Covid-19 Discussion, Part II

How are we all doing now in early May? (please don't forget to read those last messages on the previous thread, if you haven't).

Arizona is slowly reopening but my office is playing it safe so we are on work from home order till the end of May globally, then they will start gradually reopening the offices (and I expect not everyone will be allowed in at the same time).

I am not sure what I think of the reopening - I know that people need the jobs, i know it has to happen but feels like it does not happen because of the people that need it but because of the people that need the services.

I plan to spend May the same way I spent April - home, venturing to the library once (we have drive-through Service so I plan to return a few books and get out some that have too long of a wait digitally or are not available at all), stay away from the stores unless it is critical (deliveries are almost back to normal through the week as long as you order a day early - weekends are impossible but as I am home anyway, it is not a problem), take walks around the neighborhood and stay away from people.

The fact that we are into the 100s temperature-wise already (38C and up into the 40s for the non-Americans) has reduced the number of people on the street almost to none already - and the only time you can actually get a walk is late in the evenings when it cools off - while my area does not have a lot of people walking unless they had dogs, there had been more than the usual in the last month.

What I had found I miss the lot is just stopping at someone’s desk and talking about our day or something else happening. Oh well. That shall pass. I have my job, my family is fine back home - it could have been a lot worse.

Hope everyone is doing well.

Here in Indiana, we have a mapped out plan with July 4 as the target date for everything to open fully. There are other target dates along the way. Retail and restaurants are starting to open, with capacity restrictions. Hair and nail salons can open May 11. Three counties with the most cases and deaths will open later than the others.

It seems as if people are more relaxed now, and there is more traffic on the streets. Some people are wearing masks at the grocery and other places, some are not. We plan to stick close to home and are not in any hurry to get out and about, other than running to the grocery or post office or pharmacy. We do not do much retail shopping anyway. All my music performances with the community band have been cancelled until autumn.

The thing we miss most is theater and music events, and most of ours have been postponed or cancelled. Our next theater event will be end of July. We also will miss having dinner out for our wedding anniversary and my husband's birthday, both tomorrow May 6.

The Dutch government announced a phased roll-back of the preventive measures last night, conditional on our good behaviour and on the infection rate remaining low. Primary schools and libraries reopen this month (schools with half the children at once), golf and tennis are allowed again (but not competitions), also hairdressers and the like; in June public transport is back to normal, but with facemasks; secondary schools are back; museums, catering and performance venues can open again, but no more than 30 people at once including staff, prebookings only. So no symphony concerts, not even in July, when the number goes up to 100. I suspect a lot of venues will simply stay closed until September — apart from churches, poetry readings and arthouse cinema, there's not much that would be viable even with 100 people. Gyms and saunas are also to stay closed until September, and are protesting volubly, so that will probably change.

Meanwhile, testing rates are supposedly being ramped up, and it's all gone very quiet around the famous contact-tracing app.

The facemask thing is an obvious compromise of necessity: we've been told ad nauseam (by the government) that non-certified masks serve little purpose except to create a false sense of security, and that certified masks have to be reserved for medical use, but the public transport operators have told the government that there is no way they can guarantee social distancing with anything approaching normal loads, so the false sense of security looks like the best option...

So far I've missed five concerts I had tickets for this season, with two more to come that will certainly be cancelled (one of them an opera!). In all probability I would have gone to four or five more than that. I'm missing it, but of course I know that mingling around in a crush of (mostly elderly) people in a concert interval would be the worst possible thing. And seeing performers online is some compensation — the Rotterdam concert hall, De Doelen, which is one of the venues I attend most often, has done a nice series of empty-hall lunchtime chamber concerts on YouTube, for instance.

>4 thorold: I was planning to attend the Grachtenfestival in Amsterdam in early August before I flew to Edinburgh for the Festivals there. Edinburgh has cancelled its festival season for 2020, but I haven't heard anything about the Grachtenfestival.

>5 kidzdoc: The latest I've seen is that they are hoping to run at least part of the festival in some form (small venues). They will make a further announcement on or soon after 12 May: https://www.grachtenfestival.nl/nieuws/2020-update-grachtenfestival-2020?lang=en (in Dutch)

>6 thorold: Thanks, Mark!

In Ontario- the number of new cases has remained the same for a while and 70% of those sick have been "resolved"- I think that means that they are well.
A few things are opening up- nurseries and garden supply stores, hardware stores, can open with safeguards this weekend. People with cottages have been told to use them during the Victoria Day weekend but bring all their own groceries and don't go into the towns.Retail stores with a door to main street can open for curb pickup on Monday.
However, all big crowd events have been cancelled for the summer.

As you know, Georgia is open for business. According to a local blog, Decaturish, the zip code I live in has the highest COVID rate in the county, due in large part to the number of long-term care facilities with outbreaks here. And per the state's website, the county I live in has the 2nd highest rate in the state. Sigh.

I am grateful that my employer (the public library) is working on a phased plan to reopen while I continue to shelter in place. I plan to attend (via Zoom) the library's Board of Trustees meeting on Monday. Our director is presenting the plan to them, and this will be my first exposure to it.

I bought several cloth masks this week via Thread Beauty Spa, a local business that is not planning to open anytime soon. The owner is coordinating the efforts of Tucker Makes Masks. For every mask sold one is donated to front line workers and people who can't afford them.

Meanwhile, it has been a beautiful spring here, and I can't believe I still need the heat on in May, but I do. No one in my family is sick (including my 90+-year-old father) and only one person has lost a job. My nephew has filed for unemployment, but I have no idea whether he's started receiving it yet.

>9 markon: Glad to hear you and yours are doing well, Ardene. I haven't much to add, other that I'm glad someone is having spring. It's snowing here today!

I'm finding it more and more difficult to decipher fact from fiction with orders loosening and politics get even more heavily involved. Virginia is going to enter phase 1 on May 15 as long as numbers don't spike and hospitals are still doing ok. I believe our governor, who is also a physician, is really trying to do the right thing even under enormous political pressure to reopen more quickly.

It's really hard to even figure out what phase 1 is, but from what I've read it's still telework, schools closed, no gatherings of 10 or more suggested, masks in public. BUT restaurants who have outdoor seating can open with 50% capacity, retail can open if they limit store entry, salons can open a half capacity and use PPE. Gyms can hold outdoor classes of 10 or fewer people. Churches can open at 50% capacity. Non-essential medical care has already reopened with safety measures in place - this makes sense to me as some of this "non-essential" care is pretty essential!

I guess parks will remain closed which I think is odd considering the above. My boys would love to go play tennis which would be virtually contactless considering they are in the same household. Certainly less contact than getting nails done!

Our state is extremely split politically. I think our area of Northern Virginia would overall rather have the stricter rules remain in place, at least judging by my neighborhood's strict compliance so far. However, my husband's parents live in a more rural, very Republican area of the state and they are practically back to business as usual, doing virtually whatever they want. Even though they are older and high risk. They think this is all some massive conspiracy theory.

>10 labfs39: Snowed from 6 am to 9:30 am here, also. 35ºF at the time.

>11 japaul22: We went to the pharmacy this morning and we couldn't believe the amount of traffic there was, and while there were only a few people in the pharmacy, only about half were wearing masks (although the staff was still wearing masks). We went out yesterday and bought two pairs of shoes by takeout! (hubby wanted a second pair just like he has, and we bought the grandson some summer sandals one size up -- so no fitting necessary). We then had lunch takeout at our favorite local breakfast place. Pretty exciting, right?

Here in New Hampshire, the virus has NOT peaked yet. Deaths are still on the rise. Totals: just under 3,000 cases, 121 deaths (we are a relatively small state, and about half of the state is reasonably rural). Still, the governor has unveiled a plan for loosening restrictions over the course of May. Most things will have have certain restrictions. Golf courses and hair salons..etc will be able to open, drive-in theaters, restaurants using outdoor seating (no more than 6 to a table!) and retail stores can open if staff wears masks and allows only to 50% capacity. Students will not be returning to school, though. Companies that have been closed are making their own decisions about when to reopen. Most of the people I have talked to are not planning to resume "normal' habits anytime soon. We will likely carry on as we have been as we also now watch the five year old grandson three days a week (one five year old and two stressed out parents trying to work from home was not working well).

Our governor is a Republican, although not a Trump lackey (he walks a fine line). He has handled things fairly well, but I think he should have kept the current restrictions going through the end of May. There have been gun-waving protestors at the state capital much like those seen elsewhere. It is commonly believed that a core of these have been paid to produce the small agitated group.

>12 avaland: I'm glad you've gotten your grandson back! A few weeks ago, we returned to our weekly dinner with my Dad. We eat outside and try to stay at least 6 feet separate, as we all sit around the fire pit out back.

As our already lax restrictions are lifted, people are discarding their masks and behaving as though things were back to normal. It's surprisingly hard to be one of the few wearing a mask, but at least most employees at the grocery stores are.

>13 RidgewayGirl: Having the grandkid does mean that we're pretty tired by Thursday evening.

This morning we saw a school bus drive by. Empty, but presumably getting ready to restart school.

Ok. I'm frustrated. My daughter's orthodontist called to reschedule an appointment that was cancelled due to covid weeks ago. We made a new appointment for Weds am, but then was told that I would need to sign a release saying she hasn't been exposed to anyone with covid. Well, I'm presumed to have had covid, although I was not tested because I didn't meet the criteria (fever, cough, fatigue, shortness of breath wasn't enough). Although my daughter never had symptoms, she lives with me and was thus exposed. I explain all this to the orthodontist office person. She consults with the dentist, who consults with his medical advisor, and tells me that my daughter can only be seen if she has a negative covid test. If I haven't been able to be tested despite having symptoms for six weeks, I wasn't confident that I could get an asymptomatic teen tested. Sure enough, I called the clinic, and she does not qualify for a test. So my daughter can't have her braces adjusted until she gets a test, which she doesn't qualify for, and we have no idea how long this requirement is going to remain in place. Wow.

Dr Rupert Beale, a physician researcher and group leader at The Francis Crick Institute in London and husband of Rachael (FlossieT), one of my closest LT friends, has been contributing articles for the past several years to The London Review of Books, where Rachael works. He is the head of the Cell Biology of Infection Laboratory, which is looking at the antibody response to coronaviruses in general, and SARS-CoV-2 in particular. Last week Rupert wrote an excellent article about the COVID-19 pandemic, particularly in the UK, US and South Korea, a country that took early steps to provide testing for as many of its citizens as it could, developed smartphone apps to allow tracking of cases and contacts, and had plenty of masks for its citizens to wear, resulting in far lower COVID-19 morbidity and mortality rates than all of the First World countries in North America and Western Europe. He also discusses the challenges to making an effective and long lasting vaccine to provide acquired immunity against SARS-CoV-2, as the body's immune system does not appear to be able to ensure long lasting natural immunity, and he is optimistic that we will have a good vaccine by late 2021. This article should be available to read without a subscription to the LRB.

How to Block Spike

The COVID-19 pandemic has had at least two worrisome sequelae. First, because children are staying at home and not going to school or church or seeing their friends, those who live with abusive parents are at greater risk of suffering unwitnessed child abuse without anyone that can report it to law enforcement officials or child protection services, and we hospital pediatricians are seeing more cases of kids so badly injured that they require emergency care and, at times, hospitalization. Second, parents are not bringing in their children for well check visits, including routine immunizations. My friends who are primary care pediatricians, along with the American Academy of Pediatricians, have noticed this and sounded the alarm for the past month and a half, and, in an article that will appear in this week's issue of the Morbidity and Mortality Weekly Report, the CDC has found that orders for childhood vaccines from the Vaccines for Children (VFC) program have plummeted since late March, which is an indirect but reliable marker of how many kids in this country are getting vaccinated. I and my pediatric colleagues are very concerned about this, as kids have already started intermingling in Georgia, due to the warming weather and the relaxation of shelter in place restrictions by the governor, and if these kids aren't adequately protected against vaccine preventable illnesses such as influenza, measles, rotavirus and serious bacterial infectons we could be dealing with significant outbreaks of any of these infections due to inadequate herd immunity.

MMWR: Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020

NYT: What's Scaring the Pediatricians

NYT: The Coronavirus Could Cause a Child Abuse Epidemic

SC is opening up as fast as it can. Not quite as quickly as Georgia, thankfully. But we are number one in not testing anyone, so we win with that one. A friend's husband is pretty sure he had COVID, but was only able to see a nurse practitioner after insisting, and she refused to test him, despite his symptoms, as he is under 65.

>16 labfs39: that’s a crazy catch-22. I would think tests are more readily available currently and will be more so soon. I hope your daughter can get tested soon.

>16 labfs39: Sounds similar to the struggle we have had with my husband's allergy shots, even though neither of us has covid. The clinic where he gets the shots is closed indefinitely. He tried to get the shot at his allergy doctor's office, and they wanted his serum and records sent back to them from the clinic. The clinic staff is working remotely, and told him to just take some over the counter stuff and use nasal spray, without even looking at his records to note his other medications and health conditions. Then they said his serum had been sent, but it was not. Only one person could send the serum, and she was out sick for a week. We were caught in the middle between the clinic and physician's office. He missed two allergy shots and was suffering miserably, since this is the season when plants and pollen start appearing.

After many phone calls between the clinic and the allergy doctor's office, it took three weeks for his serum to be sent. Finally this week everything arrived at his doctor's office and he was able to get his shot. It was very frustrating.

I posted this on Darryl's thread, but am reposting here:

After 6 weeks, I have finally kicked the fever and, according to the CDC, "recovered." The fatigue and cough is taking longer to pass, although it's much better. I'm not sure if the fatigue is a continuing symptom, or simply weakness and fatigue from having been ill and inactive for so long. Despite having significant symptoms, including shortness of breath, I was not tested (in Maine), and when I tried to get my daughter tested, learned that locally they still are not testing unless you are being admitted or are a healthcare worker/first responder. I have lost all faith in the statistics being reported as having any correlation to reality.

I think another issue that is starting to be problematic (as >21 LadyoftheLodge: also experienced) is that healthcare workers/employers, etc are having a hard time deciding when someone has recovered from COVID. I was in the medical center yesterday for routine imaging, and the first person I dealt with said that I was still contagious and thus unable to get the imaging. The CDC recommends at least 10 days from onset of symptoms (I was 7 weeks) and 72 hours from fever (I was 8 days) with other symptoms improving, but not necessarily absent. Finally she called a nurse who confirmed that I could have the imaging since I met those criteria. People are scared about acknowledging that people are "well" and rightly so, I think. I'm not sure anyone knows enough about post-illness implications to give a definitive and unchanging response.

Been at work for the last 3 weeks, and still feeling the effects. First couple of weeks were exhausting, but relatively easy. Since so many of the workers in the environmental world are either absent or in quarantine they have all available Hazmat workers pulling hazardous duty. I now remember why there's no one under 28 that does this kind of work. I regret keeping my certification. Last week responded to a chemical fire and had a bad allergy day. Between the smoke and my invisible enemies it just about finished me. Even without terrible respiratory symptoms I can feel this effects in my lungs. Even the milder cases have a long tail.

>22 labfs39:, >23 stretch: Thanks for your updates, been wondering how you both were.

Here in rural northern California (Mendocino County), we've been lucky so far. The county is around 3,500 square miles with only around 90,000 people, so that's one reason. Our shelter in place orders are pretty strict. Masks are mandated in public. Parks are closed, particularly to discourage San Francisco Bay Area folks from coming up here to "recreate." We recently had a clump of 5 cases, all in one family, brought on by one family member driving down to the SF Bay Area to visit relatives and bringing the virus back to his household. But they were identified and sequestered together, so that seemed OK. However, we now have three new cases brought on by folks getting together for a live-stream church service. It was felt that the choir needed to attend together so they could sing on camera. As a group. So now one of the choir who lives in Mendocino County has covid and two choir members who traveled back to neighboring Lake County are also sick. Also, it turned out late yesterday, the minister. So we are waiting for the other shoe to drop. How many folks did these people infect before their virus was identified?

In Indiana, we are opening up slowly with a controlled plan. Masks are recommended in public, businesses open with reduced capacity, parks and large venues closed until June. Church services just resuming this week, with many restrictions in place. People in the "vulnerable" groups are supposed to stick with the stay at home rule a bit longer. Our county has had just one death and 35 cases as of today. Most people in our county are spread out and many live out in the county as we do. No one lives in town, since we are an art colony and tourist venue. There are a lot of senior citizens and retirees here, and two senior apartment complexes which are close to town.

My husband and I feel more informed about the situation by watching the M-W-F press conferences with the governor, since we get local information and statistics. This helps reduce the anxiety generated by national media.

Work during quarantine-lite continues to be very effortful and absorbing. I am a pediatric speech therapist in the Florida panhandle, and I switched to doing teletherapy in March, which has been a crazy-steep learning curve. Overall, it has gone pretty well, though. Various speech therapy FB groups and speech therapist friends have been super helpful, as people share questions, ideas, solutions, lesson plans and materials, etc. I still spend a lot of extra time prepping for therapy, though. I feel very fortunate to be able to still work, but, phew! And there are a few kids for whom teletherapy has not worked well, despite my best efforts. Now some therapists are discussing how/when to go back to in-person therapy. Masking, clear barriers, how many in-office patients per day, etc. are all being discussed. Obviously these are particularly challenging issues when dealing with children and speech modeling, etc. If insurance stops covering teletherapy (which would vary state by state), that may force the issue for many therapists.

My sons, who are 4th and 7th graders, will finish up schooling-from-home this week. Woo hoo! My older son’s online work has actually been pretty good, both in content and amount. My younger son’s work was super easy; he could finish each week’s assignments in only 1-2 hours. We added on Rosetta Stone Spanish lessons for him. All of my sons’ schoolwork is done through state or district-wide online programs and apps. None of it is taught by their teachers. So weird. I have no idea how many kids from their schools have actually been doing the schoolwork. I feel so badly for students who are high school seniors or college students.

Tourists have been trickling back into our town (Destin) over the past few weeks, but they have really flocked in for Memorial Day weekend, since the vacation rental ban was lifted last week. Hardly any tourists wear masks, while it’s hit-or-miss for the locals. Now to see what happens with our COVID numbers, which had been very low and holding steady…

My area (N. Ireland) is in a sort of weird semi-shut / semi-open status where people are now largely making up their own rules outside of government policy. Garden nurseries, golf courses and drive-in church services were officially allowed to open last week, and you can now meet with up to 6 people outside who are not from your own family. It seems that many small business owners have now decided to interpret this as a green light for quietly reopening shops which aren't officially on the 'you can now open' list. Garden nurseries are low in stock, as many didn't grow as much as usual or threw out what they had started growing as they didn't expect to have any trade.

People are returning to outdoor beauty spots in large numbers, but there is a strong sense of caution whilst the country is still recording daily deaths (albeit at a low rate of single figures), and many people are still only going into public places if they really need to.

Our European neighbours who rely heavily on their tourist trade are getting set to lift their mandatory quarantines for visitors in time for the start of the summer season. There's a lot of anger that the UK is so far maintaining it's requirement for people to quarantine for 2 weeks after they return from a flight abroad (although how they are policing this I can't imagine), as it's felt this will kill their summer Brit visitor numbers. Selfishly, I'm rather hoping this continues so that my airline cancels the flight we were due to travel to Majorca on in July and I get my money back. We've decided not to go regardless of what government policy states at the time - with social distancing measures still in place it wouldn't be the holiday we'd planned, and the risks involved with being crammed into airlines and airports like sardines doesn't seem worth it.

>28 AlisonY: Unfortunately, restrictions are, here in South Carolina, more suggestions than rules and we've decided to continue our social distancing at the beach at the end of June. Since the beach is open, we can't get the money we paid back. We'll go there and back without stopping and bring enough groceries to last us. Luckily, the beaches on Edisto are sparsely populated so we should be able to adequately distance ourselves from others. We'll be sorry to miss our usual activities.

And my father has hit his limit. He's an extrovert and also 81, so he was being very careful, but kind of broke this weekend and went to church, then out to lunch with some of his church friends and then he came over to our house and insisted on hugging everyone. Hopefully this was a one time reaction to isolation and that he comes to no harm. He has slowly become more and more emotionally brittle with the isolation. I'd been going over and standing in his driveway to talk to him a few times a week but that isn't enough and the people at his church have taken a very insouciant approach to the pandemic, making it harder for him to be isolated since they aren't. In the end, he's an adult who gets to make his own decisions. Gov. Cuomo in New York was helpful in getting him to feel the importance of self-isolating, but while NY's numbers are shrinking, South Carolina's are not, but our Governor is largely silent.

