Thanks Jerry, by all means! I stand by the stuff I write and try to build it on a foundation of good references, so for anyone who is still playing the game - the more the merrier :)
I sure wish we had head to head trials of mRNA vaccines vs novavax: the Moderna RSV vaccine has dismal protection after a few months and I’d like to know if waning immunity is due to the platform— some extremely important decisions are looming for the fall, and which COVID vaccine to get is one of them.
Thank you so much for this update! As someone who has been very very careful, I’ve loosened up and there is a strong urge to throw caution to the wind and be like everyone else. But, realistically, I’m at higher risk and don’t want to be sick.
Recent bizarre moment: I’m masked in my Harvard hospital primary immunodeficiency clinic, explaining to the unmasked immunologist that I mask in medical facilities and public transportation as he says “good plan.” Crazy right? All the patients are immune compromised…
Hi Jan - totally agree with all of your points (as usual!).
I'm watching the evolving mRNA platform durability question, too. Daniel Griffin mentioned this on the most recent TWiV. I'm planning a monster RSV vax post in August, I'll have to trim it down, but the Moderna RSV results were indeed discouraging. I don't think this was head to head against the Pfizer/GSK RSV vaccines so not fair to compare, but...
Was it just the RSV vaccine efficacy against infection that waned faster than we would like, or did the durability against severe disease/hospitalization etc drop off, too? No need to answer, will read this study soon.
All these respiratory diseases with short incubation periods make eradication impossible, unlike long incubation period viruses. Learned/confirmed that from Paul Offit!
And the Harvard immunodeficiency unmasked immunologist?!?! Please be a soldier for your patients, man, and they shouldn't have to explain themselves even for a second!
I was thinking of confronting him, but I just let there be a nice long pause…
My wonderful PCP is infectious disease boarded and during my physical— both of us masked— she said “ isn’t it nice to have less respiratory infections?” They all staff their in house urgent care in rotation.
Isn't it normal for antibody levels to contract a few months after immunization, just as with infection? This was discussed several times by the virologists and immunologist on microbe.tv/twiv. Or is the mRNA vaccine durability issue with memory immune cells?
Hi Joe - great question and I think the jury is still out. Hospitalization and death rates remain much lower than before vaccines (and infections) so I think both are providing a kind of durable protection from cellular immunity, but you are correct the antibody titers drop off within 3-6 months, and with the short incubation time of SARS CoV2 we don’t stand a chance at eradication. Hopefully the nasal vaccines will keep our respiratory pathway especially in the nose more topped off with antibodies and cellular soldiers where we need them 🤞
I just wrote this huge reply and realized I posted it to the wrong comment. Sorry about that! 🙃
(Here's my original comment in case anyone wanted to read it:
Dr. Daniel Griffin from TWiV has a bunch of videos on the "Paxlovid rebound" phenomenon, which is not actually a thing. Even people who don't take Paxlovid will have this "rebound," because that's just how covid works.
The first phase is when you get infected and the virus is replicating in your body-- you'll feel crummy. Then you'll start to feel better as your body starts to fight it off. But then you'll feel cruddy again in the next phase, which is the inflammatory phase (and you'll sometimes test positive again during this inflammatory phase).
The goal of Paxlovid is to reduce the viral replication in the first phase-- the less virus you have running around in your body, the less inflammation you'll have from it later... this is why you have to take Paxlovid during the first 5 days-- because it doesn't help once the virus is done replicating.
Again: with or without Paxlovid, folks will have these phases. But the news cycle picked up on the whole "Paxlovid didn't instantly cure me and I actually felt cruddy and tested positive a few days later" thing, and now the world thinks "Paxlovid rebound" is some phenomenon caused by the drug. Nope, it's caused by Covid.
With all that said, with these newer variants (and the general public just kinda being tired of worrying about covid), most people don't think to test until they've been feeling cruddy for a few days, at which point taking Paxlovid isn't going to do much since you're probably 5 days into your infection by that point. But when they don't feel better from taking Paxlovid (even though they're taking too late in the game), they blame the drug and say it doesn't work.
(I hope this made sense. Sorry it's all rambling.)
