The Road goes ever on and on ... Day 156 (656)

Yesterday, I questioned whether the availability of rapid at-home covid tests was making the daily case counts superfluous or even too wrong to be of use. Using counts is called case-based surveillance, and it does work when all the results are reported accurately. The alternative is sentinel surveillance, the method by which influenza is counted. Sentinel surveillance relies on a network of health care centers or personnel to track cases. The overall case numbers are extrapolated from the number of cases tracked. The data missing due to at-home tests also negatively affects percent positivity figures. At-home testing is very much a double-edged sword. It allows people to isolate when necessary but leaves public health figures in the dark. I'm interested in seeing how the public health folks resolve this. 

Between December 14 and 20, 2020, 3,561 people were surveyed about how hopeful or fearful they felt. The study was repeated between December 14 and 16, 2021 with a survey of 2,602 people. In 2020, 58 percent of Republicans reported feeling fearful compared with 36 percent of Democrats. In 2021, 69 percent of Republicans reported feeling fearful compared with 45 percent of Democrats. Overall, 36 percent of respondents felt fearful in 2020 compared with 54 percent in 2021. In 2020, 63 percent of all respondents felt hopeful, a percentage that dropped to 44 percent in 2021. Respondents were also asked what issues mattered the most to them. Topping the list in 2021 were jobs/economy, democracy, and health care. Finally, two words that 2021 respondents wanted to hear less often were "covid" and "Trump." The one word most people wanted to hear more of? Travel.

As New Year's Eve draws nearer--The Professor and I do not expect to be awake to welcome 2022--I am fine tuning my resolutions for the coming year. Reading through the resolutions I made for 2002 through 2012 and 2018 through 2020, has offered perspective on how best to phrase the new ones. I will say here that the resolutions I made for 2021, stated as five things I would do each month, were for the most part successful. I did make at least 12 pies and used my Instant Pot at least 12 times. I fell short on  starting, working on , or finishing a creative something each month, and if I donated or tossed 12 banker's boxes full of "stuff," it was in the first several months. I did meet my fitness goals for the year, several of which were set by the programming behind my Apple watch. I failed totally at ending this blog when I became fully vaccinated. Given how fully vaccinated is evolving, that was likely a very good thing. 

Finally, 2021 slapped us in the face one more (I almost typed "last" but didn't want to jinx us all) time with the death of Betty White a mere three weeks before her 100th birthday. She was an icon, someone to look up to no matter who was doing the looking, a lady well worth her while. Godspeed, Betty, to your new year as we creep to ours.

The Road goes ever on and on ... Day 155 (655)

Word is that the FDA is planning to approve third, booster shots for children ages 11 through 15. That this came out today is appropriate. The Professor and I chatted with a neighbor this morning. He said that for a long time, his family did nothing because their daughter who's about nine was not able to be vaccinated. Now that she is vaccinated, he and his wife look at their teenage son and wonder just how vaccinated he still is months after his second injection. I expect they'll have him out for a booster the first day they're available. 

Covid cases in the US remain at their highest level, 488,000 on Wednesday. The seven-day average was over 300,000 as well. New cases have more than doubled in two weeks. In the past week alone, over two million cases have been reported nationally, and 15 states and territories reported more cases than in any other seven-day period. The WHO chief has warned that Delta and Omicron could combine in a "tsunami" of cases. Deaths are averaging around 1,500 per day, though a CDC forecast holds that over 44,000 people could die of covid over the next four weeks. 

A brief summary of the new CDC guidance on isolation and quarantine: People who are infected can re-enter society after five days if they are asymptomatic or their symptoms are resolving. They should then be masked for the next five days, indoors and out. Some groups, including nurses, have argued against this. Michigan has said that it will not follow this guideline. Some medical people say they would have required a negative test. A virologist at the University of Saskatchewan calls not requiring a negative test "reckless and, frankly, stupid." Those in favor of the revised guidelines estimate that less than a third of the people who should have isolated in the past really did so. The other argument against the new guidelines is that they make no distinction between vaccinated and unvaccinated people. 

