I am old enough to remember the great American philosopher, Alfred E. Neuman, whose major mantra “What, Me Worry?” was spread far and wide by Mad Magazine.
We all appreciate how overwhelming and chaotic and painful life can be, but let’s credit Alfred for so often reminding us to smile, even laugh in the midst of madness. Still, sometimes it’s necessary to counter the chaos and the pain with a thoughtful, effective plan. To take action before we flash that gap-toothed Neuman smile.
But, making an unanticipated comeback, it appears “What, Me Worry?” has become the latest American approach to the COVID pandemic:
There are moments when I’m amazed to find myself reading, not Mad Magazine, but the British Medical Journal “The Lancet”; checking the COVID sections of the UK’s Financial Times and heading over to the Johns Hopkins Coronavirus Resource Center; or looking at the latest graphs at Our World in Data.
Such is the incredible impact of COVID-19 on our lives, and my continuing desire or need as a journalist, not to mention the inescapable reality that I’m just one more possible victim, that I’m driven to learn about and communicate the current state of COVID.
I confess there’s some bizarre mental gymnastics my mind invariably goes through as I spend time learning about the on-the-ground reality of those treating COVID and the plight of those battling long COVID. This information is sobering, and frightening. Then I have to try to navigate an American universe dedicated to pretending things aren’t that bad. Here’s a tweet from Rachel Hoopsick, an Associate Professor of Epidemiology at the University of Illinois that offers another look at the now required balancing act between illusion and COVID reality:
Just the other day, Johns Hopkins offered this COVID update: The U.S. is one of the ten nations in the world most affected by the COVID virus:
Johns Hopkins notes that “the first case of COVID-19 in US was reported 949 days ago on January 21, 2020. Since then, the country has reported 94,190,979 cases, and 1,043,840 deaths.”
The New York Times offers another way to understand this story. Their color-coded map of the world’s COVID hotspots is based on average daily cases per 100,000 people for the last week, and the United States is bright red, with a daily average rate of 88,391 cases. For comparison, Japan is at 191,960; South Korea at 103,940; Australia at 11,944; and Russia at 40,610.
Two years in, pretty much everything about COVID remains confusing, often controversial. As COVID case numbers and COVID deaths seem to have stabilized at numbers that two short years ago would have been unacceptable, the Centers for Disease Control has published new guidance which makes the case for relaxing measures we once thought necessary to reduce the risk of contracting COVID-19. Policies were once in place that were thought to protect individuals and those congregating in office buildings and factories and retail establishments, attending institutions like schools and colleges, or visiting indoor spaces like theaters and arenas and museums.
The CDC explains: “As SARS-CoV-2, the virus that causes COVID-19, continues to circulate globally, high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post–COVID-19 conditions) and associated hospitalization and death. These circumstances now allow public health efforts to minimize the individual and societal health impacts of COVID-19 by focusing on sustainable measures to further reduce medically significant illness as well as to minimize strain on the health care system, while reducing barriers to social, educational, and economic activity.”
This decision seems, to me, to be more about politics and public relations than public health. Yes, vaccination has helped immeasurably to blunt what could have been much worse: the severe peaks of the first year, the overflowing Emergency Rooms, and the lack of ICU beds. But we now know that the vaccines developed to combat the earliest varieties of COVID, no longer are as effective against the current Omicron variant.
So, yes, there’s “What, Me Worry?” But then there is “Yes, I’m Worried!”
Here’s some more about the new CDC policy:
“Continuing to increase vaccination coverage and ensuring that persons are up to date with vaccination are essential to preventing severe outcomes … Public health efforts need to continue to promote up-to-date vaccination for everyone, especially with vaccines targeting emerging novel variants that might be more transmissible or immune-evasive.” (Emphasis added.)
And yet the CDC is reducing its requirements to check vaccination status: “CDC’s COVID-19 prevention recommendations no longer differentiate based on a person’s vaccination status because breakthrough infections occur, though they are generally mild, and persons who have had COVID-19 but are not vaccinated have some degree of protection against severe illness from their previous infection. In addition to strategies recommended at all COVID-19 Community Levels, education and messaging to help individual persons understand their risk for medically significant illness complements recommendations for prevention strategies based on risk.” (Emphasis added.)
This is how ABC News 11 in Raleigh, N.C. characterized the new policy: “Updated CDC COVID guidelines remove distinction between vaccinated and unvaccinated … The CDC said they’re trying to shift more of the responsibility from institutions to individuals. If you are exposed to COVID and you’re not vaccinated, you don’t have to be isolated, so this ends the difference between vaccinated and not vaccinated. If you are exposed to COVID and want to take a test before leaving quarantine, you should wait at least five days to do so or if you’ve been ‘fever-free’ for a day. The new guidance also drops the ‘test to stay’ recommendation which states students exposed to COVID had to test regularly to continue going to class. The new guidelines also deemphasizes the concept of social distancing.”
