Covid-19: A Year-End Wrap-Up

iStock

By Mary Carpenter

GOOD NEWS about Covid keeps getting better—notably as vaccinated individuals contract the virus but generally have less severe symptoms. And as of last week, DC-area “community levels” are low, based —per 100,000 population, in the previous seven days–on new Covid-19 hospital admissions; percent of staffed inpatient beds occupied by patients with confirmed cases; and new Covid-19 cases.

What may be the best news involves recent reports that existing drugs may help treat the “brain fog” affecting many people after a Covid infection. Another result of the enormous research money and effort devoted to Covid is the recent understanding of genetic mutations that may help protect individuals against Covid infection and may lead to better vaccines, as well as an increasing ability to predict and prepare for future evolutions of Omicron variants.

Winter preparedness is the U.S. government’s latest watchword for the Covid pandemic—making free tests once again available at Covid.gov as of this week and promising to alleviate strains on the health care system “if necessary,” one government official told ABC News. “We know what to do in this moment. We have the tools and infrastructure and know how we need to effectively manage this time.”

Sore throat is the now most frequently reported symptom for the latest circulating Omicron variants, followed by runny nose and blocked nose —while the shortness of breath and fever reported toward the beginning of the pandemic have become less common. And while an unusually early flu season may also be peaking early, current Covid symptoms are similar enough to those of flu— notably fatigue and headaches—as well as to RSV that physicians recommend testing before making decisions about treatment.

Less good news comes from rising nationwide levels of cases, hospitalizations and deaths. Last week, all five New York City counties met the CDC threshold for “high community spread” (same definition as above); and infections caused by three viruses —Covid, RSV and flu—reached high enough levels that indoor masking was “strongly” recommended, though not yet mandated.

In addition, the recent mortality risk from Covid has skewed “more dramatically” toward those 65 and over —the age group now with 90% of all Covid-related deaths despite a 94% vaccination rate, writes David Wallace-Wells in the New York Times. Wallace-Wells blames public health messaging that “protection is a choice” as well as “treatments like Paxlovid…criminally underutilized given their efficacy in vulnerable populations.”

(According to the latest thinking, the recurrence of symptoms that can follow a course of Paxlovid is, in fact, “Covid rebound…a brief return of symptoms that starts about two to eight days after you tested negative or stopped feeling sick,” according to Cedars-Sinai. Rebounding symptoms occur in about 10% of people following Covid infection—and while more prevalent in those who have taken Paxlovid, they are not caused by the drug.

But Paxlovid may also be an example of “drugs [developed] for a world of Covid virgins and now that world is gone,” writes pathologist Benjamin Mazer in The Atlantic. Early groundbreaking research, notably on vaccines, involved homo uninoculatus uninfectus, a person who has neither gotten sick with Covid nor ever taken a vaccine—leading Mazer to lament that “we have reached a turning point in our pandemic expertise where some of the astounding progress made since 2020 has started to decay.”

Covid “superdodgers,” on the other hand, have given researchers an important boost in the search for genes that might be protective—similar to those previously found for norovirus (that causes vomiting and diarrhea) and HIV, which led to new vaccines. In the case of HIV, Rockefeller University pediatric geneticist Jean-Laurent Casanova told NPR, one mutation dramatically lowers the risk of symptoms because the virus enters the bodies but “slides off their cells, ‘like water sliding off a glass window.’”

Covid protection for people who have dodged the virus to date may come from several mutations, including one on the HLA gene that spurs the immune system response. According to NPR, “Having one of these mutations would make you a sort of Covid mini-dodger. And perhaps that finding will…lead to a vaccine that does what everyone wishes our current vaccines would do: turn everyone into a Covid superdodger.”

Better protection against Covid may also come from new studies on the evolution of Omicron variants, German computational biologist Moritz Gerstung told New York Times reporter Carl Zimmer. Omicron’s lineages have been acquiring mutations that threaten “what has been one of the most important defenses against Covid: monoclonal antibodies [notably, the drug Evusheld that helps protect people with compromised immune systems],” writes Zimmer. But, Gerstung told him, the new findings have “made me very hopeful..an instance of how one could basically get ahead of the game.”

Finally, Yale University researchers studying “brain fog” in people with long-haul Covid found that drugs used to treat ADHD and traumatic brain injury (TBI) “can mitigate or even eliminate” the symptoms. Linked to inflammation in the brain similar to that seen with TBI, brain fog can include lack of mental clarity, poor focus and concentration, memory problems, difficulty with multi-tasking and more that lasts months or longer following the original Covid infection.

Most worrisome is that “even mild cases of Covid-19 set off enough inflammation to produce impairments to cognition and brain health,” writes retired Harvard public health expert William Haseltine in Forbes. Research on mice, as well as on blood samples from people with long Covid, found compounds involved in inflammation in both the blood and fluid surrounding the brain and spinal cord.

The two-drug regimen “successful in relieving brain fog” in a small group of patients with long Covid included the antioxidant NAC (N-acetylcysteine), available OTC, used in treating TBI and also taken by many hoping to stave off the effects of aging; along with guanfacine, which has been effective in treating ADHD—as well as TBI and PTSD.

Promising results from the regimen may also help patients with other inflammatory conditions. The Yale researchers saw cognitive benefits in one patient with MS—and, exciting for sufferers of other post-viral syndromes, in one post-Lyme patient. With so much research money and effort focused on Covid, hopes run high that further advances in protection and treatment could diminish fears about catching the virus—enough finally to make this coronavirus a benign threat similar to seasonal flu.

—Mary Carpenter regularly reports on need-to-know topics in health and medicine.