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 282 (782)

Covid has at last hit close to home. Son #2 emailed last night to say he and his partner would not be coming Saturday for a Mother's Day eve dinner as she contracted covid either at work or at a jiu jitsu tournament she attended. He's so far testing negative, but they're taking no chances, which I greatly appreciate. They're both vaccinated and as boostered as 30-somethings can be, so fingers crossed her case is asymptomatic or otherwise mild. It had to happen sooner or later. 

The FDA is putting limits on the Johnson & Johnson vaccine. Only people ages 18 or older and otherwise unable to get vaccinated will be allowed to get it. "Otherwise unable to get vaccinated" includes things such as being allergic to some component of the two mRNA vaccines. The Johnson & Johnson vaccine raises the risk of thrombosis with thrombocytopenia, a dangerous clotting condition, after getting vaccinated. 

An article in Nature reports that infection with Omicron BA.1 gives unvaccinated people narrow immunity to future BA.1 infections. For vaccinated people, it provides cross-immunity to Delta and other variants. I'm assuming that the researchers did whatever was needed to rule out that the vaccinated people already had the cross-immunity so as to ensure that it was coming from the infection. At least if it's been published in Nature, they should have.

Also just out is a piece in the Lancet on the phase coming after covid-19, advising that it would be a "grave mistake" to forget about certain characteristics of this pandemic. First, the situation is by no means the same everywhere. Different factors influence the coronavirus in different places and at different times. Second, the global vaccination strategy is far from on track. Vaccine inequity is real. Over 40 countries have fewer than 20 percent of residents completely vaccinated. This vaccine inequity has been mirrored by treatment inequity, specifically the availability of Paxlovid. This inequity is meaningful given that Paxlovid reduces the risk of hospitalization and death by 89 percent. Finally, besides continuing to prepare for future pandemics, we also need to catch up on regular care such as childhood vaccines that may have been put off so far. 

Just an FYI, the 14-day changes in the US as of yesterday: Cases are up 59 percent; hospitalizations are up 20 percent; and deaths are down three percent. Hospitalizations include those for covid and those found to have covid while being admitted for another reason.

Finally, some philosophical advice from Chinese president XI Jinping on the zero-covid policy in China: "Persistence is victory. This is far from the time to rest and take a breath ... Resolutely fight against all words and deeds that distort, doubt, and deny the country's pandemic policies." In other words, you have been warned.

The Road goes ever on and on ... Day 281 (781)

Between the leak of the Supreme Court's Roe v. Wade draft and the continuing war in Ukraine, there wasn't a lot of coronavirus news out there this morning. The number of people who were at the White House Correspondents' Dinner Saturday night and have since tested positive for covid continues to grow. Besides multiple journalists, few of whose names I even recognized, the Secretary of State tested positive. Given his recent international travel, though, he might have contracted covid elsewhere. I again cross my fingers that POTUS doesn't get it. 

WHO again announced a revised covid death toll based on excess deaths rather than numbers reported by countries. As before, that number is about double the sum of all the national numbers. The reported numbers total in the neighborhood of six million, despite there being 15 million more deaths than normal in the time span of the pandemic. Excess deaths in Mexico are roughly twice their reported covid toll. Pakistan's excess deaths are about eight times its reported covid toll. Topping both of those countries, Egypt's number of excess deaths was roughly 12 times its reported covid death toll. Between home tests complicating case numbers and how deaths are counted country to country, we will never know just how bad the last couple of years have been.

The BA.2.12.1 subvariant will likely be dominant in the US in a matter of weeks. In the week ending this past Saturday, it accounted for 36 percent of new cases compared to 26 percent one week earlier, and 19 percent in mid-April. Fortunately, there's no indication so far that it's more serious than the original Omicron.

One reporter described China as "prisoners of their own narrative" in regard to their zero-covid policy. They can't change course now much as they might want to. The effects of zero-covid have hurt China's competitiveness as a global manufacturing center. Countries are less willing to invest there given the uncertainty and instability accompanying the lockdowns that support zero-covid.  

Research is ongoing to develop a covid vaccine nasal spray. Injected vaccines prepare the immune system to fight covid after it has entered the body; they don't keep it out in the first place. The hope is that as a nasal spray, a vaccine would produce a strong immune reaction in the nose and throat where most covid infections start. Over a dozen clinical trials are underway.  

