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.

A fairy tale wedding

A few days ago, spouse B, daughter T, and I attended the wedding of M and S. M is B’s and my niece and is the cousin closest in age to T.

M is also a big fan of Disney World. S chose to propose to M there and M planned their wedding and reception with a Cinderella theme, including the napkin above. There were castles and glass slippers and golden coaches incorporated into decorations, dancing into the night, a beautiful gown with yards of tulle.

Many echoes of a classic fairy tale.

But M and S don’t have an ordinary life. M is nurse with special training in emergency medicine who currently serves as a flight nurse, transporting critically ill or injured people to medical centers that can give them the best care possible. S is a state trooper, doing his best to keep people safe and assist them in emergencies.

They both do extraordinary things on a regular basis.

They also are facing an extraordinary challenge. Early in their courtship, M developed a serious medical issue but S stayed by her side, even when M tried to break up with him in order to protect him.

The strength of their bond in the face of adversity brought more than the usual number of tears at the wedding and during the toasts at the reception, where even the especially-stoic state troopers choked up over M and S’s love story.

Even at a fairy tale wedding, there are no guarantees of how long the “ever after” will be.

M and S showed us, though, that their love is strong and eternal, whatever obstacles are thrown in their path.

Pfizer booster

As part of my ongoing participation in the Pfizer/BioNTech COVID-19 vaccine phase III trial, yesterday I received a third vaccine injection, seven and a half months after my second. There was a blood draw to test levels of antibodies, T cells, etc. and the blood work will be repeated in a year. I will continue a weekly symptom check through a phone app and have a couple of phone appointments over the next year, too. The data collected will be used to inform on-going decisions about how often boosters may be needed in the future.

I’m fortunate that my side effects have been milder than they were with the second injection. I have a very sore arm, which is obviously from the shot. I’m tired and have a bit of a headache, which could be side effect and could be just life in general these days. Today is the one-month anniversary of Paco’s death, so how I am feeling could be attributable to that rather than to vaccine side effects. When spouse B and daughter T, who are also study participants, received their third doses, they both lost a day to fever, body aches, and fatigue; because I had had a similar reaction to my second dose, I was expecting a similar experience, but apparently have lucked out.

In the United States, a third dose of the Pfizer vaccine is approved for those aged 65 and up, people who have medical risk, and those in certain professions that have close contact with vulnerable populations. It’s possible that the third dose will be recommended more generally in the future as more data become available. It’s also likely that emergency use authorization for children aged 5-11 will come soon, with shots in arms starting in early November.

Recommendations on booster doses for Moderna and Johnson & Johnson are expected soon, as well as the possibility of mixing manufacturers, for example, someone who had the J&J vaccine having a booster from Pfizer. All the companies are continuing to study the vaccines for long-term efficacy and side effects, as well as safety, efficacy, and dosage for children six months through seventeen years. Currently, in the United States, only Pfizer is approved for ages 12-17.

Another helpful development is that Merck has applied for emergency use authorization of molnupiravir, an oral anti-viral to combat COVID. It would be given to patients in the early stages in hopes of keeping their illness from becoming severe. While it is already possible to give treatments by injection or infusion, such as monoclonal antibodies, this medication would be easy to prescribe and administer for home use. A decision by the FDA is expected within weeks.

Meanwhile, over the summer, COVID cases were devastating parts of the US, especially states with low vaccination rates. Total fatalities are over 700,000 with over 44 million cases recorded. In some areas, hospitals were so overwhelmed that they had to send patients out of state to receive care. This applied to COVID patients and also to patients suffering from other serious conditions. Two states, Idaho and Alaska, had to implement crisis standards of care, which means that whether or not an individual receives treatment beyond comfort care is determined by the likelihood of survival as there is not enough capacity to treat everyone that needs help. This resulted in non-COVID deaths from heart attack, stroke, etc. – patients who ordinarily would have been treated successfully but who died because there were not personnel, equipment, and space available to treat them due to intensive care units being filled with COVID patients.

The delta variant was the power behind the summer surge, but, at least, the fear of it encouraged more people to seek vaccination. The increase in vaccination rates is helping the case numbers to fall at this point. Still, the current rate of fully vaccinated people is only 57% with 66% receiving at least one dose. I am hopeful that the Pfizer vaccine being approved for elementary age children in the coming weeks will add significantly to our vaccination totals, at least in states where the vaccination rate among adults is higher.