What Jill says below! Totally agree with her astute commentary and referencing Dr. Daniel Griffin who almost always gets it right. That being said, I do think there is a rebound in viral replication for some people, especially older and immunocompromised, with only a 5 day course of Paxlovid. Some folks likely need 10. There is conflicting evidence on this, and I think that is because there is no one-size-fits-all answer. But I would agree that regardless, Paxlovid is the way to go, and fear of "rebound" is not a good reason to withhold prescriptions. This doc should review the resources Jill mentions in her comment. I'm also going to cut and paste a few paragraphs from previous Covidlandia segments I've written, with hyperlinks available in the actual posts (sorry they don't carry over with cut and paste!) :
1/2024 Covidlandia:
Although some studies have found evidence of “Paxlovid rebound,” the overall synthesis of the evidence shows this is not a thing. Since the beginning there has always been the potential for people to feel sick, get better for a couple days, and then get sick symptoms again. The former is caused by viral loads in the body, and the latter is usually caused by immune system cytokines and inflammation. Take home : don’t fear “rebound” when deciding to take medicine for Covid.
2/2024 Covidlandia
Rebound after antivirals? This study says yes.
The CDC has concluded that Paxlovid rebound is not a thing. And yet there are some studies which do contradict this. This recent one, published in Clinical Infectious Diseases, recently found:
Symptomatic rebound occurred in 32% of 130 patients who received nirmatrelvir/ritonavir as compared with 20% of 241 untreated patients
Virologic rebound occurred in 27% of treated vs. 7% of untreated patients
Patients with more severe COVID-19 were more likely to experience rebound.
The average daily number of symptoms was similar in the treated and untreated groups, but the average viral load was lower in treated patients.
One individual study does not change the overall consensus, but in my mind I think Paxlovid rebound is probably a limited thing - but does not in any way change my prescribing habits or recommendations. Rebound or not, antivirals reduce the risk for severe outcomes and the risk for long COVID. Doctors are not using it enough, and patients are not asking for it enough. Maybe a 5-day course is too short.
4/2024 Covidlandia (kind of related)
SARS-CoV-2 can persist in the body for more than a year after infection.
This was from a new study in The Lancet. In the blood of 171 people who had Covid-19, researchers found proteins from the virus in 25% of the participants.
“The fact that every new SARS-CoV-2 infection has the potential to become chronic is perhaps the single most concerning aspect of this virus,” said Polybio president Amy Proal. The study’s authors said SARS-CoV-2 persistence could contribute to long Covid in adults and children.
This is also what I’m talking about with antiviral treatment, staying up to date with vaccines, and never feeling ashamed by choosing your own level of caution.
It’s not just me. In a recent interview NIH Director Monica Bertagnolli, MD confirmed that data shows live SARS-CoV-2 virus can persist in tissues for months or even years. Not just old particles and viral junk, but actual live replicating virus. She also discussed the need for better antiviral medications to stop viral reservoirs in the body to possibly prevent Long Covid. It was noted by Dr. Ruth Crystal that “this was the first time that someone from the government said that there are definitely viral reservoirs of SARS-CoV-2 in the body.”
A Rod Serling moment? "So welcome back to some monthly highlights from a place I call Covidlandia, a forgotten land between black and white, carefree and cautious, pandemic beginning and end." I like it!
I'll have a blurb in the next substack post on Paxlovid on past the 5 days symptom onset study that shows a benefit. Also, a study of 24% reduction of adolescence hospitalization. Keep wondering why the (*%%$) do we keep fighting this battle? Keep subscribing it! ;-)
As for NASEM report on PASC, I've seen some analysis that brought up some points about the the symptoms. I have to admit over 200 symptoms is a bit mind boggling and maybe a bit of an bloat.
Will look forward to your next post, and will try to keep up (my email inbox is 200+ unread and that's no exaggeration). The 200 symptoms is pretty bloated though certainly possible, and my patients would tell me it's absolutely true, so I'm going to stick with them and the experts... while trying to focus on the most common and disabling ones for people.
Had to look up Rod Serling, but yes! Twilight Zone indeed! This whole world of the 2020's is twilight zone crossed with black mirror.
