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Ask Dr. Halverson: Life can be better, but not back to normal in the next year

web 4 17 Halverson photo
By Dr. Jim Halverson
Many medical experts are now advising us that COVID-19 will have a significant impact on our lives well into 2021. Acceptance of this reality will allow us to prepare to take steps to better live with this pandemic. Let’s look at some of the facts that will make the pandemic continue for at least another year.
    1. COVID-19 numbers are not decreasing significantly nationwide. We are continuing to average nearly 45,000 cases per day. As we enter the colder months, many parts of the country are likely to have increasing cases as outdoor activities decrease and maintaining social distancing  becomes more difficult. This will lead to a greater viral presence and further delay reopening safely in many areas of the country. When vaccines become available, it will take longer for immunity to “catch up” with viral spread and get case rates to the low levels required to reopen our businesses and schools, and to resume many social and recreational activities.
    2. Vaccines, the ultimate answer to ending the pandemic, will not be a rapid game changer. Approval of the current vaccines in phase 3 trials is likely still two to four months away. Following approval, distribution and administration of the anticipated 160 million to 200 million vaccines will take at least two to three months as individuals will be prioritized for receiving the vaccine. Additionally, two of the current vaccines that are farthest along in trials require a booster shot one month later for full effectiveness. This will require administration of up to another 200 million vaccines. 
    3. Even when people have been immunized, current formulas show that vaccines must be at least effective in 75% of the people who receive it and that at least two-thirds of our population needs to take the vaccine to achieve herd immunity to effectively stop the spread of COVID-19. Current polls indicate that less than that percentage of people will take the vaccine when it is first available. Hopefully, more people will get immunized as the vaccine effectiveness and safety continues to be demonstrated. 
    4. As immunity grows in our nation, case numbers will slowly drop. We will still all be required to continue social distancing, wear masks and follow proper hygiene during this time as all of us will have individual immune responses. It will simply not be possible for all of us to have tests to measure our immune response and whether or not we have enough neutralizing antibodies to protect us against significant exposure. As cases decline, we will gradually process through the four tiers of reopening as per California guidelines, a process that takes a minimum of 11 weeks.
Adding up all of the time required to go through all of these steps, it is obvious that it will be at least six months from the time that vaccine administration begins before Ventura County can reach Tier 4, the most permissive of all the tiers. Significant restrictions still exist at that level (see California’s 4-Tier COVID-19 Reopening Guidelines) so it will be even longer before we arrive at our “new normal.”
Hope
Accepting the reality of this pandemic and the time it will take to get it under control helps us to move forward and find ways to improve our lives in the year ahead. Here are several reasons for optimism.
    1. Rapid testing
 Molecular tests are the gold standard for detecting the SARS-COV-2 virus. They detect viral genetic material in a sample collected from the nose or mouth. Point-of-care tests (where samples are collected at testing centers or health care facilities) are now available that can provide test results within an hour. In addition, several at-home tests (where you collect the sample at home and send it in for testing) have been FDA approved. Results are usually available in two to four days.
Antigen tests, which also detect the virus in oral or nasal samples in as little as 15 minutes, are also available at many sites. These are considered nearly as accurate as molecular tests. The U.S. government recently awarded a contract to deploy 150 million antigen tests that can be used in schools and in special-need populations such as nursing homes and correctional facilities.
School reopenings will be much safer when rapid testing is combined with social distancing, the wearing of masks and proper hygiene. In addition, many major sporting activities such as professional and college football, basketball and baseball are taking place due to rapid testing. High school sports should also be able to begin as scheduled in California at the start of 2021.
Airline travel, although still discouraged except for essential reasons, should also be safer. Hawaii has announced that beginning Oct. 15, 14-day quarantines can be waived if visitors have a negative test within 72 hours prior to arrival. Other destinations are likely to follow. Of course, it is very important that you are aware of the status of COVID-19 in the area you are traveling to and follow the guidelines of that area.
Remember that a negative test simply makes it very likely that you do not have enough virus to detect at the time of the test. If you are concerned about a possible exposure, continue to follow the 14-day quarantine guidelines from the Centers for Disease Control. 
    2. Improving communication from state and local authorities.
Halloween is a very good example. Many are disappointed that trick-or-treating has been highly discouraged by public health officials. However, suggestions for safe activities to celebrate that day are available on the Ventura County Public Health website. When this pandemic started, state and local health officials were struggling to catch up with the rapidly spreading virus. Now, they can help give us guidelines on how to plan for safe and enjoyable activities during the coming months.
    3. Ojai Valley compliance and results
We continue to benefit from very good compliance with guidelines in our Ojai Valley. Large gatherings are not occurring, masks are being properly worn and social-distancing guidelines are generally being followed. We have one of the lowest case rates in Ventura County for COVID-19. I encourage you to express your gratitude and appreciation to all who are helping to keep you safer.
Conclusion
While the approval and administration of a vaccine will significantly increase immunity to the coronavirus, it will still take time to achieve at least the 60% to 70%  immunity to stop the spread of the virus. Social-distancing guidelines will continue for all of us until this pandemic ends. This is a marathon, not a sprint. Both, though, require continuing to run and stay on the course.
Stay committed, stay properly informed, stay safe and stay well.

 

— Dr. Jim Halverson is a longtime Ojai physician who writes a weekly column on COVID-19 for the Ojai Valley News.

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