Tag: illness

COVID into the fifth year

Four years ago, here in the US, things were pretty much shut down due to the COVID-19 pandemic. B was working from home. I was the household’s designated shopper and would go, masked, to the grocery store every other week to stock up, although I’d sometimes have to visit more than one store because supply was a problem. We managed to keep ourselves safe, although we were horrified at the death toll in the US and around the world and at the people who became very ill. Over time, we also saw that some people had lasting damage to their lungs or other organs and others had symptoms that debilitated them for months.

Now, things are much better, due to vaccines and other precautions that have cut down on serious illnesses, although the US has slipped on vaccination, even as the virus has mutated in ways that make SARS-CoV-2 more infectious and immune-evasive. There are still way too many people getting sick and suffering long-term damage or death. While there are studies and some treatments on-going, there are still a lot of people suffering from long COVID.

We finally had our first case of COVID in our house last November, when B contracted it at a rare, in-person event for work. He isolated in part of our house and daughter T and I remained infection-free.

I don’t know how much longer we will be able to manage that status.

I was disappointed when the Centers for Disease Control and Prevention changed their guidance about isolating when infected with COVID. The new recommendations are for respiratory viruses in general and say that people can resume normal activities when their symptoms are improving and they have been without fever for 24 hours without being on fever-reducing medication. People are supposed to use masking, distancing, and other strategies to protect others from infection for five days afterward.

While I appreciate CDC’s reasoning, which is based on statistics, I don’t find it personally useful. It is typical that a person with COVID is infectious for ten days. It’s entirely possible to be fever-free and have improving symptoms and still be infectious. I’m afraid that most people won’t hear or won’t follow through on the part of the recommendation for masking and taking precautions to avoid exposing others after they leave isolation. This is especially troubling to me because so many people are not current on their vaccinations and/or are vulnerable due to age or health conditions. It’s great that the immunity level in the population halved the rate of serious illness and death, but that’s cold comfort if you expose a loved one, neighbor, co-worker, etc. and they become seriously I’ll or die.

If/when I contract COVID, I will isolate and mask until I test negative and am reasonably sure I can’t transmit the virus to anyone else. I want to protect my family and my community, especially our elders and those with medical issues, from contracting a virus that could cause them severe symptoms.

Please remember, when you see someone wearing a mask in public, to be kind and understanding. It’s entirely possible that they are trying to protect your health, not just their own.

(COVID Photo by Martin Sanchez on Unsplash)

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

Triple whammy

There are a lot of people sick with respiratory viruses here in the US.

We are still struggling with COVID. Today’s (Oct. 28, 2022) statistics from the Centers for Disease Control show a weekly case count of 265,893 with 2,649 deaths. The case count is almost certainly low, as many at-home positive tests are never reported to health departments and some jurisdictions don’t gather data at all. The uptake of the reformulated boosters has been poor, with only 7.3% of people age five and over having received an updated booster.

While the community risk level map shows the majority of the country in the low (green) level, the community transmission rate is substantial or high in much of the county. You can see the various maps using a drop down menu here. The community transmission rate is based on case counts and/or positive test results; the community risk map also includes data on other factors, such as hospital admissions and stresses on the health care system. A personal illustration: Although the community risk level in my county (Broome in New York State) has been low in recent days, I have had a rash of friends being sickened with COVID. This is explained by our community transmission rate being high, which is the highest of four levels. (As I was writing this post, the maps were updated. Due to the emerging strains on the health care system, our county community risk just shifted from low to high.)

Meanwhile, the flu season has hit earlier and harder than usual. The predominant strain is H3N2, which is known to have a high incidence of complications, especially among young children, elders, and the medically vulnerable. Like many other illnesses, the effects of inflammation from the flu raise the risk of heart attack and stroke for weeks following the initial infection, further endangering not just personal health but also the stability of medical institutions, such as hospitals. So far this flu season in the US, the CDC reports 880,000 flu cases, with 6,900 hospitalizations and 360 deaths. Generally, flu season starts in October but this year it is running about six weeks earlier than usual.

The third virus that is currently surging is RSV (respiratory syncytial virus). For most people, RSV is like a cold but for infants, young children, and elders it can progress to lung infections. These can lead to hospitalization and even death, especially among elders. Unfortunately, there is not yet a vaccine against RSV. I actually participated in a clinical trial for one a few years ago but none has yet reached a level of effectiveness to be approved.

The triple whammy of COVID plus flu plus RSV has already pushed some pediatric hospitals to the edge of their capabilities. Ironically, the RSV rate is a critical factor. Because so many infants and young children were isolated due to COVID risk and lack of day care/school interaction during the pandemic, there is a much larger group than normal that is vulnerable to RSV infection.

