Most of the U.S. population has now returned to pre-pandemic lifestyles. There are very few, if any, jurisdictions with community-wide mandates, and the CDC has relaxed its covid guidance considerably this year. President Biden recently said in an interview that the pandemic is over in the United States. There is still, however, a small percentage of the population that is very afraid of COVID-19. They are quite vocal on social media. The intriguing thing is that these people do not skew heavily toward any demographics. Some have underlying health issues, but many do not (or at least they have not revealed any). They seem to represent the general population in terms of age, gender, and race. It is a mixture of medical professionals and non-medical people.
Before the pandemic, germophobia was a condition recognized by psychologists. What we are seeing today, then, could perhaps be described as “coronaphobia.” But this does not fully capture what is going on. These people feel abandoned by public health leadership. They feel that public health and politicians, who they previously trusted to keep them safe, succumbed to pressure from a restless mob majority.
The first question we need to consider, is what the reality of covid is, now that there is widespread vaccine and natural immunity against the underlying coronavirus. In terms of putting covid into perspective against pre-pandemic respiratory illness, it is difficult to use many of the covid metrics that are widely followed. Case counts, test positivity, hospitalization rates, hospital occupancy, death counts, and excess mortality either use methodologies that are not consistent with respiratory surveillance before the pandemic, or are affected by factors other than covid itself.
The most reliable metric, in my judgment, to depict the reality of covid relative to normal respiratory illness, is the percentage of total deaths attributed to influenza and/or pneumonia. The CDC has tracked this going back at least 25 years. In the COVID-19 pandemic, influenza has not been prevalent, so if this metric is above the baseline, it would be due to COVID-19. Furthermore, pneumonia deaths captured by this metric are determined by clinical evaluation, so people who died of other causes and just happened to have a positive covid test are not included.
In the winters from 2014-15 to 2019-20, the peak of this metric ranged from 7.6% to 10.9%. Since then, there have been six waves driven by COVID-19, with the peaks listed below:
Apr 2020: 15.8%
Aug 2020: 10.7%
Jan 2021: 19.4%
Aug 2021: 16.8%
Jan 2022: 17.0%
Aug 2022: 6.5%
Source: https://www.cdc.gov/flu/weekly/weeklyarchives2022-2023/data/NCHSData41.csv (retrieved 10-21-22)
The first three peaks shown above occurred with virtually all covid cases being people immune naive to the coronavirus. The fourth and fifth waves occurred with vaccines widely available but low uptake in some regions of the country. This was with the backdrop of increasingly contagious covid variants which made it harder for people without vaccination to continue avoiding infection.
The most recent wave, however, which peaked in August 2022, occurred with nearly the entire population having either vaccine or natural immunity. Here we can assess the virulence of breakthrough infections or reinfections compared to normal respiratory illness. Recall that during normal winters, this mortality metric peaks at 7.6% to 10.9%. The most recent covid wave peaked below this range, at 6.5%. Given that the prevalence of covid was high at this peak, the inference I would draw from the mortality statistics is that covid is now less lethal than influenza, but more contagious, hence the summer wave.
Now, with this in mind, let’s return to the question of what to do about coronaphobia. Given that, as shown above, covid is still capable of causing severe illness and is more contagious than pre-pandemic viruses, fear of covid should not simply be dismissed as irrational anxiety (although I have no problem telling the general public that they can live normally).
The people who are very worried about severe covid and long covid are hopeful that eventually there will be a new vaccine or a new drug that eliminates these risks. They believe that we should continue masking and distancing until such a pharmaceutical product is available. But are these really developments that we can count on?
For any pathogen, the expectations for vaccination must be calibrated to natural immunity. For seasonal respiratory viruses such as influenza and coronaviruses, this means short-term protection against infection (due to neutralizing antibodies) and long-term protection against severe illness (due to T cell memory). Coronaviruses are a type of common cold virus, and people get cold viruses over and over again. Contrast this to childhood diseases such as measles, which people caught once as children and were then protected for life against reinfection. Correspondingly, those childhood diseases are now kept to a minimal level through vaccination.
But unless there is a radical breakthrough in vaccine technology, I do not see such long-term protection possible with coronaviruses. There was hope that mRNA would be such a breakthrough, but it turned out not to be.
As for antiviral drugs, you cannot kill viruses with antivirals the same way you can kill bacteria with antibiotics. Ultimately, the immune system must do the job of clearing viral infections. The only benefit of antivirals is if they subdue viral replication, giving the immune system enough time to get into action. But drugs such as Paxlovid for covid, or Tamiflu for influenza, basically represent the limit of what we can do in terms of antiviral therapy.
As for long covid, this is mostly a collection of inflammatory conditions that result from the immune system’s fight against the virus. But the medical establishment is very weak when it comes to treating chronic inflammatory diseases. Until there is a pill to cure irritable bowel syndrome, interstitial cystitis, rheumatoid arthritis, fibromyalgia, etc., I am not expecting a “miracle pill” against long covid. Ultimately, I believe the solution to long covid (as with severe acute covid) is going to be immune system support, because a healthy immune system has nuance to avoid inducing inflammatory disorders.
However, the concept of immune support with regards to covid is difficult for some people to grasp, and I think this is due to the manner in which covid mitigation was presented to the public. The language used to describe mitigation had engineering overtones. Lockdowns, mask mandates, quarantines, and physical distancing were presented in a mechanical, formulaic, and deterministic nature. Vaccination was presented with language evocative of computer programming, similar to antivirus software and security patches. The message gave the impression that humanity is a computerized machine that got infected with malware in 2020, and the response was to perform emergency operations on the machine to do damage control until the malware problem was solved. The people who are still very worried about covid perceive that the machine is not truly fixed yet, and that the supervisors have given up on damage control.
