How Long COVID

 

We already know that the novel coronavirus, COVID-19 (aka SARS-CoV-2), is probably going to be with us for a long time. We are not even close to herd immunity on a global level – and without a global approach, the disease can continue to mutate and threaten without much hope of ending. Even within the United States, where vaccines are freely accessible and clearly effective to those over 12 years of age, vaccine resistance (accompanied by “mask” and social distancing resistance) – most of it based on disinformation and politization of a medical reality – pretty much assures the disease will continue to defeat the best medical intentions, private and governmental. People travel, and travel spreads the disease.

American levels of polarization have just added “vaccinated” vs “unvaccinated” as two categories of risk and exposure. With vaccines still not available for young school-aged children, and with some states (now facing judicial opposition) insisting the there can be no mandate by employers or school districts for vaccinations or masks, the Delta strain of the virus is exploding in those jurisdictions. Delta is unlikely to be the last super-toxic variant of COVID-19, and we can only hope our vaccinations keep up with that roiling threat of new varieties. None of our current treatment options for those infected – notably Regeneron (a monoclonal antibody) and remdesivir (a broad-spectrum antiviral) – offer a cure for the disease. We seem to be sitting in wait at least for the same kind of containment we have achieved over HIV infections, but that took decades.

Increasing numbers of children are now getting COVID infected with some deaths recorded, but their greatest threat is as carriers of the disease back into their homes, where unvaccinated adults are likely to become infected with the “heavy viral load” Delta virus, which currently accounts for most U.S. infections. Those vaccinated can still face a “breakthrough” infection, but death or severity requiring hospitalization is no longer a material threat to them. Thus, the explosion of new cases is largely a “pandemic of the unvaccinated.” And that has a profound impact not just on our overall health but on the ability of our economy to recover.

What we cannot fully appreciate, but are beginning to understand, are the lingering or recurring aftereffects that plague recovered COVID patients well beyond the main impact of the disease. Sometimes months or even a year (or more?) later. Jason Maley, a Harvard Medical School instructor in medicine and director of BIDMC’s Critical Illness and COVID-19 Survivorship Program (in the  April 13th Harvard Gazette) explains: “Long COVID or what’s now — through the National Institutes of Health — being referred to as ‘post-acute sequelae of COVID-19’ [PASC,] is persistent symptoms or new symptoms that develop, generally speaking, at least four to eight weeks after the initial infection with COVID-19. It can include the continuation of symptoms that happened when a person was first sick, like shortness of breath, or fatigue, or it can be new symptoms where a patient feels like they’ve improved and they’re recovering and then a month after being infected, they have worsening chest discomfort and brain fog and difficulty thinking, and all sorts of symptoms from head to toe that can either persist or develop somewhat newly after they’re infected.” Loss of a sense of taste or smell can also occur.

Those having suffered and recovered from a bout with COVID-19 face a new pre-existing condition that has often expensive and prolonged symptoms. The disease has not been with us long enough to measure many of its potential longer-term effects, but what we know already is disturbing. Melissa Healy, writing for the August 27th Los Angeles Times, updates what we know so far about the challenge of long-haul COVID: “COVID-19 patients in Wuhan were among the pandemic’s first victims, and a comprehensive new study finds that a year after shaking the coronavirus, survivors were more likely than their uninfected peers to suffer from mobility problems, pain or discomfort, anxiety and depression.

“A detailed accounting of 1,276 people hospitalized for COVID-19 in the pandemic’s opening months reveals that a full year later, almost half continued to report at least one lingering health problem that is now considered a symptom of ‘long COVID.’ … One out of five said they had continued fatigue and/or muscle weakness, and 17% said they were still experiencing sleep difficulties. Just over one in four said they were suffering anxiety or depression in the wake of their bout with the SARS-CoV-2 virus… For the growing number of patients who identify themselves as COVID ‘long haulers,’ the new accounting offers cause for optimism — and concern. The period from six to 12 months after infection brought improvement for many. But most patients struggling with symptoms at the six-month mark were not yet well six months later.