A new, not-yet-peer-reviewed study coming out of South Africa says that a Johnson & Johnson booster provides strong protection against Omicron, with the second shot raising protection further than do two doses of the Pfizer vaccine. The FDA did not recommend a second Johnson & Johnson shot here because of the vaccine's link to a blood clotting condition. 

The National Health Service in Britain is erecting field wards on the grounds of eight hospitals. There were around 183,000 new cases Wednesday, days before the full impact of the Christmas holidays might be seen. The wards are called "Nightingale hubs" and each will handle 100 patients. This reminds me of the field hospitals set up around New York City in the very early days of the pandemic. 

China continues to pursue its zero-covid policy. They have locked down Xi'an, home to 13 million people because there were 1,117 covid cases there between December 9 and 19, a spike attributed to Delta rather than Omicron. The Winter Olympics in China may well be more "interesting" than the Summer Olympics in Japan were. 

Finally, I came across a mention of the likelihood that results of at-home covid tests are not often reported to the medical authorities. This mention was followed by the possibly rhetorical question of whether case counts serve a useful purpose if they are potentially inaccurate or at best estimates. Should we continue to report and use those figures? Hospitalizations and deaths are at least documented. I don't think there are a lot of at-home deaths that are going unreported. 

The Road goes ever on and on ... Day 154 (654)

"Lots of" does not begin to describe the amount of chatter there has been about the CDC and various other entities shortening the isolation and quarantine times. Some medical people support the decision while others don't. There is certainly some confusion out there as to exactly why this decision was made. Says a senior pastor of a church in Chicago, "Either we're in a surge that we need to take very seriously or are we winding down the pandemic and that's why we're shortening the isolation and quarantine times. They might want to give us a little more information to go with." 

The CDC director explains that, "Not all of these cases are going to be severe. In fact, many are going to be asymptomatic. We want to make sure there is a mechanism by which we can safely continue to keep society functioning while following the science." And what does the science say? Omicron may have a shorter incubation period, 72 hours. It was four to six days for Delta and the original virus. People infected with Omicron may thus become non-contagious faster than people with other forms. Cutting the time-out length will help keep hospitals staffed, airplanes flying, and the continuation of other services depending on number of workers. As for the public health side, the CDC director also noted that the decision to shorten the isolation period was driven by the evidence on transmissibility but also what isolation period people "would be able to tolerate." 

I go back and forth as to whether this is a good idea. I guess that people staying isolated or quarantined for five days is better than their looking at 10 days and saying, "Screw that! I'm going out!" England has shortened its period to seven days and also requires two negative lateral flow tests taken a day apart. I've seen nothing about negative tests on this side of the pond. Some of the professional sports leagues have testing requirements, but I haven't seen any mention in what I've read about the CDC,

Cases are going crazy. We may very well hit the half million mark today or tomorrow. The seven-day average number of cases is 267,305, up 126 percent over two weeks. Closer to home, Maryland, Virginia, and the District of Columbia all broke records on Monday. For the District, there have been almost 1,000 percent more new cases over the past two weeks and over 9,000 new cases since December 24. Maryland's seven-day average for new cases is more than double the previous high in January 2020.

And really, really close to home, the local university is seeing surging cases among faculty and staff. There were 54 new cases Monday, and 53 more new cases yesterday. Since those numbers represent only tests given or processed at the university, there are likely more out there who tested privately. The Professor notes that he is glad not to be one of them. No word yet on classes in January. The interim January term is supposed to start on Monday. I wonder how the profs teaching those classes are doing. 

I wonder what the over-under on cases tomorrow should be....

The Road goes ever on and on ... Day 153 (653)

Looking to covid in the future rather than in the present, the dean of Brown University's School of Public Health predicts, "January is going to be a really, really hard month and people should just brace themselves for a month where lots of people are going to get infected." In the present, the seven-day average number of cases was about 240,000 yesterday. Back to the future one expert says, "I think we're going to see half a million cases a day--easy--sometime over the next week to 10 days." At the same time, POTUS says that Omicron's surge in cases "should be a source of concern but it should not be a source of panic." Much as I like POTUS, this comment probably won't win him any new friends and is going to hurt him with some others. 

