Pandemic Update for 2022-01-10: Endemic
Items of recent pandemic news: The data on incidental Covid; where the Omicron wave may go and when; months-long persistence of the virus in multiple organ systems; and an entreaty to the President to think endemic. Plus a frippery.
Quotes of the week
- National Institutes of Health researchers — “Our data prove that SARS-CoV-2 causes systemic infection and can persist in the body for months.”
- Michael Osterholm — “People hold out please, this is not going to be months and months. This wave is going to be in the weeks ahead.”
Advisors to Biden: Think endemic
Three medical experts, members of the Biden administration’s pandemic transition team, have publicly called on the president to shift the country’s approach to the virus, accepting that it will be endemic and that we need a way to live with it.
The three are Zeke Emmanuel, Michael Osterholm, and Celine Gounder. Long-time readers will recognize those names. Here are the trio’s open letter in JAMA and a summary from CIDRAP (where Osterholm is director).
The primary recommendation is explicitly to abandon a “zero Covid” strategy in favor of a harm reduction approach (as we wrote about last month). As part of this shift, the authors call on the White House to press forward with vaccine mandates and to redouble efforts to make home testing ubiquitous and affordable.
These goals would fit into a renewed commitment to rebuild public health. In this country, with our emphasis on individualism and history of neglect of the public sphere, such a change in direction will be a heavy lift.
SARS-CoV-2 persists throughout the body long-term
A study posted last weekend in preprint form describes the most comprehensive look yet at SARS-CoV-2’s persistence in the body following an infection. The National Institutes of Health led the study in which the bodies of 44 people who died of Covid-19 were autopsied. The researchers found virus in the heart, brain, and many other organ systems up to 7 months following symptom onset.
Bloomberg has a summary of the research, which is under review for publication in Nature.
The findings are mostly about data from fatal Covid cases, not long Covid per se, but the researchers point out that delayed viral clearance in organ systems other than the respiratory tract could be a potential contributor to long Covid.
While the team’s methods (which are spelled out in the preprint) have not yet been reviewed by outside experts, the autopsies seem comprehensive compared to most post-mortem studies of Covid-19 patients published to date. And they mostly occurred within a day of death.
Bloomberg notes that at this time the conclusion that SARS-CoV-2 invades the tissues of multiple organ systems is not established consensus among researchers in the field.
Now we are accelerating
When we last looked at case acceleration in this state, just after Christmas, Minnesota was in surprisingly good shape compared to the Northeast. Our Delta wave was fading and Omicron had not caught traction here yet. We just embarked on the vertical part of the Omicron tsunami.
Epidemiologist and modeler Jeffrey Shaman has a NY Times op-ed laying out where Omicron may go from here, and the timing in different areas of the country. He expects New York and parts of New England to peak right about now with other regions such as ours falling in later — think late this month. Katelyn Jetelina largely agrees with Shaman:
The IHME projection, just out — dissected here by Zvi Mowshowitz — is in the same ballpark: peak by late January and a relatively rapid decline. Although note that the decline could be slowed by people loosening their behavior once the peak passes. Once we are through this wave, more than 50% of the US population will have been infected.
Hospitalized “with Covid” vs. “for Covid”
States are beginning to break out reporting on cases of “incidental Covid.” California was first, New York followed, and now Massachusetts has decided to distinguish those patients who are hospitalized for something else but show up positive for the virus in routine screening. The Massachusetts governor is taking credit for having championed the “with Covid” distinction since fall of 2020. Ontario announced a similar data breakout last week.
It seems like in the Omicron wave something between 40% and 60% of Covid cases reported by hospitals are incidental. But how exactly “incidental” is defined matters.
The Washington Post reports on some of the nuances of the “with Covid” vs. “for Covid” distinction. For example, how do you classify someone who goes to the hospital with heart arrhythmia that was (probably) brought on by Covid? How about someone who is admitted with gastric problems but then contracts the virus in the hospital?
To reward your patience, the frippery today is an introduction to the comedian Stevie Martin. No, not Steve Martin — this one is a Brit and female. (Also not to be confused with our Canadian time traveler.)
