Kevin Kavanagh, M.D.
By Kevin Kavanagh
This month my family had encounters with two Lexington doctor offices. In one the staff rolled her eyes when asked about masks, parroting the misinformation that viruses are two small to be filtered, ignoring the fact that what is floating in the air are larger viral-droplet aerosols which N95 masks efficiently capture. The other had a mask optional policy in a practice which services high-risk elderly patients in a county which is in the CDC’s “red” zone for transmission and hospitalizations. No wonder Kentucky is 49th in the nation in their Covid-19 response.
Almost all in Kentucky appear to believe the pandemic is over and that “herd immunity” has snuffed the virus out. Misinformation has severely injured our nation. Here is a fact: If you live in the United States, overall your chance of dying of Covid-19 with the Omicron variant is greater than it was with the Delta variant. Infectivity is what increases the danger of activity participation.
In addition, immunity is waning, both in those who have been vaccinated and those who have had a previous infection. “Herd immunity” may help end a surge, but the virus quickly adapts and strikes again.
The risks of “long Covid” are real and all too common. It occurs in approximately 30 percent of those treated for Covid-19 and up to 70% have symptoms of cognitive difficulties and brain fog. The risks of cardiovascular disease increases and the chances of dying almost doubles (8.39 additional deaths per 1000) in the first year after the acute infection. And there is a recent report from Harvard Medical School which found viral antigens circulating in the plasma of a majority of long-Covid patients for up to a year after infection. This observation raises the possibility of an ongoing low-grade infection in long-Covid patients. There is also emerging evidence that repeated bouts of infections can add to the burden of long Covid in a graded additive fashion. In other words, repeated infections appear to add to the damage caused by previous infections.
The latest risk is from the Omicron BA.4 and BA.5 variants. These variants are causing surges in both Israel and the United Kingdom with an increase in hospitalizations. Unfortunately, a study from Ohio State University found that infection with Omicron appeared to be ineffective in producing adequate neutralizing antibody titers against BA.4/5. A report from the New England Journal of Medicine found that even those vaccinated and boosted may have little protection against reinfection with BA.4/5. Another report observed that BA.4/5 is more infectious than BA.2 (the first Omicron subvariant, which is more infectious than BA.1, which is more infectious than Delta, which is more infectious than Alpha, and so on,)
Overall, there is a mind-boggling set of guidelines generated by a narrative which changes depending upon the type of vaccine, how many doses one has received, if one has had a previous infection and which variant caused the infection, along with the time from the last vaccine dosage and/or infection.
As new variants continue to rapidly emerge, the guidance actually becomes simpler: All immunity is waning, and one needs to keep your immunity as strong as possible. This means to stay up to date with your vaccinations and boosters, even if you have had a previous infection. We also must slow down the spread of the virus and protect our elderly.
Businesses need to adapt by implementing the following:
- Improve building ventilation (increasing to five complete air exchanges per hour would reduce airborne disease transmission by 50% or more.
- Offer curbside pickup with personnel wearing N95 masks.
- Set aside an hour first thing in the morning for mandatory masking when those who are at high risk for severe Covid-19 can do their shopping.
- Churches should also increase ventilation, offer online alternatives, and conduct the first morning service with mandatory masking.
Finally, we all need to wear high-quality N95 masks during times of high viral spread. I am not sure how to motivate Kentucky’s population to do so. At the very least we need to use our vote to express political feelings, and our love for our neighbors to dictate how we act in public.
Kevin Kavanagh of Somerset is the founder of HealthWatch USA. This first appeared in the Lexington Herald-Leader.