JN.1

It’s been four years since the first cases of COVID-19 were confirmed in the US but it’s still a major health issue. While vaccines, treatments, and preventative measures have made the current situation less severe than the initial onslaught of SARS-CoV-2, people are still getting sick, with some needing to be hospitalized and some, unfortunately, succumbing to the disease, including the person I referenced in this post. In the week of Dec. 31, 2023-January 6, 2024, COVID caused 4% of all deaths in the United States.

The virus continues to mutate. The current strain that is dominant in the United States and globally is JN.1, which is related to the BA.2.86 variant of Omicron. The good news is that the most recent vaccine, which is based on the related XBB lineage, is a good match for JN.1, so the vaccine significantly reduces the risk of severe symptoms, hospitalization, and death while offering some protection against infection. The bad news is that, in the United States, only about 8% of children and 19% of adults are estimated to have received the newest vaccine, contributing to a surge of cases, amplified by holiday travel and gatherings.

More good vaccine news. This large study from Sweden concludes that vaccination reduces the risk of developing long COVID and that additional vaccine doses reduce risk even more. As someone who has particular concerns about long COVID, I appreciate that these studies are continuing to increase our understanding.

Another recent study shows that the Omicron variants don’t cause peak viral loads until day 3-4, much later than the earlier strains of the virus. The practical implication of this is that at-home COVID tests may not pick up a positive reading until several days into the illness, during which time the person could be infecting others. It also has implications for prescribing anti-virals, which need to begin within the first five days of symptoms to be effective. For me, this is a reminder to mask around other people whenever I have symptoms, as an early negative test might not be accurate.

A study published just a few days ago seems to put some science behind what we have all experienced, that SARS-CoV-2 doesn’t have a “season” in the way that some other viruses, like influenza, do. Changes in temperature and humidity don’t appear to have significant influence in transmission. This seems to go along with what we have experienced in the United States, with major waves happening in different seasons of the year. We’ve had waves in the heat of summer as well as the cold of winter. This suggests that our current winter wave is due more to low vaccination rates and holiday travel and gatherings than to the fact that it is winter. It also highlights the importance of increasing ventilation and using masks in crowded indoor spaces, as both summer heat and winter cold tend to drive people to gather indoors.

Four years in, I’ve written a lot of COVID-19 posts. From my days as part of the Pfizer/BioNTech vaccine trials through the present, I’ve always tried to give the most updated information and public health guidance available. It’s frustrating that there is less information from the Centers for Disease Control and Prevention than when the state of emergency was still in effect but some useful recent data can be found here. A lot of the information in this post came to my attention through this post from Dr. Katelyn Jetelina, writing as “Your Local Epidemiologist” and this post from Those Nerdy Girls.

Through all these challenges, especially when spouse B had the first case of COVID in our house in November, I’ve managed to avoid infection, unless I had a totally asymptomatic case at some point. I use my research to make decisions about vaccination, masking, crowd avoidance, etc. that are right for me and my family. I don’t think that advocating for health measures ought to be seen as controversial or political. There are, though, forces in the US that have warped disease prevention into a political test. It’s very sad that Republicans are more likely to die from COVID than non-Republicans. Please, don’t put your health and the health of your family and neighbors at risk over politics. COVID-19 is still out there. Take care of your health and your loved ones.
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Energy, exercise, mitochondria, long COVID, ME/CFS, etc.

I almost started to cry when I heard this piece on National Public Radio’s Morning Edition. (The audio clip is at the link, as well as a written transcript which may offer a bit more information than the audio in addition to links to the studies cited and to people providing commentary.)

The piece discusses that people with long COVID have physical changes in their tissues that showed cause for their exhaustion or “post-exertional malaise.” The mitochondria in the muscle cells were not functioning properly, so the muscles could not get the oxygen and energy they needed. It appears that this mechanism is also at work in people diagnosed with ME/CFS and other similar, poorly understood syndromes that exhibit these symptoms.

A member of my family was diagnosed with ME/CFS, then called fibromyalgia/chronic fatigue syndrome in the United States, as a young adult, although she had been having symptoms since early adolescence. She was told that she needed to exercise to build her strength, which was common advice at the time but which proved to be detrimental to her. If she tried to push herself physically at all, she would wind up in so much pain and with so much fatigue that she could barely move for a week or more. As I was listening to the radio piece, I was thinking back to those days, when she was so debilitated that we would strategize when or if she could join the family from her upstairs bedroom because she could only manage the fourteen stairs between the levels once a day, at most.

