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Looking backward and forward at COVID-19 mitigation strategies

Looking backward and forward at COVID-19 mitigation strategies

Dr. John Livingston
August 23, 2021

Some 20 months into the pandemic, America is still having heated debates about appropriate and wise virus mitigation strategies. The disease like AIDS has become politicized, and the agenda and narrative are overshadowing evidence and logic.  Conclusions regarding masks, vaccines, and the opening of schools and churches have been tainted by economic and political agendas that only confuse the collection and evaluation of the data. 

The line separating collective and individual risk has been blurred. The homogenization of groups of people into the collective whole has resulted in thousands of people being harmed and even the death of large groups of people in hospitals and nursing homes. Clinicians have taken a back seat to the public health specialists, who themselves are far removed from patient care responsibilities. Clinicians are busy taking care of patients rather than being interviewed in the media. 

Our ability to take care of sick COVID-19 patients has been a great untold story. Passive immunity — which includes convalescent antibodies, monoclonal therapy, new techniques and strategies in ventilation and vaccination — is being communicated via email and various social media sites. Professionals aren’t waiting months for “peer-reviewed” articles in the traditional medical literature, and they’ve saved more lives than masks and Type 2 mitigation strategies. Ask the thousands of healthcare workers in New York State and New Jersey who prophylaxed themselves during the height of the pandemic or ask your own doctor or PA if they have on hand any “hydroxy.”  Or ask (as I did today) your pharmacist in Boise if there has been a run on hydroxy over the past 18 months.

I have written about COVID-19 since March of 2020 for Gem State Patriot, Redoubt News, and the Idaho Freedom Foundation. My positions regarding social distancing, masks, handwashing, and vaccines have not changed. What has changed is my understanding of the extremes that individuals will go regarding risk avoidance when they don’t understand the context of the risk they are trying to avoid. 

As of July 30, not a single person under age 18 has died from the virus. The new delta variant is more easily transmissible but less lethal across all age groups than the original COVID-19. This is very consistent with previous seasonal viruses — as the virus mutates and evolves, the R0 factor goes up and becomes more easily transmissible and less virulent. A child is more likely to die in a car accident in Idaho than they are from COVID-19. A child living in Idaho in 2019 was more likely to die from the seasonal flu than from COVID-19 in Idaho in 2021.

Where do we stand today in Idaho with the delta strain of COVID-19? Doctors Marty Makary, Jay Bhattacharya, and Scott Atlas addressed some of the more contemporaneous issues with the delta variant in a recent article in The Wall Street Journal, citing studies from Sweden, Iceland, and Ireland. 

Schools are actually safer places for children to be than enclosed areas with adults. Masking is fourth on the list of mitigation strategies for children at school behind proper ventilation, including open windows and exposure to sunlight, distancing, dividing, and separating students. Only then is masking recognized as an effective mitigation strategy. It should be acknowledged, though, that only properly fitted N-95 masks protect wearers from the virus. Popular cloth masks are basically worthless in protecting kids from COVID-19. 

Citing studies from the University of North Carolina and Brown University, the doctors point out that the risk of infection was statistically the same in classrooms with unmasked and masked kids.

Unlike my friend Dr. Ryan Cole, I have decided that the vaccine makes sense for me. The risk of a severe adverse reaction is less than the risk of the disease. The math changes for the elderly and those with comorbid conditions. Infants and children are more likely to have adverse reactions to the vaccine than young adults and preadolescents because of the naturally “revved up” state of their immune systems. People who have had previous infections or vaccinations and have positive antibodies are at higher risk for complications including thrombotic and immune complex and antibody mediated reactions.

“The jab” has become so politicized as to be almost comical. I saw a clip from MSNBC last week about the “recalcitrant Trump supporters” who refused to take the vaccine and were putting their neighbors at risk for selfish, childish reasons. Here are some facts that may surprise everyone: People ages 18-35 are the least vaccinated group. Sumpter County in Florida, where the largest senior living facility The Villages in our country is located, has a vaccination rate today of over 80%, and it voted 90% for Trump. 

Looking at level of education as a marker for conforming to vaccination recommendations shows those with less than a high school education have a slightly higher rate of vaccination than those with a PhD, which have the lowest rates of all groups. Those in STEM fields have the lowest vaccination rate when compared to those in the humanities. And in New York City, the two groups that are resisting vaccinations the most are Black men, with a vaccination rate less than 40%. In Williamsburg, New York, Hassidic Jews have a vaccination rate of 35%. In Alaska, the highest rates of the vaccinated are in the indigenous native populations.

In Idaho, I would recommend that schools stay open and follow the mitigation techniques described above. Masks should be optional because they really don’t work unless student have a medical-grade face-covering. Anyone that tells you otherwise is either misinformed or lying or trying to make themselves feel better. If you want to wear a mask, go ahead. It is a “long run for a short slide” at best.

Children should not be vaccinated if they are under 12 years old, and many experts say even those who are under 18 shouldn’t get the jab. If you don’t want to be vaccinated, don’t get vaccinated. If you have already had the disease and have antibodies, or have been vaccinated and have antibodies, what do you care? If I get the disease, it will probably be worse than if you get the disease, but it is my choice to suffer from the ramifications of my own decisions — not yours.

Teachers over 35 should be vaccinated, if they want. Those with comorbid conditions or over 65 should get vaccinated, if they want. These remain recommendations based on science, not mandates based on a political narrative.

Finally, let’s stop being little “Chicken Littles.” Idahoans are fully capable of making our own decisions about what is best for ourselves and our families. Talk to your family doctor. Many share almost all of my feelings, but those employed by large hospital systems are afraid to speak out publicly and are reluctant to advise their patients in such a way privately. Ask them what they are doing with their own families.

As my former chief of surgery used to say to patients who weren’t working hard enough to make themselves better: “The time has come to either start living or start dying. The choice is yours.”

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