Mastodawn

Augie Ray Feb 3, 2023

Our Endemic COVID Future Is Probably Not What You Think--Why More Action Is Necessary Now (A long 🧵 ):

Many think we're already “post-COVID.” We're not, but it does beg the question of what the future has in store for us. If we ignore how tired everyone is of #COVID19 and instead explore the latest data and studies, we may see that we've not yet fully understood or adjusted to our COVID future. We've gone back to “old normal” when a “new normal” is necessary.

Augie Ray Feb 3, 2023

WHY WE'RE NOT POST-COVID

No, the pandemic is not over. The World Health Organization says we're still in a pandemic. WHO declared the public health emergency on 30 January 2020 and a pandemic on 11 March 2020, and it's the entity that gets to decide it's over--not you, me, or President Biden. Days ago, WHO held a meeting to discuss COVID, and it determined the pandemic remains a public health emergency of international concern.
https://www.euronews.com/next/2023/01/30/who-to-keep-highest-alert-over-covid-as-public-health-emergency-of-international-concern

WHO keeps highest alert over COVID three years on

Three years after COVID was first called a global health emergency, the World Health Organization (WHO) has decided to keep its highest alert over the disease.

euronews

Augie Ray Feb 3, 2023

Some claim COVID is endemic, but this is not true. It will be endemic, eventually, but it isn't yet. For a disease to be endemic, it must be consistently present and cause a steady, predictable number of people to get sick. This is far from the case with COVID-19 right now. In the last three months, the US has seen two variants become predominant in rapid succession, and these were variants scientists had only just discovered four months earlier. That is not predictable. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

COVID Data Tracker

CDC’s home for COVID-19 data. Visualizations, graphs, and data in one easy-to-use website.

Centers for Disease Control and Prevention

Augie Ray Feb 3, 2023

The US has also had three surges of hospitalizations in the past year. Unlike the flu, which has a predictable annual season, COVID is not yet steady.
https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions

COVID Data Tracker

CDC’s home for COVID-19 data. Visualizations, graphs, and data in one easy-to-use website.

Centers for Disease Control and Prevention

Augie Ray Feb 3, 2023

The US has not had a significant surge in COVID death in a year, although it continues to have a troubling level of COVID fatalities, losing around 3,500 people a week. But, we may yet see another significant wave of deaths. Other nations, like Japan and Sweden, have experienced their first- or second-highest levels of #COVID19 deaths of the pandemic in the past month or so.
https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=new_deaths_smoothed_per_million&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=SWE~JPN~NOR~AUS~HKG~FIN

COVID-19 Data Explorer

Explore global data on COVID-19.

Our World in Data

Augie Ray Feb 3, 2023

None of this suggests that we've yet reached a stable place with COVID. Experts warn new variants could soon cause yet another surge of illness and hospitalization.
https://today.tamu.edu/2023/01/30/what-you-need-to-know-about-xbb-1-5-covids-latest-variant/

What You Need To Know About XBB.1.5, COVID’s Latest Variant

Texas A&M experts explain how the subvariant of Omicron has become the dominant strain in parts of the U.S.

Texas A&M Today

Augie Ray Feb 3, 2023

BUT WHAT MIGHT OUR COVID-ENDEMIC FUTURE LOOK LIKE?

Too many folks repeat the discredited idea that COVID is “just the flu.” It's led to folks thinking that COVID will be a minor inconvenience for the vast majority of the public on some annual basis. First of all, "just another flu" would be nothing to take lightly. The flu hospitalizes between 250,000 to 600,000 people annually in the US most years, and it kills between 20,000 to 60,000 people.
https://en.wikipedia.org/wiki/United_States_influenza_statistics_by_flu_season

United States influenza statistics by flu season - Wikipedia

Augie Ray Feb 3, 2023

But #COVID19 is not "just the flu.” A new study suggests that our endemic future is one with risks that demand much more public, not just individual, action. It concludes that “individuals seeking to opt out of adverse outcomes upon SARS-CoV-2 infection will find it challenging to do so, as large reductions in contact rate are required to reduce the risk of infection.”
https://www.medrxiv.org/content/10.1101/2023.01.22.23284884v1.full

Augie Ray Feb 3, 2023

Some specific findings from this study include:

There's little individuals can do to protect themselves short of enormous sacrifice if we don't implement public health solutions. Vaccinated people wishing to reduce their frequency of infection by half will need to reduce their contact rate 10-fold. People who only reduce their contact rate by half will “experience infections rates only marginally less” than those who have a median level of contacts with others.

