What comes after emergency?

As someone who participated in a COVID vaccine clinical trial, who has other vulnerable people in my life, and who tries to be a diligent and responsible community member, I’ve been following the science, public health information, and news about the pandemic over these last, long 3.5 years. I’ve done so many blog posts about it, I’ve lost count.

As you may know, the World Health Organization and the United States are winding down their public health emergency declarations.

This does not mean, though, that the pandemic itself has ended. COVID-19 is still widespread across the world and hundreds die every day as a result. There is still the potential for new variants and COVID is not yet seasonal, like influenza. Eventually, COVID will become endemic, as the flu is, but we aren’t there yet.

While some US programs, such as tracking hospitalization rates and wastewater testing, will continue, others will end. I will miss the COVID maps and risk ratings that the CDC has been providing. Besides the overall community risk assessment, the transmission rate maps were important to me in deciding how much public masking I needed to do or whether large, indoor gatherings were advisable at all. It’s true that, with so many COVID cases discovered through home testing and never officially recorded, the statistics are not as comprehensive as they were during the months of testing centers, but, for example, it’s helpful for me to know that my county has a moderate transmission rate but the county to our east is currently at the highest transmission rate level, two notches higher than here. Having that information could inform a decision between using a drive-through or dining in on my way through the county, as well as alerting me that the higher infection levels could spread in my direction. After Thursday, that information will not be readily available to me.

I’ll still follow the science and public health advice as best I can and will get my next booster when recommended. I’ll test at home if I have symptoms and avoid being in public when I’m sick with anything, COVID or not. I’ll keep a supply of KF94 masks in my size nearby for high-risk situations that may arise. I’ll try to do all the things we should be doing all the time, like eating well, getting enough rest, and practicing good hygiene.

I still, though, don’t want to get COVID if I can help it. To the best of my knowledge, I’ve never been infected, although I could have had an asymptomatic case at some point. I know very few people who are in that category these days.

Will the end of the emergency declarations and the resulting decline in data be a factor in my eventually contracting COVID?

Impossible to predict, but fingers crossed.

COVID-19 origin stories

A leak of a “low confidence” assessment from the United States Department of Energy that COVID-19 originated from a lab leak in China has set off another round of upset.

The base problem is that no one has access to all the data to come to a definitive conclusion and likely never will.

Most epidemiologists, researchers, and US government departments think that the most likely origin is from markets in Wuhan that dealt with wild animals that harbored the virus which then jumped to people. This article in Science is representative of that opinion. The animal to human route is a common mechanism which we have seen with diseases such as ebola and SARS-CoV-1.

Rather than arguing about lab leaks, we should put our energies toward strategies that will help to avoid or contain future illnesses. Yes to tightening controls at laboratories doing research on pathogens. Yes to limiting exposure to wild animals that can carry diseases to humans. Yes to rapid response and open sharing of information about emerging diseases.

No to wild speculation that is not grounded in fact. For example, there is no evidence that SARS-CoV-2 was lab-engineered rather than naturally occurring. It is irresponsible to share disproven theories.

As I know from public health statistics and recent cases among friends, COVID-19 is still out there, sickening millions and adding to the global death toll of over 6.8 million people. Protect yourself in accord with your local conditions and resources. Vaccinate and receive the bivalent booster if it’s available. Increase ventilation in indoor spaces. Avoid crowds. Wear a high-quality mask indoors when transmission rates are significant. Wash your hands. Take extra caution if you or someone you live with or visit is especially vulnerable due to age, medical condition, etc. Make sure you have accurate, scientifically valid information behind your decisions. Be respectful of those who choose to mask in public. They are trying to protect themselves and their loved ones. It’s possible they are getting over an illness themselves and are being cautious in order to protect you.

At some point, COVID-19 will become endemic. We aren’t there yet. Do your best to be a help, not a hindrance, to that end.

implicit bias

Yesterday, I reported for jury duty, although I wasn’t chosen to be a juror.

After some initial paperwork, all the prospective jurors watched two short videos. One was the basics of court cases, which had been digitized from an older film version, making the audio and visual quality mediocre at best. The other was a very good video about implicit bias.

Implicit bias is the phenomenon of having unconscious thoughts or feelings about something or someone. The video pointed out that most of what our brains do every day is unconscious, ingrained from prior experience. For example, we don’t have to consciously reason out that you pour coffee into a cup rather than a shoe. Our unconscious mind knows what we need to do in most of our daily activities and can handle millions of details while our conscious mind can only handle a few dozen. However, our unconscious mind may also be the home of stereotypes of people of a certain race, gender, religion, occupation, socioeconomic group, etc.

