The Emerging U.S. COVID-19 Story: Implications for European Health Systems and for Vaccines, Surgeons, and the Epidemic Team
Several computer models are projecting that COVID infections will continue to recede at least through the end of the year. Researchers stress that there are many uncertainties that could change that, such as if more infectious variant start to spread in the U.S.
What is happening in Europe may be the first hint of what’s to come. Infections have been increasing in countries like the U.K., France, and Italy.
“In the past, what’s happened in Europe often has been a harbinger for what’s about to happen in the United States,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “So I think the bottom line message for us in this country is: We have to be prepared for what they are beginning to see in Europe.”
We will need to be ready for this. Countries need to be in a position to conduct surveillance, to deal with increases in cases and perhaps deal with increases and hospitalizations. There is no change in severity yet. She said the vaccines remain effective, but that they have to remain alert.
The U.S. experience may not correspond to Europe’s according to Justin Lessler, an epidemiologist who helps run the COVID-19 Scenario Modeling Hub.
That’s because it’s not clear whether Europe’s rising cases are related to people’s greater susceptibility to new subvariants they’ve not yet been exposed to. In addition, different countries have different levels of immunity.
We have a vaccine that people are being pushed to try and get more people to do. It’s matched against the still-dominant variant, which is BA.5, and almost certainly will have a reasonably good degree of cross-protection against the BQ.1.1 and the others, and yet the uptake of these vaccines, as we are already in the middle of October, is disappointing,” he said.
The New Boosters: Why the U.S. is Going into the Winter Surf and Why People Aren’t Getting Vaccined
Amy Kirby is a national wastewater supervision program lead at the Centers for Disease Control and Prevention and she says that it’s too early to say something big is happening.
The PolicyLab at the Children’s Hospital of Philadelphia reports that infections in some areas of New England have started rising, as have hospitals in northern areas such as the Pacific Northwest.
“We’re seeing the northern rim of the country beginning to show some evidence of increasing transmission,” Rubin says. The winter is starting to return.
It appears that this year’s surge won’t get the same severity as the last two years in terms of disease and deaths.
“The risk of reinfection is definitely not trivial,” says Ziyad Al-Aly, an assistant professor of medicine at Washington University School of Medicine in St. Louis and an author of the new study. “So going into the winter surge now people should do their best to try to prevent getting reinfected.”
“Not only have people gotten vaccinated, but a lot of people have now gotten this virus. Some people have gotten it many times. And that does build up [immunity] in the population and reduce overall over risk of severe illness,” Nuzzo says.
The poor uptake of the new boosters, combined with the immune evasiveness of the new variants and the waning of population immunity, is almost surely a recipe for rising cases and hospitalizations in the weeks ahead.
But booster uptake in the U.S. was already sluggish. “Nearly 50% of people who are eligible for a booster have not gotten one,” says William Hanage, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health. It’s crazy. It’s really crazy.”
And the demand for the newest boosters is pretty lethargic so far. Even though more than 200 million are eligible, less than 8 million people have gotten a new booster since they became available over the Labor Day weekend.
With the likelihood of a surge, it’s critical that people keep up with their vaccinations. “The most important thing that we could do is to take off the table that this virus can cause severe illness and death,” she says.
Scrabble variants of the Omicron family tree in the United States and Europe: a new phase of evolution for Covid-19?
In the United States, these are BQ.1, BQ.1.1, BF.7, BA.4.6, BA.2.75 and BA.2.75.2. In other countries, the recombinant variant XBB has been rising quickly and appears to be fueling a new wave of cases in Singapore. Cases are also rising in Europe and the UK, where these variants have taken hold.
Dr. Peter Hotez, who co-directs the Center for Vaccine Development at Texas Children’s Hospital, says he thinks of them collectively as the Scrabble variants because they use letters that get high scores in the board game like Q, X and B.
The CDC estimated that the variant accounted for almost 1 in 3 new Covid-19 infections nationwide last week.
The United States can still use antiviral drugs like Paxlovid and molnupiravir if the virus stops working.
Though they each descend from slightly different branches of the Omicron family tree, these new offshoots have evolved to share many of the same mutations, a phenomenon known as convergent evolution.
Some experts believe that convergence means a new phase of evolution of the virus that will see several versions circulate at the same time.
“What is likely to happen is that we have several co-circulating, semi-dominate lineages going into the winter season,” said Nathan Grubaugh, an associate professor of epidemiology at the Yale School of Public Health.
“That’s because with convergent evolution, perhaps several different lineages can independently obtain similar transmissibility levels versus a single new variant taking over.
