Kevin Kavanagh, MD

Far too few have been fully vaccinated in the U.S.to ward off a run on our hospitals, and avoiding hospitalizations is an extremely low bar for public health, since 10% to 30% of the patients even with mild to moderate disease will develop long COVID.

As long as the immune escape variants are on the rise in the U.S. and less than half of our population is fully vaccinated, the best advice is to continue public health strategies.

Those of you who advocate reopening at the peril of those who are vaccine hesitant—letting nature decide the fate of the ill-informed—need to remember that survival is not the same as recovery.

Infection preventionists need to stress the importance of aerosolization with increased recommendations for N-95 masks and we all need to realize that a prerequisite of reopening a business, school or public venue should be safe ventilation.

What happens in India, or anywhere else in the world, doesn't stay there. The longer COVID-19 hangs around, the more chance it has of mutating into a variant that the vaccines won't stop.

If you work in a health care facility, you need to be vaccinated against SARS-CoV-2. If you choose not to become vaccinated, then you should choose not to be working in a health care setting.

Infection preventionists (IPs) are now faced with delivering a difficult message. It is much easier to advocate for vaccinations which prevent disease, than it is for vaccinations which lessen the severity of disease or reduces your chances of becoming infected.

The same mutation is found in the variant in Brazil but more disturbingly it is found in the New York variant.

SARS-CoV-2 is aerosolized. If a non-vaccinated person who is shedding the virus visits a vaccinated relative in a nursing home, he can easily spread the virus to all who reside in the facility.

The CMS update on when nursing home residents can have visitors raises grave concerns. The recommendation appears to assume that herd immunity is reached at 70%.

There needs to be a shift from droplet precaution standards to airborne spread standards and we need to invest in the safety of our frontline workers.

Frequent, (three times a week) screening of our athletes has been key to the opening of professional sports. Our students deserve the same safety precautions as professional athletes.

We need to have mandatory reporting of worker and patient acquisition of SARS-CoV-2 and the development of COVID-19 with metrics to provide us the most accurate estimate of cases so we can effectively plan and allocate resources.

The good news? The fact that 3 different viruses with 3 different lineages came up with the same mutation to evade natural immunity and the vaccines. And initial reports are that it only partially evades the vaccines.

Infection preventionists need to educate primary health providers on the importance of utilizing monoclonal antibodies to prevent hospitalizations from severe COVID-19.

Infection preventionists need to spread the message and articulate the uncertainties of this new variant of COVID-19. They need to emphasize that it is just not the old who are at risk and employ stricter containment measures.

We must treat this strain with the respect it deserves, but we must not panic. There is no doubt that increased infectivity equates with increases in deaths, but it does not mean the vaccines will not work.

V-Safe and VAERS are 2 monitoring systems for patients who are given a COVID-19 vaccine. Infection preventionists can play a vital role in educating about the strengths and drawbacks of each.

Infection preventionists are an important component of fostering trust in the healthcare system and need to actively articulate to both patients and on social media the need to be vaccinated and to follow public health advice.

Faced with greater than three times the number of cases as the last surge, along with exponential growth with no end in sight, there is little hope healthcare workers can safely treat patients without a drastic change in policy and a more productive and secure supply line.

The worst-case scenario is that if an effective and safe COVID-19 vaccine is found, a large segment of our population will elect to use hydroxychloroquine or another ineffective treatment instead, allowing the virus to continue to thrive, and devastate our nation.

By their nature, challenge trials have to be performed in young healthy individuals. SARS-CoV-2 is most lethal in the elderly and those with co-morbidities. Thus, an effective vaccine may be found for the young, but not in the elderly with an aging immune system.

For infection preventionists and frontline healthcare workers, the Great Barrington Declaration places their lives and livelihood at risk. A field hospital has been activated in Wisconsin and the state is at risk of running out of hospital beds and trained staff.

The real impact of these recommendations are what they mean for aerosolization, outdoor gatherings of any type and food handling practices.

Patients afflicted with COVID-19 have an increased susceptibility to antibiotic resistant infections both from prolonged hospitalizations and the use of immunocompromising agents such as dexamethasone.

It is imperative that infection preventionists engage and combat this messaging on social media and wherever it occurs. To not do so, allows misinformation to fan the pandemic, placing all of our lives at risk.

Infection preventionists need to be able to articulate to those who feel that the young are safe just because their fatality rate is extremely low, that even in this age group there are major concerns regarding long-term consequences of this virus.

This year we have to do more than just rely on the flu vaccine. Avoiding the flu plus COVID-19 catastrophe is contingent on the US widely embracing public health guidance of wearing masks, meticulous hand hygiene and social distancing.

Infection preventionists are of utmost importance to work with school systems and provide the safest strategies and environmental modifications which can suppress the transmission of the SARS-CoV-2 virus.

The resources used to study hydroxychloroquine (HCQ) would have been better spent on more promising treatment modalities, such as studying Camostat mesilate or nafamostat mesylate therapy for COVID-19, a compound which has been shown to block TMPRSS2.