Moving from group to personal protection
The "Choose Your Own Adventure" phase of the pandemic.
Recently, a Federal judge in Florida knocked down the CDC’s requirement to wear a mask on public transport. The CDC had sought to extend this requirement, first implemented in early 2021, to May 3, 2022. For those of us practicing infectious disease, this seemed prudent, as we watch the spread of the BA. 2 subvariant of the Omicron variant of COVID-19. While this new subvariant is even more infectious than the highly infectious Omicron variant, it is not known if it will lead to an increase in severe illness and hospitalization.
As Dylan Scott phrased it in his Vox article from April 20, “We are transitioning from a world of stay-at-home orders, business closures, and universal masking requirements to a choose-your-own-pandemic experience.”
Now that we have effective active immunization (vaccines), passive immunization (monoclonal antibodies like bebtelozimab and Evusheld), therapeutics (paxlovid, molnupiravir, remdesivir, fluvoxamine and maybe more), and ample rapid testing, the need for societal interventions imposed by governments, corporations and other large entities has passed.
Or has it?
There are a host of individuals in our society who may not yet benefit from some of the above interventions. The severely immunocompromised may not respond to vaccines. The indigent and socially marginalized may not have access to therapeutics. rapid tests, or effective respirators, such as N95/KN95 masks. And children under age of 5 are STILL not eligible for vaccination.
Many of the barriers to care, not just vaccines, are enumerated in the image below, which while specific to vaccines, could equally apply to all therapeutics and testing.
If our governments won’t implement group protection, instead leaving protection to the individuals, what should individuals do?
The answer comes down to risk tolerance: what are you willing to risk for yourself and those around you? Many people will judge themselves to be low risk—or maybe don’t understand the risks at all.
This is nothing new. Some of us engage in risks that others would not tolerate: we ski, ride motorcycles, enjoy using firearms. None of these are without risk—all are popular. And some of us who engage in one risky behavior may not accept others. The difference, of course, is that our risk-taking around COVID-19 affects not just ourselves, but those around us as well.
I would counsel to consider the following factors:
Are you severely immunocompromised, such as on medication that lowers your immune system, or suffer from a condition that renders low immunity? Or, does anyone you live with, work with, or visit often, have those conditions? If so, you would do well to continue to wear a high-quality (eg N95 or KN95) while in indoor settings—including on airplanes.
Do you live with children too young to receive vaccine? While their risk of dying is low, COVID-19 may affect even young children.
Do you feel a sense of responsibility to your community? If so, continue to wear a mask indoors, to protect others from inadvertently catching COVID-19 from you. Best would be an N95 or KN95 type mask. A surgical or procedure mask would be next best. Least helpful would be a cloth mask, but all face coverings provide some level of transmission reduction.
Use test kits liberally, especially if going into an indoor setting with many people. Not transmitting COVID-19 to others is community service—and you may not know if you have infection without testing yourself.
Vaccination has proven very effective at reducing risk of developing severe complications of COVID-19 infection, but has proven less effective at preventing getting infected at all. It may reduce the risk of transmission onward if the vaccinated person becomes infected, but not completely.
Completely avoiding COVID-19 infection is likely near impossible. At some point, the odds are pretty good we all will end up infected. However, I intend to push that day as far into he future as reasonably possible, so that there is more ample supply of therapies.
But I’m not going to be a hermit either. Over the last few months, I have started to go to a few indoor dining venues, and having some more maskless interactions with people in my home.
Life goes on. We do the best we can. We must each, individually, decide what that means.
Thank you for your insightful newsletter! You help so many of us navigate these difficult times.
Thank you for your words.