Frequently Asked Questions about COVID-19 — October 5, 2022

“Shared expectations lead to predictability.”

590.  “Brain fog” is a disabling and not well understood long-COVID condition.

         Q:  What, exactly, is “brain fog”?

         A:  Long-COVID continues to dominate the current reports on research of COVID-19.  Among the more common conditions being discussed are neurological conditions, including severe headaches and “brain fog.”  In a recent article published by National Geographic, long-COVID headaches are contrasted with migraine attacks.  One author stated, “if migraine headaches can be rated as “9 out of 10 in severity, many people have long-COVID headaches that are “20 out of 10.”  In other words, these can become totally debilitating.  Research is underway exploring the changes in the vascular, chemical, and neurologic changes COVID-19 causes leading to this resulting condition.

Ed Yong is a staff writer at The Atlantic.  He won the Pulitzer Prize for Explanatory Reporting for his coverage of the COVID-19 pandemic. On September 22, he published an article entitled,”One of Long-COVID’s Worst Symptoms Is Also Its Most Misunderstood.”  He explained that “brain fog isn’t like a hangover or depression. It’s a disorder of executive function that makes basic cognitive tasks absurdly hard.”  Executive functions are the set of mental abilities that includes focusing attention, holding information in mind, and blocking out distractions. These skills are so foundational that when they crumble, much of a person’s cognitive edifice collapses. Anything involving concentration, multitasking, and planning—that is, almost everything important—becomes absurdly difficult.

Brain fog is by far one of the most disabling and destructive of long-COVID conditions.  Ed states, “It’s also among the most misunderstood.  From 20% to 30% of patients report brain fog three months after their initial infection, as do 65% to 85% of the long-haulers who stay sick for much longer. It can afflict people who were never ill enough to need a ventilator – or any hospital care.  And it can affect young people in the prime of their mental lives.”

Several examples are cited when health workers with brain fog seek care for themselves.  They find that physicians – even those who have treated COVID-19 patients – often fail to recognize this condition.  Patients are diagnosed as having clouded thinking like that which accompanies hangovers, stress, or fatigue.  But, in reality, brain fog involves real changes to the structure and chemistry of the brain. It is definitely not a mood disorder.

In some severe cases, people have to stop driving – suddenly, they can’t remember where they were going.  One case was cited where a woman couldn’t unload her dishwasher because she couldn’t associate the objects inside with where to place them in the cupboard.

Memory suffers, too, but in a different way from degenerative conditions like Alzheimer’s. The memories are there, but with executive function malfunctioning, the brain can neither choose the important things to store nor retrieve that information efficiently.

Most people with brain fog are not so severely affected and gradually improve with time. But even when people recover enough to return to work, they can struggle with minds that are less nimble than before.

The same constellation of problems in the brain also befalls many people living with HIV, after seizures from epilepsy, after seizures, cancer patients experiencing so-called “chemo brain,” and people with several complex chronic illnesses such as fibromyalgia. It’s part of the diagnostic criteria for myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS.  Brain fog existed well before COVID, affecting many people whose conditions were often stigmatized, dismissed, or neglected.  But with the large number of cases associated with COVID-19, scientists are now encouraged and focusing on researching this condition seeking its characteristics, its cause, and perhaps its cure.

“Improving UUS:E Building Ventilation” — October, 2022

At UUS:E President Peggy Webbe’s request, Jim Adams prepared the following summary of the Meetinghouse ventilation status. He expressed his willingness to discuss this issue further with interested persons …

The UUS:E Building & Grounds committee (B&G) has implemented various measures to improve the indoor air quality within the Meetinghouse. These measures help to reduce the risk of COVID-19 transmission through a combination of fresh air (ventilation, best choice) and filtration (air purifiers, acceptable alternative). Note that these measures, while providing significant improvements do not eliminate the virus transmission risk inherent with indoor spaces. Also, any such measures can never make the air quality equivalent to being outside.

Transmission of viruses, like COVID-19, is inherently higher risk in an enclosed space or building where the exhaled breath of an infectious person can be transported in the air and remain aloft for hours. Bringing fresh outdoor air into a room (ventilation) can dilute and/or displace any present airborne virus, reducing the risk of infecting others. Where increased ventilation is not possible, the use of HEPA air purifiers is an alternative means of removing the virus from the air. None of these measures completely eliminate the viral risk.