The video was a very helpful reminder that we do need to consciously consider the influence our unconscious mind has on our thoughts and decisions, especially when dealing with new people and situations. During a trial, there are bound to be many instances of potential implicit bias. Do you trust a witness of the same race as you more than one of another race? Do you believe or disbelieve every word from a police officer because of the way you unconsciously react to authority figures?

I thought that the video did a good job of pointing out that everyone has implicit biases because everyone has an unconscious mind that is making it possible to function. The thing that is needed, during a trial and in everyday life, is to bring your conscious mind to bear on a situation and to ask yourself if your initial reactions are influenced by unconscious bias. The hope is that the recognition will make your judgments and actions fairer.

While I’m not acting as a juror this week, I will try to be more conscious of my own implicit bias in my daily life.

It will always be a work-in-progress.
*****
Join us for Linda’s Just Jot It January! Find out more here: https://lindaghill.com/2023/01/24/daily-prompt-jusjojan-the-24th-2023/

XBB.1.5

A new COVID subvariant has emerged here in the United States. It is designated XBB.1.5 and is considered the most transmissible Omicron variant to date by the World Health Organization. It is also considered to be highly immune evasive, which means it is more likely to cause infection among those who have COVID antibodies, whether from vaccines or prior infection. However, the vaccines should still be effective in reducing hospitalization and death rates from infection.

XBB.1.5 is especially prevalent in the northeastern region of the US. It is powering the rise in regional cases accounting for 72.7% of cases in the past week. It is also likely the driver behind Broome County, New York, where I live, again moving into the CDC’s high community risk level classification. (That will mean mandatory masking at our concerts this weekend.)

The XBB.1.5 subvariant orignated in the US, but has spread to some other countries. Meanwhile, China is suffering through a huge infection wave, although there is no reliable official data on its extent.

In many places, especially in the Northern Hemisphere winter, there are also high rates of flu and RSV.

As always, I’ll repeat my advice. Vaccinate, if you are eligible and vaccines are available to you. In particular, if you are eligible for the bivalent COVID booster, get it as soon as possible because it is much more protective against all Omicron strains than the original formulation. If you are sick, get tested. If you contract COVID or flu, immediately contact a medical provider to see if you can take antiviral medication to cut down on symptom severity. When there is risk in your area, use a high-quality mask in indoor public spaces and avoid crowds. Increase ventilation and/or air filtration indoors. Wash hands frequently and avoid touching your face (more for flu/RSV prevention than for COVID). Try to eat and sleep well. Look out for one another.

We need to work together for this pandemic to end. We are all tired of COVID but we need to fight effectively and continuously. Ignoring the risk and letting the virus spread just gives it even more opportunity to mutate and develop more virulent strains. We are now in our fourth year of the COVID pandemic. Let’s work together to make it the last.
*****
Join us for Linda’s Just Jot It January! Find out more here: https://lindaghill.com/2023/01/06/the-friday-reminder-for-socs-jusjojan-2023-daily-prompt-jan-7th/

two years into COVID vaccines

After yet another period of high community risk level for COVID here in Broome County, New York, we have just today returned to medium level. After a post-Thanksgiving spike in infections, we experienced a hospitalization spike which had increased our community risk level. With the US health system also dealing with an early, hard-hitting flu season and RSV, the dreaded triple-demic, in some areas hospitals are reaching capacity and sending patients to other locations. Additionally, infection rates are predicted to rise as family and friends gather for Hanukkah, Christmas, and New Year celebrations in the coming weeks.

This comes at a time when only 14.1% of people five and over in the US have received the new bivalent COVID booster, which was designed to better combat the Omicron BA.4/5 variants and is proving effective against the current dominant strains, BQ1 and BQ1.1, which are part of the BA.5 lineage.

Furthermore, a recent study indicates that the US vaccination program likely saved 3.2 million lives and prevented 18.5 million COVID-related hospitalizations. The vaccines are estimated to have averted nearly 120 million infections. Another recent study shows that in the two years of COVID vaccine availability in the US, the excess death rate among Republicans is significantly higher than among Democrats, mirroring the difference in vaccination rates, a sad reflection of the politicization and misinformation around vaccines by many prominent Republicans.

It’s horrifying.

The mistrust sown over the COVID vaccine among Republicans seems to be spreading to other vaccines as well. A newly published survey finds that over 40% of Republican or Republican-leaning respondents oppose requirements for the MMR (measles, mumps, rubella) for school children.

This does not bode well for public health measures. It’s frightening how many people will believe politicians or media figures rather than doctors and public health experts on these important issues. People have been infected because they weren’t up to date on vaccinations. People have been hospitalized, developed long COVID, experienced complications, or died at higher rates because they refused vaccines or boosters. The data show this.

