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Friday, Feb. 11, 2022

Looking Forward to an Endemic COVID-19

Learning how to live with disease on a daily basis

The Omicron variant is the most contagious but least virulent COVID variant we have faced during the pandemic. This combination of lots of cases and less severe illness leads to greater natural immunity in the population. Along with America’s intense vaccination efforts, this will greatly reduce the impact of COVID in the near future.

It doesn’t mean COVID-19 will be eradicated. The virus will be with us always but at much less a threat. We will manage the disease with vaccinations, natural immunity and therapeutics. COVID will become more like the seasonal flu as we get past the epidemic. Like influenza, we will be able to identify the disease and prescribe treatment to shorten the illness and reduce the symptoms.

The next step is to turn greater attention to therapeutics. As a physician, I don’t throw my hands up in defeat if prevention of heart disease doesn’t work. I have lots of therapies to consider for each individual patient. I have strategies to use for outpatients in the office and those I can use in the hospital. Developing therapeutics should be our main goal now.

Right now, we have monoclonal antibodies that have worked well for many in this pandemic. We have promising new oral drugs from Pfizer and Merck and others in the pipeline. Studies on Fluvoxamine (antidepressant) and Budesonide (antiasthma drug) show promise in off-label use. Studies on Hydroxychloroquine and Ivermectin continue but thus far have mixed reviews. There are no studies on vitamin D, vitamin C and zinc, but many practitioners recommend them.

Beyond disease prevention, one lesson learned during the pandemic is realizing that the real goal is to prevent overall harm. In retrospect, lockdowns and school closures and unproductive restrictions on jobs and economic activity often caused more damage than the disease. The harm of lockdowns continues today in job issues, critical shortages and inflation.

The harm of school closures as prevention has been substantial. The education loss of our children is greater than one year — with the most significant loss in those more disadvantaged. Child and adolescent physical and sexual abuse, substance abuse, anxiety and depression have all increased. In the past year, we exceeded all previous records of opioid use and suicides in children and adolescents. These harms exceed the harm of the virus itself in children, where the rate of severe illness is low.

The results of school closures will be felt for years. Virtual learning is not even close to in-school learning in effectiveness.

In school, learning is hindered by significant absences due to quarantines. In Los Angeles in September of 2021, 30,000 students have been quarantined with only 60 positive COVID tests – a 0.2% positivity rate.

COVID is a much milder disease in children, with the rate of severe illness being very low.

The whole idea of vaccine mandates is controversial for several reasons. People who have recovered from COVID have natural resistance — an immunity superior to vaccines. In addition, vaccines don’t necessarily prevent the transmission of the virus to someone else, and vaccine efficacy declines over time. Lastly, all will feel the impact of removing people with critical job skills from the workforce.

The vaccine mandate prevention effort builds on the false premise that only unvaccinated people can spread the virus, and only the vaccination could prevent its spread. These mandates should not be left to stand long. It is easy to criticize people who refuse vaccination, but these are people who staffed our hospitals and faced COVID every day over the last two years. Essential workers need to be added back to the workforce sooner rather than later.

Any other decision would defeat the goal of getting America back to normal again.

The health-care workforce shortage is real. The presence of burnout, difficult working conditions, illness and viral infections – seasonal and COVID – should cause us to pause before adding vaccine mandates as another negative impact on our worker shortage.

The biggest challenge now is deciding when we will declare the COVID pandemic over. The tendency will be to hang on to previous decisions. The right thing to do will be to correct course when new data contradicts the narrative.

Fear is a powerful emotion that has been used too much during this epidemic. It is why too many do not feel safe even with the harshest of restrictions. We need to avoid looking backward and holding on to fear. There is a lot of science now that supports hope. There is reason for more confidence this pandemic’s hold on our lives will end soon.

Dr. Phillip Rozeman is a practicing cardiologist. He is former board chair of the Greater Shreveport Chamber, Shreveport Medical Society, and has been honored as a recipient of the John Miciotto Lifetime Healthcare Achievement Award.

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