Another Year Down

I can't believe I went a year and a day without writing anything here. Actually, I can believe it. There are a lot of things I didn't do in the last year that I wish had been possible. I'm not going to start a list, because the list would be too long and it would depress me even more than long COVID alone does. 

I didn't make any resolutions for 2024, so there's no progress for me to check in on. Most days I float through somehow, accomplishing nothing. While I am no longer taking non-trivial morning and afternoon naps, I still need at least one or I am essentially useless the next day. I read the paper on and off. Look at social media. Occasionally write emails. Lately, I've actually been able to read for more than 15 minutes before I can no longer focus, so I've actually finished some books. I did start taking walks again, under the guidance of a physical medicine and rehabilitation doctor. That more than anything else has helped lift the major depressive disorder I was feeling. The doc also had me going to physical therapy. One's balance takes a hit after sitting or lying down for a whole year. 

Between the walking and the physical therapy, the slight lower back ache I had had on and off turned all the way on. Some days I had trouble walking without pain. The physical therapist thought it might be due to the scoliosis she said I had. The doctor thought that if I got my hips stronger, that would take care of the pain. After he had me lie on my back and be unable to lift my left leg due to pain, he sent me for x-rays. The good news is that they showed what the cause of the back pain is. The bad news is that it's not clear what can be done about it, though more information coming out of an MRI on July 19 should shed more light on that. 

It's called anterolisthesis. My L4 vertebra is sliding forward on my L5 vertebra. The sliding is somewhere between 25 and 50 percent, meaning it's Level 2. Level 1 is better; Level 4 is not. This may be something my mother had. At one point, she had a rod put in her back to hold her back straight. That's one of the last-resort treatments for anterolisthesis that I refuse to think about until after then MRI results are in and explained to me. 

So, this has been an enlightening post, hasn't it? Let me finish with the horoscope from The Washington Post that tells of the year ahead for someone born on July 1.

You are adventurous, imaginative and impulsive. You have an excellent memory. This is a year of learning and teaching. You might take time to renew your spiritual or religious beliefs. Explore philosophies that will give you a better self-awareness and understanding of the true meaning of your life.

 I'm not at all sure how to interpret all that. I do not, for example, feel very adventurous, imaginative, or impulsive. I'm too tired for any of that. And what is the true meaning of my life? A friend told me I did not seem upset enough about the anterolisthesis on top of the long COVID. Without really thinking, I told her I had both so other people did not to have either. The fates could have given two people one thing each. By giving me two, at least one other person has stayed healthy. Gotta laugh because the alternative doesn't accomplish anything. 

I'll try to get back here before another year passes, not that anyone has asked where I was this year. And for what it's worth, I'm now 68. Sixty-seven could have been worse, but at least it was a prime number.I don't have another prime age until 71.

Halfway to 2024 Already

I should wait until Saturday to post this because then I could comment on its being six months between posts. Normally, I use my birthday post to report on how I'm doing with the resolutions I made six months ago. That's easy this year since I never made any. The Christmas cards never got mailed either. It's been a rough seven months. I'll still post whatever horoscope has a special forecast for people born on July 1.

Long COVID continues. My condition has improved somewhat from six months ago if only napping once daily rather than twice is a sign of improvement. While it is nice to be able to do something--anything--in the mornings, I have on more than one occasion done enough that I feel it the next day. Today is one of those days. I am trying to get the binding done on what is now a quilt I should have given to the intended recipient 26 years ago. Without the long COVID, it would have been finished and presented in January. Now, I hope to present it in July if I don't overdo it as I did yesterday.

Apart from the last six months, the last two have been compounded by the death of my mother in early May. I thank the deities that I saw her the day before she passed and that it was one of our better get-togethers. As I walked out the door, we were both laughing. Last year, my brother came to visit for Mother's Day; this year, that would have been too late. He went home two weeks before Mom died. I wonder if that helped her release herself from her body in this life. I remain convinced that she knew she was going to pass. At our last meeting, she asked me what I might want of the various things she had hanging on the walls. She said that one thing, something I did not want, really appealed to one of the aides, and she wanted that aide to have it. The aides told me that the day before she passed she'd been in a particularly jovial mood; the next day, they said, she had left that mood behind and asked to be helped into bed at lunchtime. On every other day, she only got into bed when it was time to sleep. I made sure that each got what she wanted.

Mom did not want a memorial service or funeral, nor did she want an obituary. I honored her wishes on the former, but did write a short obituary. I also let faraway friends know of her death. Many days in the past two months, the activity du jour has been dealing with some aspect of her estate. Her estate was larger than anticipated, and I need to go through the probate process. Advice to anyone thinking of their demise: Make your bank accounts "payable upon death" to your beneficiary(ies). If Mom had done that, there would have been no need for probate.

