I 'm really disappointed and worried about the number of experts being given media attention as they put their focus at how well we are doing against the virus, rather than focusing on the damage still being done and what can be done to combat it. Over 400 deaths a day is 150 thousand deaths a year - about 5 times the number of flu deaths in an average year. Where is the government money and will to keep fighting this disaster. Where is the financial support for new vaccines, including possible "universal" vaccines and nasal vaccines, and more anti-viral treatments? The effort to deal with Covid has gone from "warp speed" to a crawl. Where is the money and why have the CDC and FDA been allowed to return to the glacial speed which characterized their former review processes? The "new normal" is to sound the praises of our "successes" and encourage complacency. I am sorry to say that your article - as honest and informed as your writing always is - will be utilized as another expert opinion to add to the current analysis of the virus as mostly conquered and now something we'll just have to learn to live with. That is probably not your opinion but it will be read that way. Please emphasize how much more can and should be done, not just relying on individuals to protect themselves from a society which has apparently abandoned a sense of social responsiblity.
I apologize if this comment seems too strident and critical. I do appreciate your work very much which is why I am so upset at reading another article that seems to lend strength to those who want to "put it behind us".
Thanks so much for your message. I think your comment is fair and reflective of the frustrations of many: this emergency is not over. And I agree. But we can have two things at the same time: A decrease in severe disease and the desperate need to continue to fight, communicate, and innovate. It's not one or the other. And I caution people in thinking that way. It's incredibly imperative (but difficult) to communicate this message.
The decrease in severe disease can only be seen as potentially transient. That's why it's so important to maintain vigilance and to continue to communicate the importance of continuing to work on this disease.
As for "Where is the money", I fear there's been too much coverage, as you've noted, to the "improved status" leading a lot of the population... those inclined to believe there was ever a public health emergency in the first place... to think we've reached an endemic state. With the inherent problem they don't understand endemicity, and further don't understand that not all endemic viral outbreaks are without severe consequences. Instead, the message they're starting to hear is, "It's over" and that's what they communicate to their Congress-critters. Then, there are House and Senate members who never believed in the virus, or perhaps did but have spread disinformation for their own reasons. Thus, Congress, hearing from their constituents that, "It's over" doesn't see any reason to support efforts to continue important research and development. Or to put a more cynical point on this, perhaps one party is considering politicizing the number of ongoing deaths as a failure of the other party in the 2022 elections.
Communication, as Katelyn notes, is imperative and difficult. Overall, we've done a poor job of communicating to the public the important information about COVID-19. Katelyn, you're a breath of light in that regard. Thank you.
Is there a decreased risk of severe disease at the individual level? This is something I have struggled to understand. I know many people have had COVID and/or had vaccines, which reduces their individual risk. But if you are a person who has not had COVID and is immunocompromised and high risk, is the disease really any less severe than it was 2.5 years ago? With precautions completely gone and transmission very high (at least where I live), it's hard not to feel like there is no hope for these people.
One of the hypotheses is that earlier omicron infection provides some degree of immunity to later (BA.5) infection. A lot of the US population were hit with BA.1 or BA.2/BA.2.12.1. BA.5 is pretty good at evading the immune response elicited especially from ancestral strains of SARS-CoV-2 (Delta and prior), where vaccines were extremely effective. Recent literature suggests, but it's not absolutely proven, that an immune response to an omicron infection, e.g., BA.1, may provide some degree of protection against serious illness. Note that other parts of the world are seeing increases in serious illness and hospitalization, and they're finding BA.5 as the cause.
Note that there are a lot of people who have HAD COVID but were asymptomatic. With well over 60% who are seropositive, and with the likelihood many were (re)infected during the initial surge for omicron, that number is almost certainly increasing. They could have a humoral response that will, again, reduce the severity if not precluding infection.
To your specific question, a COVID-naive person with a compromised immune system and at high risk should pursue immunization and boosting along the appropriate schedule to minimize their risks.
