This isn’t an apologists take on medicine or public health over the past 3 years.
Every field and every person whose had something important to say about Covid has made mistakes along the way.
But don’t confuse initial transmission dynamics for political dynamics.
Maybe ‘blue’ cities weren’t more concerned about Covid early on because they—and public health more broadly—are generally “left-leaning”.
What if it was just because more of their people were dying at rates not seen from an infectious disease in nearly a century?
Reflecting on how we should have responded, and how we must improve pandemic response in the future, are critical exercises. This includes recognizing and repairing our mistakes.
But reinterpreting the past only works against us. It makes important change less likely.
What won’t help is the pendulum swing from ‘we’re in this together’ to ‘we’ll manage this by ourselves’.
Public health is a collective exercise, by definition.
We fix it together.
Or we don’t.
All indications from genomic surveillance of the virus, wastewater. and the clinical outcomes that are still being tracked (albeit more limited and less periodicity as time goes on), that we’ve (finally) entered an endemic phase. There are no new SARS-CoV-2 variants that have yet cropped up with a growth advantage over XBB.1.5 (the recombinant with 2 significant mutations added on) which is dominant throughout much of the world, or its cousin, XBB.1.9.1. For all the talk about the convergent “variant soup” that preceded the most recent wave, the XBBs took hold and are not giving way to a long list of Omicron family sub-variants (Table below). Moreover, the XBB.1.5 variant ascent to dominance was not associated with a surge of Covid hospitalizations or deaths in the United States or elsewhere in the world, which might have been predicted based on its properties of enhanced transmissibility and immune evasiveness compared with earlier versions of Omicron.
We’ve been dealing with Omicron since November 2021, starting with BA.1 and marching through a number of its lineages (such as BA.2, BA.2.12.1, BA.5, BQ.1.1) over these 16+ months. It’s getting harder to think how further mutations added on to Omicron will pose a major threat, given how the population immunity wall that has been progressively built over 3 years—from infections, vaccination, boosters and their combinations— seems capable of fending off major waves vs this family of the SARS-CoV-2 virus. But there are 2 points of concern…
First, we sit at a very high baseline of daily Covid hospitalizations and deaths in the United States, over 25,000 and about 400, respectively. This is far beyond (double) where we were in June 2021, pre-Delta, when we got down to close to 10,000 hospitalizations and ~200 deaths per day. There’s still no shortage of circulating virus (currently XBB.1.5) getting people infected and some of the folks of advanced age and immunocompromised are the ones chiefly winding up with severe Covid. The virus is finding the vulnerable people more easily since their guard is let down, abandoning high-quality masks and other mitigations, and the low rate of keeping up with boosters in the last 6 months (the age 65+ rate is 40%). There are about 15% of Americans (more than what many people think or have been led to believe), based on all the serologic data available, who never had Covid and are relying on their vaccines/boosters to avoid their first infection. Reinfections among the 85% with prior Covid are not uncommon and not necessarily benign. No less, the pervasive attitude is the pandemic is over, life goes on. That’s helping the virus find new or repeat hosts…
That brings me to the second concern, which is considerably more important. That we will or might see on “Omicron event.” This likely occurred from the hyper-accelerated evolution of the virus within an immunocompromised host that was then transmitted…
When 10 scientists who are following the pandemic and the virus evolution closely (including me) were recently asked what are the odds of another Omicron event in the next 2 years, the range was 5-30%, with no one thinking it is zero, and good convergence at the 10-20% level (unpublished data). And that’s in the 2-year window. SARS-CoV-2 will be with us for many years, so over time that likelihood forecast for a Pi new family of variants (and beyond Pi) increases. There are too many routes for us to see evolution of a Pi family of variants as shown in the graphic below. That is why we must prioritize development and validation of next generation vaccines that can achieve variant-proof protection (e.g. against all betacoronaviruses) and have improved defense against infection that can be accomplished via mucosal immunity with oral or nasal vaccines…
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It remains critical to understand how #COVID19 pandemic began to prevent future ones.
To do so, Dr @mvankerkhove explains:
-which studies need to be done
-the impeding factors to conduct such studies
-the importance sharing relevant information with WHO and scientific community pic.twitter.com/wnhcNLgyZn— World Health Organization (WHO) (@WHO) March 7, 2023
Much more than a single health issue, COVID-19 has set back human development like nothing else in many decades. This 2020/21 decline in life expectancy continues through 2022/23. It is unlikely to end itself any time soon. What happens next is up to us. pic.twitter.com/C5ygJOhaOB
— Prof Brendan Crabb AC (@CrabbBrendan) March 6, 2023
Oh look it's that mysterious bug that goes around that no one can seem to shake🙄
Same script, flawless translation. https://t.co/hciLrjk962
— Naomi Wu 机械妖姬 (@RealSexyCyborg) March 3, 2023
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The number of recorded Covid cases in India is now above 3000 — basically doubled over the past two weeks or so. And I'm sure it's a huge undercount, since people generally aren't testing any more.
