The Covid-19 End(emic) Game

Here to Stay

Covid-19 is here to stay, but the mass outbreaks may be over for the time being. A new variant could occur at any time, perhaps is brewing now, but barring that, we can be cautiously optimistic.

A huge winter surge did not occur this year, as many expected (myself included). In New Hampshire, for example, there was about a 50% increase in hospitalizations after the start of the school year, and again after the holiday season (shown circled below).

“Endemic” means that the disease is here to stay (true) and that the infection rates are fairly constant (we don’t know this yet). The graph for New Hampshire shows the low point for hospitalizations, last June, which was just 17 people for the whole state (1.4 million people). We may be approaching that low point again, with the latest number being about double the low point, and trending down. Spring weather should encourage this trend to continue downward.

The End Game

On the other hand, we still know people who have been infected (again) with covid-19. And every new infection is another roll of the dice as to severity and whether some Long Covid symptoms will stick around or pop up later. So, for those who want to reduce their risk at this point, here are some of the best things to do:

- Use daily antigen tests (virtually eliminates the risk). For short-term gatherings under your control—the workplace, choral rehearsals, family get-togethers, etc.—it’s simple to have everyone do an antigen test that day. If you have one-on-one sessions with people—dental hygienists, barbers, medical people, etc.—you can ask them to do a test, and probably provide the test. Sometimes they will say no, sometimes yes. And if you develop any kind of symptoms, do two antigen tests on successive days. See Aug. 5th, 2022 Blog Post.

- Continue to have great fresh air ventilation (reduces the risk by 80%). This is especially important where you are gathering with lots of other people, such as at restaurants or theaters. You can maintain your spaces, or check other spaces you enter, with a Safetulator Fresh Air Meter. And you can supplement actual fresh air with in-room air purifiers. See Jan. 11th, 2022 Blog Post and Sept. 2nd, 2022 Blog Post.

- Maintain a mask-friendly culture for those people who want to wear masks (properly-worn masks can reduce the risk by 25% or more). Better masks can be close to 100% effective. See Mar. 10th, 2022 Blog Post and Dec. 16th, 2022 Blog Post.

- If you do get covid-19 again and know it, follow the best practices to avoid spreading it to others in your family. And don’t return to circulation until you get a negative antigen test. See Feb. 9th, 2023 Blog Post.

The Finish Line

Hard to say exactly when and where it is, but for me, I’m thinking that when New Hampshire hospitalization rates stay at levels less than the 2021 lows, I’ll be setting aside my masks except for intense exposures like airplanes (where 100% of tested wastewater contains the covid-19 virus!). I’ll wait and see about the antigen testing—it will depend on what others want to do in the groups involved. And, of course, I will continue to pursue excellent fresh air ventilation for all its benefits that go far beyond covid-19.

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To Avoid Covid-19, Do as They Do, Not as They Say

Remember that you can gather safely by simply doing daily morning antigen testing for those who will be attending. (First discussed here: Aug. 5th, 2022 blog.)

While prominent people are telling us we generally don’t need to wear masks, or to be sure to have good ventilation, or to do testing, when they themselves are gathering, guess what they do? Testing ahead of time! Of course. Some recent examples:

Alaska legislators did “voluntary” testing after covid-19 spread through the group.

https://www.kinyradio.com/news/news-of-the-north/alaska-legislators-on-guard-after-multiple-covid-cases-are-confirmed-in-the-capitol/

After the Golden Globe awards were held (Jan. 10th, 2023) with no covid-19 safety measures, a number of celebrities came down with the disease. The next event, the Critics Choice Awards (Jan. 15th, 2023) took notice and required everyone have a negative test ahead of time.

https://deadline.com/2023/01/two-banshees-of-inisherin-stars-will-not-attend-the-critics-choice-awards-1235222460/

And when the world leaders gathered for Davos 2023 (January 16-20, 2023), you can be sure they had PLENTY of safety measures in place: testing, HEPA filters, and more. Bruce Y. Lee said in Forbes:

