Frequently Asked Questions about COVID-19 — May, 18, 2022

“Shared expectations lead to predictability.”

541.   Questionnaire Result #1 – The pace of changing restrictions is explored.

         QHow many members of our congregation want to lift all restrictions quickly?

         A:  Our UUS:E congregation feels comfortable with the pace we have been changing restrictions to match the rise and fall as risks fluctuate.  The number who want to go slower is almost as large as the group who want to go faster.  This is the conclusion of one analysis made from the questionnaire conducted in April.

The UUS:E Emergency Preparedness Task Force decided to determine how the congregation views their comfort levels on a series of actions we may be taking.  In April, a questionnaire was developed and copies were sent out to members and friends of the church.  After nearly 2 weeks, 147 people had returned replies.  In the narrative sections, where respondents used their own words to convey their thoughts, 51 commented on their view of the pace we have been moving toward a return to normal.  The majority, 27 of those responses, felt the current pace was good.  Rating the pace as needing to go faster were 14 and needing to go slower were 10.  The conclusion was reached that “In the future, these respondents would likely accept changes that would be slightly less restrictive than we had made before.  But that edge is narrow, and dramatic moves to remove or impose restrictions would not be possible.  Those on either side can easily see that not everyone feels the same way that they do.  This analysis will be used as we develop future changes to our policies.”    

542.  Hospitals that treat the uninsured face a financial crisis.

         Q:  How long will federal funding cover the costs of care for Covid-19?

         A:  In a recent New York Times article, Noah Weiland, health reporter in the Washington office, defined a fiscal crisis hospitals are starting to face as federal funds for pandemic aid is drying up.  Previously, billions of dollars in aid not only guaranteed that uninsured Covid patients would not face medical bills during the pandemic, it also offered a lifeline for financially stressed institutions that provide extensive uncompensated care for the poor.  This infusion of aid is now ending.  Doctors and nurses say that a wide range of health problems that worsened during the pandemic are now overwhelming hospitals.  And by law, patients without the ability to pay must be treated, raising the costs to hospitals.

This Covid-19 Uninsured Program provided more than $20 billion in reimbursements to roughly 50,000 hospitals, clinics and other providers for testing, vaccinating and treating the uninsured.  A pandemic relief package that has stalled in the Senate will most likely not be passed leaving reimbursements during future Covid waves unlikely.  And the Biden administration’s social policy bill, which would have provided poor adults in states that did not expand Medicaid with access to free coverage, appears all but dead.

543.   A new CDC tool can evaluate cruise ships’ ability to manage Covid.

         Q:  Are all cruise lines operating safely now? 

         A:  The CDC has established a “cruise ship status dashboard.”  This new color-coding system gives travelers information they can use to make informed decisions before choosing to travel. Color status designations indicate the number of COVID-19 cases reported for each ship in the program, whether an investigation is needed, and additional public health measures a ship is taking.

This website can be found at:

https://www.cdc.gov/quarantine/cruise/cruise-ship-color-status.html

But participation is not mandatory and many ships do not appear in this dashboard.  In addition, managing Covid on a ship cannot be compared to how Covid is managed onshore.  On a cruise ship, quarantine usually must be in the stateroom, away from scheduled activities and excursions.  Development of serious cases at home can have care provided in a hospital, of which there are now many available.  On a cruise ship, the medical ward is usually small and limited in the services it can provide.  The number of crew members on board is limited, and if any test positive, they can not help others while they are quarantined.  If tested positive toward the end of the cruise, the passenger will have to leave the ship before the quarantine period is over and complete it in a hotel at their own expense.  Most cruises do not provide compensation for post-cruise quarantines – or for the added costs of the delayed return travel home!

544.  New York City is in a higher CDC category of infection but is not taking action.

         Q: How can I find out if it is safe to visit my brother out west?  I don’t know anything about conditions out there!

         A:  There is now a “Covid-19 Visit Risk Calculator” to help people safely go anywhere.  This includes making a visit, attending a meeting, going to a party, or simply sightseeing.  Vaccination programs against COVID-19 are well underway and various jurisdictions are lifting their previous COVID-19 public health measures. However, COVID-19 remains an important public health issue as it continues to spread in communities around the world, especially with the emergence of variants of concern such as Omicron. As a result, careful assessment before deciding to visit with others remains vitally important.

Using the best available scientific evidence and the input of leading experts in infectious diseases, public health and epidemiology, this website was developed in Toronto, Canada by the Ryerson University’s National Institute on Aging (NIA) to help people of different ages and states of health better understand the factors that affect the risk of getting COVID-19 when visiting others. Many of these same factors also apply to the risk of getting other respiratory infections like influenza.

It takes about 3 minutes to answer this website’s short online risk calculator questions,  The tool can be used at any time for a fresh assessment.  The information you provide to access and use this website is collected anonymously.

You can access this tool at:

My COVID-19 Visit Risk Calculator (2021 – 2022) (covidvisitrisk.com)

545.  Covid-19  is surging faster than our New England neighbors.

         Q:  Are we better or worse with Covid-19 than our neighboring states?

         A:  The New York Times is publishing a daily dashboard tracking the coronavirus in places across the United States.

This can be found at:

https://www.nytimes.com/interactive/2021/us/covid-cases-deaths-tracker.html

It is interesting to review how Connecticut is doing compared with its neighboring states.

As of May 15, 2022:

 

Daily Cases per 100,000 population 14 day change Daily deaths per 100,000 population 14 day change
Connecticut 53 +105% 0.16 +150%
Massachusetts 61 +56% 0.12 +44%
Rhode Island 72 +59% 0.11 +43%
New York 53 +43% 0.11 +27%

 

All four neighboring states over the past two weeks have seen an increase in the prevalence of cases and deaths within their borders.  But the rates of increase in cases in Connecticut is nearly double that of Massachusetts and Rhode Island, and over double that of New York.  The Connecticut rate of deaths is well over 3 times that of other neighboring states.  Connecticut is experiencing a greater surge than our neighboring three states.  If you are eligible, getting a booster shot is of significant importance to prevent infection – even if you are already fully vaccinated.

 

Frequently Asked Questions about COVID-19 — May 11, 2022

“Shared expectations lead to predictability.”

536.   Remote learning during the pandemic has reduced learning by 5-10 year-olds.

         QAre there studies that show the difference between learning remotely and in-person classes?

         A:  At the start of the Covid-19 pandemic in March, 2020, schools everywhere closed.  Remote learning became the national policy.  Some months later, many areas of the country resumed in-person classes.  In many other areas, classes remained online for months.  This created a huge experiment, testing how well remote learning worked.

The Center for Education Policy Research at Harvard University released a study called the Consequences of Remote and Hybrid Instruction during the Pandemic.  The study examined student scores in the standardized Measure of Academic Progress test, which measures reading and math capabilities and is given in grades K through 5th grade.

Students who stayed home for most of 2020-21 fared much worse than those who returned to in-person classes. On average, they lost the equivalent of about 50 percent of a typical school year’s math learning during the study’s two-year window.

The findings are consistent with other studies. “It’s pretty clear that remote school was not good for learning,” said Emily Oster, a Brown University economist and co-author of another related study.

One of the most alarming findings is that school closures widened both economic and racial inequality in learning.  Pre-pandemic, math, and reading skills improved, especially for Black and Latino students.  The Covid closures have reversed much of that progress.  Low-income students, as well as Black and Latino students, fell further behind than students who are high-income, white, or Asian. “This will probably be the largest increase in educational inequity in a generation,” stated Thomas Kane, an author of the Harvard study.

There are two main reasons. First, schools with large numbers of poor students were more likely to go remote.  Second, low-income students tended to fare even worse when schools went remote. They may not have had reliable internet access, a quiet room in which to work, or a parent who could take time off from work to help solve problems.

537.  A major research effort is launched to study long Covid.

         Q:  What causes long Covid?

         A:  It is well-known that what we don’t understand enhances fear.  Since the pandemic began, we have all learned there are long-term consequences that sometimes occur after a patient recovers from the acute phase of Covid-19. This phenomenon appears in so many different ways, lasts from weeks to longer than a year, and is so unpredictable in its outcomes that the resulting fear of its consequences demands answers.  The answer – many answers – are the goal of a new initiative being undertaken with the start of a major research project called “Researching Covid to Enhance Recovery” (RECOVER). The National Institutes of Health (NIH) received funding from the American Rescue Plan to create this project, and the parent award of $470 million has been given to New York University (NYU) Langone Health based in New York City.  Multiple sub-awards to more than 100 researchers at more than 30 institutions will be made.  This major new award to NYU Langone supports extensive studies of Covid-19 survivors.

