Headlines are suddenly full of news about the new XBB variant surging in the US. If you read my updates, you first heard about this variant in my post on October 8. The news stories are full of claims that we don't yet know if this variant increases the severity of disease. That isn't quite true, so if you'd like to know the current #COVID19 status in the US and be better informed for activities this weekend, here is a five-minute 🧵 update:
- XBB.1.5 is surging very rapidly, having increased 10x from 4% of US cases to 41% in just three weeks (https://covid.cdc.gov/covid-data-tracker/#variant-proportions). It grew out of NY and has become predominant in the northeast US, and experts predict it will spread across the US in the coming weeks. In the past two years, the first week of January was the peak of holiday surges, but this year, it appears we'll see increased transmission and risks throughout January.
XBB.1.5 is getting so much attention in the news media for two reasons. First, it's the fastest surge of a variant since the first Omicron variant. Also, it's getting more attention in the expert community because it made a rare 2-nucleotide substitution, and studies suggest it is as different from the original 2020 SARS-CoV-2/COVID strain as SARS-CoV-2 was from the 2002 SARS-CoV-1 (https://www.biorxiv.org/content/10.1101/2022.09.15.507787v3.full).
- This variant is the second in a row (behind BQ.1.1) to cause the current surge in the US. COVID in wastewater is in its second-highest surge of the pandemic (but still far behind last year's peak: https://biobot.io/data/). Walgreen's is reporting the highest positive testing rate of the pandemic (https://www.walgreens.com/healthcare-solutions/covid-19-index). The CDC's data on positive rate does not show it at its peak, but it has doubled in the past two months and is rising aggressively.
- The risk of COVID infection is high in much of the country. The CDC Transmission Level map presently shows that 71% of the US is at the highest level of transmission and another 15% are at the substantial level. https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Risk
- While news stories about XBB.1.15 frequently claim we don't know if it causes cases of greater severity, that isn't entirely true. The problem with news media is that by the time we have concrete evidence a new variant is more dangerous, it's too late--hospitals are already full. What we do know strongly suggests this variant puts more folks in the hospital at a higher rate than throughout this past year but lower (probably) than past surges.
In New York, for example, COVID hospitalizations are at their highest since February (but still two-third fewer than last holiday's peak): https://coronavirus.health.ny.gov/daily-hospitalization-summary. The same is true, for example, in Connecticut (https://www.ctpublic.org/news/state/2021-06-28/tracking-covid-data-vaccinations-hospitalizations-your-towns-infection-rate). In both states, hospitalizations are still rising rapidly, but they seem unlikely to surpass last year's peak.
- COVID hospitalizations in the US are rising and have just matched the mid-2022 surge (https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions). Risks are greater for older Americans, as has been typical throughout the pandemic: Hospital admissions for people 70+ have doubled in two months and are rising steeply. The situation for children isn't as bad, but that could change very rapidly--hospital admission for kids rose by 28% in the past week.
- All of these risks are manageable, but only if we cared, and most in the US are pretending the pandemic is over. Masks work (https://theconversation.com/as-viral-infections-skyrocket-masks-are-still-a-tried-and-true-way-to-help-keep-yourself-and-others-safe-195788), and many know they should wear them, but they won't because they fear others' judgement. (Risking your health because you care what strangers think feels like messed-up priorities to me.)
While people continue to fly without masks, a recent study in Malaysia found COVID in the wastewater of 96% of the flights (https://www.audacy.com/wwjnewsradio/news/national/coronavirus-found-in-samples-from-96-percent-of-flights). Now, tens of thousands attending CES in Clark County, NV, a county with substantial COVID transmission. The event's COVID policies won't prevent a transmission--masks are recommended “if you are more comfortable,” one complimentary COVID test is available for people who ask, and organizers request people not attend if sick. https://www.ces.tech/logistics/in-person/health-protocols.aspx
@augieray Please don't circulate the Malaysia study. It tells us nothing about contagious COVID prevalence or how safe it is to fly.
