COVID:19 Update - Monday, October 4, 2021

Historical context, further evidence about masks, a new anti-viral treatment option, and a bit of crystal ball gazing.

1. Given the discussions around vaccine mandates, I wanted to provide some historical context. Vaccine mandates are not something new - in fact, George Washington instituted the first-ever vaccine mandate. During the Revolutionary War in the early 1900s, he mandated that all military personnel get vaccinated against smallpox. A large number of American's were unconvinced that smallpox was a dangerous disease and they did not believe there was any need to be vaccinated. From where we sit now, it is hard to conceive of that, but it is true. Smallpox is the only disease that we have ever successfully eradicated, and it was done entirely through vaccination. In 1905 the Supreme Court ruled in support of mandatory vaccinations (Jacobson v. Massachusetts). Some people are saying we now have "forced vaccination" but those words are not accurate. People are being forced to make hard decisions - this is true, but we have not forced vaccinations but that has been done in the past - in fact, shortly after the 1905 ruling by the Supreme Court, in some cities, Public Health officials and Law enforcement went door to door physically forcing vaccines on the unvaccinated. Given that historical context, nomenclature becomes important. Mandating vaccination and forcing it is not the same.

When influenza hit in 1918 shutdowns ensued and people were made to mask - even in their own homes! Churches were canceled, schools were closed, extreme measures were taken to preserve lives. Later, in the '50s Polio became the disease of concern. Thanks to the March of Dimes and a few dozen celebrities, vaccine hesitancy was low and through vaccination, we successfully eliminated wild Polio from the United States. In 1977 the US government introduced the Childhood Immunization Initiative and people began to protest - they didn't believe the vaccines were necessary and many expressed concerns that the government was violating their rights. Misinformation began to take hold and the anti-vaccine movement was officially born. You see, hesitancy has always been part of the vaccine picture, as have mandates. But pre-COVID most states were actually moving toward stricter vaccine requirements. According to the Kaiser Family Foundation, the current divide is largely according to politics. You can read more about that here: https://www.kff.org/policy-watch/the-red-blue-divide-in-covid-19-vaccination-rates/

2. Yet another study has come out showing the efficacy of mask-wearing. You can read it here: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab797/6370149 If you are in a hurry, or just not interested in reading the study, here is the nitty-gritty of it: "Masks reduced viral RNA by 48% in fine and by 77% in coarse aerosols; cloth and surgical masks were not significantly different." - assuming the mask fits properly. Fit matters.

3. A new anti-viral pill by Merck has reported great success in treatment for COVID. This is very good news. The pill is not yet approved for use but they stopped the clinical trial early because they were having so much success they felt it was unethical to continue to deny treatment to people. So stay tuned for more on that.

4. Finally, people have asked me what I think is going to happen, and while it is certainly crystal ball gazing at this point, here are my thoughts for what they are worth. In actuality, it hasn't changed much from early on. If you have been with me since then you know we discussed that I thought this would most likely become endemic (meaning always with us). We missed the boat to eliminate it (in my opinion) but it won't always be like this. We can still get it under control. Some illnesses we can prevent you from ever getting (Polio) and some we get really good at treating if caught quickly (Strep throat). I believe that COVID will eventually be like Strep. If you get it we treat you (hopefully with an anti-viral med like the Merck pill). But we didn't have a really good treatment option previously which is evidenced by the 700k COVID deaths. Hopefully, the Merck pill will soon become available and there will be more like it - making treatment easier and quicker.

FINAL THOUGHTS: I attended a funeral today, and as funerals have a way of doing, it made me reflect on life. Here is one of the things I walked away with - do not spend your entire life beating yourself up. Sometimes you just have to accept the things you cannot change and move forward. Life is hard enough without fighting yourself every step of the way. So love yourself so that you can then love others. Not in an exasperated way, but in a truly, deeply genuine way. Love yourself. Sure you may have a few wrinkles. You can spend the rest of your life despising them - or you can just embrace them as proof that you made it this far. Ok, so you have some cellulite. You can spend years and lots of money trying to scrub it away all while loathing the way you look - or you can just say, "yep" and move on loving that your body is working despite the cellulite. No one is going to show up at your funeral and say, "you know, she was alright but....she had some cellulite. And did you see those wrinkles? Wowza!" So whatever "it" is, just accept the things that need accepting so that you can love yourself because life is hard enough.