Bob Cass lifts a set of light weights as one of his breathing exercises at his house in Iowa City on Thursday. (Savannah Blake / The Gazette)
Using the door to his bedroom, Bob Cass stretches his lungs as part of his breathing exercises at his house in Iowa City on Thursday. (Savannah Blake / The Gazette)
Bob Cass uses his spirometer to record his oxygen levels, which sends directly to his doctor at his home in Iowa City, Iowa on Thursday, March 3, 2022. (Savannah Blake / The Gazette)
Bob Cass is doing a series of stretches to help work on his lungs at his home in Iowa City, Iowa on Thursday, March 3, 2022. (Savannah Blake / The Gazette)
A set of different respiratory stretching exercises sit on Bob Cass’ couch in his home in Iowa City, Iowa on Thursday, March 3, 2022. (Savannah Blake / The Gazette)
As the number of cases decreases and health systems no longer face the serious threat of being overwhelmed, things have started to relax.
Aside from any development of coronavirus variants, some may see this as a sign that the pandemic may be becoming endemic. But vulnerable groups have not left the pandemic yet.
“We’re still here. This is affecting us,” said Bob Cass, a 66-year-old recipient of a single lung transplant.
As Iowa approaches the second anniversary of COVID-19, the milestone marks a new phase in the pandemic. A year ago, there were fewer treatment options for coronavirus-infected patients, and vaccines were not available.
Recent changes in federal and state recommendations on public health signal a “normal” life that returns for many, causing them to drop pandemic safety measures such as wearing masks and taking physical distances.
However, for those who are immunocompromised, have chronic medical conditions or are otherwise vulnerable to serious illness if they become infected with the new coronavirus, the risk is still very real. For some, the recent move by top officials suggests a lack of recognition of the risk these vulnerable groups face.
“I still have a risk, I have to protect myself,” Cass said. “The chances are low of catching it, but it only takes once.”
Cass received his organ transplant at the Cleveland Clinic in August 2019 as a result of idiopathic pulmonary fibrosis, a progressive and severe lung disease that causes scarring in the lung, making it difficult to breathe. He and his wife moved to Iowa City in February 2020 to be close to the transplant center at the University of Iowa Hospitals and Clinics.
As a transplant recipient, Cass faces an increased risk of all types of infections, even from something like the common cold. He was accustomed to wearing masks in public and washing hands frequently before it became common practice throughout society.
And he was used to assessing his own risk when venturing out into public spaces, such as a grocery store. But Cass remembered hearing from some people around him who thought the pandemic was not a concern because they were healthy and likely had small consequences of COVID-19.
For Cass, these beliefs minimized his experience as an exposed individual and reinforced his isolation
“Seeing resistance to vaccines and (against) wearing masks, it was frustrating for me. I felt like I was not counting,” he said.
Relaxing COVID public health measures
Many experts agree that COVID-19 will eventually reach the endemic phase. Although it is unclear whether the US has achieved points yet, top management has begun to end long-standing COVID-19 emergency policies and recommendations in recent weeks.
Two weeks ago, the Federal Centers for Disease Control and Prevention relaxed its mask guidelines and recommended continued mask use only for those living in communities where high COVID-19 rates burden local health systems.
Under this new guidance, most Iowans can now be in a public environment without a mask. Only a few counties had a high level of COVID-19 in the past week.
The COVID-19 pandemic has been on a downward trajectory in recent weeks, with infection rates significantly lower than they were at the peak of the most recent rise in mid-January. Last Wednesday, hospital admissions in Iowa were at the lowest total number since August, according to latest state-wide coronavirus data.
Despite this, things have not changed for medically vulnerable people or those with children under the age of five who are not yet eligible for a COVID-19 vaccine, said Danielle Pettit-Majewski, director of Johnson County Public Health. Removal of mitigation measures for society puts pressure on these groups to take extra precautions in the future.
“You tell people who are disabled or have small children, ‘you are alone,'” she said. “It places a great deal of the burden on people who have many health barriers, and it has many social consequences and social consequences.”
