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4 / 11 / 2023 – 1st Edition
“Hello and welcome!
So much has changed in the world since early 2020 and the start of the pandemic. As things progress we find ourselves 1/3 of the way through 2023 and resources we once relied on to stay up to date have long disappeared. The goal of this newsletter is to provide open access to information to help you make choices and feel as informed as you can.
This newsletter will consist of a few sections: research articles about long term effects of infection; developments in both policy and proposals regarding funding, mandates, and so on; globally sourced conversations and updates; and conversations from both community, professional, and scientific sources on all things COVID.
I am a high risk disabled individually compiling this information, so there will naturally be bias towards believing that the pandemic is still ongoing and poses a risk, but my goal for this space is to create a resource that is neutral allowing you to access this information.
Let’s Catch Up, What We Know Today
To get things started, I would like to play a little bit of catch up since that has not been an ongoing publication I think it’s valuable to start off with some of the basics.
Vaccinations – how do they work, what are they intended to do, and how well are they holding up? Do I need the new booster
The World Health Organization has specified: “In general, the COVID-19 vaccines are very effective at preventing serious illness, hospitalization and death from all current virus variants. They are less effective at protecting you against infection and mild disease than they were for earlier virus variants.” under Do the Covid-19 vaccines protect against virus variants?
What this highlights is a different understanding than what was advertised to the general public prior to the approval of the various vaccines. Many studies early on showed reductions in deaths and hospitalizations, whereas communication about vaccines and what they should do has been centered on the idea that you cannot catch the virus or be sick if you are vaccinated.
The initial studies documenting reduction of severe outcomes remain true, but the vaccines we currently have available in the US market (Pfizer, Moderna, and Johnson and Johnson) do not prevent the acute infection.
American Family Care published a useful article discussing the Omicron variant and the increased incidence of “breakthrough” infections for people who have been vaccinated.
For a refresher on the technology behind available vaccinations, please reference the CDC’s guide.
The new bivalent booster was released to the public in September of 2023. Studies have shown that comparing the old boosters/vaccines to the new bivalent booster designed to target newer variants of the virus the old vaccines had about a 25% efficacy rate against severe disease compared to 62% with the new bivalent boosters. This is an increase of protection of 37%. (From the NIH)
Currently, people can only receive one bivalent shot. Advocates have been calling for approval for high risk groups to receive a 2nd one prior to the one year mark, the FDA as of April 3rd is moving forward to approve the second shot according to the Washington Post. The Post article also links to various studies for more information on waning effectiveness and benefits of a second booster. Both Canada and the UK have moved forward with approving 2nd boosters.
Masks – debunking that masking doesn’t work, studies on best masks, and resources for buying reputable masks.
One of the biggest pieces of mask information has come from the “Cochrane Study” which has served as evidence against masks. However, experts have come out over and over again saying that the claims being made are a misrepresentation of the study that was conducted. This best is highlighted by FactCheck.org in their piece: What the Cochrane Review Says About Masks For Covid-19 – and What It Doesn’t.
In plainer language assessing the same study, you can read this New York Time’s piece.
Other things that are important to note over the time of the pandemic is that the standard for masking has changed. We began with cloth masks, shifted to surgical masks, and now focus more on N95 and respirators. The difference here has to do with the size of the particles being spread. We know now that COVID-19 is airborne and is spread via very small particles. This is very different than the initial assumption of it being spread via water droplets.
The best explanation I’ve found in a single place addressing the science behind masks, evaluating risk, and very good graphics exploring transmission and all of these topics comes from Bill Comeau. His summation with citations can be found in his article: The Science Behind Masks and Their Use
The place I personally recommend buying masks from is Project N95.
Are COVID tests still accurate, where did testing procedures come from, and what else should I know?
Firstly, some of us may still have COVID tests at home that now have expired. The FDA has this tool in order to check if your COVID test has been given an extended expiration date.
This entire NPR article is very good in understanding the current value of tests, what we are finding is that tests may take longer to show a positive result even when you’re already showing symptoms and that: “According to the CDC, antigen and PCR tests are both good at avoiding false positives, but PCR tests are generally more sensitive than home tests. That means antigen tests aren’t all that useful for ruling out COVID-19, but they can be valuable for confirming that cold really is COVID-19.”
I think the whole article is really worth reading.
What we have learned about tests is that there are limitations. You may not be able to get a reliable positive test until almost a week into your infection, whereas you may have been contagious in the days leading up to you first noticing symptoms. This is an important point in understanding the spread of COVID occurring frequently in people who just don’t know they are sick yet. On the back end of an infection, it is also less clear when negative tests – for example PCR tests may be positive long after you are no longer infectious while at home tests are less likely going to continue giving you positive results – mean you’re good to go. Best practices suggest waiting for a negative at home test and no longer having symptoms before assuming your infection has cleared.
But what about the official 5 day guideline? Let’s talk about where that guideline came from. (Now remember the CDC says the 5 days of isolation is for asymptomatic infections after your positive covid test and recommends masking for 5 days thereafter.)
But where did 5 days come from? The Delta Airline’s CEO, as reported on by NPR at the end of 2021. This policy change was done for economic reasons, not scientific ones as backed by the conclusion of contagiousness in nurses for Omicron in this study: “In conclusion, we showed that viral shedding continues for ≥10 days among mild cases infected with Omicron, and a symptom-based approach might not be a good approach for the cessation of isolation. The HCWs who ended their isolation and turned back to work should be alerted of their contagiousness until 10 to 14 days.” published to reflect the most recent variant in July 2022 by the National Library of Medicine. Duration of infectious shedding of SARS-CoV-2 Omicron variant and its relation with symptoms.
Other things you should know include some different swabbing techniques. Some people are noticing that they are able to better detect their infection by using nose or throat swabs, or a combination. This isn’t really confirmed as one way being better, so I’ve chosen to highlight this article which discusses the pros and cons and various research.
If you have a positive at home test, it is worth getting a PCR test done as well since your PCR test result will become a part of your medical record. Having your COVID infection documented can have impacts on your future should you have persistent symptoms or need to file disability claims.
How much COVID is really circulating in my community?
Over the years the maps we have relied on to evaluate COVID levels in our communities have changed. In March of 2022 there was a quiet shift from Transmission maps which we had been using up until that point to a new metric called “Community Levels” as the public facing map to base decisions on. This change came about to evaluate “high” community transmission based off of hospitalizations rather than percent positive tests. On a basic level, this shifts when the public becomes aware of higher rates of COVID in their community to be slightly later because it takes time for people to be hospitalized. An additional layer to this choice is understanding that our vaccines have been very effective in terms of reducing death and hospitalization, therefore we may meet our goal of lower hospitalization but then we are measuring something that isn’t reflective of COVID levels in the community. NPR Discussing this change.
In December of 2022, the CDC quietly changed their masking guidelines back to referencing Transmission maps rather than Community Level maps. At the time of the change this shifted 9% of the country from high community levels to 71% of the country being in high transmission.
With the addition of at home tests and the lack of reporting of at home tests, the rate at which COVID infections were reported dropped dramatically. Back in September the estimate from Chris Murray – the director for the Institute of Health Metrics and Evaluation – was that only 4-5% of all tests are being reported (reported by NBC news), with a study from January 2023 theorizing that 80% of COVID cases go unreported (Jama Study). This means the numbers that we are seeing that are populating maps are a remarkable undercount.
With the reduction in tests being reported, the reliability of maps continues to decrease. Over the last few months, some states have chosen to stop reporting altogether, and many outlets have also stopped updating their numbers. One source remains: waste water data. From the CDC regarding the National Wastewater Surveillance System:
- Wastewater surveillance captures presence of SARS-CoV-2 shed by people with and without symptoms. By measuring SARS-CoV-2 levels in untreated wastewater over time, public health officials can determine if infections are increasing or decreasing in a sewershed.
- Wastewater surveillance can be an early indicator that the number of people with COVID-19 in a community is increasing or decreasing.
This information gives us one official source to continue to monitor, look for early warning signs, and compare waste levels to previous periods of time. Additionally, the wastewater website linked below also provides regional data and local information regarding which variants are currently showing up.
Community Level Maps can be found here.
Community Transmission Level Maps can be found here.
Wastewater Data can be found here.
What should I look for during my COVID infection and what are my the best practices during an infection?
As of April 2023 there are a handful of consistent symptoms to look out for if you think you may have COVID-19.
- fever
- dry cough
- shortness of breath
- sore throat
- loss of taste or smell
- headache
- congestion
In addition, some children are experiencing more gastrointestinal symptoms. Some discussions indicate symptoms similar to pink eye may also be present.
Recommendations like drinking lots of fluids and resting have always been prominent with flu like illnesses, and as we learn more about COVID the idea of “rest like you’ve never rested before” falls on the safest and most cautious end of advice. This TIME article discusses the importance of resting as much as possible and the implications as it relates to potential for Long COVID.
In this case, rest means literally doing nothing. Not reading. Not scrolling through social media. Not cooking a small meal. But truly laying still and resting like your life depends on it.
This of course comes with the full acknowledgement that best practices are not accessible to everyone.
Know your medication options! This FDA Guide helps walk you through what treatments are available that can help reduce your COVID symptoms and prevent severe outcomes.
The medication EvuSheld is no longer viable: see Matthew Cortland’s public discussion of this here.
CPC Mouthwash – Some research suggests reduced viral load when using a CPC mouthwash with at least a 0.07% amount. This research study discusses these recommendations.
Use of Enovid nasal spray to help clear the virus in ones nasal passages has also been backed up in this study.
What is Long COVID? What are my risks?
Initially Long COVID was rather isolated in discussion to people within the disabled community who had been familiar with other post viral illnesses. Now, years into the pandemic we know that COVID poses a high risk of long lasting complications that can range from a few weeks after an initial infection, begin weeks after an infection has cleared, and potentially last a lifetime.
Symptoms can vary as COVID is a multi-system infection and the long term impacts can affect different organ systems, the CDC has a list which includes but is not limited to: fatigue, cough, chest pain, increased heart rate, headache, sleep problems, and joint pain. The CDC’s list can be found here.
For more specific Long COVID information, jump down to the research area.
Who is at risk for Long COVID? A study conducted across multiple countries points to the answer being “anyone who has been infected with COVID” with an emphasis on highlighting that 90% of those in the study with Long COVID had what is considered a mild case. Now, it is important to remember that “mild” in medical terms as discussed here is defined as an infection that doesn’t require hospitalization.
This graph pulls data from the CDC study on Long Covid assessing the percent risk of catching long covid after each subsequent infection. For a 1% risk shown with the green line, after 10 infections you have a 10% risk. For the grey line of 10%, after 7 infections you have a 50% chance. The CDC’s estimate falls roughly around 20%, putting 5 infections at a risk of 70% of having Long Covid.
What this study ultimately highlights is that subsequent infections pose a steadily increased risk of having longer term complications, pointing to reducing how many infections you have being a reasonable goal.
What long term effects do we have research on? What other research publications should I know about?
Long COVID Now Looks Like A Neurological Disease – March 2023
COVID Infection Increases Diabetes Risk – February 2023
Long COVID and research on impacts of various organ systems – January 2023 – this study includes information on immune disregulation, impacts on the reproductive system, neurological impacts, vascular system and more.
COVID and Blood Clots – December 2022
COVID Incidence after Lifting Universal Masking In Schools – November 2022 – I find the attached graphic to explain the study and conclusions better than the paraphrased study.
Comparing Immunodeficient Population to General Population regarding incidence of COVID – Sept 2022 – this study is additional contextualized with the belief that high risk populations are behaving in a way that is engaging in social distancing, masking, avoiding various indoor settings and so on, thus supporting the lower incidence of infection relative to the general population when universal protections were dropped.
Increased prevalence in POTS post COVID infection – July 2022
Link between COVID and Alzheimer’s – December 2021
Immune Deficiency Post COVID – September 2021 – For further discussion here, please jump to the conversations where I have linked a threaded conversation full of various research articles on the subject of one’s immune system after having COVID.
Analysis of Over 50 Long Term Effects of COVID-19 – August 2021
COVID as a Vascular Disease – May 2021
Conversations from Around the Community
Notes on community conversations: some individuals may have relevant credentials I will add those as I find them. These are meant to allow you to see conversations that are occurring, but all pieces within and opinions formed or conclusions drawn are not necessarily sound. I find community conversations to be an insight into the direction things may go and helpful in some areas that don’t receive much public commentary. But again, some conversations may sound more alarming than they end up being down the road.
Impacts on the Immune System: Discussions are occurring all over that after an infection people feel as if they just keep getting sicker and are more susceptible to the next illness. Studies consistently are showing that COVID has the ability to suppress our immune systems and cause deficiency. Andrew Ewing has compiled a lengthy thread of scientific studies that all support this theory. Andrew is a chemistry researcher. This conversation continues and is expanded and translated from a German study, raising cause for concern by the German Health Minister. Eric Feigl-Ding, an epidemiologist and health economist, shares his thread translating these concerns.
Ventilation: Air filtration and purification has been one of the cornerstones to reducing transmission. Amanda Hu – a certified filter technician – shares a thread on her observations of changes in ventilation systems as she goes about her day. It appears many places are upgrading their ventilation even when they might not be sharing these upgrades publicly.
Watching the new XBB.1.16 Variant in India: A threaded conversation led by Chris Turnball mostly summarizes data and reports coming out of India as they are presented. Within the quotes are a substantial amount of data points regarding variant presence, wastewater data, and responses from India + neighboring countries.
Potential for another wave: A threaded conversation led by Laura Miers. Laura is a long covid advocate who has been considered a thought leader and reporter throughout the pandemic. In this thread Laura has pulled various examples that could be early signifiers for an incoming wave.
How Are Different Communities Responding to Covid
At the Davos convention (The World Economic Forum), billionaires from around the globe gathered putting in place a whole host of precautionary measures to keep their gathering COVID free. This has been dubbed the “Davos standard” and opens up a line of discussion regarding how those with the most resources are striving to avoid infection despite that being in opposition to how the general public has been encouraged to go back to normal. Standards implemented include PCR testing, air filtration and more. You can read an analysis of it here.
Throughout the pandemic, the film industry has remained perhaps the most cautious with strict COVID protocols to ensure minimal disruption to tv shows and movies. In Hollywood with the end of the emergency declaration, the precautions will also be ended as reported on by the LA Times. For many folks, film sets were the guide for how things have really been going with COVID so it stands to reason the after effects of these protocols being removed will be watched closely. Other places – like Tiny Desk with NPR have had strict testing and videos surface showing relatively good adherence to masking for their concert series that are all occurring behind the scenes but bring light to the desire to protect irreplaceable talent. This video shows one instance behind the scenes.
What policy changes have recently happened?
Biden Ended the COVID National Emergency earlier than expected on April 10th, reported on by NPR.
On May 11th, the Public Health Emergency will end, this article highlights what will be impacted.
Project Next Gen launched by the White House is $5 billion investment into the development of vaccines and additional COVID therapies, reported on by The Washington Post. This project can help in the development of more effective vaccines and newer drugs that will offer protection against the evolving variants.
Thank you for reading the first edition of this newsletter! If you have any specific comments or are looking for information/have questions let me know and I can hopefully include any answers in the following newsletter!
4 / 20 / 2023 – 2nd Edition
Welcome to the second edition of In The Pandemic Loop!
If you missed the first edition it’s available in the public archive and can be found here! In the first edition some basics were covered including: vaccines, masking, testing, what to do when you have a COVID infection, evaluating COVID levels in your community, Long COVID (plus some a research heavy section on various areas mostly relating to Long COVID), government policy changes, and some community conversations – notably around ventilation.
Updates from the WHO
In a briefing on Wednesday, the World Health Organization shared updated information regarding COVID and where we stand today, including the following quote on LONG Covid Incidence: “An estimated 1 in 10 infections result in post COVID19 condition, suggesting that hundreds of millions of people will need longer-term care” – Dr. Tedros. The first edition of this newsletter shared a graphic with some potential risk assessment for percent risk of getting Long COVID, this information from the World Health Organization. This puts the WHO’s estimate at 10% while the CDC’s estimate is closer to 20%.
