Thank you for a great update. Question about covid wastewater levels being "very high" and "27% higher than last winter and yet to slow down."
I know a lot of people with "colds" right now - sore throats, congestion, fatigue, sometimes coughs and fever. They keep testing for covid but their tests remain negative. Are the covid at home tests still working with the newer variants?
I am having what you say - 2 weeks so far with congestion, sore throat, fatigue, and I do test negative for COVID. I have not had a fever and my symptoms are not that similar to what I had with COVID (granted, different cases will present differently.) My husband tested for COVID when he was out of town right around Christmas and was working with some people who started having symptoms. He only had a scratchy throat at the time of testing, but it was immediately positive. A couple of days later he came down with more symptoms. And many people in the place he was working also tested positive.
This is a long and anecdotal way of saying that it seems the home tests still work pretty well.
Anecdotal, but I know several people who recently had/currently have covid and tested positive on home rapid tests. It's definitely picking up JN.1 because that's about 70% prevalence in my community. I think if they are negative with those symptoms after several days, the likelihood is that it's flu or a cold or some other, unspecified virus -- not covid.
Every expert I've seen online says that yes, they absolutely still work. Best practices still apply: tests turn positive between 48-96 hours after exposure, and the best way to check is to do two tests at hour 72 and 96 post exposure (you can move that up 24 hours with a molecular or PCR test). There's a lot of other crap floating around right now.
My doctor has said recently that people aren’t testing positive until about 4 days after symptoms start - which could be 6-8 days (or more) after exposure. Many people have no idea they’ve been exposed, so it would be difficult to test “X days after exposure.”
But for some reason nowadays people with symptoms are taking more days before their test turns positive, underscoring importance of serial testing.
Well, and those tests are not cheap (we don’t get free tests through our insurance). We have spent probably over $1000 on tests because we want to be good humans. But, serial testing isn’t cheap.
Yes, and we have gotten them every time they have been offered. But, with four people in my home, and doing serial testing, that is one round of tests. We can afford them, but it is definitely pricey. And I do understand why people opt not to test, especially those without access to tests due to finances or other reasons.
This is what is so frustrating - if it's just the sniffles, and we want to be safe... People can't stay home for a week waiting it out. I suppose that's when you mask.
This could be a good thing - it gives us an off-ramp from testing to "staying home when sick"
I feel like the social contract should be - use tests at first, but try to pay attention to your symptoms when you have covid, so you're aware for next time. Tests can be regarded as "training wheels" - eventually, learn to make do without them unless it materially impacts your course of action.
That is great, but some people cough for weeks. Schools want children back as soon as the fever is gone. My son had Covid last year and missed six days of school, and the make-up work was insane. Not to mention being warned that he was approaching the “maximum of ten days” absence quota. The days of extended absences being allowed ended in 2022. There are no mask requirements in our district. I agree with best practice, but it is not at all realistic in our society. Our way of life makes it impossible. Sadly. Even for those of us who try to do the right thing.
And there’s where you HAVE to work with your primary care provider(s). A persistent cough isn’t necessarily a COVID symptom if all other indicators suggest recovery. That becomes a point where your doc might prescribe something else to control the cough such as steroids.
Right, so if you've got symptoms, testing is immaterial unless you're fixing to leave isolation before the five days is up. People who are presumptively immunocompetent should be given guidelines on the "time equivalent" of a test.
The Philadelphia measles outbreak has been made worse by a parent and daycare who ignored isolate and quarantine instructions from the health department.
Katelyn, about the variation in wastewater from era to era -- Marc Johnson (AKA SolidEvidence) has tweeted about how equipment improvements can completely change sensitivity in detection. He pulled a sample from his lab and compared old equipment vs new 2023 upgrades, he found that the new equipment was more sensitive (higher reading) by 2x-10x, which would severely skew if comparing readings against previous eras. I have actually seen a few local sewersheds post an announcement when they upgrade equipment and the jump in y-axis levels appears to be 2-3x. Is this something you can dig into and combine with the "replication in stool" factor for a primer? I feel like so many people are modeling based on exact y-axis values when every wastewater team I've seen is telling them specifically NOT to do that (which is why SCAN's category system focuses on trends and limits any back comparison to a 12 month window).
