March 19, 2021 Covid update

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The news and messaging regarding the pandemic over the last two weeks have been extremely confusing. On the one hand, in some states (including Arizona) the number of cases and hospitalizations continue to decline. In other states (specifically Michigan) there has been an alarming increase in Covid19 cases. Governors of several states are relaxing restrictions on indoor gatherings and mask wearing while public health experts maintain that we may just be experiencing the quiet before the next bad surge.

Knowing who is right is essentially impossible at this moment in time. However, it is important to understand why there is this divide in opinion.

Basically, three main elements worry public health experts. First and foremost is the emergence of Covid19 mutants. These variant strains of the virus are more contagious and according to recently published studies, more deadly. The UK variant known as B1.1.7, which is becoming the dominant strain in the US, has been shown to be up to twice as deadly than the original (or wild type) strain of the virus. Thankfully, current vaccines do protect against this specific variant.

The second major worry is that only 16% of the US population has been vaccinated against Covid19. Many people may still get the virus and become very ill or even die from it. We are literally in an “arms race” trying to immunize people as quickly as possible. As the percentage of people immunized increases, concerns will ease, yet we need at least 70% of the population to be immunized for ideal protection (also described as herd immunity).

The third element is the continuous surge in cases and deaths whenever people stop wearing masks and start congregating in closed spaces. The worry is people will think the risk is past, yet with the more contagious and deadly strains now emerging, nothing could be further from the truth.

On the other hand, we know that Covid19 can be very unpredictable. Why are some states improving when others are worsening? Why in the first surge a year ago were only some areas (such as New York City) severely impacted while others (such as Arizona) were much less affected? Is there a way to find a middle ground between resuming public activities without putting huge numbers of people at risk?

The short answer is sort of. Because we lack an effective therapy for serious infections and because we do not yet have herd immunity, we must remain vigilant about our preventative practices. These practices primarily consist of avoiding large gatherings of people (more then 10-15) and continuing to wear masks while around strangers. If you have been vaccinated and you are in a small gathering with others who have also been vaccinated, then it is now considered safe to be unmasked when together. Six feet remains the recommended ideal social distancing although three feet is now being considered acceptable in schools. Be aware though children under age 12 are not currently considered to be major spreaders of Covid19, and this is possibly why three feet appears safe in schools.
To fully be safe we need to have the ability to identify and isolate those who are infected. Sports have provided a good model, with many infected asymptomatic athletes being identified because they are being tested on a continuing basis. This intense monitoring is not really feasible for the whole population yet applying it to areas where there are rising numbers of cases would make sense.

Finally, many people would like to travel again and are wondering if vaccinated why they are still being advised not to. With the variant strains we are unable to currently gauge how much risk a vaccinated individual may have. Remember that vaccines are designed to prevent a more serious case or death from Covid19. You can still be infected, and if you get infected with a strain that is not well protected by our current vaccines then you could spread it to others or even get ill yourself. I realize the frustration many feel with these recommendations yet in medicine caution is always the better part of valor and we must work with the data and evidence available to us.

Take care.