September 8, 2023
The pandemic isn’t over, but I now have a new website called The Better Health Blog where I cover the latest information about COVID-19 and other respiratory viruses of concern. The blog’s main focus is on healthy lifestyles and preventive medicine. Check it out.
August 30, 2023
COVID-19 Reinfection Risks
As new cases continue to rise, with hospitalizations up 21 percent compared to the previous week, it seems that for most people getting COVID-19 a second, third, or fourth time may be inevitable. The longer the coronavirus is with us, the more common repeat infections become, especially with the SARS-CoV-2 virus continually evolving to become more transmissible and better able to evade our immune system’s defenses.
There is no such thing as a risk-free COVID-19 infection, and it is still unclear as to whether symptoms tend to become more or less severe from one bout of the illness to the next, or if one’s risk of developing Long-COVID increases with multiple infections. The data suggests that people who have had a severe first infection are more likely to end up hospitalized for a reinfection, especially if they are older or immunocompromised.
However, for many younger and healthier people who get infected multiple times, subsequent infections typically are as mild or less severe than their first, according to a recent report (not peer reviewed). This is likely due to partial immunity from previous infections and/or vaccinations, plus the fact that the latest circulating variants seem to be causing less severe illnesses for most people than the earlier strains of the coronavirus did.
Still, there’s no escaping the fact that every time you get infected, no matter the severity, there is always a chance that you can develop longer-term symptoms. People with two or more bouts of COVID-19 were more than three times as likely to develop lung and heart issues, and more than one-and-a-half times as likely to experience a neurological disorder, than those who were infected only once, as detailed in a new report.
According to the CDC’s Variant Tracker, the EG.5 subvariant (nicknamed Eris) is estimated to cause more than a fifth of U.S. cases, and is gaining ground against its competitors. However, there’s a new player in town that’s causing concern among epidemiologists. It is designated as BA.2.86, and it has 35 new mutations compared to the XBB.1.5 variant, more than 30 of which affect its spike protein, the key that allows entry into your cells.
Moderna has announced that its preliminary clinical trial data for its new vaccine formulation, which should be available at the end of September, showed a significant boost in neutralizing antibodies against the EG.5 variant. However, the new vaccines could face a setback if BA.2.86 spreads more widely. Because surveillance efforts have been drastically reduced since the pandemic emergency was declared over, it is not yet known how widespread this highly mutated variant is, and how much ground it has been gaining.
An even more pressing question is how effective the upcoming XBB-targeted vaccines will be against BA.2.86, because they are not a good match for its spike protein. There is likely to be “immune escape” that makes it more difficult for our front-line, antibody-mediated immune response to recognize this new variant, even after prior vaccinations, boosters, and infections. According to a current report, there’s no reason for alarm right now. We’ll just have to keep monitoring the situation as new data becomes available. You can follow the CDC’s current risk assessment as it is periodically updated.
As you would expect, I’ll be getting the XBB booster as soon as it becomes available, and I will continue to mask with an N95 whenever I’m indoors around other people with unknown infectious status. As I’ve said many times before, vaccination is only one layer of protection. For me, the minor inconvenience of masking pales in comparison to the major inconvenience of becoming ill. You may feel differently, but don’t say I didn’t warn you, because…
Long-COVID Is No Joke
According to a just-published study, almost a third of adult patients who had COVID-19 in 2020, but did not require hospitalization, had one or more post-acute symptoms of the infection two years later. Of those with severe enough illness to be hospitalized, 65 percent still had significant problems after two years, including cardiovascular disease, blood clots, diabetes, gastrointestinal issues, and kidney disorders. Considering the sheer number of people affected, this represents a substantial cumulative burden of health loss due to SARS-CoV-2 infections.
Another study revealed the limitations of commercially available diagnostic tests early in the pandemic. The researchers estimate that approximately 10 million people in the U.S. during the first year of the pandemic had COVID-19, developed Long-COVID, yet tested negative. These findings suggest that a positive diagnosis for COVID-19 should not be a requirement for treating people whose symptoms correspond to the syndrome, which is now considered to be “a pandemic within the pandemic.”
There is some good news: According to at least one study (not peer-reviewed), people who took the antiviral drug Paxlovid within a few days after being infected with the coronavirus were 26 percent less likely to have Long-COVID symptoms 90 days later. Still, it’s going to take many more years of careful follow-up studies to fully understand the ways and the extent to which this novel coronavirus has harmed us.
August 6, 2023
The Summer Covid Surge
The CDC reports that all their metrics indicate the coronavirus is alive and well and still killing people. The amount of virus detected in wastewater, the percentage of people testing positive, and the number of people going to emergency rooms due to COVID-19 began increasing at the beginning of July, 2023. Hospitalizations have increased by more than 12 percent since June 22, and ER visits by 17 percent. Summer surges are to be expected, especially when people congregate indoors to escape the heat. Fortunately, this summer’s surge is much less dramatic than those of summers past.
The best protection against all airborne infections continues to be masking, even if you’re the only person in a crowded room who is wearing one. If you do develop flu-like symptoms, or even if you think it’s only a cold, please get tested and have a “Paxlovid plan” in place, in case you test positive. Early treatment with Paxlovid dramatically reduces hospitalizations, and may also decrease the risk of Long-COVID, according to a recent study.
The SARS-CoV-2 virus continues to evolve rapidly, causing substantial numbers of infections, hospitalizations, and deaths among older and medically vulnerable patients. Because the emergence of new variants is hard to predict, and immunity acquired from vaccines and infections wanes over time, the only way to stay ahead of the virus is for booster vaccines to be regularly updated. Project NextGen will coordinate the federal government’s efforts to advance vaccine and treatment innovations, and deliver them to the public.
Your Blood Tells a Covid Story
As of March, 2022, the estimated nationwide seroprevalence of antibodies due to COVID-19 infection of people ages 16 years and older was 77.5 percent, based on a study of blood donors. That number should be much higher now, with the Omicron variants causing a great many breakthrough infections. People with blood type A are more likely to contract COVID-19 because the spike protein of the SARS-CoV-2 virus has a higher affinity for their red blood cells. Genetic factors are the reason that some people who test positive for the virus do not develop any symptoms of an infection. At present, we can’t do anything to change your blood type or genetic resistance, so it’s up to you to stay safe.
What’s New with Long-COVID
A new office has been formed within the U.S. Department of Health and Human Services that will lead the nation’s response to Long-COVID. This debilitating condition is marked by symptoms that last weeks or months beyond the initial infection; brain-fog can last for years. Estimates suggest that up to 23 million people in the United States alone have experienced the syndrome. Clinical trials for Long-COVID patients through the National Institutes of Health’s RECOVER Initiative are now underway, but have been criticized for being too limited in scope and way overdue.
More than 200 symptoms are associated with Long-COVID, affecting nearly all organ systems, including the nervous, cardiovascular, gastrointestinal, pulmonary and immune systems. Indicators that are used to classify someone as having the syndrome include a worsening of symptoms after mental or physical activity; fatigue; brain fog; dizziness; gastrointestinal symptoms; heart palpitations; changes in sexual desire or capacity; loss of or change in taste or smell; excessive thirst; chronic cough; chest pain; and abnormal movements. A recent article clarified these criteria.
July 5, 2023
Covid: Is It Over?
Most Americans now seem to think so. According to an Axios-Ipsos poll in May, 2023, 62 percent said that COVID-19 is over, compared with 47 percent who felt that way in February. More than half said they never mask in public. The proportion of respondents who said they always or sometimes mask dropped from 30 percent in February to 23 percent in May.
Since the CDC stopped tracking data, it is harder to get a handle on COVID-19’s prevalence. The coronavirus remains among the most common respiratory pathogens out there, and it is still infecting tens of thousands people. It has already killed 40,000 this year alone, and hundreds still die daily. Devastating complications of an infection continue afflicting otherwise healthy people, and symptoms of Long-COVID linger in about one out of ten people who get the disease.
Many of my subscribers had remained covid-free until recently, when they let their guard down and became infected in the usual high-risk places; in a restaurant, at a gym, during airline travel. It is too soon to know what the long-term consequences of those recent infections will be, but even a mild case increases the risk of developing diabetes, heart disease, and dementia down the road.