Marc Johnson has been so fantastic to follow. Thanks for this insight; I must has missed his thread on it. And I very much agree with SCAN's approach. This is also why CDC's wastewater team only does a look-back comparison of 12 months, too. The technology and generalizability have changed SO much in a short amount of time. It makes me nervous to compare across years.
I appreciate the effort data modelers are putting into it but I feel like it sends the wrong message when the systems providing the data are literally saying "don't do this." It confuses an already confusing topic, you know?
Thanks for the update. I've seen several folks point to the decreasing hospitalization and death rates from COVID as indicating we have better immunity now, but I've been wondering how much this is skewed by survivor bias. The people most likely to die have died already, we don't have the same population we had a year or two or three ago. As someone who is high risk and has still managed to avoid COVID, to would be good to know the relative contributions of improved immunity vs. survivorship bias.
I'm a 66 year old cancer survivor and just managed to complete the vaccine trifecta last week - Sanofi Fluzone high-dose flu, Moderna Spikevax COVID, and GSK Arexvy RSV - despite local shortages of all three vaccines due to high local community uptake. Side effects were noticeable (the vaccine's working!) but tolerable.
I visited my PCP the week before and she made several points:
1) Small to medium clinical practices are having the most trouble getting vaccines - they have no leverage against the big hospital and pharmacy groups. The practice my PCP is in has given up on adult vaccines to focus on early childhood inoculations. They're referring adult patients to local pharmacies for their shots.
2) Most of the elderly patients she's admitted to the local hospital for respiratory infections this year have been for flu, followed by COIVD. She hasn't admitted anyone for RSV, but she's seeing a lot of it - and it's a tenacious infection (2 weeks plus) that's leaving patients with depleted immunity - after recovering from RSV some are returning in a week or two with bad colds, flu, COVID... After she related this I went out and immediately scheduled my RSV vaccine.
COVID looks like it's going to be part of the respiratory illness picture indefinitely, and long covid is going to disable people long after nasal/oral COVID vaccines - which are the best hope to dramatically reduce incidence and transmission - have been approved and deployed. Get vaccinated. Wear a mask in congregate settings. Take anti-virals and isolate if you get sick.
I'd say that we should pressure our political representatives to shake lose more money to speed up development and approval of new vaccines and anti-virals, but that's not going to happen in an election year
Yes, in the wake of COVID, my state, NY, implemented a minimal required paid sick leave for all workers, even temporary, part-time, or contract workers. I had been hoping that one good thing about this whole pandemic would be that paid sick leave would become more common, but I have been disappointed. New York's requirement isn't a lot, but it is more than most (all?) other states.
So the government may not be able to enforce a condition BUT the underwriters of the leave benefits could. Basically, a paid sick leave benefit is an insurance policy. When the employer pays for an employee to stay home, they make a claim with their insurance company for the loss they incur (both the wages and the loss in productivity). This is considered a property/casualty line, so the insurance companies have a lot of latitude in terms of how they set their premiums (or even who they'll write policies for at all). It's not hard to imagine insurers gently nudging employers towards requiring vaccination (or even, under certain circumstances...masks)
TLDR - it's better than you think, you just gotta know where to look
Thank you! I agree that the lack of vaccinations in nursing homes is a tragic failure to learn from the pandemic. Do you know if the CDC or state health departments are urging them to vaccinate?
Hello, Thank you, as always for the information. I'm writing from Massachusetts. That being said I know from conversations that the vaccination rates in my suburban area are very low, even in high risk elderly. The local senior centers have clinics but with not much uptake there and that's the "healthy population" of seniors. But could you tell me why you think nursing home rates of vaccination are so low? I just don't understand why the doctors there don't order them for the patients, especially since they are covered by Medicare.
Thanks so very much for the update & all the info! I very much appreciate, as I don't see it elsewhere.
