The Choose Your Own Adventure Phase of the Pandemic
And to be clear this is NOT good
When I was in elementary school, I loved the Choose Your Own Adventure books. For those of you who didn’t learn to read in the 1980s or were not as nerdy as me as a child, in the Choose Your Own Adventure books the reader assumes the role of the protagonist (the main/leading character of the book). The reader makes choices throughout the book to determine the actions and plot outcomes of the book.
In a Choose Your Own Adventure book, two readers can have entirely different experiences. And the book can have entirely different outcomes based on the choices of the reader. For us nerdy 80s kids, this meant that we could read the same book multiple times and in essence read multiple stories.
As we enter a new phase of the pandemic — with new variants, global case counts decreasing, local case counts (in the US) increasing, hospitalizations down, and access to home tests — I feel like we are living in a Choose Your Own Adventure book. People are deciding for themselves if the pandemic is over, if they are at risk, if they care about contracting an infectious disease, if vaccines are good for them, if they are worried about unvaccinated kids under 5, if they care about CDC recommendations.
The video below (not only made me laugh but) really struck a chord with me. As he sings (to the tune of We Don’t Talk about Bruno), he says —
“We don’t talk about COVID, no, no…
We have zero clue what is next…
All the new guidelines seem kind of puzzling…
I’m at the point where I just don’t understand.”
Watch this first (it’s like 2 minutes) and then come back to talk about COVID.
I’m here to talk about COVID.
I’m here to discuss science. To talk about what is known and what is not. To share how I am navigating the pandemic at this point in time (as a mom of two and an epidemiologist). And to quite honestly critique how governmental public health is falling short and put forward some new ideas for data monitoring, health communication, policy changes, and improving community health.
It seems to me that the Choose Your Own Adventure phase of the pandemic has taken root and everyone is making their own decisions (some decisions of omissions) about how to go about life while we are (in fact) still in the middle of a pandemic (despite what Dr. Fauci is saying; more on this below…). Some people are masking, some boosting, and others are not. Some people are still denying the threat COVID poses despite 1 million deaths from the disease in the US alone.
The reality is COVID is still a threat to our health. And long-COVID is devastating (there is no good news about long-COVID and my worries about how it is going to impact us both individually and as a community are keeping me up at night).
COVID is still a threat to all of us, but at the same time — we have vaccines that protect us from severe illness, hospitalizations, and death. We have antiviral medications that we can take to reduce symptoms if we are positive. This reality played out perfectly last week when Dr. Fauci said at a press conference that the pandemic phase of COVID was over, but then he refused to attend the Washington Correspondent’s dinner (where there would be 2000 people at an indoor event) because he didn’t want to get sick. This begs the question —
Is COVID over? Is there still a risk? WHAT AM I TO DO?
It has been two long here, yes. But we need to continue to talk about COVID. And we cannot treat health or this pandemic as a choose your own adventure book. We need to work collaboratively — as a team — to slow the spread of the disease, protect the most vulnerable, and ensure that everyone can lead a healthy life.
So let’s talk….
What is the state of the pandemic?
According to the New York Times COVID Tracker, globally the number of new COVID cases has decreased by 28% over the past two weeks, and the number of deaths has COVID deaths has decreased by 13%. In the United States, the number of COVID cases has risen by more than 50% over the past two weeks; however, the number of COVID deaths has decreased to only 375 per day (a 3% decrease over the past two weeks). Cases are increasing in the northeast, and there is significant community spread of disease in Puerto Rico and southern Texas.
Nothing has stabilized. We have not reached a point in time where there is predictability or a steady state of disease. We are still in the middle of a pandemic. Sorry, Dr. Fauci — this epidemiologist thinks your remarks last week were wrong.
As mentioned previously, 1 million Americans have died from COVID in the past two years. And the World Health Organization has determined that there have been 15 million excess deaths caused by COVID (in 2020-21 alone). These are 15 million people who would not have died during the past two years had there not been a pandemic.
The pandemic is not over.
But (more to come below) we do NOT need to act like it is March 2020 anymore. We have entered a new phase of the pandemic — one where we all must agree to monitor our own health and the rate of community spread, and act accordingly to ensure individual and community health.
What is the virus up to?
The SARS-CoV-2 virus continues to circulate worldwide. Additionally, it continues to mutate/evolve — All viruses mutate. Some viruses evolve over time to become less deadly. We know that the SARS-CoV-2 virus (like all other viruses) needs to continue to spread from person to person and it doesn’t necessarily want to cause severe disease. It is possible that future variants will spread easily, but not cause severe illness. This is possible, but not a guarantee.
We cannot predict with certainty how the virus will evolve in the future.
What we do know is that there are several subvariants of Omicron circulating worldwide, including the new ones — BA.4, BA.5, and BA.2.12.1. Additionally, there is evidence from a study completed in South Africa (that is available online as a preprint/NOT peer-reviewed) that these new variants may be able to evade the immune system (specifically, immunity from previous infections). HOWEVER — we cannot rush to conclusions based on these results. The sample used in the South African study was small and less than half of the population there is vaccinated. There is still so much to learn about these subvariants, and we cannot make conclusions or policy decisions based on a single study (that was completed in a laboratory with a small number of samples).
But we need to proceed cautiously; knowing that new variants will arise.
