By Dr. Steve Miszkiewicz
LCO Community Heath Center
Chief Medical Doctor
Last week we finished with no positive cases. The state of Wisconsin is also under 500 positives/day as well. We are not out of the woods, but we can see the meadow! I would like to remind everyone that next week we will move drive-up testing from the Covid trailer to the urgent care entrance. It will still be by appointment and we still come out to cars under the covered area by what was the elder care area and is now urgent care.
Sars-Cov 2 Future
1) At this time various experts believe that at least 90 and maybe 95 % of the population have been exposed to Sars Cov 2 in one way or another (vaccine or infection). Should this conferred immunity (vaccine) or natural immunity (infection) last a prolonged period and if the virus does not mutate around this immunity worst case scenario is that people may get the infection if exposed to a high viral load but due to their immune status they will not have severe symptoms. Otherwise most people will be safe and the pandemic will essentially be over.
2) If our immunity wanes and people do not get boosters as directed or even vaccinated after infection as recommended then their will most certainly be sporadic outbreaks like with influenza. These will largely be dictated by vaccine rates within communities and influenced by hygiene practices (social distancing, hand washing, and masking). This assumes no significant mutation or new variant.
3) This is worst case scenario: Sars-Cov 2 mutates and becomes as contagious as omicron and lethal as Delta and is so “new” that it evades both vaccine and natural immunity. This is quite obviously by far the nightmare scenario. While it is unlikely and there is no current evidence that it will happen the problem is that it “could” happen.
This leads to my main point, that while Covid at this time is quiet, it may not and probably will not be forever. It will be very important that we keep our vaccination rates high. It appears that we will need at least yearly boosters much like Influenza and those at high risk might need 2 per season. For 2022, a combination Covid and Influenza vaccine probably will not be available but may be for 2023 if needed.
If we learned lessons from the first two years it is that wide spread Lockdowns do not work. It is safe to say we are going to have to learn to live with at least sporadic outbreaks and periodic Covid vaccines. It will be how we handle these outbreaks that determines the future of Sars Cov 2. My opinion is that we will plan to treat these infections the very way we have treated influenza now that the majority of people have some immunity. If we test and the patient is not high risk or very ill, home isolation for a minimum of 5 days. Should a high risk patient become ill we will treat based on severity of illness with oral meds, IV outpatient infusions, or hospital based treatment as soon as possible. This will only be possible if we are able to maintain surveillance with on demand testing. As treatment will be predicated on how fast we get the patient tested.
One last point, and that’s “herd immunity”. Had Sars-Cov 2 never mutated, herd immunity would have been achieved by now. However due to its ability to mutate I doubt we will ever have herd immunity. Much like influenza we will have herd “resistance” with vaccines and previous infections, our body will adapt and survive for the most part. If you get Covid and have some level of immunity you will or can still get sick but you will survive. We have reached the point of herd resistance with 90-95% exposure via vaccines and previous illness, but it all depends on the mutation and resultant variant as to how we are able to respond to it. Some years will or could be bad and others minimal much like the flu. It will be paramount that we continue to vaccinate and use medications at our disposal to treat the most vulnerable.