“The most critical time in any battle is not when I'm fatigued, it's when I no longer care.” Craig Lounsbrough, American author and professional counselor
“We should regret our mistakes and learn from them, but never carry them forward into the future with us.”
Lucy Maud Montgomery, Canadian author
Most people are tired of hearing about SARS-CoV-2 and the COVID-19 pandemic; they have lost interest not only in what’s happening with the virus but also in the relevant science. In the February 15, 2024 article in Medpage Today, “COVID’s Latest Adaptation: It Has Lulled Us to Sleep,” Dr. Donald W. Simborg, a retired physician and medical informatics expert, declared, albeit halfheartedly, “The virus has won. We are now sleep-walking our defense.”
The war against SARS-CoV-2 is not over and the virus has not won. (See Scientific American February 6, 2024,“Rampant COVID Poses New Challenges in the Fifth Year of the Pandemic.”). But if you are one of those who’s been dozing off, this week’s Germ Gems post highlights what you need to know.
What you need to know about SARS-CoV-2. SARS-CoV-2, the virus that causes COVID-19, is a RNA virus, and therefore able to mutate rapidly—often at what seems like lightning speed. Omicron is the main variant in the U.S. This variant spreads more easily than both the original virus that causes COVID-19 and the Delta variant. Yet, Omicron seems to cause less severe disease than either the original virus or the Delta variant.
Currently, the Centers for Disease Control and Prevention (CDC) and World Health Organization are tracking BA.2.87.1, a new Omicron subvariant that has more than 30 changes in its spike protein when compared to its predecessor XBB.1.5, the variant that the updated (2023-2024) vaccine is designed to protect against. No cases of infection by BA.2.87.1 have been reported to date in the U.S. Nonetheless, the worry is that this subvariant has the potential to evade immunity, including that provided by protective antibodies elicited by vaccination. So stay tuned.
Improvement in trust—the good news. Many of the setbacks in the global and local responses to the COVID-19 pandemic can be traced to failures on the part of those entrusted with public health to communicate meaningfully—in an honest, understandable, and trustworthy manner—with their constituencies. People lost trust in public health institutions. It appears that trust is now being restored.
According to a February 12, 2024 article in Scientific American, “CDCs Labs Are Making a Comeback,” trust in the CDC is rebuilding. Also an article in the February 2024 issue of Nature, “Largest post-pandemic survey finds trust in scientists is high,” suggests people around the world have high levels of trust in scientists. These developments are crucial not only in waging the ongoing war against SARS-CoV-2, but also in dealing with other public health emergencies as they arise.
What you need to know about COVID-19 vaccines. The COVID-19 vaccines are safe and effective. (The CDC and the Food and Drug Administration continue to monitor for vaccine adverse events and have found nothing to derail their widespread use.) In the first ten months that they were available, the COVID-19 vaccines saved over 200,000 lives and prevented over 1.5 million hospitalizations in the U.S. Yet, no area of public health has been impacted more negatively by the erosion of trust in the CDC than that of the uptake of COVID-19 vaccines.
There are still roughly 20,000 people hospitalized with COVID-19 every week in the U.S. and about 2,000 deaths a week caused by the disease. By February 2024, however, just 21% of adults had received the latest COVID-19 booster. This feeble acceptance of booster doses of the vaccine can be attributed in part to vaccine hesitancy fostered by promoters of misinformation but also to “vaccine fatigue.”
On February 28, 2024, the CDC Director Mandy Cohen, MD, MPH. endorsed the recommendations of its Advisory Committee on Immunization Practices that adults ages 65 and older should get an additional dose of the latest COVID-19 vaccine this spring. This recommendation coupled with 54% protection against serious outcomes conferred by the most recent booster should make following this advice a “no-brainer.”
And, if the protection afforded by the vaccine against severe and life-threatening disease isn’t enough to persuade you to get off the fence about the vaccine booster, you also need to know that the booster is the most effective means of preventing the disabling illness Long COVID.
