Tag: vaccine

COVID update – late summer 2023

There are many people here in the United States who are no longer taking COVID-19 seriously and a disturbing number who never did.

I am not one of them.

I’ve written dozens of posts over the past three and a half years about it, including about my family’s participation in the Pfizer/BioNTech Phase III clinical trial. I’ve tried to encourage people to take precautions to reduce their chances of infection and serious illness. In that vein, I offer this update.

There was a summer wave in the US with the most prevalent strain being Omicron XBB.1.5. On September 12, the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices will meet to develop a recommendation for a newly formulated booster based on the XBB.1.5 variant. It’s anticipated that the recommendation will be that most people get this new booster, which is expected to be available by the end of September. I will get the booster as soon as I am able. To my knowledge, I’ve still not contracted COVID and would love to keep it that way. Even if the vaccine does not keep me from getting infected, it, along with taking an anti-viral such as Paxlovid, will likely keep me from being hospitalized.

Of course, SARS-CoV-2 continues to mutate. Even now, the variant mix has shifted in the US. EG.5 has become the highest in prevalence with FL.1.5.1 next in an array of variants currently circulating. (You can find current data in the US at the CDC site here.) It is expected that the new booster, though based on XBB.1.5, will still be effective against these other Omicron strains.

The unfortunate wild card at this point is another Omicron variant BA.2.86. The link is to a 8/22 post from epidemiologist Dr. Katelyn Jetelina, explaining why this variant may be more problematic than others, perhaps even warranting the World Health Organization to name it a variant of concern with the name “Pi.” BA.2.86 has over 30 mutations of the spike protein, which is part of the virus that our bodies learn to recognize via vaccines, infection, or both. The fear is that we could see another world-wide wave develop because BA.2.86 might be able to evade our defenses. Researchers are studying it to see if our current tests, vaccines, and treatments will work against it and how it might affect individuals and populations exposed to it. The current number of cases world-wide are thought to be small, but that has been the beginning status of any variant that has become dominant.

Part of the problem is that we don’t have as much data to work with. Most COVID cases aren’t reported to public health authorities anymore. Surveillance and genomic sequencing are lower. This results in less public awareness and information. Theoretically, we should be able to ramp up our system more quickly if a new wave occurs but I wish we had kept up our system in the first place in a proactive stance.

I’m concerned about the attitude that equates COVID infection with other viruses. A study in the journal Nature Medicine shows increased risks for an array of medical conditions, including diabetes, pulmonary and cardiovascular problems, two years after COVID infection, even if the initial case was mild.

“A lot of people think, ‘I got covid, I got over it and I’m fine,’ and it’s a nothingburger for them. But that’s not everything,” said the study’s senior author, Ziyad Al-Aly, a clinical epidemiologist at Washington University School of Medicine in St. Louis. After a couple of years, “maybe you’ve forgotten about the SARS-CoV-2 infection … but covid did not forget about you. It’s still wreaking havoc in your body,” said Al-Aly, chief of research at the Veterans Affairs St. Louis Health Care System.

source: https://www.washingtonpost.com/health/2023/08/21/long-covid-lingering-effects-two-years-later/

The risk of long COVID is real. The article cited above, which is free to access, explains more about the attempts to do research and get care for people with long COVID. People need to realize that they might be someone who gets COVID and has a mild case without long-term repercussions or they might become seriously ill or they might have symptoms for months and years to come. They could also infect someone else who would face the same uncertainties.

I’m once again imploring people to take COVID seriously. Vaccinate, if it is recommended for you. (Being in the US, I’m most familiar with recommendations here but people should look to their own local health authorities and medical practitioners for guidance in their area.) Test and treat an infection. Stay home if you are sick and avoid infecting others. Avoid crowds indoors; wear a high-quality mask if you can’t. If infection rates are significant in your area, mask indoors when you are away from home. Increase ventilation and air filtration. Wash your hands. Get adequate rest and nutrition. Remember that everyone deserves respect, so never question someone else’s decision to mask; they could be immunocompromised, caring for a vulnerable person, etc. and need that protection.

Eventually, we may get to a place where COVID is endemic, like the flu, but we aren’t there yet. Be careful and be kind as we continue to face this still-formidable challenge.

What comes after emergency?

As someone who participated in a COVID vaccine clinical trial, who has other vulnerable people in my life, and who tries to be a diligent and responsible community member, I’ve been following the science, public health information, and news about the pandemic over these last, long 3.5 years. I’ve done so many blog posts about it, I’ve lost count.

