The View from the Hermitage, Day 472

The healthiest community in the US is also the community with the highest median family income. I would hazard a guess that Los Alamos, New Mexico also ranks right up there in terms of the average highest education level completed. Los Alamos is the healthiest community due to the low prevalence of obesity and diabetes not to mention the low levels of mental illness and substance dependency. As for that highest median family income, it's $121,000.

North Korea has from the outset of the pandemic claimed to have had no covid infections. There may be some there now since Kim Jong Un just called a special meeting of the Politburo and berated some of his top advisers for their failures in coronavirus prevention. Political pundits say that North Korea will never admit to having a covid outbreak but Kim's statements suggest that something significant has happened. 

A few other international notes: Queensland, Australia has only eight days of the Pfizer vaccine left. They evidently have some AstraZeneca vaccine but it is not clear what ages can safely get the AstraZeneca vaccine. Delta is now the dominant covid strain in Portugal. A scientific adviser to the UK government warns that reopening could lead to a surge and set up a repeat of last summer. Then, infections never got low enough to be dealt with, leading to a fall spike when schools reopened. Vladimir Putin claims that he received the Sputnik V vaccine in March. Inquiring minds wonder if that is true, then why must journalists and others meeting with him quarantine before they do so. Putin opposes mandatory vaccinations and supports people who say they have medical excuses not to be vaccinated. I have read that a lot of Russians claim to have medical excuses because they do not want the Sputnik V vaccine.

The Delta variant made it to South Dakota, meaning that it has now been found in all 50 states. It currently makes up about a fourth of all cases. At the same time, the vaccination rate is down 75 percent from its peak in mid-April. Dr. Fauci says this could likely led to two Americas, one made up of the areas in which most people have been vaccinated and the other with low vaccination rates and covid spikes. He called those spikes "entirely avoidable, entirely preventable" with vaccination. Every time the virus gets more transmissible, the number of vaccinated people needed for herd immunity rises. In Mississippi, 29.7 percent of people are fully vaccinated. The unvaccinated people have accounted for more than 90 percent of cases and deaths in the past month. Besides Mississippi, Alabama, Arkansas, Wyoming, and Louisiana have fewer than 35 percent of their populations fully vaccinated, troubling given that a recent poll shows that most adults who plan to get vaccinated have already done so.

CNN had the article "What if the government got it wrong on masks again?" on its website. The solution, at least to me, is that wearing a mask can't hurt and not wearing one can. 

I have my "I'm not dead yet!" t-shirt and birthday tiara set out for wearing tomorrow. I have been told that my birthday is being delayed until the family can gather on Saturday, but I say I can wear a tiara whenever I want to, and I want to tomorrow.

The View from the Hermitage, Day 471

Four in 10 Americans say that going to a July 4 celebration feels risky this year. Last year, eight in 10 did. That said, people are not totally changing their behavior in light of concern over the Delta variant. Vaccines seem to be acting as scientific and psychological shields. There's some disagreement over how to deal with Delta. WHO says that even fully vaccinated people should keep wearing masks. CDC says that fully vaccinated people are okay without masks. Los Angeles County has started requiring masks indoors regardless of one's vaccination status. South Africa is entering lockdown for at least two weeks. Four of the state capitals in Australia--Sydney, Brisbane, Perth, and Darwin--are under lockdowns of varying lengths. Bangladesh is imposing its most severe lockdown yet; people can only leave home in emergencies, and soldiers will be patrolling the streets. Ireland has said that when dining indoors is again permitted only those vaccinated or recovered from covid in the previous nine months will be able to do so.

I've read a couple of reviews of Nightmare Scenario: Inside the Trump Administration's Response to the Pandemic That Changed History by Yasmeen Abutaleb and Damian Paletta. It's pretty damning but also frightening in terms of how close we came to things being done very differently and not in a good way. XPot evidently asked about sending cruise ship passengers who tested positive to Guantanamo Bay and waxed philosophically about his national security adviser John Bolton being "taken out" by covid. As for the coronavirus task force chaired by Mike Pence, XPot referred to it as (I apologize in advance for the profanity) "that fucking council that Mike has."

Bloomberg has ranked countries in terms of their covid resiliency. Metrics include vaccination rates, available airplane seats, and the severity of lockdowns. The most resilient countries, in descending order, are the US, New Zealand, Switzerland, Israel, and France. The least resilient, again in descending order, are Indonesia, India, Malaysia, Philippines, and Argentina. I was quite surprised to see the US ranked at the top. Having read a Axios summary of the Bloomberg work, I may have to try to find the original for more detail on how resiliency was calculated. 

