I was discussing my anxiety symptoms over text with a friend earlier. She asked if I had been exposed to COVID recently since it seems to be going around again. I said I am unsure but not showing any classic COVID symptoms, such as a fever or cough. Just to be safe, I did a rapid test, and it was negative, though the test expired in 2023.
I remember hearing the CDC or other health organization say that the text kits were fine post expiration date. I am pretty sure I did not contract COVID again. That would suck even more.
It is also harder to find data online regarding new cases. A lot of the sites I used to visit are shut down. I did get this from the OC Healthcare Agency.
The coughing I posted about yesterday got worse, and this morning I felt terrible. I was still coughing and my chest hurts each time I coughed. Add to that, I had three locations on my feet that felt like a neuropathy attach was incoming. I usually staty home on Mondays anyway, but I emailed work telling them I may not reply to emails and I walso cancelled my English volunteer session.
A coworker texted me this morning saying she tested positive for COVID. I met with her one-on-one Tuesday. I think I would have tested positive by now if I go infected. I did a few more testes, including one this morning, and I am still negative. Other than Thursday mahjong and dinner, I have noe come in contact with anyione for the past several days.
Another coworkesaid I was obsessive with the tests when I show her the above photo. I have lots of test kits at home, and I do need to know if I have COVID ASAP so I can get some follow-up medication. I think I am okay and will likely go to work tomorrow.
I did not think I would write another post about COVID-19, yet here we are again. I have not heard much news about COVID after China imploded from the sudden end to their zero-COVID policy. However, it does look like there is a slight increase in cases in the US. Here is Orange County data for new cases:
New cases for all timeNew cases for last twelve months
From the top chart, the number of new cases seems flat when compared to the past spikes in cases. If you zoom in to the past twelve months, there is a rise in cases since the summer. Will that continue, flatten out, or even decrease? I heard there may be a new vaccine out in September. Is this rise due to the long wait since the last approved booster?
Additionally, it has become harder to find COVID data. I used to use occovid.com or the New York Times page. I believe occovid.com has been shut down, or at least I cannot connect to the site anymore. The previous NYT COVID page stopped updating in March 2023, and the new page needs a login.
The World Health Organization (WHO) released a statement saying that the COVID emergency is over.
The WHO Director-General concurs with the advice offered by the Committee regarding the ongoing COVID-19 pandemic. He determines that COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC).
The logic is that hospitalizations and deaths due to COVID are low enough that it is no longer an emergency but a daily fact of life. Does that mean the most virulent strains are relatively harmless? Are recent mutations not as dangerous as previous strains like delta and omicron? Locally, I do not see many people wearing masks, even in healthcare settings, and the FDA/CDC has not approved the next vaccine booster for immunocompromised people
Per the WHO, there are still active cases and deaths from COVID, but just not like the past three years. This is data for the US:
Without context, the chart is just a visual aid. However, it represents three years of everyone’s lives, 765 million cases, and seven million deaths worldwide. I am sure the numbers are higher, mainly due to China’s fake numbers and underreporting by many other countries. That means on average, one out of ten people were infected, and one out of 100 people infected died.
I went to my local medical lab for a blood draw this morning. This is the same lab that I have gone to for the past ten years. During COVID, there were strict masking rules, like all medical facilities at the time. Today, the lab check-in receptionist said that masks were optional when she saw me putting on my KN94 mask. Indeed, I only saw one other patient wearing a mask, and only one lab staff out of ten wearing a mask.
Is the pandemic truly over? There has been little news about vaccine boosters and new variants. In the past, if you Google COVID, there is an interactive case count app on the result page with data from the New York Times. That is no longer available. I had to go to the CDC website to find this:
It is hard to see but the weekly case count is negligible. Should I still be worried? It has been almost six months since my last bivariant vaccine booster. Should I get another one?
I originally scheduled an appointment with my nephrologist for January 6th. I totally forgot about this over the Christmas and New Year’s holiday and had to postpone the appointment to January 19th so I can get the blood draw for lab tests done. Even with the additional two weeks, I still procrastinated and barely got the lab draw before my new appointment time. Even though there was a two-day gap, most of my test results did not show up in time for the appointment.
