Pandemic Update for 2021-11-16: Herd
Items of recent pandemic news: The Great Resignation among healthcare workers; the CDC may stop talking about herd immunity; the sobering prevalance of long Covid; the fifth pandemic wave crashing over Europe; and considerations for oral antivirals. Plus a frippery.
The fifth wave
Europe is tightening anti-pandemic measures as a new wave of infections, fanned by low vaccination rates in eastern Europe, rages across the region. In a commentary in the Guardian, Eric Topol warns that the US is sleepwalking into the wave that is about to roll over us on this side of the Atlantic.
The new measures being put in place across the EU mostly target the unvaccinated. Austria’s are toughest, imposing a lockdown on unvaxed people over age 12 but not on those who have taken shots. Germany is considering mandating tests for unvaccinated people before they can get on a bus or train.
Spain and Portugal, which boast immunization rates of 80% and 90%, respectively, are instead loosening pandemic restrictions.
Considerations for the oral antivirals
Read this piece in Stat News for a really good overview of the orally available therapeutic drugs for Covid-19 that are about to come available. (Pfizer just filed with the FDA for authorization and, following Merck’e lead, will allow other companies to manufacture its drug.)
Among the subtleties of these drugs I hadn’t appreciated till now: since they were tested entirely in the unvaccinated, the EUAs that may eventually be issued by the FDA will probably restrict their use to that population. Stat notes that after the third potential oral drug, made by Atea and Roche, failed to prove efficacy in a Phase II / III trial, observers speculated that the failure may have come from the inclusion of vaccinated people in the trial. “For those who have received the vaccine, hospitalization and death are much less likely. This means that it is harder for a drug to show efficacy, because there are fewer infections to prevent.”
A second surprising (to me) wrinkle with Pfizer’s oral antiviral is that it can be expected to interfere with some kinds of cancer treatments. Oncologists know that protease inhibitors are “[not] completely benign and harmless in terms of their drug-drug interactions and toxicity,” as one cancer specialist put it.
Long Covid is present in 50% of recoverers
A question for the unvaccinated: do you want to flip a coin on whether you will be sick for potentially the rest of your life?
A systematic review of 57 studies covering over 250,000 recovered Covid-19 patients has found that, six months out, over half experience symptoms of long Covid and a decline in well-being. The Washington Post has a summary of the research.
The litany of symptoms is familiar by now:
Over 47 million people in the US have been infected with SARS-CoV-2.
For a ray of hope on this subject, watch and listen to just under two minutes of Daniel Griffin’s recent clinical update on This Week in Virology. Dr. Griffin tells of a conference call he initiated with colleagues across the country, and he asked them: How many cases of long Covid are you seeing in vaccinated people? The response was: silence. While this is anecdote, not data, it is among the best news I have heard on long Covid since the syndrome first came to prominence last year.
CDC is de-emphasizing herd immunity as a goal
The LA Times is reporting that at its advisory committee (ACIP) meeting on Nov. 2, CDC representatives indicated a desire to stop talking about herd immunity as an aiming point for anti-pandemic efforts. The idea that once a population reaches a set point of immunity, by infection or vaccination, that the virus would stop spreading and the pandemic would end, has always been too simplistic to capture the realities of the situation.
It looks like the CDC may begin talking about low and steady numbers of infections, hospitalizations, and deaths as a marker of when we can move on to the next phase of the pandemic.
This potential change in messaging is not without cost. However inexact the term “herd immunity” is, it does convey the reality that getting vaccinated benefits not only the individual but also the society. Experts worry that dropping talk of herd immunity may take some steam out of the push to get everyone vaccinated.
One-fifth of US healthcare workers have quit
A new Ed Yong piece in the Atlantic is ordinarily cause for celebration, but this one is a stone bummer. The healthcare system has never seen anything like the wave of workers leaving their institutions — or in too many cases, leaving the field entirely. Here’s Yong on how bad it may be for years after this pandemic fades into memory:
Frippery: How mRNA vaccines work
Normally I choose fripperies that are orthogonal to the pandemic and all its pomps, but this video explanation of how mRNA vaccines work is too good not to share. It is immunology 101. The details are all correct, down to the relative sizes of things (check out the vaccination needle at 0:26) and the names of the immune system components and their functions.
The video was produced at the Vaccine Makers Project at Children’s Hospital of Philadelphia. The project’s YouTube channel features a handful of other educational videos, each around 2 minutes long, including ones on how antibodies work and how viruses reproduce.
(Children’s Hospital is the home of Dr. Paul Offit, an internationally recognized expert on vaccines, virology, and immunology who sits on the FDA’s advisory panel VRBPAC and is a former member of the CDC’s advisory committee ACIP.)
In the line of immunology tutorial videos, I am still partial to Fork Hands, featured as a frippery last March.
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