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.
Thanks, good information. I'm torn about this fall's vaccine. Last year I got mine 10/3/23 then picked up Covid from a mildly symptomatic family member Christmas eve. My husband, vaccinated a month later, did not get infected. We also plan a big international trip end of January. Not sure if I can get it now and again in 3 mos. Scheduled flu shot tomorrow as I am likely to deploy with the Red Cross Disaster Health Services to Helene relief within the week. Flu shots now seemed to protect me the entire season when in practice, even before we were taking any mask precautions in rooms. Do plan to take N95's to use in shelters which are likely to be high risk situations.
The timing is really tricky! But most of all, I wanted to write a note to thank you so much for your work to help the folks devastated by Helene. Good luck and may all go well!
Good point! I’m An NP working in a health department in W-S. Most likely will be deployed west soon. I’ll need to get both flu & Covid vaccines before then.
Hi Cameron - it really is a game of probabilities to juggle, and there is no "right answer" for timing like you've said and experienced.
As you probably know I'm a big fan of N95's on planes, especially long flights to cool places. They have not failed me yet. I especially prefer not to get Covid in other countries, so I try to mask up more in museums, taxis, trains, etc. Outdoor restaurants might be tricky depending on your destination in January! I also take Paxlovid with me.
Thank you for helping with the Red Cross disaster health service. I should volunteer for something like that when I have less responsibilities than this phase of life. Best of luck, it's going to be pretty shocking at times I would imagine, and your service is greatly respected.
Thank you for this. I consider my body to be a living scorecard where the effects of a lifetime of infections of various kinds are recorded. Given that the effects of Covid are writ large there and that those effects accumulate and compound over time, I am Covid aversive and wear a mask. If I end up as an 80 year old criminal arrested in the state of Florida for a mask violation, so be it. I can't wait to talk to the judge.
Manuiwa, please send me a direct message if you are arrested in Florida and I will do my best to raise a righteous army! Or write a medical letter of justification for your masking!
I used to think that building up a library of infectious exposures during my life and career would serve me well as I got older... but now I'm more along your lines of thinking, with cumulative wear and tear from each infection more likely than benefit, and accelerated "immunosenesence" possible with infections like Covid. I've always had a healthy respect for flu, and always masked in the office for the past 20 years when I suspected I was seeing someone with influenza in season. Best of luck and health ;)
Thank you--this serves as a wonderful reality check as it's so easy to assume there is no Covid based on lack of masks and yet the wastewater and good modelers show that we came off a very high wave, to a relative high baseline and are likely to see another wave in December.
I also try and balance social acceptance/living life/reasonable precautions--quite the balancing act and your writing is so helpful.
I read the Edward Niremburg deep dives on Novavax and the promise of a nasal vaccine: https://deplatformdisease.substack.com --summary=Novavax is fine but not worthy of the worship it's gathered in some corners, and the nasal vaccine only induces IgA and will need frequent reboosting but may prevent infections more than the longer lasting intramuscular vaccines.
My daughter lives in Asheville and is currently in Charlotte as it's unclear when there will be water/food/gas there. It's Katrina for North Carolina. Terrifying.
Well, my sisters live in Western North Carolina and it was a bit concerning that I couldn't reach them since everything was down. Thankfully, they are OK for now. Sigh of relief there...
Posted recently that IgA was associated with faster viral clearance and symptom resolutions than IgG. Still, intranasal needs more work.
Hi Jan - I'm so sorry to hear that your daughter is caught up in the devastation around Asheville. We had planned to go there this summer actually and changed plans last minute, so I am really sad that a city of such wonderful reputation, people, and culture has been so thoroughly damaged. It sounds like she is OK, which is a consolation.
I know we are on the same wavelength about all things Covid, and I think your quick summaries of Ed's articles are spot on. He has some major skills for the immunological deep dives.
Wishing you and yours strength, resilience, and some good hugs and cries.
The amount of suffering and unmet needs in western North Carolina right now is staggering--our daughter wisely left relatively quickly when it was apparent that the lack of water/food/gas/power wasn't going to be fixed quickly. Many of her friends have left as well but they're refuges at the moment, and their community is devastated --not hyperbole. The trauma for the people in the states impacted by Helene, and especially the Asheville area can't be overstated.
Thanks for the good wishes--and hugs and cries are in order.
Yet another treasure trove of information from you, Ryan. Thank you so very much! I particularly appreciated your note on high-risk indoor spaces. In health care settings, particularly, it is frustrating to observe the lack of progress on ventilation, including, as a minimum step, having CO2 monitors available in the kinds of spaces you outline.
