The Road goes ever on and on ... Day 156 (656)

Yesterday, I questioned whether the availability of rapid at-home covid tests was making the daily case counts superfluous or even too wrong to be of use. Using counts is called case-based surveillance, and it does work when all the results are reported accurately. The alternative is sentinel surveillance, the method by which influenza is counted. Sentinel surveillance relies on a network of health care centers or personnel to track cases. The overall case numbers are extrapolated from the number of cases tracked. The data missing due to at-home tests also negatively affects percent positivity figures. At-home testing is very much a double-edged sword. It allows people to isolate when necessary but leaves public health figures in the dark. I'm interested in seeing how the public health folks resolve this. 

Between December 14 and 20, 2020, 3,561 people were surveyed about how hopeful or fearful they felt. The study was repeated between December 14 and 16, 2021 with a survey of 2,602 people. In 2020, 58 percent of Republicans reported feeling fearful compared with 36 percent of Democrats. In 2021, 69 percent of Republicans reported feeling fearful compared with 45 percent of Democrats. Overall, 36 percent of respondents felt fearful in 2020 compared with 54 percent in 2021. In 2020, 63 percent of all respondents felt hopeful, a percentage that dropped to 44 percent in 2021. Respondents were also asked what issues mattered the most to them. Topping the list in 2021 were jobs/economy, democracy, and health care. Finally, two words that 2021 respondents wanted to hear less often were "covid" and "Trump." The one word most people wanted to hear more of? Travel.

As New Year's Eve draws nearer--The Professor and I do not expect to be awake to welcome 2022--I am fine tuning my resolutions for the coming year. Reading through the resolutions I made for 2002 through 2012 and 2018 through 2020, has offered perspective on how best to phrase the new ones. I will say here that the resolutions I made for 2021, stated as five things I would do each month, were for the most part successful. I did make at least 12 pies and used my Instant Pot at least 12 times. I fell short on  starting, working on , or finishing a creative something each month, and if I donated or tossed 12 banker's boxes full of "stuff," it was in the first several months. I did meet my fitness goals for the year, several of which were set by the programming behind my Apple watch. I failed totally at ending this blog when I became fully vaccinated. Given how fully vaccinated is evolving, that was likely a very good thing. 

Finally, 2021 slapped us in the face one more (I almost typed "last" but didn't want to jinx us all) time with the death of Betty White a mere three weeks before her 100th birthday. She was an icon, someone to look up to no matter who was doing the looking, a lady well worth her while. Godspeed, Betty, to your new year as we creep to ours.

The Road goes ever on and on ... Day 155 (655)

Word is that the FDA is planning to approve third, booster shots for children ages 11 through 15. That this came out today is appropriate. The Professor and I chatted with a neighbor this morning. He said that for a long time, his family did nothing because their daughter who's about nine was not able to be vaccinated. Now that she is vaccinated, he and his wife look at their teenage son and wonder just how vaccinated he still is months after his second injection. I expect they'll have him out for a booster the first day they're available. 

Covid cases in the US remain at their highest level, 488,000 on Wednesday. The seven-day average was over 300,000 as well. New cases have more than doubled in two weeks. In the past week alone, over two million cases have been reported nationally, and 15 states and territories reported more cases than in any other seven-day period. The WHO chief has warned that Delta and Omicron could combine in a "tsunami" of cases. Deaths are averaging around 1,500 per day, though a CDC forecast holds that over 44,000 people could die of covid over the next four weeks. 

A brief summary of the new CDC guidance on isolation and quarantine: People who are infected can re-enter society after five days if they are asymptomatic or their symptoms are resolving. They should then be masked for the next five days, indoors and out. Some groups, including nurses, have argued against this. Michigan has said that it will not follow this guideline. Some medical people say they would have required a negative test. A virologist at the University of Saskatchewan calls not requiring a negative test "reckless and, frankly, stupid." Those in favor of the revised guidelines estimate that less than a third of the people who should have isolated in the past really did so. The other argument against the new guidelines is that they make no distinction between vaccinated and unvaccinated people. 

A new, not-yet-peer-reviewed study coming out of South Africa says that a Johnson & Johnson booster provides strong protection against Omicron, with the second shot raising protection further than do two doses of the Pfizer vaccine. The FDA did not recommend a second Johnson & Johnson shot here because of the vaccine's link to a blood clotting condition. 

The National Health Service in Britain is erecting field wards on the grounds of eight hospitals. There were around 183,000 new cases Wednesday, days before the full impact of the Christmas holidays might be seen. The wards are called "Nightingale hubs" and each will handle 100 patients. This reminds me of the field hospitals set up around New York City in the very early days of the pandemic. 

China continues to pursue its zero-covid policy. They have locked down Xi'an, home to 13 million people because there were 1,117 covid cases there between December 9 and 19, a spike attributed to Delta rather than Omicron. The Winter Olympics in China may well be more "interesting" than the Summer Olympics in Japan were. 

Finally, I came across a mention of the likelihood that results of at-home covid tests are not often reported to the medical authorities. This mention was followed by the possibly rhetorical question of whether case counts serve a useful purpose if they are potentially inaccurate or at best estimates. Should we continue to report and use those figures? Hospitalizations and deaths are at least documented. I don't think there are a lot of at-home deaths that are going unreported. 

The Road goes ever on and on ... Day 154 (654)

"Lots of" does not begin to describe the amount of chatter there has been about the CDC and various other entities shortening the isolation and quarantine times. Some medical people support the decision while others don't. There is certainly some confusion out there as to exactly why this decision was made. Says a senior pastor of a church in Chicago, "Either we're in a surge that we need to take very seriously or are we winding down the pandemic and that's why we're shortening the isolation and quarantine times. They might want to give us a little more information to go with." 

The CDC director explains that, "Not all of these cases are going to be severe. In fact, many are going to be asymptomatic. We want to make sure there is a mechanism by which we can safely continue to keep society functioning while following the science." And what does the science say? Omicron may have a shorter incubation period, 72 hours. It was four to six days for Delta and the original virus. People infected with Omicron may thus become non-contagious faster than people with other forms. Cutting the time-out length will help keep hospitals staffed, airplanes flying, and the continuation of other services depending on number of workers. As for the public health side, the CDC director also noted that the decision to shorten the isolation period was driven by the evidence on transmissibility but also what isolation period people "would be able to tolerate." 

I go back and forth as to whether this is a good idea. I guess that people staying isolated or quarantined for five days is better than their looking at 10 days and saying, "Screw that! I'm going out!" England has shortened its period to seven days and also requires two negative lateral flow tests taken a day apart. I've seen nothing about negative tests on this side of the pond. Some of the professional sports leagues have testing requirements, but I haven't seen any mention in what I've read about the CDC,

Cases are going crazy. We may very well hit the half million mark today or tomorrow. The seven-day average number of cases is 267,305, up 126 percent over two weeks. Closer to home, Maryland, Virginia, and the District of Columbia all broke records on Monday. For the District, there have been almost 1,000 percent more new cases over the past two weeks and over 9,000 new cases since December 24. Maryland's seven-day average for new cases is more than double the previous high in January 2020.

And really, really close to home, the local university is seeing surging cases among faculty and staff. There were 54 new cases Monday, and 53 more new cases yesterday. Since those numbers represent only tests given or processed at the university, there are likely more out there who tested privately. The Professor notes that he is glad not to be one of them. No word yet on classes in January. The interim January term is supposed to start on Monday. I wonder how the profs teaching those classes are doing. 

I wonder what the over-under on cases tomorrow should be....

The Road goes ever on and on ... Day 153 (653)

Looking to covid in the future rather than in the present, the dean of Brown University's School of Public Health predicts, "January is going to be a really, really hard month and people should just brace themselves for a month where lots of people are going to get infected." In the present, the seven-day average number of cases was about 240,000 yesterday. Back to the future one expert says, "I think we're going to see half a million cases a day--easy--sometime over the next week to 10 days." At the same time, POTUS says that Omicron's surge in cases "should be a source of concern but it should not be a source of panic." Much as I like POTUS, this comment probably won't win him any new friends and is going to hurt him with some others. 

The CDC is changing its guidance on how long to isolate following a positive test or potential exposure. The 10 days of isolation they were suggesting has shortened to five days followed by five days of serious mask-wearing. The CDC says that most viral spread happens in the first five days and with proper masking, viral spread after that is minimal. People who were sick but whose symptoms are improving and who no longer have fever can also leave isolation after five days as long as they stay masked. The same holds for fully vaccinated people who have been exposed as opposed to tested. The National Basketball Association is taking the CDC guidance a step further and saying that players testing positive but whose viral load is low can return to playing sooner. 

