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-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.

Saying good-bye to Anita

This morning, I sang for the funeral of Anita Alkinburg Shipway. She was a member of the music ministry at a church that I attended for a number of years, but our primary connection was through poetry.

When I joined the Binghamton Poetry Project in 2014, Anita was already involved. I got to know her better when we were both invited to join Sappho’s Circle, a women’s poetry workshop convened by Heather Dorn. We later also participated in some workshops with the Broome County Arts Council.

I always admired Anita’s storytelling ability both in conversation and in writing. She often used the tools of narrative poetry to reveal the truth – and quirks – of human nature. She smiled and laughed easily while also being very sympathetic when we most needed it. I appreciated the depth of her wisdom as an elder.

When the pandemic moved the Binghamton Poetry Project to Zoom, Anita joined us as often as she could, despite some technical challenges. We often joked with her about the cuckoo clocks in her home that would add their voices to ours. She shared a poem about them here. You can find more of her poems in the Binghamton Poetry Project online anthologies.

Originally, Anita was scheduled to participate with me in a Zoom reading for National Poetry Month in 2021, sponsored by the Broome County Arts Council and WordPlace. Unfortunately, she got trapped in the Zoom waiting room and wasn’t able to be recorded. I sincerely regret not being able to share any video of her reading her work.

Anita died at Mercy House, a residence for those near the end of life. Anita had volunteered at Mercy House and it’s a comfort to know that she was in such a familiar and peaceful place in her last days.

I was upset to learn that COVID played a part in her death. Apparently, a COVID infection interacted with other medical conditions and Anita could not recover. It reminded me again to remain cautious. I know that, despite my best efforts, I may someday contract COVID and could infect someone else, but I don’t know if I could forgive myself if I was being cavalier about infection and passed the virus on to someone who suffered grave consequences.

Anita visited Top of JC’s Mind and would occasionally comment on posts. More often, she would write to me directly. I remember having a discussion with her about what it means for something to be “top of mind.” Apparently, her Midwestern upbringing a generation before my New England one resulted in a different interpretation of the phrase.

No matter.

Today, Anita is at the top of JC’s Mind.

Rest in peace and eternal joy, Anita. May choirs of angels greet you and lead you to paradise.
*****
Join us for Linda’s Just Jot It January. Find out more here: https://lindaghill.com/2023/01/10/daily-prompt-jusjojan-the-10th-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.

Triple whammy

There are a lot of people sick with respiratory viruses here in the US.

We are still struggling with COVID. Today’s (Oct. 28, 2022) statistics from the Centers for Disease Control show a weekly case count of 265,893 with 2,649 deaths. The case count is almost certainly low, as many at-home positive tests are never reported to health departments and some jurisdictions don’t gather data at all. The uptake of the reformulated boosters has been poor, with only 7.3% of people age five and over having received an updated booster.

While the community risk level map shows the majority of the country in the low (green) level, the community transmission rate is substantial or high in much of the county. You can see the various maps using a drop down menu here. The community transmission rate is based on case counts and/or positive test results; the community risk map also includes data on other factors, such as hospital admissions and stresses on the health care system. A personal illustration: Although the community risk level in my county (Broome in New York State) has been low in recent days, I have had a rash of friends being sickened with COVID. This is explained by our community transmission rate being high, which is the highest of four levels. (As I was writing this post, the maps were updated. Due to the emerging strains on the health care system, our county community risk just shifted from low to high.)

Meanwhile, the flu season has hit earlier and harder than usual. The predominant strain is H3N2, which is known to have a high incidence of complications, especially among young children, elders, and the medically vulnerable. Like many other illnesses, the effects of inflammation from the flu raise the risk of heart attack and stroke for weeks following the initial infection, further endangering not just personal health but also the stability of medical institutions, such as hospitals. So far this flu season in the US, the CDC reports 880,000 flu cases, with 6,900 hospitalizations and 360 deaths. Generally, flu season starts in October but this year it is running about six weeks earlier than usual.

The third virus that is currently surging is RSV (respiratory syncytial virus). For most people, RSV is like a cold but for infants, young children, and elders it can progress to lung infections. These can lead to hospitalization and even death, especially among elders. Unfortunately, there is not yet a vaccine against RSV. I actually participated in a clinical trial for one a few years ago but none has yet reached a level of effectiveness to be approved.

The triple whammy of COVID plus flu plus RSV has already pushed some pediatric hospitals to the edge of their capabilities. Ironically, the RSV rate is a critical factor. Because so many infants and young children were isolated due to COVID risk and lack of day care/school interaction during the pandemic, there is a much larger group than normal that is vulnerable to RSV infection.

There is also concern that the rate of new cases of all three viruses may climb even higher as the weather gets colder and people spend more time indoors.

Some things that people can do to help: Vaccinate as appropriate. Wash hands frequently. Avoid touching your face. Cover coughs and sneezes. Stay home and away from people as much as possible if you get sick. Mask in crowded places or avoid going to them. Get adequate rest and eat healthy foods. If you develop symptoms, talk to a health care provider so you can get testing and supportive treatments to help keep you from developing more severe symptoms and avert a hospital stay, if possible.

I know some level of sickness is inevitable but we can help cut down the case numbers if we watch out for ourselves and our communities.

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.

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: still COVID

Another of my occasional reminders that COVID-19 is still with us.

Join us for Linda’s One-Liner Wednesdays, which I occasionally use to shamelessly promote another blog post. 😉 Learn more here: https://lindaghill.com/2022/08/24/one-liner-wednesday-upon-the-throne/