State of the Pandemic
Yes, COVID is still causing illness & death and disrupting day-to-day life
Recent data show that COVID case counts and hospitalizations are increasing. The CDC map of the United States shows the level of community spread of COVID is increasing (more orange and yellow colored counties, especially in the northeast).
And news headlines are encouraging masks and drawing attention to the rise in cases.
In spite of all of this, a member of my pod family, a well-educated, vaccinated individual who works from home and takes a lot of steps to mitigate disease spread, recently asked me —
When can we stop taking COVID so seriously?
SERIOUSLY — when? when will COVID not be a headline? do we need to keep masking? do we need to be concerned? can we travel? what about vaccines? what about case counts? hospitalizations? deaths? WHEN?!?!?!
It is time to talk about (1) what we know, (2) what questions remain unanswered, and (3) what steps we need to take now in order to move forward (to live in the next normal — not March 2020 when COVID was truly unknown and fearful, but also not 2019 when COVID did not exist).
WHAT DO WE KNOW?
The SARS-CoV-2 virus is here to stay. Eradication (global elimination) is not an achievable goal. So we need to learn to live with the virus (ignoring it is not an option). As we move into the NEXT NORMAL (which we cannot predict perfectly), learning to live with the SARS-CoV-2 virus (and COVID-19, the disease caused by the virus) means — as a community we need to improve vaccine acceptance, vaccine technology, treatment & therapeutics, ventilation systems, surveillance systems, testing capacity, public health education, and access to healthcare.
The virus is evolving/changing. And our policies/recommendations to prevent disease spread from last month or a previous variant may no longer apply. For example, we know that Omicron is highly infectious and can infect individuals despite vaccination status. At this point in the pandemic, policies related to masking, quarantine, isolation, and testing should be the same for those who are vaccinated and those who are not. Thinking those who are vaccinated will not become infected or spread COVID-19 is just wrong. And believing that incentivizing vaccinations with special privileges (like not needing to mask) is a good health policy is foolish (dangerous). Vaccines work (see below), but they were never designed in order to provide the vaccinated group with different rights and privileges; they are designed to prevent severe disease and death.
However, because of vaccines and treatment options — we do not need to institute community-wide lockdowns at this point in time (as we did throughout 2020 when COVID was so new). We can keep individuals out of the hospital through vaccinations and once an individual is diagnosed we can treat them. Additionally, we can use wastewater surveillance to (attempt to) forecast surges in COVID cases.
Vaccines work — individuals who are unvaccinated are 2 times more likely to be diagnosed with COVID than individuals who are vaccinated. And individuals who are unvaccinated are 8 times more likely to die from COVID compared to individuals who are vaccinated.
Vaccines are safe — the risk of getting COVID-19 (the disease) far outweighs the adverse health effects associated with the vaccine. And (for what it is worth), natural immunity (immunity created following a COVID infection) is variable. There is no guarantee that an individual who contracts COVID will have lasting immunity. Or immunity to fight the next variant or not infection.
WHAT QUESTIONS REMAIN UNANSWERED?
How worried should we be?
It has been said that “worry never robs tomorrow of its sorrow, it only saps today of its joy.” Worrying about COVID is not productive. What we need is to stay informed (I’ll keep you up-to-date!) and take specific, well-informed action to prevent disease spread and seek treatment (when we become sick); more below. This action may include individual actions, such as getting tested for COVID if you are feeling ill. On the other hand, it could include advocating for increased public health funding (read: voting in November), supporting efforts to bring public health concepts to health education classes, or speaking up in favor of wastewater surveillance, better access to data, and sick-leave for all employees so we can all stay home when we are sick (breaking cycles of infection).
We need to be aware that future surges in cases will come, as will new variants, more deaths, and (hopefully) better vaccines, treatments, and policies to mitigate disease spread. We should worry not; rather we should work to decrease disease spread and be prepared for whatever this virus throws at us next!How will the virus evolve next?
We should expect new variants in the future. Will those variants be even more infectious? will they be able to evade our immune system? will they be more deadly? These are questions we CAN NOT answer.