Aww, thanks! That's such a sincere and *human* compliment, I appreciate that so much! I'll give the chatbot the win for the "cool teenager" voice this time ;)
Thank you very much for sharing your experiences and keeping us apprised on data, studies and updates. Even though I wish the news in Covidlandia was better, I admit the cool teenager talk made me laugh out loud :)
Hi Pamela, thanks for stopping by and I know you keep up with the latest from all over, too. So many sources it's hard to winnow it down, I'll try harder next time to write less.
My daughter and I laughed out loud, too, and it was kind of an impulse add to the whole post. glad it helped lighten the mood for you too!
Thanks for the great update, Doc! Those Enro masks (especially face-brace thingy that goes underneath) look pretty cool-- I might pick one up. Didn't have buying a cloth mask on my 2024 bingo card, but I'm singing with a choir next weekend and having some extra face-space could be handy.
Thanks again for the great comment above. I only mask in tight indoor situations, but the whole N95 thing gets to be a bit much even for me. The Enros "worked" recently while doing an insanely packed tour of the Anne Frank House in Amsterdam with bad ventilation and shoulder to shoulder people. Not perfect, but works in a fashion-conscious pinch!
Chiffon silk is electrostatically charged and in combination with cotton is found to have the same filtering efficacy as N95 material! (Link below.) At beginning of pandemic when N95s were unobtainable, we bought a pile of natural silk/organic cotton masks on ETSY. Very comfortable, forms to face and then toss it in the washer/dryer. Another advantage is that carrying a silk mask folded in pocket is more manageable then a N95 that can not be crushed. https://nano-magazine.com/news/2020/4/24/the-best-material-for-homemade-face-masks-may-be-a-combination-of-two-fabrics
Please keep us up to date on Covid, this is sort of the current 'ignored disease de jure' as was smoking, air quality, maybe plastics, etc.
Hi! I’ve never heard of this but I really appreciate the links and idea. Materials seem sound and environmentally friendly… something I do feel quite bad about with other types of disposable masks. The Enro masks are washable so we do that. And I will keep the Covidlandia updates coming! I think the monthly format is about right for now, but when waves or timely advice I will expedite that along with the other sources out there. Totally agree about the potential parallels with other public health “pandemics” you’ve mentioned! We all float on alright.
Thanks once again, Dr. McCormick. Your Trip Advisor for July in Covidlandia makes it look like a place to skip. I appreciate the hyperlinked call-outs; that’s helpful. All I can do is sigh and keep trudging along. Keep well, even through your July plans, and see you on the other side!
See you on the other side indeed, hope we make it through unscathed! And the TripAdvisor analogy is hilarious. Covidlandia gets 1 star for sure, although we are trying to spruce things up with a little humor, thanks for adding yours ;)
Invaluable, as always! I am so glad NYC data is now showing on the CDC site, as it makes comparisons much easier. (My local area is toggling up and down a bit, but basically going up.)
I was particularly interested in the study on masks. I do think it has been solidly proven over time that a legit N95, properly fitted, is far and away the best choice. At the same time, for many of us, it really isn't practical as a daily choice (and for some, like me, the Aura slips off my chin, so subverts the fit). So of course, as a KN95 Powecom user, I was keen to understand what this study adds to the store of knowledge already available. With that preamble, here are my observations/questions:
1) Am I right in reading the study as measuring effectiveness at blocking outward transmission (source control), and not for testing blocking of intake (respiratory control)? If also for respiratory control, I'd be very surprised, so long as the KN95s are worn correctly, that they would perform poorly compared to cloth. I had thought, from Lindsey Marr and others, we'd learned the lesson long ago that cloth masks do not have anything like adequate filtering material for respiratory control compared to N95s and KN95s.
2) Re the KN95s, it is certainly true of the Powecom, eg, that folks do seem to have a lot of trouble getting them to fit tightly. While I see that the study, at one point, notes that some volunteers used their own masks "if study personnel judged them to be well-fitted," there's a big caveat in the closing sentence below:
"Most surgical masks, KN95 respirators, and all the N95 respirators used in the study were provided by our research team, while some volunteers used their own masks if study personnel judged them to be well-fitted. Volunteers who were provided with respirators having a nose wire were instructed to pinch it to fit their nose. Those wearing N95 respirators were instructed to place one strap around their neck and another over the top of their head. No other respiratory protection training was provided."
