware that the hospitals, especially the ICUs, that were literally in that person's neighborhood were saturated with unvaccinated COVID patients.
I have no room for the tolerance of willful ignorance.
I read it too -- yeah it can be hard to take, the self-righteousness of people who obviously don't work anywhere near the sick or dying. I tried hard to read with an open mind, too, but couldn't help a snarky thought or two, eg, "How _nice_ for you that your life has been so grand and trouble free."
At the same time, as hard as it is to read, it's good that we read it and see how other people think. The demographic represented in the article is often the same demographic that doesn't vaccinate their kids for measles either, so they're probably beyond dialoging with. The people who accept vaccines but who think the mRNA ones are deadly poison are the ones we need to reach. I think.
Dear Dr Jetelina, Sorry to be your nitpicker (but I read almost your every word), you mean “into a descent” and not “be on our decent”. Kudos for your wonderful public spirited work.
So far, China has done such strict lockdowns that they have avoided widespread contagion. This combined with the expectation that Sinovac is not as effective as the mRNA vaccines would seem to imply that the Chinese population may not have strong immunity.
What happens if Omicron or some other variant spreads quickly enough in China that they can't lock it down in just one region? Do you think that there is a large risk that China is a "ticking timebomb" for new infections and mutations that could disrupt the economy and pull the world back from becoming "endemic"?
Thank you for your great summary of actions that can be taken to help "end" this pandemic. I am a veterinarian and am curious on what scientific information you are basing your assertion that "If the globe works together, we could possibly eradicate SARS-CoV-2 with vaccines. (Now that we have numerous animal reservoirs, though, this is close to impossible)." While a number of different animal species have been affected, the actual case numbers of SARS-CoV-2 in animals is quite rare, especially in comparison to the high infection rate among people. Additionally, the ability for the virus to pass from animals to people has only been documented in a handful of cases. I am concerned that your statement will allow people to discount the great benefit of vaccination if they assume this disease is already out of control in animal populations.
Vaccinating people prevents the spread of SARS-CoV-2 to animals that are in close contact with people. Vaccines are also being developed for use in animals to help protect them from SARS-CoV-2. Multiple diseases in animals have been eradicated through vaccination (and extermination, though much less desirable) campaigns. If vaccination campaigns do not end the SARS-CoV-2 pandemic, it will be because of the anti-vaxx human reservoirs, not animal reservoirs.
I would like to hear more about what measures would be required if a “killer variant” with a catastrophic level of fatalities arrived tomorrow.
That is something we could be ready for if taken seriously. At the moment it would be economically devastating in addition to needless tragedy.
We’ve had ample warning, and we know how unprepared we are.
The only current solution I see is many billions of comfortable N95 masks like the 3M Aura that most people can wear all day, and near universal vaccinations - along with everything else you’ve mentioned.
Once people start dying fast, people will wear those masks, but if they don’t exist it won’t matter. We would be completely defenseless.
Jessica Hockman MD, a pediatrician, stated in her Instagram that the current studies of mask efficacy in schools were flawed, the data was “bad”, and stated we don’t have any good studies to prove masks work in schools to reduce transmission. What would you say to this?
Everything you mention to mitigate and prepare is sensible. It is also, I fear, impossible in the West. You mention that Sars disappeared after 1.5 years:
“An example of this was SARS. It started in 2002 and while it was mainly concentrated in Asia, it did spread across the world. A short 1.5 years later the SARS pandemic ended. The virus was stopped largely due to an effective, global public health response: Testing, isolating and quarantining, and restricting travel.”
This is the current (and I fear) future policy in US, UK, Europe Canada and the west in general. With one difference; the plan is to HOPE it goes away while we do nothing wrt public health. We will do nothing because we cannot. As you paragraph indicates Sars went away because it happened in Asia and they were able to muster a public health response. We simply cannot, as the past 2 years has shown. So, the relevant question is what happens if we do nothing but vax? That we can do, and have done.
UK and several EU member states have been more proactive than the US. For that matter, so has Canada. The US, on the other hand, has accelerated the weakening of public health procedures and regulations under the guise of "rights", forgetting that promoting the general welfare is a central tenet to our founding.
To your question, if we could get everyone who safely can, to vaccinate, we'd be in a much better place overall. If we can increase the pharmaceutical treatments known to work, we could better treat the breakthrough infections as needed. If we can't sell the vaccine to 30% of the population, regardless of cause, we will see this virus continue to ravage the population for some time to come.
I agree only option now is to get everyone vaxed. It is a tech fix that requires little in the way of PUBLIC health. So, as this is the only thing we can do, we should do what we can to do it. It is too bad, however, that we cannot do the other stuff KJ noted. It is not impossible, but it seems to be impossible for us. And it will remain so in the future unless we develop some level of solidarity. Right now, this seems utopian, unlike in many other countries.
Thank you so much, I'm hopeful when I read your articles, and as a preschool director it's been a long road, but it's so good to be informed so we can continue to do our best to protect our youngest children and their families. I'm feeling reminded that this is "Not Forever But for Now"..
I just want to say thank you.
