#pcdc

The Weather:

Wastewater levels appear to have dropped slightly  in the West, Midwest, and South regions. The national average decreased, from 608 copies/ml to 509. However, wastewater levels remain higher than the past six months and as high as this past Winter of 2023. Until we see a significant drop, the risk for a COVID infection ranges between substantial to high. As an important reminder, when looking at wastewater data, it is important to examine your own region and/or county to estimate your current level of risk. Check your county or state for local information. Another source for wastewater tracking is SCAN. As mentioned in previous reports, Biobot data has shown retroactive data updates in reports published up to several weeks prior, likely due to variations in the timing of reporting across wastewater sites. In the meantime, to account for retroactive fluctuation, we will continue to report the previous week’s wastewater data as it appears to fluctuate significantly less than the most recent findings. Note that the “September 30” date refers to the “data collection date” rather than the last data point reported (September 20). Since the CDC stopped providing a national COVID transmission map, the People’s CDC has been working on something to replace it. The People’s CDC is building a new COVID transmission map that will be measured at the state level. We look forward to potentially sharing it in the near future.

Hospitalization:

New weekly hospitalizations associated with COVID have increased, reaching a new peak of over 19,000 during the week of September 9, 2023. This number is nearly 3 times the total number of hospitalizations since July 1, 2023, in which there were over 6,000 hospitalizations. More recently, there has been a slight decrease in new hospitalizations.

The CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) will meet virtually August 22, and infection control guidelines for healthcare settings will be reviewed. Our community and advocacy groups have pressured HICPAC to strengthen infection control recommendations and include broader expertise on the committee. As a direct result of this advocacy, CDC sent HICPAC’s proposed infection control guidelines back for more review and expanded representation on the committee, including a member of National Nurses United on the Isolation Workgroup. We must keep pressure up to ensure infection control for aerosol-transmitted infectious diseases is strengthened, not weakened. 

Despite a legal obligation to request public comments on the draft and despite ongoing calls for more transparency, HICPAC has not opened a public comment period in the Federal Register. HICPAC has limited oral comments from the public to 45 minutes, so many registrants will be excluded.

Since many politicians are campaigning for our votes this year, it’s prime time to write to your elected officials to insist HICPAC be made accountable to the public. You can use our Action Network campaign to simultaneously 1) write a public comment to CDC/HICPAC and 2) alert your elected officials that healthcare needs much stronger isolation and infection control precautions, including universal masking.

Amid this summer’s nationwide COVID surge, the CDC has acknowledged that COVID spreads year round, including in summer, and that emergence of new variants leads to unpredictable patterns of spread. However, the draft infection control guidance continues to threaten rollbacks in the use of N95 respirators for aerosol-transmitted pathogens and further weaken isolation protocols and related guidance. Despite the demonstrated benefits of universal masking in healthcare settings in the ongoing COVID pandemic, HICPAC’s draft guidance fails to integrate this lesson to prevent avoidable healthcare-acquired infections.

Use our Action Network campaign below by clicking on the blue button to write to your elected officials and CDC’s HICPAC asking them to make HICPAC accountable to the public and share your concerns about the need for universal masking and clear isolation protocols by August 22, 2024.

Send Letter to Govt Officials/HICPAC

How to use the universal masking infection control letter template

Click through to Action Network and edit the letter as you wish (or write your own using the letter for inspiration or talking points). Note: The White House and many elected officials set a 2000 character limit.

Personalize your comment with a brief statement on how the lack of universal masking in healthcare has impacted your life or your community. For example:

Delayed or missed medical appointments

Unsafe experiences, such as with workers or other patients who showed symptoms of COVID or other aerosol-transmitted infectious diseases

Infections or potential exposures that occurred in healthcare settings

Challenges faced in asking healthcare workers to mask

Disproportionate impacts of the lack of masking in healthcare on high-risk patients and marginalized communities

Letter template:

Dear Elected Official and Members of HICPAC:

CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) is meeting August 22 about major revisions to infection control guidance. Though legally obliged to accept public comment, it has not made draft guidelines public or posted them to the Federal Register. I urge you to act to require HICPAC to open public comment for its August meeting and going forward.

Most importantly, HICPAC’s most recent draft guidelines would seriously weaken infection control, and prioritize healthcare profits over patient and healthcare worker health. Healthcare should not make us sick. 

