We are clearly in the middle of an infection surge in the U.S. Hospitalizations are increasing but not reflecting case acceleration, and deaths are nearing pandemic lows. The individual risk of severe disease continues to decline thanks to immunity and treatments.
It strikes me that there's another factor in play here: Do we as a society and as individuals care about working to prevent harm to others more at risk?
Our society tends to focus on the greatest good for the greatest number, especially of those we center - as opposed to preventing harm for those on the margins. We tend more so than other counties to be individualistic rather than focusing on the vulnerable.
From my point of view, people and government declaring this to already be endemic, dropping protections like masking or free tests, dropping funding, etc. are effectively saying to vulnerable people that "Your deaths are acceptable to us." Sometimes this is crass and obvious as a form of social homocide, other times it's more subtle as part of focusing on "normal" people and not thinking about others.
Granted that everyone will die someday, but for me a key question is whether society believes it is entitled to the deaths of those less fortunate so people can go to a movie?
This isn't a new issue, but rather one COVID has put into stark relief. COVID's effects have quite disproportionally harmed older people, poorer people, disabled people, minorities, etc. Declaring COVID "over" magnifies those harms.
Thank you as this is the balanced voice we need and wish this would get to all the different important entities that are involved. The headlines from many epidemiologists has been frightening to read as PCR tests are no longer free, masks are all but gone in Texas and our leaders are focused on other things, BUT we are so much more fortunate than so many countries and yet we ARE TERRIBLE at public health measures. It does not make sense. This has affected every aspect of our lives for the past three years how can we stop??? This virus has no boundaries so it should not be a Republican/Democrat issue, it is a human one. We can do this. I continue to contact my elected representatives to let them know this is important. In a sea of confusion you are a port in the storm and we are so grateful for your dedication.
I fear another “epidemic “ of hospitals going broke. Ours just had to lay off 105 people and not fill 76 positions while most every day we are at maximum capacity and sometimes boarding patients in the ED. I survived this cut, but who knows what fall will bring. We aren’t the only hospital system struggling, either.
I always like what you write but don't often tell you that. This interplay of science, political priorities, personal citizen fatigue, and our usual difficulty as semi-evolved chimpanzees has made this a big mess. How many deaths are okay? How much time on ventilators, how much long covid, how much cost...I feel that if there was a ravaging bear in the room, we would respond quickly and mostly accurately. This is different. Somebody coined the word "permademic," which is a real possibility. Anyway, thanks again and keep them coming.
Love your work, thank you so much for all you do. I would love to know whether long covid or longer term issues due to covid (such as a new diabetes diagnosis) are even being considered as part of any broader public health conversations, especially for young children. I run a preschool, and I want to know if it makes sense to stop wearing masks indoors or outdoors, and when it makes sense to keep wearing them. It seems like these decisions aren't backed up sometimes by reason and I wish there was a more nuanced dialogue from the experts about covid risk (now and future health) for preschool-age children balanced against risks of wearing masks for years in early education programs.
This is a tangent to the topic at hand, but you referred to SARS-CoV-2 as a 'respiratory virus'. I was under the impression that we had learned that it was more of a vascular disease affecting the entire body, with typical entree via the respiratory system but that it would attach to anything with ACE2 receptors, which would also include epithelial cells anywhere throughout the body. Hence the risk of blot clots, strokes, heart problems, organ damage, etc. (I have no medical background so forgive the broad generalities and possible inaccuracies.)
Is that not consensus that this is different type of virus? I get frustrated when people refer to it as a respiratory virus as I think it lets them mentally put it in a category with bad colds and flu and thus discount its severity on individuals and the community.
Thanks for these elaborations. I appreciate all of you taking the time to write out your knowledge for us.
I do have a friend who works in a hematology clinic which has had an uptake of younger patients who have been throwing microclots since contracting Covid. It has been notably unusual for the clinic. I have no data though on numbers and percentage increase, just anecdotal observation. As a layperson, I had never heard of blood clots being a possible downstream effect of any other "respiratory" virus.