>29 RidgewayGirl: I'm chuckling at what you said on your dad, as my mum is exactly the same. Much to my Dad's annoyance (and he's good reason - he's in a critical vulnerable position), my mum has similarly absolutely reached the limit of her hermit tolerance and is now popping out to the shops. As you say, for extroverts who are at that advanced age it's hard to argue with them, but I do worry.

Sadly, after ten good days, I had a relapse (I first had symptoms and self-quarantined on March 22). The state of Maine tripled it's testing capacity last week, so I was finally able to be tested. The results came back negative, but according to the study below, the false negative rate at 21 days is 66%. Since I'm two months out, the test is meaningless for me at this point.

A study published in the Annals of Internal Medicine summarizes false negative rates over time:

"Over the 4 days of infection before the typical time of symptom onset (day 5), the probability of a false-negative result in an infected person decreases from 100% (95% CI, 100% to 100%) on day 1 to 67% (CI, 27% to 94%) on day 4. On the day of symptom onset, the median false-negative rate was 38% (CI, 18% to 65%). This decreased to 20% (CI, 12% to 30%) on day 8 (3 days after symptom onset) then began to increase again, from 21% (CI, 13% to 31%) on day 9 to 66% (CI, 54% to 77%) on day 21."

Another wrinkle in the abysmal history of diagnostic covid testing.

>31 labfs39: A local friend developed sharp body aches and cough and fever about a week after returning from France (to visit family) in early March. She tested negative for COVID-19 about a week in, and tested negative again when she was hospitalized overnight about three weeks in, but she tested negative for everything else too, and her doctor is sure it was COVID-19 based on the symptoms plus the travel (she blames the airport, which was crowded with groups from various parts of the world). The results were especially frustrating because the county was just beginning to get organized and medical staff kept insisting that the tests were 90+ percent accurate and dismissing her concerns, so she felt vindicated when reports emerged about the high rate of false negatives. (She's OK now.)

I saw my first patient with COVID-19 today, a previously healthy preteen with a skin infection in his axilla and persistent high fevers, with no other symptoms. The infectious disease (ID) physician seeing him recommended checking him for SARS-CoV-2, to my surprise, and I learned an hour ago from the senior pediatric resident on the team that his test was positive. Meanwhile, a teenage patient who I was convinced had MIS-C (multisystem inflammatory syndrome of childhood), due to his persistent fevers, abdominal pain, and presence of ground glass opacities in his lungs on a CT scan we did yesterday, tested negative for the virus and antibodies against it. I would have bet a month's salary that the older boy had COVID-19, despite the negative test result, and I'm still shocked that the first boy has it.

We didn't use full enhanced contact droplet precautions for the younger boy, only procedure masks and gloves, so hopefully I, my team, the ID team, and the nurses who saw him won't contract COVID-19 from him.

I'm glad there is a growing awareness of the prevalence of persistent covid. I'm on day 83

COVID-19 Can Last for Several Months: The disease’s “long-haulers” have endured relentless waves of debilitating symptoms—and disbelief from doctors and friends.

>31 labfs39: P.S. I received a call from my doctor's office. After waiting so long to be tested, they used the wrong swab invalidating it.

>34 labfs39: Wrong swab, how awful.

>34 labfs39: Honestly.

>34 labfs39: I can believe it. My LT friend who fell ill with COVID-19 over two months ago was still symptomatic and experiencing those "waves of debilitating symptoms" last week.

That's awful that your doctor's office sent the wrong swab. You should not be charged for their mistake!

I donated a pint of whole blood at my local American Red Cross center this morning, mainly because the NPR affiliate for Atlanta reported last week that supplies for blood and platelets are urgently needed, as hospitals are resuming elective surgeries and because the need for donated blood is higher in the summer months, and especially because the Red Cross is now offering testing of serum antibodies against SARS-CoV-2, the novel coronavirus. Although I haven't developed symptoms consistent with COVID-19, the infection caused by SARS-CoV-2, I have taken care of two or three patients who had COVID-19, along with two or three others with Kawasaki disease or multisystem inflammatory syndrome of childhood earlier this year, before we understood that this can be caused by the novel coronavirus, and, given my exposures to patients, my partners and fellow health care workers in the hospital in my which I work, I'm curious to find out if I'm one of the fortunate people who was infected with the virus but remained asymptomatic. There is no charge for the test, and I should know my result on the Red Cross app on my mobile phone in 7-10 days.

A good friend of mine, a fellow pediatrician in metro Atlanta, also donated blood today on her day off, for the same reason.

More information: Discover Your COVID-19 Antibody Status

I replied to a question by my friend Katie (katiekrug) on my thread just now, which may be useful in this discussion as well.

They are doing free antibody testing here, but I've seen a lot of stories about how they aren't super accurate. I haven't read any of the stories closely, so I"m not sure what the deal is. I expect the Red Cross will be using the best test available.

In the beginning of the pandemic companies quickly produced rapid antigen tests and far less rapid antibody tests for SARS-CoV-2, the novel coronavirus. As a primer, since we throw these terms around casually, antigens are proteins on the cell walls of viruses, bacteria and fungi that are unique to each organism, whereas antibodies are proteins produced by B cells, a type of white blood cell, that are specific to each organism and block the organism's ability to infect cells, or allow other parts of the immune system to recognize the infectious organism and kill it.



Apologies — and kudos! — if everyone knows this already.

In the beginning these tests varied in their sensitivity and specificity. Sensitivity, also known as the true positive rate, is a measure of whether the person being tested has the infection, whereas specificity, or the true negative rate, measures those who do not have it. Both are extremely important; a test with high sensitivity more accurately picks up patient with the infection, whereas one with low sensitivity misses a significant number of cases, which is known as false negativity, i.e., the person tests negative for the infection but truly has it. Similarly, a est with low specificity has a high false positive rate, and indicates the person has the infection when she really doesn't. Needless to say high false positive and false negative rates are worrisome, as some people who have the infection will not be diagnosed and treated promptly and properly, whereas those who are not infected may be misdiagnosed and given treatment that could be ineffective or even harmful in some cases.

Right. With that background, companies produced tests quickly, and many of them had low sensitivity and/or specificity. The FDA (Food and Drug Administration) began to rigorously evaluate these tests, and those with sufficiently high sensitivity and specificity (95-97% or higher) were given Emergency Use Authorization, whereas other tests were voluntarily withdrawn by the manufacturer or were not deemed acceptable. At the moment, if my information is correct, three antibody tests, which are collected from the serum, have received EUA by the FDA, although manufacturers and researchers continue to evaluate antigen and antibody tests.

Rapid antigen tests are performed from nasopharyngal swabs, and are now being done at certain facilities and testing centers, including some sites operated by CVS (there is one here in Midtown Atlanta, on Georgia Tech's campus). Anyone can get the rapid test at CVS free of charge, provided that they meet criteria for testing and have been referred for testing by a health care provider. In addition to the sensitivity and specificity of the test itself there the potential for operator error that can cause a test to be falsely negative. The swab has to be inserted deep into the nasal cavity using a special swab, and it has to be twirled and left in place for perhaps a minute to ensure accuracy. If testing is performed too soon there may not be enough virus present to give a positive result, and the same holds true if it's done too late in the process. Similarly, it takes time for antibodies to be produced, and if one is tested too early they may be undetectable, and for those with milder infections their antibodies can likewise be undetectable weeks to months after they were infected.

That being said, I'm sure that the Red Cross is using one of the FDA approved antibody tests, one that detects the level of neutralizing antibodies against SARS-CoV-2. Those people who have sufficiently high levels will be asked and encouraged to donate plasma (the straw colored liquid that is free of red blood cells, white blood cells and platelets) to be used to treat patients with severe COVID-19, which is being done in the US and being investigated for use in the UK and other countries.

I expect that my antibody test will be negative, as the severity of the infection correlates with antibody level. I have been more tired than usual over the past month or so, and required far more sleep than I normally do, and given my known exposure to several COVID-19 patients I wouldn't be completely surprised if I tested positive. Needless to say I would be thrilled if I did test positive, as it may mean that I would be one of the fortunate ones who had the infection with few or no symptoms, and probably would not become seriously ill if my antibody level waned and I was exposed to the virus again.

We've learned a lot about SARS-CoV-2 and COVID-19, but there is still so much that we don't know.

Thanks for that, Darryl, including the background part.

Thanks for that, Darryl. I haven't had much interest in getting tested in part because of what I've heard about the lack of accuracy, so that's some good information and I appreciate it. The other reason is that I don't know if either a positive or negative result would affect my immediate plans. I'm working from home probably through the end of the summer at least—my husband's office isn't scheduled to reopen until January—and my only public forays since March have been very limited (masked, distanced, etc.). I don't know that I'm going to be out and about much for the next few months, and a diagnosis one way or the other wouldn't really change my strategies.

On the other hand, I should probably donate blood. I'm B positive (my blood type and my philosophy, haha) and I'm sure that would be useful.

>40 dchaikin: You're welcome, Dan.

>41 lisapeet: You're welcome, Lisa. Thanks to rigorous testing by the FDA the antigen and antibody tests are much more accurate than they were in March and April. One problem with antibody detection is that the levels of IgG and IgM, two easily measurable antibody types, are dependent on the severity of the infection; those with more severe infections will have higher antibody titers, and presumably will continue to produce antibodies at relatively high levels. Those with asymptomatic or mild infections will have lower antibody titers, which can still be detected, even in asymptomatic people. There was a story in the Atlanta Journal Constitution an hour or two ago about routine testing of first responders in Alpharetta, a northern suburb of Atlanta; 10 of them tested positive for SARS-CoV-2 despite showing no symptoms of COVID-19, the disease that results from infection with SARS-CoV-2. That's why it's entirely possible that I could also test positive.

Another problem with antibody testing is that the body doesn't mount a strong natural immune response to the human coronavirus family. There are four routine strains of coronavirus that cause infections, particularly upper respiratory tract infections in children, but the natural immunity to those viruses wanes rapidly over time, and reinfection with those same strains is possible, which is mainly due to the mutability, the mutation rate, of this family of viruses. Just because you have a positive antibody or antigen test at one point in time doesn't mean that you are fully protected from future infection, although we don't yet know if second infections are milder than first ones or not. For that reason I won't change what I do based on the result of my antibody test; I'll still shelter in place as much as I can, wear a mask and practice good hygiene and social distancing, and avoid public transportation at all costs. I normally take the metro to and from work, along with a shuttle bus from the metro station to the hospital I work in, but I haven't done that since the pandemic began, and I'll drive from Atlanta to Philadelphia to visit my elderly parents next month rather than take the chance of acquiring the virus in either airport terminal or on the plane and passing it onto them or the wife of their close neighbor, who underwent a double mastectomy for breast cancer yesterday. As much as I would like to I don't see myself traveling abroad or visiting friends in the states in NYC, Chicago or elsewhere until we have a good vaccine, as acquired immunity (that provided by a vaccine) will probably be more important than natural immunity in eliminating the spread of SARS-CoV-2 by herd immunity...as long as a significant percentage of antivaxxers don't refuse the vaccine for themselves or their children.

>42 kidzdoc: Ah yes, antivaxxers! My husband and I have had that discussion recently, since both of us get our flu shots and recall the days of the polio scare and vaccine. Our parents would not have considered endangering us or our siblings by not getting the vaccines. I used to be an elementary school principal, and antivaxxers were not a big problem at that time. Things seem to have changed though.

>43 LadyoftheLodge: Indeed. My sister is in OR where there is a sizable population of antivaxxers who now also have decided that wearing a mask is bad for your immune system.

I'm curious what other states/countries are doing for school in the fall. Here in Virginia we had a peak of cases back in April and are slowly opening back up. We'll be in Phase 3 (allows groups of up to 250, restaurants and stores can be open with social distancing, masks still required indoors, salons open) starting July 1.

Our state guidelines came out for schools and our very large school district has released its plan. We're in Fairfax County which has 180,000 students in the district. What they are doing is giving parents a choice. You can send your student to school two days a week which will allow for social distancing in classrooms and everyone will wear masks. The other two days will be independent work at home (no teacher contact). Mondays are planning days for teachers. OR you can withdraw from the in-person school experience and choose 100% distance learning 4 days a week (only 2.5 hours of instruction a day, so the hours are comparable between the two plans). It will be taught by county teachers, but not necessarily teachers from your home school. And online classes will be by grade level but from mixed schools across the county and "class sizes" aren't capped for online learning.

I have a 5th grader and 2nd grader. We are leaning toward sending them to in person school. Distance learning did not work AT ALL for my then 1st grader. I think it's important for him to have some face to face (or mask to mask!) time. And I think we'll do the same for my 5th grader.

Of course, right now the county isn't planning to provide any childcare on the 3 days my kids will be completely off from school. They also have changed bell schedules to accommodate bus schedules that need to change to have fewer kids on the bus. So my 10 and 7 year old will be at school from 10:05-4:50. I don't think any before care will be offered. All that to say that my husband and I will be back to our full time work schedules and have no idea what we're going to do for childcare. I guess we'll look for a babysitter or nanny but it's going to be a HUGE expense. Luckily we are both still making our full salaries but it's going to be hard to find the childcare at all and then very expensive.

So life is still very stressful in my household. But we are grateful that so far we've all remained healthy and that we are still employed. I suppose the rest will fall into place.

>45 japaul22: It's still very much up in the air here in N. Ireland. It looks like my youngest will be going back full time in August as she is in the most critical year of primary school. Her teacher told me they will be taught in the assembly hall so they can fit them all in and spread them out. I've had no confirmation from my eldest's secondary school yet, but it's a moving picture and some relaxations of the rules have been accelerated in recent weeks, so who knows where we'll be at around the end of the August. I'm really hoping he's not part-time - there has been little thought as to how that is manageable for working parents.

Today the 2 metre distancing rule was reduced to 1 metre, and we're now allowed to have a small number of people indoors so long as there is social distancing. My friends and I are in no hurry to meet indoors just yet - maybe later in the summer, but for now we're not taking any chances. Our biggest issue is that my dad still has to shield because he has cancer, which means my kids still can't go round to their grandparents as normal. My daughter in particular is almost grieving over losing that normality with them, and cries herself to sleep most nights every week.

>45 japaul22: Decisions are still being made. I filled out the questionnaire about what possible solutions will work for us, but the only hard part about this is that my son is going to be a senior in high school this fall and I'm sad he won't get the full senior experience. It looks like they're thinking of doing 2 days of in-school and 2 days of on-line learning each week, which has got to be hard on teachers who have to prepare for both. They're also looking into a delayed start to the school year given that COVID cases in SC are still increasing.

>45 japaul22:

10 and 7 years old seems old enough to be able to be alone for two hours in the morning until they have to ride the bus. Maybe this would be a good opportunity to test self-dependence and a new sense of responsibility?

Indiana has issued a set of guidelines which include many options for school districts,similar to the ideas discussed here. I have not yet heard what our local schools will do. I do not have kids in school and all the courses I teach are online, so will stay tuned for what is finally decided.

>48 lilisin: yes, that might be the plan. My boys are mature for their age, have a cautious streak but aren't easily frightened, and get along very well. We actually just set up a home phone (I'm not ready to get them cell phones though we might look into one of the watches that can send texts to a limited list of people) so that if we end up leaving them home alone sometimes we have a way to get in contact and a way for them to call in an emergency. They don't ride the bus, though, they are walkers and I think many of our neighborhood kids won't be walking with them if their families choose distance learning or homeschooling or go on different days with the school split in half.

Anyway, the teachers union is already threatening to strike if they are required to be in the classroom for safety reasons so maybe this will all change again . . .

And Arizona is back to square 1: bars, gyms, water parks, movie theaters and so on are closed again until at least July 27 (with an option to extend if needed); pools are open but with no more than 10 people; gatherings over 50 people are prohibited, school year start is pushed back to at least August 17 (it is usually late July/very early August). Restaurants are open for now... (not that I plan on visiting)

Not unexpected but still...

>51 AnnieMod: We're skyrocketing, too, but our governor has stated that he won't close anything. So in things to do this week, I have to either put my gym membership on hold or cancel it, since they've started charging me again because they are open. On the list of risky COVID activities, breathing heavily in a room with other people breathing heavily has got to be up there. And mask-wearing is uneven here, to put it nicely.

We are holding steady here in terms of new cases and other metrics, but I will eagerly await the Governor's press conference tomorrow to see what we will do. The county where I live has only 38 cases, and it has been about the same for months, with one death that occurred early on in the pandemic. Unfortunately, mask wearing seems to be dropping off, especially among young adults, teens, and kids. We get lots of tourists here.

Schools. Tx has no set overall plan, but it seems parents will have a choice to keep kids home or send them to school and teachers (like my wife) will be required to provide equal education regardless of that choice - while being required to attend school themselves. My kids are doing 8th (middle school) and 10th (high school, same school mom teaches at) in the fall. I think the education aspect will be terrible and the health safety aspect probably terrible as well - although I can’t predict how terrible.

>52 RidgewayGirl:

It almost feels like a parent sending the kids in timeout - if you won't behave like a rational person, you are grounded... It would have been funny in other circumstances. One of the CEOs of a major fitness chain is already making noises about suing the governor.

>53 LadyoftheLodge:

I really hope it keeps up that way for you. My county is beyond hope at this point - we are adding a few thousand cases per day (living in the biggest county with the biggest population kinda made it inevitable when the whole state is spiking I guess) and it probably will get worse. And we were doing so well back in April/May.

>54 dchaikin:

Dan, I am not sure Arizona has a plan either - I just know they pushed the start a bit.

How exactly do they expect the same teachers who spend their day in school and deal with the kids there to deal with the "stay home" ones? I know that most teachers are superheros already but it sounds like whoever came up with this idea had never taught... Plus the kids most likely to be in school are the ones with parents who are most likely to be exposed (because they have to go to work) so that makes it even worse for the teachers.

>55 AnnieMod: It seems as if the people who come up with some of these ideas have never taught. Teaching is a hard job even on good days (speaking from experience as a middle school teacher, now retired from full time teaching).

Here in SC, the numbers of new cases are sky-rocketing and last week a five-year-old child died. And while mask wearing has improved, it's still hit or miss. In Greenville County, which has the highest number of cases, there is a mandate ordering people to wear masks inside stores. This is being treated as optional by both customers and employees. At the Walgreens today, the employees outside of the pharmacy were all wearing their masks only covering their chins and when I asked an employee to please pull hers up, she declined and told me I didn't need to wear mine.

Schools are set to open after Labor Day. It's becoming clear that this will not happen, no matter what the Governor orders as we have no intention of taking even the most cursory of preventative measures.

I'm frustrated. This is a crisis we are determined to do nothing about.

Here in New Hampshire new Covid cases are way down from a high in very late April and early May. We now have restaurants open at 50% capacity and so on. I drove by the town fields the other day and was horrified to see 40 or 50 kids interacting in what looked like a soccer camp, and no masks. At this point I am assuming an uptick in Covid cases come fall. We sadly canceled our week lakeside in Maine mostly because we don't know yet what the school situation will be for the grandson and whether we will be needed to assist (OR if he goes to school whether we then must decide if watching him will be now a bigger risk for us).

Here school plans are being left to the individual districts. NH has 167 school districts which in total serve roughly 190,000 students. The town/district where my daughter lives has proposed 2 days in school, 2 days remote, and the fifth day a kind of make up day. She has been reading some of the public forums and, while expected, she notes a segment of the population who declares their child "will never wear a mask."

Meanwhile, I'm trying to take care of some medical appointments ahead of the fall and have picked up supplies for various fall outdoor projects. I will shortly do another round of mask-making. We wonder if we will get to see and hold our new granddaughter when she is born in Virginia in October (they say they'll come up around the holidays, but will that be truly safe?)

Here in Indiana, the individual school districts (known as corporations here) decide upon their own plans for reopening. Our local schools will go to in-person school on August 5, although parents have an online option. Masks required and social distancing in place at school and on the bus. There are also plans for what to do if there are Covid outbreaks--same as the schools would do if there would be an outbreak of flu or other contagion, which they have had in the past. Then they would revert to partial or total online. We live in a small county, and have just one HS, one MS, one intermediate, and a few elementary schools. Our county has had only 47 positive cases and one death so far.

We have restaurants open at 75%, bars at 50%, retail at 100% and large gatherings limited to 250 people, all with social distancing. Individual businesses and localities decide on mask requirements, no state mandate but encouragement to wear masks from the Governor's office. At the hardware store yesterday, no one was wearing a mask, but at the grocery most were masked.

Arizona is getting from bad to worse and they are essentially not testing enough so the real numbers are probably much worse... If someone likes numbers: "During the past three weeks, cases increased by 108% and tests increased by 59%." (according to local news but the numbers do line up). 14.4% positive cases from all tested (a bit over 750,000 tests) - but it was 20+% two weeks ago and 17% so far last week (dates of when the tests are done, not when the results are out) - the lower overall is because of previous months.