The research community needs to keep up with the endless research findings that are published each day. I believe we should share summaries of these findings and critiques of them with the public — in order to demonstrate that the public health community is continuing to work tirelessly to understand COVID the disease and the SARS-CoV-2 virus.
And to also share a sense of COVID calm.
As we gather new information, we are thinking. We are trying to put the pieces of the ever-expanding COVID puzzle together. And while we may get frustrated over unanswered questions, trends that cannot be connected, or data outliers — we are at a space where a COVID-calm attitude is needed.
We know how to prevent, diagnose, and treat individuals with COVID (something we did not know in March of 2020). We know the disease is here to stay, and we cannot predict the future. So I am calling for a sense of COVID calm as the virus continues to do its thing (we cannot control it) and the new pieces of the COVID puzzle are put together.
What data is important to make healthy choices?
CDC has created a new(ish) color-coded map to show the level of community spread in each county across the US. To determine the level of community spread (green-yellow-red), CDC is looking at the number of hospital beds being used, COVID hospitalizations, and the total number of new positive cases (as determined by PCR testing). While this data is helpful, it is also limited. And for me — as an epidemiologist and mom, I am taking the map as one source of information.
I am also looking at — viral levels in wastewater and listening to the town gossip.
The results from rapid antigen tests and home tests are not being recorded; no one is tracking the results and there are no trends to follow. This means that case counts do NOT include positive results from home or rapid tests. In my hometown, there was a recent COVID outbreak on our college campus. The nearly 200 cases diagnosed over the past 10 days are not included in the state or national counts because rapid antigen tests are being used on campus. So — knowing what is going on locally is so important. I have long told my students that epidemiology is —
“Town gossip with a healthy dose of Pepto-Bismol.”
I am listening to school officials about the number of students who are absent and who are getting sick. I am reading the local newspaper and using Facebook as a source of disease information. And I continue to use Google Trends to see how often people are searching for COVID symptoms, where to buy a home test, and should they seek medical care for COVID.
The CDC dashboard is limited.
Wastewater surveillance may be the most important preventative tool available to us. Sewage treatment plants around the country are measuring the number of viral particles in the sewage as a means of predicting increases in cases. I am working hard to get sewage surveillance in my hometown. In the meantime, I am watching the trends in communities close to ours to see what is happening. Again, I am approaching this surveillance with a sense of calm — the number of viral particles will fluctuate. So an increase does not mean mandatory masks or shutting down the economy. But looking at the trend line can help us predict if more cases are on the horizon or if we are at a steady-state of disease.
Wastewater surveillance is part of the future of public health.
How am I handling masking? vaccinating? boosting? summer travel?
To mask or not to mask…. this is still an unknown. I believe that masks are still needed in poorly ventilated indoor environments where lots of people are gathered. However, I am trying to take my mask off as often as possible while case counts are low. I am also navigating all my feelings associated with a mask. I have long been critical of individuals who were not masking (or not masking properly) in the midst of the Delta and Omicron spikes. Now that cases are down, I am navigating the fact that I wore my mask as a badge of honor and as a preventative measure. And now that case counts are low, taking it off is ok (the risk of exposure is low), but I still want to signal to people that community health, disease mitigation, and prevention are important to me.
I’m struggling with when to mask and when not to.
And my struggle is complicated by the fact that there is little research to help guide my individual decisions on a day-to-day basis.
I am committed to masking when I have symptoms of disease (if I must go out), masking before I travel (especially when a negative PCR test is needed), on public transportation, including the jetway in airports, and in spaces where I am asked to do so.
As for vaccinating — this is simple. VACCINES SAVE LIVES. Vaccines prevent severe disease and death. They also help individuals to clear the virus faster. Everyone 5+ should be vaccinated against COVID and should have at least one booster shot. Immunocompromised individuals should have two boosters.
Summer travel — we are planning to travel. I am traveling internationally next month (will share details next week). My kids are planning to go to summer camps/school. But we know that a positive test or rise in cases could disrupt our plans. What I do know is that as a family we enjoy traveling and it is good for our hearts, minds, and souls to get away together. While COVID is a risk, the benefit of doing something we enjoy together far outweighs the risk. This could change at a moment’s notice, but for now, we are planning to travel this summer.
What am I expecting for the summer in terms of disease/the pandemic?
I don’t know… that’s the truth.
Dr. Brix recently came out and said she expects another spike this summer. While I appreciate her cautionary tale, there is NO WAY to know what the summer hold or how the virus will mutate. Yes, we have seen spikes the previous two summers, but that is not predictive. It is cautionary, but there is no way to predict a summer spike.
We need to expect that things will change.
We need to expect the unexpected.
We need to expect COVID to be part of our lives moving forward.
We cannot control the virus, but we can work to mitigate disease spread.
And we must think about working to mitigate disease spread (and not just COVID) together as a community (both local and global). The idea that health can be treated like a Choose Your Own Adventure will be our ruin.
What we need to do is come together as a team — where we each have individual roles, positions, responsibilities, strengths, and weaknesses. But TOGETHER we have a shared goal — to create a healthy community for all. If we think about public health or our pandemic response as a team effort, I believe we can wrestle through the unknowns, talk about disease, learn from one another, and ultimately create a space where health — physical, mental, emotional — is possible for all.
Life is a team sport.
Thanks again for sharing your information and appreciate your thought process. It makes me feel more confident making decisions.❤️