I said I was aware of the Cochrane thing because it’s a waste of time to rehash the PR mess and spin. There is nothing wrong with the review. “only studies that support your conclusion count”? LOL. No. How about you? The review I posted last is from a highly respected group and is an interesting read. Do you have the expertise in epidemiology and infectious disease to sift thousands of studies and properly evaluate their methodology and statistical analysis? I don’t, and observational research is quite tricky, so I appreciate papers like this one. The first review (meta-analysis) I shared is led by a professor who is the head of a WHO advisory committee, so not really a slouch. That doesn’t mean every study they do is the best thing ever, but it speaks to the totality of real-world evidence right now. They mention that a review published in 2021 could not find any real-world evidence for HEPA filters and infectious disease; they broadened their inclusion of studies (maybe too much?) to have some to examine. You, I and others mentioned filtration potentially being beneficial beyond Covid- I believe you mentioned learning, I said asthma, etc. so it seemed relevant, even if people on this board are right and it’s not a great analysis. It’s fine to think there is enough laboratory evidence already. That’s one way to look at it, but I have a different POV. I went looking and satisfied my own question: there are better studies in schools and nursing homes being done currently, and, maybe most personally relevant right now, there is no support for the sales pitch I get for UV light or a higher MERV rating than the very good system I already have, from my HVAC guy, lol.

Here is a much better review, focusing on SARS-CoV-2 specifically, but many NPIs, including ventilation and filtration. Again, they did not find many real-world studies on air filtration; two of the four were using animal models. https://royalsocietypublishing.org/doi/full/10.1098/rsta.2023.0130 This review does include the MMWR school study, but no other school studies. The section on ventilation discussing the different studies they looked at and the quality of the evidence is very interesting.

Who is “Brandon” from the last newsletter?

I agree with you that it’s too broad for that. I understand about meta-analyses. Agree to disagree about masks. We have a Cochrane analysis which is not conclusive for positivity, and regardless of what one thinks about that, conditions now are not the same. I think any possible group effects are tiny, but that is opinion. And please no one back at me about the public back-and-forth about that Cochrane review. __ Here’s a recent study on filtration and COVID in German kindergartens, adding to real-world info, FWIW. https://bmjopen.bmj.com/content/13/7/e072284 Interesting end of the conclusion. I think for preschool and kindergarten-age children, I’d say that any other preventive behaviors are unnecessarily restrictive for Covid, at least currently, so I’m not sure what other measures they would suggest- thinking as an American and what I know of our schools. Maybe Germany has other good ideas. Probably one of the issues with filtration studies re: Covid transmission is the same issue that possibly affected that N95 mask trial in health care workers: people in buildings with air filtration aren’t only getting infected in said buildings.

Some studies show that long Covid is more likely after hospitalization. That is a different thing than the total number of long Covid patients, because only a small percentage of people with Covid are hospitalized, so even though there is a lower percentage of non-hospitalized who have PASC, it makes sense that they are still the largest share of PASC patients. Personally, I think the -published meta-analysis is more interesting as a collection of studies that meet certain stringent criteria, more than for the “meta” part of it that lumps all of them together and makes a conclusion. As I said earlier, I was interested in studies on how particular air quality measures affect different outcomes in real world settings, not just Covid. But this literature review that looked for Covid-era real-world filtration studies with sound methodology, and did not find any. If their criteria were sound, the conclusion is that for the answers on filtration and Covid transmission, we need more information. Only one peer-reviewed study besides the one I posted was shared (from the same foundation/Marche region of Italy in the publication I had posted). 🤔 Evidence-based medicine is about asking questions, yes based on basic science research, but ideally testing in real-world settings, using the best controls possible. There are many examples of things that “should” work, even with evidence from observational studies, that have failed in real life, because the real world is not a laboratory. Evidence-based medicine does not find masks decrease transmission in real-world population studies, which is why I said that I thought ventilation was doing the heavy lifting in the study and not masks. This is not the same thing as whether I will reduce my risk of catching a virus when I wear an N-95 in a crowded indoor venue for an hour (I’d like to think it would, though I can’t prove it), but that is not the context in which masks were worn in that MMWR study, masks, probably cloth, on schoolchildren for 7 hours a day, taking them on and off to eat and drink. What?