The Road goes ever on and on ... Day 280 (780)

Back to long covid, a British study found that only about a third of patients who experienced symptoms after being hospitalized felt fully recovered one year later. Most patients saw little improvement in areas such as physical function and cognitive impairment. Some showed lingering cognitive decline similar to that measured after 20 years of aging. The degree of impairment seemed linked to the severity of illness. I found one aspect of the researchers' method quite interesting. Each of the 46 subjects were matched with 10 people matching them on characteristics such as gender, age, education, and first language; the 10 matches had not had covid. 

Top FDA officials say that we may need to update covid vaccines every year and progress to annual covid vaccination similar to the seasonal flu shot we are now advised to get. That states are scaling back what covid statistics they report and how often they report them means it may be harder to identify outbreaks and new negative effects stemming from the virus. 

As researchers delve deep into the variants of concern such as Delta or Omicron, we should not forget that the variants of interest that did not progress to concern may also yield important information. Learning what mutations in Gamma, Iota, Lambda, and Mu did not work and why will add to the study of the more concerning variants. It is also important to investigate variants that may not "work" in a certain place at a certain time but may thrive in others.  

About a fifth of parents of children under the age of five say that they're "eager" to have their child vaccinated. Some 38 percent say they will wait and see how things go before deciding. I'm wondering if the other 42 percent are in the "hands off my kid" camp.

I once briefly wondered about covid and organ donation but never dug into the subject. Fortunately, someone else did. Between March 2020 and March 2021, nine covid-infected donors donated organs to 19 recipients. The three recipients who received bilateral lungs acquired covid. One died, while the other two transmitted covid to others. the 16 recipients of non-lung organs did not acquire covid. The three lung specimens tested negative for covid pre-transplant but post-transplant lung specimens came back positive. If you need lungs, be careful out there!

According to one "official" tally, as of this morning, the US had recorded 81,553,778 cases and 995,622 deaths. Another "official" tally has the number of deaths high enough that it could go over one million today. That's a number that should be marked but by no means celebrated. 

The Road goes ever on and on ... Day 279 (779)

Here's something not too heartening: During the Omicron surge in January and February, 42 percent of the people dying of covid had been previously vaccinated. If you're younger than I am, you may not have to worry so much. Those deaths were concentrated among the elderly (I'm still wondering if I am), for whom vaccines are less effective. It seems that the potency of the vaccines may wane more quickly for older age groups. 

If you're purchasing home covid tests over the counter, give the packaging a close look. There are now counterfeit at-home test kits that look very similar to the legitimate ones. The counterfeit ones may have spelling or grammar errors on the labels, though. So far, there have not been counterfeit ones detected among the test kits shipped as part of the government's free test program.

Cases and hospitalizations are rising in a majority of the states. We're also about to hit one million deaths. Vaccinations still matter even if the potency wanes over time. Right now, 77.6 percent of Americans have gotten at least one dose of vaccine, while 30 percent have gotten a booster. The addition of boosters to the shot regimen has led to a move away from the "fully vaccinated" label. Now, if you've had the full initial vaccine dose and at least one booster, you are said to be "up-to-date" on your covid vaccinations. 

Beijing is refurbishing a 1,000-bed facility built for the 2003 SARS outbreak to equip it for covid. They are also setting up a 10,000-bed quarantine facility for people who test positive and their close contacts. I can't help but think that any close contacts who have not yet contracted covid will certainly contract it in such a crowded facility. 

Vice President Harris has tested negative and will be returning to work. As advised by the CDC, she will wear a "well-fitting" mask for ten days. She was given Paxlovid after testing positive, just as POTUS's Test-to-Treat program advises. 

I saw a new type of variant mentioned, actually two types. The terms "variant of interest" and "variant of concern" have been around for quite a while. Today I saw "variant being monitored" which is less serious than even a variant of interest. On the other end, there is "variant of high consequence." I assume that is something like Delta or Omicron, something that has graduated through the other levels. 

