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On March 11, 2020, the World Health Organization officially designated the novel coronavirus as a pandemic. Two days later, then-President Donald Trump declared a national emergency.

The third anniversary of those moments passed by over the past week without much fanfare. President Biden has already said the national emergency for covid-19 will end this May, and most Americans have returned to their pre-pandemic lives.

In this week’s newsletter, I reflect on three remaining questions that scientists and policymakers must continue to address.

How can we protect the most vulnerable?

With covid becoming endemic and no longer a daily consideration for most people, the question of how to safeguard those still at high risk should be the top priority for health officials. This is in line with how we address virtually all other diseases such as HIV and cancer. The priority should be the elderly, the immunocompromised and others who are not able to utilize existing treatments.

Globally, more than 80 percent of covid deaths in 2020 and 2021 occurred among individuals 60 and above. In the United States last year, nearly 90 percent of covid deaths were among people 65 and older. The antiviral Paxlovid is effective in reducing hospitalizations and deaths in this age group, but many cannot take it due to certain medical conditions or because other medications they are taking interact poorly with the drug. And now that the Food and Drug Administration has withdrawn its authorization of the preventive antibody Evusheld, the immunocompromised are left with fewer options.

Over the past three years, we have seen science and public health deliver remarkable successes with a record-setting vaccination campaign. We should marshal this same energy toward developing improved treatments and ensuring that these therapies reach people most at risk.

In the meantime, federal health agencies should allow second bivalent boosters for those who want them. And entities frequented by vulnerable people, such as hospitals and senior centers, should keep in place their mask requirements.

How should we think about long covid?

There is no question that long covid is a serious and often life-changing ailment that affects many Americans. Yet it remains ill-defined and poorly understood.

Research, including a recent Nature paper, increasingly indicates that vaccination can reduce the incidence of long-haul symptoms. Another study, which is online but not yet peer-reviewed, suggests that taking Paxlovid can decrease the likelihood of developing long-term symptoms.

We need far more studies like these. One crucial area of inquiry is what happens with repeat infections, which will almost certainly become more common with covid exposure going forward. We might come to expect some frequency of post-covid symptoms, and the resulting disability, as a “new normal.” In that case, health resources must shift from avoiding the coronavirus to reducing and treating its worst consequences — including long covid.

How do we prepare for the twists and turns ahead?

Covid has not settled into a predictable seasonal pattern. Variants that are currently circulating are all offshoots of the milder and extremely transmissible omicron strain, but it’s entirely possible that a more dangerous strain that can evade the protection of existing vaccines might emerge.

One silver lining from the past three years is the increased attention to disease surveillance. Wastewater testing has proved successful at detecting covid outbreaks early. These efforts should continue so that troublesome variants can be flagged. We also need to renew the urgency to develop vaccines that can cover a broader range of variants.

Then there’s the turmoil from the investigations into covid’s origins. As I’ve argued previously, such inquiries should not delay necessary progress both to improve laboratory safety and to reduce zoonotic transmission. I hope political leaders approach these goals with scientific rigor rather than cherry-picked data points to fit predetermined theories.

For more than three years, covid has been inserted into the partisan culture wars, hindering our response and eroding trust in public health. Covid may no longer be a pandemic, but the impact of the virus itself is far from over. There is much work to be done to protect those still at risk and prepare the United States for future infectious diseases.

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“I’m 73, immunocompromised and have had all available covid vaccines and boosters. I live alone with no support system and mostly stay in the house, though I do shop for food and run other errands. I always wear a KN94 mask. But I suffer from rhinorrhea, and my nose starts dripping as soon as I put the mask on. What good is it to be in, say, a supermarket, touching all the items, breathing the same air as the largely unmasked other shoppers, if I have to pull off the mask to blow my nose every other minute, with hands that are likely contaminated?”Sheila from Nevada

A well-fitting, high-quality (N95, KN95 or KN94) mask, when worn properly and consistently, protects against covid and other respiratory diseases. It sounds as if your concern is that you constantly have to take off your mask to wipe your nose. I think the mask can still be protective if you take some additional precautions.

For instance, you should bring hand sanitizer with you and use it before wiping your nose or otherwise touching your nose, mouth or eyes. Bring your own tissues and throw them away after each use, then sanitize again before touching shared public items. You might need to repeat this process multiple times during the shopping trip.

Also, try to be in a part of the store that doesn’t have shoppers around you when you lower your mask. It also helps to go shopping during a time of day that is less busy.

Finally, you might consider discussing your rhinorrhea with your physician. Depending on the cause, there might be medicines you could take that could decrease the discomfort — and anxiety — from the runny nose.

“Are we still in a pandemic? Is it still recommended to test before gatherings?” — Susan from California

These are separate questions. I think there is a case to be made that we are no longer in the pandemic stage of covid-19, but that doesn’t mean we should forego precautions.

If you are vulnerable to severe outcomes from covid, you should consider asking others to test just before seeing you. Taking a rapid, at-home antigen test can catch asymptomatic covid. It won’t catch every case, but every precaution — including home testing and improving ventilation — can reduce the risk of contracting the coronavirus.

“Does covid-19 pose a greater risk to people diagnosed with atrial fibrillation?” — Jane from Connecticut

There are some studies that suggest patients with atrial fibrillation are at greater risk from covid-19. Researchers from Intermountain Healthcare in Salt Lake City found that people with this irregular heart rhythm were more likely to require hospitalization and intensive care. They are also more likely to suffer a major cardiovascular event compared with those who do not have atrial fibrillation. Another study, published in the European Heart Journal, found a similar association.

The more risk factors a person has, the higher their likelihood of severe disease from the coronavirus. If, for example, the heart rhythm abnormality were due to congestive heart failure, the risk would be higher than isolated atrial fibrillation. Those who have diabetes and cancer would also have higher risks.

The Post has also compiled Q&As from my previous newsletters. You can read them here.

A new study in the Journal of Clinical Oncology found that cancer screening rates are still below where they were pre-covid. Compared with 2019, screening rates for breast cancer in 2021 declined from nearly 60 percent to 57 percent. For cervical cancer, it fell from 45 percent to 39 percent, and for prostate cancer it fell from nearly 40 percent to 36 percent. These decreases were most significant among Asian patients, who saw breast cancer screenings fall 25 percent and prostate cancer testing drop in half. These alarming findings could translate to millions of people at increased risk of missed cancer diagnoses and potentially more advanced cancers.

There is more evidence that natural immunity affords protection from covid. A Lancet meta-analysis of 65 studies from 19 countries found that for at least 40 weeks, the risk of severe covid is about 90 percent lower among previously infected adults compared with their never-infected peers. “Although protection from reinfection from all variants wanes over time, our analysis of the available data suggests that the level of protection afforded by previous infection is at least as high, if not higher than that provided by two-dose vaccination using high-quality mRNA vaccines (Moderna and Pfizer/BioNTech),” the authors wrote.

A randomized controlled trial from Australia published in JAMA Pediatrics found that text message reminders to parents can increase influenza vaccine uptake. About 600 participants, all children with special-risk medical conditions, took part in the study. Nearly 39 percent of parents in the group who received text messages and had clinician reminders vaccinated their children; 26 percent in the group that was reminded by clinicians only did the same. A greater proportion of the group that received text messages also received the vaccine on time, during the optimal seasonable influenza period. “This is an important finding, given the critical importance of timely influenza vaccination for this group,” the authors wrote.

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