Friends, I Think We Need To Talk About Covid.

Friends, I think we need to talk about Covid.

I want to get a few caveats out there before I start:

I am aware that there are people who need to exercise extreme caution about Covid; I live with someone who has two solid organ transplants and who is at the most immune compromised level of immune compromised. *I* have to be extremely cautious about covid.

Masking does prevent a certain level of transmission, and people who think they may have covid should mask and people who are concerned that they may be at high risk for covid should mask.

You should be vaccinated and boosted with the most recent vaccines that are available to you; covid is highly transmissible and very serious, you do not want to get covid and if you do get covid you don't want it to be severe and if you do get covid you don't want to give someone else covid and up-to-date vaccinations are the best way to reduce transmission and help to prevent severe cases of Covid.

We should be testing before going to any gatherings, and informing people if we test positive after gatherings, and testing if we suspect we have been exposed.

It is bullshit that there aren't good protections for workers who have covid; you should not be expected to go to work when you are testing positive

It is bullshit that people who are testing positive are not isolating for other reasons; if you have Covid you should not be going out and exposing other people to it even if you are experiencing mild symptoms or no symptoms.

We do need better ventilation systems for many kinds of spaces. Schools need better ventilation, restaurants need better ventilation, doctor's offices and hospitals and office buildings need better ventilation and better ventilation can reduce covid transmission.

I want to make it clear that Covid is real and there are real steps that individuals and systems can take to prevent transmission, and that there are systems that are exerting pressures that needlessly expose people to covid (the fact that you can lose your job if you don't come in when you're testing positive, mainly; also the fact that covid rapid tests should be ubiquitous and cheap/free and are not).

All of that being said: I'm seeing some posts circulating about how we're at an extremely high level of transmission and the REAL pandemic is being hidden from us and, friends, I'm pretty sure that is just incorrect and we're spreading misinformation.

I'm thinking of this video in particular, in which the claim is made that "your mystery illness is covid" in spite of negative tests. The guy in the video says that there's nothing else that millions of people could be getting a day, and that he predicted this because a wastewater spike in December meant that there was a huge spike in cases.

I've also seen people saying that deaths are where they were in 2021-2022, and that we're still at "a 9/11 a week" of excess deaths and friends, I'm not seeing great evidence for any of these claims.

I know that we (in the US, which is where the numbers I'm going to be citing are from) feel abandoned by the CDC and the fact that tracking cut off in May of 2023. But that only cut off for the federal tracking.

I live in LA county and LA county sure as shit is still tracking Covid.

If you want a clearer picture, you can see the daily case count over time compared to the daily death count:

Okay, you might say, but that's just LA.

Alright, so here's Detroit:

Right, but maybe that's CDC data and you don't trust the CDC at this point.

Okay, here's fatalities in New York tracked through New York's state data collection:

It's harder to toggle around the site for South Dakota, but you can compare their cases and hospitalizations and deaths for early 2022

To cases and hospitalizations and deaths from early 2024

And see that there's really no comparison.

Okay, you might say, but people are testing less. If they're testing less of course we're not seeing spikes, and they're testing less because fewer tests are available.

Alright, people are definitely testing less than they were in 2021 and 2022. Hospitalization for Covid is probably the most clear metric because you know those people have covid for sure, the couldn't not test for it.

Here are hospitalizations over time for LA:

Here are hospitalizations over time for New York:

As vaccination rates have gone up, cases, deaths, and hospitalizations have gone down. It IS clear that there are case spikes in the winter, when it is cold and people are indoors in poorly ventilated spaces and people are more susceptible to respiratory infections as a result of cold air weakening the protection offered by our mucous membranes, and that is something that we will have to take precautions about for the forseeable future, just as we should have always been taking similar precautions during flu season.

So I want to go point-by-point through some of the arguments made in that video because I'm seeing a bunch of people talking about how "THEY" don't want you to know about the virus surge and buds that is just straight up conspiracism.

So okay, first off, most of what that video is based on is spikes in wastewater data, not spikes in cases. This is because people don't trust CDC data on cases, but I'd say to maybe check out your regional data on cases. I don't actually trust the CDC that much, but I know people who do tracking of hospitalizations in LA county, I trust them a lot more. Wastewater data does correlate with increases in cases, but this "second largest spike of the entire pandemic" thing is misleading; wastewater reporting is pretty highly variable and you can't just accept that a large spike in covid in wastewater means that we're in just as bad a place in the pandemic as we were in 2022. We simply have not seen the surge of hospitalizations and deaths that we would expect to see in the weeks following that spike in wastewater data if wastewater data was reflective of community transmission.

