Be Well With Chelle

Also important to consider:

"In the U.S., we are clearly in an infection surge right now, although you wouldn’t really know it due to underreporting, lack of communication, and pandemic fatigue. Using rough estimates, I plotted “true” case estimates against reported case numbers in the graph below. While we’re not close to the Omicron peak, we are already higher than the first two waves."

"Another perspective is the old CDC transmission map, in which we have “substantial” or “high” transmission (more than 50 reported cases per 100K) across 66% of counties. This strikingly contrasts with the new CDC community map, which shows only 4% of counties need to mask because hospitals will not reach capacity within 3 weeks."

State of Affairs: May 16 Global deaths due to SARS-CoV-2 are continuing to plummet and closing in on levels we only saw at the beginning of the pandemic. Although we are hopeful this continues due to increased vaccination and infection-induced immunity, many eyes are on four specific areas across the globe:

Wow, a lot has changed. This article has updated guidance with respect to the definition of and transmissibility. It also breaks down the difference between and .

Ugh. I recently bought conventional kale because organic wasn't available, and I thought, one bag won't hurt...

Kale, one of the most popular health foods, is full of vitamins and antioxidants. It also made the top 3 of our Dirty Dozen™ due to conventional kale commonly being contaminated with a pesticide called Dacthal that is a possible carcinogen and is also prohibited from use in Europe.

This has been a rough week for me for the past five years -- since my father passed away after unexpectedly landing in the ICU, and fighting the good fight on and off a ventilator for almost a month. It's also the week that the world as we knew it was gearing up to shut down in 2020. This year, I am also deeply saddened and angry about the situation in Ukraine, and it's all too much for me; I feel it building up, and I haven't been able to let it out.

This article was serendipitously shared by a friend today. Now I know exactly what to do to jump start the release of tears that I need.

Bonus: if you get to the end of the article, you'll find the link to a really cool music video with a large scale Rube Goldberg machine that's fascinating to watch... and has an message to help you through these .

How to Care for Your Loving Heart Sometimes it helps to cry your heart out.

In case you've also been waiting for info on "health lost" due to long COVID... or you didn't know you've been waiting for it and are now interested, because you thought long COVID only meant loss of taste and smell...

Long COVID Mini-Series: Burden This week I’m diving deep into long COVID. We’ve been so focused on the pandemic’s impact on lives lost that we’ve neglected to recognize health lost. This mini-series will be 5 posts in total on long COVID: burden, impact on specific organs, predictors, kids, and treatment. This is

I'm a bit late in sharing this, but it's such good info about the efficacy of and masks compared to cloth and surgical masks as we battle the omicron surge that I had to go back to YLE's page to grab it.

A quick note on masks and CDC guidance... Masks A post or two ago I mentioned a meta-analysis about masks and forgot to include a hyperlink to the study. I know many of you are looking for it, so here it is. In short, the authors pooled 72 studies to assess how different public health mitigation measures (like masks, socially distancing, ha...

If you follow my page, you know that I deeply respect what Katelyn Jetelina does to help laypeople better understand and navigate the pandemic. This is a very important post on how and WHEN to use rapid tests, both from a personal perspective and from a public health perspective.

Antigen Tests and Omicron

There’s no question that rapid antigen (Ag) testing is limited right now due to high demand: stores are sold out, health departments are prioritizing based on need, and online orders are delayed. While this shows that the U.S. government did not adequately prepare for Omicron, it also shows that people are finally leveraging one of the most under-utilized tools of the pandemic.

(This is copy and pasted from my newsletter. To see the figures and hyperlinks in this post go here: https://yourlocalepidemiologist.substack.com/p/antigen-tests-and-omicron?justPublished=true)

***Mixed messages***
But there’s still confusion about Ag test reliability in the wake of Omicron. And rightfully so, given the mixed messages over the past two months. Rapid testing stories are in the news and lighting up Twitter daily. In some stories, rapid tests are heroes, sparing elderly relatives from ill fated gatherings. In others, they are villains, accused of providing a false sense of security.