Because Mom's estate was larger than anticipated, we have been able to make some gifts to the kids. I'm also going to upgrade my plus-25-years-old sewing machine. Then I think I'll let things sit for a while while I regroup and try to recover as much as I might be able to. I just started reading The Long COVID Survival Guide: How to Take Care of Yourself and What Comes Next--Stories and Advice from Twenty Long-Haulers and Experts. I don't know that it will make anything better, but it will help remind me that I am not alone in this and that in comparison to many, many other people, my case is a mild one. Even so, writing this after doing some work on the quilt guild's website has left me somewhat drained and thinking of a morning nap.

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 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 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 305 (805)

Not a long post today. Between the Uvalde school shooting and response and the war in Ukraine, I found woefully little coronavirus news this morning. Perhaps that is a good thing. Perhaps it is not. I know some people have gotten numb to any new information and simply want back the pre-pandemic normal I don't think we'll ever reclaim. 

Long covid, perhaps my major worry in terms of if I were to catch covid. It seems that vaccinated people don't have much less risk of long covid compared to unvaccinated people. The risk reduction is only about 15 percent. From a University of Pennsylvania bioethicist: "How worried should people be? A lot more worried than they are. People are behaving as if the pandemic is over. The problem with long Covid is it's like the problem of hypertension or another illness that is in the future. We inherently discount the future, especially if the things we need to protect future bad effects from coming are onerous, like wearing a mask."

The area in which I live is now in the high transmission category, with masks recommended in indoor settings. I don't know how people are responding to this and have no real intention of going out to find out. The only place I might go, to visit My Mom, has required that staff and visitors wear masks since visitation resumed. If only the residents wore them as well. (Thanks, Mom, for wearing one every time you leave your apartment.)

The Road goes ever on and on ... Day 283 (783)

Happy Mother's Day Eve! I have blueberry muffins in the oven to take to My Mom tomorrow. I may add some French fries; she's craving those, and they don't serve them at her assisted living facility. If you're a mother, I hope your youngin's treat you right tomorrow. If you're a son or daughter, treat your mother right tomorrow. You should actually do that every day, hard though it may seem.

Public Service Announcement over, it's back to the coronavirus. Some of the demographics of the one million Americans dead from covid are not at all surprising. Three fourths of the dead were over the age of 65. An elder care expert notes, "A million things went wrong and most of them were preventable." On average, more men died than women. Overall, more Whites died, but Black, Hispanic, Pacific Islander, and Native American people suffered disproportionately more than other groups. Mississippi was the state with the highest per capita death rate. 

The White House is warning of a fall surge and developing plans on how to provide vaccines if covid aid stops. The possibility exists that 100 million Americans--30 percent of the population--will get covid this fall or winter in a model that assumes the virus stays an Omicron family variant and not a brand new variant. The wave is actually predicted to start in the summer as people in the South spend more time indoors to escape the heat. Right now, the government can't provide enough booster for the general population without more funding. Older and immunocompromised  people would likely be given priority.

Will long covid be the next phase of the pandemic? Right now, there is no treatment and some difficulty precisely defining it. As many as 24 million Americans may have experienced long covid symptoms. Women are 33 percent more likely to have symptoms than men. Symptoms include brain fog, fatigue, organ damage, chest and joint pain, loss of senses of taste and smell, cough, headache, and gastrointestinal and cardiac issues. Insurance companies often decline payment because it cannot be precisely diagnosed. The demand for long covid care right now far outstrips the current capacity. That better change if it is the next phase.

The Road goes ever on and on ... Day 236 (736)

Supreme Court Justice Clarence Thomas was admitted to a hospital Friday, news not made public until Sunday, with "flu-like symptoms." My first thought was, naturally, could those symptoms be covid rather than influenza? The Court knew I would be thinking this (along with millions of other curious people) and had a spokeswoman announce that Thomas's stay in a hospital is not covid-related.

Hong Kong appears to be stopping its zero-covid policy. It's not clear how well it was working given that researchers suggest that almost half the city may have had covid at some point. Residents stranded overseas will soon be able to return from nine countries that previously had worse covid situations than Hong Kong. Not allowing residents to return is evidently known as a "circuit breaker flight ban." Returnees will need a negative PCR test and must still quarantine for seven days, down from 14. To the north of Hong Kong, Shanghai Disneyland will be closed until further notice. 

As for lessening restrictions here in the US, Dr. Fauci says we are "clearly going in the right direction" on the pandemic. He cautions, though, that now is "no time at all to declare victory because this virus has fooled us before, and we really must be prepared for the possibility that we might get another variant and we don't want to be caught flatfooted on that." He also says that while retirement is tempting, he will not consider it until the pandemic is over. 

