The Road goes ever on and on ... Day 314 (814)

Case counts and hospitalizations continue to decline in Massachusetts, Maine, Connecticut, and New York. Every other region in the US is seeing a rise in hospitalizations, particularly Alabama and Louisiana, where hospitalizations have risen by 70 percent. Some experts have suggested that counting covid patients in an ICU is a better gauge of covid's magnitude given that hospitalization counts include patients admitted because of covid and those admitted who are then discovered to have covid. There are currently about 3,000 patients in ICUs, some 11 percent of all hospitalized patients with covid. This is actually the lowest rate since September 2020 and has held steady since May. The covid situation should improve over the summer but most sources expect it to worsen come fall and winter.

The US wasted over 82.1 million covid vaccine doses between December 2020 and May 2022, 11 percent of the total doses distributed. CVS and Walmart together are responsible for over 25 percent of the doses thrown away. Health Mart, DaVita, Rite Aid, Publix, and Costco got rid of over 25 percent of the doses they received. Two states, Oklahoma and Alaska tossed over 25 percent of the doses they received. Part of that was due to the distribution pattern. Because doses were distributed in standard quantities, more doses than needed were sent to many remote areas. Some doses expired; others were spoiled by power outages or improper storage. Because the vaccines come in multidose vials, any doses left unused in open vials at the end of a day were discarded. CDC guidance advised that vaccinations be prioritized even if it meant opening a new vial for one shot. Four states were not included in the analysis: Louisiana, Maine, Ohio, and Oregon. It sounds bad, but the overall amount of waste is not out of line with WHO estimates for large vaccination campaigns. 

The FDA has yet to authorize administration of the Novavax vaccine. Besides the vaccine, approval is needed for the manufacturing process. Novavax has had issues with this over the past two years. The US Department of Health and Human Services is said to want there to be a second non-mRNA vaccine available, meaning that the FDA likely won't delay their approval processes.

Finally, China is holding college-entrance exams or gaokao. These determine the under two percent of candidates who can enroll in the top universities. Students who have covid or who are close contacts of people with covid will test in isolation or hospital rooms. I guess that because the percentage of students "promoted" is so small, they can't just get rid of the tests for a year or two as US universities have done with the SAT and ACT. In fact, the pandemic has influenced some universities into making those tests optional or not considering them at all. 

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 312 (812)

Not much coronavirus news out there today either, but there was one article worth mentioning since it's something I've wondered about from time to time. You've tested positive for covid. What  next? If you tested positive at a clinic or community testing site, your result is reported to a public health department. A home test taken under the supervision of a trained telehealth worker is also reported. So what about home tests done at home on your own? The CDC "strongly encourages" reporting the result to your primary care physician, who may report it further. However, only a few state health departments collect data from home tests. Some other states allow counties to collect home test data if they want to, but it's not required. 

There are, it seems, four ways to report a positive home test.

1) Some home tests are accompanied by a mobile app through which the result can be reported. 

2) As noted above, results can be shared with a PCP; what happens next may or may not send the result forward.

3) The result can be reported to a local health department who may or may not do anything with it.

4) Participation in crowdsourcing may be an option. OutbreaksNearMe.org was developed to deal with influenza results but now handles covid as well. The site can create maps and analyze case data submitted by volunteers, that is, people reporting their home results. 

I don't think home tests are going away any time soon if ever. I wish there were a better way to record the results. We know that the official number of cases is too low, in some cases, way, way too low. If I were to get a positive result on a home test, I would at least report it to my PCP and, depending on her advice, the local health department. In the meantime, I hope not to face that minor dilemma.

The Road goes ever on and on ... Day 311 (811)

None of the several sources I checked this morning had anything about covid. There was an article on how the mRNA method developed for the covid vaccine is proving useful in the search for an HIV vaccine. A candidate vaccine can be developed in a matter of months rather than years. A possible vaccine can be developed and tested in less time than developing an old-school vaccine would. Something good to come out of the pandemic.

I spent the afternoon taking a virtual class in wet felting from the Shaker Village in Maine. I made what could be used as a possible bird's nest, though there are many other uses. I shall definitely try this again.  

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 309 (809)

A not-yet-peer-reviewed survey in New York City suggests that covid cases could be undercounted by a factor of 30. The authors suggest that undercounting could be even worse elsewhere given that New York likely has better access to testing than many other places. There may be a disadvantage to getting tested. A positive test can mean staying home from work or school. This presents something of a "don't ask. don't tell" situation. The survey also showed over half the covid patients did not know about Paxlovid. Those who did and who got it tended to be younger and with better access to resources, in other words, probably not the people who most needed it. 

