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Epidemiologist talks new COVID-19 ‘normal’ just in time for the holidays

Christmas eve holiday party decorated table set with disposable medical mask and alcohol hand sanitizer bottle.
Helin Loik-Tomson
Dr. Andrew Pavia said a more normal holiday gathering is more possible this year, as long as people are vaccinated.

The holidays are coming up, and for the second year in a row, celebrations will take place in a pandemic. KUER’s Caroline Ballard caught up once again with University of Utah health epidemiologist Dr. Andrew Pavia to find out the answers to frequently asked questions about where we stand with the virus and how to gather safely.

This interview has been edited for length and clarity.

Caroline Ballard: We’ve heard the phrase “the new normal” thrown around so much it can lose its meaning. But, is this the new normal? 

Andrew Pavia: As long as much of the world isn't able to get immunized, as long as this virus continues to evolve, there's fresh wood to burn, if you will. The virus is going to stay with us. The question is what it's going to look like.

We can't sustain where we are right now. Our hospitals in Utah are at a breaking point, and they have been for weeks. What I hope the future holds is that the virus will still be here, but at a much, much lower level. The real question is how are we going to get there. It's going to depend on our getting much higher levels of immunity in the population through vaccination and to some degree, through infection. It's going to require really understanding how long immunity lasts, which is really something we're trying to do now as we're getting into the era of boosters. The other unknown, of course, is human behavior and politics. Those are really what got us into a much more complicated situation than we ever imagined we would be in.

CB: How has the state's response to the pandemic affected the spread of COVID-19?

AP: Unfortunately, I think our recent response has been very poor. Initially, the state did many things right. Back in March of 2020, we closed schools, we limited behavior, we marshalled a lot of forces. In the fall of 2020, we had indoor mask mandates. And throughout last school year we had masks in school. Those things worked really quite well, particularly masks in school.

This year's been a different story. We faced a really, really contagious variant of the virus, the Delta variant, and people are tired of wearing masks. They're not wearing masks in the grocery stores, at sporting events, in indoor gatherings. And we've banned the requirement to use masks in school, which has been an unmitigated disaster. All these things have contributed to this very long surge we're experiencing right now.

CB: With positivity rates what they are in Utah, what precautions should a fully vaccinated, otherwise healthy person be taking?

AP: If you're fully vaccinated, and you're otherwise healthy, and you're not around other people who you're likely to spread the virus to — let's say you work from home and you're just going out with friends, you can live life fairly normally.

If, on the other hand, you have elderly parents whose response to the vaccine isn't that good, if you work in a setting where there are many unvaccinated people or if, like me, you work in a setting where there are people are too young to get vaccinated, you have to take more precautions. But it's really not that hard. We know that outdoors is safe and all of our experience and our data says that outdoors continues to be very safe. Indoors, it's really a question of ventilation and crowding. If it's a crowded, poorly ventilated indoor space, you need to wear a mask. We're tired of wearing masks. We don't like them. But really, by now, we should be able to pop a mask on when we go into the grocery store.

CB: About 55% of all Utahns are vaccinated. At this point, what is a good strategy to convince people to get vaccinated?

AP: Everyone who's not vaccinated has their own reasons, and they're different. We have to respect those and listen to those. Sadly, many people have just listened to misinformation and it's caught hold, and people have these worries that we know just aren't true. They worry about effects on fertility or effects on pregnancy, and we have really good information to tell them not to worry. So we have to communicate that.

We have other people who have gotten caught up in the politics of this. And when you've decided you're not going to get vaccinated because you don't want to do what someone else is trying to tell you to do, that becomes sort of part of your persona and your way of thinking about yourself. That's hard to break.

We have to listen. We have to keep working on people one by one. We have to reach people where they live through trusted sources — whether that's in their church or in their doctor's office. But at this point, it's a ground game.

CB: There have been, throughout the pandemic, a lot of comparisons between flu and COVID. As a way for somebody to grasp it — right now, how different are their infection rates and mortality rates?

AP: As somebody who spent 20 plus years studying flu, I look at this a lot. This virus is very different. In a bad flu year, there will be somewhere between 40,000 and 60,000 deaths. In a typical year, it's 20,000 to 40,000. We've had more than 10 times that many deaths each year that COVID has been circulating in the United States. So that's a combination of it being more lethal and it's spreading so much more easily in a group of people with no immunity.

If we look at children, you know, we often say, ‘Well, kids are getting off relatively lightly compared to adults with COVID.’ But in a bad year, we might have 150 to 180 deaths from influenza. And the numbers in the U.S. are pushing toward 750 pediatric deaths from COVID.

So this is a worse disease. It's more easily transmitted. But it's also a very different disease in that it doesn't just affect the lungs and rarely the brain the way a flu does, but this can affect the heart, the liver. It definitely has serious impact on the brain. So this is a different beast. The other thing that's really different is that flu has a real seasonality. It spreads much, much better in the winter when the temperatures are cold and people are indoors. And we thought that COVID would do that based on what other coronaviruses do, but that's absolutely not true. It has spread year round. It may get a little bit worse when we move indoors, but it does not respect season.

CB: For a long time, the Utah Department of Health said a person over person test positivity rate below 5% would help get us to those more normal levels. Are we still aiming for that or have the goal posts moved?

AP: One goal post that has moved is the idea of herd immunity. We're never going to get to a point where so many people are immune that this virus just stopped spreading.

In terms of goal posts, it's harder and harder to use test positivity because we have home testing. We have lots of people who are choosing not to get tested, even though they pretty much know they've got COVID because they can't smell or taste. So we may have to rely on things like hospitalization rates as a marker, as well as just the number of cases that are diagnosed. Another marker that we use that may be really helpful is looking at the number of people who show up for medical care with a COVID-like illness.

CB: What will it look like when, fingers crossed, COVID rates come down, things become a little less intense and it does tend to resemble flu, at least in how many people are getting it and how many people are getting really sick with it?

AP: Remembering that predictions are difficult, especially about the future — best guess is that it will come and go with waves. We'll have bad years of COVID and milder years. It will predominantly affect people who are not vaccinated or a long way out from their vaccine, or those who don't respond well to the vaccine. But hopefully, we'll get the numbers down to where instead of seeing 10 to 15 people die a day, we might see 10 to 15 die a month. I know that sounds bad, but that's the definition of a disease that we can handle.

CB: We are coming up on the holidays — our second pandemic holidays. How should people be thinking about traveling, visiting family, gathering — all of those kinds of things that I think we all hoped that this year would be a little easier to do? What would your advice be?

AP: Well, I think we have a lot more ability to go back towards normal this year, but it does require thinking about risk, and it requires taking precautions. I think you can travel if you're vaccinated, and you wear a mask when you're indoors in crowded places. I think you can visit family if your family isn't particularly vulnerable. If they are, you need to think about what extra precautions you could take. If you've got a 65-year-old mother who's on cancer treatment, you probably need to get tested before you visit her — in addition to being vaccinated and having her vaccinated. If your entire family is fully vaccinated, you can lead a pretty normal holiday time. But when you mix vaccinated and unvaccinated, you are playing with fire.

Caroline is the Assistant News Director
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