"What's Up With COVID and What We Can Do About It: 2026 Edition" © 2026 by Hazel Newlevant is licensed under CC BY-NC-ND 4.0.
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2024 Edition (updated March 2025)
Citations
| Back Cover | ||
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| 1 | "Every chain of transmission that is broken is valuable." | Becca, Organizing and Covid-19 (Part 1) (02/16/23) Death Panel, 16 Feb 2023. |
| PAGE 1 | ||
| 1 | Business interests in ignoring COVID | Cde. Dremmel. "Let Them Eat Plague!" The Red Clarion, 9 Jan. 2023 |
| 2 | MERS, Measles, COVID, SARS-1, the common cold, influenza, RSV, and tuberculosis are all airborne | Wang, Chia C., et al. “Airborne Transmission of Respiratory Viruses.” Science, vol. 373, no. 6558, Aug. 2021, https://doi.org/10.1126/science.abd9149. |
| 3 | Chickenpox is airborne | Jimenez, Jose L., et al. “Systematic Way to Understand and Classify the Shared‐Room Airborne Transmission Risk of Indoor Spaces.” Indoor Air, vol. 32, no. 5, May 2022, https://doi.org/10.1111/ina.13025. |
| 4 | We need enforceable clean air standards, like clean water | Doubleday, Julia. "What would an adequate COVID response look like?" The Gauntlet, 5 Sept. 2024. |
| PAGE 2 | ||
| 5 | Respiratory aerosol emissions increase with louder vocalization and more physical activity | Peng, Z., et al. “Practical Indicators for Risk of Airborne Transmission in Shared Indoor Environments and Their Application to COVID-19 Outbreaks.” Environmental Science & Technology, vol. 56, no. 2, Jan. 2022, pp. 1125–37, https://doi.org/10.1021/acs.est.1c06531. |
| 6 | Respiratory aerosols spread and linger like smoke | University of California San Diego. "It's Not Just COVID-19: Most Respiratory Viruses Actually Spread by Aerosols." SciTechDaily, Sept. 2021, https://doi.org/10.1126/science.abd9149. |
| 7 | A respirator mask is an air filter for your face | Mishra, Tabitha. Air-Purifing Respirator. Safeopedia, 29 May 2024. |
| 8 | Less exposure time, more distance, and more airflow can stop airborne transmission | Peng, Z., et al. “Practical Indicators for Risk of Airborne Transmission in Shared Indoor Environments and Their Application to COVID-19 Outbreaks.” Environmental Science & Technology, vol. 56, no. 2, Jan. 2022, pp. 1125–37, https://doi.org/10.1021/acs.est.1c06531. |
| 9 | Omicron (BA.1) can be conservatively estimated to be 2.5 times more transmissible than the wild type | Jimenez, Jose L., et al. “Systematic Way to Understand and Classify the Shared‐Room Airborne Transmission Risk of Indoor Spaces.” Indoor Air, vol. 32, no. 5, May 2022, https://doi.org/10.1111/ina.13025. |
| PAGE 3 | ||
| 10 | 59% of transmission starts from asymptomatic or presymptomatic people | Johansson, Michael A., et al. “SARS-CoV-2 Transmission from People without COVID-19 Symptoms.” JAMA Network Open, vol. 4, no. 1, Jan. 2021, https://doi.org/10.1001/jamanetworkopen.2020.35057. |
| 11 | 40.5% of positive tests were asymptomatic | Ma, Qiuyue, et al. “Global Percentage of Asymptomatic SARS-CoV-2 Infections among the Tested Population and Individuals with Confirmed COVID-19 Diagnosis.” JAMA Network Open, vol. 4, no. 12, Dec. 2021, p. e2137257, https://doi.org/10.1001/jamanetworkopen.2021.37257. |
| 12 | Virus levels in sewage closely follow actual cases | Hoerger, M. (2025, September 1). “Technical Appendix.” PMC U.S. COVID-19 Report for September 1, 2025. Pandemic Mitigation Collaborative. http://www.pmc19.com/data |
| PAGE 4 | ||
| COVID wastewater reporting | ||
| PAGE 5 | ||
| 13 | SARS-CoV-2 directly infects endothelial cells (the lining of blood vessels) | Karakasis, Paschalis, et al. “Vascular Alterations Following COVID-19 Infection: A Comprehensive Literature Review.” Life, vol. 14, no. 5, MDPI AG, Apr. 2024, p. 545, https://doi.org/10.3390/life14050545. |
| 14 | COVID endothelial dysfunction can damage every organ system | Turner, Simone, et al. “Long COVID: Pathophysiological Factors and Abnormalities of Coagulation.” Trends in Endocrinology & Metabolism, vol. 34, no. 6, Apr. 2023, https://doi.org/10.1016/j.tem.2023.03.002. |