Experts agree that improved air quality should be incorporated as part of a layered defense against COVID-19. It is recommended that this be done using outside air ventilation and/or air purification, targeting a combined 4 – 6 air changes per hour (ACH) though a combination of these approaches. ACH is a simplified way of quantifying the amount of ventilation or filtration flow relative to the size of the space involved. For example, if your ventilation systems flows 4000 cubic feet of fresh air per hour into a 1000 cubic foot room, that equates to 4 ACH (4000/1000). However, due to the mixing involved during that hour, this does not mean that all air in the room is replaced 4 times per hour. In fact, due to mixing, it would take approximately 45 minutes to replace 90% of the room air with a flow level of 4 ACH. As and mentioned previously, these levels of air flow can never make an indoor space equal to outdoors, where air replacement around a person(s) occurs within seconds with even the slightest breeze.

A major component of the air quality improvements is provided by existing features of the building heating and air conditioning (HVAC) system. The HVAC system includes 3 heat recovery ventilators (HRV) which introduce fresh air into the building when required. Up to now, these HRVs were controlled by wall mounted CO2 sensors, and only provided fresh air when enough people were present in a space to bring the CO2 levels up to uncomfortable levels (which was rarely the case). B&G recently made changes to the HVAC control system (aka “new thermostats”) to allow the HRVs to now be used on demand. A large HRV now provides 4 ACH of fresh air to the sanctuary, and the 2 smaller HRVs provide 1 ACH of fresh air to the remaining common spaces and offices upstairs, and all areas on the Garden Level except for the classrooms. To achieve the target 4 ACH in these common spaces and offices, air purifiers with the required flow have been put in place throughout the building. All bathrooms utilize motion detector actuated vent fans for these low occupancy spaces.

The RE classrooms all have their own wall mounted HVAC unit, which provide heating and cooling. However, they unfortunately do not have any fresh air capability. Therefore, each classroom space has been provided with special ventilation window fans which provide at least 4 ACH of fresh air for these spaces, year-round. Testing was conducted by B&G to confirm the fans provide the required 4 ACH, and that the HVAC units are able to maintain comfortable temperatures in the room during winter.

For all of the improvements to work, they must be turned on properly when spaces are occupied. Instructions have been placed above each thermostat describing how to turn on the HRV ventilators, and instructions are in each classroom describing how to utilize the window fans. Air purifiers should be turned on manually when people are present for significant time in the other spaces.

 

Frequently Asked Questions about COVID-19 — September 28, 2022

“Shared expectations lead to predictability.”

589. Australian studies show a variety of immunity factors may link to long-covid.

         QIs immunity a factor for those who contract long-covid syndromes?

         A:  A continuing worldwide concern continues over Covid-19 as we try to learn more about the causes and manifestations of long-Covid.  Long-Covid is the continuing chronic presence of debilitating illness affecting a variety of different organ systems in the body.   It doesn’t affect everyone who is infected by the Covid-19 virus, but some authorities have estimated that as many as 1 person will develop long covid in every group of 20 who were infected.  A recent report out of Australia looked at how Covid-19 affects the immune system.  The Australian affiliate of the ABC network reported that when you catch a virus, there will be one of three outcomes:

  1. Your immune system clears the infection and you recover (for instance, with rhinovirus, which causes the common cold.)
  2. Your immune system fights the virus into “latency,” and you recover with a virus dormant in your body (for instance with the virus that causes chickenpox, that later can emerge as causing shingles.
  3. Your immune system fights, and despite best efforts the virus remains “chronic,” replicating at very low levels.  This can occur for the hepatitis C virus.

But international evidence suggests changes to our immune cells after Covid-19 infections may have other impacts. It may affect our ability to fight other viruses, as well as other pathogens, such as bacteria or fungi.

Research in Australia has found Covid-19 alters the balance of immune cells up to 24 weeks after clearing the infection.  There were changes to the relative numbers and types of immune cells between people who had recovered from Covid compared with healthy people who had not been infected.

Another study focused specifically on dendritic cells — the immune cells that are often considered the body’s “first line of defense.” Researchers found fewer of these cells circulating after people recovered from Covid. The ones that remained were less able to activate white blood cells known as T-cells, a critical step in activating anti-viral immunity.

