Covid-19 Catchup: All the Developments You May Have Missed

Covid-19 Catchup: All the Developments You May Have Missed

Given Covid fatigue, you’re excused if you cut down on doomscrolling and tried to ignore the bad pandemic news as 2020 wound down. But welcome to 2021. Covid-19 hospitalizations and deaths continue rising in the United States and elsewhere, vaccine rollouts are proceeding slower than hoped, and a post-holiday surge in cases looms.

Here are brief summaries of several important recent developments and ominous trends:

Coronavirus mutant strains are everywhere
As viruses routinely do, SARS-CoV-2 has been gathering mutations since its emergence a year ago. Most have proven benign and largely unimportant, but recently evolved strains, including in England and South Africa, are up to 70% more infectious, mounting evidence indicates.

The most widespread and concerning mutated strain is the U.K. version called B.1.1.7. Its spike proteins, the protrusions you’ve seen on countless illustrations, bind more readily with human cells, allowing it easier entry. The strain has been found in California, Colorado, Florida, New York, and 33 countries, and is expected to spread swiftly and widely.

So far, the mutated strains are not causing more severe symptoms in those who are infected, nor do they raise the risk of death in an infected person. Experts also say the relatively minor viral evolutions are not enough to render current vaccines less effective, and Covid-detecting tests should still work.

But the higher transmissibility means prevention efforts are more important than ever, both to stop new cases from spiraling and to help thwart further mutations. “The potential for virus mutation increases with the frequency of human and animal infections,” states the World Health Organization (WHO).

U.S. deaths could skyrocket
The ongoing high rate of new cases and rise in the U.S. Covid-19 hospitalizations guarantee an ongoing increase in deaths, above the current running average of 2,600 per day. But assuming the virus becomes more transmissible due to mutations, deaths could skyrocket, given a less-than-intuitive reality of math:

All other things being equal, a hypothetical 50% increase in the fatality rate of the virus would cause deaths to jump about 50% above current levels in a one-month period. No such scenario is expected.

But a 50% increase in transmission — apparently already happening — would spike the death toll more than six-fold in the same one-month period. (Adam Kucharski, a mathematician and epidemiologist at the London School of Hygiene & Tropical Medicine, explains the complex calculations here.)

U.S. vaccine rollout is botched
After a disappointingly slow start, U.S. Covid-19 vaccinations ramped up in recent days to some half a million a day. But the lack of federal coordination, which Sen. Mitt Romney, R-Utah, calls “inexcusable,” left the nation well shy of the White House goal of 20 million doses by the end of 2020.

Only about 4.2 million Americans have been vaccinated so far. In the meantime, debate continues over who should be inoculated first, centering around older people, essential workers, and health care workers. As one example of the poor rollout, many primary care doctors still have not been vaccinated and don’t know when they’ll get their turn. “Many are angry and frustrated and fed up, frankly,” Emily Maxson, chief medical officer at Aledade, a company that works with thousands of providers across 27 states, tells Statnews. “They’re absolutely downtrodden.”

The challenge is immense. If the U.S. hits President-elect Joe Biden’s goal of 100 million shots in 100 days (starting with his inauguration January 20) and sustains that pace, and people get the necessary two shots each, then by the end of July, only about a third of the population will have been vaccinated.

All this math suggests it could be fall, at least, before the pandemic is apt to substantially subside.

Debate brews over one shot vs. two
Scientists are debating whether it makes sense to hold back the second doses of vaccines that are required for optimal immunity, in order to more quickly give a larger number of people some level of immunity via a first shot (the exact levels of immunity conferred won’t be accurately known until some retrospective studies can be done).

Britain has decided to delay second doses.

“I would not be in favor of that,” says Dr. Anthony Fauci, America’s top infectious-disease expert. But other experts are warming to the idea.

“If the virus is spreading slowly, we want to do the right thing and give the most vulnerable [people] two doses and [require] others to wait,” tweets Akiko Iwasaki, PhD, a professor of immunobiology at Yale University. “I am still a proponent of a two-dose vaccine but given the urgency, we can delay the second dose until more vaccines become available,” Iwasaki says.

