Corona Virus: It's a Marathon, Not a Sprint

[Max Peck]

The context that is missing from that tweet is that he has been saying that he would consider recommending reinstatement of mask mandates if the situation gets bad enough. The situation is steadily worsening, but he's apparently not going beyond urging people to mask up even though he knows what's coming.

The provincial governing party just won an election, so they can mismanage this into the ground (literally, for a lot of vulnerable people) and still have plenty of time for it to blow over before the next opportunity to kick them to the curb.

[Smoove_B]

The changing demographics of COVID-19 deaths

Striking: 95% of people dying from Covid aren't up-to-date on vaccination.

To clarify the "new" language that is being pushed, "up to date on vaccinations" means you've received every vaccination you're eligible for. No more primary complete, no more primary + booster, no more primary + bivalent, etc...

You're either up to date (i.e. have received all vaccinations you are eligible for) or you're not.

[Smoove_B]

Research coming out about NFL games in 2020 and how they caused super spreader events:

As the NFL sought to resume play during the early months of the COVID-19 pandemic, with some teams choosing to allow fans into stadiums, league officials insisted that football crowds had no negative impact on public health.

“We’re proud of that,” Commissioner Roger Goodell said at the time, “and we’re going to build on that.”

But newly published research suggests that even at significantly reduced capacity, stadiums with 20,000 or more in attendance were associated with subsequent case spikes in surrounding communities.

Details:

The study, in the journal JAMA Network Open on Friday, examined 269 games during the 2020-21 season, when some teams chose to play in empty stadiums while others allowed up to 37% capacity.

The Dallas Cowboys and Tampa Bay Buccaneers had comparatively lenient policies, hosting crowds as large as 30,000. Researchers found that COVID-19 case rates more than doubled in the counties where those stadiums were located and in neighboring counties.

By contrast, teams that banned crowds or had fewer than 5,000 in attendance were not associated with spikes.

...

The data presented by Leal and her colleagues reinforce a 2020 study by Stanford researchers that suggested campaign events for former President Trump led to more than 30,000 additional COVID-19 cases and at least 700 additional deaths. Leal said: “Certainly our findings could translate to other mass gatherings.”

The 2020-21 NFL season began just eight or so months into the pandemic, before the widespread availability of vaccines or specialized treatments. That fall, there was much discussion about the trade-off between public safety and a growing desire to regain some normalcy.

And thankfully everything is normal now, so it was worth it.

[LawBeefaroni]

In hindsight, sure it was a terrible idea. But at the time there was no way to know that putting 30,000 people in an indoor environment, plying them with alcohol, and encouraging them to scream in support of their team was a bad idea. It was unknown territory.

[Smoove_B]

Totally unknown. Who could have predicted it?

Not entirely related to COVID-19, but I did see that Children's Hospital Association and the Academy of Pediatrics asked Biden to officially declare an emergency over the RSV + Influenza + COVID-19 wave that is currently overwhelming them in...November. Not really sure what to expect, but if only there was something we could all be doing to help hospitals not get overrun to the point where kids are dying. I guess we'll never know.

[Zaxxon]

What does it mean to care about COVID anymore?

Heading into the third pandemic winter, things have changed. Most Americans seem to have tuned out COVID. Precautions have virtually disappeared; except for in the deepest-blue cities, wearing a mask is, well, weird. Reported cases are way down since the spring and summer, but perhaps the biggest reason for America’s behavioral let-up is that much of the country sees COVID as a minor nuisance, no more bothersome than a cold or the flu.

And to a certain degree, they’re right: Most healthy, working-age adults who are up-to-date on their vaccinations won’t get severely ill—especially now that antivirals such as Paxlovid are available. Other treatments can help if a patient does get very sick. “People who are vaccinated and relatively healthy who are getting COVID are not getting that sick,” Lisa Lee, an epidemiologist at Virginia Tech, told me. “And so people are thinking, Wow, I’ve had COVID. It wasn’t that bad. I don’t really care anymore.”