NIH launched RECOVER to learn why some people have prolonged symptoms or develop new or returning symptoms after the acute phase of the infection The most common symptoms include pain, headaches, fatigue, “brain fog,” shortness of breath, anxiety, depression, fever, chronic cough, and sleep problems.  “We know some people have had their lives completely upended by the major long-term effects of Covid-19,” said Francis Collins, MD, NIH Director, when announcing the award. “These studies will aim to determine the cause and find much-needed answers to prevent this often-debilitating condition and help those who suffer move toward recovery.”

538.   The FDA limits the use of the Johnson and Johnson vaccine.

         Q:  What is happening to the J & J authorization for its vaccine? 

         A:  On May 5, 2022, the U.S. Food and Drug Administration limited the authorized use of the Johnson and Johnson Covid-19 vaccine to individuals 18 years of age and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate and to individuals 18 years of age and older who elect to receive the Johnson & Johnson vaccine because they would otherwise not receive a COVID-19 vaccine.  The FDA has determined the risk of thrombosis with thrombocytopenia syndrome (TTS), a syndrome of rare but potentially life-threatening blood clots.  This in combination with low levels of blood platelets with the onset of symptoms after about two weeks following administration of J&J vaccine, warrants limiting the authorized use of the vaccine.

The FDA and CDC have identified 60 confirmed cases, including nine fatalities. The FDA has determined that the reporting rate of TTS is 3.23 per million doses of vaccine administered and the reporting rate of TTS deaths is 0.48 per million doses of vaccine administered.  Examples of individuals who may still receive the J & J Covid-19 vaccine include:  individuals who experienced an anaphylactic reaction after receipt of an mRNA COVID-19 vaccine, individuals who have personal concerns with receiving mRNA vaccines and would otherwise not receive a COVID-19 vaccine, and individuals who would remain unvaccinated for COVID-19 due to limited access to mRNA COVID-19 vaccines.

539.  New York City is in a higher CDC category of infection but is not taking action.

         Q: Does the government have to follow CDC guidelines?

         A:  New York City entered a higher risk level for the coronavirus on Monday, May 2, 2022, a troubling reminder that the pandemic is not over and that the virus still has the power to harm.  The city moved into the medium, or yellow, risk category as cases continued their steady rise, a development that could trigger the return of public health restrictions, although they are not required to be reinstated at this point.  The new CDC guidelines recommend individual, not governmental actions.  Case levels in New York and around the country are probably much higher than the official statistics because many residents are testing at home, and positive at-home tests are not typically included in official tallies.

State health officials recently announced a troubling new development: two new versions of the subvariant — BA.2.12 and BA.2.12.1, which appear to spread more rapidly than BA.2 — seem to be behind steep case increases in upstate New York, where more than 30 counties, including those that contain Buffalo, Rochester, Syracuse, and Binghamton, have already entered the high community transmission level, according to the CDC.

Dr. Jay Varma, the director of the Cornell Center for Pandemic Prevention and Response, said that he was skeptical about the utility of the alert level, because changes to it do not trigger actual policy shifts, and because it doesn’t take into account the rate at which things are worsening.

540.  New subvariants BA-4 and BA-5 are identified in South Africa.

         Q:  Are we seeing an end to mutations of Covid-19?

         A:  No.  Coronavirus cases are surging again in South Africa, and public health experts are monitoring the situation.  South Africa experienced a decline in cases after hitting an Omicron-fueled, pandemic peak in December. But health officials have said in the past week, cases have tripled, positivity rates are up and hospitalizations have also increased.  The surge has the country facing a possible fifth wave.  The spike is linked to BA.4 And BA.5, two new subvariants that are part of the Omicron variant.  Tulio de Oliveira, director of South Africa’s KwaZulu-Natal Research and Innovation Sequencing Platform, said that BA.4 and BA.5 demonstrate how the virus is evolving differently as global immunity increases.

“What we are seeing now, or at least maybe the first signs, is not completely new variants emerging, but current variants are starting to create lineages of themselves,” Dr. de Oliveira said. Since its initial identification in South Africa and Botswana last November, Omicron has produced several subvariants.  Some scientists are trying to understand how the BA.4 and BA.5 are affected by the immunity from previous Covid 19 infections in South Africa.

 

Frequently Asked Questions about COVID-19 — May 4, 2022

“Shared expectations lead to predictability.”

531.   China’s attempts to eliminate Covid’s spread are unusually extreme.

         QHave other countries accepted the notion that Covid-19 will become endemic?

         A:  No.  The New York Times recently reported that in China, parents have organized petitions, imploring the government not to separate children infected with coronavirus from their families. Residents have confronted officials over containment policies that they see as inhumane, then shared videos of the arguments online.  As the coronavirus races through Shanghai, in that city’s worst outbreak since the pandemic began, the authorities have deployed their usual autocratic playbook to stamp out Covid-19, no matter the cost. What has been different is the outpouring of public dissatisfaction rarely seen in China.

The crisis in Shanghai is shaping up to be more than just a public health challenge. It is also a political test of this zero-tolerance approach on which the Communist Party has staked its legitimacy.  For much of the past two years, the Chinese government has stifled domestic criticism of its Covid strategy, using a mixture of censorship, arrests, and its previous success at keeping caseloads low.   But in Shanghai, which has recorded more than 70,000 cases since March 1, that is proving increasingly more difficult.

This scenario is now just beginning in the capital city of Beijing.  The intolerance of China’s government is shown when only seventy people tested positive in the city’s 3.5 million population caused an order to have every citizen in 11 of its 16 districts in Beijing take 3 separate PCR Covid tests over the next 5 days.  Knowing the harsh conditions mandated for Shanghai, citizens have cleared store shelves hoarding food and supplies in case neighborhoods become fenced in, patrolled 24/7 by drones, and firmly locked down.  In other Chinese cities, mass testing in response to a scattering of coronavirus cases has already been a prelude to similar stringent restrictions.  The disruptions to China’s economy have become significant with the restocking of goods being seriously reduced by not allowing workers to leave their homes to manufacture them.  Worldwide shortages of some essential products, such as computer chips, are now being felt.

532.  The W.H.O. global vaccination goals for Covid-19 will not be met.

         Q:  Will enough people be vaccinated to reduce the chance of troublesome future variants?

         A:  The World Health Organization has set the goal to immunize 70 percent of people in every nation by June 2022 to control Covid-19 worldwide.  Now, it is clear that the world will fall far short of that target by the deadline. And there is a growing sense of resignation among public health experts that high Covid vaccination coverage may never be achieved in most lower-income countries, as badly needed funding from the United States dries up and both governments and donors turn to other priorities.

“The reality is that there is a loss of momentum,” said Dr. Isaac Adewole, a former health minister of Nigeria who now serves as a consultant for the Africa Centers for Disease Control and Prevention.  Only a few of the world’s 82 poorest countries – including Bangladesh, Bhutan, Cambodia, and Nepal have reached the 70 percent vaccination threshold. Many are under 20 percent, according to data compiled from government sources by the Our World in Data project at the University of Oxford.  By comparison, about two-thirds of the world’s richest countries have reached 70 percent. (The United States is at 66 percent.)

Public health experts say that the consequence of abandoning this global effort could lead to the emergence of dangerous new variants that would threaten the world’s work to live with the virus.  “This pandemic is not over yet — far from it — and it’s imperative that countries use the doses available to them to protect as much of their population as possible,” said Dr. Seth Berkley, chief executive of Gavi, the nonprofit that runs the global vaccine clearinghouse.  Fewer than 17 percent of Africans have received a primary Covid immunization.  Nearly half of the vaccine doses delivered to the continent thus far have gone unused. Last month, the number of doses injected on the continent fell by 35 percent contrasted to the previous month in February.

533.   The FDA Approves First COVID-19 Treatment for Young Children.

          Q:  Have any Covdid pediatric therapeutics received full authorization by the FDA? 

          A:  On April 25, 2022, the U.S. Food and Drug Administration fully approved a Covid-19 therapeutic drug for children who have been infected with Covid-19.  It expanded the emergency use authorization (EUA) approval of the drug Veklury (remdesivir) to cover pediatric patients 28 days of age and older weighing at least 3 kilograms (about 7 pounds) who show positive results of direct PCR Covid testing.  To qualify for this treatment, the child must be either hospitalized or if not hospitalized, have mild-to-moderate symptoms, and be at high risk for progression to severe disease.  This action makes Veklury the first fully approved COVID-19 treatment for children under 12 years of age.

534.  European and American officials: Covid-19 is no longer in an emergency phase.

         Q: Is Covid still a high-risk disease?

