Double Down to Dig Ourselves Out
I’m glad you enjoyed my last two newsletters (here and here) about fighting fear with hope when hope is rooted in facts.
But I want to be clear: while I’m optimistic about the vaccines, I’m also quite worried. Not about vaccinated people infecting each other—because that risk is close to zero—but because most of us haven’t been vaccinated yet. For this reason, and because the virus continues to run roughshod through the country, we need to stay vigilant.
The new coronavirus variants are worrisome. They are significantly more contagious than the “original” coronavirus still widely in circulation. The new variants so far don’t appear to be more lethal—meaning an infected person is not more likely to die from an infection with a new variant—however the more people who do get infected because of increased contagiousness, the more people we can expect to die from COVID-19.
It’s basically a race between the virus’ ability to mutate, infect more people, and consequently outsmart the vaccines versus our human ability to double down on risk mitigation and get people vaccinated.
The bad news: we cannot let our guard down; in fact, we need to double down on risk mitigation. The good news: we already know how to control this beast. (We just aren’t doing it that well.)
We need swift, aggressive action and all hands on deck—and a three-pronged approach:
1. We need more vaccine doses.
The sooner we vaccinate wide swaths of the population, the more lives we save and the less opportunity we give the virus to mutate.
Production of Pzifer-BioNTech and Moderna vaccine doses is ramping up. Johnson & Johnson’s safe and effective single-dose vaccine is likely to be approved by the FDA soon. Doses of J & J are already being shipped in anticipation of this green light. The Novavax vaccine is showing great promise and, if all goes well, should be available in late spring. The Oxford-AstraZeneca shot looks good so far, too, and preliminary data from the UK suggests what most medical folks predict: that the COVID vaccine not only protects against COVID-19; they also likely reduce transmission.
But vaccination alone won’t get us through this crisis. We don’t have enough doses to stem the surging case rate. We’re also seeing widespread vaccine hesitancy, sadly among the very populations who stand to benefit the most. And the virus is still spreading like wildfire as we’ve opened up the economy without strict adherence to risk mitigation rules.
2. We need to blanket the country with cheap, rapid, at-home testing.
We need continued PCR testing for diagnostic purposes (in other words, to prove that a sick person has COVID and not something else). But for surveillance purposes, and to crush the curve, we need cheap, self-administered antigen tests used frequently to help identify and isolate asymptomatic people.
I like to think of antigen tests as “contagiousness” tests. They don’t do a great job of picking up all infections, but they’re fantastic at telling us if someone is contagious at that moment.
To refresh your memory on COVID testing (PCR or antigen? Rapid or regular? How long after an exposure do I test?), click here and here. And to read more about the science and enormous potential public health benefits of rapid tests, spearheaded by Michael Mina at Harvard, click here.
Just this week, progress on this front was made as the federal government invested over $2 million in the first at-home rapid test to be available without a prescription. Blanketing the country with easy-to-use home tests would dramatically reduce asymptomatic spread of coronavirus.
However, testing alone won’t cut the mustard. While testing has become more widely available, a negative test does not predict the future. A negative test on Thursday doesn’t mean you can’t test positive on Friday. And as COVID case rates continue to rise, so does the number of asymptomatic carriers. The main driver of community spread continues to be people infected with coronavirus who don’t—and often won’t—exhibit symptoms. In bars, restaurants, workplaces, grocery stores, and in our homes, these folks (perhaps even you and I!) unwittingly feed the raging pandemic.
3. We need universal mask-wearing and to double down on risk mitigation.
To reiterate: the newer, more contagious variants do a better job evading our best efforts to contain them. Put another way, If you were lucky enough to get away with slip-ups before now (e.g. dining indoors, close-talking with friends, bunching up in the grocery line), you might not be so lucky the next time.
We should double mask in higher-risk scenarios (for example, any indoor spaces with non-household members, or in a taxi or pharmacy where distancing is more difficult and ventilation is not optimal). I recommend doubling up on your cloth mask, swap your cloth mask for a KN95 or KF94 mask, or put a cloth mask over your surgical mask. When you add risk, you add more protection. In my opinion, N95 masks aren’t necessary unless you’re a healthcare worker treating suspected or diagnosed COVID-19 patients.
Masks and distancing in a vacuum, however, aren’t enough. While MOSHPIT continues to be the best way to prevent infection, until we more universally adopt masks and aggressive risk mitigation rules, cases will continue to surge. It’s the LAYERING of risk mitigation elements that is more important than ever.
And to get the job fully done, to catapult us into a post-pandemic place, let’s layer the layers.
Let’s vaccinate, test-and-isolate, risk mitigate, and cooperate.
We need all of it, together.
P.S. I’m thrilled to be hosting Dr. Monica Gandhi on Facebook live on Monday, February 8, 2021, at 7:45 pm to discuss the vaccines and decision-making after you or your loved ones have been vaccinated. Dr. Gandhi is Professor of Medicine and Infectious Diseases and Global Medicine specialist at UCSF/San Francisco. Join us!