| Synthesis of COVID organ damage studies | Ochilov, Ulugbek, et al. “Silent Invasion: COVID-19′S Hidden Damage to Human Organs.” COVID, vol. 5, no. 9, MDPI AG, Sept. 2025, p. 156, https://doi.org/10.3390/covid5090156. |
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| 15 | COVID disrupts blood-brain barrier, resulting in brain fog linked to cerebrovascular damage. BBB disruption around the primary olfactory cortex is linked to anosmia (loss of smell). | Greene, Chris, et al. “Blood–Brain Barrier Disruption and Sustained Systemic Inflammation in Individuals with Long COVID-Associated Cognitive Impairment.” Nature Neuroscience, no. 27, Feb. 2024, pp. 1–12, https://doi.org/10.1038/s41593-024-01576-9. |
| 16 | COVID anosmia linked to alterations in brain function, potential marker for virus-induced neural tissue damage | Kausel, Leonie, et al. “Patients Recovering from COVID-19 Who Presented with Anosmia during Their Acute Episode Have Behavioral, Functional, and Structural Brain Alterations.” Scientific Reports, vol. 14, no. 1, Nature Portfolio, Aug. 2024, https://doi.org/10.1038/s41598-024-69772-y. |
| 17 | Global prevalence of ever experiencing Long COVID is 36% | Hou, Yiren, et al. “Global Prevalence of Long COVID, Its Subtypes, and Risk Factors: An Updated Systematic Review and Meta-Analysis.” Open Forum Infectious Diseases, vol. 12, no. 9, Oxford University Press, Aug. 2025, https://doi.org/10.1093/ofid/ofaf533. |
| 18 | Long COVID risk increases with each infection | Bowe, Benjamin, et al. “Acute and Postacute Sequelae Associated with SARS-CoV-2 Reinfection.” Nature Medicine, vol. 28, no. 28, Nov. 2022, pp. 1–8, https://doi.org/10.1038/s41591-022-02051-3. |
| 19 | Viral persistence is a causative factor for many LC patients | Prakash, Swayam, et al. “Insights into Persistent SARS-CoV-2 Reservoirs in Chronic Long COVID.” Viruses, vol. 17, no. 10, MDPI AG, Sept. 2025, p. 1310, https://doi.org/10.3390/v17101310. Accessed 4 Nov. 2025. |
| 20 | Microclots are a mechanism of LC | Turner, Simone, et al. “Long COVID: Pathophysiological Factors and Abnormalities of Coagulation.” Trends in Endocrinology & Metabolism, vol. 34, no. 6, Apr. 2023, https://doi.org/10.1016/j.tem.2023.03.002. |
| 21 | COVID-induced organ damage, including heart problems and gray matter loss, can cause LC symptoms | Ewing, Andrew G., et al. “Review of Organ Damage from COVID and Long COVID: A Disease with a Spectrum of Pathology.” Medical Review, vol. 0, no. 0, De Gruyter, July 2024, https://doi.org/10.1515/mr-2024-0030. |
| 22 | COVID can reactivate EBV and herpesviruses | Davis, Hannah E., et al. “Long COVID: Major Findings, Mechanisms and Recommendations.” Nature Reviews Microbiology, vol. 21, no. 3, Jan. 2023, pp. 1–14, https://doi.org/10.1038/s41579-022-00846-2. |
| 23 | Post-exertional malaise one of the most common LC symptoms | Davis, Hannah E., et al. “Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact.” EClinicalMedicine, vol. 38, July 2021, p. 101019, https://doi.org/10.1016/j.eclinm.2021.101019. |
| 24 | At least 11% of subjects get PEM 24 hours or more after the triggering event; PEM is the hallmark of myalgic encephalomyelitis | Chu, Lily, et al. “Deconstructing Post-Exertional Malaise in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: A Patient-Centered, Cross-Sectional Survey.” PLOS ONE, edited by Urs M. Nater, vol. 13, no. 6, June 2018, p. e0197811, https://doi.org/10.1371/journal.pone.0197811. |
| Why LC causes PEM: mitochondrial dysfunction | Stone, Will. "A discovery in the muscles of long COVID patients" may explain exercise troubles. NPR Morning Edition, 9 Jan. 2024. |
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| PAGE 6 | ||
| 25 | COVID deaths in the U.S. have not dropped below 150/week since March 2020 (as of 1/8/2026) | Ahmad FB, Cisewski JA. Provisional COVID-19 Mortality Surveillance. National Center for Health Statistics. 2026. DOI: https://dx.doi.org/10.15620/cdc/20250305007 |