From my own anecdotal experience, pinching an N95 Powecom to one's nose is not sufficient to assure it fits as tightly as it can. For one, the crease really needs to be worked repeatedly to get a tight fit to the nose. Indeed, in observing others wearing Powecoms (and there are lots around), I see that almost all who wear them have a gap above the nose. This leads me to wonder whether this contributed to the results showing them underperforming the cloth masks.
Hi Susan, good commentary here, and anytime you reference Lindsey Marr you are on the right track! With vaccines, boosters, etc I do believe and studies support that "viral dose" matters in terms of converting to an infection, so perfection with masks shouldn't be the enemy of good. So if you choose to mask in a tight situation it really does depend on all the factors like ventilation, time spent next to the guy with Covid sitting on the plane, etc. with N95's holding up the best and being more important with taking care of Covid patients, etc. I wouldn't dare wear a surgical to see sick people. And this study WAS source control/outward detection so we cannot totally assume it is the same for inhalation (as the masks are pulled inwards to create a better seal with inhalation/negative pressure, right?)
I am going to check out the Powecom KN95s as I have never found a KN that fits my face well.
Will check back later to make sure I've answered your questions, going to run home now it's been a typical Monday ;)
You truly are the bestest, really above and beyond the call of duty! I hadn’t thought of the inhalation aspect, and it makes so much sense! No obligation, please know, but if you should try out a Powecom, I would love to know whether it fits for you (or not). PS: I think I mentioned I visited my almost 96-year old Mom in San Diego recently. I am relieved to report my Powecom seems to have done its job. For your amusement, I thought to bring my aranet, but felt too self-conscious. Silly me, as I am really curious what the readings would have been both in the airport and on the plane (which was very full).
I keep forgetting to bring my aranet toy to places just for more information but I’ll do that more :) It’s a great instrument for home ventilation as you know, and sometimes our CO2 levels hit 1200 with AC on and gas stove 😖
Glad you will check out the Powecom KN95s. Love to hear your reaction. And appreciate, Susan, your comment about how to get the top to pinch tighter. lts been a problem for me for a long time.
This just came into my inbox, so I thought I’d give a little shoutout to the Village Apothecary, which is also validating what Dr. McCormick has written here about the current Covid numbers. The Apothecary head pharmacist writes:
We're the Hudson Valley's Best!
First, a big thanks to you all for voting for us in Chronogram's 5th Annual Chronogrammies.
Village Apothecary won for Pharmacy. I won for Public Health Advocate/Activist! What an honor for me and the team!!!!
I appreciate how you all feel and I will keep up the good work to be deserving of this recognition...
...like keeping you updated on vaccines :)
Your Summer Update - COVID Surge!
If you're even half paying attention, I hope you've seen that COVID is surging once again.
This should not be a surprise to anyone; nearly every June/July since this thing started we've seen a run up of infections as the Omicron strains keep mutating.
We expect a small reprieve at the end of August, followed by the beginning of our big fall surge.
Here's your vaccine update to get you oriented to the current situation and prep you for the fall [there is lots more, but this gives the idea—this little independent pharmacy in Woodstock, NY, was a savior for a lot of us, particularly when vaccines were scarce—they did community outpost vaxing, as well as onsite, and he, like Dr. McCormick and Dr. Jetelina, work hard on public-facing communications].
I hope you don't mind, but I posted the link to this post on Facebook.
Thanks Jerry, by all means! I stand by the stuff I write and try to build it on a foundation of good references, so for anyone who is still playing the game - the more the merrier :)
I sure wish we had head to head trials of mRNA vaccines vs novavax: the Moderna RSV vaccine has dismal protection after a few months and I’d like to know if waning immunity is due to the platform— some extremely important decisions are looming for the fall, and which COVID vaccine to get is one of them.
Thank you so much for this update! As someone who has been very very careful, I’ve loosened up and there is a strong urge to throw caution to the wind and be like everyone else. But, realistically, I’m at higher risk and don’t want to be sick.
