On April 13, 2020 I spoke at a press conference stating that COVID-19 social mitigation measures would be our “new normal” until we had vaccines. By the end of December 2020, safe and effective COVID-19 vaccines became available in the U.S. in limited supply. Now in April 2022, the COVID-19 vaccine supply in the U.S. is bountiful, with vaccines FDA-approved for those 5 years and older. We also now have new medications that can prevent and treat COVID-19. Compared to the early days of the pandemic, COVID-19 is now preventable, treatable, and controllable. But just as we adapted before, we need to adapt again. It is now for us to make individual choices to keep ourselves and others healthy and safe. It is for us to know about and use the many available COVID-19 control tools.
Despite major advances in COVID-19 care and prevention over the past two years, we remain in the midst of a serious pandemic. In the US, there are about 30,000 new cases, 1,500 new hospitalizations, and 400 new deaths per day per due to COVID-19. We face the continued evolution of COVID-19 to a more contagious virus that appears in unpredictable waves of infection. We face a response to COVID-19 that is varied and at times contentious. We face opposition to vaccination. We face a public increasingly tired of COVID-19 mitigation measures. We face erosion of trust in public health and health leaders. We also recognize that with a polarized public, attaining unified local responses may be difficult, but we also can see the destructiveness of community infighting.
We face continued legal challenges to COVID-19 control measures that are influencing the public health response and limiting CDC authority and action. Federal mandates that large businesses vaccinate their employees have been overturned at the Supreme Court. The recent reintroduction of a mask mandate in Philadelphia is being legally challenged. Less than a week after the CDC extended the mask mandate for travel in response to rising Omicron B2 variant infections, a federal judge vacated the travel mask mandate. These legal rulings means that the authority of the CDC and departments of health are being limited.
Like the virus, we need to recognize that how we are responding to COVID-19 has evolved. The April 2022, the new normal means that individuals, businesses, schools, and communities, will shoulder an increasing responsibility for controlling COVID-19. The new normal is that “recommendation” will replace “mandate.” The new normal is that we work together in conjunction with public health to protect each other and ourselves. The new normal does not mean that COVID-19 is over yet.
First, vaccinated or not, it is our duty not to infect others. If one has COVID-19, we need to isolate. We need to know the symptoms of COVID-19 and get tested when we feel ill. Because up to 30% of individuals with COVID-19 may not have symptoms yet can spread to others, testing is especially important if one is going to be around medically vulnerable individuals, or in closed, crowded settings where there is increased risk of spread. Over the counter COVID-19 tests, which have excellent performance when used serially continue to need to be made widely available.
Second, we need to recognize the importance, safety and efficacy of COVID-19 vaccinations and booster shots for adults and children. Severe COVID-19 infection overwhelmingly now occurs in unvaccinated individuals. More than a third of COVID-19 vaccine-eligible individuals in the U.S. are not vaccinated and misinformation about COVID-19 vaccines have contributed to this problem. .
Third, we need to recognize those who are most vulnerable to the adverse effects of the virus and make sure that these individuals remain protected. We also need to realize that individuals without medical conditions can get severe COVID-19, too. This protection comes in the form of vaccination and booster shots. We need to make sure that appropriate medical preventative therapies are used for those who are medically vulnerable. Evusheld is a new combination monoclonal antibody treatment that markedly reduces one’s chance of getting COVID-19 if you are immunocompromised. However, only about 30% of available Evusheld doses have been used.
Fourth, whether vaccinated or not, we need to make sure that when somebody gets COVID-19 that they can get treated with antiviral agents. The medications include Paxlovid or Molnupiravir, and monoclonal antibodies. Test-to-treat programs need to be publicized and medication availability expanded.
Fifth, we need to realize that the way we track and publicly report COVID-19 infections in communities may be outdated. With there being so many home tests, coupled with an absence of a standardized home testing reporting, we do not know the true numbers of those with COVID-19. Public health officials along with the medical community will need to find and present this information in a unique way. Wastewater testing is one potential strategy as is random surveillance testing of those in the community or testing those seen in healthcare settings.
Six, we need to continue to rely on basic COVID-19 preventative measures. COVID-19 is much less transmissible outdoors than indoors and spreads the greatest in closed, crowded spaces. Proper indoor ventilation needs to become the new normal of our indoor life.
Seven, face masks also have roles in COVID-19 mitigation, as the chance of becoming infected with or spreading COVID-19 is reduced if individuals wear a well-fitting, high-quality face mask. But face mask effectiveness may vary with variant. Face mask use can be facilitated by making high quality masks freely and widely available. We also must recognize how contentious the face mask issue has become and ask ourselves what their role is in layered mitigation strategies. For example, focusing on ventilation and COVID-19 screening alone may be sufficient to control COVID-19 spread without face mask use. The new normal means that we also need to be respectful of personal, business or community choices to wear or not wear a face mask.
Eight, we need the medical community to continue to stand up and be an authoritative source of information. Medicine has been long based on facts and data and public health measures. Increasingly we hear “talk to your trusted healthcare provider.” The medical community has an obligation to call out misstatements and set the facts straight. The medical community needs to step-up to counter false narratives and offer vaccines and boosters to those in their care. The medical community needs to play an even greater role in prescribing the new and effective COVID-19 therapeutics for this preventable and treatable disease.
Barring further severe waves of infection, our collective response will be transitioning to individual persons, businesses, or local organizations. We now have vaccines, medications, and strategies to prevent, treat, and control COVID-19. As before, public health will need to continue its critical role in this pandemic and ensure that COVID-19 control tools and therapeutics are available. Two years into this pandemic, it is for us to know how to and act to keep ourselves and others healthy and safe.
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Contributor: Scott A. Rivkees