Still, there are many reasons to continue caring about COVID. About 300 people are still dying every day; COVID is on track to be the third-leading cause of death in the U.S. for the third year running. The prospect of developing long COVID is real and terrifying, as are mounting concerns about reinfections. But admittedly, these sometimes manifest in my mind as a dull, omnipresent horror, not an urgent affront. Continuing to care about COVID while also loosening up behaviors is an uncomfortable position to be in. Most of the time, I just try to ignore the guilt gnawing at my brain. At this point, when so few people feel that the potential benefit of dodging an infection is worth the inconvenience of precautions, what does it even mean to care about COVID?

...

But, now more than ever, we must remember that COVID is not just a personal threat but a community one. For older and immunocompromised people, the risks are still significant. For example, people over 50 account for 93 percent of COVID-related deaths in the U.S., even though they represent just 35.7 percent of the population. As long as the death rate remains as high as it is, caring about COVID should mean orienting precautions to protect them. This idea has been around since the pandemic began, but its prominence faded as Americans put their personal health first. “If you’re otherwise healthy, it’s so easy just to think about yourself,” Lee said. “We have to think very carefully about that other part of infectious disease, which is the part where we can potentially hurt other people.”

Orienting behavior in this way gives low-risk people a way to care about COVID that doesn’t entail constant masking or skipping all indoor activities: They can relax when they know they aren’t going to encounter vulnerable people. Like the productivity adage “work smarter, not harder,” this perspective allows people to take precautions strategically, not always. In practice, all it takes is some foresight. If you don’t live with vulnerable people, make it second nature to ask: Will I be seeing vulnerable people anytime soon? If the answer is no, do whatever you’re comfortable with given your own risk. If you are a healthy 30-something who lives alone, going to a Friendsgiving with other people your age is different from spending Thanksgiving dinner with parents and grandparents.

...

Low-risk people can, and should, take an active role in bolstering the protection of vulnerable people they know. In practical terms, this means ensuring that people in your life who are over 50—especially those over 65—are boosted and have a plan to get Paxlovid if they fall sick, Nuzzo said. “I think our biggest problem right now is that not everybody has enough access to the tools, and that’s a place where people can help.” She noted that she is particularly concerned about older people who struggle to book vaccine appointments online. Caring “doesn’t mean abstaining, per se. It means facilitating. It means enabling and helping people in your community.” This holiday season, caring could mean sitting down at a computer to make Grandma’s booster appointment, or driving her to the drugstore to get it.

If you have lost your motivation to care about COVID, you might find it in the people you love. I didn’t feel a personal need to wear a mask at the concert I attended yesterday, but I did it because I don’t want to accidentally infect my partner’s 94-year-old grandfather when I see him next week. To have this experience of the pandemic is a privilege. Many don’t have the option to stop caring, even for a moment.

[Little Raven]

If you have lost your motivation to care about COVID, you might find it in the people you love. I didn’t feel a personal need to wear a mask at the concert I attended yesterday, but I did it because I don’t want to accidentally infect my partner’s 94-year-old grandfather when I see him next week. To have this experience of the pandemic is a privilege. Many don’t have the option to stop caring, even for a moment.

This makes no sense to me. If you go to a concert where virtually nobody will be masked, you wearing a mask doesn't seem terribly likely to lower your odds of contracting COVID. (unless maybe you wear an N95, properly fitted, and never take it off to drink beer or cheer or talk to anyone, in which case....why are you going to a concert?) If you're actually worried about the 94 year old grandfather, the proper thing to do is NOT GO TO THE CONCERT.

[Zaxxon]

If you're actually worried about the 94 year old grandfather, the proper thing to do is NOT GO TO THE CONCERT.

Yes, but this article is written from the 'Murican perspective.

[Kraken]

We went to an art museum yesterday to see a Life Magazine photography exhibit, and wore masks through the ticket line and the Life exhibit, which was kind of crowded and claustrophobic. I'd say mask use was around 20%. After we left the special exhibit we went to the cafe, in a huge open atrium, and of course didn't mask up there. Then we went into one of the permanent exhibition halls that was lightly attended and had high ceilings; we didn't mask there, either. Probably should have but my mask was getting nasty and needed replacing.

