The Covid Effect in Deaths and Other Diseases: a Commentary by Kent Sepkowitz, MD, MPH, NJ, NY, USA

I will be starting a book leave before this is my last newsletter. I’ll be back in late January. Until then, other Times journalists will be writing The Morning, and I look forward to reading their work along with all of you.

Hundreds of deaths in the US are caused by people not receiving the Paxlovid and other drugs that reduce the severity of Covid.

Editor’s Note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. CNN has more opinion on it.

What to do if you can’t stop taking a prescribed cardiac medication during the outbreak of Covid-19: A Myth about the “Night of the Death of the 1918 Flu Influenza”

The very same people who take heart and blood-thinning medications are the ones who benefit the most from Paxlovid. When I took Paxlovid in April, I knew to stop a cardiac medication that prevents me from veering into atrial fibrillation, a common heart rhythm disturbance. I got back into the abnormal rhythm after I stopped taking the drug. That’s just another example of the M.O. that clouds all medical advances. On resumption of my cardiac medication post-Paxlovid (as recommended), my heart rhythm returned to its regular beat.

I’m quite alarmed by the tone of some news articles that suggest that the problem is new and has somehow been overlooked until now, instead of as a “Review Topic of the Week” in the medical journal. A review is a collection of work that is put together into a readable whole. It’s certainly not anything new or edgy.

We have seen such reactions throughout the Covid-19 pandemic as guidelines changed in response to new facts or harsh public criticism, making the CDC and others look like clueless sticks in the mud.

In the early days of Covid-19, many current experts rush to the history books in order to learn from the 1918 flu epidemic. When they looked at the articles and reviews, they found that the current tools, such as masks and tranquilizers, were only half-hearted in their use, and that they were unpopular even though there was clear evidence that they were effective.

So, to those who may be reading this in the 22nd century, hoping to find a way to convince your comrades to behave in a socially responsible direction as Covid-63 rips through your temperate resin bunkers and stilted ocean homes, we say this: Yes, there is well-demonstrated evidence on what to do — but learning about it is not likely to help.

Rather, our collective message relies on one of the few effective and non-reviled public health messages to date: Only you can prevent the next pandemic.

What are they? There is not a single simple solution for the problems we face, that may be the reason the need for vaccine is more important than on the vulnerabilities of age. Communication from public health officials to politicians and the media can help, emphasizing that more shots are good, but that different groups probably need different approaches, and that even with up-to-date vaccination and bivalent boosting, infection is a considerable threat.

What should Americans do during the holiday season? The United States has the most Covid-19-related deaths in the last three years, according to NPR

One answer is that we prefer not to see deaths in a country as a background noise or morbid wallpaper. We don’t need to understand who is dying or why in part because we don’t want to reckon with the fact that around 300 Americans are now dying from Covid-19 every day, at a rough pace of about 100,000 per year, making it the country’s third leading cause of death. This is normalization at work, but it is also a familiar pattern: We don’t exactly track the ups and downs of cancer or heart disease either.

Throughout the last few years, the country has also struggled to consider individual risk and social risk separately. In the first year of the pandemic, we seemed to build our sense of individual risk backward from the social need to limit spread — underemphasizing some of the differential threat and focusing instead on universal measures like social distancing and mask wearing. With the arrival of vaccines, we started building a picture of social risk in the opposite way, up from one person to another.

What should Americans do during the holiday season? NPR asked public health experts. They would advise Americans to take precautions to protect themselves and others who face the highest risk of severe disease, including older people.

In the first week of December, the US had the most Covid-19-related deaths in months. Even with vaccines and treatments widely available, the CDC reported nearly 3,000 deaths for that week.

More than 77% of hospital beds nationwide are occupied, down slightly from nearly 80% earlier this month, according to data from the Department of Health and Human Services — the highest levels seen since last winter’s omicron surge.

What to do for the holidays? And what to do? The American public needs to be prepared for the coming holiday season, says Dr. Henry Wu

“Everyone is ready to do as much as they can in a normal holiday period, even though many have given up on it for a couple years,” said Dr. Henry Wu, an epidemiologist and travel doctor. “We are entering a new normal, where we have to decide what to do.”

