outbreak! (ebola, sars, coronavirus, etc)

Bob Wachter's new thread just now is, well, disconcerting.

Covid (@UCSF) Chronicles, Day 848
It’s been a few weeks since my last update – the flow of Covid news & research has slowed a bit. But there’s still plenty of questions that come up, so in this🧵I’ll answer a few that I get asked commonly, including how my wife is doing. (1/25)

— Bob Wachter (@Bob_Wachter) June 13, 2022

Ugh

"I’m living a fairly full life (no hesitation to travel, for example), but it’s with a KN95 in place in most indoor settings" is pretty much where I've been.

Same. Yesterday in the supermarket it was down to me and one other person ( worker) with a mask. As recently as a couple weeks ago, there would always be at least a dozen

Ned, how's your dad?

Thankfully recovered and there doesn't seem to be any continuing ill effects; just chatted with him the other day. We'll be on vacation in mid-July and I'll take the chance to see how he's doing then; being 81 he's naturally slower and has been for some time so I don't want to mistake one thing for the other. But again, I won't know in full until I have a chance to hang with him for a while.

As for masking, always still, and I'm holding off on concerts until at least late August. Movies, only if I am substantially away from everyone in a crowd. Said vacation I mentioned is for the world track and field championships in Eugene, and since they're outdoors that's a relief, but we could be sitting near enough people for a stretch each day that I will likely mask there too.

Movies have (at last!) resumed late morning screenings, so I'm often the only person in the damn theatre -- as was the case with Crimes of the Future, which, you know, of course.

I've mentioned it to a number of ilxors but not on ilx proper:

I tested positive on 5/26, finally negative on 6/5. I didn't regularly check my temperature, but as far as I can tell, I never had a fever. Had the booster way back at the end of November last year, right before Thanksgiving. Not eligible for a second booster as, despite my bad habits in the last year, I'm still relatively young and relatively healthy.

I'm a strong proponent of doing whatever you can to avoid this crap. I have no clue when or where I picked it up. My suspicion is that I probably had an asymptomatic infection that wasn't even detectable, was an idiot and drank too much, and the virus took the opportunity to rear its head. I'd already felt kind of crappy for weeks (thanks, allergy season) and my protocol of working from home for the first part of the week -- I'm basically on a limited time-in-office schedule -- if I was anywhere around people over the weekend didn't work out. I was in the office helping a couple coworkers do some pretty heavy troubleshooting and, of the handful of people I was near, I managed to infect one. I feel terrible about that!

Luckily, a couple of kind friends urged me to contact everyone I'd been around ASAP. Sent an email to coworkers, texted a friend, and people adjusted their behavior accordingly. My coworker had a worse time, but he credits the quick warning with his successful effort to keep his pregnant wife uninfected and he's been vocal in the past about enjoying working in the office and has said he knows he's been balancing that with the risk.

I think the thing I'm left with is this stupid thing that every ding-dong has said for several years running where "it's just like the flu." I think this is wrong, in that we've got this new virus with a changing profile, it's more infectious, and the average number of days it runs and the possible severity and affects are worse. But on the other hand, this is influenza:

Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle tissues (myositis, rhabdomyolysis), and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have flu, and people with chronic heart disease may experience a worsening of this condition triggered by flu.

I know a number of people who had weird long-term affects from the flu, and this was when they were in their 20s. We've got this standing culture, at least in the US, where we don't properly let people isolate, recover, and receive ongoing care. On the other hand, we've got a completely voluntary system of flu shots, where strains that are predicted to hit are inoculated against one or twice per year. Right now, the funding and interest in researching vaccinations targeting new strains seems somewhat minimized, and it's mind-boggling to me.

I think an ongoing effort to normalize the creation, production, and distribution of targeted vaccines, and the infrastructure to get those to as many people as possible, is the best route, along with keeping public awareness high and encouraging masking when possible. I feel like flu shots are unevenly distributed, and it follows the broken health system and capitalization of health among employers. I started getting a seasonal flu vaccine years ago when my employer had them for a small fee, and once they realized a vaccinated workforce pays off, they made it free. I literally would just walk into a meeting room and get a vaccine between meetings. I got a flu vaccine at my local health department last year with my covid booster, free of charge. Make it easy, make it standard, and keep it rolling.

Maybe it's just my brain fog talking, but ¯\_(ツ)_/¯

have you had any long COVID symptoms, mh?

I appreciate the honesty.

It's only a week out, so I've no clue. I usually tend to not have that much of an appetite when ill and that started bouncing back after the initial five or so days of being sick. I've had a few moments where my quick immediate memory is a bit off, but I've been kind of frazzled for a couple months between returning part-time to the office, questioning what returning to semi-normalcy (hah, hah) looks like, etc. so I'm not sure if it's a true brain fog.

I'm back to a normal amount of sleep and haven't done a lot of strenuous physical stuff lately, so I'll find out as I attempt that. The weather's been mediocre so I haven't had the opportunity to go on any long walks yet.

Ah, and in case it wasn't clear, the prior weeks definitely were just allergies. I took a few tests on days when I felt particularly congested but was in the clear.

