New #LongCOVID article out today in one of the top science journals, @Nature.

The most striking finding to me was that more frequent vaccination reduced the risk of yearlong LC from the 4.3-5.2% range (in their sample, which is low) to just 0.38%. That's a >10x reduction.

1/ Trimmed version of Table 1
Their sample is at the low end of #LongCOVID estimates overall, so for a fairer comparison, I could imagine 20% of the under-vaccinated group with LC & about 2% in the more frequently vaxxed group.

We could quibble on the base rates, but the risk reduction is the key stat.

2/
I always advocate for multilayered mitigation because a 0.4-2% chance of a new severe disability is considerable for individuals and populations. Effects are cumulative. Also, vaccines wane, and evading variants emerge unpredictably. Forward transmission is common. Etc.

3/
With many public health officials acting like vaccines eliminate long COVID risk 100%, I think there is a backlash to argue "they don't prevent LC."

I'd like to see more discussion about the *extent* of risk reduction, rather than black-or-white do-or-don't thinking.

4/
We see this everywhere. Debates about whether masks do or don't work. Whether tests do or don't work. Whether vaccines do or don't work. Whether air cleaners do or don't work.

It's all dichotomous (black-or-white) thinking, which serves a defensive process.

5/
I hope to see more messaging like this: "You should get the new booster because it will reduce your risk of getting sick and getting long COVID. It's not perfect. Few things are. That's why masking, testing, and air cleaning are also important."

6/
Studies like this are important in advocating for more frequent and open vaccination policies. Many outside the U.S. cannot get boosted. My young children in Louisiana don't have access. We should be updating vaccines & boosting 2-3x/year. This is more evidence for that.
7/
Here's the full article if interested. It examines many predictors of differing trajectories of #LongCOVID.



8/nature.com/articles/s4146…

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More from @michael_hoerger

Oct 23
PMC C0VID-19 Tracker, Oct 23, 2023
"As Good As It Gets"

U.S. #wastewater levels are higher than during 44% of the pandemic:
🔹 1.05% (1 in 95) are infectious
🔹 >500,000 C0VID cases/day
🔹>25,000 #LongCovid cases/day

Fall cases bottom out in 2 days or so.
1/
PMC19 Cases and Forecast, 6 month view. We've passed the late-summer wave, are projected to bottom out for the fall on October 25 (or perhaps a little later). Then, every day remaining in 2023 will see worse transmission.
Zooming out from the 6-month view to the full pandemic, note that fall transmission is bottoming out at a high rate.

The U.S. 8th wave this winter will start to pick up soon, at a fast clip, and transmission will accelerate in December.

2/ Graph of C19 wastewater data from Biobot, with case estimates and forecast, full pandemic to date.  There is more COVID-19 transmission today        than during 43.8% of the pandemic.  CURRENT ESTIMATES FOR October 23, 2023 Wastewater Levels (copies/mL) 345 New Daily Cases 502,000 % of Population Infectious 1.05% (1 in 95 people) New Daily Long COVID Cases  25,000 to 100,000   WEEKLY ESTIMATES FOR October 23, 2023 New Weekly Cases 3,500,000 New Weekly Long COVID Cases  176,000 to 703,000   2023 CUMULATIVE ESTIMATES AS OF October 23, 2023 Total 2023 Cases To Date 181,044,020 Total 2023 Long ...
With 1.05% of the U.S. population actively infectious (Oct 23), larger group activities continue to be increasingly risky.

Expect similar numbers the next two weeks. Then, activities will get much more dangerous.

#MaskUp #FitTest #VaxUp (if allowed/available)
3/ Number of People | Chances Anyone is Infectious 1	1.1% 2	2.1% 3	3.1% 4	4.1% 5	5.1% 6	6.1% 7	7.1% 8	8.1% 9	9.1% 10	10.0% 15	14.6% 20	19.0% 25	23.2% 30	27.1% 35	30.9% 40	34.4% 50	41.0% 75	54.7% 100	65.2% 150	79.5% 200	87.9% 300	95.8% 400	98.5% 500	99.5%
Read 9 tweets
Oct 17
Did you know, you can still access recent national C0VID #wastewater data in the U.S.?

I'll walk you though it.

🧵
1/ Verily national wastewater graph
First, go to Verily's #wastewater website.


Click on the little Line Graph icon on the left side.

2/ data.wastewaterscan.org
Click the line graph icon
When you click on the Line Graph icon, it makes an annoying pop-up.

In the 1st menu, choose SARS-CoV-2.

In the 2nd menu, click *ANY* location. We want national, but they don't include it there. So pick anywhere, and we'll fix it later.

3/ Useless pop-up window
Read 11 tweets
Oct 11
Biobot (blue) versus Verily (black) #wastewater data.

You'll see Verily data suggest the most recent wave (#7) has had considerably more transmission than Delta (#3). And that last winter (#6) was similar (or worse!) than the prior winter's BA.1 surge (#4).

