The Maskers Comic
Fact-checking MedIa and Government News

Worms in Your Spaghetti

  • Misinformation is often intertwined with facts that are either intentionally or unintentionally placed as a way to propagate a narrative at the expense of responsible, scientific messaging.
  • We have dubbed this column, “Worms in your Spaghetti'' with the purpose of pulling out “worms” of misinformation, separating out the “spaghetti” of data, and focusing in on the “meatballs” (or chunks of hearty vegetables, depending on your preference) of good information.
  • Finally, we summarize and learn what we can do to fight back against misinformation in our wrap-up section, “the cannoli”, and send any leftovers in a "doggy bag" appendix at the end of each article.
  • Check out our Worm Collection below for the latest COVID-19 fact-checking of media and government news:

#3 Biden's Call to End the Public Health Emergency in May 2023 Means Individuals and Policy-Makers Will Have to Take More Actions, Not Less

3.05.2023 by Shea O'Neil

The ending of the US PHE does not mean that Covid is not a significant threat nor that we as a country don't still need the government relief. Removing provisions that affect access to food, healthcare, tests, and treatments will increase hardship as well as transmission of COVID-19. It increases the problems of complacency and misinformation. We will all need to work harder to reduce transmission. The Cannoli? We can.

#2 Increases in Disease Prevalence and Severity A Likely Result of COVID-19 and Long COVID. The "Immunity Debt" Hypothesis is Unfounded.

2-17-2023 by Shea O’Neil

Weigh the evidence between Immune Damage being caused by the Covid-19 virus, versus the Immunity Debt Hypothesis (which states that immune damage is caused by not being infected). In this second edition of Worms in Your Spaghetti, we take a closer look at the massive increases in RSV and flu we have seen this season (and last season), and factor in the newest data and research on how the Covid-19 virus can cause long-term immune damage, along with the Cannoli: How to Protect Oneself.

#1 The WHO Continues to Ignore Long COVID Catastrophe

11.15.2022 by Shea O'Neil

Reviewed and Published by the WHN

A recently published scientific consensus states COVID-19 is a global threat, and strategic actions by health organizations and governments to implement awareness are needed. Instead, dominating headlines is The WHO's report of a 90% drop in death rate, and a call for optimism-- but is the COVID-19 death rate and accurate metric to use in making public policy? Find out in this Worms

#3 Worms in your spaghetti

The US Call to End the Public Health Emergency in May 2023 Means Individuals and Policy-Makers Must Take More Actions to Prevent Transmission, Not Fewer

Published on 3-5-2023

by Shea O'Neil

Today’s Dish: The US Ending of the COVID-19 Public Health Emergency

The Spaghetti: 

On January 30th, the White House announced that it will be terminating both the public health (PHE) and national emergencies declared in response to Covid on May 11th 2023[2]. The US PHE has been extended every 90 days since January 2020 as the virus has evolved into variants [3] that have found new ways to challenge treatments [4] and vaccines [5], cause both acute [6] and long-term [7] health damages, and cause over 1.1 million confirmed [8] deaths (along with unexpected increases in excess deaths [9]). The White House had last extended the emergency earlier in January [10] as the highly infectious and immune-evasive Omicron XBB1.5 variant spread across the country. So why end the emergency now?

The Worms: 

It is difficult to say that the decision was based purely on scientific reasons. The announcement [11] came one day before the House Republicans would be voting on legislation to end the emergency immediately. Although the proposed legislation to end the PHE immediately was not expected to make it past a democratic-led senate or get by the presidential veto, the White House’s administrative policy statement [12] mentioned the bill in its title, along with its announcement to end the PHE in May, wherein the Office of Management and Budget (OMB) said that ending the emergency abruptly now would have “highly significant impacts on our nation’s health system and government operations”, whereas "this wind-down would align with the Administration's previous commitments to give at least 60 days' notice prior to termination of the PHE." Political pressure apparently played an unspoken role in the decision to end the PHE. 

Financial factors also seemed to play a role in the recent “decoupling” of certain protections from the PHE, including the end of the government funding for vaccines and treatments for all, the end of extra government protections to keep people insured, and the end of extra government food assistance programs that helped people stay out of poverty. These changes will go into effect in March and April. In its Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap [2], the Human and Health Services Department (HHS) said that the plan to transition to more traditional health care coverage “in part reflects the fact that the federal government has not received additional funds from Congress to continue to purchase more vaccines and treatments.” At least they acknowledged the role of financial factors here.

Yet, the government also mentions statistics and continues to say we are in a better place than we were three years ago as a reason for ending the PHE in May. They state [2]: "Since the peak of the Omicron surge at the end of January 2022: Daily COVID-19 reported cases are down 92%, COVID-19 deaths have declined by over 80%, and new COVID-19 hospitalizations are down nearly 80%." These statistics, however, paint an inaccurate picture of the current crises.

Due to changes in testing use, accuracy, and surveillance, case data is underestimated. A recent study found COVID-19 rates are likely 40 times higher than CDC estimates during Omicron [13]. Wastewater data shows COVID-19 is still highly prevalent, and significantly higher than case data shows. This past winter, hospitals were more full than they’ve been throughout the pandemic [14]. And assessing COVID-19 risks with only the current death rate metric does not include health damages and deaths from long covid. Long covid can result in organ damage [7], development of new chronic illnesses [15], autoimmune disease [16], and immune dysfunction [17] that can cause severe, and often long-term health issues, including leading to death.

A recent study shows COVID-19 led to an increase in deaths from heart attacks and strokes (with the most increases occurring in ages 25-44) [18], previously a low-risk age population for these events). Even the CDC has recognized long covid as a deadly problem, and has created new February 2023 guidance to include long covid deaths in future reports [19]. As for their mention in this announcement to end the PHE, there was no mention. As we have stated in previous Worms in Spaghetti articles, omitting important information is a form of mis- and dis-information.

The Meatballs:

With many losing health benefits and under more financial duress, the end of free COVID tests, and the unaddressed problem of complacency [1], the end of he PHE could have significant implications for people’s ability to get timely COVID diagnoses, to prevent transmission, and to get treatments. 

The WHO had stated: "Moving forward past the PHEIC requires [1] a focused commitment of WHO, its Member States and international organizations to developing and implementing sustainable, systematic, long-term prevention, surveillance, and control action plans.” The end of the US COVID-19 PHE will result in none of these, and in fact runs contrary to these goals.

5-23-23 Update: On May 5th 2023 the WHO declared an end to the COVID-19 Public Health Emergency of International Concern (PHEIC). This was shortly after the US federal government declared an end to its Public Health Emergencies and their related protections. These moves create greater weaknesses in testing surveillance, treatment access, and healthcare system support while increasing the already pronounced problem of complacency, greatly exposing the public to the harms of COVID-19. 