The truth of the matter, however, is that humans have a biological immune system that is far more sophisticated than any feat of computer science or engineering. It is this immune system that enabled us to live amidst constantly mutating viruses before covid. Mutations and variants would indeed be a big problem for computers programmed in binary code to recognize something very specific. This is similar to the problem that self-driving cars have run into; in real life, road and traffic situations have deviations from standard form that these cars’ programming cannot sufficiently accommodate.
But the human immune system is wired from birth to deal with new pathogens. That is how we survived our first encounters with all the endemic viruses as children. These generic immune functions do weaken with age, however, which is why the risk of severe outcomes for covid increases with age. Also, regardless of age, the robustness of this immunity depends on sufficiency of key vitamins (particularly vitamin D), nutrition from diet, body mass index status, blood sugar status, and physical fitness.
Obesity, diabetes, and old age have been recognized by the medical establishment as risk factors for severe viral illness, both before and during the pandemic. But vitamin D deficiency has not. And this is unfortunate because vitamin D plays a key role in activating T cells to fight viruses and modulating T cell activity to prevent severe inflammation.
Sources on vitamin D and the immune system:
Another reason vitamin D is important: It gets T cells going – Scientific American Blog Network
Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review – PMC (nih.gov)
Furthermore, vitamin D deficiency is associated with many of the other factors associated with elevated risk of severe COVID-19, including obesity, diabetes, hypertension, lower socioeconomic status, and Hispanic and African-American ethnicity. Thus, a truly equitable response to COVID-19 would be for public health to promote and facilitate vitamin D supplementation. A random white person in the U.S. population has a 31% chance of being vitamin D deficient, an Hispanic person has a 63% chance, and a black person has an 82% chance.
Source on vitamin D deficiency: https://doi.org/10.1016/j.nutres.2010.12.001
Furthermore, the seasonality of respiratory illness could be explained by vitamin D cycles. During the spring and summer, people receive vitamin D from sunlight during time spent outdoors. But during the late-fall and winter, sunlight provides almost zero vitamin D. Public health, on the other hand, always attributes the high level of viral illness during winter to people spending more time indoors with close contact. However, given that during the summer, people still do many indoor activities (shopping, work, church, dining, public transportation, cinemas and concerts, evenings with their households, etc.), it seems unlikely that summer lifestyles would break viral transmission.
And now, with COVID-19, the effectiveness of any pharmaceutical interventions, whether vaccination or antiviral therapy, will depend on the strength of a person’s immune system. Vaccination, in and of itself, has no power to fight a virus; it is merely a “simulation” of a viral infection that gives your immune system an opportunity to mount a response similar to what it would do if naturally infected. The durability of the immunity generated from vaccination, and the robustness of that immunity against virus variants, depends on the person’s immune system.
Also, cytokine storms, which can lead to respiratory distress syndrome and long covid, are not caused by an “overactive immune system” per se, but rather, an immune system that is lacking finesse control, to use a music analogy. But there are supplements, in addition to vitamin D mentioned already, which can help to fine tune the immune response: For example, vitamin K2, vitamin C, and quercetin. Foods with anti-inflammatory properties can also be helpful in this regard. Conversely, intake of foods that can contribute to inflammation, such as refined sugar and processed meat, should be moderated if people are worried about viral illness.
Vitamin and mineral supplements are safe for most people at normal doses. Potential drug interactions should be considered, but otherwise, the negative articles that you see in mainstream medical literature about supplements stem from a fallacy, propagated by some in the naturopathic community, that certain conditions can be “cured” by taking megadoses of supplements. But this is falling for the same fallacy that mainstream medicine is often mired in: The idea that you can fight and eradicate a virus or an inflammatory syndrome with something really powerful, whether it be a vaccine, a drug, or a humongous dose of a supplement.
But the reality is that we cannot truly fight viruses, and we do not need to, because we have an immune system that allows us to live amidst viruses. Supplements are helpful to the extent that they give our immune system the nutrients needed to operate the way it is designed to. Back in 2020, one could have made the case that people would be better off if they avoided exposure to the novel coronavirus until acquiring immunity through vaccination, or at least ensuring a normal vitamin D level. But the point of this article is not to debate mandates in the first year of covid. The bottom line is that, when vaccines were widely available, the combat language regarding covid should have ended. The public health messaging should have pivoted to strengthening the immune system.
But that pivot was not made, and it still has not happened as of today. The combat language lives on in journalism and rhetoric from public health leadership. We still hear about “putting our guard up” and “letting our guard down.” We still hear about the “fight” against COVID-19. We still hear about when it might be appropriate to “declare victory.”
But despite the ongoing wartime rhetoric, public restrictions have been dropped. Thus, in the minds of some people, there is a sense that we have surrendered the battle to COVID-19.
This is why we need for public health to get actively involved in promoting immune health. The supply of key vitamins should be ramped up (which is not a big deal, given how fast masks and vaccines were churned out). Medical insurance should pay for vitamin D serum concentration tests, and this should be made part of bloodwork at routine checkups.
Diet and lifestyle advice has the potential to be a fraught matter, given the authoritarian nature of public health during the first two years of the pandemic, so it is important for the communication about immune health to be an empowering message, rather than telling people what they must do. The way I see it, the SARS-CoV-2 coronavirus is in a transitional phase from pandemic to endemic. How fast this transition goes depends largely on what we do for our health. It is time for public health to recognize this.
Resolving the Hysteria 