Q.: We don't seem to have much flu in Oregon (yet), but I don't know why, as we're surrounded by states that do. I also read that experts here are predicting a mild flu season for Oregon, but how could that be? Oregon is NOT an island! I have neighbors who have Covid now, brought home by one of them who spent the holidays in California. So I'd think flu would be similar.
Also, I know at least one well-educated, elderly friend, who thinks Covid is 'over'--he insists it is! Maybe that's partly because he doesn't see hardly anyone masking anymore in grocery stores etc. I've never stopped (masking). I can't take Paxlovid, for one thing--can't swallow pills. Plus I'm old (80), & have no one to help me if I get sick.
Q: About the above on Paxlovid: could I crush the pills, regardless of icky taste? Am told no....but just wondering.
Q: And further on masks: my nose runs, often profusely, under my KN95 masks, has since the beginning of the pandemic. Always in grocery stores, not always, but usually, in other stores. I've tried various allergy meds, Sudafed, Afrin etc....no help. It seems I'm the ONLY person in America with this problem, but how could that be?? It has limited my life a lot, as I have to be able to get out of a store/place quickly....to take off the mask while I blow my nose. If anyone has any ideas, I'd appreciate!
Have you talked to a doctor about a prescription med? My wife has had a problem with a runny nose in the winter. This winter, she's been using a nasal spray (Ipratropium) that an allergist prescribed, and it seems to have gotten the runny nose under control.
Thanks very much for this nasal spray suggestion! I have, for years, used a steroid nasal spray (fluticasone), as I have longtime allergies. But strangely, it doesn't work for the mask problems. But I've not tried the above nasal spray, which led me to read more about vasomotor rhinitis, which is possibly what I have. Alas, I lost my regular doc due to not being able to do a visit because of my nose running under the mask! Catch-22!
As always thanks for all the info and informed opinion. I subscribe to and read your publication to hep stay alive. I’m 72 and a recipient of a kidney transplant so I’m immunocompromised. I would really appreciate it if you could devote some attention to the problems of the immunocompromised. Should time of year affect what we can safely do? Can we fly safely? Are restaurants and hotel rooms safe yet? Do we need special masks? How effective are air cleaners? If we get Covid how does that affect CPAP use? Can we visit with very small numbers of people indoors?
We are about 2.5 percent of the population and almost no one is giving us very specific advice. HELP!!!
Thanks. We have, so far, managed to dodge this latest wave without a lot of upheaval. We have kept our vaccinations current and always wear an N/KN95 mask in public indoor spaces. Nothing is 100%, but I figure it can't hurt to shave the odds in one's favor.
J Weiland tries to estimate infections from wastewater. What is your hunch JN.1 is significantly different in wastewater concentration? "No knowing" isn't the same as completely unknown.
Thanks for posting this! It would be interesting to know what percentage of the population was infected with covid during this most recent surge. These people are all getting a “booster,” mostly JN.1. Probably at least 50% of population infected, which is much higher than fall booster coverage.
It will also be interesting to see what variant(s) get targeted for ‘24 booster? If it’s JN.1, won’t a lot of people already have immunity through past infection?
Let’s hope this year’s boosters are rolled out earlier than in ‘23 so that people have a chance to get them before getting sick (and concluding: I no longer need a booster because I now have natural immunity).
Thank you for a great update. Question about covid wastewater levels being "very high" and "27% higher than last winter and yet to slow down."
I know a lot of people with "colds" right now - sore throats, congestion, fatigue, sometimes coughs and fever. They keep testing for covid but their tests remain negative. Are the covid at home tests still working with the newer variants?
I am having what you say - 2 weeks so far with congestion, sore throat, fatigue, and I do test negative for COVID. I have not had a fever and my symptoms are not that similar to what I had with COVID (granted, different cases will present differently.) My husband tested for COVID when he was out of town right around Christmas and was working with some people who started having symptoms. He only had a scratchy throat at the time of testing, but it was immediately positive. A couple of days later he came down with more symptoms. And many people in the place he was working also tested positive.
