The Road goes ever on and on ... Day 336 (836)

Monkeypox note du jour: The pox even made the Coronavirus Briefing column of today's New York Times. Experts say that the new campaign to vaccinate anyone who may have been exposed is too small and too slow. The longer it takes to contain monkeypox, the greater the chance that it becomes entrenched in the US.

Macau, China's gambling mecca, is locking down sections of the city for mandatory covid testing after the worst spike so far in covid cases. There have been 223 new cases since Sunday. With zero covid in effect, on Thursday, they shut down parks, pools, salons, and theaters. One hotel and casino resort was also closed. All the other casinos were left open ... for now. Many people in Macau, especially people over 60, have not gotten a third dose (first booster) of the vaccine. Hong Kong's cases are also surging even as they relax some of their restrictions.

Dr. Fauci says that without Paxlovid he probably would have been hospitalized when he first tested positive. His daughter got married in New Orleans while he was isolating; he participated in the wedding remotely. He would like to see a study done to compare a five-day course of Paxlovid to a 10-day course. He's on his second five-day course now. 

It appears unlikely that day care providers or early childhood centers will require that children be vaccinated. Only seven states nationwide require flu shots for children that young, though all states require vaccination against measles, mumps, and rubella. 

The British Medical Journal ran an article on the potential for long distance (I did not see how they defined "long") airborne transmission of SARS-CoV-2 in indoor community settings. They reported "evidence suggesting that long distance airborne transmission ... might occur in indoor settings such as restaurants, workplaces, and venues for choirs, and identified factors such as insufficient air replacement that probably contributed to transmission." Cheery news, eh?

Tomorrow is my birthday and assessment of my January 1 resolutions six months in. I have not decided whether I will do two distinct posts or just replace the covid one with the birthday one. This will be my third pandemic birthday. Will there be a fourth? Your guess is as good as mine.

The Road goes ever on and on ... Day 335 (835)

The CDC has activated an Emergency Operations Center to deal with monkeypox. Clinics nationwide will start offering vaccinations against monkeypox to anyone who may have been exposed. Previously, vaccinations were only available to people with known exposure.

Meanwhile, around 60,000 Army Reserve and Army National Guard soldiers remain unvaccinated one week before the vaccination deadline. The Army has struggled the most despite setting their deadline seven months later than any other branch of the service. 

FDA advisers have recommended updating covid boosters to also target some form of Omicron or its subvariants. Pfizer and Moderna wanted a vaccine combining the current vaccine paired just with Omicron; however, Omicron has been outdated by its variants. Together BA.4 and BA.5 now account for over 50 percent of the new cases in the US. The advisers did not consider who should be eligible for a fall booster. The article I read called combating a virus evolving faster than clinical trials can deliver results "scientific angst." I do like that term. 

The lockdowns in Shanghai, while officially over, continue to affect people. Some are suffering a form of Post-Traumatic Stress Disorder. Some districts in the city will briefly lock down for mass testing each weekend until the end of July. It's not looking like a good summer there.

Scientists say that evidence is mounting that persistent pockets of covid in the gut or elsewhere may contribute to long covid. Covid proteins, most commonly the covid spike protein, have been found in the blood of 65 percent of long covid patients tested up to 12 months after the original diagnosis. This only happens if there is a reservoir of virus somewhere in the body.

Dr. Fauci is having rebound symptoms after finishing a first course of Paxlovid. He tested negative for three days and then tested positive on the fourth day. He is now on a second course of Paxlovid. While many sources say that a rebound infection is less severe than an initial one, Dr. Fauci describes his symptoms as "much worse." He is calling for an "aggressive" national vaccine campaign. He estimates that the number of covid cases is at least a couple fold if not more than the number reported. He says he has many friends who tested positive at home but due to no or mild symptoms never reported the result.

Two quickies to end with. Elmo, age 3 1/2, got vaccinated! This upset Ted Cruz. He also got upset when Big Bird, age six, got vaccinated. And scientists have confirmed the first case of a cat transmitting covid to a veterinary surgeon.

The Road goes ever on and on ... Day 334 (834)

Today's monkeypox factoid: The CDC has confirmed 244 cases in the US, while WHO counts 3,400 globally, most of which are in Europe.

We should know by the end of the day what the FDA's independent advisory panel is recommending in terms of a fall covid booster, basically if the vaccines should be reformulated to target Omicron or its subvariants. Good question since BA.4 and BA.5 now account for half of the new cases in the US. The possible time line has a decision on the vaccine's makeup being made by next week so that booster shots could start in October. If the vaccine is to be targeted, Pfizer and Moderna say they will need as much time as possible to get vaccines ready. The epidemiology folks at the University of North Carolina in Chapel Hill project a best-case covid scenario of 95,000 deaths in a period ending in March 2023; the worst-case scenario is over 200,000 deaths. In other words, we won't be out of the woods for a while yet no matter what a lot of people are saying.

China is cutting the quarantine time for international arrivals in half while maintaining its zero covid policy. The quarantine period was two weeks and will now be one. Arrivals will spend seven days in a government-run quarantine facility followed by three days at home. There will be regular covid testing during those ten days. Local governments are free to impose additional requirements. A representative of the European Chamber of Commerce in China says that "China may have to maintain a restricted immigration policy beyond the summer of 2023." The isolation for suspected close contacts of covid patients will become the same as the quarantine period for international arrivals. 

Alameda County in the San Francisco Bay Area is dropping the mask mandate it imposed three weeks ago, saying that cases were getting under control again. 

Finally, in a "Really? You just figured this out?" move, a WHO official says that the more times a person becomes infected with covid, the more likely the person is to be "unlucky" and develop long covid. I'm not sure what the grounds would be for thinking that the chances for long covid would decrease with subsequent infections. That the chances would remain at around 20 percent for each infection makes more sense to me. That's probably why someone else is in change and not me, not that I would even want to be.

The Road goes ever on and on ... Day 333 (833)

On the monkeypox front, WHO has decided that monkeypox is not a "public health emergency of international concern," but merely an "evolving health threat." Good to know.