On the subject of variants, I found an interesting passage from Science Writer Carl Zimmer: "Scientists have been trying to figure out what those mutations do for the variants, and it looks like it helps them evade immunity from earlier forms of Omicron. A year ago, we were amazed at how fast Delta was spreading at the time. And in a year, we've gone through several upgrades of this virus, and now it spreads way faster. It's on a par with measles." I find the last thought disconcerting. On a par with measles, one of the most contagious common diseases out there. Remember R-naught, the number of people one person infects? It's somewhere between 15 and 20 for measles. If covid is getting to that point, we could be in trouble even with vaccines.

The Road goes ever on and on ... Day 278 (778)

Remember Deborah Birx? The former White House Coronavirus Response Task Force coordinator under the man who used to be president? She advises that the US should prepare for a summer surge across the South. She might be right. On Saturday, the national seven-day average number of new cases was 54,000. A week ago, it was 49,000, and a month ago, 31,000. New York City is entering a higher risk level as cases keep rising. Depending on how high it goes, it could mean some public health restrictions come back. Recorded case levels are currently as high as they were for Delta but still lower than for Omicron. The qualifier here is that the growth of home testing means case levels are surely higher than officially reported. 

As mentioned a couple of days ago, South Africa is seeing a surge from BA.4 and BA.5. Preliminary data suggest that these subvariants evade natural protection produced by infection with the original Omicron. The result is symptomatic infections with the new subvariants. The original Omicron often appeared as asymptomatic infection. A physician who led the pandemic preparedness response for the H1N1 swine flu virus observes, "We're at an awkward global moment where the past can't really predict the future." As for that future, climate change is putting pressure on species to migrate. Unfortunately, this offers new chances for viruses to jump from one species to another, and the receiving species could be us. As for today, BA.4 and BA.5 are present in the US but so far at low levels.

Italy is relaxing restrictions. It is now possible to enter restaurants, theaters, and gyms without presenting proof of full vaccination, recovery from covid, or a recent negative test. Mask mandates have been dropped in select venues, though people are encouraged to wear masks indoors or in crowded place even where they are no longer required. 

I've mentioned to people and maybe even here that one of my big pandemic fears is long covid. I read today that a small portion of people with long covid may have shown no covid symptoms or only very mild ones. Not exactly what one wants to hear. Covid is considered an "acute illness," while long covid is considered a "subacute chronic illness." "Acute" means something lasts one to two weeks. "Subacute" implies two to four weeks. As for "chronic," that's four to six weeks or longer. I am not at all sure what "subacute chronic" means. Woman and older adults are more likely to develop long covid than men and younger adults. Of course when I read something like that I wonder how the author is defining "older." Am I considered "older" at 65? Will I not be so considered until I reach 70? I'm not sure I want to know. Ignorance can, indeed, be blissful. 

The Road goes ever on and on ... Day 277 (777)

Not a lot of coronavirus news out there today. There may be in a few days, though. Each of the 2,600 guests at the White House Correspondents' Dinner last night had to prove they'd been vaccinated, boosted, and negative on a covid test in the 24 hours preceding the dinner. Watching some of the highlights, I can't help but wonder how much of a superspreader event this might turn out to be. I saw no masks. POTUS did not put one on after he finished speaking. Please, pretty please, let him not have gotten it.

China is entering its five-day Labor Day celebration. It's normally a big travel time, but likely not this year. Beijing is tightening things even more. A negative test is now required to enter some public areas and sporting events and to use public transit. Even restaurants will require a negative test for entry. The time period within which the test must happen varies. For public transit, it is one week. For sporting events, group travel, malls, shops, and scenic spots, the test must be within the previous 48 hours. Covid testing will be free as of Tuesday so not being able to afford a test can't be used as an excuse. 

US hospitalizations are declining, but there are still many, many unmet needs from poor and uninsured patients who delayed seeking care during the earlier days of the pandemic. Some patients were afraid to go to the hospital or had trouble finding transportation. People waited months to get care for things such as a broken wrist or torn rotator cuff. The delays made the injuries worsen and become harder to treat. Federal programs that paid for covid care for uninsured people are ending. Such programs also gave financial aid to hospitals that offer the poor extensive uncompensated care for things such as the broken wrist or torn rotator cuff just mentioned. Health care in the US needed help before the pandemic and needs even more now. 

I wonder if there is an over-under for the number of positive tests to come out of last night's dinner. Any guesses?