Other studies have found different impacts on T-cells and other types of white blood cells known as B-cells (cells involved in producing antibodies).

After Covid-19 infections were cleared, one study found evidence many of these immunity cells had been activated and “exhausted.” This suggests the cells are dysfunctional and might not be able to adequately fight a subsequent infection. In other words, sustained activation of these immune cells after an infection may have an impact on other inflammatory diseases.

One study found people who had recovered from Covid-19 have changes in different types of B-cells. This included changes in the cells’ metabolism, which may impact how these cells function. Given B-cells are critical for producing antibodies, we’re not quite sure of the precise implications.

Having a healthy immune system and being vaccinated are critically important to have the best chance of fighting any infection, according to the CDC.

What impact will these changes have?  One of the main concerns is whether such changes may impact how the immune system responds to other infections, or whether these changes might cause or worsen other chronic conditions.

It is reassuring to know that scientists are working on a better understanding of long-Covid syndromes.  It is concerning to know how complicated the causes between a viral infection and the possible subsequent emergence of different chronic conditions.  It is also frustrating not being able to link the causation between Covid-19 and the subsequent possible development of chronic conditions.  A person diagnosed with diabetes weeks or months after recovering from Covid-19 can easily assume these two events are not related.

In the absence of scientific evidence, most experts advise continuing caution when gathering in groups (masks, social distancing and ventilation), The popular feeling of security may not actually be representing reality by failing to recognize the possibility of long-Covid.

Frequently Asked Questions about COVID-19 — September 21, 2022

“Shared expectations lead to predictability.”

587. The CDC is now undergoing a thorough review and reorganization

         QI hear the CDC is not preforming as well as it could.  What’s happening?

         A:  For weeks, news media have been issuing reports that the U.S. Centers for Disease Control and Prevention has been examining ways to streamline its work enabling it to provide clearer, less confusing messages to the public.  In the September 19 issue of Time Magazine, Alice Park of the Time staff published an article based on questions asked and responded to by Rochelle Walensky, MD, MPH, the CDC director.  Walensky stated she had learned for herself that in its 26-year history, the CDC has always been preparing for a pandemic but never had to manage one.  To identify areas where changes can be made, more than 170 people inside and outside the agency were interviewed by senior staff asking critical questions about the recent successes and failures of the agency in managing Covid-19.

It was identified that the CDC has developed an infrastructure of academia.  The agency was driven by research, publication of studies, and generally has communicated with scientists, public health experts and academics.  Walensky has concluded the CDC was no longer an agency for public health officials.  “We have to be an agency for the American people,” she stated.

Discussing the bad headlines about confusing advice over masking and other mitigation measures, she stated, “We all didn’t like the headlines.  We found ourselves having to convey the nuances of the reasons behind the decisions we made with science that was difficult to convey.”  She concluded it was more important to communicate in ways that convinced the American public.  The agency is now moving to establish ways of communicating that is more readable, more accessible, and not tied down by scientific details.

One of the issues raised in their review was the lengthy time it takes to set up case studies of large numbers of people, collect the data, publish the results and have others review and agree the findings are valid and safe.  All of this before deciding to authorize it for general use.  In the traditional peer-review process, agreement can be quite prolonged.  The CDC is talking now about possibly posting early study data on a pre-publication server to let other experts see the results and collaborate earlier.

Dr. Walensky stated that the culture at CDC will be changing, but this will take time and effort.  The emphasis will be shifting away from publishing public health data, studies and publications, and focusing more on publishing public health actions.

588. Native Americans have suffered greatly with Covid-19.

         QHow well have American Indian tribes survived the pandemic?

         A:  Ashley Wu and German Lopez are two reporters for the New York Times, who recently published an article addressing the impact of Covid-19 on Native Americans.

The C.D.C. revealed early in September that from 2019 to 2021, the life expectancy of Native Americans fell from 71.8 years to 65.2. Covid was largely to blame.  The average Native American person is now expected to live as long as the average American did in 1944.  There are many reasons for this.  Native Americans tend to have higher rates of underlying health problems that exacerbate Covid, as well as worse access to health care.  “Even prior to the pandemic, rates of death among Indigenous people were higher in lots of categories,” said Dr. Laura Hammitt, an epidemiologist at Johns Hopkins University. Covid magnified those health disparities, causing a drop in life expectancy with no modern precedent in the U.S.

