Winter is almost here, and with it may come runny noses, coughing, and congestion. But how do you know if you just have a common cold, or if you have one or more of the three respiratory viruses that make up the “tripledemic” – RSV (respiratory syncytial virus), COVID-19, and influenza?
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WebMD Poll: Another Year of Tough COVID Questions
March 15, 2023 — Last year, on the second anniversary of the COVID-19 pandemic, we asked our audience questions about their pandemic experiences. A year later – and 3 years into living with COVID – we followed up with some more.
In total, our poll received 696 responses. Nearly 66% of those who answered identified as female, and 76% reported that they are older than 45. The confidence level used for editorial polls is 95%.
The fall of 2022 started out with President Joe Biden claiming that “the pandemic is over” on CBS’s 60 Minutes. Since then, he has ordered an end to the COVID-19 emergency orders issued in 2020, causing people to wonder if this really might be the beginning of the end of the pandemic.
In 2022, WebMD readers, for the most part (84%) did not see an end in sight. But a year later, attitudes seem to be shifting. Our current poll found that nearly a third – 30% – of our audience thinks the pandemic has come to an end. However, 42% of men said the pandemic is over, compared to just 25% of women.
The data, however, says differently. While daily life may have returned to its normal pace and we’re no longer in the midst of a state of emergency, many experts agree that we shouldn’t let our guard down. New cases and the number of deaths per week have indeed leveled off since January 2022, but data shows that there are still thousands of new cases reported daily. And given the evolution of the virus’s many variants, doctors and public health officials continue to urge caution.
The availability of vaccines and boosters is a big part of why we all feel more comfortable doing the everyday tasks that we may have taken for granted during the pandemic’s first couple of years. How many people, though, are actually protected against the virus? According to our poll, 7 in 10 respondents have been fully vaccinated against COVID-19; nearly 6 in 10 of those fully vaccinated have received at least two boosters (57%).
However, these numbers don’t totally reflect the reality of vaccine and booster uptake in the U.S. According to CDC data, Americans on the whole – quite similar to our findings – have completed their initial vaccination series at a rate of nearly 70%. But of those who have gotten fully vaccinated, only a little more than 23% have gotten at least one dose of the bivalent booster.
Sixty percent of respondents to our poll said that they have had COVID-19 at least once, which is notable when compared to an exhaustive nationwide survey that found that about half of Americans have had COVID. Within that study, however, researchers said there is a large chunk of positive at-home tests that have gone unreported.
Whether you had COVID-19 or not, the pandemic has undoubtedly changed the way we see and interact with the world around us. Last year, an overwhelming 88% of respondents agreed on this; this year, about half of our readers agreed with this statement – possibly indicating a growing acceptance of the changes happening around us.
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3 Years On, Why Don’t We Know the Extent of Long COVID?
SOURCES:
Amesh Adalja, MD, senior scholar, Johns Hopkins University Center for Health Security.
Manali Mukherjee, PhD, immunologist, assistant professor, Division of Respirology, Department of Medicine, McMaster University.
Sarah Wulf Hanson, PhD, research scientist, Institute for Health Metrics and Evaluation, University of Washington.
Lisa McCorkell, co-founder, Patient-Led Research Collaborative.
Julia Moore Vogel, PhD, program director, Participant Center, All of Us Research Program, Scripps Research Translational Institute.
The BMJ: “Long COVID outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study.”
Nature Reviews Microbiology: “Long COVID: Major findings, mechanisms and recommendations.”
CDC National Center for Health Statistics: “Long COVID Household Pulse Survey.”
Nature Medicine: “Unexplained post-acute infection syndromes.”
Patient-Led Research Collaborative.
World Health Organization: “Post COVID-19 condition (Long COVID).”
CDC: “Post-COVID Conditions: CDC Science.”
The European Respiratory Journal: “Circulating anti-nuclear autoantibodies in COVID-19 survivors predict long COVID symptoms.”
Emerging Infectious Diseases: “Postacute Sequelae of SARS-CoV-2 in University Setting.”
International Severe Acute Respiratory and emerging Infection Consortium (ISARIC): “Clinical Characterisation Protocol (CCP).”
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Future COVID Vaccines Must Be Better; Science Races to Respond
SOURCES
David L. Hoey, president and CEO of Vaxxas, Cambridge, MA, and Brisbane, Australia.
Pablo Penaloza-MacMaster, PhD, assistant professor of microbiology and immunology, Feinberg School of Medicine, Northwestern University, Chicago.