The covid-related sinus congestion was... different.. in that I noticed my throat felt weird and the cough was different. I was congested, but I think my sinuses were just incredibly swollen for a few days. Tried to clear my eustacian tubes by blowing one morning and regretted it immediately, because I could not get my ears to pop until the next day and everything sounded underwater and I could feel sinus pressure. It was several days until I could really yawn and feel things clear naturally. When I searched for that among symptoms, I found a few articles about covid-related hearing loss which didn't put me in a great mental place. Everything's fine on that front. Note that I kept up my normal allergy season regimen of pseudoephedrine, steroid nasal sprays, and antihistamines and I think that helped in the long term.

I’m now just, hey, Yakov Smirnoff voice, what a virus!

blargh

Over the past few weeks it's been noticeably how the number of COVID patients at the hospital I work at continues to steadily increase. We've had zero patient stretches before, and the most recent was I think two months back or so with nobody being treated. We're now at 32.

the actual reporting numbers have been a mess here, as most places, and my go-to source for how risky it is out there is my city’s wastewater testing program. the sewage doesn’t lie
https://i.imgur.com/TiXcYCs_d.webp?maxwidth=640&shape=thumb&fidelity=medium

that highest point at the end of May was about the day I tested positive 🤦‍♂️

Florida is finally beginning its descent. wastewater is declining in Orange and Seminole Counties, and today's 7-day average case total is 5% lower than last week's.

expect transmission is way higher than in other states with similar case numbers because our positivity rate is insanely high, much higher than other states, meaning we're significantly undertesting. figure transmission will remain high for a bit but hopefully by sometime in mid July it'll be low again.

my brother is already back to normal.

thankfully

everyone i know (pretty much all remote worker types) is getting it an there's an outbreak at daycare, but wastewater evidence is that the wave isn't that big relative to prior waves. so i guess this is the the 20%(?) of the population who have avoided it so far running out of luck in the presence of an incredibly contagious strain. was bound to happen.

anecdotally of course, but p much majority of my friends who got it were people who managed to avoid getting it for 2 years and, as you said, ran out of luck. few of them were people that had a previous strain, and none that I know of that had BA.1 (though it is *possible*).

I sort of have that "everyone I know is getting it" feeling but I think it's an effect of a steady drumbeat of hearing about cases -- when I ACTUALLY think of my close circle of friends in an attempt to be exhaustive, and these are people who have been traveling, out and about, etc., I would say a minority have gotten COVID (rather: a minority know themselves to have gotten COVID) and certainly a small minority have gotten it in the current wave.

I would say a minority have gotten COVID (rather: a minority know themselves to have gotten COVID)

in the US? certainly a majority have had covid.

given no more than 1 in 3 *symptomatic* cases get reported (per CDC), and 86m cases have been reported, it seems unlikely to me that a minority know they've had covid.

I mean obviously I only know if they've told me, so maybe better would be "it's a minority who have found out they had COVID and told me so."

Or more accurately still: "it's a minority who have found out they had COVID and told me so and I remember this about them."

haha ok

feel like pretty much everyone I know has gotten it at some point in the last 6 months. mostly around January but this last month or two has also been pretty bad. I don't know anyone (including myself) who actually reported their case, so I suspect the *actual* number of infections is way way higher than what's reported

for sure, but we know from wastewater it's not like 100x higher than reported. this really is a smaller wave than last winter.

lmao

https://pbs.twimg.com/media/FVUJL3IWIAU6Nqn?format=png&name=large

biden next probably

No one in my immediate family, including me, my two unvaccinated nieces and unboosted sis and bro-in-law, has gotten yet, which is some kind of miracle. The latter work from home, the two have had school all year.

I still have about a dozen friends who've escaped.

I still can't tell if my carefulness or luck is responsible, or if I'm one of those rare weirdos with pre-existing immunity somehow. there was the false-positive infection where I had actual symptoms for a day (my voice was scratchy and wrecked), only for them to disappear overnight and 11 tests over 6 days turning up negative (including PCR).

I had one point blank exposure to a friend who was already symptomatic - I hugged them, and sat next to them for several hours unmasked (and this was Omicron), and didn't get it at all. whereas a friend who merely saw her for 5 minutes and hugged her got it within 2 days of seeing her.

obviously I'm going with the assumption that this isn't the case, so I've been mega careful. even got ripped on for my mask last night by some fuckboy (who I ignored). half afraid one of these assholes will just intentionally cough on me and be like "btw I have it!".

You know how I mentioned 32 COVID patients in my hospital yesterday? Today: 37.

Sorry for potentially dumb question that was answered in one of your previous posts Ned, but does that mean 37 additional patients in the hospital today? Or 32 patients yesterday, now there are 37 patients? Assuming the latter, but second guessed myself.

The latter, just reporting overall numbers. So it could be 5 new admissions, or it could be 6 new admissions but one person got to go home, etc.

Wtf

https://www.marketwatch.com/story/pfizer-says-paxlovid-doesnt-help-covid-19-patients-unless-they-are-high-risk-11655315039

i only read the headline, but that's not what the study says. see https://www.statnews.com/2022/06/14/pfizers-paxlovid-study-fails-to-answer-key-questions-over-benefit-for-broader-populations/ for a more useful take.

and remember the list of risk factors for which there is clearer evidence covers like 80% of US adults (bmi > 25, current or former smoker, etc.).

