I see the value in addressing the burden that ILI brings seasonally, with C19 playing a large role in that while *also* being a year round factor. It's astonishing that healthcare settings aren't more proactive with airborne infection control (mitigation efforts, testing), seasonally or otherwise. Is there any way we can help to address that?
I'm thankful for your data updates. When I consider the area under the curve, it certainly doesn't look like Covid is seasonal. It's transmissibility and the fact that high tides occur across climate conditions while never retreating below a high threshold, it looks nothing like other viruses. Flu data across the year resolves to a tiny blip for all but a few months, while C19 is ever-present at orders of magnitude above anything else. (3rd chart in the link below) The main reason I'm concerned about talking in seasonal terms is that the public has been trained to ignore the presence of Covid. High population immunity doesn't seem to be getting us any closer to shifting that high baseline of Covid. What do you think can help us to effect change?
Thanks for the data: while Covid is not seasonal--peaks occur in several seasons--it definitely adds to the burden of respiratory diseases that are seasonal. This year's surge also seems to be driven by the JN.1 variant, low vaccination rates, and lack of behavioral mitigation. As there is no PHE and dismantling of the public health support to track and treat Covid, it makes this data so helpful, as I'd written before, we're in an information vacuum. I hate going on Twitter to follow BNO news and try to avoid the crazy of the platform. Lots of viral activity and strained health care systems--especially in the northeast where I live.
Glad to do it! Well, I really do think SARS2 has a degree of seasonality to it, which I'd guess will increase over time. So far, we've seen winter peaks but also this weird late summer thing (Delta, Omicron sub variant). But I expect it to behave like other coronaviruses and there's no reason that it eventually should not, once it is "truly" endemic (it sorta is, but it sorta isn't; that's for another time). The question I have is this: have there always been these summer spikes (pre-Covid) in viral illness? CDC never tracked things the summer (or at least did not publish). My sense is probably "no" on the level of mortality (just looking through some data), but that's not the only outcome we care about. So, maybe? The thing is that everything is a bell curve. A virus that is more contagious than "usual" might be able to overcome the unfavorable conditions that summer brings. So that's probably where COVID is right now. Over time, as the population gains immunity, that might become less significant.
Meanwhile, to your larger point on public health--I really hope RSV vaccine coverage in seniors increases next year. I'd also like to see a new study on a 2nd flu vaccine in bad years. I've been meaning to write about this, but there's really not much on the effectiveness of a flu vaccine cadence like this: Dose #1 in October, Dose #2 in January. I think for very high risk folks, that might be warranted, depending on waning. We know very little and I think we could save *thousands of lives per year* with better flu, RSV, and COVID booster cadences for high risk folks.
I think the apparent seasonality is driven by behavior, waning immunity and then throw in new variants. The fall surge was explained by my state epidemiologist as increased density of population and back to school. This last surge by holiday season and JN.1. Unfortunately it’s not flu or RSV where we have months to not expect to encounter it.
We don't have that for 2024 but for 2023, all cause respiratory (including COVID) was about 10% higher than 2019. When you remove COVID from that, 2023 was actually *down* a bit from 2019. Tells me that to at least some extent, some COVID deaths are people who would have perhaps died from another virus anyway if not for COVID. This, by the way, is an argument for increased infection control measures in December-February (pooled tests in nursing homes, masks, vaccines, etc). But the other thing that is tough is that (as I wrote in the newsletter), a lot of deaths end up in categories that do not "look" like respiratory deaths, even though they are--cancer being the example. If "cold, covid, and flu" season is associated with increased cancer mortality (which it is ), I think that tells us we should be doing a better job of protecting those high-risk groups.
Please stop spreading misinformation by referring to Covid as seasonal. It’s demonstrably not, & your feeling that it one day might be doesn’t mean that you can talk about it as if it were seasonal today. So many of the problems we have today in public health (👀ing at those measles outbreaks) are due to mis & disinformation. We just don’t need more of it.
I see the value in addressing the burden that ILI brings seasonally, with C19 playing a large role in that while *also* being a year round factor. It's astonishing that healthcare settings aren't more proactive with airborne infection control (mitigation efforts, testing), seasonally or otherwise. Is there any way we can help to address that?