Augie Ray Feb 3, 2023

People who are vaccinated and not taking measures to reduce their contact rate can expect to spend an average of 6 days a year acutely sick with COVID-19 and be infected 1.4x annually. That's a #COVID19 infection every 8.5 months on average. Now is a good time to remind the "just the flu" folks that the average American gets the flu once every 10 years or so.

https://www.cdc.gov/flu/about/keyfacts.htm

Key Facts About Influenza (Flu)

Learn key facts about influenza to fight against flu.

Centers for Disease Control and Prevention

Augie Ray Feb 3, 2023

The study estimates that 2% of vaccinated individuals who have a median contact rate will experience long COVID so severe that it impacts their employment. Sounds small, but think of 1 of every 50 people being that disabled. That is a frightening situation.

Augie Ray Feb 3, 2023

Not only isn't COVID like the flu in terms of its evolution, transmission and frequency, we're also learning #COVID19 infections are likely much more dangerous to long-term health. To focus on just three out of 150 studies demonstrating the ways COVID can damage hearts, brains, immune systems, reproductive organs, kidneys and organs:

One study found that people who had COVID have a 43% higher risk of developing auto-immune issues.
https://www.medrxiv.org/content/10.1101/2023.01.25.23285014v1

Augie Ray Feb 3, 2023

Another study found those who had #COVID19 have a 60% greater risk of myocardial infarction and 39% higher risk of stroke.
https://www.mdpi.com/2075-4418/13/3/491

Long COVID Syndrome and Cardiovascular Manifestations: A Systematic Review and Meta-Analysis

(1) Background: Long COVID syndrome is a significant cause of morbidity in COVID-19 patients who remain symptomatic with varied clinical presentations beyond three weeks. Furthermore, the relevance of considering cardiovascular outcomes in post-COVID-19 syndrome is important in the current COVID-19 pandemic; (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review and meta-analysis. Systematic searches were conducted from multiple databases without language restrictions until October 8, 2022, to find studies evaluating cardiovascular outcomes such as arrhythmias, myocardium and pericardium diseases, coronary vessel disease, and thromboembolic disorders in post-COVID cases. The pooled odds ratio (OR), and standard mean difference (SMD) with their corresponding 95% confidence intervals (CI) were computed to find the association; (3) Results: Altogether, seven studies with a total of 8,126,462 (cases: 1,321,305; controls: 6,805,157) participants were included in the meta-analysis. Pooled odds ratios of cardiovascular outcomes were significantly higher in post-COVID cases (OR > 1, p < 0.05) than in controls. However, the mortality (OR: 4.76, p = 0.13), and heart rate variability (SMD: −0.06, p = 0.91) between cases and controls were not statistically significant; (4) Conclusions: Significant cardiovascular sequelae in long COVID syndrome highlight the importance of careful cardiac monitoring of COVID-19 patients in the post-COVID phase to address cardiovascular complications as soon as possible; larger-scale prospective studies are required for accurate estimation.

