Category: medical care

US environmental update

Trying to get the United States back to a better position regarding climate change and environmental issues in general has been a major task for the Biden administration. While some things were relatively straightforward, such as rejoining the Paris climate accords, others have been much more difficult.

Unwinding the changes that the prior administration had made to regulations was sometimes blocked by the courts. The biggest blow was the Supreme Court decision in West Virginia v. Environmental Protection Agency, in which a 6-3 majority found that the EPA can’t regulate emissions from coal-fired power plants unless they have been given specific direction by Congress. It was odd that the Supreme Court heard the case because it was brought against the Clean Power Plan, which was proposed by the Obama administration, but never enacted. The Biden administration had no intent to revive that plan, as circumstances have changed, so it appears that the conservative majority heard the case for the purpose of striking down the manner in which executive branch agencies and departments go about executing the laws that have been passed by Congress. This ruling could bog down not only EPA work but also the regulatory work of other Cabinet departments. [Please note that this is my layperson understanding of the case and its implications. There has been a lot of legal commentary which can be found in myriad places online, if you are interested.] An August 26 post with an update on the impact of this case can be found here.

Legislation to address the climate crisis was an important cornerstone of the Biden agenda. The House of Representatives passed a strong bill dealing with climate change and the care economy, including health care, universal education for three- and four-year-olds, provisions for child and elder care, permanent expansion of a fully refundable child tax credit, and other measures for social justice and equity. The bill was paid for by increasing taxes on wealthy individuals and corporations. Unfortunately, the 50-50 split in the Senate combined with Senate rules gave a couple of Democratic senators power over what was in the bill and they opposed some of the financial and energy provisions, so it looked as though it would not pass.

This was extremely discouraging to millions of people in the US, as well as to millions in the rest of the world who are depending on US action to cut carbon in the atmosphere and provide leadership for other countries to do the same.

And then, a surprise announcement that Senator Joe Manchin of West Virginia, who made his money from coal and had shot down prior versions of the bill, had reached an agreement with Senate Majority Leader Chuck Schumer on a version of the bill that he could support. Additional changes wound up being made to get Senator Kyrsten Sinema of Arizona on board. Senator Schumer kept the Senate in session in Washington into their August recess to pass the bill with Vice President Harris casting the tie-breaking vote. House Speaker Pelosi called the House back into session to pass the bill last Friday and President Biden will sign the bill into law this week.

While the Inflation Reduction Act is not as strong as the original legislation, I’m very happy that it will become law. It should bring down energy costs over time. It is projected to lower US greenhouse gas emissions by about 40% of 2005 levels by 2030; the United States goal in the Paris accord is a 50-52% reduction, so we hope that additional measures will be enacted to reach that goal. However, before this bill, we were on track for only a 25% reduction, so this is a major improvement. This article is a good summary of some of the main environmental/energy provisions of the bill.

I am grateful and still a bit shocked that this bill is about to become law. Yes, there is more to do, both on environmental and economic justice issues, but, at least, we have made a good start. This is important because people and the planet need this help and because it shows that the Democrats are actually serious about governing in a bipartisan way when it is possible, such as with the infrastructure law, and alone, if necessary. I hope that the progress in the last 18 months will encourage voters to keep the Democrats in the majority so more can get done in the next session. Perhaps, it will even give more Republican Congresspersons the impetus to support popular, commonsense measures that benefit the public. We have all witnessed past Republican majorities who were unable to pass much substantive legislation; for example, the Trump administration announced multiple “Infrastructure Weeks” but never got close to passing legislation. We have also, sadly, seen Republican minorities block action on legislation and appointments through the filibuster and other holds and delaying tactics. I think these need to be reformed so that the Congress is not bogged down and unable to do the work our country needs to function.

As the new programs ramp up, I encourage people in the US to be on the lookout for provisions that can help them make their lives greener, whether that is rebates on efficient electric appliances, incentives to buy used or new electric vehicles, or the opportunity to purchase renewable energy at lower than current rates. Support candidates who make the health and well-being of people and our environment their top priorities. We need representatives who are looking out for us, not just corporate profits and tax loopholes.

In my district, that means voting for the Democratic candidate. Make sure that you know the candidates’ positions in your area before casting your ballot.

the aftermath of Dobbs

When I wrote this post after the leak of US Supreme Court Justice Alito’s draft opinion on an abortion law in Mississippi, we weren’t sure if there would be changes before the decision was announced.

When the decision was announced on June 24, it was little changed from the draft. The majority signed on to the opinion that Roe v. Wade had been “wrongly decided” and threw the matter of the legality of abortion to each state’s legislature.