I'm thankful for your data updates. When I consider the area under the curve, it certainly doesn't look like Covid is seasonal. It's transmissibility and the fact that high tides occur across climate conditions while never retreating below a high threshold, it looks nothing like other viruses. Flu data across the year resolves to a tiny blip for all but a few months, while C19 is ever-present at orders of magnitude above anything else. (3rd chart in the link below) The main reason I'm concerned about talking in seasonal terms is that the public has been trained to ignore the presence of Covid. High population immunity doesn't seem to be getting us any closer to shifting that high baseline of Covid. What do you think can help us to effect change?
Thank you and Benjy for good work.
https://thosenerdygirls.substack.com/p/a-lot-more-americans-are-dying-of
Thanks for the data: while Covid is not seasonal--peaks occur in several seasons--it definitely adds to the burden of respiratory diseases that are seasonal. This year's surge also seems to be driven by the JN.1 variant, low vaccination rates, and lack of behavioral mitigation. As there is no PHE and dismantling of the public health support to track and treat Covid, it makes this data so helpful, as I'd written before, we're in an information vacuum. I hate going on Twitter to follow BNO news and try to avoid the crazy of the platform. Lots of viral activity and strained health care systems--especially in the northeast where I live.
Glad to do it! Well, I really do think SARS2 has a degree of seasonality to it, which I'd guess will increase over time. So far, we've seen winter peaks but also this weird late summer thing (Delta, Omicron sub variant). But I expect it to behave like other coronaviruses and there's no reason that it eventually should not, once it is "truly" endemic (it sorta is, but it sorta isn't; that's for another time). The question I have is this: have there always been these summer spikes (pre-Covid) in viral illness? CDC never tracked things the summer (or at least did not publish). My sense is probably "no" on the level of mortality (just looking through some data), but that's not the only outcome we care about. So, maybe? The thing is that everything is a bell curve. A virus that is more contagious than "usual" might be able to overcome the unfavorable conditions that summer brings. So that's probably where COVID is right now. Over time, as the population gains immunity, that might become less significant.
Meanwhile, to your larger point on public health--I really hope RSV vaccine coverage in seniors increases next year. I'd also like to see a new study on a 2nd flu vaccine in bad years. I've been meaning to write about this, but there's really not much on the effectiveness of a flu vaccine cadence like this: Dose #1 in October, Dose #2 in January. I think for very high risk folks, that might be warranted, depending on waning. We know very little and I think we could save *thousands of lives per year* with better flu, RSV, and COVID booster cadences for high risk folks.
I think the apparent seasonality is driven by behavior, waning immunity and then throw in new variants. The fall surge was explained by my state epidemiologist as increased density of population and back to school. This last surge by holiday season and JN.1. Unfortunately it’s not flu or RSV where we have months to not expect to encounter it.
An interesting number to look at would be all cause respiratory mortality and compare to previous years.
We don't have that for 2024 but for 2023, all cause respiratory (including COVID) was about 10% higher than 2019. When you remove COVID from that, 2023 was actually *down* a bit from 2019. Tells me that to at least some extent, some COVID deaths are people who would have perhaps died from another virus anyway if not for COVID. This, by the way, is an argument for increased infection control measures in December-February (pooled tests in nursing homes, masks, vaccines, etc). But the other thing that is tough is that (as I wrote in the newsletter), a lot of deaths end up in categories that do not "look" like respiratory deaths, even though they are--cancer being the example. If "cold, covid, and flu" season is associated with increased cancer mortality (which it is ), I think that tells us we should be doing a better job of protecting those high-risk groups.
Please stop spreading misinformation by referring to Covid as seasonal. It’s demonstrably not, & your feeling that it one day might be doesn’t mean that you can talk about it as if it were seasonal today. So many of the problems we have today in public health (👀ing at those measles outbreaks) are due to mis & disinformation. We just don’t need more of it.
Thank you
It would be interesting to look at cancer and cardiovascular mortality and general and see how much it tracks with respiratory virus season.
This has been done. HIGHLY.