The link between people who refuse to be vaccinated and become sick fails with Native Americans as a group.   Vaccination rates among Native Americans are higher than they are among Black or Hispanic Americans, according to CDC data.  Yet Native Americans have died from Covid at one of the highest rates of any race or ethnicity since the start of the pandemic.  Other than vaccinations, other factors appear to be the reason for this.  For instance, Native Americans have some of the highest rates of health conditions, such as obesity and diabetes, that make a person much more likely to die from Covid.

Health care is also often inaccessible. The Indian Health Service, a federal program that provides care to more than two million Native Americans, have a fraction of the funding on a per-person basis received by Medicare, Medicaid or the Veterans Health Administration. “How can somebody think this is not a problem? Yet it’s become normal,” said Loretta Christensen, the Indian Health Service chief medical officer.  As a result, Native Americans frequently have to travel long distances to get health care, and its quality can be shoddy. A quarter of Native Americans reported experiencing discrimination when visiting a doctor or a health clinic, one poll found.  Cultural and language barriers can also make it difficult for Indigenous people to get the care they want. Given those obstacles, some try to tough out illness at home, with potentially deadly results.

Poverty also is surely a major factor.  Widespread poverty limits what precautions people can take to avoid Covid. People living paycheck to paycheck can’t afford to take time off work to avoid spreading or catching the virus. Native Americans also often lack access to internet, electricity and running water — making remote work, virtual schooling or telemedicine impossible.  And Native Americans often live in crowded, multigenerational homes. So, if they are sick, they can easily spread the virus to the rest of the family, including older relatives who are much more vulnerable to Covid.

The authors conclude that preventing deadly pandemics isn’t just about containing the pathogens that cause them, but also about improving the health of communities across the board.

 

Frequently Asked Questions about COVID-19 — September 14, 2022

“Shared expectations lead to predictability.”

586. The drug Paxlovid is proving to be less effective for younger patients.

         QDoesn’t the drug Paxlovid mean we don’t have to worry about Covid restrictions?

         A:  Many see Paxlovid as a miracle drug that makes it safe to “return to normal” in the face of expanding number of Omicron Covid-19 infections.  Even though it was developed for people at higher risk of developing serious disease, most people consider this a universal “silver bullet.”  “No need to worry,” many people say.  “There’s no need to wear masks when around other people.  No need to get vaccinations or booster shots,” some believe.  After all, there is this new drug Paxlovid that prevents people from getting serious disease and reduces the risk of Covid.”  These popular expectations are not shared in a recent study.

In the recent issue of Time Magazine, health correspondent Jamie Ducharme stated, “Paxlovid, the antiviral drug noted for its ability to keep high risk Covid-19 out of the hospital, works very well for seniors but provides little benefit for people younger than 65.”  This is the conclusion reached by the authors of a study published in the New England Journal of Medicine in August.

Researchers in Israel tracked more than 100,000 adults aged 40 and older who got Covid-19 from January to March 2022, when the Omicron subvariants were widespread.  Most of these individuals had been previously vaccinated or had been previously infected with Covid-19.  All were considered high risk for developing serious disease and were eligible for Paxlovid.  Only about 4,000 had actually taken this antiviral medication.

Seniors over age 65 who were at high risk for serious disease saw significant benefits with 73% having a reduced chance of dying compared to others in that age group that didn’t get the drug.  But among people between the ages of 40 to 64, Paxlovid provided little or no benefit.

“Paxlovid is still benefiting older adults and younger people who are immunocompromised by lowering their risk of hospitalization and death.  Covid-19 vaccinations are also doing a good job at preventing severe disease, if not all infections.  But as research on Paxlovid mounts, the drug is appearing less universally impressive,” concludes Jamie Ducharne.

Relevant fact:  Needed federal funding for Covid is now tied to the debt ceiling.

There are no more at-home antigen self-testing kits available for free distribution.  Once the current level of vaccine and modified booster doses are given out, federal funding is not available for additional vaccines to be provided at no cost to those asking for them.   Recently, several news services explained that action on these and other public health issues will need additional federal appropriations or these program initiatives will have to shift to the private sector meaning insurance payments or direct payment by patients who don’t have insurance.  The White House has asked Congress for $47 billion in emergency aid to cover continuing support for managing the Covid-19 pandemic along with additional war supplies for Ukraine, and disaster relief in Kentucky and other states.  This request will become part of the debate over raising the debt ceiling which will have to be resolved to prevent the government shutting down after September 30 – just weeks away from the mid-term elections.