There are still terrifying amounts of misinformation floating around about the vaccines that are keeping some people from taking them. Unfortunately, this is keeping the pandemic alive, resulting in illness, death, lack of access to medical care, and the possibility of even more dangerous new variants developing.

We are all in this together. Please, everyone, get vaccinated if you are eligible and follow reputable public health guidelines on masking, avoiding crowds, handwashing, etc. Your choices affect your family, friends, neighbors and community directly and your nation and the world, as well. We can’t truly end this pandemic until there’s no population anywhere still vulnerable to COVID-19.

If you won’t do it for yourself, do it for someone you love.

SoCS: pins

I don’t often wear jewelry other than my wedding ring and watch, but in the summer I sometimes wear pins to keep my V-neck dresses from getting too low. 

Most of my pins are old and came to me through family. I wear a blue and gold flower one that my dad gave to my mom back at the time of their wedding in 1954.

I recently wore one that is even older. It was my maternal grandmother’s and is a cameo, a sea scene in white over an orange background.

I guess this is the point where I would take photos to add to this post, but I’m not home. I’m with Paco (my 96-year-old father) in his room at the nursing home. He is continuing to decline and a hospice referral went in yesterday. The admission process will probably take awhile given that this is a holiday weekend in the US. I’ll try to post updates going forward but my track record is not great. Everything is too unpredictable.

*****

Linda’s prompt for Stream of Consciousness Saturday this week is “pin.” Join us! Find out more here: https://lindaghill.com/2021/09/03/the-friday-reminder-and-prompt-for-socs-sept-4-2021/

SoCS: ups and (mostly) downs

When I saw that Linda’s prompt for Stream of Consciousness Saturday this week was “up/down”, I knew that I needed to write a follow-up to last week’s SoCS in which I talked about my father (Paco) and his recent fall, hospitalization, and move to a rehab facility.

When I wrote last Saturday, it seemed that, though there was a long way to go, things were trending up.

Everything changed on Sunday when new complications arose. For various reasons, I will not even attempt to elaborate.

Let’s just say it has been a very “down” week.

We are working hard at untangling a mass of symptoms and trying to keep him safe and comfortable, but it’s an uphill battle. I know he is 96 and so, very vulnerable and prone to complicating factors but it is still so hard to deal with.

And to watch.

I know intellectually that I am doing all that is possible for me to help him and his care team, but my heart aches because I can’t make it better.

We have no idea what the outcome will be. It’s not just one day at a time, which is Paco’s favorite saying. It’s one hour at a time. One moment. One more early morning phone call telling me that he fell again during the night.

There are up moments here and there. When Paco easily remembers my name. When he gets to enjoy a slice of blueberry pie for dessert at lunch. When he manages to make a little joke with his aides.

I had planned to go to vigil mass today at a friend’s church, but was too tired to make the drive, so I went to a nearby church instead. I was blessed to see Sister A. there. She had been one of the stalwart visitors during my mother’s final illness, a span that stretched over two years. Because of the pandemic and other circumstances, I had not seen her in months. I was able to fill her in on Paco’s condition and she assured me that she has been lifting him up in prayer.

After such a “down” week, that assurance was a much-needed balm.

*****
Join us for Linda’s Stream of Consciousness Saturday! Find out more here: https://lindaghill.com/2021/06/25/the-friday-reminder-and-prompt-for-socs-june-26-2021/

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/

Grim milestone

It has just been announced that the United States has reached 500,000 deaths from COVID-19.

A half a million deaths among the 28 million confirmed cases. About 30% of those infected continue to have symptoms for weeks/months.

All of this in about a year’s time.

I had been watching a recording of mass for the first Sunday of Lent. When it finished, I tuned to a news channel. One of the frequent medical contributors, herself a physician, was speaking about the deaths and was struggling to keep from crying. The host noted how appropriate it was to react emotionally, as she herself was.

Such enormous loss. So much suffering. A reminder that, despite medical advances, we are nearing the death toll of the 1918 flu pandemic.

My eyes are filling with tears as I write this, both from the huge losses in our country and the world and from the losses of each one. Just recently added to the list a friend of my sister’s, the father of B’s co-worker, a resident in the apartments of Paco’s senior community.

Even with the vaccines becoming available, there will be many more illnesses and deaths. There will be uncertainty from the new variants’ effects, how long immunity will last after infection or vaccination, how people will behave as recommendations and policies change.