The CDC is changing its guidance on how long to isolate following a positive test or potential exposure. The 10 days of isolation they were suggesting has shortened to five days followed by five days of serious mask-wearing. The CDC says that most viral spread happens in the first five days and with proper masking, viral spread after that is minimal. People who were sick but whose symptoms are improving and who no longer have fever can also leave isolation after five days as long as they stay masked. The same holds for fully vaccinated people who have been exposed as opposed to tested. The National Basketball Association is taking the CDC guidance a step further and saying that players testing positive but whose viral load is low can return to playing sooner. 

The CDC is actively investigating or observing 68 cruise ships following outbreaks on board. Seven others are being monitored for covid, but the case numbers are below the threshold for starting an investigation. That threshold is positive cases reported in over 0.10 percent of passengers or a single crew member in the previous seven days. While I greatly enjoyed our trips along the Norwegian coastline on the coastal ferry and mailboat, I have no desire whatever to take one of the multi-story resort cruises around the Caribbean or other sun-drenched body of water. Truth be told, I have no desire right now even to sail on the coastal ferry. 

New York City schools will reopen in-person classes on Monday, January 3 but with changes in their covid policies. The city was quarantining entire classes if there were any possible exposure. Now, they will use an enhanced testing program to allow asymptomatic students who test negative to remain in school, a program known as "Stay Safe, and Stay Open." The outgoing mayor announced the program, but the incoming mayor is on board with the decision. The aim is to detect more infections while mitigating disruptions. The specifics of how it will work were described as follows: After one student tests positive. all the other students are given rapid at-home tests. Students who are asymptomatic and test negative can return to school the next day. They will get a second at-home test within seven days of the original exposure. Major in-school spread across classes or levels can mean a temporary closure. The testing plan is to test 20 percent of students in each school weekly. BUT (there's always a catch) the only students who can be tested are those whose parents have given permission for testing. If you won't get your child vaccinated, will you let that child be tested?

I remember sometime in a past post to this blog noting that we had passed the milestone of at least one in every 500 people having died from covid. That number is now at least one in every 406 people. At least one in every six people living in the US have been infected. I wonder how that one in six might change after (I wish I could say "if" here, but I don't feel comfortable with that) half a million cases are counted in one day. 

The Road goes ever on and on ... Day 152 (652)

New York City's new mayor will be sworn in at midnight January 1. One of his first major decisions will be whether public schools re-open on January 3. He does not support large-scale shutdowns, saying, "We can't close down the city anytime a new variant comes up." He is not alone on the school-closing front. Some 300 schools in Maryland, New Jersey, New Mexico, and New York have already said they will remain closed. New Jersey has told schools to do the first two weeks of school remotely. It is not an easy decision. One public health expert says that the only reason to close schools would be severe staffing shortages. Apart from schools, the number of children hospitalized with covid has been rising. Pediatric hospitalizations in New York have quadrupled. It does not help that just 16 percent of children between the ages of five and 11 have been vaccinated compared with 71 percent of children between the ages of 12 and 17.

Flights continue to be canceled or delayed. The main reason given is medical, though weather has played into some of the decisions. Dr. Fauci weighed in an air travel: "When you make vaccination a requirement, that's another incentive to get more people vaccinated. If you want to do that with domestic flights, I think that's something that seriously should be considered." That's an interesting idea, but would there be exceptions for emergency cases in which someone not fully vaccinated needs to get to the other coast because an immediate family member is seriously ill or dying? Would vaccine passports be used? Some states have essentially outlawed those. With only 62 percent of Americans fully vaccinated, the number of people asking for an exemption would likely not be small. 

The national record for average daily cases is 251,232 set in January 2021. I expect to see a new record in the early days of 2022 if not before 2022 arrives. Delaware, Hawaii, Massachusetts, New Jersey, New York, and Puerto Rico have seen more cases in the past week than in any other seven-day period.

Continuing with domestic covid news, five of the 42 post-season college football bowl games have been cancelled due to at least one of the teams not having enough players given covid issues. The local university is one of those teams, backing out of the bowl game that would have been the farewell game for a coach leaving not because he was fired or because he was taking a job at another school. He's trying to figure out what to do with his life other than coach football. There are four teams in the running to be national champion. The two semi-final games and the final game will be counted as forfeitures if one team cannot play due to covid. With one semi-final and the final cancelled we could crown the last team standing as national champs, not something I want to see happen. Finally, at least four large cruise ships have had to cut their voyages short due to covid outbreaks. It will be interesting to see how many keep on cruising.

