A few weeks ago I told you I’d see you on the other side…. well, we made it.  In this neck of the woods, I think it is safe to say that Omicron has torn through for the most part.  We strained our systems, but never broke.  So now what?  Simply stated, it is time to start Movin’ On.  Of course, nothing is so simple.  Today’s goal is to provide a basis to start that process.

Disclaimer:  As always, I will be clear as to what is factual and what is opinion.  To that point, all opinions stated here are my opinions, and do not necessarily reflect those of all providers at Peds First.

A little early 80’s music for you to start off today.  Gotta love that Flying V.

Nationally, Omicron continues to tear through the country.  Locally, we survived the wave without overwhelming the hospitals.  Congratulations.  The end.

Before delving into a bunch of hot topics including masks, vaccines, and mandates, I want to address some basics about science that are very often misconstrued and generate much angst among the members of our society.

Nearly daily, I am confronted with comments during discussion on various topics along the lines of “everything is always changing, clearly they don’t understand anything.” It is easy to see why many would get that impression with constant changes to isolation/quarantine rules, vaccination schedules, and a litany of other recommendations.  The real issue is that of messaging.  Scientists are constantly trying to learn more.  They generate new hypothesis and test them.  And there are margins of error – science allows for that.  At the end of the day, data speaks, and it is up to us to listen and be open minded when new information contradicts past experience.

This methodology is not unlike raising your child.  We don’t treat our preteens like we did when they were toddler’s.  Why?  Because now they can walk, talk, prepare some food for themselves, wipe their own butt, possibly do a load of laundry, along with a litany of other tricks.  We incorporate data on our kids to find the best ways to communicate with them, decide what help they require, what help is no longer necessary, and what guidelines must be imposed on them.  We evolve as they do.

A typical Frank Zappa performance.  Some musical brilliance, some peculiar interludes.  As I have started what I consider “Boot Camp,” in which I am trying to learn some music theory, I stumbled on this clip called the Frank Zappa Chord Bible.  If you make it through without injuring brain cells, you will likely reach the conclusion I have, specifically that Frank continues to be among the most misunderstood American composers of the last 50 years.  A true freaky gifted individual.  

I think this pandemic is wrapping up as stated a few weeks ago.  As parts of this country (and world) finish getting blasted with Omicron, I believe we will arrive at the place where Covid becomes “endemic.”  This is otherwise known as your new normal.  It’s time to learn to live with it or the Torture Will Never Stop.

Now is it possible that we could have another wave with some variant even more contagious, that evades all prior immunity, and is far more deadly?  Sure.  Could happen with influenza viruses as well.  Hell, someone could import Ebola or some other crazy illness from abroad.  Based on prior pandemics, this is not the likely short-term outcome.

Fact is this, while you can be aware of potential negative outcomes, and while you should make preparations should they occur, you cannot live paralyzed with fear about lower likelihood events.  The conditions under which we have lived for the last couple of years are not acceptable for much of the population as a new lifestyle choice.

On the topic of facts, and a major premise for the upcoming discussion points: Every member of society with significant risk from covid infection has had access to vaccination for many months at this time.  For free.

With our basis for discussion in hand, let’s start tackling the topics y’all seek answers to.  The meat and potatoes if you will.  Recipes provided below should anyone be seeking some comfort food this weekend when you’re snowed in.

Has the time arrived where we can stop requiring the wearing of masks? 

In my humblest of opinions, yes.  Does that mean in all circumstances?  Absolutely not.

So, what circumstances do you need one? 

This is where we must find our way.  I don’t believe there is debate that masks remain required during surgeries.  How about those in an urgent care medical facility?  A strong argument could be made that such a rule would limit a wide variety of transmissions between patients and staff both with each other and themselves.  But the slope gets slippery.  What about nursing homes for example?

Who does not need to wear a mask?

Anyone fully vaccinated in most circumstances.  Low risk individuals, such as our children, regardless of if they are vaccinated.  If someone wants to wear a mask despite not “needing” to, please do so.  It does not bother me if someone else chooses a little extra security/protection.  Some folks buy alarm systems.  Some have cameras all over their homes.  Others don’t even lock their doors consistently.  Not my house….not my concern.

Who should wear a mask? 

Elderly unvaccinated folk in public places should strongly consider such.  Even elderly who are vaccinated.  Being elderly with this virus is a not an issue to be played with lightly.

How about the private businesses that require one?  Can they?  Should they? 

Should you be able to have a dress code at a club or restaurant?  How about in a place of worship?  This in my opinion is up to the private business.  Don’t like it, go somewhere else.  If we are scrapping mandates and letting people choose their own adventure, then we have to let private businesses choose as well.

How about at a public venue? 

Can you wear a Giants jersey safely at Lincoln Financial Field?  Sure, you have the right to get your ass kicked if you choose.  Don’t believe me? Ask Johnny Knoxville.  On a side note, you can wear a Jet’s jersey anywhere.  They have sucked long enough nobody cares.

Soul II Soul Movin’ On

If this is the end of the pandemic, do I still need to get vaccinated or boosted?

Yes.  This virus is not going to go away completely.   It is likely to be a persistent nuisance. And by nuisance, it may kill 50-100,000 people annually once endemic.   If your goal in life is to take minimal risks for maximal benefit, vaccines are for you.  Need some excitement trying to earn your Darwin Award.  Your body, your choice.

How often are we going to have to boost?

Unless the risk from the vaccine changes, who cares.  Poke me every five months if needed.  I want to live to be 100, if I can do so while healthy.  Cent’Anni!  Currently, there is no known answer for need to boost multiple times yet.  There is gray area on the topic of boosting in general (more on that in a bit).  We get lifelong immunity from a smallpox vaccine, a couple of doses of MMR vaccine, four doses of polio vaccine.  We need boosters annually for influenza, every five years if in certain risk categories for pneumococcus, and every ten years for tetanus and pertussis.  Science will provide the answers regarding covid vaccine boosters in all good time.