Thanks. I was looking at the study and wondering why it wasn’t included in the large review just published. I presume it didn’t meet some criteria for methodology. But also I believe the journal it’s published in is considered a predatory journal. ETA: or not? Unclear. another edit: the lead author of this article also has a sole affiliation with the Hume Foundation. I haven’t double-checked authors with the other study I found, but I suspect they are connected at least by funding, if not being the same research group with some of the same classrooms included. I can’t find where it lists funding sources, but I assume the government provided the funding for the intervention, but perhaps not the researchers, data collection, etc. The bolded: probably so, just like how all the private schools I was aware of that reopened in May 2020 or at least by September, while the public school kids go shut out of full access to education for a long time, nearly two years in some cases.

This article is more along the lines of what I was looking for on real-world filtration evidence for different infections. The U.K. article I came across is paywalled, but I found this summary from the institution. https://www.uea.ac.uk/about/news/article/air-cleaners-dont-stop-you-getting-sick-research-shows Here is the preprint, though the article apparently will be published. https://www.medrxiv.org/content/10.1101/2023.06.15.23291419v1.full.pdf My takeaway is that real-world Covid studies with good methodology (according to the standards these researchers use) have not been completed, but there are some currently being done or awaiting publication, which is good. There is some evidence that trends toward a reduction of viral infections, though not statistically significant.

Quoting you again, sorry, because I found this review article from Center for American Progress, but it was from 2022 so maybe there are more recent school studies, published in the past year? They cite only two real-world studies on school ventilation: the CDC one @Corraleno linked above, and an Italian one with about 3,000 classrooms, and it appears the Italian analysis was by the Hume Foundation (I don’t know what that is) and not published anywhere but their website that I can find, so more of an unpublished observation, as far as I can tell. Anyway, most of the article talks about the federal funding designated for this issue and how some schools, about half, had been planning to use it. It underscores for me that it is/was up to people in their local school districts to be active in following up if it’s an issue they care about.

I hadn’t seen this one, interesting. I hope someone is doing intervention trials with dietary styles that have been shown to result in a healthier microbiome,

Okay. 👍 I agree it is important. For the last part, I wasn’t talking only about people who have long Covid symptoms after vaccination, I mean in general, the folks who claim to be vaccine-injured in any way, and there seem to be a whole lot of those. Aren’t a lot of us skeptical about these claims, until proven otherwise by studies linking certain conditions with vaccinations (like myocarditis, possibly some other things, rarely), since that is how vaccine science decides whether vaccines could trigger certain things, or not. And when the best population studies we have do show that just as many people have fatigue and brain fog without having Covid as they do after Covid, there is something more that needs to be teased out. I wonder if it will turn out that Covid is a -specific- trigger for some of these symptoms, or whether the processes are similar to viral syndromes generally and it just seems more common because we just had a pandemic with 90%+ of the population newly infected.