Anyway, the results showed up today in the myQuest app. Here is a summary of important items:
Creatinine was high at 1.61. The normal range is up to 1.30. However, I have never been at 1.30 post-transplant, and results are usually a bit high. I also think I was a bit dehydrated on lab draw day so my doctor asked me to hydrate, and we will wait for the next set of results.
Hemoglobin is still high along with the correlated Hematocrit value. It is not any higher than prior tests so my doctor probably will not do anything different. I am unsure if these results were available during my appointment.
This test shows I have COVID antibodies. Of course, with so many different shots and getting COVID in June, this result is mostly useless. Antigens from getting COVID six months ago is likely gone by now, so these antibodies are either reaction from the bivalent vaccine booster, or the last Evusheld injection. From past vaccine experience, I have only minimal reactions, so the test results are not likely from the vaccine booster. We know the Evusheld antibodies will trigger the test result but are not really effective versus the latest BQ variants. The end results is regardless of the test results, I am likely not protected from the new COVID variants.
There was one more flagged test result for low Vitamin D. I have been taking one gel capsule daily. My doctor will likely increase that to two. These are over-the-counter stuff from Costco anyway.
==========
I forgot to mention that my Tacrolimus reading is low-ish at 5.5. I cannot remember what UCLA recommended, but five to nine sounds correct. My prior test result at UCLA was 10.5 so they reduced the prescription. We will see if my local nephrologist will raise it again.
==========
One more. I spoke with the Natera researcher at UCLA transplant center. I asked about test result feedback since I rarely hear from them, other than quarterly blood test lab draws. He told me according to their research criteria, there is no sign of organ rejection so far. 🎉
Since the notification only gives you a two-day window and no location, I have no idea where the close contact may have occurred. This system probably works better when everyone is in lockdown and not leaving their house. Since life is mostly back to pre-COVID norms, these exposure notifications are mostly useless.
In this case, the only place I visited on January 19th was my nephrologist’s office, then the drive-thru line at Raising Canes. On Friday, I did go to work so there was “close contact” with at least one hundred people? I guess I should test myself just in case I got infected with COVID again.
I saw a post on Reddit about transplant patients being told to stop taking Evusheld. I just got my shots on December 1st. I did some more research and found even worse news.
The Food and Drug Administration on Wednesday ended its emergency authorization for the only remaining Covid-19 antibody therapy cleared for use, saying variants that render it ineffective are now dominant in the United States.
The news about bebtelovimab makes official what has been anticipated for several weeks, as the Omicron sublineages BQ.1 and BQ.1.1 have been growing in prevalence. Still, it comes as a blow to both providers and patients who are at risk for more severe outcomes. The rapid evolution of the SARS-CoV-2 virus had already knocked out several other monoclonal antibodies for the treatment of Covid.
Eli Lilly, the maker of bebtelovimab, has stopped the commercial distribution of the treatment, the FDA said. Various companies are working on updated antibody therapies, but none appears close to being authorized.
The article goes on to state that Evusheld is also not effective against the new “BQ” variants: BQ.1 and XBB. BQ.1 is a subvariant of BA.5, which I got on the way back from Paris back in June. XBB is a combination of two BA.2 variants. BA.5 and BA.2 caused the recent bump in cases over the summer and is causing havoc in China now. I guess the two new mutations can evade injected antibodies.
This totally sucks for me. Due to anti-rejection medication, my response to COVID vaccines have been minimal, even though I just received my fifth shot, a bivariant booster. I also got both Evusheld and bebtelovimab this year, but evidently, they are not effective against BQ.1 and XBB. It is likely I will start working mostly from home again until there is updated medication available. 😱
==========
In hindsight, I probably should not have attended our company’s party yesterday. It felt like there were 10,000 people in attendance.
I have been slacking at work with regards to wearing a mask indoors. I still wear a KN94 mask when I go to crowded areas but have mostly been maskless at my desk. However, unlike in previous months, I have been going into the office almost every day. Now there is news that Los Angeles County may bring back an indoor mask mandate again. Let the whining begin…
In what has now become a pattern during the pandemic, coronavirus cases are rising as we enter the holiday season in L.A. County.