It’s been difficult to follow, but the big scientific developments have been:
-Nov 27: Private companies, like Abbott and Quidel, evaluated their antigen tests using computer predictions and reported that they did not anticipate any impact on rapid test performance. These companies noted ongoing lab and clinical studies to verify their predictions.
-Dec 17: UK corroborated this data in mid-December by analyzing 5 test brands used in the UK. They concluded that the mutations in Omicron “do not affect performance in the laboratory setting” and noted that clinical studies are underway to close the gap between lab and real-world.
-Dec 27: CDC updated its isolation guidance and excluded testing parameters because “they didn’t work”
-Dec 28: FDA released a broad statement stating: “Early data suggests that antigen tests do detect the omicron variant but may have reduced sensitivity.” and “It is important to note that these laboratory data are not a replacement for clinical study evaluations using patient samples with live virus, which are ongoing.”

These events ignited a lot of confusion among the public about what to make of rapid testing. To understand what’s going on, it’s important to tease apart analytical performance (how the tests perform in the lab, with ideal samples) and real-world performance (how the tests perform in patients). And, ultimately, what it means for you at home.

***Analytical Performance***
All evidence has shown rapid Ag tests can physically detect Omicron. In other words, when the antigen test is presented with the same amount of virus for the same amount of time, Ag tests perform roughly as well for Delta compared to Omicron (though one pre-print study reported slightly lower sensitivity with lab samples). That said, every brand of rapid test is unique, and needs to be rigorously re-evaluated. In the U.S. alone, there are dozens of options.

Antigen tests continue to work with Omicron because they target a fairly stable part of the virus called the nucleocapsid or N-protein. Unlike the highly mutated spike protein, Omicron has only 4 mutations in the N protein. Fortunately, none of these changes seem to alter the tiny part that rapid antigen tests detect. This is fantastic news because it means that we still have a tool to help calm the Omicron storm.

So, we know that rapid tests can find Omicron if we spoon feed virus to them in a lab. What about in the real world?

***Real Word Performance***
We don’t know how well rapid tests detect Omicron in the real world because there aren’t any published, real-world studies. All we have to go on is reassuring studies with lab samples, a cautious statement from the FDA, and a slew of anecdotes and hypotheses.

We’ve discussed the reassuring lab studies above. Let’s touch on the FDA statement: “Rapid tests do detect Omicron but may have reduced sensitivity”. What does this mean and how can this be given the discussion above?

Sensitivity is the ability for a diagnostic test, like a rapid Ag test, to have a positive test result in subjects with the disease. So, in other words, this is the probability that someone is positive given that they have COVID19. The FDA stated that this probability (or sensitivity) is reduced with Omicron. The implication is that there could be more false negatives when testing for Omicron than other variants.

The FDA did not release any data to support this statement. They did, however, mention that tests with killed virus showed no difference in performance, but tests with known amounts of live virus showed lower sensitivity. This disconnect between killed and live virus samples suggests that the highly infectious nature of Omicron may pose a challenge to testing—if it becomes contagious at lower doses, it’s easier to miss.

The real world performance of rapid tests is also impacted by whether we are looking in the right place, at the right time. If the nose is not an early replication site for Omicron, then rapid tests that swab the nose won’t do as well - not because of a technical failure, but because the virus isn’t there yet.

Indeed, anecdotal evidence suggests that this may be happening with Omicron, with citizen scientists on Twitter reporting better luck with throat swabs than nasal swabs. Similarly, a pre-print found that saliva swabs are better than nasal swabs for early Omicron detection (by PCR) and another preliminary study found that Omicron is better at replicating in the bronchus (compared to the lungs).