The FDA's independent advisory panel has been asked to make a recommendation on whether to update existing covid vaccines to target a new version of the virus before fall boosters. One issue is that there is not time for lengthy human trials. Should the vaccine target Omicron or BA.4 and BA.5? What if a new mutation surfaces before fall? Pfizer has said that it might be able to have a targeted vaccine ready by October, while Moderna says it could not be ready until the end of 2022 or early in 2023. One option is sticking with the existing vaccines. They provide little protection against infection but do protect well against severe disease. Either way, there may not be enough vaccine available to offer everyone a booster. Boosters may have to be limited to people over the age of 70 or people over the age of 50 who have serious underlying conditions. This is very much a developing story.

A study published in the British Medical Journal reported that 32 percent of older adults in the US who survived covid infections had symptoms of long covid up to four months later, over double the rate found in an earlier study of adults between the ages of 18 and 64. There are other studies showing symptoms lasting a year or more. I will admit that the possibility (probability?) of long covid figures in my consideration of whether a specific action is worth the risk of doing. There are some sources who say we should stay masked in indoor public settings for an indeterminate amount of time. One said that she expected to stay masked in such settings for the rest of her life. I'm not sure I'd go that far, but it may merit some thought.

A study in the Canadian Medical Association Journal says that Canada handled the first two years of the pandemic better than several other countries with similar infrastructure and health care. Results covered the period from February 2020 to February 2022 for the countries of Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the UK, and the US. Compared to the other countries of the G10, Canada had the highest vaccination rate, the lowest number of covid cases, and the lowest number of deaths related to covid. The Canadian per capita case rate was 82,700 per million people. All the others except for Japan were over 100,000 per million. The per capita death rate was 919 per million people, the second lowest after Japan. All the other countries had death rates over 1,000 per million. Over 80 percent of eligible Canadians had gotten two doses of vaccine as of June; the other G10 countries fell between 64 and 70 percent. The authors cited Canada's implementation of strict and persistent public health measures kept in place for almost all of the two-year period. They acknowledge that there was a significant economic impact. In response to the question of whether it was worth it, a co-author of the study remarked, "Was it worth it? That's not a scientific question. That's a values and morals and policies question."

And doesn't that sort of sum up much of the pandemic? The interplay of the science with the values and morals and policies. I'm not sure we'll ever sort out exactly what was right when, where, and for whom.

The Road goes ever on and on ... Day 332 (832)

I'm not sure what it means that I found more info on monkeypox than covid today. I do not want to be tempted to expand this blog into monkeypox, though if it is declared its own pandemic, I'll have to take it under advisement.

So, Justin Trudeau says that people who choose not to be vaccinated must accept consequences including job loss and restricted access to transportation and other services. I agree with him wholeheartedly.

Finally, (I told you there wasn't much), The Guardian had a long, interesting even if I could not understand much, article on research at Cambridge University on whether mitochondria have the potential to help treat patients with long covid and chronic fatigue syndrome. If you find this intriguing, you can read the article here. I don't have a subscription, but I was able to access the article, so have at it!

More covid news tomorrow, or at least I hope so.

The Road goes ever on and on ... Day 331 (831)

Children between the ages of six and 11 can now get vaccinated with the Moderna vaccine, though it's not clear if this will be a big thing or not. Fewer than one-third of children of those ages have gotten two doses of the Pfizer vaccine. Vaccinations for children even younger are not so easy to find. The pharmacies at Publix and Kroger grocery stores will only vaccinate children ages five and up. CVS stores with a MinuteClinic will vaccinate children as young as 18 months; all other CVS store require a child to be at least five. A representative of the American Pharmacists Association says that all pharmacists are trained to give shots to children ages three and up; extra training, which not all stores will provide, is needed to vaccinate very young children. A mother in Woodstock, IL was unable to find a vaccine for her 14-month-old child. Pharmacies said the child was too young, and her pediatrician was not offering vaccine to young children citing waning interest. A volunteer group, Vaccinate Under 5, has put up a national database of places to get children under the age of five vaccinated. The mother in Illinois was able to get her child vaccinated though it required a 30-minute drive. 

The Broadway play "American Buffalo" will require audience members to wear masks until the play closes its run on July 10. The play is performed as theater in the round; the producers reported the decision was made "due to the close proximity of the audience to the actors as a result of the intimate size of the theater and the staging in the round."

Austria is abandoning the vaccine mandate it announced but never really enforced. Elsewhere in the world, there were no new locally transmitted covid cases in Shanghai Saturday for the first time since March. There were only two cases in Beijing. Unfortunately, other cities in China are still in various stages of lockdown. 

There is also monkeypox news, but news related to the coronavirus pandemic. Public health experts are concerned that the federal response to monkeypox may be repeating some of the mistakes made with the coronavirus. The window to control the outbreak is closing and may indicate just how badly prepared we are for another pandemic. One issue is testing. Britain is reporting five times as many cases as the US with a population 20 percent smaller than the US. Britain is testing more possible cases than the US. In many places in the US, testing is only offered to men who are intimate with other men. In other words, the problem with testing is access not capacity. Early in the onset of an outbreak testing is vital. Every aspect of the response to the outbreak relies on rapid diagnosis. The CDC says that right now the time between onset of rash and diagnosis averages 11 days. This longer delay means the virus has more time to spread.

And my window to get some therapeutic quilting done is also closing, though not rapidly. The bread is out of the oven, so once I post this, I can get back to that quilting.  

The Road goes ever on and on ... Day 330 (830)

Gonna be brief today. The morning's news making the demise of Roe v. Wade more certain than a leaked draft had sent me to therapeutic sewing, which left me with just the few notes I took before the news broke. I expect more therapeutic sewing will be needed in the days to come. Now on to the coronavirus...

I came across a list of long covid symptoms or outcomes in children, even infants. For infants and up to three years of age, conditions cited included mood swings, rashes, and stomach aches. For children ages four through 11, add memory and concentration problems to the mix. Finally, for early teens, we have memory and concentration problems, mood swings, and fatigue. Don't get me wrong, but aren't those last three typical of almost all young teenagers? 

The CDC signed off on the Moderna vaccine for children ages six through 17 years. Nice to have options. At the same time, though, the CDC director dismissed the importance of counting rapid covid tests in the case stats saying, "You don't need to count the rain drops to know how hard it's raining." In other words, we don't need to know how hard it's raining to make informed decisions about footwear, outerwear, or the need for umbrellas. 

In the first year in which they were available, covid vaccines cut the global death toll by 20 million. If the WHO goal of vaccinating 40 percent of each country's population by the end of 2021 had been met, some 600,000 more deaths could have been prevented.

