Endemic Defense

Last update: Wednesday 3/29/23

This reference page suggests a personal defense strategy for living with COVID during the remaining months (years?) of the endemic. It does so by providing links to authoritative sources of information about vaccinations, mitigations, treatments, and self-tests -- the most important tools that ordinary citizens can use  to defend themselves, their families, their friends, and their associates against severe illness from infection by the sub-variants of Omicron.

Alerts about updates to this page are posted on this blog's @neoskeptics Twitter account from time to time. Updates are highlighted (yellow) and/or printed in bold (red).

  

A.  Vaccinations | B. Mitigations | C. Treatments | D. Tests | E. Use Cases | F.  CDC Caution

Introduction

President Biden's COVID.gov page is a game changer ... if it is used as a cornerstone of a personal COVID defense strategy, such as the one proposed in this note. The president's page puts COVID information at your fingertips, but it doesn't provide context for this information and it doesn't suggest real life situations wherein this information would be useful. 

Parts A, B, C, and D of this note provides a framework. You should read these parts completely just once; thereafter only read their news updates that will be highlighted in yellow and/or red. Part E provides the use cases that suggest situations wherein you might need to wear masks, keep social distancing, get a COVID test, or obtain anti-viral medications.

Primary readers

The editor of this blog anticipates that the readers who will be most interested in this reference page will be U.S. residents 65 and older, the primary victims of all variants of the coronavirus. Diabetics, transplant recipients, and persons who have other health conditions that make them especially vulnerable to COVID should also consider the precautions suggested here. Hopefully, these tools will be of particular interest to younger readers who are concerned about the health of their relatives, friends, and associates who are older and/or health vulnerable.

Note: Full disclosure requires that the editor of this blog acknowledge that he is a long time member of the 65+ demographic ... :-)

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A. Vaccinations (and boosters)

For older readers, the stats about severe illness and death from COVID leave no choice but to become fully vaccinated as soon as possible and to stay fully boosted (however many additional shots that requires). Ever since the sudden emergence of Omicron (December 2021), breakthrough cases, i.e., infections of vaccinated persons and reinfections, have become commonplace.

• Given that only 22,606,262 U.S. residents 65+ have received a bivalent booster shot according to the CDC (3/1/23) out of the 52,362,817 persons in this age group, we should still anticipate substantial hospitalizations (and deaths) among older residents 
  
  
• CDC reports high effectiveness of boosters for immunocompromised. Unfortunately, some immunocompromised persons, including those 65 and older, don't know that "fully vaccinated" for them means a "primary dose" of three vaccinations, not two; a booster shot for them is a fourth shot. If they only get three jabs, they are not boosted
    
• "New Covid Booster Shots Cut Risk of Hospitalization by Half, C.D.C. Reports", Benjamin Mueller, NY Times, 12/16/22 
• "Omicron BQ, XBB subvariants are a serious threat to boosters and knock out antibody treatments, study finds", Spencer Kimball, CNBC, 12/14/22
  -- "Alarming antibody evasion properties of rising SARS-CoV-2 BQ and XBB subvariants", Qian Wang et al., Cell, 12/13/22 
  ... Note: This study suggests that the CDC's  findings are limited to Omicron variants that preceded the BQ and XBB variants that are now dominant
  
  
• "Two new studies paint encouraging picture of Covid-19 vaccine’s performance", Helen Branswell, STAT, 1/25/23 
• "OHSU researchers find immune response to COVID-19 strengthens over time", Erik Robinson, OHSU, 1/26/23 
• "What people on Medicare can expect once the Covid-19 public health emergency ends", Rachel Cohrs, STAT, 2/9/23 
  

• "Past SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysis", COVID-19 Forecasting Team, The Lancet, 2/16/23 *** 
  -- "Covid-19 infection offers strong protection against reinfection for about 10 months, study finds", Jen Christensen, CNN, 2/16/23
  -- "Immunity acquired from a Covid infection is as protective as vaccination against severe illness and death, study finds", Akshay Syal, M.D., NBC News, 2/16/23
  
  
• "Who Is Most at Risk for Long Covid?", Pam Belluck, NY Times, 3/25/23 
• "Robust T cell responses to Pfizer/BioNTech vaccine compared to infection and evidence of attenuated peripheral CD8+ T cell responses due to COVID-19", Fei Gao et al., Immunity, 3/15/23
  -- "Getting COVID-19 Could Weaken Your Immune System", Alice Park, Time, 3 27/23
  
• WHO, "Focus Covid booster campaigns on high-risk people, WHO’s vaccine experts recommend", Helen Branswell, WHO, 3/28/23 *** 

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B. Mitigations 

For the foreseeable future, the most prominent mitigations -- masks and social distancing -- must continue to frame our day-to-day interactions. 