"There’s that old saying, 'Do as I say, not as I do.' So a big question is what are political and business leaders actually doing about Covid-19 precautions for themselves right now? Plenty of them have been publicly pushing for Covid-19 precautions to be dropped. In fact, some have even claimed that the pandemic is over … Yet, the pandemic doesn’t look too over at that annual gathering of political and business leaders at Davos, Switzerland, known as the World Economic Forum (WEF).” Read the rest of his story at: https://www.forbes.com/sites/brucelee/2023/01/20/world-economic-forum-is-taking-all-these-covid-19-precautions-at-davos/

Note that daily antigen testing is actually better than PCR testing for purposes of gathering together. PCR tests have to be sent to a lab for analysis, so they are two or three days old by the time the gathering begins, and someone could have contracted covid-19 in the time in between. Antigen tests can be done anywhere, they are less expensive (as low as $5), and they reflect the current health status.

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You Can Isolate and Not Spread Covid-19

When you come down with covid-19, it is totally possible for you to isolate from others in your household and avoid spreading the disease to them.

Most people don’t know how to do this effectively, because proper, detailed advice has never been given. For example, this is all the CDC has to say about it:

“• Wear a high-quality mask if you must be around others at home and in public.
• Do not go places where you are unable to wear a mask. ...
• Do not travel.
• Stay home and separate from others as much as possible.
• Use a separate bathroom, if possible.
• Take steps to improve ventilation at home, if possible.
• Don’t share personal household items, like cups, towels, and utensils.
• Monitor your symptoms. If you have an emergency warning sign (like trouble breathing), seek emergency medical care immediately.”

If this is all you do, you will most likely spread it to others in your household. If you want to avoid spreading it, here are the best practices to achieve that end.

Step 1: Set up an isolation room where the sick person will remain, except for trips to the bathroom. This room will need to have an operable window to the outside.

Since the virus is almost totally spread through the air, the ONLY way a room actually counts as an isolation room is if it is completely cut off from the air in the rest of the dwelling. (See Note A.) To do this, see if there are any air registers in the isolation room. Make sure the HVAC system is running and blowing air. Isolation room registers that blow air INTO the room are OK. Any registers that draw air OUT OF the room must be closed off and completely sealed with materials such as cardboard and duct tape.

Set up a fan in the window to blow air out of the isolation room. There are window fans made for this purpose, or you can use any fan available. Block off any part of the window not filled up with the fan so the blown air does not “short circuit” but actually exhausts the room. The fan needs to run only at low speed. Its purpose is to be sure that any air leaking around the room’s door will be coming into the room, not out of the room and carrying virus to the rest of the dwelling.

fan in window

The isolation room will now be at “negative pressure”, and other members of the household need not wear masks, although those who want to do so certainly can. The rest of the dwelling should have good ventilation with a balance of fresh air and exhaust air, such that CO2 levels are below 800 ppm. Or “in the green” of a Safetulator Fresh Air Meter (See Note B.)

Step 2: Set up the bathroom that the sick person will use in the same fashion as the isolation room. As the CDC says, a separate bathroom is nice, but not required. If it’s a shared bathroom, wait 30 minutes after the sick person leaves, then disinfect surfaces before others use the room. The sick person should make direct trips to and from the bathroom, and not be in any other areas of the dwelling.

Step 3: Brief contact in the same room as the sick person is of course a necessity—delivering a tray of food, for example. But brief means something like ten seconds. In one documented case, the disease was passed on from one person to another with just five minutes of being in the same room! (See Note C.) Everyone involved in this brief contact needs to wear an N95 or KN95 mask—not a surgical mask, or a cloth mask, or any other kind of mask. Except of course if the non-infected person wears a Safetulator Mask, which will provide almost complete protection.

Step 4: Testing to end isolation should start on the third day. Use a home antigen test each morning. There is no magic number of days after which you can end isolation and not be contagious to other people. (See Note D.) The key to safely ending isolation is that a properly-administered negative antigen test shows that the person is no longer contagious. (If you want to be doubly safe, you could wait until you get another negative test on the second day, especially if you have any lingering symptoms.)

That’s It. Of course, this is a lonely life for the sick person, and it won’t be possible to follow this routine for children. Luckily, we have many computer-assisted ways to stay in frequent or continuous contact with the sick person, for their health and well-being is the primary focus.