But today is overwhelmingly sad.

Again.

the meaning of January

Linda’s Just Jot It January is designed that anything one jots down can be transformed into a #JusJoJan post of the day.

Fortunately for all of you, I haven’t been taking this literally.

Otherwise, my January would be filled with texts, emails, and long lists of questions and reminders as I have tried to navigate the complexities of dealing with the care of my father, known here as Paco, in the time of COVID.

As the new year began, Paco was nearing the end of a stay in the rehab/skilled nursing unit in the health care center of his senior community, following five days in the hospital in mid-December. We were trying to finalize his move into the assisted living unit, which also triggered the need to close out his independent living apartment as soon as practicable. There were also issues with his medical and personal care to deal with – and, due to COVID restrictions, it all had to be done by phone or email or picking up and dropping off documents and forms and signed permissions, with only occasional in-person contact, none of which could be with Paco.

It’s been, in turns, confusing and frustrating and harried and bureaucratic – and perpetually exhausting.

It’s also been very difficult to write about.

So, here I am, trying once again to sum up the situation and convey it in words, unsure that I am capable of doing so.

A few days before Paco move to assisted living, we noticed that he was struggling with some everyday kinds of things like using the telephone. I expected that an infection he had had had returned and managed to convince the medical team to test for it. It turned out that I was correct but the test results didn’t come back until Paco had already moved to his new place in assisted. He was started on a new medication, but the combination of the infection, medications, being in a new environment, having to do another 14-day COVID quarantine because he had moved to a new unit within the health care building, and not being able to see family or have them help him set up his new place has made an already daunting situation extremely difficult.

I am doing the best that I can to care for him, but it is not good enough and I can’t manage to fix everything in a timely way. I’ve made some progress but the pace has been slow. While I am not by nature an impatient person, after so many weeks of this, I am frustrated and immeasurably sad.

The comfort I have is that Paco is seemingly unaware of all the complexities of the situation. He doesn’t usually remember the things he used to do before this latest illness, so he isn’t really missing them. While his memory is impaired at this point, he has not had the personality changes that affected other members of his family when they developed dementia, so he is generally in a good mood, although his fatigue level does sometimes put a damper on things.

So, here we are, starting another week. There are more lists of things to do, people to call, tasks to accomplish. One big thing that is (nearly) completed is the closing out of Paco’s old apartment. I turned the keys in last week, but the person I needed to interface with wasn’t there, so I’m not entirely sure we’re finished with the process.

Sometimes, people choose a word or phrase for the new year. Perhaps, for me, this will be the year of “not entirely sure.”

Like last year, 2021 may be a year of uncertainty.

in the middle of a nightmare

The pandemic has been more severe in the United States than globally for months – and now things are getting worse very, very quickly.

Yesterday, there were over 159,000 new cases diagnosed, which broke a record set the day before. There are entire states that are out of intensive care beds – or hospital beds in general. In some states, hospitals have to triage patients and turn some away who would benefit from care in favor of other patients who are sicker but have a higher chance of recovery.

Some places are so short-staffed that COVID-positive staff are continuing to work if their symptoms allow.

The hospitalization rate is also a lagging indicator. If the hospitals are this stressed now, what will the situation be in two weeks, given the huge numbers of new diagnoses this week?

I’ve reached a new level of dread.

New York State, where I live, still has one of the lowest infection rates in the country. Governor Cuomo is tightening restrictions on gyms, indoor dining and gatherings, as well as further ramping up testing and contact tracing in hot spots. Unfortunately, after all these months, there is an outbreak among residents in the skilled nursing unit of my father’s senior living community, as well as a number of staff members. The health center is in a separate building from where Paco lives in an apartment, so we are hoping the virus won’t spread, but it is very worrying for all of us.

And what, you may ask, is the Trump administration doing to address the explosion of cases, hospitalizations, and deaths?

Nothing.

Vice-president Pence, who chairs the coronavirus task force, finally held a meeting this week after several weeks without doing so during the campaign. There were no new actions or recommendations after the meeting.

Meanwhile, President-elect Biden has named a first-rate committee of physicians and public health experts to set up the plan against COVID for his administration, which will begin January 20th. Unfortunately, because the Trump administration refuses to acknowledge that Biden will be taking office, the Biden task force does not have access to the current plans in development for vaccine deployment, distribution of supplies, etc., which is an appalling and dangerous state of affairs.

