Coronavirus

[dhanson865]

for all the talk about lower case numbers it ain't safe outside my house...

 

[scottf200]

Such a good article with a reasonable and decipherable presentation it.

Understanding Risk - Katelyn Jetelina

Understanding Risk

We’re coming to the end of a wave. The CDC is changing guidance. Schools are removing mask mandates. More than 253 million people have at least one dose of the vaccine. A lot is changing, and today looks very different from March 2020. Together, many of us are reflecting on our own risk...

yourlocalepidemiologist.substack.com

 

[EVNow]

https://twitter.com/x/status/1498773294534828037

 

[madodel]

https://twitter.com/x/status/1498773294534828037

COVID, the new lead.

 

[AlanSubie4Life]

Good informative thread. No real surprises here or anything, but good to see a few pieces coming together. Occam’s Razor really does hold true most of the time!

A lot more work to be done on investigating origins though. Early days. I don’t know what the chances are of finding the host species but it seem possible (though perhaps not likely) with a little tracing - there are only so many possibilities!

https://twitter.com/x/status/1499060168327237633

 

[TespaceX]

CA has set a date for allowing schools to possibly not require masks.
And, on that topic, wouldn’t expect anything less from Florida leadership. How about start with greeting the students rather than railing on them for wearing masks. Jeez.

https://twitter.com/x/status/1499086276519239680

 

[EVNow]

CA has set a date for allowing schools to possibly not require masks.

In WA now it’s up to cities.

I don’t understand the urgency to remove mandates. Reeks of politics.

 

[JRP3]

I think it reeks of reality. Levels are down to last summer levels in many places, more people are vaxed, boosted, and/or previously infected, Omicron is much less severe, and people are aware of all of this and are less willing to support mandates. I've been fully supportive of all mandates all along but can see how now is the time to start relaxing them.

 

[AlanSubie4Life]

In WA now it’s up to cities.

I don’t understand the urgency to remove mandates. Reeks of politics.

I don't think so. Everyone (with the exception of young children, which hopefully will change soon) can be vaccinated, and have had ample time to do so. Overall levels of immunity are high. The other thing is that we know that N95 masks work really well to protect the wearer, and are readily available (I am not aware of any instance where someone wearing an N95 has been infected while wearing the mask, in fact!). It's likely that if everyone wore N95s indoors without exception (obviously this will never happen and can never happen), cases would drop to very low levels in a couple weeks.

We need a proper plan going forward, for sure, not just hope and pray that it doesn't come back (because there probably will be future waves, though to me it doesn't seem like a guarantee until we see another substantially different variant). But I support an immediate relaxation of restrictions based on local conditions, with an eye to how to prevent things from getting out of hand in future (it's not good for the economy, or anyone, to have a lot of people out of work for 1-2 weeks, even if it's "just a severe cold," so we should avoid that).

If a relaxation of restrictions and a return to normal can be paired with a good strong plan to bolster the healthcare system, improve surveillance, improve ventilation, & improve rapid treatment & testing, it seems fine. I also think people should be educated that if they wear their N95 and never take it off indoors (no exceptions!), they'll be fine, if they wish to avoid infection. This helps substantially mitigate risks for the immunocompromised; they're no longer at the mercy of the irresponsible decisions of others (I'm not saying they'll be unaffected by the relaxation of restrictions, of course). More should be done to get Paxlovid to a wider range of people, faster (but note there are SIGNIFICANT drug interactions which complicates this).

It's possible cases will continue to drop even with restrictions removed (practically speaking, there have been no real restrictions for the last 5-6 months), and I do still think that the goal should be to minimize case numbers. But the benefit of interventions is proportional to prevalence. And in most cases prevalence is now fairly low.

I think it would be good if wastewater monitoring could be used as a leading indicator for individual locations to assess what is happening. This would allow municipalities to quickly alert the population that conditions are changing and that more caution is advised. I don't like the hospitalization and case metrics as mechanisms to increase restrictions, because they lag by far too much. It makes us vulnerable to a situation where we respond 2-3 weeks too late.

