Long Covid - A Year of Bad News

Nine million Americans report that they currently have Long Covid.

https://www.cidrap.umn.edu/covid-19/survey-18-million-americans-say-they-have-long-covid

“Long COVID [is] a condition with no known cure and is defined by long-lasting symptoms following a case of COVID-19. More than 200 symptoms are associated with Long COVID, commonly including fatigue, cognitive dysfunction, intolerance to exercise, chronic pain, and more.”

https://time.com/6309054/long-covid-recovery-rare/

The statistics and the stories are sobering, and full recovery remains elusive. Here is a selection of important news stories over the past year.

September 2023: "Long COVID is a roller coaster.”

"Ask Patricia Anderson how she is doing, and you probably will not get a routine answer. 'Today, I’m working and I’m fine,' she said on a recent Tuesday. 'Saturday and Sunday, I was bedridden. Long COVID is a roller coaster.' …

The virus caused extreme chills, shortness of breath, a nervous system disorder and such cognitive decline that, for months, Anderson was unable to read a book. 'I was very sick for a long time, and I never really got better,' she said."

https://www.seattletimes.com/nation-world/long-covid-poses-special-challenges-for-seniors/

August 2023: Long COVID Recovery Remains Rare.

One doctor says: "A small number, no more than 10%, have stubborn symptoms that don’t get better, no matter what. … A big chunk see some improvement, but remain sick. And [only] about 15% to 20% report full recovery."

https://time.com/6309054/long-covid-recovery-rare/

July 2023: Doctors Unable to Work

The report at the following link is from a survey of 600 doctors with long covid. It found that nearly half of them can no longer work full time.

https://www.bmj.com/content/382/bmj.p1529

October 2022, from the Washington Post:

"On [Oct. 5, 2022], the Centers for Disease Control and Prevention, … released data on long covid. [They found] that more than 80 percent of people with long covid experience limitations in day-to-day activities. 'We want to highlight that there are quite a few people in the country whose day-to-day activities are still significantly impacted by long covid.”

https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm?

September 2022: Long Covid Is Not Just for Adults

The researchers conducted MRIs of the lungs. "Our study demonstrates widespread functional lung alterations are indeed present in children and adolescents."

https://www.cidrap.umn.edu/news-perspective/2022/09/some-kids-teens-have-long-term-lung-damage-after-covid-19

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Practical Steps to Healthy Fresh Air Ventilation

Last time [see Aug. 31, 2023 blog post] we reviewed the Top Five Best Practices to Minimize Covid-19 Spread. The first three all deal with fresh air ventilation, where we advocate having a fresh air level that complies with CDC, WHO, State of Vermont, and our own recommendations. The approximate carbon dioxide (CO2) level that corresponds with these recommendations is less than 800 parts per million (ppm). The amount of fresh air goes down as CO2 readings go up. The CO2 level in unpolluted outside air is about 400 ppm.

Note that these are all RECOMMENDATIONS, not mandatory or legal requirements. Fresh air ventilation in buildings is only loosely regulated, by design standards for a new or renovated building, and never “enforced” after construction that I have heard of. The only mandatory standard is from OSHA, which is 5000 ppm CO2 over an eight-hour period. (At this level, there is almost no fresh air ventilation and I would hope people would be complaining of the bad smell of the air long before this reading is reached.)

Having excellent fresh air, with CO2 less than 800 ppm, which is “in the green” on our Safetulator meters, reduces the spread of covid-19 and other respiratory illness by a factor of five [see Jun. 10, 2022 blog post], allows our brains to function at a normal high level [see Oct. 14, 2023 blog post], and also dilutes all other smells and air pollutants that might be coming from inside the building, including airborne PCBs.

Last time, we included a handy checklist for taking CO2 readings and being sure HVAC equipment is doing its job. We got some questions on exactly how to implement these practices. Here are the points raised, and the answers.

• How exactly do we do the CO2 tests?

===> To test, enter the room (with typical occupancy), go to a representative spot (not where any air is blowing on the sensor, and not within two feet of a person), wait two minutes for the reading to stabilize, then read the meter.

