State of COVID, May 2024

December 16, 2023•4,591 words

What We Know About COVID

Last updated May 10, 2024

Please use this URL to reach this page: https://covidnow.info. You can send corrections and updates to webmaster at the same domain.

How to read this page: scan down for bolded headers with super-short summaries. Then read the details in the sections you care about.

Change log

Table of Contents

Summary of Current Status (TL;DR)

April 20, 2024: Yale School of Public Health published a series of graphics describing what we know about the lasting effects of COVID on the immune system. Facebook • Sources & Citations

Our knowledge of COVID is still young and developing. The virus is developing variants faster than we can study them. We can't say much about long-term effects for sure, because the virus has only been circulating for < 5 years.

COVID causes immune dysregulation (lots more sickness), neurological damage (brain damage), and increases risk of heart attacks and strokes. Long COVID can strike even mild cases of COVID, and sometimes doesn't begin until 30+ days after the initial COVID infection.

Fun fact: A man got vaccinated 217 times and had no ill effects. He also didn't get COVID. Source

  • KP.2, a variant of the JN.1 lineage, may be 3.1x as immune evasive as JN.1, and 1.22 times as contagious (Re). Pre-print
  • 2/3 of spread is asymptomatic. CDC
  • As of April 26, prevalance is about 1 in 185 on average in the US JPWeilend I normally don't link to social media threads, but Weiland is an infectious disease modeler.
  • Children and schools a major vector for spread. Infectious disease modeler
  • Two large-scale studies show even mild COVID causes cognitive deficits. • NEJM1 • NEJM2
  • Cognitive deficit equivalent to 2-9 IQ points, even in mild, fully-recovered cases NEJM
  • Vaping certain products can increase susceptibility to COVID-19
  • 300,000 Colorado residents with Long COVID
  • Getting sick more often? If you've had COVID, you could have immune system damage. See below.
  • JN.1 accounts for 95-97% of all USA COVID cases, 2/17/24 CDC
  • * JN.1 is dominant. It may be more dangerous than Omicron, due to its ability to "fuse" with lower lung cells. source (See additional sources in this article.)
  • Immunity from JN.1 is completely gone within a year Medrxiv preprint
  • Get your booster to be protected against JN.1 Pre-2023 vaccines and boosters show same rates of hospitalization with JN.1 as unvaccinated people, according to a Medrxiv-published pre-print study.
  • Damaged immune response may be causing neurological damage, not the virus itself Source
  • Ventilation helps reduce transmission in indoor spaces. CDC
  • Wear N95, KN95, or P-100 masks indoors in crowds, or in any poorly-ventilated spaces where virus may accumulate.
  • Neti Pots, nasal irrigation, and gargling early in an infection or after exposure substantially reduces severity of symptoms and chances for hospitalization.
  • Rapid tests can falsely show negative even when someone is contagious. This is because immune symptoms in vaccinated/previously infected people appear early, before viral load is high enough to show up on a rapid test. So someone can be infected for 4-5 days or more before a test will show positive. Swab both throat and nose for increased sensitivity (though possible false positive) results.
  • The virus stays in your system even after you recover. Institut Pasteur
  • Reinfection damages your immune system, it doesn't make you stronger.
  • Even mild cases can produce long COVID and organ damage.
  • Long Covid can (and most often does) happen in cases that were mild or asymptomatic. Many other non-intuitive co-factors. Medscape article
  • Long COVID is real and evidence suggests that it involves brain damage. Long COVID may be caused by the body's immune response, not directly by the COVID virus.
  • Dec 2023, State of COVID in Canada. 37.9% of people with 3 or more COVID-19 infections suffer prolonged symptoms. 72.5% of those continued to experience symptoms after 12 months. 22.3% of those with prolonged symptoms took days off and the average was 24 days off in the year since the first report. Most common symptoms included brain fog, fatigue, and shortness of breath. Source • h/t Anthony Kearns, LinkedIn
  • The US just had its second biggest surge, second only to the Omicron surge. Twitter thread • CDC regional map • CDC wastewater graph

See below for details and sources.

