Dr. Nicole Saphier: COVID-19 and America – the state of emergency is over and it's time to declare it

On March 25, 2020 President Donald Trump declared a State of Emergency for the United States as New York City was reporting nearly 4,000 patients hospitalized with COVID-19, a number that doubled by the following week. 

On that day, NYC recorded approximately 20,000 new cases with close to 900 deaths occurring each day; totals, which seroprevalence studies have suggested, likely captured less than 25% of the true disease burden.

A week later, the Centers for Disease Control and Prevention (CDC) urged mask use by the public prompting state mask mandates and capacity restrictions to be implemented across the country.

After a year of some of the country’s strictest lockdown measures and prolonged restrictions, NYC now has a 7-day average of 825 new daily cases and roughly 25 COVID-related deaths per day, both numbers diminishing each week. 

CORONAVIRUS IN THE US: STATE-BY-STATE BREAKDOWN

Across the country, new cases, hospitalizations and deaths have dropped precipitously since early January as a massive vaccination campaign took hold. Now, over 59% of American adults have received at least one dose contributing to the immunity of the nation.

Reliable data confirm the vaccines not only protect against severe disease, but also offer protection from asymptomatic transmission and circulating global variants. There is no doubt that people in this group should be mask free in all settings unless they choose to wear one, as indicated in the updated CDC recommendations. 

However, the CDC continues to offer little guidance about the unvaccinated including those who have recovered from infection and young children.

The CDC and subsequent statements by President Biden, including a tweet he sent that declared, "Get vaccinated or wear a mask until you do" set a treacherous precedent by indicating that only the vaccinated among us can return to normal life; affirming the vaccine as the only means to eliminating the pandemic. 

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This neglects the true definition of herd immunity where once a sufficient amount of the population has immunity, as demonstrated by declining cases, hospitalizations and deaths (and not the number of people vaccinated) the entire community can resume activities with low risk of transmission. 

Our economy and our children can’t wait for the slow rollout of the CDC to acknowledge real world data about the severity of risk amongst the entire population, not just the vaccinated. 

The wall of protection from the amount of natural immunity has consistently been ignored. To date, the amount of reinfections following natural infection are similar if not less than breakthrough cases after vaccination, demonstrating the robustness of natural immunity.  

A study last month in The Lancet shows that people who recovered from a prior SARS-CoV-2 infection had an 84% lower risk of reinfection and a 93% lower risk of symptomatic infection. Some argue that this data only shows 7 months of follow up. They point out that how long the immunity lasts after infection remains unknown. But the same can be said of the COVID-19 vaccines, which also have limited long-term data. 

Prior SARS data suggest similar immune responses to SARS-CoV-2 and the vaccines as elicited by the original SARS coronavirus, which had lasting immunity of at least 2-3 years.  

Our economy and our children can’t wait for the slow rollout of the CDC to acknowledge real world data about the severity of risk amongst the entire population, not just the vaccinated. 

According to CDC data, the number of COVID-19 hospitalizations continues to fall by about 10% weekly, with a new low of less than 31,000 hospitalized; a number the country hasn’t seen since March 2020. With fewer hospitalizations it is not surprising that 54 states and territories are reporting less than 5 deaths per 100,000 daily with 9 states having reported 0 to 1 death last week. 

Johns Hopkins’ tracking shows that the United States has a percent positivity of 3.1%, the lowest it has been since the pandemic began. That’s within the "blue" risk level on the CDC website which represents a low risk of transmission.  

Even with the low risk level, some people worry that without requiring proof of vaccination an unvaccinated person can place the immunocompromised and children at risk by not wearing a mask but the same is true for any contagious illness. 

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The real goal is to achieve a previously acceptable level of risk when it comes to the health of the population. In California, there is currently a higher prevalence of active tuberculosis than COVID-19, yet the low incidence of the illness has not warranted routine mask wearing by the general public. 

In a similar vein, influenza and respiratory syncytial virus (RSV) have higher combined mortality rates in young children than SARS-CoV-2 and mask mandates haven’t been instituted to prevent those infections despite higher caseloads during peak seasons.

While the percent of positive cases has expectedly risen in children as more adults become vaccinated, the risk of severe illness resulting in hospitalization and death remain rare.  Of the states reporting, 0.00%-0.03% of all child COVID-19 cases result in death, with 306 pediatric deaths total nationwide.

As we exit the state of emergency, it is important that vaccine companies seek full FDA approval for vaccines in young children rather than extending it through the Emergency Use Authorization since the data does not reflect COVID-19 to be an emergency in young children. Nor are the current studies powered enough to ensure the vaccine immune response does not also lead to multisystem inflammatory system in children (MIS-C) -- a concern following infection. 

To date, 3742 cases of MIS-C have been documented out of the nearly 3.9 million confirmed SARS-CoV-2 infections in kids, reflecting a < 0.1% incidence. 

Moving forward, messages from public health entities and government leadership must be transparent and unambiguous regarding fluctuating community transmission and true risk level while continuing to encourage adults to get vaccinated. Continued vaccination efforts will further lessen the spread of the virus and prevent future variants from escaping existing immunity from evolving.

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At the current rate, the number hospitalized, and daily deaths will reach levels consistent with bad flu years by Memorial Day; a day which can also be known for "emaskipation."

The emergency is over. It is prudent now for our leaders and health officials to have less tunnel vision and to allow the country to return to pre-COVID activities, without mask mandates.  

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