At this point in the pandemic, many of us are exhausted. Exhausted by two years of intermittent lockdowns, social distancing, remote learning and masking. Exhausted by the endless "if this, then that" mental gymnastics required of a simple trip to the grocery store or gathering with a group of friends.
The tantalizing possibility that the virus that causes COVID-19 could evolve to become endemic is the floating door from the Titanic on which we'd all like to ride back to normalcy. We're anxious to say goodbye to the iceberg that so utterly destroyed our pre-pandemic lives. We talk about "learning to live" with the virus, but what we really want is for it to fade seamlessly into the background of everyday life.
But what does endemic really mean, and will we actually get there? Will there ever be a day when we can ditch our masks for good and relegate COVID-19 caseload dashboards to our distant memories? Will we ever be able to get over the feelings of loss and -- let's face it -- anger caused by the past two years of disruption? Who needs vaccine boosters and how often?
I conferred with experts from around Stanford Medicine to discuss these and other questions.
Endemic is a multifaceted word. The Greek word demos means people, and endemios means native. The Merriam-Webster dictionary defines endemic as "belonging or native to a particular people or country" or something that is "restricted or particular to a locality or region." By that measure, pretty much anything can be defined as endemic: mullets sported by '80s American rock bands, heirloom Jell-O mold recipes passed down through generations of Midwestern church ladies, or fuzzy toques sported outdoors during Canadian winters.
But endemic means something more specific to biologists and clinicians. "When biologists talk about something being endemic, they are referring to a particular kind of relationship between different life forms," said David Relman, MD, the Thomas C. and Joan M. Merigan Professor, professor of microbiology and immunology, and a former president of the Infectious Diseases Society of America.
Many times, one of those life forms is a virus or bacteria that uses humans as its host. Like a lightning-sparked forest fire, the initial meeting between a pathogen and humans can be explosive. The disease-causing organism can race unchecked through a population while the human immune system struggles to catch up. Presto, an epidemic! But this kind of ongoing conflagration is not sustainable: The virus runs out of hosts to infect because they've all either become immune or died.
"In many cases, epidemic viruses fizzle out after a year or two if they are unsuccessful in establishing an endemic relationship with their host," Relman said. "Viruses want an opportunity to replicate and persist."
Clinically, an endemic relationship with SARS-CoV-2 is still tantalizingly beyond our grasp.
"If we are able to move beyond repeated, continuous surges into a time when COVID-19 is more seasonal, like the flu, it could be appropriate to call the virus endemic, meaning we can expect a certain amount of disease in a certain time or place in some predictable pattern," said Abraar Karan, MD, an infectious disease fellow at Stanford Medicine who has cared for many COVID-19 patients during the pandemic. "But I don't know when, in the next few years, this might happen. Right now, we have too many waves and variants coming back to back."
"It's difficult to know with confidence what endemicity might look like in the clinic," Relman agreed. "We may see seasonal epidemics, periodic asynchronous flares, or epidemics; or ongoing smoldering disease across the globe. But we are not there yet."
But what does endemic mean to the general public? To many, the term implies that we can relax our vigilance -- that COVID-19 is not a big deal anymore. After all, it's probably always going to be with us.
"The idea of a world with zero COVID-19 is really not possible anymore," Karan said. "The best we can hope for is to keep cases low and to prevent waves and surges."
Relman is cautiously hopeful that we are moving in the right direction. "I can't think of too many endemic microbes or viruses that, over time, have continued to cause the level of disruption that this virus has caused over the past two years," he said.
At this point, it seems that we're straddling a line between a pandemic and an endemic virus that will be with us forever: a kind of "pendemic," if you will. Recently the Centers for Disease Control and Prevention loosened isolation recommendations for infected people and relaxed many restrictions on indoor gatherings. This move means that decisions about precautionary measures, such as masking and avoiding crowds, are up to the individual. But relaxed restrictions are not the same as telling people, "You don't need a mask."
"Evidence suggests that now is an appropriate time to loosen mask mandates based on an individual's risk profile," said Ashley Styczynski, MD, MPH, an adjunct clinical assistant professor in infectious disease at Stanford who co-authored a large-scale study on the effect of masking on community transmission in Bangladesh. "But it's still too early to say there's no use for masks at all. Of all the things we can do to slow the spread of the virus, from masking to social distancing to stay-at-home orders, masks are the least restrictive intervention. I believe they will remain a critical part of our response as the virus continues to evolve."
N95s and KN95s are similar in terms of filtration efficiency, Styczynski said. (Surgical masks are slightly less efficient.) N95 masks, which usually have straps that fit over the back of the head rather than around the ears, have the tightest fit, giving them a protective advantage. But that also means they can be less comfortable than other types of masks. The elastic on N95s, KN95 and surgical masks can weaken after prolonged or repeated use, compromising the fit. Surgical masks have the loosest fit, but they have been shown to be more effective than cloth masks at preventing community transmission.
"A person who wants to limit transmission to themselves or others should choose a high-quality mask like an N95 or a KN95," Styczynski said. "For others, a surgical mask alone or under a cloth mask could be a good choice. The most effective mask, however, is the one that you will wear. So it's important to balance mask effectiveness and comfort."
Fit is important, but a mask that leaks a bit is more effective than no mask at all, Styczynski said. "You probably won't be wearing any of these masks perfectly. But a bit of air leakage doesn't mean the mask is pointless because not all viral particles are aerosolized. Surgical masks block droplets, for example. And all masks remind people not to touch their noses and mouths frequently."
To check the fit of your N95 or KN95 mask, Styczynski recommends taking a slow breath in while wearing your mask to check for leakage. "If the material of the mask slightly collapses when you inhale, you know your mask is filtering the air," she said. "When you breathe out, cup your hands around the outside of your mask to check for air leaks."
One of the most obvious, and difficult to manage, tolls of the past two years is the effect of the pandemic on our collective mental health. Many of us are experiencing a stew of emotions that can bounce from anxiety to frustration to sadness -- to flat-out anger at people with whom we disagree.
"Realizing that you can't control what other people are doing and that their actions could affect your life is basically a recipe for anxiety, and that can lead to friction and stress," said clinical psychiatrist Debra Kaysen, PhD, who specializes in the treatment of post-traumatic stress disorder and related conditions.
"We're in a period now where people have to figure out where their own personal comfort zones are, and act accordingly," said Kaysen. "And this can change day by day, according to the people and activities with which they engage."
This is tough for those of us (myself included) who just want to know what to do.
Kaysen recommends breaking down a situation (say, a crowded indoor wedding) into smaller questions: Will the attendees be vaccinated? Can I wear a mask? Then seek out reliable, science-based information about specific risks. If the process is too overwhelming, she suggests setting aside a specific amount of time to worry about things and then accepting the uncertainties and moving on. "Constant worry is never helpful, and it just makes you tired," she said.
Anger is also exhausting, and rarely productive, Kaysen said. "One of the most helpful things is to try to understand the other person's perspective, at least a little," she said. "The other is to avoid dehumanizing the other person, which we often do when we assign people to groups or categories. Empathy and compassion are important."