Community Conversations stemming from this announcement have included this graphic. As this is something spreading around the community I want to address it with the caveat that the WHO did not develop this nor the mitigation strategies listed below the WHO’s quote. Many of the mitigation strategies have been recommended by both the WHO and the CDC, but the lines “avoid as many infections as possible with layers of protection” and “play the long game, avoid getting infected…” are recommendations from the creator, despite being positioned by other members of the disabled and Long COVID communities as changes in the World Health Organizations stance.
New COVID Variant and Symptoms to note and Potential COVID waves
On March 22nd, the WHO designated the strain XBB.1.16 as a variant under monitoring naming it Arcturus. You’ll recall some of the community conversations last week were discussing the risk of potential surges while focusing in on the variant that had been circulating around India. That’s what this is. This new variant is presenting with a symptom we would recognize as pink eye – conjunctivitis. This has been reported on by multiple outlets, but I’m linking to ABC Detroit’s report as it is the most clear cut with what we know today.
The CDC variant tracker (which can be accessed here) shows projections that this particular variant is circulating in the US.
Looking at a global scale, the Southeast Asian region has seen an increase in reported cases by nearly 109% – this fortune article provides a nice graphic from the WHO to show reported cases and the percent change. This article discusses additional lineage of the variant and how previous variants are recombining as they come back in contact with each other.
A look at reported infections across the globe indicate in 11 countries so far dramatic spikes in deaths and or infections are being reported. The Corona Heads up account has compiled graphics from across Europe to Peru showing these increases.
Omicron and Repeat Infections
New research is emerging out of a German study showing that the development of antibodies – studies in children comparing Delta variants to Omicron variants and resulting antibodies – indicate that Omicron variants of the COVID virus are not producing sustained responses in our immune system that prevent in some cases immediate reinfection. Rajeev Jayadevan, an MD, breaks down this study published this April regarding antibodies in saliva in a twitter thread if you’re interested in reading a simplified version of the study.
Bivalent Boosters, Effectiveness Against New Strains, and Novavax
In a pre-print study that has yet to be peer reviewed out of the Cleveland Clinic, early research suggests the bivalent boosters – the updated COVID vaccines released last fall – are showing to be ineffective against the XBB lineages of the virus. It is highly critical to note that this study is evaluating infection risk while all other studies related to vaccines has focused numbers on hospitalizations and death as the endpoints for vaccine effectiveness.
To additionally contextualize the above research, this article from an Infectious Disease Paper discussed slight decrease in effectiveness of boosters between the BA.4-5 variants and the XBB lineages. It also highlights the timeframe for which individuals received their booster (Early September) and the waning effectiveness perhaps contributing to efficacy.
The CDC has officially moved forward with approval for second Bivalent Booster shots, outlined by the Washington Post. This approval is for those over the age of 65 and immunocompromised individuals. Matthew Cortland with Health Progress spoke directly with FDA leaders about this and what high risk individuals should do, landing on the clearest answer being that it’s between you and your doctor to determine if your risk makes you immunocompromised. You can read Matthew’s discussion here. You can get your booster at your local pharmacy where you can check a box indicating you are immunocompromised, no doctor’s notes are required.
Community Conversations: Accessing Novavax A request for public comment went out for the public ACIP meeting on April 19th, one of the community asks was to help in requesting vaccine equity and use of the Novavax vaccine. At this point in time, we have funded this vaccine but it is not available to people – especially those who received other vaccine types. Novavax appears to be working more effectively at preventing disease, compared to simply preventing severe disease and death.
COVID and Disability
Long COVID can prove to be a disabling condition, impacting people’s quality of life in a variety of different ways. For many people, the idea is simple: if you get sick for something long term, you can apply for disability: Social Security Disability. This USA Today article discusses some of the challenges people are facing in this process. These challenges range from proving the existence of cognitive symptoms like brain fog, having access to specialists who can fill out the paperwork, and the financial burden of being out of work combined with the extensive wait times both required by Social Security but made worse by lengthening processing times at Social Security offices due to large influxes of applications.
On the same subject, Imani Barbarin – a well known disability advocate and professional of communication – discusses in video format the difficulty of getting on disability and the importance of being able to demonstrate you ever had a COVID infection in the first place.
Research To Note
Autonomic Dysfunction Related to Post Acute COVID Syndrome – April 2023 – this research provides some of what we already know regarding common symptoms that persist after 6 months, most notably this study breaks down some of the pharmacological treatments and specifies treatment guidelines.
Risks of COVID and Long COVID for those with cancer – April 2023
A study conducted within the VA comparing COVID and the flu indicates that COVID is 38 times more common, and 60% more deadly than the flu.
Research previously had been published showing adverse cardiac events for men after receiving vaccination, after allegations of falsely representing these findings the Tampa Bay Times released previous versions of the studies indicating the opposite findings. This is summarized by Dr. Panthagani an Emergency Medicine Resident for easy understanding and breakdown here.
COVID Smell Loss is Linked to Brain Damage – April 2022
Conversations Around the Community: Masking in Healthcare Facilities
One of the major topics recently has revolved around the removal of mask mandates in healthcare settings across the US, UK, and Canada. When we look at this from a legal standpoint and the rights patients have, two Law professors from Harvard have outlined that the legality of putting patients at risk is thin at best. “Likewise, hospitals cannot necessarily avoid liability by arguing that patients consent to unmasked care. ” The overarching idea here is that hospitals and doctors have sworn an oath and have a duty to do no harm, where something like masking in a health care facility is a low cost and effective measure to keep people safe.
Building off of this, Chris DeGroot a wastewater analyst out of London has been monitoring waste water at hospitals and indicates that the wastewater specifically from hospitals is always positive for COVID. This isn’t much of a surprise, but this kind of data makes an argument for maintaining masking in health care facilities because we have clear and concise evidence that COVID is present and circulating.
A survey of Epidemiologists from last Fall, which was just recently published indicated that 97% of respondents had no intention of dropping masks in their facilities. This study is now outdated, but the reasons reported are worth acknowledging: they wanted to avoid respiratory infections and staffing issues.
There are however proposals and many discussions suggesting that masking within healthcare facilities becomes a new standard of practice. I’m linking to this tweet where pictures of the published study are shared as the study is behind academic access restrictions. The study suggests that masking goes far beyond COVID, but vastly reduces the spread of other airborne pathogens within hospital settings.
With masking going away, we are beginning to see a trend with larger hospitals, starting with Kaiser in San Francisco which dropped it’s masking on April 3rd. They are now experiencing a COVID outbreak and have temporarily reinstated masks as reported on in the San Francisco Chronicle.
One major advocacy effort currently under way, partially in response to the dropping of masking in healthcare facilities is the request for the CDC to issue Indoor Air Quality Targets in healthcare facilities that would be equivalent to HEPA filtration. Matthew Cortland has been leading a community based letter effort and shared their own letter here. This is an ongoing campaign.
Advocacy Opportunities and Additional Resources
If you are interested in staying in the loop on actionable items you can do, Matthew Cortland has started their own newsletter you can sign up for here.
There are quite a few COVID advocacy groups popping up across the US and Canada along with Long COVID groups, this spreadsheet was created to be a directory of these groups.
Thank you for reading the second edition of this newsletter! If you have any specific comments or are looking for information/have questions let me know and I can hopefully include any answers in the following newsletter!
5 / 4 / 2023 – 3rd Edition
Hello!
As we enter into our third installment many changes have happened. Yesterday the official emergency declaration for COVID expired and the World Health Organization declared that COVID is no longer a global health emergency. This announcement from the WHO came with the acknowledgement that someone is dying every 3 minutes from COVID – and that is just what is reported, stating that despite it no longer being a global health emergency, COVID is not over and should still be considered a global health threat. (the WHO transcript can be found here.)
For many, this is a time of great confusion and it is with this newsletter that I hope to continue to provide access to high quality information that gives you the confidence to make choices for yourself and those around you.
Updated Guidance + Information on Variants of Concern
The CDC has updated it’s guidance regarding children and COVID-19 and the flu with an additional line that reads: “COVID 19 can cause serious health problems, so it’s more important than ever to protect your child’s health” with a follow up section that suggests having your child wear a mask to school.
With the end of the Emergency Declaration, the Community Levels and Community Transmission Maps are no longer updated. There are no more maps. Wastewater data is still somewhat available and provides a breakdown of variants that are present in wastewater facilities. At the time of publishing some of the wastewater features appear to be down.
Previous iterations of this newsletter touched on community concern and government acknowledgement of the new variant “Arcturus” out of India. Wastewater data in India is suggestive that this current wave may have been larger than the large wave in 2022. Although there is community speculation around the severity of this new variant, the only confirmed information we have is the more common symptom of pink eye (conjunctivitis).
Hospitals and Masking – Conversations, Patient Rights, and Legal Challenges
In response to dropping of masks in healthcare facilities in California, Dr. Noha Aboelata a family medicine doctor and founder of Roots Community Health Center share’s her perspective in The Mercury News on this change. She touches on subjects like policy changes not being rooted in science, along with digging into some of the ethical questions surrounding the duty of health care professionals to protect patients.
The People’s CDC developed a ADA Health Rights presentation breaking down who qualifies for legally covered accommodations, particularly in healthcare settings as it relates to requesting masks. This guide breaks down examples of reasonable accommodations, provides a template for the request along with how to make a request.
Mass General Brigham – the largest hospital provider in Massachusetts – added within it’s removal of masking policy a Q&A section for patients to reference. One of the topics was “Can I ask my healthcare provider to mask?” to which they said “no” bringing about a lot of backlash from patients. Matthew Cortland breaks down the formal complaint they filed with the Office for Civil Rights here. Cortland believes this kind of blanket ban is unlawful and is a violation of the American with Disabilities Act. Other patients have since requested ways to also submit formal complaints and Matthew compiled a bit of guide that can be referenced here.
As of May 10th, Mass General Brigham has moved to remove the verbiage in their policies banning patients from requesting healthcare professionals wear a mask, as shared during a demonstration outside the hospital.
It is important to note that many hospitals, despite dropping mask mandates, have not done what Mass General has and are allowing patients to request masks. Other community conversations (far too many to link) discuss issues like the power dynamics between doctor’s and patients and how making these requests may negatively impact care received.
Flying and COVID
Airlines play a large roll in COVID and policies in the US around COVID. One community conversation for the last year has revolved around CO2 levels on aircrafts and the safety or lack thereof when boarding. For instance, many airplanes are not on and therefore not circulating air during the boarding and deplaning time periods. Delta airlines has updated it’s Community Safety and Cleanliness Guides which can be accessed here with specific notes that they are refreshing air with outdoor air at 10 to 30 times an hour with HEPA filters. From direct experiences, some people are noticing the increased use of on plane ventilation while others are notating that these features aren’t in consistently in use.
This observation in the changes in Delta’s commitment to safety adds to last week’s notes on upgrading ventilation systems – which can be getting higher quality air filtration – or for airplanes committing to keeping airflow going during boarding and deplaning.
Long COVID
This Nat Geo article highlights some experiences of Long COVID patients for whom exercise is “bad medicine” and can do much more harm than good. In those referenced nearly 75% reported that post exertional malaise is a side effect they are experiencing. This article explains what PEM is and the slow approach therapists are taking in building up resistance while prioritizing rest and preventing worse outcomes.
In Canada, their chief science officer has signaled that COVID may be a mass disabling event and has put forth requests of the country to help fund Long COVID research, create better clinical guidelines, and create a public access network informed by scientists and clinicians to better keep the public informed. They believe the prevalence of Long COVID to be between 10-20% of infections.
Dr. Rae Duncan is a Cardiologist who has put out a video discussing Long COVID and kids. This video is then broken down into sections if you’d prefer to read it, by Dr. Claire Taylor on twitter. Although the video and conversation is centered on kids, the area highlighted that sparked some community conversation was a quote from Dr. Rae Duncan in analyzing the population age of those she sees in clinic. She went from seeing an average age of 55-80 years old (pre-pandemic) to 16-40 years old with 50% of these patients having Long COVID complications.
A topic related to Long COVID is “excess death” which calculates how many people have died beyond what is expected for a given place at a given time, often compared to another period of time. An article has recently come out of the UK calling into question excess death and trying to hypothesize why people are dying at such a high rate and why the existing tools to explain it don’t. One helpful breakdown out of Australia helps to visualize excess death when compared to periods of high vaccination and periods of other factors like reduced precautions. I’ve included this in the Long COVID section, but could have also placed it within research. Looking to both research on long term impacts of COVID and sustained post viral illness, there’s more sound evidence for higher mortality rates after a COVID infection that may not be labeled as COVID when we are considering excess deaths.
Vaccinations and Sudden Death + Other Things You May Have Questions On
One clear area of concern has been about the safety of vaccines, with vaccine injury and vaccine related death being a deterrent for some and a talking point for others. An epidemiologist and emergency medicine physician came together to write this informative piece helping break down what’s being discussed with the science. This piece has very helpful graphics, touches on rumors and their sources (like sudden death among athletes), and also breaks down the real risks we know about vaccines.
COVID and Your Pets
Early on it was believed that you couldn’t spread COVID to your pets, additional evidence has emerged suggesting the opposite. US News reported on cats specifically that were being infected with the same variant as people in their household from early 2020 to February of 2022. The same variant is important here as it indicates human to pet transmission, as opposed to other variants of COVID circulating that may be transmitting between animals.
A Canadian study goes a step further looking at both cats and dogs and suggests that close contact with your animals while you’re sick can cause them to be sick with similar symptoms. Two things that stand out here is that cats appear to be infected more than dogs, and a case study of a veterinarian in Thailand who was infected by a cat who sneezed on him, who subsequently had caught the infection from it’s owner. These risks have been evaluated and implemented into Canada’s guidance for pets and long term care facilities to help reduce the chain of transmission.
Although less prevalent, some community conversations suggest that on occasion these pet infections prove to be deadly with stories circulating of folks having to put down or deal with a dead pet while dealing with their own COVID infection. Other conversations suggest pets can be at risk for the same long term complications (like diabetes) after a COVID infection.
How Different Government Groups Continue To Respond to COVID
The White House hosted it’s annual Correspondent’s dinner at the end of April. This year, after COVID was spread amongst staff and attendees last year, the White House is requesting all attendees take a rapid test prior to attending and submit said test as reported on by Deadline. The event in 2022 ended up being a super spreader as staff were not held to the same testing requirements, it is unclear if the precautions this year were more uniformly enforced.
The CDC also held their own annual event at the end of April. There were no protections in place as mandatory for this conference, and it has turned into a superspreader event. The CDC has opened a probe into themselves to gather more information as reported on by the Washington Post.
Beyond testing and precautions either being taken or being a suggestion from the past the DOD (Department of Defense) has made great strides towards advancing a wearable technology that can help to detect infectious disease. For COVID this new technology has been used to successfully identify asymptomatic cases and cases upwards of 48 hours to 6 days prior to onset which can be implemented to vastly reduce the spread of infectious disease:
“The DOD invests heavily in maintaining the readiness of its workforce to conduct essential missions. However, the risk of infectious disease, like COVID-19, has long been an unpredictable variable. With RATE, the DOD can use commercial wearables to noninvasively monitor a service member’s health and provide early alerts to potential infection before it spreads” – Schneider (defense.gov article)
Working to continue to improve and fund for mass use of this technology will help the military preserve it’s health and wellness of it’s members.
Research
A conversation on a few areas of research surrounding different viral reservoirs, what we know and what we are still looking for by NPR. May 2023
Elevated Risk of Death for 18 Months Post Infection – January 2023
Surges in COVID linked to Spike in Heart Attacks – October 2022
A Study on UVC Light and how it makes indoor air safer – March 2022
Research demonstrating COVID’s impact on cognitive functioning – Jan 2021 – and an additional community discussion on the topic digging into the ideas that infection can cause brain damage that leads to not only brain fog but memory impairment that causes individuals to not remember things like severity of infection (termed anosognosia).