I know others who are sharing that concern, including people who are healthy (for their age) but concerned about bringing home an infection to immunocompromised people after travel. What do you think of this cobbled-together (and admittedly variably practical) plan, assuming the travel by the healthy person is deemed very important and both traveler and immunocompromised people are infection-naïve, are vaxxed to the max permitted by their medical condition/immunologist? Travel includes flying, taxi to/from airport, no other public transportation. (1) Wear N95 (properly, and rotate or dispose of them) at all times indoors (including the plane) and outside when people are nearby; (2) Fastidious hand-washing (or alcohol goo used properly); (3) Shower and wash hair twice daily (not sure how much that helps...) (3) When arrive home (assuming asymptomatic) isolate to the degree possible for 3 days and on day 4 take a home *Molecular* test (like Cue or Lucira); possibly again on day 5. I realize the feasibility of this plan is variable and almost certainly not foolproof (and, of course, is based on one's belief how bad it would be for either party to become infected...which makes me wonder what kind of travel would be that 'necessary' at this point in the pandemic?) Not a good sign that I'm already thinking of more variables!
Covid, Polio, and Monkeypox, oh my! If ever there was a time we needed YLE it is the present. With climate change rapidly changing the epidemiological landscape, data-driven analysis is our best response. So keep it up Katelyn. Covid is definitely not leaving the stage yet. Worse it may be just the warm up act.
Not to mention Ehrlichiosis, anaplasmosis, A(H1N1), Enterovirus D68, St Louis Encephalitis, West Nile, Begaza Virus, A(H5N8), A(H9N2), A(H5N6) and of course, tick borne Encephalitis!
I should mention that all the above are serious problems and form a sea of potential distress. To me, D68 is particularly distressing, striking as it does at children.
My husband and I, in our mid-70s, are aware that--despite several boosters--we'll continue to be at risk as long as the right wing's pro-COVID propaganda machine exists. Apart from voting, we can't come up with any way to stop it. That's disheartening (and don't get me started on Dobbs. I swear, GOP politicians and media personalities seem evil to me).
We can’t forget that many elderly have been vaxxed and boosted x 2 and are running out of time for immunity and possible prevention of serious outcomes. No clear path to the next step? Even Fauci hedging on this. What’s going on? Seems like we could be headed for another perfect storm to me.
My husband and I have had several boosters, and it's looking like the most recent one might just carry us to the projected new general-purpose injection this fall. Of course, Republican politicians are fighting that tooth and nail. But I've got my fingers crossed so hard that it's difficult to type this comment.
I don't know that my last booster is recent enough to carry me over the finish line to the BA1/4/5 booster but I may throw in a LAV against -whatever- to give my innate immune system a boost.
Not sure when the ‘projected’ vaccine or booster is anticipated this fall which is why my comment. I don’t understand your statement about Republican politicians ‘fighting it tooth and nail’ or your evidence of this or what they’re fighting. We have to stop politicizing this. That’s not where my comment was coming from.
The proposed vaccine is likely a pan-coronavirus vaccine in Phase III trials from the US Army. Congressional funding for additional efforts on COVID (see the WaPo article; I'm expressing no political comments, but it's as good as we're likely to get at analysis) research, vaccine development, planning for additional outbreaks, testing, or international vaccine distribution are essentially not happening. Note that international vaccine distribution to the point of shots in arms is necessary to actually get a handle on this virus. It's NOT something that can be quelled solely in the US.
Agree with much of what you say. It seems there’s a caveat with getting shots in arms internationally since even when vaccines were finally made available, just like in the US, people were suspicious and resistant especially in third world countries. I’m not certain that problem will ever be solved so spending money on it seems wasteful at some level. I think International health organizations need to help with the financial part and distribution part and should not be solely on the shoulders of the US. My opinion of course.
It’s not solely on the shoulders of the US taxpayers. There are international organizations who are working to spread vaccines of all forms internationally.
Thanks for the WaPo article. Unfortunately I don’t think this article clearly provides all the information except this being the reason some republicans wouldn’t sign the bill as quoted here “the deal collapsed as Democrats raised questions about the removal of international aid from the package and lawmakers of both parties objected to a separate plan to lift pandemic restrictions at the border” I don’t know if you saw that. It seems once again the devil is in the details and both parties were pushing back, however Wa Po makes it appear as though the Republicans were responsible. It seems there were some items added to the bill that weren’t Covid related and other items the other majority party wasn’t happy with so it’s a net-net in my opinion. Back to my original point…the next gen of vaccines are being developed but everyone wants to tie it to politics. We should have learned from the last experience that this isn’t the way to approach it. Washington was handing money out like candy to children for Covid and much of it wasn’t used for Covid. Everyone got stimulus money whether they needed it or not. Covid is not a crisis any longer. There needs to be accountability. Some cities are still trying to spend money they received. A lot of money was spent on vaccines that don’t prevent us from catching the virus as was originally promised. Now the chickens have come home to roost 2 and a half years later and we’re still no better off.