Recent bizarre moment: I’m masked in my Harvard hospital primary immunodeficiency clinic, explaining to the unmasked immunologist that I mask in medical facilities and public transportation as he says “good plan.” Crazy right? All the patients are immune compromised…
Hi Jan - totally agree with all of your points (as usual!).
I'm watching the evolving mRNA platform durability question, too. Daniel Griffin mentioned this on the most recent TWiV. I'm planning a monster RSV vax post in August, I'll have to trim it down, but the Moderna RSV results were indeed discouraging. I don't think this was head to head against the Pfizer/GSK RSV vaccines so not fair to compare, but...
Was it just the RSV vaccine efficacy against infection that waned faster than we would like, or did the durability against severe disease/hospitalization etc drop off, too? No need to answer, will read this study soon.
All these respiratory diseases with short incubation periods make eradication impossible, unlike long incubation period viruses. Learned/confirmed that from Paul Offit!
And the Harvard immunodeficiency unmasked immunologist?!?! Please be a soldier for your patients, man, and they shouldn't have to explain themselves even for a second!
I was thinking of confronting him, but I just let there be a nice long pause…
My wonderful PCP is infectious disease boarded and during my physical— both of us masked— she said “ isn’t it nice to have less respiratory infections?” They all staff their in house urgent care in rotation.
Isn't it normal for antibody levels to contract a few months after immunization, just as with infection? This was discussed several times by the virologists and immunologist on microbe.tv/twiv. Or is the mRNA vaccine durability issue with memory immune cells?
Hi Joe - great question and I think the jury is still out. Hospitalization and death rates remain much lower than before vaccines (and infections) so I think both are providing a kind of durable protection from cellular immunity, but you are correct the antibody titers drop off within 3-6 months, and with the short incubation time of SARS CoV2 we don’t stand a chance at eradication. Hopefully the nasal vaccines will keep our respiratory pathway especially in the nose more topped off with antibodies and cellular soldiers where we need them 🤞
Thanks for keeping us all updated on Covid. My PCP cautioned against the use of Paxlovid due to an increase in reoccurring infections as high as 20%.
Do you have any thoughts about this?
Also, are there any studies regarding increased inflammation in a joint replacement after a Covid infection?
Thanks .
I just wrote this huge reply and realized I posted it to the wrong comment. Sorry about that! 🙃
(Here's my original comment in case anyone wanted to read it:
Dr. Daniel Griffin from TWiV has a bunch of videos on the "Paxlovid rebound" phenomenon, which is not actually a thing. Even people who don't take Paxlovid will have this "rebound," because that's just how covid works.
The first phase is when you get infected and the virus is replicating in your body-- you'll feel crummy. Then you'll start to feel better as your body starts to fight it off. But then you'll feel cruddy again in the next phase, which is the inflammatory phase (and you'll sometimes test positive again during this inflammatory phase).
The goal of Paxlovid is to reduce the viral replication in the first phase-- the less virus you have running around in your body, the less inflammation you'll have from it later... this is why you have to take Paxlovid during the first 5 days-- because it doesn't help once the virus is done replicating.
Again: with or without Paxlovid, folks will have these phases. But the news cycle picked up on the whole "Paxlovid didn't instantly cure me and I actually felt cruddy and tested positive a few days later" thing, and now the world thinks "Paxlovid rebound" is some phenomenon caused by the drug. Nope, it's caused by Covid.
With all that said, with these newer variants (and the general public just kinda being tired of worrying about covid), most people don't think to test until they've been feeling cruddy for a few days, at which point taking Paxlovid isn't going to do much since you're probably 5 days into your infection by that point. But when they don't feel better from taking Paxlovid (even though they're taking too late in the game), they blame the drug and say it doesn't work.
(I hope this made sense. Sorry it's all rambling.)
This is a really helpful explainer of Covid rebound vs. “Paxlovid rebound”. Thanks so much!
Awesome, thank you. Added to this with comment above, and not rambling at all!
