The Way The World Ends

“This is the way the world ends,

Not with a bang but a whimper”

TS Elliot   The Hollow Men, 1925

I have delayed sending this update, fearing that the other shoe would drop, and another surge of Covid cases would emerge from some far-off corner of the world. That does not seem to be happening.  Covid cases are down sharply in every state and continue to decline.  Hospitalizations and deaths from the disease are also declining precipitously.  In Maryland, the positivity rate for Covid testing is 1.8%, the lowest level since all of the fun began exactly two years ago.  The infection number, which predicts infections going forward, is also at the lowest level in all 50 states since March of 2020.   

So, the world may be ending with a bang, for other reasons apparent on the evening news, but   Covid seems to be ending with a whimper. It is extremely unlikely that we will see another surge of this anytime soon, if at all.  The Omicron variant, as predicted, seems to have vaccinated the unvaccinated.  We are now seeing, after several false starts, what herd immunity looks like.  

So, what do we do now? Is it time to lose the masks?  Yes, I think so.  You are unlikely to encounter someone in the grocery store who is infected, and if you do and you have been vaccinated and had a booster shot, you are unlikely to catch it from them.  Are large indoor gatherings without a mask, OK?  Yes, I think they are OK too, especially, again, if you are fully vaccinated (3 shots).   How about airports and airplanes?  Soon, but not yet.  

In our office, we are recommending that you wear a mask in the common areas – waiting room, reception area, and lab, because some patients that pass through are immunocompromised from an illness or chemotherapy. In the exam rooms, you can take your mask off if you feel comfortable.  If the coast looks clear in a month or so, with sustained low viral loads in Maryland, we will retire the mask requirement entirely.

We are getting a lot of questions about getting an additional booster shot (a fourth shot).  An additional booster shot has not been approved by the CDC or FDA.  At this point, I do not recommend getting an additional shot, for the following reasons: 1) Antibody levels to the virus have remained quite high in patients who have received 3 shots of mRNA vaccine, even 6 months out from the last inoculation.   2) The current vaccines were targeted for the initial strain of the virus.  They are less effective against the Delta and Omicron variants, though they do protect against hospitalization and death. Vaccines are under development which are targeted at Omicron and Delta strains.  If we do see another surge of virus, it will likely be in the late fall, and it will likely more closely resemble these newer strains. It would be wiser to get a newly designed booster then.  3) As above, this thing may be over, and you probably will not need another shot. Certain patients who are on immunosuppressive therapy and have not produced adequate antibody levels with standard vaccine dosing are getting additional booster shots on an experimental basis.  

So, it may be time to celebrate the end of the Pandemic era.    Almost 1 million people have died in the US since the first recorded death in March 2020.  Over 6 million people have died worldwide.  Some think this number may be inflated.  But even if that is so, it does not take into account deaths related to delayed care, fear of going to the emergency room with an acute illness, delayed screening tests, and mental health crises.   Deaths in the United State exceeded by 4 times the initial worst case scenario estimates of 250,000 deaths, predicted 2 years ago. We will feel the effects of this pandemic on the way we work, play, and live for many years to come. 

Farewell Covid, we will not miss you.

Stephen Katz, MD, Adult Internal Medicine

Severna Park Medical Associates

Concierge Medicine for Annapolis

31 Robinson Road Severna Park, MD 21146

410-544-5900

Fax: 410-544-5939

AnnapolisConciergeMedicine.com