today

This wasn’t the plan.

I expected right now I would be in a plane somewhere over the Atlantic after a month in the UK visiting daughter E and her family, meeting granddaughter JG, walking granddaughter ABC home from nursery school, celebrating US Thanksgiving in London on what is there just the fourth Thursday of November.

I thought I would get to attend mass for the first time since March as we celebrated JG’s baptism, wearing the white dress that I, E, and ABC wore before her, as well her Aunt T and great-aunts.

Of course, there would have been two weeks in quarantine before any of the visiting, but still…

It was a blessing in disguise that the news of the UK lockdown leaked early, before we flew out, so that there was time to cancel. It took most of the month, but I finally got all the charges refunded.

I had planned to get a lot of writing done while we were in quarantine and to do a long-delayed, self-guided retreat, neither of which happened this month as the usual things that needed doing were before us here and the inevitable bumps in the road appeared that needed attention. I was also impossible to ignore/escape the maelstrom of news on the election and its aftermath and of the horrifying, continuing escalation of the coronavirus pandemic.

Enter the first Sunday of Advent, with its message of watching in hope.

I’m struggling with that.

By nature, I’m neither an optimist nor a pessimist. I try to be more of a realist. I know that with over 13 million confirmed cases so far and a seven-day average of new confirmed cases of about 160,000, compounded by Thanksgiving travel, the United States is going to have further acceleration in COVID cases in December and most likely into January, as well. There are also going to be spikes in hospitalizations and deaths flowing from that. Although there will likely be some vaccine administration starting in December, there won’t be enough to make much of a dent in transmission. The exception is that, if health care workers are vaccinated first as expected, we may be able to keep our hospitals staffed well enough to meet the surge in cases this winter.

I do have hope that the incoming Biden administration will have staff and appointees who are capable of improving the lives of people here and beginning to repair our international relationships. However, I am disheartened by the efforts of the current administration to undermine the chances that Biden’s team can implement changes quickly and easily. There are a number of last-minute rule changes, treaty withdrawals, troop withdrawals, and other measures that will make the transition even more difficult than anticipated in this time of public health emergency, economic downturn, civil rights protests, and general distrust in government.

Sigh.

So, one foot in front of the other. Doing the best I can manage under the circumstances.

Stay tuned.

the Moderna vaccine

Today, Moderna announced that their early data indicate their coronavirus vaccine is 94.5% effective. This follows the announcement last week from Pfizer/BioNTech that their vaccine, with which I and two members of my family are participating in the phase III clinical trial, is over 90% effective in the immediate time period after the second immunization.

Like the Pfizer vaccine, Moderna’s is a messenger RNA vaccine. The caveats that I wrote about here apply, but there is now hope that there will be two effective vaccines approved for emergency use in the United States before the end of the year. I’m sure the companies are also pursuing approval in other countries, as well.

Unlike Pfizer, Moderna accepted US government funds for the development of their vaccine. Like Pfizer, the US government also pre-ordered 100 million doses from Moderna. Initially, priority will be given to health care workers and other front-line occupations, expanding to highest risk people. Availability, pending full approval, for the general public will not be until spring 2021.

The Moderna vaccine will be easier to distribute than the Pfizer one because it can be kept for up to a month in a refrigerator. The Pfizer vaccine currently needs a super-cold freezer or dry ice for transport and storage.

Having two good candidates that might be available for the most vulnerable this winter is great news. I’m hoping that more of the vaccines currently in Phase III trials will also be shown safe and effective in the coming weeks. The more vaccines we can make available, in the US and around the world, the better, so we can get the pandemic under control globally.

Meanwhile, Pfizer, Moderna, and other companies need to continue their trials, following everyone who received the vaccine for the coming months to watch for how effective the vaccine is over time, if it protects some people better than others, e.g. seniors or children, and how much it might reduce symptoms in vaccinated people who do become sick with COVID versus unvaccinated. It’s possible that the placebo group may be released early from the studies when the vaccine is fully approved for ethical reasons. The companies may very well ask those participants if they would like to join the study as a second set of vaccinated subjects, doubling the amount of data on vaccine efficacy over time.

So, more good news today, but we have to keep in mind that masks, distancing, restrictions on gathering, etc. will need to stay in effect for months still. Until we have a large majority of the population fully vaccinated – and both the Moderna and Pfizer vaccines need two doses several weeks apart – we need to stay on guard. Sadly, the United States passed 11 million cases recently and is approaching a quarter of a million deaths. We need to do better now, not let more people suffer while we wait for the vaccines to be generally available.

in the middle of a nightmare

The pandemic has been more severe in the United States than globally for months – and now things are getting worse very, very quickly.