The CDC is actively investigating or observing 68 cruise ships following outbreaks on board. Seven others are being monitored for covid, but the case numbers are below the threshold for starting an investigation. That threshold is positive cases reported in over 0.10 percent of passengers or a single crew member in the previous seven days. While I greatly enjoyed our trips along the Norwegian coastline on the coastal ferry and mailboat, I have no desire whatever to take one of the multi-story resort cruises around the Caribbean or other sun-drenched body of water. Truth be told, I have no desire right now even to sail on the coastal ferry. 

New York City schools will reopen in-person classes on Monday, January 3 but with changes in their covid policies. The city was quarantining entire classes if there were any possible exposure. Now, they will use an enhanced testing program to allow asymptomatic students who test negative to remain in school, a program known as "Stay Safe, and Stay Open." The outgoing mayor announced the program, but the incoming mayor is on board with the decision. The aim is to detect more infections while mitigating disruptions. The specifics of how it will work were described as follows: After one student tests positive. all the other students are given rapid at-home tests. Students who are asymptomatic and test negative can return to school the next day. They will get a second at-home test within seven days of the original exposure. Major in-school spread across classes or levels can mean a temporary closure. The testing plan is to test 20 percent of students in each school weekly. BUT (there's always a catch) the only students who can be tested are those whose parents have given permission for testing. If you won't get your child vaccinated, will you let that child be tested?

I remember sometime in a past post to this blog noting that we had passed the milestone of at least one in every 500 people having died from covid. That number is now at least one in every 406 people. At least one in every six people living in the US have been infected. I wonder how that one in six might change after (I wish I could say "if" here, but I don't feel comfortable with that) half a million cases are counted in one day. 

The Road goes ever on and on ... Day 152 (652)

New York City's new mayor will be sworn in at midnight January 1. One of his first major decisions will be whether public schools re-open on January 3. He does not support large-scale shutdowns, saying, "We can't close down the city anytime a new variant comes up." He is not alone on the school-closing front. Some 300 schools in Maryland, New Jersey, New Mexico, and New York have already said they will remain closed. New Jersey has told schools to do the first two weeks of school remotely. It is not an easy decision. One public health expert says that the only reason to close schools would be severe staffing shortages. Apart from schools, the number of children hospitalized with covid has been rising. Pediatric hospitalizations in New York have quadrupled. It does not help that just 16 percent of children between the ages of five and 11 have been vaccinated compared with 71 percent of children between the ages of 12 and 17.

Flights continue to be canceled or delayed. The main reason given is medical, though weather has played into some of the decisions. Dr. Fauci weighed in an air travel: "When you make vaccination a requirement, that's another incentive to get more people vaccinated. If you want to do that with domestic flights, I think that's something that seriously should be considered." That's an interesting idea, but would there be exceptions for emergency cases in which someone not fully vaccinated needs to get to the other coast because an immediate family member is seriously ill or dying? Would vaccine passports be used? Some states have essentially outlawed those. With only 62 percent of Americans fully vaccinated, the number of people asking for an exemption would likely not be small. 

The national record for average daily cases is 251,232 set in January 2021. I expect to see a new record in the early days of 2022 if not before 2022 arrives. Delaware, Hawaii, Massachusetts, New Jersey, New York, and Puerto Rico have seen more cases in the past week than in any other seven-day period.

Continuing with domestic covid news, five of the 42 post-season college football bowl games have been cancelled due to at least one of the teams not having enough players given covid issues. The local university is one of those teams, backing out of the bowl game that would have been the farewell game for a coach leaving not because he was fired or because he was taking a job at another school. He's trying to figure out what to do with his life other than coach football. There are four teams in the running to be national champion. The two semi-final games and the final game will be counted as forfeitures if one team cannot play due to covid. With one semi-final and the final cancelled we could crown the last team standing as national champs, not something I want to see happen. Finally, at least four large cruise ships have had to cut their voyages short due to covid outbreaks. It will be interesting to see how many keep on cruising.

A lab in Sydney, Australia mistakenly told 400 people that they had tested negative when, in fact, they had tested positive. Another 995 people were told they'd tested negative when their results were not yet known. Testing centers are overloaded. International travel requires a negative test but so does visiting Queensland and Tasmania. Forget the cause of the mishap and deal with it. How many people have the initial 400 people been in contact with? Unless they are as much of a hermit as I have been, there are probably a lot more people out there who will be testing positive in the near future. I would much rather be told I tested positive when I had not than the opposite. I would feel a nontrivial amount of guilt at potentially exposing other people. 

The Road goes ever on and on ... Day 151 (651)

Still in the midst of the Christmas weekend, the number of airline flights canceled globally has passed 5,400. Over 1,000 of those have been in the US. I wonder how many people sweating out getting rescheduled ever considered flight cancellation as an side-effect of covid. The only time we've had flights canceled, it was our flight only. We weren't standing in line at the ticket counter for hours waiting to get to the head of the line only to discover all other flights going where we wanted to go had already filled up.

US hospitalizations are on the rise while remaining under the peaks hit in January. ICUs especially are strained with workers sometimes working 16-hour days for weeks on end. Many hospital workers have left citing burnout or anxiety as reasons. The ones who remain are now getting infected, with the CDC allowing health care workers to return to work after seven days instead of 10. I wonder how many workers would like those extra five days just to have a bit of a break. One thousand military health care workers are being deployed across the country to help. Of special concern, pediatric admissions are rising. As of Thursday, over 50 children under the age of five were hospitalized. The American Academy of Pediatrics calls cases in kids under the age of 18 "extremely high."

March will mark the second anniversary of the "15 Days to Slow the Spread" featuring guidelines set by the ex-president and his coronavirus task force. We could very well be seeing record numbers of caseloads by then. We are currently averaging almost 200,000 new cases daily, more than in last summer's Delta peak. The seven-day global average of cases exceeds 755,000. Will it hit one million? I would not be surprised if it did. Experts say that we are likely to see an "almighty surge" to start the new year. They also say that we will never be without covid but need to move it into the background. Looking ahead, Dr. Fauci agrees, saying, "It's conceivable that, sooner or later, ... everybody will have been infected and/or vaccinated or boosted. When you get to that point, unless you have a very bizarre variant ... that evades all protection--which would be unusual--then I think you could get to the point where you have this at a steady level." He also noted that it is "entirely conceivable" that we may need a fourth shot of vaccine. 

We are not alone in facing or being in an almighty surge. France just saw over 100,000 new cases in one day, the most since the pandemic began. Hospitalizations have doubled over the past month. Over one person in 100 in the Paris region tested positive in the past week. They are seeing surges of both Delta and Omicron. The government does not want to close schools nor do they want to do anything that would hurt their economic recovery. The percent of positive tests in Kenya has gone from one percent to over 30 percent in three weeks. In Uganda, 50 lawmakers and staff tested positive after attending sports tournament in Tanzania.

The week between Christmas and New Year's sees the release of every list that was not released between December 1 and Christmas. Lists of noted people who died usually come out before Christmas, overlooking anyone who, like Desmond Tutu, died in December. I expect this happens because at the dawn of a new year, the focus should be ahead rather than behind. This year we may even have a separate list of people who died because of covid, 2021 being the first year spent entirely with covid. We will also this week see lists of Outs and Ins and the Best of almost any medium or genre. And then there are lists of New Year's resolutions. For several (maybe more) years I have posted my new ones here along with an evaluation of how I did on the expiring ones. I'm thinking along those lines now. I recently came across the cards on which I've written my resolutions for years past starting with 2002. Looking for themes should be interesting and will likely help me set the ones to shoot for in 2022. 

The Road goes ever on and on ... Day 150 (650)

Merry Christmas

or

Happy Holiday of your choosing

stay warm ... stay safe

The Road goes ever on and on ... Day 149 (649)

A relaxed Christmas Eve always demands a hectic Christmas Eve Day, or at least so it seems. Random one-shot things today. The director of the Center for Infectious Disease Research and Policy at the University of Minnesota called Omicron a "viral uzi," noting that it "is a game-changer. As much as Covid has been an immense challenge, Omicron takes it to a whole new level."

Best get-together advice I've seen: Plan for the most vulnerable person in the room. "Who do we put at risk if we're infected?"

Over 3,500 flights have been canceled for today and tomorrow around the world due to crew members either having covid or having been exposed to someone who had it. Weather had something to do with some of the cancellations as well.

New data from Britain suggest that booster protection against asymptomatic covid wanes against Omicron within 10 weeks. Protection from Delta lasts longer. Results are supposed to be taken with caution since people who caught Omicron early may not be representative of the broader population. I had my booster over 10 weeks ago. Hmmm.

Some scientists warn against a fourth shot saying that immune cells may stop responding to shots if too many doses are given. 

The ban on entry from countries in southern Africa will expire at midnight on December 31.

A large number of white-tail deer in Ohio and Pennsylvania have been found to be carrying the coronavirus responsible for covid-19. It is not clear how the virus jumped from humans to deer; it seems inevitable for it to return the other way.

And now to finish the needle-felted ornament that is the cat's present. 