This is a long and anecdotal way of saying that it seems the home tests still work pretty well.
Anecdotal, but I know several people who recently had/currently have covid and tested positive on home rapid tests. It's definitely picking up JN.1 because that's about 70% prevalence in my community. I think if they are negative with those symptoms after several days, the likelihood is that it's flu or a cold or some other, unspecified virus -- not covid.
Every expert I've seen online says that yes, they absolutely still work. Best practices still apply: tests turn positive between 48-96 hours after exposure, and the best way to check is to do two tests at hour 72 and 96 post exposure (you can move that up 24 hours with a molecular or PCR test). There's a lot of other crap floating around right now.
My doctor has said recently that people aren’t testing positive until about 4 days after symptoms start - which could be 6-8 days (or more) after exposure. Many people have no idea they’ve been exposed, so it would be difficult to test “X days after exposure.”
But for some reason nowadays people with symptoms are taking more days before their test turns positive, underscoring importance of serial testing.
Well, and those tests are not cheap (we don’t get free tests through our insurance). We have spent probably over $1000 on tests because we want to be good humans. But, serial testing isn’t cheap.
You’re aware of the free tests available from https://www.covid.gov/?
Yes, and we have gotten them every time they have been offered. But, with four people in my home, and doing serial testing, that is one round of tests. We can afford them, but it is definitely pricey. And I do understand why people opt not to test, especially those without access to tests due to finances or other reasons.
This is what is so frustrating - if it's just the sniffles, and we want to be safe... People can't stay home for a week waiting it out. I suppose that's when you mask.
More days to positive is not really new, at least in children. I can attest to this. Guidance for a home test rapid on day 3-5... and 48 hours later.
I see this in my patients. PCR test day 3 better capture. I see this as well.
That’s a good protocol to follow, likely borne of experience.
This could be a good thing - it gives us an off-ramp from testing to "staying home when sick"
I feel like the social contract should be - use tests at first, but try to pay attention to your symptoms when you have covid, so you're aware for next time. Tests can be regarded as "training wheels" - eventually, learn to make do without them unless it materially impacts your course of action.
For those who test positive, I like to think in terms of not ending isolation until all the following are realized:
1. 48 hours symptom free
And
2. 2 consecutive negative home tests at least 24 hours apart
And then, for the next 5 days, masks everywhere.
That is great, but some people cough for weeks. Schools want children back as soon as the fever is gone. My son had Covid last year and missed six days of school, and the make-up work was insane. Not to mention being warned that he was approaching the “maximum of ten days” absence quota. The days of extended absences being allowed ended in 2022. There are no mask requirements in our district. I agree with best practice, but it is not at all realistic in our society. Our way of life makes it impossible. Sadly. Even for those of us who try to do the right thing.
And there’s where you HAVE to work with your primary care provider(s). A persistent cough isn’t necessarily a COVID symptom if all other indicators suggest recovery. That becomes a point where your doc might prescribe something else to control the cough such as steroids.
Right, so if you've got symptoms, testing is immaterial unless you're fixing to leave isolation before the five days is up. People who are presumptively immunocompetent should be given guidelines on the "time equivalent" of a test.
I find the scare quotes around the words "cold" and "allergy" a little off-putting. They're not necessarily Covid, and they still suck
The Philadelphia measles outbreak has been made worse by a parent and daycare who ignored isolate and quarantine instructions from the health department.
Katelyn, about the variation in wastewater from era to era -- Marc Johnson (AKA SolidEvidence) has tweeted about how equipment improvements can completely change sensitivity in detection. He pulled a sample from his lab and compared old equipment vs new 2023 upgrades, he found that the new equipment was more sensitive (higher reading) by 2x-10x, which would severely skew if comparing readings against previous eras. I have actually seen a few local sewersheds post an announcement when they upgrade equipment and the jump in y-axis levels appears to be 2-3x. Is this something you can dig into and combine with the "replication in stool" factor for a primer? I feel like so many people are modeling based on exact y-axis values when every wastewater team I've seen is telling them specifically NOT to do that (which is why SCAN's category system focuses on trends and limits any back comparison to a 12 month window).
