How and if we can learn to live with COVID

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COVID-19 indicators are surging on Long Island, with an 85% spike in average daily new cases over the past two weeks and the seven-day positivity rate hitting nearly 10%.

The Island averaged 1,555 new cases a day over the seven days ending Monday, and 838 cases a day over the seven days ending April 25.

Some medical experts are tracing the jump largely to the decision by New York State to drop a mandate requiring masks in schools that started March 2 and a Florida federal judge's decision in late April that ended mandatory face coverings on airplanes and other forms of public transportation.

“How many times do we need to be taught the same lesson: Every time you take the masks off the numbers go up,” said Dr. David Battinelli, physician-in-chief at Northwell Health.

“It’s what we’ve been talking about forever: When you do lift all the behaviors, whether it be social distancing, masking, less of a push on the need for vaccines and boosters, you’re going to see cases go up,” he said.

The seven-day positivity average on Long Island hit 9.96% in test results from Monday. That is the highest level since Jan. 26 when the region was coming out of the initial record-breaking omicron surge.

The latest wave is being fueled by the BA. 2 12.1 subvariant of the omicron variant.

Medical experts said that is a vast undercount because many people are doing home tests whose results are not reported to the state.

“What we are seeing because of these choices is just this huge wave” of cases “at a time when the wave should be controlled,” said Sean Clouston, an associate professor of public health at Stony Brook University.

“Just a ton of cases in the schools, and it’s totally 100% preventable, because we’ve prevented it already,” he said. “It’s quite frustrating.”

With COVID-19 cases going up across the Island, so are the number of people hospitalized with the disease. Suffolk’s hospitalizations of COVID-19 patients doubled in less than two weeks, from 78 to 161 patients between April 27 and May 8.

Nassau went from 133 patients to 154. Northwell’s number nearly doubled, from 135 to 263 between March 31 and May 10.

The state stopped counting negative antigen results April 4, so it no longer uses any rapid tests to calculate its positivity rates, because counting only positive but not negative results would lead to an inflated percentage of positive tests, health department officials have said.

Battinelli said he was especially concerned about the mask mandate being dropped on public transportation after the Florida federal judge's decision, which he added, is a big factor in the jump in numbers.

“The airport thing to me is very concerning because you’re mixing literally millions and millions of people from all over the place,” he said.

Doing so in schools would be harder, according to Battinelli, because there would be a lot of resistance, but he thinks it should be an option, and students and staff should be encouraged to mask up again.

Clouston said he believes the mask mandate for schools should be reimposed.

Many of the people who are hospitalized and have COVID-19 are not severely ill because they came into the hospital for other reasons initially, Battinelli noted.

Still, Battinelli noted that the number of people hospitalized or dying is not increasing nearly as rapidly as the number of new cases.

The groups most impacted by the growing number of cases are the vulnerable: people who are not vaccinated, the elderly, or those with underlying health conditions, experts said.

Battinelli said he doesn’t expect the case numbers to drop soon, that is, unless masking is brought back.

“You’re going to see this for quite a long period of time,” he said.

A late-semester spike in coronavirus cases at Johns Hopkins University, spurred by recent social events, has some students pleading for the option to take exams online.

After many months of strict health protocols at Hopkins, the campus in Baltimore has seen more than 500 cases in the past week and, according to its online dashboard, had filled all available isolation housing.

The spike shocked some students because of the school’s international reputation in public health and its early and enduring warnings about the dangers of the pandemic.

Some students worried that a concert at the university’s Spring Fair, headlined by rapper Meek Mill and held indoors, had touched off an outbreak.

A spokeswoman for the university, Jill Rosen, wrote in an email Tuesday that the recent increase in cases among undergraduates “has been traced mainly to end-of-year social activities.” Contact tracing indicated that the concert was just one of several factors, Rosen noted, including a number of off-campus social events.

The event was planned and held at a time when transmission on campus was low, she said, and it was held in accordance with the pandemic protocols Hopkins had in place at the time. Those allowed for gatherings without mask requirements so long as attendees were fully vaccinated and boosted. Masks were encouraged, she said, and attendance capacity at the concert was limited.

On Friday, a message to students from university leaders said the event “is a reminder that even in a population with universal vaccination such as ours, the virus can still spread.” The school’s covid dashboard said 99 percent of its students and employees are fully vaccinated.

University leaders announced additional protocols through the end of the semester, such as required twice-weekly testing, and masks in libraries, study sites and events of more than 50 people. Masks have long been required in classrooms, and requirements for their use had recently been reinstated in common areas of dormitories and in campus dining spaces when people aren’t actively eating or drinking. Through the end of the semester, food and drinks for indoor events for groups of 50 or more people must be offered outside, or as grab-and-go options

An online petition to have online final exams for undergraduates this spring had garnered more than 1,300 digital signatures Tuesday. “The main reason is covid exposure and concerns about our health,” the petition’s author wrote. “So many students are quarantined or isolated right now, they will miss their original exam time(s) ….”