 

[EVNow]

The issue is while the cases are down, they are still near delta highs in a lot of places including WA.

And there is zero chance of any follow up actions.

They seem to always remove restrictions too early …

 

[AlanSubie4Life]

The issue is while the cases are down, they are still near delta highs in a lot of places including WA.

And there is zero chance of any follow up actions.

They seem to always remove restrictions too early …

Keep in mind that case numbers lag by a week or so, so things are better than they seem. I haven’t looked at Washington closely but if they are dropping at 30% a week or whatever they’ll probably be below Delta levels soon if not already.

I am not sure what you mean by follow-up actions - I do think there should be and I think there is at least a push to do test-to-treat, which will be super important to reduce hospital burden in future. I am sure the reality will be disappointing but the fact that we cannot execute on that doesn’t mean we should maintain restrictions (which everyone ignores if they’re enacted when not needed) indefinitely. That’s just compounding the problem. Do what is the right thing. And hope the local governments actually push for improvements in the areas mentioned above. Eventually we’ll figure it out, though it may take another wave.

 

[dhanson865]

"new" cases might be down but the old ones are still dying. It's going to take a few more weeks to see the deaths bottom out and I'm still masking even if you want to tell me not to worry.

 

[TespaceX]

At least in my parts of California, even with the relaxing of mandates, I estimate that at least 2/3 of people are still wearing masks every time I go out for shopping and errands.

 

[EVNow]

Keep in mind that case numbers lag by a week or so, so things are better than they seem. I haven’t looked at Washington closely but if they are dropping at 30% a week or whatever they’ll probably be below Delta levels soon if not already.

In my city the numbers have kind of stabilized. In the school district too. We’ll know what happens with all the mid-winter break traveling soon.

Worse, they don’t even ask students in close contact with known cases to test/isolate, if the student is vaccinated.

I am sure the reality will be disappointing but the fact that we cannot execute on that doesn’t mean we should maintain restrictions (which everyone ignores if they’re enacted when not needed) indefinitely. That’s just compounding the problem. Do what is the right thing. And hope the local governments actually push for improvements in the areas mentioned above. Eventually we’ll figure it out, though it may take another wave.

Not about maintaining restrictions indefinitely … but what is the right time to remove masking restrictions in schools ?
- cases at delta highs
- cases at pre-Omicron lows

I think end of March would be fine. Now it’s premature.

So, why now ? Look at Biden’s approval rating.

 

[AlanSubie4Life]

So, why now ?

Because cases are plunging and immunity is at all time highs. I don't know specifically which county you're in - in King County they're definitely not at Delta highs and they're likely on a trajectory to fairly low levels. But everything is local (for example, Idaho, Kentucky and Maine should be using different procedures at the moment).

I don't know what is the right decision on schools. My opinion is that since N95s are so effective at protecting the wearer, assuming they are sized to fit children, that their use should be strongly encouraged, and that's probably good enough. I think maintaining cohorts and other less disruptive interventions to limit spread should be kept for now. It's not clear to me that a situation where children take off masks to gather indoors at lunch is really that effective anyway. For very young cohorts who cannot yet be vaccinated, I think all possible precautions should still be taken. At this point, everyone over 4 can be vaccinated, and everyone can also very effectively protect themselves through masking, so I kind of think it's an individual decision that should be strongly encouraged (with the rationale for it: getting infected with COVID sucks and is bad for you and it may mean you can infect others, and personal N95 masking, especially in combination with vaccination, is very effective at stopping all of this). Again, I haven't heard of a single instance of a vaccinated individual who has been infected while wearing a properly fitted N95. (It would be interesting to hear about one that can be clearly demonstrated; I just have not heard of a single case; everyone I know who was infected had an unmasked exposure, and no one I know who is serious about mask use has been infected.)

I'd love to see us get to June 2021 case levels but I'm not sure we'll get there with reduced restrictions, etc. It's very hard to predict though! We might! But case levels are low enough that masking isn't as important right now in most places (it depends on your location).