First, if the Administration had to repurpose ANY funding from testing to any other priority, that was proof they don't have the money needed to handle priorities. Testing is perhaps our biggest failure from a public health perspective, starting with the origins of the emergency in this Country.
As always, thank you for your hard work and wisdom, Dr. Jetelina.
Have you heard any whispers about approval of a 4th dose (2nd booster) for people under 50? I thought that was coming last week, but then I didn't hear anything.
Ah! Thank you, Dr. Hart. I hadn't seen that, and it's exactly the information I was looking for. I guess it looks as though my next booster won't be for a few months, now.
We heard of a great project. A friend was visiting family in the Toronto general area and the local libraries were lending out CO2 meters so that members could check the ventilation in buildings.
I'm actually concerned we're seeing fewer diagnoses that include "with COVID" today. Also, I'm aware that there are some medical facilities no longer testing for outpatient procedures. The upshot of this is we are missing hospitalization data specifically for COVID, but may see increases in hospitalizations that are non-specific. At that point what we'll have is the pandemic-averse telling us it's no longer a COVID problem but people are just getting sicker.
I'm wondering if the reason we ARE apparently seeing less severe disease is the combination of slowly increasing vaccination totals, and omicron infection providing a more omicron-specific hybrid immunity for BA.5 in the US vice other countries where they might have avoided the initial omicron surge, but are now caught in the BA.5 push.
Thank you for this piece - and like @David McNiff, I hope it will be experienced as both reason for (cautious) optimism and importantly as a guide on how to be aware. Unfortunately, there are enough nuances and potential consequences (intended or not) that many people are just looking for thumbs-up-or-down message (especially ones that concur with what they already believe). For example, the charts comparing hospitalizations in unvaccinated, vax/not boosted, vax/boosted look like being unvaccinated --> likelier to be hospitalized but there are articles floating around that purport to conclude exactly the opposite. And, as you point out, it's not always easy to distinguish hospitalized because of Covid vs. with Covid not complicating the clinical picture vs. Covid complicating the clinical picture (i.e., Covid + existing clinical picture). The measure, excess hospitalizations, is useful as an overall impact metric but how do we count the part of the 'excess' stemming from e.g., more advanced cancer due to delayed detection or worse heart failure because patient didn't want to leave the safety of their home?
I have just been reading about Evushield. It's not the firsts time I've heard of it, but the gist of the story is that the treatment is woefully unpublicized. In the article it noted that this was available due to an FDA EAU provision. The article also went on to indicate that this was for the immunocompromised and immuno (insuffiecient). That reminded me that there are many studies and anecdotal stories about how vulnerable the elderly are compared to the general population. Why aren't the elderly being included in the "most vulnerable" category along with the "immunocompromised" whenever treatments or recommendations are brought up. Surely what matters is the ability for immune systems to fight off the virus and the elderly suffer from that problem in a big way. So far the only example of acknowledging that basic truth is the availability of a second booster and I have seen much published demographic information on how much that helps the elderly versus the general population.
Correction: I HAVEN'T seen much information. And why don't the health agencies produce stats on how many of the aged (over 65) die from COVID as a % of their national age group and compare it the same statistic for other age groups? Instead we see that a large number of the dead are elderly. I'd like to know the real odds for people over 65 compared to those for other age groups. They must be much higher than the undifferentiated national population.
I've seen that info online. The odds of hospitalization and death definitely get higher with age -- start going up around age 40 I think, and the older you are the worse your odds are. Vaccination greatly improves everybody's odds, but vaccinated elders are still more likely to be hospitalized for covid and/or die from it than younger vaxed people. Here's a table that shows risk for unvaccinated people of different ages who have tested positive for covid. You can use the slider to set the age: https://www.economist.com/graphic-detail/covid-pandemic-mortality-risk-estimator
thanks very much. I went on-line to do some crude estimating of my own using CDC data which was for fully vaccinated people as I remember it, my back of the envolope results were that about 0.6% of those in the demographic 65-74 died of COVID died and about 1.6% of those between 75 and 85 died.
I've often had that thought about Evusheld myself. There's a thing called immune senescence that happens to some (most?) elderly people: Their immune system just sort of wears out. Seems like those folks need Evusheld just as much as other immune compromised people do. I've also wondered whether older people should get double or triple dose covid vaccines. Same logic as giving the elderly get triple-strength flu shots: give the immune system a harder kick to get it going.
