Covid never left, but it’s back in force again in Flagler and Florida, and is on pace to be raging locally and regionally in the next few weeks. 

The public health response, however, is vastly different than it was in the first two years of the pandemic, with a focus on a hands-off approach that leaves everything to personal choices and personal health conditions. There are no efforts or public health recommendations to reinstitute broad-based masking, social distancing or any types of lockdowns, whether in schools, nursing hoes or the workplace. 

Strong recommendations remain in place to get vaccinated, to get boosted, to keep freely available Covid testing kits at home, to immediately test following any sign of a cold, and to immediately take Pfizer’s antiviral medication Paxilovid if one tests positive. In sum, a vast array of safety measures, therapy and pills are freely available–if people choose to use them, and if they’re aware of them. Neither is necessarily the case, which is why cases are spiking likely more sharply than they  would otherwise do. 

The Covid spike is led by a new, still-more infectious Omicron variant. Cases are spiking in Flagler County as elsewhere in the state and the country, where some 100,000 cases a day are being recorded for the first time since February, with hospitalizations again rising and the White House warning of 100 million cases by fall and winter. Cases in Florida are up 75 percent over the past 14 days. They are up from 21 percent in Maine to 179 percent in Mississippi over the last two weeks, for a nationwide average of 52 percent. 

As of midnight last night, there were 206 recorded cases in Flagler County, up from 121 from last week. The number is not as accurate a representation of the actual community spread of the virus as it was in the first two years of the pandemic, when all testing took place at clinics, health departments, hospitals and other sites that reported their results to central databases. Now, most of the testing takes place at home. So health officials say a multiplier of three or four must be applied to the numbers that are reported by health agencies, making Flagler County’s current tally closer to 600 to 800 cases for the week. 

Hospitalizations are again rising. There are nine patients with a primary diagnosis of Covid at AdventHealth Palm Coast, but none in the intensive care unit. Hospitalizations are up 39 percent across Florida in the last 14 days, 31 percent across the nation. In mid-afternoon Friday, the News Service of Florida was reporting that Covid hospitalizations had jumped 24 percent in the past week after a nearly 20 percent increase the previous week, with a total of 1,941 inpatients who had Covid, up from 1,560 a week earlier and 1,303 two weeks earlier. ICU patients totaled 168, up from 103 two weeks earlier.

“The bunk that cases are not important is preposterous,” writes Eric Topol, a cardiologist, writer and researcher. “They are infections that beget more cases, they beget Long Covid, they beget sickness, hospitalizations and deaths. They are also the underpinning of new variants.”

There are no plans, recommendations or even discussions about curtailing public meetings and gatherings or public events like upcoming gatherings for Memorial Day weekend or July 4, though the holidays are expected to be accelerants of the new surge. “There’s no recommendation by the State Department of Health to restrict any of those activities,” Snyder said. 

But individuals may and should choose to take precautions, based on their profile: “elderly folks with comorbidities, chronic disease, nursing home patients, immunocompromised individuals, people who have symptoms should consider wearing a mask,” the health department director said. “That’s their personal choice, but that would be the preventive measure that that would be recommended. But that’s a personal decision.” 

The approach is reflective of a health department headed by a surgeon general who does not consider Covid to be a threat to be tackled or contained so much as accommodated or endured, so long as society’s parameters–the economy, education, tourism–are left intact. 

The approach is also reflective of the latest evolution of a response that has constantly been adapting to the changing nature of the virus and, most essentially, to the fact that two years of half measures or no measures have resulted in a high level of herd immunity, if at the catastrophic cost of 1 million deaths, millions more hospitalized at one point in the pandemic and nearly one in three Americans getting infected. Add the vaccines to the mix, and a form of herd immunity is in the 90 percent range, though “immunity” is a fluid term: it waxes and wanes based on a combination of an individual’s vaccination and booster status and whatever Covid mutation is circulating. 

“We’ve made a lot of changes, circumstances have changed,” Bickel said. “People really need to consider their individual health situation. You just can’t make a blanket recommendation anymore. So with that in mind, I would say the critical thing to think about is that more than 90 percent of the population has some immunity to Covid, but it’s basically partial immunity. And that’s affected by the variants, or if they had the vaccines, when they got vaccinated or infected.”

The virus remains as contagious as any virus. Bickel compares it to the infectiousness of measles or chickenpox before vaccines. It was once assumed that anyone born before 1957 had gotten measles. “And what does that say? That means everybody got it,” Bickel said. “If you didn’t get it, it was a rarity, it was so contagious. It spread around. It was almost basically impossible not to get it. That’s where we are with Covid.” 

So conditions are at a point where quarantines and isolation are no longer effective, especially with the high proportion of infected, asymptomatic people mingling with everyone else. And more especially: because vaccines and antiviral medication are making the fight more effective up front, before the disease makes its ravages and sends someone to an ICU. “It’s why hospitalization rates and death rates are way down,” Bickel said, “and this is why we have this huge disparity between cases and hospitalizations, and deaths, but it’s not keeping people from getting infected.” 