* COVID can continue to be present in a person's waste for long after they are contagious.
* They only tested for the presence of COVID in the waste, not its concentration. Without that this says nothing about the risk of infection.
Flying may be a COVID risk, but bad proof like this gives the back-to-normal people ammunition.
@jik I think the study has merit. It suggests almost every flight had one or more people who were COVID positive. While the air in flight might be better, we know CO2 levels during boarding, taxiing, and deplaning can be terrible. Rather than complain about the study, wouldn't someone like you prefer to recommend more people wear masks? XBB.1.5 is spreading rapidly, and nitpicking studies seems to detract from the larger, more important, message.
@augieray
What the study says is that there are traces of COVID in the waste tank of every flight. That is not at all the same as every flight having someone COVID positive on it.
Having said that, I would actually expect most flights to have at least one COVID positive person on them. There's nothing surprising or revelatory about that. 1/3
@augieray Again, that doesn't prove that it's unsafe to fly. Of course I want people to mask, and there's ample good evidence of why people should do that, which is why it's bad to circulate BAD evidence like this study.
Note that the study authors very carefully did not make any claims about what their discovery proves in terms of the safety of flying. It's people—like you—who are circulating the study who are doing that. And that's bad. 2/3
@augieray "Wouldn't you rather focus on x than pick on this study" is a red herring and attempt to change the subject and I expect better from you. That's a ridiculously false dichotomy. I am capable of doing more than one thing at a time. 3/3
@augieray Actually it occurs to me that there are two more points I want to make here.
1) In my opinion, the single biggest danger COVID educators need to avoid is sensationalism. The things we are telling people need to be rock solid, because if any one thing isn't, the people we're fighting will use that to discredit us entirely.
2) If flying were significantly more COVID dangerous than normal life, there would be ample evidence of that by now. There isn't any.
That's incorrect, if you're talking scientific data into the subject. Even the author of the best model says:
“Nobody is screened. Nobody is asked if they’ve come down with COVID. There was no attempt made to figure out where people got it. We have so little data.
...
“If we had actual data from the United States, then maybe we wouldn’t have needed a model.”
Of all places Nerd Wallet did an article on the subject this past summer if you want to take a look as that's where the quote came from.
https://www.nerdwallet.com/article/travel/covid-transmission-on-planes
You're much better off looking at CO2 levels before takeoff when HEPA filters are not running as a proxy. I think you'd have to conclude from that that it's not a very safe place to be sitting, but, you're somewhere between hard scientific data and anecdotal evidence with CO2 alone.
Yuck! That's not healthy outside of COVID, but, I kind of wished we used rebreathed air percent instead of CO2 just to make it a little more personal.
At 2,400 ppm CO2 somewhere around 5.5% of the molecules in the air are freshly out of someone else's lungs(with a few assumptions made).
@nazgul I’m curious what device you use to track CO2 on your phone?
Aranet4. Great device, albeit a bit expensive. Runs on one battery forever (I’ve had mine since July and it’s still in the same battery). Stores a week or so of data.
@nazgul Thanks, appreciate the info! Seems like that device actually provides “meaningful” CO2 numbers, so probably worth the money if you’re looking for accuracy. Thanks again.
@BE @augieray I stand corrected, thank you.
The suspicious part of me wonders if we don't have any hard real-world data is because the airlines won't cooperate with scientists who want to study this because they don't think they'll like the results.
In any case, the rest of what I said still stands: IMO this is a useless study which doesn't tell us anything we don't already know and will only convince people to change their behavior if it's misinterpreted.
Small sample, but looks like a cool little study. I've never seen that one before. Gave it a quick scan, but I plan on reading it more thoroughly later today. Thanks for sharing it!
