The Road goes ever on and on ... Day 222 (722)

Eric Topol is a physician and scientist whom I've followed on Twitter during much of the pandemic. I first heard of him when he was a cardiologist at the Cleveland Clinic. He's now at the Scripps Research Institute. He recently started a series of articles under the title Ground Truths. His latest, "The Epidemic of Covid Complacency," is pretty compelling. You should be able to get to it without subscribing, though I'm glad I subscribed and hear when new articles appear. There is no cost to subscribe.

The organizers of the convoys now descended upon the nation's capital are threatening a week of traffic disruptions. Their loose collection of demands includes an end to all pandemic-related restrictions. Given the speed with which localities and states are loosening or removing restrictions, it's not clear to me just how meaningful this demand is. The plan is for vehicles to fill all the traffic lanes of the Capital Beltway and drive at the minimum legal speed twice daily. The drivers are mostly white, middle-aged men. One of the organizers explained yesterday, "We're not anti-vaxxers. We're not. We just want freedom, freedom. We want to choose. We just want the choice. So tomorrow is a basically a show of just how big we are and how serious we are."

In terms of pandemic restrictions, the CDC reports that over 90 percent of the US is now at low or medium risk, meaning requirements for masks and other precautions can be loosened. Still, only 65 percent of Americans are fully vaccinated. Some physicians and public health officials are worried people as well as public leaders will think the pandemic is over. These experts caution that we need to prepare for another variant which could be more transmissible. They advise that we continue investing in masks, tests, ventilation, vaccination, wastewater monitoring, and other response measures. Above all, we need to expect the unexpected and not prepare for the best-case scenario. 

China is facing its biggest covid outbreak since the early days of the pandemic. There were over 800 new cases over the weekend, almost as many as there were in the previous week. Cases in 17 of 31 provinces are really testing the nation's zero covid policy. The policy has changed somewhat from trying to lock down entire cities to locking down residential districts or work sectors. People coming in from Hong Kong, which is battling its own surge, are being required to quarantine for two weeks. 

New York City public schools are mask-optional as of today for all students ages five and older. Four-year-olds in preschool and kindergarten must still wear masks. One problem is that vaccination rates are not consistent across schools and districts. Teachers are not thrilled with the program and want to make sure that in-school and take-home testing continues. I liked the description offered by a fifth grader: "It feels like Covid is kind of over, even though it is not. It feels like everyone just kind of gave up on it." Out of the mouths of babes?

An article in Nature suggests that covid may cause greater loss of grey matter and tissue damage in the brain than naturally occurs. The general implications are not clear; the study was done on people between the ages of 51 and 81. It seems that the shrinkage and tissue damage is primarily in brain areas related to smell. That would be consistent with the number of covid sufferers who report that the sense of smell they lost while having covid never completely returned.

Last but certainly not least, the global death toll is said to have passed six million. That would be the clearly undercounted global death toll. 

The Road goes ever on and on ... Day 221 (721)

The UK has seen a large rise in long-term illnesses since the pandemic began. Among the causes are long covid, breathing difficulties, and mental-health problems. Some 14.2 million people aged 16 to 64 said that they had had a health condition lasting 12 months or more in 2021, up 1.2 million from the year before. This suggests that the "average" level of health could be decreasing. 

The vehicle convoys--the truck convoy has expanded to include recreational vehicles and cars as well as trucks--are gathering in Hagerstown, Maryland, about 70 miles northwest of the District of Columbia. It is not clear what their plans are after at least one rally at the Hagerstown Speedway. The head of the DC Homeland Security and Emergency Management Agency says that the convoys have said that they will stay out of the District. It's not clear if that is true; one source did say a group might be heading to the Capital Beltway.

The mayor of Boise, Idaho says that she has faced "real and grave" threats including protesters with torches and pitchforks outside her home over her support of covid restrictions. She said that some other city officials had resigned due to the threats. She now has a protective details and has changed her routines including canceling her morning trail runs. Health regulations have been especially divisive in Idaho, not surprising considering only 53 percent of residents are fully vaccinated.

