St. Lawrence County doctor describes what the endemic phase of COVID-19 will be like

Dr. Andrew Williams is President of the St. Lawrence County Board of Health. Screenshot from Zoom

The latest COVID-19 surge in the North Country appears to be in retreat, with the region’s positive test rate slowly declining. This surge hasn’t caused as many hospitalizations and deaths as previous coronavirus spikes.

Dr. Andrew Williams, president of the St. Lawrence County Board of Health, says we’re at a different place in the pandemic.

“We are in a better spot now because of the vaccinations that have occurred, because of the natural immunity that’s developing in the community,” Williams said, “and now we have these oral therapies that are available.”

Dr. Andrew Williams on what the COVID-19 endemic could be like

Williams says public health leaders are “shifting gears” to focus on people who are at the greatest risk of serious illness from COVID-19. He told David Sommerstein that includes trying to make those anti-viral therapy drugs more widely available. Their conversation has been lightly edited for clarity.

DR. ANDREW WILLIAMS: In some parts of New York State, they’ve developed what’s called a “test and treat” approach where there are pharmacies or clinics that are designed to do rapid testing and then provide the [anti-viral therapy] treatment.

Unfortunately, in this region of New York State, those resources aren’t available. So people need to test on their own or test in a testing center, and then contact their primary care physician. The Community Health Center of the North Country is designated to be able to provide treatment for people who don’t have a primary care provider, so people can also contact the health center for that purpose.

DAVID SOMERSTEIN: Do you feel as a medical professional that we’re moving more towards an endemic part of COVID, where people are going to get COVID, and this is a part of regular life, and we have ways to treat it?

WILLIAMS: I think that’s right. I mean, there’s a lot of discussion about the transition from pandemic to endemic. I think we’ve made that transition. I don’t think COVID is going away. The virus seems to develop these sub-variants that either evade natural immunity or, to some extent, evade vaccination-based immunity.

So I don’t see COVID going away, and I do see it as unfortunately being part of daily life and another illness that’s out there that we as physicians have to identify. Now, fortunately, we have the opportunity to also treat it for those people who are at higher risk.

SOMERSTEIN: A bunch of testing sites in St. Lawrence County and across the North Country have folded up shop because there just weren’t enough people going to get tests. These are the PCR tests, the better quality tests. How important is testing right now? What does it mean that all these places are closing?

WILLIAMS: What we’ve seen in terms of testing is an evolution throughout the pandemic, now endemic, where initially, there was very little testing at all. Then we worked very hard with our local medical community to make high-quality rapid testing available. And then home testing sort of entered the scene.

I believe what we’re seeing right now is that a large portion of people who have symptoms are at least initially doing a home test. So that’s an important factor. It’s also an important factor as we try to understand the number of cases in the community.

SOMERSTEIN: Yeah, I was gonna say that there is likely a significant underreporting of the number of cases that are actually out there because of the home test.

WILLIAMS: Exactly. I think a number of people who develop symptoms and do a home test, I believe most of them are doing some form of self-isolation. But often, they’re not reporting that test to public health. So we’re unable to share that information with the community. So in a way, we’re really unable to understand exactly how many cases we have in the community.

SOMERSTEIN: What are public health officials saying we should do now? More masking. more testing? What is the top line most important thing that people should know to do with COVID circulating in the community?

WILLIAMS: I think the most important thing is to really focus on those people in the community who are at higher risk for severe disease. So whether it’s based on their advanced age or comorbid medical illnesses, like people who have diabetes or are immunocompromised, where their immune system can’t fight the infection, people in those categories who are at high risk really need to work to protect themselves. And people who interact with those folks should also be looking out for them.

I think also coming up with a plan. So for people who are at high risk, they should have a discussion with their medical provider and say, if I should become ill with COVID, how do I go about getting tested rapidly and how do I access the oral medication [anti-viral drug treatment] in a timely fashion so that they can be treated and stay out of the hospital?


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