The time has come for DIY mandates on covid

Here we are in the grip of yet another covid-19 surge, yet most people I see out and about are behaving as if the pandemic is over. And I live in Los Angeles County, whose public health department is arguably one of the most vigilant and proactive in the U.S.

We all have pandemic fatigue. Even people who should know better have let precautionary measures slide. If you are sensing a mea culpa on the way, I won't disappoint.

I confess I have been far less cautious over the past couple of months than I was early on. I have left home without a mask on a trip to the grocery or pharmacy, and instead of returning to get one, I've walked in unmasked, telling myself I'd be there for only a short time.

In June, I took a 12-hour trans-Atlantic flight on which virtually no passengers or crew members were masked. I wore my mask initially, a snug-fitting KN95. But after eating, I kinda sorta forgot to put it back on. In July, with covid clearly surging, I hosted a birthday party for my daughter without asking guests to test themselves before coming to the house.

And there's more where that came from.

Whether through luck or booster-bolstered immunity, I have managed to evade the virus. But worrisome reports about the BA.5 omicron subvariant — which has spread like a California wildfire, in part because it can circumvent some defenses afforded by vaccines and prior infections — have provided the head-butt I needed to shore up my behavior.

I didn't actually violate any rules in the situations I described above, because none were in place. Public mandates — such as masking and requiring that people be vaccinated to enter restaurants, gyms, and other indoor venues — have been so bitterly politicized that returning to them now, especially in an election year, would be like trying to cram a genie back in the bottle. I think many of us are coming to terms with a future in which keeping covid at bay will hinge on personal responsibility.

Most of California is in the high-risk covid transmission category, as determined by the Centers for Disease Control and Prevention. Yet even in pandemic-smacked L.A. County, reporting thousands of new infections a day and a double-digit rate of positive tests that is well into the danger zone, serious resistance emerged as health officials recently discussed — and ultimately shelved — a plan to reinstate a mask mandate. Multiple cities in the county, including Beverly Hills, Long Beach, and Pasadena, said they would not enforce it. Business owners openly questioned whether they would ask their employees to impose such a rule on unwilling and sometimes hostile patrons.

Kathryn Barger, a member of the county Board of Supervisors, wrote in an open letter to constituents that "masking mandates are polarizing and are unenforceable." A better way to go, she said, would be "trusting the public to make personal COVID-19 prevention decisions to keep themselves and their loved ones safe, promoting the efficacy of vaccines and boosters, and investing in equitable access to COVID-19 treatments."

Let's face it: Covid is with us for the foreseeable future, and we can only speculate about other variants that might blindside us down the road or how many times we can chance reinfection without risking lasting damage to our health. Given this inconvenient truth, now is an excellent time to adopt everyday habits that reduce our risk of contagion — and not just from covid.

"There will continue to be cases of covid-19 for decades and centuries, the same way there have been for influenza," says Dr. Saahir Khan, an infectious disease specialist at Keck Medicine of USC. In many Asian countries, he notes, there's a culture "where every winter when these viruses are circulating at a high level, people wear masks in public places. And I think that has to become part of the culture here."

The covid complacency that has overtaken so many of us is in large ways a credit to the vaccines and treatments that have sharply reduced the severity of illness from an infection. But the current vaccines have proved far less protective against infection itself, especially when faced with the evasive mechanisms exhibited by BA.5.

Shira Shafir, an associate professor of epidemiology at UCLA's Fielding School of Public Health, experienced that disconcerting reality firsthand. When I called to interview her for this column, she was at home with covid. Shafir's 70-year-old mother had been planning to visit from Arizona, so she and her husband opted to test themselves and their young son. Their son tested positive, and they told her mom not to come.

"My son had no symptoms," Shafir says. "We only tested him because my mother was coming to visit — and thank goodness we did, because otherwise my mother would have been exposed and in all certainty would have gotten infected."

The next day, Shafir tested positive, and the day after that, her husband did. Both she and her husband are boosted, and their son, who participated in a Pfizer vaccine trial for children under 5, has received three shots.

A starting point for developing your covid defensive strategy is determining how much transmission is happening in your community. If you are in an area of high prevalence, as more than 45% of U.S. counties were in late July, significant caution is warranted. An easy way to find out is by consulting this CDC webpage, which will show you which category your county is in. You can also follow your local health department on social media.

Another good measure is purely anecdotal: "If you know a lot of people right now who have covid, it means there's a lot of covid," Shafir says.

I know of at least 10 people, both friends and professional contacts, who have been infected in the past few weeks, all vaccinated and boosted. And that has set off the alarm bells I needed to reacquaint myself with basic safety measures.

Among them: Wear a mask in indoor public spaces and crowded outdoor ones. If you are at high risk of serious illness, avoid those places, and find alternatives such as curbside pickup and home delivery.

If you want to host a dinner party, ask guests to take a rapid home test before they come over. If you are taking an airplane, put on a mask the moment you enter the airport, and at a minimum keep it on until the plane is in the air and then again when you land.

If you test positive, follow these guidelines: Isolate from people for at least five days after your first symptoms or a positive test result. You can end isolation after the fifth day if you have a negative test, no fever, and your symptoms are improving.

If you are one of those people who don't worry about covid because you don't believe it will make you terribly sick, remember this: The course of the illness can still be highly unpredictable and includes some chance of ending up with long covid, which can leave you with brain fog, shortness of breath, and heart damage.

If you're not convinced by any of that, then at least have some consideration for neighbors, co-workers, and relatives who may be older and sicker than you.

"That is what concerns me," says USC's Khan. "I want to make sure society is doing its best to protect those people."

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Posted in: Healthcare News

Tags: Brain, Brain Fog, Children, Contagion, Coronavirus, covid-19, Efficacy, Epidemiology, Fatigue, Fever, Health Care, Heart, immunity, Influenza, Medicine, Omicron, Pandemic, Pharmacy, Public Health, Vaccine, Virus

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