Finally, WHO is deciding whether to declare monkeypox a global emergency. The fact that such a decision was not considered until monkeypox reached richer countries is upsetting some people.

I, meanwhile, will remain upset about today's Supreme Court ruling. I could not find the pair of coat hanger earrings I once had, but I did put on my "The best decision I've ever made was marrying a Canadian" t-shirt.  

The Road goes ever on and on ... Day 329 (829)

It seems that the administration of the previous or expired POTUS was trying to obtain herd immunity via mass infection. Needless to say, this likely contributed to oh so very many preventable deaths in the fall and winter of 2020-21. Wacko (in my humble opinion) doctor Scott Atlas pushed the White House to change CDC guidance and limit the amount of covid testing. He also disparaged and politicized mask-wearing as a mitigation measure without proposing alternatives. The purpose of limiting testing was that it would hurt the now-out-of-office POTUS in the election. Deborah Birx, one of the legitimate doctors advising the White House, described White House efforts to suppress information as cases surged in late 2020. She said that documents held back included data on viral spread and recommendations for containing it. Birx sent regular updates to each state and said she was told to change those reports about 25 percent of the time. If she did not make the requested changes, the reports were not sent. It makes me wonder even more than I already have how things would be today if the US had taken the pandemic seriously from the day it was declared or even before. 

Back in the present day, New York City will no longer enforce the mask mandate for businesses. It is not clear how much it was still being enforced in the first place. An epidemiologist at the CUNY Graduate School of Public Health says vaccination mandates would help in light of masks no longer being required but only if there is some incentive or disincentive offered or imposed. 

It did not surprise me to read that Americans in lower socioeconomic communities are about half as likely as those in wealthier communities to get antivirals such as Paxlovid. One contributing factor is that the antivirals require a prescription and must be started in the early days of infection. People in the lower SES communities may not have easy access to a Primary Care Physician, which makes getting a prescription within the prescribed time limit difficult. 

A couple of quickies: Florida-based Publix grocery stores will not offer covid vaccinations to children under the age of five. You've seen this here before, but Omicron subvariants BA.4 and BA.5 can escape antibody responses in people who have been fully vaccinated and boosted and previously infected. It's not monkeypox, but sewage samples in London have shown evidence of a rare polio virus. Right now, they're saying it's no biggie because children are vaccinated against polio. At the same time, though, they're encouraging people who may have missed one or more of their child's routine vaccinations to catch up. Britain was declared polio-free in 2003 and, I'm sure, would like to stay that way.

The Road goes ever on and on ... Day 328 (828)

A not-yet-published report on covid re-infection raises some troubling questions. Data were drawn from US Veterans' Administration records and reflected 5.4 million people who had not had covid, about 250,000 people who had had covid once, and about 39,000 people who had had covid two or more times. Comparing people with multiple infections to those with single ones suggests that all-cause mortality as well as adverse cardiovascular and lung-adverse outcomes doubled for those infected more than once. There was also a three-fold risk of hospitalization for those infected more than once. Increased risk persisted for six months following infection. Through the Delta wave, the rate for re-infections was one percent or less. From Omicron BA.2 and following subvariants, re-infections are increasing due to the progressively increased immune escape of each subvariant. Finally, the current BA.4 and BA.5 subvariants are different enough form the original BA.1 that the BA.1-specific vaccine expected to be released come fall suggests that the vaccine will not be as protective as anticipated. 

The European CDC says that BA.4 and BA.5 will soon become dominant in Europe and lead to a summer surge. The French vaccination chief says that the question is not whether such a surge is coming but how intense it might be and when it might start. Right now, the highest wave is in Portugal. 

The BBC website had quite the article on long covid. Fascinating even if it wasn't all good news. Right now, 20 percent of covid sufferers have symptoms that last between five and 12 weeks. Ten percent have symptoms that last longer. It's estimated that 31 million Americans may have had long covid at some point in the last two years. According to the British Office for National Statistics, long covid affects more women than men, more people living in "deprived areas," more social and healthcare workers as well as teachers, and more people in their 30s and 40s. 

As might be expected, long covid has serious implications when it comes to employment. Eighty-five percent of people with long covid said their symptoms worsened after increased stress and increased mental or physical activity. In the UK, only 44 percent of people requesting job accommodations due to long covid reported receiving them. Some experts think that long covid could be responsible for 15 percent of the US's 11.4 million unfilled jobs. Employers are working to adapt to this new normal. Some experts advise using symptoms rather than diagnoses to determine appropriate job accommodations. This makes sense to me given that the symptoms of long covid vary a lot from person to person. 

And the beat goes on ...

The Road goes ever on and on ... Day 327 (827)

North Korea may be ready to declare victory against the not-so-novel-now coronavirus, if you want to believe the story coming from state media. The report is that 18 percent of the 26 million residents have had covid symptoms, but only 73 have died. News or state propaganda? Take your pick. The country is in a bit of a Catch-22, though. If the government says that covid is over, it will make Kim Jong Un look like a great leader. In saying so, though, the pandemic restrictions that have been adopted and that have given the government even more control over citizens would no longer be needed. North Korea may have accepted vaccines from China, though it apparently ignored offers from South Korea and the US.

Broadway theaters are dropping mask mandates as of July 1. Some patrons do plan to keep wearing them. A theater studies professor and Tony Award voter who attends regularly notes, "It's important when you have people packed that tightly together, to control the flow of airborne germs at a time when we don't know what the long-term effect of covid is going to be." I'd have to agree with that. People are packed pretty tightly together in most theaters. I think I'd still be wearing a mask, too.

A bipartisan panel of health experts has called for an overhaul of the US public health system to greatly expand the role of the federal government and create a "national public health system." They'd like the federal government to have the authority to set minimum health standards and coordinate nearly 3,000 state, local, and tribal agencies. The panel says that this will help stop the "archaic approaches to aggregating data," which they say is one reason so many Americans have died during the pandemic. 

A study coming out of China about the low risks of infection with Omicron questions the necessity of the country's zero-covid program. Of the more than 33,000 patients hospitalized after a positive test, only 22 developed serious illness. All of the 22 were over the age of 60 and had underlying medical conditions. 

