On a recent morning, I had a first visit/consultation with a physician from Columbia-Presbyterian in New York City. In going to the city and back to Cooperstown, Columbia presents a special challenge to me.
It is a difficult facility to maneuver through under fully normal conditions and these times aren’t normal. It would have required driving about four hours each way and maybe even an overnight stay. Both the physician and I chose to do a telemedicine visit.
Most of you already know about telemedicine.
It was starting to be used by patients who had to travel long distances to see a doctor, especially if there was a satellite clinic where the transmission could be accommodated. Now, with the advent of multiple video options, the patient can be anywhere, from home to half the world away.
At the beginning of the COVID-19 lockdowns, many large practices, including hospital-based ones, decided video and telephone appointments were better than nothing. What they found out was that many times they were equal, if not better, than an in-person visit.
Probably the one thing holding back telemedicine use was the refusal of insurers, especially Medicare and Medicaid, to pay for such visits. These visits take the same, if not occasionally more, of the physician’s or mid-level provider’s time. Reimbursement, when given, was less than the equivalent amount of time for an office visit.
With the onset of COVID, insurers were forced to accept the value of telemedicine, given the lack of options if as many people were to be seen as before the pandemic. As an emergency measure, tele-visits were being approved. They still are, even when an in-person option exists.
I and multitudes of people, from the President of the United States on down, have tried to convince people to get vaccinated when they are eligible, and to maintain basic public health precautions; wearing masks properly, washing hands and surfaces frequently, and maintaining social distance. Only about 60 percent of the adult population has followed these recommendations and a similar percent say they will get vaccinated.
If this continues, we may never get to go back to things the way they were, because enough of the population will remain vulnerable and the virus will still circulate and mutate. Once it mutates enough, it will defeat the immunity provided by most of the vaccines.
So, to the people who refuse to follow the best practices to eliminate COVID as a continued threat to normal, social, life, if you are not going to get the shot for some reason you picked up through rumor, learned on the internet or because of political position, maybe you will try to protect yourself, friends and family. If not, it is hurting you where it really matters, in the wallet.
There comes a time in the history of an epidemic when the risk of discomfort, disability and death begins to be outweighed by the risks of continued isolation and continued restrictions on normal societal behavior.
If we can stay the course on the rate of vaccinations that we’ve seen lately since the mega-sites opened, we can soon reach that point. The CDC has indicated that if all the individuals in a space have been fully vaccinated, they can congregate in small groups and without masks with very low risk of illness.
This also assumes we are beginning to reach a level of herd immunity so that the risk of a person who is infected coming into contact with a person who has no protection is decreased solely by the numbers of safe people around them.
The CDC has recently changed its guideline regarding distance that schoolchildren must stay apart. It is been reduced from 6 feet to 3 feet somewhat with the comment that the extra 3 feet doesn’t really matter much. It doesn’t mean that there’s a decreased risk of communicability, it just means that the distance between masked children may be decreased.
There is also a consideration of increased damage to the population from the isolation of individuals from normal society.
Despite the chilling toll – 3,483 COVID-19 cases and 54 deaths – Otsego County people, our neighbors, friends and family, have a lot to be proud of as we ended The Year of The Pandemic on Monday, March 15, we found in revisiting the last 52 editions of this newspaper.
Throughout, there was worry, dismay and grief in the face of the implacable and mysterious foe, but little panic. In reviewing the newspapers, there was, and is, much determination, focus and purpose among our neighbors and our community leaders.
At the county level, board Chairman David Bliss promptly issued an emergency declaration on Friday, March 15, 2020, that outlined many of the steps that have marked our lives since then. Going forward from there, the county board was tough and visionary in the face of disappearing sales- and bed-tax revenues.
The reps laid off 59 FTEs, no fun for anyone. Then – guided by county Treasurer Allen Ruffles – they assembled a plan based on historically low-interest loans and fast-tracking roadwork, which the state CHIPS program still reimburses, to ensure solvency. When President Biden’s $11 million stimulus allocation was announced in recent days, it was appreciated at 197 Main, but not essential.
On a parallel track, county Health Department rallied under Public Health Director Heidi Bond, doing the COVID testing and contact tracing that – along with masks and social distancing – have been central in controlling the disease to the extent we have.
She was already heralded as this newspaper’s 2020 Citizen of the Year, but not enough appreciation can be expressed to her team’s hard work and accomplishment.