A few people on Twitter were tracking 2.75 in various Indian regions and it looks like it's not necessarily outcompeting BA.5. Is that the general consensus then, that 's likely to be regional based on prior Omicron exposure?
Yes, and no. We were seeing that sort of immune response before the study was published and it's been discussed. You just have to be on the right Twitter feeds, or read the right preprints :-)
TO say the immunity derived from BA.1/2 is either decent (that's an interesting term I don't usually use for immune response) or long-lived is a bit premature. There is some evidence the immune response from BA.1/2 may not persist for more than a couple of months, but those data are preliminary, and a couple of studies have differing findings. The elicited antibodies are not preventing infection but are likely reducing its intensity.
"Decent"...Danish study VE against positive BA5 test > 80%?
"Long-lived" as of now, still going.
I don't understand Boston wastewater data. Boston is full blown BA5 but wastewater is way below BA1 and BA2 peaks and not climbing. Been going sideways for weeks. If BA1 + vax immunity waned in 6 months, there should be rising cases I would think.
Dr. Jetelina, do you have any reliable models for assessing Covid infection likelihood for vaccinated but unmasked travelers on a plane flight, presuming that most travelers on the flight aren't masked? Asking primarily for vaccinated kiddos that can't mask (<2 yrs old).
I didn't read this as evidence of BA.5 failure as an infectious pathogen. The key element here is the reduction in risk for breakthrough infection (not my favorite term; I prefer reinfection) is seen in cases of hybrid immunity: Prior infection AND a highly vaccinated population, implying most of those were indeed vaccinated.
IN some ways, this observational registry-based study supports other work (including a Qatar study noted in the preprint) that BA.1/BA.2 infection does provide some degree of immunity against BA.5. This, however, appears to not be a neutralizing immunity but rather reducing the degree of illness.
Registry-based studies can be a bit confusing. They produce results based on a large number of individuals and make statistical processing a bit easier and seem more significant than they may actually be. Registry studies may not contain all the data you're going to need to evaluate because they are designed to catalog demographic, rather than all clinical information.
This study will, when accepted, be valuable as an adjunct but is not sufficient in itself to draw conclusions.
Thank you so much for these updates! I'm wondering if there is any data on the effectiveness of Evusheld against the newer variants. My mother is immunocompromised and we have applied for the treatment (supply is limited), but now I'm wondering if it will offer her any additional protection against this current strain.
Dr. Jetelina, with so few cases actually being reported and the majority of people (in the U.S., anyway) relying on home tests, how are they getting data to track variants? Is it relying on people who wind up in the hospital? My child has covid, and I assume she has BA.5 but it made me realize that there would be no way for officials to watch variants if there's no "official" test (I did report her positive to my county health department, but I don't think they even track much anymore).
There are still cases referred for formal lab testing using molecular assays that can be used to sequence the genome. You don't say what area of the Country you're in but likely correct that the culprit is BA.5 because it's overwhelmingly implicated in most of the current infections. Note that the US lags the UK and other parts of the world in actually doing genomic sequencing, however.
I feel our decisions at the national level to not allocate sufficient funds to continue free on-request testing were an error, but in a lot of ways, at-home testing is a wonderful thing, if people will test often and pay attention when the results change to positive, AND then follow isolation and quarantine guidance to not put others at risk. Note that the 5-day isolation recommendation is contingent on no fever and resolution or ongoing resolution of other symptoms at 5 days. Some of us are recommending a negative home antigen test to demonstrate you're no longer contagious.
Lack of tracking of the home tests by state and local health authorities is one of the big failures in testing, but certainly not the only one. Even accounting for poor results because some people can't seem to follow directions, if everyone reported these data, good information would fall out of the dataset, as we've discovered "crowd-sourced" data can prove very useful, and the poor performers are overwhelmed by people interested in simply providing good data. I've thought of setting up such a site but I fear it's too late. I may still take the time to develop something but one small site late in the game would have to go a long ways to be recognized and provide useful data. That said, in Colorado, any reports of test positives are recorded and added to the State records. I wish more states would do that.
