COVID
The world is now far enough past the 2023 Lunar New Year’s celebration that we can say that it did not result in a significant surge in cases hospitalizations or deaths. Retrospectively looking at graphs of the data from the first of the year up until now, there was a noticeable but slight increase in all parameters that corresponded to that lunar new year travel period, but it was minimal, and looking at the world as a whole, both reported cases and deaths due to COVID-19 are at the lowest levels since the pandemic started during the first quarter of 2020. While we would hesitate to say that we are completely done with COVID, we do feel comfortable saying that we are in a very good place.
Could there be yet another COVID variant that causes a new surge of cases? Of course, that could happen, but it is probably no more likely than the possibility of a new significant flu variant emerging and creating significant global disruption. In fact, in the past 2 weeks, there have been several articles concerned about the emergence of a new H5N1 avian flu that has made the jump from birds to mammals in several areas of the world. There is no evidence of any jump to humans at this point and there is a long history of bird flu jumping to nonhuman mammals and never making the jump to humans. So, while bird-to-mammal flu jumps are concerning, nothing we have seen so far indicates a high risk that we have an impending new flu pandemic; but it does mean that the global public health community needs to maintain vigilance.
This most recent hype also makes the point that people outside of medicine should ensure that they maintain access to a trusted source of information so that when the drums about new COVID variants or new flu strains begin to beat, you will have a better chance of sorting what is truly concerning from what is hype. Fortunately, our global COVID experience combined with years of research on respiratory infectious diseases has left us better able to deal with any emerging pathogen, especially a new coronavirus or new influenza strain. Global monitoring systems for emerging infectious diseases combined with our now well-proven ability to turn out reasonably reliable vaccines based on mRNA technology means that it is very likely that we would recognize a new emerging human pathogenic virus and have the ability to field life-saving vaccines and antiviral medications in a timely manner.
Masks
Speaking of research, another major study released in the last 2 weeks by the Cochrane Library, a highly respected medical study consortium, reasonably demonstrated that masks, and any type, have minimal benefit to the wearer in reducing the risk of contracting a respiratory virus. While there was always a vocal contingent that argued this was the case, this is the first major work that confirms it. Importantly, however, this does not mean that our 2+ years of masking were for naught. While the Cochrane study did not address this, as we have covered before, there remains less controversy as to the benefit for someone who is ill to wear a mask to decrease the amount of infectious material they are spewing into the environment. So, for a disease likely early variants of COVID for which there was a prolonged asymptomatic but infectious phase, universal, or at least widely adopted, masking can be beneficial to reducing transmission. But that is not where we are today. There is no long asymptomatic-but- infectious phase for either COVID or flu. Hence, it is very difficult to make an argument for masking except for someone known to have COVID or other respiratory diseases as manifested by cough, sneezing, and runny nose. Interestingly, this is exactly what the Surgeon General of the United States said in late-2020 when he was nearly laughed out of the room by the CDC and most popular media outlets. In retrospect, we do not significantly fault the public health community for pushing masks as we were developing information, but now we have a more complete understanding and without a new pathogen that again demonstrates an asymptomatic but infectious period, it is our hope that we can put this universal masking argument to rest.
Vaccines
A major controversy that remains with us is regarding vaccination; especially as it pertains to the need for future boosters for those who are fully vaccinated. Last week, the CDC added COVID primary series and COVID boosters to the schedule of recommended vaccinations for children and adults. This recommendation was added almost simultaneously with new studies coming out that continue to question whether there is a significant benefit for any vaccinations for children or boosters for adults up to age 50. A major study this week from Northwestern University looked at the relative mortality rates for various vaccination statuses and various age groups and found that while vaccination and boosters significantly reduced mortality rates in those over age 60 and likely reduced mortality in those between 50 and 60, there was minimal benefit demonstrated for those under age 50 in terms of relative mortality. That being said, if vaccination could be demonstrated to significantly reduce impactful disease in younger people, it may still be justifiable, but increasingly we see that COVID, especially in those under 50 and more especially in children, behaves like a fairly typical upper respiratory infection. So while we are still gathering data on potential adverse events associated with the vaccine, it appears to me to be premature for CDC to add the vaccines to the general vaccination schedules, other than for at-risk populations, especially at a time when the general trust in the CDC is low, and these vaccines are not formally approved by the FDA for all ages for whom CDC has added to the vaccination schedules.
One last issue that has been the subject of a recent study regarding the severity of disease for subsequent COVID infections. Late last year, a US Veterans Health Administration study demonstrated that 2nd or 3rd infections were more likely to be more severe than the first. The study was well done, but the population was not reflective of the general public. The average age of the population was 63 and with multiple chronic medical conditions. No subsequent studies have corroborated the findings for more general populations, although it has been shown that people who were sick enough to be hospitalized with a first COVID case have a 50% chance of hospitalization with a second case. In many cases, this is because the same risk factors are still present, but it should lead physicians to consider anyone who has been hospitalized with COVID to be at high risk, and therefore eligible for early treatment with Paxlovid for any subsequent COVID infections.
