The receptionist wears a medical mask covering only her mouth; her coworker dispenses entirely with this nicety–but the pulmonologist escorting the preceding patient to the front desk participates in the same charade, his N95 mask dangling uselessly under his nose.
Once we’re seated in his office, he pushes the mask up but it slips back down. I mention my fear of a third Covid infection; he tries to push it up again, but it just will not stay there. It’s too damn big for his face and the nose bridge doesn’t fit. Exasperated, he slips a medical mask over the N95, to hold it up. (I assume this extraordinary measure is performed solely on my behalf: In the fall of 2022—even as Long Island experiences the nation’s highest Covid infection rates–mask wearing is fast becoming a discarded nuisance in many dental and medical practices.)
Anyway, what brings me here?
I have it all written down and am scanning my notes.
Over the past two summers the pandemic was assumed to be on pause, but significant spikes were actually occurring. Although I had kept up with all the Pfizer shots and boosters I experienced two separate breakthrough infections.
The second time, the initial symptoms are mild, just an ankle rash and an elevated temperature. Even though I’m eminently qualified by reason of age, it’s a Saturday and my primary care practice’s on-call physician (who’s treated me before) refuses to prescribe Paxlovid without an online visit. I can’t download the app. So I turn to an urgent care clinic, where a rapid test is performed with such breakneck speed (a few swirls in each nostril) it’s hardly surprising the result is negative. But when I show them the screenshot of my positive home test, they say, “Yes, you have Covid,” and call in a prescription.
Paxlovid quickly eliminates the fever. But upon awakening the morning after completing the five-day dosage, I insert a finger into a pulse/oximeter and my blood oxygen level reading is 82—which qualifies as a medical emergency. (The normal range is 95 or above.)
Early in the pandemic, it was observed that about 7-10 days after becoming symptomatic, some Covid patients experience catastrophically low oxygen levels (hypoxemia) without a trace of breathlessness or discomfort. The condition, known as “happy hypoxemia,” is just as likely to presage severe disease as hypoxemia with respiratory symptoms.
Not fully aware of the potential danger–and fearful of emergency room ministrations–I instinctively reach for my iphone to see if there are any do-it-yourself methods to raise blood oxygen levels. There are: First, breathe deeply through the nose—and then exhale slowly through the mouth through clenched teeth—to expel all CO2 (and thus prevent incoming O2 from competing with exhalation). I stand up straight, move about, and step outside to breathe in some fresh air. These measures are helpful—my O2 level has risen to 90 as, oximeter on finger, I set forth on a short walk–but halfway down the block it slips to 88.
When I reach the on-call physician at my primary care practice—it’s still early in the morning—she only wants to know what my O2 level is “at this very moment, as we are speaking.” “It’s ninety-two.” She says to go to the ER if I feel breathless or dizzy.
My blood oxygen levels soon improve. However, a few times, upon awakening from a nap, for a moment or so the oximeter registers 88. (It’s usually 98.)
I ask the pulmonologist if he thinks the low blood oxygen levels I experienced during my Covid infection might indicate a preexisting condition. Might I have pneumonitis? (Was I routinely exposed to bird droppings? he wants to know.) Sleep apnea? A recent home test was inconclusive (a monitor strapped to the chest made sleeping on my side impossible.) . . . perhaps the cumulative damage from previous infections . . .?
He can’t answer any of my questions. He says he doesn’t know what my pre-Covid condition was. He hasn’t treated me before. There aren’t any records to compare. He mentions that Mount Sinai Hospital in NYC has been doing research on Covid and hypoxemia–and I may want to get in touch with them–but he doesn’t have any contact information.
He prescribes a chest X-ray to rule out severe lung damage from Covid–which he’s fairly certain I don’t have–and also a home nocturnal oxygen-level test (performed by a medical oxygen supplier that happens to have a plethora of consumer complaints, and a few state legal actions).
He closes with a solemn warning about consulting the Internet for medical guidance/information. So where does that leave me? I need to figure out how to time my bivalent booster shot. My PCP follows the CDC guidance: You “may” wait for three months after having Covid to get a booster. However there’s a division of opinion: Other experts advise waiting four to six months–and possibly longer. If you have residual immunity from a recent vaccine or infection, the vaccine won’t offer much additional protection.
