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Pandemic Lessons: How has Covid changed us for good?

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Should we keep a mask handy to wear in public, even if we're fully vaccinated? That's one of the questions we may have to answer as we figure out how to manage our health amid the new realities brought on by Covid-19. 

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Eat right.


Take your vitamins and get a good night’s sleep.

Managing our own health used to be an almost passive activity for many of us, one we relegated – at best – to maybe following those bits of advice above. That’s not necessarily a good thing, but it’s a true thing – and now, it's a so-2019 thing. Because today, if we wake up with a stuffy nose, a slight cough or a touch of a headache, we need to think about it: Is it a common cold? Allergies? The start of the flu? Or … a sign of Covid-19?

And then we'll start thinking: What might I have caught – and from whom? Do I know anyone who’s sick? Should I call my doctor?

“We’re going to be thinking about this more in the future, especially in the winter, when we’re in respiratory season: ‘Maybe I should be wearing a mask every time I go to the grocery store,’ ” said Dr. John Sellick, an infectious diseases specialist with Veterans Affairs, Kaleida Health and the University at Buffalo. “Even if I’m vaccinated, a mask is a good idea because there are all these other viruses floating around.”

The pandemic has transformed our way of thinking about health year-round, but especially in the late fall and winter, when cold weather pushes us inside and cold, flu and Covid viruses have an easier time jumping from person to person in the more-stagnant indoor air. We asked doctors and scientists for insight on the implications of those changes.

Covid-19, influenza, colds and even allergies can all feel somewhat similar – at least in the early stages. What kind of complications does that present?

The way Covid-19 presents itself in infected people is “not cookie cutter,” said Dr. Joseph Chow, president of TeamHealth Ambulatory Care, which has more than two dozen urgent care centers located from Western New York to Florida.

“We’ve found especially with Covid it can present with varying symptoms,” Chow said. “In the beginning, it was fever, cough, shortness of breath. Then loss of taste or smell. Now with some patients who have (or even have not) been immunized, some symptoms are merely fatigue and nasal congestion.”

Sometimes the confluence of those symptoms, combined with other factors – say, if the patient is unvaccinated, and there’s a surge in cases locally – make it relatively easy to assume the person has Covid. If the patient is vaccinated, the chances of Covid are less likely – but far from zero, as the Delta variant’s spread increased the instance of breakthrough cases. And if the patient is unvaccinated but already had Covid, then their post-infection immunity may help them evade the virus a second time.

May – not will. Scientists are a long way from being able to authoritatively measure the strength and consistency of post-Covid immunity. What they know for now is that it exists and, like the vaccines, it is imperfect.

“Natural immunity unquestionably affords a degree of protection, but the magnitude of that protection and likely variability from individual to individual makes it less desirable than vaccine-induced immunity, which we know what we’re going to get, and it’s more reliable and we can count on it,” said Dr. Thomas Russo, chief of infectious diseases at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. “But clearly, natural immunity is better than not being infected at all" when it comes to protection.


• Reinfections are possible, but uncommon. From February through September, “approximately 950 Erie County residents have had at least two positive COVID-19 tests, at least 90 days apart,” county Department of Health spokesperson Kara Kane told The Buffalo News in a late-September email. Erie County documented approximately 43,600 cases during the time frame, and those numbers don’t reflect vaccination status of people who tested positive.

• Breakthroughs are noticeable but infrequent. Much like other jarring events – think car accidents, or sports injuries – breakthrough infections are notable when they happen to people we know, and because of that, they may feel common. But when you look at the numbers, it’s clear that they are still infrequent. As of Oct. 17, the New York State Department of Health reported breakthroughs in 0.9% of the population of fully vaccinated people 12 and older. That’s less than one in 100 people. The state also reported hospitalizations of 0.06% among fully vaccinated people. That’s six of every 10,000 people.

All of this means when you’re not feeling well and talk to your doctor, testing will be the tool to help differentiate one virus from the next.

“Flu typically presents with sudden onset of fever/chills, body aches, headache,” Chow said. “We’ll have to rely more on testing to really tease out between these, as the treatments can be different for each.”

Calling the doctor every time you don’t feel well seems burdensome. Is it necessary?

