In Palu, Indonesia, “a wild crocodile with a used motorcycle tire stuck around its neck for six years has finally been freed,” the Associated Press reported a few days ago.

In a way, that’s an apt metaphor for the stranglehold the coronavirus has put on the world the past two years: We can’t wait to shed this tiresome (excuse the pun) burden. The world seems headed in that direction as masks come off and COVID-19 restrictions ease, despite cautions from global health authorities.

The path ahead remains uncertain – what else is new under the pandemic sun? – as we strain to break free of the virus’s grip. The country and the world may be bitterly divided socially and politically, but where COVID is concerned we all live together in a State of Flux.

Here’s what our dashboard says at this stage of the journey:

252 million people in the U.S. have received at least one COVID-19 shot, reaching 76% of the country’s population and 81% of the vaccine-eligible (age 5 and up).

• 214 million are fully vaccinated (sans boosters), representing 64.5% of the population and 68.6% of the vaccine-eligible.

• 92 million have had a booster, including 46% of fully vaccinated adults. Another 84.7 million are booster-eligible.

The needle is moving more slowly now, with daily shots (first and second doses as well as boosters) averaging 547,000 and trending further downward. In early December, the daily average was more than 2 million. By way of comparison, in the bygone early gold rush when demand exceeded supply – April of last year – the figure topped 3 million.

To give the vaccine effort a boost, the Ad Council partnered with Artsai, a creative ad tech company based in San Francisco, to use artificial Intelligence to reach the vaccine-hesitant with a variety of tested messages. As Sabrina Sanchez reports in PRWeek, target states included Missouri, Mississippi, Florida, Nevada, Arkansas and Louisiana. One of the most effective calls-to-action was simply “get the facts on COVID-19 vaccines.” The six-week initiative drove more than 60,000 visits to vaccination websites and led to more than 25,000 incremental shots.

The Omicron wave has crested but is not quite crestfallen. Cases have plummeted from more than 800,000 a day in mid-January to less than 150,000 within the past month. New hospital admissions have taken a dive as well, from more than 21,000 a week in mid-January to less than 10,000 in mid-February. However, we’re still averaging more than 2,000 deaths a day.

Where to go from here? Our weekly countdown searches for guideposts.

10. A cautionary tale

Among other countries, Denmark, Sweden and Norway are relaxing pandemic restrictions, going so far as to declare that COVID-19 is no longer a public health threat or a “socially critical” disease. World Health Organization Director-General Tedros Adhanom Ghebreyesus  literally begs to differ, warning that “it’s premature for any country either to surrender or to declare victory.” He advises health authorities to use “every tool in the toolkit, not vaccines alone.”

Source: Getty Images.

9. Simon says take one step back

The Food and Drug Administration postponed the meeting of its vaccine advisory committee, originally scheduled for Tuesday, to evaluate data on two doses of the Pfizer/BioNTech vaccine for children 6 months to 4 years of age. In light of newly emerging information from clinical trials, the agency says it needs to examine third-dose data before making any recommendations for the 18 million youngest vaccine recipients. Just days before, the talk was about getting little vaccines into little arms by the end of this month. Now we’re looking at April (come she will).

As for the young’uns who are already vaccine-eligible, 31% of kids 5 to 11 have had at least one shot and 23% are fully vaccinated. The comparable numbers for adolescents ages 12 to 17 are 66% and 56%. To give you an idea of the pace of progress, each of those numbers went up by one percentage point in one week’s time.

Some observers believe the delay will be a good thing in the long run, given the perception among many of the vaccine-hesitant that the approval process has been rushed from the get-go. The postponement, the FDA says, will facilitate “transparent public discussion.”

8. Mandates and (e)motions

• Attorneys General of 16 states are trying to upend the federal vaccination mandate for healthcare workers, Danielle Brown and Kathleen Steele Gaivin report in McKnight’s Long-Term Care News and McKnight’s Senior Living. Among other points of contention, the suit claims that the federal “scheme” will exacerbate a workforce crisis in long-term care. The Supreme Court upheld the mandate one month ago, but the AGs are pushing back and pressing on.

