Please remove if this isn't appropriate, but your mention of toilet paper couldn't help but recall to me that we were okay in that area in 2020 as we had a WhoGivesACrap.org subscription. (They donate half of profits to build toilet facilities in Third World; highly recommend the Bamboo over the Recycled; fun shipments to get.)
HI Cheryl, and not inappropriate at all :) I wish I had started a company with such a fun name and good citizenship. We've been using more bamboo products as well. Rich countries of the world helping with sanitation helps everyone, especially with human dignity and disease prevention. Heard something about the 120 million toilets built in India under Modi. I take so much for granted....
Similar to the comment above, I’d say Don’t use toilet paper! Install a diy bidet sprayer 25-35$ and easy to install alongside any toilet or bb if you can and want to, you can have a toilet w pre installed automatic bidet function. Then get some rags or tea towels — I made a stack of these from an old flannel sheet — and use them to dry off. No need to flush a lot of paper !! ( in Vermont the Rich Earth Institute collects human urine for use in composting. So I rarely have to flush at all!! Ok enough for the bathroom talk! Thanks for this column. I read it regularly.
This is a great idea, especially for us rural folks who are members of the Septic Tank Club. Keeping paper out of the system keeps the stinky-tank trucks off my property.
Thanks Phoebe. Such a good idea. I always think of bidets as fancy additions, but this sounds really accessible. People like you are really doing the little things that add up to a more sustainable life! I'll need to reflect on this more. We compost and do a bunch of other little things that hopefully add up to something helpful, too. The planet needs massive help. There is a theory that one reason we are not seeing signs of advanced civilizations in our galaxy is that they either learn to live sustainably and eschew impossible endless growth and therefore leave a small trace in the cosmos, or they perish from that unsustainable perpetual growth mindset.
Ryan, first off, sending all best wishes to you, your friends, and family. Given your opening note, I am all the more grateful that you took the time to bring us up to date on this. This is the clearest, most helpful, article I have read on the topic. Thank you so, so much for all you do and all you are.
Hi Susan, and many thanks! I think my lane is best kept to reading, curating, and then presenting ideas via actionable primary care level writing. Very grateful for all the specialists and researchers. Glad to work in parallel with them. I'll keep you posted if/when I start to get even more concerned about this topic! And thank you for your genuine best wishes. Some good, grueling progress this week...
My spouse caught covid from a relative at Thanksgiving (a very mild case -- thanks, vaccines) and became symptomatic nine days ago. I have tested negative so far, due to a recent vaccination, adherence to CDC guidelines, and a stockpile of disinfectants and N95 masks. I will be ordering more masks, gloves, and disinfectant wipes in order to have a one-month supply on hand at all times. Better to have and not need than need and not have!
Hi CBA, I'm sorry to hear about the case, but happy to hear it was mild and that so far you seemed to have escaped it! "Chance favors the prepared mind." - Louis Pasteur, an appropriate person to quote in this article which includes raw v pasteurized milk, right?
We need to put that quote on a T-shirt. Having had ancestors who died of tuberculosis, brucellosis, and dysentery contracted from unpasteurized dairy products, I can't imagine why anyone would think things were better pre-Pasteur.
You and I both been keeping notes on this. I'll have some more updates, hopefully tomorrow. I also recall the getting the flu shot could help with preventing chimeric viruses? Certainly antivirals are important here (Recall Hickam's Dictum.) Great work here !
Hi KB - looking forward to your new collection and I know you track this stuff closely, too. Fascinating regarding prevention of chimeric virus activity. Would be a cool topic to learn more about!
Great article! Particularly appreciate the comments about flu shots and possible weak cross-reactivity. I am going to be publishing a piece on the latest H5N1 news soon (was supposed to be yesterday but I got burned out and hit wall) and will make sure to include this piece in the roundup 👍
Awesome, will look forward to reading that, Eric. I'm struggling to keep up with email and a million other things this week (month, year!) so there is a daily wall I hit, too! Might take a few days to open your post but I will read for sure. Thanks!
Thank you as always for a clear well researched post. Hope your loved ones are well.