One example is a retired couple who recently flew to Hawaii. They developed symptoms shortly after their arrival and tested positive, despite being masked (but not with N95s) during their flight. Subsequently, the man developed incapacitating atrial fibrillation which has not yet responded to treatment. Another example is a family of three who became ill after dining out on Mothers Day. The man missed work for about a month due to lingering fatigue. Let those examples serve as cautionary tales.
Don’t get me wrong. I’d love for the pandemic to be over, but that’s just not the reality yet. The coronavirus continues taking its toll on the most vulnerable; the immunocompromised, the elderly, and those with chronic illnesses such diabetes and obesity. Although people are less likely to die or require hospitalization during the acute phase, COVID-19 can still wreak havoc with various organ systems each time someone gets an infection. The last remaining metric for assessing the pandemic’s impact in your community is the CDC’s county-level map of hospital admissions. Please check it out.
While socializing is good for our physical and mental health, vulnerable people should continue to be selective about who they socialize with, and in what kinds of environments. Summertime is a great time for socializing outdoors. When entertaining indoors, it is not unreasonable to ask guests about their current state of health, immunization status, potential exposures, and if in doubt, to take a rapid antigen test before arriving.
If you’re going to travel, wear an N95 or equivalent mask at the airport and on the plane, skip dining at indoor restaurants, and continue testing for COVID-19 if you develop symptoms of a respiratory infection. If you can persuade your physician to provide you with a prescription, it would be a good idea to travel with some Paxlovid in your suitcase, in case you test positive during your trip. Trying to get medical help while away from home can prove quite challenging.
Unfortunately, access to affordable testing can be problematic, now that the federal government has stopped mailing free kits, and Medicare and private insurers are no longer required to pay for them. Public health experts are concerned that higher rates of transmission will occur as more people stop testing and their stockpiled test kits expire. People will be more likely to dismiss their respiratory symptoms as “just a cold,” and not refrain from attending gatherings.
Uptake of the bivalent booster dose remains low. Only 17 percent of eligible Americans have received it, according to the most recent CDC data (May 10, 2023). For those aged 65 and older, only 43 percent are up-to-date on their boosters.
Masking in Healthcare Settings
It pains me to see that masking requirements have been dropped for most healthcare facilities. It seems obvious that those are indoor settings where people with contagious respiratory infections, and those who are most medically vulnerable, are likely to encounter one another. For what it’s worth, I still mask to the max at my doctor’s office, and don’t understand why other people consider it to be such an inconvenience. If I need to remove my mask for part of the exam, I expect my healthcare provider to be wearing one.
The Department of Veterans Affairs announced a new masking policy: Masks are no longer required in most clinical settings, but are still mandated in areas that serve high-risk patients, such as dialysis clinics, transplant centers, chemotherapy units, and urgent-care and emergency departments. The VA guidance is also clear that patients with COVID-19 should still mask, and that patients can request healthcare personnel to mask up. This compromise is based on the fact that veterans and their families did not want continued universal masking in all healthcare settings.
While most Americans do not support mask mandates, healthcare settings have a responsibility to safeguard their most vulnerable patients. They need to have policies that allow patients, along with their family members and caregivers, to request that providers wear masks while seeing them. A recent article in the New England Journal of Medicine makes a strong case for masking in healthcare settings to protect patients from all respiratory viral infections, not just COVID-19.
Paxlovid and Statins
Paxlovid is not recommended for people who are taking statins, which is a very large percentage of the older population. Consequently, Molnupiravir is prescribed for them instead, although it is significantly less effective as an oral antiviral agent. The FDA’s Checklist Tool for Prescribers says that patients who are taking atorvastatin and rosuvastatin should temporarily discontinue taking it during their five-day Paxlovid course. Those on lovastatin and simvastatin should discontinue use 12 hours before starting Paxlovid, then restart it five days after finishing their course of Paxlovid. Unless there’s another reason not to take Paxlovid, those who are on statins should insist on it, and follow the FDA’s guidelines.
America’s Herd Immunity
The CDC recently reported that more than 96 percent of the American blood donors sampled had antibodies against SARS-CoV-2 from previous infection, vaccination, or both. Of those tested, about 48 percent had hybrid immunity (from infection plus vaccination). Unfortunately, breakthrough infections still frequently occur with the highly infectious Omicron XBB variants that are currently circulating. Bivalent booster protection against infection declines after about two months, although protection against severe disease remains strong.
A New Booster Is Coming
An additional bivalent booster four months after the last one is recommended for people aged 65 and older, as well as those who are immunocompromised. An XBB-specific booster has been approved for this coming Fall, and should provide longer protection against infection. It will target the XBB.1.5 variant, which is being supplanted by two even more infectious XBB derivatives; XBB.1.16 and XBB.2.3. It is still expected that a vaccine targeting XBB.1.5 will be much more effective against all XBB strains than is the current bivalent booster.
The most recent CDC data shows that the bivalent vaccine is 62 percent effective in protecting against hospitalization for up to two months, but this protection drops to only 24 percent by four to six months. Protection against critical illness, defined as admission to an intensive-care unit or the morgue drops from 69 percent to 50 percent over a similar time frame. A recent CDC analysis found that nursing home residents who were up-to-date with their coronavirus vaccinations were 31 percent less likely to contract the virus than those who were not.
Although eligibility guidelines have not yet been determined, it is expected that people who have received a bivalent booster at least four months previously, along with anyone who did not receive a second bivalent booster, will be eligible. The CDC says people who have had COVID-19 can receive their next booster if it has been three months since their recovery. Those people could probably wait longer if they have hybrid immunity, which appears to be stronger than vaccination alone. That still begs the question: “If I am eligible for a second bivalent booster, should I get one now, or wait until the Fall for an XBB booster?”
I’m inclined to recommend waiting at this point if you are not immunocompromised, but for those who are elderly and/or chronically ill to continue effectively masking in all high-risk settings. People who are moderately or severely immunocompromised can receive boosters as often as every two months, with the approval of their healthcare provider. In any case, whoever you are, don’t rely upon the bivalent booster as your sole protection. A recent report from the CDC showed that the bivalent booster’s effectiveness against a symptomatic XBB infection was just 43 percent among those age 65 and older. That’s still better than nothing, and the bivalent booster is generally good at keeping people out of the hospital.
Covid Clouds on the Horizon
As the coronavirus continues to evolve, it appears to be getting more infectious but less lethal. Its incubation period, the time between exposure and the onset of symptoms, seems to be getting shorter. The mean virus incubation period during the time that the SARS-CoV-2 Omicron BA.5 variant was dominant was 2.6 days (95% CI: 2.5–2.8 days). For the XBB variants, it may be even shorter. The original strain had an incubation period of 5-10 days.
In India, the BF.7 (short for BA.5.2.1.7) subvariant is showing very high transmissibility because of its capability in eluding the immune system, its short incubation period, and its marked ability to cause reinfection. BF.7 has a very large growth value (R0 = 10-18), making it two to three times more contagious than the parent Omicron (R0 = 5-6). This has resulted in a big surge of infections. So, there it is, déjà vu, all over again.
June 3, 2023
R U a NoVid?
If you are among the few people reading this who have remained Covid-free, congratulations! You are officially a NoVid.
Those who have successfully said “No!” to COVID-19 are few and far between. According to the CDC, by the third quarter of 2022 an estimated 70 percent of people aged 16 years and older who were blood donors had SARS-CoV-2 antibodies from previous infection(s). The percentage of previously infected people has been steadily increasing since then. The public’s perception is that the pandemic has ended, yet the coronavirus still presents a deadly threat for many individuals.
Pandemic fatigue, complacency, and erroneous risk assessments have recently allowed many of my subscribers to become infected by this pervasive pathogen. Some of those COVID-19 infections have had disastrous consequences, causing strokes, heart damage, and accelerated dementia. After staying healthy through the worst years of the pandemic, these health-conscious people let their guard down once mask mandates were dropped and the public health emergency officially ended. They began dining out, going to the gym, traveling, and inviting untested guests into their homes.