Coronavirus (Covid-19) Tracker https://t.co/5zfSb4o9lm via @ndtv
— Neeran Karnik (@neeran) March 8, 2023
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Best short summary I’ve seen:
It is still the best advice to avoid getting infected or as few times as possible. This is not entirely possible by individual measures but needs structural changes & implementation of health protection measures (indoor air quality, sick leave, access to testing, sometimes masks)
— Isabella Eckerle (@EckerleIsabella) March 7, 2023
How soon after exposure should my patient take a rapid test?
We answer this & other common #COVID19 diagnostics questions on our Testing FAQs page ➡️ https://t.co/mUdKexUOxu pic.twitter.com/7gFZpCrH1J
— COVID-19 Real-Time Learning Network (RTLN) (@RealTimeCOVID19) March 6, 2023
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Can Covid leave you chronically infected?
The virus can remain in different parts of the body for months after infection, according to research published in @nature. @nih's Dr. Daniel Chertow explains https://t.co/wBkxHpBfLV pic.twitter.com/HlIYg4KCQh
— Bloomberg Quicktake (@Quicktake) March 2, 2023
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Study of #LongCovid cases finds about "half of the participants reported symptoms of varying severity 1 year after #COVID19…included fatigue, dyspnea, alopecia, concentration problems, memory problems, sleeplessness, and joint pain…" ETC.https://t.co/mlpi6Yvggt
— Laurie Garrett (@Laurie_Garrett) March 7, 2023
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In a study of 946 patients, people 50 & up had cognitive trajectories went 1 of 3 ways after severe #Covid:
1) 69%—no cognitive impairment 1 month after discharge
2) 20.3% —short-term impairment
3) 10.7%—long-term impairment at 1 yr https://t.co/IF2owYHLZA— delthia ricks 🔬 (@DelthiaRicks) March 7, 2023
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My carefully calibrated efforts to avoid getting Covid are mostly to avoid Long Covid. As @EricTopol shows in today’s Substack, this isn’t just about symptoms—we should be equally motivated by persuasive evidence that Covid infections raise cardiac risk. https://t.co/AlXL47Pc2x
— Bob Wachter (@Bob_Wachter) March 4, 2023
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NYC wastewater tests for #COVID19
"We report detecting increasing frequencies of novel cryptic #SARSCoV2 lineages not recog'ed in @GISAID database…contain mutations rarely observed in clinical samples…indicate presence of a nonhuman animal reservoir."https://t.co/rjs9MVFcAv— Laurie Garrett (@Laurie_Garrett) March 7, 2023
Ronnie DeSantis and his merry men have a lot to answer for:
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Start of a thread:
Intelligence assessments are not the same as scientific papers. I wrote about the differences here. 1/https://t.co/4LZGFRDYTA
— Cheryl Rofer (@CherylRofer) March 4, 2023
On The Road – lashonharangue – Namibia – Part 5
Baud
I don’t know what Allison F. is talking about. I dropped dead from the vaccine over a year ago.
Raven
In Georgia there is a 28% turnover rate among public health workers.
NeenerNeener
Monroe County, NY:
80 new cases on 03/01/23.
103 new cases on 03/02/23.
68 new cases on 03/03/23.
81 new cases on 03/04/23.
63 new cases on 03/05/23.
60 new cases on 03/06/23.
46 new cases on 03/07/23.
Deaths now at 2199, up 3 since last week.
Hospital beds: we’re at 4% available now, including 14 ICU beds among 4 hospitals. The largest hospital still has no regular available beds, but it does have 7 available ICU beds (out of 130).
I tried to get another Omicron booster last weekend but the pharmacist at Target said no until the CDC recommends it. I did manage to score 8 more free COVID tests, though, so the trip to Target wasn’t a total waste.
trnc
We are always the victims of our own success.
New Deal democrat
One year into endemic COVID, it appears we are going to have a spring respite for the third year in a row.
In the past year, confirmed cases have varied between a low of 27,400 last April 3 to a high of 140,000 on July 17. The winter Holiday wave only reached a peak of 76,800. As of yesterday, cases were 34,400. In the past month, confirmed cases on average have been the lowest since last April.
Since with the advent of home testing over a year ago, fewer and fewer people are having the “official” tests to confirm their cases, Biobot’s waste particles analysis is the better metric. At the peak of the Omicron wave, Biobot measured 4,553 particles per milliliter. By contrast, the lowest number was 40 per milliliter on May 26, 2021, at the point where we thought the initial round of vaccinations might conquer the virus.