Your discussion of masks and politics is interesting and timely. Even without bans, so few people mask that it can feel awkward to wear one (though I never let that stop me). It’s also interesting to be in a location, as at my local PT site, where none of the staff wear masks. When, once in a great while someone does, I can’t help but wonder whether they may have Covid or another virus!
As an aside, related to our earlier exchange on the electronic medical record/AI, I ran across an article on that topic I found fascinating. Just as you indicated, the medical record seems to be there primarily for billing, not patient care. On reading this, I decided to join you from the patient side and forego filling out any of the huge, repetitive multiple choice surveys I keep getting before each patient visit—that is, if Epic will let me! These demands on health care professionals are so counterproductive for patient care. What a mess!
Hey Susan, I wonder the same thing even as I wear a mask in the office! It's jarring to me since so few people wear masks in our office. We require "sick" folks to do that, but some people (readers of my substack perhaps!) still come in when healthy wearing a mask. Definitely sick people in the waiting rooms, often unmasked until we ask them to.
Will look forward to reading that article, thank you! I really do wish the EMR's had been set up by people with a respect for patient narratives, intuitive flows, minimal clicks, and seamless screens. Instead they are festooned with checkboxes, templates, and sprawl a narrative across no less than 50 screens during some visits as I track down data and stitch together a story in my head.
Always glad to hear of your curiosity and insight, and many a patient complains to me of the ridiculous amount of pre-visit stuff!
One point about masking is this is not new as the history of a past pandemic (1918 Flu Pandemic) also had its anti-maskers. You know I am a history buff of diseases and see a lot of pandemic history repeating itself. https://www.history.com/news/1918-spanish-flu-mask-wearing-resistance
Wow. There really is nothing new under the sun. I will read this article later, thank you so much. Have you listened to Rachel Maddow's "Ultra" podcast? So interesting how many 1950's post WWII pro-fascism American stories are repeating themselves in the US right now
I'm a history buff as well and when this pandemic swamped the world like a giant tsunami I collected all the books on past pandemics I could (about 15)- even the English sleeping sickness- a truly frightening disease. I agree that the there are many similarities in the two great pandemics of recent times. That "let's get back to normal" impulse has always been very strong. Our response to Covid differs in the extreme politicization and attacks on "medical tyranny"- deep indicators of the increasing politicization of our society.
I never heard it called English Sleeping Sickness, just sleeping sickness which the etiology is still unknown. Encephalitis lethargica may be related to the H1N1 of 1918-19 period. This is still a highly debated subject. Think I might include a bit on it in next post.
You're completely correct and I misnamed it. It popped up in northern Europe and was not the modern disease of that name. It showed up in the Tudor times, was incredibly lethal and had a very high lethality. It was commonly called "the English swett". I think it disappeared completely after a few waves, had an indiscriminate list of social classes from laborers to aristocrats, so there is speculation on the transmission mechanism.
Notable was how quickly it acted: one could retire for the night seemingly healthy but be dead by morning. In the PBS TV series, Wolf Hall, Thomas Cromwell, lost both his wife and daughter to it, which suggests to me it was human to human airborne transmission.
That's a 'horse of a different color' indeed. Well, we could talk about the 249 pandemics in recorded times but for this one, I think a decent case could be made for the Hantavirus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917436/
Many thanks for this newest Covidlandia post. The mask banning is something that should alarm us all, whether we choose to wear them or not.
"…this 'overbroad and vague' bill 'also gives law enforcement the ability to target people based on their political beliefs.'"
Protecting one's own life should not depend on someone else's opinion or an arbitrary law on how you should or should not do it...or do anything. We are on a dangerous path to losing even more of our freedoms, and the freedom over our own bodies should be sacrosanct.
Hi Mim - you could flesh this comment out a bit more and it would be a great presidential campaign speech.
It's unconscionable that protecting one's life and health should be on the table for political and ideological attacks, agreed.
The painting and poem were done by my daughter for a school project... but she let me use this illustration to make this series more genuine (and fun for me!) She gets a little extra allowance too :)
Excellent Covidlandia post as usual, Doc. I continue to be disturbed by the intentional infection study. Knowing what we know about long COVID, and also what we DON’T know about why some people are more susceptible to it, it feels extraordinarily unethical from a research standpoint.
Headed to a reunion this weekend; will be masking but also trying your neosporin up the nose hack. I did it last weekend for a birthday dinner in a restaurant. I masked for most of the dinner but obviously had to be unmasked to eat. So far, so good.
Hi Amy - thanks for reading and I share your concern about that intentional infection study, especially before vaccination. One of those interesting findings built upon a shaky ethical foundation. Ugh.