My first thought was, “they should have known better,” but even experts have fallen into the same trap. In what should be filed under the heading of “morbid irony,” a superspreader event recently took place among the maskless epidemiologists attending an in-person CDC conference in Atlanta, GA. At last count, 181 of the conference attendees had tested positive for COVID-19. That’s ten percent of the people who were at the conference.
The decision to drop masking mandates and other public health measures, and have society “return to normal,” was more of a politico-economic one than something based upon science. According to a statement issued by the Department of Health and Human Services, “COVID-19 is no longer the disruptive force it once was.” Tell that to the elderly and medically vulnerable, who are being sacrificed to the coronavirus. Those who are no longer productive and/or are receiving entitlements have little value to the Economy.
With the current crop of Omicron variants, one out of every ten people who become infected will develop Long-COVID, even those who had only mild symptoms during the acute phase of their illness. Too many of them end up with heart, lung, or brain damage, as well as an increased risk for developing type 2 diabetes.
I don’t know about you, but I can’t afford to lose any IQ points, particularly at this stage of life when too many neurons are opting out of my brain circuitry. Just because the current variants are less likely to kill us than those that circulated during the first year of the pandemic doesn’t mean that they should be dismissed as inconsequential.
I find it especially troublesome that mandatory masking has been abandoned in healthcare settings. I favor those healthcare providers who will at least mask-up at their patient’s request. As a Washington Post reader put it, “Is it really safe or wise that health-care settings and hospitals no longer require masks? It seems to me that people at higher risk for covid complications will now be very vulnerable to catching covid when they seek health care. Many of these people, of course, are already older or have an underlying medical condition; some may avoid or delay seeking needed care out of fear of infection. Shouldn’t a health-care setting be the one place that higher-risk people do not have to fear catching covid?”
My answer: Absolutely yes!
It’s not only COVID-19 transmission that I’m concerned about when I don my mask in public. There are numerous other diseases that can spread via exposure to infectious airborne particles, including:
Respiratory syncytial virus (RSV)
Seasonal influenza (Flu) virus strains, such as A(H1N1) and A(H3N2)
Human metapneumovirus (HMPV) that usually causes upper respiratory infections
Streptococcus pneumoniae, a bacterium that causes pneumonia
Mycoplasma pneumoniae, a bacterium that causes “walking pneumonia”
Rhinoviruses that cause upper respiratory infections such as the common cold
Varicella zoster virus, which causes chickenpox and shingles
Paramyxoviruses that cause measles and mumps
Group A streptococcus, a bacterium that causes strep throat and rheumatic fever
Bordetella pertussis, a bacterium that causes whooping cough
Mycobacterium tuberculosis, a bacterium that causes TB
Corynebacterium diphtheriae, a bacterium that causes diphtheria
Meningococcus, bacterium that cause infectious meningitis
Bacillus anthracis spores, from a bacterium that causes anthrax
Aspergillus nigricans spores, from a fungus that causes bronchopulmonary aspergillosis
Coccidioides spores, from a fungus that causes valley fever and coccidioidomycosis pneumonia
One-way masking remains very effective, as long as you are consistently wearing a well-fitting, high-quality N95 mask or its functional equivalent. So what if you’re the only person shopping in Costco who is wearing a mask? You do you, and let the fools take their chances.
Especially for people who are medically vulnerable, such as those who are elderly, frail, have chronic illnesses such as diabetes, cancer, or obesity, or are immunocompromised or immunosuppressed, continuing the tried-and-true mitigation measures of masking, social distancing, improved ventilation, testing potential contacts, and hand sanitizing can be life-saving. Even what starts out as a cold can pave the way for a secondary bacterial lung infection and a fatal case of pneumonia. Remember the old adage about an ounce of prevention being worth a pound of cure.
When it comes to indoor dining in a restaurant or having drinks with friends at a tavern, you need to ask yourself if it is worth the risk. You are guaranteed to be ingesting and/or imbibing unhealthy substances, as well as sharing air with people of unknown infectious status. Why pay rip-off prices just so you can be poisoned, and then have to run the gauntlet of potential airborne infections?
Because masking and social distancing has prevented not only Covid but the flu and colds, if you haven’t caught a cold for the past three years, getting one now will be far more severe because you’ve lost your immunity to the common cold viruses. So, is it worth being sick for a week with a doozy of a cold just so you can dine out?
To keep your immune system in top shape, make sure that you are getting the right amount of restorative sleep, exercising regularly, mitigating stress, eating nutritious meals, and avoiding junk foods, fake foods, and environmental toxins. Keep your blood pressure and blood sugar under control. And, by all means, see that your vaccinations are up to date.
If you are eligible for a second bivalent booster (65 years of age or medically vulnerable), get it now if it has been at least four months since your first bivalent dose. I expect Moderna’s bivalent vaccine to be slightly more effective than Pfizer’s booster, along with perhaps more of a reaction. According to the pundits, there will likely be an Omicron-specific monovalent vaccine this Fall, available as eligible people’s third four-month-interval booster.
The CDC’s data shows that for people aged 65 and older, the vaccine’s effectiveness against emergency department visits due to COVID-19 is the greatest (at 61 percent) during the first 60 days following the booster. By four to six months, effectiveness decreases to 25 percent. If you’re planning to travel, you should get your booster at least two weeks prior to departure.
Finally, be sure to have a Paxlovid backup plan, if all else fails.
If you haven’t done so already, I invite you to take a look at my recently revamped website, which has many pages of information about how to optimize the various components of a healthy lifestyle: https://drmick.com/
Please stay safe out there. You may be done with the pandemic, but the latest coronavirus variants aren’t done with you.
Updated May 20, 2023
The End of the Pandemic?
After taking a vacation from following the pandemic during the month of April (in order to work on my taxes and latest books), I’ve noticed some remarkable changes. Mask mandates in healthcare facilities have ended. The World Health Organization has declared the COVID-19 global health emergency over.
In the U.S., the federal Public Health Emergency for COVID-19, declared under Section 319 of the Public Health Service Act, expired on May 11, 2023, leaving in its wake a death toll of at least 1.1 million Americans. COVID-19 is still killing more than 100 people a day, but the CDC will no longer be tracking covid-related deaths. At last count, over 80 percent of those deaths were among people age 65 and older. If you don’t belong to that demographic, why be upset about getting your inheritance sooner?
New, more transmissible strains of the SARS-CoV-2 coronavirus continue to emerge and spread widely. A surge in Arcturus variant infections is predicted to begin later this month, and possibly peak in June. With most people now sharing air with one another, it has been a gift for virus evolution. It may only be a matter of time before a much more deadly variant of the coronavirus appears and starts killing off those who are young, healthy, and complacent.
One concern I have about the Arcturus (XBB.1.16) variant is that symptoms such as loss of smell and/or taste have reappeared, along with a new symptom, conjunctivitis. Loss of smell and taste due to a SARS-CoV-2 infection has been linked to an increased risk of Long-COVID. The presumption is that the virus has invaded people’s brains, causing long-term fatigue and brain fog due to persistent inflammation.
The longer the duration of taste or smell loss, the greater the risk of developing long-term symptoms. New research suggests that even a mild case of COVID-19 can affect the function and structure of the brain to the extent that it could lead to problems with memory and thinking skills. There may eventually be a syndrome identified as “Covid Brain” among those showing mild cognitive impairment following an infection. That differs from the “Brain Fog” associated with the acute phase of the illness, in that the person with the syndrome is likely to be unaware of their impairment.
Despite the continued risks posed by the coronavirus, the vast majority of people are going about their lives without taking precautions against airborne infections. CDC data shows that only about 27 percent of eligible adults have received their first bivalent booster. Ironically, a recent CDC conference of epidemiologists turned into a super-spreader event when dozens of its unmasked attendees later tested positive for the coronavirus.
Remember that being vaccinated and up-to-date with your boosters is only one layer of protection. If you want your risk of infection to be close to zero, additional preventive measures are required. It should come as no surprise that I continue to mask with an N95 in all indoor public spaces, ask my family members to test before visiting indoors and will not spend prolonged time near other people of unknown infectious status, even if I am masked. That’s because I place a very high value on my health. How about you?
Both the FDA and the CDC have said they will review updated formulations for the coronavirus vaccines in June. They haven’t indicated what those formulations might be, but it is expected that they will more closely target the currently circulating variants. New COVID-19 boosters will most likely become available in the Fall, coinciding with the release of annual flu vaccines and the new RSV vaccine for seniors.