Are your kids going back to middle or high school in the fall? If school starts early in August and you want your kids vaccinated, you need to get moving. Kids can only receive the Pfizer vaccine which requires three weeks between the two doses and another two weeks for full immunity to be reached. That's five weeks, which pushes into early August.

CNN had an interesting piece on what changes made in response to covid might stay with us even after the pandemic is no more. First is how we greet each other. They think the handshake might come back but not for everybody and suggest people might feel more comfortable keeping with elbow bumps or Namaste signals. I like the Japanese bow myself. Second is thinking twice about travel. I never go on a trip without travel insurance, and I bet a lot of other people will be doing that now. I will also be thinking twice about the country to which I am going in terms of their response to the coronavirus. If they did not handle it adequately, I don't think I want to go there. We may be joining Asians in wearing masks and taking other precautions when we think we might be ill. While the 1918 influenza pandemic drew women into the workforce, the coronavirus has forced more than 2.3 million women to leave the workforce. One in four of these women quit due to a lack of affordable child care. Scientific progress is likely to remain more interdisciplinary, collaborative, and creative. The combination of mRNA technology and rapid genetic sequencing gave us viable vaccines sooner than many expected. Childhood will change significantly. Parents have much more experience now with virtual schooling and homeschooling. Even as children go back to in-person schooling, extracurricular activities such as music lessons may well continue to be virtual, meaning no commuting. Finally, work may look very different in the future. It may become more hybrid, at times at home and at times at an office. Companies have learned better how to keep operations going; sending employees home to work in conditions such as a natural disaster will be easier now that it's been done once.

 

The View from the Hermitage, Day 470

New findings suggest that the Pfizer and Moderna vaccines may protect people for years as long as the virus and variants don't change too much. Even if the virus does change significantly, people who recovered from covid-19 before being vaccinated may not need boosters. Research is also suggesting that mixing the Pfizer and AstraZeneca vaccines appears to offer good protection. Countries that have been administering the Sinovac vaccine may want to offer a different vaccine as a second or third dose to the people who initially got Sinovac. In Indonesia, 26 doctors have died from covid this month, 10 of whom were fully vaccinated with Sinovac. In central Java, 500 medical workers have tested positive in the last two weeks. All had been fully vaccinated. The Philippines health department said they would no longer tell the public which vaccination sites had which vaccines after people started waiting at 2:00 am at a site said to have the Pfizer vaccine instead of Sinovac.

The outbreaks Down Under continue. Sydney now has 130 cases, and there are new outbreaks of varying sizes in Darwin, Brisbane, Canberra, and Perth. However, there have been no deaths from covid this year, and only two people have been in intensive care. Experts say that what is needed now is strong adherence to public health guideline and good luck.

Speaking of adherence to public health guidelines, human behavior is far more important in shaping the course of the pandemic than any known variant. Changes in activity such as travel, failure to mask, not keeping socially distant, and remaining unvaccinated will help spread covid as much as or more than any variant. While the Delta variant did sweep over India, breached containment measures, crowds, and a poor public health infrastructure contributed to the spread. Figuring out the precise details of a variant may take years of research. Human behavior can be changed much more easily. The thoughts in this paragraph come from Amy B. Rosenfeld and Vincent R. Racaniello. They are not psychologists, but virologists and are very wise in the ways of human behavior.

Here in the US, one of the major barriers to mass immunity is that young adults in their late teens and 20s don't see themselves as being at great risk. As a result, they're not getting vaccinated. According to a recent federal report, only about a third of adults ages 18 to 39 report having been vaccinated. Rates are especially low among Black people; people ages 24 and younger; and people with lower incomes, less education, and no health insurance. While some people in this age range are staunchly opposed to vaccinations, a large portion are skeptical or not really interested. The people in these two groups are persuadable if the right means can be found. Of course, as cases and deaths drop in the US, it becomes harder to convince anyone how important it is to be vaccinated.

I made June's Instant Pot meal last night, Penne Bolognese from Instant Pot Obsession, and it will be made again ... and again ... and again. It was that good. Son #1 took the leftovers home with him this morning; I'll hear his review tomorrow. I expect he will like it as much as The Professor and I did. I'm thinking of mixing things up in July and trying a breakfast dish or a dessert.