MDPI

Augie Ray Feb 3, 2023

And another study uncovered the much greater risk of cognitive impairment in people following a COVID infection.

https://www.sciencedirect.com/science/article/abs/pii/S0165178122005972

Augie Ray Feb 3, 2023

Doctors won't necessarily tie individual heart attacks, strokes, diabetes diagnoses and the like to past #COVID19 infections from which people have recovered. Instead, what we'd see in a population that is repeatedly infected is an increasing burden of poor health and rising excess deaths. And that is precisely what is happening. Excess deaths (which is the number of people dying above historic averages) are very high and rising in many countries.
https://ourworldindata.org/grapher/excess-mortality-p-scores-projected-baseline?country=GBR~IRL~CHE~SWE~JPN~HKG~DEU

Excess mortality: Deaths from all causes compared to projection

The percentage difference between the reported number of weekly or monthly deaths in 2020–2024 and the projected number of deaths for the same period based on previous years.

Our World in Data

Augie Ray Feb 3, 2023

Take Ireland as an example. Currently, the #COVID19 risks are lower than they've ever been since I moved here in October 2021. Our hospitalizations and positive rate of testing are the lowest they've been in 15 months. So, why do we have record levels of deaths so great that mortuaries can't keep up?
https://www.breakingnews.ie/ireland/number-of-deaths-in-recent-weeks-leading-to-funeral-delays-1425557.html

Number of deaths in recent weeks leading to funeral delays

The rise has resulted in capacity issues at Cork City Morgue, with bodies having to be stored in hospitals overnight.

BreakingNews.ie

Augie Ray Feb 3, 2023

The excess-death situation is so pressing that actuaries--the people who guide long-term decisions for pensions and insurance companies--are beginning to adjust their assumptions. Continuous Mortality Investigation says “mortality in 2022 may be indicative of future mortality… life expectancy assumptions at age 65 are likely to fall by around 6 months, equivalent to 2%… higher death rates seen in the latter part of 2022 may be indicative of future mortality.”
https://www.lcp.uk.com/media-centre/2023/02/life-expectancy-assumptions-could-fall-by-6-months-if-cmi-proposals-adopted/

Life expectancy assumptions could fall by 6 months if CMI proposals adopted

The CMI has issued its consultation to help shape the next version of its mortality projection model, which is used by the majority of pension scheme trustees and sponsors in setting their funding and accounting assumptions. The consultation focuses on how to respond to the very high mortality rates seen in England & Wales over 2022, to which the model is calibrated.

While the typical group of COVID-minimizing, herd-immunity-hyping, mask-hating folks love to blame the vaccines for excess deaths, the evidence is substantial and in no doubt among experts that vaccines do much more good than harm. No vaccine is 100% safe, but we get vaccinated because the risks are miniscule compared to the risks of getting a deadly or disabling disease.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/is-the-covid19-vaccine-safe

Is the COVID-19 Vaccine Safe?

Our experts answer some frequently asked questions about vaccine safety.

Augie Ray Feb 3, 2023

Our endemic future isn't a return to 2019 norms but demands a new way of thinking of public health. If your personal risk isn't enough to encourage a change in your perception and behavior, perhaps you'll care more about the threat to the economy.
https://www.bloomberg.com/opinion/articles/2022-12-07/long-covid-is-a-threat-to-the-whole-economy?leadSource=uverify%20wall

Augie Ray Feb 3, 2023

We are seeing a historic decline in lifespans. We can wait a few more years, lose more lives to disability and death, and see how much more our lifespans decline, or we can begin to understand that #COVID19 wasn't a temporary situation for us to get past. COVID, I believe, must be recognized as a global change in the risks we face and the way we live. We need to stop pretending our 2019 normal makes sense and figure out what our 2024 normal ought to be.
https://www.forbes.com/sites/joshuacohen/2023/01/01/the-number-one-health-story-from-2022-is-the-troubling-decline-in-life-expectancy/

The Number One Health Story From 2022 Is The Troubling Decline In Life Expectancy

The biggest health story from 2022 isn’t Covid-19. It isn’t RSV or influenza, either. It isn’t cancer, diabetes, or cardiovascular disease. It’s something that encompasses all these diseases and much more. It’s the troubling decline in U.S. life expectancy.

Forbes

Augie Ray Feb 3, 2023

HOW TO RESPOND TO OUR COVID-ENDEMIC FUTURE

There is a range of things we ought to do to create the conditions for a healthier, safer future. But, none of this will work on a voluntary basis. Public health can't be left to individual choice. It's called “public” health for a reason!

