I like this. We are back to suffering an epidemic of “presenteeism” as people go to work and children to school with “just a cold.”
The worst I’ve seen recently was a family of 5 who got floridly ill at Disney, decided not to test because they had to make the plane, wore no masks despite febrile illnesses, and only tested for Covid when they got home.
They were all positive, and we can assume the ripple effects extend well beyond the passengers on the plane, 95% of whom did not mask, or found respirators too burdensome.
My wife and I recently went to Disney, too. And we became symptomatic and tested positive 4 days after returning. I'm reasonably certain we were infected either on the last day at Disney or during travel. (And, yes, we traveled in N95s, and the 3rd person in our row was also masked on the plane). Paxlovid resolved my symptoms within 12 hours of the first dose. That said, we stayed home until symptom free, and 2 negative RAg tests, and still masked when we had to go out for another 5 days.
While at Disney, the number of people who were coughing and sneezing could well have fueled a Masters thesis in Public Health focusing on symtomatic spread of an aerosol-borne illness.
"In this survey study of US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19."
Would be interesting to see how other countries stack up. Nordic, New Zealand, and Asian countries likely better?
Except that non high risk individuals are also susceptible to long covid and could therefore benefit from taking Paxlovid, which would mean testing. Also, for those of us who are truly high risk, Covid is more than just another upper respiratory infection. A test confirming Covid therefore would at least alert those infected to take even further precautions for the benefit of those who are at higher risk. Too early to treat Covid like just another respiratory infection.
May not be required, but most certainly recommended and helpful plus I would venture that the "no test" population would be less likely to take Paxlovid anyway. It's a nice thought to treat every upper respiratory infection like Covid in terms of protecting others, but the reality is probably the opposite -- that people will treat Covid, like every other viral infection -- meaning going to work with it, sending their kids to school with it, etc. A positive Covid test might give them pause.
The pandemic may be politically 'post' however SARS-COV-2 continues to evolve and infect. Without testing and tracking, we are flying blind into the unknown with suboptimal vaccines and treatment.
My main concern is this: Right now, we're in a test-to-treat phase, and Paxlovid does an effective job of knocking back the virus (although I've wondered if we should be running 5-, 7- or 10-day courses of the drug combo). Until Paxlovid, or a replacement becomes available OTC, simply assuming you've got COVID and staying home is likely to have significant public health effects. I'll argue that the changes in testing and reporting, along with the politicization of this virus and the pandemic, have done damage to Public Health's ability to track the disease already. Similarly, the transition to home testing without some form of even crowd-sourced reporting means we no longer have any clue of the cases present.
On the other hand, a strong recommendation to "stay home if you're sick", enforced by employers' and schools' policies that would normalize this behavior and reward it, will go a long way toward decreasing spread.
I've not seen the longer trials, either, but there's been debate as to whether or not longer courses of Paxlovid could affect rebound illness. Although current data (that I've seen so far) don't support Paxlovid as treatment for long-COVID, I'd also like to see an extended duration study on that topic, too.
The cytokine inflammatory phase varies. In some people it's the inflammatory response to the immune process, yes. In others, the response appears out of proportion and without control parameters. If we're looking at reservoirs of active virus remaining in patients with PASC, there might be a benefit to a second course of therapy or longer therapy.
The potential benefit of metformin in reducing incidence of PASC is another interesting twist, and it was used for the short term and at modest doses. I'm wondering if there will be a follow-on study looking at the potential for metformin to reduce or reverse symptoms of PASC in adults.
Common sense would dictate that, if you have symptoms of any viral illness, you should stay home with your germs if at all possible. Yet I've seen the vast majority of my friends and coworkers show up to work with symptoms, with the lame excuse that they either tested negative for Covid, or that they were vaccinated for it -- even after it was well-established that the vaccine did not prevent transmission.
Perhaps, instead of forcing unvaccinated-but-healthy individuals to stay home unpaid or even lose their jobs so that vaccinated-but-immunocompromised people could go out, it would have been better to fund federally-guaranteed medical leave so that immunocompromised could stay home, and also so that vaccinated and unvaccinated alike could use sick leave if they have symptoms. And why is there no discussion of immunity following infection, which seems to be significantly longer-lasting than vaccine-induced immunity?