There is also concern that the rate of new cases of all three viruses may climb even higher as the weather gets colder and people spend more time indoors.

Some things that people can do to help: Vaccinate as appropriate. Wash hands frequently. Avoid touching your face. Cover coughs and sneezes. Stay home and away from people as much as possible if you get sick. Mask in crowded places or avoid going to them. Get adequate rest and eat healthy foods. If you develop symptoms, talk to a health care provider so you can get testing and supportive treatments to help keep you from developing more severe symptoms and avert a hospital stay, if possible.

I know some level of sickness is inevitable but we can help cut down the case numbers if we watch out for ourselves and our communities.

A fairy tale wedding


A few days ago, spouse B, daughter T, and I attended the wedding of M and S. M is B’s and my niece and is the cousin closest in age to T.

M is also a big fan of Disney World. S chose to propose to M there and M planned their wedding and reception with a Cinderella theme, including the napkin above. There were castles and glass slippers and golden coaches incorporated into decorations, dancing into the night, a beautiful gown with yards of tulle.

Many echoes of a classic fairy tale.

But M and S don’t have an ordinary life. M is nurse with special training in emergency medicine who currently serves as a flight nurse, transporting critically ill or injured people to medical centers that can give them the best care possible. S is a state trooper, doing his best to keep people safe and assist them in emergencies.

They both do extraordinary things on a regular basis.

They also are facing an extraordinary challenge. Early in their courtship, M developed a serious medical issue but S stayed by her side, even when M tried to break up with him in order to protect him.

The strength of their bond in the face of adversity brought more than the usual number of tears at the wedding and during the toasts at the reception, where even the especially-stoic state troopers choked up over M and S’s love story.

Even at a fairy tale wedding, there are no guarantees of how long the “ever after” will be.

M and S showed us, though, that their love is strong and eternal, whatever obstacles are thrown in their path.

Pfizer booster

As part of my ongoing participation in the Pfizer/BioNTech COVID-19 vaccine phase III trial, yesterday I received a third vaccine injection, seven and a half months after my second. There was a blood draw to test levels of antibodies, T cells, etc. and the blood work will be repeated in a year. I will continue a weekly symptom check through a phone app and have a couple of phone appointments over the next year, too. The data collected will be used to inform on-going decisions about how often boosters may be needed in the future.

I’m fortunate that my side effects have been milder than they were with the second injection. I have a very sore arm, which is obviously from the shot. I’m tired and have a bit of a headache, which could be side effect and could be just life in general these days. Today is the one-month anniversary of Paco’s death, so how I am feeling could be attributable to that rather than to vaccine side effects. When spouse B and daughter T, who are also study participants, received their third doses, they both lost a day to fever, body aches, and fatigue; because I had had a similar reaction to my second dose, I was expecting a similar experience, but apparently have lucked out.

In the United States, a third dose of the Pfizer vaccine is approved for those aged 65 and up, people who have medical risk, and those in certain professions that have close contact with vulnerable populations. It’s possible that the third dose will be recommended more generally in the future as more data become available. It’s also likely that emergency use authorization for children aged 5-11 will come soon, with shots in arms starting in early November.

Recommendations on booster doses for Moderna and Johnson & Johnson are expected soon, as well as the possibility of mixing manufacturers, for example, someone who had the J&J vaccine having a booster from Pfizer. All the companies are continuing to study the vaccines for long-term efficacy and side effects, as well as safety, efficacy, and dosage for children six months through seventeen years. Currently, in the United States, only Pfizer is approved for ages 12-17.

Another helpful development is that Merck has applied for emergency use authorization of molnupiravir, an oral anti-viral to combat COVID. It would be given to patients in the early stages in hopes of keeping their illness from becoming severe. While it is already possible to give treatments by injection or infusion, such as monoclonal antibodies, this medication would be easy to prescribe and administer for home use. A decision by the FDA is expected within weeks.

Meanwhile, over the summer, COVID cases were devastating parts of the US, especially states with low vaccination rates. Total fatalities are over 700,000 with over 44 million cases recorded. In some areas, hospitals were so overwhelmed that they had to send patients out of state to receive care. This applied to COVID patients and also to patients suffering from other serious conditions. Two states, Idaho and Alaska, had to implement crisis standards of care, which means that whether or not an individual receives treatment beyond comfort care is determined by the likelihood of survival as there is not enough capacity to treat everyone that needs help. This resulted in non-COVID deaths from heart attack, stroke, etc. – patients who ordinarily would have been treated successfully but who died because there were not personnel, equipment, and space available to treat them due to intensive care units being filled with COVID patients.

