Author: books

I don’t consider myself a biohacker, but I do intentionally engage in practices that I believe will extend my healthspan and lifespan. Cold plunges are one of them. Cold exposure goes into the bucket along with things like resistance training, intermittent fasting, sun on your skin, and sauna—all stimuli that stress the body and prompt it to become stronger and more resistant to chronic and acute health issues. 

I’m tempted to say that cold plunges are an easy way to challenge your system, but if you’ve ever stepped up to the edge of an icy stream or cold pool, you know there’s nothing easy about forcing yourself to get in, sink down to your neck, and make the intentional choice to stay there. Veteran cold plungers and winter swimmers will tell you that over time your body acclimates so it becomes easier to tolerate the cold. You’ll even come to eagerly anticipate your next plunge. That’s all true. But there will always be a part of your brain that tells you, “You don’t have to do this. C’mon, stay warm and dry.”

Each plunge requires you to overcome that little voice. It’s not easy, but it’s simple in the sense that just about everyone can find a way to harness the power of cold. And everyone should because the benefits of cold exposure are pretty impressive: 

• Reduces inflammation by lowering pro-inflammatory cytokines and increasing anti-inflammatory cytokines
• Triggers the release of immune cells that can ward off illness 
• Converts white fat into more metabolically active brown or beige fat
• Ramps up metabolic rate and boosts weight loss
• Promotes mitochondrial biogenesis
• Improves insulin sensitivity

More than these physical benefits, the fact that it’s not easy is arguably the biggest upside of all. The mental fortitude you build when you intentionally and repeatedly put yourself in uncomfortable situations is undeniable. One of the most profound disconnects between our modern world and the one our ancestors inhabited is just how comfortable we are most of the time. We now have to go out of our way to simulate the physical and mental challenges that for most of history were just a part of everyday life. 

I’ve been regularly immersing myself in cold water for years now, and I’m convinced that that’s one of the reasons why I still feel as good as ever mentally and physically. Here’s how to get started.

How I Cold Plunge

Early in the day, I like colder temperature for shorter duration. Generally that means water in the mid to low 40s for a minute or two. (That’s Fahrenheit; 4 to 7 degrees Celsius.) Get out, lightly towel off, dress. Don’t do anything special to warm up. Go about your day energized and refreshed.

Later in the day, I like a little less cold (48 to 51 degrees F, 8 to 10 degrees C) but for a longer duration, anywhere from 3 to 5 minutes. If it’s after 6 p.m. and my intention is to prepare myself for a better night’s sleep, I want to be a little chilly (shiver slightly) after I get out, but only for 20 or 30 minutes. If you overdo it, shivering into the night can be a bit uncomfortable (and I have done that). So if I feel I’ve gone too long, I might take a warm shower to bring my body temperature up a bit. Sometimes I hit the sauna for 12 minutes before I plunge. That can buy me a few more minutes in the cold.

My favorite is in summer to plunge for a few minutes and then air dry in the warm sunshine. Depending on where I’m at in the world, I might do my plunges in an unheated swimming pool, lake, or ocean. More recently, I received a cold plunge tub (looks like a bathtub) for my home by Plunge, and I’ve been having fun playing around with the ability to manipulate the temperature. 

Now, this is just what I prefer. I crafted this protocol, if you can call it that, by looking at the research, talking to friends who are experts in performance and recovery, and mostly doing what feels good to me. I’m not overly concerned with getting it “right” every time. And I don’t really plunge for exercise recovery. I do it for the mental challenge and the great feeling after I get out. The “buzzy” feeling and energy I enjoy afterward tell me I’m accessing the benefits. 

Cold Plunge Best Practices

When I talk to people about cold exposure, first they tell me how much they hate the cold and could never do it. Then they all have the same questions: How cold does the water have to be? How long do I have to stay in? How often? Can I just take cold showers instead? 

First, the water should be cold enough to make you want to get out. That’s not specific, and that’s kind of the point. Hormetic stressors only work when they fall in that Cinderella zone between too much (so stressful that they do more harm than good) and not enough to force the body to adapt. Everyone’s “just right” place will depend on their personal cold tolerance, baseline health, and how many other stressors they’re juggling. 

Likewise, optimal time and frequency are also somewhat subjective. Generally, I like to stay in for a few minutes each time. More if the water is a bit warmer, less if it’s really frigid. Stanford neuroscientist and popular podcaster Andrew Huberman suggests that 11 minutes total per week, broken up into two to four sessions, might be best for boosting metabolism. Ten to fifteen minutes per week seems like a reasonable goal to me. 

Cold exposure—swimming in arctic waters, sitting in the snow wearing little to nothing for as long as possible—has become the extreme sport du jour. But that’s not what we’re talking about here. There is no medal for long-distance endurance in the cold plunge. Do what feels right. I have stayed in too long a few times (to set records for myself) and then regretted it because I overstressed my body. The idea is a brief hormetic stress and immune boost. Doing too much can have the opposite effect.

Cold plunges versus cold showers

Years ago, cold showers were all the rage. Now cold plunges rein supreme. Both have their merits, but I’m partial to plunges over showers. Fully immersing yourself in cold water is the most efficient way to stimulate the vasoconstriction and hormone release we want. In a cold shower, the water only hits some of your skin, so you don’t get as cold as fast. It’s too easy to “cheat” by keeping more of your body out of the water (even unintentionally). 

