• Rosalind Kaplan, MD

Are We There Yet?

by Rosalind Kaplan, MD

No. That's the general consensus of the medical community regarding Covid. We are not 'there', if 'there' equals 'done with the pandemic.' Still, we are in a much better place than we were a few weeks ago, and I do think it's time to figure out how to live 'normally.' That is, to live with the least disruption possible from Covid, with the understanding that it is not going away. Omicron is waning in the US, but there is still lots of it. There will almost certainly be other variants and surges of Covid infection will almost certainly occur.

The media and the Biden administration and the CDC and the WHO and a thousand other politicians and some very smart people and some not-so-smart people are confusing the public with contradictory information and data and recommendations and actions. It seems like guidance changes from minute to minute, and how is anyone supposed to know what makes sense in this chaos? Then there are the folks who have no interest in data or guidance and just believe what they believe--either that Covid is a hoax and vaccines contain microchips, or on the other far side of the aisle, that a person who dares to unmask in public should be executed on sight.

We are ALL tired, brittle, anxious, frustrated, angry and impatient. Admit it--you are not as calm and rational about Covid as you would like to be. How could you be, after the last two years? Ultimately, we all have to make a thousand covid-related decisions a day, whether we are prepared to or not. We will have to try to be calm and rational, but sometimes decisions are made out of emotion or values that don't have to do with rational thought.

Even as a physician, I'm not in a position to tell you what to do. Sure, certain things are obvious to me:

1. Almost everyone should be vaccinated. Those with contraindications generally know who they are, but it's a decision to be made with guidance from one's own physician. Vaccines are safe and effective against severe disease and death. But not 100% effective against either of those. NO vaccine is 100% effective. A booster is very important. Yes, a study showed waning antibodies 4 months after a third dose. BUT IT ALSO SHOWED THAT THERE WAS STILL ROBUST PROTECTION AGAINST SEVERE DISEASE. We don't yet know whether an Omicron-specific booster is a good idea or not. We don't yet know if a 4th dose is necessary or useful and what the timing should be.

2. Elderly, immunosuppressed and chronically ill people remain at higher risk of severe illness and death even with vaccination and need to be protected. Nobody ought to fuss about wearing masks indoors to protect these folks.

3. If you have symptoms that could represent Covid, stay home!! If you test negative, and you are getting better, it's okay to go back out into the world, but wear a mask until symptoms are gone or you are ten days out from the initial symptoms. We should never have been going to work and school with flu and severe cold symptoms. We should all use all the tools we have at our disposal- hand hygiene, masks, ventilation and physical distancing to protect others from our germs when we have symptoms. This is just good common sense and part of what ought to be a civilized society's social contract. You wouldn't think it's okay for someone to have unprotected sex when they have an undiagnosed abnormal penile drip or vaginal discharge, right? So why is it okay cough and sneeze on others when you have nasal discharge or a cough?

4. If you test positive, and not sick enough to be hospitalized, isolate for 5-10 days from onset, depending on your symptoms and whether you can physically distance and wear a mask when you go back out- if you can, and you feel okay 5 days after your symptoms started (and no fever for 24 hours), you can return to activities as long as you wear a mask for at least 5 more days when around others.

YOU DON'T HAVE TO TEST NEGATIVE TO DISCONTINUE ISOLATION- some people test positive by PCR for a long time after infection and recovery.

Beyond this, I have no answers. I don't know exactly when mask mandates can safely be lifted, and 'safe' has so many meanings. Kids in school really are suffering from wearing masks- socially, emotionally and educationally. But that needs to be balanced with the suffering from Covid infections and the suffering of the medical community, as well as the available resources. There is no right answer from what I can see.

If mask mandates are lifted but you remain uncomfortable, you could continue masking indoors. Wear a high quality mask, such as a KN95. It will protect you as well as others.

What makes no sense is arguing with rules in businesses or on planes about wearing masks or not wearing masks. Getting aggravated and angry doesn't help anyone- not the person who is angry, and certainly not those who have the anger directed against them. It also doesn't make sense to me to disrespect other people's boundaries. If you are in the supermarket line next to me, and you aren't wearing a mask, I will want to stand farther away from you right now. If I can't do that without asking you to move, I will likely ask you (nicely) to move away from me. If you feel the need to argue with me or say something rude because of that request, ask yourself why. How am I hurting you? If you say 'no' to me (nicely), then it will be on me to get out of line to get away from you. We both have free will--to a point. But the nature of living in society is that we can't just do whatever we want to.

If you find that some of your actions in all of this uncertainty are contradictory, hopefully it will help to know that you are not alone. I have been generally cautious. I wear N95 or KN95 masks in stores and offices and, of course, at work.

I'm not yet entirely comfortable in restaurants, even those that require proof of vaccination, because we eat with masks off. But I will occasionally eat out, indoors. I try to go places that have lots of space and lots of ventilation, and that have distance between tables.

I'm not entirely comfortable with air travel, but I do it, with a quality mask.

I haven't gone to the movies or to an indoor concert yet. I suppose it might be okay, with a mask.

I avoid unmasked social gatherings of more than a few people still.

AND YET-- I go to the gym and I don't wear a mask to exercise. This is not a cautious act.

So how am I making these decisions? Honestly, I have to weigh the risks and benefits. I do it, almost unconsciously now, over and over every day.

The risk to myself and my family-- pretty low, even if I go to the gym. We are all vaccinated and healthy. The benefit, for me, of going to the gym and exercising comfortably is high.

The risk to those around me--I go on the assumption that those who go to the gym and don't mask are healthy, not immunocompromised, and are willing to assume the risk. But if I'm going to be around people of unclear risk- in the supermarket, perhaps--or who I know to be

frail or at high risk, I mask. I don't want to put patients or elderly friends or relatives at risk.

If Covid infections, hospitalizations, and deaths continue to drop, I'll likely start going to the movies and eating indoors more often. I don't know when I'll be ready to stop wearing a mask in public indoor spaces, even when there are no longer mandates. I guess I'll know when I'm ready.

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