Ohio NAACP Health UpDate #21

OHIO NAACP UPDATE-21                                                                                    March 7, 2025 

 Guidance for COVID-19 and Health Preventive Maintenance

 With the release of the new COVID-19 guidelines, the Centers for Disease Control and Prevention (“CDC”) on March 1, 2024, dropped its 5-day isolation requirement for COVID-19 patients. Under this approach, people no longer need to stay home if they have been fever-free for at least 24 hours without the aid of medications and their symptoms are mild and improving, they can resume normal activity, wear a mask, and limit contact with others. 

 The guidelines apply to COVID, influenza and respiratory syncytial virus, among other respiratory ailments, which should make it easier for people to comply, Dr. Mandy Cohen, the CDC’s director explained.

 The thought is that COVID-19 is no longer the devastating killer disease it was in 2021 and that the declining hospitalization and death rate is symbolic of a change in tide:  the disease is milder largely due to the new reality-most people have developed a level of immunity to the virus because of prior infection, vaccination or both. 

 Whereas I can’t argue with the declining rates of death and hospitalizations, as I’ve said before, the new guidelines disproportionately impact Blacks because we constitute a large portion of the essential worker’s pool and by us manning the front lines , we have less opportunity to shelter in place or work virtually from home until the illness has passed. 

 The problem is two-fold: (1) the 5-day period after contracting Covid, one is most contagious (typically through day ten in a declining fashion), and during that time likely to spread the disease to others. Unfortunately, this will lead one to avoid  getting  tested rationalizing “it doesn’t matter, I have to go to work anyway.”; and (2)  people not getting tested timely will miss the 5-day window of opportunity to intervene with prescribed anti-virals which may be lifesaving, especially in the immunocompromised, elderly, or those with underlying illnesses which remain disproportionately, people of color. 

 As we see people coughing, sneezing, and sniffling and do not know if they have COVID, influenza, RSV, or an unspecified illness, we should keep our distance as we come in contact with them in public places.

 Even before President Joe Biden’s administration ended the public health emergency in May 2023, much of the public had moved on from COVID-19, with many people giving up on testing and masking, much less isolating themselves when they came down with symptoms. COVID has become part of the fabric of our nation and unlike the seasonal flu, it is year-round.  This is why I implore my patients to, at least annually, receive the updated COVID vaccine, or more frequent if recommended by their physicians, if they are moderately or severely immunocompromised, on immunotherapy, chemotherapy, or the like.    

 According to the CDC, as many as 7 percent of Americans report having suffered from a myriad of lingering COVID symptoms including fatigue, difficulty breathing, brain fog, joint pain, and ongoing loss of taste and smell.  Also, the newer isolation recommendations do not apply to hospitals and other health care settings with more vulnerable populations where a 5-day isolation is still practiced.  

 Therefore, to protect oneself, stay vigilant, wash your hands, wear masks around others, and maintain your distance if you are unsure if others around you are truly “sick.” Also, we recommend testing early for any symptom of an Upper Respiratory Tract Infection (“URI”) whether it be a runny nose, sore throat, or cough as you may unwittingly infect your entire staff at work or carry it home and infect your family. Worst yet, if you live or visit with elderly or infirm, they may not fare as well if they contract the disease from you. Also, if you test positive for COVID-19 and it is within the 5-day window of symptoms, Paxlovid and other anti-virals can be prescribed which prevent the virus from multiplying and hence may keep mild-moderate COVID-19 from becoming severe. 

 Paxlovid is highly effective against severe COVID, reducing the risk of death by 73 percent if taken within the first five days of an infection, according to a preliminary study by the National Institutes of Health. We urge people who are elderly, have comorbidities and are otherwise high-risk to contact your doctor about getting a prescription as soon as they have symptoms or test positive.

  Finally, COVID-19, which was mostly mild in 80% of individuals or asymptomatic in approximately 25%-40% in the earlier variants, is even milder and more asymptomatic in the present variants. Most individuals who either experience symptoms and/or are exposed and diagnosed with COVID-19, are usually not tested, but instructed to self-quarantine or isolate at home, although now, only until they are 24 hours fever free, even though they remain contagious and typically shed for up to 10 days.  

 According to the CDC, fully vaccinated individuals who experience a positive exposure (or contact) with COVID-19 do not have to quarantine if they remain asymptomatic. 

I.                   How do I get evaluated? 

 If you have a fever, cough, and/or new shortness of breath or any of the symptoms below, you may have coronavirus. People with COVID-19 have a wide range of symptoms ranging from mild symptoms to severe illness.  The following symptoms may appear 2-14 days (incubation period) after exposure to the virus: 

 •     fever 

•     cough 

•     shortness of breath or difficulty breathing 

•     repeated shaking chills

•         fatigue 

•     muscle pain or body aches 

•     headache 

•     sore throat

•         congestion or runny nose 

•     new loss of taste or smell 

•     vomiting or diarrhea 

 If you develop any of these symptoms, especially if you have been in close contact (within 6 feet) of a person known to have COVID-19, you should first self-test or you should contact your Primary Care Physician (“PCP”) or a health care provider that is testing for COVID-19 through the use of telemedicine visits. If you are over 60, have comorbidities or are immuno-compromised, it is especially important as prescribed anti-virals may save your life.  If you are unclear, you should seek medical care and have your health care provider evaluate you.

