War on SARS-CoV-2: Year 4 of the COVID-19 Pandemic
“You may have to fight a battle more than once to win it.”
- Margaret Thatcher, Prime Minister of the United Kingdom, 1979-1990
“A lie gets halfway around the world before the truth gets a chance to put its pants on.”
- Winston Churchill
By March 11, 2020, the date that the World Health Organization (WHO) deemed COVID-19 a pandemic, all major public health officials had declared war on SARS-CoV-2, the virus that causes COVID-19. We now know what does and what doesn’t work in fighting this virus. Vaccines are the most effective weapon we have in our arsenal, but they are being underutilized. This caused the Center for Disease Control and Prevention (CDC) to issue a wake-up call on January 9, 2023: “Stay Up to Date with COVID-19 Vaccines and Boosters.” In this week’s Germ Gems post, I highlight the key progress we’ve made in this war and identify major battles that lie ahead.
Where things stand. By January 10, 2023, over 665 million COVID-19 cases and 6 million COVID-19 deaths were recorded globally. The U.S. continued to lead the world with more than 101 million cases and 1.1 million deaths. (The following day, the U.S. shattered global records by reporting 1.35 million cases of COVID-19 in a single day.) If these statistics aren’t worrisome enough, on January10 the latest SARS-CoV-2 subvariant XBB.1.5, described by some as “crazy infectious,” accounted for 25% of U.S. cases. As stated in a December 23, 2022 editorial in Nature, “There’s no room for COVID complacency in 2023.”
Building our arsenal. On May 15, 2020, President Donald Trump formally announced Operation Warp Speed (OWS). The aim of OWS—to deliver 300 million doses of a safe and effective vaccine for COVID-19 by January 2021—seemed preposterous to most scientists. After all, the usual timeline for vaccine development is five years. But to almost everyone’s astonishment the goal of OWS was achieved. This extraordinary accomplishment depended upon experts in multiple disciplines (research and technology, the pharmaceutical sector, and government) working together.
The COVID-19 vaccines remain the most important weapon we have in our arsenal. Cumulatively, these vaccines have prevented more than 18 million COVID-19 hospitalizations and more than 3 million COVID-19 deaths globally. And these vaccines keep on giving. In particular, the primary mRNA and bivalent vaccine boosters developed by Pfizer/BioNTech and Moderna continue to provide safe and highly effective prevention of SARS-CoV-2 infection.
The two other discoveries that were crucial in making progress in our war against SARS-CoV-2 were: (1) determining how the virus is transmitted; and (2) developing effective antiviral drugs against COVID-19. Once it was known that the virus was transmitted mainly by aerosols via coughing, singing and speaking loudly, we deployed weapons like the N95 and KN95 masks and while not perfect, wearing masks helped. In addition, researchers developed Paxlovid, an antiviral drug that prevents severe and fatal cases of COVID-19. Finally, development of reliable rapid diagnostic tests and point of care treatment were important milestones in the fight against SARS-CoV-2.
The virus responds: it mutates. Despite the vaccines, boosters, and masks, people still get infected and sickened by SARS-CoV-2. Why? Because our enemy has an astonishing capacity to mutate.
From the outset of the pandemic, coronavirus experts knew that SARS-CoV-2 would mutate. But it is doubtful anyone saw the blinding speed of mutations—mutations that really picked up steam when the Omicron variant emerged in November 2021.
The “variant soup” or “gaggle of new Omicron subvariants” started with BA.5 last summer. In his article on November 26, 2022, “Happy Birthday, Omicron,” New York Times journalist Carl Zimmer describes how this “swarm” of Omicron subvariants confounded vaccine development and therapy (including the role that mutants play in reinfections and in the loss of effectiveness of monoclonal antibodies).
Recently, the Omicron subvariant XBB.1.5 arrived. It is said to be the most transmissible (contagious) of all. So far, this subvariant doesn’t appear to cause more severe disease than earlier subvariants, but it’s too early to determine definitively whether the current SARS-CoV-2 vaccines and boosters will continue to hold up.
Warped theories speedily disseminated. Social media and the Internet are responsible for fueling the speedy dissemination of misinformation and disinformation about COVID-19. This includes dissemination of incorrect information about the ineffectiveness or dangers of preventative measures (such as, vaccines and masks) as well as treatments like Paxlovid. Equally confounding is the transmission of misinformation about measures that clearly don’t work, for example, taking the drug ivermectin to treat COVID-19.
Vaccine hesitancy is one of the most inscrutable aspects of the war against SARS-CoV-2. Battling the virus is challenging enough, but infiltration of the public health ranks with anti-vaccine and anti-science promoters is unconscionable. Both the WHO and CDC have committed substantial resources to root out perpetrators of bogus information about vaccines—misinformation which makes parents reluctant to have their children vaccinated against other common pathogens. Several innovative techniques to squelch misinformation have been developed, and a study published in Nature on January 9, 2023, suggests some progress is being made (the global COVID-19 vaccine acceptance rate rose by 5% from 2021 to 2022).
Two major battles that lie ahead. One of the biggest concerns for the near future is the current onslaught of cases and deaths occurring in China, a country that became victim of relaxing its failed “zero COVID” policy. (See Dr. Dhruv Khullar’s January 8, 2023, article in The New Yorker, “The Dire Aftermath of China’s Untenable ‘Zero COVID’ Policy.”) Reliable data from China is difficult to come by, but some epidemiologists suggest the current COVID-19 wave in China is infecting 37 million people a day and could ultimately kill one million people.
The second big challenge in both the short and long term is the illness called long Covid, a so-called “pandemic within the pandemic.” Long Covid is a baffling, debilitating condition that afflicts an estimated 19 million Americans. As discussed in my September 7, 2022, Germ Gems post, “Long Covid: Older Adults at Risk,” long Covid shares many of the features of another disabling disease for which there is no established treatment, that is, Chronic Fatigue Syndrome.
The good news on the long Covid front, however, is that the National Institutes of Health and other research organizations are funding a large number of basic science studies and clinical trials directed at discovering the pathogenesis of long Covid and finding an effective treatment.
Battle fatigue. There is much to be optimistic about in the war against SARS-CoV-2. In particular, we have effective vaccines and drugs, and new ones are being developed. Nevertheless, public health workers and healthcare providers involved in the fight against SARS-CoV-2 must be disheartened by articles, such as, this January 12, 2023, publication in Politico, “Seniors shrug off White House urgent pleas to get vaccinated as new variant spreads.”
Let’s face it, although the “fog of war” is lifting, everyone is suffering from the “fatigue of war.” Fortunately, many talented warriors (healthcare providers, public health practitioners, and researchers) are forging ahead. And it’s reassuring to know that on January 10, 2023, the CDC announced an investment of $3 billion in rebuilding US public health infrastructure and that they also renewed the “COVID-19 Public Health Emergency,” thus maintaining access to care.
Although the War on SARS-CoV-2 is far from over, our troops have made great progress. It seems that Leo Tolstoy, the Russian writer and author of War and Peace, had it right: “The two most powerful warriors are patience and time.”