That said, cold showers are certainly better than nothing, and it doesn’t have to be either-or. You can do both. Studies have also found cranking your thermostat down to 62 degrees Fahrenheit (19 degrees Celsius) for a couple of hours a day stimulates brown fat. That’s not even that cold. You can also take advantage of nature’s thermostat and go outside in cold weather slightly, not dangerously, underdressed. 

Nothing entirely takes the place cold water immersion, though, especially when it comes to the mental benefits of doing hard things. Yes, you have to steel yourself to crank the faucet all the way to cold if you’re enjoying a nice warm shower. But it’s not the same as fully submerging yourself. 

Crafting Your Cold Plunge Routine

Here is how I would start incorporating cold plunges if I was a beginner:

1. Start slow. Gradually work your way up to colder and/or longer plunges (to a point—you can only go so cold and so long before it becomes dangerous).
2. Aim for 10 to 15 minutes per week as a baseline.
3. For the biggest benefits, submerge up to your neck and keep hands and feet under (or alternate dunking them in and out).
4. When you get out, dry off and allow your body to warm up naturally if possible. Dress in climate-appropriate clothing, but don’t blast the heater or start chugging tea unless you’re shivering uncontrollably. Some shivering is to be expected.
5. Supplement cold plunges with less intense cold exposure via turning down the thermostat, taking cooler showers, and going outside slightly underdressed. Be aware of your total stress load. Don’t overdo it.
6. Adjust your plunges based on your subjective experience each time. 

I’ll say it again: this is not a competition. What is tough for you might be easy for someone else, and vice versa. What’s tolerable for you today might feel almost unbearably difficult for you next week if other life stressors pile up. 

The goal with each plunge is to challenge yourself in a way that feels hard but adaptive. If you’ve ever purposefully put yourself in a hard situation—cold exposure, training for a marathon, climbing a mountain, or anything else where you butt up against your ability to endure—you’re familiar with wanting to quit and simultaneously wanting to continue because you feel yourself getting stronger in the moment. That’s the razor’s edge you’re aiming for. If it just plain hurts, cut the plunge short. Come back another day.

As you become more accustomed to cold plunging, experiment. Play around with water temperature, duration, and time of day. You might incorporate breathing exercises to bring a meditative aspect to your plunges (never practice controlled hyperventilation in water, though). Try getting in and out multiple times. Move your limbs around underwater. This disrupts the pocket of warm water that forms near your skin’s surface and makes the plunge feel colder. 

Be Safe

The beauty of cold exposure is that you can start mild and get more intense, monitoring how you feel along the way. Cold plunges of the type I’m talking about here are generally safe, but they are stressful. If you are concerned about your ability to handle the stress, listen to your gut or talk to your doctor. 

Plunging in very cold water elicits a cold shock response. This can be dangerous for people who have asthma or cardiovascular conditions. I’d caution even the most hale and hearty readers, if you decide to take this to extreme levels, take the time to acclimate to cold water and learn proper safety precautions. The Outdoor Swimming Society is a good place to start. 

All right, that’s what I do. I’m interested to hear what you’re up to. Who among you is already doing regular cold plunges? Who wants to start?

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

If you’d like to add an avatar to all of your comments click here!

After welcoming a new baby, the last thing that a parent wants to do is to leave the baby in the care of someone else. But that’s often the situation for parents and families of newborns in the Neonatal Intensive Care Unit (NICU).

Due to the nature of care and the NICU environment, parents and family members cannot always be with the baby 24/7. They may even miss critical milestones or updates if they need to step away from the NICU for work, to care for other children or even to get some much-needed rest.

Today at IWK Health in Halifax, Canada, that’s not the case. IWK’s Chez NICU Home program provides families with online education, resources, and virtual connections to help them become more active participants in the care of their baby while in the NICU.

Chez NICU Home includes a web-delivered application created by the IWK that provides evidence-based education and resources for families with the ability to track their infant’s progress. From daily care activities, feeding and nursing, to the discharge process and understanding common NICU conditions, Chez NICU Home provides families with the information they need at anytime, anywhere. 97% of families that participated in the Chez NICU Home application agreed that the resources were extremely beneficial during an otherwise stressful time.

Each NICU room is also equipped with a high-quality Webex video device and collaboration technology that connects families to appointments with healthcare providers and local health professionals, or to family members who are unable to be there in person. For example, if spouses need to care for other children out of town, they can virtually participate in clinical rounds via Webex to get the latest update on the baby’s progress.

Leveraging Cisco technology to provide critical support and virtual connections has helped more than 450 families thrive during their stay in the NICU at IWK Health.

Chez NICU Home was a collaboration across IWK Health that included Innovation Services, a team of researchers, clinicians, and IT, in partnership with Cisco Canada and OnX. It was developed with support and financial contribution from the Government of Canada through the Atlantic Canada Opportunities Agency (ACOA) and the IWK Foundation.

Share:

Almost all living creatures on Earth breathe in some way, even trees and plants. While breathing is something all people have in common, unfortunately we don’t all breathe clean air. Human activity and some natural forces allow toxic materials into our atmosphere, which is the layer of gases that surrounds our planet. This air pollution can threaten our health and quality of life.