As we approach the holiday season, now is the best time to think about what plans you have for the holidays. What are the most important events for you? Who do you wish to see?

Some people may feel totally comfortable getting together at a bar. Others were not so much. “If you want to protect the vulnerable person, whether they’re elderly or an infant, you should incorporate some lessons from the last few years,” he said.

Thinking through those questions can help you decide which safety measures to take. “Everyone in the family and individual is going to be different,” he said.

Only about 14% of eligible Americans have gotten an updated Covid-19 booster, and 1 in 5 people in the US remain completely unvaccinated, according to the CDC.

This year’s vaccine is a pretty good match to the strain circulating, that’s what the sense is. According to Malani in an interview with NPR, flu shots can help prevent hospitalizations, deaths and transmission, since they don’t prevent all infections.

This was the easiest to reach agreement with. “If you have symptoms, if you are feeling unwell, we are going to ask you to stay home. Rochelle Walensky, the head of the CDC, toldNPR last week that they don’t want people to gather if they are unwell.

One scientific review of 130 COVID studies conducted by mid-2021, published earlier this year in the journal PLOS Medicine, suggests that the risk of getting infected from someone who’s asymptomatic is much lower than from someone with symptoms.

If you do feel sick, get tested — COVID tests are widely available this year at pharmacies and grocery stores. And health care providers can arrange a flu test.

Natural air flow is effective at dispersal and multiplication of respiratory diseases such as COVID.

Not everything can realistically be moved outdoors. The social gatherings and religious services will be indoors. Spending time indoors is inescapable for family members who are traveling long distances to see each other.

How to protect yourself from getting sick in a crowded or poorly ventilated indoor space, based on the recommendations of Dr. M. Gandhi

For more flexible plans, such as catching up with an old friend from high school, you could go for a walk at the park, ice skating or strolling an outdoor holiday market when the weather is nice.

For the indoor gatherings, Gandhi suggests doing what you can to improve ventilation. The weather may allow for windows to be open. If not, HEPA filters, cracked windows and ceiling fans can help too.

She says that it’s the largest non-pharmaceutical intervention that has been revealed during the P/E.

Some indoor time in public might be unavoidable during a holiday season, like during travel and religious services. The CDC and some other organizations are encouraging people who are more vulnerable to wear high-quality, well-fitting masks in public.

A lot of people are sick in crowded indoor spaces right now, from the subway to the airplane. So put that mask on,” Malani said.

But in laboratory settings, masks like N95s or KN95s have been shown to block virus particles. Wearing a high quality mask can cut your chance of getting sick when around others who aren’t wearing masks, though they aren’t perfect.

A mask isn’t difficult, according to the person. I encourage people to keep that mask handy when you are in a crowded and poorly ventilated indoor space.

White House Response to Covid-19 and the Omicron Coronaviruses (Omega)Vulnerabilities: Tools, Tests, and Treatments

The availability of protective measures, tests, and treatments is important to prevent a repeat of the Covid-19 surge of the past two winters, health officials say.

The number of cases is now below that of earlier waves but the proportion of the population in areas that meet the US Centers for Disease Control and Prevention criteria for a high Covid-19 community level is increasing. Los Angeles County, New York City, and Phoenix are other places that are included.

Elderly people are bearing the brunt of a rise in Covid-19 hospitalizations. Hospitalization rates are four times higher for seniors than for any other age group.

The White House said on Thursday that Covid-19 season doesn’t have to be as bad as last winter’s, when there was a lot of cases with the Omicron coronaviruses variant.

“We have the tools, we have the infrastructure, and we have the know-how to manage this moment,” White House Covid-19 response coordinator Dr. Ashish Jha said at a briefing.

The Biden administration has been in daily contact with state and local public health leaders, monitoring hospital levels, he said. If states and communities need medical personnel, supplies and other resources from the federal government, they are prepared.

The government has reopened Covidtests.gov to let more Americans get access to free tests. Each household in the US can order up to four at home tests that ship as early as next week.