People who are now eligible for another bivalent booster are those considered most vulnerable to severe outcomes from COVID-19. Anyone age 65 or older, or who is immunocompromised, should get their second bivalent booster as soon as four months have elapsed since receiving their first bivalent booster. By getting one now, they are likely to be eligible again in the Fall. Despite the pandemic emergency declaration expiring on May 11, 2023, COVID-19 vaccinations and Paxlovid will continue to be free for as long as government supplies last.
Keep in mind that the effectiveness of boosting to prevent infection is modest and fairly short-lived. People who prioritize avoiding infection should continue with all preventive measures, including masking in public indoor spaces and doing their socializing and dining with others outdoors. Check out the current Covid Risk Forecast for your county.
A recent report underscores the fact that the bivalent booster’s protection against infection wanes much more quickly than does its protection against severe illness. Two to four weeks after vaccination appears to be the time of peak protection against infection. By week 16 after the booster, there is no additional effectiveness against infection compared to people who did not receive the booster. However, effectiveness against hospitalization or death was more than 67 percent after two weeks. By 20 weeks, it had decreased to about 38 percent.
COVID-19 is now the fourth most common cause of death in the U.S., which is still way too high for the pandemic to be dismissed as being over. Could a “living with covid” approach adopted by those under age 65 reflect an indifference toward the elderly, since most of the pandemic’s death toll has shifted to that segment of the population. Ageism, or discrimination against seniors, is a well known feature of American culture.
Advanced age is, all by itself, a significant risk factor for severe outcomes from a SARS-CoV-2 infection. A recent CDC analysis shows that someone between 75 and 84 years of age has 9.2 times the risk of hospitalization compared to someone who is 18 to 29 years old. Those in the older population were 140 times more likely to die from the disease, usually as a result of a secondary bacterial pneumonia. Hospitals are repositories for drug-resistant microbes and are often the site for infectious disease transmission by healthcare workers. They are best avoided, and an ounce of prevention is the ticket to a healthy ride.
If you have had several negative rapid antigen tests after one that turned positive, remember that false negatives occur much more frequently than false positives. Any positive test after a known exposure should be taken as confirmation that you have COVID-19. If you are eligible, you should begin taking Paxlovid within five days of testing positive. It is important to have a Paxlovid plan in place before you test positive, since the medication still requires a prescription in most cases.
People’s interest in the coronavirus and avoiding infection by the latest variants seems to have waned. So, I probably won’t be updating the blog more than once a month. The current “back to normal” attitude has been a blessing for the coronavirus as it continues to evolve, and a curse for high-risk people who have been abandoned by the public health system. Since we are no longer watching out for each other, those of us who are the most vulnerable will need to be extra careful in order to to stay healthy. It is what it is.
A Healthy Lifestyle for Illness Prevention
I began my medical career as a physician and surgeon working in the Emergency Department of a large metropolitan hospital. My mission there was to save lives and repair bodies suffering from injuries and illnesses. It wasn’t long before I recognized that a lot of the acute problems I was seeing could have been prevented by a healthier lifestyle. That experience piqued my interest in all aspects of preventive medicine, which then became a regular feature of my medical practice when I set out on my own.
Lifestyle interventions to prevent obesity, diabetes, heart disease, strokes, chronic kidney disease, and cancer are far more beneficial and cost effective than treatment after those diseases have become established. A health-promoting diet and regular physical exercise are key elements for chronic illness prevention. Nutrition even plays a role in immune system functioning, and a healthy diet can lower the risk of hospitalization and death from COVID-19. For more information on healthier lifestyles, you may want to check out my Prescriptions for Healthy Living website.
Now, more than ever, there is an urgent need for preventive interventions, so I have written a book that could literally save your life. Its information is especially important for parents of young children. Changing family eating practices and guiding children toward healthier eating habits early in life is critical if they are to grow up as healthy adults.
My first book on healthy living, called Rx for Healthy Eating, is very different from typical cookbooks. This is where the science of healthy eating joins forces with the art of creative cooking, enabling its readers to quickly and easily prepare delicious and nutritious meals. They will soon discover that their healthy, home-cooked meals are far better than anything typically found in restaurants. Those who are new to cooking will learn how to set up an efficient, cost-effective kitchen, while experienced cooks will find tips, tricks, and shortcuts that will make their cooking a lot more fun.
A hundred internationally inspired, health-oriented recipes put the book’s knowledge to practical use. Its quick and easy recipes are relatively simple and appropriate for cooks of all skill levels. They provide a guided opportunity for readers to put into practice what they have learned when they create tasty and healthy dishes in record time.
I hope you’ll take this opportunity to invest in your health by ordering this book. Giving a gift of better health is a great way to show someone that you care about them. If you are not yet acquainted with the many advantages of an eBook format, please check out my two digital companion books, available here on Amazon. eBooks are always eligible for free updates, and they are very easy to give as gifts by email.
March 28, 2023
A Plague Upon the Elderly
Three years into the pandemic, older people are still in jeopardy. Most Americans are now going about their daily lives, while pretending that COVID-19 no longer poses a threat, because they are likely to be able to avoid the most serious consequences when an infection strikes. Meanwhile, seniors continue to face real dangers from the disease.
Senior citizens over age 65 make up 17 percent of the U.S. population, but they have accounted for three-quarters of all COVID-19 deaths, which currently remains at over a couple of thousand deaths each week. The immune systems of older people tend to be weaker, making it harder for them to muster enough antibodies after vaccination, or to successfully fight off an infection. They are also more likely to have comorbidities, such as diabetes, impaired kidney function, and chronic diseases of the heart and lungs, which further increase their risk of severe illness and death.
In one study, 32 percent of adults over age 65 had chronic symptoms lasting far beyond their acute bout of COVID-19. Persistent coughs, and lingering muscle aches and joint pain, can indirectly impact muscle strength and flexibility, affecting older people’s ability to live independently. Older COVID-19 survivors were also at higher risk for accelerated cognitive decline.
Unfortunately, ageism, the willful ignorance of or an indifference toward the needs of older people, is baked into American culture. The elderly tend to be perceived as an unwanted burden by those who are young and healthy, and a drain upon the economy by those who would like to abolish Medicare and Social Security. For the past three years, most Americans didn’t care about the plight of seniors during the pandemic, and there is no indication that will change in the future.
House Guests and Covid Precautions
We were just about to visit an older couple and stay with them for a few days, when we received a phone call from the woman that her husband was ill and had just tested positive for COVID-19. She tested positive herself several days later. That raised many questions about how to host, and become, house guests, as safely as possible.
If you are at risk for a severe SARS-CoV-2 infection, the safest way for a guest to stay with you is to ask them to take precautions during the five days prior to their visit. That would involve wearing an N95, KN95, or KF94 mask in all indoor public spaces and to avoid dining indoors at restaurants and with others outside their own household. At the same time, you should reciprocate by taking the same precautions yourself.
Your house guests should be properly masked at all times during their airline flights and other travels by pubic transportation. They should take a rapid at-home antigen test just before their flight, and again upon their arrival at your home. You should also test yourself just before they arrive, and have a contingency plan in place if anyone should test positive.
While your guests are staying with you, they should continue masking in all indoor settings outside your home. That will preclude restaurant dining indoors, as well as spending unmasked time indoors with others outside your household. Socializing outdoors, without being too close, is an alternative to a brief indoor visit with all participants adequately masked.
Unfortunately, that begs the question: Is going to all that trouble to have house guests really worth it? Only you can answer that one.
Airline Travel
A recent CDC study examined aircraft wastewater from incoming international flights from Britain, the Netherlands, and France. A whopping 81 percent of samples were positive. Twenty-seven different SARS-CoV-2 genomes were detected; all from the Omicron sub-lineage.
Safer Travels by Car
If someone is not staying in your home and they are not following precautions, but you want to travel with them in a car, you should both wear N95 or equivalent masks while in the car, and keep the windows open while driving.
Rapid Antigen Test Update
Rapid antigen at-home diagnostic tests, which are the main tests now used for COVID-19 detection, continue to identify the most widely circulating variants. However, rapid antigen tests are generally less sensitive, and therefore less likely to pick up early infections, when compared with molecular tests, the most common of which is the PCR test.