Sigh. No. What I have implied is that long Covid is not as common as some links and comments I have read on this board say that it is. What I have stated outright, over and over, is that as a syndrome, it is too poorly defined. This is not some crazy idea that is coming out of my own brain and typing fingers, lol, it is something that has been mentioned by experts and in peer-reviewed literature. What I have implied that there are numerous other illnesses I give more thought to as being concerning and a risk to me over long Covid, like cancer, heart disease, autoimmune diseases, the list goes on, because it was implied earlier that everyone should worry about it equally. And so what? Everyone has different things on their personal plate of concerns. I think the controlled studies are clear that most people with prolonged Covid symptoms get better. *Even for these folks, we should be investigating for good treatments. Another ** that I will repeat- we nor our medical practitioners should assume that a every new onset of nonspecific symptoms (fatigue, diarrhea, etc, as listed in the studies) following a viral illness are necessarily “long COVID”. That might sound obvious and silly to you, but it is happening. We need to know better what it is and what it isn’t, and AFAIK it is supposed to be given after excluding other potential causes. What I think we’d agree on is that there is a distinct subset of people who have chronic, debilitating symptoms that are linked to Covid in some way. And of course, not just anosmia and dysgeusia. Since we don’t have a causal pathway at this time, I don’t know that we can say that Covid is responsible for all of them. It is still early days in this research, research that needs to continue. And I’m unsure what you mean by the bolded, because I think you are inadvertently reinforcing something I was trying to point out. This study absolutely was looking at long Covid I.e. PASC, as it is defined by the WHO. But it might not reflect the smaller subset of people who are not getting better after 6 or 12 months or however one thinks we should define this more severely affected group. *But then if that’s the case, definitions need to be redrawn and symptoms better defined in order to properly study what may, or may not, be different groups with different processes going on. ETA Maybe there is a basic difference in perception here : do you see long COVID as a very defined entity that is always clearly and obviously separated from other causes? How so? What about those people in the studies and who have been profiled in the media who believe they have it and never tested positive for COVID? What about a friend of mine who was told she had long Covid after an unremarkable viral illness, when she had several negative home tests for Covid? Several months later, with symptoms that sure, are on the long Covid list, but really could be from anything. I know that is far from inclusive of everyone who has long Covid, but there were a lot of those people in some of the early studies. I’m wondering how those examples are any different from people who insist that they have a problem that was caused by a Covid vaccination; maybe a few of them are correct, but we can’t just assume.

https://www.nature.com/articles/s41467-023-42726-0 A summary thread by the study lead Interesting takeaway that just like in at least one other study I remember, the primary difference from symptoms in matched controls was altered taste and smell, but: “development of persistent symptoms was more common after reinfection”, as seen in some other studies which were not as well-done and inclusive as this one. Does that mean these symptoms need to be grouped better in order to study long COVID syndrome(s) properly? Do they need to better categorized and defined? Seems so. It’s going to be a while.

I agree that it’s a terrible idea to stop investigating long Covid separately this soon. There are people with long Covid subjecting themselves to sketchy medical practitioners and dangerous therapies, like triple anticoagulant therapy, instead of only trying new things as part of research studies. Its like 2020 all over again where people were taking ivermectin and hydroxychloroquine and IV vitamin C and who knows what else for Covid, but maybe much worse.

No, I don’t think modeling studies are enough. Thank you for the link. I would hope they could do something like this again, in 2023, but with more outcomes. There are a lot of interventions going on in this studio at the same time, most schools were hybrid, the range of the kids having in-person school was huge— I don’t know if that was accounted for, but very different than conditions today— and I know there has been a lot of criticism over the methodology of the observational studies published there, but just glancing at it, looks very interesting. Taken at face value, it looks like you can get most of the benefit from ventilation alone, which makes sense, and I’d prefer schools do that as much as possible, but filtration is looking good on its own when ventilation isn’t possible. What about masking, since schools no longer mask? I doubt masking made any difference, but it’s part of this study, and other MMWR observational studies have purportedly shown benefits, so if one believes masking is critical, you can’t separate out those effects here. I know that some of the money given to schools a couple of years ago was supposed to be for improving air quality, I just don’t know what happened there. I know it will differ by locality; locally, many organizations said they already had improved air filtration. I still don’t think filtration is a real answer for preventing Covid sequelae, but maybe the chance for more real-world evidence is behind us for now, given that it would be hard to take a group of schools prospectively and ask them to test children regularly for Covid again with some particular filtration interventions. I doubt anyone would agree to that, so maybe it’s just pie in the sky on my part. But you could do it for adults…