You may have seen photos of Vladimir Putin meeting with people. Putin sits at one end of a massively long table, and the other person sits at the other end. The Federal Protective Service has maintained a virus-free bubble in which Putin stays, protection far stronger than most other world leaders have maintained. At Putin's residence and the Kremlin, all visitors must pass through disinfectant tunnels to enter. All world leaders visiting with Putin must quarantine for two weeks or tests negative on a PCR test. Some world leaders have refused the PCR test if Russian doctors conduct it; they don't want the Russians to have the sample of their DNA that a PCR test would provide. 

In a small online poll of 1,250 Americans in February, 56 percent reported having medical debt. Thirty percent of the group with medical debt said that it was from covid treatment. Such treatment was typically provided free of charge in the early days of the pandemic, but no longer is. 

Finally, Spain is dropping many of its covid restrictions and telling people to act responsibly. I still wrestle with how many people will be and just how responsible they will be. It's on them, though. I can only really control my own behavior on this front.  

The Road goes ever on and on ... Day 220 (720)

Pandemic news, well, new pandemic news, was hard to come by this morning. As you might expect, the focus is on Ukraine and its defense against Russian aggression. The Professor has a couple of coworkers who are Russian. One has made it quite clear that he supports Putin's undertaking. Fortunately, these are not people with whom The Professor interacts on a daily basis. 

We are nearing the second anniversary of WHO's official pronouncement of a pandemic on March 11, 2020. Those two years sometimes seem to have flown by, while other times they seem to have taken forever. I wonder whether WHO will offer some official announcement when it decides the pandemic has passed. On to current news...

Covid hospitalizations in the US are at about the lowest point of the past year. The US currently averages 55,701 new cases daily; 41,014 covid patients are in hospitals, a 23 percent drop from last week. That is about one-fourth of the mid-January peak and lower than it's been for most of the last year. Love it or leave it, it's easy to see why restrictions are being loosened or disappearing. 

The covid numbers in Hong Kong are surging probably more than our numbers are dropping. The healthcare system is on the verge of breaking down; beds have been moved outdoors because there is no room inside. Whatever number is reported, it is likely to be a significant undercount. People are not reporting positive tests to avoid being placed in government isolation facilities. For the week ending on March 3, Hong Kong reported more deaths per million than any other country or territory. A major problem is that though 78 percent of the population ages 12 and older are fully vaccinated, only 48 percent of people ages 70 and older are. At the start of this year, only 25 percent of people over the age of 80 had been vaccinated.

Three truck convoys should be arriving in Washington, DC this weekend. The "People's Convoy" from California should arrive today. The "American Freedom Convoy" from the Midwest should arrive on Monday. Somewhere in between is a convoy that started in the Northeast. I have not read what their plans may include, things such as blocking the streets leading to the Capitol or White House. I wonder if they have thought about simply blocking traffic around the Beltway. It's hard to imagine just how much trouble that might cause.

 The Professor and I could not resist watching Contagion last night. The virus there seemed to have a much more rapid onset and progression. Some of the mob-like scenes seemed over-the-top, but then my view of what was going on in Italy or New York City in the pandemic's first days was whatever the news media provided. The movie seemed to totally bypass any clinical testing and approval of vaccines. To say more would be a spoiler. It wasn't a bad movie. It definitely made me think about what this has been like for the scientific first-responders, the epidemiologists and virologists under pressure to provide answers immediately if not before. I think we'll look for something a little more lighthearted if we decide tonight is another movie night.

The Road goes ever on and on ... Day 219 (719)

Just a few quickies this morning. The afternoon is getting full, and the evening is movie time (on Netflix) with The Professor.

Baricitinib (don't you just love all those i letters?), an anti-inflammatory drug taken for rheumatoid arthritis, can reduce death from severe covid by about one fifth, according to the Randomised Evaluation of Covid-19 Therapy (Recovery). When other drugs are added, the risk of death could go down by over 50 percent. As with much pandemic news, this has not yet been peer-reviewed.

