Viewpoint: COVID-19 Forever Cancels the Old Normal

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Contrary to the “vaccinate and all will be well” narrative, “mild” does not mean just avoiding hospitalization, nor does surviving a COVID-19 acute illness means you have recovered. Vaccines are an important layer of armor but they, in themselves, will not stop COVID-19.

The concept that we must live with COVID-19 is slowly becoming accepted, even most coronavirus deniers have come to realize that herd immunity is not possible. Unfortunately, this pandemic has become a political issue with one side advocating that COVID-19 is a mild illness and questioning the need for control measures, and the other side trying to vaccinate their way out of the pandemic and lessening the need for other control measures. What is not accepted by either side, is that living with COVID-19 means not going back to normal.

Kevin Kavanagh, MD

Kevin Kavanagh, MD

There is agreement that COVID-19 is a pulmonary illness. However, in many cases this is not true. The virus does spread by respiration and is airborne, but it infects almost every organ of the body. This is exemplified by the numerous delayed fatalities from a myriad of seemingly unrelated disorders in those who have not been hospitalized with COVID-19. One news commentator was concerned that patients who are admitted with heart attacks and strokes were being classified as Omicron patients, ignoring the abundant evidence that SARS-CoV-2 is as much a cardiovascular virus as it is a respiratory virus.

Omicron’s increased infectivity can cause significant societal damage, exponentially more than an increase in case fatality rate. In the United States, COVID-19 cases are skyrocketing, and hospitalizations have surpassed record levels. Deaths are also rising, but slowly. Those who gleefully point to the lower-case fatality rate ignore the crippling of our health care system, preventing many individuals with unrelated conditions from obtaining needed care. I myself had to postpone needed surgery for cancer due to the hospital being filled with unvaccinated COVID-19 patients.

Even mild illness which occurs en masse can cripple the economy. Contrary to the “vaccinate and all will be well” narrative, “mild” does not mean just avoiding hospitalization, nor does surviving a COVID-19 acute illness means you have recovered. Vaccines are an important layer of armor but, they in themselves, will not stop COVID-19.

Before we can live with COVID-19 we must redetermine both the human and dollar cost society can tolerate and build a COVID-19 infrastructure to meet this new normal. This means improvements in indoor ventilation, availability of widespread rapid testing, and the use of high-quality N95 masks.

Buildings: Many opportunities were missed during the pandemic, with COVID-19 relief funds being used to make up lost time and bring our society back to the old normal. Schools have spent COVID-19 dollars improving sport programs and facilities. States have also spent their money on convention centers and tourism. Ironically both expenditures were appropriated with the hopes COVID-19 will disappear but with an endemic virus these activities will ironically help spread the virus. Instead, we need to be upgrading building ventilation, redesigning restrooms, and building traffic-flow, along with building increased capacity for curbside and home delivery services.

Masks: On the issue of masking there has been abundant mixed messaging. Currently almost all infectious disease experts, except the Centers for Disease Control and Prevention (CDC), agree that N95s or comparable masking are required. Senator and doctor, Rand Paul, has stated “Most of the masks you get over the counter don’t work,” and “…N95 masks, I have always said those do work.” CNN Commentator Leana Wen, MD, has referred to cloth masks as “little more than facial decorations.” She also advocates for the wearing of N95 masks. Maybe if Senator Paul and Doctor Wen agree on something, the CDC should listen.

Testing: Rapid testing needs to be expanded. Rapid tests are designed to detect individuals at the height of their contagiousness. They are most useful in screening individuals just before a gathering. Although highly accurate if positive, a negative test does not mean you are not infected. For this purpose, it is best to test on the day symptoms start and then again one or two days later. This is why rapid tests are sold in boxes of two. The proposed federal mandate of testing unvaccinated individuals once a week, makes little sense. Similar to what is done in Singapore with health care workers, rapid testing should be performed daily.

Public health is focused on the community, not one’s own health. In public health, as vaccine efficacy falls, it is even more imperative that all who can, become vaccinated. We must slow down the spread of this virus. It is easy to advocate for personal freedom and act irresponsibly when someone else is funding your safety net.

If our society is averse to mandates because they infringe on one’s personal freedom, we then should consider promoting personal responsibility by having those infected with COVID-19 at least pay a portion of their medical bill. Our current course is unsustainable.

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