         A:  The European Union said on Wednesday that it was moving out of the emergency phase of the Covid-19 pandemic.  The move comes as the number of deaths and hospitalizations across Europe has dropped significantly because of the prevalence of the less severe Omicron variant, as well as high immunization levels. Three-quarters of Europeans are fully vaccinated, and over half have received an additional booster shot.  This compares to the 66% of Americans who are fully vaccinated.   The E.U. announcement, which came from the European Commission, the bloc’s executive arm, is an attempt to coordinate the management of the pandemic as it becomes less acute, though national governments continue to set their own policies on public health. Wednesday’s recommendation is not legally binding, and countries are free to follow or ignore it.

Ursula von der Leyen, the commission’s president, said on Wednesday that it was crucial to stay vigilant.  “New variants can emerge and spread fast,” Ms. von der Leyen said. “But we know the way forward. We need to further step up vaccination and boosting, and targeted testing — and we need to continue to coordinate our responses closely in the E.U.”

A week after the UE announcement, Dr. Anthony Fauci, chief medical adviser to President Biden. during an interview on the PBS Newshour stated The U.S. is no longer in the grip of the COVID-19 pandemic, despite the coronavirus’s continuing global threat.  “We are certainly right now in this country out of the pandemic phase,” Fauci said.  “Namely, we don’t have 900,000 new infections a day and tens and tens and tens of thousands of hospitalizations and thousands of deaths. We are at a low level right now.”  In an interview with the Associated Press on April 27, Fauci said the pandemic isn’t over. “We are in a different moment of the pandemic,” he said. After a brutal winter surge, Fauci added, “we’ve now decelerated and transitioned into more of a controlled phase.  By no means does that mean the pandemic is over.”

535.  More than half of the U.S. population has contracted Covid-19.

         Q:  How many people have been infected by Covid-19?

         A:  The New York Times published an article last week, that was republished by many local newspapers, stating that, “By February, nearly 60% of the population had been exposed (infected) by the coronavirus, almost double the proportion seen in December 2021, according to data released by the Centers for Disease Control and Prevention.”  This increase was among every age group, while infections of the Omicron variant were greatest among children and adolescents, probably because those age groups were the least vaccinated.

 

Frequently Asked Questions about COVID-19 — April 27, 2022

“Shared expectations lead to predictability.”

526.   With full vaccinations and booster shots, the impact of Covid-19 resembles flu.

         QIs the current Covid-19 disease still worse than the seasonal flu?

         A:  A special report was recently written in the New York Times, highlighting that the share of cases that turn into severe illnesses is declining.  Three main reasons were given:

  • Vaccinations and booster shots are effective and universally available to Americans.
  • Treatments are increasingly available for therapeutics like Evusheld for the immunocompromised and Paxlovid for vulnerable people who get infected.
  • Tens of millions of Americans have already been infected with the virus, providing them with at least some immunity.

These trends will not eliminate severe Covid. The number of nationwide hospitalizations will probably rise in the coming weeks, especially if cases continue to rise.

The declining share of coronavirus cases that result in serious illness would be very good news, stated Dr. Craig Spencer, director of global health in emergency medicine at Columbia University. Among other things, a decoupling of cases and severe illness would mean that hospitals were less likely to become overwhelmed during future Covid surges, which becomes another factor that reduces bad health outcomes.

Vaccines and treatments like Paxlovid tend to turn Covid into an illness of similar severity to seasonal flu.  This has been verified by the county surrounding Seattle, Washington, which keeps detailed data.  The daily Covid death rate for boosted elderly people has recently hovered around two per million. In a mild flu season nationally, that is higher than the death rate but somewhat lower than during a heavy influenza season.

For boosted people, the odds of severe Covid really do resemble the odds of severe influenza. And it was noted you don’t tend to see news stories every time a member of Congress or a Broadway star contracts the flu.  It is understood why the country is still treating Covid as a serious illness. For one thing, the large number of unvaccinated people means that Covid is still killing about 500 Americans a day. For another, Covid has dominated life for more than two years, and we can’t flip a switch and return to 2019.

Yet it would not be rational to treat the 2022 version of Covid as if it were identical to the 2020 version.  It isn’t.  Vaccines, treatments and even natural immunity have transformed the impact of the virus, especially for Americans who have chosen to protect themselves.

527.  A historical review of convalescence identifies better paths for recovery.

         Q:  How did our forefathers manage long-term diseases like tuberculosis differently?  

         A:  There is much anxiety today about the possibility of contracting “long-Covid’ consequences of this pandemic.   Historical studies have shown that prior to the 20th century, many illnesses took a long time for a patient’s recovery.  A raft of infectious diseases from typhoid to tuberculosis were included. This process of restoration—a stage between acute illness and full health—was a major focus of physicians and families. For centuries, the care of convalescents came with its own set of theories and rules, intended to prevent relapse and integrate patients back into normal life.  With medical advancements, tolerance for long recovery waned.

“Modern medicine is uncomfortable dealing with things where we don’t have a quick fix,” says Lancelot Pinto, consultant pulmonologist in Mumbai. “When there were no cures, patients were allowed to live out the natural history of the disease.  We have forgotten how this was accepted, and we have lost the methods that make this acceptable.”  He suggests that once a drug is found for COVID-19, “the workplace office will expect you back in five days.”  But Pinto also acknowledges the opportunity for advancing understanding of long-term mechanisms in virus illnesses. Post-viral symptoms have been documented in diseases from SARS to dengue but remain poorly studied.  Renewal of former ways to enhance convalescence is needed.

Sally Sheard, historian and executive dean of the Institute of Population Health at the University of Liverpool, stated “One of the clearest messages from my work on convalescence is that you cannot rush the process.”  Some COVID-19 patients were discharged too fast, to free up beds, while others were delayed in hospital too long because they had no help at home, she says, adding, “so maybe we need halfway or recovery homes,” not unlike convalescent homes, or a tuberculosis sanitarium.

The pandemic has brought new attention to long-term recovery as scientists gain a growing understanding of long COVID-19—a condition in which symptoms linger long after the initial diagnosis and illness. Many hospitals around the world have set up post-acute care clinics for these patients.

528.   The transportation mask mandate has been stopped by a judicial decision.

         Q:  What does the federal court action removing the CDC travel mask mandate mean?

         A:  On Monday, April 19, Tampa, Florida-based Federal District judge Kathryn Kimball Mizelle threw out the mask mandate the Centers for Disease Control and Prevention had imposed on all interstate transportation hubs including commercial airports and airplanes.  Mizelle’s analysis focused on two distinct holdings — her interpretation that the CDC lacked the statutory authority to impose such a mandate which is worded to promote “sanitation,” and that, in any event, the CDC rules applied nationwide, and rather than find for the plaintiffs that had sued for relief, she rendered it invalid nationwide. Therefore, by Monday afternoon, most major airlines and transportation services were no longer enforcing mask requirements.

In the past, the Supreme Court by its rulings has made it difficult to bring class-action suits that apply to all members in a defined class.  “Universal injunctions” have become far more common.  A universal injunction is a court decision that if a single group wins a case to stop an action, the court can extend that injunction to other similar groups even if they were not part of the adjudicated case.

Judge Mizelle’s action was defined as a “universal injunction.” If not appealed, it will become a judicial precedent that any group that feels aggrieved by having to follow a public health mandate can sue with the result that can dictate a nationwide order against that mandate.  This precedent could allow parents in one school that dispute a mandate against students requiring school vaccinations to lead to a nationwide removal of such mandates.  If that suit was brought in the late summer, it might take months – or longer – before an appeal could be successful in re-establishing that mandate.  CDC is one of the world’s most prestigious public health organizations. Mizelle’s precedent could put public health policies in control of the judicial system, replacing science with lawyers and the prevailing political will.

529.  Factors are identified to decide when a second booster could best be taken.

         Q: If vaccines and boosters wane, should I wait until Fall and my long trip to get boosted?

         A:  In a recent forum, New York Times science and global health reporter responded by stating that timing the vaccines for maximum protection is indeed key. The ability of the vaccines to prevent infections drops off sharply but protection against severe illness lasts longer.  It takes about a week for the booster to kick the immune system into gear. So, for people younger than 60 and in relatively good health, it may be OK to time a vaccine dose for the next surge or a trip to see vulnerable relatives. But for older adults and others at higher risk, experts recommend a second booster shot now. With numbers rising nationwide, they say, you’ll want to be protected against infection, not just severe illness, and a second booster shot will extend the longevity of the shield.

530.  U.S. Supreme Court rules that a military mandate for vaccination is valid.

         Q:  If workers cannot be mandated to be vaccinated, what about the military?

