The Road goes ever on and on ... Day 340 (840)

Happy Independence Day! In true American fashion, there was an active shooter at a parade in Highland Park, north of Chicago. One report said there were at least five people killed and 16 people injured enough to go to a hospital. Another report said that the shooter was still at large. Happy Holiday? Not! All this has happened after I had put on my "CANADA: Looking Better Every Day" t-shirt and moose earrings. 

Very, very little covid news out there this morning. So let's start with the now-daily monkeypox note. If the monkeypox rash moves into a patient's eye, it can cause permanent damage including, in rare cases, blindness.

If monkeypox is not enough, there is now news of Pasco County, Florida's being in quarantine due to a rapidly-growing population of invasive giant African land snails. They carry something called rat lungworm, which can cause meningitis. They also eat over 500 different plant species as well as paint and stucco off houses as a source of calcium. Some people keep them, illegally, as pets. If a snail is released or escapes, it can lay 1,200 eggs each year. Two giant African land snails were also found in luggage at Atlanta's airport, discovered thanks to two members of Customs and Border Protections's "Beagle Brigade."

As for covid, any strain should be evaluated on three things: infectivity, immune escape, and severity. The BA.5 subvariant is worse than others on the first two items. Severity is still up in the air. Hospitalizations are up, but deaths are not ... yet. As for number of cases, one estimate is that we could be missing 80 percent of all cases due to home testing. That would put the current US peak about the same as the initial Omicron peak in January.

Finally, a legislator in Hong Kong tested positive for covid a day after having appeared in a group photo with Xi Jinping. The legislator stood two rows back, and everyone was masked. A new round of testing has been ordered in Macau. I don't know how it works that casinos are still open but staff have been asked to stay home. Self-serve gambling? Slot machines and electric poker? They need to be careful in Macau. The population is 600,000, but there is only one hospital. One.

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 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 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 297 (797)

The stats on monkeypox are around 80 confirmed cases in 12 countries that would not necessarily be expected to have the virus. Lots of questions have come with it including how are people with no connection to Africa getting it? So far, older people don't seem to be catching it to the same extent young people are. Those smallpox vaccinations we had as children may still be working. Given that the recommended treatment for monkeypox is to administer a smallpox vaccination, that should not surprise me.

Coronavirus infections and hospitalizations continue to rise here in the US. Infections are up some 50 percent in two weeks. Rates are rising among children as well as adults. It's not clear how helpful the booster shot for children ages five through 11 will be; only 30 percent of American children in that age range have even gotten a first shot. The booster comes at least five months after the second shot. Experts point out the expectation that new strains will circulate in the fall and urge parents to be ready. 

North Korea reported 263,370 new cases Friday and two more deaths bringing the overall totals to 2.24 million cases and 65 deaths. I agree with the many experts who say those numbers are understated to make it look as if the country's response is being effective. They still have not accepted help from any other country including their neighbor, China.

Finally (it's a weekend; news is always slow then), BA.4 and BA.5 have been labelled variants of concern in the UK. Some of that concern is that their growth advantage could be due to some degree of immune escape. If that escape strengthens, boosters may not be sufficient to slow or stop it.

The Road goes ever on and on ... Day 293 (793)

Found lots of news this morning, so let's start with the quickies. 

The FDA has authorized boosters for children ages five through 11 years. 

Well-trained scent dogs can detect covid. Attempts may be made to see if they can differentiate different variants. 

Shanghai health officials say that the outbreak there is under control and the goal is to reopen fully by June. 

New York City is moving to a high covid risk level. Masks are recommended though not required ... yet. 

A growing body of scientific evidence suggests that long-term exposure to air pollution leads to worse outcomes for people exposed to covid. Even short-term exposure can have an impact, just not as strong.

Dr. Fauci, when asked, replied that were our ex-POTUS to become POTUS a second time, he would not continue to work in that POTUS's administration. 

The government is providing more covid test kits. This time, they will send two packs of four tests each. Lots of people may end up needing them. The seven-day rolling average number of cases Sunday was the highest in almost three months and 150 percent up from one month ago.

North Korea is up to 56 deaths and 1.5 million cases. Experts differ in assessments of what North Korea needs most right now. It may not be vaccines since so many people have already gotten covid; however, a South Korean professor of preventive medicine counsels that vaccines might be good to send if they can be given to elderly people and people with pre-existing conditions. North Korea could probably also use fever reducers, test kits, masks, and daily necessities. I don't think it's going to end at all well there.

The CDC is urging all domestic travelers to "consider getting tested as close to the time of departure as possible (no more than three days) before your trip." Consider? I'm thinking the language used there should be a little bit stronger. How about replacing "consider" with "plan on"? Or drop "consider" and change "getting" to plain old "get"? In terms of international travel, the CDC has added four countries to its highest level of risk: South Africa, Lesotho, Antigua and Barbuda, and Taiwan. 