Jasdave Chahal, PhD, co-founder and chief scientist, Tiba Biotech, Cambridge, MA, and Brisbane, Australia.
Vaxart news release: “Vaxart Announced Positive Top-line Phase II clinical Study Data Demonstrating Safaety and Immunogenicity of Its Wuhan S-Only COVID-19 Pill Vaccine Candidate.”
Mark Herr, spokesperson, Vaxart Inc.
The Commonwealth Fund: “Two Years of U.S. COVID-19 Vaccines Have Prevented Millions of Hospitalizations and Deaths.”
The Lancet Infectious Diseases: “Global impact of the first year of COVID-19 vaccination: a mathematical modelling study.”
CDC: COVID Data Tracker, “Needle Fears and Phobias—Find Ways to Manage.”
U.S. Specialty Formulations news release: “Research Demonstrates Benefits of Oral COVID-19 Vaccine.”
CanSino Biologics Inc. statement: “Inside Information.”
Coalition for Epidemic Preparedness Innovations: Email statement; News releases: “The Race to Future-Proof Coronavirus Vaccines;.” “Coming in from the cold: needle-free patch technology for mRNA vaccines aims to end need for frozen storage and improve access.”
Executive Office of the President: “Statement of Administration Policy.”
Science: “Mosaic RBD nanoparticles protect against challenge by diverse sarbecoviruses in animal models.”
Caltech news release: “Nanoparticle Vaccine Protects Against a Spectrum of COVID-19-causing Variants and Related Viruses.”
U.S. Government Accountability Office. “Operation Warp Speed.”
Bharat Biotech International Limited news release: “Bharat biotech launches iNCOVACC: World’s 1st intranasal COVID vaccine for Primary series and Heterologous booster.”
The Lancet preprints: “Immunogenicity and Tolerability of BBV154 (iNCOVACC®), an Intranasal SARS-CoV-2 Vaccine, Compared with Intramuscular Covaxin® in Healthy Adults: A Randomised, Open-Label, Phase 3 Clinical Trial.”
Cell: “Intranasal pediatric parainfluenza virus-vectored SARS-CoV-2 vaccine is protective in monkeys.”
National Institute of Allergy and Infectious Diseases news release: “NIAID Issues Further Awards to Support Pan-Coronavirus Vaccine Development.”
CEPI news release: “CEPI and DIOSynVax partner in quest to develop broadly protective Betacoronavirus vaccine.”
CDC: “Understanding How COVID-19 Vaccines Work.”
Nature Immunology: “The T-cell immune response against SARS-CoV-2.”
National Institutes of Health: “T cells protect against COVID-19 in absence of antibody response.”
PNAS: “Vaccine-induced systemic and mucosal T cell immunity to SARS-CoV-2 viral variants.”
Cell Reports: “Pre-existing immunity modulates responses to mRNA boosters.”
University of Minnesota Center for Infectious Disease Research and Policy: “Coronavirus Vaccines R&D Roadmap.”
NIH news release: “2NIAID Studies Highlight COVID-10 Natal Vaccine Potential.”
U.S. Specialty Formulations news release: “Research demonstrates benefits of oral COVID-19 vaccine.”
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COVID at 3 Years: Where Are We Headed?
March 15, 2023 – Three years after COVID-19 rocked the world, the pandemic has evolved into a steady state of commonplace infections, less frequent hospitalization and death, and continued anxiety and isolation for older people and those with weakened immune systems.
After about 2½ years of requiring masks in health care settings, the CDC lifted its recommendation for universal, mandatory masking in hospitals in September 2022,.
Some statistics tell the story of how far we have come. COVID-19 weekly cases dropped to nearly 171,000 on March 8, a huge dip from the 5.6 million weekly cases reported in January 2022. COVID-19 deaths, which peaked in January 2021 at more than 23,000 a week, stood at 1,862 per week on March 8.
Where We Are Now
Since Omicron is so infectious, “we believe that most people have been infected with Omicron in the world,” says Christopher J.L. Murray, MD, a professor and chair of health metrics sciences at the University of Washington and director of the Institute for Health Metrics and Evaluation in Seattle. Sero-prevalence surveys — or the percentage of people in a population who have antibodies for an infectious disease, or the Omicron variant in this case — support this rationale, he says.
“Vaccination was higher in the developed world but we see in the data that Omicron infected most individuals in low income countries,” says Murray. For now, he says, the pandemic has entered a “steady state.”