A lab in Sydney, Australia mistakenly told 400 people that they had tested negative when, in fact, they had tested positive. Another 995 people were told they'd tested negative when their results were not yet known. Testing centers are overloaded. International travel requires a negative test but so does visiting Queensland and Tasmania. Forget the cause of the mishap and deal with it. How many people have the initial 400 people been in contact with? Unless they are as much of a hermit as I have been, there are probably a lot more people out there who will be testing positive in the near future. I would much rather be told I tested positive when I had not than the opposite. I would feel a nontrivial amount of guilt at potentially exposing other people. 

The Road goes ever on and on ... Day 151 (651)

Still in the midst of the Christmas weekend, the number of airline flights canceled globally has passed 5,400. Over 1,000 of those have been in the US. I wonder how many people sweating out getting rescheduled ever considered flight cancellation as an side-effect of covid. The only time we've had flights canceled, it was our flight only. We weren't standing in line at the ticket counter for hours waiting to get to the head of the line only to discover all other flights going where we wanted to go had already filled up.

US hospitalizations are on the rise while remaining under the peaks hit in January. ICUs especially are strained with workers sometimes working 16-hour days for weeks on end. Many hospital workers have left citing burnout or anxiety as reasons. The ones who remain are now getting infected, with the CDC allowing health care workers to return to work after seven days instead of 10. I wonder how many workers would like those extra five days just to have a bit of a break. One thousand military health care workers are being deployed across the country to help. Of special concern, pediatric admissions are rising. As of Thursday, over 50 children under the age of five were hospitalized. The American Academy of Pediatrics calls cases in kids under the age of 18 "extremely high."

March will mark the second anniversary of the "15 Days to Slow the Spread" featuring guidelines set by the ex-president and his coronavirus task force. We could very well be seeing record numbers of caseloads by then. We are currently averaging almost 200,000 new cases daily, more than in last summer's Delta peak. The seven-day global average of cases exceeds 755,000. Will it hit one million? I would not be surprised if it did. Experts say that we are likely to see an "almighty surge" to start the new year. They also say that we will never be without covid but need to move it into the background. Looking ahead, Dr. Fauci agrees, saying, "It's conceivable that, sooner or later, ... everybody will have been infected and/or vaccinated or boosted. When you get to that point, unless you have a very bizarre variant ... that evades all protection--which would be unusual--then I think you could get to the point where you have this at a steady level." He also noted that it is "entirely conceivable" that we may need a fourth shot of vaccine. 

We are not alone in facing or being in an almighty surge. France just saw over 100,000 new cases in one day, the most since the pandemic began. Hospitalizations have doubled over the past month. Over one person in 100 in the Paris region tested positive in the past week. They are seeing surges of both Delta and Omicron. The government does not want to close schools nor do they want to do anything that would hurt their economic recovery. The percent of positive tests in Kenya has gone from one percent to over 30 percent in three weeks. In Uganda, 50 lawmakers and staff tested positive after attending sports tournament in Tanzania.

The week between Christmas and New Year's sees the release of every list that was not released between December 1 and Christmas. Lists of noted people who died usually come out before Christmas, overlooking anyone who, like Desmond Tutu, died in December. I expect this happens because at the dawn of a new year, the focus should be ahead rather than behind. This year we may even have a separate list of people who died because of covid, 2021 being the first year spent entirely with covid. We will also this week see lists of Outs and Ins and the Best of almost any medium or genre. And then there are lists of New Year's resolutions. For several (maybe more) years I have posted my new ones here along with an evaluation of how I did on the expiring ones. I'm thinking along those lines now. I recently came across the cards on which I've written my resolutions for years past starting with 2002. Looking for themes should be interesting and will likely help me set the ones to shoot for in 2022. 

The Road goes ever on and on ... Day 150 (650)

Merry Christmas

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stay warm ... stay safe