• How frequently and over what period of time should we collect the CO2 tests?

===> First take baseline tests with the windows closed, and all HVAC systems running normally. If it’s all good, then you don't need to test again unless something changes. You could test once or twice more this school year if you want to be sure something hasn't broken and not been noticed.

• What are the courses of action that need to be taken if elevated CO2 levels are found in classrooms?

===> Step 1: Simply open windows. This will almost always be an adequate solution from a CO2 standpoint, but as the weather gets cold, opening windows will not be acceptable unless the covid-19 virus spread returns to crisis levels. But opening windows buys you time to take care of the more permanent measures, shown below. You can experiment to determine how much window opening is needed—for rooms with all the windows in one wall, often it is just two windows that need to be fully opened.

===> Step 2: Involve your staff or contracted HVAC technicians and check each HVAC unit that provides fresh air to be sure it is passing the fresh air on into the rooms. From the checklist, you already know that the intake openings through the walls or roof are working and that the unit's filters are clean. Now check the inside of the units—follow the path of the fresh air flow and make sure there are no obstructions, or closed dampers. Dampers or their motors may be stuck or failed or may have slipped. There may be an adjustment or setting for the amount of fresh air being delivered, and this setting can usually be increased.

===> Step 3. If there are just a few rooms that are not getting enough fresh air, and if it is acceptable for the doors to these rooms to be open to an adjoining space with better fresh air, these open doors may do the trick. If needed, you can try a small fan blowing in or out through each doorway.

===> Step 4: An excellent way to add "ventilation" is with in-room air purifiers--see our Jan. 11, 2022 blog post. Contrary to that post, the manufacturer ended up NOT discontinuing our favorite model, the Classic 205, and there is also the Classic 280i which is slightly fancier but at the same or lower price. Please consult a mechanical engineer to find out the number of air purifiers needed. Note that air purifiers alone are never enough, as you still need some real fresh air, just not as much of it.

===> Step 5: For long-term HVAC revisions or equipment replacements, consult a mechanical engineer. A complete design guide to this work can be found on our web site at COVID-19 Mechanical Engineering Recommendations (PDF) .

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Your School Can Minimize Covid--Without Masks Or Remote Learning

Back In The Covid Life Again

It’s been 3-1/2 years since the Covid-19 pandemic began. We have all the experience and tools we need to manage the virus and prevent outbreaks and surges, and to prevent large numbers of cases, hospitalizations, deaths, and life-altering “long covid”.

As we once again gather together in schools and other buildings, the amount of virus in our communities is on the rise. In the U.S., the only reliable current monitoring comes from sampling for the amount of the virus in sewage at the treatment plants. These numbers are now at an historically medium level, not counting the huge Omicron surge of the winter of 2022-2023. At the current level, in the past when we were counting carefully, there were 300-600 deaths a day attributable to covid-19. That means 100,000+ a year!

[https://biobot.io/data/covid-19]

Although barely reported, current covid-19 outbreaks are temporarily shutting down or affecting operations in multiple schools and other buildings throughout the U.S., including an emergency call center in Kentucky.

https://spectrumnews1.com/ky/louisville/news/2023/08/30/lexingtons-health-department-recognizing-potential-covid-case-increase-

And yet, many people don’t seem to know that they have missed doing the most effective measures for control of covid-19, and instead seem to be resigned to their fate of continuing frequent cases. A spokesperson at the call center said “We had in place precautions … hand washing, the masks, and we had hand sanitizing stations …” 

This might sound OK until you realize that hand washing and sanitizing come from the early and wrong advice about how the virus spreads [see Mar. 21, 2022 blog post], and that masks reduce the risk by only about 25% [see item #1 in the March 10, 2022 blog post]. Here’s how we can do better. (Check the referenced previous issues of this blog for all the details.)

Top Five Best Practices to Minimize Covid-19 Spread

1. Great fresh air ventilation in buildings. This is like having everyone wear a really really good mask without the hassles, and has been shown to cut the number of cases of covid-19 and other airborne infectious diseases by 80%! [See Dec. 16, 2022 blog post and Oct. 14, 2022 blog post and Dec. 6, 2021 blog post.]

