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COVID’s Last Gasp

It is darkest before dawn. COVID is surging, particularly in the Northeast. Yet, it is not a wild-eyed prediction to say that this will be COVID’s last gasp. While the virus will be around for a long time, it will cease to be a serious threat.

Why? Because of vaccines and because of two relatively unheralded medical advances: the 89%-effective home-use Pfizer COVID self-treatment pill and the new at-home COVID rapid test.

Soon, when feeling the mildest initial symptoms, Americans will be able to test themselves at home, and, if positive, treat themselves by popping the Pfizer pill, which is highly effective if taken within the early days of COVID onset – including effectiveness against Omicron, according to initial analysis.

It is expected that the Pfizer pill will receive Emergency Use Authorization from the Food and Drug Administration by year’s end, at least for people at high risk.

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The rapid-result antigen tests, endearingly dubbed “RATs,” are already in use, except that the Biden Administration has them tangled up in convoluted distribution and cost-reimbursement schemes. RATs and the pill are just as important as vaccines and should be made just as widely available free of charge. The U.K. is distributing packages of 7 tests for free, and Singapore has mailed tests to every household.

Instead of embracing additional weapons against the virus, the Administration is obsessed with vaccines, which have already achieved a great deal and are almost universally available.

The CDC reports that 72% of all Americans have received at least one-shot and that roughly 15% (49 million) have contracted COVID and survived, for a combined total of 87% effective immunity (without accounting for overlap in people infected and later vaccinated). This suggests that we are approaching full herd immunity, with the exception primarily of young children who have virtually no risk of serious illness.

Ninety-five percent of extremely vulnerable elderly Americans have had one shot, 87% are fully vaccinated and 52% have been boosted. Since those over age 65 account for over 75% of COVID fatalities, these are the vaccine metrics that really count.

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The Administration’s exclusive focus on vaccines and its overreaching and unsuccessful attempts to impose vaccine mandates are counterproductive at best. Only someone living under a rock hasn’t heard the message about vaccines. The messaging has passed the point of diminishing returns: vaccine resisters are not being persuaded; more likely, they are being driven into stronger resistance.

This is not to downplay vaccines, nor to recommend going without the shot. Unvaccinated people run 14 times the risk of death compared to those vaccinated, according to CDC data. While Omicron appears to evade immunity both from vaccination and from prior infection more than prior variants, it is surely the case that the current wave involves predominantly unvaccinated people.

Yet, the exclusive focus on vaccines ignores RATs and the Pfizer pill, to which anti-vaxers might be more amenable, not to mention appreciated by vaccinated people worried about breakthrough infection.

Both the tests and the pill must be distributed widely and made available without charge. Finally, yesterday, the Administration announced a free-give-away policy for tests, but the FDA has been sitting on Pfizer’s application for EUA of its pill. Even then, the public must be educated, if this enormously promising combination is to realize its enormous potential.

The RATs detect the virus most reliably during its contagious phase, namely the three-to-five-day period of maximum contagiousness, mostly before symptoms fully manifest, according to a doctor and a data scientist writing in City Journal. They recommend constant vigilance and something like regular weekly use of RATs and use before attending populous gatherings to prevent super-spread events.

Similarly, the Pfizer pill is only effective if taken in the early days of infection/symptoms.

The new messaging needs both to educate and to inspire vigilance and immediate responsiveness. If people procrastinate – who doesn’t – the RATs-pill combination won’t be effective. The requirement of constant vigilance and proactivity is a major challenge for a COVID-weary populace. However, once the amazing benefits become manifest, the message and the required routines should become self-reinforcing. Nothing succeeds like success. Ironically, sometime thereafter, the public may embrace vaccines more universally as a more convenient one-and-done option relative to remaining on constant high alert.

The sooner public health messaging progresses from “Get Vaccinated” to “Get Vaccinated and Self-Test and Self-Treat” the better.

The Biden Administration needs to follow the science, which is not static as its vaccines-only policy implies. The science is highly dynamic. The Administration must adjust its COVID strategy in response to continuing medical advances. If it does, the current COVID wave should be COVID’s last gasp.

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