This past weekend Bassett performed an amazing feat of vaccinating a large group of people, more than 1,100 over two days. The confirmation of vaccine availability only came though on Wednesday, March 3, leaving but two full days to prepare. Nevertheless, I visited on Sunday and it had the appearance of a military operation (which in a sense it was).
The Bassett community, from Dr. Tommy Ibrahim on down should be proud, as should the staff of the Clark Sports Center, which hosted the event.
I want to especially commend the Bassett Director of Network Pharmacy, Kelly Rudd, Pharm.D., who was in command of the clinic from planning through implementation.
She worked from the list of patients from the state, a list of patients from Bassett’s own scheduling system, and an ad hoc group of volunteers who worked to contact and track down people qualified to be vaccinated, but for whom the computer-driven scheduling system was difficult or even impossible to use.
Also, many thanks are due to the Bassett staff who took the time to make hundreds of calls to help schedule seniors 65+.
There are many reports of computer-savvy individuals signing up friends, family members, and neighbors for vaccine appointments. To see this community spirit and kindness is a great thing.
The clinic was also able to smoothly access the waiting list to make sure no dose went unused. The volunteer group – which went out and identified about 175 people who had difficulty finding appointments on their own – included church members, other faith-based organizations, philanthropic NGOs (non-government organizations) including the Community Foundation of Otsego County, and additional individuals.
Many had been working on an individual basis, but recognized the synergy of working together.
This past Sunday the Director of the CDC (Centers for Disease Control and Prevention) approved the use of the COVID-vaccine produced by Janssen/Johnson & Johnson. The day before the FDA determined that the vaccine was safe and effective for the prevention of COVID-19 and gave it an EUA (emergency use authorization).
On Monday, the state Task Force unanimously recommended its use.
The entire current inventory of 3.9 million doses is scheduled to ship this week. J&J says it plans to manufacture enough additional doses to ship 16 million by the end of March. New York State is supposed to receive somewhere between 93,000 doses and 160,000 this week depending on whether you believe the Feds or the state. In any event, this is very good news.
There have been some concerns from some people; two called me today. They are concerned that this vaccine is not as effective as those already approved. They want to know if they should get the J&J vaccine now if available, or wait to get either the Moderna or Pfizer one.
This marks the 50th column I’ve written in this series.
It’s hard to believe on many levels: How long we have been restricted or locked down, that I am still doing this weekly when we figured we would need to do this for at best a few months, that there remain new things to write about (in fact, every week brings new information), that my publisher makes me pay for my own subscription.
I am very grateful to my readers who have given me useful feedback, my publisher for giving me a forum to spread this information, and to my daughter who is a real scientific editor and has helped me with advice and, at times, review of my work.
In celebration, I’ve decided to write a column with good news for a change. (This is NOT to mean that we don’t still have to be vigilant, maintain masks and social distancing, avoid crowds, etc.)
Just that there’s finally some good news to write about.
►In a study of 600,000 people in Israel, which has vaccinated a higher proportion of its population than any other country, there has been a 94-percent drop in symptomatic COVID-19 infections. The vaccinated group was also 92-percent less likely to develop the severe form of the illness if present.
I was asked to give a talk at the Center for Continuing Adult Learning recently in Oneonta. It was supposed to be on vaccine development and distribution, but two days before I was to give it, I was asked by a participant to address treatment of active COVID-19.
Up to this point I have avoided discussing this because each physician chooses treatment for each patient based on many factors, including recommended protocols, approved medications, and most important, consideration of each patient as an individual.
Nonetheless there is some general advice from the NIH (National Institute of Health).
The NIH divides severity levels for COVID-19 into five parts with their recommendations.
►ONE: Not hospitalized, mild to moderate COVID-19.
There is insufficient evidence to recommend for or against any specific antiviral or antibody therapy.
SARS-CoV-2 neutralizing antibodies are available for outpatients who are at high risk of disease progression.
Antibodies bind to the virus, block its ability to get into a cell, and trigger a response from white blood cells to come and attack the virus.
Antibodies could be natural or manufactured. Dexamethasone is a steroid anti-inflammatory which is approved in more severe stages and should not be used here.
►TWO: Hospitalized but does not require supplemental oxygen.
Dexamethasone should not be used. There are insufficient data to recommend for or against the routine use of Remdesivir. (Remdesivir is a drug specifically to treat viral diseases). For patients at high risk for disease progression, the use of Remdesivir may be appropriate. (Yes, I too find this statement very confusing.)