The Cannoli: 

In order to truly end the problems COVID causes to the public, it will be up to individuals and policy-makers to take more actions to reduce transmission. Medical facilities canupgrade PPE for staff[20] which has been shown toreduce hospital-acquired infections drastically. State policy-makers can expand Medicaid protections [21] to reduce the number of people falling into gaps[22] in coverage, and reform SNAP programs[23] tokeep more from falling into significant food hardship. Building operators can enhance ventilation and purification standards[24]. Employers can offer adequate sick days for staff along with following the WHO’s updated masking guidance [25], to recommend mask use indoorsirrespective of the local epidemiological situation. Schools can strongly recommend masking, as studies show even a small increase in the proportion of people wearing masks in schools can significantly decrease the probability of a new COVID-19 case [26]. Individuals [27] can wear n-95 or equivalent masks, stay up-to-date with vaccinations and boosters, test if exposed or symptomatic or as part of a screening process, use ventilation/purification strategies, and lower capacity and remote options.

The Doggy Bags: 

Doggy Bag #1: Summary of changes that go in effect in March/April: 

Doggy Bag #2: Summary of Changes that will be affected by the PHE ending in May [2]

  • COVID-19 Test and Treatment Costs: The requirement for private insurance companies to cover COVID-19 tests without cost sharing, both for OTC and laboratory tests, will end in May. Mandatory coverage (without cost-sharing) for COVID-19 testing under State Medicaid programs will end on September 30, 2024. Medicare beneficiaries who are enrolled in Part B will continue to have coverage without cost sharing for laboratory-conducted COVID-19 tests when ordered by a provider, but their current access to free over-the-counter (OTC) COVID-19 tests will end in May. Paxlovid [34], previously free, may now require out of pocket costs. Note: Paxlovid does require a prescription, although, as of February 2023, there is no longer a requirement of a positive test in order to receive a prescription [35].

  • Health Organizations Ability to Monitor COVID-19 As of May 11th, HHS will no longer have the authority to require lab test reporting for COVID-19, which will impact the ability to calculate percent positivity for COVID-19 tests. Hospital data reporting will continue through April 30th 2024, as required by the CMS conditions of participation, but reporting may be reduced from the current daily reporting to a lesser frequency. CDC’s ability to acquire vaccine administration data will also be affected. 

  • Hospitals and Nursing Homes Certain Medicaid COVID-19 PHE waivers and flexibilities that helped keep people safe in hospitals and nursing homes, expanded facility capacity for the health care systems, and helped the healthcare systems weather the heightened strain created by COVID-19 will either end on May 11, or remain in place for six months following the end of the PHE. 

  • FDA COVID-19 Guidance Documents “Certain FDA COVID-19-related guidance documents for industry that affect clinical practice and supply chains will end or be temporarily extended.” There was very vague language in this category and little seemed to be decided on how the FDA will address these issues, but what is known is there is no current plan. 

  • FDA’s Ability to Detect Shortages of Critical Supplies The requirement for device manufacturers to notify FDA of significant interruptions and discontinuances of critical devices outside of a PHE which will strengthen the ability of FDA to help prevent or mitigate device shortages will expire. It was apparent in 2020 that not having critical supplies, such as PPE and medical equipment, was a big problem. Allowing this to end is not responsible. 

Doggy Bag #3- Petitions

Oppose Ending the National and Public Health Emergency Declarations 

Petition to Tell elected reps: Maintain healthcare coverage , we need robust public health infrastructure: 

Petition NJ retain masking in Healthcare facilities:, or Take Action: Call NJ Dept. of Health Commissioner's Office to Say You "Want the Mask Mandate in Healthcare Facilities to Continue" at 609-292-7837 between 8:30 am and 5 pm Eastern Time,  if outside of that time frame you should still be able to leave a message. 



[2] Affairs (ASPA) AS for P. Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap. Published February 9, 2023. 

[3] The New XBB.1.5 Variant: What You Need to Know. WHN. 

[4] Update - AstraZeneca’s Evusheld no longer authorized as COVID-19 preventative for immunocompromised | Immune Deficiency Foundation. 

[5] Miller J, Hachmann NP, Collier AY, et al. Substantial Neutralization Escape by SARS-CoV-2 Omicron Variants BQ.1.1 and XBB.1. New England Journal of Medicine. Published online January 18, 2023. doi: 

[6] UpToDate. 

[7] Banerjee A. Three in five long COVID patients have organ damage a year after infection. The Conversation. 

[8] Worldometer. United States Coronavirus. Published 2021. 

[9] Estimated cumulative excess deaths during COVID. Our World in Data. 

[10] COVID-19: Renewal of Determination that a Public Health Emergency Exists. 

[11] President Biden to end COVID-19 emergencies on May 11. AP NEWS. Published January 30, 2023. 


[13] Study shows COVID-19 rates were likely forty-times higher than CDC estimates during BA.4/BA.5 dominant period in the U.S. Published February 27, 2023. Accessed March 5, 2023. 

[14] McPhillips D. Hospitals in the US are the fullest they’ve been throughout the pandemic -- but it’s not just Covid. CNN. Published December 8, 2022. 

[15] Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology. Published online January 13, 2023:1-14. doi: 

[16] COVID-19 linked to 40% increase in autoimmune disease risk in a huge study. Published February 22, 2023. 

[17] Chang T, Yang J, Deng H, Chen D, Yang XP, Tang ZH. Depletion and Dysfunction of Dendritic Cells: Understanding SARS-CoV-2 Infection. Frontiers in Immunology.. Published February 21, 2022. 

[18] COVID increases your risk for cardiac complications—immediately and into the future, experts say. Here’s how you can protect your heart. Fortune Well. Accessed March 5, 2023. 

[19] Vital Statistics Reporting Guidance.; 2020. 

[20] Ferris M, Ferris R, Workman C, et al. Efficacy of FFP3 respirators for prevention of SARS-CoV-2 infection in healthcare workers. eLife. 2021;10. doi: 

[21] Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches KEY POINTS. 

[22] States Must Act to Preserve Medicaid Coverage as End of Continuous Coverage Requirement Nears | Center on Budget and Policy Priorities. Center on Budget and Policy Priorities. 

[23] Temporary Pandemic SNAP Benefits Will End in Remaining 35 States in March 2023 | Center on Budget and Policy Priorities. Center on Budget and Policy Priorities. 

[24] Guidelines for Ventilation - WHN clean air. WHN. 

[25] WHO updates COVID-19 guidelines on masks, treatments and patient care. 

[26] Wastewater study finds masks prevent COVID-19 in schools. 

[27] Individuals Archives. WHN. Accessed March 6, 2023. 

[28] Moderna promises to provide vaccines at no out-of-pocket cost. Endpoints News. Accessed March 5, 2023. 

[29] Pfizer plans to sell Covid vaccines at $110 to $130 per dose. NBC News. 

[30] Kimball S. Millions at risk of losing health insurance if U.S. ends Covid public health emergency in January. CNBC. Published October 19, 2022. 

[31] Tolbert J, 2023. 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision. KFF. Published January 11, 2023. 

[32] August 2022 ISSUE BRIEF 1 Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches KEY POINTS. 

[33] Daniels M. Emergency COVID SNAP benefits to end Feb. 28. Accessed March 5, 2023. 