The delta variant was the power behind the summer surge, but, at least, the fear of it encouraged more people to seek vaccination. The increase in vaccination rates is helping the case numbers to fall at this point. Still, the current rate of fully vaccinated people is only 57% with 66% receiving at least one dose. I am hopeful that the Pfizer vaccine being approved for elementary age children in the coming weeks will add significantly to our vaccination totals, at least in states where the vaccination rate among adults is higher.

There are still terrifying amounts of misinformation floating around about the vaccines that are keeping some people from taking them. Unfortunately, this is keeping the pandemic alive, resulting in illness, death, lack of access to medical care, and the possibility of even more dangerous new variants developing.

We are all in this together. Please, everyone, get vaccinated if you are eligible and follow reputable public health guidelines on masking, avoiding crowds, handwashing, etc. Your choices affect your family, friends, neighbors and community directly and your nation and the world, as well. We can’t truly end this pandemic until there’s no population anywhere still vulnerable to COVID-19.

If you won’t do it for yourself, do it for someone you love.

SoCS: pins

I don’t often wear jewelry other than my wedding ring and watch, but in the summer I sometimes wear pins to keep my V-neck dresses from getting too low. 

Most of my pins are old and came to me through family. I wear a blue and gold flower one that my dad gave to my mom back at the time of their wedding in 1954.

I recently wore one that is even older. It was my maternal grandmother’s and is a cameo, a sea scene in white over an orange background.

I guess this is the point where I would take photos to add to this post, but I’m not home. I’m with Paco (my 96-year-old father) in his room at the nursing home. He is continuing to decline and a hospice referral went in yesterday. The admission process will probably take awhile given that this is a holiday weekend in the US. I’ll try to post updates going forward but my track record is not great. Everything is too unpredictable.

*****

Linda’s prompt for Stream of Consciousness Saturday this week is “pin.” Join us! Find out more here: https://lindaghill.com/2021/09/03/the-friday-reminder-and-prompt-for-socs-sept-4-2021/

SoCS: ups and (mostly) downs

When I saw that Linda’s prompt for Stream of Consciousness Saturday this week was “up/down”, I knew that I needed to write a follow-up to last week’s SoCS in which I talked about my father (Paco) and his recent fall, hospitalization, and move to a rehab facility.

When I wrote last Saturday, it seemed that, though there was a long way to go, things were trending up.

Everything changed on Sunday when new complications arose. For various reasons, I will not even attempt to elaborate.

Let’s just say it has been a very “down” week.

We are working hard at untangling a mass of symptoms and trying to keep him safe and comfortable, but it’s an uphill battle. I know he is 96 and so, very vulnerable and prone to complicating factors but it is still so hard to deal with.

And to watch.

I know intellectually that I am doing all that is possible for me to help him and his care team, but my heart aches because I can’t make it better.

We have no idea what the outcome will be. It’s not just one day at a time, which is Paco’s favorite saying. It’s one hour at a time. One moment. One more early morning phone call telling me that he fell again during the night.

There are up moments here and there. When Paco easily remembers my name. When he gets to enjoy a slice of blueberry pie for dessert at lunch. When he manages to make a little joke with his aides.

I had planned to go to vigil mass today at a friend’s church, but was too tired to make the drive, so I went to a nearby church instead. I was blessed to see Sister A. there. She had been one of the stalwart visitors during my mother’s final illness, a span that stretched over two years. Because of the pandemic and other circumstances, I had not seen her in months. I was able to fill her in on Paco’s condition and she assured me that she has been lifting him up in prayer.

After such a “down” week, that assurance was a much-needed balm.

*****
Join us for Linda’s Stream of Consciousness Saturday! Find out more here: https://lindaghill.com/2021/06/25/the-friday-reminder-and-prompt-for-socs-june-26-2021/

SoCS: and the hits just keep on coming…

No, this is, unfortunately, not going to be a post about what’s on the Top 40.

I have been scarce/non-existent here at Top of JC’s Mind for the last week because my 96-year-old dad, known here as Paco, fell in his assisted living unit last Saturday. B and I had visited him in the 1-1:30 visiting slot, but he fell about 3:00. We think he was in the kitchenette but aren’t sure. Although he hit the floor pretty hard, he managed to get himself up and over to the couch where he called for help.

He has had a few falls before, but he hit much harder this time. His left side took the force of the fall. He was sent by ambulance to the local hospital where the extent of his injuries was revealed and he was admitted with a bump and cut on his head – luckily no concussion – bruises and contusion on his left arm and elbow, deep bruising on his left hip – luckily no break – a cracked left rib, and two wing fractures of back vertebrae.