People who test positive for Covid 19–particularly those 50 and older–should be evaluated for treatment, according to Jha on CNN.

“We want to encourage people to use those tools, and given how widespread and how available those tools are, I think if people did that, we could get through” the Covid-19 season, Jha said.

But the CDC came out with two studies Friday detailing the bivalent vaccine’s effectiveness against COVID-related emergency department visits and hospitalizations and effectiveness against hospitalization specifically among older people.

The CDC recommended a bivalent booster in September to better protect against the omicron variant. Both broad and omicron-specific protection is offered by the new booster, which targets parts of the original virus strain.

In October of this year, two studies from Harvard and Columbia University found that the new shots did not produce better antibody response against the omicron BA.5 variant.

The vaccine’s effectiveness at preventing severe disease continues to be proven. Seniors have higher booster take-up than other age groups. According to the CDC, less than 10% of adults under 50 and less than 5% of children have gotten an updated booster.

The Uphill Battle for the U.S. Children’s Immune System During the 2019 Covid-19 Epidemic: A Senior Vice President at the Kaiser Family Foundation

In September, the senior vice president of global health and HIV Policy at the Kaiser Family Foundation told NPR that it was going to be an uphill battle. “I do think it’s a tough sell just because of where we are on this point in the pandemic.”

She’s a 76-year-old woman, and she was well aware of the risks posed to her and her husband’s health by Covid-19, flu and other colds that are sweeping the United States amid a rough respiratory virus season.

Only about 13% of all reported cases in the US have been among people 65 and older, according to data from the US Centers for Disease Control and Prevention. But about half of all hospitalizations and three-quarters of all deaths have been in this age group.

When Covid-19 swept through nursing homes in 2020, there was never more than a three-fold difference.

“Right now we have an immunity wall built up against the Omicron family – between shots and prior infections and combinations thereof – that seems to be keeping younger folks in pretty good stead. The immune systems of older people are not as strong.

Booster deficiency is the main culprit. It seems that immunity is waning. The effect would be minimal if there were more seniors with their booster.

New variants that are more immune evasive and relatively low utilization of treatments like Paxlovid may have played a role in the rising hospitalization rate among seniors, Topol said.

Stewart still keeps an Eye on Covid-19 trends but she is less active on her personal mitigation measures. She’s found a balance between caution and contentment that she says works for her – but getting her vaccines is really what helps her feel safest.

“I’m paying attention to the fact that it’s picking up, so I’m a little bit more careful than I was, say, six weeks ago,” she said. “With the pickup, I haven’t reverted to how I was handling it a couple of years ago, but I’m more aware of who I’m around and maybe wearing my mask a little bit more than I used to.”

A home test was negative for Covid-19 and confirmed by another test at a health care provider’s drive through, which brought some relief, she said. But even if it was positive, knowing she was vaccinated and boosted gave her reassurance.

She said that the viruses were dangerous, but so was isolation. For now, there is a way forward and that is through vaccination.

Dr. Preeti Malani is a doctor at the University of Michigan Health who specializes in infectious disease and geriatric medicine.

Source: https://www.cnn.com/2022/12/23/health/senior-wave-covid/index.html

Boosting the Immune Response to a Cold Case of Lyme Disease: an Insight from a Family Member who was unable to play baseball

A lot of people who had previous Boosters have not gotten this one and I worry that there is confusion and misinformation. I say to seniors and to everyone, if you have not been boosted, go get boosted.

Any person can get this, said Malani. If you are older, you’re more likely to have severe symptoms, be hospitalized, and die.

We all wanted a vaccine that prevented transmission. We don’t have a vaccine that does that, but it does reduce transmission and it does reduce severe outcomes,” said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

Even though she and her husband get together with small groups of friends that they think are safe and vaccine free, they still plan to stay away from baseball games.

According to Malani, a friend seemed to be trying to get permission to spend time with family this holiday season. She was eager celebrate in-person with loved ones after years spent about, but anxious about letting her guard down amid a rough respiratory virus season.