We are moving into a phase of the pandemic where it is not possible to provide the public protections so the defenses will have to be at the personal health level. Those at risk are now going to have to protect themselves rather than the protection afforded by public policy and the communities actions. Our rates have been so low for so long because we asked community members to mask early on. The current variant is much more highly contagious and the newest even more highly contagious variant BA2.12.1 is already in Whatcom County and will likely replace the BA 2 strain in the next few weeks.
What I believe is essential now is that people at risk and those that live with them will need to take on the responsibility of not getting COVID. This is much more difficult than when the community was protecting them. Some would say we are throwing the elders, children under 5 and the half of the school age population that is not immunized and those with disabling immune compromise under the bus. I think what they need to do now to not get COVID is the following:
What those at high risk and the household contacts of high risk people need to do now:
Test- high risk individuals-- before you gather with those you do not live with every day (TWO tests 24 hours apart)
Test- all the rest of us before you are with new people inside an enclosed space, OR those at high risk from infection
Mask to protect yourself if you are at high risk
Mask to protect high risk if you are going to be around them
Up the quality of mask to at least KN 95 or N 95 well fitted to face (these will be work to breath through)
It is NEVER too late to vaccinate. Unvaccinated people remain at dramatically higher risk of hospitalization and death if infected. And Booster shots significantly reduce risks even further.
Ask for treatment if high risk. The new strain is even more contagious, but remains vulnerable to our vaccines, antivirals and protection methods if we use them. Everyone 12 yo and older (and over 40 Kg) that is higher risk should be offered Paxlovid as soon as possible after diagnosis. For some high risk people that can not vaccinate or in whom vaccine will not work well due to medical conditions preventive medications are available and should be used (talk to your doctor).
Paxlovid even for mild to moderate infection is indicated. it is also complicated and checking kidney function (eGFR) and liver function tests (LFTs) is essential prior to treatment (both are in the commonly run Comprehensive Metabolic Panel) Depending on those results dose may need to be adjusted or medication may be contraindicated if severe enough compromise is found. AND Check for drug interactions, which are very common (and include things like St. John’s Wart herbal treatments) but can easily be looked up with online tools. Some medications like simvastatin have to be stopped for 24 hours before starting Paxlovid and then not restarted until 48 hours after the treatment course is completed.
Long COVID is real and relatively common, but it will be a year before we really know the significance of the medical condition that raise after acute COVID. What is emerging is concerning. It dose not require severe illness with the acute infection, even mild infections can lead to long COVID symptoms. A recent study showed a 38% increase in type 1 diabetes in a matched control study of those infected vs not infected with COVID. For now it will still be important to avoid infection even thought it appears to be causing only mild disease in the upper airways and lungs. Any tissue or organ that has ACE receptors becomes infected and can be impacted. The pulmonary symptoms that we have spent so much time being concerned about at just one small aspect of the total body infection when they occur. It infects circulatory, cardiac, brain, pancreatic, and many other body systems.