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.

How low can you go?

This month, my county (Broome in New York) has finally made it into the low community risk level for COVID-19, using the current US Center for Disease Control tracking method. Our community transmission rate is still in the medium category, the second lowest of four categories. Both of these are the lowest levels that I recall seeing since this tracking model went into effect.

In recognition of this, I’ve begun to back off from masking in indoor public spaces. For example, I went to church on Easter and this weekend unmasked. On Friday night, I ate and sang unmasked with Madrigal Choir at a retirement dinner in honor of a Binghamton University professor who is a long-time choir member.

It feels a bit strange after masking for so many months.

I know there is still risk. A friend came down with COVID a few days ago. I had not seen her recently, so I wasn’t exposed, but it’s definitely a reminder that I may not be able to stay COVID-free forever. The number of people I know in the never-been-infected category is tiny at this point.

I don’t want to get sick and I especially don’t want to transmit COVID to someone else but I’m feeling that, with the community risk level at low and major personal events like my two cataract surgeries and visit from our UK branch of the family completed, I can let down my guard a bit. I’ll still be tracking our local statistics so I can put more precautions back in place as warranted.

Madrigal Choir is going into a busy week, getting ready for our final concert of the season next Sunday, so fingers crossed…

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.

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.

Vaccinated and (mostly) unmasked

Shortly after I wrote this post, the US Centers for Disease Control and Prevention published new guidance regarding mask wearing/distancing among fully vaccinated people in response to newly published research findings.

The good news is that fully vaccinated people can stop wearing masks indoors with extremely low risk of contracting or spreading coronavirus. Mask wearing is still recommended in medical settings such as hospitals. Requirements to mask on public transport remain in effect, as do any mandates or policies put in place by state/local governments and businesses.

The bad news is that people who are not fully vaccinated might also stop wearing masks – and wouldn’t stand out because others would just assume if they weren’t wearing a mask that they were vaccinated – and so could be exposing themselves and their contacts to coronavirus, which would drive up infection rates. This is not helped by states that have already dropped their mask mandates or never had them in the first place.

Some governors immediately dropped their mask mandates while others, such as Governor Cuomo of New York where I live, are reviewing the situation before making any changes.

Personally, I expect that I, though vaccinated, will not be making many changes in my mask behavior immediately. The few stores that I frequent are likely to keep their mask policies in place for now. Visiting my father in the health care building of his senior community will probably still require masking because, although they are vaccinated, the residents are still vulnerable due to their age and underlying health problems. If the state does drop the mask mandate, small businesses, such as hair salons and restaurants, may decide to let vaccinated customers unmask and could easily ask for proof of vaccination to give peace of mind to their employees and customers.

I am frustrated by the media commentary surrounding this CDC announcement. For weeks, commentators have been complaining that the CDC was too slow in changing its recommendations for vaccinated people and that it was a disincentive to get vaccinated. The CDC was waiting for additional scientific findings to be published before making changes, but, now that they have, the commentators are complaining that it happened too fast.

They are also complaining that the CDC guidance is confusing. It’s not. It is meant for use on an individual level and it’s very clear about what activities fully vaccinated individuals can do without masking/distancing and what activities unvaccinated people can do without masking/distancing. The CDC and the federal government are not the ones with authority to require masks in stores, churches, etc. State and local governments and businesses do that.

So, please, everyone, stop whining, learn about the recommendations from the CDC and the policies in place in your local area, and behave accordingly for the safety of yourself and others.

If you are eligible for vaccination but haven’t done it yet, make arrangements to do so as soon as possible so you don’t become seriously ill or pass the virus on to someone else.

Remember to be kind and respectful to others. Some vaccinated people will choose to continue wearing masks because they are immunocompromised and more susceptible. I know people with allergies who are continuing to mask outdoors to protect themselves from high pollen counts. Some parents of children who are too young to be vaccinated wear their masks to be a good example for their children. It is not your business to criticize someone else’s decision and masking is never a wrong choice when it comes to public health. In some countries, masks have been common for years, especially during flu season or when there are air quality problems.

The CDC recommendations rely on public trust. Unvaccinated people need to demonstrate that they are worthy of trust by following the public health guidance. Overall infection and death rates are down, but they will spike again if people don’t continue to vaccinate and mask/distance until they complete the vaccine process. A spike might not happen until colder weather drives more people indoors, but it won’t happen at all if we can get the vast majority of teens and adults vaccinated by fall.

The prospect of the epidemic phase of COVID-19 being over by fall is within reach, but only if people follow this guidance and get vaccinated.

Let’s do it!