The state is semi-closed (bars and gyms completely closed; restaurants at 50% I think) for now - so no change since my last post above in >51 AnnieMod: .

>60 AnnieMod: At least some measures are being taken in Arizona. In SC, the Governor has ordered bars and restaurants to stop serving alcohol after 11 pm. That is it. Everything is open and I ended up having to cancel my gym membership since they started charging me again and say that COVID is not an adequate reason to put a membership on hold. Also, they required an in person visit to close the account, so I was in a low ceilinged room with fans blowing everywhere and I and the employees behind the counter were the only ones in masks.

>61 RidgewayGirl:

True - although the gyms are uniting to sue the governor.

In a semi-funny story -- I live across the street from a gym so last weekend they decided to protest the closure by having a morning training session in the open - at 6:30 am with very loud music and speakers. Sunday morning is not a good time for that... When they did it again on Monday, now at 5:30 am, I had enough and went complaining to my leasing office - and apparently I was not the only one. It is a heavily residential area (it did not use to be but now it is), mostly apartment and condo complexes. By Tue morning enough people had complained apparently that now it is at normal volume - you can hear it if you are outside but it does not wake you up...

The best measure in Arizona of course is the weather at the moment - most people stay home anyway when it hits 110... And still the numbers are going up. Cannot even imagine how much worse it would have been in milder temperatures.

In our never-ending school saga, our district decided to start everyone with virtual learning this year. We had initially been given a choice between distance (virtual) learning and a hybrid model with 2 days in school and classes of about 10 kids. Our local COVID numbers are actually pretty good (though who knows how long that will last with the rest of our state and states to the south of us, where many are traveling for vacations, with numbers that are sky-rocketing) but despite our decent local numbers, they just don't have the staff to implement both hybrid and virtual plans.

I'm relieved in a way and think it was the right decision, despite having chosen the hybrid in school option for my kids originally. It's certainly safer this way from a COVID standpoint. However, learning through a computer did not work at all for my 7 year old last spring and I don't see how it will be any better this year. I'm also deeply concerned for the English second language learners, kids who don't have a good support network at home, and those who don't have the resources to supplement what will certainly be a dismal year of learning.

The contrast between taking care of our communities by staying home and safe that is required because of COVID and the simultaneous discussion around Black Lives Matter and inherent inequities in our community systems (definitely including schooling) is really upsetting me. Our district of 189,000 children has a enormous wealth disparity. We have wealthy people setting up learning pods and hiring away teachers from our local schools to teach small groups of kids. And then on the other hand, we have families who have no English speaking adults at home, no wifi connections (yes, the district says they will provide), dual working parents who may have no alternative but to leave young children home alone, etc.

It's all very upsetting and I'm livid that our national response has been so abysmal that it's left us here, more than 4 months after this all started.

I share your frustration, Jennifer. We couldn’t have handled this much worse nationally.

Our school district in suburban Houston hasn’t committed. I’m hoping all online because I don’t want my wife (who is a high school teacher) and two kids so exposed. Seriously, once a kid gets it, all their family get it and probably many of their classmates, who are in the same building breathing the same air 5-days a week, get it too. I think the one good thing the US did was shut down most of the schools in March. I think that really slowed the spread in the spring and it kept the spread through kids much lower than it could have been.

I agree with you whole-heartedly, Jennifer. It's hard to imagine how this pandemic could have been more badly handled.

And absolutely there are two conflicting needs here. Kids absolutely need to be back in school. While some parents have the resources (time, money, education, interest) to ensure that their kids get what they need, the kids in low income or abusive or neglectful households will be irreparably harmed by not getting back to school and fall further behind their luckier peers. And some children do better with on-line learning than others.

Kids (and those working in schools) also have the need to not get infected with a virus whose long-term effects are still unknown. Some children who were asymptomatic are seeing lung damage.

Our school district has come up with a plan for 0, 1, 2 or 5 days a week of in-school learning. The SC Governor is ordering schools to be ready to open on time with full-time in-school tuition, but he's also shrugging and saying that he can't just tell people they have to wear masks or close crowded bars and gyms. I have no idea when the school year will start or in what form and I can't imagine how stressful this must be for parents with children too young to be home alone all day and who both have jobs, as they try to make plans without any idea of what sort of childcare is needed.

I have nothing to offer, but my heart goes out to all of you with kids who have to deal with these decisions—both your district's and your own.

My kid starts his clinical rotations in the fall, which is a different sort of worry. But he's a big strapping lad of almost 33 and I imagine the hospitals will do the best they can to protect this next generation of doctors.

Indiana's governor just made masks mandatory for the state, which relieves local businesses and schools from having to make that decision. I don't know how that can be enforced, but at least it gives businesses some backbone for refusing service to unmasked people.

I agree, the decision to close schools for face to face instruction was appropriate in March. It's good that education decisions are state's rights issues and up to individual school districts to do what seems to be best for their own students. No matter what plan is made, there will be disadvantages for some kids and parents. I am glad to be retired from public education.

My daughter called earlier this evening to say that she is sick and when she called her OB doc (she's 6 months pregnant) to get a refill for her nebulizer and they instead sent her for a Covid viral test (drive-by, deep nasal swap). Both her 2 yo and husband had this just before her so she's hoping it's just a normal virus. She possibly had Covid back in February when she had what she thought was bronchitis; her OB doc then said they would give her an antibody test, but then later said they would test her when she comes in to deliver in October. It's 24-48 hrs for the results. She lives in Fairfax County, Virginia outside of DC (same as japaul22).

>68 avaland: I hope that your daughter tests negative for SARS-CoV-2, Lois.

We're seeing many more patients in our system (Children's Healthcare of Atlanta) that are testing positive for the virus, and more that require hospitalization as well. I finished my last night shift of the week a little over an hour ago, and the last patient I saw, from 11 pm to midnight, was an older teenage boy with COVID-19 pneumonia who is moderately ill and has been deteriorating over the past five days. He was coughing frequently during the hour I spent in his tiny room in our Emergency Department, and although he and his parents wore masks and I wore protective goggles, an N95 mask, and a disposable gown and gloves, and used a glove to cover the bell and diaphragm of my stethoscope to keep it relatively sterile while I examined him, I'm still concerned that I may pick up the virus from him, given my lengthy exposure. I also saw a 13 day old baby with COVID-19 on Monday, who is now critically ill in our PICU (Pediatric Intensive Care Unit). I wouldn't be surprised if the teenager ends up there this weekend as well.

The number of cases of COVID-19 in Georgia has been skyrocketing since early June, after people came back from going to beaches along the Georgia coast and North Florida during and after the Memorial Day weekend, both places which are seeing many more COVID-19 cases than metropolitan Atlanta is. (The teenager and his parents went to Florida just before he got sick.) The adult critical care beds are filled to capacity or nearly so throughout SE Georgia, and even the best of the 12 zones in the state had 81% ICU capacity earlier this week. The latest data suggest that the number of hospitalized patients, critically ill patients, and those who have died from COVID-19 have plateaued, so hopefully things won't get any worse than they already are.

I'll isolate myself for the next 10-12 days at home and watch for any symptoms of COVID-19 before I hopefully fly to Philadelphia to visit my parents early next month.

In Ontario, our new cases were hovering around 120 early last week and then they went up to about 160-90- Yesterday we were down in the province to about 138- apparently the majority of cases are now people below the age of 40. There is something called " covid fatigue" where younger people disregard social distancing. Toronto is still in " Stage 2"- so outdoor patios are open, malls, stores, hair salons and nail salons can open. However only groups of 10 can meet. Most of the province is in "Stage 3" where restaurants can have indoor dining and cinemas, gyms and bars can open. As well in Stage 3 there can be indoor gatherings of 50 and outdoor gatherings of 100. Our mayor is concerned about large gatherings in bars and a possible increase in Covid cases as a result. There are currently 97 patients in hospitals with Covid, with 30 in intensive care and 21 of those are on ventilators.
The Federal government denied the Blue Jays baseball team request to play home games in Toronto- too much crossing of the border with teams from all over the US- so the home games will be played in Buffalo.
Everyone I know is still being careful- not rushing out to restaurant patios. I spoke to a dietitian who usually worked out of one of the big hospitals- she thought the she would be back in her office in July but now says that she will still be doing her work by phone until at least January.

If it makes you feel any better, I'm not sure the UK response has been much better. Restaurants, pubs and shops are now open, but a number still remain closed. Although in England face masks are now (at long last) mandatory in shops, in NI they're trialling encouraging face mask wearing without making it mandatory in the hope that at least 80% comply. Good luck with that - I went to the supermarket this morning and would say 30% at the most were wearing them.

Last weekend I went on my first 'browsing' shopping trip since Lockdown, and it wasn't remotely enjoyable. Too many idiots weren't bothering to socially distance, and many of the shops looked like they'd not restocked in a while, plus a few were closing down.

Although cases are now very low here, there are still cluster outbreaks occurring. Of my two children, one is going back normal days / hours because she's in a key year of primary school, but my son will be in school 3 days one week, 2 days the next. We're still only supposed to have a small bubble of people who come into the home, and social distancing must apply, so I've no clue how I'm going to manage to return to the office in September and manage the kids' new regime. I'm in no hurry to bring my childminder back into the home, as she's not been great at sticking to the COVID rules around the number of people she interacts with and wouldn't be able to drive the kids to school / bus stop with current distancing rules anyway.

One of my staff members is back to playing full contact sport, and already in that sport a number of clusters have broken out at various clubs. I'm not delighted about going back to the office with him, as although he's sensible he admits many of his fellow players are young lads who are partying hard and ignoring all COVID rules. However, that type of sport is allowed so I can't ask him not to play.

A scientist on the UK government's Sage committee who are advising on COVID said last week that he believes the virus is now here to stay and it will be decades before it's fully eradicated. I have to admit I found that a most depressing thought - this 'new normal' of shops being full of plastic screens and walking around in face masks is very far from normal. I think I'm going to go back to avoiding the news again.

>69 kidzdoc: Thanks, Darryl, her test was negative, thankfully. I hope you can avoid catching the virus. A difficult situation, indeed.

https://www.smithsonianmag.com/history/during-great-book-scare-people-worried-co...

Coming across this article from last year that is scarily very relevant this year, what do most of you feel about borrowing books from the library in these COVID-19 times? A few of our libraries opened last month as a test bed, and the rest are opening at the end of the month. I could do with cutting down the amount of books I'm buying, but I do still feel a little funny about borrowing books, even though I think the libraries are being very sensible about not allowing books to be re-borrowed within 72 hours of return, etc.

I'm possibly being a little neurotic, but cases are spiking here again (although by comparison to other places we're still very low).

I've been reporting quite a bit on the REALM project from the Institute of Museum and Library Services here in the U.S.—they're doing extensive testing on library materials, in partnership with a major lab in Columbus, OH. You can read their dispatches here. Nothing too earth-shattering, but it's science-based and they run sensible tests specifically for libraries and museums.

Lois, belated but I'm glad to hear your daughter tested negative.

I'm looking at my son coming to stay for a few weeks while he starts his clinical rotations at a hospital in Brooklyn as part of his third year of med school. I've been appropriately careful with masks, distancing when I can, and hand-washing, but haven't been super virus-phobic up until now and I'm going to trust that with the proper precautions on his end we'll all be OK. He's working in a test center in downstate NY now, and his girlfriend is a labor and delivery nurse in the hospital there, and their two roommates also work at the hospital, and no one's gotten sick. So I'm going to just put my trust in their good habits and not worry too much. Fortunately our house is large (and drafty), and the washer-dryer is literally ten steps from the back door, so he can dump his clothes on his way in every day.

>74 lisapeet: Thanks for that link, Lisa - looks like the 72 hours window does what it needs to.

>73 AlisonY:

My library had a drive-through service through the whole mess - they never closed as they were already set up for it. They isolated the books for 72 hours post check in (they did not process the return until that point - they have a night/driver-through check-in system that does not require people to do anything so it was not hard to setup) and there had been no issues (that I know of). And you can always leave the books for a few days in the bag when you bring them home...

So I was pretty comfortable using my library extensively. Just my 2 cents.

>73 AlisonY: I have my own Little Free Library which I reopened in mid-June. I am in Maryland. I have been receiving donated books, both individual books and many together in grocery bags. I bring them into my house, put them aside for three days without touching them and wash my hands after bringing them indoors. I have had no problem with this. I now have a book on hold at my public library. They will have contactless pickup. I will put the book in the car trunk, bring it into my house, put it in the three day quarantine bag, and wash my hands. Books don’t seem to be a problem if handled in this way. I’m more afraid of congregating, maskless people at our local park and playground.

>76 AnnieMod:, >77 SqueakyChu: You're all convincing me. Time to get a few orders in.

>77 SqueakyChu: I occasionally find books at the Little Free Library near the grocery store where we shop. When I find one that I like, I leave in my entryway for several days (it's hot!) and then wash my hands before and after handling them. I applaud you for creating your own Little Free Library, and I have often thought of doing that myself. We live on a country road, so I am not sure how that would go over though, or if it would get much traffic.

I am also more worried about congregating, maskless people--I saw two big groups like that yesterday. One was at church--must have been a wedding party, they were all grouping up and taking photos of each other and running around. We ended up leaving. Another group was at a local event venue, many cars and people walking around without masks. Thankfully, we were not going there.

>79 LadyoftheLodge: My father has given up on attending church as even the earlier service, which was for those who wanted to wear masks and social distance, ended up being less than careful. He said that of the fifty or so attending, only three wore masks and there was no change in the usual hugs and handshakes. He was hurt that no one wanted to bother to behave safely for the higher risk church members in attendance. I don't think this behavior is malicious, but it is dangerously careless. A friend of mine has not gone back to church since March and finding out that there was a recent outbreak at that church has not changed her mind.

>79 LadyoftheLodge: >80 RidgewayGirl: My synagogue has decided not to do in person services at this time. Even though I rarely attend services because I’m hard of hearing and find communicating frustrating, I was glad they decided to Zoom and stream services. I actually watched a streamed service this past Sabbath and was comforted by it. I was also comforted knowing our congregation is not putting people in needless danger. In a very sad twist of fate, my own rabbi’s grandmother died this week at age 103...of COVID-19.

>79 LadyoftheLodge: I don’t see people congregating either at my Little Free Library or the one I visit every few days in our park. Little Free Libraries off the beaten track get their traffic from the map on the littlefreelibrary.org website, word of mouth, signage, and neighborhood listservs. My husband built our Little Free Library as well as some for a few friends. It’s interesting to see what these stewards have been doing during the pandemic. One stayed open with the steward actively maintaining it, one steward closed hers entirely and it remains closed, one steward has hers open but doesn’t go near it although others use it, while I closed mine for three months and missed it so much that I carefully resumed stocking it. Thankfully, all of us remain healthy.

>81 SqueakyChu: My synagogue and most of the other Reform and Reconstructionist synagogues in Toronto are having "zoom " or live streamed services. ( I think even one Conservative one is also doing live streaming) Although services are allowed in churches and synagogues up to 30 % capacity , most are not comfortable doing so. Depending on Covid 19 data from the province , one major synagogue has a plan to go back to limited service some time after Oct. However a lot of people are worried about a second wave happening-especially when school starts.

My congregation is streaming services with a zoom social hour, and our national organization said in May they think we'll need to do this for at least a year. While I miss seeing people in person, I would not be comfortable attending at this point in time.

>74 lisapeet: Thanks. Since that time my son-in-law here in NH has tested negative; and my ex has tested negative (he is still working and has seen our mutual grandson twice since March, so we were interested in the results).

Our church has been back up and running for the past month or so. I think numbers are lowish (I haven't been yet), but they are being very careful about where they seat people (perhaps a little over-careful, but better that way than the other). Live-streaming is also proving popular. I think this virus will change how people choose to church for the long-term.

>85 AlisonY: We have already had a good-sized outbreak (40 cases) due to people attending a church event in early August. In Maine, at about the same time, there was a wedding which had more than the permitted crowd size (50 for indoor gatherings); 30 people got Covid, who passed it on to 35 more, who—as best they can trace—have passed it on to 23 more. There has been one death linked that. Imagine having that be the legacy of one's wedding. The three northern New England states have done a good job keeping the spread down despite the influx of "summer people." Still, it shows how vulnerable we still are....

Our Methodist church has not reopened for services. We just got a survey asking about fall. We are still running our charitable programs (especially providing food to local homeless shelters and food to local school families). We are also doing small prayer services (10 or fewer people, masked) a few times a week.

The on line services, I'll admit, don't do much for me. Until we can safely gather, with singing and sunday school for the kids, I don't see us returning. Could be a long time . . .

In the midst of a pandemic, other $#!+ happens too. My father had a stroke in late July, and has been wending through the hospital system. The main hospital building restricted visitors to one per hospitalization, so my mother was it and was exhausted by 2x per day visits; my brothers and I (all local) were not allowed to substitute. The hospital rehab facility allowed one visitor per day, temperature check and the usual array of COVID questions (have you exhibited symptoms, been exposed, traveled, etc.) at the door, so we were able to rotate. The retirement community where they've lived for 15 years has a rehab facility too, and my father was just moved there yesterday. This one allows up to three visitors at a time, but restricted to an outdoor patio or indoor conference room, so visits have to be scheduled a day in advance and the staff has a calendar to ensure that the spaces don't get too crowded. Everyone in the family had been scrupulous about COVID protocols until this happened, had not set foot in each others' houses since early March, but now we gotta get stuff done. My mother stopped driving last winter because her eyesight has deteriorated, so she needs transportation and she needs assistance with tasks around the house that until this event my father had been providing and we had not been aware of. So we're all masked up in our cars and their house, and remain otherwise careful and cautious but always anxious. My mother is frail and COVID would kill her, and if we weren't in emergency mode none of us would go near her. The situation would be difficult regardless, but COVID adds another twist.

>88 qebo: - In spite of all that (and it's plenty!), you and your siblings are very lucky you are local. I live a 6-hour trip away from my mother and my brother lives only 3 hours from her but he is in the States (we are in Canada) and would have to quarantine for 2 weeks if he crossed the border so and he is still working full time so that just isn't feasible. Yes, covid is vicious on so many levels. I have made one trip to Montreal just a few weeks ago and may have to make another one soon. And I am no longer allowed to stay overnight with my mother in her apartment (an assisted living facility) as I used to so I stayed at a hotel ($$) and it took me one hour each way to commute between the hotel and her apartment, daily. But we do what must be done, don't we?

>88 qebo: Where are you? It's always interesting hear one's stories with the geography in mind.

My kids have returned to school this week, and I have to say despite the risks I'm very glad. My youngest has been hugely upset about Coronavirus, and is very sensitive to the abnormal normal that is now the school daily routine (temperature checks on arrival, constant hand washing, movement restricted within their class bubble, etc.), but despite everything I think it's been really important to get her back socialising with her peers, and of course back to being properly taught. They're not allowed in school if they have even the slightest sniffle, so I expect there will be a lot of in and out as we go through winter, but it's a start.

My oldest is at a large secondary school with about 1,500 pupils, and he's just been in for one half day so far but will be in properly from next week. Already one child (in one of the oldest classes) has tested positive for COVID-19, but the school seems to be working closely with our Public Health Agency who are satisfied that the class bubble system means only those in the same class as the affected pupil need to quarantine for 2 weeks. Time will tell, I guess, how well this works in practice, but in fairness to both schools they're doing the best they can amidst constant confusion and changes of policy.

Not covid related, but an angle on the flaws in the US healthcare system that have helped bring us to this fix, historian Timothy Snyder recounts how he nearly died, last December, of an abscessed liver that wasn't diagnosed in time.

>91 AlisonY: They're not allowed in school if they have even the slightest sniffle... My daughter says that this is also the case in her school district, thus our grandson, who has allergies, would never be allowed in school even if they wanted him to attend school in person. His remote learning will begin this Weds. at our house. His mother will work-from-home at our house for a few weeks until we all know what we are doing. There is no mask mandate there?

>93 avaland: Primary school children don't have to wear a mask at all. Secondary school children just have to wear one on the bus and in the corridors & other public areas, but not in their own classroom. Not sure how I feel about that.

How's everyone doing? We're having some restrictions reintroduced as cases are going up. From tomorrow there's no more meeting in other people's houses (unless you're a carer, etc.), as the evidence seemingly points to this being the place that the virus is mostly getting transmitted on the island of Ireland.

We've been stricter than others anyway because of my dad's health, so this isn't a huge change for us except that we can't allow our parents to come into our house any more, or have us go into theirs. More of an issue for my mum as she likes popping in for short bursts to see the kids, and temperatures are already getting autumnal so outside gatherings aren't so much fun.

