The Road into 2023

Fortunately, I stopped the daily pandemic blog when I did. Remember the couple of times I said I was afraid of long COVID were I to get COVID? That apparently happened. Fatigue just kept growing. The first thing I noticed was that going up stairs was noticeably harder. I then realized that I was only making it through each day by ingesting over a gram of caffeine between coffee and caffeinated gum. Besides telling me to cut down on caffeine, my doctor ordered several types of blood work. When all the various tests came back normal, the diagnosis by exclusion pointed to long COVID. Doctor's orders were to stop doing all the things I'd been doing even if they had seemed fairly easy. This may be the year of no Christmas cards. This may also be the year of no resolutions, at least for now. I don't think "get my energy back" counts as a resolution, but that would be the big thing I'd be hoping for for 2023. 

Happy New Year to all, and to all however late a night you want. Mine will be an early one. 

The Road goes ever on and on ... Day 500 (1,000)

So here we are at Day 1,000. So much has changed, and so much hasn't. China continues to relax restrictions while still saying that zero-COVID remains in place. That may be true, but then why are there calls for the "full mobilization" of hospitals to ensure "combat effectiveness." Cities are said to be "accelerating the upgrading" of hospitals for "critically ill patients." For those critically ill people, there are fewer than one ICU beds for every 10,000 people. Local officials have been told to keep track of the health of everyone ages 65 and older. A virus testing center in Beijing shut down because all the employees were infected. Social media advised citizens to "please be patient." The official case count of 363,072 is up almost 50 percent from October 1. Zero-COVID, this is not.

Many people around here agree with POTUS's statement that the pandemic is over. The Professor and I treated ourselves to our favorite coffee shop this morning (it is a small local business, not Starbucks). The sign on the door saying that masks were no longer required but they appreciated patrons who wore them was gone. There were not many people there, but we were the only ones with masks. There were one or two other people wearing masks at the grocery store, but none of the staff wore them. As with the coffee shop, there was no signage about masks.

And I sit here on the Thousandth Day just up from the afternoon nap I have never before been able to take as a healthy adult. Naps are for sick people, and it appears I am one. I had a couple episodes of brain fog yesterday. I'm starting to wonder about things I may have done. I remember putting something in one place but it's no longer there. When I do find it, I have no memory of putting it where I found it. I worry about me. The pandemic is not over here.

Actively searching for and reading whatever news I could find each and every day did influence the way I looked at things. For one, it made me paranoid about being exposed and getting sick. I learned to accept that not everyone thought this way. When in-person instruction re-opened at The Local University, I accepted that there would come a time at which masks were no longer required. When The Professor put his mask aside and ended up with COVID, I, too, caught it. I had drawn the line at wearing a mask at home with The Professor and Son #1, who visited daily to run and get a dose of dog. I did not nag The Professor about wearing a mask after they were no longer required at The U; I could but do not regret that now. I am getting used to being the only one in the room wearing a mask.

I learned not to correct comments other people made; because I did not go anywhere, this rarely mattered in person. I learned to click past such comments on social media and remind myself of the First Amendment. Because we usually are drawn to similar people, I really do not personally know any anti-vaxxers, people who deny the pandemic exists or existed at all, or pandemic conspiracy theorists. That I some years ago ended social media friendships with people who openly supported our EX-POTUS probably helped in that regard. 

I at one point mentioned that I would keep this blog going until I was fully vaccinated. That did not happen. I mentally had other breakpoints that passed. Now, as it becomes harder to find new news about SARS CoV-2 coupled with not knowing how long I will be as tired as I am now, it seems to be time. I won't stop reading what comes into my inbox or what notifications appear on my phone. If something I read intrigues me, I will take some notes and post something here. If I write about some other thing that interests me, I'll post that, too. In other words, The View from the Hermitage has not really changed; The Road goes ever on and on and may for some time. I just need to wander elsewhere. I have enjoyed reading your comments, really. When I learn whether what ails me might really be long COVID, I'll post something about that. I hope it isn't, but if it's not, then I hope it can be treated. 

Merry Christmas to all, and to all a good night ... for now.

The Road goes ever on and on ... Day 499 (999)

If there was new news out there concerning the pandemic in general or SARS-CoV-2 in particular, I did not find it. Nothing in new digest emails, no newspaper delivered, and no headlines on the news websites. I called that a reason to nap, which I did. People who know me well know that I don''t nap, can't nap even. The Professor has napping down to an art, but I don't. The only times I'm able to nap are when I'm sick, which I guess I could be. Tomorrow is the big millennium in days, not years.

The Road goes ever on and on ... Day 498 (998)

I just finished reading the transcript of an interview with Dr. Fauci as he prepares to retire from government service at the age (when he actually retires) of 82. It was quite interesting and worth reading. It would be nice to have a beer with him and talk more about getting the public to understand and appreciate science.

COVID vaccines and treatments will be going commercial eventually. Just as we now have to buy our own COVID tests, we'll be paying for the vaccines to get before those tests as well as the treatments to request after those tests come up positive. Pfizer and Moderna have said that their vaccines will likely be between $82.00 and $130.00 per dose. This may leave people with no health insurance high and dry when it comes to being vaccinated. 

The CDC released the results of their studies on the effectiveness of the bivalent boosters against infection. Compared to being unvaccinated, the bivalent booster was 42 percent effective against infection for people between the ages of 18 and 49, 28 percent effective for people between the ages of 50 and 64, and 22 percent effective for people over the age of 65. The more the time between the doses, the more protection offered. That's one reason they say to wait so many months between the last booster and the latest one. Data on the effectiveness of the bivalent booster against severe disease will be coming. 

The BQ.1 variants of Omicron now account for about 70 percent of the cases in the US. BQ.1.1 in particular accounts for 37 percent. The rise in hospital admissions is similar to what has been seen in France, who as before has been several weeks ahead of the US in COVID progression.

Not much new info in today's post; I pretty much did no news reading today. I've been concerned for some time about how much caffeine it's been taking me to get through a day and how tired I am even after a decent night's sleep (defined as not having to get up to use the bathroom). After a noteworthy episode of what might be called brain fog--forgetting I had turned on the water in the kitchen sink and not noticing until the hot water heater had been emptied--I finally admitted to myself that I might have a mild ( I hope) case of long COVID. I now have an appointment to see my doctor on the 20th. While I by no means have the severe symptoms a friend of mine has had, there is clearly something going on. If coming posts are not as long or detailed, it's probably because I'm taking care of other things such as me.

I will definitely have something to offer on Sunday, Day 1,000 though. I've been thinking a lot about that.

The Road goes ever on and on ... Day 497 (997)

Many things took longer than planned today, and dinner prep is calling now. I do have notes for today and just saw some more news worth including, but it will have to be tomorrow. Apologies!

The Road goes ever on and on ... Day 496 (996)

The Japanese attacked Pearl Harbor 81 years ago today. A new recruit who was 17 on that day would now be 98. The greatest generation gets smaller every day; some are taken by a new enemy, COVID-19.

There are various estimates of the number of people who have had COVID. Different reports use different methods, populations, and timing. The CDC's estimate for a time period ending in May 2022 is 42 percent. A not-yet-peer-reviewed paper posits 94 percent for a period ending last month, November 2022. An article in the Canadian Medical Association Journal says 61 percent for a time period ending in August 2022. Finally, a study reported in The Lancet suggested 58 percent for a period ending in February 2022. Until that Lancet study popped up, I was going to note that the three percentages were in line if ordered by date. That is, 42 percent for May, 61 percent for August, and 94 percent for November. 

China has rolled back rules on isolating people with COVID and loosened virus test requirements. Experts say, though, that it will be mid 2023 before all requirements can be lifted. 

A COVID opinion survey of 1,147 US adults done between December 2 and 5 had some interesting results. For example, 69 percent of respondents agreed with the statement that "the federal government should continue funding prevention measures."  At the same time, 44 percent agreed with the statement that "America has already spent enough fighting COVID; it's time to stop and move on." At one end of the continuum, 45 percent believe that "public health officials lied about how effective COVID-19 vaccines and masks are" and 39 percent believe that "Dr. Anthony Fauci should be investigated for his role in the COVID-19 response." Only 30 percent claimed to be acutely aware of the state of the public health emergency and still take steps such as masking, while 70 percent strongly or somewhat believe that we are moving to a point where the virus won't disrupt daily lives.

The international vaccine agency, Gavi, is discussing ending Covax, the program to deliver COVID vaccines to countries who could not afford them. Demand for those vaccines is lessening. Gavi manages stockpiles of emergency vaccines and supplies routine childhood shots to developing countries. If Covax ends, COVID vaccines would be rolled into the standard immunization program for 54 countries. Other countries would have to pay something for the vaccines.

My Mom's assisted living facility is up to five cases of COVID. Three are in the general population including one who sits with My Mom at meals. My Mom is not sociable by nature, something I'm glad about now. Watching TV in her apartment exposes her to so many fewer germs than watching TV with other people in the lounge would. I'll be dropping things for her off at the entry desk until they've hit the magical (and relative) zero-COVID.