The next claim is that "there is nothing else that is infecting millions of people a day" and covid isn't doing that either. The highest daily case rates were in January of 2021 and they were in the 865k a day range, which is ridiculously high but isn't millions of cases a day.

But what we can see is that when people are tested by their doctors for Covid, RSV, and the Flu, more tests are coming back positive for the Flu. Covid causes more hospitalizations than the other two illnesses, but to be honest what the people in the video are describing - lightheadedness, dizziness, exhaustion - just sound like pretty standard symptoms of everything from covid to the cold to allergies. There are lots of things your mystery illness could be.

The video goes on to talk about the fact that people aren't testing, and why their tests may be coming back negative and I'd like to point out that the same things are all true of Flu or RSV tests. People might be getting tested too early or too late; getting a negative test for the flu isn't a good reason to assume you've got covid, getting a negative test for covid isn't a good reason to assume you've got the flu, and testing for viruses as a whole is imperfect. There are hundreds of viruses that could be the common cold; there are multiple viruses that can cause bronchitis; there are multiple viruses that can cause pneumonia, and you're not going to test for all of these things the moment you start feeling sick.

He then recommends testing for multiple days if you have symptoms and haven't had a positive test (fine) and talks about the location of the tests (less fine). Don't use your rapid tests to swab your throat or cheek unless it specifically says that they are designed to do so. Test based on the instructions in the packet.

He points out that the tests probably still pick up on the virus because they're not testing for the spike protein, they're testing for the RNA (good info!)

The video then discusses something that I think is really key to this paranoia about the "mystery illnesses" - he talks about how covid changes and weakens your immune system (a statement that should come with many caveats about severity and vulnerability and that we are still researching that) and then says that it makes you more susceptible to strep or mono and that "things that used to clear in a day or two now hit you really hard."

And that's where I think this anxiety is coming from.

Strep throat lasts anywhere from three days to a week. A cold takes about a week to clear. The flu lasts about a week and can knock you on your ass with exhaustion for weeks depending on how bad you get it. Did you get a cough with your cold? Expect that to take anywhere from three to eight weeks to clear up.

I think that people are thinking "i got a bad virus and felt really sick for a week and haven't gotten my energy back" but that just sounds like a bad cold. That sounds like a potent allergy attack. That doesn't even sound like a bad flu (I got a bad flu in 2009 and thought i was going to straight-up die I had a fever of 103+ for three days and felt like shit for three days on either side of that and took six weeks to feel more like myself again).

Getting sick sucks. It really, really sucks. But if you're getting sick and you're testing for covid and it's coming back negative after you tested a few times, it's almost certainly not covid.

The video then says "until someone provides evidence that it's not covid, it should be assumed to be covid because we have record levels of covid it's that simple" but that's not simple. We don't have record levels of covid and he hasn't proved it. We have record high levels of wastewater reports of covid, which correlates with covid cases but the spike in wastewater noted in december didn't see a spike with a corresponding magnitude of cases in terms of either hospitalizations or deaths, which is what we'd have seen if we had actual record numbers of covid.

He says that if you want to ignore this, you'll get sick with covid, and that about 30-40% of the US just got sick with covid in the last four months (which is a RIDICULOUSLY unevidenced claim).

He says that we need to create a new normal that takes covid into account, which means masking more often and testing more often and making choices about risk-avoidant behaviors.

Now, I don't disagree with that last statement, but he prefaces the statement with "it doesn't necessarily mean lockdown" and that's where I think the alarmism and paranoia is really visible here. We are so, so far away from "lockdown" type levels that it's absurd to discuss lockdown here.

What I'm seeing right now is people who are chronically ill, people who are immune compromised, and people who are experiencing long covid (which may not be distinct from other post-viral syndromes from severe cases of flu, etc, but which may be more severe or more notable because of the prevalence of covid) are talking about feeling abandoned and attacked and left behind by society because covid is still out there, and still at extremely high levels.

I am seeing people who feel abandoned and attacked because the lgbtq+ events they are attending don't require masking. I am seeing people who are claiming that it is eugenicist that their schools don't have a negative test policy anymore.

And this comes together into two really disconcerting trends that I've been observing online for a while.

