Light at End of Covid-19 Tunnel

By Paul E. Lemanski, MD, MS, FACP

In my last article on Covid-19, I discussed the transitioning from a lifestyle-based approach to a vaccine. In the interval since my last article, four vaccines have had preliminary data support their efficacy and safety. These include the mRNA vaccines from Moderna and Pfizer, and more traditionally developed AstraZeneca vaccine, and the Russian Sputnik 5 vaccine. In that same interval, the United States and the world have seen a surge in new cases of Covid-19, and unfortunately, an increase in hospitalizations and deaths. This surge may have been caused by a preference for staying indoors in colder weather where the virus is more easily transmitted; or it may be due in part, as well, by Covid fatigue, in which the population reduces the use of proven mitigation strategies – including masking, social distancing, handwashing, targeted quarantine and contact tracing – because of the sheer mental fatigue of sustaining such strategies for months. 

Pending final FDA approval of the Moderna, Pfizer and AstraZeneca vaccines and their distribution and implementation, the rise in infections and deaths have had some suggesting a reinstitution of lockdowns, closing of schools, and return to more draconian means of “controlling” the spread of the virus. While acknowledging the real concern behind the suggestion and the evidence that it has worked in the recent past to reduce transmission, I still believe a more balanced approach is best, reserving such draconian strategies as a last resort. As I’ve shown in prior articles, there is not just an economic consequence, but also a real health cost to a resumption of such draconian methods. Moreover, there is the additional concern that even if resumed such extreme methods may not be adhered to by a population suffering from the current high level of Covid fatigue.

Instead, a more “balanced” approach that relies on risk-stratifying the population may be more practical; such an approach reserves the more aggressive and socially disruptive interventions, such as lockdowns and stay-at-home orders, only for those older and sicker individuals because of their higher risk. The majority of the population at lower risk would rely on proven lifestyle-based mitigation strategies to keep the rate of infection lower. Of course, those lifestyle-based strategies work only if universally implemented – or nearly so. 

I would suggest the mandating of universal masking in public – even if enforced with significant economic penalties – is a more socially acceptable solution than lockdowns, school closings, and shutting down the economy. Such a mandate, however, needs to be communicated clearly and consistently. The fact that many of our politicians still do not mask in front of the public sends a mixed message that undermines the importance of universal masking, which is one of the simplest, “relatively” easy, and yet most effective mitigation strategy available. 

If the population is getting fatigued with “doing it all” let’s choose the easiest to enforce and single most powerful mitigation strategy – masking – and mandate it. Perhaps lawyers in the federal government can find a way to legally force states to achieve 95-97% masking or lose some future federal funding (as part of a Covid relief bill) for every percentage point the state average falls below 95%. It would then be up to the states to impose escalating economic penalties on individuals to achieve masking rates of 95-97%. A masking mandate is strong medicine and not everyone will like it. However, again, it is better than lockdowns, school closings, shutting down businesses and the economy, and precipitating economic recession or depression.

It is equally important to emphasize to the population that the most recent vaccine efficacy and safely results provide light at the end of the Covid tunnel. The antidote to Covid fatigue is hope that in six months, we will have achieved a degree of herd immunity from the vaccine and natural infection, that will prevent further transmission of the virus – and allow a return to a more normal life. That hope should help us to “hang in there” and combat the fatigue. 

The logistical challenge of first effectively distributing and then immunizing many millions of people remains. So is the challenge of convincing people to take the available vaccine. A masking mandate will need to be maintained probably till the third or fourth quarter of 2021, but is more acceptable than thousands of more deaths and overwhelming our hospitals and healthcare system. We may also observe, as the populations of many Asian countries have learned, that masking in public works to decrease multiple upper respiratory infections including influenza. As the benefit of masking in public becomes clearer to Americans, we may also become more accepting of its practical value and see it as a voluntary beneficial tool rather than an imposed restriction of our freedom.

In conclusion, despite a recent rise in Covid-19 infections, hospitalizations and deaths, there is reason to be hopeful. Extremely promising Covid vaccine efficacy data and acceptable safety data suggest an end to the pandemic in 2021 is achievable. There is, thus, light at the end of the Covid-19 tunnel. In the meantime, our population needs to do a better job at slowing transmission of the virus using proven lifestyle-based mitigation strategies. A universal masking mandate would help in this regard, as it is the single most effective – as well as enforceable – mitigation strategy. Additionally, a consistent, clear message needs to be sent by our political leaders and they need to be seen to lead by example of their own masking in public, and their lining up first to receive the vaccine in a public display meant to reassure their constituents.

Paul E. Lemanski, MD, MS, FACP is a board-certified internist practicing internal medicine and lifestyle medicine in Albany (centerforpreventivemedicine.com). Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.