Policy Changes
In addition to the Emergency Declaration ending on May 11th, the White House has moved to end Vaccination mandates for: federal workers, international travelers, contractors, Head Start employees, and many hospital workers as reported on by the NY Times.
A discussion led by Conor Browne, a forecaster who works to predict risks of future viruses and impacts on commercial/other organizations, highlights the various policy changes within the US in addition to the recent declaration by the WHO and contextualizes it within his field of work. His conversation highlights a mix of policy decisions, viewpoints, and risks for future (non-SARS) diseases and how current choices set the stage for potential healthcare system collapse and a vast reduction in preparedness should another pandemic occur.
Different insurances are making different choices when it comes to pandemic era policies. Medicare for example has expanded coverage for telehealth through the end of December 2024. This is a move many believe is a bit of a bridge to allow for more permanent teleheatlh coverage to be a standard of care for those on Medicare. The Drug Enforcement Administration (DEA) has extended it’s prescribing guidelines to allow controlled substances to continue to be prescribed through the 11th of November 2024 through telemedicine for patients who have had in person appointments establishing care prior to November 11, 2023.
Thank you so much for reading the third edition of this newsletter! Remember if you have questions or topics you are interested in finding more about please drop me a note and I can try and include information in the next newsletter.
5 / 20 / 2023 – 4th Edition
Welcome to our 4th edition! I wanted to start out this newsletter with a community discussion that highlights why I created this newsletter:
Nate Bear, a community member working in media and public relations breaks down why COVID messaging has shifted from taking up almost all air space in the news and media, to being but a minor blip here or there and all but a media blackout. He shared this as a Twitter thread, but for ease of reading this is a link to it compiled on his substack. Overall, I share this because it is extremely thoughtful and informative as to why the information climate has shifted so dramatically, and why individuals like myself are working extra to help locate information to provide places people can turn.
Air Quality Guidance by the CDC
In previous newsletters I had highlighted some air filtration research in addition to advocacy efforts being done to get indoor air quality standards issued. Feel free to reference back to those if you’re interested.
The CDC issued on May 11th it’s first Air Quality standards for Ventilation. This goes over guidance, importance of ventilation improvements and various strategies. This confirms much of what has been discussed throughout the pandemic, but extends to other areas of importance like addressing low air quality from smog or smoke, and how improved air quality can improve health outcomes. At this time this is simply a guideline and there is still work to be done to make these standards backed by policy in places like healthcare settings and schools.
ASHRAE (a leader in air quality standards) also issued it’s own improved ventilation standard.
Global Response to COVID
In multiple countries, the impact infections can have on cardiovascular health is beginning to have more attention drawn to it. In Australia, the Heart Foundation has called for heart checks for anyone who has had a COVID infection. In Canada, the Heart and Stroke Foundation has notated that even mild infections can cause heart problems, especially in younger populations and that monitoring blood pressure and further screenings are important.
Dr. Eric Feigl-Ding sounds the alarm bell for the XBB wave that had previously been raising concerns in India, now causing surges in China. He notes that China had also stopped updating it’s weekly case statistics so the full extent of the wave may not be seen. A few important area’s he highlights from various articles include the larger percent of cases that are reinfections and the new XBB targeted vaccines that will soon be available in China, with four additional ones in the pipeline. At this time here in the US there is no indication that we will have access to the Chinese XBB vaccines.
New Covid Treatments On The Horizon and Efficacy of Existing Ones
As the virus changes and evolves, the treatments currently on the market become less effective. One treatment known as Evushield had been used for immunocompromised individuals as a pre-emptive measure, but is no longer viable. Drug maker AstraZeneca reports to CBS that a new drug trial is underway that could be approved by Emergency Use by the end of the year. If you are interested in participating in the clinical trial you can learn more here.
The Department of Health and Human Services continues to issue guidance (an example here) to get updated vaccines if available as in this tweet they say “repeat infections increase your risk for both hospitalization and Long COVID.”
The WHO has advised a transition from the multi-strain vaccines we’ve been using to a monovalent – meaning targeting a singular strain of the virus with each vaccine. This advise comes with the XBB strain continuing to be the more dominant strain that remains evasive of existing vaccines. The article states that the FDA will meet on June 15th to discuss which strains to create targeted vaccines for for the upcoming fall/winter. There currently is not a monovalent vaccine targeting the XBB sub-lineage in the States.
A new study comparing mRNA vaccines to Novavax done at 3 months post jab show promising continued effectiveness of Novavax over the other vaccines. This study is broken down by a few people. Daniel Park (epidemiologist) breaks down the visuals showing that the viral load after three months in non-detectable in those vaccinated with Novavax. Michael Lin (MD PhD) provides and even longer break down of the full study, along with some hypothesis to what it all means comparing the various vaccine types.
Tests, Availability, and Community Conversations
Effectiveness of at home Rapid tests continues to decline, although people have experienced positive COVID tests at home in the past, studies are showing new variants are not showing up as the tests aren’t sensitive enough to them. This study concludes that Omicron continues to follow the trend and has the lowest sensitivity.
With the end of the Emergency Declaration, many people were left to believe that their insurance would decide and issue guidance for continuing to access vaccines and testing. It became immediately transparent that these things were not thought out and folks are unable to get PCR tests. For Medicare recipients like myself and Justine Barron (whom I share this community conversation with regarding access) we received a simple email instructing us that we could continue getting tests and they would be covered when ordered by a doctor. Justine points out that CVS is no longer even offering PCR tests. Our conversation continued trying to troubleshoot how one could safely get a test – some places have allowed drive-thru no contact tests, but these appear to all be gone. Although some may be able to get a test at their doctor’s office, this does not appear to be a consistent offering.
Another community member, Wendi Muse links a tiktok video breaking down the troubles folks are having trying to access PCR tests. The conversation leads to a bleak reality: no place was prepared for the changes to go into affect, tests cost over $100 and are being given out in many cases on a reimbursement basis leaving it up to your insurance to decide if it’ll be covered, and that is financially inaccessible to much of the population.
Though much of this conversation started right after the Emergency Declaration ended, another community member share’s their journey this week, highlighting the extreme difficulty and barriers for even those with access to the most resources to acquire PCR tests.
Celebrities and COVID
Famous Angels’ baseball player Jared Walsh opens up about his difficulties with Long COVID to The Athletic. This post is summarized through quotes on this thread on twitter to highlight parts of his journey for those who do not subscribe to The Athletic. Walsh continued to play for a while as his symptoms continued to get worse, documenting some of his on field challenges with neurological difficulties.
Eight celebrities have come forward to share some of their challenges in this brief article regarding their initial and long covid complications.
Children and Schools
A pre-print (not peer reviewed) study looks at the correlation of children who had COVID infections prior to August 2022 and the contribution to the large RSV wave that occurred in late 2022. Dr. Deepti Gurdasani provides a nice breakdown of this study which shows a 40% increased risk for children. One study referenced published in January 2023, confirms higher risk in children post COVID infection for strep.
A study out of Switzerland has shown that the use of portable air filters and masking reduces the spread of COVID. Mask mandates proved most effective, while use of air filtration provided more protection than without air filtration.
These studies come at the same time as many changes are being made at school. Stephanie Tait highlights in a community discussion how her school district will no longer be asking those who test positive for COVID to isolate and that they should come to school so long as they don’t have a fever. This of course ties into the conversation from above surrounding availability and effectiveness of tests, furthering that most infections will go undetected due to tests being unavailable. It is also important to note from the third edition of this newsletter, we highlighted the updated CDC’s guidance (which can be found here) suggesting kids mask and when sick should stay home according to the CDC’s K-12 Guidance.
Community Conversations on Excess Death
In the last edition we covered the topic of excess death around the world, how it’s being discussed and how different government’s are considering various causes. This edition, a community discussion on how the coverage of excess death is shifting is highlighted. One area that is shifting is the use of what years to compare excess death, it’s noted that due to the pandemic they were using 2015-2019 as the 5 year time span as to not include pandemic related deaths. The recently released excess death toll from England and Wales now includes 2021 and 2022 in it’s calculations. The inclusion of pandemic related deaths makes calculations of what is considered “in excess” shift.
Is COVID is Endemic, What Does That Mean and What Are People Saying?
Endemic: “In epidemiology, an infection is said to be endemic in a specific population or populated place when that infection is constantly present, or maintained at a baseline level, without extra infections being brought into the group as a result of travel or similar means.”
An article out of the San Francisco Bay area offers some clarification as to what some doctors mean specifically by endemic and their belief that we are heading that way with COVID: “We as a society have to be prepared for as much as 100,000 to 250,000 people a year dying of those vulnerable groups,” Dr. Chin-Hong said. “But, in general for your average person, it will probably fizzle out.”
At this point, “endemic” with some baseline level means hundreds of thousands of people dying. Some estimates point to the risk of death from COVID now being about 1% according to the WHO. Say we take 200,000 as a middle ground that means 200,000 is 1% meaning we’re having about 20 million infections. Current estimates of long Covid are between 10% and 23% with some estimates reaching as high as 40%. Continuing on this train of thought, if COVID is leveling out where we are now and we say 15% of people get Long COVID that is 3 million people each year who will have long term negative health outcomes that may result in disability.
It is also important to ask what these doctor’s mean by the average person? Are average people not vulnerable? As we gain research that shows that previous COVID infections makes you vulnerable, does “average” exist on a sliding scale pushing average people to naturally be a more vulnerable group in the way “excess death” has now slid to include pandemic deaths? These topics and more are being explored and pondered over across the community, with no good answers.
Related, [very close to] on this day in 2020, The New York Times published the names of the 100,000 people who’s lives were claimed by COVID. “An Incalculable Loss“
The RECOVER Initiative and New Research/Long COVID Guidelines
On May 25th the research was published to JAMA on the findings from the RECOVER Initiative. What this research has done is work to isolate post covid symptoms that are not present in non-covid patients to create some functional list of symptoms as a guide. This Washington Post article helps break down what this research is about, what key symptoms have been highlighted while also giving recognition to many other symptoms that are common and present, but may not fit the criteria as well for being exclusive to COVID.
Within the community, researcher Hannah Davis breaks down some important findings from the study and shares some graphics from the study.
Research
Vaccination post-bone marrow transplant. May 2023
A study in mice indicates that the Omicron variant is capable of causing brain infection. May 2023
Novavax Effectiveness compared to mRNA in upper airways. May 2023.
Long COVID outcomes one year after infection. January 2023
Resources:
A large group of individuals came together to create a comprehensive resource titled “How To Talk To Your Loved Ones About Covid” in an accessible Google Doc. This is long, in depth, builds a substantial framework for why this work is important, what it is for, and guides for navigating a repetitive process of leading conversation and sharing valuable information about COVID.
Thank you for reading and continuing to share these letters with those you know! If you have feedback or things you’d like to know please reach out and I can try and include the answers (as best available) in the next edition.
6 / 4 / 2023 – 5th Edition
Good evening and welcome to our fifth edition of the In The Pandemic Loop newsletter, designed to bring you the most relevant and up to date information from a variety of sources including: scientists, policy leaders and shapers, community leaders and members, and global perspectives.
Notably, as we enter into summer here in the Northern Hemisphere, areas across the Southern Hemisphere are providing a preview as to what our winter surges may look like. In this edition I’ve worked to highlight ways to determine how much COVID is impacting your community, what’s happening abroad and how both American citizens view the pandemic and how the government is (quietly) working to continue to protect against infection.
I want to acknowledge that for many COVID may not be at the forefront of our minds with the hazardous air conditions coming from wildfires in Canada. With that in mind, it may be worth revisiting previous editions of this newsletter to look at both discussions of ventilation and masking to protect against COVID and against smoke.
How Much COVID Is Currently Circulating?
The wastewater data charts coming out of India looking at their winter/early spring COVID wave, charged by the Arcturus variant (see previous newsletter editions for discussions of symptoms, worldwide discussion of the variant) paint a devastating picture of the scale of infection. This link goes to a visual graph which shows the wastewater data COVID levels during this wave superseding all previous waves.
Community member Laura Miers leads a discussion on this information highlighting how the same thing may happen here in America, but with the lack of funding for our own wastewater data it is very difficult to really see it. As of May 22nd, New York City wastewater data showed as much as 350% increases, with Stanford levels (May 15th) showing rises as well. As of the latest samples on May 30th levels in the New York City Area remain high.
Another (semi) useful tool is the CDC’s wastewater surveillance tool, highlighted by Dr. Noha Aboelata here. This tool allows you to adjust throughout wastewater data to change the settings to show you if there was detectable virus in the wastewater sample. You are able to navigate to your area – if your area is testing to get some idea of what COVID is like in your area. Although many of the sites show a majority high level detection in the last 15 days, some places are registering as “non-detect” – if you do have a non detect marker in your area I’d encourage you to look up your local wastewater to confirm. In my location for example the non-detect is inconsistent with the readings published saying there were “low” and not “no” virus genes in the water here.
COVID Surges in Other Countries, What Does That Mean For the US
The Southern Hemisphere is currently experiencing their winter, which has served as a precursor for our own outlooks for fall/winter in the Northern Hemisphere. Australia is reporting nearly 31,000 new cases, their Chief Health Officer Dr. Kerry Chant continues to encourage those with symptoms to stay home, noting that “even if you have rapid antigen tests that are negative, please just stay home” echoing the sentiment that these tests are no longer accurately providing results for COVID infections due to new variants.
This follows a code “white” at one major Australian hospital, where they ran out of beds for a second time in a 24 hour period of time. Similar issues are a problem over in Brazil, where occupancy of ICU’s is being reported at or near full capacity.
China is experiencing what they consider a “rolling” COVID wave which they anticipate to be something that spikes with new infections every six months according to this Nature Article.
How Soon Can I Be Re-Infected?
With a host of other diseases circulating combined with tougher than normal allergy seasons and wildfire smoke impacting large swaths of North America, it might be hard to even identify you have a COVID infection at first. The overlap of symptoms, especially from allergies might be even easier to believe that one simply is suffering from allergies if they’ve had COVID recently due to outdated information as to how long immunity from an infection may offer protection. Based on case data from June of 2022, published early June of 2023, reinfection is possible within 16 days. This case study follows an individual who had their COVID tests sequenced confirming their subsequent infections were caused by BA.1.1 and then BA.2.
With this information, we can shift our thinking a bit. Previously it was thought to be unlikely that you were reinfected if you’d had COVID within 90 days. Studies like the one above demonstrate that the newer variants are not providing immunity after infection and the claims of “immune evasion” have been true for the duration of time where the Omicron sub-lineage has been the dominant one circulating.
Again, you can see which variants are circulating based on wastewater data here: biobot – all current variants circulating are Omicron sub-lineages.
Supporting this study is another study looking at a larger group of people who had repeat infections within 60 days and breaks it down into age groups and vaccination status. The primary conclusion here is that unvaccinated children ages 4-11 had the highest rate of repeat infections. A preprint of this study (here) has an additional visual that I think is helpful for those looking to make comparisons: the graph shows the ages + infected with vaccination status alongside community averages for vaccinations. I will encourage that you keep in mind much of this data is now a year old so information regarding boosters is now outdated, please reference previous editions of this newsletter for efficacy of various vaccines with more real time information.
How common is reinfection? This study out of France suggests that 1 out of every 7 reinfections occurred under 2 months.
How Long Can A Person Have COVID, A Unique Finding In Ohio
Something strange has occurred and is being donned the “Ohio Cryptic Lineage” outlined by Marc Johnson – whom I presume is the one analyzing the data – indicates that for over two years a singular individual has been shedding so much COVID into the sewer system that they have created a trackable and distinct virus lineage detectable within the wastewater data. This evolving story has turned into a bit of a search for the individual who is most likely experiencing extreme GI duress, in hopes that this individual can be found and can receive treatment.
In another thread, Mark offers additional clarification regarding the history of locating individuals who are experiencing health events detectable in wastewater, who’s responsibility it inevitably falls on (the public health department), and the end goal of not publicizing who this person is but rather helping to get them healthcare – as something so severe is surely causing damage to their intestines.