I urge you to press HICPAC to strengthen CDC infection control guidance in line with scientific data. HICPAC must establish universal masking in healthcare as a new standard of infection control across all settings for the following reasons:

Many healthcare exposures to aerosol-transmitted infectious diseases (including COVID, measles, influenza and TB) are preventable through multiple mitigation measures including isolation procedures, universal masking, ventilation, and air purification.

Many aerosol-transmitted pathogens are transmissible without symptoms and without predictable seasonality. Diagnosis and isolation may be delayed, leading to exposures that could have been prevented by universal masking.

Well-fitting N95 respirators or better masks provide both protection for the wearer and source control. One-way masking has limited protection; masks should ideally be worn by all to reduce transmission. Hospitals should distribute N95 grade masks to visitors and staff.

Universal masking protects patients when they cannot mask (such as infants, people with specific medical conditions and procedures involving the nose or mouth).

When masking is only on request, people are unprotected in many shared spaces such as lobbies and waiting rooms.

In addition to universal masking, HICPAC must recommend layered mitigations in all types of healthcare facilities: higher HVAC standards, clear robust isolation protocols to separate infectious people from others – including by routinely testing staff and patients for COVID and other infectious diseases, isolating and cohorting infectious patients, and keeping staff with an active infection away from healthcare facilities and in-person patient contact.

The Weather

Similar to this time last year, COVID wastewater levels in many states have decreased and now remain at low levels except for the states of Tennessee and Missouri, which are at high levels. Arkansas, Alabama, Delaware, Minnesota, and Virginia have moderate viral levels detected by wastewater surveillance. This reminds us that it is important to continue the practice of precautions, especially among those most vulnerable to a COVID infection.

When considering trends in wastewater levels across all four regions, they have stopped decreasing as seen in the provisional data (gray shaded area). The national wastewater levels are indicated as “Low.” While lower wastewater levels indicate decreased spread, the risk for infection remains moderate especially as current wastewater levels remain slightly higher than previous low periods.

Wins

During the past few weeks, we have taken several actions against removing vital public health measures, especially the change in COVID isolation guidelines. This included the People’s CDC press conference from March 13, a recording and our press release are available. We also have a pre-proof of the People’s CDC External Review in the American Journal of Preventive Medicine Focus that additionally highlights the shortcomings of the CDC’s approach to public health and recommends a more equitable pandemic response. This week, we have assembled an expert letter asking the CDC to correct their COVID isolation guidelines.

Community groups continue to show us that it is possible to push back against corporate efforts to further privatize healthcare – and win. In Massachusetts, the Boston Center for Independent Living and SEIU 1199 led a successful drive to prevent cuts to publicly funded personal care attendants (PCAs) for disabled people. When we fight, we win.  

Variants

Currently, JN.1 remains the dominant variant in the US, and is 83.7% of circulating variants as of 4/13/2024, down from 88.5% on 2/3/2024. JN.1.13 has increased to 9.1%, up from 0.7% on 2/3/2024. Other variants comprise 7.2% of the remaining total. A recent study, published in The Lancet Infectious Diseases, provided additional information on recent COVID variants that shed higher levels of wastewater; however, this cannot discount that COVID transmission remains at higher risk during rises in wastewater levels.

Hospitalizations

Total new hospital admissions caused by COVID have decreased to 7,318 during the week of April 6, 2024. Although the number of new hospital admissions are lower than the past, many counties in the US continue to experience increases in new hospital admissions. Over 25% of all counties are experiencing an increase in new COVID hospital admissions between the last week of March 2024 and the first week of April 2024. Most concerning, we still do not know the total number of hospital-acquired infections, since reporting over these numbers halted in May 2023. Despite this decrease in new hospital admissions and wastewater levels are currently at low levels nationwide, total hospitalizations do not completely reflect the current amount of circulating virus.

Prevention and Precautions

The CDC recently released guidelines to improve ventilation and implementation of air purification to prevent the spread of infectious diseases, specifically airborne pathogens. A group of scientists have also jointly published a policy statement in the academic journal Science supporting the establishment of higher standards for ventilation and the importance of air purification in indoor settings. Two studies published in the last month have validated the significance and value of both ventilation and air purification in schools and childcare centers to prevent the spread of COVID.

Vaccine uptake remains limited. Only 22.8% of adults and 14.1% of children have received the updated COVID vaccine as of 4/11/2024 -  a slight increase from 21.1% of adults and 12.8% of children on 3/10/2024. The Bridge Program remains available for those underinsured or without insurance for no-cost access to these vaccines, but may end December 31, 2024.