“The findings, catalogued by a team of Chinese researchers, were published late Thursday [8/26] in the medical journal Lancet… ‘This is not good news,’ said David Putrino, a rehabilitation specialist who works with COVID long haulers at Mount Sinai Hospital in New York. ‘If you run the numbers here, about one-third of the group that had persistent symptoms are getting better after 12 months, while two-thirds are not.’… Putrino also called the findings a ‘wake-up call’ to public health officials that even when the pandemic is over — a distant enough prospect in the midst of a fourth wave of infections — its downstream consequences will not be…

“There will be a lot of them. More than 87,000 COVID-19 patients are being hospitalized each day in the United States, and 2.7 million have receiving hospital care in the past year alone… The half who contend with persistent symptoms will show up in doctors’ offices with clusters of vague and perplexing complaints including brain fog, heart palpitations, pain and exhaustion. And despite emerging evidence that time and specialized treatment can help many to improve, few will have the wherewithal to spend months in intensive rehabilitation for their symptoms, Putrino said…

“When the [Wuhan] study’s COVID-19 patients were examined at six months, 68% said they had at least one of 15 symptoms considered hallmarks of long COVID… At one year, 49% were still afflicted by at least one of those symptoms… The proportion of patients with ongoing muscle weakness and fatigue dropped from 52% to 20% during that time. Patients experiencing loss of smell dropped from 11% to 4%, and those afflicted with sleep problems fell from 27% to 17%. The 22% who reported hair loss at six months dwindled to 11% a full year out…. At the same time, the numbers of patients reporting breathing difficulties saw a slight increase, rising from 26% at six months to 30% after a year. Likewise, patients who reported new depression or anxiety increased from 23% to 26% during that period… An editorial published alongside the new study noted that only 0.4% of COVID long haulers are receiving rehabilitative treatment for their symptoms.” 

In short, those unvaccinated who simply will not accept their responsibility in continuing and spreading the disease to others or who continue to believe that the disease is not as virulent as it is, also face the potential of a very long-term set of health threats should they contract COVID-19. Aside collateral and permanent damage to critical organs, they now may also face a very long-term litany of debilitating aftereffects that could materially impact their quality of life… and their ability to earn a living. With the FDA finally fully approving Pfizer’s mRNA vaccine, the excuses for remaining unvaccinated have all but disappeared.

I’m Peter Dekom, and the entire nation faces a serious long-term challenge made so much worse by our politized and polarized body of vaccine resisters, most of whom are basing their decisions on inadequate or distorted “information.”

Natural Selection, Malthusian Herd Culling and History

The above graphic, courtesy of the VisualCapitalist.com, tells you of a violent and persistent battle between humanity and various killer plagues. Human beings have always had a disproportionate impact on nature, at first more likely to cause the extinction of various species from over-hunting, later from destroying habitats and pollution. And nature, call it God if you like, has always pushed back. If disease were not sufficient to contain human beings, a species with no senior animal predators, nature turned us on each other. Wars. Crimes. Genocide. A growing belief in some tribalistic religiosity that that “non-believers” must be exterminated. We called it “man’s inhumanity to man,” but we certainly imposed the value system on every other life form on the planet as well.

Indeed, even in some of our most basic religious scriptures are rife with descriptions of how earth’s resources (including nonrenewable resources) are there for the taking, although some updated interpretations (particularly of the Bible, as reflected in recent papal encyclicals) suggest that environmental responsibility is a necessary adjustment to religious interpretation. Is there a bigger force at work, particularly here in the United States, where education is easily accessible but where deep evangelical forces are fighting back against science and medicine? This is increasingly relevant as man-induced climate change, an evolution if you will of man’s discovery of the use of fire way back when, seems to be defining a particularly challenging future for life on earth. Speaking of evolution…

Ever since the famous 1925 case of Tennessee vs Scopes (now known as the “Scopes Monkey Trial”), evolution appears to have won out over the demands of Christian fundamentalists that creationism is the only legitimate explanation of the earth and mankind. Still today, there remains a vast swath of fundamentalist Christians that adhere to creationism as the only explanation. “Scopes was found guilty and fined $100 (equivalent to $1,500 in 2020), but the verdict was overturned on a technicality. The trial served its purpose of drawing intense national publicity, as national reporters flocked to Dayton to cover the big-name lawyers who had agreed to represent each side. William Jennings Bryan, three-time presidential candidate and former Secretary of State, argued for the prosecution, while Clarence Darrow served as the defense attorney for Scopes. The trial publicized the Fundamentalist–Modernist controversy, which set  Modernists, who said evolution was not inconsistent with religion, against Fundamentalists, who said the Word of God as revealed in the Bible took priority over all human knowledge. The case was thus seen both as a theological contest and as a trial on whether modern science should be taught in schools.” Wikipedia.

