Scare Tactics

Looking back over the last three years, we should be humbled by the deaths and injuries incurred by SARS-CoV-2. The pandemic has done great damage. It still is in China, which curiously continues to cling to rigid lockdowns. The virus was unprecedented and unpredictable. There were some politicians and commentators who unwisely predicted a self-limited infection but even more individuals who could not resist catastrophizing future disaster. Clearly, no one knew. There are and always will be dangers on both sides of the prophecy trajectories.

Now we are encountering new bold predictions about a horrific winter putatively due to a rebound of more common winter respiratory viruses with another wave of the newest Omicron variants. Should we not err on the side of warning of the worst possible outcomes? I think not.

Let me provide some background, as I see it. One of the truly astonishing phenomena of the COVID pandemic was the virtual absence of the typical winter emergence of influenza in all ages and respiratory syncytial virus, mostly noted in infants and young children, in the winter of 2020-21. In my 40+ year career, I have never witnessed anything like this before. This suppression raises the question of how effective was masking. In a recent post, I took the position that masking, particularly the typical blue paper surgical masks favored by most of us, was at best marginally effective in preventing transmission of SARS-CoV-2. What other factors could have led to such a suppression of the normal contagion of influenza and RSV? I think that lockdowns as well as fear and social distancing dramatically reduced close contact among our citizens that largely reduced the contagion. I remember quite well my own social behaviors that winter. My wife and I continued to go out to dinner, at least once weekly by dining early in the evening, choosing carefully protocoled restaurants and obeying the diktats of the hospital where I worked which included screening on campus entry, masking everywhere, no in-person conferences, rigorous screening of all patients and families, encouragement of virtual clinic versus in-person clinic visits, and limits on number of people per elevator. The downside of wiping out the contagion of respiratory viruses in the winter of 2020-21 was the failure for natural immunity to develop and deepen in our youngest children. It should be no wonder that we have been experiencing a rebound in the number and severity of respiratory illnesses this winter. This is immunologic common sense.

However, we still know virtually nothing about the virulence of the most recent Omicron variants. There is little reason to be concerned about this virulence, based on serial Omicron variants seen so far. As well, it is still too early to know if the recently released but tepidly accepted bivalent vaccines will be protective of the elderly and medically vulnerable. Let us be careful and humbly wait and see.

What is the bottom line? We so badly need humility in all uncertain matters. Yes, we should educate the public that the severe influenza season in Australias this past summer (their winter) may well portend a rather severe influenza season in the northern hemisphere. How should we responsibly respond? We physicians should urge our fellow citizens over the age of 6 months to consider the annual influence vaccine. You may be surprised to know that in the USA, we have never come close to getting 50% of our population vaccinated against influenza in any year. This evident skepticism is troubling and not supported by any reasonable data. Reasons are largely mythic in my opinion. In addition, we should educate the public that if and when influenza becomes prevalent in their home communities, you should know that early diagnosis and treatment (usually oral oseltamavir or Tamiflu) are vital to modify the natural history of the disease, especially in the vulnerable members of our population. RSV is very contagious and we all are infected multiple times during our lives, usually with less severe symptoms over the years. Early diagnosis for infants and young children makes sense even though there is no specific anti-viral treatment for this pathogen. The search for an effective, safe vaccine has extended for decades and has remained fruitless.

Take all predictions with a huge grain of salt. Many experts find it impossible to resist the temptation to throw around their intellectual weight despite the absence of accurate predictors.