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The Epidemic of Covid Complacency
Isn’t it great? The pandemic is over. We don’t need masks. The virus is contained. Forget about vaccines since they don’t work. The vulnerable are protected. Future variants will be benign.
The only problem is that none of this is true. Any proclamation that the pandemic is over ignores the potential recrudescence of a new variant with high transmission and immune escape. We will still benefit from using masks for many situations including protecting immunocompromised and vulnerable people, which also includes nearly 100 million Americans who haven’t been vaccinated, many without infection-acquired immunity. We are still averaging nearly 50,000 confirmed new cases a day, at a time when rapid tests are increasingly being used and not factored in. This is more than 3-fold the level of new cases, and 2-fold the number of Covid hospitalizations, than in June 2021. The metrics do not lend any support to the mission of containment accomplished.
The vaccines, particularly with a booster shot, work exceptionally well to protect against hospitalizations and deaths, as I previously reviewed. The newly updated CDC data indicates a 3-shot 92% reduction of hospitalizations and a 96% reduction of deaths during the Omicron wave, through the end of January 2022, across all ages 18+. For only 2-shots, the reduction of hospitalizations was 75% and for deaths 85%.
Notably, the United States ranks 55th in the world for booster shots and 67th for 2-shot vaccinated. It is remarkable that we are at the lowest rate of primary vaccinations and booster uptake since the beginning of their respective campaigns.
We are far from protecting the vulnerable. The booster rate for age 65+ in the United States is 66% whereas it is over 90% in many European and Asian countries. Any letdown of mitigation leaves our >7 million immunocompromised individuals more vulnerable. There are about 19 million young children below age 5 for whom no vaccines are approved. Ignoring Long Covid will not make this disabling condition go away, now affecting millions of Americans, with recent reports of serious cardiovascular and mental health impact at 1-year. The important, unique report of longitudinal brain imaging and cognitive testing in 401 cases, before and after infection, and 384 controls, from the UK Biobank and University of Oxford researchers, was just published in Nature. It demonstrated the reduction in grey matter and brain size, particularly in the limbic region, and cognitive decline. The idea that cases are no longer important or meaningful defies such findings. The UK recently reported that 2.4% of its population is suffering from Long Covid symptoms, self-reported. That equates to tens of millions of Americans. It’s a myth that SARS-CoV-2 is destined to become progressively less virulent. Alpha was worse—more pathogenic—than its predecessors D614G or Wuhan; Delta was worse than Alpha.
Plan For A Worse Version of the Virus
As I recently wrote in the LA Times, we don’t want to rely on luck with respect to how the virus will further evolve. Sure, it could become a 5th common cold coronavirus but we certainly can’t count on that. Its 30,000 bases can mutate in seemingly an infinite number of ways, and there are multiple particular pathways that are concerning.
Four ways SARS-CoV-2 can evolve to be more fit
✓ Immunocompromised hosts
✓ Animal reservoirs transmit to people
✓ Recombination from co-infections
✓ Unrestrained spread through large populations
There have been multiple case reports of rapid and extensive evolution of the virus in people who are immunocompromised, which likely accounts for how Omicron was created and spread. We continue to discount the importance of the extensive, broad range of animal reservoirs even though there has been documented evolution of new lineages in deer, with potential transmission to humans, and case reports of spillover from pet hamsters to people. Further, we know of the potential for a human-animal hybrid version that can occur as was the case with bird flu and influenza. There have been recent reports of simultaneous co-infections with Omicron and Delta, which like the human-animal hybrid, affords the potential for a recombination event to occur that brings together components of two different strains. Like zoonotic spillover these human co-infections are rare, but likely under-detected, and it only takes a limited number—one—to take hold. Put that in perspective with the billions of people who have not even had 1 dose of vaccine around the world, and likely without any protection from prior infection, who can unwittingly provide a path to facilitate the virus’s evolution. And why rapidly getting global vaccine equity is so damn essential. In aggregate, the calculus is not in our favor. Too many ways the virus can come back to haunt us. Not good odds if you’re taking bets.
Biden’s New National Preparedness Plan
On March 2nd, the Biden Administration released a 96-page plan which was far more comprehensive than any prior planning document. It included better data and genomic surveillance, wastewater surveillance, aggressive countering of mis- and dis-information, a Test-to-Treat strategy of rapid testing and on the spot Paxlovid pill pack distribution at pharmacies, more research on Long Covid, and prioritization of a pan-β-coronavirus vaccine. All these components are essential to be prepared for a new variant and a next phase of the pandemic. Yes they will require additional funding beyond the $4 trillion Congress has authorized for Covid relief. Indeed, the budget crunch has led to the Administration not buying over 9 million Paxlovid pill packs it had originally committed to in January. While readiness requires support of this multi-pronged plan, the current movement towards a quiescent phase may well induce a lull in our defense against the virus. Further, the ongoing war in Ukraine has appropriately commanded worldwide attention, such that the pandemic has become a mere distraction at the moment.
Now is the wrong time to become complacent. Our vaccination and booster rates have left us in a highly vulnerable position, worse than many low and middle-income countries. Premature cessation of mitigation measures, particularly in many regions of the country with high levels of circulating virus, leaves our immunocompromised population susceptible. The math for a more harmful version of the virus is unfavorable. Unwillingness to support a solid plan to be prepared—for the first time in the American pandemic—is looming. The United States has performed poorly relative to peer countries from the start of the pandemic. Not taking advantage of this moment to get ahead of the virus, instead of being entranced with a false sense of security, will just add to a historic big miss.