| 26 | COVID increases risk of heart attacks | Yeo, Yee Hui, et al. “Excess Risk for Acute Myocardial Infarction Mortality during the COVID‐19 Pandemic.” Journal of Medical Virology, vol. 95, no. 1, Oct. 2022, https://doi.org/10.1002/jmv.28187. |
| 27 | COVID increases risk of strokes | Knight, Rochelle, et al. “Association of COVID-19 with Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales.” Circulation, vol. 146, no. 12, Sept. 2022, pp. 892–906, https://doi.org/10.1161/circulationaha.122.060785. |
| 28 | COVID increases risk of cancer | Li, Jia, et al. “Causal Effects of COVID‐19 on Cancer Risk: A Mendelian Randomization Study.” Journal of Medical Virology, vol. 95, no. 4, Wiley-Blackwell, Apr. 2023, https://doi.org/10.1002/jmv.28722. |
| 29 | Excess deaths show the true toll of COVID | The pandemic's true death toll: Our daily estimate of excess deaths around the world. The Economist. Updated June 22, 2024. |
| 30 | COVID exhausts CD4+ T cells, as does HIV | Salamon, Spela, et al. “COVID-19 Is ‘Airborne AIDS’: Provocative Oversimplification, Emerging Science, or Something in Between?” AJPM Focus, Elsevier, Oct. 2025, p. 100458, https://doi.org/10.1016/j.focus.2025.100458. |
| 31 | COVID makes other infections more likely, for at least a year following | Cai, Miao, et al. “Rates of Infection with Other Pathogens after a Positive COVID-19 Test versus a Negative Test in US Veterans (November, 2021, to December, 2023): A Retrospective Cohort Study.” The Lancet Infectious Diseases, vol. 25, no. 8, Elsevier BV, Apr. 2025, https://doi.org/10.1016/s1473-3099(24)00831-4. |
| T cells disregulated for at least 20 months | Jiang, Zhengqi, et al. “Persistent Attenuation of Lymphocyte Subsets after Mass SARS-CoV-2 Infection.” International Journal of Infectious Diseases, vol. 163, Elsevier BV, Dec. 2025, p. 108287, https://doi.org/10.1016/j.ijid.2025.108287 |
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| 32 | Kids are twice as likely to get LC after the second infection | Zhang, Bingyu, et al. “Long COVID Associated with SARS-CoV-2 Reinfection among Children and Adolescents in the Omicron Era (RECOVER-EHR): A Retrospective Cohort Study.” The Lancet Infectious Diseases, Elsevier, Sept. 2025, https://doi.org/10.1016/S1473-3099(25)00476-1. |
| 33 | LC is now the most common chronic illness in U.S. children | Laws, Jasmine. “Why Are So Many Children Getting Long COVID?” Newsweek, 10 Jun. 2025. |
| PAGE 7 | ||
| 34 | COVID vaccines have reduced death and hospitalization | Rahmani, Kazem, et al. “The Effectiveness of COVID-19 Vaccines in Reducing the Incidence, Hospitalization, and Mortality from COVID-19: A Systematic Review and Meta-Analysis.” Frontiers in Public Health, vol. 10, Aug. 2022, https://doi.org/10.3389/fpubh.2022.873596. |
| 35 | Vaccination with the 2023-2024 updated COVID vaccine was associated with 54% lower risk of symptomatic COVID infection in the following 4 months. | Link-Gelles, Ruth, et al. “Early Estimates of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccine Effectiveness against Symptomatic SARS-CoV-2 Infection Attributable to Co-Circulating Omicron Variants among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, September 2023–January 2024.” Morbidity and Mortality Weekly Report (MMWR), vol. 73, no. 4, Feb. 2024, https://doi.org/10.15585/mmwr.mm7304a2. |
| 36 | Vaccination reduces LC risk | Watanabe, Atsuyuki, et al. “Protective Effect of COVID-19 Vaccination against Long COVID Syndrome: A Systematic Review and Meta-Analysis.” Vaccine, vol. 41, no. 11, Mar. 2023, pp. 1783–90, https://doi.org/10.1016/j.vaccine.2023.02.008. |
| 37 | Antibody levels quickly decline | Morales-Núñez, José Javier, et al. “Overview of Neutralizing Antibodies and Their Potential in COVID-19.” Vaccines, vol. 9, no. 12, Nov. 2021, p. 1376, https://doi.org/10.3390/vaccines9121376. |
| 38 | Mutations in spike protein cause immune escape | Tian, Dandan, et al. “The Global Epidemic of SARS‐CoV‐2 Variants and Their Mutational Immune Escape.” Journal of Medical Virology, vol. 94, no. 3, Oct. 2021, https://doi.org/10.1002/jmv.27376. |