Having had covid twice now, I'm becoming fatalistic. It's just part of the landscape. I still carry a mask and use it when I'm in an obvious high-risk environment, like the Life exhibit yesterday. I'm not rigorous about avoiding such environments anymore.

[Smoove_B]

America:

COVID-19 exacted a higher infection-related and excess all-cause death toll from the United States than from 20 peer countries throughout the pandemic but had less of an impact in the most-vaccinated states in the Delta and Omicron surges, suggests a study published late last week in JAMA.

Adjusted for population size, the United States had 155,000 to 466,000 more deaths than peer nations in the second half of 2021 and early 2022, the investigators estimated.

And:

US per-capita COVID-19 deaths overall and in both state subgroups significantly exceeded those of all peer countries, with 370,298 COVID-19 deaths (112/100,000) during Delta and Omicron (61/100,000 and 51/100,000, respectively). But COVID-19 death rates were significantly lower in the 10 states with the highest vaccination coverage (73% coverage; 75 deaths/100,000 people) than those in the 10 least-vaccinated states (52% coverage; 146/100,000).

Excess all-cause mortality in the United States exceeded COVID-19 mortality (145/100,000) and that of peer countries, as did excess all-cause death in the 10 US states with the lowest vaccine uptake. In the 10 most-vaccinated states, however, excess all-cause death rates were similar to or less than that of several peer countries during both Delta and Omicron.

[Holman]

We've managed to get through the entire pandemic so far without catching Covid.

I live in a house with me, my wife, my 80+ mother-in-law, and two teens (one now in college but visiting from time to time). As far as I can tell, our reasonable masking and hand-washing policies have kept everyone Covid-free since the beginning. If anyone ever brought it home, they would have spread it, and it seems unlikely that we would all have been asymptomatic.

Everyone is vaxxed and boosted to the max, and maybe that's what makes all the difference. At the same time, we're still tending to avoid crowds, and when we enter them we use masks. (I teach unmasked four days a week in campus contexts where now almost no one wears a mask. However, the rules are that everyone has shown proof of multiple vaccinations to be there in the first place.)

I'm starting to assume that vaccines and boosters keep you so safe that masks are necessary only in large crowds where you can't count on other people's vaccine hygiene. The campus walls of vaccine requirement have probably been the biggest factor in our safety.

[hitbyambulance]

sorry, but need to interject:

(unless maybe you wear an N95, properly fitted, and never take it off to drink beer or cheer or talk to anyone, in which case....why are you going to a concert?)

maybe - just maybe - for the actual music?

(perhaps i'm a special case here, but i don't drink and there's usually no one else i know at the concert. and cheering... not something i do. concerts aren't primarily for the social aspect, for me.)

i wear my half-face 3M respirator with N95 filters without removing it and all is fine. like i mentioned before, i still haven't been infected with COVID and i see self-proclaimed hermits here saying they've already contracted it twice, so i must be doing something right.

[Defiant]

How infectious disease experts are responding to Covid nearly three years in

[Kraken]

i see self-proclaimed hermits here saying they've already contracted it twice, so i must be doing something right.

Hey! I resemble that remark.

The first time I got it is no mystery; Wife brought it home from a conference in Canada. Since she tested positive before I did I knew it was coming and got Paxlovid within half a day of testing positive. Fixed me right up and my only symptom was mild fatigue. That's fine; I like naps.

The second time is more of a mystery. Wife came down with symptoms, but tested negative. I felt fine but started testing daily. I soon caught her cold or RSV or whatever it was and, after a couple of days, tested positive for covid. She kept testing negative every day. Our symptoms were identical, with hers being more severe. After five days, I tested negative with a little help from Paxlovid again, but my symptoms didn't change. To this day IDK if I had any covid symptoms beyond our shared cold.

My best guess is that I got it at a restaurant, but why Wife never got it, and what she/we had besides covid, are mysteries. She still isn't quite over it and it was very slow to leave me.

[Max Peck]

Did your wife get a PCR test, or were the negative results solely from home rapid antigen tests?

[malchior]

"Fun" stuff making the rounds. I'm going to guess if there is a link between sudden death and anything - it'll be COVID itself.