I highlight this as an example we haven’t really seen before, early on in the pandemic there was talk about what happens when a person who cannot fight off the infection themselves becomes a vector and the virus mutates within them possibly creating dangerous new strains. What this wastewater case shows us is a mutated version of the virus and an extended period of time where a person is infected.
Community and Government Responses to COVID
After success in other government facilities (including being adapted by the Pentagon years ago) Far-UV light installation contracts have been approved for the 189th Airlift Wing and Headquarters. The use of Far-UV has become heavily used across Air Force facilities and is being implemented in some health care facilities as a way to help stop the spread of COVID.
The Connecticut Senate has reintroduced masking and COVID Testing requirements for their floor of the Capital building in response to increased cases.
Gallup has been running polls to gauge how the American public views the pandemic, with the most recent poll revealing that despite the lack of COVID precautions visibly being taken in public, a large amount of people still believe the pandemic is happening (51%) with 25% of the population still being very worried about catching the virus. Other figures to note is include:
- 23% of people still avoiding large crowds, with 10% avoiding even small gatherings
- 31% of individuals continue to mask – reporting they’ve worn one while out in the last 7 days to avoid catching COVID
The Clean Air Club highlights the results from above in a community discussion regarding why so many people report wearing a mask despite the lack of visual evidence we see when out and about. The reality comes down to the fact that COVID cautious people just aren’t out in public, which is supported by Gallup’s numbers above. If you’re looking for a bunch of masks at a large crowded concert nearly 1/4th of people aren’t going in the first place.
Continuing the Conversation On Excess Death
In previous editions of this newsletter, I highlighted excess death in both government statistics, questions from the community and discussion on how the calculation has been changing. TIME published this paper in 2022 highlights a study published in Lancet, estimating that globally (as of December 2021) the global death total is very likely 3x higher than estimated. This is an estimate of 18.2 million excess deaths between the onset of the pandemic and December 2021. Another year and a half has gone by in this time, and as of today the official totals are close to 7 million COVID deaths globally. Current estimates still align with the TIME article suggesting between 15-20 million excess deaths in addition to the current number.
Research
Long COVID in Brazilian Health Care Workers – June 2023
Outpatient Treatment of COVID-19 and Incidence of Post COVID 19 Condition Over 10 Months – June 2023 + additional community notes by Matthew Cortland discussing one of the trialed medications Metformin and it’s ability to reduce the risk of long COVID
Thank you for continuing to read, share, and interact with this newsletter – so long as y’all find value in this information I will strive to continue compiling it.
6 / 19 / 2023 – 6th Edition
Happy Summer to those who find this time of year especially delightful. There are some important new areas of research and discussion in this issue focusing on Long Covid, Omicron variant risk factors, how COVID diffuses in the air around us, and information on our own government + global news.
News on Vaccines
As of Thursday, Moderna has filed for FDA approval for an updated vaccine for Fall that targets the XBB.1.5 variant – this comes after recommendations to switch to a monovalent vaccine that more effectively works against current variants that are circulating. XBB.1.5 is the current dominant variant.
How Severe is Omicron Really and How is It Circulating In Our Communities?
Within this thread discussing some general statistics on Long COVID, this particular tweet provides a graphic breakdown of which COVID variants are producing the most Long COVID outcomes. It shows that pre-alpha (the variant that became dominant over winter in 2020) is responsible for 545,000 Long Covid cases, with drops to 247,000 cases (alpha variant) and 327,000 cases (delta) with subsequent strains. This increases again to 698,000 cases with the latest Omicron lineages. I highlight this within the severity conversation because Omicron has repeatedly been discussed as “mild” and the post virus scientific studies on Omicron’s impact show it is much more serious.
In discussing this study from May which works to understand statistics around infections, reinfections, and outline risk related to vaccination status and Long COVID, heart surgeon Harry Spoelstra highlights some areas of the study in plain language. He outlines that the risk for Long Covid after a single Omicron infection is about 9.7%, increasing to 20% after an Omicron reinfection (so two Omicron infections), and a difference between single infection risks being 9.7% for vaccinated individuals and 17.7% for non-vaccinated individuals.
Looking specifically at risk within our broader community, community member J Weiland – scientist and infections disease modeler – has taken the time to use wastewater data pulled from Biobot’s data to break down a true estimate of how many COVID cases we would have each day. This estimate suggests the number would be roughly 200,000 cases per day here in America.
If we look at these estimate case numbers in context of previous time periods that have been considered “lulls” – accounting for undercounts in those time periods as well you could say we are currently experiencing case loads similar to summer of 2021 and April of 2022. Community conversations however highlight that a lull in cases – despite minimal numbers to really go off to make precise judgement calls – puts high risk populations even more at risk. Lull’s in viral activity mean that high risk individuals may attempt to get medical care they have been putting off in the midst of everyone else deciding they’re going to “make up for past years” and have the best summer of their life, engaging in even higher risk activities. During these lull’s it is important to remember that in the US a little over 1,000 people are still dying each week, which means vastly more people are infected. In the context of community spread and evaluating personal risk this is a good time to take wastewater into account, but it remains an imperfect measure. Your risk is still “something” even if it isn’t as high as in non-lull periods. (this note has no links as it’s just been observed discussions in community spaces)
Narrowing in on the New York City area, community member Laura Miers highlights the continued issue of minimal available hospital capacity – an issue reflected globally.
More specifically looking at the air and how the virus is circulating and remaining present in the air, a new study by Al Haddrell (who I’ve linked to breaking down the research) helps us understand how the virus is impacted by various elements in the air. Equally as helpful, he takes the time to answer questions at the bottom of his thread which provide even more info in plain language. Of note within this research – which focuses on the Delta variant, but Omicron studies are not far behind, helps us understand that with moderate humidity half of the virality is lost almost immediately. Isolated from humidity, which becomes a non factor have 10 minutes, 95% of infectivity is lost at 40 minutes. He also works to debunk a previous singular study that cited virus particles sticking around for 16 hours showing us the data and it being an outlier, so perhaps less reliable.
In a practical sense the application of measuring air’s impacts on the virus remaining in the air can help us make decisions like: if I’m going to an airbnb and want to air out the space, doing so for 40+ minutes is an ideal baseline. The information around acid in the air increasing how long the virus hangs around can help inform choices on ventilation in spaces where candles or stoves, or certain cleaning products may be more present.
Managing Long COVID
One of the more common Long COVID presentations is that of ME/CFS, which is characterized by extreme fatigue and worsening condition from exercise and general exertion. This study from June of 2023 looks at pacing as a strategy for disease management and looks at the degree to which all participants adhere to the pacing strategies provided to them. Patients who better adhered had better rates of recovery than those who didn’t. Discussions within the broader disability community over the years have acknowledged that pacing is an important factor in perhaps not getting sicker, but that results of this study should be taken in context with other studies that demonstrate things like graded exercise therapy may be harmful to those with ME/CFS.
Long Covid has recently been linked to thyroid disfunction, and community members discuss not only monitoring thyroid levels post COVID infection but indicate that if you are presenting with depressive symptoms it may be in your best interest to also have your thyroid levels checked.
Community Conversation on Nasal Sprays
Multiple nasal sprays have garnered attention, especially among the COVID conscious/still-COVIDing communities as an additional tool to use to help reduce infection risk. Some community members are discussing alternatives to enovid due to cost or concerns about it’s production in Israel – community member Mo highlights their use of Xlear, which in studies has demonstrated the ability to kill the virus prevent it from attaching to cell walls.
For more info on Nasal Sprays, community member Laurie Allee has a very in depth thread with a host of research and different types.
How the Government Continues to Adjust With COVID
The White House continues to follow it’s contradictory patterns in how they approach COVID prevention. Leading up the College Athlete’s Day, a memo was sent out requestion masks and social distancing at the event, which was then reported as old guidance. It is unclear what the current protocols are, but the event moved forward unmasked and not distanced.
The CDC put out a memo, with internal acknowledgement regarding the relationship between large populations having Long COVID and labor shortages. In there webinar regarding supporting Long COVID patients and helping them get back to work from June 15th of this year, they break down the complexities of Long COVID, who is often impacted and highlight multiple studies acknowledging upwards of 18% of people with Long COVID whom have not returned to work within a year. This memo is designed for and geared towards clinicians and designing supports for a gradual return to work with critical notes such as “not returning to 100% after being off for a long time” while also highlighting some specific symptoms and various accommodations.
Attached here is the pdf transcript from the above webinar, separate from the acknowledgements from within our government I think this document highlights what we know about Long COVID, how it can impact daily life, and what treatments/further complications are known and regardless of the original context I think for those looking for a well rounded understanding of the long term implications this is a well worth while read.
The Department of Health and Human Services issued an advisory geared at clinicians regarding mental health impacts of Long COVID.
Celebrities and COVID
Professional and Olympic cyclist Filippo Ganna has put a pause on cycling to focus on recovery. Ganna caught COVID at a previous race, roughly a month ago and seems to now be dealing with effects of Long COVID.
During a concert in the UK, Robbie Williams stops out of breath and announces to the crowd that he is “fucked” and that he is suffering from Long COVID.
Other Countries and COVID
We looked at statistics in the US as it relates to public perception and behavior surrounding COVID, so I want to highlight some of the same questions and how the population in Japan is responding differently. Of the surveyed group, 40% always mask whether indoors or out with closer to 65%-70% responding always or often. Places like public transport, hospitals and the supermarket are where people mask the most. Notably 55% of respondents want to often or always wear a mask in the future with the top reason being “not wanting to get infected.”
In the United Kingdom, a priest shares their experience interacting with families surrounding funerals. Anecdotally, people are catching COVID, dying, and then the deaths are not being notated as caused by COVID. Families are sharing they have positive COVID tests, consistent symptoms, and frequently dying of gradual heart failure. For anyone who has followed research and the increase in heart problems post infection, these heart failures are still COVID deaths despite not being counted as such. At the same time, England is acknowledging they are swarmed with heart disease and cardiovascular issues.
Research
A link between a type of Long COVID and persistent inflammation, similar to autoimmune disorders – June 2023
The existence of Superspreaders spreading higher than normal viral loads – discussion with link within to Lancet study – June 2023
A link between Covid-19 and Alzheimer’s established – June 2023
NovaVax demonstrates lower side effects compared to other vaccines in booster recipients – June 2023
COVID-19 is the leading cause of death for children and young people in the US – Jan 2023
Thank you for continuing to read and share and interact with this newsletter, feel free to ask questions of share information as you come across it as well! Your continued support will keep this effort going to help folks stay informed as best as possible.
7 / 6 / 2023 – 7th Edition
Welcome to the 7th Edition of In The Pandemic Look. This week we’re digging into some new research that looks at how many people have really had COVID, some related COVID symptoms + diseases, discussions around vaccines, testing, and impacts in different industries as the world continues to adjust to living with COVID.
As always this letter takes the approach of combining information directly from the scientific community with valuable community discussions lead by both experts and common community members to get a well rounded analysis and understanding of how the pandemic is continuing to impact people today.
Rates of Infection, A Community and Scientific Conversation
Doctor Noha Aboelata shares some nice alt text included graphics highlighting a recent study of seroprevalence – the amount of something measured in the blood – of COVID infections. This data helps us to understand how many people have had COVID based on those who have donated blood. This initial data set is suggestive that as many as 1 in 4 people haven’t had COVID.
Additional community notes help us contextualize this data. One community member highlighted this study of Long COVID patients which demonstrated that after 4 and 8 months post infection 19% and 61%, respectively, of patients who had developed antibodies “seroreverted” meaning despite having had antibodies + a COVID infection, they no longer do. This had a large impact on the numbers mentioned above as the 25% of people who based on bloodwork did not have a COVID infection also includes people who had an infection and are not continuing to produce the antibodies that are being measured.
To get a clearer picture of how much COVID is circulating currently in the US, we look towards what folks are saying and some fact checking on the idea that “covid just disappeared” that helps us understand thousands of people are still being hospitalized each week with a couple hundred deaths being reported each week as well according to the CDC. The CDC’s wastewater chart also provides a look as to which regions may be experiencing higher infection rates.
Hospitals and COVID
In a report coming out of Australia, over 650 people have died after they caught COVID at the hospital – deemed a hospital acquired infection. This is out of a little under 6000 suspected cases. What’s notable in this article is the commentary surrounding the risks of hospital acquired infection and the expressed concerns for anyone who may be actively avoiding health care settings, especially since masks have been dropped, due to being higher risk.
Following an outbreak among staff and patients at one Boston area hospital, mask mandates have been reinstated in some areas. This follows a trend we are seeing across the country in large area hospitals that have dropped mask mandates with the end of the Public Health Emergency and are now experiencing influxes of cases that require masking return.
Vaccines and Testing
New research on a combo of Pfizer + Novavax vaccines in children demonstrates a high immune response.
But Can I Get Novavax if I’m up to date with my shots? No probably not. Across the community people are continuing to present anecdotes about their attempts to get Novavax after having and mRNA based primary series and boosters. Nigh_Bird documents their experience getting contradictory information from pharmacists for why they can’t get the booster, including the pharmacist’s ability to pull up patient records. Dr. Sean Mullen share’s his experience being denied even with a prescription. The current CDC protocol limits Novavax to people who completed their primary mRNA series but received no boosters. The continued difficulties getting Novavax + the lack of availability, in conjunction with more and more research showing that the Novavax vaccine offers the best protection remains an area of tension and frustration for many.
Will Novavax Rules Change? Maybe! There have been a few opportunities for public comment relating to vaccines where efforts were made to update guidance on Novavax and safety of mixing the mRNA with it. It is possible by the time mono-valent vaccines are available in the Fall we could have updated guidance as well.
We have long suspected that at home COVID tests are waning in their ability to detect an infection – especially early enough that you won’t spread the virus to others – but a new study helps to break down how tests are limiting as a tool for tracking infection, such as only taking a nasal swab, and the effectiveness of taking a dual mouth, nose, throat swab is. Roughly 44% of tests gave an accurate result.
COVID around the World
Hiroshi Yasuda, scientist and professor, highlights some areas of disease activity to pay attention to in the future, specifically the surge of Acute Macular Neuroretinopathy since the easing of COVID precautions in December of 2022. More can be read in the research section below of the established connections.
Yasuda also provides us with reports from Okinawa area hospitals – translating this article – that patients are struggling to find care and hospitals with capacity even after visiting 7 to 8 locations. Roughly 2/3rds are older and presenting with fevers, and of those with fevers 70% are returning positive COVID tests. Some hospitals are putting a limit on the number of fevered patients they will admit.
Looking at Australia, we continue to heed their winter infection experience as a preliminary warning for what our fall and winter surges could look like. Previously we had linked the rise in RSV cases to COVID infections, so I think it’s worth including that some Australian states are reporting a 10 fold increase in RSV cases compared to this time last year. The article also highlights some limitations like increase in testing or a lack of numbers to compare to in some jurisdictions.
Impacts Across Industries
Show business has been one of the more complicated in terms of Covid precautions, many of which have come to an end over the last year. Broadway is having it’s fair share of complications as COVID continues to circulate. In London, at the end of June Moulin Rouge had to cancel it’s weekend show and industry reports highlight other performers – including Lea Michelle calling in sick from their shows.
In the last edition, we discussed some celebrities who have had COVID including cyclist Filippo Ganna who is pausing his career to focus on recovery. This year the Tour De France will enforce it’s Covid precautions based on case impacts from the event Filippo got sick at. The protocols being instated include masking and limiting interactions with fans throughout the race, but do not include testing prior or leaving the event should you return a positive case.
Community Conversations Around Excess Death
New US Data has been published showing a “negative” amount of excess death since December. You can use this site (Our World In Data) to adjust to the US to see the statistics in graph format. Community members have pointed out to those sharing the raw projected data that it is skewed due to the inclusion of pandemic years in the projections. From previous discussions in this newsletter you’ll recall that previous excess death during the pandemic was calculated using the years 2015-2019, whereas we are shifting to include 2020 and 2021 in new calculations which includes the large amounts of excess death caused by COVID. Nate Bear highlights that if we were to continue using pre-pandemic data we would be sitting around 6-8% excess death, which is an improvement from the 15-20% excess death percentages of 2022.