Yesterday, there were over 159,000 new cases diagnosed, which broke a record set the day before. There are entire states that are out of intensive care beds – or hospital beds in general. In some states, hospitals have to triage patients and turn some away who would benefit from care in favor of other patients who are sicker but have a higher chance of recovery.

Some places are so short-staffed that COVID-positive staff are continuing to work if their symptoms allow.

The hospitalization rate is also a lagging indicator. If the hospitals are this stressed now, what will the situation be in two weeks, given the huge numbers of new diagnoses this week?

I’ve reached a new level of dread.

New York State, where I live, still has one of the lowest infection rates in the country. Governor Cuomo is tightening restrictions on gyms, indoor dining and gatherings, as well as further ramping up testing and contact tracing in hot spots. Unfortunately, after all these months, there is an outbreak among residents in the skilled nursing unit of my father’s senior living community, as well as a number of staff members. The health center is in a separate building from where Paco lives in an apartment, so we are hoping the virus won’t spread, but it is very worrying for all of us.

And what, you may ask, is the Trump administration doing to address the explosion of cases, hospitalizations, and deaths?

Nothing.

Vice-president Pence, who chairs the coronavirus task force, finally held a meeting this week after several weeks without doing so during the campaign. There were no new actions or recommendations after the meeting.

Meanwhile, President-elect Biden has named a first-rate committee of physicians and public health experts to set up the plan against COVID for his administration, which will begin January 20th. Unfortunately, because the Trump administration refuses to acknowledge that Biden will be taking office, the Biden task force does not have access to the current plans in development for vaccine deployment, distribution of supplies, etc., which is an appalling and dangerous state of affairs.

What is even more appalling and dangerous is that, with the situation becoming more and more dire daily, the Trump administration is making no attempt at all to save people for illness, disability, and death.

I’m finding the level of stress and dismay crushing.

People desperately need help now.

January 20th is still a long way off.

over 90%

Today, Pfizer/BioNTech announced analysis that showed over 90% effectiveness of their coronavirus vaccine, currently in Phase III clinical trials. There are over 43,000 people around the world enrolled in this study, including spouse B, daughter T, and me. My most recent post on the trial is here.

That is an extraordinarily high percentage for a vaccine; for comparison, most years, the seasonal flu vaccine is about 50% effective. Lest you think that Pfizer or BioNTech are exaggerating the data, neither company did the analysis. That was accomplished by an independent science review board.

While this is welcome news, there are some cautions involved. The number of cases of COVID among the large study group is still small; as time goes on, it’s possible that the efficacy rate might drop. Because the virus and the vaccine are so new, there is no way to know how long immunity might last. This is part of the reason that the study is set to last for two years, so more data can be collected about the long-term efficacy, longevity, and safety of the vaccine.

Besides the speed with which this vaccine was developed, the remarkable thing is that this is among the first messenger RNA vaccines to be tested in a large trial. If it is shown to be safe and effective, there are hopes that the Moderna vaccine, also currently in Phase III trials and an mRNA vaccine, may be effective as well. Additionally, there are vaccines that were developed in more traditional ways in Phase III trials. The more vaccines that are shown to be safe and effective, the more people can be vaccinated in a shorter timeframe, so that we can bring the global pandemic to an end, perhaps as early as late 2021 or early 2022.

It’s possible that Pfizer will be able to apply for emergency use authorization in the United States later in November, after there is two months of safety data from half the study participants after their second dose. This, along with manufacturing safety data and the efficacy numbers, will be considered by the Food and Drug Administration to determine if the vaccine can begin to be distributed, with full approval coming after more data is collected.

It’s worth noting that Pfizer/BioNTech have a contract to provide 100 million doses to the United States government if the vaccine is approved. Unlike some other companies, though, Pfizer and BioNTech did not take money from the US for their research and trial expenses. The contract is for $1.95 billion but the US government will distribute it free of charge.

My hope is that this and several other vaccines will be approved over the next few months so that as many people as possible can be protected as quickly as possible, starting with frontline health workers, first responders, and those most vulnerable due to age, underlying conditions, living facilities, and occupation.

We got the sad news today that there are several people in the skilled nursing unit of Paco’s senior community who have tested positive for the virus. Access to the unit had already been restricted, so there is hope that it will not spread any further, but we are all worried about those impacted.