Marc Johnson has been so fantastic to follow. Thanks for this insight; I must has missed his thread on it. And I very much agree with SCAN's approach. This is also why CDC's wastewater team only does a look-back comparison of 12 months, too. The technology and generalizability have changed SO much in a short amount of time. It makes me nervous to compare across years.
This is his specific thread on it: https://twitter.com/SolidEvidence/status/1735312949269737509
I appreciate the effort data modelers are putting into it but I feel like it sends the wrong message when the systems providing the data are literally saying "don't do this." It confuses an already confusing topic, you know?
I started following him the other day
Thanks for the update. I've seen several folks point to the decreasing hospitalization and death rates from COVID as indicating we have better immunity now, but I've been wondering how much this is skewed by survivor bias. The people most likely to die have died already, we don't have the same population we had a year or two or three ago. As someone who is high risk and has still managed to avoid COVID, to would be good to know the relative contributions of improved immunity vs. survivorship bias.
I have anti-vaxxer fatigue.
I'm a 66 year old cancer survivor and just managed to complete the vaccine trifecta last week - Sanofi Fluzone high-dose flu, Moderna Spikevax COVID, and GSK Arexvy RSV - despite local shortages of all three vaccines due to high local community uptake. Side effects were noticeable (the vaccine's working!) but tolerable.
I visited my PCP the week before and she made several points:
1) Small to medium clinical practices are having the most trouble getting vaccines - they have no leverage against the big hospital and pharmacy groups. The practice my PCP is in has given up on adult vaccines to focus on early childhood inoculations. They're referring adult patients to local pharmacies for their shots.
2) Most of the elderly patients she's admitted to the local hospital for respiratory infections this year have been for flu, followed by COIVD. She hasn't admitted anyone for RSV, but she's seeing a lot of it - and it's a tenacious infection (2 weeks plus) that's leaving patients with depleted immunity - after recovering from RSV some are returning in a week or two with bad colds, flu, COVID... After she related this I went out and immediately scheduled my RSV vaccine.
COVID looks like it's going to be part of the respiratory illness picture indefinitely, and long covid is going to disable people long after nasal/oral COVID vaccines - which are the best hope to dramatically reduce incidence and transmission - have been approved and deployed. Get vaccinated. Wear a mask in congregate settings. Take anti-virals and isolate if you get sick.
I'd say that we should pressure our political representatives to shake lose more money to speed up development and approval of new vaccines and anti-virals, but that's not going to happen in an election year
So you think Flu/COVID/RSV will always be this high every winter? Uuughh. Time for businesses to start being more flexible with sick time.
Yes, in the wake of COVID, my state, NY, implemented a minimal required paid sick leave for all workers, even temporary, part-time, or contract workers. I had been hoping that one good thing about this whole pandemic would be that paid sick leave would become more common, but I have been disappointed. New York's requirement isn't a lot, but it is more than most (all?) other states.
I had hoped it would tie to having been vaccinated...
Yup! It's ridiculous.
So the government may not be able to enforce a condition BUT the underwriters of the leave benefits could. Basically, a paid sick leave benefit is an insurance policy. When the employer pays for an employee to stay home, they make a claim with their insurance company for the loss they incur (both the wages and the loss in productivity). This is considered a property/casualty line, so the insurance companies have a lot of latitude in terms of how they set their premiums (or even who they'll write policies for at all). It's not hard to imagine insurers gently nudging employers towards requiring vaccination (or even, under certain circumstances...masks)
TLDR - it's better than you think, you just gotta know where to look
Thank you! I agree that the lack of vaccinations in nursing homes is a tragic failure to learn from the pandemic. Do you know if the CDC or state health departments are urging them to vaccinate?
Despite my best efforts and limited socializing, I get covid following Christmas. Work? Asymptomatic kid? Those are the only possibilities.
Had to miss a busy work week.
But- I did clean my house... a lot.
Thank you Paxlovid. That’s really all I have to say.