The request for additional Covid-19 aid has already become a sticking point for many months as the White House has said more money is needed, and Republicans have pointed to the trillions that have already been approved and money that still has not been spent.”  If new support is not given for additional Covid-19 resources, testing and vaccinations will no longer be free.  This can only reduce the ability to control future surges and morbidity resulting from the disease.

Frequently Asked Questions about COVID-19 — September 7, 2022

“Shared expectations lead to predictability.”

585. Five Critical new vaccine procedures and booster shot developments announced.

         QThe new booster guidelines are confusing.  How will these work?

         A:  The White House has announced a coordinated effort to provide everyone with modified booster shots in September.  These shots have been modified to make them more effective against the Omicron B.A. subvariants which are more infectious than previous mutations.  Large quantities of the booster doses have been pre-ordered.  This campaign comes as the U.S. is preparing for its third pandemic winter, and as Covid-19 is currently averaging about 90,000 new infections and 475 deaths every day.

There remains confusion about who is eligible and the timing for each of the two different available boosters – those manufactured by Pfizer and by Moderna.  Clarification is offered:

Do you have a medical condition or are you using therapies that blunt the effects of vaccinations?  You may be advised to not get a Covid vaccination.  You should discuss with your healthcare provider other available therapeutics or ways to reduce your risks.

Have you not yet received the required existing vaccine shots?  The booster shots are formulated to only be given to people who have already received the original vaccines developed in 2020.  This original vaccine will remain available and you should obtain the required shot(s) as soon as possible.

When can you receive a booster shot?  The F.D.A. authorized the modified boosters for people who were at least two months out from their last shot (whether that was the original vaccine or a booster), but you might want to wait longer. Experts said that protection from boosters become more effective by waiting three to six months after immunization or infection.

Where can you get a booster shot?  The new vaccine will most likely be available at pharmacies, doctors’ offices, and community health centers. Many mass-vaccination clinics and other sites across the country have closed, so you may have to seek out a new vaccination site. You can search a directory of sites online at vaccines.gov.

Will the booster shots continue to be given at no cost as were previous vaccines and booster shots?   The initial doses of the modified booster shots have been ordered and paid for.  But with the increasing public relaxation of the need to continue prevention measures, new and additional funding is no longer available.  Congress may be asked to provide additional funds, but the impact of Covid funds running out has already eliminated the free distribution of rapid antigen home tests.  If costs are an issue for your contemplating getting a booster shot, you are advised to not delay.

Relevant facts:  Few young children are vaccinated, and Covid-19 is expected to grow.

In an August 28 Hartford Courant article, Ulysses Wu, M.D., infectious disease specialist at Hartford HealthCare reflected on the expected rise in Covid cases in schools and among younger children.  Connecticut Health Department figures were quoted as, “Since the Covid-19 vaccine was approved for those 6 months to 4 years old in June, vaccination numbers have been sluggish.  As of August 16, only 14,506 children, or just 7.9%, have received at least one shot.”  Pfizer’s vaccine requires three shots and Moderna’s requires two.

There is also a relatively low vaccination rate for school-age children.

Frequently Asked Questions about COVID-19 — August 31, 2022

“Shared expectations lead to predictability.”

584.  New study shows “long Covid” is keeping up to 4 million people out of work.

         QHow has “long Covid” affected people’s ability to return to work?

         A:  Millions of people who have had “long Covid” find themselves suffering from a host of debilitating symptoms that can persist for weeks, months, or even longer after their initial coronavirus infection symptoms fade.   Fatigue is the most common complaint.  And that’s often coupled with some breathing problems, either coughing or shortness of breath.  Neurological issues including headaches, tingling or numbness in the arms and legs, ringing in the ears, changes in vision, as well as trouble with thinking, or “brain fog” are also on the list of commonly reported “long Covid” cases reported according to the Centers for Disease Control and Prevention.

Science has yet to understand “long Covid” syndromes. The main reasons for this are these chronic conditions emerge after the acute effects of Covid-19 have passed, and there is much diversity in the chronic conditions that result from Covid.

