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.

SoCS: and the hits just keep on coming…

No, this is, unfortunately, not going to be a post about what’s on the Top 40.

I have been scarce/non-existent here at Top of JC’s Mind for the last week because my 96-year-old dad, known here as Paco, fell in his assisted living unit last Saturday. B and I had visited him in the 1-1:30 visiting slot, but he fell about 3:00. We think he was in the kitchenette but aren’t sure. Although he hit the floor pretty hard, he managed to get himself up and over to the couch where he called for help.

He has had a few falls before, but he hit much harder this time. His left side took the force of the fall. He was sent by ambulance to the local hospital where the extent of his injuries was revealed and he was admitted with a bump and cut on his head – luckily no concussion – bruises and contusion on his left arm and elbow, deep bruising on his left hip – luckily no break – a cracked left rib, and two wing fractures of back vertebrae.

The fall, pain, unfamiliar surroundings, etc. also worsened his cognitive condition. Paco already is suffering from dementia and this fall completely unmoored him. On Wednesday, he was stable enough to transfer to a rehab unit. We are hoping that his cognition will improve as he heals and gets stronger. It’s a much calmer and more stable environment than being in the hospital.

Tomorrow is Father’s Day in the United States and it’s hard because we won’t be able to see Paco as visiting in the rehab facility is extremely limited.

The other hit that our family is trying to absorb is that we just got word that a member of our extended family has been diagnosed with metastatic cancer. She is only thirty. She is strong and fighting but everyone is devastated.

And the hits just keep on coming…

*****
Linda’s prompt for Stream of Consciousness Saturday this week is “hat/het/hit/hot/hut.” Join us! Find out more here: https://lindaghill.com/2021/06/18/the-friday-reminder-and-prompt-for-socs-june-19-2021/

Governor Cuomo

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

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

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

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

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

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

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

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

DT and COVID

As I’m sure the whole world knows, the president of the United States is hospitalized with COVID-19. It’s been a bit difficult to get the straight facts on his condition, but it is increasingly looking like his case is on the more severe side.

He does have multiple risk factors, including his age, gender, and weight. He is being treated aggressively by his medical team, including with an experimental antibody treatment and with remdesivir. These are both given early in the course of the disease to help the body fend off the virus.

Today, though, it was revealed that the president is being given the steroid dexamethasone, which is usually given only to more severe cases later in the disease course, when there are significant lung complications and/or the need for a ventilator.

The medical team is even talking about the possibility of discharging him back to the White House, which does have its own sophisticated medical unit, tomorrow.

This doesn’t seem to add up. If his condition warrants dexamethasone, it would seem best to keep him in the hospital for close observation.

Another concern is that days seven through ten of COVID often see an exacerbation of symptoms. The president is only on day four. It seems it would be much safer to keep him in the hospital. It’s not as though he is cramped for space or lacking amenities in the presidential suite at Walter Reed; besides medical care, it also has its own secure conference room and kitchen/dining space.

I also wish that the president would temporarily sign over powers to Vice-president Pence in accordance with Article 25 of the Constitution. We know that the president has suffered with a high fever and times when his blood oxygen level has dropped below normal. COVID is nothing if not unpredictable. Foreign powers could take a provocative action, surmising that the president would not be well enough to respond appropriately. I think it would be safer for the country to have the vice-president, as long as he remains well, exercise the presidential powers until the president is fully recovered. Pence can always confer with president when his symptoms are well-controlled, but he would have the power to respond on his own if the president were to be unwell when a crisis arose.

The president and First Lady’s illness with COVID would be problematic enough, but a number of senators and other government and campaign staff and advisors have also been infected or exposed. Because the incubation period can extend to fourteen days, there are many people who should be in quarantine to make sure they don’t expose others while pre-symptomatic or asymptomatic. Somehow, despite the seriousness of the situation, Sen. Mitch McConnell plans to push ahead with the confirmation hearing of Amy Coney Barrett to the Supreme Court. He considers that worth the risk, while he won’t put the latest House-passed coronavirus relief package up for a vote.