Who wins?

1/ Graph of biobot and verily wastewater data. Both show similarly timed waves but vary in magnitude.
Here are the correlations among Biobot levels, Verily levels, & IHME true cases for the 1st of each month from Jan '21 to Apr '23.

Biobot correlates r=.94 (freakish) with IHME. Verily only correlates r=.67.

Either Biobot is much better, or Verily knows something we don't.
2/ Correlation table for biobot, verily, and ihme data
The CDC awarded Biobot's contract to Verily.

Once Verily brings on Biobot's former CDC-contracted wastewater sites, that should help. Case estimation will be easier if they fold in the historic data to more accurately represent the nation.

Forecasting is easy regardless.
3/
Read 5 tweets
Oct 9
Our new article is out documenting the burden of the #pandemic on food service workers.

What it boils down to is fighting an #AIRBORNE virus with droplet dogma.

I will walk you through some of the more shocking highlights.
1/
🧵 Background As an illustrative example of COVID-19 pandemic community-based participatory research (CBPR), we describe a community-academic partnership to prioritize future research most important to people experiencing high occupational exposure to COVID-19 – food service workers. Food service workers face key challenges surrounding (1) health and safety precautions, (2) stress and mental health, and (3) the long-term pandemic impact.  Method Using CBPR methodologies, academic scientists partnered with community stakeholders to develop the research aims, methods, and measures, and interpret...
During the BA.1 Omicron wave, for example, food service workers could often get free #HandSanitizer.

Yet, free high-quality masks (e.g., #N95) were hard to come by.

N95s prevent people from inhaling airborne virus into their lungs. Hand sanitizer does not.

2/ Survey Result, Statistic  Free hand sanitizer, well stocked 17 (73.9%) Encouraged to stay home when sick 16 (69.6%) Free soap, well stocked 15 (65.2%) Free gloves 13 (56.5%) HVAC (heating/air conditioning) system is well-maintained 10 (43.5%) Health insurance 9 (39.1%) Free cloth masks 9 (39.1%) Free surgical masks 9 (39.1%) Free COVID-19 testing 7 (30.4%) Paid sick leave 5 (21.7%) Free high-quality masks, e.g., N95, N99, N100, KN95, KF94 5 (21.7%) Dental insurance 4 (17.4%) Vision insurance 3 (13.0%) Mental health services/counseling 2 (8.7%) HEPA filters are provided in areas with many pe...
With a lack of #PublicHealth guidance, many in the food service industry have faced decision fatigue in handling C0VID-related issues.

Participants said co-workers struggle with what to do if sick (87%), when to return to work (83%), or whether to get a booster (61%).
3/ Estimate, whether any co-workers experience decision fatigue by area, No. (%)  What to do if possibly sick with COVID-19 20 (87.0%) What to do if a family member is diagnosed with COVID-19 19 (82.6%) How to interact with customers about showing proof of vaccination 19 (82.6%) When to return to work after COVID-19 19 (82.6%) What to do if a family member may have COVID-19 18 (78.3%) What to do if diagnosed with COVID-19 17 (73.9%) How to interact with customers who dislike vaccines 17 (73.9%) How to interact with customers who dislike masks 16 (69.6%) When a child should return to school aft...
Read 9 tweets
Oct 2
PMC C0VID-19 Tracker, Oct 2, 2023

U.S. #wastewater levels are higher than during 58% of the pandemic:
🔹 1.56% (1 in 64) are infectious
🔹 >745,000 C0VID cases/day
🔹 37,000+ #LongCovid cases/day

Click the full Tweet for more details on each forecast...
1/5

Wastewater levels are up from 505 copies/mL last week to 512 copies/mL this week. Before one screams "SURGE!!!," let's dig into the details. That's about as small an increase as possible, and well within the range of data corrections to real-time reports.

The Real-time model (red line):
It assumes that real-time data reports are accurate. However, real-time data often get corrected. Biobot and the CDC are currently in a transitionary phase of modifying when and which sites report, so I take the real-time data with a grain of salt. If it is accurate, however, the model suggests a rebound in cases, peaking around Oct 11, before bottoming out around Nov 1, before cases begin rising again for the winter wave.

Alt Model #1, Turtle (green line):
The turtle model ignores the most recent week's worth of data from Biobot, treating it as unreliable. Thus, it assumes that rather than a small increase this week, levels are actually continuing to decline and that corrections to real-time reports will later reflect that. It's essentially saying that the bump you're seeing in the real-time model is just noise. Cases will stay almost completely flat the next 6 weeks, with an official low point around Oct 25, before cases begin rising again for the winter wave.

Alt Model #2, Cheetah (orange line):
The cheetah model aims to correct for biases in real-time data reports. If last week's real-time report overestimated levels by 10% upon correction, it assumes this week's real-time report suffers the same bias. Last week's real-time report was quite accurate, so the cheetah model just looks close to the real-time model, same mini-peak, same valley, same rise in November for the winter wave.

