Learning to live with COVID-19

For most of us today, the main question is: “When will the COVID-19 pandemic end?” I think the really relevant question is: “When will normalcy return?” When can we sigh with relief?

There is no clear epidemiological definition of normal life with COVID-19 – it cannot be measured by the number of cases or the number of deaths. Living with COVID-19 means that we as a society are coping with the virus, using countermeasures to allow a return to “regulatory” behavior. Does this question be answered by Gov. Jay Insley’s announcement of the abolition of the state-wide mask mask mandate requirement on March 12? Is it customary to attend sports events without a mask? Or is it a feeling that if I get COVID-19, is it okay? It is normal that each of us knows that the effectiveness of available means no longer fades compared to the risk of infection and its consequences.

We apply this approach to all other respiratory diseases. For example, during the flu season we get the flu shot, the effectiveness of which is usually 50% to 60%. We still go to work and our kids go to school. We suffer from influenza A with a large number of cases as well as 30,000 deaths a year, but between the vaccine and oral antiviral drugs most of us do not go to the hospital and our lives are not disrupted.

How close are we to this approach with COVID-19? When can we begin to make individual decisions that allow us to work together to fully open up our society? Our current vaccines are good, but the rapid rate of variation of variants and decreased immunity with both mRNA vaccines do not evoke the level of confidence we had a year ago before variants appeared. But we have new tools – new powerful oral antivirals and improved disposable monoclonal antibodies – that, in my opinion, change the equation to the flu-like. These agents are very effective in preventing complications from COVID-19. Paxlovid, an oral antiviral pill, has been shown to prevent hospitalization in almost 90% of people if administered within three days of the onset of COVID-19 symptoms. Similar data exist with a single intravenous treatment or with the restoration of monoclonal antibodies. Programs of “testing and treatment” with Paxlovid and these monoclonal drugs for use in pharmacies and emergency care facilities are proposed and discussed.

Once programs for administering these new tools are established, normal behavior can be achieved for many. It will take work to introduce and adjust the widespread use of these tools, mainly because access is usually a problem for new drugs and because people perceive risk differently. But what will happen is that we will have more options and we will be able to make decisions based on personal risk assessment.

The usual will vary depending on the person and the event, and we as a community need to both recognize these issues and be tolerant of them. Wearing a mask still remains an effective tool to reduce the risk of infection with COVID-19 and other viruses such as influenza. You can still ask if you can go to the cinema and sit shoulder to shoulder with a stranger. Or eat indoors at your next family-style restaurant with a large crowd? What about a concert hall with huge ceilings, and 2,000 people present?

As for me, over the next few weeks I will continue to be cautious about attending indoor events. However, last week in Seattle I attended a theatrical performance where all participants had to be vaccinated and I was in a well-fitting N95 mask. Yes, I know of breakthrough asymptomatic cases of omicron, but I did this calculation and decided I wanted normalcy.

The economic devastation and behavioral consequences of the COVID-19 outbreak frightened us all. Every economy in the world has suffered – and everyone has changed their lives in some way. Although antiviral drugs are the main tool that helps us cope with COVID-19, they are not a scientific point for achieving life before COVID-19 or “premature”.

Science has the potential to improve the game and improve our vaccines so that they completely prevent COVID-19 infection. So no breakthroughs, no illnesses, no hospitalizations, no complications, nothing. In experiments with animal models and in some of our studies on the prevention of monoclonal antibodies in humans, there is evidence that very high levels of antibodies to the virus can primarily prevent its infection. We stop him from invading, so to speak. These data show me that if we increase immunity after vaccination to a level that would prevent infection, then we could indeed reduce the spread of the virus worldwide. I do not mean the elimination of the virus, but a significant reduction in the number of cases in our communities. Our current vaccines do this infrequently, especially with the omicron variant.

We have scientific abilities and I think society needs to push towards the next generation of vaccines. I am absolutely convinced that we can – and should – achieve this goal. The results may well lead to a confident public, a life made fuller and richer by all the things and people that nourish our communities.

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