Kaysen gives an example: "I can understand that the lockdown was an economic hardship for business owners, and that must have been especially frustrating if case levels in their area were relatively low at the time. Or I can acknowledge that wearing masks and social distancing isn't fun, even though it may be necessary at times."
It can be difficult to feel your life is restricted while others appear to be living life as normal with seemingly no consequences.
"It's become necessary to practice an acceptance of uncertainty," Kaysen said. In general, humans are pretty bad at this. "It's particularly difficult for people prone to anxiety to accept that they cannot control outcomes, particularly around what they perceive as a threat. We want things to be black and white. Instead, we have many shades of gray that make up a constantly evolving picture."
There's more clarity around COVID-19 vaccines: It's been conclusively shown that vaccination saves lives.
"It's almost miraculous how well these vaccines work," said Yvonne Maldonado, MD, the Taube Professor in Global Health and Infectious Diseases. But the initial push to vaccinate all eligible Americans stumbled in the face of vaccine misinformation and hesitancy. And subsequent recommendations about booster shots have been fraught with confusion and frustration as the public tries to parse complicated scientific information almost in real time.
"The virus is mutating quickly, and this is a challenge to vaccine manufacturers," Michael Lin, MD, PhD, an associate professor of neurobiology and of bioengineering said. "We need to develop vaccines that remain effective in the face of new viral strains for longer than six months. We're not currently in that situation."
Lin's lab researches antiviral drugs to combat SARS-CoV-2 and he has been an active proponent on Twitter, and in the media, of the need to develop variant-specific boosters against the virus.
Recently, the Food and Drug Administration authorized -- and the CDC subsequently recommended -- a second booster shot to certain groups of people who received their first booster at least 4 to 6 months earlier. But many eligible people eager for another booster are left wondering whether to get one now, even though cases are relatively low, or to wait until promised omicron-specific boosters become available.
"It really depends on what happens with the evolution of the virus and the development of new vaccines," Lin said. "But it's quite possible we could get an additional level of protection from an annual booster every fall."
Still, the available vaccines and boosters, all of which target the original strain of the virus, drastically reduce the chance of becoming seriously ill or dying. And vaccine researchers and manufacturers are continuing to optimize their shots.
"We're going to get much better at building modular vaccines that can protect against more than one variant," Maldonado said. "We're also looking at traditional platforms used by vaccines like Novavax, which could be quickly adaptable to changing conditions. We couldn't do this initially because we were focused on learning whether the first vaccines were safe -- and they are incredibly safe. Now we're going to keep improving the technology to combat future variants and even other viruses."
Down the line, COVID-19 vaccine boosters could come in the form of a sniff, rather than a jab. Nasal-based vaccines target the "front door" of viral entry, revving up immune cells in the mucosa to barricade the door the moment the virus enters the nasal passages. "This could be the best way to quash infection and prevent transmission," Lin said.
Two years ago, we consoled ourselves with the idea that eventually we'd get back to a "new normal" in which we could comfortably cohabitate with the SARS-CoV-2 virus. Now, as the "pendemic" enters full-blown toddlerhood, we're realizing that uncertainty is a mainstay as we forge our own paths, lugging invisible abacuses bedecked with our individual risk and benefit beads and remembering what we left behind.
"There are still questions that no one can really answer with any degree of certainty," said Bali Pulendran, PhD, the Violetta L. Horton professor of pathology and microbiology and immunology. "But when historians look back at this time, there won't be any doubt about the devastating impact of this pandemic. We've seen 1 million deaths in this country. All of us have been through a war of sorts, a world war against this virus."
Read more the two-year mark of the beginning of the pandemic: Two years into the pandemic, medical scientists consider what the future may hold
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Prime Minister Boris Johnson of Britain was among those told that they would receive fixed penalty notices, which usually result in a modest fine.Credit...Hannah Mckay/Reuters
LONDON Prime Minister Boris Johnson was told on Tuesday that he would receive a fine for breaking lockdown rules at Downing Street, making him the first holder of his office to be found breaking the law in living memory.
In a statement Londons Metropolitan Police said it had identified at least 50 breaches of the law as part of its inquiry into the partygate scandal that has dealt severe damage to Mr. Johnson.
Though the police did not name any of those fined, the prime ministers office later said that Mr. Johnson and the chancellor of the Exchequer, Rishi Sunak, had both been told they will receive fixed penalty notices for breaking the law.
In its statement, the Metropolitan Police said that the inquiry into allegations of breaches of Covid lockdown rules in Whitehall and Downing Street, the complex of offices and official homes at the heart of the British government, continues to progress, and that, as of Tuesday, it had made over 50 referrals for fixed penalty notices, the process for levying a fine without a court appearance.
The prime minister and the chancellor of the Exchequer have today received notification that the Metropolitan Police intend to issue them with fixed penalty notices, Downing Street said in a statement. Such notices are given when the police believe a criminal offense has been committed, result in a modest fine, and, though there is no appeal, could be disputed in court though there was no suggestion from Downing Street on Tuesday that Mr. Johnson intended to do so.
The announcement on Tuesday immediately revived the furor over the partygate scandal, with the leader of the opposition Labour Party, Keir Starmer, demanding Mr. Johnsons resignation.
More important, however, will be the reaction of lawmakers in the governing Conservative Party, the only group who could force a no-confidence motion for Mr. Johnson. It would happen were 54 of them to demand one.
While that prospect seemed imminent earlier this year when the crisis threatened to sweep Mr. Johnson from power, his political fortunes have rebounded since largely because of the focus on the war in Ukraine. Some lawmakers who had called formally for a vote on Mr. Johnsons future withdrew their requests, arguing that now was not the time to replace him.
Nonetheless Mr. Johnson is now in the uncomfortable position of being the only prime minister in living memory to have broken laws that he made himself. In addition, he has denied that coronavirus rules were breached, exposing himself to the charge that he misled Parliament. By convention, that is normally regarded as a resigning matter in British politics.
Lawmakers are away from Parliament this week because of the Easter recess, a factor that could make it harder for Mr. Johnsons internal critics to organize against him. Some of Mr. Johnsons allies have argued in the past that receiving a fixed penalty notice is more akin to a speeding ticket than a successful prosecution and a group of loyal lawmakers have rallied around the prime minister in recent months.
The prime ministers position inside the Conservative Party has also strengthened in recent days because of a crisis engulfing the chancellor of the Exchequer, Rishi Sunak, the man many assumed to be in prime position to take over were Mr. Johnson to fall. Significantly, Mr. Sunak was also told he would be fined over partygate, as was Carrie Johnson, the wife of the prime minister.
However, the situation remains precarious for Mr. Johnson. The scandal has been particularly damaging because, at the time of the Downing Street parties, many people in Britain were prevented from having contact with dying relatives.
Boris Johnson was partying and breaking his own lockdown rules, while we were unable to be at loved ones sides in their dying moments, or in miserable funerals with only a handful of people, said a statement on Twitter from a group called Covid-19 Bereaved Families for Justice U.K.