         A:  The Supreme Court ruled a week ago Monday that the Pentagon may take disciplinary action against a lieutenant colonel in the Air Force Reserve who refused to be vaccinated against the coronavirus on religious grounds.  The court’s brief, unsigned order gave no reasons, which is common when the justices act on emergency applications. The court’s three most conservative members — Justices Clarence Thomas, Samuel A. Alito Jr. and Neil M. Gorsuch — noted dissents but did not explain their thinking.  In this case, Lt. Col. Jonathan Dunn, who has been removed from his command after serving for nearly two decades as a pilot, trainer, and commander, said he sought only “protection against further punishment, including a discharge.”  Colonel Dunn, who has received many other vaccinations without objection, said he decided that the coronavirus vaccine violated his faith after seeing President Biden speak about it, leading him to conclude that “the vaccine ceased to be merely a medical intervention and took on a symbolic and even sacramental quality.”

 

Frequently Asked Questions about COVID-19 — April 20, 2022

“Shared expectations lead to predictability.”

521.   The mortality rate for diabetics infected by Covid-19 is staggering.

         QWhat is the impact when someone with diabetes catches Covid-19?

         A:  After older people and nursing home residents, no other group seems to have been hit harder by Covid than people with diabetes. They account for a staggering 30 to 40 percent of all U.S. Covid deaths, several studies suggest.  In a recent New York Times article, the issue was discussed.

Diabetes patients who are hospitalized with Covid spend more time in intensive care, are likelier to be intubated and are less likely to survive. One study found that 20 percent of such patients died within a month of admission.  Diabetes is a chronic disease that hobbles the ability to regulate blood sugar and inexorably wreaks havoc on circulation, kidney function and vital organs.  Though researchers are still trying to understand the dynamics between diabetes and Covid, most agree on one thing: Diabetes often impairs the immune system and decreases a patient’s ability to withstand a coronavirus infection.  Diabetics often struggle with hypertension, obesity and other medical issues, which can fuel chronic inflammation inside the body.

Like the pandemic, which has had an outsize toll on communities of color, the burden of diabetes falls more heavily on Latino and Black Americans, highlighting systemic failures in health care that have also made the coronavirus far deadlier for the poor.  “It’s not that diabetes itself makes Covid inherently worse but rather uncontrolled diabetes, which is really a proxy for other markers of disadvantage,” said Nadia Islam, a medical sociologist at NYU Langone Health.

About 1.5 million Americans are diagnosed with diabetes each year, according to the C.D.C., and roughly 96 million, about one in three adults, are at high risk for developing the disease. The disease claims 100,000 lives annually but draws less funding or notice than illnesses such as cancer and heart disease.  Experts say addressing the nation’s diabetes crisis will require well-funded public education campaigns that drive home the importance of exercise and healthy eating. That would require seismic changes to a food system geared to cheap, processed food.  “The only way to move the needle is to reform a system that prioritizes cures and new drugs over prevention,” said Dr. Sudip Bajpeyi, a researcher at the University of Texas at El Paso.

522.  There were more deaths in the U.S. in 2021 than in any other year in its history.

         Q:  How does the number of people who died from Covid affect the national death rate?  

         A:  The Associated Press recently released a report that 2021 was the deadliest year in U.S. history.  The main reason for this was Covid-19 said Robert Anderson, who oversees the CDC work in death statistics.  His tabulations show there were 3,465,000 deaths last year, which is about 80,000 more than 2020’s record-setting total.  It is noted that 2021 was the year that vaccinations became available, which should have led to a lower number of deaths.  “We were wrong, unfortunately,” said Noreen Goldman, a Princeton University researcher.  Covid-19 deaths rose in 2021, to more than 415,000, up from 351,000 the year before.  The reason was the emergence of new variants and an unexpectedly large number of Americans who were reluctant to get vaccinated or to wear masks.  In addition to the Covid-19 deaths, other diseases showed increases in the number of deaths.  Cancer rates rose slightly and rates continued to rise for diabetes, chronic liver disease, and strokes.  It is expected that deaths from drug overdoses especially in adolescents,  will also be shown to increase once that data review is completed.

523.  China is imposing severe restrictions in an attempt to eliminate Covid-19.

         Q:  Is acceptance of Covid-19 as an endemic disease accepted everywhere?

         A:   The New York Times has reported that China’s largest outbreak since the beginning of the pandemic is now gripping Shanghai, its largest city and a global financial center.  The city of 26 million recently reported more than 2,600 Covid infections daily for several days, from just a handful in early March.  Hospitals and medical staff are stretched thin. The government has ordered 3,000 military medics and 10,000 medical workers to Shanghai.

The Chinese government has reacted by introducing steps focusing on eliminating this disease entirely.  This approach is contrary to that of other countries which have relaxed many of their restrictions and are treating Covid-19 as an endemic disease.  The Chinese government has introduced a two-step lockdown and plans to test all 26 million residents.

  • Infections in a neighborhood will require that everyone living in it to remain there – the entire neighborhood will be locked down.
  • Offices and businesses not considered essential will be closed and public transportation suspended.
  • Deliveries will be left at special checkpoints.

One of the more controversial moves has been to remove children from families where adults have tested positive to protect the kids from contracting the disease.  This forced disruption of family structure has caused widespread frustration and anger.

524.  The national travel mask-wearing requirement has been extended until May 3.

         Q: Are masks still required on planes and trains because of the BA.2 subvarient?

         A:  Yes.  The Biden administration announced on Wednesday, April 13 that it is extending the nationwide mask requirement for airplanes and public transportation for 15 days as it monitors an uptick in Covid-19 cases.

The Centers of Disease Control and Prevention said it was extending the order, which was set to expire on April 18, until May 3 to allow more time to study the BA.2 Omicron subvariant that is now responsible for the vast majority of cases in the U.S.

“In order to assess the potential impact the rise of cases has on severe disease, including hospitalizations and deaths, and health care system capacity, the CDC order will remain in place at this time,” the agency said in a statement.

525.  White-tailed deer found to have Covid-19 years ago, before human infections.

         Q:  Is it true that wild populations of deer had Covid-19 long before the human pandemic?

         A:  Last month, National Geographic reported that a white-tailed deer in Canada likely infected a human with coronavirus, according to new research.  Previous work has shown that the virus is circulating widely in U.S. white-tailed deer populations.  Before this latest report, however, the virus appeared to be very similar to that found in nearby humans, suggesting that the deer likely were sickened by us—not the other way around.  A team of 32 government and academic researchers in Canada has concluded in a new study in late 2021, that more than a dozen white-tailed deer in Canada had been infected with coronavirus that had a constellation of “mutations that had not been previously observed among SARS-CoV-2 lineages.”  What’s more, further analysis revealed that a person who had close contact with white-tailed deer in Ontario was infected with the same variant of coronavirus.

For the research, scientists took nose and tissue samples from 300 dead white-tailed deer in southwestern and eastern Ontario between November and December 2021. All the animals had been killed by hunters and were already being tested as part of an annual surveillance program for chronic wasting disease, which kills deer and their relatives. A few samples tested weren’t usable, but the researchers found that 17 of 298 deer—6 percent of the animals—tested positive for a “new and highly divergent lineage” of the coronavirus.  Their results also showed that the variant is an older version of COVID, one that predated Delta and Omicron, suggesting that coronavirus has been circulating among deer for a long time.  After discovering the coronavirus cases, the study authors analyzed whether the deer virus would likely be able to evade an existing COVID vaccine and concluded the vaccine would likely still provide robust coverage.

 

Frequently Asked Questions about COVID-19 — April 13, 2022

“Shared expectations lead to predictability.”

516. The BA.2 subvarient is now the dominant strain of Covid-19 in the U.S.

         QIf the mutation of the Omicron variant is more infectious, is it now dominant?

         A:  The highly infectious BA.2 Omnicron subvariant is now the dominant version of the coronavirus now circulating in the United States, according to federal officials.  Some officials warn of a new U.S. surge based on a significant increase in cases in other countries.

Over the week ending March 25, the BA.2 subvariant made up 55% of all new cases of Covid-19 in the U.S., according to the CDC.  That was up from 39% the week before.  BA.2 is estimated to be between 30% and 60% more infectious than Omicron.

Officials have uniformly recognized that over time, vaccinations provide waning immunity.  Peter Chin-Hong, a University of California San Francisco infectious disease expert, urged those age 65 and older – to get their second booster shot quickly.

517.  There are four current strategies that can minimize Covid’s future effects.

         Q What can we do now to help reduce the negative outcomes from future Covid cases?  