The number of cases in the US is soaring, but death rates are close to pandemic lows. Still, the daily rate of 314 deaths is more than twice the rate for suicide or car crashes. People's immune systems are said to be stronger due to vaccinations or past infections. As might be expected, older people make up a large share of the deaths. 

Are we there yet, Mom? No, but we may be getting closer. 

The Road goes ever on and on ... Day 326 (826)

I debated whether to number this as day 326, omitting the 325 that yesterday's post would have been or making today 325 as if yesterday didn't exist. The former won since yesterday did, in fact, exist and was not a bad day at all. Lots of fresh air going on walks, takeout from a Turkish restaurant for dinner, catching up with the kids. Yeah, it was a good day.

So, finding coronavirus news today was so difficult I worried the pandemic had ended yesterday while I was vacationing from the blog. You'll see what I mean when you see just how little I have to report today.

Children as young as six months can be vaccinated against covid as soon as tomorrow here in the US. Only 18 percent of parents surveyed said they would get their children vaccinated as soon as a vaccine was available. It's going to be interesting to see how accurate that prediction is. I can imagine more parents wanting their children vaccinated as the school year looms. We shall see.

Macao is said to be something of the gambling center of the world, and the casinos are, for now, remaining open as other businesses close due to a covid outbreak. Macao is part of China, so zero-covid rules. There were 31 cases identified Sunday after eight months with no cases. All 600,000 residents are being tested. Schools, tourist attractions, cultural venues, and non-essential businesses are closing. Restaurants are limited to takeout. Casinos remain open but are not expected to see as much business as usual. The only visitors allowed into the country are those from Hong Kong, Taiwan, or mainland China. Most of these visitors must quarantine for 10 days upon arrival. As for why the casinos are permitted to stay open, over 80 percent of Macao's national income comes from gambling. 

And that, believe it or not, was the news I found. There were a couple of human interest feature stories about topics such as children who lost a parent to covid, but that was about it. I expect that as we move away from the weekend, pandemic news will return, much as we might like it just to disappear. 

The Road goes ever on and on ... Day 324 (824)

I'm declaring a weekend away. Today has been spent making muffins, delivering muffins, picking up an engagement ring  whose missing prong had been replaced, and picking up light rum to go with the watermelon daiquiris we might be making tomorrow. (We had only dark rum.) I'm beat. Tomorrow is Father's Day and a belated birthday, and time to research and write will be limited. Happy Father's Day to all that are or play the role of fathers. 

Until Monday...

The Road goes ever on and on ... Day 323 (823)

The FDA has officially authorized both the Pfizer and Moderna vaccines for children down to six months in age. Pfizer's regimen is three shots; Moderna's, two. These will by no means end the pandemic, but will help more people return to something resembling normal. Parents who have been working from home so as not to send an unvaccinated toddler to day care may now be more comfortable with the idea of day care. I have only ever encountered one parent who was not vaccinating their children. When I helped administer a cooperative preschool, we had one family affiliated with Christian Science. Instead of a doctor's statement that their child had been vaccinated, they provided a signed form on which they agreed to keep their child away from school should any childhood virus start to appear. 

The Omicron variant may actually pose less risk for long covid than the Delta variant. Between December 2021 and February 2022, 4.5 percent of long covid cases were in people who had Omicron compared with 10.8 percent for people who had Delta. In this study, one in 23 people who caught covid went on to have covid symptoms for more than four weeks. Note: The study relied on self-reported data.

Some evidence is emerging that vaccines tailored to fight the BA.1 variant of Omicron may not be very effective against the BA.2 variant and its successors. Can we come up with modifications to vaccines that keep pace with the developing variants? I'd like to think that we can, but I'm not that optimistic. 

Children in Japan no longer must follow mokushoku at school. The term refers to "silent eating." Children were not permitted to talk during meal time, a measure put in place to help stop the spread of covid. Some school districts were worried that no talking was affecting the social and emotional development of children as young as six years. Desks must still face forward and children are asked to speak quietly. Children will continue to wear masks for the pre-meal communal chorus of Itadakimasu, a message of thanks for their meal. Parents are still divided on the mask issue. Some say that removing the ban is premature. While children are no longer masked during meals, they are masked for every other school activity with the exception of physical education. They do not have to wear masks when walking to or from schools.

The day after tomorrow is Father's Day. I will not be giving The Professor a gift, at his request. I did offer to make him a special dessert or dish. He has requested blueberry muffins, so blueberry muffins will serve as a gift. Don't tell him, but I would have made them anyway.

The Road goes ever on and on ... Day 322 (822)

Dr. Fauci has tested positive for covid. This does not worry me as much as it would have, say, in June 2020. He is fully vaccinated and has had both recommended boosters. He is said to be experiencing "mild" symptoms and will work from home until he tests negative. He has not been in close contact with POTUS or other government officials recently. Still, I worry somewhat that I don't feel more worried about this. While most people are recovering just fine, people do still die from covid. 

And people do still develop long covid. It's been reported that six months after infection, some long covid sufferers experience neurocognitive deficits of the same magnitude as being intoxicated, i.e., drunk. Neurocognitive deficits equivalent to aging 10 years have also been reported. We still don't know how long the "long" in long covid lasts. It would not surprise me if we never know.

The FDA advisory panel unanimously authorized the Moderna vaccine for children under age six, and the Pfizer vaccine for children under age five. There is worry, though, that the clinical trial data may already be outdated. The trials were done before the original Omicron variant, BA.1, mutated to its more transmissible subvariants. The Pfizer vaccination regime is three injections which some experts worry parents will not finish. Many adults have skipped the final dose(s) of the adult vaccine; will they skip the same for their young children? One of the 50 states has not yet pre-ordered any childhood vaccines. You might not be surprised--at least I was not surprised--to hear that it's Florida. 

An article in the Proceedings of the National Academy of Sciences claims that the US could have saved over 338,000 lives and over $105 billion in health costs if it had a universal healthcare system. The US had the highest death rate among the large wealthy countries of the world and is the only one without universal healthcare. One outcome of this that was especially bad here is people going to work when sick so as not to lose a job that provides health insurance. 

