How To Achieve The “New Normal” Life With COVID-19

The skeptical cardiologist finds much wisdom in a series of opinion pieces written by six former advisors of the Biden administration’s COVID transition team.

The first article, “A National Strategy for the “New Normal” of Life With COVID” recognizes what is becoming increasingly clear: COVID-19 is here to stay.

We are not going to totally defeat SARS-CoV-2, they write:

The goal for the “new normal” with COVID-19 does not include eradication or elimination, eg, the “zero COVID” strategy. Neither COVID-19 vaccination nor infection appear to confer lifelong immunity.

The authors recommend viewing SARS-CoV-2 in the same category as seasonal influenza and other respiratory viruses:

Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections.

The new normal would treat SARS-CoV-2 as we have done the other viral respiratory illnesses that have become endemic:

What should be the peak risk level for cumulative viral respiratory illnesses for a “normal” week? Even though seasonal influenza, RSV, and other respiratory viruses circulating before SARS-CoV-2 were harmful, the US has not considered them a sufficient threat to impose emergency measures in over a century. People have lived normally with the threats of these viruses, even though more could have been done to reduce their risks

Better Testing, Surveillance, Masking and Ventilation

The second paper, “A National Strategy for COVID-19: Testing, Surveillance, and Mitigation Strategies” co-authorizd by David Michaels, PhD, MPH; Ezekiel J. Emanuel, MD, PhD and Rick A. Bright, PhD details a proposed public health approach to this new normal.

It appears that SARS-CoV-2 will persist, and the COVID-19 pandemic will continue for some time. Consequently, to achieve a sustainable “new normal” with substantially lower virus transmission and mortality from COVID-19, testing, surveillance, masking, and ventilation all need significant improvement.

Here are their proposals

  • The CDC needs to collect and disseminate accurate real-time, population-based incidence data on COVID-19 and all viral respiratory illnesses.
  • Every person in the US should have access to low-cost testing to determine if they are infected and infectious.
  • when the CDC tracking system receives notification of a positive test result from a health care facility or at home, the system should automatically provide clear guidance on self-isolation and treatment options that may include anti–COVID-19 medications or an opportunity to participate in research studies to assess therapeutic interventions

Mitigation Measures

  • The most effective way to prevent transmission of respiratory diseases, including COVID-19, is to eliminate exposure to potentially infectious individuals, encouraging individuals who may have illness to stay home. This requires systematic access to testing and paid sick and family medical leave for all US workers, especially low-wage, temporary, freelance, contractor, and gig economy workers.
  • Upgrades to ventilation and air filtration systems, including increasing the intake of outside air, using efficient filters (rated at minimum efficiency reporting value of 13 or higher) and adding high-efficiency particulate air filtering devices. These systems will need to be implemented in offices, schools, public transportation, and other congregate workplace and social settings, such as restaurants and bars

Masks

It has been clear for a while that cloth and surgical masks aren’t particularly effective against this airborne virus, therefore:

  • The country needs to encourage use of high-quality filtering facepiece respirators (FFRs), such as N95s or KN95s, rather than cloth or surgical masks, to reduce transmission of respiratory viruses including SARS-CoV-2 in crowded indoor settings where community exposure risk is elevated.7
  • To meet demand and prevent reliance on imported products of questionable quality, there needs to be a national initiative to sustainably produce domestic FFRs and ensure they are readily available to all US residents for free or very low cost. The government could mail vouchers to US households to pick up FFRs at pharmacies, grocery stores, schools, and other locations.

The public needs better guidance on what masks to wear, when to wear them and assistance in obtaining effective masks:

  • There needs to be a system for clear recommendations from trusted public health authorities, advising local governments and the public about the appropriate use of facial coverings, depending on the setting; an individual’s vaccination, immune, and risk status; and the level of community transmission.
  • An easily interpretable risk assessment map that encompasses these variables to provide immediate risk determination at the zip code level for individuals could be developed and updated daily.
  • Such a system would help reduce confusion and guesswork that many individuals face today as they make daily decisions on how to protect themselves.

In summary

To reduce COVID-19 transmission, achieve and sustain a “new normal,” and preempt future emergencies, the nation needs to build and sustain a greatly improved public health infrastructure, including a comprehensive, permanently funded system for testing, surveillance, and mitigation measures that does not currently exist

This revised viewpoint and these recommendations seem appropriate to me. Let me know your thoughts.

Neonormally Yours,

-ACP

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20 thoughts on “How To Achieve The “New Normal” Life With COVID-19”

  1. There seems to me to be one substantial feature of Covid-19 that keeps it from being lumped into the family of respiratory virus infections. If I get the flu I may be ill with it, and could potentially die of it, but if I recover then I can recover to my original state of health, and continue my life as before. However with Covid-19 it would seem that an infection from which I recover may, in the form of Long Covid, leave me with a serious long term impairment to my ability to enjoy my life, a threat of which I don’t think we as yet have a good understanding.