Some signs are obvious: If you’re having trouble breathing, if you’ve lost your taste and smell, if you have a high fever or startling chills, you should call. But when the symptoms are more subtle, the question of when to call is best be answered between you and your doctor, because your own health conditions and history – along with your work situation – all play into the scenario. “If you have many comorbidities, your doctor may guide you more cautiously to be seen sooner than later,” Chow said, “because your risk of complications (from Covid or flu) would be higher.”

A vital point: Keep in touch with your doctor, so they can help you quickest when it matters most. “The better you and your doctor know your health, the better the doctor can advise on your condition,” Chow said. “For example, getting your Covid and flu vaccinations up to date would be a good piece of information to know if you presented for nasal congestion.”

Even with those vaccinations, you could still have Covid or flu, Chow added, but “knowing you are immunized gives us another piece of information to help us decide what it could be as we take a history of your illness.”

How permanent is this change?

Pretty permanent, it seems.

The vaccination rate in some parts of the world is low – even in the single digits. “There is going to be a reservoir of virus for quite some time,” said Luis Schang, a Cornell University virologist.

That means the virus will continue to spread, and with spread comes the possibility of “serious and significant mutations in the virus, causing more adverse outcomes or more infection,” said Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Children’s Hospital. “The viruses want to survive as much as we don’t want them to survive, and by having enough folks who are not vaccinated – who are at risk – you’ll get enough transmission among those populations.”

But aren’t we doing better than that in North America?

Yes, we’re doing better than single digits. But don’t take too much comfort in that.

In the United States, 57% of people are fully vaccinated. (New York’s fully immunized number, for reference, is 66%.) Canada, at 74%, is far ahead of us. Mexico, by contrast, is doing less well, with 41% of the population fully vaccinated.

But all of that matters only so much, because “viruses get on airplanes just like people do,” Nachman said. “They travel with them, and that means new people will then see that new pathogen or new variant and get exposed. That risk is always there.”

What, then, can we do?

The overarching answer, which is oft-repeated because it is scientifically verified through the administration of 6.8 billion doses worldwide, is to get vaccinated. It’s the most reliable way to avoid infection altogether and to minimize the potential for complications should you get a breakthrough. Even a frequently cited study from Israel, which touted the benefits of post-Covid immunity, found that the greatest protection comes from getting a dose of vaccine after having had the virus.

Curbing the spread of Covid also slows the development of mutations that could be more elusive or lethal.

The safety of the vaccines has been well established, again through the administration of hundreds of millions of doses in the United States, and billions worldwide. Serious adverse reactions have been extremely rare, and in any risk-benefit calculation, the potential danger of a bad Covid outcome far outweighs the potential of a complication following vaccination.

“This is one of the safest medical products I’ve ever seen,” said Sumit Chanda, an infectious diseases expert with Scripps Research. “You have a better chance of getting in a car accident driving to work or getting sick from eating a piece of pineapple than having an adverse event (following) these vaccines.”

The Centers for Disease Control and Prevention has authorized the mixing of vaccines, meaning if you received Pfizer for your initial doses, it’s OK to get Moderna now – or vice versa. Likewise, if you received Johnson & Johnson, you can get another shot of that, or switch over to Moderna or Pfizer for the booster.

We asked Sellick for guidance on that combination of options. “What I’ve been telling the cadre of people who’ve been emailing and texting me is, ‘If your primary series was Pfizer or Moderna, get whatever you want,’ ” he said, noting that they are “almost identical vaccines,” and the flexibility to switch from one to the other may be helpful in smaller towns, where the local pharmacy or hospital only has one product available.

If you received a Johnson & Johnson vaccine, he added, it’s fine to switch to Moderna or Pfizer. A study released earlier this month by the National Institutes of Health showed a strong immune response in people who followed that course. “It’s not chiseled in stone,” Sellick said, “but it’s a very reasonable thing to do.”

Notice that Sellick can’t give an ironclad, you-must-do-this answer. That’s because this is still new, and the research is evolving. Pfizer’s own study, for example, shows great results in preventing infection – including from Delta – with a third shot. But that’s one study, with many to come. The implications Covid transmission and the reliability and frequency of vaccination needs to be played out over time.

We have information by the load, but we haven’t had time – not yet. So for now, the “reasonable thing to do” is also the best thing we can do.


The Buffalo News: Good Morning, Buffalo

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