It seems that the Chinese government is using the national covid app for political purposes. Thousands of people heading to a protest in one city suddenly had their health apps turn red, indicating they were infected and could not enter the city. After they started home, their apps switched back to green, or negative for covid. Saudi Arabia is relaxing some covid rules before the hajj. The one million pilgrims expected will still need to show proof of vaccination, something that will no longer be required of people in their daily lives. Italy has dropped the mask mandate for theaters, sports centers, and entertainment venues. Passengers on Italian public transit must stay masked. Masks are encouraged but not required on airplanes. The deputy health minister explains, "The goal is to live with the virus, and this means returning to social life."

I can't say I'm on board with that for now. Getting there is likely to take, for me, a lot more information on long covid--its causes, outcomes, and any treatments.  

The Road goes ever on and on ... Day 322 (822)

Let's get monkeypox news out of the way first. WHO is renaming it. The current name does not follow WHO naming guidelines that discourage the use of geographic regions or animals. When the new name has been announced, I'll let you know.

The FDA advisory panel voted to authorize Moderna's vaccine for children and teens ages six through 17. The FDA must now officially authorize it and pass the approval process to the CDC advisory panel. The FDA advisers are meeting today regarding vaccines for children ages six months through five years. The full FDA may take this on as soon as Friday. The CDC will be in session Friday and Saturday, opening the door for shots to be available as early as next week. Testing on the vaccines in these age groups was done in the day of the Omicron BA.1 variant, not the later, more transmissible subvariants. 

Canadians no longer need to prove vaccination status for travel within Canada. People entering Canada from the US still need to prove that they've been vaccinated; they no longer need to also show negative test results. All travelers must continue to wear masks on federally regulated transportation. Passengers on cruise ships must also remain masked. Truckers passing in either direction still need proof of vaccination. For comparison, 84 percent of Canadians are fully vaccinated compared with 67 percent of Americans, and 60 percent of Canadians have gotten boosters compared with only 31 percent of Americans.

Not much out there today. I wish I could take that as a good sign, but I don't. I think too many people right now are trying to be all three monkeys at once, covering ears, eyes, and mouths for the full effect.

The Road goes ever on and on ... Day 321 (821)

June 14 has lots of connections. It's Flag Day! It's the birthday of a wise old man, now deceased, I knew in my years-ago church-going days. It's also the birthday of someone I think of as a daughter-in-law. It's a good day.

Lots of Little today:

The Rolling Stones are on a 60th anniversary tour and have postponed a stadium concert in Amsterdam because 78-year-old Mick Jagger has tested positive for covid. There's no word yet on their concert scheduled for Friday night. You remember rocker Mick Jagger, right? The guy who said that if he was still doing rock and roll when he'd be in his sixties, he should be shot or otherwise disposed of? Yeah, that Mick Jagger.

The CDC has added three countries to its Level 3 list (the places they don't want you to visit): Mexico, New Caledonia, United Arab Emirates. I can't say that any of those are high on my list of places to go and things to see, so this has little effect for me.

A couple of notable people are in the midst of covid relapses. The US Health and Human Services Secretary who tested positive just one month ago is again testing positive. Canadian Prime Minister Justin Trudeau tested positive in January and tests that way again, now, in June.

Long covid continues to loom. One in every five covid infections leads to long covid. Vaccines only offer a 15 percent reduction in the risk of developing long covid. Long covid is the main reason I still wear a mask when around other people, even outdoors, and pass on indoor activities involving too many other people.

As for getting vaccinated or boosted, please do so if you're eligible. But keep that mask on and some cautions in place. Looking at covid deaths in Oregon in May, 58.1 percent were in fully vaccinated people.

FDA's committee of independent vaccine experts is debating the merits of the Moderna vaccine for children between the ages of six and 17. The doses being considered are half adult strength for children ages six through 11 and adult strength for those between 12 and 17. 

China is making lab tests for covid a permanent feature of daily life. A person needs a negative test result to go shopping, ride a bus or the subway, and take part in public activities. One problem with this is that hourly workers are not paid for the time it takes to get tested. Another is that some local governments are diverting money from poverty alleviation projects to cover testing costs; total costs are estimated to be in the billions of dollars. Shanghai will shift the cost of the tests to residents as of August. Needless to say, this is not a popular decision.

Queen Elizabeth still reigns, Ukraine is still fighting back, and thoughts and prayers have not brought GOP and Second Amendment advocates to their senses. I will keep praying for that, though.

The Road goes ever on and on ... Day 320 (820)

You may have noticed that from time to time news articles stating that this or that vaccination program is encouraging pregnant women to be vaccinated, or for women who are trying to become pregnant to be vaccinated. An article in JAMA Network Open reports that babies born to women who had covid while pregnant may face a higher risk of developmental disorders such as autism and bipolar disorder. This risk is not limited to covid infections. Infections with viruses such as influenza and measles raise the risk of disorders such as autism, schizophrenia, and depression. The covid study looked at the records of 7,550 babies. Three percent of babies born to mothers who did not have covid were diagnosed with a brain developmental disorder before their first birthday. For babies exposed to covid in utero, that percent was 6.3. After accounting for other factors that might influence a child's risk for these disorders--including preterm births, mother's age, and baby's gender--babies with in utero covid exposure were 86 percent more likely be diagnosed with a brain developmental disorder before their first birthday. 

The FDA is expected to rule this week on emergency use authorization for the Moderna and/or Pfizer vaccines given to children under the age of five. If the FDA gives emergency authorization, the CDC will have to ratify it. The CDC has ended the requirement that travelers entering the US by air have to present the results of a negative covid test. Sports teams will no longer have to travel by bus from Toronto to Buffalo to get on a plane there.

One candidate to be the Republican nominee in the race for governor in New York cannot appear in person at an upcoming debate. Andrew Giuliani, son of Rudy, has not been vaccinated for covid and refuses to get vaccinated. He says that he has "natural immunity" and will submit to multiple tests to prove he is not infected. The studio hosting the debate is holding firm on its vaccine mandate. Giuliani can appear in the debate remotely, though at least one of the other candidates is not at all happy with that ruling. He's holding out for in-person or not-at-all.

The last time I had my hair trimmed, my stylist told me that she and her housemates had gone through a bout of covid. She said she was glad she could not get it again and was not at all happy when I told her she could get infected again ... and again ... and... (She did not take her feelings out on my hair, thankfully.) Some people are reporting they've had covid three times now. Some scientists believe that covid will become "an inevitable infection that everyone gets multiple times," similar to the common cold. There are some differences, however. There is not as yet a seasonal pattern to covid. There is no long cold analogous to long covid. A case of Delta or an earlier variant was roughly 90 percent effective in preventing reinfection in both vaccinated and unvaccinated people. Since Omicron appeared, however, infection offers only about 50 percent effectiveness. Immune defenses do wane; an October 2021 per-Omicron study estimated that reinfection could come after only three months.