    Reply
    • David,
      Long Covid is a bit of a mystery. Papers written on it tend to be weak retrospective chart reviews.(https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003773#sec016)
      In my patients I see prolonged symptoms for months after significant upper respiratory illnesses of all types. We need better prospective studies to determine if COVID-19, especially the current variant and especially in the vaccinated has more significant long term sequelae than matched patients with other seasonal respiratory illnesses.
      In the paradigm shift proposed, avoidance of infection is still recommended.
      Dr P

      Reply
  2. Did the NIH et al put all their eggs in the vaccine basket? I didn’t read anywhere about treatments. AAPS says there are very promising signals from drugs like ivermectin, HCQ, mAB, and fluvoxamine. We are 24 months into this and there are no out patient treatment protocols for covid. Very curious of the NIH with a trillion dollar budget. Mask is akin to a chain link fence to keep out mosquitos – ya a couple will hit the fence wire but please. Masks do project apprehension and drive fear. BTW got anything for my full on day 3 omicron (despite or in spite being fully Pfizer’d)

    Reply
    • Rick,
      We have 4 outpatient treatments that I mentioned a couple of posts ago with paxlovid, the first oral treatment and the first choice of treatment for those with mild to moderate covid within 5 days of symptom onset.
      Here’s the discussion on those treatments is here and here
      Effective masks are useful at preventing infection because the virus travels on larger aerosol particles
      Dr P

      Reply
  3. Well maybe I am wrong. I don’t know anything about medicine, but I do know about history. ALL pandemics end. Infectious diseases aren’t like chronic diseases. Some people think the common cold virus started out like covid 19. As more and more people develop some immunity to it, the disease will fade into the background. People will no longer die from it. The disease is getting through the first layer of the immune system, but B and T cells seem to be longer lasting. We do not know how long the B and T cell immunity lasts. People getting infected after vaccination is actually good. Eventually, everyone will get this disease as a baby, and it will come back sometimes. The people of the Spanish flu survived it. I am pretty sure we will too.

    Reply
  4. Effective therapeutics and timely access to effective therapeutics, taken prophylactically or during the first few days of an infection, would help

    Reply
  5. I have a less pessimistic view. I think the advent of Paxlovid, and hopefully more therapeutics to come, will help to end the pandemic even without eliminating SARS cov 2. After all, the vaccines we do
    have are based on new approaches.

    Reply
  6. Dr. Pearson, regarding cloth masks, ConsumerLab (paywalled, but worth it) has the only nuanced discussion I have seen so far about them. Media reports (and this post) I have seen so far do not distinguish between single-layer cloth masks versus the three-layer varieties. Sure, N95 is the “gold standard,” but it looks to me like one can get pretty close with a well-made three-layer cloth mask if one does their research. I would love to hear your thoughts on this. I very much appreciate this post, as I do everything else of yours that I have read–so very helpful!

    Reply
  7. I agree with both papers I also believe we are entering into a world of self monitoring for respiratory viruses We will be monitoring individually on a continuous basis Blood Oxygen SPO2, Heart Rate and Temperature these are the new norms

    Reply
    • There’s a whole class of people who won’t be doing such things. I run into them every day – the contractor rehabbing my bathroom, my biweekly housekeeper, various service/repair guys. These people exist in a different world, and it is not one where the people coming up with these plans seem to recognize.

      Reply
  8. This is The Blue State Plan. Central planning, one size fits all, subsidized by the federal government, imposing costs on small businesses which they probably can’t afford.

    And ultimately, a Trojan Horse for the idea that the New Normal is actually a Permanent Emergency justifying who knows what other measures deemed advisable by The Experts.

    Of course, there’s no thought that perhaps elements of the Plan are not actually within the Constitutional authority of the federal government. But I suppose that was not within their remit.

    Like Cheryl, I spend most of my working life as a government employee, so I understand where she’s coming from. But my take is that a system could be put in place but it won’t actually work, except for employing bureaucrats to require and analyze reports…

    Reply
  9. Thanks for an excellent summary of these two JAMA papers published on Jan. 6th. (Just to clarify the first sentence a bit, perhaps “series” should be changed to “pair” and “six” to “five.”)

    Reply
    • Bruce,
      There was a third paper in that issue of JAMA on the same topic, which I did not write about. I believe there was a sixth author on that one.
      Does three qualify as a series? Maybe not.
      Dr P

      Reply
    • Why is there no information being given as to how the average person in the US, a great many who are obese with T2D, can improve their immune systems?

      Reply
      • Charles,
        Great point. There seems to be an attempt by public health leaders to ignore the huge risk that obesity confers.
        They should be imploring the obese with metabolic syndrome/diabetes to lose weight as part of an overall health strategy to mitigate risk of Covid complications.
        Dr P

        Reply
        • In fact it appears that the popular position that we should not “body shame” people. As a result I am seeing more TV commercials with what appear to be fairly overweight people in them as the new normal.

          Reply
  10. And the likelihood of these changes being implemented are basically nil. Not that I’m a pessimist, more of a realist having worked in government for most of my life.

    Reply

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