Could evolution explain the severe polarization we are experiencing in the United States where COVID vaccines are both obviously highly effective and easily obtained –  but for religious reasons, unbridled fear based on disinformation and conspiracy theories or some thoroughly unsupported “constitutional” theory of individual liberty – millions of Americans remain unvaccinated? As populist governors seek to blame just about anything other than a plague of unvaccinated hordes – from a very small number of undocumented border-crossers even to those who are indeed vaccinated – for the variant Delta outbreak, is evolution culling the herd? Why are people so willing to risk children, still not eligible to be vaccinated to justify their own choice, to avoid both getting vaccinated or taking simple mask/social distancing preventative measures? 

Are Arizona Governor Doug Ducey, Texas Governor Greg Abbott and poster-boy for anti-scientific reality, Florida Governor Ron DeSantis (among other red state leaders), simply the accelerants, the instruments if you will, of evolution? In recent history, science contained HIV (it took decades, and the disease is still here, but…) and clearly can grapple with the novel coronavirus (and so far, its variants), so people who oppose science and its proscriptions (and hence vaccination) – generally religious fundamentalists, less educated, more gullible persons and political idealogues – seem to have been targeted by nature for infection by the highly contagious and ultra-virulent Delta strain of the virus. Why them?

If nature culls herds to improve the quality of the survivors, a basic tenet of evolution, has nature determined that our species is better off without that self-defined spectrum of vaccine skeptics and opponents of preventative masking and social distancing? Every single state that has lifted restrictions, even going to the point of forbidding full implementation, has experienced soaring infection and mortality rates among the unvaccinated. Hospital capacity, even for those with non-COVID hospitalization needs, has accordingly been stretched to the limits and beyond. It may be a politically charged and unfortunate observation, but ask yourself if this is simply nature’s determination of who lives and who dies? There are indeed very many good and decent people who are voluntarily offering themselves and their children to nature’s cruel sacrifice.

I’m Peter Dekom, and if maximizing survivability through vaccination vs facing horrific medical risk is indeed a choice, those who cannot make the choice supported by science just might be cooperating with nature’s consistent evolutionary process.

The Other Plague that Just Won’t Go Away

 

HIV is still with us, but for those with access to the right treatments, it has been dramatically contained to the point where it can be non-transmissible and medically undetectable. It only took decades to develop. But one disease that stubbornly lingers, one that could easily spread heavily to the United States with climate change, is malaria. The Bill and Melina Gates Foundation, divorce notwithstanding, has focused on this killer with massive contributions to treatment and research. Here’s what our CDC says about the disease, which infects millions every year:

“In 2019, an estimated 409,000 people died of malaria—most were young children in sub-Saharan Africa. Within the last decade, increasing numbers of partners and resources have rapidly increased malaria control efforts. This scale-up of interventions has saved millions of lives globally and cut malaria mortality by 44% from 2010 to 2019, leading to hopes and plans for elimination and ultimately eradication. CDC brings its technical expertise to support these efforts with its collaborative work in many malaria-endemic countries and regions…

“A very efficient mosquito (Anopheles gambiae complex) is responsible for high transmission… The predominant parasite species is Plasmodium falciparum, which is the species that is most likely to cause severe malaria and death… Malaria is one of the most severe public health problems worldwide. It is a leading cause of death and disease in many developing countries, where young children and pregnant women are the groups most affected. According to the World Health Organization’s World Malaria Report 2020external icon

• Nearly half the world’s population lives in areas at risk of malaria transmission in 87 countries and territories.

