Covid-19

Review: Lucy by the Sea

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Lucy by the Sea, Elizabeth Strout. New York: Random House, 2022.

Summary: Lucy Barton goes with her ex-husband William to a house on the coast of Maine during the COVID lockdown of 2020.

On a premonition, Lucy Barton cancelled her book tour in Europe. Then her ex-husband William, a parasitologist, shows up at her apartment and insists that she pack up and leave with him to get out of New York City to an out of the way place in Maine. It is early March of 2020 and COVID-19 has arrived in New York City. William has followed the epidemic and can foresee what is in store. He wants to get Lucy and their daughters out of the city. Reluctantly, she closes up her place and goes with him to an old house with character on the coast of Maine, found for them by an old friend, Bob Burgess.

Much of the book is Lucy’s interior monologue. We go through those early weeks that we all remember of hearing of the rapidly climbing number of infections, of friends getting sick, of worries about family, particularly Lucy’s younger daughter, who wants to stay in New York with her loser boyfriend. We re-live socially distanced and masked encounters. And we remember lives reduced to daily routines of household life, Zoom calls, walks outdoors, punctuated by the news. At points, like many of us, Lucy wonders if she is losing her mind, or at least her memory. We relive that growing recognition both of how bad things were and that this wouldn’t be solved by a few weeks of lockdown.

Sharing a house with your ex raises all kinds of memories for both of them. William had gone on to a number of affairs and failed marriages. Chastened by age and health issues, he takes stock of all the failures in his life. For both of them, as they watch one daughter in an unhealthy relationship and another unable to have children and going through a rocky period in their marriage, they relive their own failed relationship as they try to offer what help parents can and cannot do, as they re-negotiate their relationships with their adult children, and with each other. I will leave you to find out how being in lockdown together works out for them.

Bob Burgess, whose wife is the town minister, becomes Lucy’s sounding board as they take walks together. Like so many of us, Lucy has to sort out all her feelings about those who don’t wear masks, including a sister who has converted to a conservative form of Christianity, who nearly dies but doesn’t. for all those who support the current president, for those who refuse the vaccine including a woman who she works with at a food pantry.

What is striking is that we see both her interior reactions and a posture of listening, of just trying to understand and not change. Coming to terms with some of the wounds of her own past, she finds herself in a place of gentleness with others, something I wish I could have achieved at times during this period.

Strout portrays people who grew during the isolation of lockdown. They examined their own and other’s flawed and broken and yet unique lives, and the efforts to love as best as they could. They nurtured relationships even as it appeared the country was trying to tear itself apart.

This is not a book to read if you don’t want to relive those years. But I found that the reading reminded me of my own journey of trying to make sense of our radically changed lives and country. And I got to do this with this delightful woman, Lucy Barton. I wonder to what degree she is an alter ego of Elizabeth Strout. What I do know is that I’ve loved her Olive Kitteridge books and this as well (Olive makes a kind of cameo appearance!). And there was the delightful discovery, in writing this review, that there are several previous Lucy Barton books. You can bet that I will be on the lookout for them!

Review: How To Make A Vaccine

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How To Make A Vaccine, John Rhodes. Chicago: University of Chicago Press, 2021.

Summary: A concise handbook discussing the science behind vaccine development, including an explanation of the different types of vaccines, including the various COVID-19 vaccine candidates.

There have been endless polemics for and against vaccines, especially in the years of COVID-19. This book is not one of those. Rather, it represents what I believe is good public science–explaining in terms that a thoughtful layperson may grasp the science behind vaccine development, particularly as it bears on the COVID-19 vaccines. John Rhodes is a research scientist from the UK who has held positions at both Cambridge and the NIH as well as working as director of strategy in immunology at GlaxoSmithKline from 2001 to 2007. Writing from outside the U.S. context he takes the reader step by step through the science while not drawing policy or personal conclusions for us, giving us space to step back from the debates and become learners.

He begins by discussing the pathogens vaccines fight, in this case, the coronavirus that causes COVID. In particular, he focuses on the target, ACE2 proteins to which the spikes on the virus affix themselves, and how this target of attack affects the body. Then he discusses the array of cells that make up our immune system including surveillance cells and different kind of B- and T-cells and how they interact both with pathogens and each other, and how the body manufactures cells with the specificity to kill each pathogen. We learn about the thymus, an organ that disappears in adults and its critical role in ramping up our immune system. And Rhodes discusses the crucial role of adjuvants in the vaccine material, chemical or microbial agents delivered with whatever form of vaccine material that helps the body identify it as foreign and intensifies the immune response, enhancing vaccine effectiveness.

