Frequently Asked Questions about COVID-19 — February 23, 2022

“Shared expectations lead to predictability.”

476. Another approach to wearing masks in this post-omicron surge.

         Q:  Will I need to get a second booster shot later?

         A:  Washington, D.C., and Maryland last week  became the latest localities to loosen mask mandates following similar moves earlier from a number of governors across the U.S.  President Biden said that it was “probably premature” to lift indoor mask mandates, though he acknowledged that it was a “tough call.”  As masking becomes a new option for many, Tara Parker-Pope published her thoughts about this.  She is a columnist covering health, behavior, and relationships and the founding editor of Well, the New York Times’s award-winning consumer health site.

“In terms of cases, we are exiting the Omicron surge,” she stated. “But there’s still a lot of people getting sick, and just because we’re not at the peak of the surge doesn’t mean we don’t have to take reasonable precautions.”  She continued she believes everybody has to think about the most vulnerable people around them and consider them when making decisions. “If you use that as your guidepost, then you sort of know the answers.  You continue to take reasonable precautions, and that means masking around strangers.  But I also believe that vaccines protect us, booster shots protect us, and people who are vaccinated can have a fair amount of freedom and don’t need to wear masks all the time.  In hospitals and airplanes, you should wear a mask — period,” she stated.   “Also in airports, trains, and places where you’re going to be spending a long time in the same spot. I also think you should wear a mask in places where it’s easy and not that inconvenient. So like the grocery store or running into the dry cleaner — it’s no big deal, so why not just take the precaution?”

“But let me clarify something,” she continued.  “If you are unvaccinated, you should wear a mask, you should avoid crowds and you should hopefully talk to some trusted people about the vaccine and get more information. I recently lost an unvaccinated family member to Covid, and it’s a brutal way to die. It’s a lonely way to die, and it’s a painful way to die. And I don’t wish that on anybody.”

477. Difficulty with exercising after having Covid is a common after-effect.

         QWhy do some people recovering from Covid find it difficult to exercise?

         A:  This worsening of symptoms after engaging in even just a little bit of physical activity is sometimes called “post-exertional malaise” and it seems to be common among long Covid patients. When researchers performed an online survey of 3,762 people with long Covid, as part of a study published in August, they found that 89 percent reported the condition.  Some people are simply too tired to exercise, while others experience debilitating symptom relapses like fatigue, brain fog, or muscle pain afterward.

There are a number of theories on the causes, but experts say these problems are not just about becoming out of shape, and they also don’t seem to be a result of lung or heart injury.  In one small study, researchers found that some veins and arteries in long Covid patients were not working properly, preventing oxygen from being delivered efficiently to their muscles.  Other research implicates problems with how the heart rate responds to exercise. One small study found that when women who had recovered from Covid took a six-minute-long walking test, their heart rates didn’t accelerate as much — or recover as quickly — as the heart rates of similar women who had not been infected with Covid-19.  To overcome this long Covid condition, “You can’t just jump into exercise, or you’re going to be set back,” said Natalie Lambert, a biostatistician and health data scientist at the Indiana University School of Medicine. But you should “slowly try to reincorporate it if you are feeling better.” She added that long Covid is complex, so doctors may need to tailor their recommendations.

478. Sweden has just authorized a fourth shot – a second booster – for older people.

         Q: Are other countries finding booster shots losing effectiveness requiring repeat doses?

         A:  Sweden’s public health agency recommended a week ago Monday that people aged 80 and over receive a second booster dose of coronavirus vaccine, which would be a fourth overall shot. It also warned, as the country removes some of its pandemic restrictions, that the virus is spreading increasingly among people who are at elevated risk of severe illness.  Data published by the U.S. Centers for Disease Control and Prevention last week suggested that the added protection from booster shots tends to diminish significantly after about four months. This raises the possibility that people who would be at high risk of serious complications or death may need another dose.  Before Omicron emerged, officials and scientists debated whether boosters were necessary or advisable for people of various ages as a wide swath of nations authorized them anyway. But there was a broad shift in that thinking as Omicron, which evades immune defenses better than previous variants, swept the world, leading to more support for boosters.

“We believe that people who are 80 years and older will benefit” from a second booster dose, said Anders Tegnell, chief epidemiologist at Sweden’s public health agency.  Some scientists argue that trying to give everyone another shot every few months is unrealistic, and that booster effort should be focused instead on older adults.  They appear to get the most benefit from boosters, according to CDC data.  Other people who are especially vulnerable may need added boosters because they have weakened immune systems or live in long-term care facilities like nursing homes.

479. Highway and pedestrian deaths are rising because of the pandemic.

         Q:  Fewer cars are on the road now.  Why are highway deaths going up?

         A:  A significant issue is now identified rising from the stresses of the pandemic: a significant increase in pedestrian and vehicle crash deaths nationwide.  Authorities cite drivers’ anxiety levels, larger vehicles, and fraying social norms.  Empty roads allow some to drive much faster than before. Some police chiefs eased enforcement, wary of face-to-face contact. For reasons that psychologists and transit safety experts are just beginning to explain, drivers also seemed to get angrier.

David Spiegel, director of Stanford Medical School’s Center on Stress and Health, said many drivers were grappling with what he calls “salience saturation.”  “We’re so saturated with fears about the virus and what it’s going to do,” Dr. Spiegel said. “People feel that they get a pass on other threats.”  Dr. Spiegel said another factor was “social disengagement,” which deprives people of social contact, a major source of pleasure, support, and comfort. Combine that loss with overloading our capacity to gauge risks, Dr. Spiegel said, and people are not paying as much attention to driving safely.  “If they do, they don’t care about it that much,” Dr. Spiegel said. “There’s the feeling that the rules are suspended and all bets are off.”

480. New thoughts on the 1889 Russian Flu.

         Q:  What can we learn about the history of diseases that can guide us now?

         A:   In May 1889, people living in Bukhara, a city that was then part of the Russian Empire, began sickening and dying. The respiratory virus that killed them became known as the Russian or the Asian flu. It swept the world, overwhelming hospitals and killing the old with special ferocity.  This was well before the age of modern medicine.  While the morbidity and mortality results were recorded, little was learned or documented about the virus that caused this pandemic at that time.  Another reported characteristic similar to Covid-19 was a loss of taste and smell – just as with Covid-19.  Gina Kolata, in an article in the Atlantic last week, reviewed some new research into that precursor of our current worldwide situation.   The Russian flu finally ended a few years later, after at least three waves of infection.  Its patterns of infection and symptoms have led some virologists and historians of medicine to now wonder: Might the Russian flu actually have been a pandemic driven by a coronavirus? And could its course give us clues about how our pandemic will play out and wind down?

“There is very little, almost no hard data” on the Russian flu pandemic, said Frank Snowden at Yale.  There is, though, a way to solve the mysteries of the Russian flu. Molecular biologists now have the tools to pull shards of old virus from preserved lung tissue from Russian flu victims and figure out what sort of virus it was.  Some researchers are now on the hunt for such preserved tissue in museums and medical schools that might have old jars of specimens floating in preservative fluid that still contain fragments of lung.

Tom Ewing of Virginia Tech, one of the few historians who has studied the Russian flu, can’t help noticing striking parallels with today’s coronavirus pandemic: Institutions and workplaces shut down because too many people were ill; physicians overwhelmed with patients; and waves of infection.  Time will tell.