Thank you so much as always! So much important information!
Hello, Thank you, as always for the information. I'm writing from Massachusetts. That being said I know from conversations that the vaccination rates in my suburban area are very low, even in high risk elderly. The local senior centers have clinics but with not much uptake there and that's the "healthy population" of seniors. But could you tell me why you think nursing home rates of vaccination are so low? I just don't understand why the doctors there don't order them for the patients, especially since they are covered by Medicare.
Thank for continuing to provide these updates!
Thanks so very much for the update & all the info! I very much appreciate, as I don't see it elsewhere.
Q.: We don't seem to have much flu in Oregon (yet), but I don't know why, as we're surrounded by states that do. I also read that experts here are predicting a mild flu season for Oregon, but how could that be? Oregon is NOT an island! I have neighbors who have Covid now, brought home by one of them who spent the holidays in California. So I'd think flu would be similar.
Also, I know at least one well-educated, elderly friend, who thinks Covid is 'over'--he insists it is! Maybe that's partly because he doesn't see hardly anyone masking anymore in grocery stores etc. I've never stopped (masking). I can't take Paxlovid, for one thing--can't swallow pills. Plus I'm old (80), & have no one to help me if I get sick.
Q: About the above on Paxlovid: could I crush the pills, regardless of icky taste? Am told no....but just wondering.
Q: And further on masks: my nose runs, often profusely, under my KN95 masks, has since the beginning of the pandemic. Always in grocery stores, not always, but usually, in other stores. I've tried various allergy meds, Sudafed, Afrin etc....no help. It seems I'm the ONLY person in America with this problem, but how could that be?? It has limited my life a lot, as I have to be able to get out of a store/place quickly....to take off the mask while I blow my nose. If anyone has any ideas, I'd appreciate!
Have you talked to a doctor about a prescription med? My wife has had a problem with a runny nose in the winter. This winter, she's been using a nasal spray (Ipratropium) that an allergist prescribed, and it seems to have gotten the runny nose under control.
Thanks very much for this nasal spray suggestion! I have, for years, used a steroid nasal spray (fluticasone), as I have longtime allergies. But strangely, it doesn't work for the mask problems. But I've not tried the above nasal spray, which led me to read more about vasomotor rhinitis, which is possibly what I have. Alas, I lost my regular doc due to not being able to do a visit because of my nose running under the mask! Catch-22!
As always thanks for all the info and informed opinion. I subscribe to and read your publication to hep stay alive. I’m 72 and a recipient of a kidney transplant so I’m immunocompromised. I would really appreciate it if you could devote some attention to the problems of the immunocompromised. Should time of year affect what we can safely do? Can we fly safely? Are restaurants and hotel rooms safe yet? Do we need special masks? How effective are air cleaners? If we get Covid how does that affect CPAP use? Can we visit with very small numbers of people indoors?
We are about 2.5 percent of the population and almost no one is giving us very specific advice. HELP!!!
Thanks. We have, so far, managed to dodge this latest wave without a lot of upheaval. We have kept our vaccinations current and always wear an N/KN95 mask in public indoor spaces. Nothing is 100%, but I figure it can't hurt to shave the odds in one's favor.
J Weiland tries to estimate infections from wastewater. What is your hunch JN.1 is significantly different in wastewater concentration? "No knowing" isn't the same as completely unknown.
Some color here might be helpful.
https://twitter.com/JPWeiland/status/1743420513999868363?t=AXINWLDXHFyk2I-iM7n1nA&s=19
Thanks for posting this! It would be interesting to know what percentage of the population was infected with covid during this most recent surge. These people are all getting a “booster,” mostly JN.1. Probably at least 50% of population infected, which is much higher than fall booster coverage.
It will also be interesting to see what variant(s) get targeted for ‘24 booster? If it’s JN.1, won’t a lot of people already have immunity through past infection?
Let’s hope this year’s boosters are rolled out earlier than in ‘23 so that people have a chance to get them before getting sick (and concluding: I no longer need a booster because I now have natural immunity).