“Why is there so much emphasis on the efficacy of the COVID-19 vaccine at preventing hospitalization?” one of my infectious diseases colleagues asked at a recent meeting. “Is that the most important goal here? Shouldn’t the most important goal be to prevent infection in the first place–since we now recognize the many devastating long term effects of this disease that has never before been “seen” by a human host and to which therefore we have evolved little in the way of defense?” he added.
“Shouldn’t we be developing vaccines with better mucosal immunity–like the oral polio vaccine–vaccines that prevent infection in the first place?”
His question is an apt one. The fact that patients are developing autoantibodies even after asymptomatic or mild illness is highly concerning. Also concerning is that –again, even after mild illness– they can develop significant heart and lung injury ; and that MRIs and PET scans show that even patients with mild illness may develop stroke or what looks like Alzheimer’s due to “endotheliitis.” All of these factors mean that these patients will then likely be on a completely different Kaplan-Meier survival curve–with broad, negative implications both to the individual and to society at large.
We have known since the beginning of the pandemic that some COVID-19 patients look immunologically a lot like patients who are infected with another virus– HIV: they can develop CMV and PCP, so called “opportunistic infections;” we have known that infection with COVID-19 can lead to reactivation of underlying viral illnesses like EBV (a known trigger for cancer, especially for Hodgin lymphoma and nasopharyngeal cancer), HSV and VZV following infection. I have seen cases of relatively young patients with mild infection go on to develop encephalopathy, or brain infection and swelling, with mental status changes.
To cavalierly dismiss the omicron variant with the statement that “most cases will be mild” brings back not-so good memories of the early days in this pandemic when the public was soothed with false reassurances that the illness it engendered was “mild” and mortality from it not worse than a bad year for influenza.
This is a new virus that humans have never seen before. Some people’s immune systems are being left in disarray, with significant decreases in blood cells that fight infections, suggesting a high level of immune dysfunction. We don’t know why this isn’t universal, and why some patients are more affected than others. Until we learn what these risk factors are and how to protect those most at risk, more caution is warranted. Is there perhaps the equivalent of the CCR5 deletion that protects some patients from getting HIV–that protects patients from this severe form of COVID-19 illness? Until we understand this– it is really not prudent to tell the American people–”go ahead and jump in, the omicron is fine, all of you are doomed to become infected.”
The message sent out to patients is resignation–there is nothing they can do to protect themselves, and they should resign themselves to getting this illness–“everyone is going to get it, so why bother protecting yourself?”
Saying that “ everyone” will get omicron also fails to mention that such an eventuality would lead to massive numbers of deaths among our most vulnerable–and belies a willingness to accept a staggering death rate in the US–for if “everyone gets it,” all those who are immunocompromised are at high risk of dying. Just announcing such a thing has to be called out as a remarkably tone-deaf statement also, since people of color and those living in low income communities have been disproportionately hurt by this pandemic across our country and across the world.
We need to continue to look at this pandemic through a public health lens–not a private wealth one. It is clear that COVID-19 has a tremendous potential to become, in classic virus lingo, “the gift that keeps on giving.” Please do not stop taking all possible precautions.
“Maybe it’s time to get back to the basics of public health,” said Dr. William Burman, former director of Denver Health, in a talk last year about the COVID-19 response in Colorado.
This message is overdue both for our country and for Massachusetts.
Since current vaccines do not afford protection against infection, it would be prudent, just as early in the pandemic, for governments to consider the full range of targeted public health measures available when confronted by a massive surge in infections, rather than the rote repetition of “masks and vaccines” as if those were the only strategies available to us; in other countries, the use of non-pharmaceutical interventions like shelter in place, mandatory isolation and quarantine, limiting numbers of people working together and meeting together, temporary dedicated hospitals for COVID-19 patients have all proved effective in limiting mortality. We could do studies to determine ventilation standards that would ensure viral clearance. Institution of NPIs when case numbers rise will prevent the continued devastation of our economy and health care systems , many of which are already overwhelmed and failing, and ensure equity.
Things will keep getting worse as long as variants can keep evolving–unless we change our public health strategy.
Remember: this pandemic is far from over.