It is still far from clear how big a potential winter surge could be. Some officials are optimistic the wave will not be as bad as past seasons.
But officials warn that continued spikes in COVID-19 could bring a return to an indoor mask mandate.
Looking at the new case trend, the number continues to grow over time, though not very quickly. Maybe it is the coming flu season that has the public health officials worried?
The case rate in Orange County is lower. From the chart, Los Angeles County is averaging 3000+ cases daily, while Orange County is at 320. LAC has more people but only a bit over 3x OC so the infection rate is definitely much higher.
My nephrologist scheduled me for another round of Evusheld shots last week. This time there were no issues since it has been five months since I had COVID.
I received the shots at the cancer infusion center. This time it was a female nurse. I know they are all very professional, but I felt I had to pull down my pants more than the previous time. The shot locations definitely feel a bit lower down. They kept me for about 45 minutes after the shots to see if there were any adverse reactions. Other than a sore butt, everything was fine. This plus the bivalent vaccine booster from threes ago should help prevent against another COVID infection.
During my video call with UCLA Transplant Center, the doctor said that I should continue to wear a mask indoors since flu season is upon us again. I did get a flu shot in late September, and I just got the latest bivalent booster from Moderna last week. Since case count has been very low, I think I have been lulled into complacency, and have not been too rigorous in wearing a mask at work. Now, I am receiving emails from county health agencies warning that the number of new cases is increasing again.
Here is recent new case count for Los Angeles County:
Orange County:
It is hard to see any trends in the Orange County chart since the scale is messed up by last year’s Omicron spike. Here is the last 90 days from another source:
There does seem to be a slight increase, but it is hard to tell if it is just noise, or the start of another winter spike in cases. In any case, I am scheduled for another Evusheld injection in early December. Hopefully, that and the last booster shot will prevent another infection.
With the prevalence of the various Omicron variants and many people contracting COVID, there seems to be less media focus on the pandemic. Just from my anecdotal observations, mask use has gone down at work and locally in Orange County. I know I am less careful now that I have had COVID and received a bebtelovimab injection.
This is also visible from the case count history. Here is the past twelve months in Los Angeles County:
The January 2022 spike was the original Omicron variant. The long low bump is likely the BA.4/BA.5 variant finally hitting the US after spreading in Europe first. Does this mean the pandemic is almost over? There are more spikes in the worldwide case chart, but new cases have also flattened out to about 450k cases daily. For now, I am still going into the office only two days per week. If the numbers continue to drop, will work revoke my medical exemption to work from home?
I finally saw my nephrologist today after five months. I was supposed to see her every two months. The appointment was scheduled for early July, after our Europe trip. However, due to COVID, I had to cancel all my appointments and I am catching up now.
There was not much change. We went over my labs and talked about how after two and a half years, there is still a lot of confusion about COVID prevention and treatment. She has patients from many different transplant centers, and each has different guidelines on vaccinations and preventative antibodies treatments. In my case, we are going to wait a few months, check my antibodies levels, and get either the bivalent vaccine or Evusheld again.
Here are some important test results:
Creatinine
1.46 mg/dL
EGFR
57 mL/min/1.73m2
Urea Nitrogen (BUN)
34
Potassium
4.7 mmol/L
Phosphate
3.3 mg/dL
Calcium (two different tests)
10.1 mg/dL or 10.9 mg/dL
PTH
207 pg/mL
Hemoglobin
17.6 g/dL
Hematocrit
51.4%
Bold items are out of range. Most of them have been borderline high since the transplant so my nephrologist was not worried. She is holding off on having me take Sensipar for the high calcium, but she did increase my Losartan dosage from 25 mg to 50 mg to deal with the high hemoglobin. My blood pressure is a bit higher too so more Losartan will help.
Next step is to schedule an appointment with UCLA transplant center since I have not talked to them since February. They were okay with six to twelve months between appointments so no I should be okay.
