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On Call: Shouldn't We Be Past This?

Thu, 09/16/2021 - 12:36
The line for drive-through Covid-19 tests at the site behind East Hampton Town Hall
Durell Godfrey

In so many ways, the fact that we are still having to deal with the Covid-19 pandemic feels like a kick to the gut, like something that shouldn't be real but nonetheless is. Some things -- checking to make sure your children have their masks in hand before heading out the door for school, for instance -- seem to have become second nature for many, if not most of us, but others still feel so alien. 

Some have written or explained to me in the office that part of this is the supposed fault of shifting guidelines. I do my best to describe how science, particularly medical science, is a process, one in which we make the best decisions we have based upon the available evidence, and then as new evidence comes along, we make better ones. Sometimes those new decisions will seem in opposition to the old ones, and this, as I've written before, reflects the inherent nature of the scientific process and not necessarily a failure.

At this juncture in the pandemic, it is worthwhile once again to review some of the current guidelines. Some of them vary by town, county, state, or region. For example, most, if not all, of our schools here on the East End require students, even vaccinated teenagers, to wear masks and attempt some form of social distancing while in school. This reflects the continued danger that the Delta variant of Covid-19 poses to our communities, and to our children in particular, many of whom are too young to be vaccinated. As opposed to early in the pandemic when the overwhelming majority of cases in children seemed to be mild with some rare (and devastating) exceptions, now in states like Texas and Louisiana where case numbers have risen, more and more children have become significantly and sometimes seriously ill, spending time in hospital wards and pediatric intensive care units. Mask wearing, social distancing, and good hand hygiene remain the best measures we have to protect our children.

Another guideline that remains is the strong encouragement, and in some work environments, requirement to be tested if exposed to Covid-19. The Delta variant is both more easily transmitted and possibly more virulent than the earlier variants we faced last year, and so the Centers for Disease Control updated their guidelines last month to once again recommend that anyone with an exposure to someone who has Covid-19 or suspicious symptoms indicating Covid-19 should be tested immediately if they are not vaccinated and again in five to seven days if the first test is negative, or sooner if symptoms develop. While awaiting test results, unvaccinated people should quarantine.

Vaccinated people should be tested three to five days after exposure and should wear a mask indoors until they receive a negative test result. They should continue to wear masks indoors and watch for symptoms for three to five days after a negative result on a first Covid-19 test.

Unvaccinated people should continue to wear a mask indoors and watch for symptoms for 14 days after exposure, even after a negative result on a second test. 

In general, the C.D.C. also recommends that even vaccinated people wear masks indoors in public spaces if they are in areas with high local rates of Covid-19.

Finally, the best protection against becoming seriously ill or dying from Covid-19 remains vaccination with one of the available vaccines. A report published Friday by the C.D.C. showed that unvaccinated people had a greater than 10 times risk of hospitalization and death from Covid-19 compared to vaccinated ones. Vaccinated people can still become sick, and sometimes seriously so, but the rates remain dramatically lower. Moreover, with hundreds of millions of people having been vaccinated at this point, we know that the vaccines are safe, and that what adverse effects do occur are overwhelmingly rarer than the risk in our country of becoming sick with Covid-19 itself. 

At some point, the protection likely wanes, and that is where the discussion of booster shots has come into play, but so far only individuals who are immunocompromised -- meaning people with active cancers undergoing treatment or some people with autoimmune diseases who are on medications that lower their immune defenses -- have been officially authorized to receive these booster shots so far. If you think you may qualify for this based on your immune system, you should contact your primary care doctor to discuss your options. With regard to everyone else, there is a strong expectation that the C.D.C. will release guidelines very soon regarding when and how to receive booster shots.

This is just a quick snapshot of where we are at this moment in time, and in many ways, it does not reflect the immense toll of the pandemic to date. Every medical colleague I have is struggling with the ongoing physical, emotional, and mental burden of fighting this war, and every step you as a member of the public can take to stay up to date with guidelines and do your part to keep not just you and your families but also the most vulnerable among us safe is a vital component in getting us to a place where we can lay that burden down. 

Joshua Potter, D.O., a physician with Stony Brook Southampton Hospital's Meeting House Lane Medical Practice, oversees the practice's Shelter Island office. He specializes in family and neuromusculoskeletal medicine. Opinions expressed in this column are his personal and professional views and not necessarily those of his employer.

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