Hope the reunion goes well! I've only tried the Neosporin trick once or twice before big events like that. I didn't get sick either, despite >200 people crowded together in surge time frame, so who knows. I'm concerned that if I do that too much I'll create some inflammation, promote resistance, play with the local microbiome, etc. But for huge "special occasions" I'm not above the pregame 1-2 days before hand as Dr. Akiko Iwasaki showed...
Thanks as always. I was on the phone with a 70 year old friend (first known infection) who hates the Paxlovid mouth. I tried to convince him to hold on. What are your thoughts (this month) about Pax? And I have seen so MUCH Covid over the past 2 weeks! Yikes!
As a long Covid sufferer I can attest to the fact that it is absolutely devastating. I'm on year five and my system is still showing the damage. Masking up is excellent advice, but i fear the social pressure inhibits what would otherwise be an act of common sense. I'm in Yellowstone right now and some people are wearing masks but they are mostly Asians..
Hi Jerry - I personally like the 3M Aura mask. I’ve been professionally “fit tested” by our hospital and this confirms the excellent seal. I find them pretty breathable but after an 8 hour flight your face can be pretty indented! But as far as efficacy on planes they are at least 12 for 12 no infections for me, including some pretty bad delays where the ventilation was palpably nonexistent! Best of luck, hope it’s a good trip.
In general, good seal (minimal fogging of your glasses) is probably the most important thing, as well as enough comfort to sustain the wearing. I stretch the headbands to make less tight for my big old head.
Thank you for all this work! I find your summaries so helpful.
Thanks, good information. I'm torn about this fall's vaccine. Last year I got mine 10/3/23 then picked up Covid from a mildly symptomatic family member Christmas eve. My husband, vaccinated a month later, did not get infected. We also plan a big international trip end of January. Not sure if I can get it now and again in 3 mos. Scheduled flu shot tomorrow as I am likely to deploy with the Red Cross Disaster Health Services to Helene relief within the week. Flu shots now seemed to protect me the entire season when in practice, even before we were taking any mask precautions in rooms. Do plan to take N95's to use in shelters which are likely to be high risk situations.
The timing is really tricky! But most of all, I wanted to write a note to thank you so much for your work to help the folks devastated by Helene. Good luck and may all go well!
Good point! I’m An NP working in a health department in W-S. Most likely will be deployed west soon. I’ll need to get both flu & Covid vaccines before then.
Good luck and thanks!
First thing, thanks for helping with those affected by Helene.
I posted a few times about the continuous dangers from Infectious Diseases in the aftermath of a disaster, so please be careful.
Hi Cameron - it really is a game of probabilities to juggle, and there is no "right answer" for timing like you've said and experienced.
As you probably know I'm a big fan of N95's on planes, especially long flights to cool places. They have not failed me yet. I especially prefer not to get Covid in other countries, so I try to mask up more in museums, taxis, trains, etc. Outdoor restaurants might be tricky depending on your destination in January! I also take Paxlovid with me.
Thank you for helping with the Red Cross disaster health service. I should volunteer for something like that when I have less responsibilities than this phase of life. Best of luck, it's going to be pretty shocking at times I would imagine, and your service is greatly respected.
Thank you for this. I consider my body to be a living scorecard where the effects of a lifetime of infections of various kinds are recorded. Given that the effects of Covid are writ large there and that those effects accumulate and compound over time, I am Covid aversive and wear a mask. If I end up as an 80 year old criminal arrested in the state of Florida for a mask violation, so be it. I can't wait to talk to the judge.
Manuiwa, please send me a direct message if you are arrested in Florida and I will do my best to raise a righteous army! Or write a medical letter of justification for your masking!
I used to think that building up a library of infectious exposures during my life and career would serve me well as I got older... but now I'm more along your lines of thinking, with cumulative wear and tear from each infection more likely than benefit, and accelerated "immunosenesence" possible with infections like Covid. I've always had a healthy respect for flu, and always masked in the office for the past 20 years when I suspected I was seeing someone with influenza in season. Best of luck and health ;)
As always, Ryan, very informative.
Thanks Arthur, sorry it was such a long read... and I cut out 5 more studies at 2AM because they were not as relevant, and I got tired!
Thank you--this serves as a wonderful reality check as it's so easy to assume there is no Covid based on lack of masks and yet the wastewater and good modelers show that we came off a very high wave, to a relative high baseline and are likely to see another wave in December.
I also try and balance social acceptance/living life/reasonable precautions--quite the balancing act and your writing is so helpful.
