Emily Oster

12 min Read Emily Oster

Emily Oster

COVID-19: Where to Go from Here

Emily Oster

12 min Read

When I started this newsletter my vision was to write about pregnancy and parenting.

The COVID pandemic dramatically changed the focus of this work, and for most of the first two years, the majority of the posts here were about COVID-19. Over the past year, this has become less and less true. Looking through the archives, it has been months since I wrote about COVID.

One reason for this is that there haven’t been a lot of updates. But more importantly, people stopped asking. This newsletter aims to be responsive, and, frankly, I get more questions these days about lead in chocolate than COVID-19. But the other day someone emailed asking, more or less, “What is the general deal with COVID now? How do we think about it going forward?”

It seemed like an appropriate time to address this. The COVID situation has evolved, for now, to what seems like a steady state. COVID is not gone, and (more on this below) it is still a significant health concern. But with high vaccination rates, and a large share of the population having had the virus, it has receded as a threat. Barring unexpected changes, we have arrived at a place where we are likely to stay for a while.

This means that when I address questions — which I’ll do below — these are really long-term answers. There was a time when the COVID situation seemed to change minute by minute; that time is not now.

Questions below! (Here’s a list if you want to jump…)


How do I keep up with current COVID rates?

We do not know precisely. The U.S. has never been good at tracking COVID rates during the pandemic, and this has gotten essentially impossible over the past year. If people test at all, it’s with rapid tests at home, and these are generally not reported.

Some hospitals still do asymptomatic testing, but it is not common and not necessarily reported.

Your best bet for ongoing surveillance is wastewater, and the CDC has a nice wastewater tracking site. This doesn’t translate in a direct way to case rates, but it gives you a sense of how things are evolving over time. Most of these data showed a seasonal peak in December 2022 and now a decline.

I know there are still a lot of COVID deaths every day. Why is this?

There are still many COVID deaths every day, which is tragic. An extremely large share of these deaths are in older individuals. This has been true throughout the pandemic, and it has continued to be true.

Based on CDC COVID tracker data, the death rate from COVID in the 75+ group (in the most recent week with complete reporting) was five times higher than for those 65-75, 17 times higher than for those 50-64, 73 times higher than for those 40-49, 166 times higher than for those 30-39, and 664 times higher than for those 20-29. There were no deaths in people under 20 during this period, so we cannot do a calculation there.

What this means is that understanding why we are still seeing COVID deaths means understanding why we are still seeing them in older people. One reason is that this is, sadly, an age group with high mortality from many things. In the case of COVID, though, there are interventions that are likely to reduce death rates in this group. This includes booster vaccination and treatments like Paxlovid. Higher vaccine uptake and better treatment access isn’t going to completely eliminate these deaths, but it would reduce them.

I read a scary headline about COVID and child deaths — can you unpack this?

A study was recently published looking at causes of deaths in children ages 0-19 in the U.S. and arguing that COVID-19 was the eighth leading cause of death in this age group. The time period for the study was August 2021 through July 2022.

The methods in the study are straightforward and do not need much explanation. They look at pediatric deaths, and their causes, and rank them. What I think is probably useful to unpack is some context.

Every death of a child is an unspeakable tragedy. Full stop. Thankfully, child deaths in this age range are very rare. By far the most common cause, amounting to 25%, is preterm birth or other perinatal conditions. Accidents are the second (18% of deaths), followed by congenital conditions and chromosomal abnormalities, assault, suicide, cancer, and heart disease. COVID follows heart disease.

It is not clear why cause-of-death rankings are of inherent interest. Depending on how you group the causes, these rankings would change. What we should focus on is actual numbers. During this period, COVID accounted for 821 deaths of children in the U.S., the vast majority in children under 1 or 15-19. This makes it a very rare cause of death, but, again, that is not to dismiss it.

The perhaps more important context is where we have come to since this moment. At this point, post-Omicron, the vast, vast majority of children have had COVID-19. A good share, especially those over 5, are also vaccinated. Since September 2022, there have been a very small number of deaths in any child age group. The risks are therefore much lower even than they were before.

What is the long-term plan for COVID boosters?

The current plan for COVID-19 boosters is to recommend them once a year, similar to the flu, with a shot that is targeted to the expected strain. There is some debate about exactly when the CDC will choose the strain (this matters to vaccine manufacturers). As consumers, we should expect a recommendation to get a COVID-19 booster at around the same time we get a flu shot.

The value of the booster is an increase in protection for several months after vaccination. This includes good protection against serious illness and death, and likely some protection against symptomatic infection. The expectation is that COVID will have a seasonal pattern similar to other respiratory viruses, so the vaccination in the fall will provide protection during that key season.