[34] Paxlovid | HHS/ASPR. 

[35] You No Longer Need a Positive COVID Test to Receive Paxlovid. Verywell Health. 

#2 Worms in your spaghetti


Written 2.17.2023
Updated 11-28-23
by Shea O’Neil

Come for the Spaghetti, Stay for the Cannoli

Misinformation is often intertwined with facts that are either intentionally or unintentionally placed as a way to propagate a narrative at the expense of responsible, scientific messaging. 

We have dubbed this column, “Worms in your Spaghetti'' with the purpose of pulling out “worms” of misinformation, separating out the “spaghetti” of data, and focusing in on the “meatballs” (or chunks of hearty vegetables, depending on your preference) of good information. 

Finally, in our wrap-up section, “the Cannoli”, we summarize and learn what we can do to fight back against misinformation, and send any leftovers in a "doggy bag" appendix at the end of each article. 

Today’s Dish: COVID-19 and Long COVID Effects vs “Immunity Debt”

“A hypothesis is an assumption made before any research has been done. It is formed so that it can be tested to see if it might be true. A theory is a principle formed to explain the things already shown in data. Because of the rigors of experiment and control, it is much more likely that a theory will be true than a hypothesis” [Merriam Webster]. 

Today we will be examining whether the huge increases in viral prevalence and severity that we are seeing with the flu, RSV, and COVID-19 are due to the hypothesis of "immunity debt" or the theory that these increases are a result of COVID-19 infection and long COVID in the population. Let’s start by weighing the evidence.  

Weighing the Evidence: 

COVID-caused Immune Damage

  1. COVID-19 infections cause damage to the immune system. Studies show that when you damage the cells of the immune system, you become more vulnerable to future infections and worsened health outcomes

  2. Infections and reinfections from SARS-CoV-2, the virus that causes COVID-19 infection, deplete key cells of the immune system and this damage is long-term [1] [2] [3[4] [72][74].

  3. The depletion of these cells undermines the ability of the immune system to fight other infections [5][6][7][8][9][10][68][69] [71], and worsens long-term health outcomes across a wide variety of bodily systems [11][12][13].

  4. A 2020 article in the New York Times headlined that the coronavirus short-circuits the immune system in a manner similar to how HIV causes AIDS [14]. Both diseases cause immune dysregulation involving decreased T-cells, natural killer cells, and B-cells, as well as increased cytokines that create serious immunological dysfunction.  

  5. A March 2023 Nature study showed that COVID-19 causes damage to the immune system for at least 6 months after even mild cases, and that this immune damage affects t cells, and has cascading effects on the immune system's ability to clear the virus fully, leading to further bodily damage [67]. 

  6. A 2023 study, the first-in-human T cell activation PET imaging study of individuals in the post-acute phase of SARS-CoV-2 infection, researchers found COVID-19 may result in persistent T cell activation in a variety of body tissues, that this activity may persist for years following initial symptom onset and associate with systemic changes in immune activation as well as the presence of Long COVID symptoms, and that SARS-CoV-2 persistence in gut tissue may contribute to these processes [72]. 

  7. A study (November 29th 2022) has shown that among RSV-infected children in 2022, approximately 19% had prior documented COVID-19 infection, significantly higher than the 10% among uninfected children. These results suggest that prior COVID-19 infection is a risk factor for RSV infection.  The study notes: “In 2022, the incidence rate was higher than in any other previous years including for peak months in 2021 in children 5 and under” [16], showing this trend is increasing.

  8. And finally, a study published October 13th, 2023 concluded that COVID-19 contributed to the RSV surge in 2022, likely due to its long-term adverse effects on both the immune system and respiratory system [71]. The authors state: "Individuals infected with COVID-19 can have long-lasting changes in both innate and lymphocyte-based immune functions, precisely the systems most engaged in defense against respiratory viruses. If the immune debt… was the main contributor, we would expect that the level of RSV infection in 2022 to be similar to that in 2021. In 2022, significantly more children contracted COVID-19 due to the relaxation of preventive measures and the dominance of the highly transmissible Omicron variant. Studies show that SARS-CoV-2 virus fragments can persist in the body and have the ability to stimulate tissue-specific immunity in children and children affected by long COVID may have a compromised cellular immune response."

  9. A 2022 Study in the Journal of Clinical Medicine suggested that: “children affected by Long COVID may have a compromised ability to switch from the innate to the adaptive immune response, as supported by our data showing a contraction of naïve and switched B cell compartment and an unstable balance of regulatory T lymphocytes occurring in these children” [73].

Historical data also shows COVID-19 infection and reinfection can cause damage to the immune system that makes one more susceptible to getting other infections, and makes it harder to fight off those infections resulting in more severe cases. 

  1. We can see this in the unique case of New Zealand, which had low COVID-19 in its population in 2021: When they suddenly removed pandemic protections and increased travel, they saw an increase in RSV cases (as would be expected when protective measures are taken away). What was notable, however, was that the severity of RSV cases did not increase at this point [e]. In other countries, however, such as the US, which–unlike New Zealand at that time–had high transmission of COVID-19 in the population and were in the second year without mask mandates or other protections, there were notable increases in both cases and severity (see cases and hospitalizations graphs in Spaghetti section). In other words, those places with higher prior COVID-19 infections in the population had not just more RSV cases but worsened severity of cases of RSV, reinforcing the studies on COVID-caused immune damage that negatively impacts one's ability to fight other infections.

  2. If pandemic measures like masking fall, there is not much of a surprise that respiratory infections like COVID-19, RSV, and flu would see an increase, since they all can spread in the air, and in crowded environments. And they did in many countries, including the US ([US RSV Surveillance Data]). However, in a study that looked more closely into cohorts of children with and without prior infection with COVID-19, researchers showed that those with prior COVID-19 infection had doubled the risk of an RSV infection compared to those without prior COVID-19 infection, suggesting prior COVID-19 is a risk factor for RSV infection, especially in children [16]. 

  3. Research also indicates that although children sometimes seem able to rapidly clear SARS-CoV-2, and appear to have milder initial infection, longitudinal analysis of data suggests that they are less likely than adults to harbor memory t-cells,which may not only compromise their cellular immunity, but also their ability to resist reinfection [15]

  4. Together these studies indicate that infection from COVID-19 does not prevent reinfection, does not have a health benefit, can make the immune system weaker, and thus could likely play a role in the increases and severities of other illnesses including RSV and flu.

Immunity Debt

  1. The “immunity debt” hypothesis suggests that immune systems will be more protected from future infections by being infected by viruses, and that preventing infections leads to a vulnerability to future infections. 

  2. The phrase "immunity debt" was first used in a 2021 opinion paper [Worms Exhibit 1a], which suggested that the lack of exposure to certain viruses could lead to higher numbers of cases in the following years. This hypothesis proposed that pandemic measures implemented in 2020 had prevented immune systems from being exposed and stimulated as usual, and thus made them more vulnerable. To be considered scientifically valid, a hypothesis must be able to explain existing evidence and be supported by specific studies. There is no evidence presented in this opinion paper, nor has there been in any study since, showing that the existing data on RSV, flu, or COVID-19 is explained by the “immunity debt” hypothesis. 