Older people must employ practices that protect them, regardless of what other people are doing or not doing. This principle has two immediate consequences:

• Older people should avoid crowded public indoor spaces where social distancing cannot be maintained.
  
  
• Older people should wear the highest quality masks. Their masks must protect them from infection regardless of whether other people are wearing masks and regardless of the quality of the masks worn by others.
  

At the present time, the best masks that satisfy the high standards implied by the second requirement are N95 masks (a/k/a "respirators"). N95 masks are the gold standard favored by U.S. health care professionals.  Free N95 masks are available at many local pharmacies and healthcare providers

• COVID.gov ==> Free N95 Masks
  -- "N95, KN95 masks provide best protection against covid, CDC study shows", Lenny Bernstein and Frances Stead Sellers, Washington Post, 2/4/22
  

Improving indoor air quality has recently received the endorsement of the White House.

• "We Have the Technology to Stop Superspreading Without Masks", Donald K. Milton, Edward A. Nardell and David Michaels, NY Times, 4/21/22

• "Ventilation reduces the risk of COVID. So why are we still ignoring it?", Lidia Morawska and Guy B. Marks, The Conversation, 12/1/22

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C. Treatments

The most recent treatments are pills developed by Pfizer and Merck that can be self-administered at home. These pills are potential game changers whose positive impact may prove to be comparable to the impact of our most effective vaccines. Health conscious members of any community's oldest age groups should become familiar with them now so that they will be well positioned to ask for them in a timely manner should the need arise.

• "One-stop Test to Treat", 4/5/22 ... Note: This announcement signifies that the "Test to Treat" initiative that President Biden announced in his "National COVID-⁠19 Preparedness Plan" is now operational. The landing page for Test-to-Treat also can be reached via COVID.gov 
• "Fauci says he believes Paxlovid kept him out of the hospital, even though he tested positive again.", Sheryl Gay Stolberg, NY Times, 6/29/22
• "Everything You Need to Know About Paxlovid — Especially, Should You Take It?", Michelle Andrews, KHN, 7/28/22
  
  
• "Covid-19 Symptoms Can Rebound Even if You Don’t Take Paxlovid", Knvul Sheikh, NY Times, 10/27/22
• "A Crucial Group of Covid Drugs Has Stopped Working", Emily Mullin, Wired, 2/8/23
• "F.D.A. Advisers Endorse Paxlovid’s Benefits as a Covid Treatment", Carl Zimmer and Christina Jewett,  NY Times, 3/16/23

The FDA's list of EUA approved drugs and treatments can be found 
==> HERE

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D. Home self-tests and professional tests

The Biden administration is once again offering free at-home text kits

• COVID.gov ==> COVID.gov/tests
  -- "At-Home COVID-19 Antigen Test Kits: Where to Buy and What You Should Know", Ellen Lee, NY Times, 12/15/22 

Note that negative self-tests can be misleading if you have symptoms or if someone in your household or a close contact in your workplace has tested positive, as illustrated by the following article.

• "Sore throat and cough top symptoms that could be Covid", Michelle Roberts, BBC, 7/14/22
• "At-Home COVID-19 Antigen Tests-Take Steps to Reduce Your Risk of False Negative", FDA, 8/11/22
• "People Exposed to Coronavirus May Need to Take as Many as Three At-Home Tests, F.D.A. Says", Emily Anthes, NY Times, 8/12/22 
  
• "Do Rapid Tests Still Work?",  Dana G. Smith, NY Times, 1/26/23
  
  
• "FDA Authorizes First Over-the-Counter At-Home Test to Detect Both Influenza and COVID-19 Viruses", FDA, 2/24/23 *** 
  -- "First At-Home Combination Test for Flu and Covid Is OK’d by the F.D.A.", Christina Jewett and Emily Anthes, NY Times, 2/24/23 
  -- "The FDA has cleared the first home flu and Covid test — but its maker just declared bankruptcy", Brittany Trang Feb. 26, 2023, STAT, 2/26/23
  -- "Flu and COVID combo shots won't come in time for this year, FDA official says", Alexander Tin, CBS News, 3/2/23

Free COVID test locations

• "Search for No-Cost COVID-19 Testing​", CDC, 1/26/23
• "Stock Up on Free At-Home COVID-19 Tests While You Can, Jamie Ducharme, Time, 1/31/23

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E. Use cases
This section provides straight-forward suggestions as to when health conscious older people should employ the most important mitigation tools.