• The armed services are starting to dismiss soldiers and sailors who refuse COVID-19 vaccination. The Air Force has discharged more than 140 active duty personnel and has approved nine religious exemptions, while rejecting thousands of others, Air Force Times reports. The Navy in January booted 45 sailors, including 23 on active duty and 22 considered “entry-level separations” within the first 180 days of service. The Marines have separated at least 200.

Secretary of the Army Christine Wormuth says she’ll begin “involuntary separation proceedings” for soldiers who refuse the COVID-19 vaccination order and are not awaiting a decision on a personal exemption. About 96% of active Army members and 83% of reservists are fully vaccinated. Overall, the Pentagon says that 97% of the 1.3 million active duty personnel have received at least one shot.

• Challenges to vaccination mandates are still bouncing around in court.The New Jersey Supreme Court Tuesday rejected a police union’s attempt to undo a mandate for corrections officers and others working in high-risk settings. New York City fired 1,430 unvaccinated municipal employees this week, less than half of 1% of the workforce of 370,000. Court challenges failed.

7. The long haul is a tough road

• Neurologic symptoms such as “brain fog” and sleep problems are among the more worrisome aspects of long-haul COVID, Nicola Davies reports in Neurology Advisor. Davies speaks with three experts to explore what patients and providers can do to recognize and manage these complications.

• Pain syndromes are common in people suffering from long COVID, John Schieszer writes in Clinical Pain Advisor. The most prevalent complaint is widespread pain, such as diffuse muscle or joint pain.

• COVID-19 patients are at risk for heart attack, stroke, arrhythmias and a variety of other cardiovascular problems for up to a year after they are infected, Alicia Lasek reports in McKnight’s Long-Term Care News, findings one cardiologist called “stunning.”

• A year after being treated for COVID-19 in the ICU, 74% of patients continued to have physical symptoms, researchers from the Netherlands report in JAMA. Complaints included general weakness, joint stiffness or pain, muscle weakness or pain and shortness of breath. In addition, 26% reported mental symptoms (depression, anxiety, PTSD) and 16% had cognitive issues.

Source: Getty Images.

6. Can’t spell profit without a capital P

It was a very good year for the coronavirus and a very, very good year for Pfizer. The company’s COVID-19 vaccine set a record for single-year sales of a pharmaceutical product at $36.8 billion, Marc Iskowitz reports in MM+M.

This is what you call market share: 57% of the fully vaccinated in the U.S. have received the Pfizer/BioNTech vaccine, compared to 35% for Moderna and 8% for J&J. For the pediatric population 5 to 17 years of age, Pfizer/BioNTech is the only vax in town.

5. Measure for measure

• For the Centers for Disease Control and Prevention, R&R stands not for rest and recreation (they would love to have a measure of that), but Review and Revise. They’re taking a look at the metrics for easing COVID-19 restrictions but are not ready just yet to back away from recommending masks in schools and public indoor settings in areas of high transmission.

• Public health experts are calling for clearer benchmarks on easing restrictions, Axios reports. They’d like to see measures the public can readily understand – a la weather forecasts or air quality reports, perhaps tied to local case rates, vaccination rates or the burden on ICUs.

• Some say the CDC needs to provide statistical “off-ramps” that will lead us away from restrictions, an interesting choice of words at a time when truckers protesting vaccine mandates in Canada have Ottawa mired in gridlock.

• Meanwhile, the CDC’s COVID data tracker has added a webpage on wastewater surveillance for SARS-CoV-2, a helpful tool (stool?) to predict local outbreaks. Can’t say we aren’t getting the straight poop from the government.

4. Booster shots: the three-point play

The Centers for Medicare and Medicaid Services has begun posting data on booster shots in nursing homes for residents and staff, Danielle Brown reports in McKnight’s Long-Term Care News. The information appears on the CareCompare website.

Here are a few recent nuggets from the seemingly bottomless CDC data mine:

• Based on data from 25 jurisdictions, the fully vaccinated are 14 times less likely to die of COVID-19 than the unvaccinated. The boosted are 97 times less likely.

• Boosters tend to benefit seniors more than the young.