@BE @thirzajane @jik Another study to check out about flight risks is this one. It got a lot of attention two months ago because genomic testing allowed Chinese researchers to discover an infected guy jogging outside transmitted #COVID19 to 35 people in a park. But, what I also found interesting is that he was infected on a flight not by someone on that flight but someone who'd flown the same plane the day before. The plane wasn't disinfected overnight.
https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2022.209
Wow, I did not know the part about the plane in that story.
@thirzajane @BE @augieray This is a good study, thanks. My read is that given that only seven passengers out of 86 were infected on a 19-hour flight, it's actually pretty _safe_ to fly, at least on a short flight, if you're vaccinated and keep a good mask on the whole time. I'm assuming they didn't keep their masks on the whole time because the paper doesn't address that and it's exceedingly unlikely for a 19-hour flight.
I want to preface this with a disclaimer of sorts. We're splitting hairs...if someone next to you(or near you) on the flight has COVID and you're not wearing a mask you're probably going to get it. Despite our disagreements about the minutiae of flying I'm pretty sure we all agree on that and wish there were better data.
So, I came to a different conclusion than you did, now having read it, from that very small sample size!
It's actually way *less* safe than the model that everyone uses showing a 1/1000 chance of contracting COVID on a plane. This study is suggesting transmission during the flight(when HEPA filtration should be a thing) across 4 rows, and with mask and glove wearing:
"passengers A, B, D, F, and G self-reported mask and glove use while on the airplane but passengers C and E did not"
That insinuates that even wearing a mask you could be infected on a flight from at least 4 rows away. As you pointed out, 18 hours is a long time to wear a mask without taking it off to eat or drink, so it's likely that they did take their masks off at some point, even briefly.
I keyed in on the 2 hour refueling stop in which no one left the plane.
"No passengers entered or exited the aircraft during the 2-hour refueling period in Kuala Lumpur."
I assume that's like sitting on the runway in which the HEPA filters aren't running? But I honestly don't know, so I'm going to leave that aside for the moment in my analysis.
One limitation is that I don't see a discussion of the time the plane spent on the runway, was it delayed and sat for a while, etc. I think that would have been a great data point as that's almost certainly the most dangerous time for a more "normal" shorter flight. But, again, we're talking a study on a single flight with 86 passengers and 7 positive tests. It's the definition of small sample size.
@jik @thirzajane @BE Thre is more risk on a 19-hour flight than a three-hour flight. Except, since the safest part of a flight is while the plane is in the air with filters engaged and the most dangerous is on the ground (boarding, deplaning, taxiing), I think your analysis may be overstated. Both short and long flights have equal risky time on the ground. From the start of this conversation, you've gravitated to the assumption flying is safe. I don't think we have data to show that.
@augieray @thirzajane @BE I don't think flying is safe and haven't said I do. Despite its causing personal hardship, I haven't flown since COVID and don't plan to. Interestingly, you have, so which of us thinks flying is safe enough?
My position, which I've been clear about, is that the Malaysia study is worse than useless, and that there is thus far no evidence that flying with a good mask is significantly more risky than time in public in other contexts.
@augieray @thirzajane @BE My attitude about flying in the age of COVID is the same as my attitude about any other exposure to other people: I'll do it if there's no other practical choice, and I'll take sensible precautions. I assume on this we agree.
Safe/unsafe is meaningless. Nothing involving contact with others is "safe" nowadays. All we can do is minimize risk, not avoid it entirely.
I was last on a flight January of 2020, personally.
The reason I find this discussion so interesting is that the only number I ever see thrown out there by people calculating their own risk of flying is Professor Barnett's model and he himself said there was practically no data behind it.
So, yeah, it doesn't change anything for me, but, a lot of people do probably use the 1/1000 number to decide whether or not to fly still, sadly.
Not to beat this fully to death or anything....but I found an interview with Prof. Barnett that I hadn't seen before from this past summer where he discussed this quite a bit. The host seemed to spend a lot of time trying to get him to say that driving was more dangerous than flying, but, there's some good parts so I'll link to it.