  3. Not only does this “immunity debt” hypothesis forgo providing any scientific studies, historical data also does not support it. RSV has not shown up more severely in places that had lockdowns versus those that did not. For example, in Sweden, where no lockdowns or mandatory masking happened, they still had exceptionally large RSV outbreaks [17]. Also, in the U.S., this is the second year in a row that RSV cases and the flu have surged in both prevalence and severity (as seen in US RSV Surveillance Data for hospitalizations). If prior infection with RSV meant future immunity to it, we would expect less cases this year after a surge last year, and with less severity. We saw the opposite (see Spaghetti Section). 

  4. RSV and COVID-19 infections do not provide extended immunity.

  5. RSV infection immunity is known to wane very rapidly over time, they have short-lived antibodies, and thus reinfections are common in subsequent seasons, and can even be seen in the same season [19]

  6. The severity of RSV infections has been found to be related less with prior infection, and more to the immune response mounted by the host, including their T-cell-specific immunity. Anti-RSV antibodies are short-lived [18] and virus-specific memory cell responses are surprisingly absent after RSV infection, giving RSV the ability to cause recurrent symptomatic infections [30].

  7. These studies indicate that the severity of RSV infections has little to do with prior infection, and more to do with the host’s innate immune response, including T-cell-specific immunity [18], which studies have shown is part of the immune dysfunction seen from COVID-19 infection [1][2][3][4].

  8. COVID-19 reinfections have become commonplace, and each reinfection results in higher risks for significantly worsening health outcomes [12]. This goes against the idea that more infections strengthen the immune system.

  9. A study on the antibody resistance profile and viral receptor binding affinity of SARS-CoV-2 Omicron BQ.1, BQ.1.1, XBB, and XBB.1 sub variants showed that these sub variants were barely susceptible to neutralization by sera from vaccinated individuals with or without prior infection, including persons recently boosted with the new bivalent (WA1/BA.5) mRNA vaccines. The study’s authors state, “The extent of the antigenic drift or shift measured herein is comparable to the antigenic leap made by the initial Omicron variant from its predecessors one year ago” [21]. Since the variants can quickly evolve (especially when methods to slow transmission such as masking are not being used) immunity acquired from vaccination or past exposure is not stopping infection. Thus, contrary to the "immunity debt" hypothesis, exposure is not preventing reinfection from COVID-19. 

  10. The idea that immunity requires "exercise" or else it deteriorates, is not accepted or demonstrated scientifically. 

  11. On the contrary, infections and reinfections with viral diseases have been tied to immune system and organ damage, as well as the development of new or worsened health conditions [11][12][13]

  12. Research has also debunked the “hygiene hypothesis”, showing that when it comes to viral exposure, infection with viruses (such as the flu or RSV) does not lower a child’s chances of developing health issues like allergies later in life, and, on the contrary, is tied to worsened health outcomes– such as an increase in developing asthma. Avoiding viruses that make one sick by using good hygiene practices not only protects our health, it also helps stop the spread of many infectious pathogens in the community [22][70].  

The Spaghetti

  1. There was an increase in RSV detections and RSV-associated emergency department visits and hospitalizations in multiple U.S. regions in "this year" season (2022-2023), with some regions nearing seasonal peak levels as early as November 2022 [18]

  1. RSV-NET Interactive Dashboard | CDC [23] 

Image A: RSV-Associated Hospitalizations Sky-Rocket this Season, 2022-2023. The green dotted-line (this year)shows the early and steep 2022-2023 surge in RSV hospitalizations. The solid green line (last year)(2021-2022) also had an early start, but not nearly as steep as this year. 2020 (the blue square-dotted line) shows the incredibly low cases when measures to stop COVID were being taken en masse, revealing their effectiveness. 

  1. On November 14th, 2022, the Children’s Hospital Association and the American Academy of Pediatrics urged the White House to declare an emergency to support the national response to the alarming surge of RSV combined with increasing flu circulation that are pushing some hospitals to the breaking point, citing: “Across the country, more than three-quarters of pediatric hospital beds are full, and many states are reporting more than 90 percent of their pediatric beds are occupied.” [24] Many hospitals had zero pediatric beds available, and sick babies and children are being sent out of state, and far from their families for care [25].

B. Weekly U.S. Influenza Surveillance Report | CDC [26]

Image B: Weekly Influenza Surveillance Report: The red triangle-dotted line shows an early 2022-2023 surge in influenza-like illness (ILI) outpatient visits. The orange line (2021-2022) was not nearly as steep and did not reach 2022-2023 ILI levels even at its peak in February. 2020-2021 (the pink line) shows the record-low cases compared to both the past and future years when measures to stop COVID were being taken en masse, again making a compelling case for their use to knock out other viruses on top of COVID-19 to prevent unnecessary illnesses and deaths.

  1. COVID-19 cases and hospital admissions surged after Thanksgiving 2022 [27]—up 27% from the prior week, showing real time effects of gathering indoors unmasked, as well as travel without mask mandates, and transmission maps showed high levels of COVID-19 across the US [28]

C. Covid in the U.S.: Latest Maps, Case and Death Counts - The New York Times[27]

Image C: COVID in the US: Focusing on the red bar graphs’ heights to the right, you can really see the peak in late November 2022 (this occurred right after Thanksgiving), and its effects in 14-day change, with a 53% increase in test positivity, and more than 25% jump in hospitalizations that have been seen in all but 4 states. Although it is noted that cases are lower than last year, the number of people testing and number of tests actually being reported are vastly lower than last year as well, meaning we are flying blind but what we can see is a significant surge, and its relationship to holiday gathering. 

Long-term immunity due to prior infection with flu, RSV, or COVID-19 has not been shown in the historical data, but the effectiveness of using COVID precautions has been. It is important for the media and health organizations to recognize these basic observations, along with the aforementioned studies on COVID-caused immune dysfunctions, because they affect public perceptions and behaviors. Instead, what we are seeing is a predominance in the media of, well, worms.   

The Worms:

Immunity debt has been presented in recent media and press releases to suggest that people are better off being exposed to viruses in order to strengthen immunity; or stated another way, that humans who are NOT exposed to viruses could have damaged immune function. There is no scientific support for this hypothesis, or in what we know about the immune system. Yet, there is an increasing trend in the media to convey it as such, and to tie it to increasing incidences of flu, RSV, COVID-19, and influenza-like illnesses. Let's take a closer look.

Worm #1: CNN writes: “The pandemic behaviors created an ‘immunity gap’ or ‘immunity debt’ that makes more people in the US vulnerable to diseases like RSV.” (CNN, [Worms exhibit 2b]

  1. Counter to this sentence, as stated above (Section: Weighing the Evidence), there are no studies that support the idea of an immunity debt, aka that preventing infections makes people more vulnerable to diseases like the flu or RSV. The evidence shows quite the opposite: COVID infection can damage the immune system and cause increased susceptibility to other diseases [1][2] [3] [4] [12] [29], and this is consistent with the observed large number of cases.