[Smoove_B]

"Fun" stuff making the rounds. I'm going to guess if there is a link between sudden death and anything - it'll be COVID itself.

Yesterday or Sunday a number of prominent anti-vax Twitter accounts were restored *and* had the $8 "verified" access. With their information being boosted by the zombie algorithm that Musk has curated, the noise just got louder.

[Smoove_B]

A great summary of our current situation this morning:

In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.

[Kraken]

Did your wife get a PCR test, or were the negative results solely from home rapid antigen tests?

Home test kits of two different brands.

[Smoove_B]

I guess we'll see how this goes:

The Biden administration is launching a critical, six-week push aimed at stepping up Americans’ Covid-19 booster vaccinations heading into the holiday season.

“With winter and holiday gatherings right around the corner, more Americans getting their updated vaccine will help avoid thousands of preventable Covid-19 deaths. The six-week campaign will focus on reaching seniors and the communities that were hardest hit by Covid-19 through making it more convenient to get vaccinated and increasing awareness through paid media,” a fact sheet shared first with CNN said.

Biden’s chief medical adviser, Dr. Anthony Fauci, kicks off the campaign during Tuesday’s White House press briefing, which will likely be his last appearance from the briefing room podium ahead of his expected December retirement. Fauci, who has served under seven US presidents and became a household name in the early days of the pandemic, will detail the urgency of getting vaccinated as public health officials have expressed concern about the confluence of Covid-19, RSV and the flu this season.

There's gotta be something else they could be pushing, but I just can't seem to think of anything that would potentially lower rates of transmission for respiratory illnesses. Maybe lung scrubbing? Like a car-wash but for your lungs? I dunno. I'll keep researching it.

How do the current numbers look?

The push comes as more than 35 million Americans have already received the updated, bivalent booster shot, White House press secretary Karine Jean-Pierre told reporters aboard Air Force One. But that’s a fraction of the Americans eligible – 267 million Americans have received their primary Covid-19 vaccine, according to data from the US Centers for Disease Control and Prevention.

Not great. What about the big funding request I'm hearing about?

The new funding for these efforts also comes as the White House is calling on Congress to include $10 billion in supplemental funding for Covid-19 response as part of the must-pass government funding bill.

That $10 billion request reflects a paring down from an original $22.5 billion request submitted earlier this year that has gone unfulfilled.

...

The $10 billion request includes $2.5 million “to ensure continued access to vaccines and therapeutics (including for the uninsured) as we transition to commercialization of vaccines and therapeutics, and for Strategic National Stockpile maintenance costs,” $5 billion for “development of next-generation vaccines and therapeutics,” $750 million for long Covid-19 research and treatment, and $1 billion in funding for the State Department to “provide support to prevent, detect, and respond to Covid-19 and other infectious diseases, including through vaccines, tests, and treatments, and through efforts to close gaps in routine immunizations.”

Not feeling good. There's been an acknowledgement that money needs to be spent on outreach - mobile clinics, community outreach, etc... but just based on what I saw from NJ's presentation on how that's going to work...I'm not quite clear how that's just going to magically appear in time to hit this "6 week push" goal that's been set. Local health is currently in its death throes and now you're expecting them to somehow ramp up and kick off a mass vaccination program targeting marginalized people? I guess planning for this back in May would have been too much to ask.

[Zaxxon]

Why would you start a 6-week holiday push when a 6-week holiday push should be ending?

[Smoove_B]

There were comments made by Jha suggesting that Black Friday would be a great time to take an elderly relative to get vaccinated - because everyone else will be out shopping. If I wrote that in a movie script, producers would laugh me off the lot.

And yeah, the timing on all this is absurd. I guess they're just hoping they can get a few more people vaccinated before whatever is going to happen this week, happens. And then of course Xmas and all the other social holidays.

Good luck folks; you're on your own.

[Kraken]

The view from the most highly vaccinated (tied) state

A new subvariant has taken over as the predominant version of coronavirus circulating in Massachusetts, causing experts to worry about a potential rise of infections this winter, especially as people gather indoors for the holidays. But for most people who have been fully vaccinated, they say, it will likely pose more of a nuisance than serious health threat.