It’s not that long-standing Supreme Court precedents have never been overturned or declared “wrongly decided” – the Dred Scott decision springs to mind – but the Dobbs case was the first time that such a reversal came at the expense of a recognized right.

Many lawyers and Constitutional scholars have faulted the majority’s decision on historical and legal grounds, as Alito seems to cherry-pick sources in support of his view while ignoring the mainstream history and scholarship to the contrary. For example, while it is true that the Constitution does not specify a right to an abortion, it also never uses the word “woman” or “family.” There are many rights that have been recognized by the courts over the centuries that are not specifically cited in the Constitution under the Ninth Amendment which states “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” The right to privacy and to bodily autonomy belong to each person and should not be under the jurisdiction of the government at any level. The Alito opinion also seems to violate the Thirteenth Amendment against involuntary servitude and the Fourteenth Amendment which promises “equal protection of the laws.”

While Alito said that abortion was a unique situation in terms of privacy protections, Justice Clarence Thomas wrote a concurrence that openly questions other rulings, such as those allowing contraception and marriage equality in all states. Somehow, he didn’t suggest that the Loving case, which forced all states to allow interracial marriage, had been wrongly decided, one assumes because he is a partner in one.

It’s now a little less than a month since the decision was handed down and there is upheaval. There have been many protests and public demonstrations. Some states moved to ban all abortions or all after six weeks of pregnancy. Some states are even trying to prevent people from crossing state lines to receive care, as though being a resident of a state gave them ownership over you. While the House has passed legislation to codify abortion rights similarly to Roe and to allow interstate travel for medical care, the Senate Republicans have blocked both measures from coming to a vote.

Some states are protecting and codifying the Roe framework. My home state, New York, had done this previously and is now beginning the years-long process to amend the equal rights protections of the state constitution to include “sex, including sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes, and reproductive health care and autonomy”. Bonus: this will protect marriage rights and stand against all gender-related discrimination, as well as returning reproductive health rights to each individual.

Before the decision was handed down, those of us warning of the dangers to the health and well-being of pregnant people were scolded for being alarmist, but we were being realistic. Every day, there are stories in the news of delayed care for miscarriages that threatens the health and life of the mother. There are stories of rape victims having to go to another state for an abortion. The most heart-breaking of these is the case of a ten-year-old rape victim who had to travel from Ohio to Indiana to receive an abortion at six and a half weeks pregnancy. This child has had to endure not only rape and the severe threat to her health that pregnancy at such a young age entails but also the trauma of some politicians and commentators questioning the veracity of her story.

These cases show the dangers of trying to legislate what should be private medical decisions. While some are contending that it’s not really an abortion if a child is pregnant and her life is endangered or if there is an ectopic pregnancy or if there is an incomplete miscarriage, medically speaking, all pregnancies end either in live birth or an abortion. Miscarriage is not a medical term; on medical records, it is termed a spontaneous abortion. Health care providers are being put in the impossible situation to provide the best care to their patients or to be forced by lawyers to wait until their patients are clearly dying themselves before intervening to remove a doomed fetus. When the federal government reminded hospital emergency rooms that they are required to treat any endangered pregnant person to save their life, the state of Texas filed suit, saying that their state law against abortion should take precedence.

Some states are making moves not only against abortion but also against contraceptives, even though these are not abortifacient. They are trying to prevent people from crossing state lines to receive care. As I mentioned previously, while the US House of Representatives has passed legislation to codify abortion rights and to affirm the right to interstate travel, the Senate is not taking these up because of obstruction by Republicans. Chillingly, there is talk of the Republicans passing a national abortion ban if they regain the Congressional majority. Meanwhile, Republicans fail to pass legislation that would uphold the health and dignity of each person, such as universal health care, living wages, social welfare support, etc.

As a Catholic woman, I knew this was coming. Alito was parroting the arguments that Catholic bishops have made against abortion and Thomas went even further down that road in his calls against contraception. I have struggled for years against a church that denies my full personhood as a woman, despite their lip service to the concept of human dignity. I did not expect my country to follow suit.

Like most women my age, I didn’t think we would still be fighting these kinds of equality battles, but we will. I can’t predict the manner or timing of victory, but we will not be demoted to second class citizenship by a skewed Supreme Court.

finally, but…

Broome County, New York, where I live, finally managed to get into the low community risk category on the CDC’s COVID map late last week, after many months in the high category with a few weeks of medium thrown in.

This is long hoped for news, but it is likely only a very temporary lull.