There has been a significant drop in the amount of covid misinformation on social media in the last week. Attention has shifted to Ukraine. It seems that some anti-vaccine proponents are moving to support Russia. I find this interesting. A lot of anti-vaccine proponents say that vaccination is too controlled by the federal government. They should go see how controlled things are in Russia.

New York City prepares to stop requiring masks in schools. It can be argued that masks seem less important in light of the Ukraine situation; however, there is concern on how dropping masks may affect people who are immunocompromised. 

Two of Hong Kong's largest consumer retail chains are rationing some food and drug items to curb panic buying. If you need an ambulance in Hong Kong, you might have a long wait. Delays of one day are common; the record wait so far is one day, 15 hours. A third of ambulance workers either have tested positive or have been in close contact with a covid sufferer.

Los Angeles County (the city of Los Angeles is a separate entity) is lifting almost all indoor mask and vaccine verification requirements. Large indoor events will still require proof of vaccination or a negative test. Individual businesses can opt to keep requirements in place.

So far, there's been no real discussion of the possibility that the mass exodus from Ukraine could carry with it multiple super-spreader events. The countries absorbing the evacuees have enough on their plates without adding covid spread. Still, it's something to keep in mind.

The Road goes ever on and on ... Day 218 (718)

Some participants in covid "challenge trials" never got covid despite being exposed in various ways or even having the virus placed directly inside their nostrils. Some did report minor symptoms, but their viral levels never got high enough to trigger a detectable level of antibodies, T-cells, or other defenses. One theory as to why this happened is that these people may maintain "memory T-cells" from previous infection by another coronavirus. There is also some evidence that having had the H1N1 strain of influenza might provide partial protection against covid. Finally, there could be a genetic component as there is with Malaria and norovirus.

It does not surprise me that the pandemic has hit women with more serious social and economic impact than men. In terms of loss of work as of September 2021, 25 percent of those affected were women compared with 20 percent men. Females were also more apt to drop out of school or to report an increase in gender-based violence. The pandemic has not created new inequities between genders, but it has exacerbated existing ones. 

About one in every four Americans is unvaccinated. I find this fact hard to grasp when the global rate of full vaccination is now up to 56 percent and will at some point pass the US rate. I don't think that the rest of the world has serious vaccine mandates; are those people just more trusting in science or in their governments? I wonder.

One of my state's two Senators, Tim Kaine, has announced he has long covid two years after his initial infection. He said his nerves feel as if he'd had five cups of coffee. He is pushing for more research on long covid, as discussed in The Covid National Preparedness Plan put out by the White House yesterday. That plan carries a commitment to efforts to "detect, prevent, and treat long covid." Specific proposals include an interagency research plan and "centers of excellence" to provide care.

The Surgeon General has requested major tech platforms provide information about the scale of misinformation on social networks, search engines, crowd-sourced platforms, e-commerce platforms, and instant messaging systems. He also wants to know "exactly how many users saw or may have been exposed to instances of Covid-19 misinformation" and aggregate data on the demographics of those exposed. The Surgeon General says that "this is about protecting the nation's health." The data coming in from every tech platform sounds overwhelming to me, but I guess that's why the government has data scientists.

One of the pandemic's longest border closures has ended. Western Australia is now allowing entry from both within and outside of Australia. The border closure served them well. Until the Omicron surge, they had registered only 11 deaths. One of my friends in Perth hopes to be seeing her son soon. Living in Melbourne, he was unable to come home to visit; I'm not sure if she could have visited him and been able to return to WA.

The Road goes ever on and on ... Day 217 (717)

The war in Ukraine did not bump the coronavirus from POTUS's State of the Union address last night, though covid might otherwise have gotten more attention. POTUS said that the country is "moving forward safely, back to more normal routines" and that "covid-19 need no longer control our lives." He said we must stay on guard so as to be ready if a new variant arises. He specifically used the word "if" almost as if doing so made "when" not likely. I differ with him on that one. There will be new variants probably sooner rather than later. They may not be as deadly or transmissible as Delta or Omicron, but they will be out there.