         A:  David Leonhardt on March 28 published an article in the New York Times that identified four separate strategies to minimize the bad outcomes from Covid-19:

  1. Promote increasing the number of people getting booster shots. Almost one-quarter of U.S. adults have been vaccinated but have not received a booster shot, according to Kaiser Family Foundation surveys. “I remain most worried about lack of booster uptake among the elderly and the immunocompromised,” Jennifer Nuzzo, a Johns Hopkins University epidemiologist, stated.  Efforts to promote getting booster shots are needed.  The FDA has just authorized a second booster shot four months after the first one.  Everyone who is eligible needs to get one.
  2. Many of the immunocompromised need to get a new medication. A small percentage of Americans who are receiving cancer treatments and those who have received certain organ transplants find that vaccinations either cannot be taken or provide limited immunity.  Fortunately, a drug now exists that may help many of them.  It is a monoclonal antibody injection called Evusheld, developed by AstraZeneca.  Given before exposure to the virus, it can provide months of protection from developing the disease.  With enough doses ordered to treat 850,000 people, about 80 percent of the doses are sitting unused.  “The biggest problem is that there is absolutely no guidance or prioritization or any rollout in place at all,” Dr. Dorry Segev of N.Y.U. Langone Health stated, “It’s been a mess.”
  3. Promote post-infection treatments. A knowledge gap is also hampering the distribution of Paxlovid — a post-infection treatment from Pfizer that sharply reduces the chance a Covid illness will become severe. It is most effective when prescribed shortly after symptoms begin, but many Americans do not know it exists. One thing to keep in mind: This drug is now authorized only for high-risk people such as those over age 64 or those with serious underlying medical conditions.
  4. Too many people wear low-quality masks or take them off at times, and Omicron is so contagious that it takes advantage of these gaps.  But masks can still help reduce Covid’s spread.  Masks also make sense for people who have returned to work or school five to 10 days after a Covid infection, Dr. Shira Doron of Tufts Medical Center stated.  Note: masks can be worn anytime, even when not required.

518.  Increased rage and criminal activity during the pandemic may be resolving.

         Q:  Why are people becoming so weird in relating to each other during the pandemic?

         ABad behavior of all kinds —everything from rudeness and carelessness to physical violence—has increased.  Olga Khazan, a staff writer at The Atlantic recently wrote on why this is happening,  There are many possible explanations.  One likely cause is the rage, frustration, and stress coursing through society right now.  The pandemic has created a lot of “high-stress, low-reward” situations, and now everyone is teetering slightly closer to their breaking point.  People have been coping with the pandemic by drinking more and doing more drugs.  A lot of auto accidents, including aggression-driven crashes, result from alcohol or drug use.  One study found that Americans have been drinking 14% more days each month during the pandemic.  Americans have also been buying more guns, which may help explain the uptick in the murder rate.

The pandemic has loosened ties between people.  Kids stopped going to school; their parents stopped going to work; parishioners stopped going to church; people stopped gathering, in general.  “We’re more likely to break rules when our bonds to society are weakened,” Robert Sampson, a Harvard sociologist who studies social disorder, stated. “When we become untethered, we tend to prioritize our own private interests over those of others or the public.”  The turn-of-the-20th-century scholar Émile Durkheim called this state anomie, or a lack of social norms which leads to lawlessness. “We are moral beings to the extent that we are social beings,”

Some of the antisocial behavior Americans are seeing will resolve itself as the pandemic loosens its grip.

519.  Everyone eligible should get their booster shots when these are available.

         Q: I didn’t get the first booster shot earlier; why should I get one now?

         A:  The authorization of the first booster shot during the Omicron surge cut seniors’ risks of hospitalization and death by more than 70 percent. But the extra shots still didn’t come close to eliminating risk.  Not all who were eligible got boosted.  Adults ages 65 and older were still hospitalized at nearly twice the rate, and dying at 16 times the rate of 18-to-49-year-olds.  The FDA has authorized a fourth shot for older people, and not much is stopping seniors who want to re-boost from doing so already.

The dilemma is that not all those who could get their first booster shots have done so.  Those who didn’t contract Covid-19 now can feel that their holding off was justified.  For many older Americans, the sense of protection – no matter how small – is worth the safety of avoiding an infection that might be prevented.  For many others, the motivation to get anything beyond the original vaccinations may be seen as of little importance because breakthrough cases are perceived as always being mild and of little consequence.  Yet, each breakthrough case can allow a new variant to emerge or surge in its dominance.  And, as been shown, even mild Covid cases can result in delayed long-term acute medical consequences such as stroke and heart attack.  For their personal protection, and to reduce the pandemic’s threat to the population, everyone eligible should get their booster shots when these are available.

520.  Indoor ventilation will be a public health priority for future airborne infections.

         Q:  Why is Covid more infectious indoors than outside?

         A:  Public health traditionally controlled infectious diseases by controlling the environment by which infectious agents spread between people.  Cholera spreads when mixing sewerage gets into drinking water.  Cholera was resolved in England in 1846 by building separate aquafer systems for each.  Now, Covid, along with the common cold and influenza remains omnipresent because we have not addressed the control of indoor air!

We lost the focus to do this in the early stages of Covid-19.  Remember that the original dogma was that the novel coronavirus spread through droplets that quickly fell out of the air. We didn’t need ventilation or masks; we needed to wash our hands and disinfect everything we touched.  The 6-foot social distancing was based on the distance that droplets fell to the floor or other surface.  But a year and half of evidence have made it clear that the tiny virus-laden particles indeed linger and spread in the air of poorly ventilated areas. This explains why outdoors is safer than indoors; why a single infected person can super-spread to dozens of others without directly speaking to or touching them. Many scientists are now pushing to reimagine building ventilation and clean up indoor air.  We don’t drink contaminated water. Why do we tolerate breathing contaminated air?  We’ve long accepted colds and flu as inevitable facts of life, but are they?  Why not redesign the airflow in our buildings to prevent them, too? The same measures that protect us from common viruses might also protect us from the next unknown pathogen.

A rule of thumb has emerged that at least four to six complete air exchanges an hour in a room can provide protection. The challenge ahead is cost.  Federal budgets were proposed to fund schools to update ventilation systems, but Congress dropped that provision before the bill was passed.  For those agencies that have made some progress in ventilation, it is imperative that they not relax now when the number of cases has been reduced.  The next new variant or disease may surge faster than it will take to make indoor spaces safe again for people to gather.

 

Frequently Asked Questions about COVID-19 — April 6, 2022

“Shared expectations lead to predictability.”

511. The FDA approves a second booster (a fourth shot) for mRNA vaccinations.

         QWhen can I get my second booster shot?

         A:  On Tuesday, March 29, the Food and Drug Administration authorized a second COVID-19 booster for people age 50 and older.  This is a step to offer extra protection for the most vulnerable in case the coronavirus rebounds.  This decision opens a fourth dose of the Pfizer or Moderna vaccines to those people at least four months after their previous booster.

512.  A substitute drug is available in place of vaccines for vulnerable patients.

         Q I am immunocompromised.  What can I do to get some protection against Covid-19?  

         A:  Evusheld is the first FDA authorized drug to prevent COVID-19 in high-risk people who aren’t adequately protected by vaccination alone. The FDA granted emergency use authorization on December 8, 2021.  It has been shown that Evusheld reduces the risk of symptomatic COVID-19 by 77% in unvaccinated high-risk adults.  When the immune system is exposed to a foreign protein – for example, by infection or vaccination – it produces antibodies in response to the potential threat. Evusheld is a monoclonal antibody drug that binds to the spike protein of the virus that causes COVID-19 and prevents it from entering and infecting cells.  It functions differently from antiviral drugs like molnupiravir, which work by stopping the virus from replicating within cells.  This means that Evushield must be taken before a person becomes infected.  The protection from developing Covid symptoms lasts for months.  It is expected that Evusheld will need to be given about every six months to keep antibody levels high enough to be effective against the virus. Patients may need to keep getting repeated doses as long as there is a significant risk of COVID-19.

Not all immunocompromised patients are eligible for this prophylactic, and it is important that anyone who knows they have limited immunity from vaccines contact their physician for guidance.  Evushield is administered by two injections in one outpatient visit with an hour remaining afterward for any of the rare reactions to emerge.

513.  A new teenage anxiety is appearing named (by them): “mask fishing.”

         Q:  I heard some teenagers talking about mask fishing.  What is this?

         ATeenagers are showing anxiety over an issue called “mask fishing.”  This is a new term played on the former term “catfishing,” the slang for improving one’s image online.  For a generation that has grown up with smartphones and Instagram, creating a more positive illusion of identity was commonly accepted.  “Some of these people really haven’t seen my face outside of social media and things like that,” one teenager was quoted in a recent New York Times article.  “What I post on social media I make a little bit different than what I look like day-to-day.”  That’s catfishing.   But now that New York City has ended its mask mandate for public schools, students are dealing with old anxieties about their appearance and the pressures to fit in.  As they get a closer look at each other’s faces, they’re finding out who among them has been mask fishing.  “The majority of the people in my classes that I don’t see outside of school, I don’t know what they look like without their mask.”