Recently went to a medical appointment and had to psych myself to wear a mask--but it involved mandatory restroom use and that pushed me to do it. I got a portable C02 meter and it was fascinating to see how high it was in the decent sized exam rooms.
I hope we don't face another pandemic with the incoming administration's picks for top posts, but none of that is in my personal control--just the ability to mitigate.
Hi Jan, thank you for stopping in and for your kind words. Playing with the CO2 meter is fun and horrifying sometimes. Being on a plane still takes the gold medal in the situations I've measured for ppm. And yes, personal mitigation strategies are appropriate to pursue as we watch the incompetence and intentionally hostile picks fill a government intended to fail. Hard to believe, but don't stop believin' !
Thank you for the very needed information. I’m somewhat relieved to know flu vaccines may be helpful since i have been getting them for many years. Although we are in trouble with in incoming trump administration which may delay new vaccine development and may not even recognize H5N1 as a serious problem if it does start to spread human to human. I am very concerned about this. Also I am following what is going on in the Congo with this disease X.
That we might have an anti-vaxxer leading HHS is a bit bizarre given that Trump by some accounts is a germophobe and insisted on getting vaccinated. It seems to me very strange for him to reward Kennedy with this particular post, since he will suffer too if H5N1 does become widespread, or pandemic, and we have not developed a vaccine against it.
Trump has ideals? Mebbe —but even though I try to understand him, so as not to sink to hating him, I’d be hard-pressed to say which are or ever were his ideals, good or bad! But I always listen to others’ thoughts about Trump so maybe you see more depth to the man or allow as it must be there, than I do. Or maybe you meant RFK jr??
I saw a little about that but sounds like there is still much unknown. I know very little about malaria but I didn’t think you had respiratory symptoms with it.
I share your concern Janette, and some of the optimism that a good catalogue of previous flu shots might help broaden one's arsenal of protection. Only time will tell, but the ferret studies were hopeful. Some of the death rates in other mammals like sea lions etc have been shockingly high. Also watching the disease in Congo developments, but still feeling like this is beyond a primary care newsletter as of yet. Let's hope it stays that way, and I'm thankful for all the under-appreciated work that public health workers do all across the world, every day.
Thank you, Dr. McCormick, for turning up the volume on this, in a tricky time, sounds like. Others I also respect are amplifying, too. I’m following closely, and preparing. Best of love, luck, and care to yours who may be in need.
Hi Donna, thank you for your words! The general volume going up has caught my attention, too. I've been trying to avoid this whole thing to some degree. Every patient/person I talk to is just not psychologically ready for another pandemic. That exhaustion alone will be a formidable challenge.
Great post! I’m a foodborne illness case investigator, and people are either drinking raw milk more or admitting to it more, even those in high risk groups like kids and elderly. Sooooo many bad things in raw milk that can sicken you. Glad to see there will (finally!) be national milk testing, but I fear it will barely have time to get off the ground before the anti-science brigade marches in. Thanks for taking the time to post, you’re keeping some of us out here sane, I’m sure.
Crazy, ain't it? My mom was a genealogist, and found several dairy-farming ancestors who died from diseases carried in unpasteurized milk. When pasteurization came along, most farmers were ecstatic to find a way to prevent these illnesses and sell a better product. I doubt they whined about missing the good old days of milk-borne tuberculosis, brucellosis, and dysentery.
Wow! Tragic, but fascinating at a distance. On another topic one of my great grandmother's brothers died of the 1918 flu pandemic, in his prime. An entire branch of a potential family tree gone.
I lost a healthy 40 year old cousin to the flu a few years ago. Did you see the study recently showing the flu deaths being missed after hospital discharge, an average of 9 days after? I’ll find the link. Refrains of “Just the flu” has never felt right to me.
That's really really important work! Thank you for doing this. I suspect you are correct on both suppositions - paradoxically more people drinking raw milk since the H5N1 warnings came out, and more people admitting it. It really shows the impossible job that public health educators and policy makers have in this country, as a large number of people react with opposite, defiant actions.