The View from the Hermitage, Day 469

At the end of week 67 of this blog, I've decided to keep going for a while. I may change the title at some point if I can come up with something catchy. Since I do leave the subdivision on rare occasion--usually medically related or to visit my mom--"hermitage" is not really accurate any longer. I've toyed with putting the stopping point at whenever WHO and Dr. Fauci declare the pandemic over. I'm not confident that will happen soon, though. I'm just waiting for the first vaccine-resistant variant to appear, wondering if the vaccines can keep pace with it. 

The vaccination rate in the South is so low that some experts suggest the South could come to have its own distinct pandemic. There are various reasons for the North-South gap, several of which arise from a distrust of science. These are an underestimation of the pandemic in general and a fear of rapidly developed technology such as the mRNA vaccines. Many Southern states have a generally poor medical infrastructure. Finally, state leaders in many cases send mixed signals about the need for and value of vaccinations. This should not be because to put it bluntly, the wide majority of deaths right now are among unvaccinated people. Republican strongholds have particularly low vaccination rates. All 16 states that have so far met the July 4 goal of 70 percent partial immunization voted for POTUS in November 2020. Rural areas may have limited online access, restricting the flow of information. Finally, the are "hospital deserts" in rural areas and "pharmacy deserts" in urban ones, making it difficult for the people who want to be vaccinated to get immunized.

The vaccination rates in the Mountain West are not as low as those in the South, but are still alarming. In Idaho and Wyoming, fewer than 40 percent of the adult population have gotten even one dose. Montana, Utah, and Nevada have better rates but remain well below the national average of 54 percent. As in the South, political conservatism plays a major role. The sparse population, as with hospital and pharmacy deserts may make it hard for people to seek out vaccinations. 

There's something not necessarily new about the Delta variant every day. It is more transmissible because people with Delta have higher viral loads. India has the most cases of Delta in the world, followed by the UK. The resurgences in Israel and Australia are being driven by Delta. The covid cluster in Sydney is now up to 110. New exposure hubs include a vaccination clinic at Sydney Hospital. A second link is a seafood wholesaler whose drivers tested positive; so far, 10 new cases are connected to this. 

There are other outbreaks across Australia. The Northern Territory is facing its biggest threat since the pandemic began. A mine worker tested positive, and 15 people who had close contact are unaccounted for. Two of the miner's close contacts agreed to isolate but are now "uncontactable." A physiotherapist returned to Western Australia from Sydney. She quarantined until she tested negative then resumed her normal routine going to numerous venues and seeing clients before developing symptoms and testing positive. Western Australia's health minister noted that "this person did everything right" but there are still consequences.

Can your employer ask about your vaccination status? In the US, the answer is yes. In general, employers can require employees to be vaccinated as long as they provide exemptions or reasonable accommodations to employees not getting vaccinated for health or religious reasons. The employer must keep records private.They cannot ask why an employee is not vaccinated. There are risks associated with asking employees, though. Employees may believe that the employer should not be asking or invading their privacy. This could hurt employee relations and diversity efforts.

There's yet another cause for concern with vaccinations. Only three in 10 parents of children ages 12 to 17 intend to allow those children to be vaccinated immediately. This is setting up conflicts between kids who want to be vaccinated and parents who don't want to let them. Forty states require parental consent for vaccination of minors under 18. In Nebraska, that age is 19. In South Carolina, the age is 16 but a bill has been proposed to bar providers from vaccinating anyone without parental consent. The age in Oregon is 15 but at least one county has ordered country-run clinics to obtain parental consent for anyone under 18. In the District of Columbia, the age of consent is 11. In New York and New Jersey there are bills pending to make the age 14; Minnesota has a bill pending to make it 12. Some states including Tennessee and Alabama have bills pending to prevent public schools from requiring vaccinations.

 There's always something ...

The View from the Hermitage, Day 468

Remember SARS and MERS? Coronavirus blasts from the past. How about one over 20,000 years old. Australian and US researchers have found evidence of a coronavirus epidemic in East Asia 20,000 years ago. They studied the genomes of over 2,500 people from 26 different populations around the world, and found genetic signals related to a coronavirus in five different populations in China, Japan, and Vietnam. 

Vaccine drop-in centers are opening throughout England. People 18 and older can get a first dose, while those over 40 who had their first dose at least eight weeks ago can get their second dose along with folks under 40 who had their first dose at least 12 weeks ago. Right now, 43.87 million people--83.3 percent of the adult population--have gotten a first dose, while 32 million people have gotten a second. The goal is to have offered a first dose to all adults by July 19 and have at least 65 percent of all adults fully vaccinated by July 21 when the final stage of lockdown is supposed to ease. 