I think across the world this is going to feel like a lonnnnngggggg winter.

I just checked the stats and here in New Hampshire we are still doing fairly well, but there seems to be an uptick in case, most in the 20-29 year old range, with few hospitalizations. I do wonder how businesses will weather the winter, when take-out drops because it means leaving a warm house, and frigid temps eliminate outside tables.

We made a quick, therapeutic trip up to my hometown in Maine last Tuesday, so I could get my fill of salt air, ocean waves, open space. It being Tuesday and off-season meant only a small number of people were prowling the beach. My husband and our grandson flew a red kite (the grandson's obvious joy at running loose on a beach reminded me of Ray Bradbury's story "All Summer in a Day"). We had local seafood take-out and my cousin asked me to do a drive-thru, so we talked to her from the car as she stood outside her house, all of us masked. It was only 100 miles one way, but it's the furthest we've been from home since 2019!

Indiana shows cases, hospitalizations, and deaths continuing to drop. The county where I live has low community transmission, which is generally true for our state. Some counties show an uptick because colleges are located in them and there is a lot of testing for COVID going on there. The largest number of cases in the state are in the 20-29 year old range.

My sister came to visit us for a few days and we went to eat at a local restaurant that turned out to be quite busy. Everyone had on masks and stayed distanced. We had not been to any local restaurants since early March.

Interesting to hear where the US is at. I think in the first wave we were a month or two ahead of the States, so it will be interesting to see if you get a similar pattern to us, i.e. a reduction in cases for 3 months and then a resurgence again. Certainly it seems that since our COVID measures were relaxed the cases have started to increase, particularly as people become more relaxed with friends and family within their own homes.

>97 LadyoftheLodge: Did you eat inside or outside? We have not been inside to sit for a meal since last winter. We had a regular breakfast thing once or twice a week that I miss.

>99 avaland: We sat inside, in a booth, so I felt comfortable being separated from others by walls on three sides. (Outside seating was an hour and 20 minute wait). There were just too many people there overall though, and the food and service were not that great. We are not planning to go back to that restaurant for a long time, it just isn't worth it.

In the Netherlands we seem to have a similar pattern to the rest of Europe — rate of infections has been climbing since the end of the summer holidays, mainly amongst young people, as people return from abroad and the universities open; until last week there wasn't any matching rise in the figures for hospitalisations and deaths. But they are now starting to go up as well: presumably all those socially-active young people have been infecting their elders.

There's been some tightening up of the rules in the last few days, but it seems largely symbolic (bars in the cities aren't allowed to stay open after 1 a.m.!).

Restaurants have been open here all summer, but when I go eating out it's to be with people from other households, so I've mostly been avoiding them. Once I had dinner with one other person (not quite 1.5m apart, but nearly) on a weeknight in a restaurant where we were almost the only customers; another time I ate outdoors in a beach café with half a dozen friends in a strong wind.

>97 LadyoftheLodge: I've read that some places have a mask rule for bars and restaurants — I can't imagine how that works. Are you just supposed to sit there looking at the food?

Arizona seems to be doing much better than in July and August but we are still at late May - early June levels (or thereabouts) and that is high enough. The news in the last days are reporting alarming numbers in the young population and schools are reopening (hybrid mode for most it seems) so we may be heading towards another dumpster fire around here.

My office is officially open, I refuse to work from there (partially because almost noone does, partially because after hating working from home now I am used to it and I would rather do that...), I officially cancelled all my travel plans for the rest of the year. And I had not been in a restaurant since March (and probably won't this year)...

Masks are recommended (and required in places) - although if you look outside you rarely see any masks (it is not an area where people walk a lot so 6 feet distance is not a problem)

In other news, the weather is getting better as we are moving from Arizona summer into summer so the late evenings are nice again for walks. :)

It is one weird year...

For whatever this may be worth to everyone, this is from the Santa Rosa (California) Press Democrat, actually a pretty good newspaper:

https://www.pressdemocrat.com/article/news/if-you-caught-covid-19-you-likely-ate...

I've only eaten at a restaurant once since March, and that was outside in Harlem—a really pleasant experience, nice service, good food. I forgot what it was like to have someone else cook and clean up.

I finally got a COVID test when we went for flu shots on Sunday, and got the results back already—negative, as I'd imagined. Though that was good timing because I've had the most miserable reaction to my flu shot, which has never happened before—fever and body aches and, of all things, cellulitis in my ear so I had to go back to the doc-in-a-box this morning and am now taking a round of antibiotics. Fortunately, I guess, this was my week off and I didn't have much else planned beside home projects, so at least I don't have to try and work through feeling crappy or worry about what I'm leaving undone—I got everything set up ahead of time. So all I really have to do is sleep and read, which is fine, honestly. I had been hoping to clean out my basement but I guess not.

As expected here in France as in most of Europe the numbers of people testing positive for Covid 19 is increasing after the summer holidays when people were let out to enjoy themselves. I think governments were hoping that the rise in numbers would not happen until November, but here we are in mid-September and experiencing 10,000 new cases a day - this will translate into large numbers of deaths in a months time.

I am trying to ensure we don't catch the wretched virus. We have everything going for us as we live in a very sparsely populated area of France in an old farmhouse with plenty of land around us. We can shop at lunchtime when all the local French people are busy eating lunch. We are too old to go out to work. We can easily avoid all the disease ridden young people and the weather is mild enough to meet with friends outside the house. We will continue to use the local restaurants in our small nearby town while they are still serving outside - I am expecting that they will have to close soon either because of orders from the government or people not wanting to go out and eat. I am quite happy to stay at home where I have everything I need and so barring emergencies that is what I will do. We do miss going out on trips, but there is plenty of countryside around to get lost in and we both enjoy walking.

We will be first in the queue for our flu jabs this year which will be available next month.

It's not what we were expecting this time last year, and we feel sorry for other people who are not so fortunate as ourselves. I am fairly pessimistic about the virus and also climate change and I keep looking for signs that some country somewhere has a government that realises that if they don't drastically change the way people live and work then things will get worse fairly quickly. It makes me spit to hear politicians obsessed with trying to get back to normal, how it was before the virus - look guys it ain't going to happen.

>104 lisapeet: I forgot what it was like to have someone else cook and clean up.

I had been using a lot of deliveries... so except for cleaning my own dish, that was not really a problem. But I miss just sitting in a restaurant on Sunday morning with my newspaper and not worrying about who is making the coffee. Oh well - maybe next year? :)

Hopefully the bad reaction clears up soonish... My allergies had been up again lately and my doctor wants to wait with the flu shot (if I get it at all).

>106 AnnieMod: Thanks, Annie. I'm feeling a bit better today, so hopefully the antibiotics are doing their thing.

>96 avaland: I meant to say earlier, I love this photo! That's a little bit of expansiveness we could all do with right now.

>107 lisapeet: Glad you are feeling better. Yes, I love the photo for that reason.

>101 thorold: There is a mask rule for restaurants and bars here. Wear the mask when in public spaces, walking to your table, going to the restroom. Masks can be removed when you sit down to eat.

>105 baswood: Your situation sounds a lot like ours. We are very fortunate not to go out to work (husband retired and I work from home on the computer), we have most of our food delivered and just go to the small local grocery for produce and paper goods. There are rarely more than five people in the store at any time, and the same small group of people work there. We have a university town 8 miles away but rarely go there unless we have an appointment of some kind. We enjoy our home, as you said, and our travel also has been cancelled for all of this year. This is certainly not what we were expecting for 2020.

Ontario has seen more Covid 19 cases in the past two weeks- and in the age group of under 40. There have been some new regulations for bars and restaurants limiting late openings.

Just wondering, for those here in the states, has Covid changed the way you will vote this year?

Here in New Hampshire Covid and vulnerability to it has been deemed a reason to get an Absentee ballot so we have taken advantage of that. We applied for the ballots maybe two weeks ago and received our ballots yesterday (I don't know if having those ballots the house affected my decision to watch the debate...or what, but we watched the whole thing).

We can mail the ballots in or make an appointment at the town clerk's office to turn them in person. We will do later. I will miss going to the high school to vote in person. I've been voting in person since 1973 (Yup. During Watergate)

>111 avaland: Just wondering, for those here in the states, has Covid changed the way you will vote this year?

Absolutely. I've lived in Atlanta since 1997, and several years ago (four? six? eight?) Georgians were permitted to cast their ballots in certain polling stations two or three weeks in advance of Election Day, which I did for all major (national, statewide) and most minor (local) elections. This year, after the pandemic was announced, the Georgia Secretary of State decided to mail no excuse absentee ballots to all registered voters for the June 9 primary election. I'm sure that most Americans who have followed the election heard about the debacle that took place here, especially in Atlanta and Fulton County, where Atlanta is located; however, I had no problem with the process. Instead of mailing my ballot I deposited it on the morning of the primary election into a specially designated ballot drop box installed by the Fulton County Board of Elections, which was outside of one of the downtown public libraries. I was able to track my ballot on the Secretary of State's web site, and by early evening I saw that my ballot had been received, and counted.

I requested and received an absentee ballot for the general election on November 3, and I'll fill it out and drop it off early next month (October, not November).

Interestingly, my current polling station in Midtown Atlanta is the century old First Presbyterian Church of Atlanta, on Peachtree & 16th Streets, directly across from the High Museum of Art, the city's largest museum. I had never voted in a church before, but as a Christian (Lutheran, not Presbyterian) it doesn't bother me to do so. I wonder if others also vote in churches, synagogues, mosques, etc., and if anyone is troubled by that.

Georgia and the city of Atlanta have had several special and runoff elections since June, and for those no absentee mail in ballots were provided. I have not voted in any of these elections, due to COVID-19 concerns.

>111 avaland: >112 kidzdoc: Fascinating glimpses of the actual ballot casting process. So, from a nerd outsider's perspective, not entirely familiar with the mechanics of voting in the US:

>111 avaland: If you can make an appointment at the town clerk's office to turn them in person, how does that lessen any vulnerability of going to an actual polling station? It seems to contradict the idea of a mail in ballot for non contact purposes.

I was able to track my ballot???

>112 kidzdoc: I had never voted in a church before...I wonder...if anyone is troubled by that

Was that in the actual church part, or in a church hall, used for functions such as meetings, lunches and so on? In the three provinces in which I have voted, church halls and school auditoriums are probably the most common voting locations, as there is room for the community to vote speedily. Because these spaces are regarded as community spaces for community activities, there doesn't seem to be any reluctance to use them for voting. However, if it was in the actual church section, I imagine it would be a different matter all together.

I do love the atmosphere of going to an actual polling station, with everybody so cheerful and excited, with people bringing small children to show them the process, the care taken by the clerks and so on.

>113 SassyLassy: I happened to be in the US on Election Day once — I suppose it must have been eight years ago — and I was really impressed by how excited everyone was about the process of voting. I'm more used to people in Britain and the Netherlands who typically seem to regard it as a necessary but inconvenient chore — a bit like getting a 'flu shot — and only get excited when the results start popping up, but that's clearly not how it is for Americans. (If my experience was typical!)

>114 thorold: You're right - the last time I was in the UK during an election (Scotland) the voters seemed very dour, but I related that more to the expected outcome (Conservative).

I wonder if the UK and Netherlands attitudes reflect how what is sometimes called "civics" is approached and taught in school, or if it reflects on the actual candidates about whom no one may be getting excited.

>111 avaland: Like the idea of following how covid will change voting activities in this election. It will be interesting to follow the responses.

>114 thorold:, >115 SassyLassy: We get "I Voted" stickers. I bet the UK doesn't have stickers.

>112 kidzdoc: Yeah, Stacey Abrams has been on MSNBC quite a bit lately.

>113 SassyLassy: It's not strictly an absentee ballot in that we will not be out of town/state/county. I suspect the option of turning them in person was added. We have no problem popping into the town clerk's office to deliver the ballots (wearing masks and sanitizing our hands before and after) instead of standing in a line to go into a booth (covered by curtained "door") used by others to fill in a paper ballot and then take it to and insert it into the optical scanner. This process will also help reduce the number of people coming in person to the high school (which will make that aforementioned process easier and safer for those going to vote and those working the polls). My oldest daughter works the polls as a 'moderator' in her community.

I do want to note that in high school I have "Government" class as a freshman (this was in Maine), Michael believes he had "Civics" (this was in Kentucky). Some of us were nominated to attend a week long leadership/citizenship program called Girls' State (Boys' State) where mock political exercises were done. We were all assigned roles ( I was the "press", as I was already writing for the Portland Press Herald youth pages). ETA: I don't want to exclude the influence of parents (my father a WWII veteran) who religiously voted every election.

I'm really sorry they phased out civics class. I never took one and managed to graduate high school without the slightest idea of how the federal government, its branches, or the judicial system worked. Obviously I taught myself and filled in the gaps (or maybe not obviously, but I'm a journalist who often writes on government-adjacent library issues so I kinda have to know this stuff), but it was a lot of catching up, and I can't imagine how kids who aren't motivated to learn these things manage. I'm pretty sure my son did get civics class at his fancy-ass magnet public high school, from 2001-05, but I'm guessing that's more the exception than the rule? I'd be glad to be proved wrong. I know a lot of libraries are stepping into the breach to offer civics classes for teens and adults, but there has to be an interest and impetus to get there.

Sorry, that wasn't COVID-related—just a rant. I have my absentee ballot but am seriously considering going to vote early in person instead. And I live in a blue state where my vote probably doesn't make much difference, but I'm determined.

>111 avaland: has Covid changed the way you will vote this year?
Yes. I requested a mail-in ballot for the PA primary in June, and for the general election in November, even though the polling station is a 5-minute walk from my house and sparsely populated. For the primary, where my vote didn't matter because the candidate is always a done deal by the time PA gets a say, I wanted to experiment with the procedure, just in case. I got an email notification that my ballot was received. For the general, I should have a ballot imminently but I don't entirely trust the postal system even if I mail it a month in advance, so I will use the one dropbox that exists in the entire county (which was going to be taken away in response to a lawsuit but was recently announced as an available option for this election).

>112 kidzdoc: I wonder if others also vote in churches, synagogues, mosques, etc., and if anyone is troubled by that.
My current polling station is the township office, but three recent polling stations have been churches, probably others before because I never thought of this as odd. Churches often offer/rent space to organizations for meetings, and these are about the only times I set foot. I'm not Christian by anything beyond ethnic heritage, and don't have a visceral reaction to secular use of sacred space, but I'm always curious to see interiors, and get a positive impression of churches that support the surrounding community.

>118 lisapeet: My son attends a public high school in SC and one of his mandatory classes last year was Government.

>111 avaland: Yes, COVID is changing how I vote this year. I very much enjoy the process of voting in person on election day -- even the standing in line with my neighbors. While SC does not have early voting, they do have absentee voting, which can either be done by mail, or in person at a local election office. I did this for the primary in February as I was volunteering with a campaign and so was working that day, and it's quick and easy to do. The courts have forced SC to allow all voters the option of voting absentee, while usually one requires a reason (documentation may be required).

>112 kidzdoc: Until a mega-church bought up the local Baptist church, my polling place was in their gymnasium. Now it's at the local elementary school.

Yes, it has changed the way I vote, as this is the first year I requested an absentee ballot, although I have done early voting at the courthouse. Indiana is a "vote in person" state, so the only way to get an absentee ballot is to meet certain criteria. I will mail in the completed ballot, which arrived in the mail yesterday.

>118 lisapeet: I took mandatory Civics and Indiana History in Grade 8 and mandatory Government class in high school. They were both fascinating, much more than I thought they would be. My husband has a political science degree, so he can usually answer my many questions about government.

Donald J Trump has tested positive for Covid.

>115 SassyLassy: Well, I can remember taking part in some fairly riotous mock-elections at school, at a time when the real-world options were less-than-glamorous Heaths and Callaghans. I think it may well reflect a deeper difference in the way people in the US are brought up to think of their country and its institutions, and the civics lessons are an effect of that, rather than a cause. But obviously it's really about the stickers, as >116 ELiz_M: says.

And Dickens probably has a lot to answer for as well — generations of British legislators have been obsessed with overcoming the negative image of democracy in the Eatandswill bit of Pickwick Papers, with the result that it's become basically illegal to have fun of any description in or near a polling station.

(Sorry for the slight side-track)

I will vote the same way this year - early voting at a low crowd time. But i am nervous about the idea of being stuck in a line. I want to be in and out quickly. Usually I am.

So tx compromised our mail-on balloting yesterday in a very deliberate and manipulative manner. The governor announced a restriction to only one mail-in drop off station per county. That’s insane for blue Houston (Harris Country), which had 12 open. Blue votes will go down because people will have trouble driving 30 miles into town to get there and because people may not feel as safe about going somewhere pulling from the whole country. (We are “red” in terms of caseload - whatever the most critical danger rating is). This also impacts Dallas (blue), Austin (very blue), San Antonio (blue), Fort Worth (red), El Paso (blue) and all other larger cities.

>124 dchaikin: Interesting notes, Dan. I hope the voters can overcome the obstacles.

>124 dchaikin: - That sounds downright criminal to me. How is that allowed?

>126 jessibud2: Ever since SCOTUS struck down the Voting Rights Act, there have been egregious acts intended to disenfranchise voters. It will eventually be struck down in court, but this will happen long after this election.

>127 RidgewayGirl: - Forgive me for my ignorance, I am not American, but why would the Supreme Court strike down the Voting Rights Act? Aren't they supposed to uphold the rights of the people and isn't the right to vote one of the most basic? When did that happen? Can I assume that it was within the last 4 years......

128> The Supreme Court, which has had a Conservative majority for a while, struck down the part of the Voting Rights Act that provided for the U.S. Justice Department reviewing and either allowing or disallowing new state laws that might infringe upon citizens' ability to vote. The rationale given was that racism was no longer a major problem and so the oversight was no longer needed. The Voting Rights Act is still the law of the land--it's an overstatement to say it has been struck down--states cannot pass laws that explicitly prevent any ethnic or other group from voting. However, while the Act still stands, it has essentially been gutted, so states can pass laws like the Texas law Dan describes above, that make it harder to vote across the board for everyone, even though the clear intent is to help Republicans. The Democrats are the majority party (not in every locale, but generally across the country). In order for Republicans to stay in power, they have to keep Democrats from voting. Hence laws like this one and the Administration's effective efforts to cripple our Post Office.

I will be voting by absentee ballot this year for the 2nd time in my life. (I voted in my home state when I was 19 or 20, even though I was living in another state.)

I voted early in the Georgia primary this year. I live in DeKalb County, which is so overwhelmingly Democratic that the Republican party often doesn't have anyone up for election in local races, so if I want a voice, I have to vote in the primary.

I'm choosing to vote absentee this fall because I don't think there will be any low turnout time in the early voting process unless I can get there by 7:00 a.m. when the polls open (not happening.)

My workplace (a public library) is an early voting location. During the 2018 elections, there was a line down the long end of our building and our parking lot overflowed into the neighborhood the entire three weeks of early voting.

The differences I expect to see this yeare are:
- We're closed to the public, so our patrons will not have to fight their way through our lobby to get into the building.
- We have permission from our administrative office to block off a set of parking spaces for staff this year so staff doesn't have to park and walk, and we can leave for lunch and have a parking space when we come back.
- I don't know how our patrons will use curbside pickup because there won't be anywhere for them to park and wait for us to bring their items outside. We're trying to suggest they send holds to nearby branches for that three weeks.

I tried to sign up to be a poll watcher this year, and went through three trainings, but I missed the window where they asked us to sign up for a time slot, so I won't be doing that.

Ironically? we turned our ballots in to the town clerk's office on October 2nd, the day the President was found to have Covid.

I vote in Virginia and I plan to vote in person early. I've never done that before - I've always just voted in person on election day. But this year, I want to get my vote in early. We have in person voting open currently but only at one location in our enormous county. There have been lines in the hundreds long every day. On October 14, about 14 more locations open up. I will vote sometime after that. I was originally planning to vote on election day, but now I'm nervous that if I wait something will happen (someone in my household will be sick or quarantined or who knows what) and I won't be able to vote. So it's important to me to get it done ahead of time.

I live in Indiana and I just received my absentee ballot in the mail. Like >132 japaul22:, I was afraid something would happen to prevent me from getting to the polls, as I always have voted early in person. I opted for the absentee ballot, but this is the first time I have done this.