Merry Christmas to all, and to all a good night! 

The Road goes ever on and on ... Day 148 (648)

Word came today that the New Year's Eve celebration would still go on, though that might change before December 31. Instead of 58,000 people, though, there will be only 15,000. I have not yet heard how those 15,000 people will be chosen. They must have proof of full vaccination, wear masks, and practice social distancing. I'm not sure of the specifics on distancing--family groups, maybe? The last New Year's Eve on which The Professor and I saw midnight was December 31, 2018, aboard MS Lofoten anchored outside Tromso, Norway. The fireworks display was the best I've seen. 

The graph showing case numbers in the District of Columbia shows a vertical line. Cases on Saturday nearly tripled the previous record high. An ER nurse in the District comments, "What do you do when you have a tidal wave coming at you in a little paddle boat? There's going to be a huge uptick. Our entire waiting room is going to be all Covid-positive." 

Data from the UK suggest that Omicron appears to reduce the chance of a hospital visit 20 to 25 percent and an overnight admission by at least 40 percent. The data were based on 56,000 Omicron cases and 269,000 Delta ones. Still, new daily cases just went over 100,000 for the first time. There were 301 hospital admissions on December 20, up 78 percent in one week and the highest single day number since February 7. For unvaccinated people who had not had a case of covid, risk of hospitalization was about 11 percent lower for Omicron than Delta. Modeling suggests that there could be 3,000 hospitalizations per day at the peak of the wave in January if no new restrictions are put in place. 

Meanwhile in Europe, the continent, Spain is responding to a daily all-time record of almost 50,000 new cases in one day and enacting an outdoor mask mandate. Italy is considering an outdoor mask mandate as well as making the health pass valid for six months rather than nine, and banning parties or events, indoors or out, until the end of January. In Greece, all outdoor and indoor areas not currently requiring masks must start to require them. There will be no public events until January 3 at the earliest. Data from France suggest that unvaccinated children are helping drive the surge there. Vatican City now requires all workers to be vaccinated or recovered from covid. Regular testing is no longer an option. Finally, Putin has said there will be no vaccine mandates. Russians, he says, are "inventive people" meaning "whatever you start to push, they find ways to circumvent it." 

There's more news I could include, but Son #1 asked for my help with his Christmas present to Son #2, and I have a bit more to do tonight so that I can hand it off in the morning for him to finish. The Professor is making butter tarts tonight, and I've already been called into the kitchen for a consult. Multitasking may be my middle name this evening. 

The Road goes ever on and on ... Day 147 (647)

Late-breaking news: The FDA has given authorization to Pfeizer's antiviral, Paxlovid. It can be used by adults and children over the age of 12 with mild to moderate covid who are at risk of progressing to more serious disease. The full course of treatment is 30 pills with three pills twice daily for five days. The drug will only be available by prescription and muct be given within five days of symptom onset. The bad news with the good news is that there are only 180,000 courses of treatment currently available. There should be another 80 million ready by the end of 2022; the federal government has reserved 10 million of those.

Only one of the three monoclonal antibody treatments currently available works against Omicron.  Sotrovimab was developed by GlaxoSmithKlein. While the other two treatments were developed using blood of people who survived covid-19. Sotrovimab was developed using blood of people who survived the 2003 SARS epidemic. 

Opinions on the plan POTUS discussed yesterday are mixed. One criticism was that it is a reactive plan instead of a proactive one. Only 30 percent of Americans have gotten boosters. The roll-out was rocky which may have contributed to the 30 percent. Covid tests are critical to the plan but in short supply. Finally, hospitals are already stretched thin. Perhaps military or federal aid could have been given sooner. I am not sure how POTUS was supposed to get vaccine-hesitant or -resistant people to be vaccinated, but that was another dig at him, that only 62 percent of Americans are fully vaccinated. An emergency doctor and academic dean for Brown University's School of Public Health summarized, "Everything in this plan that he released today is what I want to see. I just wish we'd had it earlier."

England has cut the number of days of isolation required for people after they show symptoms. It was 10 and has been shortened to seven. Two negative tests, one each on days 6 and 7, are required to end isolation at seven days. In the US, isolation lasts for 10 days after showing symptoms. A vaccinated person is good to go if there has been no fever in 24 hours and symptoms are improving. Unvaccinated people are required to isolate for a full 10 days if they have contact with an infected person. 

Israel is beginning to give a fourth dose of vaccine to people over 60 and to medical workers. Whether this is in response to Omicron, I do not know. I wonder if the idea will cross the pond and happen here as well. Things are going to get complicated number-wise what with number or percent of people who have had at least one dose, two doses, three doses or four. What would "fully vaccinated" mean after that? 

I heard today of two children in different places who were exposed to covid via their preschool. In both cases, the kids are too young to be vaccinated. So far both have tested negative. I do not want to think how I might have handled that happening with one of my children. I don't think I would have handled it at all well. I also today heard several people say that we will all eventually be infected with some coronavirus variant known or not yet known. Survival of the fittest in real time? 

The Road goes ever on and on ... Day 146 (646)

Omicron is a debutante, two weeks ago making an appearance in one percent of new covid cases in the US. One week ago, she was up to 13 percent. She has now come out in all her glory, making her appearance in 73 percent of all new cases in the US, a six-fold increase in one week. She accounts for over 95 percent of the new cases in parts of the Northwest and Southeast. According to a senior scholar at the Johns Hopkins Center for Health Security, "All of us have a date with Omicron. If you're going to interact with society, if you're going to have any type of life. Omicron will be something you encounter, and the best way you can encounter this is to be fully vaccinated." 

POTUS will address the nation this afternoon, laying out his plan for dealing with the menacing Omicron wave. The plan includes sending the military to help hospitals; deploying ventilators as needed; invoking wartime production to produce covid tests; sending free tests to people starting next month; and opening more vaccination centers. This will help in two of the three areas said by one expert to be the major shortcomings of the US in this pandemic. I would hope but not necessarily expect more vaccination centers to help with the sorry state of boosters in this country. Though 73 percent of Americans have gotten at least one vaccine dose, less than 20 percent have gotten the full course plus a booster. Producing more covid tests would help with the incredible shortage we're currently experiencing. People who want to take a rapid test before a gathering or before seeing an elderly relative can't find one. POTUS's plan does not address our other big shortcoming which is the slow rate at which anti-viral treatments are being evaluated by the FDA. Most people are being as flexible as possible with covid-related matters, but the FDA does not seem to be flexible in their evaluation and approval timing. 

Several European countries report growing instances of fake covid passes and vaccination certificates. They have detected over 180,000 since summer. France has around 400 investigations ongoing into networks suspected of providing fake passes, including some connected to health professional. Where there is money, there is a way.

POTUS spent about 30 minutes in the company of an official who later tested positive for covid. POTUS is already tested on a regular basis, though I expect tests are going to be even more frequent for a while. The official was fully vaccinated and had gotten a booster shot. Omicron is going where omicron wants to go; we're going to have to get used to that.

A couple of observations I find worth thinking about. From an ICU nurse: "The surge feels worse than ever before, and the patients are sicker."  From Dr. Fauci: "It's not going to be eradication, and it's likely not going to be elimination. It's going to be a low, low, low level of infection that really doesn't interfere with our way of life, our economy, our ability to move around in society, our ability to do things in closed indoor spaces." And, finally, from the WHO head: "An event cancelled is better than a life cancelled." I guess that, put together, those mean that while we may have descended from bad to worse, we will at some point in time slow covid down enough that we can live with it similar to influenza; in the meantime, though, we need to be realistic about how we get to that live-with-it stage. 

The voices from the backseat ... Are we there yet, Mom? From the front seat, weary of answering no, we're not, a deep sigh.

The Road goes ever on and on ... Day 145 (645)

As European countries put new restrictions in place or tighten the ones already in effect, we in the US are doing very little in terms of trying to slow the pace of Omicron. New York City will announce this week whether they will hold or cancel next week's New Year's Eve celebration in Times Square. The fact that they have noted that it will be outside and allow entry only to vaccinated people leads me to believe it will still be held. Some local governments and private institutions have been putting in place pandemic measures that feel like last year, but it may well be too little even if it's at the right time. Several governors, including one currently testing positive for covid, have said they have no intention of putting restrictions in place again. 

So just how bad are things here? Last week saw a 17 percent increase in covid cases and a nine percent increase in deaths. Descriptors bandied about include "viral blizzard," "winter of severe illness and death," and "extraordinary." Fifty million Americans remain unvaccinated, and it's not at all clear if many or most of those ever will get vaccinated. New cases in New York City are up 60 percent over two weeks. Washington, DC is seeing three times as many new cases daily as at the start of December. POTUS will address the nation tomorrow night. According to his press secretary, he "will announce new steps the Administration is taking to help communities in need of assistance, while also issuing a stark warning of what the winter will look like for Americans that choose to remain unvaccinated."