What made a terrible situation worse was that the doctors would think she “wasn’t trying to get better,” essentially blaming her for her condition when the root of the problem was their lack of understanding of ME/CFS. Effort or mental attitude is not going to repair one’s mitochondria.

I appreciate that research money going to study long COVID is also increasing understanding of ME/CFS and other conditions with similar symptoms. (You can read some of my prior posts referencing long COVID and its commonalities with ME/CFS here and here.) I’m hoping that increased understanding will bring more effective treatments and, at least, an end to blaming patients for “not trying hard enough” to get better.

Compassion is needed in these situations, not judgmentalism.

Compassion is always needed. 
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another COVID-19 risk

I had saved this article on a research study that showed that SARS-CoV-2, the virus that causes COVID-19, can directly infect coronary arteries, which may help to explain the increased risk of heart attack and stroke among people who have contracted it.

It came to mind now because we received news that a friend’s family member with COVID has suffered a heart attack.

While it’s not known if infection and inflammation of the coronary arteries caused this particular person’s heart attack, it is a stark reminder that COVID can cause serious health complications. Way too many people are still getting sick and dying from it.

While there are no iron-clad ways to avoid infection, preventative measures like vaccines, avoiding crowds, and masking in indoor public spaces reduce your chances of infection and its follow-on risks.

Even if you don’t care about your personal risk of infection, remember that you could pass the infection on to someone who may be more vulnerable than you due to their age or underlying health condition. I know this has been a powerful motivating factor for me.

Please do what is right for you to protect yourself and others to the greatest extent possible.
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Join us for Linda’s Just Jot It January! Find out more here: https://lindaghill.com/2024/01/08/daily-prompt-jusjojan-the-8th-2024/

One-Liner Wednesday: new antibiotics?

A beneficial use of AI is its use by MIT researchers in identifying compounds that may be able to kill MRSA bacteria.

Yes, I am enough of a geek to be excited about sharing this news for Linda’s One-Liner Wednesday! To join in, visit here: https://lindaghill.com/2023/12/27/one-liner-wednesday-that-time-again/ 

still positive

Spouse B is still testing positive for COVID on Day 11, although the line on the test kit is fainter so maybe he is getting closer to the two negative tests 48 hours apart to be ready to be unmasked together without worry.

Not sure yet what we will do about Thanksgiving. It will just be the three of us and we were planning to do something other than the traditional turkey dinner. Maybe we will just postpone until we can all eat together in the same room. T and I have been eating in the dining room while B sequesters himself in his office at mealtimes.

We all remain grateful that his symptoms were relatively mild and short-lived but we are anxious to actually spend time together again. We are also grateful that T and I aren’t infected but we want to make sure we remain cautious. B would feel so badly if his case spread to us because we got tired of following protocol. Given the length of time that has passed, we all realize T and I dodged catching it when he was infectious before and in the early hours of the symptomatic phase.

So, at least, three more days of masking in our future.

I might need to order some more KF94 masks…

(COVID Photo by Martin Sanchez on Unsplash)

YAG x 2

In April, I had cataract surgery on both eyes with fancy, extended depth of focus implanted lenses.

Things went well and I’m not wearing glasses full-time, which hadn’t happened since I was six. However, I have run into a couple of common aftereffects that I’ve been dealing with over these past months.

One is an aggravation of my existing problems with dry eye, which I whined about a bit here. We are treating it in several ways and it is improving.

The other was that I developed some filminess or cloudiness in my vision due to posterior capsule opacification, also known as secondary cataracts. The treatment is to use a YAG laser to make an opening in the capsule to allow light through and rectify the cloudiness. (YAG stands for yttrium aluminum garnet.)

I had YAG treatment in both eyes earlier this month and I’m happy to report that it worked well for me. The filminess is gone, which is great because we weren’t sure if part of that was due to the dry eye. I do have increased floaters in my eyes which will probably calm down over the next few months.

I’m able to read my computer without enlarging the text for the most part now and, for the first time ever, made it through a choral rehearsal on Sunday without glasses. I do have a pair of glasses that I can use for fine print and low light situations, as those will continue to be challenging even when all the healing is complete.

It’s been a joy to be able to see without devoting extra brain power to assist. Over these past months, I’ve been having to concentrate consciously on visual processing. It’s been tiring. I’m grateful to be able to look around and just be able to see what’s in front of me without extra effort.

One of these days, I might even get a new headshot taken without glasses, even if it takes a bit for me to recognize myself after 57 years of wearing glasses all the time…

out of luck

I’m sad to report that, despite our best efforts, we finally have a case of COVID-19 in the house.

