Wednesday, May 18, 2022

COVID: Cold vs. Flu Model

From the NYTimes:

 How Often Can You Be Infected With the Coronavirus?

The spread of the Omicron variant has given scientists an unsettling answer: repeatedly, sometimes within months.

A virus that shows no signs of disappearing, variants that are adept at dodging the body’s defenses, and waves of infections two, maybe three times a year — this may be the future of Covid-19, some scientists now fear.

The central problem is that the coronavirus has become more adept at reinfecting people. Already, those infected with the first Omicron variant are reporting second infections with the newer versions of the variant — BA.2 or BA2.12.1 in the United States, or BA.4 and BA.5 in South Africa.

Those people may go on to have third or fourth infections, even within this year, researchers said in interviews. And some small fraction may have symptoms that persist for months or years, a condition known as long Covid.

“It seems likely to me that that’s going to sort of be a long-term pattern,” said Juliet Pulliam, an epidemiologist at Stellenbosch University in South Africa.

“The virus is going to keep evolving,” she added. “And there are probably going to be a lot of people getting many, many reinfections throughout their lives.”

It’s difficult to quantify how frequently people are reinfected, in part because many infections are now going unreported. Dr. Pulliam and her colleagues have collected enough data in South Africa to say that the rate is higher with Omicron than seen with previous variants.

This is not how it was supposed to be. Earlier in the pandemic, experts thought that immunity from vaccination or previous infection would forestall most reinfections.

The Omicron variant dashed those hopes. Unlike previous variants, Omicron and its many descendants seem to have evolved to partially dodge immunity. That leaves everyone — even those who have been vaccinated multiple times — vulnerable to multiple infections.

The new variants have not altered the fundamental usefulness of the Covid vaccines. Most people who have received three or even just two doses will not become sick enough to need medical care if they test positive for the coronavirus. And a booster dose, like a previous bout with the virus, does seem to decrease the chance of reinfection — but not by much.

At the pandemic’s outset, many experts based their expectations of the coronavirus on influenza, the viral foe most familiar to them. They predicted that, as with the flu, there might be one big outbreak each year, most likely in the fall. The way to minimize its spread would be to vaccinate people before its arrival.

Instead, the coronavirus is behaving more like four of its closely related cousins, which circulate and cause colds year round. While studying common-cold coronaviruses, “we saw people with multiple infections within the space of a year,” said Jeffrey Shaman, an epidemiologist at Columbia University in New York.

If reinfection turns out to be the norm, the coronavirus is “not going to simply be this wintertime once-a-year thing,” he said, “and it’s not going to be a mild nuisance in terms of the amount of morbidity and mortality it causes.”

An infection with Omicron produces a weaker immune response, which seems to wane quickly, compared with infections with previous variants. Although the newer versions of the variant are closely related, they vary enough from an immune perspective that infection with one doesn’t leave much protection against the others — and certainly not after three or four months.

23 comments:

  1. It looks like we may quickly see if this new model of the virus prevails. The BA.2.12.1 variant seems to be spreading rapidly across the country.

    The BA.4 and BA.5 variants are spreading in South Africa; typically, variants that start there became predominant here a few months later. These variants could come in very soon after the BA.2.12.1 variant runs its course.

    That will mean that we will have a lot of virus activity during the summer months as well as winter months.

    It looked like earlier forms of Covid might behave like the flue because they were associated with people coming indoors. But close inspection reveals that happened during the months when people came inside for the air-conditioning as well as the heat in winter.

    Now the Omicron variants are so contagious that one does not have to be with a lot of people for a very long time to get it. Also, most cases are so mild that people may not realize they have it even though they can infect other people. Therefore, one cannot isolate with vaccinated and from sick people and feel safe.

    So, people who have compromised immune systems or even eighty year olds like myself who don’t want to have repeated Covid episodes on the chance of getting long Covid will just have to adopt a hermit life style. Social activity may have to be limited to the spring-summer-fall periods when one can meet one of two persons at a time outdoors.

    When the Biden administration released more home tests yesterday, I signed up. I told Betty we need to have contingency plans should she become infected. Seemingly the earlier recognized and treated the better the outcome. That may mean we have to test ourselves after we think that we might have been exposed to others who might have the virus.

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  2. COVID is climbing around here. Some towns and counties around here have been re-classified from "medium" to "high" incidence of infection. In our own parish, at I heard of at least six parishioners who tested positive within a three-day period last week. Personally, I was too ill to work this past Monday morning. I took one of the home-kit COVID tests but it came back negative (for whatever that is worth).

    Fortunately, it seems that virtually everyone who tested positive last week, has been able to self-isolate for five days and then more or less bounce back.