Not too long ago, the news was that the majority of new cases were in people who had not yet been vaccinated. Reports out of Denmark are that most of the people infected there are fully vaccinated. As for the severity of a case of Omicron, data from Imperial College London found no evidence that Omicron is less severe than Delta based on the proportion of people seeking hospital care after they have been infected. I'll be looking for more detail on that study given how important the results would be. 

Mild or severe illness aside, there are three signs of hope. First, anti-viral drugs are becoming available. These reduce the amount of virus produced in the body and lessen that chance patients will need hospital treatment. Second, cases in South Africa appear to have peaked while early signs are that deaths could be lower than in earlier waves. The caveat is that many South Africans have infection-induced immunity in addition to that induced by vaccines. Finally, Omicron appears much more efficient than Delta in reproducing in bronchial tubes in the upper respiratory tract, where it can be more easily coughed out onto other people. However, it appears far less efficient in spreading to the lungs where it poses the greatest danger to an infected person.

And on a "you have to be kidding, right?" note, this year's flu shot seems to have been poorly matched to the flu strains circulating this season. I'll have a respiratory disease, bartender; make it a double. 

It's clear that we won't be putting in place anything like the restrictions being put in place in Europe. I read that hospitals will be filled to a greater capacity than they were in the spring of 2020. Is it pandemic fatigue that makes people today not see the value in inconvenient-for-a-short-while measures most people accepted at the outset? The less people do to help slow the spread of variants such as Omicron or to help block the development of even more such variants, the longer we may very well be only wishing we could be home for Christmas.

The Road goes ever on and on ... Day 144 (644)

How are things going in the Netherlands? The prime minister explains, "We have to act now to prevent a worst-case scenario. Without measures, we could be witnessing an uncontrollable situation at the start of January." What measures? The country is in nationwide lockdown. All but the most essential stores plus restaurants, hairdressers, gyms, museums, and other public spaces are closed until at least January 14. Schools and universities are closing a week early for the Christmas break and will stay closed until at least January 9. If that doesn't sound like enough, households are recommended to have no more than two visitors, though four will be allowed for Christmas and New Year's. Outside gatherings are limited to two people. Omicron will become the dominant strain by year's end. Hospitals have been canceling regular care for weeks and are still running out of beds. Cases are at record highs, though there is likely some error in the counts for the early days of the pandemic. 

The UK's health minister is not ruling out more restrictions there. London's mayor says that new restrictions are "inevitable" and could affect social distancing and household mixing. Cases in Greater London are up 200 percent over the last two weeks. There were 65,525 new cases last week, and 26,418 in the last day of the week. Paris has canceled the New Year's Eve fireworks. Denmark has closed theaters, concert halls, amusement parks, and museums. Ireland has imposed an 8:00 pm curfew on pubs and bars and limited attendance at events both indoors and out. 

So much for how Europe is handling Omicron. Here, only 30 percent of vaccinated Americans have gotten a booster. Just over half of Americans ages 65 and older have gotten boosters. New York saw 3,909 covid patients enter hospitals on Friday, an increase of 70 percent. Test positivity was 7.53 up from 2.6 percent on September 22. The number that floored me was that in Tompkins County, home to the city of Ithaca and Cornell University, cases rose 640 percent over a 14-day period. No, that is not a typo. The only decimal point would be one after the zero. They are seeing 224 cases per 100,000 people; the rate in New York City is 61 per 100,000.

Harvard University has announced that they will be offering remote learning for the first three weeks of January. The Professor is worried that the local university might go the same route. Having taught remotely for several semesters, he does not want to do it again. We appear to be lagging behind Europe in terms of Omicron's impact. Are we willing to reinstate stronger restrictions as several European countries are? I know that we likely won't here in Virginia unless there is a federal order. Our governor-elect is a conservative who has been mentioned as a potential running mate for He Who Shall Not Be Named in 2024. I don't expect any mandated mitigation measures here. [Yes, I have reverted to my original way of referring to a certain orange someone.]

The Road goes ever on and on ... Day 143 (643)

New York City is becoming pandemic ground zero as it was at the pandemic's 2020 start. They recorded 21,027 cases Friday. If you ignore the fact that many cases were probably missed in the early days, this is a record for the entire pandemic. Cases have gone up 56 percent in 14 days, while hospitalizations are up 25 percent. The current percent positivity is almost eight percent. Probably in response to Omicron's ability to bypass two doses of vaccine, New York State is changing their definition or "fully vaccinated" to include the booster dose. At Cornell University in Ithaca, 99 percent of the student body was vaccinated (under the two-dose standard). The university still saw 1,567 cases arise in the seven days ending Thursday out of a student body of over 26,000 students. In New York City, Broadway shows have closed temporarily as has Radio City Music Hall, home of the Rockettes. 

A federal appeals court has reinstated POTUS's executive order requiring companies with at least 100 employees to require employees be vaccinated, have a valid exemption, or agree to be tested weekly. The school system in Prince George's County, Maryland, home to some 131,000 students, will go to remote learning for the four days they are open next week as well as for the first two weeks in January. Not what anyone wanted, probably, but out of an abundance of caution likely the right thing to do. The CDC just endorsed a strategy already in use by some systems, Test to Stay. Unvaccinated students who are explosed to covid can remain in school as long as they're tested twice in the following week and both tests are negative. A caveat is that the tests underlying this strategy were carried out before the arrival of Omicron. 

Pfizer has been testing its vaccine on children between the ages of six months and five years. With two doses of a low-dose vaccine, about one-third of the adult dose, children between the ages of six months and two years showed a immune response equal to that shown by adults between the ages of 16 and 25, to  adult doses. Children between the ages of two and five did not show this increase. Pfizer will also test using one-third the adult dose as a booster for children between the ages of five and 11.

WHO gave emergency authorization to Novavax, a vaccine developed by US company Novavax and the Serum Institute of India. Novavax has promised to deliver 1.1 billion doses to Covax. Novavax is not an mRNA vaccine and does not need the cold storage required by the Pfizer and Moderna vaccines. It does, however, require two doses, meaning there may be extra coordination needed in rural areas. 

Are South African and the UK sending warning messages to the US? Both have been dealing with the surge in Omicron cases that the US presumably will suffer all too soon. The research released regarding their experiences with Omicron say that it is more transmissible but is less likely to cause severe disease. There is, of course, a cautionary "BUT." The US lags both the UK and South Africa in terms of the average immunity people have from being vaccinated or having had covid. They are not dealing with the vaccine-hesitance or -resistance we have here. It doesn't help that some of the vaccine-deniers claim that the fact someone who is fully vaccinated and boosted can catch Omicron suggests the vaccine doesn't do anything, so why should they take it. They don't look at the next card on the table, the one that mentions protection against severe disease, hospitalization, or even death. They need to stay at the table until Mother Nature plays the rest of her hand.  

Christmas is but one week away. If you are traveling to visit family and/or friends, be careful. Find some rapid tests to have on hand just in case. Stay masked in public settings or on public transit. If you have a feeling you should not do something, don't do it. You'll never know if you made the right decision, but that's better in this case than learning you didn't.

The Road goes ever on and on ... Day 142 (642)

I may actually be more afraid now than I was during the spring of 2020 as the pandemic was first spreading. Vaccinated or not was not an issue then, and masks seemed commonplace. Now I'm reading that with Omicron displacing Delta as the variant supreme we could see over a million new cases per day just in the US. At least that's what some expect based on how things have progressed in Southern Africa, Britain, Denmark, and Norway among others. When I was a child, it was hard to picture one million. I knew that New York City was the biggest city, people-wise, in the US, and the population then was seven million. If a million people are getting sick each and every day, how can anyone ignore the pandemic?

As of 8:00 this morning, the case count in the US was 50,513,437, with 138,883 of those being reported yesterday. There had been 803,652 deaths, 1,141 from yesterday. If we continue averaging 1,141 deaths each day, we will hit one million deaths in early June. One million people dying is even harder to imagine than one million people falling ill. Is it any wonder that mental health professionals say that they can't keep up with the demand for their services.

According to the CDC, only a little more than half of nursing home residents have gotten boosters. I do not know how they are defining "nursing home." My mom is in an assisted living facility; would that count? She has gotten a booster, but there were other residents who did not. The staff situation is also not clear; are there some who have yet to start the vaccination process? Having POTUS's mandate halted, there may well be. I visited my mom yesterday, keeping my mask on until I was inside her apartment. When I was leaving, she accompanied me to the front desk where I had to check out. On the way there and standing in line for the terminal, it hit me that my mom was the only resident wearing a mask. I am not taking this as a good sign. Visitors and staff were masked but not residents, except for Mom.

