The End (of the Pandemic) is Near!

COVID 19 has been a tremendous challenge for all of us.  The pandemic has brought many changes, some for the good, but it has also taken too soon many of our family and friends.  Our hearts go out to all who have lost loved ones to COVID.

However, through the unprecedented effort of both private industry and our governments since early 2020, the nature of the pandemic has taken a turn.  We all came together to slow the spread of the virus until we could get a vaccine that would protect us.  That vaccine is here, and as of now, Arizona is in the position where any adult who wanted to be vaccinated against COVID has been vaccinated.

The Arizona Medical Association had its annual meeting last month, and we had Cara Christ, MD, director of the Arizona Department of Health Services, as well as representatives from both Pfizer and Moderna, on a webinar.  Dr. Christ told us that they were releasing appointments for COVID vaccination on a daily basis, and generally there are same-day appointments available.  To verify that, although I had already been vaccinated, I went on the ADHS vaccination website (https://podvaccine.azdhs.gov/), and found an appointment within 24 hours, and many appointments within the next few days.  I have also frequently seen signs on the 101 promoting walk-in vaccination sites.  Anywhere in the USA you can text your zip code to GETVAX (438829) to get the location of several nearby sites with available COVID vaccine.

The process for signing up for a vaccination appointment is simple and quick.  If you have not been vaccinated yet, I urge you to do so, whether or not you believe you have had COVID.  Of course, all of the COVID vaccines approved so far are approved under an “Emergency Use Authorization,” so a vaccine mandate does not seem appropriate to me.

Now, how do we end the pandemic and go back to normal?  When it seems like governmental organizations that are supposed to base their recommendations on science make abrupt changes in those recommendations that seem to be influenced by other considerations, what should we do?

I have said all along that, once everyone who wanted to receive a vaccine had been vaccinated, it will probably be time to return to normal.  In Arizona, at least, we are there.

Many of the recommendations had seemed to be based on the notion that we cannot return to normal until an arbitrarily defined “herd immunity” is achieved from vaccination alone, disregarding the natural immunity we expect following viral infection.  The justification for vaccinated individuals continuing to wear masks was that they could develop a low-level sub-clinical infection that could result in transmission to vulnerable non-vaccinated persons.  However, the vulnerable were offered vaccination months ago.  Since then, all adults have been offered vaccination.

Even a single dose of vaccine is essentially 100% effective after about two weeks in preventing severe COVID requiring hospitalization or resulting in death, and children have an extremely small chance of becoming seriously ill from COVID.  Although there will always be some who are at increased risk from COVID or other viral diseases, the decision about how to manage any risk should always be based on the balance of competing considerations.

Further, to decide that those who are vaccinated must still be seriously restricted because there are some who have chosen not to be vaccinated had some perverse effects, not the least that it significantly reduced the incentive to become vaccinated and thus tended to increase vaccine hesitancy, as recognized by the CDC even before their recent changes in recommendations (https://perma.cc/CE8Z-5CKC).

So, at this point, I do not believe there is any scientific COVID-related justification for a vaccinated person having to wear a mask except in limited circumstances, such as healthcare, and particularly during surgery, where we have traditionally always worn masks.  

I would also say that I do not understand why a person who is vaccinated should be concerned that anyone else has chosen not to be vaccinated or has chosen not to wear a mask.  I do believe that all adults, and probably everyone over 12 years of age where there is an approved vaccine, should be vaccinated, primarily for their own benefit, but I also believe it should be an individual choice.

I am often asked how we can know that the unmasked individual standing next to us in line has been vaccinated or not.  My answer is that we cannot, but that it does not matter.  The risk of not being vaccinated falls entirely on those who are not vaccinated.  If you have been vaccinated, it does not increase your risk if someone else is not vaccinated.  Although children under 12 cannot currently be vaccinated, the risk to them from COVID 19 is extremely small.

At my office, based on the science we established a “mask-optional” policy at the end of March, because all of my employees had chosen to be vaccinated against COVID, and because my office and scheduling are managed so patients rarely have any close contact with other patients.  If you would like us to wear masks when you visit, just let us know and we will be happy to do so.  Otherwise, please feel free to wear a mask if you like, but it is neither required nor encouraged.

If anybody disagrees with my position or would like to discuss it, please feel free to give my office a call.  But it has been great being able to see the smiles again!