Last update: Thursday 8/11/22
EXECUTIVE SUMMARY ... TLDR
Facts and values
This draft of a strategic plan stems from the following mix of facts (based on CDC data) and values
- <Values>The primary goal of the nation's pandemic managers should be to save lives ... but their efforts to save the lives of the few who are vulnerable to the virus should not impose intolerable burdens on the lives of the many who are not. </Values>
- <Facts> Throughout the pandemic, the virus has focused its killing on two vulnerable groups: the oldest members of our society and those made vulnerable by certain preexisting health conditions, e.g, immunocompromised, obese, diabetic.
COVID-19 rarely kills children, but its lethality increases with the age of its potential victims. Almost 75% of COVID deaths have been inflicted on those in the 65+ age group, despite their representing only 16 percent of the total population.
Contrary to the CDC's mantra, we were never "All in this together". Younger age groups were challenged by a very bad flu; whereas the oldest members of our society continue to experience a kind of geronticide.
</Facts> - <Values> The virus will continue to have substantial impact on a third group ==> Persons in younger age groups who have frequent contact with loved ones who are vulnerable. They should continue to go out of their way to conduct their lives in a manner that minimizes their chances of becoming infected in oder to avoid passing their infection onto the vulnerable people they love. </Values>
- <Facts> Vaccines and boosters have had limited impact on COVID deaths among the younger age groups; but vaccines and boosters have yielded substantial reductions in deaths among their oldest recipients. <Facts>
Pandemic management strategies based on these facts and values
- Mitigations for younger age groups should be abandoned asap
Most younger Americans are fed up with the pandemic. They want to go back to normal living NOW. These selfless younger folk sacrificed two and one half of the best years of their lives in the belief that their sacrifice would enable more of us old guys and old gals to live a few more years. They should be profoundly thanked for their sacrifice and allowed to return to normal living, unburdened by future guidance/mandates for masks, Zoom classes, and other mitigations. - Mitigations for vulnerable persons (older, health conditions) and those who love them should be continued. Risk averse younger persons who want to avoid long COVID should also adhere to these mitigations
-- Keep up-to-date on booster shots
-- Wear properly fitted N95 masks in all public indoor spaces
-- Maintain social distancing in public indoor spaces
-- Avoid indoor crowds
-- Avoid poorly ventilated indoor spaces
-- Self-test regularly and test asap when symptoms appear ... or when you have reason to believe that you have been in close contact with an infected person
-- Obtain Paxlovid asap if your tests are positive and your doctor agrees ... except if you are immunocompromised; if so, ask your doctor about Evusheld right now, before you get infected.
-- Keep up-to-date with regards to new guidance about boosters, tests, and treatments via occasional visits to COVID.gov
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A. What's our goal?
With over one million U.S. lives already lost to the virus, losing as few additional lives as possible would seem to be a reasonable goal. The CDC would certainly agree. The mantra "CDC 24/7: Saving Lives, Protecting People" appears in a banner at the top of most of the CDC'a web pages ... and that's a problem, a big problem.
This mantra might be appropriate for the CDC as the nation's leading authority with regards to the medical aspects public health, but it is not appropriate for the manager of a deadly pandemic. A democratic society must always strive to achieve what's best for the many, not what's best for the few. In the case of a pandemic, saving the lives of the few is not acceptable if it imposes intolerable burdens on the lives of the many ... which is about where we are today.
The napkin in the image logo of this blog note reads "A goal without a plan is just a wish". Beyond this, it's clear that an unachievable goal can never be more than unfulfilled wish. The CDC was doomed to blunder from surge to surge because its goal of saving the most lives regardless of the cost to the rest of the nation was not achievable. The rest of this note provides a rough draft of the top level components of a realistic plan, i.e., it presents a set of strategies for securing an achievable goal within our democratic context.
Goal: Saving the most lives among those who are most vulnerable to COVID-19
The most important data with regards to the effective management of the coronavirus pandemic can be found on the CDC's COVID-19 Mortality Overview page:
- COVID-19 rarely kills children, but its lethality increases with the age of its potential victims. (See "During the Omicron Wave, Death Rates Soared for Older People", Benjamin Mueller and Eleanor Lutz, NY Times, 5/31/22)
- COVID-19 inflicted almost 75% of its deaths on the oldest members of our society, age 65+. According to the U.S. Census Bureau (Table S010), the population of the 65+ age group is only 16% of the total population.