I've been offline for a while and am just getting caught up on this thread. I thought I would give a quick covid update. As you may know or have read previously in this thread, I moved from Florida to Maine March 1, and developed covid symptoms March 22. I was ill for three months with a cough, severe fatigue, and a low-grade fever every day. At it's worst I was short of breath and would get exhausted taking a shower and have to rest in bed the rest of the day. I'm doing better, although I'm still coughing, having heart palpitations, and getting tired unexpectedly. I have difficulty focusing and concentrating and have only read two books since becoming ill. This is unusual for me as I've often read one or two books a week on average. At first I thought it was because I was so tired, but now I'm not sure. So that's what's happening with me on the covid front. My doctor wants to do a lung cat scan with contrast, but it's expensive and my insurance doesn't cover much of it. We'll see. I'm not coughing as much any more. I've had my flu shot. Fingers crossed I won't get my annual bout of bronchitis this winter.

As for voting, I have filled out my absentee ballot and will turn it in to the town clerk's office. It was my first time participating in ranked voting. Maine is the only state that uses it in presidential elections. I like the idea of ranked voting, but there is a lot of confusion about it here in Maine, and I wonder how it's impacting people's participation.

>134 labfs39: I've been wondering about you. I'm sorry your illness is still dragging on. Have you been officially diagnosed as a COVID long-hauler?

I like the idea of ranked voting too, and have been curious how it's going in Maine.

>134 labfs39: I'm so sorry to hear that you've been sick for so long. I hope it resolves soon and you have a full recovery.

>134 labfs39: Lisa, it's good to hear from you. I'm sorry your experience with Covid has been so lousy. I hope you can find ways to support & take care of yourself, and your daughter.

I'm now curious about ranked voting (- will have to look it up online.

>134 labfs39: Glad to have an update, Lisa. Hang in there! Is your daughter physically in school or is she doing remote learning?

>134 labfs39: Oh man, I'm sorry to hear about your COVID long haul (whether or not you've been officially diagnosed as a long hauler). I know at least one person here who's dealing with that, and even though she has the benefit of a good medical program backing her up I know it's really frustrating and scary.

>134 labfs39: I'm sorry that you're still battling post-COVID symptoms, Lisa. Unfortunately I'm sure you're awake that others are dealing with symptoms similar to yours for months after they were infected with SARS-CoV-2, although I imagine that is little if any comfort.

Long COVID sounds terrifying. It's in the UK and local press a lot at the moment as currently there is very little support for people as doctors don't yet know what to do. There's talk of a need for a long-haul specific fund. I'm sure it will come; so much money has been spent already it's becoming like toy money anyway.

We're starting to see a big COVID priority effect on diseases such as cancer now. There was dreadful local press last week when over 100 cancer operations were cancelled as staff and resources were prioritised on COVID. It feels like the end of the NHS if you want any kind of relatively prompt medical attention now. It couldn't cope before COVID - I can't see how it will ever catch up on the backlog.

Thanks, all. I'm fortunate that although it's been long-lasting, my bout with Covid has not been severe enough to warrant hospitalization. I wish there were statistics about those with prolonged symptoms. It might broaden the public's focus on positive tests and mortality as the only barometers of Covid's effect.

One week to go...

>142 labfs39: One week to go...

Wishing you the best!

Today France is back to where it was in March earlier this year - Lockdown. I have been telling people all summer that we would be back to this sooner rather than later, especially those that do not always wear a mask.

I am not allowed to leave my house to socialise and not allowed to invite anybody inside. All restaurants and cafes are closed and only shops selling essential items are open. If I want to go shopping, visit the doctors, dentist, courts of law, government administration offices or take a child to school (most schools are open) then I have to carry a signed authorisation which I need to show to the police. (unfortunately I don't have any children, but I am allowed to help a person older or more handicapped than me).
I can go for a walk for i kilometre around my house, but again I have to sign an authorisation form for every trip.

I have to say I approve of all the lockdown measures especially since the government is doing all it can to support people who are unable to work. (Factories and essential services are remaining open and of course all those industries involved in food production and making toilet rolls.) There is no doubt that the virus is out of control again and hospitals are filling up fast.

Yesterday was a gorgeous warm autumn summers day and we went to our local restaurant (outside and 2 meters apart from the next table). They were full and were soon turning people away. It all felt like a macabre celebration because although the lockdown is to last for a month (1st December) I think it will be for at least two months again. I am lucky because I live in the countryside, but I do feel for those people trapped in apartments in town. It is tough for them.

Here's a bit of inspiration as we head into the potentially difficult winter.

https://www.youtube.com/watch?v=iZgmIx3FmKc&t=16s

As we approach the holiday season, how is everyone doing?

As noted before, we are retirees and live in a town of just under 8,000 people on the Massachusetts border and adjacent to the city of Nashua (pop 89,000). We have had 58 cases of Covid total in town. While NH remains on the lower end of the scale overall, cases here have spiked dramatically over the last month. The Republican governor has issued an mask mandate (I thought we had one already!) and people traveling anywhere out of state must self-quarantine for two weeks upon their return. Additional schools have recently moved to remote learning. Restaurants pulled in their outdoor seating well over a month ago.

We still have our 5 yr old grandson here for three days, two of which are his remote learning. He seems to be having more mood swings these days: crying and temper tantrums. This ups the stress level for us. He hasn't played properly with another child since March.

We still have medical appointments we need to go to (the hospitals are locked down again -- no visitors...etc), and we shop as necessary. We both have longer Covid hair, ha ha. Hubby is quarantining the mail as it comes in. We do a take-out lunch once or twice a week. We don't go anywhere without a mask and hand sanitizer. I completed all my holiday shopping more or less in October. We have stockpiled nonperishable and freezable food just in case things get really crazy.

And while we have been thinking of ourselves, we have not forgotten to donate to local nonprofits who provide for those in need. People are really hurting.

Thanksgiving this coming week is going to be drop-off pies (if you must know the pies requested by family are: chocolate, apple and sawdust) and a Zoom meet-up. Bummer we don't get to gather or see the new 5-week-old granddaughter, but better safe.

OK, that's our update, and yours?

Current map of US showing # of cases per 100,000 population:

https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days

I tried to find something similar for Europe....

BBC Scotland always provides excellent up to date info on that country if you keep scrolling through:

https://www.bbc.com/news/uk-scotland-53511877

The capital of the province where I live:

https://www.nytimes.com/2020/11/18/opinion/covid-halifax-nova-scotia-canada.html...

Tighter measures have been introduced in the city today. Halifax has five universities, with a correspondingly young population, and the new cases in the last two weeks are mostly in the 18 -35 age group. The good news is that no one is currently hospitalized:
https://novascotia.ca/coronavirus/data/

This is a good site for global cases / 100,000:

https://www.worldometers.info/coronavirus/

In N. Ireland we're going back into lockdown this Friday for 2 weeks. The main difference from the first lockdown in the spring is that this time the schools are remaining open throughout, which I'm thankful for. It won't hugely affect our household, but you have to hugely feel for all the businesses who have brought in extra stock for Christmas and will now lose 2 key weeks of trading. Bars and restaurants have been closed for the past month again (although restaurants can do takeaways). I think bars have only been open for 30 odd days in total since March. It's very sad - I expect there will be a lot of shutters staying permanently down in Belfast and other towns up and down the country.

I'm really pleased the children have remained at school since September, save for an extra week off at Halloween in an attempt at a circuit breaker. They're much happier being back amongst their friends and being properly taught, and to be quite honest I don't think I could have kept up homeschooling for much longer along with work. I take my hat off to those who have no choice in other countries. My son goes to a large school with around 1,200 pupils, and they have done their best to keep pupils within class bubbles. So far around 10 or so pupils and teachers have tested positive since September, but they have only had to make affected class bubbles isolate, and for everyone else school life has carried on as normal. They wear their masks on transport and in school corridors, but it's not mandatory within the classroom.

Additional mixed 'bubbles' are going to be allowed over Christmas to enable families to be together. We're going to be having Christmas by ourselves this year as my Dad is immunosuppressed, which is sad but the right thing to do. I do fear that generally we'll see a spike in cases after Christmas with the additional mixing. I'm not sure it's worth it for the sake of one day.

I only knew of one person who had COVID in the first wave. This time so far I know of 5 at least, so it feels much more 'real' yet in many ways there are less restrictions than in wave 1. Since masks became mandatory the shops seem to have stopped caring about restricting numbers or implementing one-way systems, and the closer we get to Christmas the more horrendous it becomes shopping at the large supermarkets.

>146 avaland: Organizing Thanksgiving day... which would normally be local family event with various nieces and nephews converging from other states, but it's now 5 separate households following COVID protocols. The major logistical problem is that my father is in a rehab facility after a stroke, and is allowed no more than a half hour slot per day for visitors, with no more than three visitors at once, and that slot will probably go to my mother and brother and nephew (who works at home and rented a car to drive here so he can buy my parents' car to drive back). So my other brother and I will probably visit separately the day before and the day after. With that in place, next up is arranging visits to my mother which are more flexible but still restricted because she is in an apartment building with tiers of eldercare. My brothers and I can manage fine without a holiday event, but my parents are feeling isolated. They are actually in the same retirement community building, but the two parts of the building have different visitation rules even for people who live in it.

>149 AlisonY: I'm very jealous of your open schools! Our entire school district (5-18 year olds) that serves 189,000 children has been closed since last March with virtual learning only except for a very small group of high needs kids (1% of the school population). In the meantime, bars, restaurants, gyms, salons, are all open with some capacity restrictions. To me, that is practically criminal.

That being said, my kids are doing ok because we are able to give them a lot of support at home and we have good internet and bought them better laptops than the school provided. Our school district is very diverse, though, and that is certainly not the experience of the majority of students. It is a strain, as my husband and I both work full time, but we are "making it work". My kids have been playing with two other families that live on our block (outside only) which gives them some much needed peer interaction. With the rising numbers, we've started also making them wear masks while they play outside. They've been great sports about it. Kids are resilient, thank goodness.

Our area is seeing an increase in percent positivity, but overall it's not too bad yet, especially compared to the rest of the country. We have high mask compliance and people seem to be taking the guidelines seriously.

No Thanksgiving travel or gatherings for us this year, besides seeing my mom who lives locally and has been helping us with childcare anyway. Even so, we'll eat outside and keep the visit brief. For Christmas we might visit my husband's parents and brother, who live a 4 hour drive away. We are considering this because we will be able to quarantine before and after the visit because of the long holiday break.

I'm trying to look at the positives - lots of time with my kids, fewer of the activities that make us feel so busy but aren't always rewarding, and a slightly reduced work schedule for me. Also very grateful that none of our extended family or close friends have gotten this virus.

Numbers are going up here in Georgia, as well as in the county I live in, although Dekalb county's 2-week positivity rate is between 5-6%, while the states is around 8%.

I have an every-other-week work schedule (I'm still getting paid full time, thankfully.) I have been meeting face to face with a few friends (outside, masks on.)

No one in my family has been sick with Covid. However, my father is in rehab recovering from a broken leg (a fall in his apartment.) I can call him, but none of us can visit which is hard for him and us.

My sisters (both elementary special needs teachers) have been pulled off in-person teaching. I'm glad for health reasons, but the kids they teach reallly need in-person teaching, so that isn't good for them.

My brother's family, and his two adult children, are doing fine so far.

I am choosing not to travel at the holidays. I hope to visit family in the Midwest in the spring, when I can drive or fly, depending on what I'm most comfortable with. I will probably Zoom with my sisters Thanksgiving day, and that will be my celebration.

>151 japaul22: I'm curious re the "positives" you mention... do you think you will make changes when you can return to 'normal' to maintain some of the positives?

>153 avaland: I think we will be more willing to say no to bigger, less personal events that aren't as meaningful to us. But most of what isn't happening right now will come back and though it makes us busy, I'm expecting that the pros will outweigh the busy-ness cons. A large part of what is making me less busy is a reduced work schedule because there isn't much we can do in the way of performing (I'm a musician). Also, our commute times are so much shorter with so many working from home. Where my commute would normally take 45-90 minutes, it now takes reliably 25 minutes. That's huge but I won't have control over that when things return to normal.

My kids normally each do one sport per season (except summer where we just go to the pool) and they do piano lessons. I'm sure we'll start doing all of that again. But school with before care (to accommodate my work schedule) is almost 9 hours a day. With virtual school, it's more like 6 hours with about 90 minutes of tech breaks. And they have Mondays completely off right now for teacher planning.

So, while I'm trying to live in the moment and take advantage of the fact that we have more time to play games, read books, watch movies, take hikes, etc., I'll be happy for most things to start up again. Especially seeing a wider circle of friends and family in person. But it's also part of the way I like to approach life to appreciate the moment I'm in as best I can, even when it's hard.

Arizona seems to be in the "good" list lately after leading the naughty lists for awhile so it seems to be calm here. Probably the calm before the storm. My office just moved but we are still allowed to work from home so I am basically doing what I had been doing for the last 8 months - stay home :) And I am back to reading - for 3 months I did not touch a book (which is very very unusual). It is a weird year.

What I am worried about is Bulgaria - they seem to be heading towards a second full lockdown. My family is ok, noone had fallen ill (yet) but still... :(

The dreaded second (if not third) wave of COVID-19 is here, and it may end up being worse than we all feared and predicted. I was on hospital service all week, and saw six patients with it, one of whom the pulmonologist who was co-managing him with me sent to the PICU yesterday afternoon. The organization I work for publishes a weekly Virometer, a list of positive viral test results for the entire system, and on Tuesday the number of positive SARS-CoV-2 tests nearly doubled. I expect that this number will explode next Tuesday, based on what we've seen in the hospital, and on conversations I've had in the Facebook group of Atlanta area pediatricians yesterday and today. I suspect that we'll see many more cases of COVID-19 in the next week or two, as kids infected during Thanksgiving Week come to us to receive care.

ETA: In contrast, I haven't cared for a single patient with influenza and only one infant with RSV bronchiolitis this season, which is absolutely unheard of and astonishing for the first week in December, when we are usually up to our ears in babies and young toddlers with RSV, and influenza cases start to rise significantly.

Because of alarmingly rising COVID cases in the county, visits have been suspended at both the rehab facility where my father has been for a few months and the apartments that we got my mother moved into just a few weeks ago. Worse, although both are in the same building, connected by a 5 minute walk through the hallways, the medical and residential areas are sealed off from each other so my mother may not visit my father. This is a retirement community and they are not the only spouses in this situation.

I wonder if people are just tired of being careful and given the lack of direction from government (there is only so much Dr. Fauci can do) they've given up? My aunt, who is 78 and has COPD, went to Thanksgiving dinner at a friend's house. They were a small group, but two tested positive soon after the dinner (traced back to a golf game and shared car with a college-aged grandson of two of the participants) and so there was quite a bit of stress involved until the test (for which she paid $150) came back negative.

The new spin is that COVID isn't at all dangerous and the death rates are being artificially created by just attributing all deaths to COVID. Apparently, some alleged doctor has been willing to say that the death rates now are exactly the same as they were last year, with no excess deaths. SC is an interesting state to live in these days.

>158 RidgewayGirl: The new spin is that COVID isn't at all dangerous and the death rates are being artificially created by just attributing all deaths to COVID. Apparently, some alleged doctor has been willing to say that the death rates now are exactly the same as they were last year, with no excess deaths.

Oh, FFS...

>158 RidgewayGirl: The half-truth is that the for profit clinics are more than happy to over report cases of they think it'll get them paid.

When I was down with Covid Workcare (my company uses a third party for our medical monitoring) wanted to count my parents as positive, who live over a thousand miles away. And that was before I even tested positive.

For a lot of working class folks clinics run by the likes of Workcare and Concentra are their only contact to the medical world. It's not hard to see how a conspiracy can start when the testing was so limited, that even slight exposure to the virus was enough to be counted in their system. Which is entirely separate from the rest of the medical system, but good luck telling that to a true believer.

>158 RidgewayGirl: The test cost $150??
O.K. I live in Canada- no cost to the Covid test- I got mine and had my results (negative ) with 24 hours. Our numbers in Ontario are high although we are in a lockdown situation. The worst outbreaks are in areas of low income and long term care homes-this is frustrating as everyone knew of the dangers in long term homes early in the spring. Any changes that were needed were not made.

>161 torontoc: My state, Virginia, has some free testing but it's only for those with symptoms or sometimes with confirmed exposure, not if you just had a possible exposure or want to travel/coming back from travel, etc. My health insurance will only do testing if you have symptoms, and even then, they tend to just recommend the quarantine rather than testing. Because we don't have national healthcare, everyone's plan handles this differently. So if my family wants a test for peace of mind (for instance my job puts me in relatively high exposure circumstances) we would have to pay $120 per test. And try to find a place with appointments to actually do it. Most tests results are coming through in 2-3 days from what I've heard.

Just a few miles away, testing in D.C. and Maryland is much more readily available and free.

>161 torontoc: That was my reaction, as well.

Possibly the only silver lining of living in NYC, which was hit the hardest and early, is that most testing is free. If I make an appointment through the City website they don't even ask for insurance. One of the Brooklyn hospital systems, within walking distance, has walk-in testing. Again their tests are free for the patient, but if you have insurance they bill the company.

We have drive-through testing up near me in the Bronx, free and no appointment necessary. I think NYC learned its hard lessons early, one of them being that accurate testing and reporting is key.

>159 kidzdoc: "Oh, FFS..." Did you go to the Trump rally in Georgia" or would that be FFFS.......

We are still in lockdown in France until 15 December, but shops are now open, with some restrictions. We had a mobile test unit come round for free testing. We did not bother because we have been isolating, but many of the more elderly people (yes there are more elderly people than us) took advantage of a trip out. Many of our neighbours are not too good with their mobile phones or computers and so we have been checking their results for them, unsurprisingly all have been negative.

We are in the second category for vaccinations which we expect to be available towards the end of February or March next year. We will be biting their hands off.

>165 baswood: "Oh, FFS..." Did you go to the Trump rally in Georgia" or would that be FFFS.......

That would be "Oh, FN," or "Oh, f*** no." It was held in Valdosta, a medium sized city in south Georgia which is over 200 miles south of Atlanta. I wouldn't have attended that rally even if it was 2 miles from here.

This past week the Advisory Committee on Immunization Practices in the United States gave its recommendations on which groups should receive one of the FDA approved SARS-CoV-2 vaccines first. As expected, in Phase 1a healthcare workers and residents of long-term care facilities will be first in line to be vaccinated, and since I work in a large hospital in a major healthcare system, Children's Healthcare of Atlanta, I'll likely be one of the first LTers to receive the first dose of one of these vaccines, possibly as early as this month. The youngest daughter of a good friend of mine, a primary care pediatrician whose office is close to the hospital, received the Moderna vaccine series earlier this year, as she is a second year medical student and enrolled in the Moderna Phase 3 trial. As has been reported elsewhere, Ellen felt crummy for a day or two after she received the second dose of the vaccine, which is supposed to be similar to the way that recipients of the Shingrix (shingles) vaccine feel after they receive the second dose of it, with pain and redness at the injection site, low grade fevers, and general malaise. These are indications that the vaccine is doing its job, by inducing an inflammatory response by the immune system to a perceived threat, and therefore is a good thing, although Ellen's mother smartly said that she'll try to get her first and second vaccinations on a Friday in a weekend that she doesn't have to work, so that she can recuperate at home. She also shared a useful article about the vaccine written by an immunologist at Emory University School of Medicine, where we both trained as pediatric residents in the past century:

Vaccines against SARS-CoV-2 will have side effects – that’s a good thing

Once I receive the vaccine I'll report here, and in Club Read 2021, about my experiences getting it.

>166 kidzdoc: Continuing your "oh, FFS" theme, did you see that some people working in finance thought they should be vaccinated early? Such a vital line of work, you know.

>167 dukedom_enough: Seriously?! Oh, FFS, indeed.

In France, we're in semi-lockdown (schools and shops are open, with restrictions on the number of customers allowed inside, but restaurants, cinemas and sports facilities are closed) until 15 December for sure, as said in >165 baswood:. The government will tell us soon whether there will be a new easing in time for Christmas. Numbers are not quite where they should be, but cancelling Christmas would be unpopular! A medical pundit has suggested relegating grandparents to the kitchen for Christmas dinner, to general consternation (and widespread mocking, as in this new take on an old song about inviting your grandmother for a waltz: Vous boufferez sans nous, grand-mère). Another said we should be prepared to spend the day in silence and to leave 1 meter between guests, to avoid aerosols.

Here in Southern California, the governor has put everything on lockdown again as of Sunday at midnight. No dining in or outside of restaurants, limited capacity in retail stores. Public schools have been closed, but some of the private schools are still open. All of the branches in the county library system where I work were completely closed from March until the middle of June. In June, we began express service (people could request books and then pick their items up). In October, our branch, and quite a few of the others in the system, opened with limited capacity and, of course, the requirement that patrons (and staff) wear face masks. As of today, we are back to the whole express service thing. What we are finding interesting in library world is how in March the county libraries were completely closed, but now libraries are considered as part of the "retail" sector.