The data of who is hospitalized will be our guide.  If vaccinated, how many doses and when were they vaccinated?  How old are they?  It may be that elderly need it yearly, middle aged folks once every five years, and kids twice until older.  We simply do not know yet.  We must continue to collect data and make educated recommendations.  Until then, make boosters available to those that want them.

How should society approach access those that choose not to vaccinate?

Depends on what type of risk they expose others to.

We, as a society have set the expectation that those who prepare our food wash their hands prior and wear gloves when doing so.  We similarly expect barbers to sterilize, or use a fresh blade, when they shave a client.  We mandate all sorts of protections in this country where appropriate.  This is not a new concept.

I think it is fair to expect healthcare workers to be vaccinated.  You do not expect to contract illness from your providers.  I think the client (ie: patient) has the right to expect such.  Same with nursing home workers.  What other industries?  Tough question to answer.  Ultimately that answer may change based on what we learn from the initial decisions we make.  Again, we must be open to reassessments as we gain data/knowledge.

I also think it is fair for a private business to decide how they wish to conduct business.  A vegan restaurant does not need to serve meat.  You get to choose who to patronize.  They get to decide the rules of their business.  Not vaccinated should not be considered discrimination if not permitted into a private establishment.  You may be fine with the risk.  They may choose to cater to those who are not.  Their body, their choice.  It works both ways.

Public spaces – enter at your own risk.  That applies to all in a land with no mandates.  And why there is a niche for private businesses to cater to vaccinated only.

How should we approach the costs of decisions not to vaccinate?

If you smoke cigarettes, have fun getting life insurance.  What about vaccinations?  Insurance companies are a business be they private or public.  If private they seek profits, if public they just raise taxes or screw someone else out of proper care to balance costs.  If you want to take on that additional risk, great, but there is a cost to it, and you should bear it.  I should not have to be financially impacted by your decision making.  Same for all types of preventative medicine: this includes well care visits, flu vaccines, colonoscopies, mammograms, etc.   Differential risk based on choice yields differential cost based on those same choices.

Will the covid vaccine be mandated for schools?

I am betting they do, but should they?  Are the kids high risk?  Nope.  Have we mandated flu vaccines?  Not universally, but in some areas, they have.  Since kids are at higher risk for bad outcomes from the flu, we need to decide our pain point – admit both or neither to the schedule.  As before, is the mandate really about the kids anyways?

Boosters for kids?

These are going to be very hard to prove necessary due to their low overall risk.  My opinion – don’t go there unless there is data to show you need to.  This ultimately goes for all ages.

Don’t confuse “not harmful” with beneficial.  Don’t confuse beneficial with recommended.  You may elect to make something not harmful available to all.  You should make something beneficial available.  You make something recommended when there are significant benefits to be had.  Of course the definition of “significant” can be debated.  We have been operating with war time rules.  Now that the smoke is clearing, the data collection must continue, with ongoing analysis of real endpoints (such as prevention of negative outcomes).  Recommendations follow from that analysis.

As mandates pertains to children – the data underlying them must apply to children.  You do not get to use them as a means to an end.  An example of such would be not mandating a teacher to be vaccinated, but mandating the student with the goal of protecting said teacher.

Keep on Moving — Bob Marley style.  

Isolation/Quarantine

The premise behind isolation and quarantine protocols is to mitigate spread in the community.  Part of that goal is to minimize the chance we will lack the resources to manage those who fall ill.  Part of that goal was to minimize infecting those who are of higher risk, especially at the time there was no vaccine available.

News Flash:  We are at a point where we will not overwhelm the hospitals.  Furthermore, everyone has had ample opportunity to get vaccinated.

So what are we accomplishing at this point?  Why are we continuing to treat this infection different than all others?  It will not stop an endemic infection.  How about this novel concept:  Don’t go out if you are sick.  Who cares what virus you have contracted?  Nobody wants it regardless.  Stay home.

Testing

As a general rule of thumb, one should only be obtaining diagnostic tests in the setting where there is an action to be made based on the information gathered.  We test for strep because you get an antibiotic to prevent rheumatic heart disease.  We test for influenza because there is a medication called Tamiflu as an option for treatment and to provide prophylaxis for contacts.

Unless there are decisions to be made based on obtaining a covid swab, it needs to stop being routinely performed.

When would be good to swab?  If you are planning of visiting high risk individuals (such as in a nursing home).  If you are yourself high risk and may be able to treat with Paxlovid or monoclonal antibodies.  Again, testing where there is an action to be made based on the information gathered.

Again, feel sick?  Stay home.  It shouldn’t matter if you have covid, influenza, rhinovirus, or crimean-congo virus.

Emmylou Harris live – I’m Movin’ On.  If you should ever get the opportunity to see her live, she is spectacular.  

Society has its work cut out for it over the next few months.  Finding our collective comfort zone will not be easy.  In doing so, it is my hope that folks will stop focusing on political dogma and look at what is going on around them at any given time.  We all need to continue to learn.  What might work today, may not tomorrow.  The ability to take a step back, challenge your thought process, and adapt to updated information is always critical.  This goes not just for covid, but for life in general.

As it pertains to covid, while we adapt to a new normal, common decency still applies.  Don’t put your fellow human at undue risk.  If you are not feeling right or if you know you were very likely exposed to an infectious disease, don’t share it with others.   No matter how good a vaccine works, or a medication, or voodoo for that matter, there are folks that will suffer poor outcomes from any infectious disease. Try not to be the one who inflicts that upon them.

Stay safe all.  Enjoy the snow!