The U.S. Environmental Protection Agency (EPA) created a tool called the Air Quality Index (AQI) to inform the public of the level of air pollution and the risks it can pose to our health. Air quality can change very quickly, and the AQI allows people to stay on top of current air conditions in their area, just like the weather forecast.

Below, we’ll discuss how to use the AQI to understand air quality in your community and what you can do to keep you and your loved ones safe when the air quality is poor.

What is air quality?

The average human takes about 22,000 breaths every day, supplying our body with the oxygen it needs to function. Clean, oxygen-rich air is essential for our health, but the air around us can also contain harmful substances, called pollutants. Air quality refers to the level of pollutants in the air.

Good air quality means the air is relatively clean and there are few or no pollutants present that day.

Bad (or poor) air quality means the air contains one or several pollutants in amounts that are hazardous to our lungs and overall health.

What causes bad air quality?

Poor air quality is polluted air, and there are many sources that contribute to air pollution:

• Human industry: Our cities, agricultural areas, power plants, factories and oil refineries pump pollutants into the air in the form of smoke, soot and smog.
• Transportation: Cars, buses, airplanes, trains and any machine with a combustion engine put pollution into the air through the exhaust they produce.
• Nature: The smoke and microscopic matter from forest fires, dust storms and volcanic activity can pollute our air, while wind and geographic features – like valleys – determine where many pollutants end up.

Air quality is more of a concern during the summer months, when the combination of pollutants in the air and heat creates dangerous conditions that can negatively affect everyone’s health.

Who is most at risk from poor air quality?

Air pollution isn’t good for anyone, but it’s especially bad for the very young and very old, people with certain health conditions, and people who spend a lot of time outside. Those most at risk of experiencing negative health effects in bad air quality are considered “sensitive groups.” This category includes:

• People who have cardiovascular or lung disease, including asthma, COPD and lung cancer
• Adults aged 65 and older
• Children and teenagers
• Pregnant women
• People who frequently exercise outside
• People living in poverty
• People who smoke tobacco or who live with someone that does
• People who live and work close to major roadways or industrial areas
• People who work outside

For some of these groups, it’s not a current health condition that makes them more sensitive to poor air quality, but other ongoing factors that increase their level of risk in air pollution, as well as their vulnerability if they were to develop an illness.

What is the air quality index (AQI)?

In 1970, the EPA established the Clean Air Act, a set of laws that restricts and regulates the amount of pollutants allowed in the air in the United States. The Air Quality Index (AQI) was created soon after. The AQI notifies the public of the air quality around where they live and work, and empowers them to make assessments of the individual health risks involved in venturing outside that day.

The AQI measures the following five pollutants:

• Airborne particles (solid matter)
• Ground level ozone
• Carbon monoxide
• Sulfur oxide
• Nitrogen dioxide

Most of these pollutants are invisible to the naked eye, colorless and odorless, and this makes air pollution hard to detect on our own. That’s why these substances are monitored by the EPA, which has determined a safe range for each. When any one of them surpasses their safe range, an air quality alert is triggered.

What is an air quality alert?

The AQI is divided into five categories, based on the level of pollutants in the air and the corresponding health risk they pose. As a measurement tool, the AQI spans from 0 to 500. An AQI of 50 and below means the air quality is good. The AQI increases with the amount of air pollution to reflect the rising health risk, first for select groups of people, and then for everyone.

An AQI of 200 and above means the amount of pollution in the air has reached dangerous levels for everyone, regardless of their current health or planned outdoor activities.

The Air Quality Index reads as follows:

0-50: Good (green) 
The air is clean and clear, and pollutants are mostly absent. It is safe for everyone to be outdoors.

51-100: Moderate (yellow) 
There are some pollutants in the air, but they are still within a safe range. However, people with certain health conditions that make them more sensitive to air quality should watch for symptoms.

101-150: Unhealthy for sensitive groups (orange) 
One or more pollutants in the air have surpassed their safe range. People in sensitive groups may want to limit outside exercise, while everyone else can continue outdoor activities with caution.

151-200: Unhealthy (red) 
People in sensitive groups should avoid extended or vigorous exercise in the outdoors. Everyone else should plan to shorten outdoor exercise or reschedule it for the morning when pollution can be lower.

201-300: Very unhealthy (purple) 
Health alerts are triggered. People in sensitive groups should avoid any outdoor exertion. Everyone else should avoid extended or vigorous exercise, and plan to move all activities indoors.

301 and up: Hazardous (maroon) 
Everyone should avoid all outdoor activities.

Why air pollution is a health risk

If you spend time outside on a day when the AQI is high, the air pollution can make you feel unwell very quickly, but this is usually temporary. However, breathing polluted air for months or years can result in long-lasting or permanent health impacts. The length of your exposure determines the repercussions to your health.

Short-term exposure to air pollution can cause:

• Trouble breathing
• Headaches
• Dizziness
• Nausea
• Nose, throat, eye or skin irritation
• Recurring pneumonia and bronchitis

Long-term exposure to air pollution can cause:

• Damage to the cardiovascular system
• Diminished lung capacity and function, leading to chronic wheezing, coughing and shortness of breath
• New chronic lung conditions like asthma, emphysema and lung cancer
• The worsening of existing lung conditions like COPD and asthma, with more frequent asthma attacks
• A shortened lifespan

What to do when the air quality is bad

If you’re wondering about the air quality where you live or work, go to airnow.gov and enter your city or zip code. It will tell you the current AQI for the area, the forecasted AQI for the next three days and more.