As you may know, the World Health Organization and the United States are winding down their public health emergency declarations.

This does not mean, though, that the pandemic itself has ended. COVID-19 is still widespread across the world and hundreds die every day as a result. There is still the potential for new variants and COVID is not yet seasonal, like influenza. Eventually, COVID will become endemic, as the flu is, but we aren’t there yet.

While some US programs, such as tracking hospitalization rates and wastewater testing, will continue, others will end. I will miss the COVID maps and risk ratings that the CDC has been providing. Besides the overall community risk assessment, the transmission rate maps were important to me in deciding how much public masking I needed to do or whether large, indoor gatherings were advisable at all. It’s true that, with so many COVID cases discovered through home testing and never officially recorded, the statistics are not as comprehensive as they were during the months of testing centers, but, for example, it’s helpful for me to know that my county has a moderate transmission rate but the county to our east is currently at the highest transmission rate level, two notches higher than here. Having that information could inform a decision between using a drive-through or dining in on my way through the county, as well as alerting me that the higher infection levels could spread in my direction. After Thursday, that information will not be readily available to me.

I’ll still follow the science and public health advice as best I can and will get my next booster when recommended. I’ll test at home if I have symptoms and avoid being in public when I’m sick with anything, COVID or not. I’ll keep a supply of KF94 masks in my size nearby for high-risk situations that may arise. I’ll try to do all the things we should be doing all the time, like eating well, getting enough rest, and practicing good hygiene.

I still, though, don’t want to get COVID if I can help it. To the best of my knowledge, I’ve never been infected, although I could have had an asymptomatic case at some point. I know very few people who are in that category these days.

Will the end of the emergency declarations and the resulting decline in data be a factor in my eventually contracting COVID?

Impossible to predict, but fingers crossed.

COVID-19 origin stories

A leak of a “low confidence” assessment from the United States Department of Energy that COVID-19 originated from a lab leak in China has set off another round of upset.

The base problem is that no one has access to all the data to come to a definitive conclusion and likely never will.

Most epidemiologists, researchers, and US government departments think that the most likely origin is from markets in Wuhan that dealt with wild animals that harbored the virus which then jumped to people. This article in Science is representative of that opinion. The animal to human route is a common mechanism which we have seen with diseases such as ebola and SARS-CoV-1.

Rather than arguing about lab leaks, we should put our energies toward strategies that will help to avoid or contain future illnesses. Yes to tightening controls at laboratories doing research on pathogens. Yes to limiting exposure to wild animals that can carry diseases to humans. Yes to rapid response and open sharing of information about emerging diseases.

No to wild speculation that is not grounded in fact. For example, there is no evidence that SARS-CoV-2 was lab-engineered rather than naturally occurring. It is irresponsible to share disproven theories.

As I know from public health statistics and recent cases among friends, COVID-19 is still out there, sickening millions and adding to the global death toll of over 6.8 million people. Protect yourself in accord with your local conditions and resources. Vaccinate and receive the bivalent booster if it’s available. Increase ventilation in indoor spaces. Avoid crowds. Wear a high-quality mask indoors when transmission rates are significant. Wash your hands. Take extra caution if you or someone you live with or visit is especially vulnerable due to age, medical condition, etc. Make sure you have accurate, scientifically valid information behind your decisions. Be respectful of those who choose to mask in public. They are trying to protect themselves and their loved ones. It’s possible they are getting over an illness themselves and are being cautious in order to protect you.

At some point, COVID-19 will become endemic. We aren’t there yet. Do your best to be a help, not a hindrance, to that end.

XBB.1.5

A new COVID subvariant has emerged here in the United States. It is designated XBB.1.5 and is considered the most transmissible Omicron variant to date by the World Health Organization. It is also considered to be highly immune evasive, which means it is more likely to cause infection among those who have COVID antibodies, whether from vaccines or prior infection. However, the vaccines should still be effective in reducing hospitalization and death rates from infection.

XBB.1.5 is especially prevalent in the northeastern region of the US. It is powering the rise in regional cases accounting for 72.7% of cases in the past week. It is also likely the driver behind Broome County, New York, where I live, again moving into the CDC’s high community risk level classification. (That will mean mandatory masking at our concerts this weekend.)

The XBB.1.5 subvariant orignated in the US, but has spread to some other countries. Meanwhile, China is suffering through a huge infection wave, although there is no reliable official data on its extent.