Also, if viral infection is a public health issue, why are self-serve buffets still allowed? And why don't public toilets have lids to limit "toilet flume," long known as a significant enabler of viral spread?
We saw the quarantine of the elderly and immune-compromised at the start of the pandemic, especially in places like Oklahoma. This implied there was no risk to younger patients, something we determined was not consistent with reality. On the other hand, universal medical leave makes a lot of sense. Just not as a tool to tell one group of people they can’t venture out.
Vaccine-induced immunity appears to be more universal (in terms of blunting severity of all forms of COVID than infection-induced immunity. Hybrid immunity appears to be better than either. And, there are studies suggesting hybrid immunity does a better job of training T-cells overall.
Vaccine-induced immunity wanes within a few months, leaving the recipient as susceptible as they were pre-vaccination unless they get repeated boosters, while infection-induced immunity remains effective for at least a year. Moreover, repeat infections are typically significantly milder -- as we would expect for any reasonably healthy immune system vs common upper respiratory infection.
Those who are at risk for severity or complications should consider vaccination -- and also consider their own susceptibility to vaccine risks.
Some people have had severe adverse events following their first vaccination, while others have had them only after several uneventful vaccinations. Experts still don't seem to know in advance who will have a bad response, or why.
Perhaps 'sub optimal' was a poor choice of words for what I meant - which is that a vaccine which does not stop transmission, provides a 43% less likely chance of death or severe disease for a person in my age group, and does not extend protection for a long period of time is a disappointment. No matter how excellent it is out of the needle, if it is not working by the time another booster becomes available, I don't consider it 'optimal.'
I appreciate the advice for people who are in non-high-risk groups. However, that doesn’t consider transmission to people who are in high-risk groups that they may come in contact with. We are still putting Iris groups at risk.
I like this. We are back to suffering an epidemic of “presenteeism” as people go to work and children to school with “just a cold.”
The worst I’ve seen recently was a family of 5 who got floridly ill at Disney, decided not to test because they had to make the plane, wore no masks despite febrile illnesses, and only tested for Covid when they got home.
They were all positive, and we can assume the ripple effects extend well beyond the passengers on the plane, 95% of whom did not mask, or found respirators too burdensome.
My wife and I recently went to Disney, too. And we became symptomatic and tested positive 4 days after returning. I'm reasonably certain we were infected either on the last day at Disney or during travel. (And, yes, we traveled in N95s, and the 3rd person in our row was also masked on the plane). Paxlovid resolved my symptoms within 12 hours of the first dose. That said, we stayed home until symptom free, and 2 negative RAg tests, and still masked when we had to go out for another 5 days.
While at Disney, the number of people who were coughing and sneezing could well have fueled a Masters thesis in Public Health focusing on symtomatic spread of an aerosol-borne illness.
"In this survey study of US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19."
Would be interesting to see how other countries stack up. Nordic, New Zealand, and Asian countries likely better?
Except that non high risk individuals are also susceptible to long covid and could therefore benefit from taking Paxlovid, which would mean testing. Also, for those of us who are truly high risk, Covid is more than just another upper respiratory infection. A test confirming Covid therefore would at least alert those infected to take even further precautions for the benefit of those who are at higher risk. Too early to treat Covid like just another respiratory infection.
May not be required, but most certainly recommended and helpful plus I would venture that the "no test" population would be less likely to take Paxlovid anyway. It's a nice thought to treat every upper respiratory infection like Covid in terms of protecting others, but the reality is probably the opposite -- that people will treat Covid, like every other viral infection -- meaning going to work with it, sending their kids to school with it, etc. A positive Covid test might give them pause.
Spot on advice, “...assume you have COVID...” and act accordingly. Great approach.
The pandemic may be politically 'post' however SARS-COV-2 continues to evolve and infect. Without testing and tracking, we are flying blind into the unknown with suboptimal vaccines and treatment.