| 39 | COVID vaccines get updated to better match currently-circulating variants | “Staying Up to Date with COVID-19 Vaccines.” U.S. Centers for Disease Control and Prevention, 19 Nov. 2025. |
| PAGE 8 | ||
| 40 | Rapid antigen tests can't detect lower viral loads; wait at least 5 days post-exposure if asymptomatic; retest in 48 hours; PCR and at-home molecular tests are more sensitive. | Dunn, Angela. “How Accurate Are Rapid COVID-19 Tests?” GoodRX, 16 Dec 2024. |
| 41 | Throat swabs improve accuracy | Todsen, Tobias, et al. “COVID-19 Rapid Antigen Tests with Self-Collected vs Health Care Worker–Collected Nasal and Throat Swab Specimens.” JAMA Network Open, vol. 6, no. 12, American Medical Association, Dec. 2023, pp. e2344295–95, https://doi.org/10.1001/jamanetworkopen.2023.44295. |
| 42 | Instructions | Ontario Health. “COVID-19 Rapid Antigen Tests: How to Collect a Sample.” 9 Feb. 2022. |
| 43 | How to swab tonsils | Public Health England. “How to Take a Combined Throat and Nose Swab for COVID-19.” YouTube, 13 May 2020. |
| Free rapid antigen tests | ||
| PAGE 9 | ||
| 44 | Respirator masks are designed to seal to the face and have an electrostatic charge; excellent at protecting you and others | Greenhalgh, Trisha, et al. “Masks and Respirators for Prevention of Respiratory Infections: A State of the Science Review.” Clinical Microbiology Reviews, vol. 37, no. 2, American Society for Microbiology, May 2024, https://doi.org/10.1128/cmr.00124-23. |
| How N95s are better | MinutePhysics, and Aatish Bhatia. The Astounding Physics of N95 Masks. YouTube, 18 Jun. 2020. |
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| 45 | Head straps are better than ear loops | Yung, Chee Fu. “Poor Performance of Masks Secured Using Ear Loops.” JAMA Internal Medicine, vol. 181, no. 2, Nov. 2020, https://doi.org/10.1001/jamainternmed.2020.6393. |
| 46 | Elastomerics seal better | Chiang, James, et al. “Elastomeric Respirators Are Safer and More Sustainable Alternatives to Disposable N95 Masks during the Coronavirus Outbreak.” International Journal of Emergency Medicine, vol. 13, no. 1, July 2020, https://doi.org/10.1186/s12245-020-00296-8. |
| PAGE 10 | ||
| 47 | Aura is good | ResTestThePlanet. “Best Picks.” TestThePlanet.org, 12 Mar. 2024. |
| 48 | seal check | Occupational Safety and Health Administration. "How to Perform a User Seal Check with an N95 Respirator." YouTube, 28 Jan. 2010. |
| 49 | DIY fit test | Provenzano, Destie, et al. “Alternative Qualitative Fit Testing Method for N95 Equivalent Respirators in the Setting of Resource Scarcity at the George Washington University.” Apr. 2020, https://doi.org/10.1101/2020.04.06.20055368' |
| DIY fit test instructions | pneustrum. "How to do a DIY mask fit test". YouTube, 27 Jul. 2021. |
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| PAGE 11 | ||
| 50 | Shaping the nose wire took fit factor from 9.2 to 122 | Parenting Mishmash. "Here's my results for the Kid95, bifold headstrap mask with a chin staple, 9.2 N99 mode Fit Factor with a pointy nose wire and 122 N99 mode Fit Factor with a properly shaped nose wire." X.com, 5 Jan. 2025. |
| 51 | What is fit factor? | Mishra, Tabitha. "Fit Factor." Safeopedia, 11 Jan. 2022. |
| 52 | Staples to improve fit factor | Parenting Mishmash. "Surgical masks, cup masks, duckbills & trifolds can be adjusted with a chin pleat if they are too big or the shape is wrong and leaves a gap underneath your chin, you can improve the protection of whatever masks are available to you by fixing the fit, audio blank." X.com, 11 Jul. 2024. |
| PAGE 12 | ||
| 53 | Rubber band mask brace | Dardas, Agnes Z., et al. “A Simple Surgical Mask Modification to Pass N95 Respirator-Equivalent Fit Testing Standards during the COVID-19 Pandemic.” PLOS ONE, edited by Markus Ries, vol. 17, no. 8, Aug. 2022, p. e0272834, https://doi.org/10.1371/journal.pone.0272834. |
| Free mask brace template | https://www.fixthemask.com/products/v2-diy-rubber-sheet-brace |
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| Fix the Mask Brace | https://www.fixthemask.com/products/essential-mask-brace-mixed-pack-s-m-l |