Want to get back out on the water in a resort with a keel? Celebrity Edge, the first major cruise ship to restart operations from a US port, has sailed at 35 percent capacity. All of the crew members and 95 percent of passengers are fully vaccinated. Guests over the age of 16 who can't (or won't) show proof of vaccination  are required to wear masks on board and take a series of antigen tests at their own expense. Guests who have been vaccinated get antigen tests for free. The CDC guidance under which the Edge sailed expires as of July 18.

The Delta variant accounted for 21 percent of all new cases in the US for the two weeks ending on June 19. Delta has now been found in 49 states and the District of Columbia. Only South Dakota did not report any Delta cases. Bangladesh is locking down for a week thanks to an outbreak fueled by Delta. At least 200 Delta Plus cases have been identified worldwide. Delta Plus has some worrisome traits including increased transmissibility, stronger binding to receptors of lung cells, and potential reduction in antibody response.

Haiti is one of the poorest countries in the Western Hemisphere and has yet to be able to begin a vaccination program. One Haitian clinic is seeing 15 to 20 new cases every day. Even health care workers cannot get vaccinated. A handful of workers were able to fly to the US to get vaccinated, and about 30 more got special permission to get vaccinated at the US embassy. At the same time, as many as four-fifths of health care workers may choose not to get vaccinated. Health workers in Haiti have tried getting vaccine doses from Florida that are about to expire but so far have not been successful. Health authorities in Florida say that they cannot send the vaccines without formal permission from the US government, permission that has yet to be granted. 

The NCAA College World Series is happening right now in Omaha, Nebraska. Covid was not an issue until 14 of the 27 players on North Carolina State's team tested positive. NC State chose to play Vanderbilt yesterday with the 13 other players. They lost that game and were supposed to play a second game today until the NCAA cancelled the game and forfeited NC State. No specific reason was given, though I wonder if it might have been the possibility that some of the remaining 13 players might also be positive. 

Had covid? Need or want to have elective surgery? It is not clear how long someone who has had covid should wait for elective surgery once they're through with covid. Obviously, the respiratory system is integrally involved in anesthesia. A recent study suggested that waiting at least seven weeks reduces the risk of death when compared to that of people who did not have covid. The American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation have offered the following guidelines.

Wait four weeks after an asymptomatic or mild case with only non-respiratory symptoms. 

Wait six weeks after being symptomatic but not hospitalized.

Wait eight to 10 weeks if symptomatic with diabetes, immuno-compromised, or were hospitalized.

Wait 12 weeks if spent time in intensive care.

Obviously, one's mileage may vary, and one's doctor may disagree. The point is to have a discussion with that doctor about how long to wait. Elective means just that; you don't have to have it done at any specific time. 

The View from the Hermitage, Day 467

Israel is reimposing a mask mandate in light of a covid surge driven by the Delta variant. Half of the new cases are people who had been vaccinated. That's the bad news. The good news is that the infections of vaccinated people are much milder than those of unvaccinated people. Delta is also driving the latest surge in Africa; it's now been detected in 13 countries. Cases have been consistently rising since May. WHO says the current wave could be the region's worst yet. According to the director of the African CDC, this third wave has been "extremely brutal." In Uganda, 99 percent of the cases are from Delta; in Zambia, 77 percent.

Delta could cause more problems here in the US. More than one in 10 people who got a first dose of Pfizer or Moderna have missed their second dose. This makes them much more vulnerable to Delta. Delta appears to be behind the outbreak in Sydney. There have been 22 new cases, bringing the total to 65, making this the largest outbreak in six months. There are likely to be more new cases. Nine hundred or so clients visited a hair salon while several employees there were infectious. Raising even more concerns about Delta, many of the confirmed infections appear to have occurred after only seconds of contact. There was also a child's birthday party where at least 17 guests had tested positive as of Thursday night. The rest of the guests are expected to be infected along with household contacts of almost everyone who was there. 

The UK reported 15,810 new covid cases today, cases having risen by almost 50 percent in one week. As of June 16, 83 cases of Delta Plus had been identified in the US compared with 41 in the UK and 40 in India where Delta Plus is considered a variant of concern. Delta Plus cases have also been identified in Canada, Japan, Nepal, Poland, Portugal, Russia, Switzerland, and Turkey.

The Chinese vaccines have been getting some very bad press of late. Since the pandemic began, 401 doctors in Indonesia have died. At least 20 of them were fully vaccinated with Sinovac. Some countries in the Middle East are giving residents a third dose of one of the Chinese vaccines. Personally, I'd ask for a different vaccine.