Hello, I don’t drink raw milk but we have a local creamery that does a low pasteurization process. Should I avoid? I don’t drink much milk but do enjoy the occasional pint. I also find that the low pasteurization milk makes fabulous home-made yogurt. I’d appreciate your informed comment. Many Thanks!
Thank you as always and take good care of yourself! I bought a bunch of N95s recently. May be helpful to remind people that the N 95s can be used multiple times. And Covid is still here! My 25 year just got her second known infection. Sigh.
Very true. Remember the days of hanging masks up to dry and disinfect with time and exposure?! We had a clothesline with paper bags and rotated these until better PPE supplies were available... ugh.
I worked in the hospital in 2020-2021, I remember well the magic paper bags! I’d been a hospital nurse for 13 years by that point, and it was very strange using crisis type infection control rather than what I’d been taught as best practices.
Thank you Arthur, and I’m worried too. The bungling approach to the pandemic definitely increased deaths hospitalizations and long covid by the millions. The thorough creation of alternate realities and willful denial of actual truth will be devastating in another pandemic of this takes off. Case reporting and the like will be suppressed or not collected at all, just like larger mass extinction events like climate change, which isincreasingly claiming human lives and property. Sad stuff, wish I could end with an upbeat, meaningless motto about being great again or something
I hope your friends and family will be all right, Dr. Ryan.
Re: vaccines. In anticipation of RFK Jr. making them unavailable, I’ve already stocked up on new KN95 masks. Meanwhile, I’ve written senators not to approve his nomination. Fingers are crossed.
Strong work Mim. I do think that letters and phone calls can push the needle. My mother in law called Senator Cory Bookers office one night, late, and he actually answered the phone and talked with her for almost an hour. There are still good public servants out there, we need to elevate them too!
Great, easy to understand review of the current situation Thank you! I’ve been watching this situation closely since it started in March and it has rolled out exactly like scientists back then said it would. Two questions: 1) I get my flu shot yearly. I’ve seen some discussion that the pneumococcal vaccine may have protective properties for this virus. I also think that the age recommendations for it were changed in October and it is being recommended for a slightly younger population. Any thoughts on that? I’m now eligible under the younger age guidelines. 2: I’m seeing differing recommendations for infection control for this flu on surfaces. It has to do with the outer structure of the virus requiring slightly different surface clean times/products than Covid to kill it. And that surface cleaning may be more important with this virus because of its longevity on surfaces. Do you have a good source for that?
Hi Tara, sorry for the delay, holidays, and all that! You bring up some very good points about the pneumonia shot and collateral protection against viruses, which might seem counterintuitive because as you know, this is a vaccine against bacteria, here’s a post I wrote about that study:
And off the top of my head I think most research lately shows respiratory transmission via aerosols is the primary mode of influenza spread, with ventilation being crucial for prevention. While surface cleaning remains important, studies indicate fomite transmission plays a smaller role than previously believed. but I think you are correct, flu more likely to spread than COVID via surfaces, though still mostly respiratory
Thank you for such a great response as always. The concept of viruses and bacteria being bidirectional is quite fascinating. I think I’m going to talk to my doc about the pneumonia vaccine. Especially with Mycoplasma being such an issue lately. Maybe it would help that too. I’m in Northern Jersey and a friend tested positive for Covid the other day. Wastewater seems to be going up so I wasn’t surprised to hear of a case. Will be interesting to see what this wave does.
Yes, definitely a wave building but less than previous years it seems, also waiting to see if the hospitalization numbers stay down, hopefully we have turned some corners until another more virulent variant arrives. I’m probably going to get my pneumonia shot at 50 but get the shingles shots first. 😊
So relevant, so clear, as always.
Please remove if this isn't appropriate, but your mention of toilet paper couldn't help but recall to me that we were okay in that area in 2020 as we had a WhoGivesACrap.org subscription. (They donate half of profits to build toilet facilities in Third World; highly recommend the Bamboo over the Recycled; fun shipments to get.)
Cheryl, I agree. This is a wonderful company with a very good product. I recommend keeping a subscription going.
HI Cheryl, and not inappropriate at all :) I wish I had started a company with such a fun name and good citizenship. We've been using more bamboo products as well. Rich countries of the world helping with sanitation helps everyone, especially with human dignity and disease prevention. Heard something about the 120 million toilets built in India under Modi. I take so much for granted....
