By Mary Carpenter
COVID in March, 2022, brings lifted mask mandates and altered priorities—which altogether shift responsibility away from the collective onto the individual, leaving each person to decide how much risk they are willing to take, writes Katherine Wu in the Atlantic. For many people, what she calls the “Great American Unmasking Part Deux” is too much too soon.
For the “vulnerable vaccinated”—those over 65, because immunity following vaccination appears to wane more quickly with age, as well as people with underlying or immune-compromising conditions —the most pressing question is if and when to get a fourth vaccination. While Israeli researchers found that the fourth dose offers “very little extra protection,” says infectious disease specialist Gili Regev-Yochay in Tel HaShomer, “for those vulnerable populations …I would recommend they receive any protection they can.”
Remaining uncertainties, however, create good reasons to hold off on a fourth shot, notably questions about how long vaccine-induced immunity remains protective; and how well suited current vaccines are for fighting Omicron variants. In addition, new variants could arise at any point, and vaccines coming down the research pipeline might offer better protection against them. Finally, many who believe autumn will be the next period of widespread concern about Covid suggest waiting on an additional booster at least until summer’s end.
Meanwhile, a different immune system weapon— “memory T-cells” — have shown better endurance over time than antibodies and may even offer “abortive immune protection,” stopping the virus before it enters and infects the body. The T-cells created by an earlier SARS virus have lasted 17 years to date; and with the Omicron variant, T-cells have proved so protective that they are expected, researchers told the New York Times, “to mount a similarly robust attack on any future variant as well.”
While the first two shots of mRNA vaccines increased the levels of T-cells against the coronavirus, the third dose appeared to have no effect. But new vaccines in the works that specifically target T-cell production could provide a complementary shot “particularly in [populations] with impaired ability to mount sufficient immune responses,” according to German researchers.
“Test to treat” is an appealing component of the U.S. government’s newly proposed Covid plans, according to Washington Post contributing columnist Leana Wen. That proposal calls for increasing numbers of easily accessible sites, such as pharmacies, that would offer both free testing and, for those who receive positive results, immediate availability of the antiviral pills that must be taken early in the course of a Covid infection.
Supplies of the currently most effective antiviral pill, Pfizer’s paxlovid, are increasing, but the medication requires a prescription, involving consultation with a physician followed by an additional visit to a pharmacy or health care center. Drawbacks to the government’s plan include its high price tag, plus the possibility of resistance to paxlovid in future variants of the virus.
For now, the “Swiss cheese model” is the recommended method of protection from Covid infection: using several different strategies, such as boosters and good masks, so that holes or failings in each strategy disappear when they are layered together, explains David Leonhardt.
“Let’s dispense with the notion that masks are only protective if everyone is wearing them,” writes Harvard public health expert Joseph Allen. One person wearing a good N95 or KN95 “medical” mask (filtration rate of 95%) and talking to an unvaccinated person is better protected than when both people wear standard surgical masks (filtration rates closer to 70%). According to Allen, “One-way masking is fine.”
Endemic is what many hope this virus will become—meaning “within the people” vs. epidemic, “upon the people,” writes Donald S. Burke on STAT. The four currently endemic coronaviruses —a gang of four known as CCC (common cold coronaviruses) —cause mild upper respiratory infections and have infected “almost everyone on earth” during childhood. On the other hand, endemic viruses like Ebola remain virulent and deadly.
The SARS-CoV-2 virus could “still shock the human species with a devastating evolutionary leap…depending on the organs damaged and the extent of [the damage],” explains Burke. Most animal coronaviruses infect cells lining the gastrointestinal as well as the respiratory tract—but researchers have found the SARS-CoV-2 virus in the intestine, kidneys and nervous system.
This virus is “pantropic…far more mutable than we initially assumed,” explains Joel Achenbach in the Washington Post. “It can infect an incredible array of animals…the latest variant, Omicron, came out of nowhere on the family tree of the virus.” Achenbach quotes coronavirologist Benjamin Neuman of Texas A&M University: “Viruses are basically unaccountable – a swirling ever-evolving cloud…as the virus pinballs through a complex immunological landscape.”
During this “pandemic limbo,” I watch the numbers—of hospitalizations and deaths, cases and variants. Covid infections in the U.S. appear to be on the decline, or at least leveling off—although cases of the so-called “stealth omicron” BA.2 variant, which is more transmissible and better at evading immunity than the original omicron, are now doubling every week. But Yale epidemiologist Nathan Grubaugh told NPR last week that the BA.2 variant should only “extend our tail, meaning it might slow down the decrease in cases.”
While many suggest that Covid will become no worse than the seasonal flu, for now severe illness such as lung injury is more frequent with Covid, and the mortality rate is higher. New Japanese research found the omicron variant “40% deadlier than seasonal flu,” although some have criticized the study design.
My greatest reasons for caution stem from the risk of Long Covid—a risk still unknown for the Omicron variant, because not enough time has passed. That diagnosis usually comes about three months following the original infection, according to the LA Times. Early research suggests, however, that “being vaccinated before getting Covid-19 could help prevent the lingering illness or at least reduce its severity.”
For now, I plan to wear a mask indoors in crowded places. Although proof-of-vaccine cards and recent negative test results may provide good layers for the Swiss-cheese model of protection, even an individual possessing both of these could be contagious with a new infection. And I recently discovered a KF94 mask that fits better and is more comfortable than the N95s, as well as offering a high level of protection (94% filtration) and receiving high scores on reliability—as long as the package confirms “made in Korea.”
—Mary Carpenter keeps track of news on the Covid-19 front.