I live in Riverside County and the sheriff has made it abundantly clear that he will not be enforcing any restrictions - because Gov. Newsom is a dictator, blah blah blah. Orange County sheriff has said much the same thing. I can see some logic in this: law enforcement does not want to be overwhelmed with stupid calls. But, at the same time, the mixed messages sent to the public is freaking ridiculous.

Good grief.
Or as kidzdoc so astutely puts it: FFS!!!!

After being the good kid for awhile (after being on everyone's task list for one of the worst states for a bit), Arizona is back with breaking daily records in positive cases and pretty much any other metrics - except for deaths so far but... it is early days (nothing to do with the fact that everyone and their grandmother decided that Thanksgiving is a good time to come to the warm states, I am sure. Add the snowbirds who seem to be trying to get here before the states close again (be it because of the pandemic or because of the usual great weather in winter) and... it had been busy at the airport(s) apparently). Welcome to the sunny states I guess.

Meanwhile, Bulgaria is on partial lockdown until a few days before Christmas (don't get me started on some of the... inane ideas on what remains open - plus reopening all retail on Dec 21 will not end up with everyone in the malls, right?) and despite my Mom being careful (and my sister not so much...) and so on, I still worry.

At this point it seems like even people that kept their heads earlier in the year are getting a "well, I cannot be careful forever, I will do what I want" kind of thinking. Which scares me more than anything - vaccines or nor, if this thinking prevails, we are up for a long winter with a lot of heartbreak. Add the usual "it is a conspiracy" people (way too many even among the ones that usually don't fall for it) and... FFS looks like the easiest way to react.

So I am sitting at home, venturing away from my street once a week to the library (drive through), trying to get out for a walk at least daily and contemplating a move in March (now that will be interesting).

We've started vaccinating in the UK today. There is so much spin now in news reporting that I don't think anyone knows what to believe any more. We hear all the positive and reasonable explanations on why this trial could be safely shortened (by normal testing standards), but then there's that nagging little fact that the government are providing the indemnity, not the pharma companies. The anti-vaxers are peeing their pants in delight over that one.

My family will all take it when we're offered it nonetheless. I don't think my Dad will be able to get it as his immunity is compromised. Annoyingly myself and my kids will be at the end of the queue in terms of priority order, so it could still be the summer before we get to hang out with my dad properly, which saddens me.

Unfortunately in the UK we're learning nothing from North America's post-Thanksgiving spike, so we expect a further spike in January as the government and devolved assemblies are too frightened to ask people to rein in Christmas. We're having Christmas alone with just our own immediate family. My parents don't feel safe going to either daughter's house for a prolonged period, and I think that's sensible. I wish everyone else would wise up and forgo the big extended family Christmas for one year to protect people.

>172 AlisonY: I wish everyone else would wise up and forgo the big extended family Christmas for one year to protect people.

Amen! The only person I may see is my friend Susan, outside with mask, weather permitting.

Canada has just approved the Pfizer vaccine- all the provinces will start getting delivery next week. The long term care homes - those caring for the residents and the residents will be the first vaccinated. The issue is that the vaccine should not be moved and needs to be stored in special deep freezers- there are 14 depots for the vaccine across Canada.
However, numbers of those infected with Covid are still high in Ontario and Alberta- so we are in a lockdown situation.

>174 torontoc: - Yes, this is what I was wondering about. If the vaccine can't be moved, and vulnerable seniors in long term care residences are to be the first to receive it, how will that happen? Most of those places are in lockdown and many of the seniors can't be moved. Shouldn't the medical people be going to the residences, and not vice-versa? Even if they provided buses for everyone, how many seniors (many in wheelchairs) could possibly fit on a transport vehicle? And what about those who aren't located near a designated vaccine depot? It will take forever to do this effectively, and can it even be done in the limited time the vaccine will be viable for? I haven't heard any of the talking heads on the radio or tv even mention this logistic.

And forgive my genuine ignorance, but does it get injected into your arm in a frozen state? Because if not, why does it have to be kept as such an incredibly cold state? And if it does need to thaw, surely that would allow for time to go to the seniors and not expect them go to the vaccine.

Colour me confused. What else is new.

>166 kidzdoc: interesting about the effects of the vaccine

I did a free drive through test in November before moving my mother to assisted living. (I’m in suburban Houston, she’s in suburban Philadelphia). There was no knowable risk but it was still nice to see it come back negative. And then it was awkward to immediately get on a plane (including airport and rental car line exposure - the latter being a most uncomfortable 30 minutes.)

My mother has moved but her facility has been on constant lockdown as two residents and some staff tested positive - all at different times and each requiring a two-week lockdown extension. So my mother with dementia hasn’t left her room in a month and has yet to see her facility. !! That’s not what we wanted. I hope she has access to a vaccine soon.

My wife and kids are in person in school and _every_day_ someone is there who will tests positive soon, as we are duly k informed a couple days later. But so far their immediate classmates haven’t been affected. (We had one scare - but the sickness wasn’t covid. phew.). Also I was shocked to see some large (unmasked!!) family gatherings for Thanksgiving posted on fb by neighbors and I expect to see more for Xmas. I don’t understand this.

Hope everyone stays well.

>175 jessibud2: I read somewhere that thought the Pfizer vaccine needs to be stored in deep cold, it can be in a normal refrigerator for 24-48 hours before it's administered. And they have a strategy for how to ship it. So it isn't convenient, and it needs to be stored in a deep freeze, but immunizing seniors in long term care seems like it should work with the refrigeration if they are really organized! I'm sure Darryl knows more detail.

I just got the shivers thinking about the cold vaccine.

According to our local BBC news the Pfizer vaccine can be kept in a fridge for up to 5 days. Here (in NI) it's being rolled out mostly in care homes initially, and to staff in hospitals. It takes 28 days to get immunity, so you have to feel for those vaccinators who only received their first jab on Tuesday and are now having to do mass vaccinating.

First dose is on day 1, with immunity starting to build from day 12; second dose is on day 21, and by day 28 you have full immunity. According to the news report anyway... I have to say my trust in news corporations has decreased dramatically in recent years.

As you've probably heard, the US Food & Drug Administration's Vaccines and Related Biological Products Advisory Committee is meeting now to discuss Emergency Use Authorization (EUA) of the Pfizer-BioNTech SARS-CoV-2 vaccine, which was first administered in the UK on Tuesday, and approved for use in Canada yesterday. (You can watch the committee meeting here.) If, as expected, the committee gives its approval of the vaccine, distribution of it in Phase 1a, which will be initially administered to healthcare workers and residents of long-term care facilities, will begin as early as next week.

The lead article in today's issue of The New England Journal of Medicine is the eagerly awaited peer reviewed study of the Phase 2 & 3 trials of the Pfizer-BioNTech vaccine. I subscribe to the Journal, but you should be able to read this article, free of charge:

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

"A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups."

Recipients of the vaccine and placebo received two injections, given 21 days apart.

Amongst the study's limitations are the exclusion of certain groups, namely children under 16 years of age, pregnant women, and immunocompromised persons, with the latter group being at especially high risk for severe COVID-19. A limited number of 17 and 18 year olds were enrolled in the study, and the committee is discussing whether or not to approve the vaccine for use in that age group.

The committee is also asking for an update over the past four weeks of the cases of severe COVID-19 in recipients of the vaccine and placebo (salt water injection) in the ongoing study. As the chairman rightly said, clinicians and the general public are most concerned with prevention of infections that lead to significant morbidity and mortality, far more so than mild cases that mimic routine cases of influenza or other common respiratory viral infections. Unfortunately Pfizer-BioNTech did not have an update. It is also discussing the ethical question of whether to unblind the study early, and allow participants in the trial who received the placebo to get the vaccine, which was discussed in the NEJM article.

You may have also heard that two recipients of the Pfizer-BioNTech in the UK, both National Health Service staff members with histories of severe allergies, developed anaphylaxis, or severe allergic reactions, shortly after receiving it:

Two in U.K. Suffer Allergic Reaction to Pfizer’s Covid-19 Vaccine

Some people who are skeptical about the SARS-CoV-2 vaccines have expressed the concern that the development process was rushed, and that they haven't been rigorously tested before being approved for use in the (not exactly) general population. The technologies for these new messenger RNA (mRNA) vaccines have been developed for a decade or longer, though, and it just so happens that they were utilized to develop the Pfizer-BioNTech, Moderna and other vaccines. This 2018 article from the journal Nature discusses the technology in great detail:

mRNA vaccines — a new era in vaccinology

>174 torontoc: The long term care homes - those caring for the residents and the residents will be the first vaccinated. The issue is that the vaccine should not be moved and needs to be stored in special deep freezers- there are 14 depots for the vaccine across Canada.

>175 jessibud2: Yes, this is what I was wondering about. If the vaccine can't be moved, and vulnerable seniors in long term care residences are to be the first to receive it, how will that happen? Most of those places are in lockdown and many of the seniors can't be moved. Shouldn't the medical people be going to the residences, and not vice-versa?

This is from Pfizer-BioNTech's COVID-19 Vaccine U.S. Distribution Fact Sheet:

In the U.S., our distribution approach will be to largely ship from our Kalamazoo, Michigan, site direct to the point of use (POU). We also will use our existing distribution center in Pleasant Prairie, Wisconsin.

We will be utilizing road and air modes of transportation in the United States, where we expect to be able to get product to any POU within a day or two.

We also have developed packaging and storage innovations to be fit for purpose for the range of locations where we believe vaccinations will take place. We have specially designed, temperature-controlled thermal shippers utilizing dry ice to maintain recommended storage temperature conditions of -70°C±10°C for up to 10 days unopened. The intent is to utilize Pfizer-strategic transportation partners to ship by air to major hubs within a country/region and by ground transport to dosing locations.

We will utilize GPS-enabled thermal sensors with a control tower that will track the location and temperature of each vaccine shipment across their pre-set routes, 24 hours a day, seven days a week. These GPS-enabled devices will allow Pfizer to proactively prevent unwanted deviations and act before they happen.

Once a POU receives a thermal shipper with our vaccine, they have three options for storage:
- Ultra-low-temperature freezers, which are commercially available and can extend shelf life for up to six months.
- The Pfizer thermal shippers, in which doses will arrive, that can be used as temporary storage units by refilling with dry ice every five days for up to 30 days of storage.
- Refrigeration units that are commonly available in hospitals.

The vaccine can be stored for five days at refrigerated 2-8°C conditions.

After storage for up to 30 days in the Pfizer thermal shipper, vaccination centers can transfer the vials to 2-8°C storage conditions for an additional five days, for a total of up to 35 days. Once thawed and stored under 2-8°C conditions, the vials cannot be re-frozen or stored under frozen conditions.

The various storage options at the POU allow for equitable access to the Pfizer vaccine to areas with differing infrastructure.

In short, the Pfizer thermal units can be sent to cities and regions throughout the US, and presumably Canada, where the vaccine will be administered. They can be stored in standard refrigerators at specific locations which can keep the vaccine stored from 2-8°C, or 35.6-46.4°F, for up to five days. So, as long as care facilities have refrigerators to store the vaccines, they can do so without needing specialized storage units.

>175 jessibud2: And forgive my genuine ignorance, but does it get injected into your arm in a frozen state? \

Per my comment above, the vaccine does not need to be frozen. It can be stored at standard refrigerator temperatures, but I don't know if it can be warmed above 8°C.

Because if not, why does it have to be kept as such an incredibly cold state?

This is due to the instability of the messenger RNA (mRNA) molecule. Messenger RNA comes from the much more stable DNA or regular RNA that forms the genetic material of all cells, from mammals to viruses. mRNA is then read, like an instruction manual by structures called ribosomes, which build chains of amino acids based on the information it gets from the strip of mRNA. The chain of amino acid then folds upon itself in a particular configuration to form a protein; in this case, the mRNA vaccines code for the Spike protein of SARS-CoV-2, which is inserted into the membrane of the cell that takes up the vaccine and produces this protein. The immune system recognizes the Spike protein as an invader, and produces specific antibodies and white blood cells against it, which causes both an immediate response (which is why recipients can get fever, soreness or redness at the injection site, and malaise), and, more importantly, the development of immunological memory: if vaccination is successful the immune system will quickly recognize the novel coronavirus's Spike protein when it enters the body, and once it does it will generate a robust immune response and kill the virus before it can cause a significant infection.



ETA: mRNA molecules are meant to be read in real time, and not hang around and continue to be transcribed to produce protein. The cells have enzymes which rapidly degrade them, and that's why the vaccines must be kept extremely cold, to keep these destructive enzymes from breaking down the mRNA molecules.

This article from ScienceNews discusses the mRNA vaccines in greater detail:

Here’s why COVID-19 vaccines like Pfizer’s need to be kept so cold

There will be a pop quiz on all of this tomorrow morning. Class is dismissed.

>182 kidzdoc: - Thanks for this, Darryl. I have already flunked. ;-)

>183 jessibud2: Uh oh. This class might need a better teacher...

Thanks so much Darryl!!

>185 dchaikin: You're welcome, Dan!

The meeting of the FDA's Vaccines and Related Biological Products Advisory Committee ended a few minutes ago, and 17 of the 22 committee members voted to approve the vaccine, which means that administration of it to healthcare workers and residents of long-term care facilities can now begin, hopefully as early as next week.

F.D.A. Advisory Panel Gives Green Light to Pfizer Vaccine

Thanks for breaking all that down, Darryl. Every step is a good one in this process.

One of my former physician colleagues and neighbors, who recently retired from Children's and moved with her husband to Charleston just before Thanksgiving, posted this very useful commentary from another physician on her Facebook timeline, which I thought was worth sharing widely. Apologies in advance for typos.

A clear, concise and SCIENTIFIC explanation about the COVID vaccine:

I wanted to provide some info on the Pfizer and Moderna vaccines which are soon to be available. Let me first say that I will not entertain any anti-vax comments based on conspiracies such as “they want to track you”, “there is a microchip”, “It will cause autism”, “Fauci will get rich”, “It will give you Covid”

Both the Pfizer and Moderna vaccines are mRNA vaccines. How do these work? mRNA or (messenger RNA) is simply a genetic template that once it enters a cell is capable of being read by the cellular machinery and translated into a small SARS-Cov2 protein called “spike protein”. Spike protein is a viral protein that is primarily used by the virus to gain entry into cells.

Ok let’s make this clear now, this mRNA vaccine does not make the whole virus. It only makes a small portion of a viral protein called “spike”. So there is NO (ZERO) biological possibility of getting COVID19 from this vaccine. Same goes for the influenza vaccine. In addition, while mRNA is technically genetic material (nucleus acid) it is NOT DNA. DNA and RNA are two different molecules with two different functions in the cell. Think of RNA as just a carbon copy of a piece of DNA used as a template to make proteins so that DNA can remain in the nucleus and keep doing its day job. This mRNA will NOT go into the nucleus, it will NOT change your DNA, and it will NOT integrate into your genome or alter your genetics in any way. Again, it is simply a template for making a small protein of the virus in order to introduce this foreign protein into the body to mount an immune response.

Ok let’s talk about symptomology. As I mentioned there is 0% chance of getting COVID from both the Pfizer and Moderna vaccine. But that does not mean there will not be some symptoms. As with most vaccines, the majority of symptoms will be at the injection site. Anytime there is anything “foreign” injected under the skin there will be some inflammation and soreness. That is natural and expected and will have no lasting effects. Think of it as if you stepped on a rusty nail, it is going to be sore for a while, because the body will inflame that area and fight anything foreign that was on the nail. So far, both vaccines have been through 10s of thousands of test subjects in phase 3 trials. With not one single major adverse event. This is great news for the vaccine as it appears to be quite safe and effective just like the safety profile of all other vaccines.

Ok let’s talk about the delivery. All vaccines are given with substances that either can enhance their immunogenicity (adjuvants) or can help them get gain entry into cells. In this case, being an mRNA vaccine, naked mRNA cannot readily enter cells but it does need to gain entry into the cells in your arm in order to begin making that foreign spike protein. The delivery vehicle for both of these vaccines is called a lipid nanoparticle or LNP for short. I have worked on these in my career. How do these work? Well consider LNP to be little tiny spheres that surround the mRNA. Since in order to get into a cell, a molecule needs to be hydrophobic (greasy) these LNPs are lipid based (grease) and will slip into the cell easily carrying their payload of mRNA into the cell. Once inside the cells the LNPs break open and “delivers” the mRNA payload. The LNP debris is simply broken down further by the cell and gotten rid of. Both the Pfizer and Moderna vaccines are based on this LNP delivery. “What does this mean for safety”? LNPs have been given to hundreds of thousands of subjects thus far and are used as a delivery method in other approved medicines, not just these vaccines. The ONLY thing to say about LNP safety is that LNP can exacerbate the local inflammation, so your arm may be a bit more sore than a flu vaccine. But in most cases there will be little discomfort.

Finally, I want to talk about systemic symptoms like fever, chills, etc. This COVID19 vaccine is given in two doses. We call this is a “prime/boost” strategy of immunization. During the first injection you will likely experience no “whole body” symptoms other than a sore arm. But during this first injection, your immune cells have been “primed” to respond to any further exposure to the same protein. Therefore, upon your second dose, there will be a greater immune response, as your body has developed “memory” from the first innoculation and can quickly “recognize” this same foreign protein and mount a robust immune response. This second “boost” will in fact “boost” your immunity further and is required to develop that high efficacy (greater than 90%) we have heard about from the clinical trials. But.... this second “boost” may be accompanied by the release of normal immune proteins (called cytokines) into the bloodstream. These cytokines can cause some transient fever, fatigue, and generally “feeling bad” for a day or so. This only means the vaccine is working well and will go away within a day and this “feeling bad” will not happen in every person receiving the vaccine. So while this vaccine will likely not be without “some” discomfort please remember and keep this in perspective. There is much less discomfort from this vaccine than dying on a ventilator from COVID19. So PLEASE get the vaccine. We need enough people getting the vaccine to finally once and for all kick this virus in its little virus butt.

Finally, if you do not go back for the second boost you will NOT have adequate immunity to COVID19. I repeat, you HAVE to go back for your second dose. I suspect compliance on this will be an issue but the initial “priming” will not protect you adequately from COVID19. Also, both of these vaccines appear to be highly efficacious. Which is great news. Much more effective than influenza. So far the efficacy is in the order of what we see with polio, yellow fever, and measles vaccines. Both Pfizer and Moderna are reporting greater than 90% immunity to infection and more importantly if infection did happen in the small percentage of folks outside that 90% none of those subjects had severe COVID19 that required hospitalization or resulted in mortality.

If EVERYONE, were to get this vaccine as it is rolled out this nightmare will be OVER. I implore you to please set aside any conspiracies or non-factual things you read on google or through the grapevine and rely on us scientists to give you the facts. I have absolutely zero benefit (financially or otherwise) from asking you to take this vaccine other than to keep my family and yours safe from this deadly virus in 2021.

In summation:
1. Both the Pfizer and Moderna vaccines are safe
2. Neither will give you COVID
3. Neither will “alter” your DNA
4. There will be local discomfort on the first innoculation and possible some fever and fatigue with the second. Not everyone will experience the fever on the second boost.
5. It is highly effective in stopping covid and cannot be compared to the highly mutable influenza virus that we have to chase each year with a new vaccine.

And In the meantime WEAR A MASK!

Stop making biology political. Biology does not care who you voted for.

_________________________________

Feel free to share this post.

>188 kidzdoc: thanks again. Terrific info.

>189 dchaikin: You're welcome, Dan. I misspoke on Thursday in implying that the approval of the FDA advisory panel was sufficient to start the distribution process of the Pfizer-BioNTech SARS-CoV-2 vaccine. Approval by the FDA leadership was the last step, and that came this evening. Distribution of the vaccine will now begin, and the first doses will be given next week.

As I mentioned in my thread this evening, I completed an online vaccine application form that Children's made available to the clinical staff (physicians, nurses, advanced practice providers (physician assistants and nurse practitioners), respiratory therapists, and everyone else who provides direct care to patients stricken with COVID-19) yesterday afternoon, for those who wanted to get the vaccine. Our Physician in Chief stated that vaccinations of clinical staff would likely begin next week, so I expect to receive the first dose in the next few days, as my partners and I are treating COVID-19 patients. Depending on the timetable of the administration of the second dose I may have to alter or possibly postpone my plans to visit my parents again at the end of December through early January. In the Pfizer-BioNTech trial the second jab occurred 21 days after the first one, and if I get the first vaccination next week I would be due for the second dose in the first week of January, during my planned visit to Philadelphia*. I probably shouldn't say anything about the vaccination in Facebook, to stay out of trouble, especially since our Physician in Chief is one of my Facebook friends, but I don't see any reason why I can't talk about it here, and I'll let everyone know what my experience with it is.