Worm #2: The Hill writes in discussing the current RSV outbreak: “Now that most children are back in daycare and school at a time when masking is less widespread, RSV has had the opportunity to spread among children whose immune systems have never encountered the virus before. This phenomenon has been described as “immune debt” due to pandemic prevention measures. The first time the immune system encounters a virus, symptoms of infection can be more severe as the body is learning to fight the virus, while subsequent infections tend to cause minimal or mild symptoms as the body now has a template to target the virus effectively.” (Worms The Hill, [exhibit 3c])

  1. This statement is true for some diseases, but it does not apply to RSV. RSV immunity is short-lived [19] [30]. Reinfections are common, with some even occurring in the same season and, more commonly, the following season. The severity of these infections is related less to prior infection, and more to the host's cellular immune response [19]

  2. Although there is a plethora of data and studies showing COVID-related damage to the immune system, there is no mention of this in the article. Exclusion can also be a form of mis- and disinformation.

Worm #3: CDC Newsroom Transcript Quote: “You know, in the previous years, atypical presentations of atypical seasons, due to mitigation against COVID left a large swath of the United States population uninfected. So we’re seeing more RSV because in the last two years, we’ve not seen infections in children as we have previously. And so these children, if you will, need to become infected to move forward because it’s a disease very common in children” ([Worms exhibit 4d]).

  1. Counter to this sentence, as stated above (Section: Weighing the Evidence), there are no studies that support the idea that preventing infections makes people more vulnerable to diseases like the flu or RSV or that being infected makes them less vulnerable. 

  2. Moreover, as stated above, RSV immunity wanes quickly [19]. In addition, even countries that used very few pandemic measures are still seeing surges in RSV cases this year (2022) [17]

  3. Children do not need to become infected to “move forward.” RSV was responsible for many preventable infections, hospitalizations, and deaths in the past, but it does not need to be this way going forward, nor does it need to be increased due to immune damage from COVID-19. We can see in historical data, the tools we have do work to stop both RSV and COVID-19 (see Spaghetti section graphs). RSV infections are also tied to the development of asthma and can worsen other heart and lung conditions [29]

  4. Delaying RSV infections is also beneficial, since older children typically have more developed immune systems to better fight RSV, whereas young children tend to get sicker from flu and RSV than other age groups, and infants younger than 6 months old stand to suffer the most, with nearly double the risk of RSV-related death compared to older children [20]. Therefore, preventing and delaying viral exposure is beneficial. 

  5. The evidence shows COVID-19 infection frequently causes immune damage, which can cause increased susceptibility to other diseases, and this is consistent with the observed large number of cases and worsened severity of flu and RSV [1] [2] [3][4] [12][29].

Worm #4: CDC Newsroom Transcript Quote: “So we’re talking about it now, because people have a lot of questions. We want to answer the questions that are out there and reassure the American public that there are ways to prevent this. And that is prevented just by taking the vaccine for COVID. And for influenza, and that we have ways of preventing RSV infection by washing your hands avoiding contact. And if family wishes, they can use masks. But those are the reasons why we’re talking about it.” (Worms Exhibit [4d]).

  1. COVID-19 infections are not suitably prevented by using only one prevention tool or notably “just by taking the vaccine”. The most recent bivalent mRNA vaccine boosters protect against symptomatic infection in 40% to 60% of cases, meaning that even when vaccine protection is at its most potent, about a month after getting the shot, people may still be quite vulnerable to breakthrough infections if using this tool alone.  Another recent study shows vaccines offer very little protection against long COVID [31]

However, vaccines are still recommended, as they tend to reduce hospitalizations from the acute phase of COVID-19 infections and show many benefits over being unvaccinated [32].  

With vaccine efficacy and booster take-up waning, and the variants evolving, the amount of protection offered by vaccines is helpful but not sufficient on its own, and a multilayered approach is necessary [33] [34] [35].

  1. Masking should be emphasized as a major preventative action, not as a side note. The CDC speaker said influenza and RSV (both viruses that are commonly spread through the air) can be avoided just by washing hands and avoiding contact, and then gave a very optional statement afterwards about masking. Since all of these diseases are spread through the air, masking is the best tool we have, and should be highlighted as such. Studies have shown well-fitted respirator masks significantly reduce risk of COVID-19 infections [49] [50] [51]. They also show that places with mask mandates have significantly fewer viral infections compared to those with masking optional policies [52].

The Meatballs (or Juicy Vegetables Depending on Your Preferences):

Meatball/Veg #1:It is well-established in the scientific literature that COVID-19 infection can cause significant short-term and long-term damages to the immune system and increased susceptibility and risks of contracting other viral infections.

  1. Prior COVID-19 infection is a risk factor for RSV infection. A recent 2022 study showed that among RSV-infected children aged ≤5.0 years, the RSV-positive children had significantly greater health determinants and comorbidities, including preterm births, immunological diseases, and chronic pulmonary disorders of perinatal origin, which increase RSV contract risks. The study also showed RSV-positive children had a significantly greater prevalence of previous SARS-CoV-2 infections (19%) [56].

  2. Evidence is emerging that COVID can cause dysregulation of critical immune cells known as T-cells, which can be prematurely aged through infections with SARS-CoV-2. Not only can these T-cells then lead to unrecognized organ damage, but the exhaustion of those hyperactivated T-cells means they may be less able to guard against other pathogens [2] [57], including but not limited to viruses like influenza and RSV. Infants in particular may be especially vulnerable to more serious RSV infections due to immaturity of the immune system and the fact that passive transfer of maternally-transmitted antibodies likely has an immunosuppressive effect [19]

  3. Even mild infections with COVID-19 can lead to long-term immune system damage and dysfunction [48] [58]. It is known that in older adults, changes in the immune system and particularly cellular immunity lead to increased susceptibility to RSV [59]. Immune damage and dysfunction have been noted to happen after COVID-19 infection in individuals from a variety of ages making them more vulnerable to other infections due to dysfunction of cellular immune function [48]. A recent Nature study found that even when initial COVID-19 infection was considered mild, immune damage and dysfunction remained persistently high at least 8 months after infection [2].

Meatball/Veg #2: If you have had COVID-19 before, you have even more reason to use preventatives to avoid reinfections. 

  1. Immunity gained from infection or vaccination does not give long-term protection from reinfection from COVID-19[35].

  2. Reinfections by COVID-19 cause greater likelihood of health damage, both short-term and long-term, including, but not limited to, damage to the immune system, and greater susceptibility to future infections from other pathogens as a consequence [1] [2] [3] [4] [12].

  3. Coinfections with COVID-19 and flu or RSV have significant negative health outcomes [8][9]

Meatball/Veg #3: Protective measures work together to prevent infection. If you don’t catch COVID-19, flu, and/or RSV, your body stays stronger.

  1. Increased prevention strategies can help protect against infection by reducing exposure to infectious viruses, and reduce chances of developing immune system and organ damage, as well as the development of new or worsened health conditions [11][12] [13]

  2. When it comes to viral exposure, infection with viruses (such as the flu, RSV, and COVID-19)) does not lower one’s chances of developing health issues [70]. 