II.                Emergency Warning Signs 

 There are Emergency Warning Signs for COVID-19.  If you develop any of the following symptoms, you should call or go to your nearest Emergency Room (“ER”) and inform them you will be arriving: 

 •     trouble breathing 

•     persistent pain or pressure in the chest 

•     new confusion  

•     inability to wake or stay awake 

•     bluish lips or face 

 COVID-19 can be indolent and vary in vulnerable individuals early in the course of the disease.  Then it may quickly and significantly relapse even though one may seem to be improving.  The relapse usually occurs within the first 7-10 days, which is why it is important to confirm its existence so prompt treatment with Paxlovid within the 5-day window may be recommended. 

 STEPS to FOLLOW When Testing POSITIVE FOR COVID-19

 For individuals with confirmed or suspected COVID-19 who do not need to be hospitalized and individuals with confirmed COVID-19, who were hospitalized and determined to be medically stable to return home, need to: 

 Isolate until fever-free for 24 hours without the use of medications and if symptoms are mild and improving. 

If it is determined you do not need to be hospitalized and can be isolated at home during your first day of illness until you have no temperature, and your symptoms are improving. As you return to normal activities, you should follow the steps below: 

 Stay home except to get medical care. 

Individuals who are mildly ill with Covid-19 are able to isolate themselves at home during their illness.  They should restrict activities outside their home, except when getting medical care.  Do not go to work, school, or public areas and avoid using public transportation, ridesharing, or taxis.  

 Separate yourself from other people and animals in your home. 

 People. 

 As much as possible, you should stay in a specific room and away from other people in your home.  Also, you should use a separate bathroom, if available, and wear a mask at home.

 Animals.

 You should restrict contact with pets and other animals while you are sick with Covid-19, just like you would around other people.  There have been no reports of pets or other animals becoming sick with COVID-19.  But until more is known, it is recommended that you should limit contact with animals while you are sick.  If possible, have another member of your household care for your animals.  Avoid contact with your pet, including petting, snuggling, being kissed, or licking, and sharing food.  If you must care for your pet while you are sick, wash your hands before and after you interact with pets and wear a face mask. 

 Personal Protection. 

California still recommends people with COVID wear masks indoors when they are around others for 10 days after testing positive even if they have no symptoms or are becoming sick. California guidance states, and we concur, “You may remove your mask sooner than 10 days if you have two sequential negative tests at least one day apart.” 

 You should wear a face mask when you are around people, and others should wear a face mask inside your home for 10 days unless you test negatively two times in a row and at least 2 days apart.  People who live with you should not stay in the same room with you and should wear a mask if they enter your room. The CDC urges those who end isolation to limit close contact with others, wear well fitted masks, improve indoor air quality and practice good hygiene like washing hands and covering coughs and sneezes for five days.

 Cover your coughs and sneezes. 

 Cover your mouth and nose with a tissue when you cough or sneeze.  Throw used tissues in a lined trash can.  Immediately wash your hands with soap and water for at least 20 seconds or, if soap and water is not available, clean your hands with an alcohol-based hand sanitizer containing at least 60% alcohol. 

 Clean your hands often. 

 Wash your hands with soap and water for at least 20 seconds, especially after blowing your nose, coughing, sneezing, going to the bathroom, and before eating or preparing food.  Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing personal household items. 

 You should not share dishes, drinking glasses, cups, eating utensils, and towels or bedding with other people or pets in your home.  After using these items, they should be washed thoroughly with soap and water. 

Clean all high touch surfaces daily. 

 High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.  Also clean any surfaces that have blood, stool, or body fluids on them.  Use a household cleaning spray or wipe according to label instructions. 

 Discontinuing home isolation. 

Patients with confirmed Covid-19 should remain under home isolation precautions until the risk of secondary transmission to others is low.  The decision to discontinue home isolation now has been shortened to 24 hours of freedom from a fever-without the aid of medications and feeling better, yet one remains contagious for at least a week after contracting the virus and, therefore, should continue masking for 10 days!  

 Deadly Cost of Deferred Care  

 According to Active Health Management, a leader in providing physicians peer-reviewed alerts, it is critically important to reconnect with your physician(s) safely and effectively for well visits, meds, labs, and routine screenings during the aftermath of the COVID-19 Pandemic.  During the time of the pandemic data showed: 

 ·         a 60% drop-off in outpatient services; 

·         a 60% reduction in chemotherapy attendance; 

·         a 76% reduction in specialty referrals for early cancer detection; and, 

·         over 60% of respondents to one survey believe that some of their patients will experience avoidable illness due to care if they procrastinate or avoid it entirely. 

 According to The New York Times (June 6, 2023, Abelson), while hospitals and doctors across the country say many patients were still shunning medical services out of fear of contagion-–especially with new cases spiking--Americans who lost their jobs or have a significant drop in income during the pandemic are now citing costs as the overriding reasons they do not seek the health care they vitally need.  

