Dr. Bailey, infection disease specialist, provides an update on COVID-19.
As we prepare to welcome 2022, it seems appropriate to look back at what anniversaries along the brief, but eventful COVID timeline we are about to pass.
Although first identified in late 2019, it was not until January 2020 that the initial COVID cases were documented domestically. As was expected, those first to manifest illnesses were the elderly and immunosuppressed, and these cohorts (along with those with comorbid conditions) have continued to be at highest risk for severe COVID symptoms, hospitalization, and death. With no vaccine or antiviral agent with proven efficacy, our caregivers were still able to develop and refine management protocols for COVID care that lead to steadily improving outcomes. The ability to utilize remdesivir, first as an investigational agent and later when granted emergency use authorization (EUA) and ultimately FDA approval, added to our armamentarium of steroids and immune modulating agents.
January 2021 saw us in the midst of our biggest COVID surge to date, driven in part by the emergence of the delta variant while COVID vaccination had yet to be rolled out to the public at large. We all helped meet the challenges of this period and welcomed a reduction in cases later in the spring. This situation likely occurred due to the increasing proportion of the vaccinated within the population throughout the early part of 2021, the benefit of natural immunity among those who had recovered from COVID despite not being vaccinated (or receiving a boost to their immunity if vaccinated on top of their illness), and the absence of a potent new variant strain to supplant the reigning delta strain for much of the summer into the fall. The contribution of the monoclonal antibodies made available under EUA from November 2020 to May 2021 should not be forgotten either; several of these were effective against the delta variant.
Over the past month or so we have seen a rise in cases and (to a lesser extent) hospitalizations due to COVID and likely attributable to the emergence and growing predominance of the new omicron variant.
Initial reports characterized this variant as more easily transmissible but causing less severe illness than the delta variant, and these characteristics have, for the most part, been borne out by observations over the past weeks. In addition, it appears to have a shorter incubation period and perhaps a shorter period of high transmissibility; this has led the CDC to shorten its recommended quarantine and work exclusion timelines.
There is also good news regarding COVID therapeutic agents (remdesivir, steroids, immune modulator agents) all have predicted efficacy against omicron. In addition, several new oral antiviral agents are on the verge of being granted EUA status (Lagevrio [Merck} and Paxlovid [Pfizer]) which should further aid efforts to treat infection early and prevent disease escalation and the need for hospitalization.
The outlook for preventative interventions is less positive but not without some reasons for optimism. Only one of the current monoclonal antibody products (Sotrovimab) seems to have retained efficacy against omicron; although currently in very short supply, efforts to produce and distribute it in large quantities by early- to mid-January are underway. The current COVID vaccines all retain some degree of protection against the omicron strains, but somewhat reduced as the time from completion of an initial series of doses increased; this protection “gap” can be overcome with a vaccine booster, however. And all vaccinated health care workers are encouraged [and mandated this year in California] to get a booster whenever they are beyond six months from completion of an mRNA vaccine series [the Pfizer or Moderna vaccine] or beyond two months from an initial J&J vaccine dose.
MY FUTURE PREDICTIONS:
Although no one can reliably predict the future, particularly when it comes to COVID, there are some predictions that to me seem more likely than not to occur:
- The omicron variant will result in a more abbreviated surge than the one we experienced a year ago over the holidays. This is based on its increased transmissibility and its reduced disease severity; a suggestion of this can be seen already in the data trends from the regions of southern Africa where omicron was first reported.
- Although we may well see spikes in cases from time to time due to the emergence of future variant strains, these will be less severe than the 2020 (and perhaps the 2021) holiday surges and may be confined to certain locales [dependent of community immunity] rather than as a nationwide phenomenon.
- Risk mitigation strategies such as hand hygiene, masking while in crowded situations with poor ventilation, and self-isolating if COVID symptoms develop, will continue to be the most effective means of controlling spread. Remember: vaccines and monoclonal antibodies do not completely prevent infection from COVID; they only provide a boost to the immune system’s ability to fight off the infection with only mild, if any, symptoms. Fully vaccinated and boosted individuals can still get COVID and pass infection on (as proven by the large number of breakthrough cases observed to be mild).
- I predict within the next year, the number of those susceptible to COVID will decrease to where it transitions from an epidemic to an endemic illness (from ongoing or intermittent crisis with mandated response to accepted way of life with decisions based upon individual risk assessments allowed). The focus would shift – appropriately – to protecting the most vulnerable among us while minimizing disruptions for the majority of the population for whom COVID will join other respiratory viruses and influenza as an annoying but very likely non-life-threatening illness.
To read an update to monoclonal antibody and novel oral antiviral therapies, click here.