But Covid is the Sandy Koufax of viruses: it loves throwing curveballs. Those are the variants that, with each successive edition, lower the effectiveness of vaccines and raise the death tally of breakthrough infections. 

So the strategy is now group-specific: “if you look at who the people are who are getting the serious illness, it’s people who are immunosuppressed, people with comorbidities, that may have incomplete vaccination or have not been boosted, and we have people still unvaccinated, and some of them are infected. A lot of those are kids. We got a ton of hospitalized kids that people don’t even really realize, including over 1000 deaths, kids under 18. So we’ve got these different groups, and that’s why you know, you need to sort of understand which group you’re in.” 

Here are the groups and what measures people in each should take or be aware of:

The general population: Even for the healthy, the young and the middle-aged, there’s still a huge advantage to being vaccinated, because that’ll significantly diminish both the severity of Covid or changes of getting hospitalized, and the likelihood of long Covid, a debilitating condition that affects millions. “That’s like not wearing your seatbelt when you drive. Yeah, you might do just fine. But if you get in an accident, it’d be nice to have,” Bickel said. Boosters are also encouraged at around five months from the last vaccination shot. Vaccines have prevented an estimated 250,000 deaths, Bickel said. 

People with comorbidities, including being overweight: That group includes the vast majority of people over 40, who have such conditions as high blood pressure, heart conditions, are overweight. The same vaccine principles apply. “For those people, if you’re vaccine hesitant, you need to do some soul searching because honestly, the data is so overwhelming and your odds of getting very sick and dying are not insignificant,” Bickel said. 

The immunosuppressed, such as those who are undergoing cancer treatment–chemotherapy, radiation–or have other conditions that affect their immunity. They should not only get vaccinated and boosted, but also wear N-95 masks, avoid crowds and indoor spaces, including restaurants, and get Evusheld, the monoclonal-therapy-like antibody given prophylactically, meaning that it’s administered preventatively, before an individual gets Covid. For people in that group, Bickel said, “they should be extremely careful, they should assume that we are now throughout the country in a very high risk Covid transmission time period. They shouldn’t be complacent, think there’s not that much Covid out there. No, there’s a lot of Covid out there.” 

Nursing home residents: The operative word for nursing home residents, who are always in the high-risk category for Covid, is boosters. 

Children: get them vaccinated. True, most children do not get sick from Covid. “Is it true that children never get sick from Covid? No, it’s not true at all,” Bickel says. There’s been tens of thousands of children hospitalized, quite a few of them with no pre existing condition.  So it’s just like influenza, it kills children sometimes. And what’s the downside risk of getting a vaccine to a child, a Covid vaccine? It’s so close to zero. ” He notes, for example, that in 2021, there were just 21 cases of measles in the country–thanks to vaccines. So why not minimize Covid the same way for children?

Then there are broader strategies for everyone. Now with the availability of home-testing, people should get tested with any flu-like or cold-like symptoms, and do it again a day or two later. If you’re positive, then it’s time for Paxilovid, acquired by prescription and freely available at pharmacies. The five-day regimen (10 tablets, twice a day) quickly and effectively reduces and eliminates Covid symptoms for most. There may be issues with the drug for some people, but 99 percent of patients will be eligible for it, Bickel said. 

None of those new strategies mean that previous strategies were pointless, the doctor stresses. Science is not dogmatic. It’s adaptable by necessity. Covid has been an unpredictable, shifty, sneaky virus, and continues to be. The response has had to be calibrated accordingly, while also contending with political cross-currents that have had the same consequences of yet another unpredictable mutation. 

“Circumstances change, and there is an optimal strategy or a range of optimal reasonable strategies for each situation, and it’s not a one size fits all. It’s just not,” Bickel said. “So if your instrument is that blunt, then it’s probably you’re just being ideologically driven. And to me, there are these people who’ve taken stands on Covid from the beginning, the libertarian stance or whatever. They had to assume that Covid was not that bad, so that everything that came up after that was: it’s a hoax, it’s exaggerated, people are dying with Covid not from Covid, hospitalization data are fake. It’s like because they already came to their conclusions, they couldn’t admit any fact that would disprove it.” Not that there was unanimity among experts. But that’s the nature of scientific inquiry, which defies dogmas and invites doubt, opting instead for reasoned consensus–the one response that was generally absent throughout the pandemic, at leats nationally. 

“We had all these battles out in public and they just kept paralyzing response,” Bickel said. “It’d be one extreme than the other extreme, or one state would do it one way and another, another. All those complaints and concerns are valid. They just never were balanced out. I don’t disagree with DeSantis’s point about freedom and all that. It’s just he took it to such an extreme and then it became a partisan thing, a stance that you wouldn’t change from, like this idea that the economy is a trade-off with the health of the country. There’s almost no economic data to support that. Actually the data more supports the opposite.” 

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