COVID-19 Cases Are Going To Ebb And Flow, With Or Without Restrictions
- A growing number of health experts are voicing concerns about ongoing COVID-19 restrictions at this point of the pandemic.
- While COVID-19 cases are surging and deaths are the highest they’ve been in two months, experts say the severity is nowhere near what it was early in the pandemic.
- The negative mental health impacts of the pandemic are one reason some experts stress the importance of not reinstating restrictions and mandates.
Restrictions during the start of the pandemic, such as masking and physical distancing were helpful at curbing transmission, keeping hospitals from becoming overwhelmed, and buying time for scientists to develop effective vaccines and treatments.
However, at this point, a growing number of healthcare professionals believe restrictions and mandates are outdated and, in some cases, even overkill.
“[In the beginning], we had no other tools in how to deal with this, but it’s the time we have kept restrictions going that really highlights the fact that there has been very limited discussions in the harms of the restrictions, which has allowed policymakers to keep them in place way beyond when they were possibly effective,” Dr. Jeanne Noble, emergency care physician and director of COVID-19 response at UCSF, told Healthline.
Dr. Monica Gandhi, professor of medicine at the University of California, San Francisco, agreed. Prior to vaccines, she said public health officials did everything in their power to limit transmission since cases could lead to hospitalizations among vulnerable people.
“However, since the advent of the vaccines and with increasing population immunity, cases no longer track with hospitalizations but have become ‘uncoupled’ from severe disease since vaccines are so effective at preventing severe disease,” Gandhi told Healthline.
For instance, recent study results found that higher vaccination coverage was associated with significantly lower COVID-19 incidence and significantly less severe cases of COVID-19 during the Delta surge.
Because the country has a lot of natural or acquired immunity from COVID-19 at this point, Noble said precautions like social restrictions don’t make a measurable difference.
Currently, immunity against COVID-19 is both from vaccination and natural infection with 78.5% of the population having had at least one dose of the vaccine and at least 50 to 60% for adults 18 to 64, 33% of adults over 65, and 75% of children having had an infection by February 2022, according to the Centers of Disease Control and Prevention (CDC).
Exposure is likely much higher today after subsequent Omicron waves, Gandhi noted.
“Cases have risen and fallen across states in the U.S. regardless of restrictions, such as mask mandates or vaccine mandates. Our high rates of population immunity in the United States, however, is keeping our case rates much lower than before and our COVID-19 deaths lower than any time since the beginning of the pandemic,” she said.
Although daily deaths from COVID-19 have surpassed 400 per day once again, they have still dropped significantly from the peak of the pandemic, which was incurring more than 3,300 COVID-related deaths a day.
Why Spikes In Cases Shouldn’t Cause Alarm
Increased cases of COVID-19 is largely driven by the highly transmissible BA.4 and BA.5 subvariants of Omicron, which became the predominant subvariants in the U.S. in June, according to the CDC.
“[The] reason that cases rise and fall so predictably is likely because new infections generate antibodies in the nose and mouth (called IgA mucosal antibodies), which prevent onward transmission to others, leading the cases to eventually die down,” explained Gandhi.
To explain the science, Dr. Bruce E. Hirsch, attending physician and assistant professor in the infectious disease division of Northwell Health in New York, broke it down into two parts.
The variants are developing additional capability of spreading more effectively and some of the new variants are developing the capability of escaping the immune response of the previous ones.
“So, we’ve seen people who’ve had COVID more than once, and it seems to be the more current variants like BA.5 that are able to infect a person who developed an immune response to an earlier COVID variant,” Hirsch told Healthline.
Severity Of Disease
Severity relates to how effective the COVID variant is at finding sites on the lower respiratory tract as opposed to the upper respiratory tract.
“The current variants are really good at infecting the nasal pharynx, and not so effective at causing pneumonia, which is much worse to have and can affect a person’s health in adverse ways,” said Hirsch.
Why Ongoing Restrictions Are Overkill
Gandhi believes that restrictions should not be in place at this time. One reason she points to is that COVID-19 cannot be eradicated because animals can harbor the virus, making it impossible to make animals immune.
“Moreover, the symptoms of COVID resemble other pathogens and it has a relatively long infectious period,” she said.
Additionally, increasing population immunity seems to be making COVID-19 more predictable in its evolution, resembling the seasonality of influenza and the common cold, she said.
When it comes to masks, she stated, “Given that more than 30 states in the U.S. have not had any mask mandates since spring of 2021 (with the remainder of states discontinuing mask mandates a year later), but that cases rose and fell in the same pattern across states since the advent of vaccines…I don’t think we should resume restrictions like mask mandates at this point in the pandemic.”
As of February 2022, the CDC decided not to recommend masks unless hospitalizations from COVID-19 were high, an approach Gandhi agreed with.
Mandates on vaccines should no longer exist either, according to Noble. However, her stance changed over time. Because vaccination is an effective and necessary tool against severe disease from COVID-19, in the beginning of the pandemic, she advocated that vaccine mandates could be the quickest way to return to normal and an avenue to getting public health officials to drop restrictions, particularly on children.
