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

[LordMortis]

Doctor today asked if I had had COVID yet, and when I said "no" she all but flatly said I should resign myself to getting COVID eventually no matter how well I insulate myself and that because I am on remicaid to make sure to be in touch with the clinic/hospital system for advanced treatment the moment I do.

[Isgrimnur]

[LordMortis]

Yeah, it wasn't great conversation and I'ma still stay mostly in isolation and mostly masked when not in isolation. She was trying to be a realist with regard to risk and I'm trying to be the last person to get infected.

[Blackhawk]

We may all get infected. Hell, we all likely will get infected.

The longer we wait, the better off we'll likely be.

[Smoove_B]

The longer we wait, the better off we'll likely be.

Yes. There is value in (1) delaying infection and (2) minimizing the number of times you are infected.

These are things I'd never thought I'd be saying, yet here we are.

[ImLawBoy]

I saw a headline not long ago saying something along the lines of a prior Omicron infection may be more effective in preventing additional infections than a booster. That's the kind of thing that makes me want to bash my head into a wall. I should go get infected so that I can better prevent infections? I get that it might be interesting from a scientific perspective, but that sure seems like an odd message to send the non-scientific community.

[Smoove_B]

Yes. On the whole, messaging on the pandemic has been terrible. I know exactly what you're referring to - and the context was in trying to get people to vaccinate because the mentality of "prior exposure protects me" isn't working for the newest variants. However for whatever reason, a significant number of people (still) believe that the natural exposure route is somehow better than getting vaccinated.This mentality has existed for 20+ years with the anti-vax movement, but it's really being a stumbling block for pandemic response.

[LawBeefaroni]

Just got a note from kiddo's kindergarten classroom. A kid who was in his classroom yesterday just tested positive. They have class pods, where each classroom is separated from the others. So they're just closing his classroom. They require 5 days of closure and kids have to wear masks for 5 more days. Since this is a long weekend, they'll get 8. Unmasked kids require 11 days.

On the plus side, they're now crediting us for COVID closure days.

[ImLawBoy]

They're not bothering closing my kids' classrooms when there's a positive. It just turns to 10 days of mandatory masking for everyone, and unvaccinated kids have to go remote for 5 or 10 days. Boy twin's teacher sent a note on Sunday that two people in the class tested positive (including her!), but since they were already on mandatory masking from an earlier positive it's just extending the existing period.

I did chuckle at a medical notice we received from their school the other day. Someone in the school tested positive for chickenpox. How quaint!

[LawBeefaroni]

I did chuckle at a medical notice we received from their school the other day. Someone in the school tested positive for chickenpox. How quaint!

You know, we haven't had a school lice event in like 3 years.

[Zaxxon]

I think it's wonderful that there are some schools which are still notifying parents of illnesses of any type.

[Smoove_B]

Just in case anyone was looking to play the odds, this was casually dropped today. I'm not sure if this is supposed to be reassuring, but here you go:

https://twitter.com/CDCgov/status/1529147728068063232

New @CDCMMWR: Approximately 1 in 5 adults ages 18+ experience a new condition a month or more after surviving #COVID19.

Note the limitations on the analysis:

The findings in this study are subject to at least five limitations. First, patient data were limited to those seen at facilities serviced by Cerner EHR network during January 2020–November 2021; therefore, the findings might not be representative of the entire U.S. adult population or of COVID-19 case patients infected with recent variants. Second, the incidence of new conditions after an acute COVID-19 infection might be biased toward a population that is seeking care, either as a follow-up to a previous complaint (including COVID-19) or for another medical complaint, which might result in a “sicker” control group leading to underestimation of observed risk. Third, COVID-19 vaccination status was not considered in this analysis, nor were potentially confounding factors (e.g., SARS-CoV-2 variant, sex, race, ethnicity, health care entity, or geographic region), because data were not available, were inconsistent, or included a high proportion of missing or unknown values; for example, data were not matched by data contributors, so controls were not necessarily from the same health care entity or region of the country. Differences between the groups might influence the risks associated with survival from COVID-19 and incident conditions, which require further study. Fourth, International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to identify COVID-19 case-patients, and misclassification of controls is possible. However, the inclusion of laboratory data to identify case-patients and exclude controls helped to limit the potential for such misclassification. Finally, the study only assessed conditions thought to be attributable to COVID-19 or post-COVID illness, which might have biased RRs away from the null.