I read the Edward Niremburg deep dives on Novavax and the promise of a nasal vaccine: https://deplatformdisease.substack.com --summary=Novavax is fine but not worthy of the worship it's gathered in some corners, and the nasal vaccine only induces IgA and will need frequent reboosting but may prevent infections more than the longer lasting intramuscular vaccines.
My daughter lives in Asheville and is currently in Charlotte as it's unclear when there will be water/food/gas there. It's Katrina for North Carolina. Terrifying.
Well, my sisters live in Western North Carolina and it was a bit concerning that I couldn't reach them since everything was down. Thankfully, they are OK for now. Sigh of relief there...
Posted recently that IgA was associated with faster viral clearance and symptom resolutions than IgG. Still, intranasal needs more work.
My daughter updated her phone and used satellite texting but it was sporadic. I’m glad your sisters are safe.The devastation is incomprehensible.
Agree with you about the nasal vaccines.
KB so glad your sisters are OK. That loss of communication in crises is terrifying. Experienced that on 9/11/01 in Philly.
I'll take the IgA and an extra serving of IgG please.
Hi Jan - I'm so sorry to hear that your daughter is caught up in the devastation around Asheville. We had planned to go there this summer actually and changed plans last minute, so I am really sad that a city of such wonderful reputation, people, and culture has been so thoroughly damaged. It sounds like she is OK, which is a consolation.
I know we are on the same wavelength about all things Covid, and I think your quick summaries of Ed's articles are spot on. He has some major skills for the immunological deep dives.
Wishing you and yours strength, resilience, and some good hugs and cries.
The amount of suffering and unmet needs in western North Carolina right now is staggering--our daughter wisely left relatively quickly when it was apparent that the lack of water/food/gas/power wasn't going to be fixed quickly. Many of her friends have left as well but they're refuges at the moment, and their community is devastated --not hyperbole. The trauma for the people in the states impacted by Helene, and especially the Asheville area can't be overstated.
Thanks for the good wishes--and hugs and cries are in order.
Yet another treasure trove of information from you, Ryan. Thank you so very much! I particularly appreciated your note on high-risk indoor spaces. In health care settings, particularly, it is frustrating to observe the lack of progress on ventilation, including, as a minimum step, having CO2 monitors available in the kinds of spaces you outline.
Your discussion of masks and politics is interesting and timely. Even without bans, so few people mask that it can feel awkward to wear one (though I never let that stop me). It’s also interesting to be in a location, as at my local PT site, where none of the staff wear masks. When, once in a great while someone does, I can’t help but wonder whether they may have Covid or another virus!
As an aside, related to our earlier exchange on the electronic medical record/AI, I ran across an article on that topic I found fascinating. Just as you indicated, the medical record seems to be there primarily for billing, not patient care. On reading this, I decided to join you from the patient side and forego filling out any of the huge, repetitive multiple choice surveys I keep getting before each patient visit—that is, if Epic will let me! These demands on health care professionals are so counterproductive for patient care. What a mess!
Here’s a link to the article: https://prospect.org/health/2024-10-01-epic-dystopia/?utm_source=ActiveCampaign&utm_medium=email&utm_content=Meyerson%20on%20TAP%3A%20Why%20the%20Longshore%20Workers%20Strike%20Is%20Economically%20Justified&utm_campaign=20241001%20FC%20Meyerson%20on%20TAP
Hey Susan, I wonder the same thing even as I wear a mask in the office! It's jarring to me since so few people wear masks in our office. We require "sick" folks to do that, but some people (readers of my substack perhaps!) still come in when healthy wearing a mask. Definitely sick people in the waiting rooms, often unmasked until we ask them to.
Will look forward to reading that article, thank you! I really do wish the EMR's had been set up by people with a respect for patient narratives, intuitive flows, minimal clicks, and seamless screens. Instead they are festooned with checkboxes, templates, and sprawl a narrative across no less than 50 screens during some visits as I track down data and stitch together a story in my head.
Always glad to hear of your curiosity and insight, and many a patient complains to me of the ridiculous amount of pre-visit stuff!
Well, once again an excellent summary.
One point about masking is this is not new as the history of a past pandemic (1918 Flu Pandemic) also had its anti-maskers. You know I am a history buff of diseases and see a lot of pandemic history repeating itself. https://www.history.com/news/1918-spanish-flu-mask-wearing-resistance
Wow. There really is nothing new under the sun. I will read this article later, thank you so much. Have you listened to Rachel Maddow's "Ultra" podcast? So interesting how many 1950's post WWII pro-fascism American stories are repeating themselves in the US right now
Have not heard her podcast but I might try to squeeze one in.