If someone tests negative with a rapid antigen test but has COVID-19 symptoms, it is possible that they don’t yet have enough virus in their nose to test positive, but they still could infect someone else. If they have symptoms but test negative, the test should be repeated at two-day intervals. If they have access to a PCR test, then by all means, they should get one.
Because most people are no longer masking, a lot of other respiratory viruses are making the rounds. Symptomatic people who test negative for COVID-19 may actually be ill from other viruses, including the common cold. Please use your best judgement to keep yourself and others from getting sick, regardless of the infectious agent.
The FDA repeatedly monitors the performance of coronavirus diagnostic tests and has information on its website about how current tests are faring in detecting the Omicron variants. They have identified two rapid antigen tests that have shown reduced performance in detecting Omicron. Check the website for more information.
March 11, 2023
In Other News…
Governors and public health officials and in at least 30 states are now legally prevented from issuing mask mandates, ordering school closures, and imposing other public health measures in the event of another infectious disease outbreak. In order to impose any emergency orders, officials will have to get approval from state legislatures, almost all of which are dominated by the Republican lawmakers who had pushed through restrictive legislation in the name of “free-dumb.”
Admittedly, there was a lot of public confusion and frustration over the government’s inconsistent and contradictory guidance during the worst phases of the COVID-19 pandemic. Among the snafus were a reversal on whether people should wear masks, confusing messages on when to stop isolating after an infection, and disagreements about the duration of school closures.
America’s patchwork public health system now makes it that much harder for state and county health officials to protect people from infectious diseases that can easily cross state borders. Blue states will have to face the public health threat posed by the red states that have officially adopted a laissez-faire attitude toward public health.
Who Was That Masked Man?
New York City’s Democratic Mayor, Eric Adams, is asking store owners to require their customers to briefly remove their face masks when entering, to help law enforcement identify the perpetrators of the retail crime that’s been running rampant throughout the city. Such is the consequence of liberal “soft on crime” policies and restrictive gun laws that render citizens and business owners helpless when it comes to defending themselves against predation by criminals.
Need a Hug?
Transmission of the coronavirus depends upon how close you are to individuals who are infected, how heavily they are breathing, and the duration of your exposure to them. A brief, outdoor hug poses a minimal risk (but never zero), while dining indoors for an hour comes with a significant risk if anyone in the area is a COVID-19 carrier. The safest way to hug: You both hold your breath, and turn your faces away from each other.
March 5, 2023
Good News for Some, Not So Good for Others
As of March 4, 2023, nationwide covid-related hospitalizations are down by 4 percent, and deaths are down by 7 percent. Overall, an increasing number of counties across the nation are forecast to have a low risk for COVID-19. That’s the good news. However, there are still over 300 covid-related deaths a day, on average, with nearly 90 percent of those among seniors.
Paxlovid to the Rescue
A large study of a highly vaccinated population, encompassing all age groups as well as those with underlying medical conditions, showed that the oral antiviral medication, Paxlovid, reduced the risk of hospitalization by 40 percent and death by 71 percent, compared to a matched cohort that had not received Paxlovid.
Dwindling Masking Requirements
Healthcare facilities, the last holdouts still imposing masking requirements, will soon be dropping them. I don’t know about you, but I don’t like the idea of visiting a doctor’s office, urgent care facility, or hospital emergency department where sick people congregate, and if maskless could spread their respiratory viruses. Consequently, I will continue to double-mask, one of which is a well-fitted N95 (or a FFE equivalent respirator), for the foreseeable future, especially when going to a healthcare facility, or even a grocery store, for that matter.
The Pandemic’s Origin
Although some government officials may disagree about the origin of COVID-19, they do agree on one aspect: It was not an intentional act of bioterrorism. No person or agency intended to weaponize a virus in order to cause a global pandemic. Consequently, Congressional Republican proposals for holding people individually accountable, placing sanctions on China, and demanding reparations for “killing millions of people across the world,” makes absolutely no sense.
The source of the COVID-19 pandemic, according to virologists who study pandemic origins, is not a divisive issue. They collectively tell us that there is overwhelming evidence that points to an animal origin. In fact, the abundant data indicates that the pandemic was a spillover event, in which a non-human virus is transmitted from an animal to a human, usually through close contact.
Two substantial, peer-reviewed articles lay out the strongest evidence to date that the COVID-19 pandemic originated in animals at a market in Wuhan, China. One study concluded that the coronavirus most likely jumped from a caged wild animal to people at the Huanan Seafood Wholesale Market in December of 2019, based on photographic and other evidence. The other study looked at the genetic sequences of the SARS-CoV-2 virus actually found at the market, and concluded that two species of animals were likely involved.
Even if there was a “lab leak” in Wuhan, there is absolutely no evidence that malice was involved. Wherever deadly viruses are stored, there exists the potential for accidental release and exposures. When the U.S. FDA lab moved to a new location in 2014, it found hundreds of vials of virus samples in an unsecured storage area, six of which contained the deadly smallpox virus, and nobody knew that they were there.
In another incident that year, the CDC inadvertently sent out vials containing the highly pathogenic H5N1 avian flu virus to the USDA. It wasn’t until months later that USDA researchers began suspecting that something wasn’t right when their experiments yielded unexpected results that they couldn’t explain. In 2022, poliovirus was found in the wastewater of a polio research lab in the Netherlands, and one employee was infected as a result. The accident was described as an “unnoticed breach of containment at the facility.”
Fortunately, none of these incidents resulted in mass outbreaks, but if they had, what would appropriate “accountability” look like? If a global outbreak had occurred as a result of human error, should other countries impose sanctions, require reparations, or demand civil and criminal penalties be imposed upon the lab workers? Just because Lyme disease was first identified in the U.S., should our country be held responsible for its spread to the rest of the world?
Long-COVID and Lifestyle
In a study of nearly 2,000 women, participants who maintained a healthy weight, exercised regularly, didn’t smoke or abuse alcohol, and ate and slept well, were about half as likely to develop Long-COVID as those who didn’t have a healthy lifestyle. This suggests that there are many things people can do to improve their health and reduce their chances of developing persistent symptoms following an acute episode of COVID-19.
February 22, 2023
From the Headlines
The XBB.1.5 variant is now the dominant strain, by far, projected to account for about 85 percent of all new infections. Across age groups, vaccine effectiveness was generally similar to what is was with BA.5. Vaccine effectiveness against symptomatic infection was 49 percent among people aged 18 to 49; 40 percent among those 50 to 64; and 43 percent among those 65 and older, according to a CDC analysis.
This season’s flu vaccine has been only 35 to 42 percent effective at preventing the hospitalization of seniors with the illness, according to preliminary CDC data. A second wave of flu later this year is still being anticipated by epidemiologists.
People over the age of 65 remain at higher risk for contracting severe COVID-19 and dying as a result. During October, 2022, nearly 90 percent of COVID-19 deaths were among the older age group, despite their making up only 16 percent of the population. That’s their highest death rate since the pandemic began, despite the availability of vaccines, boosters, rapid antigen tests, and antiviral pills that can be taken at home.
According to an analysis of CDC data, COVID-19 is now a plague of elderly, reviving the debate over what society considers to be an acceptable loss. With the Public Health Emergency (PHE) ending on May 11, 2023, and the CDC’s COVID Data Tracker Weekly Review publishing every other week, starting March 3, 2023, it seems that the government is quickly losing interest in the pandemic, despite the ongoing risk for seniors.
The good news for seniors: Now that the vast majority of hospitals across the nation are no longer being overwhelmed by a surge of Covid, Flu, and RSV cases, there will be plenty of room for them in friendly neighborhood ICU.
According to a Canadian study, anyone 60 years of age or older, or with an underlying health condition, who tests positive for COVID-19 should contact their healthcare provider immediately, so they can receive Paxlovid within five days of the onset of illness.
Moderna announced that it will provide free coronavirus vaccines for uninsured and underinsured individuals, once the government ends its public health emergency on May 11, 2023.
Being even partially vaccinated against COVID-19 reduces the risk of a heart attack or stroke, according to a new study.