University leaders responded noting students’ concerns and acknowledging that the end of the semester combined with a rise in cases was stressful. “We do not plan to pivot entirely to online examinations, but we have taken several steps to ensure that students can successfully and safely conclude the academic year,” they wrote, including reminding instructors that students in university-imposed isolation must not be penalized for failing to attend a class or exam in person.

Several area colleges reinstated some pandemic rules such as mask mandates after seeing a rise in virus cases earlier this spring, including Hopkins and Georgetown University last month. Gallaudet and Howard universities switched temporarily to virtual classes.

All pandemics end eventually. But how, exactly, will we know when the COVID-19 pandemic is really “over”? It turns out the answer to that question may lie more in sociology than epidemiology.

“I believe that pandemics end partially because humans declare them at an end,” says Marion Dorsey, an associate professor of history at the University of New Hampshire, who studies past pandemics, including the devastating 1918 influenza pandemic. Of course, she notes, there is an epidemiological component, characterized by the point at which a disease still circulates but is no longer causing major peaks in severe illness or death. This is sometimes referred to as the transition from a pandemic disease to an endemic one. But for practical purposes, the question of when this transition occurs largely comes down to human behavior.

“Every time people walk into stores without masks or even just walk into stores for pleasure, they’re indicating they think the pandemic is winding down, if not over,” Dorsey says. Whether or not there is an official declaration of some kind, “I don’t think anything really has a meaning until, as a society..., we act as if it is.

Author and historian John M. Barry, who wrote one of the most definitive chronicles of the 1918 pandemic—The Great Influenza: The Story of the Deadliest Pandemic in History—has come to a similar conclusion. A pandemic ends “when people stop paying attention to it,” he says. The rest of the matter is a combination of the virus’s virulence, and the availability of vaccines and therapeutics.

The 1918 pandemic—which is estimated to have killed at least 50 million people worldwide, though accurate data are hard to come by—is often described as having three waves. The first came in the spring of 1918, followed by a notoriously deadly second wave that fall and then a third, wintertime wave in early 1919—with cases eventually subsiding by the summer of that year. But Barry says a new variant emerged in 1920 and effectively caused a fourth wave. This wave killed more people in some cities than the second one, even though there was widespread immunity to the virus by then. Although many cities and public institutions imposed restrictions during the second and third waves, virtually none did so during the fourth. By 1921, the flu death toll had returned to prepandemic levels. But moving on too soon was a mistake, Barry says.

Ultimately the 1918 pandemic pathogen (an H1N1 flu virus) evolved to become less virulent: it lost much of its ability to infect cells in the lungs, where it could cause deadly pneumonia.

The 1918 virus did cause several bad outbreaks in the years afterward, Barry says, noting that one of them—a particularly severe flu season in 1928—led to Congress to expand and reorganize the Hygienic Laboratory to create what is now the National Institutes of Health.

The city’s vaccine mandate has been put on “pause” for the NYPD so the force can avoid losing nearly 5,000 cops and employees as the weather — and crime — heats up, The Post has learned.

Currently, 91 percent of the NYPD’s uniformed cops and other personnel are vaccinated, City Hall says. That leaves an estimated 4,659 NYPD employees unvaccinated despite a deadline to get the shots by Oct. 29.

“In a nutshell, no decisions will be made, no further members will be forced to leave until further notice,” said a veteran NYPD sergeant, explaining the unwritten rule. “There hasn’t been any memo, just basically keep everything status quo and if issues arise we will revisit it down the road.”

Coronavirus cases are up more than 25 percent in the United States over the past two weeks—and those are just the ones we know about. Experts warn that the true size of the current outbreak could be 10, or even 14, times worse than the official counts suggest.

What exactly is the average person supposed to do with that information? Many people know that COVID cases—as shown in all those jagged charts and splotchy, color-coded maps that decorate front pages—are likely underreported right now. That uncertainty makes calculating one’s own risk extra tricky. If cases could be 10 times worse than what you see on a graph, how do you know if your local outbreak is bad enough that it’s worth slapping your mask back on? Or, more drastically, canceling plans altogether?

All of this uncertainty could be a bargain worth taking. Washington Secretary of Health Umair A. Shah told me that his state’s COVID team anticipated this data gap cropping up with the distribution of at-home tests, which aren’t always included in official tallies. But for Shah, giving people the tools to swab themselves outweighed concerns about losing track of the data.

The gap between reported and actual cases is “probably as much of an undercount as we’ve ever had during the pandemic,” Jason Salemi, an associate epidemiology professor at the University of South Florida College of Public Health, told me.

Salemi cited three big reasons for the size of the fissure this spring: first, the increased availability of at-home tests; second, a decline in testing overall; and third, the mix of viral conditions—or the fact that variants thought to cause less-severe disease are circulating around a country that’s already got a good amount of immunity thanks to vaccination and infection. The last combo can lead to fewer people coming down with symptoms, which may make them less likely to get tested, he said.