1. Vaccinations & booster shots
If you are not vaccinated, get vaccinated asap. If you are vaccinated, stay fully boosted, i.e., get as many booster shots as you are allowed to get at any time.

• Use COVID.gov to find out if your vaccines and booster shots are up to date.
  
• Use COVID.gov to find conveniently located providers of vaccinations and boosters.

2. Masks & distancing

Regardless of CDC guidance, for the foreseeable future:

• Risk averse older people should avoid crowded public indoor spaces where social distancing cannot be maintained.
  
  
• Older people should always wear N95 or KN95 masks in indoor public spaces
  
  
• Use COVID.gov to learn how to take care of N95 masks, wear them properly, and find conveniently located sources of free approved N95 masks. Otherwise use Amazon to find authentic N95  and KN95 masks and compare prices & user ratings 
   -- N95 masks can be found ==> HERE ... Many are made in USA, e.g. Honeywell, 3M, etc 
   -- KN95 masks can be found ==> HERE
  
  
• Verify the authenticity of N95 masks by finding them on the official list of approved masks found on the CDC's National Institute for Occupational Safety and Health (NIOSH) page ==> HERE
  
  Verify the authenticity of KN95 masks by finding them on the official list of approved masks found on the FDA'S Emergency Use Authorization (EUA) page ==> HERE

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3. Tests & treatments

Deciding to acquire test kits is a no-brainer; deciding when to test yourself or to be tested by healthcare professionals requires more consideration. The following scenarios are suggested for older users ... and for younger users who are concerned about their face-to-face interactions with their vulnerable older relatives, friends, and associates.

• Routine self-tests
  Older people should routinely test themselves at least once each week.
  -- If a self-test is positive, immediately get a PCR test (the gold standard for testing) at a doctor's office, a clinic, a drug store, or some other facility where the tests are administered by professionals. Use COVID.gov to find conveniently located PCR test centers.
     ---- If the PCR test is negative, you're OK.
  
  -- If the self-test was negative, test yourself again two or three days later.
  ---- If the second test is also negative, you may be OK
  ------ However, if someone in your household has tested positive, you should put on an N95 or KN95, isolate yourself, and test again and again
  ------ Or if you are showing symptoms of infection, you should put on an N95 or KN95, isolate yourself, and test again and again
  
  ---- If the second test is positive, use COVID.gov to locate a nearby "One-Stop Test to Treat" site wherein you will be tested again. if their test also returns positive, you will receive immediate treatment, very likely the new antiviral pills discussed in the previous section of this note. These pills must be taken within a few days after you are infected, which is why weekly routine self- tests are suggested. 
  
  ---- If no site is available near you, ask your doctor about other treatments. If you are in one of the nation's oldest age groups, the primary audience for this blog note, you should not assume that you can make it through 10 days of self-isolation because of an Omicron infection without the benefit of some kind of treatment.
  
  
•  In-person meetings with relatives, friends, or associates
  -- Administer a self-test just before the meeting. If the result is positive, don't attend the meeting and follow the same procedures as after a positive routine self-test (described above)
  -- Don't visit with or meet anyone who has not received a booster shot
  -- If your attendees have been boosted, insist that they receive a rapid test just before the meeting or visit. Perhaps you can offer them one of your self-tests ... :-).
  
  
• After facing unknown risk in finding yourself in a public indoor space where social distancing was not possible, or meeting someone who had not been tested just before the meeting
  -- Administer a self-test when you get home
  -- Follow the same procedures as after a routine self-test (described above)
  
  
• After close contact with someone who tested positive
  -- Administer your self-test when you get home
  -- Follow the same procedure as for a routine self-test (above)

These kits can be purchased on Amazon.com  

• Use Amazon to find authentic test kits and compare prices & user ratings ==> HERE
• Verify the authenticity of test kits by finding them on the official list of approved tests found on the FDA'S Emergency Use Authorization (EUA) page ==> HERE

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F. Closing words of caution about the CDC

Unfortunately, older members of our society must always remember that throughout the endemic, the CDC has been and will continue to be a lagging indicator of best defensive practices, not a leader. This means that health conscious elders and other health compromised members of our society most do much more than whatever the CDC recommends to protect themselves and do it much sooner than whenever the CDC belatedly recommends these additional precautions.  

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Related notes on this blog:

• "U.S. Pandemic Who's Who ", This reference page is occasionally updated