I 'm really disappointed and worried about the number of experts being given media attention as they put their focus at how well we are doing against the virus, rather than focusing on the damage still being done and what can be done to combat it. Over 400 deaths a day is 150 thousand deaths a year - about 5 times the number of flu deaths in an average year. Where is the government money and will to keep fighting this disaster. Where is the financial support for new vaccines, including possible "universal" vaccines and nasal vaccines, and more anti-viral treatments? The effort to deal with Covid has gone from "warp speed" to a crawl. Where is the money and why have the CDC and FDA been allowed to return to the glacial speed which characterized their former review processes? The "new normal" is to sound the praises of our "successes" and encourage complacency. I am sorry to say that your article - as honest and informed as your writing always is - will be utilized as another expert opinion to add to the current analysis of the virus as mostly conquered and now something we'll just have to learn to live with. That is probably not your opinion but it will be read that way. Please emphasize how much more can and should be done, not just relying on individuals to protect themselves from a society which has apparently abandoned a sense of social responsiblity.
I apologize if this comment seems too strident and critical. I do appreciate your work very much which is why I am so upset at reading another article that seems to lend strength to those who want to "put it behind us".
Thanks so much for your message. I think your comment is fair and reflective of the frustrations of many: this emergency is not over. And I agree. But we can have two things at the same time: A decrease in severe disease and the desperate need to continue to fight, communicate, and innovate. It's not one or the other. And I caution people in thinking that way. It's incredibly imperative (but difficult) to communicate this message.
I'll echo this.
The decrease in severe disease can only be seen as potentially transient. That's why it's so important to maintain vigilance and to continue to communicate the importance of continuing to work on this disease.
As for "Where is the money", I fear there's been too much coverage, as you've noted, to the "improved status" leading a lot of the population... those inclined to believe there was ever a public health emergency in the first place... to think we've reached an endemic state. With the inherent problem they don't understand endemicity, and further don't understand that not all endemic viral outbreaks are without severe consequences. Instead, the message they're starting to hear is, "It's over" and that's what they communicate to their Congress-critters. Then, there are House and Senate members who never believed in the virus, or perhaps did but have spread disinformation for their own reasons. Thus, Congress, hearing from their constituents that, "It's over" doesn't see any reason to support efforts to continue important research and development. Or to put a more cynical point on this, perhaps one party is considering politicizing the number of ongoing deaths as a failure of the other party in the 2022 elections.
Communication, as Katelyn notes, is imperative and difficult. Overall, we've done a poor job of communicating to the public the important information about COVID-19. Katelyn, you're a breath of light in that regard. Thank you.
Re: "... those inclined to believe there was ever..." I believe you meant to type "never".
Is there a decreased risk of severe disease at the individual level? This is something I have struggled to understand. I know many people have had COVID and/or had vaccines, which reduces their individual risk. But if you are a person who has not had COVID and is immunocompromised and high risk, is the disease really any less severe than it was 2.5 years ago? With precautions completely gone and transmission very high (at least where I live), it's hard not to feel like there is no hope for these people.
One of the hypotheses is that earlier omicron infection provides some degree of immunity to later (BA.5) infection. A lot of the US population were hit with BA.1 or BA.2/BA.2.12.1. BA.5 is pretty good at evading the immune response elicited especially from ancestral strains of SARS-CoV-2 (Delta and prior), where vaccines were extremely effective. Recent literature suggests, but it's not absolutely proven, that an immune response to an omicron infection, e.g., BA.1, may provide some degree of protection against serious illness. Note that other parts of the world are seeing increases in serious illness and hospitalization, and they're finding BA.5 as the cause.
Note that there are a lot of people who have HAD COVID but were asymptomatic. With well over 60% who are seropositive, and with the likelihood many were (re)infected during the initial surge for omicron, that number is almost certainly increasing. They could have a humoral response that will, again, reduce the severity if not precluding infection.
To your specific question, a COVID-naive person with a compromised immune system and at high risk should pursue immunization and boosting along the appropriate schedule to minimize their risks.
That's my feeling.
Um, no, we probably need the bivalent vaccine because ancestral strains are still around.
I know others who are sharing that concern, including people who are healthy (for their age) but concerned about bringing home an infection to immunocompromised people after travel. What do you think of this cobbled-together (and admittedly variably practical) plan, assuming the travel by the healthy person is deemed very important and both traveler and immunocompromised people are infection-naïve, are vaxxed to the max permitted by their medical condition/immunologist? Travel includes flying, taxi to/from airport, no other public transportation. (1) Wear N95 (properly, and rotate or dispose of them) at all times indoors (including the plane) and outside when people are nearby; (2) Fastidious hand-washing (or alcohol goo used properly); (3) Shower and wash hair twice daily (not sure how much that helps...) (3) When arrive home (assuming asymptomatic) isolate to the degree possible for 3 days and on day 4 take a home *Molecular* test (like Cue or Lucira); possibly again on day 5. I realize the feasibility of this plan is variable and almost certainly not foolproof (and, of course, is based on one's belief how bad it would be for either party to become infected...which makes me wonder what kind of travel would be that 'necessary' at this point in the pandemic?) Not a good sign that I'm already thinking of more variables!