My spouse B tested positive yesterday. We think he was exposed at an in-person work event on Wednesday.

We are taking precautions to isolate from each other but daughter T and I were both exposed to B before he developed symptoms when he was probably infectious, so it’s a waiting game at this point. We’ll be testing before going out in public and masking when we do to avoid infecting anyone else, in case we are pre-symptomatic.

So far, B has had fever and symptoms similar to a bad cold. Our primary care practice wants to hold off on prescribing Paxlovid but will if his condition worsens over the next couple of days.

I knew our luck would run out one day but I’m upset and worried to have COVID in the house. Because I’ve been reading about it and observing the twists and turns in its history since the beginning, I know that things sometimes go very badly, even in someone who is healthy and up-to-date on vaccines, so…

Photo by Martin Sanchez on Unsplash

age and/or competence

Here in the United States, there is lots of discussion and public opinion polling around whether there should be an upper age limit for the presidency and other powerful federal positions, such as Supreme Court justices.

This is sometimes termed more simply as “Is Joe Biden too old to run for re-election?” Joe Biden is currently 80. Donald Trump, current leader in the race for the Republican party nomination, is 77.

Thirty-five is the Constitutional minimum age for the presidency, presumably to allow the president to have gained some measure of life experience and maturity to handle such a demanding position, but there is no upper limit specified.

I prefer that there not be one.

Rather, I want to be able to look at the personal qualities and policy positions of the candidate. Their physical and mental health status is part of that analysis.

Age is not necessarily a good indicator of health status or fitness. Joe Biden, as evidenced by his physical examination results from February, 2023, does not have major medical issues. His gait is stiff due to some arthritis. He works out on a regular basis. He has been able to keep up a rigorous daily schedule, including frequent travel, both domestically and internationally.

The president has a stutter; sometimes, his word pacing and choice are efforts to compensate. That we seldom hear him stutter is a testament to the work he has done over the years to address this issue. There is no evidence of cognitive impairment.

Of course, not all recent presidents have been as extensive in reporting their physical exam results. Donald Trump’s results were not reported in detail.

In the more distant past, the physical condition of the president was often kept private. For example, the public did not know the extent of damage caused by Woodrow Wilson’s 1919 stroke. Franklin Roosevelt’s post-polio condition was kept out of the public eye as much as possible. Not even Harry Truman as vice-president knew how ill FDR was with cardiovascular disease before his death in 1945 at age 63.

My mother, who had experience with family members dealing with cognitive decline, observed that Ronald Reagan’s behavior and speech while he was president reminded her of someone who was developing dementia. She was not surprised when his diagnosis with Alzheimer’s disease was made public five years after he left the presidency. There was a lot of debate about when Reagan’s cognitive decline began and there is no definitive determination, although some analysis has shown that his speech patterns changed over the years of his presidency in ways that indicate cognitive decline. Reagan was 77 when he left office at the end of his second term.

So, circling back to the present debate on the age of presidential candidates, it seems to me that age alone is not a good indicator of health or fitness for the rigors of the presidency. President Biden seems to be doing well at age 80 with both the physical and mental demands of the job. I also appreciate his even temperament and moral grounding, which, as a fellow Catholic, I recognize as rooted in Catholic social justice doctrine and in line with the American concept of working for the common good, articulated in the Constitution as a call to “promote the general welfare.”

On the other hand, when Donald Trump was president, he was not known to keep a very rigorous schedule of official duties. He didn’t seem to understand the complexities of the job, such as dealing with classified materials. He was volatile and resorted to bullying, name calling, and lying to try to get his way, regardless of facts, laws, or policies. Sometimes, when he is speaking without a teleprompter, he doesn’t seem able to construct cogent sentences. I don’t know if there is a medical diagnosis that elucidates these behaviors or not, but I don’t think his age is the salient factor.

While I would prefer younger presidential candidates, in their fifties or sixties perhaps, it is much more important for me that the president be someone who is dedicated to the American people and the rule of law, trying to do what is right for the good of the country and protecting those who are under threat.

If that person happens to be 80-something, so be it.

One-Liner Wednesday: booster

Today, I’m getting my sixth dose of Pfizer/BioNTech COVID-19 vaccine, this one targeting Omicron variant XBB.1.5 and shown to be effective against other currently circulating Omicron sub-variants. Please consider joining me if your health professional or public health agency recommends it for you.
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This public health message is brought to you as part of Linda’s One-Liner Wednesdays. Join us! Find out more here: https://lindaghill.com/2023/09/20/one-liner-wednesday-the-ultimate-404-error/

Two years without Paco

I work up in the very early morning darkness today thinking about my father, known here and in real life for the last 33-ish years of his life as Paco, the name bestowed on him by my firstborn and his first grandchild E as she was learning to talk.