We had been high for so long due to our lower level of up-to-date vaccination and the fact that an Omicron subvariant that became dominant originated in central New York.

Unfortunately, another Omicron subvariant BA.5, is making its way into our area. BA.5 is already the most dominant strain in the US and carries the dubious distinction of being more contagious than other forms of Omicron. It may also have a tendency to more often affect the lower part of the respiratory tract, although this is still being researched; Omicron in general has been more likely to remain in the upper respiratory tract. It also appear to more easily infect people who are up-to-date on vaccination and those who have already had Omicron, even if the prior infection was only a few weeks ago. It’s difficult, though, to tease out which effects in the population are from the variant itself and which are from decreasing immunity that occurs over time.

It is also unfortunate that repeat infections increase the post-infection risk of stroke, heart attack, and other serious illnesses and bring the risk of long COVID.

Even with BA.5, though, being vaccinated and boosted is helpful. It lowers rates of severe disease, hospitalization, and death. Pfizer and Moderna are each developing vaccines/boosters that are more effective against Omicron that will be available in the fall. Of course, masking, avoiding crowds, and other public health measures are also helpful if transmission is high in your area.

Remember: the pandemic is still with us. Another new variant is spreading in India and several other countries and could cause another global wave of infections if it can out-compete BA.5. Stay alert and do what you can to take care of yourself, your family, and your community.

I’ll be doing that here. Even though our current infection rate is low, it has begun to creep up. I’ll be watchful.

COVID update

Remember the COVID-19 pandemic?

It’s still going on, even though most people here in the US are ignoring it. We crossed the one million death threshold in mid-May, although it is likely that the true number is higher as not all deaths caused by COVID are listed as such.

The good news in the US is that both the Moderna and Pfizer/BioNTech vaccines have been approved for children beginning at six months. It remains to be seen how many parents/caregivers decide to vaccinate their babies/toddlers/preschoolers. If it were me, I’d be first in line, but I expect we won’t see very high numbers. Only about 30% of 5-11-year-olds are fully vaccinated, despite availability since November, 2021. This boggles my mind, given that these same parents have vaccinated their children against a host of other serious diseases, yet have chosen to leave them unprotected against a disease that has sickened and killed so many here and around the world. It’s true that the vaccines are not a guarantee against infection but they prevent some infections and usually keep those that do occur from causing hospitalizations or deaths. From a public health standpoint, the more people who are vaccinated, the more likely it is that the pandemic will end and COVID-19 becomes endemic.

We are still far from that point, especially as new variants and subvariants are better at evading immunity, whether from vaccination or infection. The US right now is still dealing with Omicron subvariants. BA.2.12.1 is still responsible for the majority of cases here at about 56% but BA.4 and BA.5 are up to 35% of cases which is a large increase and a sign that they may out-compete the already wildly contagious BA.2.12.1.

Our county, which has been struggling with high infection rates for months, mostly due to BA.2 sub-variants that originated in central New York before causing misery more widely, is finally back in the “medium” risk category according to the CDC. It’s a bit discouraging in that Broome and our neighbor Tioga are the only two counties in all of upstate New York that haven’t dropped down into the “low” category. Maybe soon. Meanwhile, I’m continuing to avoid crowds and mask in public places like stores and church.

As you may recall, spouse B and I left the Pfizer/BioNTech COVID vaccine trial this spring in order to receive a fourth shot to boost our immunity before we travelled, but daughter T is still participating. Next month will be the one-year anniversary of her third dose, so she will be having an in-person visit for blood tests and such.

Pfizer and Moderna have both developed newer forms of their vaccines to better battle Omicron. The Food and Drug Administration scientists are meeting today to begin consideration of a new round of booster shots this fall to try to increase protection. It would be great if we can do so. I will definitely get another booster if it is offered, as I am still trying to keep from getting infected because I don’t want to be sick, especially with long COVID.

In the UK, where our daughter E and her family live, BA.4 and 5 are causing another spike in cases. Last week, it is estimated that 1 in 40 people in England and 1 in 20 in Scotland were currently infected. While the UK was initially slow to immunize children, earlier this year they began routine availability for COVID vaccination at age five. ABC’s recent fifth birthday came with the opportunity for her first Pfizer dose, for which we are grateful in the midst of the current wave. While it remains true that children have much lower rates of severe illness than adults, by not immunizing them you are allowing a large pool of little people to congregate, pass around germs, and spread them to their homes and communities. It’s one thing when we are talking about colds or even flu, but COVID-19 is a much more serious public health threat.