Rhodes then turns to vaccines proper, and their discovery through the immunity relatively harmless cowpox confers on those exposed to smallpox. The name vaccine even arises from this, as vacca is the Latin for cow. The basic trick of every vaccine since is triggering the body to produce antibodies against an infection without introducing that infection. Two main ways (until recently) this was done was to either use dead virus or live attenuated virus, as was the case with the polio vaccines that turned summer from “polio season to just “summer.” Eventually additional approaches including viral vectors and various approaches using DNA and RNA material have been developed

Next, Rhodes walks us through the development process and the stages in that process:

  1. Exploratory: Studying the virus to determine what components to include to provoke a strong response to the virus without adverse reactions.
  2. Preclinical: Conducting tissue and animal studies to study effectiveness with different dosages and adjuvants.
  3. Phase I trials: These are human trials with small numbers to study the safety of the vaccine but also whether they provoke an effective response.
  4. Phase II trials: These are with larger groups continuing to study safety as well as dosage and adjuvant effects in producing an effective response.
  5. Phase III trials: These involve tens of thousands of subjects, continuing to look for even rare adverse reactions. Often these are done in regions with high infections to better establish the real-world effectiveness of the vaccine.
  6. Regulatory review and approval. Producers submit an application to certification agencies in each country, such a the FDA in the US. Even after certification, ongoing reporting occurs through the Vaccine Adverse Event Reporting System.

He also discusses long term vaccine research, such as that on DNA and RNA vaccines that have been going on for twenty years, leading to their stunning effectiveness.

There were an unprecedented number of contenders for COVID-19 vaccines, representing the various types of vaccines already discussed: inactivated whole-virus vaccines, protein subunit vaccines (also non-living), live attenuated viruses, non-replicating viral vector vaccines, replicating viral vector vaccines, virus-like particle vaccines, and DNA and RNA vaccines. He describes how each works, the ways they interact with the immune system and where they were being developed. He also takes a chapter to warn us against magic bullets and the importance of therapeutics. The history of COVID since this book was written amply illustrates this point–with new variants that reduce (though not eliminate) vaccine effectiveness on one hand and a growing array of therapeutics.

While there has been much controversy surrounding vaccines, Rhodes focuses on the amazing story of how quickly a myriad of vaccine candidates entered trials and how vaccine campaigns began in many countries within a year of the discovery of the virus. It represented advances not only in the science of vaccine development but also unprecedented collaboration of scientists around the world and the clearing of administrative hurdles without compromising safety protocols.

There will always be the threat of dangerous pathogens and it is right to not count on “magic bullets.” But there is much to rejoice in as one learns about the immune system and the science of vaccines. Very few people die of the horror of tetanus or polio. Small pox only exists in freezers. New vaccines hold the promise of protection against malaria, a perennial killer in tropical climates. The research and collaborative steps taken in developing vaccines in record time that seriously reduced the threat of a pathogen novel to the human species seems to me worthy of celebration rather than opprobrium.

I found myself alternating between wonder and hope as I learned more about the science of vaccines. Perhaps it is time, in the aftermath of the pandemic and when the arguments and polemics have quieted, to learn about our amazing bodies, about the dangers novel pathogens pose, and the progress human ingenuity has made to give us the tools to fend off those dangers. This book is a good place to start.

Review: Love in the Time of Coronavirus

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Love in the Time of Coronavirus, Angela Alaimo O’Donnell. Brewster, MA: Paraclete Press, 2021.

Summary: A collection of poems written over the first year of the pandemic exploring the pilgrimage of those confined to their homes, exploring the ways we come to terms with endless days, the small gifts of love, and moment of hope amid the horror.

We all remember those days of 2020 when we discovered how an invisible virus changed our world–all the precautions, the lockdowns, the empty streets, and rising infections. Angela Alaimo O’Donnell lives in New York, which became the epicenter of horror last spring, with morgue trucks outside of hospital. Like most, the scope of her and her husband’s life narrowed down to the confines of an apartment. With the lockdown, she began a pilgrimage in words to chronicle her experience.

She takes us through the seasons of the first year of the pandemic: lockdown and rising cases, illness, recovery and relapse, staring at an unworn wardrobe, and finding herself oddly touched by the thank you’s of students on Zoom. The growing realization that this is not going away quickly, the relief of a contemporary lull, injuring oneself exercising in one’s apartment, Advent and the advent of a new wave of cases, standing in line for vaccines and the tentative steps of emerging into the world. We trace the church year from Easter to Advent, unchanging hope of resurrection and Christ’s coming in a changed and dying world.