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  3. It seems as if everyone is getting it now. The recent variants seem less serious but Omicron did kill someone I knew, an unvaccinated cancer survivor. I wonder why I haven't contracted it yet. I've been taking zero precautions for months and do not shun gatherings and public places. My health care corporation is still not offering the second booster. I may go to CVS for one.

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  4. New cases are up more than 80% in the last two weeks here. The county is recommending masks indoors again but not mandating them. My husband and I flew to Florida a couple of weeks ago to use up expiring credits on Southwest. ( will never fly SWA again now that we’ve used them). It was right after they dropped the mask mandate on planes which upset me a lot. We had gotten our second boosters two weeks earlier and we survived the two flights (every seat full, mostly unmasked passengers).

    In our nuclear family of 8 adults and 7 children only one d-I-l and I haven’t yet gotten Covid. I am careful and not out and about a lot I never stopped wearing a mask indoors even after the mandate was lifted. Covid hit our grandson’s second grade class a week or so ago so the whole family had to be tested. My grandson was positive but no symptoms.he was vaxxed. My son was positive with a very mild sore throat for a day. The two year old, unvaxxed of course, was positive, very low fever for a few hours but fine when she woke up from her afternoon nap.. I can understand why I haven’t gotten it, but am amazed that my son’s wife hasn’t. They are out and about, school child, school vents, daughter in day care, birthday parties and other social events. But she’s still escaped it. My husband got it after flying to California the week before Christmas, 2 1/2 months after his first booster. He was pretty sick, but not enough to be hospitalized. He was given the monoclonal antibodies infusion though. It turned it around in a day. We are supposed to go to his 60th college reunion in a couple of weeks. He’s very anxious to go because the 70th might be really poorly attended! The members of this class are in their 80s now. But we are now going to drive instead of fly. We won’t stay in New England to visit friends as originally planned but will come straight home. A neighbor died last summer - he refused to get vaccinated. His wife was vaccinated. She sold the house last fall and moved out of the area. This was pre- omicron. Delta?

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  5. We haven't had Covid, that we know of. I do kind of wonder if a cold we had a few months back was actually Covid, but it didn't really seem out of the ordinary. We have been double vaxxed, and boosted,(once). I suppose we should get our second booster, but I wish it was updated for the variants. We haven't worn masks much in the past several months. Very few people here do anymore. The mask mandate at work expired a month ago..

    My brother in law, who has auto-immune issues, has had Covid twice in spite of being double vaxxed and boosted.

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    1. To the best of my knowledge, neither my wife nor I have had Covid. It's difficult to explain why. While I don't think we've been irresponsible, and both of us have the advantage of working from home, we haven't exactly remained cloistered over the last 2+ years. I am at the parish every weekend, serving at multiple masses, interacting with parishioners before, during and afterward. In recent weeks I've also been helping cover for our music director, who has been having another bout of health problems. The choir has had a half-dozen or so Covid positives within the past week, but so far, it seems I've dodged that bullet. I've seriously been wondering whether I'm a super-spreader, but as I say, I self-tested this week and it was negative.

      We go to restaurants occasionally, and very occasionally we'll go to a concert or a similar outing. We've avoided flying and indoor crowds (and, for that matter, outdoor crowds - I don't like being in places where people are packed like sardines, whether it's indoors or outdoors). We still have various combinations of children coming, going and/or living here at any given time, and they all have their own sets of interactions at their work and school, so we're anything but hermetically sealed. Two of the kids have tested Covid positive over the course of the pandemic, but they seem to have come through just fine.

      I have received both sets of shots and both sets of boosters - I am sure that is a big reason I've managed to avoid infection so far (as far as I know). My two initial vaccinations and first booster were Moderna; the latest booster was Pfizer - I had heard a doctor in the media say that there may be some incremental benefit to mixing and matching between those two "recipes" of the vaccine. But then a few days ago, I heard the same guy remark that there isn't really a consensus on that approach. D'oh!

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    2. For our parishioners (and music ministers), wearing a mask is optional. Some parishioners continue to wear them, while the majority don't. Clergy are required to wear them during the Liturgy of the Eucharist. I suspect that approach is mostly Covid Theater, but I comply. I don't mind wearing a mask as long as it's not for a long period of time.

      Now, as cases around here are starting to climb again, I'm voluntarily wearing the mask more when I'm on the altar. I don't wear it when I'm reading or preaching at the ambo, but keep it on for most of the rest of the mass. I figure it can't hurt, and it may actually help a little. And maybe it will encourage some others to wear, or continue to wear, a mask.

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    3. A group of scientists is now conducting a study to try to figure out why some people don’t get Covid in spite of frequent exposure. Our primary care doc has 6 kids, a bunch of grandkids, spouses of kids etc and many patients. They were all together at Christmas. Everyone in his family except for him got Covid during the holidays.

