By Kevin Kavanagh
We all need to recognize the dangers of Covid-19 and the risks it imposes to our long-term health and our country’s workforce. Long Covid occurs in about 30% to 35% of cases. It commonly occurs with even mild disease and with reinfections. The severity is additive, with each exposure, and the symptoms can often persist for over a year (the longest that patients have been followed).
There is no such thing as “herd immunity” and I beg to differ with the CDC regarding “immune debt” causing the current increase in respiratory infections, and their statement regarding respiratory syncytial virus infections: “And so these children, if you will, need to become infected [with RSV] to move forward because it’s a disease very common in children.”
“Immune debt” is just another push for “herd immunity,” and to use this to explain the increase in RSV infections is mind-boggling, since we had a significant number of infections last year. At the end of November this year, pediatric hospitals were filled with RSV, but at that time there were corresponding more RSV infections in the previous year. We are on track to have an even larger RSV season, but “immune debt” is an unlikely cause.
Another explanation for rising RSV hospitalizations is “immune theft” due to Covid-19, which as of last March had infected over 75% of children. Mounting research has shown that Covid-19 is associated with immune dysfunction which can persist for at least eight months (the longest time studied).
Why not make indoors as safe as outdoors? Unfortunately, increasing ventilation alone is unlikely to stop the spread of Covid-19. But poorly ventilated areas are by far the least safest places. Consumers can use a portable CO2 monitor to at least make sure minimum non-pandemic standards are being met. We do have the technology to greatly improve indoor settings. It is decades old and has an excellent safety record. It is called upper room germicidal UV-C lighting.
We also need to use well-fitted N95 masks whenever possible, especially when encountering others on short exposures during store pickups. The public repulsion to masking is both social and based on fake science. The viral particles which float in the air are droplets, much larger than one micron. But most importantly, an N95 mask is not a strainer. N95 masks work more like flypaper, trapping viruses because they stick to the fibers, and not because they are blocked by them. N95 masks are extremely good at capturing very small particles.
We need proper and clear messaging to retailers regarding standards for indoor safety and N95 masking, but the CDC is airing a commercial which appears to promote mask-less congregation in crowded indoor settings (elevator, public transportation, etc.) for those who have been boosted. This messaging ignores the suboptimal efficacy rates of boosters in preventing symptomatic disease, spread and even Long Covid.
Vaccinations and boosting do provide another layer of protection, but according to a large National Institutes of Health study, they only provide 34% to 38% protection against Long Covid. They also do not eliminate symptomatic infections and spread. These are all too common. However, vaccines do provide good protection against hospitalization and death. What is needed is a mucosal vaccine which produces large quantities of immunoglobulin antibodies inside the nose, which should stop the spread of disease. There are promising vaccines being studied. The absence of an “Operation Warp Speed” initiative for these mucosal vaccines is one of the greatest failings of our pandemic effort.Whenever possible, consumers should use online shopping, curbside pickup and as a last resort in-store pickup. Retail establishments need to offer these options, plus make sure their personnel are wearing N95 masks. Rapid testing is also important. We all should be testing immediately before indoor gatherings and family events. A recent study from Yale found this strategy could decrease spread by 40%.Thus, testing, masking, avoiding indoor crowded settings along with keeping vaccinations and boosters up to date are the best strategies we have to stay safe during times of high viral spread. These strategies will also work with the seasonal flu and will also help to protect against RSV, for which there is no vaccine.
Above all, we need to have clear and comprehensive public-health messaging. We must be willing to make a few compromises in the way we live, for the safety of others and ourselves.
Kevin Kavanagh is a retired physician from Somerset and chairman of Health Watch USA, which is dedicated to infection control. This was originally published in the Louisville Courier Journal.