The Johnson & Johnson vaccine has been shown to remain durable and effective even in the Omicron surge. In fact, the CDC says that Johnson & Johnson had the lowest breakthrough infection rate of the three principal vaccines since December 25, 2021. Pfizer had the highest breakthrough infection rate, while Moderna was in the middle.

As long as there is covid, there will be long covid. Seven in 10 people reporting long covid say that they have concentration and memory problems. Many under-perform on cognitive tests. Of 181 participants in one study, 78 percent reported having difficulty concentration; 69 percent, brain fog; 68 percent, forgetfulness; and 60 percent, difficulty finding the right word when speaking. Researchers found a cluster of symptoms characterized by fatigue, chest pain, body, pain, headaches, and limb weakness to be predictive of cognitive symptoms and memory-test performance six months later. There are no ways known to prevent long covid. The best protection is to get vaccinated and, if you should get infected, start treatment as soon as possible.   

Ten pilots from JetBlue, American Airlines, and Southwest Airlines are suing the CDC over the federal transportation mask mandate. The suit alleges that masks are ineffective and "harmful to human health in at least 68 ways." I find that intriguing. At least 68 ways? I could not begin to think of that many health hazards brought on by masks. The only one I found cited in reports on the lawsuit was mask fatigue, "the lack of energy that accompanies and/or follows prolonged wearing of a mask." I can't imagine that a mask interferes with oxygen uptake enough to wear you out, but I've been wrong lots of times before. Maybe I should spend an entire day, save for ingesting nourishment, wearing a mask and see how tired I feel. 

The Road goes ever on and on ... Day 208 (708)

The FDA is reviewing data concerned with authorization of a second covid booster in the fall. It is not clear if there is an intended target population such as all adults or certain age ranges. It is also not clear if the dose should target Omicron or be general as the other doses have been.

While the FDA looks into a second booster, news has come out that the CDC has collected and withheld data that might have been helpful to state and local health authorities. One example would be the effectiveness of boosters in 18 to 49 year-olds. Experts looking into this have had to use Israeli data in the absence of any from the US.

Covid has served as a "giant catalyst" in terms of different technologies, data, and research. In the words of a virologist, "Covid has stimulated the rapid translation of previous knowledge into practice. Developing science takes many years and needs an opportunity to be implemented. Covid has provided an easier regulatory environment, with fast-tracked trials, so vaccine developments, for example, have been really quick." The mRNA technology underlying the Pfizer and Moderna vaccines is being studied for vaccines against plague, dengue, Zika, and Ebola. Sarah Gilbert, architect of the Oxford vaccine, explains, "We've got the cake and we can put a cherry on top, or we can put some pistachios on top if we want a different vaccine, we just add the last bit and then we're ready to go."

It is unclear why 10 to 30 percent of people infected with covid develop long covid,but four factors appear to increase the risk. The first is high levels of viral RNA early in the infection, which sounds to me as if people who get sicker faster might be more at risk. The presence of certain antibodies also raises the risk. It may be that these antibodies don't fight as hard against covid, or perhaps they get in the way of the antibodies being produced to fight the covid. Third is a reactivation of the Epstein-Barr virus. which among other things causes mononucleosis. Finally, there is Type 2 diabetes something we've all likely heard of. 

Around the world, New Zealand will lift vaccine mandates and social distancing measures after the Omicron peak passes. Next door, Australia has reopened its border for fully vaccinated travelers. The first to arrive in Sydney were greeted with plush koalas and kangaroos, jars of Vegemite, and welcome serenades by a quartet of drag queens. South Africa is changing vaccine rules to try to increase uptake. The interval between the first and second doses of the Pfizer vaccine is being cut in half, 21 days rather then the 42 it has been. The time between a second dose and booster is also being halved, from six months down to three. As of March 1, all travelers, even unvaccinated ones, may enter Israel. They must pass two PCR tests, one before departure and one after arrival. Finally, Queen Elizabeth is alive and possibly kicking, and Russia has not yet (but probably will soon) invaded Ukraine. 

The Road goes ever on and on ... Day 30 (530)

SARS-CoV-2. The gift that keeps on giving. Today's distressing news, at least to me, is that a new study published in The Lancet found that almost half of hospitalized covid patients were still experiencing at least one lingering symptom one year after becoming ill. That's one year, folks. The study tracked 1,276 Chinese covid patients discharged between January 7 and May 29, 2020, with a median age of 57. Patients were assessed six months out and one year out. Patients, well, survivors, were given a physical exam, lab tests, and a six-minute walking test of endurance and aerobic capacity; they were also interviewed. 

One year out, 49 percent had at least one lingering problem.  Compared with people who had not had covid but who had similar pre-existing conditions, covid survivors had worse health overall 12 months later. Covid survivors were much more likely to be experiencing pain or discomfort, anxiety or depression, or mobility problems. Seventy-five percent of patients had needed supplemental oxygen in the hospital but had not needed intensive care, a ventilator, or even nasal oxygen. Women were more likely than men to have lingering symptoms. Some issues such as shortness of breath were more common in people who had been more severely ill, but other issues did not correlate with severity of covid. 

