build back smarter

The United States is having a rough couple of weeks on the hurricane front. First, Fiona caused major damage in Puerto Rico, and now, Ian has cut a huge swath of destruction across Florida and is making a second landfall in South Carolina.

There have been massive flooding, wind damage, and major infrastructure impacts, including roads, bridges, and electrical, water, and communication systems. Sadly, there have also been injuries and deaths attributed to the storms and their aftermath.

Aid is being rendered by governments at all levels, by utilities, by charitable organizations, and by volunteers.

After the immediate emergency needs are met, attention will turn to rebuilding.

The first question to ask is “Should we?” There are places where the answer may be “No.” I’m thinking about places like barrier islands and directly on shorelines that are geologically unsuitable, being vulnerable to both storms and sea level rise. Further, the sand that characterizes these areas is meant to move and their natural structure serves to help protect inland areas from the worst of the storm surge and winds. Building there is asking for trouble and re-building there is setting up for losses in the future. With stronger and more frequent storms forecast due to global warming, it may be wisest at this point for government and insurers to buy out property owners in these vulnerable places so that homes and businesses can move to safer locations inland.

In other places, rebuilding may be possible but with much stricter requirements. For example, buildings can be elevated so that flood water can rise beneath them without damaging living space. Structures can be designed to be wind-resistant so roofs don’t blow off during storms. Mobile homes, unless they really are mobile, i.e. on wheels so they can be easily relocated away from danger, should not be allowed at all in storm zones.

It’s vital to rebuild infrastructure with resilience in mind. Five years ago, hurricane Maria destroyed the power grid in Puerto Rico. It was still fragile when Fiona hit but locations that had switched to solar power with battery backup were able to keep their power on. Tropical coastlines are great places for solar power and also for offshore wind, which could have the added benefit of reducing wind speeds from storms.

These changes won’t be easy but they are necessary. The alternative is to continue the cycle of destruction and expensive rebuilding over and over again.

Some of you may be thinking that I don’t understand the difficulty and trauma of leaving a beloved location instead of trying to rebuild there, but I have seen it up close in my town. After the last two record floods of the Susquehanna in 2006 and 2011, many people here faced the decision to rebuild in the same place, perhaps with elevation, or move elsewhere. If people took buyouts, the sites of their former homes were converted to greenspace. There are two neighborhoods near me that are dotted with these lots that used to be homes and yards.

My family lives with the realization that our home, on which we carry flood insurance even though we are not technically in a flood zone, could be impacted in the next record flood. (We are just a few blocks from places that flooded last time.) Depending on the damage incurred, we could be faced with the same decision to take a buyout or repair and elevate our home. It’s painful to think about and I don’t know which we’d choose.

We’ve been here for over 35 years. It would be hard to leave the neighborhood. I do know, though, that we wouldn’t ignore reality/risks and try to rebuild as we are now.

I opt for safety over sentiment.

COVID bivalent boosters

As you may recall, spouse B, daughter T, and I were all participants in the Phase III clinical trial for the COVID-19 vaccine from Pfizer/BioNTech. We then all participated in a follow-on third dose trial. B and I left the trial this spring because we were eligible to receive a fourth dose and wanted the extra protection before travelling. T stayed in the trial until its end earlier this summer.

Here in the United States, a new booster was recently approved which combines the original formulation with a new one designed to better combat the Omicron BA.4 and BA.5 variants. BA.5 is the dominant variant currently in the US, accounting for about 88% of cases. About 11% are caused by BA.4. The new booster is expected to strengthen protection against serious illness/death and, one hopes, cut down on symptomatic infection somewhat, as well.

Given that I am still trying to remain COVID-free and that I have several trips coming this fall, I decided to receive one of the new boosters at my local pharmacy. I chose to receive the Pfizer formulation because all my others have been theirs, although there is a Moderna version which is also a fine choice. This was my first time receiving the vaccine in a pharmacy setting. My prior doses had all been in a medical office or a state vaccination site. I made an appointment online and everything was very fast and efficient.