Were we working together more easily in the early days of the pandemic? Did we have a common interest that we've since lost? Ed Yong, a science writer at The Atlantic says, "Individualism couldn't beat Delta, it won't beat Omicron, and it won't beat the rest of the Greek alphabet to come. Self-interest is self-defeating, and as long as its hosts ignore that lesson, the virus will keep teaching it." There were people who, along the way, did not want to comply with mitigation measures such as masks, capacity limits, or distancing. But the big schism to me seemed to come with vaccines. I'm not sure we'll ever be on the same page of the pandemic-ending manual.

And so it's a not-too-much-news Friday. My mind seems full of what ifs, whys, and yes buts. I've decided that I am more scared now than I have been at any point along the way to here. 

The Road goes ever on and on ... Day 141 (641)

Some of the news seems more of the same today. Delta is still surging in the US and France even as both prepare for the Omicron surge they know is coming. Britain is in the throes of such a surge; there were 78,610 new cases Wednesday and 88,376 new cases Thursday. Different, though, is that Nepal wants vaccine shipments slowed as they are running out of cold storage space. I have to admit that when I see "Nepal," I think of Mt. Everest and wonder why they don't just store the vaccine outside the back door given how cold it must be there. Finally, to complicate things even more, flu cases are starting to increase in various countries.

The covid case numbers for states are going nowhere but up. Connecticut and Maine saw increases of 45 percent or greater over the past two weeks; Maine had a 49 percent increase. Rhode Island and Wisconsin had increases between 30 and 45 percent. Showing increases between 15 and 30 percent were New Hampshire, New York, Massachusetts, Delaware, the District of Columbia, New Jersey, Pennsylvania, Ohio, Indiana, Illinois, and Kansas. Some states did go down a wee bit: Alaska, Montana, North Dakota, Utah, Wyoming, South Dakota, Colorado, and New Mexico. The states not listed saw increases of up to 15 percent. 

The US is now averaging 122,000 new cases per day, a slight increase over a week ago and a 41 percent increase over two weeks ago. Deaths are averaging 1,300 per day. Michigan has the most cases per capita followed by Montana, Arizona, Kentucky, and Wisconsin. The vaccination rate in the US is, unfortunately holding steady. According to the CDC, over 40 percent of Americans are not fully vaccinated. As an aside, 49 percent of Americans hear "fully vaccinated" and think two doses of Pfizer or Moderna or one dose of the Johnson & Johnson vaccine. The other 51 percent hear "fully vaccinated" and think of the above plus a booster. According to the CDC, 27 percent of Americans including 52 percent of senior citizens, have gotten boosters. 

Given that many hospitals are near capacity with patients infected with the Delta variant and hospital staff members are dealing with PTSD or burnout, the expected Omicron surge is very definitely not a good thing. Three percent of covid cases in the US are Omicron, as are 13 percent of cases in the New York and New Jersey region. Both the National Hockey League and the National Basketball Association are postponing games because of the number of players out with covid. The National Football League has yet to do anything about upcoming games but is in the midst of its worst surge since the start of the pandemic. 

In terms of those hospitals at or near capacity, have you thought at how much they cost when it comes to treating covid? Complex hospitalizations range from an average of $49,127 in Maryland to an average of $128,650 in New Jersey. Average costs for non-complex hospitalizations range from $12,531 in Maryland to $44,239 in Alaska. Finally, average outpatient treatment costs range from $580 in Maryland to $1,538 in Nevada. The lesson here? Try to have a mild case that can be treated on an outpatient basis, and if you can, relocate to Maryland. 

The Road goes ever on and on ... Day 140 (640)

Remember Cornell University's moving final exams online and telling students to begone? Princeton University did the same right after. A large proportion of each school probably comes from far enough away that they fly to and from university. I wonder what some of those kids may be paying to cancel or reschedule their flights. The kids whose finals ended early in the exam period are probably breathing a sigh of relief that they'd already left. 

Interesting factoid: People in London having cold-like symptoms are more likely to have covid than a cold. The UK seems right now to be experiencing two covid epidemics, one from Delta and another from Omicron. New cases in one day just set a new record for the entire pandemic, 78,610. Right now, infections are doubling every 2.5 days. Right next door, Ireland will likely be tightening restrictions as Omicron is expected to be dominant there next week. 

The governments of Denmark and Norway are both tightening restrictions in the face of covid surges.  Denmark is seeing a 50 percent increase in the number of new cases. There were 7,799 new cases Monday, twice the number of the previous Monday. They are closing schools and colleges early, putting limits on nightlife, and urging remote working where possible. Denmark says that Omicron will be dominant in Copenhagen this week and nationally soon after. Norway says that Omicron is "becoming established and will dominate" country before Christmas. Norway's prime minister warns of a "total saturation of the national health system" and adds, "There is no doubt, the new variant really changes the rules. That's why we need to act fast and we need to act again. For many this will feel like a lockdown, if not of society then of their lives and of their livelihoods." Right now, Norway is banning the sale of alcohol in bars and restaurants, requiring remote working where possible, extending mask mandates, and restricting access to pools and gyms.

Elsewhere in Europe, Italy is making entry requirements stiffer. Everyone coming in from the EU has to test negative, while anyone who is unvaccinated must quarantine for five days. Poland is restricting the number of people in restaurants, hotels, and theaters. The Polish cabinet is divided on vaccine mandates for health care workers, teachers, and the military. France is warning of a sixth surge. Countries in southern Europe that did not have autumn surges are starting to have winter ones. The EU Commission President warns that Omicron could be dominant in Europe by mid-January, 

Google is requiring that all US staff must be vaccinated by the middle of January or face serious repercussions. Staff who miss the January 18 deadline will first go on paid administrative leave for 30 days, then six months of "unpaid personal leave." If they still are not vaccinated, they will become unemployed. 

The US just went over 800,000 deaths. That's the highest reported death toll in the world and very likely an underestimate. The US accounts for four percent of the world's population but 15 percent of the world's known covid deaths, not a distinction to be proud of. A University of Washington model predicts 880,000 deaths by March 1. In March or April of 2020 one of the worst-case scenarios projected 240,000 American deaths. Don't we wish it had been that few.

A not-yet-peer-reviewed article reports that Omicron grows 70 times faster than Delta in bronchial tissue (the tubes from the windpipe to the lungs) which may account for its greater transmissibility. The article also reports that Omicron grows 10 times slower than Delta in lung tissue which may account for its symptoms being milder.

Finally, a statement by the WHO director general that pretty much sums up my current view: "Omicron is spreading at a rate we have not seen with any previous variant." As one-time Boston Celtic Paul Pierce liked to say, truth.

The Road goes ever on and on ... Day 139 (639)

Shades of spring 2020, Cornell University in Ithaca, New York is shutting down for the semester. Students and staff are being sent home. The remaining final exams will be moved online. They had almost 500 new student cases at one time, and that was too many. They also had a percent positivity rate of 3.01. Ha! The percent positivity rates of the local university are 4.56 for students and 4.92 for faculty and staff. Finals here end on Friday, and numbers of cases are about what they've been all semester, so we may be okay. There was no word in the Cornell press releases about spring semester, so the best may be yet to come.

Happy first anniversary! One year ago today, the first dose of covid vaccine was given to a front-line nurse. That seems so short time ago at the same time as it feels longer than one year. Last week was two years since the first confirmed case; now we're one year since having vaccines that help prevent it. Early on, the demand for vaccines greatly exceeded the supply. As the pandemic appeared to lessen and restrictions were relaxed, the demand for vaccines plummeted. 

The Air Force dismissed 27 service members for refusing to get vaccinated. Each branch of military services set their own vaccination deadline, and the Air Force's was the earliest, November 2. All 27 had fewer than six years of service. The military has granted no religious exemptions, though it has granted medical ones. It also has allowed those members whose service is ending within a certain time frame not to be vaccinated. The Pentagon has not yet declared whether boosters will also be required. 

Omicron is expected to become the dominant strain in Denmark this week. England has seen the first death from Omicron, and 10 people have been hospitalized. If even a small percentage of people with Omicron need to be hospitalized, it could overwhelm the health system. South Korea just saw its deadliest day of the pandemic. Ninety-four people died in 24 hours; some died waiting for hospital beds. Another 906 people are in serious or critical condition. 

Here, a senior official in the Biden administration warns, "Everything points to a large wave. A large wave is coming. It will be fast. It won't be as severe, but regrettably, there will be plenty of hospitalizations." One article described Omicron as a dress rehearsal for the next pandemic. Yes, we already have vaccines and treatments. But the next pandemic will come on as rapidly as Omicron did and without warning. Are we ready? I hope so, but my gut reaction is that we probably are not. 

If you're looking for a good read relating to the pandemic, get The Premonition: A Pandemic Story by Michael Lewis. I'm about halfway through it, and it is spell-binding. 