From an editorial that The Lancet published about the study: "The need to understand and respond to long Covid is increasingly pressing. Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many millions of people globally, Long Covid is a modern medical challenge of the first order."

That was enough detailed news. Here are a few quick items from around the country, Hawaii is seeing a record number of hospitalizations with vaccinations static. Overall, 62.1 percent of Hawaii is fully vaccinated, but only an estimated 40 percent of native Hawaiians are. Many native Hawaiians harbor a distrust of the government since the US-supported overthrow of the monarchy in 1893. Natives make up 21 percent of the population and, until July 10, 2021, accounted for 21 percent of covid cases. From July 11 to August 16, they accounted for 28 percent. 

Calls to poison control centers have increased three-fold compared to before the pandemic started, with most of those calls right now being about ivermectin. An Arkansas doctor is being investigated for prescribing the drug thousands of times. That number seems high to me, but I'm just reporting what I read. The prescriptions must have been issued electronically because I can't imagine signing my name that many times.

Illinois has issued a statewide indoor mask mandate. Educators there are already subject to a vaccine mandate. The Maryland Board of Education has issued a statewide mask mandate. Oregon has seen a 10-fold increase in hospitalizations since July 9, the highest ever since the pandemic started. Educators and health care workers there must get vaccinated or lose their jobs.

The US Open tennis tournament starts on Monday open to a full house of spectators. Arthur Ashe Stadium will be considered an outdoor space even when the roof is closed. Evidently, the ventilation system is that good. There will be no entry requirements, and no masks required outdoors. I'm not feeling too optimistic about this.

The View from the Hermitage, Day 352

Just when I thought I'd figured out what to write here--or at least how to start today's post--a news notification pops up that Texas governor Greg Abbott is removing the mask mandate and, as if that was not enough, opening everything 100 percent effective March 10. His exact words were "It is now time to open Texas 100%. COVID has not suddenly disappeared. But it is clear from the recoveries, from the vaccinations, from the reduced hospitalizations, and from the safe practices that Texans are using, that state mandates are no longer needed." He did leave a loophole that if hospitalization rates exceed 15 percent hospital bed capacity for seven days, county judges may add local mitigation measures, but it is not clear that reinstating mandates would be required or just optional.

Like, wow! Really? I guess he didn't read yesterday's blog post with comments from the CDC and WHO directors that we should not reopen things prematurely. He may be one of the CPAC attendees who gave South Dakota governor Kristi Noem a standing ovation when she mentioned the many times Dr. Fauci had been wrong. Are the safe measures he mentioned the reasons why all those rates have gone down? If that's the case, what's going to happen in April or May after several weeks of unsafe practices? 

A new poll shows Americans as more hopeful and less frustrated, stressed, or worried than a year ago. Another poll suggests that the most vaccine-hesitant demographic is white Republicans. Neither of those findings surprises me. I wonder, though, if many of those white Republicans will be less vaccine-hesitant now that their leader, XPot, has admitted to having been vaccinated. Anything that gets more people willing to be vaccinated is fine by me.

China and Russia are practicing vaccine diplomacy that I don't think we are at least not yet. China has provided vaccines to 20 countries in  South America and Africa and plans to send them to at least 40 more. Even so, the Economist Intelligence Unit estimates that more that 85 poor countries will not see widespread immunization until 2023. The WHO's emergency services director has said that it is "premature" and "unrealistic" to hope that the virus ends in 2021, though vaccines could help us "accelerate toward controlling the pandemic." If we can get those vaccines to where they need to be, that is.

I've read various reports of what has been called long covid, a condition in which some symptoms or aftereffects of covid don't stop. It evidently affects children as well as adults, which to me is pretty frightening. The article I read said that in the UK, 13 percent of kids under the age of 11 and 15 percent of kids aged 12 to 16 reported at least one symptom five weeks after a confirmed covid infection. In one case a 45-year-old fitness instructor and her daughter are still experiencing multiple symptoms since getting infected a year ago. One support group, Long Covid Kids, reports 1,700 kids with long-term symptoms. 

Moving away from covid to political correctness, six Dr. Seuss books are no longer being published because they contain racist imagery. Of the six, I've only heard of two and may well have copies on the basement bookcase holding most of the kid books. Those two would be And to Think That I Saw It on Mulberry Street and If I Ran the Zoo. I'll have to clear the boxes from in front of the bookcase and see if I can find them. The four unfamiliar ones are McElligot's Pool, On Beyond Zebra!, Scrambled Eggs Super!, and The Cat's Quizzer.