Past lessons are our best guides for the post-pandemic COVID surge
A high-level federal health official told me recently that a mainstay of the response to the increasing rates and hospitalizations due to COVID was going to be increased availability of rapid testing along with the promotion of Paxlovid. I agree with this approach.
Paxlovid is an amazing antiviral drug that has worked incredibly well to decrease symptoms and severity of all variants and subvariants since it was first authorized for emergency use in December 2021 and then received full approval for adults in May 2023. Little clinical resistance has developed.
As far as rapid tests are concerned, I and other clinicians treating COVID have become more and more adept at using repeated testing combined with characteristic COVID symptoms (cough, nasal congestion, fatigue, sore throat, headache, diarrhea) to make early diagnoses. These early diagnoses can be coupled with Paxlovid treatment, though it is not for everyone. Studies have shown that it is highly effective at reducing the severity of COVID, especially in older patients, immunocompromised patients and those with chronic diseases including cardiovascular and neurological diseases.
If anything, both Paxlovid and rapid testing are two hugely important tools in the fight against COVID-19 that haven’t received the credit they deserve. I remember saying publicly at the beginning of the pandemic that if we only had a drug as effective for COVID as Tamiflu is for flu, we would be in much better shape. And then, miraculously, we had one.
Another valuable tool we have to offer that wasn’t there at the beginning of the pandemic, but has been so politicized that its value has been undermined, is the COVID mRNA vaccine. For all the excess focus by naysayers on side effects, the risk of the virus remains far greater. This is why I will be recommending the new XBB boosters for the elderly and others at high risk of COVID-19 complications when they come out in a few weeks. In fact, I hope to have them in my own doctor’s office, where I can carry on a vaccine risk-benefit conversation with my patients.
I have been longing for this kind of COVID-19 vaccine availability for a long time. The evidence shows that these boosters are effective on the current widespread variant EG.5, which is an omicron offshoot of XBB. It is not yet clear how effective the vaccine will be against the BA.2.86 subvariant if it begins to spread widely, but it will certainly offer some protection.
For younger and healthier individuals who already have significant immune memory from prior COVID infections and from prior vaccination, the booster may not be necessary; but for others, it will be very helpful. One of my high-risk patients asked me the other day if he should have the new shot having missed the bivalent booster, and my answer was a definite yes.
When it comes to masks, I feel that the political battles have been caustic, costly and completely unnecessary, reminiscent of the mask wars during the 1918 Spanish flu pandemic.
In terms of political weaponry over public health matters, we don’t seem to have learned anything since then. In fact, the COVID pandemic has not proven that mask mandates reduce spread, but there is evidence that the right masks help in medical settings and in other close quarters where those at risk of severe infection can add an additional literal layer of protection by wearing a high-grade mask properly. Mandates no, tools yes.
One extreme tool we need to stay away from completely is lockdowns and closures. Beyond the frightening initial days of the pandemic, these never worked to slow the spread, and instead spread fear. People who were locked down together spread COVID among themselves, and school closures caused a lot of damage in terms of socialization and learning that our kids may never fully recover from. Fear of a virus can be more contagious and potentially harmful than the virus itself.
The solution is to not give in to grandstanding or politicizing but to make sure the right medical tools are available for use when they are truly needed by those who need them the most.
Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; The Politics of Fear and the Power of Science.”