Please, get a bivalent COVID booster if you are eligible. Begin or continue the primary vaccination series if you haven’t completed it. If you get symptoms, test immediately and contact a health professional if you test positive to see if antiviral medication is right for you. Don’t go out and expose others if you sick with COVID, flu, or anything else. Mask indoors when infection levels for COVID, flu, RSV, etc. are high in your area. Avoid crowds. Increase ventilation. Wash hands and avoid touching your face – more for flu/cold prevention than COVID. Try to eat and sleep as well as possible.

If you are someone who has been getting health information from pundits, please turn to your personal health care provider, public health department, or national health organizations, such as the CDC. Look for data and advice from public health experts, not anecdotes.

For readers outside the US, turn to your public health experts to see what measures are available and appropriate for you.

Reminder to all: COVID 19 is still a global pandemic. Act accordingly for your health, your household’s and community’s health, and global health.

Review: The Letter

At the Vatican on October 4, 2022, the feast day of St. Francis of Assisi, a new film premiered, entitled The Letter.

The Letter in the title refers to Laudato Si’: On Care for our Common Home, Pope Francis’s 2015 papal encyclical which was addressed not only to Catholics around the world but also to all people of good will. Its release in May helped to build momentum for the Paris climate talks that fall that resulted in 196 countries signing onto the landmark agreement on climate change.

Laudato Si’ espouses integral ecology, which involves both care for the earth and care for all people, especially those most vulnerable. The encyclical cites science and various faith traditions to build a framework for fighting climate change and for lifting up those dealing with hunger, poverty, dislocation, water scarcity, and other challenges.

The film’s title has a second meaning, as the first part of the film shows five people around the world receiving a letter from Pope Francis, inviting them to the Vatican to discuss the issues of Laudato Si’ with him. Together, they represent both “the cry of the earth and the cry of the poor.” It is these five people and the communities they represent that form the bulk of the film.

They are:
~ Cacique Dadá, an indigenous leader of the Borarí people from the Maró Indigenous Territory of Brazil, representing indigenous communities
~ Arouna Kandé, a climate refugee from Senegal, representing the impoverished
~ Ridhima Pandey, a teen-aged climate justice activist from India, representing young people who are inheriting a world that has been damaged by prior generations
~ Greg Asner and Robin Martin, a married couple from Hawai’i in the United States, who are both marine biologists studying the impacts of climate change on ocean ecosystems, representing the voice of nature

The stories of their native places are stunningly conveyed by director Nicolas Brown and the team of Off The Fence Originals, in conjunction with The Laudato Si’ Movement. I especially appreciated the segments from the Amazonian rain forest and the Pacific marine environments.

I also appreciated the diversity of age, race, gender, country of origin, and faith portrayed in the film. While Pope Francis and the Vatican officials are, of course, Catholic, we see participants who follow other faiths, including Islam and indigenous traditions. It is a true reflection of the encyclical being addressed to “all people of good will.”

In keeping with that diversity, people in the film speak in their native languages with subtitles and narration available in English, French, Spanish, Italian, and Portuguese. There are also subtitles available for the entire film in many other languages. You may watch the film free of charge at the link in the first paragraph of this post or on the YouTube Originals channel. Details about offering a free screening for groups can be found here.

My hope is that many people around the world will view the film and take action on social and environmental justice issues. We are one human family and we must together care for each other and our common home.

long COVID and ME/CFS

One of the fears that I have about COVID is the risk of experiencing long COVID, where any number of a vast constellation of symptoms occurs for months/years after the acute infection phase.

The symptoms are very similar to those that characterize ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome). I have a family member with ME/CFS, so I am achingly familiar with the level of disability that can result. ME used to be referred to as fibromyalgia in the US, but now the ME designation is more common.

The October 5, 2022 edition of the (US) National Public Radio show On Point features an extensive discussion of long COVID and ME/CFS and how long COVID researchers and clinicians are learning from their peers who have been working for years on ME/CFS. All of these conditions are underdiagnosed and undertreated, so I wanted to share this with all of you. I believe this link will permanently take you to a recording of the episode. If the link breaks, you can try searching from the On Point link above or searching on your favorite podcast platform.

Anyone who has experienced these conditions or seen a loved one contend with them knows how difficult they can be. I want to raise awareness so that everyone affected can get the help they need. I also want everyone to realize that these conditions exist and are serious. Too often, affected people are dismissed and told their symptoms are “all in their heads.” While there is still much to learn, help is available, although it may be difficult to find, depending on the medical resources nearby. I hope we will all support research and treatment expansion so that the millions of people affected get the help they need.

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/