As usual, I renew my plea. Vaccinate if you are eligible and have access. Pay attention to infection rates in your area. Mask in indoor public places unless transmission rates are low. Avoid large crowds. Increase ventilation. Stay home if you are sick. Test and talk to your health care provider if you have symptoms. The SARS-CoV-2 virus has already caused immense suffering. Do everything you can to keep it from affecting you, your loved ones, and your community.

a fraught and complicated topic

Anyone in the US can probably guess from the title that this post is about abortion, which is all over the news right now, due to the publication of a first draft of an opinion by Justice Samuel Alito which would overturn the Supreme Court rulings in Roe v. Wade and Planned Parenthood v. Casey, ending the right to obtain a pre-viability abortion throughout the US after 49 years. If the final ruling follows this draft, each state would be free to adopt its own laws regarding abortion. While some states have already codified abortion laws in line with the Roe framework, other states have laws that would greatly restrict or totally ban abortion if Roe is struck down.

It’s been a political earthquake. It’s also being cast as yet another liberal versus conservative, blue versus red, pro-choice versus pro-life issue, but it is much more complicated than that.

Years ago, I started to draft a post called “shades of gray in a black-and-white world” that would have dealt with abortion as an example. I don’t tend to be an either/or person; everything to me is a complex web of concerns with many different aspects and perspectives to take into account. (You can blame my INFJ-ness or just Joanne being Joanne.) I’ll try to make myself as clear as I can in this post but my greater goal is to explore the varied factors that come into play.

At its root, I don’t think any branch of government should be dictating what a person who is pregnant does before the baby can survive on its own. I think that is a private medical and moral decision that belongs to the mother, her partner if they are available in a supportive way, her medical practitioner, and any advisors who can help.

I am Catholic and know that the Church currently teaches that life begins at conception but I think that is a problematic definition. Most fertilized eggs don’t implant in the uterus and it seems foolish to define all those as miscarriages. It’s tragic when an embryo implants elsewhere; if you have defined life as beginning at conception and prohibit all abortion, then an ectopic pregnancy couldn’t be treated until the embryo has died, by which point there will probably be life-threatening internal bleeding in the mother’s abdomen. Defining fertilized eggs as persons also gets problematic with frozen embryos used for assisted fertility treatment. I would certainly not be considered alive if I were placed in liquid nitrogen! (The Catholic Church opposes most fertility treatments, including in vitro fertilization, but it is germane because, of course, frozen embryos exist.) Other faiths believe personhood begins at different junctures, with many Muslims believing in ensoulment at 120 days after conception and many Jews marking birth as the beginning of full personhood. Because there is no consensus on when life begins among people, the government is overstepping its bounds to impose one.

The vast majority, about 92%, of abortions in the US are performed within the first 13 weeks gestation, or 15 weeks of pregnancy because weeks of pregnancy are, for some stupid reason, still counted from the date of the late menstrual period meaning you are considered two weeks pregnant at the time of conception. One of the very confusing things with laws in various states is referring to abortion bans at six weeks or fifteen weeks. It’s often referring to weeks of pregnancy, so we need to bear in mind that the gestational age is two weeks younger. 44% of abortion in 2019 were medical, using pills to cause a miscarriage early in the pregnancy, rather than surgical. Medical abortion can be used up to the tenth week of gestation.

Only 4% occur after 16 weeks gestation. These are most often done because of grave medical problems with either the mother or fetus. Sometimes, second trimester abortions are performed because of barriers of distance and/or cost to reach a provider. Rural women and people with low income/wealth often have this barrier, as do people without medical insurance or who have Medicaid because federal funds cannot be used for abortions.

The largest factor in choosing to have an abortion appears to be economic. 49% of people seeking abortion are living below the poverty level, with an additional 26% up to twice the poverty level. 60% already have at least one child. Unlike most modern democracies, the United States is not very supportive of families and children. I wonder how many would choose to raise the child rather than have an abortion if the US offered free or low-cost medical care, paid parental leave, guarantees of a living wage and/or subsidies for food, housing, day care/preschool, etc. that people in much of Europe have available to them.

Even the favorite alternative of those who oppose abortion, carrying the child to term and placing it for adoption, is expensive. If the mother is struggling financially and has other children to care for, she is literally faced with a choice between impending medical bills for delivering the new baby and feeding, clothing, and housing her present family. Abortion may be her most practical route to keeping her family afloat.