Other preventive measures. The wearing of a N95 fitted face mask (or respirator) to prevent picking up or spreading the virus remains contentious. Most recent analyses, however, support mask use in community settings. (See “Masks During Pandemics Caused by Respiratory Pathogens—Evidence and Implications for Action,” JAMA Network Open, October 31, 2023).
On February 13, 2024 the CDC dropped the five-day COVID-19 isolation guideline for those with a clinical bout of the disease. According to the CDC’s new guidelines, stay home until your symptoms are mild and improving and it’s been a day since you’ve had a fever. Then remain cautious, wear a mask and keep your distance from others. The CDC decided that this shift to a more practical approach was warranted because most people have developed a level of immunity to the virus due either to a prior infection or vaccination.
What you need to know about treating COVID-19. Nirmatrelvir-ritonavir (Paxlovid), molnupiravir (Lageviro) and remdesivir, three FDA-approved antiviral agents, remain the most widely used drugs in the treatment of outpatients with COVID-19. And there are number of new drugs in the pipeline that look promising, e.g., sotroviramab, simnotrelvir, and ensitrelvir. (The antiparasitic drug Ivermectin, however, continues to show no benefit—even in studies of ever increasing doses.)
Paxlovid consistently outperforms molnupiravir. It also has an advantage over remdesivir as Paxlovid is taken orally versus intravenously. But, Paxlovid is being underused. (See, MedPage Today January 31, 2024 article, “Why Aren’t More Doctors Prescribing Paxlovid to High Risk Patients?) Why?
Its potential for drug-drug interactions, high cost, medical misinformation, and distrust of the pharmaceutical industry all factor into Paxlovid’s poor uptake. Yet, there’s no question that the benefits of early Paxlovid treatment are substantial; its use is associated with an 84% lower risk of hospital care.
The U.S. government decision on March 8, 2024 to end free courses of Paxlovid and free COVID testing for uninsured people does not help. This is a time when the government needs to expand its “Home Test to Treat” program and to promote its collaborations with U.S. pharmacies in testing for and treating COVID-19.
Unanswered questions. Many aspects of the biology and pathobiology of SARS-CoV-2 remain under investigation. Two unanswered questions stand out in my mind: (1) what is the origin of this particular coronavirus?; and (2) when, if ever, will it become seasonal?
Did the SARS-CoV-2 spillover into a human from an animal or was it created by “gain of function” research in the Wuhan Institute of Virology? Research into this question is now curtailed if not over. For delicate political reasons, I am convinced that this question won’t be answered in my lifetime, if ever. But I believe the question of whether SARS-CoV-2 will become a seasonal pathogen can and eventually will be answered.
SARS-CoV-2 has six cousins. Like SARS-CoV-2, two cousins also emerged in the 21st century and caused devastating pandemics: the relatively short-lived severe acute respiratory coronavirus 1 (SARS-CoV-1) that first appeared in China in 2003; and the Middle East Respiratory Syndrome (MERS) coronavirus that was first reported in Saudi Arabia in 2012 and is an on-going problem. In addition to those two microbial marauders, SARS-CoV-2 has four other cousins that are more of a nuisance—they cause seasonal common colds—than killer viruses. It is hoped SARS-CoV-2 follows the lead of these more benign relatives. (See January 12, 2024 Science, “COVID’s Cold Cousins” for a timely review.)
In a January 29, 2024 Science News article, “Here’s why COVID-19 isn’t seasonal so far,” geneticist and science writer, Tina Hesman Sacy, PhD makes the case that for now, SARS-CoV-2 “is on its own ever-changing timetable. Whether it eventually settles into a seasonal virus may depend on us. The strength of our collective immune systems and our willingness to take precautions to not spread any illness to others may eventually wrestle it into seasonal submission.” In other words, this is not the time to doze off. Instead, it is time to listen to the advice of your healthcare provider and to the recommendations of the reconditioned CDC.
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