Related data out of Quebec shows that they have also – on average – returned to a baseline of excess death, but community member Dr. Lisa Lannattone highlights that when broken down by age groups for the beginning of 2023 the those in the 80+ group experiencing what is considered negative excess death is dragging down the average, as those aged 0-49 are still elevated between 15-20% excess death.
Updates From Ohio, The Mysterious Cryptic Lineage
In previous editions I highlighted a very unique case discussing someone who is in Ohio with their own unique strand of Covid – likely a long lasting version of the virus that is present in their gut. Marc Johnson, the person providing updates and doing this research, has offered another update. At this time the person remains unidentified and they are not actively looking for them. The viral load itself appears to ebb and flow, which is suggestive it behaves perhaps like chronic Lyme disease where the disease activity has flares. Some interesting commentary is also provided by Marc about some of the sequencing that is being done and how various lineages work.
Research
Effects of Corsi Rosenthal Boxes on Air Quality – July 2023
Review of How RSV Epidemiology Has Changed During COVID – July 2023
Association between COVID and AcuteMacular Neuroretinopathy – June 2023
Retinal Tissue and Microvasculature Loss Post Covid Infection – March 2023
Thank you as always for reading and sharing these newsletters. So long as y’all remain interested and find value in this format of synthesized information, I will continue to strive to publish them.
7 / 20 / 2023 – 8th Edition
As the Summer continues and the pandemic ebbs and flows with even less public conversation happening around COVID, it continues to get harder to find any reliable insight as to where we stand to continue making the best decisions for ourselves. For this edition of the newsletter I start with highlighting our White House’s protocols as I believe the best comparison we can make is to the highest office and the safety measures they believe to be standard.
This edition also explores covid in the community, other countries response, the new Gallup community perception poll, and new developments + research.
How Governments Continue to Respond To COVID
The White House has continued to keep it’s COVID Testing policy in place despite the more public facing end of the Emergency Declaration and a complete stoppage of public health messaging that had encouraged the general public to take the pandemic seriously. (The full press briefing is here) A few members of the Israeli delegation tested positive for COVID, the current policy is that anyone who meets with the president is tested for COVID. Of additional note, the White House also does not follow the “5 days after a test return to work” reduced isolation period that was public guidance beginning in 2022.
Looking back towards Japan as they continue their response to the latest wave of COVID, officials acknowledge that the health care system is incredibly strained and is urging residents to stock up on food and medical supplies while also avoiding use of emergency services for mild infections. Looking at people who died at home from COVID, an alarming 38% had no or light symptoms before dying, with some instances having a rapid deterioration. With the government and other officials asking people to not add to the strain on the hospitals, it is very likely many more people will die at home following the same trends from winter.
Jumping over to New Zealand, their public COVID guidance Twitter account (Unite Against COVID-19) has shared in it’s continued effort to reduce the spread that the “best protection is when everyone wears a mask” with continued messaging that it’s important regardless of vaccination status for the protection of you and the community.
How COVID Is Circulating In and Impacting Our Communities
We have been looking towards wastewater as our main metric for understanding how much COVID may be actively circulating in various areas since other metrics have long been discontinued. A study out of Denmark shows that when done on a large scale, wastewater data can give us a strong incidence (or level of new cases) reference point. It is very important for US based readers to remember this is for Denmark and they set up a very robust system for measuring wastewater data, and in comparison to much of the US our wastewater statistics aren’t as robust. This does however give us an opportunity to improve wastewater research as a means of monitoring COVID and other viruses.
One area of impact we return to when it comes to COVID within our communities is the impact on the community and individuals after an infection. Previous editions of this newsletter have explored topics like excess death, highlighting the large swaths of people who are dying, in addition to various areas of disability and recovery from conditions grouped together as Long COVID. The COVID Longhauler Advocacy Project highlights the new US Labor Bureau’s statistics on disability here. These statistics show that we have reached the highest reported number of disabled people (34 million) a sharp increase from previous years. Pulling together the research we have regarding rates of Long COVID risks and the CDC’s own guidelines on the impact COVID has had on the labor force, much of the new disabled population can also be attributed to COVID.
Continuing to look at recovery from Long COVID, linked below in the research section is another publication that reports that only 7.6% of unvaccinated individuals are recovering after 2 years. This is consistent with other research that has been published over the last few months.
Community Perception of COVID Risks
We have a new Gallup poll that helps us understand how the broader United States population feels about COVID. The last one was published in February. At that point 51% of people still believed the pandemic was ongoing. The new poll from June shows that the majority has shifter, with 64% of Americans now believing the pandemic is over in the US. This poll does not include some of the behavior of “returning to normal” nor the masking habits that the poll from February included.
Some other poll results to note:
- public concern about catching COVID has dropped to 18%, similar to June of 2021
- among US adults, 46% say they are not at all worried about catching COVID
- roughly 43% of Americans feel there life is back to normal, with an equitable 41% saying that life is not back to normal and will not return to normal
*please remember these statistics are focus on public perception and are not data points related to actual pandemic numbers
Legal Challenges Around COVID
One of the early concerns when the pandemic began was getting infected at your place of work. As the pandemic has progressed conversations and debates have existed between the disabled community and workers right’s organizations and activists regarding how protection from COVID is a worker’s safety issue. A California court has ruled that you cannot sue your employer if you are infected at work and bring that infection home to your family. This ruling sets a difficult precedent moving forward for holding workplaces liable.
Masking was a legal issue prior to the pandemic, with many states having outright bans on wearing a mask in public places – think along the lines of “if you wander around the beach in a Halloween mask on any day other than Halloween you may be arrested” type of laws. As mask mandates have been dropped in most places, and limited places having “you may mask if you choose” types of policies we begin to shift back towards more laws and policies that prevent masking altogether. In-N-Out has instituted a ban in 5 states – Texas, Utah, Arizona, Colorado, and Nevada – that says employees cannot mask at work.
New Developments and Other Things of Note
Researchers have created and tested a new device that can monitor covid levels in a room, giving us close to real time information as to how much of the virus is currently in a space. This device has the potential to be implemented into spaces like schools and hospitals, but could also be a tool individuals who can afford it can access in order to have precise risk personal risk assessment when navigating through spaces.
Although not a new development per say, Pfizer’s statement regarding the causes of Long COVID is a very important admission regarding some long COVID risks, particularly in it’s acknowledgement of immune dis-regulation which can help us better understand how people’s immune systems are functioning at a lower capacity post-covid and are unable to fight off regular cold infections. This statement is also a very nice plain language wrap up of a lot of what we know about Long COVID and why it persists.
Musicians are one group that have remained in the public eye and are experiencing impacts of both behavioral changes brought on by the pandemic and risks associated with hosting live music events during a pandemic. This Teen Vogue article – exploring the increased violence and hostility at events – also serves as a pivotal source of information regarding the current state of the pandemic and how some musicians feel ignored in their continued efforts to avoid the virus.
Research
Toxicity of the spike protein in COVID-19 is a redox shift phenomenon – July 2023 – this research has prompted some researchers to advise full body PET scans for Long COVID patients
The Immunology of Long COVID – July 2023 – notably the conclusion from this research highlights that ” The oncoming burden of long COVID faced by patients, health-care providers, governments and economies is so large as to be unfathomable, which is possibly why minimal high-level planning is currently allocated to it. If 10% of acute infections lead to persistent symptoms, it could be predicted that ~400 million individuals globally are in need of support for long COVID.”
A Study 2 Years Post COVID – July 2023
Thank you for continuing to read, share, and subscribe to this newsletter! If you’re looking for specific information that you haven’t seen covered feel free to reach out and I can try and provide resources for the next newsletter. Again, so long as y’all value this effort of synthesizing pandemic information I will continue to strive to compile it for you!
8 / 2 / 2023 – 9th Edition
Kicking off August we are surrounded by subtle warning signs and more clear announcements from large news organizations prompting the general public to prepare for a late summer surge. CNN announced earlier this week to begin stocking up on tissues and COVID tests, so I wanted to start this newsletter off with a section that goes back over some of the preventative measures covered in previous issues before diving into new info.
What Preventative Measures Can I Take/What Items Can I Stock Up On With COVID Cases Increasing?
The Clean Air Club – an organization out of Chicago – has put together a nice grouping of graphics discussing nasal sprays. Nasal Sprays have been clinically proven to reduce and all but eliminate any virus that may be in your nose. Community members have been relying on nasal sprays to reduce risk of infection preventatively – say when they go out, if they have to take their mask off, and so on. Scientists have been studying the nasal sprays in infected populations and have demonstrated their effectiveness in fighting off the virus and reducing severity of illness. (For specific research on specific sprays please reference the master thread that had been shared in a previous newsletter.)
The nasal sprays discussed as most effective are Carrageenan based sprays (Nasitrol, Salinex, Agovirax, and Betadine Cold Defense Nasal Spray), Hypromellose Nasal Sprays (Taffix), Nitric Oxide Nasal Sprays (Enovid, Sanotize, and VriX), and Xylitol Nasal Spray (Xlear). Some of these are limited in which countries they are available in.
Combining a nasal spray with masking using an N95 or better mask with a good seal to your face adds an additional layer of protection. With wildfires continuing to blaze it may also be worth investigating R95 masks which have the N95 rating in addition to filtration for smoke hazards like ozone. You can also increase to a P100 respirator, I personally have found the 3M 6000 series to be a comfortable P100 to wear (you can get it at a lot of places but Home Depot has it).
The Readimask is also an option to consider for medical situations – it’s a strapless and metal free mask that adheres to your face – making it a safe option for getting an MRI, or something to utilize to cover your nose while receiving dental care. It offers an N95 level of protection.
Do you need assistance with masks? Kirsten has been working to send masks to those in need and you can reach out to her here. If you’d like to financially support the distribution efforts, you can donate here.
A third layer you can add to your toolbox is a CPC mouthwash – Crest Clinical Mouthwash has 0.07% CPC which is the minimum amount you want to look for. Gargling with CPC mouthwash has proven clinically effective at reducing the viral load of COVID after use. There is also a CPC breath spray that some people have been using. (citation) previous newsletters also have a handful of research linked to CPC results.
Community members have also discussed using Lumify eye drops as a preventative measure before entering public spaces. Transmission via the eyes has been an on and off concerns during the pandemic which has increased with the more common conjunctivitis symptoms in recent variants. A study from 2020 showed that Lumify completely inactivated the COVID virus, though I am unable to find more recent studies as variants have evolved.
What about tests and vaccines? As previously noted in other newsletters, tests continue to wane in their ability to pick up the virus so if you are feeling sick and have the ability to isolate from others – or mask and prevent transmission – that is the best option. None of the currently available vaccines (except novavax if you haven’t been previously vaccinated) are holding up against the current dominant strands of COVID-19. Pfizer, Moderna, and Novavax all have more targeted vaccines prepared to roll out this Fall. It is expected they may roll out towards the end of September, being August now if you haven’t already received your booster due to the time requirements between doses it may be best to wait for the new ones.
All of these measures can be combined with improved ventilation and use of air purification devices.
What if you have COVID? What should you do? This in depth guide has been written by a doctor of pharmacy for both adults and children, includes dosing schedules and potential drug interactions on what is available and how to take it to reduce the severity of infection and hopefully in turn reduce risk of Long COVID.
The Future of COVID Coverage and Treatment
Since the passage of the Affordable Care Act, preventable care has required certain screenings, tests and medications to be covered. A national panel will be meeting to discuss the inclusion of COVID screening as a recommended preventative measure which would make tests free to those with insurance.
New research has emerged (research linked below) that has uncovered an antibody with the power to stop COVID and perhaps neutralize future strains as well. This article discusses the broad range of neutralization that is occurring with this antibody that is even inclusive of the current dominant XBB.1.16 strain. Discoveries like this lend to a promising future that new vaccines that are able to go beyond stopping hospitalization and death, but stopping the virus altogether may be possible.
According to the UK Blood Donation guide, Long COVID has been added to the list of conditions that prevent folks from being eligible to donate blood. A list of symptoms has been provided in which if you are still experiencing them, you cannot give blood. This change has prompted discussions to re-emerge regarding the patient who died after receiving an organ transplant that was infected with COVID. Both of these instances bring up new questions as to if the US will follow suit and limit blood donation as well.
The White House is forming a Long COVID Research and Practice office which will study the condition and work to help those who have been diagnosed.
COVID and Hearing Loss, and Other Symptoms
Some new research is pointing to hearing loss being a lesser known symptom of an acute COVID infection, but also a risk associated with Long COVID. This article digs into the different research that exists and discusses the various ways hearing loss can show up during and after an infection. One of the symptoms notated related to hearing loss is tinnitus which is a ringing in the ear like sensation that is considered to be extremely disruptive in some cases and can also be a Long COVID symptom.
The mental health of folks with Long COVID also deserves attention. Recent studies show large increases from 18% to nearly 45% of sample groups asking if they have suicidal thoughts in Long COVID groups. This TIME article digs into some of these complications and I feel it’s worth including for anyone who may also be struggling.
How Air Flows, How To Evaluate if Outside Is Safe
Conor Browne, biorisk specialist, has taken the time to do a lovely breakdown of a phenomenon called “dead air” which can occur in outdoor and crowded environments that will increase the amount of virus circulating in an area. This is in response to an outdoor market being the source of an outbreak, where it’s been determined that if conditions are right you can definitely get infected. Browne’s breakdown is valuable because it teaches us that the still, humid, non moving air in an outdoor environment is what is considered “the right conditions” as the air simply isn’t moving and isn’t being replenished by clean fresh air.
COVID and The Box Office
The New York Times ran an article after the opening for Barbie and Oppenheimer suggesting that the pandemic has ended due to the bounce back of the revenue from both of these movies compared to pre-pandemic times.
Amid the warnings of the late Summer Covid surge, as notated by the Daily Mail, the large Barbieheimer premier will certainly lead to… a lot of sick people.
It didn’t take long for anecdotal reports to come in all over Twitter within a few days of everyone sharing their Barbie outfits and pictures from the movie theater, a lot of people are “feeling really crummy” and many have shared that they have tested positive for COVID. For privacy reasons, I am not linking to specific people who have shared they contracted COVID after attending Barbie.
The Summer Surge
All signs point to a surge so lets look at the data. The current major metric for evaluating surges in the US is hospitalization, and according to CBS hospitalizations have risen nearly 12% across the country as of the week of July 22, 2023.
We can look towards other metrics, like wastewater data – which we documented in the last edition of this newsletter as being one of the most accurate determinants of current caseloads – to see there are also surges showing up here. (You can view biobot’s data here). Community discussions highlight that over the last five weeks cases have increased by 97%.
Analyzing the biobot data (from July 26th) with 325 copies per mL, with no relevant case count to draw from we can compare this wastewater amount to November 2020, August 2021, and April 2022 which were all points of a coming surge. The 2020 and 2021 dates correlate to roughly 100,000 daily new cases. These numbers drop in April of 2022 coinciding with the vast reduction in testing being reported.
Fox News has suggested people consider masking again – A doctor on MSNBC on Tuesday highlighted the increase in positive tests you may be noticing from friends and family in addition to the 12% hospitalization increase and adds that masks should be brought back with the hospital uptick.
Some Myth-busting: COVID Vaccine Levels of Protection
One commonly shared sentiment is that being up to date on vaccinations means you are not at risk, or are at a much lower risk of developing Long COVID. This has been aided by the Boston Globe publishing a piece regarding how most of us can go back to normal. You may seek this article out, but as it’s misinformation I will not link to it here.
In May of 2022 research was released concluding that risk for Long COVID was only slightly reduced (by 15%) in people who have been vaccinated.
COVID Impacts In The Community
One community that has shared it’s impacts of COVID is the teaching community. A recent survey conducted by EdWeek shows that 1 in 5 educators are experiencing symptoms related to Long COVID. The article goes through a variety of experiences held by educators, some now only working part time, describing their various symptoms, and some teachers taking long term leaves of absence with unclear paths for the future.