Covid, Polio, and Monkeypox, oh my! If ever there was a time we needed YLE it is the present. With climate change rapidly changing the epidemiological landscape, data-driven analysis is our best response. So keep it up Katelyn. Covid is definitely not leaving the stage yet. Worse it may be just the warm up act.
Not to mention Ehrlichiosis, anaplasmosis, A(H1N1), Enterovirus D68, St Louis Encephalitis, West Nile, Begaza Virus, A(H5N8), A(H9N2), A(H5N6) and of course, tick borne Encephalitis!
I should mention that all the above are serious problems and form a sea of potential distress. To me, D68 is particularly distressing, striking as it does at children.
My husband and I, in our mid-70s, are aware that--despite several boosters--we'll continue to be at risk as long as the right wing's pro-COVID propaganda machine exists. Apart from voting, we can't come up with any way to stop it. That's disheartening (and don't get me started on Dobbs. I swear, GOP politicians and media personalities seem evil to me).
Perhaps not so much evil as horribly cynical.
We can’t forget that many elderly have been vaxxed and boosted x 2 and are running out of time for immunity and possible prevention of serious outcomes. No clear path to the next step? Even Fauci hedging on this. What’s going on? Seems like we could be headed for another perfect storm to me.
My husband and I have had several boosters, and it's looking like the most recent one might just carry us to the projected new general-purpose injection this fall. Of course, Republican politicians are fighting that tooth and nail. But I've got my fingers crossed so hard that it's difficult to type this comment.
I don't know that my last booster is recent enough to carry me over the finish line to the BA1/4/5 booster but I may throw in a LAV against -whatever- to give my innate immune system a boost.
Not sure when the ‘projected’ vaccine or booster is anticipated this fall which is why my comment. I don’t understand your statement about Republican politicians ‘fighting it tooth and nail’ or your evidence of this or what they’re fighting. We have to stop politicizing this. That’s not where my comment was coming from.
The proposed vaccine is likely a pan-coronavirus vaccine in Phase III trials from the US Army. Congressional funding for additional efforts on COVID (see the WaPo article; I'm expressing no political comments, but it's as good as we're likely to get at analysis) research, vaccine development, planning for additional outbreaks, testing, or international vaccine distribution are essentially not happening. Note that international vaccine distribution to the point of shots in arms is necessary to actually get a handle on this virus. It's NOT something that can be quelled solely in the US.
Agree with much of what you say. It seems there’s a caveat with getting shots in arms internationally since even when vaccines were finally made available, just like in the US, people were suspicious and resistant especially in third world countries. I’m not certain that problem will ever be solved so spending money on it seems wasteful at some level. I think International health organizations need to help with the financial part and distribution part and should not be solely on the shoulders of the US. My opinion of course.
It’s not solely on the shoulders of the US taxpayers. There are international organizations who are working to spread vaccines of all forms internationally.
"Congressional covid funding deal appears ‘dead’ after GOP criticism" [https://www.washingtonpost.com/health/2022/06/16/covid-funding-deal-appears-dead/]
Thanks for the WaPo article. Unfortunately I don’t think this article clearly provides all the information except this being the reason some republicans wouldn’t sign the bill as quoted here “the deal collapsed as Democrats raised questions about the removal of international aid from the package and lawmakers of both parties objected to a separate plan to lift pandemic restrictions at the border” I don’t know if you saw that. It seems once again the devil is in the details and both parties were pushing back, however Wa Po makes it appear as though the Republicans were responsible. It seems there were some items added to the bill that weren’t Covid related and other items the other majority party wasn’t happy with so it’s a net-net in my opinion. Back to my original point…the next gen of vaccines are being developed but everyone wants to tie it to politics. We should have learned from the last experience that this isn’t the way to approach it. Washington was handing money out like candy to children for Covid and much of it wasn’t used for Covid. Everyone got stimulus money whether they needed it or not. Covid is not a crisis any longer. There needs to be accountability. Some cities are still trying to spend money they received. A lot of money was spent on vaccines that don’t prevent us from catching the virus as was originally promised. Now the chickens have come home to roost 2 and a half years later and we’re still no better off.
