Coronavirus Outbreak: Part 3

Right, but you can get multiple variants of Covid at the same time too. That’s how recombinant variants like XBB occur, right? That’s what I’m struggling to get my mind around, how Covid variants compete but then different viruses wouldn’t? If you can be infected by multiples in both situations?

I honestly don’t understand the topic well enough to weigh in with any certainty.

But people like Dr Osterholm and YLE have started to talk about it as a potential factor, so I’ve started paying more attention to the theory.

Osterholm’s point is that many places in the country (like Texas and Florida) have had few to no mitigations in place since around May 2021, and a relatively small amount of mitigations for all but the first month or two of the pandemic. Dropping mitigations doesn’t come close to fully explaining the patterns he’s seeing.

ETA: Here’s part of a transcript from one of his recent podcasts. I don’t think he sees a clear explanation for exactly what type of viral interference is happening, just that something is happening beyond dropping mitigations.


What it’s worth, he’s a huge proponent of N95 masking and very dismissive of using surgical (“procedural”) or cloth masks, in case that’s not clear from this excerpt.

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Since this question has been asked here in the past…


https://twitter.com/joeyfox85/status/1611903098460454913?s=46&t=Kwey8zQzyHU45Ypl-c9_HA

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So, my work has had people with a respiratory (not Covid, includes lingering cough) virus and now a stomach virus with violent vomiting, other nasty intestinal distress and fever. I’ve had the first, exposed to the 2nd yesterday. Send good vibes :worried:

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I’ve read a lot with these newer variants it’s 3-4 days. I really don’t think it’s 14 for anyone anymore - that was early caution. I consider myself out of the clear now by day 4 after a risky event and by day 5 almost 100% confident.

Actually I have anecdotal evidence it’s taking longer for people to show positive now. It had gotten to the 2-5 day range, but I personally know many people who thought they were in the clear and then tested positive on days 8 or 9.

It’s a delay with the tests. They probably have symptoms by day 4 but don’t test positive until later. They’d my understanding.

So you’d still consider yourself clear by day 4 or 5?

It’s kinda hard to say anything definite about recent variants due to timelines from data collection->publication with the variants mutating so quickly.

Here is a study published in November using data from the last half of 2021, so at least a chunk of it is Omicron.

I’ll keep an eye out for anything with more recent data.

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Yes. If no one in house has symptoms.

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I don’t think that the mechanisms driving surges in illness are completely understood, so I imagine any explanation of why different diseases are surging at different times will be somewhat speculative.

I see that he doesn’t think that changes in masking and “immunity debt” are adequate explanations for the case numbers we’re seeing, but I’m wondering if he is really pointing to viral competition as a root cause. Maybe he is just saying that there’s something going on that the existing hypotheses don’t seem to account for very well?

Here’s my best understanding: the difference lies in the resulting immunity.

You can get multiple variants of Covid at the same time. Early in an infection, your immune system is just ramping up; you don’t really have enhanced immunity from Covid compared to prior to your infection. If you are exposed to a new variant, you can catch that at the same time / just prior to / early in a Covid infection. After resolving an infection with one strain of Covid, though, your body has enhanced immunity against Covid (as compared to your immunity prior to infection), even against other strains of Covid. (My guess is late in your infection, when you’re getting better and viral loads are dropping, this is the case too, but I’m not certain.) After your infection resolves you’re less likely to catch Covid again, especially in the following months. In other words, if you get one variant of Covid-19, after you’ve recovered the resulting immunity makes you less likely to contract a different variant, especially in the near term. That’s why variants compete. The more contagious one spreads more and ends up making it harder for the less contagious variant to spread.

If you get one respiratory virus (ex. flu/RSV/covid), it doesn’t have much (if any) impact on whether you get a different virus.

Like I said, I really could be missing something here. Given my current understanding, though, I don’t get how viral competition between different viruses could be a thing. If anyone hears a compelling argument that it could be, please do share. I’d love to understand it more.

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Some key bits:

We found that a staggering 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. These symptoms had an impact on health as severe as the long-term effects of traumatic brain injury. Our study also found that women have twice the risk of men and four times the risk of children for developing long COVID.

We found that patients who were hospitalized for COVID-19 had a greater risk of developing long COVID – and of having longer-lasting symptoms – compared with people who had not been hospitalized. However, because the vast majority of COVID-19 cases do not require hospitalization, many more cases of long COVID have arisen from these milder cases despite their lower risk. Among all people with long COVID, our study found that nearly one out of every seven were still experiencing these symptoms a year later…

While our study focused on the three most common symptoms associated with long COVID that affect daily functioning, the condition can also include symptoms like loss of smell and taste, insomnia, gastrointestinal problems and headaches, among others. But in most cases these additional symptoms occur together with the main symptoms we made estimates for.

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As someone with COVID currently, are we at the point where this is another flu and we start responding as such? RSV and flu dont typically kill their hosts, but certain populations are more vulnerable, same as COVID. My symptoms have been nothing different than what i would have gone to work with, pre-COVID, if I was out of sick days.