Follow the tips below to stay safe on those days when the air quality is very unhealthy (purple) or hazardous (maroon):

• Avoid spending any time outdoors and keep children from playing outside
• Limit activities that cause you to breathe heavily
• Keep windows and doors closed to prevent outdoor air pollution from spreading through your home or workplace
• If it’s a hot day, turn on the air conditioner, but only if your AC model has a filter and doesn’t draw from outside air – if you don’t have air conditioning, try to go somewhere that does
• If you have to go outside, wear a N95, KN95 or P100 mask to protect yourself from inhaling pollutants

Indoor air quality

Good air quality in your home and workplace is just as important to your health and well-being as the air quality outside. In the U.S., we spend a lot of time indoors, so indoor air is the majority of what we breathe. And when the air quality outside is poor, you should be able to have an indoor space where you can safely stay until conditions improve.

Some common sources of indoor air pollution include:

• Household features and appliances that burn fuel like stovetops, furnaces and fireplaces
• Biological matter like mold, mildew and bacteria
• Household products that contain asbestos like insulation, ceiling and floor tiles, roofing shingles and vinyl materials
• Lead-based paint or pipes
• Secondhand tobacco smoke
• Wood furniture or flooring with stains or finishes containing formaldehyde
• Volatile organic compounds (VOCs) found in carpet, varnishes, glues and adhesives, upholstery, air fresheners and other products

Ways to improve indoor air quality

With so many potential sources, it’s easy to become overwhelmed at the thought of eliminating indoor air pollution. However, knowing there’s a problem is the first step to fixing it. And you can preserve your health and the health of your home by taking just a few steps to clear the air.

• Address air pollution directly by sealing, enclosing or removing any sources of pollution (including harsh cleaning solutions)
• Increase indoor ventilation by opening windows whenever possible and using ceiling fans
• Purchase an air filtering device that continuously pulls in dirty air and emits clean, filtered air
• Keep your home clean – dust, wipe down and vacuum surfaces often (in that order, to prevent the vacuum from kicking up too much debris) to get rid of dust and other irritants, and opt for cleaning products with natural ingredients, like vinegar.

Exercising during an air quality alert

Before going outside to exercise, it’s a good idea to check the current AQI, just like you would the weather. If the air quality is poor that day, consider:

• Your health history and current medical conditions
• The type, duration and intensity of the exercise you plan to do

Those in sensitive groups can exercise outside when the AQI is 150 or below, but should plan for a short, easy workout and watch out for symptoms. People who are not in a sensitive group can exercise outside when the AQI is below 200, but should also keep exertion mild and to a minimum.

Keep in mind that, no matter the AQI level, exercising near busy, congested roadways can expose you to high levels of vehicle emissions. Plan a different route for your run or bike ride that follows mostly residential streets, trails and parks.

Air quality in Minnesota and the Upper Midwest

The air quality across the state of Minnesota has been improving since 2003, and much of the Upper Midwest benefits from good air quality. However, as wildfires become larger and more frequent in western states and southern Canada, the Upper Midwest could experience increasing air pollution from smoke. Additionally, our increasingly warmer and drier summers allow for higher levels of harmful ozone pollution.

But not everyone in the Upper Midwest gets to enjoy good air quality. Low-income communities and communities of color in urban areas are disproportionately impacted by air pollution. This is typically the result of proximity to major highways and industrial areas. Air pollution will continue to be a problem until all of us can breathe clean air.

Care to help you breathe easier

It’s important to keep yourself and your loved ones safe during periods of poor air quality for long-term health and well-being. If you have concerns about air quality in your area, talk to your primary care doctor about what you can do to protect your lungs and your overall health.

For more information on air pollution and to get up-to-date air quality conditions in your area, visit airnow.gov.

I am still afraid of catching COVID. As a young, healthy, bivalently boosted physician, I no longer worry that I’ll end up strapped to a ventilator, but it does seem plausible that even a mild case of the disease could shorten my life, or leave me with chronic fatigue, breathing trouble, and brain fog. Roughly one in 10 Americans appears to share my concern, including plenty of doctors. “We know many devastating symptoms can persist for months,” the physician Ezekiel Emanuel wrote this past May in The Washington Post. “Like everyone, I want this pandemic nightmare to be over. But I also desperately fear living a debilitated life of mental muddle or torpor.”

Recently, I’ve begun to think that our worries might be better placed. As the pandemic drags on, data have emerged to clarify the dangers posed by COVID across the weeks, months, and years that follow an infection. Taken together, their implications are surprising. Some people’s lives are devastated by long COVID; they’re trapped with perplexing symptoms that seem to persist indefinitely. For the majority of vaccinated people, however, the worst complications will not surface in the early phase of disease, when you’re first feeling feverish and stuffy, nor can the gravest risks be said to be “long term.” Rather, they emerge during the middle phase of post-infection, a stretch that lasts for about 12 weeks after you get sick. This period of time is so menacing, in fact, that it really ought to have its own, familiar name: medium COVID.