I'm a history buff as well and when this pandemic swamped the world like a giant tsunami I collected all the books on past pandemics I could (about 15)- even the English sleeping sickness- a truly frightening disease. I agree that the there are many similarities in the two great pandemics of recent times. That "let's get back to normal" impulse has always been very strong. Our response to Covid differs in the extreme politicization and attacks on "medical tyranny"- deep indicators of the increasing politicization of our society.
I never heard it called English Sleeping Sickness, just sleeping sickness which the etiology is still unknown. Encephalitis lethargica may be related to the H1N1 of 1918-19 period. This is still a highly debated subject. Think I might include a bit on it in next post.
Remember to party like it’s 1349!
You're completely correct and I misnamed it. It popped up in northern Europe and was not the modern disease of that name. It showed up in the Tudor times, was incredibly lethal and had a very high lethality. It was commonly called "the English swett". I think it disappeared completely after a few waves, had an indiscriminate list of social classes from laborers to aristocrats, so there is speculation on the transmission mechanism.
Notable was how quickly it acted: one could retire for the night seemingly healthy but be dead by morning. In the PBS TV series, Wolf Hall, Thomas Cromwell, lost both his wife and daughter to it, which suggests to me it was human to human airborne transmission.
That's a 'horse of a different color' indeed. Well, we could talk about the 249 pandemics in recorded times but for this one, I think a decent case could be made for the Hantavirus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917436/
In one of my early substack post, I did a cursory overview of pandemic history. https://jkd0811.substack.com/p/the-next-pandemic/comments#comment-44225344
Many thanks for this newest Covidlandia post. The mask banning is something that should alarm us all, whether we choose to wear them or not.
"…this 'overbroad and vague' bill 'also gives law enforcement the ability to target people based on their political beliefs.'"
Protecting one's own life should not depend on someone else's opinion or an arbitrary law on how you should or should not do it...or do anything. We are on a dangerous path to losing even more of our freedoms, and the freedom over our own bodies should be sacrosanct.
--------------------
Is that your poem AND your drawing, Dr. Ryan?
Hi Mim - you could flesh this comment out a bit more and it would be a great presidential campaign speech.
It's unconscionable that protecting one's life and health should be on the table for political and ideological attacks, agreed.
The painting and poem were done by my daughter for a school project... but she let me use this illustration to make this series more genuine (and fun for me!) She gets a little extra allowance too :)
Excellent Covidlandia post as usual, Doc. I continue to be disturbed by the intentional infection study. Knowing what we know about long COVID, and also what we DON’T know about why some people are more susceptible to it, it feels extraordinarily unethical from a research standpoint.
Headed to a reunion this weekend; will be masking but also trying your neosporin up the nose hack. I did it last weekend for a birthday dinner in a restaurant. I masked for most of the dinner but obviously had to be unmasked to eat. So far, so good.
Hi Amy - thanks for reading and I share your concern about that intentional infection study, especially before vaccination. One of those interesting findings built upon a shaky ethical foundation. Ugh.
Hope the reunion goes well! I've only tried the Neosporin trick once or twice before big events like that. I didn't get sick either, despite >200 people crowded together in surge time frame, so who knows. I'm concerned that if I do that too much I'll create some inflammation, promote resistance, play with the local microbiome, etc. But for huge "special occasions" I'm not above the pregame 1-2 days before hand as Dr. Akiko Iwasaki showed...
Thank you! I thought that too - not to overdo it, but to use it for those large group gatherings. It’s still an antibiotic, after all.
Thanks as always. I was on the phone with a 70 year old friend (first known infection) who hates the Paxlovid mouth. I tried to convince him to hold on. What are your thoughts (this month) about Pax? And I have seen so MUCH Covid over the past 2 weeks! Yikes!
As a long Covid sufferer I can attest to the fact that it is absolutely devastating. I'm on year five and my system is still showing the damage. Masking up is excellent advice, but i fear the social pressure inhibits what would otherwise be an act of common sense. I'm in Yellowstone right now and some people are wearing masks but they are mostly Asians..
Are there specific things to look / watch out for in N95 masks? I have plenty of regular masks, but will be flying soon.
Hi Jerry - I personally like the 3M Aura mask. I’ve been professionally “fit tested” by our hospital and this confirms the excellent seal. I find them pretty breathable but after an 8 hour flight your face can be pretty indented! But as far as efficacy on planes they are at least 12 for 12 no infections for me, including some pretty bad delays where the ventilation was palpably nonexistent! Best of luck, hope it’s a good trip.
In general, good seal (minimal fogging of your glasses) is probably the most important thing, as well as enough comfort to sustain the wearing. I stretch the headbands to make less tight for my big old head.
Sorry, first reply was full of autocorrect misfires!