post-vaccine life

With my immediate family in the US vaccinated against COVID-19, we are inching our way back to a more interactive life while still following the national and New York State guidelines.

The most important thing that has happened for us personally is a greater ability to see my dad, known here as Paco, who lives nearby in the assisted living unit of his long-time senior community. After months of not being able to visit, we can now go to his apartment, albeit in pre-arranged thirty minute slots. I can also sign him out to go for a car ride; previously, he was only allowed away from the unit for medical care.

This has meant that I can see him more times per week and that I can take him out for treats. Last week, we went to an ice cream stand in the afternoon. This morning, I was able to bring him to get a doughnut and coffee. We are still being cautious about indoor spaces, so I don’t bring him into buildings. We enjoy our treats in the car or at outdoor tables.

The best thing, though, was that my older sister and her spouse were able to come visit for a couple of days last week. They hadn’t been able to visit since last summer. They live in Maryland and couldn’t enter New York until recently due to our travel/quarantine restrictions. Because of the vaccines, those have been relaxed. With all of us vaccinated, we were able to have everyone to our house for dinner. B made lasagna from Nana’s recipe, homemade Italian bread, sautéed asparagus, and apple pie. It was all delicious – and extra heartwarming to be together after so many months apart.

We are also starting to work our way back to activities like dining indoors. I’ve had one lunch and one dinner inside restaurants. We wore masks when not eating or drinking and the tables were spaced so that we weren’t very close to other diners. We are likely to continue doing carryout more often than dining in for a while, especially because dining in most likely involves having to make reservations while carryout is easier to do spur-of-the-moment.

There was just a national policy announcement clarifying mask use recommendations for outdoor events in light of vaccinations. Vaccinated people can exercise, socialize in small groups, and eat outdoors without needing to wear a mask. They should, though, continue to mask if they are in a large group setting, such as a sporting event or concert where the crowd would be close together for extended periods. It is good to have this clarification, but it won’t make much difference for our family. New York has had a mask mandate in place for over a year, but it was adapted in order to deal with the circumstances. Given that we don’t live in a congested area, we were already accustomed to taking maskless walks in our neighborhood. If we stopped to talk to someone, we would just keep six feet of distance between us. Still, it was good to see that there are now different recommendations in place for vaccinated and unvaccinated people. Perhaps it will serve as motivation for people who haven’t yet been vaccinated to arrange to do that. In many locations, you don’t even need to make an appointment in advance.

If people need more motivation to get vaccinated, they can switch on a news report from India to see the horrific toll that the virus takes when it sweeps through an unvaccinated population. The infection and hospitalization rates are staggering. A new variant has emerged and there are so many deaths that the system to handle them is overwhelmed.

This virus remains very dangerous, capable of inflicting serious illness and death. The vaccines are safe and very effective. Everyone aged sixteen and over in the United States has access to vaccine and should be immunized unless there is a personal medical issue that precludes it. If you don’t feel personally vulnerable, remember that, even if you yourself don’t get severe symptoms, you could pass the virus on to someone else who could become very ill or die.

The only way to end the pandemic is for there to be large-scale immunity everywhere. Every effort we make, whether it is our individual vaccination and precautions or our large-scale efforts such as sending vaccines, treatments, and supplies wherever they are needed around the world, is part of what is needed to end this.

And remember: People taking vaccines approved for emergency use are not “guinea pigs.” The “guinea pigs” are the hundreds of thousands of people like me and my family who volunteered to be in clinical trials. (B, T, and I are all part of the Pfizer/BioNTech phase III trial. I’ve posted about it a number of times over the past months.) Government agencies and the pharmaceutical companies are continuing to collect data and have affirmed that the dangers of contracting COVID are much, much greater than any side effects of the vaccine.

Please, everyone do your part to keep yourself and others safe. Vaccinate, mask, distance, and practice good hygiene. Pay attention to credible medical and public health sources. The rewards of being able to safely gather, to give a hug to a loved one, to see a friend’s smile are simple, yet profound.

We just need to work together to make it possible for everyone, everywhere.

vaccine update

Here in the United States, we are continuing to roll out coronavirus vaccines as quickly as possible, although there are a few snags.