Dr. Ashish Jha, who is the White House COVID-19 response coordinator, and Dr. Anthony Fauci, the long-time director of the National Institute of Allergy and Infectious Diseases, have said that it is possible that we may have reached a point where an annual booster will be enough to protect the vast majority of Americans from serious illness/death from COVID, similar to annual flu shots. Some people who are especially vulnerable due to age or medical condition might need more frequent boosters. The wild card, though, would be the emergence of a new strain that could evade our antibodies and current vaccines.

So, my message is to receive one of these new boosters as soon as they become available wherever you are. The US has been first to authorize them, but it seems they will become more widely available globally soon. Remember, though, that these are booster doses given to people who have already completed an initial vaccine series. If you haven’t completed an initial vaccine series, start NOW!

Meanwhile, here in Broome County, our community risk level is still medium. While I wait for the new booster to take full effect, I will still mask for indoor gatherings and shopping. I’ll be evaluating what to do after that, although these boosters are so new that data may be hard to come by.

I hope to stay well and hope that you do, too.

One-Liner Wednesday: Pakistan

A third of my country is under water right now – bridges, roads, schools, and other critical infrastructure sinks, and people run to evacuate their homes.

Anam Rathor, writing about Pakistan in this important post

Note: In the comments, there is a link to a post from Sadje with information on organizations that are helping Pakistan. Check it out here: http://lifeafter50forwomen.com/2022/09/07/my-country-needs-your-help/ and help if you are able.

Join us for Linda’s One-Liner Wednesdays! Find out more here: https://lindaghill.com/2022/09/07/one-liner-wednesday-alert-creature/

still COVID

I’m sad to report that the total death toll in the United States from COVID-19 is now over 1.04 million with over 93 million confirmed cases. The actual case count is no doubt higher, as some states have stopped reporting and many cases that are detected by at-home testing are not reported to health agencies at all. New cases are still occurring at a rate of 93,000 a day with 457 deaths (7-day rolling average on August 22, 2022).

It’s still heart-breaking.

And still considered by most experts a pandemic, although perhaps heading in the direction of being considered endemic in the United States soon, as influenza is.

Most cases in the US now are Omicron variants BA.4 or BA.5. There is some hope that new boosters that contain components targeted at Omicron variants might give some additional protection going into the fall and winter, especially against hospitalizations and deaths, but we will have to see if a) people actually get vaccinated and b) the vaccines do boost protection for any length of time.

And/or c) a new strain could develop that evades all prior immunity, is even more wildly contagious, doesn’t respond to current treatments, and/or causes more severe illness.

At home, B, T, and I all still remain uninfected to the best of our knowledge. It’s possible that one or more of us have had an asymptomatic case but there is no real way to know. Any time that we have had symptoms, we have tested, as we have also for travel and after known exposures. We also have had extra tests as part of our participation in the Pfizer/BioNTech vaccine trials. T remains a participant in the third shot trial; B and I exited the trial in order to receive a fourth dose before travelling to the UK this spring. I believe that our vaccination status has helped us to avoid infection and plan to receive one of the new booster shots this fall, if I’m eligible for what will be my fifth dose. T may be eligible for a booster after she finishes with her trial participation this fall if those boosters are available to people under 50.

Broome County, New York, managed to have only a few weeks in the Centers for Disease Control category of low community risk for transmission before going back up to medium. I’ve gone back to masking with a KF94 while shopping or in other indoor public places. I’m making determinations on small gatherings on a case by case basis. Other than church services, I’m avoiding large gatherings.

Some people think I’m being overly cautious at this point but I am still trying to avoid infection, if I can. At the very least, if I do become infected, I will know that I was doing everything I could to keep myself healthy so that I don’t suffer guilt on top of COVID. I am well aware that, even with multiple vaccine doses, masking, avoiding crowds, etc., Omicron, especially BA.5, has been quite successful at evading immunity and protections. I know from what the public health experts are saying and also anecdotally among my friends. There are very few left who have managed to stay COVID-free in recent months.