What is even more appalling and dangerous is that, with the situation becoming more and more dire daily, the Trump administration is making no attempt at all to save people for illness, disability, and death.

I’m finding the level of stress and dismay crushing.

People desperately need help now.

January 20th is still a long way off.

charting a pandemic path

Around the world, most of us are sharing in the battle to limit the damage from COVID-19 to the extent possible.

In some places, the path is proscribed by local or national government and there are not a lot of personal decisions to make.

Here in my county in upstate New York (USA), things are not laid out as clearly. I have been trying to prepare and make plans, but circumstances keep changing – and so must the plans. Our state and local governments and community organizations have been much more proactive than the federal government, but, as more and more cases are diagnosed closer and closer to where I live, additional measures continue to roll out.

Over a week ago, I started the general preparedness guidelines to have a couple of weeks of food and medications available in case we had to self-isolate. This was not a big deal for our house, but I have been much more concerned about preparing things for my dad, known here as Paco. He lives in a senior community in an independent living apartment, so he has a number of services available in-house, but I visit every day to check on him, make sure his medications are all organized and his schedule is laid out, etc. Early last week, a sign went up that people who were having any symptoms of illness should not visit. This is practical and a commonsense precaution that I would follow anyway, but, later in the week, the health care part of the center was closed to all visitors, except those whose loved one is in very grave condition. This meant that Paco could no longer go over to concerts and singalongs held in the health care facility. At the same time, they cancelled activities in independent living that involved outside performers or volunteers. For example, the Irish dancers would not be able to come for a scheduled pre-St. Patrick’s Day performance.

At this point, I had to face the probability that even healthy visitors might not be able to visit independent living at some point, so I started making contingency plans that could be carried out reasonably well without me. Sadly, we’ve had to cancel a planned visit from my sisters and their families to celebrate Paco’s 95th birthday later this month. They all live in areas where the virus is more prevalent and we didn’t want to risk them bringing it with them, given that they might not have obvious symptoms.

Thursday night into Friday, several large employers announced that they would be having most of their employees work from home starting on Monday. The universities had also announced that they were moving most of their instruction online for several weeks or the rest of the semester. Professional sports leagues announced they were suspending or delaying their seasons. Some combination of these functioned as a trigger that caused some people who hadn’t been taking the virus very seriously to spring into action – or, at least, into shopping. I went to my favorite grocery store to pick up a few things for Paco and for my household and was surprised to find that there was almost no peanut butter, canned legumes, frozen vegetables, etc. in the store. And I hadn’t even checked the cleaning supplies and paper goods aisles. The evidence of panic-buying took me by surprise. Given that I had been in concern and preparation mode for days, I had obviously underestimated the number of people who were suddenly paying attention and freaking out a bit.

On Saturday, the county executive announced that all primary and secondary schools will close through mid-April. Now, people are even more upset.

It appears that there are some people who still think that fears of the virus are overblown, given that we have no known cases in our county, even though our neighboring counties do have confirmed cases; they don’t want their personal and family routines disrupted. Others have been following the news and the advice of medical experts and realize that, while we can’t stop the virus completely, there will be fewer deaths and more treatment available to those with severe illness if we can spread out the number of cases over a longer period of time, so as not to overwhelm our medical system. The way to do that is to reduce the number of people who are in close contact and in large groups, also known as social distancing.

There are a number of different opinions about how much distance is required and how many is considered too many to be in a crowd. This leaves some situations to personal discretion. I admit that I had a difficult time figuring out what to do about church attendance this weekend. Our diocese has dispensed with our obligation to attend mass, but services are still being held. I am not especially concerned about my getting seriously ill, but I am concerned with the possibility of bringing the virus into Paco’s community, so I’ve decided to participate in a mass on television. At least for now, I plan to still shop. occasionally eat at restaurants, and attend small gatherings with friends. If we start seeing community spread in my town, though, I’d cut back further. If we get to that point, I’m sure I wouldn’t be able to visit Paco; it’s likely that only residents and staff would be allowed in the building.

I admit that it is disconcerting to know that, despite our best efforts, people are going to continue to get sick, some of them severely sick, and some of them will die. I hope that our communities will face up to this challenge and do as much as we can to protect people, especially the most vulnerable.

Be well. Be kind. Be thoughtful. Be considerate.