However, the Food and Drug Administration on January 4 urged staying the course with the plans for two doses of the vaccines, which “have now shown remarkable effectiveness of about 95% in preventing COVID-19 disease in adults,” the agency said in a statement. “At this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence.” Expect more scientific discussion and debate on this in the coming weeks.

The threshold for herd immunity just went up
The ultimate goal of vaccinations is to achieve herd immunity, whereby enough people are immune to the coronavirus that it fades away because it finds so few fresh hosts to infect. For months, scientists have estimated that the threshold could be anywhere from an optimistically low 40% to around 70%, depending on a host of factors ranging from the rigor of prevention efforts to how infectious the virus is.

“If you’ve been thinking of vaccines as the light at the end of the tunnel: Yes, that light is there, as bright as ever. But the tunnel just got a bit darker and a little bit longer.”

But already in November, Fauci was putting the threshold at 75% to 85%. Given that new strains are proving more infectious, immunity (through vaccinations and by people who’ve contracted the disease) will almost surely be on the higher end of that spectrum, many experts are now saying.

“It’s not what anyone wants to hear, but the coming months may well be the hardest of this pandemic,” tweets science writer Kai Kupferschmidt, who has written in detail about the new strains. “If you’ve been thinking of vaccines as the light at the end of the tunnel: Yes, that light is there, as bright as ever. But the tunnel just got a bit darker and a little bit longer.”

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Credit: Covid Tracking Project
Death rates in hospitals are declining, but remain “very high”
A bit of good news: Physicians are learning better tactics and treatments, improving survival rates of Covid patients admitted to hospitals, according to a new study in the journal JAMA Internal Medicine. But there’s a catch: Survival rates worsen when hospitals become overloaded, as many now are.

Covid-19 is five times deadlier than the flu for people hospitalized with either disease, studies have already found. The new research involving 38,517 patients admitted to 955 U.S. hospitals through June found death rates ranged from 16% in the worst situations to 9% in the best, and in general, improved as caseloads went down in May and June. “The factor most strongly associated with outcomes or their improvement, based on our data, was how much Covid-19 spread there was in the hospital’s surrounding community,” says lead researcher David Asch, MD, a professor of medicine at the University of Pennsylvania.

“Covid-19 outcomes in U.S. hospitals have improved remarkably, and remarkably fast,” says study team member Natalie Sheils, PhD, a research scientist at UnitedHealth Group. “But a death rate of more than 9% among hospitalized patients is still very high, and Covid-19 remains a very dangerous disease.”

Covid symptoms last at least six months for some people
Covid-19 is having long-term effects on the brains and bodies of some survivors. A new survey of 3,762 people in 56 countries thought to have long-term symptoms, so-called long-haulers, finds dozens of persisting agonies even six months after contracting the disease, either on an ongoing basis or in relapses.

The most common long-haul symptoms, both for those who deal with them for a few weeks and those suffering for months: fatigue, malaise, and cognitive dysfunction (including memory and concentration problems).

The online, self-selecting survey results have not yet been peer-reviewed, but the indications confirm previous research and anecdotal reports of the emerging problem whose ultimate timeline remains unknown.

Another recent study found that 9% of people discharged from hospitals after surviving Covid-19 between March and July were later readmitted, and 1.6% were readmitted more than once.

Masks work, new research confirms, but…
False contentions that rising Covid cases prove masks don’t work fail to acknowledge what science has shown: If the majority of people had not been respectful of the need to mask up, the U.S. caseload and death toll would be even higher.

A new review of more than 100 studies finds “masks and face coverings worn by members of the public reduce the spread of respiratory viral infections including SARS-CoV-2.” The authors, writing in the Annals of Internal Medicine, note that a little goes a long way, given how each Covid infection tends to beget more than one additional case. “Even small reductions in the transmission rate can lead to large reductions in the number of people becoming infected over time,” they write.

The coronavirus is known to be airborne, and other recent research has concluded that masks protect both the wearer and others. But masks are not perfect, and distancing of six feet (and ideally more in many settings, experts say) remains crucial, another new study confirms. “A mask definitely helps, but if the people are very close to each other, there is still a chance of spreading or contracting the virus,” says Krishna Kota, PhD, an associate professor at New Mexico State University and one of the article’s authors. “It’s not just masks that will help. It’s both the masks and distancing.”

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