The biggest is that the one-shot Johnson & Johnson vaccine is on temporary pause, due to six cases of a rare blood clotting problem that have been reported among women aged 18-48 within two weeks after vaccination. Given that over six million doses have been administered, the percentage affected is tiny, but the two agencies in charge are being cautious, especially as a small number of similar cases have been reported in Europe in connection with the Oxford/AstraZeneca vaccine, which, like the J&J, is an adenovirus-based vaccine. The pause is allowing them to gather and assess data. Additional cases may surface because of the attention this is receiving in the media. It also lets physicians know to ask about vaccine status when a patient presents with blood clot symptoms. This is important because vaccine-related blood clots call for a different treatment regimen. The hope is that the J&J vaccine will again be cleared for distribution within the next two weeks.

The public reaction has been mixed. Some people say that this pause shows how closely public health officials are tracking the various vaccines and their effects, which raises their confidence level. Others are worried that this means the vaccines weren’t sufficiently tested. A few who have received the J&J vaccine are panicking.

As someone who has been involved in vaccine trials, currently the Pfizer/BioNTech coronavirus vaccine but previously trials for flu, adult RSV, and pneumonia vaccines, I can attest that researchers are very careful in how they conduct trials. However, when you have a side effect that seems to appear in such a small number of people, you are unlikely to find it in a trial of thirty thousand people. If it turns out that the blood clot complication does occur, a person is more likely to be struck by lightning than to develop a blood clot after J&J vaccination. I hope this would calm anyone who is panicking, although people often fear rare events while ignoring those that are much more likely to impact them.

I admit that it boggles my mind that, with over thirty-one million known COVID cases in the US and over 565,000 deaths, people would fear an extremely rare side effect more than the virus itself. There are still about 25% of adults who say they will not get vaccinated, which raises the prospect that we won’t be able to stop community spread and end the pandemic because the pool of susceptible people will remain too large. Also, remember that some people who have been vaccinated may still be infected, but their chances of being severely ill are greatly diminished. Still, the way to end the pandemic is to have 85-90% of people vaccinated so that cases of the virus can be contained rather than spreading throughout the community.

It will help when those younger than 16 can be vaccinated. Pfizer has currently asked for permission to add 12-15-year-olds to those eligible after conducting a trial with that age group. Pfizer, Moderna, and others are also conducting research on the best dosages for younger children.

Meanwhile, research is continuing into how long immunity from the vaccine will remain strong. Spouse B and daughter T who received the Pfizer vaccine last August as part of the phase III trial are part of the effort to answer that question. The six month figures showed that immunity remained strong but they will be followed for at least two years to see how that may change with time. The Pfizer CEO Albert Bourla has said that he thinks a yearly booster is a possibility; they have begun studying this with phase I trial participants. We’ll see when B and T have their one-year follow-up in August whether or not they will have extended the booster dose study to phase III participants.

It is my sincere hope that by then we will have been able to fly to the UK to visit our family there and to meet granddaughter JG in person. While we are doing all we can to make that safely possible, it is frustrating to still see so many people not willing to cooperate with public health measures to keep themselves, their loved ones, and their communities safe using masks, distancing, limits on gatherings, vaccines, etc. to end the pandemic.

Yesterday, there was a Congressional hearing at which Dr. Anthony Fauci, one of the leading health officials in the country, was testifying. Rep. Jim Jordan illustrates the dynamic that has resulted in the unfortunate and dangerous politicization of the pandemic. This is a public health issue, not a “freedom” issue. Living in a free society does not mean that everyone is free to do or say whatever they want; we each have a corresponding responsibility not to cause harm to others or damage their rights and human dignity.

This brings me to my last point. The pandemic affects the whole world. Under the prior administration, the United States suffered terrible losses and did not contain the spread of the virus. Under the Biden administration, the US is making progress and has taken some steps to help the rest of the world in the fight against COVID. The US is now part of the COVAX initiative to help distribute vaccines to lower-wealth countries, although this is just getting underway. It has also sent some of its stockpile of the AstraZeneca vaccine, which has not yet been approved for emergency use in the US, to Canada and Mexico where it has been. While I expect the US to retain doses of approved vaccines as boosters, I’m hoping that once everyone who will accept the vaccine in the US has been vaccinated that we will distribute all the other doses to countries that need them, along with whatever other logistical and medical help is needed.

We can never end the pandemic until the virus has nowhere on the globe where it can run rampant. To me, this is a moral imperative. Others may be motivated by economic self-interest. Whatever the reason, it needs to happen.