He talks a bit about how he said that US Airlines wasn't being forthright about the COVID risk on planes. Some of the answer's here:
"Well, part of what I was doing was reacting to what USairlines were saying, and US Airlines do a fabulous job at preventing crashes, but to other sources of risk, I don't think they especially distinguished themselves and United airlines and said that the risk of getting COVID-19 or United flight was, was nearly non-existent quote unquote in Southwest airlines. Not to be out done said that it was virtually non-existent well, it's not non-existent. And what I pointed to in terms of data in that article was the many flights overseas in which we have evidence in the peer reviewed medical literature that an infected person caused COVID to many others on the plane to several others.
Now, not everyone you'll have to be seated pretty close to the infected passenger. It is true that the planes have good air air, air purification systems. So if I'm in seats eight, an and someone is infected in 20 B, it's extremely unlikely. This will affect me. But if the infected person is in 20 B, that's not great news for the person in 28 or 20 C or a 21 B. So I have done calculation, but I cited several instances there. You know, one of the earliest examples was a passenger on a flight from London to Vietnam here on air, via Vietnam era airlines was infected with COVID-19 and of the 12 business class passengers within two rows of her, 11 of them came down with COVID on the flight. Okay. And whereas other business class passengers who are further away from her, the risk was I think one and nine or something."
@BE @augieray @thirzajane Yes, exactly this. The messaging we need to get across isn't that flying is particularly unsafe, but rather that it isn't particularly safe, despite what the airlines were claiming at the start of the pandemic.
(They're not really claiming that anymore, since they're not really claiming anything at all about COVID, since like everybody else they're trying to pretend it doesn't exist.)
@BE @jik @thirzajane Given what little data we do have about flying during the pandemic, I am 100% certain the risk is MUCH higher than 1/1000. Don't get me wrong, I'm flying. I try to avoid flying during surges, remain masked, wait in emptier areas of the airport & try to be the last one to board to minimize the risky time on the ground. I've taken 12 flights and avoided COVID. My wife, however, came back from a trip with it. We suspect the plane or airport, but we're obviously not certain.
@augieray @thirzajane @BE My primary concern in this discussion is that if COVID educators harp on the safety of flying, when there is no hard evidence that it is significantly more dangerous than other forms of public exposure and plenty of empirical/anecdotal evidence that it isn't, that causes low-COVID-signal people to doubt _everything_ about COVID safety warnings. It's counterproductive if your goal is to change behavior.
@jik @thirzajane @BE Few are listening to anything. Most are going to concerts and conferences unmasked. Few are getting the new booster. Saying we can't share a study that suggests flying might be risky because we lack more data is laughable. Even where we do have data--on the importance of timely boosters or the effectiveness of masks--most choose to ignore it. You are fighting hard for one activity--flying--and, IMO, missing the larger point about the need for more caution in all activities.
@jik @BE @augieray 7 out of 86 with most the seats in the ‘infection zone’ empty. Presumably had they all been filled (e.g., by others from the 86) the numbers may have been higher.
Agree with the comments from all regarding the highest risk times, likely unmasking to eat, etc. Also that bus trip.
Good discussion.
@thirzajane @BE I just realized that while this study says 5 of the people who got COVID were masked, doesn't say what kind of masks they were. Given the amount of mis/disinfo about masks and droplets vs. aerosol that was circulating in September 2020, coupled with the fact that there was a shortage of N95s, it seems unlikely that they were wearing adequate masks.
Given this, this study tells us even less about the safety of flying with a good mask.
I wish we had more, better data. 😕
@jik @BE Probably were surgical masks given the time and the sometimes odd insistence on those in preference to better masks. But still, most of the people on planes now are entirely unmasked. I don’t think there are ever going to be studies / better data now because the waters are so muddied by variables.
@BE @jik @augieray
I’ve been really unhappy with CO2 levels on some planes, especially Alaska. This was a recent flight from Seattle to Hawaii. It was bad enough on the flight, but then we got stuck on the tarmac in Hawaii for 20 minutes and it go so bad we got headaches.