(Following my first Covid infection, I waited only three months [per CDC guidance] to get a booster. And then in line with the guidance for seniors and immunocompromised people, I got a second Pfizer booster only four and a half months later. Three months after that I got Covid again.)
mRNA vaccines generate a strong increase in antibodies that confers excellent protection against getting Covid for three months at most. And probably very little after five months.
But mNRA vaccines (as well as infections) also produce Covid memory T-cells—which can take many months to mature but are stronger and more long-lasting than antibodies. It’s unknown how long T-cell protection—stronger in some than in others—might last. It’s possible it could remain stable and not be improved by boosters. (Vaccine funding and research have focused mainly on antibodies.) Whether or not the general public could forgo frequent boosters—which would continue to be given to the elderly or immunocompromised–may hinge upon the length of this T-cell endurance.
The annual booster now recommended by the FDA would be updated each year. Because the immune system likely reacts to infection by producing antibodies against the first strain of a virus it’s encountered (a/k/a immune imprinting) updated boosters might not offer protection against newer variants. However, they could still boost antibody levels and prevent serious illness in high-risk individuals.
However, unlike the World Health Organization and the governments of Canada and the UK, which all recommend high-risk people who received a bivalent booster over six months ago to receive another –the FDA and CDC remain at a standstill, and so far not haven’t issued any recommendation. According to a statement by an FDA spokesperson, the agency is closely monitoring “the emerging data.”
In our local area, public service ads on TV (targeting the elderly, obese, and those with diabetes and heart conditions, etc.) keep reminding us we should keep up with our vaccines and “have a plan in place.” Two little nagging questions—what is supposed to be our “plan” and how do we implement it?
Upon arriving at a CVS the week before Christmas to receive my bivalent booster, I notice no one in the entire store—except for the person who comes out to vaccinate me—is wearing a mask. Why, I ask her, aren’t any other pharmacy employees wearing masks? “Because they don’t have to.”
There seems to be a virtually universal sentiment now that masks are a useless restriction. Most have moved on from the disease that dares not speak its name. A few weeks ago when I went to a clinic to get an ultrasound, I asked the technician if she would put on a mask. “I don’t have to,” she replied.
“I’m asking if you would.”
“I’ll have to find out what my rights are.”
With government funding drying up, data collection ending, and the medical establishment focusing its energies elsewhere—the disease nevertheless continues to mutate and kill hundreds of Americans a day—mainly the old and weak. One group that continues to be proactive, the People’s CDC (peoplescdc.org), was the subject of a piece in the New Yorker late last year, written by Emma Green, who described them as a “ragtag coalition of academics, doctors, activists, and artists who believe that the government has left them to fend for themselves against Covid-19”—she sees them as a hapless assemblage in which “no one is in charge,” and “no one’s expertise is valued over anyone else’s.”
Evading the main issue of what their struggle is all about, she riles at their “activist-speak” and challenge to the official word on Covid. Grabbing a quote from somewhere, she claims the group believes “the CDC’s data and guidelines have been distorted by powerful forces with vested interests in keeping people at work and keeping anxieties about the pandemic down”—Is this an implausible notion? As for one of their typical aspirational statements, “All of us believe there’s no acceptable number of deaths,” Green takes some trouble to point out that zero Covid is unattainable. So is zero anything. Why does she object to the basic thrust of the group?
“COVID, like nearly all public health issues disproportionately harms and kills low-income, Black, indigenous, latine, elderly and disabled people. This systemic injustice is the overarching emergency.” they declare in “Weather Report,” a newsletter I receive every two weeks in my inbox:
“Biden’s White House is planning to let our current COVID-related public health emergency (PHE) declarations expire on May 11th, 2023. WE CAN’T LET THAT HAPPEN.”
“Join us in demanding our elected representatives legislate access to healthcare for all, and guarantee free access for all US residents to: COVID vaccines, tests, treatment, N95 masks, paid sick leave, well ventilated public spaces, and all other means we need to weather this ongoing crisis.” Such as expanded Medicaid & no cuts to Medicare, and food stamps for all who need them.
Well said. At a time when other avenues are shutting down, they are at least helping to keep people informed about a health problem that isn’t going away.