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| PAGE 13 | ||
| 54 | Outdoor transmission not observed beyond close proximity | Jimenez, Jose L., et al. “Systematic Way to Understand and Classify the Shared‐Room Airborne Transmission Risk of Indoor Spaces.” Indoor Air, vol. 32, no. 5, May 2022, https://doi.org/10.1111/ina.13025. |
| 55 | Ceiling fans help mitigate short range transmission by mixing the air faster | Fox, Joey. "Ceiling Fans are an Important Tool." It's Airborne, 16 Apr. 2024. |
| 56 | Cross ventilation is more effective than opening a single window | "Ventilation matters - why clean air is vital to health." National Engineering Policy Centre, n.d. |
| 57 | CO2 monitors can show how well-ventilated a space is | Tran, Lucky. "This Tech Can Help Detect Virus Risk." YouTube, 6 Jul. 2024. |
| 58 | Global average CO2 was 422.8 ppm in 2024 | Lindsay, Rebecca. "Climate change: atmospheric carbon dioxide." NOAA Climate.gov, 21 May 2025. |
| 59 | 600 ppm generally indicates excellent ventilation | Fox, Joey. "Intro to CO2 Monitoring." It's Airborne, 12 Mar 2023. |
| CO2 monitor lending program | ||
| Estimate ventilation rate with a CO2 monitor | Jimenez, Jose L. "How to quantify the ventilation rate of an indoor space using an affordable CO2 monitor." Something in the Air, 18 Nov 2022. |
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| PAGE 14 | ||
| 60 | How fast SARS-CoV-2 decays at different CO2 levels | Haddrell, Allen, et al. “Ambient Carbon Dioxide Concentration Correlates with SARS-CoV-2 Aerostability and Infection Risk.” Nature Communications, vol. 15, no. 1, Apr. 2024, p. 3487, https://doi.org/10.1038/s41467-024-47777-5. |
| 61 | Cognitive performance gets worse as CO2 increases | Cedeño Laurent, Jose Guillermo, et al. “Associations between Acute Exposures to PM2.5 and Carbon Dioxide Indoors and Cognitive Function in Office Workers: A Multicountry Longitudinal Prospective Observational Study.” Environmental Research Letters, vol. 16, no. 9, Sept. 2021, p. 094047, https://doi.org/10.1088/1748-9326/ac1bd8. |
| 62 | 1150 ppm is typical in high school classrooms | Fox, Joey. "Intro to CO2 Monitoring." It's Airborne, 12 Mar 2023. |
| 63 | Filtration removes aerosols but not CO2; airplanes filter in-flight but have high CO2 levels; more aerosols exhaled when vocalizing | Haddrell, Allen. “SARS-CoV-2, CO2, and You.” YouTube, 7 Nov 2024. |
| 64 | Low CO2 may not be low risk in small/low occupancy spaces | Fox, Joey. "Stopping Airborne Transmission—Designing Isolation Rooms & Low Occupancy Spaces." It's Airborne, 3 Aug. 2023. |
| PAGE 15 | ||
| 65 | ASHRAE 241 is designed to reduce airborn disease transmission, sets CADR (equivalent clean airflow rate) minimums per person. | Washington, Karen B. "ASHRAE Publishes Standard 241, Control of Infectious Aerosols." ASHRAE, 7 Jul. 2023. |
| 66 | How ASHRAE 241 was designed based on infection risk modeling | Jones, Benjamin. “I Need How Much Air to Control Infection?” ASHRAE Journal, Dec. 2023, pp. 22-24. |
| 67 | MERV-11 is the minimum to capture infectious aerosols, MERV-13 is preferable | Fox, Joey. "Is it Possible? Is it Expensive? Is it Worth it? Cost & Feasibility of ASHRAE 241—Part 9." It's Airborne, 23 Feb. 2024. |
| 68 | 350 CFM per room minimum | Fox, Joey. "Stopping Airborne Transmission—Designing Isolation Rooms & Low Occupancy Spaces." It's Airborne, 3 Aug. 2023. |
| 69 | 5.1.3 Where the occupancy category for a proposed space or zone involves group vocalization above a conversational level, the equivalent clean airflow rate required per person in IRMM shall be multiplied by a factor of 2. | ASHRAE Standard 241-2023, Control of Infectious Aerosols, p6. |
| 70 | CFM/person requirements | Fox, Joey. "Calculating the Equivalent Clean Airflow Rate for a Room ASHRAE 241—Part 8." It's Airborne, 1 Feb. 2024. |
| PAGE 16 | ||
| Infection rates in different wings of a long-term care facility, compared to their rates of ASHRAE 241 compliance | Wagg, Leo, and Lexuan Zhong. “Optimizing Ventilation Strategies for Mitigating SARS-CoV-2 Transmission in Long-Term Care Facilities: A Collaborative Study with Practical Implications.” IBPSA Publications, vol. 13, IBPSA-Canada, June 2024. |
