Pandemic Lessons: Where do we stand?

Not that we’ve disregarded Covid-19 itself. Sniffling and sneezing in public will still evoke worried glances. If you have kids or teens, chances are good that you also have a stack of at-home tests sent home from school. If you get a cold or a cough, you might unbox one, swab your nose and wait 10-15 minutes for the verdict.

The virus has spread widely enough that you likely know many people who have had it, at least once. You likely have battled the virus yourself.

Covid-19 is so consistently a part of our lives that we couldn't possibly forget it. But pandemic restrictions? For many among us, they're nothing but a buried memory. Restaurants are full. We shop. We travel. We gather for weddings, birthdays and graduations. We might wear masks. We might not. Life is being lived.

This is our normal. But how are we actually doing?

The answer is impermanent — like the virus itself, it evolves.

“Cases are getting down to much more manageable levels,” said Dr. Thomas Russo, chief of infectious disease at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.

That’s today, as compared to the earlier part of spring. But there's no guarantee how long it will remain true.

Where do our infection numbers stand?

Western New York’s numbers are among the best in the state. As of June 9, according to state figures, the region had an average of about 14 cases per 100,00 people. That’s down from 62 cases per 100,000 people a month ago, and it’s considerably better than the current statewide average of 30 cases per 100,000.

Those figures don’t represent the actual Covid-19 numbers, which are surely higher because many people take at-home tests and don’t report the results. But still, Russo said, “The downward trend is unequivocal.”

Hospitalizations are heading in the same direction. On June 9, Western New York hospitals had an average of 156 patients with Covid-19. That’s down from 239 at the end of May.

Public health officials often refer to the level of Covid-19 in a region as the “community burden of disease.” Right now, Russo gauges Western New York's burden at a “low to medium level.”

“My guess is in a couple of weeks,” he said, “we’ll probably be at pretty low levels.”

For people who have been living cautiously, either avoiding crowds or shying away from unmasked situations like restaurants, that means it will be easier and safer to go out, especially in the open-air summer months. But that doesn’t mean the virus will remain tamped down.

What are the potential problem scenarios?

The same as before: variants.

Alpha, Beta, Delta, Omicron – they’ve all caused issues, and the further they spread, the more they mutate. The original Omicron variant has mutated multiple times into subvariants that spread with nagging and sometimes nerve-wracking efficiency.

The single point of solace is that the variants have – so far – generally led to a less intense version of Covid-19 than was seen at the outset of the pandemic.

“The good news is that despite it being incredibly, much more infectious, it does not seem to be much more lethal in the adult population,” said Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine. “Is that because we have such a high volume of vaccinated adults? Perhaps. Is it because it perhaps may be less lethal? I don't know.”

What doctors and scientists don’t know – yet – are the best ways to treat and rehabilitate patients with long Covid. 

Although infectious disease experts can say that more variants will emerge, they cannot predict when – or which of those mutations will be most problematic.

Referring to the less-lethal characteristics of the current variations of Omicron, Nachman said, “That could change in a minute. And if we have something that was as contagious and then became a bit more lethal, well, that would be very difficult for all of us.”

If we can’t tell what’s coming, what can we do now to prepare?

Gauge the likely level of immunity you have in your household, and act accordingly.

“What’s the perfect game plan?” Russo said. “No one is going to avoid seeing this virus at some point. The perfect game plan is to max your immunity via vaccination, whether that’s three or four shots.”

If you’ve been vaccinated and boosted, you likely have strong protection from serious infection. If you have those vaccinations and were previously infected, your protection is likely even stronger. “Every little bit of immunity counts,” Russo said.

We shouldn’t rely solely on vaccination, however. While having a full course of initial vaccines and a booster shot has largely kept otherwise-healthy people out of the hospital, it is “imperfect in preventing against infection,” Russo said, “particularly the further out you get from your most recent boosts.”

Likewise, remember that prior infection isn’t a guarantee against reinfection. Nachman referred to recent research that shows young people who had Covid-19 or a serious and sometimes-related condition called MIS-C (multisystem inflammatory syndrome in children) are “not having cross-protective antibodies against Omicron” and are “actually incredibly at risk” for contracting the virus.

People who are immunocompromised, which can include organ transplant patients and those with HIV/AIDS or blood cancers, are likely living with a greater daily risk than others. Since their immune systems are unable to mount a strong defense even with the help of vaccination, they are wise to take extra protective measures. The same is true for the people around them on a daily basis.

In a March interview with The News, Dr. Brahm Segal, an infectious diseases specialist at Roswell Park Comprehensive Cancer Center, advocated continuing to wear a mask in crowded situations.

“It’s an added precaution that won't do any harm,” he said, “and I think would be very helpful.”

People 50 and up are eligible for a second booster shot. If you’re generally healthy and haven't yet gotten that shot, when is the best time to do it? Now, or closer to the colder months, when people start gathering indoors and the virus is more likely to spread?

The answer, Nachman said, is “nuanced.”

If you’re traveling this summer or planning to attend a larger family gathering, Nachman said, “I would say, ‘Get your booster.' ” But if you already have your initial vaccines and booster and are considering a fourth shot, but are planning a more relaxed and careful summer around home, she advises waiting until fall.

Russo’s take on the same question centers on age. If you are 60 or older, he advises, “Get the fourth shot. The data shows that (it) decreases the likelihood you’re going to land in the hospital and die.”

A widely publicized Israeli study published in May affirmed the significant protection a fourth vaccination – or second booster – provides people 60 and up.

For most people ages 50-60, however, Russo has recommended getting the fourth shot immediately only if someone has comorbidities that place them at higher risk of developing a dangerous case of Covid-19. Otherwise, waiting till the winter months are closer might be more advisable.

The best advice, as always, is to consult your own physician.

“Focus on, ‘What will it do for you right now?’ ” Russo said. “We’re at the tail end of this wave right now. If you don’t travel and you remain in Western New York, with each passing day, the likelihood that you will get infected is significantly decreasing.”