Just how much of a threat is medium COVID? The answer has been obscured, to some extent, by sloppy definitions. A lot of studies blend different, dire outcomes into a single giant bucket called “long COVID.” Illnesses arising in as few as four weeks, along with those that show up many months later, have been considered one and the same. The CDC, for instance, suggested in a study out last spring that one in five adults who gets the virus will go on to suffer any of 26 medical complications, starting at least one month after infection, and extending up to one year. All of these are called “post-COVID conditions, or long COVID.” A series of influential analyses looking at U.S. veterans described an onslaught of new heart, kidney, and brain diseases (even among the vaccinated) across a similarly broad time span. The studies’ authors refer to these, grouped together, as “long COVID and its myriad complications.”

But the risks described above might well be most significant in just the first few weeks post-infection, and fade away as time goes on. When scientists analyzed Sweden’s national health registry, for example, they found that the chance of developing pulmonary embolism—an often deadly clot in the lungs—was a startling 32 times higher in the first month after testing positive for the virus; after that, it quickly diminished. The clots were only two times more common at 60 days after infection, and the effect was indistinguishable from baseline after three to four months. A post-infection risk of heart attack and stroke was also evident, and declined just as expeditiously. In July, U.K. epidemiologists corroborated the Swedish findings, showing that a heightened rate of cardiovascular disease among COVID patients could be detected up to 12 weeks after they got sick. Then the hazard went away.

This is all to be expected, given that other respiratory infections are known to cause a temporary spike in patients’ risk of cardiovascular events. Post-viral blood clots, heart attacks, and strokes tend to blow through like a summer storm. A very recent paper in the journal Circulation, also based on U.K. data, did find that COVID’s effects are longer-lasting, with a heightened chance of such events that lasts for almost one full year. But even in that study, the authors see the risk fall off most dramatically across the first two weeks. I’ve now read dozens of similar analyses, using data from many countries, that agree on this basic point: The greatest dangers lie in the weeks, not months, after a COVID infection.

Read: Long COVID could be a ‘mass deterioration event’

Yet many have inferred that COVID’s dangers have no end. “What’s particularly alarming is that these are really life-long conditions,” Ziyad Al-Aly, the lead researcher on the veterans studies, told the Financial Times in August. A Cleveland Clinic cardiologist has suggested that catching SARS-CoV-2 might even become a greater contributor to cardiovascular disease than being a chronic smoker or having obesity. But if experts who hold this assumption are correct—and the mortal hazards of COVID really do persist for a lifetime (or even many months)—then it’s not yet visible at the health-system level. By the end of the Omicron surge last winter, one in four Americans—about 84 million people—had been newly infected with the coronavirus. This was on top of 103 million pre-Omicron infections. Yet six months after the surge ended, the number of adult emergency-room visits, outpatient appointments, and hospital admissions across the country were all slightly lower than they were at the same time in 2021, according to an industry report released last month. In fact, emergency-room visits and hospital admissions in 2021 and 2022 were lower than they’d been before the pandemic. In other words, a rising tide of long-COVID-related medical conditions, affecting nearly every organ system, is nowhere to be found.

If mild infections did routinely lead to fatal consequences at a delay of months or years, then we should see it in our death rates, too. The number of excess deaths in the U.S.—meaning those that have occurred beyond historic norms—should still be going up, long after case rates fall. Yet excess deaths in the U.S. dropped to zero this past April, about two months after the end of the winter surge, and they have stayed relatively low ever since. Here, as around the world, overall mortality rates follow acute-infection rates, but only for a little while. A second wave of deaths—a long-COVID wave—never seems to break.

Even the most familiar maladies of “long COVID”—severe fatigue, cognitive difficulties, and breathing trouble—tend to be at their worst during the medium post-infection phase. An early analysis of symptom-tracking data from the U.K., the U.S., and Sweden found that the proportion of those experiencing COVID’s aftereffects decreased by 83 percent four to 12 weeks after illness started. The U.K. government also reported much higher rates of medium COVID, relative to long COVID: In its survey, 11 percent of people who caught the virus experienced lingering issues such as weakness, muscle aches, and loss of smell, but that rate had dropped to 3 percent by 12 weeks post-infection. The U.K. saw a slight decline in the number of people reporting such issues throughout the spring and summer; and a recent U.S. government survey found that about half of Americans who had experienced any COVID symptoms for three months or longer had already recovered.

This slow, steady resolution of symptoms fits with what we know about other post-infection syndromes. A survey of adolescents recovering from mononucleosis, which is caused by Epstein-Barr virus, found that 13 percent of subjects met criteria for chronic fatigue syndrome at six months, but that rate was nearly halved at one year, and nearly halved again at two. An examination of chronic fatigue after three different infections—EBV, Q fever, and Ross River virus—identified a similar pattern: frequent post-infection symptoms, which gradually decreased over months.

Read: It’s not just long COVID

The pervasiveness of medium COVID does nothing to negate the reality of long COVID—a calamitous condition that can shatter people’s lives. Many long-haulers experience unremitting symptoms, and their cases can evolve into complex chronic syndromes like ME/CFS or dysautonomia. As a result, they may require specialized medical care, permanent work accommodations, and ongoing financial support. Recognizing the small chance of such tragic outcomes could well be enough to make some people try to avoid infection or reinfection with SARS-CoV-2 at all costs.

But if you’re like me, and trying to calibrate your behaviors to meet some personally acceptable level of COVID risk, then it helps to keep in mind the difference between the virus’s medium- and long-term complications. Medium COVID may be time-limited, but it is far from rare—and not always mild. It can mean a month or two of profound fatigue, crushing headaches, and vexing chest pain. It can lead to life-threatening medical complications. It needs recognition, research, and new treatments. For millions of people, medium COVID is as bad as it gets.