New York State update

As you may recall, I post occasionally on New York State government and politics, especially as it relates to the pandemic. This has necessarily led to some reference to the investigations into Governor Cuomo. Many New York politicians of both parties have called on the governor to resign, claiming he can’t govern effectively under a cloud of suspicion, while the majority of New York voters say in public opinion polls that he should remain in office while the investigations continue.

Given Governor Cuomo’s high profile nationally, both as a leader on pandemic policy and as the chair of the National Governors Association, there has been national coverage on the allegations and investigations, although this waxes and wanes depending on what else is happening. When there is a lot of coverage of a mass shooting or trial or a major piece of federal legislation, we don’t hear about Governor Cuomo for a few days until things calm down and we are back to the question of how can he govern under these circumstances.

Meanwhile, he has been governing. There have been numerous speaking engagements at vaccination sites, especially those in high-need neighborhoods, in the continuing efforts to get as many people vaccinated as quickly as possible without leaving any demographic groups behind. This week, there was the announcement of a monument dedicated to essential workers who continued to serve the public while most people were encouraged to stay safe at home. Updates to COVID policies have been rolled out as data and conditions warrant.

Most significantly from the political standpoint, our state budget has passed. Unlike most states, the New York fiscal year starts April first, so the budget was a few days late being passed. While the governor’s office is heavily involved in budget process, the delay was due more to timing of the American Rescue Plan passage in Washington, which established how much federal aid was coming to New York, and to COVID, which complicated the negotiation process which usually happens in person. Unfortunately, the Speaker of the Assembly, our lower house in the legislature, tested positive for COVID during the negotiation process but continued to serve from home.

So, our state government continues to function, which is good as we are facing yet another critical time period with the pandemic. While the overall infection rate is still quite low, cases on average are rising with sizeable presence of the B.1.1.7 variant and another variant that first appeared in New York City. We are giving out the vaccine as quickly as we can get doses. Thirty-five percent of NYers have received at least one vaccine dose, with twenty-two percent fully vaccinated. That still leaves millions of people, especially younger adults, teens, and children vulnerable to infection, so we have to continue to be cautious with masking, distancing, and gathering size and conditions.

The newly passed state budget has money to help with public health efforts, in addition to rent assistance, increase education aid, and small business programs to help everyone in our pandemic recovery. It will take time and effort, but we will build back better, a phrase that Governor Cuomo was using before President Biden and that others in the environmental and social justice movement were using before the governor took it up.

SoCS: Who knows?

Who knows?

These days, seemingly no one.

I guess that is a bit overbroad. It depends on the context and what comes after the “who knows” bit.

If someone asks, who knows what the dinner plan is for tonight, there’s a pretty good chance that I would have an answer. I couldn’t tell you if the plan would have follow through, but I could at least tell you the plan…

The hardest questions are the “who knows why” variety.

Yesterday, the Capitol Police, who are the ones who guard the Congress in Washington, DC, lost another officer in the line of duty. A second officer is hospitalized and expected to recover.

The man who attacked the police with his car and a knife is dead and the news reports are full of questions about why he did this.

So, who does know why?

Perhaps, no one knows. Even if he were alive, he might not be able to articulate a reason, especially if he was suffering from mental illness.

Even without knowing, I hope that everyone will offer support to all the impacted families and work together to reach out to those who are suffering. I also hope that Congress will honor the service of the Capitol police who protect them and their families by expanding the number of officers and giving them more resources for training, equipment, and protection. Of course, we should also expand medical care, including mental health care, so that every person always has access to it.

We may not know why this happened, but we can work to make it less likely to happen in the future.

*****
Linda’s prompt for Stream of Consciousness Saturday this week is to begin a post with who or whom. Join us! Find out more here: https://lindaghill.com/2021/04/02/the-friday-reminder-and-prompt-for-socs-april-3-2021/

2019-2020 SoCS Badge by Shelley!

vaccines vs. variants

Right now, the United States is a place of both hope and fear regarding COVID-19.