- The 44 to 64 middle age group suffered the second biggest share of COVID deaths, 21%, which is less than its 26 percent share of America's population reported by the U.S. Census
- Together the oldest and middle age groups accounted for 96% of COVID deaths but were only 42% of the total population
- Least impacted were the young groups, 0 to 43, which represented a solid 58 percent majority of the U.S. population, but only suffered 4% of its COVID deaths ... and as asserted in the first bullet, other CDC data shows that deaths among the very youngest age groups are rare events, even among the unvaccinated. Unvaccinated death rates for ages 5 to 11 are about .04 per 100,000; death rates for ages 12 to 17 are about .09 per 100,000; and for ages 18 to 29 are about .16 per 100,000
- Another group of COVID victims also incurred disproportionate losses: persons made more vulnerable by certain underlying health conditions, a/k/a/ "comorbidities", e.g., persons who were diabetic or immunocompromised. Most of these victims were in the 65+ age group. This group merits special attention because previous pandemic experience has shown that the usual vaccine and booster regimens may not be appropriate for them. (See
"Covid and Diabetes, Colliding in a Public Health Train Wreck", Andrew Jacobs, NY Times, 4/3/22 )
B. Vaccines and boosters
Experts agree that our vaccines and boosters are still highly effective in reducing severe illness and death among people whose vaccinations and booster shots are up-to-date, but they don't offer much protection against infection, especially against infection by the highly transmissible Omicron sub-variants
On 7/25/22 the CDC's COVID Data Tracker page reported that 92 percent of persons in the 65+ age group have been vaccinated ... which sounds good, but doesn't bear closer inspection. The same page reported that only 71 percent of the fully vaccinated have received a first booster, i.e., 71% * 92% = 65%. Worse still, only 37% of the first boosted have received a second boost, i.e., 37% * 65% = 24%. In other words, only 24% of the nation's most vulnerable residents are up-to-date on their primary vaccines and booster shots. Therefore 76% of our oldest residents are are inadequately protected against severe illness and death from Omicron's highly transmissible sub-variants.
This scandalous failure to keep our vulnerable oldest residents up-to-date on primary doses and booster shots must be overcome within the next few months. The content of all guidance and the wording of all messaging should be honest and unflinching: COVID does not kill everyone; its primary victims are the oldest and/or those who have specific comorbidities.
Vaccine Strategies
- We should give highest priority to greatly intensified efforts at all levels (federal, state, and local) to fully vaccinate and boost all of the nation's oldest residents.
- Highest priority for vaccines and boosters should also be given to persons having comorbidities that make them more vulnerable to COVID.
- Second level priority in the allocation of vaccines and boosters should be given to middle age residents.
- Lowest priority should be given to the youngest, least vulnerable age groups
The Biden administration recently announced that Moderna and Pfizer would deliver new boosters in September that are designed to provide enhanced protection against infection by Omicron sub-variants. (See "Biden Administration Plans to Offer Updated Booster Shots in September", Noah Weiland and Sharon LaFraniere, NY Times, 7/28/22)
This is great news, but only if the highest priority access to these new boosters is given to the 76 percent of the nation's oldest and most vulnerable residents who have not received their second booster shots.
- Therefore the most important metrics for the Biden administration and the CDC to watch each week are the percentage of age 65+ residents in each state who are up-to-date on their booster shots .
- No state should receive allocations of the new boosters for distribution to younger residents until at least 70 percent of their senior residents are up-to-date on their booster shots.
C. Treatments
Given the abysmal failure of the Biden administration and the CDC to attain acceptable vaccination and booster levels for the 65+ group using existing boosters, it is inconceivable that they will achieve a 70 percent coverage in most states any time soon with the new boosters. So the shortfall in protection will have to be met by more widespread and more equitable distribution of antiviral medications for persons who become infected.
Treatment Strategies
- Highest priority for access to antiviral medications, like Paxlovid, should be given to infected persons aged 65 or older. (See "Everything You Need to Know About Paxlovid — Especially, Should You Take It?", Michelle Andrews, KHN, 7/29/22)
- Greater effort should be made to ensuring equity in the distribution of these drugs to members of Black, Hispanic, and other minority communities. (See "Antiviral drugs for Covid are inequitably prescribed, a C.D.C. study finds.", Roni Caryn Rabin, NY Times, 6/21/22)
- The CDC should make greater efforts to provide doctors with clearer explanations as to when and for whom antiviral meds should be prescribed. (See "Doctors are clamoring for more clarity on Paxlovid prescribing amid Covid-19 rebound concerns", Edward Chen, STAT, 7/7/22)
- The Biden administration and the CDC should exert substantially greater efforts to publicize the effectiveness of Evusheld among doctors and their immunocompromised patients. (See "As new variant spreads, a crucial drug to protect the most vulnerable goes vastly underused", Jason Mast, STAT, 7/22/22)
D. Masks and other mitigations
This final section is about those who are risk tolerant with regards to COVID and those who are risk averse.