What's really bothering me lately is the amount of information we now have is all tied to the first and second waves (i.e. original strains) of SARS-CoV-2. The virus is outpacing us - not only in what we're learning about it but in how we're responding (vaccinations, theraputics).

And yet we continue to let the virus have the advantage by encouraging it to change through uncontrolled spread. We are so stupid.

[Smoove_B]

More on Long COVID - study published in Nature today with less than good news:

https://twitter.com/EricTopol/status/15 ... 1127759872

Just out @NatureMedicine The natural history of post-vaccine breakthrough infections (BTI) in 33,000 people, >13 million controls
https://nature.com/articles/s41591-022-01840-0

—Vaccination protection from #LongCovid ~15%, much less than many other studies (~50%)

If you can see the picture, the bolded summary text at the top is likely the best to focus on, namely the end:

Altogether the findings suggest that vaccination before infection confers only partial protection in the post-acute phase of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection.

[Enough]

Well that's depressing as F Smoove. So besides vaccination/masking/avoiding people what can we do once infected to reduce the odds of long-term issues?

[Smoove_B]

No one knows. Maybe some day we'll identify genetic markers for risk or come up with something specific related to determining who is at highest risk for Long COVID. Right now...it's all still puzzling things together based on the insanely large pool of people that have been exposed and are now suffering.

I saw some other anecdotal commentary online today regarding resting heart beat - that for people that have otherwise cleared a COVID-19 infection, a significant number of them now have their resting heart rates 20-30% higher than before the illness. How common is it? Is it a "silent" long-term impact of exposure? Again, no idea.

This is why I continue to do everything I can to delay exposure (i.e. while I'll never be unmasked around strangers indoors any time soon). I'm no longer worried about dying (and having been for a long time). I'm concerned my lifespan will be diminished and/or I'll have quality of life issues indefinitely after recovery.

[Blackhawk]

No one knows. Maybe some day we'll identify genetic markers for risk

Hooray for natural selection?

[Smoove_B]

Hooray for natural selection?

Humans or the virus?

[Max Peck]

Too bad that everyone decided that "living with COVID" means living with COVID.

[Blackhawk]

Hooray for natural selection?

Humans or the virus?

I was referring to humans, but yeah - either one works.

[Smoove_B]

Weekly update (for those that still care)

https://twitter.com/wsbgnl/status/1529932272329031680

New CDC “community levels” are out

Under the pre-Feb 25th guidance universal masking would be recommended in 77% of counties. Under the new guidance universal masking is recommended in 8% of counties.

[Unagi]

Yikes. Well, as someone said in the comments:

My county is red even in the new bogus map.

[Zaxxon]

Well, made it to our vacation spot, deep woods Minnesota, with nary a human about outside our group. I checked today's map, and sure enough, this county is now red. FML.

[LawBeefaroni]

We're back in the "everyone has it" phase.

[Smoove_B]

I was waiting for an explainer, but this will do:

https://twitter.com/EricTopol/status/15 ... 9935136770

The US current BA.2/BA.2.12.1 wave may be extended by the BA.4/5 variants, owing to their growth advantage and higher fitness, as aptly reviewed here

For reference, in May of 2021 it had all but disappeared in the United States - dramatic reductions. We're now seeding a higher baseline level in the summer of 2022 than we had at the start of the Fall of 2021 - and another variant is inbound. Meanwhile, we're still rolling around with Version 1.0 of a vaccine to address a virus that has changed at least 4x since the vaccine was given the green light.

Once again, this coming Fall and Winter have the potential to be brutal.