The Road goes ever on and on ... Day 495 (995)

My Mom just called. They have a COVID case on the memory care floor of her assisted living facility. Residents of that floor don't mix with residents of the other floors, though staff may go to both areas. As a result, staff are now required to wear masks. Residents don't have to wear masks since it's figured they would not get exposed. (Yeah, right.) My Mom has had both a flu shot and the bivalent booster; I hope that's enough to keep her 90-year-old self safe. 

As for respiratory ailments in general, it's the worst flu season in over 10 years. Evidently, the care taken during the pandemic has left us "immunologically naive" and more vulnerable to the viruses out there. RSV, flu, and COVID are all rising at the same time, though RSV may be peaking in some regions of the country. It appears to have peaked in the South but is still rising rapidly in the West. Flu is rising fast and shows no sign of slowing down. COVID is rising everywhere, driven by seasonal changes, behavioral changes, and a broad mix of variants. It takes about two weeks to see the epidemiological impact of holidays, and Thursday will be two weeks from Thanksgiving. Canada tracks hospitalizations by age; the highest risk groups are those ages four and under or adults over the age of 65.

Federal funding for COVID care will be ending soon, and the effect on about 30 million uninsured people will not be pretty. They may end up having to pay for COVID testing and treatment; it would not be surprising if some stopped seeking care altogether. Evidently, some people have so far been charged over $3,000 for a basic COVID test. Hospitalization with COVID can top a million dollars. So far, treatments such as Paxlovid have been free, though seeing a doctor to get a prescription may not be. Both vaccines and treatments will be on the commercial market by summer and there is no telling what companies will charge for them. The White House has proposed a Vaccines for Adults program mirroring the program for childhood vaccines. The program supplies vaccines and reimburses providers for any administrative fees that arise. Whether such a program will be approved is hard to say and might even depend on the outcome of the special Senate election taking place in Georgia today.

The Road goes ever on and on ... Day 494 (994)

Non-COVID news first today. The Oxford word of the year is "goblin mode." The runner-up was "metaverse." I know what metaverse is all about, but I drew a blank on goblin mode. Fortunately, the article I was reading included a definition: "A type of behavior which is unaplogetically self-indulgent, lazy, slovenly, or greedy, typically in a way that rejects social norms or expectations." Now that I know what the term means, I don't plan on trying to use it in everyday speech or writing. I was doing fine without it before and can continue to do so.

Two independent research groups have shown a greater than 60 percent increased risk of newly diagnosed diabetes after a case of COVID. Also reported is that severe COVID can cause markers of old age in the brain. It seems that the genes active in the brains of older people are also as active in the brains of people who had serious COVID. It's the gift that keeps on giving!

Another reason for seniors to get whatever booster they can. New York and California hospital admissions for seniors with COVID is higher than it was during the Omicron BA.2 and BA.5 waves and the Delta wave. The BQ.1.1 and XBB subvariants  have surpassed their ancestors.

China classifies infectious diseases into categories that also carry suggestions for disease management. Category A diseases include bubonic plague and cholera. Category B includes SARS, AIDS, and anthrax. Category C includes influenza, leprosy, and mumps. COVID has been classified as a Category B but managed as a Category A disease. COVID appears to be on the way to being managed as a Category B or possibly even Category C disease. The reasons for this include that 95 percent of cases are asymptomatic or have only mild symptoms and that the fatality rate is now low. This sounds more and more like the end of zero-Covid to me.

 

I do have trouble with the argument that asymptomatic cases give a disease less clout or reason to be taken seriously. A person infected by someone with asymptomatic COVID will not necessarily have their own asymptomatic case of COVID; they could develop serious COVID. Many more factors are at play than how serious the case to which someone is exposed is. 

The Road goes ever on and on ... Day 493 (993)

Most of what i'll share today comes from one source but one I count as very credible, Eric Topol of the Scripps Institute. Much of the late morning and early afternoon was spent getting ready for and at a meeting of our Homeowners Association. There were 16 people seated around a large dining table. I was the only person wearing a mask. The neighbor who sat down beside me asked if masks were required; I thought that was funny given that only one person had one on. I told him they were optional. He did not pull one out of a pocket to wear.

I'm not giving up my mask any time soon. It's not looking at all good out there. Hospitalizations are up 25 percent. ICU admissions, test positivity, wastewater surveillance virus levels, and new cases are also rising. Cases continue to be undercounted due to home testing. Seniors (this sounds so much more polite than "elderly" to me) continue to bear the brunt of it. An analysis by the CDC and Kaiser Family Foundation shows that with most seniors having had the first two shots, more deaths are among those who have not added a booster to the initial doses.

More than one factor is in play here. Immunity is waning in no small part due to the pathetic booster rate. The US ranks lower than 70th among nations of the world. Less than one-third of seniors have gotten the bivalent booster. Having had a booster in the past four to six months does not do much to block infections, but it does a good job at preventing serious disease and hospitalization. Vaccinations have been available for almost two years now, and the CDC is still calling that "fully vaccinated." Boosters do not count toward the "fully."

Few mitigation measures still matter. The weather is turning cold, and people are turning to indoor gatherings for the holidays. My being the only masked person of 16 is not unusual. I haven't read anything about air filtration or ventilation lately. I am reminded of the childish "if I can't see you, you can't see me." Ignoring, not seeing, COVID does not mean it is no longer out there.

Omicron's BA.5 variant now accounts for only 14 percent of new cases in the US. BQ.1 and BQ.1.1 now account for almost 63 percent of new cases. The major difference between the two BQ variants is that BQ.1.1 is more immune evasive and resistant to Evusheld. Both are resistant to Bebtelovimab which is why the FDA has withdrawn its Emergency Use Authorization. This means that we have lost the most preventive measure for immunocompromised people, Evusheld. There is no replacement on the horizon. The prevalence of BQ.1 was dropping in France, but is no longer. Hospitalizations have risen as BQ.1.1 has become more dominant. France now has the highest hospital admissions per capita. It's worth noting here that the French booster rate is 50 percent higher than ours. Finally, Paxlovid remains underprescribed for seniors despite its reducing severity and hospitalizations as well as long COVID.

A new wave is sweeping across Asia with cases rising in Japan, Australia, Hong Kong, and South Korea. Japan is seeing the beginning of a second BA.5 wave. They have done a great job of dealing with COVID but still have 120,000 new cases daily. Cases rising in Australia and New Zealand not to mention South America suggests that cold weather is not the large factor some would like to think. 

How do we handle all this? Getting more bivalent booster doses into people, especially seniors, is one way. Ideally, everyone over the age of 50 would get the booster, but I think we know that that isn't going to happen. Can we re-introduce some of the mitigation measures we've dropped? Masks, anyone? Not gonna work unfortunately. We need to work harder toward a pan-coronavirus vaccine or we can abandon hope of yearly boosters. A pan-influenza vaccine seems effective; why not one for coronaviruses as well?

As we ponder all this, we should note that tomorrow is the start of National Influenza Vaccination Week.

The Road goes ever on and on ... Day 492 (992)

The country in which I live is listed by the CDC as having a low COVID transmission level. Looking at the county statistics posted by The New York Times, though, the two-week average number of new cases has been up over 100 percent for Thursday and yesterday. I'm not sure I'd think of that as "low." Maybe the increased numbers of people testing positive are not transmitting COVID to others. The test positivity rate has gone from three to 7.5 percent in the same time. Given the number of people relying on home tests, that positivity rate is likely not at all accurate. 

Also from the CDC are early data showing that people ages 12 and over who got their bivalent booster are 15 times less likely to die from COVID than unvaccinated people. That fact probably won't persuade die-hard anti-vaxxers to get vaccinated, but you can at least use it to try to persuade them. 

China continues to preach zero-COVID even as it relaxes restrictions. Testing booths have been removed in Beijing. Other cities have announced that they will no longer require commuters to show a negative test result. Cities may also drop the requirement that people test negative to use public transport or visit parks. It's all coming too late to save Christmas, though. Current shipping from China to the US is down 34 percent compared with earlier this year. Production of iPhones has stayed down at the factory in Zhengzhou. Honda has paused production at their factory in Wuhan, and VW has done the same at their factory in Chengdu. Experts are noting the "strategic long-term impact" supply chain issues will have for companies such as Apple or Tesla. One put it as, "... for this to happen to Apple in the Christmas season is a gut punch." In response to the problems, some countries are starting to shift at least part of their operations to places such as Vietnam or India.

The Grinch had best look out. COVID may be doing a better job at stealing Christmas.