There is simply no way either the prime minister or chancellor can continue. Their dishonesty has caused untold hurt to the bereaved, it added.
Even after being judged to have broken the rules, Mr. Johnson still faces further embarrassment because he has promised that once the police investigation is complete, he will publish an internal government report into the parties that took place in Downing Street. An interim version of that document, compiled by the senior civil servant Sue Gray, was damaging enough to precipitate the police investigation.
The Metropolitan Polices inquiry into the parties is still underway and its statement on Tuesday said that officers were continuing to assess significant amounts of investigative material a hint, perhaps, that further fines are to come.
Against this backdrop, Conservatives face a test of their popularity next month in local elections in which a poor result would further increase pressure on Mr. Johnson.
Megan Specia contributed reporting.
Coronavirus cases are once again on the rise in Los Angeles County, according to data released Monday, prompting officials to urge residents to keep up safety protocols as the spring break holiday season arrives.
Data show that for the seven-day period that ended Monday, an average of 960 new cases were reported daily countywide, which equates to 67 cases a week for every 100,000 residents. Thats up 23% from the previous week, when L.A. County reported an average of 783 cases a day.
Caseloads of this magnitude remain a far cry from the tens of thousands of new daily infections during the height of the Omicron surge. In mid-January, L.A. County was reporting 42,000 new coronavirus cases a day.
Nevertheless, the trendline is the source of some concern, especially given the proliferation of BA.2 an Omicron subvariant estimated to be 30% to 60% more contagious than the earlier version that swept the globe last fall and winter.
Scientists are also now tracking an even more potentially contagious subvariant, XE, which some early estimates indicate may be 10% more transmissible than BA.2.
The evidence is becoming clearer that given the current approved vaccines and the reality of a mutating virus, some of us will need to boost our immune systems a couple of times during the year in order to be optimally protected, county Public Health Director Barbara Ferrer said in a statement. This includes those infected with Omicron over the winter, since natural immunity ... also wanes over time.
Given that many residents are likely to travel or gather in the coming weeks either for spring break or to mark holidays such as Easter, Ramadan or Passover Ferrer said it remains important to do our very best to make use of the powerful tools at hand, vaccinations, boosters, testing, and masking, to keep ourselves and those most vulnerable to severe illness, as safe as possible.
There are more than 1.7 million L.A. County residents age 5 and up who havent received a single vaccination dose, and an additional 2.8 million vaccinated residents who havent received a booster, even though theyre eligible for one.
L.A. Countys coronavirus case rate hit a post-winter surge low of about 609 cases a day from March 18 to 24. That was about two weeks after the region ended its universal requirement to wear masks in indoor public spaces one of the last counties in California to do so.
Since then, the countywide case rate has ticked upward, a development officials have said is likely fueled by a combination of waning immunity, the loosening of masking rules and the spread of BA.2.
The daily reported caseload is just one of many metrics health officials utilize to track and assess the pandemics trajectory. Another, the proportion of conducted tests that are confirming coronavirus infection, has also inched up slightly as of late, but remains low at 1%, county health officials said.
And while cases have crept up a bit, the number of people hospitalized with COVID-19 countywide has continued to trend downward. As of Sunday, 265 coronavirus-positive patients were hospitalized countywide down about 8% from a week ago.
Experts in California have said there are unmistakable signs of an uptick in coronavirus cases in the state. But whether this latest uptick ultimately proves to be a temporary blip or the harbinger of something more significant, however, remains to be seen.
For the weekly period that ended Thursday, California was averaging about 2,800 cases a day, or 50 cases a week for every 100,000 residents, up 9% over the prior week.
Orange Countys case rate is also increasing. Orange Countys case rate is about 134 cases a day, or 30 cases a week for every 100,000 residents, up 12% over the prior week.
San Francisco, which now has one of Californias highest case rates, on Thursday was recording about 127 cases a day, or 102 cases a week for every 100,000 residents, a 6% increase over the prior week.
A coronavirus case rate of 50 or more cases a week for every 100,000 residents is considered substantial, while a rate of 100 or more is considered high.
Dr. Robert Wachter, chair of UC San Franciscos Department of Medicine, tweeted Thursday that the percentage of asymptomatic patients testing positive at UC San Franciscos hospitals had risen to 2%, up from 1% in late March.
If youve let guard down, time to be more careful, he wrote.
By Monday, the rate had dipped back down to 1.6%, Wachter said in an email. That means that in San Francisco, theres a 28% chance that at least one person attending a party with 20 asymptomatic people will test positive for the coronavirus.
Some experts are optimistic that the case numbers so far offer glimmers of hope that this spring will not bring a second Omicron surge on the magnitude of those seen elsewhere such as Britain, where hospitals have once again come under strain.
Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, tweeted Saturday that its clear that wave 6 (BA.2), yet still in the works, will not resemble the fifth surge of the pandemic, or last winters Omicron surge.
But Myoung Cha, chief strategy officer for San Francisco-based Carbon Health, disagreed with confident takes that this surge wont be big. He noted many people this year are self-diagnosing with at-home tests the results of which are not reliably reported to the government.
By contrast, lab tests conducted at official facilities are automatically reported to the authorities.
The current case rates are massively undercounted versus prior surges, Cha tweeted Sunday.
As is the case anytime COVID-19 shows signs of resurgence, the question on many peoples minds is when, or whether, health authorities may consider reimplementing restrictions.
In Philadelphia, where cases have jumped by more than 50% over the last 10 days, officials on Monday announced the return of an indoor mask mandate, effective April 18.
Philadelphia had preexisting criteria in place that would trigger a return to a mask order when average new cases a day exceeded more than 100 and when cases have risen by more than 50% in the previous 10 days. On Monday, officials reported that the city of 1.58 million people was averaging 142 new cases a day, or 63 cases a week for every 100,000 residents.
Philadelphia Mayor Jim Kenney said the return of the mask mandate in indoor public settings was needed to prevent higher case rates.
Our city remains open; we can still go about our daily lives and visit the people and places we love while masking in indoor public spaces, Kenney tweeted.
A number of universities in the Northeast have announced a return to universal mask policies. Columbia University, Georgetown University and American University have announced the return of indoor mask requirements recently.
So far, officials in L.A. County and the state have not indicated that conditions warrant the imposition of new measures or mandates though, in both cases, they still urge residents to mask up indoors while in public.
Speaking with reporters last week, though, Ferrer said people should be concerned about the rise in the number of school outbreaks countywide. There were 14 new outbreaks in K-12 schools in L.A. County for the week that ended Thursday. For the previous week, there were four.
She noted that in some other settings where masking is still required like nursing homes and homeless shelters there has not been an increase in outbreaks.
Ferrer also expressed some optimism that a second increase in Omicron cases this spring wouldnt be as bad as the winter surge. People who have been infected with the earlier Omicron subvariants earlier this winter, BA.1 or BA.1.1, are likely to have a degree of immune protection against the latest Omicron subvariant, BA.2, at least for the near future.
