Frequently Asked Questions about COVID-19 — April 13, 2022

“Shared expectations lead to predictability.”

516. The BA.2 subvarient is now the dominant strain of Covid-19 in the U.S.

         QIf the mutation of the Omicron variant is more infectious, is it now dominant?

         A:  The highly infectious BA.2 Omnicron subvariant is now the dominant version of the coronavirus now circulating in the United States, according to federal officials.  Some officials warn of a new U.S. surge based on a significant increase in cases in other countries.

Over the week ending March 25, the BA.2 subvariant made up 55% of all new cases of Covid-19 in the U.S., according to the CDC.  That was up from 39% the week before.  BA.2 is estimated to be between 30% and 60% more infectious than Omicron.

Officials have uniformly recognized that over time, vaccinations provide waning immunity.  Peter Chin-Hong, a University of California San Francisco infectious disease expert, urged those age 65 and older – to get their second booster shot quickly.

517.  There are four current strategies that can minimize Covid’s future effects.

         Q What can we do now to help reduce the negative outcomes from future Covid cases?  

         A:  David Leonhardt on March 28 published an article in the New York Times that identified four separate strategies to minimize the bad outcomes from Covid-19:

  1. Promote increasing the number of people getting booster shots. Almost one-quarter of U.S. adults have been vaccinated but have not received a booster shot, according to Kaiser Family Foundation surveys. “I remain most worried about lack of booster uptake among the elderly and the immunocompromised,” Jennifer Nuzzo, a Johns Hopkins University epidemiologist, stated.  Efforts to promote getting booster shots are needed.  The FDA has just authorized a second booster shot four months after the first one.  Everyone who is eligible needs to get one.
  2. Many of the immunocompromised need to get a new medication. A small percentage of Americans who are receiving cancer treatments and those who have received certain organ transplants find that vaccinations either cannot be taken or provide limited immunity.  Fortunately, a drug now exists that may help many of them.  It is a monoclonal antibody injection called Evusheld, developed by AstraZeneca.  Given before exposure to the virus, it can provide months of protection from developing the disease.  With enough doses ordered to treat 850,000 people, about 80 percent of the doses are sitting unused.  “The biggest problem is that there is absolutely no guidance or prioritization or any rollout in place at all,” Dr. Dorry Segev of N.Y.U. Langone Health stated, “It’s been a mess.”
  3. Promote post-infection treatments. A knowledge gap is also hampering the distribution of Paxlovid — a post-infection treatment from Pfizer that sharply reduces the chance a Covid illness will become severe. It is most effective when prescribed shortly after symptoms begin, but many Americans do not know it exists. One thing to keep in mind: This drug is now authorized only for high-risk people such as those over age 64 or those with serious underlying medical conditions.
  4. Too many people wear low-quality masks or take them off at times, and Omicron is so contagious that it takes advantage of these gaps.  But masks can still help reduce Covid’s spread.  Masks also make sense for people who have returned to work or school five to 10 days after a Covid infection, Dr. Shira Doron of Tufts Medical Center stated.  Note: masks can be worn anytime, even when not required.

518.  Increased rage and criminal activity during the pandemic may be resolving.

         Q:  Why are people becoming so weird in relating to each other during the pandemic?

         ABad behavior of all kinds —everything from rudeness and carelessness to physical violence—has increased.  Olga Khazan, a staff writer at The Atlantic recently wrote on why this is happening,  There are many possible explanations.  One likely cause is the rage, frustration, and stress coursing through society right now.  The pandemic has created a lot of “high-stress, low-reward” situations, and now everyone is teetering slightly closer to their breaking point.  People have been coping with the pandemic by drinking more and doing more drugs.  A lot of auto accidents, including aggression-driven crashes, result from alcohol or drug use.  One study found that Americans have been drinking 14% more days each month during the pandemic.  Americans have also been buying more guns, which may help explain the uptick in the murder rate.

The pandemic has loosened ties between people.  Kids stopped going to school; their parents stopped going to work; parishioners stopped going to church; people stopped gathering, in general.  “We’re more likely to break rules when our bonds to society are weakened,” Robert Sampson, a Harvard sociologist who studies social disorder, stated. “When we become untethered, we tend to prioritize our own private interests over those of others or the public.”  The turn-of-the-20th-century scholar Émile Durkheim called this state anomie, or a lack of social norms which leads to lawlessness. “We are moral beings to the extent that we are social beings,”

Some of the antisocial behavior Americans are seeing will resolve itself as the pandemic loosens its grip.

519.  Everyone eligible should get their booster shots when these are available.

         Q: I didn’t get the first booster shot earlier; why should I get one now?

         A:  The authorization of the first booster shot during the Omicron surge cut seniors’ risks of hospitalization and death by more than 70 percent. But the extra shots still didn’t come close to eliminating risk.  Not all who were eligible got boosted.  Adults ages 65 and older were still hospitalized at nearly twice the rate, and dying at 16 times the rate of 18-to-49-year-olds.  The FDA has authorized a fourth shot for older people, and not much is stopping seniors who want to re-boost from doing so already.

The dilemma is that not all those who could get their first booster shots have done so.  Those who didn’t contract Covid-19 now can feel that their holding off was justified.  For many older Americans, the sense of protection – no matter how small – is worth the safety of avoiding an infection that might be prevented.  For many others, the motivation to get anything beyond the original vaccinations may be seen as of little importance because breakthrough cases are perceived as always being mild and of little consequence.  Yet, each breakthrough case can allow a new variant to emerge or surge in its dominance.  And, as been shown, even mild Covid cases can result in delayed long-term acute medical consequences such as stroke and heart attack.  For their personal protection, and to reduce the pandemic’s threat to the population, everyone eligible should get their booster shots when these are available.

520.  Indoor ventilation will be a public health priority for future airborne infections.

         Q:  Why is Covid more infectious indoors than outside?

         A:  Public health traditionally controlled infectious diseases by controlling the environment by which infectious agents spread between people.  Cholera spreads when mixing sewerage gets into drinking water.  Cholera was resolved in England in 1846 by building separate aquafer systems for each.  Now, Covid, along with the common cold and influenza remains omnipresent because we have not addressed the control of indoor air!

We lost the focus to do this in the early stages of Covid-19.  Remember that the original dogma was that the novel coronavirus spread through droplets that quickly fell out of the air. We didn’t need ventilation or masks; we needed to wash our hands and disinfect everything we touched.  The 6-foot social distancing was based on the distance that droplets fell to the floor or other surface.  But a year and half of evidence have made it clear that the tiny virus-laden particles indeed linger and spread in the air of poorly ventilated areas. This explains why outdoors is safer than indoors; why a single infected person can super-spread to dozens of others without directly speaking to or touching them. Many scientists are now pushing to reimagine building ventilation and clean up indoor air.  We don’t drink contaminated water. Why do we tolerate breathing contaminated air?  We’ve long accepted colds and flu as inevitable facts of life, but are they?  Why not redesign the airflow in our buildings to prevent them, too? The same measures that protect us from common viruses might also protect us from the next unknown pathogen.

A rule of thumb has emerged that at least four to six complete air exchanges an hour in a room can provide protection. The challenge ahead is cost.  Federal budgets were proposed to fund schools to update ventilation systems, but Congress dropped that provision before the bill was passed.  For those agencies that have made some progress in ventilation, it is imperative that they not relax now when the number of cases has been reduced.  The next new variant or disease may surge faster than it will take to make indoor spaces safe again for people to gather.