- NOTES -

Note A - There are numerous documented cases where covid-19 was spread between people in separate, nearby rooms because the HVAC (Heating, Ventilation and Air Conditioning) registers were sending air into and out of the rooms, and the equipment mixed together air from multiple rooms and then blew it around to all the rooms again. This happened even in hospitals!

Note B - If you don’t have a meter, open a window a few inches in every room, and adjust the openings based on wind direction and whether each room’s door is open or closed.

Note C - In an extended study where all participants had location/proximity sensors, this transmission happened in a restaurant where the infected person was standing under an air conditioning unit blowing away from the person. It was 20 FEET AWAY where the person who contracted covid-19 was sitting!

Note D - The CDC’s five-day timing recommendation has no basis in science. Multiple studies have found that, after five days, anywhere from 31% to 80% of people will still be contagious. The point is, that there is wide individual variation, as one would expect with any medical matter.

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Here is my outlook on the three main covid-19 themes for 2023:

Covid-19 Is Here To Stay

I expect no big surges or declines in the amount of virus in circulation, nor in hospitalizations, nor in deaths, even as new variants come and go. The winter surge this year has not materialized nationally, even with new variant XBB.1.5. This is in stark contrast with the last two years, with peaks in deaths being in January 2021, September 2021 (Delta), and February 2022 (Omicron), as shown below from the Washington Post.

In the last nine months, U.S. covid-19 deaths have been fairly constant at 300-500 per day.

And hospitalizations have been in the range of 25,000 to 50,000 for the last eight months (the pink area to the right of the vertical line in the graph below).

Covid-19 was the third leading cause of death again last year, after heart attacks and cancer, with less than 300,000 deaths (https://www.cnn.com/2023/01/17/health/covid-death-reporting-2022/index.html ) and will drop to maybe half that number if the present levels continue.


Most People Will Get Reinfected Over and Over Again

Maybe you think you have never had it? You could be like half the people in the U.S. who have had it with such mild symptoms they didn’t realize it. Such is the conclusion of multiple studies, including two with links shown below.

https://www.npr.org/2022/08/19/1118402942/omicron-variant-unaware-covid-research-study

https://www.cidrap.umn.edu/covid-19/42-us-adults-likely-have-had-covid-almost-half-them-say-they-didnt

Overall, 9 in 10 Americans "have been infected with the COVID-19 virus at least once, according multiple studies of covid-19 antibodies in the blood.

https://www.montereyherald.com/2022/11/26/just-1-in-20-people-in-the-u-s-have-dodged-covid-infection-so-far/

https://www.ny1.com/nyc/all-boroughs/health/2022/12/16/cdc-estimates-90--of-u-s--kids-have-had-covid-19 )

As long as most people do not take practical precautions (including good fresh air ventilation, selective use of highly-effective masks, and smart use of antigen tests), the virus will not die out, and reinfections will become the norm.


“Long Covid” Is Affecting Millions

Long Covid is affecting millions of Americans. The precise number can’t be pinned down because definitions vary from study to study, but the CDC has pegged it at 15 million U.S. adults.

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm

And even though you don’t have to have had a bad case of covid-19 to get it, the impacts can be profound. A large multi-country study "found that … 90% of people living with long COVID initially experienced only mild illness with COVID-19. After developing long COVID, however, the typical person experienced symptoms including fatigue, shortness of breath and cognitive problems such as brain fog – or a combination of these – that affected daily functioning."

https://theconversation.com/long-covid-stemmed-from-mild-cases-of-covid-19-in-most-people-according-to-a-new-multicountry-study-195707


The Good News …
is that readers of this blog know how to use the best available practices and technology to reduce the frequency and severity of their covid-19 infections. See our previous post, “Highlights of the 2022 Blogs”, for more details.

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Highlights of the 2022 Blogs

Here is a list of the 2022 blog posts most useful today [and today’s comments on them].

Jan. 4 - Videos that explain everything about masks—which masks are the best, how to use them, how to sterilize them for re-use. [These are just as useful today as a year ago.]

Jan. 11 - A complete guide to in-room air purifiers, which are efficient at removing virus from the air, and can be used in addition to fresh air when the fresh air isn’t enough. [Very popular in schools, and rightly so. The recommended models are still good choices.]

