A quick hopeful update on COVID: We might actually be nearing the end.

Michael CalozBlog: Synthesizing & Simplifying Complexity, Living with the Pandemic2 Comments

dandelion blowing in the wind

Disclaimer: Just like last time, I’m not finding enough energy in myself to write a full post up to my usual standards with my typical degree of fact-checking from multiple sources. But, below is some hopeful info I’ve found after just a few hours of research. 

Disclaimer 2: As always, I’m not a medical professional. I just read a lot of different articles and synthesize the information as best I can from the most reputable sources.

Could the pandemic be almost over?

I’m finally seeing some very promising news about COVID.

It seems like a fair chance that we might be just 1-2 months away from COVID shifting from pandemic to endemic. In other words, it won’t be gone by any means; but, it might be the “final state” that we can expect it to stay in for many years. So, if we don’t decide to return society to “normal” at that point, there might never really be a better point.

Please please please still get the vaccine and the booster. It keeps you and people around you dramatically safer from serious illness. And please keep being just as safe for what might end up being the final few months of the pandemic. It’s not endemic yet!

And again, Long COVID is still the unknown variable here (and, new variants could always appear). But, I’m more hopeful than I have been in a while about COVID.

(Note that this applies to the United States, but I’m not as clear on the timeline for other countries that might have less access to things like boosters, the new Paxlovid treatment, etc. Hopefully they won’t be too far behind though!)

Here are some of my favorite quotes from two threads by Bob Wachter, Chair of the UCSF Department of Medicine (one of the top hospitals in the country):

  • “Today, near the Omicron peak, the odds an asymptomatic person has Covid is ~10% in most of U.S. At 10% prevalence, when you enter a room w/ 20 people, there’s an 88% chance that one of them has Covid. Do that enough times without masks and you’re going to get infected.”
  • “In a month – if cases fall to prior non-surge #’s – the prevalence among asymptomatic people may be more like 0.2% – even in less vaxxed regions, which’ll have more people whose immunity came from infection. (They should still get vaxxed for better & longer protection.)… 0.2% means that the odds of an asymptomatic person having Covid=1-in-500. That room of 20 people: now a 4% chance (1-in-25) that someone’s infected. Not zero – you’ll still want to be careful if you’re at very high risk. But for most, % is low enough to feel pretty safe.
  • “And here’s where some other variables kick in. The low probability of being exposed to Covid should be multiplied by the probability that you’ll have a really bad case if you DO catch it. That chance has gone down with Omicron’s relative ‘mildness,’ particularly if you’re vaccinated. And with a low community prevalence, if you do get sick, hospitals won’t be overwhelmed and you’ll be able to get the care you need. That also makes an infection less risky. And tests will be more abundant, so you’ll be able to get diagnosed more quickly. And if you do get Covid & you’re at high risk, you’ll have an easier time getting a med (preferably the Pfizer pill, Paxlovid), which will markedly lower your chance of getting very sick. Yes, the specter of Long Covid (for some, mild; others disabling) continues – maybe a ~5% chance in a vaxxed person. Some will look at those odds as being concerning enough that they’ll continue to act very cautiously. I probably won’t, but it’s an understandable choice.”
  • “The bottom line is this: in a few weeks – when this surge ends – things are going to be as good as they’re likely to get for the foreseeable future. What will my trigger be for switching to less cautious mode? It’s a bit arbitrary – there’s no bright line separating ‘too risky’ & ‘not risky.’ This means that others may come up w/ different thresholds. Mine will be case rates <10/100K/day (recognizing that reported cases now underestimate case #’s due to home testing). I’d also like to see test positivity rates of <1%.
    • For reference, in Multnomah county (where I live in Portland, OR), the case rate is still 156/100K/day with a positivity rate of 19.96%, i.e., not even close. So, please keep staying safe until we get there, and check covidactnow.org for updated case rate numbers in your county.
  • “After we reach these thresholds in SF (or wherever you are), how will this change my (or your) behavior? The main questions center on indoor spaces crowded with unmasked people of uncertain vaccination status. Small indoor groups, visiting friends & family, indoor dining: all fine, without masks. My practice will be to always carry a KN95, and to don it in very crowded, poorly ventilated spaces with lots of unmasked people, particularly in parts of the U.S. or world with low vax or high case rates… Testing: I’ll keep tests on hand & test promptly for new symptoms. I’ll probably also test when visiting very high-risk people (ie, >80 or immunocompromised). Otherwise, I’ll use my basic indoor rule: no mask is OK in small-medium size groups in regions w/ low case rates.”
  • “In sum, I’ll wait till cases & test positivity rates fall to pre-surge levels before acting less cautiously – that’ll probably be 3-4 wks from now. When they do, I’ll carry a mask but use it only in crowded indoor spaces where risk seems unusually high. Other than that,… I plan to act, well, normal. I’ll accept the possibility that I’ll get Omicron, reassured by the high likelihood that it’ll be a mild case, that I’ll be able to diagnose it quickly & isolate, & that chances of Long Covid are very low in fully vaxxed people. Of course, I’ll quickly resume more cautious behavior if circumstances change.”

Sources: https://twitter.com/Bob_Wachter/status/1482424425676898304 (scroll up to the top) and https://twitter.com/Bob_Wachter/status/1484729223000379395 

Some additional perspectives:

  • I think it’s worth underscoring what Dr. Wachter said about caring for immunocompromised people, and I want to clearly name that—even if COVID becomes endemic—it will still represent a huge amount of ongoing challenge for disabled people, immunocompromised people, and people from systemically-marginalized communities like BIPOC.
    • Here’s an excellent article on that (by Mia Mingus), and a sample quote: “I cannot casually check-in anymore or be asked how I’m doing in the middle of mass suffering, illness and death. I cannot listen to or read about the high rates of infections, illness and death in BIPOC (Black, Indigenous and People of Color) communities with no mention of BIPOC disabled people in the middle of a pandemic. I cannot listen to the CDC say they are ‘encouraged’ that only those ‘who were unwell to begin with’ will die from Omicron… We will not allow disabled people to be disposable or the necessary collateral for the status quo.”
    • And one more quote from that article: “Why have we allowed and contributed to the framing of vaccines as an individual choice instead of collective action, interdependence and solidarity with disabled people (especially those who are high risk), elders, children who cannot get vaccinated, the global south, essential workers and those who do not have the option to work from home? For those who are able to be vaccinated, getting vaccinated is not about personal choice. It is not like deciding to get an abortion; stop saying this. Not getting vaccinated is not ‘my body, my choice,’ it is more like drunk driving or exposing someone to secondhand smoke.”
  • How worried should we be about Long COVID with Omicron? https://www.nytimes.com/2022/01/19/health/omicron-long-covid-symptoms.html
  • More hopeful perspectives: https://twitter.com/tomaspueyo/status/1483198811547869185, https://twitter.com/tomaspueyo/status/1485003236809531396, https://twitter.com/tomaspueyo/status/1484658004805005317
  • A counter perspective (that the virus won’t necessarily evolve to remain mild): https://twitter.com/TRyanGregory/status/1485019200842350599
  • Paxlovid (Pfizer’s new oral antiviral) is awesome and basically what people were hoping drugs like Ivermectin were: https://twitter.com/tomaspueyo/status/1483960468565864450

Stay safe out there!

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