The sooner we have vaccines – and better treatments – the better.

Pfizer vaccine update

My spouse B, daughter T, and I are participating in the Pfizer/BioNTech coronavirus vaccine trial. My most recent update on our personal experience is here, but I wanted to share an open letter from Pfizer which you can find here.

President Trump has been intimating that a vaccine would be available under emergency authorization by election day November third, which has led to fears that the companies might compromise the science in order to meet that deadline. The companies, though, have been trying to reassure the public that they will adhere to sound scientific and public health principles.

The letter from Pfizer’s chairman and CEO Albert Bourla explains that there are three necessary components for vaccine approval: effectiveness, for which they expect data by the end of October; safety, for which they will have data in the third week of November; and manufacturing data to ensure consistent quality. If there are good results confirmed by outside experts, Bourla believes that Pfizer will be able to apply for emergency use authorization from the United States Food and Drug Administration shortly after the safety data are available in the third week of November.

Even if the emergency and final authorization is approved, Pfizer will continue its study for two years in order to monitor safety and longevity of effectiveness.

I appreciate Pfizer’s transparency of their process and truly hope that their vaccine will be shown to be safe and effective so that we can begin to protect first our most vulnerable and eventually everyone from COVID-19. I also hope that lots of other companies in the US and around the world will also produce safe and effective vaccines so we can end the pandemic as soon as possible.

JC’s Confessions #16

In the first few seasons of The Late Show, Stephen Colbert did a recurring skit, now a best-selling book, called Midnight Confessions, in which he “confesses” to his audience with the disclaimer that he isn’t sure these things are really sins but that he does “feel bad about them.” While Stephen and his writers are famously funny, I am not, so my JC’s Confessions will be somewhat more serious reflections, but they will be things that I feel bad about. Stephen’s audience always forgives him at the end of the segment; I’m not expecting that – and these aren’t really sins – but comments are always welcome.

JC

I should be watching the Senate Judiciary committee’s hearings on the nomination of Amy Coney Barrett to the United States Supreme Court right now.

I can’t bring myself to do it.

There are a lot of reasons.

First, it renews my sorrow at the loss of Ruth Bader Ginsburg.

Second, it is difficult to cope with the nomination going forward under the current circumstances. There is the proximity to the election with voters already casting their ballots and the hypocrisy of the Republicans in moving forward with the confirmation process when they would not allow a hearing for President Obama’s nominee in 2016 many months before the election. There is also the fact that the Senate is not in session due to several senators being COVID positive; if it isn’t safe to be in session, in-person hearings should not be held, either.

Third, I’m leery of how the subject of religion will be handled. Like me, Judge Barrett is Roman Catholic, as are five current members of the Supreme Court with a sixth having been raised Catholic. In a country that is predominantly Protestant, it seems odd to have so many Catholics on the Court. I realize that justices make determinations on the basis of the law, but there are times that some of the arguments made in cases cross into religious belief and the Catholic hierarchy sometimes makes arguments that are factually incorrect. For example, some recent cases have upheld employers’ refusal to offer birth control in the medical insurance of women employees on the grounds that birth control is abortifacient, which, while taught by the Catholic bishops, is not medically true. Likewise, you see arguments that same-sex marriage is an assault on religious freedom even though it is a civil law; while some religions choose to offer ceremonies for same-sex couples, no religion is compelled to do so.

Fourth, I remain suspicious of the originalist/textualist bent that Judge Barrett exhibits. That judicial philosophy fails to account for how the meaning of words changes over time. In my view, one of the strengths of our Constitution and laws is that it can be interpreted in the light of new circumstances. Let’s face facts: many of the men who wrote the Constitution were slaveholders who never envisaged that one day Blacks, women, and people who don’t own property would be voters. Many modern issues could not have been imagined by people in the 18th century.

However, some issues that were clearly spelled out in the legal writings of the 18th century are ignored by originalists when it suits them. For example, the second amendment very clearly places the right to bear arms in the context of a “well-regulated militia” but originalists often ignore that part of the text and original intent. It’s also very clear that the Founders understood that corporations are not people; a future Supreme Court may someday strike down the Citizens United ruling on that basis.

I don’t know what will happen with this nomination or with the Court in the coming years, but, right now, I can’t bear to watch.

looking for antibodies

Last week, B, T, and I had our third visit in the Pfizer/BioNTech coronavirus vaccine trial.