The Road goes ever on and on ... Day 138 (638)

This afternoon I found an incredibly, well at least to me, interesting aspect of the coronavirus pandemic. It seems that the Merck antiviral, molnupravir, might insert errors into DNA which could in theory harm developing fetuses, sperm cells, or even children. It's not clear whether it might also cause mutations in human DNA and extend the risk to men wanting to be fathers. A member of an FDA advisory committee says,"Do we want to reduce the risk for the mother by 30 percent while exposing the embryo and the fetus to a much higher risk of harm by this drug? My answer is no, and there is no circumstance in which I would advise a pregnant woman to take this drug."

The antiviral works by disguising itself as a building block of RNA. When the virus enters a cell to replicate, the drug slips into the virus's RNA and inserts enough errors that the virus can not survive. But the same compound that interferes with the virus's genetic material can also resemble a building block of DNA--the patient's own or that of a developing fetus. At least it does in hamsters according to one study. Because the drug performs the error-insertion in developing cells, one doctor said her would not give it to pregnant women, breastfeeding moms, children, or teenagers, all of whom have cell division going on. Merck says that the hamster study exposed the animals to a longer course of the drug than people would get and that its own rodent studies showed no problems. That said, they have so far not released the results of their own rodent studies.

Merck said that it did not include pregnant or breastfeeding women in their clinical trials just in case there might be a problem. so there's really no way of knowing how the drug might act in a human. Are hamsters a valid stand-in for humans? I can't see infecting a pregnant chimpanzee with covid and then the antiviral, though that would be closer to a pregnant human. Is 30 percent efficacy worth the ethical dilemmas this raises? Would it be simpler not to authorize its use? I know that I would not have taken it while pregnant. (Note to self: Do not include comment about my kids having enough to deal with given they have half of my genes.)

Also of interest are the results of a survey of 1,089 adults in the US in early December. Compared with October, more Americans are worried about getting covid, but they are not taking more precautions. In December, 36 percent of respondents said that they were extremely or very worried about themselves or family members getting covid. In October, only 25 percent expressed those levels of concern. The October and December surveys both showed some 31 percent of people somewhat worried. Finally, 33 percent were not too or not at all worried in December compared with 43 percent in October. (Results have a 4.1 percent margin of error). But, (another discussion with a "But"), only 21 percent of respondents reported taking safety precautions such as wearing masks or avoiding long-distance travel. Behavior did not really change between October and December despite the changes in level of concern. 

As if those issues aren't of enough concern, only about half of US nursing home residents have gotten a booster shot. Only 44 percent of eligible adults ages 65 and older got a booster shot before Thanksgiving. Covid has killed one of every 100 Americans in this age group. There have been about 800,000 deaths from covid; about 600,000 or 75 percent have been in people over the age of 65. One in 100 older Americans has died of covid compared with one in 1,400 for people under 65. Covid is the third leading cause of death for older Americans after heart disease and cancer, causing about 13 percent of all deaths in that group. At least older Americans are the most vaccinated group; 87 percent are fully vaccinated. 

Fully vaccinated people in England who have had contact with a person who tested positive have been advised that they should take a rapid lateral flow test every day for seven days. The problem with this? They appear to be out of such tests in England. The government website from which such tests used to be ordered now announces, "There are no more home test kits available. Try again later." The website through which a test could be booked is overloaded. Just a wee bit of a problem there.

And last but not least, Elon Musk is Time magazine's 2021 Person of the Year. How jealous are Richard Branson and Jeff Bezos not to mention the ex-President who used to manipulate images so that he, too, could be Person of the Year?

The Road goes ever on and on ... Day 137 (637)

The Professor somewhat pooh-poohed the thing in this morning's news that most concerned me. News from the CDC on Friday was that most of the Omicron cases in the US--34 out of 43--were fully vaccinated. Fourteen of those had also gotten a vaccine booster, though five of those were within the two-week post-injection period in which the experts say the vaccine is not at full strength. The bottom line is that nine out of 43 people, or 21 percent, were as fully vaccinated as one can get right now. So far it seems as if any symptoms for Omicron are mild, but that's not what scares me. It's the long-term effects, both long covid and the problems like heart inflammation that can pop up later. It's also the possibility of transmitting Omicron to someone more vulnerable, like an 89-year-old parent. 

Tuesday is the first anniversary of the first covid vaccination in the US. Since then, 200 million people have been fully vaccinated. At the same time, the US could this week pass 800,000 deaths. I expect that in 2022, that number will pass one million. How soon in 2022 that happens is up to us. An article in today's Outlook section of The Washington Post lays out just how we are our own worst enemy in fighting covid, or at least many or most of us are. In Bangor, Maine, the organization sponsoring the Christmas Parade decided to cancel it this year as it did last year. After a public outcry, another organization took over holding the parade. As it turned out, the weather the day of the parade was cold and rainy which may have lessened the number of spectators. Do the people who protested the initial cancellation not understand the role crowds play in the transmission of any virus, let alone this one? Do they think covid can't or won't happen to them? I do not understand. 

It seems that Omicron developed from the original coronavirus not one of the variants. One theory behind this is that Omicron arose in a remote region of southern Africa and only recently spread. That seems a bit far-fetched to me. Another theory is that the virus mutated in an animal infected with covid (more on animals with covid coming) and then was transmitted back to humans. The final theory is that Omicron arose in a person with a weakened immune system, someone like a person undergoing cancer treatment or who had received a donated organ. Given that sub-Saharan Africa is home to two-thirds of the global population living with HIV, Omicron could also have arisen in a person with HIV. Under this scenario, the virus mutates in an HIV patient's body until it gets the right mutations to burst out and infect others. Viruses have been known to live in the body of an HIV-infected person for 216 days. My money is on this third theory.

Still, the coronavirus has been confirmed in a number of animals including hippos, snow leopards, gorillas, lions, tigers, cougars, ferrets, hamsters, minks, dogs, and cats. Research is ongoing to develop a vaccine suitable for animals. The worry is that the virus can mutate in animal(s) and then be transmitted back to humans. Early in the pandemic, mink farms were shut down and minks slaughtered because of the disease coming back to humans. In the Netherlands, scientists visited the homes of pet owners who were infected with covid. In 20 percent, the pet cats and dogs had antibodies for coronavirus. 

Other random notes: Across US prisons, 34 of every 100 people are known to have been infected with covid. That's roughly four times the infection rate of the general US public. The major factor? Crowding. Scientists are advising the government of the UK that Omicron could cause between 25,000 and 75,000 deaths in England in the next five months if no additional mitigation measures are taken. Taiwan found the first Omicron cases there in three people who had traveled abroad. And protests continue in Vienna against the extra restrictions imposed on unvaccinated people.  

The Road goes ever on and on ... Day 136 (636)

So this is it for today. First thing this morning, I spent a nontrivial amount of time reading about last night's tornadoes. Then I made blueberry muffins, a dozen of which I took with me when I went to my neighborhood shepherd's open house where I selected yarns as compensation for the Fall Fiber Festival. I'm thinking scarf, so I got black silk for the warp and a camel-colored silk-cotton blend for the weft. It is impossible to get away quickly, and between chatting and helping another person get what they needed, I did not get home until about 20 minutes ago. Having taken no notes from the little coronavirus news I saw this morning, I will take today off and be back tomorrow hopefully with something to say.

The Road goes ever on and on ... Day 135 (635)

Omicron appears to have been discovered in Virginia. The state health department is not being too transparent in terms of details, but the region in which the case has been identified includes Charlottesville. It was only a matter of time until Omicron was found here. Virginia is apparently the 24th state to have identified Omicron, though that "24th" was as of this morning and could be higher now. It's gonna get interesting now.

Nationwide, covid hospitalizations are up 40 percent compared to a month ago. Hospitalizations are up 88 percent in the state of Michigan. It seems that younger and younger people are dying of covid there. One contributing factor may be weather. We are headed into not only winter but also our first winter with the Delta variant, at least until Omicron becomes dominant. I base that statement on the predictions from Britain that Omicron will become the dominant variant there before Christmas. 

As for Britain, right now 30 percent of the cases reported in London are Omicron. The UK just reported its highest number of new cases since January 9, almost a year ago. There were 58,194 new cases and 120 deaths that occurred within 28 days of a positive covid test. I found an intriguing reference in one of the articles in the Guardian. It was to the effect that the UK government has been "presented with some very challenging new information" about Omicron. Health officials will consider possibly necessary new actions while awaiting additional data. 

Only about one in 10 Americans say that the covid vaccine would violate their religious beliefs, and 60 percent say that too many people are using religion as an excuse to avoid vaccination. A majority of Americans are critical of religious exemptions with the sharp divide seen in so many covid issues. Over 80 percent of vaccinated Democrats say they're angry at people who won't get vaccinated. Over 80 percent of unvaccinated Republicans say they're angry at people telling them to be vaccinated. 