Based out of a survey in London, doctors have also been surveyed regarding Long COVID. Some notable results from this survey include 60% of doctor’s who responded notating a reduced ability to carry out day to day responsibilities due to post acute COVID symptoms, with even more reporting that their symptoms have not been investigated thoroughly.
Continuing some former discussions of COVID and celebrities, the Vancouver Sun released a very interesting article regarding a nasal like virus neutralization technique being used by doctors on a variety of celebrities – including the members of KISS and a few former football and hockey stars – all were treated with what is called “Steriwave” and believed it helped them. The article expressed hopes that this treatment can be more broadly used, but it currently seems limited to wealthier folks who can afford the experimental therapy.
The mortality conversation also continues with official data coming out as to leading causes of death, of which COVID cracks the top 10 in all age groups. MD Tyler Black breaks down the data and shares some graphics comparing COVID deaths to other leading causes. For children, COVID is a top 10 cause of death, compared to middle age folks where it is a top 3 cause, and top 7 for young adults.
Research
Neutralizing Covid Antibodies – July 2023
Thank you all for continuing to read and share this newsletter. Please remember if you have questions or are looking for info on something specific you can always reach out and I can do my best to help.
8 / 13 / 2023 – 10th Edition
As we continue through the month of August news of new variants of concern and cases surging have made their way beyond various cautious communities and into more mainstream discussions. It is true that cases are rising and in this edition we’ll cover impacts across communities, community discussions, hospital strain, and symptoms to be aware of in addition to Long Covid risks.
If you’re looking for info on protocols to follow if you get sick or preventative measures you can take, I went over all of that in the previous article which you can reference here.
How Much COVID is Currently Circulating
This wastewater graphic paints the best picture we can access at this point in time. Community discussion highlights that despite the perceptions, actual amounts of COVID have leveled off at the highest peaks from 2020 and 2021. These numbers may be down from the surges caused by Delta and Omicron, but they are not down to anything resembling pre-pandemic levels. Previous discussions around wastewater have shown that wastewater levels have remained proportionate to cases when cases were being monitored. This updated graphic shows us the estimated cases coinciding with wastewater data as of August 17th.
This article highlighting the lack of actual tracking while pulling research as to what we do know paints a bleak picture of the hidden surge happening in the US. Some figures and key points worth noting include: a US case total estimate of 419,000 new infections per day based on wastewater data, a 40% jump in hospitalizations based on CDC data, and the Walgreens Covid-19 index returning a 44.7% positivity rate in tests which is the highest rate since the start of the pandemic. These numbers are all regarding the last month worth of data.
Looking at the most up to date information, as of August 5th week over week data shows a 14.9% increase in hospitalizations – the fourth week in a row they are climbing. Emergency room visits for children has also steeply increased.
One tool that provides a useful visual going off of Hospital data from the CDC is the by county map of “hospitalizations” and selecting the “% change from prior week” I think percent change can help people who do not have access to wastewater data get a more localized idea as to if cases may be going up in their area. For example we are looking at areas in orange which represent an increase in hospitalizations this week compared to last.
Related to hospitalizations I want to highlight Dr. Roger Seheult’s community discussion echoing the increase in how much COVID they are seeing in the ER. Dr. Seheult notates he believes the increase is due to the new variant which I have highlighted discussions on below.
What Should We Know About the New EG.5 Variant
One of the early places to pick up variant activity was Ireland, where the EG.5 variant dramatically surged between July 23rd and July 30th. The graphic shared shows that the variant has dominated and taken over the previous dominant grouping of various XBB “soup” that had been comprising most of the cases. This is relevant when we look at what vaccines are being developed for a Fall roll-out as they target the XBB strain.
EG.5 has been called “Eris” and reporting out of the UK, where Eris cases are growing, break down what symptoms are prominent and which are less common now:
- Symptoms to watch for include: sore throat, runny nose, blocked nose, sneezing, wet and dry cough, headache, hoarse voice, muscle aches, and altered smell
- Symptoms that are less common include: shortness of breath, loss of smell, and a fever
It is noted that many of these symptoms are rather indistinguishable from a “cold” but it is important to note that a list of symptoms does not account for severity of presentation or risks of Long Covid – please jump to the Long Covid section for more on that.
Reports from India are indicating that symptoms from Eris seem to be appearing a week before tests are coming back positive. This is different than asymptomatic spread that has been referenced throughout the pandemic, if you are experiencing symptoms you are most definitely contagious even if it takes longer to show on a test.
This article from the Bay Area discusses the increases of EG.5 and projections demonstrating it will become the dominant variant soon. The symptoms in this article are less in agreement with the above symptoms, so for now I will defer to the above ones as the UK has a higher amount of EG.5 cases. The main reason for sharing this article is the discussion of similarity between XBB and EG.5 and that being of the same subvariant of Omicron (despite different letters) should remain effectively targeted by the XBB specific vaccinations that are set to roll out this fall. Spokespeople from both Moderna and Pfizer regarding their new XBB targeted vaccines have been reported to effectively work on EG.5 in trials as well.
Notes on other Variants – XBB and BA.2.86
One symptom that is popping up for the XBB variants that is drawing attention is gastrointestinal symptoms. These have been common throughout the duration of the pandemic, but it is being notated in places like Hong Kong people are stocking up on diarrhea medications and vomiting medications.
Community discussions and observations are also notating incredibly unpleasant GI symptoms. Many folks are documenting misdiagnosis and attempts to figure out what’s wrong – guesses of salmonella and such – only for tests to come back positive for COVID.
Additional Note on At Home Testing: Many changes have been made in how we test using the at home tests. The latest guides are a multi-pronged approach swabbing both the mouth and nasal cavity (broken down here, with the alt text provided separately here). Knowing how to properly collect a sample is the most effective way to optimize the use of at home testing and increase the likelihood of getting an accurate test result.
I also want to highlight very early community discussions on the variant identified as BA.2.86 which has been popping up in an alarming fashion the last few days. Community member Shay Fleishon does a wonderful job sharing what we know in this thread. Some key notes include: only 5 isolated cases have been detected via sequencing and noted elsewhere that the sequencing comes from wastewater data not from identified individuals who have had it. At this time, this makes up a tiny fraction of cases in a tiny area of the UK and there is no info on symptoms, severity, transmissibility, and so on. Community discussions are a valuable way to learn information early and be on alert for future information, but they are not intended to be dire warnings or used to fear-monger risks that simply are too soon to be evaluated.
Changes in CDC Guidance
Many changes in guidance have occurred over the last few years and with media coverage slowing down much of it is occurring without formal press releases or announcements to guide the general public. Community discussions have helped bring these changes to a more visible space. Chris Turnbull highlights a change made on August 5th on the Clinical Care page regarding COVID-19. Two key points include:
- “symptoms during reinfection are likely to be less severe than during initial infection, but severe reinfections do occur and some people can experience more severe COVID-19 during reinfection”
- “reinfection with SARS-CoV-2 within 90 days of initial infection can occur”
Both of these updates are in contrast to previous CDC guidance.
Additionally, there is a graphic going around that I will not link that makes claims that death numbers are not being updated. I attempted to use the Provisional Mortality Statistics to recreate these claims to no avail. This chart from the CDC does show COVID related deaths by week in the US with notations that delays up to 2 weeks are expected. I mention these two things together as the CDC chart relies on the Provisional Mortality data so claims that deaths are simply not being added are relevant, however to the extent of my ability I am not able to verify if these claims have any real merits.
What Does “Up To Date” On Vaccinations Actually Mean
I want to do a quick recap on what up to date on vaccinations means, as the guiding principle for much of the population has been “vaxxed and relaxed” but when were you last vaccinated? How many vaccinations have you gotten and what’s considered up to date for regular or high risk.
There was a primary series of vaccinations consisting of 2 mRNA vaccines when vaccines initially rolled out in spring and summer of 2021. The first booster which was recommended to all was in Fall of 2021.
For high risk individuals, a second booster was available in the Spring of 2022.
The bi-valent boosters which were more targeted were available in Fall of 2022, with a second dose being available in Spring of 2023.
For regular individuals, 3 doses of the vaccine including the recent bivalent booster would be considered “got all my shots”, whereas 6 or more (depending on doctor recommendation) may be the total for higher risk populations (which includes older populations). The CDC defines “up to date” as having received 1 updated (otherwise referred to as bivalent) vaccine.
Based on data from the CDC, 81% of the US population has received 1 vaccine with 70% receiving 2 doses or equivalent. Only 17% of the US population has received a bi-valent booster dose.
Previous editions of this newsletter have covered efficacy of vaccines and the vaccines waning over time, so it is worth acknowledging the large percentage of the population who has not received an additional vaccine in nearly 2 years and how that contributes to ideas like “herd immunity” and how implausible it is to rely on protection from vaccines most people (83%) are not actually up to date on.
When Will The Next Vaccines Be Available? Early projections suggested early to mid-September. Eric Topol shares one reason for delays – the end of the Public Health Emergency now means vaccines require a different kind of application for use. Discussions on Pharmacy availability also suggest it could take until Mid-October before contracts are approved for Walgreens and CVS.
Let’s Talk Long-Covid
Research out of the UK is suggestive that 1/3 of their population has been infected with COVID and 11% of those infected have Long COVID. Jennifer Brea has been highlighting the discussion comparing rates of long term symptoms post infection across different diseases since 2020. An 11% rate of Long Covid puts it in line with diseases like EBV, Q Fever, and Ross River Virus.
In a pre-print study evaluating “heavily vaccinated individuals” defined as 3 vaccines whom were infected with Omicron, 1 in 5 of a large pool (22,744 participants) reported having Long-Covid symptoms 90 days after their Omicron infection. Of these people, they had a median of 6 symptoms which included fatigue and difficulty concentrating. A smaller section of individuals (1,778 people) who had been working or studying prior to infection, 17.9% of this smaller group reported reducing or discontinuing work due to Long Covid.
This study is important when compared with other “risks of Long Covid” studies among the population because it demonstrates that vaccination is insufficient in preventing long term complications. It is also important to re-iterate that Long Covid risks were not a metric used to define the success of current vaccinations on the market.
One Long-Covid treatment is Nattokinase, and community member Jennifer Brea takes a moment to draw attention to some adverse effects that others with connective tissue disorders may want to be aware of when considering it as a treatment option.
Madeline Miller, community member and a first-waver, writes a heartfelt experience surrounding her new life with Long-Covid. I think this is an important read that is a deeply relatable for other’s with complicated long term symptoms, but also an easy to understand and simply put evaluation of what this life is like and how our knowledge of these risks should inform our future behavior.
Additional Notes on COVID from Abroad
Much of my newsletter has a United States centered view of the pandemic, because well I am US based. With that in mind, things that happen abroad may not fit neatly into above sections but add to the overall discussion so I will place those things here.
Starting with, the Alberta Health Emergency Department that had to close! due to a staff shortage caused by illness. Emergency department’s don’t just close and instances like this – likely sparked by the EG.5 variant combined with dropping of masking – paint grim pictures for the future of healthcare services.
The Ministry of Health in Trinidad and Tobago has issued a statement regarding an uptick of pink eye cases – as previously discussed the XBB ‘Articus’ variant has a very distinct symptom akin to pink eye.
The UK is poised to sell the next set of vaccines for COVID privately, rather than offering them for free to the general public this fall. Details on their Autumn booster program are listed in the article and offers info on who will be eligible for the vaccine.
Also out of the UK comes recommendations from scientists based on current hospitalizations and surge warning signs to resume masking.
Celebrities and Mystery Illnesses
The largest celebrity recently who has had to completely stop their tour is Paramore due to an “ongoing lung infection” but as formerly discussed, no one can actually say COVID. Previous iterations of the newsletter have highlighted contractual agreements that are preventing celebrities from saying COVID, but some community discussions also highlight the insurance implications: for years now, COVID has been on the list of exclusions and is not included in cancelation policies. If performing artists or venues shared anything related to a COVID infection, no one would be able to get a refund.
The Fan Expo in Chicago this last weekend also had a handful of artist cancelations “due to illness” including Chevy Chase who may also be experiencing pneumonia related testicular issues (ouch if not a joke), and Aleks Le, Brent Spiner, and Xander Mobus who are all “under the weather.”
After Taylor Swift’s Los Angeles concert at Sofi stadium, some fans have taken to Reddit to find out if other people caught COVID there. The answer is yes, and multiple anectodes are accessible regarding folks who had no contact with one another, but attended the concert all having similar timelines with symptoms beginning and then testing positive for COVID. News outlets and the LA public health department are also pointing to large gatherings like the Eras Tour as superspreader events.
Related to concerts, fans from the ATL Beyonce concert are putting out videos urging others to get tested as many folks are reporting having gotten COVID while in attendance.
Vanna White will be temporarily out due to COVID on Wheel of Fortune, the first time she has missed episodes in over 30 years.
COVID and Misinformation by Trusted Leaders
An investigative study was done into a large swatch of doctors (52) across the US who are very active on social media and have spread countless amounts of misinformation. This study evaluates the immense harm that these doctors have caused by spreading false and misleading info on masks, vaccines, and treatments and the results call for a “rigorous” evaluation of the harm these doctors have caused.
Thank you for continuing to read and share this newsletter, please remember if you have any specific questions to let me know and I can try and locate information for you.
8 / 31 / 2023 – 11th Edition
In this edition we look to see how rapidly spreading new variants are impacting communities, how schools and hospitals are being impacted, and other things to note.
There are countless examples of closures happening in schools, and raising cases that are prompting the return of masking to go alongside the “summer surge” which may quickly be rebranded as the start of a very early Fall/Winter cold/flu/covid season. To look back on best practices around masking, general preventative options beyond vaccines, and reliability of tests please glance back at earlier additions of this newsletter.
How Is COVID Currently Circulating? Is It Getting Worse?
With the new Eris variant on the rise plus a new variant (Pirola) beginning to show up in the US and a continuation in hospital trends continuing to increase week over week, the CDC has now adjusted it’s guidance anticipating how the virus will continue to spread. The CDC said this week that they anticipate an acceleration in new cases and hospitalizations over the coming weeks. This comes after the fifth consecutive increase in hospitalizations week over week.
​In response to the detection of BA.2.86 in wastewater facilities across the US, some jurisdictions are taking preventative measures to help protect citizens. The New York City Health Commissioner put out a statement notating that with the degree of mutation for this variant, protection from vaccines may be much less and encourages community members to revisit precautions like masking, staying up to date on vaccinations, testing and staying home when sick.
A steakhouse in Arkansas has reportedly had to close as 14 members of it’s staff came down with COVID within a 48 hour time period. Callahan steakhouse representatives notated that they haven’t experienced anything like this throughout the duration of the pandemic. The owner continues to warn other leaders in town that he went to multiple locations in town and was unable to find more COVID tests.
In Anderson County, SC the state detention center has had to stop all visitation due to a COVID outbreak. In addition to shutting down visitation, all staff will be wearing masks between units to help prevent spread from quarantined cell blocks.
Reports out of New Jersey indicate that one in every four nursing home in the state is experiencing a COVID outbreak.
Kaiser Permanente in Santa Rosa, California has reinstated mask mandates amid increasing cases. Masking is now required for all staff, doctors, nurses, patients, and visitors and the hospital is encouraging everyone to get the new vaccines once they become available this Fall. This comes as they report test positivity has increased to 23% positive, up from between 15 and 18 percent. Nearby Sutter Health Facilities is now strongly recommending masks.
In Syracuse, NY the Samaritan Health System has also reinstated masking due to increase in COVID case.
Morris Brown College in Atlanta has implemented a two week long mask mandate in response to positive cases being reported at it’s student center in hopes of curbing the spread of the virus further on campus.
Additional NY hospitals and the Lionsgate film studios have also reinstated masking. Some discussions in various Facebook pages in different Alabama school districts have also been encouraging the resumption of masking, no official requirements have been put into place.
Variants in the US: XBB and it’s various flavors still make up the majority of COVID cases in the US, with Eris (EG.5.1) now at 14.1% of cases. The XBB.1.16 variant with pink eye like symptoms comprises roughly 27% of cases. using biobot wastewater data
Some community members have notated the presence of bad vomiting spells with COVID infections. Most interesting is folks in unrelated areas reporting unusually high numbers of people pulled off the road to get sick – once noted on a prolonged road trip on August 25th, with others seemingly confirming it in other areas being observed. These currently are all anecdotal reports, but vomiting and other gastrointestinal symptoms have been observed and reported throughout the duration of COVID.
