As vaccine and mask mandates are being eliminated, it is up to myeloma patients to chart their own course to move forward. “Knowledge is power” has never been truer and more relevant.  Ezra Klein’s opinion piece on the New York Times mentioned a recent article in The Lancet, “Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021,” which illustrates why the U.S. has fared so poorly overall, when it comes to dealing with the COVID-19 pandemic. 

Considering all the variables, what stands out is that the U.S. has the lowest score (versus all other countries) as far as “trust” in government and in fellow citizens are concerned. Director of the global health program at the Council on Foreign Relations and senior author Thomas Bollyky notes that “public health is rooted in the soil of trust.” 

In Denmark, they created public support for vaccination where no mandates are required. In the U.S., a high level of dysfunction is holding us back because there is no trusted voice. 

Amid the chaos, however, myeloma patients can still be informed to be able to take the best actions and stay safe. Obviously, the vaccination rate is extremely high (including boosters) among myeloma patients. I will highlight common sense principles to help guide fully vaccinated patients on ways to move forward. 

Importance of the 3 Cs

During the first 21 months of the pandemic, for every 1,000 residents, the U.S. had 545 COVID-19 cases, Japan had 67, Singapore had 59, and South Korea had 26. Why the huge difference? Age is certainly a factor since richer countries have an older population. However, the key difference among these countries was trust in the government. 

In Japan, there was a very effective campaign called the 3 Cs: AVOID Closed spaces, crowded places, and close contact settings. These became buzzwords in 2020 and 2021. Combined with the traditional reliance on masks to avert transmission of infections, this campaign had an enormous impact. 

Attitudes about masks

Myeloma patients can choose to protect themselves with the best and most high-quality masks possible. A recent Washington Post article summarizes the reduction in COVID-19 infections with different types of masks:

• N95 masks or equivalent: 83% reduction in transmission
• Surgical masks: 66% reduction in transmission
• Cloth masks: 56% reduction in transmission

The so-called one-way masking (i.e., wearing a mask around those who are not wearing one) is very effective. This means myeloma patients can still mask up (at their personal discretion), especially in situations where avoiding the 3 Cs most apply. 

Do plexiglass barriers work?

It is important to be aware of the benefits and limitations of plexiglass barriers, which are being widely used right now. Obviously, if masks are being worn, there may be fewer airborne droplets, which is excellent. However, the team at Florida Atlantic University showed that although the plexiglass stops about 80% of the droplets, some still escape over the top and to the sides. Some droplets can also bounce backwards. What this means is that over time, in an enclosed space, droplets can linger in the air and end up being a cause for concern. Thus, while plexiglass is helpful for short-term encounters, good cross ventilation is required, nevertheless, to disperse escaping droplets. 

Reasons for ongoing cautions

New variants

If the levels of community infections are dropping dramatically (as they are right now, in many parts of the U.S. and Europe), why is there still a need for ongoing cautions? The main aspect, which I have emphasized, is the high likelihood of new omicron type variants. We already have the BA.2 variant, which is currently being monitored. 

There are hopeful indications that the Centers for Disease Control and Prevention (CDC) and other health agencies will be checking more closely for possible emerging variants of concern (VOC in WHO nomenclature).

The CDC also announced a new cooperation for wastewater analyses with the National Wastewater Surveillance System (NWSS). This means that large communities across the country will be monitored continuously for potential early appearance of new variants. 

In retrospect, the omicron variant was already present in wastewater in the U.S. even before new patient cases were documented. This early warning will be an important new tool, in addition to the more broadly implemented COVID-19 sequence analyses. 

Lack of access

Another reason for caution for myeloma patients: access to key treatments is currently very limited. Evusheld™ (which I have discussed in my previous blog) is an excellent COVID-19 antibody treatment for any patient who has responded poorly to vaccination. However, it is in very short supply. Likewise, Paxlovid™  — the pill for early anti-virus treatment for any patient testing positive for COVID-19 — is also hard to come by. 

As these management tools become more broadly available, it will be possible to relax a bit on the 3 Cs. Particularly troubling are the inequities in access to key therapies and tools requiring special efforts to improve as described in a recent Los Angeles Times article. Fortunately, masks are accessible and avoiding the 3 Cs has been proven effective. 

Some positive news

Hope and re-emergence

As we move forward into Spring, perhaps a bit earlier than usual (The U.K. experiences Spring a month early), it is imprimatur to always look at the positives. 

To demonstrate: Despite being severely depleted by agriculture and chemical use, Monarch butterflies are making a fantastic comeback. 

Apparently, planting native milkweed in parks and other open areas is an effective initiative as it greatly expands the food source for Monarch caterpillars, when they emerge. This past spring, I had the pleasure of witnessing this happen in our own the backyard as — Monarch butterflies emerged from the milkweed that I had planted. 

An inspiring innovation

Another piece of good news was unveiled — the Netherlands Expo Pavilion in Dubai at the World Expo. The brainchild of Dutch architect Michiel Raaphorst, it is a tower with a self-sustaining environment. The Netherlands Expo Pavilion creates its own water (by condensation) to grow food, amid the extreme desert heat of Dubai. Whether this will provide a sustainable solution for vertical farming in this type of tower space remains to be seen. But it is an exciting start!  

Practicing mindfulness

This past week, the passing of Thich Nhat Hahn was announced. The Zen Master was a driving force when it came to educating about mindfulness. 

In a wonderful NPR interview, one of his devotees explained that Thich Nhat Hahn will always be with us because of the practices he shared — to stop, breathe deeply, and focus; to generate the energy; and to find calm in our daily lives. By his presence, he could produce calm and focus for huge appreciative audiences. 

Thich Nhat Hahn’s earlier books are 50 years old now, but have stood the test of time. 

Let us honor Thich Nhat Hahn by working hard to achieve greater calm and to focus on our daily lives. I remain hopeful that the coming months will, indeed, see an end to the pandemic.

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