STAT readers on new CDC Covid guidelines, weight loss drugs and mental health, and new psychiatric meds

STAT now publishes selected Letters to the Editor received in response to First Opinion essays to encourage robust, good-faith discussion about difficult issues. Submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

“The CDC’s new, relaxed Covid isolation guidance makes perfect sense,” by Ashish K. Jha

I was disappointed to read “The CDC’s new, relaxed Covid isolation guidance makes perfect sense.” It inaccurately portrays the ongoing risks of Covid-19. In recent weeks, there have been an average of 2,000 deaths and 20,000 hospitalizations per week. The CDC just released the first data on the prevalence of long Covid in 2024, showing that 6.8% of U.S. adults are currently experiencing long Covid (up over a percent from the prior data collected last October), including after reinfections and among people who have been vaccinated. And while I agree that viral loads decrease along with symptoms, it is still irresponsible and inconsiderate to go out into public unmasked while contagious. The CDC’s new policy encourages individuals to think only about themselves — when they are no longer sick, they can resume normal life. But we know most people are contagious even if they never show symptoms and after their symptoms resolve.

Instead, we should be focusing on the data point that matters — viral load — when determining when it is safe to return to everyday life. By allowing known Covid-positive people to resume normal life, we shift the burden of Covid prevention to those who are at the highest risk. Most high-risk individuals have been taking much more precautions than the general population, and will need to increase those actions. Many feel unsafe seeking medical care, using public transportation, and going to the grocery store. Many of us act as if every stranger we encounter could have Covid; our lives depend on it. Instead, our governments should focus on low-effort ways to reduce Covid spread, such as setting standards for clean indoor air, testing to leave isolation (using freely available rapid antigen tests), offering high-quality masks and recommending them in public indoor settings, and mandating paid sick leave. We should improve public health communication about the risks of long Covid, long-term health impacts of Covid infection, and the ongoing risks of certain populations. Our policies should adapt to the current research and technology — but not at the expense of the high-risk individuals in our communities.
— Julia Moore Vogel, Scripps Research & Patient Led Research Collaborative

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Please tell me how I, as a high-risk individual, can stay safe? Ideally, I’d like a way that I can stay safe while also going to work, buying groceries, and accessing health care. Expecting vulnerable people to stay home in isolation forever while creating ever increasing numbers of disabled, vulnerable people through infections is the road to ruin.
— Joy Matthews

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Burdens on people are one thing when the potential consequences largely only impact themselves or others not at high risk. When they put other people at serious risk by spreading a disease that is highly contagious and causes possible hospitalization and death to so many people — those over 65 alone are also over 30 million people in the U.S. — then burdens should have much higher requirement for being “too onerous.”
— David McNiff

“It’s time to rethink everything about our approach to psychiatric drug development,” by Amit Etkin

A valuable contribution. I wonder if “exposure” (AUC) is ever measured as a component of “precision” that could be correlated to drug effect in the real world? Should we not consider variable clearance and drug-drug interactions as a component of performance along with biomarkers and patient perceptions of success? Such measurements show great promise with antibiotics and small molecule chemo. I realize psychiatry (like pain) is more ambiguous. We can’t decide if we don’t measure in individual patients post approval.
— Peter Kissinger, Purdue University, Inotiv, and Phlebotics

“The complicated connections between weight loss drugs and mental health,” by Jody Dushay and Karen S. Greenberg

As a therapist, someone who has been maintained for years on antidepressants, and a patient now on Ozempic, I was so pleased to see this thoughtful discussion taking place. I have some additional thoughts for consideration: 1) I suspect that increased suicidality could also be related to the disappointment that weight loss brings. That is, being in a smaller body may solve specific problems (e.g., knee pain), but we have been led to believe by social conditioning (especially for those raised as girls) that it is a key to overall happiness. When you arrive in your smaller body and you find that the challenges of your life basically the same — oof, what a letdown. We know intellectually that this will be the case, but emotionally we are often holding onto a belief like, “If I could just get this weight off, everything would be OK.” 2) I’ve noticed since starting Ozempic that my dream intensity has ramped up significantly, even on a low dose. I wonder if this is a common side effect, and what this can tell us about how semaglutide is interacting with the brain.
— Tara McGrath, LMFT