The Road goes ever on and on ... Day 491 (991)

Paxlovid is a product of Pfizer. The Moderna analog is Molnupiravir. At the time these were put forward for emergency use authorization, some experts expressed concern that Molnupiravia was highly mutagenic. I wanted to make sure that I was reading things correctly, so I looked up "mutagenic" on dictionary.com. "Capable of inducing mutation or increasing its rate." Experts were concerned about Molnupitavir's effects if given to pregnant women; would it contribute to mutations in the fetus? Now experts are pointing to a new variant with more mutations in two months--72--than its lineage had caused in three years. Might that large increase be due to Molnupiravir? Some experts are calling on the FDA to repeal the Emergency Use Authorization until such questions have been answered.

Possibly in an attempt to quell protests and possibly (probably?) in an attempt to sustain zero-COVID, China is setting vaccination goals. Vaccinations have never been mandatory in China, even among the elderly or the immunocompromised. The targets set under the new plan are for 90 percent of people over the age of 80 to have gotten at least one dose of vaccine by January and for 95 percent of people between the ages of 60 and 79 to have had at least two doses. The vaccines will likely be those made in China which are not as effective for as long as the mRNA ones offered here.

Finally, Pantone has named its Color of 2023. And the winner is 

not the red I see here, but something called Viva Magenta. It is described as "powerful and fearless, it is a pulsating color whose exuberance promotes optimism and joy. Powerful and empowering, it is an animated red  that encourages experimentation and self-expression without restraint; an electrifying, boundaryless shade ... audacious, witty and inclusive of all." All that said, it still looks like red to me.

The Road goes ever on and on ... Day 490 (990)

WHO and the European CDC say that Europe may be entering another COVID wave. In the past, the US has lagged several weeks behind Europe in terms of new cases and hospitalizations. While I hope that won't happen on this go-round, there are no guarantees.

More on long COVID. An online survey of 1,487 people in East England who tested positive in 2020 found that 52.1 percent of them said they had had post-COVID syndrome symptoms. One predictor of who might have such symptoms was BMI. Another risk factor found was being a woman; men were at significantly lower risk for developing long COVID. The people who responded to the survey were 61 percent female, had a mean age of 50, and had a mean BMI of 28.4 (considered "overweight"). Only 11 of the people responding had gotten a first dose of vaccine. A Scottish study published in Nature Communications found that six to 18 months after infection, one out of every 17 people had not yet recovered from COVID, and 42 percent had only partially recovered. 

Over 75 percent of pediatric hospital beds are full right now due to respiratory viruses. Children under the ago of five have been especially hard hit. Pediatric hospitalization with RSV is seven times higher than it was in 2018, the last full season before COVID emerged. Hospitalizations for flu are the worst in 10 years, and COVID cases are starting to rise. So far, there have been three deaths from RSV and 12 from the flu. Some physicians say that a national emergency should have been declared a month ago. The curves for new cases and hospitalizations have been described as "almost vertical." Flu test positivity is 30 to 35 percent; there is as yet no test for RSV. One theory is that COVID has weakened children's immune systems. It also does not help that the rate for flu vaccinations is low this year, while preventive measures such as (yes) masks and hand washing are not stressed to the extent they were in the early days of the pandemic. 

It is not clear if the Chinese government is backing down on COVID. Additional restrictions have been eased but not stopped, and a Vice Premier downplayed the severity of Omicron. One economist noted that the Vice Premier's comment coupled with the easing of some restrictions sends "yet another strong symbol that the zero-COVID policy will end within the next few months." I wouldn't bet on that just yet, but it is certainly one possibility.

The Road goes ever on and on ... Day 489 (989)

With Day 1000 soon to be here, there was a comment asking about what that felt like. That is a strikingly long time. I'm reflecting and will try to offer cogent thoughts when that day arrives. Stay tuned. For other numbers, today's notes are in what is the 19th journal or leftover notebook that I've used since I started hanging onto such things in December 2020. I may have to keep going so as not to face the countless blank pages that would go unused were I to quit writing in it now. 

The media reports on the situation in China now may or may not even mention COVID. The response of the Chinese Community Party to the protests reports that they will "resolutely crack down on infiltration and sabotage activities by hostile forces." "Hostile forces" sounds so external--forces coming in from outside rather than rising up inside.  Some cities are seeing governmental shows of force--armored vehicles, random ID checks, or looking through photos on a phone, etc. The number of people detained is not known. Some experts predict that zero COVID could last another year. Economists and health experts say that China can't relax the controls that are keeping most people out of China until tens of millions of elderly have been vaccinated. There are districts or cities in which vaccination of the elderly has been stepped up, but it's going to take a while.

The NIH bulletin I got today had some interesting reports. Research suggests that there is a new antiviral medication that acts by changing the receptor cell in a person rather than changing any part of the viral cells. In theory, this means it should work on whatever new variants might emerge. Another research program suggests that any rebound is not due to Paxlovid and rather might come from a more active response from the patient's immune system. That system goes into overdrive cleaning up the last bits of the virus, possibly stirring it up in the process. Preliminary reports suggest that the development of long COVID may be influenced by past respiratory infections including Epstein-Barr virus.

The research report I found most interesting was by researchers from the NIH Clinical Center, the National Institute of Dental and Craniofacial Research, and the National Institute of Allergy and Infectious Diseases. They examined tissue from 44 patients who died of COVID or who had tested positive for COVID before they died. For some, the positive test was in the days before death; in others, it was months earlier. The patients ranged in age from six to 91 years old. SARS-CoV-2 was found in almost every organ and organ system including "skin, eyes, stomach, muscles, fat, glands, and six different parts of their brains." Whether a patient was symptomatic or not did not matter.

I found this report fascinating and not necessarily in a good way. We tend to think of COVID as a respiratory infection since it travels in aerosol form and starts out in the respiratory system. Unless we're physicians or scientists, we probably stop thinking about it there. Much as we would like to believe, it doesn't stop in the respiratory system in some (many?) cases. Every organ and every organ system. What we've been calling "long COVID" may be from viral matter left behind in non-respiratory organs and systems. Are people even trying to treat those other organs and systems? That said, I do know someone with long COVID who has been assured by her doctor that all her organs are fine. More on which to reflect in the coming days. 

The Road goes ever on and on ... Day 488 (988)

COVID may be about to explode in China. About 90 percent of the population is vaccinated with the primary series of Chinese vaccines. The problem is that those vaccines are not very effective against Omicron, and only 30 percent of people over the age of 80 have gotten even one booster. Infection-based immunity is low; over 30 studies show that the hybrid immunity of vaccination plus infection builds a more complex immunity wall. The six-month picture depicted in an article in Nature Medicine is grim: 11.2 million symptomatic cases; 2.7 ICU admissions or 15.6 times the ICU capacity; and 1.55 million deaths, 75 percent of which would be in people over the age of 60. A COVID outbreak could start to open floodgates. A massive outbreak would be the worst yet for supply chains. It would also open the door to an unknown number of variants.

Quickies: 

Global COVID surveillance is down 90 percent. This means that there will be little warning of a new variant. Even now, it is not clear which form of Omicron is underlying the current wave.  

For the first time in the US, more vaccinated people are dying of COVID than unvaccinated ones. In August 58 percent of COVID deaths were in people who had been vaccinated or boosted. 

A not-yet-peer-reviewed study reports that the COVID found in New York City's rat population shows susceptibility to Alpha, Delta, and Omicron variants. It is not clear if the rats could spread the virus to humans.

A specialized MRI showed lingering brain abnormalities up to six months after someone recovers from COVID. The brain regions affected are linked to fatigue, insomnia, anxiety, depression, headaches, and cognitive problems. Future research may look at patients with long COVID.

The US government has extended the COVID-19 public health emergency through January 11, 2023.

 A CDC study compared 200,000 patients who took Paxlovid with 500,000 patients who did not. The good news is that the Paxlovid group had a 51 percent lower hospitalization rate. The bad news is that only 28 percent of people eligible for Paxlovid were prescribed it.

There are still so many things about COVID that may or may not be related and that, together, add up to a somewhat scary picture. Right now, I'm not sure the end of official pandemic status as declared by WHO will be declared in 2023. And even if it is, we'll be feeling the effects of the coronavirus for many, many years to come.

 

 

 

  

The Road goes ever on and on ... Day 487 (987)

Let's start with some non-coronavirus quickies. First, a monkeypox one, or, an mpox one. Worried about the negative aspects of the "monkey" part of monkeypox, WHO has replaced "monkey" with "m." There is some sort of one-year transition period, but the article from which I pulled this bit of info was already using mpox. Measles is becoming an international threat due to the healthcare disruptions during the pandemic. That's all we need--another highly contagious virus with an effective vaccine people may or may not be getting. Merriam-Webster has declared its word of the year to be "gaslighting," referring to deliberate efforts to manipulate another person into distrusting their own judgment. Could that word have been chosen in response to all the divisiveness in today's world, with one group calling into question another group's belief about science, vaccines, or other relevant topics?

