Resuming responsibility for our own healthcare with help from COVID.gov ... Revised 4/7/22

Last update: Thursday 4/7/22 

Returning to normal living ultimately means that each of us will resume responsibility for our own healthcare. President Biden's COVID.gov initiative, recently enhanced with a vital "Test to Treat" option, will make it much easier for each of us to become our most important healthcare giver once again. 

In normal times, we sought advice from our physicians and other healthcare professionals, advice that we expected would be tailored to our specific individual physical and emotional conditions. We didn't follow their recommendations blindly. We sometimes sought second, and even third opinions. Not so during the current pandemic. The pandemic seemed to threaten all of us, so we accepted the notion that our pandemic doctor, a/k/a the CDC, would provide one pandemic guidance for all of us.

But now, as Omicron subsides, we are at an inflection point. More variants may follow Omicron. If the new variants are about as mild as Omicron, but are not substantially more lethal, AND if our vaccines and antiviral medications continue to be highly effective in preventing severe illness, we will continue our drift from pandemic to epidemic, from striving to suppress the virus to learning how to live with it. 

The new waters across which we drift are littered with old problems, problems that we downplayed during the pandemic's first two years, problems that will now become outsized impediments to our progress. Some of us will be more risk tolerant, others more risk averse, reflecting the unequal risks that COVID has imposed on us.

Unequal treatment by the virus
Back in 2020, well intentioned folk often chanted that we were all in this together, but that was never true because the virus treated some of us far more harshly than others. Here's a partial list of such disparities:

• Young vs. old 
  Whereas the 1918 influenza virus tended to kill young people more often than old people, the coronavirus inflicts more severe illness and death on old people than young people.  As of December 2021, the pandemic had killed one out of 100 residents of the U.S. 65 or older, but the pandemic only killed one out of 1400 residents under 65. Indeed, three-quarters of U.S. Covid deaths were among people 65 and older. 
  
  --"As U.S. Nears 800,000 Virus Deaths, 1 of Every 100 Older Americans Has Perished", Julie Bosman, Amy Harmon and Albert Sun, NY Times, 12/11/21
  
  
• Healthy vs. compromised
  The coronavirus had more severe impact on those whose health was compromised by "certain medical conditions" -- diabetes, obesity, heart disease, cancer, immunocompromised, etc, etc, etc. Not surprisingly, the higher hospitalization and death rates among Blacks, Hispanics, and other minorities reflected greater prevalence of these underlying conditions among minorities which, in turn, reflected their inadequate access to adequate healthcare.
  
  
• Office workers vs. others
  Most office workers sheltered at home throughout most pandemic, thereby minimizing their exposure to the virus; but other employees could not work from home (waiters, waitresses, bus drivers, Uber drivers, sanitation workers, security guards, maintenance workers, grocery and meal delivery drivers, mechanics, barbers, beauticians, etc). They either went to work and faced exposure to the virus or stayed home and faced unemployment
  
  
• Teenagers vs. younger children
  The education of all children was impaired by on-the-fly remote learning classes, but younger kids suffered far more damage to their acquisition of good study habits and socialization skills, habits and skills they had barely developed. Teenagers might be able to text or phone each other for help in coping with the shortfalls of remote instruction, something most younger kids would not know how to do.
  
  
• Others vs. parents of younger children
  At least one of the parents or guardians of younger children had to stay home to provide daycare whenever their schools flip-flopped from in-person to remote instruction. Staying at home with the kids often meant loss of income or total unemployment, an affordable penalty for parents who were affluent, but financial disaster for those who weren't.
  
  Stay-at-home parents also became their children's in-person teachers, a task for which the diplomas/certificates they received when they graduated from elementary school made them eminently qualified to perform because we all know that anyone who knows something automatically becomes qualified to teach it, right? ... :-(
  
  -- "Too Many Americans Don’t Understand What Happens in Their Schools", Maia Bloomfield Cucchiara, NY Times, 3/8/22
  -- "It’s ‘Alarming’: Children Are Severely Behind in Reading", Dana Goldstein, NY Times, 3/9/22 
  
  
• Male parents vs. female parents
  The burden of providing in-home instruction to children usually fell on mothers or other female members of the household; This often required curtailing their working hours if they worked at home, or giving up their jobs to stay at home.
  
  
• Affluent parents of small children vs. non-affluent parents
  For the most part, affluent parents (and their children) faced manageable disruptions in their children's learning processes throughout the pandemic. Their children's expensive private schools did not resort to remote learning as often as public school because they could offer smaller classes that observed social distancing and could quickly upgrade their ventilation systems (if necessary). During brief remote learning interludes, affluent parents could hire qualified tutors for their children and rest assured that their home Internet connections were fast enough to accommodate the learning requirements of all of their children doing homework at the same time.
  