One study correlating long Covid chronic conditions with prior infections of Covid-19 was reported on August 24, 2022, by the Brookings Institute in Washington, DC.  Katie Bach, a senior fellow at Brookings examined why there continue to be labor shortages and missing workers as the economy is recovering.  Earlier, in January 2022, Brookings published a report that assessed the impact of long Covid on the labor market. Data on the condition’s prevalence was limited, so the report used various studies to make a conservative estimate: 1.6 million full-time equivalent workers could be out of work due to long Covid. With 10.6 million unfilled jobs at the time, long Covid potentially accounted for 15% of the labor shortage.

This June, the Census Bureau finally added four questions about long Covid to its Household Pulse Survey (HPS), giving researchers a better understanding of that condition’s prevalence. This August Brookings report uses that new data to assess the labor market impact and economic burden of long Covid, and finds that:

  • Around 13 million working-age Americans (those aged 18 to 65) have long Covid today.  This is an estimated 8% of working-age Americans.
  • Of those, 2 to 4 million are out of work due to long Covid.

A recent Federal Reserve Bank of Minneapolis study corroborates these conclusions. Using a longitudinal survey, the study found that 24.1% of people who have contracted Covid-19 experienced symptoms for three months or more, which the author defined as long Covid.  And according to the Centers for Disease Control and Prevention, about 70% of Americans have contracted Covid-19. If 24.1% of them have had long Covid, 34 million working-age Americans have, at some point, had long Covid.

The Minneapolis Fed study also found that 50% of respondents had recovered from long Covid. If we exclude that 50%, we are left with around 17 million people who may currently have long Covid—very near the estimate of 16.3 million.

The Brookings recent study also reports that mild symptoms, employer accommodations, or significant financial need can all keep people with long Covid employed. But in many cases, long Covid impacts work. Understanding that impact requires additional data points:

  • First, we need to know what percentage of people with long Covid have left the workforce or reduced their work hours. Estimates vary.  Citing several other studies in the U.S. and Great Britain, Brookings concludes that of the 16.3 million working-age Americans with long Covid, we can assume 12.2 million were in the labor force.
  • We also need to calculate the reduced hours of the people with long Covid who kept working. The Minneapolis Fed study found that, on average, they reduced their hours by 10 hours a week; using that number and a 40-hour work week, we can assume that these workers reduced their hours by 25%.  Using the Minneapolis Fed, and different data from two other studies on the extent of work reductions gives us 2 million, 3 million, and 4 million full-time equivalent workers out of the labor force due to long Covid, respectively. The midpoint of this range—3 million full-time equivalent workers—is 1.8% of the entire U.S. civilian labor force.

This may sound unbelievably high, but it is not inconsistent with the experiences of comparable economies. For example, a Bank of England representative recently stated that labor force participation has dropped by around 1.3% across the entire 16- to 64-year-old population and that the majority of that impact is from the rise in long-term sickness suspected to be long Covid. Meanwhile, one-quarter of UK companies cite long Covid as one of the main causes of long-term staff absence.

It is also consistent with the current labor market experience in the U.S., where employers in face-to-face industries such as education, transportation, food service, hospitality, and health and social care are facing persistent labor shortages.

Editor’s comments: While this academic report is focused on economics, it raises an important perspective on assessing public health risks.  This report and its finding are already being seen by many experts as pathfinding in that it proposes an outline of the extent of long Covid that even now appears to be unreasonably larger than suspected.  It challenges prior assumptions and is encouraging further research to refute or confirm these conclusions.  The public has been told there is a shortage of teachers because of the pressures of culture wars, and frustrations over Covid restrictions.  What if many teachers are leaving their profession because of chronic disabilities not before seen as related to long Covid?  Has long Covid played a factor in the shortage of hotel and restaurant workers?  Truck drivers?  How will individuals assess their personal risks differently if this theory turns out to be true – if there really are increased long-term health risks than from what is now seen as an easily treated minor disease?

Frequently Asked Questions about COVID-19 — August 24, 2022

“Shared expectations lead to predictability.”

583. Long Covid in children remains a threat while more research is needed.

         QIs long Covid a risk that students may face interrupting their school experiences?