►THREE: Hospitalized and requires supplemental oxygen, but does not require high-flow oxygenation, mechanical ventilation, or an ECMO (extracorporeal membrane oxygenator – sort of like a heart/lung machine used in open heart surgery).
Use one of the following three options: Remdesivir for patients who require minimal oxygenation, Dexamethasone and Remdesivir for patients who require increasing amounts of supplemental oxygenation, or Dexamethasone alone when combination therapy cannot be used or if remdesivir is not available.
►FOUR: Hospitalized and requires oxygen through a high-flow device or non-invasive ventilation. Use one of the following options; dexamethasone or dexamethasone and remdesivir.
►FIVE: Hospitalized and require mechanical ventilation or ECMO. Use dexamethasone.
There are other drugs that have been considered for use in COVID-19.
One is Invermectin. Others are monoclonal (all one type) antibodies as described above. Another drug fluvoxamine (Fluvox) is a drug used for obsessive-convulsive disorder and was hypothesized to block excessive inflammatory reactions.
Bottom line if sick is, find a physician who you trust. A good physician will listen to a patient’s concerns and questions and then when you are comfortable with them, your best shot is to follow their instructions.
On Friday, Jan. 29, Janssen/Johnson & Johnson announced its vaccine had proven effective in Phase 3 studies. This brings a third vaccine on line in the fight against COVID-19 and potentially increases the pace of vaccinations by 50 percent.
Additionally, the J&J protocol is for a single dose and the storage requirements are much less stringent than those of the two vaccines already available in the United States, Moderna and Pfizer.
On the other hand, the statistics on efficacy for the J&J vaccine are not as high as those reported for the other two. It is reported as 85 percent effective globally against severe disease and 70
percent effective against moderate to severe disease.
Many scientists consider this on balance very good news.
If we remember back to last year the goal for efficacy was 70 percent which would have made that equivalent to the flu vaccine. Only because of higher numbers with Moderna and Pfizer do 85 percent and 70 percent seem low.
Furthermore, the J&J vaccine is a one-dose regimen and requires only basic refrigeration to last for weeks, making it much easier to distribute and complete a course of vaccine (i.e., only one shot).
This should especially help in people hesitant to get a shot at all.
I had my first COVID-19 vaccination Sunday, Jan. 26. To get an appointment, I went through all the protocols and algorithms that I discussed previously in this column.
I was able to find an appointment Sunday in Plattsburgh. A day later I found an appointment for Utica on Feb. 3 and canceled the Plattsburgh appointment and then I kept looking for something closer and sooner.
Lucky for me, some close friends were also going through the various procedures and last Friday, Jan. 24, they found Kinney Drugs in Richfield Springs was scheduling appointments for the next two days; this past weekend.
They had just scheduled theirs and immediately called me and told me about it.
I went online, followed the protocols, and filled out forms. I put in a request for an appointment for Saturday, and up popped my appointment, assigned to Sunday.
I have no complaints. In fact, that system worked better than the state system inasmuch as it asked you when you wanted an appointment but, regardless, apparently gave you the next available.
If the appointment you asked for was already taken by the time your request went in, you’d still get one without having to reenter all that information.
Unfortunately, the state Department of Health’s online registration requires you to put in a great deal of information, then you pick the time from what you saw earlier in the process, and if the appointment that was in that spot had already been taken by somebody else while you were doing the application, you have to go all the way back into the beginning to try and find next available appointment.
By RICHARD STERNBERG • Special to www.AllOTSEGO.com
If you’re like me, and I only mean that in the COVID-phobic sense, you have been trying to figure out how to get vaccinated. I have been on-line an average of an hour a day for about two weeks trying to find appointments. Then I heard on the news that the New York State vaccination site at Jones Beach (Long Island) now has a three-month wait. What to do?
Two weeks ago, I wrote about the priorities that the state, i.e., Governor Cuomo set out. 1A was to be healthcare workers on the frontlines and nursing home residents, 1B was to be essential workers, 1C was to be people over 65 and high-risk individuals.
Then it changed, and changed again.
Every state has its own priority system. Doses have gone unused. People are flying to Miami just to get vaccinated (and maybe a little sun while they are there).
There is a large amount of concern about this new strain of COVID that just Monday was confirmed to have reached New York State.
At this time, I keep hearing that it is more contagious than the strain we are familiar with but not more lethal.
What we don’t know, and what we will have to find out, is whether it is as sensitive to the approved vaccines as the strain we are most familiar with.
