The fall/winter season always means more respiratory sickness—the weather changes, people head inside, and social networks change (school starts, holiday celebrations occur). But the last four years have resulted in very unusual patterns. This makes predicting this season a fool’s game. But I’ll take the bait and give it a shot.
I saw a school in Kentucky has already shut down due to high levels of staff and student illness:
Oh, I guess it’s multiple Kentucky schools now.
As someone immunocompromised for fall for the first time and *still* recovering from my very first COVID case (caught from 2 family members coming into my house, one with symptoms not disclosed til the end of the visit.), I’m dreading the Fall and hoping I survive it. Very thankful for Paxlovid. I have no doubt I would be hospitalized otherwise.
Masking absolutely works. I masked through all other exposures (including as a hospital nurse with COVID patients) and came out negative. So since there are no accommodations for working from home at my company, I’m just going to be wearing the best masks I can find starting now.
As a communicable disease nurse, it’s going to be a very busy and probably ugly winter. The politicization hasn’t toned down at all. I suspect the uptake of vaccines to be fairly abysmal other than the older folks. I hope I’m wrong. With other opportunistic infections like invasive strep stepping on the coattails of our damaged immune systems, this could be a lot of heartache. I wish we could all just take common sense precautions instead of running headlong into a hurricane to prove a point.
Good forecast, and for what it’s worth I agree. I’m guessing Covid “wave” first this fall with BA.2.86 since it’s by far the most contagious (of these 3 viruses), and booster uptake will be low and less effective than if we had a more closely matched vaccine. Not vaccine makers’ fault.
And I enjoy not being sick, so I’ll be wearing that N95 I never stopped wearing in higher risk situations.
When I get Covid I want it to be “worth it.” Family gathering instead of public bathroom kind of thing.
And I’ll be taking paxlovid, or oral remdesivir once it arrives.
Twoish weeks before mid Nov is Halloween.
Halloweeen smart this year, folks.
Just a reminder, the countries that kept schools open throughout 2020 and didn't mask children also had Flu and RSV disappear so the hypothesis on causality should be reconsidered - other confounders must be at play. You had previously mentioned possibility of "Viral Interference" as an alternative hypothesis - have you given that any more thought?
I'm just pointing this out because your chart might give the impression that made any difference which we know is incorrect.
Of course, the "changed behaviors" hypothesis disrupted the patterns in unpredictable ways, it's reasonable question if it had more harm than benefit. I found this article linked within the stat article you shared interesting , especially because of how much time it spends discussing "immunity debt" without using that term.
At a high level, we need to consider why mitigation (school closure, business closure, stay at home orders, mandatory masking, etc) was followed by very high excess deaths, while reduction of mitigation was followed by a return to "baseline" mortality.
The hypothesis that without heavy mitigation excess deaths would have been even higher is falsified by the fact the countries that did less had the better outcomes in terms of mortality.
 Original you need Stat account to read:
Archive version to bypass account lock:
I think "seasonality" is something of misnomer. The driver, it seems to me, is close proximity to strangers in an indoor setting. Down south, that means air conditioned spaces during a long summer. Up north it means heated indoor spaces in winter. The low hanging fruit is to do as your Mother told you, and stay out of bars. And avoid crowds.
Should we be getting the flu shot in September then? I usually wait until mid October.
FDA had a vaccine meeting in June. I seem to recall that both Moderna and Pfizer said they could manufacture enough monovalent boosters so that shots would be ready in August, with Novavax close behind. It's now August, so where are our boosters?
Are boosters intentionally being held back, and if so why? Is there a plan to delay shots so that the first recipients are protected through the holidays (mRNA protection wanes after 3-4 months)? Or is the younger generation being used to re-build our "immunity wall" now that schools and colleges are back in session? Or is there a fear that if people got boosted during our current mini-surge, they would "get covid anyway right after my booster" (like last year)?
I received a call from my physical therapist's office yesterday asking me if I wanted to move up my appointment because because people were cancelling due to covid. I asked what percent had cancelled because of covid in the last week? "Out of 100 patients, probably 4 this week, and 2 the week before." Not exactly scientific, but that's roughly 4% this week and 2% last week, mostly adults and the trend line is increasing. This excludes back to school kids who are more at risk - so in schools these percentages are likely higher.
What percent of the population will have already been infected with the new variants by the time the monovalent boosters are finally released in September or October? Likely 20% - probably more. And how will we be able to know how well the new boosters work when the reality is a new immunity wall was being re-built a month or two before their release?
Are we still a month out from updated covid vaccines?
When I was just a pup at CDC, almost 50 years ago, the then-leader of influenza surveillance and response at CDC, Mike Gregg, was asked by a reporter whether the upcoming year was going to be a big flu year. He responded that if he could answer that question, he could get rich on orange juice futures. YLE is being properly humble about the difficulties of prediction in a complex environment. You have to try but you can't make promises.
I’m curious if anyone has data on whether the 65+ folks who opted for a second bivalent booster this Spring received enough additional protection to prevent severe disease and death? To the extent people are currently being hospitalized and dying, are the folks who took the Spring booster better off than their peers?
Love your posts.
A few weeks ago I was reading about tree canopies and evidence that trees avoid having their branches touch adjacent trees' branches even when adjacent trees are of another species (maybe access to sunlight is the driver but they grow to where they are almost touching consistently). That came to mind when you mentioned the three virus' peaks not overlapping as some feared. If the same pattern occurs this winter it would be interesting to investigate if that behavior is more common than not.
Thank you so much for this info-filled update. One thing I am wondering about, if anyone has a thought, is the sequence in which to get the three shots. (We’d prefer not to get the Covid booster with the other two, to minimize side effects; we are unclear on side effect issues with the RSV, so not clear whether flu and RSV shots could be combined without problems.)
With a novel virus when do we typically get a break or get ahead? I mean our students are suffering on all levels, it is really heart wrenching.
New 67 y.o. grandfather here! ...wondering a bit about RSV.
Wife and I planning on RSV vax ASAP mostly to help protect grandkid. Also, there is RSV monoclonal antibody treatment for the kid - mom is going to ask ped. about on next visit.
Other than maintaining good IAQ, anything were missing?
Sounds advice, as always. But I would love some guidance on how to find an effective mask that fits properly.
Most mask guidance seems very general--e.g., buy N95s. If I drill deeper, it can become mind-blowingly complex--e.g., spreadsheets of data incomprehensible to a layperson. Not much credible guidance in between, at least not that I've seen.
Parents are frustrated with the lack of information about whether their child will be eligible for the new covid booster. Doctors are frustrated too!
This does damage to uptake.
The new infant RSV ppx, how quickly will insurers actually pay if we order it? History says it will be a battle.
Just received my first shipment of influenza vaccines. We start with those. The rest we shrug our shoulders and say, I don’t know...