First, if the Administration had to repurpose ANY funding from testing to any other priority, that was proof they don't have the money needed to handle priorities. Testing is perhaps our biggest failure from a public health perspective, starting with the origins of the emergency in this Country.
As always, thank you for your hard work and wisdom, Dr. Jetelina.
Have you heard any whispers about approval of a 4th dose (2nd booster) for people under 50? I thought that was coming last week, but then I didn't hear anything.
Thank you!
That was addressed in an article in the Washington Post on Friday.
See https://www.washingtonpost.com/health/2022/07/22/booster-shots-coronavirus-under-50/
Ah! Thank you, Dr. Hart. I hadn't seen that, and it's exactly the information I was looking for. I guess it looks as though my next booster won't be for a few months, now.
We heard of a great project. A friend was visiting family in the Toronto general area and the local libraries were lending out CO2 meters so that members could check the ventilation in buildings.
I'm actually concerned we're seeing fewer diagnoses that include "with COVID" today. Also, I'm aware that there are some medical facilities no longer testing for outpatient procedures. The upshot of this is we are missing hospitalization data specifically for COVID, but may see increases in hospitalizations that are non-specific. At that point what we'll have is the pandemic-averse telling us it's no longer a COVID problem but people are just getting sicker.
I'm wondering if the reason we ARE apparently seeing less severe disease is the combination of slowly increasing vaccination totals, and omicron infection providing a more omicron-specific hybrid immunity for BA.5 in the US vice other countries where they might have avoided the initial omicron surge, but are now caught in the BA.5 push.
Thank you for this piece - and like @David McNiff, I hope it will be experienced as both reason for (cautious) optimism and importantly as a guide on how to be aware. Unfortunately, there are enough nuances and potential consequences (intended or not) that many people are just looking for thumbs-up-or-down message (especially ones that concur with what they already believe). For example, the charts comparing hospitalizations in unvaccinated, vax/not boosted, vax/boosted look like being unvaccinated --> likelier to be hospitalized but there are articles floating around that purport to conclude exactly the opposite. And, as you point out, it's not always easy to distinguish hospitalized because of Covid vs. with Covid not complicating the clinical picture vs. Covid complicating the clinical picture (i.e., Covid + existing clinical picture). The measure, excess hospitalizations, is useful as an overall impact metric but how do we count the part of the 'excess' stemming from e.g., more advanced cancer due to delayed detection or worse heart failure because patient didn't want to leave the safety of their home?
I have just been reading about Evushield. It's not the firsts time I've heard of it, but the gist of the story is that the treatment is woefully unpublicized. In the article it noted that this was available due to an FDA EAU provision. The article also went on to indicate that this was for the immunocompromised and immuno (insuffiecient). That reminded me that there are many studies and anecdotal stories about how vulnerable the elderly are compared to the general population. Why aren't the elderly being included in the "most vulnerable" category along with the "immunocompromised" whenever treatments or recommendations are brought up. Surely what matters is the ability for immune systems to fight off the virus and the elderly suffer from that problem in a big way. So far the only example of acknowledging that basic truth is the availability of a second booster and I have seen much published demographic information on how much that helps the elderly versus the general population.
Correction: I HAVEN'T seen much information. And why don't the health agencies produce stats on how many of the aged (over 65) die from COVID as a % of their national age group and compare it the same statistic for other age groups? Instead we see that a large number of the dead are elderly. I'd like to know the real odds for people over 65 compared to those for other age groups. They must be much higher than the undifferentiated national population.
I've seen that info online. The odds of hospitalization and death definitely get higher with age -- start going up around age 40 I think, and the older you are the worse your odds are. Vaccination greatly improves everybody's odds, but vaccinated elders are still more likely to be hospitalized for covid and/or die from it than younger vaxed people. Here's a table that shows risk for unvaccinated people of different ages who have tested positive for covid. You can use the slider to set the age: https://www.economist.com/graphic-detail/covid-pandemic-mortality-risk-estimator
thanks very much. I went on-line to do some crude estimating of my own using CDC data which was for fully vaccinated people as I remember it, my back of the envolope results were that about 0.6% of those in the demographic 65-74 died of COVID died and about 1.6% of those between 75 and 85 died.
I've often had that thought about Evusheld myself. There's a thing called immune senescence that happens to some (most?) elderly people: Their immune system just sort of wears out. Seems like those folks need Evusheld just as much as other immune compromised people do. I've also wondered whether older people should get double or triple dose covid vaccines. Same logic as giving the elderly get triple-strength flu shots: give the immune system a harder kick to get it going.
