Thoughts of a retired physician

  On 4 March, Los Angeles County lifted its indoor mask mandate for covid. This was after California had lifted its state mandate. Margan and I went to REI today for some hiking shoes. We were masked and I estimate that about ½ to ⅔ of the people we saw inside were also masked – leaving a high proportion who were not. The national data and the LA County data all show falling numbers of cases, hospitalizations, and deaths , with numbers among the lowest troughs seen during the pandemic. However, the BA.2 omicron variant represents ever more of the cases seen , likely because it is more transmissible than the BA.1.1 variant and immunity from vaccines and prior infections wanes with time. The WHO reports BA.2 is now the dominant variant worldwide at 85% of isolates sequenced. Wastewater surveillance shows many communities have BA.2 being shed into sewage nationwide.  At the same time, uptake of vaccines has fallen to very low levels in the United States – less than 160,000 doses daily

  Covid cases, hospitalizations, and deaths are at their lowest point in Los Angeles County since July 2021 (727 new cases, 25 new deaths, and 432 current hospitalizations as of 19 March 2022). The masking mandates have pretty much been lifted except for public transit and healthcare facilities. And still. The omicron variant BA.2 is producing surges in Europe . Asia is seeing rising cases. It has been described for several months in Africa where case counts are less precise. BA.2 is perhaps 30 to 50% more transmissible than its cousin BA.1. New York City is experiencing a rise in test positivity and cases of BA.2 in the past 10 to 14 days and is an airplane ride from Los Angeles or any other city for that matter.  The encouraging news is that vaccinations and prior omicron BA.1 infection seems to provide protection against BA.2’s ability to produce severe disease and death. How robust this “immune wall” is and how long it will persist remain objects to study. Experts such as Drs.

  This was a busy week and next week promises the same. Multiple physician appointments (when did medicine become a commodity, I missed that – fortunately). The continued threat of Russian aggression in Ukraine becoming a general war in Europe remains. But at least we had a wonderful Sunday with our two older grandsons, Maxwell and Sebastian at the Los Angeles Zoo. They turned 12 and 9 respectively in February and as you can see, have grown a lot. Sebastian is closing in on our height while Maxwell – well, you can see that we have to look up at him now. My advice to all is enjoy life and family – precious items as time will otherwise stream by.

  Ukraine continues to fight and Putin is now using the standard tactic when his military falters – bludgeoning civilians and screaming ever louder that Ukraine is a danger to Mother Russia. The reality is that Russian military forces have stumbled badly. What in all likelihood was envisioned as a 72-hour war is now approaching 2 weeks and the incompetence of the Russians is beyond astounding. This by no means indicates they will lose, but if they defeat the Ukrainian army and the Ukrainian civilians, they then have to occupy Ukraine, install a puppet government, and face a hostile population and the possibility of an ongoing insurrection.  Phillips P. O’Brien has a cogent post on Twitter worth the read. The oft said phrase about war – amateurs talk tactics, experts talk logistics – is the core of his tweet. It appears obvious that the Russian army has yet to master the science and art of logistics. The stalled convoys have run out of fuel. Troops are being given rations that are year