A large part of my motivation to keep from getting infected is fear of long COVID. While SARS-CoV -2 is too new a virus for researchers to fully understand, it’s possible that I may have some genetic risk factors that could come into play regarding long COVID. None of this is helped by the fact that the underlying medical conditions I have are themselves not well understood.

So, I’ll keep on doing the best I can to stay as healthy as possible.

Wish me luck.

I’m going to need it.

heatwave kitchen

I did something I seldom do this morning.

I wore an apron.

Like many other locations in the Northern Hemisphere, this week we are having a heat wave. It was already 90 F (32 C) by 11:00 AM, so two hours before solar noon, given Daylight Saving Time. Not quite as bad as daughter E in London which set an all-time record at 40 C (104 F) earlier this week, but hot enough that I wanted to get kitchen work that involved heat out of the way this morning.

When I was at the farmstand earlier this week, they were selling beets for only a dollar a quart, so I bought some to roast. I decided to peel and cut them in chunks before roasting. Because I didn’t want to risk splattering my cream and blue print sundress with red beet juice, I donned the apron that B wears sometimes when he is baking.

While the beets were roasting, I made cooked butterscotch pudding for a pie. When I was growing up, my mom used to make pudding pies or sometimes fruited jello pies in the summer. I think that it isn’t a very common practice anymore because there were no pie directions on the pudding package. I remembered the modifications well enough, I hope, that the pie should set. Bonus: I had a graham crust in the cupboard so I didn’t have to bake one.

Admittedly, I don’t have to worry about our kitchen getting unbearably hot because of our air conditioning, provided very efficiently by our geothermal heat pump system. (Geothermal heat pumps use much less energy than conventional central air systems but I wanted to get my electric cooktop and oven work done early so as not to add to the electricity burden which rises in the late afternoon/evening.)

As I keep hearing about people in Europe and the US suffering from extreme heat, my mind goes to heat pumps which will keep them warm in the winter without burning methane and safely comfortable in the increasingly hot summer heat waves, all while helping to combat the greenhouse gas emissions that worsen climate change. Bonus: Heat pumps can break the stranglehold that Russia and other oligarchies have over fossil fuels, promoting peace and economic stability. So much conflict has fossil fuels as an underlying cause. We would do well to stop using them as quickly as possible, so, for peace and the planet, let’s transition to heat pumps NOW.

Pfizer study exit

As you many recall, spouse B, daughter T, and I have all been participants in the Pfizer/BioNTech COVID-19 vaccine Phase III clinical trial since summer of 2020. B and T received the vaccine while I was in the placebo group, although I received the vaccine through the trial after the emergency use authorization came through. All three of us continued in the study of third doses.

I had hoped that Pfizer would extend our study to include fourth doses but they have decided not to do so. After researching and discussion with family and medical practitioners, I have chosen to end my participation in the trial early in order to receive a fourth shot, which I did on Saturday.

In the US at this point, government and public health officials are not making COVID policy as much as providing information for individual decision-making. I admit that this is frustrating as community behavior is so important with pandemics in general and the increasingly contagious omicron variants in particular. Emphasis has also shifted away from individual infection rates and toward making sure there aren’t enough serious infections to cause the health system to collapse.

My priority is still to try to avert infection. I don’t want to be sick if I can help it. While rates of hospitalization and death are low among those vaxxed and boosted, serious cases are still possible. While some are lucky to have no or mild symptoms, many still feel like they are suffering the worst flu/virus ever, being out of commission for at last a week. I am also concerned about the risk of long COVID, estimated to affect as much as thirty percent to over forty percent of total cases. Vaccination is estimated to halve the risk. (Please note that definitions of long COVID and the risk factors are currently in flux. As more data are collected and analyzed, these estimates will likely change.) Due to some factors in my family history, I may be at increased risk for developing long COVID. I also know that COVID infection can cause severe flares in people with interstitial cystitis, which I have.