The SARS-CoV-2 virus has been unpredictable from the beginning — every time we think we understand or are able to forecast what will happen next, the virus does something we did not expect. We need to let go of the expectation that there is a magic virus crystal ball that will tell us what is next. Instead, we need to advocate for better viral surveillance, variant testing, and the development of indicators of disease. We need pushback against cookie-cutter policies that are not applicable to all. We need strong local public health agencies, coordination between public health and clinical medicine, and cross-sector collaborations to prevent disease spread and capture the lessons learned in schools, manufacturing, small businesses, childcare centers, airports, and so many other places. We need to recognize health in all policies and the responsibility we all bear to create healthy communities.
We also must stop listening to individuals who claim to know the future of the virus. They do not know. We need to silence those who speak about/with such certainty and lean into people who acknowledge what is unknown and are working creatively and thoughtfully day by day to improve community health. I suggest following Marin McKenna, Mike Osterholm, Public Health On Call (podcast), and me(!!!).What about long COVID?
Thinking about long COVID keeps me up at night. Individuals with long COVID experience symptoms for at least 3 months (usually longer). The list of symptoms associated with long COVID has grown to more than 200, but the three most common are shortness of breath, fatigue, and cognitive disfunction/brainfog. There are so many unanswered questions about this life-changing, debilitating, and long-term disability associated with COVID infection — who is at most risk? what are the risk factors associated with development? what role does the vaccine play in development? what about my kids? how do we diagnose and treat it? how do we explain the effects to motivate individuals to take action to slow disease spread? when will we have enough data to begin to understand this complex disease?
So many questions and there are very few answers. If you need a reason to take COVID seriously and take steps to slow disease spread (vaccinations, masking, test-to-treat programs) long COVID is your reason.
WHAT DO WE DO NEXT?
Individually, I believe we all need to commit to the following —
First, recognizing that COVID will be part of our lives forever. We will need to think about vaccines, testing, treatment, and illness forever. We will need to teach our children about disease mitigation, how home COVID tests are administered, how to properly isolate while ill, and what steps to take to decrease disease spread, especially when COVID is spreading throughout our communities. Along with this recognition, we must let go of our expectations to predict the future. Becoming comfortable with the uncertainty of what tomorrow will bring is needed.
The time has (long) come to take steps forward together against the SARS-CoV-2 virus (NOT each other) in order to create healthy communities. In order to do it, we must start by adopting a shared mission to love our neighbors. We must care for each other and work collectively to slow the spread of all infectious diseases. To do this, we must all agree to the following —
Stay home when you are sick.
While you might be able to go to work and push through with a cold, stay home. Keep your germs to yourself. Do not expose others; stop the chain of transmission from person to person. This also means we must also keep our kids out of school when they are sick.Wear a mask if you must go to work or school when you are sick.
Encourage people to seek out COVID testing and treatment.
Do not make fun of someone or out them for testing positive for COVID. Or the flu. Or for having lice. These are infectious diseases; they are not a joke nor should we be gossiping about them. Diagnosing an illness allows for proper treatment and slows the spread of disease. Let’s work to create a healthcare system where seeking testing, getting diagnosed, and receiving treatment and instructions for isolation are the basic tenants of the healthcare system and the rights of all individuals.Recognize the amount of stress we have experienced individually and as a community during the past two years. Let’s be supportive and loving toward our neighbors, friends, community leaders, teachers, and school nurses, among others.
Finally, let’s not forget the lessons we have learned by living through a pandemic —
A threat to health anywhere is a threat to health everywhere. We live in a global society where a virus can easily hitch a ride on an airplane. What is happening on the other side of the globe matters. Threats anywhere are threats everywhere.
Being healthy includes physical, mental, emotional, and community health.
We need to put the PUBLIC back into health. For decades now, we’ve been told that being healthy is an individual responsibility — eat well, exercise, don’t drink too much alcohol, don’t smoke, have safe sex, and don’t do drugs. And while these are all healthy practices, health can only be achieved/maintained when we are all healthy. We need to see health in all policies, places, and people.
And (last, but not least) —