Keeping safe from COVID: Apparently it's all up to you

The most recent COVID-19 subvariants, currently accounting for at least half of US infections (and probably comparable world-wide) are the BA.4 and BA.5 subvariants of the Omicron variant. The bad news is that they are spreading rapidly, infecting many people. The good news is that a high percentage of those infected are getting milder illness, and the percentage of people requiring hospitalization or dying is lower than for previous infections (such as the original Omicron variant and its first variant from last winter, BA.1). This is explained (see “Family Practice News” article, here on MEdge) by the fact that we have (a bit simplistically) two different types of lymphocyte cells that produce immunity. B-cells produce antibodies (called humoral immunity), while T-cells directly attack invading germs that they have been primed to recognize by prior exposure through infection or immunization, which is called cellular immunity. Essentially, the new subvariants have mutated to avoid detection by antibodies (thus resulting in more infections) but not to resist destruction by T-cells (thus the less severe infections).

The other piece of bad news is that you can still get sick, can still get hospitalized, and can still die from COVID. And, of course, you can still infect other people, whether in public or in your home, and if some of those are more susceptible with lower immunity (say, older parents or grandparents, or those with chronic disease) and are infected by you, they can die. You will have been, sorry to say, the vector for their death. Like a deer who carries a tick that carries Lyme disease. And then there is “long COVID”, persistent serious symptoms lasting for months or years (from the CDC, over 13% at one month, several percent at a year, over 30% in people who were hospitalized). Sometimes getting infected is essentially unavoidable; people do have to go out, and even if they have been immunized, and boosted, and take care like wearing masks and staying reasonably distanced, and not eating indoors at restaurants, they can still get infected. But I have just listed a lot of things that a lot of people could do and many are not doing, and to the extent that they are not, infection is much less “unavoidable”. When you cross the street, you can be careful, cross on the green in a crosswalk, look both ways, and still be hit by a person careening around the corner at high speed who isn’t looking. But if you cross in the middle of a busy street, with no light, trying to dodge cars, you have greatly increased your risk. There is, to put it mildly, a LOT of misinformation about COVID that persists (see cartoon!)

 

A lot of people talk these days about individual responsibility and not being able to trust the government, and they definitely have some justification. But they often are looking at the wrong problems and coming up with the wrong solutions. No matter how many guns you carry, or how fast they shoot, or how big the magazine is, you can’t shoot the virus. You can do the things I mentioned above (get vaccinated and boosted, try to not be indoors with lots of other people, wear a good mask if you have to be in public, and also a mask if you are around vulnerable family or friends). A note on masks: any mask will help protect other people from you because it is right in front of your mouth and nose. Unfortunately, for you, this isn’t protective if other people are not wearing masks, certainly the norm these days. To protect yourself from others, you need an N-95, well and tightly fitting, since if folks are infected they will have been spewing virus all over.

Government agencies (and they don’t always have their acts together and agree even at the federal level, not to mention all the 50+ states and territories and thousands of local jurisdictions) have generally not been requiring masks recently. The federal government has been sending access to home test kits, and they and local governments have been closing sites that can do more accurate testing. Getting a vaccine is not always so easy, even if you want one. The CDC and FDA and Secretary of HHS Xavier Becerra and Anthony Fauci (whatever his title) often seem to not agree with each other, and often disagree with something else that they recently said themselves. And what agency is responsible for doing and saying what is a mystery to most people. Yes, sometimes the pronouncements of these agencies and individuals change because the scientific knowledge has changed – this is what Fauci is fond of saying, even when he contradicts himself because the science did not change – but there is another major reason, and, sadly, this gets back to you and to me.

Governments make policy and implement it (more or less effectively -- less, in general, for mask mandates) but they are nothing if not political. Political means that they (or those who appointed them) need to be elected and re-elected, and this is their main goal. If they pursue policies (like, say, mask mandates) that people find intrusive and don’t want to do, they can lose votes. And if they pursue policies that keep people from working and shopping and such then businesses lose money, and the politicians can and will lose donations. So they try to walk a fine line between encouraging some restrictions (sotto voce) and loudly proclaiming that things are getting better, that society should open up, that our economy will be growing, and you can go back to work.

So, those of us who are concerned about us and our families getting COVID and maybe getting very sick and maybe dying, and even more likely suffering the continuing problem of “long COVID”, should be very cautious about jumping on the “things are getting better; you should go back to normal” bandwagon. Things are not the “old” normal, but everywhere you go people have taken the “blue pill” (The Matrix, 1999 reference), drunk the Kool-Aid (Jonestown, 1978 reference) or are on soma (Brave New World, 1932 reference) and are not being careful, so you need to be extra careful. There are a lot of places to get infected, and they are sometimes places that you hadn’t though about or planned for. A friend recently went to an outdoor concert with adequate distancing, wearing masks – but prior to entering was in a tightish line to get in. And got COVID. Waiting in the passport control line at an international airport, people were jammed together, and few were wearing masks. Being safe most of the time doesn’t protect you from when you are not safe. [see: Anything. Because something didn’t happen once, or twice, or fifty times, doesn’t mean it won’t happen next time.]

There are a lot of really bad things going on now. Domestically, the Supreme Court (#SCOTUS-6) is doings its best to put you and everyone else at risk, abandoning Roe v. Wade, increasing the probability people with die, allowing almost anyone to walk around with almost any kind of gun, increasing the probability people will die, limiting what the government can do to slow (forget prevent!) global warming increasing the probability people will die, threatening democracy, which will not necessarily direct cause people to die but increases the risk of all the others. They are moving on to making almost anything else that will protect us illegal with one hand, while things that put us at risk are legalized with the other. Plus the world, the wars including that in Ukraine, and world-wide climate change. That is how they get you – how many things can you worry about, fight to change? Well, it has to be all of them. Including the virus causing a world-wide pandemic that could kill you.

Government needs to make easy free effective accurate testing widely available on virtually every corner, not depend on home tests which are not only much less accurate but do not allow accurate data collection. It needs to make it very easy and free to get immunized. It needs to require masks for people gathering indoors. It needs to have a consistent and broad policy on the use of paxlovid and other treatments. It needs to enforce effective protections – only the BEST kind of masks and respirators – for healthcare workers, particularly in hospitals. It needs to, with all the problems listed above, not be distracted by actual red herrings, like refugees and immigrants.

But too much of this will be politically unpopular. Many of us want to stay in the Matrix, at least while we can. Amazingly, the American Public Health Association (APHA) has just announced that masks will be optional at its November meeting in Boston! Can any public health person tolerate this? Do they understand the optics?

So if APHA won’t mandate masks, the government probably won’t take the risk. So you have to take care of yourself and your family. Do what you can, do more, be extra cautious.

Maybe it will help enough.