I've read that many people are getting reinfected, and more frequently. I think this changes things too. It's one thing to get a cold or flu every 2-3 years. But another to get sick with covid 3 times a year.
I have always felt we do, and did not track influenza deaths well, and never as robustly as we do for COVID. I think your comparison to a bad flu year is good, but I always question the numbers that we have for influenza. Having worked as an infection control practitioner, I know many community cases are just not reported, people get sick, ride it out at home, and go back to their lives. Yes, some people die, and it gets back to the question of dying from influenza or with influenza in patients with multiple co-morbidities.
Some of the lessons that we have learned from this pandemic, as others have stated, need to stay in place: funding of public health, reporting, stockpiles of pandemic materials (that are rotated so they are not outdated), better reporting, virology, etc.
This "clearly defined our end goal." It seems that the effectiveness of vaccines against infection changed the playing field. Before vaccines the goal was for a vaccine that could simply keep people out of the hospital and be at least 50% effective at that. The first vaccines worked almost too well at keeping people from getting infected so for many, the goal changed to "Keep from getting infected." I wonder that because the overwhelming number of deaths (in 2022 75% were 65 and over and 20% were 45-64) that we have already subconsciously as a nation have found a high death rate acceptable as the norm. That we will basically ignore deaths in 65 and over and simply look to under 65 as being acceptable as long as it stays under about 65,000 or so.
As you stated there are multiple groups (and of course individuals) each with a different goal. It seems to then make different groups look at each other as "crazy" which also makes it hard to see what an overall goal is.
And where one gets their information/lives plays such a huge role. We see cases increasing on in CA and in the NE in places that are well vaccinated, but because they were well vaccinated their were lower rates of infections. These places were also hard hit in 2020 so there is some left over trauma about hearing "cases are rising" that don't happen elsewhere. So case sensitivity differs geographically.
What I don't understand right now is:
(1) Why isn't more money being put into finding a nasal vaccine?
(2) Why isn't their more clarity from the government about yearly/how often we need vaccinations? We have people well over their 6 month booster not knowing what to do since vaccines are more for keeping people from getting very sick, not simply from getting infected
(3) Why isn't there more information/discussion about how long covid symptoms might last/more discussions on the percentage of people who have long lasting symptoms (Meaning % symptoms last 2 months vs % symptoms lasting 6+months)?
I think the issues of long covid hitting the country economically (Fewer people in the workforce and economic losses in the insurance industry) will have an great impact on what defines an end goal and where energy is put (both my media and government).
I was shocked to read that Covid is currently the 3rd leading cause of US deaths this year. You wouldn't otherwise know that because of how political Covid continues to be. I don't how to solve the political problem, but I do know it increases the challenge in making good decisions and providing proper guidance. That challenge has been equal to the virus itself IMHO.
After doing everything we could to avoid this, my oldest caught it at school (he was the only remaining child masking in his class). When my husband went positive, we opted to ask for the antiviral since the supply issues seem to be resolved and he has risk factors. Our doc was very against it, though did call it in. I thought the use of antivirals would be welcomed, are there reasons to avoid the antivirals?
Thank you for your newsletters, which I forward to others regularly. Our local Coronavirus group has a question about this statement “Unfortunately, viruses mutate randomly. We don’t know the next move.” What is the science behind this? Many are of the belief that viruses mutate to be more transmissible and less severe. The Omicron variant has a lot of people convinced the danger of a more deadly variant is passed. Would love to hear more about this topic in your newsletter.
Thank you Katelyn for a balanced multi-perspective piece on the contributors to and implications of policy decisions. As well, individuals and families/social groups must make decisions based on evolving, imperfect data. The analyses that ought to inform such decisions aren't necessarily based on the everyday questions people have. Take for example questions of viral transmissibility. People think in terms of their own situation (including their perceived risk level) - e.g. for how long could a person who tested positive X days ago potentially transmit the virus if not wearing a mask, if wearing surgical vs. KN95 vs. N95 masks, if they were or were not vaccinated/boosted (and how long ago)? Could someone be a 'carrier' without being infected? How would they know? These highly detailed questions are more likely to be asked by people at high risk if they get infected, but may not much affect policy-making.