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| 71 | 2-PC-fan DIY air purifier can deliver 88 cfm | “Do It Yourself Air Purifier: ASSEMBLY INSTRUCTIONS.” Let's Air, version 2.1, 23 Aug. 2024. |
| 72 | 5-filter CR box can deliver 600-850 cfm | Dal Porto, Rachael, et al. “Characterizing the Performance of a Do-It-Yourself (DIY) Box Fan Air Filter.” Aerosol Science and Technology, vol. 56, no. 6, Apr. 2022, pp. 564–72, https://doi.org/10.1080/02786826.2022.2054674. |
| Air Cleaner Recommendation Tool | ||
| Independently tested air purifier reviews | ||
| PAGE 17 | ||
| 73 | Infectious for at least 10 days | Adam, David. “How Long Is COVID Infectious? What Scientists Know so Far.” Nature, vol. 608, no. 7921, July 2022, pp. 16–17, https://doi.org/10.1038/d41586-022-02026-x. |
| 74 | Exit isolation after two negative tests, at least 24 hours apart | “What To Do if You Have COVID,” People's CDC, 10 Jan. 2024 |
| 75 | Dehydration associated with LC | Hultström, Michael, et al. “Dehydration Is Associated with Production of Organic Osmolytes and Predicts Physical Long-Term Symptoms after COVID-19: A Multicenter Cohort Study.” Critical Care, vol. 26, no. 1, Oct. 2022, https://doi.org/10.1186/s13054-022-04203-w. |
| 76 | You need rest | Ducharme, Jamie. “Why You Should Rest—a Lot—If You Have COVID-19.” Time, 23 Sept. 2022 |
| 77 | Pacing is important for coping with PEM | Seltzer, Jaime. “PACING & MANAGEMENT GUIDES.” #MEAction, n.d. |
| PAGE 18 | ||
| 78 | Saline irrigation helps relieve symptoms and clear virus faster | Huijghebaert, Suzy, et al. “Saline Nasal Irrigation and Gargling in COVID-19: A Multidisciplinary Review of Effects on Viral Load, Mucosal Dynamics, and Patient Outcomes.” Frontiers in Public Health, vol. 11, Frontiers Media, June 2023, https://doi.org/10.3389/fpubh.2023.1161881. |
| 79 | Fewer household contacts got infected when patients did 4x daily seawater nasal washes | Ludovic de Gabory, et al. “Seawater Nasal Wash to Reduce Symptom Duration and Viral Load in COVID-19 and Upper Respiratory Tract Infections: A Randomized Controlled Multicenter Trial.” European Archives of Oto-Rhino-Laryngology, vol. 281, no. 7, Springer Science+Business Media, Feb. 2024, pp. 3625–37, https://doi.org/10.1007/s00405-024-08518-y |
| 80 | Healthcare workers using saline irrigation in addition to personal protective equipment had fewer infections | Huijghebaert, Suzy, et al. “Saline Nasal Irrigation and Gargling in COVID-19: A Multidisciplinary Review of Effects on Viral Load, Mucosal Dynamics, and Patient Outcomes.” Frontiers in Public Health, vol. 11, Frontiers Media, June 2023, https://doi.org/10.3389/fpubh.2023.1161881. |
| 81 | Antihistamines can help prevent cytokine storms | Morán Blanco, Juan Ignacio, et al. “Antihistamines as an Early Treatment for Covid-19.” Heliyon, vol. 9, no. 5, May 2023, p. e15772, https://doi.org/10.1016/j.heliyon.2023.e15772. |
| Famotidine (Pepcid) inhibits cytokine release via vagus nerve signaling | Yang, Huan, et al. “Famotidine Activates the Vagus Nerve Inflammatory Reflex to Attenuate Cytokine Storm.” Molecular Medicine, vol. 28, no. 1, 16 May 2022, https://doi.org/10.1186/s10020-022-00483-8. Accessed 29 June 2022. |
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| 80mg famotidine, 3x daily, led to faster symptom resolution in a small RTC (n=56) | Brennan, Christina M., et al. “Oral Famotidine versus Placebo in Non-Hospitalised Patients with COVID-19: A Randomised, Double-Blind, Data-Intense, Phase 2 Clinical Trial.” Gut, vol. 71, no. 5, 9 Feb. 2022, https://doi.org/10.1136/gutjnl-2022-326952. |
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| H1-blocker antihistamines competitively bind to SARS-CoV-2 spike proteins, preventing viral entry | Yu, Fei, et al. “The Histamine Receptor H1 Acts as an Alternative Receptor for SARS-CoV-2.” MBio, vol. 15, no. 8, 2 July 2024, https://doi.org/10.1128/mbio.01088-24. |