The poems, nearly sixty, are written more or less in the form of sonnets. The songs capture both the small things of daily life and the horror of mass graves on Hart Island. The changing of the seasons reminds us of the resurgence of life as does the resurgence of wildlife in a world temporarily devoid of people. There is love. The lost love of the aged who have died too soon. There is the love for children one cannot visit, for students on a screen, for the small kindnesses of delivery. All this is dwarfed by the love in the ICU: “The old man who gave up his/breathing machine to the young man beside/him. The nurse who grieved him as he died./The EMT who knelt beside the body/long after the heart had ceased to beat.”

This collection captures the deep passion we have to live, to love, and to hope in the face of the most daunting challenge we have collectively faced in our lifetimes. We grieve, we tremble, we sicken, and hopefully recover. Then we enjoy the beauties we see in a simple walk. As the author concludes, “The virus can’t destroy/this urge to bless our life & praise/even these pandemic days.”

What is striking though is that this collection reflects a particular posture, a particular response to the pandemic. One that allows the pandemic to deepen and transform, a metamorphosis of sorts. Instead of clamoring and contending, there is a kind of quiet acceptance that the pandemic is what it is, but the things that truly make life worth living, goodness, truth, beauty, and faith, hope, and love only shine more brightly when the distracting noise of our pre-pandemic normal is silenced.

If we look back over the last year, and have second thoughts about our own responses, a new variant and another wave offer fresh chances to lean into the lessons of the pandemic. Someday our grandchildren will ask us about this time. Will we change the subject or share a glimpse of the depths we cultivated in these years? These poems give words to what all of us have experienced. We still have time, it appears, to be formed for better, or for worse. These poems invite us into the better. Will we follow?

____________________________

Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher in exchange for an honest review. The opinions I have expressed are my own.

Pandemic as Dress Rehearsal

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OK. I’m just going to put it out there. I am convinced that the pandemic is a dress rehearsal for a more serious challenge that makes infection control, treatment, and a global vaccination campaign look like child’s play. The challenge is our rapidly warming planet and the ways it will change and imperil life on our planet, the only one we have.

An article from 2013 states that the last time CO2 levels on earth were as high (then 400 ppm, recently as high as 420) was before we humans were around. The oceans were 100 feet higher, the arctic was a tropical paradise. Since 1800, planetary temperatures have risen 2 degrees Fahrenheit, on average, and far more in some locations. The evidence of a changing climate is evident in rising sea levels, melting glaciers all over the planet, more extreme storms in some areas, drier, prolonged drought and fire seasons in others. The growing season where I live is at least two weeks longer than when I moved here 30 years ago. In some places, summer temperatures have hit 120 degrees Fahrenheit, levels that challenge human habitability. Coastal cities globally face inundation.

At this point CO2 outputs continue to rise as the rest of the world catches up to the US in outputs, and likely global temperatures will follow. If the permafrost melts, large amounts of methane, a more potent greenhouse gas, will be emitted, further accelerating global warming. Now some forms of life survived while others died during this previous time of high CO2 levels. One thing that is clear is that some people will die from heat or famine or flooding. Many others will be displaced and what will happen when they (or we) try to share the remaining habitable places. We haven’t even begun to reckon with other creatures on the earth. Even if we make the requisite effort to reduce CO2 output to “net zero” by 2050 or earlier some of this will happen. If it is not evident yet to everyone, I believe we are facing an existential threat.

It is one that:

  • Threatens our very existence.
  • That will wreak significant global devastation even if we take the necessary actions, which may mitigate but not eliminate the consequences of what we have already done contributing to global climate change.
  • Will require significant changes in the way we live.
  • Will require concerted efforts to address the primary causes of CO2 emissions–cows, coal, and petrochemicals.
  • Calls for a shared ethic of pursuing the common good.
  • Cannot be accomplished without global cooperation and coordination.

Do you recognize the parallels with our global responses and sometimes lack of responses to the coronavirus? I think the verdict is mixed. We did mount a global scientific effort to study the virus, sequence its genome, and develop highly effective vaccines in record time. Efforts to mitigate the virus’s impact worked to a certain extent, more in some countries than others. In the US where personal freedom is more highly valued than acting for the common good, these efforts have faced a tug of war between public health and personal freedom that has led to an acceptance of infection rates, hospitalizations, and deaths that have outpaced the rest of the world. At this point, there are great inequities of vaccination rates reflecting distribution of vaccines in various parts of the world. Meanwhile the virus continues to mutate becoming more effective in spreading itself, especially in parts of the world where it can continue to spread unchecked, which imperils us all.