The concerns felt by many were explained in another quote: “Three years ago, it would have been like, ‘I have so much acne lately, I do not know what to do, but guess what?  It was middle school.  Everyone had acne. Everyone was dealing with the same thing. It was everyone’s insecurity.  But now it’s become a more personal thing, and it feels like, ‘Oh, this person doesn’t have it; I didn’t know because I haven’t seen their face. So it’s only me that has it.’”  Yet another concern, “I’m still pretty anxious about taking my mask off completely,” she said. “If people see the newer version of me where I don’t look the way I did, there’s a lot of stress that I’ll be seen as less pretty as I may have once been.”

514.  Expert scientists predict Covid-19 will become endemic – like the seasonal flu.

         Q: Will we have to get shots every year for Covid like we do flu shots?

         A:  Sarah Cobey, MD at the University of Chicago along with Jesse Bloom, MD, and Tyler Starr, MD at the Fred Hutchinson Cancer Research Center in Seattle are three scientists who study the interaction of immunity, virus evolution, and transmission.  They collaborated recently to discuss the future of Covid-19.  Will it go away?  Will it become seasonal like the flu?  What can we expect?  The following is extracted from their report:

It’s impossible to say whether future variants will have larger Omicron-like jumps or less dramatic changes, but we are confident Covid-19 will continue to evolve to escape immunity.  While transmissibility of most viruses does plateau at a certain point, many human viruses that escape immunity keep doing so. The influenza vaccine has been updated annually for decades to chase viral evolution, and some influenza viruses show no sign of slowing down.  Immune escape is an endless evolutionary arms race because the immune system can always make new antibodies and the virus has a vast set of mutations to explore in response.

Taking all this together, we expect Covid-19 will continue to cause new epidemics, and they will increasingly be driven by the ability to skirt the immune system. In this sense, the future may look something like the seasonal flu, where new variants cause waves of cases each year.  If this happens as expected, vaccines may need to be updated regularly similar to the flu vaccines unless we develop broader variant-proof vaccines.  And of course, how much all this matters for public health depends on how sick the virus makes us.  That is the hardest prediction to make because evolution selects viruses that spread well, and whether that makes disease severity go up or down is mostly a matter of luck.  But we do know that immunity reduces disease severity even when it doesn’t fully block infections and spread, and immunity gained from vaccination and prior infections has helped blunt the impact of the Omicron wave in many countries.  Updated or improved vaccines and other measures that slow transmission remain our best strategies for handling an uncertain evolutionary future.  The development of a broad variant-proof vaccine, currently being undertaken, will be an ultimate answer to this and other annually recurring viral diseases.

515.  A personal reflection on three habits someone wants to continue after Covid.

         Q:  There are a lot of bad memories from the last two years.  Is there any good from this?

         A:  Tish Harrison Warren is a priest in the Anglican Church in North America, and an opinion writer for the New York Times.  She recently reflected in an article on the past two years, identifying three practices she and her family hope to continue. From her column:

First, in the early days of the pandemic, when my family of five abruptly found ourselves crammed into a small house, we developed a practice of having tea around 4:30 each weekday afternoon. With cookies, Earl Grey, juice for the kids, and sometimes a shot of bourbon for the adults.  We would ask one another, “Who do you need to apologize to or reconcile with today?”   This ritual helped our family to take responsibility for the ways we griped at, nipped at, or yelled at one another, and to seek forgiveness. We would leave the tea feeling more connected, more tender toward one another, and more able to offer and receive love.  I’d like to continue this, at least as a weekly rhythm.

Second, a month or two into the pandemic, as it became clear that seeing people outside was a safer way to interact, we began to center our nights on our backyard firepit.  Our ancestors sat around fires for hundreds of thousands of years but I had somehow lost this ancient custom.  I found again and again that something about those flickering flames brought easier connections with others.  The crackle and beauty of staring at a fire actually lowers blood pressure, according to a University of Alabama study.

Lastly, hiking had long been a favorite family activity, but Covid took it to a new level. With city playgrounds shut down and a longing to be out of the house, we bought a hiking pack to carry our baby with us and hit the trails. There are days when we leave the trails exhilarated, having seen something extraordinary or beautiful. So, I hope we keep this up, even now, when it’s safer to be inside with other people again.

Frequently Asked Questions about COVID-19 — March 30, 2022

“Shared expectations lead to predictability.”

506.  It is uncertain if the more infectious BA.2 subvarient will cause a surge.

         Q:  Is another surge in Covid-19 cases possible?

         A:  The New York Times on March 23 published an article assessing the possibilities of yet another Covid surge.  Reporter Jonathan Wolf identified that barely two months after the Omicron wave, U.S. epidemiologists are already warning of another swell in the pandemic.  Though Covid case numbers are falling in most of the U.S., scientists warn that the quiet may soon give way to another surge driven by an Omicron subvariant, BA.2. It is already fueling an increase in cases in 18 countries, including Britain, France, Germany, and Italy.  BA.2 is more contagious than the version of Omicron that just spread through the U.S.  Some places like New York City are seeing early signs of cases ticking up, though at very low levels overall.  And BA.2 is quickly becoming more prevalent in many places.  But whether that turns into a wave — as some countries in Europe are seeing — is hard to know for sure.  Jonathan states, “There are a few possibilities. Some experts predict that a BA.2 wave could come as soon as April, or perhaps later in the spring or in the early summer.  Spring is also when people do more socializing outside, which could slow down transmission somewhat.  A worst-case scenario is that the U.S. follows the path of the U.K., where not only have cases surged, but so have hospitalizations,”  The U.S. has vaccinated and boosted people at lower rates than Western Europe, and Americans are dying from Covid at far higher rates than people in other European countries.  Experts worry that those low booster and vaccination rates, especially in older people, could put the U.S. in a vulnerable position once BA.2 takes hold.  Plus, there’s the fear that some parts of the U.S. have effectively been without restrictions for months and this could speed a rise in cases.  Many epidemiologists have expressed concern that instead of preparing for a possible new surge, US officials appear to be relaxing their efforts.  The result would be a rapid loss of control should a new surge begin with greater numbers of serious cases and death than happened just last January.

507.  America is about to test how long the “new normal’ can hold.

         QAre the new CDC guidelines effective in reacting quickly if a new variant emerges?

         A:  The scientific consensus is that the general public has accepted a loosening of mask mandates even if this means the number of serious cases and deaths from Covid result.  “Whenever it arrives, the next surge could put the country’s tolerance for disease and death in full relief,” states Katherine J. Wu, a staff writer at The Atlantic.   She continues, “Outbreaks have erupted across Asia.  Massive swaths of Europe, including the United Kingdom, are firmly in the grip of a more transmissible Omicron subvariant called BA.2.”  As early as last week, several states’ wastewater-surveillance sites are witnessing a rise in viral particles, which, in previous waves, has predicted an increase in documented infections.

Katherine explains, “However it manifests, the next American surge will be a stress test of the nation’s new COVID strategy, a plan that focuses on mitigating severe disease and death, and almost nothing else. Places that follow the CDC’s lead will let infections climb, and climb, and climb, until they’ve seeded a rash of hospitalizations, with more to follow. Only then will our new guidelines say that’s enough.  By the time the government says that it’s time to act, any wave we experience will be well underway. Whatever happens next, we’re living the reality the CDC’s guidance bargained for. The country’s new COVID rules have asked us to sit tight, wait, and watch. We may soon see the country’s true tolerance for disease and death on full display.” Katherine gives an example. “On the CDC’s risk map, the state of New York, for instance, where cases have been gently moseying upward for about a week, remains awash in a uniform shade of green—denoting ‘low’ COVID-19 community levels.  Counties would need to clear 200 new cases per 100,000 people over a seven-day period to warrant a flip to the yellow tones of ‘medium.’ At that point, the CDC would suggest that people who rub elbows with folks at high risk for severe disease might want to consider self-testing or masking indoors.”

508.  Americans want to return to normal.  But they also don’t want Covid to return.

         Q:  What does public polling show people want for CDC guidelines to work?

         A:  Natalie Jackson, the director of research at Duke University’s Public Religion Research Institute, recently explored polling information on the new CDC guidelines.  She reported that recent opinion surveys give mixed messages about how Americans perceive the current state of the pandemic, and what they think we should do about it.  In a February Washington Post/ABC News poll, for example, 58 percent of Americans said that controlling the spread of the coronavirus is more important than loosening restrictions on normal activities. Yet, in a Yahoo News/You Gov poll conducted the same week, 51 percent said we need to learn to live with COVID-19 and get back to normal.