It strikes me that there's another factor in play here: Do we as a society and as individuals care about working to prevent harm to others more at risk?
Our society tends to focus on the greatest good for the greatest number, especially of those we center - as opposed to preventing harm for those on the margins. We tend more so than other counties to be individualistic rather than focusing on the vulnerable.
From my point of view, people and government declaring this to already be endemic, dropping protections like masking or free tests, dropping funding, etc. are effectively saying to vulnerable people that "Your deaths are acceptable to us." Sometimes this is crass and obvious as a form of social homocide, other times it's more subtle as part of focusing on "normal" people and not thinking about others.
Granted that everyone will die someday, but for me a key question is whether society believes it is entitled to the deaths of those less fortunate so people can go to a movie?
This isn't a new issue, but rather one COVID has put into stark relief. COVID's effects have quite disproportionally harmed older people, poorer people, disabled people, minorities, etc. Declaring COVID "over" magnifies those harms.
Brilliant post! Now, if we could just get the two camps of scientists/ engineers to stop yelling at each other...
...it would help.
You are spot on that this is complicated!
can you please update us on Monkey Pox?
Thank you as this is the balanced voice we need and wish this would get to all the different important entities that are involved. The headlines from many epidemiologists has been frightening to read as PCR tests are no longer free, masks are all but gone in Texas and our leaders are focused on other things, BUT we are so much more fortunate than so many countries and yet we ARE TERRIBLE at public health measures. It does not make sense. This has affected every aspect of our lives for the past three years how can we stop??? This virus has no boundaries so it should not be a Republican/Democrat issue, it is a human one. We can do this. I continue to contact my elected representatives to let them know this is important. In a sea of confusion you are a port in the storm and we are so grateful for your dedication.
I fear another “epidemic “ of hospitals going broke. Ours just had to lay off 105 people and not fill 76 positions while most every day we are at maximum capacity and sometimes boarding patients in the ED. I survived this cut, but who knows what fall will bring. We aren’t the only hospital system struggling, either.
I always like what you write but don't often tell you that. This interplay of science, political priorities, personal citizen fatigue, and our usual difficulty as semi-evolved chimpanzees has made this a big mess. How many deaths are okay? How much time on ventilators, how much long covid, how much cost...I feel that if there was a ravaging bear in the room, we would respond quickly and mostly accurately. This is different. Somebody coined the word "permademic," which is a real possibility. Anyway, thanks again and keep them coming.
Love your work, thank you so much for all you do. I would love to know whether long covid or longer term issues due to covid (such as a new diabetes diagnosis) are even being considered as part of any broader public health conversations, especially for young children. I run a preschool, and I want to know if it makes sense to stop wearing masks indoors or outdoors, and when it makes sense to keep wearing them. It seems like these decisions aren't backed up sometimes by reason and I wish there was a more nuanced dialogue from the experts about covid risk (now and future health) for preschool-age children balanced against risks of wearing masks for years in early education programs.
This is a tangent to the topic at hand, but you referred to SARS-CoV-2 as a 'respiratory virus'. I was under the impression that we had learned that it was more of a vascular disease affecting the entire body, with typical entree via the respiratory system but that it would attach to anything with ACE2 receptors, which would also include epithelial cells anywhere throughout the body. Hence the risk of blot clots, strokes, heart problems, organ damage, etc. (I have no medical background so forgive the broad generalities and possible inaccuracies.)
Is that not consensus that this is different type of virus? I get frustrated when people refer to it as a respiratory virus as I think it lets them mentally put it in a category with bad colds and flu and thus discount its severity on individuals and the community.
Thanks for these elaborations. I appreciate all of you taking the time to write out your knowledge for us.
I do have a friend who works in a hematology clinic which has had an uptake of younger patients who have been throwing microclots since contracting Covid. It has been notably unusual for the clinic. I have no data though on numbers and percentage increase, just anecdotal observation. As a layperson, I had never heard of blood clots being a possible downstream effect of any other "respiratory" virus.
I've read that many people are getting reinfected, and more frequently. I think this changes things too. It's one thing to get a cold or flu every 2-3 years. But another to get sick with covid 3 times a year.