In many places, especially in the Northern Hemisphere winter, there are also high rates of flu and RSV.

As always, I’ll repeat my advice. Vaccinate, if you are eligible and vaccines are available to you. In particular, if you are eligible for the bivalent COVID booster, get it as soon as possible because it is much more protective against all Omicron strains than the original formulation. If you are sick, get tested. If you contract COVID or flu, immediately contact a medical provider to see if you can take antiviral medication to cut down on symptom severity. When there is risk in your area, use a high-quality mask in indoor public spaces and avoid crowds. Increase ventilation and/or air filtration indoors. Wash hands frequently and avoid touching your face (more for flu/RSV prevention than for COVID). Try to eat and sleep well. Look out for one another.

We need to work together for this pandemic to end. We are all tired of COVID but we need to fight effectively and continuously. Ignoring the risk and letting the virus spread just gives it even more opportunity to mutate and develop more virulent strains. We are now in our fourth year of the COVID pandemic. Let’s work together to make it the last.
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Join us for Linda’s Just Jot It January! Find out more here: https://lindaghill.com/2023/01/06/the-friday-reminder-for-socs-jusjojan-2023-daily-prompt-jan-7th/

two years into COVID vaccines

After yet another period of high community risk level for COVID here in Broome County, New York, we have just today returned to medium level. After a post-Thanksgiving spike in infections, we experienced a hospitalization spike which had increased our community risk level. With the US health system also dealing with an early, hard-hitting flu season and RSV, the dreaded triple-demic, in some areas hospitals are reaching capacity and sending patients to other locations. Additionally, infection rates are predicted to rise as family and friends gather for Hanukkah, Christmas, and New Year celebrations in the coming weeks.

This comes at a time when only 14.1% of people five and over in the US have received the new bivalent COVID booster, which was designed to better combat the Omicron BA.4/5 variants and is proving effective against the current dominant strains, BQ1 and BQ1.1, which are part of the BA.5 lineage.

Furthermore, a recent study indicates that the US vaccination program likely saved 3.2 million lives and prevented 18.5 million COVID-related hospitalizations. The vaccines are estimated to have averted nearly 120 million infections. Another recent study shows that in the two years of COVID vaccine availability in the US, the excess death rate among Republicans is significantly higher than among Democrats, mirroring the difference in vaccination rates, a sad reflection of the politicization and misinformation around vaccines by many prominent Republicans.

It’s horrifying.

The mistrust sown over the COVID vaccine among Republicans seems to be spreading to other vaccines as well. A newly published survey finds that over 40% of Republican or Republican-leaning respondents oppose requirements for the MMR (measles, mumps, rubella) for school children.

This does not bode well for public health measures. It’s frightening how many people will believe politicians or media figures rather than doctors and public health experts on these important issues. People have been infected because they weren’t up to date on vaccinations. People have been hospitalized, developed long COVID, experienced complications, or died at higher rates because they refused vaccines or boosters. The data show this.

Please, get a bivalent COVID booster if you are eligible. Begin or continue the primary vaccination series if you haven’t completed it. If you get symptoms, test immediately and contact a health professional if you test positive to see if antiviral medication is right for you. Don’t go out and expose others if you sick with COVID, flu, or anything else. Mask indoors when infection levels for COVID, flu, RSV, etc. are high in your area. Avoid crowds. Increase ventilation. Wash hands and avoid touching your face – more for flu/cold prevention than COVID. Try to eat and sleep as well as possible.

If you are someone who has been getting health information from pundits, please turn to your personal health care provider, public health department, or national health organizations, such as the CDC. Look for data and advice from public health experts, not anecdotes.

For readers outside the US, turn to your public health experts to see what measures are available and appropriate for you.

Reminder to all: COVID 19 is still a global pandemic. Act accordingly for your health, your household’s and community’s health, and global health.

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.

COVID bivalent boosters

As you may recall, spouse B, daughter T, and I were all participants in the Phase III clinical trial for the COVID-19 vaccine from Pfizer/BioNTech. We then all participated in a follow-on third dose trial. B and I left the trial this spring because we were eligible to receive a fourth dose and wanted the extra protection before travelling. T stayed in the trial until its end earlier this summer.

