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A rough winter awaits. Did we relax our vigilance too soon?

Eric Topol started off his latest article, “The new COVID wave“, stating “Things are once again going in the wrong direction in the United States.” (What else is new?)

Stop coronavirus

Did we stop masking too early? (from Anytime-V (Drug Addiction Clinic Vita https://www.vperemen.com/ – Wikimedia Commons)

Walk into a store and you would think – except for a few oddballs (like me) – that the pandemic was over. Masking is at an all-time low. Young people, middle-aged people – even seniors with frail immune systems – pour into crowded stores, unmasked.

Yet, while the pandemic has loosened its grip, it’s still around. Two hundred and fifty people a day in the U.S. are dying of it. That’s down 12% from two weeks ago, but with hospitalizations and infections jumping 25%, increased death rates are sure to follow.

Trevor Bedford from the Hutchinson Foundation reported that modeling efforts suggest cases could peak at around 150,000 new cases a day during the holidays.

Nobody, though, thinks the surge is going to be anywhere near as bad as the big surges in the past. Eric Topol believes that the vaccinations, boosters, and past infections have built a “fairly formidable immunity wall” in the U.S. and a more formidable one in Europe. Death rates are much, much lower now – about 1 in 2,000 compared to 1 in 200 early in the pandemic.

The Immune Evasion Chronicles: A Monoclonal Antibody Fades but Paxlovid Hangs in There

As expected, the virus is continuing to find more and more ways to evade the immune system. The BQ.1.1 variant – which is fast becoming the dominant variant in the U.S. – has a mutation in the spike protein that gives it “a big edge”, Topol reported, “in immune evasion”. The new variant is more resistant to Evusheld – which was protective against COVID-19 in immunocompromised individuals – and has left the monoclonal antibody Bebtelovimab in the dust. Citing its inability to protect against the latest strain of the virus, the FDA recently pulled Bebtelovimab from the market in the U.S. At one point six monoclonal antibodies were being used to fight the virus – now there are none.

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Thankfully, whether you’ve been vaccinated or not, Paxlovid still appears to be effective, and as a bonus, also as Health Rising recently reported, reduces the incidence of long COVID by about 25%. The RECOVER Initiative is beginning a Paxlovid long-COVID treatment trial early next year. (Topol also recently reported that the “rebound” effect is no more likely in Paxlovid users than non-Paxlovid users).

The Gist

  • Masking is at an all-time low for the coronavirus pandemic era yet the most immune-evasive coronavirus variant is sweeping the West, the flu season has started early and is the worst in decades, and the RSV virus is hammering children in particular. 
  • Two-hundred and fifty people are dying every day from the coronavirus and hospitalizations and infections are increasing rapidly. While the new variant may be milder – and no one expects a huge wave like before – it has also knocked out two medications that were in use. (Thankfully, Paxlovid is still effective and can reduce the risk of long COVID to boot.)
  • The bi-valent coronavirus vaccines can help – if you can tolerate them. They are more effective against infection and studies make it clear they can also reduce the risk of getting long COVID. 
  • The more times you get infected with the coronavirus, though, the greater risk you have of coming down with any number of health problems as well as long COVID. 
  • The poll asks how you are about masking, handwashing, social isolation as well as how you’ve done with a flu or bivalent vaccine. Please check it out! (Responses are anonymous.) 

 

The Reinfection Ripple

Then there’s the danger of the coronavirus triggering long COVID (and we should start thinking about “long flu” and long RSV infection…). The coronavirus appears to have turned out to be a pretty spectacular initiator of long COVID. With the virus hanging in year after year, researchers have been studying the ramifications of getting hit with the virus more than once.

It turns out they are not good. It appears that the more times you get hit with the coronavirus, the greater risk you are at of coming down with long COVID.

A recent huge Veterans Administration study (@ 6 million!) found that getting reinfected with the virus carried a doubled risk of death, and a tripled risk for lung, heart, blood, kidney, diabetes, mental health, bones, and muscle, neurological disorders, and long COVID. Each additional infection further increased a person’s risk of coming down with long COVID.

Even being fully vaccinated and having a prior infection wasn’t enough to stop this pattern. It also didn’t matter which variant a person had been exposed to. Because the VA’s population tends to be older and less healthy overall, the situation may not be quite as bad as the study makes it out to be. On the other hand, the VA’s male population may understate the risk that females – who make up the majority of long-COVID patients – face of coming down with long COVID.

If you already have long COVID (or presumably ME/CFS), another coronavirus infection can make things worse. A recent UK online survey found that 80% of long-COVID patients reported that a new infection worsened things. Dr. Luis Ostrosky-Zeichner, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital, said a new infection could be “devastating” for some patients. Ostrosky told Yahoo! News:

“It’s pretty devastating. They may have been making a lot of headway with this four- to five to six-month recovery process, and then it’s a huge setback for them. Very demoralizing, very disheartening for them when this happens.”

Ostrosky also said that, in his experience, relying on past experiences doesn’t work.

“You might have had a really mild case before, but you don’t have anything assured whether the next case is going to be as mild or if it’s going to be more severe… There’s also so much we don’t know about what kind of damage accumulates with repeat infections. So don’t let your guard down.”