Long COVID

Senator Bernie Sanders, as chair of the Senate Health, Education, Labor, and Pension Committee, proposed draft legislation to address Long COVID. This proposal aims to allocate $1 billion annually for a decade to the NIH for Long COVID research, establish a centralized research entity and advisory board, create a rapid grant process for clinical trials, develop a patient data database, and enhance public education on Long COVID. We ask that you share your thoughts to their official contact by email specifically on allocating funding for effective treatments and specific measures in the prevention of Long COVID by April 23, 2024. Currently, Long COVID Alliance has compiled a list of active opportunities in studies and clinical trials that people with Long COVID may participate in, which may help the clinical community contribute knowledge of Long COVID and potentially support the development of effective treatments.

Take Action

An invaluable home-based program that supports testing, evaluation, and treatment for COVID, Test to Treat program, is ending on April 16, 2024. Send a letter to your local representatives to ask them to help save the program that helps so many at-risk people!

It’s been over a month since the CDC released new, irresponsible guidelines on COVID isolation which are not substantiated by scientific evidence. Our fight to take public health out of the hands of corporate interests and protect our collective well-being continues. As part of our strategy to push back, we’ve put together an expert letter to CDC Director Mandy Cohen telling her to reinstate science-based COVID isolation guidelines. We urge the CDC to consider the highly variable length of infectiousness in their recommendations and to adopt a test-based approach for ending isolation. This letter is for public health professionals, scientists, healthcare workers, disability advocates, and others who consider themselves experts in public health. Sign this letter asking the CDC to correct their updated COVID isolation guidelines.

Avian Flu (Awareness Update)

The People’s CDC is monitoring Avian Influenza (AKA “Bird Flu”) as it has been spreading in many avian and mammalian species around the world at alarming rates. The current strain of concern is subtype H5N1 clade 2.3.4.4b and is highly pathogenic in poultry, causing systemic infections and rapid onset of illness and death among avian species (1). As such, this is called a highly pathogenic avian influenza (HPAI). This specific clade emerged in 2020 and has now been detected on every continent (2,3,4, 5). Over 500 species of birds and 360 species of other animals have been infected worldwide. Hundreds of thousands of wild animals have died from avian influenza since its emergence in 2020 (1, 6). Here in the U.S., at least 28 outbreaks have occurred in cattle farms (6, 7).

While human cases remain low, case fatality in humans has historically been around 50% (6). The outbreak among many non-bird animals is alarming and allows for opportunities for viral mutations that may lead to further infections among humans (1,6). The ecological consequences of such mass death around the world are currently unknown but guaranteed to be devastating as food webs are severely disrupted and conservation efforts suffer (1, 5). Humans are already feeling the direct impact of this as farmers are forced to cull entire flocks of poultry to control the spread, which may result in increased prices in the food supply (6). Humans will probably continue to feel the impacts of this historic spread, regardless of the number of human cases. We will continue to monitor the situation and share updates as the situation develops.

UC Davis

CDC

CDC

Viruses

Nature

Vox

The Weather

Amid the CDC’s COVID-minimizing and dangerous rollback to isolation guidance, a new Pew Research poll shows that 27% of Americans are very or somewhat concerned that they will get COVID and require hospitalization, and 40% (nearly half) of Americans are very or somewhat concerned that they will unwittingly spread COVID to others. This number rises substantially for low income brackets, and Black, Hispanic, and Asian adults. Concern about hospitalization was highest in adults with a high school education or less. Despite efforts by the CDC, the Biden Administration, and corporate media to downplay the public’s concern about COVID, these numbers show that a substantial proportion of Americans care about protecting one another.

A popular program providing free rapid antigen tests through the USPS ended on March 9, 2024. Despite the limitations of rapid antigen tests, these home tests continue to be a vital way to quickly identify COVID cases, both to prevent further onward spread as well as to identify the need for treatment with Paxlovid. You can use our letter campaign to let your elected officials know we still need free rapid home tests.

COVID wastewater levels are decreasing, with no states registering “Very High” levels as of 3/15/2024. Eight states are currently at “High” and 15 are at “Moderate” levels of SARS-CoV-2 detected in wastewater.

Wastewater levels show a downward trend in the provisional data (gray shaded area) in all regions. The national wastewater levels are overall indicated as “Low.” Lower wastewater activity is an indication of lower overall viral spread, which is certainly a good thing. However, the “Low” designation is not a representation of low risk in our day-to-day lives, and continued masking and multilayered precautions continue to be necessary to protect ourselves and our communities. State and local trends can also provide additional information, where available.