The hope comes from the increased pace and availability of vaccine distribution. The two-shot regimens from Pfizer and Moderna and the single-shot Johnson & Johnson have all been approved for emergency use and are being distributed as quickly as possible. There have been over three million shots given daily in recent days. It’s possible that a fourth vaccine, a two-shot course from AstraZeneca may also receive emergency use authorization in the coming weeks. Approximately 29% of adults in the US have received at least one vaccine dose. While most states concentrated first on the older demographic and health care workers, eligibility has expanded to include medically vulnerable adults and middle-aged adults. In some states, the eligibility age has or will soon drop to 16 where Pfizer vaccine is available or 18 with the other two vaccines. Trials are underway to determine the appropriate dosages for younger children. New data have shown that the Pfizer and Moderna vaccines are 90% effective at preventing infection in real-world application; this expands the information from the trials which looked for COVID symptoms and could have missed asymptomatic infections.

There are problems looming, though. A significant proportion of adults say that they will not be vaccinated at all. There is also a political divide in evidence. A recent survey showed that 49% of Republican men are refusing the vaccine. It will be very difficult to halt community spread if so many millions of people remain unvaccinated.

This vulnerability is in addition to the fact that too many places have relaxed their rules about wearing masks, the size of public gatherings, and capacity of indoor venues. Travel within the US has skyrocketed, including air travel. Many college students have gone on spring break trips to warmer states and gathered in large crowds without masks. The majority of states are seeing their COVID cases rise. Yesterday, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said that she felt a sense of “impending doom” because cases, hospitalizations, and deaths are rising as restrictions have been lifted. She and other health experts fear that the US is at risk for a fourth surge. The protection of the vaccines won’t be able to keep pace with the virus spread by people not observing public health guidance on precautions.

There is also the problem of more infectious variants. The B1.1.7 variant is spreading rapidly in some regions and there is a separate variant that has been identified in the New York City area. While the current vaccines seem to be doing a good job preventing these variants, it will still be harder to stop community spread with the more infectious variants in circulation.

I urge everyone to get vaccinated as doses become available for their age group in their localities. Because spouse B, daughter T, and I all participated in the Pfizer/BioNTech Phase III trials, we are fully vaccinated, B and T last August during the blinded phase of the study and myself in February when the placebo group was offered the vaccine to join the study group on long-term efficacy. (There are numerous posts about our experiences with the vaccine trial if you type Pfizer in my blog search box.)

I appreciate the things that are easier to do now that I am vaccinated. The most important thing is that I am much less worried when I visit my 96-year-old father, know here as Paco. Paco is also fully vaccinated and, while I still follow the protocols to mask and distance, I am now allowed to visit inside his apartment in assisted living.

I took an unmasked walk outdoors with a friend. I have been able to do some health care visits in person rather than virtually. I go to the grocery store with just one mask instead of two. I went to mass in person for the first time in a year and have reserved a place to attend Easter Vigil Saturday evening. My fully vaccinated sister stayed overnight at our house where we could safely be together maskless.

She and I even ate at an indoor restaurant for lunch, masked when we were not eating. The restaurant had good table spacing; our region currently allows 75% capacity at restaurants and our community transmission rate is low. In general, we usually still order carryout, but I think in a few months we may be more comfortable with dining in on a more regular basis. One of the good things about living in New York State is that we have generally been cautious about public health measures and the extent to which certain activities are allowed. Extensive testing is being done so that, if the number of cases begins to rise, they can react quickly to dial back on activities to keep the outbreak from getting worse. Having seen this measured, data-driven approach work in New York, I am that much more worried when I see other places abandon mask mandates and capacity restrictions precipitously. It not only hurts their own residents but also people in other locations because travelers can bring the virus home with them.

I don’t know yet when I will be comfortable resuming travel. If we can continue robust vaccine distribution and infection rates are low, maybe B and I will be able to take a short trip together for our anniversary in June. I had hoped to return to North Adams for another private writing retreat this spring, but I need to see what happens with vaccine distribution and transmission rates over the next few weeks to decide if that would be wise.

Of course, the big prize will be when we can go to the UK to visit daughter E, son-in-law L, and granddaughter ABC and finally get to meet granddaughter JG in person. We are hoping it will be on or before her first birthday in August, but it is impossible to plan. While the UK has also been on a vigorous push for vaccine distribution and re-opening, E and L haven’t been eligible for vaccination yet and what the rules will be for summer visitors from the US is a mystery.

Still, we are closer to being able to go than we have been before and we have also built up our own capacity for patience. Love, care, and concern for others are great motivators to remain cautious and vigilant until the pandemic is truly over.