These are examples that show Americans have seemingly conflicting views about the pandemic.   She next set out to answer the question: is it the polls or the American people who are confused? And what do Americans really think?

She ruled out that the polling was flawed and do give reliable results.  COVID surveys, however,  do provide a muddy picture of how people are thinking about the pandemic. She found an example by answers given that show if the government decides to require masks, these people are okay with it.  At the same time, if the government decides not to require masks, they’re okay with that too.  In conclusion, she finds that what these recent polls show is that no single question can capture public opinion on COVID-19.  Americans express a strong desire to get on with life, but also believe that COVID remains a real problem.  Americans’ attitudes are complex because the issues involved are complex.  If Americans can agree about anything, it’s that this complexity is here to stay. According to the Kaiser Family Foundation poll, 78 percent of Americans believe that “normal” life will look different than it did pre-pandemic.

509. Current federal funding for Covid-19 is nearly exhausted.

         Q: With all the experiences of two years, aren’t we better prepared for future outbreaks?

         A:  “All epidemics trigger the same dispiriting cycle. First, panic: As new pathogens emerge, governments throw money, resources, and attention at the threat. Then, neglect. Once the danger dwindles, budgets shrink, and memories fade. The world ends up where it started, forced to confront each new disease unprepared and therefore primed for panic.”  Ed Yong, staff writer for the Atlantic made this observation in a recently published article.  Now, he has observed that this cycle is returning with accelerated rapidity.

This week, Congress approved a 1.5 trillion spending bill but did so after removing $15 billion in coronavirus funding.  The bill without Covid funds was later signed into law.  Young stated, “The decision is catastrophic, and as the White House has noted, its consequences will unfurl quickly.”  Yong continued, “The government will no longer be able to reimburse health-care providers for testing, vaccinating, or treating millions of uninsured Americans…”  As early as June, domestic testing will be at risk.  Free doses won’t be available of antiviral pills that immuno- compromised people need.  Vaccines in poor countries will be curtailed.  If the FDA approves further booster shots, they may have to be paid for by the patients.  He concludes with the thought, “A country that so readily forgets its dead is surely prone to also forgetting the lessons of the all-too-recent past, setting itself up for further failure in an all-too-imminent future.”

510.  Cardiac complications from breakthrough covid cases are being explored.

         Q:  Are there any complications from even mild breakthrough Covid cases?

         A:  The Sunday March 20 Tampa Bay Times newspaper gave front-page exposure to a trend that scientists have been investigating for some time.  The headline: “Did Covid Attack his Heart?”  Juan Sosa 58, who had been previously vaccinated, had just gotten over a mild case of Covid-19.  Then came a heart attack  He barely survived.

His case fits a similar pattern among Covid-19 patients nationwide.  Several studies have shown that the virus can damage the heart.  A study in 2020 published in The Lancet found that the risk of a first heart attack increases between 3 and 8 times in the first week after a Covid-19 infection was diagnosed.  That study followed nearly 87,000 people in Sweden during an eight-month period.  Their risk of stroke also increased up to 6 times.    Another study published in Nature Magazine a month ago looked at health data from the Department of Veterans Affairs for about 153,000 veterans who contracted the virus.  Researchers found they suffered from an elevated risk of severe heart conditions for up to a year afterward.  They had a 53% higher risk of stroke, 63% higher risk of heart attack and 73% increased risk of heart failure.  Even mild breakthrough cases were included in the data.  Richard Becker, MD, director of the Heart, Lung and Vascular Institute at the University of Cincinnati College of Medicine is a leading researcher on this topic.  He concluded, “The potential for long-term cardiovascular risk is of great concern.”

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

“Shared expectations lead to predictability.”

501.  Accepting the new CDC guidelines differs if people are liberal or conservative.

         QWhy is acceptance of the new CDC guidelines supported by so many?

         A:  David Leonhardt, a reporter for the New York Times, published an article last week that identified the attitude toward returning to normal more rapidly was influenced by their ideology of liberalism vs. conservativism.  It had been previously thought that Republicans were more apt to fight vaccinations and masks while Democrats were more likely to want them continued.  But each party has been showing a division within its ranks, and a recent poll reinforces that the liberal to conservative views of people is a stronger indicator of seeing the threat of Covid now as being at different levels of risk.  Views that spread from eagerly getting shots while others delay and refuse; between those who believe Covid precautions should continue and those who favor rapid moves to normalcy.

In this poll of 2,200 adults conducted earlier in March 2022, each person self-identified their views as being one of seven categories: Very liberal, Liberal, Slightly liberal, Moderate, Slightly conservative, Conservative or Very conservative.   The responses to several questions were then recorded.  The results show that 45% of those who were “very liberal” felt that “Covid poses a great risk to their health and well-being,” while 21% of those identified as “very conservative” felt this way.  More than 60 percent of very liberal Americans believe that mask mandates “should continue for the foreseeable future.” Most moderates and conservatives see mandates as a “temporary strategy that should end this year.”

502.  Public health for Covid-19 is moving from protection to personal preference.

         Q:  Why does political ideology so strongly shape Covid beliefs?

         ADonald Trump certainly plays a role. As president, he repeatedly made false statements downplaying Covid. Many Republican voters adopted his view, while many liberal Democrats went in the other direction. But Trump isn’t the only explanation. Every group of Democrats disdains him, yet some Democrats disagree about Covid. Apart from Trump, the pandemic seems to be tapping into different views of risk perception.  In recent years, these progressives have tended to adopt a cautious approach to personal safety.  It is especially notable in child-rearing. Parents seek out the healthiest food, sturdiest car seats and safest playgrounds. They do not let their children play tackle football, and they worry about soccer concussions. A cautious approach to personal safety has big benefits. It has helped popularize bicycle helmets, for example. In the case of Covid, very liberal Americans have been eloquent advocates for protecting the elderly and immunocompromised and for showing empathy toward the unvaccinated.  Yet the approach also has downsides. David Leonhardt states in his recent New York Times article, “It can lead people to obsess over small, salient risks while ignoring bigger ones. A regimented childhood, with scheduled lessons replacing unstructured neighborhood playtime, may lead to fewer broken bones, but it does not necessarily maximize creativity, independence or happiness.  When it comes to Covid, there is abundant evidence that the most liberal Americans are exaggerating the risks to the vaccinated and to children.  Consider that many liberals (including Sonia Sotomayor) feel deep anxiety about Covid’s effects on children — even though the flu kills more children in a typical year and car crashes kill about five times as many.  Long Covid, similarly, appears to be rare in both children and vaccinated people.”

This, of course, doesn’t address the science that indicates immunity from vaccinations and boosters wane over time, and this has been identified as an actual increasing risk.

503.  A variant already here may cause a new surge – but nobody can be sure of it.

         Q: When could we find a new variant that could make us go back to lockdowns?

         A:  There are an increasing number of articles appearing lately about several countries that are now experiencing surges of Covid-19 cases caused by a subvariant referred to as BA.2.  For example, it was recently reported that New York City has found that 30% of its reported cases were caused by the BA,2 subvariant that is more infectious than the original Omicrom variant.  On March 17, Rachel Gutman published an article in The Atlantic that attempted to present a balanced view.  But the title of the article, “Another COVID Wave Is Looming – How Bad Will It Be?” reveals the concern that is rising.  She writes, “About three weeks ago, COVID case rates in the United Kingdom made an abrupt about-face, spurred on by a more transmissible Omicron subvariant called BA.2.  Case rates are rising, too in Switzerland and Greece and Monaco and Italy and France. Given that BA.2 is already present in the United States, The Washington Post reports that epidemiologists and public-health leaders suspect that North America will be next. After all, the paper said, “in the past two years, a widespread outbreak like the one in Europe has been followed by a similar surge in the United States some weeks later.”

Rachel goes on to say that not all surges in Europe have been followed by rising cases in the U.S.  She cites that different vaccines used here, but not in Europe, may have different effects.  Also different have been the earlier more strict steps taken in this country than many European countries have imposed.  “There are a number of things which tug the U.S. experience away from the European one,” Bill Hanage, an epidemiologist at Harvard, said in a recent press call.  Rachel concludes. “The fact that Europe has, at times, been two steps ahead of us might come down to chance.”

Predicting the future of disease behavior faces difficulty in accounting for how policy and Americans’ behavior would change, says Lauren Ancel Meyers, who directs the COVID-19 Modeling Consortium at the University of Texas at Austin. He stated he is not yet sure about the BA.2 variant,  “We’ll know… only after it’s over and case rates climb up again.” Meyers said he expects to have better predictions in a week or so.  In other words, no one can predict now if we are about to see another surge in cases.

504. 35 companies sign on to produce generic versions of Pfizer’s Covid pill.