         A:  While the public uses “long Covid” for shorthand, the scientific name is “post-acute sequelae of Covid,” or PASC. Researchers believe this is not a single disease but several distinct illnesses affecting many organ systems.  Scientists still do not know how the virus triggers such a wide spectrum of symptoms that can persist months after the initial infection.  Also not understood is why some of these symptoms show up in some patients but not in others, or what exactly the risk factors are for developing them.  But the most common long-term effects in children appear to be neurological.

In a recent study, one in ten children who have been hospitalized develops post-acute sequelae of Covid (PASC), or long Covid.  The study conducted by Lurie Children’s Hospital in Chicago, the University of California Davis School of Medicine, and the University of Calgary found nearly 10% of hospitalized children reported symptoms of PASC in the months after first contracting Covid.  PASC is defined as having symptoms that persist or return three months after initial infection, according to the World Health Organization.  The symptoms may have an impact on a person’s everyday function, although they may come and go, according to the study, which was recently published in the Journal of the American Medical Association.  As part of the eight-country study, researchers examined 1,884 children who initially presented to the emergency department and were followed up 90-days later. Long Covid (PASC) was found in nearly 10% of those who were hospitalized and also 5% of children discharged from the emergency department. Risk factors for the post-Covid condition included an initial hospitalization of 48 or more hours, four or more symptoms at the initial emergency department visit, and being at least 14 years of age or older. The most reported persistent symptoms were fatigue or weakness, cough, difficulty breathing or shortness of breath, according to researchers.

The most effective way for children to avoid contracting Covid-19 and reduce the possibility of PASC becoming a chronic condition that requires management for months or longer is to obtain vaccinations, and as appropriate and when available, receive booster shots that have been re-engineered to focus on the Omicron subvariant B.A.5.

Opinion 6:   Are CT and CDC back-to-school procedures sufficiently adequate?

According to research done on Covid-19 tests administered at Johns Hopkins Hospital, “Researchers estimated that those tested using a rapid at-home antigen test when the average patient began displaying symptoms of the virus, the false-negative rate was 38 percent.  The test performed best eight days after infection (on average, three days after symptom onset), but even then, had a false-negative rate of 20 percent.”  Many authorities have stated that the antigen tests may require a heavy viral load to report a positive test.  The assumption is that a negative test may indicate an infected person’s viral load is below that when a person could be passing it on to others.  But current research has not yet tested that assumption.

On August 16, the First Lady, Jill Biden, experienced symptoms of a cold coming on.  She took a rapid, antigen Covid test and it came back negative.  Because she is the First Lady, she routinely takes a more accurate PCR test that is processed in a laboratory. And the results later came back positive.  She began isolation and following CDC guidelines based on that PCR test.

The most recent CDC guidelines for parents to evaluate their children’s need to stay home if they might have Covid-19 were reported in FAQ 582 last week.  The new process is called “Test-Mask-Go.”  If a child has symptoms of a cold, such as infrequent coughing, congestion of a runny nose, doesn’t have a temperature over 100°F, and feels well enough to go to classes, he or she can go to school wearing a mask and participate in all activities with the other children.

If any parent feels the possibility that these steps are not adequate to prevent Covid-19 infection of others, they might consider sending their healthy children to school every day wearing a mask.  And be certain their child is vaccinated and if eligible, receives the soon-to-be-available booster shot.

 

Frequently Asked Questions about COVID-19 — August 17, 2022

“Shared expectations lead to predictability.”

582.  National and Connecticut Covid school restrictions are being relaxed.

         QHow are schools preparing differently for Covid-19 when they soon reopen?

         A:  In a recent Hartford Courant article, Connecticut was reported as modifying the Covid-19 requirements for children returning to school.  These changes follow new CDC guidance.  Both state and federal authorities openly state the intent is to no longer prevent new infections but to address the issues of increased hospitalizations and serious disease while still allowing an increase in the advantages of in-school learning.  Students with mild symptoms of Covid-19 are now allowed to attend classes under specified circumstances.  Children who complain of not feeling well should have their temperatures taken.  Kids who have a temperature over 100° F should remain home.  If the temperature is taken at school, the child must wear a mask and be isolated until a parent can come to pick them up to take them home.