The Broad Institute of MIT and Harvard projected last Thursday that the virus, an offshoot of the Omicron family dubbed BQ.1.1, accounted for 39 percent of COVID-19 cases in the state. And the Centers for Disease Control and Prevention reported on Friday that the variant and its predecessor, BQ.1, constituted nearly half of cases nationwide.

The spread of BQ.1.1 is of concern because multiple small studies published earlier this month suggest the variant is among the best yet at evading antibody immunity, the body’s first line of defense against infections. Even people who recently received new bivalent booster shots from Pfizer or Moderna — which were updated to match the formerly dominant BA.5 variant — have alarmingly low antibodies to protect against the new virus.
...
Recently released data from the Massachusetts Department of Public Health show that COVID-19 cases, hospitalizations, and deaths have remained relatively unchanged this fall, and in some cases might be slowing down. Waste water data across the state also indicates the spread of the virus has plateaued, at least for now.

“There’s no sign of a wave or a surge of any kind,” said Bronwyn MacInnis, the director of Pathogen Genomic Surveillance at the Broad Institute of MIT and Harvard.

National data from the CDC also reflect that finding, suggesting that newer variants, including BQ.1.1, are displacing BA.5 without a corresponding increase in infections, Kuritzkes said. “There’s been more of a churn than a real upswing.” But he and others expect that will change as cold weather and the holidays lead to more people congregating indoors.

Dr. Jeremy Luban, a professor and virus researcher at UMass Chan Medical School, sees indications that BQ.1.1 will be more transmissible. “That means if you go into a crowded bar, you’re more likely to come out with the virus than if it were a previous variant, and infect more people yourself,” he said.

“It could cause another wave,” Luban added, but he softened that unwanted forecast with the prediction that things might not be as bad this time around. “It’s unlikely that it will cause our hospitals to fill up the way it did before,” he said.

Indeed, as we near the close of the third year of the pandemic, many scientists say that immunity to the virus is greater than ever before and doubt that new offshoots of Omicron will cause as many hospitalizations and deaths as prior ones. Even though antibodies against BQ.1.1 may be low, another arm of the immune system composed of T cells can still help prevent many mild infections from becoming severe ones.

“The huge majority of vaccinated people have no particular reason to be anxious about BQ.1.1,” Hanage said.

[Smoove_B]

Someone is absolutely messing with us. From the CDC:

Adults perceiving a high level of COVID19 community transmission are more likely to take preventive actions, but a low percentage perceived local COVID-19 spread accurately. The more people know, the more likely they are to take action.

Also from the CDC, The fun Community Levels of COVID-19 map they prominently share:



Compared with:



The Community Transmission Levels map they bury deep on the CDC site, but is actually referenced in the research above - the research that demonstrates this type of information influences people to change their behaviors.

Goddamnit so much.

[Freyland]

Smoove, I just want to make sure you are taking a doctor recommended daily thiamine supplement.

[Isgrimnur]

Work announced yesterday that we’re going to postCOVID protocols.

[malchior]

[Smoove_B]

Smoove, I just want to make sure you are taking a doctor recommended daily thiamine supplement.

Certainly not for mosquito bite prevention!

Hit the liquor pretty hard this last weekend; trying to dial it back a bit now.

[Smoove_B]

The usual peak season for flu and RSV hasn’t even started yet, and the situation is already catastrophic. Will all falls and winters be like this?

That's what is so crazy about this. Never before have we experienced what is currently happening - three respiratory viruses surging in various communities nationwide at the same time. And yet everyone (besides hospital workers) are just acting like we're post-pandemic, everything is fine. I had a meeting last night (virtual) where we voted to continue virtual meetings for the next calendar year. Two of the people work in hospitals. One of the people voted against it, saying everything was fine - after just hearing how hospitals in our state are underwater. This was the same person that told me the pandemic was over in the summer of 2021, so f them.

[Smoove_B]

Work announced yesterday that we’re going to postCOVID protocols.

My wife's employer announced that a year ago and mandated return to work a minimum of 3x a week. Oddly enough it doesn't seem to be working. People are not coming in, though to be fair when they do they're not masking. Regardless, her building is like 1/2 empty and I think it's being tolerated only because the company is set to have another banner (i.e. record breaking) year.