Updated at 3:30 p.m. ET on October 17, 2022

In the fall of 1988, Matthew Farrow, a 5-year-old boy with a rare blood disorder, received the world’s first transplant of umbilical-cord blood from a newborn sibling. It worked: Farrow was cured. This miraculous outcome broke open a whole new field in medicine—and, not long after, a whole new industry aimed at getting expecting parents to bank their baby’s umbilical-cord blood, just in case.

These days, in fact, being pregnant means being bombarded at the doctor’s office and on Instagram with ads touting cord blood as too precious to waste. For several hundred dollars upfront, plus a storage fee of $100 to $200 every year, the banks’ ads proclaim, you could save your child’s life. Cord-blood banking has been likened to a “biological insurance policy.”

In the U.S., the two biggest private cord blood banks are Cord Blood Registry and ViaCord. Together, they have collected more than 1 million units. But only a few hundred units of this privately banked cord blood have ever been used in transplants, the great majority by families who chose to bank because they already had a child with a specific and rare disorder treatable with a transplant. For everyone else, the odds of using privately banked cord blood are minuscule—so minuscule that the American Academy of Pediatrics (AAP) recommends against private banking. It does make an exception for families with that disease history. “But that’s a rare circumstance,” says Steve Joffe, a pediatric oncologist and ethicist at the University of Pennsylvania, “and not one that anybody is going to build a successful business model around.”

ViaCord and Cord Blood Registry do offer free services for families in which someone has already been diagnosed with a condition treatable with cord blood. In general, the companies reiterated to me, cord blood does save lives and they are simply providing an option for families who want it.

But the marketing also gives the impression of much more expansive uses for cord blood. The private banks’ websites list nearly 80 diseases treatable with transplantation—an impressive number, though many are extremely uncommon or closely related to one another. (For example: refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation.) They have also recently taken to highlighting the promise of still-unproven treatments: Temporary infusions of cord blood, they say, could eventually treat more common conditions such as cerebral palsy and autism. Video testimonials feature parents talking excitedly about the potential of cord blood for their children. But the evidence isn’t there yet—and may never appear. Nonetheless, says Paul Knoepfler, a stem-cell scientist at UC Davis, “the cord-blood companies seem to be trying to expand their base of potential customers.”

The initial exuberance around cord blood came from a real place. The blood left over in umbilical cords is replete with cells that have the special ability to turn into any kind of blood, including red blood cells, which carry oxygen, and white blood cells, which make up the immune system. Adults have stem cells in their bone marrow and blood—which can also be used for a transplant—but those in a baby’s umbilical cord are more immunologically naive. That means they are less likely to go awry and attack a recipient’s body. “They don’t cause as much havoc,” says Karen Ballen, an oncologist at the University of Virginia. This allows doctors to use cord blood that matches only four out of six immunological markers.

Because cord blood is so valuable, publicly run banks have been collecting donations since the 1990s. Despite amassing fewer units overall, public banks worldwide have provided 30 times as many units of blood for treatment—and saved more lives—than private ones, because they are accessible by any patient in need. Although the AAP recommends against private banking, it does recommend donating to public banks.

One appeal of private banking, though, as the companies highlight, is that the cells in a baby’s umbilical cord are a perfect match for them in later childhood or adulthood. But this is usually irrelevant: In most of the diseases that can be cured by a cord-blood transplant, doctors would, for medical reasons, not use the patient’s own cells. In cases of inherited disorders such as sickle cell anemia, for example, a child’s own cord-blood stems have the same problematic mutation. For children with one of many types of leukemia, the concern is that cord blood could contain leukemia-precursor cells that cause the cancer to reappear; in addition, donor blood-stem cells are better because they can mop up remaining leukemia cells. Doctors would “never” use banked cord blood from a child with these types of leukemia, says Joanne Kurtzberg, a pediatrician and cord-blood pioneer at Duke University, who helped treat Farrow when he was a young boy.

When privately banked cord blood is used in transplants, it is more likely to go to a sibling. Genetically, siblings have about a 25 percent chance of being perfect matches for each other. The chances of finding a suitable match among unrelated bone-marrow or cord-blood donors from a public bank, on the other hand, range from 29 to 79 percent, depending on one’s ethnic background. (The majority of donors are white, so it’s highest for white patients.) In any case, not banking a matched sibling’s cord blood doesn’t foreclose the possibility of a transplant, because that sibling can still donate bone marrow. “I often encounter families who have some guilt around not storing the cord blood, and I will point out, ‘Well, your donor child that matches our patient is still here,’” says Ann Haight, a pediatric hematologist and oncologist at Emory University.

Even if a baby’s cord blood is banked, there’s no guarantee that it will contain enough cells for a transplant. In fact, most may not: Public banks only keep 5 to 40 percent of their donations, as the rest don’t meet their standards. Private banks will save much smaller samples, which they argue serve a different purpose. Whereas public banks are looking for large samples that are mostly likely to be used for transplants, says Kate Girard, the director of medical and scientific affairs at ViaCord, “when families are banking with us, this is that child’s only cord, so our threshold is way lower.”