I would assume that the FDA Vaccines and Related Biological Products Advisory Committee will meet again next week to give its approval to the Moderna SARS-CoV-2 vaccine, and that its distribution will follow shortly after the Pfizer-BioNTech vaccine. Since both are mRNA vaccines created with similar technologies, one question I have would be "Can a person who receives one approved manufacturer's vaccine get a second dose of the other vaccine?"

My friend Jenny (lunacat) also brought up a very important concern about her husband, who has sadly been diagnosed with multiple sclerosis (MS) since I last saw them in London in 2018. The NEJM article about the Pfizer-BioNTech vaccine trial included the following statement: "Key exclusion criteria included a medical history of Covid-19, treatment with immunosuppressive therapy, or diagnosis with an immunocompromising condition." John has an autoimmune disease, which I would consider to be an immunocompromising condition, and there is a good chance that he is receiving immunosuppressive therapy. If so, that would mean that people with MS were not included in this trial, and raises the question of whether those who receive the vaccine will experience a flare up of their disease, which could be disabling, serious, or potentially fatal. We must remember that the approval for this vaccine is for emergency use, and that question, and many others, will clearly need to be addressed in the coming months.

I've been saying for at least two months that people who receive both doses of an approved SARS-CoV-2 vaccine will, or should, be allowed to travel internationally within a week or two of getting the second jab. Qantas Airways, the national carrier of Australia, recently announced this policy for international travelers, and I assume that other countries and international carriers will make similar announcements in the coming months.

*I know, I'm not following the recommendations from Dr Fauci, the CDC, and the Governor of Pennsylvania to not travel, and I absolutely would not do so if my parents, who are no longer independent, were not dependent on me to meet their needs.

>188 kidzdoc: I haven't been keeping up with this thread much lately. I haven't been keeping up with much of anything on this group other than my own thread lately, I'm afraid, other than in a very sporadic way. But having read this now I just wanted to say THANK YOU SO MUCH, Darryl, for all this good, concise explanatory material. And I am making a note of this post that you passed along from your friend, in particular, as something to quote to friends if necessary. "Biology does not care who you voted for" really ought to be the motto of 2020.

Seconding Betty here. Thank you, Darryl. Your guidance has been so welcome.

Anyone else watching clips of the trucks loaded with vaccines rolling out and clips of the first people to get the vaccine and tearing up? This isn't over, but the light at the end of the tunnel can now be seen.

>192 RidgewayGirl: Anyone else watching clips of the trucks loaded with vaccines rolling out and clips of the first people to get the vaccine and tearing up?

I was, in fact, doing precisely that last night. I swear, watching those vaccine doses get shipped out, I felt very much the same thing I feel when I think about the Apollo moon landings. Human beings frustrate me so deeply, in so many ways, especially this year. But look what we can do, when we put all our hearts and our minds and our science into something. We really can do things that seem incredible, faster than one might reasonably expect.

>191 bragan: You're very welcome, Betty. I'll continue to provide updates and links as I get more information, along with my personal experience getting the SARS-CoV-2 vaccine, which may happen as early as this week.

The first shipments of the Pfizer-BioNTech vaccine are currently underway in the United States, to nearly 150 sites today and over 400 others tomorrow. The Moderna SARS-CoV-2 vaccine will be reviewed by the FDA's Vaccines and Related Biological Products Advisory Committee on Thursday of this week (meeting link here), and similar to the process of the Pfizer-BioNTech vaccine last week, approval from the committee will likely come late that afternoon, with approval by the FDA on Friday or Saturday. Once that happens we'll have even more vaccine available, first to healthcare providers and residents of long term care facilities in Phase 1a, then to people in Phase 1b (essential workers in the Education Sector, Food & Agriculture, Utilities, Police, Firefighters, Corrections Officers, Transportation), followed by those in Phase 1c (Adults with high-risk medical conditions, and Adults 65+).

I just finished attending a CDC Clinician Outreach and Communication Activity (COCA) webinar titled What Every Clinician Should Know about COVID-19 Vaccine Safety. The CDC will be monitoring individuals who receive the vaccine and clinicians who administer it via several methods: a smartphone app called V-safe After Vaccination Health Checker, which recipients of the vaccine will be asked to download upon receipt of the vaccine. Users of the app will be asked about their symptoms on a daily basis for 7 days, then weekly after that, for 6 weeks post vaccination, followed by checks at 3, 6 and 12 months. Once the recipient receives the second vaccine dose, 3-4 weeks later, the timing for this monitoring resets, with daily checks for another 7 days, followed by weekly checks for 6 weeks and checks at 3, 6 and 12 months. Those who experience an adverse event thought to be due to the vaccine, or clinicians of these recipients, can report it to the Vaccine Adverse Event Reporting System through the Department of Health and Human Services, a system that is already in place for other childhood and adult vaccinations. Vaccine safety will also be monitored by the Vaccine Safety Datalink, a collaborative project between CDC’s Immunization Safety Office and nine health care organizations, and by the Clinical Immunization Safety Assessment (CISA) Project, which is a national network of vaccine safety experts from the CDC’s Immunization Safety Office (ISO), seven medical research centers, and other partners, which provides a comprehensive vaccine safety public health service to the nation.

The webinar also discussed what symptoms are to be expected from the vaccines and when, and which ones should prompt further evaluation. Counting the day of vaccination as day 1, recipients can expect to experience fevers, fatigue, headache, chills, myalgias (muscle aches) and arthralgias (achy joints) for the first three days after vaccination. The symptoms will be mild to moderate, and should resolve in two days. These symptoms will mainly be felt by those 18-55 years of age, and will be more likely with the second dose of the vaccine. (BTW, those who get the Pfizer-BioNTech vaccine with the first dose should not get the Moderna vaccine with the second one, and vice versa.) Signs and symptoms that are not expected include shortness of breath, rhinorrhea (runny nose), sore throat, or loss of taste or smell, and symptoms after day 5 post vaccination are not to be expected, either. These criteria apply to healthcare workers and residents of long term care facilities who receive the vaccine, but I assume that they will apply to others who are vaccinated as well.

One of my friends from the 75 Books group asked me a question about the timing of approval of the SARS-CoV-2 vaccines in children, which is probably appropriate to post here.

I read somewhere today that the current one is only okay-ed for those 16 and older - any thoughts on what they'll do for the kiddos?

I watched most of the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee meeting about the Pfizer-BioNTech SARS-CoV-2 vaccine last Thursday. The data from Phases 2 & 3 of the trial of that vaccine, which were published in an article in The New England Journal of Medicine last week (Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine), included a limited number of 16 and 17 year olds, and because of that several committee members were reluctant to approve the vaccine for people under 18, although the committee as a whole did vote to approve it. The Moderna vaccine trial did not enroll anyone under 18, as far as I know, although we'll find out when the FDA advisory committee meets this coming Thursday to discuss approval of the Moderna vaccine. So, no one under 16 years of age will get approval for either vaccine at this time, and 16 and 17 year olds will only be allowed to receive the Pfizer-BioNTech vaccine.

Although the published data from Pfizer-BioNTech only included recipients 16 years of age and older, the trial itself included patients as young as 12 years old, according to the president of the American Academy of Pediatrics and other sources. Moderna has only recently announced that it would enroll 3,000 12-17 year olds in a trial of its vaccine. No one as far as I know has done any testing in the 0-11 year age range.

So, having said all that, I think the best we can hope for is that kids 12-17 years of age will be approved to receive either vaccine by the spring or early summer, and those younger than that by late summer or early fall, probably after they return to school in August and September. This makes it that much more important that as many adults as possible receive the vaccine, to protect children from the virus as much as possible.

NPR: A COVID-19 Vaccine For Children May Still Be Many Months Away
_________________________________

I should have mentioned that both doses of the Pfizer-BioNTech vaccine spaced 3-4 weeks apart are required to achieve the 90+% efficacy that has been widely reported, and that will happen two weeks after the receipt of the second shot. I would assume the same would hold true for the Moderna vaccine, as it is also a messenger RNA (mRNA) vaccine.

>195 kidzdoc: Thank you for all the information, Darryl.

>196 dukedom_enough: You're quite welcome. The first shipments of the Pfizer-BioNTech vaccine arrived at Children's on Wednesday. The first doses were administered on Thursday, and I booked an appointment to get my first jab on Wednesday morning.

ETA: The FDA gave its approval for the Moderna vaccine last night, so shipments of it will begin this weekend. As I expected, that vaccine is only approved for recipients 18 years of age and older, so 16 and 17 year olds can only get the Pfizer-BioNTech vaccine, and no kids less than 16 yo can get it. That was a welcome announcement, as shipments of the Pfizer-BioNTech vaccine to states have been significantly less than expected, by 25-40%. This seems to be due to yet another misstep by the Trump administration, as Pfizer representatives said that it had millions of vials of the vaccine waiting to be shipped, but they had not received authorization for the federal government to do so.

January 20th cannot come soon enough...

>197 kidzdoc: - And yet, didn't I just hear that trumpty dumpty and his henchmen have already got their jabs? Since when are they anywhere near as important as front line workers or the most vulnerable patients? And why is he getting a jab at all? Isn't he *immune* from the virus he doesn't even believe exists? Grrrr

>198 jessibud2: The ogre has had the virus itself, so no jab for him. The VP got it though. Normally I could see "a" president getting a vaccine early, but there is nothing normal about this president.

>199 avaland: - True, indeed. But even if he hadn't had it (and I still have my doubts, to be honest), he has only days left of being president. I can't see how that could possibly take precedence over front line workers especially since there are such limited numbers of the actual vaccine available so far.

>198 jessibud2: And yet, didn't I just hear that trumpty dumpty and his henchmen have already got their jabs? Since when are they anywhere near as important as front line workers or the most vulnerable patients?

You heard correctly, Shelley. I actually completely agree with the decision to vaccinate President Trump, VP Pence, and at least other key members of his Cabinet (CIA Director, Attorney General, Secretaries of Health & Human Services, Defense, Homeland Security, Treasury, and arguably others). They — and especially the team that will replace them on January 20th — are far more important to this country than an individual front line health care worker like myself, and IMO it's easy to make the case that others like them, e.g. the 50 governors and mayors of large cities, can be also classified as people who are critical to this country. In the grand scheme of things their vaccinations won't have a huge impact, as that would likely represent far less than 1000 vaccine doses out of as many as 10 million doses that will be administered this month, so it's a drop in the bucket.

Needless to say I care far more about the staff of the incoming administration than those of the current one. It's highly likely, though, that there will be meetings between the two teams as part of the transition process, possibly F2F and certainly online. If there are F2F meetings then the incoming teams will be at increased risk of getting infected, and an outbreak amongst the incoming staff is the last thing we need now, especially given Joe Biden's advanced age.

And why is he getting a jab at all? Isn't he *immune* from the virus he doesn't even believe exists?

Maybe...maybe not. The vaccine is still recommended for those with documented COVID-19, for two reasons: first, the immunologic memory generated from this infection seems to be neither robust nor long lasting, as measurable antibodies to SARS-CoV-2 seem to only last for a short period of time, possibly as little as three months. I haven't seen the data, but apparently these antibodies that result from vaccination are measurably higher, and last longer, although no one yet knows exactly how long, which is why the Pfizer-BioNTech and Moderna vaccine trials will continue well into 2021. So, if Trump was first infected in late September or early January, he theoretically could get reinfected with the same strain of SARS-CoV-2 as early as 1-2 weeks from now.

Second, there have been case reports of people getting infected with COVID-19 twice, with strains of SARS-CoV-2 that were antigenically distinct from the first one (antigens are proteins that the immune system recognizes as foreign, and as threats to the body). Many viruses mutate fairly rapidly, like the influenza viruses, but unlike the varicella (chickenpox) virus — which is why we need annual influenza vaccinations but only two for varicella — and eventually one or more mutations that allow the virions (infective viral particles) to infect cells but evade detection by the memory white blood cells that are on patrol to prevent future infections from a particular pathogen (a disease causing bacterium, virus or parasite). Those successful mutants then become the prominent infective strains, which have been detected, especially in NYC and Western Europe.

So, is Trump immune from SARS-CoV-2? Possibly. Is he absolutely immune? Definitely not.

I mentioned this on Thursday to the mother of a teenager hospitalized with COVID-19 that I sent home yesterday, and to several nurses this week. I should state that my comments are not my opinions, but are recommendations or statements from the CDC, the FDA, and other official government entities.

>199 avaland: According to a story from CNN on Thursday, Trump is waiting on advice from his medical team before he gets the vaccine. He was given a monoclonal antibody cocktail when he was hospitalized with COVID-19, so I suspect that they want to check his serum antibody titers before recommending the jab. If they are still high there is no point for him to get it now. These antibodies were administered exogenously, and not produced by his own white blood cells, so they will eventually be eliminated from the body, whereas his immunologic memory will, or least should, have generated protective antibody. After he leaves office, though, he should be treated as any other citizen, and only receive the vaccine when the group he falls into is scheduled to get it.

Trump won't be getting vaccine until it's recommended by medical team

>200 jessibud2: I do believe that he, Rudy Giuliani, Chris Christie, and others had COVID-19, especially since they were very reckless in practicing recommended public health measures to keep from getting infected.

This afternoon a CDC panel recommended that frontline essential workers (teachers, firefighters, police, school support staff, day care employees, corrections personnel, public transit, grocery store and postal workers, and those in working in food production and manufacturing) and those 75 years of age and older should be next in line to receive one of the SARS-CoV-2 vaccines, after the current phase that targets front line health care workers and residents of long term care facilities. This second group consists of 51 million Americans, and it is hoped that most if not all of those who choose to do so will be fully vaccinated by the end of February.

Frontline Workers and People Over 74 Should Get Shots Next, C.D.C. Panel Says

>199 avaland:, >200 jessibud2: Well, my apologies for the misinformation. Both of us here had not heard that, although we did here about the VP.

>201 kidzdoc: I personally may think doctors like you are worth far more to the country than anybody currently in the White House, but I think I'm actually glad to know they're all getting the shots, just for the effect it might have on convincing any of Trump's devotees who might be on the fence about vaccination to follow suit.

Here in Ontario , more hospitals are getting the vaccine to give the shots to long term care workers and medical staff.
The province is also going into a 28 day lockdown as numbers of those with positive tests are going up.

>203 avaland: No problem, Lois. I hadn't heard that, either, but your comment made me wonder why Trump would not be getting the vaccination if Pence was, and do a Google search to see what I could find out. The CNN story came up immediately, and reading it made sense from a clinical standpoint.

>204 bragan: Thanks, Betty! I know that I'm respected and valued at work by my colleagues and especially by the parents of the hospitalized children I care for, but I also know that I am easily replaceable if I choose to resign, as there are many recent and past graduates who would love to take my spot, so I have no illusion about my importance to the organization I work for, or medicine in general.

I agree; the vaccination of the members of Trump's cabinet, especially if it's widely publicized, could help to overcome vaccine hesitancy amongst others, especially those Trump supporters who still think that the pandemic is a left wing hoax.

>205 torontoc: That's good and bad news, Cyrel. Fliss (flissp), one of my closest British friends, who lives in Cambridge, told me yesterday that London and SE England recently entered Tier 4 restrictions, which means that she won't be able to visit her sister and her family for Christmas in London this year.

How is the vaccine rollout going in Canada?

>206 kidzdoc: The public hasn't heard much about the vaccine rollout this week- we know which hospitals in Ontario will be the centres. We are also waiting for the approval of the Moderna vaccine-that vaccine will go to the isolated northern centres first as well as the territories in the north because it is easier to store.

>207 torontoc: Thanks, Cyrel. The rollout of the Moderna vaccine is currently underway, as nearly 6 million doses, fourfold more than last week's Pfizer-BioNTech rollout, are currently being shipped across the country, especially to rural areas, for the reason you mentioned. I don't know which vaccine I'll receive on Wednesday morning, but both seem to be equally efficacious and are based on the same technology, so it matters not to me.

Look out for the new strain 70% more contagious on its way over from England.

This has forced prime minister Johnson to impose a new Lockdown over much of London and South East England. This is a part of the country that has escaped the strictest lockdown levels over the last few months, which I have not been able to understand because it is the most populous area. Has the prime minister exaggerated the "new" strain as an excuse to impose the recent lockdown? I wonder, especially as just three days ago he was saying that everything would be open for 5 days Xmas holiday. If he has exaggerated it then the unfortunate consequence is that France has closed its borders. Ho hum

>209 baswood: I read an article in today's issue of The New York Times about this potential "British invasion", which has seemingly caused panic in the UK, led by Boris Johnson's about face on lockdowns in London and SE England, which are now under Tier 4 restrictions. I had also heard about this yesterday from three of my closest British friends, both formerly active LTers, in an online discussion we had that afternoon, as Fliss (flissp), who lives in Cambridge, said that she wouldn't be able to travel to London to visit her sister and her family. I also looked at the Twitter feeds of Dr Rupert Beale, who as I mentioned previously is the group leader of the Cell Biology of Infection Laboratory at the Francis Crick Institute in London (and the husband of my friend Rachael (FlossieT), who also participated in that lengthy and very enjoyable online discussion), and Dr Muge Cevik, a virology researcher at the University of St Andrews, to find out what they were saying and thinking.

After doing so, this story reminds me most of the video of Barack Obama on the campaign trail for Joe Biden and Kamala Harris that went viral a month or two ago. In it someone passes him a basketball in a high school gym, he takes one dribble, and casually sinks a three point shot in the right corner, to the shock and delight of those in his party. His response: "That's what I do! You don't understand!" Any upstanding virus that read any of these articles would look up and say "That's what we do! You don't understand!" Viruses mutate all the time, including the family of human coronaviruses, most of which cause routine respiratory viral infections, and certainly SARS-CoV-2, which mutated from a virus that infected bats to one that was transmissible to humans and caused severe disease in them. Scientists in Wuhan Province identified over 100 variants of SARS-CoV-2 in their initial studies of it (reference: On the origin and continuing evolution of SARS-CoV-2), and at least half a dozen COVID-19 strains have been isolated across the world.

The claim that this new strain is 70% more contagious is, for me, hard to interpret without more specific information. If you put 100 unprotected people in two separate rooms with poor circulation and add one person infected with the "old" strain into Room 1, and another one with the new strain into Room 2, will 70% more be infected in Room 2 than in Room 1? Are those who maintain a six foot distance, wear masks and practice recommended public hygiene measures 70% more likely to be infected as well? Are those previously infected with an older strain more likely to get sick again? Is COVID-19, the disease that results from SARS-CoV-2, more serious and deadly in those infected with the new strain? And, most importantly, will the two approved vaccines still work against this new strain?

More investigations are needed to answer all of these questions. The good news is that there is no reason at this point to think that those who continue to practice recommended measures will be at increased risk of falling ill, and the vaccines are very likely to be effective, at least for the time being. The Spike protein that is translated from the messenger RNA in both viruses and displayed on the surface of human cells that produce it generate dozens if not hundreds of antibodies to the protein itself that allow the immune system to recognize it and generate a response against it. Is it possible that one, a dozen or 50 antibodies won't recognize the new strain of SARS-CoV-2, which does have mutations in the Spike protein? Definitely. Will the immune response to this strain be weaker than the previously identified strains? Possibly. Is it likely that few or none of the antibodies generated by the vaccine will attack this new strain? At this point, no. As SARS-CoV-2 continues to mutate, as viruses do, it may eventually develop a mutant strain that is still infectious but sufficiently different to evade the immunity generated by the currently available vaccines. If that happens new vaccines may need to be developed. However, we're already doing that for the annual influenza vaccines, and now that Pfizer-BioNTech, Moderna and other vaccine developers have perfected (or nearly so) the technology to create them it will be relatively easy to create new vaccines, by isolating the genetic material of this RNA virus, isolating the gene that encodes the Spike protein on the RNA molecule, generating the messenger RNA for the protein, and enclosing it in the same lipid nanoparticles that make up the current vaccines, a process which should theoretically take far less time than it took to create the original vaccines.

For me the most alarming thing that resulted from that story and resultant announcement by the British Prime Minister was the photos and videos of the massive crowds of passengers in Paddington, St Pancras and other major London train stations, who were fleeing the city on overcrowded trains to escape the Tier 4 restrictions, similar to the wealthy city dwellers who fled to the countryside once the plague significantly affected their neighborhoods in medieval times. I can't think of a better way to spread the new viral strain to other English counties and European countries than that.