  3. Avoiding viruses and microbes that make one sick by using good hygiene practices not only protects health, it also helps stop the spread of many infectious pathogens in the community [22].  

The Cannoli

The jury is in: There is a large amount of evidence that supports COVID-19 as a major causal factor in the recent surges in cases and severity of RSV, influenza, and flu-like illnesses, whereas the "immunity debt" hypothesis remains unfounded in studies, historical data, and in the current scientific knowledge-base. 

Current SARS-CoV-2 variants are highly immune evasive [36], every reinfection causes greater likelihood of damage, not only to the immune system, but to many body organs and systems. The result is an increase of diseases that are often associated with increased susceptibility to and/or worse outcomes from viral infections, whether it be the flu, RSV, COVID-19 [12] [16] [37] [68], or other infectious diseases– such as cases of scarlet fever that were rising in the U.K in December 2022 [38].

Very important, as discussed above, is that the increase in both size and severity of RSV and flu infections cannot be explained by changes in pandemic measures alone. This is shown in historical data, in the spaghetti section in the differences in the US cases and hospitalizations data, notably between the 2021 (year without mass pandemic measures and mandates) and 2022 (second year as such) years with increase in both cases in severity. COVID infections have been tied to increase in other infections, including those with RSV, with one study showing an increase by a factor of 2 [16]. It is shown in the case of New Zealand (discussed in Weighing the Evidence), that there was no matching increase in severity of RSV cases seen in a population without high prior COVID-19 exposures. 

The immunity debt hypothesis is unfounded and is often misused and misunderstood in a way that could cause greater harm. Yet, it is being placed in a loud-speaker position in the headlines, and health authorities have also mentioned it in press releases. There is much confusion in the media, in the public, and even amongst healthcare practitioners due to this misinformation, that has led people to fear the use of the tools that have the most potential to protect them from both short-term and long-term immune damage, viral infections, and negative health outcomes of long COVID and repeat infections. The flagrant projection of such an unfounded hypothesis as "immunity debt" by the media and health organizations when the stakes are so high raises the suspicion that this is not just misinformation, but disinformation – which is intentional misinformation given for political and/or economic gain. 

It is inappropriate and misleading to relay a message that not only goes directly against the scientific evidence and consensus on how to end COVID-19 as a public health threat [39], but also that can result in actions that bring significant short-term and long-term harm to individuals and the public as a whole. 

The only way to combat such disinformation is to relay the research to the public and point out the worms. Perhaps we can use them one day to catch the big fish that are behind all of this. In the meantime, we can at least enjoy a worm-free meal: Skyrocketing cases of flu, RSV, and COVID-19 can be curbed by using preventatives such as wearing N-95 mask equivalents or better, implementing purification/ventilation strategies to reduce airborne transmission, using testing and isolating strategies to reduce spread, using social distance and avoiding crowded spaces, and by staying up-to-date on vaccinations to reduce risk of severe acute illness symptoms and hospitalizations. Multilayered prevention is key. Bon Appetit! 

The Doggy Bags

Some take-home selections from each section:

Doggy Bag 1: RSV and COVID-19 Viral Infections, Co-Infections, and Effects

  1. Studies have shown that expectant mothers diagnosed with COVID-19 are around 40 percent more likely to deliver prematurely [40][41], and that preterm infants are diagnosed with RSV at higher rates and worsened severity of infections both in infancy and in early childhood [42], providing further evidence for COVID-19-related increases in RSV cases and severities in infancy and early childhood.  

  2. Current surges of RSV hospitalizations have been seen across all ages, including 10 times higher rates amongst seniors ages 65+, 5 times higher for 1-4 year olds, and 7 times higher amongst infants 6 months and younger [23]

  3. RSV infections are also tied to the development of asthma and can worsen other heart and lung conditions [29]. Infants younger than 6 months old stand to suffer the most, with nearly double the risk of RSV-related death compared to older children [20]. Because infants under the age of 6 months and premature infants are particularly susceptible to RSV, it is extremely important to protect them from potential exposure to this virus. 

  4. Studies indicate that you can be infected with both the flu and COVID-19 at the same time, that being infected by one may increase risk of being infected by the other, and that viral coinfections can significantly increase the susceptibility of patients to severe disease and can result in more serious damage to the immune system than in those without viral coinfections [9],[10],[43]

Several literature reviews have investigated coinfections of SARS-CoV-2 with other respiratory pathogens, such as RSV. One study that analyzed 32 pediatric patients under 2 years old who were hospitalized with COVID-19 found that 18.7% of cases were coinfected with RSV. Those patients required a significantly longer length of stay. Another study among 250 patients diagnosed with COVID-19 detected RSV in 4.8% of the patients and showed patients coinfected with viral pathogens had longer hospital stays than patients coinfected with atypical bacterial pathogens [43]

Furthermore, a systematic review of over 100 articles showed as many as 19% of patients with COVID-19 had coinfections, and 24% have superinfections, both of which were associated with poorer outcomes, including increased risk of mortality [9].

And finally, in a study of 48 COVID-19 patients (29% ICU and 71% non-ICU) there was evidence of coinfections in 34 COVID-19 patients (71%) with Influenza A being the most common, and to which a direct relationship with mortality was seen [10]. It is apparent in the research that infections are NOT providing any strengthening of the immune system, but in many cases are making people more susceptible to coinfections and worsened outcomes. 

Doggy Bag 2: Influenza-like Illness

  1. In the fall of 2021, the percentage of positive flu tests was split almost equally between influenza A and B. This year, almost all of the positive flu tests have been for influenza A [18]. This is important because researchers have found that infection with influenza A may increase a person’s susceptibility to COVID-19 by increasing the amount of ACE2—the receptor that allows the virus to infect our cells—in the lungs, thus increasing the odds of getting COVID-19 and the risk for severe illness [45]

  2. COVID prevention strategies help stop flu, RSV, and other illnesses.

  3. Infections from RSV, the flu, and SARS-CoV-2 spread through close contact with an infected person, as well as through the air and contaminated surfaces, entering our bodies through the eyes, nose, and mouth [29][46].

  4. Risk reduction measures against COVID-19 also work against flu and RSV infections [29][46]. Mask wearing, social distancing, increased ventilation and purification, and hygiene practices such as hand-washing and disinfecting surfaces can help protect from all three viruses [47]

  5. As seen in Spaghetti Section Images A and B above, in the winter of 2020, when these protective measures were more common, the U.S. saw an overall drop in non-COVID respiratory infections, an almost nonexistent flu season, and reduced hospitalizations for RSV.

Doggy Bag 3: COVID-Related Immune Damage

  1. COVID-19 infections cause cardiopulmonary disease and immune dysfunction [1][2] [12]. These are major risk factors for hospitalization and mortality in children and adults of all ages who are infected with RSV, and helps explain why we have been seeing not only more cases, but also worsened severity of RSV infections in the population.  