***What does this all mean?***
Antigen tests are not perfect but they are still a valuable tool… for the question we (the public) want answered. Right now a lot of people just need to know one thing: Am I infectious and therefore need to isolate? This is very different from the question that clinicians, hospitalists, and scientists want to know: Does someone have any level of COVID19 virus in the body?

Because these are different questions, we need different tools. Rapid Ag tests answer the first question by detecting very high levels of virus, which turn the test positive. People are only contagious once they reach a certain threshold of virus. So, by default, catching high levels of virus will result in capturing whether someone is contagious. On the other hand, PCR tests are very effective at detecting the presence of very low levels of a virus. Importantly, the threshold in which PCR tests can detect virus is below the level of contagiousness. So, people can stay positive with a PCR for a long time (some documented cases show up to 60 days) but not be contagious. With an Ag test, though, that person would be positive for a much shorter duration and, more or less, while they are contagious.

Notably, this figure was made pre-Omicron, and it seems that there might be a slight shift with Omicron, such that symptoms, and possibly contagiousness, could begin before the first positive rapid test, due to the virus elsewhere in the body. Soon, we’ll no doubt see real-world studies that illuminate the grey area in those first few days of infection.

The next time you read about antigen test performance, consider the question being asked. Are we talking about flagging infectious cases or simply detecting any amount of virus? When the FDA evaluates rapid tests, they typically focus on the latter. To do so, they compare Ag tests to the “gold standard”—PCR tests. Because PCR tests remain positive for much longer, we’re of course going to find a lot of people who are still positive on a PCR but negative on an Ag test. This makes Ag tests look like they are failing. But, in fact, they are, by and large, answering the question as we would hope: Am I infectious?

***What should I do?***
Rapid Ag tests can detect Omicron and they can, most of the time, tell you whether you’re contagious. The first couple days after exposure or symptoms, they may not work as well. To counter this, here are four tips:

1. Wait. If you have symptoms or were exposed it’s important to isolate and wait a day or two to use an antigen test. This will ensure fewer false negatives.

2. Throat swab. Swab the throat and the nose to better detect Omicron. The UK has actually recommended this method since May 2020 for many of its tests (see instructions below). Here is their YouTube video. Avoid swabbing your throat after eating/drinking anything acidic — like coffee, soda, or fruit juices — as this could produce a false positive. Also avoid brushing your teeth or using mouthwash before a throat swab too as this could lead to a false negative.

3. Line. Pay attention to the intensity of the positive line. If the line is very, very dark, this means you have a lot of virus and are infectious and a risk to your family and community. If the line is very faint, you could be in the beginning or the end of the contagious period. This is why it’s important to have a second test 24 or 48 hours after seeing a faint line to see if you’re still positive. This will give you an idea of whether you’re in the beginning or the end. Below is a display of rapid antigen tests over 11 days from my dear colleague in the UK (before Omicron). You can see that the second red line (indicating a positive test) gets very dark and then lighter and lighter until the test is negative.

4. Retest. A single negative rapid test can’t reliably rule out COVID-19, because it may be that you tested too early, and that the answer will change in a few hours, or a few days. If you think you probably have COVID, but the test was negative, and you need a definite answer, test again in 1-2 days (and isolate as a precaution).

***A plea***
I’ve been shouting from the rooftops for two years about how we need to implement public health mitigation measures more, not less, and this includes testing. So, my advice at this time may come as a surprise to many: Do not test right now if it is optional. We are in dire need of tests.

Optional means that you’re asymptomatic and not seeing vulnerable people. Optional means you’re boosted and healthy. Optional means you can work from home. Optional means you’re conducting asymptomatic screening to go on vacation or because you’re returning from a concert.