The thing is, we have seen human beings at their best and worst through all of this–selflessly caring for the very sick in ICUs and hoarding toilet paper. We’ve seen the capacities of researchers to study something that was novel and learn immense amounts about how it infects and spreads and effects the body and where it can be attacked in the space of a year. Medical personnel have made major advances in treatment. And we’ve seen it turned into a political football, where nearly every insight into prevention, treatment, and the safety and efficacy of vaccines has been contested.

It makes me wonder how we will respond to the coming climate challenge. Now some of you don’t buy that this is really an issue. I do. Truthfully, I’d rather you were right. I respect you if you think differently. But I would hope you might think about the “what if?” Because if “what if” turns out to be true, this will be one of those situations where we either choose to “hang together or hang separately.” We can choose to listen to our better angels and work for the global good. Or we can choose a “survival of the fittest” (and the richest) ethic in a hotter and less hospitable world. Ultimately, what happens to the earth is beyond me. But what kind of person I will be as we face these challenges is not. At this juncture of the pandemic, it seems time for me to consider how I’ve played my own part in this “dress rehearsal” for the greater challenge before us.

My Thoughts on Receiving the Vaccine

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This picture was taken moments after receiving the second dose of the Pfizer vaccine on March 9. We were sitting in the parking lot outside the Celeste Center at the Ohio state fairgrounds for our fifteen minute wait after receiving our shots from the efficient volunteers working with the Columbus Health Department. As I reflect on all this, I find myself filled with a profound sense of gratitude to God in so many ways:

  • For those volunteers–EMTs, nurses, and other health professionals serving on their day off.
  • For our local public health officials, who organized this vaccine site and have provided invaluable health advice throughout the pandemic.
  • For genetic sequencing technology that made it possible for scientists around the world to have the complete genome of the COVID virus, the operating instructions that make the virus work.
  • For the researchers who invested years in their academic training and long hours in vaccine research.
  • For new vaccine technologies, including the mRNA technology that helped reduce the time to initially make the vaccine and is tailored to activate my body’s immune response to the spike proteins on the virus that enable the virus to infect us. From what I hear, it is also easily tweaked, as the virus mutates.
  • For the regulatory agencies like the FDA that ensured that the vaccine is safe and effective through the standard process of testing the vaccine.
  • It is amazing that it is over 90 percent effective. Flu vaccines are typically 40-60 percent effective. The hopes with COVID was a vaccine that was 50 percent effective.
  • For both the Trump and Biden administrations who facilitated the development, production, and distribution of the vaccines (although companies did not receive payments from the government until vaccines were delivered). Despite the highly partisan nature of our politics at present, both parties and administration contributed to this amazing effort.
  • For our state’s governor who has wrestled with the hard decisions balancing lives and livelihoods throughout the pandemic, and opening vaccination to all adults a month ahead of the president’s target. We can argue ways it might have been done better or differently, but I’m thankful for not having to make those decisions and our governor’s willingness to make hard and sometimes unpopular decisions. That is good servant leadership.
  • I’m grateful that we are already seeing lower case numbers, lower hospitalizations, and lower death numbers, especially among our elderly population (and I hope we all team up to keep it that way).
  • I’m grateful for the possibility in the next week of being able to share a meal in person with vaccinated friends in safety.
  • I’m grateful that because of the vaccine that even if I should be infected, it is far less likely that I can infect others. Throughout this, my concern is less that I’ll be infected than that I could infect and be the source of serious illness in someone I love.
  • Perhaps above all, I find myself in wonder afresh that the vaccine and the research that produced it is an expression of what it means to be created in the image of God and given dominion under God for his creation. It means the capacity to create vaccines that subdue viruses. I see vaccines like the one in my arm as yet another way in which we were made to glorify God and love our neighbors.

Finally, as I mentioned, I’m glad for a chance to do something tangible to love my neighbor. I see vaccines (like masks) as not so much about protecting me as protecting others. Because of the requirements of social distancing and our age, we’ve not been able to do things with people. We’ve found other ways to care, but it is nice to do something physical and not virtual that makes a difference.

Side effects? They’ve been minimal for both of us. I had a sore arm for a day or so after–like most vaccines, and was a bit tired the night of the second shot. My wife had a bit more–tiredness for a couple days and a rash near the injection site that disappeared within three days–all within the range of normal.