  2. Even mild infections with COVID-19 can lead to long-term immune system damage and dysfunction[48]

  3. Studies indicate an ongoing, sustained inflammatory response following even mild-to-moderate acute COVID-19 [1][2].

Doggy Bag 4: Masks Work and People Don't Mind Wearing Them When Directed to for their/each other's Health and Safety 

  1. Studies have shown well-fitted respirator masks significantly reduce risk of COVID-19 infections [49] [50] [51]. They also show that places with mask mandates have significantly fewer viral infections compared to those with masking optional policies [52]

  2. Some countries are calling for a return to masking policies through either stronger recommendations and/or considering mandates [53]

  3. In a November 2022 survey by Nanos Research, 7 in 10 Canadians support or somewhat support a return to mandatory wearing of face masks in indoor public places this past fall if authorities deem it necessary due to rising COVID cases, while three in ten are opposed or somewhat opposed [54]. This shows the importance of calling out health authorities who are not using the research and data to give strong, clear, loud recommendations to the public to wear well-fitted, high-quality respirator masks in public spaces.   

Doggie Bag 5: Preventative Measures

  1. COVID-19 continues to pose a serious threat to the public [39].

  2. Studies have shown well-fitted respirator masks significantly reduce risk of COVID-19 infections [49] [50] [51]

  3. 50% of the spread is from people not having any outward symptoms of infection (asymptomatic), so masking cannot only be done when sick[60][61][62]. Proper masking should be done in any public places where multiple households are interacting without sufficient prior testing/isolation periods. A well-fitted respirator mask, such as N95, provides significantly more protection than surgical and cloth masks and should be used when possible [49] [50] [51]

  4. Places that mandate masks have lower COVID infections and places that take away mask mandates result in a significant increase in COVID-19 infections [52]

  5. Using masks, distance, good hand sanitation, and ventilation/purification, reduces chances of infection from RSV, flu, and COVID-19 [49] [50] [51]

  6. Staying up-to-date with vaccinations reduces chances of hospitalizations from the initial acute phase of COVID-19 infection [32].

  7. Testing and isolation reduce the chances of transmitting contagious diseases to others [63] [64]

  8. The scientific consensus supports wearing a high quality, well fitted mask, and using other preventative measures to reduce the risks of COVID-19 to your health and the health of the community [39]

  9. Avoiding crowded environments and using social distance reduces chances of infection [65].

  10. Using only a single COVID-19 Rapid Antigen Test (RAT) result as a screening tool for being negative is very limited due to lower accuracy in picking up the newer variants [66]. A negative RAT result is not sufficient in ruling out COVID-19 infection. Serial testing and/or use of molecular PCR tests reduce this risk of false negatives [63] [64] The take-home message is that testing is only one layer in a multilayered approach and should not be counted on alone as a prevention tool.

  11. Definitely, when experiencing symptoms from any of the above illnesses (most of which have overlapping symptoms), stay at home to avoid spreading diseases to others outside your household. In addition, studies support a 14-day isolation period to prevent transmission of COVID-19 to others [61]. If residing with others, take extra actions such as room isolation and increasing ventilation/purification to reduce exposure to household members. 

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[70] Lloyd, C.M., Saglani, S. Early-life respiratory infections and developmental immunity determine lifelong lung health. Nat Immunol (2023). 

[71] Wang, Lindsey, et al. “Association of COVID-19 with Respiratory Syncytial Virus (RSV) Infections in Children Aged 0-5 Years in the USA in 2022: A Multicentre Retrospective Cohort Study.” Family Medicine and Community Health, U.S. National Library of Medicine, Oct. 2023,

[72] Peluso, Michael J, et al. “Multimodal Molecular Imaging Reveals Tissue-Based T Cell Activation and Viral RNA Persistence for up to 2 Years Following Covid-19.” medRxiv : The Preprint Server for Health Sciences, U.S. National Library of Medicine, 31 July 2023,

[73] Buonsenso D, Valentini P, De Rose C, et al. Recovering or Persisting: The Immunopathological Features of SARS-CoV-2 Infection in Children. Journal of Clinical Medicine. 2022;11(15):4363. doi

[74] Boyce L. LibGuides: COVID Impacts: Immune Dysfunction.


Worms Exhibits:

  1. Immunity Debt Opinion Paper: Cohen R, Ashman M, Taha MK, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Infectious Diseases Now. 2021;51(5):418-423. 

  2. CNN: Christensen J. Pandemic “immunity gap” is probably behind surge in RSV cases, scientists say. CNN. Published October 26, 2022. 

  3. The Hill: Dr. Priya Edward. Immunity debt: Why so many kids are sick with RSV. The Hill. Published November 3, 2022. Accessed December 13, 2022. 

  4. CDC Newsroom: CDC. Published January 1, 2016. Accessed December 13, 2022. 

  5. Hatter L, Eathorne A, Hills T, Bruce P, Beasley R. Respiratory syncytial virus: paying the immunity debt with interest. The Lancet Child & Adolescent Health. 2021;5(12):e44-e45. doi:10.1016/S2352-4642(21)00333-3 

Media Sources that Combat Worms 

  1. Newswise
    There is no evidence that “immunity debt” is real, however, the end of COVID-19 mitigation efforts means a higher risk for viral infections. Accessed December 14, 2022. 

  2. Forbes: Lee BY. Are “Immunity Debt” Claims After Covid-19 Precautions Accurate Or Misinformation?. Forbes. Accessed December 14, 2022. 

  3. Global News : “Immunity debt”: Why experts say this new term promotes COVID-19 “misinformation” - National | Global News. Accessed December 14, 2022. 

  4. Infection Control Today: Respiratory Spread and the Flawed Concept of Immunological Debt: A New Understanding. Infection Control Today. Accessed December 14, 2022. 

WHO Continues To Ignore Long COVID Catastrophe 

Nov. 15, 2022 

By Shea O’Neil, verified by the World Health Network Covid Action Group

How to Pull Out the Worms and Focus on the Spaghetti and Meatballs When Reading the News 

Misinformation is often intertwined with facts that are either intentionally or unintentionally placed as a way to propagate a narrative at the expense of responsible scientific messaging. We call this misinformation “Worms in your Spaghetti.” It is the purpose of this column to pull out these “worms”, and create a public focus on the "spaghetti and meatballs" of good information, as is laid out in a new scientific consensus on “A multinational Delphi consensus to end the COVID-19 public health threat.”1 

The Dish:

A recently published scientific consensus statement1 of more than 300 experts calls for multilayered COVID prevention approaches in order to end COVID-19 as a global threat, along with laying out initiatives for government agencies and global organizations to take in order to communicate and implement these approaches strategically.

However, the news that has dominated the headlines recently is the WHO’s report2 of a 90% drop in death rate attributed to COVID-19, and a call for optimism – a headline that has been used by ABC, CBS, WebMD News Brief, among others.

The Worms:

The WHO, and the news releases above, continue to irresponsibly ignore the two main threats posed by Omicron variants:

— their increased transmissibility, and 

— their ability to cause significant long-term health problems in the general population (long COVID)7. 