If you don't believe me, let me ask you three questions:

First, are you masking on long flights? No? Then you're ignoring the guidance provided by WHO to keep you and others safe.
https://www.reuters.com/world/whoeurope-backs-travel-checks-us-given-spread-latest-omicron-variant-2023-01-10/

WHO urges travellers to wear masks as new COVID variant spreads

Countries should consider recommending that passengers wear masks on long-haul flights, given the rapid spread of the latest Omicron subvariant of COVID-19 in the United States, World Health Organization (WHO) officials said on Tuesday.

Reuters

Augie Ray Feb 3, 2023

Second, do you mask when in crowded indoor spaces? No? Then you are disregarding the latest advice WHO offers, which is masking “for anyone in a crowded, enclosed, or poorly ventilated space.”

https://www.who.int/news/item/13-01-2023-who-updates-covid-19-guidelines-on-masks--treatments-and-patient-care

WHO updates COVID-19 guidelines on masks, treatments and patient care

The update is part of a continuous process of reviewing such materials, working with guideline development groups composed of independent, international experts.

Augie Ray Feb 3, 2023

Third, after you've had a potential exposure, do you test yourself? In fact, do you test three times? No? Then you are turning a blind eye to the FDA advice you conduct serial testing across three tests each 48 hours apart. Almost no one is following the guidance from public health organizations. Social pressures, COVID exhaustion, and poor risk awareness have combined to make voluntary compliance completely useless. We need public solutions to protect public health.
https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety

Augie Ray Feb 3, 2023

This is why we need governments to act and business leaders to care. We know leaders are aware of the ongoing #COVID19 risks--just look at how they protected each other at the World Economic Forum. Shouldn't each of us expect the same level of concern and care from our leaders that they extend to each other? The protections extended to attendees show us what we must consider--filtration for safer air, testing to reduce COVID transmission, and masks where possible.
https://www.linkedin.com/pulse/equitable-protect-corporate-leaders-from-covid-19-more-augie-ray/

Is It Equitable to Protect Corporate Leaders From Covid-19 More than Employees and Customers?

A simple question to encourage you to think more about #COVID19 risks and engage in a discussion about equity in the workplace: If the world's top business leaders recognize and take precautions against COVID during an ongoing pandemic, shouldn't they ensure the same for employees and customers? Sho

Augie Ray Feb 3, 2023

Governments can lead in many ways. Belgium, for example, is implementing a “ventilation plan” that requires businesses to make a CO2 monitor clearly visible. CO2 itself is not a (huge) risk, but it is a good proxy for estimating how much of the air we inhale is rebreathed air from others--the higher the CO2, the more we're breathing others' air, and the higher the risk of infection.
https://workinmind.org/2022/04/05/belgium-agrees-on-ventilation-plan-for-public-places-co2-meters-essential/

Ventilation Plan | CO2 Meters | Public Bars | Restaurants | Belgium

The Government in Belgium has finally agreed on a “ventilation plan” for all places open to the public, such as bars, restaurants and cinemas

Work in Mind

Augie Ray Feb 3, 2023

California has implemented some new permanent COVID-19 regulations. The regulations require that employees shall receive training regarding COVID-19, must be informed of COVID cases in the workplace, and be protected with air filtration through MERV-13 or higher filters. Regulations like these implemented at the state or national level would help to ensure safer workplaces, events, and commercial environments.
https://www.fisherphillips.com/news-insights/10-key-things-new-calosha-permanent-covid-19-regulation.html

10 Key Things to Know About the New Cal/OSHA Permanent COVID-19 Regulation

By now, California employers are familiar with the state’s COVID-19 safety protocols for the workplace. After several years, however, Cal/OSHA’s Emergency Temporary Standard (ETS) is being replaced by…

