Nebraska infectious disease authority predicts rough fall ahead ‘living with COVID’

LINCOLN, Neb. (Nebraska Examiner) – Americans could be in for a pandemic jolt this fall when it comes to COVID-19, with the nation less willing and less prepared to repel the highly contagious virus, according to a national authority on pandemics.

By mid-August, fewer than 15% of U.S. citizens will have gotten a vaccination in the last six months, said Dr. James Lawler of the Global Center for Health Security at the University of Nebraska Medical Center. That figure was about 55% a year ago.

The general abandonment of precautionary measures like wearing face masks and avoiding big crowds, plus the lack of vaccine protection, will make the nation more vulnerable to another surge of infections this fall, Lawler said.

‘Let ‘er rip’

“Living with COVID? Maybe that’s a strategy, but it’s like living with your house on fire,” he said.

“We’ve kind of adopted the ‘let ‘er rip’ strategy, and that’s probably not going to serve us well,” he said.

The Nebraska Examiner recently interviewed the infectious disease authority to learn more about where we stand with the COVID-19 pandemic, and what we’ve learned in the nearly 2 ½ years since it arrived in the state.

The interview comes as schools – considered prime breeding ground for transmission of the coronavirus – reopen for fall classes, and the football-loving Cornhusker State gets ready to crowd into Memorial Stadium for games.

What have we learned?

  1. This is not the flu.

COVID-19 was the third-leading cause of death in the U.S. in 2021, which Lawler labeled “incredible.” The average life expectancy in the country has fallen the past two years, from 78.8 years in 2019 to 76.6 years in 2021.

With about 480 people a day dying from COVID-19 right now, that would translate into 175,000 deaths in 2022. That, Lawler said, is five times as many deaths caused yearly by the flu, which is between 33,000 and 35,000.

  1. The ever-changing variants of COVID-19 make it difficult to combat.

We’ve seen the Alpha, Beta, Delta, and Omicron variants since the first COVID-19 cases arrived. Lawler said that once science gets good data on one variant, the virus changes. Now, the nation is dealing with the BA.5, an even more contagious variant.

“It’s still a pretty new disease,” he said. “We’ve had the luxury of studying other diseases for decades or centuries … you have to make decisions before you have perfect information.”

  1. Data shows that vaccines, when they’re up to date, prevent severe illness and hospitalizations.

Vaccines, Lawler said, have saved an estimated 20 million lives worldwide, and 2 million in the U.S.

“But you need to stay up to date, you need to be boosted to keep your immunization at an adequate level,” he said.

A recent Centers for Disease Control report on more than 100,000 vaccinated and unvaccinated people in 10 states showed that those with three shots, with the latest shot within 120 days, had 84% protection from the BA.1 Omicron variant against hospitalization or visits to the emergency room. The rate of protection was lower, 56%, against serious illness from the BA.2/BA.2.12.1 variant. Data for the BA.5 variant is not yet available.

The rate of protection is “not as high as we’d like it to be,” Lawler said, but it still makes a big impact.

The study showed that protection starts to wane after four or five months, he said, so it’s vital that people are “up to date” on their vaccinations, including getting recommended booster shots.

  1. We’re not just talking about avoiding death and hospitalization.

Studies indicated that between 5% and 35% of those infected get “long COVID” symptoms, Lawler said.

But beyond that, there’s evidence that getting COVID, even milder cases, can lead to other long-standing health issues later, such as new onset diabetes, heart disease, blood clots, kidney disease and even mental health disorders.

“We have potentially overemphasized hospitalization and death as the only significant consequences and that’s not true,” Lawler said.

Hospitals are already full, he said.

“We are saddling society and our health system with all of these additional burdens, and we’re doing very little right now to prevent it,” Lawler said.

  1. Masking, distancing, and avoiding crowds works.

The death rate from COVID-19 is 12 times lower in Japan than in the U.S., Lawler said. That’s because the Japanese pushed a “Three Cs” public health campaign – avoid close contact, closed spaces and crowds. The success in Japan came even though the country had later access to vaccines, he said.

“They had buy-in,” Lawler said.

“We know what works. We just have to commit to doing it.”

  1. So, can we go to a Husker football game?

Outdoor events are safer than indoor events, especially indoor events in confined spaces or with poor ventilation, Lawler said. But your risks rise when you’re talking with someone face-to-face, or singing or shouting together – thus transmitting the droplets that carry the virus.

“Honestly, I would recommend that people going to the game wear face masks. You’re going to have people yelling, hooting and hollering,” he said. “But it’s a lot lower risk than going to the bar afterwards.”

“If you’re going to have a party, have it outdoors,” Lawler said.

  1. What about schools?

Classrooms are prime locations for transmission of the virus – with 25 kids sitting together in a room for seven hours, he said.

“The myth that kids don’t get infected by COVID has thankfully been disproven,” Lawler said. He added that “just about” every kid in the country was infected during the past school year.

Masking all kids in a classroom would dramatically reduce transmission, he said.

8. So what’s the bottom line?

We kind of threw all of our hopes on the vaccine, and hoping that enough people got vaccinated and enough people got infected that you’d create immunity, Lawler said. But that hasn’t happened.

As of Aug. 3, 64.8% of Nebraskans were considered “fully vaccinated” by the Centers for Disease Control, with at least two shots of vaccine (a definition that Lawler believes is too lenient). That compares to a national rate of 67.8%.

Fewer people are wearing masks and avoiding crowds than a year ago, Lawler said. Meanwhile, he said, the state is seeing the highest rate of infections since the first Omicron variants peaked in January.

The low vaccination rates and lack of other precautions have created a “Maginot Line,” according to Lawler, in which the virus, like the Nazi army in World War II, simply went around the protective barrier.

Nebraska, he said, has done a pretty good job of getting the most vulnerable populations vaccinated. But with the rates of serious disease and deaths rising in those under 50 and among children, getting the necessary shots is even more important now for those groups.

Lawler said that, above all, Nebraskans need to make sure their vaccinations are up to date – protection begins to wane after four or five months.

In addition, he said, reduce risks by taking preventive measures like wearing face masks in public and avoiding crowds, close contact and confined spaces.

“If we can do those four things and get everyone up to date with the vaccinations, we can do a lot to reduce transmission,” Lawler said.

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