Dear Residents:
In response to continuing requests, Lawrence resident Dr. Marc Sicklick has provided an update on the current status of the COVID situation as well as an outlook on vaccines and any future courses of action.
The Village appreciates his insights and willingness to be of service, and trusts you find the following information of interest and value.
Very truly yours,
Alex H. Edelman
Mayor
Marc J. Sicklick, M.D.
—
October 19, 2021
FROM PANDEMIC TO ENDEMIC
At some point, realistically more likely sooner than later but not yet, the COVID pandemic will become endemic. That means that it will cease to be worldwide and will be localized to pockets of those most vulnerable. The world will co-exist with this virus, just as it does with a multitude of other viruses. The virus will not be wiped out. The world will not be wiped out. Society will decide on an acceptable mortality and morbidity rate and then fully reopen.
Some combination of vaccines and infections will reduce the at risk pool. Newer medical therapies will be developed for those who get sick. We will move on.
STATE OF VACCINES:
I have been firmly convinced from the beginning that all vaccines need (at least) a third dose, an additional delayed shot, 6 or more months after the second dose, in order to properly prime the immune system. The Israeli data clearly shows this and also shows the drop off in immunity without it. Their data is from both laboratory studies and clinical outcomes. The CDC and other government agencies know this The timing of full availability is still uncertain. This need is NOT a failure of the vaccine. It is how the vaccine was always required to be administered and presented. Older, commonly accepted vaccines that are on the market for both children and adult immunizations have also required several doses in order to reach adequate immunity. This has never been misconstrued as vaccine failure.
Whether those who received the Johnson and Johnson should get another dose of the J and J as a booster or should get a Pfizer or Moderna as the booster dose is being evaluated and should be discussed with your doctor.
Israel no longer considers someone to be considered fully immunized if the two doses of the original priming shots were greater than 6 months ago. That seems to be correct.
Many of us are seeing patients who are 6 months or more after their second dose and who now have mild or moderate COVID. Fortunately, the protection against severe COVID and death seems to be holding up for most of the immunized.
The anti-vaxxers, at this point, can not and will not change their minds. They are entrenched in their position and convinced that, whatever their reason is, they are correct. So until they get natural immunity by infection, hopefully with no more than mild illness, those of us who want protection for ourselves and our friends and families need the third dose. A third of those who are eligible for the vaccines have not been fully immunized, and will likely not be getting the vaccine. The purpose of immunization is now about protecting yourself, not about herd immunity.
Vaccinated people can still get and transmit COVID. But the odds on suffering severe illness, based on Israeli data, drop eleven fold after full immunization. The goal of the vaccine is NOT to prevent infection. It’s to prevent serious illness and death. The fact that the vaccinated get infected does not mean that the vaccine doesn’t work. The fact that these people have a very reduced chance of severe disease and death does mean that the vaccines work.
WHERE ARE WE HEADED?
Those who are susceptible will continue to catch and spread COVID. The numbers of daily infections in New York State are projected to triple by January 1, as will deaths. We will peak close to last January’s peak, but nowhere near the spring of 2020.
This projection will only change with more people either getting fully vaccinated or truly infected.
I am hopeful that the 5-12 age group will soon have access to a pediatric dose of the Pfizer vaccine. This will further reduce the vulnerable population and will reduce the need for quarantines.
MONOCLONAL ANTIBODIES:
These have been life saving. The federal government is now buying up these medications and will control distribution. They want to make sure that it is fairly distributed according to their definition of fair and according to their agenda.
ANTI-VIRALS:
These have been used in health care settings. Merck has applied for emergency approval for an oral antiviral agent, molnupiravir, which can be taken at home and seems to cut illness and death by 50%. This can be a game changer. I am hopeful, but we need to see larger numbers. I do not expect the FDA to approve this until December.
It will be interesting to see if those who refuse the vaccine because of the “unknown” future effects, despite over a billion doses already having been administered, will take this new medication and not worry about its unknown future effects.
NORMAL:
Compare life in the spring of 2020 to now and we are already pretty normal.
The only shortages are those caused by a lack of workers in the production and delivery systems. Stores are open. Entertainment venues have reopened. We’ve stopped praying that our banks will be open. Some have stopped praying altogether. Cleansing agents and toilet paper are on store shelves. Schools are open. Politicians aren’t shutting down jobs.
It will be even better once more people worry about other people.
People with “colds” still go to groups and expose everyone else. I see people not isolating and not quarantining who should be. Many do worry and follow the rules, but too many don’t. Add this to the 40% or so locally that are not fully vaccinated and add those with waning immunity and I don’t have the expectation that COVID will disappear.
So the real answer is that we are already in the new normal. People will make personal decisions based on what they want and most will not significantly inconvenience themselves for the abstract concept of the greater good.
The positive is that we have made tremendous progress in the last eighteen months and will continue to do so as we preserve life, improve it and live it.
Sincerely yours,
Marc J. Sicklick, M.D.