Approximately one in four patients with untreated COVID-19 experience symptom relapse, while almost one in three exhibits a relapse with an increase of viral load, a recent study has found. Unfortunately, many high-risk patients are avoiding treatment with Paxlovid due to concerns about rebound.
People who took the oral antiviral Paxlovid to treat COVID-19 were not more likely to experience a rebound or relapse than those who didn’t take the medication, according to a new study. The findings address concerns that the use of Paxlovid, which works by stopping the spread of the virus in the body, increases the risk of COVID-19 rebound.
In a U.K. study, 59 percent of people diagnosed with Long-COVID had multi-organ functional impairment lasting at least a year. This has had serious implications for their quality of life and long-term health.
Long-COVID patients who suffered severe infections reported higher rates of heart and lung problems six months after coming home from the hospital. The study highlighted the fact that new symptoms can develop long after the initial infection.
In a late-stage trial, Merck’s antiviral treatment for COVID-19, Lagevrio (molnupiravir), failed to reduce the risk of infection among household contacts following home exposure to another individual already infected.
Coronavirus survivors are about 58 percent more likely to be diagnosed with new-onset type-2 diabetes, compared to those who haven’t had COVID-19, according to a new study. That adds to the list of metabolic and cardiovascular problems facing patients after an infection.
Treatment with the diabetes drug metformin showed a significant, dose-dependent effect in lowering SARS-CoV-2 viral load within days of administration, according to the latest analysis of the Phase-3 COVID-OUT clinical trial. However, it did not prevent emergency department visits, hospitalizations, or deaths associated with COVID-19.
Natural immunity acquired from a COVID-19 infection cuts the risk of hospitalization or death from reinfection by roughly 90 percent for at least 10 months, according to a recent meta-analysis. That’s about the same as the protection provided by two doses of an mRNA vaccine. However, experts stress that vaccination is the preferable route to immunity, given the risks of complications and Long-COVID from even a mild infection.
Researchers also looked at the protective effect of prior coronavirus infection alone compared with hybrid immunity (the combination of both vaccination and recovery), and found that people with hybrid immunity had far superior protection. At 12 months, effectiveness of previous infection without vaccination in preventing hospital admission or severe disease was nearly 75 percent, versus more than 97 percent for hybrid immunity. In the same time frame, protection against reinfection waned to about 25 percent for those with previous infection versus around 42 percent for those with hybrid immunity.
One of the implications is that people with hybrid immunity might be able to extend the length of time before booster vaccinations are needed, compared to individuals who have never been infected.
If you have Long-COVID, the National Institutes of Health (NIH) is funding studies at a number of medical centers. Known as RECOVER, the studies are still recruiting both adults and children with Long-COVID as patients.
February 7, 2023
Aside from the terrible loss of human lives due to the pandemic, and the lingering physical and cognitive disabilities of Long-Covid among many of its survivors, one of the tragic consequences of COVID-19 has been felt by people who’ve lost their sense of smell and taste as a result of an infection. They have my sympathies, for where would we be if we couldn’t experience the joy of eating healthy, tasty food? (That’s a depressing thought.)
It’s All Relative
Covid-related deaths are now averaging 472 daily. Compare that to the 2,608 per day around this time in February, 2022. That’s good news, relatively speaking, just not for those who are still dying, and for those who will miss them. Clearly, the pandemic is not over; it’s just not as bad as it used to be, thanks to vaccinations, bivalent boosters, and whatever immunity people have acquired after surviving previous infections.
Long-Covid continues to take its toll, with unprecedented numbers of people suffering from physical and cognitive disabilities due to inflammation and damage to multiple organ systems. In spite of this, the vaccination of younger children and the implementation of the current boosters has faltered. Only 5.4 percent of children two to four years old have completed their primary series, and only 15.7 percent of the eligible U.S. population has received a booster, according to CDC data.
The White House continues to request Congressional approval for about $10 billion in funding for tests, masks, and antiviral treatments, in anticipation of future COVID-19 surges, but it keeps meeting with strong Republican resistance. House Republicans are pushing efforts to undercut the Biden Administration’s remaining pandemic measures, such as the vaccination requirement for most foreign travelers coming into the U.S. by plane. Remember that, the next time you vote.
Covid Is Here to Stay
We have to recognize that COVID-19 is not ever going away. There is still going to be one variant after another, likely becoming more infectious each time, and possibly more deadly. What’s needed is a vaccine that will provide good protection against infection by all current and future variants.
A vaccine doesn’t have to be perfect; vaccines rarely are. It just has to be good enough to keep most people from becoming infected, and to keep those that do have a breakthrough infection from becoming severely ill, regardless of the variant involved. Unfortunately, such a pan-coronavirus vaccine still seems like a long way off.
Without a “good enough” vaccine, avoiding COVID-19 over the course of one’s lifetime is going to be very difficult, if not impossible. The best strategy would be to put it off for as long as possible, because treatments are likely to keep improving over time. However, it is highly likely that by now almost everyone has been infected, and those who think they haven’t been infected probably had an asymptomatic case. This coronavirus is becoming endemic in the human population, along with its four siblings that are still hanging around, causing colds.
According to an NIH study, the reduced severity of SARS-CoV-2 infections by those who became infected while wearing a mask could be due to the increased humidity in the respiratory tract that comes from being masked. Thus, it seems that masks not only provide the best protection against infection, they also help to reduce the severity of any infection, should they fail to prevent it.
COVID-19 Emergency Coming to an End
The Biden Administration announced that both the National Emergency and Public Health Emergency that were declared and renewed in response to the pandemic will be extended one final time. In accordance with the Administration’s commitment to give at least a 60-day notice prior to termination of the emergency, most federal pandemic assistance will come to an end on May 11, 2023.
Once the emergency ends, in most cases Medicare beneficiaries will have to pay out-of-pocket for at-home testing and treatments, except for Paxlovid. The oral antiviral medication will still be covered for Medicare recipients through 2023.
Booster vaccinations will continue to be covered at no cost, as will any testing that has been ordered by a healthcare provider. Medicare enrollees will still be able to continue getting their healthcare via tele-health visits through 2024.
Medicare Advantage plans have been required to cover enrollees who receive care for COVID-19 at out-of-network facilities, and treat them the same way as if they had gone to in-network facilities. However, this will end once the public health emergency expires, as will additional funding for hospitals that had been receiving a 20 percent increase in Medicare reimbursements for treating COVID-19 patients.
Those with private insurance could face charges for lab tests, even if they are ordered by a provider. Vaccinations will continue to be free for those who go to in-network providers, but going to out-of-network providers could incur charges. Vaccinations are covered under the Affordable Care Act’s pandemic-era measures, the Inflation Reduction Act, and a 2020 relief package.
States will be able to start processing Medicaid redeterminations and disenrolling residents who no longer qualify, beginning April 1, 2023. About 15 millions people are expected to lose their Medicaid coverage as a result of that process, according to HHS. Increased food stamp benefits will also come to an end. I wonder if Medicare recipients will be facing chaos? It’s as if the Administration didn’t learn anything from its troop withdrawal fiasco in Afghanistan.
Federal funding for the uninsured already ended in the Spring of 2022, making it more difficult for those without healthcare coverage to obtain free testing, treatments, and vaccines. The Biden Administration had to develop a plan to shift the COVID-19 response to commercial markets, because Congress failed to authorize the necessary additional funding last year.
Bad News for the Immunocompromised
The monoclonal antibody combo, Evusheld, is no longer authorized by the FDA for use in the U.S. because current data shows it to be ineffective against the latest SARS-CoV-2 variants. Now, more than ever, vulnerable people will need to mask up, keep their distance, and especially avoid indoor dining and drinking in proximity of people with unknown infectious status.
For millions of Americans who are immunodeficient or immunocompromised (or who live with someone who is), it has become extremely difficult to survive in a country where most people no longer see COVID-19 as a threat. Also at risk for hospitalization and death from a COVID-19 infection are elderly Americans, and those with multiple health problems that make them more vulnerable to severe outcomes.
Public health policies are no longer able to address this issue, because it requires balancing the needs of too many different groups. Nearly every policy decision will be perceived as being too restrictive by some, and as too permissive by others. That’s clearly a lose-lose proposition.