 The twin risks in this crisis--potential infection and the cost of medical care--have become daunting realities for the millions of workers who were furloughed, laid off, or caught in the economic downturn.  It echoes the scenarios that played out after the 2008 recession when millions of Americans were unemployed and unable to afford even routine visits to the doctor for themselves or their children. 

 According to a January 2021 survey completed by the Kaiser Family Foundation, nearly half of all Americans said they or someone they live with had delayed care since the onslaught of COVID-19.    

According to the CDC, a recent analysis shows a sharp decline in ER visits during the pandemic.  Officials said there were worrisome signs that people who had heart attacks waited until their conditions worsened before going to the hospital. 

  More recently, people have begun to return to medical care, and everyone needs to have a PCP or practitioner they trust and communicate with; however, two things to note: First, in an era of widespread and worsening physician shortages, PCPs are in short supply and high demand. So are specialists. Secondly, individuals’ conditions have worsened because of the amount of time they have avoided or postponed care.  Many practitioners are complicit in this care deficit by under-prescribing medications for hypertension, diabetes and in recommending age-appropriate cancer screening. This practice of therapeutic inertia defined as lack of treatment intensification in a patient who is not at evidence-based goals for care. 

 Truncated time with patients limits practitioners’ opportunities to advise, instruct, and timely intervene in medical care especially in the Black community who bear a disproportionate burden in hypertension diabetes and nearly all cancers.  A man with hypertension that did not get his meds refilled had a cerebral stroke and almost died from complications of a cerebral hemorrhage.  A baby with club foot will now need more complicated treatment because it was not addressed immediately after birth.  Many people have allowed cancer to progress unchecked or undetected by deferring specialist care, e.g., not getting a colonoscopy (recommended beginning at the age of 45), not seeing a urologist recommended for elevated PSA (annual blood test screening for prostate cancer beginning age 45), or not getting a recommended mammogram (annually beginning at age 40) which picks up breast cancer years before it is felt, or after getting a mammogram, neglecting to get a recommended breast biopsy or diagnostic mammogram before the disease is spread.

 With the plummeting impact of the coronavirus, we see people once again seeking much needed health care but now due to the labor shortage, hospitals closings, and physicians retiring, we are not getting the preventive care required to make an impact in our survival curves.  Times to see specialists for cancer preventive care such as gastroenterologists (for colonoscopies) and gynecologists (for Pap/HPV testing) have significantly minimized opportunities for people to receive timely care.  The scheduling times to get mammograms have lengthened to as much as 6 months and we are entering an era where we are not health conscious, health literate, and do not take command of our health.  The health disparities in our community will only worsen. 

 Heart Disease-still the number one killer

 Heart disease still sits alone as the number one killer accounting for over 600,000-800,000 lives yearly in the U.S. for the past century. The rate of a heart attack occurs every 39 seconds and someone dies of a cardiovascular event every 36 seconds. All cancers combined have not surpassed ischemic heart disease which has consistently been the leading cause of death each and every year. In that vein, we have detailed our know your numbers campaign below to empower our people, to help diminish cardiovascular events along with the accepted age norms for optimal health maintenance in cancer screening.

 Know your numbers: Modifiable risk factors for heart disease: 

 1.                   Know your blood pressure, which should always be less than 140/90 and optimally less than 130/80.

 2.                   Know your blood sugar, which should be less than 100 at all times. 100 million people in the U.S. are prediabetic. One out of three will go on to become diabetic, especially if they miss the window to intervene with diet and exercise.

 3.                   Know your cholesterol, which should be less than 200 and bad LDL cholesterol less than 130, less than 100 if diabetic, and less than 70 if one has ASCVD (atherosclerotic coronary heart disease) or prior vascular event such as a stroke or heart attack.

4.                   Know your BMI-weight for given height, greater than 30 is considered obese.

5.                   Strict smoking cessation, including cannabis use with studies now showing daily use associated with 42% increase in strokes and 25 % increase in heart attacks.

Age-appropriate Cancer prevention schedule:

 ·         PAP should be done every 3 years beginning at age 21 or PAP/HPV every 5 years beginning at ages 30-65. 

 ·         Mammograms should be done every year beginning at age 40. 

 ·         Colonoscopy should be done beginning at age 45 every 10 years and more if polyps are found. 

 ·         PSA for prostate cancer screening should be done yearly beginning at age 45. 

 ·         CT scan chest should be done annually beginning at age 50-80 for smokers with 20-pack/year history. 

                 Since there are so few PCP’s and caring physicians that we trust, we propose the following be initiated in your chapter: Monthly educational program concentrating on a different disease state each month highlighting the significance of screening and prevention in order to meaningfully impact our survival curves and wipe out health care disparities. Remember health is wealth and your greatest asset is your health!

Respectfully submitted,  

Frederick D.  Harris, M.D.,  

Assistant Professor Cleveland Clinic Lerner School of Medicine, C.W.R.U. 

Board-Certified Internist 

Cleveland Clinic Community Care Section Head

Ohio NAACP Health Chair