Covid: September, 2022

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By Mary Carpenter

AS THE U.S. appears to be heading into what some call its third pandemic winter, many unknowns remain.  Most questions concern how much one can or should do— isolation, masking, testing—to remain safe and healthy.

Vulnerable individuals, including those age 65 and older, worry about spending time in public places and especially about eating out. And people who receive a positive Covid test result and are eligible for Paxlovid worry about whether or not to take the drug—which lowers risk of severe disease but can cause rebound Covid symptoms. Another question concerns Evusheld, a practically unknown medication that boosts antibodies in people whose levels are low.

But last week brought the answer to what had been the most pressing conundrum: whether to get an additional Covid booster ASAP or wait for new vaccines that target omicron subvariants BA.4 and BA.5—which together now account for most Covid cases in the U.S. On Wednesday, the FDA issued emergency use authorization for the new bivalent booster—one half is the original shot; and the other, a reformulation against BA.4 and BA.5. On Friday, the CDC added its support.

The new boosters should be in pharmacies now—available to anyone over 18 who has completed the initial vaccination doses, whether or not they have received boosters, as long as their last shot was at least two months ago. White House coordinator Ashish Jha told the New York Times, “If you’ve not gotten a vaccine shot this year, go get one now. It could save your life.”

Not everyone is excited about the new vaccine. Some point out that there has not been enough time to do human studies on increased efficacy compared to the original vaccine. Based on a primate study, cellular immunology specialist at the National Institute of Allergy and Infectious Diseases Robert Seder told the Washington Post that an omicron booster did no better than an additional shot of the original vaccine.  Instead, Seder is working on a nasal vaccine that could help block infections.

And while “vaccines are super important… they can’t do this job alone,” Katherine Wu, a reporter for The Atlantic with a degree in microbiology, told The Atlantic newsletter. Wu calls current public messaging “baffling” — first that “things are so much safer now…leaving people to wonder why they need a booster at all;” and that other “pandemic protections are unnecessary now that the updated booster is here…we know that vaccines, as good as they are, can’t prevent all infections. They can’t totally prevent long COVID.”

The U.S. continues to average about 90,000 infections and 475 deaths every day —with high numbers for the most part among the under- and unvaccinated. Fifteen million seniors have not received their first booster, according to Bipartisan Policy Center medical advisor Anand Parekh. “The CDC estimates that among those 50 and older, the unvaccinated had a 29-fold increased risk of dying from Covid-19, and vaccinated people with only one booster had a 4-fold increased risk, compared to those with two or more booster doses.”

Good Covid news in recent months has, however, led to a “receding level of anxiety among the very liberal, including many younger adults,” according to the New York Times’s latest Covid poll, reported in its Morning Newsletter. “The share of the very liberal who say the virus presents a great risk to their own personal health has fallen to 34 percent,” a 13-point drop since March. What is different, according to “The Morning,” is that the antiviral drug Paxlovid —as well as the immunity-booster Evusheld—are now “widely available, reducing the risks for vulnerable people.”

While Paxlovid has proved most effective in reducing hospitalization and deaths from the Omicron variant in those 65 and older, new Israeli research suggests that it has “little effect” in younger patients.

But many people are wary of Paxlovid’s risk of rebound—Covid symptoms that recur within days after the five-day course of the drug—that could be affecting anywhere from 2% to 6%, or a much higher percentage, of patients. Dr. David Ho, professor of medicine and at Columbia University, believes there is some evidence that a longer course of the drug would do a better job of clearing the virus and preventing rebound.

“I think people should consider the possibility of Paxlovid rebound like a known side effect of the medication,” George Washington University health policy expert Leana Wen told CNN. “However, the possibility of this side effect is not a reason to avoid a medication that is highly effective at reducing severe illness.. that can reduce the likelihood of being hospitalized or dying by nearly 90%.”

Early evidence also suggests that Paxlovid could improve clearance of the virus from the body to help stave off long Covid. According to a recent NIH study based on autopsies of 44 people who died from Covid or were infected when they died, “the virus can last in widespread parts of the body—including the brain—for seven months after infection.”

“Some long Covid sufferers are in their third year with the condition,” writes New York Times columnist Zeynep Tufekci. The most reliable statistics on long Covid, according to Tufekci, come from an ongoing British national survey that has found 2.8 percent of people in Britain reported “ongoing symptoms that they attributed to having had Covid”—with .6% saying daily activities had been “limited a lot.” In the U.S., he wrote, “.6% would mean about “two million people potentially facing a debilitating condition.”

About Evusheld, STATnews headlines in July called it “a crucial drug to protect the most vulnerable [which] goes vastly underused.” Available since December 2021, Evusheld injections contain two antibodies that stay in the blood for about six months, “smothering the virus in the event of exposure or infection.”

Evusheld was “supposed to offer salvation, a way of protecting immunocompromised people who couldn’t respond to vaccines” because of having cancer or a genetic condition, according to STAT. But “only a tiny fraction of the roughly 7 million patients who might be eligible have received it. Hundreds of thousands of doses sit on shelves in hospitals and infusion centers across the country.”

I have not yet had Covid and remain concerned about catching it, mostly because of the risk of long Covid. I will get the new vaccine as soon as possible. And if, as scheduled, I need to do maskless in-person presentations this fall, I will ask my doctor about Evusheld. Otherwise, I will wear a mask and try to avoid spending time, especially eating, indoors in public places—and to smile through whatever ribbing I get about my behavior from other people.

—Mary Carpenter continues to update us on the latest news from the Covid-19 front.