I am hopeful that given what weve seen and what were doing, we should be able to avoid a really big surge, Ferrer said.
In a round of interviews with morning network shows, Dr. Ashish Jha, the incoming White House COVID-19 Response Coordinator, said hes not overly concerned right now about the rise in cases nationally.
Case numbers are rising. We were expecting this, because we saw this in Europe a few weeks ago, Jha said on NBCs Today show. But the good news is: Were coming off of some very low infection numbers. Hospitalizations right now are the lowest they have been in the entire pandemic.
So weve got to watch this very carefully. Obviously, I never like to see infections rising, I think weve got to be careful, but I dont think this is a moment where we have to be excessively concerned, Jha said.
Two years into the pandemic, colleges are still fine-tuning their COVID-19 mitigation policies, changing course as needed to keep students safe and case counts low. In the latest pivot, some colleges are reinstating mask mandatesjust as coronavirus cases begin to increase on campus.
Over the last week, colleges across the countryincluding American University and Georgetown University in Washington, D.C.; Columbia University in New York; and Rice University in Texas, to name a fewhave reinstated mask mandates to mitigate the spread of COVID-19 on campus.
Many of the colleges making such changes already have vaccine and booster mandates.
The reversal comes amid changing public policies nationwide. Many cities are dropping mask mandates, and the Centers for Disease Control and Prevention recently rolled back recommendations to wear face coverings indoors, at least among those living in areas designated low to medium risk according to local data. For example, Washington, D.C., dropped its indoor mask mandate on March1, but American and Georgetown have reintroduced their own requirements.
The uptick in COVID-19 cases at colleges comes, for some, on the heels of spring break.
Many of these colleges had spring break about two weeks ago. And there are some that are just having it now, said Gerri Taylor, co-chair of the American College Health Associations COVID-19 task force. I think were going to see rolling surges that will hit certain colleges based on their spring break schedule, or based on any unmasked, unvaccinated indoor events.
Some colleges have made a direct link between spring break and revived mask mandates.
In response to travel-related COVID cases among undergraduates after Spring Break, we last week reinstated limited aspects of the campus precautions originally lifted in March: required masking in common areas of residence halls and dining facilities, and twice-weekly testing for undergraduate students, Jill Rosen, a spokesperson for Johns Hopkins University, said by email.
While some colleges are reintroducing mask mandates, others are keeping them optional. The University of Michigan, for example, made masking optional in March, a couple of weeks after its spring breakthough face coverings are required in classrooms and certain other spaces.
University officials noted that the uptick in caseswhich jumped the week of April4 and then leveled off, according to Michigans COVID dashboardis linked to large indoor gatherings.
Dr. Preeti Malani, chief health officer at Michigan, compares coronavirus mitigation measures now to a dial, whereas prior to vaccinations they were more like switches that colleges flipped on or off. But with years of data and experience managing the pandemic, officials are more confident in their ability to make targeted strategic changes rather than instituting broad mandates.
When everyones coming back to campus after traveling, maybe thats when you dial up the masking requirements indoors until you know that youre not going to see a large increase, Dr. Malani said. And that may be the case in the fall. Its very difficult to know how fall will look.
Beyond masking, colleges are taking actions like hitting pause on large events, reducing capacity in some common areassuch as dining hallsand urging general pandemic precautions.
Large college parties are canceled this weekend, Kevin Kirby, vice president of administration at Rice University, said in a message to faculty, staff and students last week. The Dean of Undergraduates is meeting this evening with college magisters and student presidents to discuss modifications to events and event planning for the remainder of the semester in the colleges. Students should look for updates from college leaders. Students can continue to eat indoors in college commons and surrounding areas, but at half the designated occupancy.
Rices coronavirus dashboard shows 111 positive tests in the past seven days and a noticeable upward trajectory for early April.
Given that some colleges canceled in-person instruction for much of 2020, Dr. Michael McNeil, chief of administration for Columbia Health, said reintroducing mask mandates is about keeping students where they want to be and not losing progress made during the pandemic.
If there is a bit of an uptick, were not going to overreact, but we want to be responsive, McNeil said. Were not going to ignore this uptick, especially because were staying in that green zone. But we want students in the classroom, students want to be in the classroom; this is a step to help support that.
Reinstating mask mandates is also about reaching the end of the semester, which is on the horizon.
We are focused on helping the AU community stay healthy, limit isolation, and maintain their academic and professional pursuits, Matthew Bennet, a spokesperson for American University, said by email. The mask requirement resumed to support our community of care and help students, faculty, and staff successfully and safely complete the semester as we approach the conclusion of classes, the exam period, and our commencement celebrations.
For most colleges, the end of the academic year is in sight. But the end of the pandemic? Not so much.
Taylor notes that the pandemic seemed to be easing up last year, and then the Omicron and Delta variants arrived, introducing a surge in coronavirus cases. Though colleges have reason to be optimistic, she said, that should be balanced with heavy doses of vigilance and caution.
I think were going to continue to see ups and downs from COVID, Taylor said. Im optimistic for this spring and summer. Im more concerned about the fall, when we go back indoors. I think at certain periods in the next year, were going to have to pull out those masks again.
While colleges dont have much in the way of certainty, they do have an arsenal of tools at their disposal. Dr. Malani points to vaccine and booster requirements and robust testing as ways that colleges can keep case counts down. Using such tools can help universities establish policies that allow students to stay safe in the classroom while also enjoying their college experience. After all, COVID-19 isnt the only health concerntheres also a student mental health crisis.
If you think about the risk of COVID versus the risk of isolation and mental health issues, you can manage the risk of COVID. And I think thats the difference between 2020 and now, Dr. Malani said. As were thinking about COVID risk, I hope were thinking about all other risks, whether its loneliness and isolation, its substance use, other high-risk behavior, or academic concerns.
Despite the return of mask mandates, some experts point to positive momentum since the onset of COVID-19. Though the future of the pandemic is unknown, the tools to battle it are in hand.
If we continue to do what we know, which is to use empirical evidence to inform our decision making, if we continue to listen to and be responsive to our populations, and if we continue to act individually and collectively, we can see our campuses through to the other side, Dr. McNeil said. We, of course, dont have a crystal ball and cant tell exactly what thats going to look like or when thats going to happen. But I think we can get there, and were certainly on the right path.
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Thousands of doses of COVID-19 therapeutics and preventive treatments sit unused in Michigan because doctors haven't been prescribing them, the state's top doctortold the Free Press last week.
"The issue in the beginning had been that we thought demand would outpace supply and that didn't really happen in the state of Michigan or in most of the country,"said Dr. Natasha Bagdasarian, the state's chief medical executive.
"What we really saw was the clinicians were a little bit hesitant to prescribe it ...because they were still learning about it."
Doctors haven't been prescribing Evusheld, the preventive coronavirus antibodytherapyfor people who are immunocompromised and who may not respond well to vaccines, at the rate at which Bagdasarian hoped they would.
