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.