COVID-19 Harmonization: Balancing Risks and Benefits of CDC's Latest Move

The CDC’s recent decision to harmonize recommendations for respiratory viruses has the public and infectious disease societies in support. The Infectious Diseases Society of America (IDSA) supports the CDC’s harmonization in a recent blog post.IDSA’s immediate past president Carlos del Rio has supported rolling back COVID-19 incubation recommendations as early as December 2021 when he was an advisor at Delta Airlines and petitioned the CDC to drop the isolation rates for vaccine breakthrough infections from 10 to 5 days due to concerns it “…may significantly impact (Delta’s) workforce and operations.” Currently, IDSA is supporting the CDC in dropping the isolation time to 0 days for asymptomatic carriers. In view of protracted viral shedding in patients who have become symptom-free after infection (11% had positive cultures at 10 days) and a 40 to 50% rate of asymptomatic infections, some have concerns regarding this decision.
 
The lower-case fatality rate of the Omicron variant is overridden by its high infectivity, increasing the chances of becoming severely sick from participating in social activities. The Omicron wave was associated with some of the highest community rates of deaths and hospitalizations during the pandemic. SARS-CoV-2 is much more infectious than influenza, possibly approaching that of measles. SARS-CoV-2 also has a higher incidence of death and long-term sequelae, including autoimmune diseases.

However, we need to ask: Should SARS-CoV-2, with its frequent period of asymptomatic spread and high infectivity, be harmonized with other non-ACE2 receptor respiratory viruses? And is COVID-19 even a respiratory illness, as opposed to a multi-system disease that can masquerade in many different forms, similar to syphilis?

A better prevention harmonization may well be with the measles and polio viruses.

• Before 1963, measles caused an estimated 3 to 4 million cases annually, 48,000 reported hospitalizations, 1,000 cases of encephalitis, and 400 to 500 deaths.Measles is one of the most infectious diseases known to man and similar to COVID-19, it spreads through contact with surfaces and aerosolization.
• Polio is even more elusive. Over 50% of individuals are asymptomatic, and approximately 25% of people have influenza-like symptoms. One to 5% of patients develop meningitis, 0.5 to 0.05% will develop paralysis, and between 0.05 to 0.001% will die.

Measles and polio cases mainly affect the young, but as a senior citizen, I can testify that life and livelihood at all ages are just as precious.

The impending loss of herd immunity for measles is an ominous development. Measles is a DNA virus and thus has a lower mutation rate than SARS-CoV-2, but it still can mutate. Historically, there was a rapid uptake of the measles vaccine, and the spread was halted. But now the virus is spreading and mutating. Already, a strain of measles has been detected in Italy which escapes tests. If we keep on spreading the measles virus, we risk it developing resistance to the vaccine.
 
COVID-19 is still ravaging our society, with over 200 deaths each week and over 20,000 individuals in the hospital each day. And the tolls of long COVID may be mounting, not decreasing. During the first week of February 2024, 6.8% of all adults are experiencing long COVID symptoms, up from 5.3% during the week of October 18 to 30, 2023. In Sweden, a country that had very few COVID-19 interventions, a major insurance company, If, reported that after the pandemic, 1 in 3 young adults are experiencing brain fog.

We need to ask, if we are allowing asymptomatic individuals with COVID-19 to mingle in our community, how can we effectively message the public to increase their vigilance and vaccination rates for diseases with similar or even less severe outcomes?

The mantra that “we are now in a better place” gives a misleading impression. We are still in a dangerous place that requires increased vigilance and strategies to prevent infectious diseases.

I started my medical career attending to cancer patients. I would hear the pleading from patients and their friends, trying to minimize the disease and avoid treatments. But you cannot bargain with cancer, nor can you with COVID-19. The virus does not care what society is willing to do; it only exists to reproduce and, in its wake, is left with death and disability.