As for divisiveness, Dr. Fauci spoke about it on his Sunday-talk-show retirement tour yesterday, saying he is very troubled by today's divisiveness and its effect on public health. He blamed the divisiveness on anti-science, anti-vaccine thinking. Appearing on a different show, he said he  was maintaining a "completely open mind" about the possible laboratory origin of SARS-CoV-2 while also believing that the evidence for a natural origin "is pretty strong."

China remains on edge. While authorities have put up barriers and patrolled streets where protests have been held, they have also eased some restrictions. The gates blocking access to some apartment complexes in Beijing have been removed, and some cities are scaling back or ending mandatory testing. The COVID wave continues with over 40,000 new cases Monday. Of these, over 36,000 are asymptomatic. There is some concern about what happens if China backs off zero COVID. Chinese people have no real "wall of immunity" citizens of other countries have due to vaccination or infection. Right now, there are no mRNA vaccines available in China without which a giant COVID wave could produce newer, more dangerous variants. The countries that have been most successful at dealing with COVID, including New Zealand, South Korea, Japan, and Denmark have followed a pattern of containment (2020), vaccination (2021), and treatment (2022). China's pulling off all three of those at the same time would require a miracle.

Finally, here's some new evidence that might actually persuade some men to get vaccinated or at least to avoid catching COVID. It seems that men infected with COVID have one third less sperm compared to uninfected men over six months later. And of 100 men infected but not hospitalized, four had no visible sperm, something not seen in 100 men who were not infected. Serious male contraception or a blow to someone's masculinity? I'm a woman, so I wouldn't know.

The Road goes ever on and on ... Day 486 (986)

The extra-long weekend, Wednesday through today, has played havoc with my inner calendar and clock. I look forward to knowing tomorrow that it is Monday, the next day will be Tuesday, and so on. The Professor will leave at a known time and return home at a roughly known time. Of course, when classes end on December 5, I'll have to adjust to a new schedule.

Not much news other than that the situation in China gets more and more interesting every day. The protesters have moved from yelling to call for an end to the lockdowns to yelling to call for the departure of Xi Jinping and an end to the Chinese Communist Party. They also call for no more testing; rather, they'd like their freedom. Given that some people have been confined in their homes for some four months, I can't say I blame them for protesting. It will just be very interesting to see what sort of response the government prepares. 

Here's hoping there's more news tomorrow, not all of it bad.

The Road goes ever on and on ... Day 485 (985)

China had a record number of COVID cases this week including 31,656 on Thursday alone. Get your Valentine's Day and Easter shopping done soon; there are likely more supply chain disruptions coming. Protests are rare in China, but there are some happening. There was one in Xinjiang after a deadly fire triggered by the long lockdown there. Besides damaging the economy, zero COVID has undermined trust in the government. China needs to get the latest surge under control. Hospitals there are not ready for a sustained surge in serious cases. Bloomberg Intelligence estimates that lifting COVID controls could put 5.8 million Chinese into intensive care. Given that China has four ICU beds per 100,000 people, that's not good. Only 40 percent of Chinese over the age of 80 have gotten any booster; of people over the age of 60, two-thirds have been boosted. These vaccinations were of the China-made vaccine. The government did just make Western-made mRNA vaccines available, but only to foreigners residing in China.

Existing monoclonal antibody treatments are not working well against Omicron variants, leading scientists to look for other antibodies that are attracted to vulnerable parts of the virus that have not yet been targeted. Most treatments so far have targeted the region of the spike protein where the virus attaches to the human cell. The drawback here is that the target changes frequently. Some scientists are now targeting the other end of the protein, an area called the stem helix. This part has not changed as new variants and subvariants have developed suggesting that it plays a vital role. Others are looking at the fusion peptide that inserts into the human cell membrane to pull the cell closer to the viral molecule. The antibodies under development are not as potent as the earlier ones but may be effective against a wider variety of coronaviruses.

I don't want to see a post-Thanksgiving wave lead into another Christmas one, but it might be worth it if it persuaded more people to get the latest booster. I've given up hope of anyone who is not yet vaccinated changing their mind this late in the game. Odds are that COVID is not going away. 

The Road goes ever on and on ... Day 484 (984)

If you hadn't already figured it out, I won't be posting anything substantive today. I've been taking care of things I did not do yesterday or the day before. I don't think I missed any thrilling news, but if I find any I did miss, tomorrow is another day.

The Road goes ever on and on ... Day 482 (982)

Dr. Fauci has given what is probably his last White House COVID briefing, expressing optimism that we will not be seeing a winter COVID surge. He said that between infections and vaccinations, people have "enough community protection that we're not going to see a repeat of what we saw last year at this time." He did urge Americans to get the appropriate booster. The White House response coordinator also stressed the importance of boosters noting, "Nothing I have seen in the subvariants makes me believe that we can't manage our way through it effectively, especially if people step up and get their vaccine." Only 35 million Americans have so far gotten the latest booster; the government purchased enough doses for almost five times as many people. There are some concerns at the federal level about the XBB subvariant; so far, though, XBB has led to jumps in cases but not hospitalizations. 

A Japanese brokerage firm estimates that 49 cities or one-third of China's population and two-fifths of the economic output are under partial or complete lockdowns. This is a sharp increase from last week. The Chinese population has little immunity, having had very few infections and very few vaccinations. Only one-third of Chinese citizens aged 60 or older have never gotten a booster.

COVID misinformation is still out there. A representative from the Johns Hopkins Center for Health Security noted that getting vaccines made is one thing, and that vaccines don't matter unless "a missing social behavioral piece" is addressed. The estimate is that five to 30 percent of unvaccinated Americans have been influenced by COVID misinformation. Misinformation, especially in social media, is usually issued by a right-wing group or personality, making our current political divide even more deadly. I wish I had a solution, but I don't. I'd love to hear ideas on the subject.

Tomorrow is Thanksgiving Day. When I am not preparing or consuming food, I plan to enjoy family time. In other words, there will be no post here tomorrow. See you on Friday!

The Road gies ever on and on ... Day 481 (981)

Another slow news day. That does make it easier to get things done. I made the crust for the pumpkin pie I'll make tomorrow. I also made bread; that's in the oven even as I type. No one seems worried about a holiday surge unlike the last two years. Maybe the coronavirus and news thereof are taking their own holiday this year.

I think that a few days ago I mentioned a cruise ship heading to Sydney with 800 people confined to their cabins presumably due to COVID. Princess, Carnival, and Royal Caribbean have reinstated mask mandates and other virus restrictions on some cruises based in Australia and New Zealand. The cruise lines only recently reopened after having been shut down for two years.

Zero COVID continues. Beijing has moved teaching online and urged people to stay home. This may or may not be a good test for China's recent shift away from even stricter measures. Two more elderly people, both with pre-existing conditions, died, bringing the total on the current wave to 12. 

Finally, it was noted in an article on the bivalent booster that it is likely more important to get unvaccinated people their initial vaccination(s) than to get vaccinated people boosters. That does not give you leave to ignore a booster for which you are eligible at an appropriate time. I'll be going as a New Year's present to myself. 

The Road goes ever on and on ... Day 480 (980)

Had your own case of COVID yet? It's estimated that as of November 10, 94 percent of Americans had had COVID at least once, and that many of those infections were in the last year. Your bad cold could have been COVID, but you may not have self-tested. Or maybe you were truly asymptomatic. I'd say being asymptomatic would be good except that someone who is asymptomatic and doesn't know it could be infecting lots of other people. 

Speaking of being contagious, I found a comparison of the flu, RSV, and COVID in terms of how long a sufferer remains contagious. For flu, consider yourself contagious for five to seven days after the onset of symptoms. The contagion period for RSV is three to eight days, though some infants with less developed immune symptoms can be contagious for as long as four weeks. Evidence is showing that a person with COVID can remain contagious for as long as eight to ten days. Going to a holiday gathering? If you have any respiratory symptoms now, I wouldn't go. And testing yourself the morning of the gathering is not a bad idea.

So far, there is no reason to fear a BQ.1 or BQ.1.1 surge. France was the first country to get a high proportion of BQ cases; it became the dominant variant there in October just as hospitalizations were falling. Only now are hospitalizations and cases starting to increase, and that increase has not been rapid. BQ.1 and BQ.1.1 are now dominant here in the US, and there have been no major increases in cases, percent positivity, hospitalizations, ICU admissions, or deaths. Some models show the BQs hanging around for several months. This may be the first time in the pandemic that a variant with marked immune evasion has not caused a major new wave of infections. 

Between vaccinations and natural immunity from infection, the SARS-CoV-2 virus may well be having difficulty finding new hosts. The bivalent booster does have some neutralizing antibody cross-protection against BQ1.1. Now if only more people would get that booster. Are we there yet, "there" being out of the woods and free from worry? Many experts say we are not. The SARS-CoV-2 mutation rate has risen by 30 percent in the past year, meaning that Omicron and its subvariants could still mutate into something more dangerous. How lucky do you feel?