Vaccines: they work, but stay current

A twitter thread about how immunity and vaccines work, and what affects how long immunity lasts.

  • CDC study: COVID vaccines don't cause elevated risk of myocarditis in young adults CDC
  • Novavax produces more antibodies than mRNA vaccines Source
  • Novavax may provide 95% immunity after 10 months Source
  • Vaccines reduce the risk of heart damage Source
  • Get the latest booster. Pre-2023 vaccines booster produce the same levels of hospitalizations/outcomes against JN.1 as in unvaccinated people. Source
  • Vaccine effectiveness wanes over time. Source
  • Vaccines reduce transmissibility BUT… It depends which vaccine, and which variant. The original vaccine reduces transmission of original variants by 70%+, but that drops to 55% for Omicron. Source
  • Cardiac risk from COVID-19 infection far outweighs risk from the COVID vaccine for all age groups Source

Nasal sprays and vaccines

Nasal sprays and vaccines are being developed for COVID and other diseases.

  • A random controlled test on iota-carrageenan sprays in 2021 shows promising COVID protection. Medrxiv
  • Iota-carrageenan may neutralize several early Omicron variants in-vitro Source

Are parties risky?

As of March 22, 2024, based on wastewater numbers, around 1 in 98 (1%) people are COVID positive.

See How to Gather Safely below if you're planning a party.

Even though the chances of any one person having COVID may seem small, if you have many people in a group, the chances that someone in the group currently has it can be high.

  1. Identify which line represents the community prevalence you think is accurate.
  2. Scan over the X axis to the number of people you think will be at the party.
  3. Look up to where that number intersects the community prevalence line you chose.
  4. Look at the Y axis to find the percentage chance that someone at the party will have COVID.

COVID group probabilities

Example: 30 person party with 3.5% community prevalence:

COVID probability example

Are schools risky?

According to infectious disease modeler JP Weiland, yes.

How to gather safely: outdoors or well-ventilated

  • Ask people with symptoms to stay home (see Symptoms below)
  • Ask people to test beforehand and stay home if they test positive.
  • Important: Rapid tests are only partially effective. Current rapid tests seem to be giving a lot of false negatives. Have people test. If they test positive, they should stay home. If they test negative, they should test again after 48 hours. (No one actually does this, so requiring a negative test will likely allow some false positives through, on average.)
  • Party outdoors and/or with good ventilation.
  • Ventilation guidelines. CDC guidelines
  • Ventilate during a party. Build and use a Corsi-Rosental box. Corsi-Rosental instructions.
  • Ventilate after a party. CDC Ventilator Calculator

Masks: use N95s, KN95s, or P-100s when indoors

  • ReadiMasks are NIOSH-approved N95 masks that seal with medical adhesive rather than straps. You can seal them around just your nose(!) during dental procedures to minimize inhaling air during dental work. Video of use • Readimask website
  • Masks work for respiratory illness, guidance in plain English. CDC
  • Masks work. CDC
  • Choosing which mask to use. CDC • Infographic
  • Masks work. Source
  • Mask using a high-quality respirator like an N95, KN95, or P-100. Learn to check the fit. Source
  • 3M Aura N95 9210+ work well and are glasses-compatible. Link
  • Blue surgical masks and masks worn incorrectly don't protect you. They protect against droplets, not against aerosols. COVID is an aerosol.
  • For a more attractive mask with KN95 equivalence, the Flomask Pro is pricey and NIOSH-certified.

After a Gathering: nasal irrigation (Neti Pot or squeeze bottle)

  • Use a Neti Pot or other nasal irrigation system Use in the nose and gargle 2-3x per day after a crowded party. Nasal irrigation produces a substantial decrease in hospitalizations and symptom severity if done early in a COVID infection, no matter which saline formulation is used. Source • Source • Source • Source • Source

One safe option is to act as if you've been exposed after a party. For the next three days, use a neti pot or nasal irrigation 2-3x/day and gargle with a CPC containing mouthwash. These are inexpensive, have no downside, and may offer substantial protection.