Similar to the comment above, I’d say Don’t use toilet paper! Install a diy bidet sprayer 25-35$ and easy to install alongside any toilet or bb if you can and want to, you can have a toilet w pre installed automatic bidet function. Then get some rags or tea towels — I made a stack of these from an old flannel sheet — and use them to dry off. No need to flush a lot of paper !! ( in Vermont the Rich Earth Institute collects human urine for use in composting. So I rarely have to flush at all!! Ok enough for the bathroom talk! Thanks for this column. I read it regularly.
This is a great idea, especially for us rural folks who are members of the Septic Tank Club. Keeping paper out of the system keeps the stinky-tank trucks off my property.
Thanks Phoebe. Such a good idea. I always think of bidets as fancy additions, but this sounds really accessible. People like you are really doing the little things that add up to a more sustainable life! I'll need to reflect on this more. We compost and do a bunch of other little things that hopefully add up to something helpful, too. The planet needs massive help. There is a theory that one reason we are not seeing signs of advanced civilizations in our galaxy is that they either learn to live sustainably and eschew impossible endless growth and therefore leave a small trace in the cosmos, or they perish from that unsustainable perpetual growth mindset.
Ryan, first off, sending all best wishes to you, your friends, and family. Given your opening note, I am all the more grateful that you took the time to bring us up to date on this. This is the clearest, most helpful, article I have read on the topic. Thank you so, so much for all you do and all you are.
Hi Susan, and many thanks! I think my lane is best kept to reading, curating, and then presenting ideas via actionable primary care level writing. Very grateful for all the specialists and researchers. Glad to work in parallel with them. I'll keep you posted if/when I start to get even more concerned about this topic! And thank you for your genuine best wishes. Some good, grueling progress this week...
My spouse caught covid from a relative at Thanksgiving (a very mild case -- thanks, vaccines) and became symptomatic nine days ago. I have tested negative so far, due to a recent vaccination, adherence to CDC guidelines, and a stockpile of disinfectants and N95 masks. I will be ordering more masks, gloves, and disinfectant wipes in order to have a one-month supply on hand at all times. Better to have and not need than need and not have!
Hi CBA, I'm sorry to hear about the case, but happy to hear it was mild and that so far you seemed to have escaped it! "Chance favors the prepared mind." - Louis Pasteur, an appropriate person to quote in this article which includes raw v pasteurized milk, right?
Your prep sounds good :)
We need to put that quote on a T-shirt. Having had ancestors who died of tuberculosis, brucellosis, and dysentery contracted from unpasteurized dairy products, I can't imagine why anyone would think things were better pre-Pasteur.
You and I both been keeping notes on this. I'll have some more updates, hopefully tomorrow. I also recall the getting the flu shot could help with preventing chimeric viruses? Certainly antivirals are important here (Recall Hickam's Dictum.) Great work here !
Hi KB - looking forward to your new collection and I know you track this stuff closely, too. Fascinating regarding prevention of chimeric virus activity. Would be a cool topic to learn more about!
Great article! Particularly appreciate the comments about flu shots and possible weak cross-reactivity. I am going to be publishing a piece on the latest H5N1 news soon (was supposed to be yesterday but I got burned out and hit wall) and will make sure to include this piece in the roundup 👍
Awesome, will look forward to reading that, Eric. I'm struggling to keep up with email and a million other things this week (month, year!) so there is a daily wall I hit, too! Might take a few days to open your post but I will read for sure. Thanks!
Thank you as always for a clear well researched post. Hope your loved ones are well.
Recently went to a medical appointment and had to psych myself to wear a mask--but it involved mandatory restroom use and that pushed me to do it. I got a portable C02 meter and it was fascinating to see how high it was in the decent sized exam rooms.
I hope we don't face another pandemic with the incoming administration's picks for top posts, but none of that is in my personal control--just the ability to mitigate.