[Kraken]

Meanwhile, ICU admissions for covid in MA have reached their lowest level since the pandemic began.

On Wednesday, 814 patients with the virus were hospitalized, one of the higher levels since mid-February. But, of those, only 79, or 9.7 percent, were in the ICU.

By comparison, in mid-February, around 19 percent of patients hospitalized with COVID were being admitted to intensive care.

“The good news is we’re seeing fewer patients with critical illness from COVID,” said Dr. Paul Biddinger, chief preparedness and continuity officer at Mass General Brigham.

This week’s rates are a few notches higher than they were on April 24, when ICU admission rates bottomed out at 6.3 percent of the 396 COVID-positive patients in the hospital.

Several factors are contributing to the lower rates and helping decouple cases from serious illness, including rising rates of vaccination in Massachusetts, the use of boosters, and the number and greater availability of therapies. Some seasonal trends may also be playing a role.
...
Overall, fewer people who contracted COVID this spring have been severely ill, compared to last winter. State data show that since mid-April, approximately one-third of COVID-positive patients were hospitalized primarily for COVID, compared to 40 to 50 percent in January and February, when the state began releasing a breakdown of causes of COVID-related hospitalizations.

Among the reasons for the decrease in severe illness has been the state’s robust vaccination and booster programs. As of May 26, 5.38 million Massachusetts residents had been fully vaccinated — over 290,000 more than in early January. Of those, 3.05 million had received a booster — almost a million more than in January. In March, the FDA authorized a second booster dose for older adults, and as of late May, approximately 463,000 people had received one.

“The good news is we are nearly 80 percent fully vaccinated in Massachusetts,” Biddinger said. “We have pretty good rates of boosters. Vaccination and boosters are by far the most important strategy we have for limiting severe illness and death.”

Hospital systems also have more tools to fight serious disease. Though the FDA authorized Paxlovid to help prevent serious disease in December 2021, supply was initially limited. More of the drug is now being produced, and hospitals have amped up efforts to provide access.
...
“The perception out there amongst some providers and patients is that this form of COVID is not so bad, since it’s so prevalent in the community,” Nesto said. “But who knows, six months from now, whether there will be another variant that will change the picture of what we’re experiencing. We would not want people to be lulled into a sense that COVID is here to stay and it’s not so bad. Patients still need to get vaccinated and boosted.”

[Smoove_B]

I'd need to look at the specifics, but our hospitalizations and ICU beds were definitely significantly lower (they're trending down now) than during the last wave's peak - and that's why nothing will ever be done again because everything is fine (it's not). When we really get a handle on what Long COVID looks like and what repeated illness might mean, I suspect there's going to be a lot of angry people that thought everything was fine.

Regardless, our 7 day average right now is somewhere around 4K new cases, which is crazy. Who knows what the real numbers are, but there is damage being done.

I know I'm a broken record on this, but I'm tired. So goddamn tired.

[Max Peck]

It looks like we're probably pretty much out of the BA.2 wave here, although it's possible there might be an uptick caused by people being displaced and forced into close contact by the fallout from last week's storm. The last I heard there are probably still a couple of tens of thousands of people without electricity (and in some cases without running water) a week on from the initial outages.



The waste water monitoring project seems to have ceased reporting on variants of concern about a month ago, so I'm not certain whether or not the BA.4/BA.5 variants are circulating here. If not, I suppose we may be in for another wave when they get here if I am correct in understanding that they are adept in evading immunity from previous infections. Time will tell.

At this point, I'm a year on from being fully vaccinated and about 5 months on from my booster shot, so I'm not sure how much protection remains from vaccination. I'm presuming that protection from infection is poor and protection from severe disease is fairly good, so I plan to continue to take precautions such as masking (FFP3/N95) when around other people (and avoiding being around too many other people if not necessary). Luckily, the urban hermit lifestyle still agrees with me.

