Herewith three items of recent pandemic news: The toll of long Covid; Johnson & Johnson has no vaccine to ship; and the CDC’s unexpected new guidance on mask use in the vaccinated. Plus news briefs and a frippery.

The Centers for Disease Control and Prevention abruptly reversed a year of guid­ance on masking to prevent the spread of Covid-19. Yesterday the Biden administration said that fully vaccinated people no longer need to wear masks, indoors or out, except in limited circumstances (such as in doctors’ offices, buses, airplanes, or prisons). The CDC recommended that unvaccinated people continue to mask up indoors.

The new guidance caught experts and state officials by surprise.

The federal recommendations do not override policies put in place by states, counties, cities, native tribes, businesses, schools, etc. States are reacting variously to the new guidance. In Minnesota, for example, governor Walz has lifted all mask restrictions as of today for the vaccinated and the unvaccinated alike. The governor said he did not want to put businesses in the position of having to police customers’ vaccination status. (Of course this state-level easing does not override rules at lower levels either — after Walz’s an­nounce­ment the mayors of both Minneapolis and St. Paul said that their cities’ mask mandates will remain in place.)

A glaring issue with the new CDC guidelines is that we don’t know who has been vaccinated and who has not, and we can’t know. As The Atlantic points out, Americans have always been on an honor system where vaccination is concerned. The CDC-issued vaccination cards are trivial to forge, the CDC is warning that right-wing websites are providing instructions and urging people to do so. In this Washington Post op-ed, a doctor faults the CDC for loosening the guidelines without a requirement to prove vaccination status.

The NY Times has a survey of 723 epidemiologists and other experts in public health and infectious diseases. In the days before the CDC’s turnabout they were asked how long they expected people in the US to continue wearing masks in public. Over 80% said a year or more; only 5% believed that some restrictions could be lifted before this coming summer. Eighty-eight percent said vaccinated people should still mask up in large outdoor crowds.

Those experts will probably continue to wear masks outside the house for some time to come. I will too. For example I don’t expect the corporate headquarters of Trader Joe’s or Lund’s to order that the signs requiring masks inside their stores be taken down. Jason Kottke lists 11 reasons why it is OK to continue masking in public (content warning: the last reason is kind of rude).

Here is some of the coverage of the CDC’s surprise move.

We have been writing about the Emergent BioSciences factory in Baltimore that has been causing manu­fac­tur­ing issues for Johnson & Johnson (1, 2, 3, 4). All of the J&J vaccine that the federal gov­ern­ment has so far shipped out has come from a manufacturing facility in the Netherlands; but that factory has commitments to fulfill to the EU as well.

The vaccine maker, after its travail with a pause in vaccinations over blood clot issues, and a resumption 10 days later, has now run out of vaccine. Zero doses will be shipped to states next week. (Its absense shouldn’t impact the overall vaccination program as Moderna and Pfizer are shipping enough to cover the need.)

The White House coronavirus task force coordinator estimated that the Emergent facility could put its problems behind it and achieve FDA certification within a few weeks. When that happens a large stock of J&J vaccine now in storage will become available to ship.

Not all states will stop giving out J&J shots; some have supply on hand from the 10-day pause. The Wash­ing­ton Post’s coverage linked above notes the case of Connecticut, which has around 125,000 doses in storage but has only been able to inject 6,000 into arms since the FDA lifted the pause on April 23. The demand just is not there.

The Mayo Clinic has published a descriptive study profiling the first 100 people to seek help from the clinic’s Covid-19 Activity Rehabilitation Program (CARP) between June and December last year. Reading even a summary of their experience is enough to make one extremely wary and respectful of this virus.

The cohort was relatively young, most under 65 — average age was 45. Women comprised 68% of the group. Most, 75%, had a mild case of Covid-19 and had not needed to be hospitalized. Most had no co-morbidities going in. On average they sought out CARP three months after the time of their acute disease.

One third of the group said they had trouble getting through daily activities. Of the ones who had been working full-time before Covid-19, two thirds had not returned to unrestricted work.

The most common symptoms experienced were fatigue (80%), headache / dizziness / pins & needles (59%), and shortness of breath / cough (59%), followed by brain fog, sleep disturbance, and mental health symp­toms such as depression or anxiety.

The patients were offered physical, occupational, and brain therapies and other interventions as ap­pro­priate for each case, with the goal of returning people to normal function in their lives and work.

Here are a summary of the research from CIDRAP and the preprint from Mayo.

• How experts finally convinced WHO and CDC about aerosols — Wired a long narrative centered on Lindsey Marr, a researcher who straddles the line between aerosol science and medicine. She and a group of colleagues worked to document and correct a decades-old error in the study of infectious diseases. That error revolves around the boundary between the size of expelled droplets and aerosol particles.
• Covid Heart is not a thing — Dose Covid-19 result directly in myocarditis? At what rate? A study published last July set off alarm bells with the claim that 78% of recovered Covid-19 patients showed heart ab­nor­mal­ities. Its results were not widely replicated, and a paper published online last week seemingly puts the question to rest. To paraphrase a Stat News op-ed: Does Covid-19 attack the heart more ag­gres­sively than any other viral illness? The verdict is in. It doesn’t.
• Novavax delay — The company was widely expected to release preliminary results from its Phase III trial in the second quarter and apply for an EUA. The CEO announced on an earnings call that manufacturing regulatory issues will most likely push it into July. By that time the shot may not be needed in the US, but its relatively simple manufacturing and easy handling characteristics mean that the rest of the world will be anxiously awaiting Novavax.

Were you as thrilled as I was by the poem the Youth Poet Laureate (above left) read at the recent in­aug­ur­ation, “The Hill We Climb?” Now imagine the difficulties of translating that poem into another language. Imagine the epic battles over who gets to do those translations: Should it be only a young person? Only a Black person? Only a woman? Turns out there isn’t a lot of diversity in the world of literary translators.