Boosters are likely to be recommended for everyone, but they are most important for people who are at risk for serious illness and death — older people and the immunocompromised (more specifically on pregnancy below).

From the ParentData Archive: Should You Get the Bivalent Booster?

Vaccines for kids: Should they get boosters? Should I vaccinate at six months?

For healthy children who are already fully vaccinated or have had COVID, or both, the added value of a booster is fairly minimal. They are already extremely well-protected from severe illness, and the protection from symptomatic illness is relatively short-term and incomplete. If you would like to get your child a booster, the safety profile looks great, so there is no reason not to. But the protection value is small.

If your child has not been vaccinated and has not had COVID, an initial vaccine is the best way to give them some protection against serious illness. This category includes babies who reach six months without having had COVID. An initial vaccine series will provide good protection.

I’m pregnant. How much more careful should I be? Should I get a booster? What if I get COVID?

Pregnancy is a mild form of immunocompromise, so it is always a good idea to be a little more cautious about any disease exposure. And during the Delta wave of COVID (in fall 2021), there was evidence that unvaccinated women in particular faced higher risks of stillbirth and maternal morbidity as a result of COVID. A large review, based on global data from the early pandemic period, recently underscored this.

With vaccinations and with the Omicron variant, though, these excess risks appear much lowered. At this point, for healthy and vaccinated pregnant people, it makes sense to think of COVID like other respiratory illnesses — perhaps with a slightly higher threshold to avoid, but not a cause of panic. You will probably not be prescribed Paxlovid, given the lower risk and the digestive side effects. However, there are some circumstances in which it might be prescribed, and the limited data on safety are reassuring.

There is some value to getting a booster during pregnancy, if you do not get COVID while pregnant, for the same reason you get a Tdap booster: to provide immunity to the baby. Ramping up maternal antibodies at the right time (toward the end of the second trimester of pregnancy) increases the amount of active antibodies for your baby. This has been shown to protect infants against hospitalization in the first six months of life, before they can get their own vaccines.

From the ParentData Archive: Pregnancy COVID Updates

Are there any updates on long COVID?

Long COVID, the persistence of symptoms past acute infection, has remained somewhat elusive. We still have no clear agreement on what symptoms should appear in this definition and no comprehensive sense of how common it is. The most common long COVID symptom is persistent loss of taste and smell, but depending on the paper, you’ll see lots of other symptoms there.

We see figures like “20% of people develop long COVID,” but this seems extremely unlikely given what we observe in the world. What we do know is that persistent COVID symptoms are less likely with the Omicron variant, and even before Omicron, kids appeared to be unlikely to develop long COVID. New research out of Israel has shown that most long COVID symptoms resolve within a year.

Bottom line: This remains an evolving space, but the data we do have so far is becoming more reassuring.

From the ParentData Archive: Long-Term COVID Risks in Kids and Pandemic Baby Developmental Delays

I heard there was a study saying masking doesn’t work — true?

There is a recent Cochrane Review that discusses masking and also hand-washing. A Cochrane Review is intended to be a comprehensive review and meta-analysis of randomized controlled trials. In this case, when the researchers look at masking, they look at trials that covered both flu and the COVID-19 pandemic.

Based on trials of masks in community settings (i.e. where some people are encouraged to mask and some are not), they conclude that there is little overall evidence to suggest that encouraging masking works to reduce incidence. Basically, these community-based studies generally do not show lower flu or COVID-19 infection rates when masks are used.

Some people were very upset with this conclusion, although there is general agreement that Cochrane Reviews represent a high standard of quality. What I would say is that the findings are true but deserve context.

Mandating or encouraging masks in a community setting does not seem to have measurable impacts on COVID-19. A big part of this is likely about adherence. That’s not to dismiss this — the real world is the real world, so this is definitely the answer to the question What would happen if we mandated masks? (Answer: nothing.)

It’s not necessarily the answer to the question of whether you could lower your own illness risk by constantly wearing a well-fitting N95 mask at all times when around other people. Based on our understanding of the physical impact of masks, probably you could. This may have some downsides (for you personally), and it’s worth weighing those against your personal risk of illness.

I heard the COVID state of emergency is ending. What does that mean?

This has implications for the powers of the executive branch. Most of this isn’t likely to be super-visible to people on the ground, at least not in the short term. One change that does matter broadly is the link between the Medicaid continuous enrollment program and the end of the COVID emergency. More detail on this is here.

Bottom line: should I still be taking COVID precautions, and which ones?

One concrete answer: boosters for older people, vaccinations (or boosters) for pregnant people, and vaccination for babies at six months if they haven’t had COVID yet.