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| 82 | People on chronic antihistamine treatments appear to have lower rates of Long COVID | Puigdellívol-Sánchez, Anna, et al. “Long COVID and Reduced Thrombosis in Antihistamine Treated Patients: An Observational Study in the Metropolitan Area of Barcelona.” Preprints, MDPI AG, Dec. 2025, https://doi.org/10.20944/preprints202512.1797.v1. |
| UPDATE 1/26/2026 | ⬆️ Problematic study design, as explained by Michael Hoerger. Patients without chronic prescriptions were excluded from the study, so the comparison is between people with antihistamine-treated chronic conditions and people with more serious chronic conditions. |
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| Famotidine treatment post-COVID reduced cognitive impairment | Momtazmanesh, Sara, et al. “Effect of Famotidine on Cognitive and Behavioral Dysfunctions Induced in Post-COVID-19 Infection: A Randomized, Double-Blind, and Placebo-Controlled Study.” Journal of Psychosomatic Research, vol. 172, 1 Sept. 2023, p. 111389, https://doi.org/10.1016/j.jpsychores.2023.111389. |
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| 83 | Paxlovid lowers LC the risk the older you are | Dalton, Alexandra F., et al. “Risk of Post-COVID-19 Conditions among Adolescents and Adults Who Received Nirmatrelvir-Ritonavir for Acute COVID-19: A Retrospective Cohort Study.” Open Forum Infectious Diseases, vol. 12, no. 10, Sept. 2025, https://doi.org/10.1093/ofid/ofaf567. |
| 84 | 75% of US adults at increased risk of severe illness from COVID | Ajufo, Ezimamaka, et al. “U.S. Population at Increased Risk of Severe Illness from COVID-19.” American Journal of Preventive Cardiology, vol. 6, June 2021, p. 100156, https://doi.org/10.1016/j.ajpc.2021.100156. |
| 85 | Metformin reduced LC incidence by 41% | Bramante, Carolyn T., et al. “Outpatient Treatment of COVID-19 and Incidence of Post-COVID-19 Condition over 10 Months (COVID-OUT): A Multicentre, Randomised, Quadruple-Blind, Parallel-Group, Phase 3 Trial.” The Lancet Infectious Diseases, vol. 23, no. 10, June 2023, https://doi.org/10.1016/s1473-3099(23)00299-2. |
| Metformin reduced LC incidence by 63% for higher-weight adults | Chaichana, Ubonphan, et al. “Effect of Metformin on the Risk of Post-Coronavirus Disease 2019 Condition among Individuals with Overweight or Obese: A Population-Based Retrospective Cohort Study.” Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, Jan. 2025, p. ciaf429, https://doi.org/10.1093/cid/ciaf429. |
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Further resources
Clean Air in Schools
More than 70% of COVID spread to households in the U.S. starts with a child, and they're getting it from school. But if the classroom uses mechanical ventilation, students are at least 74% less likely to get infected!
Resources for improving air quality in schools - A collection maintained by me.
COVID monitoring
Pandemic Mitigation Collaborative - Weekly-updating estimates of how many people currently have COVID in the U.S., based on wastewater data.
WastewaterSCAN - Reports from individual wastewater testing sites, which can give a local sense of where COVID is spiking.
People's CDC - COVID-19 weather reports.
Masks
r/Masks4All Wiki - A list of respirator recommendations and suppliers around the world.
ResTestThePlanet - Quantitative fit test results for various disposable respirators, and recommendations of the best-performing types.
Lola Germs - Fun and highly informative videos about masks and other COVID-related topics!
Lola's Elasto Guide - Info on elastomeric respirators, and reviews of various types.
MaskBloc.org - Lists active Mask Blocs around the world. Blocs provide masks, COVID-19 tests and other equipment to their communities for free.
Clean Air
CleanAirCrew - Information on clean air, masks, and instructions for building DIY air purifiers.
Clean Air Club - Lends out air purifiers for shows in the Chicago area. They have a map of other Clean Air Lending Library organizations!
COVID Action Map - A combined map of mask blocs, clean air orgs, advocacy orgs, community spaces, and more.