My work is once again offering vaccine shots. This time, the shot given are bivalent boosters, and we can choose which company’s product we want. I contacted my nephrologist to see if I should get the booster, and the answer was a definite “yes, but wait.”
Similar to the reason given when I was rejected for Evusheld shots, I should have enough immunity from my COVID infection, and any antigens produced will be neutralized by my immune system. The recommendation is to wait 4-6 months before getting the booster post COVID infection.
I have a lab draw Friday morning, so I was going to drive in to work afterwards for the booster shot. Now I think I will wait a few more months instead.
Today, the U.S. Food and Drug Administration amended the emergency use authorizations (EUAs) of the Moderna COVID-19 Vaccine and the Pfizer-BioNTech COVID-19 Vaccine to authorize bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination. The bivalent vaccines, which we will also refer to as “updated boosters,” contain two messenger RNA (mRNA) components of SARS-CoV-2 virus, one of the original strain of SARS-CoV-2 and the other one in common between the BA.4 and BA.5 lineages of the omicron variant of SARS-CoV-2.
The Moderna COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 18 years of age and older. The Pfizer-BioNTech COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 12 years of age and older.
The monovalent COVID-19 vaccines that are authorized or approved by the FDA and have been administered to millions of people in the United States since December 2020 contain a component from the original strain of SARS-CoV-2.
So, it was not really like that. Nobody yelled at me. The nurse was actually very nice and apologetic that the hospital would not give me the shots.
This is my second time getting Evusheld. The cancer infusion center, where the antibody shots are administered, scheduled today’s appointment for me. Their logic was that since I got COVID, and received additional monoclonal antibodies at the hospital, I do not need the Evusheld shots again. I am unsure if this is just for this six-month period, or if I have immunity for a longer period.
I wasted two hours this morning driving to the infusion center, waiting to check-in, and waiting for them to reject my appointment. It also cost me $2 for parking.
During the initial COVID outbreak, I remember my iPhone kept asking me to approve Exposure Notifications. I imagine this was using the iPhone network to track close contacts and to provide a notification if one of them tested positive for COVID. This was released with iOS 13.7 in early September 2020.
So after almost two years, I finally got a notification tonight.
A couple of issues. First, the notification is for a 48-hour period. Is the by design? I am sure Apple knows the exact moment of the proximity contact; at lease give us a narrower window. Second, there is no location. For this notification, it was for Wednesday and Thursday. This means it is 99% likely that it was a work contact since I did not see anyone outside of work. If you visited a lot of places during the 48-hours, this notification would not give you any useful information other than to get tested for COVID. Finally, I assume that the notification is two days late is because the contact only tested positive today?
I guess I will wait until tomorrow morning to do another rapid test.
So after two plus weeks, I am finally over my COVID infection. The positive indicator was very faint on Thursday, and totally not there last night. I still have a slight cough and itchy throat, but I often have those symptoms for no real reason way before COVID.
The question now is what variant did I get? Based on the new cases history for France above (the curve for Italy is similar), I think it was the BA.4/BA.5 variant.You can see the massive spike in cases for the first Omicron variant (BA.1) in January, then the smaller bump for BA.2. I was feeling pretty good about our trip to Europe since we left during the low in early June, but a month later, we can see the effect of BA.4/BA.5. I read that the BA.5 variant appears to have a R0 of > 18. That is higher than measles and puts it as the most infectious virus ever.
Here is the same chart for Los Angeles County. This is my main area of concern as I decide whether to return to the office or continue to work from home. The timing of each spike is different, but the original Omicron spike is evident. Looking at the slow increase of the past few months, is it due to BA.2 or BA.4/BA.5? I had fairly mild symptoms during the past two weeks, but if I get reinfected, will I have similar symptoms or maybe something a lot worse?
It seems that after two and a half years of COVID, we know much more about the virus but there is still a lot of questions.
The day before leaving for our Europe trip, I posted about COVID cases in Italy and France. At that time, it appeared that the case count in each country was trending downwards. I did not continue checking during our trip. After testing positive for COVID upon our return from Paris, I just updated the case data.