With all of this in mind, Dr. Anthony Fauci has continued to downplay the current risk levels and has seemed to accept and continued to encouraged by the fact that older people, the ill and disabled will fall by the wayside during this surge. This article continues to highlight Fauci’s views, many of which have been highlighted as inaccurate in this newsletter regarding immunity, but this article does do a good job explaining where each talking point isn’t in alignment with the reality we’re living in.
What is BA.2.86 – Pirola?
In the last edition of this newsletter I introduced the variant BA.2.86 which had been brought to some folks attention through community discussions. This heavily mutated strain at the time had been spread through the UK, but it was far too early to know how this strain could impact folks. Now, as the CDC adjusts it’s guidance and projections, many government officials and researchers are rapidly trying to learn more about BA.2.86 in anticipation of it spreading.
On August 30th, JAMA has published a medical brief including information from the CDC regarding the monitoring of BA.2.86. In this brief it is noted that this variant has 35 genetic differences from XBB.1.5 – the Omicron strain most dominant throughout this year – which is a comparable to the differences between the original Omicron variant and the Delta variant.
For a simple read on BA.2.86 The Washington Post put together a nice article. This article highlights the different areas this variant has shown up, various concerns from scientists, and challenges in predicting impact due to different levels of immunity among the population but also challenges in public health messaging that have come from not updating the names for new variants – suggesting the public may be fatigued. I do want to highlight that the beginning of this article states that tests should still be able to detect this variant, but as previous editions of this newsletter have highlighted tests are both insufficiently available and remarkably less reliable so an at home test should not be your only form of deciding IF you are sick.
Schools and Kids
For many families, kids went back to school over the last few weeks. Students and parents and school districts are now facing a challenge at avoiding respiratory infections while waiting for flu and updated COVID shots to be available, which aren’t expected until mid to late September. Many officials are beginning to note that even though they expect flu cases to impact school, they echo the sentiment that it is much earlier than expected to see any kind of surge.
A school district in Kentucky was forced to close just two weeks into the school year, canceling classes for a few days and shifting classes the rest of the week to be conducted virtually. Their attendance rate dropped to nearly 81% with a handful of staff members also calling out sick. Across all of the schools nearly 1/5 of students are out with strep, the flu, and COVID.
Another school district south of San Antonio, Texas also had to temporarily close just weeks after classes began due to COVID. For this small school district, 23% of it’s staff members tested positive for COVID, so the school is unable to keep it’s classrooms staffed.
Additionally, a high school football game in Palm Beach County, Florida has postponed a football game due to an outbreak among players.
Community members are discussing and warning as many kids will also begin their return to school following Labor Day weekend, that the existing school closures are a warning for what will likely be a more common trend across the country as we move into Fall, especially in the time period before updated vaccines are available and before the regular flu shot is normally administered.
Updates On New Vaccines and Other Notes
Novavax has released a statement, following suit with Pfizer and Moderna, that it’s planned release for boosters this fall are effectively neutralizing both Eris EG.5.1 variant and XBB.1.16.6 in it’s animal studies.
Will current vaccines be efficient against BA.2.86? At this point in time, no research has been done and there is no reliable answer rooted in science and trials. Any info you read that says one way or another on the effectiveness can only be speculation.
Using the Provisional Death data provided by the CDC, community member and doctor Denise Dewald highlights this chart comparing deaths caused by COVID and deaths caused by Influenza. Many people repeated compare the impact and disease severity of the flu and COVID and this chart gives us a visual documenting that COVID is in fact 20-40x more deadly than the flu.
Although this newsletter monitors COVID, I do want to include some information on the spread of Tuberculosis (TB) as much of the human behavior and relaxed precautious related to COVID have contributed to TB outbreaks. Community member Laura Miers has compiled this thread breaking down numerous hospitals, schools, and testing facilities that have had TB outbreaks. It’s noted that TB has increased 26% in children age 0-4 in the last year.
News From Around the Globe
Australia is reporting a “horror flu season” that has caught many parents off guard over their winter months. 69% of those admitted to the hospital since April have been under the age of 16. Although in the article they mention they are unsure as to what is driving the worsening flu season and symptoms, numerous research has been published indicating that prior COVID infection leaves everyone with less ability to fight off infection, which can lead to worse outcomes with colds and flu’s that were less impactful before COVID.
As a reminder, we look towards cases and trends in Australia as they experience their winter to help us here in America and those in the UK prepare for the trends we may experience heading into our Fall and Winter.
In Japan, as cases rise alongside cases in the US, they are facing many of the same challenges and closures that we are. As of August 31st, they are reporting over 149 class closures due to COVID. The school boards are urging implementation of ventilation within schools, though masking is up to individuals.
Research
In this research section I have worked to add additional links beyond new research that has articles and plain language evaluations of the research to help you as a reader understand and share the latest research even if research articles are inaccessible/too hard to understand just what is being discussed.
Evidence of Protection from Prior Infection and Vaccination – Nature August 2023 – Professor Akiko Iwasaki breaks down this study in to simpler terms in this thread where she explains that risk for a repeat infection is more dependent on the viral load one encounters. This means that prolonged exposure to more of the virus, regardless of vaccination or immunity from previous infection, increases the risk of developing infection again.
Increased Risk of Reinfection in Older Populations for Those Who Had Early Omicron Infections – The Lancet August 2023 – the Toronto Star published a piece on this study for a simpler breakdown of the results.
Post-COVID after 2 years – Nature August 2023 – The Washington Post published a piece discussing this study.
COVID is Spreading in White Tail Deer – August 2023
Referencing a Study done at Northwestern University, this article discusses the substantial amount of people who also have Long COVID despite never having a positive COVID test.
For further reading, this longer essay on Long Covid by the Intelligencer may be of interest to some.
Thank you for continuing to read and share these newsletters. If you have questions or are looking for something specific, I am always available to try and help! So long as y’all value these, I will continue to strive to publish them.
9 / 11 / 2023 – 12th Edition
As we move into Fall, new Covid vaccines are now available for most of the general public with the CDC recommending everyone over the age of 6 months receive one along with this seasons flu and rsv shots. There is a shift in referring to the new shots as “boosters” and instead referring to it as the 2023 seasonal covid vaccine much like that for the annual flu shot.
This edition of the newsletter looks at the new boosters, provides info on the lesser known Novavax option that will also be heading for approval soon that some may want to wait for, along updated discussions on verbiage like “asymptomatic”, how testing protocols are changing, and continued long covid and “surge” coverage.
News on Updated Booster Vaccines and other Public Comments
At the end of the first week of September, the community was able to submit a large amount of public comments that will help mold what the future of COVID vaccines and tracking may look like. Notably was comment request regarding the mRNA vaccines and requesting that these updated boosters be available to the full breadth of the public – some early recommendations going in to public comment suggested they could be exclusive to those at high risk and those over the age of 75. Secondary to the mRNA vaccines was a comment request surrounding Novavax and requests for that vaccine to be available to anyone who may want it, regardless of previous vaccines, age, or risk factors. The final big point for commenting was surrounding the continued investment in wastewater data across the US. As previous editions of this newsletter have highlighted, robust wastewater tracking has the ability to accurately monitor case levels and we wanted to ask that investment continues and is increased so more areas of the country and rely on this data.
On September 11th, the FDA announced it’s authorization for the mRNA booster vaccines by both Pfizer and Moderna for those over 12 and for emergency use in those over the age of 6 months with varying dosing guidelines depending on age.
As of Friday, September 15th both Pfizer and Moderna boosters are available at pharmacies for people to receive updated boosters. Community conversations however indicate available isn’t without difficulty. Some community members are sharing that insurance companies are not fully set up with the new booster codes, so pharmacies are giving the option for patients to receive the booster at cost ($191) and then submit for reimbursement.
The Biden Administration has set up a program to help get uninsured and underinsured American’s access to the vaccines since they are no longer free to everyone with the end of the Public Health Emergency. However, this program is not fully up and running and may cause additional delays in when people can receive their vaccine. Both Walgreens and CVS are a part of this program, but questions remain as to how it will function.
At the time of this announcement they are continuing to review the Novavax comments and a decision regarding approval and who can get Novavax’s updated booster isn’t expected for upwards of a few weeks.
Find a Vaccine Near You using vaccines.gov, using the Novavax finder (call to confirm stock), or by checking your local pharmacy website.
What Information Do We Have On Novavax To Know If It’s Right For Me?
Novavax was only released as an option in July of 2022, so we are a bit behind in terms of research and public communication regarding the success of this vaccine. I like this article as a simple breakdown between the mRNA and Novavax put out by Yale Medicine.
However, this article doesn’t answer the critical question many people are asking, where is the information on Novavax that really says it’s better? Much of this information has circulated around COVID conscious communities but isn’t very accessible to the general public. Here I will attempt to compile community discussions – often of research studies – to help make it a bit more accessible.
Community member ShellPhish breaks down the early studies of Novavax showing that the vaccine offers a durability over time that mRNA vaccines do not, in addition to protection against future variants that indicates updated vaccines aren’t 100% necessary as Novavax shows promising results against them. They shared an updated thread in March of 2023 discussing continued evidence for Novavax discussing that annual boosting with Novavax can potentially achieve broad protection that mRNA vaccines are failing to achieve.
Biomedical Researcher Jeff Gillchrist breaks down how Novavax works in plain language while discussing both groups who have received full Novavax vaccinations and studies on those who previously had mRNA and have been boosted with Novavax. This is from November of 2022.
A pre-print study from February of 2023 suggests that Novavax is twice as effective as Pfizer in preventing severe disease. This is in line with additional studies suggesting 99-100% effectiveness in preventing hospitalization, with this study showing 99% efficacy against severe disease and 90% vs infection. This particular point regarding prevention against actual disease is why many community members are interested in Novavax and advocated for it’s availability to the broader public.
Recent data from Novavax shared during the Tuesday meeting discussing all of the vaccines gives us information on the updated booster shot that will be available soon. Epidemiologist Eric Feigl-Ding shares with us the slides from that presentation highlighting the ability for Novavax to neutralize the new variants.
Jeff Gillchrist on Sept 10th gives us another simple to understand thread comparing how Novavax works to the mRNA vaccines to help us understand how Novavax’s mechanism of actions provide differing and more long lasting protection. This thread also recaps info from his previous thread but with some more up to date studies. Also of note he pulls out the data regarding comparison of side effects – for many who had adverse reactions to the mRNA vaccine, Novavax may be much safer for them to take.
Testing for the Newer Variants
How to properly test for COVID has been discussed a handful of times, but I want to revisit it as we continue to see many folks reporting a variety of symptoms despite negative COVID tests. This (paywalled sorry) research study from Nature highlights that as many of 90% of cases are not picked up on at home rapid test. Community member Adam J. Moore, MPH breaks down some of the insights from this study that show that improved testing methods – using a rapid test 3 times, each 48 hours apart – caught nearly 75% of asymptomatic cases.
Direct Quote from the research study: “More than 150 participants tested positive for SARS-CoV-2 on PCR tests. On the day of infection onset, rapid tests detected almost 60% of infected participants who had COVID-19 symptoms, but only 10% of those who didn’t. However, repeating the test 3 times, 48 hours apart, led to detection of infections in 75% of asymptomatic participants. Two tests conducted 48 hours apart identified 92% of symptomatic participants.”
What Does ASYMPTOMATIC Mean?
Throughout the duration of the pandemic the word “asymptomatic” has been thrown around but without a whole lot of education around what that means. It has also been confused with the period of time between exposure to a virus and when symptoms being – when during that time you may infectious prior to symptom onset.
Asymptomatic in simple terms means an infection that you are infected with where you are not showing any symptoms.
This article in the Atlantic helps us understand Asymptomatic spread and how it may have evolved over the duration of the pandemic. Estimates show transmission of the virus in this way (likely a combination of asymptomatic and pre-symptomatic) is responsible for roughly 50% of spread. This article leads into a community conversation I want to highlight, and that is how we understand what our COVID symptoms are. This article mentions that with the rise of the Omicron variant, most infections began showing symptoms in about 3 days – which likely reduces the amount of pre-symptomatic spread because folks at least know they are sick. This is described as “people having an immune response” to their infection which may be because their immune system is more prepared to fight off the virus.
This leads into the community discussion regarding symptoms many people are experiencing being an immune response, NOT symptoms from the virus. This highlights symptoms like a fever, cough – many of the same symptoms we were warned about when getting the vaccine where we were told this is our immune system responding – when put in the context of being exposed to the SARS COVID virus, many symptoms we are experiencing is our body’s attempt to fight off the virus. The damage the virus can do we have seen more documentation of when looking at Long COVID and things like heart damage, multi-system organ failure, and so on.
This community discussion brings up and interesting factor when it relates to asymptomatic infections not inherently being risk free. Previous studies have shown that the risk for Long COVID exists whether you had symptoms or not. The community discussion brings a new idea that not showing symptoms could be due to a weakened immune system – previous ideas for asymptomatic infection include various genetic components that prevent people from showing symptoms. This new idea correlates to some research regarding “immune evasive” variants, that the virus may be able to sneak past our body’s defenses, and in some asymptomatic cases go completely undetected. It also brings up questions as to how we choose to discuss immune system evasion, because if the virus is able to infect more easily are we really discussing immune evasion, or is the virus able to overpower our existing immunity?
One easy to understand comparison when thinking about COVID would be Lyme disease. Often times people are bit by ticks and do not show the initial rash and do not have any symptoms of the initial infection. Infections carried by ticks can lay dormant in our bodies and months to years later, symptoms of the disease can present itself. If you were to take a Lyme disease and related tick borne illness blood test even without any initial symptoms, if you’ve been bitten and infected this result may show up as positive. I bring up this comparison in the asymptomatic conversation because Tick Borne Illness like COVID can cause long term problems, and for many people in both cases the long term impacts of the infection – whether we ever knew we were infected in the first place – can be incredibly damaging to our bodies and even cause disability.
This comprehensive study that compares results from various asymptomatic infections and Long Covid indicates that is more difficult to track and research those who did not have symptoms, but that there is still risk associated with long term complications regardless of initial infection presentation. At this time it is believed the risk is lower for those who were asymptomatic, but the challenges highlighted in this study surrounding if those who had no symptoms would even seek care or be included in the research indicate we simply need more time to pass to have better data.
Continued Responses To The Current Surge
J Weiland continues to provide coverage based on wastewater data giving us predictions as to how many COVID cases are ocurring in the US each day. As of September 14th, community spread is considered high, with case levels estimating to be around 650,000 new infections per day, down from the week before. This levels off near the height of non delta and omicron case levels.
Teachers across Las Vegas are calling in sick as the pandemic continues to surge, forcing closures at 4 Clark County schools. In response, teachers are receiving notices that they are under investigation regarding the “sick-outs” and their may be disciplinary action. The school district is considering the teachers mass call out to be a strike which is illegal under Nevada law and they have filed a restraining order against the teacher’s union.
Dillard University joins in a few other campuses to reinstate mask mandates in response to increasing cases.
A British Columbia hospital has seen a rapid increase in COVID cases but is choosing not to declare an outbreak due negative public perceptions. There is documented inter-hospital spread infecting patients whom have been admitted for reasons other than COVID. The hospital has chosen to implement protective measures in some areas including masking and eye protection.
In Dallas County Alabama mask mandates have returned to public facing offices in the courthouse.
Actor Will Keenan was attacked for wearing a facemask and is now permanently blind in one eye.
Austrian physicians speak out against the continued handling of the pandemic across Europe, calling on the medical community to step up and be much more on top of informing the public about the risks of COVID. The above link is to a translated version of the article linked within.
Notes on Long COVID
Previously communities including nurses and teachers have been highlighted regarding the impact infections have had on them. This article highlights the issues facing the firefighting community with both acute and long term infections. Miles Griffis wrote a longer form article for High Country News last year discussing firefighters and the impact COVID and long COVID have had on the ability to fight wildfires.