And yet according to National Geographic, the latest research reveals “Most COVID-19 patients recover from their acute infection within two weeks, but bits of the virus don’t always disappear from patients’ bodies immediately. Now a new study, one of the largest focusing on hospitalised COVID-19 patients, shows that some patients harbour these viral remnants for weeks to months after their primary COVID-19 symptoms resolve.
“The study suggests that when the genetic material of the virus, called RNA, lingers in the body longer than 14 days, patients may face worse disease outcomes, experience delirium, stay longer in the hospital, and have a higher risk of dying from COVID-19 compared with those who cleared the virus rapidly. The persistence of the virus may also play a role in long COVID, the debilitating suite of symptoms that can last for months.”
To me, this new “What, Me Worry?” guidance seems so very counterproductive. The fact that the CDC is telling people they can resume their public lives after five days when the latest research shows the virus may still be extremely potent just increases the chances of greater spread.
And even if some vaccinated folks have come down with breakthrough infections, the fact that they have been immunized will likely limit the severity of their illness. And the fact that some unvaccinated folks having come down with COVID might now have gained some immunity doesn’t mean they and the rest of us wouldn’t have been better protected had they gotten all the shots.
Finally, our continuing low vaccination rates points to the limitations of relying on the current community education and messaging campaign. Mandating vaccination has worked wonders in the past. Coupling childhood vaccination requirements with school attendance has worked well. And even with the well-publicized decision of several professional athletes to say no to COVID shots, the overwhelming percentage of their teammates, performers, fans, and attendees accepted the need to present a filled-out vaccination card and willingly complied.
According to Our World in Data, “this chart presents the COVID-19 death rate among unvaccinated people (zero doses received), people with a full primary vaccination series, those who received one booster dose, and those who received two booster doses.”
Perhaps it’s time to remind President Biden and the public relations folks working at the CDC about some of the data they just recently released. Their June 22, 2022 Press Release announced: “Nearly One in Five American Adults Who Have Had COVID-19 Still Have Long COVID … New data from the Household Pulse Survey show that more than 40 percent of adults in the United States reported having COVID-19 in the past, and nearly one in five of those, 19 percent, are currently still having symptoms of long COVID. The data were collected from June 1 to June 13, 2022 by the U.S. Census Bureau and analyzed by CDC’s National Center for Health Statistics (NCHS).” (Emphasis added.)
Meanwhile, here’s the COVID-19 situation as of August 31, 2022 for the Commonwealth of Massachusetts:
Remember when we were told that the young were relatively safe from coming down with COVID? Well, what I found particularly interesting is the large number of COVID cases in the age ranges of 20-29 and 30-39, with greater numbers than the cases among the 40-49, the 50-59, and the 60-69 age groups.
Meanwhile, here at home in Berkshire County, while 93 percent of those 65 and older in the County have been vaccinated, only 77 percent of all residents are fully vaccinated. As for the figures for the nation: 67 percent are fully vaccinated, but only 33 percent are boosted.
And yet, as it becomes even more apparent with the rapid spread of Omicron that we are going to need an updated vaccine better targeted to this new variant, the issue of vaccination will once again take center stage. This is the wrong time for the CDC to relax requirements and mandates for vaccination.
The Conversation explains how there’s now a critical need for a new vaccine: “A recent study suggested that first generation COVID vaccines prevented up to 20 million deaths around the world in their first year of use … Although the vaccines continue to offer protection against deaths and hospital admissions, recent research has shown the initial course of COVID vaccination provides limited protection against symptomatic disease caused by the omicron variant. So this second-generation bivalent or dual-variant vaccine targets both the ancestral strain of SARS-CoV-2 and the omicron variant BA.1. It contains 25 micrograms of the original coronavirus vaccine and 25 micrograms of vaccine that specifically targets the omicron variant.” (Emphasis added.)
The new CDC guidelines, in an effort to help propel the return to normalcy, have decided to change the way it measures and communicates risk. CDC recommends the use of three indicators to measure COVID-19 Community Levels: 1. New COVID-19 hospital admissions per 100,000 population in the last seven days; 2. percent of staffed inpatient beds occupied by patients with confirmed COVID-19 (seven day average); and 3. new COVID-19 cases per 100,000 population in the last seven days.
“At the Low level, individual and community-level recommendations focus on best practices in infection prevention and control in community settings, in addition to promoting up-to-date vaccinations as the front-line strategy to protect from severe disease. These include improving ventilation, testing to identify infection early, and following recommendations for isolation and after an exposure.
“The Medium level strengthens emphasis on protecting people who are immunocompromised or at increased risk for severe disease, and enhanced prevention measures for high-risk settings.
