Wow—has it really been three months since my last post? I had to double check that.
So, what’s new with COVID-19? Well—not really that much.
I did receive my Bivalent booster—so called because it includes mRNA directed at producing antigen (the substance that promotes an immune reaction) for both the original COVID-19 strain and the BA.5 subvariant of the Omicron variant. Omicron has proven an especially hardy variant of COVID-19—it has now lasted for over a year as the dominant variant (remember Alpha and Delta?). I would recommend a Bivalent booster for everyone, unless they have a significant reaction to a previous COVID-19 vaccination.
Yes, hospitals are still busy with the so-called “Tripledemic” of COVID-19, influenza and respiratory syncytial virus (RSV). Yet, the number of people we see dying from COVID-19 in ICUs is nothing like this time in 2021 and 2020. That is a good thing.
For most people, COVID-19 continues to be an inconvenience—highly transmissible and can cause reinfections. But for most people, it is not a threat to their life and ability to function.
Yet, for some people, COVID-19 continues to be a threat. Some will develop “long COVID”, and for some, especially people who are immunocompromised due to illness or medication, COVID-19 remains a threat to their life. Because of the risk of long COVID to myself, or the risk of transmitting COVID-19 to others, I continue to mask up when I am indoors in most public places. We still wear masks on airplanes, unless we are eating.
Yet—life goes on! And I enjoy going to a book club we just joined; we enjoyed hosting gatherings for Thanksgiving, Hanukkah and Christmas; and I enjoyed seeing the Vikings play the Bears at US Bank Stadium (you know you are old when your son buys the tickets!). I’ve even been to a very few indoor restaurants. No masks for any of those events.
What all this involves is calibrating risk. I spoke to one person, an engineer, who told me he doesn’t “believe in masks” because they are “not 100% effective”. But is that really the right metric? What in life is 100%? Just death and taxes, so far as I know. Everything else involves some risk. Most of us internalize our risk calculations as we go through life—wearing seat belts, the “five second rule” for eating things that fall on the floor, tugging on Superman’s cape, not spitting into the wind, or messing around with Jim.
A novel virus with unknown and unpredictable complications seems like a good reason to modulate risk and wear a mask when it is a minor inconvenience. And masks do reduce the risk of both acquisition or transmission of COVID-19—as well as influenza and other respiratory pathogens.
Multiple studies have suggested that wearing a mask is associated with decrease risk of transmission. Respirator level masks are better than paper procedure masks, and paper procedure masks are better than cloth masks, but all of them are better than no masks. Unfortunately, we cannot do a double blind, placebo controlled trial to demonstrate the benefit (what would be the placebo mask?), so we have to rely on large observational studies to demonstrate benefit—and they do.
What will 2023 bring?
—Now that China has swung from “Zero Covid” to “Anything Goes”, I expect to see multiple new subvariants of Omicron that will be more infectious, probably this spring. Look for new Bivalent or Multivalent Covid-19 boosters again in the summer or Fall.
—New COVID-19 therapeutics would be appreciated. While Paxlovid, Molnupiravir and Remdesivir are all somewhat effective, there is still room for improvement in effectiveness, decreased side effects, and ease of administration. And the ever-possible risk of antiviral resistance from emerging variants/subvariants of COVID-19 remains. We have lost the monoclonal antibodies for treating infection, and the utility of Evusheld to prevent infection is becoming more limited.
—Reduction of “friction” in healthcare settings related to steps to reduce COVID-19 transmission. Already, we are seeing healthcare institutions stopping routine testing of asymptomatic people, permitting visitors (at their own risk) to patients with COVID-19, and reducing the use of masking in areas where patients are not present. The last big step will be dropping of masking while caring for patients. Most likely this won’t happen until after the respiratory virus transmission “season” is over—and COVID-19 virus is receding in the community. My money would be on checking the amount of COVID-19 RNA in wastewater. It’s still pretty high right now in the Twin Cities, although not as high as a year ago. When it drops low, we might start seeing the masks going away in hospitals.
Happy New Year!