Feb. 2 - First reports of how long people are infectious: 95% of people in the study were no longer infectious after ten days. [Still good advice to follow, since a third of the people in the study were infectious after five days.]

Feb. 16 - Link to an excellent story in The Atlantic on the history of fresh air ventilation in the U.S.

Feb. 25 - U.S. excess deaths surpass one million. [Still a good read.]

Mar. 21 - Finally, the story of how the CDC and the medical community got it wrong in the early days of the pandemic. [Still a very important story.]

Mar. 29 - Stories from people’s euphoria of returning to noisy, crowded places.

Photo of large CO2 meter

Apr. 29 - Introduction of “The Big Meter” to let people know that a building has good, fresh air. [We have these for sale.]

June 10 - New study: 80% of people with Omicron were still contagious after five days. [I wish everyone knew this, and the CDC would promote it!]

July 21 - “Someone in the Room Has Covid-19” [An interesting post because the infection levels are still about the same today!]

Aug. 5 - Groundbreaking news that a negative antigen test was shown to mean that the person is not contagious TODAY. [We are using this fact to ensure that our workplace will NOT be spreading covid-19, since we have morning antigen testing for all workers.]

Sept. 2 - Safetulator products for sale - a HEPA filter mask, and a small fresh air meter, both used to fly cross country while staying healthy. [These products are still available.]

Oct. 14 - "Breathe fresh air - and be smarter." An update on the benefits of fresh air. [Also a handy half-page handout on the subject.]

Nov. 11 - “Holiday Gathering Without Covid-19” [Includes a buyers’ guide to home antigen tests.]

Dec. 1 - An almost-secret way to reduce ALL kinds of diseases in the winter: proper indoor humidity. Backed up by historic and recent research. [Includes a make/model recommendation.]

Dec. 16 - A study showing that fresh air ventilation reduced covid-19 infections by 80%! [Also lists a USA antigen test that costs just $5.]

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Highlights From Past Blogs

To Slow the Surge, Pick Your Percentage

The Winter 2022-23 Surge is Here

The best continuing number to watch is the hospitalization rate, since most cases are never tabulated. Covid-19 hospitalizations have been climbing steadily, increasing by more than a third in the last four weeks.

Washington Post, Dec. 15, 2022

Washington Post, Dec. 15, 2022

Nationally, the surge is far from uniform, but at each location it’s either here now, or probably coming sooner or later. The latest variants are increasing nationwide, and seem to be very easily transmitted.

CDC, Dec. 12, 2022

CDC, Dec. 12, 2022

Slowing the Surge and Avoiding Infections

For your holiday gatherings, and in general, you can pick your percentage of risk reduction: three choices are

- Minus 25%

- Minus 80%

- Minus 100%

Minus 25%: Wear a traditional mask, N95, KN95, or cloth mask. The 25% reduction in the number of covid-19 cases is from a large, multi-school study we have mentioned before. Mask effectiveness can be better if you are careful, but the 25% number reflects how a large number of people wore their masks in the real world. Here is a blog post reference: March 10, 2022 Blog Post

Minus 80%: Another exciting confirmation of the effectiveness of fresh air ventilation was just published. "A recent study .. involving 316 classrooms and 205,347 students, found that [covid-19] infection rates decreased 80% with ventilation rates greater than … 21 cfm per student.” This amount of fresh air, or a little more, is what we have been advocating and engineering since the summer of 2020. When our Safetulator™ Fresh Air Meters are “in the green”, you are getting fresh air at this level. Here is the article on the recent study:

https://www.infectioncontroltoday.com/view/covid-19-how-to-reduce-spread-without-vaccines-monoclonal-treatments

Minus 100%: This one is great in that it involves nothing out of the ordinary once the day gets rolling. Each person gathering together simply takes an antigen test first thing, each day of being together. A negative result means you are not contagious for the day. (Probably nothing is really 100%—if you make a mistake doing the test, then your negative result is meaningless.) See our blog post describing antigen testing: Nov. 11, 2022 Blog Post

And there’s a new brand we can now recommend: InBios, made in the USA, easy to use, and about $5/per test from Amazon and elsewhere.

InBios

InBios

Have a healthy and joyous holiday season!

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