Prior to COVID, our symptoms dictated our behavior. If you felt up to it, you usually went about your life. If we aren’t there yet, is there a point we will be? I’m just curious.

I am vaxxed and boosted and quarantined, and intend to keep getting boosters, FWIW.

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Statistically, we obviously aren’t there in terms of mortality or long term health impacts. Mentally, many people (and employers) are there. Morally is up for debate given the statistical bit. Public health officials are kind of all over the place on both the mental and moral aspects so it’s not surprising the public is also all over the place.

I will just speak to the statistical bits for the moment.

Long term health impacts: Although there have been people with post infection syndromes in the past, nothing with both the significance and scope of what we are seeing with Covid. The data is still pretty nebulous, but ballpark-ish @Beth33 ’s post above outlines them well. (Although, technically diseases like polio probably had a larger significance/scope in post-infection impacts, but we responded to those accordingly, so just thinking of diseases we treat like the flu.)

At a personal risk assessment for someone with no underlying vulnerabilities, the best analogy I can give is smoking. Many people choose to smoke, despite the known health risks, for various reasons. Some people choose not to smoke but are in smoke filled environments on a regular basis despite the known health consequences. We don’t have enough data to directly correlate how much health damage is done by different levels of smoke exposure vs different quantities of repeat Covid infections. Some people smoke and have no apparent related health problems. Some people are infected by Covid and have no apparent related health problems. But the correlation with poorer health is still very strong for both.

Until they get a handle on treating Long Covid, I would consider it in the same broad realm as smoking. Do I want my kids doing it or being exposed to it on a regular basis? Nope. Is it realistic to think they’ll never encounter a smoke-filled environment? Also nope. Are they likely to have health consequences from an occasional encounter? Still nope. Are they likely to have health consequences from extensive encounters? Yep. Where is the line? :woman_shrugging::woman_shrugging::woman_shrugging: Therein lies the rub.

Mortality impacts: At a population level, it is clearly still no where near the flu. For the last 6 months of 2022, following the Omicron wave with widespread infection acquired immunity and vaccines (second generation ones most recently), it’s hard to imagine the immunity wall of protection being much higher. And yet…


~75k deaths in from July-December, so 150k on an annualized basis.


So from a mortality standpoint, the impact of Covid is still over twice as bad as flu and RSV combined. (And that’s assuming Covid deaths in the next 6 months aren’t more than the past 6 months, which I wouldn’t bet on.). And most think that Covid number is an undercount (probably by around 20%), whereas the flu and RSV number is an estimate that’s already got its undercount factored in.

It’s hard for me to understand treating it like the flu when the impacts are clearly so much more significant than the flu. It seems like the impacts are what should drive the level of response.

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At this point it is a moral choice. Our schools are following standard sick advice now - you can return to school id fever free for 24 hours and symptoms have improved. Mask suggested but not required. Honestly I don’t think most are staying home if they feel ok.

Personally, I think people should wear a mask in public if still positive and should avoid social visits, especially elderly. Please tell people you have it too.

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Yeah, for sure… we are really trying not to go anywhere as long as we test positive, and if we do have to go out, we mask, do curbside as much as we can, etc.

But some people are testing positive for a month, even after they no longer have symptoms, and not everyone has the luxury of just dropping out of contact with society for a month.

I keep feeling like at some point it’s going to come down to people doing the best they can, but that’s going to look SO vastly different for everyone. For instance, I know that the person we caught this from sent her child to daycare the entire time because he didn’t have a fever and his symptoms were mild. Even if she followed the CDC rules, he’d still be allowed to go after five days, unmasked (because he’s a toddler under 2), while he was still quite likely contagious. It’s crazy to think how many people he alone probably infected through the workers and other children in his class.

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I mean it is pretty unreasonable to expect someone to stay at home for a month. But limiting to essentials masked is good. And yes, the young child dilemma who can’t wear a mask.

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On rapid antigen tests? PCRs, yes, so those shouldn’t be used for test-to-exit. But I don’t think I’ve been hearing about people testing positive on antigen tests past 2 weeks at the most if their acute symptoms had resolved.

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my boyfriend (55 yo) just spent 16 days testing positive on rapid tests after exhibiting symptoms for about 6 of those days, he also started paxlovid on day 1 of testing positive/symptom onset. I got covid a few days before him and took 12 days to get clear, no paxlovid, even though both of us experienced mild to moderate symptoms for about a week. It was super frustrating to both of us because the general advice is that that doesn’t happen! I had a rough time convincing family and friends that we should stay isolated until testing clear, they all acted like 10 days was some magic number.

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16! Wow! I’ve definitely heard a lot more people test positive until day 11 or 12 in the last couple months. Must be something in these newest strains.

I know dozens of friends/family who have had Covid and took antigen tests. Each of them tested negative on antigen tests at some point between day 5 and day 13. I have never heard of someone testing positive on an antigen test for a month (though it may be theoretically possible, especially for someone who is immune compromised).

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