This will be my last 🧵 of caution urging you to take care this New Year's Eve. There's a lot going on that the media and even the CDC are not promoting. I guarantee the risks are greater than you think they are. Some of you think we're in the end-stages of the #COVID19 pandemic. I think we're likely in the Fμ<% Around and Find Out (FAFO) stage. All the maskless crowds, parties and travel combined with the failure to get the bivalent booster is the FA part, and 2023 may bring us the FO portion.

In the US, there has been a leak of CDC info that suggests the agency has failed to disclose just how dangerous the new VBB.1.5 variant is at the current time (https://twitter.com/DrEricDing/status/1608704548536975360). If accurate, XBB.1.5 went from almost no US cases to 40% of cases in a month. It'a already predominant in the Northeast US, and in states where it is most established, COVID hospitalizations are at their peak for the past 12 months.

Even if this isn't accurate, we know XBB.1.5 is very immune-evasive and growing, and it's likely to spread across the US in the next few weeks, accelerated by all the maskless holiday partying, singing, and traveling. Even the experts who are normally cautious are sounding the alarm on this variant (https://erictopol.substack.com/p/a-new-variant-alert).

You don't need to believe the leak to realize the situation is not "normal" right now. COVID in US wastewater is at the highest level it's been in eleven months--in fact, it's the second-highest level of the entire pandemic, and it's rising (https://biobot.io/data/). And the CDC's Transmission Levels Map shows 71% of the US is at the highest transmission level and another 15% are at substantial transmission (https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=).

COVID hospitalization are still quite moderate, but where XBB.1.5 is taking hold (HHS regions 1 and 2), they are the highest in 11 months (https://covid.cdc.gov/covid-data-tracker/#hospitalizations).

It's not just the US that's FAFOing. COVID deaths in Japan have never been higher (https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=new_deaths_smoothed_per_million&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=~JPN). No one is entirely sure why, given the Japanese have a much higher vaccination rate and are much more likely to wear masks. One explanation is that, even though masks help, activity has returned to normal.

Another is that Japan hasn't succeeded in rolling out the Omicron booster (the 5th vvax dose) to a 80% of the population (https://www.kantei.go.jp/jp/headline/kansensho/vaccine.html). And, there is some speculation among those studying COVID's evolution that the COVID variant driving the surge in Japan has picked up a mutation that extends the period of asymptomatic infection.

The rest of the globe is seeing it's own share of troubles. Ireland is bracing for record overcrowding in hospitals (https://www.irishtimes.com/health/2022/12/30/hospitals-brace-for-record-overcrowding-in-new-year-as-infections-surge-in-state/). Hospitals in the UK are declaring a wave of "critical incidents" due to overcrowding and a nurses strike (https://inews.co.uk/news/hospitals-england-critical-incidents-a-and-e-departments-struggle-2054842?ico=related_stories). And, of course, the situation is reportedly horrific in China with overcrowded hospitals and morgues, but it's impossible to get a sense of the scale of the COVID disaster in that nation (https://www.nytimes.com/2022/12/29/health/china-covid-outbreak-predictions.html).

All of our maskless activities are inviting COVID to spread, and as it spreads, it mutates. The more it mutates, the more it finds the wholes in our defenses, overcoming immunity protection from past infections and vaccinations. And, with China having reversed its Zero COVID policy and inviting global travel, experts are worried the pace of new variants will only increase (https://www.theguardian.com/world/2022/dec/28/chinas-move-to-open-up-travel-sparks-concern-over-spread-of-new-covid-variants).

The US faces a mix of issues. COVID testing is the lowest it's been since May 2020 (https://covid.cdc.gov/covid-data-tracker/#trends_7daytestresultsreported_select_00). Activity level is high. Masking is low. And new variants are growing behind BQ (the one perdominant the past month) and XBB (the one about to become predominant.)

Meanwhile, just 1 in 6 people have gotten the bivalent booster (https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5). And we know vaccine protection fades in four to six months, but 80% of the US hasn't been jabbed in over six months. The nation is poorly prepared for the more immune-evasive variants to come.

And, if COVID was just a mild disease, all of this might seem like much ado about nothing. But we know a significant share of people will get Long COVID. Even more concerning is that more than 100 studies have found COVID can leave our bodies with significant issues (https://docs.google.com/spreadsheets/d/12VbMkvqUF9eSggJsdsFEjKs5x0ABxQJi5tvfzJIDd3U/edit?usp=sharing). COVID raises the risk of heart attacks by 93% in the eight months following infection. Brain scans show two years after COVID, grey matter is reduced in parts of the brain.

COVID can causes muscle decline that persists six months after infection. Suicide rates in veterans are 30% higher the year after a positive COVID PCR test. And multiple sutdies have found immune system damage that persists for at least six to 12 months after infections. Even the WHO, which has been famously slow to act on COVID cautions, is now warning about the immune dysfunction, vascular damage, and neuroligical issues that those infected with COVID can experience (https://twitter.com/Sandyboots2020/status/1608402400817336322).

Too many are Fμ<%ing Around. Perhaps most of you won't "Find Out," but with the growing body of knowledge that COVID isn't "just the flu," I fear a lot of folks could face diminished health for years and possibly the rest of their lives. That is an awfully steep "find out" price to pay because you couldn't wear a mask or be a little more careful.

Stay informed, be safe, stop pretending the pandemic is over, and do what you can to save your or others' lives in the months ahead--starting tomorrow night on New Year's Eve. I wish you a safe and healthy 2023.

P.S. If you do get COVID in the coming week, you might want to be aware of a new study that found that patients that initiated a twice-daily saline nasal irrigation were 8x less likely to be hospitalized than the current national rate (https://pubmed.ncbi.nlm.nih.gov/36007135/).