Symptoms: assume it's COVID

Symptoms start before the virus multiplies. Your immune system is more sensitive than rapid tests. You'll have immune cold symptoms like runny nose, sore throat, and so on as soon as you're exposed, even though you'll still test negative.

When you have symptoms, assume it's COVID: mask around other people and isolate until you know for sure. Ideally, take a test that sorts out COVID vs. flu vs. RSV vs. other infections.

Asymptomatic infection and false negatives are still common in the first several days of COVID.

Some cases have gastro-intestinal symptoms only. Lack of appetite, nausea, vomiting, diarrhoea, and abdominal pain. These may not be the symptoms people expect with covid, but around 50% of people experience them after SARS-CoV-2 infection, and in some people they’re the only symptoms.1 Gastrointestinal (GI) symptoms may be the first sign of infection or may develop later and persist as part of long covid. BMJ

Rapid tests: partially effective, false positives

The current rapid tests were developed for the 2020 variant of the virus, and they still seem to work. However, they often don't show positive until several days after infection.

  • Testing positive on a rapid test—whether on day 5, 10, or 20—may mean you're still contagious. PBS News Hour • CDC
  • Swab throat and nose. Some variants multiply more in the throat than the nose. Swab throat (tonsils) and nose for best results. YouTube how-to
  • Rapid tests still work against latest variants (Jan 2024). Annals of Internal Medicine • MSN article • NIH
  • Rapid tests can give false negatives. Bloomberg article explaining theories why
  • Test twice, 48 hours apart. If you test negative but have symptoms, wait 48 hours and test again before assuming you're genuinely negative. (I've heard that even 48 hours is not enough, but can't find definitive sources for that claim.)
  • Safest assumption: be skeptical of negative tests and retest a couple of days later. Assume positive tests are correct.

A rapid test repeated in nose and throat (mid-December 2023)

COVID rapid test with nose and throat swabs

Affordable rapid tests

At the moment, rapid tests are appearing at all price points, often upwards of \$20 per test. Here are sources to buy them in bulk at cheaper price points. These sources and brands have not been vetted. Order at your own risk.

What if you get it? Neti pot, nasal irrigation, gargle, Metformin

  • NEJM study released April 2024 suggests Paxlovid may not be effective at reducing duration of the disease, but it does still seem to reduce symptom severity. NEJM
    • CDC website last updated Dec 2023 still says: check with your doctor about taking Paxlovid within the first 2-3 days of infection. CDC web site
  • There is some evidence that Mouthwash with CPC (cetylpyridinium chloride) may reduce the COVID viral load in the mouth. Example: Crest Pro-Health CLINICAL. Study1 • Study2 • Study3 • Study4 • Study5
  • Use a Neti Pot or other nasal irrigation 2-3x per day. Neti pots and squeeze bottle nasal irrigation may decrease the need for hospitalization and may decrease severity of symptoms. Source • Source • Source • Source • Source
  • Metformin looks promising, but isn't yet officially approved for treatment. Lancet study done on early variants • NIH web site
  • Avoid exercise? Maybe? Exercise is complicated. It may make recovery harder. It may help recovery past a certain point in the disease. The NIH overview suggests that it's complicated. NIH overview • Popular Source

Reinfection

Post-COVID brain, immune, and organ damage (there's a lot!)