We will get to a point where we can screen ourselves as often as possible to reduce community spread and protect those around us. And this is the intended public health solution: Break as many transmission chains as possible. But because of Omicron and lack of preparation, we find ourselves in an impossible situation where many, many people need tests and can’t get them. So save the tests for:
-Medical treatment: In order to get an antiviral in a timely manner, people need to test, see a doctor, and get a prescription within 5 days to prevent severe disease. These people need tests right now.
-Medically vulnerable: Vaccines, and particularly boosters, will keep a large amount of people out of hospitals, but elderly and immunocompromised, even if fully vaccinated, are still at risk of severe disease. They need to be able to detect infection early through access to tests.
-Breaking transmission chains to vulnerable: Those that live with an immunocompromised family member or going to a nursing home that need to be sure to break the transmission chain before arriving.
-Avoiding more disruptions: Others need tests to get back to their jobs for paychecks, or because they are essential workers and we rely on them to show up at car accidents or to work in the ICU. Kids also need to get back to school. We have consistently put them last, throughout the pandemic, and need to change that.

***Bottom line:***
Antigen tests continue to be a fantastic tool in this pandemic and they work against Omicron. But please consider the bottleneck of testing until we increase our supply in the United States, and how this calls for “pandemic thriftiness.” I still have hope that, one day, the United States will be prepared for the next wave.

Love, YLE and Dr. Chana Davis

This is copy and pasted from my newsletter. To see the figures and hyperlinks in this post go here: https://yourlocalepidemiologist.substack.com/p/antigen-tests-and-omicron?justPublished=true

Dr. Chana Davis, PhD is a brilliant scientist in Canada whose expertise lies in genetics, biomarkers, and diagnostics. She helped make sense of all the scientific literature on COVID19 antigen tests. She can be found at on Facebook, Insta, and Twitter.

I've been working on setting intentions (not resolutions!) for the new year. Intentions are more like, "be more _____" or "do more _____" rather than the concrete and measurable goals of resolutions that can feel like failure if you make a misstep.

This article gives some other good guidance on how to in 2022.

3 pandemic habits to drop in 2022 It’s not too late to make a few more New Year’s resolutions.

My fab and funny doc (although she didn't have time for her iconic humor and anecdotal stories in this post) does a thorough job of answering the question, "If Omicron causes milder disease, and carries the so-called silver lining, why is everyone so stressed out?"

This happened in my own family recently (a positive rapid test but a negative PCR test), so I found this infographic helpful. The poster is a PhD/scientist. You can see the full post here: https://www.instagram.com/p/CYFKHWMvxm3/

3 words that describe why I'm passionate about being a Beautycounter consultant: Certified B Corporation

Read about our other inspiring certifications and associations here: https://www.beautycounter.com/richellecolucci-nunn?goto=/associations

Although this update is local to me, it is good advice for folks everywhere who don't get info from their local government.

My biggest takeaways:
>Vaccines and boosters are meant to prevent severe illness and death, but when you have comorbidities or are elderly, vaccines/boosters are only one weapon in your arsenal, and you MUST take additional precautions.
>Speaking of additional precautions, note that they are recommending that you presume you'll be exposed to COVID when in an indoor public place. That means a) wear a mask, and b) dining in a restaurant is NOT safe right now. You don't get magical immunity from having a plate of food or adult beverage in front of you.

>To , you MUST STAY HOME if you are feeling ill until you can be tested. Don't dismiss it as "just a cold" -- if you can catch a cold, you can catch COVID. It's also not time to play the "allergies" card -- just get tested, please!
>Yes, it totally sucks, because we all thought we'd be in better shape for this holiday season, but if you get together with family and friends for the holidays because you love them, give them the best gift you can this year: a postponed holiday celebration. As a child and parent of divorce, I can assure you that the day you actually celebrate with loved ones does not make one bit of difference. It's the feeling in your heart, not the date on the calendar, that's important.

Excerpt below is from: https://warren-county-ny-covid-19-warrencountyny.hub.arcgis.com/pages/warren-county-covid-19-information (Note: the daily update changes, so the text below will be soon replaced by the 12/27 update.)