I have always felt we do, and did not track influenza deaths well, and never as robustly as we do for COVID. I think your comparison to a bad flu year is good, but I always question the numbers that we have for influenza. Having worked as an infection control practitioner, I know many community cases are just not reported, people get sick, ride it out at home, and go back to their lives. Yes, some people die, and it gets back to the question of dying from influenza or with influenza in patients with multiple co-morbidities.
Some of the lessons that we have learned from this pandemic, as others have stated, need to stay in place: funding of public health, reporting, stockpiles of pandemic materials (that are rotated so they are not outdated), better reporting, virology, etc.
This "clearly defined our end goal." It seems that the effectiveness of vaccines against infection changed the playing field. Before vaccines the goal was for a vaccine that could simply keep people out of the hospital and be at least 50% effective at that. The first vaccines worked almost too well at keeping people from getting infected so for many, the goal changed to "Keep from getting infected." I wonder that because the overwhelming number of deaths (in 2022 75% were 65 and over and 20% were 45-64) that we have already subconsciously as a nation have found a high death rate acceptable as the norm. That we will basically ignore deaths in 65 and over and simply look to under 65 as being acceptable as long as it stays under about 65,000 or so.
As you stated there are multiple groups (and of course individuals) each with a different goal. It seems to then make different groups look at each other as "crazy" which also makes it hard to see what an overall goal is.
And where one gets their information/lives plays such a huge role. We see cases increasing on in CA and in the NE in places that are well vaccinated, but because they were well vaccinated their were lower rates of infections. These places were also hard hit in 2020 so there is some left over trauma about hearing "cases are rising" that don't happen elsewhere. So case sensitivity differs geographically.
What I don't understand right now is:
(1) Why isn't more money being put into finding a nasal vaccine?
(2) Why isn't their more clarity from the government about yearly/how often we need vaccinations? We have people well over their 6 month booster not knowing what to do since vaccines are more for keeping people from getting very sick, not simply from getting infected
(3) Why isn't there more information/discussion about how long covid symptoms might last/more discussions on the percentage of people who have long lasting symptoms (Meaning % symptoms last 2 months vs % symptoms lasting 6+months)?
I think the issues of long covid hitting the country economically (Fewer people in the workforce and economic losses in the insurance industry) will have an great impact on what defines an end goal and where energy is put (both my media and government).
I was shocked to read that Covid is currently the 3rd leading cause of US deaths this year. You wouldn't otherwise know that because of how political Covid continues to be. I don't how to solve the political problem, but I do know it increases the challenge in making good decisions and providing proper guidance. That challenge has been equal to the virus itself IMHO.
After doing everything we could to avoid this, my oldest caught it at school (he was the only remaining child masking in his class). When my husband went positive, we opted to ask for the antiviral since the supply issues seem to be resolved and he has risk factors. Our doc was very against it, though did call it in. I thought the use of antivirals would be welcomed, are there reasons to avoid the antivirals?
Thank you for your newsletters, which I forward to others regularly. Our local Coronavirus group has a question about this statement “Unfortunately, viruses mutate randomly. We don’t know the next move.” What is the science behind this? Many are of the belief that viruses mutate to be more transmissible and less severe. The Omicron variant has a lot of people convinced the danger of a more deadly variant is passed. Would love to hear more about this topic in your newsletter.
Thank you Katelyn for a balanced multi-perspective piece on the contributors to and implications of policy decisions. As well, individuals and families/social groups must make decisions based on evolving, imperfect data. The analyses that ought to inform such decisions aren't necessarily based on the everyday questions people have. Take for example questions of viral transmissibility. People think in terms of their own situation (including their perceived risk level) - e.g. for how long could a person who tested positive X days ago potentially transmit the virus if not wearing a mask, if wearing surgical vs. KN95 vs. N95 masks, if they were or were not vaccinated/boosted (and how long ago)? Could someone be a 'carrier' without being infected? How would they know? These highly detailed questions are more likely to be asked by people at high risk if they get infected, but may not much affect policy-making.