If the temperature is below 100° F and the child has any symptoms of Covid, such as infrequent coughing, congestion, or a runny nose, the child can be tested using a free self-test.  Five million of these self-tests in 2-test kits are now being delivered to all Connecticut school systems and child-care programs.  If the test shows negative, the child feels well enough to attend classes in-person, and is not living with someone who has had Covid-19 in the prior 2 weeks, they still should attend classes but must wear a mask while in the school or child-care building.  To help parents and school officials remember, this new procedure is named, “Test-Mask-Go.”

The CT Department of Public Health’s guidance advises that any student exhibiting mild flu-like symptoms take a COVID test at school or at home every day until their symptoms stop. It also urges students with a fever, or who live with someone who recently tested positive for COVID-19, to stay home regardless of test results and refer to the CDC’s Quarantine & Isolation Calculator[1] for more information on how long to self-isolate.

Parents may want to check with their child’s school officials for specific procedures because not all schools have school nurses or other designated personnel who can test and hold several students waiting for parents to come to pick them up.

Opinion 5    More long-covid cases than previously reported raise the current risk.

Apoorva Mandavilli, a reporter for The New York Times who covers infectious disease and global health recently stated, “What we know about transmission in schools is still what we knew before, which is that children can and do spread the virus.  Ventilation in schools is going to be even more important this fall, simply because the variants that are circulating are more contagious.”

 

[1] https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fyour-health%2Fquarantine-isolation.html

 

Frequently Asked Questions about COVID-19 — August 10, 2022

“Shared expectations lead to predictability.”

581.  A dramatic new plan for booster shots is being planned.

         QWhen can I get a booster shot that is designed to address the Omicron BA-5?

         A:  Two weeks ago, the White House announced a planned change was being considered to prevent more people from being infected with Covid-19 starting this fall.  The following explanation was drawn from several publications including the New York Times, Bloomberg News, and The Atlantic.

Up until now, all second booster shots have been limited to people who are over the age of 50 or who have compromised immunity.  The 4 manufactured mRNA-approved vaccines and the booster shots that were developed by these companies to reinforce waning protection have not been taken by a sufficient number of people to prevent an extended number of new infections.  For the past several weeks in Connecticut, vaccinations have remained steadily low with 80.4% of the residents have received just the initial two shots, and only 42.8% just one booster shot.  This low number of people who are vaccinated is not unusual.  It reflects the general national “anti-vax” attitude.  The consequence has been a series of mutations that have made the current Omicron BA-5 subvariant highly resistant to natural and vaccine immunity.  Many people who are vaccinated are now contracting the disease.  Many more are being infected who are partially vaccinated including those who have not received their booster shots.

Pfizer and Moderna have been working for months to re-engineer their booster shots to have a greater effect on the BA-5 subvariant, and clinical trials have shown the success of that effort.  A decision has been reached to not introduce these re-engineered shots as the next in a series, but to move faster to make these new shots available for all people who have been vaccinated to receive them when they are available in enough quantity.  For example, the slow pace of people taking booster shots has now reached a point that now exceeds the number of people over age 70 who are hospitalized than the peak for those over the same age when the Delta variant was at its peak.

The Department of Health and Human Services, using existing and available Covid funds, has ordered 171 million doses of the modified booster from Moderna and Pfizer.  Congress has been asked to provide additional funding to provide doses for every citizen, but so far has not responded.

Sometime early in September, the White House plans to announce the first annual booster campaign where everyone who has been vaccinated (probably including children) can receive the modified booster shot.  This will be ahead of the anticipated surge of cases in the coming cold weather.  Then, like the seasonal flu vaccines, each future year’s booster shots, modified for any new mutations, can be made available.  The experts point out that currently more patients are now hospitalized with Covid than with the seasonal flu.  And the death rate for Covid-19 is far greater than with the flu.  This new approach is designed to bring the risks of Covid infections on par with those of the flu.

Opinion 4:  More long-covid cases than previously reported raise the current risk.

Katherine J. Wu, Scientific Writer for The Atlantic recently reported that things are not great right now.  “It is true that hospitalization and death rates are down, but the more people you have infected, even a very small percentage can turn into an untenable number of hospitalizations and deaths. And every infection carries the risk of long COVID, or taking people away from school or work or their family.”  Data from Great Britain is now showing the number of people with long Covid is much larger than previously identified.  Previous independently reported chronic conditions are now being shown to actually be caused by Covid-19.