Voters, pay attention to how candidates on your ballot are handling this health and governmental crisis. Are they prioritizing your and the country’s health and well-being or their own power?

on the way out of town

This is the final post about my long weekend in Northampton, Massachusetts to sing Brahms at Smith College.

I was up early for breakfast with CK as my plan was to attend 8:00 mass on my way home. As in many other places, the Northampton-area Catholic churches have consolidated, so I was not very familiar with the church building itself.

As a former organist and church musician, I always pay particular attention to preludes and all the music. The organ was in a loft, so I couldn’t see the musicians. I noticed that there were mistakes in the prelude, but that isn’t uncommon, especially at early masses at Catholic churches, which sometimes fall to student organists or people who are trained as pianists rather than organists.

The cantor/songleader was also in the loft and announced the opening hymn, “Holy, Holy, Holy” – a very familiar hymn that is usually one of the first an organist learns. The introduction started as one expects but became increasingly atonal, ending in a cluster chord that was held for much longer than expected.

The voice of the cantor came over the microphone, asking for a doctor to come to the loft. A woman in the section of pews in front of me jumped over the back of a pew to reach the aisle more quickly and rushed to aid the organist.

The chord on the manuals stopped, although a bass note from the pedals remained. We could hear the parishioners who had gone to the loft asking questions, trying to get a response.

I’m sure I was not the only person in the congregation who immediately began praying.

After a couple of minutes, the priest came to the front of the church and led a “Hail Mary” for the organist. He told us an ambulance was on the way and that we would begin mass shortly. He said that she would be okay, although I am not sure how he could have known.

The organist’s name is Jeanne.

At some point, the long-held pedal note stopped, a bell rang from the front of the church, and we began mass.

You could hear the ambulance squad arrive and enter the loft. Jeanne must have still been on the organ bench because there was a pedal glissando as they lifted her off.

Between readings, an usher came to the front of the church and spoke to the priest, who excused himself and went back to her before she left for the hospital.

We continued the mass with no music. It turned out that it was the last weekend for the relatively-young-as-Catholic-priests-go pastoral associate who was being re-assigned to Pittsfield.

We did sing a verse of “Holy God, We Praise Thy Name” as he processed out to greet his parishioners for the last time.

It’s been two weeks now since that day. I read the bulletins and the church’s website for some mention of Jeanne, but there was none. I hope that the priest was correct – that she really was okay.

 

triple threat

My mom, known as Nana here at Top of JC’s Mind, has been having some cardiac issues and has been going to rehab twice a week. Last week, she had to miss because of the giant snowstorm and because she seemed to be suffering from a cold.

She had already been to the walk-in medical clinic once for her cough, but on Friday, her condition worsened, so she went back. They were concerned that she might have developed pneumonia so they ordered a chest X-ray from the hospital. The plan had been for her to stay at the hospital until the X-ray was read, but they were so busy, we had to take her home to wait for the results the next morning.

When the X-ray came back positive, we went back to the hospital. We spent the day in the emergency room, while they ran more tests. We were shocked that Nana’s “cold” had actually been type A influenza. The extra-strength flu vaccine that she had received last fall had kept down the usual fever and body aches that one expects from flu.

The other factor involved was some continuing problems with congestive heart failure symptoms. We are hoping to get a better understanding of the cardiac factors involved so we can chart the best possible course going forward.

Nana has been improving steadily with intravenous antibiotics and diuretics. We are hopeful that she will be able to come home in a few days, in time for Paco’s 92nd birthday this weekend.

We would all appreciate any healing thoughts and/or prayers that you might send out on Nana’s behalf.

 

Nana on her way home!

Many thanks to all those who have been keeping my mom, known here as Nana, in their thoughts and prayers as she has been in New York City for an aortic valve replacement.

I am happy to report that she is on her way home! As often happens with heart procedures, while the TAVR procedure went well, one thing led to another. First, there needed to be a temporary pacemaker, which then needed to be replaced with a permanent one. She developed a bit of a-fib, which required some new meds and a re-jiggering of blood pressure meds. The next things we knew, what we had thought might be a three day hospital stay turned into eight.