Instead, they focus on the death rate from known COVID-19 infections during the acute disease phase, which is not an appropriate metric for evaluating the threat of Omicron variants for three reasons: 

(1) Many deaths are not accounted for in the death rate metric because they happen after the acute phase of illness due to COVID-related organ damage.3,4 

(2) The WHO itself has admitted that the death rate is currently undercounted and is an unreliable metric.

(3) And finally, the severe long-term outcomes from COVID-19 infection (the main threats posed by current variants) are not measured by the death rate metric, nor are they being addressed by any actions, initiatives, or even mentioned during the WHO's news release.

These red flags insinuate that propaganda narratives are at play, including downplaying the known long-term risks of COVID-19 infections, and promoting concepts of return to normalcy, both of which are counter-productive to the measures recommended by the scientific consensus, and its emphasis that COVID-19 does pose a serious risk globally.1

The Spaghetti:

 "A multinational Delphi consensus to end the COVID-19 public health threat"1

Published by Nature on 03 November 2022

A diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories made recommendations of specific actions to end the persistent COVID-19 threat to public health, which have been further endorsed by 184 organizations globally. The highest-ranked recommendations call for the adoption of

  1. Whole-of-society and whole-of-government approaches

  2. Maintaining proven prevention measures using a vaccine-plus approach. 

The Meatballs: 

Quotes from the Scientific Consensus:

Whole-of-society and Whole-of-government Approaches

  1. A government’s decision to reduce COVID-19 pandemic control measures does not mean that the threat to public health has ended. 

  2. There continues to be systematic risks of COVID-19 infection for healthcare workers in many healthcare settings. 

  3. The COVID-19 pandemic disproportionately impacts the most vulnerable populations within communities, countries, and globally.

  4. Public health policy should take better account of the potential long-term impact of the unchecked spread of COVID-19. 

  5. Relying on individual, voluntary compliance with transmission prevention is insufficient to end COVID-19 as a public health threat.

  6. Prioritizing the treatment of severe COVID-19 over the prevention of SARS-CoV-2 infection risks increasing infections, long COVID, and overall burden of disease. 

  7. Sources of false information undermine the social cohesion needed for an effective public health response. 

Maintaining Proven Prevention Measures Using a Vaccines-plus Approach

  1. Vaccination alone is insufficient to end the COVID-19 pandemic as a public health threat.

  2. The assumption that endemicity automatically means that variants will have low virulence is not scientifically sound and should not be a basis for public policy decision-making.

  3. Governments should now prioritize early case detection so that the health systems can facilitate earlier treatment and care.

  4. Governments should reduce economic barriers to SARS-CoV-2 tests, personal protective equipment, treatment and care.

  5. In settings in which access to PCR or antigen tests may be limited, providers should consider adopting a syndromic approach to COVID-19 diagnosis for symptomatic individuals. 

  6. Wide use of high filtration and well-fitting facemasks (for example, N95, KF94, KN95, FFP2/3) is important to reduce transmission. 

  7. Prevention of SARS-CoV-2 transmission in the workplace, educational institutions and centers of commerce should remain a high priority, reflected in public health guidance and supported through multiple social measures and structural interventions:

  • Remote work/schooling policies

  • Ventilation

  • Air filtration

  • Facemask wearing

  • Financial incentives (support measures)

The Cannoli:

By focusing on the death rate metric instead of focusing on the high personal and societal consequences of long Covid, the WHO (and aforementioned news sources) are ignoring their responsibilities to present relevant and accurate information to the public. They waste the opportunity to act as a megaphone to inform the public of risks, and to relay a call for action by both the government and the public that would end COVID-19 as a global threat. 1  
Instead, they call for ill-warranted optimism based on an unreliable and inappropriate metric that not only dissuades action, but also ignores the personal hardships of the many individuals and families from around the world suffering from the short-term and long-term effects of COVID-19. 
As we await organizational action, the public needs to be aware that the scientific consensus recommends we follow the multilayered approach outlined above, and continue to regard COVID-19 as a persistent public threat1, as it is we, the public, that will be paying for the consequences most dearly. Remember, inaction is an action of its own. 


  1. Lazarus, J.V., Romero, D., Kopka, C.J. et al. A multinational Delphi consensus to end the COVID-19 public health threat. Nature611, 332–345 (2022). 

  2. WHO Director-General's opening remarks at the media briefing – 9 November 2022

  3. Al-Aly, Z., Bowe, B. & Xie, Y. Long COVID after breakthrough SARS-CoV-2 infection. Nat Med28, 1461–1467 (2022).   

  4. Bowe, B., Xie, Y. & Al-Aly, Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med (2022).  

  5. Van Noordan, Richard. COVID death tolls: scientists acknowledge errors in WHO estimates. Nature. June 2022. 

  6. Lazarus, J.V.,  Kamarulzaman, A., Binagwaho, A. “How the world can end Covid-19 as a public health threat”. STAT NEWS. 3 November 2022.

  7. Long Covid Learning. “What are we learning about Long Covid? Should the risk of chronic illness change what precautions we take?” 11 November 2022.


The Good:

  1. Whether they read the Worms #1 article or not, there has been at least one good change by the WHO, with their January 2023 update on mask guidance that includes wearing a mask regardless of the local epidemiological situation due to the high global transmission of COVID-19. 
  2. In an address in February 2023, their COVID-expert strongly recommends masking as part of the strategy to protect oneself and others. 
  3. In their February 2023 extension of COVID as a Public Health Emergency of International Concern (PHEIC) they both warn against complacency, speak about the unknowns of the new variants of concern, and specifically warn about the serious health risks of long COVID and lack of current treatments. This was a good step, but short-lived.

The Bad: 

  1. Unfortunately, in May 2023 the WHO chose to end the PHEIC, stating: "The Committee considered the three criteria of a PHEIC: whether COVID-19 continues to constitute 1) an extraordinary event, 2) a public health risk to other States through the international spread, and 3) potentially requires a coordinated international response. They discussed the current status of the COVID-19 pandemic. They acknowledged that, although SARS-CoV-2 has been and will continue circulating widely and evolving, it is no longer an unusual or unexpected event." So, although it met their three criteria, they chose to end it based on an illogical and made up fourth criteria that has no basis in helping truly end the pandemic, but instead surrendering to it. 
  2. They also noted that although the number of weekly reported deaths and hospitalizations continue to decrease, there is concern that surveillance reporting to the WHO has declined significantly, that there continues to be inequitable access to life-saving interventions, and that pandemic fatigue continues to grow. 
  3. The PHEIC is a means for dealing with these important issues, and ending the public health emergencies will only support countries that are ending the programs that were helping people, providing less support for those trying to implement changes to improve things like masking, clean air, and testing, and will only increase complacency among the public. It is a mistake whose consequences will only further the short term and long term problems caused by covid-19, including long Covid, safe access to medical treatment, and inequitable distribution of risks onto vulnerable populations. Although their masking guidance remains active, they make no direct mention for or against masks, which is another misstep. They speak of complacency yet do nothing to curb it in this May 2023 address.