I think you’re assuming things about me because again, you are reading things into my post that I did not say. No, I wasn’t aware of the research you mention here; I will look for it. Please read my posts instead of making assumptions. Where am I arguing against indoor air quality? I said the opposite. What I am saying is that there are a number of things we can do that can potentially affect air quality- there’s a spectrum, isn’t there? And they are associated with various costs. I know that because I looked into what I could do for my own home a couple of years ago, and I found that there was not a lot of info behind the various options they were trying to sell me. And I’ve heard other info on this topic from people who know and understand more than I do. How much do we do, and what result can we expect for the $$ spent? That’s all. I agree that there are many reasons beyond Covid to think about air quality, and I said that before. But this thread has referred to air quality in the interest of preventing Covid infections due to the concerns about Covid sequelae, so what data is there that air quality will have that desired result? And what specific measures for particular buildings can expect this result? Are there pilot studies looking at this, in schools, in businesses?

As someone who said in the post before yours that I focus on general health measures but no longer mask, I don’t think most people, including myself, think we are completely bulletproof from any illness. Maybe very young people still do. I don’t know what a “superior immune system” means; I think we know that people in certain populations do better with certain illnesses or are less likely to contract them as a group, but that varies by illness, and individual variation is huge. ETA: I hadn’t read bookbard’s post. Surely the person who said unhealthy people deserve to die is an extreme (disturbing) viewpoint. Researchers are not monolithic in their expertise or in their opinions about how people should live, or what society should do, in response. I’m all for cleaner air, but first I’d like real-world studies showing that certain levels of air filtration make a significant difference in viral transmission, the incidence of Covid, the incidence of long Covid, other infections, asthma, things like that. Not just basic science lab research. Due to the massive expense, I think we should have better indications that measures are effective before deploying in public buildings on a massive scale. I know that some buildings did improve air filtration during the pandemic. There are different levels of things that can be done, and I don’t think we can outfit every building with hospital standards.

I didn’t say I thought that. Maybe he chose that patient because she was willing to speak, but maybe also because those patients are “easier” to understand and more obvious that a Covid infection was the inciting event. And long Covid is a syndrome that might turn out to be more than one thing. Yes, many cases of “long Covid” (poorly defined as it still is) are in people who had mild infections. The cause(s) might not be as clear in all those people. That is what all the studies that have better controls and better methodology are trying to get at. I don’t think in 2023 that 100% of those who are posting online about having long covid or in a support group for long Covid or seeking medical attention for long Covid, actually or solely have disease resulting from Covid. I believe they are suffering and deserve medical attention. I think some of them have other issues that are not being diagnosed because of medical ignorance and the hype over long COVID in preference to other things. I said that before, in the part of my post you didn’t quote. That is part of my frustration with this, as I stated, that I hear people being brushed off in the name of “long Covid”. And that’s really why I responded in the first place. I wouldn’t want patients to feel minimized, but from my perspective, the topic is everywhere and is the opposite of minimized in media. It’s true the public isn’t as interested anymore, c’est la vie. The trouble is that humans have experienced groupings of nonspecific symptoms for forever. Sometimes there isn’t a clear answer as to the cause, and sometimes that is because medical understanding is limited. It must be very difficult to sort out. People who suffer need to be supported and offered help, regardless. The comparison to paralytic polio is inappropriate IMO, when the definition of long Covid includes a catch-all of nonspecific symptoms that are not necessarily disabling. The incidence of “chronic disabling long Covid” in children, if there are clear, well-medically-documented cases in kids who were not hospitalized and without significant pre-existing conditions, must be incredibly small. Polio it is not. As far as worrying about it, I don’t tell anyone else what to do, but I put most of my health focus on lifestyle factors, where I believe the biggest health returns are. Not incidentally, I believe (even without solid proof) that some of these things I do will give me a better chance of doing well with whatever infections come my way. However, for me personally, continuing to wear masks, avoid social situations, and avoid gathering indoors, which is what I gather you mean by worrying about it, would not be part of a healthy lifestyle for me in the long term, either mentally or physically. Nor can I ask my children to do that. No disrespect to those who chose that. Any “worrying” I do is reading about the research periodically, because I think it’s important. Still very murky, from what I can see. So many complex questions that reading a lot of articles,, or even peer-reviewed papers, cannot get around.