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Evusheld,made by AstraZeneca, was shown in clinical trials to protect 77% of vulnerable peoplefrom developing COVID-19 for as long as six months after the double-injection treatment.
They also haven't been prescribing the COVID-19 antiviral pills Paxlovid and Molnupiravir as much as expected orbebtelovimab, a monoclonal antibody infusionthat can be administered soon after a person is infected to reduce the risk of hospitalization, Bagdasarian said.
As of Friday, the Michigan Department of Health and Human Services reported a supply of:
"With therapeutics, while theoretically, the issue we thought would be supply, in reality, we had a harder time actually getting it out to folks to be used."
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Part of the reason also is because not as many people are sick right now with COVID-19 in Michigan, so demand is down.
Case rates have fallen to one-year lows, and hospitals are getting a reprieve from the crush of sick patients who filled their rooms and lined their halls just a few months ago.
The Biden administration is concernedthat this moment of relative pandemic quiet could leave the nation unprepared for another wave of sickness and deathas the BA.2 omicron subvariant rages in someother parts of the world.
The administration lobbiedheavily for billions more dollars infederal funding to buy additional coronavirus tests and antiviral treatments,to pay for more COVID-19 research,vaccines and monoclonal antibody therapy. But a bipartisan bill that would have delivered $10 billion to partially fund those efforts stalledlast weekin Congress.
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"Make no mistake: Inaction will leave our nation less prepared for any future surges and variants," said Jeff Zients, White House Coronavirus Response coordinator,in a statement issued Friday. "It will mean fewer vaccines, treatments, and tests for the American people. This is deeply disappointing and it should be unacceptable to every American.
"Weve worked too hard and come too far to leave ourselves and our economy vulnerable to an unpredictable virus. The virus is not waiting on Congress to negotiate. Congress must act with urgency."
In the meantime, Bagdasarian said state health leaders are doing all they can to ensure doctors know about the availability of the current supply oftreatments in Michigan and that theyare prescribing them to people who need them.
"We need to be able to encourage physicians to prescribe therapeutics and Evusheld as pre-exposure prophylaxis in the appropriate clinical situations," she said. "We've been doing things like webinars, but clearly we need more clinician education.
"We need to educate patients and families so that they can be strong advocates … and then working with with communities and working with individuals so that they can ask for these medications ... themselves.
"One of the things we've been talking about is going around and speaking to all of our health care systems in the state to really talk about how to integratethese COVID-19 tools into our everyday patient encounters."
With COVID-19vaccines, she said, it's a similar situation.
When they first came to market in December 2020, there wasn't enough supply to meet demand. But now, Bagdasarian said, "vaccines are widely available and recommended for individuals over the age of 5 and there remains almost half of our state who are not fully vaccinated."
Nearly 60% of Michiganders almost 6 million people have been fully vaccinated against COVID-19 as of Friday, according to the U.S. Centers for Disease Control and Prevention. That compares with roughly 67% of the overall U.S. population.
But only about 3.2 million Michigan residentshave gottenat least one booster dose,the CDC reported, roughly one-third of the state's population. Far fewer people ages 50 and older and those who are immunocompromised, noweligible for a second booster dose, have gotten them.
While booster doses are important, Bagdasarian said, especially against the omicron variant, reaching the people who've yet to get a single dose of a COVID-19 vaccine remains among state health leaders' biggest challenges.
"We have been working with community leaders, with communities, with trusted messengers and really trying to talk about vaccines and trying to communicate about vaccines in different ways," she said.
"Early on in the pandemic, we did a great job reaching out to people who were over the age of 65. And we've got great (vaccination) rates in our older Michigan residents. Where we are really struggling is with younger Michigan residents and with communities of color."
Vaccination rates in Michigan are above 70%among people ages 50 and older, state data shows, but among younger age groups, the percentage of those fully vaccinated is much lower:
And among Black Michiganders, just 40.7% are fully vaccinated. That compares with a vaccination rate of 61% among Asian and Pacific Islanders; nearly 55% for Hispanic and native Hawaiian, American Indian and Alaska Native populations, and 53% of non-Hispanic white Michiganders.
"That means we need a different communication strategy and a different approach and to work with different trusted messengers and to really get out there and talk to communities more," Bagdasarian said.
"Individuals who had fewer reservations about vaccines, who had more trust in vaccines, they are already vaccinated. And now we need to work on partnering with communities who are maybe still a little hesitant and showing them the evidence and showing them why vaccination is a good option.
"There are no easy solutions."
More: Art exhibit inside Sparrow Hospital shows caregivers' reflections of COVID-19 pandemic
With coronavirus case rates so low right now, people aren't as concerned about the virus as they might have been a year ago, she said.
"We're in a recovery period right now," Bagdasarian said. "That doesn't mean that the pandemic is over. It means that we are just getting ready for what's in the future."
That future is likely to include another surge, she said, whether that's driven by BA.2, which now accounts for more than half of all coronavirus cases in the state,or another strain of the virus.
"We know that the proportion of BA.2 isolated in the U.S. and in our region of the United States has increased," Bagdasarian said. "We are watching very carefully for impacts here in our state. ... There are some early signs that BA.2 is having an impact here."
More: Michigan coronavirus cases: Tracking the pandemic
More: Listen to the 'On The Line' podcast: Chasing out Nain Rouge and the devil of COVID-19
There hasbeen an uptick in the number of Michigan wastewater facilities reporting plateaus or increases in detection of coronavirus in sewage compared with previous weeks, according to a state health departmentreport released Thursday.
COVID-19 hospitalizations have plateaued, too.
Because so many people are using at-home rapid antigen tests when they have symptoms of the virus rather thanseeking tests at health care providers that report to the state health department, case rates and the percentage of positive testsare no longer the most accurate measures of how much spread is happening in the community.
Even if this isn't the start of another COVID-19 surge, Bagdasarian saidthe BA.2 subvariant"will not be the last ... we're concerned about."
"COVID isn't now some pandemic that's on the side that will be gone soon," she said."It's a part of our society. It's something that's here to stay and we have to be able to live with it and treat it as any other preventable disease."
Contact Kristen Jordan Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus.
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When Queen Elizabeth came down with COVID-19 in late February, the palace only said that she was experiencing mild cold-like symptoms, and further details were unavailable. Within two weeks, she was back to doing her usual work, including an in-person meeting with Justin Trudeau, but the effects apparently lingered. In a conversation with National Health Service workers organized by the Royal London Hospital last week, she went into more detail about her course of the virus.
After hearing former patient Asef Hussain discuss the lingering effects of his battle with COVID, the queen responded with a question that hinted at her own experience. It does leave one very tired and exhausted doesn't it, this horrible pandemic? she said. Its not a nice result.
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When speaking to a patient who had a severe case of COVID, she asked about what it was like to battle the illness while isolated from family. It obviously was a very frightening experience to have COVID very badly, she said in response to the patients story.