2. Monitor carbon dioxide (CO2) to make sure you are achieving #1. In Vermont, for example, the state issued to every public school an advanced CO2 meter that also measures small particle air pollution as from wildfires. Keep the CO2 reading below 800 ppm, as the state recommends. [COVID-19 Mechanical Engineering Recommendations] The rooms need to be monitored when they have normal occupancy. Some buildings have automatic electronic systems that do this, or you can take around your hand-held meter. Some buildings have large, permanent meters installed to show people that the building fresh air is “in the green zone”—this is an excellent practice. [See #3 in the Apr. 29, 2022 blog post.]

3. Be sure your building’s mechanical ventilation systems are set right and working well. There’s a ton of information on this topic here in our blog and website. And here’s a new, simple checklist for the start of the school year.

Checklist (PDF)

4. Establish a culture that it’s OK to stay away when you’re sick, and have the best facilities and practices when someone gets sick during the day. In 2020, Vermont encouraged all schools to set up Isolation Rooms where sick people can avoid infecting anyone else because the air from the room is exhausted, not recirculated. If your school does not have this, you can set it up in any room with a window and a window fan to exhaust the air. [See Feb. 9, 2023 blog post.]

5. Use covid-19 antigen tests—now less than $5 each. [See Dec. 16, 2022 blog post.] These tests give results in 10-20 minutes, use a short nose swab (not those terrible long ones from the early days of the pandemic!), and tell you definitively whether or not someone is contagious to spread the virus today [see Aug. 5, 2022 blog post]. They are not sensitive enough to detect a low level of the disease, below the level where you are contagious. So someone with symptoms and a negative test should still be sent home for the day and asked to stay home as long as there are symptoms, and to re-test daily. 

The antigen tests also can be used by people who want to be sure they are not contagious when they gather with other people—family gatherings, teacher meetings, singing rehearsals, nursing home staff, etc. I have not seen any studies on this, but my feeling is that the dollar cost of these tests turns out to be less than the cost of absent teachers and students, medical expenses, and the anxiety associated with covid-19 outbreaks or continuing cases and risk.

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News and Views As We Approach the Fall

Here’s a roundup of recent news, along with my viewpoints.

The Summer Bump Is Now a Slow Surge

The amount of covid-19 virus in our communities, number of cases and hospitalizations, stories of famous people who have been infected again, all are on the rise as we approach the change of seasons and the start of the school year. Vaccines and past infections are wearing out—a woman was in the news for getting the disease for a fifth time!

https://www.wkrg.com/baldwin-county/spanish-fort-woman-tests-positive-for-covid-19-a-5th-time-as-cases-rise/

The good news for much of the country is that more temperate weather will result in more open windows and more fresh air from mechanical systems in buildings—so that will help a bit. The bad news is that most people are not using the best methods to minimize the spread of the disease. And many are in complete denial— in fact, "22% of Republicans say there never was a COVID-19 pandemic.”

https://today.yougov.com/topics/health/articles-reports/2023/07/27/few-americans-say-currently-covid-19-pandemic

At Schools, People Are Keeping Their Fingers Crossed

And apparently, that’s about it. In Chicago, the school system has about 100 staff and students already known to be infected, but they are not planning to be testing students at school, even when the students report being sick. "The district will no longer do in-school COVID testing, but will provide at-home rapid tests to students and staff … “ It would reduce the spread if they would immediately isolate and test the students who report being sick during the school day. Since adults are more susceptible to covid-19 than children, schools could almost eliminate the spread by having all adults do an antigen test at the start of each school day, ensuring that none of them are contagious that day.

https://chicago.chalkbeat.org/2023/8/16/23835168/illinois-chicago-coronavirus-schools-new-year-covid-guidance

Outbreaks Are Again Occurring in Nursing Homes and Hospitals

For example, in Santa Cruz County, California, “four of the county’s seven nursing homes were experiencing COVID outbreaks as of Tuesday, meaning each had three or more infections at once. … Five deaths had been reported across the seven facilities in the past two weeks. …”

This is so sad, and so easily preventable. Cases and deaths easily can be prevented by daily antigen testing of each person who has been outside the facility the day before. As we reported in the Dec. 16th, 2022 blog post, tests cost no more than $5 each.

https://www.santacruzsentinel.com/2023/08/16/really-alarming-santa-cruz-county-nursing-homes-hit-hard-by-recent-covid-spike/

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The Covid-19 2023 Summer "Bump"

Where Are the Data?