I also want to acknowledge:

  • For some people, their school or child care center still has COVID-specific policies that make getting COVID very disruptive. Despite CDC guidelines generally updating away from these, it is a challenge for working parents when it is still part of the protocol.
  • For people whose children are immunocompromised or under six months (and can’t be vaccinated yet), the need for precautions may remain. This is as much about other illnesses at this point as it is about COVID, but it is a reality that remains more front-of-mind than it has been in the past.

Going forward, different people are going to make different choices about risks. In case it is useful, I have two thoughts to frame your thinking.

First: for the vast majority of people, COVID-19 illness at this point will present like a standard respiratory virus. That doesn’t mean you want to court it! No one likes to be sick. But treating it very differently than you treat colds or the flu isn’t well backed-up by the evidence.

Second: whatever precautions you plan to take now should be ones you are comfortable with indefinitely, since you should not expect the situation to change.

One legacy of the past three years is continued fear of COVID, especially for people who have been extremely cautious. It may be difficult to break out of this and to put COVID in a broader context, but it may be time to do so.

Covid-19 rapid antigen tests arranged in a pattern on a yellow background.

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Emily Oster

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Do you brand things a certain way to get your kid to accept it? Like calling carrots “rabbit popsicles”? Or telling them to put on their “super speed socks” in the morning? Share your rebrands in the comments below! You never know who you might be helping out 👇

#emilyoster #funnytweets #relatabletweets #parentingjokes #kidssaythedarndestthings

Do you brand things a certain way to get your kid to accept it? Like calling carrots “rabbit popsicles”? Or telling them to put on their “super speed socks” in the morning? Share your rebrands in the comments below! You never know who you might be helping out 👇

#emilyoster #funnytweets #relatabletweets #parentingjokes #kidssaythedarndestthings
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Have you ever panic-googled a parenting question when everyone else is asleep? If so, you’re not alone. 

Today is the first episode of a new biweekly series on my podcast: Late-Night Panic Google. On these mini-episodes, you’ll hear from some familiar names about the questions keeping them up at night, and how data can help. First up: @claireholt!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #emilyoster #claireholt #parentingstruggles #parentingtips #latenightpanicgoogle

Have you ever panic-googled a parenting question when everyone else is asleep? If so, you’re not alone.

Today is the first episode of a new biweekly series on my podcast: Late-Night Panic Google. On these mini-episodes, you’ll hear from some familiar names about the questions keeping them up at night, and how data can help. First up: @claireholt!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #emilyoster #claireholt #parentingstruggles #parentingtips #latenightpanicgoogle
...

Sun safety is a must for all ages, especially babies! Here are my tips for keeping your littlest ones protected in the sunshine:
☀️ Most importantly, limit their time out in hot weather. (They get hotter than you do!)
☀️ Keep them in the shade as much as possible when you’re out.
☀️ Long-sleeve but lightweight clothing is your friend, especially on the beach, where even in the shade you can get sunlight reflecting off different surfaces.
☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster

Sun safety is a must for all ages, especially babies! Here are my tips for keeping your littlest ones protected in the sunshine:
☀️ Most importantly, limit their time out in hot weather. (They get hotter than you do!)
☀️ Keep them in the shade as much as possible when you’re out.
☀️ Long-sleeve but lightweight clothing is your friend, especially on the beach, where even in the shade you can get sunlight reflecting off different surfaces.
☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster
...

I’m calling on you today to share your story. I know that many of you have experienced complications during pregnancy, birth, or postpartum. It’s not something we want to talk about, but it’s important that we do. Not just for awareness, but to help people going through it feel a little less alone.

That’s why I’m asking you to post a story, photo, or reel this week with #MyUnexpectedStory and tag me. I’ll re-share as many as I can to amplify. Let’s fill our feeds with these important stories and lift each other up. Our voices can create change. And your story matters. 💙

#theunexpected #emilyoster #pregnancycomplications #pregnancystory

I’m calling on you today to share your story. I know that many of you have experienced complications during pregnancy, birth, or postpartum. It’s not something we want to talk about, but it’s important that we do. Not just for awareness, but to help people going through it feel a little less alone.

That’s why I’m asking you to post a story, photo, or reel this week with #MyUnexpectedStory and tag me. I’ll re-share as many as I can to amplify. Let’s fill our feeds with these important stories and lift each other up. Our voices can create change. And your story matters. 💙

#theunexpected #emilyoster #pregnancycomplications #pregnancystory
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OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76. 

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76.

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife
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My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster

My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster
...

We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy. 

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙

We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy.

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙
...

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster
...

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months. 

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages. 

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months.

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages.

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords
...