• In 2019, malaria caused an estimated 229 million clinical episodes, and 409,000 deaths. An estimated 94% of deaths in 2019 were in the WHO African Region.”

This nasty disease loves the weak and vulnerable, particularly children. Malaria brings high fevers, chills, rising and falling, with an incredible draining of energy; it is a highly efficient killer. As heat rises in North America and Europe, we could be next. But perhaps recently developed treatments and vaccines might hold out hope, if only we could get these medications to those who need it the most. At least, finally, there is a renewed hope of conquering or at least mitigating the impact of this horrific disease, one so powerful, it has brought entire armies to their knees.

The results of a field test trial, “published in the New England Journal of Medicine, focused on giving very young children a vaccine already in use and anti-malarial drugs at the time of year they are most vulnerable - often the rainy season (from June in Burkina Faso), when mosquitoes multiply… “It worked better than we thought would be the case,’ said Prof Brian Greenwood, a member of the research team, from the London School of Hygiene & Tropical Medicine (LSHTM), which led the trial… ‘Hospital admissions were less, deaths were less in both countries - and we really didn't expect to see that.’

 

“Over three years, the trial found three doses of the vaccine and drugs before the worst malaria season, followed by a booster dose before subsequent rainy seasons, controlled infections much better than vaccines or drugs alone - and, the researchers said, could save millions of young lives in the African Sahel.” BBC.com, August 25th.

 

The big picture looms: human beings populate the earth at more than double what scientists believe is a sustainable level. We are consuming irreplaceable natural resources at an alarming rate and continue to pollute our waterways and air, especially in the climate changing release of greenhouse gasses from an unrelenting addiction to fossil fuels. Nature seems to be committed to culling the herd, but I for one would prefer not to be culled. And that requires personal and governmental responsibility that has yet achieved to any significant level. Time’s up!

 

I’m Peter Dekom, and I sure hope people the world over get the message and do something while pressuring their governments to do the same.

Now Alone at the Bottom – Florida is Officially the Biggest Loser

 

*Update 8/30/21

Maybe we should call it the “novel scarlet fever,” since the massive new Delta-variant novel coronavirus infection rate disproportionately impacts red states (and high-level red state vacation destinations like Vegas). Places where vaccination rates are below national standards and masks are anything but mandatory. But only one state, the reddest of the red when it comes to COVID (the darker the red in the above map, the greater the infection/mortality rates), Florida actually has more COVID-related deaths today than it did at the peak of the pre-vaccine infection period. The only state in the union with that ignominious distinction. Blame on undocumented aliens crossing the southern border hundreds if not a thousand+ miles away, which obviously should have registered greater-than-Florida increases in such border, is not statistically sustainable as the above map clearly indicates.

In effect, those who refuse vaccinations and will not mask and/or test accordingly, are inflicting millions if not trillions of dollars of hard economic damage on the nation without absorbing a whit of what they are rather directly the cause of. Not even counting the suffering and death they may be inflicting on innocents under some constitutionally unsupported, self-determined notion of “individual freedom.” The right to infect and kill others? 

One Delta infected individual, on average, transmits the disease to eight to ten other individuals, which obviously creates an exponential infection rate. As travelers from “wide open” states travel to states with appropriate COVID restrictions and regulations, they undo the efforts of safe and sane governmental regulation. And now that the FDA is fully approving the mRNA vaccines (Pfizer already and next Moderna), the remaining vaccine skeptics have just plain run out of legally tenable reasons not to get vaccinated.

As the newly elevated governor of New York, Kathy Hochul, adds new transparency to her office, as well as new vaccine and mask mandates particularly of school children (those under 12 still not eligible for vaccination), some red state governors, folks like Arizona’s Doug Ducey, Texas’ Greg Abbott and most all Florida’s Ron DeSantis, continue to issue and support anti-mask, anti-vaccination mandates from school districts, employers, etc. literally making it illegal for anyone to require such preventative measures. They’ve even cut funding to public schools and school districts that still have resisted these inane policies, even as the Biden administration is attempting to replace the withheld funding.