So should Americans just throw out case-level data entirely? Experts told me that the numbers do still have some use, even if they’re less illuminating than before: monitoring the direction of the pandemic—particularly if used in combination with other metrics that aren’t affected by testing volume or the popularity of at-home tests.

They pointed me toward several alternatives, including hospitalizations, the number of people on ventilators, the number of patients in the ICU, deaths, and wastewater data, as well as keeping tabs on what variants are circulating. “If I had a cockpit with all those gauges, I would look at all that,” Shah told me, though he stressed that he’d prefer that members of the community focus more on taking action than on data—that is, masking up and getting boosters over refreshing charts.

If you are frequently monitoring the data, maybe consider your cadence. I asked Salemi if people who are very worried about COVID should really be checking four or five pandemic metrics daily. “I think you’re doing yourself a big disservice if you’re looking at these numbers every single day, because there are reporting anomalies and things that change,” he said.

Tara Kirk Sell, of the Johns Hopkins Center for Health Security, said that she’s personally watching COVID case numbers “mostly to understand trends” and assumes they’re undercounted. “I don’t worry too much that I don’t know exactly what the level is since ‘a lot more people are getting sick right now’ is close enough for personal decision making,” she told me over email.

Elizabeth Carlton, an associate professor at the Colorado School of Public Health, suggests starting with the CDC’s community-levels map, which assigns counties colors using a combination of three metrics (one of which is cases). Green is low, yellow is medium, and red is high. If your county is in the red, then “no more data-sleuthing needed,”she wrote in an email—start wearing a mask indoors. If it’s yellow, “a simple approach is to round up.” As for green: “Personally, I have been treating green as low-risk and, in that case, rarely wear masks in public unless it’s really crowded. That said, I don’t have an immune-compromised household member and at least one person in my household already had a SARS-CoV-2 infection.”

Another option would be to forgo charts overall, and mine your social network for clues. “If you’re hearing your friends and your co-workers get sick, that means your risk is up and that means you probably need to be testing and masking,” Samuel Scarpino, the vice president of pathogen surveillance at the Rockefeller Foundation’s Pandemic Prevention Institute, told The New York Times earlier this year.

And of course, you can always put to use the very thing that’s contributing to the chaos: Just last week, the Biden administration made a third round of free at-home tests available to Americans. While they may not sharpen our collective understanding of the pandemic, they can at least provide individuals with a bit of control—something that’s been hard to come by amid two years of upheaval.

What if you had a condition where medications and vaccines have the potential to trigger long periods of debilitation? The need for COVID-19 vaccines has created quite a dilemma for these patients.

Fibromyalgia often makes 73-year-old Nancy Ries feel invisible.

"People don't believe you because it's nothing you can see or measure," she said.
"Patients with fibromyalgia and chronic fatigue syndrome represent a vulnerable patient population as it relates to vaccines," said Dr. Elizabeth Volkmann.

A UCLA rheumatologist. Dr. Volkmann says the first two shots are designed to be close together to produce an immune response. But on rare occasions, in someone with an auto-immune or immune system disorder, it can trigger a flare-up.

"We typically find that that second dose that was given three to four weeks later, is the one that really does it in terms of causing more inflammation," Volkmann said. "The boosters seem to be better tolerated because they're spaced out more."

So, knowing the vaccine could cause flare-ups in patients with fibromyalgia, CFS, Lupus, vasculitis, rheumatoid arthritis and other conditions, Dr. Volkmann offers this advice: make sure you sleep and eat well before you get a shot and schedule time to rest afterwards.

"If you do this, I think that you can, you know, easily recover from getting this vaccine and it's far better again than getting the COVID infection," Volkmann said.

Am not so sure this epidemic is over .. So I am still masking and trying to avoid compact smaller places with lots of people . And still maintaining distance. Am not so sure ,it is really a post pandemic
Situation yet. But it did crash alot of economies . Or the reactions to it did.

Let’s start with basic definitions:

AN EPIDEMIC is a disease that affects a large number of people within a community, population, or region.
A PANDEMIC is an epidemic that’s spread over multiple countries or continents.
ENDEMIC is something that belongs to a particular people or country.
AN OUTBREAK is a greater-than-anticipated increase in the number of endemic cases. It can also be a single case in a new area. If it’s not quickly controlled, an outbreak can become an epidemic.

A simple way to know the difference between an epidemic and a pandemic is to remember the “P” in pandemic, which means a pandemic has a passport. A pandemic is an epidemic that travels.

But what’s the difference between epidemic and endemic? An epidemic is actively spreading; new cases of the disease substantially exceed what is expected. More broadly, it’s used to describe any problem that’s out of control, such as “the opioid epidemic.”

Endemics, on the other hand, are a constant presence in a specific location. Malaria is endemic to parts of Africa. Ice is endemic to Antarctica.

Going one step farther, an endemic can lead to an outbreak, and an outbreak can happen anywhere.

You can see why it’s so easy to confuse these terms. They’re all related to one another and there’s a natural ebb and flow between them as treatments become available and measures for control are put in place — or as flare-ups occur and disease begins to spread.