SoCS: the last year

I had planned to post about the pandemic anniversary today, so it was fortuitous that Linda took the occasion to have us write about our past year. She also gave us permission to edit if we chose, so this post will be only stream-of-conscious-ish. I’m hoping to only need to do light editing.

So, compared to most other people in the US, I have been fortunate over this pandemic year. My spouse B has been working from home so we didn’t take a financial hit. He and I and daughter T have been safe in our home. My state, New York, was initially hit very hard by the pandemic, although not as much so in my home region of the Southern Tier. While we did have a period of time as a local COVID “hot spot,” we followed the precautions on masking, avoiding gatherings, handwashing, etc. and stayed safe.

This is not to say that we didn’t have to make changes in our lives. T’s job search has been on indefinite hold. Grocery shopping and meal planning became a major endeavor for me, due to shortages and restrictions. Some of my poetry activities moved online, but the year hasn’t been as productive as I had hoped. The Boiler House Poets Collective annual residency at MASS MoCA was cancelled due to COVID, although I did craft my own writing retreat in North Adams in late summer which turned out to be a perfect time, given the sooner than expected fall surge. (Additional posts from that time are here and here.)

There are two big personal impacts for me as a result of the pandemic. The first is the separation from daughter E and her family, who live in London, UK. We visited in December, 2019, with plans for several 2020 trips, including a visit to meet our new grandchild, and a plan for them to visit us here in the States in December 2020. None of that happened, due to COVID. While we have been in touch virtually, we have all been largely confined to our respective homes. It’s been hard watching from a distance as they dealt with likely cases of COVID in their household at a time when there wasn’t even testing available unless one needed hospitalization. We missed granddaughter ABC’s third birthday and the birth of granddaughter JG. We missed ABC starting nursery school, which has been variously in person and virtual depending on how viciously the virus was spreading in London at any given time. JG is now seven months old and we have no idea when we will be able to visit. She may be a toddler by the time we get to meet in person.

The second personal difficulty has been trying to care for my almost-96-year-old father, known here as Paco. Before the pandemic, we visited him every day in his apartment in the independent living building of his senior community. His memory was poor, but we were able to keep him safe and on an even keel. Once the pandemic began, though, we needed to limit contact, so we reverted to handling most things by phone with screened staff handling some tasks that had to be in person. This proved to be difficult but when Paco developed a medical problem that required a few days in the hospital, it became impossible for him to be safe in his apartment. In December, he moved to the health care building, first for three weeks of rehab in the skilled unit and then permanently to the assisted living unit. This is where he needs to be at this point, but due to state COVID rules, it was very difficult to visit in person. I am happy to report, though, that yesterday and today we had our first visits to his new apartment; before that, we had to meet in the visitors room or do window visits where we spoke by phone on either side of a window. We still have to mask and distance, but we could at least organize and tidy his rooms for him.

The greatest difficulty that is more universal is the sorrow at the immense cost the pandemic has exacted. So much illness. So much death. So many without even the most basic essentials for a secure existence. So much social isolation. So many who risked their own health to meet the needs of others. In the United States, the bewildering politicization of the crisis.

As we have been commemorating this first anniversary of the pandemic, though, I am feeling hopeful. We are about seven and a half weeks into the Biden administration and vaccine distribution has seen a big boost. Although the number of cases, hospitalizations, and deaths is still much too high, it is lower than it has been in months. In New York State, we are able to continue our gradual, science-and-metrics-driven increase in public activities. I went to church in person for the first time in a year today. It feels like we are making real progress toward ending the pandemic.

Real hope after a year of fear.

I’m very grateful for the vaccines and the people who are being diligent in observing public health measures. I’m grateful that B, T, and I were able to be of public service as participants in the Pfizer vaccine trial, which I’ve written about frequently here at TJCM.

I admit the fear isn’t totally gone. It’s upsetting to see people who are ignoring public health advice still. Especially with so many variants of the virus active and so many people unwilling to be vaccinated, it’s possible the virus will start to surge again.

Still, for the first time, the hope outweighs the fear in my mind.

Please, everyone, be careful. Stay safe. Protect yourself and your neighbors. We can end the pandemic after this awful year.

Together.