December 26, 2021

1 fatality, 105 new COVID cases over weekend

Warren County Health Services regrets to report an additional COVID-19 death of a Warren County resident. A person in their 60s who had lived at home before contracting COVID-19 died at a hospital. This person had been vaccinated, and had a history of comorbidities.

Warren County Health Services and the Warren County Board of Supervisors offer their deepest condolences to the loved ones of this individual.

Health Services reported 105 additional COVID-19 cases on Saturday and Sunday, along with 115 recoveries. Health Services is monitoring 522 active COVID cases as of Sunday, 509 of them involving mild illness.

Twelve (12) Warren County residents are hospitalized as of Sunday. One (1) vaccinated patient is critical and the remainder have moderate illness. One person (1) is moderately ill outside of the hospital.

Nine (9) of the 12 who are hospitalized are unvaccinated.

The majority of new cases in Warren County where the source of infection can be identified continue to stem from family/household exposures, workplace exposures and indoor events/gatherings.

Presume you will be exposed to COVID-19 when going into a crowded public setting or at a workplace where you interact closely with others, and please take precautions accordingly. Please follow New York State mask/face covering guidelines if venturing into public places that do not have vaccine mandates.

Thirteen (13) of Sunday’s cases involved individuals who had been fully vaccinated. Cumulatively as of Sunday, 2,004 of 46,533 fully vaccinated Warren County residents have tested positive for COVID-19. To date, 1,905 of 2004 had mild or asymptomatic infections, while 77 became moderately ill, two (2) seriously ill and two (2) critically ill. Eighteen (18) passed away, all of them elderly and/or with extensive health issues, seven (7) of them at nursing homes.
Warren County Health Services recommends that Warren County residents:
Do not go to work or elsewhere into public when feeling ill. Quarantine until you are able to get a COVID-19 test.
Get a COVID-19 vaccination, and a booster dose, as soon as you are eligible. Call Health Services at 518-761-6580 or go to https://bit.ly/36LRv5e for options.
Wear a mask or face covering in public indoor places per New York State guidelines. New York State's new COVID-19 requirements related to masks or vaccination for public spaces is in effect. Find details here: https://on.ny.gov/3dHrZkf.
If diagnosed with COVID-19, please consult a physician or urgent care center to discuss treatment, as early treatment is imperative in many cases.

Warren County COVID-19 Information Get Vaccinated. Get Tested. Stop the Spread. Warren County & NY State COVID-19 Helplines Warren County Public Health    518-761-6580Mental Health Assistance    518-792-7143Domestic Violence Assistance    518-793-9496Victim Advocacy Services    1-866-307-4086NY Project HOPE -- 1-844-863-9314 ...

Excerpt:
Marketing claims on consumer products like “natural,” “hypoallergenic” or “for sensitive skin” have no federal standard or definition in the U.S. Some products might also claim to be “formaldehyde-free” because companies are not directly adding formaldehyde to the product, even though they are still using formaldehyde-releasing ingredients.

Does DMDM hydantoin really cause hair loss? Here’s what you need to know DMDM hydantoin, a preservative in shampoos, conditioners and other water-based personal care products, is the focus of several class-action lawsuits against Johnson & Johnson and Unilever claiming exposure to the substance led to hair loss.

If you are trying to live more cleanly, but are overwhelmed when trying to evaluate products, here are some easy tips.

A new study of the endocrine-disrupting chemicals known as phthalates, found in everyday products like perfume and toys, adds to the mounting evidence of their chronic health harms—and potentially billions of dollars in costs. Avoiding phthalates is possible. Learn how at https://bit.ly/3bai3Pd.

A great resource for families who have questions about safe(r) holiday gatherings or travel in the times of Omicron uncertainty.

