As usual, the official (underestimated) case rate continues to bounce around. Right now we're not seeing worrying trends in local hospitalizations and deaths, but I am starting to see a worrying increase in the concentration of viral particles in wastewater in Hampshire County. We'll keep a close eye on that, because it may be the first signal of an upcoming increase in transmission.
The biggest thing on my mind this week is something the president said this weekend. The President declared the pandemic over during an appearance on 60 Minutes on Sunday, September 18th, 2022. I cannot state in strong enough terms how much the pandemic is not over. At the most basic level, a pandemic declaration is made by the World Health Organization and the Director General provided an update just a few days before the president's appearance, on Wednesday, September 14, 2022, confirming that the pandemic is not over. I want to point your attention to a few key points that indicate we are very much still in a pandemic situation:
- First and foremost, it is stunning to hear anyone in a position of leadership state that the pandemic is over when 350-400 Americans die each day from COVID-19. This is an incredibly high death rate, period. And it's an incredibly high death rate compared to other leading causes of death - it ranks as our third or fourth leading cause of death in the United States. Only heart disease and cancer kill more people each day, compared to COVID-19. Are we "done" with cancer, or heart disease? I should hope not. I hope we never settle for 350+ deaths per day as an acceptable death rate for a disease in the US. I'm stunned that while the friends and family of 350ish people mourned their loved ones death on Sunday, the president said the pandemic was over. The loss of life is staggering, unacceptably high, and almost entirely vaccine-preventable. Our next step must be to get more of the country vaccinated, not to declare the pandemic over. Speaking of which...
- The omicron-specific bivalent booster has been made available and experts are encouraging everyone to get the booster a few months after their last infection or vaccine dose. The number of lives this booster will save depends on how many people receive it. We need a strong booster campaign, not mixed messages about the importance of a booster for a pandemic that's over! Americans hearing that might wonder if it's over, why should they bother getting a booster? If we can run a successful bivalent booster campaign this fall, defined as increasing booster vaccine rates over the current trends in booster doses, we can save somewhere between 100,000 and 160,000 lives this fall and winter. We cannot save those lives if folks don't get the booster dose. Please do not consider the president's statement to mean that you don't need a bivalent booster dose!
- The SARS-CoV-2 virus continues to mutate rapidly, faster than other viruses we consider endemic (normal / expected), like influenza. In fact, experts are closely watching a newly identified variant, BA.2.75.2, with the potential to cause serious disruption in the coming months. It's difficult to call a pandemic over when we're actively watching a circulating variant that we suspect will evade immunity and treatment. (More on the variant below.)
- Finally, the last point I'll make in regard to the pandemic not, in fact, being over, is that the WHO Director General said on Wednesday that we're in an excellent position right now to have the pandemic situation end and move to an endemic situation, but that we're not there yet. He compared our current position to a marathon runner who sees the finish line - if we declare it over prematurely, we risk losing important progress we've made. In the case of COVID-19, that means more avoidable death. Here's his quote - I think it summarizes the situation beautifully, and I sincerely wish the president had shared this on 60 Minutes:
"We have never been in a better position to end the pandemic. We are not there yet, but the end is in sight. A marathon runner does not stop when the finish line comes into view. She runs harder, with all the energy she has left. So must we. We can see the finish line. We’re in a winning position. But now is the worst time to stop running. Now is the time to run harder and make sure we cross the line and reap the rewards of all our hard work. If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption, and more uncertainty. So let’s seize this opportunity."
The Director General of the WHO also released a summary of months of work by expert working groups at the WHO last week. He outlined six key steps for moving from a pandemic state to an endemic state:
- Countries need to attempt 100% vaccination rates in high-risk groups, including health care workers, with a goal of 70% overall vaccination rate.
- Countries need to invest in testing and sequencing, integrating and automating surveillance and testing services for COVID-19 and other respiratory diseases like influenza. This is not the time to shut down testing sites, or reduce funding for free tests!
- Countries need to integrate COVID-19 treatment into all healthcare practices, addressing issues of both information and access to effective treatments.
- Countries need to plan for surges and have supplies, equipment, and health care workers ready to deploy.
- Countries need to maintain strong infection prevention and control precautions for health care workers and within health facilities.
- Countries need to develop clear and accurate communication from leadership about COVID-19, and train health care workers to identify and address misinformation.
Lastly, I wanted to provide an update on that BA.2.75.2 variant I mentioned above. It has mutations on it that we know have the potential to evade immunity and treatment, and worryingly, exhibits very low levels of antibody neutralization in the lab. Essentially, what this means is that it has the potential to be a problem, and in our early tests, it is indeed a problem. Right now we don't have enough of this variant circulating to be sure what it will do in the population, but in lab testing, almost all of the antibodies we have that normally "neutralize" the virus that causes COVID-19 aren't working. This means it could be super infectious, more infectious than the other variants we've seen so far, including BA.4 and BA.5. Experts are watching it closely. It certainly has the potential to cause disruption and a surge in cases. We hope that prior infection and vaccination will provide protection against severe disease and death, and hopefully the bivalent booster will help that situation immensely. It probably will not, however, protect against infection. And infection itself isn't great, even if you don't end up super sick! We still have to think about things like Long COVID, the disruption of staying home for a week, and how to protect vulnerable members of our community. The real test will be to see if BA.2.75.2 becomes the dominant variant and if so, how quickly. We'll be sure to keep watching for developments in the coming weeks.
Stay well (and get the bivalent booster!),
Megan W. Harvey, PhD (she/her)