The fall, pain, unfamiliar surroundings, etc. also worsened his cognitive condition. Paco already is suffering from dementia and this fall completely unmoored him. On Wednesday, he was stable enough to transfer to a rehab unit. We are hoping that his cognition will improve as he heals and gets stronger. It’s a much calmer and more stable environment than being in the hospital.

Tomorrow is Father’s Day in the United States and it’s hard because we won’t be able to see Paco as visiting in the rehab facility is extremely limited.

The other hit that our family is trying to absorb is that we just got word that a member of our extended family has been diagnosed with metastatic cancer. She is only thirty. She is strong and fighting but everyone is devastated.

And the hits just keep on coming…

*****
Linda’s prompt for Stream of Consciousness Saturday this week is “hat/het/hit/hot/hut.” Join us! Find out more here: https://lindaghill.com/2021/06/18/the-friday-reminder-and-prompt-for-socs-june-19-2021/

Grim milestone

It has just been announced that the United States has reached 500,000 deaths from COVID-19.

A half a million deaths among the 28 million confirmed cases. About 30% of those infected continue to have symptoms for weeks/months.

All of this in about a year’s time.

I had been watching a recording of mass for the first Sunday of Lent. When it finished, I tuned to a news channel. One of the frequent medical contributors, herself a physician, was speaking about the deaths and was struggling to keep from crying. The host noted how appropriate it was to react emotionally, as she herself was.

Such enormous loss. So much suffering. A reminder that, despite medical advances, we are nearing the death toll of the 1918 flu pandemic.

My eyes are filling with tears as I write this, both from the huge losses in our country and the world and from the losses of each one. Just recently added to the list a friend of my sister’s, the father of B’s co-worker, a resident in the apartments of Paco’s senior community.

Even with the vaccines becoming available, there will be many more illnesses and deaths. There will be uncertainty from the new variants’ effects, how long immunity will last after infection or vaccination, how people will behave as recommendations and policies change.

But today is overwhelmingly sad.

Again.

the meaning of January

Linda’s Just Jot It January is designed that anything one jots down can be transformed into a #JusJoJan post of the day.

Fortunately for all of you, I haven’t been taking this literally.

Otherwise, my January would be filled with texts, emails, and long lists of questions and reminders as I have tried to navigate the complexities of dealing with the care of my father, known here as Paco, in the time of COVID.

As the new year began, Paco was nearing the end of a stay in the rehab/skilled nursing unit in the health care center of his senior community, following five days in the hospital in mid-December. We were trying to finalize his move into the assisted living unit, which also triggered the need to close out his independent living apartment as soon as practicable. There were also issues with his medical and personal care to deal with – and, due to COVID restrictions, it all had to be done by phone or email or picking up and dropping off documents and forms and signed permissions, with only occasional in-person contact, none of which could be with Paco.

It’s been, in turns, confusing and frustrating and harried and bureaucratic – and perpetually exhausting.

It’s also been very difficult to write about.

So, here I am, trying once again to sum up the situation and convey it in words, unsure that I am capable of doing so.

A few days before Paco move to assisted living, we noticed that he was struggling with some everyday kinds of things like using the telephone. I expected that an infection he had had had returned and managed to convince the medical team to test for it. It turned out that I was correct but the test results didn’t come back until Paco had already moved to his new place in assisted. He was started on a new medication, but the combination of the infection, medications, being in a new environment, having to do another 14-day COVID quarantine because he had moved to a new unit within the health care building, and not being able to see family or have them help him set up his new place has made an already daunting situation extremely difficult.

I am doing the best that I can to care for him, but it is not good enough and I can’t manage to fix everything in a timely way. I’ve made some progress but the pace has been slow. While I am not by nature an impatient person, after so many weeks of this, I am frustrated and immeasurably sad.

The comfort I have is that Paco is seemingly unaware of all the complexities of the situation. He doesn’t usually remember the things he used to do before this latest illness, so he isn’t really missing them. While his memory is impaired at this point, he has not had the personality changes that affected other members of his family when they developed dementia, so he is generally in a good mood, although his fatigue level does sometimes put a damper on things.

So, here we are, starting another week. There are more lists of things to do, people to call, tasks to accomplish. One big thing that is (nearly) completed is the closing out of Paco’s old apartment. I turned the keys in last week, but the person I needed to interface with wasn’t there, so I’m not entirely sure we’re finished with the process.

Sometimes, people choose a word or phrase for the new year. Perhaps, for me, this will be the year of “not entirely sure.”

Like last year, 2021 may be a year of uncertainty.