*****
Linda’s prompt this week was to write about our experiences over this last pandemic year, stream of consciousness style or not, or “day/week/month/year.” I chose the first option. Join us! Find out more here: https://lindaghill.com/2021/03/12/the-friday-reminder-and-prompt-for-socs-march-13-2021/

more good vaccine news

An update to my last post on coronavirus vaccines in the United States:
The Johnson & Johnson vaccine did receive emergency use authorization over the weekend and is currently being distributed. Because the company had manufactured some doses in advance through Operation Warp Speed, there will be some large shipments going out followed by a lag as Johnson & Johnson ramps up their manufacturing operations.

President Biden announced on Tuesday that another large pharmaceutical company with vaccine expertise, Merck, will be helping Johnson & Johnson to manufacture its vaccine. Merck ended a couple of vaccine trials it was conducting due to ineffectiveness and will be aiding the country in manufacturing its rival’s vaccine under the Defense Production Act. This Act is also being used to increase production of other needed items, such as vials.

Unlike the Pfizer/BioNTech and Moderna mRNA vaccines, the J&J vaccine is a more conventional vaccine, using inactive adenovirus to carry the vaccine into the body and activate the immune system. It only requires one dose and can be stored at refrigerator temperatures, so it is much easier to distribute to more rural areas.

While President Biden had previously said that any adult who wanted to be vaccinated would be able to be by the end of July, he now expects that to be possible by the end of May. This would allow most of us to resume what we have been calling “normal life,” although I think that some changes from our old ways of doing things will probably be in evidence indefinitely.

However, there are some big ifs. The first is that individuals would need to almost universally accept the vaccine to prevent it spreading in the community and to minimize the impact of new, possibly more dangerous variants. This would need to happen in every state – and in every country, if unrestricted international travel is allowed to resume. The second is that people would need to continue masking, distancing, limiting gathering size, etc. until most of the adults in the community were immunized or could be rapid-tested to show they were not likely currently infectious. New York is currently piloting holding sporting events using technology to screen for immunization/negative tests to allow higher occupancy for fans.

Another consideration is teens and children. Currently, only the Pfizer vaccine is authorized for use in 16- and 17-year-olds; it is currently being tested in 12-15-year-olds with plans to test in younger children after that. Other companies are also now beginning to study their vaccines in children and teens. Wide adoption of the vaccine among adults is the quickest route to protecting children, given that widespread vaccine use is unlikely for them until 2022.

The wild card continues to be how long-lasting vaccine effects are and how well they prevent serious illness from current and future variants. To that end, spouse B and daughter T are having blood draws this week to evaluate how their immunity is holding up as part of the Pfizer Phase III trial. They received their immunizations in August 2020 and will continue as part of the study into 2022. It’s also possible that Pfizer will be piloting the use of booster shots or of new vaccine formulations to better deal with variants, using the subjects already enrolled in Phase III. They have begun some of this research with Phase I/II participants.

Other vaccine researchers are continuing to study boosters and new vaccines, as well as longevity of immunity. Part of the story about Merck helping to produce the J&J vaccine and other similar partnerships around the world is that the extra doses may be needed as boosters in the future. If not, the surplus vaccines can be distributed through the COVAX initiative internationally to reach underserved populations.

All in all, it’s a hopeful time, but only if people are informed, thoughtful, and community-minded. Please, observe safety measures, get vaccinated when it is your turn, and be kind. We can end the pandemic sooner if we all work together.

Governor Cuomo

During the pandemic, I have listened to dozens and dozens of press briefings with New York Governor Andrew Cuomo. I appreciated his updates on COVID, the latest medical findings, and what New York was doing to address the illness and all the other issues that arose from it. I live in upstate New York, so the information he provided was especially relevant to me, but there were many around the United States and even abroad who tuned in.

In recent weeks, there have been legislators and press members who have been critical of the governor and his administration’s handling of the reporting of deaths in relation to nursing homes. The state reported deaths by where they occurred; people who died in hospitals were reported as hospital deaths, even if they had been nursing home residents prior to hospital admission. This was the state’s consistent practice and one which was straightforward and easy to compile from death certificates. All COVID deaths in the state were reported, categorized by place of death.

The problem arose because legislators and the press wanted to know how many nursing home residents later died in hospitals and how many formerly hospitalized patients died in nursing homes. This information is more difficult to compile and the governor’s staff, who worked seven days a week for months on end, did not have time to comb through all the records to assemble a report. Unfortunately, this was perceived as a cover-up of something nefarious and things have gotten totally out of hand with accusations flying everywhere.