Another reason to bank these smaller samples, a spokesperson for Cord Blood Registry pointed out, is that they can still be used for experimental infusions treating conditions such as cerebral palsy and autism. (About 80 percent of units released by CBR have been used this way, as have about half from ViaCord.) The private banks partner with researchers, such as Kurtzberg at Duke, who are running clinical trials to test these treatments. The theory goes that cells from cord blood can make it to the brain, where they might have some neuroprotective role—but the mechanism remains unknown, and the effects are not entirely clear. As Kurtzberg told me, “The therapy is not proven.”

The current state of cord-blood science might be summed up thus: Proven uses are very uncommon, and unproven uses are, well, unproven. Of course, a future discovery could lead to a real breakthrough in the use of stem cells from cord blood—an idea private banks trade on. Who knows what might be in store for cord blood later, when your baby is 30, 50, 70 years old? In a recent Cord Blood Registry survey of new parents, a spokesperson told me by email, 45 percent named “belief in future treatments” as the primary reason for banking their child’s cord blood and tissue. Knoepfler, the stem-cell scientist, notes that scientists have been excited for decades about the promise of stem cells. But translating interesting results in the lab to a doctor’s office, he says, “​​is really much harder than many of us realized. I include myself in that.”

Medical discoveries have actually changed the ways cord blood is used over years, but they have so far resulted in less use of cord blood. In the past several years, doctors have refined a protocol to use half-matched donors in transplants. Doctors generally get more cells from these donors than from an infant’s banked cord blood, which means the transplants “take” more quickly and the patient spends less time in the hospital. For this reason, cord blood has been falling out of favor. Public banks have started scaling down their collections; the New York Blood Center, which had launched the world’s first public bank, recently stopped collecting new donations. How cord blood gets used in the future is still unknown.

More than 30 years ago after Kurtzberg first treated Farrow, she is still in touch with him. He’s 39 now, and doing well. Having watched cord banking grow and evolve over the years, she remains a proponent of public banking and the possibilities ahead. When it comes to private banks, however, she says, “I don’t think it’s a necessity. I think it’s nice to have if you can do it.” There isn’t much harm in private banking, after all, as long as parents can afford the several thousand dollars over their child’s lifetime.

Afford might be the key word here. The ads for cord-blood banking feel a lot like those for any number of “nice to have” baby products aimed at anxious parents, be they organic diapers or BPA-free wooden toys tailored to your child’s age and cognitive development. If anything, the stakes of cord-blood banking are higher than anything else you might choose to buy. The opportunity only comes around “once in a lifetime,” and it could literally save your child’s life—even if the chances of that are very, very small. “It’s playing to parental guilt and the desire for parents to have healthy children and do whatever they can for their kids,” says Timothy Caulfield, a health-law professor at the University of Alberta who has studied cord-blood banks. “There’s a huge market based on exactly that.”

It’s telling, perhaps, that Cord Blood Registry ran a giveaway of $20,000 worth of baby products this summer. The curated package of luxury “baby essentials” resembled the registry of parents who want the best for their kid, and can afford it. Included were a Snoo smart bassinet ($1,695), an Uppababy stroller and car seat ($1,400), Coterie diapers ($100 for a month’s supply, guaranteed to be “free of fragrance, lotion, latex, rubber, dyes, alcohol, heavy metals, parabens, phthalates, chlorine bleaching, VOCs, and optical brighteners”), and, of course, a lifetime of cord-blood and tissue banking ($11,860).

This article originally misspelled Kate Girard’s last name.

It is a truth universally acknowledged among health experts that official COVID-19 data are a mess right now. Since the Omicron surge last winter, case counts from public-health agencies have become less reliable. PCR tests have become harder to access and at-home tests are typically not counted.

Official case numbers now represent “the tip of the iceberg” of actual infections, Denis Nash, an epidemiologist at the City University of New York, told me. Although case rates may seem low now, true infections may be up to 20 times higher. And even those case numbers are no longer available on a daily basis in many places, as the CDC and most state agencies have switched to updating their data once a week instead of every day.

How, then, is anyone supposed to actually keep track of the COVID-19 risk in their area—especially when cases are expected to increase this fall and winter? Using newer data sources, such as wastewater surveillance and population surveys, experts have already noticed potential signals of a fall surge: Official case counts are trending down across the U.S., but Northeast cities such as Boston are seeing more coronavirus in their wastewater, and the CDC reports that this region is a hot spot for further-mutated versions of the Omicron variant. Even if you’re not an expert, you can still get a clearer picture of how COVID-19 is hitting your community in the weeks ahead. You’ll simply need to understand how to interpret these alternate data sources.

The problem with case data goes right to the source. Investment in COVID-19 tracking at the state and local levels has been in free fall, says Sam Scarpino, a surveillance expert at the Rockefeller Foundation’s Pandemic Prevention Initiative. “More recently, we’ve started to see lots of states sunsetting their reporting,” Scarpino told me. Since the Pandemic Prevention Initiative and the Pandemic Tracking Collective started publishing a state-by-state scorecard of breakthrough-case reporting in December 2021, the number of states with a failing grade has doubled. Scarpino considers this trend a “harbinger of what’s coming” as departments continue to shift resources away from COVID-19 reporting.