This brings me to one of the most troubling aspects of prohibiting abortion – forced childbearing. Carrying a child against one’s will is, to my mind, a form of involuntary servitude. I know from my own experiences with pregnancy that bearing a child is work which is physically, emotionally, and spiritually taxing. With my first pregnancy, which was planned and hoped for, I still experienced a lot of emotional upheaval, especially in the first trimester. I can only imagine what it would have been like if I had been without a partner, uninsured, living in poverty, unhealthy, in an abusive relationship, or a victim of sexual violence. Yet, some of the state laws restricting abortion carry no exceptions for rape and incest. Forcing a woman to bear a child that results from sexual violence or coercion magnifies the trauma. It’s especially dangerous if a tween or teen is involved.

Despite some progress, mothers in the United States bear a disproportionate amount of the labor and consequences of raising children. This is especially true if they are single parents. The poverty rate for single mothers is high. Often, the father doesn’t contribute substantially to the household finances. Many women who are unexpectedly pregnant face the loss of schooling, employment, and family support. It’s not just whether or not to have a baby or an abortion; it’s looking at 18+ years of raising a child without adequate support from the father, family, and community. While the stigma of single parenthood has lessened somewhat in my lifetime, it is still there, especially within certain religious communities. There is also still significant employment discrimination against women, in particular during pregnancy. Rolling back reproductive rights will likely worsen this.

While the leaked draft tries to say that the overturning of Roe v. Wade does not have legal implications beyond abortion, it’s unlikely that other private matters won’t be affected. The most obvious is access to contraception. It wasn’t until 1965 that the Supreme Court ruled that married couples must be allowed access to contraceptives and 1972 that any person could access them. I feel the right to use contraceptives is under particular threat because of the way the Catholic Church teaches about them and the fact that six of the current justices are Catholic, with an additional one who was raised Catholic. Only one of those seven is not in the conservative camp.

As a Catholic woman, I have been told that taking birth control pills is like having an abortion every month, ditto for morning after pills and IUDs. The fact that this is total garbage from a medical standpoint is apparently irrelevant to the Church. The Church also opposes surgical sterilization for males and females and privileges the life of the unborn over the mother. I, like millions of other Catholics, reject this teaching and follow my own conscience on these matters personally. I am fortunate that I never had to face a personal decision on abortion during my child-bearing years, but I do know that if I had had an ectopic pregnancy, I would not have hesitated to have surgery to save my life. I also probably would have had an abortion if we discovered that I was carrying a child who had problems that were “incompatible with life” as it is euphemistically termed. I don’t think I could have chosen to put myself and my child through the pain and trauma of birth, knowing that they would die soon after.

Other people might make other choices but that is the whole point. Each individual chooses what is right for them, within the realm of medical science and individual conscience. The government is not the entity doing the choosing.

Besides birth control, there are other issues that are considered privacy issues. Many people are concerned about the impact on marriage. The 2015 Obergefell case that established marriage equality throughout the US could be in danger. Some worry that even the 1967 Loving case that prohibited states from racial discrimination in granting marriage licenses could be at risk. Another ruling that could be in jeopardy is 2003 Lawrence v. Texas, which struck down the remaining state laws that prohibited same-sex relations.

By chance, I had had an opportunity to discuss a possible overturn of Roe v. Wade not too long before the leaked opinion draft. I sometimes do online surveys and had been invited by one of these polling organizations to participate in an online focus group about abortion. I admit that I was a bit leery of it beforehand, but it was very interesting. Most of the group thought that Roe v. Wade was likely to be overturned soon, while I and a few others thought it would be a longer process. I had thought that the present case would uphold Mississippi’s 15-week ban, changing the timeframe of Roe without going so far as to say it was wrongly decided. I suppose this is still possible if Alito’s draft opinion didn’t draw the support of four other justices, though I feel that is unlikely at this point. In the focus group, we did view some short promotional videos that a client organization might use in the event of tightened abortion restrictions. I expect to see some of them debut after the Court formally announces its decision in June or early July.

There are already lots of marches and demonstrations going on and I expect more. There might be repercussions for the midterm elections in November but with the level of gerrymandering and voter suppression in the country already, it’s difficult to predict the outcome.

I also don’t know what reforms are possible. One of the reasons this ruling is possible is that the Republicans have interfered with the seating of federal judges and justices. Two of the justices likely voting in favor of this overturning of Roe were appointed by Donald Trump but those seats would have been made by Democratic presidents if the Senate confirmation process had not been co-opted by Senator Mitch McConnell. A few weeks before the 2020 election, I wrote a post about one possible approach to addressing this. And all of this is complicated by the structure of the US government that gives disproportionate power to less populous states through the Senate and the electoral college.