Quickies: A vet in Thailand may have gotten covid from a cat. An as-yet-unpublished study found that ivermectin does not reduce the time needed to recover from covid. (Surprise! Surprise!) The president of the opposition party in India has been hospitalized with "covid-related issues." Finally, a team of international scientists assembled by WHO says in its first report that bats likely carried early versions on the coronavirus and may have transferred them to animals sold at the market in Wuhan.

The Road goes ever on and on ... Day 319 (819)

I'm ba-a-ack! I almost feel normal today. Unfortunately, the seven pounds of water weight I lost is probably going to be back before I know it. I at least felt up to going on a walk with the dog this morning., It wasn't a long walk given that it was raining, but what distance we did walk felt okay.

So, in the days before I went on sick leave, I reported something about the death rate from Covid now being higher for white Americans than for Black Americans. It really is as shown by plotting Covid deaths over time by race/ethnicity. That's all well and good until one considers Simpson's Paradox, something I don't remember learning anything about in the various stat classes I took. Simpson's Paradox concerns how "statistical association between two variables in a population emerges, disappears, and reverses when the population is divided into subpopulations." One very important risk factor not addressed in the comparison of death rate by subpopulations is age, the strongest known risk factor for dying of covid. White Americans are far more likely to outlive Black or Hispanic Americans, suggesting that age should be considered in addition to race/ethnicity.

The source I read worked with covid death data from 2022. These data are provisional due to the length of time it takes to process death certificates. Before adjusting for age, per capita covid deaths for white Americans were 43 per 100,000; for Black Americans, 37 per 100,000. In other words, the numbers support what was shown in the earlier plot. After adjusting for age, however, those per capita deaths became 31 per 100,000 for white Americans and 40 per 100,000 for Black Americans. The gap is narrowing, though, and deaths among white Americans have increased faster over the last three years. 

The CDC has added four countries to its Level 3 travel warning (over 100 deaths per 100,000 residents over the past 28 days): Guyana, Mongolia, Namibia, and St. Kitts and Nevis. Most European countries remain at Level 3. Two countries were moved from Level 3 to Level 2 (50-100 cases per 100,000 residents over the past 28 days). I haven't felt a desire to travel by air, though I'm warming to car travel as we did the past two summers. 

It's felt good to feel better today. I hope the improvement continues.

  

The Road goes ever on and on ... Day 318 (818)

Covid is still spreading, the war in Ukraine still rages, and Queen Elizabeth still lives. I'm still under the weather and becoming very good friends with the couch.

The Road goes ever on and on ... Day 317 (817)

I got news, and it's good, bad, or both depending on your view. The day before yesterday, I felt like death warmed over and stayed on the couch for pretty much the whole day. Yesterday, I felt fine, normal, peachy, the works. Today has been like Wednesday, pretty damn crappy, which I think is a bad thing. The covid self-test was negative, which I view as a very good thing. The bottom line is that this is all the blog you get today. Your mileage may vary in whether that fact is good, bad, or meh.

The Road goes ever on and on ... Day 316 (816)

I'm not sure what sort of illness got into me yesterday, but I'm feeling better today. I still feel a bit weak, but then a day of eating next to nothing will do that to you. So, on with the blog...

In the early days of the pandemic, per capita death rates for Black Americans were almost twice the white rate and over twice the rate for Asians. The rate for Latinos was in between but still above average. The racial gaps have narrowed as whites decline to be vaccinated. Over the last year, the death rate for whites is 14 percent higher than Blacks and 72 percent higher than Latinos. One obvious factor in this difference is that vaccination rates for both Blacks and Latinos are slightly higher than for white Americans according to a Kaiser Family Foundation survey, The share of white Americans who have been vaccinated has barely changed in the last year. Why? Politics! Only 60 percent of Republicans are vaccinated compared with 75 percent of Independents and 90 percent of Democrats. 

Ethnicity aside, the US continues not to do well with covid vaccinations. According to the CDC, 48.7 percent of Americans over the age of 12 have been fully vaccinated and gotten at least one booster. Canada's analogous percent would be 55.5. In 27 countries of the EU, 62.6 percent of people are fully vaccinated and at least partially boosted. In the UK, that would be 69.6 percent. The FDA has given emergency authorization to the Novavax vaccine. This would be the second non-mRNA vaccine. Approval must still be given to the manufacturing process which has had past difficulties.  

Moderna released results on their vaccine targeting Omicron. Combining the new vaccine with the original Moderna vaccine produced 1.75 times the level of antibodies as the original vaccine alone. Moderna is gathering data on the updated vaccine's effectiveness against the BA.4 and BA.5 subvariants of Omicron. Those two now represent 13 percent of the new covid cases in the US compared with 7.5 percent a week ago. 

The American Academy of Physical Medicine and Rehabilitation report that patients with long covid have an added risk for cardiovascular complications including pulmonary embolism, arterial and venous thromboses, myocardial infarction, and stroke. These may arise weeks or months following infection with symptoms ranging from "mild to incapacitating." Five to 29 percent of covid survivors complain of chest pain, shortness of breath, or palpitations months after recovering from acute infection. In the future, covid infection may be held to be a cardiac risk factor similar to smoking. 

The White House is expected to announce a rollout plan for covid vaccination of children under the age of five. Vaccinations could start as early as June 21 if the FDA, as expected, gives authorization to both Pfizer and Moderna vaccines. It should be noted, though, that only 18 percent of parents say that they will get their younger children vaccinated "right away," while 38 percent say that they will "wait and see." Factoring into this may be that covid infections tend to be less serious in children than they are in adults.

Experts are now saying that the monkeypox virus can be airborne, but that is only a small factor in its overall spread, There is no firm estimate of how much airborne transmission contributes overall. One worry is that the virus could become endemic in some animals here in the US, opening the door for more frequent outbreaks.

The Road goes ever on and on ... Day 315 (815)

There's been a flu-like bug going around lately, and I seem to have let it catch me. I kept thinking I'd feel better and get up and write up the notes I took early this morning. Not gonna happen. I now return to the couch. I will do a covid test if this does not let up.