ItalyFrance
Coincidentally, the COVID case count started to increase just as we left for our trip on June 5th. I am unsure whether I would have changed anything if I had this data available, since I am unsure where I contracted the virus. Perhaps be more careful and wear a mask on the flights back from Paris?
For LA County, the case count was stable to slightly decreasing. It does seem that the US lags European trends by a few months so maybe the count will decrease then spike up again?
This is important because my work wants everyone to return to the office. I thought I had an exemption due to taking immunosuppressive medication, but HR said I now need a doctor’s note. This is after spending over a decade as part of company management.
Today has been one of the worst health days since getting my kidney transplant. Why post-transplant? Because dialysis sucks so bad that anything is better than having to do dialysis.
I mentioned in a prior post that my sister’s family all tested positive for COVID yesterday. I initially tested negative, but the results came back positive on today’s retest.
Ugh. I then spent the entire morning calling all my doctors for instructions or to move upcoming appointments. My nephrologist recommended that I go to the ER and get a monoclonal antibodies infusion to help prevent worsening symptoms.
I drove to the ER at 11:20 am and was put in ER room #27 after an hour. I have been to St. Joseph hospital so often that it is like a second home. I then waited for another hour to see a doctor, then one more hour for the pharmacy to prepare the medication. Finally, a nurse came to insert an IV, and infuse the antibodies. The procedure took about a minute, but including the 60 post-infusion observation period, I was there for four hours. While waiting, I was on my work phone rescheduling several meetings scheduled for this afternoon.
IV
The drug they administered was called bebtelovimab, which has to be the worst named medication ever. The nurse could not pronounce it. After leaving the ER, i went home and made some more work calls, then decided to take a nap. I had turned on the AC and a fan, and I was getting some chills under the cover. At some point, I fall asleep and the AC compressor stops working. This happens occasionally at our house. I then woke up with what felt like the worst fever ever. I tried to measure my temperature with my cheap Chinese made infrared thermometer and it gives me 98.4. Since that cannot be correct, i found a under-the-tongue thermometer and it said 99.9. Ugh again. I then go downstairs and continue to nap on the sofa, finally waking up at 9:00 pm. Having noticed the AC problem, I reset the brakers and everything is fine. I also noticed my fever is gone, and my worsening cough reverted to what it ws this morning.
What happened? Did I just have the shortest fever session? Was I delirious? Did the medication kick in even though it was supposed to take 24 hours¿ Right now it is 10:00 pm and I feel ok, whereas I felt like death at 7:30 pm. Super strange.
I am back from my 16-day Europe trip. The trip went mostly well except for one “day from Hell” where we could not get a taxi or van to our Eiffel Tower tour, and we missed our Louvre tour since the tour agency changed the meeting place without notifying us. We also had to walk forty minutes back to our hotel at midnight after a night tour since all the taxis were full during that time.
The food in Italy was great, but we ate a lot of pasta and pizza. We did not eat any French food since our schedule was so packed, and most French restaurants near our hotel were expensive and had non-children-friendly menus. We did eat dinners at a Japanese and a Vietnamese restaurant; prices were like what we have here in Orange County.
We also walked a lot. Some of it was due to the many walking tours, but there was also walking in airports, train stations, and just in general since we did not have our cars. Here is the log from Apple Health app.
On WFH days, there is not much walking since I am in my house all day. Starting June 5th, you can see a significant increase in the daily number of steps. The 17,688 day was the night walking tour and having to walk from Notre Dame to the Louvre (hotel area) at night.
On the health side, I was mostly okay except for two medium intensity neuropathy attacks. We did spend $1,500 on travel insurance, but it was worth the peace of mind. My sister’s entire family tested positive for COVID this morning (day after trip), but I tested negative so far. I still need to test for a few more days, and self-quarantine due to close-contact or exposure to COVID infected persons.
==========
One other health related item. I packed the wrong medication before the trip, so I had way too much Rosuvastatin and no Metoprolol. Since i did bring Losartan, it was not a big deal to miss the medication for two weeks.
Life with chronic diseases 