In San Diego, R effective is starting to uptick, from very low levels, possibly due to relaxed restrictions, but case numbers still dropping very fast. Obviously when case levels get low enough it's hard to keep Reffective well below 1. It'll be interesting to see how it changes. This plot was a good leading indicator, actually, for the obviously imminent Omicron surge (there were tons of other indicators as well of course). https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/COVID-19 Watch.pdf

Back in the office here in San Diego. Life is normal. It's frustrating, because it sounds like from informal polling that basically no one at the office got COVID, so having everyone be away from work for two months was nearly completely pointless in terms of generating immunity (of course, now the risk of an introduction (we've had a few) is far lower so of course it was not completely pointless in general). It's possible that a group which is 100% boosted actually has minimal ability to spread, though - seems to have been the case here. Hopefully! A very hard thing to test.

 

[AlanSubie4Life]

BA.2 is making an extremely unimpressive showing. Looks like Trevor Bedford was probably right, as usual (it's a bit more transmissible, but doesn't escape from Omicron immunity or vaccine immunity any more than Omicron BA.1, so will just result in a few more infections in people who are vulnerable).


At this point we just have to hope the vaccine's perfect record against all variants is maintained.

 

[golfcart]

Public schools here dropped the mask mandates March 1st, but will still allow anyone who wants to have their children wear them to do so. I think the timing is right on this. Omicron wave is basically over by all indications here and anyone that wants a vaccine for themselves or their school-age kids has had plenty of time to get one. They've even been doing vaccine clinics at the schools for free if you want to come in and get one.

My kid is not wearing a mask to school for the first time in almost 2 years and it is great to see. Learning to read peoples expressions is important at that age and it is awesome to see all of the children laughing and smiling at each other again.

Our office is letting people back in though most prefer to continue teleworking if they can. In my city of 475,000 people we are averaging 35 cases and 2 deaths a day with things asymptotically approaching zero as best I can tell. Mask use ticked up during peak omicron, as expected, but since then it is mostly older folks and people in Subarus (non WRX) wearing them.

I'll be happy to see the mandates drop all around at this point. The folks that are still really concerned are more than welcome to wear their N95 to the grocery store but that point has passed for me. Lets hope this is it for a while and we have some normalcy until next winter at least!

 

[dhanson865]

Let me make another comparison: The low point of new cases 7 day average in 2021 was 12,196 per day and the current 7 day average is 51,413.

That's ~4.2 times as many cases per day and people are calling that "low". That would be ringing alarm bells in 2021.

 

[golfcart]

I think New Zealand will be one of the most interesting places to watch now that it is spreading there. Close to 80% vax rate (95% of people over 12 are vaccinated) before opening things up if what I'm reading is correct. Cases are skyrocketing, of course, even with the high vax rate because the vaccine protection wanes over time and does not eliminate (though does reduce) your chances of catching and spreading it... particularly with omicron which is more able to infect vaccinated individuals and is wildly contagious.

COVID Vaccine Effectiveness

Hopefully they will be able to avoid the worst of the hospitalizations and deaths by waiting as long as they did, learning from other countries, and getting out so many vaccines ahead of time. I guess we'll find out in the next month or so. This graph below of cases in New Zealand is crazy

According to this model they now have the highest Reff of all 180 countries they analyzed.

COVID-19 Model

I have to give them credit they really kept the numbers down up until now... but I suppose this was going to have to happen at some point unless they wanted to live under lockdowns, border restrictions, and quarantines forever. Some experts think that half the country could become infected in the next 3 months.

 

[JRP3]

Let me make another comparison: The low point of new cases 7 day average in 2021 was 12,196 per day and the current 7 day average is 51,413.

That's ~4.2 times as many cases per day and people are calling that "low". That would be ringing alarm bells in 2021.

We're at late July 2021 levels, no one was "ringing alarm bells" then. And again, it's less lethal, more people are vaxed and boosted, and the trend is still dropping not increasing. No one is saying you can't keep taking maximum precautions to protect yourself but the conditions are such that it's reasonable to relax mandates at this point.