August 14, 2022

I’m confused. And, if I’m confused, I imagine many of you are as well. Once again, the national public health system is changing its guidelines but without offering clear and concise reasoning behind these changes so that we all can make the wisest choices for ourselves and our families. This has been one of my biggest beefs throughout the whole Covid pandemic – poor messaging. Under the prior administration, it was deliberate for political purposes. Under the current administration, it appears to be due to a lack of marketing acumen which can allow for the necessary information to be reduced to easily digestible concepts and then given to all of the various media outlets in a consistent fashion. I am no fan of Fox News, but the federal government could learn a thing or two from them. They’re masterful at this sort of work.

Anyway, I have done a little poking around into the new CDC guidelines and some reading on what else seems to be happening these days in Covidland so I’ll do my best to clarify what all this means as I see it. First off, our late summer BA5 omicron surge appears to be waning somewhat. The number of new cases reporting daily has been slowly dropping and, at current trends, should be back under 100,000 a day by Labor Day. The number of people in the hospital and the ICU also are slowly descending (roughly 50,000 and 5.000 respectively at the moment). The only indicator that has been creeping up is the death toll which is nearing 500 a day, well over double what it was a couple of months ago. This is probably the usual lagging indictor phenomenon where the death rate rises 4-6 weeks after the case numbers start to go up. Will these numbers go back to the lows of late spring? Will numbers really start to peak in the fall? Who knows. Tune in tomorrow…

When one looks at the CDC guidelines, it’s clear that their ultimate goal regarding the pandemic at this stage is not to prevent all disease and transmission but rather to prevent serious disease that requires hospitalization. The agency is smart enough to recognize that mild disease from which one can recover at home is likely to simply be an endemic part of our lives going forward. They understand that the acute care health system, as battered as it has been over the last few years, is in difficulties and that the most important thing for society is to preserve its functioning so that it can take care of all of the other non-Covid related needs we have, especially in light of the rapid aging of the population due to the demographic position of the Baby Boom. I think we just need to keep that lens firmly in place while scrutinizing what the agency has to say. The major problem with this approach is that it does not take into account different risk stratifications for different populations; when that happens, higher risk subgroups are more likely to bear the brunt of disease morbidity and mortality.

The current CDC guidance on quarantine/isolation is to remove the requirement that someone who was exposed, but not sick, should isolate for five days in order to break transmission chains. No one was really doing this anyway, at least not in recent months, and I suppose that they feel the risks to society from excess quarantines and short staffing were worse than the risk of potential transmission. They still request quarantine for five days from initial symptoms/testing positive with an additional five days of total masking. This is all well and good, but there is some evidence that BA5 remains infectious on day 5. The CDC making this recommendation means, of course, that employers can require workers to come back to work after five days, even if they might transmit to coworkers. It will be interesting to see if there is a spike in workplace transmission as compared to general community transmission. There are also social justice concerns as lower paid workers are more likely to have jobs needing in person contact while higher paid workers may have work from home options. There is no requirement under CDC guidelines that there be a negative test to ‘clear’ someone. PCR tests in particular can read positive for days after the ability to transmit has been lost. I don’t know if this is a good or a not so good thing.

The CDC continues to publish weekly data by county on whether transmission locally is low (masks not needed), medium (masks should be worn indoors by those most at risk) or high (everyone should mask indoors in public). These numbers are not generated based on the risk to an individual being exposed but rather on what transmission rates are likely to do to the local health system in terms of generating serious cases which will require hospital or other acute care. Therefore, they are affected by such things as vaccination rates in the population, statistical analysis on the amount of native immunity present from previous waves, numbers of hospital and ICU beds available etc. Jefferson County Alabama, is currently in the ‘high’ level. I don’t think the local population is reading the CDC website however as I don’t think I’ve seen a lot of masks recently at the grocery store. We’re still masking at work and at church so I’m not worried. King County Washington, where I’m travelling shortly, is in the low category. There’s no CDC readings for Delta Airlines jumbo jets travelling between the two.

The most American piece of the new CDC guidelines is basically that guidance should be tailored to the individual and the individual’s understanding of risk. That’s all and good, but as a public health strategy, it will open up a lot of subgroups to higher risks of infection or reinfection and that in turn is going to mean continued cases, continued rise in long Covid cases with completely unknown sequelae in the future, and the potential of putting the elderly and those with compromised immune systems in harms way. Fortunately, we do have a decent weapon in the arsenal with the oral antiviral Paxlovid which seems to be quite effective against omicron and helps prevent cases from advancing to the point that hospital care is needed. It’s now widely available and it may be why the current wave hasn’t been worse.

What does this all boil down to? First, get your vaccines and boosters. Fully vaccinated at this point means at least one booster and, if you’re over fifty or have a chronic illness, I’d go get that second one and not wait. Yest, there’s supposed to be an omicron specific one in the fall but who knows when that will actually be in widespread distribution. I’m planning on taking each and every booster that comes down the pike as those unknown long Covid issues (and long Covid seems to strike 15-20% of those with an infection and the more infections you have, the more likely you’re going to get it) are not something I want to learn about first hand. Second, if you do get sick, get tested and, if positive and symptoms are anything above minor cold symptoms, get a prescription for Paxlovid. If you’re without insurance and can’t afford that trip to urgent care, head straight for the pharmacy. Under the current FDA rules, pharmacists can prescribe and dispense without physician authorization. Third, when indoors with others I’d read the room and put your mask on if you think there’s a chance someone there could expose you. Fourth, you know the litany – wash your hands, use common sense, stay home if you’re sick with anything.

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