What Jill says below! Totally agree with her astute commentary and referencing Dr. Daniel Griffin who almost always gets it right. That being said, I do think there is a rebound in viral replication for some people, especially older and immunocompromised, with only a 5 day course of Paxlovid. Some folks likely need 10. There is conflicting evidence on this, and I think that is because there is no one-size-fits-all answer. But I would agree that regardless, Paxlovid is the way to go, and fear of "rebound" is not a good reason to withhold prescriptions. This doc should review the resources Jill mentions in her comment. I'm also going to cut and paste a few paragraphs from previous Covidlandia segments I've written, with hyperlinks available in the actual posts (sorry they don't carry over with cut and paste!) :
1/2024 Covidlandia:
Although some studies have found evidence of “Paxlovid rebound,” the overall synthesis of the evidence shows this is not a thing. Since the beginning there has always been the potential for people to feel sick, get better for a couple days, and then get sick symptoms again. The former is caused by viral loads in the body, and the latter is usually caused by immune system cytokines and inflammation. Take home : don’t fear “rebound” when deciding to take medicine for Covid.
2/2024 Covidlandia
Rebound after antivirals? This study says yes.
The CDC has concluded that Paxlovid rebound is not a thing. And yet there are some studies which do contradict this. This recent one, published in Clinical Infectious Diseases, recently found:
Symptomatic rebound occurred in 32% of 130 patients who received nirmatrelvir/ritonavir as compared with 20% of 241 untreated patients
Virologic rebound occurred in 27% of treated vs. 7% of untreated patients
Patients with more severe COVID-19 were more likely to experience rebound.
The average daily number of symptoms was similar in the treated and untreated groups, but the average viral load was lower in treated patients.
One individual study does not change the overall consensus, but in my mind I think Paxlovid rebound is probably a limited thing - but does not in any way change my prescribing habits or recommendations. Rebound or not, antivirals reduce the risk for severe outcomes and the risk for long COVID. Doctors are not using it enough, and patients are not asking for it enough. Maybe a 5-day course is too short.
4/2024 Covidlandia (kind of related)
SARS-CoV-2 can persist in the body for more than a year after infection.
This was from a new study in The Lancet. In the blood of 171 people who had Covid-19, researchers found proteins from the virus in 25% of the participants.
“The fact that every new SARS-CoV-2 infection has the potential to become chronic is perhaps the single most concerning aspect of this virus,” said Polybio president Amy Proal. The study’s authors said SARS-CoV-2 persistence could contribute to long Covid in adults and children.
This is also what I’m talking about with antiviral treatment, staying up to date with vaccines, and never feeling ashamed by choosing your own level of caution.
It’s not just me. In a recent interview NIH Director Monica Bertagnolli, MD confirmed that data shows live SARS-CoV-2 virus can persist in tissues for months or even years. Not just old particles and viral junk, but actual live replicating virus. She also discussed the need for better antiviral medications to stop viral reservoirs in the body to possibly prevent Long Covid. It was noted by Dr. Ruth Crystal that “this was the first time that someone from the government said that there are definitely viral reservoirs of SARS-CoV-2 in the body.”
A Rod Serling moment? "So welcome back to some monthly highlights from a place I call Covidlandia, a forgotten land between black and white, carefree and cautious, pandemic beginning and end." I like it!
I'll have a blurb in the next substack post on Paxlovid on past the 5 days symptom onset study that shows a benefit. Also, a study of 24% reduction of adolescence hospitalization. Keep wondering why the (*%%$) do we keep fighting this battle? Keep subscribing it! ;-)
As for NASEM report on PASC, I've seen some analysis that brought up some points about the the symptoms. I have to admit over 200 symptoms is a bit mind boggling and maybe a bit of an bloat.
Will look forward to your next post, and will try to keep up (my email inbox is 200+ unread and that's no exaggeration). The 200 symptoms is pretty bloated though certainly possible, and my patients would tell me it's absolutely true, so I'm going to stick with them and the experts... while trying to focus on the most common and disabling ones for people.
Had to look up Rod Serling, but yes! Twilight Zone indeed! This whole world of the 2020's is twilight zone crossed with black mirror.
Dr. McCormick, you're a much better writer than any chatbot. Thanks for all the current info from Covidlandia.
