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Is COVID in the Rearview Mirror? Not Really.

By Susan Schaefer for Next Avenue

Dr. David Meyers, 75, has a long and accomplished career in the practice of medicine. He has served as the emergency department medical director at Resurrection Hospital in Chicago, as well as chief of emergency medicine at Sinai Hospital in Baltimore, Md. Meyers was also Chief of the Medical Practice Division at EmCare, Inc, a large physician practice management company.

At 73, Meyers earned his Master's degree in Bioethics (MBE) at John's Hopkins University's Berman Institute of Bioethics. He maintains medical staff privileges at Sinai, where he teaches residents and confers with the hospital on quality improvement and safety. Meyers is a member of the hospital's ethics committee and also teaches a course to pre-med students at Johns Hopkins.

I've known Meyers since my graduate and his medical school days at Temple University in Philadelphia, when his interest in clinical ethics began. In addition to clinical ethics, his particular interests are moral distress, and just institutional culture.

Meyers and I met via Zoom to discuss his perspective about the past two COVID pandemic years, and to look forward to living in a COVID endemic world.

Susan Schaefer: What impresses you looking back over this pandemic?

Dr. David Meyers: Well, it's now two years since the first cases of COVID-19 illness due to the SARS-CoV-2 coronavirus were reported in the United States. As of mid-February 2022, nearly eighty million cases have been reported, and deaths are nearing the one million mark.

While the infection rates are now going down nearly everywhere in the U.S., deaths lag behind the reduction in cases, and will continue to rise a while longer. So, even though the trends are moving in the right direction, the threat is not behind us.

In addition, the virus has shown an ability to mutate unpredictably so these favorable trends may not persist if the virus changes.

Why should we not take this disease for granted?

COVID-19 illness manifests itself in many ways, ranging from very mild symptoms, in some cases none, to severe illness and death. Long COVID refers to a long list of symptoms affecting virtually every organ system which can persist for months and even years after COVID -19 infection, and include "brain fog", fatigue, tiredness, shortness of breath, diarrhea, sleep problems, smell and taste abnormalities, and more.

Long COVID is more common in women, and its frequency increases with age. Treatment options are few, so prevention by vaccination, masking and handwashing are the best defenses against this syndrome.

The most recent variant of the virus, Omicron, is now the most prevalent form in the U.S. It appears to be less virulent in terms of severity of illness, but it is more communicable than earlier variants. That has led to more illness in vulnerable populations, particularly unvaccinated older adults, and those with weakened immune systems.

These features of the virus create challenges for each of us as individuals with differing susceptibilities, risk tolerances, personal values and living conditions and as members of communities with differing values, needs and expectations.

What are some of the most common and significant aspects of dealing with COVID-19?

Much has been written about and explored in this area. Territory that is well covered includes:

Masks & masking: Debate continues, however if wearing [them], your masks should be N95, KN95 and KF94 types, and well-fitting with no air leakage anywhere.
Vaccinations & boosters: Current information is found on the CDC website.
Testing: Every household in the United States is eligible to receive at no cost four home COVID tests.
Treatment: Two years into the COVID-19 pandemic, several effective treatments have been developed. One drug, remdesivir (trade name Veklury®), has full FDA approval for treatment of certain hospitalized patients. Several others have received "emergency use authorization," meaning they have been vetted to be safe and effective enough to justify use in settings of public health emergencies but have not completed the full approval process.
What can we expect in the future? What are our responsibilities to ourselves and society?

I look at this from the practical aspects of life in a time of COVID-19.

For two years, our daily lives have been disrupted, friends and family have gotten sick and died, our economic, social and cultural routines have been altered dramatically and full recovery to our pre-pandemic state is nowhere in sight.

In fact, it looks more and more likely that COVID-19 will transition from a pandemic crisis to an endemic fact of life, much like today's influenza evolved from the flu pandemic of 1918.

Our overriding goals should be to minimize our own illness and the possibility of transmitting it to our loved ones, friends, co-workers, and others. These are individual and societal obligations, and they are both served by vaccinations, masking, social distancing, and other disease-mitigating behaviors.

The issue is probably most acute for vulnerable populations — children under five, and those who cannot be vaccinated due to circumstances of coexisting illness such as cancer and immune compromise and living circumstances.

Other personal concerns such as when and how to travel safely, when to return to work and school — in short, when to resume life outside our homes and safe "bubbles"— will also depend on our assessment of the risks of disease in our communities and our ability to use the tools available to us.

While we know a lot about COVID-19, the disease and recommendations regarding appropriate responses to it are constantly evolving. The CDC websites are generally reliable for up-to-date information on their recommendations and thinking about the disease; other sources I find particularly valuable are Dr. Leana Wen and Dr. Peter Hotez.

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