The glut of undistributed covid tests should get smaller. Starting next week, families can request more free tests--four per household--from covidtest.gov. POTUS also announced a "Test & Treat" program in which someone who tests positive at a drugstore can immediately obtain, free of charge, antiviral treatment pills. I guess you could test at home and, if positive, go to a drugstore for another test and then get the treatment.

The CDC no longer recommends universal case investigation and contact tracing for anything but cases in high-risk settings. Home testing with no required notification of positive results makes it hard to run a formal program. I would like to think that someone who tests positive would do some contact notification on their own, but that may be presumptuous.

Hawaii is moving to loosen restrictions, though an indoor mask mandate will remain in effect. Testing and quarantine requirements have ended as has the requirement that state and county employees show proof of vaccination or negative test results. 

For the men out there, it seems that the coronavirus invades cells in the penis and testicles of rhesus macaques. This may help explain why 10 to 20 percent of covid patients report "male genital tract dysfunction" otherwise known as erectile dysfunction. The paper has not yet been peer-reviewed, and the study was based on only three monkeys; still, it might be worth investigating further.

The Road goes ever on and on ... Day 216 (716)

Lots of poll results today but first there's news I don't think many parents wanted to hear or read. It appears that the Pfizer vaccine is far less effective in five- through 11-year-old children than in older children. While it still offers protection against hospitalization, it appears to offer almost no protection against infection even just a month after vaccination. This may be due to the fact that the dosage is but one-third of the dose adults and teenagers get. In support of this, for the two weeks ending January 30, there was 67 percent effectiveness in 12-year-old children versus 11 percent effectiveness in 11-year-old children. Given that biological differences would be minor here argues that the problem is a dosage one. Giving younger children the higher, teenage dosage may not be an option. The higher dosage may cause too many fevers, a side effect particularly dangerous in young children. I know parents who home-schooled their children planning to send them back to classrooms once vaccinations of younger kids started. I don't want to think how they're feeling right now.

According to an Axios/Ipsos poll, only 35 percent of people think the current administration has done a good job restarting the economy and supporting small businesses. While 58 percent think that the administration did an excellent or good job on supporting vaccine development and delivery, only 43 percent trust the current administration to provide accurate information on the virus. This is down from 54 percent a year ago.

In a Washington Post-ABC poll, 60 percent of Americans say that some restrictions should remain in place. A majority, 64 percent, think that the virus is only "somewhat under control" or "not at all under control." Even so, most say that they have fully or mostly returned to pre-coronavirus activities. In an Economist-YouGov poll, 52 percent of Americans say they support mask mandates for indoor spaces. In an Associated Press-NORC poll, half of Americans support mask mandates when people are around others outside their homes. Fewer than three in 10 oppose such mandates. In the same poll, 38 percent say that restrictions should end, while 58 percent believe some measures should remain in place to control the spread of the virus. 

A CDC analysis of blood samples suggests that 140 million Americans have had covid, about double the number usually cited. There are 14 states in which half of people carry covid antibodies in their blood. Wisconsin leads the list at 56 percent. The others, in descending order, are Iowa, Illinois, Ohio, Wyoming, Texas, Indiana, Mississippi, Nebraska, Michigan, New Jersey, Tennessee, and Louisiana, followed by Georgia with 50 percent. New York came close, at 49 percent. 

Finally, a preprint from Canadian researchers reports the first case of deer-to-human covid transmission. The variant involved was said to have a "new and highly divergent lineage." It had 76 consensus mutations including 37 previously associated with non-human animal hosts, 23 of which were not previously reported in deer. The claim of deer-to-human transmission is based on identifying a "epidemiologically-linked" human case from the same geographic region and sampling period.