The Vaccines Hold Up

Vaccines  – if you can tolerate them – are helping. With Health Rising’s polls suggesting that vaccinations may result in severe symptoms lasting a month or longer in 20-30% of ME/CFS/FM deciding whether to risk that or an infection that may be equally debilitating is no laughing matter.

The Coronavirus Vaccine Side Effects Poll for ME/CFS and Fibromyalgia

Studies indicate, though, that the Pfizer and Moderna bivalent boosters produce significantly higher immune responses and are 30-50% more effective than the original vaccines. Topol pointed out that while seniors, in particular, are helped by boosters, fewer than 1 in 3 in the U.S. have had the bivalent booster.

Vaccinations and Long COVID

Other studies are pretty clear that the vaccines may provide some protection against long COVID. While we don’t have studies that assess the vaccine’s ability to protect against a relapse in ME/CFS, if they are protective against long COVID in the general population, they might provide protection for people with ME/CFS or long COVID.

A systematic review of 18 studies reported people who had been vaccinated with at least the two original shots had a 29% lower risk of developing long-COVID symptoms (cognitive dysfunction/symptoms, kidney diseases/problems, pain, and sleeping disorders/problems sleeping. (The authors believed more symptoms would have shown up had the studies been more complete and a common definition of long COVID used.)

People, on the other hand, who only had one vaccine shot did not show any protection against long COVID. People who had been vaccinated after a COVID-19 infection also showed a reduction in long-COVID symptoms. The authors proposed that by increasing antibody titers, the vaccinations may have helped to eliminate viral reservoirs that play a role in long COVID.

“Tripledemic” Produces Noteworthy Winter Bug Season

Three bugs

At least three bugs (coronavirus, flu, RSV virus) are widely circulating this winter.

This year the situation is being complicated by a truly noteworthy winter bug season. Our lucky streak of relatively mild flu and bug seasons has ended. Flu season has begun much earlier and with much more force than usual in the U.S. and Canada. The winter flu season usually doesn’t get going until December, January or later, but this year it showed up in November in spades.

Plus, it’s being exacerbated by the emergence of the respiratory syncytial virus (RSV) – a common respiratory virus – which has shown up with a vengeance. Like other respiratory viruses, RSV typically produces mild colds, but in small children and seniors it can be deadly. It can also exacerbate symptoms in people with respiratory illnesses like asthma.

Dr. Rose Zacharias, president of the Ontario Medical Association, warned that “In the coming months, Ontario will likely face the triple threat (coronavirus, flu, RSV) of respiratory illnesses.” Canada’s chief public health officer, Dr. Theresa Tam, reported that one way or the other Canadians are probably going to encounter one or more of these viruses “as long as influenza, RSV, SARS-CoV-2 and other respiratory viruses continue to co-circulate at a high level”. Alberta, Canada just reported that it’s already having its worst flu season in decades.

Children and teens are getting hit hardest. Dr. Rod Lim, emergency medical director of the ER at the Children’s Hospital in London, Ontario, called the situation – multiple viruses, staffing shortages, and early entry into the flu season – “a little bit of a perfect storm”. With record volumes of children being seen he warned of an “incredibly challenging winter”.

A similar pattern appears to be playing out in the U.S. Last month, federal health officials stated that the U.S. had already passed “the epidemic threshold” for flu and outlined plans to deploy troops, FEMA personnel, and supplies like ventilators from the Strategic National Stockpile if necessary.

Last Friday, the CDC reported that 44 states are seeing high or very high flu activity and that hospitalizations doubled over the last week. Plus, the dominant flu strain so far is a nasty one that’s typically associated with higher rates of hospitalizations and deaths, particularly in seniors.

As in Canada, RSV infections are putting a strain on the number of intensive care unit beds available for children. In November, Orange County in California declared a health emergency in its pediatric hospitals. Similarly, almost every major hospital on the East Coast was reportedly nearly full. The Feds have even said they’re prepared to go nuclear if things turn really bad, providing National Guard troops, FEMA personnel, and ventilators.

Lapsed Vigilance?

That brings us full circle. We’re way past the question of whether we’ve let our guard down – as a society we have. Masking, hand-washing, isolation – they’ve all pretty much gone by the wayside.

The multiple infectious threats (coronavirus, flu, RSV) present this winter, however, suggest we should remain vigilant. Being vigilant and masking up in this era of low mask-wearing means standing out in a crowd – not a pleasant thing for anybody.

For me, I think the mask debate has largely burnt itself out and most people really don’t care anymore. Still, it’s strange to walk into a store and be the one or five, or ten percent of people wearing a mask.

So, the question of this blog is where do you find yourself on the issue of pathogen protection this winter? Are you or have you been wearing a mask, washing your hands, and avoiding crowds? For myself, I’ve been wearing a mask, but I can’t remember the last time I remembered to wash my hands after being around people. That’s changed.

Please take our pathogen protection poll. It includes questions about masking, handwashing, etc., and your experiences with flu vaccines as well as the bivalent boosters if you’ve had them. (There’s some potentially good news for flu vaccines, by the way. A new kind of mRNA superflu vaccine being tested appears to be effective against 20 different flu strains.

Please take the Poll!

Note that all responses are anonymous.

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