“At the High level, additional recommendations for individuals and communities focus on wearing masks indoors in public and providing added protection to populations at high risk.”
CDC is doing all it can to make it easier for workplaces, retail establishments, and schools to relax COVID safeguards, like requiring vaccinations and masking. For example, “CDC now recommends case investigation and contact tracing only in health care settings and certain high-risk congregate settings.”
No longer will you know if someone you know or work beside has COVID. For those infected:
In short, if infected: Stay home. Wear a mask around others. If you test negative after 5 days, on the sixth day you can resume your previous activities but should wear a mask around others in public.
Dr. Ashish Jha, White House COVID-19 response coordinator, defended the new CDC guidance: “In terms of whether we need mandates and those policies, that really has been something I felt very strongly for the entire pandemic – that decisions on mandates should be made by local public health officials, mayors and governors. Every community is different.” (Emphasis added.)
This seems to be the new American mantra—whether it’s denying a woman the right to control her own body, how easy or hard you make it for people to vote, or making it more likely people will come down with COVID—it’s a local decision. As if local politicians are better prepared to protect fundamental human rights. Or as if local Boards of Health know as much about pandemics than people who have spent a lifetime studying them. The science of COVID and the capacity of the Coronavirus itself to spread transcends both geography and the pedestrian politics of the moment.
Here, in Berkshire County, we seem to be in a temporary holding pattern. For days now, my New York Times Coronavirus Tracking email has delivered the same message: “Case Details: The average number of new cases in Berkshire County was 32 yesterday, about the same as the day before. Since January 2020, at least one in four people who live in Berkshire County have been infected, and at least one in 305 people have died.”
So great is our power “to get used to” that the CDC considers 32 recorded new cases a day “low impact.” Ignoring, of course, that this number doesn’t reflect all the positive home tests that never make it to the official count.
As of September 1, 2022, Johns Hopkins noted that, using a seven day average, there were 111,211 new cases, 751 new deaths, and 37,438 new hospitalizations of COVID.
And sadly the getting used to fact is that many Americans have stopped paying attention to COVID’s daily death toll:
Our World in Data offers a visual view of new COVID hospitalizations in the United States:
Again, the CDC notion that we “have substantially reduced the risk for medically significant COVID-19 illness” is relative. The graph above reveals that a few days ago, on August 27, 2022, there were 38,209 new COVID hospitalizations. But not so long ago, on June 27, 2022, there were 13,372 new COVID hospitalizations.
Finally, one of the most disturbing aspects of the new push to find a way to live with COVID, to minimize any COVID inconvenience, is the tendency to downplay what the medical community refers to as “post-acute sequelae of SARS-CoV-2 infection (PASC)” and what we ordinary civilians know as “long COVID.”
Well, The Lancet offers results from a very recent study: “Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients.”
The authors went through “health-care records of approximately 89 million patients collected from hospital, primary care, and specialist providers (mostly from the USA, but also from Australia, the UK, Spain, Bulgaria, India, Malaysia, and Taiwan.” They matched 1,285,437 people with a recorded diagnosis of COVID-19 with the same number of patients who were suffering with another respiratory infection. The age break down was 185,748 children; 856,588 adults; and 242,101 older adults.
This is what they found: “This analysis of a two year retrospective cohort studies of individuals diagnosed with COVID-19 showed that the increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout. The differing trajectories suggest a different pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern …
“Risks of the common psychiatric disorders returned to baseline after one to two months … By contrast, risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the two-year follow-up period. In summary, post-COVID neurological and psychiatric outcomes followed different risk trajectories: the risk of cognitive deficit, dementia, psychotic disorder, and epilepsy or seizures remained increased at two years after a COVID-19 diagnosis, while the risks of other diagnoses (notably, mood and anxiety disorders) subsided early and showed no overall excess over the 2-year follow-up. Children are not at increased risk of mood or anxiety disorders (even over the first 6 months) but share adults’ risk of several other diagnoses. The comparable risks seen after the emergence of omicron indicate that the neurological and psychiatric burden of COVID-19 might continue even with variants that lead to otherwise less severe disease. These findings are relevant for policy makers involved in anticipating and addressing the health burden of the pandemic, for researchers seeking to identify the mechanisms underpinning brain sequelae of COVID-19, and for patients and clinicians wishing to know the neurological and psychiatric risks following SARS-CoV-2 infections.” (Emphasis added.)
Or as the Chief Scientist for the World Health Organization (WHO) put it:
As for parents, caretakers, teachers, and school staff starting a new year, here’s some advice from the American Academy of Pediatrics:
I hope you will at least consider putting aside the COVID “What, Me Worry?” advice for the near future, and think about a policy of care and concern (with, when necessary, some calculated worry).