Immune Imprinting and Hybrid Immunity
The immune system responds more strongly to the strain of the coronavirus that it first encountered, which may result in a weakened response by people who’ve previously been infected to new strains. A single bout of Omicron doesn’t seem to help update the imprinted response of people who were previously infected with a pre-Omicron strain. Imprinting doesn’t make COVID-19 more severe than it would be in someone without a previous infection, but it might explain why so many people who’ve already had COVID-19 are being infected again.
Researchers agree that variant-specific boosters, such as the current bivalent mRNA vaccines, are worthwhile, because they still provide an increase in immunity, even if it’s not as strong. You’re still better off having some immunity, as any degree of immunity is better than none at all. Some people, who have a more adaptable immune system, will benefit more from the bivalent booster. Since there’s no way to know which of us that is, we all should get the updated booster, period.
January 28, 2023
Aren’t you ready for some good news about the pandemic? I know that I am. So, here it is:
New Hospital Admissions Down for Most Age Groups
The 7-day daily average for new covid-related hospital admissions for the period January 18–24, 2023, decreased by about 16 percent nationally, compared to the previous week’s 7-day average, according to CDC data. The current risk map shows an overall improvement, but people in your county may still be at high risk.
Hospitalization data includes all hospitalized patients who tested positive for COVID-19 during their admission, regardless of the reason they were in the hospital. It covers those who were admitted for complications of a SARS-CoV-2 infection, those who were admitted for another condition that was probably exacerbated by having COVID-19, and those admitted for non-covid reasons but who tested positive for COVID-19 on routine screening.
Unfortunately, the news is not so good for seniors. The CDC’s Respiratory Virus Hospitalization Surveillance Network (RESP-NET) showed that COVID-19-associated hospitalization rates among adults 65 years of age and older have been increasing since December 17, 2022.
If you’re a senior who wants to attend a public performance such as a movie, a concert, or a play, you should still wear a properly fitted N95 mask (or its functional equivalent) for the entire time you are indoors, regardless of what other people may or may not be doing. Health-care workers treating COVID-19 patients wear similar masks and are well protected, even when in close contact with patients who have high viral loads and are actively shedding the virus.
Covid Still Deadly, After All These Years
The current 7-day average of new deaths has decreased by almost 5 percent nationwide, compared with the previous week’s 7-day average. As of January 25, 2023, a total of 1,103,615 COVID-19 deaths have been reported in the United States.
Preliminary data shows that COVID-19 killed more than a quarter million Americans during 2022, making it the third leading cause of death in the U.S. Since that’s fewer deaths from COVID-19 than in 2021, I suppose that’s also good news, kind of.
COVID-19 death rates are tracked differently than hospitalization rates. Data includes only the deaths in which COVID-19 played a meaningful role. The CDC gets death data from state health departments in weekly reports, which provide an early look at death trends. Death certificate analysis, which is more reliable, takes more time to collect and report.
There are two types of causes of mortality listed on death certificates:
* Underlying (primary) when COVID-19 was the main reason the person died.
* Contributing (secondary) when another condition is listed as the underlying cause, but COVID-19 hastened the person’s death.
For example, if a person had congestive heart failure, and COVID-19 put too much stress on their already weakened heart, the infection would be listed as a secondary cause of death. People who incidentally were found to have COVID-19 at the time of their death, but it is unrelated to the cause of their death, would not have COVID-19 appear on their death certificates.
Death data are not perfect, and errors and misclassifications do happen. The CDC and its National Center for Health Statistics are constantly reviewing incoming data, verifying it with state vital records offices, and ensuring standardized and accurate death certificate reporting. Contrary to the absurd claims of conspiracy junkies, COVID-19 deaths in the U.S. are NOT being over-counted.
Bivalent Boosters Working
More good news: Data released this week by the CDC suggests that bivalent boosters are holding up well against the latest circulating variants. According to the study, the updated boosters reduced the risk of symptomatic infections caused by the now dominant XBB.1.5 sub-variant by more than one-third for people 65 and older, and by about half for most younger adults.
As it turned out, according to CDC surveillance data, the early waves of respiratory syncytial virus (RSV) infections and those caused by the seasonal influenza viruses peaked before the New Year. Fortunately, the post-holiday surge of coronavirus infections did not come close to overwhelming most hospitals.
Silent Infections
There are still some people who have not contracted COVID-19 because they have taken many precautions. There are others who may have genes that make them more immune to the coronavirus. But then, there are those who weren’t aware that they have had a SARS-CoV-2 infection.
According to a recent study by the CDC, this last group is probably the largest. Researchers found that about 44 percent of people who think they’ve never had COVID-19 actually did. They might have remained asymptomatic, or had very mild symptoms that they ignored. It’s also possible that a rapid antigen test produced a false negative, or missed their diagnosis if they took it before they had a sufficient viral load for the test to turn positive.
At least 75 percent of children who’ve contracted COVID-19 showed no symptoms. This suggests that they unknowingly harbored infectious virus in their noses and may have been spreading it to others. Schools are ranked among the highest public sources of coronavirus exposures. In retrospect, closing schools was probably an effective strategy for reducing SARS-CoV-2 transmission prior to the widespread availability of safe and effective vaccines.
Because hybrid immunity has been shown to be the most effective, you may want to find out whether you have previously contracted an infection. To do so, you can take a SARS-CoV-2 nucleocapsid antibody test. This test does not detect antibodies produced by the vaccines, but only by the virus. You can ask your healthcare provider to order it through laboratories such as Quest and Labcorp, but check with your insurance carrier first to find out how much it will cost.
January 8, 2023
While the media has been obsessed with the cardiac arrest of a player on the football field, Republican dysfunctionality in the House of Representatives, and what the British royals are up to, Americans seem to have forgotten that we are still in the midst of a pandemic, with no end in sight.
Why COVID-19 Still Matters
The SARS-CoV-2 coronavirus keeps evolving, producing ever more infectious variations. In the U.S., the Omicron XBB.1.5 sub-lineage, the most transmissible strain to date, continues to gain ground against its closest competitors, BQ.1 and BQ.1.1. XBB.1.5 is spreading quickly, and new hospital admissions for COVID-19 show a 7-day daily average increase of 16 percent compared to the previous week, while covid-related deaths have increased by 8.3 percent.
The XBB lineage emerged as a result of two different Omicron sub-variants swapping parts of their RNA inside human hosts who were simultaneously infected. While XBB does not appear to be better at escaping antibodies than its other immune-evading predecessors, it has become much better at binding to host cells and replicating once inside. Each wave of mass infections creates more opportunities for the coronavirus to mutate into something far more dangerous.
A recent laboratory study showed that while the new bivalent booster produced a strong neutralizing antibody response against the BA.4 and BA.5 lineages for which it was developed, it did not provide a strong response against the latest strains, specifically BA.2.75.2, BQ1.1 and XBB.1. That’s very troubling, because it suggests that although people who’ve received the bivalent booster are less likely to become severely ill from a breakthrough XBB.1.5 infection, they are still at risk for developing Long-COVID, as well as spreading their infection to others.
A new study of 1.2 million individuals with symptomatic COVID-19 estimated that of those with at least one out of three Long-COVID symptoms (persistent fatigue with body pain or mood swings; cognitive problems; or ongoing respiratory problems) three months after a symptomatic SARS-CoV-2 infection, 90 percent of patients initially experienced only a mild illness. The study also found that women have twice the risk of men, and four times the risk of children, for developing Long-COVID.
Masking is Still Your Front-Line Defense
If you have chronic illnesses, or are immunocompromised, or are pregnant, or are older than age 65, please put your mask back on and resume social distancing! New York City and Los Angeles public health officials are currently urging people to mask up in schools, stores, worksites when around others, on public transportation, and whenever in crowded outdoor settings. In spite of the danger, public health officials are reluctant to impose mandates because of public resistance and the violent threats that have previously been made against them and their families.
Second Line of Defense: The Bivalent Booster
Preliminary data shows that people ages 12 years and older who received an updated bivalent booster were 15 times less likely to die from COVID-19, when compared with people who were never vaccinated. A recent analysis found that the bivalent booster provided additional protection from COVID-19 in people who previously received two or more doses of the original monovalent mRNA vaccine. Getting the updated booster restored protection that had decreased over time. A bivalent booster is recommended for all people ages five years and older if it has been at least two months since their last COVID-19 vaccination.