Nukit Open Air Purifier - Pattern to laser-cut your own air purifier frame—just add HVAC filters and PC fans! Or you can buy a similar metal frame from Nukit.
It's Airborne - Info on improving air quality, and purifier reviews.
Clean Air Stars - air purifier finder tool. Search based on room occupancy, required clean airflow per person, and acceptable noise level.
Testing
Walgreens and CVS will order you at-home COVID tests and bill your insurance, so they're potentially free.
"What to Do if You Have COVID" (not medical advice)
People's CDC - COVID-19 weather reports and guides including "Safer In-person Gatherings" and "What to Do if You Have COVID."
Clean Air Club's "My Covid+ Plan" - Example list of supplies, symptom tracking, dose schedules, and bloodwork to get done post-infection.
"I have COVID! What should my kids and I take to reduce chances of severe illness and Long COVID?" (Updated 9/14/24) - A list of potential treatments to speed COVID recovery and reduce the risk of Long COVID, from a Doctor of Pharmacy studying Long COVID.
"You’ve Got COVID! Minimize Your Symptoms and Reduce Your Long COVID Risk" - Blog post from RTHM, a telehealth concierge service for Long COVID patients. September 14, 2024.
Paxlovid
COVID-19 Drug Interactions Checker - Check for possible drug interactions with Paxlovid ("Nirmatrelvir/ritonavir (5 days)").
NYC Health + Hospitals Virtual ExpressCare - For those in New York State: telehealth visit to get assessed for Paxlovid, billed to insurance. If you do not have insurance or cannot afford to pay, Virtual ExpressCare will connect you to trained financial counselors who can help you enroll in health insurance or financial assistance through NYC Care, Medicaid, and Medicare, with visit fees as low as $0, depending on your income and family size. The standard self-pay charge for Virtual ExpressCare telehealth visits is $125.
Get a Paxlovid Prescription Online: Dr. B’s $15 Online Healthcare
PAXCESS - A program run by Paxlovid manufacturer Pfizer that gives discounts on Paxlovid. Enroll in the PAXCESS program before picking up your prescription! PAXCESS will not reimburse you for anything you've already paid.
Metformin
Metformin has been shown to reduce the risk of Long COVID. Why isn’t it more widely used? - by Rachel Fairbank, The Sick Times, October 28, 2025. "Metformin tends to have minimal side effects, with the most commonly reported being gastrointestinal (GI) issues, such as nausea or diarrhea. For patients who are experiencing GI upset, it can help to start with a lower dose and taper up gradually."
An Expert Report on Metformin for the Prevention and Treatment of Long COVID - Analyzing evidence from the COVID-OUT trial, the ACTIV-6 trial, and the NIH RECOVER Initiative. "There is high-quality evidence from one large RCT, supported by observational data, suggesting metformin is effective at preventing Long COVID when given during acute infection, particularly in higher-risk individuals (e.g., those with overweight or obesity)."
AgelessRX - Telehealth visit with a clinician to consult for a Metformin prescription, for $55.
Long COVID
PandemicPatients.org - Information about Long COVID and Post-COVID conditions, and advocacy for public policies that reduce spread, empower survivors, enhance the safety of shared spaces, and invest in public health.
Long COVID and Fatiguing Illness Recovery Program ECHO - Webinar series about treating various Post-COVID Conditions, aimed at providers but very useful for patients who want to learn more and self-advocate.
Patient Resources and Support Webinar - From the LC&FIRP ECHO series, a video lecture by lived experience expert Alison Sbrana, focused on how to get Long COVID accommodations. Alison walks viewers through her list of resource links.
#MEAction - Learn more about myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a common presentation of Long COVID, and how to manage it through pacing.
ME and more - "Long Covid Isn't Always MECFS : How to tell when it is." - Blog post by Samantha Lincroft about identifying the defining characteristic of ME/CFS: post-exertional malaise. MECFS one of the many conditions that can be triggered by Long COVID.
Long COVID Physio - Pacing guide. Pacing is a strategy and rehabilitation approach that balances rest and activities in daily life, to manage symptoms such as fatigue and post-exertional malaise.
CURE ID - Case reports of different repurposed drugs that have been used to treat Long COVID.
The Sick Times - News about COVID-19 and Long COVID.
Communicating about COVID
The John Snow Project - Simple and effective factsheet and informational videos about airborne transmission.
How to Talk to Your Loved Ones About Covid - Guide to explaining the dangers of COVID to your loved ones and moving them toward taking more precautions.
What Therapists Need to Know About COVID-19 in 2024 - Slide deck by Olivia Belknap and Erin Batali.
COVID-Safer
Covid Safe Providers - A map of user-provided listings of COVID-safer medical providers and services in the U.S. and Canada.