Dr. Thomas W. McGovern February 28, 2022

Coronavirus

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Are we there yet?

Like kids in the back seat during a long family trip, we have each been asking that question regarding the COVID-19 pandemic. But to answer the question, we have to define what “there” means?

If we mean the way things were before 2020, then we are not there yet, but maybe we can see it from where we are. The omicron surge was much more intense in speed and numbers than the prior COVID-19 surges our country has seen. Fortunately, this variant attaches to lung tissue 10 times less effectively than previous SARS-CoV-2 versions and has caused predominantly upper respiratory infections instead of pneumonia.

How will we know when the pandemic is over? Since “pandemic” refers to an infection growing exponentially and spreading globally, only a global entity such as the World Health Organization can declare it over — as they declared it begun nearly two years ago on March 11, 2020.

What the numbers say

How will we know when it is over in the United States? In one sense, socially, it will be over for us when we don’t have to change our pre-2020 behavior for masks, testing, distancing or vaccination requirements to participate in various activities. Even the U.S. Centers for Disease Control and Prevention (CDC) has reduced masking recommendations, and states and municipalities known for more onerous restrictions are lifting their mask mandates in public places and even in some schools.

In another sense, it will be over when hospitalization numbers are similar to pre-2020 for a given time of year, and in an even better sense, when excess deaths are no longer occurring.

We aren’t there yet. Hospitalizations and new COVID-19 hospital admissions are rapidly dropping and haven’t been this low since before the delta variant surge. Deaths are dropping but are still quite high. Even though omicron had a 65% reduction in hospitalization, 83% lower ICU admission rate and 75% to 91% reduced fatality rate compared to delta, the number of deaths during the omicron wave have exceeded the summer/fall delta wave because omicron is so much more infectious.

Omicron multiplies 70 times faster than the delta variant in upper airways and is 3-4 times more transmissible. Those dying of COVID are overwhelmingly unvaccinated. Fatality rates were 0.5/100,000 persons per week among fully vaccinated persons compared to 9.7 for unvaccinated persons — a 95% reduction in risk of death in those who had been vaccinated.

Perhaps the pandemic will be over when a certain percentage of the population has immunity to SARS-CoV-2 so that exponential growth of infection can no longer recur because so many people are protected. Currently, this number is about 75% of Americans. If you have been vaccinated or infected, and if you don’t have a high-risk condition, the end of the pandemic is closer for you than for others.

We must remain humble that a new variant could emerge at any time, just as variants of influenza have continued to emerge since the 1918-19 flu pandemic. Jesus said, “The poor you will always have with you,” and infectious disease experts are saying, “COVID-19, you will always have with you,” just as we will always have influenza with us. But as more people develop immunity, COVID-19 will likely become a seasonal infection dangerous to progressively smaller slices of our population.

Protection from the virus

As the omicron surge resolves, most people who have been staying away from Mass should consider returning. Your parish and your fellow parishioners want you and need you. God created us as social beings, and to some extent, we whither without that contact. There are now excellent treatments for high-risk individuals who get infected, and there is strong protection for those who have received three doses of an mRNA vaccine.

Is it too late to benefit from vaccination if you have not been vaccinated? No. First, COVID-19 will keep circulating, and people will keep dying from it. As mentioned above, your risk of death decreases significantly (95% with omicron) if you do meet the current variant, and vaccination will most likely provide protection against the next variant.

While we don’t know what the next variant will look like, researchers produced an engineered “super-virus” with 20 different spike-protein mutations. Previously infected individuals were unable to neutralize that virus, while vaccinated individuals could neutralize it.

What if you’ve already been infected and not vaccinated? Your risk of a subsequent poor outcome from a second infection — estimated as a 50% risk within two years — is cut in half with a subsequent single dose of mRNA vaccine. Additionally, your neutralizing antibody levels are 10-55 times higher if you have received three vaccine doses or been infected and vaccinated compared to someone previously infected but not vaccinated.

