How we should deal with COVID now

In March, the Centers for Disease Control and Prevention released new COVID guidelines ending the fiveday isolation recommendation. The agency now advises staying home only if you have symptoms, such as fever. Otherwise, you can return “to normal activities” if, for at least 24 hours, your symptoms are improving overall and any fever has gone away without the use of fever-reducing medication.

As is often the case with COVID-19, the news has started a back-and-forth as to whether the latest government rules are too strict or too loose. Our approach to the virus as endemic remains uneasy as the annual death toll, estimated at fewer than 70,000 in 2023, drops closer to but remains significantly higher than the toll of the flu. But these conversations dodge many of the realities of COVID-19 in this phase. While we continue to debate ways to shape individual human behavior for collective protection, we’re squandering some of the resources we’ve already put toward fighting this disease.

Vaccination got us past the worst of the pandemic, yet now we’re under-using it to control COVID-19 and, more importantly, reduce deaths. In the United States, immunization rates for the recommended boosters remain low even in high-risk groups, such as older adults and the immunocompromised. As of early March, the rate among those 60 years or older was 42% (and just

23% for all adults eligible for the latest version of the vaccine).

We’re missing opportunities to vaccinate people who might not on their own pursue a shot. Inoculation should be easily available to those who show up at health facilities for whatever reason — testing, routine care, emergencies — and would be open to being vaccinated then. Doctors, nurses and other health care providers remain the most trusted sources of vaccine information.

Counseling patients about vaccines requires providers’ time. The Centers for Medicare & Medicaid Services reimburses physicians if they counsel certain patients, or their caregivers, about receiving a recommended vaccine even if the patient declines the vaccine that day. This provision covers beneficiaries of Medicaid and the Children’s Health Insurance Program. But for most other insurers, vaccination costs are reimbursed only if a patient ends up getting vaccinated. Not consistently making vaccine counseling reimbursable, unlike, say, nutritional counseling, disincentivizes health care providers to spend the time needed.

Another payment problem arises around antiviral medications such as Paxlovid — imperfect but useful tools to reduce death among those infected. The drugs are most useful if administered soon after infection, and Pfizer set the out-of-pocket price for a five-day course at $1,390. After the COVID-19 public health emergency ended, the Department of Health and Human Services reached an agreement with Pfizer to increase access through the Paxcess program, which ensures that the drug is free for those on Medicaid and Medicare and the underinsured. There’s also a copay assistance program for others who cannot afford the drug.

Unfortunately many people, including pharmacists, are not aware of this program. Access to a mortality-reducing drug should not be a well-kept secret. The Department of Health and Human Services should embark on an expanded pharmacist and health care provider information initiative, working with all major pharmacy chains, to add electronic prompts for Paxcess to prescription fulfillment systems.

Another underused COVID resource: improved indoor ventilation and air filtration. These interventions include increasing indoor airflow through mechanical means (such as modification to HVAC systems) or natural means (such as keeping the windows open); proper filtration of circulating air through air cleaners or through heating, ventilation and air conditioning; and installing ultraviolet irradiation equipment to kill viruses.

Fortunately, there is federal funding available for locations with high population density, including schools, to improve indoor air quality. But far too few have since upgraded their ventilation and air filtration systems. More use of that funding, alongside support from the private sector, could make buildings healthier. These meat-and-potatoes approaches — vaccination, access to treatment and clean air — may not be the most exciting tools. But they reflect the best of public health: strategies that are so effective they almost invisibly reduce life-threatening illness.