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    4. Chance may play a role. About 4,000 Pennsylvanians contract COVID daily now. That's a one in 3,000 chance daily. Even if that rate continues for a month, that's a 1% chance. Of course, if you come out unscathed in the middle of a cluster, there could be a special reason.

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  6. My doctor says she has had many patients, especially the unvaccinated aged 25-50, with multiple bouts of covid. She said she is not surprised, since it's a novel virus that keeps mutating.

    For a lot of people advised to take extra precautions and who have fallen into solitary routines, anxiety can be a daily challenge, even for those who like a fair amount of solitude and are good at entertaining themselves. My guess is that, over time, the anxiety will prove to be as corrosive to health as having long covid.

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    1. The experience of solitude like all life's situations depends upon whether it is seen as a choice or as an imposition.

      In the case of Covid, Betty and I had opted for solitude and began the process of isolation weeks before everyone else, largely in response to the post that Margaret had made on this blog.

      https://newgathering.blogspot.com/2020/03/maybe-more-than-you-want-to-know.html

      With Betty's medical background and my scientific background, we have been confident that we can evaluate everything and make wise decisions, i.e., we are not at the mercy of presidents, governors, bishops, pastors, and even health care providers.

      Solitude has been a life-long vocation for me. When I first met Betty, I gave her three of Merton's books to read: Seeds of Contemplation, a collection of the Sayings of the Desert Solitaries, and a collection of material from his journals which included his affair with "M." I told Betty that while I did not have an Abbot to interfere with our relationship, I did have a vocation to spiritual if not physical solitude. She has wonderfully respected all the aspects of my life that support that interior solitude even though she now lives with me full time. She has grown to understand and value solitude in her own life even though she is far more extroverted than I.

      If the virus ever disappears sufficiently to allow us to resume all social activity, I am not going to be very eager to do so. A lot of the social activity that I had engaged in B.V. (before the virus) was mainly a balance to my interior life. Now that I have Betty in my life all the time, I will be very selective in including others into the balance.

      While B.V. I was in the choir largely the social reason of participating in parish life, I doubt that I will rejoin the choir A.V. unless Betty resumes being a cantor, and I do that to accompany her.

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    2. My point was really about those with chronic illnesses who were advised to strictly isolate and who have become entrenched in solitude. Some report feeling a newfound and intense awkwardness with people or deep discomfort being away from home.

      People in my cancer group report feeling this, and some are quite upset by it ... which adds another layer of anxiety. Their families want them to do more safe socializing, but even doing so safely is making them upset and pissing off their families.

      I think we've all discovered some folks whom we're perfectly happy not to have seen due to covid and plan to take off our social registers. But for some people, this seems to be a much more generalized and lingering type of anxiety that extends even to loved ones.

      I am mostly glad to be out a bit more, but an hour, two tops, is my limit for now.

      But the experience of others having some acute mental stress tells me that checking in people might be especially important now that things are opening up.

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    3. FWIW - my parents are in their 80s. Their attitude is, 'We've lived long lives and have been abundantly blessed. We'd rather see our children, grandchildren, siblings, et al. If God decides it's time for us to go, so be it.'

      Just offering this as another approach to the situation. Personally, I think there is something to be said for it. But it's kind of a complex problem to think through: they could be setting themselves up as carriers and infect loved ones.

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    4. Sigh. This is not about being a recluse by choice or being a healthy elder who's decided they've lived enough. This is about people, many in their 30s and 40s, who are already dealing with an incurable illness and the anxiety that brings, did what doctors told them in a an unpredictable situation, and are now having distress trying to regain normality. My hope in posting was to highlight the situation, and to suggest that if you know someone with a chronic illness who seems to be avoiding social situations, it would be nice to check on them.

      But I guess you could just tell them, Suck it up and enjoy being a hermit! I do! Or, Stop being a pussy. My parents decided they were ready to die, so what's wrong with you?

      I guess we've all got empathy burnout, and I'll go eat worms for awhile.

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    5. People avoiding social situations out of anxiety; I've got a family member who is going through that. Fortunately he is gradually working his way out of it, but it takes time. You can't just turn it on and then turn off the "caution" button. Fortunately or unfortunately, he is able to work from home. I say maybe unfortunately because sometimes going to work makes you stretch your comfort zone a bit. We do talk frequently and I try to encourage him if I feel he needs a bit of support.

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    6. I don’t actually know anyone who is more isolated than my husband and I. We walk most days and chat occasionally with neighbors we see, but that’s it. We don’t socialize, but that’s partly because most of our friends have either moved away or passed away and that happened before Covid. The one person in the isolated category is our friend in the late stages of MS. He’s been confined to his hospital bed at home for years now, so Covid didn’t change his lifestyle.

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    7. Jean said (after her initial comment):

      My point was really about those with chronic illnesses who were advised to strictly isolate and who have become entrenched in solitude. Some report feeling a newfound and intense awkwardness with people or deep discomfort being away from home.