I suppose this is not surprising because this is the second anniversary of his death. You can read a tribute that I wrote to him a few weeks after his passing here.

What is unfortunate is that in the early morning darkness in which I am now writing this post I am remembering so much of his final years, when I was struggling to get proper support and medical care for him, exacerbated by the pandemic. Even though I was living locally, there were long stretches in which I could not visit in person at all or only for short amounts of time. Phone and video calls were often frustrating, as you can tell from this poem, which was first published in Rat’s Ass Review.

Video Chat with our 95-year-old Father

You said it was scary
today
that we were there

in your bedroom
your three daughters
in pulsating squares

on a screen
You remembered where
home

is for each of us
but not where
it is for you

confused that you
could see us
hear us

but we were not
there
with you

We talked about the snowy
winter, so like our New England
childhoods, when you would

wrangle your orange
snowblower to clear
our way out

We asked if the cut
and bruise on your hand
had finally healed

if you had finished
all the Valentine
goodies we’d sent

Distracted
by a sound
from the living room

you set the tablet
aside
left us

staring at the ceiling

What was most difficult was that, no matter how hard I tried, I couldn’t secure correct diagnoses or treatments for Paco, illustrated by the fact that his death certificate states that he died from end-stage heart failure, but he was only diagnosed with heart failure about ten days before he died. I had been trying for months to tell the staff at his assisted living and then skilled nursing units of his continuing care community that he was having unexplained symptoms and had accompanied him to outside doctors and emergency room visits, when the pandemic protocols allowed me to stay with him, but it was never enough to get to the bottom of his health difficulties.

I thought I had worked my way out of most of the trauma of that but, in the early morning darkness of this anniversary day, apparently there is still some of that pain left. It’s not that I think I could have further prolonged his 96 years – something that would not have served any of us – but that his final months would have been so much easier for him if he could have received timely, proper diagnosis and medications.

One of the comforts of Paco’s death was the thought of his reuniting with my mom, known here as Nana, who died in May, 2019, also of heart failure and, gratefully, before the pandemic struck. I drafted this poem, which was first published by Wilderness House Literary Review, only a couple of weeks after Paco’s death.

We probably should have taken off					

his wedding ring before
he died		    before
his hands cooled	      started
to claw
but we couldn’t		       remove
that symbol
			of Elinor
	of two years
		   three months
			twenty-three days
						left
without		her
after
	sixty-five years
		      one month
			   three days
married to her
			the ring
				of her
even    in    days    of    delirium
	    haze			confusion

his ring		not
	sixty-seven years	  old
		but	   twenty
her gift 	         a remedy
	 for missing		some		thing
		of his
  to cling to 		during his three weeks
			       in the hospital
his chest cracked			 open
     		widow-maker averted
				somehow

She inscribed 		his ring	
      ALL MY LOVE  “ME”
     the way she signed 	cards to him
birthday	anniversary	  Christmas
	St. Patrick’s Day
		valentines
the words against his left
	ring finger		believed
to lead most directly to the heart
	which finally failed
		after ninety-six years
			five months
				nineteen days
as hers had
	after eighty-seven years
		     six days

While I go to the sink
to fetch soap 		to ease
the ring off 	his finger
my sister works
it over	 his reluctant 	knuckle

I carry it 	home 
to my daughter
Elinor’s and Leo’s rings
	   unite
on their granddaughter’s finger

[For those of you who might be new to Top of JC’s Mind, I will note that it is really unusual for me to fold poems into posts like this, but somehow, in the early morning darkness, it seemed appropriate.]

I’ll close this post by explaining the significance of the four-generations photo, taken a few weeks before Paco’s death, that begins this post. It shows Paco, me, eldest grandchild E who named Paco, and great-granddaughters, then 4-year-old ABC and just turned 1-year-old JG. This was the first and only meeting of Paco and JG, who had been born in London, UK, in the early months of the pandemic. ABC lived here in the States with us for her first two years and remembered Paco very well. The restrictions on international travel had kept E and her family from visiting but they were able to get special permission to travel together to come visit Paco one last time.

Paco’s health declined quickly after that visit and I’m so grateful that we all had that brief, sweet time together.

Remembering that final farewell through a few tears in the still-before-dawn darkness of this anniversary morning.