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The Executive Briefing - Tuesday, December 13th

Telling COVID from flu or RSV (it’s not easy!)


  • Nearly 1 in 10 counties in the US are encouraging indoor masking again, including NYC, LA County, and the states of WA and OR. (NPR)
  • COVID vaccines have saved over 3 million lives in the US, but the fight isn’t over. (CNN)
  • BQ.1 and BQ.1.1 variants now make up nearly 70% of US cases. (CNBC)
  • Many in the medical community are leaving Twitter after new site-owner Elon Musk called for prosecuting Dr. Fauci and mocked the use of identifying pronouns for gender inclusion in the process. Musk dissolved the trust and safety board and rolled back Twitter’s ban on COVID misinformation. (Axios)
  • POTS, a debilitating heart condition, has been linked to COVID infection, and to a lesser degree, to vaccination. (NBC)
  • COVID cases in San Francisco kids are up 50% over the past 2 months. (SF Chronicle)

Public Health News:

  • Most US kids haven’t received either a flu or COVID vaccine. It’s fueling the tripledemic that’s slamming hospitals. (Fortune)
  • Flu surged the week after Thanksgiving. (CDC)
  • The CDC is warning that stuffed frozen chicken products have a high risk of Salmonella when cooked in the microwave. Even though the label must include oven-only instructions, consumers are still heating these products in microwaves. (MMWR)
  • Fentanyl hidden in other drugs, like cocaine and fake Adderall, is fueling another spike in overdoses. (Bloomberg)
  • 1 in 100 heart disease deaths are linked to extreme temperatures. (The Hill)
  • The Listeria outbreak linked to Brie and Camembert products from Old Europe Cheese, Inc is now over. (FDA)
  • Displaying restaurant inspection grades was linked to fewer foodborne illness outbreaks, a new study shows. (Food Safety Magazine)

Mental Health News:

  • Men engage in talk therapy less than women, and convincing them that asking for help is a sign of strength, rather than weakness, may encourage them to seek support. (NY Times)
  • More than 1,200 families are suing social media companies over kids’ mental health. (60 Minutes)
  • Gun violence can have a negative impact on mental health, especially for young people. (Teen Vogue)
  • In Atlanta, a group of Black psychiatrists is bringing care to teens of color whose needs aren’t commonly addressed. (NY Times)

If you or someone you know may be considering suicide, call 988 or message the Crisis Text Line by texting HOME to 741741.

Best Questions:

What do mask recommendations in NYC, LA, and other areas mean for our business?

In NYC and LA county, local government officials have now returned to strongly recommending indoor masking due to a rise in COVID cases and hospitalizations, along with flu and RSV. In both places, they’ve stopped short of a full mask mandate. Ultimately, this leaves your own mask policy for employees and patrons up to you. As a private business, you’re able to set and change your mask policy barring any local mandates, but the reality of reinstating a mask mandate may prove controversial. If you’re considering it, we recommend creating some set guidelines for when you reinstate masks (like when the COVID Community Level is “high” in your county, or when the case positivity rate is above 10%, for example), so that it’s a clear metric that your employees can understand and track. Manipulating other precautions, like temporarily switching from sick calls back to daily wellness checks for all employees in an area with an outbreak, might be easier to swallow than reverting to a mask mandate.

How do you know if you have the flu, COVID, or RSV?

It can be very tricky to tell them apart without testing since so many symptoms are shared. The New York Times put out a nifty chart (found here) where you can click your symptoms and see how common they are for each of the three illnesses involved in our current triple threat. Flu may have a quicker onset and COVID may have more of a “constellation” of symptoms. Right now with the variants circulating in the US, sore throat is the most common first symptom for COVID. RSV on the other hand may look more like the common cold in adults, with runny nose and sneezing. Ultimately, the only way to know for sure is to test, and at-home COVID tests are far more available than at-home flu and RSV tests.

If someone tests positive again two weeks after they first got sick, how should it be treated?

This can be tricky, because it’s possible for some people to continue testing positive (especially on PCR tests) for weeks or even months after their initial infection, and it doesn't necessarily mean that they’re infectious. But rebound is also possible - if someone tests negative and gets better and then develops new symptoms and tests positive a few weeks later, it could be a rebound or a totally new infection with a different variant. Unfortunately, it can be hard to tell, so we recommend treating those cases as new infections, which means isolating for five days and wearing a mask in public for another five.

Can you have long COVID if you never tested positive in the first place?

It’s possible that you had COVID even though you never tested positive, especially on rapid antigen tests which are less sensitive than PCR tests. So it’s entirely possible that you can experience long COVID without ever being sure that you had it. There is an antibody test that’s available that can test for prior infection (even if you’ve been vaccinated) but it’s not super readily available - we’d only recommend it if you need proof of a positive test to get treated for long COVID.

Best Listen:

If you haven’t already, check out our most recent podcast, a flash briefing about the Tripledemic, and some much-needed optimism from Roslyn’s guest, Dr. LJ Tan.

Listen to the Zero (Half) Hour here!

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Disclaimer: This post is meant for general information and educational purposes only and does not constitute, and is not intended as, any form of medical, legal or regulatory advice or a recommendation or suggestion regarding the same.  No recipient of this information should act or refrain from acting on the basis of this information without first seeking legal advice from counsel in the relevant jurisdiction.