For the past several months, Covid-19 cases in the United States have waned, giving many the impression that the pandemic has come to its end. Now, cases have started to increase, alarming health officials as the general public shows Covid-19 fatigue- exhaustion from talking, reading, and hearing about Covid-19, as well as adhering to preventative policies. With this mindset, we will encounter any new wave of infections unprepared and experience more unnecessary loss of life.
Yet, there are many ways to continue being cautious, while also learning to live with the reality that Covid may likely become endemic. Dr. Stephen Parodi, an infectious diseases physician and associate executive director for The Permanente Medical Group in Oakland, CA, explains, “Endemic diseases can be at high levels. They can be at lower levels. So, where I think we’re at a crossroads is that we have an opportunity to actually get that to a lower level, manageable level, where we’re not getting impacted in our hospitals, not having to close down schools, close down businesses,” he added. “That really is through a combination of a concerted effort around testing, vaccination, isolation, quarantining, that looks a lot more normalized than what we’ve had to do over the last two years.” He goes on to explain that there is no specific marker for when a disease is endemic, “This shift to looking at it from a severity of disease standpoint is important. A measure of endemicity really is going to look at how many people are developing severe disease at a given time. If we’re seeing increases in that, we’ve got to take action. If we’re not, that’s a different set of actions, and that’s similar to what we do for influenza year over year.”
As with many other health issues, preventative measures are the ideal way to avoid severe complications. In the case of Covid-19, there are several practices that, when practiced in tandem, help prevent infection and the spread of illness.
Primary vaccinations and boosters are available for adults and children 12+, and children 5+ are eligible for their primary vaccines. Vaccinations prevent severe illness and risk of hospitalization and death from Covid-19. You can read more here about the importance of the Covid vaccine in helping prevent infection and the spread of the disease. For information on where to find vaccinations in Arizona, read here.
In late April 2022, the CDC updated its masking policies for the second time; The latest recommendations allow people in the United States to remove their masks if they want- indoors as well as outdoors, based on whether their county falls into the category of “low” risk. The categories, low, medium, or high, are based on data such as hospital beds being used, hospital admissions, and total number of new COVID-19 cases per 100,000 people in an area in the previous week. You can check the risk in your county using a tool on the CDC website.
As a result of a court order, as of April 18, 2022, the CDC’s January 2021 order requiring masks on public transportation and at transportation hubs is no longer in effect. But, the CDC continues to recommend that people wear masks in indoor public transportation settings at this time. The Department of Justice is in the process of fighting this order and reinstating the mask order as CDC guidelines recommend.
The choice is an individual one, with many factors to consider such as vaccination status, your exposure to people who are at higher risk of severe disease, specific setting of a gathering (whether indoors or outdoors, and density of people in attendance), and many other factors. Masking is a straightforward way to prevent infection of yourself and others. In light of how quickly the virus can shift its course, please keep your mask handy, as recommendations may change in the future based on transmission levels and virulence of new variants.
The American Medical Association encourages people to continue testing when they develop symptoms or may have been in close contact with somebody infected with Covid-19. But, they also explain that as the pandemic shifts, so do the testing guidelines, especially as more people continue to get vaccinated. Your line of work, if you are around somebody who is more susceptible, travel, as well as state and local guidelines (that often shift), all play a role into why people may test. In certain situations, testing is an important factor in keeping everybody safe- as in a medical setting where it is important to separate those that have Covid and those who do not- but the tests are not without their limitations, and are a snapshot in time. Dr. Scott Koepsell, MD, PhD, a pathologist and vice chair for clinical operations at Nebraska Medicine in Omaha shares, “a negative test today doesn’t ensure safety for tomorrow because people can be infected at any time point. You have to really consider factors of exposure. Are you wearing your mask when you’re around others in public? What are your symptoms?” he said. “And those all have to be taken into consideration when interpreting these tests.”You can read more about what to consider when testing, and more info, here.
According to the CDC, a person with COVID-19 is considered infectious starting two days before they develop symptoms, or two days before the date of their positive test if they do not have symptoms. The guidelines for when to quarantine and isolate vary depending on vaccination status, symptoms, exposure level, and more. The CDC provides this quarantine or isolation calculator to help guide you through next steps if you’ve tested positive for Covid-19, have been in close contact with somebody who has tested positive for Covid-19, or if you have develop symptoms.
Seek treatment when necessary
Monoclonal antibody treatments: The Food and Drug Administration has issued EUAs (emergency use authorization) for several monoclonal antibody treatments for COVID-19 for the treatment, and in some cases prevention, of COVID-19 in adults and pediatric patients. Monoclonal antibodies are laboratory-made molecules that act as substitute antibodies. They can help your immune system recognize and respond more effectively to the virus, making it more difficult for the virus to reproduce and cause harm. monoclonal infusion
Antiviral pills: Another option are antiviral pills, such as Paxlovid, which received emergency use authorization in late December 2021. The treatment is available to anyone ages 12 and older who weighs at least 88 pounds, and is at high risk for severe disease. Pfizer recently began Phase 2 and 3 trials in children and teens ages 6 to 17. The at-home oral antiviral pills can reduce the risk of severe illness and death by as much as 89% and can be prescribed by a medical provider. You can read more about Paxlovid and Molnupiravir (which was also provided EUA, but was only shown to reduce the risk of hospitalization and death by roughly 30%), here.
Decrease risk factors for severe illness
Certain underlying health issues result in a higher risk of severe illness or death from Covid-19. In some cases, efforts can be made to decrease the risk of developing those health concerns, or managing the condition- ultimately reducing the risk associated with Covid-19. The CDC shared a grouping (although not to be considered a complete list) of factors that are high risk, based on published meta-analysis or systematic review. Some risk factors include:
- Chronic kidney disease
- Chronic liver diseases like cirrhosis and fatty liver disease
- Heart conditions (e.g. coronary artery disease, heart failure)
- Physical inactivity
- Pregnancy and recent pregnancy
- Mental health disorders, including depression
We are all tired of hearing and talking about COVID, but it’s not over. Last week the number of souls lost to COVID surpassed one million. 400 lives are still lost everyday. If we all take advantage of the incredible and vast resources at our disposal we can keep anyone else from dying or living with the consequences of surviving a COVID infection. Sadly, in too many cases, the issues don’t end when the acute infection is over. Next week I’ll discuss those consequences in detail.