I am very concerned about the possibility of inadvertently infecting others, including my family. I also have several immunocompromised friends who I want to protect.

Infection rates are high in my county now. I am continuing to mask in public and am back to avoiding crowds, including church services, concerts, and plays. Even with the high case counts here, most people are not taking precautions so I am being extra careful.

The boost to resistance to infection is likely to be short-lived, only a few weeks, but this is a critical time for me to have that extra protection. In mid-May, I am travelling to Northampton, Massachusetts to attend my 40th reunion at Smith College. The protocols there are strict, including mandatory vaccination and boosters, indoor masking, and many outdoor activities, so I feel relatively safe attending.

Ten days after my return, B, T, and I will travel to London, UK to visit daughter E and her family. Again, we will be very cautious with our behavior to avoid infection. We also want to protect our family, especially granddaughters ABC and JG who are too young to be vaccinated. JG is even too young to mask.

I’m happy to report that my side effects from my fourth shot have been mild, mostly a sore arm and a bit of tiredness.

I am grateful to Meridian Clinical Research who handled the trial locally and to Pfizer and BioNTech for developing the vaccine and getting it out to so many people so quickly. I am happy to have been of service by participating in the trial and stand ready to participate in additional clinical trials as they become available.

I will close with my accustomed plea for people to do all they can to end the pandemic with whatever means are available to them – vaccines, distancing, masking, avoiding crowds, increasing ventilation, etc. The pandemic is not over and our lack of attention only increases the possibility of new variants and extends the length of time before SARS-CoV-2 becomes endemic.

Covid red again

Like many places around the world, COVID cases are rising here in Broome County, New York (USA), so much so that we are once again in the highest risk category from the Centers for Disease Control and Prevention. Technically, the high risk category is now orange, not red, but I used red in the title of this post because it seems to be yet another “code red” to me.

Broome County is in one of the red zones with the Covid Act Now site that I use regularly. Our current rating is “very high,” the fourth of five levels. Our seven day average is 50.2 daily cases per 100,000 residents. This figure is likely an undercount, as not all people who test positive with a home test are contacting the health department or a medical professional to report the case or seek advice and treatment. UPDATE 4/19/22: The Covid Act Now site is now using the (much less useful) CDC rating system. Fortunately, the more granular data by neighborhood is still available, as are statistics like percentage of population with booster shots.

There are a number of factors involved in the current rise in cases. Our vaccinated and boosted rate is only 35.5% so we have many vulnerable people. (While it’s true that boosted people are still vulnerable to infection, they are much less likely to fall seriously ill with COVID.) It is also likely that we have cases of two new omicron subvariants that have recently emerged in central New York. While information is still being gathered, these may be even more wildly contagious than the previous versions of omicron.

You would think that our government officials would be re-instituting indoor mask mandates, but they have yet to do so. This is what I feared would happen. When the mandates were lifted, politicians and public health experts said they were doing it to give people a break while cases were relatively low so that they could bring mandates back if we had another surge, but only a few jurisdictions, like the city of Philadelphia, are actually following through.

Instead, government officials are relying on individuals to make their own decisions. The problem is that the majority of people in the US are not seeking out credible information about the risks in their localities. As a participant in the Pfizer/BioNTech COVID vaccine trial, I have been following the science closely. Discussions with my personal medical team have reinforced the wisdom of trying to avoid or, at least, continue to postpone infection. Nearly all the public health goals at this point are aimed at reducing serious infection, hospitalization, and mortality, but I also want to avoid illness, infecting others, experiencing long-COVID, and developing complications. I had continued to wear a KF94 mask in public and avoid crowds as much as possible, including singing masked for this performance and this video. With our current infection levels, we will most likely return to take-out dining only.

I did attend Easter Vigil last night, as I knew that it would not be very crowded, unlike the services today. I was masked but the majority of attendees were not. I admit that I cringed when I heard some very loud coughing jags near the back of the church. I was sitting near the front, so I was very far away from them, but I realize that many people are infected without knowingly being in close contact.

