It’s time to rethink your COVID-19 risk tolerance

BILLIONHe US is taking an accelerated course on learning to “live with the virus”. Policymakers and health professionals agree that we have moved to a COVID-19 endemic stage. This has produced Comment widely about what living with the virus and achieving a “new normal” might look like — liberating some while confusing others. Many people have spent two years avoiding and fearing the virus and are now advised that it is safe to unmask and resume normal social life. For them, this did not provide a comforting sense of natural transition, but instead caused a national emotional upheaval. Psychologists call this conflict avoidance.

CDC’s New Lookup map tool For COVID-19 the community tries to balance the main goals of preventing hospital overcrowding and flattening the curve of the critical illness. The agency’s previous map based on transmission levels reflected most of the county in intense magenta. The new map mostly green low risk peace of mind. Critics of the new approach say the agency “seems to have move the goalposts to to justify the political imperative for people to return to their normal lives”. What both critics and advocates of the new CDC tool miss is that — red or green — the tool are not change our previous fundamental relationship with the virus that we have had since the beginning of the pandemic. We are all still advised to avoid it cautiously until it becomes “safe enough”. This old model will not lead us to a “new normal”.

With our new CDC guidelines old paradigm dilemmas still endless. When do I put on the mask? Do I send my kids to school with sniffles? Can I return to work after cancer chemotherapy? Do I need one? forth? When do I use the rapid at-home test? Should our family fly to our familiar summer vacation spot?

In this age of cautious optimism, few people understand the stark reality that for the country to successfully navigate the endemic phase, most of us must move from avoiding to accepting contagion. transmission and infection. Let’s sit with that for a second. This should be the focus of our endemic phase policies and practices. This is the seismic shift that will eventually allow us to live in a sustainable new normal.

Here are five guidelines that will help us get there:

1) Accept that we can’t run faster than Omicron

Omicron is a particularly contagious variant. It is ubiquitous and will eventually infect nearly all susceptible individuals, whether they are trying to avoid infection or not. The Institute for Health Metrics and Evaluation estimates that about three-quarters of the country has “Functional immunity” to Omicronand hope this will continue to “grow through the end of the Omicron wave.”

As with many respiratory viruses such as flu, colds and pneumonia, we will see a seasonal pattern with more cases (positive tests) spikes. The next outbreak of tall tree Warnings should not be raised to deviate from the new paradigm of stable endemicity, as long as vulnerable populations — already bearing the burden of disease — are protected from infection. We have accepted to live with many other infectious pathogens with similar characteristics in the past without undue emotional distress or physical breakdown. Now it’s COVID-19’s turn.

2) Identify “vulnerable” and “non-vulnerable” risk groups

The public has been conditioned by the terrible numbers of the entire population (all positive cases, hospitalizations, and deaths). This drives risk awareness and action for much of COVID-19 policy. During the pandemic, this has resulted in a completely incorrect and erroneous views of individual risk and have led to excessive mass avoidance behaviors and bad policy. This defective lens must now be replaced.

To facilitate the “new normal,” Americans can be divided into two distinct risk-based subgroups: those who, if infected, have a similar or lower risk of hospitalization and death than influenza group (referred to as the “non-vulnerable group”) and the risks associated with a much higher risk of these outcomes (known as the “vulnerability”). The real risk is a continuum from very low to very high, but this simplified binary classification is intended to provide a clear understanding to the public.

The identification of vulnerability is based on three dominant factors that predominately lead to severe outcomes from Omicron infection: age, immunological susceptibility, and underlying disease conditions. Poverty and ethnic/racial factors also pose risks, but indirectly through social disparities and health-equality.

Age is the biggest predictor of infection outcome. Recently CDC Research Compared with people under 30, people over 65 with the disease are 5-10 times more likely to be hospitalized and 65-340 times more likely to die. The absolute numbers are amazing. People over 65 make up 13% of the population and in January are produced 80 percent the total number of deaths due to Omicron. People over the age of 75 make up 6 percent of the population and account for about half of the average 2,600 daily deaths during the period. January increase.

Individual and population susceptibility is reduced through infection or complete vaccination. Both about 80-90 percent protection against critical illness and death, with efficacy that declines significantly with age and over time. The sensitivity level is an ever-changing dynamic equilibrium between the wax force and the weakening force. It will increase slowly in the coming months as Omicron decreases. With an expected increase in transmission and further enhanced uptake later in the year, we should again expect higher population immunity.

CDC has listed twenty basic medical conditions with conclusive evidence of higher risk for serious COVID-19 outcomes: obesity, advanced diabetes, possible psychosis highest association with death. Additionally, an estimated 10 million Americans are immunocompromised, have autoimmune disease, cancer, chemotherapy regimens, or other reasons for immunosuppression.

In this new model, about 20-25 percent of the US population is at significantly higher risk of serious illness from current Omicrons than from seasonal flu. These vulnerable populations are anyone over 65 years of age, and increase exponentially with age, immunological susceptibility, and significant comorbidities. Immunocompromised people of all ages are also included. This group must avoid infection, which is their primary measure of prevention.

The remaining 75-80 percent of Americans are “non-vulnerable” defined as having a similar or lower risk of serious Omicron outcomes than seasonal flu. This group does not need to avoid infection. Their key indicators are critical illness and death, not cases.

3) Prioritize protection of vulnerable populations at high risk

This binary now creates a much simpler, targeted, and efficient disease mitigation framework: the new normal that is not vulnerable can be similar to the old normal when interacting with normals Not vulnerable to other injuries. However, when non-vulnerability factors are directly related to the welfare of “vulnerable” populations, specific support measures are needed. In practice, this means wearing masks common on public transport, vaccinations, boosters, and masks for healthcare workers and in centralized settings, such as nursing homes. old man. As a country, we have a precedent for balancing “freedom to come” with “freedom” — in establishing smoke-free public spaces, for example.

For those in the vulnerable group, there is unfortunately no startling new normal. This is not a society but a contagious imposition. COVID-19 and its variants have caused unimaginable damage and inequality to vulnerable people. Vaccines and boosters have slowed but yes no root this tide. Society will need to work actively through protective public facilities, and every vulnerable individual and household will need a workable plan.

4) Plan for the most likely scenario

Many people are rightfully apprehensive about important “unknowns” related to COVID-19 infection. This includes the emergence of new variants, the dangers of Long Covid, lack of approved vaccines for infants and young children, and other possible adverse events. These are all legitimate concerns, however, the positive risk-benefit calculation for most individuals and societies favors the restoration of our normal lives. Strategic decisions in war often focus on “most likely” assumptions while also preparing for “worst-case scenarios”. As new information evolves, we must maintain the ability to pivot quickly if things take a turn for the worse.

5) Unify the country through reducing restrictions

This “new normal” can perhaps take us from the ravages of politics and partisan ideology to focus on what is good for the country in saving and restoring lives. The main issue is protecting vulnerable people, not covering up and other interventions. Mandatory protective measures should focus only on areas that intersect with vulnerable people. And hopefully many or even most Americans, regardless of their political views, can agree on this preference.

Gathering together as a society is likely to be most effective when it embodies the collective for individual expression. This will not only generate a public health dividend, but it will also boost the economy and help restore America’s full productivity and dynamism at a particularly difficult time in our history. ta.

Adopting these guidelines will accelerate our progress towards the new normal. It will take time, perseverance and social consensus to achieve our goal. But the pandemic was clearly visible off the ramp.

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