As I’ve noted previously, I’m not into vaccine arguments. I studied the information and made my personal decision a long time ago. Now I’ve acted on that decision. I’m won’t argue with you about yours. But I will give thanks that I could make the decision I did.

Will I Accept Vaccination?

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As I sit down to write, word came that the FDA had authorized the Pfizer COVID-19 vaccine. This followed authorization of the vaccine in the U.K. this past week. There is a great deal of controversy about the vaccines, some from those who oppose all vaccines, and others with concerns about the vaccines for COVID.

I do not want to argue about this. I don’t have the time, and your argument really isn’t with me but the scientific experts and public health people who know more about this stuff than either of us. I simply am going to share my own thinking and decision. In short, when my turn comes, which likely won’t be for several months yet, I will accept vaccination.

Here’s how I think about it. While there is a very small risk of side effects with any vaccine, the risk of death at my age with COVID is significantly greater. I have not been infected and so am susceptible. I am not afraid of death as a Christian who believes that when death comes I will rest in peace with the Lord and rise in glory at the resurrection. But I treasure the gift of embodied life and here, as in other matters of self-care, I choose to care for the body with which I have been entrusted.

I have been vaccinated throughout my life without ill effect. I was born about the time the first polio vaccine was approved. I have friends a few years older suffering the lifelong effects of polio. I’ve not had concerns about tetanus (a gruesome way to die) or diptheria or pertussis because of vaccines. I had measles, mumps, rubella as a child. I’m glad my son didn’t. I harbor the chicken pox virus in my body because that vaccine wasn’t around when I was a child. I’ve had the shingles vaccine to prevent the adult version of this childhood disease. I’ve had yearly flu vaccines and pneumonia vaccines. I think I’ve had the flu only twice in my adult life. I do realize some people have allergies that may rule out vaccines and they should discuss this with their health care provider.

Beyond my own health is the wider health of our society. That society begins with my wife who has the same risk factors and is a cancer survivor. Vaccines work by interrupting the chain of infection. COVID must find an organic host or die. I think we have had enough COVID. Enough (and more than enough) have gotten very sick or died including dear friends. I don’t want to be the cause of sickness and death in another. I want COVID to run out of hosts and die, or at least be severely suppressed. That can only happen if most of us get the vaccine. I suspect we always will need to be watchful, but vaccines, when used widely, have eradicated some diseases. I’m glad to do my part. We don’t need more years like 2020 with its losses of lives and livelihoods and all the other impacts on our society.

I’ve read all the claims about dangers or conspiracies (so don’t post them or send them to me). I’m not convinced. What does convince me is the process. I have friends who have been in trials, and all spoke about the informed consent, the monitoring, and deliberate care. Some of these friends are scientists who recognize when corners are being cut. None were. No, the vaccine doesn’t change my genetic code. No Bill Gates is not inserting microchips in all of us. The animus against Bill Gates puzzles me when he and Melinda Gates have done so much with their money to save lives, with nothing to personally gain except the satisfaction of doing it. Yes, he was pretty cut-throat in building Microsoft. But maybe his life suggests the hope of redemption. Personally, I don’t have any time for the Gates-bashing crowd–I’m just challenged by his example of generosity which makes me ask myself how generously and generatively I live. But I digress.

I hope vaccination will not be a political football in the U.S. The current occupant of the White House lent his endorsement to the effort to develop the vaccine in record time. The presumptive president-elect has signaled a target of 100 million vaccinated in 100 days. Former presidents of both parties have said they will be vaccinated on screen. I don’t see being vaccinated as a litmus test of political loyalty any more than any other vaccine I’ve ever received.

I’m most glad that our front line health care people have first access to the vaccine. I want those who have not already gotten sick to be spared. I also hope we cooperate when it is our turn, so they will not have to keep seeing the horrors of these past months of watching people say good bye to loved ones on a I-pad, of being the only one with someone as they take their last breaths. Yes, this is part of medicine, but not in the heart-breaking numbers they are seeing right now.

I decided to write about this because I sense many who read me have at least some regard for some of the things I say. If you differ, it does not change my regard for you. If you think I’m out to lunch or deceived, pray that I might see the light–but don’t argue or send me articles. I’ve likely seen them or ones like them. I just wanted you to know how I’ve been thinking about this decision and what I’ve decided. I look forward to the day when this is in the rear view mirror, when we can make up for all the celebrations we’ve missed. I hope we can be there together or enjoy each other’s pictures on Facebook. Stay safe my friend.

[I am serious about not wanting to argue about this. I consider it a waste of time and energy. And I will take down posts that try to do this.]