The Road goes ever on and on ... Day 479 (979)

So it's approaching 5:00, and the only news I've noted is one line from last night, which is that the BQ.1.1 Omicron variant demonstrates resistance to all available monoclonal antibodies. Today was one of those days. I did get various things accomplished or at least advanced; unfortunately, this blog was not one of them. You may be reading this more this week as the list of what to do each day grows. The week is nice for reminding me of things I am thankful for but might otherwise overlook. I can't argue with that.

The Road goes ever on and on ... Day 478 (978)

The pandemic is not over, but some things are changing. Fewer people are dying in hospitals and more are dying at home or in hospice or nursing home care. Fewer people are getting severe COVID, and patients are less likely to be in an ICU or on a ventilator. The rates for both of those--ICU and ventilator--have dropped more than halfway since the Delta wave. People ages 65 and older are becoming a larger share of COVID deaths. This could be because younger people are more vaccinated; half of the people over the age of 65 who die have only gotten one booster. It could also be that older people have weaker immune systems, or are more likely to have worrisome preexisting conditions. The fact that people over the age of 80 are less likely to get Paxlovid than are people under the age of 65 contributes as well. Finally, while more men are still dying than women, disparities between racial and ethnic groups have narrowed.

In terms of deaths, most deaths list COVID as an underlying cause of death. It can also be a contributing cause of death if it places stress on some body system that is already in trouble, such as a comorbidity. COVID can also be incidental as when a person who has COVID dies from some unrelated trauma such as a car accident.  

In terms of being someone age 66 and with a couple preexisting conditions, I have skipped all quilt guild functions since the show in April of this year, at which I wore a mask constantly. I was not the only one wearing a mask either. I recently saw photos of a guild workshop I might have enjoyed but did not attend. No one sitting closely around a large table was wearing a mask. Just because I'm paranoid doesn't mean I won't get infected again, but I can at least do my best to lower the probability. 

The Road goes ever on and on ... Day 477 (977)

Declaring today lost. I'll take my few notes from today over to tomorrow. Had things to do today with family and a friend I think of as family. Now, after an afternoon walk with The Family Dog and My Brother, it's time to relax. 

The Road goes ever on and on ... Day 476 (976)

It won't be a long post today, but the 2000-piece jigsaw puzzle done without a picture of what the puzzle was is done. It's The Family Dog burrowed into the sheets and comforter of the master bed. It was a birthday gift from Son #1. I wanted to finish it by today so that we don't have to deal with the puzzle box in which we work ,on the floor somewhere through the Thanksgiving holiday. My Brother arrives today for a Thanksgiving stay, which is what set the date of puzzle completion. I still have three other puzzles to do "blind," a puzzle of Mars, and an all-black puzzle to do.

The Professor would request kudos if he'd read about the study reported from The Royal Society -- COVID and Relative Humidity. The Professor runs a humidifier all winter long to keep the humidity in the house around 50 percent. The researchers used meteorological data from around the world, and a long procedure I will not describe (TL;DR). They computed indoor average conditions for each country using measured outdoor condition variables and established human thermal comfort zones. They found that COVID outcomes were less severe at intermediate indoor levels between 40 and 60 percent. More severe outcomes came at both lower and higher humidity levels. 

A study on Paxlovid rebound looked at 127 COVID patients treated with Paxlovid and 43 who were not. Most--95 percent--had been vaccinated at least once. Patients did rapid testing every other day for 15 days and completed a symptom survey daily for 17 days. Patients were interviewed after six months as a follow-up. For rapid antigen testing, viral rebound occurred in 14 percent of the Paxlovid patients and five percent of the control subjects. Symptoms were reported by 18 percent of Paxlovid patients and seven percent of control patients. While there was a Paxlovid rebound effect, it was not as high as the general public perception has been. The researchers noted that Pfizer, the maker of Paxlovid, had no involvement with the study.

On the number front, WHO reports the first global increase in weekly COVID cases in four months; WHO cautioned the the count was lower than it really was due to a decline in testing. Meanwhile, the US death rate showed a seven-day average below 300 for the first time since June 2022. The lowest since the pandemic began was 222 in July 2021.

All sorts of articles are out there about the holidays and COVID. Fortunately both The Professor and I have few relatives who might visit or who might invite us to visit them. We did do rapid tests on Sunday, as did My Brother. Had any been positive, we would have changed plans. All were negative, fortunately.

The Road goes ever on and on ... Day 475 (975)

A study published in JAMA Network Open reports that half of patients are still experiencing at least one post-COVID symptom two years after the acute infection. Hospitalization during the infection made no difference. The study looked at almost 700 patients who were infected during the first wave. Of those patients, 59.7 percent of the ones who had been hospitalized and 67.5 percent of those who had not still had at least one symptom two years later. The most prevalent symptoms were fatigue (44.7 percent of hospitalized patients; 47.7 percent of non-hospitalized patients), pain including headache (35.8 hospitalized; 29.9 percent not), and memory loss (20 percent hospitalized; 15.9 percent not). In other words, the severity of a COVID infection did not appear to be a risk factor for the development of long COVID symptoms. One drawback of the study is that there were no non-infected control subjects. There was also no control for vaccination status, though there was no vaccine available during the first wave. Symptoms were self-reported via a telephone interview. 

In Guangzhou, China, crowds broke down street barriers in a protest against the zero COVID policy. The deputy head of the district admitted, "We have also realized many of our shortcomings." In a similar protest, signs were hung on highway overpasses in Beijing during the Party Conference in October. "Say no to COVID test, yes to food. No to lockdown, yes to freedom."

The triple threat of viruses is growing. There are hints that RSV may be peaking, but that may not mean anything. It normally peaks in January, and it is not clear what effect the coming holidays might have. Flu arrived earlier and is rising more steeply than in previous years including non-pandemic ones. There is a lot of regional variability; Virginia, my home, is in the highest level. Results from South America, where flu season is ending, suggest that this year's influenza vaccine is a winner in terms of the strains of flu out there. Unfortunately, only 28 percent of Americans have gotten flu shots this year, 10 percentage points lower than was usual before the pandemic. Finally, there are over 300 COVID variants circulating; not one is dominating on a global level. Having three viruses so active at the same time may put an undue strain on hospitals. It also raises the probability of co-infections, including one person's having all three simultaneously. Masks, anyone?

The Road goes ever on and on ... Day 474 (974)

A dreary wet and cold day. We may have bypassed autumn and gone straight to winter. By Son #1's metric of is The Family Dog wearing her coat, we are indeed in winter. The local community continues to recover from the events of Sunday night. The weather argues against another candlelight vigil on the lawn at the center of the university, as was held last night. Attendance was mentioned in one source as being in the thousands. No word has been given on whether the last two football games will be played. There is also no word on if the second injured victim was a football player. There is still a lot to learn.

Coronavirus is still here. Around 315 Americans die daily, and there are over 27,000 Americans in hospitals with COVID. Only half of the Americans eligible for boosters have gotten them, and only 10 percent have gotten their most up-to-date ones. I trust the people coming for Thanksgiving and won't mask then, but if I were eating out, even outside, I definitely would. Is it possible that the winter surge will not be as severe as in past years? That may well depend on whether a new variant arises.  

A 2021 study reported that over half of American adults reported symptoms of major depressive disorder after having COVID. The risk of developing depression or some other mental health problems remains high for up to a year after the COVID infection. A clinical epidemiologist explains, "There's something about the coronavirus that really affects the brain. Some people get depression, while other people can have strokes, anxiety, memory disorders. and sensory disorders." Some people, of course, have no such symptoms. 

One theory behind the development of mental health problems post-COVID is that the immune system may be overreacting and causing inflammation in the brain. One of the biggest risk factors for developing post-COVID mental health issues is having a diagnosed mental health disorder before getting sick. Other risk factors according the WHO include age; young people are at the greatest risk of suicide or self-harm. Women are more likely than men to report mental health conditions, but the psychologist in me asks whether this is because women develop more conditions or are more comfortable reporting them. Finally, people with pre-existing conditions such as asthma, cancer, and heart disease are at greater risk.

It's a good thing I can no longer be mistaken for a young person. If that were so, I'd check all four of the risk boxes: a woman who suffers from depression and who has asthma and high blood pressure. 

The Road goes ever on and on ... Day 473 (973)

No coronavirus news today. While today has not been as bad for the community as August 12, 2017 was, it hasn't been a good one. We think it can't happen here until it does. Late last night, a bus returned to The Local University from a class trip to a play in Washington, DC. As the bus was unloading, one of the students pulled out a gun and started shooting. Three young men were killed; two were injured. One of the injured students is in critical condition. It seems that all five of the victims were on or had connections to the university's football team, as did the shooter, also a student. The shooter was not apprehended until about noon today. Classes were cancelled (for tomorrow as well), and students were told to shelter in place. That order was lifted after local and state police had thoroughly searched the university. 

