By Carol A. Cates, MSN, MBA, RN
Chief Nursing Officer
Odessa Regional Medical Center
I haven’t written about COVID in quite a while. Honestly, I keep hoping I will never have to write about COVID again, but the surges in COVID cases just keep coming. Fortunately, the surges, are causing less severe disease, which has resulted in fewer people needing hospitalization and better still, fewer people dying because of this awful infection. The other thing that is going on is, now, nearly 3 years into the pandemic, we know a huge amount more about COVID. We know how it is transmitted, how long people are contagious, and how we can better control the spread of COVID.
When COVID first started showing up in the US, it seemed like guidelines changed every day, sometimes every few hours! It was so confusing and so hard to keep up with. That was because we knew so little about COVID, and everything we did was based on trial and error to a certain extent.
Let me give you another example. I think about back in the early days of medicine when doctors thought that bleeding people would cure disease. Now we know because we have over a hundred years of experience and research, that bleeding people is bad far more often than it is good.
I used to wonder how bleeding ever became a regular practice, because it seems obvious to me that it’s bad to bleed people on purpose. But back then, doctors didn’t have access to all the data we have now, all they had trial and error. The only results they could see were from their own practice, and maybe a couple of colleagues.
Heart disease was nearly as prevalent then as it is now, and in patients who have heart failure getting rid of excess fluid is something that works and works well in getting them better. Now we have drugs called diuretics, which force the body to make more urine, which in turn gets rid of excess fluid. Those drugs are our first defense against excess fluid in people with heart failure now. Back then those drugs didn’t exist.
Bleeding people probably started because someone noticed that a patient with a bad cut started breathing better and feeling better. So then next time that person started having trouble breathing, they tried it on purpose, and it worked on that one person again. So, then they tried it on others, and it kept working a good portion of the time because bleeding does get rid of excess fluids. The problem came when they did it to excess and did it with everyone.
After many, many deaths, new drugs and a much better understanding of disease and chronic illness in general, doctors figured out bleeding doesn’t work for most things, and the routine practice of bleeding stopped. We do still purposefully take blood or plasma from some people to help with heart failure and other disease conditions, but now we know when that will help rather than harm, and only do it for those patients it will help. In a much-compressed time frame, because we can look at things in a larger scale because of better communication and technology, that has happened with COVID, we know much better what helps and what hurts and are not dependent on trial and error.
That is why we haven’t had many updates in COVID prevention since the vaccine came out in late 2020. We have learned what works to prevent. But, after over a year of vaccinations, and the virus mutating where it is generally causing less severe disease, the Centers for Disease Control and Prevention (CDC) felt that the data supported making some new changes. The great part about these recommendations, is these changes that make COVID a bit easier to live with.
The first is quarantine versus isolation. Some people think they are the same thing, but they really are not. Quarantine happens when you are exposed to a disease. Isolation happens when you have the disease.
Some diseases, we quarantine quickly because we want to cut off every opportunity for it to spread—and COVID when it was at is worst, and we didn’t know exactly how it was transmitted, that was certainly the goal. But we have learned with COVID, especially the newer forms, that traditional quarantining is just not necessary.
The CDC now recommends that if you have been exposed, you don’t have to quarantine, you just need to wear a good-fitting, high quality mask, ideally an N-95, for 10 days, and they need to test at 5 days. That lets people work, go to school, and do all the things they need to do in a day. If the test is negative, they still need to mask for the full 10 days.
But, if the test is positive, it gets a bit more complicated. At that point isolation is a must. If symptoms are improving and there is no fever for 25 hours, people can stop isolating at 5 days. But, if the person has moderate to severe disease, which means, shortness of breath, difficulty breathing, or hospitalization, the isolation needs to continue for 10 days.
This is because now we know people who are sicker generally have a bigger viral load, and the bigger the viral load, the more time it takes to clear it out of a person’s system, so they are not contagious.
COVID, unfortunately, is probably here to stay, just like colds and flu, and these new recommendations limit its ability to spread and cause big outbreaks if we all follow them. Hopefully, the variants will continue to cause less severe disease in most people just like it has for colds and flu, and the recommendations will continue to become fewer.
My final recommendations based on all of this is, is if you are sick, no matter what the cause, a cold, the flu, COVID or anything else, stay home and away from others. Be cautious around anyone who is at high risk for severe disease if you think you have been exposed to COVID or any other illness.
Finally, please consider getting vaccinated when there are vaccines available for viral illnesses, especially the flu each year, and COVID as those vaccine frequency recommendations continue to evolve. There are lots of options out there now for COVID vaccines, including traditional vaccines, not just mRNA vaccines. Vaccination does not prevent COVID and flu completely, but they absolutely reduce the extent of the illness, and they absolutely reduce the risk of death. I have seen that not just in the data, but here in the hospital and among the people I love.