[Formix]

MiL is currently in the ICU with COVID. She is vaxxed and boosted, but the SiL and BiL (who she lives with) are not. SiL got COVID, and passed it through the house since nobody quarantined, MiL, who is on oxygen, has no immune system to speak of, and who has SiL as primary caregiver went from no symptoms to in the ICU in about 48 hours. The prognosis is not good. So, yes, we're done with COVID, it ain't done with us.

[Max Peck]

Vaccines may not prevent many symptoms of long covid, study suggests

A large U.S. study looking at whether vaccination protects against long covid showed the shots have only a slight protective effect: Being vaccinated appeared to reduce the risk of lung and blood clot disorders, but did little to protect against most other symptoms.

The new paper, published Wednesday in Nature Medicine, is part of a series of studies by the Department of Veterans Affairs on the impact of the coronavirus, and was based on 33,940 people who experienced breakthrough infections after vaccination.

The data confirms the large body of research that shows vaccination greatly reduces the risk of death or serious illness. But there was more ambiguity regarding long covid.

Six months after their initial diagnosis of covid, people in the study who were vaccinated had only a slightly reduced risk of getting long covid — 15 percent overall. The greatest benefit appeared to be in reducing blood clotting and lung complications. But there was no difference between the vaccinated and unvaccinated when it came to longer-term risks of neurological issues, gastrointestinal symptoms, kidney failure and other conditions.

“This was disappointing,” said Ziyad Al-Aly, lead author and chief of research and development service at VA Saint Louis Health Care System. “I was hoping to see that vaccines offer more protection, especially given that vaccines are our only line of defense nowadays.”

[Defiant]

Top Gun: Maverick doing really well in the theaters during a Covid surge makes me think we should name the next variant "Maverick" and make Sarah Palin the press secretary of the CDC to give us frequent updates about the "Maverick variant"

[Max Peck]

You Are Going to Get COVID Again … And Again … And Again

Two and a half years and billions of estimated infections into this pandemic, SARS-CoV-2’s visit has clearly turned into a permanent stay. Experts knew from early on that, for almost everyone, infection with this coronavirus would be inevitable. As James Hamblin memorably put it back in February 2020, “You’re Likely to Get the Coronavirus.” By this point, in fact, most Americans have. But now, as wave after wave continues to pummel the globe, a grimmer reality is playing out. You’re not just likely to get the coronavirus. You’re likely to get it again and again and again.

“I personally know several individuals who have had COVID in almost every wave,” says Salim Abdool Karim, a clinical infectious-diseases epidemiologist and the director of the Center for the AIDS Program of Research in South Africa, which has experienced five meticulously tracked surges, and where just one-third of the population is vaccinated. Experts doubt that clip of reinfection—several times a year—will continue over the long term, given the continued ratcheting up of immunity and potential slowdown of variant emergence. But a more sluggish rate would still lead to lots of comeback cases. Aubree Gordon, an epidemiologist at the University of Michigan, told me that her best guess for the future has the virus infiltrating each of us, on average, every three years or so. “Barring some intervention that really changes the landscape,” she said, “we will all get SARS-CoV-2 multiple times in our life.”

If Gordon is right about this thrice(ish)-per-decade pace, that would be on par with what we experience with flu viruses, which scientists estimate hit us about every two to five years, less often in adulthood. It also matches up well with the documented cadence of the four other coronaviruses that seasonally trouble humans, and cause common colds. Should SARS-CoV-2 joins this mix of microbes that irk us on an intermittent schedule, we might not have to worry much. The fact that colds, flus, and stomach bugs routinely reinfect hasn’t shredded the social fabric. “For large portions of the population, this is an inconvenience,” Paul Thomas, an immunologist at St. Jude Children’s Research Hospital, in Tennessee, told me. Perhaps, as several experts have posited since the pandemic’s early days, SARS-CoV-2 will just become the fifth cold-causing coronavirus.

I feel like it is optimistic to think that the cadence of reinfection will resemble flu or the common cold given the much higher transmissibility of the current crop of dominant variants, but muh feelz are bad science. And then we have long-COVID, which seems like more of a concern than long-flu or long-cold.