She spoke to the NHS employees to commemorate the opening of the new Queen Elizabeth Unit, a 155-bed wing of the hospital devoted to accommodating patients with breathing issues. According to the Guardian, the units construction was accelerated due to rising case counts in London, and it was completed in only five weeks, when a similar project would usually take about five months.
One construction worker on the project said it was an example of Dunkirk spirit, in reference to the World War II battle where commercial ships from across the U.K. helped evacuate British soldiers who were trapped on beaches under Nazi siege. Thank goodness it still exists, she said in response. It is very interesting, isnt it, when there is some very vital thing, how everybody works together and pulls together marvelous, isnt it?
Though the queen has seemingly recovered from her bout with COVID, she is still dealing with ongoing health issues that began when she was briefly hospitalized in October. Last month she canceled a planned appearance at the annual Commonwealth Day church service amid mobility problems and only announced her decision to attend a memorial service for Prince Philip on the morning of. This week, she is sitting out the annual Maundy Thursday celebration where she hands out a traditional sack of coins to a group of elderly people. On Friday, the palace announced that she would be replaced by Prince Charles.
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Two-plus years into the Covid-19 pandemic, you probably know the basics of protection: vaccines, boosters, proper handwashing and masks. But one of the most powerful tools against the coronavirus is one that experts believe is just starting to get the attention it deserves: ventilation.
The challenge for organizations that improve air quality is that its invisible, said Joseph Allen, director of the Healthy Buildings Program at the Harvard T.H. Chan School of Public Health.
Its true: Other Covid tools are more tangible. But visualizing how the virus might behave in poorly ventilated spaces can help people better understand this mitigation measure.
Allen likens it to cigarette smoke. If Im smoking in the corner of a classroom and you have low ventilation/filtration, that room is going to fill up with smoke, and everyone is breathing that same air.
Then apply that to the outdoors.
I could be smoking a cigarette, you could be a couple of feet from me, depending which way the wind was blowing, you may not even know Im smoking.
If youre indoors, you could be breathing in less fresh air than you think.
Everybody in a room together is constantly breathing air that just came out of the lungs of other people in that room. And depending on the ventilation rate, it could be as much as 3% or 4% of the air youre breathing just came out of the lungs of other people in that room, Allen said.
He describes this as respiratory backwash.
Normally, thats not a problem, right? We do this all the time. Were always exchanging our respiratory microbiomes with each other. But if someones sick and infectious those aerosols can carry the virus. Thats a problem.
Weve known for decades how to keep people safe in buildings from infection, from airborne infectious diseases like this one, Allen said.
From the beginning of the pandemic, Allen and other experts have waved red flags, saying that the way we were thinking about transmission of Covid-19 surfaces, large respiratory droplets was missing the point.
Hand washing and social distancing are appropriate but, in our view, insufficient to provide protection from virus-carrying respiratory microdroplets released into the air by infected people. This problem is especially acute in indoor or enclosed environments, particularly those that are crowded and have inadequate ventilation, hundreds of scientists stated in an open letter in July 2020.
Eventually, the World Health Organization and the US Centers for Disease Control and Prevention acknowledged what the experts had been saying all along: that Covid-19 could also spread by small aerosolized particles that can travel more than 6 feet.
The coronavirus itself is very small about 0.1 microns but that doesnt affect how far it can travel.
The size of the virus itself doesnt matter because, as we say, the virus is never naked in air. In other words, the virus is always traveling in respiratory particles that develop in our lungs. And those are all different sizes, Allen said.
Singing or coughing can emit particles as large as 100 microns (almost the width of a human hair), he said, but the virus tends to travel in smaller particles between 1 and 5 microns.
The size of these particles affects not only how far it can travel but how deeply we can breathe it into our lungs, and how we should approach protecting ourselves from this virus.
When youre talking about an airborne disease, theres the whats right around you, you know, the sort of the people who you know can cough in your face, the 6 feet thing, and then theres the broader indoor air, because indoor air is recirculated, said Max Sherman, a leader on the Epidemic Task Force for the American Society of Heating, Refrigerating and Air-Conditioning Engineers.
Outdoors is safer than indoors has become an accepted mantra with Covid-19. Allen points out that protecting ourselves indoors is where our focus should always be, even beyond the pandemic.
Were [an] indoors species. We spend 90% of our time indoors. The air we breathe indoors has a massive impact on our health, whether you think about infectious disease or anything else, but it just has escaped the public consciousness for a long time, he said.
Making sure our indoor air is healthy is not that complicated, Sherman said. You just want to reduce the number of particles that might be carrying Covid or any other nasty [virus].
The way you do that is through ventilation and filtration.
Filtration just like it sounds is filtering or cleaning the air, removing the infected particles. But think of ventilation as diluting the air. Youre bringing more fresh air in to reduce the concentration of those particles.
Dilution is exactly why we havent seen superspreader events outdoors, Allen says.
We have hardly any transmission outdoors. Why is that? Unlimited dilution, because you have unlimited ventilation. And so, even in crowded protests or outdoor sporting events like the Super Bowl, we just dont see superspreading happening. But if we did, wed have the signal be loud and clear. We just dont see it. Its all indoors in these underperforming, unhealthy spaces.
Even before the advent of HVAC systems, ventilation was integrated into many building designs.
The 1901 Tenement Housing Act of New York required every tenement building a building with multifamily households to have ventilation, running water and gas light.
Builders added ventilation to many of these buildings with a shaft in the middle that runs from the roof to the ground, allowing more airflow.
In the late 19th century, people are finally starting to understand how disease spreads. So airshafts and the accompanying ventilation were seen as a solution to the public health crises that were happening in tenement buildings, said Katheryn Lloyd, director of programming at the Tenement Museum. There were high cases of tuberculosis, diphtheria and other diseases that spread. Now we know that spread sort of through the air.
Today, were facing the same challenge.
Getting basic ventilation in your home is important, full stop, Sherman said.
One of the easiest, cheapest ways to do that is to open your windows.
Open doors or windows at opposite ends of your home to create cross-ventilation, the Environmental Protection Agency advises. Opening the highest and lowest windows especially if on different floors of a home can also increase ventilation. Adding an indoor fan can take it even further.
If a single fan is used, it should be facing (and blowing air) in the same direction the air is naturally moving. You can determine the direction the air is naturally moving by observing the movement of drapes or by holding a light fabric or dropping paper clippings and noting which direction they move, the EPA says.
Just cracking a window can help a lot, Allen says: Even propping a window open a couple inches to really facilitate higher air changes, especially if you do it in multiple places in the house, so you can create some pressure differentials.
Its important to note that if you have an HVAC system, it must be running to actually circulate or filter the air. The EPA says that these systems run less than 25% of the time during heating and cooling seasons.
Most of the controls these days have a setting where you can run the fan on low all the time. And thats usually the best thing to do because that makes sure youre getting youre pushing air through the filter all the time and mixing the air up in your in your home, Sherman advised.
This could be something to keep in mind if youre going to have visitors or if someone in the household is at higher risk for severe illness.
