Last week, (while I was learning to play pickleball in the mountains) the CDC acknowledged what most people, by around summer of 2021, had concluded. The SARS-CoV-2 virus can be a merciless killer of the elderly and immunocompromised. Almost everyone else should behave as if they lived in Florida.
In short, the CDC is adopting the focused protections advocated by the Great Barrington Declaration and more than a few researchers and physicians who have been busy repairing their reputations after one helluva a grinding in the sausage maker of American politics.
The new guidance offers an unequivocal change in direction in several areas:
- Reduces the area of public health concern to "medically significant COVID disease," which is defined as severe acute illness and post-COVID conditions. The guidance further acknowledges that the risk for "medically significant illness increases with age, disability status, and underlying medical conditions." The rest of us need to sleep it off.
- Recognizes that medically significant disease can be reduced through immunity derived from vaccine and/or prior infection. The first mention I have found that rejects the theory of immunity long cherished by mothers around the world - prior infection - is a CNBC panel discussion in Nov. 2020 that included PFE's Albert Bourla and Bill Gates. This theory was adopted by Dr. Deborah Birx, as reported in her memoir, Silent Invasion. However, a repudiation of prior infection as sufficient protection has formed the basis for vaccine mandates.
- Encourages those at risk for medically significant COVID to stay up to date on vaccine, use pre-exposure prophylaxis like Evushield, and treat the condition with antivirals and monoclonal antibodies.
- Discourages broad asymptomatic testing and suggests a focus on people with symptoms or with known or suspected exposure. It does encourage asymptomatic testing in congregate living arrangements such as nursing homes. The new policy recognizes that testing everything with a pulse, as we have done for nearly 2 1/2 years, may not be cost effective. The money is running out and at some point insurance reimbursement for COVID will need to align with long standing policy to pay for tests that support the diagnosis and treatment not trips to the beach house.
- Recommends isolation only for those that are sick and only for 5-10 days.
In fairness - sort of - the COVID variants since Delta have done much less damage than the original wild strain that began circulating in 2019-20. Is that because the variants are less dangerous or immunity more prevalent? Hard to say without more research. The CDC has made little use of its sequencing appropriations leading some to speculate that Omicron, with all its letters and numbers may have gone unrecognized were it not for the massive testing performed.
The guidance, which is certain to be taken up slowly by states and institutions as the federal money dries up, is bad news for PFE and MRNA. The bull case that SARS-CoV-2 will always be circulating may be true but the public response to it looks like the seasonal flu. The future of their mRNA vaccine probably will probably be akin to annual flu shot with 38% uptake among people 18-49; 54% for 50-64 and 75% for people over 65.
Of course, that assumes no hard feelings for vaccine mandates, some adverse events, and emerging questions about immunity to other diseases.
The CDC's focus on the most at-risk appears to be a challenge to PFE's bull case for Paxlovid as well. The CEO is making good on his promise to promote the drug beyond the immunocompromised by running radio and television ads. Unfortunately, the CDC's guidance gives insurers a good reason to control the use of the drug, which may not be all that effective anyway.
Another step in the right direction for lovers of sound public health policy.
Emily Evans
Managing Director – Health Policy
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