The main purpose of the visit was to draw blood to analyze for the presence of antibodies and other factors involved in viral immunity. Because the study is placebo-controlled and blinded, neither we nor the researchers will know our individual results, but the data will be important in determining how quickly and how well the vaccine works.

Our next appointments aren’t until March when more blood work will be done to check on antibody levels again and to see if they have remained and/or declined. In the meantime, we will continue to check in weekly through a phone app which asks about possible COVID symptoms. We will also contact the office if any of us develop symptoms that could be COVID, so that we can be tested.

The Pfizer phase III trial data will be evaluated when a certain number of COVID cases develop among the participants. When these case benchmarks are reached, the researchers will be able to determine how much protection the vaccine group exhibited compared to the placebo group. That percentage helps to determine if the vaccine will be approved.

If the vaccine is approved, Pfizer may decide to end the trail early so that the placebo group members can receive a vaccine to protect themselves. They would continue to follow the vaccine group from the trial for two years as planned, collecting data on how durable the immunity is and any side effects that might not be evident immediately.

We have also passed the window of time after the second injection in the trial when one couldn’t receive any other vaccines, so all three of us have now gotten our seasonal flu shots. We do always get flu vaccines every year, but public health experts are particularly strong in their recommendations that everyone get a flu shot this year. They are afraid of having a bad flu season on top of the coronavirus pandemic, which would make the fall and winter even more dangerous.

Please, all the Northern Hemisphere folks reading this, make arrangements to receive a flu vaccine, if you haven’t already done so.

for the archives

A few weeks ago, a poet-and-church friend who is a faithful reader of Top of JC’s Mind asked if I would like to get in touch with a friend of hers who is involved with a local historical society. Their historical society is joining with others in New York State to assemble an archive related to the pandemic. My friend thought that my posts about being in the vaccine trial might be appropriate for the archive.

It turned out that the archiving project was interested in my vaccine trials posts and any others that dealt with living in the time of COVID. I had sent the vaccine posts first. Then, I worked my way through my blog archive, copying the links to other pandemic related posts.

I knew that I wrote about the impact of COVID-19 quite a lot, but I was surprised at how long the list of posts was – fifty-six posts, from late February through September 11, in addition to the handful of vaccine ones. I joked with the archivist about it being either “an embarrassment of riches or just an embarrassment!” Since then, any time I write about our pandemic experiences I send her the link.

I had asked her how they were preserving the archive. She said that, while they do keep links on their computer, they are printing the materials for posterity. Archival technologies tend to come and go but paper lasts for a very long time.

It’s humbling to think that, decades from now, some future historian might stumble across some of my posts and be able to glean some insights about what it has been like dealing with these fraught times in our communities in upstate New York. First person contemporaneous accounts are highly sought sources for historians and documentarians and I would be honored if my posts are able to assist someone with their research some-year in the future.

scatter-brained

I’ve been wanting to write a post for several days, but have felt too scattered to do it.

I’m still feeling too scattered, but am determined to do it now regardless, ignoring the fact that I have unread email messages going back to Sunday, although I think I’ve caught all the important ones, and a long to-do list of other tasks.

Our national drama and the pandemic continue to demand an outsize share of my thoughts. The president’s behavior and rhetoric are increasingly bizarre, possibly as a result of the high-dose steroids he is taking for COVID. There are over two dozen known cases among White House and campaign personnel and cases and quarantine of the Joint Chiefs of Staff, our highest ranking military officers. The president is planning to resume public campaigning, even though he is most likely still infectious. The medical information that has been released publicly is at best incomplete and at worst misleading.

Yesterday, arrests were made as a result of a plot to kidnap and possibly kill Michigan governor Gretchen Whitmer. I’m grateful that the governor and her family are safe but appalled that a self-styled right-wing militia was planning such a horrible attack. Gov. Whitmer, like many other governors around the country, has enacted executive orders to address the pandemic. She has been vilified by protesters, some of whom were armed, Republican legislators, and the president. She has been publicly threatened with violence and been subjected to sexist slurs. Still, it was shocking to learn that there was a serious plot to kidnap her and “try her for treason” before the November election. Instead of expressing support for her yesterday after the news broke, the president tweeted criticism of her and her policies, along with mischaracterizations of her and other Democrats.

In local COVID news, there has been an uptick in cases here in Broome County and we are officially on yellow alert, which sets lower limits on gatherings and increased testing for schools. Our county executive had already asked residents to stay at home as much as possible, so there isn’t much additional impact on daily life, but the official recognition by New York State has reminded me to be even more cautious with outings.