Thank you to any of you who have made it this far in a longer-than-usual post. I do not know what the coming weeks will bring with this latest addition to political tensions in the US. It’s hard to keep my fears in check.

Please, stay safe.

Pfizer study exit

As you many recall, spouse B, daughter T, and I have all been participants in the Pfizer/BioNTech COVID-19 vaccine Phase III clinical trial since summer of 2020. B and T received the vaccine while I was in the placebo group, although I received the vaccine through the trial after the emergency use authorization came through. All three of us continued in the study of third doses.

I had hoped that Pfizer would extend our study to include fourth doses but they have decided not to do so. After researching and discussion with family and medical practitioners, I have chosen to end my participation in the trial early in order to receive a fourth shot, which I did on Saturday.

In the US at this point, government and public health officials are not making COVID policy as much as providing information for individual decision-making. I admit that this is frustrating as community behavior is so important with pandemics in general and the increasingly contagious omicron variants in particular. Emphasis has also shifted away from individual infection rates and toward making sure there aren’t enough serious infections to cause the health system to collapse.

My priority is still to try to avert infection. I don’t want to be sick if I can help it. While rates of hospitalization and death are low among those vaxxed and boosted, serious cases are still possible. While some are lucky to have no or mild symptoms, many still feel like they are suffering the worst flu/virus ever, being out of commission for at last a week. I am also concerned about the risk of long COVID, estimated to affect as much as thirty percent to over forty percent of total cases. Vaccination is estimated to halve the risk. (Please note that definitions of long COVID and the risk factors are currently in flux. As more data are collected and analyzed, these estimates will likely change.) Due to some factors in my family history, I may be at increased risk for developing long COVID. I also know that COVID infection can cause severe flares in people with interstitial cystitis, which I have.

I am very concerned about the possibility of inadvertently infecting others, including my family. I also have several immunocompromised friends who I want to protect.

Infection rates are high in my county now. I am continuing to mask in public and am back to avoiding crowds, including church services, concerts, and plays. Even with the high case counts here, most people are not taking precautions so I am being extra careful.

The boost to resistance to infection is likely to be short-lived, only a few weeks, but this is a critical time for me to have that extra protection. In mid-May, I am travelling to Northampton, Massachusetts to attend my 40th reunion at Smith College. The protocols there are strict, including mandatory vaccination and boosters, indoor masking, and many outdoor activities, so I feel relatively safe attending.

Ten days after my return, B, T, and I will travel to London, UK to visit daughter E and her family. Again, we will be very cautious with our behavior to avoid infection. We also want to protect our family, especially granddaughters ABC and JG who are too young to be vaccinated. JG is even too young to mask.

I’m happy to report that my side effects from my fourth shot have been mild, mostly a sore arm and a bit of tiredness.

I am grateful to Meridian Clinical Research who handled the trial locally and to Pfizer and BioNTech for developing the vaccine and getting it out to so many people so quickly. I am happy to have been of service by participating in the trial and stand ready to participate in additional clinical trials as they become available.

I will close with my accustomed plea for people to do all they can to end the pandemic with whatever means are available to them – vaccines, distancing, masking, avoiding crowds, increasing ventilation, etc. The pandemic is not over and our lack of attention only increases the possibility of new variants and extends the length of time before SARS-CoV-2 becomes endemic.

Covid red again

Like many places around the world, COVID cases are rising here in Broome County, New York (USA), so much so that we are once again in the highest risk category from the Centers for Disease Control and Prevention. Technically, the high risk category is now orange, not red, but I used red in the title of this post because it seems to be yet another “code red” to me.

Broome County is in one of the red zones with the Covid Act Now site that I use regularly. Our current rating is “very high,” the fourth of five levels. Our seven day average is 50.2 daily cases per 100,000 residents. This figure is likely an undercount, as not all people who test positive with a home test are contacting the health department or a medical professional to report the case or seek advice and treatment. UPDATE 4/19/22: The Covid Act Now site is now using the (much less useful) CDC rating system. Fortunately, the more granular data by neighborhood is still available, as are statistics like percentage of population with booster shots.

There are a number of factors involved in the current rise in cases. Our vaccinated and boosted rate is only 35.5% so we have many vulnerable people. (While it’s true that boosted people are still vulnerable to infection, they are much less likely to fall seriously ill with COVID.) It is also likely that we have cases of two new omicron subvariants that have recently emerged in central New York. While information is still being gathered, these may be even more wildly contagious than the previous versions of omicron.