Cases have surged in South Africa over recent months even as data showed 98 percent of the people had some antibodies from vaccination, infection, or both. The prevalent virus forms, BA.4 and BA.5, suggest that the virus is becoming better at reinfection.This means that outbreaks will keep happening or, in the words of an infectious disease specialist, "The virus will continue to evolve so that it can continue to spread in the population. It doesn't end. This virus is with us for the rest of time."

The virus appears to be losing ground in North Korea, though. There have been, officially, only 70 deaths. That makes the fatality rate 0.002 percent, the lowest in the world. Given that deaths peaked while cases were still rising, there may be a problem with the numbers. One reason may be that local officials are not reporting data so as to avoid punishment. WHO has tried multiple times to send vaccines and other assistance but no offers have been accepted. That imports from China doubled from March to April suggests assistance is coming from the Chinese. North Korea bought masks for the first time from January to April 2022. 

Cadaver-sniffing dogs, explosive-sniffing dogs, and now covid-sniffing dogs who may be able to detect covid more effectively than PCR tests. In one study, dogs detected 97 percent of the symptomatic cases and nearly 100 percent of the asymptomatic ones. It seems that while dogs are more sensitive to positive cases, PCR tests are better at detecting negative ones. In two of the dogs' false positives, the patient had another coronavirus respiratory illness. Finally, while PCR tests can take days to yield results, a dog can process 20 samples in 15 seconds. Has covid testing gone to the dogs?

The Road goes ever on and on ... Day 308 (808)

Thinking of traveling to Europe this summer? (I'm not.) Italy is no longer requiring travelers to have a valid coronavirus pass. N95 masks will be required on public transit and in cinemas, concerts, and schools until June 15. US travel industry leaders want the government to drop the requirement that vaccinated travelers take a covid tests before flying to the US. They say it hurts the travel industry and is not a requirement in most other countries. In Canada, incoming vaccinated travelers are stopped at random for testing.

As I ponder turning 66 in a month, I note that coronavirus data consider "older" to mean ages 65 and over. I guess I'm already old or, as My Older Brother reminded me a year ago, an official senior citizen. The death rate for older people has soared during the Omicron wave.  The Omicron death peak for older people was 163 percent of the Delta peak. For people ages 12 through 64, the Omicron peak was 69 percent of the Delta ones. Almost as many people ages 65 and up died in four months of Omicron as died in six months of Delta, even though Delta caused more serious illness. More stats on older Americans. The death rate for unvaccinated older people was 156 per 100,000 compared with 24 per 100,000 for vaccinated and seven per 100,000 for boosted. For the same age group, the estimate is that 13 percent are unvaccinated, three percent have gotten one dose of an mRNA vaccine, and 14 percent are vaccinated but have not gotten a booster dose. As of mid-May, over a quarter of Americans ages 65 and older had not had their most recent dose of vaccine within one year. The facility in which My Mom lives gave a first booster to everyone who would take one but does not plan to give a second booster until fall, hoping that the vaccines by then have been modified to better deal with Omicron. I offered to take her out for a booster, but she said she'd wait until they did the in-house one in the fall.

Many people have said that we should learn to "live with covid." The two million people in the UK who are literally living with (long) covid might disagree. One-fifth of them had the infection two years ago and are still having symptoms. Two-fifths have suffered covid symptoms for one year. 

As for when the pandemic might end, one source cites two central questions. First, how durable is our immunity and how durable must it stay? Second, how fast will the virus continue to evolve? 2021 could be described as the year of the variant. First came Alpha, over 50 percent more transmissible in humans than the original virus was. Then came Beta and Gamma, both of which exhibited immune escape. Delta, 50 percent more transmissible than Alpha not to mention more severe, came next, followed by Omicron. Will 2022 be the year of reinfection? We won't reach the end of the pandemic on any one criterion. 

Looking to how the next pandemic might develop, WHO agreed on Monday to form a committee with the intent to better respond to future global health emergencies. The committee would convene as soon as possible after an international public health emergency was declared. The lack of such a group is seen as one of the weakest points surrounding this pandemic.

Are we there yet? To the end of this pandemic? To the start of a new one? And just how will monkeypox evolve?