By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Greenwich Health Dept.
Once again, for the 12 th time, the nation’s Secretary of Health and Human Services has met with public health officials about the status and consequences of America’s bout with the COVID-19. This broad government/public health review is being conducted every 90 days in order to determine if a continuation of our COVID-19 Public Health Emergency Declaration Status remains warranted. This latest review concluded that America is still in a pandemic state, and another continuance of the public health emergency declaration that was initially signed on 1-27-20 was enacted. Xavier Becerra, Secretary of Health and Human Services signed the declaration renewal on 1-11-23:
Many factors underlie that determination, such as the current number of cases, hospitalizations, and ICU admissions; the positivity rate, which should be below 5% before a community considers lifting restrictions (Dowdy & D’Souza, 2020), the nature and transmissibility of the circulating viral mutations, and the percent of the population that is vaccinated and boosted. National, regional, and local outbreak trends are important. The Secretary and other public health officials undoubtedly considered many COVID-19 impact areas including morbidity (illness), mortality (deaths), and quality of life (and death), along with resource utilization, and economic cost. They likely discussed how and to what extent vaccines, treatments and medications are being used, along with an assessment of the adequacy of essential healthcare personnel and other workers, medical equipment, preventive and therapeutic products, and supply availability. In considering the impact of such a devastating disease one considers not only our resources, but also who is and who is not willing to availing themselves of those resources, and why or why not.
In Connecticut and across the country we continue to have individuals as well as active, organized groups of COVID-deniers and vaccine-deniers, along with distributors of unintentional misinformation and those vociferously and intentionally engaged in disinformation campaigns about the pandemic itself, disputing the proven value of personal and community prevention measures, as well as around the safety and effectiveness of vaccines, treatments and therapeutics.
All of this jeopardizes the health, well-being and very lives of individuals, their children, and the many others in the midst of us who are most susceptible to SARS-CoV-2. These include children, the elderly and infirm, those with underlying health conditions, pregnant people, and those with compromised immune systems, the unvaccinated at any age, as well as people who fall prey to the purveyors of misinformation and disinformation. A clarion call has been made by scientists and professional communities for scientists and clinicians to educate themselves on the roots of the politicization of these pandemic-relevant issues, along with the factors that influence why some people are so receptive to embracing scientific misinformation (Bolson & Palm, 2022). These adverse factors have undoubtedly prolonged and continue to prolong our COVID-19 public health emergency status as well as impacting the health and well-being of our citizenry. All of this information supports the Secretary of Health and Human Services’ decision to renew the nation’s public health emergency status, which serves to remind people that we are still in the grips of a very real and quite deadly pandemic, which, by its very nature is a world-wide epidemic that could worsen at any point based on external circumstances.
Worldometer (1-18-23) shows the U. S. population to be at 334,805,269. America alone has had over 103.6 million COVID-19 cases since the pandemic began. We’ve lost 1,125,895 of those people, but on the positive side, 100,492,965 victims have survived. The U. S. is currently experiencing 1,498 COVID-19 deaths per day based on a 7-day moving average. Across the country we now have nearly 2 million active cases, and those are only the ones we know about. Of those, 4,335 people are described as being seriously or critically ill. Many more of all ages are being treated at home, and some of those are also very ill as contact tracers here in Town can tell you. Home-tested people are not represented in either state or national COVID-19 numbers; only those receiving positive laboratory tests are recorded.
Many COVID-19-exposed people never test despite being symptomatic, or possibly having only mild or no symptoms, yet all, when infected, remain highly contagious to those around them, especially our most vulnerable.
Worldometer-Connecticut revealed that that we’ve had 960,058 cases of COVID-19 since the pandemic was declared in January 2020. To date we have lost 11,864 of our friends, neighbors and loved ones, but the silver lining is that another 924,161 went on to recover; many of these recoverees, however are reporting that they are suffering with Long-COVID symptoms, which takes a heavy toll. The most recent CDC information (NIH, 2022) noted that 1 in 13 COVID-19-infected adult’s had symptoms exceeding 3 months or more after becoming ill, and that 20-25% of adult survivors, depending on their age, developed a health condition that appears related to their prior bout with COVID-19 (Levine, 2022). The American Medical Association stated that the cognitive health symptoms of Long-COVID patients has as great an impact on their cognitive health and quality of life as do those who suffer the long-term effects of traumatic brain injury (Hanson, et al, 2022). At this point we only have a 3-year lookback period for Long-COVID. Let’s see what greater time will show. At this time, our Connecticut COVID-19 death rate has been slowing down; we are currently experiencing 10 deaths a day based on a 7-day moving average and we’ve begun to see some days when no deaths occur. Today our Connecticut positivity rate was 12.31%; still more than two-and a-half-times the minimum advised level (5%) for a community to reduce its restrictions (Dowdy & D’Souza, 2022); however the public has tired of COVID-restrictions and those were lifted in Connecticut last February. Public Health now issues scientific and evidence-based guidance that can be taken or declined and our numbers indicate the impact of that approach. Few now use masks or exercise voluntary social separation, and, most unfortunately, we remain sub-optimal on vaccination and booster rates despite Connecticut not having had a positivity rate below 5 % since April 2022.