You would think that our government officials would be re-instituting indoor mask mandates, but they have yet to do so. This is what I feared would happen. When the mandates were lifted, politicians and public health experts said they were doing it to give people a break while cases were relatively low so that they could bring mandates back if we had another surge, but only a few jurisdictions, like the city of Philadelphia, are actually following through.

Instead, government officials are relying on individuals to make their own decisions. The problem is that the majority of people in the US are not seeking out credible information about the risks in their localities. As a participant in the Pfizer/BioNTech COVID vaccine trial, I have been following the science closely. Discussions with my personal medical team have reinforced the wisdom of trying to avoid or, at least, continue to postpone infection. Nearly all the public health goals at this point are aimed at reducing serious infection, hospitalization, and mortality, but I also want to avoid illness, infecting others, experiencing long-COVID, and developing complications. I had continued to wear a KF94 mask in public and avoid crowds as much as possible, including singing masked for this performance and this video. With our current infection levels, we will most likely return to take-out dining only.

I did attend Easter Vigil last night, as I knew that it would not be very crowded, unlike the services today. I was masked but the majority of attendees were not. I admit that I cringed when I heard some very loud coughing jags near the back of the church. I was sitting near the front, so I was very far away from them, but I realize that many people are infected without knowingly being in close contact.

The ease of the spread of COVID was brought home to us over the last couple of weeks. B had gone into the office for the first time in over two years because they were having a new product launch. There was only a fraction of the workforce there, all of whom were vaxxed and boosted. Despite that, B got a message three days later that a co-worker with whom he had been conversing had developed symptoms and tested positive. B immediately masked at home and kept his distance from T and I. He did not go out in public and did self-testing. I am happy to report that we are now over ten days from his exposure with no symptoms or positive test, so he is in the clear, but the story illustrates how easily one can be exposed and risk unwittingly infecting others.

I’m not sure what additional actions I may need to take for my and my family’s protection. If the numbers stay this high, I may forgo attending mass in person and return to televised or recorded services until the numbers are better. I will probably try to speak to the local researchers in charge of the Pfizer vaccine trial to see if they are planning to offer a fourth shot to those fifty and older. The CDC has opened the option for our age group to receive a fourth dose but we need to follow the study protocols to remain enrolled in the study which is still ongoing with weekly symptom checks and periodic blood draws to check antibody levels, etc. B and daughter T received their third dose last July, while I received mine in October. We are all well beyond the four-month interval to be eligible for a fourth shot, although T is not old enough to qualify. At this point, we probably have decent protection against hospitalization but not not much against infection. It’s hard to say for sure, though, because B and T are part of the data set on which such findings are based. (I’m a bit behind them because I was part of the placebo group in the initial phase of the study, so I was vaccinated and boosted later than they were.)

I am hoping that this wave in the Northeast will pass quickly. I always hope for surges to pass quickly to reduce suffering but I have an additional personal reason this time. I am scheduled to attend my 40th reunion at Smith College beginning on May 12th. It’s the first time since 2019 the event will be held in person. It’s planned in a cautious way, with all participants required to be vaxxed and boosted, many events being held outdoors, and indoor masking requirements in place except while eating or drinking. Even with a surge, we should be okay to go ahead but it will be less stressful if the surge has passed by then.

So, once again, fingers crossed. I’m doing what I can to keep myself, my family, and my community safe. I urge all of you to stay informed from credible sources in your area and take whatever steps you can with vaccination, masks, testing, medications, etc. to get the virus levels down and protect public health and your own.

We know what can happen if we don’t pay attention and act. The United States is closing in on a million known COVID-19 deaths. It’s already a stunning level of tragedy here and around the world. Please do all you can.

still masked

Last Friday, the US Centers for Disease Control and Prevention (CDC) changed their methods of assessing COVID risk to include the strain on the health care system, resulting in about 70% of the population now being classified as being in low or medium risk areas, meaning that indoor masking in public places and distancing measures can be rolled back.

However, Broome County, New York, where I live, is still in the high risk category. In the even more granular Covid Act Now tracker, our risk level is rated as very high, the fourth of five levels, with 26 daily new cases per 100,000 residents as of today, February 27.

The problem is that, when New York State rescinded its mask mandate, our local government also rescinded theirs. Our local conditions don’t warrant that, but, without a rule in place, the vast majority of people will not be masking in public, which will likely delay further progress in getting our case numbers down. Another thing that would help would be increasing our vaccine booster rate, which has crept up to 34% but is still low for our state, as is the 63% full vaccinated rate.

