I believe we have reached a new stage in the pandemic, a “new normal”, that will likely be with us for some time. Now, one of the things COVID has taught is that just when we think we understand COVID, it throws us a curveball, so it is always possible that things could change. However, for now, I believe we are at a stage in the COVID pandemic where, for the most part, we can go about living our lives and not being afraid of COVID.
Regardless, I am writing this now because I know that while some of you are already “done” with COVID, and probably more than half of you have already had COVID yourselves; I know many patients, family members, and friends who are still significantly curtailing their normal activities because they are afraid of COVID. COVID fear has consequences, and in my opinion, may currently have more risk than the virus itself. We saw what happened when we took kids out of school (the right thing to do initially, but wrong later on): they not only lost out on their education, but very important social interactions. The same is true for adults- not seeing friends and family, not exercising, not traveling or dining out, etc.-all of these can lead to mental and physical health issues.
To understand why I can say with confidence that you now no longer need to be afraid of COVID, it’s important to look back at where we once were. Those who have read my prior communications know that I am not a COVID denier, having promoted vaccines, masks, social distancing etc. In the spring of 2020, when COVID first hit, we knew much less about the disease and how it was transmitted (remember wiping down groceries?) and had neither vaccines nor treatments. Being scared of COVID back then made a lot of sense. The first vaccines became widely available about a year later (remember the challenges of trying to get that first dose?) and by the summer of 2021 we finally felt like we would be able to move on from COVID. Then the variants hit in the fall of 2021, and we learned that even if you were vaccinated, you could have a “breakthrough” case and still get sick, which not surprisingly reignited COVID fear. Part of the problem was that the initial vaccines were so effective against the original strain, we got distracted from the purpose of the vaccines, which was not to necessarily prevent getting sick, but to prevent severe illness (hospitalization, ICU admissions, and death). Even today, with all the current variants, the vaccines remain highly effective in doing this. Thus, focusing on cases and getting infected with COVID makes little sense. Many have felt during this entire pandemic that it is the people who aren’t careful that will get COVID, and if I just “stay safe”, I will be fine. However, even Dr. Fauci got COVID! That should tell you something. (The 81-year-old doctor is reportedly doing well).
In late 2021, the delta variant caused a surge of cases, including even in those that were vaccinated. While hospitalizations and deaths from delta were limited to primarily unvaccinated, elderly patients, and were substantially less than previous outbreaks; across the country there was still a significant impact of COVID. Then in early 2022, easily available oral treatments became available, and they were a game changer. Despite the massive first Omicron wave in January 2022, while cases were higher than they had ever been, hospitalizations and death remained low. Currently, we are just getting finished with a second Omicron spike, hospitalizations and deaths are barely elevated. This is impressive since this more recent Omicron wave is probably far worse than the January spike, but since most people are now home testing (remember when it was difficult to get a rapid test?) the reported numbers aren’t likely accurate. While some of the remarkable reduction in COVID severity may be due to the variants themselves, which are more contagious but less harmful; the combination of vaccines and oral treatments have made a remarkable impact.
What all of this means is that the combination vaccinations, boosters, home testing, and oral treatments which are all easily available now has rendered COVID 19 from a once potentially fatal disease for those at risk (older than 65, heart disease, diabetes, etc.) to not much more than a bad cold. Even if you are at risk for severe COVID disease, if you are vaccinated and boosted, your risk of dying from COVID is 1 in a million or less, which are similar to risks we take every day (riding in a car, crossing the street, etc.) and likely lower than dying from influenza or pneumonia, where vaccines and treatments are great, but not nearly as effective as what we have for COVID.
Now, one of the big bugaboos about getting back to normal is “long COVID.” Dr. Robert M. Wachter, who is a professor and chair of the department of medicine at the University of California, San Francisco, recently wrote a piece in the Washington Post that somewhat contradicts my opinion. While he agrees that there is no longer the need to fear death from COVID for those boosted and vaccinated, he is concerned about long COIVD as a possible consequence of getting a COVID infection. Long COVID is prolonged symptoms from the disease, which can last for weeks or months after the illness. It can also cause symptoms like fatigue and brain fog. One problem with understanding long COVID, is that there is no clear definition of the illness, and thus challenging when looking at data regarding how common it really is. While having prolonged symptoms (cough, fatigue) a few extra weeks more than a typical cold may be common (i.e. 20%), Dr. Wachter (in my opinion) tends to lump this with what people are actually worried about- severe and prolonged fatigue, brain fog, etc. which is probably much more rare.
At least 60% of the entire US population or 200 million Americans have had COVID. If severe long COVID (prolonged fatigue, brain fog, etc.) was as high as even 1% of infections, then there would be 2 million Americans with this condition today. While there is no specific data available on this currently, my feeling is that if 2 million Americans had severe and prolonged fatigue and brain fog, we would know about it by now. Also, severe long COVID sounds a lot like chronic fatigue syndrome, which is thought to possibly be caused by a virus. It is my opinion that the severe form of long COVID (and not the more common longer than usual cold symptoms definition), may be nothing more than chronic fatigue syndrome, which can be caused by any virus, COVID or the common cold.
Even Dr. Wachter, who is being extremely cautious due to his concerns for long COVID states that, “I will ditch the mask at the supermarket and resume indoor dining when I am confident that case rates have fallen considerably, to below 10-20 cases per 100,000 per day.” While we aren’t quite there yet as a country, we are almost there with cases from this latest Omicron wave are coming down, and in some parts of the country, including Maryland, we are already at these low rates.
Now, does this mean we can absolutely ignore COVID? Of course not. COVID will likely be here for some time, and we will likely see spikes of variants like the latest Omicron spike we are on the way down from. We will need to continue to get vaccinated and boosted (I am guessing people at risk will need boosters every six months for some time, and a new more Omicron specific vaccine may be available this small, which should further reduce risk). We will continue to need to test for COVID if we are sick and stay away from others (like we should have been doing with any other cold or flu) if we are positive. If you are at high risk for COVID severity and test positive, please call me so I can prescribe Paxlovid. Since no one wants to get sick, when there is a large spike in cases, like the most recent Omicron waves, it is certainly reasonable to again start wearing masks in public and potentially avoid very crowded places (restaurants are probably fine, bars probably not), until the wave starts to decline (as it is doing now). However, when cases are at a baseline level and you are feeling well, you should go about your normal (or pre-COVID normal) life. See friends. Travel. Go to restaurants. Go to a movie. Exercise in a gym. Go to a museum. Do the things you enjoy, or used to enjoy before COVID, without fear.
Matthew L. Mintz, MD, FACP