Motive? It's not clear. There was a suggestion on a sub-Reddit that the shooter had been hazed by some of the students he shot, that the hazing involved the football team. We may never know for sure unless the young man in custody, charged with three counts of second-degree murder and three counts of using a firearm in the commission of a felony, tells us. 

Even though I was nowhere near the university and the news came early enough that The Professor stayed home, that it happened here is unnerving and upsetting. I cannot imagine what the parents of the victims, dead or injured, are feeling. They trusted the university, city, state, other entity, to take care of their children, and that trust has been violated. I feel also for the parents of the shooter. They, too, have lost a child, though in a much different way. 

COVID sucks, but this sucks more. 

The Road goes ever on and on ... Day 472 (972)

In response to the lack of coronavirus news newsworthy enough on which to expound, I did a little searching on the coronavirus situation in Turkmenistan. WHO reports:

In Turkmenistan, from 3 January 2020 to 5:01pm CET, 11 November 2022, there have been 0 confirmed cases of COVID-19 with 0 deaths, reported to WHO. As of 4 September 2022, a total of 13,514,000 vaccine doses have been administered.

China should feel no small degree of jealousy in another country's success when it comes to zero COVID. While there have been no confirmed cases, there have been reported ones. The Wikipedia entry on "COVID-19 pandemic in Turkmenistan" has some details on these, and is well worth reading. I particularly liked this paragraph:

-------

Reporters Without Borders reported that the government of Turkmenistan had banned the word "coronavirus" and that people could be arrested for wearing masks or discussing the pandemic.^[39][40] The organization later corrected their report, clarifying that the word itself was not banned, but maintained that it had been removed from informational brochures and that the government was restricting information about the virus and providing "very one-sided information".^[41] According to Chronicles of Turkmenistan, state media did not begin reporting on the measures that had been taken until 25 March.^[42]

-------

Things seem so much simpler in an autocracy, right? If you read to the end of the Wikipedia entry, it mentions the nationwide vaccination mandate. Not hard to get one of those through in an autocracy. As much as I think Americans should be savvy enough to get vaccinated, I don't want the right to choose vaccination to go the way of the other major choice recently taken away. Choice. It matters.

The Road goes ever on and on ... Day 471 (971)

It was another slow news morning. If news continues to be thin and/or too technical to summarize easily, I may think of stopping posting every day or at all, but only after I've hit Day 500 (1,000) in about four weeks. I would be able, then, to write about the other things I find myself thinking about. Or not. I have a few weeks to think about it and, who knows, there may be another winter surge that merits attention.

China is keeping its zero COVID policy even as it eases some other restrictions. People entering China now must quarantine in a hotel for five days followed by three days isolation at their home. It used to be 10 days of quarantine followed by seven days at home. The penalty for airlines bringing in travelers with COVID has been scrapped while the requirement that airlines test all passengers has been reduced. The government has limited contact tracing and eased some lock-down measures, though local governments can override this and keep in place some restrictions such as mass testing. China is still the last country adhering to strict pandemic rules, and it is not clear how long zero COVID will remain in effect. There were over 10,000 local cases Thursday, the highest daily count in over six months. The pandemic is not seen as over in China.

It will be interesting to see how the relaxation of the restrictions meshes with continued zero COVID. It would be interesting if some objective criterion were to emerge showing that China was right all along in suppressing as much COVID as they could. And then there's Turkmenistan, a country that as far as I can tell has reported no COVID. It's an autocracy, with pretty tight restrictions. The Professor and I actually had a 2020 trip that included Turkmenistan cancelled by the pandemic. The requirements to get a visa were onerous, and it looked as if visitors had to be accompanied by a guide. Now, the tour company has reworked that tour and replaced Turkmenistan with Kyrgyzstan. I think I'll dig around and see if I can find anything out about COVID in Turkmenistan. It's not as if I have something else to do. NOT!

The Road goes ever on an on ... Day 470 (970)

Today is Veterans Day to honor all who have served in whatever service in whatever role. If you can't thank someone in person, thank someone via email, or just with appreciative thoughts. We who did not serve owe them a lot.

I read a couple of studies this morning with information worth remembering. Reading about the first told me that still masking in public is a good thing for me, especially given that I've had one round of COVID. That statement gives away that the study had to do with repeat infections. A paper in Nature Medicine reported a study of some 40,000 reinfections among over 440,000 COVID cases and over five million controls. I should say up front that the subjects were at Veterans Administration hospitals meaning that they are not representative of Americans in terms of age, sex, or race. 

Reinfections are bad for your health. A second or third infection was more closely associated with worse acute and post-acute (long COVID) outcomes than was a single infection. The study looked at a range of factors including hospitalizations, presence of at least one symptom, cardiovascular, coagulation and hematological, diabetes, fatigue, gastrointestinal, kidney, mental health, musculoskeletal, neurological, and pulmonary. For all of those factors, two infections were worse than one infection, and three infections were worse than two. Vaccination had no substantive protective effect in reinfected people. 

In other words, the more times you have COVID, the greater the odds that you'll have some or another problem later. I've had it once, and my plan is not to have it again. I'll be getting my third booster around the end of the year, about when the experts say the natural immunity from my case will be wearing down. Masks will be my friend for quite a while. 

A German study on long COVID looked at 157,000 people, 12,000 of whom were children or adolescents. There were five times as many matched control subjects. Rather than give the details of the study, I'll jump right to the conclusion: "The results of the present study indicate that post-COVID-19 cannot be dismissed among children and adolescents." 

The bottom line is you don't want to get COVID, and if you do get it, you don't want to get it again. And if you're wearing a mask somewhere, any kids going with you should be wearing one as well. 

The Road goes ever on and on ... Day 469 (969)

A study published in the New England Journal of Medicine sheds some light on the value of mask mandates in schools. The researchers looked at case rates in districts in the Boston area after school mask mandates were lifted in February of this year. Two of the districts maintained the mask mandate for the course of the study. Before the mask mandate was lifted, the case rates for all the districts were very similar. When the mandate was lifted, case rates went up quickly, and about 30 percent of all of the cases during the study period were attributable to the dropping of the mask mandate. Interestingly, the districts that kept the mask mandate in place on average had buildings in poorer condition, more crowded classrooms, and a higher proportion of individuals with underlying risk factors. Dropping mask mandates, therefore, was not in the best interests of the children or staff. In other words, masks offered protection even with conditions that otherwise would be expected to lead to more cases. 

Another new study compared initial COVID infections with repeat ones. Hospitalization and death rates were more likely to rise with repeat infections; long COVID was also more likely. In other words, "...cumulative risks and burdens of repeat infections increased according to the number of infections."

A New York Times virus briefing discussed planning for the upcoming holidays. For people believing the pandemic is over, this is a moot point. For the rest of us, planning for holiday events should center around the highest risk person attending. A week-long mini-quarantine period is also useful staying in as much as possible for the week preceding an event. Finally, a person who has any symptoms at all should stay at home. One Times reader offered the following: "I will not travel or interact if not feeling well. I will home-test if there are adults over the age of 65 attending any gathering. I will not attend any event in which a mask is required." The last thought might mean that the person will not attend any event risky enough that the organizers are requiring masks. At least I hope that is how the statement is intended and not as an anti-mask thought.

JAMA Network Open has a report on research being done at Northeastern University. So far, that research suggests that women are at higher risk of long COVID than men are. As one of the researchers put it, "You're almost twice as likely to get long COVID just being a woman, controlling for everything else." Now that's a cheery thought. That said, the only person I know who has suffered from long COVID is a woman. If not, it would be fascinating to know why. I wonder if men simply ignore or repress symptoms more than women do so that their cases are not recorded.

The Road goes ever on and on ... Day 468 (968)

I did not sleep well Monday night before yesterday's 15-hour Election Day, nor did I sleep well last night. My post today will be somewhat selective. I don't have the energy to get too far into too many things. Yesterday tired me out more than usual. I was shadowing the precinct chief whom I am replacing rather than my usual job of being ballot officer. We also had a very unexpected turnout, as many as we would expect for a presidential election. We started the day with 700 ballots; a mid-day delivery of extra ballots was the only way we could give out over 800. We finished the day giving out pre-folded ballots that had been prepared for absentee ballot mailings. As for results, the candidate of my choice did not win in my precinct or overall. I will have to live with that. The fact that the predicted "red wave" did not sweep over the country is noteworthy. Our constitutional republic might survive after all.

There are a couple of results from recent polls not on the elections but on the coronavirus. A Pew Research Center survey conducted in mid-October found 23 percent of respondents saying that the COVID outbreak would be "very important" to their vote. In an October Gallup poll, only one percent of voters thought that the COVID virus was the most important problem facing the country. Many Republican candidates attacked the Democrats' COVID funding and promised to get rid of various mandates including the military vaccination one. At the state level, many Republican incumbents campaigned on how quickly they had reopened their districts or states.