No major religions or denominations oppose covid vaccines, and many have publicly endorsed them. However, only 41 percent of white evangelical  Protestants agreed with a statement that there are no religious reasons to refuse vaccination. White evangelical Protestants are also the only major religious group among which a majority of members believe the statement that "the government is not telling us about other treatments for Covid-19 that are just as effective as the vaccine."

One in five Americans say that the issue of vaccination has caused major conflict within their family. We are fortunate, it seems, in having a relatively small number of family members with whom to congregate on a holiday. There are relatives on The Professor's side of the family and probably on my side as well who are not going to get vaccinated, but they are far enough away that the subject of getting together never comes up. I did put at the end of my annual Christmas letter that we were only accepting guests who were fully vaccinated, but no one has complained so far. Given how few times we have had people stay with us, I don't expect it will become an issue.

The Road goes ever on and on ... Day 134 (634)

Omicron is out there, still somewhat lurking, while here in the US we continue to deal with the dastardly Delta variant. In the last two weeks, cases went down more than 20 percent in only one state, Wisconsin, where cases dropped by 22 percent. Cases went up over 20 percent in seven states: Rhode Island (a 40 percent increase), Massachusetts, Connecticut, Delaware, Kansas, Illinois, and Indiana. Cases in Alaska and Montana decreased between 10 and 20 percent. As a country, we are averaging over 120,000 new cases per day, a 27 percent increase over two weeks ago. Deaths are up 12 percent to an average of 1,275 per day. 

New Hampshire, New York, and Maine are calling on the National Guard to help health systems overwhelmed by rising numbers of cases. Right now, there are 15 percent more hospitalizations than there were two weeks ago. Michigan leads in hospitalizations per capita. Maine has 73 percent of residents fully vaccinated, behind only Vermont and Rhode Island nationally, and just saw cases reach a pandemic peak. Maine Medical Center, the state's largest hospital, has at times this week had no critical care beds available. On November 8, there were 980 people hospitalized with covid in Missouri; there were over 1,600 people on Wednesday. Missouri's University Health system had 10 covid patients in early November and had 39 on Wednesday. Says the system's chief medical officer, "What we're seeing now is still overwhelmingly the Delta variant." 

The Global Health Security Index developed by the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security showed no country as being prepared for various health emergencies and problems such as the next pandemic. The US ranks at the top of the list but is still considered unready. Maybe Omicron will be a good motivator for countries to start looking ahead. 

Omicron is spurring wealthy nations to push booster shots even harder, causing WHO to express concern over vaccine equity, and not for the first time. Booster shots are now outpacing first shots globally. Only 8 percent or 103 million of 1.3 billion Africans are fully vaccinated. Some 73 percent of the vaccine shots globally have been in high- or upper-middle-income countries. Only 0.8 percent have been in low-income countries. Some wealthy countries have offered poorer countries vaccine doses about to expire. Countries have had to turn them down because they lack the capability to get them to people before they expire. 

An epidemiologist at the University of Pennsylvania sees some value in the Omicron variant, saying that it "is pulling the fire alarm. Whether it turns out to be a false alarm it would be really good to know if we can actually do this--get a new vaccine rolled out and be ready." WHO has appointed an independent scientific panel to advise on whether vaccines need reformulating. For now, boosters are taking the place of new vaccines. The FDA has authorized Pfizer boosters for teenagers ages 16 and 17 on an emergency basis. The CDC is expected to endorse the FDA's recommendation. 

Over 167,000 children have lost parents or in-home caregivers to covid in the US. That should not surprise me given the overall number of deaths, but it still somewhat slaps me in the face. The number internationally is in the area of two million. I looked for a corresponding number of parents who have lost children to covid, but the only reference that Google gave was from the Wall Street Journal and required an $8.00 per month subscription to read. I go back and forth wondering about the toll paid by each group. I cannot imagine losing a child, especially a young one, but at the same time, I cannot imagine what it is like for a young child to lose their principal caregiver, the one who ideally takes care of and teaches the child about life and the world in which they live. I never experienced the latter and now pray I never experience the former.

The Road goes ever on and on ... Day 133 (633)

An outright theft from Axios:

10 key dates in our pandemic journey:

1. Dec. 8, 2019: The World Health Organization's official date for the onset of the first cases in Wuhan, China, that were later confirmed to be COVID-19.
2. Feb. 23, 2020: Italy becomes the first country outside China to impose a lockdown.
3. March 11, 2020: The WHO declares a pandemic. 4,616 deaths have been recorded.
4. April 2020: School closures affect 82% of the world's students, according to UNESCO.
5. Sept. 28, 2020: The world crosses 1 million deaths, with the U.S. and Brazil recording the most.
6. December 2020: The FDA authorizes the Pfizer vaccine for emergency use Dec. 11, followed by the Moderna vaccine Dec. 18.
7. Early July 2021: After falling sharply in the spring, cases begin to rise again in both the U.S. and E.U., with the unvaccinated hit hardest.
8. Nov. 1, 2021: The official worldwide death count hits 5 million.
9. Nov. 5, 2021: Half the global population has had at least one shot.
10. Nov. 24, 2021: South Africa reports the Omicron variant.

Yes, two years ago today the coronavirus took root. I can't say it has blossomed; it's more like an overgrown ground cover than a flower. Of course, most of us knew nothing of it until February 2020. I first heard about it when I was at a meeting of what I call my online quilt guild in San Marcos, Texas. I flew in and out of San Antonio. When it turned out that one of the early cases in the US was someone flying into San Antonio for some sort of military boot camp, this thing then called the novel coronavirus got my attention. I would add an item numbered 3.5, but the automatic numbering makes that difficult. The added item would be March 16, 2020 ... Jean Lightner Norum starts a daily pandemic blog. 

Some experts are starting to warn of a covid-flu "twindemic." Sixty percent of Americans are fully vaccinated against covid. On the flu side, 41 percent of adults and 39 percent of children have had a flu shot. The CDC says that the dominant strain this year is A (H3N2). In previous years, this has meant more hospitalizations and deaths among people ages 65 and older. I'm sure there are places that will give the covid booster and a flu shot, one in each arm on the same visit. The Professor and I doubled up on shingrix and flu shots.

It appears that Omicron partly evades the immunity provided by two injections of the Pfizer vaccine. Blood samples of people who had gotten two doses of the Pfizer vaccine showed a 25-fold reduction in antibody levels against Omicron. Two weeks after a booster injection, the neutralizing antibodies against Omicron were comparable to the levels of antibodies against previous covid variants. People who had a case of covid before they were vaccinated seem to have more protection. I would not, however, recommend that as a vaccine strategy. And Dr. Fauci warns, "We shouldn't be making any definitive conclusions, certainly not before the next couple of weeks." 

Omicron is doubling in the UK every two or three days such that it could be the dominant strain before Christmas. Scotland has called for working from home. England is expected to announce new restrictions this evening (which is pretty much right as I'm typing this) that may also require working from home where possible. Various places around the world are canceling or cutting back their New Year's Eve celebrations. Rio de Janeiro has canceled the celebration planned for Copacabana. Baltimore has scaled back their celebration. I haven't seen anything about Times Square and actually don't expect to. I don't think they'll cancel or limit it a second year in a row, though requiring vaccination to be there is something of a limit. South Korea is shutting unvaccinated students out of study rooms, libraries, and private cram schools known as hagwon.

WHO's top official in Europe says that since Omicron has now been detected around the world, travel bans will not contain it and should be lifted. He called for five "pandemic stabilisers:" increasing vaccination rates, giving boosters to the most vulnerable, doubling mask-wearing rates indoors, ventilating crowded spaces, and providing "rigorous therapeutic protocols for severe cases." 

Here is a link to the top 10 emojis of 2021. Spoiler: the poop emoji is not one of them. If you happen to be in Des Moines, Iowa, check out their Canada geese management plan. They are trying to make Des Moines less habitable for geese by installing tall plant buffers and riprap along riverbanks and reducing winter water aeration to create more freezing. Let us know if those work, Des Moines. We could probably use our own Canada geese management plan here.

If your mind wants to wonder, try to imagine what the third year of the pandemic will be like. I expect I'll be doing a bit of that.

The Road goes ever on and on ... Day 132 (632)

It is not surprising that people in counties that voted for the former president are nearly three times as likely to die from covid than those in counties that voted for POTUS according to a study conducted by National Public Radio. The study started with May 2021 or roughly when vaccines became universally available to adults. Counties that went for the former president by over 60 percent had lower vaccination rates and higher covid death rates. The tenth of the counties that were the most Republican had death rates six times higher than the tenth that were the most Democrat. Hawaii, Nebraska, and Alaska were excluded because they don't report election results and/or vaccine results by county. Underlying much of this is that while 91 percent of Democrats are vaccinated, only 59 percent of Republicans are. Finally, 94 percent of Republicans think at least one false statement about covid and vaccines might be true, and 46 percent believe that four or more might be true. Only 14 percent of Democrats believe four or more might be true. The most widely believed false statement? That the government is exaggerating the number of covid deaths. 