We are happy that she is doing well and looking forward to having her back in town. She will need to rest and has a program to start exercising to get her back to her usual activity schedule, but she is doing so, so, so much better than when she was having congestive heart failure symptoms.

We are very grateful to the medical team that made it possible. I am also very grateful to my sisters and their husbands who have been on hand down in NYC to help both Nana and Paco at this stressful time.

Here’s to hearts that are healing!

One-Liner Wednesday: Thanks

Sending thanks to all those who have been keeping my mother Elinor in their thoughts and prayers; she is due home from NYC tomorrow with her new heart valve and a bonus pacemaker.
*****
This sequel to last week’s One-Liner Wednesday is brought to you by Joanne, with additional thanks to Linda. Join us for One-Liner Wednesday! Find out how here:  https://lindaghill.com/2016/10/19/one-liner-wednesday-presidential-poop/

waiting

As many of you know, my mom, known as Nana here at Top of JC’s Mind, is having an aortic valve replacement procedure today. I am in the unaccustomed position of waiting at home instead of in the hospital.

My two sisters and my dad are waiting at Columbia (New York-Presbyterian), so she has plenty of support and on-site vigilance. I am holding down the fort here, getting ready to spread news to all the local folks and more far-flung family and friends after the procedure is complete.

And waiting…

Some people expressed surprise that I was not going down to New York City, too. As the local daughter, I have been the go-to person for all the prior medical goings-on with Nana and Paco, as well as with my mother-in-law, now deceased, my spouse, and my daughters.  And I haven’t regretted a moment of it.

Still, I admit that it is less stressful to be here in my den at my computer desk typing away than being in a waiting room a couple of hundred miles from here.

It’s cutting down on the recycled waiting-anxiety.

The most difficult solo waiting room experience I ever had was the day that my dad was in for hernia surgery and my mom had a heart attack and was simultaneously having a heart catheterization and stent placement.

Being with someone doesn’t necessarily make it easier, though. I think both B and I struggle with waiting in hospitals right now because six months ago we shared a heartbreaking wait in the CICU while the staff tried unsuccessfully to revive his mom, known here as Grandma.

I am finding that being here at home, though, with the company of daughter T, is making it easier to wait and to keep realistic. The procedure the doctors are using, called TAVR, is not much different than a heart catheterization. Sitting here at home, I don’t know when the procedure will begin or how long it is anticipated to take. I do know from past experience that you always need to allow a lot of extra time beyond what they tell you, as they usually quote the actual procedure time, not the hours of preparation and recovery that need to be factored in before word gets out to the waiting family members.

It is a lot easier to sit here and think that, with a 10 AM report time, I won’t likely hear that she is done with the procedure until the middle of the afternoon.

I know that many of you have Nana in your thoughts and prayers. You are on my list of contacts when there is news.

Thank you for your support.

Peace,
Joanne

 

Progress

Yesterday, Nana had her evaluation at Columbia’s Structural Heart & Valve Center.

We had arrived in NYC the day before, expecting a three to four hour evaluation beginning at 9:00 AM. What happened was a marathon of testing and consultation that stretched from our arrival at 7:15 AM to 6:00 PM when we finally finished.

All the effort to go to New York City was definitely worth it. The advanced testing they were able to do determined that only the aortic valve needs to be replaced at this time, which can be done using a heart catheter technique, called Transcatheter Aortic Valve Replacement (TAVR). They were able to schedule the procedure for mid-October.

We were so impressed with all the medical professional and support staff. They were caring and compassionate, as well as being knowledgeable and experienced. Because we came from a distance, they did not only the diagnostic testing they needed to do but also the pre-admission testing so that there will only have to be two trips down to New York.

Tomorrow, I leave for a long-planned reunion residency of the Boiler House Poets at MASS MoCA. I feel much better going knowing that we have a positive plan in place for my mom. As I did for the original residency last November, I hope to blog every day from North Adams, so stay tuned.