The Road goes ever on and on ... Day 314 (814)

Case counts and hospitalizations continue to decline in Massachusetts, Maine, Connecticut, and New York. Every other region in the US is seeing a rise in hospitalizations, particularly Alabama and Louisiana, where hospitalizations have risen by 70 percent. Some experts have suggested that counting covid patients in an ICU is a better gauge of covid's magnitude given that hospitalization counts include patients admitted because of covid and those admitted who are then discovered to have covid. There are currently about 3,000 patients in ICUs, some 11 percent of all hospitalized patients with covid. This is actually the lowest rate since September 2020 and has held steady since May. The covid situation should improve over the summer but most sources expect it to worsen come fall and winter.

The US wasted over 82.1 million covid vaccine doses between December 2020 and May 2022, 11 percent of the total doses distributed. CVS and Walmart together are responsible for over 25 percent of the doses thrown away. Health Mart, DaVita, Rite Aid, Publix, and Costco got rid of over 25 percent of the doses they received. Two states, Oklahoma and Alaska tossed over 25 percent of the doses they received. Part of that was due to the distribution pattern. Because doses were distributed in standard quantities, more doses than needed were sent to many remote areas. Some doses expired; others were spoiled by power outages or improper storage. Because the vaccines come in multidose vials, any doses left unused in open vials at the end of a day were discarded. CDC guidance advised that vaccinations be prioritized even if it meant opening a new vial for one shot. Four states were not included in the analysis: Louisiana, Maine, Ohio, and Oregon. It sounds bad, but the overall amount of waste is not out of line with WHO estimates for large vaccination campaigns. 

The FDA has yet to authorize administration of the Novavax vaccine. Besides the vaccine, approval is needed for the manufacturing process. Novavax has had issues with this over the past two years. The US Department of Health and Human Services is said to want there to be a second non-mRNA vaccine available, meaning that the FDA likely won't delay their approval processes.

Finally, China is holding college-entrance exams or gaokao. These determine the under two percent of candidates who can enroll in the top universities. Students who have covid or who are close contacts of people with covid will test in isolation or hospital rooms. I guess that because the percentage of students "promoted" is so small, they can't just get rid of the tests for a year or two as US universities have done with the SAT and ACT. In fact, the pandemic has influenced some universities into making those tests optional or not considering them at all. 

The Road goes ever on and on ... Day 313 (813)

Beijing started relaxing pandemic regulations at midnight Monday. It is now possible to dine inside a restaurant. Masks are still required as are daily temperature checks. Certain activities including riding the subway or going to work require a negative PCR test. There were six confirmed cases in Beijing on Sunday, so they're not out of the woods just yet. Shanghai had three local community cases followed by an official warning that people must remain vigilant. Those nine cases were out of a nationwide total of 86 confirmed cases.

The latest US wave is lessening in the Northeast.  While there were over 29,000 patients in hospitals, up 16 percent over the past two weeks, 3,000 of whom were in ICUs, hospitalizations are declining in the Northeast. Experts say that things will worsen come fall and winter, and summer will depend on vaccinations, demographics, and the availability of health care. While cases decline in the Northeast, California is moving closer to reinstating mask mandates. One in six Californians now lives in counties with a high community level as determined by the CDC. The areas of biggest concern are in Northern California. Alameda County, home to Oakland, already reinstated a mask mandate on Friday. The mandate does not apply to public schools since they are about to close for the summer. It also does not apply to the community of Berkeley which has its own health department. The Special Olympics dropped a vaccine requirement for the games to be held in Orlando after Florida's governor threatened $27.5 million in fines.

The Novavax vaccine not yet authorized by the FDA appears to carry the risk of myocarditis, though one of the myocarditis cases reported during the clinical trials was in a person who received a placebo rather than the vaccine. Data show that the vaccine does reduce the risk of mild to severe disease. The vaccine has been anticipated by people who are allergic to some element of the mRNA vaccines. It's not clear how the reported myocarditis risk will affect the FDA authorization process.

Finally, the CDC reports that two distinct monkeypox viruses have been detected in the US, raising the possibility that it has been circulating here for longer than thought.

The Road goes ever on and on ... Day 312 (812)

Not much coronavirus news out there today either, but there was one article worth mentioning since it's something I've wondered about from time to time. You've tested positive for covid. What  next? If you tested positive at a clinic or community testing site, your result is reported to a public health department. A home test taken under the supervision of a trained telehealth worker is also reported. So what about home tests done at home on your own? The CDC "strongly encourages" reporting the result to your primary care physician, who may report it further. However, only a few state health departments collect data from home tests. Some other states allow counties to collect home test data if they want to, but it's not required. 

There are, it seems, four ways to report a positive home test.

1) Some home tests are accompanied by a mobile app through which the result can be reported. 

2) As noted above, results can be shared with a PCP; what happens next may or may not send the result forward.

3) The result can be reported to a local health department who may or may not do anything with it.

4) Participation in crowdsourcing may be an option. OutbreaksNearMe.org was developed to deal with influenza results but now handles covid as well. The site can create maps and analyze case data submitted by volunteers, that is, people reporting their home results. 

I don't think home tests are going away any time soon if ever. I wish there were a better way to record the results. We know that the official number of cases is too low, in some cases, way, way too low. If I were to get a positive result on a home test, I would at least report it to my PCP and, depending on her advice, the local health department. In the meantime, I hope not to face that minor dilemma.

The Road goes ever on and on ... Day 311 (811)

None of the several sources I checked this morning had anything about covid. There was an article on how the mRNA method developed for the covid vaccine is proving useful in the search for an HIV vaccine. A candidate vaccine can be developed in a matter of months rather than years. A possible vaccine can be developed and tested in less time than developing an old-school vaccine would. Something good to come out of the pandemic.

I spent the afternoon taking a virtual class in wet felting from the Shaker Village in Maine. I made what could be used as a possible bird's nest, though there are many other uses. I shall definitely try this again.  

