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Protecting the Vulnerable – The New York Times

Protecting the Vulnerable The New York Times


With the Omicron wave receding, many places are starting to remove at least some of their remaining pandemic restrictions.

This shift could have large benefits. It could reduce the isolation and disruption that have contributed to a long list of societal ills, like rising mental-health problems, drug overdoses, violent crime and, as Substack’s Matthew Yglesias has written, “all kinds of bad behavior.”

But the removal of restrictions has downsides, too. Millions of Americans remain vulnerable to Covid. The largest group of the vulnerable, by far, is the unvaccinated, who have the ability to protect themselves and have chosen not to.

Another group of people, however, have done what they can to stay healthy — by getting vaccinated — and yet remain vulnerable. They include the elderly and people with immunodeficiencies that put them at greater Covid risk. According to the C.D.C., more than 75 percent of vaccinated people who have died from Covid had at least four medical risk factors.

Today’s newsletter focuses on five steps that can help protect the vulnerable as society moves back toward normal.

At this point in the pandemic, there is a strong argument that a targeted approach — lifting restrictions while taking specific measures to protect the vulnerable — can maximize public health. The right approach, Jennifer Nuzzo, an epidemiologist at Johns Hopkins University, told me, involves “moving away from broad, blunt tools to more precision tools.”

The public conversation often misses this middle ground. It can sometimes seem to be a debate between doing everything to slow the spread of Covid and doing nothing, said Katelyn Jetelina of the University of Texas, who writes a helpful newsletter about public health. In truth, she said, “There has to be a balance.”

I want to start by emphasizing the importance of the vaccines, including the booster shots. Consider this chart, based on C.D.C. data:

Yes, some Americans remain so opposed to a Covid vaccination that there is little chance of persuading them. But others may still choose to receive shots if they are readily available. Booster shots are vital, too, to overcome waning protection. Boosters are especially important for the vulnerable vaccinated — the elderly and immunocompromised.

“Vaccination is the most valuable intervention we can do,” William Hanage, an infectious-disease expert at Harvard, told me.

For the vulnerable vaccinated, the best approach is what epidemiologists calls “the Swiss cheese model.” It’s a multifaceted approach in which each strategy, including vaccines, has holes. But when the strategies are layered on top of one another, the holes tend to disappear.

One such layer is masking with an N95 or KN95 medical mask, even if others are maskless. “One-way masking works,” as Olga Khazan of The Atlantic has written.

Joseph Allen of Harvard has argued that somebody wearing an N95 mask and talking to an unmasked person is at less risk than somebody who’s wearing a standard surgical mask and talking to another person wearing a standard mask. “Let’s dispense with the notion that masks are only protective if everyone is wearing them,” Allen wrote in The Washington Post.

Here’s a Wirecutter guide to buying N95 and KN95 masks, and here’s how to spot a fake.

In December, the F.D.A. authorized a drug called Evusheld, made by AstraZeneca. It is designed to be an additional layer of protection on top of the vaccines, to prevent Covid in immunocompromised people.

The Biden administration has bought 1.7 million doses, which is not enough to protect every American who could benefit but is significant. A larger immediate problem is confusion around the distribution. Many people don’t know Evusheld exists or don’t know how to find out if they’re eligible and how to get a shot.

Rob Relyea, an engineer at Microsoft whose wife has cancer, has created an online resource, in the absence of information from official sources. The country needs a “better communication plan around Evusheld,” Relyea tweeted. “Each hospital should proactively reach out to immunocompromised patients.”

The confusion around Evusheld is another example of how the fragmented U.S. health care system harms people.

One piece of recent good news is the increased availability of rapid Covid tests, at drugstores and elsewhere.

Rapid tests are an important tool for allowing the elderly and immunocompromised to socialize confidently with friends and family. Stefanie Friedhoff of Brown University’s School of Public Health has written about a friend of hers who leaves a batch of tests in her hallway for people to take before they visit her husband, who has Parkinson’s disease.

Rapid tests can also help vulnerable people find out when they have contracted Covid — and quickly begin a treatment to reduce its severity. “Time is critical, as close to symptom onset as possible,” Dr. Paul Sax of Brigham and Women’s Hospital in Boston notes.

Although some post-infection treatments no longer work against Omicron, others, like remdesivir, seem to. The most effective treatment may be Paxlovid, a Pfizer drug designed to fight Covid.

Unfortunately, these treatments can also be difficult to locate. My colleague Rebecca Robbins has written about her maddening search to find one for her mother, who’s 73 and has had cancer. Rebecca had to locate Paxlovid herself, at a Rite Aid 60 miles from her mother’s home, and hire an Uber driver to pick it up.

The supply of Paxlovid, in both the U.S. and other countries, will expand rapidly in coming months, which should help. Yet some of the logistical hurdles will surely remain. (Related, from Times Opinion: “Covid drugs may work well, but our health system doesn’t.”)

Vulnerable people — and their families — can take some big steps to protect themselves, including high-quality masks and rapid tests. But government agencies, hospitals and doctor’s offices can also play a crucial role, helping people locate potentially lifesaving treatments. “It’s incumbent upon policymakers to give people the tools to do that,” Dr. Scott Gottlieb, a former F.D.A. commissioner, said on CBS yesterday.

One final point: Some of these issues are not unique to Covid. The flu, for example, kills more than 30,000 Americans a year, most of them elderly or immunocompromised. If Covid can focus the country on finding better ways to protect them in the future, it would be one silver lining from a tragic pandemic.

More virus news:

Quiz time: The average score on our latest news quiz was 9.2. Can you beat it?

A Times classic: Mating rituals from the animal kingdom.

Lives Lived: Ivan Reitman injected marshmallow boogeymen and toga parties into pop culture with movies like “Ghostbusters” and “National Lampoon’s Animal House.” He died at 75.

The Los Angeles Rams beat the Cincinnati Bengals in last night’s Super Bowl, 23 to 20. The Rams, playing in their home stadium, took the lead in the final two minutes when Matthew Stafford threw a touchdown to the game’s M.V.P., Cooper Kupp.

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