         Q:  Have any COVID therapeutics been authorized to be made generically?

         A:  Thirty-five manufacturers around the world have signed agreements to produce generic versions of Pfizer’s Paxlovid Covid pills and sell them inexpensively in 95 lower-income countries that together are home to more than half the world’s people.  The United Nations-backed organization responsible for encouraging pharmaceutical companies to release their patent rights and allow generic copies to be produced made the announcement last week.  Paxlovid is for treating Covid, not preventing it.  Because it is made in pill form and can be taken at home, Paxlovid is much easier to distribute than treatments like monoclonal antibodies that are typically given intravenously.

A course of Paxlovid involves taking two drugs in concert, in a total of 30 pills over five days. Twenty of the pills contain the principal drug, nirmatrelvir, which was developed by Pfizer.  The other 10 pills in the treatment contain a low dose of ritonavir, a generic H.I.V. drug that slows the breakdown of nirmatrelvir so that it remains active in the body longer.

The UN organization reached a similar deal with Merck for its Covid pill, molnupiravir, to be made by other manufacturers and sold inexpensively in 105 lower-income countries. Twenty-seven generic drug makers in 11 countries have signed on to produce molnupiravir for that effort.

505. Moderna and Pfizer ask FDA for authorization for a second booster for adults.

         Q:  When can I get a second booster?  I got the first one last October.

         A:   Last week Tuesday, Pfizer and Moderna asked for emergency authorization for a second booster for those 65 and older. Federal health officials have said they are concerned about the waning potency of the booster shot that was authorized last fall.  About 48 percent of eligible American adults, or 93 million people, have gotten booster shots, according to the C.D.C. More than two-thirds of those 65 or older who are eligible have gotten them.

Peter J. Hotez, MD, a vaccine expert at the Baylor College of Medicine in Houston, said, “I’m a strong proponent of giving a second booster now.”  He said the first booster shot had “made a huge difference” in bolstering protection against hospitalization and even infection from the Omicron variant.  “It’s also clear that protection is waning now pretty quickly a few months after your third dose,” he said. “So it’s short-lived. The hope is that a second booster would restore it.”  Some scientists oppose the move right now, stating that studies have yet to determine if serious disease is associated with waning immunity. Given the anxiety over the new CDC guidelines, for many whose boosters were given many months ago, approval may easily provide some relief.

 

Frequently Asked Questions about COVID-19 — March 16, 2022

“Shared expectations lead to predictability.”

496. Ambulance wait times are as long as a day in Hong Kong.

         Q:  Is the surge in Omicron variant cases diminishing worldwide?

         A:  Europe and the U.S. have nearly recovered from the surge attributed to the Omicron variant, but this is not the same around the world.  Hong Kong’s hospitals, doctors and nurses are stretched thin from a recent massive surge in Covid-19 cases.  One-third of its ambulance workers have tested positive for the coronavirus or are quarantining because they were in close contact with positive cases. That’s nearly 1,000 employees, said Saphine Yip at the Fire Services Department.  The longest wait time for an ambulance was a day and 15 hours, she said.  Officials are battling the city’s worst coronavirus outbreak, with 56,827 cases reported last Thursday. The city has recorded 1,153 deaths since the Omicron variant began to spread in January, and a majority of deaths have been among the older people who are not vaccinated.

For much of the pandemic, Hong Kong avoided huge outbreaks by employing tough border controls and social distancing rules. For the better part of the past two years, officials recorded single- or double-digit daily cases, and most of those were considered imported cases from travelers who had recently arrived in Hong Kong and were still in quarantine.

497.  Australia is also considering its “new normal” by lifting Covid restrictions. 

         Q:  Are  other countries accepting the new normal of only preventing hospitalizations? 

         AAustralia, in the Southern Hemisphere, now facing the winter season, is considering relaxing its pandemic rules, including quarantine requirements for close contacts of people who test positive for the coronavirus.  The country is shifting from trying to prevent transmission entirely to protecting those at risk of severe illness, health officials said two weeks ago Friday.  About Covid-19, “It’s not over, and there will inevitably be new variants, and there will inevitably be a level of virus within the community going forward,” Greg Hunt, the country’s health minister, told reporters in Australia. He also urged people to get booster shots as the country continues its vaccination campaign.

The considerations come after Australia had been facing its largest outbreak since the pandemic began. The country was reporting an average of 29,422 new daily cases according to the Center for Systems Science and Engineering at Johns Hopkins University.  However, the average number of deaths has declined over the past two weeks.  This was probably influenced by 94 percent of the population over age 16 having received a second dose and nearly two-thirds of eligible people having received a booster.

498. Public health policy has officially changed in combating Covid-19

         Q: Why aren’t masks and other methods part of protecting the community any longer?

         A:  As cases across the country plummet, more states are lifting mask mandates — and schools are following suit.   New York City officially announced the end of its school mask mandate for children over 5 years old last week. Also, Maryland, Delaware, Massachusetts, New York State, and Connecticut ended mask requirements, and by mid-March, they will also be gone in California, Oregon, Washington State, and New Jersey.  In part, this move has political roots.  People do not like being told what to do.  Politicians find this an attractive target to organize their reelection campaigns around, and recent court decisions banning mask mandates force other politicians to consider dropping their arguments promoting masks.  The fact that the prevalence of infections in schools is dropping also encourages removing mandates. This political and cultural momentum has caused leaders to accept that Covid-19 cannot be eliminated.  From this, there is the tendancy to shift from preventing infections to, instead, preventing serious disease, hospitalizations, and deaths.

499. Switching from prevention to controlling Covid-19 alters public health practices.

         Q:  How do we reduce the number of new infections if we don’t include wearing masks?

         A:  A recent article in The Atlantic stated – “And just like that, the national attitude on COVID is flipping like a light switch. As the United States descends the bumpy back end of the Omicron wave, governors and mayors up and down the coasts are extinguishing indoor mask mandates and pulling back proof-of-vaccination protocols. In many parts of the country, restaurants, bars, gyms, and movie theaters are operating at pre-pandemic capacity, not a face covering to be seen; even grade schools and universities have started to relax testing and isolation rules. These policy pivots mirror a turn in public resolve: Two years into the pandemic, many Americans are ready to declare the crisis chapter of COVID-19 over, and move on.”

The article continued, we’ve been at similar junctures before—at the end of the very first surgeagain in the pre-Delta downslope. Each time, the virus has come roaring back. It is not done with us. Which means that we cannot be done with it. What’s up ahead is not COVID’s end, but the start of our control phase, in which we invest in measures to shrink the virus’s burden to a more manageable size. “This is the larger, longer game we’re having to think about,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, stated. But, the article continues, we must reinvent public health because our present system does not have the tools needed to control a disease. Public health has tools to prevent diseases.  After a detailed analysis of what is needed, the conclusion is reached that if a new infectious disease or a variant emerges, it will be difficult to control unless and until its rapid spread can first be prevented.  Installation of required ventilation systems at all indoor venues is one answer that illustrates the cost it will take to reinvent public health.

500. The seven habits of the most Covid-resistant countries.

         Q:  How come some countries have fewer Covid cases and deaths than we do?

         A:  Uri Friedman, the managing editor at the Atlantic Council, recently wrote an article published in The Atlantic identifying the seven habits of Covid-resistant nations.  South Korea, New Zealand, and the Nordic countries have fared better resisting the effects of Covid-19.  Below are the broad lessons that other countries could learn from.

  1. Learn from past shocks to prepare for the next crisis.

In 2015, an outbreak of Middle East respiratory syndrome (MERS), also caused by a coronavirus, gave confidence in applying ways to prevent the virus from spiraling out of control. Other countries without this experience were either panicking or complacent.

  1. Channel scientific and other expert advice into policy and strategy.

As Sridhar, the public-health expert, has argued, Korea’s short-term focus on “maximum suppression helped buy time for scientists” to gain control early.

  1. Follow the data in real-time.

Rapid responses depend on governments responding decisively to fluid realities. That, in turn, requires a commitment to know and follow current data.

  1. Communicate clearly and transparently with the public.

New Zealand has been the world’s brightest star for crisis communications during the pandemic.  South Korea consistently conveyed a coherent strategy to its people.

  1. Cultivate public trust in government and fellow citizens.

Scholars have discovered correlations between countries’ resilience to COVID-19 and their levels of trust in government and within society.

  1. Design centralized systems sensitive to local concerns.

Countries that were centralized but carried out programs through local authorities found they were empowered to find solutions that work at the local level.

  1. Recognize that no country can cope with shock entirely on its own.

South Korea’s commitment to continuous learning, scientific expertise, and following the data extended  to assimilating insights from other countries as well.