That study makes Paxlovid sound pretty good actually!

Basically "in our sample, Paxlovid cut the risk of hospitalization in half, but hospitalization in this group is so rare that we can't be sure the difference wasn't just chance" -- sure, I'll take it

Ok thanks for keeping me at bay there!

I read the article but I was having trouble parsing it

Among adults vaccinated against COVID-19, the odds of developing long COVID amid the omicron wave were about 20 percent to 50 percent lower than during the delta period, with variability based on age and time since vaccination.

The finding comes from a case-control observational study published this week in The Lancet by researchers at Kings College London. The study found that about 4.5 percent of the omicron breakthrough cases resulted in long COVID, while 10.8 percent of delta breakthrough cases resulted in the long-term condition.

While the news may seem a little reassuring to those nursing a breakthrough omicron infection, it's cold comfort for public health overall since the omicron coronavirus variant is much more transmissible than delta.

"Far more people were infected first with omicron than with delta," Kevin McConway, an emeritus professor of applied statistics at the Open University, said in a statement. "So even if the percentage of infected people who got long COVID during the two waves is on the scale that these researchers report—and it may well be—the actual numbers of people reporting long COVID after first being infected during omicron is still far larger than during delta."

Seems like good news… I mean, my personal calculation of acceptable risk no longer revolves around the chance of hospitalization or death, which has become pretty distant, but instead the chance (I’ve seen the CDC [or maybe the nih?] say 1 in 5) of experiencing long term/lingering complications. I’m masking in pretty much every indoor situation and avoiding crowds, shows, restaurants, parties etc, and that’s why.

If in the omicron era that’s more like 1 in 20, I’ll take some heart from it.

Still never had it (that I know of), still wearing an N95 everywhere and will keep doing that.

My family wants me to stay at my sister's house next week and her husband is an anti-vaxer who refuses to be tested. Umm.......guys?

I would have a problem with that, straight up. Refusing to be tested is next- level assholery.

"I have cold like symptoms but I refuse to get tested, you will assume I merely have a cold, and I will spread my germs freely"

Don’t do it IMO

do it but wear a mask at all times and when you eat switch to a mask with a hole in it and eat through the hole

and keep saying “i wish i didn’t have to do this” every so often while staring at the guy

refuses to be tested? is he having some symptoms? or just hypothetically wouldn't test if he did?

if he developed symptoms with you there it would be too late for you to avoid him by the time he tested?

the unvaxxed thing would be enough for me to stay someplace else i guess.

Seems like good news… I mean, my personal calculation of acceptable risk no longer revolves around the chance of hospitalization or death, which has become pretty distant, but instead the chance (I’ve seen the CDC [or maybe the nih?] say 1 in 5) of experiencing long term/lingering complications. I’m masking in pretty much every indoor situation and avoiding crowds, shows, restaurants, parties etc, and that’s why.

If in the omicron era that’s more like 1 in 20, I’ll take some heart from it.

― covidsbundlertanze op. 6 (Jon not Jon), Saturday, 18 June 2022 17:15 (two days ago) link

Long COVID is not distributed evenly across age groups, health conditions, severity of COVID, etc., even though a young, healthy person with a mild case certainly *can* get it. I don't know your personal characteristics, but, e.g. a 35yo otherwise healthy person probably never had a 1/5 risk of long COVID and probably doesn't have a 1/20 risk from Omicron. And then Long COVID certainly has a range of outcomes, so the odds of something severe/debilitating and/or prolonged is also going to be lower than 1/5 or 1/20.

This is just one study, so always take one study with a grain of salt, but just as an example: https://www.nature.com/articles/s41591-021-01292-y -- 13% had symptoms lasting more than 28 days, but only 4.5% for more than 8 weeks and 2.3% for more than 12 weeks. Odds also rose with age: symptoms past 28 days were "significantly associated with age, rising from 9.9% in the individuals aged 18–49 years to 21.9% in those aged ≥70 years. Most common symptoms were fatigue, intermittent headaches, anosmia, respiratory symptoms. The most severe and scary ones like memory loss and neurological issues were only a small percentage of the people who had long COVID symptoms.

Long COVID is real, and the most severe forms of it are real too. I'm just saying that in one's personal risk calculation, it's possible to have an exaggerated sense of how likely an otherwise healthy/youngish person is to wind up with any kind of severe long term effects. It's not like 4-6 weeks of fatigue/headaches is so great either, and even a 10% chance of that if you get COVID might seem like enough reason to want to be pretty careful, it's just pretty unlikely that you wind up debilitated.

Maybe so but I find the merest prospect of debilitation really spices up what might otherwise be a pretty normal family get together so kudos, that cousin

my bf got it beginning the end of may and had "mild" pneumonia and now has weird eczema on his face. not hospitalized and too early to tell about the long covid obv but if someone refuses to acknowledge it at all i would not stay at their house.

sorry to hear that about the bf, harbl