More than one scientist will tell you that the coronavirus is here to stay, that it is adept at dodging defenses, and that it may come in waves two to three times annually. Some people who had Omicron BA.1 already have had a reinfection with BA.2, BA.2.12.1, BA.4, or BA.5. These people could actually have a third or even fourth infection before 2023 rolls around. Says a South African epidemiologist, "The virus is going to keep evolving, and there are probably going to be a lot of people getting many, many reinfections throughout their lives." A virologist at the Scripps Research Institute adds, "If we manage it the way we manage it now, then most people will get infected with it at least a couple of times a year. I would be very surprised if that's not how it's going to play out. ... Every single time we think we're through this, every single time we think we have the upper hand, the virus pulls a trick on us. The way to get it under control is not 'Let's all get infected a few times a year and then hope for the best.'"

Could I post something without referring to monkeypox? Not today. There are new cases in England not linked to Africa. People suspected of having monkeypox should be isolated in a negative pressure room as soon as possible. They should be masked and their lesions covered for any interaction. The last case in the US was in November 2021, so within the time frame of the pandemic. The first time monkeypox was found outside Africa was in the US in 2003. There were 47 cases. The infection came from animals imported from Africa including two African giant pouched rats, nine dormice, and three rope squirrels. These African animals passed it to US lab animals who then passed it to humans. 

Intrigued by African giant pouched rats, I lifted the photo below from National Geographic:

They're actually kind of cute if they don't have monkeypox.

The Road goes ever on and on ... Day 292 (792)

Delaying coronavirus news, two new cases of monkeypox have been found in London and appear to be unrelated to the first case. Possible new pandemic? Who knows?

The European Centre for Disease Prevention and Control has labelled BA.4 and BA.5 as variants of concern. Both, along with BA.2.12.1 have minimal cross immunity with BA.1. This means that the Omicron-specific vaccines due out in July may not provide as strong protection as hoped. A reduction in vaccine effectiveness could mean more breakthrough infections even after four doses. There could also be more breakthrough infections in the one or two weeks after an injection when the protection should be the highest. Under Delta, vaccinated adults accounted for 23 percent of deaths; under Omicron, 42 percent. If that's not unsettling enough, the family of Omicron variants is evolving more rapidly than any other variant family has. 

North Korea now reports 50 deaths and over 1.2 million cases. Experts note that the death toll is likely understated to protect Kim Jong Un's dignity as leader. Over 564,860 people are reported to be in quarantine. A South Korean analyst calls the case total an "outright lie." While North Korea reported 390,000 more cases and eight deaths in one day, South Korea had 25,000 more cases and 48 deaths. Another analyst estimates that the real number of cases is at least three times larger than reported. 

What test kits North Korea has are likely reserved for people in leadership positions. Kim said during a ruling party Politburo meeting that medicine not getting to pharmacies in time is due to pharmacies' "irresponsible work attitude." Meanwhile, South Korea has indicated its willingness to send vaccines, medicines, equipment, and even health personnel to North Korea if it is willing to accept them.

Students at high-profile Peking University are protesting lockdowns calling them poorly communicated and unfair. While students are required to isolate and are unable to order food, teachers and their families are allowed to move freely. There was even an attempt to erect a wall to separate students from faculty and staff members. Needless to say, this too caused a protest. 

Scientists are working to pull together a nasal spray vaccine. People may be more receptive to this than they are to an injection. More importantly, whereas an injectible vaccine combats a virus once a person is infected, a nasal vaccine can capture a virus before it can attach to cells, a process called sterilizing immunity. That certainly sounds like a good thing. 

US cases are up 60 percent from two weeks ago, and up even higher considering home testing. Hospitalizations are up 23 percent from two weeks ago. Many counties are moving to medium or high risk on the CDC's scale. High risk is where masks are encouraged. 

The Road goes ever on and on ... Day 284 (784)

Happy Mother's Day to all who "mother" anyone in any way. In the interest of marking the day, there is very little coronavirus news out there. There is, though, a confirmed report of a case of monkeypox in the UK. Remember monkeypox? A computer model cited it as a potential new pandemic. What I've read suggests that it does not spread easily between people. You can read more about it here, thanks to the BBC. Scroll down a bit, and there's a section on what the symptoms are and how someone might catch it. 

Other news bits include clear signs of a fifth wave in South Africa. The test positivity rate there right now is 31 percent. Here in Virginia, the test positivity rate is over 10 percent for the first time since February. The hospitalization rate for unvaccinated people is twice that for fully vaccinated people, and the death rate is 14 times higher.

Listen to a/your mother: Get vaccinated. Stay boosted.