It's good to have someone smart explain the big picture AND offer solutions to make things better going forward. This is a terrific post, thank you for your work!
I have ME/CFS, which I fear leaves me highly vulnerable to long Covid, so my husband and I continue to be extra careful. I haven't felt safe to swim in an indoor public pool since Omicron hit, and if it weren't for Omicron I would be in Virginia right now enjoying a break from Maine's long winter.
Since learning about the coming Omicron variant, I have been coming to grips with the reality that this pandemic is not going away, and that I am not likely to feel safe anytime soon. The endemic picture you paint isn't exactly hopeful, from where I stand. But Katelyn, I am so appreciative of the work you put into sending these missives. I want to know the facts, and you offer the best of what we know clearly and compassionately. I can FEEL that they are sent with love, and that makes all the difference.
Thanks for the update. Locally, here in Hawaii, I was VERY disappointed to hear one of our local physician leaders Pooh-Pooh N-95 and KN-95 masks, stating that because they weren’t fit-tested they were thus ineffective, discounting the fact that cloth and surgical masks are not fit tested and that in fact even a non-fit-tested KN-95/KF-95 is going to still filter out more virus than a cloth or surgical mask. It was the kind of down-playing that plays right into the hands of all the denialists and minimalists.
Ugh. This is embarrassing and incredibly damaging. 😩
Masks have two tasks- (1) protect the wearer from exposure to droplets and smaller particulates in the environment (from infected persons); and (2) protect surrounding persons from exposure to droplets etc. produced by the mask wearer. Fit testing addresses (1)- protection of the wearer. Poor fit much reduces protection of the wearer (but not as low as zero). A non- or low-achieving fit tested mask still addresses (2) to a useful degree, reducing quantity and projection of particulates into surrounding air. In industry ,only task (1) is needed for protection from industrial toxic agents. Exhalation valves are included to reduce pressure produced by exhalation. It took us all a while to recognize that masks, respirators for disease control should not have unfiltered exhalation valves (usually meaning having no exhalation valves, though filtered ones are available). For example masks with exhalation valves are now banned on commercial air routes.
Yeah, it seems there are real downsides to acrooss-the-board universal N95's (cost, environmental impact) that aren't really worth it if the N95's aren't fitted properly. Especially when cases are plummeting. We can make them available to people who need them the most (immunocompromised people, people who may be at high risk of long covid) and we can also throw in "fit testing" and "training" as services reimbursable by insurance.
I for one have gone back to cloth masks
I happen to fall into the group that believes an N95 is really best used when it's fitted and fit-tested. I've been fitted, and tested enough that sealing my mask is second nature, but my wife is used to a different protocol in her field, so she's less concerned (although more careful now than when she was in practice) with the same degree of seal I want to see. Training the public to properly seal their masks would be a daunting task unless we've got a YouTube fiend (or TikTok?) who could popularize it (which really isn't a bad thought) and if properly sealed, N95s can easily prove uncomfortable if worn all day long. So, between fit-testing and discomfort, I fear the masses might have a little difficulty using the masks correctly or for longer periods.
"All of these groups are struggling right now because we all want this pandemic to be over too, but we aren’t collectively taking the necessary measures to actually end it."
SAY IT LOUDER FOR THE PEOPLE IN THE BACK!!
Thank you for this writeup! I'm currently cooped up at home with Omicron (day 4!), hoping to see a negative test in my future soon. To clarify, please confirm my understanding: Current general epidemiological opinion is that once you've rapid-tested negative *after* a confirmed positive infection, and symptoms are gone, it's safe to end isolation?
There are some immunologists and virologists on Twitter pointing out that immunity from COVID is very short-lived. There are stories on Twitter of people who got Omicron in December, tested negative, and are now positive again.
We aren’t seeing information about Long COVID in the media, either, but more and more COVID survivors of even mild infections are becoming disabled or debilitated by persistent symptoms that seem to have no treatment. There is also growing evidence that kids who get COVID are at higher risk for diabetes.
What are ways to spread the word more loudly about these issues? I think it might go a long way to counter some vaccine hesitancy if we communicate plainly about the risks of even mild infections. How do we amplify that?
Megan, for me twitter has not helped my fear at all surrounding this virus as anyone can post and it may seem like the truth. The NYT and the NIH have good information on Long Covid. Just wanted to let you know what has helped me in the 24 hour news cycle.
It does indeed look like we are on the DESCENT with our epi curve now. And that is in fact DECENT news. I have a question -- what is the best evidence you would cite to a non-believer for the assertion (which you repeat today) that the virus can be transmitted by asymptomatic people? Thanks.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787098
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707
https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00059-4/fulltext
These can get you started.
thanks
I read the op-ed article whose link you inserted when speaking about an open mind.
Actually, I had read it when it was first published. I opened it with a view towards tolerant curiosity. Not for long. I was astonished and appalled at the ignorance and lack of compassionate world-view the author had. It dripped with self-righteousness and was coming from a very privileged perspective. All the while, I was aware that the hospitals, especially the ICUs, that were literally in that person's neighborhood were saturated with unvaccinated COVID patients.
I have no room for the tolerance of willful ignorance.
