“Shared expectations lead to predictability.”
526. With full vaccinations and booster shots, the impact of Covid-19 resembles flu.
Q: Is the current Covid-19 disease still worse than the seasonal flu?
A: A special report was recently written in the New York Times, highlighting that the share of cases that turn into severe illnesses is declining. Three main reasons were given:
- Vaccinations and booster shots are effective and universally available to Americans.
- Treatments are increasingly available for therapeutics like Evusheld for the immunocompromised and Paxlovid for vulnerable people who get infected.
- Tens of millions of Americans have already been infected with the virus, providing them with at least some immunity.
These trends will not eliminate severe Covid. The number of nationwide hospitalizations will probably rise in the coming weeks, especially if cases continue to rise.
The declining share of coronavirus cases that result in serious illness would be very good news, stated Dr. Craig Spencer, director of global health in emergency medicine at Columbia University. Among other things, a decoupling of cases and severe illness would mean that hospitals were less likely to become overwhelmed during future Covid surges, which becomes another factor that reduces bad health outcomes.
Vaccines and treatments like Paxlovid tend to turn Covid into an illness of similar severity to seasonal flu. This has been verified by the county surrounding Seattle, Washington, which keeps detailed data. The daily Covid death rate for boosted elderly people has recently hovered around two per million. In a mild flu season nationally, that is higher than the death rate but somewhat lower than during a heavy influenza season.
For boosted people, the odds of severe Covid really do resemble the odds of severe influenza. And it was noted you don’t tend to see news stories every time a member of Congress or a Broadway star contracts the flu. It is understood why the country is still treating Covid as a serious illness. For one thing, the large number of unvaccinated people means that Covid is still killing about 500 Americans a day. For another, Covid has dominated life for more than two years, and we can’t flip a switch and return to 2019.
Yet it would not be rational to treat the 2022 version of Covid as if it were identical to the 2020 version. It isn’t. Vaccines, treatments and even natural immunity have transformed the impact of the virus, especially for Americans who have chosen to protect themselves.
527. A historical review of convalescence identifies better paths for recovery.
Q: How did our forefathers manage long-term diseases like tuberculosis differently?
A: There is much anxiety today about the possibility of contracting “long-Covid’ consequences of this pandemic. Historical studies have shown that prior to the 20th century, many illnesses took a long time for a patient’s recovery. A raft of infectious diseases from typhoid to tuberculosis were included. This process of restoration—a stage between acute illness and full health—was a major focus of physicians and families. For centuries, the care of convalescents came with its own set of theories and rules, intended to prevent relapse and integrate patients back into normal life. With medical advancements, tolerance for long recovery waned.
“Modern medicine is uncomfortable dealing with things where we don’t have a quick fix,” says Lancelot Pinto, consultant pulmonologist in Mumbai. “When there were no cures, patients were allowed to live out the natural history of the disease. We have forgotten how this was accepted, and we have lost the methods that make this acceptable.” He suggests that once a drug is found for COVID-19, “the workplace office will expect you back in five days.” But Pinto also acknowledges the opportunity for advancing understanding of long-term mechanisms in virus illnesses. Post-viral symptoms have been documented in diseases from SARS to dengue but remain poorly studied. Renewal of former ways to enhance convalescence is needed.
Sally Sheard, historian and executive dean of the Institute of Population Health at the University of Liverpool, stated “One of the clearest messages from my work on convalescence is that you cannot rush the process.” Some COVID-19 patients were discharged too fast, to free up beds, while others were delayed in hospital too long because they had no help at home, she says, adding, “so maybe we need halfway or recovery homes,” not unlike convalescent homes, or a tuberculosis sanitarium.
The pandemic has brought new attention to long-term recovery as scientists gain a growing understanding of long COVID-19—a condition in which symptoms linger long after the initial diagnosis and illness. Many hospitals around the world have set up post-acute care clinics for these patients.
528. The transportation mask mandate has been stopped by a judicial decision.
Q: What does the federal court action removing the CDC travel mask mandate mean?
A: On Monday, April 19, Tampa, Florida-based Federal District judge Kathryn Kimball Mizelle threw out the mask mandate the Centers for Disease Control and Prevention had imposed on all interstate transportation hubs including commercial airports and airplanes. Mizelle’s analysis focused on two distinct holdings — her interpretation that the CDC lacked the statutory authority to impose such a mandate which is worded to promote “sanitation,” and that, in any event, the CDC rules applied nationwide, and rather than find for the plaintiffs that had sued for relief, she rendered it invalid nationwide. Therefore, by Monday afternoon, most major airlines and transportation services were no longer enforcing mask requirements.
In the past, the Supreme Court by its rulings has made it difficult to bring class-action suits that apply to all members in a defined class. “Universal injunctions” have become far more common. A universal injunction is a court decision that if a single group wins a case to stop an action, the court can extend that injunction to other similar groups even if they were not part of the adjudicated case.
Judge Mizelle’s action was defined as a “universal injunction.” If not appealed, it will become a judicial precedent that any group that feels aggrieved by having to follow a public health mandate can sue with the result that can dictate a nationwide order against that mandate. This precedent could allow parents in one school that dispute a mandate against students requiring school vaccinations to lead to a nationwide removal of such mandates. If that suit was brought in the late summer, it might take months – or longer – before an appeal could be successful in re-establishing that mandate. CDC is one of the world’s most prestigious public health organizations. Mizelle’s precedent could put public health policies in control of the judicial system, replacing science with lawyers and the prevailing political will.
529. Factors are identified to decide when a second booster could best be taken.
Q: If vaccines and boosters wane, should I wait until Fall and my long trip to get boosted?
A: In a recent forum, New York Times science and global health reporter responded by stating that timing the vaccines for maximum protection is indeed key. The ability of the vaccines to prevent infections drops off sharply but protection against severe illness lasts longer. It takes about a week for the booster to kick the immune system into gear. So, for people younger than 60 and in relatively good health, it may be OK to time a vaccine dose for the next surge or a trip to see vulnerable relatives. But for older adults and others at higher risk, experts recommend a second booster shot now. With numbers rising nationwide, they say, you’ll want to be protected against infection, not just severe illness, and a second booster shot will extend the longevity of the shield.
530. U.S. Supreme Court rules that a military mandate for vaccination is valid.
Q: If workers cannot be mandated to be vaccinated, what about the military?
A: The Supreme Court ruled a week ago Monday that the Pentagon may take disciplinary action against a lieutenant colonel in the Air Force Reserve who refused to be vaccinated against the coronavirus on religious grounds. The court’s brief, unsigned order gave no reasons, which is common when the justices act on emergency applications. The court’s three most conservative members — Justices Clarence Thomas, Samuel A. Alito Jr. and Neil M. Gorsuch — noted dissents but did not explain their thinking. In this case, Lt. Col. Jonathan Dunn, who has been removed from his command after serving for nearly two decades as a pilot, trainer, and commander, said he sought only “protection against further punishment, including a discharge.” Colonel Dunn, who has received many other vaccinations without objection, said he decided that the coronavirus vaccine violated his faith after seeing President Biden speak about it, leading him to conclude that “the vaccine ceased to be merely a medical intervention and took on a symbolic and even sacramental quality.”