[stessier]

It seems like the people at work who take no precautions are getting it about once a year. Once every 3 years would be nice.

[Smoove_B]

It seems like the people at work who take no precautions are getting it about once a year.

Expect that to change; the current guess is ~3 times a year for people that refuse to vaccinate based on the new variants and their immunity escape ability. Assuming they continue to dominate the circulating strains? Pain. Jury is still out for people that are vaccinated, boosted, etc...

I'd linked to the actual study last week, but I'm glad to see it's getting out into the mainstream press. Unlike the 1 in 5 risk for Long COVID, which seems to have slipped out unnoticed. Or that we have more kids hospitalized in the United States for a respiratory virus than at any time over the last 30+ years.

EDIT: As of 5/27, we've hit ~8200 deaths from COVID in May of 2022. We've given up.

[msteelers]

It seems like the people at work who take no precautions are getting it about once a year.

Expect that to change; the current guess is ~3 times a year for people that refuse to vaccinate based on the new variants and their immunity escape ability. Assuming they continue to dominate the circulating strains? Pain. Jury is still out for people that are vaccinated, boosted, etc…

I’m vaccinated and have received a booster. I had Covid back in January, and just tested positive again yesterday.

Im not surprised I got it again as I had let my guard down and also put myself into a couple of high risk situations. Luckily nobody else in the household seems to have it yet and I’ve been able to somewhat isolate. It’s also been very mild so far.

[LordMortis]

We're finally pulling back locally with hospitalizations and reported cases but have a long way down to pull back to a reasonable level. Naturally, they want to change the narrative now that testing minimization is no longer a positive news marker toward ending the pandemic. Locally, they are pushing to differentiate between hospitalizations of COVID from hospitalizations with COVID. Which is a good thing to publish but not for the reasons they want. They want a dip in hospitalization reporting like they have a dip in cases reported from the move to stop testing.

[ImLawBoy]

I needed to go into the office yesterday for the first time in a few months (we're moving offices, so I needed to get my stuff packed up and ready to go). I used my old method of dropping the twins off at school and then hopping on the L at the station nearest to their school to head downtown. The train was pretty crowded, what with recorded messages playing that there may be delays due to staffing shortages related to COVID. You'd think that would motivate more than 3 or 4 people on the train to wear a mask. You'd think wrong. I think next time I have to go downtown I'll suck it up and pay for parking.

[LawBeefaroni]

I needed to go into the office yesterday for the first time in a few months (we're moving offices, so I needed to get my stuff packed up and ready to go). I used my old method of dropping the twins off at school and then hopping on the L at the station nearest to their school to head downtown. The train was pretty crowded, what with recorded messages playing that there may be delays due to staffing shortages related to COVID. You'd think that would motivate more than 3 or 4 people on the train to wear a mask. You'd think wrong. I think next time I have to go downtown I'll suck it up and pay for parking.

CTA is a disaster. Smoke filled getaway cars with no masking doubling as a "solution" to the mental health crisis.

[Blackhawk]

So, now two of the four members of my household have decided that they're no longer interested in masks, distancing, or any other sort of precaution. These are people with whom I live in a cramped apartment. This mostly renders my precautions meaningless, including all of the looks and comments when I'm the only person out of hundreds in a public setting wearing a mask. The reason? "I'm just tired of COVID." So. Fucking. Stupid.

[Smoove_B]

That's terrible. I'm not sure what would be happening if we all weren't on the same page in my house; I cannot imagine it would be going well.

In other news:

https://twitter.com/COVIDnewsfast/statu ... 2058221568

As of yesterday afternoon, 93% of the United States of America is experiencing moderate to extreme community transmission. This is one of the worst heat maps I've seen to date for the pandemic. Extremely dangerous out there, masks are critical.

We're going to show that virus who's boss!

NJ hit highest hospitalizations since February (just under 1K), but we're well below the record levels of December/January, so who cares?

[Zaxxon]

We're going to show that virus who's boss!

Hey, if everyone has it, no one can get it.