I am personally concerned that we are losing our focus on standard epidemiologic ways of preventing spread: This is not the time to give up on distancing, masks, and avoiding groups let alone crowds.
In preparing these columns, as I have stated in the past, there is a plethora of new information available every day.
There are at least 50 articles I can choose from, not including original scientific journal articles, that number several hundred each week on all platforms. None of these individual articles can give an overall picture of what is happening and the basic science in an organized fashion.
Interestingly, a close friend, an electrical engineer, turned me onto an online course offered by the Massachusetts Institute of Technology this past semester for undergraduates and graduate students. There were 13 lectures, about 45 minutes long, on many aspects of the COVID-19 crisis by experts who are leaders in their fields. The course is available to anyone online at no charge.
While some of the lectures, and lecturers, are a bit esoteric, some were quite easy to follow. Many explain things so simply and well that the average interested person can come away with a fairly complete understanding of the important points of this pandemic and how the biology behind treating it works and is implemented.
I suggest at least taking a look at it and going over some of the lecturers. I admit several of the lecturers, while leaders in their fields, had problems speaking to a non-technical audience but most of them did a good job of educating overall.
To access the course, Google “MIT course 7.00”, then hit the first listing. Individual lectures can also be found through YouTube.
I am over 40 years from studying this material as coursework and much of what we know about viruses and immunology has changed since then but as I said above, some of the lecturers were able to distill out the essence of what they were saying so that anyone with only a high school biology background could follow it.
I particularly found interesting the first lecture, “COVID-19 and the Pandemic,” the second lecture “Corona Virus Pathology” and the fourth lecture, “Insights from the Corona Virus Pandemic” (which is given by Dr. Anthony Fauci, who is a wonderful teacher)
Number 10, “Vaccines”, is also among the easiest to understand for non-technical audiences.
It is very important that all of us try to obtain as much factual knowledge as possible.
Only in this way can we make informed decisions for ourselves and our families. Taking a course like this one I describe is as equally important as to gathering information by reading individual articles.
Unintentionally but inevitably, and catastrophically, the Russian National Figure Skating Team has carried out an experiment that lets the rest of the world see what happens when you expose super-elite athletes indiscriminately to the risk of contracting COVID-19.
While not immediately fatal, it is not pretty and suggests what the long-term consequences of contracting the disease may be for other young people.
According to the Dec. 17 edition of The Wall Street Journal, the Russian Women’s National Ice Skating team is regarded as the very best in the world and has such deep reserves of young talent that it was expected to remain the best indefinitely.
They are a very close group, literally and physically. The members of this group have pretty much disdained rules and recommendations regarding avoiding disease spread up to now.
There are social media posts of them partying without spacing or masks, posts of competition venues where very many coaches, athletes, spectators and officials are wearing their masks below their mouth or not at all, while athletes are withdrawing from the national championships because of positive tests or complications from recent positive infection.
2018 Olympic silver medalist Evgenia Medvedeva is hospitalized with serious lung damage after testing positive in November.
European Champion Alena Kostornaia missed a competition earlier in December because of a positive test has not recovered sufficiently to compete according to officials.
The National Championship was won by Anna Shcerbakova a teenager. Scherbakova herself withdrew from a late November event citing “pneumonia.” She has now won the event three times but was noted to be having trouble breathing after her programs.
Other skaters performed well below expectation. Former world champion Elizaveta Tuktamysheva who was expected to finish better came in seventh. She had announced that she had tested positive. She was reported as looking sluggish and exhausted at the Nationals.
Many who did compete had been reported as having had the virus earlier in the season. Coaches, some of who are at high risk because of age alone, have reported positive and ill.
Up until now the Russian National Federation has progressed their season as if the virus didn’t exist. Any attempts at safety protocols seem to have been ignored.
So, what do we learn from this experiment? Young people do get the disease and, when they do, they may not die from it at the same rate as the elderly but they do have medical consequences, sometimes permanently.
Why do these symptoms seem so frequent in these Russian athletes while they have not been reported with the same frequency in our general public?
Part of the answer is that these people are under a publicity magnifying glass – when they can’t perform, it is noticed. The same is evident in our professional athletes.
These are also people who have trained to perform at the extreme limits of physiologic capability, who have increased their capacities beyond normal people and therefore any slight damage to their organs whether lungs, heart, muscle, etc., are readily noticed.
The same damage is most probably occurring in the average person, but the average person does not frequently try to perform at their extreme.