The CDC has now also reported that 7 of 8 Connecticut Counties are at HIGH-RISK of spreading COVID-19. The only Connecticut County exception is New London County; Fairfield County, where we live, is once again a high risk county. The CDC (CDC.gov) is recommending that people wear a mask at indoors at gatherings and avoid close contact with others. Please be careful, especially if you are health-compromised, immune compromised, elderly or very young, pregnant, or unvaccinated, or if you plan to be in contact with others who might be.
So what does this all mean and why does it matter? When a Public Health Emergency is declared, the government becomes empowered to enact policies that it would not be allowed to enact under non-emergency situations. A medical epidemic or pandemic constitutes such a circumstance. These actions are empowered under various legal authorities (HHS/ASPR/legal, 2023). The declaration of a national public health emergency also empowers States to take certain actions to address the cause, prevention of further spread, and the remediation of the emergency so as to protect the public and reduce the human and economic impact of that event on their state.
What, then, is the message to all of us? Protect yourselves and your loved ones because only you can do it! Get vaccinated and boosted. Wear a mask when needed, and stay socially separated especially when in indoor groupings. The decision to wear or not wear a mask is up to you, as is your decision about gathering in indoor groups, maintaining safe social distancing, handwashing and practicing safe respiratory hygiene measures. Stay home if you are sick and keep your children home if they are sick. Stay away from vulnerable others is you are sick or have been exposed to someone with COVID-19. These are easy ways to safeguard you, those you love, and others around you.
References
Bolsen, T. & Palm, R. (2022). Politicization and COVID-19 vaccine resistance in the U.S. Prog Mol Biol Transl Sci.;188(1):81-doi: 10.1016/bs.pmbts.2021.10.002. Epub 2021 Nov 10. PMID: 35168748; PMCID: PMC8577882. Retrieved from Politicization and COVID-19 vaccine resistance in the U.S. Dowdy D. & D’Souza, G.(2020) COVID-19
Hanson, S., Abafati, C., Aertz, J., et al. (2022). Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA; 328(16):1604-1615 doi:10.1001/jama.202.18931. Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021
Dowdy, D. & D’Souza, G. (2020). COVID-19 Testing: Understanding the “Percent Positive”. Johns Hopkins Bloomberg School of Public Health. Retrieved from COVID-19 Testing: Understanding the “Percent Positive”
Levine, H. (2022). Do I have Long COVID? Here’s how to tell. WebMD. Do I Have Long COVID? Here’s How to Tell
NIH. (2022). What Is Long COVID? National Institutes of Health/COVID-19 Research. Retrieved from Most Long COVID Cases Started With Mild Symptoms: Study
US-HSS. (2023). Renewal of Determination That a Public Health Emergency Exists. HSS.gov; Emergency Renewal of Determination That A Public Health Emergency Exists
US-HSS. (2023). Renewal of Determination That a Public Health Emergency Exists. HSS.gov; Administration for Strategic Preparedness and Response. Retrieved from Renewal of Determination that a Public Health Emergency Exists
US-HSS. (2023). Renewal of Determination That a Public Health Emergency Exists. HSS.gov; Administration for Strategic Preparedness and Response/Legal. Retrieved from Legal Authorities, Policies, and Strategies
US-HSS. (2023). Renewal of Determination That a Public Health Emergency Exists. HSS.gov; Emergency. Retrieved from Renewal of Determination That A Public Health Emergency Exists
Worldometer (2023). COVID-19 Coronavirus Pandemic. Worldometer; Connecticut. Retrieved from https://www.worldometers.info/coronavirus/usa/connecticut/
Worldometer (2023). COVID-19 Coronavirus Pandemic. Worldometer; USA. Retrieved from https://www.worldometers.info/coronavirus/