  • Immune system damage
    • post-COVID, increases frequency of other infections, consistent with immune damage World Health Network
    • Immune system damage from severe cases. Source
    • Immune system damage from mild-to-moderate cases. Source
    • Increased risk of auto-immune diseases. Source
    • Immune system damage persists after recovery. Source
  • Viral Persistence
    • The virus stays in your system even after you recover. Institut Pasteur • Nature
    • COVID virus may stay in the lungs after an infection. • Source
    • Meta-analysis: The prevalence of post-COVID symptoms is 30% for two-years after COVID-19 hospitalization. See footnote1 for an important note. Source
    • Covid fragments assemble into "zombie" sequences provoking immune response after infections are over. Study • Plain English
    • COVID found in spermatozoa up to 3 months after infection Source
    • Covid fragments assemble into "zombie" sequences provoking immune response after infections are over. Study • Plain English
  • Brain damage
    • A decline in executive function and especially verbal fluency was found in acute patients, partially persisting in recovered. (Small sample size) Source
    • 200,000-person study: COVID leads to memory loss NEJM • ScienceNorway
    • Even fully recovered mild COVID patients had cognitive deficit equivalent to 3-point loss in IQ NEJM
    • Two large-scale studies show even mild COVID causes cognitive deficits. • NEJM1 • NEJM2
    • Trinity College-brain fog caused by blood vessel damage Trinity
    • Neurological damage (brain damage) from mild COVID Source
    • Post-COVID, multiple cognitive impairments ("brain fog") Nature
    • Cognitive decline and brain damage in hospitalized patients Source-preprint
    • Damaged immune response may cause neurological damage, not the virus itself Source
  • Heart damage Source • Source
  • Multiple organ systems. Source
  • Even mild cases can produce long COVID and organ damage. Source
  • Exercise intolerance-decreased oxygen uptake by organs Source

COVID stays in the body

As of March 2024, COVID appears to stay in the body, like HIV, HPV, Herpes, etc.

  • Chinese study suggests that Long COVID is caused by Covid in the tissues Lancet
  • COVID stays in the lungs Source
  • Virus can stay in the body News story I am searching for links to the actual studies.

Long COVID: it's real and common

Most concerns have been about the severity of initial infection. A more troublesome concern is "Long COVID," which can cause extreme disability.

Click here for a graphic from SCIENCE that summarizes currently known mechanisms of Long COVID

April 20, 2024: Yale School of Public Health slides: COVID and the immune system. Facebook • Sources & Citations

  • University of York: 28% of COVID patients develop Long COVID. Vaccination reduces chances by factor of four. Article
  • Chinese study suggests that Long COVID is caused by Covid in the tissues Lancet
  • What we know about Long COVID so far (Jan 2024) Nature • Science
  • Increasing evidence of COVID brain damage
    • COVID-19 infections can trigger new-onset dementia in adults over 60 SSRN
    • Long COVID could be brain damage Medscape
    • Long COVID patients show cognitive slowing 2-3 standard deviations below the mean. (2-3 standard deviations is bad, very bad) Source
    • Neurological damage (brain damage) from mild COVID Source
    • Long COVID and Impaired Cognition NE Journal of Medicine 2/29/24
    • Immune dysregulation may cause neurological damage Source
  • Sleep apnea associated with increased Long COVID risk NIH
  • Long COVID patients have T-cell dysregulation (immune system malfunctions) • Source
  • Multiple rounds of vaccinations lower Long COVID risk • Scientific American article with links to primary sources.
  • Exercise may harm Long COVID sufferers who have post-exertional malaise • Source
  • Most Long COVID patients are from mild or asymptomatic cases. More women than men. Many other co-factors including non-obvious ones like joint hypermobility, history of anxiety or depression. The article is worth reading • Source
  • Long COVID affects ~5.3% of COVID cases in vaccinated people • Source
  • As of Dec 2022, roughly 7% of all adults have had Long Covid at some point, with ~3,500 LC deaths as of 2022. Source1 • Source2
  • Long COVID frequency in Canada, suggests that reinfection increases the risk of Long COVID. • Source
  • "Long" diseases are common in viral infections. Long HIV is AIDS. Long chicken pox is Shingles. Long Epstein Barr is Multiple Sclerosis. We already know that Long COVID can be anything from loss of taste/smell to crippling fatigue, stroke, and heart failure. We have no idea what Long COVID is over 5+ years.
  • CDC reports "thousands" of deaths from Long COVID • CDC • Medscape commentary