The claim that the pandemic is still as bad as it's ever been and in fact may be worse but we can't know that because "they" (the CDC, the government, capitalist institutions that want you back in the office, the university industrial complex that wants your dorm room dollars) are covering up the numbers and

Significant grievance at the fact that people are acting like number one is not true and are putting you at risk either out of thoughtlessness (because they don't realize they're putting you at risk) or malice (because they don't care if the sick die).

And those things are a recipe for disaster.

I think I've pretty robustly addressed point one; I don't think that there's good evidence that there's a secretly awful surge of covid that nobody is talking about. I think that there are some people who are being alarmist about covid who are basing all of their concern on wastewater numbers that have not held up as the harbinger of a massive wave of infections.

So let's talk about point number two and JK Rowling.

Barnes and Noble is not attacking you when it puts up a Hogwarts Castle display in the lobby. Your favorite youtuber isn't trying to hurt you when they offhandedly mention Harry Potter.

If you let every mention of Harry Potter or every person who enjoys that media franchise wound you, you are going to spend a lot of your time wounded.

People are not liking Harry Potter at you.

Okay.

People are also not not wearing masks at you.

You may be part of a minority group that experiences the potential for outsized harm as a result of majority groups engaging in perfectly reasonable behaviors.

There are kind, well-meaning, sensible people who go out every day and do something that may cause you harm and it's not because they want to hurt you or they don't care about whether you live or die, it is because they are making their own risk assessments based on their own lives and making the very reasonable assumption that people who are more concerned about covid than they are will take precautions to keep themselves safe.

We are not at a place in the pandemic where it is sensible to expect people with no symptoms of illness to mask in public as a matter of course or to present evidence of a recent negative test when entering a public building in their day-to-day life.

I think now is a really good time to sit down and ask yourself how you expect things to be with covid as an endemic part of our viral ecosystem. I think now is a good time to ask yourself what risk realistically looks like for you and for people who are unlike you. I think now is a good time to consider what would feel "safe" for you and how you could accomplish feeling safe as you navigate the world.

I'm probably going to continue masking in most indoor spaces for years. Maybe forever. There are accommodations that SHOULD be afforded to people who have to take more precautions than others (remote learning, remote visits, remote work, etc.), and we should demand those kinds of accommodations.

But it is going to poison you from the inside out if you are perpetually angry that people who don't have the same medical limitations as you are happy that they get to go shopping with their faces uncovered.

So now I want to talk to you about my father in law.

My father in law had a bone marrow transplant in 2015. That's the most immune compromised you can get without having your organs swapped out.

The care sheet for him after the transplant was a little overwhelming. The list of foods he couldn't eat was intimidating and the limitations on where he could go was depressing. It cautioned against going to large events, it recommended outdoor gatherings where possible but only if he could avoid sunlight and was somewhere with no history of valley fever. It said that he should wear masks indoors any time he was someplace with poor ventilation and that he should avoid contact with anyone who had an illness of any kind, taking special note to avoid children and anyone recently vaccinated for measles.

It was, in short, pretty much what someone immune compromised would need to do to try to avoid a viral infection. Sensible. Reasonable. Wash your hands and social distance; wear masks in sensitive contexts and don't spend time in enclosed places with people who have a communicable illness.

This is what life was always going to be like for people who are severely immune compromised, and it was always going to be incumbent upon the person with the illness to figure out how to operate in a society that is not built with them in mind.

It is not the job of every parent I encounter to tell me whether their child has been vaccinated against measles or chicken pox in the last three months. That isn't something that people need to do as part of their everyday life. However it IS my responsibility to check with the parents I'm hanging out with whether their children have been vaccinated against measles or chicken pox in the last three months so I know if it's safe for my immune compromised spouse to be around them.

If you want an environment in which you feel safe from covid, at this point in the pandemic (when the virus is endemic and not spreading rapidly as far as we can see from case counts) it is your responsibility to take the steps necessary to make you feel safe. Some of those steps will involve advocating for safety improvements in public spaces (again, indoor ventilation needs to be better and I'm personally pretty extreme about vaccination requirements; these are things we should be discussing in our school board meetings and at our workplaces), some of those steps will involve advocating for worker protections, guaranteed sick time, and the right to healthcare. But some of the things you're going to need to do to feel safe are going to come down to you.

If you are concerned about communicable diseases you have to be realistic about the fact that our society doesn't go out of its way to prevent communicable diseases - norovirus among food service workers pre-pandemic is pretty clear evidence of that. You are going to have to be proactive about your safety rather than expecting the world to act like Covid is at 2021-2022 levels when it is measurably not.