Yes, and this was known and written about years before Covid. Underreporting and under-investigation is just as big of a problem as over reporting. Thanks for linking the CNN article, it was interesting. A little bit of research, with a lot of speculation, showing how research into long Covid is still very much in its infancy. With regard to his representative patient, I don’t think anyone questions that people who were in the ICU could have a prolonged recovery, including neurological symptoms. That is not unique to Covid, even if the specific symptoms may be. Or that people who were pretty acutely sick at home took a much longer time to recover. Many people like that, though I don’t think there is going to be an adequate answer for the fatigue and “brain fog” with this syndrome that involves medication. I liked how he talked about the importance of qualifying and quantifying sufferer’s specific complaints, though. I think what is more questionable for Covid being the cause of symptoms, are those who think they had Covid but never had a positive test, and then attribute all sorts of symptoms to Covid. I don’t just mean in early 2020 before there were tests, I have heard this from a couple of people in 2023. And even doctors throw up their hands when people have nonspecific symptoms and say that maybe it’s long Covid, with no evidence of Covid. I’ve heard that so many times the last few years. I think that’s lazy thinking on behalf of medical practitioners, and ignores the fact that medicine doesn’t have answers to everything, and never will. But blaming things on Covid may mean other potential diagnoses are neglected. It doesn’t seem that many studies have been done comparing Covid infection to other upper respiratory infections, and seeing how the incidence of prolonged symptoms compare. It seems like it would be higher with Covid, but I wonder if it would be as different as we think, considering how much long Covid is publicized in comparison, or in comparison to those with MECFS or prolonged symptoms after other common viruses. For children, the best, controlled studies have shown an incidence of long Covid less than 1%, reassuring, though I haven’t seen what it is for children that were so ill with Covid they were hospitalized. Some studies for non-hospitalized adults have also shown that it’s primarily anosmia that can be linked specifically to Covid infection. Anosmia and other malfunctions in sense of smell are awful. I hope researchers are working out how to better help those that have it.

Good info, but avoids some of the more obvious questions that are brought up by these studies and others: why is yearly boosting of healthy young children still recommended? Either do the real studies to show benefit vs. risk is favorable to them once they already have some immunity, or very few will follow the advice, as is clear from the vaccine uptake for this age group.

https://www.bmj.com/content/383/bmj.p2582?utm_campaign=usage&utm_content=tbmj_sprout&utm_id=BMJ005&utm_medium=organic&utm_source=twitter

There are so many problems with this conclusion for this particular study that I don’t know where to begin. I am not saying that no one has long-term effects as a result of their Covid infection, not at all. It looked interesting so I clicked through and read it. But, no. Part of the problem with getting anywhere with long Covid is shoddy research like this.

I have offered non-food options at Halloween for over 20 years. No signs, just out as an option. Many people do this. It’s nothing to do with woke. Aside from allergies or kids not liking the candy you have, some parents of younger children appreciate not having to deal with so much candy.

Definitely do not want several people sitting around chitchatting, no. And when I had my babies, only wanted people there for very short visits, other than DH. For any other stays, I’d be very sick or post-surgical and possibly immobile and on meds that might affect my thinking. So yes, I would want someone there at all times if possible. Having been there with sick relatives and had to advocate for them, I want the same when it’s my turn. And sometimes things change quickly and having someone there could make a difference.

I think this is too simplified a comparison to know for sure, even for this one example. Property taxes, which I think are more likely in the US, vehicle taxes, fuel taxes, and huge differences in sales taxes— much higher in general in Europe, which adds up. There are taxes added on utility bills we pay here; how about over there? Probably there are other things I’m not thinking of. It’s a good point that it could vary a lot with different family incomes and situations, and might not be true that EU taxes are higher than the US in every situation.