While some of the Russians (and others) will never perform at elite levels again, some will have long-term damage that will affect activities of daily living. Any damage in anyone will have long-term consequences that will have heretofore unknown effects on life expectancy and long-term impairment or disability.
To those who continue to underestimate this disease, stop it. Dying is not the only bad outcome of contracting COVID-19.
I said this in April and I say it again now. Stay safe. Wear a mask. Socially distant. Stay within your pod (and if any one member doesn’t, then you all aren’t). We are getting close to getting vaccinated. Don’t screw up now.
In the NFL the lowest of the low, the New York Jets, beat the previously postseason-bound Cleveland Browns. This gave the Jets a second win and seems to knock them out of the competition for worst record and therefore first pick in the draft, according to another article on the same Journal sports page.
How could this happen?
Well, the Browns lost all their first- and most of their second-string receivers due to contact-tracing protocols for COVID-19.
The fans of the Jacksonville Jaguars, formerly the next-to-worst team in the standings, were noted to be celebrating. Now they get to draft Clemson quarterback Trevor Lawrence.
COOPERSTOWN – Following complaints that arose after last week’s snowstorm, the Cooperstown Village Board is once again debating snow removal from sidewalks in the village.
“There has often been a suggestion that the village take more responsibility for snow removal on sidewalks,” said Trustee Cindy Falk. “I think that those of us that have been involved in this discussion in the past understand that that needs to be done equitably.”
Cost is a factor, she said, and has stopped other municipalities in the past.
I wish I had the time, stamina, and column inches to write an article daily. That’s how fast the news is coming.
Since last week, Pfizer has begun distribution and vaccinations around the nation, the Moderna vaccine has been approved and it will start distribution by the time you read this, with inoculations going into arms probably by Thursday the 24th.
The 350 Tier One healthcare workers from Bassett Healthcare will have been inoculated, though they all had to travel to either Utica or Elmira to receive the network’s allotted doses, according to a Bassett spokesman. They will get the Pfizer vaccine.
According to the Governor, we can expect more doses in the weeks ahead.
All I want for Christmas is my two vaccines.
There have been some surprises with the roll out. It seems some five dose vials of the Pfizer vaccine actually contain six doses. On the other hand, the logistics have not gone quite as well as we were told to expect. I guess that’s not a surprise.
In the United States, the priority for the order of who gets the vaccine has been announced.
Tier One-A is front-line healthcare workers and nursing home residents and staff.
Tier One-B is essential workers.
Tier One-C is high risk individuals which includes those over 60 or 65 depending on their state of residence and those with other risk factors.
After that I am not sure but it seems to be everyone else lumped together. It is not clear when and if minors will get the vaccinations, since they haven’t been tested in those under 16.
There has been some controversy over the 1-B group, not so much if essential workers should get it next, but who is an essential worker.
Overall, there are probably more than 20-30 million people in this category in the United States: police, fire, EMS, teachers, other healthcare workers who interact with the general public, grocery store workers, food processing plant workers, certain other government employees, and many others.
As someone with eight risk factors and counting, I am willing to wait my turn for most of these, but unfortunately there will be some who get moved up the list but probably don’t deserve it.
For example, an attorney friend of mine in New Jersey says they are classified as essential workers.
Shakespeare would definitely not agree. Neither do I. Some yes, but all of them? Corporate attorneys who haven’t been in a courtroom in decades and only represent clients who can pay them more than $500/hour?
There are other vaccines coming out soon. Janssen/ Johnson & Johnson, AstroZenica/Oxford, and Novavax are among those in stage three testing in the USA that may be able to get FDA approval.
China and Russia have both approved their own vaccines and are inoculating people at home and overseas.
The entire United Arab Emirates’ Tour de France winning cycling team has been inoculated with the Chinese Sinopharma vaccine.
Hopefully the vaccines from outside North America and Europe will also generate honest, reproducible data. We need every dose that can be produced that works. There are seven billion people in the world and frankly most of them would benefit by being vaccinated.
In the meantime, we can decrease deaths and slow down progression of the disease with the same simple methods that I have been advocating for nine months. (Yes, it’s that long.) Wear a mask, socially distance, don’t get lackadaisical just because you know some else well.
My god-daughter and her husband both contracted it from their 11-month-old. All are well. We just lost an Otsego citizen who caught COVID from a group home worker who contracted it at a Thanksgiving dinner.
Small group, known people. But someone died because of it. We are so close, people: Stay the course (and any other cliché you can think of).
Merry Christmas and I wish everyone a New Year that at least begins to approach sanity.