Composite Model (black line):
This is the average of the three models. It's what's used for deriving all of the statistics reported. It basically suggests that cases will be mostly level at a high rate the next 6 weeks with minor fluctuations up or down. The composite model's take-home points are 1) continued high cases the next 6 weeks, 2) minimal fluctuation on a day-to-day basis during that time, 3) a low for the remainder of the year around Oct 25, and 4) a winter wave starting to pick up in mid-November.

Next Tweet, let's examine regional variation.
CURRENT ESTIMATES FOR September 27, 2023 Wastewater Levels (copies/mL) 512 New Daily Cases 745,000 % of Population Infectious 1.56% (1 in 64 people) New Daily Long COVID Cases  37,000 to 149,000   4-WEEK FORECAST FOR October 25, 2023 Wastewater Levels (copies/mL) 491 (-4% lower) New Daily Cases 714,000 % of Population Infectious 1.49% (1 in 67 people) New Daily Long COVID Cases  36,000 to 143,000
Regional variation suggests the need to pay attention for an increase unanticipated by the models.

The northeast is still rising steadily, and they are seeing 3-4x more FL 1.5.1 than other regions.

Caveat: this occurs during a time of Biobot/CDC reporting delays/issues.

2/5 Screenshots from Biobot. The northeast cases are still rising, whereas elsewhere, cases are basically flat, very minor uptick or downtick. Subvariant data suggest regional differences.
Zooming out from the 6-month & regional views to the full pandemic, note we're in a steady state of high transmission between the 7th & 8th waves of the U.S. pandemic.

We will likely see at least 1.4% of the population actively infectious every day for the rest of 2023.

3/5 There is more COVID-19 transmission today        than during 58.1% of the pandemic.  CURRENT ESTIMATES FOR September 27, 2023 Wastewater Levels (copies/mL) 512 New Daily Cases 745,000 % of Population Infectious 1.56% (1 in 64 people) New Daily Long COVID Cases  37,000 to 149,000   WEEKLY ESTIMATES FOR September 27, 2023 New Weekly Cases 5,200,000 New Weekly Long COVID Cases  261,000 to 1,043,000   2023 CUMULATIVE ESTIMATES AS OF September 27, 2023 Total 2023 Cases To Date 220,500,000 Total 2023 Long COVID Cases To Date  11,025,000 to 44,100,000
Read 5 tweets
Sep 25
PMC C0VID-19 Tracker, Sep 20, 2023

U.S. #wastewater levels are higher than during 58% of the pandemic:
🔹 1.55% (1 in 65) are infectious
🔹 >740,000 C0VID cases/day
🔹 37,000+ #LongCovid cases/day

Expect a high trough (600-750K cases/day) until a winter wave.
1/4
CURRENT ESTIMATES FOR September 20, 2023 Wastewater Levels (copies/mL) 509 New Daily Cases 741,000 % of Population Infectious 1.55% (1 in 65 people) New Daily Long COVID Cases  37,000 to 148,000    4-WEEK FORECAST FOR October 18, 2023 Wastewater Levels (copies/mL) 461 (-9% lower) New Daily Cases 671,000 % of Population Infectious 1.4% (1 in 71 people) New Daily Long COVID Cases  34,000 to 134,000
Let's zoom out from the 6-month view to the full pandemic.

The 7th U.S. C0VID wave has been huge, slightly smaller than Delta, & is now on the decline nationally.

We're seeing 5 million infections/week nationally, much higher than people realize, so continue with advocacy.
2/4 CURRENT ESTIMATES FOR September 20, 2023 Wastewater Levels (copies/mL) 509 New Daily Cases 741,000 % of Population Infectious 1.55% (1 in 65 people) New Daily Long COVID Cases  37,000 to 148,000   WEEKLY ESTIMATES FOR September 20, 2023 New Weekly Cases 5,200,000 New Weekly Long COVID Cases  259,000 to 1,037,000   2023 CUMULATIVE ESTIMATES AS OF September 20, 2023 Total 2023 Cases To Date 180,900,000 Total 2023 Long COVID Cases To Date  9,045,000 to 36,180,000
1.55% of the U.S. population is actively infectious with C0VID (Sep 20).

Schools and in-person work remain extremely risky.

If in the U.S., schedule a #booster. Go remote. #MaskUp. Read up on and improve indoor air quality. Avoid indoor dining. #RapidTest.
3/4 Number of People  |  Chances Anyone is Infectious  1	1.6% 2	3.1% 3	4.6% 4	6.1% 5	7.5% 6	8.9% 7	10.4% 8	11.8% 9	13.1% 10	14.5% 15	20.9% 20	26.8% 25	32.3% 30	37.4% 35	42.1% 40	46.5% 50	54.2% 75	69.0% 100	79.0% 150	90.4% 200	95.6% 300	99.1% 400	99.8% 500	>99.9%
Read 4 tweets

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