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Living in the Bizarro Post-Pandemic World

I finished last week on our practice’s inpatient service at Memorial Hospital caring for the sickest of the sick and I noticed something I had not seen in a while: A whole floor filled with COVID-19 patients. A couple of them even died. And while it wasn’t nearly the rough patch we saw during earlier spikes (at one point nearly 400 people, over 30% of all the inpatients in Savannah, were hospitalized because of COVID), it was a stark reminder that the virus is still out there wreaking havoc, albeit on a smaller scale.

After the week ended, Daphne I decided to go to downtown Savannah to eat dinner. I was off, we had no other plans, and it seemed like a nice way to end a difficult week.

Simple, right?

Only it wasn’t.

We left early, making certain we’d have time to find parking—but in between the clumps of sunglass-wearing pedestrians clad in shorts and t-shirts, sorority girls in pedal pubs reinventing cheers from high school, plodding horse-drawn carriages and the like, just reaching downtown was a challenge. And then there was no parking.

“The parking deck’s full,” Daphne said as we drove past City Market.

In fact, all the decks were full. We ended up parking several blocks from down downtown and walked to the restaurant, making it just in time for our reservation.

Clearly, tourism in Savannah is booming.

So here we are, two and a half years in, living in the bizarro post-pandemic world. Whether the “post-pandemic” designation is clinically appropriate or not is immaterial. While it is true that China, with its draconian “Zero COVID” policies, is still intermittently locked down, and people in the U.S. and elsewhere are still getting, and still dying from, COVID-19 (although at not as high a rate), any discussion about whether we are still in the throes of the tail end of the pandemic or transitioning into what is termed the “endemic” phase is a matter of academic interest only. Public perception has moved on.

Where does that leave us?

First, one thing needs to be said: We are clearly better off than we were two years ago.

In 2020, the world’s medical community was learning about COVID 19 on the fly. We aren’t used to having to share treatment ideas in real time on social media, but that’s where we were back then. Some treatments worked and some didn’t. People were dying everywhere (https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker?utm_campaign=r.coronavirus-special-edition&utm_medium=email.internal-newsletter.np&utm_source=salesforce-marketing-cloud&utm_term=20220716&utm_content=ed-picks-article-link-5&etear=nl_special_5&utm_campaign=r.coronavirus-special-edition&utm_medium=email.internal-newsletter.np&utm_source=salesforce-marketing-cloud&utm_term=7/16/2022&utm_id=1237694 ). The amount of disinformation in the public domain, and the politicization of that information, made the whole situation more than a little terrifying. Health care workers were dying, as well (https://news.un.org/en/story/2021/10/1103642 ). For those of us in the medical profession, the prospect of transmitting the virus to family members or loved ones was simultaneously horrifying and pervasive.

The advent of COVID 19 vaccination decreased both viral transmission and disease severity. That’s a fact. A June 2022 study published in the Lancet estimated that vaccination prevented nearly 20 million deaths worldwide (https://www.statnews.com/2022/06/23/covid19-vaccines-prevention-global-deaths/ ). Data from the CDC recently published in JAMA revealed that vaccination prevented an estimated 1.6 million hospitalizations and 235,000 deaths in the U.S. alone between December 2020 and September 2021 (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793913 ). Newer post-infection treatments like Pfizer’s Paxlovid can reduce the risk of hospitalization in high-risk COVID patients by ~90% (https://www.bmj.com/content/375/bmj.n2713 ).

After over two years of dealing with COVID, we also have developed a better sense of who is at the highest risk (the elderly and immunocompromised) and about the environments with the greatest risks of disease transmission (crowds, closed spaces). We can use that knowledge to avoid putting ourselves and the people we care about into high-risk situations. So it’s clear at multiple levels that we are far better off now than we were then.

So, what’s in store for us going forward?

Three important things to remember about risk mitigation, all of which are backed up by the preponderance of published medical data. First, vaccines work, both to prevent some transmission and to mitigate disease severity. Second, mask-wearing can be helpful in preventing disease transmission, particularly in enclosed spaces. Third, transmission rates are higher in crowds and indoors. And finally, the elderly, sick and infirm are at strikingly higher risk.

The most surprising thing we’ve seen about COVID 19 has been its ability to mutate. The latest dominant variant (Omicron BA.5) is currently causing over 70% of U.S. infections—and is up to six times as contagious as the original COVID 19 strain we saw in early 2020. Moreover, BA.5 has shown an astonishing ability to reinfect persons who have previously had COVID. For this reason, the efficacy of vaccination in prevention COVID infection is not nearly as good as it was previously. However, prior infection and/or vaccination (and the cell-mediated immunity that they provide) is likely keeping infections less severe, which is probably why the hospitalization numbers are not as bad as we saw during previous waves (https://www.healthline.com/health-news/ba-5-what-we-know-about-protection-from-vaccines-and-previous-infections#). Vaccine makers have come up with Omicron BA.5-specific vaccine boosters which should be available in the early fall (https://www.npr.org/sections/health-shots/2022/07/26/1113615330/reformulated-covid-vaccine-boosters-may-be-available-earlier-than-expected ). It is strongly encouraged that everyone, and especially those at high risk, get those newer booster vaccines when they become available.

At-home COVID testing has become commonplace now. In order to protect at-risk persons who are older or who have underlying health problems, universal COVID testing of even asymptomatic persons prior to any exposure to high-risk individuals should be undertaken routinely. If you cannot test, or even if you test negative but are symptomatic, contact with those high-risk persons should be avoided. Persons who are elderly or who have pre-existing health concerns should avoid high-risk situations such as crowds and indoor gatherings—and if they are forced into those situations, they should wear an N95 or KN95 mask to mitigate risk.Good ventilation is a key factor, as well. For this reason, outdoor gatherings are always less risky than indoor gatherings.

In most cases, COVID-19 infections with the omicron BA.5 variant run their course in 3-5 days. If you are over the age of 60 or are considered high risk, you should consider getting post-infection treatment with Paxlovid. Moreover, you should seek medical attention if you are short of breath or if you have persistent symptoms.

What is abundantly clear at this point is this: COVID 19 is not simply going to go away. High transmission rates and the ability of the virus to mutate have kept it around for over two years. Those same high transmission rates and inherent mutability will allow it to hang around indefinitely. This will force us to continue to adapt as the virus evolves. Despite these variables, we are far better able to deal with COVID 19 these days, with vaccination, mitigating strategies and medical therapies. To protect ourselves and the ones we love, we all need to make intelligent, data-driven choices that will allow us to live with this virus, even as we get on with our lives and continue our gradual transition into the “new normal.”

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