In Florida, “new daily cases appear to have topped out at 138 per every 100,000 residents — more than two and a half times last summer’s peak. As a result, the state’s current hospitalization rate (80/100,000) is nearly one and a half times last summer’s peak; new daily deaths (1/100,000) are higher than ever. And they’re both still climbing.

“In other words, Florida did roughly twice as badly as California last summer in terms of COVID cases, hospitalizations and deaths. This summer, however, Florida is doing roughly four times worse in terms of cases and hospitalizations — and nearly six times worse in terms of deaths…

“‘Vaccines are working to prevent deaths in many other countries that have seen post vaccine spike in cases, and most other states in the U.S. as well. Florida is different,’ Dr. Vincent Rajkumar, a professor of medicine at the Mayo Clinic, recently explained on Twitter. ‘What’s different in Florida is that, relative to the vaccination rate (~50%), the relaxation of distancing and masking was disproportionately high. Leaders expressed disdain for masks and mask mandates. The total number of people unvaccinated is high. And hospitals got overwhelmed.’” Yahoo News, August 25th. 

That Florida and Texas public school teachers are resigning in record numbers as their own government leaves them unprotected, that it will take years to replace them, does not seem to trouble red state leadership. After all, science, medicine and full education are no longer red state values. And the infection and mortality rates incurred in defiance of science, medicine and a full education reflect that reality.

However, at least the Florida judicial system still cares about the rule of law and the health and welfare of its citizens, especially the youngest in public schools. “A Florida judge on Friday [8/27] knocked down the state's order banning local school boards from implementing mask mandates, saying the sweeping action from Tallahassee doesn't ‘pass constitutional muster.’

“Leon County Circuit Judge John C. Cooper's decision followed a four-day trial, which was held online as the state struggles to contain the spread of Covid-19… School districts have the right to set policies, like mask mandates, as long as they have ‘compelling state interest’ and have a ‘narrowly tailored’ plan of action, according to Cooper.” NBC News, August 27th. DeSantis faces reelection at the end of 2022. Let’s hope his endangering political career ends there. And that judges in other states with same inane rules see the issue with the same clarity.

I’m Peter Dekom, and I just wonder when such irresponsible governors become labeled as the obvious fomenters of unnecessary death and economic destruction that they truly are.

Migrating to Hell for Lower Taxes and Cheaper Housing

    

If you do not have school-aged children or simply do not believe that COVID is a genuine threat, if you hate colder weather, expensive real estate, a high cost of living and staggering local taxes of every kind… and if your job is not location dependent or you are retired… you might consider doing what so many Americans have been and are doing: Leaving the colder or expensive place and moving to the warmer cheaper place. You may not care about descending desertification, alternatively coastal erosion, flooding or dangerous tropic storms. The states that offer cheaper, warmer lifestyles with lower costs are primarily red states, those worst prepared for the accelerating threats of climate change and most devastated by all things COVID. 

Even if there are short term benefits and you side-step the COVID inanity, water shortages, fires and floods, exceptionally heavy downpours from exceptionally damaging storms, maybe more than a few tornados, failing power grids and roads from a lack of infrastructure investment, coastal erosion, sink holes and collapsing support for buildings, power outages and record levels of searing heat… long, long bouts of unrelenting intolerable weather… too hot, with water rationing in the cards… assuming there is water to be rationed.

Indeed for all the damage from COVID and the selfish-resisters, what the vast majority of those who will face the worst – Y, Z and following generations – fear the most is not political polarization/gridlock (with intolerance, racism and violence thrown in the mix) or even COVID’s likely longer term persistence; what they are worried most about, what their unthinking and seemingly unfeeling parents and grandparents have left as the prior generations’ legacy gift to its children… is the extreme impact being imposed on them by accelerating climate change. And it is not a theory, they know it is not “just normal cyclical climate patterns,” it is hard and fast fact… with a whole lot of irreversibility built in. The parents are impacted the least. The “kids” will live with this reality vastly more intensely.