Hi Jan, thank you for stopping in and for your kind words. Playing with the CO2 meter is fun and horrifying sometimes. Being on a plane still takes the gold medal in the situations I've measured for ppm. And yes, personal mitigation strategies are appropriate to pursue as we watch the incompetence and intentionally hostile picks fill a government intended to fail. Hard to believe, but don't stop believin' !
Thank you for the very needed information. I’m somewhat relieved to know flu vaccines may be helpful since i have been getting them for many years. Although we are in trouble with in incoming trump administration which may delay new vaccine development and may not even recognize H5N1 as a serious problem if it does start to spread human to human. I am very concerned about this. Also I am following what is going on in the Congo with this disease X.
That we might have an anti-vaxxer leading HHS is a bit bizarre given that Trump by some accounts is a germophobe and insisted on getting vaccinated. It seems to me very strange for him to reward Kennedy with this particular post, since he will suffer too if H5N1 does become widespread, or pandemic, and we have not developed a vaccine against it.
Agreed. I wish he were not transactional to the point of criminality and abandonment of his own ideals. Those ideals that are good ones at least.
Trump has ideals? Mebbe —but even though I try to understand him, so as not to sink to hating him, I’d be hard-pressed to say which are or ever were his ideals, good or bad! But I always listen to others’ thoughts about Trump so maybe you see more depth to the man or allow as it must be there, than I do. Or maybe you meant RFK jr??
10 of 12 samples in the Congo tested positive for malaria. There may be more things going on than that, but wasn’t sure if you’d seen that update.
I saw a little about that but sounds like there is still much unknown. I know very little about malaria but I didn’t think you had respiratory symptoms with it.
I share your concern Janette, and some of the optimism that a good catalogue of previous flu shots might help broaden one's arsenal of protection. Only time will tell, but the ferret studies were hopeful. Some of the death rates in other mammals like sea lions etc have been shockingly high. Also watching the disease in Congo developments, but still feeling like this is beyond a primary care newsletter as of yet. Let's hope it stays that way, and I'm thankful for all the under-appreciated work that public health workers do all across the world, every day.
Thank you, Dr. McCormick, for turning up the volume on this, in a tricky time, sounds like. Others I also respect are amplifying, too. I’m following closely, and preparing. Best of love, luck, and care to yours who may be in need.
Hi Donna, thank you for your words! The general volume going up has caught my attention, too. I've been trying to avoid this whole thing to some degree. Every patient/person I talk to is just not psychologically ready for another pandemic. That exhaustion alone will be a formidable challenge.
Great post! I’m a foodborne illness case investigator, and people are either drinking raw milk more or admitting to it more, even those in high risk groups like kids and elderly. Sooooo many bad things in raw milk that can sicken you. Glad to see there will (finally!) be national milk testing, but I fear it will barely have time to get off the ground before the anti-science brigade marches in. Thanks for taking the time to post, you’re keeping some of us out here sane, I’m sure.
Crazy, ain't it? My mom was a genealogist, and found several dairy-farming ancestors who died from diseases carried in unpasteurized milk. When pasteurization came along, most farmers were ecstatic to find a way to prevent these illnesses and sell a better product. I doubt they whined about missing the good old days of milk-borne tuberculosis, brucellosis, and dysentery.
Ha.
Wow! Tragic, but fascinating at a distance. On another topic one of my great grandmother's brothers died of the 1918 flu pandemic, in his prime. An entire branch of a potential family tree gone.
My grandfather contracted the 1918 flu after fighting in France during WWI. He had chronic lung problems for the rest of his life, but lived to be 90.
I lost a healthy 40 year old cousin to the flu a few years ago. Did you see the study recently showing the flu deaths being missed after hospital discharge, an average of 9 days after? I’ll find the link. Refrains of “Just the flu” has never felt right to me.
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae547/7874914
That's really really important work! Thank you for doing this. I suspect you are correct on both suppositions - paradoxically more people drinking raw milk since the H5N1 warnings came out, and more people admitting it. It really shows the impossible job that public health educators and policy makers have in this country, as a large number of people react with opposite, defiant actions.
Hello, I don’t drink raw milk but we have a local creamery that does a low pasteurization process. Should I avoid? I don’t drink much milk but do enjoy the occasional pint. I also find that the low pasteurization milk makes fabulous home-made yogurt. I’d appreciate your informed comment. Many Thanks!
