Brij –

I read your piece on August 5 in The Bakersfield Californian. It’s one of the best pieces I’ve seen framing where we are with COVID-19 and what our response should be today.

I’m sharing your words below – thank you for this service to our community:

– Sonya

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The wheel has come full circle, but revolutions continue. COVID-19 has lost its novelty but has loaded up on contagiousness. The virus, fortified with more than 50 mutations in its current iteration, has perfected the art of cognito invasion. The magnitude of the infection in public with fading immunity gives the virus a vast petri dish to continually reinvent itself. Yet, the virus may hit an evolutionary ceiling in its cat and mouse game with acquired immunity and pale into manageable irrelevance.

For now, the infections continue to rage with considered disregard to prior immunity with one important caveat: the hospitalization rate among the vaccinated and under the age of 60 is much less than 1 in 1,000. The mortality rate is even lower. As a society, we have paid the bulk of the price for the pandemic’s ravages and made peace with now an insidious enemy.

The tamed does not equal timid of the virus. It can inflict a broad spectrum of clinical severity on the afflicted with an apparent disregard for personal invincibility. I have seen 98-year-olds with multiple co-morbidities barely notice the infection, while a young 18-year-old may agonize with severe muscle pain, fever, chills and unshakable lethargy.

I suffered a mild sore throat and muscle pains that took me out of in-person patient care for a week. The muscle pains were rather interesting. I was reminded of post-marathon torture without the benefit of a medal.

The isolation compelled introspection, and these are my thoughts for the building tool kit to deal with this chameleon of a pathogen.

In the wee hours of the pandemic, Japan ascribed its success to adherence to the strategy of avoiding 3C’s (closed spaces, crowded places and close contact). When infection positivity rises in a community, at-risk populations may benefit from avoiding the 3C’s. The dose-response curve is eminently relevant in infectious diseases. The elderly and immunocompromised should benefit from masking and distancing amid micro flare-ups.

The infected should have comfort in the attenuated virulence of the virus and available therapeutics. For people under 60 with prior vaccination (and likely prior infection), the treatment is rest and Tylenol.

Of course, we still need the discipline to take us out of circulation for a week or so to minimize the infectious spread.

For the elderly, immunocompromised or unvaccinated/COVID virgins with severe symptoms, an out-patient antibody infusion is an available miracle.

Paxlovid is an enigma, though. It has all the hype, overuse and cost. Paxlovid is helpful in a narrow segment of the afflicted: elderly, unvaccinated, and sick. The current indiscriminate use lays waste its utility in the needy and opens the possibility of drug resistance, a menace we face on the antibiotic side. There is no evidence that Paxlovid lowers the long-haul symptoms. There is as yet an inadequately quantified rebound rate after Paxlovid. We need to restrict Paxlovid usage to the small population who have been demonstrated to benefit from it.

From a public health perspective, we must address the correctable risk factors that exacerbated COVID and non-COVID mortality. Obesity, diabetes and hypertension have been significant determinants of adverse outcomes in people infected with COVID.

Obesity is a complex and expanding metabolic problem. Obesity-related diabetes, dubbed diabesity, is the number one cause of preventable blindness. The corrupt corporate culture that has promoted simple carbohydrates and processed foods has a foundational role in the obesity epidemic. The calorie-dense, addictive and nutritionally vacant foods stimulate a spike in insulin that helps park calories in fat tissue while starving energy needs. The body becomes a victim of insatiability and expanding girth. Healthy food choices are imperative, both at individual and corporate levels.

Healthy food, regular exercise and not smoking have been demonstrated to lower all diseases by 80 percent. We all need to take ownership of our health.

As far as COVID is concerned, I’m back to work, aware that the next round is likely a few months away. But COVID computations don’t crowd out attention necessary for my day job.

The pandemic has passed.