I am annoyed at those in the legislature who are upset with the governor over this. When they requested the information they were not in session. Like many states, the New York legislature only convenes part of the year, usually January through June. If the legislature wanted this information, they could have offered to have the legislative staff compile it, rather than expecting the executive staff to add it to their already long list of duties.

There has also been questioning of the state policy to release COVID patients to skilled nursing facilities after hospitalization, especially in spring 2020 when the virus was so widespread in New York. This was based on federal policy. It got patients who had recovered sufficiently out of the hospital, putting them in a more comfortable, less risky environment while freeing up hospital space for more critically ill patients. Although these discharged patients were likely no longer contagious, the nursing homes had to be equipped to place them in isolation. Because I was listening to Governor Cuomo’s press conference every day, I knew that, contrary to some reporting at the time, nursing homes were not “forced” to take patients; they only accepted them if they were equipped to do so. Somehow, this morphed into stories that COVID was introduced into nursing homes by these recovering patients. In truth, COVID entered the nursing homes through staff who were living, shopping, etc. in the local community.

I am not an uninterested bystander in this case. My father lives in a senior facility which has been operating under COVID precautions for almost a year now. Despite that, they have lost at least six residents to COVID and have had more infections from which residents were able to recover. The cases originated from the outside community, not from a resident discharged from the hospital. The staff of the facility is tested at least weekly and screened for symptoms daily, but, as we know, the coronavirus is virulent before symptoms and before it shows up as positive in a test, so staff have unknowingly exposed residents, their families and co-workers.

Somehow, it has become easier to just blame Governor Cuomo. The legislature is threatening to revoke the emergency powers it granted to the governor to handle the pandemic, which is their right to do. However, if they do that, they had better be prepared to remain in session and react quickly to changing circumstances with disease variants, vaccinations, etc. The New York state legislature is not known for being agile – or even functional a great deal of the time – so they had better think carefully before they vote. It’s a lot easier to complain than it is to govern.

There have also been complaints of the governor bullying people and recently of sexual harassment. I am not commenting on those accusations at all as I have no basis to judge their veracity. I did want to address the reports on deaths and nursing homes because those are matters of public record and were clear to me as they were unfolding. Suffering the loss of a loved one is difficult enough without having questions about the circumstances of their death circulated in the press.

good news, bad news, and uncertainty

Yesterday, I got my second dose of the Pfizer/BioNTech coronavirus vaccine as part of their ongoing Phase III trial. As I have written about previously, spouse B, daughter T, and I are all participants but they both received the vaccine last August, while I was in the placebo group. After the vaccine received emergency use authorization, Pfizer unmasked the study so that placebo group folks could receive the vaccine as well, which I gladly did.

B and T both had a day after their second vaccination that they didn’t feel very well, so I planned today as a down day for me. I do have a sore arm, headache, some body aches, fatigue, and a low-grade fever, but ibuprofen and rest are helping somewhat. Only a small minority of people have this level of side effects, but I am more than willing to not feel well for a day in order to have as much protection as I can from the severe form of COVID-19. While the science is not yet clear if the vaccine prevents asymptomatic or mild disease, the data show that moderate and severe cases that lead to hospitalization and/or death are rare.

I am grateful that Paco was among the first at the Health Center in his senior residential facility to receive the vaccine. Two weeks from now, when I will be considered to have peak immunity, it will ease my mind when I am allowed to meet with him indoors to know we are both fully vaccinated. We will still need to wear our masks and keep some distance, but it will feel safer than it has over this past year.

More good news on the vaccine front is that Pfizer and Moderna have been able to ship more doses of their vaccines than they had previously and that the Biden administration has improved distribution in conjunction with the states and local pharmacies and health centers. Pfizer has applied for permission to store its vaccine at regular, rather than ultra-cold, freezer temperatures for up to two weeks, which will make distribution easier. Another positive development is that the Johnson & Johnson vaccine candidate may receive emergency use authorization as early as this weekend. It is a one-dose vaccine that can be stored in the refrigerator, which will make distribution in rural areas and neighborhoods without good transportation options much more effective.

The worry, though, is that more variants of the virus are appearing. Some of them are more easily transmitted and may cause more severe disease. It’s not clear how well some of the vaccines work against some of these variants. It’s also not always apparent which variants will become widespread. For example, a new variant has been identified in New York City, but no one knows if it will become dominant, cause greater sickness, or be prevented by the vaccine.