Avoiding COVID: vax, mask, ventilate, far-UVC

  • Ventilate CDC
  • Don't vape, or make sure your vaping formulations don't increase COVID-19 susceptibility. Source
  • Get the latest booster. Pre-2023 vaccines booster don't protect at all aganist JN.1. Source
  • Use good ventilation (6 or more air changes per hour) and air filtration (MERV-13 or better) when indoors with others. Mask in unventilated rooms where others have been in the last few hours.
  • Build and use a Corsi-Rosental box. Corsi-Rosental instructions.
  • Stay up to date with boosters. Pre-2023 vaccines don't protect against JN.1.
  • Be on the lookout for sterilizing ultraviolet Far UVC (222nm) technology Source • Source • Source • Source

Other Resources: Research, People, Dashboards

People to Follow

Other research compilations

Collections of links to science:

COVID Tracking Dashboards

March 2024: The reduction of available COVID data is continuing. Hospital COVID tracking is being reduced to weekly or less.

As part of their commitment to pretend COVID ended in 2022, most United States administrations have dismantled their COVID tracking infrastructure. Here are sites known to work:

FAQ about COVID and viruses

  1. Wastewater numbers are high, but hospitalization numbers are steady. Every single surge, this has been reported. This forgets time lag. Wastewater today turns into symptoms in a week. Symptoms take 5-10 days to get bad, if a case is going to be severe. That leads to hospitalization. Then it takes an additonal week or two to know if hospitalization leads to death. It's an error to try to correlate the two without accounting for the time lag.

  2. Wasn't COVID officially declared over in Feb 2022? The declaration was a political communications strategy, not based on public health. Here's the memo from HOUSE.GOV

  3. Surely it was over before then. We were back in the office with no precautions. The World Economic Forum at Davos, attended by top world leaders, billionaires, and celebrities, told a different story. They had masking, ventilation, filtration, and Far UVC air sterilization. We got to return to offices without mitigations, while they were using more mitigations than any workplace has yet set up. Source

  4. Isn't COVID like the flu now? COVID is much worse than the flu. It causes both immune and organ damage and is several times more fatal. News source • Original study

  5. Won't COVID get less severe over time? No. This is a myth. Some viruses get milder over time. Others don't (e.g. encephalitis, flu, measles, HIV, etc.) Source PDF of article from SCIENCE

  6. Isn't Omicron milder? Not really. This was inappropriately hopeful reporting before we had much data. These conclusion also had not properly controlled for the new vaccines. Source

  7. Are more dangerous variants possible? Yes. Source PDF from Nature Reviews

Caveats about this site

Governmental agencies, businesses, and private media outlets have misrepresented the science through ignorance or for political reasons throughout the pandemic. This page is my attempt to link to scientifically-based research or public health sources. Use it at your own risk.

The virus is changing faster that we can know things for sure. For example, by the time we know the hospitalization rates for a variant, it will be too late to take preventative measures. That's why I include pre-prints in my links. While pre-prints haven't yet been replicated or peer-reviewed, they're at least based on attempts at hard data, rather than hearsay or wishful thinking.