- Readers are reminded of the crucial bit of CDC data that was noted in the first section of this discussion ==> Only 4 percent of COVID deaths were inflicted on the youngest residents of the U.S., ages 0 to 43, even though they constituted a solid 58 percent majority of the population. Small death tolls like these are what would normally occur in the wake of a bad flu; they are not the stuff of the mainstream media headlines nor the CDC guidelines that have monopolized our attention for two and one half years.
For two and one half years the headlines and guidelines have screamed that "We were all in this together" ... even though this was never true. So no one should be surprised that a majority of the population in the younger age groups have finally declared their desire to return to normal living, to escape this cruel fiction that has distorted their lives.
Nor should anyone object, especially those of us in the oldest age brackets. These selfless youngsters have sacrificed two and one half of the best years of their lives in the belief that their sacrifice would enable more of us old guys and old gals to live a few more years. They should be profoundly thanked for their sacrifice and allowed to return to normal living, unburdened by future mandates for masks, Zoom classes, and other mitigations.
One might anticipate that our society would naturally divide into its more risk tolerant, less vulnerable, younger members vs. its risk averse, more vulnerable, older members. Unfortunately, two other categories crisscross age groups:
- Those who have vulnerable loved ones, i.e., family and friends who are old and/or vulnerable because of underlying health conditions, and
- Those who feel sufficiently threatened by long Covid
Those who have vulnerable loved ones
This group is more precisely specified as those who live with vulnerable loved ones or who otherwise interact with them frequently on a face-to-face basis. Others can test and retest themselves before their visits, and postpone their visits if they test positive. Not wanting to infect their vulnerable loved ones, family and friends who engage in frequent contact with them will be willing to live in a risk averse manner in order to minimize their own chances of becoming infected and passing it on.
Long COVID
Our current, very limited understanding of long COVID is uncomfortably familiar because long COVID seems to defy our common sense as randomly as did COVID when it first arrived in early 2020. Back then, we anticipated that no one could spread COVID before they developed symptoms of illness, e.g., fever, coughing, fatigue; but we were wrong. Not only could we spread COVID before symptoms appeared, some of us who became infected never developed any symptoms.
Today our common sense anticipates that persons who are asymptomatic or only developed mild symptoms will face lower subsequent risk of developing long COVID, but initial research tells us that this is not the case. Our common sense also suggests that vaccination will substantially reduce the risks of incurring long COVID, but this is also not the case.
- "SARS-CoV-2 is associated with changes in brain structure in UK Biobank", Gwenaëlle Douaud, Soojin Lee, and associates, Nature, 3/7/22 ... Note: This reference asserts that brain changes occur even after mild infections
- "Long COVID risk falls only slightly after vaccination, huge study shows", Sara Reardon, Nature, 5/25/22
Nevertheless, other research suggests that long COVID will only afflict a minority of the infected population, with estimates varying widely. Most younger folk will probably return to normal living; but others who are deterred by these estimates might remain risk averse until new research offers better odds.
- "More than 1 in 5 adult Covid survivors in the U.S. may develop long Covid, a C.D.C. study suggests.", Pam Belluck, NY Times, 5/24/22
- "How common is long COVID? Why studies give different answers", Heidi Ledford, Nature, 6/22/22
- "Millions of Americans have long COVID. Many of them are no longer working", Andrea Hsu, NPR, 7/30/22
- "More people are catching coronavirus a second time, heightening long COVID risk, experts say", Rong-Gong Lin II, Luke Money, Los Angeles Times, 8/1/22
E. Mitigations
for the vulnerable, those who love them, and others who are risk averse
for the vulnerable, those who love them, and others who are risk averse
OK, with no surprises, here are the suggested mitigations that all risk averse persons should observe for the foreseeable future, regardless of the CDC's estimates of the "community level" of infection in their counties. The first and last are highlighted in order to emphasize their importance.
- Keep up-to-date on booster shots
- Wear properly fitted N95 masks in all public indoor spaces
- Maintain social distancing in public indoor spaces
- Avoid indoor crowds
- Avoid poorly ventilated indoor spaces
- Self-test regularly and test asap when symptoms appear ... or when you have reason to believe that you have been in close contact with an infected person
- Obtain Paxlovid asap if your tests are positive and your doctor agrees ... except if you are immunocompromised; if so, ask your doctor about Evusheld right now, before you get infected.
- Keep up-to-date with regards to guidance about boosters, tests, and treatments via occasional visits to COVID.gov
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Links to related notes on this blog:
- "How well have our vaccines protected the oldest members of our society against COVID?", Last update: 6/11/22
- "Our pandemic of the elderly -- dead unvaccinated, dead vaccinated, and dead boosted", Last update: 7/21/22
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