Dr. Marc Sicklick: New CDC Guidance, Projections, Vaccines, Projections & More

Dear Residents:

In response to the continuing inquiries related to the Covid crisis, vaccines, precautions and protocols, the Village has asked immunologist Dr. Marc Sicklick to offer his views and guidance. We appreciate his efforts and trust everyone remain safe and vigilant.

With every good wish for the holiday season.

Very truly yours,

Alex H. Edelman
Mayor

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Marc J. Sicklick, M.D.
Allergy, Asthma, and Immunology

March 16, 2021

A year has passed! Where are we today? What have we learned? Where are we going?

The first thing that I want to say is that we are better off now than we were last spring. We know more. We have more weapons with which to treat. We’ve not just learned what we can do, but we’ve learned what we should not do. Most importantly, the absolute terror that we all felt last spring that controlled every moment of our lives has been replaced with fatigue. Fatigue is better than terror. Hopefully, this too will pass.

This is my overall theme. Things are getting better.

NEW CDC GUIDANCE

First of all, what are the new CDC rules for those who are fully immunized? (Fully immunized means two weeks after the second Moderna or Pfizer shot or two weeks after the one Johnson and Johnson shot)

Fully immunized people can go indoors with other fully immunized people without masks and distancing. They can also go into a single household of unimmunized people as long as the unimmunized people are not high risk. They also do not have to quarantine or swab following an exposure to a positive person as long as that person has no symptoms.

Is this new guidance a reason to celebrate?

I don’t know.

Are these new guidelines based on pure science, or is it a move to allow what people are already doing and by allowing it, to appear like they’re leading?

I don’t know.

My personal feeling is that your own common sense goes a long way. Use it. If it sounds risky, it probably is. Vaccines do help cut the risk significantly and we all need normalcy. I just don’t know what the variant virus mutations will mean to the vaccine protection in the long term.

WHAT HAVE WE LEARNED?

We have moved a tremendous distance in one year. Nothing astonishes me more than the accomplishments of Operation Warp Speed. Having a vaccine not just created, but actually placed into arms, in under a year is still beyond my comprehension. I optimistically thought that it would take 12-24 months for a vaccine that would cut the risk in half. The best decision made was to produce the vaccine in large numbers BEFORE it was approved, risking money to potentially benefit life.

We’ve also learned completely new approaches in treatments. We use steroids, anti-virals, anti-white blood medications, etc. Newer anti-virals are now in trials. There are also oral agents (pills) that are in early stages of trial.

We’ve learned that most people do well, but a small number do horribly. We’ve learned that we can predict high risk groups, but not always high risk individuals and we’ve learned that modern medicine can’t always outsmart death.

We’ve learned that destroying the economy doesn’t destroy a disease.

We’ve learned that we can close schools and deprive children of both socialization skills and an education without changing disease progression.

And, most of all, we’ve learned that we can’t predict or fully control the future.

VACCINES:

As more and more people are finally getting vaccinated despite a poorly run state distribution system that is both unfathomable and unusable to the vulnerable elderly, we are heading towards a return to more normal times. Our goal should be to vaccinate everyone willing to be vaccinated NOW, as quickly as vaccines are available, to get their shots as soon as possible, and not segregate people by artificial categories- such as age, risk, union membership, local voting patterns, zip codes, city limits, ethnic background, religion, or any other category that politicians can think of. We are ALL at risk, and every vaccinated person lowers the risk for ALL of us. We’re ALL in this together. We ALL need each other to be healthy. That’s how you get herd immunity.

Other states have heard the message and seen reality. They have removed the artificial categories and are using age as the only criteria. Some plan to be open to all, down to age 16, soon. Alaska is there now. As we’ve read in the newspapers, Israel is also down to age 16. They are moving towards age 12 soon.

The Johnson and Johnson vaccine release will be a game changer since it will increase the total number of doses available and it only requires one dose. For now. I didn’t understand the multi-week delay that it faced after the data was submitted and still don’t. Waiting on perfect data before releasing new vaccines for emergency use, vaccines that have been in use in other countries, while people die and suffer because politicians are afraid to make a non-perfect decision is analogous to your doctor seeing you when you’re sick and telling you he will prescribe the perfect medication for your illness after he or she gets the autopsy results. We need the newer vaccines now.

We need to move on as quickly as possible using the best guesstimates possible. Lives shouldn’t be lost waiting for perfection.

Aside from the one dose J and J (which further data may or may not show will do better with a future second dose), Pfizer is looking to see if a third dose of their current two dose vaccine will increase success against the newer variants. Moderna is looking to see if fine tuning their current vaccine against the newer strains is needed. Other vaccines are on the way.

PROJECTIONS:

The projected infection and death rates are on an overall downward slope. This is good news. I think this reflects both more mask wearing and more vaccinations, although the newer strains are a significant unknown. So are the new guidelines for unmasking.

The race is between virus mutation and getting the vaccines out to as many people as possible as quickly as possible.

I am cautiously optimistic. I expect a downward slope with occasional plateaus. We are currently plateaued at a level that is too high for comfort and the R number, the number that reflects whether or not people are currently spreading the virus to more than one person and is therefore a measure of virus containment, is locally over 1. That means it is spreading.

RISK FACTORS:

The disturbing news is that younger people seem to be more vulnerable to the newer strains. There are previously healthy teens and younger adults with no underlying medical issues who are reported to have developed multisystem disease. Pregnant women seem to have worse outcomes. There have been reports of fetal demise because of covid during pregnancy. All of these point to the need for continued caution.

The co-morbidities that are most linked to the largest numbers of bad outcomes are obesity, hypertension, diabetes, and heart failure. Combinations of two or more of these are worse. It is really important that all of these be addressed before illness happens. It is better to not be in the high risk priority group.

A recent study of 587,000 people showed that asthma is not linked to higher risk of getting covid and not linked to a higher risk of death from covid. This has been the experience of most asthma experts from the beginning.

WHERE ARE WE GOING?

So where do I think we are? What’s my bottom line. We will be living our new normal life by this time next year, hopefully well before. Society will decide what level of risk is acceptable and will set the standards.

It won’t be politicians setting the risk standard. People vote with their actions and my impression is that most do not want to lock themselves in a cocoon any longer. We all need to hear the real scientific data in order to make our own decisions based on science and not on wishful thinking and/or political motives.

Sincerely yours,

Marc J. Sicklick, M.D.