Politics, Bad Science Alters Decisions About COVID-19

So I am very biased and watched with horror as the committee refused to approve recalls for our frontline workers, including health care workers. This happened even after CDC director Rochelle Walensky, MD, advised the committee not to be swayed by influences other than science. It does not appear that the committee took this advice into account. Instead, he seemed to fall prey to political talking points and what I think was sub-par research to strengthen his position.

At the start of the meeting there was time for public comment, and I made a 3 minute commentary stressing the importance of having to act now and that the United States does not have the luxury of waiting. from clinical tests. Non-action is also action. I stressed the importance of a long COVID-19 and stressed that even people with mild or moderate infections were at risk. I advocated for expanding the Food and Drug Administration’s recommendations for recalls for people at high risk of occupational exposure to SARS-CoV-2. And finally, that the degree of exposure should not be taken into consideration, because being exposed is like being pregnant: either you are exposed or you are not.

A major political point of discussion, which many members of the committee seemed to have cracked down on, is that if you are not hospitalized all is well, and preventing COVID-19 that does not require hospitalization is not a priority. . Many call it a “mild” or “moderate” illness. Throughout the FDA and CDC approval process, I heard that the goal they were trying to achieve was to keep patients out of hospital and intensive care. I don’t know who set this goal. Certainly not the White House. Their goal appears to be preventing morbidity and mortality while keeping the supply chain open by protecting frontline workers. Already in Kentucky we are seeing signs of collapse with our schools having difficulty obtaining food for student meals.

The problem is that hospitalizations and serious infections are often based on a patient’s lung symptoms, and SARS-CoV-2 is not like the flu, it affects almost every organ in the body. Patients may not have a primary pulmonary presentation, some may have mainly gastrointestinal, cardiovascular, or central nervous system symptoms. Cardiovascular involvement is common and can occur in people without mild symptoms. Myocarditis is often asymptomatic. Thus, the virus damages many organs in the body, resulting in a long COVID-19 that afflicts 10% to 30% of patients with mild to moderate symptoms.

In other words, even when not hospitalized, COVID-19 often produces the most serious infection that individuals will experience in their lifetime and can produce lasting symptoms of fatigue, weakness, brain fog and cardiovascular damage. It’s amazing to me how the loss of smell is simply ignored as a minor symptom. As a retired ear, nose and throat doctor, had I had surgery that resulted in the loss of smell, I could have been sued for hundreds of thousands of dollars.

Another topic of political discussion is the claim that healthcare workers have received adequate protection and are not at high occupational risk for acquiring SARS-CoV-2. We heard that assertion at the committee meeting. Additionally, it was stated that there is research to support this position.

However, the main research I could find is that published by Jacobs et al. in JAMA Network Open who compared HIV status among health care workers with general community(4) As one commentator pointed out, Lisa Brosseau, ScD, one of the major issues with this study is that the conclusion that “these results provide reassurance that current infection prevention practices in various healthcare settings are effective in preventing the transmission of SARS-CoV-2 from patients. to health professionals ”. Not supported by data. In addition, Brosseau underlines that “the investigators fail to note that the health personnel had an overall incidence rate of infection of 440 / 10,000 (4.4%), 6 times higher than the community infection rate. average of 72.4 / 10,000 (0.7%) ”. And that “a recent study has revealed the transmission of SARS-CoV-2 between asymptomatic patients and health workers despite the use of medical masks and eye protection. It’s time to stop singling out community transmission and recognize and address the importance of work-related exposure. Finally, this study used serology and not PCR testing of actual infections. Participants from healthcare workers volunteered for serological testing. I think the control group needed a better description to rule out any bias that might have been present due to the differences between these 2 groups.

With the high viral load that healthcare workers are exposed to, as well as the many reports I hear of breakthrough infections in these workers, they absolutely need to be a priority for recalls. Healthcare workers were among the first to be vaccinated and, therefore, one would expect them to be among the first to have waning immunity to the vaccine.

Even if the exposure of the community was true, as stated by Helen Keipp Talbot, MD, of Vanderbilt University, who also voted yes, “… overwhelmed hospitals. “

This is an argument that I wholeheartedly support, as I would not want my treatment to be blocked again due to health workers with COVID-19.

Walensky acted quickly and in the evening reversed the committee’s decision. The following has been added to the CDC’s recommendations for those eligible for boosters: 19 vaccines at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

I think it was a very wise move that demonstrated proactive action and the ability to separate political rhetoric from science. I think APIC needs a paradigm shift in its thinking. These are not normal times; we need quick decisions which will often have to be based on experience and the preponderance of evidence. As John F. Kennedy said “There are risks and costs to action. But they are far less than the long-term risks of comfortable inaction. “