A few people on Twitter were tracking 2.75 in various Indian regions and it looks like it's not necessarily outcompeting BA.5. Is that the general consensus then, that 's likely to be regional based on prior Omicron exposure?
Danish study hints that vax + BA1/2 infection has decent and lasting immunity against BA5.
Maybe that's why our BA5 wave might be fizzling.
Yes, and no. We were seeing that sort of immune response before the study was published and it's been discussed. You just have to be on the right Twitter feeds, or read the right preprints :-)
TO say the immunity derived from BA.1/2 is either decent (that's an interesting term I don't usually use for immune response) or long-lived is a bit premature. There is some evidence the immune response from BA.1/2 may not persist for more than a couple of months, but those data are preliminary, and a couple of studies have differing findings. The elicited antibodies are not preventing infection but are likely reducing its intensity.
"Decent"...Danish study VE against positive BA5 test > 80%?
"Long-lived" as of now, still going.
I don't understand Boston wastewater data. Boston is full blown BA5 but wastewater is way below BA1 and BA2 peaks and not climbing. Been going sideways for weeks. If BA1 + vax immunity waned in 6 months, there should be rising cases I would think.
Dr. Jetelina, do you have any reliable models for assessing Covid infection likelihood for vaccinated but unmasked travelers on a plane flight, presuming that most travelers on the flight aren't masked? Asking primarily for vaccinated kiddos that can't mask (<2 yrs old).
More BA5 fizzle evidence
https://www.medrxiv.org/content/10.1101/2022.07.27.22277602v1
I didn't read this as evidence of BA.5 failure as an infectious pathogen. The key element here is the reduction in risk for breakthrough infection (not my favorite term; I prefer reinfection) is seen in cases of hybrid immunity: Prior infection AND a highly vaccinated population, implying most of those were indeed vaccinated.
IN some ways, this observational registry-based study supports other work (including a Qatar study noted in the preprint) that BA.1/BA.2 infection does provide some degree of immunity against BA.5. This, however, appears to not be a neutralizing immunity but rather reducing the degree of illness.
Registry-based studies can be a bit confusing. They produce results based on a large number of individuals and make statistical processing a bit easier and seem more significant than they may actually be. Registry studies may not contain all the data you're going to need to evaluate because they are designed to catalog demographic, rather than all clinical information.
This study will, when accepted, be valuable as an adjunct but is not sufficient in itself to draw conclusions.
Thank you so much for these updates! I'm wondering if there is any data on the effectiveness of Evusheld against the newer variants. My mother is immunocompromised and we have applied for the treatment (supply is limited), but now I'm wondering if it will offer her any additional protection against this current strain.
Dr. Jetelina, with so few cases actually being reported and the majority of people (in the U.S., anyway) relying on home tests, how are they getting data to track variants? Is it relying on people who wind up in the hospital? My child has covid, and I assume she has BA.5 but it made me realize that there would be no way for officials to watch variants if there's no "official" test (I did report her positive to my county health department, but I don't think they even track much anymore).
There are still cases referred for formal lab testing using molecular assays that can be used to sequence the genome. You don't say what area of the Country you're in but likely correct that the culprit is BA.5 because it's overwhelmingly implicated in most of the current infections. Note that the US lags the UK and other parts of the world in actually doing genomic sequencing, however.
I feel our decisions at the national level to not allocate sufficient funds to continue free on-request testing were an error, but in a lot of ways, at-home testing is a wonderful thing, if people will test often and pay attention when the results change to positive, AND then follow isolation and quarantine guidance to not put others at risk. Note that the 5-day isolation recommendation is contingent on no fever and resolution or ongoing resolution of other symptoms at 5 days. Some of us are recommending a negative home antigen test to demonstrate you're no longer contagious.
Lack of tracking of the home tests by state and local health authorities is one of the big failures in testing, but certainly not the only one. Even accounting for poor results because some people can't seem to follow directions, if everyone reported these data, good information would fall out of the dataset, as we've discovered "crowd-sourced" data can prove very useful, and the poor performers are overwhelmed by people interested in simply providing good data. I've thought of setting up such a site but I fear it's too late. I may still take the time to develop something but one small site late in the game would have to go a long ways to be recognized and provide useful data. That said, in Colorado, any reports of test positives are recorded and added to the State records. I wish more states would do that.