Along with her flatmate Lola-Rose Maxwell, Stevie creates video sketches about life in this technological age. I found these links on Metafilter, where one commenter characterized the collection as “a parable about what happens when people who don’t like interacting with people design everything that interacts with people.”
The video embedded below, “Verifying that you’re not a robot,” is the one you may have seen. Not a huge viral hit, but it has been viewed 6.1 million times on Twitter and a tenth of that on YouTube. I think it is the best of Stevie and Maxwell’s work. Here are some others:
- Buying food online
- Working “for exposure”
- Choosing cookie options
- Forgetting a password
- Trying to print something
[ Note added 2022-01-10: ] It turns out that the JAMA opinion piece linked above, urging a new national strategy for endemicity, was one of three linked editorials that were posted on January 6. Here they all are:
- A National Strategy for the “New Normal” of Life With Covid (Ezekiel Emanuel, Michael Osterholm, Celine Gounder)
- A National Strategy for Covid-19: Testing, Surveillance, and Mitigation Strategies (David Michaels, Ezekiel Emanuel, Rick Bright)
- A National Strategy for Covid-19 Medical Countermeasures: Vaccines and Therapeutics (Luciana Borio, Rick Bright, Ezekiel Emanuel)
While I agree in principle with the “endemic” papers, most of their proposals will never happen. In addition to the “individualism” factor Keith mentioned, there also is a huge “states’ rights” issue. The Bill of Rights exists mainly to keep the Federal government from being able to interfere with what Americans do within their own states. Calls for Federal action need to be tempered with recognition of those limitations. In particular, national mandates — vaccines, masks, quarantines, shutdowns, etc. — are unlikely to survive a court challenge, no matter how scientifically reasonable they might be. Federal surveillance programs could easily run afoul of privacy concerns. And the current makeup of the US Supreme Court doesn’t bode well for attempts to soften the Constitutional boundaries.
In addition, there is a legitimate policy question around the Federal government having to increase its deficit to fund the recommended programs. Programs that can’t be shown to be cost-effective could be difficult to get enacted. Perhaps projected savings to Medicare and Medicaid might be sufficient justification.
I’d like to see the experts give us some ideas of what we realistically can do.
I wasn’t really aware that endemicity has been a right-wing talking point for almost two years. They used it as a cudgel against any and all public health measures intended to slow the virus. Here is FL’s Ron DeSantis on the subject now. Back in the final year of The Former Guy, right-wing radicals rallied around the Great Barrington Declaration, which essentially said: let the virus rip through the population until everybody is immune.
I think those ideas about letting the virus run wild were fundamentally based on the notion of herd immunity. In My Opinion, herd immunity was always a pipe dream with this virus. SARS-CoV-2 became contagious so quickly after being contracted, there was little hope for sterilizing immunity. But the experts disagreed with me, and as recently as a month ago they were still talking about herd immunity being the desired end-point.
With Omicron becoming contagious even sooner — contagion perhaps starting within a day; the serial interval in South Korea is estimated at 2.2 days (preprint) — the likelihood of sterilizing immunity is even lower. A couple of days ago, Dr. Fauci finally acknowledged that “ultimately… just about everybody” is going to be infected by Omicron, and in that interview he didn’t talk about herd immunity at all except to say, “We don’t want [Barrington] to happen.”
A study published in The Lancet last month found that people who received both doses of the Pfizer vaccine had higher levels of IgA and IgG antibodies in their saliva if they’d contracted the virus prior to vaccination. The assumption is being made that salivary IgA and IgG levels are an indicator of defense against infection. But the levels were still quite low, and no arm of the study looked at people who’d been vaccinated first and then contracted the virus, nor at people who’d received a booster dose. That paper’s authors basically concluded that we shouldn’t declare “mission accomplished” with the current vaccines, because we need new vaccines that can provide sterilizing immunity.
Right you are, herd immunity definitely went out when Delta came in (if not, as you suggest, before). Even before that I was hearing 90%, 95% bandied about as the HI threshold — a level impossible to achieve (in this country at least) by vaccination. The assumption in HI (and in Great Barrington) has always been that a survived infection conveys protection. With Omicron, that completely breaks down.
Permanent sterilizing immunity is not going to happen against this virus. Robust protection against severe disease and death is the best we will do, and that is a lot.