Some neat ideas here!

is here to help everyone looking for the perfect gift that doesn’t include harmful chemicals this holiday season. We’ve compiled 16 gift ideas that are good for everyone on your holiday shopping list and the environment. Check it out: https://bit.ly/30bvQD3

"Remember when you didn’t get sick? Do you have a smallpox vaccine scar on your shoulder or butt? No? In the 20th century, smallpox killed 300 million people. Intensive use of the vaccine eliminated smallpox in the U.S. by the middle of the 20th century, and we stopped routine vaccination in the 1970’s. In fact, the smallpox vaccine was so successful that in 1980 the last case of smallpox was eradicated in the whole world."

Dr. Kathleen Braico: So many diseases halted by vaccines | Glens Falls Chronicle Dear Mark, I wrote the following in an attempt to help people understand the role of immunizations and how everyone in the U.S. has been protected from so many dread diseases because of mass immunizations. Perhaps this will help some people who are hesitant to get the COVID vaccine in our area. Alth...

Helpful info, as always! I love that she explains things in both scientific and layman's terms.

Omicron: We're getting (some) answers Today we got our first Omicron lab data! A week and half since Omicron broke the news. Just beautiful. As the scientist of the study said, “If I don’t die from the virus, I’ll die of exhaustion”. We’re getting more and more epidemiological data, too. Together they give us a dense, but clea...

I can tell you, with utter confidence, that the single most traumatic experience for someone suffering from covid anxiety is having a nasal endoscopy performed in the middle of a respiratory pandemic. It's over, and I have a clean bill of ENT health, so any further worry would be non-productive... but I had to vent! (No pun intended.😉)

How did I not know about this? https://www.uspsoperationsanta.com/ A great way to be well yourself is to bring joy to someone else... even if (especially if!) they don't know it was from you.

Help Santa Deliver Cheer This Year! Santa receives more letters than he can answer. You can help! Adopt a letter today and fulfill someone’s holiday wish with USPS Operation Santa®.

For parents of young children... 🤗

If you’re traveling with kids this holiday season, chances are they’ll use some type of wireless device for entertainment for at least part of the trop. But any device using a Wi-Fi or cell signal emits radiation through radiofrequency energy, which could have negative effects on your child’s growing body. ’s scientists are here to help, with five recommendations for reducing kids’ radiation exposure: https://bit.ly/3nK2jt5

I hope you'll love YLE as much as I do! Yes, her posts can be a bit data-dense, and some people love that, but not me! I love her because a) she's an epidemiologist, b) she's a mom, and c) she posts almost real-time updates from the CDC's Advisory Committee on Immunization Practices (ACIP).

In this post, she talks about Omicron and the importance of boosters.

Go get your vaccine, especially with Omicron It’s important that everyone gets vaccinated. Even with Omicron. Actually, especially with Omicron. This seems counterintuitive given the “vaccine escape” language floating around. But vaccines are still very important. This is why… First, our house is already on fire

Well, then! It's been a while, right? First, I was giddy with my post-vax freedom... then I was busy catching up on a year's worth of missed socializing... then I was putting the brakes back on with the arrival of Delta.

The time is right, then, to pick up my work on this page, helping others who want to take steps to be well, whether it's with evidence-based responses to COVID, learning to live clean(er!), or working on self-care.

To start, I'll share with you this photo of a rainbow that we chased as we chased down our boosters, traveling out of state to get them due to limited appointments available in our area.

What You Can and Can't Do Once Vaccinated Against COVID-19 The CDC and other health experts offer 10 tips on life after vaccination, including what to do about masks, antibody tests and vaccination cards.

Whoops! I've been a little busy with some life transitions and helping loved ones score a vaccine appointment, so I haven't been able to update this page lately. As more and more vaccine appointments become available, I thought I'd share this infographic to help you navigate the vaccine waters. Most importantly, remember that the vaccine isn't fully effective until two weeks after your 2nd shot (or 1st shot if you got the Johnson & Johnson vaccine).

An updated graphic, including the J&J jab, is available here: https://www.businessinsider.com/how-long-it-takes-covid-19-vaccine-to-work-2021-1https://www.businessinsider.com/how-long-it-takes-covid-19-vaccine-to-work-2021-1