Choose the most efficient filter your HVAC system can handle, and make sure you routinely change the filters.
Filters have a minimum efficiency reporting value, or MERV, rating that indicates how well they capture small particles. The American Society of Heating, Refrigerating and Air-Conditioning Engineers recommends using at least a MERV-13 filter, which it says is at least 85% efficient at capturing particles from 1 to 3 microns.
If thats not an option, portable air filters can also work well, but the EPA says to use one that is made for the intended room size and meets at least one of these criteria:
When you walk into a space, theres no good rule of thumb to look around and gauge how well-ventilated it might be, and that can be a challenge when people have been tasked with assessing their own risk.
Allen suggests starting with the basics: Make sure youre up to date with vaccinations and aware of where Covid-19 numbers stand in your community.
But then it gets harder. Even the number of people in a space isnt a giveaway of a higher-risk situation.
The more people in there could be higher-risk because youre more likely to have someone whos infectious, but if the ventilation is good, it really doesnt matter.
Ventilation standards are based on an amount of fresh air per person, plus the amount of fresh air per square foot, Allen explained. So if you have a good system, the more people that enter the room, the more ventilation is brought in to the room.
One tool that can help you assess ventilation in a room is a CO2 monitor, something Allen wishes he saw more in public spaces. He likes to carry a portable one, which you can order online for between $100 and $200.
If you see under 1,000 parts per million, generally, youre hitting the ventilation targets that are the design standard. But remember, these are not health-based standards. So we want to see higher ventilation rates.
Allen prefers to see CO2 at or under 800 parts per million. He also notes that just because a space has low CO2 levels, it might not be unsafe if filtration is high, like on an airplane.
Atlanta Public Schools Superintendent Lisa Herring says the installation of 5,000 air filtration units enough for every classroom in her school district is a gamechanger.
The district had begun upgrading HVAC systems in several schools even before the pandemic, but federal funding allowed it to add filtration units during a crucial time when masks have become optional.
It gives a greater level of confidence for us as a system to know that our air filtration systems are in place, Herring said.
School districts all over the country have been jumping at the opportunity for ventilation upgrades made possible by an influx of federal funding.
An analysis in February by FutureEd, a think tank at Georgetown Universitys McCourt School of Public Policy, found that public schools had earmarked $4.4 billion for HVAC projects, which could grow to almost $10 billion if trends continued.
New Hampshires Manchester School District is pouring almost $35 million into upgrading HVAC systems, and interim Superintendent Jennifer Gillis says federal funding is absolutely key.
You think about a district of our size with all the competing demands and the need to be fiscally responsible, a $35 million project, thats a large project to introduce to our budget. Having those funds available to us lets us do 19 projects and 19 projects in a very short span of time.
For Gillis, ventilation has been an important mitigation strategy and an unobtrusive way to keep people safe.
Its something that most in the building dont think about, but its a very passive way for us to create safety within the schools. Since the beginning, the goal was always lets get our kids in, lets get our staff in, but lets do it in a way thats safe for all of them.
Good ventilation isnt only about keeping students safe from Covid-19, Sherman says. It can also improve their performance in school.
Theyre going to learn better; theyre going to be awake more; theyre going to be more receptive. Theyre going to be healthier if theyve got good indoor air quality, he said.
Helping solidify ventilations role in the Covid-19 battle, the Biden administration announced a Clean Air in Buildings Challenge last month.
The challenge calls on building operators and owners to improve ventilation by following guidelines laid out by the EPA.
The main actions include creating a clean indoor air action plan, optimizing fresh air ventilation, enhancing air filtration and cleaning, and engaging the building community by communicating with occupants to increase awareness, commitment and participation.
The message may seem overdue, but its one that Allen enthusiastically welcomed.
The White House used its pulpit to say unequivocally that clean air and buildings matter. Thats massive. Regardless of what you think about what will happen next with implementation or what happens with the funding. That is a crystal-clear message that is already being heard by businesses, nonprofits, universities and state leaders. I see these changes happening already.
While COVID-19 cases in Philadelphia are rising to the point that the city will reimpose a mask mandate, a different metric heralded the uptick a few weeks earlier in other parts of the country. The clues were in poop.
For months, the citys public health department has been trying to set up a wastewater surveillance system as an early warning signal for coronavirus outbreaks. As home testing becomes more popular and diagnostic testing less accessible to the uninsured, wastewater numbers are an important supplement to increasingly imperfect testing data.
Philadelphia was early on the scene with a pilot program in May 2020, but the city has gone about a year since that initiative ended without studying its wastewater, even as the technique became more popular. It hopes to restart the program in a few weeks.
In September 2020, the CDC launched a National Wastewater Surveillance System, which has set up testing sites in 44 different states across the U.S. At least 13 counties in Pennsylvania, including Chester and Montgomery, are currently monitoring COVID levels in wastewater, and the state health department is setting up a statewide program using $4 million in CDC funding.
Philadelphia has fallen behind, but this game is a long way from being over, said Howard Nadworny, an infectious disease doctor who heads Erie Countys wastewater surveillance system, which was set up in 2020.
We are at great risk in public health of getting more blind to the state of the pandemic, Nadworny said, maybe even similar to what happened in the beginning of 2020.
Wastewater testing can be a canary in the coal mine for COVID because it doesnt rely on testing people, which may only happen after known exposures or the onset of symptoms.
The lead time depends on the delay in reported cases, said Scott Olesen, a researcher at Biobot, a private wastewater testing company. Wastewater monitoring can be particularly helpful during surges, when health departments can be overwhelmed by the volume of tests.
When Philly ran its 12-month pilot program in 2020 and 2021, we did find signals in the data, and they were nice signals. They tended to precede the case data by about three days. But not always, said Jos Lojo, an epidemiologist at the citys public health department. In other cases, the wastewater data was coincident with the testing data, and so it appears to be a nice adjunct.
Wastewater data has also been a good predictor of hospital admissions, which lag cases because it takes time for infections to become severe enough to warrant hospitalization. Some health systems have looked to wastewater data to help manage hospital capacity, such as deciding whether to schedule elective surgeries.
Wastewater data isnt just an earlier indicator it could also be a more comprehensive one. Recent research has shown that wastewater has the potential to help estimate the true number of cases in a community.
Wastewater sampling, if done hyperlocally, can also be a way to monitor specific populations without subjecting them to routine testing.
When the University of Pennsylvania ran a pilot wastewater program last year, it sampled from dormitory sewers and libraries. At the time, the university also tested students twice a week. That data aligned closely with results from wastewater testing, showing that wastewater data could track disease spread, said Jennifer Pinto Martin, an epidemiologist at Penns School of Nursing. Penn no longer requires constant testing of students, so the university is considering whether to bring back wastewater testing.
In practice, wastewater testing comes with its own challenges. For one, the extent to which monitoring can serve as an early warning system depends on which variants are circulating, said Jordan Peccia, a Yale University engineering professor who has been studying wastewater. With omicron, youre usually in the hospital pretty quickly, he said, which shortens the lead time that wastewater offers.