Here in the United States, a new booster was recently approved which combines the original formulation with a new one designed to better combat the Omicron BA.4 and BA.5 variants. BA.5 is the dominant variant currently in the US, accounting for about 88% of cases. About 11% are caused by BA.4. The new booster is expected to strengthen protection against serious illness/death and, one hopes, cut down on symptomatic infection somewhat, as well.

Given that I am still trying to remain COVID-free and that I have several trips coming this fall, I decided to receive one of the new boosters at my local pharmacy. I chose to receive the Pfizer formulation because all my others have been theirs, although there is a Moderna version which is also a fine choice. This was my first time receiving the vaccine in a pharmacy setting. My prior doses had all been in a medical office or a state vaccination site. I made an appointment online and everything was very fast and efficient.

Dr. Ashish Jha, who is the White House COVID-19 response coordinator, and Dr. Anthony Fauci, the long-time director of the National Institute of Allergy and Infectious Diseases, have said that it is possible that we may have reached a point where an annual booster will be enough to protect the vast majority of Americans from serious illness/death from COVID, similar to annual flu shots. Some people who are especially vulnerable due to age or medical condition might need more frequent boosters. The wild card, though, would be the emergence of a new strain that could evade our antibodies and current vaccines.

So, my message is to receive one of these new boosters as soon as they become available wherever you are. The US has been first to authorize them, but it seems they will become more widely available globally soon. Remember, though, that these are booster doses given to people who have already completed an initial vaccine series. If you haven’t completed an initial vaccine series, start NOW!

Meanwhile, here in Broome County, our community risk level is still medium. While I wait for the new booster to take full effect, I will still mask for indoor gatherings and shopping. I’ll be evaluating what to do after that, although these boosters are so new that data may be hard to come by.

I hope to stay well and hope that you do, too.

still COVID

I’m sad to report that the total death toll in the United States from COVID-19 is now over 1.04 million with over 93 million confirmed cases. The actual case count is no doubt higher, as some states have stopped reporting and many cases that are detected by at-home testing are not reported to health agencies at all. New cases are still occurring at a rate of 93,000 a day with 457 deaths (7-day rolling average on August 22, 2022).

It’s still heart-breaking.

And still considered by most experts a pandemic, although perhaps heading in the direction of being considered endemic in the United States soon, as influenza is.

Most cases in the US now are Omicron variants BA.4 or BA.5. There is some hope that new boosters that contain components targeted at Omicron variants might give some additional protection going into the fall and winter, especially against hospitalizations and deaths, but we will have to see if a) people actually get vaccinated and b) the vaccines do boost protection for any length of time.

And/or c) a new strain could develop that evades all prior immunity, is even more wildly contagious, doesn’t respond to current treatments, and/or causes more severe illness.

At home, B, T, and I all still remain uninfected to the best of our knowledge. It’s possible that one or more of us have had an asymptomatic case but there is no real way to know. Any time that we have had symptoms, we have tested, as we have also for travel and after known exposures. We also have had extra tests as part of our participation in the Pfizer/BioNTech vaccine trials. T remains a participant in the third shot trial; B and I exited the trial in order to receive a fourth dose before travelling to the UK this spring. I believe that our vaccination status has helped us to avoid infection and plan to receive one of the new booster shots this fall, if I’m eligible for what will be my fifth dose. T may be eligible for a booster after she finishes with her trial participation this fall if those boosters are available to people under 50.

Broome County, New York, managed to have only a few weeks in the Centers for Disease Control category of low community risk for transmission before going back up to medium. I’ve gone back to masking with a KF94 while shopping or in other indoor public places. I’m making determinations on small gatherings on a case by case basis. Other than church services, I’m avoiding large gatherings.

Some people think I’m being overly cautious at this point but I am still trying to avoid infection, if I can. At the very least, if I do become infected, I will know that I was doing everything I could to keep myself healthy so that I don’t suffer guilt on top of COVID. I am well aware that, even with multiple vaccine doses, masking, avoiding crowds, etc., Omicron, especially BA.5, has been quite successful at evading immunity and protections. I know from what the public health experts are saying and also anecdotally among my friends. There are very few left who have managed to stay COVID-free in recent months.

A large part of my motivation to keep from getting infected is fear of long COVID. While SARS-CoV -2 is too new a virus for researchers to fully understand, it’s possible that I may have some genetic risk factors that could come into play regarding long COVID. None of this is helped by the fact that the underlying medical conditions I have are themselves not well understood.

So, I’ll keep on doing the best I can to stay as healthy as possible.

Wish me luck.

I’m going to need it.

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.