Column by Richard Sternberg, M. D.

Diligence Called for,
Now More Than Ever

Again, just when it seemed we reached the point where we can go out with people and decrease our use of masks, COVID strikes back and possibly with more virulence than previous strains. The number of new strains to consider is large. New strains include BA.5.2.6, BA.4.1.9, BE.1.2, BA.4.7, BF.13 and XBB, among others. Already BA.5 and BA.4 strains have high penetrance in the U.S. The new and improved booster shots only use RNA to code for the original strains, BA.1 and BA.2

The Centers for Disease Control and Prevention and others warn that this year the winter viral season will be worse than usual because we have to deal with flu and RSV (respiratory syncytial virus). A side effect of the lockdowns and protective behavior over the last two years has been decreased contact between people so that influenza, rhinovirus (common cold), and other circulating viral illnesses have decreased, off-setting some of the increased mortality due to COVID. RSV is primarily a disease of children which makes it difficult for them to breathe and doesn’t have a vaccine yet. There are approximately 300 deaths in children in the U.S. each year from it.

It is now clear that COVID vaccination (and flu, for that matter) won’t prevent getting the infection but can decrease the symptoms. The CDC director, Rochelle Walensky, just announced that she has COVID 19. She received the bivalent booster one month ago at a CVS pharmacy.

In addition to all this there is both good news and bad news about Long COVID.

There may be a repurposed anti-alcohol addiction medicine that can help with the symptom of brain fog. On the other hand, one can develop Long COVID without having severe acute symptoms. There is an expectation that treating people with Long COVID will become more expensive than treating acute infections by the overwhelming number of cases and the difficulty dealing with some of its symptoms. It is estimated that 2-4 million people in the U.S. are out of work or doing only limited amounts of work due to Long COVID symptoms. There is mounting evidence that COVID-19 causes not only mild cognitive impairment, but is also linked to long-term conditions including new-onset Alzheimer’s and Parkinson’s diseases.

There is lot of social pressure to use a mask and precautions only in a place that demands one, like the hospital. This doesn’t appear to be good enough, especially for older adults and those with risk factors. A few people will try to space themselves out “almost six feet apart,” but I see this rule violated constantly. At this stage of the disease lock downs don’t make sense anymore.

Most people either had COVID, whether or not they were aware of it, or have been vaccinated and therefore there is some level of herd immunity. Children are at less risk to begin with and, if vaccinated and without risk factors, unlikely to get seriously ill. After watching national statistics in reading and math go dramatically down, it is clear that now in-person learning is essential for adequate progress.

The bottom line remains, and I know I am being redundant and preaching to the choir, get your vaccinations, both COVID boosters and flu, use masks, and avoid crowds.