Dr. Fauci says we should be ‘inching’ toward normality. So what’s next?

There's an old adage in public health about a village by a river.There's an old adage in public health about a village by a river.
Every few days, the story goes, villagers hear cries for help coming from the river and pull out people who are drowning. This cycle repeats itself, over and over. The village builds floats; it trains search and rescue teams. But as time passes, people continue to drown, and it feels like an impossible battle to win. Some people in the village start to say, ?We should just let them drown.? Arguments ensue, until one day they realize the drowning people are all coming from rapids upstream. When villagers put up a sign warning boaters about the rapids, boats stop capsizing ? and drowning passengers stop drifting down into the village.
Today, as we suffer through yet another Covid-19 variant surge, I wonder why we are still merely saving the drowning people, instead of also looking upstream.
Today, as we suffer through yet another Covid-19 variant surge, I wonder why we are still merely saving the drowning people, instead of also looking upstream.
Sure, doctors and researchers have created some great tools to help drowning Americans ? those who've already been infected by SARS-CoV-2. We now have rapid tests that can be used at home; oral and intravenous antivirals; monoclonal antibodies; and cutting-edge techniques to manage those who end up hospitalized, despite our best efforts. And vaccines and high-quality masks should help us reduce the risk of capsizing ? of getting infected with Covid in the first place.
But even if we're heading toward an endemic world, we're still thinking small when we should be thinking big. Here we are, a year later, still insisting that this is just a one-time surge and that the water will somehow stop flowing downstream.
So let's be clear: The time to plan is now.

 

As far as Michelle Wilson knew, she'd recovered from Covid-19.
Wilson, 65, contracted the virus in November 2020. Her illness, she said, was mild, and she was feeling ready to go back to work as a nurse in St. Louis by early December.
Full coverage of the Covid-19 pandemic
That's when her heart problems began.
"I literally woke up one morning, and my heart was racing and beating erratically," Wilson recalled. "I was having intense chest pain."
Fortunately, Wilson was not having a heart attack. But she did develop long-term heart problems, including high blood pressure, putting her at risk for further cardiovascular issues.
Despite her age, she had no prior medical history to suggest she was at risk for heart disease ? other than Covid-19.
Indeed, it appears the coronavirus can leave patients at risk for heart problems for at least one year following infection, according to one of the largest analyses of post-Covid health effects to date.
The study, published last week in Nature Medicine, found that the illness increased the possibility of heart rhythm irregularities, as well as potentially deadly blood clots in the legs and lungs, in the year after an acute infection.
Covid also increased the risk for heart failure by 72 percent, heart attack by 63 percent and stroke by 52 percent ? even among those, like Wilson, whose original illnesses were mild.
The study's lead author, Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, said he and his colleagues expected to see some elevation in heart problems following Covid, but assumed it would be limited largely to people whose health wasn't robust previously.
The elevated risk remained when researchers accounted for age and race, he said.
"It was a bit of a moment for us when we realized it was evident in all of these subgroups," Al-Aly said, "including younger adults, older adults, Black people, white people, people with obesity and those without."
"The risk was everywhere," he said.
Al-Aly's team examined the rates of new heart problems among 153,760 Covid patients for up to a year following their illness. The participants were patients who'd sought care within the Department of Veterans Affairs, and most were white men.
Cardiovascular outcomes were compared to two control groups: 5.6 million people without Covid, and another 5.9 million patients whose data was collected before the pandemic began.
Covid-19 patients in this study were infected before vaccines were available, so it is unclear how the shots might alter the findings.
But physicians on the front lines of treating Covid and its effects suspect vaccinations do cut heart risks because they reduce Covid infections in general.
"I've taken care of patients with heart problems" after Covid-19 infection, said Dr. Steve Nissen, a cardiologist at the Cleveland Clinic "The vast majority are unvaccinated."