Lynda R.
Aww, thanks! That's such a sincere and *human* compliment, I appreciate that so much! I'll give the chatbot the win for the "cool teenager" voice this time ;)
Thank you very much for sharing your experiences and keeping us apprised on data, studies and updates. Even though I wish the news in Covidlandia was better, I admit the cool teenager talk made me laugh out loud :)
Hi Pamela, thanks for stopping by and I know you keep up with the latest from all over, too. So many sources it's hard to winnow it down, I'll try harder next time to write less.
My daughter and I laughed out loud, too, and it was kind of an impulse add to the whole post. glad it helped lighten the mood for you too!
Thanks for the great update, Doc! Those Enro masks (especially face-brace thingy that goes underneath) look pretty cool-- I might pick one up. Didn't have buying a cloth mask on my 2024 bingo card, but I'm singing with a choir next weekend and having some extra face-space could be handy.
Have a good week!
Thanks again for the great comment above. I only mask in tight indoor situations, but the whole N95 thing gets to be a bit much even for me. The Enros "worked" recently while doing an insanely packed tour of the Anne Frank House in Amsterdam with bad ventilation and shoulder to shoulder people. Not perfect, but works in a fashion-conscious pinch!
Ryan and Jill,
Chiffon silk is electrostatically charged and in combination with cotton is found to have the same filtering efficacy as N95 material! (Link below.) At beginning of pandemic when N95s were unobtainable, we bought a pile of natural silk/organic cotton masks on ETSY. Very comfortable, forms to face and then toss it in the washer/dryer. Another advantage is that carrying a silk mask folded in pocket is more manageable then a N95 that can not be crushed. https://nano-magazine.com/news/2020/4/24/the-best-material-for-homemade-face-masks-may-be-a-combination-of-two-fabrics
Please keep us up to date on Covid, this is sort of the current 'ignored disease de jure' as was smoking, air quality, maybe plastics, etc.
Hi! I’ve never heard of this but I really appreciate the links and idea. Materials seem sound and environmentally friendly… something I do feel quite bad about with other types of disposable masks. The Enro masks are washable so we do that. And I will keep the Covidlandia updates coming! I think the monthly format is about right for now, but when waves or timely advice I will expedite that along with the other sources out there. Totally agree about the potential parallels with other public health “pandemics” you’ve mentioned! We all float on alright.
That cool teen summary cracked me up! Laughter is the best medicine, right😆?
It really is! In a post a long time ago about elderly patients, the secret to longevity success one of them told me was:
86 y.o. man. “My wife and I have always made each other laugh. She cracks me up, and I do the same with her.”
https://mccormickmd.substack.com/p/giving-thanks-for-longevity
Thanks once again, Dr. McCormick. Your Trip Advisor for July in Covidlandia makes it look like a place to skip. I appreciate the hyperlinked call-outs; that’s helpful. All I can do is sigh and keep trudging along. Keep well, even through your July plans, and see you on the other side!
See you on the other side indeed, hope we make it through unscathed! And the TripAdvisor analogy is hilarious. Covidlandia gets 1 star for sure, although we are trying to spruce things up with a little humor, thanks for adding yours ;)
Invaluable, as always! I am so glad NYC data is now showing on the CDC site, as it makes comparisons much easier. (My local area is toggling up and down a bit, but basically going up.)
I was particularly interested in the study on masks. I do think it has been solidly proven over time that a legit N95, properly fitted, is far and away the best choice. At the same time, for many of us, it really isn't practical as a daily choice (and for some, like me, the Aura slips off my chin, so subverts the fit). So of course, as a KN95 Powecom user, I was keen to understand what this study adds to the store of knowledge already available. With that preamble, here are my observations/questions:
1) Am I right in reading the study as measuring effectiveness at blocking outward transmission (source control), and not for testing blocking of intake (respiratory control)? If also for respiratory control, I'd be very surprised, so long as the KN95s are worn correctly, that they would perform poorly compared to cloth. I had thought, from Lindsey Marr and others, we'd learned the lesson long ago that cloth masks do not have anything like adequate filtering material for respiratory control compared to N95s and KN95s.
