Healthcare, State Government, U.S. President

A talk with Clay Marsh on COVID confusion and status of the pandemic

MORGANTOWN – COVID-19 Czar Clay Marsh weighed in recently about COVID confusion and COVID fatigue and what we need to keep in mind as it moves from the forefront of fear back in 2020 to background noise now for many.

The omicron variant spike is past, with cases in West Virginia plummeting from 3,337 on Sept. 10 to 665 on Tuesday. And the hospitalization roller coaster is on another down slope: 1,094 hospitalized on Feb. 1; 80 on April 24; back up to 397 on Aug. 9; down to 147 on Tuesday.

COVID confusion

Some have viewed the federal government as contributing to COVID confusion. In August, CDC Morbidity and Mortality Weekly Report author Greta Massetti said, “We’re in a stronger place today as a nation, with more tools — like vaccination, boosters, and treatments — to protect ourselves, and our communities, from severe illness from COVID-19. … This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

But then in September, President Biden told 60 Minutes, “The pandemic is over. We still have a problem with COVID. We’re still doing a lot of work on it. But the pandemic is over.”

While his officials walked that back, the dean of Harvard’s school of public health called Biden’s comments “premature and harmful.”

The Dominion Post asked Marsh if the pandemic is over. He said the definition of pandemic is an infection that has worldwide impact and is not following a set of predictable rules. “From that end, the pandemic still continues.”

The variants keep coming. The BA.5 variant has been supplanted by BQ.1. and BQ.1.1. But there’s hope. While the new variants are circulating in France and India, he said, there is a decoupling of cases from hospitalizations and deaths. This implies that in those two countries the population’s level of immunity is sufficient to keep people from getting as sick as in previous surges, even though the BQs are more capable of avoiding the immune system.

So we’re watching if that follows suit in the U.S., he said. “We’re hoping we have enough people immunized and enough persistent immunity to keep us from seeing the surges in hospitalizations and deaths.”

The fallout from Biden’s comment indicated it isn’t the White House that declares the pandemic over. We asked Marsh who decides.

He said most authorities recognize that as we develop more immunity against COVID, we’re likely to continue to see less of the most severe outcomes – even as we continue through the alphabet soup of variants.

So instead of instead of saying its over, it’s more appropriate to say we’re more optimistic regarding immune protections in the population – those who are vaccinated, boosted, possessing some immunity from prior infections.

He and others hesitate to call it over, he said, because cold weather is setting in and variants are still changing. But we still have the opportunity to continue strengthening our immunity, and to make use of Paxlovid – an antiviral medication shown in a recent U.S. Veterans Affairs study to reduce long COVID manifestations by 26%. It works on every age group and immunity status, whether a person is vaccinated or not, recovered from a prior infection or not.

Paxlovid has probably been underused, he said, particularly on older people. It may be another mechanism for us to reduce the consequence of long-term of COVID.

Gov. Jim Justice continues the COVID briefings (though always mixed with politics) that he began in March 2020. We asked Marsh when COVID will become just part of the background noise, like the flu.

He agreed we’ve seen the level of anxiety diminish. “These new variants don’t seem to be causing severe problems in the places they have influenced.” So if decoupling remains persistent, we’ll probably reach a point where some countries and states will say we’re not going to continue to see COVID at the level it was.

He said we should still remain cautious as we move into winter, with flu season and with RSV cases filling children’s hospitals across the country. More people have been hospitalized for flu this year than in the last 10, but that’s probably tied to weakened immunity from most of us being confined and isolated the past two winters.

Those pesky masks

At COVID’s peak, we could walk through a store and see maybe a tiny handful of mask holdouts. Now we see only a tiny handful masked.

Many medical and dental offices have made masks optional, but they remain mandatory at the offices of the major health systems – WVU Medicine and Mon Health around Morgantown, and others across the state.

The CDC most recently said, “Layered prevention strategies — like staying up to date on vaccines and wearing masks — can help prevent severe illness and reduce the potential for strain on the healthcare system. Wear a mask with the best fit, protection, and comfort for you.” For those exposed to COVID, CDC now recommends that instead of quarantining, wear a high-quality mask for 10 days and get tested on day five.

We asked Marsh when the health systems might move to making them optional.

He said the risk/benefit value of masks remains generally favorable, and they provide another level of safety.

In the hospitals, he said, they help to protect patients and protect the staff from COVID and from other viruses such as flu and RSV.

“We know today that the limitation in our care models is not related to the number of beds, it’s related to the number of people that we have to take car of patients in those beds. … It’s another way to protect our folks.”

Masks remain important, he said, as uptake of the new boosters remains at a trickle: 15% for those over 50; 23-25% for over 65; and 8% overall. “Those numbers are really not where we would like to see them.”

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