Alcohol-induced deaths skyrocketed during the pandemic. Over 49,000 people died in 2020, a 26 percent jump over 2019. The National Association of Addiction Treatment Providers said alcohol abuse was "already a crisis" but "exploded" due to the pandemic. Alcohol abuse and more sexually transmitted diseases. Hasn't the pandemic been wonderful?

The Road goes ever on and on ... Day 466 (966)

Today is the day before we get an indication of the future of democracy. Being in a small, rural precinct, I don't anticipate any protests or problems tomorrow. As always, we will do our utmost to see that the election is run fairly, and that any eligible voter arriving between 6:00 am and 7:00 pm is able to vote. We will also offer same-day registration and allow all those who register that way to vote provisional ballots. I move up to precinct chief after this election, so I will be doing my best to note the little things I might otherwise not pay attention to.

Of course, should the political party known by the color red and the animal elephant win majorities in both houses of Congress, I expect action will be taken to end the remaining coronavirus mitigation measures and financial assistance. The military mask mandate will become a relic of the past. It may well be that after such actions are taken, I will have an easier time finding COVID news about which to post. The pandemic is not over yet.

Apple has announced that iPhone 14 shipments will be "temporarily impacted" by COVID restrictions in China. The factory in Zhengzhou is "currently operating at significantly reduced capacity."  There was no indication of just how long the delay would be. Anyone having an iPhone 14 on their winter holiday wish list may want to think of a Plan B. Given the goal of zero COVID, it may be a while to get the factory back to normal capacity.

A 26 percent reduction in long COVID was seen for COVID patients treated with Paxlovid. Paxlovid has also been linked to reductions in deaths (by 48 percent) and hospitalizations (by 30 percent) once the acute phase of the illness has passed. There was no difference by number of vaccinations/boosters a person had had, prior infection with COVID, or unvaccinated status. The average age of patients in this study was 65, but the benefit for patients under the age of 60 was the same as that for patients over 70. This finding adds a third way to prevent long COVID. First, not getting COVID is 100 percent effective in avoiding long COVID. Second, prior vaccination and boosters are 30 to 50 percent effective. Third, we now have Paxlovid.

Hospitalizations are not down everywhere. Many emergency rooms are so crowded that a person might wait hours just to be triaged. Lines are going outside at some hospitals. It could be eight to 10 hours before a patient actually sees a doctor. Since winter's slippery surfaces are on the way, let's be careful out there. Sitting in the emergency room waiting to be seen while holding a towel over a bleeding broken nose is no way to spend an evening. Trust me on that one.

Finally, the BQ.1.1 variant is fading in France raising hopes that it will stay low here and allow us to avoid a winter holiday COVID wave. The bivalent booster induces some cross-immunity against BQ1.1, adding to an optimistic view. I'm not counting any eggs now, though, remembering how Omicron was announced just after Thanksgiving last year and the winter wave that followed.

Don't expect to hear from me tomorrow. My mind will be elsewhere, as will my body. Here's hoping we still have a secure democracy to wake up to on Wednesday.

The Road goes ever on and on ... Day 465 (965)

Yesterday was exhausting, and today will also be a rousing one celebrating Son #1's 35th birthday. He's halfway to 70! I feel old.

The coronavirus news I skimmed through is for the most part too technical for my weary brain to parse. There was one reference, though, that I take as good news. The BQ.1.1 continues to grow in the US as BA.5 wanes. It's also increasing in France several weeks ahead of where we now are. The good news is that hospitalizations in France are actually decreasing a bit. Here's hoping we follow that trend. 

Tuesday is Election Day, meaning the alarm goes off at 4:00 am, and if we're lucky we'll be home a bit after 8:00 pm. If there is any post that day, it will be preset the day before.

The Road goes ever on and on ... Day 464 (964)

I was nice, and agreed to work both shifts of early voting Saturday. I'm setting this up to post tomorrow morning. Given how hectic this afternoon was, I will be in no shape to post anything coherent after I get home tomorrow evening. Hope you guys have a good Saturday.

The Road goes ever on and on ... Day 463 (963)

Not much news out there, but then I didn't look for too long given working voting this afternoon and needing to do a few things beforehand. Yet another new variant that might be of concern at some point, BA.2.3 has been detected in the Philippines and Australia. 2022 may be the year with just one named variant--Omicron--but like the spider in Charlotte's Web, it will leave behind many offspring.

A panel of experts from over 100 countries has developed 41 consensus statements and 57 recommendations for dealing with and ending the pandemic. The statements fall into six categories: communication, health systems, vaccination, prevention, treatment and care, and pandemic inequities. A large factor in developing these was that public health efforts vary greatly from country to country. One of the panel's leaders summarized the panel's efforts, "... a whole-of-society and a whole-of-government approach, along with a vaccines-plus approach, which means prevention measures that include and go beyond vaccination. We can do this. We should, and we must."

I am still puzzling over "whole-of-society" and "whole-of-government" wondering if there wasn't a better way to say what I think they mean. I also fear that "prevention measures that include and go beyond vaccination" will not fare well in the US, especially if the non-vaccination measures include things such as mask mandates and restricting crowd size. Are we our own worst enemies? Could be. 

The Road goes ever on and on ... Day 462 (962)

Today has been a hard day for finding coronavirus news. Even Google was unable to steer me in the direction of new news as opposed to news that is day-old, beyond its expiration date, or not behind a payment wall. Is no news good news? Who knows with the not-so-novel-any-longer coronavirus. 

Some universities including Harvard, Tufts, Wellesley, Yale, and Fordham are making bivalent COVID vaccines mandatory for students, faculty, and staff. The goal is preventing or lessening transmission during the spring semester. The local university has said nothing which does not surprise me given that its home page has absolutely no mention of COVID.

A report by Vanity Fair and ProPublica is the subject of some attention given that it says evidence supports a biosecurity incident at the Wuhan lab in mid-November 2019. The event appeared to be urgent and non-routine. Was this incident the accidental release of some viral strain that resulted in what was at the time called the novel coronavirus? Maybe ... and maybe not. Questions have been raised about the accuracy of the translation from Mandarin to English of the documentation surrounding the incident. A team of independent translators is now reviewing that translation.

Finally, Pfizer is testing a combined COVID-influenza vaccine. That would certainly beat getting a shot in each arm. As for Pfizer's making an mRNA flu vaccine, I decided what the heck and got into a Stage 3 trial of that vaccine. I did get a flu shot; I just don't know if it was the one the pharmacies and clinics are giving or Pfizer's mRNA vaccine. I probably would have signed up to do it even without the financial incentive. We must support science for the public good.

The Road goes ever on and on ... Day 461 (961)

Just a few quick bits today since I'll be spending the afternoon working early voting. It could get dicey if the crowds we saw last week continue. A "full" slate of officials would be eight or nine, nine giving one extra person to handle things that pop up and require unusual attention, things such as same-day registration. This afternoon, there will be six of us. If we need to, we can probably get a staff member from the registrar's office to help out, but they have their own work to do. I am not optimistic about the election as a whole. Who knows what kind of election we will have in 2024 if 2022 swings red. Or might that election be our last?

I was pleased to read this morning that Shanghai Disney has kept rides operating for the people who are locked in there until they test negative for COVID. I wonder if they're charging them for food.

BA.5 is no longer the dominant COVID variant in the US. Omicron subvariants such as BQ.1 and BQ.1.1 are. There is some new evidence that the bivalent vaccine tailored for BA.5 does offer some protection against the new subvariants. That only helps if you get vaccinated, though.

Finally, there is news of the tridemic or tripledemic or threesome or whatever you want to call the threesome of COVID, RSV, and influenza. Orange County, California has declared a health emergency as all three diseases spread rapidly. RSV used to be highest in December through February; it's already higher than that. Emergency rooms are seeing more children on a daily basis than ever before. The best protection? Do what we did two years ago. Wear a mask indoors or around other people, stay home when sick, wash your hands often and refrain from touching your face. 

The Road goes ever on and on ... Day 460 (960)

When I began writing this daily musing 960 days ago, there seemed to be no real consensus on what to do with "covid" the word. Some articles had it as I've used it up to now, in all lower case. Others gave it an initial capital, while still others used all capitals. The third means, all caps, has become the standard meaning that anything else is marked as a typo or misspelling. Having gotten tired of seeing the squiggly red line under my "covids," I'm switching to the all-caps version. I probably should have done so a long time ago, but I've been lazy. It's just easier to type it in all lower case, with no shift or caps key involved. 

I mentioned that Shanghai Disney had been locked down due to COVID with visitors shut inside. A visitor can now leave after testing negative for COVID. I wonder if they're keeping the attractions open so that the people have something to do while they wait. 