Change Log

  • 2024-05-10 - added CDC link for figure that 2/3 of COVID spread is via asymptomatic people. Added GI symptoms.
  • 2024-05-04 - added Readimask links
  • 2024-05-03 - clarified that NEJM study showed no reduction in duration of Paxlovid, but, consistent with other studies, did show a reduction in symptom severity. Added KP.2 study link.
  • 2024-04-29 - added section on nasal sprays and vaccines
  • 2024-04-28 - university of York study
  • 2024-04-26 - Chinese study suggests LC due to viral persistence
  • 2024-04-22 - Yale publishes slides on current state-of-COVID
  • 2024-04-12 - CDC study says no elevated risk of myocarditis from COVID vaccine
  • 2024-04-11 - Added study that Novavax may provide 95% protection after 10 months
  • 2024-04-05 - NEJM study saying Paxlovid doesn't make a significant difference
  • 2024-04-01 - added links to CDC and PBS News Hour regarding rapid tests and isolation periods
  • 2024-03-27 - added links to other research archives and LIINC
  • 2024-03-26 - for people who really want to read studies, added links to other pages that compile COVID research studies under the "who to follow" section
  • 2024-03-24 - added link to Twitter thread about vaccines and waning of immunity
  • 2024-03-20 - kids still drive spread, JPWeiland thread link, decline in executive function and language
  • 2024-03-18 - Added the still-nascant section on viral persistence
  • 2024-03-16 - WHN post covid increase in infections
  • 2024-03-13 - New study released, vaccines reduce the risk of heart damage
  • 2024-03-12 - COVID found in spermatozoa
  • 2024-03-11 - Added information about viral persistence.
  • 2024-03-10 - Corrected CDC Tracking description to say you can see all data by clicking a dropdown. Updated with latest research about rapid test effectiveness.
  • 2024-03-07 - Added preprint study, JN.1 natural immunity gone after 1 year, 217-time vaccinated dude
  • 2024-03-06 - Norweigan study, COVID -> memory impairment
  • 2024-02-29 - NEJM Long COVID article on impaired cognition, SSRN new onset dementia study, sleep apnea, Long COVID and Cognitive Deficits
  • 2024-02-28 - added state-of-long-COVID Nature and Science
  • 2024-02-27 - added Vaping study
  • 2024-02-23 - added Longitudinal Canada study link, updated US wastewater numbers, Nature study on brain fog, Trinity college brain fog cause (brain blood vessel leakage)
  • 2024-02-21 - 300,000 Coloradans with Long COVID
  • 2024-02-16 - JN.1 is 95-97% of all US cases, what we know about COVID so far
  • 2024-02-14 - added Scientific American overview of what we know about reinfection
  • 2024-02-12 - added study suggesting disregulated immune response, not the virus, is what causes neurological damage
  • 2024-02-08 - Medscape article, Long COVID could be long-term brain injury
  • 2024-02-05 - Added links to sources for affordable rapid tests (which currently retail for roughly $26 for a package of two)
  • 2024-02-03 - New long covid research about COVID "zombie" fragments in Long COVID
  • 2024-02-01 - Updated to say we're past the peak surge in the U.S.
  • 2024-01-30 - Added meta-analysis to Long COVID section. 30% symptom prevalence 2 years after infection.
  • 2024-01-26 - Added study showing LC patients show 2-3 STD lower processing speed than controls.
  • 2024-01-25 - Added link to CDC Long COVID death report. (Most reporting has been on Long COVID treatment or disabilities. This is on the actual LC death count.)
  • 2024-01-25 - Added link to Belgian study on vaccine effects on transmissibility
  • 2024-01-21 - Added link to Bloomberg article about rapid tests giving false negatives early in an infection.
  • 2024-01-20 - Added study that came out this week, mild COVID leads to neurological damage.
  • 2024-01-18 - Added study: exercise may be bad for certain Long COVID sufferers
  • 2024-01-17 - Tried again to clarify the JN.1 study wording.
  • 2024-01-15 - Clarified the JN.1 study synopsis to make it explicit that hospitalization rates were relative to unvaccinated people, but the unvaccinated population may still have had a level of antibodies from an actual COVID infection.
  • 2024-01-15 - Added the change log.

back

  1. This meta-analysis includes those who were hospitalized, and includes patients who had the earliest strains of the virus. It's unclear how generalizable this is to current conditions. ↩

  2. As of early 2024, the CDC is still politicized. It consistently minimizes effective but unpopular mitigation measures (masking, ventilation). Since adopting the "COVID is Over" communications policy, the CDC has been removing useful ways to view data, making it harder to track COVID spread. They have replaced easy-to-understand graphs with spreadsheet downloads, have removed community maps, and have replaced useful metrics like "percent of population with COVID" with "percent of hospital admissions for COVID." (a different statistic which is only relevant to hospitals.) ↩