Written by JobSiteCare
April 7, 2022
The biggest question we’ve received over the last couple of weeks is why is it that all the data is looking like COVID is, at worst, still around at a low-level nuisance in much of the world, but we are seeing friends, family, and celebrities reporting their bouts of COVID at what feels like a very high rate. Well, this is real, but it is showing us what to expect out of COVID moving forward. The official data we see regarding COVID cases does not match what we are experiencing because most people aren’t even bothering to report, just as people don’t become a statistic when they have a bad cold or even influenza. Both changes in the virus and the availability of effective treatments have changed the game
For at least a few months to maybe even into next year, it is very likely that people will continue to catch COVID at reasonably high rates, but in most cases, it’s almost a “so what.”
Let us put this in perspective for you. Every year, there are about a billion cases of upper respiratory infections in the US alone. About 50% of those or 500M are a result of Human Rhinovirus. We think of that as the common cold and pretty much go about our business. But human rhinovirus infections are often what opens the door to severe infections like pneumonia that put more people in the hospital annually than just about any other cause. In fact, there is good evidence that this “common cold” virus, by making elderly and immunocompromised people more susceptible to deep tissue bacterial infections and by predisposing people to acute asthma attacks, actually leads to more annual deaths than the flu, especially in the very young, the very old, and immunocompromised people. Notably, COVID does not lead to secondary bacterial infections at anywhere near the rate of cold viruses.
Another 25% of common colds are caused by Coronavirus infection other than COVID and even before COVID, nearly 3% of all hospitalizations for respiratory symptoms were due to non-COVID coronaviruses.
The point of all this data is not to say that COVID-19 is not serious, it certainly can be, but just like these other viruses, in most cases, it is just a minor nuisance and just as we have been going about our daily business since time immemorial with plenty of other viruses that can cause illness and death at a predictable, but low rate, we are moving into the same situation with COVID-19. And with COVID-19, through vaccination, we have tools that can even further decrease individual risk, which is not the case with these other viruses other than flu. COVID is rapidly evolving into just another circulating respiratory virus that we’re going to learn to live with.
Because the impact of these other viruses in terms of illness, deaths, and lost productivity is more significant than they are given credit for, there actually may be something of a good lesson learned for all of us: And that is that we can take simple measures to protect ourselves and those around us from respiratory diseases. Maybe society will learn that the risk of just “powering through” a “cold” to come to work to show how resilient and indispensable you are may become a relic of an older era. If the one lesson that society can take out of this is that you should minimize how much you go out in public indoor settings with a “cold” or that, as a minimum, both individuals and organizations should apply the layered defense “swiss-cheese” approach to preventing the transmission of respiratory diseases, especially during cold and flu season, then we will have learned a great deal. Everyone needs to pay attention to the importance and value of self-screening for respiratory disease symptoms before coming to a school, workplace, or other public/semi-public indoor location…not just for preventing COVID, but for helping to prevent all the various respiratory infections that can be disruptive.
As we have noted in previous weeks, but it does not hurt to review again, the newer approaches to communicating risk that is now being used by the CDC and many other countries are helping us to transition from a primary focus on case counts to better attention to impact of the virus on individuals, as manifested by hospitalization rates, and on systems, as manifested by hospital resource availability. Up to a reasonable level, which the US CDC has assessed as 200 cases/100K/week, as long as there is minimal evidence of significant hospitalizations or lack of resources, then people should feel comfortable going about their daily business without having their lives run by how they respond to COVID. The hospitalization rate is a very good indicator of the severity of disease, and the hospital COVID utilization proportion is an excellent indicator of resource availability.
As of last Friday, over 94% of US counties are in the green category using above mentioned criteria and this includes essentially all major metropolitan areas. In the UK, cases have been fairly rapidly decreasing for 2 weeks. The Middle East, most of Africa, with the exception of Botswana, and most of the Americas, are either at or near similar levels of risk. The major trouble spot remains in western Europe and Australia/New Zealand where cases remain stubbornly high and trends are generally not showing signs of reversing. Exceptions to that finding are Spain, Poland, and the nations surrounding the Black Sea. In East Asia, case rates are still generally high, but with the exception of Japan, on a slow steady downtrend. China is still very concerning with 23 cities in some degree of significant quarantine, affecting over 120M people.
Within the US, for much of the epidemic, New York City has been a bell-weather, and right now New York cases are rising, they are not spiking, just rising slowly, with most of the rise being concentrated in younger, more active, mobile, and often unvaccinated segments of the population. Hospitalizations are not rising demonstrating that the changes in the virus and the amount of immunity from both vaccinations and prior infections are keeping this an annoyance and not the high risk that we saw with earlier variants. Just as BA2 created a wave in the UK that is now abating, we are likely to see the same in NY and possibly other areas of the US and Europe.
With regards to international travel, more countries are moving to reduce or eliminate COVID-related travel restrictions, with now 30 countries having completely dropped them. 161 countries still maintain vaccination and/or testing requirements. Only 35 countries still have closed borders, with most of these being relatively politically isolated nations anyway.
As COVID rates come down, especially in areas with rates near or below 10 cases/100k/day, the value of screening testing becomes questionable as the false positive rate begins to become more dominant. Testing when you have actual symptoms, especially if you are going to be around others at risk for infection, and especially those at risk for serious disease, is still important so we can help reduce the overall rate of transmission to negligible levels. This means that there is very little indication for PCR testing unless you are in a situation where you need to prove as conclusively as possible that you are not infected, such as when you expect to be around at-risk people.
Lastly, a couple of words on treatments: They work. No treatment is perfect, but both monoclonal antibodies and Paxlovid antiviral have demonstrated excellent effectiveness and safety. Over the last 3 weeks, we have not had much trouble locating Paxlovid for any US-based patients, and reports of fair international availability are increasing. Sotrovimab, which was initially the only monoclonal antibody felt to have good activity against omicron has been shown to have slightly decreased efficacy against BA2, but a newer monoclonal antibody, Evushield (Tixagevimab plus cilgavimab) appears to be very effective.