Read: Warning signs about the first post-pandemic winter

Hospitalization data don’t suffer from the same reporting problems, because the federal government collects information directly from thousands of facilities across the country. But “hospitalizations often lag behind cases by a matter of weeks,” says Caroline Hugh, an epidemiologist and volunteer with the People’s CDC, an organization providing COVID-19 data and guidance while advocating for improved safety measures. Hospitalizations also don’t necessarily reflect transmission rates, which still matter if you want to stay safe. Some studies suggest, for example, that long COVID might now be more likely than hospitalization after an infection.

For a better sense of how much the coronavirus is circulating, many experts are turning to wastewater surveillance. Samples from our sewage can provide an advanced warning of increased COVID-19 spread because everyone in a public-sewer system contributes data; the biases that hinder PCR test results don’t apply. As a result, Hugh and her colleagues at the People’s CDC consider wastewater trends to be more “consistent” than constantly fluctuating case numbers.

When Omicron first began to wreak havoc in December 2021, “the wastewater data started to rise very steeply, almost two weeks before we saw the same rise” in case counts, Newsha Ghaeli, the president and a co-founder of the wastewater-surveillance company Biobot Analytics, told me. Biobot is now working with hundreds of sewage-sampling sites in all 50 states, Ghaeli said. The company’s national and regional dashboard incorporates data from every location in its network, but for more local data, you might need to go to a separate dashboard run by the CDC or by your state health department. Some states have wastewater surveillance in every county, while others have just a handful of sites. If your location is not represented, Ghaeli said, “the wastewater data from communities nearby is still very applicable.” And even if your county does have tracking, checking up on neighboring communities might be good practice. “A surge in a state next door … could very quickly turn into a surge locally,” Ghaeli explained.

Read: The BA.5 wave is what COVID normal looks like

Ghaeli recommends watching how coronavirus levels in wastewater shift over time, rather than homing in on individual data points. Look at both “directionality” and “magnitude”: Are viral levels increasing or decreasing, and how do these levels compare with earlier points in the pandemic? A 10 percent uptick when levels are low is less concerning than a 10 percent uptick when the virus is already spreading widely.

Researchers are still working to understand how wastewater data correlate with actual infections, because every community has unique waste patterns. For example, big cities differ from rural areas, and in some places, environmental factors such as rainfall or nearby agriculture may interfere with coronavirus tracking. Still, long-term-trend data are generally thought to be a good tool that can help sound the alarm on new surges.

Wastewater data can help you figure out how much COVID-19 is spreading in a community and can even track all the variants circulating locally, but they can’t tell you who’s getting sick. To answer the latter question, epidemiologists turn to what Nash calls “active surveillance”: Rather than relying on the COVID-19 test results that happen to get reported to a public-health agency, actively seek out and ask people whether they recently got sick or tested positive.

Nash and his team at CUNY have conducted population surveys in New York City and at the national level. The team’s most recent survey (which hasn’t yet been peer-reviewed), conducted from late June to early July, included questions about at-home test results and COVID-like symptoms. From a nationally representative survey of about 3,000 people, Nash and his team found that more than 17 percent of U.S. adults had COVID-19 during the two-week period—about 24 times higher than the CDC’s case counts at that time.

Studies like these “capture people who might not be counted by the health system,” Nash told me. His team found that Black and Hispanic Americans and those with low incomes were more likely to get sick during the survey period, compared with the national estimate. The CDC and Census Bureau take a similar approach through the ongoing Household Pulse Survey.

Kyle Harper: Not everyone can afford to “learn to live with” COVID-19

These surveys are “a gold mine of data,” though they need to be “carefully designed,” Maria Pyra, an epidemiologist and volunteer with the People’s CDC, told me. By showing the gap between true infections and officially reported cases, surveys like Nash’s can allow researchers to approximate how much COVID-19 is really spreading.

Survey results may be delayed by weeks or months, however, and are typically published in preprints or news reports rather than on a health agency’s dashboard. They might also be biased by who chooses to respond or how questions are worded. Scarpino suggested a more timely option: data collected from cellphone locations or social media. The Delphi Group at Carnegie Mellon University, for example, provides data on how many people are Googling coldlike symptoms or seeking COVID-related doctor visits. While such trends aren’t a perfect proxy for case rates, they can be a helpful warning that transmission patterns are changing.

Readers seeking to monitor COVID-19 this fall should “look as local as you can,” Scarpino recommended. That means examining county- or zip-code-level data, depending on what’s available for you. Nash suggested checking multiple data sources and attempting to “triangulate” between them. For example, if case data suggest that transmission is down, do wastewater data say the same thing? And how do the data match with local behavior? If a popular community event or holiday happened recently, low case numbers might need to be taken with a grain of salt.

“We’re heading into a period where it’s going to be increasingly harder to know what’s going on with the virus,” Nash told me. Case numbers will continue to be undercounted, and dashboards may be updated less frequently. Pundits on Twitter are turning to Yankee Candle reviews for signs of surges. Helpful sources still exist, but piecing together the disparate data can be exhausting—after all, data reporting and interpretation should be a job for our public-health agencies, not for concerned individuals.

Read: The plan to stop every respiratory virus at once

Rather than accept this fragmented data status quo, experts would like to see improved public-health systems for COVID-19 and other diseases, such as monkeypox and polio. “If we get better at collecting and making available local, relevant infectious-disease data for decision making, we’re going to lead healthier, happier lives,” Scarpino said.