Here are my thoughts on where we are today and my path for moving forward with Covid. Sorry for the length, but I had a lot I needed to say.
1. SARS-CoV-2 is endemic. Read that again. SARS-CoV-2 is endemic. It is NEVER going away and we will never DEFEAT it in such a way as to make it go away. Eventually, everyone will become infected by SARS-CoV-2. If you are vaccinated, you should not have a severe case, but do not expect to not become infected.
2. SARS-CoV-2 will continue to mutate in ways that make it more infectious and likely less severe. This happens with most viruses and it is obviously happening with SARS-CoV-2 and the Omicron variant. Viruses will mutate in ways that allow it to evade the body's first line of defense. Past cold viruses evolved in this way and it is why we still become infected with cold viruses today. It is believed some of the coronaviruses we have today began as pandemics and were quite deadly. As people became infected, the viruses mutated and only those with mutations that allowed them to evade the body's first line of defense (antibodies) were successful in spreading. Luckily for us, the human immune system has other methods of fighting the virus, beyond antibodies and these continue to provide protection. It is much more difficult for a virus to mutate in ways to evade all of the body's defenses and you can see this with the common cold. We get sick because the coronavirus (or rhinovirus) has mutated in ways to avoid our first line of defense. They infect us for 7-10 days, since this is how long it takes for the body's immune system to mount an attack and to defeat the infection.
3. The current vaccines are no longer successful in warding off infection and they will continue to become less and less successful in warding off infection. Why? See point 2. Viruses mutate in a way that allows them to eventually evade the body's first line of defense. The vaccines we have today for the SARS-CoV-2 virus are not "neutralizing" vaccines. They are built to produce antibodies that recognize the RNA of the virus - an RNA that is constantly mutating. To create a neutralizing vaccine, you have to target a section of the virus that is slow to mutate (like the Novavax vaccine). The good news is our body's T and B-Cells continue to recognize it has been invaded by the SARS-CoV-2 virus and can mount a defense to fight it. As such, vaccines will continue to help provide protection against severe illness, hospitalization, and death.
4. The vaccines we have today will continue to struggle in providing a first line of defense, no matter how many times we get boosted. If the booster produces the same antibodies and the virus has mutated in such a way as to evade the vaccine induced antibodies, it will be able to infect us. Boosters would have to continue to evolve with the virus to provide additional protection in the long term. We are seeing increasing reports of the Omicron variant infecting people who are fully vaccinated AND boosted. I am not surprised by this and no virologist worth their salt should be surprised by this happening. Viruses mutate and only the ones that can successfully evade a vaccinated person's antibodies will survive.
5. The good news, the body's T and B-Cell defenses should do much better at protecting us against the different variants of SARS-CoV-2. This is why you are seeing people become infected with the Omicron variant, but those infections are less severe. The variant evades the antibodies, but it can not evade the protection provided once the T and B-Cells kick in and ramp up the bodies defenses. It is why people who are vaccinated should have less severe infections than those who are not vaccinated. I will repeat something I posted just last week. I personally know three people who became infected in the past couple of weeks. All were FULLY vaccinated and had also received their boosters. All became infected and all had mild cases.
6. As I have posted before, there is a vaccine (Novavax vaccine) that is finishing up trials and is ready to go through the approval process. This vaccine uses more conventional vaccine technology and it also targets an area of the virus that is less likely to mutate. Reports indicate it has an efficacy of 90% against ALL variants, including the Omicron variant. It needs to get approved as soon as possible and I believe it can become another important weapon to help fight the future variants we are sure to encounter.
7. As I posted last week, there is a new treatment that should be approved soon (Paxlovid from Pfizer) that shows some promise in successfully treating people who have become infected with SARS-CoV-2. Unfortunately, the FDA has NOT scheduled a formal review yet. It is strange to me that they are not moving with rapid pace to get this drug reviewed and approved, since we are faced with a more highly transmittable version of the virus. As I mentioned last week, Paxlovid is a protease inhibitor and as such, it seeks to block the viruses ability to replicate. In clinical trials it has shown to be effective in reducing hospitalization and death by 89%. As I mentioned last week, I am taking a wait and see attitude on how successful it will be in actual use, but the mechanism for how it works appears to be promising. Interestingly, it has the potential to not only block SARS-CoV-2, but other SARS and MERS viruses may also be blocked, since the protease it inhibits is found in these other viruses.
An earlier antiviral drug approved from Merck (Molnupiravir) has shown to be less successful in actual use than it did in clinical trials. Molnupiravir works differently than Paxlovid. It seeks to disrupt replication by mimicking a building block of the virus' genetic material.
8. Given all of this, I believe we are at a point where we must stop focusing on cases and basing health policies and restrictions on cases. Instead, we should be basing policies on severe cases that lead to hospitalization and death. Since we will always see cases and we now have ways to decouple cases from hospitalizations and deaths, it no longer makes sense to worry so much about cases. I applaud the NFL for their recent change in policy with regards to the testing of fully vaccinated and asymptomatic players. If a player is fully vaccinated and asymptomatic, they are not going to be tested. Hopefully the NHL will follow their lead (something I am not sure will happen) and colleges continue to adopt this policy. If they do not, you will see more game cancellations and have the potential for what happened to NC State baseball last year to occur again this year.
9. My son just texted me to tell me they have had to return to wearing masks to condition/lift weights and for all in-person meetings. In my view, this is utterly ridiculous, but they did not ask me for my opinion. It seems like we have not learned anything from last year and no longer trust the vaccines. I will point out that all but 3 of my son's teammates are vaccinated and they all had to get their boosters this past week. Wake will require boosters for all students, staff, and faculty, when they return to campus for the Spring semester.
If you made it this far - thanks for taking the time to read and I hope you have found something that is helpful. You are also free to disagree and challenge what I have written. Unlike The Elf, I welcome critique/criticism/comment and find this is a way we advance understanding.