Community members have highlighted a warning put out regarding Anesthesia and hope to draw the attention of those in the Long Covid community in regards to the risks of severely debilitating effects on patients with ME/CFS when put under general anesthesia. ME/CFS is a common Long Covid symptom.
Revisiting COVID’s History to Learn How It Impacts Us Now
We’re aware that NYC was hit very hard by COVID early on, as we were bombarded by horrendous images of pop up treatment facilities and bodies just piling up. This report however, highlights how much worse things really were before the government even began shutting things down. New research shows that the peak of nearly 60,000 infections a day arrived a few weeks earlier than they’d initially suspected. This research also documents nursing home outbreaks and earlier deaths that had begun across January and February. This information is critical analyzing where we are now and looking at the lack of tools really being used to track the current way, and concludes that better tools in 2020 could have allowed earlier intervention that perhaps could have saved a lot of lives.
Research
Allele of HLA is Associated with Asymptomatic Sars COVID Infection – Nature – July 2023 – a community member has shared this tiktok video of a doctor breaking down some of the findings from this study. This helps to explain the gene that is associated with some symptomless COVID infections and the prevelence of this occurring.
Determinants of the Onset and Prognosis of Post – Covid at 2 Years – Lancet Sept 2023 – a community pulls out some quotes from the study, which looks at long covid symptoms after two years. What this demonstrates is that the recovery rate is very low, and many patients may experience fluctuating symptoms and remission, but not full recovery.
A preprint study: Transmissibility, Infectivity and Immune Evasiveness of BA.2.86 – Sept 2023 – Community Member The Sato Lab has shared some results from this study, I will note it is not very user friendly or comprehendible and within the study as I could read it I was unable to draw the same conclusions regarding the EG.5 variants that The Sato Lab notates.
Thank you for continuing to read and share these newsletters. Remember if you have any questions or would like info on something specific and you can’t find it please reach out and I can try and help!
9 / 27 / 2023 – 13th Edition
“Over the last few weeks there hasn’t been a ton of new developments between vaccine approvals and the roll out efforts, however there have been a lot of hiccups throughout this process which I’ll cover first.
What Vaccine Can I Get and How Are They Covered?
Many people have experienced ongoing issues trying to get and keep vaccine appointments at large chains in the US including Walgreens and CVS. Earlier last week many reports were coming in mostly as a result of the insurance companies failing to update codes that allow coverage of the new boosters. This now has been claimed to be resolved. There are however many anecdotal reports still circulating at the time of publication that there is an inconsistent roll out of pediatric vaccines.
There is a Federal Program in place in the US that will provide a sort of gap coverage for underinsured and non-insured individuals to get the 2023-2024 COVID Vaccine. For information on the bridge program and where to get your vaccine to qualify you can visit the CDC information page. Additional community conversations have notated that your pharmacy may be unaware of this program and the onus may be on you to educate them in order to receive your free vaccine.
In Chicago, there is an at home vaccination program that all residents are eligible for. You can sign up for up to 10 people in a home and also get your flu shot at the same time. The Minnesota department of health has a similar program.
At the time of publication, there is no new information on Novavax and when that may be available to the public. Speculation and community discussions have brought into question when approval could occur and what was really meant by the last ACIP meeting in which all vaccines were recommended, but only Pfizer and Moderna received approval. It now appears we might be waiting until the next ACIP meeting at the end of October regarding if Novavax will move forward.
Non-Traditional COVID Treatment + Resources on Herbal Antivirals
Herbal Antivirals have long been a part of treatment for diseases and many conditions throughout history. Community member Nicole has put together an incredible resource with research into these herbal antivirals in a clear and easy to understand format under each type of herb.
The Current State of COVID
In conjunction with the current COVID surge and the roll-out of vaccines, the free USPS testing program has been restarted by the White House. You can order your free tests for your household here. Based on current wastewater data, J Weiland has provided as of September 26th the estimated COVID trends: suggesting we are in a decline with roughly 570,000 new cases a day in the US.
Looking to some industries that are currently experiencing negative impacts across the globe, a South London airport had to cancel over 100 flights due to an outbreak among air-traffic control.
Staff shortages and industry wide impacts have been common throughout the pandemic in varying scales. As the pandemic progresses and more people are dealing with long term symptoms, some community members highlight the impacts we may not be noticing. Community member Roe Grace mentions observations in their grocery store surrounding products that must be pulled off the shelves and theories regarding behind the scenes impacts of symptoms like brain fog on the ability to mess up dates on perishable food.
Related to this community discussion, a study out of California regarding prevalence of Long COVID in farmworkers has just been published, documenting that of those with a confirmed positive test, nearly 61% of farmworkers are experiencing Long COVID symptoms. When we are considering topics like inflation, especially at the grocery store this high percentage of essential workers having persistent symptoms that are interfering with their ability to do their job must certainly be taken into account in what we’re seeing.
UCLA Health will be resuming mask wearing for both patients and physicians on October 1st according to an internal memo.
Looking at community perceptions of COVID, a September poll by KFF looks at statistics for those planning to get various vaccines. Some notable percentages across those polled in the US, 58% of adults say they will get the annual flu shot, with 58% over 60 also saying they will most likely get the RSV shot. This is a larger percentage than the 47% of adults who say they will get the update COVID shot.
Continuing to follow BA.2.86 – The Pirola variant – which has been discussed as a potential variant of concern, community member Bloom Lab has put together a summary from some recent papers that help us understand what we know so far.
Long COVID
The CDC has recently published that in 2022 nearly 18 million people in the US experienced Long COVID, with currently an estimated 9 million people experiencing the condition today. This CBS Special (video) goes over these findings and discusses some of what the condition is. It is important to note that this special hypothesizes the case estimates to be an undercount discussing how many people have long covid “symptoms” however almost all actual research – reference previous versions of this newsletter – suggests the actual number of people who have long COVID and long term impacts from COVID is much much higher. The study referenced in the video is also below in the Research section titled “distinguishing features of Long COVID.”
A few editions back I highlighted some legal challenges surrounding COVID and workplace rights. In stark contrast to previous laws and rulings in other states, Arizona is now allowing workman’s compensation claims for individuals who contract COVID in the workplace.
Previous editions of this newsletter touched on one symptom of Long COVID being tinnitus and hearing loss. After a recent bout with COVID, celebrity Paul Simon has experienced sudden hearing loss (discussed here) and will likely never perform again. Back in May, community member Laura Miers shared an informative thread regarding various anecdotes and studies looking in to the connection between COVID and hearing loss if you’re interested in further reading on the subject.
Other Things of Note
Research out of Mass General Brigham has found that more cases of Sepsis were linked to COVID infections throughout the pandemic, citing the immune dis-regulation the virus can cause.
Research
Molnupiravir Associated Mutations in COVID Genomes – Nature – September 2023 – Similar to discussions we’ve seen regarding antibiotic resistant viruses, a study out of Nature has demonstrated that the use of the anti-viral drug Molnupiravir may be increasing the mutations occurring with the COVID virus. This Guardian article helps to break down the study’s findings.
Distinguishing Features of Long COVID Identified Through Immune Profiling – Nature – September 2023 – A thread breaking down some of the study and what questions were asked was done by one of the researchers on the study here.
COVID’s Impact on Coronary Arteries – Nature – September 2023
Thank you for continuing to read and share this newsletter.
10 / 10 / 2023 – 14th Edition, Final Entry
To start, thank you all for encouraging this effort for the last few months to create this resource to help folks stay informed. I started this with the intent of presenting information in an accessible format free from bias as I felt like I had a good variety of sources that were regularly sharing information. However, information is now nearly impossible to come by and I am putting far too much pressure on myself to keep this going.
I will leave off this newsletter with the latest information and where you can go from here to continue accessing the information you need.
Where to Get The Updated 2023-2024 COVID Vaccines:
Both Pfizer and Moderna’s 2023-2024 COVID shot are available at most pharmacies nationwide. Although some anecdotes are still being shared regarding canceled appointments and lack of availability, for the most part the access issues for the mRNA vaccines are being resolved.
Regarding Novavax: As of October 13th Novavax has been shipped out to select pharmacies, mainly Costco locations. You can use the tool on vaccines.gov to select “Novavax” and the Costco locations are populating. Costco does not require you to be a member to get a vaccine. Additional community based reports show that various Costco locations are charging up front and not accepting some forms of insurance. The up front cost of the Novavax shot is $140.
There is a good amount of mixed information regarding location specific Novavax. Joaquin Beltran shares a comprehensive list with links of locations you can check with to see if they’ve received Novavax.
There are still large swaths of the country at this time, mine included, where there is no Novavax within 75-100 miles.
How to Test:
Although COVID tests are once again being sent out by the US government, at home antigen tests remain less effective. MD Jake Scott shares this graphic breaking down some information from a recent study done on individuals who had positive PCR tests. The study shows that people were not reliably testing positive on the at home antigen tests until days 3-5 even with symptoms starting before then.
Community member Laura Miers highlights this ABC article and suggests that people test on the 4th day of symptoms.
Current Levels of COVID Circulating:
This week’s estimates of cases in the US based on wastewater levels suggest 438,000 new infections per day or 1 in 75 people currently infected. The model’s being used to predict where we go next show that cases will continue to decrease throughout the month before increasing again in November.
Experts are also issuing early warnings of another tripledemic of COVID, Flu, and RSV as Flu and RSV cases are beginning to rise, as reported by NBC.
In Canada, COVID levels remain very high with this graphic showing COVID forecasts for each providence. This correlates to very high wastewater levels, high hospitalizations, high death, and an elevated risk of long COVID.
In Stafford county UK, Royal Stoke hospital has reinstated masking due to the rise in COVID cases. At the same time staff at Shropshire NHS Trust, a health facility, has received communications that staff should not be testing for COVID and instead should stay home if they feel unwell. They cite that testing for COVID forces workers to be at home much longer than they’d like.
Following these various approaches to continuing to combat COVID, increased viral activity continues to cause strain on hospital systems. On October 10th, Plymouth Hospital Trust – another UK hospital – was forced to declare a critical incident. As early as 9 AM they had 22 ambulances waiting outside, with reports of previous days having as many as 30. This specific incident is highlighted by biorisk analyst Conor Browne as an example of both COVID impacts in the community due to increased acute virus, but also impacts on the hospitals due to less staff.
On the topic of Future COVID, community member Conor Browne answer’s a question posed to him as to what his own expectations are regarding returning to normal. I highlight this because Conor’s career is focused on biorisk analysis and his answer is thoughtful and addresses a few areas. Some things he considers in a return to normal is: air filtration in a coffee shop, access to rapid and accurate tests to see a group of friends at home, availability of 2nd gen vaccines (which he suggests may be a mid 2024 development) to travel internationally, and then reiterating that most “normal” things outside of these he can do now with a high quality respirator.
On the Topic of Long COVID:
With many people experiencing multiple infections and the expectations that many more people will have COVID multiple times, I wanted to include this article from NBC highlighting some individuals who have had COVID five times. What’s important here is that we are going to see vast differences in experiences, some people’s infections are less difficult each time with no persisting health issues, others with even mild cases experience new long term health issues, while others have worse infections and worse health issues.
A recent article has been highlighted with the acknowledgement that those in hospital roles who have gotten Long COVID had done so after the emergence of Omicron, were previously vaccinated, and had infections that did not require hospitalization. This information comes out of a study conducted in Quebec, discusses here.
Some attention has been drawn to community members discussing the impact of their COVID infections on their fertility. Karla Monterroso reports that she is now unable to have children, drawing sympathy from others in a similar boat. For those with Long COVID, and other associated illnesses, research published back in April of 2023 confirms a variety of impacts on the reproductive system.
A trial of Valacyclovir in patients with EBV shows improvement of Left Ventricular Function from 2002 regarding patients with Chronic Fatigue Syndrome. This has been shared by community members as a potential treatment for those with Long COVID who may be experiencing reactivation of previous EBV. This is another paper from 2010 that may be of interest.
The health condition known as Raynaud’s can be a symptom of Long Covid. Community member Birch share’s a photo of what Raynaud’s may look like on non-white skin here. The diverse representation of how symptoms may look on people of different races is critical to ensure proper diagnosis.
Deals on COVID PPE for the Month of October:
One community member has pulled together an extensive list of places having sales in October for PPE.
How COVID has impacted Student’s Over the Long Run:
Community member Arijit Chakravarty has put together an incredibly informative thread discussing learning loss as reflected by dropping ACT scores. This thread breaks down some common theories as to what is causing learning loss: such as time spent at home – debunking and providing statistics for how long and how many students truly were not in schools and participating in remote learning (40%). He then continues to discuss that almost all students have returned back to school, which should show a rebound in testing scores since the cause for learning loss has been reverse. However, scores continue to plummet and schools remain a place of heavy covid transmission with one of the major long term impacts being on cognitive function.
As recently reported by the CDC and covered by the Washington Post, about 1% of children in the US have Long Covid. The headlines declare that 1% is “rare” however by medical standards 1 in 100 is not a rare condition. Dr. Noor Bari shares a helpful guide based out of New Zealand that breaks down rates of incidence and terminology, 1 in 10 is very common, 1 in 100 is common while 1 in 1000 to 1 in 10,000 is considered rare. These definitions carry over broadly across the global medical community. This of course also relates back to discussions of how we count Long COVID cases and the understanding that we are likely vastly undercounting.
The Ohio Cryptic Lineage, Updates:
In previous versions of this newsletter we followed along with the careful tracking of what was deemed “the Ohio Cryptic Lineage” which was very likely a single person who was very ill releasing large amounts of waste in Ohio. The lineage disappeared in June. Although the best case scenario is that this person has begun receiving treatment, it is widely believed that they have passed away.
Continuing Conversations on Excess Death:
Recent research has confirmed a lack of association between COVID vaccination and excess mortality. This is part of a broader conversation that has suggested both that COVID excess deaths have been greatly overexaggerated and that excess mortality has been blamed by some on the vaccines rather than the virus itself. This study states that all excess deaths directly correlate to COVID deaths. Gabrielle A. Perry, Master of Public Health, joins in this conversation in a community discussion where others have claimed that COVID deaths have been stacked and falsely include those with pre-existing conditions. Gabrielle echoes the sentiment that has been discussed in previous excess death conversations that actual COVID deaths have actually been vastly undercounted.
COVID Era Policy’s
Telehealth became widely covered during the pandemic and the ability to prescribe controlled substances included in telemedicine’s abilities. The DEA has extended these prescribing privileges through Dec 31, 2024. This is in line with the existing coverage for Medicare which was also previously extended to the end of 2024.
Research
Your Hot Cup of Tea May Be Effective Against Some COVID Strains – Nature – October 2023 – Community member Emmanuel breaks down this study looking at types of tea including black tea, green tea, and matcha and it’s effectiveness on Omicron subvariants.
SARS-CoV-2 surveillance using wastewater proves effective as a way to measure other endemic viruses – Nature – October 2023
Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders After COVID Infection – Jama Network – October 2023 – Web MD has published a breakdown of this study discussing the increased risks.
People to Follow For Various Resources
Conor Browne – Conor is a bio risk analyst who looks at many biohazards as his job and consults with companies to provide risk assessment. He has provided insightful information on COVID based on his experience.
Community Member Laura Miers – Laura is a member of the Long COVID community on Twitter and carefully compiles hundreds of threads with up to date information on much of the latest COVID news and anecdotes. She has perhaps the most robust account with each new piece of information being carefully connected back to previous topics so you can always continue finding more information.
JP Weiland – Scientist and Infectious disease modeler, JP Weiland has been a continued source when it comes to analyzing wastewater data in the US and correlating that information to an estimated number of current COVID cases.
Friesein – Twitter user has been an advocate for Novavax, they are a wonderful resource at this time regarding location specific Novavax vaccines and continue to boost updates across the US.
The Following Research Publications can be checked to see what new information has been published: Jama Network, Nature, and The Lancet. Publications by various colleges like Harvard can also be a good source of research information.
My Life. My Migraine. 