“But vaccine mandates did not do that in places that had and continue to have very strict vaccine mandates. I don’t think it necessarily increased the vaccine uptake much more quickly than in places that did not enforce any kind of mandates so that they saw a clear effect of getting out under the heavy burden of COVID more so than other places,” said Noble.
According to one paper published in the Lancet, while COVID-19 vaccine mandates in schools were highly effective in improving uptake of childhood vaccines, the effectiveness of adult vaccination mandates in increasing vaccination uptake might be lower. The authors concluded that mandate policies cannot be the only approach to increasing vaccination, even though “the current evidence regarding the safety of COVID-19 vaccines in adults is sufficient to support mandates.”
As an article in Nature discussed, many issues around vaccine mandates may turn people against the vaccine, even if they believe it works.
“It’s hard to make a strong argument whether vaccine mandates were an effective tool. There is variable reasons, but a vaccine mandate does not equate into 100% of a population getting vaccinated clearly,” said Noble. “It’s debatable to say why they weren’t, but there will always be resistance to something that is forced onto people.”
Because mandating vaccines may turn out to be a tool that wasn’t particularly helpful, in the future, she said public health officials and the medical community should consider putting more resources into trusted messengers, vaccine education, and meeting people where they are.
It’s Time To Face The Harms Of Restrictions
In 2021, Noble began worrying about the toll COVID-19 restrictions and mandates were having on mental health and the negative impacts on children’s lives, in particular. While she remained dedicated to caring for COVID-19 patients, she began weighing the costs and benefits of keeping people away from their work and depriving some of their education and childhood.
“I felt the pressure of saying ‘okay, restrictions definitely are benefiting our population but certainly harming it in other ways,’” she said. “In the beginning, we had to take precautions to bide time and figure out where the disease was going, how to characterize it, how to prevent people from falling seriously ill and dying from it. But from the beginning, we have under-appreciate the harms of our COVID restrictions.”
A study from October, 2021 found that mental health across 204 countries and territories in 2020 significantly declined. Researchers cited an additional 53 million cases of major depressive disorders and 76 million cases of anxiety disorders with women and younger people most affected.
In December 2021, the U.S. Surgeon General issued an advisory on the youth mental health crisis further exposed by the COVID-19 pandemic. A press release from the U.S. Department of Health & Human Services stated that the pandemic added to pre-existing challenges faced by America’s youth, noting that the pandemic disrupted the lives of children and adolescents halting “in-person schooling, in-person social opportunities with peers and mentors, access to health care and social services, food, housing, and the health of their caregivers.”
A July 2022 study published in Journal of Adolescent Health looked at whether COVID-19-induced financial impact, stress, loneliness, and isolation were related to perceived changes in Texas area adolescent mental health and substance use. Study findings included:
- Family financial instability, including increased use of a food bank, job loss, or self-reported (negative) changes in economic situation were linked to symptoms of depression and anxiety and increased use of alcohol among adolescents
- The national prevalence of at least one mental health disorder among those under 18 years old is 16.5% with emotional disorders and behavioral problems among the most prevalent
- Adolescent substance use rates are high – over 8% of 12–17-year-olds report drug use and 9.15% report recent alcohol use
- Adolescents who did not limit their physical interactions due to COVID-19 had fewer symptoms of depression and adolescents who did not restrict their socializing were substantially more likely to report using a variety of substances
- Disruptions in school communities had a negative impact to adolescent stability and development, including the impact of school disruption on access to mental health service; an estimated 13% of adolescents (approximately 3 million nationwide) report using school mental health care
“When we did things like close schools, there were some studies that showed kids who were out of school and in remote school were more likely to test positive for COVID than kids who did in-person schooling, and this probably had to do with the fact that kids who were remote learning were largely unsupervised and their parents were at work and may have been more exposed,” said Noble.
Infectious Disease Doctors Encourage Continued Caution
While many in the infectious disease community acknowledge that the suffering and isolation that came from the pandemic response was profound, many say a balanced approach to fighting the virus is still needed.
Hirsch said precautions like wearing high quality masks appropriately, effective ventilation, vaccination, and improving one’s personal health all need to be implemented so that there is a balance between the risks and benefits of being together.
“I want people to be able to see each other with the needs of the vulnerable among them respected. Some healthy people who do not consider themselves at risk for any illness, will have long-term health consequences from COVID,” he said.
He isn’t sold on the idea that society reached a plateau with COVID-19 and explained that many infectious disease experts are concerned about the potential for a variant to develop the ability to spread easier, escape immune response, and cause more serious disease. He thinks a few more years are needed before COVID-19 is like influenza and the common cold.
“The virus is not done with us. It’s still changing and it’s continually evolving. We don’t know what future versions of the virus are going to mean for the health of ourselves or for the population,” Hirsch said.
He admitted that healthcare professionals like him who were on the frontlines and in the depths of COVID-19 in 2020 have devastating memories of those early days that are unique to their profession.
“We saw an unbelievable magnitude of death and frequency of severe illness in the beginning of the epidemic. I saw a lot of people die when our strategies and treatments were uninformed and not nearly as effective as they would be afterwards,” he said.
He believes society should live life in as “normal” a way as possible when COVID-19 hospitalizations are low while remaining cautious about future variants.
Printed courtesy of Healthline.