My main concern is this: Right now, we're in a test-to-treat phase, and Paxlovid does an effective job of knocking back the virus (although I've wondered if we should be running 5-, 7- or 10-day courses of the drug combo). Until Paxlovid, or a replacement becomes available OTC, simply assuming you've got COVID and staying home is likely to have significant public health effects. I'll argue that the changes in testing and reporting, along with the politicization of this virus and the pandemic, have done damage to Public Health's ability to track the disease already. Similarly, the transition to home testing without some form of even crowd-sourced reporting means we no longer have any clue of the cases present.
On the other hand, a strong recommendation to "stay home if you're sick", enforced by employers' and schools' policies that would normalize this behavior and reward it, will go a long way toward decreasing spread.
I've not seen the longer trials, either, but there's been debate as to whether or not longer courses of Paxlovid could affect rebound illness. Although current data (that I've seen so far) don't support Paxlovid as treatment for long-COVID, I'd also like to see an extended duration study on that topic, too.
The cytokine inflammatory phase varies. In some people it's the inflammatory response to the immune process, yes. In others, the response appears out of proportion and without control parameters. If we're looking at reservoirs of active virus remaining in patients with PASC, there might be a benefit to a second course of therapy or longer therapy.
The potential benefit of metformin in reducing incidence of PASC is another interesting twist, and it was used for the short term and at modest doses. I'm wondering if there will be a follow-on study looking at the potential for metformin to reduce or reverse symptoms of PASC in adults.
I have a query in regarding a follow-on metformin study for PASC...
Finally, a voice of reason! Thank you ,Dr. Offit!
Common sense would dictate that, if you have symptoms of any viral illness, you should stay home with your germs if at all possible. Yet I've seen the vast majority of my friends and coworkers show up to work with symptoms, with the lame excuse that they either tested negative for Covid, or that they were vaccinated for it -- even after it was well-established that the vaccine did not prevent transmission.
Perhaps, instead of forcing unvaccinated-but-healthy individuals to stay home unpaid or even lose their jobs so that vaccinated-but-immunocompromised people could go out, it would have been better to fund federally-guaranteed medical leave so that immunocompromised could stay home, and also so that vaccinated and unvaccinated alike could use sick leave if they have symptoms. And why is there no discussion of immunity following infection, which seems to be significantly longer-lasting than vaccine-induced immunity?
Also, if viral infection is a public health issue, why are self-serve buffets still allowed? And why don't public toilets have lids to limit "toilet flume," long known as a significant enabler of viral spread?
We saw the quarantine of the elderly and immune-compromised at the start of the pandemic, especially in places like Oklahoma. This implied there was no risk to younger patients, something we determined was not consistent with reality. On the other hand, universal medical leave makes a lot of sense. Just not as a tool to tell one group of people they can’t venture out.
Vaccine-induced immunity appears to be more universal (in terms of blunting severity of all forms of COVID than infection-induced immunity. Hybrid immunity appears to be better than either. And, there are studies suggesting hybrid immunity does a better job of training T-cells overall.
Vaccine-induced immunity wanes within a few months, leaving the recipient as susceptible as they were pre-vaccination unless they get repeated boosters, while infection-induced immunity remains effective for at least a year. Moreover, repeat infections are typically significantly milder -- as we would expect for any reasonably healthy immune system vs common upper respiratory infection.
Those who are at risk for severity or complications should consider vaccination -- and also consider their own susceptibility to vaccine risks.
Some people have had severe adverse events following their first vaccination, while others have had them only after several uneventful vaccinations. Experts still don't seem to know in advance who will have a bad response, or why.
Sane advice in an insane world.
Perhaps 'sub optimal' was a poor choice of words for what I meant - which is that a vaccine which does not stop transmission, provides a 43% less likely chance of death or severe disease for a person in my age group, and does not extend protection for a long period of time is a disappointment. No matter how excellent it is out of the needle, if it is not working by the time another booster becomes available, I don't consider it 'optimal.'
What about those that are interacting with high risk individuals? Shouldn’t they test when symptomatic?
I appreciate the advice for people who are in non-high-risk groups. However, that doesn’t consider transmission to people who are in high-risk groups that they may come in contact with. We are still putting Iris groups at risk.