Fisher Phillips

Augie Ray Feb 3, 2023

Businesses need not wait for government action before they decide to protect the health and wellbeing of employees and customers. In some ways, it seems small businesses may be leading the way when leaders are willing to make the right investment. For example, a Canadian restaurant invested $15,000 in filters and a CO2 monitor.
https://www.thestar.com/news/gta/2022/03/11/one-restaurants-fight-against-covid-15000-four-filters-and-a-co2-monitor.html?rf

One restaurant’s fight against COVID: $15,000, four filters and a CO2 monitor

A Mississauga establishment hired specialists to check the air quality. But experts say the government should promote air filtration and help defray the costs.

thestar.com

Augie Ray Feb 3, 2023

If customers don't care, neither will businesses, and as long as people are willing to race back into unsafe commercial environments, there's little reason for leaders to make investments that improve safety. Still, I'd hope that leaders' commitment to corporate social responsibility and diversity, equity and inclusion would encourage more action. If businesses only do what's required and not what is necessary to protect workers and employees, they risk increased costs.
https://www.benefitspro.com/2022/09/15/the-cost-of-long-covid-to-employers-is-skyrocketing/

The cost of long COVID to employers is skyrocketing | BenefitsPRO

A study from Nomi Health says the average predicted cost of long COVID to patients is nearly $9,500 within the first six months following a diagnosis.

BenefitsPRO

Augie Ray Feb 3, 2023

The 19th Century cholera outbreak in London was solved by public, not individual, action. Almost no one believed Dr. John Snow, an obstetrician, who said the Broad Street pump was the source of the disease. But, town officials decided to take the handle off the pump, making it impossible to draw water. Had they instead asked everyone to live with cholera and take individual action only if they cared to do so, thousands more would've perished.
https://www.ph.ucla.edu/epi/snow/snowcricketarticle.html

John Snow and the Broad Street Pump: On the Trail of an Epidemic

John Snow and the Broad Street Pump: On the Trail of an Epidemic

Augie Ray Feb 3, 2023

We need public action to improve public health, now in the pandemic and permanently in our COVID-endemic future. These actions should include new rules for safe air in public spaces, continued support for vaccinations, and rules to require masking on transit. Perhaps our future will be brighter--a new longer-lasting vaccine may be developed--but betting on that hope is a bad bet. Protecting people and the economy from needless harm should be more vital than encouraging a false sense of security.

Tom Ritchford Feb 3, 2023

The return on investment of simply requiring better air filtration in all public venues would be huge.

Unfortunately, it would be an investment of billions to save hundreds of billions over a decade, and societies are no longer interested in such investments.

Lilly Evans Feb 4, 2023

@augieray In U.K. where the Thatcher mantra “there is no such thing as society” still seems to rule in the deeds if not in the words of Government politicians we have little hope. Worse still, public is poorly informed of true benefits of mitigation measures. There is no outcry about total lack of improvement in school classes ventilation which would benefit pupils not just in infection reduction but also reducing air pollution.
I continue to wear FFP2 mask outside and indoors

Nick@NorthLondon Feb 3, 2023

@augieray
I guarantee that if the latest, highly virulent and species jumping, variant of avian flu (H10N3) goes literally viral, we'll see a huge right wing objection to public health measures.
They'll be significant public disorder and many services will collapse.
Pray that it doesn't come and it stays under control.

Augie Ray Feb 3, 2023

@N12nick You're probably right, but if it happens, the fatality rate might be horrifying. It'll be hard to object if people are dying. Keeping my fingers crossed we won't find out.

Nick@NorthLondon Feb 3, 2023

@augieray
Let's hope the oseltamivir stockpile is in better shape than the PPE stockpile was in 2019.

Karl Heinz Häsliprinz Feb 3, 2023

@N12nick "But the Avian Flu is just as mild as Covid" they will say...

Phil Landmeier Feb 4, 2023

@augieray It's easy for me to remember this cholera incident because I was delivered by another obstetrician named Dr. Snow in Santa Monica, 1953. I never knew his first name.