Researchers also dont know how much viral matter a person sheds, or for how long.
We have two confounding factors: One is that these variants impact people differently and they likely shed differently, Peccia said. And No. 2 is, depending on your vaccination status you respond to the infection differently.
Peccia has gotten around the problem by studying concentrations over time together with other testing data.
The CDC emphasizes trends in concentrations on its wastewater dashboard, as opposed to the concentrations themselves, in part because different sites may have different sampling methodologies making it difficult to compare numbers. Natural phenomena like rainfall can also affect readings.
The CDC is still figuring out how best to convert viral wastewater concentrations into estimates of the number of people infected with COVID, Lojo said, which could correct undercounts in the reported case numbers.
Thats the million-dollar question, he said.
Philadelphia first started testing wastewater in May 2020, just two months after the citys first reported case. Over the next year, as part of a $140,000 pilot program, the Philadelphia Water Department each week sampled wastewater from three sewage treatment plants that handle all the wastewater the city produces.
Then Heather Murphys lab at Temple University took over.
We essentially take 100 milliliters of wastewater and concentrate it down into a pellet that we then analyze for the virus, said Murphy, an epidemiology professor.
Murphy shipped the pellets to Michigan State University, where they were analyzed. Researchers also did preliminary work to identify the presence of specific variants, Murphy said.
After the pilot program ended and the city stopped wastewater testing, Philadelphia was hit with the delta and omicron waves, both of which other jurisdictions detected early in wastewater. Unable to test wastewater in real time, the city has been freezing samples since this January to better understand the omicron surge retroactively.
Philadelphia was awarded funding last August to restart surveillance and join the CDCs national program. It took almost seven months before the city signed a $700,000 contract with Temple, two weeks ago, to conduct wastewater testing through July. That will likely be extended by three to six months.
Its unfortunate that its taken so long, Lojo said.
The city described the delay as a routine part of contracting. A new city law requiring disclosure on the diversity of recipients of city contracts added to the delay, said health department spokesperson James Garrow.
Sample testing is expected to resume soon once Temple finalizes a subcontract with Michigan State. The lab expects to start producing real-time data in a few weeks.
The city now wants to go beyond measuring overall virus levels and known variants by sequencing viral particles to identify entirely new variants. Cities that have taken this step, such as New York, have discovered variants that previously went undetected.
Philadelphia plans to sample from each of the three wastewater sites twice a week, doubling its collection. Some readings cant detect COVID because of how theyre taken. Its not necessarily because there really is no virus in a sample, but because environmental conditions can affect the minimum level of virus needed to be measurable, Lojo said: Some days, the water is crystal clear. But say, after a rain on other days, the water is cloudier.
Increasing the number of samples a week should help us with respect to not only figuring out if we actually have signals, but also establishing better trend lines, Lojo said.
The city could also collect samples from more locations, getting a more detailed picture of COVID levels across different neighborhoods. That kind of hyperlocal data could, for example, help direct testing resources. Only people who actually know theyre sick in the first place can isolate and prevent spreading COVID further, so testing wastewater doesnt replace testing people. Instead, wastewater data can help officials understand where to focus their efforts. For instance, the Pennsylvania Department of Corrections studies wastewater to help determine how to more effectively deploy testing in state prisons.
City officials have discussed improving the geographic granularity by sampling from more sites.
There are some ideas trying to figure out how best to go upstream to sample wastewater in city sewers, Lojo said. Its not clear if well have enough money to be able to expand it, unfortunately.
Philadelphia could also incorporate the wastewater data into its weekly COVID alert system, but it doesnt currently have plans to do so, partly because the wastewater treatment plants also serve some of the suburbs. Theres no real good way to adjust for that in the analysis, Lojo said.
But the city isnt ruling out the possibility of using wastewater data to determine COVID restrictions in the future, Garrow said.
Wastewater sampling data were sourced from the Philadelphia Department of Public Health through a records request. The data for July 1, 2020 are excluded because the department identified it as an unexplained outlier that is not thought to be a lab error.
Hospitalization data are published by the state Department of Health. They include probable and confirmed cases of COVID-19 identified in a Philadelphia hospital setting.
A person takes a COVID-19 test in Times Square as the Omicron coronavirus variant continues to spread in Manhattan, New York City, U.S., December 26, 2021. REUTERS/Andrew Kelly
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April 11 (Reuters) - The World Health Organization said on Monday it is tracking a few dozen cases of two new sub-variants of the highly transmissible Omicron strain of the coronavirus to assess whether they are more infectious or dangerous.
It has added BA.4 and BA.5, sister variants of the original BA.1 Omicron variant, to its list for monitoring. It is already tracking BA.1 and BA.2 - now globally dominant - as well as BA.1.1 and BA.3.
The WHO said it had begun tracking them because of their "additional mutations that need to be further studied to understand their impact on immune escape potential".
Register
Viruses mutate all the time but only some mutations affect their ability to spread or evade prior immunity from vaccination or infection, or the severity of disease they cause.
For instance, BA.2 now represents nearly 94% of all sequenced cases and is more transmissible than its siblings, but the evidence so far suggests it is no more likely to cause severe disease. read more
Only a few dozen cases of BA.4 and BA.5 have been reported to the global GISAID database, according to WHO.
The UK's Health Security Agency said last week BA.4 had been found in South Africa, Denmark, Botswana, Scotland and England from Jan. 10 to March 30.
All the BA.5 cases were in South Africa as of last week, but on Monday Botswana's health ministry said it had identified four cases of BA.4 and BA.5, all among people aged 30 to 50 who were fully vaccinated and experiencing mild symptoms.
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Reporting by Jennifer Rigby, additional reporting by Brian Benza in Gaborone; Editing by Josephine Mason and Hugh Lawson
Our Standards: The Thomson Reuters Trust Principles.
From heat rash, cramps to heat exhaustion and heat stroke, heat waves can give light to different types of heat-related illnesses. Depending on the illness, you can develop various symptoms.
A heat rash may involve red, itchy skin, small bumps or blisters on the sweaty areas of the body, which can also lead to an infection.
Heat cramps are painful and can cause discomfort in the legs, arms and abdomen. Muscle spasms are common.
Heat exhaustion could lead to fast, shallow breathing along with muscle aches, headache, irritability, weak pulse and gastrointestinal issues. Dizziness, weakness and loss of consciousness are other common symptoms.
A heat stroke can go from mild to severe symptoms. It could lead to dizziness, red, inflamed skin, nausea, high body temperature upto 105 degrees. In severe cases, a person could have seizures, may hyperventilate, experience confusion, agitations and hallucinations.
As far as a COVID-19 infection is concerned, there could be some resemblance to the heat wave symptoms such as high temperature, fast, shallow breathing, headache, mental confusion and so on. However, one must take note of the associated symptoms. Look out for other respiratory ailments, such as a sore throat, runny nose, cough or impaired sense of smell and taste. If the body temperature cools down on its own and your symptoms ease off quickly after treatment, it is probably not COVID.