Previous infection provides about 85-90% protection against death against infection with the omicron variant. However, previously infected patients during the delta variant surge were 5 times more likely to test positive for COVID when hospitalized with respiratory illness than those who had been vaccinated. Current evidence suggests that the protection provided by two doses of mRNA vaccine are similar to that provided by a prior COVID-19 infection, and a three-dose series has been equated to prior infection plus one dose of mRNA vaccine. More than one dose of mRNA vaccine after COVID infection does not seem to provide an added benefit.

Is it too late to get vaccinated?

So why should someone consider getting vaccinated at this point if they have played the respiratory version of that old playground game Red Rover and avoided getting metaphorically tackled in the past two years? Two reasons. First, significant reduction in risk of hospitalization and death as discussed above.

Second, what’s known as “long COVID.” About 10% of young adults under 35 and about 30% of all adult survivors develop symptoms lasting more than two months after recovery from acute COVID or lasting beyond three months from the start of infection. Symptoms include loss of taste or smell, hair loss, memory problems, rapid heart beat or difficulty breathing. One stunning study in the U.K. using functional MRI to check brain function and volume found that there was a pattern of gray matter loss in five areas of the brains of adults who recovered from COVID compared to those who did not have COVID. Areas affected were involved in memory, taste and smell. Fortunately, vaccinated individuals who become infected do not develop long COVID.

What about childhood vaccination? The U.K. has recommended that only children 5-11 years old with comorbidities should get vaccinated, but in the United States, the CDC is recommending that all children be vaccinated. After speaking to pediatricians and infectious disease physicians, it seems that the benefits for children under 12 getting vaccinated include reducing the rare but alarmingly severe, multi-system inflammatory syndrome. Certainly, children with high-risk co-morbidities and those living with fragile adults with comorbidities should consider being vaccinated to reduce spreading infection to them. And yes, a difficult-to-perform study has been completed that demonstrates that vaccinated individuals who become infected are less likely to transmit infection to others. Also, myocarditis risk is lower in vaccinated young adults and children than in COVID infection itself. Finally, if children are vaccinated, their immune systems will be better prepared to meet future variants, and their low risk of death will be even lower.

Schools and parishes

As far as masking goes, the omicron variant is so contagious that masks are likely protecting no one except those wearing tightly fitting N95 or KN95 type masks. No longer are they protecting others from the wearers; they are just protecting the wearer. According to two public health and infectious disease specialists to whom I have spoken, at this point in the pandemic, masking children in schools, as well as testing and tracing in schools, are probably producing negligible benefits that must be weighed against the potential social and educational harms of masking.

Finally, when will it be safe to receive the precious blood from the chalice again? It depends how you define “safe.” There has always been a risk of infection of various types from drinking from a common cup, and there always will be. Such risk (pre-COVID) is apparently reduced by 90% by wiping the cup after each communicant. If the omicron numbers decrease to where COVID numbers were in June 2021, then receiving Communion in the cup — or kissing the crucifix on Good Friday — will likely be no more risky than they were during Lent in years before 2020.

On Feb. 25, the CDC gave us wonderful news in posting a new section called Community Transmission where they noted that wearing masks indoors is no longer recommended for most Americans. Each county is color coded green, yellow or orange based on the combination of three criteria: new COVID-19 admissions per 100,000 population in the past seven days, the percent of staffed inpatient beds occupied by COVID-19 patients and total new COVID-19 cases per 100,000 population in the past seven days. This is good news, because it is based primarily on those with severe illness. Masks have been symbolic of the pandemic’s restrictions on living a normal life, and the removal of masking is likely to have positive effects in our lives and serve as a signal that the pandemic is coming to an end.

Dr. Thomas W. McGovern, M.D., is a Mohs surgeon in Fort Wayne, Indiana, who previously worked in vaccine research and now co-hosts “Doctor, Doctor “on EWTN Radio and podcast. Member of the Catholic Medical Association (US)

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