Hospitalizations to date in the USA. Figure courtesy of Our World in Data.

Hospitalizations to date in the USA. Figure courtesy of Our World in Data.

I was heartened to finally see a pragmatic guideline come out of the White House and CDC: reducing quarantine from 10 to 5 days. There’s been some pushback from some epidemiologists and unions, but the truth is if we’re ever going to get back to any semblance of normality, we must become much more pragmatic. While delta is still around it will be on its way out within a few weeks thanks to the omicron strain. There’s now abundant evidence that the effects of the omicron strain are less severe if you’re vaccinated (with or without booster). The infection arrives and departs sooner, meaning a far shorter duration, in part because the virus multiplies in the upper passageways rather than the lungs, as we discussed before. What its actual severity is compared to delta is unknown because during the last year the American population has experienced a lot of different SARs-Cov2 infections (and still has some residual immunity) and about 62% are fully vaccinated, so the population is less susceptible to the virus.

Yes, we’ll have more hospitalizations and deaths, but these will be mostly in unvaccinated individuals. Therefore, our focus should not be on the record-breaking number of cases but rather on hospitalization and mortality rates. Look at Figure 1 and compare the rate of increase (i.e. the rising slopes of infections) from previous surges to the present one. Yes, the rate will go up before we’re done, and may even top the previous record, but the most important statistic is that for 40 to 50% of patients, the finding of having SARs-Cov2 was incidental to what brought them into the hospital. I do sympathize with healthcare workers who must deal with infected patients, but that’s another story. The fact is we’ve vaccinated as many people as we can, and going back to lockdowns, closing all businesses and venues, and severely curtailing freedom of movement is no longer an option unless you live in China. We need to learn to live with the virus until it eventually becomes endemic, like flu is today. My educated guess is that we’ll be there in 1-2 years.

Here are some more ideas to help us better deal with the situation:

  • We missed the boat on testing and it’s too late to anything about it. Lateral flow (antigen) tests are less accurate than PCR tests in general and many antigen tests are inaccurate from what I’ve seen (that’s the fault of the FDA for not tackling this properly). You didn’t test yourself ad nauseum before the pandemic any time you had a cold or flu and with some exceptions there’s no reason to go crazy now. If you’re going to test, do it the minute you develop symptoms. If you’re positive, isolate for 5 days. Years from now testing for viral infections will likely be a whole lot easier and cheaper so it might make sense to do much more testing then, but that’s not the current situation. We hear all the time that if you think you are infected you should quarantine, and I absolutely agree with that, but many people can’t afford to take time off because they will lose their paycheck, or they don’t have people to take care of their children. So, let’s recognize that quarantining is good in principle but is for the financially well off.
  • If you have to go to the hospital because of a covid infection don’t fight with hospital staff. They’re doing the best they can under the circumstances. Don’t insist that you be treated with ivermectin or other treatments that have not been proven to be of benefit.
  • If you are fearful about the pandemic, get vaccinated and develop your own CBT program (cognitive behavioral therapy). What can you do to get out more and interact with people or nature? Positive social interactions improve mental health. Take a first step. Then another. There may be lots of reasons to stay at home, but fear of the pandemic given what we know now should not be one of them. I recognize that there are some people who are in high-risk categories but I’m not talking to you. If you need a safety net, upgrade your masks to N95 when you interact with people and keep your distance. Stop listening to the Cassandras on the TV and social media. I may piss off some epidemiologists for saying this but it’s time to start thinking about how we’re going to deal with the “end” of the pandemic, otherwise this thing will go on forever because we’re in a bunker mentality.
  • Start planning for removal of all local, state, and federal vaccination, mask, and social distancing mandates as soon as this surge is over. Many people worry that these mandates will become permanent. I agree with them. I for one, don’t want to be wearing a mask on planes for the rest of my life.
  • Start thinking about removing all covid-related travel restrictions domestically and internationally as soon as this surge is over. We’ve all lost hugely on this one for many reasons and it’s time to think of a world without barriers to travel. Country barriers didn’t stop the pandemic from starting and they’re not doing much for us now.

We need to recognize that we’re moving toward the end of the pandemic. It’s time to think about how we’re going to achieve what we had before it all started.