I read it too -- yeah it can be hard to take, the self-righteousness of people who obviously don't work anywhere near the sick or dying. I tried hard to read with an open mind, too, but couldn't help a snarky thought or two, eg, "How _nice_ for you that your life has been so grand and trouble free."
At the same time, as hard as it is to read, it's good that we read it and see how other people think. The demographic represented in the article is often the same demographic that doesn't vaccinate their kids for measles either, so they're probably beyond dialoging with. The people who accept vaccines but who think the mRNA ones are deadly poison are the ones we need to reach. I think.
Dear Dr Jetelina, Sorry to be your nitpicker (but I read almost your every word), you mean “into a descent” and not “be on our decent”. Kudos for your wonderful public spirited work.
Wm HR Greenfield MD
So far, China has done such strict lockdowns that they have avoided widespread contagion. This combined with the expectation that Sinovac is not as effective as the mRNA vaccines would seem to imply that the Chinese population may not have strong immunity.
What happens if Omicron or some other variant spreads quickly enough in China that they can't lock it down in just one region? Do you think that there is a large risk that China is a "ticking timebomb" for new infections and mutations that could disrupt the economy and pull the world back from becoming "endemic"?
Thank you for your great summary of actions that can be taken to help "end" this pandemic. I am a veterinarian and am curious on what scientific information you are basing your assertion that "If the globe works together, we could possibly eradicate SARS-CoV-2 with vaccines. (Now that we have numerous animal reservoirs, though, this is close to impossible)." While a number of different animal species have been affected, the actual case numbers of SARS-CoV-2 in animals is quite rare, especially in comparison to the high infection rate among people. Additionally, the ability for the virus to pass from animals to people has only been documented in a handful of cases. I am concerned that your statement will allow people to discount the great benefit of vaccination if they assume this disease is already out of control in animal populations.
Vaccinating people prevents the spread of SARS-CoV-2 to animals that are in close contact with people. Vaccines are also being developed for use in animals to help protect them from SARS-CoV-2. Multiple diseases in animals have been eradicated through vaccination (and extermination, though much less desirable) campaigns. If vaccination campaigns do not end the SARS-CoV-2 pandemic, it will be because of the anti-vaxx human reservoirs, not animal reservoirs.
Superb and comprehensive as always.
I would like to hear more about what measures would be required if a “killer variant” with a catastrophic level of fatalities arrived tomorrow.
That is something we could be ready for if taken seriously. At the moment it would be economically devastating in addition to needless tragedy.
We’ve had ample warning, and we know how unprepared we are.
The only current solution I see is many billions of comfortable N95 masks like the 3M Aura that most people can wear all day, and near universal vaccinations - along with everything else you’ve mentioned.
Once people start dying fast, people will wear those masks, but if they don’t exist it won’t matter. We would be completely defenseless.
My kingdom for an N95!
Thank you once again for an update.
Certainly if the CDC and Federal / State government officials took an open approach as you have, trust would not be an issue.
Jessica Hockman MD, a pediatrician, stated in her Instagram that the current studies of mask efficacy in schools were flawed, the data was “bad”, and stated we don’t have any good studies to prove masks work in schools to reduce transmission. What would you say to this?
Everything you mention to mitigate and prepare is sensible. It is also, I fear, impossible in the West. You mention that Sars disappeared after 1.5 years:
“An example of this was SARS. It started in 2002 and while it was mainly concentrated in Asia, it did spread across the world. A short 1.5 years later the SARS pandemic ended. The virus was stopped largely due to an effective, global public health response: Testing, isolating and quarantining, and restricting travel.”
This is the current (and I fear) future policy in US, UK, Europe Canada and the west in general. With one difference; the plan is to HOPE it goes away while we do nothing wrt public health. We will do nothing because we cannot. As you paragraph indicates Sars went away because it happened in Asia and they were able to muster a public health response. We simply cannot, as the past 2 years has shown. So, the relevant question is what happens if we do nothing but vax? That we can do, and have done.
UK and several EU member states have been more proactive than the US. For that matter, so has Canada. The US, on the other hand, has accelerated the weakening of public health procedures and regulations under the guise of "rights", forgetting that promoting the general welfare is a central tenet to our founding.
To your question, if we could get everyone who safely can, to vaccinate, we'd be in a much better place overall. If we can increase the pharmaceutical treatments known to work, we could better treat the breakthrough infections as needed. If we can't sell the vaccine to 30% of the population, regardless of cause, we will see this virus continue to ravage the population for some time to come.
I agree only option now is to get everyone vaxed. It is a tech fix that requires little in the way of PUBLIC health. So, as this is the only thing we can do, we should do what we can to do it. It is too bad, however, that we cannot do the other stuff KJ noted. It is not impossible, but it seems to be impossible for us. And it will remain so in the future unless we develop some level of solidarity. Right now, this seems utopian, unlike in many other countries.
Thank you so much, I'm hopeful when I read your articles, and as a preschool director it's been a long road, but it's so good to be informed so we can continue to do our best to protect our youngest children and their families. I'm feeling reminded that this is "Not Forever But for Now"..