Dr. Bow Tie
COVID-19: We Just Can't Help Ourselves, Can We?
Imagine you're on a plane. You're someone with chronic health concerns, or who takes care of an elderly relative, or has children under 5 who cannot yet be vaccinated. You decided that cases were low enough that you could take the chance on this flight, protected by your vaccine doses and the fact that you and your family will be wearing masks, as will everyone around you.
Then, after you've boarded and things are moving and you're mid-flight...the captain suddenly comes on the overhead and announces that no one has to wear masks anymore and everyone around you rips their mask off, cheering and laughing. There goes one of the layers of protection you had hoped for when you decided to take this trip.
That was the situation faced by a great many travelers this week as a Florida judge (whose opinion on the subject was simplistic and underinformed) overturned the previously extended public transit mask mandate. As has been the case throughout the last two years, we as a nation have been slow to pick up any helpful mitigation measures, but we rush headlong into dropping those protective measures. Since the beginning, scientific communicators like me have discussed the importance of lowering risk through various measures, and being selective about one's activities and exposures.
If you're one of the ones who was cheering, that's not inherently bad. But I hope you can see why it was not a joyous occasion for many travelers. And with reports of travelers getting mocked and peer-pressured into removing their masks, the whole "well, you can still wear your mask" argument falls flat.
So...why is this not a good idea?
First, let's talk about why the above scenario was unexpected. The mask mandate had just been extended (by the CDC) through May 3rd. The Florida judge who did so based her opinion on extremely narrow definitions of words like "sanitation" while she wildly twisted definitions of detention and quarantine to fit an anti-mask narrative. I would not harp on this so much, or her qualifications, but if you're going to make potentially life-changing judicial decisions, you should understand the science and public health behind them. You should also probably be deemed by the American Bar Association as "qualified" to hold your position. I welcome questions from anyone, but when hypocrisy or underinformed politics are allowed a spotlight, I can't help a bit of snark in pointing that out.
The CDC's newer alert levels focus on hospitalizations as a measure of severity of pandemic spread. This would work if hospitalizations did not lag two weeks behind case levels. If you wait until hospitalizations hit a dangerous level, you're already mid-surge. However, with the advent of vaccines, new variants, and the dropping of mitigations, case counts do not directly correlate with hospitalizations as closely as they did. Unfortunately, we are undercounting cases with our continued lack of testing and reporting, so it's hard to determine what the relationship is there. So how do we measure and predict surges in a more timely manner, in order to prevent them rather than start from behind as we keep doing?
No, don't enter the wastewater. But do test it.
As Scrubs said in Season 6, episode 6, "My Musical" - everything comes down to poo. We have found that COVID-19 virus fragments are shed in people's stool, and that level, measured over time, is a better indicator of how much COVID-19 is present and spreading in the community. I'll link to Erie County's wastewater COVID-19 tracking below. You can Google COVID-19 wastewater and your own county to see where levels are at. In my area, they are rising. Does this mean we're in the middle of a surge? Not necessarily, which is the point. We can use rising levels to predict surges, and we should be adding back mitigation measures to prevent the surge before it happens.
So Is This Just A Way To Keep Masking Forever? Can't You Just Let It Go? No one wants to keep masking forever. But cases are starting to pick up again after the post-Omicron lull. Not all of those cases are hospitalized, but let’s talk about what ”mild” COVID means.
With Omicron we saw more of our friends testing positive than we had since the pandemic first hit. Not all of the cases required hospitalization, but many of them were significantly ill at home for several days. Most recovered, though some still ended up in the hospital (especially if unvaccinated). But the disease doesn't always end right away. I have multiple friends who still cannot smell or taste anything, or the senses are malfunctioning. This seems like a minor inconvenience, but as one of my friends put it, her morning coffee tastes like hot water now. Imagine your favorite foods suddenly become tasteless goop in your mouth that you have to choke down for sustenance. Or imagine the neural damage (because that's what it is) does not eliminate the sense entirely, but messes with it so that all you can smell is garbage, 24/7. You can't smell your new baby or the flowers in your garden.
Or imagine that you're so fatigued with basic activities like walking to the kitchen. Work is suddenly more draining than ever because you barely have the energy to get through the hours. Perhaps your autonomic nervous system is off and you struggle with a form of postural orthostatic tachycardia syndrome (POTS) where your heart races and you get dizzy while you try to walk, or you struggle with conversations because you cannot stop coughing, or your brain fog is so bad it it interferes with your work.
And all of these things can last for MONTHS or longer, even if your initial disease was not enough to merit hospitalization (a new meta-analysis shows this can happen in up to half of patients affected with COVID-19). "Mild" doesn't mean easy. And that applies even more to children, more of whom have been hospitalized or affected with PAS-C (Long COVID) in the Omicron surge than ever before (and we're still waiting on a vaccine for kids under 5 - dear FDA, please do not wait for data from both companies. Review, hopefully approve, and roll out a vaccine as it becomes available).
Thus far I have been lucky enough to avoid COVID-19, but that is not purely luck. I am vaccinated with three doses, I still mask in most public places, and I am selective about what events I attend.
It's been a while since I've posted because April turned into an extremely busy month for me. My band, after two years of postponements, finally hosted the #WorldsLargest90sParty, as we were lucky enough to reschedule it and catch a lull between case surges. Then a week later I went to the Society of Hospital Medicine conference in Nashville.
These were two crowded events, one week apart. Seems hypocritical of me, right?
Except that, as stated, early April was still a relative low point in case transmission. I wore a KN95 the whole time (which put in overtime given the mostly-maskless crowd), both to protect myself and because I knew I had to attend another event the following week.
Meanwhile, at the SHM conference, there was a vaccine requirement for attendance, and while not everyone was masked the whole time, many of us were.
These layers of protection helped me get through both events - maybe I would have been fine without them, but why take that chance? For myself or others?
Just the other day it was reported that US COVID-19 vaccination rates have stalled. Only 66% of Americans have received their first shot(s), and only 30% their booster. Vaccines provide some degree of protection to the individual, but they work best when everyone is protected.
As cases start to rise again, now is the time to get your vaccines - get your primary 2 shots if you have not yet done so, get your third shot if you have the first two, and if you're over 50 or immunocompromised, get your fourth.
Keep wearing a mask in crowds and, even with the drop of mandates, on public transit. Despite what the airlines say about ventilation, you know someone who gets a cold every time they fly. Why would you take that chance with an illness with much greater potential for lasting harm?
I know we want to go back to "normal" but ignoring the pandemic will only prolong it with further surges. We can still do fun things and be with each other, but we have to make the right choices and mitigations to do so.
As always, I welcome your questions.
Dropping Mask Mandates:
Wastewater Monitoring in WNY:
CDC's newest MMWR on kids affected with Omicron:
Global Prevalence of Long COVID: https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac136/6569364
COVID-19 vaccination rates: https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html