Since March 1, 2022, particles have varied from a low of 110 particles on March 9, 2022 to a peak of 1,160 on December 28, with a close secondary peak of 1,140 on July 20. The most recent reading last week on March 1 was 460, even lower than last October’s 536. This suggests that the “real” number of daily cases has varied from about a low of 75,000 to a high of 600,000 during the Holidays.
Meanwhile, according to the CDC’s latest update last Friday, variant XBB.1.5 accounted for over 90% of all cases. Regionally XBB varies from a “low” of 75%+ in the Pacific Northwest to over 98% of all cases in the Northeast and Mid-Atlantic. In fact, XBB.1.5 has so thoroughly transmitted through the vulnerable portion of the population of the Northeast that that Census Region now has a lower particle count than at any point since last March.
Hospitalizations, which reached a peak of over 160,000 during the Omicron wave, have varied between just below 10,300 last April 5 to a peak of 47,500 this January 3, with a secondary peak of 46,400 last July 25, are 22,700, the lowest since last April.
Finally, deaths, which during last March were still declining from their January Omicron peak of 2600, have since varied from a low of 234 at the end of November to a high of 642 in January. As of yesterday they averaged 371 for the last week.
Deaths during each of the first two years of the pandemic totaled about 500,000. Since April 1 of last year, total deaths have increased by 139,000, for an annual rate of 150,000. While this is the equivalent of very bad flu season, that masks the fact that vulnerability to dying from COVID continues to be very much a factor of immunization status and age.
Lapassionara
Many thanks, AL, for this informative post, and thanks to the commenters who add good info. I have a compromised immune system, and I expect to be getting boosted periodically into the foreseeable future. I still wear masks in public places, etc. So all of this information is useful to me.
Amir Khalid
Malaysia’s Ministry of Health reported 226 new Covid-19 cases yesterday, for a cumulative reported total of 5,044,204 cases. 223 of these new cases were local infections; three new cases were imported. It also reported no deaths, for an adjusted cumulative total that remains at 36,966 deaths – 0.73% of the cumulative reported total, 0.73% of resolved cases.
6,324 Covid-19 tests were conducted on 6th March, with a positivity rate of 1.8%.
There were 9,235 active cases yesterday, 24 more than the day before. 318 were in hospital. Four confirmed cases were in ICU; of these patients, no confirmed cases were on ventilators. Meanwhile, 202 patients recovered, for a cumulative total of 4,998,003 patients recovered – 99.1% of the cumulative reported total.
The National Covid-19 Immunisation Programme (PICK) administered 512 doses of vaccine on 7th March: 30 first doses, 56 second doses, 233 first booster doses, and 193 second booster doses. The cumulative total is 72,801,432 doses administered: 28,130,959 first doses, 27,542,960 second doses, 16,315,835 first booster doses, and 811,678 second booster doses. 86.1% of the population have received their first dose, 84.3% their second dose, 50.0% their first booster dose, and 2.5% their second booster dose.
YY_Sima Qian
There is a huge wave of Influenza A making its way across China right now, moving from north to south. Last Friday, my daughter’s kindergarten class full attendance. Came Monday, half the kids were out due to fevers or other cold/flu like symptoms. By Tuesday, only 4 kids out of 19 showed up. Parents were getting infected by their children.
My daughter only had a bit of running nose, but we decided to keep her home for a couple of days to ride out this wave.
Ten Bears
There is exactly no one that I can think of that actually needs to know my vaxx status, and it’s actually pretty easy to bullshit the bewildered with some crack about how I haven’t been vaccinated since I got kicked out of the Army (nearly fifty years ago). Or ‘why would I get vaxxed, I had it, twice, it almost killed me?’ All the while chuckling in my fist about I’ve had the full course plus an extra of what may be the biggest medical breakthrough since the polio vaccine and I ain’t dead, or turned into a frog, yet.
I actually yelled that at my kid the other night … I ain’t dead
gvg
My nephew and I recently had a bout of something so we tested. I had lots of free tests some of which were past their original expired date. I discovered that some brands little vials of test fluid had almost evaporated in spite of supposedly still being good so I tossed them and used the brands that seemed to have the original amount of fluid and look OK. I recommend people get out their stashes and look at them, in case you ought to go get a few more. Some of us have been lucky enough to not need to use all we were entitled to from our insurance company while relatives (especially with school age kids) run out. I have given quite a few out to mom relatives. I should have given more I guess.
And that brings up something else. Home testing for other things is becoming a thing people are going to take for granted. Tests are available (sometimes) for strep now. My cousin would have had an easier childhood if they had been around when she was young. Faster ordering of the antibiotic, less spread if parents knew and kept one kid home. I am thinking some of the other things are going to show up as over the counter tests soon. Probably could have sooner but people didn’t know they could be a market for it.
CaseyL
@NeenerNeener: If you have a Kroger-affiliated grocery in your area, try making an appointment with them. I was able to do so without any trouble at a Kroger grocery here (in Seattle).