Protection from the extra shot wanes after four months but remains strong in preventing severe cases with dire outcomes.

Boosters have been available to adults since last fall, but only half of the eligible have rolled up their sleeves. Uptake is lower among Black (31%) and Hispanic (37%) adults than whites (46%), says the Kaiser Family Foundation.

Older folks 65+ are busily getting boosted (66%), Kaiser notes. Younger ones? Not so much. Just 31% of 30-somethings and 24% of those ages 18 to 29 have received the extra shot. It’s a party matter as well: 62% of Democrats have received the boost, as opposed to 32% of Republicans.

Maybe we can think of the shots plus booster as a classic three-point play. A slam dunk. An and-one.

3. Meds and feds

• To help healthcare providers track down COVID-19 pills and monoclonal antibody treatments, the Department of Health and Human Services has created the COVID-19 Therapeutics Locator, Diana Ernst reports in MPR. The website shows the availability of oral antivirals molnupiravir (Merck/Ridgeback) and Paxlovid (Pfizer) and the monoclonal antibody Evusheld (AstraZeneca). Patients are advised not to contact the locations directly but to coordinate with their prescribing healthcare providers.

• Merck and Ridgeback are providing 3.1 million doses of molnupiravir to the U.S. government for domestic distribution. Merck has already shipped the pill to 25 markets worldwide and has an agreement with UNICEF to allocate up to 3 million doses to low-and middle-income countries during the first half of this year.

• Famotidine, better known as Pepcid for treating ulcers and acid reflux, is showing promise in alleviating COVID-19 symptoms in early trials. Ernst has details in MPR.

Source: Getty Images.

2. See the forest as well as the trees

• While more than half of the world’s population is fully vaccinated, 84% of Africa’s population is still awaiting a first dose. The World Health Organization is serving as our conscience in that respect, the Jiminy Cricket to our Pinocchio.

• Worldwide, more than 10 billion vaccine doses have been administered against a backdrop of more than 415 million cases and 5.8 million deaths.

• Let us take a moment to contemplate the enormity of this effort within a strikingly narrow window of human time. STAT’s Helen Branswell explains why “COVID-19 vaccines are a freaking miracle.”

1. Wherever we go, here we are

Not only do we live in a State of Flux, the flux du jour is likely to depend on where we live. Apart from federal vaccine mandates for federally connected people, vaccination and masking policies are the decentralized domain of state and local governments, local school districts and private businesses.

As they say, be sure to check your local listings. Your employer may have a vaccine requirement, but you may live in a state that opens multiple windows of opt-outs and exemptions.

In some areas, such as home care, you need a GPS to figure out who is covered by the CMS mandate and who is not. In McKnight’s Home Care, health attorneys Angelo Spinola and Will Vail sort it out.

As restrictions ease, “masking can now move from a government-imposed mandate to an individual decision,” says Dr. Leana Wen, a public health professor at George Washington University who has been writing op-eds for the Washington Post throughout the pandemic. Remember, however, that the Transportation Security Administration’s requirement for face masks on planes, trains and boats remains in effect until March 18. We need an asterisk for masker risk.

Parting shot

Talk about flux. The web page for Merck press releases begins with this three-pronged caveat: “The information contained in each news release posted on this page was factually accurate on the date it was issued. The company assumes no duty to update the information to reflect subsequent developments. Readers of the news releases should not rely upon the information as current or accurate after their issuance dates.”

There’s nothing quite so old as yesterday’s news. That must be why companies have forward-looking statements.

We look forward to a day when the tire, or the albatross, around our necks is gone. In truth, the albatross is an elegant, majestic bird with “vast archangel wings” (Melville, Moby Dick) and doesn’t begin to deserve the bad rap it has received.

…and some songs

When You Wish Upon a Star, Jiminy Cricket (Cliff Edwards)

April Come She Will, Simon and Garfunkel

Valentine, Martina McBride and Jim Brickman

Somebody to Love, Queen

You’re All I Need to Get By, Marvin Gaye and Tami Terrell

Endless Love, Lionel Richie and Diana Ross

Here’s hoping you had a Super Sunday and a lovely Valentine’s Day. Thank you for joining us. Stay well.