To combat this, both Pfizer and Moderna are looking at changing their mRNA vaccines to account for new variants, as well as studying if a third dose – or even an annual booster – might be necessary to tame the coronavirus and keep it at bay. It’s part of the reason that it is so important for the Phase III trials to continue collecting data, so we can keep immunity levels in the populations as high as possible.

For now, I’m resting, cuddled under a black fleece throw that the clinical research center gave me, with their name embroidered on it, of course. While study participants do receive a stipend, they also occasionally receive little gifts and it’s nice to have this throw to keep me warm today. The best thing, though, is knowing that the vaccines are helping people and that, despite the uncertainties, we are gaining ground in the battle to end the pandemic.

There is still a long way to go and I beg people to continue to wear masks, keep appropriate distance, wash their hands, and avoid large gatherings. Get whatever vaccine is available to you when it is your turn. Check on vulnerable people in your community to see if they need help to stay safe. Support efforts to get the vaccine to vulnerable people around the world.

It takes all of us working together to end the pandemic and rebuild our communities.

Lessons (re)learned

I’ve spent the bulk of my time over the last (more than I care to tally) years taking care of various generations of my family, which has involved a lot of interfacing with medical, educational, financial, insurance, religious, and other institutions. Since mid-December, I’ve been mired in dealing with issues around Paco’s health and his move from his independent living apartment into the assisted living unit of his senior community via a hospital stay and a stint in the rehab/skilled nursing unit. There has been an avalanche of problems with medical and caregiving issues, as well as the seemingly more mundane issues of changing addresses, getting mail forwarded, etc.

The intensity of it all has reminded me of lessons I once knew about dealing with institutions, but had managed to forget until they were in front of me, again and often. A caveat on the following list: some institutions or, perhaps more precisely, some individuals within the institution do manage to react both competently and compassionately to individuals in difficult circumstances, but this is more the exception than the rule in my experience.

  1. Institutions are set up to deal with things that fit a certain pattern. If your situation is different in some way, they don’t adjust well – or at all.
  2. Institutions care more about their rules, dogmas, and self-perpetuation than they do about you. This holds true, sadly, even for medical, caregiving, and religious institutions.
  3. Institutions are slow to react to changing circumstances. An example: insisting that you have a special form notarized in order to process an address change, even though you are already sending them a durable power of attorney and a death certificate proving that you have legal authority to do so, when, during a pandemic, this adds personal risk to their client and the notary.
  4. When an employee of the institution makes a mistake, the person can follow those instructions to the letter, but the consequences of the mistake will redound to the person or their loved one. The institution will not make allowances for their employee’s mistake and make things right, even though you were acting in good faith and doing what you were told to do.
  5. Lots of balls get dropped. You can been assured that thing X will take place tomorrow, only to find out the next week that it hasn’t – and that no one remembers that it was supposed to have taken place.
  6. It’s very difficult to get accurate information through when it needs to be relayed through multiple people. I can’t tell you how many times the answer to my question has no bearing on the question I actually asked.
  7. People hear what they want to rather than what you actually say. This is a corollary of point 1.
  8. Institutions don’t want to accept responsibility for their decisions, policies, and errors. They will blame you or the computer or something other than themselves. In New York State, they often blame Governor Cuomo.
  9. Institutions are defensive. A neutral re-telling of facts can be taken by an official as an accusation. This is a corollary of point 7.
  10. Institutions think they know more than you do. Sometimes, this is true. However, it is not true that they can understand someone as well after fifteen minutes of interaction as you do after knowing the person for years/decades.
  11. Having to do everything at a distance makes it harder. While some things are best handled electronically or in writing, others are easiest to take care of in person. One particularly gut-wrenching aspect of our current situation is that we can’t see Paco in person, so we can’t keep on top of what parts of his care plan aren’t being consistently followed. When I do see him and see that he hasn’t shaved for several days, it’s very disconcerting, knowing that someone is supposed to be helping him with that daily and that he isn’t able to articulate that to me or the staff himself. See points 4,5, 8, and 9.

I wish I could say that my relearned lessons made things easier or less upsetting, but they haven’t. I’m tired and frustrated and dreading the next set of problems/tasks awaiting me this week added to the unresolved things from last week.

Wish me luck.

I need it.