As a reminder, this is who I am and probably why you signed up to get these emails. I haven’t sent one since last March, but here’s this one.
Hey, it’s the least helpful case counts since spring 2020
Covid testing—the kind that gets reported to someone official—is way, way down both in the US and globally. Right now, we’re testing fewer people per week in the US than we were at any point since early May of 2020.
Testing always goes down when infections are down, but looking at hospitalizations (orange line) plotted against weekly testing volume shows that although we have more people hospitalized with covid than in the two big dips in the US pandemic so far, yet we’re doing far fewer tests now as during those dips.
It’s not great! But it’s how we do.
For people who are fortunate enough to be able to control their exposure, I feel like it’s mostly a head game at this point, and maybe the most important thing I can say here is: You’re not irrational for taking your health seriously and trying to lower your risk! And you may have access to data that can help you calibrate mitigations and maybe relax more when risks drop. So let’s talk about that data.
Gauging risk when we’re not testing
Back in the spring when testing really tanked and national newspapers published experts suggesting that we just try to pay attention to how many family members and Facebook friends had covid instead of worrying about the data I had to stop writing this because my brain just went belly-up. And I mean, paying attention to how many people you know locally who have covid is a fine start, it’s just a rough way to run a country.
Anyway! There’s a better way, although it’s super unevenly distributed because that’s how we do things, and that is wastewater data.
The CDC’s national map is not super useful for close analysis, but if you’re in the US, it will let you know at a glance whether your jurisdiction is collecting and reporting wastewater viral concentration data. If it is, my recommendation would be to google around for your state health department’s dashboard for the data. In Oregon, ours looks like this—in the screenshot below, I’ve selected the Portland site as an example.
What I really like about this is that you can see how clearly the overall amount of virus used to track reported cases, but has now diverged a bit, most noticeably over the early summer of this year, when viral concentrations went back up to near-peak levels but reported cases stayed at under a third of the first Omicron peak in January of 2022. When the two metrics diverge in that way, you can pretty much assume that there’s just a lot more covid around than cases would indicate.
(Science has a fantastic article about the ups and downs of wastewater surveillance and this Atlantic piece has some nice specifics also, but you can totally just dive right in and look at wastewater next to a case curve to see what’s happening in your area.)
Data only matters if it helps you make choices
At the societal level, data is important for lots of excellent reasons, but this newsletter is about us, individual people stranded in a confusing situation. And for us, I think the hardest part is doing what the data indicates we should do based on our own risk calculations—even when everyone around us changes course.
Back in the fall of 2021, our community had a fairly substantial case surge, and we were still taking a lot of precautions because our household has high risks. This fall, reported cases were dramatically lower than they were in the fall of 2021, the CDC has taken holy vows against saying the word “mask,” and the executive branch announced that the “pandemic phase” of the pandemic is over. Very understandably, nearly everyone in our community who was still taking precautions stopped.
Buuuut the wastewater data showed that there was still about as much covid circulating as there was the previous year—and the currently circulating variants are quite a lot more transmissible than the Delta variant from 2021. So I swore a lot and our family stuck to the same old well-supported boring precautions we’ve been using: high-filtration masks indoors, meetups outdoors, grocery pick-up, sparkly clean hands, all of it. Our kid, a goddamn champion, wore an Airpop to school every day. We had a giant Halloween party outdoors with a patio heater and a bonfire. Now, finally, the viral concentration numbers are dropping locally, which gives us room to loosen the most annoying precautions for our kid.
Honestly, even for me, it was rough on the brain to keep doing the things when all the governmental and cultural messaging had gone off a cliff, but I’m really grateful for the wastewater data, and for the people who tolerated us even though we probably seemed like lunatics for sticking with the plan. It’s super likely we’ll get covid in one of the winter rounds, but again, my goal for us is just to minimize infections while having a good life.
What if you don’t have wastewater data
This is the worst case, but common in much of the US. If we didn’t have wastewater data, I’d be watching hospitalization numbers very closely, and, yes, keeping an ear out for mentions of people who are out sick—but that’s extra hard if you’re in an area where covid, flu, and RSV are all making people sick at the same time. If you’re in a place where risk feels high and you have no data, good masks and avoiding sharing indoor air remain really strong choices for people who have those options.
Layers, holidays, rapid testing
Solid, rational recs here on layering up precautions and planning holiday gatherings around your most vulnerable attendees.
Opening some windows and running HEPA filters seems to cut covid transmission in half, which is extremely good and worth doing.
Rapid tests still work, variants notwithstanding, but a single test will miss around 50% of infections on average, and you’re meant to use at least two tests over multiple days to get a reasonably solid all-clear. They’re one part of a good layered approach to safer gatherings.
Wherever you are, I hope you and your family and friends are doing okay. The covid-flu-RSV combo pack hasn’t hit our region yet, but I know plenty of families who are in the middle of that particular hell. I wish you the best health and luck and the most peace.
Love,
Erin