Covid Update – Complacency WIll Get The Better of Us

Covid Update – Complacency WIll Get The Better of Us

Andrew Chuma No Comments

Despite what people may think, this pandemic is not over, and there is the potential for things to get much worse before they get better.

Watching what is going on around us these days, one would think that nothing is going on. People going about their daily lives, with an occasional masked person, today looked upon as odd rather than the norm, as it had been for over 2 years. But this attitude of complacency is allowing this pandemic to continue to simmer.

Presently, we have just under 300 deaths a day from Covid in the US. It is significantly higher in other places around the world where the Ba 4 and 5 variants are more common. At the height of the Delta wave, we had about 10x that amount, but 300 deaths a day is still significant. It’s more than how many die from diabetes or Alzheimer’s complications every day, and it seems to have hit a plateau. It’s hard to have an accurate number of daily new infections since so many of them are going unreported and are not requiring hospitalization or doctors visits but in many places in the US, hospitalizations are on the rise. Why? Again, it is about the numbers. As I have said before, a small percentage of a big number is still a big number.

In my office, I am seeing more and more people who have had Covid recently, and not surprisingly, more and more people with long-haul Covid symptoms. Loss of smell and taste, distorted taste, brain fog, weird mouth symptoms, ringing…

Presently, the main variant in the US is the Omicron Ba 1.2 1.2 variant (that is not a typo, it is just 1.2 x 2). But, just like everywhere else in the world, the Ba 4 and 5 sub variants are on the rise. Ba4 and 5 represented 5 and 8% of new cases 2 weeks ago. This week, they represent 11 and 25% of new cases, a clear and significant jump.

Although it is not definitively clear if Ba 4 and 5 cause more or less significant disease than its predecessor, it is definitely more infectious and even more concerning, it evades previous immune protection from vaccination and infection to a much greater degree. Even if one had a recent infection with one of the previous Omicron variants, there appears to be little protection against 4 and 5. Recurrent infections are becoming more and more common, and in many cases, recurrent infections are more severe.

It also appears that prior vaccination or infection is providing less and less reduction in death rate with recurrent infections. Disease severity seems to be still reduced overall, but death rates are only slightly reduced. In one study from Minnesota, whereas full vaccination and boosting reduced death rates by as much as 20x compared with those unvaccinated with previous versions of SARS-Cov-2, the rates with Omicron are barely above 1.5x risk reduction of death.

Although I am still a vaccine advocate, vaccines are not a panacea and will not save us. We need to shift our mindset from eradicating this virus to dealing with it. But dealing with it does not mean ignoring it and hoping for the best. I think that dealing with this virus will be a combination of changes in human behavior, people getting healthier in order to deal with the disease better and improvement in therapeutics, including updated vaccines, antivirals as well as other treatment modalities.

We can hope for more therapeutics, but ultimately, we know what works. Proper masking, distancing and responsible social behavior. I’m not saying we need to isolate and be hermits, wear a mask while riding a bike or keep a wide berth of all people at all locations! But reasonable, situational decisions are imperative.

  1. If you are sick (or had a positive test, even if asymptomatic), stay home. Don’t get anyone else sick. It’s just responsible behavior. Don’t rely on negative tests since there are many false negatives, especially with the new variants, and few false positives. I also do not subscribe to the 5 day isolation rule. It simply does not clear that quickly. If you do mingle with people before the 10 days, wear an N95 mask to protect them. Lastly, a negative COvid test may mean you don;t have COvid, but if you have symptoms which make you concerned enough to test, you probably have some other kind of viral infection, so stay home, hydrate, eat your fruits and veggies and be responsible.
  2. Mask appropriately. Wear a good one (N or KN95, thick or multilayer cloth, surgical or double surgical). Wear it correctly. And wear it where it makes sense. A small grocery store in the morning with few people is probably safe. A Friday afternoon at Wegmans is a Sh&* Show! Wear a mask. Or choose better shopping times. Being at an open air restaurant is probably fine. Being on the beach is fine. Riding a bike is fine. Being on the Boardwalk, shoulder to shoulder with the sweaty, screaming masses, maybe skip that one! Lastly, a recent study of many thousands of people showed that masking on planes reduces infection rates. So if you travel, be smart.
  3. Get healthy so you are resilient. Stop making excuses and eat better, eat less, move more, stress less, sleep better. Just do it already. It’s cute to say you put on the “Covid-19”, like the “Freshman 20”… but once again the most significant risk factor for getting Covid and having a worse outcome is being overweight.

If I don’t post again before next weekend, have a great July 4th. We don’t need to make America great again. It already is great. We just need to appreciate all that we have and be a little less selfish.

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Stay safe and be well.

AC

Covid Management Strategies

Andrew Chuma No Comments

I haven’t posted much recently about Covid. 

Quite honestly, there is not all that much new to talk about. In addition, headlines have been dominated by the war in Ukraine, politics, Johnny Depp and now the horrific mass shooting in Texas. 

Case numbers are slowly on the rise. Because of home testing, which is unreported, the true number of infections is likely much higher. It seems like everyone recently has had Covid or knows someone who has. 

Much to my surprise, despite my daily exposure, I have not been infected. Recent blood work shows that I have not been exposed enough to the actual virus to have developed antibodies. Without question, I have been exposed multiple times, but I attribute the lack of actual infection to vaccination (I am double vaccinated and double boosted), being careful with constant N95 masking at work and in most other public places, as well as a healthy vegan lifestyle along with daily exercise. My sleep and stress management could be tuned up a bit. Actually a lot, but no one is perfect. As an aside, studies of thousands of healthcare workers have shown that being plant-based dramatically reduces the risks of getting Covid or having significant disease if contracted. I have no delusions that I won’t get infected eventually.