Hospitalizations from influenza are at an all-time high paralleling the rise of RSV (respiratory syncytial virus). RSV is said to be up because of COVID mitigation measures that prevented many infants from being exposed and gathering some immunity. As one pediatrician put it, "The virus is now playing catch-up in these kids." Most adults can, if they come down with RSV, fight it off in a week or two, since they have some immunity from prior infections. These people may assume that RSV is a mild cold or even a mild case of COVID. Primary symptoms in adults and children are cough, runny nose, and fever. For infants, RSV may present as lethargy, irritability, decreased appetite, and a change in breathing. Besides less immunity, young children have much narrower airways. Unlike COVID, RSV can spread through touch. Viral discharge is in the form of respiratory droplets; where these droplets land becomes temporarily infectious. 

According to a new article in Nature Communications, COVID can reduce the number of bacterial species in a person's gut, with the resulting drop in diversity meaning there is more space for dangerous microbes to thrive. The wide use of antibiotics has killed off the disease-causing bacteria that are most susceptible to drugs. Antibody-resistant strains of bacteria can escape into the circulatory system and put a person at greater risk for life-threatening secondary infections. This migration to the bloodstream occurred in 20 percent of the patients studied. COVID, the gift that keeps on giving in so many ways.

The Road goes eve on and on ... Day 459 (959)

Happy Halloween! If the rain lets up, the friendly neighborhood inflatable T-Rex will be distributing candy here. If the rain does not let up, Rex will appear tomorrow evening, the Plan B for heavy rain tonight. We had so few kids here for so many years that they were taken in to trick or treat with friends in town. Two years ago, we had several families with kids and not wanting to see the pandemic cancel the kids' Halloween, I announced we would be setting out a bowl of candy on the porch and looking at costumes through the window. It worked, and we now have Halloween here. A lot of people even open their doors now to see the costumes first-hand.

The pandemic is not over. If it were, Shanghai's Disney Resort would not have closed suddenly with visitors stuck inside. Nor would Toronto hospitals be issuing alerts about overcrowded emergency departments. The CDC director tested negative after a course of Paxlovid but now has tested positive for a second time. I wonder, though, when they say she tested negative if they meant negative on two tests taken 48 hours apart. That is, after all, the guidance they were giving on their website. 

A study on non-mRNA vaccines and physical activity suggests that being active does help. A vaccine and low physical activity were 60 percent effective against contracting covid. A vaccine and moderate physical exercise were 72 percent effective; with high physical activity, the vaccine was 86 percent effective. Of course, more active people are probably, on average, at least a wee bit stronger than people who are not as active. 

A result of the pandemic that may or may not be good in the long run is that plans to build over 40 high-level (3 or 4) biosafety labs are proceeding in countries around the world. The argument for such facilities is that without them, certain geographic areas could not respond to the pandemic as well as they might otherwise have. India is building five BSL-3 labs and planning for nine more. Four institutions there have said that they will build BSL-4 labs. Globally, 27 BSL-4 labs are in the works in places including Kazakhstan, Singapore, and the Philippines. Not to cause any worry, a survey in the Philippines found that biosafety officers there had "only a weak understanding of biosafety." The argument that these labs are necessary for research somewhat overlooks the fact that at most labs, only 10 percent of the annual budget goes for research; the other 90 percent is needed to maintain the facility.

The coronavirus relies on our proteins to copy itself. Some researchers suggest that shutting off its access to those proteins would help slow or stop the spread. One such study has been published; the other has not yet been peer-reviewed. Some experts discount this work noting, "No matter what drug you approve, viruses will ultimately find a way around it." And to the suggestion that a drug cocktail might be developed as one was for HIV, one response is, "Trying to develop a combination therapy is more of a business challenge than a scientific challenge." 

 Looking ahead to the noted November holiday, Son #1 procured a frozen turkey; we had already procured a frozen tofurky for Son #2. The turkey is a bit larger than we usually get, but it seemed better to get it while we could than lose it by waiting for a smaller one. For the most part, the leftovers will freeze just fine.

The Road goes ever on and on ... Day 458 (958)

Only a couple of quickies today. I didn't want to resort to Twitter-news, and that's where most of the covid info seemed to be this morning. BQ.1.1 and BQ.1 are on track to become the dominant strains in the US in a few weeks; they currently account for 27 percent of new US cases. And the XBB variant is now dominant in both India and Bangladesh, but there has been no rise in cases or deaths ... as Son #2 would say, for now. 

With tomorrow's being Halloween, perhaps we can put discussion of to mask or not to mask to rest for a day. At one point, masks were illegal in Virginia for people over the age of 16. There may have been a loophole that the mask could not be worn to hide one's identity; I don't recall. In terms of identity, masks have made things interesting the past two years. I would not, for example, recognize the physical therapist I used this summer, and it is likely she would not recognize me. I have enough trouble recognizing people I do now when they are masked, but then I have a hard time with names and faces to begin with. 

Happy haunting!

The Road goes ever on and on ... Day 457 (957)

Six of the seven people working early voting's afternoon shift yesterday wore masks. No one commented that we did not need to wear masks around them. In response to that comment on Wednesday, I actually said nothing; I just got the couple the forms they needed to complete. I figured saying nothing said it all. I could have explained that given the number of people with whom I could potentially be face-to-face, I felt better with a mask on, but that would have been giving their comment some validity. As for the number of people with whom I could have been face-to-face, we had over 300 people vote in the afternoon on our way to 563 people voting all day.

Son #1 said he wasn't sure where he'd saved the reference, but there is a theory on covid's origins that combines the Wuhan lab and wet market. What if someone who worked at the lab sold an animal--dead or alive--that had been used in research there to a market vendor. Interesting theory and one I would not discount.

A covid outbreak in Zhengzhou, China has shut down the largest iPhone manufacturing plant; it produces about half of Apple's global supply. Some factory workers are in lockdown, and shops and hotels near the factory are closed. Last year, almost one-third of the $192 billion in iPhone sales was in the upcoming holiday season, making the timing of the outbreak not at all good. Apple has moved some of production to India, but it's not clear if they'll have enough iPhones to meet holiday demand.

And that's about it on the covid front, at least from me. The other items I found were retreads of info I've already posted or so technical that I wasn't going to give a Saturday to trying to make sense of it.

The Road goes ever on and on ... Day 456 (956)

New York City's official covid case numbers are holding steady at around 2,000 per day, but hospitalizations are on the rise, up to 1,100 on October 24 versus 750 in mid-September. Influenza came early this year along with RSV. Cases of both of these were down during the last two years when people were masking more and distancing themselves more. Some children's hospitals are already at capacity. Emergency room visits for children under the age of five for respiratory issues are at the highest they have been since the initial Omicron surge last winter. A children's hospital in Queens, New York that normally has 175 to 200 patients is up to 250. Some children are spending nights in the emergency room or operating room recovery units. 

A study shows that the rebound effect happens in people not taking Paxlovid. The study tracked participants in a clinical trial and found that 44 percent of those who recovered had symptoms flare up at various times during the four weeks after the infection. While 85 percent said that the symptoms were mild, the other 15 percent reported having at least one symptom that was moderate as opposed to mild. Common rebound symptoms were cough, fatigue, and headache. 

Two not-yet-peer-reviewed studies suggest that the protection provided by the bivalent booster and the original booster was roughly equivalent. There was no real advantage to receiving the bivalent one. Don't let this discourage you from getting the bivalent booster, though; either booster is better than no booster. And as one expert put it, "Don't drop your guard just because you've been boosted."

Working at early voting again this afternoon. In the past sessions I've worked, about half of the election officials have worn masks. I was doing paperwork for one couple on Wednesday; they said they were fine with my removing my mask unless it was an issue I had. Needless to say, the mask stayed in place, as it will this afternoon. I can't say that four to five hours of wearing an N95 mask are particularly pleasant, but it beats the options of my getting it again or my giving it to someone else. At least some of us are in this together. 

The Road goes ever on and on ... Day 455 (955)

I survived a yesterday that included behind-the-wheel training on a Honda Prius and a very wide wheelchair. I am pleased to report that the passenger survived in both vehicles as did I. I served as chief for the afternoon session of early voting; we topped out at 428 on the day. I will do it again tomorrow and try not to remember how stressful last week's 493 Friday total was. 

I only saw a headline so I have no details, but apparently a cruise ship on which "hundreds of people are confined to their rooms" is headed to Brisbane, Australia. I'm having flashbacks to the cruise ships affected at the start of the pandemic. Not a cruise I'd like to be on. 

China is giving an orally inhaled vaccine as a covid booster. Administration began in Shanghai. An orally inhaled vaccine could stop the virus before it reaches the rest of the respiratory system. The vaccine was tested in five countries as well as China. Regulators in India have approved a nasal vaccine that has yet to be used. There are about a dozen nasal vaccines being tested around the world. China has confined around 800,000 people in Wuhan. Thursday was the third straight day of over 1,000 new cases being identified nationwide.  

Any quantitative-AI types out there? NIH is running the NIH Long COVID Computational Challenge. The goal is to use artificial intelligence and machine learning tools to identify covid patients with a high risk of developing long covid. The prize pool is $500,000 going to first, second, and third places as well as up to five honorable mentions.