      Then Jean said:

      This is about people, many in their 30s and 40s, who are already dealing with an incurable illness and the anxiety that brings, did what doctors told them in an unpredictable situation, and are now having distress trying to regain normality.

      Jean,

      I think Jim and I were both responding to the very broad topic of social anxiety among the elderly and other persons advised to limit their social activity in your original comment rather than to the far more specific situations which you had in mind but had not yet expressed in print.

      Betty, of course, is someone who has many long-term health problems which were evident when I first met her. Even before Covid, she stayed with me for three months as she recovered from one of those problems. So, when Covid came along we simply decided to live together so that we could both be safer. For Betty that was not a big step. She had been married and divorced twice and raised two children. For myself, an only child who has lived alone for most of his life, even when my parents were alive, that was a big step. I have no regrets. I had accompanied my parents and two of my aunts in their final decades of life.

      As for social anxiety, Betty does experience social anxiety when she goes to doctor's appointments. Part of that is she is less safe with others than with me. Another part is that she has become used to a new normal, a very contemplative monastic like environment. It is simply sensory overload when she goes out. She has to lie on the couch and listen to the classical music to recover. Maybe these observations will be helpful to some of the people you know.

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  7. Off topic. I don’t know what is happening at Camp David today but the helicopter traffic has been almost non- stop all day. The national security and State Dept. types often meet there because it’s as secure as humanly possible. No eavesdropping. Ukraine? NATO?

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  8. I have a coworker who is taking part in a clinical trial for a combination Covid/flu shot. He said the flu part is supposed to work against both types so they won't have to figure out A or B every year. He didn't know if he was getting the real shot or the placebo earlier this week. But said he felt feverish yesterday evening, woke up with a bit of a headache, but then it went away and he was fine. So we're guessing he did get the actual vaccine(s) . Interesting, but I'm going to wait and see.

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    1. When Pfizer, Moderna, et al, were ramping up their vaccines, they put out a call for clinical trial volunteers. I signed up for both. But neither wanted me :-). I took away, from their questionnaires and other communication, that if I was either younger or older, or had more interesting/pertinent chronic maladies, it's more likely I would have been their kind of guy.

      As a digression: even for something as comparatively trivial as what I'm describing here, it's a bit of a frustration to offer to help and being told, "No thanks, we don't want/need you." I'm a big believer that one of the cardinal sins in parish life is to turn down offers to help.

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    2. Jim,

      All the questions are there so that they don't get a biased sample atypical of the general population that will get the vaccine. It is also possible that they wanted a stratified sample so that they had sufficient cases among the elderly, youth, etc. so that they could tell if the vaccine works differently in various populations. Just having a hundred or even a thousand people take the vaccine does not help if most of them were atypical.

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  9. Jim says:

    FWIW - my parents are in their 80s. Their attitude is, 'We've lived long lives and have been abundantly blessed. We'd rather see our children, grandchildren, siblings, et al. If God decides it's time for us to go, so be it.”

    Interesting but as you say complex.

    For those of us that have turned 80, male average life expectancy is still about nine years, more so for women. Life expectancy goes down as one ages. When I was sixty my life expectancy was 80. When my aunt was wondering at age 90 whether she should move to California to be with her daughter in law, I told her she still had a five year life expectancy. Not so sure I would trade ten or even five years just to see family In person now. There are abundant ways to safely communicate.

    If my parents were alive now and I was still working, I would not be happy with such an announcement. I could not guarantee they would be safe if they visited me. I would not be happy if they got seriously sick just because they wanted to see me. As an only child I would certainly not be happy if they were visiting all my relatives, especially since I might bear most of the burden of dealing with the consequences.

    If one takes a stay-at-home strategy, then one is responsible for one’s own behavior and the person or persons with whom one isolates. Once one begins interacting with other people, one then becomes responsible for them, and they become responsible for you. We take risks all the time. However, calculating the risks of the virus is far more difficult than most other risks.

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    1. I don't know how rational people are in thinking these things through. I think they experience psychic/emotional pain from being isolated (not everyone welcomes solitude) and decide, "This isolation is not worth the cost. I'm going to seek person-to-person interaction."

      Further complicating this 'calculus' (if indeed any actual calculation goes into it) is the changing profile of the virus. It seems the virus variants abroad today are more transmissible but less deadly than in the early days of the virus. Does this reduce the overall risk? It's not easy to say. Compounding that consideration even more is that much of the population is vaccinated now; but the extent of their vaccinations varies (each person could have received anywhere from 0-4 doses), and the vaccines themselves are somewhat less effective against the current variant than the original variant.

      I suspect most of us default to, "I'm tired of being alone. I'm going to risk it."

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