At New York University Langone Health System, clinical testing is all trending downward, and hospitalizations are low, says Michael S. Phillips, MD, an infectious disease doctor and chief epidemiologist at the health system.
In New York City, there has been a shift from pandemic to “respiratory viral season/surge,” he says.
The shift is also away from universal source control – where every patient encounter in the system involves masking, distancing, and more – to a focus on the most vulnerable patients “to ensure they’re well-protected,” Phillips says.
Johns Hopkins Hospital in Baltimore has seen a “marked reduction” of the number of people coming to the intensive care unit because of COVID, says Brian Thomas Garibaldi, MD, a critical care doctor and director of the Johns Hopkins Biocontainment Unit.
“That is a testament to the amazing power of vaccines,” he says.
The respiratory failures that marked many critical cases of COVID in 2020 and 2021 are much rarer now, a shift that Garibaldi calls “refreshing.”
“In the past 4 or 5 weeks, I’ve only seen a handful of COVID patients. In March and April of 2020, our entire intensive care unit – in fact, six intensive care units – were filled with COVID patients.”
Garibaldi sees his own risk differently now as well.
“I am not now personally worried about getting COVID, getting seriously ill, and dying from it. But if I have an ICU shift coming up next week, I am worried about getting sick, potentially having to miss work, and put that burden on my colleagues. Everyone is really tired now,” says Garibaldi, who is also an associate professor of medicine and physiology in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University School of Medicine.
What Keeps Experts Up at Night?
The potential for a stronger SARS-CoV-2 variant to emerge concerns some experts.
A new Omicron subvariant could emerge, or a new variant altogether could arise.
One of the main concerns is not just a variant with a different name, but one that can escape current immune protections. If that happens, the new variant could infect people with immunity against Omicron.
If we do return to a more severe variant than Omicron, Murray says, “then suddenly we’re in a very different position.
Keeping an Eye on COVID-19, Other Viral Illnesses
We have better genomic surveillance for circulating strains of SARS-CoV-2 than earlier in the pandemic, Phillips says. More reliable, day-to-day data also helped recently with the respiratory syncytial virus (RSV) outbreak and for tracking flu cases.
Wastewater surveillance as an early warning system for COVID-19 or other respiratory virus surges can be helpful, but more research is needed, Garibaldi says. And with more people testing at home, test positivity rates are likely an undercount. So, hospitalization rates for COVID and other respiratory illnesses remain one of the more reliable community-based measures, for now, at least.
One caveat is that sometimes, it is unclear if COVID-19 is the main reason someone is admitted to the hospital vs. someone who comes in for another reason and happens to test positive upon admission.
Phillips suggests that using more than one measure might be the best approach, especially to reduce the likelihood of bias associated with any single strategy. “You need to look at a whole variety of tests in order for us to get a good sense of how it’s affecting all communities,” he says. In addition, if a consensus emerges among different measures – wastewater surveillance, hospitalization and test positivity all trending up – “that’s clearly a sign that things are afoot and that we would need to modify our approach accordingly.”
Where We Could Be Heading
Murray predicts a steady pace of infection with “no big changes.” But waning immunity remains a concern.
That means if you have not had a recent infection – in the last 6 to 10 months – you might want to think about getting a booster, Murray says “The most important thing for people, for themselves, for their families, is to really think about keeping their immunity up.”
Phillips hopes the improved surveillance systems will help public health officials make more precise recommendations based on community levels of respiratory illness.
When asked to predict what might happen with COVID moving forward, “I can’t tell you how many times I’ve been wrong answering that question,” Garibaldi says.
Rather than making a prediction, he prefers to focus on hope.
“We weathered the winter storm we worried about in terms of RSV, flu, and COVID at the same time. Some places were hit harder than others, especially with pediatric RSV cases, but we haven’t seen anywhere near the level we saw last year and before that,” he says. “So, I hope that continues.”
“We’ve come very far in just 3 years. When I think about where we were in March 2020 taking care of our first round of COVID patients in our first unit called a biocontainment unit,” Garibaldi says.
Murray addresses whether the term “pandemic” still applies at this point.
“In my mind, the pandemic is over,” he says, because we are no longer in an emergency response phase. But COVID in some form is likely to be around for a long time, if not forever.
“So, it depends on how you define pandemic. If you mean an emergency response, I think we’re out of it. If you mean the formal definition you know of an infection that goes all over the place, then we’re going to be in it for a very long time.”