I am also getting increasingly anxious about our upcoming trip to the UK to visit daughter E and her family. The UK has also had an increasing number of COVID cases recently and has tightened restrictions. B, T and I are going for the month of November because we will need to quarantine for the first two weeks. Then, we will have two weeks to visit, although it’s unclear if we will be able to all congregate at their home as gatherings of more than six are prohibited. We are also hoping to celebrate JG’s baptism, but aren’t sure how many will be allowed to attend. After we return home to New York, we will need to quarantine for two weeks, bringing us to mid-December. The airline has already changed our flights once and I’m hoping that no additional travel restrictions go into effect this month.

Part of what is stressing me out is trying to plan and prepare for six weeks of travel and quarantine. Besides B, T, and me, I need to have plans in place for Paco and for the house, where my sisters and brother-in-law in various constellations will be holding down the fort in our absence. This is turning into a major re-jiggering and re-stocking effort indoors, while a long-awaited landscaping project has been going on outdoors.

Meanwhile, in my continuing quest to catch up with personal preventive health measures, I had a COVID test this morning in advance of a colonoscopy next week. Because of some pre-existing conditions, my prep is a bit more complicated than for most people, so I’m hoping I can get through it with a minimum of repercussions. Maybe I’ll write a post next week while I’m waiting for the remnants of the sedation and medications to wear off. That could be, um, interesting?

On the poetry front, I got another chapbook rejection. It was a debut chapbook competition that had drawn over 200 entries, a detail I’m including as it gives people an idea of the odds, and this contest was relatively small. On the unexpectedly happy news side, I received notification of acceptance to an anthology called Lullabies and Confessions: Poetic Explorations of Parenting Across the Lifespan from University Professors Press. I had submitted to the anthology over four years ago and had assumed my poem had been rejected although I hadn’t gotten an email about it, but the project had instead been delayed and my poem will be included. Publication is expected in print and ebook early next year.

I’m still feeling scattered, as though there is something else I’m supposed to be saying, but I want to get this out. Stay safe and be well!

DT and COVID

As I’m sure the whole world knows, the president of the United States is hospitalized with COVID-19. It’s been a bit difficult to get the straight facts on his condition, but it is increasingly looking like his case is on the more severe side.

He does have multiple risk factors, including his age, gender, and weight. He is being treated aggressively by his medical team, including with an experimental antibody treatment and with remdesivir. These are both given early in the course of the disease to help the body fend off the virus.

Today, though, it was revealed that the president is being given the steroid dexamethasone, which is usually given only to more severe cases later in the disease course, when there are significant lung complications and/or the need for a ventilator.

The medical team is even talking about the possibility of discharging him back to the White House, which does have its own sophisticated medical unit, tomorrow.

This doesn’t seem to add up. If his condition warrants dexamethasone, it would seem best to keep him in the hospital for close observation.

Another concern is that days seven through ten of COVID often see an exacerbation of symptoms. The president is only on day four. It seems it would be much safer to keep him in the hospital. It’s not as though he is cramped for space or lacking amenities in the presidential suite at Walter Reed; besides medical care, it also has its own secure conference room and kitchen/dining space.

I also wish that the president would temporarily sign over powers to Vice-president Pence in accordance with Article 25 of the Constitution. We know that the president has suffered with a high fever and times when his blood oxygen level has dropped below normal. COVID is nothing if not unpredictable. Foreign powers could take a provocative action, surmising that the president would not be well enough to respond appropriately. I think it would be safer for the country to have the vice-president, as long as he remains well, exercise the presidential powers until the president is fully recovered. Pence can always confer with president when his symptoms are well-controlled, but he would have the power to respond on his own if the president were to be unwell when a crisis arose.

The president and First Lady’s illness with COVID would be problematic enough, but a number of senators and other government and campaign staff and advisors have also been infected or exposed. Because the incubation period can extend to fourteen days, there are many people who should be in quarantine to make sure they don’t expose others while pre-symptomatic or asymptomatic. Somehow, despite the seriousness of the situation, Sen. Mitch McConnell plans to push ahead with the confirmation hearing of Amy Coney Barrett to the Supreme Court. He considers that worth the risk, while he won’t put the latest House-passed coronavirus relief package up for a vote.

Voters, pay attention to how candidates on your ballot are handling this health and governmental crisis. Are they prioritizing your and the country’s health and well-being or their own power?