The Road goes ever on and on ... Day 310 (810)

Vaccinations could be available for children under the age of five by June 21. Authorization by the FDA ratified by the CDC is needed but expected to be forthcoming. Given the tepid response to vaccinations for children ages five through 11, I expect that some parents may be reluctant to vaccinate their even-younger children. The White House coronavirus response coordinator says he expects the "vast majority" of children will be vaccinated. I'm not sure I agree with him. I think parents will be more cautious about having a baby or toddler vaccinated than an older kid. It may take something such as an upcoming vacation or event to convince people to take the plunge. 

WHO expects covid deaths in Africa to fall sharply in 2022. They're forecasting 23,000 deaths in 2022 compared with an estimated 350,000 in 2021. Since the start of the pandemic, Africa has had 11.9 million confirmed cases, a number some say was likely 70 times higher given how many cases were probably never confirmed. WHO expects there to be over 166 million new infections this year.

Not-yet-peer-reviewed research suggests 98 percent of South Africa's population has some antibodies. It is likely that 87 percent had an infection. Eleven percent have antibodies suggesting vaccination rather than infection. The country has still been hit hard in the latest wave, the one in response to BA.4 and BA.5.

Shanghai for the most part reopened on Wednesday. Some streets were reportedly fenced in again within one day after a positive case walked through the neighborhood. Routine testing is required. Residents must show a negative test result every 72 hours. I have trouble imagining how that will play out. It would be an impossible undertaking here. I'm not sure an American city with a population of 100,000 could do it, and the population of Shanghai is over 25 million.

Finally, the WHO director general notes, "The sudden appearance of monkeypox in many countries at the same time suggests there may have been undetected transmission for some time." The genetic pattern of the current strain suggests sustained human-to-human transmission since at least 2017. WHO puts the current global public health risk as moderate. It could become high, though, if the virus establishes itself as a human pathogen rather than an animal one that occasionally infects humans.

 

The Road goes ever on and on ... Day 309 (809)

A not-yet-peer-reviewed survey in New York City suggests that covid cases could be undercounted by a factor of 30. The authors suggest that undercounting could be even worse elsewhere given that New York likely has better access to testing than many other places. There may be a disadvantage to getting tested. A positive test can mean staying home from work or school. This presents something of a "don't ask. don't tell" situation. The survey also showed over half the covid patients did not know about Paxlovid. Those who did and who got it tended to be younger and with better access to resources, in other words, probably not the people who most needed it. 

Cases have surged in South Africa over recent months even as data showed 98 percent of the people had some antibodies from vaccination, infection, or both. The prevalent virus forms, BA.4 and BA.5, suggest that the virus is becoming better at reinfection.This means that outbreaks will keep happening or, in the words of an infectious disease specialist, "The virus will continue to evolve so that it can continue to spread in the population. It doesn't end. This virus is with us for the rest of time."

The virus appears to be losing ground in North Korea, though. There have been, officially, only 70 deaths. That makes the fatality rate 0.002 percent, the lowest in the world. Given that deaths peaked while cases were still rising, there may be a problem with the numbers. One reason may be that local officials are not reporting data so as to avoid punishment. WHO has tried multiple times to send vaccines and other assistance but no offers have been accepted. That imports from China doubled from March to April suggests assistance is coming from the Chinese. North Korea bought masks for the first time from January to April 2022. 

Cadaver-sniffing dogs, explosive-sniffing dogs, and now covid-sniffing dogs who may be able to detect covid more effectively than PCR tests. In one study, dogs detected 97 percent of the symptomatic cases and nearly 100 percent of the asymptomatic ones. It seems that while dogs are more sensitive to positive cases, PCR tests are better at detecting negative ones. In two of the dogs' false positives, the patient had another coronavirus respiratory illness. Finally, while PCR tests can take days to yield results, a dog can process 20 samples in 15 seconds. Has covid testing gone to the dogs?

The Road goes ever on and on ... Day 308 (808)

Thinking of traveling to Europe this summer? (I'm not.) Italy is no longer requiring travelers to have a valid coronavirus pass. N95 masks will be required on public transit and in cinemas, concerts, and schools until June 15. US travel industry leaders want the government to drop the requirement that vaccinated travelers take a covid tests before flying to the US. They say it hurts the travel industry and is not a requirement in most other countries. In Canada, incoming vaccinated travelers are stopped at random for testing.

As I ponder turning 66 in a month, I note that coronavirus data consider "older" to mean ages 65 and over. I guess I'm already old or, as My Older Brother reminded me a year ago, an official senior citizen. The death rate for older people has soared during the Omicron wave.  The Omicron death peak for older people was 163 percent of the Delta peak. For people ages 12 through 64, the Omicron peak was 69 percent of the Delta ones. Almost as many people ages 65 and up died in four months of Omicron as died in six months of Delta, even though Delta caused more serious illness. More stats on older Americans. The death rate for unvaccinated older people was 156 per 100,000 compared with 24 per 100,000 for vaccinated and seven per 100,000 for boosted. For the same age group, the estimate is that 13 percent are unvaccinated, three percent have gotten one dose of an mRNA vaccine, and 14 percent are vaccinated but have not gotten a booster dose. As of mid-May, over a quarter of Americans ages 65 and older had not had their most recent dose of vaccine within one year. The facility in which My Mom lives gave a first booster to everyone who would take one but does not plan to give a second booster until fall, hoping that the vaccines by then have been modified to better deal with Omicron. I offered to take her out for a booster, but she said she'd wait until they did the in-house one in the fall.

Many people have said that we should learn to "live with covid." The two million people in the UK who are literally living with (long) covid might disagree. One-fifth of them had the infection two years ago and are still having symptoms. Two-fifths have suffered covid symptoms for one year. 

As for when the pandemic might end, one source cites two central questions. First, how durable is our immunity and how durable must it stay? Second, how fast will the virus continue to evolve? 2021 could be described as the year of the variant. First came Alpha, over 50 percent more transmissible in humans than the original virus was. Then came Beta and Gamma, both of which exhibited immune escape. Delta, 50 percent more transmissible than Alpha not to mention more severe, came next, followed by Omicron. Will 2022 be the year of reinfection? We won't reach the end of the pandemic on any one criterion. 

Looking to how the next pandemic might develop, WHO agreed on Monday to form a committee with the intent to better respond to future global health emergencies. The committee would convene as soon as possible after an international public health emergency was declared. The lack of such a group is seen as one of the weakest points surrounding this pandemic.

Are we there yet? To the end of this pandemic? To the start of a new one? And just how will monkeypox evolve?