As we said last time: "Other countries are still testing, counting, and reporting the prevalence of covid-19—but not in the U.S. Even when you see numbers reported, they are big undercounts … Cases are hardly ever measured. Not all hospitals are reporting admissions or treatments … Deaths may still be valid, but [there is a multi-week time delay.]"

So wastewater tracking is the best we have. Biobot is the one national website that aggregates the data from a fairly representative cross-section of the sampling locations. It’s the best nationwide information source to answer the ongoing question—When is it safe to reduce our personal level of covid-19 safety? For me, I was looking to match the low point of summer 2021, but the numbers have bottomed out several times higher than that, and now are heading upward. And for people who have returned to “normal”, the wastewater data can suggest when more safety measures will be prudent.

Four Years of Summer “Bumps"

It’s interesting to look back at the four years of history:

• 2020 - a lot of masking and avoiding crowds, and a small summer bump:

• 2021 - the first rounds of vaccinations had happened, and the CDC said go out and party, but then Delta arrived and the vaccinations no longer prevented transmission, so there was a BIG late summer bump:

• 2022 - then Omicron arrived, with a huge winter surge, and then a few booster shots, but then the highest ever summer bump as the masks came off:

• 2023 - after a mild winter surge, another summer bump is now on the way—we might already be at about the peak if this year is like 2022, or the numbers could keep rising through the start of school as in 2021. We’ll find out soon how bumpy a ride we’ll have.

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It's All About the Air!

Covid-19

Other countries are still testing, counting, and reporting the prevalence of covid-19—but not in the U.S. Even when you see numbers reported, they are big undercounts, and really shouldn’t be reported at all. Cases are hardly ever measured. Not all hospitals are reporting admissions or treatments, yet aggregate numbers are still reported. Deaths may still be valid, but run the same problem of “with covid” vs. “by covid”. So is there anything left, for those of us interested in knowing the level of the “community spread” of the virus, so we know what are the appropriate risk reduction measures to take?

Yes—the sampling of the covid-19 virus in sewage. We’ll be looking into this more in the coming weeks. Some of the sampling isn’t reported too well, but there is one national website that aggregates the data from a fairly representative cross-section of the sampling locations. (For New Hampshire, for example, it includes three of the fourteen total locations.) The website is

https://biobot.io/data/covid-19

and here is a recent graph. I have been hoping for the numbers to fall to the July 2021 levels, or at least to the March 2023 levels, but such is not the case. It’s too early to really tell, but the latest numbers are rising slightly, perhaps due to air conditioning and people cocooning inside buildings to avoid the smoky air outside.

Wildfire Smoke

And speaking of smoke, at least we have good monitoring data on this! The best site I’ve found that uses the weather modeling is windy.com—select the PM2.5 page to show the smallest and most dangerous aspect of the smoke. AND they show predictions for the next few days. Where you click on the map is where they give you a numerical result. Here’s an example where the clicked spot is just at the top edge of the best Grade A air, shown in blue.

Another interesting site is purpleair.com, which uses crowd-sourced readings from individual meters. Here’s an example at the same time as the windy.com page. Purpleair.com uses the EPA’s color coding which goes from green (best) to worst (purple).

As we reported before, the best protection if you have to be out in the smoke is an N95 mask, or a Safetulator HEPA filter mask. And for the N95 masks, get ones with an “exhalation valve”, which give you better quality air to breathe, with more filtered fresh air and less of your own exhaled air. We’re still looking for the best make and model, but you can check your local hardware store. This type of mask is what they stock for shop work and construction work to protect people when dust is being generated. Be sure you have a tight enough fit so that when you exhale, you can feel with your hand the warm air coming out of the valve.

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