Governor Kim Reynolds ended the nationwide proclamation of coronavirus disaster, which reallocated resources and suspended some state laws that were in place to strengthen Iowa against COVID-19. But as of Feb. 15, the state is handling the virus “part of the normal day-to-day business.”
“Influenza and other infectious diseases are part of our daily lives, and coronavirus can be treated in the same way,” Reynolds said in a statement last month.
Local public health departments had already slowed down some efforts to respond to the coronavirus before the governor’s decision to end the disaster proclamation. Both public health agencies in Linn and Johnson counties completed the COVID-19 contact tracing December and January suspension of the disease investigation effort that had taken place since March 2020.
Going forward, Linn County Public Health will track coronavirus follow-up and training as part of the department’s day-to-day functions in the coming weeks or months, said Director Pramod Dwivedi. Officials will wait until after the spring break to see if there is any change in caseworker.
“Unless we see another variant, it looks like we’re heading for a good result, but who knows,” Dwivedi said. “This virus has always thrown basket balls at us.”
To be prepared for any surprise that comes their way, public health officials continue to stress the need for funding to support staff and resources.
Public health officials urge risk groups to continue practicing mitigation strategies while Iowa and the rest of the country navigate this latest phase of the pandemic.
“I think they will still be at greater risk,” Pettit-Majewski said.
Weighing risk versus reward
Immunocompromised individuals make up 2.7 percent of the U.S. adult population according to estimates reported in the Journal of the American Medical Association. However, it does not cater to every person who faces a serious risk of a coronavirus infection.
Age and certain chronic medical conditions can also increase people’s risk of complications from an infection.
Four out of six members of Sid High’s immediate household have chronic medical conditions. It includes High, an 18-year-old Marion resident who was diagnosed with epilepsy when he was 13. He also has postural orthostatic tachycardia syndrome or POTS and Ehlers-Danlos syndrome.
“If we get COVID, it can be very bad,” he said.
When COVID-19 arrived, the family began to isolate themselves, restrict interactions with friends and family, and often wear masks. High, who is homeschooled, quit his job at Walgreens to minimize potential exposure.
Because of their risk, his family – like many who have vulnerable loved ones – have viewed the pandemic differently than some in the community.
While it’s frustrating to see people minimize the dangers of COVID-19, High said he does not judge them for their beliefs or choices. He said he can not influence the choices of others. So instead, High will continue to take precautions and be as careful as possible in the foreseeable future.
“My family must be super safe, but other people must not think about it. It’s more serious for us than it is for some people, ”said High.
“I hope people will try to learn more about how people in the chronic illness community see the world,” he added.
A family has had to balance the dangers of COVID-19 with creating a normal life for their young daughter.
Kade and Karen Hammes’ daughter Mila Hammes, who turns three in April, was born with cystic fibrosis, a genetic disorder that affects the lungs and other organs.
The Coralville couple has to weigh the risk versus the reward of aspects of their daughter’s life over the past two years, an effort that will continue for the rest of her life, they said.
They have decided that they would send their daughter to kindergarten no matter what, but have gone back to other activities that have low rewards. They had enrolled Mila in gymnastics, but withdrew her from teaching after the highly transferable omicron variant caused cases to rise to record highs.
“We really want her to live a normal life as possible, but we also know we need to keep her health in mind,” Karen Hammes said.
From their perspective, those around them have been aware of Mila’s medical condition and have taken steps to keep her healthy.
Kade Hammes said some of his family members are unvaccinated and generally do not believe COVID-19 is a serious disease, but have urged him not to visit them if they know they have been exposed to an infected person.
“Even from those who, in my opinion, do not take COVID very seriously, they still take Mila’s health very seriously,” said Kade Hammes.
Although he still has some concerns in the short term, Bob Cass said he is optimistic about a future that involves low risk for him and others who are vulnerable.
Cass and his wife had canceled a trip to Florida to visit their father due to the recent rise in coronavirus, which was driven by the omicron variant. But if the virus continues its downward trajectory, he hopes to take the trip in the coming weeks.
“I know there is a risk in living and doing normal things, but I can choose to minimize it as much as possible,” he said. “I do not want to walk around and live in fear, but I try to be smart in the chances I take.”
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