  
• Vaccinated vs. unvaccinated
  This is the only disparity that, with rare exceptions, is self-imposed. Our vaccines have been so highly effective in preventing severe illness, no matter which variant has been dominant, that well over ninety percent of all hospitalizations at any time since early 2021 have been unvaccinated persons.

Diminished credibility of the CDC

Regular readers of this blog are aware of its editor's fixation on the unforced blunders committed by the dysfunctional CDC that became evident during the first months of the pandemic under President Trump's administration and continued unabated throughout the first two years of President Biden's administration. The CDC's blunders have cost thousands, perhaps hundreds of thousands of lives. The enduring legacy of these blunders is a loss of public trust, perhaps the most precious resource that a public health agency can bring to bear on the management of a pandemic.

• "Researchers are asking why some countries were better prepared for covid. One surprising answer: Trust.", Adam Taylor, Washington Post, 2/1/22  
  
  
• "Can Public Health Be Saved?", James Hamblin, NY Times, 3/12/22

Maximizing the greater gain vs. minimizing individual loss

A recent spate of headlines announced that Democratic governors and mayors were joining their GOP colleagues in eliminating masks and other mandates before their elimination had been endorsed by the CDC. These actions signal a shift in the center of pandemic guidance from the CDC to the nation's state houses and city halls, a shift facilitated by the CDC's loss of credibility.

• "Dropping Indoor Mask Mandate, New York Joins Blue States Easing Covid Rules", Lisa Lerer, Luis Ferré-Sadurní and Astead W. Herndon, NY Times, 2/8/22  
  
  
• "Masks Come Off in More States, but Not Everyone Is Grinning", Mitch Smith and Shawn Hubler, NY Times, 2/9/22  
  
  
• "California unveils plan to become first state to treat coronavirus as ‘endemic’ risk", Lateshia Beachum and Adela Suliman, Washington Post, 2/18/22
  
  
• "Adams Ends Pandemic Mandates in New York City Amid Concern He Is Rushing",  Emma G. Fitzsimmons, NY Times, 3/4/22

Some observers, like the editor of this blog, will welcome this shift as a long overdue acknowledgement of the substantial differences of pandemic related conditions in our states, counties, cities, suburbs, and rural areas. Federalized guidance that is grounded in local conditions should be more effective than the CDC's one-size-fits-all oracular proclamations and flip-flops.

To which other observers might reply, "Not so fast. The CDC is the devil we know. Many of us are painfully aware of its weaknesses, but how many of us are aware of the weaknesses of the largely anonymous teams of experts who are advising our governors and mayors? Some teams may prove to be better than the CDC, but surely not all. Indeed, some may prove to be far worse."

OK, let's agree to disagree until enough time passes for us to sort these new teams on the basis of their actual performance. Meanwhile, one thing we can predict with some confidence, all other things being equal, is that governors and mayors will tend to favor policies that benefit the largest numbers of disadvantaged residents in their communities. These gains for the many may come at the cost of new losses for the few. 

. 

One size does not fit all

Some people who are older, or immunocompromised, or parents of young children, or unvaccinated, or whatever my find themselves wishing that they were living in another state or in another county in the same state. As such they may voluntarily continue to wear masks, maintain social distancing, or educate their children at home. Each of us will have to determine which mitigations, if any, are necessary for us to provide the best healthcare for ourselves and for our dependents.

Gathering the data required to make such decisions has become much, much easier during the last few weeks thanks to President Biden's game changing COVID.gov initiative that puts all the information we will need at our fingertips.  For example:

• Want to know the latest about vaccines and boosters? And where to get them? Go to COVID.gov ...
  
  
• Suppose you are at low risk for severe infection, e.g., you are a healthy twenty-something. Further suppose that you decide not to get the latest booster shot. Then you have reason to suspect that you have become infected and you want to know where you can be tested, and if positive, receive prescriptions for highly effective antiviral meds right away? Go to COVID.gov 
  
  
• And perhaps the most far out possibility, suppose you are a fervid anti-vaxxer, but develop strong symptoms. All is not lost. You, too,  can find out where you can be tested and receive highly effective antivirals by going to COVID.gov

In other words, dear readers, you yourself can now determine how quickly or how slowly you return to something closer to normal living.

____________________________________

Links to related notes on this blog:  

• "In praise of COVID.gov, Lord of the game changers!!! -- Revised assessment 4/6/22", Last update: 4/6/22