So, as many escape to what they think will be a more affordable lifestyle, they may soon discover their own version of hell on earth. They are not flocking to the northern cities, where water will remain abundant and climate is, subject to the Polar Vortex, likely to moderate somewhat over the coming years… and where real estate and the cost of living are most reasonable, often lower than those popular “warm” (read: intolerably hot) venues. In addition to the Census graphic showing migration patterns within the United States, the above pictures reflect dying Arizona farmland as well as recurring flooding in Miami and Houston after heavy tropical downpours.

Adele Peters, writing for the August 24th FastCompany.com, fills in some blanks: “In Phoenix, where a drought has lasted for 27 years so far, one source of water—the Colorado River—may soon dry up. The city is also getting hotter, with a record number of days over 110 degrees Fahrenheit in 2020. At the same time, the population continues to expand. Over the last decade, Phoenix grew faster than any other American city, and Arizona was one of the fastest-growing states.

“In Michigan, on the other hand, a state that’s likely to be relatively less likely to be impacted by climate change, the population grew slowly. A recent Census Bureau map shows the overall trend [above]: Many Americans have been moving to areas that are likely going to be harder hit by climate impacts.

“Florida, where coastal cities are facing stronger hurricanes and more flooding as sea levels rise, was among the top 10 fastest-growing states between 2010 and 2020. (The trajectory has continued through the pandemic, as an estimated 330,000 additional people moved to Florida between April 2020 and April 2021.) Utah, with the fastest population growth by percentage, is dealing with extreme drought, wildfires, and ongoing air pollution from fires in other states like California. Texas, another quickly growing state, is one of the places most at risk from both extreme heat and drought…

“‘The White House has looked at international climate migration, and there’s a whole working group on that now, but there’s nothing on domestic climate migration,’ says Jesse Keenan, an associate professor of real estate at the Tulane School of Architecture who studies climate change adaptation and the built environment. ‘I think that’s a missed opportunity on many fronts.’

“People move for many reasons, of course, and climate change still isn’t necessarily a major factor. In Paradise, California, many people are now rebuilding their homes, and the population is surging, three years after the town was destroyed by a wildfire—even though the chances of another major fire are high. But it seems likely that growing numbers of people may choose to move because of climate change over time. (There might be some early signs of this now, as Maine, a place likely to be a little less impacted by climate change, became one of the more popular places for people to move in the first quarter of this year, according to data from the relocation tech company Updater.) And better planning by the government, at all levels, could help that happen more slowly.” 

Maine is beautiful but rather cold in the winters, and it is not exactly a job mecca. Sure, climate-vulnerable cities and states are planning for the approaching disasters, but I suspect those who will inevitably be subjected to those plans have no idea if they will be able to tolerate the required (and legally mandated) sacrifices and limitations. There will be changes. Huge changes.

I’m Peter Dekom, and our general lackadaisical response to climate change, coupled with the mass of right-wing climate change deniers, suggests that traditional warm weather “escape” driven migration just might produce very much the opposite of expectations.

They Will Never Stop Attacking Us

 In Memoriam:

 For the ten U.S. Marines, two soldiers and one Navy corpsman killed in Kabul, dying so others could escape… and live. Heroes all. Plus the scores of other innocents killed or injured in this malignant suicide bombing attack.

“The terrorist group behind the Kabul suicide bombing Thursday that killed U.S. Marines and dozens of others and derailed the ongoing Afghan evacuation is a competitor of the Taliban — and even more extreme… The Islamic State Khorasan, or ISIS-K, is the Afghan offshoot of the Islamic State terror group, which publicly beheaded foreign journalists and inflicted brutalities on captured Kurds and others in Iraq and Syria…

“‘There is no love lost between ISIS-K and the Taliban,’ [said Raffaello Pantucci, senior fellow at the International Centre for Political Violence and Terrorism Research at the S. Rajaratnam School of International Studies in Singapore]. ‘They are competitive organizations. They are trying to appeal to the same recruits and the same funding sources. They are trying to build the same thing in different ways.’” NBC News, August 26th. They are foreigners even to the Taliban, even trying to embarrass the Taliban, but make no mistake, our withdrawal has emboldened extremists groups again U.S. targets… everywhere.

I’m Peter Dekom, and we shall remember… it may take time… but we shall punish those who have no qualms in killing innocents fleeing for their lives… and those who guard them.