A recent Axios article highlights the expanding broad utility of wastewater testing for COVID and other infectious diseases, as well as the uncertain footing of the funding and infrastructure for this essential surveillance tool. We encourage you to write your elected officials to let them know you want to keep and expand wastewater testing in your area and nationally.

Wins

On March 13, the People’s CDC hosted a press conference to push back on the CDC’s elimination of COVID isolation guidance and demand accountability to the public (watch the video or read the press release). The online publication (pre-proof) of the People’s CDC External Review in the peer-reviewed scientific journal American Journal of Preventive Medicine Focus was also announced, which is an important authoritative resource highlighting both shortcomings of the CDC’s approach and recommendations for a more transparent, effective, and equitable pandemic response going forward. The full External Review report can be found on the People’s CDC website.

March 15 was Long COVID Awareness Day, and Senator Bernie Sanders along with six cosponsors (Tim Kaine, Edward Markey, John Hickenlooper, Tina Smith, Robert Casey, and Tammy Baldwin) introduced Resolution 590 to formally recognize March 15 as Long COVID Awareness Day. You can ask your senators to support this resolution using this letter campaign. Senator Sanders released a video promising legislation to increase funding for Long COVID research and clinical care, as well as emphasizing the importance of prevention, including vaccination and masking. For more info on Long COVID Awareness Day, see the “Long COVID” section below.

When we make our voices heard, whether with the press, with scientific publications, or with elected officials, we win.

Variants

In the CDC’s most recent Nowcast predictions, JN.1 continues to be the most prevalent variant in the United States (86.5%), with a predicted decrease in JN.1 and sublineage JN.1.13 increasing (9.5%).

Vaccines

The CDC has recommended spring boosters for people age 65 and older, at least 4 months after the previous updated dose. As of 3/2/2024, only about 42.4% of adults age 65 and older had gotten an updated vaccine, and many who were vaccinated in the fall may not realize they are eligible for another dose. 

In addition to the spring boosters recommended for people aged 65 and older, immunocompromised people are eligible for more frequent vaccination. The CDC states, “You can self-attest to your moderately or severely immunocompromised status, which means you do not need any documentation of your status to receive COVID-19 vaccines you might be eligible to receive.”

As a reminder, the currently available COVID vaccine formulations (2023-2024, first available in fall 2023) are effective against the JN.1 variant, with about 54% protection against symptomatic disease. For people of all ages, immunity wanes after 6 months, and, although current eligibility is more limited, we continue to support access to vaccination at least every 6 months for all ages.

If you have not received one of the updated COVID vaccines released last Fall, you can use this tool to find local vaccine providers that are Bridge Access Participants. The Bridge program is currently available through December 31, 2024. 

COVID in Kids

In a recent report in the CDC’s MMWR publication, cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in 2023 were highlighted. MIS-C is an inflammatory response to a COVID infection that usually occurs 2-6 weeks following an infection. MIS-C may be serious and can affect the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal tract. Although rates of MIS-C have slowed since 2020-2021, 112 cases were reported in 2023, with 82.1% of those occurring in unvaccinated children. Among cases in vaccinated children, 60% occurred in children who had not received a booster within the last year. As of 3/2/2024, only about 13.5% of eligible children aged 6 months to 17 years have received a 2023-2024 COVID vaccine. More info on Long COVID in kids is presented below under “Long COVID.” 

It is clear that kids need protection from COVID, and current efforts are inadequate. We demand that public health authorities take action to protect our children. You can find more information to support protecting kids in our Urgency of Equity toolkit.

Long COVID

March 15 marked the second annual International Long Covid Awareness Day. Across the globe, Long Covid survivors, their allies, and the community fight for increased research, treatment, and visibility for people living with Long Covid. 

Searching #LongCovidAwarenessDay on most social media platforms will connect you to posts from people all over the world describing their experience navigating their ongoing symptoms while trying to educate others about the barriers they face in seeking accessible and effective treatments.

Up to 5.8 million children in the US may be affected by Long COVID. A recent study published in the journal Pediatrics from the American Academy of Pediatrics shows that vaccination reduces the risk of Long COVID in children by about 40%. 

Take Action

Super Tuesday has come and gone with nominees in most parties now established for races at the local, state, and national level later this year on November 5th.