The ease of the spread of COVID was brought home to us over the last couple of weeks. B had gone into the office for the first time in over two years because they were having a new product launch. There was only a fraction of the workforce there, all of whom were vaxxed and boosted. Despite that, B got a message three days later that a co-worker with whom he had been conversing had developed symptoms and tested positive. B immediately masked at home and kept his distance from T and I. He did not go out in public and did self-testing. I am happy to report that we are now over ten days from his exposure with no symptoms or positive test, so he is in the clear, but the story illustrates how easily one can be exposed and risk unwittingly infecting others.

I’m not sure what additional actions I may need to take for my and my family’s protection. If the numbers stay this high, I may forgo attending mass in person and return to televised or recorded services until the numbers are better. I will probably try to speak to the local researchers in charge of the Pfizer vaccine trial to see if they are planning to offer a fourth shot to those fifty and older. The CDC has opened the option for our age group to receive a fourth dose but we need to follow the study protocols to remain enrolled in the study which is still ongoing with weekly symptom checks and periodic blood draws to check antibody levels, etc. B and daughter T received their third dose last July, while I received mine in October. We are all well beyond the four-month interval to be eligible for a fourth shot, although T is not old enough to qualify. At this point, we probably have decent protection against hospitalization but not not much against infection. It’s hard to say for sure, though, because B and T are part of the data set on which such findings are based. (I’m a bit behind them because I was part of the placebo group in the initial phase of the study, so I was vaccinated and boosted later than they were.)

I am hoping that this wave in the Northeast will pass quickly. I always hope for surges to pass quickly to reduce suffering but I have an additional personal reason this time. I am scheduled to attend my 40th reunion at Smith College beginning on May 12th. It’s the first time since 2019 the event will be held in person. It’s planned in a cautious way, with all participants required to be vaxxed and boosted, many events being held outdoors, and indoor masking requirements in place except while eating or drinking. Even with a surge, we should be okay to go ahead but it will be less stressful if the surge has passed by then.

So, once again, fingers crossed. I’m doing what I can to keep myself, my family, and my community safe. I urge all of you to stay informed from credible sources in your area and take whatever steps you can with vaccination, masks, testing, medications, etc. to get the virus levels down and protect public health and your own.

We know what can happen if we don’t pay attention and act. The United States is closing in on a million known COVID-19 deaths. It’s already a stunning level of tragedy here and around the world. Please do all you can.

One-Liner Wednesday: a find

An amazing find in the Antarctic: https://www.bbc.co.uk/news/science-environment-60662541.amp

Join us for Linda’s One-Liner Wednesdays! Find out more here: https://lindaghill.com/2022/03/09/one-liner-wednesday-in-the-light/

still masked

Last Friday, the US Centers for Disease Control and Prevention (CDC) changed their methods of assessing COVID risk to include the strain on the health care system, resulting in about 70% of the population now being classified as being in low or medium risk areas, meaning that indoor masking in public places and distancing measures can be rolled back.

However, Broome County, New York, where I live, is still in the high risk category. In the even more granular Covid Act Now tracker, our risk level is rated as very high, the fourth of five levels, with 26 daily new cases per 100,000 residents as of today, February 27.

The problem is that, when New York State rescinded its mask mandate, our local government also rescinded theirs. Our local conditions don’t warrant that, but, without a rule in place, the vast majority of people will not be masking in public, which will likely delay further progress in getting our case numbers down. Another thing that would help would be increasing our vaccine booster rate, which has crept up to 34% but is still low for our state, as is the 63% full vaccinated rate.

Earlier this month when New York dropped its mask mandate, I posted that I would continue to wear an N95 in public and to avoid crowds in an effort to stay COVID free. As a participant in the Pfizer/BioNTech vaccine trial, I am supposed to be following CDC protocols. With our county still being at high risk according to the current CDC map, I am still in compliance with my obligations to the trial.