There's a new quirk with the Olympics. Word is that some of the British Olympians are vaccine-hesitant. Well over 90 percent of the British athletes will be fully vaccinated by July 23, but there will still be holdouts. I wonder if there will be additional restrictions for unvaccinated athletes in terms of how much they can circulate.

Meanwhile, back in the US, nearly all covid deaths occurring now are among the unvaccinated. This cannot be stressed enough: the vaccines we have in the US work. Period. Full stop. Louisiana is turning to a lottery in hopes of getting more people to be vaccinated. The vaccination rate in Louisiana is lower than every state but Mississippi. Six of the bottom eight states in vaccination rate are southern. Besides Mississippi and Louisiana, there are Alabama, Arkansas, Georgia, and Tennessee. One reason they think a lottery will work in Louisiana is that their research suggests that independent of political affiliation, the people not yet vaccinated are the people most likely to buy lottery tickets. To me, not getting vaccinated is the same as buying a lottery ticket. The odds are better in the vaccination lottery, but the covid prize sucks more than the cash one would.

The View from the Hermitage, Day 466

There are a lot of interesting angles today. First, it seems that genetic sequences from over 200 virus samples taken before a pandemic was declared disappeared from an online scientific database. US researchers have now recovered 13 of those initial sequences, and they support the suggestion that a variety of coronaviruses may have been circulating in Wuhan before the initial official outbreak in December 2019. Why these sequences were deleted is not known, though it has been described as "suspicious."

Remember all the young adults who weren't bothering to get vaccinated right away? The average age of people dying from covid-19 is shifting younger. Adults under 40 made up about three percent of covid deaths in May, more than double their representation since the pandemic started.

A cluster of covid cases in Sydney has grown to 49, leading to reimposition of a travel ban for five million residents and mandatory mask wearing. Gatherings at houses are also limited to five people. The outbreak started when an airport limo driver tested positive. He was unvaccinated--which happens to be against the law--and likely got infected transporting a foreign airline crew. The stay-at-home orders come at the start of winter break, which means lots of families are altering travel plans at the last minute. This outbreak comes after several months of near-zero community transmission, something we in the US need to keep in mind.

San Francisco is going to require all 35,000 city employees to be vaccinated once a vaccine gets full FDA authorization. Both Pfizer and Moderna have applied for this though it is not clear how long full approval might take. Some 60 percent of city employees are already fully vaccinated. They say that firing employees who will not get vaccinated would be a last resort. At a Houston hospital that required vaccinations, 150 staff quit or were fired. Close to San Francisco is a recent outbreak of the Delta variant in Marin County even though over 80 percent of the people there are fully vaccinated.

 A special envoy of the African Union has accused the world's richest nations of deliberately withholding vaccines. He says, "It's not a question of if this was a moral failure, it was deliberate." Africa so far has given only 40 million doses in a population of 1.3 billion.

I learned a bit more about Delta Plus. Evidently it carries the same mutation as Beta (from South Africa), which is partially resistant to vaccines or immunity gained through a prior covid infection. It is not known yet if Delta Plus is more transmissible than the original Delta variant. 

Covid cases in Tokyo are rising again. There were 619 new cases Wednesday, the first time in a month that new cases exceeded 600. There were 570 new cases Thursday, up from 118 Thursday last week. The emperor of Japan is forbidden by the post-war constitution from making public statements on contentious issues. This may be why Emperor Naruhito stated he is "extremely worried about the current status of coronavirus infections" without calling for any specific action. Whether the emperor will attend the Opening Ceremonies is so far unknown.

Looking away from the coronavirus, the Florida governor has signed three new education bills. The first requires public higher education institutions to annually survey faculty and staff about their beliefs to ensure they promote diversity and intellectual freedom. The second prohibits public higher education from limiting student access to ideas "they may find uncomfortable, unwelcome, disagreeable, or offensive." The third calls for creation of a K-12 civics curriculum that contrasts the US with communist and totalitarian governments using "portraits in patriotism." The governor hinted that the state might end funding to schools that do not comply. I'm wondering who the patriots in portraits might end up being. I can think of at least one resident of Florida who should not be on that list but conceivably could be proposed.

Finally, the average wedding in the US costs $30,000. I find this incomprehensible. $30,000 today would have been $12,128 in 1985 when The Professor and I got married. We paid for our own wedding and spent somewhere around $3,000. I can think of a lot of better uses for today's $30,000, money that likely came from someone's parents rather than the bride and groom themselves. I do remember someone I know saying that she and her husband dug into their retirement to pay for one daughter's wedding. If either of The Sons wants us to help pay for his wedding, that wedding will most definitely not cost $30,000.