Most diseases, such as the flu andRSV, tend to occur through this process. “Now that the virus has adapted pretty well to human transmission, most of what is circulating has high fitness.”
Can the Omicron SubVariant Outpace COVID-19? The Case for a New Family of Viral Variants
The large amount of new variant is becoming more difficult for the WHO to evaluate because countries are no longer watching it.
The Centers for Disease Control and Prevention said on Friday that there are two new omicron subVariants that have become dominant in the US and are raising fears that they could fuel an outbreak of COVID-19.
The projections vary but most people feel that they will be a substantial proportion and have bumped BA.5 off as the dominant variant, Fauci told CNN.
These variants are different from BA.4 and BA.5, but they’re descended from those viruses, the result of genetic drift. They have parts of their genomes that are related to that virus.
When the Omicron arrived on the scene in November of 2004, their changes were on par with what has happened today. That strain of the virus, which is now long gone, came out of genetic left field, leaving researchers and public health officials scrambling to catch up.
“It isn’t that different from BA.5 that it would completely escape the protection that you would get from vaccine” – if people would just get the shot, Fauci said.
“It’s probably going to be significantly bigger than the BA.5 wave, at least that’s what I expect,” said Mark Zeller, a project scientist who monitors variants at the Scripps Research Institute. But Zeller says he doesn’t expect this winter’s surge to reach heights of January’s Omicron wave.
The Role of Antibody Boosters in the Survival of Vaccine-Variant Omicron B.4/B.5 Vaccination against Covid-19
The genetic changes these variants share appear to help them escape the immunity created by vaccines and past infections – a recipe for reinfections and breakthrough infections, particularly for people who haven’t had an updated booster.
Eli Lilly made bebtelovimab, the last lab-created antibodies available to help ward off severe Covid-19 infections, but some of the variant appear to be impervious to it.
But antibody therapies are particularly important for people with immune function that has been blunted by drugs, disease or age. They are the same people who don’t respond to vaccines.
The US government must be a major player in the creation of monoclonals, to protect high-risk people, given the fast evolution of the virus. “The market cannot take care of it by itself.”
Even if we received money, it would take us many months to bring aonoclonal into the market, because we don’t have the money right now.
Antibodies are a weakness for companies because it takes millions of dollars in investment to make them and the virus is evolving quickly, so they can only be used for a short time.
The current realities require that the government continue to encourage the production of new therapies and he expects that the Biden administration will again try to ask Congress to give them more funding.
Pfizer and BioNTech said Friday that the immune responses against Omicron BA.4/BA.5 subvariants were “substantially higher” in people who got its new bivalent booster compared with people who received the companies’ original Covid-19 vaccine.
Pfizer hopes that the updated data will encourage people to seek out a COvid-19 bivalent booster as soon as possible in order to maintain high levels of protection against Omicron BA.4 and BA.5 sublineages. “These updated data also provide confidence in the adaptability of our mRNA platform and our ability to rapidly update the vaccine to match the most prevalent strains each season.”
Pfizer and BioNTech are still conducting larger trials of the updated boosters, and are still testing the vaccine against other versions of the virus.
Even if you were previously bitten or had the vaccine, getting boosted this fall is still a good way to make sure you’re protected. People as young as 5 are eligible for updated boosters.
The subvariants — called BQ.1 and BQ.1.1 — appear to be among the most adept yet at evading immunity from vaccination and previous infection, and have now overtaken the BA.5 omicron subvariant that has dominated in the U.S. since the summer.
Do we anticipate an increase in the risk of BVI in the United States as a consequence of the Delta and omicron wave?
“This time of year last year we were optimistic. We were coming out of the delta wave, and it was steadily decreasing, and we went into Thanksgiving to wake up to omicron. So there is this sort of déjà vu feeling from last year,” Luban says.
Recent laboratory studies indicate that new mutations in the virus’s spike protein appear to make BQ.1 and BQ.1.1 as much as seven times more “immune-evasive” than BA.5.
That said, a new study suggests that getting reinfected with the virus still can pose significant risks, both for short term and long-term complications, including an increased risk of hospitalization, symptoms of long COVID and even death.
The size of the increase and the surge will be important in determining if this is a nationwide issue or if it is something similar to what happened with Delta and omicron.
Recent increases in other countries suggest that the subvariants could have an impact on a new wave in the U.S. The surge involving the new subvariants occurred in France, but the increase in cases quickly dissipated.
One concern is that the new subvariants will make the last monoclonal antibodies useless, and people who use them to protect themselves.