The next decision point for me will be when Broome County finally gets into a lower risk category. In discussions with my personal physicians, they have advised attempting to avoid infection entirely for as long as possible. I share in this viewpoint. Many public health commentators have gone to the less stringent goal of trying to keep out of the hospital or dying from COVID and to prevent strain on the health care system. I, however, want to protect myself, my family and friends, and my community from being infected at all, so they won’t have to deal with the threat of severe illness, long COVID, and long-term cardiovascular, pulmonary, or neurological damage that can follow infection, even in those who didn’t have serious enough symptoms to warrant hospitalization.

The CDC does say in their guidance that “People may choose to mask at any time.” That will probably be me for quite some time yet, unless our county improves dramatically soon.

Lent is about to start. I’m trying to be hopeful that our situation will improve enough that I can safely drop my crowd avoidance in time to participate in some of the Lenten and Holy Week liturgies. We’ll see.

politics and/or science

Over the course of the pandemic, I’ve posted frequently about it, the Pfizer/BioNTech vaccine trial in which B, T, and I are participating, the evolving science on the SARS-CoV-2 virus and its variants, the similarly evolving public health recommendations, and how these are being implemented here in my home state of New York and elsewhere in the United States. I do sometimes comment on the pandemic in the UK and globally, but I know best what happens close to home.

Throughout the pandemic, New York had been in the vanguard of following the recommendations of public health experts, avoiding the tendency we have seen in so many other states to ignore the benefits of masking, distancing, limiting crowds, getting vaccinated, isolating if infected, etc.

That ended this week.

Governor Hochul bowed to public and political pressure and lifted the mask mandate for businesses. While it is true that statewide the peak of the Omicron wave has passed and the vaccination rate is decent, my county’s risk is still rated as very high, with 44.7 per 100,000 daily cases. Technically, New York as a state is also in the very high category with 31.2/100,000 today (February 11), but it is counties like mine that are keeping the state in that risk category rather than dropping into the (merely) high category. Medium and low risk are a long way off at this point.

Meanwhile, the national Centers for Disease Control and Prevention are recommending not only that everyone age two and over wear a mask while in public but also that those masks be N95 or similarly protective types because Omicron is so highly contagious. Alarmingly, an even more contagious omicron sub-variant has reached the US, making protective masks that much more important.

Does this sound like the proper time to end mask mandates for businesses in New York State?

Certainly not, if one is truly following the science.

The problem is that many people are tired of having to deal with the pandemic and are complaining very loudly. The politicians who had been following the science hear them and loosen the rules that had been helping to get their residents through the current wave with as little hospitalization and death as possible. This could extend the current omicron wave and increase the likelihood of yet another new variant that has the potential to be even more transmissible or evade current vaccines and treatments or cause more severe disease.

Regardless of New York State rules, I am continuing to follow medical advice, to avoid crowds, and wear an N95 when in public. Because I am vaccinated and boosted, I will still visit with people who are similarly protected without a mask. I had hoped to return to church services this weekend but have decided that I can’t do so with the daily case rate still being so high; being stationary in a room with that many people for over an hour is too much risk for me, even masked.

Sigh.

At some point, the pandemic will end and I will follow medical and scientific advice on what my “new normal” will be. I had hoped that our state policies would be an aid in this, as they had been through most of these past months, but that remains to be seen.

I’m just hoping that this latest relaxation of protections doesn’t cause even more cases than we have already suffered.

Update: Almost immediately after publishing this post, I saw reports of this study from the CDC, which shows that booster effectiveness wanes significantly after four months. Given that B, T, and I all had our boosters on the early side due to our participation in the Pfizer/BioNTech vaccine trial, I’m all the more resolute in my vigilance regarding masking, distancing, etc. While we are all still likely to avoid severe disease or hospitalization due to our longer-than-four-months-ago boosters, I prefer to try to avoid infection entirely.

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