@augieray *nodds in agreement*

A Concerned Scientist Feb 3, 2023

I'm very interested to see how this plays out. I've mentioned this all, and sent links, to a few people I know in California and none of them knew about it, nor did their employers. Very small sample size, but seems like it's being ignored early on.

Samhain Night Feb 5, 2023

@BE @augieray I'm from CA, and this is the first I've heard of it.

Fugue State Machine Moto Feb 4, 2023

@augieray This is an excellent start.

I’m a little chafed about how it lets employers off the hook for paying their sick employees. But if that’s the compromise they had to make to get this vital workplace safety measure to stick, I can live with it.

Do Oregon next!

LindaNYC2VT Ⓥ 🌊🐖🐄🐓🦃🐬🐝🦋🦇Feb 5, 2023

@augieray @hannu_ikonen I want to live in the country California.

Elias Mårtenson Feb 5, 2023

@augieray schools were suspiciously absent from that list. I hope that ways just missed.

Jo Qatana Feb 5, 2023

@augieray it has? Is that why retail workers are wearing masks on their chins?

BillStewart415 Feb 5, 2023

@augieray But in most cases they stopped requiring vaccinations. Particularly, the requirement for Covid vaccination for schools is expiring.

Md.Poppa Feb 3, 2023

@augieray This is key. It is maddening to hear how schools have spent their covid funds foolishly. Not all, and some good tech stuff, but how schools didn't prioritize the well known HVAC deficiencies - even without air-borne diseases, just astounds me.

tippenring Feb 4, 2023

@MdPoppa @augieray the large majority of politicians, including school board members, make poor, unvetted choices all the time. Often it's because they trust the advice of career administrators, and they don't want to spend the time on validation or fact checking.

Board members that object to decisions on the grounds that they want to convince themselves before deciding on something are a small minority. They rarely convince a majority of board members that they need more information.

rrogers Feb 4, 2023

@augieray Having worked with CO2 detectors, I consider this dubious science. There are instances where the atmosphere creates strange pockets of CO2. A particulate counter/detector would be a better use of the money.

Gilberto "Velenux" Ficara Feb 3, 2023

@augieray I would argue that the sheer monetary expense is making this impossible to sustain. Tests are around 8-15€ each and not many are in the position to spend that amount every time they go out to test themselves.

Augie Ray Feb 3, 2023

@Velenux Hence, the larger point of my thread around the need for public action on public health. Relying on individuals cannot succeed--we need government and corporate action.

But, I'd point out 8-15€ each pales in comparison to the personal and financial loss of a disability.

Karl Heinz Häsliprinz Feb 3, 2023

@augieray Also that's the sales price, not the price of production. And yes, we need to scale up test production to reduce the price per piece... With public investments.

tippenring Feb 4, 2023

@augieray most people do not have the ability to accurately assess whether a space has "poor ventilation."

Augie Ray Feb 4, 2023

@tippenring I agree, but what's your point? I'd hope governments would implement rules for safer indoor air. In the absence of that, it seems this sort of advice is the best we can hope for.

tippenring Feb 4, 2023

@augieray my point is that the government undermines itself with such guidance. Advising untrained civilians to do something they are incapable of encourages the mindset that government advice is generally ridiculous, leading to people dismissing all of it out of hand without consideration.

AutisticMumTo3 She/her Feb 3, 2023

@augieray
In the UK decline in lifespan is also due to 12/13 years of Austerity, the crisis in the NHS caused by over a decade of underfunding combined with austerity affecting how much councils can spend on social care (the massive crisis in social care is having a big knock on effect on the NHS), etc. This has resulted in even pre-Covid a reduction in life expectancy in poorer socioeconomic groups and the disabled. Covid has made all that a whole lot worse.

Gurtbeef Robe Feb 3, 2023

@augieray @DemocracyMatters the AP said that the cdc has confirmed just 9 deaths from vaccines and they were blood clots from j & j one. The VAERS site people quote does not verify claims and has the same level of credibility as if people reported it here or any other social media.