Thank you as always and take good care of yourself! I bought a bunch of N95s recently. May be helpful to remind people that the N 95s can be used multiple times. And Covid is still here! My 25 year just got her second known infection. Sigh.
Very true. Remember the days of hanging masks up to dry and disinfect with time and exposure?! We had a clothesline with paper bags and rotated these until better PPE supplies were available... ugh.
I worked in the hospital in 2020-2021, I remember well the magic paper bags! I’d been a hospital nurse for 13 years by that point, and it was very strange using crisis type infection control rather than what I’d been taught as best practices.
Ryan, I hope this is not a here we go again scenario.
We all know what Trump did to make that pandemic worse.
I cannot imagine another pandemic with the new clown show in power with no one like Dr. Fauci or Dr. Birx around the Oval Office.
Thank you for all you do to keep us informed.
Thank you Arthur, and I’m worried too. The bungling approach to the pandemic definitely increased deaths hospitalizations and long covid by the millions. The thorough creation of alternate realities and willful denial of actual truth will be devastating in another pandemic of this takes off. Case reporting and the like will be suppressed or not collected at all, just like larger mass extinction events like climate change, which isincreasingly claiming human lives and property. Sad stuff, wish I could end with an upbeat, meaningless motto about being great again or something
I hope your friends and family will be all right, Dr. Ryan.
Re: vaccines. In anticipation of RFK Jr. making them unavailable, I’ve already stocked up on new KN95 masks. Meanwhile, I’ve written senators not to approve his nomination. Fingers are crossed.
Strong work Mim. I do think that letters and phone calls can push the needle. My mother in law called Senator Cory Bookers office one night, late, and he actually answered the phone and talked with her for almost an hour. There are still good public servants out there, we need to elevate them too!
Wow! I’d have liked to listen in to that conversation.
Another good legislator is my Sen. Jon Ossoff, who always replies to my letters, and not with push-button answers.
Great, easy to understand review of the current situation Thank you! I’ve been watching this situation closely since it started in March and it has rolled out exactly like scientists back then said it would. Two questions: 1) I get my flu shot yearly. I’ve seen some discussion that the pneumococcal vaccine may have protective properties for this virus. I also think that the age recommendations for it were changed in October and it is being recommended for a slightly younger population. Any thoughts on that? I’m now eligible under the younger age guidelines. 2: I’m seeing differing recommendations for infection control for this flu on surfaces. It has to do with the outer structure of the virus requiring slightly different surface clean times/products than Covid to kill it. And that surface cleaning may be more important with this virus because of its longevity on surfaces. Do you have a good source for that?
Hi Tara, sorry for the delay, holidays, and all that! You bring up some very good points about the pneumonia shot and collateral protection against viruses, which might seem counterintuitive because as you know, this is a vaccine against bacteria, here’s a post I wrote about that study:
https://mccormickmd.substack.com/p/pneumonia-shots-also-help-against
And off the top of my head I think most research lately shows respiratory transmission via aerosols is the primary mode of influenza spread, with ventilation being crucial for prevention. While surface cleaning remains important, studies indicate fomite transmission plays a smaller role than previously believed. but I think you are correct, flu more likely to spread than COVID via surfaces, though still mostly respiratory
Thank you for such a great response as always. The concept of viruses and bacteria being bidirectional is quite fascinating. I think I’m going to talk to my doc about the pneumonia vaccine. Especially with Mycoplasma being such an issue lately. Maybe it would help that too. I’m in Northern Jersey and a friend tested positive for Covid the other day. Wastewater seems to be going up so I wasn’t surprised to hear of a case. Will be interesting to see what this wave does.
Yes, definitely a wave building but less than previous years it seems, also waiting to see if the hospitalization numbers stay down, hopefully we have turned some corners until another more virulent variant arrives. I’m probably going to get my pneumonia shot at 50 but get the shingles shots first. 😊
@SistrMoon45, any insight on low pasteurization process milk? We have a local creamery that does this; tastes great altho I don’t drink often.