Recent studies have demonstrated the value of the bivalent booster for seniors. One study looked only at adults age 65 or older, finding that the bivalent booster reduced the risk of hospitalization by 84 percent, compared to those who had not been vaccinated, and by 73 percent, compared to seniors who had only received the monovalent vaccine. Another study of adults found those who had received the bivalent booster were less likely to need COVID-related emergency or urgent care services.
A recent laboratory study of neutralizing antibody effectiveness compared people who had either one or two monovalent boosters with those who had the bivalent booster, to determine how well the different boosters worked against Omicron sub-variants BA.1, BA.5, BA.2.75.2, BQ.1.1, and XBB. Results showed that the bivalent booster worked better than the monovalent against all the Omicron sub-variants, and especially against the currently circulating BA.2.75.2, BQ.1.1, and XBB strains.
Despite the obvious risks, a quarter of Americans still refuse to get any COVID vaccines, and uptake of the bivalent booster has been catastrophically low. Only 15 percent of eligible Americans ages 5 and older have received the Omicron-specific booster, and just 38 percent of seniors, the demographic that’s most at risk. More people didn’t bother getting their flu vaccination this year, either. As trust in science erodes, and ignorant people consume misinformation from anti-vax quacks and conspiracy theorists on social media and faux news, the uptake of all vaccines has suffered.
Third Line of Defense: Paxlovid to the Rescue
New research from the CDC shows that Paxlovid reduced hospitalization in adults by 51 percent. This is an important finding because the study included those with previous infection or vaccination, and nearly two-thirds were individuals under age 65. Previous studies showed that Paxlovid had a dramatic effect in reducing severe illness in older individuals and among the unvaccinated. This study underscores the necessity of ensuring those who are eligible for this safe and effective treatment receive it promptly.
Neither the bivalent COVID-19 vaccine nor the oral antiviral Paxlovid are 100 percent effective. Very few vaccines and treatments are. However, the case for booster vaccines keeps getting stronger. The protective effects of vaccination and antiviral medication are additive. Older individuals, and people with chronic medical conditions, should take advantage of both.
It takes about two weeks to develop maximum protection from the bivalent vaccine. According to a recent follow-up study, protection against infection likely wanes within a month or two, but protection against developing severe disease lasts much longer. Taking Paxlovid within five days of infection is a short-term protective strategy that’s highly effective. A large Israeli study found that for people aged 65 and older, early treatment with Paxlovid cut the rate of hospitalization by a factor of four, and the death rate by a factor of five.
Staying Active to Boost Immunity
Proven to protect against a wide array of diseases, exercise may also be the most powerful anti-aging intervention available. According to a study of almost 200,000 adults in Southern California, men and women who exercised at least 30 minutes most days were almost four times more likely to survive COVID-19 than inactive people. Exercise, in almost any amount, reduces people’s risks for a severe coronavirus infection.
At-Home Testing Caveats
Rapid antigen testing can help reduce transmission. Americans are being urged to test before and after travel, as well as prior to indoor visits with vulnerable individuals. Ideally, people would get a rapid test an hour or two before a gathering. The U.S. government is providing another round of free at-home test kits through the postal service, continuing to make community testing available, and continuing to provide free vaccines. How long these freebies will last is uncertain, now that Republicans are in control of the House.
Rapid antigen tests still work, and the problem of delayed positivity is no worse with the Omicron family than it has been with the previous variants. The same tests are about as good at picking up the SARS-CoV-2 virus as they have ever been, but they all have a lower limit of detection; that’s the smallest quantity of viral antigen that will reliably register as a positive result.
What is different now is that the Omicron sub-variants seem to take longer after the onset of infection to accumulate in the nose. The increased delay between catching the virus and reaching the minimum detectable nasal concentration of the viral antigen could be contributing to the current rate of false-negatives.
The FDA now recommends repeat testing following a negative result, whether or not a person has COVID-19 symptoms. Keeping in mind that the Omicron incubation period is about three days, a person with no symptoms who was exposed to someone with COVID-19 should have three negative tests, 48 hours apart, before concluding that they are not infected. For those with covid-like symptoms who’ve tested negative, a second test should be performed 48 hours later.
Because there isn’t any way to boost the sensitivity of lateral-flow tests, we’ll just have to accept the fact that during the first few days of an Omicron infection there are going to be false negatives. If you’ve been exposed to one or another of the latest, highly contagious strains and develop symptoms of COVID-19, you might not want to bother testing at all and just assume that you have caught it.
What to Do If You Have COVID-19
A major obstacle to public health efforts in fighting the pandemic has been the fact that the SARS-CoV-2 virus becomes transmissible before an infected person develops any symptoms. The peak period of virus shedding generally starts a day or two before symptoms appear, and continues for two or three days after. People will continue to shed active viruses that can be cultured in a laboratory for about eight days, on average, after testing positive. People can also be totally asymptomatic carriers.
With the Omicron variants, breakthrough infections in vaccinated individuals, and reinfections in previously infected individuals, have become increasingly common. In a study of California state prison inmates, researchers found that unvaccinated subjects with an Omicron infection had a 36 percent risk of transmitting their infection to close contacts, compared to a 28 percent risk among those who were vaccinated. Receipt of a recent booster dose further reduced the infectiousness of vaccinated subjects, suggesting that vaccination reduces an infected person’s risk of transmission to others.
If a person does test positive but is not feeling ill, they should still isolate because asymptomatic individuals are still able to spread the highly contagious Omicron sub-variants. In August of last year, the CDC controversially reduced their isolation guidelines to five days after a positive test or onset of symptoms, whichever comes first. If an asymptomatic person later develops symptoms after testing positive, the five-day isolation restarts on the day of symptom onset.
If someone is asymptomatic, but still tests positive after their five-day isolation period, they should still be considered infectious and continue their isolation for either 10 full days or until testing negative twice, 48 hours apart. Even if they test negative, they should wear a well-fitting mask through day 10 if they will be around others, at home or in public.
Although about 30 percent of people with COVID-19 may still test positive on a rapid antigen test 10 days after their infection, that does not mean they will spread the virus to someone else. Transmission beyond 10 days is unlikely, but if a person is still testing positive they are encouraged to err on the side of caution and avoid close contact with highly vulnerable people.
January 1, 2023
Research should eventually validate that the immunity-altering effects of one viral infection make a secondary infection with a different agent more likely. That might explain why the current “tripledemic” in the U.S. has been so severe. While waiting for the science to catch up, we’re treading on thin ice, epidemiologically speaking. Humans seem hell-bent on exposing themselves to more and more viruses. At same time, they seem determined not to take preventive measures to protect themselves against the harmful consequences.
Many of the worst human viruses didn’t start out in humans; they were originally animal viruses that made the leap to Homo sapiens after human exposure. Monkeypox was endemic in monkey and rodent populations in West and Central Africa, and only became a human problem with the accelerating destruction of the African rainforests in the 1970s. COVID-19 appears to have jumped from bats to people, possibly through an intermediate species, at a wildlife “wet market” in Wuhan, China. Avian (bird) and swine (pig) flu viruses occasionally rage through human populations.
The more forests we cut down, the more wild animals we will closely encounter as pets or for food. The more poultry and hogs we can cram into industrial farms, the more of their viruses we will be exposed to. This has created an ever increasing risk for non-human to human transmission, a process that scientists call “zoonosis.”
Barring a profound shift in the way that people interact with their environment, zoonosis is only going to get worse. An ever-growing human population, now eight billion strong and counting, is exponentially increasing the number of human contacts with wild animals. The need for increased food production because of a growing population also increases the number of humans having domestic animal contacts.
Zoonosis and vaccine-hesitancy are the two concomitant forces driving multiple viral outbreaks that could shape our future as a species. The ecological havoc caused by too many humans in relation to the carrying capacity of the environment has triggered a mass extinction event (click link for video). There seems to be no point in the foreseeable future when we won’t be dealing with at least one major viral outbreak, and probably more than one at a time. Our current COVID-19 pandemic is simply a harbinger of worse things to come.
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