>210 kidzdoc: yes indeed thanks for that Darryl

If the scientists had been really clued up they could have carried out your two room tests on the packed train compartment as people fled following the government announcement. A government minister said that they were surprised when France closed its borders I would have been surprised had they not done that. This of course lends credence to the panic measures put in place by the British Government as you would have thought that they would have checked with their European neighbours before taking action. I am sure that President Macron would have been pleased to receive a telephone call as he is himself in isolation suffering from Covid. By closing the borders however Europe has given England an advance preview of what Brexit will be like on January 1st if there is no trade deal. My money is on the trade deal being signed next week. Perhaps we can thank Covid for that.

There are now plenty of voices in England being raised about putting the whole country into level tier 4 as the panic button has been pressed, but the sensible thing would be to check again the scientific information on the new variant. (which as it turns out is not so new). If I was a gambler which I am not I would be putting my money on the new restrictions not being extended.

Congratulations on your new president elect - perhaps we can thank Covid for that too.

>210 kidzdoc: - Thanks for that, Darryl. Here in Ontario, our useless premier has done just about the same thing. We have been under a pseudo lockdown for the last 3 weeks. Three weeks in which the covid numbers have gone UP, DAILY. Small businesses, who have a much better ability to control the numbers of people allowed inside, have been shuttered and closed right up. Big box stores (Costco, Walmart and the like) have remained open and have been, as expected, flooded with tons of customers. Our premier, like trumpty dumpty, cares more about $$$ than human health, despite mouthing words that pretend the opposite. Hospitals are near, at or over capacity and doctors have been begging the premier to do something, even going so far as to write letters and petitions to him. Rising numbers daily. He should have acted after ONE week of that initial *lockdown*. Instead, he blathers on about trusting people to do the right thing and stay home. Clearly, that has not worked. So, yesterday, he made a big fuss about putting the entire province in a hard lockdown, starting Thursday. It was all over the news, all day. Then, without warning, on the 6 o'clock news in the evening, we find out that now, that is being pushed back to Saturday, clearly, to allow for holiday gatherings. What kind of message is that sending?

It's situations like these that have me most worried. We seem to live in a world of no personal responsibility. I do what I can to do my part. I wear a mask, I keep my distances when I am out, I limit my contact with others as much as possible. But it just boggles my mind that so many can't seem to find it within themselves to just do what must be done. They don't seem to realize that the longer they refuse, the longer we will be in this mess, that the old adage *short term pain for long term gain* really isn't just an empty phrase.

Sometimes (well, often), humans just baffle and frustrate me.

End of rant.

>211 baswood: Far be it from me to think that I can accurately analyze and criticize the actions of the British Prime Minister, but it seems, from the view of this outsider, that he operates in continuous crisis mode, with far too little forethought and long term vision, both in terms of the Brexit negotiations and his management of this pandemic. This SARS-CoV-2 variant didn't magically appear overnight, so there was time for Boris to discuss what was happening there with European leaders, and come up with a plan that didn't panic the British people, and the British economy, as the pound sterling seems to be ripe for another sharp downfall. (I remember that £1 was equivalent to $2.05 when I first visited London in 2007. It's now worth $1.34, although that's significantly higher than it was in mid March, when £1 was only worth $1.15.)

For the sake of the country, its people, and especially my dear British friends, I hope that Johnson is able to make a trade deal with the EU. Is his government in trouble of dissolution if he isn't able to do so?

Congratulations on your new president elect - perhaps we can thank Covid for that too.

Trump had a good chance at getting re-elected if he hadn't so badly managed the pandemic. The economy was improving, the stock market was climbing, and I suspect that a majority of Americans couldn't care less about the Black Lives Matter movement or the calls for social justice and police reform in this country. As disastrous as his presidency has been, I would prefer four more years of him as POTUS if I could exchange that for the 320,000+ American lives that have been lost during this pandemic.

>212 jessibud2: I looked up to see who the premier of Ontario was: oof. That explains a lot. It's no surprise that Ford, Johnson and Trump are doing spectacularly poorly in managing the pandemic.

It's situations like these that have me most worried. We seem to live in a world of no personal responsibility.

Absolutely. The magnitude of this pandemic did not have to take place, as public health experts, science journalists and others have been predicting pandemics for at least a quarter century, as described in books such as the The Coming Plague by Laurie Garrett, and Infections and Inequalities: The Modern Plagues by Dr Paul Farmer. There are hundreds if not thousands of other viruses in mammals sold for human consumption that can potentially mutate into highly pathogenic organisms, which could cause even more deaths and societal disruptions than SARS-CoV-2 did. I'm not convinced that the governments of the world have yet learned the painful lesson of the COVID-19 pandemic, and I fear that we will experience an even worse one in my lifetime, if not later this decade, and I'm not the only person who feels this way:

In the Congo rainforest, the doctor who discovered Ebola warns of deadly viruses yet to come

>213 kidzdoc: - Yes, you are right. I have often thought of Ford as Baby trump. And, especially for us in Toronto, it's tragic that the lessons of SARS, which hit Toronto hard in 2003, were not heeded. We haven't even seem to have learned much from covid's first wave. Frankly, it terrifies me. I have often fantasied about living somewhere in a cave, far away from people. Give me my books, my cats (and decent wifi) and I'm good to go.

I am a big fan of Dr. Paul Farmer, by the way. I've read his bio and saw a wonderful documentary of him, his work and his organization, a few years ago.

>213 kidzdoc: Thanks, Darryl, for all the information. I appreciate staying up to date on the science of this disease.

I also appreciate your thoughtful words about our current POTUS, without name calling and blaming that is so often seen in the media. I feel that LT is a place where I can come to avoid those kinds of messages, although I have seen that is not always the case.

>210 kidzdoc: Well, there's a first—Barack Obama compared to the virus in a way that made me laugh and nod.

I tell ya... eating animals is not such a great idea these days. Obviously as a vegetarian (well, pescatarian—I haven't weaned myself off fish yet, and I'm not vegan either) I'm going to think that. but between barely regulated first world factory farming and pretty much completely unregulated wet markets in many other places in the world, there are a lot of pathogens mutating out there to be afraid of.

>214 jessibud2: I laughed/cried at your posts. I am in Waterloo and felt exactly the same way when Ford made his multiple announcements this week. Leaving everything open until Boxing Day sends a really bad message to people. I laughed at your cave comment because my husband has spent a lot of time on realtor.ca half-heartedly looking for out-of-the-way homes. He is really tired of selfish people. A cave with books and wifi sends like a dream these days.

I will also add my thanks to you Darryl. Your updates are much appreciated in this age of misinformation.

It's all a bit of a mess really, isn't it?

In Northern Ireland they've voted not to stop inward travel from Britain (because of the new virus variant), but it's 'essential travel only', which of course is interpreted as do as you please. Apparently the new variant could already be here. And also is perhaps not here. Again, the facts seem to be made up as they go along.

We've noticed prices creeping up in the supermarkets over the past couple of weeks, which I can only assume is down to the Brexit mess and utter chaos at the ports. We're part of the UK, but are remaining in the EU single market for goods whilst the rest of the UK leaves because we're joined on to Rep. of Ireland. No one's really thought the whole thing through, and so they're expecting utter chaos come 1st January onwards at our ports. Some major delivery firms have now suspended their services in NI until they can figure out how the heck the new customs regulations work, and other companies have said to expect delays for anything you order.

If you don't hear from me by late January there's a possibility I've resorted to eating my books following the inevitable supermarket shelf stampede due to the on/off/on/off merry-go-round of COVID restrictions and Brexit fiasco. I do usually like to exercise my right to vote, but next time around I seriously may abstain as I've lost all confidence in the total muppets that are running both our local Assembly (the NI devolved government) and the British government.

>210 kidzdoc: Hey Darryl, I heard Obama comment on that video (on Jimmy Kimmel), and he said the pass was from one of Joe Biden's granddaughters. That granddaughter and one of the Obama girls were on the same basketball team when they were in grade school, a team that Obama coached!

Thanks for all the updates on COVID and the vaccines. I hope when there's more information you will keep us in the loop about allergic reactions to the vaccines for those of us with sensitivities. I'm wondering if the vaccines coming down the pike (and not based on mRNA) that are developed in a more traditional way might trigger less reactions.

Moderna vaccine has just been approved for Canada and the first delivery is in a few days.

I received my first vaccination, with the Pfizer-BioNTech SARS-CoV-2 vaccine this morning. The jab was almost entirely painless, even when the nurse in Employee Health pushed the contents of the vaccine into my deltoid muscle. It's roughly 12 hours since I was vaccinated and I feel perfectly fine, with a trivial amount of arm pain that I wouldn't pay attention to if I wasn't looking for it. The first dose of the Shingrix (zoster, or shingles) vaccine did hurt going in, and my arm was sore for at least once week afterward.

I'll let y'all know tomorrow how I feel, and what symptoms, if any, I'm experiencing.

>221 kidzdoc: Thanks for the guinea pig reportage, Darryl. May your painless state maintain.

Congrats, Darryl! I also remember the shingles shot hurting but more than worth the pain for what the vaccine does.

We were invited to friends's house for NYE festivities, which we declined. I told the hostess, who is an ER nurse, that I was happy that she would soon be vaccinated and she replied that she was going to quit her job rather than be vaccinated as she has heard that those who do get the shot will later develop ALS and that "a ton" of the people who have gotten the shot now have Bell's Palsy and have developed new severe allergies to many things.

How frustrating that medical professionals are as susceptible to the misinformation as others. I told her I'd send her Darryl's explanation of how the vaccine works and changed the subject.

>224 RidgewayGirl:

Wait, what? Not that I had not seen some dumb nurses (bad apples exist everywhere) but this is "I failed Biology 101 three times" dumb.

>219 kac522: I hope when there's more information you will keep us in the loop about allergic reactions to the vaccines for those of us with sensitivities.

At this point over two million Americans have received the first dose of one of the mRNA vaccines, and, as of last week, there were six documented cases of anaphylaxis (severe allergic reaction), all of which occurred shortly after vaccine administration, and all were successfully treated without mortality, serious morbidity, or need for hospitalization. Those cases have received widespread coverage in the media, due to the understandably high level of interest in these vaccines. I don't have the data to back me up, but I suspect that, when all is said and done, that these vaccines may end up being the safest ones that have ever been manufactured for widespread public use. I daresay that the influenza vaccines made from chicken eggs cause far more serious allergic reactions than the ones reported for the two mRNA vaccines so far; if I locate any information I'll share it here, or in Club Read 2021.

I'm wondering if the vaccines coming down the pike (and not based on mRNA) that are developed in a more traditional way might trigger less reactions.

Great question. I need to look into this, but my understanding is that other manufacturers are working on SARS-CoV-2 vaccines that are not made from mRNA. OTOH, the apparent success and excellent safety profile of these two vaccines, if this continues, may herald a new era in vaccine technology, and it wouldn't surprise me if it is used to redesign most childhood and adult vaccines that are in current use. There will undoubtedly be more to come on this in the coming months and years.

>224 RidgewayGirl:, >225 AnnieMod: Sadly, I'm not the least bit surprised by the hostess's comments. Just because someone has a medical degree (LPN, RN, PA-C, MD or DO) doesn't mean that they are immune from falling prey to anti-vaccine propaganda and conspiracy theories. I'm not personally aware of anyone who has openly expressed similar views, but I also have absolutely no doubt that there are several nurses or physicians I work alongside who are vaccine skeptics, whether for these (not so) new mRNA vaccines alone, or vaccines in general. Similar to those who hold extremist and unpopular political views, those folks wouldn't make their opinions publicly known, to avoid criticism, ridicule or worse from their colleagues. Earlier this month there was a widely publicized story about a family practitioner in Oregon, who commented in a video taken during a "Stop the Steal" Trump rally in front of the state capital last month that he and his staff did not wear masks, asked patients to take off their masks, and did not practice recommended hygiene or distancing in the office. The video was posted to YouTube by a local Republican group, and after the Oregon Medical Board conducted an investigation this physician's state license was revoked, meaning that he could no longer practice medicine there.

Oregon doctor's license revoked over refusal to wear mask during pandemic

As Abraham Lincoln famously said, "Better to remain silent and be thought a fool than to speak and to remove all doubt."

While driving to the hospital one morning the week before last I listened to an interview on NPR Morning Edition that featured Dr Joseph Varon, the chief of the Critical Care Department at United Memorial Medical Center in Houston, who had been on the job for 272 consecutive days caring for critically ill patients with COVID-19. NPR interviewed him earlier this year, when the ICU beds in Houston area hospitals were filled with COVID-19 patients on ventilators, many of whom died. The interview ended with the following exchange with one of the Morning Edition hosts, Steve Inskeep:

INSKEEP: We've heard about health care workers, along with people in the population at large, who are skeptical about the vaccine. Do you have anybody on your staff who's pushing back?

VARON: Well, gosh. Yesterday, I had a - not a fight, but, you know, I had a friendly argument with more than 50% of my nurses in my unit telling me that they will not get the vaccine. And, you know, of course, I pushed the concept that people should get vaccinated. And I asked, why not? And, you know, at the end of the day, like I have said before, coronavirus has become a political toy, and most of the reasons why most of my people don't want to get the vaccine are politically motivated.

Houston Doctor Expects Another Coronavirus Surge After Christmas

These are critical care nurses who see patients die on a regular basis from COVID-19, and colleagues fall ill to this infection, yet they still don't want to get the vaccine?!

In contrast, at least two dozen of my physician friends posted this meme on their Facebook or Instagram pages this month:



Unfortunately, President Trump's unorthodox views and comments has led to skepticism about the extent and seriousness of this pandemic, especially in small towns and rural areas where the virus was not circulating in the spring and summer and cities like NYC, New Orleans and Houston were inundated with sick patients. Well, the chickens have come home to roost, and it's now these less populated areas where the pandemic has now taken hold, particularly in my home state of Georgia, where the hospitals in these areas aren't very good and are not well equipped to care for critically ill COVID-19 patients. People living in these areas followed Trump's lead and refused to wear masks in public or practice other recommended public hygiene measures, and, sadly, many of them are paying the price for doing so.

>224 RidgewayGirl: I suppose one shouldn't be surprised that your medical professional friend won't get the vaccine, if she's ignoring all the social-distancing pleas of experts and inviting people over to her home on New Year's Eve. Sigh.

>225 AnnieMod: Thanks for the update about allergies, Darryl. Although I haven't had anaphylaxis shock, I have had extreme hives and rash after treatment with antibiotics. The first time within a couple of weeks, the second time within one week, and the latest time within 24 hours (different antibiotic each time). And each reaction was stronger and lasted longer than the prior time (took almost 6 weeks to abate on the last round even with the help of prednisone). Unfortunately "challenge" tests don't seem to trigger any reaction, so it's a mystery. My husband is violently allergic to shellfish and my adult son has trouble breathing by just smelling peanuts. Although none of us needs to carry an Epipen, it's still a concern, and when I get the vaccine I'm going to choose to get it in a hospital setting.

>226 kidzdoc: - I bet trumpty dumpty never heard of Abraham Lincoln's famous saying.

>226 kidzdoc: You're welcome, Kathy. Given your comments I would strongly recommend that you, your husband and son get the vaccine in a setting in which intramuscular (IM) epinephrine, as is contained in an EpiPen, IM dexamethasone (Decadron), albuterol, diphenhydramine (Benadryl), and supplemental oxygen are immediately available, and I would want to see for myself that these medications are there before receiving the jab. Hopefully by the time you're ready to receive the vaccine more information is available about these anaphylactic reactions, so that you can make a more informed decision on whether to get vaccinated or not.

I was advised by the Employee Health nurse who gave me the vaccine to stay in the clinic area for 15 minutes, so that I could be administered aid if I developed an anaphylactic reaction. I declined, as I told her that I was going back to my office just down the hall where four or five of my physician partners were sitting, which is located just outside of our Emergency Department, and she readily agreed that my idea made sense.

Thank you Darryl for all the vaccination info. We are at the hospital often, and when we asked the nurse last time we were there about the vaccine, he told us that he didn’t plan to be vaccinated. We offered to come in and take his place in the vaccination line. This cancer center/hospital where we spend so much time has a hair salon, and since we are strict isolationists that’s where I went for a haircut during my husband’s last infusion. The hairdresser told me, for whatever this gossip is worth, that upwards of 50%-60% of the employees there expressed reluctance to get vaccinated in a survey the hospital took. I found this astoundingly high, even if the survey results likely included many employees who are not health professionals.

>230 arubabookwoman: - That is astounding! Why on earth would someone who works directly in the health care field with vulnerable people NOT want to be vaccinated? Maybe I'm being judgmental, but I find that a tad disrespectful to those who are ill who they are treating, as well as to those they work with. Yikes.

>230 arubabookwoman:, >231 jessibud2: My employer (Children's Healthcare of Atlanta) has not (yet) mandated that employees and staff who are in direct contact with patients receive the SARS-CoV-2 vaccine, and I'm not aware of any others who have done so. We are, however, required to have annual influenza vaccinations by mid December, and those physicians who don't are removed from the Medical Staff; I'm the Pediatrics section chief in the hospital I work in (we have three children's hospitals in our system), and I receive reports about physicians in my group (including community pediatricians) and other groups who are not in compliance with our rules and regulations, including flu vaccination. I think an argument could easily be made that adequate protection against SARS-CoV-2 is considerably more important than protection against influenza, and I'll be very interested to see which organization comes out and mandates it, if any of them do. Some individuals and groups, particularly children 0-15 years of age and possibly people who had anaphylactic reactions to the first SARS-CoV-2 vaccine, won't be able to receive the vaccine until later this year or at all, and they run the risk of acquiring the virus from a healthcare worker or other person who refuses to get vaccinated for political reasons. If that happens, and the recipient gets seriously or critically ill or dies, can that person sue the worker, clinic or healthcare organization if that employee is proven to have COVID-19 at the time of contact and refused vaccination? This may be a stretch, but it's within the realm of possibility (or this could be late night half baked postulation by me).

>232 kidzdoc: I was literally about to ask if we know if kids will be allowed to be vaccinated. I haven't heard much about that in the UK news, and if my Dad can't get vaccinated because of his non-Hodgkin's lymphoma that's going to be terrible, as the kids still won't be able to hang out at their grandparent's house. Fingers crossed something will change on that through 2021 - everything's evolving at such a rapid pace.

>233 AlisonY: Rapid indeed, Alison. By now you've probably heard that the Oxford/AstraZeneca vaccine has been approved for use in the UK. This is from my recent Facebook post:

The Medicines and Healthcare products Regulatory Authority (MHRA) has approved the Oxford/AstraZeneca SARS-CoV-2 vaccine for use in the UK, and vaccinations there will begin on 4 January. Unlike the Pfizer-BioNTech and the Moderna vaccines, which consist of messenger RNA (mRNA) molecules which encode the virus's Spike protein that are contained with lipid nanoparticles, the Oxford/AstraZeneca vaccine consists of the double stranded DNA (dsDNA) Spike protein gene, which is carried within a replication-deficient strain of a chimpanzee adenovirus. The injected virus infects human cells, releases its enclosed dsDNA molecules, which then travel to the nuclei of infected cells, where they are transcribed into mRNA molecules, translated into the Spike protein by cytoplasmic ribosomes, similar to the mRNA vaccines, and then displayed on the outer membranes of infected cells, where they are able to be recognized as foreign by the body's immune system.

The vaccination rollout in the UK will differ from that in the US. The Oxford/AstraZeneca vaccine can be stored at typical refrigeration temperatures (2-8° C), which means that they do not require special handling and can be administered by chemists (pharmacies), NHS clinics, the offices of general practitioners, and care homes, unlike the mRNA vaccines, which require special handling. The British government intends to vaccinate as many of its citizens as possible ASAP, beginning on 4 January, as one dose provides 70% protection against SARS-CoV-2, and the second jab will be administered within the subsequent 12 weeks, instead of the three weeks recommended for the second (booster) dose of the Pfizer-BioNTech and Moderna vaccines in the US.

Unfortunately the trials of this vaccine only involved adults 18-55 yo, and, similar to the mRNA vaccines approved for use in the US, it has not been approved for use in children.

The Oxford/AstraZeneca vaccine is currently in a Phase 1,2 & 3 clinical trial in the US, and likely won't be approved here for several months, at best.

The Guardian: Oxford/AstraZeneca Covid vaccine approved by UK regulator

This is a link to the article about the vaccine in 8 December 2020 issue of The Lancet, one of the leading British medical journals:

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

This article from today's issue of The New York Times elegantly shows, in graphic form, how the Oxford/AstraZeneca vaccine works:

How the Oxford/AstraZeneca Vaccine Works