People’s CDC wants to remind you that regardless of the outcomes of these elections, we must always continue to organize and fight back against the state’s abandonment of science in favor of corporate interests.

We urge you to use and share our letter campaign demanding that elected officials renew and expand programs to provide free Rapid Antigen Tests (RATs). You can also continue to urge elected officials to support maintaining and extending COVID isolation guidance via our letter campaign. Over 13,000 letters have already been sent, and you can use the same template to send follow up letters.

The Weather

It is the job of the CDC and our public health institutions to collect essential data to give us a clear idea of the status of ongoing pandemics so that we can make informed decisions that affect the health of ourselves and our communities. Dismally, the CDC and our public health institutions have been failing to do their basic job for many months now, leaving us in the dark as a mass disabling crisis unfolds on their watch. This is why we at the People’s CDC have painstakingly put together lab-based PCR testing data from the HHS to make a new transmission map to shed light on the current situation. Our goal with these maps is to give you a  clearer idea of the state of the pandemic state-by-state during a time when understanding transmission levels is so desperately needed. Below, we can see maps of the cumulative total of new COVID cases over a 7-day period for October 5th and October 12th. Although our new methodology is a bit slower (our expected turnaround time is once every 2-3 weeks) and although there are clear gaps in data in many states due to incomplete reporting from the HHS, the main message here is that everywhere in the country, COVID transmission levels are substantial or higher. There is not a single state with reported data where the transmission levels are moderate or below. COVID is very clearly still spreading like wildfire–and we now finally have maps again that show this. If you would like to learn more about our methodology for making these maps, please check out our methods description here and the data itself on our Github. Also, please let us know if you have any feedback on these maps here so we can make them the best they can be!

Wastewater

Now that Biobot is reporting wastewater data again while they are filing an appeal to the CDC for rescinding their contract, we are moving back to reporting on Biobot data as it is easier to understand given our history of using their data. Wastewater levels everywhere in the country except the northeast have been rising, with the most dramatic rise happening in the midwest. Even in the northeast, wastewater levels aren’t necessarily decreasing but rather are plateauing. This data supports once again the reality that COVID transmission is indeed substantial or higher throughout the country and that we must remain vigilant to protect each other.

Wins

In the wake of CDC’s HICPAC’s failure to propose healthcare policy that actually protects patients from COVID, our comments and actions have shined a light on their cruelty in the media sphere. Articles from Medpage Today, Infection Control Today, and CNN have all come out in the past couple weeks making our critiques clearly visible for the public to see, adding to the pressure. Of course, these articles are imperfect–CNN specifically has a blatantly misleading title that suggests that HICPAC supports masks in healthcare when in reality they do not–but the point is that our concerns are spreading far and wide and that we should keep up the pressure to make things right. Once HICPAC publishes draft documents in the Federal Register, we will have another comment period where we can share our thoughts on it and put even more pressure on HICPAC to make healthcare actually accessible to people without risk of disablement or death.

Long COVID

A new study examining Long COVID patients experiencing long-term fatigue has shown that Long COVID is marked by T-cell aging, which gives us another marker for helping with diagnosis and treatment.

Take Action

Historically, “moonshot projects” funded by the federal government have fundamentally changed the landscape of our country from the interstate highway system to the moon landing. As we are currently living in a mass disabling crisis where at least one-in-ten infections result in Long COVID, we desperately need federal funding for a moonshot project for researching Long COVID so as to determine viable treatments and eventually a cure. This is particularly urgent because the $1.15 billion the US government had allocated for Long COVID research is pretty much gone now, with no treatments or future funding on the horizon. To this end, the Long COVID Moonshot patients group is having a Call & Letter Campaign on Tuesday, November 14th to demand Senators and Representatives commit to invest at least $1 Billion each year over the next 10 years for NIH research funding and clinical trials regarding Long COVID. Please join us in making 3-5 minute phone calls using the call guide and script here with a focus on the following bills, Long COVID Support Act (S. 2560), TREAT Long COVID Act (HR 3258), and Long COVID RECOVERY NOW Act (HR 1114), and join the Launch party on twitter spaces on November 14th at 3 pm EST.

There is an episode of the Fox animated series Family Guy where the family dog, Brian, is welcomed as a possible new contributor at the New Yorker. After he is shown around the publication’s opulent headquarters, he proceeds to the bathroom, where he sees no commodes. He asks, “Um, where are the toilets?” To which a top editor responds, “Oh, no one at the New Yorker has an anus.”