Vaccination rates have dropped, with only 48% of Amercans over 12 now being fully vaccinated with either one or two boosters, if appropriate. Although we are behind every other developed country, quite honestly, we are not that far behind. For example in Canada, they have only 55% of their over 12 population fully vaccinated. Most European countries are at least in the 60%s with adults being even much higher. Some Asian countries are in much better shape but interestingly, China is not (only 61% of their adult population is fully vaccinated. If you include over 12, the rate is much lower). In China, people just don’t trust their vaccine, and they have cause for concern. It is just not as good, and almost useless against Omicron and its sublineages. Same goes for the Russian Sputnik vaccine.

Clearly, I am a proponent of vaccination, however, just like “hoping you don’t get sick” won’t protect you, vaccination is not the strategy which will rid us of this disease. I don’t think anything will. We can only hope to manage it and minimize the degree of disease. No one can predict how this will all settle out. It would be great if it ultimately turned into another seasonal flu-like illness, with an annual Covid shot being adequate. But unlike Influenza, the SARS-Cov-2 virus does not respect seasons and is much more infectious. The Covid vaccine wanes in its efficacy after 4-6 months, but so do the Flu and Pneumonia vaccines. It DOES however lower severity of disease, risk of hospitalization, deaths as well as occurence of long-haul symptoms.

Clearly, people are not willing to do the things we know are safe like prudent, quality masking and distancing. At this stage, it seems to be a free for all.

And it is not only in the US. From what I have heard from others who have travelled, many other European countries seem to have returned to regular activity, behaving as if there is no pandemic, which is clearly still going on.

Our government policies and recommendations are conflicting and also seem to have bent to the will of the masses, recommending what is likely to be followed, which is nothing, rather than what is prudent. This is like doctors not telling patients not to quit smoking or lose weight because they know they won’t do it anyway! It’s unethical.

Take the recommendation for quarantining. The original strain of SARS-Cov-2 was contagious for up to 2 weeks. As mutations occurred, the duration dropped to 10 days. Recent studies suggest that Omicron and its sub variants remain contagious, and to a greater degree than the original form, for the same 10-day duration. So why drop isolation requirements to 5 days? CONVENIENCE! I understand the inconvenience that being sick imposes on us, but it’s no excuse. We must do what’s best for everyone and not just the individual.

I was surprised that the CDC actually recently recommended that NJ residents start masking indoors given the uptick in cases all over the state. But I was not surprised that the NJ authorities ignored this recommendation. This was clear when I was down in Wildwood recently. Not a mask in site.

For all the Covid travel restrictions, I must say that I have had a pretty amazing travel schedule these last couple of years, mostly a result of having to use up some travel funds before they expired. My wonderful wife planned an epic trip for our family which was supposed to occur just as lockdowns were initiated a few years ago. The trip was canceled but our deposit was non-refundable. Sadly, Toronto, Canada was not one of the places I visited, but I promise to get up there soon. I have many great friends I grew up with and really miss up there. I was however in Mexico (Pacific side), Costa Rica, Peru (our original epic trip destination) as well as a few domestic ski trips. In addition to the amazing sights we have seen and people we met, it has been very interesting comparing how different places have dealt with this pandemic. 

In Peru for example, a month ago, there was still a national mandate to wear either an N95 or 2 surgical masks, indoors and out, all the time. None of this loosey-goosey “face covering” ridiculousness we have had here. Now, Peru got hammered with Covid at the start of the pandemic so their paranoia was understandable. Despite the lifting of outdoor mandates the day after we got there, even after a week, most people were still walking around outside with masks. Even in the Amazon. In Mexico, we had to wash our hands and pass a “smell test” before entering the resort. It was ridiculous because you could hear people announce “coffee beans” from yards away so it wasn’t much of a challenge to pass since there was only one option to smell. Before entering all the outdoor restaurants, we had to apply hand sanitizer. In Costa Rica, even while being wheeled around in an open air golf cart, we had to wear a mask. Masks were not required on the beach, but they were to enter the outdoor restaurants 5 feet away. 

All over the world, including the US, there are inconsistencies of policy and practice. But at least in those countries we visited, there wasn’t the anger and resistance we see here, where quite honestly, rules have been pretty lax comparatively.

We have no idea how this pandemic will continue to evolve, but it will evolve. As long as the virus is allowed to spread, anywhere in the world, the rest of the world is at risk. Elimination is likely an impossibility, short of it mutating itself out of existence. But as the Influenza virus which caused the 1918 pandemic, resurfacing as H1N1 in the 80’s has shown us, nothing is gone forever. Polio may be one of very few exceptions, and that’s because everyone was forced to be vaccinated!

What we do know is that careful and responsible behavior lessens the spread and the severity of this disease.

Please get vaccinated and boosted. You may still get sick, but you have a much better chance of getting over it more easily. If you can avoid it by additional masking, distancing and being careful, do it. I am seeing more and more long-haul symptoms.

Speaking of long-haul symptoms, this concept is by no means new. Long-term side effects have resulted from every kind of infection which has existed, not to mention drug side effects. In fact, the loss of smell seen with Covid is much less permanent and problematic than the loss of smell which is more often permanent as a result of the other 4, very common coronaviruses which have existed for decades causing the common cold. Endocarditis, neurologic symptoms like brain fog, as well as many other symptoms have existed long before Covid-19. We are focussing on it more simply because Covid-19 has affected so many more people than any other previous infection. It looks like there are a lot of long-haulers, but proportionately, there aren’t.

Stay safe and Be well.

AC

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