2) Re the KN95s, it is certainly true of the Powecom, eg, that folks do seem to have a lot of trouble getting them to fit tightly. While I see that the study, at one point, notes that some volunteers used their own masks "if study personnel judged them to be well-fitted," there's a big caveat in the closing sentence below:
"Most surgical masks, KN95 respirators, and all the N95 respirators used in the study were provided by our research team, while some volunteers used their own masks if study personnel judged them to be well-fitted. Volunteers who were provided with respirators having a nose wire were instructed to pinch it to fit their nose. Those wearing N95 respirators were instructed to place one strap around their neck and another over the top of their head. No other respiratory protection training was provided."
From my own anecdotal experience, pinching an N95 Powecom to one's nose is not sufficient to assure it fits as tightly as it can. For one, the crease really needs to be worked repeatedly to get a tight fit to the nose. Indeed, in observing others wearing Powecoms (and there are lots around), I see that almost all who wear them have a gap above the nose. This leads me to wonder whether this contributed to the results showing them underperforming the cloth masks.
Hi Susan, good commentary here, and anytime you reference Lindsey Marr you are on the right track! With vaccines, boosters, etc I do believe and studies support that "viral dose" matters in terms of converting to an infection, so perfection with masks shouldn't be the enemy of good. So if you choose to mask in a tight situation it really does depend on all the factors like ventilation, time spent next to the guy with Covid sitting on the plane, etc. with N95's holding up the best and being more important with taking care of Covid patients, etc. I wouldn't dare wear a surgical to see sick people. And this study WAS source control/outward detection so we cannot totally assume it is the same for inhalation (as the masks are pulled inwards to create a better seal with inhalation/negative pressure, right?)
I am going to check out the Powecom KN95s as I have never found a KN that fits my face well.
Will check back later to make sure I've answered your questions, going to run home now it's been a typical Monday ;)
Love to see that NYC data up there!
You truly are the bestest, really above and beyond the call of duty! I hadn’t thought of the inhalation aspect, and it makes so much sense! No obligation, please know, but if you should try out a Powecom, I would love to know whether it fits for you (or not). PS: I think I mentioned I visited my almost 96-year old Mom in San Diego recently. I am relieved to report my Powecom seems to have done its job. For your amusement, I thought to bring my aranet, but felt too self-conscious. Silly me, as I am really curious what the readings would have been both in the airport and on the plane (which was very full).
I keep forgetting to bring my aranet toy to places just for more information but I’ll do that more :) It’s a great instrument for home ventilation as you know, and sometimes our CO2 levels hit 1200 with AC on and gas stove 😖
You’re too kind!
I buy the powecom from Bonafide Masks and they fit and work well for me
https://bonafidemasks.com/
Glad you will check out the Powecom KN95s. Love to hear your reaction. And appreciate, Susan, your comment about how to get the top to pinch tighter. lts been a problem for me for a long time.
This just came into my inbox, so I thought I’d give a little shoutout to the Village Apothecary, which is also validating what Dr. McCormick has written here about the current Covid numbers. The Apothecary head pharmacist writes:
We're the Hudson Valley's Best!
First, a big thanks to you all for voting for us in Chronogram's 5th Annual Chronogrammies.
Village Apothecary won for Pharmacy. I won for Public Health Advocate/Activist! What an honor for me and the team!!!!
I appreciate how you all feel and I will keep up the good work to be deserving of this recognition...
...like keeping you updated on vaccines :)
Your Summer Update - COVID Surge!
If you're even half paying attention, I hope you've seen that COVID is surging once again.
This should not be a surprise to anyone; nearly every June/July since this thing started we've seen a run up of infections as the Omicron strains keep mutating.
We expect a small reprieve at the end of August, followed by the beginning of our big fall surge.
Here's your vaccine update to get you oriented to the current situation and prep you for the fall [there is lots more, but this gives the idea—this little independent pharmacy in Woodstock, NY, was a savior for a lot of us, particularly when vaccines were scarce—they did community outpost vaxing, as well as onsite, and he, like Dr. McCormick and Dr. Jetelina, work hard on public-facing communications].