Earlier this month when New York dropped its mask mandate, I posted that I would continue to wear an N95 in public and to avoid crowds in an effort to stay COVID free. As a participant in the Pfizer/BioNTech vaccine trial, I am supposed to be following CDC protocols. With our county still being at high risk according to the current CDC map, I am still in compliance with my obligations to the trial.

The next decision point for me will be when Broome County finally gets into a lower risk category. In discussions with my personal physicians, they have advised attempting to avoid infection entirely for as long as possible. I share in this viewpoint. Many public health commentators have gone to the less stringent goal of trying to keep out of the hospital or dying from COVID and to prevent strain on the health care system. I, however, want to protect myself, my family and friends, and my community from being infected at all, so they won’t have to deal with the threat of severe illness, long COVID, and long-term cardiovascular, pulmonary, or neurological damage that can follow infection, even in those who didn’t have serious enough symptoms to warrant hospitalization.

The CDC does say in their guidance that “People may choose to mask at any time.” That will probably be me for quite some time yet, unless our county improves dramatically soon.

Lent is about to start. I’m trying to be hopeful that our situation will improve enough that I can safely drop my crowd avoidance in time to participate in some of the Lenten and Holy Week liturgies. We’ll see.

One-Liner Wednesday: from Dr. Paul Farmer

I’m not cynical at all. Cynicism is a dead end.

Dr. Paul Farmer

Dr. Farmer co-founded Partners in Health and brought health care to some of the world’s most impoverished communities. He died this week at the age of 62.

Join us for Linda’s One-Liner Wednesdays! Find out more here: https://lindaghill.com/2022/02/23/one-liner-wednesday-numbers/

politics and/or science

Over the course of the pandemic, I’ve posted frequently about it, the Pfizer/BioNTech vaccine trial in which B, T, and I are participating, the evolving science on the SARS-CoV-2 virus and its variants, the similarly evolving public health recommendations, and how these are being implemented here in my home state of New York and elsewhere in the United States. I do sometimes comment on the pandemic in the UK and globally, but I know best what happens close to home.

Throughout the pandemic, New York had been in the vanguard of following the recommendations of public health experts, avoiding the tendency we have seen in so many other states to ignore the benefits of masking, distancing, limiting crowds, getting vaccinated, isolating if infected, etc.

That ended this week.

Governor Hochul bowed to public and political pressure and lifted the mask mandate for businesses. While it is true that statewide the peak of the Omicron wave has passed and the vaccination rate is decent, my county’s risk is still rated as very high, with 44.7 per 100,000 daily cases. Technically, New York as a state is also in the very high category with 31.2/100,000 today (February 11), but it is counties like mine that are keeping the state in that risk category rather than dropping into the (merely) high category. Medium and low risk are a long way off at this point.

Meanwhile, the national Centers for Disease Control and Prevention are recommending not only that everyone age two and over wear a mask while in public but also that those masks be N95 or similarly protective types because Omicron is so highly contagious. Alarmingly, an even more contagious omicron sub-variant has reached the US, making protective masks that much more important.

Does this sound like the proper time to end mask mandates for businesses in New York State?

Certainly not, if one is truly following the science.

The problem is that many people are tired of having to deal with the pandemic and are complaining very loudly. The politicians who had been following the science hear them and loosen the rules that had been helping to get their residents through the current wave with as little hospitalization and death as possible. This could extend the current omicron wave and increase the likelihood of yet another new variant that has the potential to be even more transmissible or evade current vaccines and treatments or cause more severe disease.

Regardless of New York State rules, I am continuing to follow medical advice, to avoid crowds, and wear an N95 when in public. Because I am vaccinated and boosted, I will still visit with people who are similarly protected without a mask. I had hoped to return to church services this weekend but have decided that I can’t do so with the daily case rate still being so high; being stationary in a room with that many people for over an hour is too much risk for me, even masked.

Sigh.

At some point, the pandemic will end and I will follow medical and scientific advice on what my “new normal” will be. I had hoped that our state policies would be an aid in this, as they had been through most of these past months, but that remains to be seen.

I’m just hoping that this latest relaxation of protections doesn’t cause even more cases than we have already suffered.

Update: Almost immediately after publishing this post, I saw reports of this study from the CDC, which shows that booster effectiveness wanes significantly after four months. Given that B, T, and I all had our boosters on the early side due to our participation in the Pfizer/BioNTech vaccine trial, I’m all the more resolute in my vigilance regarding masking, distancing, etc. While we are all still likely to avoid severe disease or hospitalization due to our longer-than-four-months-ago boosters, I prefer to try to avoid infection entirely.