The European Union health commissioner is urging countries to increase vaccinations and use non-pharmaceutical mitigation measures such as masking or distancing when appropriate. Meanwhile, the head of WHO Europe division sees mandatory vaccinations as an "absolute last resort" and says that vaccine mandates should not contribute to inequalities in accessing health care. He also offered a reminder that much about the Omicron variant remains unknown.

While much does remain unknown, the evidence so far for how fast Omicron spreads continues to grow. The first of two plausible reasons for the speed of the spread is that Omicron spreads faster in people with no immunity than earlier variants did. It may also evade immunity from a previous case or from vaccination. So far, Omicron appears to be causing only mild symptoms; however, it can take over a week to develop severe covid illness, and Omicron has only been recognized as being out there for less than two weeks. The initial patients in South Africa were, for the most part, young with some having immunity due to the Delta variant. It's not clear how Omicron is going to affect older and more vulnerable people. Here, Dr. Fauci says that the signals are a bit encouraging. What risk does Omicron pose to vaccinated people? There is so far no sign that the illness of vaccinated people will be more severe, but as before, it is important to see what happens with or to unvaccinated people and those with waning immunity. 

A Harvard scientist says that the world is seeing "what appears to be a signal of exponential increase of Omicron over Delta" and that Omicron could take over from Delta as the dominant variant in a matter of weeks. The current surges in the US are due to Delta; scientists say that it will take a couple of weeks to know if Omicron will replace Delta. Experts in the UK say that in 10 days the UK could have more cases of Omicron that some of the countries on the UK's travel red list. Omicron could overtake Delta there in several weeks.

The CDC has added Portugal and France to its highest-risk travel level reflecting the surge underway in each. The Netherlands is bringing in soldiers with medical backgrounds to help support hospitals. The aim is to ensure that no hospital has to say no to a patient. This is the second time the military has been called in. The first was October 2020 to June 2021. There are currently 2,143 covid patients in Dutch hospitals, 611 of whom are in ICU. Covid patients currently occupy 59 percent of all ICU beds in the country.

As a secondary result of the pandemic, the blood pressure measurements of nearly 500,000 people show a significant rise. During the pandemic, people have been exercising less, getting less regular medical care, drinking more, and sleeping less all of which affect blood pressure. Larger increases were seen in women than men. One drawback to the study is that the researchers did not include data on the race or ethnicity of the subjects. 

Dictionary.com has unveiled its word of the year for 2021, "allyship." The word of the year for the Oxford English Dictionary is "vax." I think I mentioned some days ago that Merriam-Webster's word of the year is "vaccine." Finally, Collins, a dictionary coming out of Scotland, chose "NFT" (non-fungible token). I'll leave it to readers to look up the words they don't know. I expect that "vax" and "vaccine" will not be among the unknown. We probably know more about vaccines now than we ever expected to know.

The Road goes ever on and on ... Day 131 (631)

I have a couple of pages of notes on the stricter restrictions being put in place by various countries, mostly European ones. I was ready to start summarizing those but found an article in The Guardian that while actually dated in October is relevant today and will be relevant for quite some time. What will it take to make the current pandemic endemic? There's actually no easy answer, which makes sense given how different the conditions are in different parts of the world. One objective criterion is that an infectious disease becomes endemic when the rate of infections has more of less stabilized across years (seasonal changes are to be expected). Under this rubric, R0 is stably at one; each person who is infected will infect only one other person. This is far from the whole picture, though, keeping in mind that the R0 of measles is around 18, and WHO has declared it not only endemic but also eliminated in the US. 

On a more subjective level, a pandemic becomes endemic when health experts, global governmental bodies, and the general public are all okay with the level of illness or death that is occurring as a result of the disease. So, what is an "acceptable" level of mortality? Influenza kills 12,000 to 52,000 Americans each year according to the CDC. Some experts say that that is too high, but we as a society seem to have accepted it. With the coronavirus, though, there is covid and there is long covid, which has been recognized as a disability under the Americans with Disabilities Act. One epidemiologist summarizes the situation as, "What you want is to get to a stage where you don't have to worry about disruption because of Covid. The pandemic is over when the crises stop--not just when we get to a certain level of death."

When will the crises stop? It's probably best to consider just which aspects of our current state are crises and which are inconveniences. Clearly some that I would call an "inconvenience" are, to others, a "crisis." After two years, I wonder why we did not do what the Japanese do sooner and wear a mask when suffering from a cold. Those who won't wear a mask see wearing one as an infringement of a basic liberty. And some that I would call a "crisis" are to others a fact of life, not just an inconvenience. I see the high number of Americans who will not get vaccinated as a crisis. The vaccine-resistant see the situation as "they won't get vaccinated" period full stop. 

Assessing the current situation of the pandemic is made more difficult by the other, very different things that have happened during it. Think George Floyd, Black Lives Matter, Ahmaud Arbery, Climate Change, the Big Lie, the January 6 insurrection, and the ex-POTUS whose name I don't want to type. All of those swirl around and at times leave me not clear as to how one affected the other(s). How many people stayed home rather than joined a protest because they were avoiding crowds? How might things have gone if all those people had shown up? So much was bound together or pulled apart because everything happened in the context of the pandemic. Was this a good thing or a bad thing or will we just never know the answer?

I wish I could express my thoughts here better. I start to type one thing and another butts its way in demanding to be considered. Pandemic to endemic. Crisis to inconvenience. Thoughts to words. Transitions that may happen or may never happen. I'm just along for the ride. 

The Road goes ever on and on ... Day 130 (630)

Christmas decorating is underway. A couple of cards are hung from the mantle along with a "LET*IT*SNOW" banner. The tree (artificial) is up with the tree skirt positioned beneath it. The next step is for The Professor to check the strings of lights. Once the lights are up on the tree, the ornaments go on. The Christmas Ape will go atop the tree in the morning; Son #1, being the tallest person in the family, traditionally positions Christmas Ape. I cannot remember when the Christmas Ape displaced a star atop the tree, but it was probably about 30 years ago. If I remember, I'll include a photo of Christmas Ape in tomorrow's post.

Now, back to the not-so-novel-any-longer coronavirus. Sir Jeremy Farrar, one of Britain's most senior scientific officials, said that Omicron shows we are "closer to the start of the pandemic than the end." He went on the add, "The longer this virus continues to spread in largely unvaccinated populations globally, the more likely it is that a variant that can overcome our vaccines and treatments will emerge. If that happens, we could be close to square one."

Britain is considered a leader in genomic sequencing and testing and has detected about 160 cases of Omicron. Travel restrictions are being tightened. Everyone must be tested within 48 hours of travel to Britain, even those who are fully vaccinated. Right now, travelers need to self-isolate and test on the second day after arriving. If the test is negative, travelers may leave isolation. It it is positive, the traveler must isolate until a test is negative. 

Over 40,000 people gathered in Vienna to protest the tightened restrictions in Austria. There were about 1,500 counter-protesters. The opposition to mask and vaccination mandates is led by the far-right Freedom Party, the third largest group in Parliament. Members tend to back conspiracy theories and treatments such as ivermectin. Several protesters wore t-shirts proclaiming "Make Austria Great Again." Bring back any memories here?

After many travelers canceled trips, Switzerland dropped the 10-day quarantine requirement it had instituted. It has been replaced with a test before entering the country and another between four and seven days after arrival. A traveler arriving from a risky region must prove that they are fully vaccinated. Proof of vaccination is required to enter public establishments; masks are required for all indoor public events. 

Finally on the European front, Queen Beatrix of the Netherlands tested positive and is isolating. The now 83-year-old queen held the throne from 1980 to 2013 before turning it over to her son King Willem-Alexander. The queen was something of a neighbor the year we lived in the Netherlands. We lived in a small town about 18 kilometres outside Amsterdam, and the palace was within easy walking distance of our house. Many a morning or afternoon, I pushed a stroller past the palace while the inhabitant of the stroller napped.

Here at home, it is getting harder to get vaccine or a booster. Expanded eligibility and fear of Omicron have upped demand. In October an average of less than one million doses per day was being administered. Now, that average is about 1.5 million. Many drugstores are using an appointment system as they did at the start of immunization. This is not a bad thing.

The Minnesota man who was one of the first Omicron cases identified in the US went to a New York City anime convention with about 30 people, half of whom later tested positive. It is not clear if they also had the Omicron variant. The governor of Connecticut said that the first Omicron case there had a relative who had attended the same convention. 

We will again get together only with close family this Christmas. I understand that many people feel safe flying or otherwise traveling. I'm not ready to do that. The one trip I have planned, to a quilt show in Hampton, Virginia, in late February is now dependent on what Omicron or its yet-to-arrive cousin might throw at us. Everything is subject to change, and right now everything is going as scheduled.