Good luck to you sir. We're the weirdos still masking in the workplace, in case you were wondering. Well, hey, I didn't spend all those years playing Dungeons and Dragons and not learn a little something about courage.

[Zarathud]

Well, hey, I didn't spend all those years playing Dungeons and Dragons and not learn a little something about rolling 1s on a CONSTITUTION saving throw.

Fixed that for you.

[Isgrimnur]

Good luck to you sir. We're the weirdos still masking in the workplace, in case you were wondering. Well, hey, I didn't spend all those years playing Dungeons and Dragons and not learn a little something about courage.

Thank you. Luckily, I'm remote ~70% of the time, so if there's a flare, I will likely be able to avoid it.

[Smoove_B]

Didn't realize we crossed this milestone.

NEW: Now, more than half of people dying of COVID were vaccinated

COVID is on track to be the 3rd leading cause of death, again.

Vaccines are highly effective but protection wanes. This is not simply a pandemic of the unvaccinated

NOTE: In no way does this suggest that vaccination isn't working or should be skipped. Instead, it's suggesting that not enough people are current on vaccinations.

[LawBeefaroni]

A great summary of our current situation this morning:

In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.

At work, we still have a FEMA trailer and tent in a parking lot operating as a drive-thru testing location.

We (as an industry) are also still dealing with a mass exodus of clinical professionals, particularly nurses. If COVID doesn't worry people, perhaps dying due to lack of healthcare resources next time they get sick "normally" might.

(Eh, who am I kidding?)

[Blackhawk]

My first thought was that those statistics were... not intentionally misleading, but giving the wrong impression. As more people get vaccinated, the percentage with severe symptoms (and death is a pretty severe symptom) would naturally increase. After all, with 100% vaccination, 100% of deaths would be vaccinated people.

Then I did some digging.

One dose
September 2021: 73%
November 2022: 79%

The needle has barely budged, and yeah - that doesn't touch on boosters at all (which were a brand-new thing in September 2021.)

My own perspective really has shifted in the past year from 'help all of humanity to protect itself' to 'protect me and mine, and avoid doing harm to others myself.'

[Smoove_B]

Make no mistake, the antivax and urgency of normal crowd are shouting from the rooftops that vaccines don't work - because look, half of the people dying now are vaccinated! If they worked, those people wouldn't be dying.

Completely ignoring all other risk factors of course and just focusing on vaccination status (as a binary value - vaccinated (at least once) or not).

With every passing month I am genuinely wondering when I'll need to find a new career because what I know is useless. I have contracts now through Summer 2023; so that's something.

My own perspective really has shifted in the past year from 'help all of humanity to protect itself' to 'protect me and mine, and avoid doing harm to others myself.'

As society collapses, that's a reasonable perspective.

[Blackhawk]

"My friend got a flu vaccine in 2003. Why did he still get the flu this year? Vaccines don't work!"

My own perspective really has shifted in the past year from 'help all of humanity to protect itself' to 'protect me and mine, and avoid doing harm to others myself.'

As society collapses, that's a reasonable perspective.

Society is a mutual defense pact. When all of your neighbors are hand-waving the invaders as they through their borders, it isn't selfish to pull back your troops and put up some walls.

[LordMortis]

We (as an industry) are also still dealing with a mass exodus of clinical professionals, particularly nurses. If COVID doesn't worry people, perhaps dying due to lack of healthcare resources next time they get sick "normally" might.

Mom fell and broke her arm yesterday, tearing muscle from the bone. They can't get someone in to operate until Monday.

[TheMix]

We (as an industry) are also still dealing with a mass exodus of clinical professionals, particularly nurses. If COVID doesn't worry people, perhaps dying due to lack of healthcare resources next time they get sick "normally" might.

Mom fell and broke her arm yesterday, tearing muscle from the bone. They can't get someone in to operate until Monday.

Man, sorry to hear that. Sounds really painful.

[Smoove_B]

Ugh, missed that post. Sorry to hear it as well. I hope things are going better.