NeenerNeener
@CaseyL: No Krogers around here, only Wegmans and the odd Tops store. I suppose I could try Weggies and see if they say no….
lowtechcyclist
I remember three years ago. On Wednesday, March 11, there was a thread at my old online home titled “How should the NCAA be handling the the basketball tournament and the coronavirus?” My comment that morning was “Play the games in empty arenas, or cancel them. That’s what all spectator sports should be doing right now.”
But I didn’t really think that was going to happen until a lot more people died.
But that day seems to have been an inflection point. As I said in a different thread there just three days later:
On the morning of March 11, it was still business as usual. By the afternoon of the 12th, America was shutting down. I’ll always remember that, how sudden the transition was.
RaflW
A question, and a worry (because I wouldn’t be me if I didn’t worry!).
Anyone have info on why, for example at the Twin Cities wastewater testing site, the data has gotten noisier? eg, Feb 13, 2023 the viral load was about 3X the load on Feb 19th. That’s a huge variation in 6 days. It’s hard to see the 7-day line, but if you use a browser zoom, it becomes visible – and very choppy. It was smoother several months ago and from there pretty far back.
And my worry: The last two years we’ve seen a modest surge that peaks in April or May. Any reason to think that’s less likely this year?
Ruckus
@RaflW:
It’s likely weather related, more people are outside or go places with an easing in cold, snow, rain. It doesn’t have to be summer it just has to be not as bad. Here in SoCal it’s still cold but the sun is shinning today. That means more people out, more people mixing, many without masks on. Disease transmission is almost automatic at that point, from an airborne disease like Covid, which is easily transmitted.
Paul in KY
@Ten Bears: I think you should proudly say you got all the vaccines (if in fact you have).
andy
that business about metformin is interesting. i was put on it about a year and a half ago to treat type 2 diabetes. i was pre-diabetic before the pandemic, and it developed into the real thing in the year we couldn’t do clinic visits (thanks, redcaps!) i’m as vaxxed as i’m allowed, and i’m glad this may give me a degree of protection from long covid, though to my knowledge i’ve never had it. i actually feel really great now- my blood sugar is back to normal, my energy is good, and i’m losing weight.
i live in a blue state (Minnesota) but live in a bitch-red county (Crow Wing), and our local redcaps are desperate to prove how tough they are. we had a massive spike in cases about two weeks after the last tr*mp rally in Duluth, a couple counties east of here in the last weeks of the election campaign. i’m convinced the reason why is that our local redcaps attended and brought covid back with them, spreading it far and wide. i live a couple blocks from the hospital, and their ICU was maxed out for months. it was pretty scary around here until the vaccine was finally widely available the following spring.
Mike in Pasadena
Anne Laurie, excellent update on Covid’s latest developments. Thank you. Sign me, Still Masking in California.
different-church-lady
Insane people will not rest until everyone else is insane as they are.
different-church-lady
@Baud:
Glad you pounded the horse tranquilizers, you seem no worse for wear.
different-church-lady
@lowtechcyclist:
I remember how on that Friday everybody absolutely knew it would be their last day at work — and probably their last day in public — for a long time, without anyone actually saying it out loud to each other.
VFX Lurker
I used the CVS website to schedule booster appointments for myself and my spouse. The pharmacist called me the day of the appointment to let me know that they, too, would not give second bivalent boosters without the CDC’s go-ahead.
Still wearing a KF94 around here.
J R in WV
Our family practice Dr told us recently that he personally had 35+ patients die of covid, and every one of them refused the vaccine. He shook his head in wonder at that behavior…
I recall way back when the Salk polio vaccine became available. I was 5 or 6, and my little brother was a babe in arms. The family business, a newspaper and printing plant with dozens of employees had a shot clinic, employees, their families, and anyone, neighbors welcome to stop by and get a polio vaccination from a county health nurse. And Everyone did!!!
It is partly stuck in my memory because little brother was so terrified of the needle, it took 4 adults to hold him still and a 5th nurse to give the shot. I have never been bothered by shots and needles, stiches, any of that. Just today I had a needle installed for a CAT scan, they used some sort of dye the infused during the scan. No big deal, very proficient staff. Went in my wrist…
Hope to get another booster asap! Will have a script from my family doc, hope that will do the trick!!
And thanks so much for this very informative regular feature here on Balloon Juice !!!
And how interesting that India, a nation with 1.4 billion people, is claiming to have fewer Covid cases than a much smaller nation like Korea or Japan?!?!! oops!
Ruckus
I just got back from a medical appointment all the way across LA (50 miles) on the LA transit train system and the number of people masking up actually surprised me, I’d say 60-75%, masked up.
Mark von Wisco
I’m in the 15% that has yet to contract COVID. I really hope that I can keep it that way!